WCB Procedures

Psychological counselling

Procedure summary

Published On

May 9, 2023

Purpose

To determine if psychological counselling services can be provided to a worker or family member.

Description

The decision maker offers psychological counselling to help a worker or family member when they are experiencing difficulties related to a worker’s work injury. The family member"Member of a family” means a spouse or adult interdependent partner, parent, grandparent, stepparent, child, stepchild, brother, sister, half-brother and half-sister of a worker member as defined in Section 1(1)(q) of the Workers' Compensation Act [PDF] must be included in the definition as outlined in the Workers’ Compensation Act.

The need for counselling is often identified through open discussions with the worker or family member, or from another source such as a treating physician, medical reporting, etc. Counselling services and support are provided until the issues are resolved or treatment plateau is confirmed.

The decision maker works with the worker or family member to help them access services or identify resources to address the psychological impact of a work injury. Through a collaborative process, information about the impact of the work injury is gathered and together the worker or family member, and decision maker determine the best course of action. The decision maker refers for services with an authorized provider, taking into account the preferences and needs of the worker or family member. In the case of worker counselling, therapy is intended to address the psychological symptoms caused by the work injury. For family member counselling, therapy is intended to reduce the impact of the work injury on the family unit to help improve the worker support system in their recovery, or to support a family member or spouse in bereavement (worker fatality).

The process includes making the referral, monitoring treatment and addressing treatment extension requests.

Psychological counselling can be provided as treatment for a variety of reasons including:

Psychological issues related to the work injury or present as a barrier to return to work. (For example, anxiety, avoidance, pain management, brain injuries, post-traumatic stress disorder (PTSD) or other psychological issues).
To help develop skills and coping strategies to reduce the impact of the work injury.
Relationship challenges with the worker and their spouse, partner or a family member as a direct result from the work injury. Individual and/or joint counselling or family counseling is available.
Bereavement counselling for a spouse, adult interdependent partner or family members.

Regular attendance (e.g., once or twice per week) best supports the worker’s or family member’s needs and allows treatment to be completed within a reasonable timeframe. Most people can expect to experience improvement in about five (5) to ten (10) counselling sessions.

Key information

Psychological or psychiatric symptoms may appear at any stage of the claim. Accessing psychological support early can prevent psychological issues from becoming diagnosable psychological conditions. Managing psychological injury/psychosocial issues for an injured worker must be with the focus of return to work. This includes physical injury claims where the physical injury may resolve or reach a medical plateauMedical plateau is normally reached when the worker's medical condition has stabilized, further significant medical improvement is unlikely, and permanent work restrictions can be confirmed. before the psychological injury. It can also address work-related barriers and provide an injured worker with the support they need to manage these challenges and return to work.

When a family member requests counselling independent from the worker, decision makers must inform of the limitations of disclosure. The family member’s name and request for treatment is documented on the referral form and becomes part of the claim file. Approval for payment is also documented on the claim file. The reason a family member needs counselling and their progress in treatment is placed on a separate file and stays in the Millard Health, Health Information Unit. Treatment, progress and requests for extensions are managed by the psychological support services team in collaboration with the decision maker.

Access to a family member’s file is limited to situations where an employer requests an appeal or review of claim costs before the Dispute Resolution and Decision Review Body or the Appeals Commission. Identifying information or the family member’s name is not disclosed. When a family member is not agreeable to disclosure in these situations, a referral to the Community Support Program can be made for assistance. During a crisis, support through the mental health line may be offered to address the urgent issue, followed by a referral to Community Support Program.

Joint counselling is treated as a request from the worker and information about the counselling including progress in treatment is documented on the file.

When counselling cannot be approved for a family member, community support program or resources through their employer should be considered.

The decision maker may authorize five counselling sessions when the entitlement decision for the diagnosis is pending or there is no confirmed psychological diagnosis.

The decision maker may authorize up to ten (10) counselling sessions for family members.

Detailed business procedure

Expand all Collapse all
1. Determine whether the need for psychological counselling is related to the work injury Review the claim information and call the worker or family member to discuss their concerns and the support that they are looking for. When speaking to the worker (or their spouse/partner or adult family member), listen to their concerns and gather information by asking questions such as: How are you feeling? What does a typical day look like for you? What do you miss being able to do? How are you sleeping? What is going well? What is not going well? Do you have any concerns about returning to work? Would you be willing to participate in counselling if it is related to the work injury? When the worker (or family member) does not want to participate, explain to them that a referral can be made later if they change their mind. What is your relationship to the worker (if speaking to a family member)? Confirm the family member meets the definition as outlined in the Workers' Compensation Act? If so, explain the limitations of confidentiality and explain counselling is limited to issues developing because of the work injury. Based on the claim information and discussions with the worker or family member, decide if psychological counselling can be approved. Psychological counselling can be approved when: The need for counselling relates to the work injury or condition or claim (for example, adjusting to the impact of the work injury, relationship difficulties resulting from the injury, grief counselling). Counselling is for a worker, spouse or adult interdependent partner, or a person who meets the definition of a family member"Member of a family” means a spouse or adult interdependent partner, parent, grandparent, stepparent, child, stepchild, brother, sister, half-brother and half-sister of a worker member as defined in Section 1(1)(q) of the Workers' Compensation Act [PDF] as defined by the Workers’ Compensation Act. Counselling will help address return-to-work barriers (such as re-employment or rehabilitation). When approved, explain to the worker or family member that a referral will be made to the next available authorized provider. Ask the worker or family member if they: Prefer certain provider characteristics (for example, gender, location, hours, language requirements, in-person services, mobility needs, etc.). Are available to attend in-person sessions, phone or video conferencing. Always offer the services of an authorized provider. If the worker or family member is already attending counselling services for the work-related concern and would like to continue counselling with their psychologist or social worker, obtain details about the provider and treatment (for example, treatment start date, provider contact information, etc.) and include in the referral (step 2). Explain that when a provider declines our service request, services must be arranged with an authorized provider and they will be called if this happens. Approve up to: Ten counselling sessions when a psychological diagnosis has been accepted on the claim. Five counselling sessions when the relationship between the psychological symptoms and the work injury is not clear or the entitlement is being investigated. Medication can also be authorized as part of the treatment plan during the investigation, when required. Ten counselling sessions for joint, family or bereavement counselling services. Discuss with the employer if there are available psychological supports through the employee benefit plan in the event the diagnosis is not accepted. When a psychological condition is accepted, the condition accepted can be disclosed to the employer as well as the treatment plan. When not approved, explain to the worker or family member the reason counselling cannot be approved. Offer to make a referral to Community Support Program or discuss possible support through their employer health benefits. If urgent assistance is needed, offer the mental health support line to address the crisis, and make a referral to the Community Support Program. Communicate the decision to the worker in writing including the rationale for not approving treatment. A letter is not sent for a family member.	Administrative tasks Mental Health Support Line 1-855-675-9222 For a worker or surviving spouse/adult interdependent partner, add a file note (Psychology). For a family member, add a file note (Contact/Other) indicating a family member has requested psychological or bereavement counselling. Include the name of the family member and the provider. No other details should be included. If a family member provides additional information that is relevant to the referral, send the information by email to the psychology referral expeditor. For a list of WCB contracted psychologists, refer to the Psychological Injury Management site on the internal Electronic Workplace. Counselling benefits are automatically approved on the Mental Health Line for dollar values and time frames equal to a maximum of 25 counselling sessions. Employers are automatically notified by way of copy (CL026R) when a worker is sent their authorization letter. No details of the psychological condition can be shared with the employer unless the condition is confirmed and accepted as work related. Refer to the Community Support Program site on the internal Electronic Workplace. Send the Claimant Custom (CL000A) letter to the worker along with a copy to the provider if they are already seeing one.
2. Make the referral Complete the referral form with the reason for the referral, confirmed mechanism of injuryThis is how the injury occurred or was caused., number of sessions approved, and if there are any security or mental health safety concerns. When a referral to a specific provider cannot proceed, call the worker or family member to discuss and confirm they will be referred for their services with an authorized provider. The referral expeditor will arrange for counselling services with an authorized provider.	Administrative tasks From the eCO Create Referral screen, select Counselling and complete all sections of the FM008B form to ensure the services can be arranged without delay. The psychology referral expeditor will arrange the referral and send the letterThe Mental health line (MHL) is automatically added to the claim when a counselling referral letter is sent and automatically approves the maximum time and dollar amount for counselling services based on the letter and form received from the provider. to the treating psychologist. Document the discussion in a file note (Contact/Worker or Contact/Other, or Contact/Employer). Update the eCO travel expense line and request travel benefits, if needed.
3. Monitor the worker or surviving spouse or adult interdependent partner’s progress with treatment Call the worker or surviving spouse/ adult interdependent partner every two to three sessions, or as needed based on the claim circumstance, to discuss their treatment and progress. Note: The decision maker does not approve joint or family counselling treatment extension requests. This is done by the psychological support team at Millard Health and counselling ends when treatment plateaus or is confirmed unrelated to the impact of the work injury. Decision makers can contact family members to confirm ongoing counselling is related to the work issue and should inquire whether the family member is still interested in continuing with counselling on a regular basis. Review psychology reports and worker treatment progress. Ensure ongoing counselling is related to the work issue (s) or injury. Contact the provider, worker or surviving spouse/adult interdependent partner and/or psychological consultant if there are concerns and to discuss progress and return to work. Work together with the provider and the worker or surviving spouse/adult interdependent partner to resolve the issues and create a collaborative plan. Continue to monitor the progress with treatment. When: The worker, surviving spouse or adult interdependent partner is discharged, do not continue further with this procedure. A change in provider is required, return to Step 1. More treatment sessions are requested for the worker, continue to the next step.	Administrative tasks Document the discussion in a file note (Psychology and/or Psychology/Phone Contact with Psychologist).
4. Make and communicate a decision on the request for an extension to treatment Review the request for an extension of treatment and any other relevant reports or claim information. Consider the progress that has been made and the reason the provider is requesting more sessions. Call the treating provider to discuss the treatment extension request and progress in the treatment goals. Consider and/or ask the treating provider: Is the entitlement decision still pending? How many sessions were last approved? Is progress in treatment being made to support that it is reasonable to extend counselling? What are the treatment goals, and how close are they to meeting those goals? What is the plan to help them reach the treatment goals? Discuss the progress, treatment goals and the plan with the provider, worker or surviving spouse/adult interdependent partner with every treatment extension decision. When the relationship between the psychological symptoms and the work injury is not clear or the entitlement is being investigated, the decision maker can approve an additional 5 sessions. Investigation to confirm a psychological diagnosis and relationship to the work injury must be actively pursued during the extension period and investigative steps shared with the worker and provider, if needed. Approval can be given for up to ten additional counselling sessions, and up to a maximum of 25 when a psychological diagnosis has been accepted on the claim. If the psychological symptoms are confirmed to be not related to the work injury, the decision maker considers other supportsWCB's Community Support Program can connect workers with various agencies and organizations across the province for additional support outside of the workers' compensation system. available in the community (for example, employee family and assistance program, health benefits, etc.) When assistance is needed to interpret the clinical information, call the psychological injury coach or psychology assistant. When more than 25 sessions were approved and the decision maker confirms more sessions should be considered after reading the extension request, refer the treatment extension request to the WCB psychological consultant. The consultant will provide an opinion on whether it is reasonable to extend treatment and provide additional guidance on the management of the psychological condition. This should be communicated to the provider. If the reasons for the request for more than 25 counselling sessions are not work-related or reasonably expected to improve treatment outcomes, the decision maker can deny the extension request and explain the reasons to the worker without a psychology consultant review. Note: Treatment extensions for family members, excluding bereavement for the spouse or adult interdependent partner, are managed by the psychological support team at the Millard Health Centre. If there is a delay in completing the extension review (e.g., further information needs to be obtained etc.), additional counseling sessions are authorized until a decision is communicated to the provider. Communicate the decision and clearly explain the rationale used to reach the decision. Emphasize that the worker’s recovery is our top priority. Discuss the next steps with the worker including treatment, benefits, and plans for follow-up discussions. When the treatment extension is approved, include the number of sessions approved and the frequency of the treatment, and the time frame for completion in the approval letter. Share all specific treatment recommendations from the psychology consultant with the provider. Continue to monitor the worker’s or surviving spouse’s/adult interdependent partner’s progress as outlined in step 4. When the treatment extension is not approved, discuss any alternate recommendations made by the WCB psychological consultant or offer additional resourcesWCB’s Community Support Program can connect workers with various agencies and organizations across the province for additional support outside of the workers’ compensation system. for support. Call the provider to explain the decision to not approve the extension and follow up in writing. Send the letter to the provider denying the extension.	Administrative tasks The provider must submit a Treatment extension request (C1147, C852E or C852EAP form) to document any requests for extensions.The C1147 will trigger a mail task and a task to review the request for an extension. The mail task can be completed once the form is reviewed. Add a file note (Psychology) documenting the discussion with the worker, spouse or adult interdependent Partner. Add a file note (Psychology/Phone contact with psychologist) to document the discussion with the psychologist. Re-assign the "Psychological Treatment Extension Request" task to the Psychology Consulting, Team Desk. When an extension beyond the initial time frame or dollar value is approved, document approval for the extension on the Exception approval task that was created for the Mental Health Line Authorized counselling providers are aware counselling services can continue until an extension decision is communicated. Send the appropriate letter to the provider (Psychology Counselling Treatment Extension Approval - SP021J or Psychology Counselling Treatment Extension Denial - SP021K) - with a copy to the worker or surviving spouse/adult interdependent partner.

Supporting references

Policies

Policy 04-06, Part I, Health Care

Workers’ Compensation Act

Applicable sections

Section 78 WCA

General Regulation

Applicable sections

Related Legislation

Applicable sections

Compatibility Warning

WCB Procedures

Psychological counselling

Procedure summary

Detailed business procedure

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Supporting references

Policies

Workers’ Compensation Act

General Regulation

Related Legislation