1. Determine whether the need for psychological counselling is related to the work injury
Review the claim information and call the worker, their spouse/partner or adult 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 (of a severe or seriously injured worker), 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, ask the worker or family member if they prefer certain provider characteristics (for example, gender, location, office hours, language requirements, mobility needs, etc.). If the counselling is for a worker or a family member in a rural geographical location, confirm they are available to attend in-person or video conferencing. Explain to the worker or family member that a referral will be made to the next available authorized provider. Advise the worker or family member that reasonable attempts will be made to accommodate those preferences but there are no guarantees. The delivery method of counselling (in-person or hybrid/video conferencing) is based on clinical need and not worker or family member preference. 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). If they are seeing a non-contracted provider discuss the benefits of having a WCB authorized provider and discuss the possibility of discontinuing services with the non-contracted provider and outlining what the transition plan would look like. 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. Initially approve up to: - 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 when a psychological diagnosis has been accepted on the claim.
- 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.
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Administrative tasks
Mental Health Support Line 1-855-675-9222 211 is the main province-wide access point for finding community, social, and government services. It can be provided to the worker (or their spouse/partner or adult family member) to get connected with resources like housing, employment, food, and non-urgent mental health or addiction supports. 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 and select the links and resources tab. 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.
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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. In cases where the worker is seeing a non-contracted provider, once the referral is received by the psych referral expeditor (PRE) they will: - Determine if the requested provider is suitable and willing to meet WCB expectations.
- Notify the claim owner of lack of fit and the need to proceed to a WCB authorized provider
- Match the worker with an authorized provider.
- Notify the claim owner when the new provider has accepted the referral.
- Send the referral letter to the provider and the confirmation letter to the worker.
Once the treatment provider has been confirmed by the PRE the decision maker should provide them with a copy of the cognitive psychosocial job demands analysis (CPJDA) if it was not included in the referral package. The decision maker should then contact the treatment provider at the beginning of treatment to review the following: - Accepted injury(s), mechanism of injury (MOI) and policy under which it was accepted.
- Relevant medical reporting included in the referral package (i.e., from GPs, psychiatrists, OTs, CPA/NPA, psychiatric independent medical examination (PIME), etc.)
- The alignment of the provider’s treatment goals with return to modified work and/or full duties.
- The modified work options identified in the CPJDA. What is the worker’s capacity for these modified duties (now or in the future), and how could these modified duties become part of the treatment goals?
- How their reporting needs to include job-specific details to support modified work or return-to-work recommendations.
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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. If the worker is already seeing a non-contracted provider include the providers name in the referral. The PRE 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. See library documents for more information on the psychology referral process Document the discussion in a file note (Psychology and/or Psychology/Phone Contact with Psychologist).
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3. Monitor the worker or surviving spouse or adult interdependent partner’s progress with treatment
Call the worker or surviving spouse/ adult interdependent partner and treatment provider 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 send the approval decision letter for 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. Tips for reviewing counselling reports to assess progress: Evidence of recovery and functional improvement. - Movement toward return to work (RTW). What is the worker's capacity for modified duties (now or in the future)? Consider any modified work options outlined in the CPJDA.
- Increasing goal completion percentages
- Provider-documented progress and client accomplishments
- Alignment between reports and worker conversations
- Homework or between-session activities
Red flags / Follow-up required - Treatment modality does not align with symptoms, MOI, or DSM diagnosis
- Repeated stabilization/supportive therapy without progress
- No clear treatment plan, RTW focus, or end date
- Reports repeat earlier information without showing progress
- Focus shifting away from compensable injury
For assistance with interpreting the psychosocial measures (e.g., Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), etc.) contact a psychology assistant. If non-compensable issues arise (e.g., personal life events), consider community supports, OT referral, psychological injury (PI) screen, etc. instead of extending WCB counselling. 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.
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Administrative tasks
Document the discussion in a file note (Psychology and/or Psychology/Phone Contact with Psychologist).
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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 five 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 counselling 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.
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Administrative tasks
The provider must submit a Treatment extension request (C1147The 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., C852E or C852EAP form) to document any requests for extensions. 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.
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