Idalia Montañez, Psy.D.

Behavioral Health Intervention (BHI)

 

Behavioral health intervention, or “BHI,” refers to a brief course of mental health care focused on addressing psychosocial barriers that do not necessarily preclude a return to work, but may lengthen the timeframe for successful reintegration into the workforce. A course of BHI typically consists of 16 sessions of behaviorally-oriented counseling sessions. The following are examples of the psychosocial barriers that are the focus of BHI:

 

1. Low recovery expectations

2. Activity avoidance and unreasonable fear of worsening

3. Catastrophic thinking

4. Fear-avoidance behavior

5. Perceived injustice

6. Loss of vocational connection

7. Family/ support system issues

8. Inadequate understanding or expectations of diagnostic and treatment options

9. Inadequate understanding or expectations about the industrial insurance process.

 

Sometimes, a worker may develop mental symptoms in response to a physical injury. However, this doesn’t necessarily mean that the worker has a mental disorder. Common reactions —such as mild or moderate depression, or mild or moderate anxiety— can be addressed as psychosocial barriers impeding the worker’s ability to return to work.

 

Workers don’t need a psychological evaluation, psychological diagnosis, or authorization from their claim manager to qualify for BHI. BHI is covered for all injured workers to support their recovery. No authorization is required and there is no cost to the worker if they have an active claim. The diagnosis used for BHI is the physical injury diagnosis of the accepted condition.

 

 

Psychological Evaluations

 

Overview of Psychological Evaluations in the L&I Context

 

In the Washington State Department of Labor and Industries (L&I) environment, psychological evaluations are primarily forensic in nature. They serve a distinct purpose compared to clinical psychological evaluations that are conducted outside the L&I context. The evaluations conducted by licensed psychologists within the L&I system can be divided into regular psychological evaluations and 120-day psychological evaluations, each of which has specific procedural and contextual differences.

 

Regular Psychological Evaluations in the L&I Environment

 

A regular psychological evaluation within the L&I system typically occurs when there is a need to assess a worker's mental health status in relation to their workers' compensation claim. This evaluation may focus on determining the psychological impact of a work-related injury or illness and how it affects the worker's ability to return to work or their level of functioning. The evaluation is primarily forensic, meaning it is performed with the purpose of assisting in legal or administrative decision-making, such as determining eligibility for benefits or assessing whether the worker's mental health condition is related to the workplace injury.

 

Key characteristics of a regular psychological evaluation for L&I include:

 

• Purpose: To assess the psychological and emotional impact of a workplace injury or illness, primarily for the purposes of L&I claims, benefit determinations, or rehabilitation decisions.
• Scope: The evaluation may include an assessment of the worker's mental health history, current symptoms, cognitive functioning, and emotional well-being in relation to their workplace injury.
• Nature: Forensic in nature, with the psychologist acting as an impartial evaluator. The evaluation aims to provide objective, legally defensible findings.
• Outcome: The results of the evaluation often inform L&I decisions regarding claim acceptance, benefit entitlement, return-to-work plans, and other administrative actions.

 

120-Day Psychological Evaluations in the L&I Environment

 

A 120-day psychological evaluation is typically a follow-up assessment that occurs at the 120-day mark after a worker’s injury or when the worker has been off work for an extended period. This evaluation serves to assess whether the worker's mental health condition has improved, stabilized, or worsened since the initial evaluation, and it helps determine the worker's progress in rehabilitation and readiness to return to work.

 

Key characteristics of a 120-day psychological evaluation for L&I include:

 

• Purpose: To monitor the psychological recovery of a worker after an injury and assess whether any ongoing mental health issues may impede the worker's ability to return to work or function effectively.
• Scope: The evaluation looks at changes in the worker's psychological condition, including any persistent mental health symptoms, cognitive issues, or emotional barriers to recovery.
• Nature: Like the regular psychological evaluation, this is forensic in nature and is focused on providing objective information to inform L&I's decisions regarding ongoing benefits, treatment plans, and return-to-work timelines.
• Outcome: The results help L&I decide whether additional treatment is needed, if the worker is ready to return to work, or if further benefits should be provided. This evaluation also serves to gauge the effectiveness of interventions or rehabilitation efforts.

 

Clinical Psychological Evaluations Outside of the L&I Context

 

In contrast, clinical psychological evaluations conducted by treating psychologists outside the L&I environment are typically more focused on the overall well-being of the individual and are often less concerned with legal or administrative outcomes. These evaluations are part of ongoing treatment and focus on diagnosing, managing, and treating mental health conditions. The goals of a clinical evaluation are generally centered on the well-being of the patient and the development of treatment plans.
 

Key characteristics of clinical psychological evaluations include:

 

• Purpose: To assess and treat mental health conditions such as depression, anxiety, trauma, or other disorders that may not be related to work injuries. These evaluations are typically designed to improve the patient's overall mental health and quality of life.
• Scope: A clinical evaluation may include a comprehensive assessment of the individual's psychological functioning, mental health history, personal circumstances, and current psychological symptoms. It is usually broader and more holistic in nature, focusing on the individual's well-being.
• Nature: Clinical evaluations are generally therapeutic rather than forensic. The psychologist's role is to diagnose and provide therapeutic intervention, as opposed to serving as an impartial evaluator in legal matters.
• Outcome: The outcome of a clinical evaluation is typically used to inform treatment plans, therapeutic goals, and ongoing care, rather than to influence legal or administrative decisions.

 

Key Differences Between L&I Evaluations and Clinical Evaluations

 

1. Purpose:

• L&I evaluations (regular and 120-day) are forensic, aimed at helping the Department of Labor and Industries make decisions about workers' compensation claims, benefits, and rehabilitation plans.
• Clinical evaluations are focused on the therapeutic care and diagnosis of an individual, with no direct connection to legal or insurance determinations.

 

2. Scope:

• L&I evaluations focus specifically on the impact of a workplace injury or illness on the worker's mental health and their ability to function in relation to their work and claim status.
• Clinical evaluations cover a broader range of psychological concerns, including general mental health, mood disorders, and behavioral issues, often unrelated to work-related injuries.

 

3. Nature of the Evaluation:

• L&I evaluations are objective and forensic, intended to provide evidence that can be used in legal and administrative contexts.
• Clinical evaluations are therapeutic, designed to improve the patient's mental health and well-being.

 

4. Outcome:

• L&I evaluations result in recommendations or findings that influence legal, compensation, or treatment decisions.
• Clinical evaluations result in treatment plans, diagnoses, and recommendations for therapeutic interventions.

 

In summary, the psychological evaluations conducted within the Washington State Department of Labor and Industries are fundamentally different from clinical evaluations typically performed outside of the L&I context. While both types of evaluations assess mental health, the key difference lies in their purpose and application. L&I evaluations are primarily forensic, focusing on the worker's ability to function in the context of their workers' compensation claim, whereas clinical evaluations are focused on diagnosing and treating mental health conditions in a broader, therapeutic context.