Esteem Clinic Newstead

[Faustina Trafton]

Laura (Social Worker) provides confidential counselling and support to students and their families around a range of issues. These may include relationships, mental health difficulties, stress management, grief counselling and conflict resolution. She can provide assistance for families/students at risk of harm (from self or from others) such as suicide, self-harm, child protection issues or risk of homelessness.

Louise and Julie (School Health Nurses) offer drop-in clinics, advice and information for students to empower their health choices around topics such as sexual health and healthy relationships, addictions to drug and alcohol, resilience and mental health, body esteem, physical activity and nutrition. School Health Nurses also work to help students manage complex medical conditions and medical issues that may be impacting learning.

The Student Wellbeing Team, with the support of Student Leadership, organise whole College events as well as small group work, such as Mental Health Week, NAIDOC Week, Health and Wellbeing Program, Love Bites, Drumming, Winterfest, Protective Behaviours, Tree of Life, Health Expo and yoga/mindfulness.

Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain).

Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW.

Non-catastrophic road traffic injuries (RTIs), such as musculoskeletal injury or mild traumatic brain injury (mTBI), are the leading cause of unintentional injury [1] and the sixth highest cause of disability-adjusted life years worldwide in 2019 [2]. The prevalence of hospitalization due to RTIs in Australia increased by 12.9% over the five-year period to 2018, totalling 39,598 [3] and without consideration of people who had sustained a RTI and were not hospitalized. Road traffic injuries can have detrimental long term effects on those injured, which include but are not limited to, psychological distress [4, 5], chronic pain [6], disability [7], and reduced health-related quality of life [8, 9]. In addition to individual effects, RTIs have considerable societal impact, with total societal economic burden (e.g., healthcare and loss of productivity costs) estimated at AUD29.7 billion in Australia in 2015 [10].

Return to work is an important indicator of recovery and real-world functioning post-injury, and engagement in work can contribute to overall health [16]. Return to work following whiplash injury, for example, was associated with greater maintenance of rehabilitation treatment gains compared with those who had not returned to work [17]. Timely RTW also promotes psychological health by enhancing social connectedness, social identity, and self-esteem [18, 19]. Determining early identifiable factors associated with work incapacity following RTI is pertinent to identifying those at risk of delayed RTW, a prerequisite to developing interventions to reduce overall injury burden [20].

Factors negatively associated with RTW following RTIs, from several Australian prospective studies, include: sociodemographic factors (e.g., older age, female sex, lower occupational skill level, lesser pre-injury paid work hours, more physically demanding occupations), pre-injury health (e.g., chronic illness), psychological factors (e.g., post-traumatic stress, depression), injury severity, and high initial pain and disability [13, 21, 22]. Additionally, involvement in injury compensation claims processes is associated with poorer post-injury physical and psychological health [23]. Poorer outcomes in compensation claimants compared with non-claimants are found to be partly mediated by injury-related disability status, psycho-physiological factors such as vulnerability to stress [24, 25], and perceived injustice [6, 26]. Evaluation of a large diverse cohort is needed to validate early identifiable factors of returning to paid work following RTI and clarify the influence of claiming injury compensation on RTW. Greater understanding of these factors may inform changes to RTW and compensation law, policy and practice, encourage early assessment strategies for people injured in road crashes, and help identify potentially modifiable factors for intervention.

The aim of this study was to evaluate factors associated with RTW following RTIs in a prospective inception cohort. To address this aim three study objectives were defined: i) to describe absolute RTW occurrence and RTW occurrence by compensation claimant status at fixed times up to two years post-RTI; ii) to establish whether early identified biopsychosocial, injury, and compensation factors are associated with RTW; and iii) to identify potentially modifiable factors (e.g., psychological distress and pain) that could be intervention targets for programs aiming to facilitate RTW after RTI.

A prospective inception cohort study was conducted in NSW, Australia, to evaluate Factors Influencing Social and Health outcomes of people who sustained a mild-to-moderate RTI; titled the FISH study [27]. Study details have been provided previously [27]. In summary, eligible participants were primarily identified in emergency departments from 12 hospitals, including central Sydney metropolitan (Royal North Shore Hospital and Royal Prince Alfred Hospital) and regional hospitals (Orange, Dubbo, and Bathurst health services). Additional recruitment sources (5.2% of total recruitment) were general practitioner clinics, physiotherapy clinics, and the following databases: Claims Advisory Database, and Personal Injury Registry (NSW Motor Accidents Authority, now the State Insurance Regulatory Authority).

Eligible participants were invited to take part in the study by letter. Informed consent to participate was obtained verbally via phone for those who did not opt out. Participation involved a series of structured phone interviews; within 1-month post-injury (baseline), and follow-up interviews at 6-, 12-, and 24-months. Participants were recruited between August 2013 and December 2016; 6717 potential participants were screened, 946 refused, 3752 were beyond the to be contacted date or not reachable. 2019 people participated in the baseline interview. In the baseline interview, data were collected on participant sociodemographic characteristics, pre-injury health, injury characteristics, work status, and post-injury psychological and physical health status. These data were electronically stored on the Research Electronic Data Capture (REDCap) and Computer Assisted Diagnostic Interview platforms. Self-reported RTW status was evaluated at follow-up interviews for those who were in paid work at the time of their injury.

Participants reported which body regions were injured, whether they presented to hospital following their RTI, and for those admitted, the length of hospitalization (days). Hospital length of stay was used as a proxy indicator of injury severity, where greater length of stay was indicative of greater injury severity; less than one day (including those not admitted to hospital), two to six days, or seven or more days, based on cut-offs determined by the International Traffic Safety Data and Analysis Group [32]. Injury severity was also evaluated using the Injury Severity Scale (ISS), derived from Abbreviated Injury Scale scores of affected body regions [33]. Injury Severity Scale scores were derived by a trained coder using methods and injury data sources described by Hung et al. [34]. Participant-perceived danger of death during the crash was evaluated on a 5-point Likert scale (0-none to 5-overwhelming). Data on whether participants had claimed injury compensation (claimant status) was obtained from the State Insurance Regulatory Authority Personal Injury Register. The NSW compulsory third party (CTP) injury compensation scheme in operation at the time was a predominantly fault-based scheme allowing people injured and not at fault in a road crash to submit a claim within six months of injury [35].

After multivariate adjustment, significant sociodemographic, pre-injury health, injury, and post-injury psychological and physical health explanatory factors of any and full work duties RTW following a RTI were found, and most of these associations changed with time post-injury as shown by a significant interaction term (Table 4).

Key factors that were negatively associated with RTW over the 24-months included: making an injury compensation claim, early identified post-injury pain and early psychological distress, assessed by tools such as the OMPSQ-SF and DASS-21. Participants who claimed injury compensation were significantly less likely to RTW at all timepoints compared with non-claimants. Claiming compensation had a larger association with returning to full work duties compared with any RTW, notably reducing the likelihood of returning to full work duties by 73% at baseline and 24% at 6-months. Pain severity was a significant predictor of RTW at baseline only, with individuals with mild or moderate-severe pain 33 and 63% less likely than those with no pain to return to full work duties, respectively. Participants who exhibited probable major depressive disorder (DASS-21), pain related disability and psychological distress (OMPSQ-SF), or pain related catastrophizing thinking (PCS), versus those who did not exhibit elevated symptoms in each of these psychometric subscales, were more likely to exhibit long-term work incapacity.

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