State center gets the injured back to work

The Donley Rehabilitation and Education Center was established locally more than 60 years ago as a place to treat wounded World War II soldiers. It exists today within the workers’ compensation division of the R.I. Department of Labor and Training and aims to rehabilitate workers injured on the job.

But the center, unlike other rehabilitation clinics, is unique in that it operates similarly to a last-resort rehabilitation option for workers, physicians and the legal system alike. Because it’s a public entity, it doesn’t cost private insurers any money, which allows it to operate free from much of the bureaucracy, litigation and a stigma of distrust that typically surrounds the workers’ compensation system.

There’s no other rehabilitation facility like it in the country, according to the Donley center.

Injured workers must be referred by a physician or court; it’s free to patients covered by workers’ comp., and it maintains a high success rate.

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Indeed, in Rhode Island, the majority of injured workers – with or without rehab – typically return to work after 90 days. But for the small percentage that don’t, the likelihood of continued employment drops to less than 2 percent for various reasons, such as third-party lawsuits or delays in the system, according to Harriet Connor, assistant administrator at the center.

“If you look at someone [with workers’ compensation] who gets injured, they’re not in control of what happens to them,” Connor said. “There’s a lot of aggravation that comes with system issues … there’s a lot of conflict.”

The Donley Center specializes in treating patients who’ve been out of work for several months. Indeed, physicians at the center don’t typically see anyone who has worked within the previous six months. But the rehabilitation center has a unique track record of putting patients back to work, saying more than 30 percent of patients return to gainful employment after a typical six- to eight-week program. An additional 30 percent are deemed well enough to work, but do not return to their jobs because their employment is lost, there’s pending litigation or other reasons.

So what’s the trick?

The center uses a multidisciplinary approach, meaning there are medical doctors, physical therapists, psychologists and educators who work to improve the health of the patient. The multifaceted practice allows the center to mold each treatment plan to fit the varying needs of each patient.

Besides offering such services as case management, physical and occupational therapy, counseling and work simulation, the center also has vocational services for patients who might need to find less strenuous work after rehabilitation.

And with a long history of treating pain, it’s no surprise pain management is a large focus at the Donley Center, which continuously tries to evolve its practices, especially in the difficult field of chronic pain.

“One of the things we talk a lot about in the experience of pain is acute pain, which is the body’s warning signal. Chronic pain is the body’s warning signal of pain gone awry,” said Joanne L. Fowler, consulting clinical psychologist, who’s worked at the center for more than 20 years.

The program at Donley focuses on injured workers with conditions of chronic pain. It uses an interdisciplinary team with a biopsychosocial approach to treating patients, who’re often suffering both physically and emotionally.

“Chronic pain doesn’t go away,” Fowler said. “It has a very unpredictable presentation, so [patients] are really confused. They have good days, they have bad days, and they get more caught up in trying to control the pain, which can set them off, and is usually a fruitless pursuit.”

The interdisciplinary treatment strategy takes into account all stakeholders, including institutions, patients and referring clinicians, who aim to restore function, improve skills in coping with pain and facilitate return to work.

“Everybody on the team is providing their expertise and benefiting from each other’s perspective,” Fowler said.

Recently, in light of the rise of opiate use among Rhode Islanders, the workers’ compensation court identified those taking pain medication for chronic pain as possible at-risk individuals.

The court and Donley decided to start tracking opiate use among patients of workers’ compensation.

But the center’s No. 1 goal, or its “gold standard,” as Fowler called it, is to get injured workers back to work, which it continues to do well, despite odds being stacked against them in the field.

“People are suffering and that’s hard for everyone,” Fowler said. “It’s hard for the patient and it’s hard for the system to help them, so it feels good to be involved with it, even though we don’t always have the outcome that we would hope for.” •

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