Evaluation of the application of "FAUST-II" - a screening and inital treatment concept for mental health sequelae of work place injuries

Status:

completed 08/2022

Aims:

The naturalistic study re-evaluated the process- and outcome quality of a screening-based approach for early detection, diagnosis and intervention of psychological sequelae after acute, severe occupational injuries. An optimized concept for secondary prevention of high-risk patients has been routinely applied to SAV-cases in nine highly specialized accident-emergency hospitals since 2016. Degree and quality of implementation, application experiences, and outcomes were prospectively evaluated among psychological services, administrators of the workers-liability, and insured patients.

Activities/Methods:

Between 2018 and 2021, n=2822 patients after severe accidents at the workplace were screened with a short screening questionnaire (FSQ). 16% were identified as "risk" or "high-risk-patients". The n=211 included study participants were examined with psychometric self-report questionnaires within the first 21 days of hospital admission and after 6 months. Psychological Services collected data concerning diagnostic and therapeutic procedures and application experiences for the inpatient phase, Case Managers reported curative procedures within a 6-months follow-up phase. For control purposes 152 non-risk patients (NR) were studied additionally. Data from the methodologically comparable previous study (FAUST-II) were used for historical comparisons, because the intervention was evaluated naturalistically and without control condition.

Results:

Screening led to specific psychodiagnostic or/and psychotherapeutic interventions in 2/3 of all at-risk cases with good practicability and high acceptance during initial treatment. The concordance between risk status and clinical impression or mental examination findings was higher in NR than in RP. Standardized notification of risk status to the workers-liability insurance worked in 90%. Reports of findings with individual follow-up recommendations, which were provided for high-risk-cases (HRP) and only optional for risk-cases (RP) were available for 50%. Explicit mental health diagnoses were documented in the insurance files for 33%. Outpatient psychotherapeutic support was carried out for one third of the identified risk cases. However, most of these were still in the early stages. The process-evaluation by the Case managers was mostly positive, but more critical for the risk group than for both other groups (HRP and NR). After 6 months, a reduction in psychological accident sequelae (posttraumatic stress disorder, depression, anxiety) was not detectable. The significant initial differences between the three risk groups were maintained on average without clinically relevant improvements. Approximately half of the RP reported clinically relevant complaints, limitations in their ability to cope with everyday life, and their quality of life. The most severely distressed consistently had more frequently received treatments. Comparisons with the previous study did not yield superiority of the current intervention over that of FAUST-II, despite significantly better detection, a more positive evaluation of the screening algorithm und its procedures, and a higher rate of psychotherapeutic treatment for RP. Conclusions: The lack of evidence of efficacy for the intervention at 6 months must be evaluated in light of the priority given to treatment of severe physical injury sequelae in SAV patients, vocational rehabilitation not yet achieved in 72%, and psychotherapeutic treatments mostly still in the early stages. The significantly improved and now well-established process flows in the casualty-hospitals and at the administration lead us to expect that the screening-based action concept will show its effectiveness in treating the psychological sequelae in risk-patients – but with higher psychotherapy doses and guideline-compliant application of the corresponding psychotherapy procedures. The effects of such treatment will however only be realistically assessable after about 12 to 18 months.

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