Public Risk May/June 2021 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION MAY/JUNE 2021

MEET MELISSA STEGER PRIMA’S NEW PRESIDENT PAGE 6

ALSO IN THIS ISSUE

PLAYGROUND SAFETY: NEW STANDARD AND GUIDANCE FOR MANAGING RISKS PAGE 10

THE BIOLOGICAL BASIS OF COMPLACENCY PAGE 15

EFFECTIVE INJURED WORKER MODELS OF CARE INCORPORATE MENTAL-HEALTH ASPECTS FROM THE START PAGE 18

FREE TO MEMBERS

Effective Safety Committees: Making Them Work for You! JULY 21 | 12:00 – 1:00 PM EST SPEAKER: Christopher H. Kittleson, ARM, CPSI, Director of Loss Control Technical Services, Preferred Governmental Insurance Trust The presentation will provide an overview of how conducting an effective safety committee can help to reduce accidents and incidents. Reducing the frequency and severity of accidents and incidents provides for a safer workplace as well as mitigates liability respectively, resulting in the potential to lower insurance costs. ATTENDEE TAKEAWAYS: 1. Learn how to bring management and employees together on safety to obtain management “buy in” 2. Provide an avenue for employees to bring up safety concerns/ liability exposures 3. Assist in the education of all employees regarding safety and health issues and standards 4. Improve the culture of safety with your organization

MAY/JUNE 2021 | Volume 37, No. 3 | www.primacentral.org

CONTENTS

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Sheri D. Swain Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ PAST PRESIDENT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL PRESIDENT-ELECT Melissa R. Steger, MBA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX

Meet Melissa Steger, PRIMA’s New President

DIRECTORS Forestine W. Carroll Manager of Risk Management Memphis Housing Authority Memphis, TN Lori J. Gray Asst. Director of Finance for Risk and Wellness Services County of Prince William Woodbridge, VA JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN Laurie T. Kemper Sr. Risk Management Consultant City/County Insurance Services Salem, OR Adam Maxwell Director of Admin Services City of Westerville Westerville, OH

By Claire Howard

Michael S. Payne, ARM, HEM Risk Manager City of Reno Reno, NV NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA

Playground Safety: New Standard and Guidance for Managing Risks By Heather Olsen, Ed.D.

18 IN EVERY ISSUE

The Biological Basis of Complacency

By Sharon Lipinski

Effective Injured Worker Models of Care Incorporate Mental-Health Aspects from the Start By Kate Farley-Agee

| 4 NEWS BRIEFS | 20 ADVERTISER INDEX

EDITOR Claire Howard Manager of Marketing & Communications 703.253.1261 | choward@primacentral.org ADVERTISING Claire Howard Manager of Marketing & Communications 703.253.1261 | choward@primacentral.org

Public Risk is published 6 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2021 Public Risk Management Association

MAY/JUNE 2021 | PUBLIC RISK

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MESSAGE FROM PRIMA PRESIDENT SHERI D. SWAIN

IT HAS BEEN MY HONOR!

s I close out my year serving as your PRIMA president, I have been reminiscing about all my years as a member of PRIMA. I set out on a quest to learn as much about PRIMA and get involved in as many committees and task forces, which led me to want to serve in a larger capacity as board member and ultimately as president. Of the many benefits, PRIMA has to offer, the ones I enjoyed the most, were the in-person events. I looked forward to the Annual Conference, as I knew it would be packed with educational opportunities, spending time with friends and of course meeting new friends. As we have needed to come up to speed quickly to navigate through these unprecedented times at our entities, the same holds true with PRIMA. To say it has been an interesting year serving as president during a pandemic is an understatement. That said, I feel blessed that I was still able to work and carry on important business of PRIMA, albeit remotely. It has truly been my honor to serve as president of PRIMA—this is one for the records books. Through all the chaos and unknowns, I am so proud of accomplishments by the board. As I close out the year, there are several people I personally want to thank: The Board of Directors – This board has been the best. It is so rewarding to work with a group of people that share the same passion as you. While most of the business was concluded over the phone or an occasional virtual call, I can’t thank you enough for your devotion and dedication to continue to move PRIMA forward while honoring those that have laid the ground work before us.

As we have needed to come up to speed quickly to navigate through these unprecedented times at our entities, the same holds true with PRIMA. To say it has been an interesting year serving as President during a pandemic is an understatement. That said, I feel blessed that I was still able to work and carry on important business of PRIMA, albeit remotely. PRIMA Staff – The PRIMA staff continues to do an excellent job in supporting the board and members of the organization. You have worked hard to ensure that even through the pandemic, PRIMA members received educational benefits. Jenn, thank you for your leadership and helping me to navigate my duties as president. Corporate Partners – I missed having our in-person summit, but thanks to PRIMA staff, we had a very organized virtual session. Thank you all for your support to PRIMA. I have truly enjoyed getting to know each and everyone of you and thank you for the resources and your time in planning the best education sessions. Volunteers – Thank you for serving on committees, task forces, sharing ideas and mostly devoting your time to serve this organization we are all so passionate about. We could not do it without you.

Mentors and Friends – I am so blessed to have you in my life. I could never have reached this milestone without your support. There are too many of you to name, but you know who you are! I want to thank each and everyone of you for helping to make my time serving as PRIMA president so rewarding. Don’t worry, I am not going anywhere, I will remain a devoted member of PRIMA and hope to see again very soon! With Warmest Regards,

Sheri D. Swain PRIMA President 2020–2021 Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ

MAY/JUNE 2021 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

USING DIGITAL SOLUTIONS TO ADDRESS WORKPLACE COVID-19 RISK April 13, 2021, Robert Costantini Keeping workers safe has always been a concern for employers, particularly for those in industries like construction that are inherently more dangerous, and COVID-19 adds a whole new dimension to that risk. As the early days of the pandemic demonstrated, shutting down sites, laying off or furloughing workers or working with skeleton crews was only sustainable for the short term. Businesses had to get back to work and find new ways to adapt to remain afloat, keep workers employed and productive, build much-needed infrastructure and address supply chain shortages. Terms like “social distancing,” “contact tracing” and “Emergency Use Authorization (EUA)” are now key terms in company handbooks, safety checklists and training manuals. To have a truly safe workplace requires changes that are tangible and intangible. It requires systemic changes in a company’s culture to put safety above all else, as well as making rigorous protocols and operating procedures second nature. Encouraging workers to remain at home if they are not feeling well, and instituting strict cleaning regimens, the use of masks, regular temperature checks and wellness questionnaires must become standard practice. In addition, technology has become a valuable tool in combating COVID-19 risk in the workplace. Companies typically use manual processes, but now recognize the need to take a digital-first mindset to keep workers safe. To continue keeping their businesses running and ensuring that workers remain employed, they have embraced technologies like wearable devices and analytics that are part of internet of things (IoT) solutions. These technologies are helping to support changing workplace cultures and priorities that will remain long after COVID-19 has been controlled. Building a Tech Arsenal According to technology analysts at Gartner, there are two types of approaches to using technology to fight COVID-19. One is using proactive technology that instills safer behaviors like wearing masks and social 4

PUBLIC RISK | MAY/JUNE 2021

distancing. The other is with reactive technology, which addresses activities after a risk incident has occurred, such as contact tracing and quarantining. Safe Social Distancing IoT-based wearable sensors are addressing both proactive and reactive approaches, proactively enabling safe social distancing and reinforcing safe worksite behaviors, as recommended by the Centers for Disease Control (CDC). These solutions are addressing workers having difficulty maintaining social distancing from each other on a complex worksite where they often need to work together on projects. When workers are focused on their specific tasks, they may not be aware of their proximity to another worker. These considerations can also be distracting, especially when operating dangerous machinery or tools. Today, workers can wear advanced IoT devices to communicate with other devices and send out an audible and visual alarm when they come into close contact with one another. Additionally, through data-driven insights into close interactions between workers, companies, (like manufacturers, construction firms and others) can make more informed decisions about changing standard operating procedures (SOPs) or protocols. For example, one major manufacturer of agricultural products found it difficult to keep workers six feet apart during maintenance shutdown and turnarounds at its facilities, since it required more than eight times the number of people to be onsite as compared to normal operations. By using wearable sensors that provided audible social distancing reminders when workers were too close and tracking close interactions through the data, it was able to accommodate the increased number of workers while keeping the site safer. Companies in construction, manufacturing and other industries are finding that interactions between employees and their duration have dropped by 50%, simply by using IoT wearable devices.

Swift Contact Tracing Companies are also using IoT technologies reactively when an outbreak occurs at facilities. Wearable devices enable automated contact tracing and record close contact interactions among specific workers. They allows manufacturers to identify—within minutes, instead of hours or days—all close-contact interactions with the infected individual, and quarantine only those who have been exposed, instead of entire workforces. This is critical to preventing a major outbreak or a complete plant shutdown. Additionally, since worker privacy is a key concern, some digital contact tracing solutions allow each employee to be anonymized for privacy purposes, so that only authorized managers know the identity of each assigned IoT sensor holder, to carry out proper notifications in the event of exposure. AI-Driven Analytics Companies are also using predictive analytics and deep learning technologies to fight COVID-19. Predictive analytics can help identify patterns of behavior to better predict future outcomes. For example, there may be more incidences of close proximity during busy shifts. Predictive analytics can forecast the likelihood of these incidences so that proactive action can be taken, such as adding a new shift to decrease the number of workers needed at a given time, or helping managers determine if workers are following safety protocols. Changing Policies, Cultures and Procedures Employers must use all the tools at their disposal to keep worksites safe, starting with a culture that elevates safety. This can include rigorous safety protocols and operating procedures, and the use of smart technologies. Long after breakthrough vaccines have controlled the pandemic, new safety protocols and tech solutions will remain, as companies everywhere realize the benefits for employees, as well as their impact on corporate risk.

DISINFORMATION IS CHANGING SECURITY RISK MANAGEMENT April 20, 2021, James Blake In countries across the world, the rapid growth of social media giants such as Facebook, Twitter and You Tube as a way we consume news and process events has driven a significant escalation in dis-and misinformation in countries across the world. This context has been exacerbated by recent COVID-restrictions which has resulted in more people spending time on the internet and reading and sharing conspiracy theories and opinions or information which is not fact-checked. The recent Capitol insurrection in Washington DC saw many of those who occupied the building describing themselves as “freedom fighters” and “patriots” who were protecting the country from a “deep state” and stolen election, but without any credible evidence to support their narrative. In the US, and increasingly across Europe and the UK, the baseless QAnon Conspiracy movement—which suggests President Trump is protecting the world from a pedophilia ring made up of Democrats and Jews has grown rapidly in membership since the contentious U.S. presidential election and some members have shown intent to conduct violent attacks. The rapid spread of dis- and misinformation has the potential to change the full spectrum of security risk management from how we as risk manager consumer information to how we protect staff, information and assets. Disinformation is impacting risk managers in the following ways: 1. The information that we rely on. Risk managers need reliable information to make difficult and consequential decisions. With increasingly disputed information flows—and often a reliance on intelligence firms which consume social media feeds—it becomes increasingly challenging to know how to weigh information. 2. The threats we face. How your organization or business reacted publicly—and through its senior staff—to the January 6, 2021 events on Capitol Hill, for example, could determine whether you become at increased risk from a threat group. We are increasingly in a spectrum where populations are split in what information and news they accept. The

public footprint your organization takes will increasingly need to be built into existing ERM toolkits. This includes the way in which your staff communicates online while there are not at work. 3. When cyberattacks become a disinformation catastrophe. There is growing fear among security professionals about the potential for cyber actors to steal sensitive or embarrassing information, change it slightly, and release it online. Such actions could see a company’s share price crash, and key executives’ reputations ruined. This would make it almost impossible for organizations to defend themselves in terms of their disinformation response. 4. The growing popularity of deep-fakes and cheap-fakes. Increasingly organizations will need to enhance their monitoring and information capacity to find out whether there are profiles of senior executives or their organization online. Risk mitigation and governance The advent of emerging and consequential risk requires organizational changes to help manage it. Security teams need to ensure they employ staff adept at determining opinion from fact. This

will help in ensuring that decisions made by risk managers are commensurate with reliable and sourced information. Such a skillset can play an important role in becoming envoys with any intelligence providers to ensure that their sourcing is rigorous, consistent and not open to misinterpretation. The governance of disinformation needs to be included within organizations’ ERM framework to ensure that incidents are consistently measured, and any mitigation or crisis response is coordinated with other aspects of an organization such as communications or IT. An important consideration is that different components of organizations meet regularly and ask tough questions on preparedness efforts to ensure during times of crisis, communication is smooth, and information not siloed. Finally, the response to dis- and misinformation will likely become a critical function. Crisis communication remains an area where improvements can be made across many large organizations, entities and businesses. Increasingly there is a need for skillsets which encompass risk management and public relations learned and improved. MAY/JUNE 2021 | PUBLIC RISK

PUBLIC RISK | MAY/JUNE 2021

MEET MELISSA STEGER PRIMA’S NEW PRESIDENT “In every hardship is a hidden lesson, opportunity and silver lining. I challenge you to find yours.”

BY CLAIRE HOWARD

VER THE PAST YEAR, WE’VE BEEN TAUGHT THE VALUE in learning to embrace change by pivoting habitual company practices to altering our personal lives to exact beneficial mental maintenance. This year, our Annual Conference, #PRIMA21, is held virtually and we are welcoming 2021–2022 President, Melissa Steger, Associate Director of Workers’ Compensation and Unemployment Insurance at University of Texas System. Daydreams of being a schoolteacher ran rampant in Melissa Steger’s mind as a child but after finally receiving her degree in Education, she knew life would take her on an entirely different path. Starting her career at University of Texas System (UT System) as a temporary clerk quickly catapulted her passion to setting her sights on eventually running UT System’s self-insured, self-administered workers’ compensation program. With hard work and a keen eye for accuracy, she secured a permanent position and was promoted multiple times over a short period. In order to achieve her goal of being a director, she took time away from UT System to attain a Master of Public Administration (MPA) degree. Later in her career, Steger was able to gain valuable experience in both the regulatory and private side of workers’ compensation.

“Managing customer service at the Division of Workers’ Compensation engrossed me into the law as I offered guidance to system participants. I followed and responded to proposed legislation, led rule development teams responsible for implementing subsequent changes, and offered educational presentations,” Steger said. “I left the Division of Workers’ Compensation to build a certified workers’ compensation healthcare network which expanded my knowledge about the medical aspects of the system.” “I am now running the workers’ compensation program and overseeing the unemployment fund for over 120,000 employees within The University of Texas System. I met that career goal I set and I couldn’t be prouder.”

➊ HOW LONG HAVE YOU BEEN INVOLVED WITH PRIMA?

PRIMA has been a presence throughout my career. I have attended a multitude of conferences and presented sessions at both the state and national level. I was appointed to the Texas PRIMA board in 2016, serving two terms, and was honored as the 2016 Risk Professional of the Year. My appointment to the National PRIMA board began in 2018.

MAY/JUNE 2021 | PUBLIC RISK

MEET MELISSA STEGER, PRIMA’S NEW PRESIDENT

➋ WHAT ARE YOUR GOALS FOR THE TERM OF YOUR PRESIDENCY?

As we learned throughout the last year, risk managers need to remain agile and on our toes. Managing unexpected risks is the nature of the business and I will continue to keep PRIMA as a forward-thinking, one-stop shop resource to the risk managers we serve. During my presidency, I plan to initiate infrastructure to support the development of our next generation. PRIMA has served many brilliantly experienced risk managers across the country. I find it vitally important to share their wealth of knowledge to help advance the next generation who will continue to refine the legacies built. My career has been peppered with strong mentors who saw a glimmer of potential in me and took a chance on my ability. I understand their

System Administration. I am responsible for the operations of the self-insured, self-administered workers’ compensation program and the unemployment fund for the 14 institutions within the UT System. With more than 240,000 students enrolled in one of our 14 academic and health institutions across the state of Texas and approximately 120,000 employees within the UT System; The University of Texas System is one of the nation’s largest public university systems of higher education.

➍ WITH ALL THE CHAOS AND TRAGEDY THAT ENSUED FROM COVID-19, WHAT ARE THE BIGGEST CHALLENGES RISK MANAGERS WILL FACE WITHIN THE NEXT YEAR?

We are currently navigating a world none of us have experienced. I believe the pandemic will

Risk management has evolved from a method to keep organizations protected from external harm to one of aligning business needs and objectives with a focus on opportunities and threats. Risk management has transformed into a comprehensive, cross functional, integrated approach of understanding risk and its impact on organizational objectives and vision. Today’s risk manager must have strong communication and relationship building skills since risk lives in every aspect and department of an organization. importance in my career. PRIMA is an ideal platform to offer that same opportunity to others interested in risk management and eager to work within, build, or sustain elite risk management programs.

➌ TELL ME ABOUT YOUR CURRENT JOB AND ENTITY.

I am currently the Associate Director of Unemployment and Workers’ Compensation Insurance at the University of Texas System (UT System). My position is within the Office of Risk Management at The University of Texas

PUBLIC RISK | MAY/JUNE 2021

remain a focus for risk managers in the next year. Managing risks associated with the ebb and flow of infection, the efficacy of the vaccine, and return to whatever our new normal way of life and business becomes. As technology continues to advance so does the need for data security and protection from cyber threats. The development of computer technology is swift and risk managers need to understand imminent dangers and quickly jockey for the upper hand protection of the data and operations.

➎ WHAT SKILLS DO RISK MANAGERS NEED TODAY THAT THEY DID NOT NEED IN THE PAST?

➏ HOW HAS THE PANDEMIC CAUSED YOUR ENTITY AND EVERYDAY LIFE TO PIVOT FOR THE BETTER, RESPECTIVELY?

From a work perspective, the pandemic tried to impose a threat to the deeply engrained and unified culture of our tri-partnership. Thankfully, we had business continuity plans established, although we never expected an event of pandemic magnitude. Our pivot to offsite business operations was seamless. Although heavily engrained into our culture, what the pandemic highlighted was the importance of our soft skills mastery. Kindness, empathy, ethics, courage, grit, and resiliency all moved to the top of the list. The loss of two work events is at the forefront of my mind when I reflect on the last year. First, to maintain our culture, our tri-partnership holds and annual retreat. This event is our opportunity to refine the program. The in-person meeting is vitally important considering our team is spread across the great state of Texas. We adapted. To lift the spirit of our team and maximize the effect, we utilized our technology and turned the annual retreat into a weekly discussion spanning a six-week period. The second impactful loss was the retirement of one of our team members who gifted UT System with 20 years of successful employment. Although we hosted a surprise video meeting to celebrate her, she deserved a grander celebration with a room full of all those whose lives she impacted.

Optimistically speaking, for me, the pandemic refocused a fast-paced life back to the simpler, basic elements. It offered more time, in the daylight, at home. My workspace view was taken from one of tall buildings and concrete to that of a pasture with grazing horses that I normally only saw on the weekends. My husband and I quickly developed a habit of meeting after work on the back porch to listen to our favorite music, watch the sunset together, and just talk. In every hardship is a hidden lesson, opportunity, and silver lining. I challenge you to find yours.

➐ WHAT CAN PRIMA DO TO SUPPORT THE NEW CHALLENGES RISK MANAGERS FACE?

PRIMA can continue to stay in front of the emerging risks to provide innovatively prompt resources and solutions to our members. Staying in touch with our members and listening to their needs helps keep a pulse on the industry and challenges facing our public risk managers.

➑ WHAT PRIMA BENEFITS HAVE YOU TAKEN ADVANTAGE OF?

I find the educational topics and resources beneficial. I start my days scanning PRIMA Talk since the topics and comments are easily accessible through my email. PRIMA’s podcasts and webinars deliver meaningful education without disrupting busy schedules, and the annual conference is an event not to be missed.

➒ WHERE DO YOU SEE YOURSELF IN FIVE YEARS?

I plan to spend the next five years paying forward the mentorships, lessons, and opportunities given to me throughout my career. I believe this is essential to the sustainability of risk management. Claire Howard is the manager of marketing and communications at PRIMA.

MAY/JUNE 2021 | PUBLIC RISK

PLAYGROUND SAFETY

NEW STANDARD AND GUIDANCE FOR MANAGING RISKS BY HEATHER OLSEN, ED.D.

PUBLIC RISK | MAY/JUNE 2021

S MORE COMMUNITY MEMBERS ARE TURNING TO NEIGHBORING PUBLIC OUTDOOR SPACES FOR ACTIVE RECREATION, being aware of playground standards and having a plan to address playground hazards is important. If you ask 20 risk managers why children get injured on the playground, you may get 20 different responses. Each person may have a story about how someone they know got injured. While these anecdotes are interesting, they provide no guidelines in making the play environment safe for all children. What do risk managers need to know about playground safety?

Each year in the United States, over 200,000 children go to hospital emergency rooms with injuries associated with playground equipment. According to the U.S. Consumer Product Safety Commission most injuries occur when a child falls from the equipment to the ground. Each year, 21,000 children are treated for traumatic brain injuries (TBIs) which occurred at playgrounds (Cheng, et al. 2016). Upper extremity and head injuries are a concern as fractures account for approximately half of medically treated injuries and head injuries account for approximately one third of all injuries (Adelson et al. 2018; Tuckel et al. 2017). Children deserve to have safe public spaces to play. Playground safety includes being sure the equipment does not have entrapments or extreme wear of metal components. The playground surfacing material should be checked to make sure it can protect a child’s fall. Many communities across the U.S. are expected to have an increase in the number of hot days, amplifying heat extremes. PSC warns consumers to be aware of the risk of thermal burns from playground equipment (CPSC, 2016) as they present some of the highest surface temperatures in urban communities (Vanos, et. al, 2016) and they often lack shade (Olsen, et. al, 2019). Such information on playground hazards has led ASTM International and Canadian Playground Standards (CSA) to update playground standards.

ABOUT THE STANDARDS

ASTM International and CSA have made enormous commitment to playground safety. ASTM International developed a technical standard in 1991 to test the safety of surfacing material under and around playground equipment. This standard was to test the impact attenuation performance of playground surface material which testing occurred in a controlled laboratory setting. A new standard in 2020 was developed on procedures for testing surfacing materials at playground locations. ASTM International also has a technical standard for manufacturers to use when developing public-use playground equipment. Standard F1487 was first published in 1993 which sets forth the safety requirements for playground equipment. A summary of ASTM International playground standards listed by a common name and standard number, followed by its purpose.

• Wood fiber (F2075) – Describes the specific means of evaluating engineered wood fiber in relation to particular size, consistency, purity, and drainage ability. • ADA compliance (F1951) – To test whether surfacing allows wheeled components and children with crutches or canes to get to playgrounds. • Testing playground surfacing at the playground location (F3313) – To test playground surfaces impact attenuation within use zones of installed playgrounds. The Consumer Product Safety Commission developed two playground safety guidelines in 1981 for the consumer public and the playground industry. Today, CPSC has a Public Playground Safety Handbook freely available

• Playground Equipment (F1487) – To provide a standard for manufacturers of playground equipment used at child care centers, schools, and parks, ages 2–5 and 5–12. • Testing surfacing in the laboratory setting (F1292) – To provide a standard for checking the impact attenuation of surfacing materials within a laboratory setting.

MAY/JUNE 2021 | PUBLIC RISK

PL AYGROUND SAFET Y: NEW STANDARD AND GUIDANCE FOR MANAGING RISKS

Supervision in outdoor play areas requires adult supervisors who are alert, are aware, know safe playground rules, and intervene when inappropriate behaviors occur. Risk managers play a vital role in the advocacy of playground safety as they manage the playgrounds. While risk managers may not be physically supervising the students, they can encourage supervision signage, assist in design decisions to allow for ease of supervision, and offer playground safety training to supervisors and students.

which presents safety information for public playgrounds to promote greater safety among those who purchase, install, and maintain public playgrounds. To access the handbook, http://www.cpsc.gov/s3fs-public/325.pdf The Standards Council of Canada in 2016 launched the Standards to Support Resilience in Infrastructure Program to integrate climate adaption considerations into buildings and infrastructure standards. This project aimed to generate guidance on designing thermally comfortable playgrounds for all season of play. The CAN/CSA Z614 Children’s playground equipment and surfacing is the first standard to integrate ideas for addressing hazardous thermal conditions at playgrounds. A technical report was also produced to advance knowledge on thermally safe playgrounds and raise awareness about hazardous thermal conditions at playgrounds, https://www.scc.ca/ en/about-scc/publications/general/thermallycomfortable-playgrounds.

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THE ACTION PLAN

Standards are important, but dissemination and education on standards is needed to put them into practice. The National Program for Playground Safety works to raise awareness about playground safety. We have identified four goals for playground safety through our S.A.F.E.™ injury prevention framework. GOAL #1: PROVIDE PROPER SUPERVISION OF CHILDREN ON PLAY AREAS Supervision in outdoor play areas requires adult supervisors who are alert, are aware, know safe playground rules, and intervene when inappropriate behaviors occur. Risk managers play a vital role in the advocacy of playground safety as they manage the playgrounds. While risk managers may not be physically supervising the students, they can encourage supervision signage, assist in design decisions to allow for ease of supervision, and offer playground safety training to supervisors and students.

GOAL #2: DESIGN AND MAINTAIN APPROPRIATE ENVIRONMENTS The second crucial risk factor on playgrounds is the appropriateness of the environment. Children who play on equipment that is not appropriate for their size, strength, and decision-making abilities may be exposed to potential injury. The Consumer Product Safety Commission has examples of different types of equipment for ages 6-–23 months, ages 2–5, and ages 5–12 (CPSC, 2010). Schools who serve multiple grade levels may want to separate grade levels, equipment, and open areas (e.g. grades Pre-K; grades 1–3; and grades 4-6) as older children have greater strength than five year olds. Appropriate environment includes accessibility and environmental conditions. Considerations should be given to providing accessible play equipment selection and pathways to ensure all children have opportunities to play on the playground. The 2010 Americans with Disabilities standards requires that all play-

grounds be designed and constructed in such a manner that equipment is readily accessible and usable by individuals with disabilities (DOJ, 2010). Modern playground materials, along with extreme hot temperature peak periods, can expose children to unsafe circumstances (Hyndman, 2017). The type of playground surfacing materials under playground equipment influences the play environment’s temperature. Playground surfaces which are not protected from the sun retain large amounts of heat thus suggestions for design changes on modern playgrounds are needed to increase active play (Kennedy, et al., 2019). GOAL #3: PROVIDE PROPER FALL SURFACING UNDER AND AROUND PLAYGROUNDS The third risk factor involves the playground surfacing material. Falls to the surface are cited as the leading cause of playground injury (Hanway, 2016; Tuckel et al., 2017). Suitable surfacing under and around the playground equipment is essential for protection. NPPS suggest paying particular attention to making sure the surfacing material is maintained at the proper thickness proportionate to the height of the equipment. Public agencies were cautioned about height of equipment in relation to the depth of materials and increase in fall injury (Chalmers et al. 1996. CPSC describes two types of surface materials: unitary and loose-fill materials. The most widely used test method for evaluating the shock absorbing properties of a playground surface material is to test for impact attenuation to determine whether the surfacing material will protect a child from a life threatening injury (CPSC, 2010). GOAL #4: PROVIDE PROPER EQUIPMENT AND SURFACE MAINTENANCE The fourth playground risk factor is equipment and surface maintenance. The general layout, maintenance of equipment and surfacing materials, and the application of safety checks, inspections, and procedures are important steps to protect students from strangulation, contusions, lacerations hazards, and falls (CPSC, 2010). There is no such thing as a maintenancefree material when it comes to the development of a play area. Without good maintenance, wood will splinter, metal will rust, and plastic

will crack. Equipment should be durable and meet both the CPSC guidelines, ASTM F1487, and CSA Z614. A proactive risk management plan and policy is encouraged to be developed to provide an umbrella of safety for children. Community agencies and organizations should consider developing written policies for ongoing maintenance, repair, planning for playground Supervision, Appropriate environments, Fall surfacing, and Equipment maintenance. Prevention comes from awareness of playground safety. It is through awareness, education, and training that action can be taken to avoid the risks associated with each of the playground safety elements. Heather Olsen, Ed.D., is a professor, Department of Health, Recreation, and Community Services, National Program for Playground Safety, University of Northern Iowa. REFERENCES Adelson, S. Chounthirath, T., Hodges, N., Collins, C., Smith, G. Pediatric playgroundrelated injuries treated in hospital emergency departments in the United States (2018). Clinical Pediatrics, 57(5), 584-592. ASTM International. (2018). Standard specification for impact attenuation of surfacing materials within the use zone of playground equipment. F1292. West Conshohocken, PA: American Society for Testing Material. ASTM International. (2017). Standard consumer safety performance specification for playground equipment for public use. F1487. West Conshohocken, PA: American Society for Testing and Materials. ASTM International. (2014). Standard specification for determination of accessibility of surface systems under and around playground equipment. F1951. West Conshohocken, PA: American Society for Testing and Materials. ASTM International. (2020). Standard test method for determining impact attenuation of playground surfaces within the use zone of playground equipment as tested in the field. F3313. West Conshohocken, PA: American Society for Testing and Materials. ASTM International. (2020). Standard specification engineered wood fiber to use as a playground safety surface under and around playground equipment. F2075. West Conshohocken, PA: American Society for Testing and Materials.

Chalmers, D. J., Marshall, S. W., Langley, J. D., Evans, M. J., Brunton, C. R., Kelly, A. M., & Pickering, A. F. (1996). Height and surfacing as risk factors for injury in falls from playground equipment: A case-control study. Injury Prevention,2(2), 98-104. Cheng, T. A., Bell, J. M., Haileyesus, T., Gilchrist, J., Sugerman, D. E., & Coronado, V. G. (2016). Nonfatal playground-related traumatic brain injuries among children, 2001-2013. Pediatrics, 137(6). Consumer Product Safety Commission. (CPSC). (2012). CPSC fact sheet: Burn safety awareness on playgrounds. Bethesda, MD: U.S. Consumer Product Safety Commission. https://www.cpsc.gov/s3fs-public/3200.pdf. Accessed 29 Mar 2021. Consumer Product Safety Commission. (CPSC). (2010). Handbook for public playground safety. Bethesda, MD: U.S. Consumer Product Safety Commission. CSA Group (2020). Children’s playground equipment and surfacing. CAN/CSA-Z614: 2020. Kennedy, E.A., Olsen, H.M, & Vanos, J.K. (2020). Thermally comfortable playgrounds: A review of literature and survey of experts. Standards Council of Canada. https://www. scc.ca/en/about-scc/publications/general/ thermally-comfortable-playgrounds. Hanway, S. (2016). Injuries and investigated deaths associated with playground equipment, 2009-2014. Consumer Product Safety Commission. Hyndman, B. (2017). ‘Heat-Smart’ schools during physical education (PE) activities: Developing a policy to protect students from extreme heat. Learning Communities: International Journal of Learning in Social Contexts,21, 56-72. Olsen, H.M., Kennedy, E.A., Vanos, J.K. (2019). Shade provisions in public playgrounds for thermal safety and sun protection: A case study across 100 play spaces in the United States. Landscape and Urban Planning 189: 200-211. Tuckel, P., Milczarski, W., & Silverman, D.G. (2017). Injuries caused by fall from playground equipment in the United States. Clinical Pediatrics, 57(5), 563-573. Vanos, J. K., Middel, A., McKercher, G., Kauras, E.R., & Ruddell, B. (2016). Hot playgrounds and children’s heath: a multiscale analysis of surface temperatures in Arizona, USA. Landscape and Urban Planning, 146, 29-42. US Department of Justice (2010). ADA standards for accessible design. Play areas. Washington DC, US Access Board. https://www.access-board.gov/files/ ada/ADA-Standards.pdf Accessed 29 Mar 2021.

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WE CAN WIN THE FIGHT AGAINST COVID-19 TOGETHER!

As we begin to see the light at the end of the tunnel, count on PRIMA to continue to provide COVID-19 education, including return-to-work planning, for the public risk management community. COVID-19 education includes webinars, podcasts, blogs, and more! Check out the latest at primacentral.org/education/center/

THE BIOLOGIC A L BA SIS OF

COMPL ACENC Y

BY SHARON LIPINSKI

HE ADVERSE EFFECTS OF COMPLACENCY IN THE WORKPLACE have long been an ongoing source of risk for employers. What is not agreed upon is the reason for this problem. In the author’s own experience, she noticed that different people used the term in different ways to refer to different kinds of events.

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THE BIOLOGICAL BASIS OF COMPL ACENCY

The ability to address and solve a problem is greatly increased when the problem is properly understood, so the author embarked upon a research effort to better understand this hazard. As result, we produced a paper that explores a previously undiscussed component to complacency: basic brain design. Given how the human brain has evolved to operate, the author argues that complacency is an unavoidable risk factor that can be managed but not eliminated. With this scientifically-based understanding of complacency, employers can more effectively prevent complacency from posing a risk to their employees’ safety. THE SYMPTOMS OF COMPLACENCY

Complacency is not an easily observable condition, and objective criteria can be elusive. Based on interviews with safety professionals, the author compiled a list of anecdotal clues these professionals use to gauge the presence of complacency: • Working too fast or too slow • Eyes not on task • Occupying space in the “line of fire” or danger zone • Multi-tasking (e.g. having conversations while working) • Not taking risks seriously (e.g. goofing off or bragging) • Not following the procedures (e.g. using a 2-handed tool with 1 hand) • Not completing checklists or pencil whipping them • Skipping basic PPE or safety requirements • An increase in incidents without easily identifiable root causes • The frequency of rework incidents • Decreasing frequency of near miss or good catch reports The traditional approach to combating complacency, based on these types of clues, has been to attempt to “fix” employees’ mental and emotional states. Solving complacency is often viewed as needing to raise employees’ sense of responsibility and attention to detail. Tactics include reminding employees to pay attention and think about what they’re doing and admonishing them to slow down. However, refusing to tolerate shortcuts or wishing that employees care more about their work is not the answer.

PUBLIC RISK | MAY/JUNE 2021

More critically, the author argues that these external expressions are symptoms of complacency that are driven by a biological root. Targeting the symptoms of complacency will not eliminate this hazard. Effectively tackling this hazard requires targeting the root cause, and targeting the root cause requires understanding how the brain handles repetitive behavior.

THE NEUROSCIENCE OF HABIT Typically when someone performs a behavior or action for the first time, their pre-frontal cortex (PFC) fires and communicates with their striatum. The PFC is the part of the brain that sits above the eyeballs and is involved in many of our executive functions. The PFC is responsible for engaging in a wish list of employee behavior like planning, making decisions, and anticipating consequences. The striatum is the habit, reward, and goal motivated behavior center and has been described as the learning machine part of the brain. When the brain is doing something new, it is a lot of work, and all the neurons along this path between the PFC and the striatum fire. However, the brain is a quick learner. The next time it repeats that action, it’s a little more familiar, so fewer neurons fire. As this process is repeated, the action gets easier and easier and fewer and fewer neurons fire. When something is a habit, the PFC does not need to be involved, and it’s not all the neurons during this activity. It’s just the ones at the beginning and the end. There are two key points from the neurological studies and academic literature that are key to managing the risk of complacency in the

workplace: (1) once habits are created, the sequencing “moves” to a different part of the brain and; (2) when a behavior or action has been repeated often enough to become a habit, the PFC no longer needs to be involved to successfully complete it. Simply stated, repetition is the mother of habit. By repeating an action over and over, a person carves a neural pathway deep in the brain that requires very little energy or effort to run.

THE VALUE OF HABITS

Every second, the brain must process an unquantifiable amount of information. This includes everything from our own autonomic nervous systems (internal temperature, heart rate, eye blinking, and more) to taking in external stimuli (colors, shapes, locations, movement, and more) to just doing our jobs. With this plethora of information to process, the brain needs to rely on shortcuts. There are many different types of shortcuts, but the one applicable to our topic here is habit. A habit is a neurological shortcut the brain can use when engaged in a repetitive task. The range of repetitive tasks is quite large. Not only does it include actions like brushing your teeth and wearing PPE, but also behaviors like asking for help, reacting calmly in stressful situations, and problem solving. Beyond behaviors, people have created habits to process emotions, thoughts, decisions, and actions. Habits are an impressive productivity tool for the brain. They allow people to perform tasks more reliably and more quickly. Habitual behaviors also free up more cognition space in our brain, allowing us to multi-task and tackle more demanding undertakings. Essentially, habits free up our brain to do other things and can give us a competitive advantage. Even if productivity were not the goal, our brains would employ habits because it’s easier and relieves the cognitive toll of so much information flooding our brain through the course of our daily lives. In rather unscientific terminology, the bottom line is that the brain is essentially lazy, and the brain does not want to fire up the PFC if it does not have to for any longer than it needs to.

THE DOWNSIDE OF HABITS

But there is a price exacted when habits are triggered: the PFC is often no longer actively involved in brain processing. When the PFC is not engaging, then we have lost an important safety resource. Habits are a double-edged sword. They are essential for executing many safety protocols but they also cause us to lose another tool in our safety kit: robust PFC activity. As a result, people can be less aware of what’s going on around them.

A NEW DEFINITION OF COMPLACENCY

Based on this understanding of the biological process of the human brain, we can offer a more accurate definition of complacency that also opens the door to solving the problem in a way that does not blame people for being human. Complacency is a state of decreased external awareness and reduced sensitivity to hazards caused by the brain’s ability to activate neural pathways that require less PFC activity. This definition reflects the current neurological assessment of what happens in the brain when habits are established. Most importantly, this definition of complacency reflects that complacency is an internal state, not one easily observable. In fact, for all practical purposes, it is impossible to identify complacency externally. By looking at indicators like working too fast or slow, eyes not on task, and having conversations while working, safety professionals are looking for external clues of an internal state. Unfortunately, complacency cannot be resolved by focusing on these outer symptoms, because even if you successfully remove all outward expressions, there is still no guarantee that the employee’s mind is actually engaged in the task at hand. To offer a real world, personal example of this dynamic, the author is chagrined to admit that she can be looking at her husband, nodding her head, and still not be listening to what he is saying.

MANAGING COMPLACENCY Accepting the biologically driven nature of complacency not only eliminates the stigma of complacency, it also creates a path for managing—not eliminating—this hazard.

Complacency is never a hazard that you can check off your list, because it will never go away. Every human being’s brain will be inclined to rest in habit mode and avoid activating its executive functions whenever possible. Sp, plan accordingly. Leverage the brain’s natural tendency to use neural shortcuts to your advantage and strategically plan to re-engage the pre-frontal cortex when complacency is a disadvantage. Here are 3 key principles: 1. Across the board, you want your employees to have maximum cognitive function available for working safely, so that means streamlining forms, eliminating unnecessary steps, and providing access to physical and mental health resources. 2. Use repetition to your advantage by practicing key behaviors until they be-come deeply ingrained in the brain. 3. Strategically prompt your employees to reengage the PFC at key points, especially when an employee is about to execute an unrecoverable step.

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CONCLUSION

Complacency is a byproduct of habit—of being able to operate out of the striatum and avoid the executive functions of the PFC. Complacency is not a conscious choice or a moral failing. It’s how the brain is designed. The better the brain can get at moving behaviors to habit level, the more efficient it can be with its limited resources. Most of the time complacency works in your employees’ favor and increases their productivity, but when it poses a safety concern, effectively tackling complacency means re-engaging the PFC. The more cognitively engaged employees are, the safer they will be. Because the drive towards complacency is relentless, employers should accept that helping employees’ avoid this hazard is a constant process of strategically re-engaging the PFC, surprising employees, and triggering their awareness. Sharon Lipinski is the Habit SuperHero and CEO of Habit Mastery Consulting, which helps organizations increase their targeted safety behavior by up to 150 percent.

PRIMA WEBINARS May 19 After Action Review June 29 Property Underwriter’s Perspective on the Renewal Process July 21 Effective Safety Committees: Making Them Work for You! August 18 COVID & Litigation Against Public Health Agencies September 15 Law Enforcement Liability Issues October 20 Starting an Enterprise Risk Management Program from Scratch November 17 Exploring the Unique Challenges Faced by Injured Workers December 15 Leadership and Motivation

MAY/JUNE 2021 | PUBLIC RISK

Effective Injured Worker Models of Care INCORPORATE MENTAL-HEALTH ASPECTS FROM THE START BY KATE FARLEY-AGEE

ENTAL-HEALTH CHALLENGES PRESENT NUMEROUS HURDLES FOR INJURED WORKERS even in “normal” times. Now, because of the extraordinary fallout from the pandemic, it’s imperative to ensure that injured workers obtain access to high-quality mental-health assistance when it’s needed.

For years now, we’ve understood that anxiety and depression threaten to undercut injured workers’ recoveries. Often, these pernicious inflictions don’t creep up until well after a physical injury occurs. This stealthy advance can make these conditions hard to identify and difficult to treat. Yet before the novel coronavirus began pummeling the physical and mental welfare of so many people, it was possible, if ill-advised, to take a wait-and-see approach when considering mental-health options for an injured worker who showed signs of unease. We have come to understand this no longer works. Now, the collective gut punch delivered by the pandemic has made it necessary to devote added attention and resources to identify and treat behavioral-health challenges before they risk upending an injured worker’s recovery. To further that goal, it’s helpful to examine how successful models of care incorporate mental-health aspects from the start and make available various pathways for helping injured workers whose injuries are chipping away at their mental wellness. To start, it’s wise to turn to a strong network that has deep bench strength. This is important because finding the right provider and gaining timely access to that provider is key to helping injured workers deal with mental-health hurdles if such challenges begin to arise. This is critical because we continue to develop a better understanding of the often-inextricable links between physical and mental soundness. For example, one study of more than 15,000 retirees pointed to anxiety and depression as posing similar—and sometimes greater—risks for poor health outcomes than obesity and smoking.

SUCCESS COMES FROM MATCHING WORKERS’ NEEDS TO THEIR TREATMENTS

There is ample evidence that mental-health assistance can play an important role in a worker’s recovery. Where things get less clear is determining what behavioral-health interventions an injured worker needs to achieve success in returning to work. One fundamental question centers on the type of provider. In workers’ compensation, behavioral health providers often include psychiatrists, psychologists, and professional counselors.

PUBLIC RISK | MAY/JUNE 2021

Beyond looking at the type of provider, it’s critical to understand the level of care needed to promote a strong recovery. This includes questions about whether a treatment will be outpatient, or, though rare, inpatient. Here are some of the distinctions we often see in workers’ comp: • • • • •

Inpatient hospitalization Partial hospitalization Intensive outpatient care Outpatient counseling Medication management

Looking a little closer at some of these variations, interventions such as inpatient hospitalization obviously represent acute care whereas partial hospitalization might be limited to day treatment. Next, intensive outpatient care stands as a still-lighter touch, perhaps with three hours of treatment, three to five evenings per week. Outpatient counseling and medication management each have their place as well in helping injured workers combat mental-health concerns. Often, talk therapy can serve as an appropriate first-line treatment when mental-health obstacles emerge. Of course, none of these interventions—provider types, treatment settings, or treatments themselves—exist in a vacuum. Today, injured workers are facing the added strains of seeking recovery under the pall of a global pandemic. This compounded stress can impinge on workers’ recoveries by stirring unease about physical and financial wellbeing, among other concerns.

contact with coworkers, or challenges associated with recovering at home or in a facility? The nature of mental-health aliments can make it difficult to uncover clear-cut ties between an initial incident and subsequent bouts with conditions such as anxiety and depression. That’s why it’s helpful for adjusters and case managers to reach for proven tools such as active listening and recurring engagement with an injured worker. These conversations can help adjusters both better answer questions about compensability and help direct injured workers toward the most appropriate treatments.

THE PANDEMIC MAKES THE WORK OF GUIDING RECOVERIES MORE DIFFICULT

It’s possible and even probable that getting hurt on the job amid a pandemic could bore further into a worker’s mental wellbeing than it otherwise might. Working and living in a heightened state of strain for an extended duration makes it more likely that a worker could become injured in the first place. And unrelenting stress can likewise make recovery harder. It’s also evident that the exogenous fault lines that grew to define 2020—worries about contagion, the economy, and society at large, among others—could make anxiety and depression more likely to follow when an injury occurs.

At the same time, the breadth and scale of the pandemic, not seen in a century, also raises sometimes-difficult questions about compensability. After all, if mostly everyone is feeling stressed, is an injured worker forced to bear a heavy mental load because of an injury or simply because these are stressful days? There are a number of questions adjusters might consider asking to navigate to an answer:

There are other ways the pandemic malaise could eat away at a worker’s mental wellbeing. Fear of retaliation might keep someone from raising a hand to report an injury. Perhaps the worker feels gratitude about still having a job in the first place and doesn’t want to appear unappreciative. Or it could be that the worker fears direct retribution or even a soft reprisal such as losing favor with management. It’s likewise possible an injured worker might worry about being subsequently targeted if layoffs were to occur.

• Did symptoms begin to emerge before or after the injury occurred? • Did the injury exacerbate any mental strains the worker was already facing? • Was the injured worker seeking treatment for mental-health challenges prior to the injury? • Are the difficulties linked to fallout from the injury, including decreased income, loss of

Given the financial and operational difficulties many employers are facing, it’s little surprise that some workers might not want to rock the proverbial boat. This is the case for a segment of workers even in less economically perilous times. A 2013 survey by Findlaw.com, a legalinformation clearinghouse, found 9 percent of workers didn’t report a workplace injury for fear

of retaliation such as being fired or passed over for promotion. Now, with the U.S. economy staggering under the weight of coronavirus disruptions, it’s possible more workers would be reluctant to reveal injuries.

EXTRA SCRUTINY CAN LEAD TO BETTER UNDERSTANDING

Difficult times can require adjusters and case managers to do a little more looking under the hood of a claim to try and anticipate where an injured worker’s case might be headed. This might mean examining the medications providers are prescribing or the types of treatments providers are seeking. By applying a bit more scrutiny to some of these aspects of a claim, adjusters and case managers might be able to tell when mental-health challenges could threaten to complicate a worker’s rebound and return to work. Even for workers who aren’t injured, mentalhealth constraints such as depression can do enormous damage. In fact, about one-quarter of the U.S. workforce suffers from depression and these workers are out from work twice as often and they have five times the “lost productive time” of other workers. The cost to personal wellbeing is plainly severe. The same is true in monetary terms: A review of U.S. insurance claim data by the consultancy McKinsey reveals that the 23 percent of members with mental-health or substance-use disorders drive 60 percent of overall medical spending. Put another way, behavioral-health issues and physical issues often go hand-in-hand. McKinsey reports that people with behavioralheath conditions suffer two to six times the frequency of concurrent physical conditions compared with those who don’t struggle with these challenges.

INCREASED DEMAND WILL REQUIRE A NEW PLAYBOOK

Challenges around access appear only likely to grow in the U.S. and, indeed, throughout the world. Paradoxically, as some mental-health advocates have noted, some states hemmed in by financial difficulties arising from the pandemic are reducing the money they set aside for mental-health treatments just as

MAY/JUNE 2021 | PUBLIC RISK

EFFECTIVE INJURED WORKER MODELS OF CARE INCORPORATE MENTAL-HEALTH ASPECTS FROM THE START

demand is spiking. In addition, other states, needing space to treat patients contagious with COVID-19 have shuttered or taken over behavioral health facilities. While the outlook for treatment access remains worrisome, some mental health professionals hope the societal inequities and shortcomings highlighted by the crisis will lead to further innovations in delivering care such as using telemedicine to reach far-flung patients. The need is great. More than half of counties in the U.S. don’t have a psychiatrist and nearly two-thirds have a shortage of mental-health providers. There are other potential benefits for injured workers that could grow out of a broader need across society for mental-health interventions. One is a further breakdown in the stigma that too often surrounds mental illness. A worker already straining under physical maladies related to an injury can then suffer a cruel secondary blow—one tied to the shame that struggles with anxiety, depression, and stress can render. If more people recognize how commonplace mental-health trials are, then perhaps more workers will ask for help. Similarly, perhaps more workers will understand how physical pain, social isolation, financial worries, and other everyday concerns can conspire to throw up sizable barriers to mental wellbeing. Ultimately, it’s clear that in most cases injured workers require a menu of supports that will enable them to see their health restored and allow them to return to work. Only by viewing the whole person can adjusters, case managers, and providers hope to help injured workers achieve the best-possible outcomes. Part of this task involves reviewing the mental-health difficulties that an injured worker might be facing as part of the fallout from an injury. Once an obstacle is identified, it’s imperative to turn, in a timely fashion, to a network of accomplished providers to help the injured worker vanquish these mentalhealth complications and return to health, to productivity, and to the job. Kate Farley-Agree is Vice President, Network Products for Coventry.

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