1) Services Offered
o Initial Evaluation for Functional Restoration Program
- According to the MTUS Guidelines, the criteria for the use of a multidisciplinary pain program require that an adequate and thorough evaluation is performed including baseline functional testing so that follow up with the same tests can note functional improvements.
- The Northern California Functional Restoration Program provides a comprehensive initial evaluation which includes a Medical, Psychological and Physical Capacity evaluation of the patient. Included in this evaluation is baseline functional testing so that the patient could undergo follow-up testing during the program to confirm progress and improvement. A realistic treatment plan is developed that we feel is attainable during the FRP. NCFRP utilizes an inter-disciplinary team of professionals providing individualized treatment plans. A weekly inter-disciplinary team meeting is held, open to Insurance Carriers, Nurse Case Managers, Applicant Attorneys and other authorized and necessary participants to discuss individual patient progress. A weekly comprehensive report is generated and forwarded to Insurance Carriers, Nurse Case Managers, Applicant Attorneys and Primary Treating Physicians.
o Functional Restoration Program
- As outlined in the MTUS/Chronic Pain Medical Treatment Guidelines, page 31, there is no one universal definition of what comprises inter-disciplinary/multidisciplinary treatment. The most commonly referenced programs have been defined in the following general ways (Stanos, 2006):
(2) Interdisciplinary pain programs: Involves a team approach that is outcome focused and coordinated and offers goal-oriented interdisciplinary services. Communication on a minimum of a weekly basis is emphasized. The most intensive of these programs is referred to as a Functional Restoration Program, with a major emphasis on maximizing function versus minimizing pain.
- Components suggested for interdisciplinary care include the following services delivered in an integrated fashion:
(a) Physical Treatment; (b) Medical Care and Supervision; (c) Psychological and Behavioral Care; (d) Psychosocial Care; (e) Vocational Rehabilitation and Training; and (f) Education.
- The Northern California Functional Restoration Program consists of a variety of services geared towards facilitating recovery of functioning and quality of life – physically, medically, socially, mentally, emotionally, and vocationally with an emphasis on maximizing function versus minimizing pain. For (a) Physical Treatment, patients attend groups on strength and conditioning, proper body mechanics, ergonomics, functional movement, posture and balance, tai chi, yoga, nutrition, and biofeedback. For (b) Medical Care and Supervision, each patient attends an individual appointment with a physician on a weekly basis as well as physician lectures on medication management and the medical bases of chronic pain and its treatments. For (c) Psychological and Behavioral Care, (d) Psychosocial and (f) Education, patients are provided with intensive training in wellness-focused (active, independent) skills for managing stress and pain, communication skills for fostering healthy social support, relaxation and meditation training, education on mindfulness for attentional retaining and autogenic nervous system arousal, and specific tools for coping with anxiety, depression, and grief. Patients are also supported in (e) vocational rehabilitation and training through career planning, and skills training aimed at return to work.
2) Population Served
o The age range of the patients at NCFRP are typically between the ages of 18 and above
o NCFRP does not provide services to minors or pediatric and adolescent services. Minors are defined as any patient under the age of 18.
o NCFRP typically only accepts patients covered under Worker’s Compensation. For Cash Pay, please contact the Director of Operations.
o NCFRP provides a Spanish Program available to Spanish-speaking patients.
o All other languages can be accommodated into the program with prior arrangements with an interpreter/translator which NCFRP will provide assistance on.
3) Settings
o NCFRP services will be provided under the highest standards of patient safety and treatment at:
NORTHERN CALIFORNIA FUNCTIONAL RESTORATION PROGRAM
1335 Stanford Avenue, Emeryville CA 94608
The Northern California Functional Restoration Program (NCFRP) is part of a 16,500-square-foot outpatient clinic. The approximately 4,000 square foot area dedicated to the program includes space for a gym, a private entrance and waiting area, class room training, exam rooms, psychotherapy rooms, administrative offices and a dedicated reception area to allow for easy access to patients and providers.
4) Hours and Days of Services
OFFICE HOURS
7:30am – 4:30pm, Monday to Friday
PROGRAM SCHEDULES (subject to change)
Spanish Group 0800am – 0200pm, Monday to Friday
English and other languages 0930am – 0330pm, Monday to Friday
5) Frequency of Services
o According to the MTUS Guidelines total treatment duration should generally not exceed 20 full-day sessions, or the equivalent in part-day sessions. ODG further explains that 20 full-day sessions is equivalent to 160 hours.
o Patients will attend the Northern California Functional Restoration Program for up to 6 weeks in a continuous course treatment program. NCFRP is designed to be consistent with the MTUS/ODG recommendations of part day sessions demonstrated to be highly effective when administered over the duration of 160 hours distributed over 6 weeks. The modalities are provided to the patient on a daily basis and Medical and psychological providers are available to the patients for the duration of the 160-hour program to assist the patients’ progress not only in individual and group sessions whether in-person or telephone appointments, but also in applying relevant skills in the milieu and managing crises as they arise.
NCFRP is designed to evaluate and treat patients with persistent pain and delayed recovery through a part-day outpatient inter-disciplinary pain program. Patients learn new skills and coping tools to develop new goals and expectations to improve quality of life and return to productive activity.
Initial Evaluation Schedule:
The initial evaluation will run approximately 3-4 hours. Patients will meet with a Pain Management Physician, Psycho-therapist, Physical therapist and your designated Patient Care Coordinator who will assist patients through the entire process.
Program Schedule:
6-week Program, Monday to Friday, approx. 6 hours per day with breaks
(Schedule is subject to change to accommodate holidays)
Individual Check-ins:
- Weekly individual meeting with Pain Physician
- Weekly individual meeting with Psychotherapist
- Weekly individual meeting and testing with a Physical Therapist
Weekly Classes:
- Strength and Conditioning Program – approx. 2 hours per day
- Art Therapy, Stress Management
- Pain Management Techniques
- Cognitive Behavioral Strategies to assist in managing thoughts, emotions, and behaviors
- Physiology of Pain
- Nutrition
- Movement and Yoga Therapy
- Integrated Life Management for Chronic Pain Patients
- Understanding the Worker’s Compensation System
- Strength and Conditioning Program
- Dynamic Biofeedback & Ergonomics
- Meditation and Relaxation Techniques
- Breathing, Posture, Moving and Relaxation
6) Payer Sources
o NCFRP typically only accepts patients covered under Worker’s Compensation. For Cash Pay, please contact the Director of Operations.
o NCFRP does not accept patients under the US Department of Labor insurance
7) Fees
o NCFRP fees shall be disclosed to the insurance carrier and patient representative at the time of request for treatment through an RFA form as regulated by the DWC
o The Worker’s Compensation insurance will be held financially responsible for fees at Pain and Rehabilitative Consultants Medical Group
8) Referral Sources
o All providers treating patients with Worker’s Compensation insurance
9) Activity Limitations
o Patients have to be ambulatory and cannot be bed bound. This does not exclude patients using assistive devices such as canes, walkers and wheelchairs.
10) Behavioral Status
o Patients have to be willing to participate in the program and cannot be persistently disruptive to other patients.
11) Cultural Needs
o As part of the NCFRP Cultural Diversity and Linguistic Competency plan, NCFRP will attempt to accommodate all cultural needs. Patient Care Coordinators will help organize and explore resources for accommodations such as transportation, childcare and lodging on an as needed basis.
o NCFRP offers a Spanish Program for Spanish-speaking patients with Spanish speaking personnel, providers and materials.
12) Impairments
o The program will evaluate impairments and will attempt to provide specialized accommodations as needed
13) Intended Discharge Environments
o Discharge criteria – lack of progress, attendance, non-compliance, disruptive and violent behaviors
14) Medical Acuity
o No admission for any patients who are acutely medically ill such as active infection or patients who need acute medical care such as surgical treatment and hospitalization.
15) Medical Stability
o Patients with chronic illness have to be medically stable. Examples would include diabetics, congestive heart failure, people with chronic lung disease, kidney disease, liver disease.
16) Participation Restrictions
o Patients must be available and willing to attend the program for the duration of 6 weeks
17) Psychological Status
o Patients with psychiatric illness have to be stable. This would exclude acute psychiatric illnesses such as Schizophrenia and Bi-polar disorder.
18) Entry Criteria
Chronic pain that has not responded adequately to medical and surgical treatment and continues to limit the patient in terms of activities of daily living and or work activities. There are usually confounding psychological factors such as anxiety and depression that have contributed to a retracted course of recovery. A realistic treatment plan is developed that we feel is attainable during the FRP.
Criteria for the general use of multidisciplinary pain management programs or FRP according to the MTUS:
- An adequate and thorough evaluation has been made, including baseline functional testing so follow-up with the same test can note functional improvement
- Previous methods of treating chronic pain have been unsuccessful and there is an absence of other options likely to result in significant clinical improvement
- The patient has a significant loss of ability to function independently resulting from the chronic pain
- The patient is not a candidate where surgery or other treatments would clearly be warranted (if a goal of treatment is to prevent or avoid controversial or optional surgery, a trial of 10 visits may be implemented to assess whether surgery may be avoided)
- The patient exhibits motivation to change, and is willing to forgo secondary gains, including disability payments to effect this change
- Negative predictors of success have been addressed:
NEGATIVE PREDICTORS OF SUCCESS
The following variables have been found to be negative predictors of efficacy of treatment with the programs as well as negative predictors of completion of the programs:
- a) a negative relationship with the employer/supervisor
- b) poor work adjustment and satisfaction
- c) a negative outlook about future employment
- d) high levels of psychosocial distress (higher pretreatment levels of depression, pain and disability)
- e) involvement in financial disability disputes
- f) greater rates of smoking
- g) increased duration of pre-referral disability time
- h) higher prevalence of opioid use
- i) elevated pre-treatment levels of pain.