The Northern California Functional Restoration Program is designed to evaluate and treat patients with persistent pain and delayed recovery. NCFRP’s team of experienced pain specialists utilizes an inter-disciplinary approach modeled on evidenced-based practices and the recommendations of the Medical Treatment Utilization Schedule (MTUS). At NCFRP, our goal is to provide patient-centered, cost-effective, and outcomes-driven functional restoration treatment of the highest quality to the Worker’s Compensation industry. NCFRP has been serving the Worker’s Compensation industry for more than 18 years.

OUR MISSION

“Our MISSION is to rebuild lives by rehabilitating patients to a higher functional level, reconnecting them with the community and improving their quality of life.”

 Our PROMISE is to deliver the best possible outcomes with excellent patient experience.

OUR VISION

“Only a small percentage of Injured Workers have access to a Functional Restoration Program. Our VISION is to increase access to 100% of candidates in the Worker’s Compensation industry.”

THE NCFRP ADVANTAGE

• An all-Spanish program for our Spanish-speaking patients. Providers, instructions and materials are all in Spanish. There is no need to obtain authorizations for interpreters.
• Expansive authorizations support teams that handle authorizations and document processing from start to finish.
• Convenient locations in the East Bay, Northern California with easy access by car from the East and North Bay, and San Francisco. Excellent parking is available as well as mass transit on BART and the free Emery-Go-Round.
• Long term experience in Functional Restoration treatment with remarkable Outcome Studies that are focused on optimal outcomes for the patient, employer and insurance carrier.
• Weekly on-site progress meetings open to Treating Physicians, Claims Administrators, and Case Managers. Teleconferences can also be accommodated upon request.
• Comprehensive Initial Evaluations to assess whether the patient is a candidate for inter-disciplinary treatment.
• Weekly comprehensive progress reports faxed to all parties involved.
• Final reports with recommendations for Work Status, P&S Status and projected future medical needs.
• A formal rating report can be completed upon request and authorization.
• Commitment to the reduction of medication and health care usage, return to work and reduced disability.
• Cost-effective programs that provide flexible solutions to each client.

NCFRP CORE VALUES

The NCFRP Team Believes that:

1. A person-centered philosophy is the key to providing optimal outcomes.
2. The overarching purpose of our program is to improve the quality of life of our patients.
3. The ultimate purpose of our hard work is to serve our patients.
4. All injured workers deemed as candidates deserve a chance to attend a Functional Restoration Program.
5.  All patients, including their representatives and their families, regardless of their cultural, clinical and other demographic diversity, deserve to be treated with respect, dignity and compassion.
6. All patients and related entities should receive the highest quality care and excellent customer service.
7. Continuous quality improvement practices are necessary to achieve optimal outcomes.
8. The key to continued success is the integration of a person-centered philosophy in all aspects of the program along with the personnel’s uncompromised commitment to patient service.

The NCFRP motto is… ”Rebuild. Reconnect. Restore.”

Rebuild

At NCFRP, our first goal is to assist patients in rebuilding the life that has been devastated by chronic pain. Patients will develop coping tools to construct a realistic picture of what their life could be with a focus on mind-body wellness, the foundation of the rebuilding process.

• Optimize or reduce medication usage
• Reduce Depression
• Reduce Anxiety
• Reduce Stress
• Utilize effective coping skills and learn to independently manage pain
• Transition into a more self-directed pain management

Reconnect

People with chronic pain frequently feel disconnected from themselves, their bodies and the environment. At the Northern California Functional Restoration Program, we will utilize treatment techniques that help patients reconnect with themselves, family, work and the community.

• Improve capability of employment by increasing tolerance to work activities
• Re-engagement in social, recreational and vocational activities
• Return to Work guidance and resources
• Support systems and family participation

Restore

Once the rebuilding and reconnection processes are instituted, restoring patients to a productive and meaningful life with coping tools to confront the daily challenges of living with chronic pain is our goal. Patient will have increased self-reliance, improved coping skills that promote limited use of medications and medical services.

• Increase ability to perform activities of daily living and work activities
• Improve overall physical functioning
• Reduce utilization of Healthcare System

Chronic Pain Medical Treatment Guidelines MTUS – 8 C.C.R. § 9792.24.2

In 1977, Engel proposed an alternative, the biopsychosocial model, which focuses greater attention on the patient, rather than presumed pathophysiology. The biopsychosocial model approaches pain and disability as a complex interplay of biological, psychological, and social factors. These psychosocial factors can be easily assessed.

Researchers have found evidence that psychosocial variables are strongly linked to the transition from acute to chronic pain disability and that psychosocial variables generally have more impact than biomedical or biomechanical factors on back pain disability. (Linton, 2000) Thus, when clinical progress is insufficient or protracted, the clinician should consider the possibility of delayed recovery and be prepared to address any confounding psychosocial variables.

The Northern California Functional Restoration Program is a comprehensive, inter-disciplinary program intended primarily to correct disability in patients with various diagnoses with demonstrated barriers to recovery including but not limited to de-conditioning, de-motivation, psychological dysfunction, lack of knowledge regarding disease processes, and inadequate tools to regain health and functionality. Our interdisciplinary approach integrates physical therapy, occupational therapy, mind-body medicine, counseling, and education, with vocational rehabilitation or return to work as a goal.

As outlined in the MTUS/Chronic Pain Medical Treatment Guidelines, page 31, there is no one universal definition of what comprises interdisciplinary/multidisciplinary treatment. The most commonly referenced programs have been defined in the following general ways (Stanos, 2006):
(1) Multidisciplinary programs: Involves one or two specialists directing the services of a number of team members, with these specialists often having independent goals.
(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.

There is a reported 50% return to work statistic in chronic pain patients attending an integrated functional restoration program. Patients who have failed multiple therapies, have changed physicians in search of an answer, who continually receive higher and higher amounts or narcotic medications, have lost hope, are depressed, angry and isolated are considered prime candidates for an interdisciplinary program.

“Intensive multidisciplinary rehabilitation with functional restoration is more effective in improving pain and function than outpatient non-multidisciplinary rehabilitation. At 4-month follow-up the median scores in the experimental group were 5.7/10 for pain and 12.1/30 for disability versus 6.9/10 and 16.8/30 in the untreated control group. More impressive was the difference in median number of sick leave days: 10 in the treatment group versus 122 in the no-treatment group.” 

In the study above, even though the median scores on pain and disability were only minimally different, the scores indicate the treated patients are better able to live and work with their pain! A Goal of the Northern California Functional Restoration Program.

• Functional Restoration is a powerful multi-modality treatment consistent with the Chronic Pain Medical Treatment Guidelines (MTUS), which aims to improve the quality of life of chronic pain sufferers
• Research has shown that Functional Restoration Programs can effectively reduce the impact of pain in one’s life as well as restore function
• The principles of functional restoration apply to all conditions in general, and are not limited to injuries or pain
• To date, over 100 studies have been published in the medical literature characterizing the unique benefits of Multi-disciplinary Pain Rehabilitation.
• ACOEM Guidelines, MTUS, ODG
• Treated patients functioning better than 75% of controls
• Benefits persisted over time
• Improved return to work rates (RTWR)
• Decreased use of Health Care

Utilizing a multi-disciplinary approach, patients will learn new skills and coping tools to develop a realistic picture of what their life could be with a focus on mind-body wellness and integration, the foundation of the rebuilding process.

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:

1. a) a negative relationship with the employer/supervisor
2. b) poor work adjustment and satisfaction
3. c) a negative outlook about future employment
4. d) high levels of psychosocial distress (higher pretreatment levels of depression, pain and disability)
5. e) involvement in financial disability disputes
6. f) greater rates of smoking
7. g) increased duration of pre-referral disability time
8. h) higher prevalence of opioid use
9. i) elevated pre-treatment levels of pain.