Early Matched Case at Australia Post

Justin Pearsall (Facilitator)

I'd now like to hand over to Melanie Ianssen and Lauren to tell us about the Early Matched Care program at Australia Post. Melanie is the National Rehabilitation Manager at Australia Post and is a psychologist by background. She has over 20 years' experience working in injury management, including occupational rehabilitation, insurance and self-insurance roles. Melanie is passionate about promoting the health benefits of good work and improving the mental health outcomes for injured workers. Lauren is a Senior Workplace Rehabilitation Provider in Australia Post's Rehabilitation Team. Lauren has a background as an exercise physiologist and was a key driver in the EMCAP study at Australia Post. Thank you both for being with us today. We're excited to hear about what APG has found and achieved with this new evidence-based model of early intervention. Over to you, Melanie and Lauren Morgan.

Melanie Ianssen

Thank you, Justin, and thank you Comcare for having us here today. Lauren and I are really excited to step you through the Early Matched Care at Australia Post Study, which we'll call EMCAP from here on. What I'd first like to do is just introduce you a little bit to the rehabilitation team at Australia Post. So, we've got 40 workplace rehab providers that work internally to provide services to our 34,000 employees across Australia. We have to cover every major city and every little regional town in Australia that's got a postie, so we need to make sure that any programs we roll out have the ability to have some consistency from our colleagues in metro areas and in those more rural and remote areas. We've got 481 facilities nationally, and we open around 1,200 new rehab cases each year. By really having an internal team, we're able to hit around 95 percent return to work rate for our injured colleagues.

Now, just by way of introduction to how we really got to looking at this EMCAP study, it really started with us looking at our most expensive, high-cost claims. And the claims that you'll all know really well are the ones that we spend about 80 percent of our time on. And the question we asked ourselves was if we'd known a lot of what we know about this case right at the beginning, what could we potentially have done differently to influence the outcomes for our injured colleagues? A really interesting thing we found, going through these cases is that for the vast majority of people, there was a substantial mental health component to the reasons why we were having poor outcomes. For most of them, they were physical claims to start with, but really, by the time we reviewed them, the primary return to work barrier had really been identified as mental health, and that that had really overshot the physical injury as the primary return to work barrier.

And really, the thing we challenged ourselves to look at was, first of all, that's just not good enough for our injured workers. It's not good enough that if you go on to have a long-term case that it's nearly a given that you're going to have poor mental health outcomes. But also then looking at the implications that has for our operations as far as lost time, but also the impact that that has on incapacity costs and on the provisions. So, what we really wanted to do was look at what we could do differently in that space to try to improve outcomes for those three key areas. So, we had a look at the different jurisdictions and what was happening, and we came across Professor Nicholas, who'd done an interesting study with icare and The Department of Health in New South Wales, looking at – they called it the WISE study. Basically, we were looking at early screening of mental health to try and look at some predictors around who was likely to fall in that complex case cohort. As part of that research, we ended up partnering with the University of Sydney and we brought Professor Nicholas on board as well, to try to take that concept of early intervention a step further than the WISE study had done.

We really leveraged the national component of our business and split the country into two cohorts. We had our control states, which were New South Wales and Queensland, and then, we allocated Victoria, WA, SA and Tasmania as our intervention states. So really, what the protocol looked at was as part of our initial needs assessment, which is done within five days of an injury, that we started to administer the Orebro Pain Screening Questionnaire, which I'm sure a lot of you are already familiar with, which is a series of 10 questions. It only takes a minute or so to administer, and we administered that face-to-face wherever possible with the injured workers. And although the research has shown that a score of around 48 out of 100 is indicative of someone starting to fall into that high-risk group. So, that's how we screen people, 48 or higher was consider a high-risk score. And then, they were put into the EMCAP protocol.

In the control states, we did have a blind study, so once the injured colleague filled in the Orebro, it went into an envelope and got sent off to the study group, so that the workplace rehab providers in those states didn't actually know whether their cases had fallen into that high-risk category or not. In the intervention states, what we did is we partnered, and what we really tried to do was leverage off our existing employee assistance program. So, we had to work, obviously, within a budget, and what we wanted to do was use some of that existing service agreements and not actually set up a whole new support system for our injured workers. And so, we worked with Converge, who are our EAP provider, and we put together a smaller cohort of their counsellors, who either had a background in occupational rehab or occupational medicine or had an interest in that area. And we provided them with additional specialist training by a clinical psychologist, just really around the health benefits of good work, and how they could potentially assist the rehab process to help reduce the return to work barriers and get people back to work more quickly.

So really, the EMCAP study had two primary strains. One was a counselling component and one was a matched care component. For the counselling component, anybody that scored 48 or above, we referred directly through to one of the specialist counsellors at Converge. They had an initial appointment with them, where they did some additional screening test. And then, after that first session, we had a GP case conference with the counsellor, the workplace provider, the injured worker and the doctor. And during that session, they discussed the return to work barriers that were identified during that first session of counselling. The counselling sessions were six sessions over six weeks, so they had to be one session a week. And so, as soon as they finished one, they would book the next one in. That was a really important part of this protocol, is we didn't want that process to blow out too much. It needed to be one session a week for six weeks.

During that GP case conference, an interesting number of return to work barriers came up. Often, those barriers were personal in nature and really not something that the workplace provider could have much of an impact on. And so, if it was identified, for example, that the injured worker was going through a divorce, then we'd say "that's something that's between you and the counsellor and we will let you go away and have your six sessions. We don't need any further information on that and we'll proceed with normal rehab. There were cases, however, where some interesting barriers were identified. Some common ones were quite a few people were concerned, and this escalated more during COVID, that they had put on weight and how that was impacting their injury. And one example I'll give you is we had injured postie. He had quite a significant knee injury and had been booked in quite early for surgery to repair that knee.

During that first session with the GP, he revealed that over the last year or two, he had put on a substantial amount of weight and that that was really impacting his mental health. From our perspective, he'd actually been taken off the motorbike, because he was over the safe rider limit. And so, he actually wasn't doing his normal job coming in to having the injury. So, what we did for him is we referred him through to a dietician, which is something we probably wouldn't normally do as part of rehab, but because it was identified as a significant return to work barrier, we thought that that was a reasonable investment. Now, over a two-month period, he actually lost over 20 kilos and recovered to the point where the surgery was actually cancelled. He no longer needed the surgery. His injury was completely resolved and we actually got him back on the bike, because he came back under that safe rider limit. So, he actually ended up being better off than he was before he had his injury.

There were really creative cases came through. We had one who was a grandmother who had an upper limb injury and was really quite distressed. The primary hobby she had was crocheting, and she wasn't able to do it anymore, because of her injury, and that was causing her a reasonable level of distress. The OT got quite creative and found an aid that had to come from the UK. It was about $150, it wasn't expensive, and was able to ship that over. And with a few weeks, she was able to resume that with this aid, and actually got back to work quite quickly. So, that really early identification of what those return to work barriers are is really the matched care component of this program. And you can see from the slide here, traditionally, we look at a stepped care medical model, where you pretty much wait for things to get worse. And so, if you rolled your ankle, you'll go see the doctor and he might give you some Panadol. You'll wait a few weeks. If it's not better, you might go for an X-ray. If it's not better from there, you might get sent to a specialist. And so, you've got that sort of slow stepped care medical approach.

What we do with matched care is really bring all of that forward, and say without waiting for things to get worse, let's work in a multidisciplinary approach to see whether we can bring all of those interventions right at the beginning of the process, so see if we can avoid some of the pitfalls later down the track as far as mental health and delayed recovery and return to work. So, it's really what that Matched Care part of EMCAP is, as opposed to the traditional stepped care. So, the two key components to this process, just to recap, really are around one session a week for six weeks, utilising that existing EAP arrangement. From a cost perspective, we covered the actual sessions under our existing EAP arrangement. And then, what rehab paid for over and above was an initial and a final report that was provided through to us. And then, any phone calls, the GP case conference, we paid for that out of a rehab budget. But the actual six one-hour sessions were covered by the existing EAP arrangement that Australia Post has got with Converge.

And then, the other side of it is that matched care. Like I said, the dietician was very popular. Work conditioning programs were really popular as well. And I think that's a good example of something that we would usually push to the middle or to the end of a rehab process. What we tried to do is we had a lot of success with work conditioning programs right at the beginning of the process for this high-risk group rather than waiting for things to not progress or wait for things to get worse. So, I'm going to pass over to my colleague, Lauren, and Lauren is going to cover off the key outcomes from the study. And as I highlighted at the beginning, what we really aim to do with the study is to hit those three key stakeholders for us. And so, we wanted to look at what were the outcomes as far as mental health and mental health outcomes for our injured workers. What was the impact for operations and what improvements could we see there? And then, what was the financial impact on our incapacity costs and our provision? So, I will hand over to you, Lauren.

Lauren Morgan

So, as Mel said today, I'm going to be talking about the statistics that we really found that had come out of this study, that we really were blown away with. I don't think we ever expected what we actually saw, which was really, really exciting. So, what we might do is start with our care aspect, which is really talking about, as Mel said, how we looked after our injured employees at Australia Post. So, what we had with our care is obviously, as you can see in the diagram that we have here, we've got our pre-intervention, which is great, and our post-intervention, which is great. I want to reiterate from what Mel said as well, before we go into it, that these scores were obtained over the six-week period. So, our workers were screened at the Orebro at the time of the INA, and then screened again at the end of the six-week program.

The other screening tools that we used, which was undertaken by the counsellors was the DASS, the brief pain inventory, pain severity and pain catastrophising, which we've broken down with that as well. So, as you can see with the Orebro, or otherwise known as the OMPQ, is we had a 34 percent reduction in the score of the Orebro, which actually brought most of our participants under the at-risk category, which was [unintelligible 00:14:56], so we had an average of 40 after the intervention. With that DASS, you can see that I have broken this down into depression, anxiety and stress, that is assessed in this. Depression is reduced by 46 percent, anxiety 42, and 31 [unintelligible 00:15:14] stressed. We did find that a lot of the depression and anxiety were surrounding the claims process, and we really did find that through this process and having an extra layer of support really reduced those scores quite quickly and made people feel a lot more supported.

With the brief pain inventory, again, that was broken into two different categories. The first one being severity, severity referencing to how someone feels the severity of their injury is. And then, interference, on how much it's interfering with their everyday life and their activities of daily living. So, again, with the severity for the brief pain inventory, we had a 35 percent reduction over that six-week period and a 44 percent reduction with interference, which again was a really great thing that we saw, because obviously people were starting to understand that they could do more with their bodies and really understand their injuries and feel better in themselves. The Pain Self-Efficacy questionnaire, as you can see, the post-intervention is a lot higher than the pre-intervention, which is actually the good thing. So, the higher with Self-Efficacy, the better someone is coping with their injury. So, we had increase of 36 percent on that, and then, a decrease in 26 percent for our pain catastrophising, which again really highlighted that people were understanding their injuries a lot better at the end of their time with Converge. And really embracing the process and feeling more comfortable in them moving forward.

So, the next one we have from there is looking at our capabilities. So, capabilities again is referring to how productive someone is within the workplace and how often they are there. So, with here, again, we've got the orange as the control group and maroon is the invention group. You can see at the start of the process, which is we'd run the exact same process for the intervention and the control group. But there wasn't as much difference for us returning people to work, I think because we get involved so early on cases anyway, and that's always been a process of ours. So, there was still a 15 percent reduction and we were getting people back to work slightly quicker in the intervention group.

Our return to full hours though is when we really started to see the difference. So, a return to full hours from their date of injury, so the day that they were injured, we had a 40 percent reduction, which was the equivalent to 45 days we were getting people back to their full hours. And then, again from the actual date of any return to work, we had a 54-day reduction there as well. So, we were really moving people through this process a lot quicker. They were getting back to work, they were being productive in their workplace, they were around friends. And really, having normality again, which I think that we find is one of the greatest barriers that we find in return to work. People feel lost and they don't have the social network that a lot of people have at work. So, we really saw that increase and it was unbelievable to see the difference. We definitely didn't expect it to be that different.

And then, finally, what we'll look at under our capability and cost is our cost. Again, we definitely did not expect such a significant reduction, but after seeing how people are getting people back to their full hours, this made sense when we started seeing the difference with the reduction incapacity costs. So, between the control and intervention, we had a 34 percent reduction in capacity cost. So, it was equivalent to close enough to $3,000 on average over all the claims. And then, in turn with that, which again we didn't expect, was the 17 percent reduction in medical costs. We found that people were coping again with their injuries a lot better, because as we all know, return to work and recovery of return at work is really important. And people were really transitioning into that self-management a lot quicker than what we anticipated, bringing down those medical costs, which was fabulous to see.

What I'll go through next is a little bit more of the overview of what we actually saw generally and how many people we actually saw going through this program. So, over the intervention and the control groups, we screened over 438 people. In the intervention group, we had 178 of them and 280 of them were sitting in the control group. Fortunately, in the intervention group, we had 62 percent of those people who were scoring over on the Orebro, and again, that was 48 and above. And 56 percent of those were scoring over in the control group. What we found really, really interesting again is that both the control and intervention groups have very similar numbers of people who had gone through surgical procedures, being 20 percent for the control and 21 percent of the intervention. When we reflect that back on the wide study is that anyone who was having surgery was completely eliminated from their study. So, for us to see there we had very similar people that we were looking at and situations, we were still getting quite a significant program improvement in their return to work.

Again, the other thing we saw was that an average of 59 out of 100 with our scoring on the Orebro, which was again quite high. We didn't see that happening. We thought it would have really been the low 50s, but it really gave us the indication that we had our ideas in the right space and we were really spending our time in the right space to look after the mental health of our injured employees. On average, people only had five counselling sessions, and then, the primary presenting issue was another really useful statistic that we had. So, we found that 34 percent of our workers were actually having problems with chronic pain prior to having an injury and going into this program. So, it really gave us an opportunity to assess and work through things that had been happening on the past, as well as their recent injury as well. So, we just couldn't believe it. And I guess we have got an ageing workforce in Australia Post, so it shouldn't have been that unexpected. But it was great that these people were able to get that assistance with the speciality that we were getting from the counsellors at Converge.

The last part of today that I'm going through as well is really what we found in regards to our key learnings from the project. The first one that I want to go through is talking about our training and engagement. When we're talking about training and engagement, we did find that the initial stages, toward January and February, that we were having trouble getting people from that conversation of "look, you've scored over the Orebro," to actually transitioning them into working with Converge. I think what we put this down to is, unfortunately, there is still such a stigma around mental health and obtaining mental health. So, it was really something that we wanted to work on and really make people feel comfortable to be able to participate in this. So, we invested in our workplace rehab providers at that point. We got them to undertake motivational interviewing and really hone in their skills on how to have certain conversations and really understand how people tick and what really gets them to get involved.

The other aspect that we did do as well for the intervention group is we got a clinical psychologist to come in and have a discussion with our team. And talk about how best to approach these conversations around mental health and receiving help without it being confronting or anything like that. So, a lot of the time, we just altered our wording slightly to what we were using anyway, and it really made a significant difference with how that moved forward. So, when I talked about altered wording, the couple of things that really came across was we really used the word "consultant" or someone who can assist you with workplace matters, rather than focusing on the counsellor. As soon as we found that the counsellor was brought into a conversation, a lot of people would really put those barriers up and didn't want to discuss any further with us.

The other thing that we really found useful as well was using the Orebro and the scores from the Orebro. And I think Mel's always said this perfectly. If the people are telling us a score, they are telling us if they're not coping. And especially for those of you who are familiar with the Orebro, there's a lot of questions in there around depression, anxiety, as well as chronic pain and how they understand their pain. So, with those questions in particular, we were able to use them to really get our injured colleagues to open up. So, for example, we'd be like "look, let's have a chat about your score of anxiety. I can see you've scored an 8 on anxiety. Let's have a chat about that." Literally getting them to open up and understand, so then we go "look, we really think that you could benefit from this program and someone who specialises in that area." So, just those little tweaks really made a significant difference.

The next one that we found really important, which we've already known, is collaboration. Generally, our collaboration has always been our collaboration with our workplace managers, as well as compensation. But in a situation like this, in a program like this, your collaboration opens so much more than what we ever expected. So, that's obviously including the worker, including the GP, including their treaters, including the psychologist. And what we really took with this was an element of no surprise pathway. So, really including our injured colleague in all of these conversations, making sure that they were across the decision-making process and really open to what we were offering or what we wanted for them. The other communication that we found really significant was that communication between the counsellor and our workplace rehab providers. That really helped to change the perspective on mental health and how the rehab process works, and really made a significant difference on many of our claims.

The next one we had was our early engagement of our general practitioners. Again, for all those who have worked in OR in the past, sometimes our GPs can be quite sceptical. You go into a GP case conference and they're "no, no, no," and a lot of the time, they don't want to work with us technically. We're pushing their workers back to work without understanding what was going on. The benefit with this is we were able to get in front of them and present them something completely different and really understand what was going on. We provided them with education pieces before we went in, which was through letters, as well as the reports that we've gotten from Converge. And then, also gave them an education piece at the start of the GP case conference, with really open, clear goals. And the change that we saw in GPs was amazing. The GPs really started to collaborate with us, wanting to move forward, and really encouraged their workers to want to be involved in this process, which was amazing to see.

The next one we had was adapting to telehealth. As Mel touched on before again, unfortunately, we were thrown in the deep end with this one. We definitely didn't expect it. We wanted this to be a face-to-face service, and being Victoria was one of our main intervention states and Victoria was in such a hard lockdown last year, we had to adapt and we had to adapt quickly. We did that by working with workplace managers, educating our WRPs again, trying to educate our workers the best we can and then, working with Converge, making sure that they knew the correct links and understanding how to use the computers and really engaging that process. I think that if we didn't adapt to telehealth the way that we did, we wouldn't have had the outcomes the way that we did. It really hasn't affected how we've moved forward with the program, which was absolutely amazing.

The last one for this small part is the identification of additional services. Going into this program, we knew that we wanted to make sure we really worked on that matched care aspect, but we had no idea what services that was going to entail. So, early on in the process, we did a lot of monitoring and looking at patterns and what worked and what didn't and what really gave positive impacts to every individual case. As Mel again had touched on earlier, is that our work conditioning and dietetics was our most important and most popular two services that we really engaged. And then, obviously, what we did from there was we built relationships with two companies in particular, that we could understand the scope of EMCAP and really help to continue to move things forward for us there.

The other thing that we always kept at the front of our mind when we were working on this is what could we put in place for our injured colleagues that could impact them immediately. There may not be the traditional OR costings without impacting our costs significantly. As you could see here, on average, we really only spent $400 extra per case, and we had 60 percent of those workers really only needing counselling. So, a lot of them weren't as complex as what you'd think. And obviously 40 percent of them, we did put additional services in place. But it just made a significant difference and we had everything moving.

And again, the only thing I could stress with this enough is that we were trying to really identify those services that can make a really quick impact and really relieve the stress from people. For example, we did, for a couple of people, use once-off gardening. They may have just had an injury, might have just strained their elbow, and it was putting a lot of pressure on their relationships at home. So, we gave them a once-off gardening service that they could maintain after that. So, it was really an interesting experience. I'm very excited that it is now part of our business as usual. But I'll hand over back to Mel to finish up for everyone.

Melanie Ianssen

Thanks, Lauren. So, look, really just to wrap up, this has been a really exciting process for us. We ran the formal study over 18 months, and that finished in March in this year. So, we have now rolled this protocol out nationally, and we've even had some threads of interest from different journals and different speaking engagements. And it's interesting, because I think for all of you on this call, nothing we're doing is particularly revolutionary. Like, the services we're talking about and looking after people's mental health, a lot of this is pretty business as usual in the OR space. I think for me, the really exciting thing was looking at the timing of when we do these things and looking for that screening around mental health.

They're really the two things. As Lauren's gone through with the outcomes, in a six-week period, so really not a lot of additional monetary investment, there was a huge improvement for our injured workers. And I always think if we've taken really great care of our injured workers, then those financial benefits and the benefits to operations really just come without having to focus too much on cost reduction. If you're taking care of the individual, those things tend to come along pretty easily afterwards. We are also really keen with this protocol to give something back to the scheme. And so, we wanted to make sure that whatever we did was really scalable. And so, you certainly don't have to be the size of Australia Post to be able to put this in place. I think most companies would have an EAP arrangement in place. And being able to slightly tweak that and be able to make it more useful in the rehabilitation space is something that can be done relatively easily.

What we're really hoping to do, moving forward with this now, apart from integrating this into our business as usual, is that one statistic that Lauren talked about around 34 percent of people identified a chronic pain issue as the primary reason that they needed counselling, that was a real wake-up call for us around "wow, if we're finding this in this small cohort, how big an issue is this for us as a company?" And so, what we really want to do now is take EMCAP more into the preventative space. And so, what we're working on at the moment is putting together a chronic pain training program. So, we've got seven modules and we're looking at putting seven videos together and potentially using the pain catastrophising, where we do a pre and post-test. And we put anyone who's got any sort of chronic pain issues, so not even people that are just in the workers’ comp, but really anyone in our whole company that might be suffering from chronic pain, is to put some sort of education program together for them.

What difference may that have, if they go on to have an injury, if they've got those coping skills, could it potentially prevent injuries from happening or make that experience a bit better? That's probably next step for us, to see whether we can evolve that into the prevention space. So, thanks everyone for your time. We've got just a quick video that summarises the EMCAP program. Happy to take questions. Really, really happy if you've got any questions around how you might be able to apply this to your organisation. Lauren and I would be more than happy to answer questions in this forum or for people to reach out to us after the session today.

Voiceover

Every day at Australia Post, over 80,000 employees and extended workforce deliver mail, parcels and other services right across the country, rain, hail or shine. The health and safety of our people is our foremost priority. Work-related injuries can present challenges from both a physical and mental health perspective. Australia Post wanted to find a way to identify psychological risk factors early in an injury to ensure a safe, timely and supported recovery. So, we've created EMCAP, the Early Matched Care of Australia Post study, which is designed to support and improve outcomes for our Australia Post employees injured at work. Our purpose was to create an industry leading practice and evidence-based model to contribute to the scheme through a scalable and accessible protocol that delivers positive, economic and health outcomes.

Developed in collaboration with leading researchers at the University of Sydney, along with support from injury management and operations, the project was implemented in six states across Australia. The COVID pandemic was a challenging time for us all, yet through these hardships, the EMCAP study saw success in maintaining comprehensive engagement with workers injured at work, providing them with continued support and care in their recovery. Since the project launch, our early intervention initiative has significantly improved return to work outcomes right across Australia Post. It has assisted with early identification and management of psychosocial risk factors and resulted in reduced incidences of psychological distress. The EMCAP project will continue to be a valuable tool in reducing the cost of workplace injuries, whilst supporting the wellbeing of our injured colleagues in their return to work journey. We are proud to share it with you.

Justin Pearsall

Melanie and Lauren, thank you so much for your presentation today. It was great to hear more about the EMCAP program and the success that it has had in supporting employees at Australia Post. Also, I really appreciated hearing the details on the psychological barriers that many injured employees are facing. That Australia Post experience here is certainly similar to what we're seeing across the Comcare scheme where the complexity of claim is increasing and case managers and employers are needing to act earlier and look at more innovating and collaborative solutions to help people to recover and to get back to work as well. We've seen a lot of interest on the presentation and some questions and comments coming through. One question I have is about the employee experience of the program. What have employees said about EMCAP?

Melanie Ianssen

There was a really interesting part of this for me around employees. The percentage of employees that scored over that chose not to participate, and a lot of them came back to us and said even though they scored over, they so appreciated us checking in on their mental health. The actual impact of just doing the screening was enough to bring some of those scores down, and so, I think some of those mental health outcomes are quite obvious and that was quite clear from the six weeks. But even just being asked how they were doing, in the form of doing the Orebro, opened up a conversation that they might not have normally had with their workplace provider. So, I thought that was really fascinating, that sometimes it just is asking that question. And even some people came back and said "actually, I didn't even realise how anxious I was about this," while they're waiting for their claim to be determined. And just really by us caring enough to screen, that actually had a significant impact on a cohort of people, which I found really, really interesting.

Justin Pearsall

Absolutely. No, thanks Mel. Thanks for that detail there. Another question we've had come through is around workload with the program and did the EMCAP program create more work for the case managers and WRPs at Australia Post?

Melanie Ianssen

I'll throw that one to Lauren, because as well as managing this process for us, she also had a case load and was managing some of the EMCAP cases.

Lauren Morgan

Thank you. Look, it was a little bit more work than what traditionally we would have done in the past. But from all of our other colleagues, as well as myself, is you found that by doing that little bit of extra work in the beginning, by arranging your conversations with Converge and the counsellor, as well as the GP, really changed the direction in which the claims were going anyway. So, by putting the harder work in at the beginning, we really started to reap the benefits, moving down the claim, and how it was set up. So, yes, it was a little bit heavier than what we had been used to, but it wasn't anything unmanageable, and it definitely made the case management a lot easier down the track.

Justin Pearsall

Thanks, Lauren. Really appreciate that response. We're seeing a theme of questions coming through here a little bit about engagement with the EAP provider and with the practitioner as well. And how best to make that work and whether you saw any resistance. Could you speak a little bit to that one as well, please?

Lauren Morgan

No worries. Mel, I'm hoping that you're OK with me taking this one as well. Surprisingly, we really didn't have any resistance at all from the GP and their treaters. Luckily, we do have a work ready program that's in place at Australia Post and we do have a lot of uptake there. So, our GPs are quite versed in working with our WRPs. But even those workers that were seeing their own GPs outside of that, we really found that that was fine and they were happy to engage. In regards to the confidentiality between that, we did have a waiver. Well, not a waiver, like an authority and consent, that the workers had to sign to allow us to discuss any of their work-related conditions with the counsellor. And with the understanding that there would be themes shared with us, without a lot of detail. So, they had full informed consent with those conversations that were going on.

Justin Pearsall

Thanks, Lauren. Really appreciate that. And thank you to everyone who sent in questions there. They are just flooding in now, which is great. I am conscious of time for the forum and four our Australia Post colleagues as well. What we'll do is we'll make sure to include these questions into the post-event pack. But once again, Mel and Lauren, thank you so much for your time today and talking us through the EMPAC program. We really appreciate it.

Melanie Ianssen

Pleasure. Thank you.