11.2 Bio-psychosocial aspects of health at work

Question 1

Provision of vocational rehabilitation can require input from professionals from many
different disciplines, including medical professionals, disability advisers and career
counsellors.

According to the Vocational Rehabilitation Association (VRA), the techniques used
can include: 12

Answer 1

 assessment and appraisal
 goal setting and intervention planning
 provision of health advice and promotion, in support of returning to work
 support for self-management of health conditions
 career (vocational) counselling
 individual and group counselling focused on facilitating adjustments to the
medical and psychological impact of disability
 case management, referral, and service co-ordination
 programme evaluation and research
 interventions to remove environmental, employment and attitudinal obstacles
 consultation services among multiple parties and regulatory systems
 job analysis, job development and placement services, including assistance with
employment and job accommodations
 the provision of consultation about and access to rehabilitation technology.

Question 2

IOSH’s Good practice guide to rehabilitating people at work makes the following
recommendations:

Answer 2

policy on rehabilitation
line manager’s responsibility
Early intervention is important
regular contact with employees
Rehabilitation should begin at an appropriate stage
Rehabilitation should be considered as soon as it is clear that absence could
be lengthy
co-ordinated case management approach is best
arrange for the employee to
see an occupational health adviser
ask about what the employee can and can’t do
assess whether medical intervention, such as
physiotherapy or counselling, will speed up the rehabilitation process
plan a programme of
rehabilitation
make reasonable adjustments
consider any health and safety issues
agree the arrangements for
rehabilitation, and record them
progress should be monitored regularly
agree any significant changes to the employee’s role
with the occupational health adviser or employee’s GP or specialist

Question 3

In 1977 George Engel critiqued the prevailing reductionist biomedical model of
medicine that suggests every disease process can be explained in terms of an
underlying deviation from normal function, such as a pathogen, genetic or
developmental abnormality, or injury; and proposed a new holistic alternative - the
bio-psychosocial model.

In his critique of the biomedical model Engel noted that: 4

Answer 3

 Biochemical alterations do not necessarily translate directly into an illness and
psychological alteration may, under certain circumstances, manifest as illnesses.
 Psychosocial variables are more important determinants of susceptibility,
severity, and illness than had been previously appreciated.
 The success of the most biological of treatments is influenced by psychosocial
factors, for example: the placebo effect.
 Patients are profoundly influenced by the way in which they are studied, and the
scientists engaged in the study are influenced by their subjects.

Question 4

The bio-psychosocial model

Answer 4

Biological
Psychological
Social

=

Health