Courses A-D Flashcards
No matter what the type of disability incurred or if its severe – temporary or ongoing many people”
(1) Are away from work longer than is necessary
(2) Never RTW even though they could be productive if the working conditions were modified
(3) RTW and leave again because they cannot immediately keep up with the demands of their old job after a period of inactivity
(4) Leave work because of a disability that could have been prevented if the workplace culture, policies and procedures facilitated ergonomic improvements or job modification.
The cost of absence for individuals
Lost income and lost careers
The cost of absences for organizations
Experience high premiums, lost productivity and increased recruitment costs
The cost of absences for society
Cost of social programs for people who – under the right conditions – could be productively employed and paying taxes.
SWOT stands for…
Strengths, weaknesses, opportunities and threats
What is a needs assessment?”
A process in which the understandings of a range of stakeholders are collected and synthesized as to what is currently happening, what could happen, and what is needed to bridge the gap.
What should a needs assessment” review entail?”
Identify the current processes that are followed when an employee incurs a significant injury or illness as well as components that could be added to create an effective program.
A needs assessment” shapes..”
the design of a new program and the implementation process including the development of policies and procedures relating RTW – or the improvement of an existing program.
What is a Program Logic Model?”
identifies the outcomes that the program has been or will be established to meet and then works back from that point to outline in graphic form the assumptions and context underlying the goals, inputs (resources and investments), and the activities and people that are needed to realize the outcome.
Developing a program logic model” can be very helpful when….”
it comes time to evaluate a program because it provides a focus on intended outcomes as well as the activities and resources that were designed to produce those outcomes.
Gensy et al (2012)
Recovery tends to be faster and the likelihood of returning to work is increased if people come back to the workplace as soon as medically feasible, with modified activities in which there is no risk of re–injury as they heal.
Definition of impairment”
any loss or abnormality of psychological, physiological, or anatomical structure or function.
Definition of disability”
When a limitation restricts the ability to perform normal activities – one of which is work.
Difference between impairment” and “disability” (provide an example)”
If an individuals’ hearing becomes less acute with age, that is an impairment. However, that person is not considered work disabled if a hearing aid enables her to answer customers’ questions – if that is a job activity.
World Health Organization (WHO) views functioning and disability as….
A dynamic interaction between health conditions and contextual factors, both personal and environmental.
Disability is seen as continuum…
In which limitations are thought of as more or less and not as existing or not existing.
The Biomedical Model (Disability)
Disability results from a medical condition and involves a deviation from normal anatomical and physiological characteristics and function.
Example of the Biomedical Model
Service providers would consider aspects of the vision such as visual acuity, focus and depth perception.
Who is more likely to use the Biomedical Model?
Insurance companies – to determine whether or not someone is able to work or is entitled to have income replaced.
Biopsychosocial Perspective (Disability)
Disability is explored from various points of view including the effects of illness and injury on the body and mind, the demands of the environment in which an individual operates, the economic and community resources available to that person, and the viewpoints and judgements of the people in the society in which the individual lives.
The main characteristic of the biopsychosocial perspective:
The environment is considered to play a central role in either enabling or disabling a person with an impairment.
What is the most commonly applied approach to Disability and RTW
The biopsychosocial perspective
Social Construction Theory (Disability)
Regards impairment as an individual difference similar to gender, religion or ethic origin and posts that the negative implications of having an impairment is the way in which societal attitudes and values create disabling barriers to participation.
Example of Social Construction Theory
A young person with very thick large glasses might be discouraged from participating in sport activities even though their glasses corrected their vision to a normal range.
Vocational Rehabilitation Professional
Assist a person to gain skills to re–enter the workforce to a more suitable occupation.
Definition of Disability Management
The process in the workplace designed to facilitate the employment of persons with a disability through a coordinated effort and taking into account individual needs, work environment, enterprise needs and legal responsibilities.
Individual–focused disability management practices
Development and implementation of RTW plans
Organization–focused disability management practices
Analysis of trends, cost benefit analysis, policies and procedures
Society–focused disability management practices
Establishment of policies that protect workers, decrease accidents, and lower costs to taxpayers.
While working in the field of disability management, an individual must…
be knowledgeable about related areas including injury prevention and health promotion, and compensation and benefits
RTW activities involve ensuring that…
The appropriate assessments have occurred and that those who are completing the assessment – whether GP, physical or occupational therapists – have enough job information so that they can determine whether the employee can safely RTW and under what conditions.
RTW activities involve identifying…
barriers to RTW and identifying services that could decrease the impact of such barriers.
RTW activities involve developing…
a RTW plan in conjunction with the appropriate people
RTW activities involve implementing….
The plan – ensuring that equipment, renovations, job modifications, or training are in place.
RTW activities involve monitoring…
and adapting the plan as required.
RTW activities involve evaluating….
The process.
An effective DM program incorporates an…
Integrated approach to the protection of workers’ health, the promotion of workplace wellbeing and the provision of support and assistance of job retention and RTW.
Primary, Secondary and Tertiary Prevention
Liaising with related programs of of occupational health and safety and wellness or health promotion to create a continuum of interventions aimed at creating a more health and productive workforce.
What is one of the best ways to reduce / decrease disability costs?
Prevention of accident and injuries through occupational health and safety programs and to encourage activities that enhance health through wellness promotion programs.
Post–screening
Some organizations will do these assessments to ensure that the individual who has been offered a job has the physical ability to carry out the job tasks outlined in the job description.
Harder and Scott, 2005
The post–screening process lowers the level of injuries requiring significant physical activity
Four types of compensation for disability
(1) Workers compensation or government insurance for occupational injuries/illnesses
(2) LTD and STD
(3) Automobile insurance
(4) Government programs such as sickness benefits, pension plan disability and social assistance.
Compensation in Canada and USA
Workers who are injured as a result of work activities are entitled to workers’ compensation through insurance premiums paid by their employers
Compensation in UK and Ireland
Occupational injuries are compensated with government payments and funded through taxes.
A 20 year old worker has a…
3 in 10 change of incurring a disability before retirement age.
Mental health & Labour trends
The presence of a mental health condition reduces labour force participation from 80% to 39% – and for those who continue working resulted in an average reduction in wages for men of 4.7 % and for women 3.1%
New Zealand & Mental Health
More than 40% of the people on sickness benefits were entitled to it because of the psychological and psychiatric conditions, with the second most condition reason being musculoskeletal disorders, including sore backs and necks.
Disabilities with a psychological component are becoming…
More costly to organizations, including depression and anxiety–related disabilities, chronic fatigue syndrome and fibromyalgia.
Canadian Workplace & Stress
83% of Canadian employers ranked stress as a top tier risk factor for their workforce.
As baby boomers….
age, there will likely be an increase in the length of disability–related absences since older people require a long period of time to heal.
Correlation between worker compensation claims and individuals who are
45–49, although research indicates that the higher injuries and claims may be associated with older workers are less of a reflection of age and more of poor lifestyle habits and negative working conditions.
Early Contact
Informing the person responsible for disability management that a worker has an injury or illness. Contacting workers shortly after the absence.
Goal of Early Contact
To make sure that employees receive the treatment that they need, are aware of the benefits and entitlements, understand that their co–workers care about what happens to them, and are able to focus on RTW if their situation allows.
Importance of Informal Contact
Helping the individual to retain a relationship with the workplace.
Employers should be sensitive with informal contact as…
An employee may believe that the workplace rep is checking up on her and trying to persuade the RTW before she/he is ready and the call may cause anxiety.
Early Intervention is important as…
a number of studies indicate that the longer someone is away from work, the less likely they are to return.
Australian study of workers compensation indicated that…
50% of people who were absent from the workplace for as long as three months would RTW. That figure declined to 25% that lasted a year to 12% after two years and 4% after four years.
Cost of replacing and training skilled workers
…can run into the thousands of dollars.
Early intervention involves…
any activities that are designed to prepare the employee for returning (e.g, discussions that focus on how this could happen, assessments, ongoing rehab) or arrangements that bring the employee back to the workplace even if they cannot return to work immediately.
The goal of Early Intervention
Employees with an impairment will continue to think of themselves as people who can carry out workplace activities and be productive and that they will retain their sense of being part of the workplace community.
Examples of Early Intervention
Modifying the job / job activities, making ergonomic adjustments, allow shorter hours, adding assistive devices
Avoid light duty ghettos”
Situations in which employees are assigned to work which may not be meaningful or contribute to the productivity of the organization and are then forgotten about.
Both labour and management can…
Provide useful perspectives on work processes, corporate culture and barriers that decrease the likelihood of a RTW.
Many labour–management agreements contain…
Language and provisions about disability management.
Most people are better off financially….
Over time if they are working rather than receiving insurance payments. There is also a cost to society when people do not have wage income.
Every dollar earned in BC…
80 cents was spent to defray arising from disability – whether directly through program expenditures or indirectly through non reimbursed personal expenditures and personal/family income loss.
On an individual basis, the costs of not returning to work can be extremely high, which is why…
So many unions actively support RTW.
Employees who do not return to work are considered by the insurer to be employable in another job….
and lose their coverage – if they cannot then persuade another employer to hire them and are forced on to social assistance – the economic losses for that same 35 year old worker would rise to 800k.
Whether viewed from a societal, business or individual perspective…
It is desirable that people remain productive and retain their jobs and wage income. If insurance payments are not available or are time–limited, many people with disability are forced to depend on some kind of social assistance.
Workers’ compensation legislation requires
Organizations that employ 20 or more people to accommodate a worker who has been employed for two years if the employee with the impairment can RTW within a two year period.
Americans with Disabilities Act (1990)
Applies to employers with fifteen or more and requires them to provide an equal opportunity to benefit from the full range of employment–related opportunities available to others,” it “protects qualifies individuals with disabilities” against employment discrimination.”
(US) Employees who believe that they have not received reasonable accommodation can make a complaint to the…
Federal Employment Opportunity Commission or designated state humans right.
Rehabilitation Act (US)
Requires affirmation and non–discrimination among employers with government contracts or those who are receiving financial assistance from the federal government.
The Equal Pay and Age Discrimination Age (US)
influences requirements for accommodating people with disabilities
(UK) The Disability Discrimination Act
Prohibits employers from treating employees with disabilities in a less favourable way than they would treat employees without disabilities. Employers are required to make reasonable adjustments that will allow an employee with a disability to work or continue to working.
Occupational Health & Safety Acts
govern the actions that organizations must take in response to actual and potential accidents.
Freedom of Information & Privacy laws
Regulate what kind of health information may be received by a company without written permission from the employee.
Disability management committees may be formed…
by formal establishment, multi–level, labour–management that will continue on once the program is implemented or simply a representative group whose role is to get the program started.
The needs or situational assessment will provide information on…the current situation
the processes being followed and the outcomes being obtained
The needs or situational assessment will provide information on…the desired situation
how the organization would like the disability issues and RTW to be handled and the results they would like to obtain through a disability management program
The needs or situational assessment will provide information on…goals and objectives
Met over a period of time – such as targets for decreasing the length of absences of returning workers who have experienced injuries, illnesses or chronic conditions
The needs or situational assessment will provide information on…the budget
Funds and other support required.
The implementation plan of the needs assessment will identify
(1) the tasks to be carried out by employees who are hired or assigned to DM responsibilities
(2) the ongoing role of the joint committee
(3) desirable policies and procedures
(4) program standards and qualifications of staff.
In a unionized organization, general principles relating to the disability management process may be outlined in…
A letter of intent
Letter of Intent
Provides a brief program framework and may include statements, the role of joint committees, program eligibility, RTW processes, any limitations.
SWOT
Stands for strengths, weaknesses, opportunities, and threats.
SWOT analysis can be…
External or internal.
The SWOT process allows…
People who are involved with a disability management program to consider the environment in which the program is or will be operating.
The SWOT analysis can be
Generally informal; it may involve a small group brainstorming activity that sets the stage for a needs assessment and development of a program logic model.
The advantage of someone internal performing the needs assessment
They are familiar with the workplace and organizational culture and they know where the information needed can be obtained.
The advantage of someone external performing the needs assessment
They may be seen as objective and without preconceptions; they may not be diverted by the time pressures of other responsibilities within the company.
Much of the information for the needs analysis or program review can be obtained through:
Interviewing a rep of stakeholders, collecting data and statistics, reviewing documents (policy and procedures), visiting or researching other organizations or sources when additional ideas are needed about what could be put in place.
People to interview as stakeholders for the needs analysis
Human resources personnel, safety managers, occupational nurse, benefits administer, union officers, supervisors, potential users of the program.
People to interview as external reps for the needs analysis
Organizations providing insurance
Medical and rehab providers
Disability management staff
RTW Coordinators are..
Trained professionals who believe at an intellectual and emotional level that everyone has a contribution and who are committed to helping the people they work with make that contribution in the workplace if at all possible.
RTW Coordinators act as a…
Central point for the returning work, service providers, management, supervisor, health & safety representatives, shop steward, work representatives and others who will be involved in the process.
The RTW Coordinators are NOT…
directly involved in claims management, this is mainly an administrative process and aimed at settling a claim
RTW Coordinators must have…
Excellent communication skills, they must be able to explain constraints by legislation, insurance contracts or collective agreements, while acting as an advocate for the employee.
RTW Programs have policies that outline a hierarchy of RTW options…
beginning with the least complex – RTW to the same job OR retraining for a new career.
RTW coordination involves ensuring that
The right services and supports are provided at the appropriate time by qualified people.
The RTW process can be conceptualized as involving two major activities
Accommodation
Service Coordination
Accommodation
Includes steps taken to adapt the work environment so that it fits the physical, intellectual and psychosocial capabilities of the returning worker.
Service Coordination
A form of case management that can be described as identifying and making available services that will assist the worker in RTW – and many of these services may be aimed at stabilizing personal as well as work life.
What are the steps in the RTW process
(1) support with treatment and rehab
(2) assistance with information and how to obtain compensation and benefits if required
(3) pre–return assessment that indicates what tasks an employee can/cannot do
(4) developing the RTW plan
(5) implementation of the plan
(6) monitoring and adapting the plan
(7) evaluation
RTW Coordination and Awareness of Services
The RTW coordinator should be aware of the range of services available in the community and be able to provide information to the worker without harming the doctor–patient relationship.
Second Medical Opinion
In some cases, company policy requires an employee to obtain one in certain circumstances.
The main types of interventions – in addition to prompt and appropriate medical care –– that can assist with building work capacity is…
Occupational Therapy
Physiotherapy
Work Hardening
Counselling
Stress Management Skills Training
Pain Management
RTWC & Assistance with Benefits
The RTWC should be available to provide information or facilitate the process. Claims can be rejected for reasons ranging from forms not being filled out correctly. They should also know about LTD/STD, and government benefits.
RTWC and Insurers (When a Claim is Denied)
The RTWC may need to engage with a claims manager on behalf of the worker but must try to avoid becoming involved in the claims management process and the determination of eligibility.
Jurisprudence in most countries suggest that…
The organization needs only the amount of information that is necessary to plan, implement and monitor the RTW.
Privacy laws prevent…
Doctors and medical practitioners from providing a DX or specific information unless written authorization is offered.
In many cases a RTWC does not need to know the…
DX – only an indication from the doctor about the person’s limitations and restrictions and ideally some advice about the activities that they can carry out.
To ensure that an employee’s doctor understands the RTW program and what can be done, most RTW programs have developed…
Information packages that can be sent to the employees doctor describing the program and outlining the employee’s current job requirements.
In cases where an employer appeals a workers compensation claim as part of the appeal process, the employer..
May actually have access to the claim file.
RTW plans will include information on:
Requirements for ongoing treatment
Support services to be provided
The timing of the return
The accommodation details: Limitations, modifications, AD, and job schedule.
Any retraining
Implementation and progress checks.
Length of the RTW process
Ranges from three weeks to three months, depending on the particular situation.
Accommodations may be temporary or…
Permanent.
In the event that a worker is not able to perform the majority of their pre–injury/illness job tasks but has been medically cleared to return…
A transitional RTW can provide alternate duties to maintain the worker attachment to the workplace.
Graduated RTW
A time limited work opportunity that involves a plan of gradual reintroduction of work hours, work duties or both.
RTW Planning: Monitoring and Adaptation
Involves answering questions, finding out if there any problems, determine whether the person’s health condition is improving, change or adapt elements of the plan.
RTW Planning: Evaluation
Over the time period of the RTW plan is over, the plan should be evaluated.
Evaluating the RTW plan, employees can be asked:
If their condition improved
If they were satisfied with rehab services
They thought the RTW plan had been fully implemented
The plan targets had been met if not – why not
Any problems had occurred throughout the process
Job Accommodation
Is a change to the work environment or job tasks that enables a person with an impairment to participate in workplace activities safely and productively.
Different Types of Accommodation (Transitional)
Transitional work process in which the employee gradually increases number of hours per week or the difficulty of job tasks as he/she gains strength.
Different Types of Accommodation (Modification)
Modifying some tasks temporarily or permanently – possibly using a job bank that includes tasks that can be assigned to an employee with restricted activities.
Different Types of Accommodation (Job Design)
Changing the way that tasks are organized, chucked or shared.
Different Types of Accommodation (Ergonomic Changes)
Such as work station reconfiguration
Different Types of Accommodation (Assistive device/AT)
Talking calculators, telephone adaptation, replacing knobs with handles, and using stools or foot rests
Different Types of Accommodation (Reassignment)
To a vacant position
Hierarchy of Options for RTW
RTW to the same job, same employer
RTW to a different job, same employer
RTW with a different employer
Training for Self–Employment
Refer the worker to vocational assessment services to determine his potential for benefiting from training for self–employment. Review the marketability of skills for self–employment. Provide the worker with entrepreneurial skills.
Transferable work skills
Used when an employee cannot RTW to their job. It typically requests for employee skills, tools/equipment they are familiar with, and what previous education and training has the individual completed.
Barriers to RTW (Individual)
Job dissatisfaction prior to the injury
Prior difficulty performing job tasks
The ability to cope with stress from the job.
Fear of re–injury
Incorrect assessment of their ability to be productive.
Family circumstances
A worker whose spouse is also working and who has taken on the child care responsibilities…
May find that not paying for child care results in a very small reduction in the family income overall, and therefore they aren’t motivated to RTW.
Workers who were unhappy with the response to claims in their workplace…
were found to be 1.5 times as likely not to RTW when compared to those who were satisfied with the processes even when other factors were considered.
Lack of support in the workplace
Lack of skills / training of the part of the person with the disability
Lack of knowledge on the part of the supervisor on how to make accommodations
Attitudes or stereotypes among co–workers and supervisors
Supervisors need to be aware of the costs of having…
Employees away from work including insurance premiums, time spent training replacement workers, and human rights penalties.
Conflicts between the supervisor and a returning employee or performance issues can…
derail a RTW even though they are not the responsibility of the RTW coordinator.
Co–workers may not understand their role in RTW and why it is important
They may not support a RTW if they think they may have to spend time helping the individual with a temporary or permanent impairment, or believe they may have more physically taxing duties added to their own job activities.
RTW Coordination and Their Own Attitudes / Bias
RTWC need to ask themselves if they feel uncomfortable when introduced to someone with a disability…do they treat them differently?
The Six Stages of Grief
Research suggest that people who incur disabilities go through a number of stages including – in no specific order:
Denial
Anger
Depression
Resignation
Acceptance
Action
Overestimating people with disabilities
This problem is compounded by the fact that many individuals overestimate the productivity of someone who has no visible disabilities and underestimate what people with impairments can do in a work environment that fits their capabilities
Shop Steward
For unions
In RTWC, they provide information on how elements of the RTW program fit with the collective agreement
Provide union with union about the RTW plan
Encourage RTW
Contribute to the evaluate of the RTW plan
The Skeletal System
Comprised of the bones and joints
How many bones do humans have?
206
Bones provide structure…
For the body, attachment for the muscles, and produce blood in the marrow located within the centre of the bone.
What is the term for when a bone breaks?
Fracture
Simple fractures
Generally heal well because the bone has a direct blood supply
Why do simple fractures heal so well?
The bone has a direct blood supply
Comminuted fractures
Where the bone is fragmented
Comminuted fractures can take longer to heal as…
It may be difficult to get all the fragments in alignment.
Compound fracture
Bits sticking out through the skin
ORIF
Open Reduction and Internal Fixation
What does the ORIF procedure do?
Surgery to expose the fracture and then metal rods (for large bones) or pins/plates are used to hold the bone fragments in place while healing.
Joints
Hinges between the adjacent bones to allow movement.
To allow a smooth, fiction free movement…
Two bony ends are coverage in the cartilage and enclosed within a capsule that is filled with viscous synovial fluid
Arthritis
Cartilage gets worn down, the fluid becomes too thick and the joint becomes painful and perhaps even inflamed (swollen and warm to the touch).
Joints have…
Ligaments to attach them to one another and hold them in place.
A sprain…
Is a tear in a ligament.
Sprains are often considered less..
Severe than fractures, but a severe pain may take longer to heal a fracture and may require surgery.
Muscles
Work in groups and allow us to move.
Skeletal muscles
Cross one or more joints and help attach the bones. They allow us to move – to reach, to grasp and to stand/walk.
Cardiac muscle
Is responsible for moving blood around the body.
The muscles of the body make up
For about half our weight.
The force of a muscle contraction depends on two factors
How man fibres of muscle there are
How much stimulation the muscle receives from the nervous system
Skeletal muscles
End in tendons, which are the fibrous structures that actually attach to the bones.
Injury to a muscle or tendon is called
A strain, usually caused by overuse. Because muscles have direct blood supply, strains usually heal well, but severe strains may require surgery.
Nervous System
The brain, spinal cord, sensory organs, and all the nerves in the body.
The Central Nervous System
Includes the brain and spinal cord.
Peripheral Nervous System
Organs and nerves
The brain is responsible for…
interpreting sensory information (perception) and thinking.
The brain on an conscious level
Produces electrochemical signals carried by the nerves to control muscles, movements, and so forth.
The brain on the unconscious level
Controls basic homeostatic functions like breathing, heart rate and so forth.
The brain is protected within the skull on a cushion…
of cerebrospinal fluid.
Any interruption of the blood circulation to the brain can cause…
Major disability, and anything that increases pressure within the skull cavity
Brain tissue does not actually heal..but
some function may be regained, particularly in young people, through mechanisms of brain plasticity.
Sensory organs
Eyes, ears, tongue, and noise.
Balance
Is based on sensory organs in the inner ear
Kinaesthesia
Sense of movement that allows us to control our movements very precisely.
Prescycusis
Age related hearing loss
Presbyopia
Age related vision changes.
The spinal cord
Travels within the spinal column, protected by bony rings, and again – cushioned in cerebrospinal fluid – it relays signals between the brain and the peripheral nerves.
Injury to the spinal cord
Can cause paralysis and loss of sensation.
Typical health problems with the spinal cord
Congenital malformation
Injury due to fracture of the spinal bones
Congenital Malformation
Spina bifida
Injury due to fracture of the spinal bones
Spinal cord injury
Nerves are covered in…
Myelin sheath that insulates them.
Myelin
Makes conduction of the impulse faster and preventing dissipation of the impulse before it reached the intended receptor.
Multiple sclerosis
Attacks the myelin sheath
Damaged peripheral nerves
Do not have the potential to regenerate (heal), but this is slow and not guaranteed.
Neuralgia
Inflammation of a nerve – it is painfully acute and may be disabling.
The respiratory system
Includes the lungs and airways to the lungs, plus the muscles involved in breathing
Muscles involved in breathing
Diaphragm and intercostal muscles.
The diaphragm
Is a large muscle that forms an arch above the abdomen, it moves down to create a vacuum in the upper chest cavity, thus sucking in air and up to reduce the vacuum –– allowing exhalation.
The intercostal muscles (between the ribs)
Move the chest bones up and with creating a vacuum. The intercostal muscles are particularly involved in deep breathing, during forced exhalation, or when someone is having trouble breathing.
Typical problems in the respiratory system
Includes infection in the upper/lower respiratory system.
Tuberculosis
A persistent lower respiratory bacterial infection.
Chronic respiratory illnesses
Respiratory allergies
Astma
Chronic obstructive pulmonary disease (COPD)
The cardiovascular system
Includes the heart, blood vessels, and blood.
The heart
pumps the blood through the system, going first to the lungs to pick up oxygen and then through the arteries to the body.
Veins
Rely on gravity and skeletal muscle action to return blood to the heart.
Blood
Carries nutrients, oxygen, hormones and waste products.
Capillaries
Tiny blood vessels that are the point of the exchange with tissues – where nutrients and oxygen are dropped off and waste products –– including carbon monoxide –– are picked up to be taken away.
Red blood cells
Carry oxygen
White cells
Part of the immune system
Platelets
Allow clotting and scab formation
Plasma
The liquid part of the blood that allows it to flow.
Bruise
Hematoma
What is a bruise
It happens when the vessel wall is compressed and blood leaks out.
A cute to an artery
It can be serious or even fatal
Arteries may develop balloon–like sacs
may develop an aneurysm (due to the pressure of pumping blood and developing a balloon–like sac).
Aneurysms can occur…
In the Vena Cava –– the main blood vessel running from the heart to the lungs.
Blood vessels can only develop fatty plaques…
along the inner walls, these plaques compromise circulation, which is particularly serious if they occur in the blood vessels of the heart, lungs or brain.
Thrombus
Blood vessels blocked by a clot
Deep Vein Thrombosis (DVT)
Occurs in the limb.
Hypotension
Low blood pressure
Can cause you to lose consciousness.
Hypertension
High blood pressure
If left untreated, hypertension gradually damages the blood vessels and heart, and it can contribute to stroke.
The Endocrine System
System of all the glands in the human body as well as the hormones they secrete. Together, they operate to control homeostasis which is the healthy and balanced functioning of the body.
The Thyroid Gland
Regulates the body’s metabolic rate and can be hypo (under) and hyper (over) active.
The pancreas
Controls blood glucose levels, and the most prevalent serious disorder associated with the pancreas is diabetes.
Of the 2 million Canadian adults living with disability, roughly…
45% were in the labour force.
Unemployment is higher for persons with disabilities…
and varies by disability.
80% of adults will experience one episode of…
Back pain during their lifetime
Rheumatoid arthritis
one of the more prevalent and disabling forms of arthritis
autoimmune disease where theimmune system attacks the joints, tendons, and bones, causing inflammation anddestruction of these structures
The joints most commonlyaffected by rheumatoid arthritis are?
the fingers, thumb, and the wrists. The course ofrheumatoid arthritis is quite varied, but about half of those with rheumatoid arthritis will develop joint erosion, and a significant portion of these people will have a progressiveand debilitating course. During periods of acute flare, joints become swollen, warm,painful, and red, with a reduced range of movement
One of the major disabling characteristics of rheumatoid arthritis is…
its impact on handfunction. The involvement of feet and toes may make it difficult to find comfortablefootwear
Fatigue is anotherdisabling symptom of rheumatoid arthritis
affecting up to 80% of people with rheumatoidarthritis
Epilepsy
the most common neurological disorder. It isparticularly problematic for workers who must drive, operate machinery, or work atheights, and there are a few occupations closed to those with epilepsy, such as airlinepilot, transport driver, and the military
Brain injury and stroke may result….
in motorproblems, abnormal gait, and problems with both oral and written communication.
Cognitive impairments from brain injury and stroke may include
attention andconcentration, memory (and thus learning), information processing, safety awarenessand judgement, planning and organization, and abstract thinking
Multiple sclerosis is an…
autoimmune disease thatattacks the myelin sheath that surrounds nerves.
There are various sub–types of multiplesclerosis that have different patterns of progression, but the most common is relapsing–remitting
This means that the person hasperiods when they are worse (relapse) and better (remission). Remissions may lastweeks to months
Someindividuals with multiple sclerosis also experience cognitive symptoms
like decreasedattention span, poor judgment, memory loss, and difficulty with reasoning and problem solving…Disabling fatigue affects up to 90% of people with ms.
Angina
When blood flow to the heart muscle is reduced, it may cause pain in the chest,experienced as squeezing or pressure
Stable angina
experienced in response to exertion, such as climbingstairs, and it is relieved with nitroglycerine
Unstable angina
less common and moreserious. It may occur at rest and is not relieved with nitroglycerine. It may be a precursor to a heart attack
Myocardial infarction
If the artery becomes completely blocked, the heart muscle dies
Heart disease is very stressful, and many individuals experience fear and anxiety…
whenattempting to resume normal activities such as work. However, because so much work isnow mechanized, most workers can remain in or return to work despite cardiac healthconcerns
10% of asthma cases in adults..
Are due to occupational factors such as exposure to dust, smoke, mold, chemicals, animals or plants.
Occupational asthma should be considered…
In cases of adult–onset asthma, particularly if the person notices a link between work and symptoms.
Chronic obstructive pulmonary disease has two sub–types
Chronic bronchitis
Emphysema
**most have both!
Those with asthma and COPD
Have the greatest level of disability.
COPD is strongly associated with occupational exposure…
to vapours, gases, dust, fumes and smoking. The association with workplace exposure is more than doubled for those who never smoked.
Industries such as coal mining, welding, solvent manufacturing or use, and factor work are all associated with…
The development of chronic obstructive pulmonary disease.
To assist workers with chronic obstructive pulmonary disease…
Any occupational exposure should be discontinued and the individual should be assigned lighter duties.
Approximately 90% of people with diabetes
Have Type 2
Left untreated, diabetic hypoglycaemia can lead to…
seizures and loss of consciousness
Early signs of hypoglycemia
include shakiness, dizziness, sweating, hunger,irritability or moodiness, anxiety, and headache, whereas more severe signs may includeincoordination, muscle weakness, slurred speech, sudden vision changes, drowsiness,confusion, and seizures
Diabetic ketoacidosis
aserious acute complication of diabetes that occurs when the body produces high levelsof blood acids called ketones
Diabetic retinopathy
is the leading causeof blindness in adults
Peripheral sensory neuropathy affects sensationto…
feet, legs, and hands
Peripheral nerve and artery complications of diabetes…
causeapproximately one–half of all non–traumatic lower extremity amputations in the UnitedStates
The most commoncancer in women
breast cancer, although rates have been dropping with morescreening and earlier diagnosis and treatment
The most common cancer in men
Prostate cancer
Pancreatic cancer is the….
deadliest type, but because of its higher prevalence, lung cancer causes the mostdeaths per year from cancer
International Classification of Functioning (ICF)
provides a structure for considering theintersectionality between health conditions and contextual factors (personal andenvironmental) and how they mutually influence body structures and functions, activities,and participation in the lives of individuals and populations
The ICF consists of a set of elements which are structured into four high–levelcategories:
Body function, Body structure, Activity and Participation, and Environmental factors
prefix—peri—
which translates to surrounding
The root—card—
—which refers to the heart
The suffix—itis—
which indicates that inflammation is involved.
Occupational Medicine
is a specialty that covers employee physical health andmanagement of injury. Activities in occupational medicine would include diagnosing,managing, and preventing work–related medical problems; carrying out complex casemanagement of occupational illness; promoting optimal health and safety in theworkplace; and facilitating accommodation in the workplace in a safe and timely fashionto encourage return to work, rehabilitation, and prevention of disability
Occupational Health Nurses
involved in a variety ofactivities, including pre–placement screening, periodic physicals, providing advice toemployees about minor illnesses and injuries, assisting employees in implementing theadvice of physicians and other medical service providers, advising supervisors andmanagers about potential health risks in the workplace, developing and implementinghealth promotion programs and activities, and planning for emergencies
Allied health professionals
specialists in exercise, nutrition, health education, speech,and daily function. They provide comprehensive, patient–centred care to help people withdisabilities regain or attain physical and social skills and to live and work asindependently and productively as possible
Occupational therapists
concerned with promoting health and wellbeing through occupation. Occupational therapists define an occupation as everythingthat people do during everyday life, including self–care, work, study, volunteerism, andleisure.
Mental Health
Mental health is not the absence of mental illness. It is aboutsubjective well–being. If a person feels that they are coping, somewhat in controlof life, can cope with challenges and take on responsibility, they can be viewedas being mentally healthy. It is manifested by successfully performing of mentalfunctions and being engaged in productive activities, rewarding relationshipsand the capacity to change and cope with challenge
Mental Illness
Mental illness refers diagnosable mental health problems whichhave a clinical dimension and where, in most cases, professional intervention ortreatment is needed. It covers more serious or prolonged conditions, rather than,those requiring temporary assistance.
Difference between mental health disorders vs. mental illness
For example, depression and anxiety areclassified as common mental disorders whereas schizophrenia and bipolardisorder as considered to be serious mental disorders.
Anxiety disorders
reacts to specific contexts,experiences or objects with physical signs of anxiety or panic. These includeaccelerated heartbeat and excessive perspiration. A diagnosis is assigned where theresponse is inappropriate to the context, a lack of control of the response, or whennormal life functioning is disrupted. The main disorders include generalized anxietydisorder (GAD), panic disorder, social anxiety disorder, and specific phobias.
Mood disorders
involves feelings of persistent sadness or periods ofinappropriate elation, or cycles of extreme feelings of joy and sadness. The main diagnostic categories include depression, dysthymia, bipolar disorder, and cyclothymicdisorder.
Schizophrenia
This is a psychotic disorder which involves a split from reality.Perception and thinking are distorted which can lead to hallucinations or delusions. Ahallucination refers to seeing or hearing things that are not there and delusions refer tobeliefs that are no supported by reality.
Impulse control and addiction disorders
Alcohol and drug are common impulsecontrol disorders, as is compulsive gambling. These disorders can have seriousimplications in the workplace in terms of health and safety, dishonesty andrelationships.
Personality disorders
People with inflexible personality characteristics can be havedifficulties in work and social relationships. In extreme cases, because a person’sbehaviour or values differ from societal norms, they can be assigned this diagnosticlabel. Personality disorders can be resistant to usual treatments for mental illness.Examples include antisocial personality disorder, obsessive–compulsive personalitydisorder, and paranoid personality disorder.
Obsessive–Compulsive Disorder (OCD)
This condition causes a person to beinundated with constant thoughts or fears. This can cause him or her to engage inritualistic behaviour (compulsions) or disturbing thoughts (obsessions). Not engaging inthese thoughts and behaviours can result in feelings of anxiety and discomfort.
Depression and anxiety disorders (including GAD, panic disorder, phobias, socialanxiety disorder, OCD and PTSD) are referred to…
as Common Mental Health Disorders
Serious Mental Health Disorders or Illness
involve psychosis (losing touch with reality or experiencing delusions)or high levels of care and may need in–patient treatment
The leading cause of disability worldwide and is a major contributor to theoverall global burden of disease
Depression
Mental Health 2012 estimated that 1 in 3Canadians (about 9.1 million people)…
met the criteria for at least one of six selectedmental or substance use disorders at some point in their life
Over five percent of the Canadian population aged 15 years and over reportedsymptoms that met the criteria for a mood disorder in…
the previous 12 months, including4.7% for major depression and 1.5% for bipolar disorder
Mental health problems in the workplace are currently one of the main causes of…
workabsence, a phenomenon that has seen a marked increase in the last two decades.
Over 25% of all new disability pension claimants have a…
mentalhealth condition (35% in the Netherlands).
The economic burden of mental illness in Canada is…
estimated at $51billion per year. This includes health care costs, lost productivity, and reductions inhealth–related quality of life.
The cost to the Canadian economy resulting from the six most common mental healthconditions, including depression, dysthymia, bipolar disorder, social phobia, panicdisorder, and agoraphobia, has been estimated to be in region of…
$20.7 billion annuallyas a result of lost productivity and sickness absence. It is accepted that these costs willgrow over the coming years and could reach $29.1 billion by 2030
The Conference Board analysis indicates that 425,000 more people in Canada would bein the working…
…if they were not dealing with the impacts of mental illness.
An Ontario report that focused on three companies with a combined total of 60,000employees found that over a three–year period…
….2.5 % of employeeshad a least one depression–related disability episode resulting in 144,731 lost work dayson short–term disability. More thanthree–quarters of workers returned to work while 16 percent went on to long termdisability and eight percent quit, retired or were terminated.
Based on a study involving 18 countries, the Organization for Economic Cooperationand Development (OCED), concluded that the health–related absence rate foremployees with mental health conditions…
…was 32 percent compared to 19 percent ofother workers.
It is accepted that stress is one….
….of the more common causes ofemployee absence
The biological basis for psychological stress
The fight or flight response involves the brain, body, emotions, andactions. It is driven by a combination of hormonal and neurological processes that resultin a person being activated to either “Fight or Flight”
The hypothalamus plays an essential role in keeping usalive—
—it controls breathing, digestion, and other basic bodily functions.
The amygdala
located in the limbic region of the brain is most strongly associated with fearresponses
The pituitary gland
an important part of the stressresponse because it acts in concert with the hypothalamus to tell the adrenal glands torelease stress hormones
Making the connection between stressors (event) and a stress reaction (symptoms ofstress)…
is key to identifying appropriate psychosocial accommodations for the employeeand recommending useful strategies to cope with the stress.
The amygdala cannot distinguish…
…between non–lifethreatening and life–threatening stressors. It is also involved in the storage of emotionalmemories. As a result, it can fire at inappropriate stimuli which can result in a panicreaction
The stress response can also be triggered…
…by thinking. Situations that cause orcontribute to stress can be experienced or re–experienced, consciously orunconsciously, by a person. There is some evidence that personal factors can increasea person’s sensitivity to the experience of stress.
The tend and befriend theory” describes….”
…a way of dealing withstress that has been observed most frequently in women. Women respond to stressful situations by protectingthemselves and their young through nurturing behaviours (the “tend” part of the theory)and cope with stress by forming alliances with a larger social group
Person–Environment Fit
work–related stress arises, if aworker’s characteristics are not a good fit with the features and processes of the workenvironment….. this occursif workplace demands require ability, attitudes, skills or other attributes that a workerdoes not possess or if the opportunities available within a workplace do not fit with theaspirations and values of a worker.
Burnout
a condition in which a worker becomes negativeabout the work situation and as a result develops a cynical attitude to work and hasfeelings of reduced confidence
Burnout occurs when workers arechronically exposed to stressful work conditions…
….and when they are not offered anyopportunity for recovery.
If a person is exhausted and experiences a reduced capacityto cope with the demands of the job, this can affect his or her motivation andcommitment, as well as the quality of the work produced.
Transactional model
if a worker is experiencing occupational stress and cannot access supportin his or her relationships, the probability of a negative stress reaction is enhanced.
Personal relationships play a central part in the majority of organizations. Humaninteraction both between workers and for those in customer facing roles, can impact onfeelings and emotions. There are some occupations where relationships with otherpeople core are including social work, disability management or teaching.
Demand–Control–Support model
Attempts to capture the interaction of threekey variables (i.e. demand, control and support) in determining the extent to which aparticular job role is perceived by a worker to be stressful.
For example, a job in which a worker has high control and where the demands arelow could be considered to be relatively stress–free and relaxed. However, where thereis a risk of redundancy, these circumstances could also be associated with substantialstress.
Effort–Reward–Imbalance model
model focuses on the perception that aworker has that the effort invested in the job is being acknowledged and rewarded. If there is an imbalance between effort and reward, this can lead to dissatisfaction on thepart of the worker which can, in extreme cases, result in negative perceptions ofoccupational stress. Evidence suggests that this can lead to an enhanced risk ofcommon mental disorders
In January 2018, the WSIB in Ontario formally recognized
….mental stress as awork–related injury worthy of compensation
Acute stress, (sometimes called short–term stress or incidental stress)
….the mostcommonly experienced kind of stress. Acute stress comes from the demands andpressures of everyday living.
Toomuch acute stress is experienced…
…as headaches, stomach upset, sleeping problems,etc.
Acute stress is highly responsive to intervention or treatment and will usually remit or“go away” once…
….the stressor or trigger is removed or has abated.
For example, theexperience of a racing heart beat (acute stress) when rushing to meet a deadline(stressor) will abate once the deadline has been successfully met.
Episodic Acute Stress
a subjective dimension, for example, the chronic worrier orthe person who seems always under pressure.
These individuals tend to be chronicallyanxious, rushed, and easily agitated. It is as if they are experiencing acute stress, butrepeatedly so.
Chronic stress
…can causesignificant disruption in a person’s personal and/or work life. Examples include being trapped in a hated job or unhappy relationship. Often, the personexperiencing chronic stress becomes so used to, or familiar with, the stressors that theyignore the consequences.
Generalized Anxiety Disorder (GAD)
characterized by unrealistic and excessiveanxiety/worry about most aspects of one’s life, e.g., constantly worrying about financialmatters. Individuals with will tend to report feeling shaky or on the edge. They may alsoexperience blanks or black outs as a result of the overwhelming anxiety and tensionthey are experiencing
Panic Attacks and Panic Disorder
unexpected episode of intense, overpowering fear for no obvious reason. Repeatedepisodes are termed a panic disorder. Each episode is short, between one and tenminutes, although panic attacks have been reported to last up to an hour.
People oftenreport feeling like they are being paralyzed by the fear, that they are going mad, and thatthey may do something embarrassing in public. Attacks occur spontaneously,seemingly, in the absence of an environmental trigger.
Phobia
experience of an unreasonable fear in the presence of a particularobject, circumstance, or activity.
Agoraphobia
a fear of being in a situation where a panicattack could occur and where escape would be difficult, and social phobia, a fear ofbeing acutely embarrassed in front of other people, can have the most disabling impacton a person’s life.
Obsessive–Compulsive Disorder (OCD)
an anxiety disorder in which a person engages in a pattern of senseless anddistressing repetitive thoughts and behaviors. It is a difficult condition to cope with andcan easily overwhelm an individual’s life.
Obsessions
These are unwanted thoughts or impulses that repeat in one’s mind. Theycan be associated with irrational fear of harm to someone close or oneself.
Compulsions
The behavioral response to obsessive thoughts.Common compulsive behaviors include washing, checking things (such as locks, orwindows), or counting. Repeating things, relentlessly hoarding or rearranging objects tokeep them aligned are also common.
Tx for GAD
Cognitive behavior therapy (CBT)Relaxation, yoga, meditation
Psychotherapy,
Stress management training
Relaxation techniques sometimes using biofeedback to control muscle tension
Anti–anxiety medications
Tx for Panic Attacks / Panic Disorders.
Psychotherapeutic Interventions (CBT), Medication.
Social Phobia TX
Medications and CBT
TX for OCD
Behaviour therapy (to control habits and rituals), and medication.
Bipolar
the person alternates between oneemotional pole (depression) and another (manic).
Depression is one of the most common…
…mental health disorders. It affects about 350million people worldwide.
It was the fourth leading contributorto the global burden of disease in 2000 and is likely to reach second place in theranking of Disability Affected Life Years (DALYs) by 2020. It is already the second rankedcause of DALYs for people of all genders between the ages of 15–44 years, impactingpeople in their prime working years.
Tx for depression
Good treatment choices derive from the biopsychosocial model. Environmental factorssuch as medication (e.g., antidepressant medication, anti–anxiety or anxiolyticmedications for stress–related agitation) and cognitive–behavioural therapy orinterpersonal therapy can play important roles in the return to work process.
There are three goals of treatment for depression, regardless of the type.
● Relieve unhappy symptoms (e.g., improve mood and energy, reduce tension)● Return to normal functioning at home, work, and socially● Reduce the likelihood that stress or depression will recur.
DM professionals must not feel uncomfortable interjecting themselves into thetreatment process.
If an employee does not appear to be improving after a reasonableperiod, it is important to question the extent to which the treatment the employee isreceiving is adequate. This can be addressed directly with the treating professional, withthe person’s permission or through the employee.
The advantages of medications are that:
● They are easy to take. ● They may begin to relieve the symptoms faster than therapy (e.g. relievedepressed mood).
● Most currently prescribed medications are not addictive.
● Most medications do not prevent return to work and, in fact, may hasten a returnto productive functioning at work and at home. Nevertheless, some medicationmay require that the employee report their use depending on the nature of theirjob—for example, operating heavy machinery.)
The disadvantages of medications are:
– Not everyone benefits from them.– Some people don’t like consuming drugs
– Some drugs have side effects that cause the person to stop taking them.
– Some drugs require adherence to a strict regimen or diet.
– The first medication chosen may not be the one that eventually changes themood or symptom.
– In the case of depression, drugs may temporarily resolve a suicidal crisis butthey are no guarantee against future attempts.
Reliance and compliance are the two most limiting factors…
…as to whether medication willwork or not.
30 and 40 percent ofpeople prescribed antidepressant medications…
….do not comply with the instructions foruse in the first month. That is, they forget to take their medication, stop taking theirmedication, or modify something about their treatment regime
Cognitive–behavioural and interpersonal therapy are two frequently used psychologicaltherapies for depression and stress–related problems.
In general, these therapies helppeople to:
● Recognize the connection between thought, feeling, and action ● Identify exaggerated beliefs of inadequacy (e.g., “I am worthless” or “I can’tcope”)
● Challenge these beliefs and substitute more reasonable ones
● Understand and change relationship conflicts or workplace circumstances thatcontribute to the depression and stress.
Effective therapy can:
● Empower the person to change their situation or their perceptions of thatsituation ● Teach skills that can be used beyond the end of therapy
● Be more appealing to people who refuse to, or cannot, take medication
● In some cases, have longer lasting effects than medication, and
● Have no physical side effects.
The disadvantages of therapy techniques are:
● They may take longer to relieve some symptoms than medication ● The selection of techniques must be tailored to each individual
● They do not affect the mania characteristic of bipolar depression
● They are not the first treatment choice for severely depressed individuals orthose who are suicidal.
Primary Prevention of Psychological Disorders/Illness
Managing the workplaceconditions that can result in psychological health problems. It addresses thepotential risks to mental health by removing those that can be eliminated andmanaging those that cannot. It involves providing support or coping strategies toworkers to manage possible risks and changing workplace factors that have thepotential to result in PH&S incidents or events.
Secondary Prevention of Psychological Disorders/Illness
Involves the early identification ofworkers who are at risk of developing a mental health problem. By interveningbefore a mental health problem has yet to develop into a more serious condition,it is possible to reduce the incidence of mental health disorders in a workplace.The Guide suggests three interventions that can support secondary prevention.
Tertiary Prevention of Psychological Disorders/Illness
is about preventing workers who havedeveloped a mental health condition from exiting the workforce. It focuses onassisting them to retain their jobs or return to work after absence. It is aboutensuring access to health interventions, rehabilitation and developingperson–centered return to work plans.
Counselling
The provision of individual counselling for employees experiencing mentalhealth difficulties in coping with the work situation is common in many countries. Themain objective of individual counselling is to assist the employee to explore the natureof the difficulties which he or she is experiencing both at home and in the workplace.
Psychotherapy
While counselling tends to deal with life challenges and assistingindividuals to come to terms with personal issues that are affecting their lives,psychotherapy is more inwardly–focused—exploring and working towards resolvingdeeper emotional and psychological distress.
Cognitive Behaviour Therapy (CBT)
one of the few interventions that hasemerged in research as being particularly effective in assisting the RTW process forpeople with stress–related conditions and mental health disabilities
Psychoeducation
refers to the education offered to individuals witha mental health condition and their families to help empower them to deal with theircondition in an optimal way. Provides the people with educationspecifically targeting the difficulties they are experiencing
Group Therapy
Is recommended less often than other mental healthinterventions. In general, it can provide support to other interventionstargeted at the RTW process rather than to directly address that particular goal.
Vocational rehabilitation (VR)
most frequently involves career counselling, job searchtechniques and skills training for new jobs or careers.
Personal Capacity Building
Interventions targeted at enhancing the worker’s capacity to deal with stress situationsand personal psychological difficulties were commonly recommended in the StressImpact study
Vocational Training
In the case where the absent employee has a skill or knowledgedeficit in relation to the demands of the job role, the provision of vocational training (VT)and re–skilling becomes an essential part of the RTW plan.
Employees who have beenabsent over an extended period of time become deskilled in two ways. In the first place,they lose some of the skills that they originally had while in work; and secondly, theskills required for their job role may change while they are absent from the workplace
Conflict Management and Problem Resolution
Both are particularly important capacity building interventions in thecase where someone has experienced relationship difficulties at work prior to his or herwithdrawal from work.
Confidence Building
A key challenge for a person who has experienced a mentalhealth difficulty is the extent to which it undermines self–esteem and self–confidence.Things that would have been considered relatively straightforward and uncomplicatedprior to an episode of mental illness can become major stumbling blocks for a personreturning to work.
Coaching and Mentoring
It is often useful to provide the returning worker with accessto mentoring and coaching support during the process.
Many employers alreadyoperate such schemes and thus it can be a more acceptable way to provide supportthan supported employment or individual placement support
Stress Management Training
An important component of CBT, which is also availablefrom other sources, is stress management training. There are many stress managementtraining programmed available. Some of the more physiologically based approaches willuse bio–feedback to provide the participant with tangible evidence of the extent towhich they are tensing their body
Bio–feedback combined with relaxation exercisessuch as deep breathing can…
…assist an individual to begin to control the physiologicalsymptoms that can cause discomfort in a stressful situation.
Maintaining Positive Contact between the Employee and Employer
One of the keyinterventions in facilitating a successful RTW is the facilitation of positive andconstructive contact between the employer/manager and the absent employee.
Thiscan be a particular challenge especially in the event of a contested claim or workplaceissue. This is an important role for the DM professional.
Workplace Adaptations
Once an initial, positive contact has been made between theabsent worker and the employer representative, negotiating appropriateadaptations/accommodations and transitional arrangements for the worker is moreeasily facilitated.
A particularly useful model when considering workplace adaptations isthe Demands, Control, and Support model” of stress”
Strategy in the Demands, Control and Support Model” – Adapting Demands and Control”
Involves conducting a psychological demandsanalysis of the targeted job.
Psychological demands can arise from a number ofworkplace sources, including deadlines, the requirement for dealing withcustomers, or even the demands of repetitive work. Alternative demands andcontrol arrangements might include the provision of work that is a good matchfor the worker’s skills.
Strategy in the Demands, Control and Support Model” – Providing Support”
The final workplace variable in theDemands–Control–Support model considers support. Support is a variable thatthe DM professional can manipulate in developing an effective reintegration planfor someone returning to work following an absence for mental health reasons.
Intervening Factors: Working Relationships
Prior to embarking on a return to work process, it isessential that the DM professional clarifies the employee’s motivation to RTWand estimate the extent to which an employer is willing to accommodate theemployee’s needs. Workplace relationships are a key factor in effective return towork.
Intervening Factors: Legislation
For example, equality andnon–discrimination legislation places the responsibility upon employers to makereasonable accommodation for employees who experience impairment ordisability. In this respect, the DM professional is often in a good position toadvise the employer regarding reasonable accommodation and inclusivemeasures.
Intervening Factors: Precipitating Workplace Factors
This is an important variable in determining thelikelihood of RTW and the nature of the reintegration plan.
For example, in thesituation where an employee is in conflict with the employer due to acompensation claim, or where it is obvious that the employee is more interestedin taking a constructive dismissal action against the employer than in returningto work, the likelihood of RTW may be compromised.
Mental Health Awareness Training
Can behelpful in educating all organizational employees of the prevalence of mental healthproblems in the workforce and of the potential influence of psychosocial factors onproductivity and well–being in the workplace.
Psychological Risk Assessment
A pre–condition for the development of areintegration plan is a comprehensive risk assessment of the psychosocial factors thatcould jeopardize a successful RTW.
It is typically basedupon a site visit to the workplace, in–depth interviews with the Human Resourcedepartment and the person’s supervisor, and an in–depth discussion with the absentworker regarding their RTW ideas.
It includes apsychosocial job demands analysis, and also takes into consideration thecharacteristics of their health condition, in addition to behavioural and emotionalvulnerabilities.
Redeployment to an Alternative Position
There are cases where the DM professionalin collaboration with the employer and the worker that returning to the original jobrepresents a significant risk that the mental health of the worker will be jeopardized.
This could be the case in Post–Traumatic Stress Disorder where the precipitators offlashbacks are context or occupationally specific or where workplace relationships havedeteriorated to the extent that return to the same position could aggravate the workersmental health difficulties. In such case, redeployment is a potential strategy.
Redeployment within the Company
The first redeployment option is negotiatingwith the employer the idea of offering alternative positions within theorganization, in the event that the original position cannot be accommodated orthe employee does not want to return to the same position.
If the employer iswilling to offer an alternative job role, it is important for the DM professional toexplore with the employer available options for redeployment within theorganization.
Redeployment to another Employer
Where redeployment to another employeremerges as the only viable option for the absent worker, the RTW process shiftsto a more supportive function, and the DM professional closes the case.
In some cases, the insurer may also provide DM support.Whichever is the case, there are a number of vocational rehabilitation strategieswith which all DM professionals need to be familiar whether consulting to theemployer, working for the employer, or for a third party, such as an insurancecompany
When returning to work, it is important not to confuse the ability to work with the abilityto perform at….
….a maximum level or with a complete absence of discomfort, challenge orfrustration. It is important to ensure that the employee is prepared for this and hascoping mechanisms and strategies (e.g. learned through counselling or treatment) inplace to proactively respond to this
‘Give it a try and see whathappens’
To encourage theperson to suspend judgement about what will work and what won’t and to frame thereturn to work experience as an exploration or experiment
Enlist support
It is important to enlist the support of the employer, supervisor, or manager. To this end,the employee needs to understand their rights and their responsibilities, as well asthose of the employing organization.
Anticipate co–worker discomfort
Some co–workers express concern and support toward employees who have beenabsent due to a stress or depression–related disability.
Others may appear to ignore theemployee for fear of saying the wrong thing and causing more stress. When moresevere mental health conditions are involved, lack of knowledge about mental healthissues may increase discomfort. It is important that the employee understands that theirco–workers may be uncomfortable and that this discomfort usually stems from genuineconcern, not criticism.
An imbalance of neurotransmitters (usually too little) is thought to…
….contribute todepression much like missed telephone calls or misdirected mail causescommunication breakdown between people.
Most antidepressant medications work byincreasing the number of available…
….neurotransmitters traveling between neurons so thatproper communication can occur. The result is improved mood and fewer physicalsymptoms.
Depression isconsidered to be both a cause and an effect of….
….poor relationships.
People who aredepressed can be slow to engage in conversation and speak slowly and monotonously.They may not maintain appropriate eye contact, be slow to respond, and theirresponses badly timed.
