Week 1 Readings Flashcards
According to the authors, what type of model (operational or conceptual) is the Sherbrooke Model?
* What is its purpose?
* elements of model
* why is it important
* what are its drawbacks
- The Sherbrooke Model is operational. It represents a multifaceted intervention to prevent low back disability.
- workplace system, legislative and insurance system, heatlhcare system, personal system
- Integrated case management
- Successful in reducing time away from work
- Combination of a clinical rehabilitation intervention and occupational intervention that included an ergonomic component
- RTW 2.4 times quicker than standard care
- doesn’t explain how different elements influence one another
Describe the “Biomedical Model”. Discuss its prevalence today and its shortcomings.
Health is emphasized as the absence of signs and symptoms of disease. Ill or injured individuals are considered “patients” and are executed from normal societal obligations.
Individuals enter a passive role where the physician is the person with full decision making power related to the individual’s health and wellness.
- prevelant today, guiding how healthcare services manage work disability worldwide.
- does not support GRTW practices as it fully excuses the individual from any work obligations as injured/ill person moves into a passive patient role
- problematic for individuals with chronic or long-term illnesses or injuries, as with the model, they may never return to work and it could result in issues such as identity loss, social isolation, and financial difficulties.
- On a societal or organizational level, a large amount of workers off work can cause labour shortages and affect productivity. Furthermore, for individuals with acute illnesses, their return to work may not be as expedited or successful than if they had followed gradual return to work plans.
Why is Nagi’s model important to our understanding of disability today?
Nagi model: pathology gives rise to impairment, which may result in a limitation in a particular function, and finally, it may result in work-limiting disability. the process of disablement depends on multiple external factors and is unique to the individual. Not all physical or mental conditions result in a disability and similar patterns of disability may result from different types of health conditions. Identical physical and mental limitations may result in different patterns of disability. Environment and social environment plays a major role in disablement process
Brings into consideration physical and social environmental factors present in disablement process
Ex: social environment - reactions and expectations of reference individuals
Physical environment - physical demands encountered in environment
How is the “Social Model” different from the “Biomedical Model”?
Presents disability as not caused by illness or injury but due to societal organization. Barriers to participation are exclusively a result of the social environment and solutions demand collective effort of society. Societal ideology, culture, education, and social organization of work can shape how we all perceive disability.
What does a “biopsychosocial model” entail? How does it highlight shortcomings of the “Biomedical Model”? What is it’s major failing?
Health and illness is a product of a combination of factors including individual biology (genetic predisposition, chemical imbalances), behavioural factors (lifestyle, stress, health beliefs), and social conditions (cultural influences, family relationships, social support)
Whereas, biomedical model focuses on just the signs and symptoms of illness. health is the absence of illness
What is the International Classification of Functioning (ICF)?
Model developed by WHO
describes the dynamism of health and the illness process. Health conditions, environmental factors, and personal factors all influence 3 outcomes which are body function and structures, activities, and participation. However, unlike other models, causality is shown in the opposite direction as well. body function and structures, activities, and participation also influence health condition, environmental, and personal factors.
Critique:
- doesn’t highlight which interactions are relevant and how they play a role in determining the factors that influence the development or maintenance of enablement.
- Healthcare-centered view with attention only to individual functioning
- Doesn’t really help with understanding the various social factors that may exert a positive or negative influence on work ability/disability
- Doesn’t explain the mechanism by which contextual factors can affect disability and work participation processes
How does the case-management ecological model differ from earlier models?
- Explicitly includes social factors as an influence into worker with work disability
- Purpose: orient case management for low back disability
- Specific to work ability; other models discuss disability in general
4 main influential systems affecting work ability:
- Personal system and social relationship of person
- Healthcare system with level of attention the worker can access
- Workplace system and its main sociotechnical structures
- Compensation system: local regulation and involved actors
What key elements does the expanded ICF model capture?
- Communicates work related factors leading to problems with functioning and health
- Useful for various healthcare practitioners
- Psychosocial factors (physical, social, attitudinal environments)
- Describes the workplace (micro, meso, macro determinants) and work environment factors
- Presents physical hazards as well (vibration, air quality, radiation, biological and chemical agents, ergonomics)
What type of Model is “Previcap”? List the members of the interdisciplinary HCP team.
(prevention of work handicap) model:
Biopsychosocial approach model. Person-environment interaction motel. Interactions are directed toward worker, workplace, and the interaction between the two
disability diagnosis step: precise causes for disability are determined (physical, psychosocial, occupational, and administrative)
Progressive return to work rehabilitation phase involving HCP team that can address various causes of disability
Interdisciplinary health care practitioner team: model doctor skilled in MSIs and rehabilitation, occupational therapist, kinesiologist, ergonomist, team coordinator (case manager)
What 2 key concepts does the Previcap model identify in WMSD medical management?
Need for coordination between worker and workplace focused interventions through an interdisciplinary HCP team and team coordinator
Intervention delivered at secondary level of care (subacute or early chronic stage of injury) can still result in successful RTW as long as long temr goals of program are disability management as opposed to medical cure of disorder
How does Feurstein ICM program differ from Previcap?
Involved a case manager that is a nurse by trade that received formal training in ergonomic and psychosocial assessment and intervention for WMSD
Principles:
Reduce physicial workload and improve flexibility and endurance through exercise
Train employees in job stress management
Change work organization and work style to reduce biomechanical risk exposure
Improve managerial skill in addressing WMSD and increase supervisor support through training
Educate workers and supervisors regarding optimal health-care utilization
What % of employment law is provincial and federal?
90% provincial
10% federal
Intentional discrimination
Unintentional discrimination
refusal to train, hire promote an individual based on any of
the prohibitory grounds
harder to detect, ex: height requirements, gentlemen’s club,
Bona Fide Occupational Requirement
(BFOR)
- definition
- criteria
A core and essential function of the job
- must be imposed honestly and good faith
- is in the interest of safety and economy
- not to defeat the purpose of the Human Rights code
- must related to the performance of the job without
endangering the employee, his fellow employees and
the general public.
Duty to Accommodate
the employer has a legal requirement to
make every reasonable effort, short of undue
hardship, to remedy disadvantages in the workplace
Employers have to proactively identify and change any rules, practices, procedures, etc. that have or may have a discriminatory impact on employees based on a prohibited ground.
Undue hardship
“limit of employer’s capacity to accommodate without
experiencing unreasonable difficulty”
- financial cost;
- impact on a collective agreement;
- problems of employee morale;
- interchangeability of the work force and facilities;
- size of the employer’s operations;
- safety.
Threshold is very high
Must provide evidence to human rights tribunal
Bill 14
Mental Stress Revision to the BC Workers’ Compensation Act
Chronic stress
(a) is a reaction to:
(i) one or more traumatic events arising out of and in the course
of the worker’s employment, or
(ii) a significant work-related stressor, or a cumulative series of
significant work-related stressors, arising out of and in the course of the worker’s employment.
Bill 41
employers and workers have a legal duty to cooperate in timely and safe return to work, and certain employers are required to maintain employment with their injured workers in specific circumstances
duty to maintain employment applies only to some employers. If an employer regularly
employs 20 or more workers and has employed
the injured worker for at least one year before their injury, the employer has an obligation to
maintain that worker’s employment.
