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Assessing Cognition
and Cognitive
Demands in Stay at
Work Gowan Consulting
IFDM 2018
Gowan Consulting
Occupational Therapist’s
Across Canada and the US
Employer services
Sustainable Stay at Work and Return to Work Solutions
Individual assessments – ergonomic, accommodation,
reactivation
Group training – ergonomics, mental health, RTW expert
training
Policy/procedure development
The Bank and its
Accommodation Program Canada’s oldest bank – celebrating 200 years in 2017
Over 45,000 employees worldwide; More than 12 million
customers (operating in North America, Europe, Latin
America, Asia)
Vision: To be the bank that defines great customer
experience
Values: Integrity, Empathy, Diversity, Responsibility
Brand: Human, Intuitive, One Bank
Accommodation Program - The program enables our
strategic commitment to Diversity & Inclusion in our
workforce, workplace and marketplace
Common Employer Challenges
Difficulty identifying barrier as being related to
health condition (i.e., assumption that problems
with performance = lack of skill)
Identifying the strategies to improve
performance
Ongoing education of managers and partners
Stigma in the workplace
Cognitive/Intellectual Disability -
Definition
Disability that involves limitations both in intellectual
functioning and in adaptive behaviour
A person with a cognitive disability has greater difficulty
with one or more types of mental tasks than the average
person
Often described as a form of an “invisible” disability
Representation of Common Disabilities
affecting Cognition
Learning Disabilities - 2.3% of population over age 15.
Aging Workforce –By 2021, 24% could be 55 years of age
or over – With age, inductive reasoning, selective attention,
'dual-task' activities, and information processing shown to
decline.
Mental Health – 20% of Canadians will experience a
mental health issue in our lifetime.
Sleep Apnea - about 1 in 3 adults sleep less than 7 hours
per night
Pain - chronic pain prevalence for adults older than 18
years of age was 18.9% in 2011
How Cognitive Disabilities can affect
Work Performance & Productivity • Decreased ability to plan and execute a process/task
• Decreased ability to perform multiple tasks (“multi-
task”)
• Difficulties making decisions
• Judgement
• Comprehension (verbal/written)
• Memory
• Auditory Processing impairments
• Decreased attention, problem solving, and
sequencing
• Increased anxiety over work-performance
• Decreased self-awareness/acceptance regarding
above challenges
Process for Assessing and
Accommodating a Cognitive Disability
Identification of concerns
Manager to independently provide any possible
adjustments/support
If complex – manager/employee to connect with
Accommodation Specialist and potentially engage external
partner (e.g., OT)
Identification of specific barriers through further review
assessment
Identification and review of strategies to enable performance
Implementing strategies
Ongoing monitoring by manager
Information required for Assessment
-Assessor to gather information as follows:
Employee: Health history, employment history, description of functional job demands
and performance, completion of screening tools, daily schedule, past
intervention/accommodation, physical assessment
Employer/Manager: Description of functional job demands and employee performance;
anecdotal and objective review of performance concerns and behaviour
relative to peers; review of improvement required to meet minimum
standards or role
Job: Observation/measurement of job tasks/tools/light/environment, job
description, manager interview, performance metrics, past
intervention/accommodation
SAW and
RTW
Model
Gowan,
2016
work
workplace
worker
Optimum fit
Functional Cognitive Assessment
Conducted by Occupational Therapist
One assessment tool - Brain Fx
Specifically assesses mild – moderate brain dysfunction
Sensitive to brain dysfunction
Function focused (i.e., impact on work performance)
Can be administered in 2 hours
Typically less costly
Portable
User-friendly for assessor and participant
Standardized and evidence-based
Cognitive/
Sensory Skill
Description of
Skill
Employee
Performan
ce Level
Potential Impact on
Work
Memory –
immediate
auditory
Ability to learn 4
items in context
immediately and
remember items
for later.
Demonstrate
d ability to
recall 4
items after
listening to
list 3 times.
Employee benefits from
repeating information
aloud to prompt memory.
Memory –
immediate
visual spatial
Ability to
immediately
recall information
presented
visually.
Demonstrate
d errors and
slow
response
time.
May affect the employee’s
ability to recall information
presented visually alone.
Cognitive Concern and Impact on Work
Cognitive/
Sensory Skill
Description of
Skill
Employee
Performance
Level
Potential Impact
on Work
Problem
solving
Being able
answer math
questions and
perform
functional math
based tasks.
Demonstrated the
ability to perform
simple, single
digit math
calculations
May affect the
employee’s ability
to perform and
mental math
calculations,
estimates or
rounding up/down.
Executive
functioning
and combined
skills
Prioritization of
tasks,planning
and organizing
events according
to evident and
non evident rules
Demonstrated
difficulty with
prioritizing tasks
and organizing
information
Employee may
benefit from
additional training,
job coaching,
decision making
maps/algorithms.
Cognitive Concern and Impact on Work
Cognitive Demands Analysis (CDA)
Addresses cognitive, and behavioral aspects of
work.
A four-point rating scale is provided for each
item, with “4” representing the highest level of
demand, and unique descriptions are provided
for each rating level within each item. [6]
Attention to Detail
Definition Rating
The extent to which work tasks
require attention to or more
concentration on details of
information.
Cognitive skills needed: selective
visual and auditory attention,
divided attention
1 = attention to or concentration on
details is not required
2= attention to detail or
concentration is required for some
tasks, although not at an intense
level
3 = significant attention to detail or
concentration required for many
tasks or intense attention to detail
or concentration is required for only
some tasks
4 = intense attention to detail or
concentration is required for the
majority of work tasks.
Performance of Multiple Tasks
Definition Rating
The responsibility for performing
and/or monitoring more than one
task or function at a time and for
judging when tasks or functions
require attention.
Cognitive skills needed: memory (
immediate auditory and visual
memory), visual and auditory
distraction, divided attention,
mental flexibility, executive
functioning, and combined skills.
1 = not responsible for concurrent
multiple tasks. Responsible for
performing one task at a time until
completion or further direction
2= some responsibility for multiple
tasks, but with very clear
guidelines or cues about went to
perform each task
3 = responsible for multiple tasks,
with some time management skill
and judgment required to
determine priorities
4 = constantly responsible for
multiple concurrent tasks
Contextual Influences on Work Demands &
Worker Performance
Workplace factors need to be considered in evaluating the impact of
contextual factors on worker productivity and performance
Time pressures; deadline pressures;
safety pressures; security pressures; life and death pressures;
exposure to emotional situations; exposure to confrontational
situations;
exposure to high risk with regard to safety and physical well
being;
exposure to environmental stimuli (noise, people, machines,
distractions, etc);
The consideration of the environment is
essential for designing a successful RTW program
Creating a Job Match Job Task Plan member
Function
Gaps Accommodation
or RTW plan
Remember and
sequence 5 steps
in job task
Able to remember
3 steps without
cuing
Ability to
remember steps
SOP laminated
and available at
job site,
Checklists, job
coach, electronic
reminders
Concentrate to
enter data into a
system for 30
minutes
Limited
concentration to
10 minutes
Unable to
concentrate for
long enough
Breaks and
alternate tasks
every 10 minutes;
or refocus every
10 minutes
Ensure quiet
space – noise
cancelling
headset
Case Study - JIM
Jim is a middle-aged employee working in a call centre
who has been experiencing some depressive symptoms.
A customer contacts Jim to request a credit card. One
week later, the client follows up with their order, only to
find it had not been submitted. Jim had forgotten to
complete the order. This resulted in an official complaint
against the company, and Jim being coached by his
Manager.
The Manager notes that this is not the first mistake of
this kind that Jim has made over the last several months
and she feels that Jim is struggling in his role. The
Manager contacts an Occupational Therapist to provide
some workplace support for Jim.
Case Study (cont’d)
During the Occupational Therapy assessment,
when questioned about the incident with the credit
card, Jim notes that he had become distracted by
environmental noise, resulting in him forgetting the
work order. Jim states that lately his work
performance has been slipping, and that he has
been experiencing some mental distress about
completing his job. He also reported feeling very
anxious when discussing his performance with his
manager.
Case Study Recommendations
Potential Cognitive Strategies suggested by OT:
Take notes during phone call
Keep work order notes in specific location/folder on
computer
Send Confirmation email
Keep ‘To Do’ lists and Checklists for processes
Provision of noise-canceling headset to block out
environmental noise
Provide additional training/refreshing as needed
Review of strategies with manager and educate re.
supportive approach
Bank’s Program Successes
Managers are learning to assess performance
concerns through having better conversations
Increased collaboration and accountability with
managers, employees, partners
Increased awareness around cultural and
emotional intelligence with a laser focus on
leading with empathy and being aware of hidden
biases
Reinforcement of brand values through
Workplace Accommodation Program
Empowerment of employees
Next Steps for Employers
1. Review data on workplace costs due to cognitive
difficulties (e.g., absence rates, loss of productivity,
disability leaves)
2. Recognize indicators that may demonstrate that an
employee is struggling with cognitive barriers (i.e.
performance, lower productivity, absences, behaviour)
3. Implementation of clear assessment process
4. Support employees through implementation of cognitive
strategies
5. Train managers on supporting employees with cognitive
disabilities and mental distress
6. Clear ‘return to work’ and ‘stay at work’
processes/strategies for employees
Contact Us
Nancy Gowan
519-762-0796 or
1-888-752-9954(CAN)
www.gowanhealth.com