employee awareness and empowerment research report · 2020. 10. 10. · 1.1 project objective ......

Employee Awareness and Empowerment Research Report

The Collaborative Partnership to improve work participation

December 2019

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Table of ContentsExecutive summary .................................................................................................................................. 3

1.0 The project approach ....................................................................................................................... 5

1.1 Projectobjective ................................................................................................................................... 5

1.2 Project approach ................................................................................................................................... 5

1.3 Howtointerprettheresearchfindings ................................................................................................ 7

2.0 Findings ............................................................................................................................................ 8

2.1 Rapidreviewresults .............................................................................................................................. 8

2.2 Interventionranking ........................................................................................................................... 10

2.3 Responsestotheinterventiontypes .................................................................................................. 11

3.0 Other Empowerment Interventions ............................................................................................... 22

4.0 Conclusion ...................................................................................................................................... 32

Additional information ........................................................................................................................... 34

References ............................................................................................................................................. 35

Appendices ............................................................................................................................................ 38

Appendix1:Examplesofinterventiontypes .............................................................................................. 38

Appendix2:Detailedbreakdownofcitizenpanelattendees ..................................................................... 40

Appendix3:Projectmethods ...................................................................................................................... 42

Appendix4:Qualityappraisal ..................................................................................................................... 44

Appendix5:Detailedthematicanalysis ...................................................................................................... 51

Appendix6:Reviewquality ......................................................................................................................... 55

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Executive summaryEachyear,toomanyAustraliansareunabletoworkduetoatemporaryorpermanentinjury,illnessordisability.AmongstOECDcountries,Australiaranks21outof29foremploymentratesamongpeoplewithdisabilitiesrelativetothepopulationandevidenceshowsthatforpeoplewithaworkers’compensationclaim,returntoworkrateshavestagnatedsince2006.

TheobjectivesoftheEmployeeAwarenessandEmpowermentresearchistobetterunderstandtheexperiences,beliefs,andneedsofpeoplewithahealthordisabilityrelatedreasonforworkincapacityandidentifyevidence‑basedinterventionstoempower ‘employees’withahealthconditionordisabilitytouseworkaspartoftheirrecovery.

TheWorldHealthOrganizationdefinesempowermentas:

the process by which people gain control over the factors and decision that shape their lives

Thisdefinitionincludestheprocessbywhichpeoplebuildtheirpersonalattributesinordertoachievetheircapacity.Personalattributescanincludeconfidenceorself‑worth,buildingknowledge,developingcopingmechanisms,orenhancingpersonalskillstomakehealthandwellbeingrelatedchoices.Manyexamplesofsuccessfulempowermentinterventionsandprogramsalreadyexistinthepublichealthfield.

Thestudyaddressesanimportantgapinevidenceonempowermentstrategiesforpeoplewithahealthconditionordisabilitytouseworkaspartoftheirrecovery.Thefindingspresentedinthisreportarebasedonarapidreviewofevidenceonempowermentinterventions;qualitativeresearchtogainafirst‑handaccountoflivedexperiencethatsetsthecontextforwhatneedstobeconsideredwhenaddressingempowerment;andinsightsfromstakeholderfromtherelevantsystemsandsectors.Thisreportprovidesimportantinsightsforpolicymakers,serviceprovidersandsystemownersresponsibleforsupportingpeoplewithillhealthordisabilityandworkparticipation.

Thekeyfindingsfromthisstudyshowsthat:

• employeesaremotivatedtoworkandtheirmotivationisnotabarriertoparticipation–itisnotforlackoftryingthatpeoplehavenotsecuredsuitablework.Peopleareawarethatworkprovidespurpose,self‑sufficiency,stabilityandsocialization.Beingoffworkmakesithardertogetwork,leadstoloneliness,lossofself‑confidence,lossofperceivedcontrolandlossofsocialnetworks.

• employeesfindthebenefitandincomesupportsystemscomplexandoverwhelming,personifiedbya‘onesizefitsall’approachthatleaveslittleroomforflexibilityorempathy.Theyreportalackoftransparencyregardingtheirrights,benefitsandprocesses,significantuncertainty,ineffectivecommunicationbetweenstakeholdersthatisparticularlyproblematicaspeopletransitionbetweensystems,andacontinuousrequirementtoretelltheirstory.Theseexperiencescancontributetoworseninghealthanddelayedrecoveryfortheindividual.

• thereisastrongbeliefamongstemployeesthatemployerslackunderstandingoftheworkabilityofpeoplewithahealthconditionordisabilityandhowtoeffectivelyaccommodatethem.

“Anestimated786,000Australians

areunabletoworkduetoaninjury,illhealthordisabilityandaccessincomesupportfromacommonwealth,state,territoryorprivatesource.”

(Cross-Sector Systems Report, 2017)

“Afurther6.5millionpeople

accessemployerprovidedleaveentitlementsforperiodsofworkincapacitydueto

theirhealth).(Cross-Sector Systems

Report, 2017)

In this report the term

‘employees’referstoindividualsstaying

at,orreturningtowork,orcommencingnewwork(includingtheirfirstjob);withinjuries(psychologicalorphysical),disabilities(cognitiveorphysical),

ordisease

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Anumberofinterventionscanbeusedtoempoweremployeestouseworkaspartoftheirrecoveryincludingmentorship,educationandgoal‑settingapproaches;however,theseinterventionsrequireenablingmechanismstobeinplacebyrelevantsystemsandproviders.

Thisstudyhighlightsthatforempowermentinterventionstobeeffective,willrequireamulti‑dimensionalapproachthataddressesbroaderculturalattitudes,systemimprovementsandworkaccommodationprinciples.

• Cultural change–shiftingbeliefsandattitudestowardsthevalueofgoodworkandinclusion.Cultureandsocialnormsprovidetheover‑archingcontextandmotivationthatmakesindividualinterventionseffective.Itisahighorder‘empowerment’toolthatgoesin‑handwiththeneedforbetteracross‑communityhealth literacy.

• System change–theperceptionsandexperiencesofemployeesofthebenefitandincomesupportsystemsmaybeconsideredharsh,butpresentsaveryrealimpedimenttopersonalempowerment.Reportsshowthatpartsofthesystembycausingsecondaryconditionssuchasdepression.Reportsshowthatpartsofthesystemareoutofstepwithbestpracticeapproachestocustomer‑centricservicingandstreamlinedoperatingprocesses.

• Work accommodation–thereisaneedforemployerstohaveabetterunderstandingandimprovemanagementofthecapabilitiesofemployee’swithaphysicalorpsychologicalcondition.Thisissupportedbytheliteratureandthefindingsfromemployeesandstakeholders.Thisisthepracticalaspectoftheworkexperienceandenablingindividualstoobtain,stayatorreturntoworkisreliantonemployerengagement.

Empoweringpeopletouseworkaspartoftheirrecoveryandwellbeingcanleadtobetterhealthandeconomicaloutcomesforindividuals,theirfamilies,thecommunity,andAustralianworkplaces.Thekeymessagefromthisresearchisthatempowermentisacomplexstrategythatsitswithincomplexenvironmentsandsettings.Effectiveempowermentstrategiesdependsnotonlyontheindividualandtheirabilitytocontrolthefactorsthatshapetheirlives,butalsotheoverallcontextinwhichtheytakeplace.

Health literacyrefers

tothecognitiveandsocialskillswhichdeterminethemotivationandabilityofindividualstogainaccessto,

understandanduseinformationinwayswhichpromoteand

maintaingoodhealth.Healthliteracyiscritical

to empowerment.

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1.0 The project approach 1.1ProjectobjectiveThisprojectaimstouseanevidenceinformedapproachtoidentifyingeffectiveorsuccessfulinterventionstoempoweremployeestostayat,obtainorreturntowork.

1.2 Project approachThisstudyisaninitiativeoftheCollaborative Partnership to improve work participation(theCollaborativePartnership)andhasbeenledbyEML.TheCollaborativePartnershipisanationalalliancebetweenthepublic,privateandnot‑for‑profitsectorsandisfocusedonimprovingworkparticipationofAustralianswithatemporaryorpermanent,psychologicalorphysicalhealthconditionordisability.

Thereislimitedcurrentunderstandingofthebeliefs,perceptionsandattitudesofpeolewithatemporaryorpermanentinjury,illnessordisabilityandtheirexperienceofpeoplewithatemporaryorpermanentinjury,illnessordisabilityandtheirexperienceofnavigatingthevariousbenefitandincomesupportsystemsinAustralia,andinteractionswithemployers,andrelevantserviceproviders.Thisprojectusedqualitativeresearchmethodologytoinquiredeeplyintospecificexperiences,withtheintentionofdescribingandexploringmeaningthroughnarrativedata,bydevelopingthemesexclusivetothestudyparticipants.Whilethequalitativeapproachprovidesuswitharichunderstandingofpeople’sexperience,itdoesnotallowustoinferorgeneraliseabouttheexperienceofthosewhodidnotparticipateintheresearch.

Theprojectisinformedbyarapidliteraturereview,citizenpaneldiscussionandindividualinterviews,andexpertstakeholderinterviews.

RapidLiteratureReview

TheRapidLiteratureReviewwasfocusedoninterventionsthathavebeenproventoencourageemployeestostayat,obtain,orreturntowork.

ItwasbasedonthePICOframework:

• Population:Individualsstayingat,orreturningtowork,orcommencingwork(includingfirstjob);withinjuries(psychologicalorphysical),disabilities(cognitiveorphysical),ordisease(e.g.cancer).

• Interventions:Empowerment(unlikelytoexist),activeparticipation,navigation,self‑management(insurance),healthliteracy,schemenavigation,workplanning,problemsolving,supportmechanisms,self‑managementsupport,self‑sufficiency,socialsupport(e.g.communityinvolvement,familystability),andactiveinterventions.

• Comparison:Nospecificcomparisongroupwasset

• Outcomes:Workstatus(returntowork,stayatwork,commencenewwork),feelingofempowerment,attitudes,needs,andmotivations.

Thereviewincludedinternationaldatacoveringthelastfiveyearsandyielded71relevantarticles.

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CitizenPanelandInterviews

ThepurposeoftheCitizenPanelandinterviewswastounderstandtheattitudes,motivations,beliefs,experiences,drivers,barriersandneedsofemployeesnavigatingtheworkdisabilitysystem.

Atotalof23citizensparticipated–10fortheCitizenPaneland13inindividualinterviews.

Recruitmentensuredparticipantrepresentationacross:

• workstatus:obtaining,stayingatorreturningtowork.

• claimtype:physicalandpsychological.

• healthconditions:Injuries(psychologicalorphysical),disabilities(cognitiveorphysical),ordisease.

• crosssectorexperience:workers’compensationandmotoraccident,disabilitysupportandsocialwelfare;superannuationorlifeinsurance.

ThelineofenquirywasinformedbytheresultsoftheRapidLiteratureReview.

Participant Profile

10respondentswereinvolvedintheCitizenPaneland13participatedinone‑on‑oneinterviews.ThedistributionofparticipantsacrosstheabovecategoriesissummarisedbelowinTable1

Table1:ParticipantsinCitizenPanelandInterviews

Job status Injury type Workers’ Compensation

Motor Accident

CompulsoryThirdParty

Disability Support Pensions

Superannuation DE Services

Time in the ‘system’

Amajorityrepresentationacrossthree,fourandsixthmonthswithafewlongtail(e.g.+52weeks).

Obtaining work

Physical 1 1 2 1Psychological 1 2 2 3

Returning to work

Physical 3 1 1Psychological 1

Staying at work

Physical 1 1 1Psychological 1

2 5 7 5 4

AmoredetailedbreakdownofparticipantscanbeseeninAppendix2.

Thesamplewasrecruitedincollaborationwithapanelrecruiterthatspecialisesinsocialissuesresearch.Wealsodistributedmaterialadvertisingviapartnerstakeholdersfromspecificsystemswherepossible.

Thisstudyrecruitedacrossthedifferentsectorsof:Motoraccident:(22%);DisabilitySupportPensions(DSP)(30%);Superannuation:(22%);DisabilityEmploymentServices(DES):(17%).Therecruitmentofindividualsfromtheworkers’compensation(9%)sectorwasmorechallenging.Nearlyhalfofourparticipants(43%)werethosewithpsychologicalclaimsorconditions.Oneareaofrecruitmentdifficultywasforindividualstryingtostayatwork,whichonlycomprised17%ofthefinalsample,comparedto‘Obtainingwork’(57%)and‘Returningtowork’(26%).Additionally,wefoundthatindividualsfromthepsychologicalprofileweremuchmorelikelytobelookingfornewwork(80%)thanreturningtowork(10%)orstayingatwork(10%).

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Workers’compensationwastheleastwellrepresentedinthestudysample(9%),whereasitisoneofthelargersystemsaccordingtothetheCross‑SectorProjectReport(n=156,000;2%).Theunderrepresentationofparticipantsfromtheworkers’compensationcategorymaybepartiallyexplainedbyemployeesinthiscategorypreferringnottodiscusstheirclaimexperiencespublicly.

TherewasanalmostevensplitbetweeninterviewsconductedbyphonecomparedtoattendeesattheCitizenDialoguePanel:eightscheduledinterviewsandfiverescheduledfromindividualswhodidnotparticipateinthecitizenpanel.Six(46%)oftheseinterviewswerewithindividualsfromthe‘psychological’profile,six(46%)werefromthe‘physicalinjuriesorconditions’profile,andone(8%)wasfromthe‘diseaseorillness’profile.

Therearetwospeculationsthatarisefromthedata:peoplewithpsychologicalconditionsorlearningdisabilitiesseemmorelikelytobeoutofworkandlooking,ratherthaninworkandtryingtogetbackorstaying;andinterviewsmayhavebeenfavouredforaccessibilityorprivacyreasons.Weareunabletodetermineifthesespeculationsaretrue,orwhetherthereareotherparticipantmotivationsthataredrivingthesenumbersandparticipationrates.

ExpertStakeholderInterviews

Tenone‑on‑oneinterviewswereconductedwithstakeholdersfromacrossthesectorsandsystemstounderstandtheirperspectiveofthebiggestchallengesinempoweringemployeestoobtain,stayatorreturntoworkandcapturetheirinsightsintowhatinterventionswouldbeeffectiveandwhen.

Interviewparticipantsrepresentedorganisationsresponsiblefordisabilityservices,workers’compensation,motoraccidentcompensation,employeerights,insuranceschemesandgovernmentwelfareandemploymentservices.

1.3HowtointerprettheresearchfindingsWhilsttheintendedoutcomeofthisstudyistoidentifywhatinformationandsupportemployeesneedtousegoodworktofacilitatetheirrecoverythrough‘empowerment’and‘self‑management’,thesymbioticnatureofemployees,employers,healthcareprovidersand‘system’managersinevitablyleadstocommentaryonhowthesecomponentpartsneedtochangetofacilitaterecovery.Importantpointstobeawareofinreadingthisreportinclude:

• thereareclearsynergiesbetweentheoutcomesoftheRapidLiteratureReview,CitizenPanel,CitizenandExpertStakeholderInterviewsbutthe‘solutions’maybedifferentlyexpressed

• withtheRapidLiteratureReviewfocusingoninterventionsthathaveproventobeeffective,thekeyrecommendationsinthisreportareledbyitsevidenceandconfirmedbythequalitativefindingsfromtheemployeeandstakeholderresearch

• purposeofthisstudyistoexplorehowitmightbepossibletobestsupporttheendeavoursofpeoplewithahealthconditionordisabilitytofacilitatetheirownrecoveryanddoesnotinanywayimplythatthestudyparticipantswerenotalreadytryingtheirbest

• thestructureoftheresearchactivitieswasto:conductarapidreviewoftheliteraturethatshowsdemonstrablesuccessfulorunsuccessfulinterventions;andusetheoutputsfromthereviewtostructurethesubsequentqualitativecomponents.Thisreportwillfollowthisstructure,usingtherapidreviewresultsasaframeworkfordiscussingwaystosupportindividuals’recoveries.

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2.0 Findings2.1RapidreviewresultsArapidliteraturereviewwasundertakentoidentify,evaluateandsynthesisepublishedliteratureinvestigatingempowermentinterventionstohelppeoplereturntowork,stayatworkorcommencenewworkafterinjury,diseaseanddisability.

Rapidreviewsareanemergingmethodofefficientlysynthesisingresearchevidenceinhealthpolicyandothersettingswhereabroadoverviewofresearchevidenceisrequiredinashorttimeframe.Unliketraditionalsystematicliteraturereviews,rapidreviewsfocusonsynthesisedresearchevidence.Cautionneedstobeappliedwheninterpretingrapidreviewfindings,asmorecomprehensivereviewapproachesmayelucidatefurtherinformationandinsights,whichwouldinfluencereviewinterpretationandconclusions(Khangura,Polisena,Clifford,Farrah,&Kamel,2014).Therefore,systematicreviewsremainthedefinitivemethodofliteraturereview,andwerecommendthatsystematicreviewsareundertakenwheneverpossible.

Theliteraturereviewyieldedatotalof3549citations,aftertheremovalofduplicates.Followingscreening,23systematicreviewswereidentified.AreascoveredbythereviewsarepresentedinAppendix3anddetailedinformationregardingthequalityappraisalarepresentedinAppendix4.

TheRapidReviewidentifiedeightinterventionstypes Education

Goalsetting

Mentorship

Person‑centredplanning

Problemsolving

Strength‑basedinterventions

Support

Wordaccommodation

Interventionsarechartedaccordingtowhethertheyimproveoutcomesandthequalityofthatevidence.Outcomevariablesarepresentedinparentheses.Itispossiblethataninterventiontypeisevaluatedagainstseveraloutcomessuchas‘Support(empowerment)’vs.‘Support(RTW)’.Thedatapointscanonlyvaryalongthreepossibleevidencequalityvalues(‘weak’,‘mixed’,or‘strong’)andthreepossibleevidenceofeffectvalues(‘noevidenceofeffect’,‘inconsistentevidenceofeffect’,or‘evidenceofeffect’),foratotalofninepossiblepositionsonthegraph.Becausedatapointswiththesameevidencequalityandevidenceofeffectvalueswouldsitatoponeanother,wehavefloatedthedatapointsaroundeachpossibleposition.

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Evidenceofeffect

Evid

ence

of e

ffect

Evidence of effect

Evidence quality

Inconsistent evidenceofeffect

Weak Mixed Strong

Noevidenceofeffect

Support(RTW) •

Goalsetting(workparticipation) •

Mentorship(employmentoutcomes) • Goalsetting(empowerment) •

Mentorship(empowerment) •

• Support(employmentoutcomes)• Problemsolving(RTW)

Wordaccommodation(RTW) • Wordaccommodation(empowerment) •

• Wordaccommodation(workparticipation)

• Support(Empowerment)• Person‑centredplanning(empowerment)

• Strength‑basedinterventions(empowerment)

• Education(RTW)

• Person‑centredplanning(employmentoutcomes)

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2.2InterventionrankingThequalitativeinterviewscapturedtheperspectiveofemployeesandexpertstakeholdersrelativetotheeightinterventionsidentifiedintheRapidLiteratureReview,aswellasleadingtoanadditionaltwointerventionterritoriestobringthetotalpotentialsuiteto10.

Thischartsummariseswhatwasfoundthroughevidenceandcomparesittoemployeeandstakeholderinput.

Table2:summaryofevidenceoninterventions

Intervention Evidence Employees Stakeholders

1. Work accommodation

2. Support

3. Mentorship

4. Goal setting

5. Person-centred planning

6. Problem-solving

7. Strength-based interventions

8. Education

9. Cultural change

10. System change

Key:

EvidenceColumn:

• highqualityandclearlypointstoaneffectiveintervention

• evidenceiseitherofmixedqualityorcouldn’tagreeonwhethertheinterventionworkedornot

• evidenceisofahighqualitybutnotclearlyabletodemonstrateaneffectoftheintervention

EmployeeandStakeholdercolumns:

• clearlyindicatesupportfortheintervention

• indicatesmostfavouredapproach

• didnotindicatesupportforanintervention

• hadnoopinionofaninterventionbecausetheyhadno/limitedexperiencewithitorfocusedonotherinterventions

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2.3ResponsestotheinterventiontypesEmployeeresponsestothefollowinginterventioncanbecategorisedintokeythemesof:

• informationandprocess–whatisavailabletomeandwhodoIspeakwithtogetit?”

• empathyandunderstanding–fromemployers,supportproviders,andthegeneralpublic

• degradationofmentalhealthandwellbeing–thisisanunderpinningthemetothosenotedabove,employeessaythisisunderprioritisedbysupportproviders.

Werefertothesewhendiscussingtheemployeefeedbackonthedifferentinterventions.MoredetailsareprovidedinAppendix5.

1. Work accommodation

Evidence Employees Stakeholders

What is the problem being addressed?

Workplaceaccommodationisaboutmakingchangestotheworkplaceorthewaythatworkisdonetoallowallpeopletheopportunitytoworkaccordingtotheircapacity.

What is the approach?

Workplaceaccommodationincludeschangesinworkschedulesandworkorganization,developmentoftheworkenvironment,useofassistivetechnologies,assistanceofotherpersons,andchangesincommutingtoandfromwork.Workplaceaccommodationscanfocusonasinglepersonorawholeorganisation.

What does the evidence say?

Fivereviewsonworkaccommodationwereidentifiedinthesearchstrategy.Onereviewrevealedthatworkplaceaccommodationsarerare.Whenworkplaceaccommodationsareused,themostcommontypeisflexiblescheduling/reducedhours.Thedirectcostsassociatedwithworkplaceaccommodationsareoftenlow.

Onereviewfoundmoderateevidencethatworkplaceaccommodationspromoteemploymentparticipation,butlowevidencethatworkplaceaccommodationsadministeredbycasemanagersincreasesreturntowork.Thisisnottosaythatworkplaceaccommodationadministeredbycasemanagersislesseffective,butthatthestudiesevaluatingworkplaceaccommodationsadministeredbycasemanagersareoflowquality.Weshouldbecautiousininterpretinglowqualityevidence.

Therewasstrongevidenceformulti‑domaininterventions(acombinationofhealth‑focusedinterventions,servicecoordinationinterventions,andworkmodificationinterventions)thatincludeworkplacemodificationsinreducingtimeawayfromwork.Therewasalsostrongevidencethatmulti‑facetedinterventionsareineffectivewithoutworkplaceaccommodations.

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What do stakeholders say?

Thisdirectquoteprovidesagoodsummaryofstakeholderperspectivesonworkaccommodationanddemonstrateshowstronglytheysupporttheroleoftheemployerinfacilitatingworkcapacity:

‘Employers play such a pivotal role in people trying to stay at work. Government needs to educate them more in keeping their employees healthy.’

Specificfeedbackfromstakeholderscoversanumberofthemes:

• Theneedformanagementtobesupportive–thiswasconsistentlyraisedinrelationtoreturntowork.Thedefinitionof‘management’goesbeyondtheseniormanagerandtakesinthenotionthattheemployees’supervisorandcolleagues–thepeopletheyusedtoworkwitheveryday–havethebiggestroletoplay.‘Support’includespro‑active‘reachingout’bytheworkplacetotheemployeeandthatiftheemployeeistheonetaskedwithreachingouteverytime(oftenforlittleresult),thereisaconsequentialnegativeimpactontheirconfidence.Theemployerneedstobethe‘firstmover’.

• Stigmaanddiscrimination–seenbystakeholdersasamajorbarriertoworkaccommodation.Thiscanbeeitherconsciousorunconscious(commentssuchas‘theyshouldhavereturnedtoworkbynow’)andrelatebothtoobtainingwork(‘whyhasn’tthispersonworkedfortwoyears’;oracquireddisabilityandtheassociatedsocietalperceptualbarriers),aswellasforthosestayingatorreturningtoworkespeciallyforthosewithamentalhealthcondition.Stakeholdersregardashighlyimportanttheneedtocreateawarenessandunderstandingthatpeoplecanhaveadisability,gothroughaninjuryorillnessandstillhavecapacitytowork.

• Jobmatch–stakeholderssuggestthattherearetoolsalreadyavailablethatshouldbeusedto‘jobmatch’forexample,personalitytestscanbeusedmuchbetterforjobmatching.

• Recruitmentmethods–thosebornwithorhavingacquiredadisabilitydonothavethesameopportunitiestoworkouttheircareerdevelopmentorworkexperienceastheirnon‑disabledpeers.Eventhewayemployerstalkaboutandrecruitmakesithardforpeoplewithadisabilityforexample,:itmaynotbeclearfromthejobdescriptionwhethertheycandothejob;onlineapplicationsmaybeanimpedimentiftheycan’tuseamouseorhavevisualimpairments.Thosewithadisabilityarenottheonlyonesimpactedbyrecruitmenttactics–recruitmenttoolssuchas‘massinterviews’canbedauntingforsomeonewhoislackingconfidence,hasasociallyimpactinghealthcondition(e.g.someonewithAsperger’smaybeageniusITtechnicianbutisunabletocommunicate/sellthemselves)orhasbeenoutoftheworkplaceforsometime;theycanbedeterredfromevenapplyingforthejobinthefirstplace.

• Lackofemployeeunderstandingofwhattoexpectfromtheiremployer.

• Drivenbyrisk–Employersareriskadverseinacceptingemployeeswhoarenot100%well.

• Thereisalsoaneedtoempoweremployers–evenanemployerwillingtoemployeesomeonewhorequiresamodifiedworkenvironmentcanbedisempoweredthroughtheirsimplelackofknowledgeofhowtogoaboutitorwhatwillberequiredofthem.

What do employees say?

Thisinterventionaddressesthethemeofempathy and understanding.

Theworkplaceaccommodationsthatemployeeshadmostexperiencewithwereflexibleschedulingofworkhoursandswitchingtolightduties.Employeesnotedthattheseweretemporarysolutionsandtheirsuitabilityvarieswithindividuals’conditions.Othersnotedthatachangeindutiescanbetraumaticbecauseitmeansswitchingfromworkthatyouhavebuiltacareerontosomethingdifferent.Therearecleardifferencesinthereactionsofpeoplewhohavenotbeenoutoftheworkforceforverylongversussomewhohadbeenoutofworkforasignificanttime–thelongersomeoneisoutofwork,themorewillingtheyaretodoanything.Forinstance,somesaidtheywouldn’tbehappywithlightdutiesforthelongterm,whereasotherswhohadbeeninjuredforlongersaidthattheywouldhappilydoanythingwithintheirskillset.

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Gradedreturntoworkwasseenasanimportantformofworkaccommodation.Oneemployeecommentedthatsomeworkplaceaccommodationsarestraightforwardandeasytosecure,whereasothersaremorechallengingwhentheindividual’shealthconditionordisabilityislessvisible.

Finally,employeesmentionedthatjobsexistbuttherearefewemployerswhoarewillingtoaccommodatethosewithhealthconditionsordisabilities.

Employeesreflectedthestakeholderideathattheiremployerreachingouttothem,evenifthatisjusttheoccasionalcheckintoseehowtheyare,hasademonstrableimpactontheiremotionalwellbeingandconfidenceintheirfuture.ThiswasdemonstratedquiteclearlyintheCitizenPanelbyoneemployeewhoseemployerhadmaintainedregularcontactwiththem,andtheiremotionalwellbeingcomparedtootherpanelparticipants.

What has helped/could help?

• Flexibilityandunderstandingonthepartoftheemployer.Aforumforemployerswhoareopentoaccommodatingthosewithdisabilitytoadvertisejobpositions.

• StandardsestablishedforEmployers.

• DisabilityConfidentRecruiter.Anorganisationshouldhavetogothroughaprocessthatmakesalltheirsystemsaccessibleandinclusive.

• Theneedtoremoveemployerandculturalstigmaandbarriers–whetherconsciousorunconscious–andcreateawarenessofthebenefitsof‘goodwork’.

• Educatingemployersongoodjobdesign–howtodesignthejobtohavetheappropriatebreadthanddepth.Thatmeansclarity,authority,delegationofdutyanddecision‑makingautonomy,variationoftask–goodwork.

• ‘Onthejob’trainingforintellectuallyorphysicallydisabled–ratherthantertiaryeducation.

• Policiesthatexplainwhathappensandcommittodoingwhateverisreasonableifanemployeecannotwork/hastochangetheirworkingcircumstancesandguidancethathelpsemployeesunderstandhowtorespondiftheyareexperiencingdifficulties.

• Job coaches.

2. Support



Itcanbedifficulttomanageyourhealthconditionordisabilityifitimpairsyouphysicallyand/ormentally.Thatmeansitcanbeespeciallydifficulttofindorgetbacktowork.Supportisaboutmakingjob‑seekingandreturntoworkeasierforthosewithahealthconditionordisability.


Supporttakesmanydifferentforms,sometimesit’saboutspeedinguptheprocessofgettingsomeoneintonewwork,othertimesit’sabouthelpingpeoplestayinexistingwork.Thelatterformissometimesreferredtoasa‘place‑train’modelandIndividualPlacementandSupport(IPS)isthemoststructuredandwell‑definedformofthisapproach.Itisbasedonthephilosophythatanyoneiscapableofgainingandmaintainingcompetitiveemployment,providedtherightjobwithappropriatesupportcanbeidentified.Otherformsofsupportedemploymentcanincludecoachingandeducation.Supportedemploymentmayalsobeaugmentedforexamplewithadditionalrehabilitationorskillstraining.

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Evidencefromninereviewswaslargelyinfavourofsupportapproachesforimprovingempowerment,workparticipation,andreturntowork.Individualplacementandsupportprogramsareaneffectiveinterventionacrossavarietyofcontextsandeconomicconditionsandareperhapstwiceaseffectiveastraditionalrehabilitationprogramssuchas‘train‑place’modelsforgettingpeopleintowork.Theevidencerangedfromtentativetostrongforaugmentedsupportedemployment.Therewasmoderatetostrongevidencethatcoachingandeducationsupportimprovesreturntoworkandsicknessabsenceoutcomes.Notallreviewsarrivedatthesameconclusion–somefoundinsufficientevidenceforeffectivesupportstrategiesinobtainingandmaintainingemployment.


Stakeholdersinrolesofhelpingpeoplefindsuitableemploymentbelieve‘motivation’and‘confidence’isacriticalfactorofbeingabletofindwork.Theideasthatstakeholdersputforwardconsistentlywenttothesetwothemes:

• Training,retraining,reskillingtogain,retainorre‑enterwork.

• Motivationalinteractiontrainingtoimproveconfidence.

• Toolsonhowtogetajob–resumewritingetc.


Thisinterventionaddressesthethemeofdegradationofmentalhealthandwellbeing.Employeesbelievetoomanysupportprogramsfocusonphysicalsupportandskillstraining–therearefewprogramsaimedatsupportingmentalhealthduringrehabilitationand/orthejobsearch.Accesstorelevantsupportprogramsisalsosometimesdifficult,withoneemployeesaying

“You need to make yourself look twice as bad in order to get half the help you need”

Thissentimentwasalsoechoedbystakeholders.


• Training,retraining,reskillingtogain,retainorre‑enterwork.

• Motivationalinteractiontraining.

• Toolsonhowtogetajob–resumewriting,interviewpractice.

3. Mentorship



Navigatingdisabilitysupportsystemscanbeafrustratingandlonelyexperience.Mentorshipaddressesbothproblemsofhandlingcomplexityandofdoingitalone.


Mentorshiprelationshipsinvolvetheprovisionofongoingguidance,instruction,andencouragementfromamentorwithexperiencetopromotecompetenceandemploymentparticipationonthepartoftheindividual.

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Tworeviewssuggestthattheevidenceregardingmentorshipismixeddependingontheoutcomemeasure.Mentorshipmaybeeffectiveforimprovingemploymentorwork‑relatedoutcomes,thoughthequalityoftheevidenceislow.However,evidenceregardingtheeffectivenessofmentorshipinimprovingempowermentisinconsistentandalsooflowquality.

Someevidencesuggestedthatmentorshipcouldincreasedepressioninindividuals.Consideringthatamentormaybeapersonwithasimilardisabilityastheindividual,developingarelationshipwiththismentormayhighlighttheindividual’sownhealth‑relatedproblems.Anotherconcernisthatmentorsmayofferadviceoutsidetheirdomainofexpertise.Mentors,therefore,maybeworkplacementorswhocanhelptheindividualintheiremploymenttransitions,lifementorswhocansupporttheindividualsocially,orhealthmentorswhomaysharesimilarhealthexperiencesastheindividual.


Stakeholdershighlightthata‘lossofconfidence’startsimmediatelyandgrowsthelongersomeoneisawayfromwork.

Whilstinnowaysuggestingtheyshouldbecomeanominatedmentor,stakeholdersseetheclaimsmanagerasbeingabletotakeastrongerroleinencouragingtheircustomerstowellbeingandwork.Stakeholdersareconcernedthisiscurrentlylimitedbytheprocessdrivennatureofschemesthattypicallydisempowerclaimsmanagersfrombeingabletomakejudgementsandabilitytoformvaluablerelationshipswithclientstohelpmotivatethem.


Mentorshipapproachesspeaktothethemesofinformationandprocess,anddegradationofmentalhealthandwellbeing.Mentorsorsupportgroupswereoftentheonlywaythatemployeesfelttheycoulddiscoverwhatservicestheywereeligiblefor.Mentorshipswereofteninformalrelationshipsorvoluntaryinnature–employeesvoicedconcernabouttheover‑relianceonvolunteernetworks.Mentorsalsoprovidedsocialandemotionalsupportasmentorsoftensharedsimilarexperiencesorsituationstotheemployee.


• MakeClaimsManagersinto‘relationshipmanagers’andcreateabespoketrainingprogram.

• Useadvocacyorganisationsthatareintouchwiththeneedsoftheirspecificgroupe.g.spinalcord associationasacentralforum.

• UseBehaviouralEconomicstheorytorestructurelanguagethatispositive,constructiveandfuture focused.Introducethenotionofre‑engagingwithlife(notjustwork).

• Developawebplatformthatcontainsrelevantservicesandmotivationaltools.

4. Goal setting



Goalsettingapproachesareaboutstagingrehabilitationorjob‑seekinginordertopreserveandenhancemotivation.

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Thepracticeofsettinggoalsisthoughttoinfluenceindividuals’feelingsofempowerment.Bythoughtfullysettingmeasurablegoals,individualscantrackprogressintheirrehabilitationorreturntowork.Successfullymeetingthesegoalsisthoughttoincreaseaperson’sbeliefintheirabilitytoachievefurtheremployment‑relatedgoals(self‑efficacy).


Tworeviewslookedattheeffectofgoal‑setting.Goal‑settingapproachesmaynurtureempowerment,althoughthequalityofevidencewasmixedbutevidenceforimprovingworkparticipationandoccupationalperformancewasmixed.Itmightbethatgoal‑settingmaybeusefulforrehabilitationbutnotnecessarilyhelpfulwithemployment.


Stakeholdersbelieveoutcomesarebetterwhendealingwithsomeonewhounderstandsthechoicestheyhaveandwhatsupportcanbeputinplacetoachievethose.

Theyalsosupporttheideaofgettingtheemployeetocommittothingstheywilldo‘onestepatatime’–dependingonthecircumstancesoftheperson,agoalandachievementmaybeassimpleasawalktotheendoftheroad,makingamealortalkingtosomeoneinashop.


Goal‑settingapproachesaddressthethemeofdegradationofmentalhealthandwellbeing.Employeesseegoal‑settingasanimportanttoolinachievingtheiremploymentgoals.Goal‑settinghelpswiththementalhealthaspectofrecoveryaccordingtoemployees.Achievinggoalshelpsalleviatefeelingsofhelplessnessbydemonstratingwhattheindividualisstillcapableofdoing.


• Whileemployeesvaluegoal‑setting,theybelievethatotherthingsneedtobedonefirstbeforegoal‑settingstrategiescanbeeffective.Forexample,somethinkthatanoverhaulofcasemanagementactivitieswouldbenecessarybeforegoal‑settingstrategiescouldbeeffective.Employeeswantsupportprovidersandcasemanagerstobemoreinvolvedintheircaseandseesharedgoal‑settingasapotentiallyeffectivemeansofdoingso.

• Improvinghealthliteracyindirectlyimpactsgoal‑setting.Healthliteracyincludestailoredinformationthathelpspeopleunderstandwhatwillhappenthroughouttheirrecoveryjourney,howtogetthesupporttheyneedandhelpsthemidentifywhatispossible.

• Theuseoffuture‑focusedlanguageisanaidtogoal‑setting.

5. Person-centred planning



Employeesoftenfindthattheservicesandsupportprovidedtothemarenotsuitedtotheirneeds.Person‑centeredplanningaddressestheproblemofindividualsuniqueneedsfallingthroughthecracksforexample,aspeopletheymovebetweendifferentbenefitandincomesupportsystems.

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Thereisanongoingtransformationofdisabilityservicedelivery,progressingfromasystem‑centeredapproachtoaperson‑centeredapproach.Underaperson‑centeredapproach,supportandservicesaretailoredaroundtheindividualandtheiruniqueneedsratherthanenforcingaone‑sizefitsallapproach.Person‑centredplanningisanapproachaimedatachievingindividualisedsupportforpeoplewithdisabilityandtreatingthemwithdignity,compassion,andrespect.


Onereviewfocusesonperson‑centredplanning.Therearesmall‑scalesuccessesofperson‑centredplanningapproachesimprovingempowerment(i.e.communityandlifeparticipation).Theevidenceofthesesuccesses,however,isoflowqualitysocautiousinterpretationisadvised.Theevidenceforperson‑centredplanningimprovingemploymentoutcomesisinconclusive.


‘Schemes work in streams. But that doesn’t work for the client.’

Stakeholdersverymuchsupporttheideaofaperson‑centeredapproachwithsomealreadyachievingresultsintheirownsystemwiththisapproach.Stakeholderfeedbackwasthat‘thesystem’makesthepersontheproblemandthewayitisrunassumesthesystemknowsmoreabouttheemployeethattheindividualknowsaboutthemselves–‘wedothingsTOpeople’.

Stakeholdersareconsciousofhowmuchbeingpartof‘thesystem’detrimentallyexacerbatestheperson’ssituationandhowdealingwiththesystemcanactuallyleadtosecondarypsychologicalconditions.Thetypesofbarrierspeoplefaceincludesituationssuchas:

• wantingtoreturntoworkbutnotbeingallowedto–‘theywon’tletme’

• notknowingwhoisresponsibleforwhat,whatresourcesareavailable,orwheretogoatwhatpointintimeintheprocess

• long,drawnout,confusingsystems– ‘even if you know what you’re doing its hard and demotivating’

• theneedtorepeattheirstorymultipletimesandre‑provetheircasewhenmovingbetweenjurisdictionsoriftheygetsomeworkbutendupneedingtogoonapensionagain.

Theuniversalopinionofstakeholdersisthattheemployeeneedstobeputatthecentreoftheclaimandthatitisimportanttheyareheardandunderstood.

‘Get them to identify what they need and co-design their journey. If they co-own the way forward, they will be better engaged, more likely to make a success of the plan and less likely to fall back into the compensation system once they’re working’.


Person‑centeredplanningaddressesthethemesofinformation and processandempathyandunderstanding. Employeeswouldwelcomeanincreaseinperson‑centeredplanningapproaches.Theysaywhilethecurrentapproachofone‑size‑fits‑allmayprovideabareminimumlevelofsupport,employeesoftenneedmorenuancedunderstandingfromsupportproviders.Theeffectofaone‑sized‑fits‑allapproachleavesemployeesfeelingignored,withoneemployeesaying:“… but it’s not person-focused, they’re indifferent and that is what breaks people”.Employeesalsoexplainthattherelianceonaone‑size‑fits‑allsystemhasledtoafeelingamongemployeesthatsupportprovidersassumeallclientsarecheatingthesystem.

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• Employeessaidthataperson‑centeredapproachprobablyrequiresakeycontactorcasemanager,andthesuccessoftheapproachreliesheavilyonthequalityofthiskeycontact.Anotherpossiblebarriertoeffectiveperson‑centeredapproachesreliesontheindividual’spersonalmotivation.Someoftheemployeeswespoketosaidtheywouldratherbetoldwhattodobyexperts.Otherssaidthattheydidnotwanttositinthedriver’sseatbecausetheybeeninthedriver’sseatforyearsandgotnowhere.

• Betterpathwaysbetweensystem–thatincludescommonforms,commonprocesses,commonlanguage,commonstandards(e.g.forclaimsmanagers).

• Simpleaccessibletoolspeoplecanuseandunderstand.

• Stakeholderssuggestarecognisedleadertoachievecommonagreementacrossthevariousjurisdictions.

• Atriagesystemeitherinthesamemannerasa‘triagenurse’thathelpsguidepeopletotherightservices,oranevenbiggersuggestionofauniversaltriagesystembringingalltheexpertstogether–onestopshopsourceofmedicalandjobexpertsincludingwellbeing,doctors,psychologists,commonlawandarelationshipmanagerlinksdirectlytothese.

• Providerpartnerships.Createpartnershipwithhealthprovidersallcontributingtotheindividualemployeeplan.

6. Problem-solving



Disability,injury,andillnesscancausechronicstress,whichcanbemanagedbyhelpingindividualstochangehowtheyapproachtheirdifficulties,andgainskillstocopeeffectivelywithstress.Problem‑solvingapproachesareaboutgivingindividualsatoolkitformanagingcondition‑relatedstress.


Duringthelastdecade,therehasbeenanincreaseinthenumberofstudiesthathaveexaminedtheeffectivenessofinterventionsthatincorporateteachingproblem‑solvingskillstoworkerswhoarereceivingdisabilitybenefits.Theseskillsareaimedatenablingthemtosolvework‑relatedproblems.Evidencesuggeststhattheseskillshelptodevelopasenseofcontrolregardingstressors.Inturn,thiscanmoderatetheeffectsofworkstressorsthatcouldcontributetodisabilityandillhealth.


Threereviewswereidentifiedonproblem‑solving.Thereviewssuggestedthattheseinterventionsshowmostpromiseforpartialreturntowork,butnotsoforreturntofullduties.Problem‑solvinginterventionsalonemaynotbeenoughtoreducesickleavebutacombinedproblem‑solvingandatherapyinterventionsuchas,cognitivebehaviourtherapydidhavesignificanteffectontotalsickleavedays.Otherevidencewasmixed.


Therewasnodirectreferencefromstakeholdersbutimprovinghealthliteracywasamajorouttakefromthestakeholderinterviewsandthisgoessomewaytothenotionofproblemsolving.

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Problem‑solvingapproachesaddressthethemeofdegradation of mental health and wellbeing.Employeeshadlittletosayregardingproblem‑solvingapproaches.

7. Strength-based interventions



Asuddenchangeinhealthcanincreasefeelingsofhelplessnessandvulnerability.Strength‑basedinterventionsareaboutincreasingempowermentbyfocusingontheindividual’sstrengths.


Qualitiessuchasself‑efficacy,socialproblem‑solving,senseofpurpose,empathy,humour,resilience,andhopearealltargetedbystrength‑basedapproaches.Strengthscanbeconsideredatthepersonallevel(self‑efficacy)orattheinterpersonallevel(positivecaringrelationships),andtheapproachemphasizesthateverypersoncanbuildameaningfulandsatisfyinglifewithafocusontheirstrengths.


Wefoundonereviewthatconsideredstrength‑basedinterventions.Theresultssuggestthatastrength‑basedapproachmayimproveempowerment(e.g.self‑esteem,self‑efficacy,senseofhope)buttheevidencequalityisquestionable.Therearenotenoughstudieswithstrongmethodologytoconcludethatstrength‑basedapproacheswork.

Additionally,thereisdifficultyisolatingtheeffectofstrength‑basedapproachesastheywereoftenasingleelementwithincomplex,multifacetedinterventions.Inthecaseofseverepsychologicalsymptomologyforexample,suicidalideation,cliniciansarecautionedagainstusingonlyastrength‑basedapproachcompletelyisolatedfrommedicaltreatmentapproaches.


Thelongerapersonisin‘thesystem’,thegreaterthelossofconfidenceandtheharderitistorebuild.Oneofthestakeholdersprovidesmotivationaltrainingfortheirclientsandothers,whilstnotusingaformal‘motivational’system,traintheircustomerinterfaceteamsinpositivereinforcementskills.


Strength‑basedapproachesaddressthedegradation of mental health and wellbeing.Employeeshadlittletosayregardingstrength‑basedapproaches.

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8. Education



Understandingaconditionisanessentialfirststepinrecovery.Educationisabouthelpingindividualstounderstandtheirconditionandnavigateissuesthatrestricttheirabilitytowork.


Educationinterventionsseektoinformindividualsaboutthesideeffectsoftheirconditions,aswellastechniquesforcopingandmanagingstress.Mostinterventionsusesomeformofcounsellingtoaddressparticipants’disease‑relatedanxietiesandprovideinformationonthecausesandcourseoftheirconditiontodispelmisconceptions.Thesearesometimesreferredtoas‘psycho‑education’approaches.


Tworeviewsevaluatededucationapproaches.Educationmightbeusefulforrelievingcondition‑relatedanxietythoughthequalityofevidenceislow.Evidenceisunabletoshowthateducationhasabeneficialeffectonreturntoworkratesandoutcomes.


Outcomesarebetterifyouaredealingwithsomeonewhounderstandstheirchoices,whatsupportcanbeputinplace,andbeengagedinthatsupport.

Thisalsomeansimprovinghealthliteracy–understandingthattheyshouldbeabletogetbacktowork,workisgoodforhealthandisaformoftherapeuticintervention,thatwaitingforrecoverycandelayrecovery,andknowingtheyneedtogethelp.

Educationisalsohelpingpeopleunderstandwhattypeofworkmightbeanentryforthem–notnecessarilyalong‑termsolutionbuttore‑enter(lowerstatus,lowerpayisapsychologicalblowthatneedsframing)andtailoredinformationtodemonstratewhathappens/howtohelpindifferentcircumstances.


Educationapproachesaddressthethemeofempathy and understanding.Employeesfeltthateducationwouldbeabroadlyusefultool–notforthemselvesbut,rather,forthepeoplearoundthem.Employeesarealreadyeducatingthemselvesasmuchaspossible,mostlyoutofnecessity,sofurthereducationmaynotbethemosteffectivetoolforthem.Whereeducationmightbemoreeffectiveisineducatingothersthattheseemployeeshavetointeractwith.Employeesdescribedaneedforeducationaimedathigh‑levelculturalchange,aswellaseducationaimedatlow‑levelindividualchange.

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Educationforsupportproviders,casemanagers,employers,GPs,families,andthegeneralpublicwouldhelpempoweremployeestoachievetheiremploymentgoals.Accordingtotheemployees:

• supportprovidersandcasemanagersneedexpertisewhenworkingwithpopulationswithhealthconditions,insteadofapplyingaone‑sizefitsallapproachthatworksforthegeneralpopulation

• educatingemployersaboutthementalhealthandwellbeingcomponentofrehabilitationandreturntoworkwouldhelpcreateflexibleandunderstandingworkplaces

• thereiswidevariabilityinGPs’understandingoftheworkdisabilitysupportsystem–GPeducationwouldhelpkeepthestandardmoreconsistent

• familiesneedtobeincludedintheeducationprocessastheyoftenfeelhelpless.Changesinmentalhealthmaynotalwaysbeobvious,soteachingfamiliesaboutmentalhealthcouldhelpthemfeelequippedforsupportingtheirfamilymember.

• finally,employeesfeltthattheirrecoveryandreturntoworkwouldbegreatlyhelpedbyeducatingthegeneralpublictobemoreawareandconsciousofthosewithdisabilityorconditionsthatmakeitdifficultforthemtowork.Someemployeeshighlightedhowtheirconditionshadnovisiblesymptoms,sowouldhavedifficultyreceivingsupportfrommembersofthepublic.Othersreportedhostilityandmicro‑aggressionsdirectedtowardsthembecauseoftheirinjury/condition.


• Culturalchangearoundstigma,discriminationandthebenefitsofgoodwork.

• Healthliteracyprograms.

• Educationaroundthevalueofjobdesignandhowtoapply.

9 &10 Culture and System change

Employees Stakeholders

UndertheRapidLiteratureReviewsearchterms,noevidencewasidentifiedunderthecategoryof‘culturechange’,butrecognitionoftheneedforculturechangecameoutstronglyintheexpertstakeholderandemployeeinterviews.

Furthermore,withitsacademicprincipleofassessingspecificinterventions,theabilityorpurposeoftheRapidLiteratureReviewisnottounderstandtheinterplayacrossdifferentcomponentsofthebenefitandincomesupportsystem.Whereasforemployeesandexpertstakeholdershowthesystemworksiskeytoempowerment.

Muchoftheemployeeandstakeholdercommentarythathasbeenrelayedinthepreviouspagesallpointtotheimportanceofcultureandsystemchange–suchaspoorunderstandingbyemployersofthevalueofemployeeswithaphysicalorpsychologicalconditionandtheimportanceofchangingnormsaroundnotonlytheirperceptions,butalsotheperceptionsofthemanyplayersinvolvedintheprocessesofthebenefitandincomesupportsystemincludingdoctorsandclaimsmanagers);orthecallfromemployeesforinterventionsthatfacilitateeasieruseofandgreaterempathyfrom‘thesystem’.

Furtherexamplesoftheneedforcultureandsystemchangecanbeseeninthefollowingpageswheremoredetailedinterventionsuggestionsbyemployeesarecaptured.

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3.0 Other Empowerment Interventions TheempowermentinterventionsdescribedinthissectionwereidentifiedthroughtheCitizenPanelandindividualinterviewswithemployeesandexpertstakeholders.

Compassionandunderstandingtrainingforcasemanagers

Whatistheproblembeingaddressed?

Casemanagersmaynothavetheunderstandingorflexibilityinordertomostadequatelysupportindividualswithhealthconditionsinreturningtowork.


Compassionandunderstandingtrainingforcasemanagersrelatestothethemeofempathy and understanding.Anissuethatarosefromseveralconversationswithemployeeswasthatcasemanagersoftenlackcompassionorevenabasicunderstandingoftheemployee’scondition.Littleunderstandingfromthecasemanagerhasaflow‑oneffecttothesortsofservicesthattheemployeeisgivenaccessto.


• Greaterprovisionsforsupportproviderstogo“off‑script”–anideathatwasactivelypromotedbystakeholders.

• Stakeholdersalsoraisedtheideaofmotivationalinteractivetrainingforclaimsandcasemanagers

AdvocacygroupsWhat is the problem being addressed?

Individualscanfeelminisculeagainstthesystemwhentheyaretryingtosecurethebestsupportforthemselves.


Advocacygroupsaddressthethemeofinformationandprocess.Employeesoftensaidthelargestdrainontheirmotivationwasconstantself‑advocacy.Needingtobe“ontopofeverysinglecoginthesystem”wasdescribedasdraininganddemotivating.Someemployeessaidtheywerefortunatetohaveanadvocatehelpingthemtonavigatethecomplexityand“couldn’timaginesurvivingtheordealwithoutone”.Employeesthensuggestedthatmoreformalizedadvocacygroupswouldbeofbenefittotheirreturntowork,thoughotherscautionedontheoverrelianceofvolunteers.

Advocacygroupsdifferfrommentorshipprogramsinthattheyaremorefocusedonnavigatingthesystemswithspecificguidanceandunderstanding,whereasmentorsappearmosthelpfulinmoregeneralcontextsforexampleinnavigatingtheworldwithanew‑foundhealthcondition).

Whilethereisconsiderableoverlapbetweenadvocacygroupsandmentorshipprograms,wehavekeptthemseparatetoreflectthesource–hereasanitemthatemployeesproducedasaresourcetheyhavereliedon,andmentorshipprogramsasaninterventiondiscoveredintherapidreview.


Awebsitetoconnectindividualstowillingvolunteers.

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EmployerforumsWhat is the problem being addressed?

Job‑seekerswithhealthconditionsexpressfrustrationinsearchingforemployerswhoarewillingtoaccommodatetheircondition.Employeesarealsofrustratedthatjobserviceproviderslacktheabilitytomatchthemupwithwillingemployers.


Employerforumsaddressthethemesofinformation and process and empathy and understanding. Employeeslookingfornewworkfinditdifficulttoconnectwithemployersthatareflexibleandwillingtoaccommodateworkerswithdisabilityorimpairment.Anemployerforumthat:educatesemployersaboutworkplaceaccommodation;connectsemployerswiththosewillingtowork;andmakesiteasierforjobserviceproviderstobuildanetworkofpotentialemployerswouldhelpaddressanumberofissuesemployeesfacewithworkplaceparticipation.


Buildawarenessandunderstandingofgoodwork.

Stakeholders say

There’saneedtocreateauniversalawareness,understandingandabeliefamongstemployers,employees,healthprofessionals–allAustralians–that‘goodwork’isgoodforyouandthatgettingbacktoworkbeforeyou’re100%wellisaprovenaidtorecovery(withappropriatemedicalclearance).

‘We (the industry) all talk about the benefits of good work, but we’re in a bubble – we need to get the message beyond the people in the industry. As a nation we need to accept the importance of work.’

TransitionseminarsandmanagersWhat is the problem being addressed?

Employeesdescribethesupporttheyreceiveasfracturedandtheywantitsimplifiedtosomethinglikeaflow chart.Transitionmanagementrepresentsaunificationofsupportserviceswithafocusonnavigatingthetransitionintowork.


Transitionseminarsandmanagersaddressthethemeof information and process.Akeyoutcomefromdiscussionswithemployeesisthedesireformorecentralisedprocessregardingsupportprovisionandreturntowork.Onespecificexamplefromdiscussionsincludedthenotionsoftransitionseminarsandmanagers.Thisideaborrowsfromthedefenseforce,wheredefensepersonnelaredebriefedfromtheirdutiesandpreparedforlifeasacivilian.Asimilarexercisecouldexistforapersontransitioningfromonestageofemploymentparticipation(e.g.unemployed)toanother(e.g.part‑timeemployment).A‘transitionmanager’representsanevolutionofthecurrent‘casemanager’rolebutwithafocusonthewellbeingoftheemployeeastheynavigatetheirrehabilitationandreturntowork.


Willingnessfromsupportproviderstoinvestigatealternativesupportmethods.

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GroupactivityaccessWhat is the problem being addressed?

Employeeswithhealthconditionssometimesfeellikethere’snothingtheycandoandhavelowself‑efficacy.Theyalsofeelisolatedwhentheyareunabletowork.Groupactivityprovisionaddressestheseproblemsoflowself‑efficacyandisolation.


Activityprovisionwasakeyfocusforanumberofemployeeswhosewellbeingsufferedbycomingoffworkandsuddenlyhavingnothingtodo.Fromawellbeingperspective,employeesdiscussedthenotionofsupportprovidersofferingwellbeingactivitiessuchasgymmemberships,artclasses.Importantly,thesewouldeitherbeactivitiestobecompletedasagroup(grouprehabilitationatagym)orwereinherentlygroup‑oriented(artclasses).


Confidenceandknowledgewouldhelpindividualsapproachnewgroupsandactivities.Sometimestheydon’tknowwheretofindsuchthingsanditwouldbehelpfulifacasemanagerorweb‑basedplatformcouldpointthemintherightdirection.

Group‑basedcasemanagementWhat is the problem being addressed?

Navigatingthedisabilitysupportsystemcanbedifficultandlonelyasanindividual.Group‑basedcasemanagementallowsindividualstoshareknowledge(makingnavigationeasier)andexperienceswithothers.


Accordingtotheemployeeswespokewith,oneofthemostdifficultaspectsofbeingunabletoworkissocialisolation.Thenegativeeffectofisolationontheirmentalhealthandwellbeingwasclearlyveryimportanttoemployees.Anothersideeffectofsocialisolationwasthatemployeeswereunabletofindrelevantinformationwithoutthehelpofanotherpersonwhohadthesameexperience.Employeessuggestedthatgroup‑basedcasemanagement,wheresupportproviderscouldmanagethecasesofseveralemployeeswithsimilarconditionssimultaneously,couldsolveboththeseproblems.Bymeetingtogetherinthesamespace(physicalordigital),employeescouldshareexperiences,sharelearnings,andinteractwithothersforsocialsupport.


Awillingnessonthepartofthesupportprovidertoconsideralternativesupportstrategies.

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CustomerfeedbackasaKPIWhat is the problem being addressed?

Supportprovidersareperceivedaslackingtransparency.Empoweringindividualsbymakingcustomerfeedbackpartofthesupportprovider’sKeyPerformanceIndicator(KPI)couldaddressthisissueoftransparency.


Alargeissueforemployeeswasaperceivedlackofaccountabilityandtransparencyonthepartofthesupportproviders.Employeeswespoketofeltthatasolutioncouldbetoincludecustomerfeedbackintheperformanceevaluationofsupportproviders.

What has helped/would help?

Aplatformforcollatingcustomerfeedback.

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Table3:Summaryofpossibleinterventions

Category Problem Desired outcome Possible intervention How does the intervention empower individuals?

Culture change

Culturechange Societalattitudesandbeliefspreventindividualswithhealthconditionsfromfullparticipation(life,work).

Changeinsocietalattitudesandbeliefsregarding'goodwork';permissiontoGPsforsuggestinggradualreturntowork;permissionforfamiliestobecomfortablewithemployeereturningtowork.

Anawarenesscampaigntochangebeliefsandattitudes.

Empoweringthingsthatindividualscannotactionthemselves(dependentempowermentprovidedbyothers)

System change (support providers)

Person‑centredplanning

Supportproviderslacktransparency(e.g.employeesareonlymadeawareofaportionofservicesavailabletothem)

Supportprovidersprovidelistoffullsuiteofsupportoptions.

Educatedecision‑makersfromsupportprovidersonimportanceoftransparencyandtoolstoenablethis.


Employeesoftenfindthattheservicesandsupportprovidedtothemarenotsuitedtotheirneeds‑feelliketheyfallthroughthecracks.

Supportprovidersrestructuretheirsupportdeliveryaroundperson‑centredplanning

Engagesupportprovidersinthedevelopmentandapplicationofacommonsetofprinciples(eg:co‑designingrecoveryprogramwiththeemployee,enablingandtrainingclaimsmanagersonhowtogo'off‑script')thatincludeshortterm'simpletouptake'and'longterm'programchangesindelivery.


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Systemstreamlining

Supportisfractured,complexandconfusing.

Improveeaseofuse,betterconsistencyandbetterconnectionbetweensystems.

1.Engagewithprovidersindevelopingcommonlanguageandcommonformstomaintainconsistencyofexperiencebetweensystemsandmedicalservices.


2.Provideacrosssectoronlinetriageservicepersonedbyrealpeoplewhocanhelpnavigatethroughdifferentsystemsandtodifferentservices.

Empoweringthingsthatindividualscanactionthemselvesbutreliesonactionfromsomeoneelse(dependentself‑empowerment)

Employeeshavetorepeattheirstoriesandmedicalrequirementsmultipletimesthroughouttheirjourney,especiallywhentransitioningthroughdifferentpointsofthesystem.

Improveeaseofuse,betterconsistencyandbetterconnectionbetweensystems.

1.Investigatetoolsandoperatingstructuresthatcande‑duplicateprocessesandenablesharingofinformationacrosssystemsandproviders.

2.Identifyatransitionmanagementprocessthatfacilitatestheeaseofmovementfromonesystemtothenext.



Education Changesinhealthconditionscausestressandanxiety

Improvedhealthliteracyforemployeesandtheiremployersandfamilies

Psycho‑educationapproachtoincreasehealthliteracy


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Goal‑setting Disability,injury,andillnesscantaketheirtollonmotivation.

Goal‑settinginterventionsofferedbysupportproviders.

1.Goal‑directedoccupationaltherapyprogram.

2.Usebehaviouraleconomicsstrategiestotrainclaimsmanagerstointroducegoal‑settingobjectivesintotheirinteractionswiththeirclient.



3.Reframelanguagetopositivemotivation.


Problem‑solving Disability,injury,andillnesscancausechronicstress

Problem‑solvingincludedinsupportofferedbysupportproviders.

Problem‑solvingskillstrainingdeliveredbyoccupationaltherapist


Mentorship Navigatingthebenefitandincomesupportsystemcanbeafrustratingandlonelyaffair.

Maintaintheconfidenceandmomentumoftheemployeetostaypositive.

Providemotivationaltrainingforclaimsmanagers.


Strength‑basedinterventions

Asuddenchangeinhealthcanincreasefeelingsofhelplessnessandvulnerability.

Strength‑basedinterventionsincludedinsupportofferedbysupportproviders.

Incorporatingarehabilitationandreturntoworkstrategythatplaystotheindividual’sstrengths.


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Work accommodation (employers)

Education Jobdescriptionsdonotconveywhetherthejobcanbedonebysomeonewithahealthcondition.

Advertisementsforjobpositionsincludeastatementofminimumrequiredability.

Educatedecision‑makersfromemployersontheimportanceofinclusivelanguage,andhowemployeesdonotneedtobe100%healthytobeproductive


Support Employeesconstantlyreachout,oftenforlittleresult

Employersreachouttoemployeesaspartofclaim/casemanagement.

Designinterventiontotrainemployerstoreachoutfirstandoftentoemployeesduringtheirrehabilitation.


Workaccommodation

Groupinterviewscanbedaunting. Hiringpracticeschangedtobemoreinclusive.

Developguidelinesandeducationprogramsforemployersandrecruitmentagencies.


Education Difficulttofindemployerswhoarewillingtorecruitpeoplewithhealthconditions.

Increasewillingnessofemployerstohirethosewithhealthconditions.

Createaforumfor:(1)providingemployerswitheducationmaterialsregardinggoodwork;(2)developingjobserviceprovidersemployernetworks;and(3)puttingpotentialemployeesintouchwithwillingemployers.


Identifyasystemthatprovidestrainingandstandardsforemployers/recruitmentagenciestobecomeaDisabilityConfidentRecruiter/Employer.


Interventiontoencourageemployerstoprovide'onthejob'trainingforintellectuallyordisabledjobseekersratherthanrequiringatertiaryqualification.


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Employee empowerment

Mentorship Individualscanfeelminisculeagainstthesystemwhentheyaretryingtosecurethebestsupportforthemselves.

Employeesfeelsociallysupported Onlineresourcecollatingonline‑orcommunity‑basedmentorshipprogramsandsupportgroups.Designaninterventiontomaximisethenumberofemployeeswhoaccessthematerials.


Unsuitablementorscanhaveanadverseeffect.Thisexacerbatesincidencesofdepressionandhopelessness.

Linkemployeestopositiveinfluencers.

Useadvocacyorganisationsthatareintouchwiththeneedsoftheemployeesspecificgroupasacentralforum(eg:spinalcordassociation).


System Navigatingthedisabilitysupportsystemcanbedifficultandlonelyasanindividual.

Employeesfeelsociallysupported. Group‑basedcase/claimmanagement.


Onestopshopportal'thatconnectstoservices,mentorgroups,'goodwork'credentialedemployers,jobsearchservices,jobapplicationguidance,motivationaltrainingetc.


Education Employeesunawareofwhattoexpectofemployer

Employeesmoreclearlyunderstandwhattoexpectoftheiremployer.

Collateonlineinformationregardingemployerobligations.Designaninterventiontomaximisethenumberofemployeeswhoaccessthematerials.Employerguidelines.


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Jobseeking Itcanbedifficulttomanageyourconditionwhenitimpairsyouphysicallyand/ormentally.Thatmeansitcanbeespeciallydifficulttofindorgetbacktowork.

Employeesfeelsupported Individualplacementandsupport(IPS)approachfromjobsearchprovider.


Difficulttofindemployerswhoarewillingtorecruitpeoplewithhealthconditions.Groupinterviewscanbedaunting.

Employeesaregiventheconfidencetokeeplookingforwork.

Accesstoajobcoachingsystemmannedwithcoachestrainedforthespecialneedsofpeoplewithaphysicalorpsychologicalhealthcondition.


Lossofskills,eitherduetoonsethealthconditionorlong‑termunemployment.

Havetheskillstofindsuitableemployment.

Interventionsthatgiveaccesstotraining/retraining.


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4.0 ConclusionThepurposeofthisstudyistoidentifywhatcanhelpemployeestohelpthemselves–touseworkaspartoftheirrecovery.However,adistinctionmustbedrawnbetweenthedifferenttypesofempowermentinterventions:

1. Independentself‑empowerment–empoweringthingsthatindividualscanactionthemselvesrightnowwithouthelpfromanyoneelse.

Neithertheacademicevidence,expertstakeholderinterviewsnoremployeeinterviewsidentifiedindependentself‑empowermentinterventions.

2. Dependentself‑empowerment–empoweringthingsthatindividualscanactionthemselvesbutreliesonactionfromsomeoneelse,forexample,‘mentorship’isthemostfavouredinterventionbyemployeesbutfacilitiestoaccessmentorshipwouldhavetobeestablishedtoenableaccess.

3. Dependedempowerment–empoweringthingsindividualscannotactionthemselves.

Dependentself‑empowermentThefollowinginterventionsandexampleswereidentifiedthatindividualscanactionthemselvesonceamechanismisestablished.

• Mentorship:community‑basedprogramsandsupportgroupsoradvocacygroupforumsthatindividualscanaccessviaonlineresourcesoruseofadvocacyorganisationsthatareintouchwiththeneedsofspecificemployeegroupsasacentralforum.

• Education:acollationofonlineinformationregardingemployerobligationsandguidelinestohelpemployeesunderstandtheirentitlementswashighlysupportedbyemployees,orapsycho‑educationapproachtoincreasehealthliteracy–thoughreviewevidenceforthiswasinconclusive.

• Goalsetting:agoaldirectedoccupationaltherapyprogram.

• Systemfacilitation:aportalthatconnectstoservices,mentorgroups,‘goodwork’credentialledemployers,jobsearchservices,jobapplicationguidance;oranonlinetriageserviceprovidedbyrealpeoplewhocanhelpnavigatethroughdifferentsystemsandtodifferentservices.

DependentempowermentWhatthisinvestigationlearntfromemployeesandfromstakeholdersisthatthebesteffortsatself‑helparedefiedbysystemsthatarecomplexandunsupportive.Inthewordsofakeystakeholder‘theycannotfightabadsystem’.Whatisclearisthatthereisnosilverbullet.Employeeempowermentisreliantonbroaderchangesandamulti‑dimensionalapproach.

• Cultural change–shiftingbeliefsandattitudestowardsthevalueofgoodworkandinclusionisimportant.Culturalprovidestheover‑archingcontextandmotivationthatmakesindividualinterventionseffective.Itisahighorder‘empowerment’toolforallparticipantcohorts.Italsogoeshandinhandwiththeneedforbettercross‑communityhealthliteracy.

Thereisgrowingevidencethatdemonstratesthatwithoutshiftingculturalbeliefsandsocialnorms,inthiscasearoundthebenefitsofgoodworkandemployingpeoplewithhealthconditionsordisability,theeffectivenessofempowermentinterventionscanbecompromised.ThisisevidencedinsomeofAustralia’slargestbehaviourchangeprogramssuchasroadsafety,workplacesafetyandsmoking,whereeducationandlegislationdonotworkinisolationofcreatinganemotionalconnectiontothebenefitofaparticularbehaviour.

Stakeholdersrepeatedlyraisetheimportanceofcreatinguniversalawareness,understandingandabeliefamongstemployers,employees,healthprofessionals–allAustralians–that‘goodwork’isgoodforyouandthatworkingisaprovenaidtorecoveryandemotionalwellbeing.

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• System change –theevidencefromemployees’experiencesofthebenefitandincomesupportsystemsmaybeconsideredharshbysome,butpresentsaveryrealimpedimenttoindividualempowerment,evenleadingtoworseninghealthandgreaterrelianceonthesystembycontributingtosecondaryconditionssuchasdepression.Partsofthesystemareoutofstepwithcurrentbestpracticeapproachestocustomer‑centricservicingandstreamlinedoperatingprocesses,andthisisachallengethatneedstobeaddressed.

• Work accommodation–theneedforemployer’stobetterunderstandandsupporttheindividualcapabilitiesofemployeeswithaphysicalorpsychologicalconditionordisabilityissupportedbyevidence,employeesandstakeholders.Effectiveworkaccommodationisthecoalfaceoftheworkexperienceandenablingindividualstoobtain,stayatorreturntoworkisreliantonemployerengagement.

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Additional informationStakeholderresearch–thebesttimetointerveneStakeholderswereaskedaboutthemostadvantageoustimeintheprocesstointervene.

Earlyinterventionwasuniversallyconsideredaprioritytoprovidehopeandinspirationearlyon.Thisincludedtheveryfirstconversationonthisbasisthisisthetimewhenyougettoknowthecustomer,theirstoryandwhatthey’relike,aswellasbeingabletosetexpectationsfromthestart(i.e.tellthemwhatisgoingtohappen,theirrole,theemployersrole,wintrust,helpthemmakedecisions).

Inthecaseofinjuryorillnessthatimpactsanexistingworksituation,therewasalsothenotionthatthefirstcontactshouldbebeforethepersonbecomesinvolvedintheworkdisabilitysystem.

‘the system is focused on your health, you get a doctor, a physiotherapist, a specialist, but nobody focusses on your ability to work, and this leads to an immediate loss of confidence to work. The work conversation needs to start immediately – even if it is not a full chat because of the circumstances, it is someone saying ‘I will come and talk to you about how to help you get back to work’.

Anotherideawastheneedforearlyunderstandingandnotificationassoonassomethinghappenstoensuretheemployeranddocumentsarehandledintherightway.

Overallconsensusisthatthestrategyneedstobeaboutprevention.Understandingbypeoplebeforetheyevenfindthemselvesinthesituationsotheyknowwhattodotherebylesseningthe‘adversarial’feelingofthesituationandtriggeringthenotionthat‘ifyoufindyourselfinthissituationspeakupquickly’.

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AppendicesAppendix1:Examplesofinterventiontypes1. Workaccommodation

Examplesfromliteratureofwhatworkaccommodationinterventionsincorporate:

• Individualcasemanagementandjobsearchassistance

• Changestotheworkplaceorequipment

• Changesinworkdesignandorganisation

• Changesinworkingconditionsorworkenvironment

• Casemanagementwithworkerandemployer

• Earlycontactwithworkerbyworkplace

• RTWcoordination

• Worksiteergonomicvisit

• Healthcareprovidercontactwithworkplace

2. Support

Examplesfromliteratureofwhatsupport/individualplacementandsupport(IPS)interventionsincorporate:

• Individualplacementandsupportprinciples:competitiveemploymentasprimarygoal;eligibilitybasedonpatientchoice;integrationofvocationalandclinicalservices;jobsearchguidedbyindividualpreferences;personalisedbenefitscounselling;rapidjobsearch;systematicjobdevelopment;time‑unlimitedsupport

• AugmentedIPS:IPSwithaddedspecialisedtrainingcomponents(e.g.augmentedwithcognitivetraining,work‑relatedsocialskills,workplaceskills)

• Traditionalvocationalrehabilitationmodels:focusontheinterventionsinthesettingpriortoinitiatingworkactivity

• Supportedemploymentmodels:focusontheimmediatecompetitivejobsearch

• Work‑focusedtreatmentofhealthconditions(e.g.commonmentaldisorders)

3. Mentorship

Examplesfromtheliteratureofwhatmentorshipinterventionsincorporate:

• School‑basedinterventionswithpeermentors(e.g.class‑basedcompetency‑buildingprogramaimedatfosteringself‑determinationinstudents)

• Community‑basedinterventionswithpeermentors(e.g.programsbasedoutsideschoolsorotherinstitutions

• Work‑basedinterventions(e.g.coworkertrainingviastandardizedone‑on‑oneapproach)

• Familyemploymentawarenesstraining(e.g.standardisedknowledge‑basedtrainingprogramforfamilies)

• Onlinementorshipprogram(e.g.emailmethodsformentorstoprovidesupportandinformationsharing)

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4. Goalsetting

Examplesfromtheliteratureofwhatgoal‑settinginterventionsincorporate:

• Goal‑directedoccupationaltherapyprogram

• Group‑basedgoalsettingapproach

• Specificoccupation‑basedgoalsetting

5. Person‑centeredplanning

Person‑centeredplanning(PCP)isnotastandardizedinterventionbutanumbrellatermthatisoftenusedtodescribeapproachesandtechniquesthatsharecommoncharacteristics.Fivekeyfeaturesinclude:

• The person at the center

• Familymembersandfriendsarepartnersinplanning

• Theplanreflectswhatisimportanttotheperson,theircapacities,andwhatsupporttheyrequire

• Theplanresultsinactionsthatareaboutlife,notjustservicesandreflectwhatispossibleandnotsimplywhatisavailable

• Theplanresultsinongoinglistening,learning,andfurtheraction

6. Problem‑solving

Problem‑solvinginterventionsareusuallydeliveredasatrainingprogram.Someexamplesfromtheliteratureinclude:

• Problem‑solvingtrainingcombinedwithgradedactivity

• Problem‑solvingskillstrainingdeliveredbyoccupationaltherapist

• Problem‑solvingcomponentinguideline‑basedcareprovidedbyoccupationalphysicians

• Problem‑solvingtrainertrainingforoccupationalphysicians

• Problem‑solvingcomponentincollaborativecareinterventioninvolvingworker,manager,andoccupationaltherapist

• Individual‑andgroup‑basedproblem‑solvingtrainingdeliveredbypsychologists.

7. Strength‑basedinterventions

Examplesfromtheliteratureofwhatstrength‑basedinterventionsincorporate:

• Strength‑basedcasemanagement

• Strengths‑basedbriefsolutionfocusedcounselling

8. Education

Examplesfromtheliteratureofwhateducationinterventionsincorporate:

• Psycho‑educationalinterventions(e.g.participantslearnaboutphysicalsideeffects,stressandcopingtechniques)

• Patientcounsellingandhealtheducation

• Stressmanagementandrelaxationtrainin

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Appendix2:Detailedbreakdownofcitizenpanelattendees

20–244% 25–29

4% 30–344%

35–399%

40–444%

45–4931%

50–5422%

55–6022%

Year 1210%

AdvancedDiplomaandDiploma

30%

BachelorDegree20%

Acquiredandcongenital

components4%

Acquired87%

Congenital9%

Congenitalvsacquired

41

Acute18%

Chronic82%

Chronicvs.acute

Moderateproblem20%

Noproblem0% Mildproblem

0%

Severe problem0%

Minimalproblem0%

Moderatelysevere problem

50%

Verysevereproblem30%

Severity

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Appendix3:Projectmethods

Rapidreviewmethods–Searchstrategy

Acomprehensivesearchofthefollowingdatabasewasundertaken:PsycINFOviaOvid,MedlineviaOvid,CochraneLibraryandCINAHL.TheMedlinesearchstrategyisreproducedbelow:

Table 4. Medline search strategy

Search string

1 returntowork[tw]ORreturn‑to‑work[tw]ORRTW[tw]ORre‑employ*[tw]ORemployment[tw]ORunemployment[tw]ORunemployed[tw]ORretirement[tw]ORemployab*[tw]ORabsenteeism[tw]ORvocational[tw]OR(commenc*adj3work)[tw]OR(commenc*adj3job)[tw]OR(stay*adj3work)[tw]OR(stay*adj3job)[tw]OR(workadj2participat*)[tw]OR(modif*adj2work)[tw]OR(workadj2adjust*)[tw]OR(retainadj2work)[tw]OR(retainadj2job)[tw]OR(jobadj2retention)[tw]OR(workadj2retention)[tw]OR(jobadj3re‑ent*)[tw]OR(workadj3re‑ent*)[tw]OR(workadj3reintegrat*)[tw]OR(jobadj3re‑integrat*)[tw]OR(modif*adj2dut*)[tw]OR(lightadj2dut*)[tw]OR(workadj2ability)[tw]OR(workadj2status)[tw]OR(recover*adj2work)[tw]OR(obtain*adj3work)[tw]OR(obtain*adj3job)[tw]OR(workadj3capacity)[tw]OR(occupationaladj2outcomes)[tw]OR(sick*adj1leave)[tw]OR(sick*adj3absence)[tw]OR(workadj3accommodat*)[tw]OR(jobadj3accommodat*)[tw]OR“workplace”[SubjectHeading]OR“returntowork”[SubjectHeading]OR“work”[SubjectHeading]OR“employment”[SubjectHeading]OR“sickleave”[SubjectHeading]OR“jobsatisfaction”[SubjectHeading]OR“occupationalmedicine”[SubjectHeading]OR“rehabilitation,vocational”[SubjectHeading]OR“occupationalhealth”[SubjectHeading]OR“unemployment”[SubjectHeading]OR“absenteeism”[SubjectHeading]OR“occupations”[SubjectHeading]OR“occupationalhealthservices”[SubjectHeading]OR“workcapacityevaluation”[SubjectHeading]OR“vocationalguidance”[SubjectHeading]

2 disability[tw]ORdisease[tw]ORinjury[tw]ORillness[tw]ORdisorder[tw]ORcognitiveimpairment[tw]ORcognitivedysfunction[tw]ORmusculoskeletaldisease*[tw]ORcancer[tw]ORosteoporosis[tw]ORarthritis[tw]ORasthma[tw]ORchronicobstructivepulmonarydisease[tw]ORCOPD[tw]ORchronicpain[tw]ORcardiovasculardisease[tw]ORdiabetes[tw]ORchroniccondition[tw]ORmentalhealth[tw]ORchronicdisorder[tw]ORpsychologicaldisorder[tw]OR“Disabledpersons”[SubjectHeading]OR“IntellectualDisability”[SubjectHeading]OR“MentalDisorders”[SubjectHeading]OR“WoundsandInjuries”[SubjectHeading]OR“ChronicDisease”[SubjectHeading]OR“CognitiveDysfunction”[SubjectHeading]OR“MusculoskeletalDiseases”[SubjectHeading]OR“Neoplasms”[SubjectHeading]OR“Osteoporosis”[SubjectHeading]OR“Arthritis”[SubjectHeading]OR“RespiratoryTractDiseases”[SubjectHeading]OR“PulmonaryDisease,ChronicObstructive”[SubjectHeading]OR“Asthma”[SubjectHeading]OR“BackPain”[SubjectHeading]OR“ChronicPain”[SubjectHeading]OR“CardiovascularDiseases”[SubjectHeading]OR“DiabetesMellitus”[SubjectHeading]OR“Depression”[SubjectHeading]OR“AnxietyDisorders”[SubjectHe

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