There is a growing consensus that professional action in occupational rehabilitation should be research-based, and that practice-based knowledge is needed to achieve contextual insight and new theoretical understanding. Few study design examples exist to help inform an evaluation plan and develop research-practice interactions to examine process complexity of targeted occupational rehabilitation programs. This study design article is a proposal on a theory-driven and interactive research methodology for a process evaluation of a pragmatic intervention trial, known as STAiR. The aim of the process evaluation is to examine the delivery and implementation of an inpatient and an outpatient occupational rehabilitation program, and explore active mechanisms pertaining to patient experiences of the return to work (RTW) process. Qualitative and interactive data collection methods will include (a) participant observation of program setting and activities; (b) participatory dialogue conferences with program providers to facilitate initial logic modelling; (d) individual patient interviews at program intake and follow up; and (d) focus groups with rehabilitation teams and external stakeholders. The qualitative data will be supplemented with description of program activities and patient questionnaires. Program logic modelling is suggested to inform a logic analysis of how expected RTW outcomes and delivery of program activities are aligned and how contextual characteristics may clarify differences in achieved RTW outcomes. The proposed process evaluation approach may inform future design discussions and theoretical understanding, and it is expected that the applied knowledge gained through this study may help rehabilitation professionals better navigate potential challenges in clinical evaluation efforts.

Many organisations strive to make disability management (DM) responses to prevent work disability and promote return-to-work (RTW). However, a deeper appreciation of methods that can ensure equitable worker participation in the development and change of RTW policy and practice is needed. Using an action research approach, this study expands the concept of participation in disability management (DM) creating new insights into the resources, dilemmas and aspirations of RTW policies in organisations. Empirical data was gathered from a development and change process conducted together with managers and workers at a large health care workplace. A series of workshops were conducted, studying the common history of RTW policy evolvement and configuration, and encouraging the creation of worker-driven proposals for alternative actions to current management. Action research protocols were used to document knowledge creation. Analysis of action research processes reveals how workers insisted on discussing their work environment as an important factor for maintenance of RTW, and how consistent participatory possibilities and team oriented RTW coordination among all levels of the organisation are perceived as critical features for supportive and sustained job retention. Participatory processes created relevant knowledge of the importance of work environments in coordination of stay at work, which may strengthen RTW capacity building and advance DM in organisations.

Aim: This exploratory study examined the relationships among different types of social support accessed by patients with traumatic spinal cord injury (SCI). Method: Using a cross-sectional study design, 20 SCI patients of workforce age discharged from the Royal Talbot Rehabilitation Hospital, Melbourne, Australia during 2007 were assessed on a range of demographic, injury and social support variables. Results: Higher quality interactions (i.e., actual social support) were significantly associated with greater social integration (i.e., structural social support) and higher perceived social support. However, community integration and social integration, which measure different aspects of structural social support, were essentially unrelated. Conclusions: Actual social support influences perceived social support and social integration. Theoretically, these results suggest that actual social support influences the two main opposing models that explain the relationship between social support and wellbeing: the stress-buffering model (for perceived social support) and the main-effects model (for structural social support). From a research perspective, the use of well-defined types of social support, and psychometrically sound measures, is critical for assessing the influence of social support on rehabilitation outcomes. To effectively match rehabilitation efforts with SCI survivors' needs, future research should examine which types of social support best predict particular rehabilitation outcomes.

Individuals with additional needs, such as learning disabilities, face a crisis of unemployment in the United Kingdom (UK). Many of these individuals encounter few adult services that are in place to address their support needs. Supported work internship programs are one attempt to address this crisis. One such program for young people with learning disabilities is the Project SEARCH model. Though a number of research studies have explored the efficacy of the Project SEARCH model, the reported markers of success (e.g., subsequent employment rates) have not taken into account first-hand participant experiences. The current study aimed to establish whether participant views were consistent with the previously reported, positive, quantitative measures. We explored the views of seven interns, aged 17 to 24 years, with various learning difficulties, and three job coaches who were involved in the program from September 2017 to June 2018. Semistructured interviews were conducted and analysed using thematic analysis. Participants revealed meaningful experiences for those involved, positive self-development, and renewed aspirations for the future. The value of a strong and consistent support network involving family members, job coaches, coworkers, and supervisors was highlighted. The study also found ongoing challenges associated with the scheme. These centred on concerns that interns’ abilities were being underestimated, the impact of a reduction/withdrawal of support at the conclusion of the program, and the barriers to finding subsequent competitive employment for interns. The research highlights the value of eliciting participant voice within research, and discusses how the findings can be used to further develop supported work internship programs.

This study examined return-to-work in a sample of 468 compensatable injury cases. These included amputees, brain damage, hearing loss, mental disorders, musculoskeletal problems, nervous system, paraplegia, sight loss and miscellaneous conditions. Around 35% returned to work. It was substantially higher for work-related injuries compared to motor vehicle accidents or general insurance claims. Those who underwent surgery or were admitted to hospital had higher return-to-work rates than those never attending hospital. Psychiatric adjustment factors were a major influence on low rates of return-to-work. Other social and demographic factors were considered (gender, age, city vs. rural location, whether a spinal injury was involved, family status, years of schooling, qualifications, job status at time of accident, occupation). Eight out of 17 possible factors were more statistically significantly related than the remainder to whether someone was working but the substantive limitations of even relevant pre- or post-accident indicators are outlined.

An estimated 14,000 persons who are deaf (PWAD) reside in Barbados, many of whom are believed to live below the poverty line. Data on the employment status of PWAD in Barbados is sparse; this research seeks to fill a gap in the literature and inform social policy. Qualitative methodologies were utilized to understand how participation in the labour market influences the lives of PWAD in Barbados. The current research seeks to inquire into the phenomenological field of five persons who are deaf through a multiple case study strategy using focus group interviews. Data were analysed to derive themes common across participants and ecological systems theory was used to understand how PWAD cope in the world of work. The following research questions are addressed in an attempt to capture the unique perspectives of PWAD: (1) What are the experiences of persons who are deaf and employed? and (2) How does having a disability impact the lives of PWAD? The data revealed a relationship between environmental stressors such as attitudinal barriers and discrimination in the workplace and their psychological and behavioural impact in the form of resignation, frustration, isolation and creative coping among PWAD.

In Norway various welfare state authorities assist in disability management (DM) of long-term sick workers. This study provides empirical-based knowledge about the Norwegian DM process. The data are based on focus-group interviews with health care providers and case-workers in welfare state authorities. A key issue outlined in this article is that long-term sick workers can easily become ‘stuck’ in the rehabilitation system. The focus is on topics that can explain difficulties of re-employing long-term sick workers. Furthermore, we look at what challenges are typical for DM of these workers in Norway, with respect to re-employment issues.

Early intervention of the biopsychosocial model as a framework to achieve sustainable employment outcomes following injury, illness or disease is well documented in the International research. However in some areas of disability management the term early intervention is consistently applied exclusively within the medical model with early access to treatment and diagnostic tools.

However in Australia, whilst the knowledge of the Health benefits of work consensus statement is gaining traction, we remain lagging in effective implementation of early intervention models of the biopsychosocial model to return to work and return to life. This paper explores the structural challenges associated with successful implementation of the model and provides International learnings and applications for consideration and adaption to the Australian context. Further this paper will provide learnings from a pilot program being run in NSW that has been successful in the early triage and referral into a structured Return to Work program that is achieving strong results.

Disability management is now recognised as an effective means of managing the increasing global costs of injury and disability. However, research on disability management particularly employee perceptions of its value, are sparse. This paper reports on the Australian findings of a large international project that included Canada, China, Switzerland and Australia, which examined employee perspectives of disability management related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence. Data was collected from 365 employees in 10 large private and public companies using an online survey tool that focused on three components of a disability management program — disability prevention (DP), stay at work (SAW) and return to work (RTW) programs — in relation to the dependent variables of job satisfaction, physical and mental health, workplace morale, sickness absence. Multivariate regression was used to predict disability management's influence on the dependent variables. Results demonstrated positive perceptions regarding the perceived benefits of disability management to both individual employees and their perceptions of coworkers. It was apparent that each component of a disability management program (DP, SAW, and RTW) is positively related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence Disability management programs were perceived as more beneficial in private, as opposed to public, workplaces; however, no differences were evident according to union status or gender of the respondent. It is possible disability management may impact on organisational productivity via variables associated with workplace culture, as well as through the direct benefits flowing from preventing and managing injury. Given the significant costs associated with absenteeism, an outcome of interest to many employers was the finding that employees perceived SAW programs as the most beneficial in terms of reducing absenteeism for both themselves and their coworkers.

A Canadian sample was collected as an aspect of a large international project, with representation from Australia, Canada, China, and Switzerland. In each country, interview and survey data were collected using team-created research tools. Canadian survey data on disability management (DM) perceptions were collected from 218 employees in both public and private organisations. Our Canadian employee sample reported perceived influence of disability prevention on job satisfaction, physical health, mental health, and morale for both themselves and their coworkers. Return to work programs were seen as valuable for job satisfaction of both the employee and coworkers, as well as the physical health of coworkers. Similarly, stay at work programs were seen as valuable for mental health and morale of coworkers. There was no relationship between perceived influence of DM interventions and reduction of sickness absence. The influence of DM was perceived as more positive for private and/or nonunionised workplaces. No gender differences were evident.

Purpose: This article focuses on occupation and employment after basic vocational training for people with cognitive disabilities. The aim is to reveal supporting and hindering factors of different forms of workplace integration as perceived by those with disabilities. Method: Both quantitative and qualitative methods were used, consisting of an easy-to-read questionnaire completed by 412 graduates of practical vocational training, and in-depth interviews with 27 graduates. Results: The key findings show that workplace integration of people with disabilities takes place through a combination of various factors and materialises in different ways in terms of workplace, employment status, activity and further perspectives. Our findings suggest that supporting and accompanying people with disabilities in their work activities should always take into account both their desire for self-determination and their dependence on structural conditions.

The costs of occupational stress are rising and employers increasingly need to address occupational stress, prevention and rehabilitation issues. However, there is a relative lack of understanding about implementing strategies within specific organisational contexts. Extant literature indicates a need for integrated prevention and rehabilitation strategies that address specific organisational climates that contribute to stress. The Queensland Police Service (QPS) is one policing organisation facing significant occupational stress issues requiring organisational solutions. This article describes a Participatory Action Research case study, the aim of which is to develop an occupational rehabilitation system within the QPS to address identified stress issues. A combination of background information, interview and focus group data is being used to determine stress issues and provide potential solutions to specifically address the needs of the QPS. The findings of this study emphasise the importance of participant involvement in identifying issues and generating solutions, as well as demonstrating the value of taking a systemic approach. The findings suggest that the use of the Participatory Action Research approach is invaluable in promoting the long-term success of the QPS change process.

In 2014, the health and productivity team of the disability insurance provider, Unum, conducted a mixed methods study that included qualitative interviews with internal mental health disability claims professionals, and external interviews with employers. Quantitative data of 15 employers were analysed to identify descriptive statistics involving mental health short-term disability (STD) claims. Workplace factors were examined to understand best practices among companies, related to mental health STD, to identify work environments that may increase or decrease mental health disabilities. Quantitative data found workers aged 40 to 49 had the highest rates of mental health STD claims and workers aged 50 to 59 had the longest duration of absence. Anxiety and depression were the main reasons for mental health absences from work. Results from the qualitative interviews showed a supportive work culture (i.e., work–life balance, good benefits, successful wellness programs) may lead to higher STD claim rates, demonstrating workers in these environments may feel more comfortable disclosing and seeking help for mental health disabilities. Conclusions from this study indicate that although presenteeism rates for mental health are high and impact employers financially, having higher STD claim rates may be more cost effective than having employees with mental health conditions remain at work instead of filing STD claims, seeking treatment and returning to productive employment. Employee age can impact rate and duration of mental health STD claims, meaning employers should implement workplace practices that support overall mental health of employees.

The guidelines published by the International Social Security Association, ISSA Guidelines: Return to Work and Reintegration, provide a policy imperative towards early intervention for people with nonoccupational health conditions at risk of exiting the workforce and moving to disability dependency. Socioeconomic and fiscal imperatives have been demonstrated by the Organisation for Economic Co-operation and Development's (OECD) review on sickness, disability and work (OECD, 2010), and by an accumulating evidence base for effectiveness. This study explored how social protection agencies are responding in terms of employment rehabilitation services for employed people with acquired disabilities. Specifically, this study reviewed job retention and return processes for workers with nonoccupational health conditions from the perspective of the ISSA guidelines in four jurisdictions with differing system frameworks. The methods used included a review of relevant literature and web resources and gathering detailed system descriptions from national respondents. Although the jurisdictions differed in the concepts used, service context, the structure of welfare systems and eligibility criteria, there was evidence of an acknowledgement of the needs of employed people with disabilities. This was not, however, consistently reflected in procedures, processes or outcome measurements. While some promising characteristics were identified, there was substantial room for improvement in the job retention and return to work strategies of the relevant agencies in all four jurisdictions. It was concluded that the deployment of the ISSA Guidelines: Return to Work and Reintegration, published in 2013, had yet to make a substantial impact on services and approaches in the domain of nonoccupational health conditions in these jurisdictions.

A common suggestion in the disability management research literature is that consultative relationships between disability manager specialists and key union personnel can significantly enhance disability management services provided in unionised workplaces. However, the findings of previous knowledge validation studies have indicated that a sizeable proportion of disability managers believe they are under-prepared to provide services in unionised environments. Plausibly, these findings could reflect the dearth of existing outcome studies that expressly describe characteristics associated with the successful provision of disability management services in unionised workplaces. As a first step towards addressing the aforementioned gap in the disability management research literature, the current study reports the results of a Delphi procedure designed to provide information regarding possible factors that impact disability management services provided in unionised workplaces. The goal of the study was to develop a preliminary survey that could be used in subsequent research studies that address disability management best practises. Four thematically classified domains were identified that included: (a) disability managers' and disability management client characteristics, (b) rate of union representatives' participation in disability management services, (c) disability management service characteristics in unionised environments, and (d) disability managers' attitudes regarding working with labour union representatives. Implications of the findings are discussed in terms of rehabilitation counsellor education and development of empirically based disability management practice strategies.

This article presents results from a survey aimed at identifying the extent of alcohol prevention efforts in Swedish workplaces focusing on the dissemination of a model for secondary prevention — the ‘Risk Drinking model’. From a random sample of 929 human resource managers at Swedish workplaces, 374 answered a web-based questionnaire (response rate = 40%). Results showed that about 70% had an alcohol policy at their workplace, 51% were engaged in alcohol prevention efforts and about 19% used the Risk Drinking model. Regression analyses showed that large workplaces, workplaces where employees received training on alcohol, public sector and female-dominated workplaces were significantly associated with alcohol prevention activities. We conclude that training is important for the implementation of alcohol prevention at Swedish workplaces, and is of particular importance in small enterprises.

The purpose of this article is to contribute to knowledge about workplace-based prevention and rehabilitation programs by investigating effects on outcomes concerning employee health, psychosocial working conditions, sickness absence, sick-cases and rehabilitation indicators in 19 Swedish public human service workplaces including 311 individuals. Interviews with middle managers and an examination of documentation about prevention and rehabilitation interventions at the workplaces made it possible to group the workplaces in two workplace program groups — high versus low quality workplace-based prevention and rehabilitation programs. Statistical methods used were reliability tests, correlation analyses and t tests. Results indicate significant associations between changes in employee-judged stress and psychosocial working conditions, and changes in employee-judged health. The results concerning changes in employees’ health, stress and psychosocial working conditions (after workplace-based programs) showed significant differences between workplaces with high quality workplace-based programs compared with workplaces with low quality workplace-based programs, with the former having more favourable results. The study indicates that workplace-based prevention and rehabilitation programs with a broad change strategy and high levels of management and employee involvement can apply to small public sector workplaces.

Maximising independence through community rehabilitation. Community rehabilitation is now recognized as an integral part of the rehabilitation process. The provision of such community rehabilitation within a person's home or community enables their clinicians to focus on meaningful functional activities and independence needs of a person. Providing rehabilitation in the environment where a person normally functions, whether it is for physical, cognitive or behavioural needs, maximizes outcomes as it ensures the person's learning is occurring in a contextual environment. It also maximizes independence as it enables practice of new skills to occur frequently across the day; consequently skill development is based on regular practice. As skills are acquired these can be progressed within the home or the community environment. Integral to this process is the development of functional goals. Goals must be person centered and aligned with underlying functional needs, thus goal achievement is underpinned by a rehabilitation process where all members of the rehabilitation team are working towards the same functional outcome. Carers can be trained to assist with practice of the program, this allows autonomy as clinicians don't need to be present at all times while practicing tasks or exercises. Consequently the ability to select and train carers are vital skills required by clinicians managing injured people in the community. Allowing the injured person to have a role in carer selection can facilitate a more fruitful relationship. It is expected that as the person's skills develop and evolve there will be an understanding from all involved that the person's need for carers will reduce. At times independence can be limited if clinicians and carers continue therapy and restrict a person's ability to develop confidence in their independence; best practice would indicate treatment plans are reviewed regularly so this doesn't occur. To maximize independence, all these components should be considered.

The impression that work can be good for a worker's health is a powerful one especially when it is combined with the idea that returning people to work may also have positive benefits for employers and government, physical and vocational rehabilitation and reintegration assumes even greater significance. The Social Security Organization of Malaysia (SOCSO) is a statutory body governing the Employment Accident Insurance Scheme and the Invalidity Pension Scheme. SOCSO covers over 6 million workers and processes over 70,000 new claims annually. SOCSO introduced the RTW Program in 2007 which is a comprehensive multidisciplinary biopsychosocial rehabilitation program for its Insured Persons who are experiencing disability due to accidents in the workplace or those claiming for invalidity. This rehabilitation program is unique as it involves the concept of “disability management” in which each Insured Person who is referred to the program, is assigned to a Disability Case Manager who is actively involved throughout the return to work process. This presentation discusses the justification of introducing the RTW programme in Malaysia, with reference to the underlying rationale, association between work and rehabilitation, evidence to establish a positive relationship between health and work, and the benefits of RTW for employees, employers and SOCSO. Up to date (December 2013), 11,090 workers were motivated to participate in the SOCSO RTW Programme and 7,881 (71%) have returned to gainful employment. This clearly shows the success of the RTW Programme in not only returning a disabled worker to work but to give them their lives back. Due to this success, SOCSO has started to build its National Rehabilitation Centre for the purpose of RTW which will be ready in mid-2014. However, there is still room for improvements which establish the way forward for SOCSO in creating a more disability-management-centric system.