Conference Agenda

Session
Return to work coordination
Time:
Wednesday, 05/Jun/2019:
4:00pm - 5:30pm

Session Chair: Mette Jensen Stochkendahl
Session Chair: Maurizio Trippolini
Location: Room 96

Presentations

The Challenging Day-To-Day Situation of Return to Work Coordinators

Ellen MacEachen, Elena Neiterman, Ekaterina McKnight, Cindy Malachowski, Meghan Crouch

University of Waterloo, Canada

Introduction: Return to Work (RTW) Coordinators sit at a complex interface of workers, employers, insurers, and health care providers. This study set out to understand the day-to-day work RTW coordinators, including their performance expectations and how they make decisions when faced with competing demands.

Methods: An interpretive qualitative approach was used to gain a situated understanding of the day-to-day work and strategies of experienced RTW coordinators. The purposive sample included coordinators based within insurance and workers’ compensation, embedded in large organisations, and third party consultants to businesses. Semi-structured, in-depth interviews were conducted with 50 coordinators across Canada. Verbatim transcriptions of interviews were dual-coded and analysed using a modified grounded theory approach that emphasizes constant comparison.

Findings: Although the coordinators enjoyed the stimulation and variety of their work, burnout was also a present issue. RTW coordinators faced different pressures depending on their own employment contracts. Achieving a minimal claim duration was a performance expectation for most coordinators and particularly for contracted third party providers. A particular point of tension for the coordinators was physician recommendations about duration of work absence as it often conflicted with coordinator’s own focus on worker ability and speedy RTW. The coordinators gained the trust and cooperation of workers by creating a partnership environment, but their role in claim denial and their obligation to adhere to employer “zero absence” policies sometimes challenged these worker relationships.

Conclusion: RTW coordinators appear to be a growing profession in the context of public and also private insurer work disability policies that emphasize expedient return to work after an illness or injury. This analysis reveals some day-to-day challenges of this coordinating role and identifies strategies for managing this mediating role.



Mental Health And Work Reintegration: Tapping Return-To-Work Coordinator Strategies

Ellen MacEachen, Elena Neiterman, Ekaterina McKnight, Cindy Malachowski, Meghan Crouch

University of Waterloo, Canada

Introduction: Mental health (MH) disorders constitute a considerable time and expense component of a return to work (RTW) trajectory. This is a particularly challenging area for RTW management because of its episodic, chronic and invisible nature. Professional RTW coordination is increasingly seen as a solution to management of difficult work injury cases given the complexity of the RTW process, which requires goodwill and cooperation among different parties who can have diverse interests and needs. The objective of this study was to tap rich RTW Coordinator front line practice experience of supporting RTW for clients with MH disorders and to create a “strategies guide” to be used by stakeholders.

Methods: An interpretive qualitative approach was used to gain a situated understanding of the day-to-day work and strategies of experienced RTW coordinators. The purposive sample included coordinators based within insurance and workers’ compensation, embedded in large organisations, and third party consultants to businesses. Semi-structured, in-depth interviews were conducted with 50 coordinators across Canada. Verbatim transcriptions of interviews were dual-coded and analysed using a modified grounded theory approach that emphasizes constant comparison.

Findings: RTW coordinators faced difficulties with managing RTW for MH because, unlike for physical health conditions, few standardised benchmarks exist for setting expectations about the timing of RTW. As well, mental health absences were often intertwined with challenging workplace relationships and RTW coordinators had limited influence over the work environment. RTW coordinators described particular strategies for managing mental health absences, including creating a “partnership” environment with the worker and particular ways of communicating with healthcare and workplace parties.

Conclusions: Return to work is a complex arena, and mental health poses unique challenges. RTW coordinators had rich practical expedience that provided insight into ways that RTW can be managed in the context of varied workplace situations.



Within The Ring Or Crisscross? Integration Of RTW-Services In Norway

Lisebet Skeie Skarpaas1,2, Lise Aasen Haveraaen2, Milada Cvancarova Småstuen1, William S. Shaw3, Randi Wågø Aas1,2,4

1Oslo Metropolitan University, Norway; 2Presenter - Making Sense of Science, Norway; 3University of Massachusetts Medical School, USA; 4University of Stavanger, Norway

Introduction: In return to work (RTW) programs, a coordinator has often been provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration. The aim of this study was therefore to explore and describe if and how a coordinator was provided in the Rapid-RTW-program, and whether the provision of a coordinator was associated with certain personal or intervention characteristics.

Methods: The study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs (n=39). Employees (n=494) answered a self-administered questionnaire, which was linked to register data on diagnoses. Employees who reported to be provided with a coordinator were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models.

Results: Sixty-nine percent of the employees reported having a coordinator. The coordinators were mainly responsible for coordinating treatment within own services (i.e. horizontal coordination, 68%). Occupational rehabilitation-programs more often provided a coordinator compared treatment included assessment and surgery (OR 3.87 95% CI 2.42-6.24). More professions were involved in the programs that provided coordinators. In addition, when provided with a coordinator, there was more contact with other stakeholders like leaders and social security services, and more often, the service provided adaptations at the workplace for the individual employee. However, this signs of vertical integration were only evident for a limited number of employees.

Conclusion: In this study, seven of ten had a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Still, most of these coordinators did not coordinate vertically between all the levels and intervention arenas for sick listed employees (i.e. workplace, social security, and health care services), as recommended in earlier research.



Does Coordination Make A Difference? Time To RTW In RTW-Services In Norway

Lisebet Skeie Skarpaas1,2, Lise Aasen Haveraaen2, Milada Cvancarova Småstuen1, William S. Shaw3, Randi Wågø Aas1,2,4

1Oslo Metropolitan University, Norway; 2Presenter - Making Sense of Science, Norway; 3University of Massachusetts Medical School, USA; 4University of Stavanger, Norway

Introduction: The aim of this study was to assess if the reported provision of a coordinator was associated with time to first- and first full- return to work (RTW) amongst sick-listed employees who participated in different Rapid-RTW programs in Norway.

Methods: The sample included employees on full-time sick-leave who participated in Rapid-RTW-programs (n=326), who provided information about the coordination of the services they received. The median age was 46 years (min-max. 21-67), and 71% were female. The most common reported diagnoses were musculoskeletal- (57%) and mental health disorders (14%). The employees received different types of individually tailored RTW-programs all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%). Outcomes were measured as time to first-RTW (graded and 100%) and first full-RTW (100%).

Results: Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80-176) days versus 61 (43-79) days for first-RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full-RTW, there was no statistically significant difference between employees provided with a coordinator versus those who was not.

Conclusion: The model of coordination provided in the Norwegian rapid-RTW-programs, did not contribute to a more rapid RTW for sick listed employees. Rethinking how return to work coordination should be organised could be wise in future program development.



Comparing Multidisciplinary And Brief Intervention In Employees With Different Job Relations On Sick Leave Due To Low Back Pain – One Year Follow-up

Vivian Langagergaard1, Claus Vinther Nielsen2,3, Ole Kudsk Jensen1, Merete Labriola2,3, Pernille Pedersen3, Vibeke Neergaard Sørensen1

1Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Denmark; 2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.; 3DEFACTUM, Central Denmark Region, Aarhus, Denmark

Introduction

Not all individuals on sickness absence due to low back pain (LBP) may profit from the same intervention and the effect of a given intervention on return to work (RTW) may depend on their work situation. The aim of this study was to evaluate whether employees on sick leave due to LBP and with poor job relations will benefit more from a multidisciplinary intervention, while patients with strong job relations will benefit more from a brief intervention.

Methods

The study was designed as a randomised controlled trial comparing brief intervention with brief intervention plus multidisciplinary intervention. Employees, aged 18-60 years, were included in the study from October 2010 to August 2016 if they had been on sick leave for 4-12 weeks due to LBP with or without radiculopathy. They were divided into two groups, a group with poor job relations and a group with strong job relations based on their answers in the baseline questionnaire. Each group was randomised 1:1 to receive the brief intervention or brief intervention plus multidisciplinary intervention. The brief intervention comprised a clinical examination and advice offered by a rheumatologist and a physiotherapist, whereas the supplementary multidisciplinary intervention comprised the assignment of a case manager who drew up a rehabilitation plan in collaboration with the participant and the multidisciplinary team.

One-year RTW was estimated by register data, while functional capacity was measured by questionnaire data.

Results

Results are not available yet, but will be presented at the conference.

Discussion and conclusion

This trail will indicate whether work-related characteristics should be considered when providing treatment of LBP patients in the health care sector.