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Journal of Occupational Rehabilitation

, Volume 22, Issue 1, pp 105–117 | Cite as

The ‘Ability’ Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program

  • E. MacEachen
  • A. Kosny
  • S. Ferrier
  • K. Lippel
  • C. Neilson
  • R. L. Franche
  • D. Pugliese
Article

Abstract

Introduction In recent years, a focus on workers’ ability, rather than impairment, has guided disability management services. However, a challenge with the notion of ‘ability’ is identification of the border between ability and inability. This article considers this gray zone of disability management in the case of a workers’ compensation vocational retraining program for injured workers in Ontario. Methods In-depth interviews and focus groups were conducted with a purposive sample of 71 participants who were directly involved with the vocational retraining process. Workers in the program had on average incurred injury 3 years earlier. Procedural and legal documents were also analyzed. Principles of grounded theory and discourse analysis guided the data gathering and analysis. Results A program focus on worker abilities did not allow for consideration of unresolved medical problems. Concepts such as maximum medical rehabilitation distracted attention from workers’ ongoing chronic and unstable health situations, and incentive levers to employers directed some of the least capable workers into the program. As well, communication pathways for discussing health problems were limited by rules and provider reluctance to reveal problems. Therefore, workers completing the program were deemed ‘employable’, while ongoing and problematic health conditions preventing employment remained relatively uncharted and invisible. Conclusions This study reinforces how the shift in disability management paradigm to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and implementation. A focus on the environment in which worker ability can be enacted might be as important as a focus on improving individual worker characteristics.

Keywords

Workers’ compensation Vocational rehabilitation Injured workers Qualitative Vocational retraining Program implementation 

Notes

Acknowledgments

This study was funded by the Workplace Safety and Insurance Board Research Advisory Council. We thank the Advisory Committee members who provided advice and guidance throughout the study and the study participants who shared experience of the Labour Market Re-Entry program. Finally, thanks to the Research Action Alliance on the Consequences of Work Injury (RAACWI) group for their interest and support of this study.

References

  1. 1.
    OECD. Sickness, disability and work: breaking the barriers; CANADA: opportunities for collaboration. Paris: Organisation for Economic Co-operation and Development; 2010.Google Scholar
  2. 2.
    Victor RA, Carrubba LL, editors. Workers’ compensation: where have we come from? Where are we going?. Cambridge, MA: Workers’ Compensation Research Institute; 2010.Google Scholar
  3. 3.
    MacEachen E, et al. A deliberation on “hurt versus harm” logic in early return to work policy. Policy and Practice in Health and Safety. 2007;5(2):41–62.Google Scholar
  4. 4.
    Loisel P, et al. Disability prevention-New paradigm for the management of occupational back pain. Disease Manag Health Outcomes. 2001;9(7):351–60.CrossRefGoogle Scholar
  5. 5.
    National Health Service. NHS choices: your health, your choices [website page]. Available from: http://www.nhs.uk/chq/Pages/2584.aspx.
  6. 6.
    Haugli L, Maeland S, Magnussen LH. What facilitates return to work? Patients experiences 3 years after occupational rehabilitation. J Occup Rehabil. 2011.Google Scholar
  7. 7.
    Wideman TH, Sullivan MJL. Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers’ compensation claimants. Pain. 2011;152:376–83.PubMedCrossRefGoogle Scholar
  8. 8.
    Young AE. Return to work following disabling occupational injury—facilitators of employment continuation. Scand J Work Environ Health. 2010;36(6):473–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Braathen TN, Veiersted KB, Heggenes J. Improved work ability and return to work following vocational multidisciplinary rehabilitation of subjects on long-term sick leave. J Rehabil Med. 2007;39:493–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Chibnall JT, Tait RC. Long-term adjustment to work-related low back pain: associations with socio-demographics, claim processes, and post-settlement adjustment. Pain Medicine. 2009; 10(9).Google Scholar
  11. 11.
    MacEachen E, et al. Systematic review of the qualitative literature on return to work after injury. Scan J Work Environ Health. 2006;32(4):257–69.CrossRefGoogle Scholar
  12. 12.
    Soklaridis S, Ammendolia C, Cassidy D. Looking upstream to understand low back pain and return to work: psychosocial factors as the product of system issues. Soc Sci Med. 2010;71:1557–66.PubMedCrossRefGoogle Scholar
  13. 13.
    Tjulin A, MacEachen E, Ekberg K. Exploring workplace actors experiences of the social organization of return-to-work. J Occup Rehabil. 2009;20(3):311–21.CrossRefGoogle Scholar
  14. 14.
    Stahl C, et al. The work ability divide: holistic and reductionistic approaches in Swedish interdisciplinary rehabilitation teams. J Occup Rehabil. 2009;19:264–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Kosny A, et al. The role of health care providers in long term and complicated workers’ compensation claims. J Occup Rehabil. 2010.Google Scholar
  16. 16.
    Wales C, Matthews LR, Donelly M. Medically unexplained chronic pain in Australia: difficulties for rehabilitation providers and workers in pain. Work. 2010;36:167–79.PubMedGoogle Scholar
  17. 17.
    Lippel K. Workers describe the effect of the workers’ compensation process on their health: a Quebec study. Int J Law Psychiatry. 2007;30:427–43.PubMedCrossRefGoogle Scholar
  18. 18.
    MacEachen E, et al. The “toxic dose” of system problems: why some injured workers don’t return to work as expected. J Occup Rehabil. 2010;20(3):349–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Anema JR, et al. Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study. J Occup Rehabil. 2009;19:419–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Stoltenberg CDG, Skov PG. Determinants of return to work after long-term sickness absence in six Danish municipalities. Scand J Public Health. 2010;38:299–308.PubMedCrossRefGoogle Scholar
  21. 21.
    Audhoe SS, et al. Vocational interventions for unemployed: effects on work participation and mental distress. A systematic review. J Occup Rehabil. 2010;20:1–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Dunn EC, Wewiorski NJ, Rogers ES. A qualitative investigation of individual and contextual factors associated with vocational recovery among people with serious mental illness. Am J Orthopsychiatry. 2010;80(2):185–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Lindsay C, McQuaid RW, Dutton M. New approaches to employability in the UK: combining ‘human capital development’ and ‘work first’ strategies? J Soc Policy. 2007;36(4):539–60.CrossRefGoogle Scholar
  24. 24.
    Trexler LE, et al. Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. J Head Trauma Rehabil. 2010;25(6):440–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Vermeulen SJ, et al. Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial. BMC Musculoskelet Disord. 2010;11.Google Scholar
  26. 26.
    Kemp PA, Davidson JOC. Employability trajectories among new claimants of Incapacity benefit. Policy Stud J. 2010;31(2):203–21.CrossRefGoogle Scholar
  27. 27.
    Krause JS, Pickelsimer E. Relationship of perceived barriers to employment and return to work five years later: a pilot study among 343 participants with spinal cord injury. Rehabil Couns Bull. 2008;51(2):118–21.CrossRefGoogle Scholar
  28. 28.
    Loisel P, et al. Disability prevention: new paradigm for the management of occupational back pain. Disabil Manag Health Outcomes. 2001;9(7):351–60.CrossRefGoogle Scholar
  29. 29.
    Steenstra IA, et al. Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain. J Occup Rehabil. 2006;16(4):557–78.PubMedCrossRefGoogle Scholar
  30. 30.
    Loisel P, et al. Management of occupational back pain: the Sherbrooke model. Results of a pilot and feasibility study. J Occup Environ Med. 1994;51:597–602.CrossRefGoogle Scholar
  31. 31.
    Stahl C, et al. A matter of trust? A study of coordination of Swedish stakeholders in return-to-work. J Occup Rehabil. 2010;20(3):299–310.PubMedCrossRefGoogle Scholar
  32. 32.
    Armstrong H, Laurs R. Vocational independence: outcomes for ACC claimants. Wellington, New Zealand: Department of Labour; 2007.Google Scholar
  33. 33.
    Lippel K. Le droit comme outil de maintien en emploi: rôle protecteur, rôle destructeur. Revue Pistes. 2010;12(1):21.Google Scholar
  34. 34.
    Lippel K. The private policing of injured workers in Canada: legitimate management practices or human rights violations? Policy Pract Health Saf. 2003;1(2):97–117.Google Scholar
  35. 35.
    Kaye HS. Stuck at the bottom rung: occupational characteristics of workers with disabilities. J Occup Rehabil. 2009;19:115–28.PubMedCrossRefGoogle Scholar
  36. 36.
    Fraser RT, et al. Understanding employers’ hiring intentions in relation to qualified workers with disabilities: preliminary findings. J Occup Rehabil. 2010;20(4):420–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Wilkinson-Meyers L, et al. Estimating the additional cost of disability: beyond budget standards. Soc Sci Med. 2010;71(10):1882–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Vierling L. Four components for an improved return-to-work program. Case Manag. 1999;10(4):52–4.CrossRefGoogle Scholar
  39. 39.
    Hay K. Measuring work ability in the third millennium. J Occup Health Saf Aust N Z. 2001;17(2):175–84.Google Scholar
  40. 40.
    Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage; 1998.Google Scholar
  41. 41.
    Cheek J. At the margins? Discourse analysis and qualitative research. Qual Health Res. 2004;14(8):1140–50.PubMedCrossRefGoogle Scholar
  42. 42.
    Hodges BD, Kuper A, Reeves S. Discourse analysis. Br Med J. 2008;337(a879):570–2.Google Scholar
  43. 43.
    MacEachen E (2008) IWH study questions ‘hurt vs harm’ concept underpinning early RTW model. In: Moser C, editor. Toronto: Institute for Work and Health; 2008. p. 7–9.Google Scholar
  44. 44.
    Seidel JV. Qualitative Data Analysis. www.qualisresearch.com (originally published as Qualitative Data Analysis, in The Ethnograph v5.0: A Users Guide, Appendix E, 1998, Colorado Springs, Colorado: Qualis Research); 1998.
  45. 45.
    WorkSafeBC. Rehabilitation services and claims manual volume II. V. R. Services, editor. Vancouver: WorkSafeBC; 2010.Google Scholar
  46. 46.
    ACC. Vocational rehabilitation. N.Z.A.C. Corporation, editor. 2010.Google Scholar
  47. 47.
    IWH. Cross-jurisdictional survey of case management services for long term and complex workers’ compensation claims. Toronto: Institute for Work & Health and Logan and Associates; 2009.Google Scholar
  48. 48.
    WSIA. Workplace Safety and Insurance Act, O.M.o. Labour, editor. Service Ontario e-laws; 1997.Google Scholar
  49. 49.
    Deloitte. Value for money audit of the labour market re-entry program: executive summary of final report. Toronto: WSIB; 2004.Google Scholar
  50. 50.
    WSIB. LMR and age, E. MacEachen, editor. Toronto; 2008.Google Scholar
  51. 51.
    KPMG. WSIB Labour Market Re-entry (LMR) Program value for money audit report. Toronto: WSIB; 2009.Google Scholar
  52. 52.
    Shrey DE. Disability management in industry: the new paradigm in injured worker rehabilitation. Disabil Rehabil. 1996;18(8):408–14.PubMedCrossRefGoogle Scholar
  53. 53.
    Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine. 1995;20(24):2702–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Sullivan MJ, et al. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehabil. 2005;15(3):377–92.PubMedCrossRefGoogle Scholar
  55. 55.
    Garcy P, Mayer T, Gatchel R. Recurrent or new injury outcomes after return to work in chronic disabling spinal disorder: tertiary prevention efficacy of functional restoration treatment. Spine. 1996;21:952–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Ash P, Goldstein SI. Predictors of returning to work. Bull Am Acad Psychiatry Law. 1995;23(2):205–10.PubMedGoogle Scholar
  57. 57.
    Lötters F, et al. The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders. Occup Environ Med. 2006;63(12):794–801.PubMedCrossRefGoogle Scholar
  58. 58.
    Dozois D, et al. Factors associated with rehabilitation outcome in patients with low back pain (LBP): prediction of employment outcome at 9-month follow-up. Rehabil Psychol. 1995;40(4):243–59.CrossRefGoogle Scholar
  59. 59.
    WSIB. Labour market re-entry: the next steps for return to work. Toronto: Workplace Safety & Insurance Board; 2006.Google Scholar
  60. 60.
    WSIB. Operational Policy Manual 11-01-05, W.S.a.I. Board, editor. Ontario; 2009.Google Scholar
  61. 61.
    WSIB. Workplace modifications and assistive devices, O.P. Manual, editor. Toronto; 2009.Google Scholar
  62. 62.
    MorneauSobeco. Recommendations for experience rating. Toronto: WSIB; 2008.Google Scholar
  63. 63.
    FPC. The Fair Practices Commission 2009 annual report. Toronto: Fair Practices Commission; 2009.Google Scholar
  64. 64.
    Wood L. Communication with WSIB, E. MacEachen, editor. Toronto; 2007.Google Scholar
  65. 65.
    Loisel P, et al. Prevention of disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil. 2005;15(4):507–24.PubMedCrossRefGoogle Scholar
  66. 66.
    Kristensen TS. Intervention studies in occupational epidemiology. Occup Environ Med. 2005;62:205–10.PubMedCrossRefGoogle Scholar
  67. 67.
    Eakin JM, MacEachen E, Clarke J. ‘Playing it smart’ with return to work: small workplace experience under Ontario’s policy of self-reliance and early return. Policy Pract Health Saf. 2003;1(2):19–42.Google Scholar
  68. 68.
    Stahl C, et al. Swedish rehabilitation professionals’ perspectives on work ability assessments in a changing sickness insurance system. Disabil Rehabil. 2011;33(15–16):1373–82.PubMedCrossRefGoogle Scholar
  69. 69.
    Pransky G, et al. Development and validation of competencies for return to work coordinators. J Occup Rehabil. 2010;20(1):41–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Shrey D, Hursh N. Workplace disability management: international trends and perspectives. J Occup Rehabil. 1999;9(1):45–59.CrossRefGoogle Scholar
  71. 71.
    Kralj B. Occupational health and safety: effectiveness of economic and regulatory mechanisms. In: Gunderson M, Hyatt D, editors. Workers’ compensation: foundations for reform. Toronto: University of Toronto Press; 2000. p. 187–218.Google Scholar
  72. 72.
    Hyatt DE, Kralj B. The impact of workers’ compensation experience-rating on employer appeals activity. Ind Relat. 1995;34(1):95–106.CrossRefGoogle Scholar
  73. 73.
    Lessard C. Complexity and reflexivity: two important issues for economic evaluation in health care. Soc Sci Med. 2007;64:1754–65.PubMedCrossRefGoogle Scholar
  74. 74.
    Feuerstein M. Predictors of occupational low back disability: implications for secondary prevention. J Occup Environ Med. 1999;41(2):1024–31.PubMedCrossRefGoogle Scholar
  75. 75.
    Franche RL, et al. Workplace-based return-to-work interventions: optimising the role of stakeholders in implementation and research. J Occup Rehabil. 2005;15(4):525–42.PubMedCrossRefGoogle Scholar
  76. 76.
    Frank J. Paradoxical aspects of low-back pain in workers’ compensation, in Workers’ compensation: foundations for reform. In: M. Gunderson and D. Hyatt, editors. Toronto: University of Toronto Press; 2000. p. 97–117.Google Scholar
  77. 77.
    Ison TG. Compensation systems for injury and disease: the policy choices. Toronto: Butterworths; 1994.Google Scholar
  78. 78.
    Black DC. Advancing awareness and support for effective disability management outcomes and best practices: the fit note. In: Proceedings of the international federation of disability management, Sept 20–22, 2010, Los Angeles; 2010.Google Scholar
  79. 79.
    Prince MJ. Canadian disability policy: still a hit-and-miss affair. In: Blake RB, Keshen JA, editors. Social fabric or patchwork quilt: the development of social policy in Canada. Toronto: University of Toronto Press; 2010. p. 435–54.Google Scholar
  80. 80.
    MacEachen E, et al. How systemic problems can prolong workers’ compensation claims and change worker’s lives: an informed realist perspective. Toronto: Institute for Work & Health; 2008.Google Scholar
  81. 81.
    Cox R, Lippel K. Falling through the legal cracks: the pitfalls of using workers’ compensation data as indicators of work-related injuries and illnesses. Policy Pract Health Saf. 2008;6(2):63–84.Google Scholar
  82. 82.
    Meyerson DE. Uncovering socially undesirable emotions. Experiences of ambiguity in organisations. Am Behav Sci. 1990;33(3):296–307.CrossRefGoogle Scholar
  83. 83.
    Clegg S. Power relations and the constitution of the reluctant subject. In: Jermier JM, Knights D, Nord WR, editors. Resistance and power in organizations. London: Routledge; 1994. p. 274–325.Google Scholar
  84. 84.
    Lynch RT, Leonard J, Powers JM. Vocational rehabilitation for injured workers. Phys Med Rehabil Clin N Am. 1997;8(2):297–310.Google Scholar
  85. 85.
    Aitken RC, Cornes P. To work or not to work: that is the question. Br J Ind Med. 1990;47(7):436–41.PubMedGoogle Scholar
  86. 86.
    Shaw W, et al. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil. 2008;18(1):2–15.PubMedCrossRefGoogle Scholar
  87. 87.
    Kendall E, Muenchberger H, Clapton J. Trends in Australian rehabilitation: reviving its humanitarian core. Disabil Rehabil. 2007;29(10):817–23.PubMedCrossRefGoogle Scholar
  88. 88.
    Purse K. Outsourcing myths and workers’ compensation claims administration. Aust J Public Adm. 2009;68(4):446–58.CrossRefGoogle Scholar
  89. 89.
    Ontario LAO. Bill 99 Workers’ Compensation reform Act. In: Bill 99. Toronto; 1998.Google Scholar
  90. 90.
    Bernhard D, MacEachen E, Lippel K. Disability management experts and the impact on practice of jurisdiction. International Journal of Social Security and Workers Compensation. 2011;2(1):1–16.Google Scholar
  91. 91.
    O’Donnell C. Will Australian workers’ compensation insurance management get better soon? Work. 2000;15:177–88.PubMedGoogle Scholar
  92. 92.
    Harcourt M, Lam H, Harcourt S. The impact of workers’ compensation experience-rating on discriminatory hiring practices. J Econ Issues. 2007.Google Scholar
  93. 93.
    Lipsky M. Street-level bureaucracy: Dilemmas of the individual in public services. New York: Russell Sage Foundation; 1980.Google Scholar
  94. 94.
    Franche RL, et al. Perceived justice of compensation process for return-to-work: development and validation of a scale. J Psychol Inj Law. 2009;2:225–37.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • E. MacEachen
    • 1
    • 2
  • A. Kosny
    • 1
    • 2
  • S. Ferrier
    • 1
  • K. Lippel
    • 3
  • C. Neilson
    • 1
  • R. L. Franche
    • 4
    • 5
  • D. Pugliese
    • 1
  1. 1.Institute for Work & HealthTorontoCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.University of OttawaOttawaCanada
  4. 4.University of British ColumbiaVancouverCanada
  5. 5.Simon Fraser UniversityBurnabyCanada

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