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

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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.

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Notes

  1. For example, http://www.dol.gov/odep/pubs/fact/focus.htm: United States Department of Labour Office of Disability and Employment Policy “Focus on Ability: Interviewing Applicants with Disabilities”; http://www.owa.gov.on.ca/fact_sheets/labour_market_reentry.html: “[Ontario’s Labour market re-entry services] ensure you have the skills, knowledge, and abilities to return to the type of work you are able to do and is available”.

  2. For example: http://www.empire.ca/consumer/group-benefits/our-products/disability-benefits/en/: “We focus on ability not disability. This helps us help employees return to work as soon as their functional abilities match their job requirements”; http://www.healthsynergy.ca/DISABILITY-MANAGEMENT.html: “The focus is on ability rather than disability and encourages the management of illness or injury as early as possible”.

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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.

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MacEachen, E., Kosny, A., Ferrier, S. et al. The ‘Ability’ Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program. J Occup Rehabil 22, 105–117 (2012). https://doi.org/10.1007/s10926-011-9329-x

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