Title: Job Retention and Vocational Rehabilitation for People with Mental Health Problems.
1Job Retention and Vocational Rehabilitation for
People with Mental Health Problems.
2Aims of this Presentation
- To give a description of the Job retention Pilot
Study. - To introduce participants to a process applicable
to job retention for mental health issues,
illustrated through composite case studies - To describe some of the learning encountered
during intervention. - To give an overview of the interim results from
the evaluation
3The Context
- Average length of time taken off work for mental
health related problems is estimated at 29 days
compared to 19 days for musculoskeletal
disorders.( Jones et al. 2001/2002 Self Reported
Work Related Illness in 2001/2002 Results from a
household Survey. SW 101/102 www.hse.gov/statist
ics/causdis/swi0102pdf ) - As many as 117,000 people with mental health
problems, aged between 18 and 65 years currently
registered unemployed are capable of work and
want to work. ( Scottish Executive Health
Department (1997) A Framework for mental health
services in Scotland 1997) - Constructive Employment can have a positive
impact on mental health and well-being.
(Schneider J. (1998) Work interventions in Mental
Care, Some Arguments and recent evidence. Journal
of Mental Health, 7 81-94)
4Drivers for the Project
- The National Programme for Improving Mental
Health and Well- Being. - The Framework for Mental Health Services in
Scotland - The Mental Health and Employment Policy for
Scotland - The Mental Health (Care and Treatment) (Scotland)
Act 2003 - Fifes Multi-agency Mental Health Strategy
Group-Employment Strategy Group
52 Strands to the Project
- Job Retention
- Workplace assessment
- Meet with Employee and manager
- Short term assistance for mental health issues
- Referral on to specialist services.
- Support into Work
- Anyone who applies to Fife Council or NHS Fife.
- Application packs contain a flyer offering
confidential service. - FEAT offer support through application process
and into employment
6Rehabilitation Consultants Role
- Workplace assessment.
- Meet with employee and manager to identify what
changes might be made to assist the employee in
returning to or remaining at work. - Formulate a plan to overcome identified problems.
7Inclusion/ Exclusion Criteria
- Participants must
- Have work-related issues that are affecting their
mental health or mental health issues affecting
their work. - Have reduced performance or increased sickness
absence. - Have worked for their organisation longer than
six months, usually. If involved with the support
into work strand this may indicate earlier
inclusion. - Have consented and be willing and able to
co-operate with the rehabilitation consultant.
8Referral from OHSAS
Self Referral
Eligibility Screening
Participant Consent Obtained
Pre-intervention Assessement CORE, GHQ12,EQ-5D
Pre-intervention Assessment COPM
Allocation to Rehabilitation Consultant Assessment
and workplace visit
Action Plan agreed with client
Intervention as agreed in plan
Post-Intervention Assessement
Clients/Managers Perceptions
Objectively derived data
Post Intervention Assessment (OT)
Exit
9Structure of the model
- Aim of the project is to develop and evaluate a
model which can be rolled out across Scotland. - Need for a structured approach which allows the
model to be accepted and applied to the context
of other areas.
103 models- Kortman
- Professional Model- a wide description of role
and practice across many client groups and
situations. - Delineation- The favoured approach to be used
with a particular client or group. - Application- Specific intervention techniques
used during client contact. - Kortman B (1995)The Eye of the Beholder, Models
in Occupational Therapy. British Journal of
Occupational Therapy.58, 532-536
11Model of preference- Professional Model
- Model of Human Occupation- Considers the
individual in terms of Motivation, Roles and
Habits, Skills and the environment the individual
moves in.
12Model of Preference- Delineation
- Approach Specific to the clients needs e.g.
- Cognitive approach
- Behavioural approach
- Rehabilitative approach
- Symptom management
13Application
- The specific activities and techniques used in
the intervention e.g. - Relapse prevention plans.
- Target setting.
- Support in positively reframing client situation.
14Job Retention Pilot Intervention
- Personal contact with the employee and manager.
- Workplace assessment.
- Formulate an action plan.
- Liaison with employee and manager.
- Short term interventions and referral on
15The Model. Schematic
16Learning.
17Referrals
- The majority of referrals are for individuals
with Anxiety and depression. - The demand for assistance with job retention
issues appears to outweigh supply. - People presenting with major mental illnesses
usually require a more rehabilitative approach.
18Each Case a Minimum of 4 People
- The index client.
- The manager.
- The HR officer.
- The OH physician or nurse.
- Other (e.g.CPN)
19The Index Client
- Each case is unique and the rehab agent should
consider the following - The mental health problem the client is
presenting with. - The clients personality.
- The clients motivation, roles and habits and
skills associated with their worker role.
20The Manager is Key
- Their sensitivity to mental health issues.
- Their specialist knowledge of the job e.g. what
might be a reasonable adjustment. - Their power to implement a plan.
- Their knowledge of the client.
- The possibility of their being a contributing
factor in the clients difficulties.
21HR, OH and Other Agents.
- HR are remote from the process of the
intervention but are central to the case in terms
of attendance management and organisational
policy. - OH may have continued contact with the client and
require some level of communication. - Existing services already giving support should
be factored into planning as they may be doing
work pertinent to the return to work programme.
22The Job Task Components
- Physical
- Cognitive
- Social
- Emotional
- Environmental
23Case Study
- Mrs CStudie
- 44 yrs old
- Class and Admin assistant
- 3 year history of Anxiety, including panic
- Still attending work but performance much
diminished. - Supportive manager has accommodated difficulties
but needs action taken
24Worker Role Interview
- Showed clients level of motivation supported a
return to her role - Continued reporting for work carrying out reduced
duties had maintained her work routines - Client was able to engage with the children in
her care on a one to one basis - Client perceived her work environment as
supportive.
25Job site visit
- Although client continued to attend work she was
not fulfilling her role, concerns within the
organisation that this was unsustainable. - Manager was sensitive to mental health issues,
had made adjustments already and was keen to see
a return to full capacity
26Job Task Analysis
- Used Valpar Profile Analysis Guide to describe
the level of demands in a variety of component
areas e.g. temperaments, aptitudes, educational
development - Identified what tasks had been lost and level of
perceived difficulty in re-engagement.
27Meeting with both Manager and Client
- Facilitated communication between the two parties
- Agreed the plan together- identified tasks not
being carried out, in order of ease and set time
scales and targets to re-introduce these. - Agreed need for specialist help and time to
utilise this to ensure maintenance of progress in
future. - Agreed Review date.
28Result
- Client returned to almost full working capacity
by review date. Discharged at this point.
29Case Study
- Anne Awnimuss
- 35 years old
- Technical Officer, Science Department
- 15 year history of Schizophrenia
- 11 month sickness absence
- Fractured relationships within department
30Worker Role Interview
- Showed client had a strong identification with
her worker role and specialised skills. - Illustrated an absence of routines in work role
and during period of sickness absence. - High lighted symptoms of the illness impacting on
ability to fulfill role.
31Job Site Visit and meeting with manager
- Reinforced that client was considered to have
specialist skills valuable to the organisation. - Changes had occurred during clients absence
introducing increased level of IT equipment - Organisation willing to accommodate issues around
symptoms and medication.
32Plan included
- Phased return over 6 week period.
- Hours altered to accommodate hours of daylight
throughout the seasons. - Break times organised to accommodate onset of
drowsiness caused by medication. - Client provided with work space to minimise
contact with IT equipment.
33Result
- Client did not cope well with the early stages of
the phased return. - Client resigned but this was declined by the
organisation. Resigned whilst ill. - Same plan implemented at a lower key site.
- Client resigned.
34Some Unsolicited Comments
- advice was helpful and we put several things in
place to change his routine. The transformation
in him has been quite remarkable.- Gs manager. - .it has been very stressful for me but I have
been able to make decisions where needed. A (a
client)
35Evaluation Overview
- Pre and post intervention assessments conducted
independently of intervention. - Range of measures covering
- Occupational performance and satisfaction
- Psychological distress
- Quality of life and general functioning
- Client and managers perspectives
36Evaluation Overview Pre Post Intervention
Measures
- Non-standardised measures
- Clients Perception Questionnaire
- Managers perception Questionnaire
- Standardised measures
- Canadian Occupational Performance Measure
- CORE
- GHQ-12
- European Quality of Life 5D
37Interim Findings Group overview
- Subgroup of 11 completed cases.
- Analysis of pre and post-intervention scoring on
standardised measures using non-parametric
statistics (Wilcoxen Signed Ranks tests). - Demographic Information
- Gender 6 males and 5 females
- Age mean 42.09, range 28 to 56
38Interim Findings Employment Status
- Pre-intervention employment status
- Absent from work and receiving sick pay 8
- Absent from work no sick pay 1
- Length of absence mean26.2 weeks (range 1-72
weeks) - At work performing restricted duties 2
- Post-intervention employment status
- All 11 individuals were at work at the point of
discharge (some restricted duties).
39Interim Findings- Occupational Group
Council Total9 NHS Total2
Local office network 2 Nursing -1
Comm leisure services 2 Estates -1
Education 3
Childcare strategy 1
Finance -1
Development services-1
40Interim Findings Diagnostic group
41The Canadian Occupational Performance Measure
(COPM)Law et al (2000)
- Designed for use by Occupational Therapists to
detect self-perceived change in occupational
performance problems over time. - Performance and satisfaction scores based on
ratings for 5 individually relevant occupational
performance problems.
42COPM findings Performance scores
- This difference was statistically significant
- (T(11)0, plt.01)
N Group Mean Std Dev
Pre 11 3.19 1.30
Post 11 6.69 1.96
43COPM findings Satisfaction scores
- This difference was statistically significant
- (T(11)0, plt.05)
N Group mean Std Dev
Pre 11 3.18 1.79
Post 11 5.92 2.81
44Evaluation Overview
- Pre and post intervention assessments conducted
independently of intervention. - Range of measures covering
- Occupational performance and satisfaction
- Psychological distress
- Quality of life and general functioning
- Client and managers perspectives
45Evaluation Overview Pre Post Intervention
Measures
- Non-standardised measures
- Clients Perception Questionnaire
- Managers perception Questionnaire
- Standardised measures
- Canadian Occupational Performance Measure
- CORE
- GHQ-12
- European Quality of Life 5D
46Interim Findings Group overview
- Subgroup of 11 completed cases.
- Analysis of pre and post-intervention scoring on
standardised measures using non-parametric
statistics (Wilcoxen Signed Ranks tests). - Demographic Information
- Gender 6 males and 5 females
- Age mean 42.09, range 28 to 56
47Interim Findings Employment Status
- Pre-intervention employment status
- Absent from work and receiving sick pay 8
- Absent from work no sick pay 1
- Length of absence mean26.2 weeks (range 1-72
weeks) - At work performing restricted duties 2
- Post-intervention employment status
- All 11 individuals were at work at the point of
discharge (some restricted duties).
48Interim Findings- Occupational Group
Council Total9 NHS Total2
Local office network 2 Nursing -1
Comm leisure services 2 Estates -1
Education 3
Childcare strategy 1
Finance -1
Development services-1
49Interim Findings Diagnostic group
50The Canadian Occupational Performance Measure
(COPM)Law et al (2000)
- Designed for use by Occupational Therapists to
detect self-perceived change in occupational
performance problems over time. - Performance and satisfaction scores based on
ratings for 5 individually relevant occupational
performance problems.
51COPM findings Performance scores
- This difference was statistically significant
- (T(11)0, plt.01)
N Group Mean Std Dev
Pre 11 3.19 1.30
Post 11 6.69 1.96
52COPM findings Satisfaction scores
- This difference was statistically significant
- (T(11)0, plt.05)
N Group mean Std Dev
Pre 11 3.18 1.79
Post 11 5.92 2.81
53General Health Questionnaire GHQ-12 (Goldberg,
1992)
- Well-established measure of psychological
distress. - Change in scores from pre to post intervention
highly statistically significant (T(11)0, plt.01).
N Group mean Std Dev
Pre 11 19.82 10.55
Post 11 9.82 8.99
54CORE Outcome Measure (CORE System Group)
- Provides a measure of global distress in addition
to subscales - Subjective well-being
- Problems/symptoms
- Life/social functioning
- Risk to self and others
55CORE Outcome Measure Interim Findings
- Significant change in scores from pre to post
- Global Distress (T(11)0, plt.01)
- Problems/Symptoms (T(11)0, plt.005)
- Risk (T(11)0, plt.05)
- No significant change pre to post at this stage
- Well-being
- Life/social functioning
56European Quality of Life 5D Scale (EuroQuol
Group, 1990)
- Respondents indicate presence and degree of
problems in - Mobility
- Self-care
- Activities
- Pain
- Anxiety/Depression
- Make an overall rating of current quality of life
using a visual-analogue scale.
57EQ-5D Interim Findings 1
- Group not characterised by physical health
problems - pre intervention ratings for problems
with mobility, self-care, activities and pain
were therefore largely absent and no significant
change was present in these scores pre to post.
58EQ 5D Interim Findings 2
- Ratings of problems with anxiety/depression
- This change achieved statistical significance
(T(11)4.5, plt.05)
N Group Mean Std Dev
Pre 11 1.27 0.79
Post 11 0.55 0.52
59EQ 5D Interim Findings 3
- Ratings of current overall quality of life
- This change from pre to post-intervention
achieved statistical significance (T(10)1,
plt.01).
N Group Mean Std Dev
Pre 10 45.70 27.16
Post 11 73.91 20.57
60Summary of Interim Findings
- Small subgroup of completed cases N11
- Statistically significant changes on a range of
relevant standardised measures of - Occupational performance and satisfaction
- Psychological distress, problems and symptoms
- Quality of life
- Effect sizes substantial
- Aim to establish whether findings are replicated
in larger group - Caveat post intervention completers