Disability case management: an impact assessment in an automotive manufacturing organization. A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong. Adding contingency management intervention to vocational rehabilitation: outcomes for dually diagnosed veterans. Outcomes of managing disability benefits among patients with substance dependence and severe mental illness. Disability management practices in education, hotel/motel, and health care workplaces. Motivating disability pensioners with back pain to return to work--a randomized controlled trial. A randomized controlled trial comparing two vocational models for persons with severe mental illness. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss. A web-based intervention to promote applications for rehabilitation: a study protocol for a randomized controlled trial Barriers in implementation of evidence-based practice: Supported employment in Swedish context. Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy of physical therapy. From Evidence to Community Practice in Work Rehabilitation: The Quebec Experience Adding a vocational focus to mental health rehabilitation. Supplementing supported employment with workplace skills training. A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Long-term effectiveness of supported employment: 5-year follow-up of a randomized controlled trial. The efficacy of supported employment for middle-aged and older people with schizophrenia
A multifaceted disability management program was instituted at an automotive manufacturing organization to control rising workers ' compensation costs . A pilot program showed major cost savings over a 9-month period . When total and component disability leave rates were calculated as a percentage of the available workforce and tracked on a weekly basis over the subsequent 3 years , total disability leave rates fell by nearly 50 % . This was largely attributable to an approximately 50 % decrease in the extended ( > 1-year ) disability leave rate and a 75 % decrease in the workers ' compensation leave rate . A novel approach to biostatistical analysis showed a good fit of weekly disability leave rates to a Poisson r and om variable distribution with an identifiable break point at about 1 1/2 years after observation for extended disability leaves and at 2 years for workers ' compensation leaves . This biostatistical approach may prove generalizable to tracking leave rates in other organizations OBJECTIVES Supported employment is an evidence -based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment . Most research on the effectiveness of supported employment comes from the United States . This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting . METHODS Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were r and omly assigned to either a  supported employment program or a conventional vocational rehabilitation program  and followed up for 18 months . Both vocational and nonvocational outcomes were measured . RESULTS Over the 18-month study period , compared with participants in the conventional vocational rehabilitation program , those in the supported employment group were more likely to work competitively ( 70 % versus 29 % ; odds ratio=5.63 , 95 % confidence interval=2.28 - 13.84 ) , held a greater number of competitive jobs , earned more income , worked more days , and sustained longer job tenures . Repeated- measures analysis of variance found no substantive differences between participants in the two groups and no significant change from baseline over time for psychiatric symptoms and self-perceived quality of life . CONCLUSIONS Consistent with previous research findings in the United States , the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting . The supported employment program based on the individual placement and support model can thus be recommended for wider use in local mental health practice In this r and om-assignment trial , we evaluated the efficacy of using a contingency management ( CM ) intervention to enhance job acquisition and tenure among participants of a vocational rehabilitation ( VR ) program .  The CM intervention offered participants cash incentives up to $ 1,170 for completing tasks related to sobriety and job search and maintenance . Participants were 100 veterans with comorbid psychiatric disorders and substance dependence who were r and omly assigned either to VR only or VR + CM . Relative to participants in the VR-only group , those in the VR + CM group showed more intense job search es and transitioned to competitive employment faster and at higher rates . No significant difference was found in job tenure , though this may be due to the limited follow-up period . Abstinence rates were significantly better in the VR + CM group during the first 16 weeks of follow-up but not significantly different in subsequent follow-ups . No relationship was found between relapse and employment . These results suggest that rehabilitation outcomes may be enhanced by adding CM to current programming or by restructuring traditional work-for-pay contingencies to include direct financial rewards for achievement of clinical goals To evaluate the feasibility and efficacy of a program to manage Social Security disability benefits in a clinical sample of patients with severe mental illness and co-occurring substance dependence , 41 patients were r and omly assigned to have their benefits either contingently or noncontingently managed through their mental health center . Contingent management involved adjustments to the type or frequency ( not amount ) of disability benefits and payments for study participation based on ratings of substance use , money management , and treatment follow-through . The patients with contingent management used significantly less alcohol and drugs and showed much better money management than those with noncontingent management . Patients and case managers who participated in the study reported that they found the management strategy to be acceptable and useful BACKGROUND The high costs and the impact of work disability have become a growing concern for workplaces . As a result , workplace disability management approaches have been developed to lower disability costs , protect the employability of workers , and promote early return to work . METHODS A stratified r and om sample of 455 employers in education ( n = 157 ) , hotel/motel ( n = 110 ) , and health care ( n = 188 ) sectors who completed a mailed Organizational Policies and Practice s ( OPP ) question naire is reported . The OPP question naire asked questions about eight workplace disability management practice s. The article examined the multi-dimensionality , internal consistency , and discriminant validity of the OPP and compares disability management practice s across the three sectors . RESULTS The OPP question naire showed good internal consistency ( Cronbach 's alpha = 0.95 ) and discriminant validity . A one-way analysis of variance ( ANOVA ) for each of the eight subscales demonstrated that there were statistically significant differences between the sectors in ergonomic practice s ( F ( 2,452 ) = 15.8 , P < 0.001 ) , disability case management ( F ( 2,452 ) = 4.6 , P < 0.01 ) , return to work ( F ( 2,452 ) = 10.3 , P < 0.001 ) , and people-oriented culture ( F ( 2,452 ) = 4.5 , P < 0.01 ) . CONCLUSIONS On examining disability management practice s in education , hotel/motel , and health care sectors , the OPP seems to be a promising instrument that can be used to assess and monitor how employers are managing disability OBJECTIVE To investigate the outcome of a brief vocational-oriented intervention aim ing to motivate disability pensioners with back pain to return to work , and to evaluate prognostic factors for having entered a return to work process during the following year . DESIGN A r and omized controlled trial was conducted . SUBJECTS Participants ( n = 89 ) ( mean age 49 years , 65 % women ) who had received disability pension for more than one year were r and omized into an intervention group ( education , reassurance , motivation , vocational counselling , n = 45 ) and a control group ( n = 44 ) . METHODS Primary outcome measures were return to work or having entered a return to work process . Secondary outcome measures were life satisfaction , disability , fear avoidance behaviour and expectancy . RESULTS The intervention had no statistically significant effect on return to work or having entered a return to work process at 1-year follow-up . Twice as many in the intervention group ( n = 10 , 22 % ) had entered a return to work process compared with the controls ( n = 5 , 11 % ) . The number needed to treat was 9.2 ( 95 % confidence interval ( CI ) = 3.4 , Inf ) . Only minor differences in secondary outcome measures were demonstrated . Positive expectancy , better physical performance and less pain were related to return to work . CONCLUSION The effort of returning disability pensioners to work by a brief vocational-oriented intervention may be of clinical relevance . The effect needs to be explored further in larger sample s of disability pensioners The authors compared 2 approaches to vocational rehabilitation for individuals with severe mental illness :  the individual placement and support ( IPS ) model of supported employment and the diversified placement approach ( DPA ) , which emphasizes work readiness and offers a range of vocational options , including agency-run businesses and agency-contracted placements with community employers . In all , 187 unemployed participants with severe mental illness were r and omly assigned to IPS or DPA . Over 2 years , IPS had significantly better competitive employment outcomes than DPA . Competitive employment rates over the 2-year follow-up were 75.0 % for IPS and 33.7 % for DPA . However , IPS and DPA did not differ on paid employment outcomes . The authors conclude that IPS is more effective than DPA in achieving competitive employment , but not paid employment OBJECTIVE Work disability is a major consequence of inflammatory rheumatic conditions . Evidence regarding the effectiveness of interventions aim ed at the prevention or reduction of work disability in rheumatic diseases is limited . We conducted a r and omized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation ( VR ) program in patients with a rheumatic condition who were at risk for job loss . METHODS A total of 140 patients with a chronic rheumatic condition were r and omly assigned to either a multidisciplinary job-retention VR program ( n = 74 ) or usual outpatient care ( UC ) ( n = 66 ) . Patients in the VR group were assessed and guided by a multidisciplinary team , whereas patients in the UC group received care as initiated by their rheumatologist , supplemented with written information . The main outcome measure was the occurrence of job loss ( complete work disability or unemployment ) ; additional outcome measures included job satisfaction , pain , functional status , emotional status , and quality of life . RESULTS There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point , with 24 % and 23 % of the patients in the VR and UC groups , respectively , having lost their job after 24 months . Over the total period of 24 months , patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status ( all P values < 0.05 ) . CONCLUSION A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss Background The German welfare system follows the principle “ rehabilitation rather than pension , ” but more than the half of all disability pensioners did not utilize medical rehabilitation before their early retirement . A major barrier is the application procedure . Lack of information about the opportunity to utilize rehabilitation services restricts the chance to improve work ability and to prevent health-related early retirement by rehabilitation programs . The establishment of new access paths to medical rehabilitation services was , therefore , identified as a major challenge for rehabilitation research in a recent expertise . Thus , a web-based information guide was developed to support the application for a medical rehabilitation program . Methods / Design For this study , the development of a web-based information guide was based on the health action process approach . Four modules were established . Three modules support forming an intention by strengthening risk perception ( module 1 ) , positive outcome expectancies ( module 2 ) and self-efficacy ( module 3 ) . A fourth module aims at the realization of actual behavior by offering instructions on how to plan and to push the application process . The study on the effectiveness of the web-based information guide will be performed as a r and omized controlled trial . Persons aged 40 to 59 years with prior sick leave benefits during the preceding year will be included . A sample of 16,000 persons will be r and omly drawn from the registers of 3 pension insurance agencies . These persons will receive a question naire to determine baseline characteristics . Respondents of this first survey will be r and omly allocated either to the intervention or the control group . Both study groups will then receive letters with general information about rehabilitation . The intervention group will additionally receive a link to the web-based information guide . After 1 year , a second survey will be conducted . Additionally , administrative data will be used to determine if participants apply for rehabilitation and finally start a rehabilitation program . The primary outcomes are the proportion of applied and utilized medical rehabilitation services . Secondary outcomes are cognitions on rehabilitation , self-rated work ability , health-related quality of life and perceived disability , as well as days with sick leave benefits and days of regular employment . Discussion The r and omized controlled trial will provide highest ranked evidence to clarify whether theory-driven web-based information supports access to rehabilitation services for people with prior sickness benefits .Trial registration German Clinical Trials Register ( Identifier : DRKS00005658 , 16 January 2014 ) PURPOSE The aim of this paper is to identify initial barriers influencing implementation of supported employment ( SE ) . SE , according to the individual placement and support ( IPS ) approach , has been recognised as an evidence -based method to help people with severe mental illness to find regular employment . DESIGN / METHODOLOGY /APPROACH A systematic implementation evaluation of the first r and omised controlled SE ( IPS ) trial in Sweden was conducted in August 2008 and August 2009 . Data were collected on a regular basis from SE employment specialists , process heads , clients and representatives from mental health care units and vocational services ( social insurance and public employment offices ) using interviews , non-participant observations and document analysis . FINDINGS SE employment specialists reported that existing regulations for social insurance and employment regulations presented major obstacles to implementation . Difficulties were reported in cooperation with h and ling officers at the vocational services . Scepticism towards persons with mental illness was common and employers expected to receive subsidies if they hired a person with mental illness . SE participants expressed fear of losing their social benefits . ORIGINALITY/VALUE The results illuminate a collision between an innovative evidence -based practice and the existing systems for social benefits and work rehabilitation BACKGROUND AND PURPOSE The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers ' compensation was examined . The primary purpose of the study was to describe the level of disability , physical impairment , and rate of return to work for compensated patients . SUBJECTS One hundred thirty-eight patients ( 84 male , 54 female ) , aged 17 to 63 years ( mean = 38 , SD = 10 ) , were evaluated prospect ively . METHODS Subjects were assessed initially ( INA ) and were reevaluated 1 month later ( 1MO ) and again at the time of discharge ( DC ) . The Oswestry disability score , fingertip-to-floor distance during forward bending , maximal isometric lift , and work status were described as outcomes . Subjects were grouped based on compliance , chronicity , and leg symptoms . Each disability/impairment outcome was analyzed with paired t tests ( INA versus 1MO and INA versus DC ) . The frequency of subjects returning to work across groups was evaluated with a chi-square analysis corrected for unequal group sizes . RESULTS Overall , there was improvement in each dependent measure at 1MO and DC compared with the INA . Subjects with high compliance had a 10 % reduction in mean disability at 1MO and a 12 % reduction in mean disability at DC compared with the INA . The low-compliance group , in contrast , showed less than a 5 % reduction in mean disability at both the 1MO and DC assessment s compared with the INA . The magnitude of improvement in disability status , forward bending , and maximal lift was approximately two to three times greater for subjects with acute symptoms compared with those with chronic symptoms . The increase in mean forward bending for subjects without leg symptoms was over twice as large as the increase in forward bending for subjects with leg symptoms . Seventy-five percent of the subjects followed at DC ( 30 out of 40 ) were released to work in some capacity . There was no association between compliance or presence of leg symptoms and work status at DC . Eighty percent of the subjects with acute symptoms , however , were working at the time of DC compared with 44 % of those with chronic symptoms . CONCLUSION AND DISCUSSION Compliance , chronicity , and leg symptoms are all factors that can affect the outcome of physical therapy . The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment Background The causes of prolonged disability due to back pain are multiply determined , involving medical , social , and environmental factors . Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence -based programs to large community setting s. Objective This article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec . Methods and Results Phase A : Based on literature review and expert knowledge , the Sherbrooke model was developed and assessed through a population -based , r and omized clinical trial . Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life ; the 6-year follow-up showed the cost-effectiveness of the method .Phase B : Based on the Sherbrooke model experience and recent evidence , a new program addressing the disability paradigm was developed and implemented in the province of Quebec ( Canada ) . Results at 1- and 3-year follow-ups showed that only 24 % of workers were not working owing to their musculoskeletal disorder . The program is presently being tested through a population -based , r and omized clinical trial in a population of construction workers . Phase C : To implement the program at a provincial level , a network for management , research and education in work rehabilitation was developed . An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various setting OBJECTIVES The study examined the effect of adding two employment specialists to the staff of a community mental health center ; their sole responsibility was to develop the skills and positive work attitudes that clients with severe mental illness need to enter the state vocational rehabilitation system or to seek employment . METHODS A total of 122 clients were r and omly assigned to a program with an employment specialist or to a control group with no specialized vocational services .  Clients in the program were taught work skills and attitudes in group and individual sessions and through a trial work experience . A schedule of rewards reinforced positive changes . Outcomes measured were skill gains , changes in work attitudes , attainment of employment , and entry into the state vocational rehabilitation system . RESULTS At nine months , 34 of the 61 clients in the program achieved positive changes in vocational status that included competitive employment , participation in training and evaluation programs operated by the state vocational system , and formal referral to the system . Only one client in the control group was linked to the state system . Skill gains and positive changes in work attitudes were found for all program clients . Logistical regression suggested that program participation , rather than client characteristics , was an important predictor of a positive outcome . CONCLUSIONS Over a relatively short time period , targeted vocational programs can help clients with severe mental illness develop the skills and attitudes necessary to attain employment or entry into the vocational rehabilitation system . Vocational rehabilitation can be an integral part of the rehabilitation process for all mental health clients Introduction by the column editors : Supported employment , as design ed for persons with serious and persistent mental illness , has been termed individual placement and support . In two r and omized controlled trials ( 1,2 ) , clients who received individual placement and support services  were more likely to obtain at least one job in the competitive sector , to work more hours , and to have a higher total income than their counterparts who received more traditional types of vocational rehabilitation . However , individual placement and support did not improve the length of time the employed participants kept their jobs . An adjunctive or additional element of individual placement and support , aim ed at improving the job tenure of individuals with mental illness , would be a constructive contribution to the vocational rehabilitation for this population . In a previous Rehab Rounds column , Wallace and colleagues ( 3 ) described the development of the workplace fundamental skills module , a highly structured and user-friendly curriculum design ed to teach workers with mental illness the social and workplace skills needed to keep their jobs . The workplace fundamental skills module supplements individual placement and support by conveying specific skills that enable workers to learn the requirements of their jobs , anticipate the stressors associated with their jobs , and cope with stressors by using a problem-solving process . The earlier report described the production and validation of the module 's content . The purpose of this month 's column is to present the preliminary results of a r and omized comparison of the module 's effects on job retention , symptoms , and community functioning when coupled with individual placement and support . To enable wide generalization of the findings of the study , the program was conducted in a typical community mental health center BACKGROUND This experiment evaluated the effectiveness of 2 approaches to vocational services for persons with severe mental disorders : ( 1 ) individual placement and support ( IPS ) , in which employment specialists within the mental health center help patients to obtain competitive jobs and provide ongoing support , and ( 2 ) enhanced vocational rehabilitation ( EVR ) , in which stepwise vocational services are delivered by rehabilitation agencies . METHODS One hundred fifty-two unemployed , inner-city patients with severe mental disorders who expressed interest in competitive employment were r and omly assigned to IPS or EVR and followed up for 18 months . Following diagnostic assessment , participants were assessed with st and ardized measures of work , income , self-esteem , quality of life , symptoms , and hospitalization at baseline and at 6- , 12- , and 18-month follow-up evaluations . Employment was tracked monthly and job satisfaction every 2 months . RESULTS During the 18-month study , participants in the IPS program were more likely to become competitively employed ( 60.8 % vs 9.2 % ) and to work at least 20 hours per week in a competitive job ( 45.9 % vs 5.3 % ) , whereas EVR participants had a higher rate of participation in sheltered employment ( 71.1 % vs 10.8 % ) . Total earnings , job satisfaction , and nonvocational outcomes were similarly improved for both groups . CONCLUSION The IPS model of supported employment is more effective than st and ard , stepwise EVR approaches for achieving competitive employment , even for inner-city patients with poor work histories and multiple problems OBJECTIVE The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1 - 2 years in persons with severe mental illness . The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years . METHOD A r and omized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness .  Competitive work and hospital admissions were tracked for 5 years , and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life . A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment . RESULTS The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period . Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation ( 65 % compared with 33 % ) , worked more hours and weeks , earned more wages , and had longer job tenures . Reliance on supported employment services  for retaining competitive work decreased from 2 years to 5 years for participants in supported employment . Participants were also significantly less likely to be hospitalized , had fewer psychiatric hospital admissions , and spent fewer days in the hospital . The social return on investment was higher for supported employment participants , whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs . CONCLUSIONS The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment OBJECTIVE Supported employment is the evidence -based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment , but few supported employment programs specifically target older clients with psychiatric illness . The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia . METHOD Participants included 58 out patients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic . Participants were r and omly assigned to receive Individual Placement and Support ( IPS ; the manualized version of supported employment ) or conventional vocational rehabilitation ( CVR ) for one year , and completed assessment s at baseline , six months , and twelve months . RESULTS IPS was superior to CVR on nearly all work outcome measures , including attainment of competitive employment , weeks worked , and wages earned . Fifty-seven percent of IPS participants worked competitively , compared with 29 % of CVR participants ; 70 % of IPS participants obtained any paid work , compared with 36 % of CVR participants . Within the IPS group , better baseline functional capacity ( as measured by the UCSD Performance Based Skills Assessment ) and more recent employment were modestly associated with better work outcomes . CONCLUSIONS Middle-aged and older adults with schizophrenia are good c and i date s for supported employment services
The DM program has shown to be effective and efficient .
Nevertheless , some components are emphasized more than others ; job accommodation , facilitation of transitional duty , communication between all stakeholders , health care provider advice , early intervention , and acceptance , goodwill and trust in the stakeholders , in the organization , and in the disability management process
BACKGROUND Disability management ( DM ) is a systematic method to ensure job-retention and job-reintegration in competitive employment for individuals with a disability .
There is evidence that ' returning to work ' has a positive impact on the individual , the company and on the society .
However , a clear overview of the efficacy and efficiency of the DM programs is scarce .
OBJECTIVE To systematic ally review the efficacy and efficiency of the disability management programs .