Employee Awareness and Empowerment Research report · capacity. Personal attributes can include...

Employee Awareness and Empowerment Research Report

The Collaborative Partnership to improve work participation

December 2019

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Table of ContentsExecutive summary .................................................................................................................................. 3

1.0 The project approach ....................................................................................................................... 5

1.1 Projectobjective ................................................................................................................................... 5

1.2 Project approach ................................................................................................................................... 5

1.3 Howtointerprettheresearchfindings ................................................................................................ 7

2.0 Findings ............................................................................................................................................ 8

2.1 Rapidreviewresults .............................................................................................................................. 8

2.2 Interventionranking ........................................................................................................................... 10

2.3 Responsestotheinterventiontypes .................................................................................................. 11

3.0 Other Empowerment Interventions ............................................................................................... 22

4.0 Conclusion ...................................................................................................................................... 32

Additional information ........................................................................................................................... 34

References ............................................................................................................................................. 35

Appendices ............................................................................................................................................ 38

Appendix1:Examplesofinterventiontypes .............................................................................................. 38

Appendix2:Detailedbreakdownofcitizenpanelattendees ..................................................................... 40

Appendix3:Projectmethods ...................................................................................................................... 42

Appendix4:Qualityappraisal ..................................................................................................................... 44

Appendix5:Detailedthematicanalysis ...................................................................................................... 51

Appendix6:Reviewquality ......................................................................................................................... 55

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Executive summaryEachyear,toomanyAustraliansareunabletoworkduetoatemporaryorpermanentinjury,illnessordisability.AmongstOECDcountries,Australiaranks21outof29foremploymentratesamongpeoplewithdisabilitiesrelativetothepopulationandevidenceshowsthatforpeoplewithaworkers’compensationclaim,returntoworkrateshavestagnatedsince2006.

TheobjectivesoftheEmployeeAwarenessandEmpowermentresearchistobetterunderstandtheexperiences,beliefs,andneedsofpeoplewithahealthordisabilityrelatedreasonforworkincapacityandidentifyevidence‑basedinterventionstoempower ‘employees’withahealthconditionordisabilitytouseworkaspartoftheirrecovery.

TheWorldHealthOrganizationdefinesempowermentas:

the process by which people gain control over the factors and decision that shape their lives

Thisdefinitionincludestheprocessbywhichpeoplebuildtheirpersonalattributesinordertoachievetheircapacity.Personalattributescanincludeconfidenceorself‑worth,buildingknowledge,developingcopingmechanisms,orenhancingpersonalskillstomakehealthandwellbeingrelatedchoices.Manyexamplesofsuccessfulempowermentinterventionsandprogramsalreadyexistinthepublichealthfield.

Thestudyaddressesanimportantgapinevidenceonempowermentstrategiesforpeoplewithahealthconditionordisabilitytouseworkaspartoftheirrecovery.Thefindingspresentedinthisreportarebasedonarapidreviewofevidenceonempowermentinterventions;qualitativeresearchtogainafirst‑handaccountoflivedexperiencethatsetsthecontextforwhatneedstobeconsideredwhenaddressingempowerment;andinsightsfromstakeholderfromtherelevantsystemsandsectors.Thisreportprovidesimportantinsightsforpolicymakers,serviceprovidersandsystemownersresponsibleforsupportingpeoplewithillhealthordisabilityandworkparticipation.

Thekeyfindingsfromthisstudyshowsthat:

• employeesaremotivatedtoworkandtheirmotivationisnotabarriertoparticipation–itisnotforlackoftryingthatpeoplehavenotsecuredsuitablework.Peopleareawarethatworkprovidespurpose,self‑sufficiency,stabilityandsocialization.Beingoffworkmakesithardertogetwork,leadstoloneliness,lossofself‑confidence,lossofperceivedcontrolandlossofsocialnetworks.

• employeesfindthebenefitandincomesupportsystemscomplexandoverwhelming,personifiedbya‘onesizefitsall’approachthatleaveslittleroomforflexibilityorempathy.Theyreportalackoftransparencyregardingtheirrights,benefitsandprocesses,significantuncertainty,ineffectivecommunicationbetweenstakeholdersthatisparticularlyproblematicaspeopletransitionbetweensystems,andacontinuousrequirementtoretelltheirstory.Theseexperiencescancontributetoworseninghealthanddelayedrecoveryfortheindividual.

• thereisastrongbeliefamongstemployeesthatemployerslackunderstandingoftheworkabilityofpeoplewithahealthconditionordisabilityandhowtoeffectivelyaccommodatethem.

“Anestimated786,000Australians

areunabletoworkduetoaninjury,illhealthordisabilityandaccessincomesupportfromacommonwealth,state,territoryorprivatesource.”

(Cross-Sector Systems Report, 2017)

“Afurther6.5millionpeople

accessemployerprovidedleaveentitlementsforperiodsofworkincapacitydueto

theirhealth).(Cross-Sector Systems

Report, 2017)

In this report the term

‘employees’referstoindividualsstaying

at,orreturningtowork,orcommencingnewwork(includingtheirfirstjob);withinjuries(psychologicalorphysical),disabilities(cognitiveorphysical),

ordisease

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Anumberofinterventionscanbeusedtoempoweremployeestouseworkaspartoftheirrecoveryincludingmentorship,educationandgoal‑settingapproaches;however,theseinterventionsrequireenablingmechanismstobeinplacebyrelevantsystemsandproviders.

Thisstudyhighlightsthatforempowermentinterventionstobeeffective,willrequireamulti‑dimensionalapproachthataddressesbroaderculturalattitudes,systemimprovementsandworkaccommodationprinciples.

• Cultural change–shiftingbeliefsandattitudestowardsthevalueofgoodworkandinclusion.Cultureandsocialnormsprovidetheover‑archingcontextandmotivationthatmakesindividualinterventionseffective.Itisahighorder‘empowerment’toolthatgoesin‑handwiththeneedforbetteracross‑communityhealth literacy.

• System change–theperceptionsandexperiencesofemployeesofthebenefitandincomesupportsystemsmaybeconsideredharsh,butpresentsaveryrealimpedimenttopersonalempowerment.Reportsshowthatpartsofthesystembycausingsecondaryconditionssuchasdepression.Reportsshowthatpartsofthesystemareoutofstepwithbestpracticeapproachestocustomer‑centricservicingandstreamlinedoperatingprocesses.

• Work accommodation–thereisaneedforemployerstohaveabetterunderstandingandimprovemanagementofthecapabilitiesofemployee’swithaphysicalorpsychologicalcondition.Thisissupportedbytheliteratureandthefindingsfromemployeesandstakeholders.Thisisthepracticalaspectoftheworkexperienceandenablingindividualstoobtain,stayatorreturntoworkisreliantonemployerengagement.

Empoweringpeopletouseworkaspartoftheirrecoveryandwellbeingcanleadtobetterhealthandeconomicaloutcomesforindividuals,theirfamilies,thecommunity,andAustralianworkplaces.Thekeymessagefromthisresearchisthatempowermentisacomplexstrategythatsitswithincomplexenvironmentsandsettings.Effectiveempowermentstrategiesdependsnotonlyontheindividualandtheirabilitytocontrolthefactorsthatshapetheirlives,butalsotheoverallcontextinwhichtheytakeplace.

Health literacyrefers

tothecognitiveandsocialskillswhichdeterminethemotivationandabilityofindividualstogainaccessto,

understandanduseinformationinwayswhichpromoteand

maintaingoodhealth.Healthliteracyiscritical

to empowerment.

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1.0 The project approach 1.1ProjectobjectiveThisprojectaimstouseanevidenceinformedapproachtoidentifyingeffectiveorsuccessfulinterventionstoempoweremployeestostayat,obtainorreturntowork.

1.2 Project approachThisstudyisaninitiativeoftheCollaborative Partnership to improve work participation(theCollaborativePartnership)andhasbeenledbyEML.TheCollaborativePartnershipisanationalalliancebetweenthepublic,privateandnot‑for‑profitsectorsandisfocusedonimprovingworkparticipationofAustralianswithatemporaryorpermanent,psychologicalorphysicalhealthconditionordisability.

Thereislimitedcurrentunderstandingofthebeliefs,perceptionsandattitudesofpeolewithatemporaryorpermanentinjury,illnessordisabilityandtheirexperienceofpeoplewithatemporaryorpermanentinjury,illnessordisabilityandtheirexperienceofnavigatingthevariousbenefitandincomesupportsystemsinAustralia,andinteractionswithemployers,andrelevantserviceproviders.Thisprojectusedqualitativeresearchmethodologytoinquiredeeplyintospecificexperiences,withtheintentionofdescribingandexploringmeaningthroughnarrativedata,bydevelopingthemesexclusivetothestudyparticipants.Whilethequalitativeapproachprovidesuswitharichunderstandingofpeople’sexperience,itdoesnotallowustoinferorgeneraliseabouttheexperienceofthosewhodidnotparticipateintheresearch.

Theprojectisinformedbyarapidliteraturereview,citizenpaneldiscussionandindividualinterviews,andexpertstakeholderinterviews.

RapidLiteratureReview

TheRapidLiteratureReviewwasfocusedoninterventionsthathavebeenproventoencourageemployeestostayat,obtain,orreturntowork.

ItwasbasedonthePICOframework:

• Population:Individualsstayingat,orreturningtowork,orcommencingwork(includingfirstjob);withinjuries(psychologicalorphysical),disabilities(cognitiveorphysical),ordisease(e.g.cancer).

• Interventions:Empowerment(unlikelytoexist),activeparticipation,navigation,self‑management(insurance),healthliteracy,schemenavigation,workplanning,problemsolving,supportmechanisms,self‑managementsupport,self‑sufficiency,socialsupport(e.g.communityinvolvement,familystability),andactiveinterventions.

• Comparison:Nospecificcomparisongroupwasset

• Outcomes:Workstatus(returntowork,stayatwork,commencenewwork),feelingofempowerment,attitudes,needs,andmotivations.

Thereviewincludedinternationaldatacoveringthelastfiveyearsandyielded71relevantarticles.

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CitizenPanelandInterviews

ThepurposeoftheCitizenPanelandinterviewswastounderstandtheattitudes,motivations,beliefs,experiences,drivers,barriersandneedsofemployeesnavigatingtheworkdisabilitysystem.

Atotalof23citizensparticipated–10fortheCitizenPaneland13inindividualinterviews.

Recruitmentensuredparticipantrepresentationacross:

• workstatus:obtaining,stayingatorreturningtowork.

• claimtype:physicalandpsychological.

• healthconditions:Injuries(psychologicalorphysical),disabilities(cognitiveorphysical),ordisease.

• crosssectorexperience:workers’compensationandmotoraccident,disabilitysupportandsocialwelfare;superannuationorlifeinsurance.

ThelineofenquirywasinformedbytheresultsoftheRapidLiteratureReview.

Participant Profile

10respondentswereinvolvedintheCitizenPaneland13participatedinone‑on‑oneinterviews.ThedistributionofparticipantsacrosstheabovecategoriesissummarisedbelowinTable1

Table1:ParticipantsinCitizenPanelandInterviews

Job status Injury type Workers’ Compensation

Motor Accident

CompulsoryThirdParty

Disability Support Pensions

Superannuation DE Services

Time in the ‘system’

Amajorityrepresentationacrossthree,fourandsixthmonthswithafewlongtail(e.g.+52weeks).

Obtaining work

Physical 1 1 2 1

Psychological 1 2 2 3

Returning to work

Physical 3 1 1

Psychological 1

Staying at work

Physical 1 1 1

Psychological 1

2 5 7 5 4

AmoredetailedbreakdownofparticipantscanbeseeninAppendix2.

Thesamplewasrecruitedincollaborationwithapanelrecruiterthatspecialisesinsocialissuesresearch.Wealsodistributedmaterialadvertisingviapartnerstakeholdersfromspecificsystemswherepossible.

Thisstudyrecruitedacrossthedifferentsectorsof:Motoraccident:(22%);DisabilitySupportPensions(DSP)(30%);Superannuation:(22%);DisabilityEmploymentServices(DES):(17%).Therecruitmentofindividualsfromtheworkers’compensation(9%)sectorwasmorechallenging.Nearlyhalfofourparticipants(43%)werethosewithpsychologicalclaimsorconditions.Oneareaofrecruitmentdifficultywasforindividualstryingtostayatwork,whichonlycomprised17%ofthefinalsample,comparedto‘Obtainingwork’(57%)and‘Returningtowork’(26%).Additionally,wefoundthatindividualsfromthepsychologicalprofileweremuchmorelikelytobelookingfornewwork(80%)thanreturningtowork(10%)orstayingatwork(10%).

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Workers’compensationwastheleastwellrepresentedinthestudysample(9%),whereasitisoneofthelargersystemsaccordingtothetheCross‑SectorProjectReport(n=156,000;2%).Theunderrepresentationofparticipantsfromtheworkers’compensationcategorymaybepartiallyexplainedbyemployeesinthiscategorypreferringnottodiscusstheirclaimexperiencespublicly.

TherewasanalmostevensplitbetweeninterviewsconductedbyphonecomparedtoattendeesattheCitizenDialoguePanel:eightscheduledinterviewsandfiverescheduledfromindividualswhodidnotparticipateinthecitizenpanel.Six(46%)oftheseinterviewswerewithindividualsfromthe‘psychological’profile,six(46%)werefromthe‘physicalinjuriesorconditions’profile,andone(8%)wasfromthe‘diseaseorillness’profile.

Therearetwospeculationsthatarisefromthedata:peoplewithpsychologicalconditionsorlearningdisabilitiesseemmorelikelytobeoutofworkandlooking,ratherthaninworkandtryingtogetbackorstaying;andinterviewsmayhavebeenfavouredforaccessibilityorprivacyreasons.Weareunabletodetermineifthesespeculationsaretrue,orwhetherthereareotherparticipantmotivationsthataredrivingthesenumbersandparticipationrates.

ExpertStakeholderInterviews

Tenone‑on‑oneinterviewswereconductedwithstakeholdersfromacrossthesectorsandsystemstounderstandtheirperspectiveofthebiggestchallengesinempoweringemployeestoobtain,stayatorreturntoworkandcapturetheirinsightsintowhatinterventionswouldbeeffectiveandwhen.

Interviewparticipantsrepresentedorganisationsresponsiblefordisabilityservices,workers’compensation,motoraccidentcompensation,employeerights,insuranceschemesandgovernmentwelfareandemploymentservices.

1.3HowtointerprettheresearchfindingsWhilsttheintendedoutcomeofthisstudyistoidentifywhatinformationandsupportemployeesneedtousegoodworktofacilitatetheirrecoverythrough‘empowerment’and‘self‑management’,thesymbioticnatureofemployees,employers,healthcareprovidersand‘system’managersinevitablyleadstocommentaryonhowthesecomponentpartsneedtochangetofacilitaterecovery.Importantpointstobeawareofinreadingthisreportinclude:

• thereareclearsynergiesbetweentheoutcomesoftheRapidLiteratureReview,CitizenPanel,CitizenandExpertStakeholderInterviewsbutthe‘solutions’maybedifferentlyexpressed

• withtheRapidLiteratureReviewfocusingoninterventionsthathaveproventobeeffective,thekeyrecommendationsinthisreportareledbyitsevidenceandconfirmedbythequalitativefindingsfromtheemployeeandstakeholderresearch

• purposeofthisstudyistoexplorehowitmightbepossibletobestsupporttheendeavoursofpeoplewithahealthconditionordisabilitytofacilitatetheirownrecoveryanddoesnotinanywayimplythatthestudyparticipantswerenotalreadytryingtheirbest

• thestructureoftheresearchactivitieswasto:conductarapidreviewoftheliteraturethatshowsdemonstrablesuccessfulorunsuccessfulinterventions;andusetheoutputsfromthereviewtostructurethesubsequentqualitativecomponents.Thisreportwillfollowthisstructure,usingtherapidreviewresultsasaframeworkfordiscussingwaystosupportindividuals’recoveries.

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2.0 Findings2.1RapidreviewresultsArapidliteraturereviewwasundertakentoidentify,evaluateandsynthesisepublishedliteratureinvestigatingempowermentinterventionstohelppeoplereturntowork,stayatworkorcommencenewworkafterinjury,diseaseanddisability.

Rapidreviewsareanemergingmethodofefficientlysynthesisingresearchevidenceinhealthpolicyandothersettingswhereabroadoverviewofresearchevidenceisrequiredinashorttimeframe.Unliketraditionalsystematicliteraturereviews,rapidreviewsfocusonsynthesisedresearchevidence.Cautionneedstobeappliedwheninterpretingrapidreviewfindings,asmorecomprehensivereviewapproachesmayelucidatefurtherinformationandinsights,whichwouldinfluencereviewinterpretationandconclusions(Khangura,Polisena,Clifford,Farrah,&Kamel,2014).Therefore,systematicreviewsremainthedefinitivemethodofliteraturereview,andwerecommendthatsystematicreviewsareundertakenwheneverpossible.

Theliteraturereviewyieldedatotalof3549citations,aftertheremovalofduplicates.Followingscreening,23systematicreviewswereidentified.AreascoveredbythereviewsarepresentedinAppendix3anddetailedinformationregardingthequalityappraisalarepresentedinAppendix4.

TheRapidReviewidentifiedeightinterventionstypes Education

Goalsetting

Mentorship

Person‑centredplanning

Problemsolving

Strength‑basedinterventions

Support

Wordaccommodation

Interventionsarechartedaccordingtowhethertheyimproveoutcomesandthequalityofthatevidence.Outcomevariablesarepresentedinparentheses.Itispossiblethataninterventiontypeisevaluatedagainstseveraloutcomessuchas‘Support(empowerment)’vs.‘Support(RTW)’.Thedatapointscanonlyvaryalongthreepossibleevidencequalityvalues(‘weak’,‘mixed’,or‘strong’)andthreepossibleevidenceofeffectvalues(‘noevidenceofeffect’,‘inconsistentevidenceofeffect’,or‘evidenceofeffect’),foratotalofninepossiblepositionsonthegraph.Becausedatapointswiththesameevidencequalityandevidenceofeffectvalueswouldsitatoponeanother,wehavefloatedthedatapointsaroundeachpossibleposition.

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Evidenceofeffect

Evid

ence

of e

ffect

Evidence of effect

Evidence quality

Inconsistent evidenceofeffect

Weak Mixed Strong

Noevidenceofeffect

Support(RTW) •

Goalsetting(workparticipation) •

Mentorship(employmentoutcomes) • Goalsetting(empowerment) •

Mentorship(empowerment) •

• Support(employmentoutcomes)• Problemsolving(RTW)

Wordaccommodation(RTW) • Wordaccommodation(empowerment) •

• Wordaccommodation(workparticipation)

• Support(Empowerment)• Person‑centredplanning(empowerment)

• Strength‑basedinterventions(empowerment)

• Education(RTW)

• Person‑centredplanning(employmentoutcomes)

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2.2InterventionrankingThequalitativeinterviewscapturedtheperspectiveofemployeesandexpertstakeholdersrelativetotheeightinterventionsidentifiedintheRapidLiteratureReview,aswellasleadingtoanadditionaltwointerventionterritoriestobringthetotalpotentialsuiteto10.

Thischartsummariseswhatwasfoundthroughevidenceandcomparesittoemployeeandstakeholderinput.

Table2:summaryofevidenceoninterventions

Intervention Evidence Employees Stakeholders

1. Work accommodation

2. Support

3. Mentorship

4. Goal setting

5. Person-centred planning

6. Problem-solving

7. Strength-based interventions

8. Education

9. Cultural change

10. System change

Key:

EvidenceColumn:

• highqualityandclearlypointstoaneffectiveintervention

• evidenceiseitherofmixedqualityorcouldn’tagreeonwhethertheinterventionworkedornot

• evidenceisofahighqualitybutnotclearlyabletodemonstrateaneffectoftheintervention

EmployeeandStakeholdercolumns:

• clearlyindicatesupportfortheintervention

• indicatesmostfavouredapproach

• didnotindicatesupportforanintervention

• hadnoopinionofaninterventionbecausetheyhadno/limitedexperiencewithitorfocusedonotherinterventions

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2.3ResponsestotheinterventiontypesEmployeeresponsestothefollowinginterventioncanbecategorisedintokeythemesof:

• informationandprocess–whatisavailabletomeandwhodoIspeakwithtogetit?”

• empathyandunderstanding–fromemployers,supportproviders,andthegeneralpublic

• degradationofmentalhealthandwellbeing–thisisanunderpinningthemetothosenotedabove,employeessaythisisunderprioritisedbysupportproviders.

Werefertothesewhendiscussingtheemployeefeedbackonthedifferentinterventions.MoredetailsareprovidedinAppendix5.

1. Work accommodation

Evidence Employees Stakeholders

What is the problem being addressed?

Workplaceaccommodationisaboutmakingchangestotheworkplaceorthewaythatworkisdonetoallowallpeopletheopportunitytoworkaccordingtotheircapacity.

What is the approach?

Workplaceaccommodationincludeschangesinworkschedulesandworkorganization,developmentoftheworkenvironment,useofassistivetechnologies,assistanceofotherpersons,andchangesincommutingtoandfromwork.Workplaceaccommodationscanfocusonasinglepersonorawholeorganisation.

What does the evidence say?

Fivereviewsonworkaccommodationwereidentifiedinthesearchstrategy.Onereviewrevealedthatworkplaceaccommodationsarerare.Whenworkplaceaccommodationsareused,themostcommontypeisflexiblescheduling/reducedhours.Thedirectcostsassociatedwithworkplaceaccommodationsareoftenlow.

Onereviewfoundmoderateevidencethatworkplaceaccommodationspromoteemploymentparticipation,butlowevidencethatworkplaceaccommodationsadministeredbycasemanagersincreasesreturntowork.Thisisnottosaythatworkplaceaccommodationadministeredbycasemanagersislesseffective,butthatthestudiesevaluatingworkplaceaccommodationsadministeredbycasemanagersareoflowquality.Weshouldbecautiousininterpretinglowqualityevidence.

Therewasstrongevidenceformulti‑domaininterventions(acombinationofhealth‑focusedinterventions,servicecoordinationinterventions,andworkmodificationinterventions)thatincludeworkplacemodificationsinreducingtimeawayfromwork.Therewasalsostrongevidencethatmulti‑facetedinterventionsareineffectivewithoutworkplaceaccommodations.

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What do stakeholders say?

Thisdirectquoteprovidesagoodsummaryofstakeholderperspectivesonworkaccommodationanddemonstrateshowstronglytheysupporttheroleoftheemployerinfacilitatingworkcapacity:

‘Employers play such a pivotal role in people trying to stay at work. Government needs to educate them more in keeping their employees healthy.’

Specificfeedbackfromstakeholderscoversanumberofthemes:

• Theneedformanagementtobesupportive–thiswasconsistentlyraisedinrelationtoreturntowork.Thedefinitionof‘management’goesbeyondtheseniormanagerandtakesinthenotionthattheemployees’supervisorandcolleagues–thepeopletheyusedtoworkwitheveryday–havethebiggestroletoplay.‘Support’includespro‑active‘reachingout’bytheworkplacetotheemployeeandthatiftheemployeeistheonetaskedwithreachingouteverytime(oftenforlittleresult),thereisaconsequentialnegativeimpactontheirconfidence.Theemployerneedstobethe‘firstmover’.

• Stigmaanddiscrimination–seenbystakeholdersasamajorbarriertoworkaccommodation.Thiscanbeeitherconsciousorunconscious(commentssuchas‘theyshouldhavereturnedtoworkbynow’)andrelatebothtoobtainingwork(‘whyhasn’tthispersonworkedfortwoyears’;oracquireddisabilityandtheassociatedsocietalperceptualbarriers),aswellasforthosestayingatorreturningtoworkespeciallyforthosewithamentalhealthcondition.Stakeholdersregardashighlyimportanttheneedtocreateawarenessandunderstandingthatpeoplecanhaveadisability,gothroughaninjuryorillnessandstillhavecapacitytowork.

• Jobmatch–stakeholderssuggestthattherearetoolsalreadyavailablethatshouldbeusedto‘jobmatch’forexample,personalitytestscanbeusedmuchbetterforjobmatching.

• Recruitmentmethods–thosebornwithorhavingacquiredadisabilitydonothavethesameopportunitiestoworkouttheircareerdevelopmentorworkexperienceastheirnon‑disabledpeers.Eventhewayemployerstalkaboutandrecruitmakesithardforpeoplewithadisabilityforexample,:itmaynotbeclearfromthejobdescriptionwhethertheycandothejob;onlineapplicationsmaybeanimpedimentiftheycan’tuseamouseorhavevisualimpairments.Thosewithadisabilityarenottheonlyonesimpactedbyrecruitmenttactics–recruitmenttoolssuchas‘massinterviews’canbedauntingforsomeonewhoislackingconfidence,hasasociallyimpactinghealthcondition(e.g.someonewithAsperger’smaybeageniusITtechnicianbutisunabletocommunicate/sellthemselves)orhasbeenoutoftheworkplaceforsometime;theycanbedeterredfromevenapplyingforthejobinthefirstplace.

• Lackofemployeeunderstandingofwhattoexpectfromtheiremployer.

• Drivenbyrisk–Employersareriskadverseinacceptingemployeeswhoarenot100%well.

• Thereisalsoaneedtoempoweremployers–evenanemployerwillingtoemployeesomeonewhorequiresamodifiedworkenvironmentcanbedisempoweredthroughtheirsimplelackofknowledgeofhowtogoaboutitorwhatwillberequiredofthem.

What do employees say?

Thisinterventionaddressesthethemeofempathy and understanding.

Theworkplaceaccommodationsthatemployeeshadmostexperiencewithwereflexibleschedulingofworkhoursandswitchingtolightduties.Employeesnotedthattheseweretemporarysolutionsandtheirsuitabilityvarieswithindividuals’conditions.Othersnotedthatachangeindutiescanbetraumaticbecauseitmeansswitchingfromworkthatyouhavebuiltacareerontosomethingdifferent.Therearecleardifferencesinthereactionsofpeoplewhohavenotbeenoutoftheworkforceforverylongversussomewhohadbeenoutofworkforasignificanttime–thelongersomeoneisoutofwork,themorewillingtheyaretodoanything.Forinstance,somesaidtheywouldn’tbehappywithlightdutiesforthelongterm,whereasotherswhohadbeeninjuredforlongersaidthattheywouldhappilydoanythingwithintheirskillset.

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Gradedreturntoworkwasseenasanimportantformofworkaccommodation.Oneemployeecommentedthatsomeworkplaceaccommodationsarestraightforwardandeasytosecure,whereasothersaremorechallengingwhentheindividual’shealthconditionordisabilityislessvisible.

Finally,employeesmentionedthatjobsexistbuttherearefewemployerswhoarewillingtoaccommodatethosewithhealthconditionsordisabilities.

Employeesreflectedthestakeholderideathattheiremployerreachingouttothem,evenifthatisjusttheoccasionalcheckintoseehowtheyare,hasademonstrableimpactontheiremotionalwellbeingandconfidenceintheirfuture.ThiswasdemonstratedquiteclearlyintheCitizenPanelbyoneemployeewhoseemployerhadmaintainedregularcontactwiththem,andtheiremotionalwellbeingcomparedtootherpanelparticipants.

What has helped/could help?

• Flexibilityandunderstandingonthepartoftheemployer.Aforumforemployerswhoareopentoaccommodatingthosewithdisabilitytoadvertisejobpositions.

• StandardsestablishedforEmployers.

• DisabilityConfidentRecruiter.Anorganisationshouldhavetogothroughaprocessthatmakesalltheirsystemsaccessibleandinclusive.

• Theneedtoremoveemployerandculturalstigmaandbarriers–whetherconsciousorunconscious–andcreateawarenessofthebenefitsof‘goodwork’.

• Educatingemployersongoodjobdesign–howtodesignthejobtohavetheappropriatebreadthanddepth.Thatmeansclarity,authority,delegationofdutyanddecision‑makingautonomy,variationoftask–goodwork.

• ‘Onthejob’trainingforintellectuallyorphysicallydisabled–ratherthantertiaryeducation.

• Policiesthatexplainwhathappensandcommittodoingwhateverisreasonableifanemployeecannotwork/hastochangetheirworkingcircumstancesandguidancethathelpsemployeesunderstandhowtorespondiftheyareexperiencingdifficulties.

• Job coaches.

2. Support



Itcanbedifficulttomanageyourhealthconditionordisabilityifitimpairsyouphysicallyand/ormentally.Thatmeansitcanbeespeciallydifficulttofindorgetbacktowork.Supportisaboutmakingjob‑seekingandreturntoworkeasierforthosewithahealthconditionordisability.


Supporttakesmanydifferentforms,sometimesit’saboutspeedinguptheprocessofgettingsomeoneintonewwork,othertimesit’sabouthelpingpeoplestayinexistingwork.Thelatterformissometimesreferredtoasa‘place‑train’modelandIndividualPlacementandSupport(IPS)isthemoststructuredandwell‑definedformofthisapproach.Itisbasedonthephilosophythatanyoneiscapableofgainingandmaintainingcompetitiveemployment,providedtherightjobwithappropriatesupportcanbeidentified.Otherformsofsupportedemploymentcanincludecoachingandeducation.Supportedemploymentmayalsobeaugmentedforexamplewithadditionalrehabilitationorskillstraining.

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Evidencefromninereviewswaslargelyinfavourofsupportapproachesforimprovingempowerment,workparticipation,andreturntowork.Individualplacementandsupportprogramsareaneffectiveinterventionacrossavarietyofcontextsandeconomicconditionsandareperhapstwiceaseffectiveastraditionalrehabilitationprogramssuchas‘train‑place’modelsforgettingpeopleintowork.Theevidencerangedfromtentativetostrongforaugmentedsupportedemployment.Therewasmoderatetostrongevidencethatcoachingandeducationsupportimprovesreturntoworkandsicknessabsenceoutcomes.Notallreviewsarrivedatthesameconclusion–somefoundinsufficientevidenceforeffectivesupportstrategiesinobtainingandmaintainingemployment.


Stakeholdersinrolesofhelpingpeoplefindsuitableemploymentbelieve‘motivation’and‘confidence’isacriticalfactorofbeingabletofindwork.Theideasthatstakeholdersputforwardconsistentlywenttothesetwothemes:

• Training,retraining,reskillingtogain,retainorre‑enterwork.

• Motivationalinteractiontrainingtoimproveconfidence.

• Toolsonhowtogetajob–resumewritingetc.


Thisinterventionaddressesthethemeofdegradationofmentalhealthandwellbeing.Employeesbelievetoomanysupportprogramsfocusonphysicalsupportandskillstraining–therearefewprogramsaimedatsupportingmentalhealthduringrehabilitationand/orthejobsearch.Accesstorelevantsupportprogramsisalsosometimesdifficult,withoneemployeesaying

“You need to make yourself look twice as bad in order to get half the help you need”

Thissentimentwasalsoechoedbystakeholders.


• Training,retraining,reskillingtogain,retainorre‑enterwork.

• Motivationalinteractiontraining.

• Toolsonhowtogetajob–resumewriting,interviewpractice.

3. Mentorship



Navigatingdisabilitysupportsystemscanbeafrustratingandlonelyexperience.Mentorshipaddressesbothproblemsofhandlingcomplexityandofdoingitalone.


Mentorshiprelationshipsinvolvetheprovisionofongoingguidance,instruction,andencouragementfromamentorwithexperiencetopromotecompetenceandemploymentparticipationonthepartoftheindividual.

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Tworeviewssuggestthattheevidenceregardingmentorshipismixeddependingontheoutcomemeasure.Mentorshipmaybeeffectiveforimprovingemploymentorwork‑relatedoutcomes,thoughthequalityoftheevidenceislow.However,evidenceregardingtheeffectivenessofmentorshipinimprovingempowermentisinconsistentandalsooflowquality.

Someevidencesuggestedthatmentorshipcouldincreasedepressioninindividuals.Consideringthatamentormaybeapersonwithasimilardisabilityastheindividual,developingarelationshipwiththismentormayhighlighttheindividual’sownhealth‑relatedproblems.Anotherconcernisthatmentorsmayofferadviceoutsidetheirdomainofexpertise.Mentors,therefore,maybeworkplacementorswhocanhelptheindividualintheiremploymenttransitions,lifementorswhocansupporttheindividualsocially,orhealthmentorswhomaysharesimilarhealthexperiencesastheindividual.


Stakeholdershighlightthata‘lossofconfidence’startsimmediatelyandgrowsthelongersomeoneisawayfromwork.

Whilstinnowaysuggestingtheyshouldbecomeanominatedmentor,stakeholdersseetheclaimsmanagerasbeingabletotakeastrongerroleinencouragingtheircustomerstowellbeingandwork.Stakeholdersareconcernedthisiscurrentlylimitedbytheprocessdrivennatureofschemesthattypicallydisempowerclaimsmanagersfrombeingabletomakejudgementsandabilitytoformvaluablerelationshipswithclientstohelpmotivatethem.


Mentorshipapproachesspeaktothethemesofinformationandprocess,anddegradationofmentalhealthandwellbeing.Mentorsorsupportgroupswereoftentheonlywaythatemployeesfelttheycoulddiscoverwhatservicestheywereeligiblefor.Mentorshipswereofteninformalrelationshipsorvoluntaryinnature–employeesvoicedconcernabouttheover‑relianceonvolunteernetworks.Mentorsalsoprovidedsocialandemotionalsupportasmentorsoftensharedsimilarexperiencesorsituationstotheemployee.


• MakeClaimsManagersinto‘relationshipmanagers’andcreateabespoketrainingprogram.

• Useadvocacyorganisationsthatareintouchwiththeneedsoftheirspecificgroupe.g.spinalcord associationasacentralforum.

• UseBehaviouralEconomicstheorytorestructurelanguagethatispositive,constructiveandfuture focused.Introducethenotionofre‑engagingwithlife(notjustwork).

• Developawebplatformthatcontainsrelevantservicesandmotivationaltools.

4. Goal setting



Goalsettingapproachesareaboutstagingrehabilitationorjob‑seekinginordertopreserveandenhancemotivation.

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Thepracticeofsettinggoalsisthoughttoinfluenceindividuals’feelingsofempowerment.Bythoughtfullysettingmeasurablegoals,individualscantrackprogressintheirrehabilitationorreturntowork.Successfullymeetingthesegoalsisthoughttoincreaseaperson’sbeliefintheirabilitytoachievefurtheremployment‑relatedgoals(self‑efficacy).


Tworeviewslookedattheeffectofgoal‑setting.Goal‑settingapproachesmaynurtureempowerment,althoughthequalityofevidencewasmixedbutevidenceforimprovingworkparticipationandoccupationalperformancewasmixed.Itmightbethatgoal‑settingmaybeusefulforrehabilitationbutnotnecessarilyhelpfulwithemployment.


Stakeholdersbelieveoutcomesarebetterwhendealingwithsomeonewhounderstandsthechoicestheyhaveandwhatsupportcanbeputinplacetoachievethose.

Theyalsosupporttheideaofgettingtheemployeetocommittothingstheywilldo‘onestepatatime’–dependingonthecircumstancesoftheperson,agoalandachievementmaybeassimpleasawalktotheendoftheroad,makingamealortalkingtosomeoneinashop.


Goal‑settingapproachesaddressthethemeofdegradationofmentalhealthandwellbeing.Employeesseegoal‑settingasanimportanttoolinachievingtheiremploymentgoals.Goal‑settinghelpswiththementalhealthaspectofrecoveryaccordingtoemployees.Achievinggoalshelpsalleviatefeelingsofhelplessnessbydemonstratingwhattheindividualisstillcapableofdoing.


• Whileemployeesvaluegoal‑setting,theybelievethatotherthingsneedtobedonefirstbeforegoal‑settingstrategiescanbeeffective.Forexample,somethinkthatanoverhaulofcasemanagementactivitieswouldbenecessarybeforegoal‑settingstrategiescouldbeeffective.Employeeswantsupportprovidersandcasemanagerstobemoreinvolvedintheircaseandseesharedgoal‑settingasapotentiallyeffectivemeansofdoingso.

• Improvinghealthliteracyindirectlyimpactsgoal‑setting.Healthliteracyincludestailoredinformationthathelpspeopleunderstandwhatwillhappenthroughouttheirrecoveryjourney,howtogetthesupporttheyneedandhelpsthemidentifywhatispossible.

• Theuseoffuture‑focusedlanguageisanaidtogoal‑setting.

5. Person-centred planning



Employeesoftenfindthattheservicesandsupportprovidedtothemarenotsuitedtotheirneeds.Person‑centeredplanningaddressestheproblemofindividualsuniqueneedsfallingthroughthecracksforexample,aspeopletheymovebetweendifferentbenefitandincomesupportsystems.

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Thereisanongoingtransformationofdisabilityservicedelivery,progressingfromasystem‑centeredapproachtoaperson‑centeredapproach.Underaperson‑centeredapproach,supportandservicesaretailoredaroundtheindividualandtheiruniqueneedsratherthanenforcingaone‑sizefitsallapproach.Person‑centredplanningisanapproachaimedatachievingindividualisedsupportforpeoplewithdisabilityandtreatingthemwithdignity,compassion,andrespect.


Onereviewfocusesonperson‑centredplanning.Therearesmall‑scalesuccessesofperson‑centredplanningapproachesimprovingempowerment(i.e.communityandlifeparticipation).Theevidenceofthesesuccesses,however,isoflowqualitysocautiousinterpretationisadvised.Theevidenceforperson‑centredplanningimprovingemploymentoutcomesisinconclusive.


‘Schemes work in streams. But that doesn’t work for the client.’

Stakeholdersverymuchsupporttheideaofaperson‑centeredapproachwithsomealreadyachievingresultsintheirownsystemwiththisapproach.Stakeholderfeedbackwasthat‘thesystem’makesthepersontheproblemandthewayitisrunassumesthesystemknowsmoreabouttheemployeethattheindividualknowsaboutthemselves–‘wedothingsTOpeople’.

Stakeholdersareconsciousofhowmuchbeingpartof‘thesystem’detrimentallyexacerbatestheperson’ssituationandhowdealingwiththesystemcanactuallyleadtosecondarypsychologicalconditions.Thetypesofbarrierspeoplefaceincludesituationssuchas:

• wantingtoreturntoworkbutnotbeingallowedto–‘theywon’tletme’

• notknowingwhoisresponsibleforwhat,whatresourcesareavailable,orwheretogoatwhatpointintimeintheprocess

• long,drawnout,confusingsystems– ‘even if you know what you’re doing its hard and demotivating’

• theneedtorepeattheirstorymultipletimesandre‑provetheircasewhenmovingbetweenjurisdictionsoriftheygetsomeworkbutendupneedingtogoonapensionagain.

Theuniversalopinionofstakeholdersisthattheemployeeneedstobeputatthecentreoftheclaimandthatitisimportanttheyareheardandunderstood.

‘Get them to identify what they need and co-design their journey. If they co-own the way forward, they will be better engaged, more likely to make a success of the plan and less likely to fall back into the compensation system once they’re working’.


Person‑centeredplanningaddressesthethemesofinformation and processandempathyandunderstanding. Employeeswouldwelcomeanincreaseinperson‑centeredplanningapproaches.Theysaywhilethecurrentapproachofone‑size‑fits‑allmayprovideabareminimumlevelofsupport,employeesoftenneedmorenuancedunderstandingfromsupportproviders.Theeffectofaone‑sized‑fits‑allapproachleavesemployeesfeelingignored,withoneemployeesaying:“… but it’s not person-focused, they’re indifferent and that is what breaks people”.Employeesalsoexplainthattherelianceonaone‑size‑fits‑allsystemhasledtoafeelingamongemployeesthatsupportprovidersassumeallclientsarecheatingthesystem.

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• Employeessaidthataperson‑centeredapproachprobablyrequiresakeycontactorcasemanager,andthesuccessoftheapproachreliesheavilyonthequalityofthiskeycontact.Anotherpossiblebarriertoeffectiveperson‑centeredapproachesreliesontheindividual’spersonalmotivation.Someoftheemployeeswespoketosaidtheywouldratherbetoldwhattodobyexperts.Otherssaidthattheydidnotwanttositinthedriver’sseatbecausetheybeeninthedriver’sseatforyearsandgotnowhere.

• Betterpathwaysbetweensystem–thatincludescommonforms,commonprocesses,commonlanguage,commonstandards(e.g.forclaimsmanagers).

• Simpleaccessibletoolspeoplecanuseandunderstand.

• Stakeholderssuggestarecognisedleadertoachievecommonagreementacrossthevariousjurisdictions.

• Atriagesystemeitherinthesamemannerasa‘triagenurse’thathelpsguidepeopletotherightservices,oranevenbiggersuggestionofauniversaltriagesystembringingalltheexpertstogether–onestopshopsourceofmedicalandjobexpertsincludingwellbeing,doctors,psychologists,commonlawandarelationshipmanagerlinksdirectlytothese.

• Providerpartnerships.Createpartnershipwithhealthprovidersallcontributingtotheindividualemployeeplan.

6. Problem-solving



Disability,injury,andillnesscancausechronicstress,whichcanbemanagedbyhelpingindividualstochangehowtheyapproachtheirdifficulties,andgainskillstocopeeffectivelywithstress.Problem‑solvingapproachesareaboutgivingindividualsatoolkitformanagingcondition‑relatedstress.


Duringthelastdecade,therehasbeenanincreaseinthenumberofstudiesthathaveexaminedtheeffectivenessofinterventionsthatincorporateteachingproblem‑solvingskillstoworkerswhoarereceivingdisabilitybenefits.Theseskillsareaimedatenablingthemtosolvework‑relatedproblems.Evidencesuggeststhattheseskillshelptodevelopasenseofcontrolregardingstressors.Inturn,thiscanmoderatetheeffectsofworkstressorsthatcouldcontributetodisabilityandillhealth.


Threereviewswereidentifiedonproblem‑solving.Thereviewssuggestedthattheseinterventionsshowmostpromiseforpartialreturntowork,butnotsoforreturntofullduties.Problem‑solvinginterventionsalonemaynotbeenoughtoreducesickleavebutacombinedproblem‑solvingandatherapyinterventionsuchas,cognitivebehaviourtherapydidhavesignificanteffectontotalsickleavedays.Otherevidencewasmixed.


Therewasnodirectreferencefromstakeholdersbutimprovinghealthliteracywasamajorouttakefromthestakeholderinterviewsandthisgoessomewaytothenotionofproblemsolving.

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Problem‑solvingapproachesaddressthethemeofdegradation of mental health and wellbeing.Employeeshadlittletosayregardingproblem‑solvingapproaches.

7. Strength-based interventions



Asuddenchangeinhealthcanincreasefeelingsofhelplessnessandvulnerability.Strength‑basedinterventionsareaboutincreasingempowermentbyfocusingontheindividual’sstrengths.


Qualitiessuchasself‑efficacy,socialproblem‑solving,senseofpurpose,empathy,humour,resilience,andhopearealltargetedbystrength‑basedapproaches.Strengthscanbeconsideredatthepersonallevel(self‑efficacy)orattheinterpersonallevel(positivecaringrelationships),andtheapproachemphasizesthateverypersoncanbuildameaningfulandsatisfyinglifewithafocusontheirstrengths.


Wefoundonereviewthatconsideredstrength‑basedinterventions.Theresultssuggestthatastrength‑basedapproachmayimproveempowerment(e.g.self‑esteem,self‑efficacy,senseofhope)buttheevidencequalityisquestionable.Therearenotenoughstudieswithstrongmethodologytoconcludethatstrength‑basedapproacheswork.

Additionally,thereisdifficultyisolatingtheeffectofstrength‑basedapproachesastheywereoftenasingleelementwithincomplex,multifacetedinterventions.Inthecaseofseverepsychologicalsymptomologyforexample,suicidalideation,cliniciansarecautionedagainstusingonlyastrength‑basedapproachcompletelyisolatedfrommedicaltreatmentapproaches.


Thelongerapersonisin‘thesystem’,thegreaterthelossofconfidenceandtheharderitistorebuild.Oneofthestakeholdersprovidesmotivationaltrainingfortheirclientsandothers,whilstnotusingaformal‘motivational’system,traintheircustomerinterfaceteamsinpositivereinforcementskills.


Strength‑basedapproachesaddressthedegradation of mental health and wellbeing.Employeeshadlittletosayregardingstrength‑basedapproaches.

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8. Education



Understandingaconditionisanessentialfirststepinrecovery.Educationisabouthelpingindividualstounderstandtheirconditionandnavigateissuesthatrestricttheirabilitytowork.


Educationinterventionsseektoinformindividualsaboutthesideeffectsoftheirconditions,aswellastechniquesforcopingandmanagingstress.Mostinterventionsusesomeformofcounsellingtoaddressparticipants’disease‑relatedanxietiesandprovideinformationonthecausesandcourseoftheirconditiontodispelmisconceptions.Thesearesometimesreferredtoas‘psycho‑education’approaches.


Tworeviewsevaluatededucationapproaches.Educationmightbeusefulforrelievingcondition‑relatedanxietythoughthequalityofevidenceislow.Evidenceisunabletoshowthateducationhasabeneficialeffectonreturntoworkratesandoutcomes.


Outcomesarebetterifyouaredealingwithsomeonewhounderstandstheirchoices,whatsupportcanbeputinplace,andbeengagedinthatsupport.

Thisalsomeansimprovinghealthliteracy–understandingthattheyshouldbeabletogetbacktowork,workisgoodforhealthandisaformoftherapeuticintervention,thatwaitingforrecoverycandelayrecovery,andknowingtheyneedtogethelp.

Educationisalsohelpingpeopleunderstandwhattypeofworkmightbeanentryforthem–notnecessarilyalong‑termsolutionbuttore‑enter(lowerstatus,lowerpayisapsychologicalblowthatneedsframing)andtailoredinformationtodemonstratewhathappens/howtohelpindifferentcircumstances.


Educationapproachesaddressthethemeofempathy and understanding.Employeesfeltthateducationwouldbeabroadlyusefultool–notforthemselvesbut,rather,forthepeoplearoundthem.Employeesarealreadyeducatingthemselvesasmuchaspossible,mostlyoutofnecessity,sofurthereducationmaynotbethemosteffectivetoolforthem.Whereeducationmightbemoreeffectiveisineducatingothersthattheseemployeeshavetointeractwith.Employeesdescribedaneedforeducationaimedathigh‑levelculturalchange,aswellaseducationaimedatlow‑levelindividualchange.

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Educationforsupportproviders,casemanagers,employers,GPs,families,andthegeneralpublicwouldhelpempoweremployeestoachievetheiremploymentgoals.Accordingtotheemployees:

• supportprovidersandcasemanagersneedexpertisewhenworkingwithpopulationswithhealthconditions,insteadofapplyingaone‑sizefitsallapproachthatworksforthegeneralpopulation

• educatingemployersaboutthementalhealthandwellbeingcomponentofrehabilitationandreturntoworkwouldhelpcreateflexibleandunderstandingworkplaces

• thereiswidevariabilityinGPs’understandingoftheworkdisabilitysupportsystem–GPeducationwouldhelpkeepthestandardmoreconsistent

• familiesneedtobeincludedintheeducationprocessastheyoftenfeelhelpless.Changesinmentalhealthmaynotalwaysbeobvious,soteachingfamiliesaboutmentalhealthcouldhelpthemfeelequippedforsupportingtheirfamilymember.

• finally,employeesfeltthattheirrecoveryandreturntoworkwouldbegreatlyhelpedbyeducatingthegeneralpublictobemoreawareandconsciousofthosewithdisabilityorconditionsthatmakeitdifficultforthemtowork.Someemployeeshighlightedhowtheirconditionshadnovisiblesymptoms,sowouldhavedifficultyreceivingsupportfrommembersofthepublic.Othersreportedhostilityandmicro‑aggressionsdirectedtowardsthembecauseoftheirinjury/condition.


• Culturalchangearoundstigma,discriminationandthebenefitsofgoodwork.

• Healthliteracyprograms.

• Educationaroundthevalueofjobdesignandhowtoapply.

9 &10 Culture and System change

Employees Stakeholders

UndertheRapidLiteratureReviewsearchterms,noevidencewasidentifiedunderthecategoryof‘culturechange’,butrecognitionoftheneedforculturechangecameoutstronglyintheexpertstakeholderandemployeeinterviews.

Furthermore,withitsacademicprincipleofassessingspecificinterventions,theabilityorpurposeoftheRapidLiteratureReviewisnottounderstandtheinterplayacrossdifferentcomponentsofthebenefitandincomesupportsystem.Whereasforemployeesandexpertstakeholdershowthesystemworksiskeytoempowerment.

Muchoftheemployeeandstakeholdercommentarythathasbeenrelayedinthepreviouspagesallpointtotheimportanceofcultureandsystemchange–suchaspoorunderstandingbyemployersofthevalueofemployeeswithaphysicalorpsychologicalconditionandtheimportanceofchangingnormsaroundnotonlytheirperceptions,butalsotheperceptionsofthemanyplayersinvolvedintheprocessesofthebenefitandincomesupportsystemincludingdoctorsandclaimsmanagers);orthecallfromemployeesforinterventionsthatfacilitateeasieruseofandgreaterempathyfrom‘thesystem’.

Furtherexamplesoftheneedforcultureandsystemchangecanbeseeninthefollowingpageswheremoredetailedinterventionsuggestionsbyemployeesarecaptured.

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3.0 Other Empowerment Interventions TheempowermentinterventionsdescribedinthissectionwereidentifiedthroughtheCitizenPanelandindividualinterviewswithemployeesandexpertstakeholders.

Compassionandunderstandingtrainingforcasemanagers

Whatistheproblembeingaddressed?

Casemanagersmaynothavetheunderstandingorflexibilityinordertomostadequatelysupportindividualswithhealthconditionsinreturningtowork.


Compassionandunderstandingtrainingforcasemanagersrelatestothethemeofempathy and understanding.Anissuethatarosefromseveralconversationswithemployeeswasthatcasemanagersoftenlackcompassionorevenabasicunderstandingoftheemployee’scondition.Littleunderstandingfromthecasemanagerhasaflow‑oneffecttothesortsofservicesthattheemployeeisgivenaccessto.


• Greaterprovisionsforsupportproviderstogo“off‑script”–anideathatwasactivelypromotedbystakeholders.

• Stakeholdersalsoraisedtheideaofmotivationalinteractivetrainingforclaimsandcasemanagers

AdvocacygroupsWhat is the problem being addressed?

Individualscanfeelminisculeagainstthesystemwhentheyaretryingtosecurethebestsupportforthemselves.


Advocacygroupsaddressthethemeofinformationandprocess.Employeesoftensaidthelargestdrainontheirmotivationwasconstantself‑advocacy.Needingtobe“ontopofeverysinglecoginthesystem”wasdescribedasdraininganddemotivating.Someemployeessaidtheywerefortunatetohaveanadvocatehelpingthemtonavigatethecomplexityand“couldn’timaginesurvivingtheordealwithoutone”.Employeesthensuggestedthatmoreformalizedadvocacygroupswouldbeofbenefittotheirreturntowork,thoughotherscautionedontheoverrelianceofvolunteers.

Advocacygroupsdifferfrommentorshipprogramsinthattheyaremorefocusedonnavigatingthesystemswithspecificguidanceandunderstanding,whereasmentorsappearmosthelpfulinmoregeneralcontextsforexampleinnavigatingtheworldwithanew‑foundhealthcondition).

Whilethereisconsiderableoverlapbetweenadvocacygroupsandmentorshipprograms,wehavekeptthemseparatetoreflectthesource–hereasanitemthatemployeesproducedasaresourcetheyhavereliedon,andmentorshipprogramsasaninterventiondiscoveredintherapidreview.


Awebsitetoconnectindividualstowillingvolunteers.

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EmployerforumsWhat is the problem being addressed?

Job‑seekerswithhealthconditionsexpressfrustrationinsearchingforemployerswhoarewillingtoaccommodatetheircondition.Employeesarealsofrustratedthatjobserviceproviderslacktheabilitytomatchthemupwithwillingemployers.


Employerforumsaddressthethemesofinformation and process and empathy and understanding. Employeeslookingfornewworkfinditdifficulttoconnectwithemployersthatareflexibleandwillingtoaccommodateworkerswithdisabilityorimpairment.Anemployerforumthat:educatesemployersaboutworkplaceaccommodation;connectsemployerswiththosewillingtowork;andmakesiteasierforjobserviceproviderstobuildanetworkofpotentialemployerswouldhelpaddressanumberofissuesemployeesfacewithworkplaceparticipation.


Buildawarenessandunderstandingofgoodwork.

Stakeholders say

There’saneedtocreateauniversalawareness,understandingandabeliefamongstemployers,employees,healthprofessionals–allAustralians–that‘goodwork’isgoodforyouandthatgettingbacktoworkbeforeyou’re100%wellisaprovenaidtorecovery(withappropriatemedicalclearance).

‘We (the industry) all talk about the benefits of good work, but we’re in a bubble – we need to get the message beyond the people in the industry. As a nation we need to accept the importance of work.’

TransitionseminarsandmanagersWhat is the problem being addressed?

Employeesdescribethesupporttheyreceiveasfracturedandtheywantitsimplifiedtosomethinglikeaflow chart.Transitionmanagementrepresentsaunificationofsupportserviceswithafocusonnavigatingthetransitionintowork.


Transitionseminarsandmanagersaddressthethemeof information and process.Akeyoutcomefromdiscussionswithemployeesisthedesireformorecentralisedprocessregardingsupportprovisionandreturntowork.Onespecificexamplefromdiscussionsincludedthenotionsoftransitionseminarsandmanagers.Thisideaborrowsfromthedefenseforce,wheredefensepersonnelaredebriefedfromtheirdutiesandpreparedforlifeasacivilian.Asimilarexercisecouldexistforapersontransitioningfromonestageofemploymentparticipation(e.g.unemployed)toanother(e.g.part‑timeemployment).A‘transitionmanager’representsanevolutionofthecurrent‘casemanager’rolebutwithafocusonthewellbeingoftheemployeeastheynavigatetheirrehabilitationandreturntowork.


Willingnessfromsupportproviderstoinvestigatealternativesupportmethods.

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GroupactivityaccessWhat is the problem being addressed?

Employeeswithhealthconditionssometimesfeellikethere’snothingtheycandoandhavelowself‑efficacy.Theyalsofeelisolatedwhentheyareunabletowork.Groupactivityprovisionaddressestheseproblemsoflowself‑efficacyandisolation.


Activityprovisionwasakeyfocusforanumberofemployeeswhosewellbeingsufferedbycomingoffworkandsuddenlyhavingnothingtodo.Fromawellbeingperspective,employeesdiscussedthenotionofsupportprovidersofferingwellbeingactivitiessuchasgymmemberships,artclasses.Importantly,thesewouldeitherbeactivitiestobecompletedasagroup(grouprehabilitationatagym)orwereinherentlygroup‑oriented(artclasses).


Confidenceandknowledgewouldhelpindividualsapproachnewgroupsandactivities.Sometimestheydon’tknowwheretofindsuchthingsanditwouldbehelpfulifacasemanagerorweb‑basedplatformcouldpointthemintherightdirection.

Group‑basedcasemanagementWhat is the problem being addressed?

Navigatingthedisabilitysupportsystemcanbedifficultandlonelyasanindividual.Group‑basedcasemanagementallowsindividualstoshareknowledge(makingnavigationeasier)andexperienceswithothers.


Accordingtotheemployeeswespokewith,oneofthemostdifficultaspectsofbeingunabletoworkissocialisolation.Thenegativeeffectofisolationontheirmentalhealthandwellbeingwasclearlyveryimportanttoemployees.Anothersideeffectofsocialisolationwasthatemployeeswereunabletofindrelevantinformationwithoutthehelpofanotherpersonwhohadthesameexperience.Employeessuggestedthatgroup‑basedcasemanagement,wheresupportproviderscouldmanagethecasesofseveralemployeeswithsimilarconditionssimultaneously,couldsolveboththeseproblems.Bymeetingtogetherinthesamespace(physicalordigital),employeescouldshareexperiences,sharelearnings,andinteractwithothersforsocialsupport.


Awillingnessonthepartofthesupportprovidertoconsideralternativesupportstrategies.

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CustomerfeedbackasaKPIWhat is the problem being addressed?

Supportprovidersareperceivedaslackingtransparency.Empoweringindividualsbymakingcustomerfeedbackpartofthesupportprovider’sKeyPerformanceIndicator(KPI)couldaddressthisissueoftransparency.


Alargeissueforemployeeswasaperceivedlackofaccountabilityandtransparencyonthepartofthesupportproviders.Employeeswespoketofeltthatasolutioncouldbetoincludecustomerfeedbackintheperformanceevaluationofsupportproviders.

What has helped/would help?

Aplatformforcollatingcustomerfeedback.

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Table3:Summaryofpossibleinterventions

Category Problem Desired outcome Possible intervention How does the intervention empower individuals?

Culture change

Culturechange Societalattitudesandbeliefspreventindividualswithhealthconditionsfromfullparticipation(life,work).

Changeinsocietalattitudesandbeliefsregarding'goodwork';permissiontoGPsforsuggestinggradualreturntowork;permissionforfamiliestobecomfortablewithemployeereturningtowork.

Anawarenesscampaigntochangebeliefsandattitudes.

Empoweringthingsthatindividualscannotactionthemselves(dependentempowermentprovidedbyothers)

System change (support providers)


Supportproviderslacktransparency(e.g.employeesareonlymadeawareofaportionofservicesavailabletothem)

Supportprovidersprovidelistoffullsuiteofsupportoptions.

Educatedecision‑makersfromsupportprovidersonimportanceoftransparencyandtoolstoenablethis.


Employeesoftenfindthattheservicesandsupportprovidedtothemarenotsuitedtotheirneeds‑feelliketheyfallthroughthecracks.

Supportprovidersrestructuretheirsupportdeliveryaroundperson‑centredplanning

Engagesupportprovidersinthedevelopmentandapplicationofacommonsetofprinciples(eg:co‑designingrecoveryprogramwiththeemployee,enablingandtrainingclaimsmanagersonhowtogo'off‑script')thatincludeshortterm'simpletouptake'and'longterm'programchangesindelivery.


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Systemstreamlining

Supportisfractured,complexandconfusing.

Improveeaseofuse,betterconsistencyandbetterconnectionbetweensystems.

1.Engagewithprovidersindevelopingcommonlanguageandcommonformstomaintainconsistencyofexperiencebetweensystemsandmedicalservices.


2.Provideacrosssectoronlinetriageservicepersonedbyrealpeoplewhocanhelpnavigatethroughdifferentsystemsandtodifferentservices.

Empoweringthingsthatindividualscanactionthemselvesbutreliesonactionfromsomeoneelse(dependentself‑empowerment)

Employeeshavetorepeattheirstoriesandmedicalrequirementsmultipletimesthroughouttheirjourney,especiallywhentransitioningthroughdifferentpointsofthesystem.

Improveeaseofuse,betterconsistencyandbetterconnectionbetweensystems.

1.Investigatetoolsandoperatingstructuresthatcande‑duplicateprocessesandenablesharingofinformationacrosssystemsandproviders.

2.Identifyatransitionmanagementprocessthatfacilitatestheeaseofmovementfromonesystemtothenext.



Education Changesinhealthconditionscausestressandanxiety

Improvedhealthliteracyforemployeesandtheiremployersandfamilies

Psycho‑educationapproachtoincreasehealthliteracy


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Goal‑setting Disability,injury,andillnesscantaketheirtollonmotivation.

Goal‑settinginterventionsofferedbysupportproviders.

1.Goal‑directedoccupationaltherapyprogram.

2.Usebehaviouraleconomicsstrategiestotrainclaimsmanagerstointroducegoal‑settingobjectivesintotheirinteractionswiththeirclient.



3.Reframelanguagetopositivemotivation.


Problem‑solving Disability,injury,andillnesscancausechronicstress

Problem‑solvingincludedinsupportofferedbysupportproviders.

Problem‑solvingskillstrainingdeliveredbyoccupationaltherapist


Mentorship Navigatingthebenefitandincomesupportsystemcanbeafrustratingandlonelyaffair.

Maintaintheconfidenceandmomentumoftheemployeetostaypositive.

Providemotivationaltrainingforclaimsmanagers.



Asuddenchangeinhealthcanincreasefeelingsofhelplessnessandvulnerability.

Strength‑basedinterventionsincludedinsupportofferedbysupportproviders.

Incorporatingarehabilitationandreturntoworkstrategythatplaystotheindividual’sstrengths.


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Work accommodation (employers)

Education Jobdescriptionsdonotconveywhetherthejobcanbedonebysomeonewithahealthcondition.

Advertisementsforjobpositionsincludeastatementofminimumrequiredability.

Educatedecision‑makersfromemployersontheimportanceofinclusivelanguage,andhowemployeesdonotneedtobe100%healthytobeproductive


Support Employeesconstantlyreachout,oftenforlittleresult

Employersreachouttoemployeesaspartofclaim/casemanagement.

Designinterventiontotrainemployerstoreachoutfirstandoftentoemployeesduringtheirrehabilitation.


Workaccommodation

Groupinterviewscanbedaunting. Hiringpracticeschangedtobemoreinclusive.

Developguidelinesandeducationprogramsforemployersandrecruitmentagencies.


Education Difficulttofindemployerswhoarewillingtorecruitpeoplewithhealthconditions.

Increasewillingnessofemployerstohirethosewithhealthconditions.

Createaforumfor:(1)providingemployerswitheducationmaterialsregardinggoodwork;(2)developingjobserviceprovidersemployernetworks;and(3)puttingpotentialemployeesintouchwithwillingemployers.


Identifyasystemthatprovidestrainingandstandardsforemployers/recruitmentagenciestobecomeaDisabilityConfidentRecruiter/Employer.


Interventiontoencourageemployerstoprovide'onthejob'trainingforintellectuallyordisabledjobseekersratherthanrequiringatertiaryqualification.


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Employee empowerment

Mentorship Individualscanfeelminisculeagainstthesystemwhentheyaretryingtosecurethebestsupportforthemselves.

Employeesfeelsociallysupported Onlineresourcecollatingonline‑orcommunity‑basedmentorshipprogramsandsupportgroups.Designaninterventiontomaximisethenumberofemployeeswhoaccessthematerials.


Unsuitablementorscanhaveanadverseeffect.Thisexacerbatesincidencesofdepressionandhopelessness.

Linkemployeestopositiveinfluencers.

Useadvocacyorganisationsthatareintouchwiththeneedsoftheemployeesspecificgroupasacentralforum(eg:spinalcordassociation).


System Navigatingthedisabilitysupportsystemcanbedifficultandlonelyasanindividual.

Employeesfeelsociallysupported. Group‑basedcase/claimmanagement.


Onestopshopportal'thatconnectstoservices,mentorgroups,'goodwork'credentialedemployers,jobsearchservices,jobapplicationguidance,motivationaltrainingetc.


Education Employeesunawareofwhattoexpectofemployer

Employeesmoreclearlyunderstandwhattoexpectoftheiremployer.

Collateonlineinformationregardingemployerobligations.Designaninterventiontomaximisethenumberofemployeeswhoaccessthematerials.Employerguidelines.


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Jobseeking Itcanbedifficulttomanageyourconditionwhenitimpairsyouphysicallyand/ormentally.Thatmeansitcanbeespeciallydifficulttofindorgetbacktowork.

Employeesfeelsupported Individualplacementandsupport(IPS)approachfromjobsearchprovider.


Difficulttofindemployerswhoarewillingtorecruitpeoplewithhealthconditions.Groupinterviewscanbedaunting.

Employeesaregiventheconfidencetokeeplookingforwork.

Accesstoajobcoachingsystemmannedwithcoachestrainedforthespecialneedsofpeoplewithaphysicalorpsychologicalhealthcondition.


Lossofskills,eitherduetoonsethealthconditionorlong‑termunemployment.

Havetheskillstofindsuitableemployment.

Interventionsthatgiveaccesstotraining/retraining.


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4.0 ConclusionThepurposeofthisstudyistoidentifywhatcanhelpemployeestohelpthemselves–touseworkaspartoftheirrecovery.However,adistinctionmustbedrawnbetweenthedifferenttypesofempowermentinterventions:

1. Independentself‑empowerment–empoweringthingsthatindividualscanactionthemselvesrightnowwithouthelpfromanyoneelse.

Neithertheacademicevidence,expertstakeholderinterviewsnoremployeeinterviewsidentifiedindependentself‑empowermentinterventions.

2. Dependentself‑empowerment–empoweringthingsthatindividualscanactionthemselvesbutreliesonactionfromsomeoneelse,forexample,‘mentorship’isthemostfavouredinterventionbyemployeesbutfacilitiestoaccessmentorshipwouldhavetobeestablishedtoenableaccess.

3. Dependedempowerment–empoweringthingsindividualscannotactionthemselves.

Dependentself‑empowermentThefollowinginterventionsandexampleswereidentifiedthatindividualscanactionthemselvesonceamechanismisestablished.

• Mentorship:community‑basedprogramsandsupportgroupsoradvocacygroupforumsthatindividualscanaccessviaonlineresourcesoruseofadvocacyorganisationsthatareintouchwiththeneedsofspecificemployeegroupsasacentralforum.

• Education:acollationofonlineinformationregardingemployerobligationsandguidelinestohelpemployeesunderstandtheirentitlementswashighlysupportedbyemployees,orapsycho‑educationapproachtoincreasehealthliteracy–thoughreviewevidenceforthiswasinconclusive.

• Goalsetting:agoaldirectedoccupationaltherapyprogram.

• Systemfacilitation:aportalthatconnectstoservices,mentorgroups,‘goodwork’credentialledemployers,jobsearchservices,jobapplicationguidance;oranonlinetriageserviceprovidedbyrealpeoplewhocanhelpnavigatethroughdifferentsystemsandtodifferentservices.

DependentempowermentWhatthisinvestigationlearntfromemployeesandfromstakeholdersisthatthebesteffortsatself‑helparedefiedbysystemsthatarecomplexandunsupportive.Inthewordsofakeystakeholder‘theycannotfightabadsystem’.Whatisclearisthatthereisnosilverbullet.Employeeempowermentisreliantonbroaderchangesandamulti‑dimensionalapproach.

• Cultural change–shiftingbeliefsandattitudestowardsthevalueofgoodworkandinclusionisimportant.Culturalprovidestheover‑archingcontextandmotivationthatmakesindividualinterventionseffective.Itisahighorder‘empowerment’toolforallparticipantcohorts.Italsogoeshandinhandwiththeneedforbettercross‑communityhealthliteracy.

Thereisgrowingevidencethatdemonstratesthatwithoutshiftingculturalbeliefsandsocialnorms,inthiscasearoundthebenefitsofgoodworkandemployingpeoplewithhealthconditionsordisability,theeffectivenessofempowermentinterventionscanbecompromised.ThisisevidencedinsomeofAustralia’slargestbehaviourchangeprogramssuchasroadsafety,workplacesafetyandsmoking,whereeducationandlegislationdonotworkinisolationofcreatinganemotionalconnectiontothebenefitofaparticularbehaviour.

Stakeholdersrepeatedlyraisetheimportanceofcreatinguniversalawareness,understandingandabeliefamongstemployers,employees,healthprofessionals–allAustralians–that‘goodwork’isgoodforyouandthatworkingisaprovenaidtorecoveryandemotionalwellbeing.

33

• System change –theevidencefromemployees’experiencesofthebenefitandincomesupportsystemsmaybeconsideredharshbysome,butpresentsaveryrealimpedimenttoindividualempowerment,evenleadingtoworseninghealthandgreaterrelianceonthesystembycontributingtosecondaryconditionssuchasdepression.Partsofthesystemareoutofstepwithcurrentbestpracticeapproachestocustomer‑centricservicingandstreamlinedoperatingprocesses,andthisisachallengethatneedstobeaddressed.

• Work accommodation–theneedforemployer’stobetterunderstandandsupporttheindividualcapabilitiesofemployeeswithaphysicalorpsychologicalconditionordisabilityissupportedbyevidence,employeesandstakeholders.Effectiveworkaccommodationisthecoalfaceoftheworkexperienceandenablingindividualstoobtain,stayatorreturntoworkisreliantonemployerengagement.

34

Additional informationStakeholderresearch–thebesttimetointerveneStakeholderswereaskedaboutthemostadvantageoustimeintheprocesstointervene.

Earlyinterventionwasuniversallyconsideredaprioritytoprovidehopeandinspirationearlyon.Thisincludedtheveryfirstconversationonthisbasisthisisthetimewhenyougettoknowthecustomer,theirstoryandwhatthey’relike,aswellasbeingabletosetexpectationsfromthestart(i.e.tellthemwhatisgoingtohappen,theirrole,theemployersrole,wintrust,helpthemmakedecisions).

Inthecaseofinjuryorillnessthatimpactsanexistingworksituation,therewasalsothenotionthatthefirstcontactshouldbebeforethepersonbecomesinvolvedintheworkdisabilitysystem.

‘the system is focused on your health, you get a doctor, a physiotherapist, a specialist, but nobody focuses on your ability to work, and this leads to an immediate loss of confidence to work. The work conversation needs to start immediately – even if it is not a full chat because of the circumstances, it is someone saying ‘I will come and talk to you about how to help you get back to work’.

Anotherideawastheneedforearlyunderstandingandnotificationassoonassomethinghappenstoensuretheemployeranddocumentsarehandledintherightway.

Overallconsensusisthatthestrategyneedstobeaboutprevention.Understandingbypeoplebeforetheyevenfindthemselvesinthesituationsotheyknowwhattodotherebylesseningthe‘adversarial’feelingofthesituationandtriggeringthenotionthat‘ifyoufindyourselfinthissituationspeakupquickly’.

35

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Khangura,S.,Polisena,J.,Clifford,T.J.,Farrah,K.,&Kamel,C.(2014).Rapidreview:Anemergingapproachtoevidencesysnthesisinhealthtechnologyassessment.InternationalJournalofTechnologyAssessmentinHealthCare,30(1),20–27.http://doi.org/10.1017/S0266462313000664

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WorldHealthOrganization(1998).HealthPromotionGlossary.Geneva:WHOWHO/HPR/HEP/98.1

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AppendicesAppendix1:Examplesofinterventiontypes1. Workaccommodation

Examplesfromliteratureofwhatworkaccommodationinterventionsincorporate:

• Individualcasemanagementandjobsearchassistance

• Changestotheworkplaceorequipment

• Changesinworkdesignandorganisation

• Changesinworkingconditionsorworkenvironment

• Casemanagementwithworkerandemployer

• Earlycontactwithworkerbyworkplace

• RTWcoordination

• Worksiteergonomicvisit

• Healthcareprovidercontactwithworkplace

2. Support

Examplesfromliteratureofwhatsupport/individualplacementandsupport(IPS)interventionsincorporate:

• Individualplacementandsupportprinciples:competitiveemploymentasprimarygoal;eligibilitybasedonpatientchoice;integrationofvocationalandclinicalservices;jobsearchguidedbyindividualpreferences;personalisedbenefitscounselling;rapidjobsearch;systematicjobdevelopment;time‑unlimitedsupport

• AugmentedIPS:IPSwithaddedspecialisedtrainingcomponents(e.g.augmentedwithcognitivetraining,work‑relatedsocialskills,workplaceskills)

• Traditionalvocationalrehabilitationmodels:focusontheinterventionsinthesettingpriortoinitiatingworkactivity

• Supportedemploymentmodels:focusontheimmediatecompetitivejobsearch

• Work‑focusedtreatmentofhealthconditions(e.g.commonmentaldisorders)

3. Mentorship

Examplesfromtheliteratureofwhatmentorshipinterventionsincorporate:

• School‑basedinterventionswithpeermentors(e.g.class‑basedcompetency‑buildingprogramaimedatfosteringself‑determinationinstudents)

• Community‑basedinterventionswithpeermentors(e.g.programsbasedoutsideschoolsorotherinstitutions

• Work‑basedinterventions(e.g.coworkertrainingviastandardizedone‑on‑oneapproach)

• Familyemploymentawarenesstraining(e.g.standardisedknowledge‑basedtrainingprogramforfamilies)

• Onlinementorshipprogram(e.g.emailmethodsformentorstoprovidesupportandinformationsharing)

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4. Goalsetting

Examplesfromtheliteratureofwhatgoal‑settinginterventionsincorporate:

• Goal‑directedoccupationaltherapyprogram

• Group‑basedgoalsettingapproach

• Specificoccupation‑basedgoalsetting

5. Person‑centeredplanning

Person‑centeredplanning(PCP)isnotastandardizedinterventionbutanumbrellatermthatisoftenusedtodescribeapproachesandtechniquesthatsharecommoncharacteristics.Fivekeyfeaturesinclude:

• The person at the center

• Familymembersandfriendsarepartnersinplanning

• Theplanreflectswhatisimportanttotheperson,theircapacities,andwhatsupporttheyrequire

• Theplanresultsinactionsthatareaboutlife,notjustservicesandreflectwhatispossibleandnotsimplywhatisavailable

• Theplanresultsinongoinglistening,learning,andfurtheraction

6. Problem‑solving

Problem‑solvinginterventionsareusuallydeliveredasatrainingprogram.Someexamplesfromtheliteratureinclude:

• Problem‑solvingtrainingcombinedwithgradedactivity

• Problem‑solvingskillstrainingdeliveredbyoccupationaltherapist

• Problem‑solvingcomponentinguideline‑basedcareprovidedbyoccupationalphysicians

• Problem‑solvingtrainertrainingforoccupationalphysicians

• Problem‑solvingcomponentincollaborativecareinterventioninvolvingworker,manager,andoccupationaltherapist

• Individual‑andgroup‑basedproblem‑solvingtrainingdeliveredbypsychologists.

7. Strength‑basedinterventions

Examplesfromtheliteratureofwhatstrength‑basedinterventionsincorporate:

• Strength‑basedcasemanagement

• Strengths‑basedbriefsolutionfocusedcounselling

8. Education

Examplesfromtheliteratureofwhateducationinterventionsincorporate:

• Psycho‑educationalinterventions(e.g.participantslearnaboutphysicalsideeffects,stressandcopingtechniques)

• Patientcounsellingandhealtheducation

• Stressmanagementandrelaxationtrainin

40

Appendix2:Detailedbreakdownofcitizenpanelattendees

20–244% 25–29

4% 30–344%

35–399%

40–444%

45–4931%

50–5422%

55–6022%

Year 1210%

AdvancedDiplomaandDiploma

30%

BachelorDegree20%

Acquiredandcongenital

components4%

Acquired87%

Congenital9%

Congenitalvsacquired

41

Acute18%

Chronic82%

Chronicvs.acute

Moderateproblem20%

Noproblem0% Mildproblem

0%

Severe problem0%

Minimalproblem0%

Moderatelysevere problem

50%

Verysevereproblem30%

Severity

42

Appendix3:Projectmethods

Rapidreviewmethods–Searchstrategy

Acomprehensivesearchofthefollowingdatabasewasundertaken:PsycINFOviaOvid,MedlineviaOvid,CochraneLibraryandCINAHL.TheMedlinesearchstrategyisreproducedbelow:

Table 4. Medline search strategy

Search string

1 returntowork[tw]ORreturn‑to‑work[tw]ORRTW[tw]ORre‑employ*[tw]ORemployment[tw]ORunemployment[tw]ORunemployed[tw]ORretirement[tw]ORemployab*[tw]ORabsenteeism[tw]ORvocational[tw]OR(commenc*adj3work)[tw]OR(commenc*adj3job)[tw]OR(stay*adj3work)[tw]OR(stay*adj3job)[tw]OR(workadj2participat*)[tw]OR(modif*adj2work)[tw]OR(workadj2adjust*)[tw]OR(retainadj2work)[tw]OR(retainadj2job)[tw]OR(jobadj2retention)[tw]OR(workadj2retention)[tw]OR(jobadj3re‑ent*)[tw]OR(workadj3re‑ent*)[tw]OR(workadj3reintegrat*)[tw]OR(jobadj3re‑integrat*)[tw]OR(modif*adj2dut*)[tw]OR(lightadj2dut*)[tw]OR(workadj2ability)[tw]OR(workadj2status)[tw]OR(recover*adj2work)[tw]OR(obtain*adj3work)[tw]OR(obtain*adj3job)[tw]OR(workadj3capacity)[tw]OR(occupationaladj2outcomes)[tw]OR(sick*adj1leave)[tw]OR(sick*adj3absence)[tw]OR(workadj3accommodat*)[tw]OR(jobadj3accommodat*)[tw]OR“workplace”[SubjectHeading]OR“returntowork”[SubjectHeading]OR“work”[SubjectHeading]OR“employment”[SubjectHeading]OR“sickleave”[SubjectHeading]OR“jobsatisfaction”[SubjectHeading]OR“occupationalmedicine”[SubjectHeading]OR“rehabilitation,vocational”[SubjectHeading]OR“occupationalhealth”[SubjectHeading]OR“unemployment”[SubjectHeading]OR“absenteeism”[SubjectHeading]OR“occupations”[SubjectHeading]OR“occupationalhealthservices”[SubjectHeading]OR“workcapacityevaluation”[SubjectHeading]OR“vocationalguidance”[SubjectHeading]

2 disability[tw]ORdisease[tw]ORinjury[tw]ORillness[tw]ORdisorder[tw]ORcognitiveimpairment[tw]ORcognitivedysfunction[tw]ORmusculoskeletaldisease*[tw]ORcancer[tw]ORosteoporosis[tw]ORarthritis[tw]ORasthma[tw]ORchronicobstructivepulmonarydisease[tw]ORCOPD[tw]ORchronicpain[tw]ORcardiovasculardisease[tw]ORdiabetes[tw]ORchroniccondition[tw]ORmentalhealth[tw]ORchronicdisorder[tw]ORpsychologicaldisorder[tw]OR“Disabledpersons”[SubjectHeading]OR“IntellectualDisability”[SubjectHeading]OR“MentalDisorders”[SubjectHeading]OR“WoundsandInjuries”[SubjectHeading]OR“ChronicDisease”[SubjectHeading]OR“CognitiveDysfunction”[SubjectHeading]OR“MusculoskeletalDiseases”[SubjectHeading]OR“Neoplasms”[SubjectHeading]OR“Osteoporosis”[SubjectHeading]OR“Arthritis”[SubjectHeading]OR“RespiratoryTractDiseases”[SubjectHeading]OR“PulmonaryDisease,ChronicObstructive”[SubjectHeading]OR“Asthma”[SubjectHeading]OR“BackPain”[SubjectHeading]OR“ChronicPain”[SubjectHeading]OR“CardiovascularDiseases”[SubjectHeading]OR“DiabetesMellitus”[SubjectHeading]OR“Depression”[SubjectHeading]OR“AnxietyDisorders”[SubjectHeading]OR“StressDisorders,Post‑Traumatic”[SubjectHeading]

3 review*ORmeta‑synthesis*ORmeta‑analysis*

5 #1AND#2AND#3

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Screeningandselection

OnereviewerscreenedthecitationsagainsttheinclusionandexclusioncriterialistedinTable2.Dataextractedfromtheincludedarticleswasusedtoinformacommentaryontheoutcomesofempowerment‑focusedinterventions.

Table 5. Inclusion and exclusion criteria

Include Exclude

StudyType • Systematicornarrativereviews.Reviewsofquantitativeorqualitativestudieswillbeincluded

• Allprimarystudydesigns

Population • Individualsnavigatingdisabilitysystems;atvariousstagesofworkstatus(i.e.returningtowork;remainingatwork;commencingnewwork);withinjuries(mentalorphysical),disabilities(cognitiveorphysical),ordisease(e.g.cancer);invarioussystems(e.g.workers’compensationanddisabilitysupportsystems,superannuationandlifeinsurance,employer‑fundedincomesupport).

• Reviewsdescribingimpactonnon‑immediate/proximaloutcomes

• Familiesofindividuals

StudyDesign • Interventional(RCTpreferredbutalldesignsaccepted)

StudySetting • International(withfocusonAustralia,Canada,NewZealandandtheUS)

Intervention • Useofempowermenti.e.activeparticipation,navigation,self‑management(insurance),healthliteracy,schemenavigation,workplanning,problemsolving,supportmechanisms,self‑managementsupport,self‑sufficiency,qualityoflife(e.g.communityinvolvement,familystability),andactiveinterventions.

• Interventionsthatdon’thaveanevaluationcomponent

Outcome • Sustainedworkstatuschange

• Feelingsofempowerment

• Individuals’attitudes,needs,andmotivations

• Reductioninillnessorpoisoning(unlessinterventionsevaluatingotheroutcomesarealsoincludedwithinthereview)

Publicationstatus • English‑language

• Peer‑reviewedjournalpublicationsorreports

• Published1998‑2018

44

Appendix4:Qualityappraisal

Criterion (AMSTAR 2) Bisung (2018)

Cheng (2018)

Cullen (2018)

D’Amico (2018)

De Boer (2015)

Dewa (2015)

Dewa (2018)

Doki (2015)

Donker-Cools (2016)

1. Did the research questions and inclusion criteria for the review include the components of PICO?

No Yes Yes Yes Yes Yes Yes Yes Yes

2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?

No No No No Yes No No No No

3. Did the review authors explain their selection of study designs for inclusion in the review?

No No Yes No No No No No No

4. Did the review authors use a comprehensive literature search strategy?

No Partialyes Partialyes Partialyes Yes Partialyes Partialyes Partialyes Partialyes

5. Did the review authors perform the study selection in duplicate?

No Yes Yes Yes Yes Yes Yes Yes Yes

6. Did the review authors perform data extraction in duplicate? No Yes Yes Yes Yes No No No Yes

7. Did the review authors provide a list of excluded studies and justify the exclusion?

No No Partialyes No Yes No No No No

8. Did the review authors describe the included studies in adequate detail?

No Partialyes Partialyes Partialyes Partialyes Yes Partialyes Partialyes Partialyes

9. Did the review authors use a satisfactory technique for assessing the risk of bias in individual studies that were included in the review?

No No Yes Yes Yes Yes Yes Yes No

10. Did the review authors report on the sources of funding for the studies included in the review?

No No No No Yes No No No No

11. If meta-analysis was performed, did the review authors use appropriate methods for statistical combination of results?

N/A N/A N/A N/A Yes N/A N/A Yes N/A

12. If meta-analysis was performed, did the review authors assess the potential impact of risk of bias in individual studies on the results of the meta-analyses or other evidence synthesis?


45

Criterion (AMSTAR 2) Bisung (2018)

Cheng (2018)

Cullen (2018)

D’Amico (2018)

De Boer (2015)

Dewa (2015)

Dewa (2018)

Doki (2015)

Donker-Cools (2016)

13. Did the authors account for risk of bias in individual studies when interpreting/discussing the results of the review?

No No Yes No Yes No Yes Yes Yes

14. Did the review authors provide a satisfactory explanation for and discussion of heterogeneity observed in the results of the review?

No Yes Yes No Yes Yes No No Yes

15. If they performed quantitative synthesis, did the review authors carry out an adequate investigation of publication bias (small study bias and discuss its likely impact on the results of the review)?


16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?

Yes Yes Yes Yes Yes Yes Yes Yes Yes

TOTAL yes / applicable items 1/13 7/13 11/13 7/13 15/16 7/13 7/13 10/16 8/13

46

Criterion (AMSTAR 2) Fong (2018)

Gaudreault (2014)

Hegewald (2019)

Laires (2017)

Levack (2015)

Lindsay (2016)

McDowell (2014)

Modini (2018)


Yes Yes Yes Yes Yes Yes Yes Yes


Yes Yes Yes No Yes No No Yes


No No Yes No Yes No No No

4. Did the review authors use a comprehensive literature search strategy? Partialyes Partialyes Yes Partialyes Yes Partialyes Partialyes Partialyes

5. Did the review authors perform the study selection in duplicate? Yes Yes Yes No Yes Yes Yes Yes

6. Did the review authors perform data extraction in duplicate? No Yes Yes No Yes Yes No No


Yes No Yes No Yes No No No

8. Did the review authors describe the included studies in adequate detail? Partialyes No Yes Partialyes Yes Yes Partialyes No


Yes Yes Yes No Yes Partialyes No Partialyes




Yes N/A Yes N/A Yes N/A N/A Yes


No N/A Yes N/A Yes N/A N/A No


Yes Yes Yes No Yes No No No


Yes No Yes No Yes No No Yes

47

Criterion (AMSTAR 2) Fong (2018)

Gaudreault (2014)

Hegewald (2019)

Laires (2017)

Levack (2015)

Lindsay (2016)

McDowell (2014)

Modini (2018)


No N/A Yes N/A Yes N/A N/A Yes


Yes Yes Yes No Yes Yes No Yes

TOTAL yes / applicable items 11/16 8/13 16/16 3/13 16/16 7/13 4/13 9/16

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Criterion (AMSTAR 2) Munoz-Murillo (2018)

Nevala (2015)

Nieuwenhuijsen (2014)

Nigatu (2016)

Ratt (2016)

Sabariego (2018)

Suijkerbuijk (2017)

Trenaman (2014)


Yes Yes Yes Yes Yes Yes Yes Yes


Yes Yes Yes No Yes No No Yes



4. Did the review authors use a comprehensive literature search strategy?

Partialyes Partialyes Yes Partialyes Yes Partialyes Partialyes Partialyes

5. Did the review authors perform the study selection in duplicate? Yes Yes Yes No Yes Yes Yes Yes

6. Did the review authors perform data extraction in duplicate? No Yes Yes No Yes Yes No No


Yes No Yes No Yes No No No

8. Did the review authors describe the included studies in adequate detail?

Partialyes No Yes Partialyes Yes Yes Partialyes No


Yes Yes Yes No Yes Partialyes No Partialyes




Yes N/A Yes N/A Yes N/A N/A Yes


No N/A Yes N/A Yes N/A N/A No


Yes Yes Yes No Yes No No No


Yes No Yes No Yes No No Yes

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Criterion (AMSTAR 2) Munoz-Murillo (2018)

Nevala (2015)

Nieuwenhuijsen (2014)

Nigatu (2016)

Ratt (2016)

Sabariego (2018)

Suijkerbuijk (2017)

Trenaman (2014)


No N/A Yes N/A Yes N/A N/A Yes


Yes Yes Yes No Yes Yes No Yes

TOTAL yes / applicable items 11/16 8/13 16/16 3/13 16/16 7/13 4/13 9/16

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Criterion (AMSTAR 2) Tse (2016)

Wheeler (2016)

Vooijs (2015)

1. Did the research questions and inclusion criteria for the review include the components of PICO? Yes Yes Yes


Yes Yes Yes

3. Did the review authors explain their selection of study designs for inclusion in the review? No No Yes

4. Did the review authors use a comprehensive literature search strategy? Partialyes Partialyes Yes

5. Did the review authors perform the study selection in duplicate? Yes Yes Yes

6. Did the review authors perform data extraction in duplicate? No Yes Yes

7. Did the review authors provide a list of excluded studies and justify the exclusion? Yes No Yes

8. Did the review authors describe the included studies in adequate detail? Partialyes No Yes

9. Did the review authors use a satisfactory technique for assessing the risk of bias in individual studies that were included in the review? Yes Yes Yes

10. Did the review authors report on the sources of funding for the studies included in the review? No No Yes

11. If meta-analysis was performed, did the review authors use appropriate methods for statistical combination of results? Yes N/A Yes


No N/A Yes

13. Did the authors account for risk of bias in individual studies when interpreting/discussing the results of the review? Yes Yes Yes

14. Did the review authors provide a satisfactory explanation for and discussion of heterogeneity observed in the results of the review? Yes No Yes


No N/A Yes

16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? Yes Yes Yes

TOTAL yes / applicable items 11/16 8/13 16/16

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Appendix5:Detailedthematicanalysis

Informationandprocess


• Thecomplexityofthe‘system’isoverwhelming–(ie:Workers’Compensation,MotorAccident,DisabilitySupportPension,superannuation,lifeinsurance,DisabilityEmploymentServices).

• Lackofaccountability–beingoncallsforhoursthengettingshiftedalongtheline;delaysinpaymentsbecausethenecessaryinformationisn’tcomplete,buttheemployeeisn’tadvisedthereisaproblemthereforecan’tredressit.

• Supportprovidersaren’ttransparentinwhattheycanoffer.

• Websitesaretoooverwhelming,therearetoomanyoptions.

• Whenabletofindrelevantinformation,itisoftendifficulttounderstand.

• Onceyou’reinaprocess,youneedtospendalotoftimeandeffortfollowingituptomakesureyoudon’tfallthroughthecracks.

• Uncertainty–paymentsgetadjustedwithoutanyapparentreasonornotice.

• Thesiloednatureofthesystem–each‘supplier’onlyconsideringtheirrole.

• Repetitiveness–thenumberoftimesinformationhastobesupplied/resupplied;thenumberofdifferentmedicalexaminationsrequired(“IappliedtogoonaDisabilitypensionbutdidn’thaveenoughpoints.SoIhadtogobacktothepsychologistagainandthatcostme$300”).

• Lackofcommunicationbetweenparties(e.g.GPsaidtogetamassage,butsupportproviderwouldn’tcoverit).


• Networksofotherswithsimilarsituations:cansuggestoptionsthataren’talwaysmadevisiblebyproviders

• Centralcontactpoints:eitheranindividualoranorganisation

• Somekindofpersontoadministertriageandhelptheindividualfigureoutwhatisavailabletothem

• Someonetomakesureyouarecoping

• Havingaphysicalofficewhereyoucanspeaktosomeone

Empathyandunderstanding


• Lackofunderstandingfromsupportproviders(onesizefitsallapproach,littleroomforflexibilityinthesystem),employers(likelytoassumeyoucan’tdoanything),andgeneralpublic(“I’myoungsoIdon’tlooksick,butIam.”)

• Feelingthatyouneedthesupportprovidersmorethantheyneedyou—leadstofeelingsofbeingmanipulatedbysupportproviders

• Nobodyasksyouwhatyoucando


• Flexibleemployers

• Advocates

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Mentalhealthandwellbeing


• Beingoffworkmakesithardertogetwork,whichleadstoloneliness,lossofself‑confidence,lossofperceivedcontrol

• Workprovidesanetworkofsocialinteraction

• Lossofsocialnetworksleadstodegradationofmentalhealth

– Noprovisionfromsupportproviderstogiveyousomethingelsetodo(e.g.agymmembershipmighthaveobviousphysicalbenefitsbutcouldalsobuffermentalhealthbygivingroutineandanopportunitytodevelopnewsocialnetworks)

• Theveryreal‘effort’ofdealingwiththesystemismentallydraininganddemoralising.


• Wellbeingactivities(e.g.artclasses,yoga)tohelpbuildroutineandoffersocialcontact

• Counsellingaspartofrehabilitation

‘Good’work


• Achievingworkgoalscanhaveapositiveeffectonstabilising

• Doingsomeworkcanhelpinotherwellbeingaspectse.g.mentalhealthandmotivation

• Returningtoworkmeansbeingproductive,andhavingfocusanddirection

• Workingalleviatesfinancialstress


• Volunteeringwasusefulbecausetherewaslesspressuretoperform

Expertise


• Anumberofsupportprovidershavenospecialisedexperienceworkingwithdisabledpopulation

• Conventionaljobserviceproviderspickupcaseswithdisabilitytoearnmoremoneybutdonothavetherequisiteexpertise

• Somesupportprovidersworkinspecialtyareasbutdon’temploypeoplewithabackgroundinarea

• Casemanagersneedtoknowtheinsandoutsofthedisabilitygroup

• Ifthereisn’texpertisethenthereistensionbecausethereisn’tasharedunderstandingofwhat’sexpected


• Casemanagerswithdeepexperienceorbackgroundinareaofdisability

• Specialitysupportproviders(e.g.OSTARA)

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Transparency

• Transparencyaroundcharterofserviceprovider

• Transparencyaroundrightsofcustomers

• Transparencyaroundservicescustomersareentitledto

• Somesupportprovidershaveavarietyofdifferentactsandcharterstonavigate


• Supportgroupsandsharingexperiencesallowsindividualstogetabettergrasponwhat’savailableto them

Attitudestowork

Everyoneoftheemployeeswhoparticipatedinthisresearchwantedtoworkandhadbeenlookingforwork.Theirdesiretoworkwasnotabarriertoworkparticipation.Thisisnotanaspectoftherecruitmentcriteriabutanaturalphenomenon.

“Self-confidence dwindles the longer you aren’t in work” and…

“Stability and routine are important for mental health”.

Beingemployedisimportantfortheminanumberofways:

• providingpurpose

• beingaproductivememberofsociety

• selfsufficiency

• notbeingaburdenonfamilyandfriends

• learning,opportunity,growth

• aswellasmorefunctionalaspectssuchasmoneyandtravel.

Perceptionsofgettingemployment

• Ifyou’reolderyougetnowhere.Themarketissaturatedwithyoungpeoplewhowilldoitonthecheap.

• Youputinfor600jobsandoncetheyknowwhyyouleftyourlastjobtheydon’twanttoknow.Theydon’twantyoutohavetimeofftogethelp.

• Peoplewhoworkfromhomebecome‘invisible’.

• Youhavetolietogetwork–theydon’temployyouifyoutellthetruth.

• Supportfromcolleaguesintheworkplace/workplaceculture.Ifyou’rereturningtoworkpeopleneedtobewelcoming,haveacuppawithyou,provideaninductioncourse,bepatient.Giveyoutrainingsoyoufeelgoodandconfident.Itstartsatthetop–andwithpoliciesandpracticesinplacefornobullying/discrimination.

• Riskoffinancialpenaltiesofgoingbacktowork.

Personal challenges

• Thefearofnotfindingajob–anyjob–andbeingabletostayinit.

• Notbeingabletocopewiththejob.

• Lossofconfidence.Thebattlewiththeinjury,thelegals,doctors’appointments,paperwork.

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Other

• Disabilitysupportsystemisverypunitive—addsextrastressandpressure

• Jobserviceprovidersarecompetingforgovernmentmoney—contrastagainstCentrelinkwhohadnoproblemwithdocumentation

• Wouldenrolinprogramsthatgetthemmoregovernmentmoneyinsteadoftheprogramthatwasbestsuited

• Jobserviceproviders(JSPs)arecompetingfortheirexistence,sowilloftenexpandtheirscopetoincludethosewithhealthconditions.ThisoccursdespitetheJSPhavingnoexpertiseworkingwithpeoplelikethat

• Over‑relianceonvolunteers

• “Youneedtomakeyourselflooktwiceasbadinordertogethalfthehelpyouneed”

• Assessmentsbyindependentmedicalexaminers(IMEs)areoftenanegativeexperience

• Independentappealsbodydoesn’tevenhavedisabilityaccess—wasfiveminuteslatebecauseelevatorwasbroken,wastoldtheymissedanappointment

• Lostallpaymentsbecauseoferroronpartofdoctor

• Everysingleappointmentis3pminthecityandyoucan’tbringchildrenwithyoutotheappointment

• “Leftinjured,suffering,anduntreated,withnobeliefinyourself”.

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Appendix6:Reviewquality

Intervention Review Outcome Quality Result

Goalsetting Levacketal.,2015 Empowerment 16/16 Lowqualityofevidencethatgoalsettingincreaseswellbeingandperceivedself‑efficacy

Goalsetting Wheeleretal.,2016 Empowerment 7/13 Moderateevidencethatgoal‑directedrehabimprovesgoalattainment


Tseetal.,2016 Empowerment 6/13 Weakevidencethatstrength‑basedinterventionsimproveself‑esteem,self‑efficacy,socialsupport,spiritualwell‑beingandpsychiatricsymptoms

Goalsetting Levacketal.,2015 Workoutcomes 16/16 Unclearwhattheeffectofgoal‑settinghasonworkparticipation–notenoughdata/reporting

Goalsetting Wheeleretal.,2016 Workoutcomes 7/13 Moderateevidencethatgoal‑directedrehabimprovesoccupationalperformance

Education DeBoeretal.,2015 Workoutcomes 15/16 Lowqualityevidenceofnoeffectofpsycho‑educationalinterventionsonRTWratesorqualityoflife(comparedtocareasusual)

Education Hegewaldetal.,2019 Workoutcomes 16/16 Low‑toverylow‑certaintyevidence.UnclearwhethercounsellingplushealtheducationprogramsimproveRTW

Mentorship Lindsayetal.,2016 Workoutcomes 7/13 Partialevidencethatmentorshipinterventionsimproveschool‑orwork‑relatedoutcomes

Mentorship Wheeleretal.,2016 Workoutcomes 7/13 Insufficientevidencethatpeer‑mentoringimprovesqualityoflife


Rattietal.,2016 Workoutcomes 9/13 Lowqualityevidencethatperson‑centredplanningmayhaveapositive,yetmoderate,impactoncommunity‑andlife‑participation.Impactonemploymentoutcomesisinconclusive.

Problem‑solving Dewaetal.,2015 Workoutcomes 7/13 Inconsistentfindingsregardingeffectofwork‑focusedproblem‑solvingonRTW

Problem‑solving Nigatuetal.,2016 Workoutcomes 9/16 Problem‑solvingstrategies(amongstotherinterventions)didnotleadtoimprovedRTWrates

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Problem‑solving Dokietal.,2015 Workoutcomes 10/16 Noeffectofproblem‑solvingtreatmentaloneonsickleavereductionbutacombinedproblem‑solvingandCBTinterventiondidhavesignificanteffectontotalsickleavedays

Support Chengetal.,2018 Workoutcomes 7/13 Insufficientevidenceforeffectivesupportstrategiesinobtainingandmaintainingemployment.Noassessmentofevidencequality

Support Dewaetal.,2018 Workoutcomes 7/13 Lowquality(highrisk)evidencethatindividualplacementandsupport(IPS)programswithaugmentations(comparedtoIPSalone)maybemoreeffectiveinemploymentoutcomes

Support Modinietal.,2016 Workoutcomes 9/16 Fair‑togood‑qualityevidencethatindividualplacementandsupportprogramsareaneffectiveinterventionforcompetitiveemployment.Twiceaseffectiveastraditionalrehabilitationprograms.

Support Muńoz‑Murilloetal.,2018 Workoutcomes 7/13 Goodqualityevidencethatjobaccessstrategiesseemtoimproveemploymentoutcomes.Theeffectivenessofreturntoworkstrategiesremainsunclear

Support Trenamanetal.,2014 Workoutcomes 6/13 Someevidencethatsupportedemploymentcanimproveemploymentoutcomesbutunabletoassessqualityduetoheterogeneityofmethodsandfactors.

Support D’Amicoetal.,2018 Workoutcomes 7/13 Strongevidenceforroleofoccupationaltherapy‑basedsocialparticipationinterventionsforimprovingsocialparticipationandoccupationalengagement.Interventionsmoreeffectivewhenpairwithclient‑centeredgoalfocus

Support Donker‑Coolsetal.,2015 Workoutcomes 8/13 Strongevidencethatworked‑directedinterventionsincombinationwitheducation/coachingimprovesRTW

Support Nieuwehuijsenetal.,2014 Workoutcomes 12/16 Moderateevidencethatcoachingsupportplusregularcarereducedsicknessabsencetomoderateextent.

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Support Suijkerbuijketal.,2017 Workoutcomes 15/16 Moderatetolowqualityevidencethatsupportedemploymentandaugmentedsupportedemploymentaremoreeffectivethantheotherinterventionsinobtainingandmaintainingcompetitiveemployment

Workaccommodation

Vooijsetal.,2017 Workoutcomes 10/13 Mediumqualityevidencethatthreeoffourreviewsonworkaccommodationreportedbeneficialeffectsonworkparticipation

Workaccommodation

McDowelleta.,2014 Workoutcomes 4/13 Mixedqualityevidence.Workplaceaccommodationsarerare,butmostcommontypeisflexiblescheduling/reducedhours.Directcostsassociatedwithworkplaceaccommodationsareoftenlow.

Workaccommodation

Nevalaetal.,2014 Workoutcomes 7/13 Moderateevidencethattypesofworkplaceaccommodationpromoteemployment.LowevidencethatworkplaceaccommodationadministeredbycasesmanagersincreasesRTW.Listsanumberofdriversandbarriers

Workaccommodation

Cullenetal.,2018 Workoutcomes 11/13 Strongevidencethatcombinationsofatleasttwoofhealth‑focusedinterventions,servicecoordinationinterventions,andworkmodificationinterventionsreducestimeawayfromwork.StrongevidencethatCBTineffectivewithoutworkplacemodificationorservicecoordination.

Workaccommodation

Sabariegoetal.,2018 Workoutcomes 8/13 Reliablequalityevidencesuggestingthatpositivechangesemploymentstatus,returntoworkandsickleaveoutcomeswereachievedwithworkplaceaccommodationinterventionsthatinvolvegradedsickness‑absencecertificatesandpart‑timesickleave

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