Developing a Work Accommodation Operating Model for Workplaces and Work Ability Support Services.

PURPOSE: Workplace accommodation can help employees with disabilities remain employed or access employment rather than leave the labor force. However, the workplace accommodation process is still poorly understood and documented. AIM: The aim of this study was to develop a national operating model to make workplace accommodation interactive and procedural for workplaces and work ability support services and lower the threshold to making accommodations. METHODS: The collaborative development process was carried out by a multiprofessional expert team with eleven workplaces in the private and public sectors in Finland. The design of this study was conceptual and developmental. The development process of the operating model consisted of four phases: the orientation phase, the joint planning phase, the implementation advancement phase, and the instilling phase. RESULTS: The operating model has six stages: 1) identifying needs, 2) gathering knowledge, 3) exploring alternatives, 4) selecting solutions, 5) implementing solutions, and 6) monitoring and evaluating. The model defines the actions, roles, and responsibilities for each phase. To help implement the model, we published an information package, a guide, a planning formula, and a video animation in Finnish and Swedish. CONCLUSION: The operating model is a tool that workplaces and work ability support services can use to help working-aged people remain employed or access employment. Future studies should determine the workplace-specific functionality of this model using implementation research.

Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study.

BACKGROUND: Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. OBJECTIVE: The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. METHODS: The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. RESULTS: Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. CONCLUSION: Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.

Sustainable employability in Supported Employment and IPS interventions in the context of the characteristics of work and perspectives of the employers: a scoping review protocol.

INTRODUCTION: The sustainable employment outcomes and cost-effectiveness of Supported Employment (SE) and Individual Placement and Support (IPS) have been well reported. Research has also focused on various target groups, compliance with the quality criteria for the implementation of the SE/IPS method in diverse work life and social security contexts. However, the impact of employers' interests and the quality and opportunities of jobs or the work itself for sustainable working careers have not been studied extensively. The objective of the proposed scoping review is to systematically explore what is known about sustainable employability in SE and IPS interventions in the context of the characteristics of work and perspectives of the employers. METHODS AND ANALYSES: The scoping review methodological framework by Arksey and O'Malley and its recently enhanced versions are used as guidelines in this study. The literature search, which was conducted in Medline, Scopus, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and Social Science Premium Collection (ProQuest), identified a total of 2706 articles after the removal of duplicates. Key findings of selected studies will be charted, analysed and reported. ETHICS AND DISSEMINATION: The study does not require ethics approval, as the data are collected from secondary sources. The final version of the scoping review will be published in a peer-reviewed academic journal. Findings of the review will be used in the upcoming ethnographic observation at work study, which is part of the Finnish Work Ability Programme Evaluation Study (2020-2023).

The effectiveness of vocational rehabilitation on work participation: a propensity score matched analysis using nationwide register data.

Objective Research on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. Methods Representative Finnish register data were used to examine 3199 recently employed individuals aged 30-55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008-2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). Results Vocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0-13.7], 8.9 (95% CI 7.6-10.2), and 7.2 (95% CI 6.1-8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. Conclusions Vocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.

Dilemmatic group memberships of hard-of-hearing employees during the process of acquiring and adapting to the use of hearing aids.

We describe how hard-of-hearing (HOH) employees renegotiate both their existing and new group memberships when they acquire and begin to use hearing aids (HAs). Our research setting was longitudinal and we carried out a theory-informed qualitative analysis of multiple qualitative data. When an individual discovers that they have a hearing problem and acquire a HA, their group memberships undergo change. First, HOH employees need to start negotiating their relationship with the HOH group. Second, they need to consider whether they see themselves as members of the disabled or the nondisabled employee group. This negotiation tends to be context-bound, situational, and nonlinear as a process, involving a back-and-forth movement in the way in which HOH employees value different group memberships. The dilemmatic negotiation of new group memberships and the other social aspects involved in HA rehabilitation tend to remain invisible to rehabilitation professionals, occupational healthcare, and employers.

[Vocational rehabilitation in mental disorders]. / Ammatillinen kuntoutus mielenterveyshäiriöissä.

Supporting the working careers of patients having mental disorders is in the best interest of the individual, the community and the society. In mental disorders, recovery to be able to work is more challenging than in other disease groups. Vocational rehabilitation yields the best results when implemented early enough and in close association with work. Work trial and preparation for work are among the most common means of rehabilitation supporting mental patients' return to work. Collaboration with the workplace is needed when the work and working hours are adapted to the needs of the rehabilitee. Supported employment helps even the severely ill to be able to return to work.

The reality of returning to work and training: experiences from a long-term unemployment project.

A project called Pathway-to-Work was carried out in northern Finland between 1995 and 1998. In the course of this project, tailored return-to-work paths were planned for 140 long-term unemployed people with disabilities. The present study, based on that project, had three research objectives: (i) to describe how the participants experienced and defined their opportunities of employment and training at the beginning of the project and how the opportunities were eventually realized; (ii) to form a model of the issues that influenced the participants' decision making on the basis of their descriptions of their life situation; and (iii) to look for elements in the progression of the project that could explain the outcome in terms of the participants' situation in the labour market. The research design was composed of three parts: eight in-depth interviews, a register follow-up, and comparison with a matched control group. Comparative content analysis was used to process the in-depth interviews. The outcome was evaluated according to the following variables: (i) the changes in the participants' labour market situation during the 2-year follow-up; (ii) the changes in the participants' distress level, perceived competence, and sense of coherence during the intervention. We found that the participants had not decided whether to return to work but had left this decision to the professional working on the project. The way participants described their life situations and opportunities made it clear that they placed high expectations on the project. However, although they could realistically estimate their own potential, the labour-market situation was beyond their predictive vision. We conclude that, when targeting services to groups such as described here, more attention should be paid to understanding the clients' behaviour and the social circumstances in which they live.

Into work, through tailored paths: a two-year follow-up of the return-to-work rehabilitation and re-employment project.

Between the years 1996 and 2000, over 2000 projects were carried out in Finland with the aim of finding innovative measures for crossing the job threshold. Among them was the Pathway-to-Work Project, which aimed at tailoring return-to-work plans for 140 middle-aged, long-term unemployed participants with various disabilities and getting half of them into work or training. This study of the Pathway-to-Work Project had two research objectives. First, to evaluate the outcomes of the return-to-work rehabilitation project and second, to determine what combination of different measures seemed necessary and effective in the rehabilitation of long-term unemployed people with disabilities. The research design comprised three parts: a quantitative quasi-experimental part with a matched control group, a register follow-up and the collection of qualitative data. The main variables used to evaluate the outcomes were (1) the changes in the labour market situation during the 2-year register follow-up, (2) the changes in distress (measured by the General Health Questionnaire-12), perceived competence (measured by Wallston's Self-Performance Survey) and sense of coherence (measured by Antonovsky's SOC-13) during the intervention and (3) the description of the process in the project. In the 1-year follow-up, 31% of the participants were found to be at work and 37% unemployed. In the 2-year follow-up, 14% were at work and 59% unemployed. The jobs seemed to be subsidized for a period of half a year to a year. The difference between the project group and the matched control group was remarkable: at the end of the project, only 9% of the control group were at work and 86% unemployed. The participants' distress level decreased remarkably and their perceived competence increased, but their sense of coherence did not change. The results showed that even carefully tailored client work enables only some of the long-term unemployed people with disabilities to cross the job threshold and that other means of policy, strategy and intervention are needed to link the return-to-work interventions more closely with work, work places and enterprises.