Nature of vocational retraining programs influences ability to return to work
MedWire News: The ability of workers with a permanent injury to return to work depends greatly on the design and implementation of vocational retraining programs, conclude Canadian researchers.
The focus of vocational rehabilitation has shifted in recent years away from the impact of disability to an individual's ability to work. An example of this demedicalized paradigm is the replacement of the "sick note" in the UK with a "fit note," in which the focus becomes what is needed to return to work, rather than the illness or injury itself.
To investigate further, Ellen MacEachen, from the University of Toronto in Ontario, and colleagues conducted a series of in-depth interviews and focus groups with 41 workers who were current or previous participants in a vocational retraining program. They included: eight employers, six educators, five case managers, seven compensation service providers, and four main informants, such as legal case workers.
The team reports in the Journal of Occupational Rehabilitation that the vocational retraining program presumed worker preparedness, that workers would be "employable" after completing the program, and benefits were reduced accordingly. The program was one of last resort, and only half of participants gained employment subsequently.
The program did not allow for consideration of unresolved medical problems, note MacEachen et al. Attention was drawn from ongoing chronic and unstable health situations by the concept of maximum medical recovery, and some of the least capable workers were directed into the program as a consequence of incentives to employers.
Communication pathways prevented complaints if workers experienced barriers to vocational retraining, and the outsourced nature of the program meant that it was beyond the reach of the workers' compensation organizational ombudsman. All complaints had to be lodged with the outsourced case workers, who then had discretion about how and when to forward them on.
The team says: "This study reinforces how the shift in disability management paradigms to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and also implementation.
"It is important to recognize that work rehabilitation occurs within a network of workplaces, policies, programs, and professionals, which each play a role in worker outcomes. Therefore, a focus on the environments in which worker ability can be enacted might be as important as a focus on improving characteristics of the workers themselves."
By Liam Davenport