Inter-physician agreement on the readiness of sick-listed employees to return to work

Purpose: To determine the agreement between occupational physician (OP) ratings of an employee’s readiness to return to work (RRTW). Method: Anonymized written vignettes of 132 employees, sick-listed for at least 3 weeks, were reviewed by 5 OPs. The OPs intuitively rated RRTW as the ability (knowledge and skills) and willingness (motivation and confidence) of sick-listed employees to resume work. Inter-OP percentages of agreement were calculated and Cohen’s kappas (κ) were determined to correct for agreement by chance. Results: The percentage of agreement between OPs was 57% (range 39–89%) on the ability and 63% (range 48–87%) on the willingness of sick-listed employees to resume work. The mean κ was 0.14 (range from –0.21 to 0.79) for ability and 0.25 (range from –0.11 to 0.74) for willingness. The OP-rating of RRTW of employees sick-listed with mental disorders did not differ from the OP-rating of RRTW of employees with musculoskeletal disorders. Conclusion: The inter-OP agreement on intuitively rated RRTW showed a wide variability, which accentuates the need for instruments to establish an employee’s RRTW and for training in giving well founded return to work recommendations.

Implications for Rehabilitation

• There is little agreement between physicians’ intuitive ratings of the readiness of sick-listed employees to return to work.

• This finding accentuates the need for an instrument to establish an employee’s readiness to return to work more consistently.

• A reliable assessment of the readiness to return to work is important for motivating sick-listed employees to resume work and for advising managers on how to support and instruct the sick-listed employee.

     

Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work

Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.

Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.

Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.

Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.

• Implications for Rehabilitation

• Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.

• In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.

• Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.

     

Health,work, and personal-related predictors of time to return to work among employees with mental health problems

Purpose: To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n?=?721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median?=?21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45–0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03–1.34). Employees working in the municipal (HR: 0.62, CI: 0.41–0.94) and private sector (HR: 0.65, CI: 0.44–0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health- and work-related factors.

Implications for Rehabilitation

• Common mental health problems are one of the leading causes for sickness absence and work disability

• Return to work after sickness absence is not solely determined by improvements in health but is also affect by individual and work related factors

• This study showed that self-rated health, occupational sector and depression are predictors of time to return to work in employees with mental health problems

     

High prevalence of early onset mental disorders among long-term disability claimants

Purpose: To provide information on prevalence, comorbidity, age-of-onset and severity of mental disorders among persons claiming disability after long-term sickness absence. Method: Cross-sectional analysis of a cohort of Dutch disability claimants (n?=?346). Composite International Diagnostic Interview (CIDI) 3.0 was used to generate DSM-IV classifications of mental disorder, age-of-onset and severity; registry data were used on demographics and ICD-10 classifications of somatic disorder. Results: The mean age of respondents was 49.8 (range 22–64). The most prevalent broad categories of mental disorders were mood and anxiety disorder with a 12-month prevalence of 28.6% and 32.9%, respectively. Mood and most anxiety disorders had ages of onset in adolescence and early adulthood. The phobias start at school age. Of all respondents, 33.7% had ≥1 12-month mental disorder. Co-occurrence of substance use disorders, phobias and depression/anxiety disorders is frequent. Urogenital and gastrointestinal diseases, and cancer coincide with 12-month mental disorder in 66.7%, 53.9% and 51.7% of cases, respectively. More than two out of three specific mental disorders are serious in terms of disability and days out of working role. Conclusions: Disability claimants constitute a vulnerable population with a high prevalence of serious mental disorder, substantial comorbidity and ages-of-onset in early working careers. More research is needed to help prevent long-term sickness absence and disability of claimants with mental health problems.

• Implications for Rehabilitation

• This study shows common mental disorders, such as mood and anxiety disorders, to be highly prevalent among persons claiming disability benefit after long-term sickness absence, to have early onsets and to often co-occur with somatic disorders.

• Professionals in primary and occupational health care should assess need for treatment of workers at risk, while at the same time being careful not to medicalize normal life problems.

• Insurance physicians assessing disability benefit claims should identify factors that caused claimants to call in sick and start interventions to promote return to work.

     

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study

Abstract

Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n?=?88) and of conventional case management (n?=?80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference?=?58 days; p?<?0.01) and year two (mean difference?=?36 days; p?=?0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p?=?0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.

• Implications for Rehabilitation

• Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders.

• A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark.

• A stronger focus on cooperation with social insurance officers and employers may produce better results.

     

Sick-listed workers’ expectations about and experiences with independent medical evaluation: a qualitative interview study from Norway

Purpose: To reduce the country’s sick leave rate, Norwegian politicians have suggested independent medical evaluations (IMEs) for sick-listed workers. IME was tested in a large, randomized controlled trial in one Norwegian county (Evaluation of IME in Norway, or ‘the NIME trial’). The current study´s aim was to explore sick-listed workers’ expectations about and experiences with participating in an IME.

Material and methods: Nine individual semi-structured telephone interviews were conducted. Our convenience sample included six women and three men, aged 35–59 years, who had diverse medical reasons for being on sick leave. Systematic text condensation was used for analysis.

Results: The participants questioned both the IME purpose and timing, but felt a moral obligation to participate. Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants. However, most participants appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process.

Conclusions: According to the sick-listed workers the IMEs were administered too late and disturbed already initiated treatment processes and return to work efforts. Still, the consultation with the IME doctor was rated as a positive encounter, contrary to their expectations. Our results diverge from findings in other countries where experiences with IME consultations have been reported as predominantly negative. These findings, along with additional, upcoming evaluations, will serve as a basis for the Norwegian government’s decision about whether to implement IMEs on a regular basis.

• Key points

• Independent medical evaluations for sick-listed workers has been tested out in a large Norwegian RCT and will be evaluated through qualitative interviews with participating stakeholders and by assessing the effects on RTW and costs/benefits. In this study, we explored sick-listed workers’ expectations about and experiences with participating in an IME.

• ? Participants questioned both the IME purpose and timing, but felt a moral obligation to participate.

• ? Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants

• ? Sick-listed workers appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process.

     

Association between mental health and physical activity in patients with chronic heart failure

Abstract

Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n?=?148) and poor-MH (<68 points) group (n?=?95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r?=?0.46, p?<?0.001; EE: r?=?0.43, p?<?0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1?±?280.7 versus 7174.1?±?221.5 steps, p?<?0.001; 133.9?±?10.8 versus 215.9?±?8.4?kcal, p?<?0.001). Cut-off values of 5590.8 steps and 141.1?kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.

• Implications for Rehabilitation

• Poor mental health may negatively affect physical exercise in CHF outpatients.

• In particular step counts and energy expenditure are lower in those with poor mental health.

• It may be that focused exercise training may impact positively both on mental health and physical well being.

     

Return to work or job transition? Employer dilemmas in taking social responsibility for return to work in local workplace practice

Abstract

Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice. Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n?=?36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical. Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments). Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.

• Implications for Rehabilitation

• Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.

• Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.

• Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.

     

Examining occupational health and safety vulnerability among Canadian workers with disabilities

Objective: To compare workers with and without disabilities on their reported workplace hazard exposure and the presence of occupational health and safety vulnerability factors.

Methods: Working-aged adults in Ontario or British Columbia were recruited to participate in a cross-sectional survey (n?=?1988). Self-reported measures included demographic factors, work-related variables, perceived level of activity limitation at work, and presence of work safety vulnerability factors utilizing a novel framework.

Results: Reporting a disability at work was significantly associated with greater hazard exposure than those without a disability. In addition, those reporting a disability at work were more likely to be employed in conditions where hazard exposure was combined with inadequate policies and procedures, or hazard exposures were combined with inadequate empowerment.

Conclusions: Work safety vulnerability is one way that health inequalities can be perpetuated even among those with disabilities who have found work. Our results suggest that employers and policy makers need to focus on assessing and addressing hazard exposures and targeting occupational health and safety resources in the workplace in a way that includes workers with disabilities.

• Implications for Rehabilitation

• Workers with disabilities experience greater hazard exposure than those without a disability.

• Those with moderate and severe disabilities reported occupational health and safety vulnerability, suggesting that workplace accommodations should be available to a broader range of disability levels.

• It appears that, above and beyond standard safety procedures, providing workplace accommodations for people with disabilities may further reduce their hazard exposure and improve their safety.

     

Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture

Purpose: To examine the validity and reliability of an activity monitor to estimate upper limb activity.

Methods: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test–retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences.

Results: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r?=?0.82, r?=?0.73, respectively] and floor sweeping activities [r?=?0.54, r?=?0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC_(2,1)?=?0.91, ICC_(2,1)?=?0.88, respectively], grocery shelving [ICC_(2,1)?=?0.83, ICC_(2,1)?=?0.89, respectively], and table dusting activities [ICC_(2,1)?=?0.77, ICC_(2,1)?=?0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed.

Conclusions: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture.

• Implications for Rehabilitation

• Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions.

• After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels.

• Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence.

• Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.

     

Assessing catastrophic thinking associated with debilitating mental health conditions

Purpose: The present study examined the psychometric properties of the Symptom Catastrophizing Scale (SCS). The SCS items were drawn from the Pain Catastrophizing Scale but were modified to make them better suited to the context of debilitating mental health conditions that are not necessarily associated with pain. The number of items was reduced from 13 to 7, and the response scale was simplified.

Methods: The SCS was administered to individuals diagnosed with Major Depressive Disorder (MDD) (N?=?79) or with a chronic musculoskeletal (MSK) condition (N?=?88).

Results: Exploratory factor analyzes revealed single factor solutions of the SCS for both the MSK and MDD samples. The internal consistency of the SCS was good. The SCS was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the SCS than individuals with MSK. The SCS was shown to be sensitive to treatment-related reductions in catastrophic thinking.

Conclusions: Preliminary analyzes suggest that the SCS is a reliable and valid measure of symptom-related catastrophic thinking associated with debilitating mental health conditions.

• Implications for Rehabilitation

• Although catastrophic thinking has been identified as a risk factor for disability, current assessment tools are not well suited for individuals with debilitating mental health conditions.

• This paper describes a brief assessment instrument that can be used to assess catastrophic thinking in individuals with debilitating mental health conditions.

• The results of this study suggest that targeting catastrophic thinking might yield reductions in symptom severity and disability in work-disabled individuals with major depressive disorder.

     

Transdiagnostic group-based occupational rehabilitation for participants with chronic pain,chronic fatigue and common mental disorders. A feasibility study

Purpose: The aim was to investigate the feasibility of introducing a novel transdiagnostic occupational rehabilitation program delivered in groups mixing participants with chronic pain, chronic fatigue and common mental disorders.

Materials and methods: Observational data on group climate and individual participation were triangulated with qualitative data from focus group interviews on the participants’ experiences with transdiagnostic groups.

Results: The study included 222 participants receiving a temporary work disability benefit. Self-reported chronic pain (75%), chronic fatigue (79%), and mental distress (62%) were prevalent and the majority reported overlapping conditions (78%). Program completion among participants was high (96%). Those completing participated actively (95%) in the program. Overall group climate was stable with moderately high engagement. Participants with clinically confirmed mental disorders (22%) showed similar outcomes. Self-reported problems with “working in a group” prior to rehabilitation were not associated with how participants experienced group climate. Qualitative data supported the findings of positive participant experiences with transdiagnostic group settings.

Conclusions: Transdiagnostic groups showed high participation rates, moderately high group engagement across symptom profiles and positive participant experiences. Implementing transdiagnostic occupational rehabilitation in groups mixing participants with chronic pain, chronic fatigue and common mental disorders was feasible and acceptable to participants.

• Implications for rehabilitation

• Most research has been done on disorder-specific occupational rehabilitation programs, but emerging evidence supports a more generic approach.

• Transdiagnostic therapies, such as Acceptance and Commitment Therapy (ACT), have shown promising results for both somatic and mental disorders.

• The feasibility of implementing transdiagnostic rehabilitation groups, their acceptability to participants and the demand for such groups has not been established.

• This study indicates that it is feasible to introduce a novel transdiagnostic group-based occupational rehabilitation program for mixed groups of sick-listed participants with chronic pain, chronic fatigue and/or common mental disorders.

     

Interprofessional collaboration in mental health crisis response systems: a scoping review

Abstract

Post deinstitutionalization saw the rise of mental health crisis (MHC) response in Canada. First points of contact for individuals in a MHC are often police services or emergency departments. Professionals in these areas may report feeling unprepared, ill equipped, and a lack of confidence to work with clients in crisis. Police indicate that this work is time consuming, demanding, and “not their job”. Entry points can exacerbate the crisis given the chaotic, over-stimulating and frightening environment of emergency departments and the perceived threat of police officers. Despite the outcry of support for working more collaboratively, little is known about the impact Interprofessional collaboration (IPC) has in mental health crisis response systems (MHCRS). Purpose: Given this challenge, the aim of this scoping review is to contribute to understanding the current state of knowledge related to IPC in MHCRS. Methods: A scoping reviews was conducted to address the research topic. Results: Review of the literature identified 18 articles for inclusion, 5 experimental or exploratory papers, 7 models of care, and 6 discussion papers. Analysis identified the following themes: Support for interprofessional collaboration, quest for improved care delivery system, merging distinct visions of care, and challenges to interprofessional collaboration. Implications for practice, policy, and research are discussed, as well as issues in the literature related to: Lack of conceptual clarity, absent client perspectives, unequal representation across sectors, and a young and emergent body of literature. Conclusion: Key concepts need better conceptualization, and further empirical research is needed.

• Implications for Rehabilitation

• Conceptualizing mental health crisis (MHC) response as occurring within a system of services, rather than independent sectors, is critical to meeting the needs of clients.

• Purposefully built in mechanisms to sustain collaboration across care teams and services are required.

• Merging the distinct, and at times conflicting, visions of care espoused by the diverse sectors involved in MHC response requires deliberate effort.

     

Women’s perceived work environment after stress-related rehabilitation: experiences from the ReDO project

Purpose: The study aimed to investigate (a) if women’s perceptions of their work environment changed during a 16-week rehabilitation period and at a 12-month follow-up; (b) whether such changes were related to outcomes in terms of return to work, well-being and valued occupations. Methods: Eighty-four gainfully employed women on sick-leave due to stress-related disorders responded to instruments assessing perceptions of the work environment, well-being (self-esteem, self-mastery, quality of life, perceived stress, self-rated health) and perceived occupational value. Data about return to work were collected from registers. Non-parametric statistics were used. Results: The increase in the women’s ratings of their work environment was non-significant between baseline and completed rehabilitation but was statistically significant between baseline and the 12-month follow-up. No relationships were found between changes in perceptions of the work environment and outcomes after the rehabilitation. At the follow-up, however, there were associations between perceived work environment changes in a positive direction and return to work; improved self-esteem, self-mastery, quality of life, perceived occupational value and self-rated health; and reduced stress. Conclusion: It seems important to consider the work environment in rehabilitation for stress-related problems, and a follow-up appears warranted to detect changes and associations not visible immediately after rehabilitation.

• Implications for Rehabilitation

• Work environment

• Perceptions of the work environment seem important for return to work, although other factors are likely to contribute as well.

• Perceptions of the work environment are associated with several aspects of well-being.

• When developing rehabilitation interventions a focus on the clients' perceptions of their work environment seems vital.

     

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

Objective: Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.

Design: Community-level, cross-sectional analysis with multidimensional clinical work ability assessments.

Setting: Paltamo, Finland.

Participants: Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n?=?230, 81%).

Main outcome measures: Based on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.

Results: Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.

Conclusions: Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed.

• KEY POINTS

• Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.

• Work disabilities are common among the unemployed.

• Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.

• Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability.

     

Complete mental health in adult siblings of those with a chronic illness or disability

Introduction: Sibling relationships have lifelong significance and childhood chronic illness and disability can have considerable impacts on healthy siblings, influencing development into adulthood. Research has not yet assessed well-being in this population using measures of both mental health and mental illness. Thus, this study assessed well-being in a comprehensive manner using the complete mental health (CMH) model.

Method: Participants (N?=?144) included both adult siblings of those with chronic illness or disability and adults with healthy siblings. Measures of positive social, psychological and emotional well-being were used to assess mental health and a measure of depression, anxiety, and stress was used to assess mental illness.

Results: A high proportion of participants, both with and without siblings with a chronic illness or disability, were experiencing symptoms of mental illness, accompanied by high wellbeing. This indicates that many participants fit into the struggling category of the CMH model.

Discussion: The present research highlights the need for early intervention services to ensure that siblings of those with a chronic illness or disability are well supported in developing strengths, as well as managing difficulties. Results also indicate that targeting students in mental health promotion is important to encourage participation in services.

• Implications for rehabilitation

• Siblings of those with a chronic illness or disability need to be included in assessments in order to understand the experience of the family unit.

• It is important for families and clinicians to be aware of the needs of healthy siblings and encourage them to interact with support services in order to maximise and maintain well-being.

• Skills-based support could be beneficial, particularly for providing caregivers with strategies to meet the needs of both their child with a chronic illness or disability and their healthy children.

     

School success and participation for students with cerebral palsy: a qualitative study exploring multiple perspectives

Purpose: This qualitative study investigated perceived successful school experiences for students with cerebral palsy in Australia. Participation and appropriate support in school are complex concepts, although few studies have investigated all stakeholders’ perspectives.

Methods: Phenomenology informed the study that centered on the concept of a successful school experience. In-depth interviews occurred with students (n?=?7), parents (n?=?11), teachers (n?=?10), school principals (n?=?9) and allied health practitioners (n?=?10) to gain the perspective from multiple vantage points. Specific research questions, interview guides and demographic questionnaires were configured for each group. Interviews were analyzed thematically within and between groups.

Results: Three key themes emerged: Collaborative partnerships between families, schools and outside organizations; School culture and attitude is key; and, allied health practitioners are part of home and school teams.

Conclusions: Student and school success was impacted substantially by the capacity of adults in the student’s life to collaborate – family, school professionals and allied health practitioners. An inclusive school culture was crucial to students with cerebral palsy. All parties needed to prioritize promotion of an open and positive school culture built around problem-solving inclusive practices. Involved people, such as allied health practitioners, bring knowledge and skills that are not otherwise readily available in school environments.

• Implications for rehabilitation

• Students with cerebral palsy have high needs at school and allied health practitioners have a role advocating for, educating and providing support to students within the school.

• Teachers of students with cerebral palsy need education, training and support from allied health practitioners.

• The need for allied health and rehabilitation services continues for children and youth with cerebral palsy outside of school and across the schooling years.

• School professionals; allied health practitioners; families and students can work together to improve the student experience

     

Identifying the evidence-base for art-based practices and their potential benefit for mental health recovery: A critical review

Purpose: Art-based practices show promise as a beneficial solution for mental health services because they are in line with the whole person recovery framework currently being adopted, and have high acceptability with consumers. Nevertheless, incorporation of art-based approaches into mental health services has been impeded by claims of an insufficient evidence-base and ongoing debates about the most suitable research practices. This article addresses this gap in the literature by critically reviewing current research on the benefits of art-based practices in mental health rehabilitation settings. Method: A critical review of previous research was conducted identifying all quantitative, qualitative and mixed method studies that addressed art making and adult mental illness. Then a deductive/theoretical thematic analysis was conducted using Lal’s framework for conceptualising mental health recovery. Results: The identified areas where art-based practices were of key benefit included psychological and social recovery, particularly in the areas of self-discovery, self-expression, relationships and social identity. These findings in conjunction with the identified benefits to clinical, occupational and contextual recovery indicate that art-based practices play a substantial role in mental health recovery. To add weight to these claims, future research endeavours need to integrate the suggested recommendations detailed in this review. Conclusion: Recommendations are made to improve the quality of future research, including the need for well-designed mixed-method studies that integrate qualitative and quantitative research, whilst keeping in mind the values of mental heath recovery, would further validate this current evidence-base.

Implications for Rehabilitation

• The review indicated that art-based practices are of high benefit to psychological and social recovery particularly in the areas of self-discovery, self-expression, relationships and social identity.

• These findings in conjunction with the identified benefits to clinical, occupational and contextual recovery indicate that art-based practices play a substantial role to mental health recovery.

• Mixed-method studies that integrate qualitative and quantitative research, whilst keeping in mind the values of mental heath recovery, would further validate this current evidence-base.

     

Clinical psychology and disability studies: bridging the disciplinary divide on mental health and disability

Abstract

Purpose: Clinical psychology and disability studies have traditionally occupied very different academic, philosophical and political spaces. However, this paper aims to illustrate the positive consequences and implications of attempts to understand and bridge this disciplinary divide. Method: A narrative review format was used with evidence selected pragmatically as opposed to systematically. The construction of the argument determined the evidence selected. Results: The concept of psycho-emotional disablism, which originated within disability studies, is argued to be a useful concept to bridge the divide between understandings of distress from both disability studies and clinical psychology perspectives. However, this can be usefully augmented by psychological research on the mechanisms through which disablism can affect individuals. Conclusion: Perspectives from both disability studies and clinical psychology can be usefully combined to bring important new perspectives; combined, these perspectives should help – on theoretical, service and social levels – to improve the mental health of disabled people.

• Implications for Rehabilitation

• Mental health is an important determinant of overall health-related quality of life and psychological therapy should be available for those disabled people who would value it.

• Psychological therapists working with disabled people should be more aware of the challenging social context in which disabled people live.

• Understandings of distress should not just include individual factors but also incorporate the psychological impact of stresses caused by societal barriers preventing inclusion.

• Psychologists should be more willing to work and engage at a societal and political level to influence change.