Debra A. Dunstan

Bearing the brunt: co-workers' experiences of work reintegration processes.

Purpose Work disability research has found co-worker support to be a significant but under-recognised aspect of work reintegration (WR) processes. Although co-workers work alongside returning workers, their practical contribution to WR success or failure is often invisible to others. This study aimed to gain further insight into the role and contribution of co-workers in WR interventions. Method An exploratory qualitative pilot study was conducted in Toronto, Canada in 2011. Three focus groups were conducted with 13 co-workers, recruited for their direct experience of ‘working alongside’ a returning worker. An iterative data gathering and analysis process occurred. Themes were generated from categories in open-ended interview questions and new issues arising from the data. Findings The findings detail co-workers’ practical experiences of WR processes and their reflections on social and work conditions that impacted their participation. Co-workers’ capacity to support returning workers was related to the quality of the WR arrangements, the relationship with the returning worker, work culture, and the duration of the required support. Workplace privacy and confidentiality requirements were identified as a key challenge for co-worker participation. The effects on co-workers of WR processes ranged from the opportunity to learn new skills to disillusionment and withdrawal from the workplace. In worst case scenarios, ‘ripple effects’ including emotional distress, physical injury and termination of co-workers’ employment had occurred. Conclusion Co-workers are not a neutral party in WR procedures. Formalizing the co-worker role to include communication, consideration and recognition might improve co-workers’ WR experiences.

Does the Örebro Musculoskeletal Pain Questionnaire, predict outcomes following a work-related compensable injury?

The objective of this prospective study was to investigate the usefulness of the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) to predict return to work outcomes following a compensable musculoskeletal injury. Participants (n=196 injured workers, 66% male, 36% with back pain) were screened at 4–12 weeks, and followed up at 6 months, post-injury. Total scores on the ÖMPQ were able to differentiate between work status on both occasions, indicating the potential predictive validity of this instrument. This is the first study to evaluate the ÖMPQ in a compensable injury population, and although replication with a larger sample is required, the findings have significant relevance to the recommendation of routine screening for the early identification of injured workers at risk of long-term disability.

Treatment via videoconferencing: a pilot study of delivery by clinical psychology trainees.

OBJECTIVE This pilot study explored the outcomes of clinical psychology trainees delivering treatments via videoconferencing. DESIGN A noncurrent, multiple baseline across subjects and settings. SETTING University outpatient psychology clinic. PARTICIPANTS Six clients (two men and four women) with an anxiety or depressive disorder were randomly assigned to received six sessions of individual therapy (either via videoconferencing or face to face) from a male or female clinical psychology trainee. MAIN OUTCOME MEASURES Participants provided daily ratings (0-10) of subjective distress/well-being via text messaging, and at pre-, post-, and 1 month follow-up of treatment, completed the Depression Anxiety Stress Scales and the Outcome Questionnaire-45. Along with the trainees, participants also provided feedback on the therapy experience. RESULTS The subjective well-being of all participants improved, and all videoconferencing participants showed a statistically and clinically significant reduction in symptomology and gains in general life functioning. Feedback comments were positive. CONCLUSIONS This study suggests that there is value in clinical psychology trainees gaining experience in the delivery of treatments via videoconferencing. Further study is needed to demonstrate the potential for university clinics to deliver mental health services, via this modality, to rural and remote areas.

A Theoretical Model of Co-worker Responses to Work Reintegration Processes

Purpose Emerging research has shown that co-workers have a significant influence on the return-to-work outcomes of partially fit ill or injured employees. By drawing on theoretical findings from the human resource and wider behavioral sciences literatures, our goal was to formulate a theoretical model of the influences on and outcomes of co-worker responses within work reintegration. Methods From a search of 15 data bases covering the social sciences, business and medicine, we identified articles containing models of the factors that influence co-workers’ responses to disability accommodations; and, the nature and impact of co-workers’ behaviors on employee outcomes. To meet our goal, we combined identified models to form a comprehensive model of the relevant factors and relationships. Internal consistency and externally validity were assessed. Results The combined model illustrates four key findings: (1) co-workers’ behaviors towards an accommodated employee are influenced by attributes of that employee, the illness or injury, the co-worker themselves, and the work environment; (2) the influences–behaviour relationship is mediated by perceptions of the fairness of the accommodation; (3) co-workers’ behaviors affect all work reintegration outcomes; and (4) co-workers’ behaviours can vary from support to antagonism and are moderated by type of support required, the social intensity of the job, and the level of antagonism. Conclusions Theoretical models from the wider literature are useful for understanding the impact of co-workers on the work reintegration process. To achieve optimal outcomes, co-workers need to perceive the arrangements as fair. Perceptions of fairness might be supported by co-workers’ collaborative engagement in the planning, monitoring and review of work reintegration activities.

Screening for anxiety and depression: reassessing the utility of the Zung scales

BackgroundWhile the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung’s Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ).MethodA total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS.ResultsOverall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of ‘Misses’ and ‘False Positives’ to those obtained with the DASS.ConclusionsGiven these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

The Assessment and Treatment of Long-Standing Disruptive Behavior Problems in a 10-Year-Old Boy

A 10-year-old boy was referred for ongoing behavioral problems. These problems were reported as having occurred at home since preschool years and had become increasingly problematic outside of the home in latter years, resulting in frequent suspensions from school. A range of diagnoses had been made in the years prior to referral, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, and pervasive developmental disorder–not otherwise specified (PDD-NOS). The central intervention since age 6 had been pharmacotherapy, with intermittent support at school in the form of school counseling and teachers’ aids. However, the situation appeared to only be worsening, and the need for a more integrated, multimodal approach was recognized. In addition to individual therapy for the client and his mother, the intervention also included engagement of the father, collaboration with other educational and professional service providers, and the development of an integrated plan with shared objectives and strategies. The case explores limitations inherent in taking a medical model diagnostic approach to child behavioral problems and highlights the need to utilize an idiographic approach taking a range of individual psychosocial circumstances into account, rather than taking a more nomothetic treatment approach based mainly on diagnostic assessment.

Workplace managers’ view of the role of co-workers in return-to-work

Abstract Purpose: Theoretical and empirical research findings attest to the workplace being a social environment in which co-workers have a critical influence on the employment outcomes and return-to-work (RTW) success of other employees. However, co-workers do not have a formal role in RTW planning. The aim of this study was to explore how managers responsible for developing and implementing RTW procedures view the role of co-workers in this process. Method: An exploratory qualitative pilot study was conducted in Canada. Participants (1 male; 13 females; mean experience in RTW = 11.8 years) were workplace (n=8) or RTW managers (n=6) with direct oversight of RTW plans. The participants were recruited via invitation from a research institute and were drawn from three different provinces. Data were gathered via open-ended questions and were coded and subject to thematic analysis. Findings: Three key themes were identified: (1) Managers view RTW as having little relevance to co-workers but expect them to cooperate with the arrangements; (2) Formal procedures are inadequate when psychosocial barriers to work resumption are present, so managers use informal strategies to engage co-workers’ emotional and social support; and (3) Managers have difficulty integrating RTW procedures with other legal obligations, such as privacy and confidentiality requirements. Conclusion: Existing arrangements for the development and implementation of RTW are sufficient most of the time, but may be inadequate when an injured worker presents with psychosocial barriers to work resumption. Implications for Rehabilitation Standard RTW arrangements can be inadequate when a RTW plan requires active co-worker support. Privacy and confidentiality provisions can result in managers using informal procedures for information exchange and to engage co-workers. The use of risk management strategies – assessment, consultation and communication – could be used to include co-workers when workplace issues threaten the success of a RTW plan.

Reliability of the Emotion-Related Parenting Styles Scale Across Gender and Parent Status Groups

Research Findings: Emotional and social competence are critical to a child’s current and future well-being. A. D. Paterson et al. (2012) studied a sample of mothers and proposed that an adult’s approach to the socialization of a child’s emotions can be summarized in his or her parenting style as measured by the Emotion-Related Parenting Styles (ERPS) scale. These styles are emotion approving, emotion disapproving, active socialization, and uncertain/ineffective socialization of negative emotions. This study aimed to determine whether the ERPS scale is a reliable measure of the emotion socialization styles of parents and non-parents of both genders. Participants were 521 undergraduate students—males (n = 76), females (n = 445), parents (n = 290), non-parents (n = 231)—with a mean age of 32.26 years (SD = 9.92, range = 18–61 years). There were no significant differences between the ERPS subscale scores of parents and non-parents, but males and younger adults showed higher disapproving and uncertain responses. The factor structure of the ERPS was confirmed for females. One factor was found to be unreliable for males. Practice or Policy: The ERPS is a reliable measure of the emotion socialization styles of females. Further research is required to establish the scale’s reliability with males.

Impact and outcomes of a rural Personal Helpers and Mentors service

OBJECTIVE To describe impacts and outcomes associated with the Personal Helpers and Mentors (PHaMs) service in a rural Australian town. DESIGN A descriptive analysis of longitudinal data, uncontrolled pre-test and post-test caseworker ratings, and retrospective pre-test/post-test self-ratings and feedback comments were collected from convenience samples. SETTING A community-based mental health recovery service. PARTICIPANTS n=76 mental health consumers; mean age=37.78 years; 45% male; 63% Aboriginal; primary diagnoses=41% psychotic disorder and 61% mood disorder; co-morbid diagnosis=45% substance use disorder. INTERVENTIONS Individual recovery plan (IRP), personal goal setting, caseworker mentoring and support. MAIN OUTCOME MEASURES Gains towards goals, the Role Functioning Scale (RFS), self-ratings and feedback comments. RESULTS The most frequently addressed goals were: attend mental health treatment services, acquire suitable accommodation and be more involved in the community. IRP completers (n=19) showed a significant improvement in caseworker-rated adaptive functioning which was adequate at case closure (t(18)=-4.38, P<0.001). Participant (n=19) ratings of the service and its key performance indicators suggested global satisfaction and gains in the management of everyday tasks, use of medications and community engagement. Good rapport was reported with the locally trained and predominantly Aboriginal (56%) staff. CONCLUSIONS PHaMs shows promise for assisting rural people with mental illness to improve their everyday functioning, medication management and community involvement. Recruitment and capacity-building of Aboriginal staff appears to facilitate Aboriginal consumer participation.

A method of assessing the resilience of whole communities of children: An example from rural Australia

BackgroundChildren living in socioeconomic disadvantage are at risk of poor mental health outcomes. In order to focus and evaluate population health programs to facilitate children’s resilience, it is important to accurately assess baseline levels of functioning. With this end in mind, the aim of this study was to test the utility of 1) a voluntary random sampling method and 2) quantitative measures of adaptation (with national normative data) for assessing the resilience of children in an identified community.MethodThis cross-sectional study utilized a sample of participants (N = 309), including parents (n = 169), teachers (n = 20) and children (n = 170; age range = 5-16 years), recruited from the schools in Tenterfield; a socioeconomically disadvantaged community in New South Wales, Australia. The Strengths and Difficulties Questionnaire (SDQ; including parent, teacher and youth versions) was used to measure psychological well-being and pro-social functioning, and NAPLAN results (individual children’s and whole school’s performance in literacy and numeracy) were used to measure level of academic achievement.ResultsThe community’s disadvantage was evident in the whole school NAPLAN performance but not in the sample’s NAPLAN or SDQ results. The teacher SDQ ratings appeared to be more reliable than parent’s ratings. The voluntary random sampling method (requiring parental consent) led to sampling bias.ConclusionsThe key indicators of resilience - psychological well-being, pro-social functioning and academic achievement – can be measured in whole communities using the teacher version of the SDQ and whole school results on a national test of literacy and numeracy (e.g., Australia’s NAPLAN). A voluntary random sample (dependent upon parental consent) appears to have limited value due to the likelihood of sampling bias.