Randi Wågø Aas

“Balancing on Skates on the Icy Surface of Work”: A Metasynthesis of Work Participation for Persons with Psychiatric Disabilities

Purpose To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life. Methods A metasynthesis was conducted using 16 qualitative studies published between 1990 and 2011. Results Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): (1) fighting inertia; (2) taking control; (3) encouraging peers; (4) disruptions related to the illness; (5) lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice); (6) going mainstream; (7) social cohesion; (8) clarity in role and responsibilities; (9) environmental factors; (10) managing self-disclosure. We chose as our overarching metaphor “Balancing on Skates on the Icy Surface of Work,” as we view both iceskaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being “on the edge” between various extremities. Conclusion We have shown that, for persons with psychiatric disabilities to “get off the bench” and “onto the ice” of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).

Challenging evidence-based decision-making: a hypothetical case study about return to work.

A hypothetical case study about return to work was used to explore the process of translating research into practice. The method involved constructing a case study derived from the characteristics of a typical, sick-listed employee with non-specific low back pain in Norway. Next, the five-step evidence-based process, including the Patient, Intervention, Co-Interventions and Outcome framework (PICO), was applied to the case study. An inductive analysis produced 10 technical and more fundamental challenges to incorporate research into intervention decisions for an individual with comorbidity. A more dynamic, interactive approach to the evidence-based practice process is proposed. It is recommended that this plus the 10 challenges are validated with real life cases, as the hypothetical case study may not be replicable.

On long term sick leave due to musculoskeletal diseases and disorders. Experiences of work demands

OBJECTIVE The rate of sick leave is higher in the public sector than in the private sector in several countries, making it essential to thoroughly investigate employees in the public sector. The following research question was investigated: How do employees on long-term sick leave (> 8 weeks) due to musculoskeletal disorders or diseases describe their work demands? METHODS This paper is from the larger Rogaland RTW case study. The informants were female employees (n=8) in the first-line public sector with different types of musculoskeletal diseases or disorders. Qualitative interviews were conducted using a semi-structured interview guide based on two measures: Worker Role Interview and Work Environmental Impact Scale. Data was analysed by condensing and categorizing meaning. RESULTS Fifty-one work demands were described, only five of which were physical demands. Demands were sometimes described as merely negative or positive for the work performance, but also as both. Most of the negative demands were emotional and cognitive challenges in mastering the work tasks. Most of the demands (n= 36) were experienced to be claimed by the employee herself, with only a few being claimed by the employer or environment (n=7) or by both (n=8). CONCLUSIONS Eight employees in the public sector on long-term sick leave due to musculoskeletal problems experienced mostly cognitive and emotional demands, and defined themselves as the work-demand claimer. The results of this study point to the importance of broadening the perspective in work rehabilitation for workers absent due to diagnosis of the musculoskeletal system.

Who initiates and organises situations for work-related alcohol use? The WIRUS culture study

Aims: Alcohol is one of the leading causes of ill health and premature death in the world. Several studies indicate that working life might influence employees’ alcohol consumption and drinking patterns. The aim of this study was to explore work-related drinking situations, with a special focus on answering who initiates and organises these situations. Methods: Data were collected through semi-structured group interviews in six Norwegian companies from the private (n=4) and public sectors (n=2), employing a total of 3850 employees. The informants (n=43) were representatives from management and local unions, safety officers, advisers from the social insurance office and human-resource personnel, health, safety and environment personnel, and members from the occupational environment committee. Both qualitative and quantitative content analyses were applied in the analyses of the material. Results: Three different initiators and organisers were discovered: the employer, employees and external organisers. External organisers included customers, suppliers, collaborators, sponsors, subcontractors, different unions and employers’ organisations. The employer organised more than half of the situations; external organisers were responsible for more than a quarter. The differences between companies were mostly due to the extent of external organisers. Conclusions: The employer initiates and organises most situations for work-related alcohol use. However, exposure to such situations seems to depend on how many external relations the company has. These aspects should be taken into account when workplace health-promotion initiatives are planned.

Do psychological job demands, decision control and social support predictreturn to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study.

BACKGROUND Long-term sickness absence is a considerable health and economic problem in the industrialised world. Factors that might predict return to work (RTW) are therefore of interest. OBJECTIVE To examine the impact of psychosocial work characteristics on RTW three months after the end of a RTW programme. METHODS A cohort study of 251 sick-listed employees from 40 different treatment and rehabilitation services in Norway recruited from February to December 2012. The Job Content Questionnaire was used to gather information on the psychosocial work conditions. Full or partial RTW was measured three months after the end of the RTW programme, using data from the national sickness absence register. Logistic regression analyses were performed to investigate the association between the psychosocial work characteristics and RTW. RESULTS Having low psychological job demands (OR = 0.4, 95% CI: 0.2-0.9), high co-worker- (OR = 3.4, 95% CI: 1.5-5.8), and supervisor support (OR = 3.4, 95% CI: 1.6-7.3), and being in a low-strain job (low job demands and high control) (OR = 4.6, 95% CI: 1.1-18.6) were predictive of being in work three months after the end of the RTW programme, after adjusting for several potential prognostic factors. CONCLUSION Interventions aimed at returning people to work might benefit from putting more emphasise on psychosocial work characteristics in the future.

Organizational leadership, health risk screening, individually tailored programs, and supportive workplace culture might reduce presenteeism

To determine if Workplace Health Promotion programs (WHPs) are effective in improving presenteeism. The secondary objective was to identify characteristics of successful programmes and potential risk factors for presenteeism. The Cochrane Library, Medline and other electronic databases were searched from 1990 to January 2010 for all studies that examined WHP. A highly sensitive search strategy was used including reference list checking, hand searching, and contacting researchers. Fourteen studies (four strong and ten moderate methodological quality) were eligible for inclusion. A further 33 were considered ineligible for inclusion due to methodological weakness. The 14 eligible studies contained preliminary evidence for a positive effect of some WHP programs. Successful programs offered organizational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, poor diet, lack of exercise, high stress, and poor relations with co-workers and management. There is preliminary evidence that some WHP programs can positively affect presenteeism and that certain risk factors are of importance. The presenteeism literature is young and heterogeneous.

The influence of alcohol consumption on sickness presenteeism and impaired daily activities. The WIRUS screening study

Background Alcohol use is a global health issue and may influence activity performance in a variety of domains, including the occupational and domestic spheres. The aim of the study was to examine the influence of annual drinking frequency and binge drinking (≥6 units at one occasion) on activity impairments both at work (sickness presenteeism) and outside the workplace. Methods Employees (n = 3278), recruited from 14 Norwegian private and public companies, responded to a questionnaire containing questions from the Alcohol Use Disorders Identification Test (AUDIT) and the Workplace Productivity and Activity Impairment questionnaire (WPAI). Results Multiple hierarchical regression analyses revealed that binge drinking was associated with both sickness presenteeism and impaired daily activities, even after controlling for gender, age, educational level, living status and employment sector. Annual drinking frequency was associated with impaired daily activities, but not sickness presenteeism. Conclusions Binge drinking seems to have a stronger influence on activity performance both at work and outside the workplace than drinking frequency. Interventions targeting alcohol consumption should benefit from focusing on binge drinking behavior.

Unifying and diversifying workplace-based efforts for promoting health and preventing disability.

In the last decades, the workplace has gradually been more acknowledged as a core arena for interventions aiming at promoting health and preventing disability [1–3]. A first example of this acknowledgement is the frequent use of Workplace or Worksite Health Promotion Programs (WHPP), built on a Public Health tradition, aiming at improving employees’ health and lifestyle (i.e., physical activity, healthy eating, weight loss, relaxation, smoking, and drug/alcohol use). The body of knowledge assessing WHPP’s effectiveness is increasing [4–6]. A systematic review found more than 300 trials of WHPP published between 2000 and 2012 [5]. Still, the effectiveness of such interventions is for several of the targeted lifestyle changes inconclusive or non-consistent [5–8]. One review even found that high-quality trials tended to report smaller effects than low-quality trials [8]. A second example is Individual Placement Support (IPS), aiming at increasing participation in work, among groups with larger work disability challenges [9]. Inspired by the recovery ideology, the paradigm ∗Address for correspondence: Randi W. Aas, Presenter, Stavanger Innovation Park, Prof. Olav Hanssens v. 7a, Stavanger 4021, Norway. Tel.: +4791182266; E-mail: randi.aas@presenter.no. shift in the 80’s in psychiatric vocational rehabilitation from “train then place” to “place then train” changed the field, and IPS became the new paradigm [9, 10]. Competitive employment became the goal, and lengthy pre-employment training was replaced with rapid job search. This made us design “placement interventions” at real workplaces, where the efficient Supported Employment [11, 12] is a great example. To train first and most at workplaces, not in clinics is therefore common today in psychiatric rehabilitation. A third example is treatment of musculoskeletal disorders (MSD). “Disease prevention” in the mid-1990’s suggested to be replaced with “disability prevention”, by which workplace foci were strengthened [13–15]. Ten years ago, we were still asking if workplace interventions were an effective means for secondary prevention of low back pain [16]. Today, we know more and judge workplace-based efforts as main solutions for reducing sick leave and return to work for sick-listed employees with MSD and common mental disorders [17–21]. The Workplace Disability Prevention and Integration (WDPI) community of researchers is these days building a strong body of knowledge about workplacebased efforts worldwide, as still much is unknown. For example, we do not know why workplace interventions seem to reduce sick leave and promote return to work, but not affect health outcomes [3, 19].

The First Six Years of Building and Implementing a Return-to-Work Service for Patients with Acquired Brain Injury. The Rapid-Return-to-Work-Cohort-Study

Background and objective Despite large activity worldwide in building and implementing new return-to-work (RTW) services, few studies have focused on how such implementation processes develop. The aim of this study was to examine the development in patient and service characteristics the first six years of implementing a RTW service for persons with acquired brain injury (ABI). Methods The study was designed as a cohort study (n=189). Data were collected by questionnaires, filled out by the service providers. The material was divided into, and analyzed with, two implementation phases. Non-parametrical statistical methods and hierarchical regression analyses were applied on the material. Results The number of patients increased significantly, and the patient group became more homogeneous. Both the duration of the service, and the number of consultations and group session days were significantly reduced. Conclusion The patient group became more homogenous, but also significantly larger during the first six years of building the RTW service. At the same time, the duration of the service decreased. This study therefore questions if there is a lack of consensus on the intensity of work rehabilitation for this group.

Maximizing work integration in job placement of individuals facing mental health problems: Supervisor experiences

BACKGROUND Many people confronting mental health problems are excluded from participation in paid work. Supervisor engagement is essential for successful job placement. OBJECTIVE To elicit supervisor perspectives on the challenges involved in fostering integration to support individuals with mental health problems (trainees) in their job placement at ordinary companies. METHODS Explorative, qualitative designed study with a phenomenological approach, based on semi-structured interviews with 15 supervisors involved in job placements for a total of 105 trainees (mean 7, min-max. 1-30, SD 8). Data were analysed using qualitative content analysis. RESULTS Superviors experience two interrelated dilemmas concerning knowledge of the trainee and degree of preferential treatment. Challenges to obtaining successful integration were; motivational: 1) Supervisors previous experience with trainees encourages future engagement, 2) Developing a realistic picture of the situation, and 3) Disclosure and knowledge of mental health problems, and continuity challenges: 4) Sustaining trainee cooperation throughout the placement process, 5) Building and maintaining a good relationship between supervisor and trainee, and 6) Ensuring continuous cooperation with the social security system and other stakeholders. CONCLUSIONS Supervisors experience relational dilemmas regarding pre-judgment, privacy and equality. Job placement seem to be maximized when the stakeholders are motivated and recognize that cooperation must be a continuous process.