Community-based Interventions to Sustain Employment Julie J. - PDF document

Community-based Interventions to Sustain Employment Julie J. Keysor, PhD, PT Associate Professor Director, ENACT, the NIDRR Arthritis RRTC Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Objectives 1) Definitions: “community-based” and “work disability” 2) Review rationale for community-based approaches 3) Discuss the evidence of community-based approaches 4) Discuss gaps in the field and future directions Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Definitions: “Community-Based” and “Work Disability” Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Definition “Community-Based”: This Presentation • Programs delivered in the community by trained or untrained health professionals that were aimed at minimizing or preventing work disability • Not: workplace settings • Not: health care settings Keysor JJ, Arthritis State of the Science Meeting, April 6 th 2014 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work Disability • Work loss: Premature work cessation due to a health condition (goal: sustain employment) • Work productivity: • Absenteeism: Time missed from work due to health reasons • Presenteeism : Time of impaired performance while at work due to health reasons resulting in productivity loss • Work limitations: • Difficulty performing work related activities and functional tasks Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Why Address “Work” Through the Community Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Community Approaches? 1) Challenges with intervening in the workplace • Workers with arthritis concerned about disclosure (Lacaille et al. 2007, Gignac et al. 2009) • Arthritis-focused worksite programs are not widely available Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Why Community Approaches? 2) Non-clinical and non-workplace factors may be important • Commuting and travelling • Personal, family, and work interaction Robinson & Walters, Internat J Rehabil Med 1979; Reisine et al., Arthritis and Rheumatism, 1989; Reisine et al., Arthritis & Rheum 1995; Mancuso et al., Arthritis Care & Research 2000; Gignac et al., J Occup Rehabil 2013 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Address Arthritis Work Disability Through Community Approaches? 3) Policies and resources exist in the community • The Americans with Disabilities Act • Job Accommodations Network (http://askjan.org/ ) • Vocational rehabilitation services Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Community-based Approaches : A Review Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

The Americans with Disability Act • Requires most employers to provide job accommodations to employees with disabilities • Job accommodation: Any change in the work environment, or in the way a job is performed, that enables a person with a disability to work productively Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Job Accommodations May Sustain Employment • Use of a wide variety of job accommodations extended employment tenure (Chirico, 2000; Welch et al. 2009; Varekamp et al. 2008) • Job accommodation increased the length of time between onset of a condition that limits work capacity and the application for disability pension (Burkhauser, 1999) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Job Accommodation Use by Employees with Rheumatic Conditions • Employed persons with rheumatic conditions frequently report needing a job accommodation (Allaire, 2001) • Few employed persons with rheumatic conditions receive job accommodations (Yelin, 2000; Allaire, 2001) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Reasons for Scant Use of Job Accommodations • Individuals have to initiate job accommodation • May not be fully aware of how their health condition impacts work activities • May not be aware of resources that are available to them • May not be aware of possible job accommodations or how to access them Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

http://askjan.org/index.htm l Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Vocational rehabilitation Vocational rehabilitation (VR) programs assist individuals with disabilities obtain and maintain employment. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Job Retention VR Program for Employed Persons with Arthritis (Allaire et al., Arthritis Rheum, 2003) • Sample: 242 U.S. employed adults with a rheumatological condition • Intervention : Education & counseling VR session focused on job accommodation, career counseling, and self-advocacy, written job retention materials • Control: Written job retention materials • Outcomes : Employment retention Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 VR Employment Retention Program for People with Rheumatic Conditions (OR 0.58 ) Log rank test P=0.03 1.1 Percent Remaining Employed Job Retention Program 1 0.9 0.8 Control 0.7 0.6 0.5 0 6 12 18 24 30 36 42 48 54 Months from Randomization (Allaire et la. 2003) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

WES Demographic, Health and Work History Section 1. Demographics 1. Age___ 2. Gender _____ 3: Marital/family status: ___________ 4. Number of years of education _______ 5. Highest diploma/degree: _____ Other vocational training, certification, or license: ____________________ Health • Primary rheumatic condition: _________________________________ • Number of years with rheumatic condition ______________________ • Other health conditions/disabilities: ____________________________ • Medications: _______________________________________________ • Health Symptoms or issues: check any that are a problem Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 WES Barrier Checklist Example Barriers (problems) Section 2. Getting Ready for Work and Traveling to and from, or for Work Please check the items that are sometimes, or always, a problem for you. Getting ready for work • ____ Getting out of bed • ____ Extra time needed for dressing, preparing breakfast, etc. • ____ Doing stairs at home Traveling to and from, or for work • _x__ Using public transportation (describe)__ Walking/standing/stairs___ • ____ Driving - check which items are problems ____ Turn head as needed for rear view • ____ Get in and out of vehicle • ____ Turn key in ignition • Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Other Vocational Rehabilitation Employment Retention RCTs in Rheumatology Populations • Positive impact • No impact on • Job satisfaction • Employment retention • Job self-efficacy • Fatigue • Work performance Studies had smaller sample sizes and shorter follow-up than Allaire et al. 2003 (Verekamp et al. 2011; deBuck et al., 2005; Lacaille et al., 2008) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 VR Job Retention Studies: Systematic Review • Studies : 9 RCTs, chronic conditions (e.g., diabetes, rheumatological conditions, hearing disorders, multiple sclerosis) • Intervention: solving work-related problems (job accommodations) and empowerment • Results : 4/5 studies beneficial effect (Varekamp et al. Int Arch Occup Environ Health (2006) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Cost Effectiveness • Very little research in this area • Not cost effective: Multidisciplinary job retention VR program (van den Hout et al. Arthritis & Rheum 2007) • Sample size (N=121); study did not show an effect on employment retention • Allaire et al.’s study very modest intervention with a significant effect but costs were not studied Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Another approach…Exercise • 94 participants who participated in the Walk with Ease program who were working at baseline • Work activity limitations decreased and were maintained for 1 year • Employment retention?? Nyrop et al. Arthritis Care & Res, 2011 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Summary • Some evidence that approaches targeting job accommodations, career counseling, and empowerment can promote employment retention • Vocational rehabilitation approaches and exercise programs can decrease symptoms and work limitations • Cost-effectiveness of approaches not well established Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Approaches on the Horizon Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014