NEW WAYS a research program to identify, treat and support - PowerPoint PPT Presentation

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY NEW WAYS a research program to identify, treat and support individuals with common mental disorders to remain in work NEW WAYS JULY 2017

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Overall aims of New Ways • to develop methods grounded in theory and tested in practice for early identification, treatment and support to persons with common mental disorders (CMD) and reduced work capacity to remain in work • to perform research both at the individual and organisational level targeting patients as well as their context e.g. their work environment • to go upstream and build capacity at work places in order to promote mental health and prevent reduced work capacity • to reduce risk for marginalisation from work life in persons with CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Theoretical background • Work understood as a social activity contributing with structures, meaning and income is important for mental health and wellbeing. – High risk for long term sick-leave and permanent marginalisation from work • Person-environment-occupational model (PEOM) • Complexity – to diagnose, to assess function and work capacity, to support RTW – A process perspective on sickness absence and rehabilitation – Situational assessments due to fluctuating experiences of capacity • Agent perspective – Promote self-management, active coping and empowerment

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Modified person-environment-occupational model (PEOM) Person Environment Work capacity Activity Law et al 1996

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Common mental disorders and work - a process perspective Outside Reduced CMD off work work mental health Return to CMD at work Sickness and capacity work absence to work Well managed disorder Hensing 2015

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Empirical background • CMD are common in the working population • The correlation between specific diagnoses and functional and work capacity is low • Not much research compared to MSD • Higher risk to become sick-listed if the person has a CMD • Higher risk for slow return to work • Higher risk for recurrent sickness absence • Few studies – Recent reviews point out the need for more research

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Distribution of costs for economic support for those with sickness or functional limitations Million SEK (per year in 2014) 19 709 23 416 Sickness benefit Acitivity benefit 25 915 Assistance Other 50 026 Försäkringskassan 2015

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY New Ways organisation Steering committee Gunnel Hensing (Principal Investigator), Robin Fornazar (Project Coordinator), Kristina Holmgren, Maria Larsson, Lisa Björk Reference group Gunnar Ahlborg, Stefan Bergman, Cecilia Björkelund, Lotta Dellve Eva Hellquist, Ingibjörg Jonsdottir, Christina Möller, Lena Wängnerud Work Stream 1 Work Stream 2 Work Stream 3

New Ways Work stream 1 Work stream 2 Work stream 3 Health literacy Primary Health Care Work life Social inequity in access to care TIDAS Depression stigma at work Aim: Increase knowledge of inequity in access Aim: Evaluate if a structured use of the Work Stress Aim: Increase knowledge in of attitudes towards CMD and of its connection to gender at work places to health care due to CMD Questionnaire can prevent sickness absence Manager's perspective - a missing piece Development of a decision support PRIM-NET Aim:Study managers' knowledge, attitudes towards and Aim: Evaluate if treatment of depression in the PHC context Aim: Increase health literacy and promote healthy decisions challenges in the work with employees with CMD and behaviour among persons off sick due to CMD can be improved by the use of computerized CBT WIS-CMD MADRS-S integrated Aim: Develop and test a work instability scale for Aim: Evaluate in the PHC context if monitoring and self- depression evaluation can improve depressive symptoms C2WI GP-3Q Aim: Develop the Capacity to Work Index , a questionnaire Aim: Develop an easy-to-use tool that will be used investigating CMD-related work capacity for screening of rehabiliation needs in the PHC PRIMA Aim: Develop and evaluate an intervention to RTW among patients with stress-related mental health problems CapNote Aim: Evaluate if systematic use of the capacity note by patients, physicians and employers affects return to work

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Grant SEK Years FORTE - Research program (Dnr. 2013-2216) 18 000 000 6 - Junior researcher (Dnr. 2014-0936) 3 680 000 4 - Network (Dnr. 2014-2681) 100 000 1 3 530 000 4 - Project (Dnr. 2015-00703) 3 453 000 4 - Project (Dnr. 2016-07419) AFA Insurance - Project (Dnr. 2015-0378) 2 958 000 3 Region Västra Götaland - PhD student 3 654 557 4 - Researcher 215 007 1 - Project (Dnr. VGFOUGSB-576081) 104 100 1 878 099 1 - Project (Dnr. VGFOUREG-594071) 988 696 1 - Project (Dnr. VGFOUREG-588531) TOTAL 37 561 459

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Collaborators The Center for Research and Development & Institute of Stress Medicine

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Work stream 1 Health literacy

Work stream 1 Health literacy Social inequity in access to care Aim: Increase knowledge of inequity in access to health care due to CMD Development of a decision support Aim: Increase health literacy and promote healthy decisions and behaviour among persons off sick due to CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Social inequity in access to care Background • Many persons with CMD have an unmet need for care • Access to care is related to social position Do not request 20% care Request care, receive 17% treatment 63% Request care, do not receive treatment Persons with meetable need for mental health care (n=462) Sweden, Forsell 2006

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Aims • Investigate barriers to mental health care for persons with CMD • Investigate the relation between barriers to care and social inequity based on gender, class and ethnicity and the intersection of those structures Study 1 Study 2 Study 3-4 Quantitative Quantitative Qualitative Cross Sectional Longitudinal Is there an association Is there an association between Focus groups to explore between unmet needs and unmet needs, the intersection of ”how” the intersection the intersection of gender gender and class and future works in everyday life of and class? marginalization? persons with CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY An intersectional perspective Gender Class Ethnicity

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Development of a decision support Background There is a need of support and guidance in the process off sick-leave and return to work. (Mårtensson & Hensing 2012) User Centered Design (UCD) has previously been shown to increase the usability of the product being developed. Overall aim To promote and strengthen the possibility to make informed decisions regarding health and sickness absence among persons’ off sick due to CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Process Systematically* develop a web-based support based on needs and information from persons with current experience of CMD and sickness absence. With UCD and input from experts we will develop and revise prototypes in iterations until we reach a final product: webpage and/or mobile phone application. Phase Phase Phase 1 2 3 Design Inventory Evaluation •UCD involving participators from phase 1 with •Testing made by ”real” users •Semi-structured interviews/focus groups (n=35) web-designers and a coordinator in a design group one year after launching the •Conducted within themes of experience of the sick- •Create a prototype and get input from web-based support listing process, needs and information of support and researchers, other experts and a test group •Survey and web-analytics possibilities to take actions to prevent sick-listing •Revise prototypes until a decision of a final •Current experience of CMD and sickness absence, •Further improvements product is taken by the steering committee 18-65 years old •Launch the web-based support in collaboration •Variation in length of sick-listing (<90 days), country of with stakeholders that will take over responsibility birth, gender, age, educational level of maintenance an updates •Thematic analysis method *inspired by Elwyn et al (2011) & Elf et al. (2013)