Webinar: “Preventing Work Disability: Strategies and Resources You Can Use” Presented by Saralynn Allaire, ScD, CRC-R ENACT: Center for Enhancing Activity and Participation among Presented by Saralynn Allaire, ScD, CRC-R Persons with Arthritis Associate Director, ENACT Visit us at bu.edu/enact
Overview Define work disability 1. - associated with adult onset chronic illnesses, arthritis and other rheumatic conditions in particular Describe problem of work disability associated with arthritis 2. Review effectiveness of strategies to reduce work disability 3. Demonstrate use of one such strategy 4. Discuss availability of strategies to promote job retention 5. No disclosures
What is Work Disability? Limitation in ability to work due to impairment/ health Complete premature work cessation Limitation in types of work that can be done Underemployment Limitation in amount of work that can be done (part time work) Loss of promotions Being overqualified for job Lost productive work time Absenteeism Presenteeism
Why be concerned about work disability in adults with chronic illnesses? Costs: Individuals and families Work disability among older workers ignored – time to build up retirement savings Work disabled persons with arthritis have lower self- esteem, greater pain and depression (MacKinnon,1992; Fifield,1991; Reisine, 2006) Society Indirect costs attributable to arthritis in 2005 = $42.8 bil Social Security costs
Extent of Work Disability Associated with Arthritis More than 50% of people with arthritis in the US are employment aged, 18-64 years (Hootman, 2006 [2003 NHIS data]) 30% have arthritis-attributable limitation in ability to work – 5.3% of US adults aged 18-64 (Theis [2002 NHIS data], 2007) The working life expectancy of Canadians with arthritis is significantly reduced compared to those without it (Lacaille, 2001)
What to do? Medical treatment 1. Public policies 2. Vocational rehabilitation 3.
Medical Treatment Medical treatment is limited for many forms of arthritis and other rheumatic conditions Pharmaceutical treatment for rheumatoid and other highly inflammatory forms of arthritis has improved in recent years Evidence for its effect on work disability is mixed Residual disease effects in those diagnosed before new reatments available Only 15% achieve excellent disease control
Public Policies Disability pension programs, e.g., U.S. Social Security Disability Insurance and Supplemental Security Income programs Concerns about cost
Public Policies Anti-discrimination legislation: The Americans with Disabilities Act (ADA) 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
Effectiveness of Job Accommodations US Health and Retirement Survey data Use of a wide variety of job accommodations extended employment tenure (Chirikos, 2000) Job accommodation increased length of time between onset of work limiting condition and application for disability pension (Burkhauser, 1999) Among 581 participants with rheumatoid arthritis, work station modification facilitated job retention (Lacaille, 2004)
Use of Job Accommodations by Employees with Rheumatic Conditions Few employees with these conditions receive job accommodations (Yelin, 2000; Allaire, 2001) 63% of employed participants reported they needed job accommodation (Allaire, 2001)
Reasons for Scant Use of Job Accommodations Individuals have to initiate the job accommodation process Many persons with chronic illnesses are not fully aware of how their health affects their work And are not familiar with disability issues and resources And neither they nor their employers are familiar with the wide variety of job accommodations Suggestion by a health professional to use the ADA was associated with job accommodation request (Allaire, 2001)
Vocational Rehabilitation Vocational rehabilitation intervention consists of: Services that are job or career oriented, and Health (or disability) related
US Public Vocational Rehabilitation (VR) Program Federal/state program available in all states Mandated to prioritize those with most severe disability 80% of those served unemployed and most have little or no work experience - Vocational assessment and counseling - Skill and educational training - Job seeking skills services - Job placement assistance - Restorative services, including medical care, physical rehabilitation, surgery, etc.
Randomized Controlled Trial: Effect of Public Vocational Rehabilitation Program * Unemployed persons with musculoskeletal conditions in Alabama with desire to return to work Randomized to receive services or not At 1-2 years, participants receiving services were not more likely to return to work At longer follow-up, they were 30% more likely to do so * White, 1997, 2001
Employment Characteristics of Persons with Adult Onset Chronic Illnesses Large portions are employed at disease onset Many have considerable work experience
Job-Raising Program 10 weekly group meetings : Topics discussed: feelings about working; communication skills; stress and symptom management; job accommodations; employment rights and responsibilities; job finding skills Non-controlled trial: 141 participants with a rheumatic condition all attended Job Raising Program ( Allaire, 1997) unemployed or employed Employment increased from 26% to 41% at 6 months after program completion* What helped – developed belief that could work and information about job accommodations
Maybe it would be good to intervene on a preventive level, i.e., before people stop working
Randomized Controlled Trial: Effectiveness of Job Retention Vocational Rehabilitation* 242 employed participants with form of arthritis or lupus Randomized to receive job retention intervention or information only Job retention intervention delivered in two 1.5 hour meetings with a rehabilitation counselor Assessment of work problems and development of solutions for problems (e.g., job accommodations) Promotion of belief can work if problems addressed Information about ADA and disability-related employment resources Discussion of disclosure issues Planning for future job/career change or advancement *Allaire, 2003
1.1 Vocational Rehabilitation 1 Percent Remaining Employed Log rank Test P=0.03 0.9 0.8 Printed Materials 0.7 0.6 0.5 0 6 12 18 24 30 36 42 48 54 Months from Randomization 117 57 Vocational 122 122* 120 111 107 100 78 rehabilitation 120 118 52 materials only 81 71 105 94 Printed 86
Randomized Controlled Trial: Job Maintenance Training Program * Training program focused on solving work-related problems Work-related problems were explored and clarified Communication at work was addressed Solutions were developed and realized 122 employed participants with chronic illnesses followed for up to 24 months Results: Significant improvement in self-efficacy for solving work problems and fatigue No difference in job maintenance *Varekamp et al., 2010
U.S. Social Security Demonstration Projects * Randomized controlled trial pilot studies in 4 states Interventions mix of health care and vocational strategies People with diabetes in Hawaii Medication therapy management/education from pharmacists Setting and maintaining work, health and personal goals with a life coach 110 experimental group participants reported high satisfaction with intervention and high goal attainment * Schneider et al., 2011
Summary of What ‘Works’ Good evidence that intervening prior to job loss is effective Job accommodation and problem solving/ goal setting strategies appear to be effective
Strategy Demonstration : Problem Solving Method Used in Allaire et al., Studies* Conducted using Work Experience Survey (WES) developed by Richard Roessler (Roessler, 1995) Structured interview tool (paper form) For persons with wide variety of impairments/ health conditions * Allaire, 2003, 2011
WES Background Assesses disability-related work-site/ job/ employer barriers Facilitates development of solutions for identified barriers using problem solving methods In person or phone administration by a “rehabilitation professional” 30-60 minutes
WES Background: Theory on Role of Work Problems (Barriers) in Work Disability Some may prevent a person from doing his/ her job More often, a person can do job tasks, but experiences difficulty in working due to collection of various barriers Work → Difficulty → Reduces → Work job Satisfaction 1-2 barriers working cessation 1-2 Roessler et al., 1995; Allaire et al, 2000 ↑ Intervene here to reduce work barriers with goal of preserving job satisfaction
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