Filling the dark spot: fifteen injured workers shine a light on the workers compensation system to improve it for others

Executive summary   The Creative Ministries Network (CMN) provides support to people affected by workplace injury and work-related death. Over the last fifteen years CMN has undertaken a number of projects examining the relationship between work and suicide. These earlier studies highlighted a gap in the research into work injury and compensation in relation to workers’ mental health.[1]   Existing research has concentrated on examining the health and/or return-to-work outcomes of compensation processes rather than considering the impact of the process itself on workers’ health and recovery. The research has also largely been epidemiological and/or focused on particular industry settings, injury types or points in the process from injury through compensation, rehabilitation and return to work. Very little work has been undertaken on compensation systems[2] from the perspectives of injured workers.   This study is intended to continue CMN’s commitment to develop a better understanding of the role played by work injury in mental health and suicidality by understanding the ways in which the Victorian WorkCover system impacts on the mental health of workers with long-term injuries. The purpose was to identify how workers might be better supported after an injury, and identify changes that compensation authorities, employers and unions can make to reduce mental distress amongst injured workers who are clients of the WorkCover system.   Workers who took part in the study noted a number of positives in the current WorkCover system:   The existence of a system that had provided workers with income and financial assistance with medical and other expenses related to their injury.   The focus on return to work and the support provided to retrain and re-enter the workplace was seen as helpful.   The capabilities of insurers’ case managers and the return-to-work co-ordinators made a difference. Where these individuals were skilled both technically and interpersonally, able to show empathy and humanity, the injured workers reported a better experience and one that enhanced their mental health and recovery.   Largely positive interactions with healthcare providers.   From the perspective of the workers interviewed, the study also revealed a number of problems associated with Victoria’s WorkCover system:   Overall, workers experienced the system as unfair and unjust, believed it prioritised the interests of employers and failed to remedy the situation that had caused them injury in the first place.   The majority of workers reported being treated disrespectfully, dismissively or without humanity by the system.   Workers reported inefficiencies, errors and the complex requirements of the system combined to create a sense of being trapped in a game, where winning and disproving the worker’s version of events was the main aim.   Workers were not prepared for the evidentiary and adversarial nature of the process. This took a toll on their sense of trust, as did the poor interpersonal treatment they received from WorkCover personnel and, for some, their own employers.   Overall, workers struggled with the requirements of the process, especially at a time when the experience of being injured in the workplace affected their ability to function. The accumulation of these impacts left workers feeling devalued and dehumanised.   Specific points in the process that appeared to have the potential for particular impact on workers’ mental health were:   At the beginning, when workers were at their most anxious about whether their claim would be accepted.   Attending insurers’ doctors for medical assessment and medical panels.   Returning to work.   Workers identified several elements of their experience as helpful in terms of managing the process and contributing to better mental health and recovery. The most valued was support they had received to engage with the process. One aspect of this is technical support, independent advice to assist them to navigate the system. But workers also stressed the importance of emotional support, someone who believed their version of events without question, someone who could see the workers’ desire to return to work and could hold onto the good worker identity of the individual.   It was less important where this came from (union, family, friends, GP and psychologist were all mentioned). What was seen as vital was the person who provided the support understood what the WorkCover experience was like and could assist the worker to navigate it.   This finding highlights the important issue of how the system might better utilise trained peer support workers to assist injured workers, a topic CMN is particularly keen to engage with WorkCover on.   The project makes the following recommendations:   Recommendation 1 Funding is sought for a pilot project to develop, trial and evaluate an intervention that utilises trained peer support workers in assisting injured workers’ recovery for life and work.   Recommendation 2 A course outline be developed, drawing on workers’ lived experience knowledge, for the professional development of WorkCover insurance case managers aimed at improving their ability to deal with traumatised and ill clients.   Recommendation 3 That injured workers and/or their representatives are included in future relevant research reference groups and policy development processes.   Recommendation 4 Further research is undertaken in relation to workers’ lived experience and what supports their recovery, including interactions with the WorkCover system. This research would deliberately target workers with serious physical and psychosocial injuries but who have recovered. This research could identify what was different in the workers’ experience and how they understand their experience.     [1] Mental health’ in this report refers to the workers’ self-described experience of their own mental, emotional and psychological well-being. This definition of ‘mental health’ draws on the notion of a ‘lived experience’ knowledge base and is consistent with the conceptualisation of mental health, ill-health, distress found in the literature on mental health recovery.   [2] The ‘system’ referred to throughout this report is that of Victorian WorkCover, constituted by legislation and administered by the Victorian WorkCover Authority. The system has defined roles for private insurers, employers, trade unions, health providers, workers and injured workers. &nbsp

Configuring the caller in ambiguous encounters: volunteer handling of calls to Samaritans emotional support services

This paper discusses volunteer strategies for handling and assessing calls to Samaritans emotional support services for the suicidal and despairing. It presents findings from the qualitative components of a two year mixed methods study based on an online caller survey, branch observations and interviews with volunteers and callers throughout the UK. A thematic analysis of the qualitative data analysis was undertaken using the principle of constant comparison. Many calls fell beyond the primary remit of a crisis service, and called for rapid attribution and assessment. Uncertainty about identifying ‘good’ calls and recognizing those which were not caused difficulty, frustration and negative attribution towards some callers. This paper presents our analysis of volunteers’ accounts of how they configure the caller in intrinsically uncertain and ambiguous encounters, and how such strategies relate to the formal principles of unconditional support and non-judgemental active listening espoused by the organization

A Q-methodology study of flare help-seeking behaviours and different experiences of daily life in rheumatoid arthritis

© 2014 Lin et al.; licensee BioMed Central Ltd. Background: Previous studies have not addressed rheumatoid arthritis (RA) patients' help-seeking behaviours for RA flares, and only one small qualitative study has addressed how patients experience daily life on current treatment regimes. Thus, this study aims to identify clusters of opinion related to RA patients' experiences of daily life on current treatments, and their help-seeking behaviours for RA flares. Methods: Using Q-methodology (a methodology using qualitative and quantitative methods to sort people according to subjective experience), two separate studies were conducted with the same sample of RA patients (mean age 55, 73% female). Thirty participants sorted 39 statements about daily life (Q-study 1) and 29 participants separately sorted 23 statements about flare help-seeking (Q-study 2). Data were examined using Q-factor analysis. Results: Daily life with RA (Q-study 1): Three factors relating to the experience of living with RA were extracted and explained. Patients belonging to Factor A (mean age 62, 86% female) use effective self-management techniques to control the daily impact of RA. Those in Factor B (mean age 55, 75% male) struggle to self-manage and cope. Whilst patients in Factor C (mean age 42, 100% female) prioritise life responsibilities over their RA, reporting less impact. Flare help-seeking (Q-study 2): Two factors explaining the experience of flare help-seeking (unrelated to the factors from Q-study 1) were extracted and explained. Factor X (68.8% on biologics) reported seeking help quickly, believing the medical team is there to help. Factor Y (0% on biologics) delay help-seeking, concerned about wasting the rheumatologist's time, believing they should manage alone. All participants agreed they sought help due to intense pain and persistent, unmanageable symptoms. Conclusions: Patients with different characteristics appear to manage RA life in different ways and men may struggle more than women. Whilst all patients are prompted to seek help by persistent, unmanageable symptoms, some delay help-seeking. Further research is needed to quantify the severity of daily symptoms, the level of symptoms needed for patients to define themselves as in flare and to understand the support needs of RA men

Caring for cognitively impaired older patients in the general hospital: A qualitative analysis of similarities and differences between a specialist Medical and Mental Health Unit and standard care wards

Background: Around half of people aged over 70 admitted as an emergency to general hospital have dementia, delirium or both. Dissatisfaction is often expressed about the quality of hospital care. A medical and mental health unit was developed to provide best practice care to cognitively impaired older patients. The Unit was evaluated by randomised controlled trial compared to standard care wards. Part of this evaluation involved structured non-participant observations of a random sub-sample of participants and the recording of field notes. Objectives: The aim of this paper is to compare and contrast the behaviours of staff and patients on the Medical and Mental Health Unit and standard care wards and to provide a narrative account that helps to explain the link between structure, process and reported outcomes. Design: Field notes were analysed using the constant comparison method. Setting: A large hospital within the East Midlands region of the United Kingdom. Participants: Patient participants were aged over 65, and identified by Admissions Unit physicians as being ‘confused’. Most patients had delirium or dementia. Results: Sixty observations (360 hours) were made between March and December 2011. Cognitively impaired older patients had high physical and psychological needs, and were cared for in environments which were crowded, noisy and lacked privacy. Staff mostly prioritised physical over psychological needs. Person-centred care on the Medical and Mental Health Unit was mostly delivered during activity sessions or meal times by activities coordinators. Patients on this unit were able to walk around more freely than on other wards. Mental health needs were addressed more often on the Medical and Mental Health Unit than on standard care wards but most staff time was still taken up delivering physical care. More patients called out repetitively on the Unit and staff were not always able to meet the high needs of these patients. Conclusion: Care provided on the Medical and Mental Health Unit was distinctly different from standard care wards. Improvements were worthwhile, but care remained challenging and consistent good practice was difficult to maintain. Disruptive vocalisation may have been provoked by concentrating cognitively impaired patients on one ward

Complementary strand relocation may play vital roles in RecA-based homology recognition

RecA-family proteins mediate homologous recombination and recombinational DNA repair through homology search and strand exchange. Initially, the protein forms a filament with the incoming single-stranded DNA (ssDNA) bound in site I. The RecA–ssDNA filament then binds double-stranded DNA (dsDNA) in site II. Non-homologous dsDNA rapidly unbinds, whereas homologous dsDNA undergoes strand exchange yielding heteroduplex dsDNA in site I and the leftover outgoing strand in site II. We show that applying force to the ends of the complementary strand significantly retards strand exchange, whereas applying the same force to the outgoing strand does not. We also show that crystallographically determined binding site locations require an intermediate structure in addition to the initial and final structures. Furthermore, we demonstrate that the characteristic dsDNA extension rates due to strand exchange and free RecA binding are the same, suggesting that relocation of the complementary strand from its position in the intermediate structure to its position in the final structure limits both rates. Finally, we propose that homology recognition is governed by transitions to and from the intermediate structure, where the transitions depend on differential extension in the dsDNA. This differential extension drives strand exchange forward for homologs and increases the free energy penalty for strand exchange of non-homologs.Engineering and Applied SciencesPhysic

Food banks, austerity and critical social work

The Routledge Handbook of Critical Social Work brings together the world's leading scholars in the field to provide a cutting-edge overview of classic and current research and future trends in the subject

Active music

We are a group of eleven young people with intellectual disability and three music therapists. We did action research at a university. We wanted to find out how a music group might be helpful for young people with intellectual disabilities. We wanted to tell our own story and use our own words because we have a lot to say. We wanted people to read our story and to use our ideas to help young people with intellectual disabilities to have good lives. We went to twenty sessions of music research, and five more sessions of research analysis. We also did a lot of research work in between sessions. We found out that music groups can be fun. They can also be hard work. They help us develop skills like listening and waiting. They are places where we can be independent. But music groups are also good places to practice working as a team. They can be safe places for people to express emotions. Music helps us to know people. It brings us together. Playing musical instruments can also help physical development. A good life for us would include having the chance to play music with others or to have music lessons. But it is not always easy for us to go to ordinary lessons or music groups. It might be important for young people with intellectual disability to have support from people who understand them at first. We want to be independent but we need help to develop our dreams in practical ways. We found that doing research is fun and interesting. We were all researchers but we had different things to do. The adults had to be the organisers, setting up the research. We knew from the start the research would be about what young people think about music. The adults had done their reading and had written the literature review. The young people decided on other questions, and gathered data in lots of different ways. They also did some of the analysis, and decided on the findings of each cycle. The findings of each cycle, with more of the young people’s words, are in the appendices. Later, the adults wrote the main findings, the discussion and conclusion. We all discussed the things we wrote along the way and at the end of the research. The adults have tried to help the young people understand what has been written. The research took a lot of time and it was hard work for everybody. To be a good researcher you need to learn research skills. It is important that young people with intellectual disabilities are not exhausted by research. They need to be able to enjoy the things they are doing. We all liked being involved in research even though it was hard work. We think that research is important and helpful. Young people should be involved in research that is about them. We learnt that young people with intellectual disabilities can go to university. Going to university was scary at first but we got used to it and we started to enjoy it. We need to do more research to make sure universities are ready to welcome students with intellectual disabilities. We can use our research to show universities that it can be a good idea to support people with intellectual disabilities to go to university. We can also use our research show people what we can do; what we like to do; and what we want to do in the future. Most of us would like to do more music and research in future