Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-method evaluation

Objective: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes: Work disability episode incidence and duration. Results: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-method evaluation

Objective: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes: Work disability episode incidence and duration. Results: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group

Implementing a collaborative return-to-work program: lessons from a qualitative study in a large Canadian healthcare organization

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers’ and return-to-work-coordinators’ views on the implementation of their organization’s new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants’ perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization’s return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program

"The state they're in": unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities

Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent ‘Fantasy Paradigms’. This paper explores one example of such ‘Fantasy’ intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services

Challenges in evaluating Welfare to Work policy interventions: Would an RCT design have been the answer to all our problems?

<p>Background: UK policy direction for recipients of unemployment and sickness benefits is to support these people into employment by increasing 'into work' interventions. Although the main aim of associated interventions is to increase levels of employment, improved health is stated as a benefit, and a driver of these interventions. This is therefore a potentially important policy intervention with respect to health and health inequalities, and needs to be validated through rigorous impact evaluation.</p> <p>We attempted to evaluate the Pathways Advisory Service intervention which aims to provide employment support for Incapacity Benefit recipients, but encountered a number of challenges and barriers to evaluation. This paper explores the issues that arose in designing a suitable evaluation of the Pathways Advisory Service.</p> <p>Discussion: The main issues that arose were that characteristics of the intervention lead to difficulties in defining a suitable comparison group; and governance restrictions such as uncertainty regarding ethical consent processes and data sharing between agencies for research. Some of these challenges threatened fundamentally to limit the validity of any experimental or quasi-experimental evaluation we could design - restricting recruitment, data collection and identification of an appropriate comparison group. Although a cluster randomised controlled trial design was ethically justified to evaluate the Pathways Advisory Service, this was not possible because the intervention was already being widely implemented. However, this would not have solved other barriers to evaluation. There is no obvious method to perform a controlled evaluation for interventions where only a small proportion of those eligible are exposed. Improved communication between policymakers and researchers, clarification of data sharing protocols and improved guidelines for ethics committees are tangible ways which may reduce the current obstacles to this and other similar evaluations of policy interventions which tackle key determinants of health.</p> <p>Summary: The evaluation of social interventions is hampered by more than their suitability to randomisation. Data sharing, participant identification and recruitment problems are common to randomised and non-randomised evaluation designs. These issues require further attention if we are to learn from current social policy.</p&gt

Whose rights deserve protection? Framing analysis of responses to the 2016 Committee of Advertising Practice consultation on the non-broadcast advertising of foods and soft drinks to children

Exposure to advertising of food and beverages high in fat sugar and salt (HFSS) is considered a factor in the development of childhood obesity. This paper uses framing analysis to examine the strategic discursive practices employed by non-industry and industry responders to the Committee of Advertising Practice’s consultation responses (n = 86) on UK regulation of non-broadcast advertising of foods and soft drinks to children. Our analysis demonstrates non-industry and industry responders engaged in a moral framing battle centred on whose rights were deemed as being of greatest importance to protect: children or industry. Both industry and non-industry responders acknowledged that childhood obesity and non-broadcast advertising were complex issues but diverged on how they morally framed their arguments. Non-industry responders employed a moral framework that aligned with the values represented in social justice approaches to public health policy, where children were identified as vulnerable, in need of protection from harmful HFSS product advertising and childhood obesity was a societal problem to solve. In contrast, industry responders emphasised industry rights, portraying themselves as a responsible industry that is victim to perceived disproportionate policymaking, and values more closely aligned with a market justice approach to public health policy. Our analysis provides detailed insights into the framing strategies used in the policy debate surrounding the non-broadcast advertising of HFSS foods to children. This has relevance as to how advocacy organisations can develop counter-framing to industry frames which seek to limit effective regulation

Incapacity Benefit, employment transitions, and health: evidence from longitudinal data and a qualitative study

Background: UK welfare reform endeavours to reduce out-of-work health-related benefit receipt and support people into employment. Such reforms assume that work is good for health and that targeting welfare-to-work interventions at individuals will result in moves from benefit receipt to employment. The research in this thesis tackles two questions associated with UK welfare reforms: (1) Is work always good for health? And, (2) Is the focus on motivating individual Incapacity Benefit (IB) and Employment and Support Allowance (ESA) recipients appropriate, or are there barriers to return to work that this approach cannot address? Methods: Three approaches were taken to address the aims: 1) Longitudinal analysis, using Generalised Estimating Equations, of the West of Scotland Twenty-07 Study (Twenty-07), to explore transitions from worklessness to employment. The analyses looked at both employment and health outcomes (self-rated and anxiety or depression) and took account of the psychosocial quality of the jobs obtained. 2) A systematic review of qualitative studies that explored the barriers and/or facilitators to employment from the perspective of people out of work because of health conditions or disabilities. A qualitative synthesis, using meta-ethnography, of the included studies was conducted. 3) A primary study utilising in-depth interviews with IB and ESA recipients, General Practitioners (GPs), and Employment Advisors (EAs) in Glasgow, to gain more understanding about barriers and facilitators to work and to fill the gaps identified in the qualitative synthesis. The interviews were analysed using Framework Analysis methods. Findings: Findings from Twenty-07 data showed that only 6.6% of those out of work because of ill health returned to work within the follow-up period. After a transition from worklessness to employment those in low-quality jobs had higher odds of poor health than those who moved to high-quality jobs, even after taking account of prior health. Those who remained workless had higher or similar odds of poor health as those who had moved to low-quality jobs. Nine studies were synthesised in the systematic review. Participants in the studies identified similar barriers and/or facilitators to return to work. Barriers and facilitators were related to health, workplace factors, the need to change job, financial issues, life stage and social circumstance, support, and self-construct. Synthesis and interpretation of the studies led to themes that were then further explored. These themes were: the complex pathway of return to work; competing participant and author narratives, and a difficulty of interpretation; the distinction between expected and experienced barriers to work; differences in barriers and facilitators by participant characteristics; job quality; and work-role centrality, adaptation, and financial risk. Seventeen IB or ESA recipients, six GPs, and six EAs participated in the qualitative study. Their barriers and facilitators to work confirmed the findings of the systematic review. All IB/ESA recipients had multiple and interacting barriers that were not limited to their motivation but also related to wider labour-market and social-context issues. Those with complex social situations and mental health conditions had lower expectation that they would successfully return to work. All participant groups were concerned that the policies of the welfare system did not match up with the labour-market or the social context. Conclusions: A very low proportion of those out of work because of ill health transitioned into employment. This is concerning because current policy is to reduce the number of people receiving IB and ESA. The research showed that there is a significant challenge to support this group into employment and that policies focusing on motivating individuals may miss important barriers to return to work. There appear to be health benefits from return to work; however, job quality is important, and the potential for health improvement is limited if the job is of poor quality. Supporting people into work has the potential to improve health, but more effort is required to determine how to improve support and target where it is most needed. Further research is necessary to explore the results of the current welfare reform i.e. whether IB/ESA recipients move into work, what helps them do so, and whether they experience a change in health

Lack of evidence on mental health and well-being impacts of individual-level interventions for vulnerable adolescents:systematic mapping review

Objectives: To review empirical evaluations of individual-level interventions intended to improve mental health or wellbeing for vulnerable adolescents. Study design: Systematic mapping review. Methods: Thirteen databases covering academic and grey literature were searched for published reviews and randomized controlled trials (RCTs), and grey literature (2005-2016) and the results quality-assessed to prioritize best available evidence. We aimed to identify well conducted systematic reviews and trials that evaluated individual-level interventions, for mental health/wellbeing outcomes, where the population was adolescents aged 10-24 years in any of 12 vulnerable groups at high risk of poor health outcomes (e.g. homeless, offenders, 'looked after', carers). Results: Thirty systematic reviews and 16 additional trials were identified. There was insufficient evidence to identify promising individual-level interventions that improve the mental health/wellbeing of any of the vulnerable groups. Conclusions: Despite Western policy to promote health and wellbeing among vulnerable young people, the dearth of evidence suggests a lack of interest in evaluating interventions targeting these groups in respect of their mental health/wellbeing outcomes

Investigation into Whether Proximal Suspensory Desmitis of the Hindlimb Could Predispose Horses to Sacroiliac Disease

Proximal suspensory desmopathy/desmitis (PSD) of the hindlimb is a well understood condition with widely accepted treatment protocols; however, there is little research demonstrating understanding or potential correlation between hindlimb PSD and sacroiliac disease (SID). Several studies have examined the co-existence of hindlimb PSD and SID each investigating unique predisposing factors. This has led to little direct correlation of cause and effect with no definitive conclusions drawn. The need to be objective is highlighted by the limited number of studies and that two studies used anecdotal evidence to support their hypothesis and thus creating the question does hindlimb proximal suspensory desmopathy predispose horses to sacroiliac disease? This review looks at the two conditions and compares the literature for each, including the incidence, biomechanics, anatomy, and treatment. The review further discusses whether one disorder predisposes horses/equids to the other