Disability and Injury Management
Planning and Strategizing on how to Return Employees to Work
Absenteeism and increased turnover
Process and Practices of Returning Employees to Work
Benefits plan
Scenarios of Returning Employees to Work
Understanding performance in relation to current standards
Psychological implications for employees and staff
Role of spirituality
1. Return to Work: Outperform
and Engage Employees
9 am – 12 pm Workshop
Oct 27, 2010
Infonex 940 Vancouver
Chris Hylton, MA.
CG Hylton & Associates Inc.
chris@hylton.ca or 403-264-5288
2. AGENDA
Disability and Injury Management
Planning and Strategizing on how to Return
Employees to Work
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Absenteeism and increased turnover
Process and Practices of Returning Employees to
Work
Benefits plan
Scenarios of Returning Employees to Work
Understanding performance in relation to current
standards
Psychological implications for employees and staff
Role of spirituality
2
3. DO YOU HAVE ANY WORKPLACE
ISSUES WE CAN TRY AND SOLVE
FOR YOU IN THIS SESSION?
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•What has come up in your workplace that we
could help you with today?
•What examples do you have to share with
stories about this issue ?
•Any advice for us?
3
4. REASONS FOR AN EMPLOYEE OFF
FROM WORK
At work injury (WCB)
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Personal time injury (car accident,
skiing accident etc)
Illness or injury
Disability- visible or non-visible 4
5. DISABILITY AND INJURY
MANAGEMENT
A workplace prevention and remediation strategy that
seeks to prevent disability and injuries from
occurring or, lacking that, to intervene early
following the onset of disability, using coordinated,
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cost-conscious, quality rehabilitation services that
reflects an organizational commitment to continued
employment of those experiencing functional work
limitations.
The remediation goal of this management is
successful job maintenance, or optimum timing for
return to work, for persons with a disability or
injury. 5
6. THE GOAL
Toget employees who have been off
sick/injured to return to work as soon as
safely as possible
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Thechances of an employee successfully
returning to work decreases rapidly with
time
6 months - 50%
12 months - 25%
24 months - less than 5% 6
7. IMPORTANCE OF EARLY ON
INTERVENTION
100
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Probability of RTW
80
60
40
20
0
Time
(0 to 24 months)
7
8. REMEMBER
Makesure an employee is fully
recovered:
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Illness: can get other employees sick
Injury: cause further damage to the injury
before it can fully recover
8
9. DISCUSSION
What are the most common injuries or
illness at your work?
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What are some methods to prevent
injuries?
Areyour health and safety policies up to
date ?
9
10. 78 MILLION BABY BOOMERS WITH THE
OLDEST NOW TURNING 61 (2007)
- Can you identify currently employed
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individuals who are at significant risk of
injury?
Physical
Physical
Demand
Demand
Capability
Of Job
20 40 60
10 Age
11. STEPS TO ENSURE EMPLOYEE IS FIT
FOR WORK
1. Fitness for work form – doctor signs and
agrees that employee can return for duty
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and perform the tasks
An employee may request to see the
document or request that a medical must
be done
11
12. STEPS TO ENSURE EMPLOYEE IS FIT
FOR WORK
2. Review with employee what the doctor
recommends – modified or fully return to
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work
The employer must adhere to what the
doctor recommends
12
13. STEPS TO ENSURE EMPLOYEE IS FIT
FOR WORK
3. Complete paperwork for modified or return
to work – have employee sign and agree to
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the terms and conditions
Modified – hours/day, duration of period,
type of work, etc
13
14. October 27, 2010
Hiring Manager
[address]
RE: Joe Doe (Composite Crew Laborer)
Completed evaluation at 10:45am
Dear [Manager name],
Summary of Test Results
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We offer you the following opinion concerning the individual’s present abilities to safely and successfully
perform the essential functions of the position for which he/she was tested:
_X__ IS CAPABLE of performing the essential functions of the position sought and does not have any
present or past medical condition/impairment that we believe would pose a significant risk to
him/herself or others should he/she be placed in the position sought.
____ NOT CAPABLE of performing the essential functions of the position sought and does not have
any present or past medical condition/impairment that we believe would pose a significant risk to
him/herself or others should he/she be placed in the position sought.
____ NOT CAPABLE of performing the essential functions of the position sought because applicant
does have a present or past medical condition/impairment that we believe would pose a significant
“medical risk” to him/her or others should he/she be placed in the position sought.
Basis for conclusion
While we are available to discuss in more detail the basis for our finding, the following additional
information provides the basis for the above conclusion:
The client was deemed “Capable” as he met all testing criteria of the medical history, the dynamic lifting, 14
and the job specific demands.
15. October 27, 2010
Page 2
Summary of Test Procedures and Principles
As part of the test, we obtained a medical history of the individual and collected baseline data concerning
the individual’s physical conditioning and specific functional limitations. The primary purpose of the test,
however, was to evaluate: 1) the individual’s ability to successfully perform the job related essential
functions of the position sought: and 2) whether there was objective medical evidence that performance of
the job related essential functions would pose a risk to the health or safety of the individual or others. The
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test was conducted based on our understanding of the job related essential functions of the position
sought by this individual and the traditional physical demands associated with performance of those
essential job functions.
If necessary, appropriate, and requested, we are available to engage in further examination, testing, or
discussion with the individual noted above, to ensure that you have accurately assessed his/her
qualifications for employment with your organization.
Depending on the nature of the medical condition/impairment identified in our test, the risks posed by the
position sought, and the scope of protection afforded by relevant law, it might be appropriate and/or
necessary for your organization to engage in an interactive dialogue with the individual being tested to
explore potential reasonable accommodations that would facilitate safe and successful performance of
essential job functions.
We hope this evaluation has been helpful. Please contact me if you have any questions.
Sincerely,
15
Human Resource, Management, Employee
17. WHEN THE EMPLOYEE RETURNS TO
WORK
Challenge: How does the employer engage
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their modified employee and help them to
outperform???
17
18. STRATEGIES FOR RETURNING TO
WORK
Strengthen the self
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Strengthen the family
Strengthen the community
18
19. STRENGTHEN SELF
Fosterhealthy identities, every employee is an
individual!
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Teach how to express emotions in healthy ways
For example: anger – talk it out with your co-worker, supervisor,
manager
Teach what constitutes a healthy, respectful adult
relationship
For example: do not allow any kind of bullying or harassment in
the work place
19
20. STRENGTHEN SELF
Teachlife skills; problem-solving techniques,
practice in developing discussion, decision
making skills, anxiety reduction, communication,
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coping with stress or anger management, social &
assertiveness skills
Have programs available to employees to learn to
reduce stress
Offer EAP services – counselling to help employees
Promote self-esteem, self-mastery and handling
challenges in a healthy way 20
21. STRENGTHEN SELF
Build awareness of social influences
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Preventionmentorship utilizing community role
models for support and guidance in personal
growth
21
22. STRENGTHEN FAMILY
Strengthenparenting skills e.g. how to deal with
adolescents, how to enforce family policies on
substance abuse, drug information, parent role-
playing
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For example: be flexible with schedules for parents
who need to attend their child’s activities
Enhance family bonding and relationships
through family programs
Poster,
pamphlets, discussions and presentations
on substance abuse 22
23. STRENGTHEN THE WORKPLACE
Bridge youth & elders with inter-generational
activities
For example: in a workplace setting pair the young
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and old to work together
Peerleadership prevention activities for youth to
reinforce leadership skills
For example: senior staff can mentor the newly hired
staff
23
24. STRENGTHEN THE WORKPLACE
Celebrate holidays, birthdays, and company events
Have an open door policy
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Employees can approach management with problems
or issues and ask for advice or help
Promote teamwork
Dissuade
any harassment or bullying in the
workplace
24
25. HELP YOUR EMPLOYEES
Byhelping your employees to grow they can
reach their potential when returning to work
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Make your employees confident with
returning back to work and that you can help
to accommodate them if necessary
25
26. ENGAGING THE EMPLOYEE EXERCISE
Discussion: How can you as an employer help your
employees feel better when they return to work?
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What is something at your workplace that is positive
and motivate employees?
Give an example of Strengthening the self, family,
and community an employer can do for their
employees.
26
27. HELP STAFF HELP THE
RETURNING EMPLOYEES
Informstaff of returning employee – debrief and
explain the situation
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Have a welcome back party!
Opportunity for co-workers to interact with the
returning employee
Provideballoons, flowers, cards and /or a
welcome back banner in an employee's work
space to show that the individual was missed 27
28. HELP STAFF HELP THE
RETURNING EMPLOYEES
Clear
work out as necessary to enable an
employee to return to a clean desk or work area
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Offer your support if required
Work load
Catching up to current projects, people, and issues
28
30. ATTENDANCE MANAGEMENT
Beaware of the signs/attendance that an
employee might not be ready to come back to
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work!
Ifemployees are absent find out the reason,
and how to respond effectively
30
31. TYPES OF ABSENCES
Innocent Culpable
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Absenteeism Absenteeism
Long Repetitive
Term Short Term
Condition Absences
CANNOT DISCIPLINE! DISCIPLINE WARRANTED
31
32. INNOCENT ABSENTEEISM
Innocent Absenteeism is disability, illness, or
other legitimate health reason
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Discipline is inappropriate
May affect non-disciplinary termination
Employee has record of excessive absenteeism
Employee cannot hold regular attendance in the
future
32
33. INNOCENT ABSENTEEISM
1. Provide warnings
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2. Provide opportunity to improve attendance
3. Be consistent
33
34. INNOCENT ABSENTEEISM
Institute
attendance management program for
monitoring absenteeism
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Understandthe actual levels of absenteeism in
the workplace
Record all incidents of absenteeism and lateness
– but be careful what you count
34
35. ATTENDANCE MANAGEMENT
PROGRAM
Improve health and safety procedures
Having a safe free environment is important to
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prevent future injuries
Decreases the number of employees on leave for
injury
Management and the HR department should come to
terms the procedures for every situation at work
Should analyze every position and what hazards
might these employees encounter
Create health and safety policies that protect the
company and their employees 35
36. ATTENDANCE MANAGEMENT
PROGRAM
Provide employee assistance programs
EAP programs provide counselling services for
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employees paid by the employer
Employees can seek help/advice on any issue
they find themselves having trouble dealing
with
Helping your employees helps you the
employer to have a healthier working
environment that increases productivity 36
37. ATTENDANCE MANAGEMENT
PROGRAM
Provide attendance incentive programs
Reducing absences can help reduce turnover
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If one person is sick at work, send them home!
Less likely to get everyone else sick
Less stress due to heavy workloads from the people
who are sick
Providing incentives helps employees to go to
work and enjoy being rewarded for being there
at their jobs 37
38. ATTENDANCE MANAGEMENT
PROGRAM
Collect and publish attendance statistics
Find out the number of absences a year
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Set attendance goals and monitor achievement
Award employees who have a good attendance
38
39. ATTENDANCE MANAGEMENT
PROGRAM
An attendance management program
Can be in the form of an incentive program, rewarding
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employees with good attendance
Can be in the form of a behavioral program – the
company will only tolerate so many absences before
definitive action is taken
Writing that individual up in a report and have that
employee sign
3 strikes you’re out idea
Termination 39
40. ATTENDANCE MANAGEMENT
PROGRAM
Remember to be consistent and fair!
The program is to help employees improve their
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attendance
Not a punishment program
Can be seen as de-motivating
Increases turnover – as employees are punished
for being legitimately ill
40
41. EARLY INTERVENTION – ‘TURNING THE
TAP OFF’
Old system: ‘Sick Note’ New system: ‘Fit Note’
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Uninterrupted flow of the untreated unwell. 41
Early intervention reducing the
Cultural and behavioural change required flow on to benefits
42. BENEFITS
Reduces costs
An injured employee takes their time to heal, too
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soon and causes further injury – costing the
employer more in WCB fees or time loss from no one
filling that position
Creates a healthier working environment = better
employee attendance
Reduces stress of employees- know that their
employer is supporting their recovery
42
43. BENEFITS
Increases attendance
Employees are appreciated for their good
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attendance
Employees know that with a program in place, sick
days are treated fairly
Less stress – not as many employees calling sick
and therefore workloads are not increased to
cover the missing person
43
44. TURNOVER REDUCED
Good employees do not leave because of being
overworked!!!
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Place of employment is healthier and therefore less
likely have employees leaving
Being a supportive manager/employer for people
returning to work will motivate that employee to
come back sooner!
44
45. INNOCENT ABSENTEEISM
Don’t rigidly adhere to defined policies
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Allabsences are presumed innocent unless proven
otherwise
Can ask for doctor’s note
If culpable, then discipline may be warranted
Use progressive discipline
45
46. INNOCENT ABSENTEEISM
Provide feedback
Speak with employees when they are having
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trouble
Discipline when warranted
Implement last chance agreements when all
else fails (unionized setting)
46
47. ABSENCE ACCOMMODATION
An employer can accommodate an employee if there
are scheduling conflicts that result in absences
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For example: Single mother cannot get children to the
day care until 8am, her shift starts at 8am. She is late
almost every day. The employer can accommodate
her by starting her shift an hour later.
47
48. TERMINATION: LAST RESORT
Employer has to demonstrate:
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Record of excessive absenteeism
Incapable of regular attendance in the future
Accommodation to the point of undue
hardship
Follow program of progressive discipline
Terminate with caution = there is always a
risk of a grievance or a human rights
complaint 48
50. RETURN TO WORK AFTER
EXTENDED ABSENCE
Policies are needed in place for Employees returning
to work
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Management and HR must come together and plan
and agree on the terms and conditions that are
acceptable
50
51. POLICIES
Provide fair and equitable treatment for employees in
receipt of disability benefits
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Prove assistance, rehabilitation, and accommodation
that promotes productive return to work opportunities
for disabled employees with work restrictions.
Employees should never be rushed or pressured back to
work by management
51
52. RETURN TO WORK AFTER
EXTENDED ABSENCE
There are a couple of steps to take when an
employee returns after an extended absence
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1. Meet with the employee- find out how they feel
mentally and physically
2. If necessary find out from a doctor if the employee is
physically fit to work
3. Create a plan with the employee – if they can return
to their job duties right away or you need to modify
their job duties 52
53. RETURN TO WORK AFTER
EXTENDED ABSENCE
4. Decide on length of time on modified work, hours
per work, pay per hour/week, and anything related
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to the job
5. Write this out formally in a report
6. Have the employee sign and agree to the terms and
conditions
7. Follow up – in a week see how the employee is
doing, how they are re-adjusting to working again 53
54. PLANNING
When creating these plans with employees make sure
that you are consistent!
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Remember while everyone’s absences or injuries are
different, you must create a plan that suits their needs
but also the needs of the company
Note: employees returning back to work might not be
as fast paced, remember everyone will recover in
their own time
54
55. PLANNING EXERCISE
Situation: A meat cutter in a grocery is returning to
work after being injured at work. This worker is on
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WCB and you have been advised that they can only
work certain hours, has to go to physiotherapy, and
cannot lift any heavy things.
Get together in a small group and create a plan for this
worker.
What are the conditions to consider?
How can you as an employer make this individual
return to work transition smooth?
55
56. RETURN TO WORK ADJUSTMENTS
Thereare several methods to help an employee
return to work
CG Hylton
Changing the number of hours per week the
employee has to work
Allowing more breaks in the shift
Changing job duties
Consider that employee for another position for the
time being
Partner with another employee to work with 56
57. BEST PRACTICES IN RETURNING
EMPLOYEES TO WORK
Different
scenarios call for a different
approach on how to accommodate a returning
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to work employee
Research,
speak with HR, and decide the best
accommodations
The first time is not always right, remember
to monitor and adjust the accommodation if it 57
is not working!
58. EXERCISE SCENARIO 1
An employee in an accounting firm has recently
been disabled from the waist down.
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What are some of the accommodations to
consider?
58
59. EXERCISE SCENARIO 2
A liquor manager is a recovering alcoholic. He is
returning to work after spending 3 months in rehab.
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What are some of the accommodations to
consider?
59
60. EXERCISE SCENARIO 3
An employee in an office has pneumonia but does
not have any more sick days. That employee must
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return to work.
What are some of the accommodations to
consider?
Should the employee be put on the attendance
management program?
60
61. CASE STUDY: NURSE DONNA
Donna is a 42-year-old Registered Nurse. She has worked in a
large acute care hospital for the last fifteen years, primarily on a
medical ward.
She loves being a nurse and takes a great deal of pride in her
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work. She is a valued member of her team and often covers for
the charge nurse when she is away
It is not unusual for Donna to pick up overtime shifts. Recently,
her unit was assigned to a new manager as a result of hospital
reorganization.
Donna is recently separated and has been involved in a difficult
divorce and custody dispute over her two children.
As well, her mother was diagnosed with breast cancer and
moved in with Donna for care and support.
61
62. CASE STUDY: NURSE DONNA
Gradually, Donna started feeling overwhelmed by her
responsibilities, both at work and at home.
She was constantly tired, and often felt irritable and
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moody.
She found she easily forgot things and often could not
stay focused on a task.
She mentioned this to her family doctor during a routine
visit.
After a brief interview, her doctor diagnosed her as
suffering from depression.
She was prescribed an antidepressant and it was
suggested that she take a few weeks off work to rest.
62
63. CASE STUDY: NURSE DONNA
Donna took four weeks off work. She also met with a
counsellor though her organization’s external EAP
program.
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She attended the allotted six sessions of counselling.
She appreciated the support but found this wasn’t helping
to improve her symptoms or functioning.
Although she was not feeling much better she did return to
work, in part because of financial concerns, but also
because she felt she was letting her coworkers down.
63
64. CASE STUDY: NURSE DONNA
Donna worked for two weeks and then stopped due to
continued fatigue, poor concentration and memory as well
as unpredictable bouts of tearfulness and feelings of
anxiety.
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Donna’s doctor increased her medication and suggested
she take an additional 3-4 months off work.
She used up her remaining sick time and applied for EI
benefits.
However, after this time she Donna was still not able to
return to work.
She applied for and was accepted on to Long Term
Disability and was referred to a rehabilitation consultant
for vocational rehabilitation services.
64
65. CASE STUDY: NURSE DONNA
As Management, what returning work plan should be
created?
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What factors are there to consider?
What must she do to return to work?
What must her supervisor do to return her to work?
What must her disability consultant do to help her along
this process?
65
66. RETURNING EMPLOYEE TO WORK
An employee should feel confident they can return
to work
CG Hylton
Work out that plan! Make sure everyone
understands and agrees with the plan
Accommodate
Absences maybe an indication they are not ready
to work yet!
66
67. BENEFITS FOR EMPLOYEES
RETURNING TO WORK
Benefits plan
It is important that small businesses to large companies
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have a good comprehensive benefit plan
Invest in employees – a good benefits plan will help
retain the good employees
A security for employees – knowing if anything
happened to them they would have coverage
Carriers have the flexibility to create a plan that suits
your company’s budget and needs
67
68. BENEFITS FOR EMPLOYEES
RETURNING TO WORK
EAP Plan
Employee Assistance Program Plan
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Employers pay for a certain number of counselling
sessions for their employees
Employees can seek out counselling for advice or help
on how to deal with their daily stress, emotional
dilemmas, or build stronger relationships with
family/coworkers
Working together: HR and management
Plan with your Human Resource people
Create policies that protect the company and 68
employees
69. BENEFITS FOR EMPLOYEES
RETURNING TO WORK
WCB - Workers
Worker’s Compensation Benefit
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Employees injured at work are compensated by
WCB paid by the employer
Assessed by WCB doctors to determine if
employee is fit to return to work
http://www.wcb.ab.ca/pdfs/employers/EFS_Pers
onal_Coverage.pdf
69
70. BENEFITS FOR EMPLOYEES
RETURNING TO WORK
Insurance Company Supervisor
& WCB
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Return to Work
Coordinator
Medical Community Injured or Sick
Employee
Human Resources/Benefits
Specialized Services
Union Representative (if any)
70
71. UNDERSTANDING PERFORMANCE IN
RELATION TO CURRENT STANDARDS
Performance reviews must be fair and equitable
to all employees regardless of race, disability,
etc.
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Same standards for all employees
Theemployer should review the returning to
worker
Tasks assigned
Where completed,
Employee’s attitude, 71
Work ethics, etc
72. EMPLOYEES RETURNING TO
WORK – DEPRESSION STATISTICS
Statistics Canada on Jan. 12, 2007, found that
half a million Canadian workers experience
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depression and most of them — almost 80 per
cent — say the symptoms interfere with their
ability to work
72
73. IMPORTANCE OF EARLY
INTERVENTION
100
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80
Probability of RTW
60
40
20
0
Time
(0 to 24 months)
73
74. EMPLOYEES RETURNING TO
WORK – DEPRESSION STATISTICS
Work impairment more likely among
depressed workers
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Relatively high percentages of workers who
had experienced depression reported specific
forms of work impairment.
These included reduced activities because of a
long-term health condition, at least one mental
health disability day in the past two weeks, and
absence from work in the previous week.
74
75. EMPLOYEES RETURNING TO
WORK – DEPRESSION STATISTICS
Work impairment more likely among
depressed workers
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About 29% of workers who had had a recent
episode of depression reported reduced work
activities because of a long-term health
condition. This was three times the proportion
of only 10% among those with no history of
depression.
75
76. EMPLOYEES RETURNING TO
WORK – DEPRESSION STATISTICS
Work impairment more likely among depressed
workers
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As well, 13% of workers who had experienced
depression reported at least one day in the
previous two weeks when they had to stay in bed,
or cut down on normal activities, or their daily
activities took extra effort, because of emotional or
mental health or the use of alcohol or drugs.
76
77. EMPLOYEES RETURNING TO
WORK – DEPRESSION STATISTICS
Work impairment more likely among depressed
workers
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Only 1% of workers with no history of depression
had taken a mental health disability day in the
previous two weeks.
Also, 16% of workers who had had a recent
depressive episode had been absent from work in
the past week, twice the proportion of 7% of those
who had never had a depressive episode.
77
78. EMPLOYEES RETURNING TO
WORK – DEPRESSION
Management of depression in the
workplace must begin with the workplace.
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With regard to depression management,
neglecting the workplace may result in:
Failure to control or eliminate risk factors,
such as conflict with co-workers or
supervisors or lack of perceived control over
workload, which may initiate or compound
depression as well as increase the likelihood
of depression relapse
78
79. EMPLOYEES RETURNING TO
WORK – DEPRESSION
Delivery of treatments that ignore the
depressed person’s relationship to the
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workplace and thus worsen the disability
state
This can include recommendations of
“stress leave” without concurrent provision
of strategies to maintain or build resilience
and coping skills
This can readily result in demoralization,
inactivity, and loss of engagement with
coworkers
79
80. EMPLOYEES RETURNING TO
WORK – DEPRESSION
Poor communication between healthcare
providers, disability managers, and the
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workplace, resulting in limited
understanding of the depressed worker’s
status and delayed or inadequate
consideration of appropriate return-to-
work strategies.
80
81. UNDERSTANDING THE COURSE OF
MENTAL ILLNESS
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Diagnosis
Symptoms of
Depression
81
TIME Adapted from Janus Associates
82. STEPS TO PREVENT DEPRESSION
IN THE WORKPLACE
1. Reducing the presence or severity of
organizational and workplace
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stressors
Stress intervention seeks to modify
employment characteristics such as
excessive/unpredictable workload,
unclear job expectations, or lack of
perceived control, all of which have been
linked to depressive symptoms
82
83. STEPS TO PREVENT DEPRESSION IN THE
WORKPLACE
2. Increasing the ability of workers to cope with stress
Examples of stress management skills are:
Structured problem solving to appraise and respond
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to problems in a more effective way
Interpersonal strategies for mobilizing support in the
workplace
Conflict management to handle disagreements with
coworkers;
Relaxation techniques to reduce maladaptive tension
Communication training to clearly and assertively
express one’s viewpoint
83
85. BENEFITS FOR EMPLOYEES
RETURNING TO WORK
Is a collaborative process which assesses,
plans, implements, coordinates, monitors
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and evaluates options and services required
to meet an individual’s health needs using
communication and available resources to
promote quality, cost effective outcomes
85
86. RETURNING EMPLOYEES- ROLE
OF SPIRITUALITY
Spirituality- individual’s search for the
sacred
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Provides meaning, purpose, &
optimism
Individual’s view of self in relations to
otherwise is defined by their early primary
caregivers
Expectations for all future relationships
developed in adulthood come directly 86
from our childhood
87. RETURNING EMPLOYEES- ROLE
OF SPIRITUALITY
Increasing spirituality decreases Depression
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Religion and spirituality can be the same
Religion helps to define purpose and meaning of
who we are
Spirituality can exist without religion
87
88. RETURNING EMPLOYEES- ROLE
OF SPIRITUALITY
Whena crisis/issue arises, how well we deal with it
depends on how well we can cope
Attachment Theory
CG Hylton
The better the childhood – the faster and stronger an
individual can recover
The worse the childhood – the more easily individuals
can fall into depression or/and have substance abuse
Tocope: build spirituality – self esteem, change
those relationships in your life, be self- directing
SelfDirecting: active self – improving yourself and
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The consultant would speak to her family doctor about her current treatment plan, her response to date and other possible options. If appropriate, her doctor would refer her to a psychiatrist or outpatient mental health clinic for further consultation and recommendations.■ She was given information about community home care for support for hermother. She was also provided with resource materials including localsupport groups, some proven web sites and self-care materials.■ She was referred to an exercise therapist, sponsored through the rehabilitation consultant, to begin to become more physically active and to add some structure and routine to her week.■ She was referred to a registered psychologist who would provide cognitive behaviour therapy to improve her coping skills, mood management and problem solving. A particular focus was placed on gradual activation, including social involvement, and on planning forissues that could arise at work.■ Finally, the rehabilitation consultant spoke with Donna’s employer who indicated they were willing to support her in a supernumerary graduated return to work program when she was ready.After four months of proper medication management, psychotherapy sessions and an exercise program, she was feeling much better. Her mood, concentration and stamina had improved, she had lost weight and she had reconnected with some colleagues from work. Donna, her doctor and her rehabilitation consultant communicated and agreed that she was ready to return to work. It was recommended that there be some restrictions includingno night shifts, charge responsibilities or overtime for six months. A return to work meeting was held with Donna’s manager and union representative to discuss reintegration to the workplace. A six-week supernumerary graduated program was arranged. Alternate wards were discussed, but Donna felt that returning to her own unit would be the most supportive and looked forward to her return to work. At the end of the Return To Work program Donna was working full-time and feeling well. Her employer indicated there were no concerns about her performance. All restrictions were lifted after three months, but Donna was much more selective about picking up overtime or charge responsibilities.She enrolled in a company supported exercise facility and participated in a community program for single parents. She continued on her medications with the understanding that she would be reassessed and the medication would be gradually discontinued in the absence of renewed symptoms. In conjunction with her psychotherapist and physician, she developed some strategies to deal with future stressors or changes in functioning. Overall,she felt much more confidant about her ability to balance work and homeresponsibilities.
Typical Course of DepressionEveryone experiences normal mood variations over timeHowever, some predisposed individuals will develop progressively more distressing symptoms, often in response cumulative stress or a precipitating event such as a job loss or marital separationFor many these symptoms will resolve without treatment but for others they become progressively more severe until they surpass the diagnostic threshold and require clinical intervention.4. only ½ of those experiencing a depressive episode will seek professional help. Of those who do, some do not respond to usual dare and their depression follows a chronic course that can persist for years.Most who receive appropriate care show significant improvement in 4-12 weeks. Of those who respond to treatment some have a full remissionOthers have only a partial recovery with persistent symptoms of depressionIn either case, it is not uncommon to suffer a relapse although this is far more likely where the response to treatment did not result in full remission.Even after full recovery there is still a 50% chance of recurrence, most often within two years.