By

Gaby Grammeno

Contributor

The context for the research is that work disability – which occurs when a health condition limits a person’s ability to participate in employment – has significant consequences for the individual, their family, their employer and society.

For the individual, this typically means worse mental health, shorter life expectancy, higher pain levels, more health and social care, greater risk of suicide, and reduced quality of life. Workers’ families are affected too, with higher rates of marital separation and in many cases, financial distress due to lost income.

For employers, it means a less productive workforce due to absenteeism and presenteeism.

Prolonged absence

There is overwhelming evidence that the longer a person is away on sick leave, the less likely it is that they’ll ever return to paid work. After 24 months of prolonged worklessness, very few people will ever make a successful return to employment. The consequences for employers include increased recruitment and retraining costs.

The research, commissioned by Safe Work Australia, has culminated in the release of a final report, Early Intervention in the Workers’ Compensation Process, compiled by Monash University’s Centre for Occupational and Environmental Health and the Healthy Working Lives Research Group.

The 95-page report provides insights into how to make early interventions effective for both injured workers and employers, setting out factors that help and also barriers that need to be overcome in order to facilitate early intervention.

What is ‘early intervention’?

‘Early intervention’ refers to initiatives taken as early as possible in the first three months after a worker experiences symptoms of an illness or injury. Such initiatives can be taken by the worker, a treating healthcare provider, a colleague, supervisor or HR or workplace health and safety representative.

Work can function as an active mode of recovery if it is phased, and medically safe. Regular supportive contact with the worker is essential, as is flexibility involving, for example, adjustments to the tasks and working hours, provision of suitable equipment or rotation or sharing of roles to support the RTW process. Where it’s feasible and safe, injury and illness should ideally be managed without long-term sickness absence.

Early involvement of a case manager and coordinated interventions involving all relevant personal, work and/or insurer factors (‘multidomain interventions’) need to be focussed on what it will take for the injured person to return to work.

The focus of the research was to establish what types of early intervention were currently being applied in Australian workers’ compensation schemes and, from the evidence, which elements of early intervention are most beneficial.

The report reveals that some early intervention approaches are particularly helpful, including ‘motivational interviewing’ and cognitive behavioural therapy, as well as multidomain interventions and the early involvement of a case manager.

Motivational interviewing

Motivational interviewing (MI) is a method of counselling designed to help people find the motivation to make a positive behaviour change through resolving their ambivalence.

A number of studies reviewed by the researchers provided good evidence that MI as an early intervention can improve outcomes with regard to sustainable RTW, reducing sickness absence and improving RTW rates among people with work-related musculoskeletal conditions and psychological injuries.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a psycho-social intervention designed to reduce symptoms of mental health conditions such as depression and anxiety disorders. It aims to help a person change unhelpful or unhealthy patterns of thinking, feeling and behaving, based on the understanding that negative thinking is a bad habit that needs to be broken. The idea is to show a person how their negative thinking affects their mood, and prevents them from achieving their goals or living a full life.

The researchers found ‘moderate’ evidence that early intervention with CBT may improve RTW outcomes. The strongest evidence for CBT was when it was work-focused and used as part of a comprehensive rehabilitation program tailored to the individual worker’s needs.

The report noted that the effectiveness of work-focused CBT in improving RTW outcomes ‘may vary from person to person and depends on factors such as the individual's specific condition, their willingness to engage in therapy, the skills of the therapist, and the support system in place’.

Challenges for early RTW

Poor working relationships, lack of communication and a lack of genuine consultation between healthcare providers, insurers, regulators and employers create barriers to successful early intervention, as do limited awareness of employers, and limited knowledge of, and access to, healthcare providers.

Moreover, risks of early interventions include compromising the confidentiality of the worker, and the use of early interventions to prevent a claim being made.

What it means for employers

The recommendations most relevant to employers advised them to:

  • implement coordinated multidomain interventions where appropriate to improve recovery and RTW outcomes
  • systematically evaluate existing early intervention projects to contribute to a shared understanding of what works/does not work 
  • support early interventions with an environment that encourages regular and effective communication and genuine consultation between all the actors in the process, including injured or ill employees and their families, carers and representatives (unions), employers, and service delivery providers (including health practitioners)
  • ensure that all workers fully understand their rights, how to recognise occupational disease/injury and what actions to take in the event of an injury or when symptoms of an injury or illness emerge.

Read the report

Early Intervention in the Workers’ Compensation Process – Final Report