A survey of occupational therapy in Australian work practice

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.     

Improving work programs' delivery of information and service to workers' compensation carriers

This paper presents the results of a telephone survey of workers' compensation carriers, addressing how occupational therapy work programs can best meet these carriers' needs. Fifty percent of the market share of workers' compensation carriers in Michigan participated in the survey. Survey results indicated that workers' compensation carriers found Functional Capacity Evaluations, job analyses, and work hardening to be important work rehabilitation services. A significant portion of the respondents (88%) stated that they recognized the need for clinically successful work rehabilitation programs and indicated that if they had return to work rates for different providers, they would utilize providers that had the most successful outcome data in a specific geographical area. Occupational therapists can use these survey results to improve their services and communication with insurance to ensure that injured workers will continue to have access to the efficacious interventions occupational therapists provide in work rehabilitation.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

How are nurses at risk?

The effectiveness of occupational health and safety management systems (OHSMS) can be understood through analysis of surveys such as the experiences of exposure to occupational hazards by Australian nursing occupations. How effectively OHSMS are implemented in the Australian health industry is unclear as few studies describe current hazard exposure patterns or the impact of OHSMS in the Australian health industry. This paper concludes from the analysis of an Exposure Survey of Australian nursing occupations that nursing occupations perceive themselves to be "at risk" of injury and/or management of OHS risk in work duties is affected by the patterns of hazard exposure, occupation group as well as employee attributes, perceptions, patterns and situations of work. The results highlight the top-rated hazards and imply that the perceptions of hazards in the workplace are different to actual risk experience (e.g. injury patterns). There is an unacceptable level of exposure to diverse hazards in Australian nursing occupations workplaces in regard to regulatory and performance obligations. Stronger strategies to achieve more effective risk treatment, integrate with hospital accreditation and quality programs are discussed to benefit system performance and the welfare of those in nursing occupations.     

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.     

Summary report of action research on occupational rehabilitation and community re-integration of migrant workers with work injuries in Mainland China

This article is a summary of an action research exploring the strategies to initiate the occupational rehabilitation and community re-integration of migrant workers with work injuries in Guangdong Province, China. Using two cases of rehabilitation intervention for workers with work injury, a case management model of occupational rehabilitation and community re-integration was illustrated, in the different phases of rehabilitation. Finally, some key elements in supporting occupational rehabilitation and community re-integration for migrant workers with work injury in China were highlighted.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

Work injury rehabilitation and the tendency to return to work of workers with injuries in Mainland China

This paper aims to describe the current situation of the work injury rehabilitation system in China with its drawbacks, especially relating to the employment services for workers with injuries and bringing up the topic of the need for more work to attempt to construct a modern work injury occupational rehabilitation system: perfecting the administration mechanism of policy, establishing an occupational rehabilitation pattern with Chinese characteristics, establishing the socialization service network as the core of occupational rehabilitation and establishing a practical professional team and academic communication platform. These creative thoughts may shed light on the development of the work injury rehabilitation system as well as the return to work for workers with injuries in China.     

An historical overview of Australia's largest and oldest provider of vocational rehabilitation--CRS Australia

CRS Australia, the largest and oldest vocational rehabilitation provider in Australia, is examined over its 60-year history. The Australian government located CRS initially in the Department of Social Security, and subsequently in the Department of Community Services however, its establishment required a complexity of policy and range of skills that were not found in one arm of government alone and required cooperation from many government departments. A disagreement between the government and the medical profession about the purpose and control of rehabilitation features in the early history of CRS Australia. Factors such as greater involvement of people with disabilities and government inquiries led to a move from a centre-based to a community-based approach to vocational rehabilitation in the 1970s. CRS Australia is a large employer of health and human service professionals and has played a significant part in the development of these professions in Australia. In recent years, CRS Australia has provided greater business accountability to government and the broader Australian community. CRS Australia's role as an expert vocational assessment agency and vocational rehabilitation provider is expected to continue as welfare reform progresses in Australia.     

Health Risk and Occupational Category

This study seeks to determine the influence of occupational category on health risk by utilizing a corporate-wide health risk appraisal (HRA). A subgroup of the corporate population, 10,124 college-degree employees, completed a health risk appraisal and comparisons were made between the male subjects' (6,553) and female subjects' (3,571), occupational categories, and estimated health risk. For the males, significant differences were found between the six occupational categories; clerical, professional and craft categories exhibited greater health risk. The females displayed no significant differences between occupational categories. The authors suggest that occupational variables are likely to have an influence on health risk when mean age for the occupational category is adjusted and educational level of subjects is controlled. Findings are discussed regarding significance to employee assistance providers and other corporate personnel involved in employee health services.     

Policy and practice of occupational rehabilitation in Hong Kong and Guangzhou--a comparative study

The objective of this paper is to compare social policy on occupational rehabilitation services in two mega industrial cities in southern China: Hong Kong and Guangzhou. Comparative policy study was employed as the research and analytical method in this paper. Aim, finance, target, coverage, organization and administration, service delivery and provision of the occupational rehabilitation policy and its linkages with industrial injury compensation system and re-employment policy in the two cities were critically reviewed and compared. The results of the study reflect that the Guangzhou policy is more aggressive and more tailor-made to the specific needs of occupational rehabilitation compared to the Hong Kong policy, whereas occupational rehabilitation in Hong Kong has long been developed and knowledge and skills in the occupational rehabilitation service are more mature and fruitful. Based on the research findings, it is concluded that through experience sharing and exchange, there will be more mutual understanding regarding the system, practice, success, faults and limitations in the two cities, as well as awareness of alternative courses of action. These will help in the better development of occupational rehabilitation services with the aims to safeguard the rights and wellbeing of workers in both cities.     

Job matching and return to work: Occupational rehabilitation as the link

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.     

Disability and job stress: Implications for vocational rehabilitation planning

Because people with disabilities often experience an increased risk for physical and psychological complications of job stress, vocational rehabilitation professionals must be able to (a) identify individual and work-environmental risk factors for job stress and (b) design appropriate interventions to minimize those risk factors. The purpose of this article is to (a) present two models of occupational stress, (b) examine factors common to each of these models that are associated with employee health and well-being, and (c) suggest implications for rehabilitation planning.     

A unique collaboration of female medical providers within the United States Armed Forces: rehabilitation of a marine with post-concussive vestibulopathy

Uncle Sam's loyal nieces have come a long way from the days of World War I. The development of occupational and physical therapy was heavily influenced by an early relationship with medical specialists during the First World War. This relationship can be considered largely responsible for the eventual acceptance (by the Armed Forces) of women working in this area. Over the past decade active duty women have seen many changes in opportunities to serve and are now stationed aboard aircraft carriers, performing roles previously considered for male personnel. We report a case study of the medical care provided by both military and civilian women working for the United States Armed Forces. Initial assessment was conducted in a battalion aid station of a United States Marine Corp base and the subject was then referred to a military medical center with highly technical vestibular assessment and rehabilitation services. The subject's case represents a unique collaboration of women therapists, enabling a Marines' access to timely and accurate assessment, treatment and ultimately, successful return to active duty. This case study is one of many examples of the acceptance and successful integration of women as providers of medical care within the Military's medical framework.     

An Evaluation of a Community Collaboration Approach to Psychosocial Rehabilitation

ABSTRACT

This article reports on the results of a multiagency collaboration demonstration project that was designed to replicate the salient features of an exemplary practice, single-agency program of psychosocial rehabilitation for persons with serious mental illness (SMI). The community collaboration extended over two phases for 2 years and involved over 20 mental health service providers. The demonstration project itself was designed to be a replication of the Village Integrated Services Agency (Village ISA) of Long Beach, California. Additionally, this article reports the results of a rigorous evaluation of the project. The treatment group outcomes were substantially superior to all control group measures at or beyond the 0.05 level of significance. With due regard for limitations imposed by a small sample size (n = 50), the project demonstrates that the replicated model of intervention can be effectively implemented through a collaborative organizational structure involving a coalition of agency service providers.     

A Developmental Approach to Recognition of Prior Learning in Social Work Field Education

This paper comments on the policy issue of recognition of prior learning (RPL) in social work education. Contrasting approaches to RPL are explored through a case study of Charles Sturt University’s experiences with RPL in its professional entry social work programs. RPL for field education in Australian social work education has been a contested issue within the profession and for social work education providers since its introduction in 2008. Notwithstanding the Australian Association of Social Workers’ credentialist approach to RPL, Charles Sturt University’s experience is that a developmental approach is preferable and can be a transformative professional education strategy.     

A new approach in vocational rehabilitation in Iceland: preliminary report

The lack of vocational rehabilitation in Iceland inspired the Janus Rehabilitation initiative in the year 2000. The team currently consists of two occupational therapists, a social worker, a physiotherapist, a psychologist, and a physician. Janus uses resources from local education establishments and is located at the Reykjavík Technical School. A client-centred approach is used, enabling a flexible rehabilitation timeframe. The aim is to help the client back to employment/education. Advantage is taken of the facilities of the school where integration between education and rehabilitation takes place. Forty individuals have been admitted, with a mean time from work of 2.9 years, (range: 0-11 years). Seventeen (43%) have returned to employment/education. Twenty-three of those entering the programme are still on invalidity pension. The Canadian Occupational Performance Measurement (COPM) shows improvement in occupational performance and satisfaction. The Icelandic Quality of Life measurement also shows improvement. The results have been promising. However, a larger group is needed in order to draw clear unequivocal conclusions.     

Use of Functional Capacity Evaluations by rehabilitation providers in NSW

Returning the disabled worker to maximum productivity is a shared responsibility between the treating health practitioners and employers, with the insurer as an overseer of the injury management plan. Allied health professionals have responded to the need for standardized tools to assess work capacity by developing Functional Capacity Evaluations (FCEs). Literature exists outlining the limitations of FCEs in injury management systems; however, little is known about their uses and perceived usefulness. Questionnaires were posted to managers and therapists of accredited rehabilitation providers. The questionnaires consisted of both open and closed format questions. The response rate for the managers' questionnaire was 53%, while the therapists' questionnaire was 27%. The majority of rehabilitation providers use an assessment of their Own Design. Eight commercial FCEs were identified as being used. The majority of therapists use only one type of FCE. Therapists rated FCEs highly on their flexibility with Own Design assessment rated as significantly more flexible than the most frequently used commercial FCEs. From the data collected, it appears that cost is the main factor influencing choice of assessment. Level of evidence supporting capabilities of particular assessments does not appear to influence use. It seems that, despite there being poor research evidence to support the use of many brands of FCEs, they are still commonly used by rehabilitation providers. To achieve optimal use of FCEs, further research is required on the types of adaptations therapists make to commercial assessments and properties of Own Design assessments, including reliability and validity studies.     

The Occupational Attainment of Immigrant Groups in Australia

It is commonly assumed that immigrants are disadvantaged in the Australian labour market because of a variety of interacting factors, some related to their skills, some to cultural differences between them and the host society, and some to the time it takes to adjust to their new circumstances. Using specially-prepared cross tabulations from the 1996 Australian Census, this article evaluates the assumption for the country's 52 largest immigrant groups, as defined by birthplace. Separate analyses for male and female immigrants relate their concentration in ten occupational groups, including unemployment, to their educational qualifications, facility with the English language, and period of arrival. The analyses suggest that the first two variables are particularly relevant to appreciating the occupational distribution of male immigrants, with period of arrival also being important for females, probably reflecting different cultural norms from their host society.     

Proprietary rehabilitation: Challenges and opportunities in the new millennium

Proprietary rehabilitation has developed into a distinct professional sector with procedures, practices, and philosophy that differ from those in the public rehabilitation program. As the new millennium commences, proprietary rehabilitation will face a variety of challenges and opportunities that could affect the future of this sector of the rehabilitation profession. Among these issues are changes in occupational information upon which many proprietary rehabilitation practices are based; increased opportunities for early intervention and establishment of disability management programs within industry; adjustment to the movement to a managed health care system; and the necessity to demonstrate fiscal efficacy of rehabilitation services to workers with compensable injuries. This article discusses these issues and suggests some ways in which those involved in proprietary rehabilitation can properly position themselves to address and benefit from these challenges and opportunities.