"I'm still swimming"

Treatment of bipolar affective disorder is often difficult and lengthy. Enabling participation in a return to work process is equally daunting, primarily due to the dramatic and oftentimes sudden shifts in mood and thought. The following case study attempts to illustrate the complicated process of return to [and stay at] work for an individual who has mixed bipolar affective disorder. Work has always played a significant role in Ray's life and remains a valued goal and accomplishment for Ray. Work has been a means to structure and routine, and it has been from this routine that wellness has become possible for Ray. The metaphor, "I'm still swimming" helps to illustrate the continual treading of water, which both Ray and his occupational therapist [first author] have experienced over the past 6 years. This case study illustrates the strategies employed in maximizing the person-environment-occupation fit for Ray, as well as the importance of collaboration and partnership in the return-to-work process. It is also meant to stimulate thought and discussion about what is important for occupational therapists, and other health professionals to consider, when attempting the task of return-to-work for an individual with mixed bipolar affective disorder.     

Left behind in the return-to-work journey: consumer insights for policy change and practice strategies

This study examined system barriers that precluded injured workers from accessing services and supports in the return-to-work (RTW) process. A grounded theory approach was used to investigate injured worker experiences. Methods included in-depth telephone interviews and the constant comparative method to analyze the data. Findings revealed that consumers experienced tensions or a tug-of-war between the RTW system, the health care system, and in accessing and using knowledge. Over time consumers reflected upon these tensions and initiated strategies to enhance return to function and RTW. Insights from consumer-driven strategies that might inform future policy change and promote positive service delivery for injured workers are examined.     

Unexpected barriers in return to work: lessons learned from injured worker peer support groups

Some workers who are injured at work have unexpectedly prolonged absences from work. Experiences of workers who constitute a disproportionate cost to the return-to-work system and the systemic and compliance-related barriers they encounter during the process of returning to work are reported. A qualitative interview based study was conducted with 37 members of three injured worker peer support groups in a Canadian province. Four dimensions of peer support were identified: worker experience of being misunderstood by system providers, need for advocates, social support, help with procedural complexities of the workers' compensation, and health care systems. Peer support constitutes a partial return-to-work solution for workers with injuries, but injured workers encounter an uneven playing field. Injured worker peer support group needs and activities show us that sensitivity to structural and social issues may lead to better return-to-work outcomes.     

Danish and Norwegian hospital social workers’ cross-institutional work amidst inter-sectoral restructuring of health and social welfare

Starting in the 2000s, Denmark and Norway have undergone extensive restructuring of their health-related social benefit programmes, including how they are governed. Several reforms have sought to enhance inter-sectoral collaboration. Aiming at ensuring patients’ faster return to work, policy-makers have instituted economic incentives to both individuals and the health and welfare organisations who handle them. Through an institutional logics approach, this paper explores how hospital social workers in these countries are experiencing these changes. The ‘social’ part of post-treatment care and rehabilitation receives more attention in the Norwegian institutional set-up than in the Danish, and whilst challenges are experienced in both countries, in group interviews Danish social workers in particular express concerns about the implications of the accelerated return-to-work focus. In both countries, they report increasing difficulties in ‘making their way through’ the state-municipal bureaucracy. However, by drawing on the formal health knowledge derived from medical settings and the symbolic capital it bestows on them, they often manage to negotiate the work-and-welfare services, thereby transforming the social context for the patients.     

Measuring changes in interagency collaboration: an examination of the Bridgeport Safe Start Initiative

This paper describes the evaluation of interagency collaboration in a network of child-serving providers as part of the evaluation of the Bridgeport Safe Start Initiative (BSSI). In line with the system of care approach, the objectives of BSSI included reducing fragmentation of efforts and delivering integrated services to families of young children exposed to or at risk of exposure to family violence. Interagency collaboration was examined via social network and focus group data collected at three time points starting at baseline. Network analysis findings suggest that over time the network structure became consistent with BSSI's vision of an ideal collaborative network structure. Focus group findings, however, present a more complex picture of the status of collaboration. This paper sheds light on approaches and challenges to measuring interagency collaboration in a service delivery system and communicating social network analysis findings to stakeholders in a way that is accessible and useful.     

Reliability of the instrument DOA: dialogue about ability related to work

The aim of this study was to examine the reliability of the new instrument "DOA--a dialogue about ability related to work" [6]. DOA was developed using the Model of Human of Occupation as a theoretical base [12,13]. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual's ability to perform work-related activities. Assessments are followed by a dialogue to distinguish goals for the return-to-work process based on the client's own preferences [6,14]. 34 outpatients' clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in the study. The Spearman Rank Correlation test generally showed acceptable significant correlations in test-retest (n=34). A greater part of items correlated "moderate to good" (r=0.51-0.75). In the raters' test (n=14) Percentage of agreement (PA) was good ranging between 93.1%-96.5%, which is above the acceptable criteria of 80%. There were no significance differences between the raters. The study has indicated that items in DOA work with generally good reliability to measure ability related to work. The instrument was demonstrated to be a reliable therapeutic tool in goal setting for return-to-work in a position outside of the clients' preferences.     

Administration and application of the Worker Role Interview: looking beyond functional capacity

Assessing factors beyond the functional capacity of the injured worker is challenging, yet essential for deriving a more complete understanding of the worker. Insight into a worker's perceptions of abilities and limitations, commitment to the worker role, perception of the impact of the injury on non-work roles, ability to adjust habits and routines, and perception of the work environment allows the therapist to identify and address barriers to return-to-work. The Worker Role Interview (WRI), based on the Model of Human Occupation, is designed to assist the therapist in obtaining this information. The therapist's ratings on a four-point scale provide a picture of the factors which support and interfere with successful return-to-work. This paper describes the WRI and discusses its clinical application. A case example illustrates how the information gained from the WRI can be used for treatment planning.     

Collaboration for community-based wildlife management

Perhaps as remarkable as the general upsurge in public interest in wildlife over the last 30 years is the trend toward greater community-based wildlife management since the late 1980s. This paper discusses the challenges and opportunities at the local, community scale of collaboration for wildlife management. We explain how collaborative activity between the professional wildlife manager and community stakeholders can lead to improved identification of human-wildlife interactions and better understanding of wildlife-related impacts that are of primary management concern in the community. Community-based collaborative decision making can also effectively result in the specification of management actions that are acceptable to a community. Furthermore, agency-community collaboration can lead to co-management that goes beyond stakeholder input or involvement in decision making about management objectives and actions, and includes appropriate sharing of responsibility for implementation and evaluation. A growing role for the wildlife agency in such situations is facilitating the development of local capacity by filling information and process needs so that individuals and groups in a community can participate effectively in collaborative efforts appropriate to the necessary level of agency-community engagement. This opportunity for the wildlife profession promises to be rewarding and have lasting positive influence on communities for the benefit of wildlife management. However, most agencies cannot address every issue at a community level. Public wildlife managers need guidelines for judgment about when to engage in community-based wildlife management. They need to assess various risks associated with not engaging in a particular issue and to prioritize the potential situations where various degrees of community engagement may be desirable. This paper highlights these intriguing challenges and opportunities associated with community-based wildlife management. An erratum to this article is available at .     

Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience

Veterans’ Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n = 21) and veteran participants (n = 4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n = 19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed.     

Clarifying the role of belief-motive explanations in multi-stakeholder realist evaluation

In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders’ belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders’ belief-motive explanations (‘we believe the program works’) in realist evaluation is clarified and discussed.     

Factors affecting the organizational responses of employers to workers with injuries

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.     

Advances in collaborative evaluation

Collaborative evaluation is an approach that offers, among others, many advantages in terms of access to information, quality of information gathered, opportunities for creative problem-solving, and receptivity to findings. In the last decade, collaborative evaluation has grown in popularity along with similar participatory, empowerment, and utilization-focused evaluation approaches. Increasingly, it has brought together evaluators and stakeholders from different sectors, disciplines, and cultures to exchange knowledge on how collaboration can be used as a strategic tool for fostering and strengthening evaluation practice. O'Sullivan (2004) and Rodríguez-Campos (2005, 2008) brought forward collaborative evaluation conceptual frameworks that distinguished it from other approaches. This article updates those conceptual frameworks and discusses key collaborative evaluation advances in order to further clarify and facilitate engagement in sound practice.     

Public Sociology and the Democratization of Technology: Drawing on User -led Research to Achieve Mutual Education

In an effort to further advance public sociology and its relationship with technology, this paper looks at a democratic model of collaboration within the technological sciences. We draw on the concept of user- led research to demonstrate how sociologists, scientists and various stakeholders within the public sphere can achieve reciprocal, meaningful and sustained knowledge translation. Furthermore, we argue that by acknowledging participants’ technological needs and reducing unnecessary complexity, the user -led method advances Burawoy’s “dialogue as mutual education” within public sociology.     

An exploration of social support as a factor in the return-to-work process

Despite evidence that inter-personal relationships are important in human resource management, little is understood about the nature of workplace social support in a disability context, or what features of support are important to the success of return-to-work programs. The purpose of this qualitative study was to explore workplace disability support from worker and supervisory perspectives and to identify salient features for work re-entry. A total of 8 supervisors and 18 previously injured workers from a range of work units in a Canadian municipality were interviewed, and their views concerning supportive and unsupportive behaviours in work-re-entry situations were recorded and analyzed. A full range of social support dimensions were reported to be relevant, and were seen as arising from a variety of sources (e.g. supervisor, co-workers, disability manager, work unit, and outside of work). Respondents identified trust, communication and knowledge of disability as key precursors to a successful return-to-work process. Future research should explore the specific contributions of support to work rehabilitation outcomes as well as interventions to enhance available supports.     

Labor Supply Decisions of Disabled Male Workers

We use unique survey data, collected by the Workers’ Compensation Board of Ontario, to estimate the labor supply response of disabled male workers to benefit payouts and their post-injury wage. Our data enable us to fill gaps in the existing literature by estimating the hours as well as the return-to-work response for younger as well as older workers, based on objective rather than subjective self-reporting of disability status. Our results suggest a strong positive incentive effect from higher wages a and that lump-sum benefit payouts that are not reduced if earnings increased generally do not have adverse incentives on the return-to-work and hours decision, except for an income effect over the longer life cycle of younger men. We also discuss the policy implications of our estimates.

Advances in collaborative evaluation

Collaborative evaluation is an approach that offers, among others, many advantages in terms of access to information, quality of information gathered, opportunities for creative problem-solving, and receptivity to findings. In the last decade, collaborative evaluation has grown in popularity along with similar participatory, empowerment, and utilization-focused evaluation approaches. Increasingly, it has brought together evaluators and stakeholders from different sectors, disciplines, and cultures to exchange knowledge on how collaboration can be used as a strategic tool for fostering and strengthening evaluation practice. O'Sullivan (2004) and Rodríguez-Campos, 2005, Rodríguez-Campos, 2008 brought forward collaborative evaluation conceptual frameworks that distinguished it from other approaches. This article updates those conceptual frameworks and discusses key collaborative evaluation advances in order to further clarify and facilitate engagement in sound practice.     

Developing the Learning Door: a case study in youth participatory program planning

This article presents the results of a case study in youth participatory program planning conducted in the context of a nonformal technology-education program in eastern Finland. The purpose of the program was to have youth, university, and business stakeholders work together to create the Learning Door, a door that would meet the needs of older people and people with disabilities. The participatory program planning process that was used involved clarifying the mission, roles, and modes of collaboration as well as creating stakeholder matrices, logic models, program plans, and implementation plans. It was found that the observed program planning process was similar to the intended planning process and that the process was well received by the planning participants. The lessons learned include clarifying the nature of collaboration before the program gets underway, reviewing program planning steps often, and making clear distinctions between logic models and implementations plans.