Fit for Work? The Influence of Sick Pay and Job Flexibility on Sickness Absence and Implications for Presenteeism

Recent developments in UK policy on health and employment have sought to change perceptions about what constitutes ‘fitness for work’. With the aim of reducing the incidence and duration of sickness absence, a range of initiatives, including the introduction of the ‘fit note’, are challenging the belief that it is necessary to be 100 per cent well in order to be at work. However, this article suggests that contextual factors independent of health may also influence people's decisions about whether or not to attend work at times of reduced wellness. Drawing upon data from a qualitative study of mental health and employment, this article illustrates how the terms and conditions of a person's employment may influence sickness absence decisions in a number of ways. It is argued that sick pay provisions, size of employer and nature of work may influence both decisions to take time off and decisions about when to return to work. The degree of flexibility to manage one's workload around times of poorer health may also have a bearing on whether people feel able to carry on with their work without recourse to sickness absence. Therefore, it may be important for policy interventions to consider not only health circumstances but also structural/contextual influences on conceptualizations of being ‘fit for work’. The implications of such contextually‐influenced decision‐making for ‘presenteeism’ are also considered. It is suggested that current conceptualizations of presenteeism are somewhat ambiguous; employees coming to work despite ill health is simultaneously presented as a problem and an aspiration.     

Health and community services for trafficked women: an exploratory study of policy and practice

The trafficking of women has attracted considerable international and national policy attention, particularly since the UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (2000), of which the Australian Government has been a signatory since 2005. The provision of health and community services for trafficked women is a central feature of this Protocol, but in Australia service provision is made difficult by how trafficked women are understood and treated in policy and legal terms. This study aimed to explore the provision of health and community services for trafficked women in the Greater Sydney region through a series of interviews with government and non‐government organisations. The findings reveal that services have been inaccessible as a result of sparse, uncoordinated, and poorly funded provision. The major obstacle to adequate and appropriate service provision has been a national policy approach focusing on ‘border protection’ and criminalisation rather than on trafficked women and their human rights. We conclude that further policy development needs to focus on the practical implications of how such rights can be translated into the delivery of health and community services that trafficked women can access and be supported by more effectively.     

Making better regulation,making regulation better?

Better Regulation is a re-regulatory strategy that has unfolded in Britain (and, of course, beyond, through Europe and the OECD) across the past decade. This article beings by setting out some quantitative indicators of trends in national and local enforcement in three key areas of protective regulation – food hygiene and food safety, workers’ health and safety, and pollution control – from 2003/2004 to 2012/2013. It then goes on, in its main sections, to detail some of the ways Better Regulation under conditions of austerity has worked through at the level of local enforcement via a case study of four Merseyside Local Authorities; in so doing, it draws principally upon qualitative insights from a series of interviews, as well as data gleaned from a further series of Freedom of Information requests. In so doing, it considers how, on the ground, Better Regulation is made. It concludes that Better Regulation appears less about ‘better’ regulation, more about business-friendly regulation with diminishing law enforcement. There is good reason to suggest that regulatory functions will likely be increasingly re-cast as part of growth initiatives.     

Hitting the target without missing the point: New Zealand’s immunisation health target for two year olds

ABSTRACT

The use of health targets as a form of performance measurement has become more prominent internationally as governments have sought to control public expenditure, produce greater efficiency and improve accountability. However, health targets have faced criticism for their potential to produce negative outcomes within a health system. This paper examines how a health target was used as a policy instrument within the New Zealand health system to improve immunisation coverage at two years of age. It explores how the immunisation health target was implemented within four case study sites and discusses the effectiveness of the health target as a policy instrument for improving immunisation coverage and addressing persistent immunisation inequities. Measuring and monitoring performance towards the immunisation health target improved accountability for immunisation coverage within the New Zealand health system and focused attention on improving immunisation coverage in a way that previous policy attempts had failed to do. Health targets may be an effective policy instrument for creating change within specific areas of a health system if their potential for dysfunctional consequences are taken into consideration at the outset.     

Mechanisms of the Effect of Involuntary Retirement on Older Adults’ Self-Rated Health and Mental Health

This study examined mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 or older. Using two waves of the Health and Retirement Study (2006 and 2010), we selected a sample of 1,195 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves. Regression-based path analyses were conducted to test the mediating effects of financial control, positive and negative family relationships, and social integration on the relationship between involuntary retirement and self-rated health and mental health. Results of mediation analyses indicated that transition to involuntary retirement was directly negatively associated with subsequent self-rated health and indirectly negatively associated with mental health via perception of less financial control. Voluntary retirement was indirectly positively associated with both self-rated and mental health via perception of more financial control. No significant direct or indirect effects of retirement were found when retirement was measured with an aggregate measure without specifying its voluntariness. Findings emphasize the importance of specifying the voluntariness of retirement and recognizing the heterogeneity in the mechanisms of involuntary and voluntary retirement.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

Examining the Relationships Between Resilience,Mental Health,and Academic Persistence in Undergraduate College Students

Abstract

Objective: In this study, the relationships between measures of interpersonal resilience, intrapersonal resilience, and mental health were examined with respect to academic and social integration, key determinants of academic persistence. Participants: A sample (n = 605) of undergraduate students was recruited from 2 midwestern universities during the 2007–2008 academic year. Methods: Hierarchal (or sequential) regression analysis examined whether the inter- and intrapersonal resilience and mental health measures contributed to explaining variance in the response variables of university cumulative grade point average (GPA) and university sense of belonging. Results: The intrapersonal resilience factors contributed to explaining variance in cumulative GPA in addition to aptitude and achievement. Furthermore, there was a strong statistical correlation between the inter- and intrapersonal resilience factors and mental health. Conclusions: The demands in college are significant and there is a need for more research on the concept of resilience as it relates to college health and academic persistence.     

The Effect of Graduate School on Identity Issues

Abstract

Objectives: To provide a critical review of the efficacy of brief interventions for alcohol use in college health centers. Methods: Studies were included if (a) they examined brief intervention trials that were conducted in college- or university-based student health centers or emergency departments, and (b) they provided pre–post data to estimate change. Results: Twelve studies suggested that screening and brief interventions in these settings are acceptable, feasible, and promote risk reduction. Conclusions: Findings support continued use of time-limited, single-session interventions with motivational interviewing and feedback components.     

The Infirmary as a Short-Term Psychiatric Facility

Abstract

The purpose of this study was to describe the role of the Oregon State University Infirmary (inpatient unit) in the provision of crisis intervention services for students with emotional problems. The focus was on the working assumptions of the infirmary program, the patient population which utilized the infirmary, the dimensions of treatment, and treatment outcomes.

Data were collected for a three year span on all patients who had contact with the infirmary for problems of an emotional nature. Records were reviewed for demographic variables, presenting symptomatology, diagnosis, treatment, disposition, and outcomes. Comparisons were made between these patients and those who received outpatient services through the Oregon State University Mental Health Clinic.

Demographic data indicated that patients who were treated in the infirmary differed only slightly from either the general student population of the university or from students receiving outpatient services. Presenting symptoms reflected a wide range of emotional problems. The severity of psychopathology was demonstrated by the finding that one-quarter of the patients manifested symptoms of acute psychosis, suicidal preoccupation, acute drug reaction, or toxic alcohol reaction. Consistent with the working assumptions of the program, the focus of treatment was short-term, intensive, and symptom directed. Treatment outcomes as determined by followup data were generally positive.

It was concluded that the infirmary provided an important treatment option which extended rather than duplicated outpatient services. The need for such an option was clearly demonstrated. The study was supportive of the concept that a university infirmary has the potential for utilization as a multipurpose facility.