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Prevalence, types, and combinations of multiple problems among recipients of work disability benefits
Disability and Rehabilitation
Abstract
Purpose
For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these “non-medical” problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients.
Methods
We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit.
Results
Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level.
Conclusions
Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management.
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Implications for rehabilitation
• Clients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs.
• Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation.
• For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.
... However, there is a scarcity of research investigating the prevalence, types, and combinations of different "non-medical" problems among those receiving work disability benefits (30). Moreover, even when life experiences are common, the context, perception, and consequences of these experiences can differ significantly among individuals. ...
... The health challenges among patients referred to occupational rehabilitation are characterized by a multitude of symptoms, especially musculoskeletal and mental health complaints, and comorbidities (30,(34)(35)(36)(37). Their employment history are also marked by frequent transitions in and out of the workforce both before and after rehabilitation (38). ...
... These studies linked financial problems and psychological violence to the highest short-term mental health risks, with all forms of violence increasing the risk of reduced mental health. While financial issues often result from other negative life events, such as divorce, job loss, or prolonged sickness absence, studies identify financial issues as independently associated with severe health effects (30,64). Most of the participants in our study are also working in occupations which are associated with high sickness absence due to musculoskeletal disorders, such as manual occupations and service and care workers (65). ...
Introduction
Adverse childhood experiences (ACEs) are prevalent globally and can negatively impact an individual's lifespan by not only increasing the likelihood of encountering other negative life events (NLEs), but also escalating the risk of illness, absenteeism due to sickness, unemployment, and reliance on disability benefits in adulthood. Therefore, the objective of this study was to explore the prevalence of ACEs and NLEs, as well as their health impacts among patients undergoing occupational rehabilitation.
Materials and methods
A total of 80 participants diagnosed with musculoskeletal disorders and/or common mental disorders who participated in two occupational rehabilitation programs in Norway were included. Data were collected by questionnaire and in-depth interviews (39 participants) at the start of the intervention. Comparative quantitative and qualitative analysis was conducted between individuals with a history of ACEs and those without these experiences. Thematic analysis was used to identify the impact of ACEs and NLEs on the health of the informants.
Results
Half of the participants reported ACEs. Of these, 18% reported one ACE, 22% reported 2–3 ACEs and 9% reported 4 or more ACEs. Also, 25% were categorized as revictimized. The two groups with ACEs had more NLEs in adulthood compared to those without ACEs ( p < 0.001), revictimized the most (mean numbers between groups 3.1, 4.5 and 5.9). Furthermore, a history of ACEs was associated with a higher number of reported mental health issues compared to those who had not experienced ACEs ( p < 0.01). However, there were no significant differences between the two ACE groups. NLEs had a substantial impact on the participants’ current health status, whether they occurred in childhood or adulthood. In adult life, a high workload (psychologically or physically), interpersonal challenges, and financial struggles had an especially negative impact. Additionally, accidents and complications related to surgeries were also significant NLEs causing health problems. For most, there were complex interactions between NLEs and health.
Conclusions
The prevalence of ACEs and NLEs is high among occupational rehabilitation patients. ACEs are associated with subsequent victimization, interpersonal challenges, financial struggles, and increased mental health issues in adulthood. These findings highlight the need for systematic screening and a holistic, individualized approach in occupational rehabilitation programs to potentially mitigate the adverse effects of NLEs on health and work participation.
... A high proportion of persons claiming work disability face multiple problems [1,2]. They have to deal with two or more related, and possibly mutually reinforcing, problems over longer periods of time, resulting in problematic participation in society and the labour market [3]. ...
... They have to deal with two or more related, and possibly mutually reinforcing, problems over longer periods of time, resulting in problematic participation in society and the labour market [3]. In a recent cross-sectional survey among a Dutch sample of disability benefit recipients, 87% reported experiencing multiple problems, including having poor health, a mismatch in education, financial problems, or care for family members [1]. For people with disabilities the chances to find or keep paid employment were negatively affected by these multiple problems [4,5]. ...
... However, most of the current interventions are problem-centred, i.e., focused on problems, and on seeking expert and compensatory support for each problem separately, without taking into account other (non-health-related) factors that could obstruct participation in work. Because multiple problems are interconnected and interact with each other, they cannot be addressed separately and require a more complex intervention [1,8,10]. ...
Purpose:
As the effect evaluation of our randomized controlled trial the "Comprehensive Approach of Reintegration for clients with Multiple problems" (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol.
Methods:
Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems.
Results:
Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes.
Conclusion:
The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol.
... To comply with national studies, our study has defined having multiple problems as follows: Persons have multiple problems when they have to deal with two or more related and possibly reinforcing problems for a longer period of time, and they are unable to develop and conduct adequate management to control or solve the problems; this results in problematic participation in society and the labour market [6]. Because multiple problems are interconnected and interact with each other, they cannot be addressed in isolation from one another [4, 12,13]. Due to multiple problems, people seem to get into a vicious circle of solving one problem only to be confronted with the next [12]. ...
... Due to multiple problems, people seem to get into a vicious circle of solving one problem only to be confronted with the next [12]. Previous research has shown that the prevalence of multiple problems among people on work disability benefits is high, and can increase up to 10 problems per individual [13,14]. In our previous studies we found that, besides health issues, most clients on work disability benefit perceived additional problems such as relational problems, financial problems, domestic problems, addiction, and educational problems [13,15]. ...
... Previous research has shown that the prevalence of multiple problems among people on work disability benefits is high, and can increase up to 10 problems per individual [13,14]. In our previous studies we found that, besides health issues, most clients on work disability benefit perceived additional problems such as relational problems, financial problems, domestic problems, addiction, and educational problems [13,15]. For people with disabilities the chances to find or keep work were negatively affected by these multiple problems [6,7]. ...
Purpose:
Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the "Comprehensive Approach to Reintegrate clients with multiple problems" (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks.
Methods:
This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support.
Results:
We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients' mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes.
Conclusion:
As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention. IMPLICATIONS FOR REHABILITATIONMost traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems.A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients' wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems.In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.
... Finding and keeping a job is more difficult for some people than for others: labour market participation among people with work disabilities is low compared to among people without work disabilities [6,7]. In the context of this paper, the term "people with work disabilities" refers to people facing physical, psychological and/or social limitations that hinder their ability to find and maintain employment [8][9][10][11]. People with work disabilities often depend on agencies such as municipalities or social security offices to receive support in finding and keeping a job. It is important that the services of these agencies are evidence based, to increase their effectiveness. ...
... Studies that included participants with mental health disorders usually found limited or no effects, but in most of these studies this was explained by a low adherence to protocol [25][26][27]. Nevertheless, PWI might be a suitable intervention for people with work disabilities, because it can be used to systematically address the problems that these people may experience in multiple areas of life [8]. Since these problems can play a role in continuing employment, using PWI may especially increase the chances of sustainable employment. ...
Purpose
This study assessed the effectiveness of Individual Placement and Support (IPS), Participatory Workplace Intervention (PWI), and IPS + PWI on work participation and health of people with work disabilities.
Methods
A randomised controlled 2 × 2 factorial trial with 120 clients and an 18-month follow-up was performed. Differences between IPS and no-IPS and between PWI and no-PWI were assessed using log-rank tests and Cox proportional hazards models.
Results
In the IPS group, restricted mean survival time (RMST) for sustainable paid employment was 352 days, compared to 394 in the no-IPS group (HR = 1.47, 95% CI = 0.81–2.63). In the PWI group the RMST was 378 days, compared to 367 in the no-PWI group (HR = 0.89, 95% CI = 0.48–1.64). For the secondary outcome ‘starting any paid employment, a trial placement, or education’ RMST was significantly lower for the IPS group (222 days) than for the no-IPS group (335 days; HR = 1.85, 95% CI = 1.01–3.42). Mental health was significantly lower (worse) in the PWI group (difference -4.07, 95% CI = -7.93 to -0.22) than in the no-PWI group. For all other secondary outcomes, no statistically significant differences were found.
Conclusion
No statistically significant differences were observed in the duration until starting sustainable employment between IPS and no-IPS, and between PWI and no-PWI. The duration until starting any paid employment, a trial placement, or education was shorter in the IPS group than in the no-IPS group, but further research should explore whether this also increases sustainable employment in the longer term.
... A reason why different interventions are effective in a later stage of the RTW-process could be that people on long-term sick leave often experience multiple problems that play an important role in prohibiting them from returning to work [8,9] that take more time to address. On top of this, they often suffer from multiple disorders [10], experience multiple psychosocial problems [11] and multiple social disadvantages [12] in comparison to people with shorter sick leave. VR interventions specifically targeting people on long-term sick leave should address these problems, to increase work participation of this group. ...
Purpose
The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions.
Methods
Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies.
Results
11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not.
Conclusion
The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.
Purpose:
People with a work disability pension receive vocational rehabilitation (VR) services from the Dutch Social Security Institute (SSI) in order to facilitate return-to-work (RTW). The SSI offers tailored VR existing of two trajectories (aimed at getting fit for work or aimed at returning to work). The purpose of this study is to describe the current practice of VR. This includes a description of client characteristics, RTW barriers and the intensity, duration, content and the outcomes of the offered trajectories.
Materials and methods:
We analyzed data from 197 clients that were randomly selected from clients who attended a VR trajectory between 1 January t 2017 and 31 December 2018. Data were obtained from the SSI registration databases and client files.
Results:
Both VR trajectories at the SSI have a different aim, but in practice the content of the VR interventions often overlaps. Around half of both trajectories reached their goal. Reasons for unsuccessful trajectories were that the client did not find work or barriers were more complex than initially assessed.
Conclusions:
The SSI delivers tailored VR to the specific needs of the client, however substantiations for why a certain VR intervention is offered are limited. Guidelines are needed to support professionals.
Purpose
Many high-income countries are witnessing a shift of focus on eligibility for disability benefits towards promotion of work reintegration. However, little is known about how countries assess work capacity, and how a job match is then obtained. The current study aims to compare work capacity assessments and available efforts to achieve a job match in eight high-income OECD countries.
Methods
A survey was conducted among key stakeholders concerning organization of work capacity assessments in social security settings, and efforts made to obtain a job, across eight OECD countries: Australia, Denmark, Finland, Iceland, Sweden, the Netherlands, the United Kingdom and the United States.
Results
In most countries, work capacity is assessed at several time points, with variations in moments and in information used for job matching. In countries obtaining information on personal and work levels, the search to find a job match usually begins with the persons who have disabilities.
Conclusion
Although a shift towards a holistic focus in work capacity assessment has been recognized, medical factors still prevail. Limited emphasis is placed on the implications of functional limitations for the possibilities of work. A holistic approach to assessment needs to be coupled with holistic support measures through provision of coordinated and high quality job matching services.
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IMPLICATIONS FOR REHABILITATION
• Besides determining eligibility for benefits the outcome of the work capacity assessment can also be used for other purposes such as reintegration and should not result in a static description of work capacity but also deliver insight in support needs.
• Involving multiple institutions and disciplines in work capacity assessments may result in a broader overview of the claimants’ capacities, however this places high demands on cooperation and data sharing of all those involved.
• Incorporating the claimants own perspective on work capacity and possibilities to work might improve the legitimacy of the process and reasonably also the achievement of a good and sustainable job match. This can be achieved by using self reported questionnaires and interviews in the assessments.
Background:
The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes.
Methods:
Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results.
Results:
Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura's concept of self-efficacy.
Conclusions:
The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity.
Trial registration:
PROSPERO registration CRD42019124760. Registration date 17/4/19.
Background:
For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems.
Methods:
The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2-17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs.
Results:
Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client's situation. Three months after the training, LEs almost unanimously agreed on the statements 'I expect to use the CARm method more frequently in the future' and 'I use the CARm method in daily practice whenever possible'. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7-9). The overall satisfaction with the trainers was good.
Conclusions:
The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.
Background:
Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.
Methods:
Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.
Results:
The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.
Conclusion:
Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.
Background
This study aims to provide insight into (1) the associations between having a chronic disease and participation in paid work, volunteer activities or informal care, (2) the associations between the onset of a chronic disease and these forms of societal participation, and (3) whether these associations differ across educational level and gender.
Methods
The study population consisted of n=21 875 respondents of the Survey of Health, Ageing and Retirement in Europe aged between 50 years and the country-specific retirement age. The influence of having and the onset of a chronic disease on societal participation was analysed using a hybrid Poisson regression model, combining fixed and random effects, and presented by relative risks (RRs).
Results
Individuals with a chronic disease were less likely to participate in paid work (RR: 0.69; 95% CI 0.67 to 0.71) and volunteer activities (RR: 0.92; 95% CI 0.88 to 0.97), but more likely to give informal care (RR: 1.05; 95% CI 1.01 to 1.08). Onset of a chronic disease was associated with a higher likelihood to quit paid work (RR: 0.91; 95% CI 0.86 to 0.97) and to give informal care (RR: 1.08; 95% CI 1.01 to 1.16). Lower educated individuals with a chronic disease or with the onset of a chronic disease were less likely to have paid work than higher educated individuals.
Conclusion
Individuals with a chronic disease were less likely to participate in paid work and volunteer activities, and more likely to provide informal care. Educational inequalities were present for paid work. More insight into which factors hinder societal participation among individuals with a chronic disease is needed.
Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.
Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.
Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.
Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.
• Implications for Rehabilitation
• Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.
• In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.
• Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.
Purpose: This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders.
Method: The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis.
Results: The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise.
Conclusions: The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field.
Background: access to effective healthcare is in particular challenging for vulnerable and socially disadvantaged patients. Patients with chronic conditions are over-represented in these lower socioeconomic (LSES) groups. No generic review integrating the evidence on Self-Management support interventions in LSES patients with different chronic conditions exists.
Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment.
14,708 Dutch employees participated in a ten-year follow-up study during 1999-2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach.
Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors.
There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.
Activation policies aimed at getting working-age people off benefits and into work have become a buzzword in labour market policies. Yet they are defined and implemented differently across OECD countries, and their success rates vary too. The Great Recession has posed a severe stress test for these policies, with some commentators arguing that they are at best “fair weather” policies. This paper sheds light on these issues mainly via the lens of recent OECD research. It presents the stylised facts on how OECD countries have responded to the Great Recession in terms of ramping up their spending on active labour market policies (ALMPs), a key component in any activation strategy. It then reviews the macroeconomic evidence on the impact of ALMPs on employment and unemployment rates. This is followed by a review of the key lessons from recent OECD country reviews of activation policies. It concludes with a discussion of crucial unanswered questions about activation.
JEL codes: J01, J08, J68
Faced with economic uncertainty and declining retirement security, older adults have increasingly tried to remain in, or return to, the workforce in recent years. Unfortunately, a host of factors, such as ageism and changing skill requirements, present challenges for older adults seeking employment. Low-income older adults, in particular, may lack necessary education and skills and have limited access to job opportunities and training. In this review, we examine factors that inhibit and support employment for low-income older adults and explore the role of social work in facilitating their inclusion in the workforce.
The focus of current government policy on maximising labour market participation among those of working age is known to have particular implications for people with multiple problems and needs. This article reports preliminary findings from a study based on in-depth interviews with 50 people with experience of not only unemployment, but several additional problems, such as homelessness, ill-health or disability, substance abuse, the criminal justice system, and disruptive family relationships. It points particularly to the traumatic nature of the lives experienced by many of those participating in the study and to the corrosive culture of self-blame to which they were subject. It concludes by arguing for more holistic ways of supporting people in such situations and for a different approach to assessing 'job readiness'.
A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been promoted as one such potential approach.
One of the acknowledged limitations of British welfare-to-work policies has been that they do not necessarily succeed in assisting people with multiple problems and needs. This article will first examine conflicting aspects of welfare-to-work policies and the conflict between welfare-to-work and the concept of work–life balance, particularly as this may apply to people whose lives are especially difficult. Secondly, the article reports on the general findings of a small scale
qualitative study of the labour market experiences of people with multiple problems and needs and, more particularly, an analysis of the discursive strategies used by participants in
the study. The article concludes with some observations about how welfare-to-work might be re-conceptualised to accommodate ontological as well as practical life needs.
To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations.
Studies that were included targeted interventions toward socially disadvantaged adults with type 1 or type 2 diabetes; were conducted in industrialized countries; were measured outcomes of self-management, provider management, or clinical outcomes; and were randomized controlled trials, controlled trials, or before-and-after studies with a contemporaneous control group. Seven databases were searched for articles published in any language between January 1986 and December 2004. Twenty-six intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions.
Eleven of 17 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included cultural tailoring of the intervention, community educators or lay people leading the intervention, one-on-one interventions with individualized assessment and reassessment, incorporating treatment algorithms, focusing on behavior-related tasks, providing feedback, and high-intensity interventions (>10 contact times) delivered over a long duration (>or=6 months). Interventions that were consistently associated with the largest negative outcomes included those that used mainly didactic teaching or that focused only on diabetes knowledge.
This systematic review provides evidence for the effectiveness of interventions to improve diabetes care among socially disadvantaged populations and identifies key intervention features that may predict success. These types of interventions would require additional resources for needs assessment, leader training, community and family outreach, and follow-up.
Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical intervention might begin. Hence, as in the case of Sisyphus and his rock, the self-management process is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, self-management, from an ideological perspective, represents a minor adjustment to the fabric of our health system.
Abstract
Aim: To assess the quality of evidence and determine the effect of patient-related and economic outcomes of self-management support interventions in chronically ill patients with a low socio-economic status.
Background: Integrated evidence on self-management support interventions in chronically ill people with low socio-economic status is lacking.
Design: Systematic literature review.
Data sources: Cochrane database of trials, PubMed, CINAHL, Web of Science, PsycINFO and Joanna Briggs Institute Library were searched (2000–2013). Randomized controlled trials addressing self-management support interventions for patients with cardiovascular disease, stroke, cancer, diabetes and/or chronic respiratory disease were included.
Review methods: Data extraction and quality assessment were performed by independent researchers using a data extraction form.
Results: Studies (n = 27) focused mainly on diabetes. Fourteen studies cited an underlying theoretical basis. Most frequently used self management support components were lifestyle advice, information provision and symptom management. Problem-solving and goal setting strategies were frequently integrated. Eleven studies adapted interventions to the needs of patients with a low socio-economic status. No differences were found for interventions developed based on health behaviour theoretical models.
Conclusion : Limited evidence was found for self-management support interventions in chronically ill patients with low socio-economic status.
Essential characteristics and component(s) of effective self-management support interventions for these patients could not be detected.
Rigorous reporting on development and underlying theories in the intervention is recommended.
Domestic violence affects every age group and is present throughout the life span, but, while the mental health impact of domestic violence is clearly established in working age adults, less is known about the nature and impact of domestic violence among older adults. This review, therefore, aimed to synthesize findings on the prevalence, nature, and impact of domestic violence among older adults, and its identification and management. Electronic searches were conducted of Medline, PsycINFO, Cinahl, and Embase to identify studies reporting on the mental health and domestic violence in older adults. Findings suggested that, although prevalence figures are variable, the likely lifetime prevalence for women over the age of 65 is between 20–30%. Physical abuse is suggested to decrease with age, but rates of emotional abuse appear to be stable over the lifespan. Among older adults, domestic violence is strongly associated with physical and mental health problems, and the scarce research comparing the impact of domestic violence across the age cohorts suggests that the physical health of older victims may be more severely affected than younger victims. In contrast, there is evidence that older victims may experience less psychological distress in response to domestic violence than younger victims. Internationally, evidence on the management of domestic violence in older adults is sparse. Findings suggest, however, that identification of domestic violence is poor among older adults, and there are very limited options for onwards referral and support.
Purpose:
When it is possible that the employee's work ability can be restored through treatment or rehabilitation, disability pension in Finland is granted for a fixed period. We examined which factors are associated with return to work (RTW) after such temporary disability pension.
Methods:
The study included all Finnish residents whose temporary disability pension from the earnings-related pension system started in 2008 (N = 10,269). Competing risks regression analysis was applied to examine register-based determinants for RTW after temporary disability pension due to mental disorders, musculoskeletal diseases, other diseases, and injury over a 4-year follow-up period.
Results:
The overall cumulative incidence of RTW was 25%. RTW was more probable after temporary disability pension due to injury and musculoskeletal diseases and less probable after temporary disability pension due to mental disorders. Younger age and higher education increased RTW but differences between genders, private and public sector employees, and occupational classes were relatively small. The probability of RTW was higher among those who were employed before their temporary disability pension (subhazard ratio in multivariate analysis 2.41 (95% CI 2.13-2.72) and among the 9% who participated in vocational rehabilitation during their pension [SHR 2.10 (95% CI 1.90-2.31)]. With some exceptions, the results were fairly similar for all diagnostic causes of temporary disability pension.
Conclusion:
Return to work after temporary disability pension was relatively uncommon. Nevertheless, in all diagnostic groups RTW continued for the whole follow-up period. The low educated and those not employed before temporary disability pension need more support in their RTW. The strong association between vocational rehabilitation and RTW suggests that increasing rehabilitation among those with impaired work ability may promote RTW.
The landmark 1996 welfare reform legislation required welfare participants to transition rapidly into the labor market. However, many welfare participants have not fared well in the competition for jobs because they face multiple barriers to employment. This study draws on data from a California job readiness survey of welfare participants to examine the effects of employment barriers on male and female welfare participants. The results of logistic modeling show that individual barriers negatively affect employment outcomes and that the likelihood of employment declines with an increasing number of barriers. These findings suggest that economic development programs intended to aid welfare participants in making a successful transition into the labor market must move beyond piecemeal approaches to meeting the needs of welfare participants and include comprehensive strategies that address multiple barriers to employment.
This article presents some results of a random household survey that examined the effects of domestic violence on the labor force participation of 824 women living in a low-income neighborhood. It also uses data from twenty-four long interviews.
Eighteen percent of the respondents reported having experienced physical aggression in the past twelve months, and 11.9% reported more severe physical violence. Women who reported abuse were more likely to have experienced unemployment and held more jobs and to report more health problems. They also had lower personal incomes, and were significantly more likely to receive public assistance. At the same time, women who reported abuse were employed in roughly the same numbers as those who did not. Thus, it appears that domestic violence may depress women’s socioeconomic and occupational status attainment over time, but does not affect employment status per se. The article concludes with comments about the implications of the findings for the redesign of public assistance and job training programs.
Having a disability is a barrier to securing and maintaining employment. Most research has focussed on employment barriers among adults, while very little is known about young people's experience finding paid work.
Young people aged 15-24 were selected from the 2006 Participation and Activity Limitation Survey to explore the barriers and discrimination they experienced in seeking employment (n = 1898).
Our findings show that teens and young adults with disabilities encountered several barriers and discrimination in seeking paid employment. The types of barriers that these young people encountered varied by age and type of disability. There were fewer yet different types of barriers to working that were encountered between the two age groups (teens and young adults). Several socio-demographic factors also influenced barriers to working. Severity of disability, type and duration of disability, level of education, gender, low income, geographic location and the number of people living in the household all influenced the kind of barriers and work discrimination for these young people.
Rehabilitation and life skills counsellors need to pay particular attention to age, type of disability and socio-demographic factors of teens and young adults who may need extra help in gaining employment.
The Chronic Disease Self-management Programme (CDSMP) is a psycho-educational programme designed to increase the capacity of people with chronic conditions to self-manage. This initiative forms an integral part of the 'Expert Patient Programme' in the UK and the 'Sharing Health Care' programme in Australia. The aim of this paper is to critically appraise the principles of the CDSMP as a national self-care policy initiative in the context of existing formations and ideological approaches to self-care. Although the CDSMP appears to promote a 'social model' of disability, particularly in its generic manifestation, the use of the notion of self-efficacy as a primary marker of change means that it ultimately falls back onto an individualistic approach. The latter ignores pre-existing traditions of self-help embedded within advanced welfare societies.. We argue that state sponsored polices about self-management would benefit from greater recognition of existing social knowledge and theories about how people respond to being diagnosed with a long-term condition. Yes Yes
Mickey, R. M. (Dept of Mathematics and Statistics, U. of Vermont, Burlington, VT 05405) and S. Greenland. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–37.
Much controversy exists regarding proper methods for the selection of variables in confounder control. Many authors condemn any use of significance testing, some encourage such testing, and others propose a mixed approach. This paper presents the results of a Monte Carlo simulation of several confounder selection criteria, including change-in-estimate and collapsibility test criteria. The methods are compared with respect to their Impact on Inferences regarding the study factor's effect, as measured by test size and power, bias, mean-squared error, and confidence Interval coverage rates. In situations in which the best decision (of whether or not to adjust) is not always obvious, the change-in-estimate criterion tends to be superior, though significance testing methods can perform acceptably If their significance levels are set much higher than conventional levels (to values of 0.20 or more).
One hundred thirteen individuals, ages 18-81, were presented with a test of social problem solving, a test of practical problem solving, the Twenty Questions task (a test of traditional problem solving), the Wechsler Adult Intelligence Scale--Revised Vocabulary subtest (a measure of crystallized intelligence), and Raven's Progressive Matrices (a measure of fluid intelligence). The effects of age, sex, education, and intellectual abilities on problem-solving performance were examined. Social problem solving was positively related to higher education and higher Vocabulary scores, but it was not related to age. Social problem solving and practical problem solving were significantly related to each other and to scores on the Vocabulary subtest, whereas traditional problem solving was significantly related to scores on Raven's Progressive Matrices. These results suggest that different types of problem solving are differentially related to other intellectual abilities and to age.
To estimate the prevalence of mental disorders and psychological distress among Australian income support recipients.
Data from the 1997 National Survey of Mental Health and Wellbeing were used to examine measures of mental health, disability and use of mental health services, comparing working-age people in receipt of government payments to those with other main sources of income.
One-quarter of all income support recipients had experienced substantial levels of psychological distress during the previous four weeks and almost one in three had experienced a diagnosable mental disorder during the previous 12 months. Around 45% of unpartnered women with children in receipt of income support payments were identified with a mental disorder. In contrast, around 10% of people not receiving welfare reported substantial psychological distress and 19% had a diagnosable mental disorder. The prevalence of physical and mental disability was also greater among income support recipients. There was no difference in service use between recipients and non-recipients.
Mental illness is a significant issue among income support recipients. The presence of a mental disorder is a substantial barrier to work and other forms of social participation. Mental health is an issue with relevance beyond the health portfolio, with implications for many domains of social policy and service delivery. Understanding and better assisting income support recipients with mental health problems will be important in welfare reform and in the introduction of a more active welfare system.
Barriers to employment among long-term beneficiaries: a review of recent international evidence. Wellington: Ministry of Social Development
- S G Singley
Singley SG. Barriers to employment among long-term beneficiaries: a review of recent international evidence.
Wellington: Ministry of Social Development; 2003.
Multiple disadvantage in employment: a quantitative analysis. York: Joseph Rowntree Foundation
- R Berthoud
Berthoud R. Multiple disadvantage in employment: a quantitative analysis. York: Joseph Rowntree Foundation; 2003.
Clients with multiple problems. An orientation and report in relation to (labour)participation (Multiproblematiek bij cli€ enten
- H Bosselaar
- Maurits E Molenaar-Cox
Bosselaar H, Maurits E, Molenaar-Cox P, et al. Clients with
multiple problems. An orientation and report in relation to
(labour)participation (Multiproblematiek bij cli€ enten.
A future that works: Economic, Employment and the evironment
- D Perkins
- L Nelms
Perkins D, Nelms L. Assisting the most disadvantaged job
seekers. In: Carlson E, editor. A future that works:
Economic, Employment and the evironment. Newcastle:
Center of Full Employment and Equity, University of
Newcastle; 2004.
Assessing disability in working age population
- J Bickenbach
- A Posarac
- A Cieza
Bickenbach J, Posarac A, Cieza A, et al. Assessing disability
in working age population. In: A Paradigm Shift: from
impairment and Functional Limitation to the Disability
Approach. Washington (DC): World Bank; 2015.
Clients with multiple problems. An orientation and report in relation to (labour)participation (Multiproblematiek bij cliënten. Verslag van een verkenning in relatie tot (arbeids)participatie (in Dutch). Meccano kennis voor beleid en AStri Beleidsonderzoek en-advies
- H Bosselaar
- Maurits E Molenaar-Cox