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Anderson O, McLennan V, Randall C. Treatment and provider choice in worker injury rehabilitation: A systematic literature review. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-211171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: In the face of significant costs for injured worker rehabilitation and its impact on society, ongoing examination of how rehabilitation is carried out is warranted. OBJECTIVE: To review recent studies that explored the impact of the worker’s choice in terms of provider and treatment on the outcome for the worker in injury rehabilitation. METHOD: A systematic literature review was conducted using searches through electronic databases, with studies retrieved then subjected to a quality appraisal. RESULTS: Nineteen studies were eligible for inclusion. Studies reviewed found that choice of provider or treatment generated more positive outcomes for workers, and workers preferred a treatment provider familiar with their care. The worker’s ability to exercise choice was affected by conflict with other stakeholders and misalignment of expectations. The relationship between choice and costs was unclear, sometimes conflicting. CONCLUSIONS: The impact of treatment and provider choice on outcomes for workers remains unclear. The worker’s ability to choose may be hampered by systemic constraints, access to preferred providers, misalignment of stakeholder expectations, and the worker’s ability to engage in decision making. Greater worker engagement in their rehabilitation could potentially reduce costs as well as improve psychosocial outcomes.
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Affiliation(s)
- Olwen Anderson
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Queensland, Australia
| | - Vanette McLennan
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Queensland, Australia
| | - Christine Randall
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Queensland, Australia
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Sears JM, Edmonds AT, MacEachen E, Fulton-Kehoe D. Appraisal of Washington State workers' compensation-based return-to-work programs and suggested system improvements: A survey of workers with permanent impairments. Am J Ind Med 2021; 64:924-940. [PMID: 34462931 PMCID: PMC8500921 DOI: 10.1002/ajim.23289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Following a work-related permanent impairment, injured workers commonly face barriers to safe and successful return to work (RTW). Examining workers' experiences with the workers' compensation (WC) system could highlight opportunities to improve RTW outcomes. Objectives included summarizing workers': (1) appraisal of several WC-based RTW programs, and (2) suggestions for vocational rehabilitation and WC system improvements to promote safe and sustained RTW. METHODS In telephone interviews, 582 Washington State workers with work-related permanent impairments were asked whether participation in specified WC-based RTW programs helped them RTW and/or stay at work. Suggestions for program and system improvements were solicited using open-ended questions; qualitative content analysis methods were used to inductively code responses. RESULTS Most respondents reported positive impacts from RTW program participation; for example, 62.5% of vocational rehabilitation participants reported it helped them RTW, and 51.7% reported it helped them stay at work. Among 582 respondents, 28.0% reported that no change was needed to the WC system, while 57.6% provided suggestions or critiques. Reduce delays/simplify process/improve efficiency was the most frequent WC system theme-mentioned by 34.9%. Among 120 vocational rehabilitation participants, 35.8% reported that no change was needed to vocational rehabilitation, while 46.7% (N = 56) provided suggestions or critiques. More worker choice/input into the vocational retraining plan was the most frequent vocational rehabilitation theme-mentioned by 33.9%. CONCLUSIONS This study's findings suggest that there is substantial room for improvement in workers' experience with the WC system. In addition, injured workers' feedback may reflect opportunities to reduce administrative burden and to improve worker health and RTW outcomes.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Amy T. Edmonds
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Ellen MacEachen
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Irvine A, Drew P, Bower P, Ardern K, Armitage CJ, Barkham M, Brooks H, Connell J, Faija CL, Gellatly J, Rushton K, Welsh C, Bee P. 'So just to go through the options…': patient choice in the telephone delivery of the NHS Improving Access to Psychological Therapies services. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:3-19. [PMID: 32959917 DOI: 10.1111/1467-9566.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient-practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving Access to Psychological Therapies (IAPT) service. Analysis of 66 recordings of telephone-delivered IAPT assessment sessions revealed three patterns through which choice of treatment delivery mode was presented to patients: presenting a single delivery mode; incrementally presenting alternative delivery modes, in response to patient resistance; and parallel presentation of multiple delivery mode options. We show that a distinction should be made between (i) a choice to accept or reject the offer of a single option and (ii) a choice that is a selection from a range of options. We show that the three patterns identified are ordered in terms of patient-centredness and shared decision-making. Our findings contribute to sociological work on healthcare interactions that has identified variability in, and variable consequences for, the ways that patients and practitioners negotiate choice and shared decision-making. Findings are discussed in relation to tensions between the political ideology of patient choice and practical service delivery constraints.
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Affiliation(s)
- Annie Irvine
- Department of Language and Linguistic Science, University of York, York, UK
| | - Paul Drew
- Department of Language and Linguistic Science, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Kerry Ardern
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Janice Connell
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cintia L Faija
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Charlotte Welsh
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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4
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The Duplicity of Choice and Empowerment: Disability Rights Diluted in Australia’s Policies on Assistive Technology. SOCIETIES 2019. [DOI: 10.3390/soc9020039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of choice as a contested concept and its increasing adoption as a policy principle necessitates a critical analysis of its interpretation within Australia’s reforms to disability services. While choice may appear to be an abstract and flexible principle in policy, its operationalization in practice tends to come with conditions. This paper investigates the interpretation of choice in the National Disability Insurance Scheme (NDIS), via an interpretive policy analysis of assistive technology (AT) provision. Analysis of policy artefacts reveals a diminishing influence of disability rights in favor of an economic discourse, and contradictory assumptions about choice in the implementation of legislation. The language of choice and empowerment masks the relegation of the presumption of capacity to instead perpetuate professional power in determining access to resources by people with disability.
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VanderKaay S, Moll SE, Gewurtz RE, Jindal P, Loyola-Sanchez A, Packham TL, Lim CY. Qualitative research in rehabilitation science: opportunities, challenges, and future directions. Disabil Rehabil 2016; 40:705-713. [PMID: 27973927 DOI: 10.1080/09638288.2016.1261414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field. METHODS Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions. RESULTS Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research. CONCLUSION Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential. Implications for Rehabilitation Qualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner-client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services. Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field. Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice. In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.
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Affiliation(s)
- Sandra VanderKaay
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Sandra E Moll
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Rebecca E Gewurtz
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Pranay Jindal
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | | | - Tara L Packham
- c Hamilton Health Sciences , Hand Therapy Clinic , Hamilton , Ontario , Canada
| | - Chun Y Lim
- d Department of Child Development , KK Women's And Children's Hospital , Singapore
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Petersen KS, Labriola M, Nielsen CV, Larsen EL. Work reintegration after long-term sick leave: domains of influence on co-workers' ability to be supportive. Disabil Rehabil 2016; 38:1872-83. [PMID: 26728089 DOI: 10.3109/09638288.2015.1107772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of the study is to identify domains of influence on co-workers' ability to be supportive of returning worker during the work reintegration (WR) process. METHODS An ethnographic study design was chosen involving fieldwork at four different workplaces, at an emergency care service, a waste disposal company and at two nursing homes. Qualitative methods for inquiry were used including participant observation, individual- and group interviews of 30 participants. Data were coded and analysed according to a grounded theory approach. RESULTS Four themes were identified related to domains of influence on co-workers' ability to be supportive of returning worker during the WR process: (1) organisation of work and level of interaction; (2) disruption of work routines, (3) relationship with returning worker and (4) attitudes towards sick leave. CONCLUSION The WR process after long-term sick leave is not only influenced by the WR's arrangements made, but also by the co-workers' responses to the process. Work arrangements not only affect the returning worker's ability to return-to-work (RTW) successfully, but also the co-workers' ability to be supportive and their ability to take active part in the process. Implications for Rehabilitation The process of WR after long-term sick leave involves interaction with co-workers. Domains of influence is in the co-workers' perspective influencing their ability to be supportive during reintegration of a returning worker. Future WR management could benefit from integrating the conditions for co-worker support. We encourage co-workers to be involved in the RTW planning, monitoring and evaluation with particular focus on how the WR arrangements are influencing their work and their ability to be supportive.
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Affiliation(s)
- Kirsten Schultz Petersen
- a Public Health and Quality Improvement, Central Denmark Region, Rehabilitation Center Marselisborg , Aarhus C , Denmark ;,b Department of Public Health , Section of Social Medicine and Rehabilitation, Aarhus University , Aarhus , Denmark
| | - Merete Labriola
- a Public Health and Quality Improvement, Central Denmark Region, Rehabilitation Center Marselisborg , Aarhus C , Denmark ;,b Department of Public Health , Section of Social Medicine and Rehabilitation, Aarhus University , Aarhus , Denmark
| | - Claus Vinther Nielsen
- a Public Health and Quality Improvement, Central Denmark Region, Rehabilitation Center Marselisborg , Aarhus C , Denmark ;,b Department of Public Health , Section of Social Medicine and Rehabilitation, Aarhus University , Aarhus , Denmark
| | - Eva Ladekjær Larsen
- a Public Health and Quality Improvement, Central Denmark Region, Rehabilitation Center Marselisborg , Aarhus C , Denmark ;,c Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark , Esbjerg , Denmark
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Sears JM, Wickizer TM, Schulman BA. Expanding vocational retraining options for injured workers: An experiment in worker choice. Work 2015; 52:663-76. [PMID: 26528841 DOI: 10.3233/wor-152129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An innovative self-directed vocational retraining alternative (Option 2) has been offered to eligible Washington State injured workers since 2008. OBJECTIVE We aimed to describe: (1) how frequently Option 2 was selected and by whom, (2) the extent to which Option 2 workers used their reserved retraining funds, and (3) how worker satisfaction and employment outcomes for Option 2 workers compared with those of workers undergoing traditional vocational retraining. METHODS Five-year cohort study involving workers' compensation data, state wage files, and two worker surveys. RESULTS Fewer than 25% of Option 2 workers used their retraining funds. Retraining fund use was associated with better employment outcomes. Workers who were older, whose preferred language was not English, or who had lower pre-injury wages or less education, were least likely to use Option 2 retraining funds. Many workers chose Option 2 because they thought the approved traditional retraining plan was not a good fit for them. CONCLUSIONS Self-directed retraining may benefit workers who have the ability, resources, and motivation to independently identify and complete retraining. Additional efforts may be needed to ensure that traditional retraining plans are well-suited to workers' circumstances, and to identify and remove barriers to use of reserved retraining funds.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Thomas M Wickizer
- Division of Health Services Management & Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Beryl A Schulman
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Premji S. Barriers to Return-to-Work for Linguistic Minorities in Ontario: An Analysis of Narratives from Appeal Decisions. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:357-67. [PMID: 25240395 DOI: 10.1007/s10926-014-9544-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Previous research has shown that linguistic minorities have inferior workers' compensation experiences and outcomes; however little information exists on the structural barriers they face in relation to return-to-work (RTW). We sought to address this gap by describing barriers to RTW for linguistic minorities in Ontario using narratives from appeal decisions. METHODS We examined decisions by the Ontario Workplace Safety and Insurance Appeals Tribunal. We searched the full text of decisions rendered between October 1, 2010 and September 30, 2011 for the keyword "English". A total of 378 decisions were generated. After eliminating decisions that did not involve linguistic minorities we retained half (189) for analysis. We summarized the issues around language for each decision and identified broad themes across decisions. RESULTS We found that linguistic minorities' limitations with regards to communication and power left them vulnerable to abuse, incomprehension and misperception by employers, care providers and adjudicators. In addition, specific RTW policies and practices failed to properly consider or mitigate their lack of English proficiency. These interpersonal and structural barriers negatively impacted linguistic minorities' eligibility to benefits and services and the appropriateness thereof, as well as their eventual return to work. CONCLUSIONS Our research highlights the need to move beyond efforts to improve the linguistic competence of compensation boards to target the structural factors that impede equal access at every stage of the process.
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Affiliation(s)
- Stephanie Premji
- Department of Health, Aging and Society, School of Labour Studies, McMaster University, 1280 Main Street West, Kenneth Taylor Hall, Room 701, Hamilton, ON, L8S 4M4, Canada,
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Sears JM, Rolle LR, Schulman BA, Wickizer TM. Vocational rehabilitation program evaluation: comparison group challenges and the role of unmeasured return-to-work expectations. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:777-789. [PMID: 24682775 DOI: 10.1007/s10926-014-9509-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Despite the importance and cost of workers' compensation (WC)-based vocational rehabilitation (VR) programs, outcome evaluations are rare, in part due to the scarcity of suitable comparison groups. The aims of this study were to assess (1) the adequacy of a commonly recommended internal comparison group, i.e., workers who were eligible for but did not receive services, and (2) return-to-work (RTW) expectations as a potential source of bias. METHODS In this prospective cohort study, we used WC claims data and worker-reported RTW expectations to compare workers who received vocational retraining services to eligible workers who did not receive such services. Workers were surveyed after retraining eligibility determination, prior to the initiation of retraining activities. VR progress and RTW wage outcomes were followed for 3 years. The magnitude of confounding contributed by RTW expectations and other covariates was quantified. RESULTS Workers who were somewhat or very certain they would RTW had significantly better outcomes. RTW expectations played a strong confounding role, reducing the retraining plan effect estimate by about 23 %, while education and physical capacity each changed the effect estimate by <5 %. CONCLUSIONS RTW expectations predicted long-term RTW outcomes and can play a strong confounding role if unmeasured. We found that the internal comparison group approach, commonly recommended for VR program evaluation, is inappropriate for WC-based VR evaluations. Ultimately, there is no simple solution to the challenge of identifying a comparison group; however, measurement of RTW expectations, an easily-measured multi-dimensional construct, may be a useful addition to the VR evaluation toolbox.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, School of Public Health, University of Washington, Box 354809, Seattle, WA, 98195, USA,
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Sears JM, Wickizer TM, Schulman BA. Injured workers' assessment of vocational rehabilitation services before and after retraining. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:458-468. [PMID: 24065344 DOI: 10.1007/s10926-013-9479-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Workers' compensation-based vocational rehabilitation (VR) programs are costly and challenging to operate effectively. This study aimed to: (1) describe injured workers' assessment of Washington State's VR system before and after vocational retraining, (2) describe the factors affecting injured worker satisfaction with VR services, and (3) gather suggestions for program improvement from injured workers. METHODS Telephone surveys were conducted in two distinct samples: (1) 361 workers were interviewed after determination of retraining eligibility but before retraining plan development, and (2) 360 workers were interviewed after cessation of vocational services and claim closure. RESULTS Injured workers interviewed before retraining were more often satisfied with the VR system (69 %) than were those interviewed after VR services ended (46 %). Although 55 % were initially somewhat/very certain they would return to work (RTW) after retraining, only 21 % had RTW 3-6 months after claim closure. Poor health, poor functional ability, and multiple retraining attempts were significantly associated with dissatisfaction. Suggestions for program improvement fell most frequently into the following areas: (1) more training choices, more worker input into the retraining goal, and/or a better fit of the retraining goal with the workers' experience and abilities (25 %); (2) listen to, respect, and/or understand the worker with regard to their interests, goals, and limitations (17 %); and (3) more support with job placement, work re-entry skills, and RTW in general (9 %). CONCLUSIONS There is substantial room for improvement in worker satisfaction with VR. Injured workers' feedback may facilitate identification of opportunities to improve the VR process and RTW outcomes.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, School of Public Health, University of Washington, Box 354809, Seattle, WA, 98195, USA,
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Steel EJ, Layton NA, Foster MM, Bennett S. Challenges of user-centred assistive technology provision in Australia: shopping without a prescription. Disabil Rehabil Assist Technol 2014; 11:235-40. [PMID: 25036986 DOI: 10.3109/17483107.2014.941953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision. METHODS User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia. RESULTS There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices. CONCLUSIONS Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision. Implications for Rehabilitation Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers. An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services. Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.
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Affiliation(s)
- Emily J Steel
- a School of Health and Rehabilitation Sciences, The University of Queensland , St Lucia , Australia
| | - Natasha Ann Layton
- b School of Health and Social Development, Deakin University , Burwood , Australia , and
| | - Michele M Foster
- c School of Social Work and Human Services, The University of Queensland , St Lucia , Australia
| | - Sally Bennett
- a School of Health and Rehabilitation Sciences, The University of Queensland , St Lucia , Australia
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Sears JM, Wickizer TM, Schulman BA. Improving vocational rehabilitation services for injured workers in Washington State. EVALUATION AND PROGRAM PLANNING 2014; 44:26-35. [PMID: 24509051 DOI: 10.1016/j.evalprogplan.2013.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/28/2013] [Accepted: 12/21/2013] [Indexed: 06/03/2023]
Abstract
Workers who incur permanent impairments or have ongoing medical restrictions due to injuries or illnesses sustained at work may require support from vocational rehabilitation programs in order to return to work. Vocational rehabilitation programs implemented within workers' compensation settings are costly, and effective service delivery has proven challenging. The Vocational Improvement Project, a 5.5-year pilot program beginning in 2008, introduced major changes to the Washington State workers' compensation-based vocational rehabilitation program. In the evaluation of this pilot program, set within a large complex system characterized by competing stakeholder interests, we assessed effects on system efficiency and employment outcomes for injured workers. While descriptive in nature, this evaluation provided evidence that several of the intended outcomes were attained, including: (1) fewer repeat referrals, (2) fewer delays, (3) increased choice for workers, and (4) establishment of statewide partnerships to improve worker outcomes. There remains substantial room for further improvement. Retraining plan completion rates remain under 60% and only half of workers earned any wages within two years of completing their retraining plan. Ongoing communication with stakeholders was critical to the successful conduct and policy impact of this evaluation, which culminated in a 3-year extension of the pilot program through June 2016.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.
| | - Thomas M Wickizer
- Division of Health Services Management & Policy, The Ohio State University College of Public Health, Columbus, OH, United States
| | - Beryl A Schulman
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States
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