CAOT Position Statement
Occupational therapy and disability management services (2004, revised 2011)


The Canadian Association of Occupational Therapists (CAOT) supports the role of disability management services to promote healthy patterns of workplace occupations for individuals and organizations. Disability management refers to a process of disability prevention, early intervention and sustainable employment after the onset of a disability. CAOT also recognizes the knowledge, skills and abilities occupational therapists must have to effectively deliver disability management services. Occupational therapists have an understanding of the relationship between the person, their occupations, and environment which uniquely positions occupational therapists to provide effective, evidence-informed services that enhance workplace health promotion, disease prevention  and a person’s ability to engage in paid employment following an extended absence from work and or disability.  Occupational therapists are also uniquely positioned to provide services to prevent disability that may be associated with specific occupations or unique personal characteristics that might place individuals at risk in occupations without accommodations.

Recommendations for occupational therapists:

1. Occupational therapists develop partnerships with organizations that have a direct interest in the advancement of disability management services in the public and private sectors throughout Canada. This would include organizations such as unions, government, employers, employees, payers (workers compensation and insurers) and professionals.
2. Occupational therapists collaborate with stakeholders to advance the role of disability management in promoting healthy patterns of workplace occupations.
3. Occupational therapists promote the development of research among stakeholders that will advance evidence-informed practice in disability management.
4. Occupational therapists engage in continuing professional development activities to enhance their knowledge, skills and expertise in disability management services provided to clients.
5. Occupational therapists advocate for their role in disability management services.
6. Occupational therapists contribute to the national disability management databases that can be used for research and policy development (e.g.  NIDMAR hosts Rehabdat- free access database at http://www.nidmar.ca/rehadat/rehadat_database/rehadat_database.asp).
7. Occupational therapists utilize mentorship opportunities to share expertise, build workforce capacity and develop best practices in disability management.
8. Occupational therapists seek out opportunities for leadership within the practice context (e.g. case management policy development and multi-stakeholder projects). 
CAOT Initiatives:
To expand opportunities for healthy patterns of workplace occupations through the process of disability management, CAOT will:
1. Advocate for occupational therapists to participate in disability management service planning initiatives in all sectors.
2. Collaborate with stakeholders to develop relevant research to advance evidence-informed practice in disability management.
3. Create and design tools that deliver information on how occupational therapy can provide services in disability management, e.g. Occupational Therapy Solutions to Common Workplace Issues: A Manual to Enhance Workforce Management (CAOT, 2010).
4. Encourage occupational therapists to acquire specialized knowledge, training and credentials to enhance their ability to deliver disability management services.
5. Communicate with the National Institute of Disability Management and Research (NIDMAR) to identify modules needed for occupational therapists as required knowledge in order to sit the disability management certification examinations and which are not covered under occupational therapy educational programming.  At this time these modules are: Module A: Effective disability management, Module I: Legislation and disability, management, Module J: Workers compensation, Module L: Insurance and other benefits, Module N: Disability management in unionized organizations, Module P: Disability management from a human resources perspective, Module U: Marketing and education in disability management and return to work. A full listing of these modules can be accessed at http://www.nidmar.ca/education/education_online/online_caot.asp.

Background

1. Disability management is inherently a partnership between the employer, the employee and where appropriate the agency providing disability management services. The commitment by an employer to the provision of disability management should reflect their belief in the importance of providing employment for people experiencing functional work limitations whether they be cognitive, emotional, physical or behavioural.  Disability management reflects an organization’s commitment to provide employment for people experiencing functional work limitations. It uses a coordinated, cost-effective, quality rehabilitation service that occurs in a timely fashion (Akabas, Gates, & Galvin, 1992). The goal is for people to either return to their own occupation following a disability, return to a modified version of that job or return to alternative work.
2. Disability Management is primarily rooted in Human Rights Legislation and the Canadian Charter of Human Rights.
3. Enormous human and economic costs of health related   absenteeism, disability and lost productivity are incurred in the workplace. Workers who experience injuries and illnesses are frequently away from their employment longer than necessary. Some never return to work even though they could be productive with changes in job tasks, equipment or workspace. There are some employees who return to work and are unable to continue for a variety of reasons (NIDMAR, 2003). The Association of Workers' Compensation Boards of Canada (AWCBC) reported 373,000 lost time accidents in 2001 with direct benefit costs of $11 billion (AWCBC, 2002). Recent insurance company data shows that 49% of all non-occupational disabilities are attributed to a mental health disability  and 40% of  average cost of long-term disability plans are  psychological  claims (Scott , 2010)
4.  Disability management is a growing international approach,  which  stresses  collaboration and consensus building  to establish a climate of  professional  interactions within a multidisciplinary  group(employer,  employee/ employee’s representative,  insurers,  service providers)   to   prevent   diseases and promote  healthy   workplaces. The growing awareness of the benefits of disability management and the changing economic realities of competing in a global environment has caused organizations to develop solutions to return workers to the workplace. There is recognition of the need for disability management professionals who can work in different environments to manage the required accommodations and return to work services (NIDMAR, 2003). There are tools developed to promote best practices in this area (e.g. Institute for Work and Health, 2007)) and promote the role of occupational therapists in this areas (e.g. CAOT, 2010; IWH, OSOT, COTO, 2008). Furthermore, risk management of health is a health promotion concept that is contributing to the field of disability management. Early detection, health education (literacy) and lifestyle approaches are being considered as approaches to contain costs. Occupational therapist  are well suited to address lifestyle approaches.
5. The occupational therapy focus on person, environment and occupation fits very well with the field of disability management. Archer-Heese and Johnson’s (2002) Canada-wide survey of CAOT members has found that occupational therapists embrace disability management and return to work strategies to reduce the human and economic cost of disability in the workplace. Occupational therapist’s client centered framework is very suitable for developing disability management programs with employers (Strong & Shaw, 1999).
6. Occupational therapists have the required skills and knowledge to provide an evidence-informed approach to help others identify, engage in and achieve their desired potential in their occupations (CAOT, 2003a). Occupational therapists are university educated and understand the effects of factors such as disease and injury on the ability of individuals, groups and communities to engage in the occupations of life. Occupational therapists will be increasingly called upon to arrange for workplace accommodation for all types of workers to maximize their occupational performance on the job. Advances in assistive technology and shortages of skilled labour will increase the demand for workplace accommodation for people of all levels of ability. As the workforce ages there will be an increasing need to accommodate older workers to extend their work life. Occupational therapists provide assessment services in terms of functional capacity evaluations (FCEs), job demands analysis, ergonomic evaluation and advice, pre- and post-employment and vocational assessments. Rehabilitation roles include work injury management programs, case management RTW programs, pain management programs and job modification/accommodation advice.
7. Prevention is an important part of managing workplace disability and occupational therapists are providing services in this area which include: education/training on health and lifestyle, ergonomics, injury prevention strategies, analysis of job hazards accessibility audits and work site evaluations. The wide range of payors of these services was highlighted and include automobile insurance carriers
8. There is an increasing emphasis on integrated workplace health and wellness  (Curtis & Scott, 2003), (including mental health and addictions). For example, many employers are becoming interested in providing more comprehensive disability management services. Employers are starting to take an interest in a healthy organization, as a workplace of choice. This fits with an occupational therapy perspective of the positive interaction of the person, environment and occupation to generate healthy occupational performance.
9. Occupational therapists are competing with other regulated professionals and non-regulated workers for a share of this growing market and will require additional continuing education to advance their skills and credentials in this area.

Glossary

Disability Management: The process in the workplace designed to facilitate the employment of persons with a disability through a coordinated effort and taking into account individual needs, work environment, enterprise needs and legal responsibilities. (International Labour Organization, 2002)

Occupational therapy: is the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life. (Townsend & Polatajko, 2007)

References

Akabas, S.H., Gates, L.B., & Galvin, D.E. (1992). Disability management: A complete system to reduce costs, increase productivity, meets employer needs and ensures legal compliance. New York, NY: AMACOM.

Archer-Heese, G., & Johnson, L. (2002). Current and future work related occupational therapy services - A Canadian perspective. Occupational Therapy Now, July/August, 22-25.

Association of Canadian Workers’ Compensation Boards. (2002). Statistical Summary. Author.

Canadian Association of Occupational Therapists (2010). Occupational Therapy Solutions to Common Workplace Issues: A Manual to Enhance Workforce Management . Ottawa. CAOT Publications ACE

Canadian Association of Occupational Therapists. (2003a). Position statement on everyday occupations and health. Retrieved on September 30, 2003 from http://www.caot.ca/default.asp?pageid=699.

Curtis J., & Scott, L. (2003). Making the connection. Benefits Canada, April 2003.

Harder,  H G & . Scott   LR  (2005) Comprehensive disability management. Elsevier Health Sciences
Institute for Work and Health, Ontario Society of Occupational Therapists, College of Occupational Therapists of Ontario (2008). Working together: Successful strategies for return to work. Retrieved February 8, 20110 from ,http://www.iwh.on.ca/working-together

Institute for Work and Health (2007). Seven Principles for Successful Return to Work. Retrieved February 8, 20110 from, http://www.iwh.on.ca/seven-principles-for-rtw
International Labour Organization. (2002). Code of Practice: Managing Disability in the Workplace. Retrieved on March 21, 2011 from http://www.ilo.org/public/libdoc/ilo/2002/102B09_340_engl.pdf

National Institute for Disability Management and Research. Online education. Retrieved on October 2, 2003 from http://www.nidmar.ca/education/education_online/online_background.asp.

Scott, L. (2010).  Mind Matters  Benefits Canada 34, 2 .P33

Strong ,S and Shaw, L   (1999). A Client-Centred Framework for Therapists in Ergonomics. In K Jacobs (ed), Ergonomics  for Therapists second Edition (2) .Boston: Butterworth-Heinemann. 21-46

Westmorland MG, Williams RM, Amick BC 3rd, Shannon H, Rasheed F.(2005). Disability management practices in Ontario workplaces: employees' perceptions. Disabil Rehabil. Jul 22;27(14):825-35.

Westmorland MG, Williams R, Strong S, Arnold E.(2002). Perspectives on work (re)entry for persons with disabilities: implications for clinicians. Work.18(1):29-40

Williams RM, Westmorland MG, Shannon HS, Amick BC 3rd.(2007). Disability management practices in Ontario health care workplaces. J Occup Rehabil. ;Mar.17(1):153-65