CAOT Position Statement
Return-to-Work and Occupational Therapy (2009)

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It is the position of the Canadian Association of Occupational Therapists (CAOT) that occupational therapists have the knowledge and skills to provide quality and comprehensive return-to-work services. Return-to-work services enable the re-integration of individuals into the workplace following disruption due to physical or mental health issues. CAOT believes that engagement in meaningful occupations, including those in paid work environments, are an important determinant of health and as such views return-to-work as a valued occupational therapy service area. Occupational therapy in Canada is based on a model of practice that supports the balanced interaction between the person and their occupations with the social, cultural, physical, and institutional environment. The understanding of this relationship uniquely positions occupational therapists to provide valued and evidence-based return-to-work services.

Recommendations:

1. Occupational therapists collaborate with multiple stakeholders for research initiatives that seek to increase the understanding of how the influences of work environments, occupational performance, and health conditions impact return-to-work success and practices.

2. Occupational therapists collaborate with workers, work teams, managers, unions, health and safety committees, and health professionals to facilitate return-to-work services.

3. Occupational therapists advocate for return-to-work initiatives and research to improve return-to-work options and services for workers in Canada.

4. Occupational therapists expand their services in the workplace and health and social service sectors to contribute to return-to-work practices.

CAOT Initiatives

To promote occupational therapy return-to-work services, CAOT will:

1. Work in collaboration with federal, provincial, and territorial governments, relevant health and non-health related associations, and health research organizations to inform and influence return-to-work policy and research activities.

2. Promote the understanding of the relationship between occupational engagement, work environment, and health.

3. Partner with organizations to develop strategies to promote return-to-work services offered by occupational therapists.

4. Facilitate or support educational activities that offer occupational therapy professional development in areas such as: stress management, absenteeism reduction, time loss prevention, ergonomics, physical, emotional and psychological demand analysis, development of assessment tools, cognitive and physical work hardening interventions, workplace accommodation, navigating workplace-based labour and management teams, communication and negotiation, disability management, and workshops on musculoskeletal injury prevention.

5. Develop consumer and employer information and practice resources to educate others about the value of return-to-work services.

6. Provide occupational therapists with access to research-based evidence regarding return-to-work practices.

Background:

1. Return-to-work services are provided within the context of workplace health (CAOT, 2004) which incorporate the needs of all relevant stakeholders by encompassing practices, policies, and programs designed to improve the physical, mental, and psychosocial health of workers (Canadian Council on Integrated Healthcare, 2002).

2. Return-to-work services have increasing importance to individuals and employers with costs of disabled workers reaching $11 billion from workplace accidents (according to the Association of Workers’ Compensation Boards [AWCBC, 2002]) and workplace mental health costs estimated at $33 billion to the Canadian economy.

3. Occupational therapy programs can reduce premiums paid to insurers through effective sustainable return-to-work programs and increase employee retention. Occupational therapy can facilitate the compatibility between physical and cognitive demands of the workplace and the unique abilities of the individual.

4. The co-ordination of return-to-work services is critical for the success of return to work. Collaboration between the worker, employer, and health care providers, such as occupational therapists, may take place outside of the workplace and/or within the work environment.

5. Return-to-work interventions are comprehensive in nature and will vary in length of service according to the unique needs of the worker and their relationships to factors influencing them in their workplace settings. Occupational therapists are well known for their work in increasing workers' physical readiness to return to work through structured, goal-oriented work hardening programs (Wisenthal, 2004). Aside from interventions to address physical and mental health issues, reintegration into the workplace may require facilitation of “co-worker relationships, ongoing pain, occupational bond with the employer, and physical demands of the job, etc” (Gowan & Strong, 2004).

6. Work/Functional Capacity Evaluations are just one element of some return-to-work services and are generally defined as "a systematic process of measuring and developing an individual's capacity to dependably sustain performance in response to broadly defined work demands" (Matheson, 1986).

7. Working with employers and workers to plan and implement return-to-work strategies is an important health promotion activity and health promotion is essential to empowering people to increase control over their health (World Health Organization, 2003).

8. Effective return-to-work interventions are a collaborative effort by worker and employer. In the recent document designed for employers, Working together: Successful strategies for return to work, success has been shown to be strongly related to principles which espouse coordinated early intervention, open communication and commitment to workplace health and safety, good-will and collaboration between the worker and employer (Institute for Work & Health, Ontario Society of Occupational Therapists & College of Occupational Therapists of Ontario, 2008). The occupational therapy profession’s belief in the interrelationship among the person, occupation, and the environment uniquely positions occupational therapists to provide quality return-to-work services.

Glossary of Terms

Enabling (verb) – Enablement (noun): Focused on occupation, is the core competency of occupational therapy – what occupational therapists actually do – and draws on an interwoven spectrum of key and related enablement skills, which are value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and/or social change (Townsend & Polatajko, 2007).

Enabling occupation: Refers to enabling people to ‘choose, organize, and perform those occupations they find useful and meaningful in their environment” (CAOT 1997, 2002, p. 180).

Functional Capacity Evaluation (FCE): A functional capacity evaluation is an all-encompassing term to describe the physical assessment of an individual’s ability to perform work-related activity. It can also be known as a Functional Capacity Assessment (FCA), Physical Capacity Assessment or Evaluation (PCA or PCE), or Work Capacity Assessment or Evaluation (WCA or WCE) (AOTA, 2007).

Occupations: Groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture; everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997, 2002); a set of activities that is performed with some consistency and regularity; bring structure and are given meaning by individuals and a culture (adapted from Polatajko et al., 2004, and Zimmerman et al., 2006).

Occupational therapy: The art and science of enabling engagement in everyday living through occupation; enables people to perform the occupations that foster health and well-being; enable a just and inclusive society so that all people may participate to their potential in the daily occupations in life.

References

American Occupational Therapy Association, Work Programs Special Interest Sections. (2007). Functional Capacity Evaluation. Retrieved from http://www.aota.org/Consumers/WhatisOT/WI/Facts/35117.aspx

Association of Workers' Compensation Boards of Canada (AWCBC). (2002). Key Statistical Measures for 2002. Retrieved from http://www.awcbc.org/common/assets/ksms/2002ksms.pdf

Canadian Association of Occupational Therapists (1997; 2002). Enabling occupation: An occupational therapy perspective (Rev. ed.). Ottawa, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists (CAOT). (2004). Workplace health and occupational therapy. [Position statement]. Retrieved from http://www.caot.ca/default.asp?pageid=1137.

Canadian Council on Integrated Healthcare. (2002). A discussion paper on workplace health. Retrieved from http://www.ccih.ca/docs/CCIH%20-%20DiscussionPaper_on_WorkplaceHealth_LastVersion.pdf

Gowan, N. & Strong, S. (2004). The expanding cause of occupational therapy. Retrieved from http://www.caot.ca/default.asp?pageid=745

Institute for Work & Health, Ontario Society of Occupational Therapists & College of Occupational Therapists of Ontario. (2008). Working together: Successful strategies for return to work. Retrieved from http://www.osot.on.ca/eng/PDFs/newsItems/working_together_2008.pdf

Matheson, L.N. (1988). How do you know he tried his best? Journal of Industrial Rehabilitation Quarterly, 1, 10-12.

Polatajko, H. J., Davis, J. A., Hobson, S., Landry, J. E., Mandich, A. D., Street, S.L. et al. (2004). Meeting the responsibility that comes with the privilege: Introducing a taxonomic code for understanding occupation. Canadian Journal of Occupational Therapy, 71(5), 261-264.

Townsend, E.A. & Polatajko, H.J. (2007). Enabling Occupation II: Advancing An Occupational Therapy Vision For Health, Well-Being, & Justice Through Occupation. Ottawa, ON: CAOT Publications ACE.

Wisenthal, A. (2004). Occupational therapy provides the bridge back to work. Occupational Therapy Now, 6(4). Retrieved from http://www.caot.ca//default.asp?pageid=1185

World Health Organization. (2003). Fourth International Conference on Health Promotion, Jakarta Declaration on leading health promotion into the 21st Century. Retrieved from http://www.who.int/healthpromotion/conferences/previous/jakarta/en/

Zimmerman, D., Purdie, L., Davis, J., & Polatajko, H. (2006). Examining the face validity of the taxonomic code of occupational performance. Presented at the Thelma Cardwell research day, Faculty of Medicine, University of Toronto, ON, Canada. Retrieved March 28, 2007 at: http://www.ot.utoronto.ca/research/research_day/documents/rd_06_proceedings.pdf 

Position statements are on political, ethical and social issues that impact on client welfare, the profession of occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON. K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca .