Managing Mental Health Accommodation

Transcription

1 Managing Mental Health Accommodation Keith Hanson, Disability Management Specialist Nathan Laakso, Occupational Therapist Kathleen Stokes, Labour Lawyer

2 Learning Objectives Provide an understanding of real world solutions in managing mental health claims using objective cognitive tools the scope of mental health claims costs associated with these claims a larger strategy to manage these claims Develop a better understanding of how to manage some of these claims through actual case histories Continued on next slide 2

3 Learning Objectives Continued from previous slide What are these cognitive tools? When, why & how to use them efficiently? Cognitive Demands Analysis (CDA) Cognitive Abilities Evaluation (CAE) Cognitive Work Hardening (CWH) What are the latest legal implications as it pertains to duty to accommodate. legal strengths of the assessments how they pertain to labour law 3

4 Speakers Mr. Keith Hanson M.Sc., CDMP, Disability Management Specialist Vale, Ontario Operations Mr. Nathan Laakso Ms.OT, Occupational Therapist Ms. Kathleen Stokes B.A., L.L.B, Labour Lawyer, Weaver Simmons 4

5 VALE - Who We Are One of the 3 largest mining companies in the world Head quartered in Brazil operations in 30 countries World s leading producer of iron ore Second largest producer of nickel Continued on next slide 5

6 VALE - Who We Are Continued from previous slide Ontario Operations 6 Underground Mines 1 Smelter 1 Mill 2 Refineries (1 in Sudbury, 1 in Port Colbourne) Approx employees Key Values Life matters most Value our people Prize our plant Do what is right Improve together Make it happen 6

7 Mental Health Disability Risk 5% of all Occupational injuries/illness (2% allowed) 34% all Short-Term Disability claims 50% of all Long-Term Disability claims Incidence of mental health claims up by 70% since % of all lost days are result of mental health claims Approx. 16,000 annual lost days due to mental health disability (61 FTEs not at work all year) Case durations 2-3x that of physical injuries/illness 7

8 Managing Mental Health Key Actions 8

9 1. Long-Term Mental Health Strategy Mental Health First Aid Training for supervisors & employees Promotion & Awareness joint management/union effort Research in-house research on determinants/predictors sponsored by JOHC Implementation of CSA Voluntary Standard integrating with our current HSE Management System Managing Mental Health Key Actions 9

10 2. Proactive Risk Based Case Management Analysis of case and potential risk factors individual workplace health care provider other Early intervention in managing recovery Promotion of at work recovery and accommodation Managing Mental Health Key Actions 10

11 3. Cognitive/Psychological Demands Analysis For all Occupations Starting with most at risk Management/union involved in development process Managing Mental Health Key Actions 11

12 4. Use of Cognitive/Psychological Functional Demands Testing Significant mental illness or potential cognitive deficit that may affect Return To Work Person with mental illness returning to critical job Accommodation Managing Mental Health Key Actions 12

13 Cognitive Tools What is a Cognitive Demands Analysis (CDA)? What is a Cognitive Abilities Evaluation (CAE)? What is Cognitive Work Hardening (CWH)? How do we use these tools? 13

14 Common Cognitive/Behavioural Deficits Affecting Performance Initiation, Organization, Task completion Ability to sequence, generalize or plan Following directions/instructions Memory Attention & Concentration Problem Solving & Cognitive Flexibility Abstract Thinking Judgment Insight & Awareness Information processing Poor Communication with others High Levels of Frustration Loss of confidence & motivation 14

15 Cognitive Demands Analysis (CDA) Objective analysis of the essential cognitive, emotional and psychological components and demands of a job and the skills and behaviors required to perform the job demands Information for return to work programs Disability Prevention Pre-employment screening/job retention 15

16 What does a CDA Measure? Cognitive Demands Cognitive skills and resources required to perform work tasks Behavioural Demands The actions, efforts and interactions a worker may encounter that require a specific response or subsequent set of actions to manage or perform duties and tasks in the work place 16

17 Behavioural and Cognitive Demands Analysis Degree of Self-Supervision Required Degree of Supervision Exercised Performance of Multiple Tasks Required Deadline Pressures Attention to Detail Exposure to Distracting Stimuli Need to Work Cooperatively with Others Memory Exposure to Emotional Situations Exposure to Confrontational Situations Responsibility & Accountability Required Reading Literacy Written Literacy Numerical Skills Verbal Communication Ability to Use Computers 17

18 Degree of Self Supervision Required The extent of self-supervision required in the course of duties. Where this demand is rated high (requires the worker to be predominantly self-supervised) and the demand for Performance of Multiple Tasks required and/or accountability is also high, the worker may be expected to exercise good problem solving and judgement.

19 Degree of Self Supervision Required Rank Description Job Examples No self-supervision required; fully supervised Occasional self-supervision required; supervisor frequently provides work direction Frequent self-supervision required; supervisor occasionally provides work direction Predominantly self-supervised throughout the shift; may contract supervisor to obtain work direction as needed Parks ground crew (grass cutter) Clerk with varied task assignment and frequent direction Executive assistant, ECE worker Manager, Nurse, Accountant 19

20 Cognitive Abilities Evaluation (CAE) Determines the person s level of cognitive functioning Represents actual versus reported abilities Identifies gaps between demonstrated cognitive ability and required cognitive behavioural demands Identifies solutions (accommodations & adaptations) for return to work Job Matching Tested abilities (CAE) Abilities required for the position (CDA) 20

21 Components of a CAE Review Cognitive Demands Analysis Complete file review In-Depth Interview Medical History Job description Review of present medication & possible side effects Current Functional Status with respect to ADLs Continued on next slide 21

22 Components of a CAE Continued from previous slide Functional and formal assessment of cognition Must consider the level of the claimant, context & what skills we are trying to measure constraints (e.g. location of assessment & availability of assessments, time restraints, special certifications) putting a statement in your report cautioning the reader regarding test limitations and/or interpretation (e.g. Scores reflect an estimate of general functioning ) factors that may influence or impact performance on tests 22

23 Purpose of Cognitive Work Hardening Improve present function and overall tolerances through Re-establishing a functional routine Re-establishing time management strategies Grading tasks to promote client success Identifying, implementing & practicing additional coping strategies during work simulation Increasing self-confidence through work simulation (concentration and memory) Facilitate a RTW process to pre-leave place of work 23

24 Cognitive Work Hardening Meeting the needs and eliminating the barriers for each client Individualized Programming Educating in coping strategies, cognitive compensation & cognitive behavioral techniques Gradually adding more & more levels of complexity for an individual task Providing home practice after each session Debriefing with the client during each session 24

25 Case Examples 25

26 Case Example 1 Administrative Assistant x 12 years Several periods of disability due to depression since 2009 Most recent period off x 16 months Recommendation of RTW by her psychiatrist; employee reported being ready to return Management concerned about successful return to job duties based on previous performance and RTW failures Union concerned management not doing due diligence in accommodation and setting EE up for failure Action Plan: Conduct CDA and have EE undergo CAE Union and employee resistance 26

27 Case Example 1 Actions Initial contact with employer educating on CDA purposes & process CDA completed on site: high attention focus, multi-tasking required, communication skills, and self-supervision required CAE completed with employee: No functional cognitive deficits were identified that would inhibit her from completing the role. Able to meet demands required Gradual RTW recommended due to length of time away from position and to ensure tolerances will be met Satisfying results for both employee and employer 27

28 Case Example 1 Outcome OUTCOME Full duties to pre-illness employment 28

29 Case Example 2 Separation Circuit Operator x 8 years Work-related head injury WSIB provided general restrictions and recommendation of GRTW from Toronto rehab centre RTW initiated in alternate occupation EE struggling to work in alternate occupation even though within restrictions provided by WSIB EE and worksite report EE making errors and not able to manage demand Action Plan: Conduct CDA Have EE undergo CAE to determine job suitability 29

30 Case Example 2 Actions Alternate accommodations addressed physical restrictions only CDA completed - results indicate job requires high levels of memory, problem solving, attention, focus, and multi-tasking CAE completed on employee. Multiple areas of concerns including memory, attention, multi-tasking, new learning, problem solving etc. Work hardening program developed in the clinic; concurrent with nurses/placement facilitator exploring potential new positions CDAs screens completed on potential openings as cost saving measure. Full CDA developed on appropriate job screened. 30

31 Case Example 2 Outcomes Return to Work Strategies and Accommodations: CDA matched employee s abilities. Work hardening continued with graduated return to work implemented. On-site follow-up weekly to immediately address issues and concerns. OUTCOME Successful placement to new employment within the company 31

32 Case Example 3 Refinery Operator x 20 years Work-related head injury WSIB specialty clinic referral Physical and cognitive restrictions following recovery to RTW Previous workplace/hr issues, significant union involvement Employee resistance in RTW process 32

33 Case Example 3 Action Plan Updated FCE Conduct CDA and EE undergo CAE to determine job suitability Determine RTW plan WSIB and union supported planned approach as based on objective testing and essential demands of the job. EE has reciprocal duty to participate in reasonable accommodation actions 33

34 Case Example 3 Actions CDA Results job involved low levels of concentration, memory, planning, and basic reading and numerical skill; moderate levels of meeting deadlines and time pressures etc. CAE Results Difficulties with concentration, energy levels, pacing, planning. Employee was able to meet some demands but not every essential job demands Worksite able to accommodate small portion which he was not suited to completed. 34

35 Case Example 3 Outcomes Return to Work Strategies and Accommodations: Structured tasks and schedule with deadlines Routine, repetition, modeling Need for breaks, schedule adjustment Supportive employment approaches OUTCOME Successful transition to previous employment within the company that meets his physical and cognitive abilities. 35

36 The Legal Perspective 36

37 Accommodation Return to work WSIB and Duty to Accommodate Return to work and accommodation is a multi-party process Along with the employer and the union, there is also a duty on the complainant to assist in securing the appropriate accommodation Renaud, 1992 WSIB has a role 37

38 Medical Information Entitled to sufficient information to justify return to work with or without an accommodation If you do not have the information, you must request it For mental disability, this includes medical information 38

39 Employer May Request Info on nature of illness Description of illness but cannot ask diagnosis Duration Restrictions and abilities Treatment (may include medication in some positions) Information on how diagnosis was reached 39

40 CDA and CAE Why is this information important? The CDA and CAE can be instrumental in either facilitating a return to work or preventing it! The CDA will provide the information on the essential cognitive, emotional & psychological components of a job The CAE will provide information whether the employee can meet those demands (i.e., their level of cognitive functioning The information from CAE and CDA can provide work specific comparisons & assist in developing a realistic return to work plan 40

41 CDA and CAE Why is this information important? WSIB will not get this information for you in a form that may facilitate an accommodation and allow you to meet your obligations Go to the hearing (tribunal, grievance or WSIAT) and you have no information to defend the claim There are serious financial consequences attached to not having the employee return to the workplace 41

42 CDA and CAE Why is this information important? If Employer is of the view the Employee can come back and WSIB is advising that the Employee cannot, this information can be utilized to push for an accommodation There are instances where the Employer is of the view the Employee cannot come back to work and WSIB is advising they can (i.e. situation where the employer believes there are serious health and safety concerns) This information can be used to push back against WSIB against an accommodated return or any return. Case examples! 42

43 CDA and CAE Identify the need for an accommodation and what restrictions are at play (mental disability??) Cooperate and facilitate the implementation of the accommodation Includes accepting accommodation that is NOT preferred Use the CDA as your guide 43

44 Cooperation in the Accommodation Process To cooperate in the accommodation process Issues of seniority Bargaining unit issues Grievance management Capacity 44

45 Undue Hardship Undue hardship Use evidence! Financial cost Disruption to collective agreement Morale of other employees Interchangeability of workforce Compromised safety Suitability of return to work note 45

46 Conclusion Where are we Undue hardship Modifying existing job Bundling what does that mean New job in some circumstances Creating a job not an obligation Does not have to be employee s preferred accommodation 46

47 Keys to Success Early intervention is the key to success Use Cognitive Tools to objectively determine the workers abilities/limitations (CAE) Develop cognitive Demands Analysis (CDA) for all occupations starting with most at risk Work Collaboratively with all parties during the process Understand your obligations prepare, document, use objective tools and be proactive 47

48 Questions? Thank you! 48

49 References Blesedell Crepeau, E. (1991). Achieving intersubjective understanding: Examples from an occupational therapy treatment session. The American Journal of Occupational Therapy, 45 (11), Canadian Association of Occupational Therapists (CAOT). (1997). Enabling occupation: An occupational therapy perspective. Ottawa, ON: CAOT Publications ACE. Law, M. et al. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. The Canadian Journal of Occupational Therapy, 63 (1), 9-23 Polatajko, H. J., et al. (2007). Specifying the domain of concern: Occupation as core. In Canadian Association of Occupational Therapists (Ed.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation (p ). Ottawa: CAOT Publications ACE. Raybould, K., et al. (2001). The City of Toronto s Job Demands Analysis and Job Match System. Retrieved February 9, 2012, from Ergonomie-Self, Web site: Shaw, L., Lysaght, R. (2008). Cognitive and Behavioral Demands of Work. In K. Falk, & M. K. Deutsch (Eds.), Ergonomics for Therapists (pp ). Missouri: Mosby Elsevier. 49