The socio-professional reintegration of spinal cord injured (SCI) patients, remains challenging due to aggravating circumstances. In spite of conventional treatment the patients’ limitations regarding mobility, chronic pain syndrome, incontinence and prolonged inability to work due to decubitus ulcer and contractures often add up to an insurmountable disadvantage in the occupational rehabilitation. An international cooperation between Cyberdyne Inc. (Japan) and the professional association of raw materials and chemical industry (Germany), focusing on a new therapeutic approach reveals promising outcomes to improve the situation of these spinal cord injured patients. During the treatment the patients perform a locomotion training using the hybrid assistive limb (HAL®) exoskeleton which offers the unique possibility to record and amplify minimal bioelectrical signals by emg-electrodes on the skin of the lower extremities resulting in machine supported gait pattern synchronously to the patient´s voluntary drive. After 12 weeks of training significant improvements, regarding functional mobility has been achieved leading overall to a more autonomous and motivated patient. The presentation of the results and potential impact on the occupational rehabilitation will be based on video supported case reports.

The Australian medical profession is well trained in the assessment and management of a wide range of acute injuries/illnesses. However, the ongoing management of chronic injuries/illnesses and their ultimate assessment for the purposes of Impairment and/or Disability requires a different skill mix and medical perspective. Over the last 2 decades, Australian doctors have become well versed in various methodologies to assess the Permanent Impairment of a claimant/worker/client/patient, as legislated by multiple Australian jurisdictions.

The same outcome cannot be said for the assessment and management of injuries/illnesses leading to Disability. Most Australian doctors are not formally trained to understand the concepts of Disability versus Impairment. Some organizations continue to seek Disability medical assessments from the treating doctor only, which may lead to bias and a diminished capacity to return to paid employment.

This presentation will cover the issues of Disability assessment and management strategies within Australia, as seen through the eyes of an independent medical assessor.

Early intervention of the biopsychosocial model as a framework to achieve sustainable employment outcomes following injury, illness or disease is well documented in the International research. However in some areas of disability management the term early intervention is consistently applied exclusively within the medical model with early access to treatment and diagnostic tools.

However in Australia, whilst the knowledge of the Health benefits of work consensus statement is gaining traction, we remain lagging in effective implementation of early intervention models of the biopsychosocial model to return to work and return to life. This paper explores the structural challenges associated with successful implementation of the model and provides International learnings and applications for consideration and adaption to the Australian context. Further this paper will provide learnings from a pilot program being run in NSW that has been successful in the early triage and referral into a structured Return to Work program that is achieving strong results.

The primary function of income security organisations is to administer personal injury claims in a commercially viable and cost effective manner, while supporting the receivers of benefits/claimants to achieve a meaningful and durable return to employment. Given the pressures of commercial success in a competitive market measured by effective cost minimisation, to what extent is the level of support offered to individuals claiming benefits impacted by an organisation's purpose to be profitable? The extent of influence exercised by income security organisations in administering claims and driving employment outcomes is limited by jurisdictional legislation and regulations. Furthermore, the requirements to meet compliance requirements can often be detrimental to the quality of management of claims, resulting in a highly administrated framework. This can restrict an organisations capacity to meet individual needs, especially in cases that are not seen as fitting the norm. Considering the conflicting demands imposed by commercial pressures and regulatory frameworks, what is the level of influence that may be exercised by these organisations in facilitating employment outcomes? Employers Mutual have maintained a leading position in the NSW Workers Compensation Scheme, achieving commercial targets, meeting legislative requirements and promoting excellence in employment outcomes through:

• • Organisational vision – we help people get their lives back;

• • Focus on support and development of people as front line drivers of performance;

• • Role design – how we actually do our jobs;

• • Implementing organisation strategies and designing key support roles aligned to remunerative measures;

• • Strategic focus on early intervention to facilitate return to work;

• • Ensuring people receive the full extent of their entitlements, however, are not compensated to excess;

• • Service level agreements with employers/brokers with a key focus on return to work expectations;

• • Strong relationships with third party service providers; and

• • A structured framework that allows flexibility in decision making.

Motivational interactions is based on the foundations of “Motivational interviewing” and the “Transtheoretical Model of Behaviour Change”, Which is widely recognised as an important engagement strategy for people working in a case management capacity- working with a range of injured client/worker needs pertaining to resistance, ambivalence to change, motivation, development and return to work. The quality of the working relationship between the worker and client is said to be a significant predictor of outcomes for a client. Evidence has indicated that a collaborative positive client centred engagement that is responsive to the change process of individuals is a reliable indicator of outcomes in a range of mental health, psychosocial and physical injury issues e.g. stress, depression, anxiety, physical injury, disability, with positive relationships being correlated with better Return to work/Life outcomes.

Background: Belgium has more than 300.000 disabled people excluding work injuries or professional diseases. Until 2009, there was no return to work or disability management programs in the Belgian disability benefits public insurance.

Objectives: Facing a huge increase of disability pension claims since 2007, the Belgian Government charged the NIHDI (public social security agency) to implement a national “return to work” program. This program aims to offer options and stimulate part time job recovery or vocational training initiatives.

Methods: Since Belgium is a Federal State, the need for cooperation between NIHDI and the regional public employment services (PES) was essential. NIHDI implemented various contracts with the PES and with the Mutual Benefits Societies (semi private bodies in charge of the claim processing and the medical assessment). These contracts include objectives, financing and evaluation criteria. The NIHDI uses the expertise of international experts in return to work strategies and disability management.

Findings: The interaction between PES and physicians from NIHDI and Mutual Benefits Societies is essential. There is a strong need for medical, disability management and social guidelines in order to prevent any risk of differential results. The traditional claim processing is outdated. It is essential to integrate from the beginning of the claim processing, strong objectives for helping the social insured to return to work as soon as possible.

Objective: To show that benchmarking, through internal and/or external structured comparisons, is the ideal method to conduct more efficient and more effective processes.

The presentation illustrates that benchmarking, especially in the rehabilitation of accident victims, is the appropriate method to use to focus on the various interests, backgrounds and individual needs of accident victims during therapy management.

The objective of the project, Benchmarking the Effectiveness and Efficiency of Case Management, was to identify usable examples and methods for optimizing therapy management based on structured comparisons.

The project, in which fourteen insurance carriers took part, was initiated by the German association of accident insurance carriers, Deutsche Gesetzliche Unfallversicherung (DGUV).

The Benchmarking focused on how the insurance carriers handled the rehabilitation process, from the time of the accident to the end of the treatment period or the occupational reintegration.

The entire rehabilitation process, including the case work as well as the active planning, cooperation and monitoring of the medical, professional and social rehabilitation was divided into several segments. In this way, regardless of differences in the various procedures of the participants, fair and speedy comparisons of the segments could be established. For example:

• • Analysis of all the processes and structures of therapy management

• • Parameters for accident severity and frequency

• • Resources used (overhead, personnel cost, time)

• • Assessment of existing management tools

Results: None of the participating carriers had the “ideal organization” of his therapy management program. Nevertheless, clear “Best Practice” examples were identified within the respective sub processes. From this, several recommendations were made. The presentation points out the most significant ones.

Conclusion: The Benchmarking project was successful. The participating carriers followed the recommendations and thereby increased the efficiency and effectiveness of their therapy management program.

Objective: The study aims to explore factors of workplace injury and chronic illnesses patients in a return to work program which are associated with return to work outcomes. Design: A retrospective cohort study. Setting: Return to Work Department, Social Security Organisation, Malaysia.

Method: All participants of the Return to Work Rehabilitation Program who were absent from work due to workplace injury and chronic illnesses between January 2008 and December 2013 with no other history of injury were included. The main outcome of the study was the number in days from day one of injury prior to return of gainful employment. Hierarchical multiple regression methods were used to determine the identified factors that influence the return to work outcome.

Results: An initial study with data from January 2008 and December 2011 of cases with occupational injury showed 66% (n = 1,552) of the participants had returned to work. The average number of days to return to work was 201 days. Hierarchical multiple regression analysis identified duration of referral to the Return to Work rehabilitation program, monthly salary, Whole Person Impairment ratings, DASS 21 anxiety and DASS 21 stress scale as factors that influenced return to work, explaining 32% of the variance. However an analysis of the remaining cases such as cases with chronic illnesses will be included in the final results of this study.

Conclusion: Currently, a total of 66% participants had returned to employment after occupational injury. It is essential to understand the complex pathway from the point of injury and illnesses until returning to work in order to develop more effective return to work practices.

The United Nations Convention on the Rights of People with disabilities has driven changed expectations on the way in which States are expected to relate to disabled people and assist in building an inclusive society.

The World Report on Disabilities has provided both statistical information and examples of best practice including in the employment space.

In the employment area, states are expected to provide a leadership role and provide support for private enterprise. Taking a much more partnership approach to the employment of people with disabilities has increased understanding of respective needs and helped shape different conversations. These conversations have been informed by research in to what employers perceive as barriers to employing disabled people. Providing employers with answers to their concerns has provided them with the confidence to employ and retain employees with disabilities. The mainstream approach has moved the discussion away from differences to an understanding that in many situations, this is no different to what is already provided to other employees. Confident employers are likely to provide repeat opportunities and also be good role models for other employers.

The world financial crisis has sharpened enterprises understanding of the economic impact of failing to take a proactive approach to their employees. Responsibility for building knowledge is equally shared by the employee and the employer. The employee's direct line manager is has a crucial role in building connectedness for those for whom they have managerial oversight.

Demedicalising the way people with disabilities are either retained or enter the workforce will be crucial in building the confidence of employers. Language and culture play an important part in building a connected and confident workplace.