Work ability assessment for vocational rehabilitation Hans Jakob Beck Medcial director VIRK, vocational rehabilitation fund Iceland

Agenda: Short description of VIRK The setup Theory Example of ICF in the assessment process Conclusion

VIRK-Vocational rehabilitation fund Non profit organization founded in Iceland in 2008 in co-operation of Labor unions and the Confederation of Employers Organized on a national level covering the whole labor market Funded by 0,39% of the total salary on the labor market by employers, pension funds and the state Virk's role is to prevent that people leave the labor market due to disability by providing vocational rehabilitation, counselling and promoting activity Second parallel role is to assess disabilities and work ability

Information from applicant The setup Doctors referral Assessment of indiaction for voc rehab No service Into service Special evaluation/ICF Information from applicant Basic evaluation /ICF Vocational rehab Work ability assessment WORK

Basic evaluation d850, d820, b140, d920, b152, d870, d760, d570, b134 e factors ICF based questions You and the job market Education Interest/hobbies Social skills-personal abilities Social and financial issues Health Known risk factors for RTW included in the basic evaluation

Example of using ICF in Basic evaluation In the developmental phase of the basic evaluation we took a close look at others evaluation process. What influenced it the most was arbeidsevnemethonden coming from Denmark, Egenvurdering coming from Norway and Sassam kartan coming from Sweden. The conclusion was 6 important categories, here is example of how they connect to codes in the ICF system .

Special evaluation EUMASS core set -multidiscip. team- b126, b130, b164, b280, b455, b710, b730, d110, d115, d155, d177, d220, d230, d240, d399, d410,d415, d430, d440, d445, d450, d470, d570, d720, EUMASS core set Instruction about the use of qualifiers and information about each code Review of the rehabilitation plan and recommendation

Work ability assessment When? If further vocational rehabilitation interventions seem no longer indicated and the goal of return to work has not realized. How? A physician meets the individual and also evaluates the information gained under the rehabilitation process. Can also ask for further multidisciplinary evaluation Questions posed: Has vocational rehabilitation been fully tried out? Does the individual now have ability to work? If yes, what is the working capacity and what kind of jobs are recommended?

The use of environmental factors in basic evaluation This is the model we use to evaluate the environmental factors. In chapter 1 in the basic evaluation we have incorporated the model of Yvonne Heerkens. There we have all the environmental factors in the ICF system gatherd together and further structured into four main categorise; social connection at work , work conditions, ........ Heerkens, 2004

Theory

New approach needed Epidemiologic transition Most health problems chronic Changing labor marked and social demands Disability/ability need to be considered Not only the disease New model of health Biopsychosocial model ICF

Figure 2. Suggested attention given to domains of patient’s illness and service involved. Derick Wade Clin Rehabil 2015;30:109-118 Copyright © by SAGE Publications

Chapter 1: Attitude toward work and connection to the labor market Does your health or condition have any effect on the following factors?   None A little Some A lot A great deal Not relevant Relating to coworkers? Getting to work on time? Ability to work in a team? Finishing projects/tasks on time? Working on a job related project? Completing the work day? Looking for a job?

Chapter 2: The ability to acquire new knowledge and skills Does your health or condition have any effect on the following factors? Learning new things?   None A little Some A lot A great deal Not relevant Remembering things? Organizing yourself? Completing projects/tasks? Dividing attention or dealing with more than one thing at the same time? Paying attention and keeping your concentration? Accepting guidance? Learning new things Attending a regular organized job?

Chapter 3: Interests Does your health or condition have any effect on the following factors?   None A little Some A lot A great deal Not relevant Reading for fun? Participating in organized social activities? Attending entertainment, such as art exhibitions or going to the cinema? Pursuing interests? Travelling for fun?

Chapter 4: Social skills – personal competence Does your health or condition have any effect on the following factors?   None A little Some A lot A great deal Not relevant Coping with anger and irritation? Reacting to criticism? Controlling your emotions? Coping with increased stress? Motivation (in regards to what you usually want to do) Showing consideration? Ability to relate to others? Coping with every day life? Persistency, to endure at work

Chapter 5: Social and financial circumstances Does your health or condition have any effect on the following factors?   None A little Some A lot A great deal Not relevant Relations with your closest relatives? Support from your closest relatives and/or friends? Developing new contacts? Keeping up contacts with others (relatives, friends and fellow workers)? Ensuring your financial security? Managing your income?

Chapter 6: Health Does your health or condition have any effect on the following factors?   None A little Some A lot A great deal Not relevant Controlling your diet? Mental well-being? Controlling use of tobacco? Use of narcotics? Controlling use of alchohol? Controlling use of medicines? Exercising on a regular basis? Energy needed for daily activities? Getting uninterrupted sleep? Falling asleep? Waking up fully rested/refreshed? Physical well-being?

ICF factors: Chi square weight against work or disability at follow up

ICF average Psychological wellbeing Physical wellbeing Work Disability 2,6 2,6 3,1 Work Disability

Conclutions VIRK is can been seen as an attempt to react upon merging social problem of chronic health problems and increased disability VIRK´s model is a paralell vocational rehabilitation and work capacity assessment ICF is used as a conceptual framework and evaluation tool

Thanks for your attention

Thanks for your attention