1. Acknowledgements We grateful acknowledge the support of: Canadian Occupational Therapy Foundation, Canadian Injured Workers Alliance, Research Advisory Council WSIB, Dominion of Canada General Life Insurance Company, Injured workers from coast to coast. Background Consumer’s Self-direction in Return-to-Work: Lessons from Clients Lynn Shaw 1, Patti MacAhonic 2, Jill Dodman 1, Karen Pye 1, Monica Korzycki 1 & Martha Korzycki 1 1 The University of Western Ontario, 2 Royal Roads University, UBC Three interrelated studies* were conducted that examined the system barriers injured workers encounter in returning to function and to work. These studies consistently revealed that injured workers require access to a broad spectrum of supports. From these studies the ‘8 dimensions of Support Framework’ (Shaw & MacAhonic) emerged. This framework adopted four dimensions of social support from House (1981) however the nature of these supports described in this model were based upon support needs of injured workers in the community rather than the workplace. The dimensions were then conceptualized in a graphic. However, access to these supports are inadequate or non existent in all but one province in Canada. More efforts are needed to build capacity and resources that assist injured workers and their families who are marginalized through the tumultuous journey of experiencing chronic injury and loss of work. Therapists and injured worker advocacy groups need to partner to create access to sustainable supports that will promote the recovery of injured workers and assist them in managing occupational transitions to fuller participation in daily life as well as work occupations. Drawing upon the insights of injured workers from across Canada strategies that therapists can use to partner and support injured workers are posited. Injured workers expressed a need for greater access to resources such as training and funding as well as opportunities for self- discovery of their occupational potential. Transformational Supports: Injured workers expressed a need for greater access to resources such as training and funding as well as opportunities for self- discovery of their occupational potential. Therapists can garner support for increasing and creating partnerships for self employment through establishing links with small business communities that might provide seed funding for new occupational pursuits. In addition more efforts are needed to develop occupation based programs that focus on learning by doing, building new skills and competencies to such as speaking, communicating, negotiating and to draw upon the arts to support personal reflection, expression and action. Injured workers have identified that access to family supports, support of co-workers and peer support is essential. Emotional Supports: Injured workers have identified that access to family supports, support of co-workers and peer support is essential. Therapists can ensure that injured workers have access to emotional supports through connecting injured workers with peer support throughout the different stages in recovery and return to work. This includes networking with available injured worker support groups and programs in your local area. Therapists can also assist in creating access to supports in the workplace by educating employers and coworkers on understanding the importance of emotional support such as co-worker support in injured worker transitions back to work. Injured workers indicated that in the absence of work they need to draw upon the feedback and expertise of therapists to gain insight into their capacities to participate in occupations in everyday life including the capacity to work with an injury and how to adapt and monitor their progress through recovery, modified work and engagement in new work occupations. Appraisal and Evaluation Supports: Injured workers indicated that in the absence of work they need to draw upon the feedback and expertise of therapists to gain insight into their capacities to participate in occupations in everyday life including the capacity to work with an injury and how to adapt and monitor their progress through recovery, modified work and engagement in new work occupations. Therapists need to create and lobby for adequate time, space and opportunities with third party payers to ensure that injured workers have access to programs and time to interact with therapists to gain feedback and realize greater insights into new capacities and how to manage changing abilities and consequences of their chronic conditions at work. Injured workers require a voice at the broader political level to improve resources, supports and policies that reflect the needs of injured workers and their families. Lobbying Supports: Injured workers require a voice at the broader political level to improve resources, supports and policies that reflect the needs of injured workers and their families. Therapists can partner with injured worker groups and support opportunities to increase awareness on the need for comprehensive supports and resources in the community. In addition therapists/researchers can partner to conduct research that will inform policy, access to better resources and to encourage injury and disability prevention. Injured workers want and need access to injured worker advocates that can assist them one-on- one and partner with them in managing their claims and challenges associated with the difficulties encountered in the RTW and the Health Systems Advocacy Supports – Individual: Injured workers want and need access to injured worker advocates that can assist them one-on- one and partner with them in managing their claims and challenges associated with the difficulties encountered in the RTW and the Health Systems. Therapists and injured work groups need to work in partnership to increase awareness of the available supports in the community so that injured workers can access the expertise, advice and education at the right time. Injured workers need to have access to larger networks of support in the community to meet their diverse needs. This may include a well developed network of health professionals, educational services, training centres etc that share a common understanding of how to best support injured workers in their communities Community of Practice Supports: Injured workers need to have access to larger networks of support in the community to meet their diverse needs. This may include a well developed network of health professionals, educational services, training centres etc that share a common understanding of how to best support injured workers in their communities. Therapists need to partner with other agencies to appreciate the breadth of resources in the community and to partner with injured worker groups to provide education to other stakeholders. The cascading effects of the financial losses associated with chronic work injuries or disabilities impacts the social and occupational functioning of the entire family. Injured workers expressed the need for adequate and immediate access to information on acquiring basic resources such as food, housing, and interim financing. In addition, they need professional support to help members of the family cope with the profound impact on daily family life Instrumental Supports: The cascading effects of the financial losses associated with chronic work injuries or disabilities impacts the social and occupational functioning of the entire family. Injured workers expressed the need for adequate and immediate access to information on acquiring basic resources such as food, housing, and interim financing. In addition, they need professional support to help members of the family cope with the profound impact on daily family life. Therapists need to become aware of the local services and supports in the community (social agencies, municipalities and churches, legions etc) that are available to assist injured workers and their families. Therapists can also collaborate with other professionals and these community based organizations to be more aware of the path to access instrumental supports. In turn therapists can help injured workers negotiate these systems in a timely fashion. Transformational Supports Appraisal & Evaluation Supports Community of Practice Supports 8 Dimensions of Support Informational Supports Instrumental Supports Emotional Supports Advocacy Supports Lobbying Supports Injured workers indicated that they need easier, timely and safer access to basic information on the claims processes, information about their injuries, healing times, diagnosis, the short term and the long term return to work options, how to manage at work with pain etc. Injured workers want the access to information to be transparent, they want to know how and where to get information, what information is shared with whom and how information is used. They want credible information that they can use to make informed decisions. Informational Supports: Injured workers indicated that they need easier, timely and safer access to basic information on the claims processes, information about their injuries, healing times, diagnosis, the short term and the long term return to work options, how to manage at work with pain etc. Injured workers want the access to information to be transparent, they want to know how and where to get information, what information is shared with whom and how information is used. They want credible information that they can use to make informed decisions. Therapists can support more authentic information exchange through ensuring that injured workers not only receive information in formats that match IW needs, but by engaging them in dialogue to ensure that information is understood and useful. Studies 1. Shaw, L., Korzycki, M., Korzycki, M. Exploring barriers to and strategies for enabling return to work/return to function (RTW/RTF) for persons with chronic disabilities. COTF. 2. Shaw, L., MacDermid, J., Kothari, A., Duncan, A. Exploring the role and strategies for knowledge exchange and translation by injured worker groups. RAC WSIB Developmental Grant 3. MacAhonic, P. BC Injured worker centre feasibility study. For Canadian Injured Workers Alliance. 8 Dimensions of Support Framework Visually conceptualized by MacAhonic, P., & Shaw, L. 2007.