1. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc “BRAINWORK INTERVENTION”: Effective in reducing sick leave for non-permanent workers with psychological problems? Selwin S. Audhoe, Karen Nieuwenhuijsen, Jan L. Hoving, Monique H.W. Frings-Dresen en Judith K. Sluiter Coronel Institute of Occupational Health/Research Center for Insurance Medicine Academic Medical Center, University of Amsterdam EUMASS June 9th 2016

2. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Amsterdam… Coronel Institute of Occupational Health Academic Medical Center, Amsterdam Some activities: Work-related diseases Netherlands Center for Occupational Diseases Effectiveness of interventions/measures in occupational health practice Research Center for Insurance Medicine Disclosure: Insurance Physician Dutch Social Security Agency (UWV) PhD research Academic Medical Center More information: selwin.audhoe@uwv.nl - There is no actual or potential conflict of interest in relation to this study !

3. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Background and relevance Sick-listed non-permanent workers: - higher risk for → sick leave¹٫² → prolonged work disability¹٫² Knowledge on effective RTW interventions on these workers is limited³ Need for development of effective RTW interventions for these workers ¹Benach et al. 2002. The consequences of flexible work for health…. ²Benach et al. 2007. Precarious employment and health… ³Dutch Institute for Employee Benefits Schemes 2011.

4. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc The Dutch Social Security System Sick-listed non-permanent workers: sickness benefit up to 2 years Sickness absence counselling: Dutch Social Security Agency (SSA) Counselling usually conducted by an insurance physician SSA professionals developed Brainwork Intervention to improve work participation

5. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Aim of the study To assess effectiveness Brainwork Intervention for non-permanent workers with psychological problems, compared to care as usual: Main aim: 1. in reducing the duration of sick leave Secondary aim: 1.degree of worker participation 2.level of psychological complaints 3.self-efficacy for RTW

6. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Methods: Brainwork Intervention (1) Core elements: personal attention through face-to-face contact within 5 days classification based on (1) severity psychological problems, (2) degree of functional impairments and (3) estimated recovery time of the worker by the insurance physician early activation and provide structure¹ to the worker (among others exercise program and early reintegration) formulating explicit goals and timetables for recovery²٫³ additional specific psychological/social interventions intensive vocational counselling ¹Dutch Guideline for Mental Health Problems ²Wollburg et al. 2010. Goal setting in psychotherapy… ³Holliday et al. 2005. A survey of goal-setting used in rehabilitation

7. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Methods: Brainwork – Intervention (2) Brainwork ‘light’ – for worker with mild psychological problems (expected recovery <3 months) - Physical exercise program, enhancing coping strategies and early reintegration into primary paid - Additional specific coachingsessions - Vocational counselling Brainwork ‘intense’ – for worker with moderate - severe psychological problems (exp. recovery 3-12 months) - Physical exercise program AND - Tailored content of the intervention depending on the severity of the problems - Vocational counselling

8. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Brainwork: effectiveness evaluation Design: controlled clinical trial (CCT) Brainwork group: n = 164 Control group: n = 156 When/where: January 2014 till september 2015 in the Netherlands Outcomes: (1) duration of sick leave (2) degree of participation (3) psychological complaints (4) self-efficacy for RTW Results at 6 months follow-up

9. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Results – Duration of sick leave (1) 6-month follow-up duration of sick leave (days)

10. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Results – Degree of participation (2) 6-month follow-up % 71 68 25 28 4

11. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Results – psychological complaints (3) Score 28 23 29 24

12. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Results – self-efficacy for RTW (4) Score 3,0 3,2 2,6 2,3

13. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Summarizing Brainwork Intervention vs. Care as usual At 6 months follow-up No significant differences: in reducing the duration of sick leave degree of participation level of psychological complaints self-efficacy for RTW Possible explanation: Protocol adherence 10% Intervention group: 32% did not receive intervention

14. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Conclusion Brainwork Intervention as performed → in the short-term did not result in a significant reduction of the duration sick leave compared to care as usual Results of our study → reflect the difficulty of effectiveness study in non-permanent workers

15. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Thanks for your attention !!

16. Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc Methods: Rationale Brainwork Intervention Face to face contact: encourage worker, commitment for intervention Category classification: stepped care approach intervention Timely referral for interventions: positive effect on mental complaints and functional recovery Motivate to activate: provides active day care → promotes recovery and improves functioning Goal-setting: increases sense of control and encourages a faster recovery Guidance to work: work is structuring activity → positive impact on recovery and increases functioning