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Published: 6. July 2017
Last updated: 7. July 2017
Category: Research

The need for competency in sickness absence management

Integrating work rehabilitation and health care has not been common. Not in mental health care nor in medical care. The two services have usually existed in silos, where one silo takes care of the health problems, and the other silo deals with the process back to work. In Norway, NAV (the Norwegian Labor and Welfare Administration) is taking care of the work rehabilitation, while the health care sector deals with the health conditions responsible for the work disability. Despite efforts and policies attempting to bridge the gap between work and health in all patient treatment, few successful examples exist. One of the reasons may be the general lack of good models for how to actually do this.

Vocational rehabilitation generally falls within two traditions. The first, and until recently the most common, is called train and place. Within this approach, the idea is to prepare the client for the competitive job market by offering training of various sorts, often in an adapted and sheltered setting (e.g. traineeship in a sheltered business). The second, and more innovative approach, is called place and train. This approach takes a complete opposite position and instead of training and preparing the client for the job market, goes directly into the job market to find a job that matches the client’s preferences, talents and needs, with a suitable and willing employer. When the client has gained employment, the real training starts, and individualized and continuous support is provided. The evidence-based model within this tradition is called Individual Placement and Support (IPS) and was originally developed to help people with severe mental disorders obtain employment. IPS integrates job support as a component of the psychological treatment rather than a separate service, and has gained increasingly popularity the last couple of decades. This is not without reason; overwhelming evidence are repeatedly demonstrating its superiority over traditional approaches all over the world.

Then what about Norway? Could this same model work in one of the wealthiest countries in the world, characterized by high job security and a generous welfare system? Recent evidence shows that it does. IPS was recently tested large scale in a trial where more than 400 patients with moderate to severe mental disorders were randomly allocated to receive either IPS or care as usual. The results showed that not only did IPS lead to more competitive employment, it also resulted in better mental health and quality of life for the participants.

Finally, if this model works so well for people with mental health problems, why not for people with other health problems? This was the idea behind an ongoing study at Oslo University Hospital that tests the effectiveness of IPS integrated with interdisciplinary treatment for patients with chronic pain. Besides from mental health problems, chronic pain is the leading cause of sick leave and permanent disability in Norway and elsewhere. A successful model of helping people with chronic pain (re)gain employment is therefore sorely needed. About 60 patients with various chronic pain conditions are included in the study, and the results are so far looking very promising. For the first time, an evidence-based model that integrates job support with patient treatment is being tested in a medical hospital setting, and this study could thus serve as an example for other patient groups as well. After all, the evidence clearly points towards the success of integrating health and work rehabilitation, not treat them as separate and sequential processes. Work should be considered part of the treatment, not the endpoint of treatment.

Silje Reme is Professor in Psychology at the University of Oslo. In addition, she work as a psychologist at the Department of Pain Treatment at Oslo University Hospital.





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