The Danish National Return to Work Program. Nordisk socialforsikringsmøde Tammerfors Finland Juni 2012 Glen Winzor Head of division NRCWE

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1 The Danish National Return to Work Program Nordisk socialforsikringsmøde Tammerfors Finland Juni 2012 Glen Winzor Head of division NRCWE

2 The background From 2004 to 2008 there was a dramatic rise in long term sick leave in Denmark Massive political attention: Human and economic perspective 2008: Broad political agreement on an action plan concerning sick leave following an agreement with the social partners (trade unions and confederations of employers) It was agreed to initiate a comprehensive RTW-project targeting long term sick leave

concerning sick leave following an agreement with the social partners (trade unions and

3 The mission Establish a RTW-project on a national scale Base the project on previous national and international projects and on existing literature Include persons with all kinds of diagnoses Secure the implementation of a RTW-model in at least 20 municipalities across the country Dertermine whether the RTW-model reduces sickness leave and improves RTW Funded with 32,5 mio. EUR (+ 6.6 mio. EUR) from the national Prevention Fund Funded with additional 4,5 mio. EUR (+ 0,66 mio. EUR) from the Ministry of Employment More than sick listed persons will participate in the program

Dertermine whether the RTW-model reduces sickness leave and improves RTW Funded with 32,5 mio. EUR (+ 6.6 mio.

4 The structure of RTW in the municipalities Social insurance officers determine if a person is entitled to sickness benefit pay for sickness benefits longer than three weeks categorize and follow-up on sick-listed beneficiaries according to their chance to RTW draw-up reintegration plans for RTW, initiate RTW-activities and coordinate efforts with health professionals and employers

follow-up on sick-listed beneficiaries according to their chance to RTW draw-up reintegration

5 The structure of RTW in the municipalities Assessments of sick-listed persons 1) likely to RTW within three months 2) unlikely to fully RTW within three months, but able to participate in RTW-activities 3) unlikely to RTW within three months and unable to participate in any RTW-activities

within three months, but able to participate in RTW-activities 3)

6 The intervention Core program components multidisciplinary RTWteams standardized procedures for workability assessments a comprehensive training course for all RTWactors

7 The intervention multidisciplinary RTW-teams Arbejdsgiver Employer Fagforbund Family Det øvrige socialvæsen Trade Union Praktiserende læge + øvrigt sundhedsvæsen General medical Familie practioner Union insurance A-kasse system Other relevant Øvrige stakeholders relevante aktører standardized procedures for workability assessments a comprehensive training course for all RTWactors RTW-unit (Occupational Klinisk doctor + Psychiatrist) enhed RTW- TTA- Co-ordinator Koordinator Person on Langtidssygemeldt long term sick leave borger RTW-unit (Psychologist TTA- + Physio Team therapist)

standardized procedures for workability assessments a comprehensive training course for all RTWactors RTW-unit (Occupational Klinisk doctor +

8 The intervention multidisciplinary RTW-teams standardized procedures for workability assessments a comprehensive training course for all RTWactors NRCWE developed a standardized interview guide Must be used by the RTW-coordinators during the first consultation Is based on a bio-psycho-social understanding of health and disability Covers barriers and resources for RTW related to physical and mental health, work and occupational experiences

the RTW-coordinators during the first consultation Is based on a bio-psycho-social understanding of health and

9 The intervention multidisciplinary RTW-teams standardized procedures for workability assessments a comprehensive training course for all RTWactors RTW-coordinators Are expected to manage 50% of cases Involves the RTW-unit to clarify questions or further workability assessment in more complex cases Discuss cases and develop RTW-plans with the RTW-unit on a weekly conference Involves the sick listed person in developing the RTW-plan, RTWactivities and coordinate efforts with key stakeholders

further workability assessment in more complex cases Discuss cases and develop RTW-plans with the RTW-unit on a weekly

10 Det store TTA-projekt - Sagsflow Bør læses sammen med kommentarerne til sagsflowet Informationer Arbejdsgiver Prakt. læge 1 Visitation i jobcenteret Tilfældig udvælgelse af sygemeldte der visiteres til kategori 2 3 TTA- Koordinator Første samtale med den sygemeldte 7 8 M.fl Kategori 1 og 3: IKKE en del af Det store TTAprojekt Psykolog Fysioterapeut (el. lign.) Arb./Soc./Almen mediciner Psykiater TTA-Team Afklaring Klinisk Enhed Afklaring Afklaring 12 Ugentlig tværfaglig konference - Drøftelse af opfølgningsplan 13 Nedfældelse af opfølgningsplan sammen med sygemeldte TTA- Koordinator Opfølgning Koordinering Opfølgningssamtaler mindst hver 4. uge 16 TTA-Team Opfølgning Aktive tilbud Klinisk Enhed Opfølgning Psykolog Fysioterapeut (el. lign.) Arb./Soc./Almen mediciner Psykiater Opfølgning og koordinering indbyrdes samt med eksterne aktører, herunder især arbejdsplads

9 2 10 11 Kategori 1 og 3: IKKE en del af Det store TTAprojekt Psykolog Fysioterapeut (el. lign.) Arb./Soc.

11 The intervention multidisciplinary RTW-teams standardized procedures for workability assessments a comprehensive training course for all RTWactors 3 week mandatory course for all RTW- Coordinators, psychologists and physio therapists Managers from the municipalities and doctors participated in part of the course. Main aim was to ensure that all RTWactors had the necessary knowledge and skills to deliver the program A mixture of theory, practical casework, role plays and exercises Two course managers visit all RTW-teams throughout the program to facilitate the implementation process

12 The time frame April 2010 April 2011 March 2012 November 2012 Program starts Control municipalities are offered the full program Program ends Report

13 The aim of the evaluation Effect If participants have a shorter duration of sickness absence and a faster and more sustainable RTW Cost-effectiveness If the RTW program is cost-effective Process how the program was implemented and if it was implemented as intended how different stakeholders received the program what contextual factors might have influenced the implementation Interpretation of the effect results

program was implemented and if it was implemented as intended how different stakeholders received the

14 Preliminary experiences

15 Employments status 59% women 41% men Based on data from category 2 cases Source: Statusredegørelse. Det Store TTA-Projekt. Det Nationale Forskningscenter for Arbejdsmiljø, 2011'.

16 Mental health problems as a cause of sickness absence Based on data from category 2 cases Source: Statusredegørelse. Det Store TTA-Projekt. Det Nationale Forskningscenter for Arbejdsmiljø, 2011

17 What do the participants think? Participants in the program were more likely to report that they could see new possibilities for RTW were more satisfied with management of their sickness absence, e.g. with the cooperation with other stakeholders and the with the cooperation with the employer Source: baseline and six months questionnaire among sick-listed participants receiving ordinary sickness management and the RTW-program (Supplement til statusredegørelse. Det Nationale Forskningscenter for Arbejdsmiljø, 2011)

18 Thank you for your attention! Contact information Head of division Glen Winzor

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The Effect of a Classroom Management Intervention Results from an RCT Anders Holm, Maria Keilow, Mette Friis-Hansen, and Rune Kristensen Table 2. Course plan for the Classroom Management Intervention.