WINTER 2015 The Official Publication of VRA Canada 41831522 TECHNOLOGY vs. Competency
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Official Publication of the Vocational Rehabilitation Association of Canada 4 10 14 17 19 FEATURES Making A Change: Evolving claims management in an era of big data Inquiring Minds: A look at what s new in technology & health Smartphones & Smart Forms: What technology is doing to our bodies Ethics in ehealth A modern dilemma Collisions by the Numbers: The true cost of auto accidents LETTER FROM THE EDITOR WINTER 2015 There are big changes on the horizon for VRA Canada. Two of our long-time partners Events & Management Inc. and MCI Strategies are moving on. We are excited about what the future holds for our association and we wish the best of luck to everyone in their new endeavours. During this transition time, we promise to continue to bring you informative and interesting content in the form of this magazine and other official publications. Be sure to follow us on all of our social media accounts (Facebook, Twitter, and LinkedIn) to stay up-to-date with all our changes and to receive announcements as they happen. In this issue, we ve got an eclectic collection of articles ranging in topics from what s new in technology to the current state of claims management to what your job is doing to your body. Sit back, read, and enjoy! Sincerely, Katherine Abraham Editor, Rehab Matters Magazine CONTRIBUTORS Katherine Abraham, Hons. BA Gillian Blair, BA, CVP, RRP Phillip W Boswell, MA, BEd, RRP Alvin Brown, BSc, DOMP, RMT Joanne Johnson, MSc, BSc, RRP Terry Scott Andrew Spencer, Hons. BA Michael JL Sullivan, PhD Dan Thompson, RPP, RVP, CLCP Maria Vandenhurk, BSc, OT, MTC, RRP 2 3 15 16 16 20 INSIDE EVERY ISSUE Society News: The latest VRA developments from across Canada A Message from the National President: Addie Greco-Sanchez CAVEWAS Corner: The Role of Ethics in the Professionalization of Vocational Rehabilitation LMS PROLINK Protector Your questions answered Membership Updates: The latest VRA members and achievements 20/20/2: Answer 20 questions for 20 dollars and earn 2 CEU credits PUBLISHED BY VRA Canada Account Manager: Pam Lyons 4 Cataraqui Street Suite 310 Kingston, ON, K7K 1Z7 Tel: 613.507.5530 Toll-free: 1.888.876.9992 Fax: 888.441.8002 Email: info@vracanada.com Web: www.vracanada.com Editor: Katherine Abraham Design: Candace Morgan MCI Strategies Advertising Sales Director: Audra Leslie Tel: 647.290.3273 aleslie@graymattermarketing.ca 150 Ferrand Dr. Suite 800 Toronto, ON M3C 3E5 Tel: 416.340.7707 Fax: 416.340.1227 Web: www.mcintegrated.com Rehab Matters is published four times a year by VRA Canada. The opinions expressed in this publication do not necessarily reflect the policies of the association. PUBLICATION NUMBER: 41831522 RETURN UNDELIVERABLE MAIL TO: VRA Canada 4 Cataraqui Street Suite 310 Kingston, ON, K7K 1Z7 WINTER 2015 1
Society News: Updates from across the country British Columbia We are back into the swing of things after a very busy holiday season. Upcoming for BC Society: strategic planning is set for February 2015. The BC Society board also continues to review topics for webinars to present to our members. Manitoba The Manitoba board is currently planning for our next educational session, which will take place right in the middle of a cold Manitoba winter. We are currently exploring topics and speakers. We held an education session in October that was very well attended! We almost had more people than seats and the reviews were really, really good! We had a great speaker/presenter in David Zinger, M.Ed. Thanks to Gail Burley for an outstanding job taking reservations and getting everything together for the workshop. Ontario In November of 2014, Ontario held a successful fall conference with approximately 125 attendees participating in the event. Counted among these, were 26 students and first-time attendees from York/Seneca, who offered very positive feedback. The Ontario board welcomed a new member, Yvonne Neumann, who was approved by vote at the AGM. Our conference evaluation results noted positive approval of the presenters, our updated website, the complimentary attendee photos, and the scrumptious meals and unbelievable cheese tray at the event. Through the direction and guidance of high-end chefs who offer their time and skills at Famous People Players Theatre where the conference was held, the meals were prepared in part and served by the theatre performers and their peers. They were extremely proud to have VRA Canada s Ontario Society choose their venue for our annual education day. Subject matter experts at the conference offered their well-received topics in the following areas: medical marijuana, compassion fatigue, ethics, and Skid Row to CEO A journey back to dignity and self-worth. Special thanks to our sponsorships from WSIB, Able Translations/ Transport Limited, Ability Alliance of Canada, and Ergo Centric. Saskatchewan Saskatchewan welcomes two new BOD members: Erin Elsasser and Amber Roussin. This year s AGM is tentatively scheduled for March 2015 and will be held via video/ teleconference in both Saskatoon and Regina. Speakers are TBA. To see news from your society in this section, please submit your updates to your society s representative! A 2-Day Skills Training Workshop for the Progressive Goal Attainment Program (PGAP ): An Evidence-Based Treatment Program for Reducing Disability Associated with Pain, Depression, Cancer, and other Chronic Health Conditions PGAP is considered one of the most empirically supported interventions for targeting psychosocial risk-factors for disability. This training workshop is designed to equip rehabilitation professionals with skills in psychosocial intervention strategies such that they may be better able to assist their clients in overcoming the challenges associated with debilitating health/mental health conditions. To date, clinical trials have supported the effectiveness of the PGAP for reducing disability and promoting return-to-work in individuals who have sustained work injuries, individuals with whiplash injuries, individuals with fibromyalgia, and individuals with mental health conditions such as depression and PTSD. The demand for the PGAP has increased dramatically over the past few years and is considered a preferred service by many injury and disability insurers in North America. PGAP has been included in the 18th edition of the Official Disability Guidelines (Work Loss Data Institute, 2013) as an evidenced-based approach to the management of disability. 2015 Canadian Dates: March 27&28 (Vancouver), November 6&7 (Edmonton), November 20&21 (Toronto) Fee: Early bird rate: $750 + (G)HST as applicable per province; Regular rate: $795 plus (G)HST as applicable per province Instructor: Psychologist, Dr. Michael JL Sullivan, is a professor of psychology, medicine, neurology, physical therapy and occupational therapy at McGill University www.pgapworks.com 2
WINTER 2015 A Message from the National President Addie Greco-Sanchez, President Welcome to Your Rehab Matters Magazine Welcome to 2015. It s hard to believe that the New Year is already underway; how time flies! This year marks a major milestone for VRA Canada; 2015 will be our 45th year as a recognized professional association. We have seen many changes and evolutions in our association and profession over those years, including name changes, size, benefits, and structure. Even though we ve had a remarkable term of longevity so far, it seems as if our work has just begun. Statistics Canada reported that 3.8 million workingaged Canadians (13.7 per cent of the population) reported having a disability, and an unemployment rate of 10.4 per cent compared to a national unemployment rate of 6.8 per cent. Exclusion, poverty, and isolation are a shared reality for many Canadians living with a disability. As vocational rehabilitation professionals, we need to manage the immediate needs of our clients but also ensure that we advocate for the disabled and their roles and contributions to the Canadian labour market. As experts in the field, our voice is vital and credible to ensuring the recognition of ability in everyone. Our national conference will be held from June 16 to 19 in Ottawa this year, and will focus on Inspiring the Ability in All. This not only reflects our professional objectives but also our personal goals. Advancing our skills and knowledge is key to both these objectives. VRA Canada has invested and will continue to invest in education for our members. I encourage each of you to examine the 30 courses currently available online and I ask you to provide future topic ideas that you feel are important to your ongoing professional development. Send your suggestions to our education committee, care of Naireen Lowe, at nlowe@mcintegrated.com, for future consideration. Technology is forever changing and so is our world. What would we do without the internet and our cell phones? The association has been upgrading our technological opportunities for members online education, for instance. We are also going to introduce webinars this year and web-based Town Hall Meetings. Town Halls will provide members with the opportunity to talk directly to me and other board members about topics that affect them and the association. A Town Hall Meeting is a live discussion that provides viewers with the opportunity to pose questions and receive answers in real-time. The date and time will be posted in upcoming email bulletins. There will be changes to VRA Canada management this coming year. Contracts for both Events & Management Plus Inc. and MCI Strategies Inc. will be ending this year. Both of these organizations have served VRA Canada well and will be missed. We wish them the very best in their future endeavours. Effective March 1, VRA Canada will be partnering with Managing Matters and KMG Health Partners. Managing Matters is an experience management company that will be handling dayto-day contact for members, as well as the overall administration of the association. KMG Health Partners will be responsible for overseeing the strategic marketing, communication, and public relations of VRA Canada. We look forward to working with both of them. As I have indicated in previous issues, I encourage your comments and questions. They are important and help us to better serve the membership. Feel free to contact me at info@vracanada.com or directly at agsanchez@agsrehab.com. I also would like to encourage members to participate in their societies or at the national level. You will be amazed at what you can learn! On behalf of the VRA Board of Directors, I wish you and your family health and prosperity for 2015. Sincerely, Addie Greco-Sanchez President, VRA Canada VRA CANADA Vocational Rehabilitation Association of Canada 2014/2015 Board of Directors Addie Greco-Sanchez President Lesley McIntyre Past President Audrey Robertson Director, British Columbia Society Shelley Longstaff Director, Alberta Society Wanda Adair Director, Saskatchewan Society Lisa Borchert Representative, Manitoba Society Wanda Yorke Director, Ontario Society Leeann Tremblay Director, Quebec Society Ann Maxwell Director, Atlantic Society Paul Holtby Representative, CAVEWAS Jac Quinlan CVRP Liaison to VRA Sharon Smith VRA Liason to CVRP National Office VRA Canada 4 Cataraqui Street, Suite 310 Kingston, ON, K7K 1Z7 Tel: 613.507.5530 Toll-free: 1.888.876.9992 Fax: 888.441.8002 Email: info@vracanada.com Web: www.vracanada.com WINTER 2015 3
Making A Change: Evolving claims management in an era of Big Data By Maria Vandenhurk, BSc, OT, MTC, RRP; Joanne Johnson, MSC, BSC, RRP; & Gillian Blair, BA, CVP, RRP Preferred disability management (DM) providers of the future will manage cases using technology platforms that change the traditional understanding of claims patterns and service level clustering into more advanced models using sophisticated analysis and prediction of probability, driving optimized handling and superior outcomes. Overall, the field of disability management faces unprecedented challenges in today s competitive landscape rising claim volumes; budgetary and resource constraints; and increasing demands for better tools, processes, and technology platforms. Organizations specializing in disability claims operations are actively seeking opportunities for financial gain through significant administrative efficiency, increased productivity, and optimized performance, while improving customer service and overall stakeholder experience. Furthermore, these organizations face moral and ethical challenges to more effectively manage disability claims in order to mitigate not only the negative economic impacts but the unwanted human outcomes associated with medically unnecessary time away from work. Current research literature and industry best practice establishes that early intervention and prevention are key to mitigating these challenges. This involves deliberate and focused involvement on the part of management in advance of an employee claim as immediately as possible (1, 5, 7). Early upstream involvement in the DM process can decrease claims duration and minimize work absences, resulting in significant savings for the organization (5, 7, 13), which may include 4 reducing costs such as paying replacement workers, lost productivity, and higher disability insurance premiums. What is often overlooked with significant volumes of claims is the detrimental impact associated with extended time away from work on the health of the individual employee. Dr. Gordon Waddell (2007) from the Centre for Psychosocial and Disability Research at Cardiff University aptly states: Long-term worklessness is one of the greatest risks to health in our society. It is more dangerous than the most dangerous jobs in the construction industry, or working on an oil rig in the North Sea Too often we not only fail to protect our patients from long-term worklessness, we sometimes actually push them into it (14). Waddell & Burton (2006) further state: Worklessness is associated with poorer physical and mental health and well-being (13). Conversely, resuming work in a timely manner promotes recovery, leading to better health outcomes and improved quality of life (13). The oft-overlooked maxim that Work is Healthy provides a compelling imperative for effective, expedited disability management that impacts positively not only on the health and well-being of the worker, but can result in economic and business gains in the workplace. Achieving desirable outcomes in the DM process as well as improved timing for active intervention necessitates a new approach beyond the more traditional onesize-fits-all approach to case management (3). Implementing effective and appropriate intervention at the ideal time on a file is crucial (12). We are fortunate to live in an age where access to massive amounts of aggregate information Big Data for health, rehabilitation, and claims can be effectively leveraged to assist in directing the type of case management approach warranted for different and disparate files. This can include identifying those cases that require more comprehensive or holistic care and handling (8, 6), which are also cases that represent a disproportionate amount of the overall cost of a DM operation. The Case for Advanced Segmentation: Advanced segmentation of cases, driven by predictive modelling and analysis sourced from Big Data, is poised to revolutionize disability claims management by effectively expediting and streamlining DM processes and functions. While case segmentation (or clustering ) is not a new phenomenon in the DM world, there is a growing realization that Big Data can form the foundation of a DM model that moves beyond the traditional understanding of claims patterns. This can lead to significantly increased operational efficiency, improved experience for all stakeholders involved, and better outcomes overall (10). Ready access to The field of disability management faces unprecedented challenges in today s competitive landscape
large quantities of health and disability information and the ability to perform modelling and analysis is critical to realizing such outcomes (8), as these can ensure that specific variables are exposed as key factors within each disability claim; this provides an objective rationale for segmenting cases, as opposed to an arbitrary (and far less accurate) manual categorization of files that is traditionally employed by case managers. A system of segmenting claims supported by relevant data, based primarily predictive modelling and analysis, can bring precision and organization on a broad, organizationwide basis; this can further be refined by personal, human-based handling to ensure that each specific file is matched with the optimal DM approach and accompanying specialized services. To fully benefit from the value of Big Data, it is necessary to first identify key sources of data to be analyzed, and verify that the selected sources will maximize the practical application of the information gathered. In regards to case segmentation, claims need to be appropriately sorted based on case management needs. Common examples of relevant data sources for segmentation include: claims system data and demographics (age, gender, diagnosis, salary, benefit, occupation), data found by text-mining important documents (claims application form, attending physician statements, performance reviews), and prescription drug history (see Figure 1). Effective access to Big Data also hinges on the organization making the appropriate commitment to the necessary information technology advanced technology platforms and case management software that designates and maps criteria, such as skills and expertise to file complexity which is absolutely critical in quickly and accurately yielding the necessary measures and data points to develop and drive the model. To date, the organizational commitment to evolve technology that can support the necessary access to Big Data is lagging the claims industry. RGA (2011) surveyed 120 companies with health and life claims operations and discovered that there Figure 1 is a long way to go before existing and projected claims technology will be able to achieve the outcomes desired, and that for many systems already implemented there are universal shortfalls in current claims technology (8). It is here that the pull of Big Data specifically to achieve the appropriate segmentation of claims will become essential to DM operations looking to optimize processes and improve experiences moving forward; indeed, the industry eventually will become reliant on the required tools and technology to leverage Big Data to meet its economic and business goals across all operations. An advanced case segmentation approach works in the following way: as per Figure 1, information obtained using predictive analytics can form the basis of an automated case triage, leading to workflows in differentiated case handling that align the human talent required (i.e. case management and expertise and skills), as well as the extent of financial investment made at the case level. Simple Low-Touch, Active Management, and Complex Claims: In reviewing the texture of large blocks of claims, three broad categories of claims emerge with distinctive attributes each necessitating a unique case management approach involving different skill sets: For simple or low-touch claims, a one-off automated payment/ processing service accompanied by a brief, targeted customer service call (as required) is ideal. This brief and administrative-oriented intervention approach removes unnecessary handling costs when the recovery and return to work timeline is easily predictable and typically short in duration; or, on the other end of the spectrum, if the timeline is very long-term and payment is anticipated to be required to the end of the claim period. In these cases, direct case management interaction is not required, although further customer service efforts may establish a more suitable focus. There is enormous value in removing a cumbersome and frustrating experience for the employee who is submitting a claim, specifically by early identification that the claim needs to proceed to payment, and by issuing that payment in a timely manner; all of this can occur without unnecessary steps or requests that stem from a more mechanized process geared for the worst case scenario. A second workflow could be formed for straightforward, acute injuries or illnesses that feature predictable recovery timeframes and minimal functional impact; these cases are differentiated WINTER 2015 5
from the more complex cases requiring high-touch intervention (12). For claims characterized by some lost time and health/rehabilitative issues that need a certain level of management but also have a predictable timeline for returning to work, some basic case management and/ or adjudication involvement is required to supplement basic handling processes. For the most part, case management for this type of claim would be accomplished from the case manager s desk with appropriate monitoring and maintenance of stakeholder communications. In this workflow, appropriate resources can be deployed to ensure timely management and adequate communication, which ensures a good overall experience for the employee. A third category of claims constitute the most financial risk in that they are responsible for a disproportionate amount of the overall claim spend (2). These claims are generally referred to as complex or high-touch. The use of predictive modelling and analysis rooted in Big Data can earmark those claims for specific factors that influence health status, such as extended work absence, non-medical influencing factors, and/or the need for more extensive intervention to facilitate resolution. Complex claims demand a highly-specialized approach to case management (13); these cases require comprehensive handling that notably involves a holistic case management approach (9, 11) where there is a focus on early identification and management of the variables that pose a barrier to recovery and early return to work. This approach addresses these variables by involving innovative, customized, and timely DM solutions (12) that can include a specialized set of tools, processes, and technologies that directly address or remedy the barriers. Such an approach is essential to ensuring proactive and expedited management of the claims that pose the greatest risk for both for financial outlay (e.g. duration of claim) and employee loss (e.g. negative health impact of work absence)(13). 6 Classification flexibility coupled with the ability to move claims between these handling categories is required to fully realize the benefits of a specialized case management approach. For example, claims handled with a fully-automated workflow determined at the triage level may indeed develop characteristics that demand a multi-faceted and holistic approach as required by a more complex file; as such, mechanisms to quickly identify and redirect such cases to the appropriate type of handling are essential to ensure DM outcomes are maximized, even as the features of the claim evolve. Similarly, for those files identified at the outset suited to more comprehensive case management may resolve more quickly than anticipated, which would require options to re-route the file to the administrative, automated handling workflow. In these examples, implementation and case management software with advanced classification features can support this requirement. In addition to determining claims characteristics and directing case management approaches via segmentation, predictive modelling and analysis via Big Data can be applied to identify best practices for case management, treatment, and rehabilitation, thus maximizing the effectiveness for implementation of various interventions (6). For example, the impact of specialized psychological services, such as cognitive behavioural therapy, may vary in outcome depending on the timing of service provision as it coincides with other treatment modalities (e.g. pharmacological). Interpreting outcome information driven by Big Data, the intervention may be directed at a time when it stands to be of most benefit to the employee (4). This maximizes efficiency in terms of treatment and mitigates DM operational costs, while increasing likelihood of better gains for the individual employee, and overall positive outcomes for the organization as a whole. Conclusion Moving forward, having access to sources of Big Data, along with predictive modelling and analysis to determine the right health and DM variables, supported by the right information technology will be critical to an effective claims operation. Advanced segmentation that relies in large measure on analytics and technology to match files with particular characteristics to the optimal case management approach will form the bedrock for a solid claims operation. By enacting workflows that automate the processing of simple claims, ensuring adjudicative and other basic issues are dealt with via monitoring of standard claims handling processes, and taking an overall holistic and specialized-services approach to complex files, organizations can achieve a new level of efficiency with improved outcomes and a better experience for all stakeholders involved. Customized technological capabilities embedded with predictive analytics will undoubtedly become critical for claims operations seeking to meet the challenges of today s resource-constrained disability management environments. To view references for this article, visit our website www.vracanada.com/media.php Maria Vandenhurk, BSc, OT, MTC, RRP, founded Banyan Work Health Solutions in 1995. Her vision challenged industry norms, showed unprecedented innovation, and gained the results needed to influence change. Maria brings a fresh view to rehabilitation that straddles compassion and common sense. Leadership Foundation. REHAB MATTERS APPROVED E DIT O RIA L C O M M IT T E E Gillian Blair, BA, CVP, RRP, is an expert in the arena of frontline rehabilitation and holistic approaches to claims management. She conducts quality audits and process reviews for claims organizations both in Canada and abroad. She is a VP at Banyan, and an active participant with the Woman in Joanne Johnson, MSc, BSc, RRP, is an incisive business analyst. She helps insurers and employers transform their organizations with outstanding results by designing and implementing processes for measuring and managing key performance metrics. She has led the development and implementation of all three of Banyan s industry-leading IT Solutions (BCMSPro, Auditpro and Atworkpro).
----------------------- S PONSORED CONTENT ----------------------- Reducing Work Disability: The development of a psychosocial risk-targeted intervention By Michael JL Sullivan, PhD Twenty years ago, heated debates would arise during discussions about the influence of psychological factors in the development and maintenance of disability; today there is little room for debate. Indeed, research has been consistent in showing that certain psychosocial variables can increase the risk for pronounced and prolonged disability (3, 8, 9, 15). Four psychosocial variables have emerged as consistent and robust predictors of disability across a wide range of debilitating health and mental health conditions. These include catastrophic thinking, symptom exacerbation fears, perceived injustice, and disability beliefs (12, 13, 18). The Progressive Goal Attainment Program (PGAP ) is a psychosocial risk-targeted intervention that was developed to reduce psychosocial barriers to work resumption in individuals with debilitating health or mental health conditions. Proceeding from research highlighting the role of psychosocial factors in the development and maintenance of disability, we reasoned that an intervention specifically targeting disability-relevant psychosocial risk factors might yield positive outcomes for individuals who were work-disabled due to a debilitating health or mental health condition (9). Although PGAP was originally developed to target psychosocial risk factors associated with pain-related disability, ongoing research revealed that the determinants of disability showed striking similarity across a wide range of debilitating health and mental health conditions (6, 17). In 2008, PGAP underwent important modifications in order to broaden the range of health and mental health conditions for which it could be used. One of the changes was the modification of the screening measures used to assess a client s appropriateness for the intervention. The instructional set and the item content of the measures were modified such that they could be applicable to any debilitating health or mental health condition, as opposed to being specific to pain. The intervention techniques of PGAP were also modified to make them relevant to the life participation challenges associated with different health and mental health conditions. To date, PGAP has evolved into an intervention for targeting determinants of disability in five different disability groups: pain, depression, post-traumatic stress disorder, cancer survivors, and other chronic illnesses. PGAP was developed according to a population health model of disability management. The success of population health approaches to intervention depends in large measure on the collaboration and support of multiple stakeholders. In the implementation of PGAP, we realized that we needed to have the support of the injury insurer, we needed a community of clinicians that was willing to provide the intervention, and we needed an intervention in which clients were willing to participate. The challenge of coordinating multiple stakeholders in the implementation of a population health approach to the management of disability is enormous but not insurmountable. Now in its fourth edition, PGAP consists of 10 weekly meetings between a trained PGAP provider and a client. An educational video is used to orient the client to the procedures of the intervention as well as to foster positive outcome expectancies. A client workbook is provided to the client and serves as the platform for the intervention techniques that will be used. The primary goals of PGAP are to reduce psychosocial barriers to rehabilitation progress, promote re-integration into life-role activities, and facilitate return-to-work. These goals are achieved through targeted treatment of psychosocial risk factors, structured activity scheduling, graded activity involvement, activity exposure, thought monitoring, goal-setting, and motivational enhancement (14). In the initial weeks of the program, the focus is on the establishment of a strong working WINTER 2015 7
relationship through the use of disclosure and validation techniques. The focus then shifts to the development of a structured activity schedule in order to facilitate resumption of pre-injury/ illness activities. Each session begins with a review of the client s activity log and ends with a discussion of planned activities for the coming week. Activity goals are established in order to promote resumption of family, social, and occupational roles. Additional intervention techniques are invoked to target specific obstacles to rehabilitation progress. In the final stages of the program, the intervention focuses on activities that will facilitate re-integration into the workplace. PGAP differs from many other rehabilitation interventions in that the techniques included in the intervention have the reduction of disability, as opposed to symptom reduction, as their primary objective. There were several reasons for developing a program that focuses more on disability reduction than on symptom reduction. First, research in other areas of rehabilitation clearly indicated that symptom reduction was not a pre-condition to successful return-to-work (4, 19). Second, symptom reduction techniques, whether pharmacological or psychological, tend to be passive in nature and passive techniques have been shown to be detrimental to returnto-work outcomes (20). Finally, a focus on symptom reduction might inadvertently reinforce individuals beliefs that symptoms must be eradicated before occupational activities can be resumed. PGAP also differs from many other rehabilitation interventions in that the intervention is not discipline specific. Even though PGAP can be characterized as a cognitive-behavioural intervention, it is not necessary that the PGAP provider be a mental health practitioner. A variety of disciplines are represented as PGAP providers, including vocational rehabilitation counsellors, occupational therapists, physiotherapists, kinesiologists, athletic therapists, chiropractors, nurses, psychologists, and social workers. PGAP training is open to a number of rehabilitation disciplines because work disability is not discipline specific. The intervention techniques contained within PGAP are not intended to treat the client s underlying health or mental health problem, they are intended to treat the disability associated with the client s health or mental health condition. In PGAP, disability is construed as a reduction in participation in important life activities; disability reduction then becomes a process of re-engaging the client in important life activities. Reducing disability and promoting re-integration in important life activities are objectives that are common to many rehabilitation disciplines. As such, it seemed unnecessary to restrict PGAP training to only a subgroup of rehabilitation disciplines. Although PGAP is described as a 10-week program, the intent is to emphasize that the program extends over a maximum of 10 sessions. Since the goal of PGAP is to promote return-to-work, the program terminates when the client is ready to return to work. Clients will vary in terms of their rate of improvement through the program. Some clients will be ready to transition back to the workplace after four weeks of treatment, others will require all 10 sessions of the program (PGAP never extends beyond 10 weeks). The results of several clinical trials point to a number of advantages of the PGAP. The program has consistently been associated with high enrollment rates, indicating that the majority of individuals to whom PGAP is offered agree to participate (10, 16). When compared Michael JL Sullivan, PhD More information about the PGAP, including reprints of publications describing the outcomes of research on the PGAP, is available from the website www.pgapworks.com. Personal injury lawyers focused on client recovery Over 33 years experience dealing with complex accident and negligence claims including: Brain Injury Spinal Cord and Catastrophic Injuries Medical Malpractice Wrongful Death Claims Joseph E. Murphy, QC Giuseppe Battista, QC J. Scott Stanley Stephen E. Gibson Brian R. Brooke Alex Sayn-Wittgenstein Angela Price-Stephens Derek M. Mah Free consultation. You don t pay until your claim is resolved. murphybattista.com Vancouver 604-683-9621 to other rehabilitation interventions such as physical therapy, participation in PGAP has been shown to increase successful resumption of occupational activities in individuals with low back pain (10), individuals with whiplash injuries (14), and individuals with fibromyalgia (11). Randomized clinical trials have also supported the effectiveness of PGAP for work-disabled clients who are suffering from a wide range of debilitating health and mental health conditions (2, 5). Gains achieved through PGAP have been maintained even when assessed 12 months following termination of treatment (10). In 2013, the Official Disability Guidelines for Workers Compensation Boards listed PGAP as an evidence based intervention for the treatment of work disability (1). To view references for this article, visit our website www.vracanada.com/media.php Kelowna 250-979-7230 Get your life back. Irina Kordic Kevin F. Gourlay Leyna Roenspies Jeffrey Nieuwenburg Mike P. Murphy Dianna Robertson Bill Dick Toll Free 1-888-683-9621 8
CAVEWAS Corner The Role of Ethics in the Professionalization of Vocational Rehabilitation By Phillip W Boswell, MA, BEd, RRP CAVEWAS Corner Dear fellow colleagues and readers, here is our most recent contribution to CAVEWAS Corner. As many of you know, CAVEWAS (Canadian Assessment, Vocational Evaluation and Work Adjustment Society) is a member society of VRA Canada, serving in large part to represent and support the professional and developmental needs of vocational evaluators as well as professional rehab personnel specializing in work adjustment of injured workers and the like. In this section, you will find current and candid articles authored by CAVEWAS members, non-members (and future members alike) that will share, discuss, and communicate with you developments and changes affecting our membership. Amongst them issues of best practice, professional development and designation, as well as industry trends We hope you continue to find the content in this section stimulating, motivating, and informative and we encourage your ongoing participation and contributions. Enjoy! CAVEWAS National Board Of Directors If you are a CAVEWAS member and have any ideas, opinions or thoughts relevant to this section and you would like to share, discuss, and communicate them in the next issue, please contact: Jodi Webster at jodi@keyrehabservices.ca We also encourage you to join our group on LinkedIn. Professional vocational services primarily to those individuals who have experienced vision loss through disease onset, work place injury, motor vehicle accident, or medical complications. toll free: 1-855-736-2959 www.acuityvoc.com In Canada and the United States the vocational rehabilitation profession is striving for recognition. Adherence to an ethical code of practice signifies that one is involved in a profession rather than simply doing a job. Ethics are at the heart of who we are, how we act, and how we want others to view us. Ethics provide guidelines for what is acceptable and not acceptable. As vocational rehabilitation professionals, we must view our actions and behaviours through the lens of our code of ethics to preserve and protect the welfare of those we serve and to promote the public good. A profession can be defined as a calling, vocation, or employment requiring specialized knowledge and often intensive academic preparation. To qualify as a profession, the following characteristics are expected to be present: Knowledge A common body of knowledge for entry and competence Organizations Representative professional organization(s) Standards Benchmarked performance standards Perception An external perception as a profession Competence A need to ensure competence is maintained and put to socially responsible uses Credentials Required training for entry and career mobility Skill Development An ongoing need for skill development (lifelong learning) Ethics An enforced code of ethics Underlying the practice of any profession is the delineation of specific knowledge and skill requirements necessary for effective service delivery. This can be a challenge in vocational rehabilitation given the 10
multi-disciplinary nature of the work. Many professions claim a piece of the rehabilitation pie: some including physicians, occupational therapists, physical therapist, kinesiologists, chiropractors, nurses, massage therapists, psychologists, social workers, case managers, life care planners, economists, and vocational evaluators. Ethics is about promoting benefits and reducing harm The role of an organization, such as the American Board of Vocational Experts, is to develop a body of knowledge, establish a credentialing process, provide education and training opportunities, as well as support standards of ethics, practice, and care for members. In Canada, vocational rehabilitation is an unregulated profession. Only 20 per cent of people in Canada work in regulated professions (1). Regulated professions are controlled by provincial and territorial (and sometimes federal) law and are governed by a professional organization or regulatory body. Professions and trades are typically regulated to protect public health and safety. Regulatory bodies create entry requirements and standards of practice, to assess applicants qualifications and credentials to certify, register, or license qualified applicants, and to discipline members of the profession/ trade. Requirements for entry usually consist of such components as examinations, a specified period of supervised work experience, language competency, etc. Sometimes the requirements are different in each province/territory. One of the interesting challenges of regulation lies in establishing a standard of care and standard of practice. A standard of care is the level of skill and competence demonstrated by professionals of the same discipline, in the same locale, and faced with same/similar circumstances. A standard of practice is a guide to the knowledge, skills, judgement, and attitudes that are needed to practice safely. Standards of practice deal more with the methodological standards (i.e. the how to) of a profession. Experience often teaches us the hard way, by giving the test first followed by the lesson. Most ethical dilemmas are first recognized when the professional experiences serious uncertainty. Making decisions can lead practitioners into a gray area where there is no clear right or wrong. Having a code of ethics helps professionals when they encounter ethical dilemmas. The code of ethics can prompt, guide, and inform us in our everyday work, but ethical awareness is a continual, active process that involves deliberate methods of fulfilling our professional responsibilities. Adhering to a code of ethics is not only the right thing to do, it s what makes us professional. To view references for this article, visit our website www.vracanada.com/media.php REHAB MATTERS APPROVED E DIT O RIA L C O M M IT T E E Phillip W. Boswell, MA, BEd, RRP, teaches the Professional Conduct & Ethics course for the Rehabilitation & Disability Management program at Simon Fraser University. His practice is located in the beautiful Comox Valley where he provides VR and expert witness services to various third party providers as well as individual litigants. REHABILITATION NETWORK CANADA INC. 416-297-9373 www.rehabnetwork.ca Excellence in Rehabilitation & Employment Services Est. 1990 Expert Opinions & Assessments MVA CPP LTD WSIB Principals Frank Martino, CEO Hon. BA, RRP, CCRC, CVP Carmille Bulley, President RRP, CCRC, CVP Contact US 416-297-9373 www.rehabnetwork.ca 4151 Sheppard Ave. E. Toronto, M1S 1T4 WINTER 2015 11
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Inquiring Minds: A look at what s new in technology & health By Dan Thompson, RRP, RVP, CLCP Spinergy I am always searching for new innovators who are working to improve the quality of life for people with disabilities. In one such search, I came across a company called Spinergy based out of Carlsbad, California. What impressed me was not so much that they sell wheelchairs for people with disabilities, but that they truly represent integration and have built their business model around that! Spinergy sells bicycles, including mountain bikes and racing bikes, as well as motocross bikes and a full line of sports-specific manual wheelchairs. All of their products look high end, well-built, and elegant. What s more, Spinergy has a 20-year history of creating and supplying people with products that improve the quality of life for people with disabilities. Spingery released a relatively new product called the ZX-1 Power Add-On, which is a power add-on to a manual wheelchair. For those with fatigue issues, limited hand function, and limited upper body strength, this add-on should allow them to extend their freedom with their revolutionary system. (Check out the online edition of this article on our website to watch a video of the ZX-1.) The ZX-1 s modern, lightweight design fits most manual or rigid wheelchairs, is highly manoeuvrable, easy to operate, and is packed with features allowing people with limited hand function to engage in more day-to-day activities with style. It can fully attach to a manual chair without any tools or fasteners, and can be operated by the left or right hand. It is a bit heavy at 84 pounds and its top end speed of 3.4 mph is not as fast as some power wheelchairs, however, its shoulder- saving properties seem to be well worth it. It has a range of 5 miles. The ZX-1 looks like a great product and it would certainly make a welcome addition to the Ontario Ministry of Health s Assistive Devices Program (ADP) product list. A Cancer Breakthrough Spinal cord injury has been linked to an increased risk for bladder cancer, at up to 28 times higher than the general population. Despite studies identifying indwelling catheters as risk factors, a recent study showed that more than 50 per cent of patients diagnosed with bladder cancer did not have an indwelling catheter. This suggests that the neurogenic bladder, not the indwelling catheter, may be the risk factor for bladder cancer (3). Because a definite link has not been made, unfortunately, urologists need to perform long-term screening of all patients with SCI for bladder cancer, not just those with indwelling catheters. While there is no cure for bladder cancer, there may be hope in sight. 60 Minutes recently did a feature report on Dr Patrick Soon-Shiong (2), a South Africanborn American surgeon, medical researcher, businessman, philanthropist, and professor for the University of California. Soon-Shiong earned a Master of Science degree from the University of British Columbia, has received awards from the Royal College of Physicians and Surgeons of Canada, and later became a Fellow there. He is also the CEO NantWorks. LLC. In 2007, Soon-Shiong s founded NantHealth a supercomputer-based system and network that can analyze the genetic data from a tumor sample in 47 seconds, and transfer the data in 18 seconds (4). Soon- Shiong s research helped discovered that within cancer, there are multiple mutations. This information will allow doctors to perform more tailored treatments based on specific mutations. Since its implementation, the supercomputer has already been use with 3000 patients. Soon-Shiong s goal is to create a sort of social network for cancer patients, wherein similar mutations can be grouped together to use like treatments. For example, a breast cancer patient may have the same mutation as a colon cancer patient, and they could benefit from similarly tailored treatments (1). Soon-Shiong has long-believed that the most important advancements in medicine are made through the use of technology, wireless technology, artificial intelligence, and cloud computing (1). His vision for the future of cancer treatment, through NantWorks, is a convergence of multiple technologies that include diagnostics, supercomputing, sharing data on tumor genes, and a personalized combination of cancer drugs for multitargeted attacks. The goal is to manage cancer and achieve a sustained disease-free state. Soon-Shiong isn t afraid to think big and nurture his larger-than-life ambitions, which is good news for everyone. To view references for this article, visit our website www.vracanada.com/media.php REHAB MATTERS APPROVED E DIT O RIA L C O M M IT T E E Dan Thompson, RRP, RVP, CLCP, has, over the course of his lengthy career, dedicated himself to improving the quality of life of others with disabilities. WINTER 2015 13
Smartphones & Smart Forms What technology is doing to our bodies By Terry Scott We are in the midst of the revolution! The information revolution of the 1980s is still going stronger than ever. In fact, it seems like as soon as a new product is released it s already becoming passé. Everything is being built smaller and faster. Speed and comfort is a prerequisite to success in today s world. Thanks to the Internet, we have unlimited access to information, and technology is quickly following pace. Your new smartphone can do more than your first computer. While sitting at your desk with a large monitor, full keyboard, and a comfortable chair is often preferable, convenience is an undeniably desirable factor in today s society making the draw of the smartphone and other mobile and environmentally adaptable technology indisputable. Unfortunately, individual stress and real pain from poor work environments has built to unbearable levels. Technology has given us the ability to accomplish more tasks, more efficiently, leading many people to attempt to fit more into a single workday, often overworking themselves, resulting in negative consequences. Longer stints in a single position (sitting in front of a computer at a desk), doing the same thing day after day, opens yourself up to repetitive dysfunctions sharp or dull pain, or musculoskeletal dysfunction. Sometimes called repetitive strain injury (RSI), injuries like carpal tunnel (CTS) are also a risk. Ergonomic disorders including CTS, various tendon disorders, and lower back injuries, are the most rapidly growing category of Occupational Safety & Health Administrationrecordable injuries and illnesses (OHSA). The U.S. Bureau of Labor Statistics reports that of all occupational illnesses, musculoskeletal disorders rose 38 per cent in 6 years. In 2012 the Association of Workers Compensation Boards of Canada published that 245,365 14 workers reported sustaining workplace injuries, with 17 per cent of those injuries befalling people in the health and social service industry. On average, in Canada, 672 workers are injured on the job every day. Did you know that sitting is killing us? At least that s what recent studies from the University of Leicester are warning. Researchers have concluded that sitting more than eight hours a day can raise one s chance of a heart attack or stroke by 147 per cent. That s bad news for cubicle dwellers. Meanwhile, a recent survey by Sun Life Financial found that Canadian employers consider a sedentary lifestyle to be one of the top two health risks for workers; suggesting they may be ready to start investing in putting staff on their feet. We have the power to bring the calorie burn of a two-mile run into people s lives; all within the time they re already at their desks. 672 workers are injured on the job in Canada every day One possible solution is something called sit-stand workstations the new craze for better workstation ergonomics. In a nutshell, you have the option to sit or stand and lose some weight and tone some muscles instead of sitting all day. Height-adjustable tables have been around for years but the economics of redesigning your office is somewhat limiting. New sit-stand options allow you to raise and lower your monitor, keyboard, mouse, phone, document holder, etc. with the push of a button. Sit-stand desks offer simple ways to rev up your metabolic rate at your work or home office. According to Dr. Mark Benden, an Assistant Professor of Environmental and Occupational Health at Texas A&M s Health Science Center, standing more is the single healthiest change most office works can make, you burn 20 to 25 per cent more calories versus sitting, and it can improve your posture. Dr. Benden has documented research that says standing two hours a day can result in a 20 pound weight loss over a year s time. How s that for losing some extra flab without finding time or exerting the effort of a gym? The following five reference postures represent a range of postures observed at computer workstations, but may be useful for many other common workplace tasks as well. Reclined Sitting Posture - The user s torso and neck are straight and reclined between 105 and 120 degrees from the thighs. Upright Sitting Posture - The user s torso and neck are approximately vertical and in line (between 90 and 105 from the thighs), the thighs are approximately horizontal, and the lower legs are vertical. Declined Sitting Posture - The user s thighs are inclined with the buttocks higher than the knee, and the angle between the thighs and the torso is greater than 90 degrees. The torso is vertical or slightly reclined and the legs are vertical. Partially Standing Posture - The user s torso and neck are straight, the angle formed by the torso and thighs can range between 120 and 160 degrees. Standing Posture - The user s legs, torso, neck, and head are approximately in line and vertical. Terry Scott started Special Needs Computers in 2002, with a focus to provide simple economical solutions for office ergonomics and assistive technology (using technology for special needs individuals). Terry started working in information technology in 1980.
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Ethics in ehealth A modern dilemma By Katherine Abraham, Hons. BA What are ethics and how do they pertain to technology in the rehabilitation and health care fields? On a very basic level ethics can be defined in two ways; utilitarian ethics and Kantian ethics (the ideas of Immanuel Kant). Kantian theory argues that human will motivates moral action. However, the will can only motivate itself from a rational foundation (2). Kant s ethics revolve on duty rather than emotions. On the other hand, utilitarian ethics is located in the field of consequentialist ethics, where the principles of moral actions are considered to be based on their consequences (5). A utilitarian considers the possible results of every action and chooses the course that will lead to the most happiness. This is known as the greatest happiness principle (1). These views boil down to two positions: consideration of human autonomy and respect for others; and a course of action resulting in the greatest benefit. But how do they translate to rehabilitation and technology? The main concern in ethics surrounding advancements in health care technology stem from the idea of equality. In health care the goal is to provide treatment to everyone fairly and without discrimination. Information and communication technology (ICT) is showing no signs of slowing down, which can mean both great advancements in medical science, as well as the possibility of leaving people struggling to keep up. Trading in tried and true methods of rehabilitation for modern technology-based practices can lead to patient alienation, when a client is unable to comprehend the treatment. At the same time, neglecting the effectiveness provided by using modern techniques would be unfair to those patients who would benefit. Finding and maintaining balance in treatment is imperative. Ethics is about promoting benefits and reducing harm (5). The many aspects of and uses for technology in the rehabilitation field create just as many ethical questions Keeping in mind the ethical ideal of equality, all patients of a certain practice should be able to access the same resources. Top of the line technology based tools should not be so complex that they become inaccessible and unusable to people who are less technologically savvy. An ethical issue arises when a health care worker chooses to favour one type of treatment despite the fact that it alienates a portion of their clientele, whether they are unwilling or unable to grasp the concepts of the technology, thereby willingly choosing to provide less than model service to those individuals. Technology need not only pertain to methods of treatment, it can also be implemented into how a business is run. Updating patient databases from paper to electronic records is the simplest way to implement technology into everyday use. The very basis of electronic patient records means they will more than likely be held on a computer system, or database. Depending on the type of health care facility you are dealing with, this database could be a small, local set-up, or it could be a larger national or government database that can be accessed from several locations. Such a database would undoubtedly have high security features and be password protected, but the large scale and heightened access to it (from multiple locations) poses possible confidentiality breaches, and with them, ethical dilemmas. The sharing of patient data among or between different health care professionals, departments, and other information systems could affect the confidentiality of a patient s data or it could compromise the integrity and timeliness of the treatment of the data (5). WINTER 2015 17
Here, the professional, whether ICT or health care, has a duty to ensure that appropriate measures are in place that may reasonably be expected to safeguard: the security of electronic records; the integrity of electronic records; the material quality of electronic records; the usability of electronic records; the accessibility of electronic records (3). The many aspects of and uses for technology in the rehabilitation field create just as many ethical questions. The more applied the field, the more specific, focused, and contingent are the particular ethical questions (5). As with any new development, the pros and cons for you and your clients must be intelligently weighed and the chosen outcome should result in the benefit of the most possible people. When a deliberate decision is made to favour one practice regardless of whether it alienates a group of clients, it poses the ethical question of equality. Does more effective treatment for one group of clients outweigh the lack of treatment for another? Other ethical challenges lie in the possibility that not everyone can safely and effectively participate in technology based treatments. A lack of understanding of the particular technologies involved could place certain patients at a disadvantage, and could impact on equality and equity generally (5). Particular concern may be necessary for neurologically impaired populations, some of whom display residual equilibrium, balance, perceptual, and orientation difficulties. It has also been suggested that subjects with unstable binocular vision (which sometimes can occur following strokes, TBI, and other CNS conditions) may be more susceptible to post-exposure visual after-effects (4). As with any ethical discussion, we are often left with more questions than answers. One way to remain ethically-minded is to always consider every possible outcome. Forethought is the most powerful tool you have when making decisions that affect others. If you are able to keep the greater wellbeing of your clients in mind, you will be able to incorporate technological treatments into your practice smoothly and ethically. REHAB MATTERS APPROVED E DIT O RIA L C O M M IT T E E To view references for this article, visit our website www.vracanada.com/media.php 18