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Return to Work: The (RTW) Evaluation
The challenges facing employees who have experienced a work impairing disability or illness, seeking to return to work are many. Not only is the person depleted in terms of energy levels, physical strength, but their self-esteem and confidence will be shaken. In terms of the workplace itself, bosses may not necessarily be as supportive as one would like, fellow employees may also harbour resentment that the employee was off the job, creating extra work for those who were left. There may also be a lack of understanding of what the returnee is facing, so communications is an issue. To assist in a smooth transition it is helpful to consider programs such as the Return to Work Evaluation.
A RTW Evaluation helps ensure an employee’s readiness to return to work, and plays a critical role in ensuring a smooth transition back to work. Studies have shown that if a RTW fails, the chances of it failing a second time is 80%. Plotting a strong RTW strategy including the Evaluation can greatly prevent relapse and reduce safety risks. It can also reduce employer costs overall. This process is holistic and uses a biopsychosocial treatment model which is summarized as follows:
Collection of relevant work related background information
Prior to conducting the evaluation, it is helpful to have access to as much information about the work history of the employee as possible. Such information may include length of employment, job description, any disciplinary history or absenteeism and performance reviews. In addition to employment data, the psychologist or counsellor needs to obtain prior medical and/or mental health information. Such information often yields critical clues such as prior episodes of illness or disability, treatment recommendations, prognosis, and relevance to the employee’s work situation, past and present.
Conducting an in-depth personal interview
Because the employee’s perception of the problems is likely to be complex, the interview tends to be lengthy. In our practice, we typically schedule 2 hours for the initial appointment, with additional time as needed. The interview focuses on five areas:
- Employee’s description of work problems, if any
- Employee’s social history including education, family, legal, psychiatric, substance use, aggression, medical, and activities of daily living
- Employee’s prior work history, including previous employers
- Current symptoms, health and mental health status, and behavioral observations
- Employee’s perception of his or her ability to return to work, including suggestions of any modifications to improve work performance
Administration of standardized psychological instruments
As described above, objective, actuarially-based information is important to use. The tests that are administered are gold standards in terms of measuring the psychological factors essential to succeed in any job. These factors include things such as: cognition, pace, persistence, performance, reliability, honesty, trustworthiness, interpersonal skills, conscientiousness, motivation, and stress tolerance. The tests used commonly fall into 4 areas:
- Cognitive: Measures intelligence, concentration, and memory
- Personality: Measures personality and emotional characteristics, which may be involved in mental health problems such as depression or personality disorders
- Effort and motivation: Measures the extent to which the employee is putting forth appropriate effort and is motivated to present in an accurate manner. Ideally, employees who are either minimizing or malingering their symptoms will be identified with these tests
- Organizational behavior: Measures personality characteristics that help determine the suitability of an employee for his or her specific job. For example, managers, police officers, and sales people tend to have certain personality characteristics in common
The evaluation is not complete without specific us making recommendations that try to address the best interests of both the employee and employer.
Such recommendations usually fall in one of three categories:
- Fit to return to work – no restrictions. The employee has fully recovered from whatever problems he or she had been experiencing and is now ready to return to work
- Fit to return – with restrictions or modifications. The employee may return, but only with some provisions. These may range from initiating or continuing in mental health treatment to making modifications to their workplace environment
- Unfit to return. The employee cannot return to work because he or she would be unable to do the job due to an ongoing mental health problem, or would be a threat to the safety of self or others
To Summarize
Employers that take advantage of services such as RTW Evaluations, and work with the recommendations provided, help create a much more sustainable and long lasting RTW situation, that not only dramatically improves the chances of the RTW being successful, but greatly improves the perception of the returning employee, as well as other staff, of the employer as being caring and interested in the well-being of staff.
Other Resources
In addition to using programs such as these, employers who work with HR
and their EAP
to prepare the employee and other staff for the return, also report improved outcomes. For an example of a successful RTW program involving cancer patients, Wellspring has an excellent program https://www.facebook.com/WellspringCalgary/posts/10153097864386280. Chris is an instructor for this course at Wellspring Calgary.
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