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People Factors
The challenges of returning to work with a disability

At a glance:
Finding work can be difficult for people who are unemployed and have a disability. In this study, 10 people with disabilities describe the things that helped them achieve a successful return to work. They identify the value of vocational
vocational
Related to work or career. Vocational rehabilitation focuses on the process of returning to the workforce.
 rehabilitation, individual support, work experience, trial work, and work adjustments. They also described the difficulty of maintaining self-esteem while out of work. 
 
Perspectives:
Employee
Returning to the workforce after being out of work for a long time can be difficult.  It can be even harder for those with a disability.

Work is an important part of life.  It enables us to support ourselves, it's an important part of our identity, and leaves us feeling good about ourselves.  It allows us to contribute to our community, family, and workplace. It also gives us a connection with people around us.  Work offers opportunities for social interaction that can be hard to find anywhere else.

Perhaps the biggest challenge is adjusting to disability. This is not just a matter of working out how to do what you want to physically, it is also a matter of understanding your abilities and limitations, and establishing a sense of identity and worth. These are not easy challenges to negotiate, and people dealing with them usually need support from those around them.  Family members, friends, health professionals and others make it easier to persist when difficulties arise.

To be successful in returning to work it is important to be an active participant in the return to work process itself: when you take control of this process you improve your chances of getting back to work. This can be a hard step to take.  

Measures that improve your confidence include trial work, work experience, and vocational rehabilitation.
Employer
Returning to the workforce after a long absence is hard, especially when someone is also trying to adjust to a disability. Finding a job can be hard, both because of the disability, and because some employers are reluctant to hire a person who has been injured at work.

Workplace adjustments and support from employers makes a big difference.  Programs like work trials and work experience can be very helpful.  Such measures help people to develop a realistic understanding of their abilities and what a return to work will be like. They also allow people to develop self-confidence, which is critical to the return process.

Employing someone who has been out of the workforce for a long time provides that person with an immensely valuable opportunity.
Treater
People who have been off work for a long time need encouragement and support. Setting realistic goals is also important.

A person looking to return to work does better when they recognise the challenges and have come up with strategies for managing them.  Setbacks are inevitable, and these need to be planned for and support provided.  Meeting others who have been able to successfully find a job can help, as this makes a successful outcome seem more realistic.  

Having a structured plan can also help. This might mean measures such as allocating time each day to look for a job. Keeping a diary or notebook can also help to give structure to a return to work plan. A plan allows progress to be monitored and increases the chances of success. It can also provide a basis for useful discussions about the return to work process and the challenges that arise.
Insurer
This study shows that people do better in the return to work process when they have a sense of the importance of work to their lives, and are well supported by those around them.

People looking for a job need to recognise that they can make the biggest difference, that the responsibility for finding a job is theirs.  Others can support them, but it is their actions that will lead to success. Positive encouragement can be very valuable, especially when people feel unsure about the progress they are making.

A clear understanding of the financial situation helps people plan.  If they understand that WorkCover payments will be reduced, or cease at some point, it puts them in a better position to plan financially and for a return to work in general.

Helping people adjust to the injury and disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 is important.  Helping them identify possible future work roles can be a very valuable service if they're not able to return to their normal job. An experienced rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 provider, who understands the person and helps them to look at realistic job options, can provide motivation that help the person get back into the workforce.
Original Article, Authors & Publication Details:
B. I. Mettävainio and C. Ahlgren (2004).

Facilitating factors for work return in unemployed with disabilities: A qualitative
qualitative
A way of assessing a situation without using direct measurement. The outcome is described as a summary in words rather than in numbers. This is in contrast to quantitative assessment, where the result is expressed as a number. A summary of a group of peoples’ beliefs about motivation is qualitative and expressed in words rather than numbers. Average days off work is a quantitative measure as it is expressed as a number of days.
 study.
Scandinavian Journal of Occupational Therapy 11(1): 17 - 25.

1Arbetsförmedlingen, S-981 24 Kiruna, Sweden
2Department of Public Health and Clinical Medicine, Occupational Medicine, Umeå University, S-901 85 Umeå, Sweden

 
Background, Study Objectives, How It Was Done:
 
It is often very hard for people with disabilities to find employment.  At the time this Swedish study was conducted, those who had a disability and were out of work were less than half as likely to find a job when compared with the general population without work.

Disability is not the result of a medical condition alone – it is caused by a combination of a medical condition, personal and environmental factors. This study investigated which factors were important in helping people with disabilities gain employment. 

10 people with disabilities were selected from a national database
database
Store of information (e.g. published research articles). Information can be retrieved by searching (e.g. for key words, authors, or titles).
 and agreed to participate. The sample included 6 females and 4 males, aged between 31 and 58.  Members of the group had various disabilities including physical disabilities, internal diseases, and psychiatric illness. Group members had all been out of the workforce for some time (an average period of 4 years and 7 months, with a range between 2 months and 15 years), but they had recently found work.

In semi-structured interviews lasting 1 – 1½ hours, the participants described the factors that they believed had been important in finding work. They also gave basic information about their family situation, education, work experience and disability.

 
Study Findings:
 
The importance of work

A common theme in all interviews was the significance of work to the interviewees' sense of identity.

All participants expressed high motivation to work, and described it as a goal they had struggled for. They explained that being out of work decreased their confidence and had made them doubt their abilities.

Being out of work was described as a negative experience that decreased the joy of living and left the participants feeling isolated and passive. Participants made comments like “everybody else has somewhere to go and the chance to meet workmates and other people' and “you become antisocial and you don't dare to do anything.'
 
Being an active jobseeker

Being an active jobseeker was highlighted as an important factor in returning to work. The participants stressed that their own positive attitudes and initiative were essential.

Applying for jobs required some courage, because lack of work had, in many cases created self-doubt and a fear of failure. Employment training, work experience and rehabilitation programs were described as helpful in overcoming these obstacles.
 
Support strategies

Interviewees reported that vocational rehabilitation professionals had been important in helping them to become and remain active job seekers.

 
Timing

Interviewees said it had been important to feel physically and mentally ready for vocational rehabilitation before they began the program.

 
Individual support

Many participants said that a fear of failure and of new situations made it hard to attempt job-seeking tasks. Many only felt capable of attempting these tasks when personal support was provided.

 
Adjusted work

Adjustments to the workplace were important, particularly for managing physical aspects of disability such as heavy lifting, repetitive, or fast paced work. Some participants also required a new work environment with less social contact. Some had been uncertain about how acceptable their work adjustments would be to their co-workers, but reactions had generally been positive.

Work experience, trial work and wage subsidies were all seen as useful strategies for assisting in the return to work. This is consistent with other research which shows that work experience and trial work are effective in assisting with a return to work, and more effective than simulated work.
 
Adjusting to disability

The participants believed that personal adjustment to disability was an important part of their return to work. They had to come to terms with their reduced capacities in some areas and change their habits and routines to suit their abilities.

Adjustment had been difficult because it required a reassessment of their own beliefs about what they could and couldn't do.  It also required co-workers to adjust their expectations of participants.  Interviewees reported that counselling and testing helped them learn their limits and work out the level of activity that was appropriate for them.  This increased their confidence and allowed them to be more active in their search for work.

Participants often found it difficult to establish a sense of identity in their new role, and found individual and group therapy helpful in this respect.

Some participants reported difficulty balancing work and home life. This was more common for women, and was sometimes a source of guilt.

 
General comments:

Active job seeking was described as essential, but difficult because of the low self-esteem they suffered associated with a lack of work. Vocational rehabilitation was helpful in improving self esteem and making active job seeking possible.  The support provided by these services was referred to as “empowerment:' it gave individuals the opportunity to take control of their situation and manage it independently.

Trial periods, work experience and work adjustments were identified as helpful for improving self-confidence, and emphasized as good strategies for enabling return to work. The importance of beginning vocational rehabilitation at the right time was also stressed.

Individual support was crucial when setbacks were encountered, allowing participants to persist with their efforts and manage self-doubt.  Different people required different levels of support and it was very important that vocational rehabilitation professionals found the right balance between moral and practical support.
 
Conclusions:
Disabilities make return to work difficult. The medical aspects of a disability cannot always be changed, but the personal and environmental factors can often be adjusted. Some strategies for adjusting these factors include:

     Vocational rehabilitation that is entered into when the person feels mentally and physically ready. This develops confidence as well as physical abilities.

     Trial work and work experience: these prepare the person for the work environment and can also improve self-confidence.

     Providing personal support (practical and moral) when problems are encountered. This allows people to persist and manage self doubt when things are difficult.

     Counselling and testing to give the person an accurate understanding of their abilities and limits, and the level of activity that is appropriate for them.

     Work adjustments: These can make the work environment more accessible.

 
Being out of work for a long period of time and adjusting to a disability poses enormous challenges.  It can be difficult to find the motivation to return to work. These challenges also make it hard to prepare mentally and physically for the return to work. Some rehabilitation participants say that this sense of readiness is very important to a job seeker's chances of success.

To be ready for the return to work process, those with disabilities need to:

  • Be aware of their abilities and limitations
  • Develop new routines and habits that are helpful
  • Address the emotional aspects of disability
  • Set positive, realistic goals
References:
No PubMed Abstract Available
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