WORK A Journal of Prevention,
Assessment & Rehabilitation
ELSEVIER
Work 9 (1997) 233-235
Workers' compensation in New South Wales Australia: the OTS role Colleen M. Hartcher * PO Box 160, Lismore, New South Wales 2480, Australia
Received 28 February 1997; accepted 1 April 1997
Abstract Workers' compensation in New South Wales Australia, changed in 1987 to emphasise rehabilitation back into the workforce. This change has expanded the field in which occupational therapists can contribute to work-related injuries. The Occupational Therapists' wide ranging approach to workers with injuries, and their ability to take a multifactorial approach to problem solving, puts them in a good position to resolve complex issues relating to return to work. © 1997 Elsevier Science Ireland Ltd. Keywords: Rehabilitation; Workers; Occupational therapist; Occupational rehabilitation
1. Introduction
The introduction of the Workers' Compensation Act of 1987 in New South Wales, Australia expanded work opportunities for occupational therapists in the area of occupational rehabilitation. The Workers' Compensation Act of 1987 emphasized the employers' duty of care to pro-
* Corresponding author. Tel.: + 61 66 212526; fax: + 61 66 219945.
vide a safe and healthy work environment. The most significant shift from previous legislation was to one emphasizing occupational health and safety for prevention of injuries, regular weekly compensation and rehabilitation. In this new system, access to common law was limited. A worker's right to rehabilitation to return to work was recognised. Employers are further encouraged to embrace rehabilitation as insurance payments are directly related to return to work. Occupational therapists, with their wholistic approach to illness/injury and skills in assessing a person's
1051-9815/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved. PlJ S1051-9815(97)00044-2
CM. Hartcher / Work 9 (1997) 233-235
234
functional ability are well placed to provide services within the occupational rehabilitation arena. It is the role of Workcover New South Wales to implement the Workers Compensation. Workcover New South Wales, also controls all rehabilitation providers providing services to injured workers by controlling the services and the standards by which they are provided. Workcover (1993, p. 9) defined occupational rehabilitation as 'The restoration of the injured worker to the fullest physical, psychological, social, vocational and economic usefulness of which they are capable, consistent with pre-injury status. It is a managed process aimed at maintaining injured or ill workers in or returning them to suitable employment'. (VVorkcover, 1993,p. 9)
Occupational Rehabilitation is involved in working through the following hierarchy: 'same duties/same employer different duties/same employer same duties/different employer different duties/different employer'. (VVorkcover, 1993,p. 13)
The emphasis of rehabilitation providers remains in setting and achieving vocational goals and outcomes. Other non-vocational related services are provided through other practitioners. The priority is to return an injured worker to paid employment in a capacity which considers their medical status/skills and experience. In the following case studies, I have outlined my role as an occupational therapist to assist injured workers' return to work. 1.1. Case study 1
A fourth year apprentice chef injured his back when he slipped on a wet floor. After conservative treatment he was referred to a neurosurgeon for assessment. It was discovered he had a ruptured disc at lA-5 and proceeded to surgery for a laminectomy. He was referred for occupational rehabilitation 2 months post-surgery. The worker was keen to return to chef work as soon as
possible. He was terminated from his employment. After consultation with his employer they refused to assist with rehabilitation, by reinstating the employee. After consultation with the treating doctor, physiotherapist and assessment by the occupational therapist, it was decided to attempt a return to work as a chef, in a smaller restaurant where quantities of food to be handled would be smaller. After a workplace assessment was conducted and suitable duties identified, he underwent a work trial in a small restaurant. Work and storage benches were at a suitable height, and floors were non-slip. The worker wore a pair of shock-absorbing innersoles as the floor surface was hard. To incorporate changes of posture while working, he was also involved in waiting tables and taking telephone bookings. The worker gradually increased his working hours but was unable to upgrade beyond 4 h/day. Although the worker was able to have regular rest breaks of 5 min every hour, he experienced considerable pain. He completed his work trial at 12 weeks. At this stage he was assisted to job seek within his capabilities. Against the advice of the occupational therapist, he secured himself a job full-time in a coffee shop. This lasted 2 days, as the worker could not manage the constant standing involved. At this point, the worker was prepared to be counselled regarding appropriate employment. He required employment which allowed him to be predominantly sedentary with frequent changes in posture. He needed a predictable work environment where the pace and timing of work could be predicted. It was very important to this worker to continue using the skills he had gained in his apprenticeship. Since his interests and skills were clearly in the hospitality area, we both explored options for him to gain sedentary employment in this area. He was also sent for a vocational assessment which further assisted in pinpointing a vocational goal. The worker underwent training in hospitality management and through these contacts secured employment as a Tavern Manager. This gave him the variety of working postures required and he was able to use his pre-injury skills.
CM Hartcher / Work 9 (1997) 233-235
In conjunction with the return to work program, the worker attended a gym and swimming program for back strengthening and general fitness. Counselling and advice by the occupational therapists were necessary at times when inappropriate choices were made by the worker. Cooperation between team members and an awareness of understanding of the workers needs were essential to this workers success. 1.2. Case study 2
A 21-year-old teller had been involved in three armed hold-ups. She had received post-trauma counselling on each occasion. On the third occasion when she attempted to return to work she was unable to cope, feeling physically ill, uncontrollable shaking and severe anxiety. She was referred for rehabilitation when her employer was unable to get her back to work. On initial contact, it appeared the workers symptoms were settling, but she expressed anger at the vulnerability of the financial institution's geographic location. In consultation with her employer, this issue was addressed. The employer agreed that the geographic location was unsuitable and would be moved in 2 months time. Until this occurred, a security guard would be present. The worker would be offered alternative duties off the counter at another branch, to commence her rehabilitation. The worker and doctor agreed to this plan and the worker commenced on restricted hours and duties in another branch. She quickly upgraded to full-time duties off the counter. After this was stabilised, she commenced 1 h on the counter each day. She gradually upgraded this so that 6
235
weeks after her return to work, she was on full counter duties. Now, the next step was to return her to the original branch (which had now moved to a new location). At this time, a full-time position became available at the branch where she had been rehabilitated. Since this was closer to where she lived, the worker was offered this position, which she accepted. The worker then did some relief work at the original location and coped well. At the time of case closure this worker still required psychological counselling but her employment was now stable. Close consultation with the worker, doctor and employer were required at all times. It was agreed that the worker was to inform her employer when she was feeling anxious. Throughout her upgrading she took regular breaks from the counter when her anxiety levels increased. 2. Conclusion The occupational therapist's wholistic approach considers all factors which may be influencing a person's ability to return to their work. In my experience, complex return to work plans involve many hidden factors which have been overlooked by others. Occupational therapists' ability to question the causes and consequences of injuries and their sequelae, while considering the physical and emotional needs of workers, gives them the ability to find solutions to complex situations. References Workcover. Rehabilitation guideline: guidelines for workplace based occupational rehabilitation programs for large and medium sized businesses, 1993.
Assessment & Rehabilitation
ELSEVIER
Work 9 (1997) 233-235
Workers' compensation in New South Wales Australia: the OTS role Colleen M. Hartcher * PO Box 160, Lismore, New South Wales 2480, Australia
Received 28 February 1997; accepted 1 April 1997
Abstract Workers' compensation in New South Wales Australia, changed in 1987 to emphasise rehabilitation back into the workforce. This change has expanded the field in which occupational therapists can contribute to work-related injuries. The Occupational Therapists' wide ranging approach to workers with injuries, and their ability to take a multifactorial approach to problem solving, puts them in a good position to resolve complex issues relating to return to work. © 1997 Elsevier Science Ireland Ltd. Keywords: Rehabilitation; Workers; Occupational therapist; Occupational rehabilitation
1. Introduction
The introduction of the Workers' Compensation Act of 1987 in New South Wales, Australia expanded work opportunities for occupational therapists in the area of occupational rehabilitation. The Workers' Compensation Act of 1987 emphasized the employers' duty of care to pro-
* Corresponding author. Tel.: + 61 66 212526; fax: + 61 66 219945.
vide a safe and healthy work environment. The most significant shift from previous legislation was to one emphasizing occupational health and safety for prevention of injuries, regular weekly compensation and rehabilitation. In this new system, access to common law was limited. A worker's right to rehabilitation to return to work was recognised. Employers are further encouraged to embrace rehabilitation as insurance payments are directly related to return to work. Occupational therapists, with their wholistic approach to illness/injury and skills in assessing a person's
1051-9815/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved. PlJ S1051-9815(97)00044-2
CM. Hartcher / Work 9 (1997) 233-235
234
functional ability are well placed to provide services within the occupational rehabilitation arena. It is the role of Workcover New South Wales to implement the Workers Compensation. Workcover New South Wales, also controls all rehabilitation providers providing services to injured workers by controlling the services and the standards by which they are provided. Workcover (1993, p. 9) defined occupational rehabilitation as 'The restoration of the injured worker to the fullest physical, psychological, social, vocational and economic usefulness of which they are capable, consistent with pre-injury status. It is a managed process aimed at maintaining injured or ill workers in or returning them to suitable employment'. (VVorkcover, 1993,p. 9)
Occupational Rehabilitation is involved in working through the following hierarchy: 'same duties/same employer different duties/same employer same duties/different employer different duties/different employer'. (VVorkcover, 1993,p. 13)
The emphasis of rehabilitation providers remains in setting and achieving vocational goals and outcomes. Other non-vocational related services are provided through other practitioners. The priority is to return an injured worker to paid employment in a capacity which considers their medical status/skills and experience. In the following case studies, I have outlined my role as an occupational therapist to assist injured workers' return to work. 1.1. Case study 1
A fourth year apprentice chef injured his back when he slipped on a wet floor. After conservative treatment he was referred to a neurosurgeon for assessment. It was discovered he had a ruptured disc at lA-5 and proceeded to surgery for a laminectomy. He was referred for occupational rehabilitation 2 months post-surgery. The worker was keen to return to chef work as soon as
possible. He was terminated from his employment. After consultation with his employer they refused to assist with rehabilitation, by reinstating the employee. After consultation with the treating doctor, physiotherapist and assessment by the occupational therapist, it was decided to attempt a return to work as a chef, in a smaller restaurant where quantities of food to be handled would be smaller. After a workplace assessment was conducted and suitable duties identified, he underwent a work trial in a small restaurant. Work and storage benches were at a suitable height, and floors were non-slip. The worker wore a pair of shock-absorbing innersoles as the floor surface was hard. To incorporate changes of posture while working, he was also involved in waiting tables and taking telephone bookings. The worker gradually increased his working hours but was unable to upgrade beyond 4 h/day. Although the worker was able to have regular rest breaks of 5 min every hour, he experienced considerable pain. He completed his work trial at 12 weeks. At this stage he was assisted to job seek within his capabilities. Against the advice of the occupational therapist, he secured himself a job full-time in a coffee shop. This lasted 2 days, as the worker could not manage the constant standing involved. At this point, the worker was prepared to be counselled regarding appropriate employment. He required employment which allowed him to be predominantly sedentary with frequent changes in posture. He needed a predictable work environment where the pace and timing of work could be predicted. It was very important to this worker to continue using the skills he had gained in his apprenticeship. Since his interests and skills were clearly in the hospitality area, we both explored options for him to gain sedentary employment in this area. He was also sent for a vocational assessment which further assisted in pinpointing a vocational goal. The worker underwent training in hospitality management and through these contacts secured employment as a Tavern Manager. This gave him the variety of working postures required and he was able to use his pre-injury skills.
CM Hartcher / Work 9 (1997) 233-235
In conjunction with the return to work program, the worker attended a gym and swimming program for back strengthening and general fitness. Counselling and advice by the occupational therapists were necessary at times when inappropriate choices were made by the worker. Cooperation between team members and an awareness of understanding of the workers needs were essential to this workers success. 1.2. Case study 2
A 21-year-old teller had been involved in three armed hold-ups. She had received post-trauma counselling on each occasion. On the third occasion when she attempted to return to work she was unable to cope, feeling physically ill, uncontrollable shaking and severe anxiety. She was referred for rehabilitation when her employer was unable to get her back to work. On initial contact, it appeared the workers symptoms were settling, but she expressed anger at the vulnerability of the financial institution's geographic location. In consultation with her employer, this issue was addressed. The employer agreed that the geographic location was unsuitable and would be moved in 2 months time. Until this occurred, a security guard would be present. The worker would be offered alternative duties off the counter at another branch, to commence her rehabilitation. The worker and doctor agreed to this plan and the worker commenced on restricted hours and duties in another branch. She quickly upgraded to full-time duties off the counter. After this was stabilised, she commenced 1 h on the counter each day. She gradually upgraded this so that 6
235
weeks after her return to work, she was on full counter duties. Now, the next step was to return her to the original branch (which had now moved to a new location). At this time, a full-time position became available at the branch where she had been rehabilitated. Since this was closer to where she lived, the worker was offered this position, which she accepted. The worker then did some relief work at the original location and coped well. At the time of case closure this worker still required psychological counselling but her employment was now stable. Close consultation with the worker, doctor and employer were required at all times. It was agreed that the worker was to inform her employer when she was feeling anxious. Throughout her upgrading she took regular breaks from the counter when her anxiety levels increased. 2. Conclusion The occupational therapist's wholistic approach considers all factors which may be influencing a person's ability to return to their work. In my experience, complex return to work plans involve many hidden factors which have been overlooked by others. Occupational therapists' ability to question the causes and consequences of injuries and their sequelae, while considering the physical and emotional needs of workers, gives them the ability to find solutions to complex situations. References Workcover. Rehabilitation guideline: guidelines for workplace based occupational rehabilitation programs for large and medium sized businesses, 1993.
