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Service Delivery Model  
Low complexity 
High complexity 
No ACC intervention  
ACC refers to a 
ACC is key 
Services already in 
Suited to 
Medical fees only 
Some rehabilitation 
Client needs a 
Long term 
these support 
Short but necessary 
intervention is 
range of support: 
stable outcome 
time off work – will 
needed, but no risk 
 Serious Injury  
return to work 
difficult to 
Home Support 
quick referral 
obtain new job or 
within benchmarks 
to arrange stay-at- 
death claims    
Lump-sum / 
alternative job 
Package of 
Client contact: 
Primary health 
ACC case manager 
•     ACC 
provider has main 
/ coordinator  
coordinator, when 
client contact - eg. 
has face- to- 
•     has face-to-face 
face contact  
No active 
rehabilitation plan 
rehabilitation plan 
ACC’s core 
Accept cover 
Timely service 
Pay entitlement 
Cost and 
Check in to 
decide to invest in 
Advise on 
rehabilitation plan 
Monitor for 
development and 
outliers and flags 

y support 
Level of risk 
No risk and low 
No significant  
Risk of high 
Long term 
and liability 
risk flags – but … 
liability if not 
ACC liability – but 
for ACC: 
Fast recovery 
intensively managed 
this is accepted 
reduces ACC 
and timely 
outcomes not 

Barriers facing long term unemployed, injured, or disabled 
workers returning to work. 
Report on international literature search 
Compiled for ACC by Fiona Knight 
16 January 2004  

Table of Contents 

PURPOSE .................................................................................................................................................... 6 
BACKGROUND ..................................................................................................................................................... 6 
METHOD ............................................................................................................................................................. 7 
ORDER OF THE REPORT........................................................................................................................................ 7 

PART 1: FACTORS IMPACTING ON RETURN TO WORK .............................................................. 8 
LENGTH OF TIME OUT OF THE WORK-FORCE ........................................................................................................ 8 
THE CONCEPT OF DISABILITY .............................................................................................................................. 8 

PART 2: BARRIERS AFFECTING RETURN TO WORK ................................................................. 10 

 PERSONAL FACTORS ............................................................................................................................... 10 
Attitudinal barriers ...................................................................................................................................... 10 

Personal responses to stressful life events ......................................................................................... 11 
Response to negative experiences ...................................................................................................... 11 
Loss of status ...................................................................................................................................... 12 
Lack of confidence ............................................................................................................................. 12 
Apprehension regarding re-employment ............................................................................................ 12 
PERSONAL ABILITIES ......................................................................................................................................... 13 
(a)  Capacity to change. .............................................................................................................................. 13 

Personal expectations ........................................................................................................................ 14 
Education ........................................................................................................................................... 14 
EMPLOYABILITY ............................................................................................................................................... 16 
HEALTH FACTORS ............................................................................................................................................. 17 
Pain management ............................................................................................................................... 17 
Use of cigarettes, drugs, and alcohol ................................................................................................. 18 
(c)  Mental health ........................................................................................................................................ 19 
REFUSAL TO ACCEPT JOBS ................................................................................................................................. 20 
AGE, GENDER, ETHNICITY ................................................................................................................................. 20 
(a)  Age ........................................................................................................................................................ 20 

Gender ............................................................................................................................................... 22 
ethnicity .............................................................................................................................................. 22 
TYPE OF DISABILITY / INJURY ............................................................................................................................ 24 
PRE-INJURY CIRCUMSTANCES ........................................................................................................................... 25 
Family circumstances ........................................................................................................................ 25 
Job satisfaction .................................................................................................................................. 26 
Job history .......................................................................................................................................... 27 
(d)   criminal record .................................................................................................................................... 27 
(e)  obesity ................................................................................................................................................... 27 

EXTERNAL FACTORS ................................................................................................................................ 27 
PERCEPTION OF EMPLOYERS / LACK OF KNOWLEDGE ........................................................................................ 27 
JOB ADAPTATIONS ............................................................................................................................................. 29 
CASE MANAGEMENT/ REHABILITATION ISSUES ................................................................................................. 30 
Behavioural dimension ...................................................................................................................... 30 
Cognitive dimension ........................................................................................................................... 30 
The affective dimension ...................................................................................................................... 31 
Environmental .................................................................................................................................... 31 
LAWYERS’/ ADVOCATES’ ATTITUDES ................................................................................................................ 31 
FOCUS ON DISABILITY (RATHER THAN ABILITY) ................................................................................................ 32 
CO-WORKER ATTITUDES ................................................................................................................................... 32 
TRANSPORT ISSUES ........................................................................................................................................... 33 
RETAINING EMPLOYMENT ................................................................................................................................. 33 
SELF-EMPLOYMENT .......................................................................................................................................... 35 
Page 2 of 144 

LABOUR MARKET CONDITIONS .......................................................................................................................... 35 
COMPENSATION ENTITLEMENT ......................................................................................................................... 36 
CONCLUDING REMARKS .................................................................................................................................... 37 

PART 3: PROGRAMMES AND INITIATIVES TO REMOVE BARRIERS ..................................... 39 
ADDRESSING LENGTH OF TIME OUT OF THE WORK FORCE ................................................................................. 39 
Unemployed ....................................................................................................................................... 39 
Disabled / injured workers ................................................................................................................. 39 
ADDRESSING THE CONCEPT OF DISABILITY ....................................................................................................... 40 
ADDRESSING PERSONAL ISSUES ........................................................................................................................ 41 
Personal responses to stressful life events ......................................................................................... 41 
Response to negative experiences ...................................................................................................... 41 
 Loss of status ..................................................................................................................................... 42 
Lack of confidence ............................................................................................................................. 43 
Apprehensions regarding re-employment .......................................................................................... 44 
PERSONAL ABILITIES AND ATTRIBUTES ............................................................................................................. 45 
capacity to change ............................................................................................................................. 45 
PERSONAL EXPECTATIONS ....................................................................................................................... 46 
Education ........................................................................................................................................... 47 
Ability to speak the local language .................................................................................................... 48 
EMPLOYABILITY ............................................................................................................................................... 49 
ADDRESSING HEALTH FACTORS ........................................................................................................................ 51 
Pain management ............................................................................................................................... 51 
USE OF CIGARETTES, DRUGS AND ALCOHOL ............................................................................................ 53 
Mental health ..................................................................................................................................... 53 
Evidence-based Return to Work Guidelines ....................................................................................... 54 
REFUSAL TO ACCEPT JOBS ................................................................................................................................. 54 
AGE, GENDER, ETHNICITY ................................................................................................................................. 56 
Age ..................................................................................................................................................... 56 
Gender ............................................................................................................................................... 59 
Ethnicity ............................................................................................................................................. 61 
TYPE OF DISABILITY .......................................................................................................................................... 62 
Mental health problems ..................................................................................................................... 62 
People with traumatic brain injury (TBI) .......................................................................................... 64 
People with hearing problems ........................................................................................................... 65 
People with sight problems ................................................................................................................ 65 
People with back problems ................................................................................................................ 66 
People with serious injuries ............................................................................................................... 67 
People with spinal injuries ................................................................................................................. 67 
Other injuries / disabilities ................................................................................................................ 68 
PROBLEMS ARISING FROM PRE-INJURY CIRCUMSTANCES .................................................................................. 68 
(a)   Family circumstances ........................................................................................................................ 68 

Job satisfaction .................................................................................................................................. 68 
Job history .......................................................................................................................................... 68 
Relocation .......................................................................................................................................... 69 
Criminal records ................................................................................................................................ 70 
Obesity ............................................................................................................................................... 70 
ATTITUDES OF EMPLOYERS ............................................................................................................................... 71 
The Disability symbol ........................................................................................................................ 71 
Duration of unemployment ................................................................................................................. 72 
Educating employers regarding disabilities ...................................................................................... 73 
Understanding return to work programmes ....................................................................................... 73 
JOB ADAPTATIONS ............................................................................................................................................. 74 
Supported employment ....................................................................................................................... 74 
Assistive technology ........................................................................................................................... 76 
Modification of job duties .................................................................................................................. 76 
Teleworking ....................................................................................................................................... 77 
Work trials ......................................................................................................................................... 79 
Page 3 of 144 

CASE MANAGEMENT / REHABILITATION ISSUES ................................................................................................. 79 
ADDRESSING LAWYER AND ADVOCATE ATTITUDES .......................................................................................... 82 
FOCUS ON ABILITY RATHER THAN DISABILITY .................................................................................................. 84 
ADDRESSING CO-WORKER ATTITUDES .............................................................................................................. 84 
ADDRESSING TRANSPORT ISSUES ...................................................................................................................... 85 
RETAINING EMPLOYMENT ................................................................................................................................. 86 
Earnings supplements / financial assistance to employees ................................................................ 87 
Wage subsidies for employees ............................................................................................................ 87 
Retention incentives for employers and /or employees ...................................................................... 87 
On-job support ................................................................................................................................... 88 
Protection of employment .................................................................................................................. 89 
Quota systems .................................................................................................................................... 89 
Levy systems ....................................................................................................................................... 90 
SELF-EMPLOYMENT .......................................................................................................................................... 90 
Operating within prevailing labour market conditions ............................................................................... 93 
MULTI-TARGETED PROGRAMMES ..................................................................................................................... 95 
RESULTS BASED FUNDING ................................................................................................................................. 96 
CONCLUDING REMARKS .................................................................................................................................... 97 

PART 4: BEST PRACTICE ................................................................................................................... 100 
EVALUATION OF PROGRAMMES ....................................................................................................................... 101 
PRINCIPLES OF GOOD INTERVENTION DESIGN .................................................................................................. 102 
1  Recruitment of participants is the start of the intervention ................................................................... 102 
2  View intervention as a social influence ................................................................................................. 102 
3  Target motivation, skills, knowledge and resources for coping ............................................................ 103 
4  Build self-sufficiency ............................................................................................................................. 103 
5  To be successful requires the confidence to try to succeed.................................................................... 103 
6  Allow for individual differences............................................................................................................. 103 
7  Use active teaching and learning methods, rather than didactic techniques ........................................ 103 
8  Blend active learning with model demonstration, graduated utilisation of skills and positive feedback
 ................................................................................................................................................................... 103 
9  Inoculate against setbacks ..................................................................................................................... 104 

PREDICTING WHO MIGHT BECOME LONG TERM UNEMPLOYED ......................................................................... 104 
MODIFIED WORK DUTIES ................................................................................................................................. 106 
DEMAND-SIDE JOB DEVELOPMENT .................................................................................................................. 106 
MAINTAINING EMPLOYMENT .......................................................................................................................... 107 
BUSINESS PARTNERSHIP .................................................................................................................................. 108 
HUMAN CAPABILITY FRAMEWORK ................................................................................................................. 110 
THE CURRENT NEW ZEALAND LABOUR MARKET ............................................................................................ 112 
HELPING LONG TERM CLAIMANTS ................................................................................................................... 113 
HELPING NEWLY INJURED ............................................................................................................................... 113 
CASE MANAGEMENT ....................................................................................................................................... 114 
POLICY DEVELOPMENT ................................................................................................................................... 115 
APPENDICES ................................................................................................................................................... 117 
APPENDIX ONE: HOW TO RELATE TO PEOPLE WITH DISABILITIES ............................................................... 117 
APPENDIX TWO: OBSTACLES TO RETURN TO WORK QUESTIONNAIRE......................................................... 122 
APPENDIX THREE: IDENTIFYING BARRIERS TO REHABILITATION  .............................................................. 124 
BIBLIOGRAPHY ............................................................................................................................................... 131 
Page 4 of 144 

I would like to thank several ACC staff for their assistance in the development of this 
•  Helen Brodie and her staff in Information Services, who inter-loaned much of the 
resource material for me;    
•  Ezrai Fae, Laura Ager, Denise Udy, Raewyn Cole, Raj Krishnan and Caro Henckels 
who provided valuable comments on the draft report, and suggestions for 
incorporation in the report; and 
•  Donna Engel, who assisted with the production of the report. 
Any errors and omissions in the report are mine.  Those views and opinions stated but not 
sourced are mine, and do not necessarily reflect those of ACC.
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The purpose of this report is to:     
Identify the barriers affecting return to work for people who have been out 
of work for long periods, whether due to injury or unemployment, based on 
an appraisal of international research and interventions; 
Summarise programmes and initiatives which address these barriers; and  
Recommend initiatives to remove these barriers for ACC long term 
There are currently about 14,000 long term claimants with ACC.   While there has 
been a significant reduction in the numbers of long term claimants over the last few 
years, recently there has been a decline in the rate of reduction.   This partly reflects 
the impact of the Injury Prevention, Rehabilitation, and Compensation Act 2001, 
which required additional assessment of long term claimants before they could 
return to independence.    
Other factors affecting the numbers of long term claimants include: 
As a result of advances in road safety, technology, drug development and 
rehabilitation techniques, more people are surviving what would previously 
have been fatal accidents, but they sustain serious injuries which take longer 
times to heal.1    
People injured at a young age still have significant life expectancies.  Young 
adult males, with such long life expectancies, are a particularly high risk 
group in sustaining severe injuries, although research indicates that in 
general younger age at injury is associated with good recovery.    
This project was commissioned in the expectation that many of the problems faced 
by these long term claimants are similar to those facing long term unemployed, 
such as lack of work skills and attitudes, low self-esteem, poor employability, and 
negative perceptions and expectations of employers.   Researchers have recently 
established a relationship between depression and welfare reliance, although 
insufficient work has yet been done to quantify this relationship.2   
This project aims to identify the barriers hindering return to work, and to 
investigate overseas practices that deal with them, with a view to identifying 
appropriate programmes for use in New Zealand.  Such programmes, if successful, 
could be expected to enhance significantly the lives of long term claimants. 
1 Yasuda et al: 2001 p 853 
2 Kalil et al, August 1998 p 12 
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Research into individuals with spinal cord injuries indicated that those who were 
employed post-injury reported more satisfaction with their lives, required fewer 
medical treatments, and rated their overall adjustment higher than individuals who 
were not employed3.   There is abundant similar evidence to support making efforts 
to help injured workers regain and retain employment.  This literature search is 
designed to identify ways in which ACC can help its long-term claimants gain 
similar life satisfaction. 
The literature search focused on Internet resources and inter-loans sourced through 
ACC’s Information Services team.   Initial key words included (long-term) 
unemployment, re-employment, barriers, return to work, disabled workers, 
and work-ready.   Subsequent internet research focused on the actual 
barriers identified, and how to address these. 
A consistent pattern emerged in the barriers identified, supporting the original 
premise that similar problems face the long term unemployed and those out of 
work for long periods due to injury.  
Two significant factors which impact on return to work were identified:  
a)  Length of time out of the workforce, and  
b)  The concept of disability.    
1.10  While these are closely inter-related, and provide the focus for this report, each 
factor is first discussed separately. 
1.11  The barriers identified have been addressed simply as barriers against return to 
work, regardless of whether it was identified as a barrier to a long term unemployed 
/ disabled / injured person.   For many barriers, they are the same barriers facing 
the long term unemployed , disabled people, and injured people. 
A full bibliography of source material is included. 
Order of the report 
The report is in five main sections: 
An introductory section identifying general factors impacting on return to 
work after a period out of the work-force; 
The barriers affecting return to work; 
A description of appropriate programmes used overseas to overcome 
barriers affecting return to work;  
Analysis of different initiatives and a summary of best practice 
recommendations for ACC to assist long term claimants return to work. 
3 Yasuda, et al 2002 Article summary 
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Part 1:  Factors impacting on return to work 
Length of time out of the work-force 
International research concludes that the longer a person is out of work and 
receiving some form of benefit or compensation payments, the less chance they 
have of returning to full time work.  The motivation to find work deteriorates over 
time4.  According to Regan and Stanley of the UK Institute of Public Policy 
Research, (IPPR) “once a person has been on the benefit for 12 months, the average 
duration of their claim will be eight years, with only a one in five chance of 
returning to work within five years”.5   There is considerable evidence that the 
longer people remain in receipt of financial assistance, either their mental and 
physical health is likely to decline, or they enjoy their changed lifestyle which does 
not incorporate being at work.   
An orthopaedic physician’s study of over 100 injured workers found that those who 
lost no workdays, or returned to work within 15 workdays of sustaining the injury 
were still in employment two years later.6 
There are other reported risks when an injured worker is out of work for a long 
time.   For example, in America, because lost time has become routine and 
expected even for relatively minor injuries, the Texas Workers Compensation 
Commission cautions employers to the likelihood of malingering or of fraudulent 
Notwithstanding these concerns, most people who claim financial assistance 
following injury or illness expect to return to work.8   Up to 40% of such people do 
not see their health problems as an obstacle to finding work, but cite a wide range 
of other obstacles instead.  Each of these obstacles is investigated below.   
An ACC survey of exited claimants showed that about half those not working 
considered it was due to their health.  Other reasons included age (and ensuing 
retirement), family circumstances, employer reluctance to hire people with back 
injuries, pregnancy, redundancy, and the lack of suitable / available jobs.9 
The concept of disability 
There is a complex relationship between disability, poverty, low skills and 
worklessness.  The IPPR found that people who become disabled are more likely to 
have been at an economic disadvantage before they became disabled.10  They are 
then more likely to move into low paid, low status jobs, to be in manual 
occupations, and to have lower average hourly earnings than their non-disabled 
peers, even taking into account age, education, and occupation.  The chance of 
becoming unemployed again is higher: 33% for people with disabilities compared 
4 NZ Employment Service 1996 
5 Regan and Stanley: 2003 p 58 
6 Melhorn 1996 pp18-30 
7 Texas Workers’ Compensation Commission website: <> 
8 Pathways to Work 2002 p 11 
9 BRC January 2003 Appendix 3 Table 4 
10 Regan and Stanley 2003 p 57 
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with 20% for those without disabilities, despite evidence11 that people with 
disabilities have a better attendance record, stay longer in a job and have fewer 
accidents in the workplace than the non-disabled. 
In economic terms, as a disability reduces a worker’s productivity, it also weakens 
their relative value on the labour market, and power to compete with other job-
seekers.12  What may be a temporary impairment more easily converts to chronic 
disability  and dependence when there is a surplus of skills, and as a consequence, 
unemployment and disability are overlapping contingencies.   If someone with a 
temporary impairment cannot find a suitable job, it is likely that the labour market 
conditions will interact with their health condition to produce chronic disability.  
Whether the resulting unemployability is due to unemployment or disability is then 
hard to distinguish. 
Behavioural elements are significant determinants of chronic disability13.   These 
The recognition of symptoms of impairments;  
The perception of their incapacitating effects; and  
The choice of coping strategy.    
The first step on the road to disability is the recognition of the symptoms of an 
impairment by the person and/or significant others.  The impaired worker will then 
try to adapt their condition in a way that is socially acceptable and in agreement 
with their own preferences.  Workers will define themselves as disabled if they 
perceive themselves being impaired beyond remedy, and if they experience a 
substantial reduction in work performance.   They will be more inclined to do so if 
the financial and psychological consequences of disability are not severe. 
2.10  The response to injury can be either positive or negative: vocational rehabilitation 
and return to work, or chronic disability and persistent dependency.  The form of 
response will be influenced by the reactions of external parties including 
employers, family and household members, case managers, and health 
2.11  In choosing their response, an injured person will weigh the psychological and 
pecuniary benefits and risks.  Returning to work brings a person the stress of 
employment, having to cope with the vagaries of the labour market and assuming 
personal responsibility for one’s life and financial state. Dependency provides 
financial stability and exemption from such stresses at the risk of external parties 
not legitimising the disability, or of stigmatising the choice as morally inferior. The 
proclivity to assume the disabled role is stronger when the perceived costs are 
lower and the benefits higher.   This can partly explain the prevalence of illness and 
disability in low income, low education groups.14   
11 Wilmott 
12 Aarts and de Jong 1992 p 62 
13 Aarts and de Jong 1992 p 58 
14 Luft, Harold S: 1975 pp 43 - 57 
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Part 2:  Barriers affecting return to work 
OECD figures show that in every country unemployment was higher in 1989 than 
in 1975, even though employment rose rapidly in the 1980s and in 1989 there were 
more job vacancies.  This led to rising wage inflation, increased interest rates, and 
an abrupt end to the boom.15  This implies there was a failure during the 1980s to 
mobilise the unemployed.  The 1990s provided a controlled experiment identifying 
the factors leading to unemployment – some countries radically changed their 
treatment of unemployed people while others did not.   The various  economic 
practices implemented to address the numbers of unemployed have been generally 
well documented but few have focused on the actual barriers facing individuals. 
Many of the barriers facing a long term injured or unemployed person returning to 
work are directly related to the individual. The way individuals cope with being out 
of work has a direct relationship with their chances of returning to work.  As 
individuals react differently to the above factors, barriers against return to work are 
established.   These are described as personal barriers, compared with external 
barriers which are imposed on the person outside their personal circumstances.    
A British inquiry into inequalities in health cited being out of work as a potentially 
major risk to both physical and mental health through: 
Isolation, social exclusion and stigma; 
Changing health related behaviour; 
Disruption to future work career; and 
Trapping people on lower incomes than available through work.16 
Most research on personal barriers to return to work focuses on demographic 
characteristics, education and work experience.    Recent research has identified 
factors such as depression, substance abuse and even domestic violence as factors 
that hinder long term employment prospects.17  This research therefore has looked 
further at barriers such as psychological functioning, stressful interpersonal 
relationships, psychiatric disorders, and personal circumstances.   Many of these 
factors feature widely in the low-income and welfare populations. 
A  Personal factors 
Attitudinal barriers 
Unemployment, injury, and disability can have negative effects on psychological 
and physiological well being. Job loss is a stressful event that threatens a person’s 
sense of well being, takes away daily routines, lessens the sense of control people 
have over their own lives, and creates changes in perceptions, emotions and 
behaviours.18   It can have deleterious emotional, behavioural, and physical effects.   
15 Layard 2003 p 3 
16 Acheson D (Chair) Independent Inquiry into Inequalities in Health Report (1998) 
17 Zuckerman and Kalil 2000 Barriers to work section 
18 Leana and Feldman 1995 p 1386 
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It entails the loss of a valued role in society…often results in economic hardship  
and corrodes one’s sense of mastery, personal identity and close relationship.19   
Job loss also represents a turning point in life.  Some job losers will successful claim 
a new work role, while others will be overwhelmed by the “cascade” of negative 
financial events, an eroded sense of mastery, will suffer discouragement and 
depression and may become a burden or source of stress for the families .20 
To balance this, there is substantial research indicating that the risks of depressive 
symptoms, and the lack of motivation to undertake positive job search, are able to 
be addressed by social interventions.21   
(a)  Personal responses to stressful life events 
People vary greatly in how they manage stress and uncertainty in their every day 
lives.  Each individual has available to differing degrees resources that help buffer 
them from stressful situations or to lower the stress they would otherwise 
experience.  These include: 
Individual skills, such as problem solving and social skills; 
Levels of support (such as financial or family); and 
Energy levels, such as physical health and positive outlook on life.22 
The greater a person’s reservoir of coping resources, the greater the likelihood that 
they will cope with stress, uncertainty, and new situations. Conversely, fear or 
worry of a negative interpersonal reaction can help that unwanted event to 
happen.23   Activities geared towards obtaining re-employment (such as job search 
and retraining) are themselves quite stressful24.  
(b)  Response to negative experiences 
3.10  Social cognitive theory states that failure experiences can under-mine self-efficacy 
and can lower outcome expectancies, eventually resulting in learned helplessness.  
Many people without jobs feel frustration and discouragement over their failure to 
get a job, and this can lead to negative perceptions of themselves.  This negativity 
then pervades their expectations of employment and sense of self-worth.   They 
may blame themselves for their injury or unemployment.  The more depressed a 
person is when beginning a job search, the less likely they are to: 
Take the steps necessary to find a new job; 
Keep their spirits up in the face of any rejections associated with job search 
activities, and  
Present themselves to potential employers in a positive light25.   
19 Price, Vinokur and Friedland 1995 p 22 
20 ibid 
21 Caplan, Vinokur and Price 1997 p 345 
22 Lazarus and Folkman (1984) 
23 Peale NV: The Power of Positive Thinking 1952 
24 Leana and Feldman (1995): p 1384 
25 ibid p 1383 
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3.11  If a person was already pre-disposed to anxiety and depression, these factors will 
impact on his or her acceptance of the injury and view of the future.26    
(c)  Loss of status 
3.12  Related to this is the concern over loss of status.  A British trial to assist people 
move off the Incapacity Benefit into employment27 had mixed results when some of 
the older beneficiaries refused to participate in some aspects of the trial as they 
considered them “patronising and unsuitable for people who had years of 
employment experience”. They were unwilling to consider “work which was 
deemed to be insulting to their abilities.”  This is in reality a failure of the 
programme to meet the clients’ needs, and serves as a reminder that one size does 
not fit all.   Successful interventions are those designed to fit the needs of the 
clients, not the needs of the agencies / experts. 
(d)  Lack of confidence 
3.13  The British Department for Work and Pensions has researched various initiatives to 
help return incapacity beneficiaries to work and, in one study, found that nearly 
half of those beneficiaries actively seeking work had low confidence about working.  
More than a third considered it unlikely that they would get a job because of their 
health problems, and half of them thought that there weren’t job opportunities 
available locally for people like them28.   A Canadian study found evidence of lack 
of confidence because of age: “ If I did go back to work, given that I’m 48 years old, 
who would hire me?”29 
(e)  Apprehension regarding re-employment 
3.14  Fear of the effect of re-employment on their injury or health, and of re-injury is 
another common barrier for long term injured or ill workers against returning to 
work.   These are often unexpressed and sometimes unrecognised fears.  “ If I knew 
I could do it {work} then I would…but I’m so uncertain about it…what affect 
would it have on your health”.30   Losing a job through restructuring or continuing 
ill-health creates another perceived potential stress of applying for unemployment 
or disability benefits that acts as a disincentive to start seeking a job. 
3.15  Fear of leaving the security of a benefit to take up paid employment is a significant 
barrier31.  A British survey of more than 1600 beneficiaries revealed their top three 
concerns were financial: having enough money to live on, coping financially until 
the first pay (usually at the end of the month), and paying the mortgage/rent.   
There was, again, a great deal of concern about reclaiming the benefit if the job did 
not work out or last, due to the perceived complexities and capriciousness of the 
rules.   Fears that the job might not pay well, or that they would lose some of their 
entitlements were also important concerns.  
26 New York State Workers’ Compensation Board p 32 
27 Heenan 2002 p 392 
28 DWP: Short-term effects of voluntary participation in ONE 
29 <> 
30 <> 
31 Woodland, Mandy and Miller 2003: p 64 
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3.16  These fears were borne out by Harries and Woodfield’s research32 on the 
transitional experiences of people moving from benefit to paid employment.  The 
greatest disruption was the change in income cycles from weekly or fortnightly to 
monthly.  Making a monthly pay packet last for a monthly basis can be very 
challenging. Often, too, there were additional costs related to employment, such as 
childcare, travel, clothing and toiletries. 
3.17  Perceptions of the likelihood of being able to move off income support are likely to 
affect whether people actually do so.   British research showed nearly two-thirds of 
respondents felt trapped on income support33.  Family type, education, and ability 
to “make ends meet” have a major effect on the likelihood of a welfare claimant 
feeling trapped, whereas having a health or disability problem does not.  Perception 
of the local labour market was also a strong influence: nearly four-fifths of the 
respondents believed their chances of finding a full time permanent job in their 
areas was not very good.   Lastly, workers who attach less value to employment 
have significantly greater periods of unemployment34.   
Personal abilities 
3.18  Research has identified several personal attributes (whether innate in the worker or 
cultivated as a skill) which assist people cope with the stresses of injury and long 
term unemployment.  The converse is that the lack of these attributes helps create 
barriers against return to work. 
(a)  Capacity to change.    
3.19  With changes in technology, closure of work premises, changes in consumer 
demand, some types of jobs are no longer available. These types of changes in the 
labour market require workers and job-seekers to change as well.    Some types of 
injury rule out a return to pre-injury occupation, especially for manual workers.  If 
they are to return to work, these workers will have no option but to change their 
occupation.  Whether they succeed in finding employment will, to a large degree, 
depend on their willingness to change and their ability to change.  
3.20  Willingness to change is often seen as a generational issue: as people age, their 
tolerance to change lessens and their resistance to change grows.   Changing jobs 
can put people outside their comfort zones and increase their stress levels, 
especially when older people see youngsters performing tasks that they themselves 
are unable to do.   
3.21  The ability to learn is a key aspect of capacity to change.  Employers involved in a 
Philadelphia welfare-to-work scheme repeatedly stressed soft skills including good 
attitudes, good work habits and ability to learn.  “If some-one meets our criteria, we 
can teach them the specific skills they need for our site”35
3.22  The US National Multiple Sclerosis Society has proven that changing physical job 
demands and working conditions has helped MS sufferers cope with the effects of 
32 Harries and Woodfield 2002 p 32 
33 Shaw, et al 1996 p 122 
34 WCRI Research brief 1996 Vol 12 No9 p 3 
35 Hangley and Loizillon 2002 p 6 
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their illness and maintain their employment36.  This has a parallel for injured 
workers, whose injuries prevent them remaining in their pre-injury occupation.  
(b)  Personal expectations 
3.23  The worker’s expectation of his or her performance is probably one of the biggest 
predictors of success in returning to work.   The National Multiple Sclerosis Society 
has also proven that personal attributes such as hope, personal control and sense of 
humour helped MS sufferers cope with the effects of their illness and maintain their 
employment.  A study conducted with the Commonwealth Employment Service in 
Australia, found a significant relationship between those who blamed themselves 
and those remaining unemployed37.  
3.24  Acceptance of residual “scars” from injury is an important ability facing those who 
return to work.  Developing self-awareness and acceptance of deficits resulting 
from traumatic brain injury is the key aspect in the process of rehabilitation, and 
those unable to do this will not be able to become productive in the community38
(c)  Education 
3.25  Basic literacy and numeracy skills are key requirements for most jobs39.  Those with 
numeracy and/or literacy problems tend to take longer to regain employment after 
injury or long term unemployment.   More than half the beneficiaries (whether on 
unemployment or invalid benefit) in one study40 had no school qualifications at all, 
and more than three quarters of them had left school by the age of 16.  An 
American study identified limited proficiency in English as a further barrier41.  In 
this study, 41% of the TANF (Temporary Assistance for Needy Families) caseload 
in Los Angeles County had limited proficiency in English, reflecting the fact that 
17% of the case load were foreign-born.    
3.26  Poor English skills were identified in a study of New Zealand Employment Service 
long-term clients,42  as well as in a study of its own claimant group by ACC’s then 
subsidiary Catalyst43.   Claimants who could neither read nor write English could 
not understand any information given to them by the two agencies.   Statistics NZ 
figures from the 1996 Census show that less than 2% of New Zealand residents do 
not speak any English, compared with about 5% of the American population, 
according to US Census 2000 data44.   Studies in the US have shown a strong 
connection between language ability, employment and earnings.45 
3.27  New Zealand and international studies cite low levels of education as a significant 
barrier to regaining employment. 46  In America, the lack of a high school diploma 
can make it difficult for individuals to find jobs, either because the diploma is a 
36 source 
37 Waters and Moore 2001 p 601 
38 Ben-Yishay and Lakin: Structured group treatment for brain injury survivors 
39 DWP: Well enough to work? 
40 Woodland, Mandy and Miller 2003: p 60 
41 Goldberg 2002 p 4 
42 NZ Employment Service 1996 
43 Pack Margaret: internal ACC report 2002 
44 Wrigley et al August 2003 
45 ibid 
46 NZ Employment Service 1996 
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pre-requisite for the job, or because individuals without the skills of a high school 
graduate cannot perform the duties associated with many jobs.47   A Michigan study 
showed that only 39% of women with no high school qualification worked at least 
20 hours a week, compared with 66% of women with a high school qualification48.   
A 1996 study of employers’ entry-level job requirements found that most required 
employees to perform one or more of these following skills on a daily basis:  
Reading and writing paragraphs; 
Dealing with customers; 
Doing arithmetic; and 
Using computers49
3.28  Other American studies indicated that these skills were beyond the abilities of the 
average welfare recipient or high school drop-out, and therefore reduced markedly 
their ability to gain any employment50.   The American Testing Service estimated 
that 40% of welfare recipients had such low levels of literacy that they were unable 
to complete tasks such as completing applications for social security.51 
3.29  Compounding this barrier to employment is that many people lacking literacy skills 
are very aware of the lack, and the problems it can create.  Over time, they have 
developed sometimes quite sophisticated techniques to conceal the lack so that 
even case managers and career advisers are unaware of their lack of literacy skills. 
3.30  Higher education / higher intelligence are important factors.  In Canada, 
technological skills and advanced education are becoming minimum requirements 
for obtaining and retaining employment, while jobs in areas such as manufacturing 
are becoming scarce52.   As products and job skills become outdated, those with 
computer, maths and literacy skills are favoured.  Most studies have found that 
better educated workers are more likely to return to work than less educated 
workers, and this is backed up by the most recent BRC New Zealand survey of long 
term claimants who had exited from the ACC scheme.53    
3.31  Reasons for the higher rates of return to work for those better educated include: 
A physical impairment is less likely to have an impact as better educated 
workers jobs are usually not physically demanding; 
Better educated workers usually have more control over the manner in 
which they perform their jobs, so are able to adapt their activities to 
accommodate physical limitations; and 
Generally employers have invested more in better educated employees 
which provides an incentive to make their own accommodations  in order to 
retain these workers. 
47 Goldberg, 2002 p 4 
48 Danziger et al, 2000 p 32 
49 Holzer 1996 
50 Danziger et al, 2000. P 5 
51 Brown 2001 p 88 
52 Bunch and Crawford, 1998 p 25 
53 BRC research report: Return to sustainable earnings January 2003 
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3.32  More than two-thirds of the respondents in the New Zealand Employment Service 
survey of long term unemployed in 1996 acknowledged that lacked appropriate 
skills or work experience, while 22% admitted they had literacy or numeracy 
3.33  In 1997, New Zealand participated in the International Adult Literacy Survey (IAS), 
which was the first internationally comparable estimate of literacy skills in the 
adult population.  The IALS tested respondents from 12 OECD countries on prose 
comprehension, comprehension of graphs, timetables, and charts, and applying 
arithmetic operations.  The results showed that abut one in five workers had 
pressing literacy needs.  Almost half of all adults aged 16 – 65 were estimated to be 
at the lowest levels of ability.55 
3.34  Employability is identified as another barrier against return to work56.   While there 
is no standard definition of employability, it encompasses gaining and maintaining 
employment, having and deploying the appropriate knowledge, attitude and skills, 
and presentation (both of qualifications and experience, and during job interviews) 
that employers value.   It is having job skills and credentials which cut horizontally 
across all industries and vertically across all jobs from entry level to chief executive. 
Since it can be difficult for employers to obtain reliable information on 
employability, many rely upon general impressions of the people concerned and 
stereotypes of group to which they belong57
3.35  Several American studies found that many of the longer term unemployed were 
simply not “work-ready” in that they did not understand or follow workplace 
norms or behaviours58.   Many participants in special programmes failed because 
they did not understand the importance of punctuality, the seriousness of 
absenteeism, and either resented or misunderstood the lines of authority and 
responsibility in the workplace. 
3.36  That employers value generic employability skills above specific occupational skills 
is a well supported finding, and applies to all size companies, to the public and 
private sectors, and at all levels of management.59   Studies continue to confirm the 
need for employees to have social skills, positive attitudes about work, and basic 
communications skills.   Other research showed that employers discharge or fail to 
promote workers because of behaviour reflecting an inadequate work value or 
attitude, rather than because of a deficiency in job skills or technical knowledge.60 
3.37  A New Zealand trial programme61 targeted to assist long term unemployed was 
based on the contention that many long term unemployed had entrenched personal 
and social problems that inhibited their ability to participate in the labour market.   
The actual barriers identified during the development of the programme included: 
54 Parker 1997 pp 68-9 
55 Department of Labour p 27-8 
56 Hillage J and Pollard E (1998) Executive summary 
57 van den berg and van der Veer p 178 
58 Danziger et al, 2000 p 5 
59 Cotton p3 
60 Gregson and Bettis 1991 
61 Wehipeihana p 5 
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Alcohol or drug dependency problems; 
Anger management problems; 
Disruptive or dysfunctional family situations; 
The psychological consequences of domestic violence or abuse, either 
historical or current; 
Illiteracy  - often well disguised or hidden; 
A bad reputation in the local small community; and 
Unrealistic notions about the income generating potential of hobbies or 
artistic pursuits. 
3.38  For some participants in the programme, the barriers were not immediately 
apparent to the facilitators, or known or acknowledged by the participant.  The 
process of identifying barriers was described as  “akin to peeling an onion – as soon 
as one barrier was identified and overcome, another deeper issue would rise in its 
place…the surface barriers to employment were often mere symptoms of much 
more deep seated problems”. 
3.39  One of the facilitators for the NZ programme expressed concern that case managers 
are not able to see their clients often enough, or for long enough, for barriers such 
as these to become evident.  Further, the computerised assessment tools as used by 
Work and Income cannot take into account any problem or issue that is not 
employment related.  The lack of follow-up after attendance at programmes often 
left  participants feeling even less motivated than they were before starting 
Health factors 
(a)  Pain management 
3.40  Coping with pain has long been cited as a reason not to work.  Pain-related 
behaviours that communicate a person’s pain to others have often been supported 
inadvertently by the healthcare system63.  Patients in pain may get increased 
support and sympathy when they express suffering, which then increases “pain 
behaviour”.   One of the goals of pain rehabilitation should be to reduce the effects 
of demotivating factors for patients for return to work.  Families can inadvertently 
reinforce an injured person’s sick behaviour and delay any return to work simply 
because they are trying to help some-one they love64    
3.41  Multi-disciplinary pain management programmes give promising results in helping 
injured workers back to work65 66, with one limited study67 showing that such a 
programme was more effective for short-term patients (up to 12 months) than long 
term patients.   American studies show that increasing patients’ own resources to 
deal with pain situations can be an effective way of increasing self-confidence and 
62 ibid p 24 
63 Gard and Sandberg 1998. 
64 McIntosh, Melles and Hall 1995 p 199 
65 Morley et al: …randomised control trials of cognitive behaviour therapy for chronic pain 
66 Flor et al: Efficacy of multidisciplinary pain treatment centers 
67 Marhold, Linton and Melin 2002: p 73 
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improving motivation to return to work68.  More research is scheduled to assess the 
effects on long term patients.   In New South Wales, it is accepted that a significant 
proportion of back injury cases will never recover completely and that their back 
pain will need to be controlled and adapted to.69   
(b)  Use of cigarettes, drugs, and alcohol 
3.42  Smoking is an activity which can impact negatively on an injured worker’s return to 
work.  Smokers are already at risk of lung cancer, heart disease, emphysema, and a 
shorter life expectancy.  US Army research during an eight week basic training 
programme with new recruits70 showed that, even after controlling for other factors 
which might influence the risk of injury, the smokers were 1.5 times more likely to 
suffer fractures, sprains and other physical injuries than non-smokers.   They had 
also had more previous injuries and illnesses, were less physically active, and were 
less physically fit than the non-smokers.  Risk of injury for smokers was high, 
despite the fact that recruits were forbidden from smoking during the training 
3.43  Alcohol is connected with over half of all traumatic brain injuries.  If some-one 
used alcohol or other drugs before they were injured, there is a good chance that 
the problem will continue afterwards.71 
3.44  Injured workers are already at risk of infection and other health problems: smoking 
increases the likelihood, placing them at even higher risks.   Rehabilitation 
specialists dealing with people with spinal cord injuries72 advise them to cease 
smoking because of: 
Difficulties in breathing, especially difficulties in expelling air because of the 
build-up of mucus and other secretions in the lungs; 
Increased chances of developing stomach ulcers, poor circulation, pressure 
sores and bladder cancer; 
Decreases in the body’s supply of vitamin C, so skin wounds heal more 
slowly; and 
An impaired ability to cough, leading to respiratory diseases (20% of 
quadriplegics die because of an inability to cough). 
3.45  There is also a higher prevalence of smoking, exposure to passive smoking, and a 
heavier consumption of alcohol among people who are unemployed.73 
3.46  Drug and alcohol related problems also feature as a barrier to re-employment of 
long-term unemployed.  While the exact definitions of drugs and alcohol problems 
vary widely, and accurate estimates of affected numbers are hard to obtain, there is 
general consensus that dependency and abuse does create problems, especially in 
keeping a job.74  Former alcohol and drug abusers continue to have low self-esteem 
68 Gard and Sandberg 1998 
69 Mills and Thornton 1998 p 594 
70 Gardner John W: Press statement Smoking linked to physical injuries, 16 March  2000 
71 CTS Rehabilitation Specialists Programme website: 
72 CTS Rehabilitation Specialists Programme website: 
73 Elkeles and Seifert 1997 pp 41-45 
74 Institute for Research on Poverty: The New face of Welfare 
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which hampers successful employment and weakens their ability to make 
successful transitions from welfare to work. 
3.47  In a random analysis of 250 case files, ACC subsidiary Catalyst found addiction 
issues.  Claimants had self-medicated using prescription and /or recreational drugs 
and alcohol to manage pain.  The ensuing dependency on those substances 
hampered rehabilitation.75 
(c)  Mental health 
3.48  Mental health is a less recognised barrier to return to work, and research is still 
underway to identify what mental health problems affect people’s ability to return 
to work in order to make recommendations for policies to address this.  
3.49  Studies suggest that low income single mothers are particularly at risk of significant 
mental health problems when they lose their jobs76.   Importantly, however women 
in this group are no more likely than their employed counterparts to be alcohol or 
drug dependent.77 
3.50  The term “post traumatic stress disorder” (PTSD) was adopted in 1980 to describe 
the pattern of symptoms exhibited by some people who experienced a traumatic 
event.   Traumatic events range from high profile disasters / bombings to personal 
events such as assault, robbery, motor vehicle crash or an accident.    Any or all of 
three types of symptoms may be experienced by PTSD sufferers including: 
Persistent flashbacks;  
Avoidance of any reminders of the event; and  
Increased alertness /hyper vigilance.    
3.51  Although these reactions do not always lead to a diagnosis of PTSD, the trauma 
symptoms that individuals experience can be severe enough to affect people’s day 
to day lives and their ability to work.78 
3.52  People with existing mental illnesses are generally thwarted by three main barriers: 
Their psychiatric professionals tell them they won’t have to work, or cannot 
work because of their illness; 
People are afraid of losing their benefits; and 
People have difficulty communicating with their employers, whether to tell 
them about their illness, and how to do that.79 
3.53  Health professionals in New South Wales have identified that the costs of private 
psychiatric services are high, while publicly funded mental health services may give 
low priority to problems such as anxiety, depression, emotional stability and social 
75 Pack 2003 p 13 
76 Tainter 1998 p 1 
77 DeGroat 1998 Press statement 23 November 1998 
78 Rick, Young and Guppy Executive summary 
79 Granger Barbara of Matrix Research Institute, on website <> 
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isolation.80   In many cases, more unemployed people live in geographic areas 
where public health services may be in limited supply. 
3.54  There is growing evidence that under-employment and inadequate employment 
also lead to poor health and mental health outcomes.81    Under-employment 
Working fewer hours than desired 
Being underpaid 
Being unable to find work that fits the individual’s skills and education. 
3.55  These all constitute barriers against return to sustainable employment, and are 
addressed elsewhere in this report. 
Refusal to accept jobs 
3.56  Some men do not take part-time or temporary jobs because such jobs do not pay 
much more than they get remaining on welfare benefits82, while others with 
industry specific experience are likely to wait for re-employment in jobs similar to 
the ones they used to have, rather than accept a less well paid job in another 
industry.83  Some people price themselves out of jobs by refusing to accept the 
levels of wages offered.   
3.57  Most jurisdictions require injured workers to co-operate in their rehabilitation.   
Some workers use their right of review of their individual Return to work / 
Rehabilitation plans to stall a return to work.  Workers respond to incentives to 
exaggerate or falsify claims of work-related injuries, including that numbers of 
claims filed increases with benefits available, and some workers overstate the 
limiting effects of injuries in order to delay return to work.84   Following a study of 
3700 workers with back problems, the researchers commented on “the relative ease 
with which back pain can be overstated by patients seeking disability benefits and 
time off work.”85  
Age, gender, ethnicity 
(a)  Age 
3.58  Older workers are much less likely to return to work than younger workers86.   
American experience of the corporate downsizing in the late 1980 and early 1990s 
was that proportionately more older workers were laid off, and less investment was 
made in training or retraining older workers.  These practices put older workers at 
a disadvantage, even before they have an injury and seek re-employment or 
retraining.   As people move into their 50s and 60s, they are more likely to 
experience health related problems, and an injury can have the effect of moving 
them into early retirement. 
80 Harris et al 1998 p 292-3 
81 Price 2000 p 5 
82 Borooah 2001 Section 4.1 
83 McCormick B: Unemployment Structure and the Unemployment Puzzle 1991 
84 Johnson, Baldwin and Butler 1998 pp 39 - 62 
85 ibid p 28 
86 Baldwin and Johnson 1998 pp39 - 62 
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3.59  In contrast, the majority of executives and leaders are older adults.87    Work 
performance does not decline with age until well into the seventies and beyond.  
Given that there are no major health problems, most people remain at the same 
level of ability up to very late life.  There are, however, age related changes in the 
central nervous system which may impact on speed of processing information and 
efficiency of processing complex information. The correlation is generally more 
between cognitive ability and work performance.   Learning, memory, intelligence 
and speed are related to overall cognitive ability. Given that most jobs do not 
involve maximum levels of performance, most older workers can perform their 
work tasks satisfactorily.    
3.60  Age does affect individuals differently: older workers tend to prefer more 
responsibility, interesting work, and attention demands88 while younger workers 
prefer autonomy and social opportunities.   Some studies have shown that younger 
workers may lack the knowledge to make accurate judgements about the likelihood 
of efforts paying off.  
3.61  Human Resources Development Canada89 identified a specific list of barriers faced 
by older workers attempting to return to the workforce: 
Lack of job search skills – older workers tend to have relatively steady 
employment histories, and so have not used the skills needed for a 
successful job search.   Thus their job search techniques tend to be outdated, 
and their approaches generally less innovative than younger people; 
Absence of relevant skills for positions in the growth industries – this 
includes levels of literacy, numeracy, and technical and computer skills; 
Level of formal education.   In today’s environment, low educational 
attainment greatly hampers the abilities of workers to market themselves to 
prospective employers; 
Older workers are also generally less willing to relocate for an employment 
opportunity than younger individuals; 
Related to this is the unwillingness of many financial institutions to approve 
long term mortgages to individuals with limited years of employment 
remaining to them.; and 
Capacity for acquiring training and professional development, or perceived 
capacity for skills upgrading. 
3.62  While any one of these may relate to any person seeking to return to work after an 
absence, older workers tend to face several of them concurrently.  Some older 
workers feel social pressure to withdraw from the workforce in order to provide job 
openings for younger workers, and thus to reduce the unemployment rates among 
younger individuals90.  A British survey found that more than half the beneficiaries 
over 55 years of age did not want to work91.  However, while many displaced 
workers choose retirement over job search and/or retraining, a considerable 
number are simply not financially or emotionally prepared for retirement. 
87 Sterns and Miklos: p 255 
88 Phillips,  Barrett and Rush: job structure and age satisfaction 
89 Human Resources Development Canada Technical Report #1: 1997 Section 1.1 
90 HRDC: Lessons learned – a review of older worker adjustment programs 1997 Section 7.2 
91 Woodland, Mandy and Miller 2003: p 22 
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3.63  A Canadian study on the needs of older workers indicates that the older individuals 
who participate in active approaches to improving re-employment opportunities 
appear to benefit from programmes which are more client centred.   Programmes 
which have not addressed the specific employment barriers faced by older workers 
have been found to have little, if any, impact on these people gaining employment. 
3.64  Regardless of gender, older people with disabilities are less likely to participate in 
the labour market.  In Canada, nearly three-quarters of those with disabilities aged 
between 55 and 64 years were not in the labour force compared with only 30% for 
those aged 15 – 24 years.   In general, the high rate of non participation in the 
labour force for the older age group was attributed to age related factors  more than 
disability related factors92
(b)  Gender 
3.65  Most US studies found that men return to work sooner than women93 although this 
is not supported by Canadian studies.   Married men are more likely to return to 
work than unmarried males or women, and unmarried women are more likely to 
return to work than married women.  One study found that gender does not affect 
the probability of returning to work, but among those who return, women were 
more likely to experience multiple periods of work absence and unsuccessful return 
to work, and that part of this may reflect a need for services different from those 
provided to men.94  Women are more likely than men to report pain problems 
which can inhibit ability to work.95 
3.66  In general, the reduced demand for unskilled labour in industrialised countries has 
a disproportionate effect on male joblessness.96   Add to this that unemployment is 
concentrated among men with few or no educational qualifications, the other 
personal factors described elsewhere in this paper have a dominant effect.  New 
Zealand data is consistent with this international trend.97 
(c)  ethnicity 
3.67  An Australian study found a disproportionate number of Arab state immigrants 
(56%  injured compared with 10% in the Australian population) and Mediterranean 
country immigrants  (28 % compared with 12%)compared with Anglo Saxon 
heritage  (16% compared with 64%) in his study of 50 incapacitated back cases98.   
American research into the relationship between ethnicity and return to work for 
traumatic brain injured workers is inconsistent.   
3.68  While some studies found that race was related to failure to return to work, the 
results of other studies were less positive99.  (While 13% of the minority group 
returned to work post a traumatic brain injury compared with 30% of the white 
group, only 45% were working at the time of injury compared with 60% of the 
92 Bunch and Crawford p 40. 
93 Johnson and Ondrich 1990 p 585 
94 Butler, Johnson, and Baldwin, 1995 pp 72-84 
95 Marhold et al (2002) p74 
96 Borooah, 2001 Section 1 
97 According to Parker, prior to undertaking a survey of very long term job seekers in June 1996, 74% of all 
job seekers registered with the NZ Employment Service for more than 52 weeks were male. 
98 C Landon Smith: 1977 p 1076 
99 Yasuda et al 2001 p 854 
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white group.  This means that less than a third of the minority group returned to 
work, compared with half the white population.)   
3.69  The finding of employer audit studies that African-Americans and Latinos were less 
likely to receive job offers than are whites with comparable credentials100 is backed 
up by qualitative studies.  In the Netherlands, unemployment has reached 
unprecedented levels amongst immigrants, political refugees, caravan-dwellers and 
gypsies101.  While researchers admit there are certain real problems (language 
difficulties, insufficient or incompatible educational qualifications, and cultural 
differences) which contribute to the weak position of such groups, there are 
undoubtedly imagined problems due to gender and race stereotyping.  
3.70  Canadian research has identified that immigrant, refugee and racial minorities are 
virtually invisible to the health authorities, and therefore they do not receive 
appropriate assistance or healthcare.102  103  Studies actually state that “racism 
continues to be a barrier to employment”104, despite legal requirements for equity 
and against discrimination. 
3.71  In 1996, just over half of all job seekers registered with the New Zealand 
Employment Service were of NZ European ethnicity, and 35% Maori.105   ACC’s 
own statistics show that Maori aged 15 – 39 are over-represented amongst 
claimants compared with non-Maori.106  They are also over-represented (by 200%) 
in sensitive claims in Auckland, Wellington and Napier cities, in rubgy accidents, 
and in serious injury claims. Sixty percent of Maori adults earn $20,000 or less per 
100 Danziger et al, 2000 p 5 
101 ven den Berg and van der Veer: The myth of unemployable people 
102 ACEWH 
103 White J website <> 
104 Bunch and Crawford 1998 p 28 
105 Parker 1997 p 65 
106 ACC Fourth Quarterly Maori Report 2002/3 
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3.72  Occupational groups for Maori are shown in the table below: 
e T
l T
nd F
nd S
s S
ty S
ion S
nd I
nd R
rt a
estry a
e a
ion and
 and W
 and o
d R
rty and B
th and
tricity, G
al an
Other ethnic groups
One third of the Pacific peoples and “other ethnicity” respondents to the New 
Zealand Employment Survey reported that they had trouble speaking English. 
Type of disability / injury 
3.73  Type of disability is a more important influence on return to work than severity.   
Persons with amputations or bruises or contusions were more likely to return to 
work sooner than people with sprains, dislocations or fractures107.  A Canadian 
survey indicated that workers with soft tissue injuries felt they had greater 
difficulties than amputees or people with clearly visible disabilities.108    
3.74  Back problems are reportedly the single most costly workplace injury.109   Nearly 
80% of all adults can expect to experience a disabling episode of back pain at least 
once in their lives.  In New South Wales, back injuries account for 31% of all 
workplace injuries.110   Several studies indicate malingering, exaggeration or false 
claims of workplace back injuries, including an Australian study by a senior 
surgical registrar who found that in 38 out of 50 back injury cases studied, 
consultants doubted the genuineness of symptoms or manifestation of clinical 
3.75  Other studies show that many workers with back injuries who return to work are 
unable to continue that employment because of functional limitations associated 
with their condition111.  For workers who return to work in less than one month, 
those with neck or back injuries return more quickly than those with leg, arm 
107 Johnson and Ondrich 1990 p 584 
108 Canadian Injured Workers Alliance: 1995 p 35 
109 Johnson, Baldwin and Butler 1998 p 39 - 62 
110 Mills and Thornton 1998 p 594 
111 ibid 
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injuries etc112.   But among longer duration injuries, those with neck or back 
injuries return more slowly. 
3.76  Women have been found more likely than men to develop Post Traumatic Stress 
Disorder (PTSD) when exposed to a trauma, and low income women are even more 
likely than the general population to do so.   The prevalence of PTSD is wider than 
was previously believed113, but as yet, there are few studies of its impact on return 
to work, other than the considerable general evidence that psychiatric disorders are 
associated with lower rates of employment114
Pre-injury circumstances 
3.77  Workers who attach less value to employment, whose education and skills levels 
are low, or whose industries involve casual / intermittent employment have 
significantly longer durations off work. Those with one spell of unemployment in 
the middle of the year prior to injury took 34% longer to return to work. Knowing 
this employment history can help identify those workers at risk of long term 
unemployment when an injury occurs.    
3.78  Likewise, workers with less than six months tenure or more than 10 years job 
tenure returned to work more slowly. 115 The Washington Community Jobs 
Program reports that 75% of its programme participants  have poor work histories 
which hinder them from securing stable unsubsidised employment.116 
(a)  Family circumstances 
3.79  Family circumstances, such as marital status or having a dependent or disabled 
child or spouse can also influence the ability and motivation of an injured worker 
to return to work.  Single people were more likely never to have worked than those 
who were currently or had been married or cohabiting.  Nearly ten percent of one 
study’s respondents did not want to work because they wanted to look after their 
children, and more than three quarters did not want to work because of their 
3.80  A New Zealand study by Work and Income indicates that “dysfunctional family and 
spousal relationships often have a significant impact on some clients’ abilities to 
find and sustain suitable employment” 118.  This is endorsed by several American 
studies119 which also note that women who are in abusive relationships encounter 
increased interference from their male partners as they attempt to move from 
welfare into work.  Other US research120 indicates that between a fifth and a quarter 
of welfare respondents have children with health, learning, or emotional problems 
which inhibit their parents’ ability to work.  
112 WCRI Research brief Vol 12 no 9  
113 Kalil et al, August 1998 p 10 
114 ibid p 9 
115 WCRI Research brief Vol 12 no 9 
116 Transitional Jobs, March 2003 
117 Woodland, Mandy and Miller 2003 pp21-23 
118 Wehipeihana, June 2000 p 22 
119 Kahlil et al, August 1998 pp11-12 
120 Goldberg, 2002 p 3 
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3.81  Belgium has identified childcare as one of the most important obstacles for long 
term unemployed women to re-enter the labour market.121    American research into 
barriers facing welfare recipients trying to gain employment identified that needs 
for specialised childcare, and classified this as: 
Non-standard-hours care – early mornings, evenings, nights, weekends, and 
for shifts longer than eight hours; 
Sick-child care, for those too sick to attend school or day care; and 
Special needs care for children with physical, emotional, or mental 
3.82  The problem of non-standard-hours childcare is especially relevant to New Zealand 
with recent changes in the labour market towards increased casualisation of the 
labour force and the increase in the size of the service sector.   
3.83  The American study team also identified 16 employment liabilities, of which four 
were significantly related to a welfare recipient’s employment status: recent work 
experience, a health problem, two or more arrests in the past six years, and a child 
care problem.   Recipients with a childcare problem had only a 30% chance of 
working 30 or more hours per week. 
3.84  Spouses and partners can alter their work / non-work situations when their 
partners becomes unemployed / injured, or work fewer hours than planned.  
Known as “the added worker effect”123 there is a tendency for other household 
members capable of work to enter the labour market if the primary income earner 
becomes unemployed.  This occurs only at lower income levels. The more 
financially attractive a husband’s compensation payments are for injury / health 
disability, the more likely his partner / spouse is to remain at home to care for her 
husband. Married women change their hours worked or decide to seek work 
depending on the level of their husbands’ earnings, but on average husbands do not 
respond similarly to their wives’ earnings.124   
(b)  Job satisfaction 
3.85  Job dissatisfaction also can create a barrier to return to work.  A study in the 
aircraft industry found that if a worker did not like their job or had had difficulties 
with fellow workers or superiors, it greatly reduced the chances of the employee 
returning to that workplace125.   The Texas Workers Compensation Commission126  
actually warns employers that “the stage is often set  for extended lost time long 
before any injury occurs…with adversarial relationships between supervisors and 
employees…negative relationships with co-workers, disciplinary or pay issues, 
workload concerns or job dissatisfaction that tend to interfere with or delay return 
to work.    An employee who is satisfied with his or her job and employment 
situation is self motivated to return to work as quickly as possible”. 
121 Geers 1992 p 62 
122 Mathematica Policy Research 
123 Gardner John A p 56 
124 ibid 
125 Hendler: website: <> 
126 Texas WCC website: <> 
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3.86  A recent New Zealand survey found that just over half the employees surveyed 
complained about their bosses, saying that poor management was a bigger bugbear 
than poor salary, hours worked, work environment or job prospects.127 
(c)  Job history 
3.87  American research found that most workers with at least one year’s job tenure 
returned to their pre-injury employer, but for those who did not return, the 
duration off work was lengthened by a factor of 2 – 3.    Workers at small firms 
were much less likely to return to their pre-injury employer, thereby incurring 
longer periods off work128
(d)   criminal record 
3.88  People with criminal records face a range of barriers to employment, depending on 
what crime was committed.   People with convictions for crimes against the person 
are unlikely to get jobs in people related occupations such as education, healthcare, 
passenger transport etc.   People with convictions for theft are unlikely to get 
positions where handling money or accounting is required.  Even in occupations 
that are not formally closed to ex-offenders, employers may screen out applicants 
with criminal records.129 
3.89  Individuals with criminal records often have incomplete work histories, low levels 
of education and little exposure to the norms and interpersonal relationships of a 
typical work-place. 
(e)  obesity 
3.90  Obesity can cause both real and perceived problems in returning to work.  
Overweight people are subject to considerable discrimination in employment 
decisions, as well as being stereotyped as emotionally impaired, socially 
handicapped and possessing negative personality traits.130  There is also evidence 
that obesity hinders the ability of long term unemployed people to undertake 
employment with physical activities, not least because the person may not have 
maintained their fitness levels or stamina while being out of the workforce. 
B  External factors 
3.91  Many of the problems experienced by long term unemployed or injured people 
attempting to return to work are a result of factors beyond their immediate 
personal control.   This includes other people such as employers, case managers, 
rehabilitation specialists, legal advisers etc and situational factors such as labour 
market conditions. 
Perception of employers / lack of knowledge 
3.92  The principal reason cited by injured workers who were not successful in returning 
to stable employment was that their employers either declined to re-employ them 
127 Manual 2003 
128 WCRI Research brief 1996 Vol 12 no 9 p 3 
129 Brown 2001 p 82 
130 Roehling 1999 pp969 - 1016 
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(often on the grounds that no suitable work was available), or that the 
accommodations they made for the injured worker’s disability were unsuitable.   
3.93  Some employers Return-to-work programmes were seen as too aggressive, and 
workers felt they were required to return to work too soon.  Employees had 
negative perceptions that some Return-to-work programmes were designed more to 
reduce companies’ workers’ compensation costs than assist the workers131.   One 
study reported that 40% of workers who had never worked again after their injuries 
had sought re-employment with their pre-injury employers, but were rejected132
3.94  Employers can use the duration of unemployment as a signal of worker quality: the 
longer the duration, the poorer the inferred quality133.   British employers wanted 
the government to reduce the risks to them of recruiting long term unemployed 
people134  whom many perceived as high risk with potentially detrimental 
commercial implications.   While they reported some unfavourable experiences, 
those who considered themselves socially responsible were more positive towards 
those unemployed people they considered had used their time productively or who 
they perceived as motivated and actively seeking work. 
3.95  American employers often regard new hires as probationary135, and are quick to 
dismiss those in low wage jobs for early mistakes made, knowing that there is a 
ready supply of replacement applicants with the minimal skills required for the job.   
They expect employees to adhere to work schedules, to be punctual, to notify 
supervisors of absence through illness, to accept authority gracefully, and to be 
accommodating towards customers.  Failure to meet these norms can limit job 
tenure.  Because long term unemployed workers are unaccustomed to these 
demands, and some employers enforce them rigorously, dismissals resulting from 
unacceptable behaviour can be attributed to shortcomings in both parties. 
3.96  Related to this is the worry about discrimination from employers136.  Many 
American studies reported different groups experienced discrimination as they 
attempted to gain (re-)employment, and these people carried fear of that experience 
recurring as they continued their attempts to get jobs. 
3.97  Employers also have concerns about their ability to communicate effectively with 
people with disabilities, as well as being unfamiliar with the disability and 
discrimination legislation137.   This is especially true of hidden or learning 
disabilities.   This lack of knowledge causes employers to hesitate to discuss the 
true needs of the individual with them.138    For example, some managers are afraid 
to ask interview questions that need to be asked if applicants with disabilities really 
are going to be considered for job vacancies.   Potential employers need to feel 
reassured that the applicant is physically able to perform the job’s functions.139 
131 Manitoba League of Persons with Disabilities: Executive Summary 
132 Butler, Johnson and Baldwin 1995 pp 72 - 84 
133 Borooah, Vani K: 2000 pp3 - 25 
134 Snape  1997 Executive summary 
135 Hershey and Pavetti, 1997 p 78 
136 Kalil et al August 2000 p 20 
137 Bunch and Crawford 1998 p 49 
138 de Jonge, Rodger and Fitzgibbon 2000 
139 Pimentel (undated) 
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Job adaptations 
3.98  Job adaptations provided by employers are important determinants of long-term re-
employment following a workplace injury140.   Benefits include more stable work 
histories post-injury, and employee loyalty.  Expensive accommodations are rarely 
needed by workers with disabilities141.   According to one study, about half of the 
accommodations made by employers cost less than US$500 to implement142 
3.99  Despite anti-discrimination legislation in the United States, many employers either 
do not, or are not required to, because of small size of the company, make any 
accommodations for their injured workers, even though the injuries occurred at 
their work-sites.   Almost without exception, the workers whose employers 
declined to, or were unable to, make any accommodations at their work-site took 
longer to return to work, if they returned at all.   A British study143 found that over 
one quarter of disabled people who left their jobs because of their disability would 
have stayed in work if they were offered adaptations.  Fewer than one in five were 
actually offered any accommodations.  Accommodations include lifts and handrails, 
special equipment, and flexible working arrangements including breaks outside the 
normal tea and lunch breaks.144  
3.100  Where adaptations are supplied to injured or disabled workers returning to 
employment, the non-material adaptations are shown to be more important.  A 
Dutch study145 of adaptations provided to both blue and white collar workers 
indicated that physical adaptations were very minor compared with other changes 
for disabled workers returning to work: 
Changes in tasks and work content, whether with the pre-injury or other 
employer (70%); 
Change in duration of working hours, such as reduction or elimination of 
night working, more regular working hours, reduced working day or 
working week, shift changes and rest period (48%); 
Reducing tempo / speed of work, such as reduced productivity targets, help 
from colleagues, self-organised work patterns (41%); 
Purchase of special devices, such as wheelchairs, transport to or from the 
workplace (10%); 
Training / vocational training, job coaching (7%); 
Adapting tools / equipment / workstation / lighting / buildings etc (4%); and 
Other, including help at home in order to get to work, changing the 
workplace culture (14%). 
3.101  A hidden barrier when injured / disabled workers are having adaptations made at 
their workplace is that focusing solely on the technological / physical 
accommodations was not enough to ensure success.   An Australian study of people 
with severe disabilities using computer and technological assistance showed how 
140 MLPD: 1999 
141 Unger and Kregel 2003 
142 Job Accommodation Network 
143 Meager et al 1996 Executive summary 
144 ibid 
145 Nijboer, Grunemann and Andries: 1993 
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important it was to balance the employer’s and employee’s personal preferences, 
and the work environment in order to achieve maximum productivity and 
satisfaction.146  It could be said that this is true of all employment situations. 
Case management/ rehabilitation issues 
3.102  The case manager  and/or the vocational rehabilitation counsellor can have 
significant impact on whether clients manage to regain and retain employment.  
Rehabilitation counsellors were found to favour negative client factors, such as 
incapacities, over the positive factors, and an overemphasis on client incapacity by 
rehabilitation counsellors may restrict access for people with disabilities to 
employment opportunities147.  Other research has identified the importance of 
“client optimism” as a key psychological factor associated with successful return to 
work outcomes for people with disabilities.148 
3.103  Setting goals is fundamental to the case management process: case manager and 
client identify specific long-term goals and then break them down into the 
incremental behaviours required to achieve each goal149.   Kisthardt et al,150 during 
case management training, identified four factors why goals might fail: behavioural, 
cognitive, affective, and environmental.  All of these failures relate to the case 
manager / client interaction. 
(a)  Behavioural dimension 
3.104  Goal-directed activity requires the ability to engage in a series of specific 
behaviours, and the level of competency and skill involved in achieving the goal is 
paramount.  Goal attainment may fail if the individual lacks the required skills to 
achieve the goal.  Skills required include communication, reading, and filling out 
forms, as well as managing activities of daily living.   Attempting to achieve too 
many goals at once can diffuse the activity and limit the achievement of any, or all, 
or the goals.  Clients frequently require assistance in prioritising goals and 
(b)  Cognitive dimension 
3.105  Frequently, clients have not signed up to the identified goals.  Case managers 
report that clients agree with the goals and then proceed to sabotage them by not 
following the agreed action plan.  This may reflect more on the client’s lack of a 
sense of ownership of the goal than on resistance to treatment or denial of what 
they need to do.      
3.106  People may also change their minds, as circumstances or personal desires change, 
and a goal become meaningless and irrelevant. While this is a normal part of daily 
living, some case managers see it as pathological.   People may lack the knowledge 
and information required to complete a task, but many professionals often assume 
that clients have all the knowledge.  Lastly, the client’s knowledge of previous failed 
attempts may lead to them “talk themselves” out of achievement. 
146 de Jonge, Rodger and Ftizgibbon 
147 Strohmer, Pellerin and Davidson 1995 pp 82-93 
148 Chapin and Kewman, 2001 pp 400 - 416 
149 Kisthardt, Gowdy and Rapp: 1992 p 117 
150 ibid p 118 
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(c)  The affective dimension 
3.107  Goal-directed behaviour is influenced by and in turn influences the way people 
feel.   Success or failure depend on their feelings of satisfaction, accomplishment, 
fulfilment, or joy.   When people begin to feel overwhelmed in the process of goal 
attainment, they may seek to change direction.      
3.108  The affective dimension is also apparent when goals are set too high or too low, 
when too many goals are set, and clients feel they are over-extended.    Clients may 
also fear the results of success such as moving from the security of benefit to 
earnings.   This may lessen their enthusiasm or commitment to pursue the goal.  
Lastly, feelings of loneliness, fear and isolation can effectively block a client’s ability 
to engage in goal-planning and attainment. 
(c)  Environmental 
3.109  Goal attainment may fail if the necessary resources are not available, accessible or 
accommodating for a person’s needs.  These resources include social resources such 
as people, goods and services such as money, transport, and housing.   Often these 
resources are available and accessible but neither the case manager nor client is 
aware of this. 
Lawyers’/ advocates’ attitudes 
3.110  Research consistently shows that those who challenge decisions regarding their 
unemployment or injury compensation entitlements are unlikely to return to work.   
In Britain, those who appealed against the decision to cease giving them the 
incapacity benefit were found to be particularly unlikely to re-enter the job market 
(one in ten found work), compared with those who did not appeal (four in ten 
found work) and those who left the benefit voluntarily (seven out of ten found 
work).   Litigation is a negative factor for patients rehabilitation / managing pain / 
returning to work151.   Any unresolved conflict between the patient and any one 
associated with the injury may present a significant barrier to rehabilitation. 
3.111  One study found that patients who believe they are entitled to financial reward 
because of an accident have little desire to recover quickly, especially when 
attorneys have successfully sued for and put a dollar value to their pain an 
suffering152.  When a client’s lawyer advises non co-operation and the fostering of 
an adversarial relationship, this works against a client’s rehabilitation and their self-
esteem, and their ability to participate meaningfully in society.153   
3.112  American experience is that too many lawyers are willing to raise adversarial 
matters which stand in the way of achieving the vocational rehabilitation plan, 
perhaps protecting their own interests rather than the clients’ interests.    The 
longer the dispute process continues, the less likelihood there is that any form of 
151 Frederickson et al 1988 pp 351-3 
152 McIntosh, Melles and Hall, 1995 p 199 
153 Ehret 1988 pp11-12  
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rehabilitation will be productive154.   The process of proving that one is totally 
disabled may result in a self-fulfilling prophecy.155 
Focus on disability (rather than ability) 
3.113  The generally negative results when a job-seeker does not maintain a positive 
outlook has already been discussed.   This concept is also true when a person is 
labelled by their disability, whether by themselves or their family, a case manager, a 
medical professional, a lawyer or advocate, their employer or work colleagues.  “To 
refer to a human being as a paraplegic, a manic-depressive…or a post-traumatic is 
to elevate the deficit or deviance to the status of the dominant identity of that 
person”. 156  Assessments and interventions based on such pathology-derived 
definitions of persons and situations are more likely to perpetuate the pathology 
than to modify it.    
3.114  Ehret157 expressed frustration at the NCCI Seminar on Legal Trends affecting 
Workers Compensation that few compensation judges actually understand 
vocational rehabilitation, and their decisions frustrate rehabilitation by allowing the 
claimant to focus on continued disability rather than building on ability.   These 
negative perceptions create a significant barrier to achieving a successful return to 
3.115  The French agency which manages government activities in relation to 
employment, training, financial and social assistance for disabled adults was 
strongly criticised in the 1980s for its concentration on disability rather than 
ability, which had reduced its efficacy.158 
Co-worker attitudes 
3.116  Colleagues can create problems for injured workers or former unemployed workers 
in retaining employment.   These problems include: 
the worker feeling stigmatised by having been a welfare recipient when co-
workers were unhelpful or unco-operative,  
supervisors being impatient or not taking time to get to know the abilities of 
the new employee,  
difficulties understanding the work culture in the new environment, and 
learning how to relate to people in the right way.159 
154 ibid 
155 Marini 2003 p 42 
156 Cohen: Intervention and supervision in strengths based social work practice 
157 Ehret 1988 p 12 
158 Thornton and Lunt 1997 p 95 
159 DeBord et al: Executive summary 
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3.117  Some injured workers report problems with co-workers who are unaware of the 
employers’ responsibilities to accommodate injured workers, or did not understand 
the limitations created by different injuries.160 
Transport issues 
Transportation costs are often ignored as one of the costs of, and therefore a 
barrier to, re-employment, both in terms of time and money, such as for a parent 
whose commute includes dropping off a child at childcare.   British research on 
ways to assist long term unemployed shows that those employers who provide 
childcare support or transport for employees report higher employee retention and 
improved work performance161.    
3.119  Other studies showed that without financial assistance in getting to work, the 
health of many people with disabilities was jeopardised with the stress, risk and 
fatigue of exhausting journeys, and their concentration and quality of work suffered 
from worry and distraction.    For those with developmental disabilities, transport 
is the biggest barrier faced in obtaining work.    
3.120  Seventy-seven percent of long term unemployed surveyed by the NZ Employment 
Service study cited limited mobility as a key barrier to return to work162.   This 
Having no driving licence; 
Not having independent means of transport.; 
Living in an area without public transport; 
Being unable to move to an area where more jobs were available; and  
Living in an isolated area.    
3.121  The types of barriers varied markedly according to geographical regions: 60%  of 
survey respondents living in the Gisborne region reported having no driving 
licence compared to only 1% of respondents in the West Coast of the South 
Retaining employment 
3.122  Butler et al164 tested the long-held premise that when an injured worker first returns 
to work after their injury, this means that they are then rehabilitated.  Using data 
about Ontario workers over a 14 year period, they showed that the effects of 
injuries on employment are more lasting that previously considered:  85% of the 
workers studied returned to work, but 60% of this group subsequently had one or 
more injury related absences from work.  Thus in the longer term, the success rate 
was only 50%. 
160 Sum et al 2001 p 38-9 
161 Kellard, Adelman et al 2002 pp 35-7 
162 NZ Employment Service 1996 
163 Parker 1997 p 67 
164 Butler, Johnson and Baldwin, 1995 pp 72 - 84 
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3.123  Returning to work and keeping a job permanently are two entirely different 
matters.  In a Canadian study of 113 injured workers in 1995165, 60% of 
respondents had returned to work at least once since being injured, mostly with 
their pre-injury employer, but more than half of these people were not working at 
the time of the survey.    
3.124  In another Canadian study 85% of the workers surveyed returned to work, and 
could have been presumed recovered from their injuries166.  In reality, almost 60% 
of those who returned to work had one or more injury-related work absences, (i.e. 
50% of the survey population) leaving only 35% of the workers surveyed actually 
returning to work and staying there. 
3.125  While welfare reform world-wide has focused on moving beneficiaries from welfare 
into employment, the real challenge emerging now is to ensure these people remain 
employed.  Just being back at work is a challenge for some newly employed 
workers, with the need to work productively, maintain the required hours for the 
job, and cope with a new work environment.  “ Extensive on-going support is 
sometimes needed to ensure the client remains in employment.  Abandoning these 
clients once they are in paid employment is likely to result in them becoming 
unemployed again in a relatively short time”.167 
3.126  The transition to steady employment is often difficult and has many of the same 
barriers as gaining re-employment.  These include personal and family issues, low 
paying jobs, and limited work supports as previously outlined. Given the 
challenges that many welfare recipients confront in going to work, it is not 
surprising that job loss is common, while steady, full-time employment occurs less 
frequently.  Many recipients lose their jobs quickly, and spells of unemployment 
are often long.   Repeated returns to benefits are known to have “scarring” effects 
on people, and increase the likelihood of even further spells of unemployment in 
the future168
3.127  Studies have shown that about one-quarter of (former) welfare recipients who 
become employed stop working within three months, and at least half are no longer 
working within one year.   More than half the mothers surveyed in a New Jersey 
study left their jobs for work related reasons, such as being laid off or fired, 
receiving low pay or inadequate fringe benefits, disliking the job /its hours / its 
location, or switching to another job.  The remaining 43% cited personal reasons 
such as pregnancy, health or family problems, difficulties with child care, 
inadequate transportation, change of residence, termination of health insurance 
cover, or incarceration169.   Most of these reasons are already widely acknowledged 
as barriers to return to work. 
3.128  Economic theory describes the income compensated substitution effect, which is the 
trade-off between increased desired working hours when wages increase against the 
cost of using these hours for leisure purposes.  For the largest group in the labour 
165 Canadian Injured Workers Alliance, 1995 p 64 
166 Butler, Johnson and Baldwin, 1995 pp 72 - 84 
167 Wehipeihana p 22 
168 Kellard, Adelman et al 2002 p 11 
169 Thornton and Hershey 1990 
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force, men aged 25 – 54, time spent working may fall as wages rise, because leisure 
time is more desired than the goods that an increase in income can buy170
3.129  Both long-term unemployed and long term injured workers are interested in 
becoming self-employed as a means of re-entering the workforce.  The following 
have been identified as barriers to entering and then sustaining self-employment: 
Difficulties in obtaining start-up capital; 
Fear of losing the security of benefit or compensation payments; 
Unhelpful attitudes of advisers, regarding what types of work clients could 
or could not undertake; and 
Lack of access to appropriate training and support, including transport 
3.130  In Britain disabled people with vocational qualifications are relatively more likely to 
be self-employed, especially those with musculo-skeletal problems, and women 
with mental health problems.   The types of self-employment undertaken by 
disabled and non-disabled people were similar. While earnings from self-
employment are notoriously difficult to measure, when comparing the average 
earnings of disabled and non-disabled self-employed people using the same 
measures, self employment generated significantly less income for disabled than 
non-disabled people. 172 
3.131  Views on whether and how disabled people can achieve self-employment vary 
widely between vocational counsellors in America, with considerable disagreement 
as to the efficacy of self-employment for the self-sufficiency of disabled people, and 
mistrust of the business community.173  Access to traditional business services and 
supports is blocked by stereotypes and an absence of creativity.   Decisions about a 
person’s capacity to sustain self-employment are generally based on assessment of 
their disability, rather than on sound business factors.   In many cases, it is seen as 
the option of last resort.174 
Labour market conditions 
3.132  The process of moving into work reflects a complex blend of three principal 
factors: personal characteristics of the job seeker, state of the labour market, and 
the job / employer.   For those who have been out of work for a long period, 
regardless of cause, the state of the labour market can have real and perceived 
effects.  Some researchers cite that poor labour market conditions are directly 
associated with an increase in disability benefit applications175.  Labour market 
barriers include the availability of work, location, hours or work, and prevailing 
financial rates of unemployment / compensation benefits. 
170 John A Gardiner: Return to work incentives 
171 Boylan and Burchardt, 2003 Executive summary 
172 ibid 
173 Rizzo 2002 p 97 
174 ibid p 98 
175 Tate 1992 p 17 
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3.133  Many industrially injured people are employed in occupations in sectors which are 
undergoing substantial changes, resulting in fewer available jobs, and additional 
requirements for education. Often these industrial workers have lesser work related 
qualifications due to limited education. Additionally, their pre-injury work 
experience is likely to be in occupations with high unemployment rates (such as 
unskilled manual labour or manufacturing).  Those who lose their jobs through 
injury have a higher probability of remaining unemployed176
3.134  The labour market also encompasses hours of work.  Internationally, there has 
been an expansion of part-time, short-term, contract and other sorts of casual 
labour.  It is reported that in Canada over one third of part time workers would 
prefer to be in full time employment, and that two fifths of the Canadian labour 
market is not full time work177
3.135  Income assistance recipients should always be better off, not worse off, by working 
rather than remaining unemployed, if there is to be any prospect of their seeking 
and retaining employment.   British research178 showed welfare recipients rejecting 
lower paid jobs without career prospects.    The young welfare recipients rejected 
jobs on the grounds that such jobs lead nowhere.  Their older counterparts rejected 
jobs which compared unfavourably with their previous work, being low status, 
unfulfilling or even illegal. 
3.136  The higher income benefits are relative to what a person could earn in the labour 
market, the stronger the economic incentive to choose the benefit rather than to 
work.  Researchers estimate that a 20 percent increase in benefits will increase the 
average duration of temporary disability by 4% and permanent partial disability by 
3 %.   Studies show that low-income individuals are more likely to stop working 
completely when disability benefit levels increase while others show that limits on 
the duration of benefits can create return to work incentives. 179 
Compensation entitlement 
3.137  Australian, British and Canadian research indicates that people with back injuries 
return to work much more quickly if they have no compensation entitlement.180 181   
One study showed a very large difference in the rates of return to work for two 
groups of 70 patients with back injuries, one entitled to compensation, the other 
not.  The median time off work for the former group was twelve months, and for 
the latter one week.  In that the latter group would be returning to work from 
economic necessity, it could be surmised that they would be likely to be more 
disabled and experiencing more pain than the compensable patients, but the 
reverse is the case. When the median Pain, Disability and Impairment Scores of the 
two groups were compared, the non-compensable group showed much better 
health status.  It could therefore be asserted that in New Zealand, where 
compensation is payable regardless of where the injury occurred, this is in itself a 
barrier to employment. 
176 ibid 
177 Bunch and Crawford 1998 p 26 
178 Shaw et al 1996 p 75 
179 Gardiner 1989: p xiii 
180 Greenough and Fraser: 1988 p 954 
181 Johnson, Baldwin and Butler 1998 p 28 
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3.138  Other researchers182 found that workers compensation benefits actually encouraged 
a slower return to work after surgery / injury.  “There is no question that the large 
disincentive effects of workers compensation disability payments reflect the relative 
ease with which back pain can be overstated by patients seeking disability benefits 
and time off work”.183 
3.139  In a lump sum settlement, the claimant settles their future compensation benefits 
for a lump sum of money. The benefit to this settlement is that the injured worker 
can take a lump sum of money and get on with their life. There is a perceived 
perverse incentive created by lump sum compensation which motivates an injured 
worker to focus on their disability until settlement has been reached, rather than 
focus on rehabilitation. Anecdotal evidence that workers do improve markedly after 
receiving lump sum payments is supported by studies.184 
Concluding remarks 
3.140  American studies found that welfare recipients often have multiple barriers and 
liabilities to gaining employment and that the likelihood of employment decreases 
as the number of liabilities increases.   A multi-variate analysis predicted that the 
welfare recipients with no employment liabilities had a 58% chance of working 30 
hours or more per week, and this dropped to 33-35% if they had up to three 
employment liabilities. 185 
3.141  Except in the most severe cases, the direct physical effects of injury do not 
completely determine whether an injured worker returns to stable employment186   
Instead patterns of post-injury employment are determined by a set of influences 
that include workers’ characteristics and workplace accommodations that offset the 
limiting effects of impairments.   Successful disability management requires a 
combined effort by all interested parties: employers, insurers, unions, and workers. 
3.142  Injured workers at greatest risk of employment instability are female, have below 
average education, have a back injury, and do not receive job accommodations 
from their employers187.  Getting long term unemployed back into work remains 
one of the most serious and intractable problems facing the EU today, and the 
debate for them is where should the policy intervention lie188.   There are two 
Making the long term unemployed more employable by giving them 
education and training in the areas identified above; or 
Finding jobs for them, and putting the emphasis on inducements for 
employers, with the expectation that the desired employment attributes will 
be developed . 
The major handicap for the long term unemployed is that they are unemployed. 
182 Filan: The effect of workers’ or Third party compensation on return to work after hand surgery 
183 Johnson, Baldwin and Butler  1998 p 28 
184 Greenough and Fraser 1988 p 947 
185 .Kirby, Fraker, Pavette and Kovac: June 2003 Executive summary 
186 Butler, Johnson and Baldwin, 1995 pp 72 - 84 
187 ibid Summary 
188 Borooah, 2001 p 5 
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3.143  Two studies on the results of probably the largest and most complete survey of 
injured workers ever conducted, by the Ontario Workers’ Compensation Board, 
indicate the following: 
The majority of permanently impaired workers returned to their pre-injury 
employer, generally receiving the pre-injury wage as well as adaptations to 
facilitate their return to work; and 
Those impaired workers who moved to a different employer earned wages 
significantly lower than their pre-injury rate. 
3.144  What is less reported is that both sets of workers experienced extremely high initial 
rates of turnover189.   While the workers claimed that they were “physically unable 
to do the job”, there was insufficient data or analysis to demonstrate that there was 
a deterioration of health relative to that which existed at the time of re-
employment.   Rather, it was hypothesised that employers retain injured workers 
with some uncertainty about their abilities to perform full duties, and when 
productivity does not improve at the end of any “probationary” period, the 
employment relationship is terminated.   The conclusion therefore should be that  
paying more attention to dealing with the non-injury issues would have greatly 
reduced these problems.   In other words, had the barriers faced by long term 
unemployed workers returning to work (as outlined above) been addressed, many 
more of these workers would have retained sustainable employment. 
189 Cater 2000 p 76 
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Part 3:  Programmes and initiatives to remove barriers   
Many countries have grappled for decades with the problem of moving people from 
welfare to work, whether they are unemployed or disabled.  A wide variety of 
programmes have been initiated, debated, reviewed, rejected and re-instated.   
Creating effective return to work programmes for unemployed or injured / disabled 
workers  is easier said than done.  Many supervisors would rather not take injured 
or disabled workers back on a modified duty basis, preferring to wait until workers 
can perform their regular jobs.  For some employers, the nature of the work or the 
workplace can present obstacles to developing safe modified work alternatives.  The 
state of the economy has an impact – many employers struggle to retain fully 
functioning staff let alone accommodate workers with impairments.190  
This section reviews some return to work initiatives and evaluations which have 
been undertaken.   It also includes actions which can be taken by individuals, case 
managers or providers to address individual barriers. 
Addressing length of time out of the work force 
(a)  Unemployed 
Return to work programmes for unemployed people fit into two categories 
Workers made redundant / facing retrenchment.  The benefits of returning 
these people to employment as soon as possible are well recognised, as are 
the difficulties in maintaining their work skills and commitment in the 
absence of employment.   Those who do not return to work promptly risk 
lapsing into the second category below, or long term unemployed; and 
People in receipt of welfare payments, many of whom may be long term 
beneficiaries, and thus requiring quite different forms of assistance. 
The various programmes and initiatives dealing with early return to work are, in 
general, established return to work programmes but implemented at specific 
appropriate times, such as when notice of redundancy or retrenchment is given, 
and before a worker ceases employment with that employer.     
(b)  Disabled / injured workers 
Return to work is cited as probably one of the best aids to recovery and to 
preventing the patient’s deterioration into chronic disability.   In Britain, the best 
clinical management for back pain is to continue an active life rather than waiting 
till the pain disappears completely: this will mean faster recovery and fewer long 
term problems.191   An important conclusion of an Australian study  was that back 
injury patients are in general likely to benefit because of, rather than in spite of, 
returning to work.192   
190 Kremer 2003 p 39 
191 Waddell and Burton: Occupational health guidelines for the management of low back pain. 
192 Gun and Fraser 1992  p 4 
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An early return to work is considered a major objective of cardiac rehabilitation for 
most people of working age.193  For people with mental health problems, working 
aids their confidence, motivation and future health.194   Melhorn195 found that 
having no lost workdays or returning to work early (within 15 working days) was 
the most important element of “work survivability” (retaining employment for at 
least two years after the injury).  
Early Return to Work programmes for people recovering from illness such as 
strokes or from an injury cover a range of actions, including: 
Modified / lighter duties; 
Reduced hours; 
On job support; and 
Facilitating early return to work has become a major policy goal in Sweden, with 
the responsibility placed squarely on employers and employees.  This is achievable 
as 75% of employees work either for large companies with on-site medical staff or 
for a company with an affiliation with a medical centre.196   This includes 
maintaining personal communications with the injured workers during the 
hospitalisation / recovery phase, which is seen as a positive action by both workers 
(who like the personal touch) and case managers (who see it as motivational). 
Programmes to help long term unemployed return to work are covered in the 
programmes and initiatives listed below.  
Addressing the concept of disability 
4.10  However one defines disability, it is clear that the population of people with 
disabilities is diverse.  People with disabilities, by and large, have more in common 
with the general population than with each other.  In Canada, the focus has been 
shifting from the provision of specialised services for people with disabilities to the 
use of mainstream services, programs and facilities.   This is in part because the 
disability “system” has become fragmented, often with a lack of co-ordination.197  
Disability specific services are often needed only when regular programmes are 
unable or unwilling to accommodate people with disabilities. 
4.11  Higher individual satisfaction and quality of life occurs when people with 
disabilities are able to make use of generic programmes and services in the 
community.198    In general, the commonest impediments to the employment of 
people with disabilities are non-employment issues, such as transport, education, 
training, and on job support, or personal attributes and attitudes.   These are 
addressed in the programmes listed below. 
193 Jones and West: Cardiac Rehabilitation 
194 Duckworth: Disabled person’s perspective. 
195 Melhorn 1996 p 63 
196 Sim 1999, p 45 
197 Perrin 1999 p 14 
198 ibid p 122 
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Addressing personal issues 
(a)  Personal responses to stressful life events 
4.12  To understand work-related stress, we must first consider stress itself.  Every-one is 
under stress – there is no such thing as a stress-free life, or a stress-free job.  Every-
one is exposed to daily pressures, and most people cope with, even flourish on, 
moderate amounts of stress without suffering any ill effects.   If people feel that in 
control, stress can be experienced as a challenge, which drives them to perform 
4.13  The principal difference between healthy challenge and unhealthy stress is the 
reality or the perception of the person being able to control or influence the 
outcome.  When the sense of control is lost and coping mechanisms break down, a 
potentially healthy challenge can become dangerous stress.   Unrecognised and 
untreated, this stress can affect work productivity and attendance, attitude as well 
as physical and mental health. 
4.14  There are two types of programmes teaching stress management techniques: 
problem focused coping and symptom focused coping.   Problem focused coping 
techniques aim to control or eliminate the cause of stress, while symptom focused 
coping techniques include activities to alleviate the consequences of the stressful 
event but without addressing the actual problem.200   
4.15  In dealing with job loss, the commonest problem focused techniques include job 
search activity, retraining, or even geographical relocation to obtain re-
employment, and these are judged fairly effective in succeeding (mainly because 
these sorts of strategies open up additional opportunities for jobs).  These activities 
may however themselves cause further stress, and require some symptom focused 
techniques as well.   Both types of coping techniques are important, and if used 
properly, can have very beneficial consequences for physical and mental health.201 
4.16  Training in stress management is widely available in books, on cassette tapes, 
videos, training courses, and on the Internet, in whatever format the potential user 
would like.   It was therefore surprising to find very little mention of it in the 
various international programmes to help either long-term unemployed or injured 
workers return to work. 
4.17  Job-search Clubs are cited as a good means of reducing stress (as well as assisting 
attendees to find jobs).202 
(b)  Response to negative experiences 
4.18  Responses to negative experiences can include a progression through shock, 
frustration, discouragement, self-blame, low self-esteem, lower expectations of 
outcomes, and even learned helplessness.  Unless preventative action is taken at the 
time of the negative event, and it is successful, many people will reach a level of 
negativity which is hard to move. 
199 Pimentel 2001 
200 Leana and Feldman 1995 p 1384 
201 Susan Folkman in press release 4 December 2002 on death of Richard Lazarus  
202 Bayer 2002 on 
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4.19  A series of American studies has shown that patients who engage in forms of denial 
(of the seriousness or even the existence of a medical problem) recover better and 
more quickly from surgery than patients who do not.  While this is contrary to 
orthodox wisdom, it is now proven that false beliefs can have very beneficial 
consequences to health and wellbeing.  The same authors, however, cautions that 
denial can be destructive to the denier, in that it may prevent seeking appropriate 
medical attention, and reduce the value of any rehabilitation.203 In some situations, 
those in denial may be family and friends (such as those who  supply alcoholics 
with alcohol), or even rehabilitation professionals, who are unable to help a patient 
facing a bleak and depressing future. 
4.20  Interventions helpful in denial situations include: 
Counselling tools such as unconditional positive regard, accurate empathy, 
and confronting; 
Accepting the client as an individual; 
Relationship building, recognising the client’s anxieties; 
Helping the client understand the denial and its underlying cause; and then 
Helping the client eliminate their denial.204 
4.21  The power of positive thinking is a well established and successful concept, but one 
difficult to impose on another party at the time of a negative experience.   Most 
programmes to assist long term unemployed return to work include training in 
aspects of positive thinking, such as developing self-esteem, although this is 
generally more difficult to accomplish at that time.    
4.22  Learning how to handle the negativity has proved to be a successful concept in a 
Canadian study of unemployed managers who had given up seeking employment, 
but who had previously had job search training.  The managers were taught how to 
deal with repeated rejections in job searches and this helped them develop a 
positive attitude, that they could and would succeed in their job search.205  In 
Michigan, it is described as “fortifying the job seeker’s ability to resist 
demoralisation”.206  There are various ways of achieving this. 
(c)    Loss of status 
4.23  Addressing the concerns about status is a difficult issue, as this concern generally 
reflects attitudinal or personality traits, financial requirements and commitments, 
lack of confidence or fear for the future, or an underlying desire not to return to 
work.   Achieving a job with the same status may not be possible due to the 
vagaries of the labour market, attitudes of employers, location, and the skills of the 
worker becoming outdated ( as happens very quickly in the information technology 
(IT) industry).   In general, it is a male problem, as men often measure themselves 
by their professional achievements: their sense of self-worth is directly linked with 
their job satisfaction.207   
203 Lazarus 1983 pp 1 - 30 
204 Stewart and Gomez  p 5 
205 Millman and Latham p 95 
206 Caplan, Vinokur and Price 1997 p 343 
207 Bayer Press release 2002 
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4.24  In some cases, whether in the same or a new industry, the worker needs to restart 
at a lower level on the career ladder than pre-injury / pre-unemployment.   In the 
IT industry, the worker needs to regain employment at any level, simply in order to 
maintain their skills and keep up to date with new developments.208   Although it 
can be more stressful seeking better employment while already working, it is 
generally agreed by recruitment specialists that it is easier for a person to get 
another job when they already have one.  This can provide the proof of up-to-date 
job skills. 
4.25  If a worker does take a lower level job, it can be tough on both self-esteem and ego.  
Explaining on a curriculum vitae (CV) the presence of low level jobs in the middle 
of an executive career is often difficult and undesirable.   The CV could be 
formatted around functional activities and achievements, rather than a 
chronological list of jobs.   In the current flexible labour market, gaps in careers are 
not unusual, but the important issue is to retain polished skills. 
4.26  Human Resources Development Canada indicates that it is quite normal for a 
person looking for gainful employment to start with high expectations, leaving 
room for later concessions to lower level employment.209   This is corroborated by 
staff at employment agencies.210 
(d)  Lack of confidence 
4.27  The likelihood of gaining re-employment depends more on having the self-
confidence to seek out jobs than on the actual skills used in doing so. Those with 
an inner confidence in their ability to handle difficult situations return to working 
life faster than those who expect others to help them through their difficulties.211   
Cognitive behavioural training programmes have proved successful such as one 
where participants were trained in assertiveness, networking and contact building 
skills to build their self-esteem, self-efficacy and confidence. Their mental wellbeing 
improved – and nearly half the group also found a job. 212    
4.28  The Prince’s Trust in Britain was established to help young people aged 14- 30 to 
develop confidence and skills in order to get into work and start their own 
businesses.  The major programme is a 12 week programme to develop the 
participants’ confidence, motivation and skills through teamwork in the 
community.  Over 73% of the 74,000 participants since 1990 have found work or 
entered full time education or training.213 
4.29  The Lone Parents Organisation actively encourages lone parents to return to part 
time work so to polish their social skills, develop self-discipline and confidence, 
and the ability to judge how much stress they can efficiently work with before 
tackling the challenge of full time employment. 214   This was to help them avoid the 
syndrome that many long term lone parents who returned to full time employment 
ended up back on benefits within three months.  The Lone Parents Organisation 
208 Southgate 2003  
209 website: 
210 Graves 2003 
211 Millet  Swedish National institute for Working life Newsletter No 3 2001 
212 Proudfoot et al 1997 pp 96 - 100 
213 The Prince’s Trust Factsheet June 2003 
214 Lone Parents’ website: 
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web-site provides a comprehensive “self-help diary” designed to build self-esteem, 
confidence and social skills. 
4.30  Germany established a system of social enterprises in the early 1980s, which 
provided both employment and developed the confidence of the workers. 215  
Known as “self-help firms”, they provide normal jobs with regular contracts and 
wages for people with disabilities (generally with psychiatric disabilities) in firms 
where non-disabled people are also employed.  The firms are generally small, 
employing up to 20 workers.   Studies show that about 40% of employees with 
disabilities moved through these firms to become employed in the general labour 
market, while there was a drop-out rate of 20%.216 
4.31  The JOBS trial at the Michigan Prevention Research Center introduced a unique 
feature in its programme to assist the unemployed: the trainers for the programmes 
are themselves recruited form the ranks of the unemployed.  Such people are 
typically counsellors or teachers, and those with social and emotional competencies 
themselves, such as flexibility, empathy, self-confidence and positive outlook.  
They also have good speaking and listening skills, facilitation skills, and the ability 
to manage conflict constructively.  They undergo their own specific training.217 
(e)  Apprehensions regarding re-employment 
4.32  The transition from welfare to work is a stressful time for claimants, with fears  
about coping financially, about re-injuring oneself, and the hassles of returning to 
welfare if the job does not work out. 
4.33  The British government has several programmes to ease the transition from welfare 
to work.218    
The Job grant provides £100 for claimants moving off benefits into work for 
at least 16 hours per week for a minimum of five weeks;    
The Lone Parent Run-on gives a two week extension of welfare payments for 
people moving into work who had been receiving benefits for at least six 
The Housing Benefit Run-on provides an extension of the  Housing Benefit 
for four weeks after the claimant leaves welfare for work.  The claimant most 
have been on welfare for six months, and have received a Housing benefit as 
part of their payments.  There is very similar Council Tax Run-on, a 
Mortgage Interest run-on and an Income Support Mortgage Interest 52 week 
link; and 
Rapid Reclaim streamlines the process of reclaiming benefits for people who 
returned to work that lasted for up to 12 weeks. 
215 The concept of “work integration co-operatives” was first developed in Italy in the 1970s, when the 
patients of a psychiatric clinic rebelled against working unpaid, and set up a co-operative to do the same 
work under contract.  The founders of the co-operatives were often parents, staff of the institutions, and 
municipalities and local health or church organisations. 
216 Thornton and Lunt 1997 p 134 
217 Price and Vinokur 1995 pp 759 - 769 
218 Woodland, Mandy and Miller 2003 p 8 
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4.34  Behavioural and attitudinal change was positively associated with the amount of 
anticipated financial assistance: as the amount of financial assistance increased, so  
did the level of job search activity and the levels of confidence.   A point of concern, 
however, was that many potential recipients were unaware of their eligibility for 
this assistance, and therefore the uptake was lower than it might have been.   Poor 
administration in some places reduced the beneficial impact.219 
4.35  The Job Grant was an unexpected bonus for most people, but was valued highly for 
its psychological, as well as financial, effects.  It provided much needed motivation 
through to stability of household finances.  For those who were expecting, any 
delays in its arrival did cause financial problems, and lessened the benefit.220   
Newly employed workers who received the run-on payments were able to budget 
more effectively, and expressed greater feeling of confidence.  An appropriate 
length for the transitional period was not established. 
Personal abilities and attributes 
4.36  Australian research on what employers want in their staff indicated personality and 
attitude to be key attributes.   Reliability was rated as the most important (at 66%), 
willingness to work second (at 62%), and relevant work skills third at 52%.  
(Relevant previous work experience was rated at only 40%, and presentation at 
31%).221   How to acquire these skills is addressed below. 
(a)  capacity to change 
4.37  The capacity to change is seen as increasingly important as the nature of jobs and 
the labour market continues to change.  As the world of work is complex and 
challenging, the Canadian government decided that the key skills needed for a high 
quality work-force would be generic foundational skills rather than skills specific to 
certain occupations, levels of responsibility or limited to today’s jobs.   
They defined the Employability Skills Profile as: 
People who can communicate, think, and continue to learn throughout their 
People who can demonstrate positive attitudes and behaviours, 
responsibility, and adaptability; and 
People who can work with others.222 
All these attributes are deemed learnable, and can be learned at any age.    
4.38  The concept of lifelong learning has been endorsed by the OECD as a means of 
helping its member countries anticipate and benefit from economic and social 
changes.  Lifelong employability (defined as the capacity to be productive and to 
219 Harries and Woodfield 2002 p 114 
220 Harries and Woodfield 2002 p 108 
221 Department of Employment and Work Relations 2001 p 2 
222 McLaughlin 1992 
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hold rewarding jobs during one’s working life) is no longer guaranteed by the 
education and training received by people in childhood and youth.223   
4.39  Lifelong learning is far broader than “second-chance” education and/or training for 
adults.  It is based on the premise that every-one should be able, motivated and 
actively encouraged to learn throughout life, through programmes such as Skills for 
Life, unit standard based qualifications on the New Zealand National Qualifications 
Framework, Internet based training or group courses.  
4.40  Capacity to change incorporates adaptability, flexibility, versatility, resilience, 
responsiveness, resourcefulness.  It also incorporates attitude and/or state of mind.   
4.41  David Noer, an international authority on the changing world of work, has defined 
four types of individuals as they attempt to cope with change in a workplace or in 
their own careers.   These are posited around the individual’s capacity for change 
and their comfort level: 
an 30 – 60% 
10 - ? % 
o  ch
ty t Overwhelmed 
ap 30 – 60% 
10 – 20% 
                              Comfort level 
4.42  Faced with an uncertain climate of rapid, unsettling change, both individuals and 
organizations tend to react in predictable, self-defeating ways: they feel 
overwhelmed and victimized, they dig in their heels and work harder as though 
nothing's changed, or they try to fake their way along. According to Noer, the only 
response that works is the positive willingness to learn and meet change head-on.224 
4.43  There are books, courses, and Internet based material available to help people 
develop their attitude and capacity to learn.   As with most skills, however, the 
individual must have the willingness to learn before they will be able to learn. 
(b)  Personal expectations 
4.44  Three critical internal resources are needed for an individual to cope with job loss 
and /or stress.  These are: 
223 McKenzie and Wurzburg 1997 p 13 
224 Noer 1999 Abstract 
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Knowledge of the procedures that are effective in handling the stress – in 
this case, how to find job leads, how to be interviewed; 
Having the behavioural skills to use the above knowledge; and 
Having the energy and motivation to put the knowledge and skills into 
4.45  Research shows that workers’ expectations of slower recovery or of greater 
uncertainty in their future are consistently associated with longer periods off work 
and receiving benefits.226   This is a useful predictor of people who need additional 
assistance in order to return to work. 
(c)  Education 
4.46  Training programmes have proved successful in raising levels of literacy and 
numeracy for long term unemployed.  Part of their success is the provision of 
ancillary services (which have already been identified in this report as necessary to 
help achieve return to work) such as childcare, transportation, flexible hours for 
training sessions.   Improving the quality of trainers is important, as is using a 
range of instructional approaches, and adapting the curriculum to ensure it is 
relevant to participants.227 
4.47  Learning disabilities impact on the development of listening, reading, writing, 
reasoning and numeracy skills.  The US Department of Labor estimates that 
between 50 and 80% of adults with low reading levels are “learning disabled”.  
They present characteristics such as: 
Difficulty planning and prioritising; 
Using imprecise language or misusing terminology; 
Writing illegibly; and 
Having difficulty filling out forms.228 
4.48  The limited success of many programmes to develop basic education skills in 
America has been attributed to not taking enough account of learning disabilities, 
or the special needs of adult learners.229    The Oklahoma Adult Education and 
Literacy programme includes staff training in 
Improving awareness and understanding of adults with learning disabilities, 
and recognising the characteristics of learning disabilities; 
Recognising self esteem and social skill issues and providing ways to foster 
Understanding the differences between screening, assessment and diagnosis, 
and being able to apply appropriate screening; and 
Using specific techniques for people with learning disabilities.230 
225 Caplan, Vinokur and Price 1997 p 353 
226 Cole, Mondloch and Hogg-Johnson 2002p 750 
227 Brown 2001 p 90 
228 ibid p 89 
229 ibid p 90 
230 Brown 2001 p 94 
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4.49  Recent research has identified that approximately 15% of employees spend time on 
personal money matters on the job, and that negatively affects productivity.   If 
employees have control over their finances, they are less likely to be stressed, will 
need less time to deal with their money matters at work, be more motivated and 
have better morale than those with money troubles.231  Comprehensive financial 
education programmes have proven to be effective.   
Financial education programmes typically include: 
Understanding tax requirements;  
Budgeting for items such as childcare or transport;  
Savings and credit records; 
Potential challenges such as credit cards, hire purchase, bounced cheques 
and easy loans; and 
Understanding financial institutions. 
4.50  In Portugal, assistance is given to disabled people aged 16 or older to obtain a 
professional qualification which will allow them to hold a job and to progress 
professionally in- the normal job market.  Such training can be on or off job.232 
(d)  Ability to speak the local language 
4.51  Language barriers can be removed or reduced with training.   There are two subtly 
distinct needs: ability to speak the official language of a country, and ability to 
express oneself in words.  American experience of running Job Clubs in different 
languages is very positive233.  Incorporating teaching English as a second language 
in work-skills or vocational training courses was also successful.  In both examples, 
the motivation and success of participants increased markedly.  
4.52  Language may not be a barrier to obtaining some jobs (such as book-keeping), and 
it may be a benefit to have speakers of other languages in jobs where staff interact 
constantly with the general public (such as tourism / travel ). 
4.53  The need to address cultural differences is not always recognised as a potential 
barrier: in general this is best addressed at case manager level when following up 
clients in their new employment.   There are cultural assessment tools available, 
such as that of the University of Michigan.  It is designed to help providers 
understand the beliefs, values and practices of clients and patients which may 
impact on their care and rehabilitation.  Issues to be considered include: 
Level of ethnic identity;  
Use of informal network and supportive institutions in the ethnic/cultural ; 
Community values orientation;  
Language and communication process; 
231 Smart Solutions September 2000 Issue 4 p 2 
232 Thornton and Lunt 1997 p 215 
233 Brown 2001 p 97 
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Migration experience;  
Self concept and self esteem;  
Influence of religion/spirituality on the belief system and behaviour patterns;  
Views and concerns about discrimination and institutional racism;  
Views about the role that ethnicity plays;  
Educational level and employment experiences;  
Habits, customs, beliefs;  
Importance and impact associated with physical characteristics;  
Cultural health beliefs and practices; and  
Current socio-economic status. 234 
4.54  Other strategies which have proven successful include: 
Identifying jobs for which language is not a barrier, such as independent 
work, account, and  manual labour, and 
Facilitate the interview process with interpretation and support; 
Identifying jobs where another language is an asset, such as in tourism and 
customer service positions; 
Looking out for jobs where the supervisor is bilingual, or at least one other 
staff speaks the same language; 
Using job coaches to facilitate the transition to work; and 
Promoting workplace training in ESOL.235 
4.55  It is important to include training in the “soft skills” required in navigating 
workplace culture.  Workplace simulations and role-plays of “sticky” situations  
have proven successful in helping newcomers understand workplace cultures and 
finding ways of fitting in without giving up one’s own identity or being taken 
advantage of.236 
4.56  A listing of eleven good practice programmes identified consistent placement rates 
above 80% and job retention rates between 60 and 90%.237 
4.57  While there are many programmes to assist unemployed workers develop their 
employability, most of these address only some of the problems.   Good examples 
include the Canadian Federal Government’s Employability Improvement 
Programme which has a client centred approach, and offers a flexible choice of 
services including counselling, training and work experience.   The project-based 
training module provides integrated classroom and on the job training and work 
experience.  Project co-ordinators arrange appropriate employment activities which 
may include skills training, life skills, job search and job placement.   A review of 
234 Isaacs and Benjamin 1991 
235 Brown 2001 p 99 
236 Wrigley et al 2003 p 23 
237 Wrigley etal pp43- 62 
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the programme in 1998 indicated that participants gained and retained 
employment at higher income levels than previously experienced.238 
4.58  The Hong Kong Employees Retraining Board provides retraining courses and 
services to enhance the employability of the unemployed and the potentially 
unemployed.  The Board supplies free full-time training courses, and heavily 
subsidised part-time courses.  Specifically at the request of employers, courses 
include modules on “soft skills” such as work attitude, service culture, teamwork, 
communications skills, and work commitment.   They also cover basic computer 
skills and occupational safety and health. A study in August 1999 of retrainees who 
completed their training in January and February 1999 found that 84% were still 
employed, nearly half of them with the same employer. 239 
4.59  Employability skills can be taught and learned.   Researchers have focused on 
identifying successful practices in existing programmes and offer the following 
Employability skills are best learned when they are included among 
instructional goals and are explicitly taught; 
Employability skills and traits  are very amenable to being taught; 
The best method is to raise consciousness about values, attitudes and 
worker responsibilities, using strategies such as role play/ simulation, 
problem solving,  and group discussions rather than lectures; 
Instructors should assume the role of facilitators / coaches so that students 
take much of the responsibility for their own learning; and 
Instructors should hold and communicate high expectations for the learning 
outcomes, including punctuality, dependability, thoroughness, decision 
making capability and co-operation.240 
4.60  There are many programmes available on the Internet  for self-training in work 
habits, attitudes and values, employability, or in affective competency for 
professional training sessions.   One example is the Denver Workforce Initiative, 
whose Workin’ it out programme helps entry-level workers understand the 
unspoken rules of the workplace, and develop basic communication and problem-
solving skills.241   Other American programmes for people with limited English 
include training in cultural differences such as: 
How to indicate you do not understand; and 
How to fit in socially at work.242 
4.61  Part time work has been shown quite widely and consistently to prepare people for 
future moves into full time work.243  Researchers advise policy makers to consider 
238 HDRC 1998  
239 Kwong 1998 pp 1-6 
240 Cotton 2001 pp 7-13 
241 Relave 2000 
242 Wrigley et al 2003 p 23 
243 Evans et al p 107 
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providing greater support for part-time employment because of these benefits.  
Voluntary work is one good way of achieving this.  
4.62  In Britain voluntary work is a permitted activity for people receiving incapacity 
benefits.  This is seen as helpful for people on the way into or back to work.   It 
provides opportunities to test interests and try out skills and to gain experience in 
social interaction.   As there is no direct effect on the level of benefit, it is also 
perceived as risk-free.244   Appropriate voluntary work included: 
Helping children read at school 
Community work 
Assisting at play-centres or schools 
Work in the office of a disability organisation 
4.63  This voluntary work is required to have prior approval, but subsequent research 
has shown a range of unapproved and unreported voluntary activities done by 
beneficiaries “as a favour” or “just helping out”.  These activities included: 
Work for a residents’ association 
Community support groups 
Advocacy and self-help groups 
Youth clubs 
Driving elderly or disabled people 
Performing arts 
4.64  Working in charity shops was seen as retrograde and likely to inhibit 
Addressing health factors 
(a)  Pain management 
4.65  Pain management programmes were initiated in the 1970s.  Typically they have 
been multidisciplinary in nature, and the overwhelming majority have been based 
on operant and cognitive principles.246  Recent American programmes have been 
more psychological in nature rather than merely exercise regimes.   The relevance 
of specific muscles is usually given less prominence than enhancing functional 
4.66  Pain management programmes include:  
Medication rationalisation and withdrawal;  
Education about pain;  
244 Corden and Sainsbury 2001 p 37 
245 ibid p 38 
246 Nicholas p 5 
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Training in pain coping strategies (such as activity pacing, goal setting);  
Relaxation techniques; 
Turning unhelpful beliefs and thoughts positive,; 
Upgrading more pleasurable activities; and  
Encouraging the patients to take responsibility for managing their pain and 
recognising their achievements.247   This is especially important as research 
shows that working with one’s own resources for pain management can be 
an effective way of increasing self-confidence and thus improve motivation 
to work.248 
4.67  Most programmes also include the involvement of family and friends, particularly 
to educate them about refraining from unintentional reinforcement of pain 
behaviours.  The healthcare system can also reinforce negative pain behaviour, as it 
provides services and attention contingent upon pain.   Pain rehabilitation is likely 
to be more effective, when it focuses on the positive.249 
4.68  Researchers generally agree that pain management is quite distinct from work 
hardening (incorporating physical conditioning, work simulation, and education to 
build strength and endurance, and improve function while helping to prevent re-
injury) and work conditioning (work hardening but without the educational 
content).250    Research on all three programme types indicated that programmes 
which include a cognitive-behavioural approach can reduce the number of sick 
days lost quite significantly for people with chronic back pain, but there was no 
evidence of their efficacy for acute back pain.251 252 Effective pain management can 
also increase the general activity level of people, and thus their quality of life. 
4.69  Cognitive behaviour therapy is an important tool in the rehabilitation of patients 
with pain.  It includes identifying and using all motivating factors for return to 
work, as well as reducing the effects of demotivating behaviours.   Motivation can 
change the perception of pain, according to the “gate-control” theory.253   According 
to this theory, different aspects of an individual’s life can open or close the transfer 
of pain signals.  Cognitive factors such as increased concentration and motivation 
may also help to close the “pain gate”.    
4.70  Where pain management treatment programmes have been less successful may be 
because the workplace was seen as “something to return to” rather than an integral 
part of a comprehensive intervention.254    Pain management programmes must take 
account of both physical and psychosocial risk factors in the workplace (such as 
high time pressures, monotonous tasks, job dissatisfaction, low social support).  
247 ibid p 6 
248 Gard and Sandberg (1998) p 101 
249 ibid p 102 
250 PTRC website 
251 Schonstein et al 2003 Abstract 
252 Marhold, Linton and Mellin 2000 p 162 
253 Melzack and Wall 1965 pp971-9 
254 Marhold, Linton and Melin 2001 p 155 
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(b)  Use of cigarettes, drugs and alcohol 
4.71  Studies have shown that between 6 and 37 percent of welfare recipients have a 
substance abuse problem which interferes with employment and job retention.255   
Addressing substance abuse and mental health problems presents governments 
with unique challenges regarding screening and assessment, service co-ordination, 
treatment capacity, and funding for services.  Access to treatment can be difficult 
because service delivery systems are often fragmented.  The solution to this is 
interagency co-ordination.  
4.72  In America, smoking cessation programmes are an allowable deductible medical 
expense, as well as treatment and other costs related to alcoholism. 256 
(c)  Mental health 
4.73  The need to prevent poor mental health while job seekers remained unemployed 
has been firmly established in many studies such as in Britain 257 and in the United 
states.   In a Michigan study258 results showed that intervention was particularly 
beneficial  for people at high risk of developing depressive symptoms.  (High risk 
was defined as having a high combined index of depression, financial hardship, and 
low social assertiveness at first interview.)  The high risk participants showed 
significantly lower levels of both the incidence and the prevalence of severe 
depressive episodes, even two and a half years after the intervention. 259 
4.74  Most people who experience a traumatic event do not go on to suffer from post 
traumatic stress disorder (PTSD), but many are likely to experience some of the 
symptoms such as flashbacks or hyper-arousal.   This is considered a normal 
reaction in the short term, and for most people, such symptoms will reduce within 
a few weeks.   For most workplace traumas, fewer than 25% of the staff are likely to 
be affected in the longer term.260 
4.75  Currently there are two main strategies for managing PTSD: diffusing and 
debriefing.  Diffusing is the term used generically to describe employees getting 
together after an incident to discuss and make sense of what happened.  In many 
instances, this happens informally.   The aim of diffusing is to help people come to 
terms with what has happened, to offer reassurance and support, and to ensure 
they are aware of other help available.    
4.76  Psychological debriefing, a structured group process for reviewing events involving 
intense re-exposure to the incident, is the most commonly used form of 
intervention261 and yet it is difficult to evaluate whether it is successful in reducing 
trauma symptoms. There is a risk of secondary traumatisation with the intense re-
exposure to the incident.  The benefits of debriefing were found to be the 
development of management systems for dealing with incidents, and allowing staff 
the opportunity to diffuse.  
255 Danziger et al 2000 p 6 
256 Krentzman 2003 
257 Riddell 2002 p 45 
258 Caplan, Vinokur and Price 1997 p 348 
259 Caplan, Vinokur and Price 1997 p 348 
260 Rick and Briner 2000 p3 
261 Rick, Young and Guppy, 1998, Executive summary 
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4.77  A series of British case studies found that organisations with a range of practices 
and procedures for managing trauma in the workplace were less likely to have 
incidents occurring and harm was minimised where incidents did occur.262   These 
include risk assessment, training and education, rehearsal of critical incident 
procedures, clearly defined practices and policies for managing incidents, clear 
guidance on dealing with the immediate aftermath of an incident, as well as longer 
term support for employees. 
(d)  Evidence-based Return to Work Guidelines 
4.78  Evidence based guidelines are derived from sources which pool reported cases and 
compile data on various types of treatments, length of time off work, modified 
work possibilities, and identify factors specifically impacting on return to work.   
They have been derived to provide doctors, case managers, employers and workers 
with realistic benchmarks for managing the return to work process. They are a key 
factor in communications, ensuring that all share the same information and 
assumptions.  Research indicates that doctors appreciate having evidence based 
guidelines to compare their patients with, as this enables them to come to their 
own decisions rather than having some-one else’s view imposed on them. 263     
4.79  Disability duration guidelines are the focal point of the return to work process.  
Already, the use of such guidelines have produced significant and tangible results 
across the board.264   This includes a positive impact on the mental, physiological, 
emotional and financial well-being of a worker, their family, co-workers, employers 
and insurers. 
Refusal to accept jobs 
4.80  Whether unemployed people really want to work and the extent to which they 
search for work has been the subject of much debate.   Commitment to work tends 
to be related to age (those over 55 years) and education (lower levels of education 
reduces people’s longer term commitment to employment, especially women). 
4.81  When dealing with refusal to accept job offers and options, it is important to 
consider the reasons for the refusal.  These include: 
The remuneration is less than the person is receiving on benefit or through 
compensation payments; 
The worker wishes only to work in the same industry / the same type of job; 
The person does not want to return to work; 
Lack of confidence in their skills / ability to cope with work after an injury; 
Loss of status. 
4.82  How to address some of these reasons is dealt with elsewhere in this report (as in 
dealing with the loss of remuneration, loss of confidence and loss of status). 
262 ibid 
263 Stutzman 2001 p 36 
264 ibid p 38 
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4.83  Researchers are divided on the effectiveness of requiring unemployed / injured 
workers to accept job offers or lose their benefit payments.  Knab et al found that 
requirements to participate in mandatory welfare-to-work programmes can increase 
employment and earnings, and reduce welfare income, independent of actual 
participation in the programme.   Usually these independent effects of participation 
requirements are not known, because programme impacts are measured on those 
who actually turned up to participate.265   Not surprisingly, response to a mandate 
increases with the strength of enforcement and the level of penalties for non-
4.84  Most American states have laws saying that if a claimant for unemployment benefits 
refuses an offer of suitable work, without good cause, the claimant must be 
disqualified from receiving unemployment benefits.  The British Government  
believes harsh sanctions are necessary to break the cycle of benefit dependency and 
long-term unemployment, which remain endemic in some parts of the country.  
4.85  In 2001, nearly one in five children lived in a household where no one was in paid 
work - double the proportion in 1979 and four times that in 1968. 
4.86  The British Library Information Services states that the sanctions regime under 
both the Jobseekers Allowance and the New Deal for Young People continues to 
cause hardship to many unemployed young people who frequently have only the 
haziest idea of what they have been accused. In practice sanctions were seen as the 
sorts of things the powerful do to the socially excluded, and, because of this, they 
have little effect on job-seeking behaviour. The most socially excluded among the 
young unemployed appear to be the most likely to suffer sanctions.266  
4.87  Sanctions to force people to take jobs have been compared with healthcare: Imagine 
a world where registering with your GP entailed signing a "healthseekers' 
agreement" promising not to smoke, eat fatty food or go without exercise - and a 
health service that would refuse to treat you if you had broken it, or, additionally, 
failed to comply with a series of "for your own good" health and fitness measures. 
There is no ethical difference between this scenario and that of the benefit 
sanctions now in place: if we see healthcare as a universal social right, whatever 
people's behaviour, surely a level of basic subsistence - the means to live - must be 
4.88  The Canadian government rules for benefits state that although a claimant is 
expected to lower wage expectations as the period of unemployment lengthens, this 
must not be taken to mean that the minimum wages paid in the labour market or 
wages paid to an inexperienced worker become, at a certain point in time, 
acceptable to any worker. In certain cases, employment at those wages is defined as 
unsuitable; in fact, the "good employers", referred to in the legal provisions dealing 
with refusal of work, generally recognise pay rates based on an individual's 
4.89  They state that once a reasonable period of unemployment has elapsed since the 
commencement of the benefit period, the claimant must be prepared to accept the 
wage rates currently paid to workers in the same occupation and having the same 
265 Knab et al 2000 p 20 
266 Bivand 1999 pp12-15 
267 Williamson Judith in The Guardian April 2002, available on 
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qualifications. For employment opportunities in other than the usual occupation, 
the claimant must be prepared to accept the rates paid to a person with similar 
abilities; depending on the circumstances, they may mean the rates paid to 
inexperienced workers. 268 
4.90  The end solution is stated bluntly by recruitment specialists: “Today's job seekers 
must lower their expectations. They need to commit themselves to working their 
way up another career ladder, changing careers, taking part time positions or even 
doing temporary work until a better position is found. They must change their 
mindset and stop complaining that there aren't any jobs out there!"269 
Age, gender, ethnicity 
(a)  Age 
4.91  Lifelong learning is an important part of British government policy, driven largely 
by concern about the general skill and qualification levels of the economically 
active population.270  To remain competitive in the labour market, people need to 
continually update and learn new skills, and it is recognised that participation in 
learning has much wider benefits.     
4.92  A British study of the impact of learning on older people concluded: 
An improvement in self-confidence, self-esteem, satisfaction with life and 
ability to cope with everyday life; 
Improved ability to stand up for oneself; 
Improved ability to take responsibility; 
More people in poor health or disabled reported improvements in life than 
those in good health; 
25% declared they had done enough learning in their life; and 
22% felt they were too old to learn. 
4.93  Overall, this research supports the training / retraining of older workers for 
employment.  Another reason to support this training is a seemingly international 
lack of the suitable skills for employment: the Hudson Institute forecast in the early 
1990s that millions of new workers lack the basic skills essential for employment, 
and that a gap was emerging between education and skill levels of new workers and 
employers’ skill requirements.  This was forcing employers to look to non-
traditional workers, finding in older persons “a vast resource of talent and 
4.94  In Hong Kong, the Employees Retraining Board has special programmes for older 
workers, originated through concern for the vulnerability of elderly workers with 
low education attainment and low skills.272   They see training and retraining as a 
continuous and lifelong process for all. 
268 HRDC Rule 10.5.4 
269 Graves 2003 
270 Dench and Regan 2000 Executive summary 
271 American Association of Retired Persons 1993 p 4 
272 Kwong 2000 p4 
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4.95  Research has identified some best practice in training / retraining older workers, 
which also includes placement in part-time employment.  While there is no 
consistent definition of the older worker, in terms of chronological age, functional 
ability, and psycho-social characteristics, this merely serves to emphasise the 
individuality of older workers and the need to be flexible towards training, 
retaining and employment.    
4.96  There are a number of research findings that indicate that being old may not be the 
reason for someone being a poor learner, rather it could be due to learning and 
other individual differences, such as not having been involved in learning activities 
for some time.273 
4.97  Traditional training methodologies for older workers include: 
Interactive training (based on the assumption that older workers do not 
function well in school type environments); 
Activity learning (which reduces descriptions and memorisation, and 
involves tasks of graded difficulty, but results of studies were inconclusive); 
Discovery learning (learning through doing, rather than through verbal or 
physical instruction, which proved to be very effective but time consuming 
for the trainer); 
Comprehension, reflex, attitude, memory and procedure (cramp) technique 
(which incorporates all the previous methods of learning, and proved very 
helpful to older men); and 
Programmed instruction (which provides immediate feedback and positive 
reinforcement, and is aligned to behaviour modification). 
4.98  Recommended actions to assist successful training of older workers include: 
Trainability testing, checking out a person’s ability to learn a short task 
before investing time and resources into training.274  The approach has three 
Teaching the worker a task, using standardised instructions and 
demonstration techniques; 
The worker performs the task unaided; and 
Errors are recorded on a standardised checklist, performance is 
graded and trainability rating established. 
Changing the attitudes of supervisors and managers, as older workers tend 
to fear failure and/or inability to compete.  Recognise that in many cases, 
these people and the trainers may be younger than the older trainee; 
Base training on job or task analysis; 
Allow adequate time for mastery of skills, by moving from simple to 
complex tasks, and include demonstration of mastery of skills.   Computer 
training is the best example of this need; 
Recognise that older workers generally require longer to reach proficiency 
than younger workers by allowing longer periods for study and to complete 
273 Sterns and Doverspike p 313 
274 Sterns and Doverspike p 310 
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tasks and tests, and have slower rates of presentation (although there is 
other research which indicates no difference in learning times between 
groups of workers in their twenties and in their fifties275);   
Ensure the training environment is comfortable for the older trainee; 
Ensure the training builds on the existing skills, knowledge and abilities of 
the trainee, and use material that is both familiar and relevant to them; 
Ensure they are motivated to be trained and to learn; and 
Even with self-paced training, older trainees tend to need more support and 
interventions from the trainer.   Care must be taken, however, to maintain 
their sense of status and self esteem. 
4.99  Lastly, it is timely to remember that with the current pace of technological change, 
many new skills are becoming obsolete within a few years, and that regardless of 
age, workers’ skills will need updating roughly every five years.276 
4.100  Despite all this, there are not many labour market adjustment programmes 
specifically targeted for older workers, although it is suggested that governments 
will need to pay more attention to this segment of the labour market as the working 
population ages.   Those programmes that have started have been successful.  For 
example Sweden has achieved a 90% labour market participation rate among older 
individuals while keeping overall unemployment rates down to 5%.   Training 
programmes in the United States which were more personalised and included 
ongoing counselling and assessment activities were effective in encouraging the re-
employment of older workers.277    
4.101  Finland has established two new programmes to encourage greater participation in 
the labour force of older workers.   The first, the “Carrot Project”, involves the 
provision of help and advice to companies with at least 40% of their workforce over 
the age of 45 and includes an audit of the staff’s work ability.  Changing 
management style is seen as a key lever in this project along with developing 
participation in change management.278  The second, the Maintenance of Work 
Ability (MWA) Barometer, was established out of the need to decide the extent, 
content, and functionality of the activity to maintain work ability in work places.   
Three quarters of companies report undertaking MWA activities, which contribute 
to business success as well as help facilitate the recruitment of labour in times of 
shortage, and are used in managing the progress of senior  managers.279 
4.102  The normal ageing process encompasses physical, neurological and sensory 
changes, all of which the older worker adapts to.   Simple ergonomic changes 
which assist older workers retain their efficiency and their employment include: 
Improving lighting; 
Implement colour coding schemes to reduce need to use fine print; 
Supply magnifiers where appropriate; 
275 Murrell and Humphries 1978 pp 363 - 365 
276 Sterns and Doverspike p 325 
277 HRDC 1997 Section 7.2 
278 FNPAW 2000 p 4 
279 ibid p 4 
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Ensure instructions are given clearly and audibly; 
Ensure safety warnings are clear, including safety markings in any vehicular 
areas; and 
Recognise changes in older workers’ flexibility, strength, speed and reaction 
times. 280 
4.103  Grey Skills Home and Employment Services have been established throughout New 
Zealand to provide temporary assignments for people aged over 40. The network 
provides services such as home property maintenance services.  The success of the 
system is apparent in the fact that it is the largest home services group in NZ with 
over 400 service providers (all aged over 40).   
4.104  The philosophy of Grey Skills is:  
Towards a world where age is no barrier to success. An organisation for people who 
have had their rights infringed because of their age; to recognise and acknowledge their 

intrinsic value, and help them find quality employment with quality employers.281  
(b)  Gender 
4.105  Gender based research is focused only on the problems faced by women, largely 
because of the significant numbers of lone parent families headed by women.  Job 
loss for this group occurs frequently because of the nature of jobs they find, the 
generally low technical and personal skills they bring to jobs, and the pressures and 
disruptions of their personal lives as they juggle responsibilities between their 
children and their employers.282  The pattern of rapid job loss / job acquisition is 
repeated often.  
4.106  There is also the issue of wanting to return to work.  One quarter of unemployed 
German women with children only want to return work at a later date - even if they 
were offered a job immediately, they would not take it, according to the German 
Department of Work and Income.283  
4.107  There are not many programmes specifically for long- term unemployed or injured 
women attempting to return to work.  The few programmes that exist are related to 
affirmative action programmes to increase the participation of women in the labour 
force generally.  Ireland had long had a lower female participation rate in the 
workforce than most other countries (less than 60% of women in the 25-54 age 
group compared with 75% in the United Kingdom and over 80% in Sweden).284   
The FAS (the Irish Training and Employment Authority) developed specific 
programmes under the banner Women in Focus, starting in 1990.   This includes: 
Incentives to employers to employ and train women apprentices; 
Training programmes for women only on return to work skills;  
Specific job skills, and specialist skills required by individual firms;  
Career development;  
280 Larson 2001 pp 67 - 68 
281 Grey Skills website: <> 
282 Hershey and Pavetti  p 74 
283 press statement sourced through Internet 
284 press statement from Irish Hotels Federation 22 February 2000. 
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Training for “traveller women”;  
Community skills development;  
Home care;  
Care of the disabled; and  
Updating of skills.    
4.108  They also developed a new childcare worker training programme for unemployed 
women to meet the growing demand.285  According to the OECD, these 
programmes have been successful: The rate of employment among females in 
Ireland increased by 15 percentage points from 1994 to 2002, and the rate of 
employment for young women aged 25-29 at 78% is higher than in most OECD 
4.109  Sweden also has introduced major gender equality initiatives for all ages, ranging 
from gender equality in schooling, working life, to health, and violence.   Specific 
work initiatives include a programme to support women starting up and running 
their own businesses.287  
4.110  Australia has a Return to Work programme which assists people who have been 
unemployed for more than two years, particularly women, with information 
technology skills and other assistance to enable them to re-enter the labour force.288   
They also have a Small Business Enterprise Culture Programme which fosters skills 
development initiatives and mentoring services for small business and supports 
women in small business. 
4.111  The UK New Deal for Lone Parents is a voluntary welfare to work programme 
designed to increase the participation of lone parents into paid work, and to 
improve their job readiness and employment opportunities.  In that most of the 
317,000 participants over four years were female (94%), the results give an accurate 
portrayal of effectiveness of programmes for women.  The programme incorporates 
a Personal Adviser (PA) for each participant. PAs provided the following assistance 
as required to make the transition to work: 
Learning about the client so that they can provide support and help to find a 
job that the client will enjoy; 
A “better-off calculation” to ascertain how much better the person would be 
in  a job; 
Drawing up an action plan to help the client get that job; 
Practical and specific help in looking for and applying for suitable jobs; 
Help in accessing training; 
Help in accessing childcare; 
Help with expenses during the job search; 
285 FAS website: 
286 OECD: Babies and Bosses press release November 2003. 
287 Regeringskansliet Factsheet: Some gender equality initiatives in 2002 
288 Australian Budget Report 2000 
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In-work financial planning advice on benefits available while in 
employment; and 
Continued help and advice after the client has found work.  
4.112  PAs have a high degree of flexibility and autonomy to enable them to tailor services 
to meet the individual needs of each client.   The programme operates within a 
wider suite of measures to increase employment rates among lone parents. 
4.113  The programme has been widely evaluated.   There is a growth in repeat 
participation, and a third of all participants being on the programme for a second 
time or more.289   Any of being male, old, non-white, or having many / young 
children appeared to reduce chances of leaving the programme for work, but 
interestingly, those with the most disadvantages had better return to work rates 
than those with fewer impediments to return to work.290   The jobs gained were 
generally of good quality and sustainability, and gave good satisfaction to 
(c)  Ethnicity 
4.114  There are few programmes which address the issues regarding return to work of 
different ethnic groups, probably because most countries have anti-discrimination 
legislation which covers discrimination based on ethnicity, and this is assumed to 
be sufficient.  A British study cited two examples of addressing ethnic issues, one 
being the provision of in-work support to Maori and Pacific peoples in New 
Zealand, and the other a Finnish programme focused on the immigrant population.  
In the latter programme to support the transition into employment, immigrants are 
provided with two job coaches – one a native Finn and the other also an immigrant 
– to support the worker and employer.  Beyond the transition stage they may 
receive further training such as for specific workplace language or workplace 
4.115  The Luxembourg National Plan for Vocational Training and Integration covers all 
vocational training measures for unemployed workers, with the aim of providing 
them with the qualifications required by the labour market for those who do not 
have specific vocational training or their qualifications are insufficient or 
unsuitable.  Priority is given to those with special difficulties of vocational (re-) 
integration such as disabled people, women, and migrants. 292 
4.116  American states are developing programmes, largely in response to the growing 
Hispanic population.  Courses have also been provided for Chinese, Ethiopian, 
Liberian, Somali, Bosnian, Eastern European, Hmong, Vietnamese, and Sudanese 
4.117  Three types of programme have been identified: 
Bilingual, where skills training is taught in the native language of the 
Integrated, which teach both english and skills training concurrently; and 
289 Evans et al 2003 p 95 
290 ibid p 99 
291 Kellard et al 2002 p 85 
292 Thornton and Lunt 1997p 230 
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Sequential, where individuals begin with english language classes and 
progress to skills training after a certain level of proficiency in english is 
Generally, courses require participants to be literate in their own native language. 
4.118  As a result of the 1996 survey of long term unemployed, funding was provided to 
purchase training in English for Speakers of Other Languages (ESOL) for up to 500 
unemployed job seekers in 1996/7 and 1997/8.294   
Type of disability 
4.119  Type of disability is a more important influence on return to work than severity.  
People with amputations, bruises and contusions are more likely to return to work 
sooner than people with sprains, dislocations and fractures. 295   Partly this reflects 
the physical demands of a job, as low skilled manual workers with sprains and 
fractures are less able to return to work promptly.  
4.120  There is considerable research exploring which type of vocational rehabilitation 
works best for different disabilities. 
(a)  Mental health problems 
4.121  There is no doubt that people with severe and enduring mental health problems 
benefit from work.296  It can be a significant factor in keeping people out of hospital 
and reducing their use of medication and out-patient services.  Getting people into 
work quickly after periods of hospitalisation is critical to successful treatment.297 
Research results on successful rehabilitation include: 
An individual placement and support (IPS) programme for people with 
severe mental disorders in an inner-city context s were shown to be more 
effective than an enhanced vocational rehabilitation (EVR) programme.  
This was due to the rapid job search methods of the IPS programme 
compared with the stepwise approach of the EVR;298 
Supported employment is more effective than pre-vocational training;299 
People with mental health problems are more likely to obtain and retain 
work if they are placed in work which accords with their stated 
preferences;300 and 
The chances of gaining employment are likely to be linked not only to 
appropriate vocational rehabilitation services and the local labour market, 
but also to work disincentives in the disability pension system.  A crucial 
factor was the “earnings disregard”: the amount of earned income a disabled 
293 Wrigley et al 2003 p 43 
294  Parker 1997 p 72 
295 Johnson and Ondrich 1990 p 584 
296 Schneider 1998 pp 812 - 894 
297 Riddell 2002 p 45 
298 Drake et al 1999 pp 627-633 
299 Crowther et al 2001 p 207 
300 Mueser et al 2001 pp 411-417 
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worker may receive before his or her governmental benefits are reduced or 
4.122  There are various publications and web-sites dedicated to assisting people with 
psychiatric illnesses manage their relationship with work and employers, but few 
courses.  Boston University’s Center for Psychiatric Rehabilitation offers many 
services, including what it describes as “ the only site designed exclusively to 
provide information…for people with psychiatric disabilities”.302 
4.123  Research indicates that while there are some generalisations which can be made 
about which tasks or skills are likely or unlikely to be performed by people with 
type of mental illness, each case must be assessed individually.    
Problems with memory are associated with people with schizophrenia, 
depression and anxiety; 
Inability to maintain speed at performing assembly level tasks is associated 
with depressions and obsessive compulsive disorder; 
Difficulty staying with a project until completion is associated with those in 
the manic phase of bipolar disorder, attention hyperactivity disorder, 
schizophrenia,  and histrionic personality disorder; 
Lack of reliability / punctuality is associated with agorophobia, somatization 
disorder, avoidant personality disorder, antisocial personality disorder, 
major depression, and borderline personality disorder;  
Taking pride  in doing a good job, and staying with the task can be 
problematic for people with antisocial personality disorder, schizoid and 
passive-aggressive personality disorder, and major depression; and  
Difficulty maintaining interpersonal relationships at work may reflect 
bipolar disorder, post traumatic stress disorder, antisocial personality 
disorder, passive-aggressive personality disorder, schizoid personality 
disorder, borderline personality disorder and narcissistic personality 
4.124  It is important to remember the cyclical nature of several mental illnesses, and that 
the number and dose of prescribed medications and their side effects must also be 
considered when planning employment.    Providing on-job support systems is a 
critical part of maintaining the employment of people with mental health problems, 
such as being alert to signs of medical non-compliance, and managing  employment 
issues like supervisor and co-worker support, job appropriate job-matching, 
flexible working schedules where necessary and providing feedback 
constructively.304  Supported employment is more effective than pre-vocational 
training at helping people with severe mental illness to obtain competitive 
301 Warner 2001 pp405-9 
302 website ,> 
303 Marini 2003 p 40 
304 ibid p 41 
305 Crowther et al 2001 p 207 
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(b)  People with traumatic brain injury (TBI) 
4.125  Neurological outcomes of head injury include memory impairment, personality 
disturbance, decreased motor control, fatigue, speech and language difficulty, 
attention and concentration deficit, and lack of initiative.306  While researchers 
disagree on what are the most effective programmes to assist these people return to 
work, it is useful to summarise those which variously have been found to be 
Developing awareness and acceptance of any deficits resulting from the 
brain injury – people unable to do this will not be able to become productive 
in the community307.   Return to work is influenced less by the severity of 
the injury than by the relationship to functional independence;308 
Supported employment.  This should include learning how to lessen 
memory problems, (by learning new ways to achieve tasks or learning 
strategies to recall information more accurately) and error correction 
processes.  Care must be taken lest the worker becomes overly reliant on 
their support; 
Individualised return to work programmes, including components like 
assessment and vocational evaluation, simulated work, work hardening and 
training develop stamina, transitional employment, vocational counselling, 
job-seeking/ keeping skills training, job development, job analysis, job 
placement, one the job training and support; and 
Group cognitive skills training, with the development of thinking skills 
related to problem solving, concentration / attention, decision making, 
remembering names and faces, study skills, functional mnemonics, goal 
setting, non-verbal perception, test taking strategies.  In this project, 
members of the group successfully tutored each other.309 
4.126  Research has identified that individuals with TBI rated most difficult to assist 
tended to be younger, have functional limitations such as visual and fine motor 
impairments, and lacked numerous work-related skills.310  Job coaching has been 
proven to be successful for those with cognitive or behavioural problems. 311 
Understanding and then managing unacceptable behaviour is key to retaining 
employment, whether the person recognises that the behaviour is inappropriate, or 
they have chosen to behave that way. 312   
4.127  Lastly, the professional support person for the worker with TBI needs to fade their 
presence and assistance gradually, basing this on the performance data they have 
been collecting as they assist the worker.   It is important to retain a long term 
relationship of “touching base” with the worker’s supervisor to assess whether any 
further assistance is required. 
306 Riddell p 48 
307 Yasuda et al 2001 p 856 
308 Greenspan et al 1996 p 207 
309 Parente and Stapleton 1999 pp13 - 20 
310 Yasuda et al 2001 p 857 
311 Brantner 1992 p 3 
312 Yasuda et al 2001 p 681 
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(c)  People with hearing problems 
4.128  Many deaf people lack generic employment skills, and have ongoing problems with 
communications.  It is sometimes assumed that employing an interpreter will be 
sufficient measure to negotiate workplace adjustments with an employer and to 
establish communications with co-workers.313  
4.129  The best way of ensuring people with hearing problems retain their employment is 
to have a job coach during the initial period of employment.  This is not always 
easy to do as such job coaches require the following skills: 
Expertise in deafness and manual communication methods; 
Knowledge of other disabling conditions; 
Observation, assessment and reporting skills ; 
Teaching skills; 
Knowledge of appropriate legislation; and 
Knowledge of rehabilitation technology and job modification options. 
4.130  Use of sign language helps many people with hearing problems.  Belgium has 
recently decreed that sign language is their fourth national language, but their 
challenge is now to implement the change in the fields of education and training, 
employment, culture, information and health. American Sign Language is the 
fourth most commonly used language in the United States and earlier in 2003 
Britain recognised British sign language as a language in its own right. 
4.131  Research has identified that more attention post employment placement would be 
beneficial, to assist workers establish and maintain communications with co-
workers.  This is best achieved using a job coach rather than an interpreter.314 
(d)  People with sight problems 
4.132  Italy reserves employment in both public and private organisations specifically for 
blind people who are registered on a professional roll managed by the Labour 
Ministry.    Blind people in Italy work mainly in telephone switchboard operation, 
masseur physiotherapy and teaching.   Technology refresher courses and sighted 
assistance are provided as appropriate.  These provisions have proved so successful 
that it is unnecessary to look sheltered employment to meet the occupational needs 
of blind people.315  In the US, assistance is given to train and license blind people to 
operate vending facilities on federal and other property.316 
4.133  Light engineering, shorthand and typing, and switchboard operation, the 
traditional areas of employment for blind and partially sighted people, are declining 
at a marked rate, being replaced by call centres, customer service, and computer 
programming. This latter has been assisted by the development of synthetic speech 
and voice recognition technology.   Expansion of employment opportunities for the 
blind depends partly on finding quick solutions to access new technologies, and 
313 Riddell p 49 
314 ibid 
315 Thornton and Lunt 1997 p 174 
316 ibid p 281 
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partly on addressing the continuing prejudice of employers about hiring people 
who have difficulty seeing. 317 
4.134  Again, post employment placement support is essential, best performed by a job 
(e)  People with back problems 
4.135  A comprehensive 6 nation longitudinal study on people with back problems found 
that early interventions /return to work were more beneficial than later 
interventions.319  All people studied had been out of work for at least three months 
due to their back problems, and if they had not returned to work by the end of 12 
months out of work, they were unlikely to return at all.   
4.136  This research was supported by a Swedish study which found that the treatment 
programme was more effective for workers who had been on sick-leave for back 
problems for only a short time than for those who had been off-work for a long 
time.320   Those on short-term sick leave increased their ability to control and 
decrease pain, reduced their disability and impairment, and increased their general 
activity level, compared with a control group.    
4.137  Australian research indicates that back injury patients are in general likely to 
benefit because of, rather than in spite of, returning to work.321     
4.138  Key actions for rehabilitation are: 
Step 1 
Accurate assessment of injury, including symptoms, signs, patient’s capacity 
and the patient’s psychological state; 
Early communication with the key parties – patient (about their condition, 
recovery time, and early return to work), employer (about strategies for 
return to work), treating professionals (about treatments), family / union 
representatives where appropriate (may need to recognise cultural and 
language difficulties) , specialists for second opinions where required, and 
rehabilitation counsellors; and 
Reducing pain. 
Step 2 
Determination of reduced hours / lighter duties; and 
Addressing psychosocial factors, and increasing patients’ own resources to 
deal with pain situations. 
Step 3 
317 Jackman 2001 p 2-3 
318 Riddell 2002 p 50 
319 Bloch and Prins 2001 
320 Marhold et al (2001) p 162 
321 Gun and Fraser 1992 p 4 
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Training in the functional capacities needed in work and life situations.   
This includes handling difficulties at return-to-work such as fatigue and 
4.139  A Dutch study on return-to-work interventions for people with low back pain 
concluded that physical exercises were a key component, and that the most 
effective was graded physical activity based on a behavioural concept.322 
4.140  The psychosocial factors vary, but include job satisfaction, and low social support 
in the workplace.   The patient’s own belief about their work return is important.323 
Good relationships with colleagues are a strong motivating factor for return to 
work but bad relationships with supervisors were a demotivating factor.324   These 
need to be addressed as part of the vocational rehabilitation plan.  As stated 
elsewhere in this report, if the injured worker was not happy in their previous job, 
it is probably better that they consider and/or implement a career change, or at least 
a change of employer. 
4.141  One of the difficulties in dealing with clients with back problems is that the severity 
of pain is very subjective.  Constant medical assessment consolidates the syndrome 
of the disabled back. Diagnosis can be imprecise and inaccurate, despite the 
assistance that sophisticated methods of diagnosis can provide.  The conclusion is 
that it is better to orient attention towards rehabilitation rather than on dubious 
diagnostic aids such as X-rays.325   
(f)  People with serious injuries 
4.142  While severity of disability has a bearing on labour force participation, this is not 
due to the severity of the injury but to attitudes of employers.  High rates of 
discrimination are reported by people with moderate to severe levels of disability.326  
There are many examples in literature illustrating the potential of individuals with 
sever disabilities to work, given appropriate supports.327  The fact that such 
employment is possible, however, does not mean that it is easily obtained. 
(g)  People with spinal injuries 
4.143  Recent research on employment outcomes for people with spinal injuries reported 
that more individuals started with a new employer rather than returning to their 
pre-injury employer.  Those who returned to their pre-injury employer returned to 
work much earlier than those who found new employment.328   There was a 
significant relationship between gender and type of work: men were twice as likely 
to be in paid employment, whereas women were in non-paid roles such as 
voluntary work, education, and home-makers.   Age was also relevant: people 
injured before the age of 18 had an employment rate of 69% whereas those injured 
after 45 had an employment rate of only 9%. 
322 Staal et al 2002  p 264 
323 Marhold et al (2002) 
324 Gard and Sandberg 1998 p 106 
325 Landon Smith 1977 pp 1076-7 
326 Bunch and Crawford 1998 p 33 
327 Perrin p 17 
328 Yasuda et al 2002 summary 
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4.144  Those who were employed reported receiving fewer medical treatments, completed 
more years of education, were more satisfied with their lives and rated their overall 
adjustment higher than individuals who were not employed. 
4.145  The important conclusions from the research are the ability of people with spinal 
injuries to regain employment, and the benefits of being employed. 
(h)  Other injuries / disabilities 
4.146  Spain provides special assistance for people suffering from toxic syndrome, whether 
they lost their job as a result of getting toxic syndrome, or who are unemployed 
and suffering from the syndrome, or have been undergoing treatment for more than 
a year.329 
Problems arising from pre-injury circumstances 
(a)  Family circumstances 
4.147  Belgium provides a childcare allowance for unemployed women undergoing 
vocation training, recognising the importance of this to encourage long term 
unemployed women to re-enter the labour market.330   In Hawkes Bay in New 
Zealand, Work and Income found that providing a free childcare service helped 
reduce numbers of unemployed at the same time as satisfying the labour demands 
of seasonal industries.331    
4.148  A British study on job retention programmes in OECD countries found that the 
provision of childcare provided benefits in terms of job retention and improved 
work performance.   Childcare needed to be flexible and meet both employees’ and 
employers’ requirements.   In the United States, subsidised childcare is available for 
up to 24 months to welfare recipients moving into employment, and some states 
are encouraging both providers of childcare and employers to extend childcare 
services into non-standard hours and for emergency situations. Assistance is also 
provided in some states to transport the children to childcare providers. 332 
(b)  Job satisfaction 
4.149  While there are no formal programmes to remove the barrier of low job satisfaction 
in their previous jobs, often the programmes which address other issues such as 
poor work skills and attitudes will help the unemployed /injured workers achieve 
better job satisfaction in their new jobs.   Such initiatives are outlined elsewhere in 
this paper. If it transpires that the unemployed /injured worker was not happy in 
their previous job, it is appropriate for them to take the opportunity to consider 
and/or implement a career change. 
(c)  Job history 
4.150  While there are no programmes to address job history retrospectively, some 
countries do address the issue of maintaining a work history while unemployed.  
329 Thornton and Lunt 1997 p 235 
330 Geers 1992 p 62 
331 East Coast Regional News June 2002 
332 Kellard et al 2002 pp 33-4 
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Denmark has formal requirements for people of employable age without work who 
receive some income support to be active.333  The primary purpose of this is to bring 
people back into employment by developing their human capital: i.e. enhancing 
their qualifications and employability. It is the responsibility of the individual to 
improve his or her qualifications, working ability and ability to be self-sufficient. In 
principal, activation is a non-permanent situation, although there are some in the 
more disadvantaged groups who have been moving between schemes for some 
4.151  Activity, which must be formally organised, may include: 
Work activity which leads to some product or service, with a wage subsidy 
in public or private enterprises, in voluntary organisations, or in special 
institutions set up for social assistance recipients; 
Training or education activity, such as introductory courses, job training, 
and counselling; 
Activities of a social nature, including exchange of experience with other 
people in similar situation; and 
A mix of the above. 
Individual activity, such as childcare or gardening, is not accepted as an active 
4.152  The evaluation of the UK New Deal for Lone Parents noted that there are some 
people who “cycle” between work and benefits.334  This may be due to job-related 
problems, individual characteristics, family circumstances, or a combination of 
these.   There are other people who change jobs constantly, often for a combination 
of the above factors, or the desire for time out of the workforce, seasonal factors 
etc.  Researchers caution that these cyclically employed people have quite different 
needs and require to be treated differently from other job-seekers.  Case managers 
need to determine the underlying cause of the cycle, such as a need for training or 
education, for family support, or managing conflict. 
(d)  Relocation 
4.153  For many professional people who become unemployed, relocation to a centre 
where relevant jobs are available is often ruled out.  The usual reasons given are: 
Being part of a two-career family which means that the other party has to 
arrange a job transfer or find a new job; 
Financial concerns about selling and buying houses; 
Disruption to social relations including schooling, families, and recreational 
4.154  None of these are insurmountable.   Ways of addressing these include: 
Asking the prospective employer for assistance in finding the partner a job – 
in America, many firms have programmes to assist spouses find jobs, not 
necessarily with the same company; 
333 Rosdahl and Weise  p 161 
334 Evans et al 2003 p 107 
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Using the Internet to collect information on possible employers and job 
The partner seeking a job transfer with their existing company, including 
continuing in the same job but based at a different location, and teleworking 
from home; 
Paying some or all of the costs of relocation, whether by the new employer 
or the agency assisting the worker to find employment, including providing 
bridging finance to cover mortgages; 
Careful consideration of the value of community roots and involvement, 
hobbies, schooling etc.   Refusal of relocation should come after careful 
consideration of the issues and how these may be resolved rather than 
through inertia.335 
(e)  Criminal records 
4.155  Helping people with criminal records is relatively straightforward, and many 
programmes have been proven successful.336  In addition, employment may be a key 
strategy in reducing repeat offences.  It is important that return to work programme 
providers are aware of participants’ criminal histories, which are then handled in a 
practical and non-judgemental way.  This includes: 
Teaching participants how to address heir records in resumes and 
Ensuring participants are ready to answer questions about their past; 
Helping individuals address any current legal issues they may have, such as 
parole, creditors, child support etc; 
Focusing on presentation, communication and confidence in job search; 
Recognising that extra time is likely to be needed to find a job; 
Being alert to substance abuse; 
Preparing participants to handle questions or reactions from co-workers; 
Knowing what occupations are “friendly” to ex-offenders; and 
Being honest and straightforward with employers, and encourage them to 
provide a work trial at the least. 
(f)  Obesity 
4.156  In April of 2002 the United States recognised obesity as a disease. This was a 
contentious decision as some people believed that obesity was purely a matter of 
personal choice, of a sign of mental aberration. 
4.157  Taxpayers have been able to deduct the costs of weight loss programs as a medical 
expense since 2000 if they were recommended by a doctor to treat a specific 
disease. Obesity itself was not recognised by the Inland Revenue Service (IRS) as an 
ailment that qualified for the weight loss expense deduction. 
335 Borchardt 2002 p 9 
336 Brown 2001 p 83 
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4.158  To receive the deduction, a taxpayer must participate in a weight-loss program for 
medically valid reasons. Simply joining a gym or a weight control program to 
``improve the taxpayer's appearance, general health and sense of well-being'  and 
not under a physician's guidance will not qualify, the IRS said. 
4.159  Also not deductible are diet foods, even if they are an integral part of the weight 
loss plan. The IRS reasons that people have to pay for their food whether or not 
they are trying to lose weight.  The deduction comes in the area of medical 
expenses, which must in total exceed 7.5 percent of adjusted gross income and can 
only be taken by taxpayers who itemize their deductions. 
B  External factors 
Attitudes of employers 
4.160  Australian research into employer attitudes to the unemployed found that while 
some employers speak quite negatively about people, others feel empathy and 
sympathy for the unemployed and for their situation. Attitudes towards long term 
unemployed, however, were generally negative and pessimistic.   Rightly or 
wrongly, there was a perceived stigma around the long term unemployed and this 
influenced their bias against employing them. 337   There was almost universal 
support towards employing women who were returning to work after raising 
children, while there was an acknowledged stigma attached to older men. 
4.161  In general, the most important thing for employers is to find the right person for 
the job – the right skills, experience and attitude.338   American research indicates 
that in response to an uncertain economy when employers become more cost-
conscious and risk-averse, hiring decisions are more likely to be driven by a desire 
to avoid making a mistake rather than to recruit the most promising candidate.339 
4.162  It is important to recognise that some employers will not want to re-employ some 
individuals post an injury for a variety of reasons such as poor performance, 
attitudes or relationships. 
(a)  The Disability symbol 
4.163  The British Employment Service holds a register of employers who have 
demonstrated a commitment to employing people with disabilities, using the 
disability symbol as the representation.  These employers generally have policies 
specifically addressing the employment of people with disabilities, covering issues 
such as recruitment, retention, training and development, promoting awareness 
and adaptations.   They were six times more likely than other employers to be 
actively seeking to recruit disabled people.  In a 1994  survey, 85% of them said 
they would have paid for any necessary adaptations or modifications for existing or 
new disabled staff.340 
4.164  The disability symbol, which is a Government initiative, has been developed so 
employers can show their commitment to good practice in employing disabled 
337 Dept of Employment and Work-place Relations 2001 p 4 
338 Snape 1997 Executive summary 
339 Bricout 2003 p 45 
340 Dench, Meager and Morris 1994 Executive Summary 
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people. It is a communication tool which can be used by employers to encourage 
disabled people to apply for specific jobs. Employers who use the symbol make five 
commitments to action.  These are :  
A guaranteed job interview: To interview all applicants with a disability who 
meet the minimum criteria for a job vacancy and to consider them on their 
Consulting disabled employees regularly: To ask disabled employees at least 
once a year what you can do to make sure they can develop and use their 
abilities at work;  
Keeping employees if they become disabled: To make every effort when 
employees become disabled to make sure they stay in employment; 
Improving knowledge: To take action to ensure that key employees develop 
the awareness of disability needed to make your commitments; and 
Checking progress and planning ahead: Each year, to review these 
commitments and what has been achieved, plan ways to improve on them 
and let all your employees know about progress and future plans. 
4.165  Symbol users are expected to put the symbol on all job advertisements in the press 
or at the Jobcentre, as well as internal vacancy advertisements and job application 
forms. The symbol can also be put on letterheads, stationery, internal magazines 
and newsletters; doorways and signs, reception areas, interview rooms and at career 
exhibitions.     An internet search on the words disability symbol resulted in 
hundreds of advertisements on their accredited status from proud employers. 
4.166  Several countries also provide systems to recognise “good employers” of people 
with disabilities such as the Greek Letter of Approval, public acclaim and small 
prizes, 341  
(b)  Duration of unemployment 
4.167  One way of handling the negative perceptions of employers regarding long term 
unemployed is to involve the employers more in public employment and training 
programmes. Research shows a strong positive link between participation in such 
programmes and the experience of recruiting unemployed people.342   Following a 
positive experience of employing a previously unemployed person (whether 
directly or through a programme) lead to a readiness to take on more unemployed 
people.  But a negative experience, especially if accessed through a public 
programme, had the opposite effect.  The key message to programme managers was 
to manage carefully the selection and placement of unemployed people. 
341 Thornton and Lunt 1997 p 147 
342 Atkinson, Giles and Meager1996 Executive Summary 
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4.168  The Denver Workforce Initiative provides a work-based training programme for 
employers to address performance and retention problems.  The Managing to work 
it out
 programme for supervisors (a companion programme to the Workin’ it out 
programme for entry level workers) challenges beliefs and biases about work and 
workers, and presents strategies for resolving conflict, communicating with and 
motivating entry level workers.343 
(c)  Educating employers regarding disabilities 
4.169  An American demonstration project to find employment for people with significant 
disabilities who had been unable to gain employment on their own found that 
employers did not view people with disabilities as qualified applicants for existing 
positions.344  As a result of an employer focus group discussion, the project team 
Present job restructuring as a way for businesses to save money rather than 
creating jobs for disabled people.  Money can be saved by eliminating the 
need for overtime, or completing tasks not typically accomplished, whereas 
job creation is seen as increasing costs rather than company efficiency; and 
Employment specialists must build relationships with employers – which 
does take time – so that they can demonstrate how a person with significant 
physical disability can perform the essential functions of a particular job. 
4.170  Australian research on employer attitudes and behaviour regarding hiring 
unemployed people concluded that employers are not a homogeneous group.  Each 
employer has different needs, motivations, attitudes, prejudices, backgrounds and 
personal life experiences.345   A second study aims to segment employers into 
groups with like attitudes and motivations, so that the Department of Employment 
and Work Relations can target its approach according to what works best for each 
group type. 
4.171  The people with disabilities themselves may have to help employers understand 
their abilities.  For example, an employer may be reticent in a job interview about 
asking questions on the applicant’s ability to perform certain functions. One 
solution is that the applicants themselves bring up the topics of concern, and 
describe how they will overcome any functional limitations.  Harder to resolve is 
when a manager’s empathy and pain for a person with a disability works against the 
interests of the person with the disability.   In these cases, the manager has to 
acknowledge that the pain is their pain, not the other person’s.346 
(d)  Understanding return to work programmes 
4.172  “You don’t get injured workers well to put them back to work: you put them back 
to work to get them well”.347  This is the philosophy of an American rehabilitation 
expert, Richard Pimentel. 348 Pimentel believes that the fundamental problem for 
343 Relave 2000 
344 Inge et al, p184 
345 Department of Employment and Work Relations 2001  p 2 
346 Pimentel 1998 
347 Pimentel on 
348 Richard Pimentel, a senior partner with Milt Wright and Associates is a nationally renowned expert on job retention, attitude change 
in the workplace, return to work, workers' compensation and cost containment. A Vietnam veteran with a disability, Pimentel has 
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return to work (RTW) programmes  are the employers and workplace supervisors.  
If these people are better educated, then the problems are addressed. 
4.173  Pimentel promotes work as therapy.   At the appropriate point in the recovery 
process, providing an injured employee with work that is compatible with any 
physical restrictions and consists of activities which promote healing will facilitate 
a more rapid and complete recovery than would staying at home.   It also decreases 
the risk of a permanent disability or re-injury when they eventually return to full 
duty.349   Pimentel notes the need to teach doctors how to work with employers in 
return to work activities and how to develop work as therapy guidelines for their 
4.174  Issues identified by Pimentel for employers to understand include: 
The decision to bring an injured worker back to work should not be a 
supervisor’s decision (they will select the workers whom they like / are good 
workers.  These people will return to work anyway);  
Decisions about returning injured workers to the job should be in the hands 
of managers who are not emotionally attached to the situation; 
RTW programmes require processes to guide them – how to determine what 
tasks an injured worker can do from the details in the medical certificate 
(which normally only outlines what a worker can NOT do); and 
Employers must understand that employees want productive work which 
contribute to the company’s success while not putting them at risk of further 
injury, not some mindless make-work activities.350 
Job adaptations 
(a)  Supported employment 
4.175  Supported employment is a long established concept utilised in many countries.  In 
general, it aims to provide meaningful jobs for people with severe disabilities, 
including traumatic brain injury. It is a way to move people from dependence on a 
service delivery system to independence via competitive employment. Recent 
studies indicate that the provision of on-going support services for people with 
severe disabilities significantly increases their rates for employment retention.  
4.176  Supported employment encourages people to work within their communities and 
encourages work, social interaction, and integration. Supported employment 
services should achieve the following outcomes:  
Opportunity to earn equitable wages and other employment-related benefits,  
Development of new skills,  
Increased community participation,  
pioneered proactive risk management, return-to-work and Equal Employment Opportunity (EEO) programs to generate cost savings 
and enduring attitudinal changes in corporate culture.  
 349 Pimentel 1999 
350 Pimentel 1998 
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Enhanced self-esteem,  
Increased consumer empowerment, and  
Quality of life.  
The types of supported employment services used depend on the needs of 
individual consumers. 
4.177  In America a job coach is a person who is hired by the placement agency to provide 
specialized on-site training to assist the employee with a disability in learning and 
performing the job and adjusting to the work environment.  As the worker learns 
the tasks, the coach’s involvement gradually fades, but they are available for follow-
up as required.   Job coaching can also be used when tasks change and the 
individual needs assistance in getting acclimatised to new tasks. 
4.178  Natural supports are support from supervisors and co-workers, such as mentoring, 
friendships, socializing at breaks and/or after work, providing feedback on job 
performance, or learning a new skill together at the invitation of a supervisor or co-
workers. These natural supports are particularly effective because they enhance the 
social integration between the employee with a disability and his/her co-workers 
and supervisor. In addition, natural supports may be more permanent, consistently 
and readily available, thereby facilitating long-term job-retention.  
4.179  The different supported employment models are listed below.  
4.180  Individual Placement Model--A person with a disability is placed in a job in a 
community business which best suits his/her abilities and preferences. Training is 
provided on the job site in job skills and work related behaviours, including social 
skills, by a job coach. As the employee gains skills and confidence, the job coach 
gradually spends less time at the work-site. Support is never completely removed. 
The private or public vocational rehabilitation agency furnishing the job coach is 
always available to the employer for retraining for new assignments, assisting in 
dealing with challenging behaviours, supplying periodic consultations with co-
workers and employer, giving orientation and training for co-workers.  
4.181  Enclave Model--A small group of people with disabilities (generally 5-8) is trained 
and supervised among employees who are not disabled at the host company's work 
site. Persons in the enclave work as a team at a single work site in a community 
business or industry. Initial training, supervision, and support are provided by a 
specially trained on-site supervisor, who may work for the host company or the 
placement agency. Another variation of the enclave approach is called the 
"dispersed enclave." This model is used in service industries (e.g., universities, 
restaurants, and hotels). Each person works on a separate job, and the group is 
dispersed throughout the company.  
4.182  Mobile Work Crew--A small crew of persons with disabilities (up to 6) works as a 
distinct unit and operates as a self-contained business that generates employment 
for their crew members by selling a service. The crew works at several locations 
within the community, under the supervision of a job coach. The type of work 
usually includes caretaker / groundsman work. People with disabilities work with 
people who do not have disabilities in a variety of settings, such as offices and 
apartment buildings.  
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4.183  Small Business Model--Within a small business, there may be up to six employees 
with disabilities, but not more than the number of employees without disabilities. 
The small business operates like any business, generating work and paying 
employees from revenues received. The small business is located within the 
4.184  In New Zealand, Mainstream is a two-year, subsidised employment programme for 
people with significant disabilities. The programme is provided by the State 
Services Commission and aims to assist participants into meaningful, long-term 
employment within selected State sector organisations.   Placements are made by 
specialist employment consultants such as Workbridge. 
4.185  Almost without exception, cost-efficiency research has found that supported 
employment is a better financial option for individuals with disabilities than 
sheltered workshops. American research indicates that supported employment, 
even for severely disabled people, becomes cost-efficient to taxpayers about the 
fourth year of operation. 351 
(b)  Assistive technology 
4.186  For people with disabilities, assistive technology is an essential tool for 
independence.  It is any item, piece of equipment, or product that can increase, 
maintain, or improve the performance of people with disabilities.  It ranges from 
simple “low-tech” equipment such as a hand held magnifier, to home or vehicle 
modifications, to modified software and hardware products, to ramps, wall crutches 
and widened doorways.   With the new advances in technology, there are fewer and 
fewer instances where job modifications cannot be made to accommodate even the 
most severe injuries. 
4.187  While computers and technology are valuable accommodations for people with 
severe disabilities, focusing solely on the technology and the individual was not 
sufficient to ensure success.  The needs of the employer must be balanced with the 
employee’s preferences to ensure successful integration of technology and 
individual.352   Most technologies have a limited life span and it is important to 
prepare for when the technology becomes unreliable or out-dated. 
4.188  The work environment is another important consideration.  Voice recognition 
technology requires a relatively quiet environment to function  accurately, and by 
contrast, it can distract colleagues in open plan work spaces.  Braille printers can be 
noisy and may require sound-hoods.   
4.189  Installation of assistive technology requires a consultative approach with the 
affected worker, employers, colleagues, and may require investigation of several 
options.   Employers also need to be prepared to have an adjustment / settling in 
(c)  Modification of job duties 
4.190  Where there is a discrepancy between the physical demands of a job and the 
worker’s capacity to do that job, the next step is to assess whether some form of 
351 Kregel et al 2000 p 154 
352 de Jonge, Rodger and Fitzgibbon 2000 p 78 
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modification to the job tasks is possible.  It may be that some unessential functions 
can be eliminated, or essential tasks rearranged or reallocated to accommodate the 
injured worker.  Sometimes this is as simple as providing special equipment such as 
seating at a different height, shelving to eliminate bending and lifting.353   Care must 
be taken when reallocating duties to ensure that this is the most appropriate 
4.191  There is an increasingly strong backlash from front line supervisors, unions and the 
injured workers themselves as some employers in America go to extremes in 
devising meaningless tasks in the name of modified duties.354 
4.192  There are several issues for employers in modifying duties: 
Light duties must be meaningful and contribute value to the organisation; 
Light duties for an injured worker does not mean adding additional tasks to 
non-injured workers, making them work twice as hard  to cover the 
Smaller employers are less likely to have modified duties available;  
Larger employers may have problems with cross-department/divisional 
boundaries.  These could be budgetary, “silo” mentality, or accountability 
problems; and  
The need to have trade union representatives on-side. 
4.193  Some smaller American employers have assigned restricted duties staff to voluntary 
/ non-profit organisations to keep them active during their recovery and to 
maintain good working habits.  While the employee works as a volunteer for such 
agencies as the Salvation Army, the Red Cross or the YMCA, they are paid their 
normal wages by their employer.  These assignments are regarded as regular work.   
The employers have found this sends a good message to their work forces that there 
is no such thing as “no light duty available”.  The injured worker benefits by 
speeding their recovery, the company image is enhanced with positive public 
relations  and the local community benefits through the donation of labour to the 
voluntary agency.355   
4.194  The consistent finding from multiple surveys of employers has been that expensive 
accommodations are rarely needed by workers with disabilities.356   In one project 
in 2000, 100 accommodations were made at a total cost of US$11,235, making the 
average cost per accommodation $112.35.357 
(d)  Teleworking 
4.195  In the United States, alternative work arrangements have proliferated as employers 
seek to meet staffing and production needs through non-traditional employment 
arrangements.358  These include different work location (eg at home), work contract 
(such as on-call, temporary or leased) and employment status.  Of particular 
353 New York Workers’ Compensation Board p 33 
354 Kremer 2003 p 40 
355 ibid p 45 
356 Unger and Kreel 2003 p 5 
357 Inge et al 2000 p 183 
358 Anderson et al 2001 p 97 
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interest to people with disabilities is teleworking, sometimes known as 
telecommuting.   It is work performed at a distance from the main work-site, 
usually using information and communications technology, such as computers, 
telephone, videophones and faxes.   
4.196  Because of the flexibility of telework, it reportedly: 
Saves office space;  
Boosts productivity; 
Reduces absenteeism and sick time; 
Reduces commuting time; 
Improves staff morale and thus 
Improves staff retention rates.359 
4.197  A British company developed a successful programme for women returning to work 
who wished to become teleworkers. 360 The training was subsequently extended to 
women in prison and families with at-risk children.   Key to the project was the use 
of the most up to date information technology, both hardware and software.  The 
courses - run for two days a week for ten weeks - include personal development to 
encourage the participants to recognise their worth, increase their confidence, and 
to accept responsibility for making changes in their own lives.   The training 
stresses that teleworking and child minding cannot be carried out simultaneously.    
Barriers faced by the company included a lack of awareness of teleworking, and a 
lack of funding. 
4.198  For people with disabilities, telework offers an accessible, barrier-free workplace, 
flexible work scheduling, and the elimination of any bias or discrimination.  
Typical jobs include word processing, telephone customer service, programming, 
accounting, data entry, editing, filling orders, researching, and writing.   A 
Minneapolis study indicated that most companies require staff to attend the office 
at least for training, retraining and team meetings, and also to provide back-up 
services as required.361  Teleworking requires clearer communications, explicit 
expression of tasks and standards of performance, which provide incidental 
benefits to the company such as better delegation and staff empowerment. 
4.199  Acknowledged downsides for people with disabilities include:  
The consequent lack of social contact, given that many people with 
disabilities are already relatively socially isolated; and 
Possible lack of career and promotional prospects;362 and 
A lesser profile of people with disabilities as co-workers and productive 
members of the labour force.363 
359 Anderson et al 2001 p 98 
360 Murray 2001 pp1-8 
361 ibid p 99 
362 ibid p 101-2 
363 Bricout 2003 p 48 
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(e)  Work trials 
4.200  Work trials have long been used to help a potential worker try out a specific 
occupation, and for potential employers to assess a person’s suitability for that job.   
Usually, the worker’s wages are paid by the agency placing them in the trial, 
although the length of trials can vary from between four and twelve weeks.  
Workers benefit because they can experience a job and a company on a first hand 
basis, while employers benefit because they can become familiar with an employee.  
Although the employer is not required to hire the individual, in many cases, they 
do make an offer of employment at the end of the trial. 
4.201  To achieve any benefits, to  worker or employer, a work performed under a work 
trial must be meaningful, constructive, productive,  and add value to the company.   
In this respect, it is no different from temporary light duties. 
Case management / rehabilitation issues 
4.202  The case manager plays a vital role in the rehabilitation of a long term unemployed 
or injured worker.  All too often case managers report lack of time to invest in their 
clients.  In Michigan, welfare-to-work program managers sought greater flexibility 
to provide a wider range of screening, assessment and referral services, and to have 
more time to work with the most disadvantaged people.364   The problem is assessed 
as not so much being the client, but the services available do not meet the clients’ 
4.203  Case management as a concept can include : 
Monitoring progress of a client’s return to work,  
Referral to specialist services such as childcare, transportation, housing or 
Advice, counselling and problem-solving, and  
Calculating appropriate financial assistance for the client.   
4.204  A British study found that case management worked best if case workers were able 
to build a long-term trusting relationship with a client, and that caseloads must be 
kept low if case managers are to provide the individually intensive assistance that 
most clients require.365   This included case managers doing what they say they will 
do, listening to client concerns, and being available at relatively short notice, and 
occasionally outside conventional working hours.   
4.205  The commonly held view of case management in education, medicine, psychology 
and many other disciplines has been a deficit, disorder, problem-oriented paradigm.  
The emphasis has been on risk factors that define what is wrong, missing or 
abnormal.  Viewing the world through this deficit lens prohibits seeing strengths, 
resources and capabilities.366   
4.206  Social workers are increasingly focusing on how to discover and build on clients’ 
strengths.  Known as the “strengths perspective”, it relies on five key assumptions: 
364 Danziger and Seefeldt 2002  p 80 
365 Kellard et al p 3 
366 Utesch 2001 p 1 
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Despite life’s problems, all people and environments have strengths that can 
be marshalled to improve the client’s quality of life; 
Client motivation is fostered by a consistent emphasis on strengths as the 
client defines these; 
Discovering strengths is a co-operative exploration between case manager 
and client, not driven by an “expert”; 
The focus on strengths leads to discover how the client has managed to 
survive even the most hostile of environments (rather than blame the victim 
for their circumstances); and 
All environments, even the bleakest, contain resources.367 
4.207  Case managers can be trained in how to interview for client strengths, rather than 
liabilities and deficits.  This facilitates an active, dynamic relationship with their 
clients, where each is perceived as a real person.   This relationship is central to 
successful identification of client strengths, needs and goals.368  The approach helps 
clients use their own capacities, talents and skills towards achieving their goals, 
generally using people in their own social and community networks to assist them. 
4.208  Goal planning is fundamental to the case management process.  Goals must be: 
Expressed positively;  
Client focused, realistic;  
Easily understood; with  
One observable outcome per goal.369 
4.209  The goal plan then becomes a living document which is mutually reviewed and 
revised, encompassing progress made to date, and barriers yet to be overcome.   
Key to achievement of the plan are a series of ten activities: 

Checking that the goals are positive, clear, measurable and focused on the 

Praising and rewarding the client when goals are accomplished; 

Rewarding attempts to achieve goals despite lack of success; 

Checking that not too many goals are being worked on at once; 

Checking what resources are required to achieve each goal.  These can 
include knowledge, skills, support, co-operation, goods, services etc; 

Recognising what advocacy roles the case manager or significant others may 
need to take on behalf of the client; 
367 de Jong and Miller 1995 p 320 
368 Rapp and Wintersteen (1989) pp 23-32 
369 Kisthardt 1992 pp 120-122 
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Checking whether the case manager is pushing the client to do things they 
are unwilling to do; 

Checking the rate of progress – too fast or slow; 

Reducing the client’s fears about failure or success with a goal; and 
Encouraging the client’s active involvement in, and ownership of, the goal-
planning process.370 
4.210  Strength based case management has been found to be successful in working with 
substance abusers who have returned to employment.371 372 
4.211  A new direction in vocational rehabilitation is increased emphasis being placed on 
understanding the psychosocial characteristics of workplaces.373  These include:  
Organisational risk factors for job stress;  
Psychological work demands; 
Employee control over the work process; 
On the job social supports; 
Uncertainty on-the-job; and 
On-the-job conflict. 
4.212  Left unaddressed, these work-site factors could interfere substantially with 
employees’ desire to return to work and their ability to maintain employment and 
advance in their careers. 
4.213  An American programme called Moving Up is a national model in job placement 
and retention.  Its counselling and vocational staff are hired for their personal skills 
and background as mush as any professional credentials.  The goal is to have staff 
who engage the clients and earn their trust, and work out which approach will 
work for each person’s individual circumstances.  While it is not considered 
essential for case managers and career advisers to have personal histories similar to 
their clients, it is seen as a plus that some of the agency staff have some background 
in common with their clients, and thus they serve as excellent role models.    
4.214  Key characteristics of the agency staff are stated as: 
Understanding the needs of the students; 
Knowing the demands of the job market; 
The ability to motivate people;  
Understanding the needs of the employers they will be working with, and 
Having passion and compassion – people with energy, optimism and self-
370 ibid p 122 
371 Pack 2003 p 18 
372 Siegal et al 1996 pp93-98 
373 Koch and Rumrill 2003 p 2 
374 Proscio and Elliott (undated) pp 25-6 
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4.215  Participation in recreational activities is a critical component of the career 
development process, providing opportunities for individuals to explore their 
interests and to develop work-related skills.  With a growing preponderance of 
tedious and unfulfilling occupations, workers are increasingly seeking life 
satisfaction through avenues other than work.375   
4.216  Researchers have compiled a list of the benefits of participating in recreational 
activities for people with disabilities: 
An increase in self-determination; 
Development of friendships; 
An improvement in physical functioning; 
Enhanced perceptions of social acceptance; 
A decrease in negative attitudes towards people with disabilities;  
The development of socially acceptable behaviours; 
Establishes life-long leisure pursuits which will be helpful in coping with 
(the inevitable) change throughout life.376 
4.217  These benefits then translate into employment related benefits: 
A reduction in attitudinal barriers to employment; 
The development of a broader range of occupational interests; 
The acquisition of transferrable  job skills; 
Increased access to the “hidden” job market; 
An increase in social acceptance by peers; and 
The development of coping skills as a buffer against job stress.377 
Recreational involvement is seen as an intermediate step to vocational goal 
4.218  The level of knowledge of case managers and agency staff about various 
programmes and incentives for employing people with disabilities has a significant 
impact on the use of these measures.  While this seems obvious, research shows 
that staff do not always have the appropriate knowledge, and that complicated 
administrative procedures do not help.378 
Addressing lawyer and advocate attitudes 
4.219  It is perhaps trite to say that the best solution to the problems created by lawyers 
and advocates is not to create the decisions to be challenged.   This is just not 
possible.   There always will be some decisions which are not accepted by the 
client, and in some cases, they will seek legal or other professional assistance in 
challenging the decision.   
375 Devine and Koch 2003 p 83 
376 ibid p 83 
377 ibid p 84 
378 Corden and Sainsbury 2001 p 12 
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4.220  A controlled study on workers with low-back injuries found that the adversarial 
system is significantly associated with a poor rehabilitation outcome, partly because 
the patient was constantly recounting their symptoms and disabilities on numerous 
occasions to lawyers, doctors and the court.  This reduced compliance with 
rehabilitation exercise regimes, resulting in significant delays.  Patients who had 
settled claims and then actively sought work found that their history of a claim for 
back injury was a significant handicap, and thus a common reason that these 
patients indicated they would not go through a court claims process again.379 
4.221  More than 100 top American employment lawyers recently compiled a Top-10 on 
what employers do wrong and why employees sue.  This list provides useful 
reminders on how to treat clients to achieve the most favourable attitude and 
Distributing employee handbooks with sweeping language like: "The 
company will not tolerate any type of harassment or discrimination"; 
Making promises to employees that are difficult or impossible to keep; 
e.g., promising future stock options without having a stock option plan; 
iii)  Having procedures for addressing complaints but not following the 
iv)  Ignoring or failing to make a good faith attempt to resolve employee 
Failing to deal promptly with emotional situations, letting them fester 
and escalate instead; 
vi)  Forcing former employees to seek legal advice by refusing to  discuss 
their termination; 
vii)  Having weak HR departments that rubber stamp questionable 
employment decisions; 
viii)  Using junior HR staff to interview high-ranking company officials 
accused of wrongdoing; 
ix)  Conducting lots of investigations without ever finding anything wrong; 
Treating terminated employees with disrespect; e.g., giving a twenty-five 
year employee a two-week severance package.380 
4.222  The President of the New South Wales Workers’ Compensation Commission 
strongly endorses using alternative disputes resolution rather than court based 
challenges to decisions.  His view is that their no-fault scheme is one of full 
disclosure, speedy resolution and non-adversarial techniques.   The lawyer’s role is 
as an advisor rather than as an advocate in an adversarial situation.381   He also 
379 Greenough and Fraser 1988 p 954. 
380 Reynolds March 2001: 
381 Sheahan p 3 
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noted that almost 100% of cases had settled but only after the litigation was in 
 and the bulk of costs incurred, and that senior veterans of the adversarial 
legal culture were themselves calling for change.382 
Focus on ability rather than disability 
4.223  Probably every study on occupational injuries confirms that the longer workers are 
off the job, the less likely it is that they will return to work.   Furthermore, staying 
at home for long periods does not promote recovery but increases the likelihood of 
disability – if disability is their only focus day after day, then they will fall into a 
disability mentality.383     
4.224  Initiatives to commemorate 2003 as the European Year for Disabled People 
included the challenge to employers to look at the ability, not the disability,384  and 
the establishment of mentoring programmes pairing young people with disabilities 
with business mentors.   “See the ability, not the disability” is the motto of many 
(dis)ability organisations. 
4.225  Business in the Community’s annual Awards for Excellence include the Realising 
Ability Award as one of 15 award categories.   The award recognises best practice 
and innovation in addressing disability as a corporate social responsibility and is 
supported by the UK Employers’ Forum on disability, the Department for Trade 
and Industry and The Financial Times.385   Past recipients include a company 
employing 60 unemployed disabled people in call centre work, and another 
providing 1,000 fully accessible and accredited IT training placements for deaf and 
hard of hearing people. 
4.226  One of the best examples of the success of focus on ability comes from the UN 
Food and Agriculture Organisation (FAO), which has been co-ordinating 
mushroom production training for disabled farmers in Thailand and Cambodia. 
The course is designed for farmers, and teaches all the basics of building a 
mushroom house and growing the mushrooms, with the emphasis on food 
production not the disabilities.   The manager of the programme noted that 
“watching these people apply themselves, not only in food production, but also in 
their everyday tasks, you realise that their abilities, energy, and resourcefulness are 
Addressing co-worker attitudes 
4.227  There are few formal initiatives to address co-worker attitudes.  For many co-
workers, just gaining a better understanding of the problems of having been 
unemployed, injured, or disabled helps address any negative perceptions.  Thus, 
initiatives which improve the understanding of employers and supervisors are also 
appropriate for co-workers.  The same applies to agencies wanting to place long 
term unemployed or disabled people into employment: understanding the attitude 
of employers (and co-workers) is the first step to formulate strategies to best meet 
382 ibid p 5 
383 Pimentel 1999 p 1 
384 Hart 2003 p 14 
385 website: <> 
386 FAO News  1 December 2000 
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their needs.387  Focus groups conducted with a number of Californian employers 
revealed that just sitting down and talking through the issues with supervisors and 
colleagues was very effective.388 
4.228  Feeling empathy or pain for a person with a disability is a natural emotion.  The 
person feeling the pain must acknowledge that it is their own pain they are feeling, 
and let the pain go away.389 
4.229  Use of “natural supports” helps people with disabilities has been increasing, and 
has contributed to better integration of these people into the company workforce, 
and better understanding of their needs.  
4.230  Using a literature search, two American academics have developed a list of the key 
strategies that directly teach skills and provide advice to co-workers.390   These are: 
Use a mentor after initial job development, analysis and training; 
Use job sharing options; 
Use specifically trained mentors for initial training; 
Anticipate personnel changes; 
Establish an ongoing dialogue and regular meetings between all the people 
Model appropriate social responses; 
Be present at social activities to capitalise on potential interactions; 
Redirect questions / comments to the person with the disability; 
Reassure managers and co-workers that they can ask personal questions; 
Build trust between external support agency and work-site personnel; 
Refine new and existing social networks continually; 
Use personal contacts to enhance social support; 
Collaborate between external support agency  and work-site managers / co-
workers to develop adaptations and modifications; 
Facilitate and support involvement of work-site personnel; and 
Provide consultation on redesigning or organising the work environment to 
benefit all employees. 
4.231  Help is readily available for co-workers who feel uncomfortable meeting with 
people with disabilities.  Hints on how to act or what to say when meeting  people 
with disabilities are widely available in books and on the Internet, such as on 
Addressing transport issues 
4.232  The ability to get to work and home again on time is vital to maintain steady 
employment.  Only the United States appear to recognise the importance of 
387 Department of Employment and Workplace Relations 2001 p1 
388 Sum et al 2001 p 40 
389 Pimentel undated 
390 Storey and Certo 1996 p 68 
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transport for low income workers, and the difficulties they face accessing it because 
of cost and/or availability.391  (Other countries provide transport-related assistance 
for people with disabilities only).   States variously provide free or low cost cars, 
loans to purchase cars, financial assistance towards transport costs, and vouchers to 
cover petrol or public transport costs.   
4.233  Other forms of government sponsored assistance include van/car pools, contracting 
services to fill gaps in public transport, allowing low income workers to use 
specialist services for elderly / disabled people, using volunteers to drive 
participants to work or in emergencies, and lastly encouraging employers to 
provide transport. 
4.234  In Britain, the possession of a driving licence is known to increase a person’s 
chance of obtaining work, and evidence also suggests that people with access to 
private transport are more likely to sustain employment.392    A review of needs 
conducted for the British Department of Work and Pensions identified several 
activities necessary to assist long term unemployed into work.   Termed “mapping 
transport provision” it involves: 
Mapping of existing public transport provision on to a network of major 
employers and a network of neighbourhoods where the client groups live; 
Working with transport providers to provide subsidised services until they 
become self-sufficient.  It may also involve employers providing some 
financial contribution; 
Developing formal mechanisms for identifying and matching people with 
similar transport needs e.g. Through car pools; and 
Transport to childcare facilities, or providing childcare facilities near public 
transport services.393 
4.235  Financial assistance towards the costs of getting to work (ie for taxi fares or to pay 
some-one to drive the person) for people with disabilities was seen as fundamental: 
arriving reliably on time and ready for work was valued by both workers and 
Retaining employment 
4.236  The first few months of employment are a critical time for new workers.  Most 
programmes to assist long term unemployed workers gain employment have 
focused simply on the transition into work, with little, if any, emphasis on helping 
the former unemployed people retain their jobs in the long term.   A British survey 
conducted in 1991 identified a range of post employment support programmes 
used in OECD countries, mainly in North America.  While few of these initiatives 
have been formally or rigorously evaluated, the resulting report provides a solid 
basis for further policy development.   Some of the key concepts identified in the 
391 Kellard et al 2002 p 35 
392 ibid p 114 
393 Kellard et al 2002 p 115 
394 Thornton and Corden 2001 Executive summary 
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research and which have not been discussed elsewhere in this report are listed 
(a)  Earnings supplements / financial assistance to employees 
4.237  There is some evidence that earnings supplements may facilitate job retention, but 
employees may find it difficult to retain their jobs when the supplementary 
payments end.  US evidence indicated that providing emergency financial assistance 
such as grants or cheap loans can improve job retention.  Some post employment 
programmes offer advice and training in money management. 
(b)  Wage subsidies for employees 
4.238  Wage subsidies for employers were found to be more likely to increase recruitment 
and retention of employees if employers were committed to training and/or other 
support for employees. In Ireland and Germany, the viability of social enterprises 
depends on such support.396  A major Finnish study found that disabled people in 
subsidies work has positive images of work while their employers had positive 
images of these workers.   Up to a third of these workers in subsidised employment 
found work in the open labour market.397    
4.239  Experience, including in New Zealand experience in the mid 1990s, did not show 
good job retention rates once the subsidy payments ceased. British researchers 
found there was criticism of such financial measures if they did not have conditions 
attached to them, such as maintaining employment when the subsidy period had 
ended. 398 
(c)  Retention incentives for employers and /or employees 
4.240  Retention incentives are used extensively in the United States, to encourage 
workers to remain in employment and employers to retain their recently employed 
workers.  They are usually one-off payments made at previously defined milestone 
points, normally a specified number of months in employment.  Incentive 
payments  vary widely across the states.     
4.241  Britain introduced a Back-to-Work bonus for benefit recipients in 1996 to 
encourage people to maintain contact with the labour market.  One evaluation 
suggested that the Bonus itself did not encourage people into part-time work, rather 
that the promotion of the bonus educated people that part-time work was a 
legitimate activity.399   Respondents to another evaluation indicated that the Bonus 
would have little effect on helping them move into full time work as: 
Some respondents (mainly men) wanted full time work only, and would not 
contemplate part-time work; 
Benefits were felt to offer more security than a full time job; 
395 Kellard et al 2002 p 2 
396 Thornton and Lunt 1997 p 309 
397 ibid p 85 
398 ibid  p 309 
399 Ashworth and Youngs 1998 Executive Summary 
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Some respondents wished to work only part-time, and also there was a 
perception of a lack of suitable part-time jobs. 
4.242  Additionally, the Bonus was seen (negatively) as an enforced savings measure, as it 
comprised half the money earned above the earnings disregard that was deducted 
from their benefits.400  
(d)  On-job support 
4.243  New employees moving to work after an  absence often require assistance to adapt 
to a number of aspects of their job.  This includes: 
Job coaching.  This is practical assistance on-the-job, such as demonstrating 
what is to be done, how to organise the work, getting on with colleagues, 
ensuring punctuality; 
Mentoring.  This gives the new employee a one to one relationship with a 
co-worker or an external party (called a mentor or a buddy) who helps the 
new employee adjust to the workplace and the routine of being back at 
work.  In the united states, mentoring has had significant impact;401 
Peer support groups.  Some united states welfare to work programmes 
include these, whereby new employees share experiences and solutions with 
others in similar positions.  It may also include additional training or 
workshops on issues such as budgeting, time management, conflict 
resolution and workplace communications.   Problems with these included 
timing and location of sessions; 
Telephone help-lines.  These are toll-free hotlines to assist individuals with 
emergency or routine problems which might cause them to lose their jobs.  
Such problems include childcare, transportation, accommodation, food, 
substance abuse, health, domestic violence, and family stress.  The marriott 
hotel chain credits its telephone resource service (staffed by social workers) 
with reducing tardiness, absenteeism and turnover;402 
Post-employment education and training. Some schemes provide training at 
the work-site, others provide training outside standard workplace hours.  
Such skill training must closely match the needs of the employees and the 
employers, as well as fit with work and home schedules.  Cost can be an 
issue to both employers and employees, and some governments provide 
financial assistance; and    
Training employers in job retention techniques.  Such training includes 
developing appropriate attitudes, listening skills, conflict resolution, 
teamwork, as well as how to provide employment counselling services, hire 
ex-offenders, identify any government tax credits for employees, and 
manage employees with specific problems such as substance abuse. 
4.244  Retention efforts should begin before employment, and should be built in to 
employment preparation and placement programmes.   Evaluation of the first major 
demonstration project (the PostEmployment Services Demonstration) to examine 
400 Thomas et al 1999 Executive summary 
401 Kellard et al 2002 p 92 
402 Hershey and Pavetti 1997 p 83 
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the effectiveness of providing case management services to newly employed welfare 
recipients indicated that services must be targeted differently for different clients, 
that service delivery needs to be as simple as possible, and that close links are 
needed with employers.403 
(e)  Protection of employment 
4.245  Employment protection for injured or disabled workers is quite prevalent in 
Europe and North America, although the actual provisions vary widely.  In the 
Netherlands, disabled workers may be dismissed only with the permission of the 
Employment Service.  As a rule, a labour contract should not be broken within the 
first two years of a worker’s disability.404    
4.246  Spain has provision to ensure the re-instatement of disabled workers once they 
have completed the relevant rehabilitation process.  Those with a permanent partial 
disability are entitled to be re-employed by the same firm, either in the same job 
with a similar wage level if output remains normal, or in a job adapted to residual 
capacity without a drop in  wage or more than 25%.   In the latter case, a trial 
period of adjustment maybe permitted for up to six months. 405 
4.247  Belgium provides compensation to employees if dismissal is for neither economic 
nor urgent reasons which prevent the continuation of the contract.  Some 
protection applies during the first six months of incapacity, unless the employee’s 
injury is sufficient that they are unable to continue working.406   In most countries, 
dismissal of a disabled worker is subject to standard legal provisions for 
employment protection, and anti-discrimination requirements. 
4.248  Provisions requiring employers to keep on staff who have been injured do not 
recognise that in some cases, there may be a pre-injury poor relationship between 
the employer and worker for reasons such as performance problems or staff 
relationships.  Compulsory re-employment of the worker may not be in either 
employer’s or worker’s interests. 
(f)  Quota systems 
4.249  Quota systems represent a long standing European policy approach to the 
employment of people with disabilities.   Generally it is a legal requirement for 
public and/or private sector employers who employ a specified number of workers 
that a set percentage of these employees should be people with some specified 
disabilities.  Quota schemes are generally complex, and in some cases contentious.  
4.250  Greece operates a quota system of compulsory employment  for members  of seven 
specified groups for all employers with 50 or more staff at a rate of 7% of the 
workforce.  The seven groups include war veterans and their families, people with 
disabilities, and parents with more than five children in full-time education.407  
While the membership of quota groups varies in detail, all include people with 
403 Relave 2000 
404 Thornton and Lunt 1997 p 198 
405 ibid p 233 
406 ibid p 43 
407 ibid p 145 
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4.251  Quota percentages are variable (for instance France has six percent,   Austria four 
percent).  Some occupations are also exempt, as in France where people who drive, 
navigate or travel on board, and workers in jobs which involve heavy physical 
labour. 408   Some countries provide rewards for employers who exceed the required 
quotas, while others, like Austria, count a blind person or a wheelchair user as two 
disabled people for quota purposes.409    
4.252  Some countries allow companies which do not achieve their quota to make a 
financial contribution to a special fund, which then is used to finance training and 
job creation for disabled people.  Experience has been that firms pay into the funds 
simply as a way of discharging their statutory responsibilities, rather than 
demonstrating any commitment to employ people with disabilities.410 
4.253  Many American states have a “preferred worker” programme, which offer 
incentives to employers to take on rehabilitated injured workers who were not 
previously on their own staff.   Again, the details of schemes vary between states, 
with some (like North Dakota) showing available jobs on the Internet.  Incentives 
include not paying workers’ compensation premiums for such workers for a set 
period, repayment of additional expenses in starting a new job, subsidy on wages 
for a specified period, and payment of the costs of modification of workplace 
(g)  Levy systems 
4.254  Levy systems differ from quota systems in that employers make a financial 
contribution to s special fund, in lieu of employing the target proportion of 
disabled people.   Such a contribution may be permitted as a last resort when the 
possibility of direct employment has been exhausted, or it may be a legitimate 
choice.   Levies are usually collected into a special rehabilitation fund and 
redistributed variously to employers, disabled workers or service providers.411   
4.255  Levies can also be used  to implement labour market measures to improve the 
prospects of disabled people (as in Western Europe and Japan) or as financial 
incentives to employers to hire workers (as in Eastern Europe and China) where 
the finance is seen as compensation for employing a less productive worker. 
4.256  The aim of levy systems is to maximise employment rather than to collect revenue.  
It is seen as an equalisation measure. 
4.257  Self-employment offers many the freedom to work at their own pace in an 
environment that accommodates their special needs. Owning their own business 
often provides the flexibility that is necessary to those who require frequent 
medical attention, flexible hours, accessible work space, or other special 
considerations.   Self-employment does present many challenges and is not for 
everyone, but for many people with disabilities and chronic health conditions, self-
employment offers the hope of making a living and achieving self-sufficiency.  
408 ibid p 97 
409 ibid p 28 
410 Lunt and Thornton 1994 p 235 
411 Thornton 1999 Introduction 
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4.258  Starting a business requires a significant commitment of time, energy and 
resources. In addition, the individual must have some marketable skills or a 
product or service with a demonstrated market demand. Any person pursuing 
business ownership must be prepared to make personal sacrifices and be willing to 
learn the "how to's" of starting and successfully managing a business enterprise 
before they start up the business. 
4.259  In some countries, it is relatively rare for people with disabilities to become 
economically active through running their own business.  In the United Kingdom, 
Business Ability is a successful project (95% success rate) dedicated to developing 
self-employment as an option for disabled people.412  It provides the following 
Home visits; 
Initial assessment of suitability of self-employment option; 
Benefits advice;  
Help to appropriate financial assistance / grants / bursaries / preferential rate 
Access to ongoing business training and marketing opportunities; 
Access to free computers through fast track application; and 
Ongoing business mentor support. 
4.260  The UK also has a New Deal programme for self-employment.   Like other New 
deal programmes, this uses the system of a Personal Adviser to help and support 
clients before and during the programme, and for up to two years after the worker 
leaves the programme.   A training grant of us to £1500 can be used for courses on 
how to run a business, or to buy expert advice and guidance on getting established.  
A period of six months is allowed for “test trading”.  The worker receives an 
allowance equivalent to their Job-seeker’s Allowance plus a top-up grant.  Any 
money the business makes goes into a business account which is jointly managed 
between the worker and their training provider.  The money in the business 
account can be used only for spending on the business until the test trading period 
is over.413   
4.261  This allows the newly self-employed worker to promote their business and build up 
their customer base.  They can trade and make mistakes without risking their own 
income.   At the end of the test trading period the money in the business account is 
available to use in the business or to keep as a contingency.  If at any stage, the 
worker decides that self-employment is not for them, they can return to the main 
new deal programme to find paid employment. 
4.262  The Prince’s Trust Business Programme provides assistance to 18 –30 year olds to 
start businesses.  It focuses particularly on those who are unemployed, under-
skilled, leaving the criminal justice system or care. To receive funds, applicants 
must have been refused funding from other sources, although roughly half the 
businesses did receive other financial support.   Approximately three-quarters of 
businesses supported by the Trust were still trading 18 months after start-up.    
412 Riddell 2002 p 43 
413 New Deal: Self-employment brochure 
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4.263  Characteristics of the owners of businesses which survived include: 
White ethnic origin; 
Older rather than younger; 
Had a family background of self-employment (one or both parents had been 
self-employed at some stage); 
Had a neutral or averse attitude to risk taking; 
Were motivated by a desire for independence and lifestyle rather than 
growth or income; and 
Were generally better educated (with some tertiary qualification). 
Business owners’ characteristics such as gender, disability and household 
circumstances did not lead to any clear differences in business survival rates.414 
4.264  Men are more likely than women to enter self-employment from benefit, and they 
tend to move into sole trade or low capital, labour intensive business.  Earnings are 
typically low and hours worked high.  Success in self-employment for males is 
associated with the presence of a spouse or partner and children, and the most 
successful tend to be aged 25 – 45.   Higher qualifications and a good employment 
history or previous exposure to self-employment are also good indicators of 
4.265  In the United States, people with work disabilities are twice as likely to be self-
employed as the rest of the population.416  The U.S. Small Business Administration 
provides millions of dollars each year to support the initiatives of micro businesses.  
The Office of Disability Employment Policy works with them to extend training 
and financial support in order to increase the numbers of self employed people 
with disabilities. In addition, state vocational rehabilitation programs provide a 
variety of services to aspiring entrepreneurs with disabilities.  
4.266  The Research and Training Centre on Rural Rehabilitation Services (RTC:Rural) 
has developed a best practice model for small business development, based on 
research into the practices of all the states and their own extensive experience.417  
The model reflects the importance of the consumer doing the development work, 
rather than the counsellor.   
4.267  There are eight components in the model: 
The vocational rehabilitation provider assesses a consumer’s business 
The consumer develops a business idea, explores its feasibility, and 
conducts a market analysis; 
The consumer gets any necessary education and training; 
The consumer obtains technical/ professional assistance to develop a 
business plan; 
414 Meager, Bates and Cowling 2003 pp 2 - 3 
415 Kellard et al 2002 executive summary 
416 Ravesloot and Seekins 1996 p 189 
417 RTC:Rural web-site 
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The consumer writes the business plan; 
The consumer determines the availability of, and applies for, funding 
from other sources (note that in the first American study of people with 
disabilities who are self-employed, more than half the respondents made 
initial investments of less than $10,000); 
The vocational rehabilitation provider reviews the self-employment 
plan; and 
The vocational rehabilitation provider monitors the business’s progress. 
4.268  The range of businesses established is extensive and includes retail, professional 
services, repair services, arts and crafts, entertainment, building trades, automotive 
services, farming, health services and office services. 
4.269  For some people with disabilities and injuries, self-employment still requires some 
support systems.   This is similar to the standard business model: the smart strategy 
in planning for entrepreneurial work is to be aware of strengths and skills, and to 
build on these, while recognising limitations and needs and either building these 
skills or locating sources of support.418    Regrettably, the social service community 
tends to hold the belief that requiring on-going support means that a person is not 
sufficiently capable of making decisions.   
4.270  Notwithstanding the success of some of these small businesses, self-employment is 
not a substitute for proper job development, systematic instruction and natural 
support. Fear of the community, poor job development technique, limited vision 
when facilitating supports and misunderstanding of funding streams is cited as 
deriving self employment in a few cases. 419 
Operating within prevailing labour market conditions 
4.271  Over the last twenty or so years, the state of the labour market has been changing.   
As far back as 1997, research in Britain was indicating that regular nine-to-five jobs 
were becoming a rarity.   Employers were able to operate with different types of 
labour force: some wanted a multi-skilled, stable labour force while others 
preferred to sub-contract and hire temps.420  Workers also had varying preferences 
about the range of tasks they were called on to perform, and the hours of work.   
Many preferred to work flexible hours in order to meet family and other 
4.272  The New Zealand labour market has also become more flexible from the employers’ 
point of view, perhaps less so from the workers’ viewpoint. 
4.273  The recent American recession hit the white collar and IT sectors for the first time.  
Executive level employees were remaining unemployed for longer than lower paid 
employees.421  In that about 85% of job-seekers were finding jobs through some-one 
they knew, the solution was the development of a formal system for networking for 
418 Rizzo 2002 p 100 
419 Griffin and Hammis p 1 
420 Casey et al 1997 Executive summary 
421 Loeb 2003 
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senior executives and managers.  The  clients of this firm were generally people 
with six-figure salaries, and experience at company vice-president level.  They had 
a wealth of professional skills, but nothing in the way of job-seeking or networking 
skills.  The programme included preparation and presentation of resumes in such 
style that these would be seen at the top of the pile of resumes. Outplacement firms 
estimate that the average length of job for senior level executives is now between 22 
and 36 months, meaning that older / senior executives could find themselves 
changing jobs several times before retirement.422 
4.274  Job rotation was introduced as a pilot initiative in Denmark in 1992. Its apparent 
success has stimulated interest from across Europe, including the UK. Job Rotation 
involves unemployed people being trained in the skills needed for a specific job in a 
specific company. They then join the company for an agreed length of time and 
take over the job of an employed person. The employed person is then able to take 
time out for training. At the end of the period the employer can decide either to 
dismiss or retain the unemployed person.423 
4.275  The strength of networking for senior employees is supported by Richard Bayer, 
CEO of the Five o’clock Club, a national American career coaching organisation.424   
They recommend using social events such as corporate Christmas functions to 
network, and access potential employers.  These people are normally too busy to be 
available for cold calling, and the relaxed atmosphere gives the job-seeker a chance 
to  show their personality, their listening skills, and their knowledge. 
4.276  The job market for middle managers is generally a very tight market, as firms move 
to reduce layers of management.  One assessment in America is that 20% of those 
unemployed for more than six months are former executives, managers or 
4.277  From time immemorial, it has been assumed that governments have a duty to 
provide for the poor, and this includes providing jobs.  In a dynamic economy, 
there is always a certain amount of unemployment, because industries contract 
(while others expand), people leave jobs voluntarily for a variety of reasons, 
demand for goods and services change, currency valuations fluctuate, and 
technologies change.   One means of dealing with unemployment is to provide 
taxpayer funded job creation programmes, with subsidies ranging up to 100% of 
the costs of wages and overheads.  A strong message from much of the research is 
that these programmes will distort the prevailing labour market conditions, not 
necessarily for the best.    
4.278  Britain introduced a National Insurance Contributions (NIC) Holiday in April 
1996.  It enabled employers to recruit employees who had been out of work and 
receiving benefits for at least two years, and to claim back one year’s worth of NIC 
contributions.   Take-up of the scheme was low, and an survey of employers 
revealed that awareness of the scheme was low, and the contributions holiday was 
422 Loeb 2003 
423 Hutchinson 1999 pp175-9 
424 Five o’clock Club website: 
425 Graves 2003 
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too small to be of value to large firms, but for small firms the risk of taking on 
unsuitable workers was not outweighed by the holiday.426 
Multi-targeted Programmes  
4.279  Programmes with a mix of activities tended to help with the widest range of 
individuals.427  Targeting resources towards the most disadvantaged people and 
developing programmes to meet their needs did help them.   A mix of job search 
and education increases earnings for most for the broadest range of individuals. 
4.280  Several programmes have recently been initiated in the United States to help the 
hard-to-employ find work.  These reflect the time limits (usually 5 years) placed on 
the length of time a family can receive welfare support.  While formal evaluations 
are not planned until 2004, there are components of these programmes which are 
useful to study.   Each programme has been implemented at several sites across the 
states to enable wider evaluation. 
4.281  Enhanced Services for the Hard-to-Employ428 is designed to field and evaluate 
innovative ways to boost employment, reduce welfare receipt and promote well-
being in the target population.   The programmes include: 
Supported work, in which people are given subsidised jobs along with 
training and job search assistance until they find regular jobs; 
Initiatives which combine mental health treatment and employment 
Improved identification of those with serious employment barriers to 
increase their participation and retention in mental health or substance 
abuse treatment; and 
Two generation interventions that offer services for pre-schoolers or 
adolescents in parallel with services for their parents. 
4.282  Belgium provides a 14 week training course for lower educated unemployed aged 
between 18 and 40 years of age.429  Working in small groups of up to eight people 
for 30 hours each week, the training comprises technical training, counselling and 
guidance including job search assistance, and language and mathematics training.  
The training include traditional educational methods, demonstrations, individual 
and group work, role plays, industry visits, and on-job practical training 
placements.   They have a charter for job seekers which affirms the right of every 
job seeker to receive personal and intensive support to help their re-integration into 
the labour market.430  The provision of this assistance is completely separated from 
the provision of income support, which they encourages the building of trust 
between the long term unemployed and those trying to help them. Participation is 
voluntary with a reported success rate of 60%.431 
426 Snape 1997 Executive summary 
427 Michalopoulos  2000 Executive summary 
428 MDRC <>: 
429 Geers 1991 p 58 
430 ibid p 62 
431 ibid p 64 
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4.283  In August 2003, the New Zealand government introduced Jobs Jolt, a programme 
of 10 initiatives aimed at getting people off benefits, into employment and to 
address the shortage of skilled labour, at a cost of more than NZ$100 million. 432  
The initiatives include:  
Active case management for older workers, by reducing case management 
ratios for older workers and giving clients more active and job-focused 
assistance, including training in workplace skills such as computer literacy; 
Employment coaching, one on one to specific groups of job-seekers to 
address their employment barriers, increase their value to employers and to 
improve their chances of moving into sustainable and higher quality 
employment.  Specialist providers will work with clients to assess their 
needs, help them set suitable work goals, and gain employment.  Support 
will be continued for six months once clients are in work; 
Extra help for those unemployed for more than eight years, including one 
on one specialist assistance to address their specific barriers.  It is expected 
that this programme will also help the Ministry better understand the 
reasons behind long term unemployment; 
Job partnerships between Work and Income and industry.  A National Co-
ordinator will oversee the development of industry partnerships.  
Programmes will focus on training targeted to meet skill and labour 
shortages identified by industry, and may include on the job training, work 
experience or pre-employment training; 
Pilot programmes for enhanced service and case management for sickness 
and invalid beneficiaries.  One pilot will address enhanced case 
management, helping clients set goals, develop individual plans addressing 
their strengths, needs, barriers, and key issues.   Another pilot will be an 
expansion of the Job Club for job-seekers with disabilities who are near 
work readiness; and 
The other initiatives include clarifying the responsibilities of the 
unemployed receiving benefits, improving communities’ ability to access, 
participate in and efficiently use information communications technology, 
and assistance to the Mayor’s Task Force for various projects.  
4.284  A successful programme in Portland emphasised participation in a range of 
activities, tailored services individually, and stressed job quality.   The programme 
substantially increased participation in education and training programmes 
(particularly post-secondary education and training) and helped recipients gain 
general and occupational qualifications.433   
Results based funding 
4.285  In results-based funding models, rehabilitation providers are compensated 
according to the measured outcome of the service they have provided.  The model 
depends on being able to identify and measure appropriate components of targeted 
outcomes to which payments  can be attached.  The results are the impact on 
participants of the results of the programme.434   The concept resulted from 
432 Ministry of Social Development website: 
433 Martinson and Strawn 2002 p 2 
434 Corden and Thornton 2003 p 8 
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concerns  about the apparent stagnation of supported employment in America and 
Britain in the 1980s, and from the need for greater accountability in achieving 
4.286  Of the several models reviewed, the Oklahoma Milestones is considered a success 
and has been highly influential.   The model used six milestone payments for 


Job preparation; 

Job placement; 

Four weeks retention; 

Ten weeks retention; and  

4.287  There were two levels of funding (regular and highly challenged), reflecting 
different needs for preparation and enabling providers to offer appropriate levels of 
service.   Quality standards were incorporated in service requirements for each 
benchmark payment.  Fundamental to the model is the concept of scoring / 
categorising individuals in order to be able to pay providers more for provision of 
services to those in greatest need.   This was designed as a counter-measure to the 
risk of creaming off first all those most easily assisted. 
4.288  Britain introduced a comparable programme called WORKSTEP in 2001.  A review 
conducted in 2002 focused on the potential disadvantage of the model, that there 
could be adverse selection of people in the programme in response to financial 
incentives or disincentives perceived.   In the UK context was an increasing 
rejection of the categorisation of people on the basis of disability and a growing 
support for a social (rather than medical) model of disability.435   
4.289  The next research focus is on investigating what WORKSTEP accomplishes for 
individual disabled people and understanding how outcomes are achieved. Case 
studies of selected providing organisations involve depth interviews at two points 
in time with staff, clients, employers and Jobcentre Plus advisers. The case studies 
will be complemented by a small number of one-off studies of the delivery 
processes and outcomes. In the longer term, the evaluation strategy will address the 
overall impact of the programme and cost-effectiveness.  
Concluding remarks 
4.290  The most successful programmes are those in which staff believe that participants 
can succeed and convey that expectation from the onset of programme 
participation.436   Best practice includes: 
435 ibid p 41-2 
436 Brown 2001 p 43 
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Setting and maintaining goals: 
Set high expectations for success 
Clearly articulate and consistently enforce programme rules 
Set goals for programme performance and monitor success 
Model programme expectations on the workplace 
Focus on strengths, skills and interests rather than on barriers 
At all stages, maintain a clear focus on the goal of employment 
Define success in the context of employment 
Identify both short and long term goals, with interim benchmarks of success 
Helping participants: 
Help participants explore their interests and options 
Monitor attendance and progress in all activities and services 
Keep participants motivated to move forward 
Promote access and support for all participants 
Make an active commitment to serve all individuals, including those with 
serious barriers to employment 
Provide a range of support services to address participant needs 
Teach participants to conduct their own job search 
Invest adequate resources  
Develop personal and trusting relationships with participants 
Use employment plans as comprehensive case management tools 
Help participants help each other 
Help participants get the best job they can 
Supporting staff 
Provide staff with training, flexibility and support 
Give staff a clear mandate to serve individuals with barriers 
Provide regular, ongoing training for staff 
Provide multiple opportunities for staff development and support 
Form partnerships with agencies that have experience serving individuals 
with barriers 
Give staff the time they need to help participants with barriers 
Give staff the flexibility and tools to address individual needs 
Have (some) staff who have faced the same barriers as participants 
Working with employers 
Work closely with employers 
Use aggressive job development to increase opportunities for participants 
Build long term relationships with employers 
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Involve employers in programme design and implementation 
Focus on individuals’ strengths rather than barriers when marketing them to 
Address stereotypes and misconceptions about individuals with barriers 
Look for jobs with companies that provide a supportive work environment 
Follow up 
Continue to support participants after employment 
Build in post-employment services as a formal programme component 
Pay careful attention to the transition to work 
Facilitate access to transitional benefits 
Use post-employment follow-up to achieve multiple goals 
Help participants to up-grade their skills and advance to better jobs 
4.291  There is no one model for designing assistance.  Some problems must be addressed 
before individuals begin work, others while they are working, and still others may 
not be evident until after they have begun to work.  Programmes must be able to 
use multiple strategies at different intensities and in different combinations to be 
able to meet the needs of participants.437   Flexibility is the key to assisting 
individuals with multiple barriers.   Care must be taken to avoid participants 
becoming overwhelmed – success will normally be incremental, and recognising 
this will help participants stay motivated.438 
4.292  Research conducted in the 1980s found that job-search-first programmes might 
speed up the return to work of welfare recipients, but the jobs tended to be short 
lived and poorly paid.   This left many people living in poverty, back on welfare, 
and still severely disadvantaged.439   The important message in the evaluation of 
policies and programmes is that one size does not fit all, and that each initiative has 
strengths which have benefited at least some of the participants / recipients. 
4.293  “Leaving welfare is a process, not an event.”440   Getting a job is only one step in a 
long sequence of steps: building confidence, developing personal skills, acquiring 
job readiness skills, and triumphing over setbacks.   Even in very supportive 
programmes, high rates of job loss can occur. 
437 Brown 2001 p 5 
438 Brown p 54 
439 Hamilton G p2 
440 Hershey and Pavetti 1997 p 84 
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Part 4:  Best Practice 
Experts caution that consideration of borrowing practices from other countries 
must include an analysis of the unique economic, social, and political elements in 
each country.  What works well in one country will not necessarily work well in 
another, due to different definitions, compensation / benefit payment structures, 
cultures, and labour markets. Research has shown that Germany, Sweden, and the 
United States, for instance, have all attempted to make improvements in their 
disability programmes by introducing new requirements, practices, procedures and 
incentives, but not all have proved to be successful. 441   Equally, it can be difficult 
to pinpoint which specific new practice which might have been successful, as new 
practices are rarely carried out in isolation. 
The US General Accounting Office investigated practices for improving rates of 
return to work for people with disabilities.  They cite three specific practices which 
have been proven successful in Sweden and Germany.    These are: 
Intervening as soon as possible after a disabling event to promote and 
facilitate return to work; 
Identifying and providing necessary return to work assistance, and 
managing cases to achieve return to work goals; and 
Structuring cash and health benefits to encourage people with disabilities to 
return to work.442 
The State of Wisconsin has been at the forefront of policy development to reduce 
welfare dependency but analysts are divided on which policies were successful.  
One concluded that emphasising getting any job is more successful than aiming for 
a good job or undertaking training, and that successful schemes enforce 
participation with a clear threat of sanctions.443   Another believes that the decline 
in Wisconsin’s welfare caseload resulted from a combination of circumstances  
(strong economy, restricted benefit eligibility and payment levels) which will not 
be repeated.444 
The experience of the New Zealand Employment Service in the 1990s with its Job 
Action programme was that, while the programme was moderately successful, the  
numbers of long term registered unemployed job-seekers reduced in part because 
people allowed their registrations to lapse rather than participate in the 
programme.  This effect has been noted in a number of similar international 
Many American states have introduced sanctions on welfare clients for not 
participating in programmes.  Sanctions have a range of purposes: 
Purging the caseload of people who are not interested in working; 
Purging the caseload of those who have alternative means of support; 
441 Sim 1999 p 41 
442 ibid 
443 Mead (1998) p 23 
444 Wiseman 1996 p 516 
445 Eardley and Thompson p 29 
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Giving a clear message that help is available but only if people are serious 
about getting a job, and only for a short period of time; and 
Helping to motivate clients who might not otherwise participate in 
activities to promote self-sufficiency.446 
Sanctions range from reductions in, or cessation of, welfare payments to 
requirements to participate in specific treatments (such as substance abuse, mental 
health counselling, or parent training). 
Researchers have also found that mandatory participation requirements are not 
always necessary, and some programmes have found that there are more people 
keen to attend than the organisers have resources to serve.447  What is important, 
however, is  

To make expectations of participants clear from the start;  

To provide the services which were offered (including training, and real 
job opportunities); and 

Where applicable, to impose the penalties that were threatened. 
To achieve this, organisers of programmes must understand and work with the 
local labour market.  Resources must be devoted to: 
Cultivating relationships with firms and industries; 
Developing jobs for particular individuals; 
Keeping abreast of technical and occupational changes which dictate the 
skills required in the workplace; and 
Knowing the current state of the local labour market – employment growth 
areas, unemployment rates, prevailing wage rates and general demography. 
Evaluation of programmes 
Formal evaluations are available for only a small percentage of initiatives which 
help the long term unemployed obtain and retain employment.  A comparison of a 
range of American programmes is attached as Appendix  Five. Costs per person for 
the eleven programmes ranged from US$ 16.50 to US$1,706 per month.   
Employment rates achieved varied from 31% to 80%.   Average monthly earnings 
ranged from $85 per month for young mothers to $500 for adult women. 448 
5.10  Evaluation should ideally be built into any new programme, and implemented 
early.   Useful questions to be addressed in evaluations include: 
Are the programmes and policies being implemented as intended? 
What are the reasons for these findings 
What are the implications of the findings for future directions? 
What are some of the barriers? 
446 Nightingale and Holcomb1997 pp60-1 
447 Nightingale and Holcomb 1997 p 61 
448 ibid pp56-7 
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How can the barriers be overcome?449 
5.11  Success indicators for disability programmes include quality of life and cost 
effectiveness.450  Quality of life incorporates independent living, community 
inclusion, integration as well as employment.  
Principles of good intervention design 
5.12  The basic principles underlying successful interventions as listed below were 
derived in the Michigan studies in the late 1990s.451 Interventions which raise 
ability to survive events could be required as a result of redundancy, 
unemployment, serious illness / injury of self or in the family, loss of property.  The 
variance in such events means that any intervention needs to be tailored to the 
event, while retaining the focus on obtaining and retaining employment. 
5.13  For success in finding re-employment, there are six key tasks a job seeker must be 
able to handle: 
Identification of transferable skills; 
Identification of the market for those skills; 
Procuring interviews with employers; 
Communicating their skills and value to a prospective employer; 
Emotional, attitudinal, and behavioural management of setbacks and 
barriers; and 
When receiving a job offer, the ability to negotiate and make the best 
5.14  Programme organisers must recognise that for many of the participants, the 
training will be the first education or training since leaving school.  The following 
nine steps have been identified: 
1 Recruitment of participants is the start of the intervention 
This includes identifying the right people to participate in an intervention (as not 
all people will benefit from one), persuading them to participate, and actually 
getting them there for Day 1.  Potential clients must recognise the need for 
intervention and accept their role as an active participant.  Any barriers to 
participation such as childcare or transport must be removed. 
2  View intervention as a social influence 
A relationship of trust must be established between client and the “interventionist”  
(i.e. they will act in the client’s best interests and respect the client’s needs).  
Trainers  need to present relevant credentials such as own experience of the client’s 
449 Perrin p 113 
450 ibid 
451 Caplan, Vinokur and Price 1997 pp371-4 
452 Caplan, Vinokur and Price 1997 pp 354-5 
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situation, and specialist training for managing such interventions.   In group 
sessions moderate use of self-disclosure can help participants recognise their 
experiences and feelings are normal. 
3  Target motivation, skills, knowledge and resources for coping 
Help participants build strategies for coping with setbacks, barriers, and lapses in 
using these strategies.  Move progressively into successively more challenging 
situations which utilise the skills just learnt.    To take an example from the 
Michigan programme, job seekers learn how to conduct job seeking telephone calls 
first by watching the trainers model the wrong way, next by generating suggestions 
for improvement, then role-playing the correct approaches before applying their 
new skills in live situations.   Positive feedback is an essential aspect, from both 
trainers and peers. 
4  Build self-sufficiency 
An intervention may not provide all the resources for successful coping, but it 
needs to enhance the participants’ existing skills, motivation and knowledge so that 
they have the key resources available to them.   
5  To be successful requires the confidence to try to succeed 
As previously stated, the likelihood of gaining re-employment depended more on 
having the self-confidence to seek out jobs than on the actual skills used in doing 
6  Allow for individual differences 
This is essential to maximise levels of individual achievement.  Not only do people 
have different needs, they have different abilities to benefit from interventions.  
People are influenced by a range of factors including their own life experiences, 
their values and beliefs.  Programme providers need to recognise that the best 
results are achieved when they deal with participants according to participants’ 
values and beliefs, not according to the organisers / presenters’ beliefs.  
7  Use active teaching and learning methods, rather than didactic techniques 
Active learning leads to better skill acquisition and utilisation and reduces the 
person’s resistance to adopting new skills.453 Active learners energetically strive to 
take a greater responsibility for their own learning. They take a more dynamic role 
in deciding how and what they need to know, what they should be able to do, and 
how they are going to do it. Their roles extend further into educational self-
management, and self-motivation becomes a greater force behind learning. 
8  Blend active learning with model demonstration, graduated utilisation of skills 
and positive feedback 

No one technique will achieve 100% effectiveness by itself but using a combination 
of techniques gives participants greater opportunities to both learn and use new 
453 Caplan, Vinokur and Price 1997 p 358 
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9  Inoculate against setbacks 
Slips and lapses into previous behaviours, attitudes and moods are the norm, not 
the exception, as is the likelihood of rejections.   Interventions should prepare 
participants for these eventualities, developing strategies and practising techniques.  
Topics include recognising what could go wrong (in say a telephone interview), 
how the job seeker is likely to feel about this, what they are then likely to think, 
and how to deal both with the possible dysfunctional thoughts and actions that 
normally are associated with a setback and with the actual activity which went 
wrong.  Successful job seeking is a long string of no’s followed by a yes.   Every no 
is one no closer to a yes.   
Predicting who might become long term unemployed 
5.15  Various studies have attempted to identify those individuals who, when first 
registering as unemployed or becoming injured or disabled, are likely to be at high 
risk of becoming long term unemployed.   Many programmes of assistance  are  
restricted to people who are already long term unemployed, on the assumption that 
most people who become unemployed do find fins work again within a few months 
with minimal assistance from public sources.  Researchers generally agree, 
however, that by the time the long term unemployed are offered additional 
assistance, they are generally in need of considerably more help than when they 
were first unemployed.454  
5.16  The problem of predicting whether any particular individual will become long term 
unemployed is quite distinct from the general risk factors of long term 
unemployment, such as older age, low levels of education and skills, poor health, 
unstable employment history etc.    
5.17  Payne and Payne predict that in a group of people with poor educational 
qualifications newly registered as unemployed, 60% will find work fairly quickly, 
and 40% will become long term unemployed.455  Their feasibility study to develop a 
methodology to identify the high risk unemployed people concluded that such a 
methodology was available but sufficient errors resulted that different decision 
rules were required.   The key trade-off was between maximising the chances of 
identifying the future long term unemployed and minimising waste of resources by 
providing services to clients who do not need them.456 
5.18  A Swedish study of patients with chronic back pain found that the best predictor of 
return to work was the patient’s own beliefs about their return to work.457  Other 
key predictors were the patient’s perception of low support at work, their 
perception of physical work demands and work danger, and levels of depression 
and pain intensity.   The researchers developed a screening instrument, the 
Obstacles to Return to Work Questionnaire, which proved to be a relatively good 
predictor of sick leave.  (A copy of the questionnaire is attached as Appendix Two). 
454 Payne and Payne 2000 p 7 
455 ibid p 8 
456 Payne and Payne 2000 pp21-2 
457 Marhold, Linton and Melin 2002 p  73 
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5.19  These findings are endorsed by other researchers 458 459, including a Swedish study 
which developed the following conceptual framework: 460 
5.20  A Norwegian study identified that high pain intensity, low self-assessed work 
ability and a self-predicted absence status of longer than four weeks were good 
predictors of being off work long term.461    
5.21  All 25 Canadian General practitioners surveyed by the Canadian Back Institute 
believed that they could predict which back patients would not recover as 
expected: they did this using instinct or gut feeling combined with a relationship 
with the patient and knowing the circumstances surrounding his/her injury.462  The 
Institute developed its own checklist to determine the barriers to rehabilitation.  
This is attached as Appendix Three. 
5.22  Associated with the risk of remaining unemployed for the longer term is the need 
to assess the readiness of an injured / disabled person to engage in job seeking.  
Counsellors must process quantities of complex client information including 
medical and psychological information plus education, employment and social 
histories. 463   Many rely on their own clinical judgement to determine a client’s 
readiness to seek employment, but they can have difficulty processing verbal and 
non-verbal stimuli.  
5.23  Research has shown that rehabilitation counsellors tend to favour negative client 
factors (such as incapacities) over positive client factors, leading to a restriction of 
access to employment opportunities.  There are a variety of tools readily available 
458 Hoogendoorn et al 2000 p 2122 
459 Mills and Thornton 1998 p 594 
460 Gard and Sandberg 1998 p 104 
461 Reiso et al 2003 p 1472 
462 McIntosh, Melles and Hall 1995 p 195 
463 Mannock ,Levesque and Prochaska 2002 p 16 
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to counsellors to assess the readiness (and willingness) of injured workers to return 
to work so that the counsellor can address any barriers identified. 
Modified work duties 
5.24  Best practice includes employers having organisational return to work programmes 
which are ready to be utilised as required.   There are seven key components for 
employers to consider: 
Identify lighter jobs and create job descriptions.  Recognise that in some 
situations lighter duties will be required for limited periods of time only; 
Where modified duty jobs are not readily apparent, consider new tasks or 
ways of combining elements of existing jobs to create a modified duty job.   
Small employers should explore with staff / union representatives what 
voluntary agencies might be able to provide light duty jobs in partnership; 
Establish time limits for accommodating temporary restrictions – transitional 
duty jobs should be transitional; 
Deal with any obstacles to having an effective return to work programme  
including any cross – departmental issues or union concerns; 
Make sure modified duty jobs are safe, supervised and add value – they must 
not be make-work; 
Identify any external assistance which may be available; and 
Communicate the company programme to every-one – employees at all levels, 
union representatives.  Make it part of the company culture.464 
Demand-side job development 
5.25  The demand-side job development model is consistent with international trends 
promoting the employment of people with disabilities, and is an excellent way of 
focusing on outcomes rather than on process.   Services are provided directly to 
employers to help them meet their labour force needs by hiring people with 
disabilities.    The aim is to increase the number and range of positions that people 
with disabilities can perform, and then to assist the employer in developing a pro-
active strategy to recruit people with disabilities. 
5.26  Characteristics of demand-side job development include: 
Identifying jobs which employers are having difficulty filling, evaluating the 
essential components of the jobs, and assessing how tasks may be 
restructured to enable jobs to be performed by people with disabilities; 
A change of focus for rehabilitation professionals from “selling” clients to 
becoming consultants to employers on organisational development, 
workflow design and human resource development; 
464 Kremer 2003 p 42-3 
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Understanding employer needs in getting work done and matching 
employer needs with client competencies; 
Finding jobs and developing any job adaptations before finding the clients 
to fill the jobs; 
Maintaining on-going relationships between employers, vocational 
professionals to provide continuing support to workers with disabilities, and 
openings for career development; 
Rehabilitation professionals provide top quality service  to employers in 
terms of job candidates, and providing training/ education and support to 
supervisors; and 
The goal of any job creation and placement is to improve the employer’s  
financial position.  Employers need to make enough profit to stay in 
Maintaining employment 
5.27  Employment retention services are a key component of addressing the problems of 
long term unemployed.  As previously stated, the transition to steady employment 
after a break is often difficult and stressful.   Studies show that one quarter of 
former welfare beneficiaries stop working within three months of placement, and at 
least half are not working within a year.466   
5.28  Pre-employment programmes to help long term unemployed return to work need 
to include job retention strategies.    Such strategies should address any or all of: 
Transportation issues; 
Child  / dependent care; 
Health care; 
Frequent follow-up in the first weeks of new employment and ongoing in-
work support; 
Training in workplace norms such as punctuality, dress, communications, 
Placement in good jobs as opposed to the first available job: better initial job 
quality is linked with higher wages later on; 
Financial assistance for low income workers; 
Community resources available to support newly employed workers; 
Handling crises and emergencies; 
Instilling and supporting a will on the part if the programme participants to 
persevere and achieve; and 
Training in soft skills, entry-level job skills and life skills. 
5.29  Programmes can successfully target clients for job retention.467  One of the many 
models is attached as Appendix Four.  An important message is, however, that if 
465 Gilbride and Stensrud 1992 pp 36-7 
466 Relave 2000 p 2  
467 Rangarajan, Schochet and Chu 1998 
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people adapt programmes from overseas, they generate their own weights and cut-
off values using local data. 
Business partnership 
5.30  As American states and communities focus on welfare reform, attention was 
increasingly focused on how the business community could be part of the effort.  
Private companies were asked to participate in programmes to: 
Prepare welfare recipients for work; 
Train them in job skills; 
Hire welfare recipients; and 
Promote job retention once they are in work. 
5.31  Best practice guidelines were developed, partly to help sell the concept of 
partnership and then to ensure that partnerships worked, generally within the 
context of other initiatives such as job search and training.   Key challenges are: 
Building business community interest in a partnership – businesses will 
remain involved only if their own interests are advanced; 
Making the partnership work, where the partners have very different 
backgrounds and perspectives; 
Remaining in touch with business needs, keeping attuned to labour market 
Promoting the employment of welfare recipients without stigmatizing them; 
Maintaining a focus on the interests of the welfare recipients, while 
achieving a balance between supply and demand of labour and the 
competing interests between welfare reform and business.468 
5.32  First action is to identify appropriate potential business partners, such as those 
Urgent labour needs; 
Possible job opportunities which match welfare recipients’ skills; 
Large businesses which tend to have leaderships roles in the community; 
Small businesses because they generally do not get involved; 
Businesses with opportunities for workers to advance; 
Businesses with government requirements to hire additional or 
disadvantaged workers; and 
Businesses already committed to helping their community.469 
468 Brown, Buck and Skinner 1998 p 14-15 
469 ibid pp32-33 
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5.33  Relationships need to be developed over time, building the vision, strategy and 
goals together from the start. Goals and expectations must be clear at the start and 
be realistic.  Partnerships are about “win-win”: helping the welfare recipients and 
strengthening businesses simultaneously.   They need to be established on good 
communications and trust, and then maintained constructively.   This requires 
strong leadership and dedicated staff.470 
5.34  The American Manpower Demonstration Research Corporation  (MDRC) has 
developed a series of How-to publications which promote best practice in 
implementing welfare reform.  Titles include: 
Promoting participation: How to increase involvement in welfare to work 
Promoting partnership: How to involve employers in welfare reform 
Beyond Work first:  How to help hard to employ individuals get jobs and 
succeed in the workforce  
These are all available on the MDRC website <>
470 Brown, Buck and Skinner 1998 pp45-46 
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Part 5: Recommendations for NZ 
5.35  Before considering initiatives for implementation in New Zealand, it is important to 
answer the question “ why go back to work?”   Employment is described as a social 
institution that meets many human needs: 
It imposes a time structure on the working day; 
It implies regularly shared experiences and contacts with people outside the 
It links an individual to goals and purposes that transcend their own; 
It defines aspects of status and identity; and 
It enforces activity.471 
5.36  Understanding how a job fulfils these needs helps explain why there is a motivation 
to work beyond earning a living. 472  It also sheds light on the effects of job loss as 
distinct from unemployment – this can be in terms of bereavement. Many countries 
have not recognised the risks associated with job loss and have not implemented 
comprehensive interventions that deal with the dual reality of loss of job and loss of 
identity / family.  The remedy for job loss is a new and satisfactory job – not “any 
Human Capability Framework 
5.37  The New Zealand Department of Labour developed the Human Capability 
framework as a way of providing an integrated view of key economic and social 
objectives, and of understanding the role of the labour market in achieving them.  
It is designed to provide a better understanding of the influences, linkages and 
levers that impact on human capability.474   
5.38  The framework brings together a number of elements which affect New Zealand’s 
human capability: 
Key factors that influence people’s capacity (their skills, knowledge and 
abilities) and the diverse ways of building capacity; 
Key factors that influence the creation of opportunities for that capacity to 
be used in ways that give people financial or personal rewards; and 
The ways in which capacity and opportunity get matched, and the risks for 
people and businesses if capacity is damaged or capacities and opportunities 
do not correspond. 
5.39  The following diagram shows the variety of influences on human capacity in both 
economic and social spheres: 
471 Jahoda 1979 p 494 
472 Tu 2000 p 57 
473 ibid  p 67 
474 Department of Labour 1999 Overview 
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5.40  Current trends affecting human capability include: 
An ageing workforce; 
Increasing proportions of Maori, pacific island and other ethnic groups, 
often in population concentrations; 
Significant numbers of new entrants to the workforce have low educational 
Increasing globalisation of the New Zealand economy; 
Constant technological change; 
Changing skills levels required by industry, with a move from low skilled 
manual labour to low skilled service  sector; and 
Job growth in the high skilled market, and job losses in the low skilled 
5.41  Key policy issues identified by the department are to address the following needs: 
A flexible workforce, able to adapt to changing skill needs and prepared for 
lifelong learning;  
Innovative business development which is able to make best use of new 
global opportunities and new technologies; 
Improved workforce capacity, including educational achievement amongst 
maori and minority ethnic groups; and 
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Innovative regional solutions to address the impact of agricultural and 
manufacturing downturns, the continuing population drift northwards and 
concentrations of low capacity levels within some communities. 
5.42  The commitment by the Department of Labour to use the framework in its work 
means that ACC’s practices should be consistent with the framework. 
The current New Zealand labour market 
5.43  According to the Department of Labour475, the labour market of New Zealand is one 
of the cyclically strongest in the world at present. The unemployment rate has been 
trending down since 1999 thanks to robust job growth and is now at 4.4 percent, 
the lowest since December 1987 and one of the lowest in the OECD. Encouraged 
by this, a high number of people are participating in the labour market as the 
participation rate rebounded to a high 66.6 percent.  Approximately 30,000 new 
jobs are created each year. 
5.44  The outlook is for a weakening in the New Zealand economy over the next year 
due to a sharp fall in export returns, caused by the rise in the New Zealand dollar 
and the staggering world economy. A weakening in economic growth is expected to 
lead to a worsening of labour market conditions in 2003/04, with lower 
employment growth and a moderate rise in unemployment. 
5.45  Recent years have seen strong growth in knowledge intensive services, including 
education, health and community services and property and business services.  
Leisure and entertainment industries have also grown faster than average.  The 
occupational mix of employment within industries is also changing, with a shift 
towards white collar work.  Manual work is declining while numbers of managers, 
professionals and technicians are increasing.   Clerical work is declining, reflecting 
the impact of information technology. 
5.46  The Department’s Future of Work team notes that some groups of workers have 
suffered a drop in job tenure, but long term employment relationships remain 
strong.  Non-standard employment (such as part-time, casual, temporary and self-
employment) is on the rise. 476  The increase in part-time and self-employment is 
partly driven by people’s need for flexibility, but the increase in temporary and 
casual work is likely to lead to more job insecurity, low pay and poor working 
conditions for these workers.   
5.47  The number of older workers is expected to increase by a third between 2002 and 
2011.  The Department of Labour warns that employers may have to create new 
employment patterns to retain older workers.   Making maximum use of the 
available workforce will require breaking down the negative stereotypes that 
surround age.477 
5.48  The increase in the ageing population means that retraining is likely to be required 
to keep up with changing skill demands.   Fewer young people entering the 
workforce means that employers will need to be more flexible in order to retain 
475 Department of Labour website <> 
476 The proportion of people who work the standard 40 hour week stands at just 30%. 
477 Department of Lbaour pp16-17 
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older workers.   Migration will continue to have a major impact on the labour 
market, both inwards and outwards migration.   An increasing portion of the labour 
force will be  migrants from non-English speaking countries. 
5.49  Higher levels of skills are increasingly required, especially in communications, 
literacy, numeracy and problem solving.   Flatter management structures means 
that workers are progressively required to display judgement, leadership and 
initiative along with motivation and attitude. 
5.50  This is all best summarised : “Change is the norm. The best way of coping with the 
changing face of work is to take charge of your own destiny”478   The challenge for 
ACC is to implement it. 
Helping long term claimants 
5.51  Recent research on the needs of long term ACC claimants in return to 
independence identified five stages in the transition to independence / work: 
Pre-contemplation: not thinking abut returning to independence / work; 
Contemplation: thinking about returning to independence / work; 
Preparation: preparing to return to independence / work; 
Action: entering work or transitioning from part-time to full-time work; 
Maintenance: remaining independent from ACC / remaining in work.479 
5.52  The time taken to transition along the continuum varies from claimant to claimant, 
and some claimants move backwards in reaction to negative events (such as job 
rejections from employers). 
Helping newly injured 
5.53  This literature search has acknowledged that being pro-active when workers are 
first injured is most effective.    Various potential initiatives are identified for 
claimants, for employers, for case managers and for medical professionals. 
5.54  Initiatives which would assist new claimants cope with their changed 
circumstances include: 
Money management  training to enable new claimants to budget and live 
within their reduced level of income; 
Meeting / discussion groups with other claimants with the same / similar 
type of injury, albeit at different stages in their rehabilitation; 
Programmes for the newly injured, similar to the Spinal Injury Trust pilot 
operational in Christchurch; and 
Managing the trauma of the injury and the grieving process of the accident. 
478 Department of Labour 2003 p 6 
479 Litmus 2003 Conclusions 
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5.55  The proven benefits of early return to work for many types of injuries need to be 
explained to many of the medical profession, in particular to the patient’s General 
Practitioner. These include: 
Better self image; 
Improved ability to cope; 
Improved work survivability; and 
Improved ability to be independent.480 
5.56  There is both empirical and anecdotal evidence that many GPs respond 
unconstructively to pessimistic attitudes from injured workers, by focusing on the 
negative issues rather than on what the patient can achieve.  They extend time off 
work which allows patients more free time to dwell on the negative, rather than 
assisting patients keep their minds active and focused on more positive matters.    
5.57  This has been described as “the physician treating the whole patient”, 
acknowledging both medical and biosocial issues. Physicians cannot prove or 
disprove the existence of pain clinically, but they can address the problem that 
prolonged time away from work makes recovery progressively less likely. 481 
5.58  There is no question that to return to work after a long absence may require some 
effort on the part of the worker to face their fears or unwillingness about returning 
to work.  Many people with disabilities describe days when their symptoms are 
sufficiently severe that they have to force themselves to get up and go to work 
despite their pain.  The benefit is that once at work, their daily tasks and duties 
serve to distract them from their pain.  If GPs can work with their patients, helping 
them recognise the benefits of being at work and developing pain management 
techniques, many will be rehabilitated more quickly. 
Case management 
5.59  As case managers play a key role in the rehabilitation of claimants, it is relevant to 
list some of the effective practices identified in the course of this research.   These 
Training case managers in how to interview for “client strengths”; 
Including the goals of vocational rehabilitation right at the start of the 
claimant / case manager relationship, rather than focusing initially only on 
managing the injury and grief, and ensuring that the claimant both 
understands this and commits to it; 
Setting goals at the start and maintaining the focus on them; 
Ensuring goals are realistic ones which can be achieved step by step; 
Focusing on (the many things) the claimant can do rather than (the few) 
they cannot do; 
Understanding how people respond to negative / positive attitudes in the 
same way, and learning to manage claimants’ pessimism; 
480 Melhorn pp69-70 
481 Melhorn p70 
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Overcoming concepts of ageism (“they’re close to retirement so no need to 
get back to work”); 
Acknowledging and rewarding claimant achievements in rehabilitation in a 
small but positive way; 
Learning how to recognise literacy problems in claimants and managing this 
as a barrier to return to work;  
Exploring the work-place culture of the claimant’s pre-injury employment as 
part of their return to work.   This may result in the claimant being referred 
to another employer, or in providing assistance / support to the claimant’s 
colleagues and managers; 
Recognising the impact of changes in the labour market mean that many low 
skilled or manual workers may require new skills in order to return to work.   
This is re-skilling and not to be confused with the concept of up-skilling; 
Mapping transportation with claimants, whether for work or for family 
matters such as childcare. 
Policy development 
5.60  The OECD has provided some useful guidelines on developing policy to help 
people with disabilities obtain and retain employment.482   These are: 
Recognise the status of disability independent of the work and income 
situation.  Disabled does not equate with unable to work; 
Introduce a culture of mutual obligations: it is not just society’s 
responsibility but disabled people and employers as well; 
Design individual work/benefit packages comprising 
Rehabilitation and vocational training 
Job search support 
Financial assistance 
The potential of different forms of employment such as part-time, subsidised 
Activities to assist the social integration of people with disabilities 
Introduce new obligations for disabled people, such as participation in 
vocational rehabilitation, employment and other integration measures; 
Involve employers in the policy process.  Different approaches to encourage 
employment of people with disabilities range from moral suasion to anti-
discrimination legislation and compulsory employment quotas.  Thee 
effectiveness of these measures depends on the co-operation of employers; 
Promote early intervention 
Make financial assistance a flexible policy element, to take account of 
whether the person has been able to gain a job, changes in the person’s 
disability status over time, and not to penalise a person unfairly for taking 
up  employment; 
482 OECD 2003 
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Reform programme administration.  Promote equal access to all programmes 
for all people. Caseworkers will need an extensive knowledge of the range of 
benefits and services available, and have time to assist individuals and follow 
each case; and 
Design disability programmes as active programmes, not early retirement or 
quasi-permanent exits from the labour market.   
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APPENDIX ONE: How to relate to people with disabilities 
These Guidelines were developed by the American Psychological Association.483 
Many of the barriers which people with disabilities face are reinforced by small details of 
language and behaviour. These details may seem insignificant, but they often reaffirm 
inaccurate assumptions and cause offense. By changing how you portray and communicate with 
people with disabilities, and by modifying a few features of your environment, you, as human 
service providers, educators, and the media, are in a unique position to shape public attitudes 
about people with disabilities in a helpful way.
Language influences perceptions and behaviour. Words in popular use mirror prevailing 
attitudes in society. Oftentimes, societal attitudes create barriers for people with 
disabilities. Through language usage, we can conjure up images of people actively engaged 
in life, and we can avoid stereotypical phrases that suggest helplessness or tragedy. 
Person First Language 
When you refer to a "disabled woman," your listener or reader has already begun to form 
some kind of image of "disabled" before she/he hears the word "woman." The subject of 
the sentence then hasn't a chance to be thought of as a regular person. She will be 
considered mainly disabled and secondarily a woman until or unless your subsequent 
language jars this image loose. 
On the other hand, if you refer to her as a "woman with a disability" the reverse tends to 
occur. Your audience first starts forming an image of an ordinary woman, and then 
modifies it. The focus becomes on the individual, not the particular functional limitation. 
Once you've identified her as having a disability, and the most adaptive image you can 
conjure up for her is pretty much set in your reader or listener's mind, there is no reason 
not to use the briefer expression "disabled woman" from time to time if you feel the need 
for literary variety. 
One common way of sensationalizing disability is to describe highly successful people with 
disabilities as "superhuman." Such individuals are shown as being "incredible" or 
"extraordinary" because they strive to overcome their limitations and serve as role models 
or yardsticks for measuring personal achievement. While people with disabilities have had 
to overcome obstacles dealing with their disability, they generally have the same range of 
talents and dispositions as non-disabled individuals. Portraying persons with disabilities as 
"superstars" creates unfair expectations.  
483 From website 
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Another common way of sensationalising is to use the language of tragedy or catastrophe. 
Words and phrases like "afflicted with," "struck by," "a victim of," or "crippled with" 
disability generate sentimental feelings of pity, which can be socially damaging to the 
person described. It also leaves the reader or listener with the nebulous impression that 
individuals with disabilities face serious problems with which they cannot cope. 
If you get stuck on a person's disability, your listener or reader will get stuck there too. 
Usually, other aspects of the person are more interesting or relevant to the issue at hand. 
This is equally true regarding race, ethnicity, sex, and sexual orientation. If such 
demographics seem worth mentioning, then mention them. This can be done without 
making them the focus of the described individual's being. 
Being, Having, Doing 
It is generally useful to avoid verbs that imply that disability encapsulates all there is to say 
about a person. Also, it is useful to avoid verbs that suggest images of passivity. For 
example, the phrase "so-and-so is in a wheelchair" conjures a passive image, someone just 
sitting there doing nothing. By contrast, the phrase "so-and-so uses a wheelchair" tends to 
elicit an action image, someone wheeling a chair or operating a control device. The first 
person seems helpless and detached; the second, participatory and involved. 
Most people who have been hospitalized even briefly understand how disconcerting it is to 
be known temporarily as "the heart in room 18" or "the liver in room 24." It doesn't take 
much imagination to understand how annoying it would be to hear yourself referred to as 
a "spinal cord injury" or a "manic depressive" for the rest of your life. It's no harder to say, 
"Charlie has a spinal cord injury" or "manic-depressive illness" than it is to say, "Charlie is 
a spinal cord injury" or "manic depressive." The first suggests that disability is just one 
trait among many. The second implies that it summarises the essence of all that Charlie is. 
In summary, in the most wholesome, socially appealing image, the person is doing 
something. In the second best, one is seen as a person who has a disability. In the least 
helpful social image, one's very being is identified by disability--other facets of personality 
disappear, leaving only embodied disablement. 
Disability-Disease Distinction 
Some disabilities are progressive results of chronic conditions, but many, probably most, 
are not. The illness/injury that caused the disability is an event of the past. A person with a 
substantial disability may be healthier than you are. This distinction can be very important 
in such situations as a job search, acquiring health insurance, and getting a date. A person 
with a severe disability doesn't need the unwarranted obstacle of being seen as also having 
an active disease.  
Injury-caused disabilities are easy to distinguish from disease-caused disabilities once you 
know they result from injuries. Disease-caused disabilities pose more problems because 
most people don't know which diagnostic labels reflect acute illnesses that are long past 
and which designate continuing illnesses. To err on the safe side, assume "stable disability, 
no disease" unless the person corrects you. 
Euphemisms claimed as politically correct by various splinter groups (e.g., "impaired," 
"physically challenged," and "differently abled") have generated endless jokes and 
parodies, which may not be what their promoters wanted. Suffice it to say, these are fad 
phrases that have not gained general acceptance among people with disabilities. 
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Of the main non-euphemistic terms, "disability" has come to be preferred over "handicap" 
as the more general descriptor. This is owing to the latter's narrower meaning as well as its 
historical association with fundraising pathos. The word "disability" refers to the 
functional limitation a person experiences as a result of an impairment. The word 
"handicap" refers to the social consequences of the disability. For example, stairs, narrow 
doorways, and curbs are handicaps to people with disabilities who use wheelchairs. 
Many people feel uncomfortable around individuals with disabilities. Much of this 
discomfort stems from lack of personal contact with people with disabilities and a sense of 
awkwardness and uncertainty as to how to speak and act in their presence. 
The following section offers suggestions for increasing effective communication and 
reducing anxiety when interacting with people with specific disabilities. 
Hearing Impairments 
•  Do not make assumptions about a person's ability to communicate or the way in 
which they do it. Always ascertain which communication medium the deaf or 
partially hearing person intends to use.  
•  When interacting with people who prefer lip reading, use a well-lit, glare-free area.  
•  Face the person directly and continue speaking at a normal volume and rate.  
•  Rephrase sentences rather than repeat them.  
•  Do not cover your mouth or look away from the person, such as to take notes, 
while you are talking.  
•  Communicate in writing, if necessary.  
•  When a sign language interpreter is present, it is best to face the person and speak 
•  Omit phrases such as "please tell him/her that..." and address the person directly 
while the interpreter signs. 
Visual Impairments 
•  Ask if any particular assistance is needed.  
•  Orient the person to the area, explaining where major furniture is located. If the 
person has been there before, you should inform him/her of any changes or new 
•  Keep doors fully open or closed to prevent accidents.  
•  Offer to read written information for a person with a visual impairment, when 
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•  If you are guiding someone, let him/her take your arm just above the elbow, and 
guide rather than lead or propel the person. Give him/her clear instructions such as 
'this is a step up' as opposed to 'this is a step.'  
•  When giving directions, use specific words such as "straight ahead" or "forward." 
Refer to positions in terms of clock hands: "The chair is at your 2:00." Avoid vague 
terms such as "over there."  
•  Don't assume the person will recognise you by your voice even though you have 
met before. Identify yourself by name, maintain normal voice volume, speak 
directly to the person, and maintain eye contact. 
Speech Impairments 
•  Listen patiently and avoid completing sentences for the person unless she/he looks 
to you for help.  
•  Don't pretend to understand what a person with a speech disability says just to be 
•  Ask the person to write down a word if you're not sure what she/he is saying. 
Mobility Impairments 
•  Ask if assistance is required. 
•  Do not remove a person's mobility aid, for example crutches, without the person's 
•  When talking to someone who is in a wheelchair and the conversation continues 
for more than a few minutes, sit down or kneel to be eye level. This avoids neck 
strain and is much more positive. 
•  Don't lean on a person's wheelchair unless you have his/her permission--it's his/her 
personal space. 
As service providers and advocates, psychologists and other mental health providers need 
to ensure that their services adequately meet legal and ethical obligations. 
To improve compliance with the Americans With Disabilities Act and to better meet the 
needs of individuals with disabilities: 
•  Do not deny your services to a client with a disability. You may refer him/her if that 
individual requires treatment outside of your area of specialization.  
•  Do not separate out or give unequal service to clients with disabilities unless you 
must do so to provide a service that is as effective as that provided to those without 
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•  Watch for criteria that screen out clients with disabilities. For instance, do not 
require a driver's license for payment by check. Use policies, practices, and 
procedures in your office that can be modified for those with disabilities, such as 
making sure service animals are permitted in your office.  
•  You may need to provide auxiliary aids and services, such as readers, sign-language 
interpreters, Braille materials, large-print materials, videotapes and audiotapes, and 
computers when necessary to effectively communicate with your clients with 
disabilities. You may use alternative forms of communication, such as notepads and 
pencils, when these forms are as effective.  
•  Evaluate your office for structural and architectural barriers that prevent 
individuals with disabilities from getting the services they need from you. Change 
these barriers when they can be readily changed (without much difficulty or 
expense). Look at ramps, parking spaces, curb cuts, shelving, elevator control 
buttons, width of doorways, levered door handles, width of toilet partitions, height 
of toilet seats, high-pile carpeting, and ensure that rooms are large enough to 
manoeuver a walker or wheelchair.  
•  When building new offices or remodeling, hire an architect or contractor familiar 
with ADA requirements. 
Copyright (c) 1999 by the American Psychological Association. This material may be reproduced in whole or in part 
without fees or permission, provided that acknowledgement is made to. 
Page 121 of 144 

APPENDIX TWO: Obstacles to return to work Questionnaire 
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link to page 125 link to page 125
APPENDIX THREE: Identifying barriers to rehabilitation 484 
APPENDIX FOUR: Identifying people needing assistance with job retention 485 
484 McIntosh, Melles and Hall 1995 p 195 
485 Rangarajan, Schochet and Chu 1998 
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APPENDIX FOUR: Model For Predicting People Requiring Assistance To Return 
Page 125 of 144 

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APPENDIX FIVE: Evaluation of selected employment and training programmes  
From Nightingale and Holcomb 1997 
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Brief Report: 
Interventions for the management of long term ACC 
clients in receipt of weekly compensation 
Fiona Conlon 
Date Report Completed   
Important Note:  
The purpose of this brief report is to summarise information on the effectiveness of 
interventions for the management of long term ACC clients in receipt of weekly 
compensation and to provide best practice advice. It has not been systematically 
developed according to a predefined methodology.  
The document has been prepared by the staff of the evidence based Healthcare 
Advisory Group, ACC. The content does not necessarily represent the official view 
of ACC or represent ACC policy. 
This report is based upon information supplied up to 9 December 2008 

A c c i d e n t   C o m p e n s a t i o n   C o r p o r a t i o n  

Executive Summary 
This report examined the effectiveness and evidence for interventions for the management 
of long term ACC clients in receipt of weekly compensation.  
Some key findings are: 
  Implementing intensive case management within a system which focuses on 
compensation and medical interventions (including surgery) can be difficult. 
Knowledgeable medical and rehabilitation professionals who can provide advice 
that dovetails with the reality of the workplace setting are vital. 
  The medicalisation of injury can result in inferior outcomes in terms of RTW and a 
national guidance on, for example, post operative RTW advice, could be beneficial. 
  There is evidence for promoting RTW through interventions that target the 
emotional demands of work, job security, perceived ability to perform tasks, 
meeting role expectations and obtaining workplace support. 
  Management of injury in the workplace, rather than off-site in rehabilitation 
centres shows good evidence for success in terms of reducing work disability 
duration and associated costs. 
There has been increased concern in ACC about the growth in the number of long term 
claims. The management of these claims presents a challenge in terms of resources and 
cost. The Evidence Based Healthcare (EBH) Research Group has been asked to provide a 
high level review of recent literature based on abstracts and conversations to present the 
available evidence on interventions to address this issue.   
The search strategy involved a search of the Ovid MEDLINE® 1996 to November Week 3 
2008 database. The search was conducted on 9 December 2008 using key words relevant 
to long term claims 
361 abstracts were identified and reviewed to identify emerging themes and ideas. 
A c c i d e n t   C o m p e n s a t i o n   C o r p o r a t i o n  
Page 2 

Systematic reviews and RCTs were included together with other studies especially where 
they supported the evidence. The quality of the research studies was not evaluated and 
further review of the quality of research available is therefore recommended. 
Other sources of information: 
Conversation with Cam Mustard, President and Senior Scientist, Institute for Work and 
Health; Professor, School of Public Health, University of Toronto – (Telephone Conference 
on 18 December 2008). 
Barriers facing long term unemployed, injured or disabled workers returning to work – report 
on international literature search’. Compiled for ACC by Fiona Knight, 16 January 2004. 
The themes identified and the evidence related to these themes are summarised. 
The influence of the medical model of health 
There is good evidence to show that being fully recovered is not a stipulation for regaining 
work activities and a more function centred approach to treatment rather than a pain 
centred approach can be more effective for increasing RTW1 2.  
Healthcare providers can play an active role in the RTW process, a role that includes direct 
contact with the workplace and proactive communication with the patient. The influence 
of the GP or healthcare professional’s advice regarding absence duration influences the 
outcome and times for RTW3 4 5. 
The use of a medical paradigm for the assessment, explanation and treatment of what are 
often social conditions can generate interventions inappropriate to the problem. 
Implementing intensive case management within a system which focuses on compensation 
and medical interventions (including surgery) can be difficult. Patients may request more 
testing and passive medical interventions, delaying the initiation of functional restoration. 
More tests and pain related treatments may also reinforce a patient’s false expectations for 
a cure6. Knowledgeable medical and rehabilitation professionals who can provide advice 
that dovetails with the reality of the workplace setting are vital. Doctors may not know the 
type of work that their patients are returning to; both a lack of knowledge and ambiguity 
about their role can influence outcomes7 8 9.  
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There is some evidence to show that the primary treating physician’s behaviour can 
increase the likelihood of a RTW, while recommendations for specialty care can reduce the 
likelihood of RTW10. Similarly interventions targeting RTW applied in the acute phase of 
an injury can compete with a high rate of spontaneous recovery and may therefore be 
inefficient11. Another study of those who seek additional health care services after 
completion of a tertiary rehabilitation programme showed that this sub group accounted 
for a significant proportion of lost worker productivity, unremitting disability payments 
and excess healthcare consumption12. This suggests that the medicalisation of injury can 
result in inferior outcomes in terms of RTW and a national guidance on, for example, post 
operative RTW advice, could be beneficial5.  
The Workplace Safety and Insurance Board in Canada issued “Injury/Illness and Return to 
Work/Function: A Practical Guide for Physicians” in 2000 for treating physicians. It 
highlights the need for primary care providers to lead in coordination and collaborative 
roles with other stakeholders (e.g. workplace parties) in the context of encouraging safe 
and timely return to work. Similarly in Ontario, guidelines were released based on 
evidence based research for the management of patients in relation to low back pain. It is 
suggested that guidelines must be accompanied by effective service support to primary 
care providers to be successful (Conversation with Cam Mustard). 
Ontario is currently trialling a demonstration model in which primary health care 
providers have funding for a position within the health centre for a person dedicated to the 
coordination of RTW for injured persons, working collaboratively with the workplace and 
the compensation agency. This new innovation has not yet been evaluated (Conversation 
with Cam Mustard).  
Workplace Organisation 
Workplace interventions consisting of workplace assessments, work modifications and 
case management involving all stakeholders show good evidence of success and cost 
effectiveness with respect to RTW outcomes13 14 15 16. 
The organisation of the workplace is important for RTW outcomes. For both men and 
women the likelihood of RTW improved with the increasing number of opportunities to 
“adjust”. Adjustment latitude (i.e. opportunities to adjust one’s work to one’s state of 
health by choosing among work tasks and deciding about work pace and working hours) 
increased returning to work part time as well as full time work17. The ability to modify 
work rather returning to full duties has a lower risk of recurrence18. 
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There is good evidence to show that the predictors of RTW that are considered most 
clinically relevant are those that generally reflects the way the workplace operates. Physical 
recovery is embedded in complicated ways with workplace processes and practices 
together with environmental and social organisation in the workplace – good will and 
trust are important19 20. Key factors in the workplace culture and organisation that effect 
RTW identified in the literature are:  
  A culture of problem solving and injury management strategies 
  In house disability management programmes by corporate based case managers 
  Knowledge exchange 
  Equitable participation of workers, supervisors and health professionals 
  Positive work culture and people oriented organisational policies and procedures 
  A safety climate and ergonomic practices (including accommodation) 
  Co-worker support 21 22 23 24 25 26. 
There is also evidence for promoting RTW through interventions that target the emotional 
demands of work, job security, perceived ability to perform tasks, meeting role 
expectations and obtaining workplace support27 28 29. 
Prognostic factors for non Return to Work (RTW) 
In determining the common risk factors for recurrence, chronicity and non return to work 
in low back pain the prognostic factors with a high level of evidence were: a history of low 
back pain, a low level of job satisfaction and poor general health. The prognostic factors 
with a moderate level of evidence were: employment status, amount of wage, workers 
compensation, depression and physical factors related to work30. Prevention of these 
factors occurring and awareness of their influence is essential at all stages of work 
disability and in determining interventions for RTW. 
Stakeholder Influences 
Injured workers often do not return to work due to a complex group of factors associated 
with the development and persistence of the work disability. These factors include: the 
worker, the work place system or environment, compensation policies, the healthcare 
system and the insurance system. These systems are further exposed to multiple legal, 
administrative, social, political and cultural exchanges. Loisel’s diagram provides an 
overall societal context for the injured worker (see Diagram 1)31.  
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Any intervention directed at RTW outcomes is influenced by the diverse and competing 
interests, values and language of the worker, employers, insurers, labour representatives 
and healthcare providers. Frictions are inevitable and interventions need to meet common 
goals32. Some strategies like education and awareness raising between stakeholder parties 
appear to offer results6. 
Diagram 1. Figure adapted from Loisel et al, 200533 
Workplace based interventions 
Management of injury in the workplace, rather than off-site in rehabilitation centres shows 
good evidence for success in terms of reducing work disability duration and associated 
costs34 35 36 37. Work disability duration can be reduced by work accommodation offers, 
contact between the healthcare providers and the workplace, early contact of the worker 
with the workplace, ergonomic worksite visits with an intensive functional restoration 
programme and the presence of a RTW coordinator38 39.   
In the United Kingdom the Department of Work and Pensions is currently experimenting 
with delayed benefit reduction; protecting beneficiaries from having their benefit reduced 
or suspended for a period until they are established in the workplace. It is hoped that this 
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will address job security issues and increase a claimant’s preparedness to take a chance on 
RTW. (Conversation with Cam Mustard).   
Case Management 
There is good evidence to show that patients that received case management had fewer 
sick days and a lower cost in terms of weekly compensation than those who did not 
receive case management40   However there is no evidence to support any difference in 
RTW outcomes with case management41. 
Examples of case management in New Zealand include the Ministry of Social 
Development’s PATHS (Providing Access to Health Solutions) programme, a partnership 
between Work and Income, DHBs, PHOs, community Mental Health and NGOs in 
collaboration. This programme utilises an intensive case management approach to help 
clients identify their barriers or obstacles to preventing them from working. Options are 
explored for removing barriers through access to services. PATHS was awarded the 
“Excellence in Rehabilitation” at the New Zealand Health Innovation Awards 2008 (MOH 
website). An evaluation of PATHS undertaken between July 2006 and June 2007 found 
that in the Bay of Plenty it helped more than 550 people overcome health barriers and get 
off benefits with 350 returning to work (Ministry of Health Website). The use of ‘Work 
Brokers’, who work with employers and local training providers to grow and develop 
opportunities in the local labour market, shows success. 
Rehabilitation Interventions 
There is inconsistent and conflicting evidence for different types of interventions on RTW 
outcomes 42. For example studies reporting the effectiveness of Functional Capacity 
Evaluations (FCE) varied in outcomes, some studies reporting that performance was a 
weak indicator of faster benefit suspension and was unrelated to sustained recovery43 44 45. 
Another study reported the need for accurate job simulation and detailed intensive 
assessment of specific work activities for FCE to be a valid tool in RTW46. 
One descriptive literature review on physical exercise reported that effects varied 
depending on content related factors (types of exercise, dosage, frequency, skills of health 
care providers, etc) and contextual factors (treatment setting, compensation scheme, etc)11. 
It may be that the inter relationship between these factors account for the differences 
between reported outcomes for different interventions. 
In Ontario vocational rehabilitation programmes have had limited success: For those 
claimants placed on a vocational rehabilitation programme, the attrition rate was 50%. Of 
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the 50% who complete the programme only 50% of these successfully return to 
employment, a success rate of 1 in 4 (Conversation with Cam Mustard). 
Psychosocial factors 
A systematic review to identify psychosocial predictors of failure to return to work in non-
chronic, non-specific low back pain found strong evidence that recovery expectation is 
predictive of work outcome while depression, job satisfaction and stress or psychological 
strain are not predictive of work outcome47. Persons with positive prediction require help 
to realise their potential for RTW: offering traditional rehabilitation methods to a person 
with negative prediction of his or her return to work could be a waste of time if done 
ahead of improving self confidence and development of a positive view of what is 
There is some evidence for increased control for employees over decisions and actions 
affecting their health – a process associated with the concept of ‘self efficacy’. Self efficacy 
interventions and active involvement in one’s own condition, in relation to the workplace, 
have shown positive effects on perceived workability49 50.  
The health system can unwittingly reinforce the “sick role” and in so doing can provide 
continued justification for an “off work” identity. Depression can become, through 
institutional practices, inextricably part of someone’s identity with implications for their 
functional recovery. It is uncertain whether low self efficacy among employees is a result 
of the disability absence itself rather than a precursor of it51 52. 
There is no evidence to show that counselling that addressed motivation, goal setting and 
planning to return to work improved vocational outcomes53 54. 
While many approaches focus on the psychosocial risk factors “inside” the individual (e.g. 
pain, catastrophising, beliefs, expectancies) successful disability prevention and 
management will require methods to assess and target psychosocial risk factors “outside” 
the individual (e.g. interpersonal conflict in the workplace, job stress, etc)55 
Alcohol and drug factors 
Alcohol is known to play a significant role in absenteeism, reduction in work performance 
and accidents in the workplace56 57 58 and, along with the consumption of drugs, is linked 
to poor recovery after traumatic injury59.  
A number of interventions show evidence for effectiveness including referral to alcohol 
health workers as opposed to only providing information to injured clients60; providing 
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motivational interventions and incentives to change behaviour61 57; peer based workplace 
substance abuse prevention focusing on changing attitudes which can  reduce the injury 
rate62 63, and skills based substance abuse counselling programmes64.  
The Department of Work and Pensions in the United Kingdom reported on substance 
addiction prevalence and found it was higher in beneficiaries than the general population. 
However, there is no evidence to show that drug and alcohol programmes within a RTW 
programme are any more successful than programmes in the community (Conversation 
with Cam Mustard). 
From a review of the available evidence and conversations, it would appear that the 
current approach to long term claimants is not wholly satisfactory. The challenges faced by 
ACC are not unique and are typical of what is evidenced in other countries. The main 
findings of this review are: 
  Recognition of the factors predisposing to chronicity, can improve outcomes. 
Successful early intervention strategies are vital. 
  There is good evidence that a move a way from the medical model of managing 
injury to functional management will result in improved outcomes. 
  Rehabilitation within the workplace environment can enhance outcomes. 
Workplace processes and practices influence outcomes and opportunities for 
worker control and self efficacy improve outcomes.  
  There is inconsistent evidence for various rehabilitation interventions and it would 
seem that the context of the intervention is more important than the content. A 
focus beyond the individual client to a wider focus on the context in which the 
individual operates is required. 
  Specialist knowledge in the areas of case management, vocational expertise and 
work brokering are required. GP/specialist behaviour modifications can also 
enhance outcomes. The placement of a specialised person within the primary care 
environment to focus of coordination of RTW shows promise. 
  The competing interests of all injury stakeholders need to be understood and 
managed appropriately. 
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Limitations of this report 
  This brief report has used abstracts from research studies and therefore the quality 
of the research has not been reviewed. The brevity of the abstracts meant that 
interventions were not fully explained and described and potential confounding 
factors for the success of interventions possibly not identified. 
  The majority of the studies examine the effectiveness of interventions as early as 6 
weeks from the time of injury and less from 3 to 6 months after injury. There were 
few studies identified which looked at interventions for injured persons who had 
been absent from the workforce for longer than one year. 
  Many studies related to sickness, rather than specifically to injury. Although many 
studies focused on low back pain or non specific musculoskeletal disorders, they 
cannot be applied to all injury disability. 
  The literature search did not reveal any information specific to New Zealand and 
therefore compensation schemes and methods of intervention may not be 
consistent with the New Zealand context. There were no studies identified relevant 
to Maori and the area of cultural appropriateness of different interventions may 
need to be explored. 
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depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time 
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Environmental Medicine
2. Kool J, Bachmann S, Oesch P, Knuesel O, Ambergen T, de Bie R, et al. Function-
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3. Kosny A, Franche R-L, Pole J, Krause N, Cote P, Mustard C. Early healthcare provider 
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4. Rasmussen K, Andersen JH. Individual factors and GP approach as predictors for the 
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following surgery. Occupational Medicine (Oxford) 2007;57(7):488-91. 
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6. Loisel P, Durand M-J, Baril R, Gervais J, Falardeau M. Interorganizational Collaboration 
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8. Ouellette V, Badii M, Lockhart K, Yassi A. Worker satisfaction with a workplace injury 
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9. Schweigert MK, McNeil D, Doupe L. Treating physicians' perceptions of barriers to 
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10. Kominski GF, Pourat N, Roby DH, Cameron ME. Return to work and degree of 
recovery among injured workers in California's Workers' Compensation system. 
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11. Staal JB, Rainville J, Fritz J, van Mechelen W, Pransky G. Physical exercise 
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insights and opportunities for improvement. Journal of Occupational Rehabilitation 
12. Proctor TJ, Mayer TG, Gatchel RJ, McGeary DD. Unremitting health-care-utilization 
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13. Anema JR, Steenstra IA, Bongers PM, de Vet HCW, Knol DL, Loisel P, et al. 
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15. Hlobil H, Staal JB, Twisk J, Koke A, Ariens G, Smid T, et al. The effects of a graded 
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16. Hlobil H, Uegaki K, Staal JB, de Bruyne MC, Smid T, van Mechelen W. Substantial 
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17. Johansson G, Lundberg O, Lundberg I. Return to work and adjustment latitude among 
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18. van Duijn M, Burdorf A. Influence of modified work on recurrence of sick leave due to 
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19. MacEachen E, Clarke J, Franche R-L, Irvin E, Workplace-based Return to Work 
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21. Shaw L, Domanski S, Freeman A, Hoffele C. An investigation of a workplace-based 
return-to-work program for shoulder injuries. Work 2008;30(3):267-76. 
22. Ossmann J, Amick BC, 3rd, Habeck RV, Hunt A, Ramamurthy G, Soucie V, et al. 
Management and employee agreement on reports of organizational policies and 
practices important in return to work following carpal tunnel surgery. Journal of 
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23. Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, et al. 
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24. Post M, Krol B, Groothoff JW. Work-related determinants of return to work of 
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25. Skisak CM, Bhojani F, Tsai SP. Impact of a disability management program on 
employee productivity in a petrochemical company. Journal of Occupational & 
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26. Soeker MS, Wegner L, Pretorius B. I'm going back to work: back injured clients' 
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27. Lund T, Labriola M, Christensen KB, Bultmann U, Villadsen E. Return to work among 
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28. Bartley M, Sacker A, Clarke P. Employment status, employment conditions, and 
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29. Shaw WS, Huang Y-H. Concerns and expectations about returning to work with low 
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56. Amaral RAd, Malbergiera A. [Evaluation of a screening test for alcohol-related 
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