Behavioral Interventions to Help Workers Keep their Jobs after an Injury or Illness

For many individuals with health problems that threaten their ability to work, the decision to leave their jobs—either permanently or temporarily—is often made without fully understanding the short- and long-term effects of joblessness on their health and well-being. As a result, many of these individuals leave the workforce before they have fully explored the possibility of staying employed, which is often the better option for their long-term financial and psychological well-being.

The affected workers may find it difficult to make career decisions owing to stress, the decision’s complexity, and financial or physical hardship. In addition to the stress of having developed a mental or physical disability, the worker may experience financial pressure from lost earnings, loss of identify and self-esteem, stigma, and strain associated with disruption of family or home-life roles and norms due to the health issue. Difficulty making decisions is particularly true of those choices involving trade-offs between present and future rewards. Individuals may incorrectly believe that their current limitations will persist in the future, or have mistaken beliefs about likely economic, health, and psychological outcomes associated with work compared to benefits.

Moreover, the sources that those unable to a make a decision often seek information from face barriers themselves to providing sound advice. Physicians, for example, may not be aware of available supports that can help workers stay in their jobs, or may have limited time and attention to devote to issues outside the patient’s immediate medical concern. Employers, who typically base actions on costs and benefits, may underestimate the benefits of job retention or overestimate the costs of providing workplace accommodations.

This summary is of a policy brief and report by Kara Contreary and Irma Perez-Johnson under the Stay-at-Work/Return-to-Work Collaborative at the US Department of Labor that presents results of a review of interventions aimed at the retention or return at/to work of those newly affected by a disability. Based on the behavioural bottlenecks that can occur following the onset of a new physical or mental condition that threatens work, the authors identified a range of possible intervention strategies. Informed by behavioural principles, these interventions have potential to promote job retention by addressing common issues and shortcomings that result in workers exiting the labour market to enrol in long-term disability.

Examples of promising practices focused on overcoming behavioural bottlenecks faced by the various stakeholders include the following:

  • Worker: provide work coach and financial counselling or incentives: provide sessions with a coach or advocate whose goal is to obtain the best outcome for the worker; include referrals to services through employee assistance programs or employer resource networks and websites on disability; offer financial counselling or advice that is delivered as part of the coaching sessions; provide a financial incentive to return to work as part of the coaching sessions, such as rewards for attaining milestones in a return-to-work plan or bonus payments for returning to work.
  • Multiple stakeholders: hold multi-party dialogues: bring the disability benefits representative, worker, medical representative, and employer together to discuss the worker’s ability to remain in the job.

This research report would be of interest to practitioners and program designers interested in assisting workers newly affected by mental or physical disability to stay at or return their job.


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