Each year, JobAccess, an Australian Government initiative delivered by WorkFocus Australia, manages funding applications for equipment, training or workplace modifications to break down employment barriers for people with disability. Employers are concerned by the perceived cost of employing people with disability - a 2011 AHRI survey found that only 14.83% of respondents believed that there was no perception in their organisation that employees with a disability are high risk or potentially expensive – and many employers are not aware that the Australian Government funds eligible requests placed via JobAccess. The analysis in this paper shows just how much of a difference can be made with just $1,000… not that much money when the upside is creating sustainable employment for people with disability. This paper breaks down what can be achieved with this sum and has wider applications for employers, employment providers or countries considering implementing such a programme. JobAccess is a free service to Australian employers and people with disability and, as well as administering the Employment Assistance Fund, it provides advice and support on all matters disability employment.

Objectives: We investigate the prevalence of poverty across different workers compensation programs using large representative samples of workers’ compensation claimants who have sustained a permanent impairment from a work injury. The programs, which have existed in the provinces of Ontario and British Columbia, Canada over the last 25 years, are the Permanent Disability (PD) program, the Future Economic Loss (FEL) program, the Loss of Earnings (LOE) program, and the Bifurcated Benefits (BB) program. The nature of benefit determination and the return to work supports provided by the four programs are very different. The focus of the study is on evidence of programmatic impact on the probability of poverty in the nine years post injury.

Methods: The study included claimants sampled from each of the four programs who sustained a permanent impairment from a work injury. Claimants were identified in a Revenue Canada tax database know as the Longitudinal Administrative Databank (LAD), which is a longitudinal 20% simple random sample of all Canadian tax filers. Each claimant was matched with similar uninjured controls that were also in the LAD, based on sex, age, labour-market earnings amounts and trajectories in the four years prior to injury, family income, marital status, number of children, and a propensity score. Descriptive analysis was undertaken to compare near poverty, poverty and deep poverty levels of claimants relative to their match controls using data on family and individual earnings over a ten-year period post injury. Statistical modeling was used to determine the probability of poverty and near poverty for claimants versus controls. A key issue of interest was to determine was whether the probability of poverty differed between programs.

Results: Based on after-tax adjusted family income, the level of poverty was quite low, less than 2% in every program over a ten-year period. The level of poverty was also lower for claimants than their matched controls, but only nominally so. The BB program had the lowest proportion of poverty followed by the PD program, the FEL program and then the LOE program. In the statistical modelling analysis male claimants did not have a higher probability of poverty compared to controls, though female claimants did. Both male and female claimants had a higher probability of near poverty.

Conclusions: Poverty levels are very low for workers’ compensation claimants who sustain permanent impairments from a work injury across different programs and time periods in Ontario and British Columbia. Overall the Bifurcated Benefits program from British Columbia had the lowest proportion of claimants in poverty in absolute terms and relative to non-injured workers. Increased levels of poverty due to work injury and permanent impairment are particularly a concern for female claimants, though both female and male claimants have a higher chance of near poverty compared to non-injured workers.

Objective: The study aims to explore factors of workplace injury and chronic illnesses patients in a return to work program which are associated with return to work outcomes.

Design: A retrospective cohort study. Setting: Return to Work Department, Social Security Organisation, Malaysia. Method: All participants of the Return to Work Rehabilitation Program who were absent from work due to workplace injury and chronic illnesses between January 2008 and December 2013 with no other history of injury were included. The main outcome of the study was the number in days from day one of injury prior to return of gainful employment. Hierarchical multiple regression methods were used to determine the identified factors that influence the return to work outcome.

Results: An initial study with data from January 2008 and December 2011 of cases with occupational injury showed 66% (n = 1,552) of the participants had returned to work. The average number of days to return to work was 201 days. Hierarchical multiple regression analysis identified duration of referral to the Return to Work rehabilitation program, monthly salary, Whole Person Impairment ratings, DASS 21 anxiety and DASS 21 stress scale as factors that influenced return to work, explaining 32% of the variance. However a continuous for the remaining cases such as cases with chronic illnesses will be included in the final results of this study.

Conclusion: Currently, a total of 66% participants had returned to employment after occupational injury. It is essential to understand the complex pathway from the point of injury and illnesses until returning to work in order to develop more effective return to work practices.

Nigeria is made up of not less than 250 divergent ethnic nationalities and since independence in 1960 has had no success in reducing social inequality, social injustice and achieving even development, especially as it affects the disabled in our society. Furthermore, the neglect of the disabled is deliberately nurtured and sustained by the activities of the government, the ruling class and certain dominant social groups.

This presentation will contend that if the existing widening gap between the rich and poor remains unchecked, the long term implication will be widespread instability that will lead to further disadvantage of the less privileged (including the disabled) in Nigeria. Although the future does not look bright, there are certain measures that can be put in place that can form the bedrock for instituting a society where every individual is recognised, nurtured, their full potential is developed and are given equal opportunity.

Improving client outcomes whilst maintaining scheme sustainability In 2010 the Transport Accident Commission commenced its journey in placing Client Outcomes as a corporate objective alongside those of Scheme Viability and Client Experience. It was widely agreed to be the right thing to do but also took a leap of faith in that the impact of this focus on the more established scheme measures was at that time unknown. Through the use of both quantitative and qualitative data analysis, this presentation aims to review the hypothesis that including Client Outcomes as a corporate objective would strengthen the management of scheme viability and client experience.

Deinstitutionalisation of Kew Residential Services (KRS) residents proceeded group by group and took place from October 2002 to April 2008. Residents relocated into either newly built or pre-purchased houses located across Melbourne. In Australia and other developed countries, limited studies suggest that people with intellectual and physical disabilities relocated into group homes have poor social integration into a community.

This presentation is based upon findings from a quantitative research project aimed to investigate neighbours’ attitudes towards people with intellectual and physical disabilities living in the Inner Southern Region of Melbourne, who relocated to group homes after closure of KRS. The administered check list questionnaire contained three main parts, including (1) participants’ socio-demographic details, (2) information and strategies neighbours being introduced with the group home people, and (3) the Interaction with Disabled Persons (IDP) Scale. A total number of 290 participants whose properties located in the Inner Southern Region of Melbourne were randomly identified for participation in this study. The collected responses were analysed, applying descriptive statistics, bivariate analyses, trivariate analysis, and multivariate analyses.

The results of bivariate analyses revealed a statistically significant association between frequency of face-to-face contacts with the group home residents and neighbours’ attitudes towards them, indicating that neighbours who had contacts with the group home residents on a daily/weekly basis had more positive attitudes towards them than the neighbours who had contacts on a less frequent basis. Other variables that were identified as important in bivariate analysis were age, marital status and employment status, and were used in multivariate analysis.

In order to ensure the success of medical and occupational rehabilitation, the BGW – the occupational insurer – offers its clients to accompany them at the workplace. This aims at transferring the working methods, which the rehabilitant has acquired during rehabilitation and are therefore partly new to him, into operational practice and at verifying their fitness for practical applicability. Apart from that, this shall facilitate to identify factors jeopardizing reintegration and to beneficially influence them, if possible.

Work is resumed with the approval by the client in question and their employer, accompanied by a specialized workplace attendant. Depending on the severity of the health impairment and on the prevailing contextual factors, such care is provided on an hourly or daily basis for one or up to several weeks.

Thereby, the workplace attendant refers the client to the most reasonable and gentle mode of working that is possible. Moreover, the workplace attendant takes care of potential difficulties arising during the stage of resuming employment, in order to work out strategies early on for ensuring the success of rehabilitation and for transferring such strategies to operational practice, jointly with all parties involved, including the BGW rehab managers.

The potential need for qualification, following the motto of “Occupational placement comes before qualification”, is thereby identified at an early stage and in a purposeful way.

Principal Experience and Summary: Workplace care facilitates highly practice‐oriented reintegration; Difficulties in the reintegration process are identified at an early stage; Workplace accompaniment gears prevention very effectively to rehabilitation. Clients as well as employers perceive such support provided by the BGW as being sensible and helpful.

Disability management (DM) is quite a fresh idea to Mainland China (Mainland). The government has thus turned to professionals from outside Mainland, i.e. Hong Kong (HK). Nevertheless, since HK is under ‘one country, two systems’ policy, it has developed an approach differing from that of Mainland. A DM pilot study was jointly conducted by the Guangdong Provincial Work Injury Rehabilitation Center (GPWIRC) and the Hong Kong Workers’ Health Centre (HKWHC) to review the developments of DM reform in China and HK. In China, the foundation of DM approach is the work injury insurance system. Under this system, GPWIRC established her services to provide work injury prevention and occupational rehabilitation as a pilot study in early 2000s. Following this pilot project, GPWIRC further develops work and social rehabilitation and work injury prevention in the context of the labor insurance system. While in HK, mainly NGOs, insurance companies and some public organizations contribute to the promotion of DM approach. On the other hand, the study also reveals similar challenges that Mainland and HK are currently facing in the development of DM, such as professional's training in local rehabilitation, the underdeveloped reimbursement system and etc.. The aforementioned pilot study shows that DM's principles are accepted at a national level and some specific public organizations in China context. There thus is a research need to study the current DM development situation in the private sector. By doing so, an ongoing study, namely “Demographic change and private sector disability management in Australia, Canada, China and Switzerland. A comparative study” launched in Nov. 2013. Through this research, questions of process and procedure of the DM system used in the company, benefits gained and drawbacks encountered by the companies, and the strengths and weaknesses in the current DM systems will be answered. Other than that, data will also be collected from the employees’ perspective on their job satisfaction, physical and mental health, employee morale and workplace attendance and etc.. The primary result is expected in 2016.

Background: Despite the utilisation of best practice when delivering services, disparities in outcomes exist across ethnic groups. Access to and uptake of services is considered to contribute to these disparities which inhibits the ability of people with disabilities to participate in life to fullest extent. Objective: To investigate barriers experienced by minority cultures when accessing health services and ways in which these barriers can be overcome. Methods: Interviews with clients with spinal cord impairment who belong to minority ethnic groups, service providers and sector experts.

Findings: Multiple barriers exist when accessing services; they include language, cultural characteristics and views of disability and appropriateness of services. Culture can have an effect on the whole continuum of care from how the disability is interpreted by the individual and/or family, how they respond to care, their understanding, communication of needs, engagement with the process, and the opportunities to re-connect and participate within their communities. Community providers are aware of the needs of their clients and have strategies to overcome these barriers, however they work in isolation from funding bodies and other organisations and there is a lack of a framework or model that can guide and inform organisations and providers.

Discussion: While the research identified a multitude of barriers that can impede access to and uptake of services to people belonging to minority ethnicities, community knowledge can be utilised to overcome a significant number of barriers.

Conclusion: A number of recommendations are made to improve access to and uptake of health services including a strategic approach, interagency collaboration, cultural competency training, cultural brokering and disability awareness within the community.

The study of social enterprise development model for people with disability aimed to establish a fundamental knowledge to apply the concept of social entrepreneurship to enhance the quality of life for the disabled as well as to provide them with the capacity building. Equally importantly was the development of social enterprise sector particularly for those with impairment in Thailand based on the local context and pattern appropriate together with research in order sustain the model for the benefit of people with disability in the country. This research investigated case studies of social enterprises for those with disability from various businesses including group of disabled agriculturalists who operated a Goat Farm in Rayong Province, The Center for Intellectually Disabled Innovation as well as Betimes Solution Co.,Ltd. The study implemented literature review, in-depth interview, questionnaire as well as observation. Summary of the study is presented below. 1. Models of social enterprise based on case studies were different. This could be classified by using the three major components including organizational mobilization, stakeholder engagement and profit management. The study revealed that group of disabled agriculturalists who operated a Goat Farm in Rayong Province could be categorized as a philanthropic model while Betimes Solution Co.,Ltd could be regarded as a commercial pattern. Center for Intellectually Disabled Innovation, on the other hand, comprised of a hybrid model. All of these signified the fact that social enterprise development model could be various. 2. Key social enterprise factors for the business engaged with disabled people based on the case studies could be ranked with three major components including competitive advantage to compete with other businesses and sustain themselves, social entrepreneurship to be able to achieve both financial and social mission effectively with skills, knowledge and confidence and lastly stakeholder engagement to manage the relationships with key partners and become accepted by all parties concerned.

Twenty years ago, those of us in the allied health field were trained to believe that mature people didn't lodge workers’ compensation claims and mature workers didn't have injuries because they ‘knew their work environment so well’. Only 7 years ago, insurers believed that their book of claims in Workers’ Compensation had no age related correlation to claims costs. We now know that all of these assumptions do not stand up in relation to the current workforce in Australia and we are building a wealth of knowledge about the mature cohort in today's workforce.

This presentation will guide the audience through the process of developing a compelling business case to assist employers understand the cost benefit of proactively engaging with their mature employees and the benefits for both the workers over fifty five years of age and businesses in Australia.

In developing a business case, the first stage of a strategy is being formulated for the care and well-being of mature workers, this leads to preparedness for effective return to work measures in the event of injury and health maintenance strategies for mature workers. The side benefits to a business are vast; from reduced turnover and associated costs, the retention of knowledge to reduced insurance costs and productivity benefits.

Five years of analytical data will be presented to demonstrate the trending, the influences and precautionary tales for those committed to the psychological well-being of the mature workforce in Australia.

Aboriginal and Torres Strait Islander people carry a high disease burden with a consequent reduced life expectancy. There are reduced opportunities for conventional employment with further difficulties if the person has a disability. Nevertheless meaningful participation in community activities can occur. This paper will explore these issues giving examples of how this can be facilitated.

Background: General Practitioners complete around 91% of compensable certificates, and play a significant role in promoting the awareness of the health benefits of work. The Australasian Consensus Statement on the Health Benefits of Work developed by the Australasian Faculty of Occupational and Environmental Medicine (AFOEM) has been endorsed by 100 organisations including the Royal Australian College of General Practitioners (RACGP). The Victorian WorkCover Authority and TAC has undertaken a program of work focussing on the delivery of a general practice education and awareness raising program.

Objectives: The objectives of the program were to; engage Medicare Locals to undertake a general practice education and awareness raising program, develop training materials for Medicare Local staff to undertake practice liaison visits, recruit and train General Practice peer educators to deliver in-practice education and develop and deliver content for continuing professional development events in selected Medicare Locals.

Methods: A suite of educational resources were developed and tailored to suit delivery in a General Practice setting. The Medicare Locals were targeted if they had high certification rates, the educational events were delivered in-practice settings and Principal findings The practice target was reached in all Medicare Locals, a total of 457 general practices across the five Medicare Locals were visited. The program was successful in raising awareness of the health benefits of work amongst GPs and practice staff.

Discussion: The education has given general practitioners the impetus to talk to patients early about the health benefits of work and has the potential for GPs to be more confident in their clinical management of compensable patients.

Conclusion: That the educational program continue with the Victorian WorkCover Authority and TAC working with key peak bodies and medical colleges to ensure education about the Health Benefits of Safe Work become a mandatory component of all GP postgraduate training.

The NDIS introduces changes to the level of control, choice and flexibility that persons with a disability can exercise over the services they require to support their individual needs. One of the main stays of NDIS is the ability for persons with a disability to utilise allocated funding how and with whom they choose to create a package of supports. Coinciding with the move towards the NDIS has been the introduction of the NSW WHS Act 2011. This Act introduces and broader new definitions relating to persons with responsibilities for ensuring health and safety at work. In some circumstances the individual person with a disability will be a direct employer, or an “other” in the workplace, and will take on responsibilities for health and safety for persons working in their home. For government organisations making funding decisions and allocating funds for the purchase of support services, there continues to be an obligation to ensure that services are conducted safely with risks to health adequately managed. NSW FACS can not “contract” out of their obligations. Instead we must work in partnership with all stakeholders to manage WHS risks as far as is reasonably practicable. Our role in government means we have the resources, experience, and must respond to the community expectation that we will support persons with a disability to understand and discharge their WHS obligations as far as is reasonably practicable. This is a way of operating presents the following questions: Do persons with disability understand the WHS obligations and risks associated with their care and supports? How to individuals with disability obtain sound advice and information on WHS risks that may be associated with their care arrangements? Can WHS information and resources that organisations like NSW Department of Family and Community Services (Ageing Disability and Home Care) have established be leverages to share with our “clients”? As Government partners in NDIS are we obligated to share our knowledge and information? What is the best way to bridge the gap in understanding and what types of information, tools and training can be made available on WHS for persons with a disability.

A Joint WHS project currently underway within NSW FACS seeks to address the information and resources gap for all clients who participate in self directed funding arrangements (including NDIS). Our project will demonstrate how products and advice developed for internal staff use can be “reframed” and made accessible to persons with disability, their carers and individual service providers. The approach being applied within NSW FACS will potentially reduce costs in persons with disability being required to engage additional services to seek and develop WHS direct guidance and tools. The project being undertaken will deliver face to face training models, e-learning components and online information and tools to assist stakeholders in the NDIS and other Direct Funding Arrangements within NSW, to make informed decisions regarding WHS risk in the provision of care and support services. Guidance and information is provided on key risk areas utilising tested tools & WHS resources within the disability sector. E-learning solutions are made available to inform and train stakeholders of WHS obligations and potential risk management approaches. NSW FACS works with NGO stakeholders to ensure consistent advice and assistance is provided in the area of WHS obligations and performance expectations.

This presentation will focus on history and economic theory perspectives, using benchmark comparisons across Australian jurisdictions and leveraging materials in the public domain. The aim is to assist practitioners refine and manage their NIIS schemes for long term viability and customer/participant outcomes. The presentation will look at the Genesis of National Injury Insurance Schemes in Australia – a brief history of thinking that has shaped NIIS design, scheme Design model and rationale for a NIIS including Rationale for separating the NIIS and NDIS, What the “I” in NDIS really means, the Benchmark comparison of NDIS versus NIIS design feature and the staged approach to migrate to universal accident compensation. Moving on to exploring. NIIS Implementation Update - Motor Accident Compensation including a benchmark comparison - design models in 5 Australian CTP Jurisdiction. And finally a look at Insurance Claims Management vs Disability Management before speaking about the Next steps for NIIS and integration or possible alignment opportunities with the NDIS.

Background: KMG Health Partners has delivered education, consulting and return to work services to a diverse range of international customers and clients since 1996. Our team has been directly involved in the development of standards of practice across several countries, and has had the opportunity to engage with organisations from the commercial and government sector in Canada, the U.K., Iceland, Norway, Austria, Slovakia, Czech Republic, Netherlands, and Sweden.

Hypothesis: KMG has worked with organisations that are in various stages of development in their return to work, absence management, and disability management practices. KMG anticipated there would be common challenges, objectives, and desired outcomes amongst most countries.

Methods: KMG has modified our education programmes in various countries to ensure that the content is consistent with local legislation, policy, and current standards of practice. This has included discussion and analysis on current local practices, and subsequent recommendations for policy development, standards of practice, and service delivery for workers and employers. KMG regularly reviews and incorporates international best practices established by key agencies, including the International Labour Organisation, the World Health Organisation, International Social Services Agency, and NIDMAR.

Findings: Most countries have established or demonstrate a desire to establish best practice principles that are consistent with the 7 principles of effective disability management. Training and education that provides a common ideology for all stakeholders and meets both national and international best practice standards was observed to be a critical component to achieving success.

Conclusions: There are similarities in the challenges, objectives, and desired outcomes across many countries. Variances can be attributed to factors that include government legislation, cultural beliefs, and pre-existing social programmes. The delivery of training and education that meets national and international best practice standards is a critical component in establishing effective policies and best practice in absence and disability management.

Mental health (MH) and disability management (DM) businesses and DM professionals are proficient at addressing employee physical health, yet promoting employee MH is often ignored. Individuals claiming long-term disability (LTD), 85% identified MH conditions as their primary disability (Carls et al., 2012). Mental health LTD expenses are often higher due to longer recovery and challenges in return to work (Salkever, Goldman, Purushothaman, & Shinogle, 2000). Financial burdens of depression, anxiety, and emotional disorders are among the greatest of any disease condition in the workforce (Johnston et al., 2009). Globally, a fifth to a quarter of employees go to work everyday with a mental illness (Lorenzo-Romanella, 2011). Health care research has shown the impact of mental illness on work performance, however many employers and researchers are unaware of the value quality MH care has on employees and costs (Langlieb, & Kahn, 2005). The American Psychological Association (APA) identified five categories of workplace practices that promote psychological health in employees including: employee involvement; work-life balance; employee growth and development; health and safety; and employee recognition (APA, 2014). Organizational benefits of the five elements include: improved quality, performance and productivity; reduced absenteeism, presenteeism and turnover; fewer accidents and injuries; improved ability to attract and retain quality employees; improved customer service and satisfaction; and lower healthcare costs (APA, 2014). The presenters will discuss employer costs of MH claims and how psychologically healthy workplaces align with successful DM programs, decreasing MH claims and costs. Opportunities for future research include the United States Affordable Care Act (ACA) and its impact on MH (Mechanic, 2012) through provisions that encourage employers to adopt health promotion programs (Goetzel et al., 2012) and opportunities for research including comparisons of multinational employers regarding MH costs in countries with single payer systems, and in those without (United States), (Tanner, 2013).

Background: According to the world health organization by 2030 depression will rank first in economic burden in all high-income countries. As behavioural health disabilities continue to increase, disability managers will continue to be challenged to find ways to assist these workers in their effort to return to productivity.

Objectives: The objective of the discussion is to share a specific intervention strategy that disability managers can practically apply to effectively manage those individuals out of work on a behavioural/mental health claim. The process begins through using motivational interviewing to build a relationship so that the claims professional has the opportunity to recognize key intervention points throughout the absence from work. There are three components the disability manager should assess throughout the life of the event. The first is where the person is on the path to the disability mindset. This will help gain an understanding of current motivation for productivity. Disability is often experienced through specific consequence and those consequences can be both negative and positive. They evolve throughout the life of the leave. Recognition of the current consequence can help direct intervention. Finally specific cognitive barriers tend to emerge in the life of the disability such as faulty thinking, fear, or inactivity. If these barriers are not addressed the individual will not return to work.

Methods: A 20-person disability management team with associated clinical and vocational resources is using these techniques among an active block of over 1000 disability claimants. The work started in November of 2013 and there are currently very preliminary findings.

Findings: The results are positive with a reduction n closed duration days month over month. The technique will have been in place 1 year at the time of the conference and as a result more comprehensive data and outcomes will be shared.

The experience of unnecessary suffering as a result of another's actions or the experience of irreparable losses are likely to give rise to perceptions of injustice. Until recently, little systematic research had been conducted on the effects of perceptions of injustice on recovery outcomes following injury. It is now becoming clear that justice-related appraisals can have a dramatic impact on the physical and emotional consequences of injury. High levels of perceived injustice have been associated with more severe pain, more severe emotional distress, and more pronounced disability. Research has also pointed to multiple sources of a client's perceptions of injustice including, the person responsible for the accident, the insurance representative, as well as the health care provider. This presentation will summarize what is currently known about the relation between perceived injustice and recovery outcomes. The presentation will also address the processes by which perceptions of injustice might contribute to adverse health and mental health outcomes consequent to injury. Implications for prevention and intervention will be discussed.

Background: Delivering quality health services in a cost effective manner is becoming an increasingly critical issue for insurance companies and government agencies. The Clinical Framework used as part of peer review has been proposed as an alternative for institutions to control costs and maintain optimal clinical care.

Objectives: To develop a concise set of principles for use by clinicians and regulators to determine the need for treatment within in a compensable setting.

Method: The Clinical Framework was first implemented in 2003 at the Victorian WorkCover Authority as part of peer review of physiotherapy management of injured workers. It consists of five principles that clinicians and institutions use to determine the ongoing need for intervention. The Framework allows clinicians to exercise judgment in selecting treatment with due consideration to the evidence and patient's individual needs. Results: Following its introduction in 2003, it broadened to apply to chiropractic, osteopathy, psychology, and occupational therapy. In 2012 it was endorsed across Australia for motor accident and worker's compensation bodies by the representative bodies of the above disciplines. In 2013 Federal Minister Shorten released a review of the SRC Act which recommended amendments including “medical treatment must meet objective standards such as those in the Clinical Framework.”

Discussion: This paper will discuss some of the issues that have been addressed in implementing the Clinical Framework on over 20,000 files over the past ten years.

Conclusions: The Clinical Framework is a document that has won broad acceptance across the Australian compensable system in allied health as part of sustaining quality care while reducing unnecessary costs.