Val LougheedNorthern Lights Canada

Real Work * Real People * Real Results

Paradigms, Policies, Systems and Outcomes

The Re-Organization of the Disability Benefits

System

1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca

The Medical Model1600’s – Rene Descartes (philosopher)

Disease

“pathology of a part that is identified by objective criteria”

(Barbour, 1995, p. 10)

Impairment

• “a loss of, or loss of the use of….any body part, system or function”

• relates to a specific function

(Zabrodski, 1999, pp. 49 & 52)

Disability

• “loss of capacity to meet personal, social or occupational demands”

• relates to a specific role

(Zabrodski, 1999, pp. 51 & 52)

Handicap

• result of an impairment or disability that limits or prevents the fulfillment of one or several roles regarded as normal

• activity limitation; participation restriction

(WHO, 1980; ICF, 2001)

Impairment

Predicts

Disability

Focus ► Person and their

Disability

Health Care & Rehab ►

Fix The Person

Disability Policy Objectives -Art and

Science

• Rehabilitation Services

• Financial Compensation

Disability Policy Objectives -Art and

ScienceRehabilitation Services

“empower and enable consumers to act effectively in a spirit of self-reliance”

(Hope, Timmel and Hodzi, 1985)

Disability Policy Objectives -Art and

ScienceFinancial

Compensation

…ensures that you continue to be able to “meet your daily financial needs”

(Great-West Life, 2010)

Combining Art and Science

“twin but potentially contradictory goals”

“how to reconcile these twin goals has yet to be resolved”

(OECD, 2004, p. 3)

Disability Benefits System

1. Measure impairment2. Translate impairment into

disability3. Compensate for loss -- $$4. Fix person so they can work again

Rehabilitation and Return to Work

1. Directed by physician 2. Rehab – facility-based

3. RTW – ‘Fitness to Work” statement by physician

George Engel

The Need for a New Medical Model: A

Challenge for Biomedicine

(Engel, 1977)

Biopsychosocial Model

The Medical Model “assumes disease to be fully accounted

for by deviations from the norm of measurable biological (somatic) variance. It leaves no

room…for the social, psychological and behavioural dimensions of life”.

(Engel, 1977. p. 130)

New Definition -- Disease

“pathology of a part that is identified by objective criteria”

(Barbour, 1995, p. 10)

New Definition -- Impairment

• “a loss of, or loss of the use of….any body part, system or function”

• relates to a specific function

(Zabrodski, 1999, pp. 49 & 52)

New Definition -- Disability

“a complex phenomenon, reflecting the interaction beween features of a person’s body and features of the society in which he or she lives”

(http://www.who.int/topics/disabilities/en/)

New Definition -- Handicap

a condition that “creates obstacles to accomplishing life’s basic activities and if these obstacles can be overcome only by compensating in some way for the effects of the impairment”

(Zabrodske, 1999, p. 52)

Nordenfeldt (2003) says…

• Disease and Impairment ► Medicine and Health

• Disability and Handicap ► Action Theory and Social Science

Disability and Handicap

Only have meaning when associated with action and placed in context

► doing something, somewhere

► must understand the something and the somewhere

(Nordenfeldt, 2003)

Impairment

does not Predict

Disability

Focus ► Disabling Factors not

Disability

1. Person 2. Environment

3. System

Disability Policy Objectives Redefined

Rehabilitation Services

BPS Model “captures factors that more directly relate to functional recovery”.

(Loisel, 2009, p. 97)

Disability Policy Objectives Redefined

Financial Compensation

“The vast majority of people…who take up disability benefits never return to

work.”

(OECD, 2009, p. 19)

•Disability does not equate with ‘unable to work’

•Financial compensation should support RTW efforts

(Loisel, 2009, p. 97)

Another New Definition – Work Disability

“preventable absence or withdrawal from work [which is] disruptive, potentially harmful and costly both to the employee and the employer”

(ACOEM – Ontario Summit to Prevent Work Disability, 2010, p. 5)

Disability Benefits System

SAW/RTW

Rehabilitation and Return to Work

Holistic Problem Solving1. Person 2. Environment

3. System

Person

Impairment plus•Personal circumstances

•Social supports

Environment• Lack of modifications or

accommodations

• Psychological (fears, anxiety, depression, distress)

• Social (perceived demands, perceptions of co-workers)

• Discrepancy between demands of the work and capabilities of the worker

(Loisel, 2009, p. 97)

System

“benefits system itself has a disabling effect on people”

(OECD, 2009, p. 17)

Iatrogenesis

VIDEO CLIP Viktor Frankl video

http://www.youtube.com/watch?v=fD1512_XJEw

15 to the end

Rehabilitation Strategies in a BPS

System

S.P.I.C.E.

IT

UP!

Simplicity

Proximity

Immediacy

Centrality

Expectancy