Trr re organization of disability benefits system
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Val Lougheed Northern 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 * [email protected]
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Val's presentation at the University of Calgary -- Social Construction of Disability and Health Course; Paradigms, Policies, Systems and Outcomes
Transcript of Trr re organization of disability benefits system
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 * [email protected]
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
