Author(s):    Stefan Koch and A. Hillert                                                                                 Country:   Germany

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

Stefan Koch and colleagues at the Roseneck Centre of Behavioural Medicine,  Germany, have developed a job-related group-therapy intervention for the treatment of psychosomatic patients with high levels of occupational stress. The overall aim of this intervention is psychosomatic rehabilitation within the context of inpatient treatment. A core objective of the in-patient group therapy is to try and help people with chronic work problems and high levels of occupational stress, illness and disability to return to work; in short, to facilitate a more active participation and reintegration of patients into working life, and to teach sick-listed employees to manage and cope with stress more productively and effectively.

Implementation:

This in-patient group therapy has 8 sessions lasting 90 -100 minutes.  The group is made up of 8-10 individuals comprising of: men and women, individuals from a variety of professions, and with various health problems. Sessions are delivered over a course of 4 weeks: 2 sessions per week. The intervention programme consists of four modules:

• The first module discusses motivation and goal-setting changes in stress-relevant coping behaviour. One of the key components of this module is outlining the link between psychosocial issues and occupational stress, and psychosomatic symptoms: in both their development and maintenance over time.

• The second module examines job-specific social skills and coping with social conflicts at work. Subsequent session(s) is (are) spent utilizing role play exercises; thereby, allowing patients an opportunity to practise and develop the skills acquired during this module.

• The third module discusses coping with acute and chronic stress; specifically outlining both short-term and long-term coping strategies.

The fourth and final, module is entitled ‘job perspective’. This module seeks to discuss strategies and methods to transfer the knowledge and skills acquired through the previous three modules within the context of an inpatient programme into the ‘real world’ and fully integrated into working life.

Practical applications:

This a modular group therapy approach has an establish protocol and manual (recently published in German) making it easily applicable at practical level. Koch and colleagues indicate that this intervention’s protocol demonstrates a high level of adaptability to various kinds of clinical and counselling settings.  Additionally, the authors suggest that in order to implement this group therapy intervention effectively, the intervention leader/trainer requires a basic therapeutic background and established knowledge.

Innovative aspects:

The job-related group therapy intervention is the first clinical inpatient-treatment focussing on occupational stress management.

Evaluation (including process issues, outcomes and sustainability):

Patients in the intervention group were compared to patients in a standard symptomatic therapy only group. Measurements were taken at three time points: at admission, discharge, and at 12 months post-treatment follow up. A variety of measurements were taken: assessing the objective work environment (work status, sick days, applications for early retirement) and subjective estimates of intensity of work stressors, individual coping skills, and satisfaction with treatment.

Benefits (including cost effectiveness):

The results of the evaluation of the intervention, as compared to the standard symptomatic therapy, at 12 months post treatment assessment, demonstrate that participants were more likely to:

·         maintain work and a reduction in the demonstrated intention to apply for early retirement; 

·         a reduction in a type of coping related to ‘burn-out’;

·         and demonstrate increased satisfaction with work–related aspects to treatment (namely, occupational stress, and conflicts with colleagues).

Both treatment groups (intervention and standard group therapy) resulted in increased job satisfaction, experienced increased control at work; and an observed significant reduction in social stressors at work and occupational worries.

References:

Koch, S. & Hillert, A. Occupational stress management in tertiary prevention: Controlled evaluation of an inpatient program. In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Paper of the European Academy of Occupational Health Psychology 7^th edition (pg.138-139). Edicoes ISMAI: Castelo da Maia, Portugal.

Comments:

The protocol for this intervention has recently been published as a book; however, currently it is only available in German.

Author(s):  Marina Heiden, E. Lyskkov, M. Nakata, K. Shlin, T. Shalin & M. Barnekow-Bergkvist                 Country:   Sweden

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The focus of the programme was to use cognitive restructuring and behavioural modification techniques to improve participants’ self-care strategies, namely coping with negative emotions, increase health promotion behaviour (regular relaxation and physical exercise), improve eating and sleeping habits, and social support through building support networks. The intervention contained a series of seminars, group discussions and required daily practice of skills. Additionally, participants were asked to formulate a life-guiding plan and to participate in the support network for the group.

Implementation:

The cognitive behavioural training programme comprised of 2 three-hour group sessions per week for 10 weeks, and was based on a manual that was distributed to all participants. Each session contained an educational element with an additional task given as homework. A variety of topics relating to stress, its causes, consequences, and management strategies were outlined and discussed (for full content of cognitive behavioural training programme see Heiden et al., 2007). The majority of sessions were structured with a group discussion in regards to the assigned homework at the beginning, followed by an educational part, followed by the assignment of new homework. Over the course of the 10 week programme, participants were asked to keep a homework diary.

Practical applications:

The sessions were led by a stress management consultant with extensive experience and knowledge of rehabilitation of patients with stress-related illnesses. Additionally, the cognitive behavioural training programme was not conducted within a given workplace. Individuals participating in the intervention came from a large variety of occupational sectors, professions, and sizes of enterprises.

Innovative aspects:

The programme uses cognitive restructuring and behavioural modification techniques to improve participants’ self-care strategies, coping strategies and the return to work of individuals on sick leave due to stress-related sick leave.

Evaluation (including process issues, outcomes and sustainability):

The effects of the cognitive behavioural training programme were comparatively assessed to a physical activity programme and with usual care. Both objective (including autonomic activity, pressure-pain threshold) and subjective measurements of ratings of health and behaviour were made. Assessments of patients occurred at four time points: pre-intervention, post-intervention, 6 months and 12 months.

Benefits (including cost effectiveness):

Directly following the intervention minor differences were observed in the objective (physiological) measures that were found between groups. Patients in the cognitive behavioural training group improved their ratings of general health as compared with the physical activity group throughout the study.

References:

Heiden, M., Lyskkov, E., Nakata, M., Shlin, K., Shalin, T., & Barnekow-Bergkvist, M. (2007). Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: A randomized controlled study. Journal of Rehabilitation Medicine, 39, 366-373.

Comments:

Several of the minor differences observed during the evaluation of the intervention were not maintained at follow-up assessments (at 6 and 12 months).

Author(s):  David S Rebergen, David J Bruinvels, Allard J van der Beek & Willem van Mechelen               Country:  Netherlands

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

In early 2000, the Dutch Association of Occupational Physicians (NVAB) published a set of guidelines concerning the management of employees with mental health problems by occupational physicians. These guidelines are based on national-driven evidence and aim to promote the active attitude and activating approach by occupational physicians. Specifically, the guidelines seek to teach occupational physicians how to identify and diagnose mental health problems, and in turn how to facilitate and provide early intervention by using counselling techniques, positive behavioural instruments and return to work. Within the guidelines, return to work is viewed as part of the recovery process; not solely as the desired outcome.

Implementation:

Occupational physicians were provided with training on the guidelines and in their effective implementation in a three day course.  The training course reflected the structural components of the guidelines; namely, occupational physicians were trained in multiple cognitive-behavioural prescriptive interventions (with the overall aim of promoting problem solving skills and to structure the patients’ daily activities), and were trained to diagnose mental health problems using a simplified classification system as outlined in the guidelines. Additionally, occupational physicians were trained on delivering a graded activity treatment: phase 1, educating patients on the causes and consequences of loss of control; phase 2, patients are asked to create an inventory of stressors and to develop problem solving strategies to address these stressors; and phase 3, patients are asked to put these problem solving strategies into practice and extend their activities to include more challenging and demanding ones.

Practical applications:

The guidelines are outlined and detailed in a protocol, making it easily accessible to all occupational physicians. The delivery of the training course, to further inform and develop the implementation of the guidelines, was conducted by four professionals: including an occupational physician with experience on the guidelines, a psychologist/therapist, an experienced general practitioner/researcher on emotional distress, and a psychiatrist. The guidelines have been widely distributed to all occupational physicians, in a large variety of occupational sectors; however, they have only been formally evaluated in the police force.

Innovative aspects:

The use of a non-regulatory approach in psychosocial risk management, specifically in rehabilitation of workers with mental health issues and problems; with the overall objective of facilitating increased return to work.

Evaluation (including process issues, outcomes and sustainability):

The effectiveness of the guidelines was tested by randomly assigning participants to two groups: those who were treated by occupational physicians trained in delivering treatment in accordance to the guidelines; or to a group receiving usual care, consisting of minimal involvement from the occupational physician and, if applicable, access to the services of a psychologist. These two groups were comparatively assessed on a variety of outcome measures to determine their effectiveness. The primary outcome measures used to assess the effectiveness of the guidelines were levels of depression and anxiety, return-to-work, treatment satisfaction measured in all key stakeholders (patient, employer and occupational physician), and the overall cost-effectiveness of the programme (specifically, assessing both the direct cost to health care and the indirect cost associated to the consequences of absence from work). Additionally, the compliance and adherence level of occupational physicians to the implementation guidelines was examined. Measurements were taken at four time points: pre-intervention, post-intervention, at partial/full return to work and at a one year follow up point to assess the effectiveness of the guidelines and the sustainability of the observed effects.

Benefits (including cost effectiveness):

Presented observed benefits are preliminary findings as the study and its analyses are currently on going. The observed benefits resulting from the use of the guidelines by occupational physicians in the treatment of individuals on sick-leave due to stress-related illness were:

• A significant difference can be observed in return to work. 

• Occupational physicians reported a higher level of treatment satisfaction, and preferring to work according to the guidelines.

• The guidelines were found to be more effective for minor mental health disorders (like stress related disorders); however usual care was found to be more effective for more severe disorders (in part due to the easier access to a psychologist).

The cost-effectiveness measurements suggest that the guidelines have a positive effect.

References:

Rebergen, D.S., Bruinvels, D.J., van der Beek, A.J. & van Mechelen, W. (2007). Study Protcol: Design of a Randomized Controlled trail on the effects of Counselling of Mental Health problems by Occupational Physicians on Return to Work: the Co-op Study. BMC Public Health: BioMed Central Open Access, published July 26 retrieved from http://www.biomedcentral.com/content/pdf/1471-2458-7-183.pdf

Comments:

One primary result of the preliminary investigation of the implementation and effectiveness of the guidelines was the observation that mental health problems in the workplace were highly prevalent; and, moreover, were more prevalent than previously believed by the occupational physicians.

Author(s):   L. Havewald, K. Österburg, G. Abjornsson, B. Malmberg, B. Larsson, & B. Karlson           Country:  Sweden

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The overall aim of this intervention is to reduce the mismatch between the individual and their working conditions. The target group for this intervention are individuals on sick-leave due to stress reactions or exhaustion; due to chronic occupational stress or a combination of occupational stress and private stress. The core element of the intervention is dialogue between the patient and their manager/supervisor, which is solution-orientated, but also considers both the causes of stress and possible hindrances within the patient’s work environment.

Implementation: 
 

The intervention consisted of five steps:

• Firstly, an interview was conducted to determine whether the sick leave is work-related or not.

• Secondly, if the individuals’ sick leave is determined to be work-related, the individual is assessed by a team of professionals: a doctor, psychologist and the project coordinator.

• Thirdly, a semi-structured interview with the patient’s manger is conducted.

• Fourthly, a common dialogue between the patient and the manager is initiated, with an overall focus on deriving solutions and an overall action plan for return to work, whilst also considering both the possible causes of stress and hindrances in the successful return-to-work. The aim of this meeting is to facilitate and establish common goals through communication in complex or difficult situations.

The final stage of the intervention is a 3-hour education about work, stress and coping strategies for prevention for a group of patients, and for groups of managers from the patient’s worksite.

Practical applications:

A multidisciplinary team of professionals is required to conduct the employee’s sick leave assessment; additionally, a trained professional to facilitate the dialogue between the employee and their manager. Individuals that participated in the intervention were from a large variety of occupational sectors; indicating the intervention’s applicability across occupational sectors.

Innovative aspects:

The intervention uses the concept of social dialogue to initiate a solution-orientated approach; developed through active communication between patient and manager.

Evaluation (including process issues, outcomes and sustainability):

The following intervention was evaluated by matching intervention participants with individuals with similar ailments and characteristics (albeit not participating in the intervention). The individuals were assessed pre-intervention, and at 6 and 12 months following its completion: both subjective (namely, the patients’ perception of his or her work prior to sick leave, subjective health, sleep and sleep quality, role conflict between work and private life, and personality) and objective measurements (saliva cortisol measurements) were collected. Additionally, interviews were conducted with both the patient and his or her manager to assess their perceptions surrounding the causes of the sick leave, and what elements could/should be changed to facilitate increase work capacity.

Benefits (including cost effectiveness):

The evaluation of the current intervention is currently ongoing and only preliminary results can be provided. Six months following the end of the intervention 70% of individuals had returned to work and after 12 months 75%.

References:

Havewald, L., Österburg, K., Abjornsson, G., Malmberg, B., Larsson, B. & Karlson, B.  To facilitate return to work – Evaluation of an early intervention program to reduce sick-leave due to work stress and increase work capacity. In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Paper of the European Academy of Occupational Health Psychology 7^th ed. (p107-108). Edicoes ISMAI: Castelo da Maia, Portugal

Comments:

A team of trained professions is required for the successful implementation of this intervention.

Author(s): Sandra van Oostrom, Johannes Anema, Berend Terluin, Anita Venema, Henrica CW deVet & Willem van Mechelen         Country:  Netherlands

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The intervention is designed for employees who are currently on sick leave due to or related to stress-related mental disorders; and has the overall objective of helping facilitate successful return to work. This intervention is based on a previous intervention for return to work of sick-listed employees due to low back pain; whereby its effectiveness has been substantiated through numerous scientific evaluations. The current intervention is a participatory workplace intervention; underpinned by the principles of participatory ergonomics¹. This participatory workplace intervention for return to work consists of a stepwise process aimed to identify and resolve barriers for return to work. Accomplished by mutually developed return-to-work action plan by the sick-listed employee and his/her supervisor; through a structured process of communication facilitated by a return-to-work (RTW) co-ordinator

Implementation:

There are several steps to this intervention: In the first step, the sick-listed employee is referred to the RTW coordinator by their occupational physician. Secondly, the RTW co-ordinator contacts the employee and his or her supervisor to arrange a series of meetings. Then, separate meetings are held between the RTW co-ordinator and the employee, and, subsequently, with the supervisor; with the overall objective of discussing the barriers for return to work in structured conversations. The structured conversation with the RTW co-ordinator are based on a task analysis where the tasks involved in the employees’ job are identified and outlined, and for each task the barriers for return to work are identified. Based on the outlined barriers for RTW, the employee and supervisor discuss possible solutions to the identified problems/barriers; these solutions can relate to changes in work conditions, work content or relationships. Based on the list of solutions derived through the series of discussions between employee and supervisor, the solutions identified with a high degree of feasibility to implement are outlined; and, moreover, a method in which to implement these solutions is developed. One month following the meetings and developed action plan, the RTW co-ordinator contacts the supervisor and employee to evaluate the progress of implementation and how these solutions have contributed to the RTW of the employee.

Practical applications:

It should be noted that prior to instigating the intervention the RTW co-coordinator received training, provided by a trained psychologist. The intervention is currently being implemented and evaluated in three occupational sectors: in industry, a hospital, and a university. However, the main structure of this intervention, conducted on individuals with low back pain, has been successfully used and evaluated in a large variety of  occupational sectors and sizes of enterprises (small, medium and large).

Innovative aspects:

This participatory workplace intervention for return to work consists of a stepwise process to identify and solve barriers for return to work; based on a consensus of an action plan to facilitate return to work between the sick-listed employee and his/her supervisor.

Evaluation (including process issues, outcomes and sustainability):

The evaluation of the effectiveness of this intervention is currently ongoing. Participants, individuals on sick leave for 2 to 8 weeks with common mental disorders, were randomly assigned to either: (a) the participatory workplace intervention; or (b) usual care. Measurements were taken prior to the intervention/usual care and assessed at 3, 6, 9, and 12 months following. The primary outcome to assess the effectiveness of the intervention is lasting return-to-work, which will be acquired from continuous registration systems of the companies after the follow-up. Secondary outcomes are total number of days of sick leave during the follow-up, severity of common mental disorders, coping style, job content, and attitude, social influence, and self-efficacy determinants. An evaluation of the effectiveness of the implementation of the intervention will be assessed by: examining the level of participation by both employee and supervisor during the process; and the overall level of satisfaction with the intervention by both health professionals, and the employee and supervisor. Additionally, an economic evaluation of cost effectiveness of the intervention will be conducted.

Benefits (including cost effectiveness):

The evaluation of the current study is currently ongoing, and benefits accrued due to intervention cannot be at this time specifically discussed nor outlined. Albeit the principle investigator informally suggests that even at this early stage, the intervention appears to have a beneficial impact on sick-listed employees’ overall well-being.

References:

Van Oostrom, S.H., Anema, R.J., Terluin, B., Venema, A., de Vet, CW, & van Mechelen, W. (2007). Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool. BMC Health Services Research, 7, 127 retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-7-127.pdf.

Van Oostrom S.H., Anema J.R, Terluin B. ; de Vet H., Knol D., van Mechelen W. (2007). Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial. BMC Health Services Research, 8(1), 12.

Comments:

¹ Participatory ergonomics refers to a broad range of methods and techniques. These methods apply the active participation of workers/ and or other key stakeholders in the process in the planning and controlling their work activities; and moreover innovating their workplace. In so doing, developing or further promoting a health workplace.

Author(s): Willem Van Rhenen, Roland W. B. Blonk, Jac J. L. van der Klink, Frank J.H. van Dijk, & Wilmar B. Schaufeli              Country:  Netherlands

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

A newly developed intervention combining physical exercise and relaxation techniques was developed by van Rhenen and colleagues with the overall objective of reducing health complaints resulting from individuals experiencing high levels of work-related stress. This is a brief and concise intervention to help those suffering with stress-related illness to manage and cope more effectively. The aim of this intervention is to provide awareness and the introduction of physical exercise in daily work activities.

Implementation:

The intervention is based on four sessions taking place during working hours. The exercise programmes utilized during the intervention were designed and conducted by an authorised physical therapist. Prior to commencing the exercise programme, a consultation, takes place to modify the level and intensity of exercise programmes on an individual basis. Each training session lasted one hour and was delivered over the course of 8 weeks: the intervals between sessions were 2 weeks, 2 weeks, and 4 weeks. Every session consisted of four main components: (1) an introduction; (2) warming up and physical exercise; (3) relaxation exercise; (4) an assignment.

·         Session 1: During this introductory session the term ‘stress’ and its associated effects on physical, psychological and behavioural aspects of health were outlined. Additionally, the use of physical activities as a key coping strategy was emphasised. Next, participants began with warming up and keep fit exercises followed by teaching and practicing a relaxation exercise. At the end of the session the participants were given homework; namely, they were asked to practice the learned relaxation technique during experienced stressful situations.

·         Session 2: This session began with a review of the past 2 weeks: including a discussion of participants’ homework. A warm up session, exercise, and muscle stretching followed. During this session a concentrated focus on the relationship between heart rate and strain was emphasised. Participants were encouraged to utilize the knowledge acquired during this, and the pervious, session as homework.

·         Session 3: The third session started with an assessment and a keep-fit exercise. Subsequently, participants were asked to plan their daily exercises; and evaluate their progress.

Session: 4: In this final session, the different physical exercises & relaxation techniques were reviewed. The session ended with advice on prevention relapse

Practical applications:

The intervention has a developed protocol facilitating its easier applicability at a practical level. The exercise programme was conducted by a trained physical therapist; thus, the implementation of this intervention requires a trained professional. The current intervention has been applied in the private sector, a large-scale organisation. Albeit the author(s) emphasise their belief of its applicability and adaptability to a larger variety of occupational sectors; and various sizes of enterprises.

Innovative aspects:

The current intervention is a purposefully designed brief intervention underpinned by multi-component design: combining physical activity and teaching relaxation techniques, thereby training and teaching individuals affected by stress, and its associated negative effects on health, with a repertoire of skills to manage and cope more effectively.

Evaluation (including process issues, outcomes and sustainability):

Participants were randomly assigned to one of two conditions: (a) the newly developed combined intervention of physical exercise and relaxation; or (b) a standard cognitive therapy intervention. Participants were assessed pre-intervention, directly following the intervention and 6 months following. The outcome measures used to evaluate the effectiveness of the intervention consisted of three self-reported questionnaires on psychological complaints (i.e., measurements of depression, anxiety, distress, and somatisation).

Benefits (including cost effectiveness):

The evaluation of the combined intervention found that a demonstrated positive impact on psychological complaints, burnout and fatigue and that these effects were maintained at the 6 months’ follow up. This suggests that this newly developed physical exercise and relaxation programme is an effective method of reducing stress and increasing workers well-being.

References:

Van Rhenen, W., Blonk., R.W.B., van der Klink, J.J.L., van Dijk, F.J.H., & Schaufeli, W.B. (2005). The effect of a cognitive and physical stress-reducing programme on psychological complaints. International Archives of Occupational and Environmental Health, 78(2), 139-148.

Comments:

The intervention target group was individuals with above average stress levels; this was determined by conducting a health survey prior to commencing the intervention. Additionally, in the comparative evaluation of the interventions no significant differential effects between the two conditions were observed.

Author(s):   Bo Netterstrøm & Per Bech                                                                Country:  Denmark

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

A multidisciplinary stress management was administered to employees referred to the Stress Clinic, part of the Clinic of Occupational Medicine, Hillerød Hospital, Denmark. The key objective of this programme was to have a positive effect on the return to work rate of employees suffering from stress-related distress. These individuals came from a variety of jobs and professions, and were from a wide range of ages (25-61).

Implementation:

Employees were referred to participate in this programme by their General Practitioner. The multidisciplinary stress management programme consisted of several stages:

·                                 Identification of relevant stressors

·                                 Changing the coping strategies of the participants

·                                 Decreasing the workload and tasks

·                                 Relaxation techniques

·                                 Physical exercise

·                                 Psychiatric evaluation if there were a high score on the depression

Each patient attended six one-hour sessions during four months approximately

Practical applications:

All sessions of the multidisciplinary stress programme were carried out by a specialist in occupational medicine.

Innovative aspects:

This stress management programme uses a multidisciplinary focus to address both the elements of work design and the working environment, and promoting positive coping strategies and the promotion of health-enhancing behaviours.

Evaluation (including process issues, outcomes and sustainability):

The effectiveness of this multidisciplinary stress programme was assessed by comparing a set of individuals who participated in the intervention, to a group of employees referred to the Clinic of Occupational Medicine by their General Practitioners served as a control group (non-intervention group). The individuals were assessed at a one-hour consultation prior to beginning the intervention and after four months. Additionally, individuals were asked to fill out a series of questionnaires, examining levels of depression and stress symptoms prior to beginning the intervention, following four months, one and two years after the completion of the intervention.

Benefits (including cost effectiveness):

The evaluation of the multidisciplinary stress programme demonstrated several positive benefits experienced by the participants. Namely, the level of sick leave in the stress management group dropped from 53 to 17 % during the first year of follow-up and continued to remain stable. In both groups, stress symptoms and depression scores decreased significantly during the four months and again during the next eight months. The decrease in depression symptoms was significantly higher in the stress management group as compared to the non intervention group. The multidisciplinary stress programme demonstrated showed a significant effect on the return.

References:

Netterstrøm, B., & Bech, P (2008). The effect of a multidisciplinary stress programme on sick leave. Poster presented at the Work, Stress and Health Conference: Health and Safe Work through Research, Practice and Partnerships, APA/NIOSH, Washington D.C.

Comments:

For the non-intervention group, the reduction in sick leave was significantly lower. Additionally, no significant difference between the intervention and non-intervention groups was observed after one and two years.

Author(s):  Judy Proudfoot and her team at the Institute of Psychiatry, Kings College, London and Ultrasis plc       Country: United Kingdom

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

‘Beating the Blues’ is a computerized interactive cognitive behavioural therapy programme; which seeks to help people suffering with mild and moderate depression to get better and stay better. This programme teaches individuals life-long skills to more effectively manage and cope with mental health issues and their causes and consequences. ‘Beating the Blues’ has been primarily used in primary care settings; however, more recently, this programme has been trialed in the public sector to address emotional distress in employees with recent stress-related absenteeism.

Implementation:

‘Beating the Blues’ is made up of 8 weekly sessions; with each session taking approximately 50 minutes to complete. The ‘Beating the Blues’ programme addresses both cognitive and behavioural components. The cognitive components explored during the programme are automatic thoughts, thinking errors and distraction, challenging unhelpful thinking, core beliefs and attributional style¹. The behavioural components of ‘Beating The Blues’ for tackling specific problems consist of: activity scheduling, task breakdown, problem solving, sleep management, relaxation training and biofeedback, planning and prioritizing and graded exposure. Cognitive and behavioural exercises are prescribed at the end of each session and debriefed at the start of the next. A weekly progress report of distress self-ratings and suicidal ideation is generated for the user and for the supervising clinician. The programme concludes with a programme review, goal setting and action planning.

Practical applications:

This computerized therapeutic programme has a user-friendly approach with self-guided format which can be used at the convenience and discretion of its user. Consequently, minimal input is required in the implementation of this programme by a set of professionals; albeit a supervising clinician is recommended to monitor progress and provide additional support.

Innovative aspects:

‘Beating the Blues’ is an interactive computerised cognitive behavioural therapeutic programme which guides the patient through the various stages of therapy in exactly the same way a therapist would in face-to-face sessions; whilst minimising the need for a trained professional to implement or guide the process. ‘Beating the Blues’ can respond to patients’ particular circumstances or problems; and ensure that the training of new ways of thinking and behaving is completed at a self-determined pace.

Evaluation (including process issues, outcomes and sustainability):

The effectiveness of ‘Beating the Blues’ programme was evaluated by comparing sick-listed employees randomly assigned to either an ‘intervention group’ (using the ‘Beating the Blues’ programme plus conventional care²) or a group that received solely convention care. Measurements on depression, anxiety and attributional style were taken at the end of treatment, and 1, 3 and 6 months later. Additionally, the employees’ weekly progress report was reviewed by the scientific investigator to examine participation.

Benefits (including cost effectiveness):

This study compared the effects of ‘Beating The Blues’ plus conventional care, to conventional care alone, on emotional distress in public service employees with recent stress-related absenteeism. The results of the evaluation indicate that directly following and one month later after the completion of treatment a significant reduction in employee’s depression and negative attribution scores were observed. Additionally, one month following the programme a significant reduction in employees’ anxiety scores, as compared to conventional care, were observed. These differences were not observed at 3 months and 6 months.

References:

Grime, P. R. (2004). Computerized cognitive behavioural therapy at work: a randomized controlled trial in employees with recent stress-related absenteeism. Occupational Medicine 54, 353-359.

Comments:

¹ Attributional style refers to the optimism or pessimism with which people explain why things or events occur to them.

Author(s):   M.V. Willert, A.M. Thulstrup, and J.P. Bonde                      Country:   Denmark

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The MARS research project investigates the effect of a group-based stress management intervention for participants with elevated symptoms of work-related stress (symptoms of sustained arousal and reactivity of symptoms to demands at work). The MARS intervention is underpinned by a bio-psychosocial framework¹ and has been built on the foundations of cognitive behaviour therapy.

Implementation:

A group therapy format is used to train individuals in stress management techniques. Integral to the intervention format is the encouragement of individuals to implementation the techniques, experiences and skills gained in the group sessions at the workplace. This is partially achieved by assigning homework following each group session (i.e. assignments on how to try out newly acquired skills at the workplace between group sessions). Treatment lasts approximately 3 months.

Practical applications:

The MARS intervention is designed to allow for easy adaptation and implementation in a variety of organisational and cultural settings. The intervention is built on the foundations of cognitive behaviour therapy, which has been shown to be adaptable to different cultural settings, whilst still retaining its treatment potential. The successful implementation of this programme requires a trained health professional.

Innovative aspects:

The MARS intervention has adapted the proven effective methods and techniques from cognitive behavioural therapy used to treat anxiety and depression to address work-related stress and its consequences of individual’s wellbeing.

Evaluation (including process issues, outcomes and sustainability):

In 2007-2008, 12 groups participated in the MARS intervention. In order to assess the effectiveness of the intervention, those individuals participating in the MARS intervention were compared to participants on a waiting-listing for treatment (non-intervention group). Data was collected at several time points (prior to intervention, directly following, three months and one year following the treatment), using a variety of sources of data: 1) questionnaires on psycho-social wellbeing, health and work conditions, 2) a limited neuropsychological test battery, 3) bio-markers of stress (blood samples), 4) physiological data as well as 5) self-reported and register data on absenteeism.

Benefits (including cost effectiveness): 
 

Several benefits of the intervention have been observed:

• The preliminary analysis of the questionnaire data demonstrates a significant treatment effects on several major areas of individuals wellbeing.

• Three months after termination of treatment the gains achieved during treatment are observed to be maintained.

• Preliminary analysis of the self-reported data on absenteeism point at a possible reduction in long-term sick leave during the intervention.

• Feedback received from the participants, both in-session and as rated by questionnaires, reflects a high degree of satisfaction and perceived benefit 

  of the intervention.
• Additionally the practitioners undertaking the intervention perceive the intervention format as both feasible and functional.

As the evaluation of the intervention is currently ongoing, the one year follow-up questionnaires will be sent out in 2008-2009, which will enable an assessment of the long-term effects and the sustainability of the intervention. In addition, to date the register data has yet to be retrieved and the collected bio-physiological data analysed.

A cost-benefit analysis is planned. This analysis will examine the average cost of the intervention per participant in relation to the benefits of reduced absenteeism costs and prevented loss in productivity.

References:

Will be published in 2009 and onwards.

Comments:

After the research project examining the effectiveness of the MARS intervention has ended, the intervention has been implemented as part of the regular available treatment options for work-related stress at the Department of Occupational Health, Aarhus University Hospital, Denmark.

¹The bio-psychosocial model is an approach that postulates that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors all play a significant role in human functioning in the context of disease or illness.