Transcript Fit 4 Work

Fit 4 Work
Linking re-integration and health
An experimental approach to activation and re-integration
in for long term welfare dependent clients
Annelies Acda 03-06-2013
In this presentation
• Why work?
• Work related to health
• What is the situation?
• Outline Fit 4 Work
• Research related to F4W
• Where are we now
• Conclusions
Why work?
 The right to work is a core value of
modern society
Adam Smith (1776) noted in An Inquiry into the Nature and Causes
of the Wealth of Nations (Book I, Chapter X) that:
"The property which every man has is his own labour; as it
is the original foundation of all other property, so it is the most
sacred and inviolable...To hinder him from employing this strength
and dexterity in what manner he thinks proper without injury to his
neighbour is a plain violation of this most sacred property."
Modern vision: How employment facilitates
recovery
Employment :
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Reduces stigma by providing access to a socially-valued role
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Few other things can be done for 8 hours a day
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Strengthens self-efficacy and self-esteem
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Increases opportunities for receiving positive regard from others
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Increases opportunities for social inclusion
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Provides time structure and a reason to stay well
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Has a positive effect on health and wellbeing
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Keeping and building skills
And from a health perspective…
The labour market in the Netherlands
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The unemployment-rate at the national level : 6,8% and expected to
rise in 2014
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Challenges:
 Only about 60 % of the workforce in the larger cities is
participating in employment;
 Overrepresentation of people from a non- European background
on welfare rolls;
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Successes:
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Youth unemployment - 25% due to a more decentralised approach (2011)
Keeping people in the workforce during the crisis
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Big changes expected within the next 2-3 years, caused by
demographic developments.
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Job-openings will occur in various sectors and within all levels of the
labour market; creating substantial opening for jobs at the entry-level
(lower skilled work).
Rotterdam – an example
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Second largest city
600.000 inhabitants
32.000 households on welfare (65-)
5.000 households on welfare (65+)
2.000 migrants in integration-programs
50.000 handicapped/disabled people on individual facilities
and help in housekeeping
7.000 persons with help on burdens of debt
2.500 people in subsidized jobs
About 100.000 people depending on Social Welfare
Rotterdam
This is 1/6 of the population of Rotterdam.
Budget = 700 Mln euro per year
Participation ladder
Regular Job
Paid work with support (eg subsidised job)
Voluntary or unpaid work
Participating in organised activities
Social meeting outside your house
Isolated
Questions at the start of the Fit 4
Work experiment
1.
What is the role of paid employment in health inequalities?
 being unemployed has a profound impact on health
2.
How does health influence paid employment?
 a good health is an important prior condition to get and stay
in paid employment
 entering paid employment is beneficial for health
3.
What are the potential benefits of interventions on working life?
 better health increases work life expectancy
4.
What are the challenges in the near future?
 demonstrate cost-effectiveness of integrated (health and
re-integration) interventions
Socio economic health differences
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Why Fit 4 Work?
1.
We have to perform better on the participation rates and employment rates of
people who are longterm welfare dependent and live in a multiple problem
situation.
2.
Socio-economic health inequalities! Differences in educational level and
household income attribute approximately 30% to 50% to these health
inequalities.
3.
Poor mental health acts as a barrier for return to paid employment through
decreased motivation, lowered expectations of finding employment, and
ineffective job seeking. Unemployment may lead to poorer mental health, which
in turn will reduce the chance of re-employment.
4.
The target group has been standing at the sideline for too long.
5.
Work as a medicine.
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There will be changes in the labourmarket within the next years due to
demographic changes (retirement)
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Target group costs 13.500 euro p.p./p.y. Staying 10 years on average on welfare
rolls. This is 135.000 euro !!
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No integrated and holistic based approach has been developed in the
Netherlands (and Europe)
Fit 4 Work
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Is a collaborative experimental project between the four
major cities in the Netherlands (Amsterdam, Rotterdam,
The Hague, Utrecht, and Capelle), and the UWV (Dutch
Employment Service)
Focuses on re-integration AND health improvement within a
multi problem target group with a large distance from the
labour market
Is a collaboration between Social Welfare, Dutch
Employment Service and Municipal Public Health
departments, and includes research
Is a randomised controlled experiment (700 in F4W and
700 in other group) for four years. Evaluation on effects of
integrated health and re-integration approach on self
perceived (mental) health, social participation and paid
employment
Includes a social cost benefit analysis (“business case”)
The Fit 4 Work target group
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Up to the age of 50
Long-term unemployed (social security payments through
WIJ, WWB,
WIA, or WAJONG)
Having mental health problems
Often experience social problems and some physical health
problems.
Having various, severe and mostly related limitations in various
areas
Experience of limitations with regards to psychosocial
functioning - psychological health problems
Additional limitations may lie in the social area (such as
parenting problems, isolation, debt, domestic violence).
Participation in regular employment is often hindered by the
psychological disorder, lack of work experience,
qualifications and/or competencies or more material problems
with housing or debt.
But also having a development potential to participate in the
employment process.
The elements of F 4 W
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Integrated diagnosis on mental health problems and employment
skills, with additional attention for social problems and physical health
problems
Integral analysis in a multidisciplinary team
Intersectoral intervention plan including:
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mental health interventions (short-term outclinic treatments with a
guaranteed intake without waiting period);
reintegration programmes (offered through labour market organisations),
and, if needed;
also health promotion programmes (offered through local health
organisations);
and social interventions (offered through local organisations)
Continuity of support and care provided ("ketenbewaking”)
Immmediate intervention on perceived barriers for labour force and
social participation
Availability of labour market experts for adequate mediation towards
paid employment
Support and guidance to participants and their prospective employers
to avoid relapse into unemployment.
1
Entry
2
Screening
Check recent mental health
status
Suitable Fit 4 Work
3
Randomisatiom
4
1st Questionnaire (0)
Fit-4-Work group
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Mental health analysis
Not suitable Fit 4 Work
Check up group
In depth diagnosis
-Interdisciplinary case meeting
Plan
Carry out plan
Job placement with help
After care
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2nd Questionnaire 12mnth
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3rd questionnaire 24 mth
Standard re-integration
support
2
Back to case manager
Objectives Fit 4 Work
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Participants work according to their capacity and
ability in the employment process in mainstream
organisations;
Participants have a more positive health experience
and/or health afterwards;
Participants have reduced healthcare consumption
afterwards (thereby leading to a reduction in
healthcare costs);
Participants are more self-reliant.
Measurable outcomes
 Workplacement within 1 year
 Regular Job 12 hours per week or more
 Guidance and support on the ‘working floor’
Improvement in the health situation (lifestyle, medicine usage, addiction,
psych help)
 Sustainable outflow to work (in regular jobs) for at least 50% of the target
group
 Next step on the ‘participation-ladder’ for the other 50% pf the target group
 Cost-effective implementation
 Working method applicable for the rest of the country
Costs and benefits
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Costs of a Fit 4 Work traject 7.500 euro per year excl health
interventions (covered by health insurances)
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Duration is 3-4 years, with supported work-placement in regular
job within 1 year for at least 12 hours per week + support and
guidance to raise the working hours (work as a medicine)
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At 12 hours sustainable job (after finishing the project) 100%
return on investment after 4 years
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At 24 hours sustainable job (after finishing the project ) 100%
return on investment after 2 years
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ESF is applicable
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Not to be expressed in ‘money’ : people are working, paying
taxes, developing skills etc.
At the long term less health consumption ?
Bron: Bush et al (2009)
The experiment in a nutshell
 Partners: UWV (Dutch DWP), G4 : Departement of Social Affairs
and Employment (Amsterdam, Rotterdam, The Hague and
Utrecht, and Capelle), G4 Public health
 Execution by Reintegration Companies/Private Vendours
Procurement)
 Scientific / Academic Research : Erasmus University Rotterdam
 Support : Ministry Social Affairs and Employment & Ministry of
Health
Start 1-7-2011 (with procurement-phase)
Start 1-1-2013 (with inflow of clients)
Duration of experiment: 4 year
Participation of 700 people (receiving Fit 4 Work intervention)
and 700 people controll Group
The process
 Long term (financial commitment): hard to defend in
current financial climate
 Different organisations, different cultures, different
“languages”
 Different cities, different cultures, different political
views
 Change in staff at various departments
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How do you keep everyone on board?
Belief in outcomes has to be shared
Learn from mistakes, use them for future projects
Keep spirits high by celebrating small successes
Conclusions
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We know that being unemployed has a profound impact on
a person’s health situation. Good health is an important
prior condition to reach and to stay in paid employment.
Entering paid employment is beneficial for health. A better
health increases work life expectancy.
We need to demonstrate cost-effectiveness of integrated
(health and re-integration) interventions.
The Fit 4 Work – experiment is an interesting practice with
the potential to demonstrate this.
Involved partners need to belief in long term project in
changing circumstances.
Thank you for your attention
 Questions?