Team effort: the multidisciplinary management of referrals within occupational health

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The benefits of multidisciplinary working within occupational health are increasingly well-recognised. Janet O’Neill argues that the better your understanding of the specific skills and expertise of your multidisciplinary team, the better chance you have of delivering truly collaborative, high-quality OH interventions.

Back in December last year, Occupational Health & Wellbeing pointed out that multi-disciplinary and inter-disciplinary practice is becoming increasingly well-known within occupational health.

This article allows three clinicians from our own multi-disciplinary team at PAM Group to describe the contribution they make to occupational health attendance management.

About the author

Janet O’Neill RGN dip OH MSc is clinical director of PAM Group

It is designed to illustrate how their background knowledge and expertise can enhance the OH referral and intervention process and, in turn, the positives they gain from working within and alongside occupational health.

Psychological management referrals – Samantha Jones, occupational health psychological advisor

A counsellor can work with compassion and empathy during an OH assessment without risking further detriment to an individual’s mental health

“It is no secret that mental ill health is common and there have been many initiatives in place, in recent years, to raise awareness, reduce stigma and to support those affected.

“There is often a complex relationship between work and mental ill health, and it is believed that more than one in six employees experience mental ill health. This includes long-term/underlying conditions, as well as short-term, reactive symptoms to significant events.

“In many cases, work can be causative or a contributing factor; however, it is also noted that employment is an important aspect in maintaining a person’s mental wellbeing. It is believed that mental health is one of the most common reasons for sickness absence in the UK and, with this in mind, it is understandable that there are frequent referrals to occupational health regarding mental health conditions.

“I started on my career path with a psychology (BSc) degree and then gained experience working as a mental health support worker for an in-patient rehabilitation hospital. I followed this with an administrative role at an Employee Assistance Programme (EAP) whilst undertaking an advanced diploma in counselling and hypnotherapy.

“Once I had completed this course, I was promoted to working as a counsellor on the EAP 24-hour helpline. This gave me experience of supporting employees in managing their mental health, both inside and outside of the workplace, as well as providing guidance to assist with resolving perceived workplace concerns.

“Whilst I do enjoy undertaking ongoing therapeutic work, I have found that my strengths lie with carrying out mental health assessments and providing advice and guidance to employers so as to support a person’s recovery.

“I began my current role, which is akin to an occupational health advisor’s role, around two years ago. I undertake management referrals that specifically relate to mental health concerns. Moving forward, I aim to undertake an occupational psychology (MSc) degree to assist with increasing my knowledge and skills, in order to further help employers to support their employees’ mental health and wellbeing.

“My role within PAM Group has been a learning curve as, prior to my role, it was not common for counsellors to undertake OH management referrals. I have been well-supported throughout my time in this role, with specific training in relation to occupational health provided. I work hard to complete CPD courses to increase my knowledge and confidence in my duties.

“This has been shown in the accolades I have achieved, including my high audit scores and a ‘Newcomer of the Year’ award I won for 2018. Recently, I was supported to attend a suicide prevention conference, which included workshops on assessing potential suicide/self-harm risks. Risk assessments are a crucial part of my role, with each referral requiring an accurate assessment to ensure the safety of the employee and others around them and therefore this conference was invaluable.

“Whilst having counsellors to undertake OH referrals may not necessarily appear orthodox, it can be advantageous as it allows for management to gain a greater insight into their employees’ mental health and workplace adjustments that could be beneficial to the recovery process.

“It also allows for specialist support, including practical advice around coping strategies and treatment options, to be provided to the employee. In many cases, OH is the first avenue of support an employee comes into contact with in regards to their mental health. A counsellor can be best-placed to provide this support because their underpinning knowledge and skills, such as effective communication skills, allows them to work with compassion and empathy during an OH assessment without risking further detriment to an individual’s mental health.

“The training helps to build a high level of emotional resilience to allow the counsellor to hold conversations with employees that are often challenging and complex, to ensure that any advice and guidance provided is both relevant and beneficial to an individual and to the employer. There are also occasions where liaison with an employee’s GP, mental health team and/or psychiatrist is required, for example because of potential risk concerns or for further medical evidence to be obtained, and this is likely a duty a counsellor would have understanding and experience of.

“I love my role and I feel I have found my niche. It is, however, not without its difficulties. Whilst my counselling training has helped a long way in regards to building my emotional resilience, there are occasions where this is lowered and it can be difficult to switch off from complex cases at the end of the working day.

“To maintain my own mental wellbeing and fitness for work, I ensure I attend regular clinical supervision, I arrange therapeutic interventions for myself as required and I have self-care techniques including drawing, calligraphy, bullet journaling and exercise. Most importantly, I work hard to maintain a healthy home and work-life balance to reduce the risk of burn out and exacerbation of my underlying conditions.

“By directing employees to an OH psychological advisor, fitness for work assessments and suitability for an early referral to appropriate psychological services is obtained with the added benefit of psychotherapist having a good understanding of what service would benefit the individual.”

Occupational health physiotherapy referrals – David Stevens BSc Hons Physiotherapy, HCP, CSP, MSOM, AACP, ACPOE, occupational health physiotherapist

My reports provide the manager with a detailed and comprehensive analysis of the employee’s physical ability

“I am a chartered physiotherapist and a member of the Health Professional Council (HPC), a member of the Association of Charted Physiotherapists in Occupational Health and Ergonomics (ACPOHE) and The Society of Orthopedic Medicine (SOrthM).

“Luckily for me, when I see an employee from a factory or manual/engineering role who has a musculoskeletal problem, I can often empathise more than most. Before I became a physiotherapist, I worked in construction and engineering. Therefore, I know what’s it’s like to work in cold, nosy, dirty and dangerous environments; I know what is like to work at heights and operate heavy machinery and vehicles; I know what it is like to have a line manager who is perhaps less than sympathetic (perhaps he needs to keep production going at all costs).

“Having an ACPOHE qualification also enables me to understand the occupational aspects of manual handling and muscular skeletal issues in work.

“Musculoskeletal management referral reports make up a considerable percentage of my workload. Referrals ask questions, such as when the employee is likely to return to work, current fitness to work, what effect will the condition will have on an employee’s ability to carry out their duties, are there any modifications or adjustments needed, any particular duties the employee should or should not do and is this condition likely to reoccur in the future?

“I’m often asked to comment on an employee’s ability to physically restrain a service user if they become violent. My reports provide the manager with a detailed and comprehensive analysis of the employee’s physical ability. After reading the report, a manager should have a very good idea of whether or not the employee has the physical capability to carry out or continue in their role.

“I feel I add a hefty dash of common sense, real-life experience and an expert understanding of not only musculoskeletal conditions but also of neurological, respiratory conditions, and other common health problems such as diabetes and anxiety and depression. I do really well in my audits and get positive feedback from my peers and from employer and employee feedback.

“I have been fortunate enough to have received some excellent training from my employer covering all occupational health matters, including suicide and mental health awareness, disability discrimination, audit training, GDPR training and report writing, amongst others.

“I get lots of support from fellow colleagues and also from senior management, all I have to do is drop someone an email or give them a quick call. Senior managers often include me in how our organisation works; how well the service is going or not.

“Last year I won our ‘employee of the year’ award. I think wining anything that comes from your peers is often more important than winning a prize in a competition. The fact it comes from individuals you admire made me feel really valued. Being good at something can start to be a habit, so message to all employees out there ‘reward your employees more often’.

“A simple ‘thank you’ is often all it takes to make someone feel good about themselves. Knowing the importance of feeling valued reminds me to try and makes others I work with feel valued to. I’m generally a positive person, however, having goals and targets is the most important factor in keeping positive.”

The occupational health advisor’s role – Victoria Keenan SCPHN OH RGN, occupational health advisor

It is really important I have an understanding of those work factors that can either cause or exacerbate ill health but also the criteria that would render someone fit or unfit for a specific role

“As most readers of Occupational Health & Wellbeing will undoubtedly know, occupational health advisors (OHA) are registered nurses who specialise in the care and wellbeing of people at work.

“This requires additional training, with many OHAs undertaking diploma- or degree-level qualifications. Occupational health falls within the wider remit of public health, which is about helping people to stay healthy and protecting them from threats to their health and therefore well suited to nursing as a background.

“Leadership skills are an important aspect of occupational health nursing, as this is integral to the standards for OH nursing – a large number of OH providers are therefore predominantly nurse-led.

“OHNs require effective leadership skills both to manage the provision of OH services and to provide management with advice on health issues within the workplace. One of the aspects of occupational health nursing that I particularly enjoy is health promotion and education, such as advising employees on improving their health or educating managers on how to manage the wellbeing of their staff.

“One of my main roles as an OHA is helping employees get back to work after a period of sickness. I conduct consultations with employees (both face-to-face and via telephone) to provide advice to managers and HR about their fitness to return to work and any support to facilitate this.

“A typical management referral consultation involves assessing an individual’s health condition; how it impacts their daily living activities and how it affects them at work or, conversely how their role impacts on their health.

“As an OHA it is really important that I have an understanding of those work factors that can either cause or exacerbate ill health but also the criteria that would render someone fit or unfit for a specific role and make recommendations to their manager or HR on any adjustments that might be required.

“The consultation is based on the biopsychosocial model, which looks at the connection between biological, psychological and social factors in the role of health and illness (Watson, 2015). For example, an individual may be recovering from a surgical procedure that affects their physical capability, but they may also be experiencing significant stress at home which is affecting their health and wellbeing.

“My role therefore will be to undertake an holistic assessment of the individual to ensure they are physically and psychologically fit to return to work. This may involve using a number of screening tools to assess an individual’s health, such as alcohol audit tools, anxiety and depression tools and pain assessment scales followed by signposting, if required, to our internal services if a client has subscribed or to support via their GP and/or an EAP.

“As OHAs, we get the full range of health conditions passing through our door including work-related stress which, according to the Health and Safety Executive (2019), is of course now a major cause of sickness absence in the workplace. We also deal with general health conditions, musculoskeletal plus mental health. It is important that we engage in all CPD that is provided and clinical supervision to maintain our own wellbeing.”

Conclusions

From an OH provider’s perspective, we receive very positive feedback from employers and clients for the work of all our different clinicians and the expertise they deliver.

And, to my mind, that is, after all, what occupational health is all about. Utilising a multi-disciplinary approach saves clients time and money and enables them to receive the most appropriate advice.

Our qualified occupational health nurse advisors are all-round experts and they enable services to be joined up. Our OH physiotherapists, in turn, provide expertise around MSK disorders and our OH psychological advisors provide that vital ongoing psychological support.

All the specialisms give an added value to the client; the sum is greater than the individual parts. The National Institute for Health and Care Excellence (2019) suggests employers signpost those who are absent for four weeks or more to other, possible expert, sources of vocational advice and support relevant to their condition.

We feel that, by utilising the wider occupational health team in this way – by embracing a genuine multidisciplinary approach and ethos from the outset – we are enabling employers to do precisely this.

References
Health & Safety Executive (2019). Tackling work-related stress using the Management Standards approach. The Stationery Office: London, https://www.hse.gov.uk/pubns/wbk01.htm
Watson, H (2015). “A Biopsychosocial Approach to Return to Work”. Occupational Health Journal, pp.26-29.
Witwicka, S and Harris A (2013). “Why occupational health nurses should acquire leadership skills”. Occupational Health & Wellbeing, January 2013, https://www.personneltoday.com/hr/why-occupational-health-nurses-should-acquire-leadership-skills/
Kopias A (2001). “Multidisciplinary model of occupational health services. Medical and non-medical aspects of occupational health.” Int J Occup Med Environ Health. 2001;14(1):23-8, https://pubmed.ncbi.nlm.nih.gov/11428252/
National Institute for Health and Care Excellence (2019). “Workplace health: long-term sickness absence and capability to work”. NG146, https://www.nice.org.uk/guidance/ng146
Paton N (2019). “Come together unpicking multi-disciplinary working within occupational health”, Occupational Health & Wellbeing, December 2019, https://www.personneltoday.com/?p=243650
Waddell and Burton (2006). “Is work good for your health and wellbeing? An independent review”. Department for Work and Pensions, January 2006, https://www.gov.uk/government/publications/is-work-good-for-your-health-and-well-being
Association of Chartered Physiotherapists in Occupational Health and Ergonomics.
What we do. ACPHOE 2013. Available from: http://www.acpohe.org.uk/
Black (2008). “Working for a healthier tomorrow: work and health in Britain”. Department for Work and Pensions, March 2008 https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain
Black and Frost (2011). “Health at work – an independent review of sickness absence in Great Britain”. Department for Work and Pensions, November 2011, https://www.gov.uk/government/publications/review-of-the-sickness-absence-system-in-great-britain

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