No, not all.
Thank you very much. I certainly can start.
First, I'd like to take the opportunity to thank you for the opportunity to appear before this committee. My experience has been with people who were injured while at work, but I see disabled veterans as having been mentally or physically injured while working for their federal government employer on behalf of Canadians, and I trust that my remarks will be relevant.
In the next few minutes I will endeavour to provide some insight into why work participation is important to people with disabilities, even when they have income from disability benefit sources. I'll also describe some of the key features of sound work reintegration service and program design.
I'm certain that Canadian veterans with permanent impairments face some unique challenges. However, international work and health researchers are finding some universally common consequences of occupationally caused work disability and have identified some leading practices in work reintegration program design.
In general, there is good evidence across Organisation for Economic Co-operation and Development countries that those with disabilities have lower workforce participation, higher unemployment rates, and less income than the non-disabled population. The utilization rate for disability income support programs has been growing across OECD countries, and the exit rate from these programs has been declining. Countries are seeking ways to reduce the cost of these programs by increasing work participation, rather than simply reducing benefits and allowing people to slide into poverty.
Just a few days ago, the International Social Security Agency, ISSA, which is an agency of the United Nations, ratified a return-to-work guideline at their conference in Doha. I'd like to add that these guidelines were actually based on a Canadian standard developed by the National Institute of Disability Management and Research in British Columbia.
Those with disabilities, including those with occupational injury or illness, are stigmatized in their workplaces, in their communities, and even sometimes by their benefit and service providers. If they have a prolonged absence from work, they suffer from an above-average prevalence of depression and other mental health problems. They experience elevated rates of marital and family breakdown, financial difficulty, and substance dependence. They experience significant levels of pain, even while taking pain medications. It is important to note that these problems exist even when the person is receiving a wage replacement benefit and are not necessarily directly related to the seriousness or nature of the injury.
Work is important to well-being. It plays a major role in identity and in self-worth, and it contributes to physical and mental health.
So how can effective programs to support work reintegration be designed? A foundational step is to place work at the heart of disability policy, replacing a passive “pay benefits and monitor costs” approach with one that focuses on activating people's abilities and capacities whenever possible. This includes emphasizing outcomes, such as work reintegration, not benefit management. Setting goals and targets and measuring results ensures that the employer, the insurer, and service providers are accountable to achieve positive outcomes for the disabled person.
A second step is to create a sound disability management program. Such a program would be developed collaboratively with the employer and employees through a consensus-building process that builds a common understanding and buy-in across the entire organization. Everyone in the organization needs to know about the program and be expected to actively participate when needed. Human rights case law indicates that participation in the return-to-work process must be substantive. The program should be staffed by qualified work reintegration and health professionals.
Generally, in an organization like the federal government, or its departments, a program that is common to all employees creates consistency, fairness, and more placement opportunities for those with disabilities. Carefully thought-out and competently executed case management is critical. One size does not fit all, so case management approaches need to be adapted to the needs of specific disabilities and to individuals. However, there are several features that are common to effective case management.
One is the integration of recovery and return to work. This is very helpful, because return to work is part of the rehabilitation process and it actually enhances a person's recovery. Return to work does not need to be preceded by recovery, as is often believed, except for a period of time to begin the healing process. Care must be taken, however, to not return the disabled person to work that is unsafe.
Early intervention to assess the circumstances and needs of the person and of the workplace, and to establish supportive communications, leads to better outcomes. High quality and timely health care is a must. It's not uncommon for special expedited health care services to be arranged. Opportunities for work accommodation or transitional work should be explored. Removing barriers is an ever-present task in coordinating return to work. Reassessment at regular intervals informs comprehensive case management as the client's health improves and circumstances change.
By “early intervention” I mean within six to eight weeks following the onset of disability, following injury. Setting and keeping case management timelines is urgent. After six months off work only 50% of disabled workers ever return to full-time employment, and by two years return to work is rare.
Finally, the incentives and disincentives operating for both the individual and the employer, or a potential new employer, need to be analyzed and adjusted to align with the goal of work reintegration.
While not an exhaustive list, incentives can include allowing the disabled persons to retain their disability benefits, in whole or in part, for some period of time. They can include adjusting benefit levels to avoid poverty, while still encouraging work; providing wage subsidies or tax credits to employers, particularly if they are providing training; providing job placement and job coaching services to the individual and the employer; making costs and cost savings visible to the employer; and rewarding managers for accommodating or providing alternate work to their disabled staff.
I hope these comments are helpful to you in your review. I believe they apply to veterans. The good news is that these program design elements have shown to improve outcomes for disabled people in many types of benefit schemes around the world.
Thank you for your kind attention.
