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OCC-HEALTH  June 2012

OCC-HEALTH June 2012

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Subject:

Re: Business case argument - study leave

From:

Karen Coomer <[log in to unmask]>

Reply-To:

Occupational Health mailing list <[log in to unmask]>

Date:

Wed, 27 Jun 2012 22:51:55 +0100

Content-Type:

multipart/mixed

Parts/Attachments:

Parts/Attachments

text/plain (182 lines) , Rollnick et al (2005) Consultations about changing behaviour.pdf (182 lines)

HI Catherine
Just about to log off and noticed your post. Yes I have the paper you have quoted.

George Engel was the founder of the approach and wrote a famous paper in 1977 called The need for a new medical model: a challenge to biomedicine. Science Journal. Unfortunately, it appears at that time that a new wave of psychiatric/antidepressant drugs were released and for decades these were prescribed and the biomedical approach became much more prevalent. However, the tide is changing and one only has to look at the treatment of chronic fatigue syndrome to see that a biopsychosocial approach is now commonly used. 

The evidence from Gordon Waddell and Kim Burton  is also now contributing to the way that sickness absence is managed particularly with the flag approach. In the context of OH case management the models have changed over the years so I think many organisations would now look at having a system of signposting to physio, OT, EAP, CBT, outplacement, coaching etc as part of managing the case, so less disease focused than when I started in OH 20+ yrs ago. At an individual level I know quite a few OH Nurses and OHP's (including me) using a biopsychosocial approach in their individual case management, and that in my opinion is where CBT, NLP, motivational interviewing, coaching skills etc is so useful to identify the issues/barriers/belief systems preventing or promoting ill health. However, this style is about being more collaborative than directive in case management and so it isn't easy to always do in the time constraints that are often placed on OHN's, I attach a BMJ article on what I mean here. 

When I have more time I will post the evidence I have on where it is being used in nursing, medicine and occupational psychology.  

I am currently doing psychosocial research myself because there isn't a lot of psychosocial evidence in OH practice although like I say the biopsychosocial model is mentioned in many headline reports (which is why it might be a good argument for Carr). I have been over to Finland to see what they do and looked at Scandinavian health models and am just about to analyse the data of some research I have done with Finnish OH practitioners. So in general I do think a lot more needs to be done.  

I will come back to this when less tired.....

Good night
Karen


  

-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Catherine Mackay
Sent: 27 June 2012 21:12
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Business case argument - study leave

Dear Karen

Indeed! Following your post, I thought it would be interesting to establish if the transition from the biomedical model to the bio-psychosocial model(BPS) was researched in terms of actual use in the field; I found the following from 2008:

'Citation

The Biopsychosocial Model Thirty Years Later. Fava, G.A. and Sonino, N. 
Journal of Psychotherapy and Psychosomatics 2008; 77: 1–2. doi:10.1159 / 000110052.

Opening Paragraphs

Thirty years ago George L. Engel highlighted the inadequacies and limitations of the traditional biomedical model and advocated the endorsement of a biopsychosocial approach. The article had a considerable impact on the scientific community and attracted nearly
1,900 citations over the years. The biopsychosocial model allows illness to be viewed as a result of interacting mechanisms at the cellular, tissue, organismic, interpersonal and environmental levels. Accordingly, the study of every disease must include the individual, his/her body and his/her surrounding environment as essential components of the total system. Psychosocial factors may operate to facilitate, sustain or modify the course of illness, even though their relative weight may vary from illness to illness, from one individual to another and even between
2 different episodes of the same illness in the same individual. The key characteristic of clinical science is its explicit attention to humanness, where ‘observation (outer viewing), introspection (inner viewing), and dialogue (interviewing) are the basic methodologic triad for clinical study and for rendering patient data scientific’. Engel identified the biopsychosocial model as a more complete conceptual framework to guide clinicians in their everyday work with patients. He thought that the transition from the narrow biomedical model to the biopsychosocial model was the major challenge to medicine in the seventies.

Has the challenge been met? Not at all, as examined in a recent monograph on the biopsychosocial approach. As 30 years ago, the dominant model of disease today is biomedical, with molecular biology being the basic scientific discipline. Indeed, there has been a progressive decline of clinical observation as the primary source of scientific challenges. Yet, the evidence supporting the biopsychosocial model has considerably increased over the years. A large body of research has documented the role of stressful life events and repeated or chronic environmental challenge in modulating individual vulnerability to illness. The tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for them is a widespread clinical phenomenon that may involve up to 30 or 40% of medical patients and increases medical utilization and costs. 
Medically unexplained symptoms appear to be the rule in primary care and the traditional boundaries among medical specialties, based mostly on organ systems (e.g. cardiology, gastroenterology) appear to be more and more inadequate in dealing with symptoms and problems which cut across organ system subdivisions and require a holistic approach. Moreover, affective disturbances (such as depression, anxiety, hostility) and illness behavior, the ways in which individuals experience, perceive, evaluate and respond to their own health status, may affect the course, therapeutic response and outcome of a given illness episode.'

Anecdotal evidence leads me to believe that BPS isn't all that prevalent and that the biomedical model prevails. It would be good to know if it is more widely used in medical/nursing and so on now - do you know? And it would be interesting to know if it is used widely in OH. Do you and anyone on List have any updated information?

Best regards

Catherine Mackay




On Wed, 27 Jun 2012 17:27:26 +0100, Karen Coomer wrote:
> Hi Carr
>
> A suggestion may be to focus on the prevalence of the biopsychosocial 
> model of OH delivery. This approach is in just about in every report 
> from the DWP to the HSE. I attach an example. Biomedical model is 
> outdated now and clients do want a more holistic approach rather than 
> solely disease focused. The argument is that CBT is now an essential 
> part of the OH toolkit in order to help facilitate behavioural change 
> in the identification of flags and an action centred solution.
>
> I have a large database of research on psychosocial factors, so if you 
> need anything like that just shout.
>
> Karen
>
> FROM: [log in to unmask] [mailto:[log in to unmask]] ON 
> BEHALF OF Carr Barnes
> SENT: 27 June 2012 09:32
> TO: [log in to unmask]
> SUBJECT: [OCC-HEALTH] Business case argument - study leave
>
> Hi all
>
> Need your help! I am self funding the CBT for OH course this autumn 
> and am trying to obtain study leave from employer but meeting 
> resistance (see conversation below from bottom up) - would any one be 
> able to give me any tips for how to angle my argument?
>
> FYI - my employer has a mainly UK based clientele but there are about
> 400 employees based in Rep of Ireland working for UK owned companies.
> Most of my calls currently are based to UK clients but the business 
> are trying to bring the Irish based employees on line to UK policies 
> and proceedures but the culture is very different here and there have 
> been talks about sending me in to HR etc to try to bring them 
> "online". One problem identified is the lack of EAP and cost of ad hoc 
> EAP support although that is in SLA as a service available.
>
> I always struggle with this sort of stuff. Would be happy with even 2 
> days leave if they can't give me full 5.
>
> Dear Carr
>
> Its not really clear are you fully self funding the cost of the course 
> and your travel etc?
>
> I'm not aware of the need for OHAs to deliver this type of work within 
> the business and as far as I am aware there is no need for it in your 
> locale. I really need a stronger business case even to authorise the
> 5
> days study leave
>
> kind Regards XXXX
>
> Hi XXX
>
> I'm self funding the costs of the course (travel, hotel etc);the 
> course fees are £1700.
>
> I've attached the course brochure link 
> http://www.atworkpartnership.co.uk/conferences/CBT/index.php [1]
>
> I understand from other people who have attended that this course has 
> significantly enhanced their practice particularly in facilitating 
> early returns to work as it focuses on effective health 
> belief/behaviours management.
>
> It will also qualify me to delivery targeted CBT (in the OH 
> environment for RTW purposes) which could be very helpful to the Irish 
> aspect of our customer base as it would negate the need to find 
> practitioners here and could help combat the medical "sick role" that 
> is encouraged over here in relation to absence. Atos Ireland need 
> significant development work to bring them up to UK sickness 
> management standards and Ann is talking about me going out to visit 
> sites etc so this sort of skill will be very helpful if effecting 
> Management and HR change also.
>
> Dear Carr
>
> can you give me a little more information regarding the 5 days please?
>
> I need to know costs, travel and I also need to know the benefits to 
> the business if I were to authorise this leave
>
> Regards XXXX
>
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