(Dis)Ability Management: The Systemic Client Approach: A Case Study

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(Dis)Ability Management The Systemic Client
Approach A Case Study

• Hans Schmidt
• Rehafirst, Zürich/Switzerland
• h.schmidt_at_rehafirst.ch

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Overview

• Ability Management at the workplace in
  Switzerland We have a close look at how we try
  to manage the return-to-work process itself
• In our projects we deal with all kinds of
  accidents and all illnesses
• Introduction
• Definitions
• Ability Management
• Case Management approach
• Systemic Case Management approach
• Case Study Regulas story
• More details in the handout if you send me an
  email to h.schmidt_at_rehafirst.ch

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The Problem

• Disability cases doubled within 10 years in
  Switzerland
• Disability Management in Switzerland seems
  absolutely necessary, because of the jungle in
  our social security system
• The client has to find out
• Which insurer is responsable for his/her case
• How he has to formulate requests for benefits to
  the right insurance company

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The answer

• A rising number of employers support the
  return-to-work process of their ill or injured
  employees
• At our Company Rehafirst, we are currently
  running 7 different pilot programs, involving
  mostly government organisations, with close to
  200000 employees
• We offer support for inhouse and external
  solution

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Ability Management

• We strive to support and strengthen the client,
  rather then dwell on the pathology and deficits
  of the case
• We try to broaden the clients horizon
• The goal is to reach out and look for new
  possibilities, creating more options for the
  client.

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The Case Management approach

• We help and acompany our client throughout the
  whole recovery and reintegration process, no
  matter how long it takes and how many insurers
  are involved
• We continuously network between the different
  players and professionals involved in the case.
• We try to become the nerve center of the whole
  case

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The systemic Case Management approach

• We look at the client himself, his/her family,
  environment and the interaction of the system as
  a whole
• The Client is for us an autonomous individual, we
  do not attempt to normalize the client and to
  fit him/her into our mold
• We try to understand his/her framework and
  uniqueness
• Always keeping a client centered approach

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From problem focus to solution focus

• The problem is not the clients deficiencies or
  limitations, the problem is the lack of a better
  perspective
• Or a limited understanding of the choices
  available to him/her
• The perspective needs to be changed, not the
  client

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Systemic empowerment approach

• Our client is responsible for his/her own health.
  We are the experts of the process, we leave it
  up to the client to determine how fast or slow we
  proceed and in which direction.
• The client is the expert of his own health
  (empowerment aspect)

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Two system instruments to support the
reintegration process

• In brief two of our instruments
• Dreaming Where do you want to be professionally
  in five years?
• If due to health problems return to work is not
  possible, e.g. no transitional workplace
  available We offer a 40 hour rehabilitation
  week. Clients practice this at home by trying
  to improve a task they like to do

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Central questions in this process

• What are the clients abilities?
• What skills remain after the incident?
• Who is part of the clients support system?
• What has already been undertaken or done to solve
  the problems?
• Which goals can the client reach with the support
  of those around him/her?
• What are the goals that can only be reached with
  professional help?

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Regulas story

• She (39 years old) took her two teenage children
  on a sleigh ride.
• She was forced off the track, and run over by a
  driver on a sleigh coming right behind her
• Regula was knocked unconscious and was very
  severely injured (brain injury)
• She could no longer concentrate, needed long
  hours of sleep and suffered terrible
  forgetfulness. She could not bear any noise

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Regula is a nursery-school teacher

• This is quite a noisy job
• It soon became obvious, that on a long-term base,
  she could no longer work as a teacher in a
  nursery school
• There were also severe conflicts within the
  family system that had arisen since the accident.
  
• Her teenage children were posing a challenge, and
  her life-partner seemed unable to deal with the
  new reality facing the family and his
  relationship to Regula

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The family as a stumbling block

• Regulas case is not only a technical back to
  work case, it is not just a medical case
• The family itself became a stumbling block that
  slows down, or even hinders, the recovery and the
  back-to-work-process

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The role of the ability manager

• Anna-Lisa, her ability manager, was a former
  school teacher who had worked with children with
  intellectual disabilities, she was also trained
  in Family and Trauma Therapy
• Eight months after the accident, after careful
  observation of the recovery process Regula and
  Anna-Lisa agreed that the only solution was a
  change of profession, including a retraining as a
  remedial teacher
• The change management was only possible due to a
  close look at the family system.

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Conclusion

• The chance of success rises in direct proportion
  to the way we make our clients feel
• When they feel respected and treated as unique
  and autonomous individuals, with their goals and
  dreams being treated with dignity
• When they feel we are following their own
  instructions, their own ideas, in looking for
  answers, within their own resources
• Then we are truly elevating the chances and
  possibilities of a successful change in the
  clients life.