Factors influencing return-to-work outcomes of migrant workers after a work injury Heidi TAN Senior Principal Occupational Therapist Department of

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1 Factors influencing return-to-work outcomes of migrant workers after a work injury Heidi TAN Senior Principal Occupational Therapist Department of Occupational Therapy Heidi_Tan@ttsh.com.sg

2 Singapore: 1,368,000 foreign workforce ~ 33.6% of total workforce (Manpower Research and Statistics Department, 2018) Source:

3 Source: WSH Council Website 1 November 2017

4 The RTW Programme RTW Coordinator acts as the central person to coordinate inputs from various stakeholders to facilitate the worker to RTW. Source: WSH Council Website

5 Work Disability Prevention (WDP) Model

6 Objectives of study Gain a deeper understanding of the facilitators and barriers affecting the RTW outcome of migrant workers, and Consider the implications on practice for disability management practitioners

7 Methodology Total number of migrant workers recruited in the RTW programme in TTSH from Oct 17 to Jul 18 included in the study (N=28) 3 researchers studied 8 to 12 case studies each and identified facilitators and barriers affecting RTW using the WDP model Researchers obtained consensus on facilitators of migrant workers who RTW in SG (n=15) and barriers of migrant workers who did not RTW in SG (n=13) based on frequency of occurrences in case studies

7% were main breadwinners of family Manual labour force Construction

8 Results Demographics N=28, All males Mean age: 36 years (ranging from 26 to 52 years old) 85.7% were main breadwinners of family Manual labour force Construction (64%) Others: Operators, technicians, vehicle attendants Myanmar 4% Malaysia 3% China 14% India 18% Bangladesh 61%

9 Results Injury-related variables Type of injury Fractures (n=15, 54%) Laceration (n=7, 25%) Others; e.g. lower back pain (n=6, 21%) Area of injury Upper extremities (n=20, 71%) Lower extremities (n=5, 18%) Others; multiple areas (n=3, 11%) Severity of injury ISS 1 (n=11, 39%) ISS 4 (n=16, 57%) ISS 5 (n=1, 4%)

10 Results RTW outcome No, n=[value] 46% Yes, n=15 54% Number of migrant workers who RTW in Singapore Average length of time taken to first RTW ~ 75.6 days

Healthcare Legislative Motivated to RTW (f:12) Lower severity of injuries (f:7) Self-efficacy (f:6) Peer

11 Results Facilitators to RTW (n = 15) Communication between healthcare providers to support timely RTW (f:11) WICA (f:15) [CATEGORY NAME] [PERCENTAGE] Legislative 20% Workplace 31% Personal 34% Personal Workplace Healthcare Legislative Motivated to RTW (f:12) Lower severity of injuries (f:7) Self-efficacy (f:6) Peer support (f:1) Availability of modified duties (f:12) Supportive employer and coworkers (f:8) Safety officer involved in RTW (f:1)

12 Results Barriers to RTW (n -=13) Common law (f:6) Biomedical orientation of medical physician (f:4) Gaps in service coordination (f:1) Mistrust between employer and worker (f:6) Negative working relationships with colleagues (f:3) Lack of availability of modified duties (f:3) Employer decline RTW Coordination (f:2) Legislative Health- 11% care [PERCENTAGE] Workplace 26% Personal 54% Personal Workplace Healthcare Legislative Higher severity of injuries (f:9) Psychosocial barriers (f:8) Lack of motivation to RTW (f:7) Personal issues (f:3) Language barrier (f:2)

Discussion Top 5 facilitators and barriers in RTW Facilitators 1. Motivation (f=12) P 2. Availability of modified duties (f=12) W 3. Supportive employer and coworkers (f=8) W 4. WICA (f=15) L 5.

13 Discussion Top 5 facilitators and barriers in RTW Facilitators 1. Motivation (f=12) P 2. Availability of modified duties (f=12) W 3. Supportive employer and coworkers (f=8) W 4. WICA (f=15) L 5. Communication between healthcare professionals (f=11) H Barriers 1. Severity of injuries (f=9) P 2. Psychosocial barriers (f=8) P 3. Lack of motivation (f=7) P 4. Mistrust between employer and injured worker (f=6) W 5. Common law (f=6) L

14 Discussion Personal System Severity of injury Higher severity has a high occurrence among the barriers but lower severity did not have a high occurrence among facilitators in RTW of migrant workers No correlation and direct relationship to RTW (Comcare, 2017) Motivation Motivation or lack of motivation influenced the RTW outcome of migrant workers Strong correlation between motivation, perceived work ability and RTW status (Foreman et al, 2006)

15 Discussion Personal System Psychosocial barriers The ability of the migrant workers to cope with the injury and confidence to RTW Some presentations include denial of condition, poor pain coping ability, maladaptive or fixated expectations towards RTW e.g. cannot accept reduced pay during modified duty period Individual prediction about their ability to RTW is directly correlated with the RTW outcome (Huijs et al, 2012; Nieuwenhuijsen et al, 2013)

16 Discussion Workplace System Availability of modified duties Most migrant workers who RTW had availability of modified duties as a facilitator Work modifications can facilitate RTW and reduce the migrant workers work disability (Franche et al., 2005) However, lack of modified duties was not a frequent barrier to RTW and many migrant workers who did not RTW had availability of modified duties

17 Discussion Workplace System Employer and co-workers are supportive towards graded RTW Supportive employer and co-workers towards migrant worker versus mistrust between employer and migrant worker were both facilitators and barriers to RTW respectively Direct correlation between the workplace relationships and the worker s RTW outcome (Comcare, 2017; Dekkers-Sanchez et al, 2010; Kosny et al., 2013; Young, 2010)

18 Work Injury Compensation Act (WICA) Discussion Legislation System An injured worker in Singapore can choose to claim either one of two: Work injury compensation under WICA or civil suit under common law Only need to prove injury was due to work Compensation amount depends on age, wages and extent of injury No need to engage a lawyer. MOM can assist. Need to prove employer or 3rd party was at fault No limit to compensation, but have to justify the amount deserved before the Courts May need to get a lawyer as Ministry is not part of the court process Common Law (Ministry of Manpower, 2018) Decision to claim within one year from the date of injury

19 Discussion Legislation System All migrant workers who RTW successfully in Singapore are covered under the WICA Once migrant worker chooses common law Strains relationship with employer Significant barrier to RTW as work permit would be terminated Concerns often revolves around the claim management processes With legislations in place, it stimulates both employer and the injured worker to cooperate (Hoefsmit et al, 2013)

20 Discussion Healthcare System Communication between healthcare professionals to support timely RTW High occurrence amongst facilitators to RTW Communication focused on discussion on availability and suitability of modified work duties and readiness of migrant worker to progress to next phase of rehabilitation Allows cohesiveness and close collaboration of all stakeholders to exchange relevant information related to the injured worker Foreman et al, 2006; Mortelmans et al, 2006)

21 Discussion Healthcare System Role of the RTW Coordinator Eases communication between healthcare team and employer Eases access of communication between employer with healthcare team

22 Summary Personal System Psychosocial factors such as motivation & self-efficacy Workplace System Availability of modified duties & supportive employer/ co-workers Impact onto RTW outcomes among migrant workers Interplay of healthcare and legislative systems

23 Implications on practice for disability management practitioners To improve RTW outcomes for migrant workers: 1.Identify services or strategies to reduce impact of psychosocial barriers in RTW 2.Establish communication between healthcare professionals and employers to collaborate on RTW goals and concerns 3.Enhance positive workplace culture, relationship and trust

24 Acknowledgments RTW Coordinators Team: Joanna, Shermaine, Liwen, Wei Peng, Celestine, Yan Ming Co-investigators of study: Liwen TANG and Celestine LIM

25 References Berecki-Gisolf, J., Clay, F., Collie, A., & McClure, R. (2012). Predictors of Sustained Return to Work After Work-Related Injury or Disease: Insights from Workers Compensation Claims Records. Journal Of Occupational Rehabilitation, 22(3), Comcare. (2017). Barriers to return to work: A literature review. Australian Government, Dekkers-Sanchez, P. M., Wind, H., Sluiter, J. K., & Frings-Dresen, M. H. W. (2010). A qualitative study of perpetuating factors for long term sick leave and promoting factors for return to work: Chronic work disabled patients in their own words. Journal of Rehabilitation Medicine, 42, Foreman, P., Murphy, G., & Swerissen, H. (2006). Barriers and facilitators to return to work: A literature review. Australian Institute for Primary Care, La Trobe University, Melbourne. Franche, R., Cullen, K., Clarke, J., Irvin, E., Sinclair, S., Frank, J. (2005). Workplace-based return-towork interventions: A systematic review of the quantitative literature. Journal of Occupational Rehabilitation, 15(4), Hoefsmit, N., Houkes, I., & de Rijk, A., (2013). Work resumption at the price of distrust: A qualitative study on return to work legislation in the Netherlands. BioMed Central, 13, 153. Huijs, J., Koppes, L. L. J., Taris, T. W., & Blonk, R. W. B. (2012). Differences in predictors of return to work among long-term sick-listed employees with different self-reported reasons for sick leave. Journal of Occupational Rehabilitation, 22(3),

26 References Kosny, A., Lifshen, M., Pugliese, D., Majesky, G., Kramer, D., Steenstra, I., Soklaridis, S., & Carrasco, C. (2013). Buddies in Bad Times? The Role of Co-workers After a Work-Related Injury. Journal Of Occupational Rehabilitation, 23(3), Loisel, P., Buchbinder, R., Hazard, R., Keller, R., Scheel, I., van Tulder, M., & Webster, B. (2005). Prevention of work disability due to musculoskeletal disorders: The challenge of implementing evidence. Journal of Occupational Rehabilitation, 15(4), Ministry of Manpower (2018). Manpower statistics in brief, Singapore. Retrieved from Ministry of Manpower (2018). Work injury compensation. Retrieved from Nielsen, M. D., Bültmann, U., Madsen, I. E., Martin, M., Christensen, U., Diderichsen, F., & Rugulies, R. (2012). Health, work, and personal-related predictors of time to return to work among employees with mental health problems. Disability & Rehabilitation, 34(15), Nieuwenhuijsen, K., Noordik, E., van Dijk, F. J. H., & van der Klink, J. J. (2013). Return to work perceptions and actual return to work in workers with common mental disorders. Journal of Occupational Rehabilitation, 23(2), Young, A. E. (2010). Employment maintenance and the factors that impact it after vocational rehabilitation and return to work. Disability & Rehabilitation, 32(20),

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Protection of elderly foreigners

Protection of elderly foreigners Please provide information on the current situation on human rights of older persons and existing legislation, policies and programmes to protect and promote the human rights of older persons. The Consolidation