Re-employment & Health

1. Re-employment & Health Rogier van Rijn Erasmus MC, department of Public Health

2. Unemployment: Europe Unemployment rates 2012 6,4% 4,1%

3. Unemployment: The Netherlands Unemployment rates 2012 12,6% 10,9% 7,9% 6,4% 6,4%

4. Unemployment and Health Lower scores on all health dimensions for the unemployed Health survey 2003 GGD Rotterdam

5. Unemployment and Health Continue to be unemployed (n=918) Re-entered paid employment (n=47) Self-rated health (scale 0-100) All dimensions of health improved among re-employed subjects Health at baseline was better among subjects who returned to paid employment Schuring et al. The effect of re-employment on perceived health. J Epidemiol Community Health. 2011;65(7):639-44

6. What works and what does not? Isolated health promotion programme no effect on health and work resumption

7. What works and what does not? • Personal advisors and individual case management helped some people • Many studies suffer from selection bias; more work-ready claimants • Financial incentives; too low or too short

8. What works and what does not?

9. Summary Integrating health promotion programmes with re-employment activities Poor perceived health among the unemployed Re-employment  health Isolated health promotion programme not effective Supported employment effective (USA, UK)

10. Fit4Work (F4W) Unique collaboration between Municipal Health Services, Social Security Services and UWV in 4 largest cities of the Netherlands Objectives: Gain quick and sustainable work in the labour force Increase perceived health (mental, physical) • Fit4Work stands for: • Rapid job search and job placement • Treatment of mental problems • Support and guidance to participants

11. Fit4Work initiatives • Cost-benefit analysis (in advance) of Fit4Work • Evaluation study of Fit4Work • Process evaluation Fit4Work

12. Cost-benefit analysis in advance of a new intervention • Insight into where returns can be expected • Social justification of the focus on the target population • Insight in the information gathering for the cost benefit analysis afterwards

13. Cost-benefit analysis Comprehensive understanding of costs and benefits perspective of actors (e.g. clients, municipality) the society as a whole (taxpayer) Costs & benefits Intermediate effects Intervention

14. Literature study Interventions aimed at re-employment of the unemployed Randomised controlled trials

15. Effects: re-employment, hours worked Re-employment; mean difference of 16% (IPS vs. control) Hours worked; mean 23 hrs/ week in both groups Mueser KT. The Hartford study of supported employment for persons with severe mental illness. J Consult Clin Psychol. 2004;72(3):479-90.

16. Effects: type of work Percentage that worked at least one day Voluntary work Subsidized work Regular work Control IPS at 6 months at 18 months at 6 months at 18 months More regular work, less subsidized work and voluntary work Michion HJ. Effectiviteit van individuele plaatsing en steun in Nederland: Verslag van een gerandomiseerd gecontroleerde effectstudie. 2011. UMCG/Trimbos instituut

17. Effects: other • Income and unemployment benefit • Increase of regular work  income , benefits • Quality of life • Effects are not well known • Use of healthcare • Effects are not well known • Use of informal care • Effects are not well known

18. Total costs and benefits

19. Fit4Work initiatives • Cost-benefit analysis (in advance) of Fit4Work • Evaluation study of Fit4Work • Process evaluation Fit4Work

20. Evaluation study Fit4Work Research questions • Which factors determine the reach and uptake of Fit4Work? • What are the effects of Fit4Work on perceived mental health, work resumption, and social participation? • What are costs and benefits relative to estimated effects of Fit4Work?

21. Pragmatic Randomised Controlled Trial • Long-term unemployed subjects (age < 50yr) with mental health problems • Sufficient labour market skills • Sufficient skills to be able to provide answers in an interview • No severe acute psychiatric illness • No drug addiction or being homeless Randomisation Questionnaire (baseline) Control (n=500) Fit4Work (n=500) • Primary outcomes; • perceived mental & physical health • work resumption • social participation • Secondary outcomes; • self-esteem • resilience • social problems • medical consumption • regular re-employment programme and medical care Questionnaire (12 months) • intersectoral integrated approach • improving mental health • addressing barriers in social- and labour force participation Questionnaire (24 months) Target population (n=1000)

22. Fit4Work initiatives • Cost-benefit analysis (in advance) of Fit4Work • Evaluation study of Fit4Work • Process evaluation Fit4Work

23. Process evaluation Fit4Work • Process evaluation consists of: • Formative evaluation – implementation research • Summative evaluation - crucial element analysis Research & Business Intelligence

24. Formative evaluation • Research questions: • How well is the intervention adopted by the participating institutions and are the essential elements delivered as intended? • Is the reach of the target population sufficient? • Methods: • Interviews; participants of multidisciplinary teams • Document analysis; selection of intervention plans • Observation; attend multidisciplinary meeting • File analysis; analyse participant files

25. Summative evaluation • Research question: • Which components are considered to contribute most to the primary and secondary outcome measures? • Which subgroups seem to respond best to the Fit4Work intervention • Methods: • Data analysis of questionnaires • Casuistic analysis of participants, drop-outs, re-employed persons • File analysis

26. Thanks for your attention • r.vanrijn@erasmusmc.nl