The effectiveness of the CARm training for labour experts to improve work participation of clients with multiple problems

Background:
The last decades the way we think about health, participation and how to treat unemployed or disabled clients changed. During the last 10 to 20 years there was a paradigm shift from compensation to participation. Formerly providing compensation for income loss was priority one nowadays we look first what we can do for clients to participate and when this is temporally not available we provide compensation. The mission statement of SSI is: “It is our mission to work with our partners to make a difference for people by promoting work. If work is impossible, we ensure that income is available quickly”. In the participation act people who are able to participate in society are expected/stimulated to do so. The focus is hereby more on self-management, own strength and own responsibility. People are made dependent while they prefer to be independent through self-management or shared decision making. People have to cope themselves preferably with support from their own social support network. When the latest is not possible professionals will take a “temporary role” in order to increase the process. Own strength an self-management are probably the most used words in the participation law. Because we promote more people to participate we reach the people who are long-term unemployed and therefore have a greater distance to the labour market. This are people with Multiple problems.


Objective:
“To develop and evaluate the effectiveness of the CARm training for labour experts to improve work participation of persons with multiple problems”.


Study population:
Approximately 440 client o fthe SSI with multiple problems will participate in this study.


Study design:
A cluster radomized control trail with randomization on at the level of the labour expert. Labour experts will be randomly assigned to the intervention (20) or to the control(20) group. Each labour expert has to recrute 11 clients for the RCT. The LE's in the intervention group will receive a traiing CARm. The clients in the intervention group will be giuded in their work reintegration by a CARm trained labour expert. Clients in the control group will be guided thier work reintegration by labour experts who provide care as usual.


Outcome measures:
The outcome measures of the study are work status, precieved health, functioning, empowerment, quality of life, social support and readiness for return to work.

Measurements take place at baseline and at 3 and 12 months after baseline. A proces evaluation will be performed at labour expert level and client level.

Clients with multiple problems supported by a CARm trained labour expert will improve on functioning and work status.
The primary aim of the study is to evaluate the effectiveness of an integrated, client centred and strengths based approach compared to care as usual.

Baseline questionaire and follow-up questionnatres at 3 and 12 months after baseline measurement.

At the level of the labour expert:Labour experts in the intervention group receive a three and a half day training in the CARm method. The labour expert will be trained to support the client on mutuality, focus on needs of client, activate recources, focus on strenths rather then pathology and toward self management.

Labour experts in the control group receive no training and continue their usual practice (care as usual).



At the level of the client:

Clients in the intervention group will be guided in their return to work (work participation) by a CARm trained labour expert.
Clients in the control group receive care as usual.