Managing Mental Health Accommodation
Keith Hanson, Disability Management Specialist
Nathan Laakso, Occupational Therapist
Kathleen Stokes, Labour Lawyer
Learning Objectives
Provide an understanding of
• real world solutions in managing mental health
claims
 using objective cognitive tools
• the scope of mental health claims costs associated
with these claims
• a larger strategy to manage these claims
• Develop a better understanding of how to manage
some of these claims
 through actual case histories
Continued on next slide…
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Learning Objectives
Continued from previous slide…
• What are these cognitive tools?
• When, why & how to use them efficiently?
 Cognitive Demands Analysis (CDA)
 Cognitive Abilities Evaluation (CAE)
 Cognitive Work Hardening (CWH)
• What are the latest legal implications as it pertains to
duty to accommodate.
 legal strengths of the assessments
 how they pertain to labour law
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Speakers
Mr. Keith Hanson
M.Sc., CDMP, Disability Management Specialist Vale,
Ontario Operations
Mr. Nathan Laakso
Ms.OT, Occupational Therapist
Ms. Kathleen Stokes
B.A., L.L.B, Labour Lawyer, Weaver Simmons
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VALE - Who We Are
• One of the 3 largest mining companies in the world
• Head quartered in Brazil
 operations in 30 countries
• World’s leading producer of iron ore
• Second largest producer of nickel
Continued on next slide…
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VALE - Who We Are
Continued from previous slide…
Ontario Operations
• 6 Underground Mines
• 1 Smelter
• 1 Mill
• 2 Refineries (1 in
Sudbury, 1 in Port
Colbourne)
• Approx. 4500 employees
Key Values
 Life matters most
 Value our people
 Prize our plant
 Do what is right
 Improve together
 Make it happen
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Mental Health Disability Risk
• 5% of all Occupational injuries/illness (2% allowed)
• 34% all Short-Term Disability claims
• 50% of all Long-Term Disability claims
• Incidence of mental health claims up by 70% since
2008
• 40% of all lost days are result of mental health claims
• Approx. 16,000 annual lost days due to mental health
disability (61 FTEs not at work all year)
• Case durations 2-3x that of physical injuries/illness
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Managing Mental Health
Key Actions
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1. Long-Term Mental Health Strategy
• Mental Health First Aid Training for supervisors &
employees
• Promotion & Awareness
 joint management/union effort
• Research
 in-house research on determinants/predictors
sponsored by JOHC
• Implementation of CSA Voluntary Standard integrating
with our current HSE Management System
Managing Mental Health
Key Actions
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2. Proactive Risk Based Case Management
• Analysis of case and potential risk factors
 individual
 workplace
 health care provider
 other
• Early intervention in managing recovery
• Promotion of “at work” recovery and accommodation
Managing Mental Health
Key Actions
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3. Cognitive/Psychological Demands Analysis
• For all Occupations
• Starting with most at risk
• Management/union involved in development process
Managing Mental Health
Key Actions
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4. Use of Cognitive/Psychological Functional Demands Testing
• Significant mental illness or potential cognitive deficit
that may affect Return To Work
• Person with mental illness returning to critical job
• Accommodation
Managing Mental Health
Key Actions
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Cognitive Tools
What is a Cognitive Demands Analysis (CDA)?
What is a Cognitive Abilities Evaluation (CAE)?
What is Cognitive Work Hardening (CWH)?
How do we use these tools?
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Common Cognitive/Behavioural Deficits Affecting Performance
• Initiation, Organization,
Task completion
• Ability to sequence,
generalize or plan
• Following
directions/instructions
• Memory
• Attention & Concentration
• Problem Solving &
Cognitive Flexibility
•
•
•
•
•
Abstract Thinking
Judgment
Insight & Awareness
Information processing
Poor Communication with
others
• High Levels of Frustration
• Loss of confidence &
motivation
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Cognitive Demands Analysis (CDA)
• Objective analysis of the essential cognitive, emotional
and psychological components and demands of a job
and the skills and behaviors required to perform the
job demands
 Information for return to work programs
 Disability Prevention
 Pre-employment screening/job retention
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What does a CDA Measure?
Cognitive Demands
• Cognitive skills and resources required to perform
work tasks
Behavioural Demands
• The actions, efforts and interactions a worker may
encounter that require a specific response or
subsequent set of actions to manage or perform duties
and tasks in the work place
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Behavioural and Cognitive Demands Analysis
• Degree of Self-Supervision
•
Required
•
• Degree of Supervision
Exercised
•
• Performance of Multiple Tasks
Required
•
• Deadline Pressures
• Attention to Detail
•
• Exposure to Distracting
•
Stimuli
•
• Need to Work Cooperatively •
with Others
•
Memory
Exposure to Emotional
Situations
Exposure to Confrontational
Situations
Responsibility &
Accountability Required
Reading Literacy
Written Literacy
Numerical Skills
Verbal Communication
Ability to Use Computers
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Degree of Self
Supervision Required
“The extent of self-supervision
required in the course of
duties. Where this demand is
rated high (requires the
worker to be predominantly
self-supervised) and the
demand for Performance of
Multiple Tasks required and/or
accountability is also high, the
worker may be expected to
exercise good problem
solving and judgement.”
Degree of Self Supervision Required
Rank
1
2
3
4
Description
Job Examples
No self-supervision required; fully
supervised
Parks ground crew
(grass cutter)
Occasional self-supervision
required; supervisor frequently
provides work direction
Frequent self-supervision required;
supervisor occasionally provides
work direction
Predominantly self-supervised
throughout the shift; may contract
supervisor to obtain work direction
as needed
Clerk with varied
task assignment and
frequent direction
Executive assistant,
ECE worker
Manager, Nurse,
Accountant
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Cognitive Abilities Evaluation (CAE)
• Determines the person’s level of cognitive functioning
• Represents actual versus reported abilities
• Identifies gaps between demonstrated cognitive ability
and required cognitive behavioural demands
• Identifies solutions (accommodations & adaptations)
for return to work
• Job Matching –
• Tested abilities (CAE)
• Abilities required for the position (CDA)
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Components of a CAE
• Review Cognitive Demands Analysis
• Complete file review
• In-Depth Interview
 Medical History
 Job description
 Review of present medication & possible side
effects
 Current Functional Status with respect to ADLs
Continued on next slide…
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Components of a CAE
Continued from previous slide…
Functional and formal assessment of cognition
• Must consider …
 the level of the claimant, context & what skills we are
trying to measure
 constraints (e.g. location of assessment & availability of
assessments, time restraints, special certifications)
 putting a statement in your report cautioning the reader
regarding test limitations and/or interpretation (e.g.
“Scores reflect an estimate of general functioning”)
 factors that may influence or impact performance on
tests
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Purpose of Cognitive Work Hardening
• Improve present function and overall tolerances
through
 Re-establishing a functional routine
 Re-establishing time management strategies
 Grading tasks to promote client success
 Identifying, implementing & practicing additional
coping strategies during work simulation
• Increasing self-confidence through work simulation
(concentration and memory)
• Facilitate a RTW process to pre-leave place of work
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Cognitive Work Hardening
• Meeting the needs and eliminating the barriers for
each client
 Individualized Programming
• Educating in coping strategies, cognitive compensation
& cognitive behavioral techniques
• Gradually adding more & more levels of complexity for
an individual task
• Providing home practice after each session
• Debriefing with the client during each session
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Case Examples
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Case Example 1
•
•
•
•
•
•
•
•
Administrative Assistant x 12 years
Several periods of disability due to depression since 2009
Most recent period off x 16 months
Recommendation of RTW by her psychiatrist; employee
reported being ready to return
Management concerned about successful return to job
duties based on previous performance and RTW failures
Union concerned management not doing due diligence in
accommodation and setting EE up for failure
Action Plan: Conduct CDA and have EE undergo CAE
Union and employee resistance
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Case Example 1
Actions
• Initial contact with employer educating on CDA purposes &
process
• CDA completed on site: high attention focus, multi-tasking
required, communication skills, and self-supervision required
• CAE completed with employee: No functional cognitive deficits
were identified that would inhibit her from completing the role.
Able to meet demands required
• Gradual RTW recommended due to length of time away from
position and to ensure tolerances will be met
• Satisfying results for both employee and employer
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Case Example 1
Outcome
OUTCOME
 Full duties to pre-illness employment
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Case Example 2
• Separation Circuit Operator x 8 years
• Work-related head injury
• WSIB provided general restrictions and recommendation of
GRTW from Toronto rehab centre
• RTW initiated in alternate occupation
• EE struggling to work in alternate occupation even though
within restrictions provided by WSIB
• EE and worksite report EE making errors and not able to
manage demand
Action Plan:
• Conduct CDA
• Have EE undergo CAE to determine job suitability
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Case Example 2
Actions
• Alternate accommodations addressed physical restrictions only
• CDA completed - results indicate job requires high levels of
memory, problem solving, attention, focus, and multi-tasking
• CAE completed on employee. Multiple areas of concerns
including memory, attention, multi-tasking, new learning,
problem solving etc.
• Work hardening program developed in the clinic; concurrent
with nurses/placement facilitator exploring potential new
positions
• CDAs screens completed on potential openings as cost saving
measure. Full CDA developed on appropriate job screened.
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Case Example 2
Outcomes
Return to Work Strategies and Accommodations:
• CDA matched employee’s abilities.
• Work hardening continued with graduated return to
work implemented.
• On-site follow-up weekly to immediately address
issues and concerns.
OUTCOME
• Successful placement to new employment within the
company
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Case Example 3
• Refinery Operator x 20 years
• Work-related head injury – WSIB specialty clinic referral
• Physical and cognitive restrictions following recovery to
RTW
• Previous workplace/HR issues, significant union
involvement
• Employee resistance
in RTW process
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Case Example 3
Action Plan
• Updated FCE
• Conduct CDA and EE undergo CAE to determine job
suitability
• Determine RTW plan
• WSIB and union supported planned approach as based on
objective testing and essential demands of the job.
• EE has reciprocal duty to participate in reasonable
accommodation actions
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Case Example 3
Actions
• CDA Results
 job involved low levels of concentration, memory,
planning, and basic reading and numerical skill; moderate
levels of meeting deadlines and time pressures etc.
• CAE Results
 Difficulties with concentration, energy levels, pacing,
planning.
 Employee was able to meet some demands but not every
essential job demands
 Worksite able to accommodate small portion which he was
not suited to completed.
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Case Example 3
Outcomes
Return to Work Strategies and Accommodations:
• Structured tasks and schedule with deadlines
• Routine, repetition, modeling
• Need for breaks, schedule adjustment
• Supportive employment approaches
OUTCOME
• Successful transition to previous employment within
the company that meets his physical and cognitive
abilities.
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The Legal Perspective
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Accommodation
• Return to work WSIB and Duty to Accommodate
• Return to work and accommodation is a multi-party
process
• “Along with the employer and the union, there is
also a duty on the complainant to assist in securing
the appropriate accommodation” Renaud, 1992
• WSIB has a role
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Medical Information
• Entitled to sufficient information to justify return to
work with or without an accommodation
 If you do not have the information, you must
request it
• For mental disability, this includes medical information
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Employer May Request






Info on nature of illness
Description of illness but cannot ask diagnosis
Duration
Restrictions and abilities
Treatment (may include medication in some positions)
Information on how diagnosis was reached
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CDA and CAE
Why is this information important?
The CDA and CAE can be instrumental in either
facilitating a return to work or preventing it!
• The CDA will provide the information on the essential
cognitive, emotional & psychological components of a job
• The CAE will provide information whether the employee
can meet those demands (i.e., their level of cognitive
functioning
• The information from CAE and CDA can provide work
specific comparisons & assist in developing a realistic
return to work plan
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CDA and CAE
Why is this information important?
• WSIB will not get this information for you in a form that
may facilitate an accommodation and allow you to meet
your obligations
 Go to the hearing (tribunal, grievance or WSIAT) and
you have no information to defend the claim
• There are serious financial consequences attached to not
having the employee return to the workplace
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CDA and CAE
Why is this information important?
• If Employer is of the view the Employee can come back
and WSIB is advising that the Employee cannot, this
information can be utilized to push for an
accommodation
• There are instances where the Employer is of the view
the Employee cannot come back to work and WSIB is
advising they can (i.e. situation where the employer
believes there are serious health and safety concerns)
• This information can be used to push back against WSIB
against an accommodated return or any return.
• Case examples!
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CDA and CAE
• Identify the need for an accommodation and what
restrictions are at play (mental disability??)
• Cooperate and facilitate the implementation of the
accommodation
• Includes accepting accommodation that is NOT
preferred
• Use the CDA as your guide
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Cooperation in the Accommodation Process
To cooperate in the accommodation process …
 Issues of seniority
 Bargaining unit issues
 Grievance management
 Capacity
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Undue Hardship
• Undue hardship – Use evidence!
 Financial cost
 Disruption to collective agreement
 Morale of other employees
 Interchangeability of workforce
 Compromised safety
 Suitability of return to work note
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Conclusion
Where are we
• Undue hardship
• Modifying existing job
• Bundling – what does that mean
• New job – in some circumstances
• Creating a job – not an obligation
• Does not have to be employee’s preferred
accommodation
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Keys to Success
• Early intervention is the key to success
• Use Cognitive Tools to objectively determine the
workers abilities/limitations (CAE)
• Develop cognitive Demands Analysis (CDA) for all
occupations starting with most at risk
• Work Collaboratively with all parties during the
process
• Understand your obligations
 prepare, document, use objective tools and be
proactive
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Questions?
Thank you!
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References
Blesedell Crepeau, E. (1991). Achieving intersubjective understanding: Examples
from an occupational therapy treatment session. The American Journal of
Occupational Therapy, 45 (11), 1016-1025.
Canadian Association of Occupational Therapists (CAOT). (1997). Enabling
occupation: An occupational therapy perspective. Ottawa, ON: CAOT
Publications ACE.
Law, M. et al. (1996). The Person-Environment-Occupation Model: A transactive
approach to occupational performance. The Canadian Journal of Occupational
Therapy, 63 (1), 9-23
Polatajko, H. J., et al. (2007). Specifying the domain of concern: Occupation as core.
In Canadian Association of Occupational Therapists (Ed.), Enabling occupation II:
Advancing an occupational therapy vision for health, well-being, & justice through
occupation (p. 13-36). Ottawa: CAOT Publications ACE.
Raybould, K., et al. (2001). The City of Toronto’s Job Demands Analysis and Job
Match System. Retrieved February 9, 2012, from Ergonomie-Self, Web site:
http://www.ergonomie-self.org/documents/36eme-Montreal-2001/PDF-ENG/V4056-R032-RAYBOUL.pdf
Shaw, L., Lysaght, R. (2008). Cognitive and Behavioral Demands of Work. In K. Falk,
& M. K. Deutsch (Eds.), Ergonomics for Therapists (pp. 103-122). Missouri: Mosby
Elsevier.
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