Evaluating the effectiveness of a return to work programme for adults living in Waikato receiving a ‘sickness’ benefit.

This study is evaluating the Realising Employment through Active Coordinated Healthcare (REACH) service. The service/intervention (REACH) was implemented before this study and was co-designed by the Waikato District Health Board (WDHB) and the Ministry of Social Development (MSD)*. This study aims to evaluate the effectiveness of REACH. The study has not designed the intervention. The REACH programme is a 12 week, goal orientated programme that consists of Key Workers and Living Well Coaches who work in partnership to support clients to achieve personal goals of returning to wellness and gaining employment. Key Workers are registered health professionals who include nurses, occupational therapists, social workers and physiotherapists. Key workers all hold annual practicing certificates and meet their professional board requirements with regards to competency and continuing professional development. The team also has regular clinical supervision by a clinical psychologist. Living Well Coaches work under the direction of the Key Workers. The Living Well coaches work alongside the client and Key Worker to identify the activity each day that the client needs the most support with, whilst at the same time empowering the client to take ownership of the rest of their planned activity. This could include developing the client’s Curriculum Vitae (CV) and interview skills to helping establish health behaviors through eating plans and exercise plans. The REACH service strongly focuses on a team approach, with the Key Worker actively liaising with the client’s GP and with the Ministry of Social Development case manager. The team supports the clients to work on their identified goals in their journey to be work ready, employing a holisitic approach based on the health model, Te Whare Tapa Wha. The interventions provided are based on a cognitive behavioral therapy intervention approach, motivational interviewing and are delivered in an interdisciplinary model. The REACH Key Worker meets with clients at least weekly and Living Well Coaches having up to 5 contacts a week with clients over the 12 week period. Collectively the REACH team will visit up to three-times a day for the three-months to deliver health interventions and support the client to return to employment. However, the exact frequency and time will be determined at the discretion of the Key Worker based on the participant's progress. The location of the sessions is determined based on the client’s goals and progress. For example, locations could include the GP practice with the GP, the MSD site for a monthly meeting, the clients home and kitchen to establish an eating plan and healthy cooking strategies, it could also involve utilising local gyms, pools or parks. At completion of each 4 weeks, the client, Key Worker and Work and Income case manager meet to discuss progress to date and where to for the next 4 weeks in the programme and what supports may be required to enable maximum participation by the client. A progress report is drafted by the keyworker and provided to the case manager and GP at each four-week stage. If at the end of the 12 weeks the client demonstrates potential for further gains, an extension of the programme is negotiated with Work and Income with clearly defined outcomes to be achieved in the extension period. At the end of the programme a handover meeting occurs with the client, Key Worker and Case Manager with a plan made for next steps for the client and who is responsible to follow up these actions. A copy of this report is also provided to the GP. Follow up of the client following exit from the programme can range from monthly text/phone call to face-to-face meetings to provide individual in-work/in-training supports as the client requests. The REACH team have access to a clinical psychologist, who coordinates hourly fortnightly group and assists keyworkers to support clients when they come against difficulties with taking the next steps in their journey. A key component of the intervention is a joint visit by Key Worker and client to the client’s GP to discuss their partnership and endorsement of the programme, as well as their ongoing support to the client with their identified goals. Basic routines for sleep, nutrition and exercise are established (as able) with clients to give solid foundations to improve their work readiness. Other interventions include career guidance, CV and cover letter preparation, anxiety and or depression management as applicable and strategies for clients to manage any chronic health conditions or maintain wellness in their lives. The experience of the Key Workers, Living Well Coaches and MSD Case Managers with the REACH services will be captured and evaluated by the study through conducting Focus Groups. The experience of clients using the REACH service will be captured through interviews (Basline, will be conducted face-to-face with follow-up phone interviews), this data will be compared to clients in the control group who are receiving usual care.