Title: Collaborative case management to aid return to work after long term sickness absence: a pilot randomised controlled trial
Funder: Department of Health (England)

Abstract: This proposal seeks to develop a simple low cost intervention that can be implemented in small and medium sized enterprises (SMEs) and larger organisations in the United Kingdom and which has the potential to be an effective and cost effective intervention among employees on long term sick absence improving their well being and encouraging return to work.We propose to adapt the intervention from an existing evidence-based approach (collaborative case management). Collaborative case management draws on current best practice in the management of a range of long-term conditions (including mental health and musculoskeletal problems) and has been proven effective in a number of randomised trials in a range of contexts and patient populations. We have extensive experience of the delivery and evaluation of this intervention through previous and ongoing trials funded by NIHR and MRC and through our work on related Cochrane reviews. The intervention is based on structured assessment and follow-up by a case manager to engage clients in treatment help them identify useful interventions from a client-centred menu of options and proactively follow clients to assess progress maintain motivation and to ensure that initial treatment gains endure over time. Collaborative case management uses telephone delivery to maximise efficiency and access. The model also involves experienced mental health professionals acting in a supervisory capacity to ensure that interventions are delivered effectively and that clients who are showing limited progress in the initial phases of the intervention receive additional support and assistance. The collaborative case management model is simple useable by a range of professionals and is efficient using short contacts via telephone with a focus on self-management.Although proven in a range of disorders in routine health care settings the intervention has only recently been adapted to the occupational health context. The collaborative case management model used in the occupational health context involves additional interventions designed to help mediate between employee and employer and encourage effective return to work. However delivered in an occupational health context the model has only demonstrated preliminary evidence of effectiveness from studies in the United States and the Netherlands. As collaborative case management in an occupational health context is a new and developing approach we propose an initial 2 phase study. In phase 1 (development) we will update our current review of collaborative case management and work with stakeholders representing employees and employers to adapt the intervention to the UK context and maximise acceptability and effectiveness. In Phase 2 (internal pilot) we will assess intervention delivery and trial recruitment within an internal pilot randomized controlled trial. The collaborative case management intervention will be delivered in occupational health settings in a range of organisations. The intervention will be delivered by staff in existing employee assistance programs who will be retrained to deliver the protocol to a high level of fidelity with appropriate support and supervision. We will compare collaborative case management against usual occupational health services in the organisations in our pilot study. The main outcome will be the CORE-OM a generic measure of psychological distress. We will also employ a range of secondary outcomes including health related quality of life depression social functioning and occupational functioning (including absenteeism and presenteeism). If the intervention is judged to be feasible and acceptable and we demonstrate an ability to recruit effectively to the trial in an occupational health context we will seek funding for a definitive trial with several hundred employees assessing a range of outcomes at 3 6 and 12 months to assess effectiveness and cost-effectiveness.If the definitive trial is successful we will be able to inform policy and practice and ensure that employees have access to evidence based and effective services to better manage periods of sickness absence and to ensure that best practice in the management of long term problems are available to the public through occupational as well as health contexts.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE