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WORK: A Journal of Prevention, Assessment & Rehabilitation is an interdisciplinary, international journal which publishes high quality peer-reviewed manuscripts covering the entire scope of the occupation of work. The journal's subtitle has been deliberately laid out: The first goal is the prevention of illness, injury, and disability. When this goal is not achievable, the attention focuses on assessment to design client-centered intervention, rehabilitation, treatment, or controls that use scientific evidence to support best practice.
WORK occasionally publishes thematic issues, but in general, issues cover a wide range of topics such as ergonomic considerations with children, youth and students, the challenges facing an aging workforce, workplace violence, injury management, performing artists, ergonomic product evaluations, and the awareness of the political, cultural, and environmental determinants of health related to work.
Dr. Karen Jacobs, the founding editor, and her editorial board especially encourage the publication of research studies, clinical practice, case study reports, as well as personal narratives and critical reflections of lived work experiences (autoethnographic/autobiographic scholarship),
Sounding Board commentaries and
Speaking of Research articles which provide the foundation for better understanding research to facilitate knowledge dissemination.
Narrative Reflections on Occupational Transitions, a new column, is for persons who have successfully transitioned into, between, or out of occupations to tell their stories in a narrative form. With an internationally renowned editorial board,
WORK maintains high standards in the evaluation and publication of manuscripts. All manuscripts are reviewed expeditiously and published in a timely manner.
WORK prides itself on being an author-friendly journal.
WORK celebrates its 25th anniversary in 2015.
*WORK is affiliated with the Canadian Association of Occupational Therapists (CAOT)* *WORK is endorsed by the International Ergonomics Association (IEA)* *WORK gives out the yearly Cheryl Bennett Best Paper Award*
Abstract: BACKGROUND: Military culture and workplace are areas of interest for researchers across disciplines. However, few publications on military culture exist. OBJECTIVE: The purpose of this article is to introduce general concepts regarding the structure and culture of the United States Military and discuss how this creates challenges for reintegrating into the civilian world. METHOD: Topics that will be covered in this article include an overview of the Department of Defense (DoD) and…Department of Veterans Affairs (VA), socialization to military culture, the unique features of the military as a workplace, the cultural experiences of military personnel reintegrating back into the community, and the challenges faced by military members and their spouses. RESULTS: The provided information on military culture will expand military cultural competency so that civilian employers can enhance their ability to create supportive workplaces for veterans and military spouses during times of transition and reintegration. DISCUSSION: The unique characteristics of the military culture should be understood by those who work with or plan to work with military populations.
Keywords: Department of Defense, military personnel, military spouses, military roles, reintegration
Abstract: BACKGROUND: The prevalence of medical risk factors for suicide (e.g., mental disorders, severe disability, social disruption) may be higher among WTs compared to traditional Army units. Likewise, the extent to which traditional factors that protect soldiers from developing serious mental disorders (e.g., social support, unit cohesion, leadership) are present among soldiers assigned to the WTU is unclear. OBJECTIVES: An epidemiological consultation (EPICON) was conducted in 2010 to assess potential causes for a perceived high…rate of suicides and preventable deaths in U.S. Army Warrior Transition Units (WTUs) and to identify potential improvements to the system of care. METHODS OF STUDY: The EPICON focused on: (1) risk factors for suicide/preventable deaths; (2) chronic pain management; (3) utilization of and access to WTU medical and behavioral health (BH) services; and (4) the impact of the WTU environment on mission focus and warrior disposition. BH history was examined for soldiers who died by suicide or preventable death while assigned to the WTU (index cases) and a representative comparison group of non-index case soldiers. Surveys and focus groups were conducted at four WTUs with Warriors in Transition (WTs) and key support staff. RESULTS: The use of psychotropic and/or CNS depressant medications, prevalence of BH diagnoses and substance use disorders, polypharmacy, alcohol use, and a high cumulative number of stressors were identified as important risk factors for preventable deaths in the WTC. Areas of potential improvement to the system of care included addressing negative perceptions of the WTU environment, lack of social support, barriers to accessing BH services and issues related to coordination of care. CONCLUSIONS: There was no one single risk factor found to be associated with an increased likelihood of preventable deaths within the WTU. The unique design and operation of the WTUs as environments focused on treatment and rehabilitation provide both benefits and challenges to recovery and risk mitigation.
Abstract: BACKGROUND: A growing number of women are serving in the military in a variety of roles, yet information on their experience of stressors not associated with either combat or sexual harassment is not commonly reported. OBJECTIVE: To present phenomenological data on stressors experienced in military service, together with the use of coping strategies as a way to focus on women's mental needs following deployment from service. METHODS: Twenty women who had recently completed their compulsory…army service in Israel drew a picture expressing stressors they experienced in the army. They analyzed their own pictures on three levels: the content, context, and the composition as expressing stress and the resources they used in coping with stress. RESULTS: Six themes were raised: proximity to war situations, coping with accidents in training soldiers under their command, a conflict between political values and military orders, witnessing the injury of another female soldier, responsibility for accidental injury of a civilian, and distress over the army placement. CONCLUSIONS: Coping resources were relational, primarily family and friend support, rather than from the army framework. This reliance on relational sources of support was both a resource and a source of vulnerability and is viewed as distinct from men's style of coping.
Keywords: Arts based research, self-in-relation model, Israel Defense Forces, PTSD symptoms
Abstract: BACKGROUND: Barriers to employment in the civilian labor force are increasingly difficult problems for returning veterans with disabilities. Reduced self-perception of disability status because of predominant military norms can be particularly harmful to reintegration efforts. OBJECTIVE: We analyze rates of self-identified and externally determined disability status among U.S. veterans. Evidence of a lower self-report rate would confirm the hypothesis that armed forces culture might hold back truly deserving veterans from seeking the benefits owed,…including specialized employment training programs. METHODS: We use data from the Current Population Survey Veterans Supplement over the sample period 1995—2010 on disability status and associated demographic characteristics to present descriptive measures and limited statistical inference. RESULTS: Over the entire sample period, federal agencies considered 29% of the survey respondents to have a service-connected disability versus a 9% self-identification rate. The rate of more severe service-connected disabilities has risen steadily, while less drastic disability rates have fallen. Non-white respondents and those with lower education levels were less likely to self-identify. CONCLUSIONS: Large disparities in internal and external disability status identification raise questions about targeting soldiers re-entering the labor force. Employment policy should focus on overcoming negative cultural stereotypes and encouraging self-identification.
Abstract: BACKGROUND: Since its establishment in 1948, the state of Israel has been deeply committed to reintegrating veterans with disabilities into mainstream society. Prominently, the Israeli Ministry of Defence's rehabilitation division provides veterans with disabilities with a wide array of benefits and services aimed at restoring their physical and psychosocial functioning, especially in the workplace. The focus on employment is motivated by a prevailing assumption among professionals that successful adjustment to disability is…contingent on an individual's ability to reacquire normative occupational function. To date, however, this widely accepted wisdom has not been empirically scrutinized. OBJECTIVE: To empirically explore whether employment status is associated to psychological, social, and behavioural adjustment attributes. METHODS: One hundred and one employed veterans were compared to 111 non-employed veterans in respect to their self-reported levels of hope, acceptance of disability, social networks size and social participation patterns. RESULTS: Employed veterans reported significantly higher levels psychological adjustment as manifested in elevated hope and acceptance of disability and lighter social network than their non-employed counterparts. However no differences were found between employed and non-employed veterans with respect to their social participation patterns. CONCLUSIONS: The value of these findings, as well as wider implications for rehabilitation professionals and policy makers, is discussed.
Keywords: Hope, acceptance of disability, social integration
Abstract: BACKGROUND: More Reserve and Guard members have been activated in the past few years than in any other time in history. In addition to the high rates of psychological and behavioral challenges among military personnel, there are other equally important post-deployment reintegration challenges. Post-deployment reintegration challenges are particularly important to Reserve and Guard members, who transition rapidly from civilian-military-civilian. OBJECTIVE: This study aims to describe the scope of challenges that a battalion of National…Guard members (NGM) report experiencing after returning from a one-year deployment to Iraq. METHOD: This article reports data from a sample of 126 NGM who recently returned from a one-year deployment to Iraq. The scope of post-deployment problems at baseline, 3- and 6-month post-deployment are presented. RESULTS: Overall, the rates of post-deployment psychological and behavioral problems were elevated upon returning from deployment and remained fairly constant for up to 6 months post-deployment. Approximately 30% of respondents were unsatisfied with their relationship and upwards of 30% reported family reintegration challenges. CONCLUSIONS: Comparisons with similar research and implications for prevention and improvement of post-deployment quality of life are addressed.
Abstract: This study examined civilian employment among Army National Guard soldiers who had recently returned from Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). Of specific interest were relationships of re-employment and financial difficulties to several conditions, such as amount of social support during and after deployment, combat exposure, negative feelings during and after deployment, and postdeployment adjustment symptoms. Survey data from the Army's Reintegration Unit Risk Inventory were used (4,546 soldiers in…50 units who were deployed during 2010). Few soldiers reported financial difficulties during deployment (7.1% of the sample) and after having returned (11.8%). Of those who reported postdeployment financial difficulties, nearly one-half had reported such difficulties during deployment, and not having resumed the predeployment job was associated with more postdeployment financial difficulties. Logistic regression analyses showed the relative contribution of the study variables to changed financial status, from deployment to postdeployment. Reported deployment support (e.g., trust in the unit chain-of-command and available support) was associated with decreased financial difficulties. In contrast, increased financial difficulties were associated with having seen others wounded or killed in combat. Other postdeployment experiences, such as feelings of anger and frustration and available support, were associated with increased financial difficulties, in addition to alcohol use, trouble sleeping and suicidal thoughts. Implications of results for policy and practice to lessen financial hardships and job loss associated with deployment are discussed.
Keywords: Army National Guard, homecoming, deployment, re-employment, financial status changes
Abstract: After surviving a severe brain injury from a rocket-propelled grenade (RPG) blast and working daily to reclaim his life, one of the military's finest was ready to pursue community employment. At 27-years-old, he completed an 8-year-long, comprehensive traumatic brain injury rehabilitation program by making an autobiographical documentary. The documentary served as a stepping stone for his community employment as well as a means to encourage others to keep working toward their goals. He is now successfully…employed, on a part-time basis, with a local retailer, in his home community. This paper outlines the progression from initial concept to a completed documentary. It tracks his experiences and accomplishments through years of rehabilitation therapy, through making an autobiographical documentary, to bridging a transition from his identity as a rehabilitation patient to a working member of his home community.
Abstract: BACKGROUND: Since 1999, the German Armed Forces (Bundeswehr) have been conducting 3-weeks preventive treatment programs aimed at psychological resource-strengthening in soldiers returning from deployment. METHODS: Five hundred participants of these programs received the Posttraumatic Stress Scale 10 (PTSS-10) before and after treatment and the rehabilitation assessment questionnaire of the German statutory pension insurance body. Sixty control group subjects received the PTSS-10 twice in an interval of 4–5 months without therapeutic interventions. RESULTS: Comparison…of pre- and post-treatment PTSS-10 results in the covariance analysis showed an effect of the initial PTSS-10-stress-levels and rank category, not of the intervention. On average, the treatment program received 'very good' to 'excellent' overall ratings in the rehabilitation questionnaire. The acceptance of sports and movement therapy was significantly above average, whereas that of individual and group counselling was below. CONCLUSIONS: The results of this pilot study suggest a high acceptance of the post-deployment preventive program. Effectiveness in terms of psychometric improvement cannot be proven at this point.
Keywords: Deployment, German Armed Forces, prevention, soldiers, treatment
Abstract: BACKGROUND: A subgroup of servicemen can be identified that seek a disproportionally amount of health care in comparison to diagnostic and therapeutic perspectives. This group can be identified on the basis of an absence of a structural medical explanation for their symptoms. The symptoms manifest predominantly as fatigue and pain, and are often chronic. Patients with medical unexplained medical symptoms (MUPS) often have multiple and complex problems that would be best treated by a multidisciplinary team…of medical specialists and paramedics. The military is characterized by high loyalty towards peers and leadership, leading to neglect for personal care. OBJECTIVE: While consensus on the biological basis for these complaints is lacking, awareness on the need for effective treatments for this patient group is high. METHOD: Based on reviews, expert recommendations and clinical demand, a specialized treatment program for soldiers with MUPS has recently been developed and implemented in the system of health care in the Netherlands Armed Forces. We developed a functional rehabilitation program with blended care elements of cognitive behavioral therapy (CBT), physical therapy, case management, and psychoeducation, embedded in a day treatment setting. RESULTS: The program received high scores on participant as well as team satisfaction. The program is illustrated by two clinical vignettes. CONCLUSION: The blended care program for MUPS that focused on allostatic load awareness offered a more holistic and preventive approach that contributed to a reduction of unnecessary medical consumption, and increased job participation. We recommend that the development of guidelines for diagnoses and treatment of these complaints in military settings will improve the quality of patient care, reduce disability, facilitate reintegration, and encourage scientific research.
Abstract: BACKGROUND: Several U.S. military treatment and research facilities employ a Computer Assisted Rehabilitation Environment (CAREN) [Motek Medical BV, Amsterdam, The Netherlands] for research and rehabilitation of complex injuries exhibited by Wounded Warriors. There has been little scientific evidence of the effectiveness of this type of system for rehabilitation. OBJECTIVE: A systematic review of the literature was completed to determine what type of work has been performed on the CAREN and report findings of clinical…significance. METHODS: Specific terms were searched on electronic databases to include journal articles, abstracts, and peer-reviewed conference proceedings related to the CAREN. RESULTS: Twenty-six publications were elicited that met our criteria. These were divided by their primary focus: rehabilitation, clinical research, and technical reports. DISCUSSION: Results from published articles have determined that the system is a capable tool for both assessment and rehabilitation, but little has currently been published, particularly on patient populations. CONCLUSION: More research needs to be performed to evaluate its effectiveness as a rehabilitation tool compared to other rehabilitation methods. It is expected that a system, such as the CAREN, will challenge patients multifactorially (e.g. physically and cognitively) and provide biofeedback while decreasing rehabilitation time and increasing effectiveness of treatment.
Abstract: BACKGROUND: Evidence-based approaches to cognitive rehabilitation are limited; however, new technologies such as brain-training computer programs provide opportunities for novel interventions. OBJECTIVE: This paper describes a randomized controlled training study in a military treatment facility with service members who had combat-related cognitive symptoms. It examines challenges in study design and implementation, and provides "lessons learned" with proposed solutions. METHODS: Participants were randomly assigned to one of two 6-week computer-based cognitive training (CBCT) programs…or a treatment-as-usual (TAU) control group. Feasibility assessments included reasons for consent refusal, compliance, and drop-out rates. RESULTS: The intended sample size for the study was 114 participants before attrition. Of 291 patients referred over 2.5 years, 120 were eligible, 38 consented to participate, and 18 completed the study. Forty-two percent of the participants assigned to CBCT groups completed the required 30 sessions in 6.5 to 32 weeks. Study-design factors that affected enrollment and compliance included eligibility restrictions, lack of a computer-based control condition, and inflexible scheduling. CONCLUSIONS: Successful implementation of a high-dose computer-based clinical trial will require design changes such as expanded inclusion criteria, control by sham computer program or wait-list, dosing flexibility, and web-based options.
Abstract: BACKGROUND: Veterans and active duty service members returning from Operation New Dawn and those having returned from Operations Iraqi and Enduring Freedom frequently report the presence of overlapping, co-morbid symptom clusters consisting of chronic pain, mild cognitive complaints, and posttraumatic stress symptoms/disorder or mood disturbance. This presentation has been called Post-deployment Multi-symptom Disorder (PMD) and its implications not only impact various functional domains, but have also influenced a system/continuum of care to…rise to meet the challenges of treating PMD. This continuum is based on innovation informed by evidence-based therapies, systemic limitations, and a focus on functional improvement rather than diagnostic classification. OBJECTIVE: The purpose of this paper is to describe the symptomatic, functional and systemic challenges inherent to PMD conceptualization and treatment. METHOD: The constituent clusters of PMD are defined and exemplified, its functional impact is illustrated, and a continuum of care at a large southeastern Veterans Affairs (VA) hospital offering an interdisciplinary approach to integrated rehabilitation is described. Three case examples are provided that that underscore the importance of vocation for improved behavioral health and quality of life. CONCLUSION: The case examples demonstrate how vocational rehabilitation services are an integral component of PMD treatment.}
Abstract: BACKGROUND: Human enhancement (the enhancement of the abilities of a normative person beyond the norm) of soldiers has been debated for some time. However, therapeutic enhancement of soldiers and veterans with injuries (the enhancement of the abilities of a sub-normative labeled person beyond the norm) is much less discussed. OBJECTIVE: This article discusses 1) historical examples of policies and views linked to soldiers and veterans that have been injured in the Americas, and perception…of injured veterans and soldiers; 2) the science and technology of the therapeutic enhancement landscape and 3) views of veterans on therapeutic enhancements. METHODS: Three methods were used: a) historical search of policy documents; b) content analysis of the New York Times and c) online delivered exploratory non-probability survey using the Survey Monkey platform. RESULTS: Researchers found that veterans played a special role in policy developments in the United States, such as disability pension plans, and that veterans who were injured were portrayed more positively than other people with disabilities in the NYT from 1851–2010. However, within the current public discourse around the use of enhancement enabling therapeutic assistive devices, the voices of injured soldiers and veterans are not visible. CONCLUSIONS: Therapeutic enhancements, especially of injured soldiers and veterans, are an under researched area with various open ethical questions in need of more coverage.
Keywords: Human enhancements, veterans, soldiers, injured veterans, ethics
Abstract: BACKGROUND: Many military veterans are seeking ways beyond conventional treatments to manage their stress injuries. An increasing number is turning to nature, including hiking and fishing, farming and gardening, and building relationships with dogs or horses. Many continue to benefit from medication and therapy, but find that nature provides an additional measure of support, relief and healing in their lives. OBJECTIVE: This paper examines reciprocal interactions between humans and nature during post-conflict recovery, with…a focus on the experiences of four North American veterans who regard their personal recovery from stressful and traumatic military experiences as intimately tied to their nature experiences. METHODS: Experience-centered narrative inquiry often sheds light on details and experiences concealed or overlooked by other research paradigms. In-depth interviews about post-military experiences with recovery were conducted with four veterans who suffer from stress and/or post-traumatic distress; these experiences are further illuminated by supporting interviews, and theories and praxis in ecopsychology, cognitive science, neuroscience, biophilia, and ecological intelligence. RESULTS: Through exploring themes of sensory experience, safety, sense of purpose, and renewed relationships, this research gives space to former soldiers' stories of experience and to their individual realizations that their embodied interconnections with nature provide alternative experiences to their military training and combat exposure. CONCLUSION: The veterans' experiences with nature and recovery are pointing towards an avenue of recovery that is little acknowledged in the mainstream literature and praxis, but deserving of attention.
Keywords: Military veterans, ecopsychology, combat exposure, narrative inquiry