Active access, counseling and case management for people at high risk of permanent work disability

Background: Employment is a key resource for participation in society. It ensures income and material security and supports an independent lifestyle, and the accumulation of pension rights reduces the risk of poverty in old age. If people become chronically ill—e.g., due to mental illness—this may jeopardize staying at work and future work participation. The range of supporting services provided for this purpose under German social law is broad (e.g., medical rehabilitation, retraining, or job adjustments). Frequently, several of these services are needed to enable people to stay at work or return to work. Different service providers may be involved, such as pension insurance, job centers, the employment agency, social welfare institutions, and health insurance agencies. Employers, occupational health physicians, general practitioners, or psychotherapists are also important stakeholders. This is often an enormous networking task for persons in need. Moreover, it is often not clear to whom a person has to turn in order to apply for services.
To meet these challenges, coordinating and accompanying interventions have been proposed and implemented in recent years. In our study, we take up these approaches. We develop and test a multi-component strategy for individuals with an increased risk of receiving a disability pension. We identify these individuals using administrative data from the German Pension Insurance North. This data is aggregated into a risk score. People with high risk scores (at least 60 points) are contacted by the German Pension Insurance North and offered a telephone counseling with an external case management provider. This can be followed by a one-on-one interview and an individualized case management intervention. We expect this complex intervention to ensure that people with an increased risk of receiving a disability pension obtain the tailored support they need to sustain their work ability and work participation.

Methods: The case management intervention was developed jointly with all stakeholders involved in the multi-component strategy in several workshops during the first year of the study and guidelines for implementation were drafted. During a feasibility study, a comprehensive process evaluation was carried out, which described the population reached, the treatment dose delivered and the treatment dose received. A following randomized controlled trial tests the effectiveness of the implemented multi-component strategy.
After identifying people with an increased risk of receiving a disability pension by screening administrative data, these people are randomly assigned to an intervention group or a control group. Only the intervention group is informed about the possibility of the case management intervention. The randomized controlled trial is augmented by an observational study that includes only the participants of the case management intervention and assesses its implementation. Our primary outcome is the utilization of medical or vocational rehabilitation twelve months after random assignment. Our secondary outcomes are employment, receipt of unemployment benefits, receipt of sickness benefits, and disability pensions one year after random assignment. Tertiary outcomes are self-reported and cover health and functioning.