Appendix 4.H – About disclosing your health condition

The implementation of certain workplace accommodations for workers with CMD or MSD depends on the information disclosed by the worker about his or her health condition. The worker may feel ambivalent about disclosing information. They may believe that disclosure will have positive consequences for their health, but they may also fear stigmatization.

Do you want to better manage your rehabilitation or vocational rehabilitation disability files and ensure good social support for the workers concerned? We suggest using one of these two tools, depending on the nature of your needs:

  1. The free online tool DCIDE (Decision-Support for Communicating about Invisible Disabilities that are Episodic), developed by the Ontario Institute for Work & Health (IWH) (Gignac et al., 2020; Gignac, Jetha, Ginis and Ibrahim, 2021). It is available online free of charge in English and French, and takes around 15 minutes to complete. The DCIDE tool aims to help workers consider whether or not to share some personal health information with others at work. It leads to concrete suggestions for support strategies that you can try on your own without sharing health information, as well as support measures that others can help you implement. You can save the general summary of your personal situation and concerns for your own use.
  2. A management plan designed in seven steps (Table H.1). Although it was designed for the work reintegration of workers with a severe mental disorder (Corbière et al., 2014), it can also be applied to CMDs (and even MSDs) with a few adjustments (e.g., steps 1 to 4), and be used as soon as the RTW is decided. The objectives and examples are provided for your information. It is up to you to adapt it to the worker concerned for a healthy and sustainable RTW.

Table H.1 ─ Objectives and issues of the seven stages of personal information management (adapted from Corbière et al., (2014)

Steps Objectives Examples of questions to ask

Step 1: Background

This step makes it possible, even before the personal information management plan is designed, to consider various sources and types of information about the worker.
  • Can you tell me about the following aspects of yourself: education and training, rehabilitation experiences, job skills, holder of a disability pension, types of medications prescribed and side effects.
  • What are the elements that may facilitate or hinder the achievement of your professional goals (e.g., perseverance, punctuality problems)?

Step 2: Personal goals and interests

Assess whether the worker has established career interests and preferences.
  • What are your professional goals and interests?
  • What type of job do you want and why (e.g., mainstream or social economy, full or part-time)?
  • Have you identified a particular job?

Step 3: Personal strengths and resources

Highlight the worker’s strengths and resources.
  • What personal assets would an employer value in you (e.g. professional skills)?
  • What resources do you have to help you get a job (e.g., motivation to find a job)?
  • What resources do you have to enable you to maintain employment (e.g., support from family or a specialized employment counselor)?

Step 4: Sensitive information

Highlight CMD-related items (e.g., a diagnosis, symptoms) and other information that may have discredited the worker in the workplace. This also includes an assessment of how the worker has dealt with these negative experiences.
  • What information do you not want to be released in the workplace (e.g., your diagnosis, symptoms, medication)?
  • Could you tell me about your past experiences in the workplace, those that were not positive and that are or could be related to your current health condition?
  • Do you have holes in your resume that you may be asked about in your next job interview?

Step 5: Constraints and difficulties at work

Reframe the terms associated with the CMD into job constraints or difficulties that the employer, immediate supervisor, or others in the organization will understand
  • What are the reasons that would make it difficult for you to work full time (e.g., side effects of medications)?
  • Could you describe to me the type(s) of task(s) you would have difficulty completing (e.g., sharing a task with a colleague with whom you are in conflict)?
  • Are there any working conditions that you have or would have more difficulty with (e.g., fixed work hours)?

Step 6: Agreement on the terms to be used to describe work constraints or difficulties

Reach agreement on what terms will be used to describe the difficulties at work and under what circumstances. These can be formal situations (e.g., the first day of RTW) or informal (e.g., social events with co-workers).
  • In what terms (or words) would you like to describe your difficulties at work (e.g., for functional limitations)?
  • Do you need to use these terms in reference to your health condition or would personal work preferences be sufficient?
  • Who can use these terms (e.g., only you, your immediate supervisor)? And when?

Step 7: Workplace accommodations and natural supports

Identify workplace accommodations and natural supports in the organization that could help the worker feel more comfortable doing their job. This assessment can be done more than once and at different key or opportune times.
  • What adjustments in terms of tasks or work schedules can be put in place to help you get your work done (e.g., a flexible schedule)?
  • What changes to the work environment are needed to help you do your job (e.g., reducing the number of stimuli, such as noise)?
  • What types of organizational supports would help you do your job (e.g., colleagues and immediate supervisor)?

Content adapted from Corbière et al. (2014) and Waghorn and Spowart (2010). The italicized text applies to severe mental disorders. Thus, it is generally not relevant for CMDs and MSDs, especially when the employment relationship is retained.

To make disclosure more pragmatic, authors suggest replacing the term “disclosure” with “personal information management” (Waghorn & Spowart, 2010).  Presented in the form of a plan, the management of this information (Corbière, Villotti, Toth, & Waghorn, 2014) becomes a means of effective communication between the actors involved. Therefore, it is suggested that this tool be used by the person designated to RTW coordination.

References:

Corbière, M., Villotti, P., Toth, K. et Waghorn, G. (2014). La divulgation du trouble mental et les mesures d’accommodements de travail : deux facteurs du maintien en emploi des personnes aux prises avec un trouble mental grave. L’Encéphale, 40(S2), S91-S102.

Gignac, M. A. M., Bowring, J., Jetha, A., Beaton, D. E., Breslin, F. C., Franche, R. L., . . . Saunders, R. (2020). Disclosure, Privacy and Workplace Accommodation of Episodic Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment. J Occup Rehabil. doi: 10.1007/s10926-020-09901-2

Gignac, M. A. M., Jetha, A., Ginis, K. A. M. et Ibrahim, S. (2021). Does it matter what your reasons are when deciding to disclose (or not disclose) a disability at work? The association of workers’ approach and avoidance goals with perceived positive and negative workplace outcomes. J Occup Rehabil, 31(3), 638-651. doi: 10.1007/s10926-020-09956-1

Waghorn, G., & Spowart, C. E. (2010). Managing personal information in supported employment for people with psychiatric disabilities. In C. Lloyd (Ed.), Vocational rehabilitation and mental health (pp. 201-210). New York, NY: John Wiley and Sons.

Notes:

Ambivalence is a “normal”, common and necessary reaction to the process of decision and change. To learn more about coaching an ambivalent person through a choice: Miller, W. R., & Rollnick. S. (2012) Motivational interviewing: Helping people change. New York, U.S.A: Guilford press.