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Table 2 Summary of the practice guideline for psychological problems and subsequent adaptations in the MPP guidance document

From: Development and qualitative evaluation of an adapted return to work guideline for the sick-listed unemployed and temporary agency workers with minor psychological problems

The evidence-based guideline for counselling employed workers with psychological problems Adaptations of the guideline to create the MPP guidance document for the counselling of unemployed and temporary agency workers
(van der Klink et al. 2007)  
· “Loss of control” is the central feature of almost all psychological problems  
· Complaint-focused interventions do not automatically lead to performance recovery
· Recovery is an interactional process with the working environment* · Involvement of a vocational rehabilitation agency or temporary worker agency to find a “new working environment” for the sick-listed unemployed or temporary agency worker. By doing so, interaction with the working environment will be possible
· Involvement of a labour expert of the Dutch Social Security Agency to facilitate work reintegration
Preconditions for an adequate implementation of the guideline  
➢ the OP should start the counselling within two weeks after reporting sick
➢ at least 30 minutes per consultation
➢ follow-up consultations on average once every three weeks
➢ contact with working environment/manager on average once a month* ➢ if applicable, contact can be made by the IP or labour expert
(see above)
I Problem orientation and diagnostics  
Apply this guideline if the employee suffers from loss of control and performance problems due to  
➢ stress-related complaints (distress, nervous breakdown, burn-out, adjustment disorders)
➢ or minor or moderate depression
➢ or anxiety disorder**
➢ or other psychiatric disorders**
➢ and the employee does not present excessive resistance to the diagnosis of psychological problems
Do not apply this guideline if the complaints are the direct results of
➢ an acute emotional state (e.g., anger)
➢ or a somatic condition
Inventory and assess
➢ complaints, performance problems, causal factors
➢ problem solving skills of the employee and the manager* ➢ only address the problem-solving skills of the sick-listed worker
➢ to what extent can the complaints be explained by a stress process (demands, problems, environmental events)  
➢ possible complications in the employee with a somatic hypothesis, suicidal risk, irrational cognitions or rigid personal personality traits, victims of harassment and employees where a conflict in the work situation is the main etiological factor
Make sure that the recovery process does not stagnate
No stagnation or normal course
➢ provide supportive but cautious guidance and monitor the further recovery process
II Interventions  
Minimally conduct the role as a process facilitator and consider intervening on the level of the worker and/or the work system.* Three roles for the IP and/or labour expert: (1) role as process facilitator; (2) intervention role focussed on the sick-listed unemployed or temporary agency worker; (3) intervention role focussed on the new workplace of the sick-listed temporary agency worker or unemployed worker (if a workplace is found for the sick-listed worker with help of the labour expert).
Monitor the complaint pattern through monthly diagnostics with the Four Dimensional Symptom Questionnaire to exclude that the complaints develop into a depressive disorder/anxiety disorder.
Intervention tasks
➢ support the employee when taking recovery steps using simple cognitive behavioural interventions such as providing rationality, perspective, daily structure, positive re-labelling
The IP conducts at least the first role and part of the second role and decides who takes on the other roles (this could also be the IP).
➢ give explanations, information and support to those involved in the work environment
➢ discuss with the general practitioner if the complaint pattern and suffering remain unchanged or worsen over the course of two months
Consulting with a labour expert from the Dutch Social Security Agency to facilitate finding a “new work environment.” In the Dutch context, the labour expert co-ordinates the involvement of vocational rehabilitation agencies or temporary worker agencies.
In stagnation  
➢ indicate and initiate interventions and ensure adequate implementation  
III Prevention and relapse prevention  
➢ strengthen the problem-solving skills of employees and the work environment to avoid relapse  
➢ be available if needed by the employee based on the symptoms that previously led to reporting sick
➢ recommend further investigation (risk assessment and evaluation, preventive medical examination, organisational or workplace analysis) if there is evidence of problems experienced by many workers* ➢ relapse prevention (in terms of symptoms and sick leave) by the IP is only focused on the individual and not on all the workers of the employer. Recommendations by the IP about risk assessment and evaluation or organisational analysis are therefore not applicable
IV Evaluation and termination of counselling  
Counselling by the OP continues until after the full resumption of work* Counselling by the IP continues until the worker is able to work (and not sick-listed anymore) or after RTW/a new workplace is found for the (sick-listed) worker
Evaluate Evaluate
with the employee with (sick-listed) worker
➢ every three weeks in the first three months ➢ every three weeks in the first three months
➢ at least every six weeks after three months ➢ at least every six weeks after three months
with the manager with the manager (if the sick-listed worker is integrated into work)
➢ at least every four weeks ➢ at least every four weeks
with other practitioners with other practitioners
➢ in stagnation or relapse ➢ in stagnation or relapse
➢ in stagnation or relapse ➢ in stagnation or relapse
with the labour expert (and possibly the insurance physician) with the labour expert
➢ if structural work adjustments are necessary ➢ course of finding a new workplace
➢ or if resumption of work is not possible at the current employer  
  Some of the evaluation points can be transferred to the labour expert of the Dutch Social Security Agency
  1. Summary of the evidence-based practice guideline for counselling “employed workers” with psychological problems and the main adaptations to create the MPP guidance document for counselling “unemployed and temporary agency workers.”.
  2. * Adaptation of the guideline (made by the research team and an expert on the guideline for employed workers) at this point was necessary to execute the guideline in the context of the unemployed and temporary agency workers (no employer or workplace available).
  3. ** This diagnosis is not involved in the guidance document for unemployed and temporary agency workers.
  4. OP = occupational physician IP = insurance physician.