Assessing Cognition

and Cognitive

Demands in Stay at

Work Gowan Consulting

IFDM 2018

Gowan Consulting

Occupational Therapist’s

Across Canada and the US

Employer services

Sustainable Stay at Work and Return to Work Solutions

Individual assessments – ergonomic, accommodation,

reactivation

Group training – ergonomics, mental health, RTW expert

training

Policy/procedure development

The Bank and its

Accommodation Program Canada’s oldest bank – celebrating 200 years in 2017

Over 45,000 employees worldwide; More than 12 million

customers (operating in North America, Europe, Latin

America, Asia)

Vision: To be the bank that defines great customer

experience

Values: Integrity, Empathy, Diversity, Responsibility

Brand: Human, Intuitive, One Bank

Accommodation Program - The program enables our

strategic commitment to Diversity & Inclusion in our

workforce, workplace and marketplace

Common Employer Challenges

Difficulty identifying barrier as being related to

health condition (i.e., assumption that problems

with performance = lack of skill)

Identifying the strategies to improve

performance

Ongoing education of managers and partners

Stigma in the workplace

Cognitive/Intellectual Disability -

Definition

Disability that involves limitations both in intellectual

functioning and in adaptive behaviour

A person with a cognitive disability has greater difficulty

with one or more types of mental tasks than the average

person

Often described as a form of an “invisible” disability

Representation of Common Disabilities

affecting Cognition

Learning Disabilities - 2.3% of population over age 15.

Aging Workforce –By 2021, 24% could be 55 years of age

or over – With age, inductive reasoning, selective attention,

'dual-task' activities, and information processing shown to

decline.

Mental Health – 20% of Canadians will experience a

mental health issue in our lifetime.

Sleep Apnea - about 1 in 3 adults sleep less than 7 hours

per night

Pain - chronic pain prevalence for adults older than 18

years of age was 18.9% in 2011

How Cognitive Disabilities can affect

Work Performance & Productivity • Decreased ability to plan and execute a process/task

• Decreased ability to perform multiple tasks (“multi-

task”)

• Difficulties making decisions

• Judgement

• Comprehension (verbal/written)

• Memory

• Auditory Processing impairments

• Decreased attention, problem solving, and

sequencing

• Increased anxiety over work-performance

• Decreased self-awareness/acceptance regarding

above challenges

Process for Assessing and

Accommodating a Cognitive Disability

Identification of concerns

Manager to independently provide any possible

adjustments/support

If complex – manager/employee to connect with

Accommodation Specialist and potentially engage external

partner (e.g., OT)

Identification of specific barriers through further review

assessment

Identification and review of strategies to enable performance

Implementing strategies

Ongoing monitoring by manager

Information required for Assessment

-Assessor to gather information as follows:

Employee: Health history, employment history, description of functional job demands

and performance, completion of screening tools, daily schedule, past

intervention/accommodation, physical assessment

Employer/Manager: Description of functional job demands and employee performance;

anecdotal and objective review of performance concerns and behaviour

relative to peers; review of improvement required to meet minimum

standards or role

Job: Observation/measurement of job tasks/tools/light/environment, job

description, manager interview, performance metrics, past

intervention/accommodation

SAW and

RTW

Model

Gowan,

2016

work

workplace

worker

Optimum fit

Functional Cognitive Assessment

Conducted by Occupational Therapist

One assessment tool - Brain Fx

Specifically assesses mild – moderate brain dysfunction

Sensitive to brain dysfunction

Function focused (i.e., impact on work performance)

Can be administered in 2 hours

Typically less costly

Portable

User-friendly for assessor and participant

Standardized and evidence-based

Cognitive/

Sensory Skill

Description of

Skill

Employee

Performan

ce Level

Potential Impact on

Work

Memory –

immediate

auditory

Ability to learn 4

items in context

immediately and

remember items

for later.

Demonstrate

d ability to

recall 4

items after

listening to

list 3 times.

Employee benefits from

repeating information

aloud to prompt memory.

Memory –

immediate

visual spatial

Ability to

immediately

recall information

presented

visually.

Demonstrate

d errors and

slow

response

time.

May affect the employee’s

ability to recall information

presented visually alone.

Cognitive Concern and Impact on Work

Cognitive/

Sensory Skill

Description of

Skill

Employee

Performance

Level

Potential Impact

on Work

Problem

solving

Being able

answer math

questions and

perform

functional math

based tasks.

Demonstrated the

ability to perform

simple, single

digit math

calculations

May affect the

employee’s ability

to perform and

mental math

calculations,

estimates or

rounding up/down.

Executive

functioning

and combined

skills

Prioritization of

tasks,planning

and organizing

events according

to evident and

non evident rules

Demonstrated

difficulty with

prioritizing tasks

and organizing

information

Employee may

benefit from

additional training,

job coaching,

decision making

maps/algorithms.

Cognitive Concern and Impact on Work

Cognitive Demands Analysis (CDA)

Addresses cognitive, and behavioral aspects of

work.

A four-point rating scale is provided for each

item, with “4” representing the highest level of

demand, and unique descriptions are provided

for each rating level within each item. [6]

Attention to Detail

Definition Rating

The extent to which work tasks

require attention to or more

concentration on details of

information.

Cognitive skills needed: selective

visual and auditory attention,

divided attention

1 = attention to or concentration on

details is not required

2= attention to detail or

concentration is required for some

tasks, although not at an intense

level

3 = significant attention to detail or

concentration required for many

tasks or intense attention to detail

or concentration is required for only

some tasks

4 = intense attention to detail or

concentration is required for the

majority of work tasks.

Performance of Multiple Tasks

Definition Rating

The responsibility for performing

and/or monitoring more than one

task or function at a time and for

judging when tasks or functions

require attention.

Cognitive skills needed: memory (

immediate auditory and visual

memory), visual and auditory

distraction, divided attention,

mental flexibility, executive

functioning, and combined skills.

1 = not responsible for concurrent

multiple tasks. Responsible for

performing one task at a time until

completion or further direction

2= some responsibility for multiple

tasks, but with very clear

guidelines or cues about went to

perform each task

3 = responsible for multiple tasks,

with some time management skill

and judgment required to

determine priorities

4 = constantly responsible for

multiple concurrent tasks

Contextual Influences on Work Demands &

Worker Performance

Workplace factors need to be considered in evaluating the impact of

contextual factors on worker productivity and performance

Time pressures; deadline pressures;

safety pressures; security pressures; life and death pressures;

exposure to emotional situations; exposure to confrontational

situations;

exposure to high risk with regard to safety and physical well

being;

exposure to environmental stimuli (noise, people, machines,

distractions, etc);

The consideration of the environment is

essential for designing a successful RTW program

Creating a Job Match Job Task Plan member

Function

Gaps Accommodation

or RTW plan

Remember and

sequence 5 steps

in job task

Able to remember

3 steps without

cuing

Ability to

remember steps

SOP laminated

and available at

job site,

Checklists, job

coach, electronic

reminders

Concentrate to

enter data into a

system for 30

minutes

Limited

concentration to

10 minutes

Unable to

concentrate for

long enough

Breaks and

alternate tasks

every 10 minutes;

or refocus every

10 minutes

Ensure quiet

space – noise

cancelling

headset

Case Study - JIM

Jim is a middle-aged employee working in a call centre

who has been experiencing some depressive symptoms.

A customer contacts Jim to request a credit card. One

week later, the client follows up with their order, only to

find it had not been submitted. Jim had forgotten to

complete the order. This resulted in an official complaint

against the company, and Jim being coached by his

Manager.

The Manager notes that this is not the first mistake of

this kind that Jim has made over the last several months

and she feels that Jim is struggling in his role. The

Manager contacts an Occupational Therapist to provide

some workplace support for Jim.

Case Study (cont’d)

During the Occupational Therapy assessment,

when questioned about the incident with the credit

card, Jim notes that he had become distracted by

environmental noise, resulting in him forgetting the

work order. Jim states that lately his work

performance has been slipping, and that he has

been experiencing some mental distress about

completing his job. He also reported feeling very

anxious when discussing his performance with his

manager.

Case Study Recommendations

Potential Cognitive Strategies suggested by OT:

Take notes during phone call

Keep work order notes in specific location/folder on

computer

Send Confirmation email

Keep ‘To Do’ lists and Checklists for processes

Provision of noise-canceling headset to block out

environmental noise

Provide additional training/refreshing as needed

Review of strategies with manager and educate re.

supportive approach

Bank’s Program Successes

Managers are learning to assess performance

concerns through having better conversations

Increased collaboration and accountability with

managers, employees, partners

Increased awareness around cultural and

emotional intelligence with a laser focus on

leading with empathy and being aware of hidden

biases

Reinforcement of brand values through

Workplace Accommodation Program

Empowerment of employees

Next Steps for Employers

1. Review data on workplace costs due to cognitive

difficulties (e.g., absence rates, loss of productivity,

disability leaves)

2. Recognize indicators that may demonstrate that an

employee is struggling with cognitive barriers (i.e.

performance, lower productivity, absences, behaviour)

3. Implementation of clear assessment process

4. Support employees through implementation of cognitive

strategies

5. Train managers on supporting employees with cognitive

disabilities and mental distress

6. Clear ‘return to work’ and ‘stay at work’

processes/strategies for employees

Contact Us

Nancy Gowan

ngowan@gowanhealth.com

519-762-0796 or

1-888-752-9954(CAN)

www.gowanhealth.com