title: Usefulness of an ability-based health model in work ability assessments provided by psychiatrists and psychology specialists writing social security certificates.
abstract: OBJECTIVE
  To investigate whether adding descriptions of the health factors "ability," "environment" and "intentions/goals" to the officially sanctioned biomedical disability model (BDM) would improve assessments of work ability for social security purposes.
  
  
  METHODS
  The study was based on a theoretical design consisting of textual analysis and interpretation. Two further work ability models were defined: the mixed health model (MHM), which describes health factors without assessing a person's abilities in context, and the ability-based health model (AHM), which assesses abilities in a concrete context of environment and intention. Eighty-six social security certificates, written by psychiatrists and psychology specialists in a Norwegian hospital-based mental health clinic, were analysed in relation to the three work ability/disability models.
  
  
  RESULTS
  In certificates based on the BDM, a general pattern was found of "gradual work training". The MHM added health factors, but without linking them together in a concrete way. With the AHM, work ability was assessed in terms of a concrete unified evaluation of the claimant's abilities, environments and intentions/goals.
  
  
  CONCLUSIONS
  Applying the AHM in work ability assessments, in comparison with the BDM and the MHM, is useful because this foregrounds claimants' abilities in a context of concrete goals and work-related opportunities, as a unity. Implications for Rehabilitation A concept of health should include ability, environment and intentions/goals as components. When all three of these components are described in concrete terms in a work ability assessment, an integrated picture of the individual's abilities in the context of his/her particular intentions/goals and work opportunities comes to the fore. This kind of assessment makes it possible to meet the individual's needs for individual follow-up in a work environment.
authors.affiliation: Research Unit, Division of Mental Health and Addiction, Vestfold Hospital Trust , Tønsberg , Norway and.
authors.forename: Hans Magnus
authors.initials: HM
authors.lastname: Solli
authors.forename: António
authors.initials: A
authors.lastname: Barbosa da Silva
authors.forename: Jens
authors.initials: J
authors.lastname: Egeland
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008962:Models, Theoretical; D011570:Psychiatry; D012943:Social Security; D014938:Work Capacity Evaluation
keywords: Action theory; ICF; disability; holistic health; social security medicine; work ability assessment