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Archive for August 2017

Racism and Canada

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This is a very provocative post. I’m at the point of frustration and anger that I have needed to get the thoughts down coherently in order to deal with some of the rage I’m experiencing. I’m also at the point where I’m finding it nearly impossible to stay silent anymore. I know the cost of ‘coming out’ as Indigenous, as for the first time in my life (as a white-coded Métis) I have experienced racism directed at me personally. So, I expect there will be a cost to speaking out more publicly about such challenging issues.

Three books if you want to get into this more deeply before reading any further (the truth shall set you free): Indigenous Writes by Chelsea Vowel; Settler: Identity and Colonialism in 21st Century Canada by Emma Battell Lowman; Surviving Canada: Indigenous Peoples Celebrate 150 Years of Betrayal edited by Myra Tait; and a bonus one: Unsettling Canada: A National Wake-Up Call by the late Arthur Manuel. One of those books (Settler…) is written by settlers for settlers.

The more I listen to debates, discussions and social media posts, the more certainly I conclude that there is a deep, simmering racism beneath a lot of our gentile Canadian ways. I have seen things asserted that bear no resemblance to reason in any form (yesterday one bright spark posted on twitter that there was no systemic racism in Canada, then argued with every BIPOC who pointed out why he was wrong.)

When a group of BIPOC tell you that they experience daily system racism in Canada – what is your response? If your first urge is to argue that they’re not right in their observations you might want to stop and consider that the denial of the existence of racism is a racist activity in itself.

We saw the same thing with the white supremacist demonstrations in Charlottesville, Virginia. People said “This is not our nation!” I’m sorry to say, actually it is. The policies of government, at least where Indigenous (and in Canada the Chinese as well) were concerned, encoded genocide as state policy. What can you say when all the things your nation benefits from today are there because of the land and resources taken, and the treaties violated? From the perspective of the oppressed genocide looks very different.

I started reflecting on this anew after reading an excellent blog post – “Why I Stopped Talking About Racial Reconciliation And Started Talking About White Supremacy” Her point, you can’t talk about reconciliation until you address the underlying issues of racism. Canada refuses to address the underlying issues. She makes this statement:

And hence, white people don’t believe it when white racism is pointed out in the present. They’ve been told a fairy tale about themselves. Even when the history of POC is told, white violence is erased, and the consequences of historical injustices is minimized. White people do not connect themselves to history, once again because of pathological individualism. They simply want a friend in the present, with no acknowledgement of the past or present injustice.

[…]

It will talk about redeemed white identity without teaching about white supremacy. It will lament but not repent with action. It is comfortable with POC being displaced and paying significant mental and emotional tolls for the work, but asks little to nothing of its white people. It is profoundly anxious about white discomfort, and is always trying to control the narrative.

Take as an example the ETFO motion to rename all of their schools named after John A MacDonald. The mainly white media has taken this up as a story, with points and counter points. One theme is repeating on the anti- side, with the usual minimization strategies making an appearance. What do I mean?

This quote from a professor is what I’m speaking of:

“You just simply cannot level that kind of accusation against a man of the stature of Sir John A. Macdonald and at the same time ignore his accomplishments,” Dutil said.

Anyone who wants to discuss the question credibly must first read James Daschuk’s book, Clearing the Plains: Disease, Politics of Starvation, and the Loss of Aboriginal Life. Daschuk’s comments:

Daschuk said blaming Macdonald for genocide depends on how the term is defined, but there is no doubt he was the creator of a system that “put the boot” to Indigenous peoples for decades, especially during his time as both prime minister and Indigenous affairs minister for nine years after the 1878 election.

During this time, he established residential schools, broke treaties by refusing to supply food to starving First Nations on the Prairies and created a pass system that lasted until the 1950s, in which a status Indian living on reserve could not leave the territory without government permission, Daschuk said.

“I’ve used the analogy: George Washington was a slave owner, and we can criticize him for that, but George Washington didn’t create slavery,” he said.

“Macdonald created the system.”

Historian Elliot Worsfold points out that the tests usually applied in these situations perpetuate the dysfunctional power dynamic which caused the problem in the first place. For example the ‘Witt test’, developed when Yale was seeking to determine if a building should be renamed, looks at the persons ‘principal legacy’. Worsfold points out, quite correctly I believe, that this question is very much in the eye of the beholder. When John Ivison assesses that JAM’s legacy is such that anything negative is overcome by his legacy, this is that unitary perspective at work. This is the reason I’ve stopped reading the National Post, because of their embrace of white supremicist perspectives under the guise of real journalism.

Ivison invokes the usual tired arguments including invoking Orwell as the image of renaming. The only problem with that assertion is that the names, in many cases, are already renamed from their original Indigenous names. The defence of the existing names is another exercise of colonial power, as it perpetuates the name while denying there had ever been any other name.  Worsfold suggests that instead of ‘renaming’ these debates should be called ‘reclaiming’.

The problem with Canadians is our unwillingness to accept that such a thing as genocide could possibly be a part of our history, after all we’re the nicest people in the world. How could people so nice have a history so evil?

Therefore we conclude it cannot be. That willful blindness extends to all possible contrary voices, including academic studies and government commissions like the Truth and Reconciliation Commission. That is what the young man insisting that there was no such thing as systemic racism in Canada was doing.

So what if I told you that while health care resources on the rez are bad, but that moving to an urban area doesn’t improve things? If you’re a proponent of the ‘shut down the reserves and move to the cities and you’ll prosper’ line of thought, sorry, the evidence does not support you. Oh, and that was one of the many things JAM was trying to do.

Health care is racist for Indigenous persons.

Racism is pervasive in the Canadian health care system.

Indigenous man dies in ER waiting for treatment.

Indigenous people regularly report meeting overt racism in Canadian hospitals, and particularly are denied minimum levels of care available to all the rest of white Canada. Indigenous people are regularly denied minimal levels of pain control because it is assumed they are all drug seeking. This is your Canada, the one that argues why JAM’s name should be left in places of honour.

History should not be erased or suppressed, but what is acceptable now needs to change the way we portray the past. Here’s a great example – Duncan Campbell Scott’s memorial plaque has now been amended to include his role in creating and managing the Residential School system.

But, names on buildings are afforded a particular place of honour. It is much more difficult to attach new plaques to provide a more robust perspective on the facts of history. How do you contextualize for white Canadian students that they are in a school named for a great man, whose greatness included forced starvation as a matter of public policy?

But, even the white media’s focus on this issue is once again suppressing Indigenous perspectives. The grade school system is a dangerous place for Indigenous children. All of those who have been found murdered in Thunder Bay are Indigenous students living in that city because there are no high schools on their northern reserves. Here’s the timeline of nine who have died.

Indigenous people would first like schools and the ability to live in southern communities without being murdered, and having access to the same protection of police and care from health care that all Canadians take entirely for granted. JAM? Just another white guy who killed us. The real problem is the white guys killing us today.

So, when an Indigenous person responds harshly, realize that for us this is a literal matter of life and death. If you are willing to read our history, truly read and engage things like Daschuk’s book, read the TRC report…really read it, you might start to understand.

This is the reason for Robert Jago’s counterpoint article today in the Globe and Mail. “Sir John A. doesn’t need a school to be remembered. He lives on in Indigenous pain”. The pain of multiple people continue to live today, his legacy.

So I get so frustrated when educated people trot out the same tired reasons why we should continue to celebrate people like JAM. Those same old hackneyed rebuttals:

  • Why are we trying to revise history?
  • He’s a much more complicated figure and all that complexity needs to be considered.
  • He did really important stuff (father of confederation you know)
  • [and have to point out here that Louis Riel is also a father of confederation, but JAM had him murdered]
  • Why are we wallowing in ancient history instead of fixing things or moving to reconciliation?
  • Those were different times, different values, how can we judge him by modern standards?
  • Why are we focusing on the past instead of putting that effort into fixing the present?
  • No one is perfect. We need to learn from our mistakes.
  • Look at (this other community that was badly treated) and see how they have risen out of their adversity.
  • If the Indigenous community would only (insert thing we should do) they would be able to get back on track.

If you can’t read those statements and see within them systemic racism and the same sort of thought processes that permitted JAM to effect genocide as a matter of state policy, then you are a part of the problem. The last thing we need, or seek, is more white solutions to the problems caused by settlers and the legacy which we still live.

I have written elsewhere about my disdain for the whole concept of white privilege. The reason I dismiss those sorts of words is they are just another effort by the powerful oppressor to demonstrate why they are actually really benevolent. Look at how upset I am about my privilege! Why won’t you be nice to me (and then as Justin Trudeau said to a young Indigenous woman the other day), “you would gain more people to your cause if you were nicer”.

I will tell you what being nice has gotten Indigenous people in Canada – centuries of death, starvation and disease. That why there isn’t a lot of niceness going around right now, because Indigenous people are no longer willing to accept the same tired tropes and platitudes that we have been hearing for centuries.

So let me be absolutely clear about this point – if you are defending JAM, at least be honest enough to accept the reality that you are defending a man who perpetuated genocide as a MATTER OF STATE POLICY. That is not an interpretation, or selective history, that is a factual statement. He bragged about using starvation as a tool to solve the “Indian problem”.

That fact was recognized even while he was alive. This is not changing thought, or revision of morals, this is evil pure and simple, and it was recognized then and we should recognize it now. JAM is honoured today because the contrary voices were killed and marginalized. Here’s a political cartoon from 1888 about his favouring contractors over starving Indians:

If you can’t read the sign in the background, it says, “Starvation – by a Christian gov’t”. The caption places these words in JAM’s mouth, “Indians starving? Oh well, they’re not ‘friends of Dewdney'”. Any assertion that my distaste for JAM is a modern interpretation fails in light of the evidence.

Genocide. That’s what you’re standing for. And if your quick response is it wasn’t that bad, then please tell me how many deaths due to genocide make it something we should be concerned about. Is ethic cleansing of 50 the line to take notice? What if there’s no killing, just systematic rape of 100’s of women and girls? Is that across the line? We can probably agree that Hitler and 6 million dead in the camps is really over the line, but where is the line when genocide becomes ok?

And more importantly, how does that line change when the person did some good things in their life? Does stature even enter into consideration when your policies resulted in murder? Does achieving some good overcome the result of genocide? So if you help to found a country, does that compensate for 1,000 dead Indians? How about 10,000? How about 100,000? (Asked another way, what would people say about Hitler if the Nazis had won in Germany and stopped there? My guess is there would be a lot of statues to Hitler.)

Here’s a bit of a reflection on that approach – and remember that the entire white world stood by while 800,000+ Rwandans were murdered, most with machetes, in the early 1990’s.

Shortly after my conversation with Kagame, I ran into an American military-intelligence officer, who was having a supper of Jack Daniel’s and Coca-Cola at a Kigali bar. “I hear you’re interested in genocide,” he said. “Do you know what genocide is?”

I asked him to tell me.

“A cheese sandwich,” he said. “Write it down. Genocide is a cheese sandwich.”

I asked him how he figured that.

“What does anyone care about a year-old cheese sandwich?” he said. “Genocide, genocide, genocide. Cheese sandwich, cheese sandwich, cheese sandwich. Who gives a shit? Crimes against humanity—where’s humanity? Who’s humanity? You? Me? Did you see a crime committed against you? Hey, just a million Rwandans. Did you ever hear about the Genocide Convention?”

I said I had. It was passed by the United Nations in 1948, in the days after Nuremberg; it has been ratified by scores of countries; and it says that they will all undertake to prevent and punish genocide if it should ever happen again. “That convention,” the American at the bar said, “makes a nice wrapping for a cheese sandwich.”

That standing by is something the white world does really well, and in Canada, Indigenous issues are a cheese sandwich, in our case wrapped in the paper on which the UNDRIP is printed.

The reason we can’t let that history go is because the systemic racism, oppression that developed along with Canada is still very much in place today. The stolen wealth which came from First Nations is the wealth that makes Canada what it is today. In fact, you’re probably reading this while standing on land which was at some point forcibly removed from the First Nations (and at this point don’t say it was given up through treaties…we can’t talk about treaties until the government actually respects the treaties already in place…and actually starts following the modern treaties negotiated in more recent times). You can’t stand on stolen land, fat on stolen wealth, and then talk about how we just need to get over it.

Those who have committed genocide, look very different in the eyes of those who have experienced it.

 

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Written by sameo416

August 26, 2017 at 9:03 pm

Posted in Uncategorized

Application of a Relational Lens to Workers’ Compensation Case Management

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And this presentation is the follow-on which looks at using relationality as a means of improving WCB case outcomes. In which I attempt to draw relevant parallels between criminal restoration and restoration in Indigenous contexts and the WCB system…

Background

  • In the Hummingbird Project I outlined recommendations to improve WCB outcomes:
  • Include restorative justice training for WCB case managers as a way of transforming interactions
  • Carry out pre-screening of all WCB claimants to detect the presence of early-life trauma
  • Use that pre-screening to proactively intervene in at-risk cases
  • Creation of a supportive transitional community of healing with the ultimate goal of restoration to work
  • This was largely based on my nine years of experience within the appeal system, where I noted a pattern of cases involving the development of permanent disability from relatively minor injuries, usually because of chronic pain issues
  • That progression was often assisted by the presence of an adversarial relationship between worker and case manager; conversely it could be stopped by an unusually supportive relationship

Introduction

  • There are many parallels between the typical starting conditions for restorative justice and an injured worker:
  • We have an injured party
  • There is an implicit injurer – the workplace
  • The injurer sometimes expands to include the employer and the WCB staff
  • There is a need for physical, emotional and sometimes spiritual healing
  • The path to restoration potentially transforms all parties
  • This axis: injured —- injurer reflects many of the case studies in the justice system with victim —- offender
  • The parallels suggest a restorative approach to injured worker case management might be appropriate
  • All workplace injury involves disassociation between person and place
  • All workplace injury requires a journey, not always to perfect health, but sometimes to a place of living with permanent injury and disability
  • The restoration from disassociation involves the journey to a new home
  • This parallel resonates deeply with restorative justice principles
  • The reality of some injured worker case management is not healing:
  • Highly policy-focused
  • Begins with a presumption of denial of benefits (rather than a generous system designed to facilitate return to work, a worker must prove the right to benefits).
  • Often the decision-making is predicated on denial first, when the statutory framework intends the contrary: approval first (Ison, 3.3.37, 3.3.38, 1989)+
    • My approach is based on a particular characterisation of the return to fitness:
    • The return to fitness is best characterised as a journey:

    Se hace comino al andar” “You make the way by walking” (Neumark, p. 271, 2004)

    • That journey may be made more healing, more restorative, by the participation of a community.
    • That community may improve outcomes; an adversarial relation will worsen outcomes.
    • That the ultimate goal of the WCB system is not minimizing costs or management of the accident fund, but the restoration of health and return to work.
    • To achieve this requires setting the right place, creating safety, and providing voice.
    • This approach is very different than what is reflected in most of the appeals cases I participated in. (over 500 over the course of 9 years)++
  • Propose that this system could be reconceived so as to become transformative through:
    • The Re-Creation of Context
    • The Re-Imagining of Place
    • The Creation of Real Safety
    • The Provision for Real Voice
  • Because this is literally a healing journey, an area rich for understanding through metaphor rather than policy

Re-Creation of Context

  • The existing WCB system is posed as a linear process only
  • …when the reality is some cases will have many recursions (return to an earlier stage)
  • Those recursions are negatively interpreted as a lack of injured worker commitment.
  • First change in context is to understand that healing is individual and unpredictable.
  • In spite of the WCB acknowledgement of the individual, not borne out in praxis.
  • That difference between lived-out reality and stated reality requires new context.
  • An injured worker enters liminal space analogous to a re-birth to a different reality (Lederach, 2011)
  • Liminal space is frequently frightening as it awakens fundamental questions of being.
  • As a disabled person, my first challenge was answering questions:
    • “Who am I now?”
    • “Does the disability define me, or do I define the disability?”
    • “What does this mean to my relations, my work, to all the external things that define me?”
    • “If my work defines me, and I can no longer do that work, where do I find new meaning?”
  • Some WCB case manager understanding of an injured worker does not reflect the liminal reality of their emotional and spiritual situation.
  • This context must be based holistically around the reality of each injured worker.
  • Stated another way (following Lederach’s presentation, 2011): how does this system demonstrate the love of neighbour above self (where self reflects both system and case manager)?
  • Healing and return to work conceived as a linear process only
  • Note that this is a creation of policy, as WCB medical therapists see reality differently
  • There is a shift in world-view between medical care-givers and case managers
  • Conceptual models and metaphors both “reveal and hide aspects of a complex reality” (Lederach and Lederach, p. 55, 2010)
  • Linear metaphor presupposes certain presumptions which are not helpful (Ibid, p. 56-7):
  • Forward progress is good
  • Backward movement is a setback (language in case management letters would speak of getting recovery ‘back on track’)
  • A more nuanced metaphoric model of restoration (rather than return-to-work) and true healing is needed.
  • Such a model could look at the violation of injury as central rather than the injury itself (Sharpe, p. 179)

Re-Imagining of Place

  • Workplace injury is a violent act, analogous to an attack on person.
  • Particularly when disability results, focus turns to personal safety. (Lederach and Lederach, p. 63)
  • Compounded with an adversarial relationship with a case manager, WCB facilities become places of further threat and possible injury.
  • Combined with the focus on personal safety, this limits the possibility of healing, and makes the WCB the new source of workplace injury.
  • The place should support the development of a revised personal narrative as the foundation of identity. (Sharpe, p. 188)
  • In some cases surveillance of workers began with scheduled appointments at WCB rehabilitation centres.
  • Worker response once revealed was to see the rehabilitation centre as a place of danger.
  • The fundamental violation of place destroys creation of a place of healing. (Sharpe, p. 188)
  • Similar violation of relationship by case manager ordering surveillance.
  • Worker conclusion is similar to Australian aboriginal’s feeling of ‘not being seen’ and needing to ‘feel like a person again’. (Lederarch, 2011 quoting Judy Atkinson)
  • Paradoxically surveillance has the effect of leaving the worker “present but invisible”. (Lederarch, 2011 quoting Judy Atkinson)
  • Places of healing should be focused on achieving that end goal.
  • WCB rehabilitation centres should be centres of holistic healing (place seen to be multidimensional, including spiritual and emotional connections). (Ross, p. 45)
  • The case manager’s office should also be a place of holistic healing.
  • The metaphor of the circle, manifested as the Medicine Wheel, reflects healing places better than the linear, western, scientific model. (Monchalin, p. 33-5)
  • This ‘great wheel of relationship’ incorporates all places and all persons in the care cycle. (Monchalin, p. 27)
  • Shifts the dominant question from ‘What is my job?’ to ‘How am I related to all others in the healing process?’ and ‘How do I create safe space for all people?’
  • The need is to create physical places that are communities of total healing.

The Creation of Real Safety

  • Injured workers have been violated once, in the workplace injury.
  • Real danger in future violation because of vulnerability in recovery.
  • The entire WCB apparatus needs to become a place of safety, so healing can result.
  • This requires a focus on all relationships so a safe, restorative place may be created. (Llewelyn et al, p. 284)
  • This leads to the need for a relationship founded in equality and mutual respect for all parties, if the process is to be restorative (Ibid, p. 299).
  • Healing will result from a team, in relation, all focused on the end goal – a process which is inclusive and participative (subsidiarity). (Ibid, p. 302)
  • This allows the creation of real safety for the injured person, so they may engage in the risky processes of healing and development of a new personal narrative. (Sharpe, p. 188)
  • Sharpe also provides us an image of what those safe relationships will manifest (Sharpe, p. 187):
  • Inclusive, reflecting all impacted interconnections (for example, the family and friends of the injured person are usually not included).
  • Voluntary.
  • Dialogic, allowing open communication between all.
  • Supported, building safety in all aspects.
  • Without the sense of real safety, the ability for healing and restoration is compromised.

The Provision for Real Voice

  • “Victims need an opportunity to tell their stories in their own way, in a setting of their choice…” the alternative breaks down, “…any personal attempt to construct a coherent and meaningful narrative.” (Sharpe, p. 190 quoting Herman, J. 2005)
  • Part of the healing and restoration process is re-building a personal narrative or personal identity.
  • This also must acknowledge that the entire extended circle of relationship is wounded by the workplace injury.
  • “Individual healing is thus a socially situated activity.” Includes giving voice to the entire community of injury. (Ross, p. 237)
  • The voices of the injured are sometimes suppressed to follow policy. Such an approach reverses the proper order of questions:
  • How does this person fit into our process; versus,
  • How can we best fit our process to this person’s (community’s) needs?
  • The healing journey is most effective relationally, including repair of fractured relationships. (Sharpe, p. 192)
  • This will require overhaul of the present client-centred process, which is in reality a process-centred process (i.e., it is the process’ needs which are the focus of all activity).
  • Only through the provision of real voice to the community of injury (worker and extended circle of family and friends and co-workers) and the community of rehabilitation (the extended care team) is real restoration possible.

Conclusions

  • A more nuanced metaphoric model of restoration (rather than return-to-work) and true healing is needed.
  • Physical places involved with rehabilitation need to be safe places of total healing, considering the inter-relationship of all participants.
  • Without the sense of real safety, the ability for healing and restoration is compromised.
  • Only through the provision of real voice to the community of injury (worker and extended circle of family and friends and co-workers) and the community of rehabilitation (the extended care team) is real restoration possible.
  • The WCB claim process is one that fundamentally involves restoration and development of new personal narrative (e.g., new identity).
  • The WCB first encounters the worker in liminal space, where past definitions no longer apply.
  • The goal of the entire healing team (medical and case management) is to journey with that individual through liminality and out to new reality. That new reality will usually include some return to work.
  • This fundamental restructuring of interactions would result in better outcomes in compensation cases.

Endnotes

+Profession Ison wrote (1989) about the WCB tendency to deny as the first step in adjudicating some claims. This is particularly present in the opinions provided by WCB-employed physicians:

Where an injury arose in the course of employment, the claim must be allowed unless there is affirmative evidence of an alternative cause, and evidence that the employment was not contributory.

[…]

In practice, this statutory presumption has commonly been ignored, and it has even been replaced by contrary presumptions in the process of adjudication.

This was used as a pivotal assertion in assessing a worker’s claim for compensation based on the rupture of a subarachnoid aneurysm that occurred at work.

Decision No: 2011-698, 2011 CanLII 48880 (AB WCAC), <http://canlii.ca/t/fmllh>, retrieved on 2017-08-07

++ A startling encounter I had with a WCB case manager at a public meeting outside of the WCB context started me thinking about this injured worker – case manager relationship. When she found I was in the appeal system she very proudly said, “I have never had an appeal filed for one of my cases.”  I had seen already that there were case managers whose names seemed to frequently appear in appeal cases, and often in the context of an adversarial relationship that used destructive words to describe the worker’s symptoms: malingering, somatic, and also included the use of surveillance by private investigators. That interaction was the first time I had conceived there was a different way to deal with injured workers.

This was later reinforced in a discussion with a colleague who had previously worked as a rehabilitation counsellor at the WCB rehabilitation centre. He related that in his day, part of his job was to keep an injured worker connected with the work community, often starting with bringing them back into the workplace for coffee breaks. He sadly related that this work had all ceased as a cost-cutting measure, replaced by policy-driven requirements which placed all the onus on the worker. If the worker did not respond to that onus, they were sometimes marked as ‘uncooperative’ and had benefits restricted or eliminated.

References

Ison, Terence G. (1989). Workers’ Compensation in Canada, 2nd ed. Toronto: Butterworths.

Lederach, J.P (2011). Narratives of Care: The Social Echo of Community Transformation, http://emu.edu/now/attachment/2011/john-paul-lederach/ viewed 19 June 2017.

Lederach, J.P. & Lederach, A.J. (2010). When Blood and Bones Cry Out: Journeys through the Soundscape of   Healing & Reconciliation. New York: Oxford University Press.

Llewelyn, J., Archibold, B., Clairmon, D., Crocker, D (2013). Imagining Success for a Restorative Approach to Justice, Dalhousie Law Journal, 36(2), 281-316.

Monchalin, Lisa, (2016). The Colonial Problem An Indigenous Perspective on Crime and Injustice in Canada.   Toronto: University of Toronto Press.

Neumark, Heidi B. (2003). Breathing Space: A Spiritual Journey in the South Bronx. Boston: Beacon Press.

Ross, R. (2014). Indigenous Healing: Seeing Justice Relationally. Toronto: Penguin.

Sharpe, S. (2013). Relationality in Justice and Repair: Implications for Restorative Justice in T. Gavrielides and V.   Artinopoulou (Eds.), Reconstructing Restorative Justice Philosophy.

Written by sameo416

August 7, 2017 at 4:40 pm

Posted in Uncategorized

Use of Restorative Justice Principles to improve outcomes of Workers’ Compensation Cases

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I prepared this presentation as the end project in an introductory course on restorative justice through Simon Fraser University. The idea is to use a new approach to dealing with injured workers that 1) includes screening of all workers for the existence of early-life severe trauma so intervention can be made before the workplace injuries causes a total decompensation and total disability 2) training case managers to use RJ principles in dealing with injured workers to avoid re-traumatizing them through adversarial interaction with the WCB (in the person of the case manager). I saw those two dynamics repeatedly in appeal cases.

The original presentation in pdf: Humingbird Project RJ Intro Course April 2017

This is the text from the PowerPoint slides laid out for reading. This wasn’t a formal paper, but a presentation on an application of RJ.

Workers’ Compensation Injuries
Detection and Early Intervention in Cases of Pre-existing Complex Trauma

Definitions:

  • Case manager: WCB employee responsible for management of the case, and the principle approver for most financial and treatment benefits
  • Compensable injury: the work-related injury which is the cause of the WCB claim
  • Non-compensable injury: anything which pre-existed the workplace injury and was not in any way impacted by the workplace injury
  • WCB benefits: include both treatment and financial (wage replacement, compensation for loss of function, medical aid)
  • Disabling injury: any injury which results in a loss of time at work
  • Permanent disability: any injury which limits an ability to work permanently, meaning no hope of recovery

Experience from the WCB Appeal Process

  • I served as an Appeal Commission on the appeal tribunal for the Alberta WCB for nine years, sat on over 500 hearings, wrote over 350 decisions
  • I am a disabled veteran who experiences chronic pain (19 years so far)
  • Chronic pain cases form a large portion of complex WCB appeal cases
  • Several years in to my term, a pattern started to emerge in appeals:
    • Middle-age injured workers (more women than men)
    • Relatively minor injuries (sprains, soft tissue, bruises)
    • An adversarial experience with the WCB case manager that resulted in benefits being stopped
    • Later development of a seriously disabling chronic pain condition, far out of proportion to injury
    • In many cases, the medical file would contain evidence of early-life complex trauma (abuse usually)
  • Idea 1: If there had been an early psychological intervention, it might forestall development of chronic pain
  • Idea 2: If there had been a healthy relationship with the WCB case manager, this may have lessened severity
  • There is very little research into this phenomena
  • This suspicion is highly anecdotal, but the pattern occurred so often that I could anticipate the outcome of a particular medical history by assessing:
  • The early-life medical history (we reviewed the complete WCB medical file prior to appeal)
  • The lack of a supportive relationship with the case manager
  • The existence of an overall adversarial relationship with the WCB
  • The elimination of wage replacement benefits, and the failure to return to some form of employment (because of the presence of claimed complete disability)
  • In managing the hearing process, we could often become a source of some healing which stabilized and improved the overall outcome of the case to date (but most cases the damage had already been done).
  • An adversarial relationship served as a source of re-traumatization of an injured worker who had already been through at least two sets of trauma (early life; the accident at work).
  • The existence of an adversarial relationship with the employer would exacerbate the re-traumatization.
  • Worst cases were when an adversarial case manager and an adversarial employer appeared to work together against the worker.
  • This represented a further re-injury which sometimes awakened complex, untreated, early life complex trauma.
  • In general, processes intended to heal (and achieve a return to work) should not cause further injury.
  • One factor which could derail this trajectory was the presence of a supportive case manager.
  • Many of those cases did not make it to appeal, as the worker was receiving benefits.
  • We did see some where it was an issue beyond the case manager’s authority.
  • Even with the existence of the pre-disposing conditions, a caring case manager was often able to facilitate a return to some type of employment.
  • An adversarial relationship with the case manger became the defining event that moved the minor injury to serious disability.
  • The benefit of a supportive relationship was often attested to in the appeal process.
  • A worker would say, “I do not want my case manager to get into trouble, as she has been doing an awesome job. But I think I am entitled to this benefit, and she told me her supervisor would not allow it to be granted.”
  • The injured worker becoming an advocate for their case manager reflects an underlying significant relationship between patient and care provider.
  • In the limited sample I observed, this relationship was pivotal in determining outcome

Relation to Restorative Justice

  • When considered with the content of this course, and particularly the article by Green, Johnstone and Lambert, it is apparent that restorative principles have a place before things fall apart in any relationship. (Green et al, 2014)
  • Restorative Justice training of case managers assigned to cases screened to be ‘high-risk’ could serve to improve outcomes, and potentially limit or eliminate development of chronic pain conditions.
  • An admittedly cursory literature review revealed very little specific research in this area. Most investigation involves the efficacy of physical intervention programs such as work hardening.
  • Very few studies dealt with the detection of early-life trauma as a means of early intervention in cases which ended up with serious disabling chronic pain.
  • My goal is not to prove anything, but to highlight an area worthy of focused research.

Approach

  • Restorative Justice techniques have been presented as a means of resolving damaged relationship post-incident (after crime, after conflict, after injury).
  • The post-incident approaches appear to have good preventative value, and have merit if applied pre-incident.
  • In this case the initiating incident is the development of an adversarial relationship with the WCB, so post-injury, pre-case management is the intervention location.
  • With restorative principles governing relationship between injured worker and WCB case manager, the potential re-traumatization which awakens early-life complex trauma may be avoided.
  • Restorative principles may improve the skill of the case manager to intervene constructively rather than destructively.

Hypothesis

  • Early/Earlier Complex Trauma pre-disposes injured workers to the development of chronic pain conditions
  • Early screening and detection of the presence of complex trauma would permit intervention
  • That intervention, if done promptly after the injury, could forestall the development of a chronic pain condition
  • Restorative principles, applied to the case manager/worker ,would lessen the potential of the case manager exacerbating the development of disabling injury
  • Early screening could also lead to assignment to special restorative-trained case managers who could use restorative principles

Research into the Phenomena

  • Evidence exists that early-life or earlier complex trauma can exacerbate or predispose to the development of post-traumatic stress disorder (PTSD) or Chronic pain conditions

“…somewhat higher levels of PTSD symptoms were reported by those who reported experiencing a traumatic event prior to the target stressor…” and particularly an occurrence during childhood.  (Ozer et al, 2003, p. 57)

“A clear finding was that childhood physical abuse, stressful life events, and depression were generally associated with chronic pain…” (Roy, 2006, p. 56)

“[Somatization] is sometimes expressed as diffuse physical pain, sometimes as particular conditions.” (Randall et all, 2013, p. 513)

  • Detecting a pre-disposition to chronic pain in the existence of early-life complex trauma can forestall development of chronic pain

“…patients at greater risk of increased pain severity and chronic pain can be detected in the acute hospital with enough accuracy to warrant their identification prior to discharge.”  (Holmes et al, 2010, p. 1603)

  • A relationship exists between prior-life events and length of absence from work.

“A prior history of psychiatric illness or post-trauma morbidity have been shown to increase length of absence from work.” (Hensel, et al, 2011, p. 553)

“…the presence of secondary psychiatric diagnoses was significantly associated with not working.” (Hensel, et al, 2011, p. 558)

  • While this study did not explicitly look at early-life complex trauma, it did establish a linkage between secondary diagnoses (i.e. those not related to the injury, and pre-existing the injury) and worse outcomes for injured workers.
  • Early intervention can reduce length of disability.

“Early intervention has been associated with more rapid recovery and return to work.” (Hensel, et al, 2011, p. 553)

  • The entire injured worker must be considered in the treatment process, not just the compensable injury.

“So psychosocial factors must be taken into consideration in treating patients with chronic pain.” (Roy, 2006, p. 56)

  • Patients who had reported early-life physical and sexual abuse were more likely to develop chronic pain syndromes.

“Abused subjects reported a higher number of areas of pain in the body, more diffuse pain; also, there were more frequent diagnoses of fibromyalgia…Clearly, abuse had far-reaching health consequences in these persons’ adulthood as compared with psychiatric patients and normal persons.” (Roy, 2006, p. 58)

  • The linkage between early-life trauma and later development of chronic pain conditions was demonstrated by some studies.

“…(2) patients with chronic pain were more likely to report childhood abuse than health controls; (3) patients with chronic pain were more likely to report childhood abuse than nonabused patients with chronic pain… The conclusion was that childhood experience of abuse and neglect increased the risk of later life chronic pain as compared with individuals who were not abused.” (Roy, 2006, p. 59)

WCB-particular situation

  • An injured worker has a single point of contact with the organization, this being the case manager.
  • The case manager is presented as a trusted agent who will explain, assist and provide treatment and financial support.
  • Injured workers present with a wide variety of pre-existing conditions.
  • When an adversarial relationship develops, the care-giver becomes an enemy.
  • This can fracture trust and relationship, and converts the worker from a client to someone engaged in battle with the WCB.
  • That shattered human connection will exacerbate prior trauma that involved violation of trust, so the case manager/WCB becomes a proxy for events that occurred years earlier.

Research into the Phenomena

  • Traumatic pre-events are common in the worker population

“…somewhere between fifty-five per cent and ninety per cent of people have experienced at least one traumatic event in their lifetime.” (Randall et al, 2013, p. 503)

  • A ‘traumatic event’ is any which is, “subjectively experienced as a threat to the person’s survival.” (Randall et al, 2013, p. 507)
  • The injured worker becomes dependent on the WCB for financial survival.
  • Therefore further trauma can occur which meets Randall’s definition, as the WCB money becomes necessary for survival.
  • The primary determinant is the person’s perception of the threat. (Ibid)

Conclusions so far…

  • Early-life trauma may pre-dispose injured workers to more complicated post-accident outcomes.
  • Particularly in cases of childhood abuse, individuals were pre-disposed to the development of pain conditions and chronic pain.
  • That those pre-disposing conditions could be detected immediately after the presenting acute injury.
  • While there was some call for early screening, no study has yet assessed the effectiveness of such a program.

What can RJ offer?

  • Zehr’s model of threes illustrates the applicability:
  • When people and relationships are harmed, needs are created
  • The key to successful intervention is a supportive and trusting relationship between case-manager and worker. Adversarial relations by someone with the authority to provide or withhold money and care causes great harm.
  • The needs created lead to obligations
  • Unfortunately, the obligation is sometimes submerged in the focus on policy and procedure before care. A case manager challenged by a distraught worker has two options: to be relational, or to protect self by using the power of policy and process to displace responsibility for doing what is right on “the system”.
  • A just response is to heal and put right what has been wronged
  • Following policy becomes a “just” outcome in itself, regardless of the impact of the person seeking service. (Zehr, 2015, pp 92-3)
  • Zehr highlights a fundamental difference between supportive and non-supportive case managers – their mission
  • Is the mission to ensure policy is satisfied, but no more?
  • Is the mission to provide as much benefit as possible without exceeding that permitted?
  • Stated another way…is a case manager’s primary role to say:
    • Yes? Or
    • No?
  • Too often a focus on customer-service is submerged in the protection of quoting policy to explain why something is not possible.
  • Is the fundamental truth the interconnectedness of individuals, or the protection of the corporation? (Zehr, 2015, p. 48)
  • Can a process which is all about the negative (injury, loss of income, loss of identity, awakening of previous suppressed trauma) become one which is positive?
  • This is foundational RJ: conflict transformation explicitly creating positives from the difficult or negative (Lederach , 2003, p. 19)
  • The workplace injury could thus become an occasion of healing other traumas, not related to the work injury.
  • The fracturing of a work community by injury, is replaced by a supportive recovery community which aims at a restoration of the work community.
  • This transformation could ultimately reduce costs to the system.
  • Elliott discusses post-battle rituals (cf. Grossman) as a necessary transition for soldiers returning from combat.
  • This identifies a potential parallel: workers returning from the ‘battle’ of a workplace injury. (Elliott, 2011, p. 175)
  • Multiple traumatic experiences have more than an additive effect, so intervention is important. (Elliott, 2011, p. 176)
  • Harm caused by a person expected to be a care-giver can exacerbate a person’s experience with fractured trust from prior injury.
  • But, those exposed to harm respond when “buoyed by relational support”. (Elliott, 2011, p. 187)
  • “Dependency erodes the sense of personal power…”. Need to focus on services which lead people out of dependency and into community; contrasted with those which create dependency. (Pranis, 2001, p. 299)
  • Can cause particular trauma as the injured worker becomes dependent on the WCB for sustenance and care, and then those benefits are removed suddenly without a transition from dependency.
  • Injured workers are often isolated from all prior support systems, and have no place to turn after the final relationship (with the WCB) is severed.
  • The training of service providers to screen for indicators of complex trauma before the workplace injury could allow early intervention. (Randall et al, 2013, p. 523)
  • The ‘misbehaviour’ of workers previously traumatized can lead to an assumption that they are deliberately being difficult, as they are not behaving as a “real” injured worker should behave. (Ibid)
  • RJ principles offer a relational response to such misbehaviour.
  • A new concept for WCB case management is present in the concept of organizations which build “restorative capital”. (Green et al, 2014, p. 44)
  • The new approach must be very self-aware to avoid re-creating symbolic violence which it seeks to displace (Ibid, p. 45)
  • Rebuilding of fractured community needs to be key, to allow worker recovery and transition back into the work community. (Ibid, p. 62)

Conclusions

  • The pre-screening of injured workers for the presence of early-life complex trauma could identify cases with high potential for serious disability.
  • The assignment of such cases to case managers specifically trained in restorative justice principles could provide the recovery support system.
  • That would allow the development of a supportive transitional community of healing with the ultimate goal of restoration to the work community.
  • This could result in healthier outcomes and lower costs to the system overall.

References

Braithwaite, J. (2014).  Evidence for restorative justice. View in a new window. The Vermont Bar Journal,   Summer 2014, 18-22.

Elliott, E. M. (2011). Security, with care: restorative justice and healthy societies. Halifax, NS: Fernwood Pub.

Green, S., Johnstone, G., & Lambert, C. (2014). Reshaping the field: building restorative capital. Restorative   Justice, 2(1), 43-63. doi:10.5235/20504721.2.1.43

Hensel, J. M., Bender, A., Bacchiochi, J., & Dewa, C. S. (2011). Factors associated with working status among   workers assessed at a specialized worker’s compensation board psychological trauma program.   American Journal of Industrial Medicine, 54(7), 552-559. doi:10.1002/ajim.20944

Holmes, A., Williamson, O., Hogg, M., Arnold, C., Prosser, A., Clements, J., . . . O‘Donnell, M. (2010). Predictors   of Pain 12 Months after Serious Injury. Pain Medicine, 11(11), 1599-1611. doi:10.1111/j.1526-  4637.2010.00955.x

Lederach, J. P. (2003). The little book of conflict transformation. Intercourse, PA: Good Books.

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of   posttraumatic stress disorder and   symptoms in adults: A meta-  analysis. Psychological Bulletin, 129(1), 52-73. doi:10.1037/0033-  2909.129.1.52

Pranis, K. (2001). Restorative Justice, Social Justice, and the Empowerment of Marginalized Populations View in   a new window. In G. Bazemore & M. Schiff (Eds.), Restorative Community Justice: Repairing Harm   and Transforming Communities (pp. 287-306). Cincinnati, OH: Anderson Publishing Co.

Randall, M. & Haskell, L (2013). Trauma-Informed Approaches to Law: Why Restorative Justice Must   Understand Trauma and Psychological Coping. Dalhousie Law Journal. 36(2), 501-533.

Roy, R. (2010). Psychosocial interventions for chronic pain: in search of evidence. New York: Springer.

Zehr, H. (2015). The little book of restorative justice. New York: Good Books.

Written by sameo416

August 5, 2017 at 6:56 pm

Posted in Uncategorized

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