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The Early Years

The CWH program at ERGO-Wise® was pioneered by Adeena Wisenthal, PhD, M.Ed, OT Reg. (Ont.) in 2000.

The evolution of this intervention began with a meeting between Adeena and a disability insurer who had identified a need within the disability sector. Many of the insurer’s plan members had been off work due to a mental health disability and she could not find an appropriate treatment to help them return to work. This insurer, herself an occupational therapist, recognized the potential role of occupational therapy to address this gap due to the profession’s holistic and client-centred approach, focus on function in all life roles including the worker role, and knowledge of psychosocial and mental health issues.

A collaboration between the insurer and Adeena ensued and included a needs analysis that paved the way for program design to meet the unique challenges of this population. The early formulations of cognitive work hardening were born from this collaboration and have evolved over the past 20 years with Adeena developing, adapting, and refining the intervention to its current form (at ERGO-Wise®).

CWH is grounded in the principles of classical work hardening, an evidence-based treatment for return-to-work. Although classical work hardening was not restricted to any one domain, traditionally it was applied for physical disabilities and musculoskeletal injuries. CWH was created to tailor work hardening more specifically to the mental health realm; specifically, to people returning to work following a mental health disability leave (e.g., depression).

The Research Years

After a decade of CWH helping people return to work with positive outcomes, affirmative feedback from clients and insurers, and recognition from the Canadian Association of Occupational Therapists (CAOT) through its Innovative Practice Award (2009) there was interest in studying this intervention in more detail. Specifically, the goal was to gain a better understanding of its theoretical underpinnings, quantitative analysis of its effectiveness, and qualitative insights into the intervention’s key elements that may contribute to clients’ experience in the intervention as well as main treatment gains by clients. This formed the basis of Adeena’s doctoral research. An outline of the research progression is available here.

While such a comprehensive study of CWH was an interest to Adeena, it also gained the attention of some of the top occupational therapy researchers in Canada who collaborated with Adeena on her research leading to several publications in peer-reviewed journals.

The Expansion Years

Years of clinical success and comprehensive research naturally lead to a phase of knowledge transfer with a goal of expanding CWH’s reach. With this website we are entering this next phase; specifically, with the launch of the CWH Awareness Tool available here.

The Awareness Tool starts the roll out of knowledge transfer for stakeholders, healthcare providers, and occupational therapy practitioners. The vision is that CWH becomes more mainstream. The intent is that CWH becomes an essential treatment intervention for return-to-work following a mental health disability leave in order to enhance return-to-work outcomes. This will be a multi-pronged, multi-phased approach with training of occupational therapists in CWH being a key element in achieving these goals.

This website will grow to form the nucleus of a community of interested parties. Just as CWH evolved over many years from its infancy to the mature intervention it is today, it is anticipated that this resource site will develop and transform over the years to address the needs of the many different stakeholders involved in rehabilitation, disability, healthcare, and return-to-work.

Adeena Wisenthal PhD, M.Ed, OT Reg. (Ont.)
Adeena Wisenthal PhD, M.Ed, OT Reg. (Ont.)