ACTive Recovery Solutions

ACTive Recovery Solutions (ARS)

ARS combines elements of intensive interdisciplinary treatment and the lower costs associated with office based rehabilitation counselling to provide an innovative solution for an under-served population.  Sometimes referred to as “stuck in limbo” by disability insurers, these individuals do not meet the criteria for the most prevalent treatment services in our communities.

For many years it was believed that if an individual had been off work for more than 2 years, it was unlikely that they would return.  The study most quoted is:  Waddell, G. (1987) A New Clinical Model for the Treatment of Back Pain. Spine, 12 (7), 632-644.  While the paper discusses a broad biopsychosocial approach to pain, it presented data from a limited study of workers compensation patients in British Columbia and by extrapolating the limited data, suggested that return to work after 2 years was next to impossible.

Other studies however have demonstrated that this is far from true.  See, for example:

  • Gatchel, R.J., Adams, L., Polatin P.B. and Kishino, N.D. (2002) Secondary Loss and Pain Associated Disability: Theoretical Overview and Treatment Implications, Journal of Occupational Rehabilitation, 12, 2, 99 – 110;
  • Main, Sullivan and Watson (2008) Pain Management: Practical Applications of the Biopsychosocial Perspective in Clinical and Occupational Settings. Elsevier: Flor and Turk. (2011)  Chronic Pain: A Biobehavioral Approach. International Association for The Study of Pain Press;
  • Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain 1992;49:221–230;
  • Turk DC, Okifuji A. Treatment of chronic pain patients: clinical outcomes, cost-effectiveness, and cost-benefits of multidisciplinary pain centers.

There is evidence that intensive interdisciplinary treatment can successfully result in employees being able to increase their level of function to pre-disability levels, including a return to gainful employment.  However, programs that can accomplish these outcomes are time and labour intensive, resulting in high costs and inaccessibility for all but a few individuals.

We also know that individuals who have been off work for a year or less can be successfully treated utilizing short term, office based rehabilitation counselling at a much reduced cost.

But what happens to those employees who are caught in the middle?  Those who have been off work for 1-2 years?  Their situations are often deemed too complex for office based counselling.  Yet, they do not meet the stringent criteria for access to the most intensive and costly interdisciplinary services.

ACTive Recovery Solutions (ARS) has been designed specifically to meet the needs of this group.  With a comprehensive psychological assessment along with evidence based functional activation and physical conditioning, that begins in the individual’s home and then moves to shorter office based counselling sessions, both the duration and the costs are significantly reduced.  Our goal is to help these individuals to get their lives back, by increasing their ability to engage in valued and meaningful activities despite the presence of their symptoms.  In order to be able to afford to engage in valued and meaningful activities in one’s life, MOST people have to work.  As well, work is generally good for physical and mental health, and promotes well-being (AFOEM, 2011; ACOEM, 2006; Waddell and Burton, 2006).  It is also a key factor in a person’s self-worth and identity (Black, 2008).  Thus, it represents an appropriate counselling goal.

Evidence-based approaches give our patients the best possible opportunity to increase their functioning and get their life back.  We utilize 3rd generation CBT approaches including Behavioural Activation (BA), Acceptance and Commitment Therapy (ACT) and elements of Dialectical Behaviour Therapy (DBT) (Check out the bottom of THIS page to read about these therapies).  In addition, we use goal oriented activity plans for increasing physical conditioning and overall functional activation.  Research has shown that return to work is critical to the recovery process and should be used as rehabilitation to enhance recovery, increase activity and function, and optimize successful and sustained employment (ACOEM, 2006).  Our Rehabilitation Counsellors provide return to work coordination in order to facilitate and support the successful transition to gainful employment.

The ARS psychological assessment is conducted by a Registered Psychologist along with one of our Rehabilitation Counsellors.  The home based counselling is provided by a Rehabilitation Counsellor under the supervision of the Registered Psychologist.  The office-based rehabilitation counselling is provided by the Rehabilitation Counsellor who has access to the Registered Psychologist for consultation on an as needed basis.

Our Rehabilitation Counsellors have been trained in the use of all forms of CBT by Registered Psychologists.  They receive ongoing training, supervision and consultation from the Registered Psychologist in addition to participating in external training events.  They are all licensed health care providers with either the College of Registered Psychotherapists of Ontario or the College of Kinesiologists of Ontario.

American College of Occupational and Environmental Medicine (2006). ACOEM Guideline – Preventing needless work disability by helping people stay employed. Retrieved 14 December 2011. http://www.

Australasian Faculty of Occupational and Environmental Medicine (2011). Australian and New Zealand Consensus Statement on the Health Benefits of Work: Realising the Health Benefits of Work. October/ November.

Black, C (2008). Working for a healthier tomorrow: Dame Carol Black’s review of the health of Britain’s working age population. London: The Stationary Office, 17 March.

Waddell, G and Burton AK (2006). Is Work Good for Your Health and Well-being? London: The Stationary Office.

Acceptance & Commitment Therapy (ACT)

ACT uses mindfulness practices to help people become aware of and develop an attitude of acceptance and compassion toward painful thoughts and feelings.

Behavioural Activation (BA)

BA is designed to treat depression. BA focuses on the depressed person’s behaviours that keep him or her stuck in depression.

Cognitive & Behavioural Therapy (CT & BT)

CT deals with thoughts and perceptions, and how these can affect feelings and behaviour. BT focuses on an individual’s learnt, or conditioned, behaviour and how this can be changed.

Quota Based Physical Conditioning

This can include graduated cardiovascular training and/or progressive resistance training to assist the individual to gradually resume their pre-disability level of functioning.

Rebuilding Social, Recreational & Family Activities

JMA guides clients through a graduated return to meaningful activity while assisting them to incorporate recommended strategies for pain management.

Work Hardening

Our work hardening process uses cognitive and physical work hardening strategies designed to utilize real or simulated work activities to restore physical, behavioural and vocational functions.

J Marlin and Associates Inc. offers Cognitive Behavioural Therapy services to help individuals increase their sense of vitality, well-being, and fulfillment.

Head Office1100 Burloak Drive, Suite 603 Burlington, ON L7L 6B2

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