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Vocational Rehabilitation and Vocational Rehabilitation and integration into the communityintegration into the community
Patricia Corbett
Occupational Therapist
MSc. BA Hons DipCOT.
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Presentation ObjectivesPresentation Objectives
To define the issues affecting RTW after ABI and the values associated with work
To describe the services available and concerns relating to the needs of ABI individuals .
To describe the role of OT as part of a vocational rehabilitation service
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Definition of Vocational Definition of Vocational Rehabilitation Rehabilitation
‘ V.R is a process whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment, or other useful occupation ’
Vocational Rehabilitation, The Way Forward, British Society of Rehabilitation Medicine, 2003
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Who are the providers ?Who are the providers ?
Wolfson Vocational Service, limited number of NHS funded VR Centers
Job Centre Plus Disabled Employment Advisor and job brokers
Private companies , Rehab Uk, Unicom Provident, Case Management Firms
Charitable organisations NHS Community Teams time limited input
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Defining the needDefining the need In UK, 2.7 million people of working age receiving
Incapacity Benefit (DWP 2002) Over ¾ of a million would like to work Almost all of the 700,000 people moving onto IB
each year expect to work in due course Once a person is on IB for 1 year they have only
1.5 chance of returning to work within 5 years ( DWP)
Headway suggests only 30% of people with moderate to severe head injury are in work 5 years post injury
Pathways to work : Helping people into employment, DWP 2002
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Job Centre Plus SchemesJob Centre Plus Schemes
Pathways to workWork prepWork stepNew Deal for the DisabledAccess To WorkJob IntroductionCondition Management
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IB Recipients - DiagnosisIB Recipients - Diagnosis
Source – Dept of work and pensions
Incapacity-related benefit by diagnosis group, November 2003
Musculoskeletal26%
Mental health44%
Cardiovascular10%
Diseases of the nervous system
3%
Injury1%
Diseases of the respiratory system
2%
Other conditions or conditions not
specified14%
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Vocational difficulties in brain Vocational difficulties in brain injuryinjury
• Environmental barriers• Physical difficulties • Poor motor skills, visual field deficits,
epilepsy• Communication difficulties • Processing language, expressive dysphasia, • Cognitive difficulties, poor memory,
concentration and attention, reduced ability to learn information
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• Executive functioning difficulties problems with planning organising and
problem solving, poor insight• Fatigue, both mental and physical• Low mood, mood swings, emotional
vulnerability• Irritability, frustration aggression,
disinhibition• Difficulty with adjustment
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Political and Health agenda Political and Health agenda
Disability Discrimination Act 1995 (DDA) Incapacity Benefit Reform 2003 (DWP) Choosing Health white paper 2004 New Deal for the Disabled 1998 Getting back to work 2002 (TUC ) Publication of the National Health
Standards for People with Long Term Conditions 2005
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Evidence Evidence
Outcome of DEA clinic
Patients known return to work
Audit of patients June 2004-June 2006
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Total contactsTotal contacts
0
2
4
6
8
10
12
Clients
Follow-up
DEA Clinic Follow-up
Advice Only
Access to work
Work Prep
Work step
Working Lives
Training
Education
Voluntary Work
Paid Employ
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Most Recent ContactMost Recent Contact
Advice Only
Access to work
Work Prep
Work step
Working Links
Training
Education
Voluntary Work
Paid Employ
No Update
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International EvidenceInternational Evidence
Study that reviewed factors that consistently relate to employment outcomes following TBI looked at 85 studies (1980-2003)
Factors affecting successful return to employment (Ownsworth and McKenna 2004).
Pre injury occupational status Functional status at discharge
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International EvidenceInternational Evidence
Global cognitive functioning Perceptual abilities Executive functioning Involvement in VR service Emotional status
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Evidence Evidence Conceptual model of factors relating to employment outcome
(T. Ownsworth and K. McKenna)
Pre-injury variables(age, race, education and occupation)
Injury variables (severity of TBI and functional status in the acute recovery
phase)
Neuropsychological variables (deficits in memory, attention,
executive functioning, language, visuo-spatial skills and processing)
Metacognitive and emotional variables (awareness, emotional well
being, motivation and use of strategies)
Social/environmental variables (litigation, family & peer support,
employer support, rehabilitation and work experience)
Employment outcome: type of work, number of hours, work modifications, quality of performance and durability
Modify through rehabilitation· Self awareness· Group rehabilitation· Training in compensation· Motivational interviewing· Adjustment counselling &
cognitive-behavioural therapy
Modify social environment· Provide more financial
incentives for work· Employer education & training· Family education· Supported employment
programmes· Changes in public policy and
funding decisions
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Work site visit Work site visit
Environment
Social conditions
Core duties of the task
Cognitive demands
Physical skills
Communication
Specific task analysis
Work culture
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Case StudyCase Study
Mary K background information Presenting problems Short term memory difficulties Retrograde amnesia Reduced speed of processing Limited functional use in left arm Deaf in right ear Fatigue
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Case Study ContinuedCase Study Continued
Employment Issues affecting work Cognitive Physical including medical complications Emotional changes Coping with a court case
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Case Study ContinuedCase Study Continued
Rehabilitation Intervention Strategies to manage short term memory
loss Mobilisation of left arm Computer Training Domestic participation
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Follow up episodeFollow up episode
Return to work assessment Cognitive problems Managing work load Pressure to return full time Unable to travel to work independently Anxiety and low mood
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InterventionIntervention
Work visit and work report from OT Anxiety Management Adjustment including exploring leisure
activities Travel to work
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Case History 2 Case History 2
Background information
Social History
Presenting problems
Worker Role Interview
( G.Kielhofner 2005 )
Assessment of Motor and Process Skills ( A Fisher 2005 )
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GoalsGoals
To have a better understanding of current work skills based on previous knowledge and experience
To be able to manage fatigue symptoms with objective recording
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Case History 3Case History 3
Background information
Social History
Presenting problems
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GoalsGoals
To identify strengths, skills and knowledge acquired through current position at the RSPCA
To identify future training and experience required to develop vocational skills
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OT and integration into workOT and integration into work Skills to identify issues affecting the person, level of
disability and how this interfaces with work Provides a practical approach to rehabilitation within the
realities of living in the community. Experts in task analysis
As part of this global approach recognises the need to work with other professionals and agencies. Set joint goals.
Develop interagency work and working links to all involved providing a clear RTW to pathway, avoiding duplication
Offer education and advice re condition and likely impact on work to all involved
Identify other work alternatives if unable to return to previous job value volunteer work as a real work
Set a review system 1-2 years , trouble shoot problems
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ResourcesResources
www.jobseekers.direct.gov.uk DEA and Job Centre Plus Remploy www.remploy.co.uk AbilityMatch software Shaw –Trust www.shaw-trust.org.uk Online.onetcenter.org Volunteer centres Charities Adult Education
