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41831522 Changing Landscapes
The Official Publication of VRA CanadaSUMMER 2012
Q&A:
What’s Up, Doc? The ethics of Skype-based therapy
Stand Up! Alternative approachesto workplace bullying
Educating Canada
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1
Official Publication of the Vocational Rehabilitation Association of Canada
e-Learning: Integrating professional development into busy lives 5
Ahead of the Game: Brain injury awareness 7
Eliminating the Barriers: Accommodation at any cost 9
Bullying: An alternative approach 11
2012 Conference: Thanks to our conference sponsors 14
The Hype with Skype: The ethics of providing online therapy 20
Educating Canada: Vocational rehabilitation at post-secondary levels 23
Green Tips: Great benefits of going outside 28
A Message from the National President: Garry Derenoski 3
Society News: The latest VRA developments from across Canada 4
Member Profile: Lesley McIntyre 10
Spotlight on Professionals: Dr Raymond Rupert 17
CAVEWAS Corner: Fitting employment: Making work that ‘fits’ into work that ‘sticks’ 18
Membership Updates: The latest VRA members and achievements 22
20/20/2: Answer 20 questions for 20 dollars and earn 2 CEU credits 26
Summer 2012
PUBLISHED BY VRA Canada
>>>>>>Account Manager Anne Gauthier 4 Cataraqui Street Suite 310 Kingston, ON, K7K 1Z7Tel: 613.507.5530 Toll-free: 1.888.876.9992 Fax: 888.441.8002 Email: [email protected] Web: www.vracanada.com
>>>>>>
Editor Katherine Abraham
Design Steven La MCI Strategies
Advertising Sales Director Audra Leslie Tel: 416.340.7707 [email protected] 150 Ferrand Dr. Suite 800 Toronto, ON M3C 3E5 Tel: 416.340.7707 Fax: 416.340.1227 Web: www.mcintegrated.com
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Rehab Matters is published four times a year by VRA Canada. The opinions expressed in this publication do not necessarily reflect the policies of the Association.
>>>>>>>
PUBLICATION NUMBER 41831522
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VRA Canada 4 Cataraqui Street Suite 310 Kingston, ON, K7K 1Z7
Summer 2012
Features
Inside Every Issue
Contributors
It’s that time of year again, when we welcome both the summer season and the recurrence of VRA’s National Conference and AGM. I hope most of you are reading this issue in beautiful Canmore, Alberta while taking in everything this year’s conference has to offer. For those of you who haven’t yet contributed to the magazine, there are still plenty of opportunities to get involved! Our next issue will include a feature on breast cancer survivors and their return-to-work journeys. If you or someone you know is a cancer survivor we want to hear from you! Contact: [email protected]!
Sincerely, Katherine AbrahamEditor, Rehab Matters Magazine
Letter from the Editor
Katherine Abraham, Hons. BAShelley Fillmore, MEd, RPC, CHRPRod Lightheart, BA, RRP, RCSS, RVP, CVPArden McGregor, MA, CBISTDr Roberta Neault, CCC, RRP
Dennis Radman, Hons. BSc, RRP, CBISTTaline Sethian, MA, RRP, MCVPDr Izabela SchultzLarissa Teoh
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3 Summer 2012
As my term as president comes to its completion, I reflect on the significant changes this
association has undergone over these past four years. Our membership has grown and flourished; these new members are infusing their excitement and active participation in their local societies and are involved in our educational network, RRP review, and terminology committees. They are re-igniting the passion and enthusiasm in many long-term members.
Over the past several years, we have seen our brand evolve and increase its presence and recognition with stakeholder groups and government agencies. Our marketing and advocacy efforts are working and continued efforts in these areas are vital to the sustainability of the association and its representation of the profession.
In addition to these great advances, there have been enhanced member benefits: our ability to offer personal liability insurance at significantly reduced rates has been well received; we have enhanced member communication through email notices, newsletters and Rehab Matters; our ongoing educational and professional development opportunities have been a focus these past couple of years and will be key to the advancement of the profession moving forward.
It has been my great pleasure and an honour to have met many of our members at society conferences and events over these past years. I have developed many close associations and have learned a great deal from each encounter.
Lesley McIntyre will assume the role of president this June at our AGM in Canmore. I know that she has the skills and the fortitude to take VRA to the next level. Her strong organizational skills, knowledge of the industry, along with her incredible work ethic will serve VRA members well as we move forward.
With the anticipation of our country’s future employment issues, VRA Canada members are well positioned to provide the skills required to address these concerns.
I thank you all for your support and look forward to a strong and vibrant future for the association.
VRA CANADAVocational Rehabilitation Association of Canada
2011/2012 Board of Directors
Garry Derenoski President
Roselle Piccininni Past-President
Lesley McIntyre President-Elect
Sharon Smith Director, British Columbia Society
Samantha Schellenberg Director, Alberta Society
Nikki Lamb Director, Saskatchewan Society
Laurence Haien Director, Manitoba Society
Steve Ogden Director, Ontario Society
Dale Murphy Director, Atlantic Region
Addie Greco-Sanchez
Representative, CAVEWAS
National OfficeVRA Canada 4 Cataraqui Street Suite 310 Kingston, ON, K7K 1Z7
Tel: 613.507.5530 Toll-free: 1.888.876.9992 Fax: 888.441.8002
Email: [email protected] Web: www.vracanada.com
Garry Derenoski, RRP, CIP President
Welcome to Your Rehab Matters Magazine
Summer 2012 A Message from the National President
Attention Amateur Photographers! If you attended this year’s conference
and have photos to share send them to [email protected] OR share
them on our Facebook page!
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Alberta SocietyAlberta Society wishes to thank all those involved with the planning of VRA Canada’s National Conference “Moving Mountains 2012.” Their many volunteer hours, creativity, and outstanding contributions helped to make this event so successful. On behalf of the Alberta membership, we would like to extend a special thanks to:
Moving Mountains 2012 Planning Committee
Samantha Schellenberg (Chair) Tricia Moffat Giles Rieger Shami Sabharwal Shelley Langstaff Valerie Siska Thomas (Doug) Foulkes Betty Ann Blackwell Terena Delaney
Events Management Logistics Team
Pam Lyons, Cole Greenlees, Sue Burns
MCI Strategies Marketing Team
Naireen Lowe, Audra Leslie
Board of Directors – Alberta Society
Samantha Schellenberg (President) Tricia Moffat (Past-President) Giles Rieger (Treasurer) Valerie Siska (Secretary) Shami Sabharwal Shelley Langstaff Donna Siebert Ralph Schlosser Sheri Worthington Debbi Gallant Kendall Steinke
All Keynote Speakers and Education Session Presenters
Radisson Canmore Hotel & Conference Centre
Gayle Usher
All accommodation, catering and event staff
Society News Updates from across the country
Saskatchewan SocietyThe VRA SK Society will be seeing some changes over the coming months. Nikki Langdon passed the Society President torch to Rhonda Teichreb at the AGM on May 29. Nikki’s enthusiasm, dedication, and genuine care for our membership has left a positive mark on the society and VRA National. We anticipate her contribution and knowledge will continue to be invaluable assets to the society for years to come.
We have established a committee focused on engaging our membership through a virtual newsletter. The winter 2011 and spring 2012 newsletters were received enthusiastically by our membership, and we plan to continue with timely and relevant information. A big thanks is extended to Wanda Adair and Rhonda Teichred for stepping up to develop these newsletters. We invite society members to join us in future newsletters.
We want to take a moment to recognize the continuous behind-the-scenes commitment Kathy Potts provides for the SK Society. She quietly dedicates many hours in her role as secretary/treasurer, and goes above and beyond in working towards maintaining a viable society.
VRA SK is committed to serving our current membership by creating a positive culture of support and professional growth. In doing so, we provide value for our members and anticipate that we will grow in size and relevance in the province. We encourage each member to reflect on the contributions they can make to our society and membership.
We welcome members interested in increasing their involvement and/or with questions or concerns to contact any member of the board.
Manitoba SocietySeveral Manitoba Society members attended an annual rehabilitation conference in Winnipeg on April 16, 2012. The conference was attended by approximately 250 service providers from the profit and not-for-profit sectors of the rehabilitation industry.
The Manitoba Society had a VRA Canada display booth managed by Sue Allardyce, president, and Laurence Haien, director. Many of those in attendance stopped by the booth, received brochures, and were informed about the benefits of VRA Canada membership.
On March 1, 2012, Sue Allardyce and Laurence Haien participated in a teleconference with Garry Derenoski, president of VRA, to discuss strategies to promote the Vocational Rehabilitation Association of Canada within Manitoba and to increase our local membership. A plan is now in place to accomplish the above objectives.
Currently, the Manitoba Society is planning an educational session, which will occur in October, 2012. This one-day educational session will focus on dual diagnosis and the use of motivational interviewing to facilitate return-to-work.
To see news from your society in this section,
please submit your updates!
5 Summer 2012
e-Learning: Integrating professional development into busy lives By Dr Roberta Neault, CCC, RRP
Lifelong learning has become the new 21st century mantra. In
the complex roles that a vocational rehabilitation professional plays, the need to continue learning is inarguable. However, recognizing and accepting this need for learning doesn’t magically make it doable. The question becomes how to fit professional development into a life that’s already full.
Work-life balance, as elusive as it may be, is another 21st century mantra familiar to vocational rehabilitation professionals. We often see the results of unbalanced lives in clients recovering from physical, cognitive, and emotional exhaustion; statistics on the high cost of stress in the workplace attest to that. Vocational rehabilitation professionals as a group, then, might understandably resist the push to continue taking courses outside of work time when that work-related expectation or requirement is taking time from other important life roles.
To further complicate this, vocational rehabilitation professionals need to
acquire highly specialized knowledge in the form of courses or workshops that may not be offered in every Canadian community. Travelling for training simply isn’t an option for many people; more affordable and accessible alternatives are necessary to help professionals up-skill or earn continuing education units (CEUs).
Over a decade ago, Duxbury and Higgins (2001) wrote:
“We all play many roles: employee, boss, subordinate, spouse, parent, child, sibling, friend, and community member. Each of these roles imposes demands on us that require time, energy, and commitment to fulfill. Work-family or work-life conflict occurs when the cumulative demands of these many work and non-work life roles are incompatible in some respect so that participation in one role is made more difficult by participation in the other role.”
For many busy individuals work-life conflict occurs when family, work, and learning obligations all vie for the same hours in the day (e.g., an important work report requires some unexpected overtime, a child gets sick at a friend’s house and needs to come home, and a required course is scheduled the same evening and won’t be offered again for another six months). Flexible learning options can help to ameliorate the stress of work-life conflicts by facilitating learning at personally convenient times.
e-Learning Options
Fortunately, technology has made professional development more accessible. There are many self-directed/self-paced courses, websites, blogs, and
LinkedIn groups to browse through. Several relevant books are available in audio or e-book format. Pre-recorded podcasts and archived webinars also facilitate anytime, anywhere learning. Scheduled webinars are easy to access from anywhere with an Internet or telephone connection, but a convenient time in one part of the country (e.g., lunch hour in Ontario) may be far less convenient for others.
Some types of learning, however, benefit from discussion, interaction, and experiential activities. Even the best multi-media presentation doesn’t replicate that aspect of classroom-based courses. However, facilitated e-learning brings students and instructors from diverse locations together. Discussions can be very rich and informative and, when the course uses an asynchronous format, e-learning permits learners and instructors to fit a cohort-based interactive course into convenient moments of their days. Such courses can help to form ongoing Internet-based learning communities, in-house (e.g., employees from different branch offices), across organizations, or, in some cases, across professional disciplines.
Facilitated e-learning may be the most affordable option as well. Instructors with specialized expertise don’t have to travel to share their knowledge; instead they can teach from the convenience of their own homes or offices (or, in reality, from a cruise ship, all-inclusive resort, lakeside cabin, or local coffee shop—anywhere with Internet access). As there’s no need to rent classroom space, it’s possible to run scheduled classes with very small groups of
“In the complex roles that a vocational
rehabilitation professional
plays, the need to continue learning is
inarguable.”
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References for this article available at vracanada.com/media.php
students rather than cancelling classes when enrollment is low. Although there may be few students within each region, e-learning can bring together a group from across the country and far beyond. Neither learners nor instructors need to take time off from their day jobs; if time off is an option, however, it can be taken an hour or so at a time and vary according to daily needs rather than pre-scheduled in longer or more consistent blocks.
Some professional development is offered in a “mixed-mode” format that may include self-paced or facilitated e-learning pre-work or homework, combined with classroom-based training for part of the course. This can minimize travel and commute times while still providing some opportunity for in-person interactions prompting some to say, “the best of both worlds.”
e-Learning Benefits
Aside from the accessible, affordable, anytime, anywhere advantages already mentioned, e-learning offers additional learning benefits. From a “green” perspective, e-learning reduces the need for printed books and handouts and has a minimal carbon footprint because students and instructors aren’t commuting and there’s no need for classroom space, parking, utilities, or additional furniture or equipment (i.e., when teaching and learning happen in natural locations there is no need to duplicate resources). From an adult-learning perspective, e-learning accommodates a variety of learning styles, can be individually paced, and permits longer-term access to discussion posts and course resources (i.e., learners can go back and review discussions, save course resources to refer to them later, and, where permitted, share resources with colleagues and managers).
Tips for E-Learning Success
Lance Platt, a PhD student in an online program, was interviewed about his experience. He said:
“I would advise others that distance learning programs require a high level of self-discipline. Don’t think that just because the distance learning program takes place outside of a classroom setting that it is self paced. Distance learning programs are well
organized, structured, and demanding. Although I am not finished yet, I would encourage others to see the end from the beginning and [stick with it]. A higher education degree requires an ‘enduring to the end’ commitment.”
Lance’s experience is very similar to that of students I’ve worked with in masters of counselling programs at Athabasca and Yorkville universities, as well as in Life Strategies’ modularized LearnOnline courses, many of which have been pre-approved for CEUs by VRA. Many students do not allocate sufficient time for their e-learning commitments. Because of the inherent flexibility, they fill their days with other important tasks and then expect to fit advanced specialized learning into the corners of their lives. Although this may work on the odd occasion, it’s not a sustainable long-term approach. Rather, as Lance advised, be self-disciplined about scheduling time for learning; make the same amount of space as you would have to if you were enrolled in a classroom-based course. The only time you’ll save is the commute.
If you’ve never engaged in e-learning, start small; consider taking a short course to get comfortable with the learning management system (i.e., your e-learning “classroom”) and to become familiar with instructors’ expectations. Use the best computer and Internet access available to you. Although most e-learning programs don’t require the most recent hardware or software, technology innovations tend to increase speed and functionality. Reduce your frustration (and wasted time as you wait for screens to load) by working with appropriate and effective tools.
Be visible by making regular, meaningful contributions. Unlike in a face-to-face setting, your instructor and co-learners can’t see you looking interested at the back of the room. Unless you make a post, it seems like you’re skipping class. As e-learning discussions are in writing, learn to write clearly and concisely. Although a conversational tone is appreciated by most instructors, clarify expectations early in your course. Do proofread carefully and use spell-check before posting, your credibility will be enhanced if your posts are easy to
understand and not filled with errors.
Other Professional Development Options for Busy People
Not all learning is formal; don’t overlook the types of self-directed learning activities previously mentioned (e.g., reading, discussion forums, following relevant social media, in-house workshops). For work-based options, consider job-shadowing, arranging cross-training opportunities, finding a mentor, or hiring a coach. Conferences can provide amazing opportunities for networking and learning from subject-matter experts. Also consider learning by doing: research a topic of interest and then share your learning with your peers through a blog, lunch-and-learn session, or newsletter article.
Continuing education is essential for vocational rehabilitation professionals but, thanks to innovative technologies and advances in education, there are lots of ways to accomplish your learning goals. Explore new ways of learning to find ones that work for you.
Dr Roberta Neault, CCC, RRP, is an award-winning career management specialist, with expertise in psychometric assessment. President of Life Strategies Ltd., Dr. Neault also serves as editor of the Journal of Employment Counselling.
7 Summer 2012
Ahead of the Game: Brain injury awareness By Katherine Abraham, Hons. BA
The facts are easy to find: they’re on the Internet, in books, libraries and
pamphlets, but do we ever really take the time to read them? Understand them? Take a minute to comprehend the gravity of them? Nearly half a million people in Ontario alone live with acquired brain injuries (ABI) and this number doesn’t even begin to describe the amount of people affected by ABI such as family, friends, employers.
If that number isn’t startling enough, consider this: there are almost 18,000 emergency room visits every year in Ontario as a result of traumatic brain injuries (or TBI, meaning a brain injury caused by a blow to the head). If you’re still not convinced brain injury is that prevalent, the annual instances of TBI are greater than those of multiple sclerosis, spinal cord injury, HIV/AIDS, and breast cancer combined. The numbers are already high, and every year you can add another 50,000 Canadians who will suffer an ABI, including 44 Ontarians every day.
Unfortunately, sometimes brain injuries are not something you can avoid just by changing your behaviour. The scary reality is that anyone, anywhere, anytime can suffer a TBI. This is not to say that someone who engages in reckless behaviour, like BASE jumping without a helmet, is at the same risk-level as someone who only walks to and from the sofa every day, and slips on the way. Everyone’s best form of protection is to increase awareness of both the possibilities of injury as well as their consequences and how to deal with them.
Research shows that the use of safety equipment, such as helmets, does dramatically reduce the chances for injury to the brain in the instance of an accident. For example, in the cases of cycling collisions, wearing a helmet can reduce your risk of head injury by up to 85 percent. Jurisdictions with mandatory bike helmet laws have a 25 percent lower rate of injury than in areas without helmet legislation (BIST, 2011). Of course, prevention is the only cure, but what about when it’s too late for that?
Both acquired brain injuries and traumatic brain injuries can happen suddenly and without warning. In all cases, speedy access to medical treatment and rehabilitation are of utmost importance in ensuring the best, most successful recovery possible.
There are many organizations set up to further awareness of brain injury, including the group stopconcussions, whose goal is to advocate, educate, and build awareness of the issues surround brain injury, particularly in the world of sports. Former NHL player Keith Primeau is the co-founder of stopconcussions.com and has suffered four documented concussions during his career. Since retiring in 2006, Primeau has been on a mission to reduce the incidences of concussions in hockey and other sports. “A concussion is a brain injury and its effects can be devastating and life altering. It could be the death of sport as we know it if we don’t get a handle on this problem,” implores Primeau. Stopconcussions aims to implement their four step program “Education, Prevention, Management, Research” to further the fight against concussions in sports.
Other professionals and organizations available to aid in brain injury recovery include rehabilitation services, doctors, hospital programs, advocacy groups, and brain injury associations. All of these groups agree that seeking treatment quickly, and being dedicated to its success are the key factors in recovery. Dr Nora Cullen of West Park Healthcare Centre in Toronto says “Attitude is what plays the biggest role in patient recovery. If a patient can maintain a positive attitude, he will go farther than those people who can’t.” Along the same lines, Cullen notes the importance of the patient’s support unit to recovery. She has witnessed that patients whose friends, families, employers have not
There are 27,000 children •with ABI in Ontario schools
20% of people in psychiatric •settings appear to have a history of brain injury
In Ontario, 44 people •sustain a brain injury daily
Brain injury is the greatest •cause of disability under the age of 44
Brain injury kills more •children under 20 than all other causes combined
In Ontario, someone suffers •a brain injury every three minutes
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been able to lend emotional support suffer a loss in drive, resulting in the subsequent suffering of their recovery-progress as well.
Since brain injuries can occur in many ways, like motor vehicle accidents, slip and falls—including those from sports accidents—as well as cardiac arrest, near drowning, ruptured aneurisms, there are also varying forms and lengths of treatment. At West Park Healthcare, the average length of time for an individual to be in (initial) rehabilitation is about six to eight weeks, depending on the complexity of the injury. Dr Cullen also adds that establishing “a safe environment with adequate support and supervision” upon discharge is also a determinant for length of recovery. Dr Rolf Gainer from the Neurological Research Institute of Ontario (NRIO) says, “Each brain injury is different in terms of severity, type of injury, areas of the brain involved, the resulting disabilities, and how each person reacts to their brain injury.” Both professionals agree that while most progress stops after the two-year mark, small changes can occur for several years afterwards. Dr Gainer notes, “Early aggressive rehabilitation can influence positive change and adaptation following a brain injury.” Dr Cullen adds that during the initial two years of recovery, “the first six months have the quickest rate of recovery.”
Ruth Wilcock, executive director of the Ontario Brain Injury Association (OBIA), reports that they’ve recently had an increased rate of interest in their association. Wilcock suggests that “the increase may be due in part to concussions gaining a significant amount of media attention over the past several years.” OBIA provides education and support at no cost to persons living with brain injuries and/or their family members; they are contacted approximately 250 times per month by people looking for support. Most commonly, sufferers of brain injuries will experience personality changes, cognitive issues, behavioural issues, emotional and mental health issues, and fatigue. Often, says Wilcock, people contacting OBIA are looking for information around the life changes that they, or their family members, are going through.
The statistics show that ABI is the leading cause of death and disability among people under 45 years of age, and that 11,000 Canadians will die each year from a brain injury. There has been an increase in complex brain injuries as our demographic changes to an ageing population. “There are more people [in today’s society] susceptible to falling,” says Dr Cullen.
This increase in possible brain injury means treatment opportunities are more important than ever and hospitals and rehabilitation facilities are adapting to this changed need. West Park Healthcare is leaning towards more “functional treatments” that focus on a patient’s individual impairments rather than treating every patient as if they were all “in the same bucket.” This approach provides more specialised treatment programs for each patient and places an emphasis on inter-professional care. For example, a physiotherapist and an occupational therapist might work together on a patient’s case to create a blended treatment program using both forms of therapy to help bring a patient past a barrier. Dr Gainer reaffirms the idea that every person’s recovery and return to life activities are different, stating that: “we know that given adequate resources that someone with a brain injury can return to independence in the community.”
For Dr Cullen, preparing a patient for work re-entry is a multi-step process that includes “doing a full assessment in the area of employment, determining a re-entry level responsibly by identifying current abilities, and starting at a slow pace and ramping up gradually as the patient tolerates.” Their motto is ‘start low and go slow.’ Dr Cullen also recommends “starting at a manageable level so patients don’t become overwhelmed and lead to feeling defeated. Positive reinforcement can make a huge difference.”
“NRIO works closely with clients and clinical teams to establish vocational opportunities with a focus on quality of life and volunteering opportunities, says Colleen Boyce, executive director of the institute. Boyce describes a particular case of a now 22-year-old male who was hit by a car while cycling when he was 12. “In this case, executive functioning skills such as initiation and motivation can be debilitating factors in prohibiting the client from a successful return to work.” After completing a vocational assessment of the client to determine his education development, aptitudes, and interests, he was successfully placed in a 16-week volunteer position. While the position did not garner the client permanent paid employment, it was a milestone in identifying his strengths and developing his skills. The experience gave the client confidence in his employability as he continues to work towards his goals.
Anna Greenblatt, founding partner and co-owner of Inter-Action Rehabilitation Inc., understands that many patients are unable to return to their pre-injury work positions as they may no longer be able to manage the components and aspects of that position, and/or that the position cannot be modified to meet the patients’ needs. Greenblatt believes a patient’s “greatest challenge may be determining a new career path that is both suitable and of interest.” Greenblatt identifies some of the key issues individuals may face when returning to work as “issues with noise and light sensitivity, taking longer to accomplish tasks, communicating with coworkers, dealing with fatigue, and possible issues of accessibility.” It is these barriers and more, that make brain injury awareness even more important for employers.
While the effects of brain injury can last forever they don’t have to be devastating; the pursuit to raise awareness of brain injury and its effects is only the first step in changing the circumstances for people with brain injuries. With increased awareness and the innumerable associations and advocacy groups set up around communities, help has never been easier to find.
“A concussion is a brain injury and its effects can be
devastating.”
9 Summer 2012
Eliminating the Barriers: Accommodation at any cost By Shelley Fillmore, MEd, RPC, CHRP
One of the largest employers in Nova Scotia gets it: not only the
need to accommodate injured workers but the need to remove barriers to ensure workers can access employment after a workplace injury.
“Work is healthy, and research proves it.”
Work is about much more than a pay cheque. Work gives us an identity, a sense of self and self-worth. Work has meaning: it helps define us. We get personal satisfaction from a job well done. Beyond the personal impact, work is an essential element in our society. It is the glue that holds our community and our economy together.
When injury occurs, staying connected to the workplace and continuing to work is the most important factor in recovery.
The longer employees are off work, the less likely they are to return. So when an injury does occur, the best result for everyone is a safe and timely return to work (WCB website, 2011).
This case study shows the great lengths that the employer took to support the injured worker with transitioning back to work five years after an injury.
The injured worker sustained a lifting injury where he hurt his back in
2005. The worker went through all forms of rehabilitation, from being reviewed by orthopedic surgeons, pain physiatrists, and rehabilitation experts. The course of the treatment took five years whereby the worker opted for no surgery but had reached a functional plateau with treatment and had reached, internally, what is called the maximum level of recovery (MMR). The worker was sent for a functional capacity evaluation and it was determined that the worker’s function was that of sedentary (a desk job).
By April 2010, the employer, union, worker, family, and WCB were involved in a collaborative meeting to tease out what duties would be appropriate for the worker. As an outcome to the meeting it was decided the worker would be offered a sedentary job but due to many compensable and non-compensable issues raised by the worker, a job site analysis was requested to match the functional abilities of the worker to the tasks.
Ergonomic set up, task analysis, and functional abilities were paramount in the analysis of the employers offer and the worker’s abilities. Many barriers were identified, some of which were anticipated but many were not. Some of the barriers that were identified were limited access to the washroom, standing/sitting/walking tolerances, mental acuity, shift work to allow for medication, parking-walking distance, and ergonomic set up.
To address some of the barriers the employer was first open to assistive devices like:
A headset for the telephone and •redesigning and reconfiguring the work area to meet the needs of two people (both another worker and our returning injured worker).
To address the distance from the •parking space to the work area, the employer offered to paint and give a designated parking spot to the injured worker, which would be located less than 10 feet from the door.
The shift-work issue was removed. •This meant the worker would only work days and although shift-work was normal in the job duties, the returning injured worker would be absolved from any shifts other than the day.
The mental acuity issue that was •raised by the worker related to grogginess when the worker’s medication was needed. This was a fortunate piece because due to the shift work and the fact the position had two people working in the same area, a cot was located less than three feet from the work station. The cot was refurbished by providing a better mattress and adjusting the height to be reflective of a hospital bed to allow for ease of getting up and down. The use of the cot was extended to the worker whenever
“Work has meaning: it helps define us.”
Continued on page 27
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Member Profile: Lesley McIntyre By Katherine Abraham, Hons. BA
You may remember Lesley McIntyre from her introduction as the
president-elect in the 2011 winter issue of Rehab Matters — if not, now’s your time to get to know her. Let’s start from the beginning:
Having started her vocational career path as a permanent staffing consultant with Manpower International, Lesley left to pursue a role providing job search assistance to post-secondary students with disabilities. Within two years, McIntyre, ready to take on new challenges, found her way to Saskatchewan’s IRC Rehab where she remains today.
When asked if she could narrow down from her extensive career her most rewarding work experience, McIntyre simply replied that it would
be impossible. “I don’t have just one; I have hundreds!”
“The opportunity I have had to work with and assist any individual is in and of itself rewarding. We have been able to help our clients realize their skills and abilities; to assist them in re-entering the workforce.” It was this dedication to her profession that led McIntyre to pursue her next career milestone, presidency of VRA Canada.
Having already worked with VRA’s current president, Garry Derenoski, for years, McIntyre is more than ready to take on the role, “I saw the incredible things he was doing for the members and the association, and wanted to follow in his footsteps.” As a vocational rehabilitation consultant, McIntyre says that her “role [has] developed into management, which grew into market development, expanding existing services.
As VRA president, I see the skills and abilities I have gleaned over my tenure with IRC being applied in areas such as retention and expansion of our existing membership; ensuring
the vocational rehabilitation role is paramount in our Canadian community, with employers clearly understanding what we do, and who we are.”
On the road to VRA presidency, McIntyre describes her career history as a continual work in progress. Her drive, work ethic, initiative, and motivation remain strong and steadfast. She has been successful in communicating with all levels of private and public industry; believing her experience, competencies, methods of communication and passion will be the largest contributors to her presidency. When asked what she hopes to achieve during her time as president, McIntyre didn’t have to think twice: “It is relatively simple. Maintaining and expanding our membership and regulation of our profession.”
As far as goals for the future, McIntyre hopes that through continued promotion of the VR profession and national presence, other smaller groups across the country will recognize VRA Canada as the association of choice leading the industry, ultimately increasing the association’s recognition and membership across the country. In order to maintain a strong foundation, McIntyre subscribes to a work-philosophy of keeping it simple, which she hopes will promote “a healthy organization providing ongoing support to its members” for years to come.
“It [is her] dedication to her profession
that led McIntyre to pursue her next career milestone, presidency
of VRA Canada.”
11 Summer 2012
Bullying: An alternative approach By Rod Lightheart BA, RRP, RCSS, RVP, CVP
Bullying is not a new concept; it has been part of societies around
the world since the beginning of civilization. The bullies will not retreat to the hills anytime soon, but those being bullied need to educate themselves in self-defence skills to diminish the power afforded the bullies.
A recent court case where the unsolicited distribution of a personal video resulted in the suicide of one of the individuals involved, as well as many similar cases, has brought this concept to the new dimension. Technology has now invaded our personal lives and made bullying not just a face-to-face exchange. Technology, in the form of emails and social media, has taken this disturbing behaviour to new heights, unfortunately resulting in suicides and public humiliation. Bullying is no longer an event that occurs in the moment; it remains public domain and returns to hurt those being bullied to a new dimension. The single event now becomes a never-ending series of events.
Counsellors and therapists generally describe bullying as behaviour expressed by people with low self-esteem. Such behaviour is expressed in order to acquire control and presumed importance over others. By putting others down, they are, in effect, raising their perceived social “authority.” As in physical defense training, such as martial arts, we need to learn to understand, assess, defuse, and stop the cycle of bullying by those who are of lesser social intelligence and diminished self-esteem.
An article from Vancouver’s The Province newspaper gives an example of how the bully gains power over the bullied,
“My office bully started out acting like my best friend. Then, for reasons I can’t understand, he turned on me” (Michael Smith, 01/22/12). After describing an extended period of disability and a diminished emotional state, the worker ended with a plea to other victims, “Talk to your doctor, or someone, to get help. Don’t wait as long as I did. It was almost too late for me.”
Education of those being bullied needs to be developed into a martial art in itself. By teaching remedial and coping skills, we defuse the perceived power of the bullies. As in martial art, assessing specific reasons why the individual is being bullied (such as physical size and body nature or perceived behavioural tendency) must be identified and documented. There is not a value judgement process; it is a fact-finding mission only. We are human and come in many shapes and forms. We are who we are; we need to accept and respect who we are through realization and internalization of self-worth. The bullied are not the broken ones; we are simply the ones at the end of the stick of insult and injury. Once self-actualization is recognized, defined, and accepted within, we become empowered to develop coping skills to deflect the intended behaviors.
The Education Process:
Professional assistance in the form 1) of counselling plays a large part in assisting those in developing coping skills. The individual being bullied must first accept the fact that he/she is taking control back into his/her own hands. Simply by taking these steps the bullied persons are now taking control.
Learn what bullies have to do in 2) order to gain perceived respect and power over others.
When the bullies’ true natures 3) are comprehended, you are now capable of moving forward to the third and most pro-active step in your education process: learning to empower yourself.
By changing body gestures we can reduce the value or importance of the exchange taking place. Stand firm, stand tall, and don’t stand down. For those being bullied in the office environment, observe and document what is being done to bully you. Three words to remember: document, document, document. Are you being accused of making errors or having documents or letters being re-directed or altered to make you look less than qualified? Then change the way in which you deliver those communications. Take those exchanges back into your control and handle them personally to a positive end result. Question those who are devaluing your ideas and challenge them to come up with a better plan.
“Take those exchanges back into your
control and handle them personally to a positive end result.”
12
Rod Lightheart is a mental health
assessment/consultant, medical
case manager specialist, as well as a
human resources specialist with over
30 years of recognized expertise.
He is also a recognized vocational
case manager/assessor.
References for this article available at vracanada.com/media.php
This is called deflecting; send back what you have received and eventually the communications will alter, differ in tone and intent, or increase, but done in a respectful manner. If such negative communications continue or increase, take the issues to research and discuss this berating with the appropriate person or authority.
Educate yourself in existing laws, company policies and procedures, and counselling programs that teach you to read and re-define your responses around such behaviors. This is where you must take control of the situation and use whatever resources and means available to you to shut down, diminish, or escalate this condition to a procedural resolve.
Be the one in control of your self-respect and esteem. These are resources in the public domain that will provide you with the necessary tools to educate yourself. Understand that you need to take control over such demeaning behaviours. You have as much value as those having to use such tactics in order to “look better than you,” or make you “look less” than who you truly are. And if you don’t get the answers you need, keep searching and you will find the tools you need to define a solution. We cannot teach others not to bully; they will have to educate and understand themselves as to why they behave as they do. Educate yourself and begin to reward yourself as to who you really are to yourself and to others. You are the valued one—believe it!
For further information please contact:Mindworks Group, 312 Rubidge Street, Peterborough, Ontario K9J 3P4
Phone: 705-741-3412 • Toll Free: 1-800-559-8323 www.mindworksgroup.ca
Helping individuals living with the effects of brain injury achieve a better quality of life
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13 Summer 2012
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14
Thanks To Our Conference Sponsors...
canmore, alberta june 12 to 15, 2012
BridgePoint Financial is pleased to announce our platinum sponsorship
of the VRA Conference & AGM
Since 2005, BridgePoint Financial has been assisting treatment and rehabilitation providers with the funding challenges that can jeopardize their clients’ access to treatment.
We are honoured to be involved with this event and we hope you enjoy the conference.
bridgepointfinancial.ca 1 888 800 4966
15 Summer 2012
Thanks To Our Conference Sponsors...
THERE’S MORE TO US...
www.cbi.ca
You know us as Canada’s premier health care service provider
now come discover our vocational services!
CARF Accreditation awarded to CBI Health Group - AB for: Employment & Community
Services, Comprehensive Vocational Evaluation Services, Job & Job Development Services
We invite you to connect with our vocational teams at the Canmore VRA conference.
June 12 - 15, 2012
Vocational Consulting, Case Management and Occupational Therapy Services
Serving Insurers, Employers, Law Firms and Individuals
Disability Management, Sick Leave, Workers Compensation, Wellness Programs, Vocational Evaluations, Return to Work, Worksite and Home Assessments, and a variety HR Services
for any injury, absence or illness.
IRC is the proud receipient of the 2012 SABEX Business Of the Year Award!
To Find a Location Near YouT: 888.997.2298www.lifemark.ca
Division of Centric Health
• Vocational Services • Return To Work Programs • Brain Injury Services • Medical Care• Occupational Health Services• Physiotherapy Services• Counselling and Psychological Services • Disability Management
Helping You Reach Your PotentialDivisions of LifeMark
16
BEFORE:OUT OF WORK AFTER 20 YEARS SERVICE
NOW:ASSISTANT TO THE MUSIC COUNSELOR
Discover a Richer, More Rewarding Future
Find out how triOS can help you help your clients
1-866-898-1147www.trios.com
CONFIDENT TO TAKEON ANY CHALLENGE
For 20 years, Carolyn Myers worked at an automotive company. She was comfortable and satisfied with her career choice and embraced each day at work. She absolutely loved her job and felt like it was a second home. Then, one of the most dramatic things in her life happened, the plant closed. She had devoted her life to this plant for several years, and now everything was going to change. Unfortunately for Carolyn, she suffered a workplace injury which restricted her from finding another job at a factory.
Carolyn thought long and hard about her situation. She had very little education and therefore decided she would go back to school. She successfully her GED but still found the job market to be weak. She was already making huge changes in her life and decided to take another big leap, she enrolled into College.
“I decided to attend triOS College. After meeting with the amazing staff and instructors. Throughout my entire program, they were very helpful, supportive and made me want to be at school every day. One of the best parts about going back to school, were the people I met there. Within a few days, I met many people that were in the same situation as me. They quickly became friends, and soon they felt like my new family.”
Within three months of graduating, she was offered a job in her chosen field. She now works at a music conservatory as the Assistant to the Music Counselor. “The best part is that I can see myself be able to grow within this company.”
“triOS College has given me the confidence to take on any challenge that may come my way and the knowledge to succeed. I am now a College graduate. I am so proud of my accomplishments!”
triOS is experienced in accommodating the needs of its students and providing progress status reporting to case managers.
Providing career re-training for 20 years in Business, Law, Technology and Healthcare, triOS programs give injured, disabled and mature students the
environment to succeed in their studies and graduate into new careers.Many programs include internships to give our students real–world
experience and a foot in the door to employment.
CONTACT US TODAY!
WINDSOR | LONDON | KITCHENER | HAMILTON | BRAMPTON | MISSISSAUGA | TORONTO | SCARBOROUGH | OSHAWA
17 Summer 2012
Spotlight on Professionals: Dr Raymond Rupert By Katherine Abraham, Hons. BA
You’ve just been rocked by a shocking diagnosis and have
received recommendations for invasive surgery as soon as possible. You trust your doctors but just can’t shake the feeling that this just can’t be right: there has to be another option. For Dr Raymond Rupert and the team at Rupert Case Management (RCM), that’s exactly what they’re here to provide.
Since founding RCM in the early 1990s, Dr Rupert has provided corporations and individuals in need with “real time medical intervention,” second opinions, care co-ordination, advocacy, and making incomparable differences in many people’s lives along the way. RCM utilizes a network of over 2000 experts in over 100 specialties to provide face-to-face or virtual healthcare services. Over the past 20 years, RCM has been responsible for
the complex case management of approximately 200,000 lives.
So, what makes RCM different from other similar services, like Best Doctors? Dr Rupert says, “Our team jumps in when someone has a complex problem.” RCM’s prerogative is to go deeper; they cooperate and collaborate with treating doctors, supply expert panels of three to four doctors, and, perhaps most importantly, provide opinions in a Canadian context. As an advocate for the clients, RCM will seek out the best treatment, even if that means sourcing and securing procedures not available in Canada.
As a practicing physician since 1975, Dr Rupert has always had a passion for patient care. He believes that the best way to a better health care system is to help make the patients themselves more aware of their own situations, as well as being aware of all the options available to them. “The Colorectal Cancer Association of Canada has an excellent education program; they are training patients to be their own advocates. That’s the way it should be done,” he states. Dr Rupert, along with his team at RCM, is a firm believer that patients who understand their own situations are in a better position for recovery.
Even though the RCM services may seem large-scale, with its 2000 professionals and corporate infrastructure, Dr Rupert would stress that it is a very personal service. “We are not an elitist service. We work with companies who choose
to invest in healthcare to benefit their employees.” One of the services offered at RCM is called “guided care.” This service, designed for clients with one or more chronic illnesses, acts as support to navigate the client through the healthcare system. “We make sure patients are receiving access to the necessary services. We help them to stay active and at work as much as possible.”
With this “guided care” approach, Dr Rupert is able to significantly reduce absenteeism in his clients, meaning one of his goals is to keep the patient as active in his/her regular life as possible, including maintaining the ability to work. “We use a proactive approach to patient care because we understand their inventory of illness and problems.” Using a technique called prospective memory, RCM is able to “remember what to remember” for each client. A secure cloud-based system allows Dr Rupert and his team to proactively manage patient care by keeping extremely relevant, easily accessible patient files. This approach can make all the difference in a patient’s life.
Dr Rupert believes that RCM and its services are a complement to vocational rehabilitation, saying “We are very collaborative and enjoy working with a diverse group of professionals. Our integrated suite of benefits is really focused on return-to-work and partnership with the vocational rehabilitation community.”
BEFORE:OUT OF WORK AFTER 20 YEARS SERVICE
NOW:ASSISTANT TO THE MUSIC COUNSELOR
Discover a Richer, More Rewarding Future
Find out how triOS can help you help your clients
1-866-898-1147www.trios.com
CONFIDENT TO TAKEON ANY CHALLENGE
For 20 years, Carolyn Myers worked at an automotive company. She was comfortable and satisfied with her career choice and embraced each day at work. She absolutely loved her job and felt like it was a second home. Then, one of the most dramatic things in her life happened, the plant closed. She had devoted her life to this plant for several years, and now everything was going to change. Unfortunately for Carolyn, she suffered a workplace injury which restricted her from finding another job at a factory.
Carolyn thought long and hard about her situation. She had very little education and therefore decided she would go back to school. She successfully her GED but still found the job market to be weak. She was already making huge changes in her life and decided to take another big leap, she enrolled into College.
“I decided to attend triOS College. After meeting with the amazing staff and instructors. Throughout my entire program, they were very helpful, supportive and made me want to be at school every day. One of the best parts about going back to school, were the people I met there. Within a few days, I met many people that were in the same situation as me. They quickly became friends, and soon they felt like my new family.”
Within three months of graduating, she was offered a job in her chosen field. She now works at a music conservatory as the Assistant to the Music Counselor. “The best part is that I can see myself be able to grow within this company.”
“triOS College has given me the confidence to take on any challenge that may come my way and the knowledge to succeed. I am now a College graduate. I am so proud of my accomplishments!”
triOS is experienced in accommodating the needs of its students and providing progress status reporting to case managers.
Providing career re-training for 20 years in Business, Law, Technology and Healthcare, triOS programs give injured, disabled and mature students the
environment to succeed in their studies and graduate into new careers.Many programs include internships to give our students real–world
experience and a foot in the door to employment.
CONTACT US TODAY!
WINDSOR | LONDON | KITCHENER | HAMILTON | BRAMPTON | MISSISSAUGA | TORONTO | SCARBOROUGH | OSHAWA
18
Fitting Employment: Making work that ‘fits’ into work that ‘sticks’ By Taline Sethian, MA, RRP, MCVP
Dear fellow colleagues and readers, here is our most recent contribution to CAVEWAS Corner.
As many of you know, CAVEWAS (Canadian Assessment, Vocational Evaluation and Work Adjustment Society) is a member society of VRA Canada, serving in large part to represent and support the professional and developmental needs of vocational evaluators as well as professional rehab personnel specializing in work adjustment of injured workers and the like. In this section, you will find current and candid articles authored by CAVEWAS members, non-members (and future members alike) that will share, discuss, and communicate with you developments and changes affecting our membership. Amongst them issues of best practice, professional development and designation, as well as industry trends.
We hope you continue to find the content in this section stimulating, motivating, and informative and we encourage your ongoing participation and contributions.
Enjoy! CAVEWAS NATIONAL BOARD of DIRECTORSIf you are a CAVEWAS member and have any ideas, opinions or thoughts relevant to this section and you would like to share, discuss, and communicate them in the next issue, please contact: Jeff Cohen at [email protected] We also encourage you to join our group on LinkedIn.
CAVEWAS Corner
What is more important: finding work that is a quick fit or work
that sticks? Speed versus sustainability is the delicate balance vocational testing tries to strike by getting clients back to work quickly and cost-effectively, and with a view to long-term employment. The goal is always to identify work options that are timely, safe, and sustainable.Of the two objectives, finding work that fits quickly is much more straightforward than finding work that sticks. By definition, vocational assessments are designed to evaluate individuals’ work-related skills, academic levels, and transferrable skills to find job options that match their profile. But what does this tell us about whether the job options can be maintained by the client over time?
Although just as important as finding a suitable job option, determining the ‘stickiness’ of a particular job over time is much more challenging; especially when taking into account all the factors that impact longer-term employment retention.
Internal Versus External factors
The factors that influence the sustainability of a job can be categorized as individual characteristics and external indicators. External indicators concern mostly future labour market conditions that are beyond the control of the assessor or individual. Individual characteristics involve a client’s motivation, personality profile, transferrable skills, functional/physical tolerances, and competencies. While a vocational assessment cannot influence the individual factors that can impact a person’s long-term employment success, an effective evaluation can identify predictors that can influence employment longevity.
When you identify the personal characteristics of a client it becomes easier to find job options for which they will be better suited. In other words, a vocational assessment can be a strategic tool in identifying a strong personality-job fit that in turn creates a higher potential for a client’s long-
“An effective [vocational]
evaluation can identify predictors that can influence
employment longevity.”
“It is not more vacation that we need; it is more
vocation.” - Eleanor Roosevelt
19 Summer 2012
Murphy Battista LLP
ALEX SAYN-WITTENGENSTEIN
References for this article available at vracanada.com/media.php
Fitting Employment: Making work that ‘fits’ into work that ‘sticks’
term happiness and success at a job. If a person loves what they do, they are most likely to thrive in both the long- and short-term. The formula is simple: better job fit means more job satisfaction that leads to less turnover and greater retention.
One Test Does Not Fit All
Overall, the most successful outcomes occur when a client is “on board” with the plan of action. Vocational rehabilitation is not a one-test-fits-all process. The most effective vocational evaluations will look at the clients from a holistic perspective and identify jobs that closely parallel their profile, both right now and in terms of long-term goals. Even though they require different strategies, speed and sustainability of job options are both important to a successful and cost-effective vocational rehabilitation. The good news is that, with innovative and effective evaluation tactics, vocational assessments can identify occupations that are quick and will stick.
Taline Sethian has been conducting various types of assessments since 2004. She has extensive experience providing rehabilitation supports and identifying suitable occupational options for clients with varying disabilities. Currently, she provides vocational assessments, as well as psycho-vocational assessments (in tandem with a psychologist) for AGS Rehab Solutions Inc.
20
The Hype with Skype: The ethics of providing online therapy
Recent advances in technology have led the way for a myriad of face-to-
face services to be transplanted to the Internet. Rehabilitation professionals have begun to evaluate and harness the utility of email, instant messaging, and video conferencing to serve their clients (Zack, 2008). Using the Internet to conduct counselling, psychotherapy, and even rehabilitation is a cutting-edge method of service delivery. Providing services without the hassle and cost of travel, traffic, and parking is beneficial to both the client and professional alike. The convenience of being able to access rehabilitation services from the comfort of one’s own home broadens the catchment area to virtually eliminate the constraints of geography and busy lifestyle.
Can it be that simple—to forgo the traditional face-to-face therapy visit and make use of rehabilitation services online? The scope of the rehabilitation field is as broad as it is deep and requires the integration of a variety of schools,
By Arden McGregor, MA, CBIST & Dennis Radman, Hons. BSc, RRP, CBIST
theories, and disciplines. As rehabilitation tools become more sophisticated to meet the demands of the 21st century, so does the process of therapeutic delivery. The advantages are numerous as many of us are ‘plugged-in’ in so many ways. The regulatory bodies and professional associations to which rehab professionals traditionally turn for guidance on such matters may not have ‘technology-specific’ guidelines, as their development requires keeping pace with current technology innovation, which has always been a struggle (Nicholson, 2011). The utility and breadth these new technologies offer is awesome but rehabilitation professionals must heed the gravity of potential legal and ethical concerns.
Professionals conducting therapy and rehabilitation online are bound by the same professional ethics as apply to face-to-face treatment, including maintaining confidentiality, being available in case of emergency, intervening when a client is a danger to themselves or others, reporting the abuse of a minor, and following relevant regulations related to licensure (Finn & Banach, 2002; Zack, 2008).
Ethical issues related to providing online therapy and rehabilitation include:
Uncertain privacy and •confidentiality of online communications
Provision of emergency assistance•
Ability to fulfill mandatory •reporting requirements
Reliance on a fragile technology•
Billing, fees, and jurisdiction •(Finn & Barak, 2010)
Both the Vocational Rehabilitation Association of Canada (VRA) and Canadian Psychological Association (CPA) have codes of ethics with nearly identical guiding principles (see Fig.1)
Ontario’s Personal Health Information Protection Act (PHIPA) of 2004 stipulates that the health care professional “take steps that are reasonable in the circumstances to ensure that personal health information (PHI)…is protected against theft, loss, and unauthorized use or disclosure” (PHIPA, 2012).
The CPA specifically addresses the issues concerning therapy conducted via electronic media with these guidelines:
“Psychologists educate themselves •regarding current practices and security devices for electronic communications, and use those systems and practices that are reasonably available, and that best protect their clients’ privacy.”
“Psychologists keep up-to-date •with the e-service literature, including research literature regarding the efficacy and effectiveness of services using electronic media, and take this literature into consideration when deciding what services to provide to which clients, with what methods, and under
“Providing services without the hassle and cost of travel,
traffic, and parking is beneficial to
both the client and professional alike.”
21 Summer 2012
CPA VRAI: Respect for Dignity of Persons
(a) Respect for the dignity, rights and autonomy of persons
II: Responsible Caring (b) Responsible caring for the best interests of personIII: Integrity in Relationships (c) Integrity in professional relationshipsIV: Responsibility to Society (d) Responsibility to society
which circumstances” (Canadian Psychological Association, 2012).
However, the CPA does not provide any guidelines that are specific to any particular type of technology. This makes sense, as it’s an exercise in futility to try to construct applicable guidelines to a moving target such as today’s technologies. With each new advancement and innovation in technology, ethical and legal issues do arise from their use. The four principles of both VRA and CPA can and do serve as a framework to guide the rehabilitation professional towards protection of PHI and compliance with PHIPA.
To Skype or Not To Skype?
Some technologies, such as Skype, have made it easy—possibly too easy—to conduct therapy online. Let’s look at the Health Insurance Portability and Accountability Act (HIPAA), the US’ equivalent to PHIPA. HIPAA doesn’t certify software as being HIPAA-compliant or not. Instead, various companies claim that their software is HIPAA-compliant. Furthermore, HIPAA requires professionals (business associates) to sign an agreement with third parties, such as software vendors (covered entities), if they are handling confidential information. How does this all apply to Skype? Skype does not state on its website that it is HIPAA-compliant. Skype does not offer business associate contracts to therapists or clinics, which use it for online therapy purposes. Skype, by their own admission, fails to guarantee the privacy of its users by remaining
mute on the matter. In fact, Skype explicitly declines to meet with HIPAA’s standards. A representative from Skype shared the following: “Skype is not a business associate subject to HIPAA nor have we entered into any contractual arrangements with covered entities to create HIPAA-compliant privacy and security obligations” (Zur, 2012). As Skype continues to abstain from transparent practices that promote the privacy and protection of those that use its products, how can we be sure that using Skype is safe and meets the requirements of PHIPA? Well, we can’t.
The terms “eCounselling” and “eHealth” have become commonplace and describe vast categories of online treatment. Likewise, Brainworks has followed suit and coined the term “eRehabilitation:” a comprehensive treatment platform that uses interactive audio, video, or data communications to provide rehabilitation services at a distance. Our eRehabilitation services are online at www.eRehabilitation.ca.
eRehabilitation includes:
Rehabilitation counselling, •consultation, and therapy delivered via a secure web interface
Video on demand, video •conferencing
Interactive web based health •metrics
Email, text messaging•
Interactive web-based learning •modules
At Brainworks we ensured that privacy, the protection of PHI, and compliance
with PHIPA were incorporated into the design of the eRehabiltiation platform.
Dr Ann Cavoukian, Ontario’s Information and Privacy Commissioner, is the founder of Privacy by Design (PbD), a framework and approach of embedding privacy into the design specifications of various technologies. Dr. Cavoukian’s recent paper (Cavoukian & Alverez, 2012) recommends that the rehabilitation professional be proactive, not reactive; that privacy be the default setting, and that privacy be embedded into design.
Privacy is not an option; rather, it is incumbent for the rehabilitation professional conducting online therapy to integrate the principles of PbD into everyday practice. The onus is on the rehabilitation professional to implement good communication practises that include ensuring online interactions meet clinical standards, are culturally sensitive, and are met with meticulous confidentiality procedures (Prabhakar, 2012). eRehabilitation and online therapy can be practised in
“The scope of the rehabilitation field is as broad as it is deep and requires
the integration of a variety of schools,
theories, and disciplines.”
Fig.1
(Canadian Psychological Association, 2000; Vocational Rehabilitation Association of Canada, 2009.)
22
Arden McGregor, MA, CPsychAssoc, CBIST, is the founder and executive director of Brainworks, a rehab firm serving Ontario. As a member of the College of Psychologists of Ontario, and a certified brain injury specialist and trainer (CBIST) with 20 years experience, Arden’s expertise in rehabilitation is both respected and sought after. Brainworks eRehabilitation practice is described online at www.eRehabilitation.ca.
Dennis Radman, Hons. BSc, RRP, CBIST, is a certified brain injury specialist and trainer (CBIST) with 15 years experience in cognitive, behavioural, and psychosocial rehabilitation. As manager of rehabilitation therapy at Brainworks, he oversees its entire rehabilitation therapy program throughout Southwestern Ontario and the Muskoka region. Brainworks eRehabilitation practice is described online at www.eRehabilitation.ca.
References for this article available at vracanada.com/media.php
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an environment where the client feels safe, facilitating full participation as “technology will continue to evolve, but the ethical principles remain constant” (Koocher & Keith-Spiegel, 2008).
Other Relevant Guidelines & Resources can be found at: Canadian Psychological Association website, www.cpa.ca
Lindsay MonizLaura MoroJocelyn MorrisJillian OgleDe Andra PalmerMarni PerlisMichael ReidDonna RubertoKrista RussoJulie ScrivenerLynn SénéchalKaren ShairRadhika SundarMandy TelegaSitthideth ThongrivongJoanna TryonNatasha VeraAlvin VuuSheri WestmanJill WilliamsonLori Wood New RRP RecicpientsRob AgostinoJulie FarnandSandra JacobsenTracy LeighCheryl McKayAmber PhillipsKaren PooleSamantha SchellenbergJulie ScrivenerGeorgina StehleGerry TullioThomas UngerJill Williamson
New RVP RecipientsPatricia ChestnuttLori Wood
New RCSS RecipientsPatricia Chestnutt
23 Summer 2012
Recently, Dr Izabela Schultz, of the University of British Columbia,
set aside the time to answer a few pressing questions about the state of vocational rehabilitation education in Canada at the post-secondary level. In the following interview, Dr Schultz addresses why we have so few options for education in Canada, how our model differs from those in the US, where she thinks Canadian VR education is headed in the next 10 years, and more!
Rehab Matters: Can you summarize the Canadian Vocational Rehabilitation Counselling model?
Dr Izabela Schultz: The Canadian Vocational Rehabilitation Counselling Model [of UBC] focuses not only on the needs of the individual with disability or other social disadvantage who intends to return or transition to employment, but also on the larger socio-economic and employment environment, which facilitates or hinders one’s transition to the world of work. On one hand, we help bridge the gap between people with a complex array of employment needs and barriers and the workplace, health care system, disability compensation, and rehabilitation systems on the other.
We have shifted away from office-based, across the desk, “I will tell you what’s best for you” counselling model in rehabilitation, to the continuum of evidence-informed active psychosocial interventions utilizing both the person
Educating Canada: Vocational rehabilitation at post-secondary levels Interview by Katherine Abraham
and the multiple systems involved.
Moreover, our rehabilitation counselling model is biopsychosocial. We assess and intervene with medical and psychosocial dimensions of disability in an integrated fashion. We recognize both strengths and weaknesses of the individual in the occupational context and avoid focusing solely on impairment and pathology. We incorporate social and work accommodations within the system and, at the same time, help clients enhance their skills and adaptation approaches while preparing for transition (and while transitioning) to the workplace or other form of productive activity.
RM: How different is our model from the US model? What do you think are the reasons for these differences?
IS: The US model has traditionally focused on counselling the individual rather than helping to address systemic issues. This approach stems from the
biomedical model, which assumes that the removal of impairment (physical, mental, or both) is at core of rehabilitation counselling. The Canadian model evolved from the social model of disability and rehabilitation, which has taken a stronger root in our country.
RM: Why do you think we only have one Master’s program for VRC in Canada?
IS: Post-secondary institutions, especially research-intensive universities, which deliver graduate programs in our country, provide excellent programming in traditional scholarly areas of inquiry. Vocational rehabilitation counselling is a relatively new discipline and profession and its academic underpinnings in Canada are still under development. Although we have emerging areas of strengths in disability management, community rehabilitation, and disability studies, it has been very difficult to develop a graduate program integrating the discipline of VRC from both a conceptual (knowledge) and clinical skills training perspective. Both dimensions are necessary to have a successful program.
The University of British Columbia has a unique position among Canadian research-intensive universities. It has expertise in both medical and psychosocial aspects of rehabilitation as well as an excellent and proven model of clinical skills training in counselling, advanced in the Counselling Program of the Department of Educational and
“We are likely going to see provincial
legislative initiatives related to certification
and registration of professionals in the field of vocational rehabilitation.”
24
Counselling Psychology, and Special Education, Faculty of Education.
We hope that other Canadian universities will also initiate programs in rehabilitation counselling with strong clinical skills training components.
RM: Why is it important to create specified educational opportunities for this profession?
IS: Vocational Rehabilitation is emerging in Canada, albeit with delay, as its own unique profession, which requires considerable skills and knowledge. We are likely going to see provincial legislative initiatives related to certification and registration of professionals in the field of vocational rehabilitation, as it has already happened with other health professionals. To facilitate this process and enhance rehabilitation and vocational outcomes, universities should provide a continuum of educational opportunities for future licensed professionals, ranging from undergraduate to graduate programs with various special foci.
Frankly, it is time to move away from the old scenarios where anyone, regardless of their background or education, could call themselves “vocational rehabilitation counsellors” and work with those most vulnerable people in the population without proper knowledge and skills. We owe it to our clients and public in general.
RM: What are the educational needs of VR professionals at the graduate level?
IS: At the graduate level, we integrate training in conceptual approaches to disability, rehabilitation and counselling, and clinical skills to prepare our students to effectively work with complex clients and complex clinical and vocational scenarios using evidence-based approaches. We teach psychosocial and vocational assessment as a basis for individual planning and interventions.
Based on the surveys of professionals in the field, we realize that this is the area of weakness in training for current professionals. In concert with assessment, we teach both individual
and group counselling skills, as applied to psychosocial adjustment and vocational issues. We provide important foundational knowledge, based on most recent advances in psychosocial and medical aspects of disability and rehabilitation and return to work interventions, including job search and case and disability management.
RM: How does UBC incorporate supervised clinical training into the program?
IS: We have two components of our supervised training. In the second year of the program, we offer a full day a week of step-by-step training in counselling skills (two terms) at UBC Community Counselling Clinic in New Westminster. Students from out-of-town link with the BC students in training via videoconferencing but they train under a two-tier supervision system (local and UBC-based) close to their home. In the third year of the program (this is a part time program), the students select a practicum site of their interest. Throughout this practicum, students work under a two-tier supervision system, earning 500 supervised clinical hours. The practicum coursework allows the students the opportunity to apply the skills learned in the clinic.
RM: In your opinion, what sets UBC’s program apart from similar programs in the US?
IS: There are several components of our program that make us different. First of all, our focus on the interaction between the individual and system using biopsychosocial intervention approach is quite unique. Secondly,
we have a special expertise in complex, often nonvisible disabilities, including mental health disorders, chronic pain, neurological and brain-injury disabilities, in addition to traditionally addressed physical and sensory disabilities. We also maintain strong developmental and social perspectives on disability and rehabilitation.
RM: What are the differences between the VRC program and Disability Management?
IS: Vocational rehabilitation counselling encompasses a broad spectrum of individual, group-based, and system-oriented interventions for those who are and are not job attached. Disability management constitutes one of such important interventions, focusing on job-attached individuals and intervening with their workplaces to facilitate their return-to-work, often following illness or injury. Disability management programs do not offer a counselling skills training component. At UBC, we have developed our own disability management course that complements the broad range of skills our graduates have.
RM: From what type of backgrounds do applicants of the program usually come?
IS: Our applicants represent a very broad range of backgrounds, including psychology, community rehabilitation, social work, occupational therapy, kinesiology, employment and school counselling, recreation therapy, human resources, labour studies, disability studies, education, and other related disciplines.
RM: What are the program specialties?
IS: Our specialty includes complex disabilities, especially those with multiple barriers to employment and those disabilities, which are non-visible.
RM: What kinds of opportunities are there for graduates of the VRC program?
IS: Our graduates find employment with government vocational rehabilitation services, workers’ compensation systems, disability insurance companies, multidisciplinary rehabilitation centres and programs
“The number of university scholars
engaged in research and teaching in fields relevant to vocational rehabilitation is still
relatively small.”
25 Summer 2012
(public and private), chronic pain and cancer programs, disability management and return-to-work agencies, mental health and addiction agencies, post-secondary institutions (services for students with disabilities), and in private practice.
RM: What benefits do graduates of this program offer future employers? Future clients?
IS: Our graduates have versatile skills and knowledge; they are well-grounded in current research evidence on what works for whom, where, and when. They provide important “know-how” expertise and professional leadership in the field, which is otherwise not attainable to employers wanting effective employment interventions for their clients and constituents.
We anticipate that future clients will incorporate not only persons with disabilities but also those with other social disadvantages, for example, economically disadvantaged, immigrants, members of various minority groups and individuals with multiple barriers to employment.
RM: How can graduates change the field and future of VR education in Canada?
IS: Our graduates are future leaders not only in the profession of vocational rehabilitation but also in the burgeoning field of employment of persons with disabilities or other social disadvantages. They come with
a scientist-professional mindset, open mind, ability to critically analyze the literature for the evidence of best intervention approaches, and with ability to design rehabilitation and return to work approaches that work in the Canadian context.
They can also continue advancing their research skills and contribute to building a culture of research, evidence, program evaluation, and best practices wherever they might be employed.
RM: What do you think is holding back other Canadian universities from creating similar graduate programs?
IS: The number of university scholars engaged in research and teaching in fields relevant to vocational rehabilitation is still relatively small. Additionally, it is very difficult, especially in absence of major funding, to build a strong interdisciplinary program, which needs to combine extensive knowledge transfer with supervis≠ed one to one intensive clinical training at the professional level. Our program is a blended, mainly online “hybrid” program, with a face-to-face component. Significant technology expertise and resources are necessary for the online course delivery and considerable and costly expertise and resources are needed for the infrastructure of the clinical training.
RM: Where do you hope to see the VR education field in 10 years?
Dr Izabela Schultz is a professor of rehabilitation psychology and Director of Canada’s first master’s program in vocational rehabilitation counselling at the UBC; a blended face-to-face and online program. She has conducted research and published internationally on psychosocial, vocational, and medico-legal aspects of non-visible disabilities, including mental health disorders, pain, and brain injury.
IS: I hope to see a continuum of programs in vocational rehabilitation, starting with diploma and certificate courses at the college level, through more bachelor level courses and degrees in rehabilitation and disability studies, to a range of masters’ and perhaps specialty PhD level programs in VR. I also hope for more coordination efforts among developers and deliverers of these programs in the context of an ongoing Canadian VR educators network, working in collaboration with VR credentialing and licensing bodies. Improved access to high-quality continuing education activities for those already practicing the profession is also an important and related goal.
Rehab Matters will be writing a very special feature article detailing the struggles, triumphs, and more of women who have returned to work after breast cancer diagnoses, treatments, and recoveries. Tell us your story, tell us your friends’ stories, tell us stories about clients whom you’ve helped return to work after (or during) cancer.Contact [email protected] today if you’re interested in participating in this amazing project!
2026
1. Professionals conducting therapy and rehabilitation online are bound by the same professional ethics as apply to face-to-face treatment. A) True B) False
2. Why has e-learning become such a desirable tool in continuing education? A) Flexible schedule B) Teachers are able to reach a wider audience without enduring cost of travel C) “Green” alternative (reduction in printed books, handouts, etc.) D) All of the above
3. How many emergency room visits do traumatic brain injuries account for each year? A) 9,000 B) 15,000 C) 18,000 D) 21,000
4. What university has the only vocational rehabilitation counselling master’s program in Canada? A) University of Alberta B) York University C) Dalhousie University D) University of British Columbia
5. “Stand firm, stand tall, and don’t stand down” is the motto for what? A) Anti-discrimination B) Anti-homophobia C) Pro-rehabilitation D) Anti-bullying
6. According to the Human Rights Model for Barriers and Accommodations, what is not one of the four categories for accommodation? A) Aids and personal services B) Mobilicity C) Modifications to structures D) Employment
7. In brief, what are vocational assessments designed to do? A) Evaluate work-related skills B) Evaluate academic levels C) Evaluate transferable job skills D) All of the above
8. What has been proven to “decrease blood pressure, heart rate, and muscle tension?” A) Spending time outside B) Vegetarian diet C) More frequent breaks during the workday D) All of the above
9. What makes Rupert Case Management different from Best Doctors? A) Canadian perspective B) Database of thousands of specialists C) Provide second opinions D) Dedicated patient advocacy
10. When an injury occurs, what is the most important vocational factor of recovery? A) Relief of all work duties B) Choosing your position’s replacement C) Staying connected and continuing to work D) Maintaining contact with employers
11. Distance learning programs take place outside of a classroom and are therefore self-paced. A) True B) False
12. In compliance with HIPAA, Skype guarantees the privacy of its users who engage in professional and confidential business. A) True B) False
13. What physiological advantages are there to spending time outdoors? A) Decrease stress B) Increase attention span C) Combat fatigue D) All of the above
14. What defines the “stickiness” of a job? A) Compatibility with co-workers B) Long-term sustainability C) Fit with workplace environment D) None of the above
15. What is the greatest cause of disability under the age of 44? A) Brain Injury B) Spinal Cord Injury C) Depression D) Bullying
16. What is the most important defense against work-place bullying? A) Report to a superior B) Ignore the perpetrator C) Be the one in control D) Collect evidence against the bully
17. Which of the following is not a real online treatment term? A) eRehabilitation B) eHealth C) eVocational D) eCounselling
18. What makes the VRC program different from disability management? A) A counselling skills training component B) Focus on non-job-attached individuals C) Both of the above D) Neither of the above
19. Whose healthcare philosophy includes believing patients should be their own advocates? A) Dr Raymond Rupert B) Dr Nora Cullen C) Dr Rolf Gainer D) Dr Roberta Neault
20. Early aggressive rehabilitation can influence negative change following a brain injury. A) True B) False
The answers to the following questions are derived from the content within this publication. Each question has a CEU value of 0.1. If all questions are answered correctly, you will receive two CEU credits, for a total of eight per year. In order to participate in this unique offer, you may go online to www.vracanada.com and fill out the required information and questionnaire online. Alternatively, you may fill out the form and complete the quiz below and mail them, along with a cheque in the amount of $20 addressed to VRA Canada. CEU quizzes from previous issues may be completed at any time; there is no expiry date. To complete previous CEU quizzes please login to www.vracanada.com. Good Luck!
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Pay $20 and receive 2 CEU credits
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SUMMER 2012
Continued from page 9
Summer 201227
Shelley Fillmore, MEd, RPC, CHRP, is
an experienced counsellor specializing
in vocational rehabilitation, career
and training counselling, family
and individual counselling, pain
management, anxiety and depression
using a client-centered approach with a
solution focus.
he needed a break or if the medication was having an adverse effect on his mental acuity
The worker was concerned about •clear access to the washroom. This issue was resolved by taping a no-work area to allow for uninhibited access to the washroom
The space was ergonomically set-•up resulting in a restructured desk space
An occupational therapist •(OT) provided coaching in the workplace to support the worker’s transition back to work.
According to the Human Rights Model for Barriers and Accommodations there are four broad categories for accommodation: 1) aids and personal services; 2) modifications to structures; 3) transportation; and 4) employment. The financial and social categories are only included in the barriers section. The aids and personal services category looks at a series
of questions relating to the current use of any aids, services, specialized equipment or devices, any physical or communication therapy received, and any assistance received to perform daily activities. Any modifications to the home or work environment, as well as residing in housing designed for people with disabilities, are included as an accommodation. Transportation accommodations address the use of specialized or accessible buses.
“Employers considering the initial cost is short sighted; selling long-term cost impact for the employer can be done through a cost-benefit analysis.”
Many employers only think of the short-term implications of the front end costs for accommodation. Instead, there are long-term implications in cost savings for the employer in the form of savings to insurance systems (in this case, in excess of 2 million dollars). The hidden benefits are the employee perception of the employer, not only to what length they supported the individual that was accommodated but
increased loyalty for the employer for supporting their injured worker.
The cost for eliminating barriers may come with an initial price tag, but a cost-benefit analysis may present quite a bargain. However, the best deal for the employer is the employee perception and good will, which is priceless.
References for this article available at vracanada.com/media.php
Continued from page 9
28
Summer is here, which means warm weather, sunshine, and outdoor
activities! There are many benefits of being outdoors, including those that can help you out in the workplace. There are both psychological and physical rewards to be gained from being outside. Plus, it reminds us that we do not live in a concrete jungle and that our natural environment is something to value and cherish. When we step outdoors it is only natural that environmental awareness increases. If we are stuck indoors during the workday it is important to take the time outside of work to enjoy the outdoors. If possible, take your work outside; read a paper, conduct a meeting, or take your lunch outside.
Being in our natural environment reaps psychological and physical advantages. First of all, let us educate ourselves about the psychological benefits: studies have found that being in a natural environment can decrease
stress, improve attention span, increase confidence, and even combat fatigue. Being outside will not only help you get through the workday, but will hopefully also prompt us to cherish and learn more about the natural world around us. So, when you are having trouble focusing while at work, take your work outside and reap the benefits of fresh air, green vistas, and sunshine.
Aside from the fact that being outdoors has numerous psychological values, the physical rewards are well worth stepping out the door. Besides the obvious physical rewards of being more active while outdoors, simply being outside has been found to decrease blood pressure, heart rate, and muscle tension, and to increase energy levels. The obvious physical rewards of being active outdoors include: strengthening muscles, improving cardio stamina, increasing Vitamin D levels, becoming more flexible, and improved functioning of the immune
Larissa Teoh is a graduate from Dalhousie University and Niagara College, and worked for three years in the carbon management industry. She now pursues new opportunities and awaits the next big adventure.
system. When you take the time during the workday to step away from the fluorescent lights and concrete walls, you will feel the difference!
The next time you are feeling sleepy, stressed, and unfocused at work, take a moment to go outside and take a deep breath, or even take your work outside. Your psychological state and physical body will thank you, as will the natural environment!
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Renascent is available 24/7 to help you immediately change your life for the better. The road to recovery starts here.
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Green Tips: Great benefits of going outside By Larissa Teoh
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ICCRC Accredited Immigration Consultant
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