vocational rehabilitation and integration into the community

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Vocational Rehabilitation and integration into the community. Patricia Corbett Occupational Therapist MSc. BA Hons DipCOT. Presentation Objectives. To define the issues affecting RTW after ABI and the values associated with work - PowerPoint PPT Presentation

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  • **Vocational Rehabilitation and integration into the communityPatricia Corbett Occupational Therapist MSc. BA Hons DipCOT.

  • **Presentation ObjectivesTo define the issues affecting RTW after ABI and the values associated with workTo 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

  • **Definition of Vocational 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

  • **Who are the providers ?Wolfson Vocational Service, limited number of NHS funded VR Centers Job Centre Plus Disabled Employment Advisor and job brokersPrivate companies , Rehab Uk, Unicom Provident, Case Management FirmsCharitable organisations NHS Community Teams time limited input

  • **Defining the needIn UK, 2.7 million people of working age receiving Incapacity Benefit (DWP 2002)Over of a million would like to workAlmost all of the 700,000 people moving onto IB each year expect to work in due courseOnce 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

  • **Job Centre Plus SchemesPathways to workWork prepWork stepNew Deal for the DisabledAccess To WorkJob IntroductionCondition Management

  • **IB Recipients - DiagnosisSource Dept of work and pensions

    Chart2

    26

    44

    10

    3

    1

    2

    14

    Incapacity-related benefit by diagnosis group, November 2003

    Sheet1

    Musculoskeletal26

    Mental health44

    Cardiovascular10

    Diseases of the nervous system3

    Injury1

    Diseases of the respiratory system2

    Other conditions or conditions not specified14

    100

    Sheet1

    Incapacity-related benefit by diagnosis group, November 2003

    Sheet2

    Sheet3

  • **Vocational difficulties in brain injuryEnvironmental barriersPhysical difficulties Poor motor skills, visual field deficits, epilepsyCommunication difficulties Processing language, expressive dysphasia, Cognitive difficulties, poor memory, concentration and attention, reduced ability to learn information

  • **Executive functioning difficulties problems with planning organising and problem solving, poor insightFatigue, both mental and physicalLow mood, mood swings, emotional vulnerabilityIrritability, frustration aggression, disinhibitionDifficulty with adjustment Transport, access, equipment

  • **Political and Health agenda Disability Discrimination Act 1995 (DDA)Incapacity Benefit Reform 2003 (DWP)Choosing Health white paper 2004New Deal for the Disabled 1998Getting back to work 2002 (TUC )Publication of the National Health Standards for People with Long Term Conditions 2005

  • **Evidence Outcome of DEA clinic Patients known return to work Audit of patients June 2004-June 2006

  • **Total contacts

  • **Most Recent Contact

  • **International EvidenceStudy 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 statusFunctional status at discharge

  • **International EvidenceGlobal cognitive functioningPerceptual abilitiesExecutive functioningInvolvement in VR serviceEmotional status

  • **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 rehabilitationSelf awarenessGroup rehabilitationTraining in compensationMotivational interviewingAdjustment counselling & cognitive-behavioural therapy

    Modify social environmentProvide more financial incentives for workEmployer education & trainingFamily educationSupported employment programmesChanges in public policy and funding decisions

    Long-term adjustment early recovery pre-trauma

  • **Work site visit EnvironmentSocial conditionsCore duties of the taskCognitive demandsPhysical skillsCommunicationSpecific task analysisWork culture

  • **Case StudyMary K background information Presenting problems Short term memory difficultiesRetrograde amnesiaReduced speed of processingLimited functional use in left armDeaf in right earFatigue

  • **Case Study ContinuedEmployment Issues affecting work CognitivePhysical including medical complicationsEmotional changesCoping with a court case

  • **Case Study ContinuedRehabilitation InterventionStrategies to manage short term memory lossMobilisation of left armComputer TrainingDomestic participation

  • **Follow up episodeReturn to work assessmentCognitive problems Managing work loadPressure to return full time Unable to travel to work independentlyAnxiety and low mood

  • **InterventionWork visit and work report from OTAnxiety Management Adjustment including exploring leisure activitiesTravel to work

  • ** Case History 2 Background informationSocial HistoryPresenting problemsWorker Role Interview( G.Kielhofner 2005 )Assessment of Motor and Process Skills ( A Fisher 2005 )

  • **GoalsTo have a better understanding of current work skills based on previous knowledge and experienceTo be able to manage fatigue symptoms with objective recording

  • **Case History 3Background informationSocial HistoryPresenting problems

  • **GoalsTo identify strengths, skills and knowledge acquired through current position at the RSPCATo identify future training and experience required to develop vocational skills

  • ** OT and integration into workSkills to identify issues affecting the person, level of disability and how this interfaces with workProvides 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 duplicationOffer 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 workSet a review system 1-2 years , trouble shoot problems

  • **Resourceswww.jobseekers.direct.gov.ukDEA and Job Centre Plus Remploy www.remploy.co.ukAbilityMatch softwareShaw Trust www.shaw-trust.org.ukOnline.onetcenter.orgVolunteer centresCharitiesAdult Education

    **Purpose of this presentation to describe my experiences of working towards vocational rehabilitation for clients with an ABlTo specify the particular needs for clients with ABI and why this differs from other types of services As vocational rehabilitation has been widely available and developed in the USA and Australia to provide evidence on what has already been developed and what is effective and explain the gap in the provision of services in this country.To identify the areas for developing a service for persons with brain injury what model can we follow ? Dr Andy Tyerman interagency forum , my work in Croydon neuro rehabilitation service.

    *Why is employment important ? For the government it will save money . IB costs high with 2.7 million on IB .For the person , develops confidence ,new skills, self esteem, financial rewards. Improving health and meeting people . Enables a person to become more integrated into society. To be in work is fundamental to the structure of our society Work can mean paid employment or voluntary work. As an OT my experience of exploring occupation with a client has lead me to realise the importance that purposeful activity plays in a persons life , affirming an identity and purpose and that is meaningful. It is part of human psychology to seek to achieve goals that provide personal reward and relatedness to others, work is an activity that meets these needs. I think for ABI clients the concept of work needs to be flexible in terms of time and broaden to all types of work especially work voluntary . The journey to purposeful activity and recovery is a long route with failures to work through as adjustment to a different life are made. As an OT I assess a persons global skills, interpersonal skills, cognitive abilities ,physical, intellectual and previous knowledge and experience and attempt to match ability with right activity/job. Formal tools and observational methods.Our own experience of clients the tells us just how important work is to individuals and how easily confidence is lost particularly following a sudden onset such as brain injury. We all know of clients where the injury has lead to a traumatic severing the of life goals there maybe 30 years of a work

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