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ByByByByDAVID ROGERS, MADAVID ROGERS, MADAVID ROGERS, MADAVID ROGERS, MA

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� David Rogers � Relationship with commercial interests:

◦ Currently consulting with Ultima Medical

◦ Vocational and Employability Assessments for various providers and legal representatives.

� There are no potential sources of bias created by my association with Ultima Medical or other stakeholders.

� Expertise as a Vocational Rehabilitation Consultant developed during my 28 year career with WorkSafeBC.

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� During my career as a Vocational Rehabilitation Consultant with WorkSafeBC and in private consulting, I have conducted over 900 vocational and employability assessments.

� Developed expertise in dealing with workers with traumatic physical injury, psychological barriers, activity related soft tissue disorder, repetitive strain injuries, chronic pain conditions, etc.

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� What is Vocational Rehabilitation (VR)

� VR strategies to maintain momentum toward Return to Work (RTW)

� Evidence is integral to the VR process

� Facilitating the Accommodation of Disability

� Summary and conclusion

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•To integrateintegrateintegrateintegrate Vocational Rehabilitation (VR) strategies Vocational Rehabilitation (VR) strategies Vocational Rehabilitation (VR) strategies Vocational Rehabilitation (VR) strategies that

help to maintain the patient’s momentum of recovery and

to assist in the achievement of Return to Work (RTW)

•To recognize how evidenceevidenceevidenceevidence----based reports contribute based reports contribute based reports contribute based reports contribute to

both the assessment of employability and the RTW

outcome for persons with disability

•To discover the benefits of VR involvement benefits of VR involvement benefits of VR involvement benefits of VR involvement which help to

mitigate the effects of disability with the goal of

accommodationaccommodationaccommodationaccommodation in the Work Place.

Vocational RehabilitationVocational RehabilitationVocational RehabilitationVocational Rehabilitation:

The ethical process governed by the principles to enhance the return to work outcome for injured workers

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� To assist Workers in their efforts to overcome the injury and resulting disability

� To provide assistance in accordance with existing policies and practices of the particular Provider (such as: WorkSafeBC, ICBC, Disability insurance carriers, etc.)

� To provide reassurance, encouragement and counselling to help the worker maintain a positive outlook and remain motivated

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PHYSICAL REHABILIATION PHYSICAL REHABILIATION PHYSICAL REHABILIATION PHYSICAL REHABILIATION VOCATIONAL REHABILIATIONVOCATIONAL REHABILIATIONVOCATIONAL REHABILIATIONVOCATIONAL REHABILIATION

(To maximize recovery and function)

(To maximize vocational ability

and assist in return to work)

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MedicalMedicalMedicalMedical----AP, PT,OT, AP, PT,OT, AP, PT,OT, AP, PT,OT,

Psych.Psych.Psych.Psych.

Case ManagerCase ManagerCase ManagerCase ManagerEmployerEmployerEmployerEmployer

VR

WorkerWorker

� Visiting Job sites and meeting with all parties

� Consulting with clients and building trust

� Encouraging active participation

� Respecting choices made by worker/client

� Collaborating on vocational plans

� Overcoming barriers

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“Rehab should be done “Rehab should be done “Rehab should be done “Rehab should be done WITHWITHWITHWITH a persona persona persona person

NOT NOT NOT NOT TOTOTOTO a person”a person”a person”a person”

It is about Trust and RespectCollaboration not manipulation

The ethical process of doing good and avoiding harm

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To integrate Vocational Rehabilitation (VR) To integrate Vocational Rehabilitation (VR) To integrate Vocational Rehabilitation (VR) To integrate Vocational Rehabilitation (VR) strategies that help to maintain the patient’s strategies that help to maintain the patient’s strategies that help to maintain the patient’s strategies that help to maintain the patient’s momentum of recovery and to assist in the momentum of recovery and to assist in the momentum of recovery and to assist in the momentum of recovery and to assist in the

achievement of Return to Work (RTW)achievement of Return to Work (RTW)achievement of Return to Work (RTW)achievement of Return to Work (RTW)

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� An early referral enables Client to maintain essential attachment to the workplace AND to help manage client expectations. ( e.g.: “no one cares” “I’m unemployable”)

� When it becomes clear that Client will have difficulty returning to the pre-injury occupation

� Exceptions: ◦ Delay referral if further significant medical treatment◦ Client is unable to participate in the RTW process

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� Case File review and team meetings

� Maintain “Open Mind”

� Determine the facts based on evidence

� Interview for further clarification of issues

� Maintain the dialogue between all parties

� Consult and research labour market

� Vocational Testing

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� Start with understanding the pre-injury occupation� Determine the Worker’s Current abilities � Explore whether modified work is readily available by the employer for the worker.

� Evaluate the skill profile of the Worker� Determine the factors that will be affecting RTW� Prognosis of RTW: Same job? Similar occupation?� Consider end of service goal: to provide Clarity and Closure

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� 48 year old qualified trade Machinist presents with occupational disease due to prolonged exposure to cutting fluid. Recommendation: avoid exposure.

� Complex claims process. “Lack of Disability”. VR Focus is Preventative.

� VR action plan: Re-training as a Manufacturing Representative. Different occupation in same industry.

� Later appeal findings consider evidence of change in body chemistry

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� Investigate and document Work History, Education, Certifications, etc

� Evaluate worker’s Transferable Skills and Abilities

� Determine level of aptitudes from occupational experience

� Provide psycho-vocational testing

� Utilize the National Occupation Classification (NOC) as resource

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� Impact of Impairment and/or Disability on worker’s skill set

� Some skills may be “lost” due to lost ability

� While aptitudes remain constant, the abilities are affected when the task can no longer be performed

� Psycho-Vocational testing provides clarity

� Question: Retained skills sufficient? Skill upgrading required? Retraining necessary?

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� 58 year old warehouse worker. Significant shoulder impairment. Limited transferable skills

� Process involved preventing lose of job by consulting with supportive employer as to how Client could perform critical job demands.

� Solution: Accommodation with $70,000 purchase of warehouse equipment: pallet wrapper

� Take AwayTake AwayTake AwayTake Away:::: With job modification, retained skills are sufficient to maintain same job with same employer.

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� Both previous cases demonstrate how a disability impairs a Worker’s ability to perform the Critical Job Demands of the pre-injury job.

� For many workers it is very difficult for them to face the loss of ability that threatens their job.

� The VR’s role is to help the worker by evaluating what transferable skills are retained and to help him or her to adapt to the new reality.

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� 40 year old Ironworker has a significant shoulder injury. He is unable to safely climb and work at heights. His livelihood is threatened.

� It becomes clear that he has limited aptitudes for academic retraining.

� With his residual skills and abilities, he is able to train to become a certified crane operator with TOJ.

� Client was committed to mitigate effects of disability and he had excellent industry contacts.

� Take away: Take away: Take away: Take away: Restore ability. Restore confidence.

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� In addition to the injury and resulting disability, there are many other factors that are unique to each individual worker/client

� Factors such as personality, unique characteristics, interests, etc

� These factors impact on the client’s employability.

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� Worker profile: age, work history, seniority� Canadian education and level of Literacy� Certifications, licenses, trade qualifications� Extent of transferable skills: Unskilled? Semi-skilled or Skilled worker?

� Adjustment to the injury and Chronic Pain � Psychological condition(s)� Socio-economic factors

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� 58 year old roofer Hip and Low back. Limited transferable skills. Unable to continue in his career.

� Significant factors: Debt, Family, lost confidence

� Initial agreed Rehab plan: Truck Driver. Final Rehab Plan: Service station attendant occupation

� Take away: Take away: Take away: Take away: VR is not always “a simple and straight-forward” process. Assessment of employability with loss earnings recommendation provides closure.

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� The Tool Kit of the Vocational Rehab Consultant� Investigation and research of occupations� Professional development and expertise of LMI� Gain and apply insight of BC’s industry sectors� Always learn from workers, employers, and unions

� LMI is the essential ingredient to develop Vocational Plans for Workers.

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� 29 year old Carpenter. Dominant hand injury. Loss of grip strength. Loss of ability (skill) but not loss of hope.

� Vocational assessment with active collaboration and labour market investigation. Consultation with medical advisor.

� VR Plan: Retraining as Haul Truck Operator. Relocation assistance.

� Take Take Take Take away: away: away: away: Worker’s preferred plan achieves the mandate: Target job: suitable, available, maximizes earning capacity.

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New occupationNew occupation

PrePrePrePre----injury injury injury injury Foundation Foundation Foundation Foundation PrePrePrePre----injury injury injury injury Foundation Foundation Foundation Foundation

Skill UpgradeSkill UpgradeSkill UpgradeSkill UpgradeSkill UpgradeSkill UpgradeSkill UpgradeSkill Upgrade

� 31 year old ironworker falls from height and suffers multiple injuries. Vocational testing reveals high level aptitudes and interests in computing.

� VR Plan: Academic upgrading and Douglas College Access-ability program prepares client for career in Software development.

� Successful outcome: currently in his 9th year as software programmer with large Richmond company.

� Take away: Take away: Take away: Take away: Process of discovery. Evaluate likelihood of success in new career.

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Work Assessment Work Assessment Work Assessment Work Assessment

and Graduated and Graduated and Graduated and Graduated

RTWRTWRTWRTW

Skill Upgrading Skill Upgrading Skill Upgrading Skill Upgrading RetrainingRetrainingRetrainingRetrainingJob search Job search Job search Job search

supportsupportsupportsupport

Adaptive Adaptive Adaptive Adaptive

technologiestechnologiestechnologiestechnologiesRelocationRelocationRelocationRelocation

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Medical / Psychological Evidence is essential to the VR strategies for Return to Work and

the assessment of employability

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� Medical evidence is KEY to entitlement.� Diagnosis and prognosis of the condition(s)� Recovery or plateau?� If recovery, there is no need for VR assistance.� If plateau then must compare pre-injury abilities with post-injury residual abilities

� Medical evidence provides the reason to implement a VR strategy.

� Evidence forms basis of employability assessment

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� Medical evidence is integral to ensure that this goal is achieved

� Meaningful Return to Work action plans require clarity:

◦ What is diagnosis and prognosis?

◦ What are the Restrictions and Limitations?

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� Restrictions: Restrictions: Restrictions: Restrictions: those activities or conditions which pose undue risk of harm leading to disability or worsening of disability.

� Scope of limitations: Scope of limitations: Scope of limitations: Scope of limitations: how worker’s physical abilities are limited in terms of strength capacity, range of motion and/or degree that the action can be tolerated. Also acknowledge that there may be psychological limitations to stimuli and environment.

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� Document physical demands of the core duties

� Assess how impairment impact on doing the job

� Review psycho-social aspects of the job

� Assess skills required to perform job duties

� Request Functional Capacity Evaluation (FCE)

� Determine if Client is able or unable to adapt

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� 28 year old Field Geologist witnesses fatal helicopter crash. At psychological plateau Client has permanent PTSD with anxiety and depression. Unable to work in the “field”.

� Initial plan (affirmed by treating psychologist) fails due to unforeseen circumstances

� Revised plan based on residual skills and clearer understanding of limitations. Subsequent plan succeeds

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� Impairment is the loss of physiological or psychological function.

� Disability is the loss or limitation of opportunity.

� VR focus is on the retained skills and abilities.

� The Rehabilitation plan outlines the Client’s ability to adapt to same, similar or new occupation given the necessary support, programs and services.

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� 59 year old admin secretary. ASTD condition of both wrists. The plausible limitation due to chronic pain: avoid sustained keyboarding and mousing activities.

� VR Plan: to take advantage of adaptive technology “Speech recognition” software, Hardware components and Skill upgrading. Client was able to maintain pre-injury job.

� Take away: Take away: Take away: Take away: Technology provides opportunity for accommodation. Older worker mitigates effect of injury. Employer is key to disability management strategy.

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� Purpose of this comprehensive report� Essentially to compare the difference between pre-injury and post-injury Worker Profile.

� To assess the retained skills and residual abilities

� Identify the suitable and available occupation options

� Review the client’s ability to adapt� Forecast the long term earning capacity

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� 61 year old cabinetmaker and installer has mild stroke at work. The fall results in a moderate brain injury. Initial impression at plateau: able to adapt to another occupation.

� Community therapist evaluation of ADL provides insight and clarity. Window of opportunity closed.

� Take away: Take away: Take away: Take away: evidence critical to valid assessment of employability and long term earning capacity.

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The VR Contribution toward:Mitigating the effects of disability

Assisting accommodation in the Work Place

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� Vocational Rehabilitation is not a solution but an agent toward a solution

� VR acknowledges:

◦ That reliable information is critical

◦ The necessity to apply process and principles in ethical manner

◦ The free will of employers or injured workers

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� 26 year old hairdresser has two claims: Right wrist carpal tunnel syndrome and occupational disease eczema condition. Limitations: to avoid prolonged pinch grip and to avoid skin contact with culprit chemicals.

� Process: Rule out any suitable options with employer. Collaboration with motivated Client. Labour market research confirms worker is able to adapt with skill development.

� Take away: Take away: Take away: Take away: The value of Medical, Worker, and Employer input. Client takes initiative to mitigate effects of disability. RTW outcome as Admin Assistant becomes the EA and case closure.

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Aviation research has concluded that Human Factors are the cause of most accidents and incidents.

So, too, the VR strategy will “crash and burn” when the VR human factors approach is ill-informed, unethical, negative, and/or bureaucratic. The rush toward “case closure” at client expense is, in itself, a service failure.

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Benefits:

� VR has opportunity to listen and create dialogue

� VR can act as “sounding board” for RTW ideas, options, and opportunities to overcome barriers.

� VR is subject matter expert in the ability to adapt

� Partner with medical and psychological treatment providers

� Focus on problem solving

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� Worker responsibility to be engaged in the process and to fully participate.

� Worker’s role is to mitigate the effects of an injury or condition and resulting disability/impairment.

� Human Rights tribunals have acknowledged the requirement of Workers and Employers to act in good faith toward RTW outcome

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� VR contributes to the Disability Management approach

� VR should be an essential team player for helping Client maintain attachment to employer

� Vocational Rehabilitation’s role in building trust between parties

� Focus on Duty to Accommodate.

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� “The duty to accommodateduty to accommodateduty to accommodateduty to accommodate persons with disabilities means accommodation must be provided in a manner that most respects the dignity of the person, if to do so does not create undue hardship. Dignity includes consideration of how accommodation is provided and the individual's own participation in the process.”

http://www.ohrc.on.ca/en/policy-and-guidelines-disability- and-duty-accommodate/4-duty-accommodate

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� Where a barrier exists, or a policy or practice has adverse consequences on an individual in a protected group, the law says that the employer should reasonably accommodate that individual’s difference provided they can do so, without incurring undue hardship, or without sacrificing a bona fide or good faith requirement of the job.

� Factors that are used by the courts to assess the threshold include: financial costs; health and safety risks; and size and flexibility of the workplace.

http://www.bchrc.net/duty_to_accommodate

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� Middle aged ferry worker. Resolved ankle fracture but left with chronic pain condition. Barrier to return to full duties: the constant vibration of car deck.

� Solution: Modify duties. Limit vibration exposure. Provide custom made vibration dampening work boots.

� Take Take Take Take awayawayawayaway: Disability Management involves all parties in the RTW plan development. Work assessment and GRTW. Modified work boots.

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� Medical Community

� Accident Employer

� Union and Labour organizations

� Case Manager

� Industry Specialists

� Training Institutions

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� A 32 year old welder develops sensitivity to toxic fumes. Consult Occupation Disease specialist and strategic partner at union welding training institution.

� VR plan (dual focus): air supply helmet and skill upgrading (welding techniques/orbital welding)

� RTW outcome: clean manufacturing setting; food processing and nuclear industries.

� Take away: Take away: Take away: Take away: strategic partner provides industry insight and solution.

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� Vocational Rehabilitation strategies maintain critical momentum

� Medical and Psychological evidence is the basis for Vocational Rehabilitation to be effective in the Return to Work outcome.

� The benefits of Vocational Rehabilitation is to assist all parties to help mitigate effects of disability and to assist manage disability in the Work Place.

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� Sitting at the breakfast table with 64 year-old former metal shop labourer and his wife.

� Years of appeals, confusion and frustration.� I promise to provide Clarity and Closure with an employability assessment and recommendations.

� “If you can give me that, I will burn this file”

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Any questions? . . .

� By applying medical evidence with VR strategies, the clients benefit with either returning to suitable work or gaining some clarity and closure regarding their disability.

� In conclusion,

“I hope I have provided some clarity about Vocational Rehabilitation and, here, I will close”

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