Vocational Rehabilitation and integration into the community

1. Vocational Rehabilitation and integration into the community Patricia Corbett Occupational Therapist MSc. BA Hons DipCOT.

2. Presentation Objectives • To define the issues affecting RTW after ABI and the values associated with work • To describe the services available and concerns relating to the needs of ABI individuals . • To describe the role of OT as part of a vocational rehabilitation service

3. 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

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

5. Defining the need • In UK, 2.7 million people of working age receiving Incapacity Benefit (DWP 2002) • Over ¾ of a million would like to work • Almost all of the 700,000 people moving onto IB each year expect to work in due course • Once a person is on IB for 1 year they have only 1.5 chance of returning to work within 5 years ( DWP) • Headway suggests only 30% of people with moderate to severe head injury are in work 5 years post injury Pathways to work : Helping people into employment, DWP 2002

6. Job Centre Plus Schemes • Pathways to work • Work prep • Work step • New Deal for the Disabled • Access To Work • Job Introduction • Condition Management

7. IB Recipients - Diagnosis Source – Dept of work and pensions

8. Vocational difficulties in brain injury • Environmental barriers • Physical difficulties • Poor motor skills, visual field deficits, epilepsy • Communication difficulties • Processing language, expressive dysphasia, • Cognitive difficulties, poor memory, concentration and attention, reduced ability to learn information

9. Executive functioning difficulties problems with planning organising and problem solving, poor insight • Fatigue, both mental and physical • Low mood, mood swings, emotional vulnerability • Irritability, frustration aggression, disinhibition • Difficulty with adjustment Transport, access, equipment

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

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

12. Total contacts

13. Most Recent Contact

14. International Evidence • Study that reviewed factors that consistently relate to employment outcomes following TBI looked at 85 studies (1980-2003) • Factors affecting successful return to employment (Ownsworth and McKenna 2004). • Pre injury occupational status • Functional status at discharge

15. International Evidence • Global cognitive functioning • Perceptual abilities • Executive functioning • Involvement in VR service • Emotional status

16. Evidence • Conceptual model of factors relating to employment outcome (T. Ownsworth and K. McKenna)

17. Work site visit Environment Social conditions Core duties of the task Cognitive demands Physical skills Communication Specific task analysis Work culture

18. Case Study • Mary K background information • Presenting problems • Short term memory difficulties • Retrograde amnesia • Reduced speed of processing • Limited functional use in left arm • Deaf in right ear • Fatigue

19. Case Study Continued • Employment • Issues affecting work • Cognitive • Physical including medical complications • Emotional changes • Coping with a court case

20. Case Study Continued • Rehabilitation Intervention • Strategies to manage short term memory loss • Mobilisation of left arm • Computer Training • Domestic participation

21. Follow up episode • Return to work assessment • Cognitive problems • Managing work load • Pressure to return full time • Unable to travel to work independently • Anxiety and low mood

22. Intervention • Work visit and work report from OT • Anxiety Management • Adjustment including exploring leisure activities • Travel to work

23. Case History 2 Background information Social History Presenting problems Worker Role Interview ( G.Kielhofner 2005 ) Assessment of Motor and Process Skills ( A Fisher 2005 )

24. Goals • To have a better understanding of current work skills based on previous knowledge and experience • To be able to manage fatigue symptoms with objective recording

25. Case History 3 Background information Social History Presenting problems

26. Goals • To identify strengths, skills and knowledge acquired through current position at the RSPCA • To identify future training and experience required to develop vocational skills

27. OT and integration into work • Skills to identify issues affecting the person, level of disability and how this interfaces with work • Provides a practical approach to rehabilitation within the realities of living in the community. Experts in task analysis • As part of this global approach recognises the need to work with other professionals and agencies. Set joint goals. • Develop interagency work and working links to all involved providing a clear RTW to pathway, avoiding duplication • Offer education and advice re condition and likely impact on work to all involved • Identify other work alternatives if unable to return to previous job value volunteer work as a real work • Set a review system 1-2 years , trouble shoot problems

28. Resources • www.jobseekers.direct.gov.uk • DEA and Job Centre Plus • Remploy www.remploy.co.uk • AbilityMatch software • Shaw –Trust www.shaw-trust.org.uk • Online.onetcenter.org • Volunteer centres • Charities • Adult Education