HEALTH AND WORK Scoping the contribution of NHS Lothian Examples in practice

1. HEALTH AND WORK Scoping the contribution of NHS Lothian Examples in practice The West Lothian Rehabilitation and Brain Injury Service Elizabeth Newbigging, OT, May 2010

2. Overview of presentation • Share information to other resources within Lothian that currently provide vocational • rehabilitation • Who is CRABIS? • What CRABIS has to offer the population within West Lothian? • How CRABIS provides vocational rehabilitation to those referred to the service • Describe the pathway for a client through the Service • How does CRABIS sit within the larger umbrella of vocational rehabilitation within Lothian? • Strengths • Limitations • Next steps • Contacts

3. Overview of the service provided by CRABIS • Operational 1 February 2000. • Currently in its 11th year. • Celebrated 10th anniversary on 24 February 2010. • Joint funded through Lothian Health. West Lothian Council and Mental Health Specific • Grant. • Managed within West Lothian Community Health and Care Partnership under senior • management of the Chief Nurse.

4. Aim of Service • To provide multi-disciplinary community based rehabilitation to individuals over the age of • 16 within West Lothian. • To work with service users to increase their level of function, independence and • participation, thereby improving quality of life and community reintegration.

5. The Team • Service Manager • Occupational Therapists • Physiotherapists • Clinical Psychologists • Speech & Language Therapist • Rehabilitation Assistants • Administrative Coordinator

6. Referral Categories Category 1: Individuals discharged from hospital with complex needs requiring rehabilitation from 2 or more disciplines (EHD) e.g. CVA. Category 2: Individuals living in the community with a long-term disability who would benefit from multi disciplinary rehabilitation e.g. CVA, MS, Motor Neurone Disease. Category 3: Individuals following an acquired brain injury (e.g. traumatic, haemorrhagic anoxic, tumour) who may have cognitive, behavioural, emotional or physical sequelae. Category 4: Individuals with mild head injury who have attended St Johns Hospital A&E department.

7. Elements of Service • Active rehabilitation • Further assessment, advice, liaison and review (FALR) • Specialist assessment by the team • Bridging the gap • Vocational rehabilitation • Client centred goal planning • Carer support and advice • Community reintegration

8. Vocational Rehabilitation • Wide range of conditions with complex needs of which there are physical, emotional, • social, financial, behavioural and cognitive factors to consider. • Identified seeking employment or return to work as a goal. • Pathway differs depending on whether currently employed or seeking employment. • The client may be involved with other team members before or during vocational • rehabilitation.

9. Clients • Male and female • Various age ranges • Range of employments: teachers, nurses, building industry, sales, insurance, • Edinburgh airport, management. • All in employment at time of illness.

10. Interventions • Consent to participate in therapy, contact employer, occupational health service, G.P. • Interview/Job analysis – components of job • Initial contact letter with employer • Assessments – COTNAB, ACE-R, AMPS, TEA, BERG balance, HADS, MMSE, Driver • screening, BICRO-39, insight training etc. • Goal setting • Workplace visit • Letters/reports • Bespoke programmes • Recommendations – considering client and employers needs • Return to work reviews – client and employer – face to face, telephone

11. The Pathway Referral Screening Ax (WHO) Common to All Correspondence / Consent Obtained Work identified as a goal Occupational therapist interview

12. Job Analysis Consent Obtained Initial Contact with Employer / Occupational Health / Insurance Company / Case Manager Assessment Goal Setting Currently Employed Occupational Rehabilitation Programme Liaison with Employer Return To Work Review Discharge

13. Assessment Goal Setting Skills, Strengths, Strategies Listed Not Employed Interested in Seeking Employment Refer to Other Resource Discharge

14. Strengths and Limitations • Strengths • Dedicated team • Dealing with complex conditions is routine • Occupational therapists work as a case • manager • Knowledge of occupational performance • Activity analysis • Provides assessment to employment resources • Available for consultation even after discharged • Access to neuropsychological assessment • Link with colleagues from “B4 and on2 work” • Appreciate the need for achievement of pre- • vocational skills before vocational rehabilitation • can commence • Limitations • CRABIS is not a dedicated employment service • Intervention can be lengthy • Increase waiting time for other referrals • Accessing the workplace • Limited resources/difficulty accessing resources • for high level clients • Limited time to develop or evaluate service • Lack of formal qualification • Complexity of legislation - ESA

15. Next Steps • Continue monitoring effectiveness of the service. • Continue forging links with the vocational rehabilitation centre at the Astley Ainslie • Hospital. • Develop examples of good practice using guidelines and benchmarks of CARF, College of • Occupational Therapists, NHS Lothian, DWP and government legislation. • Publish examples of intervention within the BJOT/West Lothian Courier/Connections. • Continue formal education within the field of occupational rehabilitation • Implement examples of practice gained from today

16. Comments from Clients • I could not have recovered or got back to my responsible job without the care, support • and strategies shown to me by the team • I am so grateful for giving me a part of my life back

17. West Lothian Community Rehabilitation and Brain Injury Service The Ability Centre Carmondean Centre Road Deans Livingston EH54 8PT 01506 774 046 janet.foggo@nhslothian.scot.nhs.uk