A case study (best practice): Employment rehabilitation of a person with disability after head injury Aleksandra Denša URI-SOČA, Centre for vocational rehabilitation

Conflict of Interest Disclosure: I have no potential conflict of interest to report in regards to the presented case study.

Introduction Female, age of 24. Occupation: saleswoman. 4,5 years registered at the ESS - a long term unemployed person. Without any real work experience. Her disability was the result of a head injury in September 2006 (fall from a great high – 8 meters).

Overview of the process: 1. A two week assessment of client´s needs and functions in terms of health, cognitive and working capabilities in VRC (year 2011) 2. Participation in employment rehabilitation program - on the job training (OJT – lasted 1 year and 2 months) 3. Sheltered employment (Lasting of the program from October 2012 till the end of June 2015)

1. Assessment in URI professional team (2011) : changeable range of concentration and attention in work process, central fatigue, low efficiency (between 30-70%), requires short breaks between work tasks, needs structure in work process, needs outside support in terms of additional work instructions, and demonstration of the work tasks, mental health problems, some difficulties in terms of short and long memory, otherwise very reliable and thorough, fine motoric finger skills.

Recommended work limitations:  mentally and physical less demanding work tasks,  work tasks must be well structured,  should not be exposed to extreme noise in the work environment (deft of the left ear),  her work tasks should be well organized and should include minimum contact with other people.

2. Employment rehabilitation Client’s objectives defined in her Individual rehabilitation plan (IRP) :  Employment (either administrative paperwork – scanning, photocopying, sorting of the posts or doing easy physical tasks – packaging, labeling of the products, etc.).  Independent living (to live outside of institutional housing).  Growth of self-esteem/empowerment of the client (to be able to take care of herself in different unpredictable day to day life situations).

Used methods: Case management approach and use of bio-social model (team included). Individual and group work with the client (learning of different social skills, counseling, guiding, giving support in different situations – labor market research, writing of CV and job applications etc.) empowerment of the client. On the job training (collaboration with employers in different work fields, analyses of a work place, assessment of necessary accommodation, defying of work tasks).

Involved actors: client herself, client´s relatives, URI professional team (occupational medicine specialist, social worker, psychologist, occupational therapist, rehabilitation technologist), employers, ESS (rehabilitation counsellor), other institutions - Centre of social services, City hall of Ljubljana, Occupational activity Centre Mavrica, client was also regularly include into psychotherapy outside of the program for couple of years and also had/ha regular seasons with her psychiatrist.

On the job training (OJT) – description : Employer: Sheltered centre Most in Ljubljana. Work place of the client: “simple manual work tasks”. Duration of the OJT before employment: 1 year and 2 months. Description of work tasks: packing dietary supplements and medicine, labelling and scanning/revision of dietary supplements, shelling of medicine products, repacking and unpacking dietary supplements and medications. Importance of gradual and systematic inclusion of the client into the work environment.

OJT was performed on 2 locations (in workshops in Sheltered Centre Most – morning shift and in company Lek – morning and afternoon shift) depending on the working schedule. Working demands (employer):  able to work full time (8 hours per day),  good concentration, being able to connect with other employees and mentors in the working environment,  good motoric skills, good sight, being thorough and reliable,  achieving work stability in productivity (between 30-70%) and good quality,

 being able to fallow work instructions,  importance of memorizing basic work instructions,  ability to achieve at least minimal independence in working process, etc.  being able to adjust to changes in the working process,

Results of the OJT: stable work productivity (40%) and good quality of work, is good at task that demanded good motoric skills, is thorough and reliable, prefers working in standing position, no accommodation of work objects or environment were needed,

mentor support is especially needed when the demands of working tasks and its criteria change rapidly and often when operating such tasks the client needs more breaks between work to maintain necessary concentration, work efficiency and quality of work.

3. Where is our client now? (1/2) Sheltered employment she is still employed by the same employer, works full time – 40 hour per week, same work tasks - on both location, the support of the mentor in work environment is ongoing and needed by the client, prefers afternoon shifts, still needs outside support (counselling) in regards how to handle stressful situations (distress in relationships, etc.),

Where is our client now? (2/2) is overall satisfied with her work performance, is satisfied with her own independent living, still lives in the same sublet apartment, occupies herself with recreation (running, long walks), socializing with friends, reads a lot books, etc. in terms of social-economic stability in her life she feels safe.

Conclusion: The success/positive outcome of employment rehabilitation depends on:  client’s active participation in the program and his/her readiness and inner motivation to co-create the possible circumstances/results which are defined by the client in Individual rehabilitation plan (in regards to their disability, needs, occupation, working experience, skills),  transparent and ongoing collaboration within professional team, employers,  importance of institutional networking.

Thank you for your attention.