9/7/20151 Vocational Rehabilitation and integration into the community Patricia Corbett Occupational Therapist MSc. BA Hons DipCOT.

9/7/20152 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

9/7/20153 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

9/7/20154 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

9/7/20155 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

9/7/20156 Job Centre Plus Schemes Pathways to work Work prep Work step New Deal for the Disabled Access To Work Job Introduction Condition Management

9/7/20157 IB Recipients - Diagnosis Source – Dept of work and pensions

9/7/20158 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

9/7/20159 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

9/7/ 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

9/7/ Evidence Outcome of DEA clinic Patients known return to work Audit of patients June 2004-June 2006

9/7/ Total contacts

9/7/ Most Recent Contact

9/7/ International Evidence Study that reviewed factors that consistently relate to employment outcomes following TBI looked at 85 studies ( ) Factors affecting successful return to employment (Ownsworth and McKenna 2004). Pre injury occupational status Functional status at discharge

9/7/ International Evidence Global cognitive functioning Perceptual abilities Executive functioning Involvement in VR service Emotional status

9/7/ Evidence Conceptual model of factors relating to employment outcome (T. Ownsworth and K. McKenna)

9/7/ Work site visit Environment Social conditions Core duties of the task Cognitive demands Physical skills Communication Specific task analysis Work culture

9/7/ 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

9/7/ Case Study Continued Employment Issues affecting work Cognitive Physical including medical complications Emotional changes Coping with a court case

9/7/ Case Study Continued Rehabilitation Intervention Strategies to manage short term memory loss Mobilisation of left arm Computer Training Domestic participation

9/7/ 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

9/7/ Intervention Work visit and work report from OT Anxiety Management Adjustment including exploring leisure activities Travel to work

9/7/ Case History 2 Case History 2 Background information Social History Presenting problems Worker Role Interview ( G.Kielhofner 2005 ) Assessment of Motor and Process Skills ( A Fisher 2005 )

9/7/ 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

9/7/ Case History 3 Background information Social History Presenting problems

9/7/ 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

9/7/ OT and integration into work 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

9/7/ Resources DEA and Job Centre Plus Remploy AbilityMatch software Shaw –Trust Online.onetcenter.org Volunteer centres Charities Adult Education