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Vocational Rehabilitation - Andrew Frank

21/03/18.For most people, their work is a key determinant of self-worth, family, esteem, identity and standing within the community, besides, of course, material progress and a means of social participation and fulfilment”.

Dame Carol Black summarises the benefits of employment as we now understand it. For most individuals, work is beneficial for health, and worklessness is definitely harmful, with an increased risk of illness and suicide. Work has thus become a cornerstone of rehabilitation after injury or other long-term illness. It is thus very regrettable that the legal system is seen by some injured individuals and professionals as a huge barrier to people working.

Those rehabilitation professionals who specialise in the inter-relationships between health and work are now being called vocational rehabilitation (VR) professionals (VRPs). Most come from a health professional background although some reflect skills acquired from business (e.g. from human resources) with an interest in health conditions.

The type of rehabilitation approach needed depends on whether the individual needing vocational rehabilitation (VR) has ever worked, is still in employment but facing difficulties, or is now out of work having previously been employed. What is very clear, however, is the need for work-related issues to be considered from the first day of injury, even though active VR may not be appropriate for some time. For those in work, health or legal professionals must enquire about the nature of the job, difficulties envisaged in any return to work (RTW) and they must be advised to remain in contact with their employer. They and their families must understand that there are many ways to help injured individuals RTW even though, for some, it may mean a change in work. Some individuals and/or their families may believe that a RTW is not possible e.g. after a spinal cord injury (SCI), and these attitudes need to be challenged early e.g. by asking what makes you think that?

For those whose injuries were acquired during childbirth or childhood, education is key to long-term employment prospects, although other factors are important. Thus gaining appropriate social skills and self confidence through sport or activities such as scouting and obtaining appropriate work experience are also fundamental. Exposure to successful disadvantaged individuals during education is really valuable in inspiring young people into expecting to be able to work and have a family etc.

For those with recent injuries who are entitled to compensation, the use of interim payments may be important in providing equipment or other forms of rehabilitation that is not readily available through the National Health Service (NHS). Peer support from individuals who have similar impairments to that of the client can be immensely valuable e.g. for those who have experienced a SCI.

Individuals in employment may be able to RTW with relatively minor modifications to their workplace or tasks. The Equality Act facilitates this and VRPs are used to explaining to employers how they can assist the RTW process. Often this will minimise sickness absence (SA) to the advantage of both employer and employee. For those with more complex injuries and consequent SA, the first step is often a worksite visit following which a RTW plan can be agreed between employer and employee. Then the VRP explains how an early RTW facilitates the employee’s rehabilitation by a phased return to hours/tasks/responsibilities, job modifications (accommodations) and assisting supervisors and co-workers how they can assist in this process, including for some, the use of ‘work buddies’. These co-workers can be given appropriate training to cope with an individual’s more complex needs e.g. if they have emotional difficulties or epilepsy.

It is now considered fundamental that injured individuals are highly likely to RTW prior to resolution of all their symptoms and prior to conclusion of health management. The employer thus becomes a key part of the rehabilitation process.

Similar skills are needed when a RTW with the former employer is not possible, but additional factors are assessed by the VRP. They may include the client’s transferrable skills/aptitudes, hobbies that might convert into a wage etc. The general advice is to seek a RTW with the same employer/same job, same employer /different job but different employer/same job and different employer/different job is also viable. The government gives advice/support through the Department for Work and Pensions (DWP) Jobcentre Plus to both employer and employee where appropriate. This includes consideration of self-employment.

VR usually involves multidisciplinary working in partnership between the client/patient, health professionals, employer and insurers. The insurer is usually the government through the DWP but private insurance should be utilised when appropriate. In that situation rehabilitation can be enhanced though the use of the private sector when the Rehabilitation Code (currently under revision) should guide the process. The charitable sector is also valuable in this situation, not only in giving peer support but also advice on RTW options, funding for equipment not available through the NHS etc.

Conclusion

Vocational rehabilitation offers injured individuals the best hope of successful employment in spite of often serious injuries. Different strategies may be needed for those at different stages of working life. But aiming for employment from the first stage of an injury or acute illness gives the best likelihood of a successful return to work and the financial, health and social advantages that this brings.

Andrew Frank

Further Reading

Black, Dame Carol. Working for a healthier tomorrow. London: TSO; 2008.

British Society of Rehabilitation Medicine. Vocational assessment and rehabilitation for people with long-term neurological conditions: recommendations for best practice. London: British Society of Rehabilitation Medicine; 2010.

Connolly P, Stevens T. Get back to where we do belong. 2016.

https://www.disabilityrightsuk.org/sites/default/files/pdf/GetBack30November.pdf

Department for Work and Pensions; Department of Health. Improving Lives: the Future of Work, Health and Disability. London, Department for Work and Pensions; Department of Health, 2017

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/663400/print-ready-improving-lives-the-future-of-work-health-and-disability.pdf

Frank AO, Sawney P. Vocational rehabilitation. J R Soc Med 2003; 96(November):522-524.

Frank AO. Vocational rehabilitation: supporting ill or disabled individuals in(to) work: a UK perspective. Healthcare 2016; 4(46). DOI:10.3390/healthcare4030046

Frank AO. Why should we and how do we support injured individuals back into work? Journal of Personal Injury Law 2017; 4: 217-228

International Underwriting Association of London. The Rehabilitation Code. 2015. https://www.iua.co.uk/IUA_Member/Publications/Rehabilitation_Code.aspx

MASCIP Multidisciplinary Association of Spinal Cord Injury Professionals. Vocational Rehabilitation Guidelines. MASCIP; 2017. https://www.mascip.co.uk/wp-content/uploads/2017/12/Mascip-vocational-rehab-guidelines-NOv-2017.pdf

McNaughton D, Symons G, Light J, Parsons A. 'My dream was to pay taxes': The self-employment experiences of individuals who use augmentative and alternative communication. J Vocat Rehabil 2006; 25: 181-96.

Vocational Rehabilitation Association Vocational rehabilitation standards of practice. High Barnet, Herts: Vocational Rehabilitation Association, 2013; 1-14.

Waddell G, Burton AK. Is work good for your health and well-being? London: The Stationary Office; 2006.

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