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A professional’s guide to Vocational Rehabilitation

by Anthony Yuill

Introduction

This guide has been produced to assist case managers in understanding the place of vocational rehabilitation in occupational therapy.

Vocational rehabilitation has been thoroughly explored in professional and academic literature, and some suggestions for further reading are provided at the end of this guide. The present writer has been able to draw not only from that literature, but also from years of practical, clinical experience of the field, which itself sits at the very heart of occupational therapy.

What is vocational rehabilitation?

As well as providing financial rewards, engagement in work (like many other meaningful activities) has health benefits for the individual and can aid recovery from physical or mental health problems. Vocational rehabilitation is the process by which someone who has suffered illness, injury or disability is helped to return (or to remain in) their professional vocation. This process may draw from a wide range of possible assessments, interventions and services provided by a range of healthcare professionals and others.

Drawing together perspectives from the Vocational Rehabilitation Association and other professional bodies, the process may include:

  • Client assessment at home or work
  • Workplace evaluation and job analysis
  • Goal setting and intervention planning
  • Mitigating the medical consequences of an injury or disability
  • Support for self-management of health conditions
  • Health advice relevant to returning to work
  • Workplace modifications
  • Injury prevention
  • Psychological intervention
  • Career counselling and job placement services
  • Programme evaluations and research

What is the role of occupational therapy in vocational rehabilitation?

From the list above, it is evident that the stages of vocational rehabilitation, and the interventions on which it relies, are precisely those which lie at the core of occupational therapy itself, which is defined by the College of Occupational Therapists as “the health and social care profession that takes a whole person approach to both mental and physical health and well-being, enabling individuals to achieve their full potential”. At the heart of this process is the goal of maximizing a client’s independence in the face of whatever obstacles their individual circumstances present1.

Occupational therapists (OTs) thus work with adults and children of all ages and with a range of conditions, providing practical support in their recovery from injury and illness and in overcoming barriers that prevent the pursuit of activities (“occupations”) that matter to them. These occupations are broadly categorized as belonging to one or more of three life area: self-care, work and leisure.

The aim of occupational therapy therefore clearly includes that of vocational rehabilitation, which addresses the second of these three life areas, involving practical and purposeful interventions that promote recovery and overcome barriers to participation in work. Before recommending any such interventions to a client or their employer, an OT will first determine the extent to which a client has the functional, psychological and emotional capacity to complete their employment duties. They will do this by gathering detailed information on their health, medical or employment history, and their current ability with everyday job-related tasks. They will visit the client both at home and in the workplace, and after which the OT will produce what is termed a Vocational Evaluation.

However, as the College of Occupational Therapists (2015) notes, extended periods away from work arising from long-term illness, and the associated loss of income which results, are also correlated with social isolation, mental distress and other factors affecting both leisure and even self-care. It is essential therefore that an OT working in this field have regard to its interrelationships with the other two life areas, of self-care and leisure, in order to be consistent with the “whole-person approach” which defines their profession.

Supporting the return to work

A helpful document from the British Society of Rehabilitation Medicine (2010)2 lists a number of factors which an OT will wish to consider in planning support for a client returning to work. Their recommendations will typically form what is usually referred to as a Vocational Rehabilitation Plan or Return-to-Work plan.

Numerous tools and approaches exist to assist therapists in carrying out the best possible assessment of a client’s vocational circumstances, which may be conducted either at home or at their workplace. In any case, full consideration will be given to a client’s background, the nature of their illness or injury, information contained in any referrals, and also to the input of an important third party whose support is likely to prove crucial - the client’s employer.

Impairments to activity

Whatever assessment tool is adopted, the focus of occupational therapists’ work in vocational rehabilitation - indeed, the purpose of most of their expertise in this field - is on mitigating the effects of any impairments to a client’s physical and mental abilities insofar as these affect their ability to carry out work tasks. This may be achieved, for example, through the use of assistive technology, developing alternative techniques of work or changes to the workplace environment where these tasks take place.

Nevertheless, although impairments to activity may be mitigated to a very great extent in many cases, it is likely that some limitations will inescapably arise, and it is essential that clinical reasoning is driven by a realistic appraisal of the client’s circumstances. Consideration of these circumstances will involve not only their present level of impairment, but on the prognosis for the future - whether their condition is likely to result in increasing, decreasing or stable function, and what the prospective timescale of any changes might be. The British Society of Rehabilitation Medicine (2010) uses the example of a client with Multiple Sclerosis. In the early stages of this condition, work activity is likely to be affected by increasing fatigue, anxiety and depression, giving way to experiences of muscle weakness and difficulties with balance. Periods of remission are nonetheless common, in which decreased impairment and improved function are likely.

With conditions such as MS, the pathology ultimately places limits on the length of time a client may expect to continue being able to work, but a real difference may nonetheless be made to a client’s participation in the meantime. In the case of other conditions, there is every chance that improvements to client participation made possible by the intervention of an occupational therapist may continue indefinitely. By proper consideration of the prognosis therefore, any return-to-work programme put in place has a greater chance of succeeding for the client both now and in the longer term.

Environmental factors

As we have already seen, the physical environment faced by a client at work can make all the difference to their effectiveness. In terms of the physical environment, the OT may consider whether environmental barriers present themselves in the form of, for example, adverse lighting, noise levels, enclosed spaces, transportation arrangements and so on. If so, they will bring their expertise to bear in identifying realistic and cost-effective ways for these to be overcome (possibly, as already mentioned, through the use of assistive technology).

The social environment at work can be as important for employee wellbeing and productivity as the physical environment. A client experiencing anxiety or stress may feel especially vulnerable in open-plan office spaces, or find participating in social activities through work especially difficult. Better understanding of their condition by employers and colleagues can often make all the difference in these circumstances - another, less concrete but possibly equally important, environmental change an OT can be instrumental in bringing about.

Confidentiality considerations

Careful consideration of client confidentiality should always be given before any decision to disclose information to interested third parties such as employers. All OTs adhere to a Code of Ethics which places the client’s wishes - as well as their rights and responsibilities - at the centre of professional practice, and the client may not believe it is in their interests to disclose every detail of their condition to their employer, especially if they anticipate that an adverse or unfair judgement may be made as to their suitability for certain work-related activities. This is particularly relevant with individuals who experience work-related stress, anxiety and/or depression.

On the other hand, the effectiveness of any vocational rehabilitation programme inevitably depends on the degree of involvement and support from an employer, and so an OT will want to ensure that they too have sufficient understanding of the client’s circumstances in order to properly support them. Moreover, certain job roles necessarily require certain medical requirements to be fulfilled in order that they can be carried out safely and effectively.

It is the responsibility of an occupational therapist to advise their client responsibly, with proper regard for their rights and responsibilities under the law of both employers and employees. Further information relevant to such advice can be found by consulting the Equality Act 20103.

Ongoing support and Job retention

In some cases clients may remain employed, yet continue to experience enormous difficulties with aspects of their duties even after the intervention of an OT. Therapists should therefore monitor their client’s progress after an initial intervention programme to weigh its success in addressing their needs, identifying any ongoing areas of difficulty and making fresh recommendations when necessary. As part of this process, and with the consent of the client, the therapist may also liaise with the employer, to establish their own expectations and keep them informed of any ongoing therapeutic programmes.

Inevitably, there will be cases where the return to a client’s former employment proves impossible. An occupational therapist will then wish to explore with them alternative options that meet, as far as possible, their needs and abilities, and arrange suitable careers advice and counselling relevant to making the most of their changed circumstances.

Conclusion

Within this guide we have presented an overview of the role of the occupational therapist in vocational rehabilitation, and the kinds of expertise and help that they can be expected to offer those seeking to return to work after illness or injury.

For further details on vocational rehabilitation please visit the Vocational Rehabilitation Association website, where you can download their free Standards of Practice document (www.vra-uk.org).

To discuss how The OT Practice might assist your clients in the area of vocational rehabilitation, please contact one of our dedicated Client Managers on 0330 024 9910 who will be able to discuss in detail how we can support you in delivering the best possible service to your clients.

Frequently Asked Questions (FAQs)

How can The OT Practice help with vocational rehabilitation?

The OT Practice has a large network of occupational therapists throughout the UK with enormous experience of the vocational rehabilitation process, and in all of the areas discussed in this guide. We are therefore likely to be able to recommend an OT with precisely the necessary clinical expertise relevant to your individual client, ensuring that any intervention programmes recommended will be both clinically effective and cost-efficient.

What would follow an initial phone call to The OT Practice?

A prospective vocational rehabilitation programme would usually begin with an initial conversation to determine the health and social needs you are looking to address. A functional assessment of your client might then, with your agreement, be arranged to determine their personal goals, prior to any fuller vocational evaluation you may then wish to arrange.

This initial assessment would allow our OT, in conjunction with you and your client, to map out a possible therapeutic plan of structured intervention. This would then, of course, be discussed and agreed with you prior to any implementation.

Once a vocational rehabilitation programme was agreed, how would it move forward?

Having established with you and your client a suitable vocational rehabilitation programme, our OT would then take clinical responsibility for its implementation while routinely updating the case manager via their preferred communication method. The OT will monitor your client’s progress in relation to their work-related goals, and modify the planned interventions when necessary - although wherever these modifications would have a significant cost implication, they would first be agreed with the case manager.

On completion of the initial goals, the client might then be discharged if appropriate, following a robust final report forwarded to yourself detailing the specific therapeutic interventions made and their outcome. Alternatively, if further rehabilitation is required, then new therapeutic goals would be established following the same transparent process.

What is the likely cost of vocational rehabilitation?

Of course, the costs of vocational rehabilitation depend on the extent of an individual client’s needs and the kinds of interventions they entail, but all costs will be agreed with you prior to any programme being implemented. This will guarantee you control over your costs, and ensure you and your client receive the service you need within the budget available.

We understand very well the budgetary constraints facing case managers, and the necessity for forward-planning and transparency in costs. So for a clear idea of the likely costs of a vocational rehabilitation programme provided by The OT Practice, please call us on 0330 024 9910 to discuss your specific requirements with one of our Client Managers.

References

Lloyd, C., Vocational Rehabilitation and Mental Health (Wiley, Blackwell, 2010)

Creek, J., Occupational Therapy and Mental Health (Churchill, Livingstone, 2010)

Duncan, E. Foundations for Practice in Occupational Therapy (Churchill, Livingstone, 2011)

Suggestions for further reading

College of Occupational Therapists, Working is Good for You (2015) - available via COT website

Vocational Rehabilitation Association, Standards of Practice and Code of Ethics for Vocational Rehabilitation Practitioners (2013) - available via VRA website

College of Occupational Therapists (Specialist Sections – Work), Occupational Therapy in Vocational Rehabilitation: A Brief Guide to Current Practice in the UK (2009) - available via COT website

College of Occupational Therapists, Work Matters: The College of Occupational Therapist’s Vocational Rehabilitation Strategy (2014)

Useful web links

College of Occupational Therapists (COT) cot.co.uk
British Association of Rehabilitation Companies thebarc.co.uk
British Association for Supported Employment base-uk.org
Healthy Working Lives healthyworkinglives.com
Remploy remploy.co.uk
The Shaw Trust shaw-trust.org.uk
UK Rehabilitation Council rehabcouncil.org.uk
Vocational Rehabilitation Association (VRA) https://vrassociationuk.com


  1. See Creek (2014) and Duncan (2011) ↩︎

  2. To read the full document, visit www.bsrm.co.uk ↩︎

  3. This can be downloaded from www.legislation.co.uk ↩︎

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