Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.     

Prediction of vocational outcome of people with brain injury after rehabilitation: a discriminant analysis

Due to advancements in emergency evacuation procedures and neurosurgical techniques, more patients with brain injury (BI) can survive cerebral injury and regain a satisfactory degree of recovery through rehabilitation. Their improvement in physical and cognitive functions can facilitate their reintegration into the community, especially their return to work (RTW). Different factors were reported to affect this rate of RTW in previous studies. This retrospective study thus aimed to investigate the role of demographic data, the severity of injury, residual physical deficits, activities of daily living, and cognitive function using a stepwise discriminant function analysis (DFA). Data sets for 79 persons with BI were retrieved so as to identify predictors of their vocational outcomes upon discharge and during a follow-up period. The stepwise DFA revealed that the discharge score on the Disability Rating Scale (DRS), the attention-subtest of the Neurobehavioral Cognitive Status Examination (NCSE) or Cognistat, and pre-morbid occupation were significant predictors that correctly classified 65.8% of the subjects.     

Multi-professional vocational rehabilitation group meetings with female clients: a qualitative study

Many women require vocational rehabilitation before they can return to work. The objective with the present study was to describe female clients' situation during the rehabilitation process, as it became apparent during the rehabilitation meetings with the various actors involved. The clients' diagnoses varied, but the majority was affected with musculoskeletal disorders. The meetings were audio-taped and transcribed verbatim, after which they were analysed by qualitative content analysis. The following themes emerged: Adaptation to the rehabilitation group; client's health status; the workplace's significance for rehabilitation; and the client's decision-point. Conflict between health and work was immensely important for rehabilitation. Differences in attitude were apparent during the rehabilitation meetings, as some clients were passive and exercised less influence on the planning, than the other more active clients did.     

Individual status at the start of rehabilitation: Implications for vocational rehabilitation programs

This research investigated the situation of 143 unemployed sick leavers at the start of vocational rehabilitation in Sweden. It is argued in this paper that in order to gain a meaningful picture of the vocational rehabilitation process it is necessary to know and understand something of individual differences and status at the onset. In doing so, assessment was carried out of the possible influence of one contextual factor and five individual factors on health, duration of sick leave and unemployment. Findings suggest that individual differences exist in health status, length of sick leave and unemployment, at the upstart of vocational rehabilitating. Locus of control was found to exert important influence on the differences between the individuals in the study sample, with persons of external locus of control having a less favourable point of departure at the start of vocational rehabilitation compared to other groups. It is therefore assumed that these persons will be in greater need of support during the vocational rehabilitation process. The level of unemployment within a geographical area was also found to influence the length of sick leave. CONCLUSIONS: Our suggestion is for rehabilitation programs to be developed and selected to match the special needs and differences whether they are of individual or of social nature.     

Disability and job stress: Implications for vocational rehabilitation planning

Because people with disabilities often experience an increased risk for physical and psychological complications of job stress, vocational rehabilitation professionals must be able to (a) identify individual and work-environmental risk factors for job stress and (b) design appropriate interventions to minimize those risk factors. The purpose of this article is to (a) present two models of occupational stress, (b) examine factors common to each of these models that are associated with employee health and well-being, and (c) suggest implications for rehabilitation planning.     

A new approach in vocational rehabilitation in Iceland: preliminary report

The lack of vocational rehabilitation in Iceland inspired the Janus Rehabilitation initiative in the year 2000. The team currently consists of two occupational therapists, a social worker, a physiotherapist, a psychologist, and a physician. Janus uses resources from local education establishments and is located at the Reykjavík Technical School. A client-centred approach is used, enabling a flexible rehabilitation timeframe. The aim is to help the client back to employment/education. Advantage is taken of the facilities of the school where integration between education and rehabilitation takes place. Forty individuals have been admitted, with a mean time from work of 2.9 years, (range: 0-11 years). Seventeen (43%) have returned to employment/education. Twenty-three of those entering the programme are still on invalidity pension. The Canadian Occupational Performance Measurement (COPM) shows improvement in occupational performance and satisfaction. The Icelandic Quality of Life measurement also shows improvement. The results have been promising. However, a larger group is needed in order to draw clear unequivocal conclusions.     

Going beyond vocational rehabilitation as a training of skills: return-to-work as an identity issue

In western welfare states, labour participation is increasingly considered a vital aspect of taking part in society. Vocational rehabilitation programmes are intended to support people in the process of returning to work. These programmes pay much attention to the skills that clients need to develop in order to return to work. We argue, however, that vocational rehabilitation is more than the acquirement of skills, and that further attention should be paid to clients’ ‘identity work’ processes. Based on 45 life-stories, we present an analysis of the identity work expressed by people with a work disability in the Netherlands. We describe ‘separative’, ‘integrative’, and ‘pending’ processes of identity work. The presented typology can help vocational rehabilitation professionals become more sensitive to clients’ processes, and supports more inclusive vocational rehabilitation.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

When considering vocational rehabilitation: describing and comparing the Swedish and American systems and professions

Rehabilitation of functionally impaired in Sweden and the United States is compared and contrasted. Found is that there are fundamental differences in strategies. The Swedish system most often uses a medically oriented multidisciplinary team approach. The US system most often uses a single individual, the vocational rehabilitation counselor, to work with functionally impaired in helping them return to work. Emphasized is that a vocational rehabilitation counselor uses a unique array of skills that is not duplicated in Sweden by a single profession. Suggested is that a single person with a range of skills can more economically provide vocational rehabilitation services to those with functional impairments; whether this is practical for Sweden is yet to be determined. In contrasting the two systems it was evident that the US system has been in operation for a much longer time and that the Swedish system is maturing. Noted is that the governments of both countries are feeling pressure regarding funding of vocational rehabilitation. This is affecting the level and quality of services. The authors advocate wider contact between Swedish and US university-level training programs in rehabilitation. Felt is that each system has strengths and knowledge that can be used to benefit the other.     

Evaluating the vocational rehabilitation program using longitudinal data. Evidence for a quasiexperimental research design.

The study presents benefit-cost ratios for 14 disability cohorts served by the Vocational Rehabilitation (VR) Program. The earnings impacts are estimated in a quasiexperimental framework using an internal comparison group. The earnings data are from a unique national panel constructed by linking client data of the Rehabilitative Services Administration with earnings histories from the Social Security Administration. These earnings data accommodate a series of statistical tests that allow us to identify and control for the presence of selection bias when estimating treatment impacts. The results indicate that the VR program is cost-effective in general, although not universally so across specific disabilities.     

Evaluation of a Goal Attainment Program using the Goal Attainment Scale for Psychiatric In-patients in vocational rehabilitation

The purpose of this study is to evaluate the newly developed clinical protocol "Goal Attainment Program" to assist psychiatric in-patients in Hong Kong to formulate realistic life goals, with a view to shortening their length of stay and motivating them to join in work rehabilitation. The Goal Attainment Scale for Psychiatric In-patients was validated and used to evaluate the change in life goals after attending the four-session Goal Attainment Program. The validated 10-item version of the Goal Attainment Scale for Psychiatric In-patients (GASPI-10) was found to have good inter-rater reliability (rho_{I} ranged from 0.64 to 0.88,p < 0.01; N = 26) and internal consistency (alpha of rater 1 = 0.92, rater 2 = 0.87, N = 26). Twenty-five chronic psychiatric in-patients of Castle Peak Hospital in Hong Kong completed the Goal Attainment Program and were assessed using a pre and post-test quasi-experimental design. The T-score computation of GASPI-10 indicated that 92% of patients showed improvement in goal attainment. Some 92% of patients stated that they were willing to leave hospital, and 72% of participants planned to seek paid employment upon discharge after completion of the program. The overall results of this study verified the effectiveness of the Goal Attainment Program in instilling hope in chronic patients with schizophrenia and the use of the Goal Attainment Scale in documenting patients' progress.     

A new model for vocational rehabilitation at an organizational level -- a pilot study with promising results

Sick leave has negative economic consequences for companies. The aim of this study was to implement the model Organizational Rehabilitation in two departments at an industrial company in the county of J?mtland, Sweden, to see if it was possible to reduce the costs due to sick leave. The rehabilitation model consisted of three steps and combined economy and productivity with a good psychosocial work environment, measuring the result in costs. Step 1 consisted of a problem inventory among all co-workers, step 2 semi structured interviews with all co-workers regarding how they experience their work environment and step 3 individual agreements regarding rehabilitation interventions, i.e. interventions where the individual's specific needs and wishes outlined the foundation for rehabilitation measures with the objective of increasing work capacity. The costs were measured at the start and end of the project. The study showed that it is indeed possible to reduce both sick leave and costs. During the study, the organization reduced current sick leave from 12% (2003) to 3% (Nov. 2004) and the costs per employee from euro1 860 per month (2003) to euro440 per month (Nov. 2004). This will make an estimated saving for 2005 of euro470 000. It should be noted that the study is small and should not be generalized, but may be seen as a positive indication regarding the model organizational rehabilitation. Further research is needed.     

Further developments in Societies for Clinical Social Work: A ten-year follow-up study

In 1973, the first report of the development of Societies for Clinical Social Work was published, describing a fledgling movement among clinical workers across the nation. The present survey offers parallel data on that movement ten years later. The movement apparently continues robust growth, and seems more tightly focused on very specific goals which rank highly with society members and their leaders, particularly vendorship issues and education for clinical social work. The opinions of members of these societies suggest that they are firmly identified with social work history, education, and values, but are committed to parity with other independent professionals in the field of psychotherapy.The address of the Washington office of the National Federation of Societies for Clinical Social Work is 2101 L. Street N. W., Washington, D. C. 20037. Ken Adams of Dickstein, Shapiro & Morin is the Legislative Representative and Karen Corey is the Administrative Assistant: phone (202) 785–9700.