Early Vocational Rehabilitation after acquired brain injury Judith van Velzen Coen van Bennekom, Max van Dormolen, Judith Sluiter and Monique Frings-Dresen Heliomare rehabilitation center, Departments: Research and Development, and Institute of Vocational Assessment and Education; Academic Medical Center, University of Amsterdam, Department: Coronel Institute of Occupational Health, The Netherlands October 25, 2011 PhD-project 1. What is known about return to work (RTW) after acquired brain injury? 2. Can the rehabilitation center play a role during the process of RTW? 1
Acquired Brain Injury (ABI) Injury to the brain occurred after birth Different causes Focus during research: non-progressive ABI Traumatic Non-traumatic (stroke) Results of ABI Physical Cognitive Emotional or behavioural 2
ABI and return to work ABI is a disabling disease affecting different aspects of life Participation in work is important for many people 40% RTW within 2 years (Van Velzen et al. 2009b) No prognostic factors found in literature (Van Velzen et al. 2009a) What did people with ABI experience in the Netherlands? Qualitative research What are the limiting and facilitating factors experienced by adults with moderate to severe ABI during the process of RTW? Semi-structured interviews 12 people with ABI (2 3 years earlier), working before injury 3
Working situation Work Before ABI After ABI Paid, fulltime n=7 n=1 Paid, parttime n=4 Self-employed, fulltime n=5 n=2 Volunteer day center, parttime n=1 Volunteer, parttime n=1 Not working n=3 Number of hours (median): 40 (36-80) 30 (2-80) Number of days: 5-7 1-7 Results Most mentioned limiting factor: Tiredness Most mentioned facilitating factors: The will to return to work Ongoing recovery Knowledge and support of the employer, colleagues, occupational physician and occupational specialist 4
Conclusions RTW is a complex process in which different aspects were experienced as being important Advice: Give attention to the recovery opportunities of an individual Inform the employer, colleagues, occupation physician and the occupational specialist about (the possible consequences of) ABI Support people with ABI for long time periods An important role can be played by the rehabilitation centre Early Vocational Rehabilitation (EVR) A process guideline to focus systematically on return to work in an early stage of (inpatient or outpatient) rehabilitation Main goal is getting (more) people faster and more effective back to work 5
Characteristics of EVR Vocational rehabilitation specialist Systematic attention on RTW during an early stage of (inpatient or outpatient) rehabilitation Multi-disciplinary training of specific working skills during rehabilitation Employer and occupational physician are involved Steps of EVR Step 1: Exploring the working situation Step 2: Exploring possibilities of RTW Step 3: Work training Step 4: Stop of EVR 6
Step 1: Exploring the working situation First contact (rehabilitation) physician First contact vocational rehabilitation specialist Exploration: Was the patient working before ABI? Does the patient want to return to work? What are the goals of the patient concerning (return to) work Is the vocational rehabilitation specialist allowed by the patient to contact employer and occupational physician? Step 2: Exploring possibilities of RTW Vocational rehabilitation specialist visits employer Vocational rehabilitation specialist contacts occupational physician Overview of job requirements is made Overview capabilities patient is made by members of the rehabilitation team Matching job requirements and capabilities to explore possibilities of RTW 7
Step 3: Work training Decision about work training is made by multidisciplinary rehabilitation team Goals for vocational rehabilitation are set If applicable: training with worksamples starts Work training (1) During rehabilitation (started in the rehabilitation center) Multidisciplinair (with occupational therapist, cognitive trainer and vocational specialist) 2 stages: 1. Basic skills (for all kinds of work) 2. Specific work related training If possible followed by training on the workplace under accompaniment (for example of a jobcoach) 8
Work training (2) Physical worksamples Work training (3) Cognitive worksamples 9
Work training (4) The capabilities of the patient and the goals for vocational rehabilitation are discussed every patient discussion A decision is made whether work training should be continued (or started if not started before) If necessary, goals for vocational rehabilitation are adjusted or EVR is stopped Step 4: Stop of EVR EVR stops if: patient returned to (former or alternative) work partly or completely or is not able to (train) work at all or regular rehabilitation process stops 10
Step 4: Stop of EVR Opinion of rehabilitation team concerning possibilities of RTW written down in rehabilitation vision Rehabilitation vision transfered to patient, employer and occupational physician by vocational rehabilitation specialist If necessary, appointments about further treatment or (job)coaching are made Overview of EVR over time ABI Start rehabilitation 1 st patient discussion 2 nd patient discussion N-th patient discussion End of rehabilitation Start EVR Intake physician Intake vocational rehabilitation specialist Matching + decision work training Overview capabilities Visit employer + overview job requirements + contact occupational physician Rehabilitation vision + transfer to patient, employer and occupational physician 11
Example (1) Step 1: Exploring the working situation Man, stroke (main problems: attention, concentrating, performing dual tasks, tiredness) Former job: manager in a busy store of a large company Question: Wanted to return to (another) job Step 2: Exploring possibilities of RTW Matching job requirements and capabilities former job not possible (at the moment) Example (2) Step 3: Work training Employer and occupational physician suggested alternative job training with a computer system Training started during rehabilitation, later also on workplace (office) Step 4: Stop of EVR According to advice mentioned in rehabilitation vision patient working with help of jobcoach 12
Future of EVR EVR now used in Heliomare EVR recently written down in a book EVR is ready to be implemented in other rehabilitation centers Evaluation study started Comparison with other method %RTW, satisfaction, costs In conclusion RTW within 2 years possible for 40% of the people after ABI RTW is a complex process Knowledge and support of the employer, colleagues, occupational physician and occupational specialist are important according to people with ABI An important role can be played by rehabilitation center EVR method can help to focus systematically on return to work in an early stage of rehabilitation 13
For more information Van Velzen, J. M. et al. (2009). How many people return to work after acquired brain injury?: A systematic review, Brain Injury, 23:6, 473-488. Van Velzen, J. M. et al. (2009). Prognostic factors of return to work after acquired brain injury: A systematic review, Brain Injury, 23:5, 385-395. Van Velzen, J.M. et al. (2011). Factors influencing return to work experienced by people with acquired brain injury: a qualitative research study, Disability and Rehabilitation. [Epub ahead of print] Thank you for your attention Are there any questions? j.van.velzen@heliomare.nl 14