Skip to main content Skip to navigation

Improving vocational support for people with long-term conditions

The development of interagency recommendations for best practice

Dr Andy Tyerman, Head of Service, Community Head Injury Service Buckinghamshire PCT
Gail Townsend, Occupational Therapist, Neuro-rehabilitation Services, Buckinghamshire PCT

Way Ahead 2010;14(3):8-9

Man working at a computer

People with neurological conditions may need support from a variety of sources for a range of vocational issues throughout their working lives. Whilst current rates of employment for people with a neurological condition are low, with the right support, many people would be able to maintain their current employment or find suitable alternative occupations. People can draw this support from a diverse range of sources including: statutory services, government agencies, independent and voluntary sectors. In the following article, Dr Andy Tyerman and Gail Townsend describe the development of guidelines to facilitate a coordinated approach in the delivery of effective vocational support services to people with complex needs.


Introduction

Following publication of the National Service Framework (NSF) for Long-term Conditions1 the Department of Health, with support from the Department of Work and Pensions and Jobcentre Plus, commissioned a document to support the implementation of Quality Requirement 6 of the National Service Framework relating to vocational assessment, rehabilitation and support. Interagency guidelines for vocational rehabilitation already existed for people with acquired brain injury2 and it was envisioned that these would provide the basis of a guidance document encompassing a wider range of neurological conditions.


Development of the best practice recommendations

A working group to oversee the development of recommendations was convened by Andy Tyerman and Mick Meehan (Jobcentre Plus) - who had previously been involved in ABI Guidelines - and Dr Vera Neumann (British Society of Rehabilitation Medicine). The group undertook a consultation process involving representatives across a range of sectors and included NHS staff, Employers Disability Forum, vocational providers and a number of specialist practitioners such as disability employment advisors and work psychologists. There was also a consultation workshop for charities representing people with neurological conditions.


What's in the recommendations?

The document is divided into different sections:

  • Introduction and context for the recommendations
  • Literature reviews of exemplars of the four NSF clusters which serve to illustrate particular difficulties. Exemplar conditions used were spinal cord injury, MS, epilepsy and cerebral palsy
  • Explanation of the roles of mainstream services available to support people with vocational needs, for example Jobcentre Plus, Occupational Health
  • Recommendations for best practice (see below)
  • An implementation section to help put some of these recommendations into action. This includes key messages for specific professional groups (ie medical practitioners; community therapy staff including clinical neuropsychologists; and Jobcentre Plus work psychologists). See the key messages for community therapy staff. Other agencies and professional groups are encouraged to identify the key messages for their respective practitioners

Recommendations for best practice

Building on the NSF, the practice recommendations cover specific vocational needs experienced by people with different neurological conditions. The recommendations are divided into nine different sub-sections to account for the diversity of vocational support needs of people with neurological conditions. While the NSF covers what should be provided both by general neurological rehabilitation services and vocational rehabilitation services, these guidelines aim to support practice in all types of service that might offer help at different times and points along the disease trajectory.

The nine sub-sections address the following areas:

  1. General issues such as: disclosure; consent and capacity; open access; and re-access
  2. Identification of vocational need and provision of information
  3. Vocational and employment assessment
  4. Job retention interventions
  5. Return to occupation
  6. Withdrawal from work on health grounds
  7. Preparation for alternative occupation
  8. Transition from education to employment or other occupation
  9. Occupational and educational provision

Implementing the recommendations

The document also includes an implementation plan suggesting the following actions:

  • Local interagency review of available services in the context of the NSF for Long-term Conditions Quality Requirement 6 on Vocational Rehabilitation
  • Development of local referral criteria and protocols, drawing on these guidelines
  • Establishment of ongoing service links to discuss vocational needs of specific clients
  • Review by all relevant professional groups of training in vocational rehabilitation
  • Interagency approach to raising awareness of needs and specialist skills training
  • Research to identify new and effective vocational rehabilitation for this client group
  • Regular audit of provision against the requirements of the Equality Act and the NSF

Key messages for community therapy staff

  1. Therapists assisting people with vocational needs due to a neurological condition should recognise the complexity and variability of such needs, develop their expertise in vocational rehabilitation and establish close working links with the local Jobcentre Plus disability employment advisors, work psychologists, and vocational providers.
  2. After initial disclosure of a neurological condition to an employer people may need ongoing advice and support from the therapists working with them. Therapists should discuss the implications of maintaining work and how best to manage difficulties at the present time and in the future should the condition change.
  3. Therapists need to adopt a flexible, multifaceted approach to vocational assessment which may combine interviews and formal assessments with practical assessment or feedback on work skills, performance and behaviour.
  4. Job retention interventions for those in work should be tailored to the specific needs of the individual. This may include off-site advice, support and review (for those able to manage their own situation) or a worksite assessment followed by implementation and monitoring of specific work adjustments. This often requires information sharing and joint working with the employer and vocational services such as: occupational health; disability employment advisors; work psychologists; Access to Work advisors; and vocational rehabilitation providers.
  5. Where appropriate, when referring to vocational services, therapists should attend the initial appointment to help communicate the complexity of the neurological condition and work needs.
  6. For those seeking a return to a previous occupation, rehabilitation interventions need to focus on the specific skills or behaviours required for work, drawing on material directly relevant to that occupation. A tailored return to work plan including ongoing support and review will often need to be developed jointly with the person and employer or tutor. Therapists play an important role in identifying adaptations, equipment and coping strategies for the workplace.
  7. Therapists need to be alert to the psychological and social impact of decisions to withdraw from work and either provide or refer the individual on for advice and support about alternative occupational and leisure activities.
  8. Most vocational rehabilitation programmes are not tailored to the complex needs of people with neurological conditions. Therefore, therapists need to be proactive in discussing the benefits of making direct contact with vocational providers so that they give advice on and contribute to appropriate interventions.

Summary

These practice recommendations aim to improve vocational support for people with neurological conditions and highlight the importance of a multidisciplinary, multiagency approach in meeting these needs. Practitioners in different areas have different levels of expertise in vocational rehabilitation and the guidelines should facilitate a coordinated approach to delivering effective vocational support services to people with complex needs.

Vocational assessment and rehabilitation for people with long-term neurological conditions: recommendations for best practice will be published by the British Society of Rehabilitation Medicine and Jobcentre Plus - www.bsrm.co.uk.


Acknowledgements

The Guideline Development Group are grateful for the time taken by everyone who contributed towards the development of the best practice recommendations.

References

  1. Department of Health.
    The National Service Framework for long-term conditions.
    London: DH; 2005.
  2. British Society of Rehabilitation Medicine, Jobcentre Plus, Royal College of Physicians.
    Vocational assessment and rehabilitation after acquired brain injury: Inter-agency guidelines.
    London: RCP; 2004.

Return