When is Occupational Therapy Right for Vocational Rehabilitation
by Catherine Hayden
We are proud to work with many case managers throughout the country to provide vocational rehabilitation services to their clients. However, from our conversations with the case management community at the enquiry stage, it is clear that there are some knowledge gaps in when OT skills are the right solution for clients in terms of vocational rehabilitation and when another professional is the better solution. The aim of this article is to provide the reader with a foundation level of understanding about the role of occupational therapy within the field of vocational rehabilitation.
The World Health Organisation International Classification of Functioning defines vocational rehabilitation as ‘ a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimise work participation’ (Escorpizo et al, 2011). Put more simply, the UK government described vocational rehabilitation as ‘whatever helps someone with a health problem to stay at, return to and remain in work’ (Waddell, Burton & Kendall, 2008).
According to the vocational rehabilitation association (2023), vocational rehabilitation may involve multidisciplinary interventions to support individuals with physical, psychological and/or social difficulties who are:
- Experiencing difficulties entering the workplace.
- Having difficulty within their current job.
- Out of work but seeking to gain employment.
The UK government stated that ‘vocational rehabilitation, consisting of physiotherapy and occupational therapy, and related professions and services, can play a pivotal role in supporting people to get into work, and preventing them from falling out of work due to health reasons or disabilities’ (DWP and DoH 2016).
What is the role of occupational therapy in vocational rehabilitation?
Evidence suggests that vocational rehabilitation improves return to work for conditions such as spinal cord injuries, back pain, brain injuries and mental health conditions (Kettlewell et al, 2021). Having received training in physical and mental health, occupational therapists support those living with mental health conditions, physical conditions or learning disabilities (RCOT, 2023). Using a biopsychosocial approach, occupational therapy focuses ‘on the person (eg physical, psychological, social); their environment (eg physical, social, societal, cultural, economic, attitudinal), and their occupations (ie the activities people want to, need to and are expected to do)’ (Hammond et al, 2022). Given the aim of vocational rehabilitation is to support individuals with physical, psychological and social difficulties to return to work, occupational therapy training and expertise supports occupational therapists' key role in vocational rehabilitation.
Occupational therapists are able to work with individuals experiencing challenges as a result of accidents, illnesses, disability, trauma, learning needs and due to the process of ageing to help individuals to live as fully and independently as possible, which would include employment and other meaningful activities. Sheppard and Frost (2016) stated ‘vocational rehabilitation is becoming an increasingly common area for occupational therapists to be employed; quite logical given the overarching goal of occupational therapists – to enhance independence with daily activities’. Occupational therapists can provide targeted advice and support using the Person, Environment, Occupation (PEO) model, supporting people and employment services to understand the relationship between a person’s health and the work activities that they carry out in a work environment (RCOT, 2019). Evidence also supports the use of commonly recognised models in occupational therapy, such as the model of human occupation (MOHO) (Lee and Kielhofner, 2010) and the Canadian Occupational Performance Measure (COPM) in vocational services (Svajger and Pisker, 2016).
‘In the vocational rehabilitation setting, an occupational therapist’s role encompasses identifying physical, social and psychological strengths and potential barriers to resuming work and implementing strategies to address these barriers. This may involve engagement with treating professionals, employers and making necessary modifications to the workplace or nature of work’ (Sheppard and Frost, 2016).
Who may benefit from an occupational therapy referral?
A referral for an occupational therapy assessment could be considered for individuals :
- who are no longer able to return to their previous place of employment following an accident or illness,
- who may benefit from a period of rehabilitation to manage symptoms and enable them to be ready to return to or look for work, through the provision of strategies and techniques to support them in the work environment,
- for assessment and advice regarding adjustments and/or adaptations to the work environment to support return to work and to remain in work,
- for support regarding the management of a long-term health condition at work,
- for support in returning to previous meaningful activities or in identifying new activites prior to returning to paid employment.
What does the occupational therapy approach to vocational rehabilitation involve?
When an individual is referred to The OT Practice for vocational rehabilitation the occupational therapist will review the client’s needs prior to planning their input. Occupational therapy assessment and intervention will be individualised to each client, depending on factors such as their health issues, their functional strengths and limitations, their work skills and the type of job they wish to pursue. Occupational therapy may be provided face to face (for example for workplace assessments and functional assessments) or remotely (for treatment sessions, goal setting and liaison with others).
Below outlines the types of vocational rehabilitation intervention that can be provided by an occupational therapist when a client is referred to The OT Practice for vocational rehabilitation:
Functional assessment
- In-depth assessment of the individual’s subjective and objective physical, cognitive, psychosocial ability.
- Advice regarding the client’s function compared to the requirements for the client’s work role.
- Provision of advice on job suitability for a client’s current work following assessment of function.
- Provision of advice on possible types of job suited to an individual’s functional ability.
- Provision of an in-depth report outlining the individual’s functional ability and the impact on work and associated recommendations.
Workplace assessment
- Review of the job requirements; analysis of the job; assessment of postures, tasks, tools and equipment; observation of the work environment and observation of the client at work to allow the occupational therapist to gain an understanding of the work role and any specific issues.
- Assessments would include the client’s subjective report and the occupational therapist’s objective assessment. Employers may also be involved in the assessment.
- Provision of advice on equipment, adaptations and reasonable adjustments to support a client in the workplace.
- This could include the provision of a workstation assessment and advice on equipment or strategies to support the client’s comfort at work.
- Could take place at the point of referral or after a period of rehabilitation when the client is ready to return to their previous employment or a new role is identified.
- Provision of an in-depth report outlining the suitability of the work role and environment in comparison to the individuals’ functional needs, outline any risks and provide associated recommendations.
Liaison with others involved in the client’s care
- For example, the employer, occupational health, human resources, Access to Work, vocational consultants/ job coaches, or other health care professionals involved in the client’s care.
- The aim is to ensure joined up care for the individual and that the individual has access to the most appropriate care for their needs.
Goal setting
- Working with a client to set realistic goals and a plan to achieve this.
- Working with other treating specialists to ensure joined up care.
- May involve a recommendation to refer a client to other professionals for support if the goal is not occupational therapy specific.
Rehabilitation
- Education regarding symptoms.
- Occupational therapy support to aid symptom management and to increase the client’s functional skills and ability to manage ongoing symptoms as required to return to work.
- Intervention to support the management of symptoms such as pain, fatigue, cognition, functional ability (upper or lower limb, including mobility) mood, anxiety and reduced confidence which may impact on a client’s ability to return to work.
- Support the client to develop a routine at home that will aid their readiness to return to work, for example getting up at the time required to work and encouraging an increase in their participation with day-to-day tasks at home and in the community.
- Practice work-based tasks to aid work readiness. This may include support to set up work tasks in the client’s home to allow them to practice.
- If the client is employed the occupational therapist may support them to maintain contact with their employer to aid the transition back to work.
- Recommendations for referral to other professionals if appropriate to the clients needs.
Advice on workplace adjustments
- This could include advice regarding adjustments to work tasks, work hours or the work environment for example to support a client’s ability at work.
- Advice on graded return to work plans.
- Liaison with the employer regarding symptom management at work.
- Advice on condition management in the workplace.
- May include advice on access, adaptations and specific equipment needs. This may include software to support technology needs.
- Recommendations for follow up in the workplace if required.
Ongoing support
- Through graded return to work (for client and employer).
- Provision of further advice on adjustments if required.
- Referral to other agencies for support (eg Access to Work or coaches).
Identifying the correct employment service for a client when it isn’t OT
When considering a client’s vocational needs it is important to consider which employment service is most appropriate for the individual’s needs. Occupational therapy may not be required in some instances, for example if information on the client’s functional ability is not required. Examples of other services include:
Vocational consultants / work coaches: These services can support individuals to find jobs suited to their functional ability. Referral to this type of service may be appropriate if a client has reached their maximum functional ability and a clear indication of the type of work role that may be suitable has already been established. Vocational consultants / work coaches may provide clients with support for tasks such as:
- development of a professional CV,
- job searching guidance and assistance regarding the local job market and the skills employers are looking for,
- support to access courses and training,
- job matching and applying for jobs,
- preparing for interviews
- liaising with employers regarding work support and reasonable adjustments for health issues.
Occupational health: Occupational health services are concerned about the impact of work and the work environment on the workers physical and mental health and how the workers’ health impacts on their ability to complete their job (Health and Safety Executive, 2023). The society of occupational medicine (SOM) (2023) reported that occupational health services may include:
- Provision of independent advice for staff unable to work due to short- or long-term health issues.
- Advice on reducing sickness absence in organisations.
- Advice related to fitness to work, ill health retirement, capability, dismissal or ill health retirement.
- Advice on compliance under the Equality Act 2010 and reasonable adjustments.
- Carry out pre-employment assessments.
- Complete statutory health surveillance.
- Develop health and wellbeing documents.
When a client is returning to work and their employer has access to an occupational health service, their advice is beneficial as they will have knowledge of the job the client is returning to and other jobs within the organisation that may be more suitable. Many occupational health services have access to a multidisciplinary team, including occupational therapists who are able to provide advice on their function related to employment opportunities within the workplace. When advice is required on an individual’s fitness to work from a medical perspective, occupational health advice would be recommended.
Access to Work: Access to Work is a government scheme which aims to support people to get jobs and remain in work for individuals with physical or mental health conditions. An assessment can be provided to identify the client’s work needs and money can be provided to support physical or mental health needs in the workplace. Referral to this service would occur after a client has a job.
If an individual does not have a job, is not ready to return to work, if they need to consider other options for work outside of their current organisation or other meaningful occupations, an occupational therapy referral for vocational rehabilitation would be most appropriate. This service can offer more in-depth intervention including assessment of function, goal setting and treatment sessions to support readiness for return to work. Occupational therapists can work with a client to assess the suitability of other job roles, provide workplace assessments, advice on adjustments and follow up after return to work to support a client longer term. Occupational therapists providing vocational rehabilitation can work independently or alongside occupational health, Access to Work, work coaches and other multidisciplinary services as required, to provide this support.
Conclusion
Occupational Therapists training, their aim to enhance participation and independence with day-to-day activities and their expertise in functional assessment, equipment and adaptations gives them the skills required to support clients to stay in work, return to work or identify more suitable work (or other meaningful activity). For this reason, utilising occupational therapy intervention for clients who are unable to work as a result of an accident or ill health is beneficial and can provide positive outcomes for clients experiencing vocational difficulties.
References
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Escorpizo R, Reneman M, Ekholm J, Fritz J, Krupa T, Marnetoft S, Maroun C, Guzman J, Suzuki Y, Stucki G & Chan C (2011). A Conceptual Definition of Vocational Rehabilitation Based on the ICF: Building a Shared Global Model. Journal of Occupational Rehabilitation, 21(2): 126-133
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Health and Safety Executive (2023) (online).(accessed 10 March 2023)
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Kettlewell J, Timmons S, Bridger K, Kendrick D, Kellezi B, Holmes J, Patel P and Radford K (2021). A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK. Clinical Rehabilitation, 35(5): 750 – 764.
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Lee J and Kielhofner G (2010). Vocational intervention based on the Model of Human Occupation: a review of evidence. Scandinavian Journal of Occupational Therapy, 17(3): 177-90.
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Royal College of Occupational Therapists (2019). Good work for good health, the difference occupational therapy makes. RCOT, London.
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Sheppard DM & Frost D (2016). A new vocational rehabilitation service delivery model addressing long-term sickness absence. British Journal of Occupational Therapy 79(11): 677–681.
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SOM (2023). What is occupational health? (online)(accessed 11 March 2023)
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Svajger A and Piskur B (2016). The clinical utility of the Canadian Occupational Performance Measure in vocational rehabilitation: A qualitative study among occupational therapists in Slovenia. Work 54 (1): 223–33.
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