HEALTH AND WORKScoping the contribution of NHS Lothian

 

Examples in practice  

The West Lothian Rehabilitation and Brain Injury Service 

Elizabeth Newbigging, OT, May 2010

 

Overview of presentation

•Share information to other resources within Lothian that currently provide vocational

rehabilitation

•Who is CRABIS?

•What CRABIS has to offer the population within West Lothian?

•How CRABIS provides vocational rehabilitation to those referred to the service

•Describe the pathway for a client through the Service

•How does CRABIS sit within the larger umbrella of vocational rehabilitation within Lothian?

•Strengths

•Limitations

•Next steps

•Contacts

Overview of the service provided by CRABIS

•Operational 1 February 2000.

•Currently in its 11th year.

•Celebrated 10th anniversary on 24 February 2010.

•Joint funded through Lothian Health. West Lothian Council and Mental Health Specific

Grant.

•Managed within West Lothian Community Health and Care Partnership under senior

management of the Chief Nurse.

Aim of Service

 

•To provide multi-disciplinary community based rehabilitation to individuals over the age of

16 within West Lothian.

 

•To work with service users to increase their level of function, independence and

participation, thereby improving quality of life and community reintegration.

The Team

•Service Manager

•Occupational Therapists

•Physiotherapists

•Clinical Psychologists

•Speech & Language Therapist

•Rehabilitation Assistants

•Administrative Coordinator

Referral Categories

Category 1: Individuals discharged from hospital with complex needs requiring rehabilitation from 2 or more disciplines (EHD) e.g. CVA.

 

Category 2: Individuals living in the community with a long-term disability who would benefit from multi disciplinary rehabilitation e.g. CVA, MS, Motor Neurone Disease.

 

Category 3: Individuals following an acquired brain injury (e.g. traumatic, haemorrhagic anoxic, tumour) who may have cognitive, behavioural, emotional or physical sequelae.

 

Category 4: Individuals with mild head injury who have attended St Johns Hospital A&E department.

Elements of Service

•Active rehabilitation

•Further assessment, advice, liaison and review (FALR)

•Specialist assessment by the team

•Bridging the gap

•Vocational rehabilitation

•Client centred goal planning

•Carer support and advice

•Community reintegration

Vocational Rehabilitation

•Wide range of conditions with complex needs of which there are physical, emotional,

social, financial, behavioural and cognitive factors to consider.

•Identified seeking employment or return to work as a goal.

•Pathway differs depending on whether currently employed or seeking employment.

•The client may be involved with other team members before or during vocational

rehabilitation.

Clients

•Male and female

•Various age ranges

•Range of employments: teachers, nurses, building industry, sales, insurance,

Edinburgh airport, management.

•All in employment at time of illness.

 

Interventions

Consent to participate in therapy, contact employer, occupational health service, G.P.

•Interview/Job analysis – components of job

•Initial contact letter with employer

•Assessments – COTNAB, ACE-R, AMPS, TEA, BERG balance, HADS, MMSE, Driver

screening, BICRO-39, insight training etc.

•Goal setting

•Workplace visit

•Letters/reports

•Bespoke programmes

•Recommendations – considering client and employers needs

•Return to work reviews – client and employer – face to face, telephone

The Pathway

Common to All

Referral

Screening Ax (WHO)

Correspondence / Consent Obtained

Work identified as a goal

Occupational therapist interview

Currently Employed

Job Analysis Consent Obtained

Initial Contact with Employer / Occupational Health / Insurance Company / Case Manager

Assessment Goal Setting

Occupational Rehabilitation Programme

Liaison with Employer

Return To Work

Review

Discharge

Not Employed

Interested in Seeking Employment

Assessment Goal Setting

Skills, Strengths, Strategies Listed

Refer to Other Resource

Discharge

Strengths•Dedicated team•Dealing with complex conditions is routine•Occupational therapists work as a case manager•Knowledge of occupational performance•Activity analysis•Provides assessment to employment resources •Available for consultation even after discharged •Access to neuropsychological assessment•Link with colleagues from “B4 and on2 work”•Appreciate the need for achievement of pre- vocational skills before vocational rehabilitation can commence 

Limitations•CRABIS is not a dedicated employment service•Intervention can be lengthy•Increase waiting time for other referrals•Accessing the workplace•Limited resources/difficulty accessing resources for high level clients•Limited time to develop or evaluate service•Lack of formal qualification•Complexity of legislation - ESA

Strengths and Limitations

Next Steps

•Continue monitoring effectiveness of the service.

•Continue forging links with the vocational rehabilitation centre at the Astley Ainslie

Hospital.

•Develop examples of good practice using guidelines and benchmarks of CARF, College of

Occupational Therapists, NHS Lothian, DWP and government legislation.

•Publish examples of intervention within the BJOT/West Lothian Courier/Connections.

•Continue formal education within the field of occupational rehabilitation

•Implement examples of practice gained from today

Comments from Clients

•I could not have recovered or got back to my responsible job without the care, support

and strategies shown to me by the team

 

•I am so grateful for giving me a part of my life back

West Lothian Community Rehabilitation and Brain Injury Service

The Ability Centre

Carmondean Centre Road

Deans

Livingston

EH54 8PT

01506 774 046

janet.foggo@nhslothian.scot.nhs.uk