Introduction to Vocational Rehabilitation

Policies, Practices and Skills

Clive Langman

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136640520
• Edition: 1
• Topic: Medicine
• Subtopic: General Health

This text provides an overview of vocational rehabilitation (VR) practice, making it the perfect companion for students and practitioners with an interest in supporting people back to work and improving their sense of health and well-being.

The book is divided into three parts: the first covers the policy context of VR in the UK, defining VR, outlining the development of national standards in the sector, and looking at issues such as the economy and worklessness, and the legal background. The second part examines models of VR practice and relevant standards. It explores the nature of developing services in the public and private sectors, illustrated by case studies from a range of disciplinary backgrounds. The final part presents a detailed introduction to the knowledge and skills required in providing a VR service, including consideration of the multidisciplinary processes and stages involved.

Introduction to Vocational Rehabilitation includes numerous case studies and a dedicated chapter of issues and questions to aid reflection. Comprehensive and evidence-based, this is the first multidisciplinary textbook for students and practitioners from a range of backgrounds, including occupational therapy and health, physiotherapy, human resources, nursing, social work and health psychology.

Part 1

Health, disability and
worklessness in the
United Kingdom

1 Recognising vocational
rehabilitation

Key issues

• Post-war separation of employment from health services.
• Definitions and understanding of VR reflecting two strands of development.
• The relationship of VR to clinical rehabilitation and disability management (DM) practice.
• Major stakeholders in VR and their target populations.
• Identification of ‘core’ and ‘non-core’ VR practitioners and services.
• The development of service provider and practitioner standards.

Learning objectives

• Understanding the background to the public sector employment and disability services from when New Labour took office in 1997.
• Awareness of the reasons for the development of private sector VR.
• Understanding the differing perspectives and activities describing VR practice.
• Awareness of the Vocational Rehabilitation Association's Standards of Practice (2007), the UKRC's Rehabilitation Standards (2009a, b, c; 2010), and the Publicly Available Specification 150 (UKRC, Dept. BIS, BSI, 2010).

Introduction

Although it has received a great deal of government and private sector attention over the last decade, VR remains poorly understood within the UK. Hence, an obvious starting point for this book is to clarify what is understood by ‘vocational rehabilitation’. As VR has come to mean different things to different people, some historical explanation is required as to how this has arisen. In contrast to the United States, where the passing of the 1920 Smith-Fess Act is perceived to have marked the development of VR (Rubin and Roessler, 2001), the United Kingdom has no comparable legislation establishing VR services and marking operational boundaries. Neither are there are any mandatory organisational or individual accreditation requirements specifying VR practitioner standards and establishing a means of compliance. Although VR in the United Kingdom was given an initial thrust by the 1944 Disabled Persons (Employment) Act, public sector VR essentially describes RTW practices developed by employment and health services for their service users with health-related barriers to work. To understand VR in the United Kingdom, including differences of opinion as to what constitutes VR, is to understand this development, a matter expanded over the last 15 years in the private sector, through the interests of insurance companies. In the circumstances, Chapter 1 starts with a brief post-war history, until 1997, of RTW services for people with health conditions, providing the background for examining the various definitions of VR and its component parts. (Developments from 1997, and from when New Labour took office, are continued in Chapter 3, as these form the basis for the nature of current services.) Chapter 1 concludes with a review of recently developed service provider and individual standards.

Two strands of development: 1941–97 employment and health services

Employment services

Floyd (1997) reports that ‘vocational rehabilitation services in the UK were virtually non-existent prior to the Second World War’. Concern for people injured in the war resulted in the Tomlinson Committee being set up in 1941, and its recommendations led to the 1944 Disabled Persons (Employment) Act (Bolderson, 1991). Underlying Tomlinson's recommendations was the proposal that, following medical treatment, rehabilitation back to work should be provided by the Ministry of Labour. Hence, industrial rehabilitation services began to be developed apart from the National Health Service, which was not formed until 1948. The Act, shaping employment and disability practice for the next 50 years, offered four distinct means of promoting employment:

1 A quota scheme, whereby employers of more than twenty people were required to employ 3 per cent of the workforce registered as disabled at their local Labour Exchange – ‘the Green card scheme’. Initially, the scheme is reported to have been ‘quite successful’ (Smith et al., 1991), ‘with gradually declining effectiveness’ attributed by the government to a failure of disabled people to register enabling employers to fulfil their quota. Organisations representing disabled people maintained that it was the failure to enforce the scheme that resulted in the lack of incentive to register. Prior to the retrenchment of the scheme, preceding the 1995 Disability Discrimination Act (DDA), only eleven prosecutions were made, with fines rarely exceeding a few hundred pounds.

2 The Ministry of Labour was charged with establishing a national network of Industrial Rehabilitation Units (IRUs), renamed Employment Rehabilitation Centres (ERCs) in 1974. By the 1970s, thirty-six ERCs were located in large conurbations, with two residential ERCs, Egham and Preston, serving those unable to attend an ERC on a daily travelling basis. In the 1950s, one ERC, Garston Manor (Watford), was located alongside an NHS Hospital's clinical rehabilitation services, but this development was not replicated elsewhere. The weekly ERC case conference was led by a centre manager and attended by a peripatetic employment medical advisor, who provided an initial screening of referrals and was supported by an on-site nurse, a disablement resettlement officer (DRO), an occupational psychologist (OP), a social worker and the leader of the industrial and commercial staff responsible for the various workshops and offices. Six ERCs also had a physiotherapist attached to them. All referrals were received from DROs (retitled Disability Employment Advisors in 1994) based in Labour Exchanges (subsequently Jobcentres).

For nearly 50 years, ERCs were the most readily recognisable VR service in the UK – the modus operandi contributing to a non-clinical view of VR that continues to prevail in some circles. The rehabilitation process was based on interviews, counselling, psychological assessment and workshop observation. By the mid 1970s, the proportion of ERC clients going into open employment had dropped to less than half. An evaluation was undertaken by the Employment Rehabilitation Research Centre (ERRC), established in the mid 1970s and disbanded a decade later.¹ The report addressed the lack of changes over the previous 30 years, including outdated assessment approaches and even a failure to recognise changed labour markets and types of disability (Cornes, 1982). These criticisms and a National Audit Office (NAO) report (1987), which noted the lack of ERCs in large areas of the country and discrepancies in respect of measuring their occupancy, performance and costs per resettlement, led to changes in the way ERCs operated. The approach to assessment was changed, with the introduction of the VALPAR range of component work samples (VCWS). Effectively, assessment relied on initial interviews and examinations, followed by two days of psychometric testing, work sampling and workshop performance during the remainder of the intake week. Only if it was considered necessary was a programme of rehabilitation offered. This was viewed as a gentle introduction to work and an extended practical assessment, achieved by placement in the ERC's own workshops, commercial, clerical and/or outdoor facilities.

3 An employment placement service, effectively DROs placed in Labour Exchanges, and training at newly formed Government Training Centres (GTCs), renamed Skillcentres in 1974 and closed in the early 1990s. The 1940s also saw the emergence of specialist Residential Training Colleges (RTCs).

4 The setting up of sheltered workshops. Remploy was formed to run a large number of such workshops, although a few local authorities also responded with their own schemes. The other significant strand of the 1944 Act, the Sheltered Placement Scheme (SPS), sometimes in the past referred to as Sheltered Industrial Groups (SIGs), has continued to be based on the concept of disabled people working alongside able-bodied ones in open employment and subsidised through government.

There was little change to the nature of the disability employment services during the next 30 years, although the Piercy Committee, reporting in 1956 and reviewing the 1944 Act, had some success in promoting psychologically trained staff within IRUs.

In 1973, the Employment Rehabilitation Service (ERS) was put under the wings of the Manpower Services Commission (MSC), aligning the service with training and separating it from its referral sources, DROs and Jobcentre services, which remained within the Department of Employment. Within the latter service, the 1970s saw some other developments, and particularly a focus on addressing environmental barriers to employment. The work of DROs was supported with a number of special schemes providing clients with:

• help with fares to work;
• advice and financial assistance with regard to technical aids and with adaptations to premises (the beginning of the Access to Work scheme);
• a personal reader service for blind and partially sighted people;
• a small subsidy to employers for the first few weeks of employing a disabled person (the Job Introduction Scheme (JIS)).

Following 1987 NAO criticisms of ERCs, the Employment Service went on to publish a consultative document, Employment and training for people with disabilities (1990). ASSET (Assistance to Employment and Training) teams were initially established, providing a short assessment service prior to three key changes that followed:

1 Beginning in 1992, DROs and the assessment activities of ERCs were combined into Placement, Assessment and Counselling Teams (PACTs), each one with an occupational psychologist. Assessments were based on interviews, psychometric tests and work samples.

2 The network of ERCs was closed down and replaced by nine regional Ability Development Centres (ADCs), with responsibility for monitoring the provision of services to people with disabilities, co-ordinating staff training and research. ADCs were closed during the mid–late 1990s.

3 Tenders were sought from private, public and voluntary agencies to provide around 8,000 Work Preparation (rehabilitation) courses per annum.

The PACTs, renamed Disability Service Teams in 1999, controlled the budgets for agency rehabilitation contracts in their local areas. Work Preparation courses, typically of six weeks’ duration, have continued to be run, mainly by voluntary organisations (Lakey and Simpkins, 1994; Banks et al., 2002), although they are now due to be incorporated into a new, Supported Employment programme (see Chapter 8).

Key dates to 1997 in the evolution of policy and practice are indicated in Table 1.1. The policy approach gradually moved from assistance with assessment, rehabilitation and placing, to include the encouragement of labour market participation through tax credits, and anti-discrimination legislation.

Health services

In giving responsibility for employment rehabilitation to the Ministry of Labour, the 1944 Act separated employment services for disabled people from the emergent NHS. Smith et al, (1991) make no reference to VR within the NHS, although Holmes (2007) and Ross (2007) outline some post-war provision. Chamberlain (2007) records that, post-war, those who ran medical rehabilitation services within the armed forces transferred their skills to the new NHS. However, only one ‘of at least 25 rehabilitation centres’ had an IRU placed alongside i...

Table of contents

• Front Cover
• Introduction to Vocational Rehabilitation
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• Introduction
• Part 1 Health, disability and worklessness in the United Kingdom
• Part 2 Employment and disability services in the United Kingdom: models of vocational rehabilitation practice
• Part 3 The vocational rehabilitation process: the application of skills and knowledge
• Notes
• References
• Additional reading and sources of information
• Glossary of abbreviations
• Index