Critical Evaluation

Critical Evaluation

A Critical Evaluation of the Role of the Vocational Case Manager within Rehabilitation in Returning Someone to Work

Introduction:

Vocational case management is a program for the disabled who require further education for the purpose of attaining a suitable and stable employment; it is aimed at helping the disabled to recover through special training service. Services involved in vocational case management include the provision of supportive technology and this include special equipments that will aid them to live normal lives, counselling that help them both in their physical and psychologically, guidance, medical and psychiatric assistance to aid individuals. [1]

According to Weil and Karl 1985 the essential elements of vocational case management is the assessment of needs, service planning, service coordination and linking and the monitoring and continuous evaluation of services, client and available resources. [2] Therefore vocational management involves the provision of quality services to clients through proper planning and coordination of services.

Case management is therefore a process that involves the evaluation of the medical condition of the client, it develops and implements plans of care, coordinates medical resources,

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communicates health care needs to the individual and monitors and evaluates services that provides quality care.

Roles of vocational case management:

The major role of vocational case management is to assist employees to cope with their current situation and to have equal opportunities in their work place, the identification of those who require rehabilitation services, it also provides information to disability insurance providers, it ensures that there are more beneficiaries who return back to work and helps employees to regain the capacity to sustain regular employment.

We will focus on people who suffer brain damage, brain damage can be caused by accidents, poisoning, stroke, brain tumours, infections such as meningitis and lack of oxygen such as near drowning, effects of brain damage include poor memory, poor concentration and attention, depression and physical weakness. [3]

Early interventions and proper medical attention are the best practices that would ensure proper case management, if a client cannot cope with his current situation then he or she can obtain another appropriate job or even be retrained for new employment and in this way the quality of life and long term prospects can be greatly improved. [4]

Psychological services include assessment of memory, intellect and cognitive functions,

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evaluation of the client’s competence and reviewing of the medical records associated with the client. Psychotherapy and counselling are undertaken to help clients cope with the current state of brain damage, psychotherapy is the process of interacting with the patient with the aim of dispelling distress that arise from emotional, behaviour and thinking disorders. [5]

Some of the psychotherapy practices include counselling psychotherapy, psychoanalytic psychotherapy, behaviour therapy, cognitive therapy and group therapy. Counselling psychotherapy is aimed at helping a patient deal with the situation by focussing on the solution to the problem; the main objective is to give advice and encouraging the patient and is mostly used on people with mental disorders.

Psychoanalytic psychotherapy is aimed helping a patient understand his feelings, behaviours and thought; it is aimed at understanding the patient and also requires the skills to communicate effectively to the client. Behaviour therapy involves the assessment of a patient by interview and this helps the therapist understand the patient.

Cognitive therapy is widely used for the treatment of people with depression, this type of therapy is similar to behaviour therapy because it entails a day to day monitoring of behaviour changes and it helps in preventing the recurrence of disorders.

Group therapy entails the grouping of patients with similar complaints and in this group the patients help each other, all the above psychotherapy practices are used in helping patients return back to work, if patients do not fully recover then retraining or acquiring of different occupation is advised. [6]

When a patient has undergone the necessary medical treatment there is the need to train him to acquire new skills, those who have very limited skills need to be trained to acquire appropriate capacity to work, the use of special equipment and tools also help the patient to be

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competent enough to undertake his duties. Follow up services should be undertaken even when the patient has fully recovered to ensure that the client is competitive in the work place.

Counselling is the process of helping people cope with difficult situations through interviews and other procedures, it is aimed at allowing people to reach to a solution to their problems by themselves. Counselling may take place for a long period of time and is aimed at particular groups example seriously ill, troubled families and traumatised people after disaster.

Counselling offers a reliable and consistent way of dealing with the clients; methods of counselling include pragmatic, problem solving and practical. Duration and cost are negotiable in this form of treatment and assessment is done through asking the clients to summarize what is said and in this way the counsellor is in a position to deal with the clients distress, one major advantage of counselling is that new information is given and practical tasks can be practiced. [ 7]

According to a study done on several centres which included: Community Companions, San Jose, California; Centre For Mental Health Anderson, Indiana; Building Bridges Decatur, Illinois; Hospital Transition Program ,Eugene, Oregon; Project Wins ,Grand Rapids, Michigan; West Central Community Support Services Lebanon, New Hampshire; Breakthrough Club Wichita, Kansas and Shawnee County Community Mental Health Centre Topeka, Kansas all that deal with mental cases shows that indeed case management do help client return back to work. [8]

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The research was aimed at conducting a study that would indicate the performance of these programs, the nine centres were source of data for this research, and data was collected through interviews and focus groups. One major aim of this research was to compare the characteristics of participants who successfully obtained employment after the study with those who didn’t. The results of the study showed that 56% of the participants were employed versus a 32 % of them being unemployed. [9]

The results of the study showed that showed vocational case management plays a major role in helping people get back to work, out of a total of 205 participants 146 obtained employment. All programs in the study according to the results show that these programs increased the labour force and that all programs shared common attributes such as the commitment to provide quality services. [10]

The study also indicated that the observations were consistent with the optimum model of

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supported employment for persons with psychiatric disabilities, the most successful project however was that which blend aspects of different models in such a way that it would be easily adopted by participants. [11]

The roles of the rehabilitation coordinator include keeping the individual informed about rehabilitation plans and progress of the case, assessing the rehabilitation plans and organising services to be provided, to assist his client to recover and return to work soon, to control the cost incurred by the client and finally to advise and educate the client regarding their entitlement regarding the legislature. [12]

The Australian journal of rehabilitation counselling recommended that rehabilitation centres should review their rehabilitation coordinators in a view of developing an independent practice because the present system was conflicting with the employers and the injured workers, it also recommended the improvement of the training of this coordinators for the reason that this coordinators were selected from the existing staff who had no basic knowledge and skills required to meet the job requirement. [13]

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The journal also recommends that authorities should accredit rehabilitation coordinator practices in a way that insurers and rehabilitation providers are a credited and this will help in standardizing rehabilitation practices, finally it recommends that rehabilitation coordinators should be formalised and this would be through the provision of information about the rights and responsibility to stake holders. [14]

Vocational assessment tool:

Interview style and technique

This is a tool used to assess the usefulness of the rehabilitation process, it involves interviewing of the clients regarding their progress and treatment process, the client is questioned and information is collected which aid in the assessment of the treatment process.

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Psychometric:

This tool involves the use of psychological techniques as a way of finding out the process of recovery of a client, qualified personnel undertake the research on the client and findings are used to assess the validity of treatment and recovery progress.

Disability factors:

This tool is used mostly on people with physical injuries that can be easily observed, a cross examination of the clients physical health is undertaken and this provides information that aid in the assessment of the clients health.

Work history:

The tool is used on people who have had disabilities in the past, the work history record is a good indicator of the progress of a client, and if the work history indicates that the client has been improving in his career then this shows that the client is recovering but if it shows that he or she has deteriorated in the positions in office then there is need for urgent examination of the clients disabilities.

Realistic goals

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If a client has realistic and achievable goals then the client is likely to have recovered from his disabilities and therefore the rehabilitation coordinators should always assist the clients to set realistic goals [15]

Rehabilitation coordinators should have the following characteristics to ensure quality services to the clients:

Empathy

Coordinators should try and put themselves in the shoes of their client and to see things from the client’s perspective, empathy therefore aids in need assessment of the client.

Self determination

Coordinators must be self determined to help clients to recover from their current situation, they should always put the needs of the client first and never give up in helping their clients.

Avoiding stereotyping

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Coordinators should avoid sex typing and stereotyping and should never make judgements on any clients, all clients should be treated equally.

Flexibility

Coordinators should be flexible and avoid being mechanical, this will ensure that proper and quality services are rendered according to the special needs of a client.

Ensure credibility

Coordinators should be honest and trustworthy; they should avoid giving false hopes or setting unrealistic goals with their clients. [16]

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Be reliable and responsible

Coordinators must be honest and take responsibility for ones share of work as well as the mistake one commits; they should carefully attend to their duties and always being on time.

Listening and paying attention

They must pay attention and focus their energy on the task at hand

Have a supportive attitude

The coordinators should be interested in learning and should not be defensive; they must treat their clients and other co-workers with respect and understand that their key to success is to help the clients.

Good communication skills

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Coordinators must know how to communicate with the clients and other workers, they must create an environment in which clients feel free to disclose whatever concerns them, coordinators should recognise and interpret the verbal and non verbal expressions of the client, they must listen to the clients and interpret what they say appropriately.

They must communicate their views correctly to their clients and that their body language should correspond with their verbal language to avoid confusing the clients. Finally the clients information should be private and confidential and should not be discussed or told to others.

Setting realistic goals

Coordinators should set goals that are simple, measurable, achievable, realistic and time bound (SMART), they should always avoid giving unprofessional advice to clients, must design plans with the clients and this helps to strengthen the clients decision making and problem solving as well as their self esteem. [17]

We can therefore conclude that coordinators should put the needs of the clients first, should not discriminate, practice confidentiality, be trustworthy and honest, empathetic and be self determined, all these values guide behaviour and relationships formed with the clients and also help in the determination of a clients problems.

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Conclusion:

Vocational management is a process that entails the evaluation of the medical conditions of clients and once they are identified it helps in coordinating the implementation of medical care to the clients, it also ensures that clients quality services in order to recover.

The main role of vocational management is to ensure that clients cope with their current situation and for them to have equal opportunities at their work place; it also ensures that clients who return back to work regain the capacity to sustain regular employment and to be competent.

Rehabilitation coordinators should have the required values in order to provide quality services to the clients, they should not discriminate, they should practice confidentiality, they must be trustworthy and honest, must be empathetic and be self determined.

People suffering from mental and brain need early interventions to ensure that he or she returns back to work, counselling and therapeutic processes play a major role in helping patients recover. Patients however need to be retrained for a different occupation or they should attain a more appropriate job to be competent and productive.

References:

Richard J., William G. and Baldwin Marjorie (1995) Managing Work Disability: Why First Return to Work Is Not a Measure of Success, Industrial and Labour Relations Review, Vol.48, No.3,

Weil M., & Karl J. M. (1985) Case management in human service practice, Jossey-Bass Ltd, California:

Powell T. (1994) Head Injury: A Practical Guide, Winslow Press, USA

P. Weinstocks and L. Toms Barker (1995) Mental Health and Vocational Rehabilitation Collaboration: Work, the Psychosocial Rehabilitation Journal

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Linda Toms Barker and Ralph Warren (1996) Service Coordination and Long-Term Support in the Delivery of Vocational Services for Persons with Psychiatric Disabilities, available at www.

Dianna T Kenny (1995) Case management in occupational rehabilitation, Australian Journal of Rehabilitation Counselling, 2, 104-117

Tarvydas V M. and Cottone R.R. (1991) Ethical responses to legislative, organisational and economic dynamics: A four level model of ethical practice, Journal of Applied Rehabilitation Counselling, 22(4), 11–18

[1] Richard J., William G. and Baldwin Marjorie (1995) Managing Work Disability: Why First Return to Work Is Not a Measure of Success, Industrial and Labour Relations Review, Vol.48, No.3

[2] Weil M., & Karl J. M. (1985) Case management in human service practice, Jossey-Bass Ltd, California

[3] Powell T. (1994) Head Injury: A Practical Guide, Winslow Press, USA

[4] Richard J., William G. and Baldwin Marjorie (1995) Managing Work Disability: Why First Return to Work Is Not a Measure of Success, Industrial and Labour Relations Review, Vol.48, No.3,

[5] Powell T. (1994) Head Injury: A Practical Guide, Winslow Press, USA

[6] Powell T. (1994) Head Injury: A Practical Guide, Winslow Press, USA

[7] P. Weinstocks and L. Toms Barker (1995) Mental Health and Vocational Rehabilitation Collaboration: Work, the Psychosocial Rehabilitation Journal

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[8] Linda Toms Barker and Ralph Warren (1996) Service Coordination and Long-Term Support in the Delivery of Vocational Services for Persons with Psychiatric Disabilities, available at www.

[9] Linda Toms Barker and Ralph Warren (1996) Service Coordination and Long-Term Support in the Delivery of Vocational Services for Persons with Psychiatric Disabilities, available at www.

[10] Linda Toms Barker and Ralph Warren (1996) Service Coordination and Long-Term Support in the Delivery of Vocational Services for Persons with Psychiatric Disabilities, available at www.

[11] P. Weinstocks and L. Toms Barker (1995) Mental Health and Vocational Rehabilitation Collaboration: Work, the Psychosocial Rehabilitation Journal

[12] Dianna T Kenny (1995) Case management in occupational rehabilitation, Australian Journal of Rehabilitation Counselling, 2, 104-117

[13] Dianna T Kenny (1995) Case management in occupational rehabilitation, Australian Journal of Rehabilitation Counselling, 2, 104-117

[14] Dianna T Kenny (1995) Case management in occupational rehabilitation, Australian Journal of Rehabilitation Counselling, 2, 104-117

[15] P. Weinstocks and L. Toms Barker (1995) Mental Health and Vocational Rehabilitation Collaboration: Work, the Psychosocial Rehabilitation Journal

[16] Tarvydas V M. and Cottone R.R. (1991) Ethical responses to legislative, organisational and economic dynamics: A four level model of ethical practice, Journal of Applied Rehabilitation Counselling, 22(4), 11–18

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[17] Tarvydas V M. and Cottone R.R. (1991) Ethical responses to legislative, organisational and economic dynamics: A four level model of ethical practice, Journal of Applied Rehabilitation Counselling, 22(4), 11–18

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