WCMT-Melissa-Kelly
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Specialist Spinal Vocational Rehabilitation<br />
Mel <strong>Kelly</strong><br />
Kaleidoscope<br />
Research undertaken in 2014
Acknowledgements<br />
This research was made possible thanks to the Winston Churchill Memorial Trust, for granting<br />
me a Fellowship to travel to the U.S, UK and Switzerland. I am also grateful to the New Zealand<br />
Spinal Trust for their kind support. I would like to thank the hospitals and spinal associations that<br />
hosted me and whom provided insight and expertise that greatly assisted my research.<br />
I thank a number of valued colleagues for assistance and suggestions that greatly improved the<br />
manuscript, also Tracey Croot who reminded me to think about what I wanted to achieve and not<br />
limiting my vision, by considering the resourcing challenges.<br />
To the patients I have supported, celebrating your successes no matter how small, brings me such<br />
joy; by no means is this ‘just a job’ to me. There are many of your stories to tell; be it work<br />
related or not and you have allowed me into your lives. I thank you for being vulnerable,<br />
courageous and trusting in the ability to be knocked down but get back up again. You inspire me.<br />
Last, and certainly not least, to my beautiful family-thank you.<br />
<strong>WCMT</strong> Research Fellowship 1
Contents<br />
Executive summary Page 3<br />
Introduction – Kaleidoscope ‘Partnering people into Work Programme’ Page 5<br />
Research Fellowship Objectives Page 7<br />
SECTION 1 - History and Observations of the visited locations<br />
Rusk - New York, USA Page 9<br />
Burke - New York, USA Page 14<br />
Paraplegic Centre, Notwill, Switzerland Page 17<br />
Stoke Manderville, United Kingdom Page 21<br />
Spinal Injuries Association, United Kingdom Page 23<br />
SECTION 2 - Key areas to address<br />
A strategic collaborative approach is needed Page 25<br />
Community integration Page 27<br />
SECTION 3 - Resulting Action<br />
Great Expectations Project – Employers Page 29<br />
Ability Awareness Learning Experience Page 31<br />
Patient Workshops – Outreach and extension of service Page 32<br />
Conclusion Page 33<br />
References Page 35<br />
Appendices<br />
Appendix One: Model Explanation of ‘The Kaleidoscope Way’<br />
Appendix Two: Return to work in the context of Kaleidoscope<br />
Appendix Three: Te Whare Tapa Whā Māori Model of Health, NZ<br />
Appendix Four: Winston Churchill Memorial Trust Fellowship schedule, May 2014<br />
Appendix Five: Example schedule, Swiss Paraplegic Centre, Notwill<br />
Appendix Six: Pictorial Fellowship highlights<br />
<strong>WCMT</strong> Research Fellowship 2
Executive Summary<br />
For the 770 persons with a spinal cord injury (SCI) that Kaleidoscope has supported since 2003,<br />
it is often impossible to imagine life without work, life without meaning, and life without<br />
purpose. For many, work is the fabric of their daily lives – how they communicate with each<br />
other, social network, be a role model to their children, support themselves and their family as<br />
well as contributing to the global economy. Following SCI the top four questions a person asks<br />
are:<br />
1. Will I Survive?<br />
2. Will I walk again?<br />
3. Can I still have sex?<br />
4. Will I work again?<br />
With vocational rehabilitation being delivered in the acute phase following serious SCI, work is<br />
being addressed much sooner as part of rehabilitation. For many, just knowing someone is there<br />
to support the area of work, liaise with an employer, or to address a fear is often enough;<br />
involving the family is also vital.<br />
The opportunity provided to me by the Winston Churchill Memorial Trust (<strong>WCMT</strong>) allowed me<br />
to visit four internationally respected spinal hospitals. An insight into how vocational<br />
rehabilitation was delivered in other hospital environments and the community integration<br />
practices, would allow further development of Kaleidoscope.<br />
As a result of my learnings I have proposed three initiatives addressing each area; as well as<br />
making recommendations. The three initiatives are as follows:<br />
1. Expanding the Kaleidoscope service by piloting a group work readiness series - By<br />
hearing how other people tackle problems and make positive changes, it is my hope that<br />
patients will discover a whole range of strategies for facing their own concerns. The aim<br />
is to educate and build confidence, recognise shared experiences and develop a new set of<br />
skills and resources for community patients and where appropriate inpatients.<br />
2. The ‘Great Expectations’ Project is redeveloping our employer education and aims to<br />
transform attitudes – working to support employers when they question what is possible,<br />
accessibility is embraced and they employ a person with a SCI. Complimentary to this is<br />
formulation of a Business Advisory Committee<br />
<strong>WCMT</strong> Research Fellowship 3
3. Ability Awareness Learning Experience - Exploring the role of people with disabilities in<br />
the community enables pupils or employees to have an appreciation of SCI, but also<br />
awareness of what people ‘can do’ and how they do it<br />
Preparing, resourcing and delivering a number of initiatives is a good start. But my primary<br />
recommendation, ahead of community engagement, is collaboration. With the release of the<br />
Spinal Cord Impairment Action Plan (SCIAP, 2014), this is a call to action! So Kaleidoscope<br />
will work towards improving vocational support for the SCI community in the future by:<br />
1. Better educating healthcare professionals from non-specialist settings as well as local<br />
vocational provider knowledge of SCI. Kaleidoscope has the skills and resources in place to<br />
deliver this nationally and a collaborative model of engagement could be investigated and put in<br />
place.<br />
2. Master classes for employers - education and a lived client experience (invited consumer)<br />
3. Promoting and growing a societal expectation that a person will work following a SCI.<br />
4. Collaboration of inpatient – outpatient vocational providers during the discharge planning<br />
phase to enhance the patient journey and continuity.<br />
5. Research in the acute vocational rehabilitation setting. A quantitative evaluation of data<br />
collection and emerging themes would be valuable.<br />
6. Supporting clinical colleagues in the implementation of the SCIAP, a collective multidisciplinary<br />
approach<br />
7. Working with both ACC and the MOH where we can contribute to their education and<br />
vision, as well as add value through planning and preparation support<br />
My primary learning was that the vocational programmes visited were better resourced, mainly<br />
due to funding. The teams were greater in size and in dedicated singular roles. In saying this,<br />
excellent results are being achieved for spinal patients following vocational rehabilitation in NZ<br />
and in many cases Kaleidoscope is leading the way.<br />
<strong>WCMT</strong> Research Fellowship 4
Introduction – Kaleidoscope ‘Partnering people into Work Programme’<br />
According to a Disability Survey conducted in 2013 by Statistics NZ, 24 percent of the New<br />
Zealand population is identified as disabled, a total of 1.1 million people. The increase from the<br />
2001 rate (20 percent) is partly explained by an ageing population.<br />
At inauguration of Kaleidoscope, for the population who had a serious SCI, as a result of an<br />
accident and who were entitled to ACC Earnings Related Compensation (ACC ERC), the<br />
proportion of people confirmed in full or part-time work was 12%, implying an unemployment<br />
rate of a staggering 88%.<br />
During the course of the report I will refer to SCI, which covers serious spinal cord injury or<br />
illness (with a neurological diagnosis). Further to this the use of the word patient pertains to<br />
those persons engaged in vocational rehabilitation be it in the acute, rehabilitation or community<br />
setting.<br />
Kaleidoscope was formed in response to a clear need, and driven by a man Professor Alan<br />
Clarke. He first formed the New Zealand Spinal Trust (NZST) in 1994 to address the unmet<br />
needs of rehabilitation, information, research, advocacy and support for people with spinal cord<br />
injuries throughout New Zealand. The NZST is firmly focused on supporting independent living<br />
and improving the quality of rehabilitation through initiatives, projects and programmes that<br />
directly benefit people with a SCI. Professor Clarke said the language of good recovery is<br />
positive and personal, not cautious, p.c. or impersonal and institutional. He named this new<br />
approach the ‘New Rehabilitation’ which encourages each person to steer a new course for<br />
themselves, in the sure knowledge that fulfillment and happiness is achievable. If you think this<br />
sounds soft and fuzzy you are right. Serious recovery is very personal and involves hope, trust<br />
and happiness.<br />
Kaleidoscope is an early intervention vocational rehabilitation programme set up in 2003,<br />
dedicated to getting people who have a SCI into meaningful and sustainable employment. We<br />
have paved the way forward in developing a model of practice (Appendix 1.) which provides<br />
explanation of how we engage patients and gives context to what we do (Appendix 2.).<br />
Kaleidoscope is a programme of the NZST based at both the Burwood and Auckland Spinal<br />
Rehabilitation Units and also delivering services at Middlemore Hospital. The service delivered<br />
<strong>WCMT</strong> Research Fellowship 5
is specialist spinal vocational rehabilitation, both to acute patients and community patients.<br />
Kaleidoscope’s guiding principles are:<br />
• Everyone can have a great job<br />
• It’s healthy to be working<br />
• The sooner the better<br />
• There are thousands of work opportunities<br />
• Personal networks are the key<br />
• The process for getting a job is the same as before<br />
• You can do it yourself – whatever it takes!<br />
• Your life experiences give you unique qualifications<br />
The Kaleidoscope programme undertakes vocational<br />
rehabilitation work with people much earlier in their<br />
rehabilitation, i.e. 80% of patients are engaged within three<br />
weeks post SCI. This, combined with the holistic approach of<br />
the multi-disciplinary team engagement, sets these people up to<br />
powerfully re-enter the job market. Specialist Vocational<br />
Consultants provide on-going individual career coaching with a<br />
strong emphasis on the patient doing as much of the work as<br />
possible. Dependency can be a learned behaviour and we<br />
recognise this and want our patients to own their vocational<br />
rehabilitation, receive education and feel empowered.<br />
The other key aspect of the Kaleidoscope programme and<br />
crucial to its success is engaging employers early. Further to<br />
this, the close involvement of the local business community,<br />
tertiary training institutes and the persons family. This approach<br />
builds the patient’s confidence, self-awareness and improves<br />
their chances of getting jobs. The maintenance of hope and building resilience is recognised and<br />
carefully considered by the Kaleidoscope programme.<br />
“I haven’t fallen through the cracks<br />
because Kaleidoscope didn’t allow<br />
them to appear, and by being at work<br />
even just for lunch to start with, filled<br />
a social void and a purpose for the<br />
effort of just getting there. Work is<br />
more than just a job and money and<br />
now I see what Kaleidoscope has<br />
always seen.<br />
As a child a favourite toy of mine was<br />
a kaleidoscope, and now to me, a SCI<br />
at first is like a kaleidoscope of dark<br />
and broken pieces that won’t stop<br />
spinning to allow you to make sense of<br />
what has happened. BSU has put the<br />
colour back in my ‘kaleidoscope of<br />
life’ and now it even stops so I can<br />
enjoy the new and wonderful things I<br />
see and do.”<br />
Kaleidoscope patient – 2011<br />
<strong>WCMT</strong> Research Fellowship 6
Now, in 2015, the SCI Return to Work rate for patients that had received Kaleidoscope services,<br />
either as an inpatient or as a community patient is, 60% in paid employment. This is<br />
represented by 348 people.<br />
Our aim is to ensure New Zealanders with a SCI are valued, productive and participating<br />
citizens. Kaleidoscope will enrich not only the persons’ life, but the NZ community; through<br />
inclusion and understanding.<br />
Research Fellowship Objectives<br />
The primary focus of my fellowship was to examine the vocational hospital services available at<br />
international renowned SCI centres and look at initiatives for community inclusion. Further to<br />
this, I aimed to access any educational SCI resources provided to patients; with the intention of<br />
enhancing overall wellness through work. This is in line with Te Whare Tapa Whā; the Māori<br />
health model supporting physical, mental, spiritual and family wellness (see Appendix 3.).<br />
I’d been questioning how to provide better support and education to New Zealand employers<br />
about hiring people with SCI. How could we better promote and encourage society as a whole<br />
that people with disabilities can participate in work and the value of it to everyone?<br />
The invaluable knowledge gained from the ability to learn from other countries delivering<br />
services, was to support the development and delivery of the Kaleidoscope (Partnering People<br />
into Work) Programme nationwide. Kaleidoscope is the only acute vocational rehabilitation<br />
programme in New Zealand dedicated to getting people who have a SCI back into full or part<br />
time employment – one step towards a fully independent, productive and confident life. To date<br />
we have had institutes worldwide visiting and learning from our programme, as well as<br />
providing training internationally; the acute aspect is the most unique element. The primary<br />
objectives I worked on are:<br />
<br />
<br />
<br />
To meet with other organisations that provided vocational rehabilitation services.<br />
To discover and learn about other initiatives in the vocational rehabilitation field.<br />
To build networks with other agencies doing similar work.<br />
To improve the Kaleidoscope programme and serve as a rehabilitation model/specialist<br />
programme for a nationwide audience of community development practitioners.<br />
<strong>WCMT</strong> Research Fellowship 7
Four specialist centres were selected because of their approach to rehabilitation, international<br />
respect and that vocational support was being delivered in a hospital environment; a timetable of<br />
my travels can be found in (Appendix 4).<br />
With rates of 130 - 180 New Zealanders a year acquiring a SCI through accident or illness,<br />
demand continues to grow. The injured person might be a young person yet to leave home, a<br />
parent with a family growing up, the main breadwinner or business-owner or an older person<br />
who had spent years planning out their retirement. Kaleidoscope’s support may last months or in<br />
some minuet cases years, depending on the individuals’ ability to adapt, up skill or change<br />
direction. My goal and that of the NZST is to ensure that this effective and valuable service is<br />
available to everyone nationwide whenever they need it. Securing employment or re-launching a<br />
business, the benefits are obvious in terms of independence and financial security; also though,<br />
valuable skills and abilities return to the local economy and community.<br />
<strong>WCMT</strong> Research Fellowship 8
SECTION 1 - History and Observations of the visited locations<br />
Rusk - New York, USA<br />
History<br />
Dr. Howard A. Rusk, widely considered “the father of rehabilitation medicine”, founded the<br />
Institute for Rehabilitation Medicine in 1948 (In 1984, the institute was renamed in his honour.)<br />
Drawing on his experience treating wounded soldiers during World War II, Dr. Rusk developed<br />
the Rusk Institute around the philosophy that rehabilitation medicine provides care for the entire<br />
person-not only their illness or disability, but also their emotional, psychological and social<br />
needs.<br />
I selected this institute due to the extensive vocational department, but also because the<br />
philosophy aligned with that of Kaleidoscope and the Māori Model of Health - Te Whare Tapa<br />
Whā (see Appendix 3). With its strong foundations and four equal sides, the symbol of the<br />
wharenui (house) illustrates the four dimensions of Māori well-being. Should one of the four<br />
dimensions be missing or in some way damaged, a person, or a collective may become<br />
‘unbalanced’ and subsequently unwell. In the NZ healthcare system, we focus and treat the<br />
physical presentation and the Māori health model otherwise known as the four cornerstones, also<br />
recognises the spiritual wellness, family inclusion (wairua) and the balance of the mind.<br />
Among its many innovations, the Rusk Institute pioneered vocational training for people with a<br />
range of disabilities. This is accessible for multiple disabilities; those with a SCI are part of this<br />
integral service.<br />
Rusk’s approach to Rehabilitation<br />
Rusk was also the first rehabilitation hospital to adopt a formalised multidisciplinary team<br />
approach to rehabilitation. In this approach, the attending rehabilitation physician evaluates the<br />
patient, and then develops an individualised treatment plan that may involve sessions with many<br />
different specialists - including physical, occupational, speech and vocational therapists,<br />
swallowing specialists, cognitive, music and recreational therapists, psychologists, nutritionists<br />
and social workers.<br />
In addition to caring for the patient’s physical condition, the rehabilitation team addresses the<br />
challenges of developing new strategies for daily living; the psychological adjustment of coping<br />
<strong>WCMT</strong> Research Fellowship 9
with change and uncertainty; the need for new forms of support for patients and their loved ones;<br />
and techniques for managing pain in order to improve comfort and aid healing. Patients and their<br />
families are important members of the care team as well. Through this team approach which is<br />
shared internationally, including NZ, patients receive coordinated care that includes a broad<br />
array of resources and therapies, carefully designed to help with each stage of recovery.<br />
Rusk consists of the following sites; I visited sites 2 and 3.<br />
1. Rusk at the NYU Langone Main Campus (530 First Avenue - 9th Floor) - inpatient adult<br />
rehabilitation<br />
2. Rusk at 17th Street (301 East 17th Street, in the Hospital for Joint Diseases) – inpatient<br />
adult rehabilitation and inpatient and outpatient paediatric rehabilitation<br />
3. The Ambulatory Care Centre (240 East 38th Street) – outpatient adult rehabilitation<br />
4. The Centre for Musculoskeletal Care (333 East 38th Street) – outpatient adult<br />
orthopaedic/musculoskeletal rehabilitation<br />
Vocational Services at NYU Langone’s Rusk Rehabilitation<br />
The vocational programme has been an integral part of NYU Langone’s Rusk Rehabilitation<br />
since its inception. The components offered are:<br />
Vocational counselling services<br />
Diagnostic Vocational evaluation<br />
Work Readiness and Job Skills Training Programme<br />
Computer Skills Training<br />
Job Placement Services<br />
Vocational Rehabilitation for Limb Loss<br />
o Commencing during the pre-prosthetic Programme<br />
Business Advisory Committee<br />
Vocational Evaluation Service<br />
Vocational Evaluation Services is an in-house programme which is offered to outpatients and the<br />
manner, in which this service is setup, allows the consultants to ‘learn from the patients’. The<br />
primary goals are self-awareness, career exploration and empowering the person; respecting their<br />
<strong>WCMT</strong> Research Fellowship 10
different disabilities and skills.<br />
The environment is a small<br />
classroom setting, factoring in<br />
multiple assessment stations<br />
such as desks, workshop tasks<br />
and a computer laboratory area<br />
(shown to the right). Patients<br />
are given tasks/assessments and<br />
consultants work with the<br />
person, as well as observing<br />
behaviour; indicating preferred<br />
learning styles, vocational<br />
strengths and any other<br />
highlighted considerations. The<br />
sessions that I observed<br />
included the following tasks:<br />
A high school level mathematics practice test<br />
An aptitude exercise, whilst being timed<br />
Building a model from a manual<br />
Writing a CV on the computer<br />
Solving a puzzle<br />
Feedback is provided throughout the evaluation period and consideration is given to each<br />
individual. Each person has a journal to record daily about vocational activities, support and<br />
captures their thoughts.<br />
Initial evaluation is for a period of 10 – 15 days, followed by a case conference which is patient<br />
led. Following the vocational assessments the skills, interests, academic history, work tolerance<br />
and aptitude formulate a vocational objective and tailored rehabilitation plan. The plan is likely<br />
to include further training, work readiness support or referral to job placement services.<br />
<strong>WCMT</strong> Research Fellowship 11
Work Readiness and Job Skills Training programme<br />
In participating with the group who consented to my presence, I was able to observe the benefits<br />
of a group job skills method of delivery, versus 1:1 consulting. The vocational consultant<br />
facilitating these sessions provided an encouraging environment where patients shared openly<br />
and really engaged in discussion. They were contributing to each other’s growth and found<br />
comfort in the similar challenges of job searching. Tools utilised, that we also use in NZ, were<br />
both behavioural and motivational interviewing, as well as reflective listening and a work<br />
readiness workbook.<br />
The seminar I took part in covered:<br />
What employers look for when hiring staff<br />
Thought for discussion: People leave managers, not jobs<br />
Disability and self-promotion<br />
Using initiative in your job search<br />
Things hiring managers wish you knew: Alison Green<br />
How to target the right jobs<br />
Your soft skills and specific job skills<br />
The ups and downs of job search - peer support amongst the group<br />
Following participation in the Rusk Rehabilitation’s Work Readiness and Job Skills Training<br />
Programme, participants are able to develop good work behaviours, and job skills in actual<br />
workplace settings. Participants are placed in offices, housekeeping areas, food service<br />
operations, information technology services, patient admitting areas, employee health services,<br />
and other worksite locations, either at NYU Langone or at external organisations. Participants<br />
receive supervised training and gain real work experience while refining their job performance<br />
and skills; in NZ we call this a work trial, which also tests a person’s capacity to work.<br />
The vocational consultant monitors the participant’s progress and provides job coaching as<br />
needed. Patients who complete the programme may either get placed in a job or be referred to an<br />
occupational skills training school or an academic programme.<br />
As a result of my learnings in this area, Kaleidoscope will be launching group patient<br />
workshops, followed by assessment, development and forward-panning from what is learnt<br />
in the initial phase.<br />
<strong>WCMT</strong> Research Fellowship 12
Vocational Consultants open session<br />
A primary objective of my journey was to understand how early in vocational rehabilitation<br />
employers are engaged, how and what supports are offered to businesses and the resourcing that<br />
accompanies it. A Business Advisory Committee (BAC) was formed by the Rusk vocational<br />
department, and to date consists of 40 employers; monthly meetings are held where typically six<br />
to seven members participate. The vocational team present patients that are job ready at the<br />
meeting (no more than three) and the employers provide industry advice regarding the three<br />
patients and may also invite any of them for an interview; recruiting on skills rather than created<br />
roles. This is a strong network and typically comes from the employers of patients that the<br />
services encounter, or in some cases specific industry networks are targeted. Also as part of the<br />
BAC, vocational consultants are able to seek work trials following completion of the<br />
occupational work skills Programme. I see merit, in developing a committee like this for<br />
Kaleidoscope to engage with, on a regular basis and with a formalised structure. Subsequently, I<br />
will make steps toward developing a BAC, that will primarily include employers in the<br />
Canterbury and Auckland regions where Kaleidoscope is based; not to say that other regional<br />
organisations will be excluded.<br />
In New York, employers are concerned that if someone with a disability is hired and it isn’t<br />
successful, then performance management can’t be put in place. This is due to the government<br />
possibly becoming involved. In place however, is a 90 day trial period similar to NZ.<br />
When asked what works about vocational services in NYC for the SCI population, the response<br />
was, it is about independence for the candidate, but where required they act as brokerage –<br />
partnership. The long-term partnerships with companies are key to their success and engaging<br />
employers around their needs, “all about connections”. When a vocational consultant says to an<br />
employer “we’re from Rusk” it discloses the patient group. The skills of the consultants<br />
delivering services are essential – vocational rehabilitation counsellors with the right education<br />
and skills for the patient group are recruited.<br />
The team respect patient privacy, have key performance indicators respecting patient needs and<br />
are productive with their time.<br />
Transport to work, has the ability to impact on return to work in New Zealand. In New York,<br />
responding to the same challenge, Access-A-Ride was formulated and provides accessibility<br />
services. Access-A-Ride is for people with a disability who are unable to use public transport<br />
<strong>WCMT</strong> Research Fellowship 13
such as buses and trains. The service is available 24 hours a day, seven days a week, including<br />
holidays, and the one-way fare for each registered passenger is the same as the full fare on a<br />
bus/subway train; personal carers travel at no cost.<br />
Primary barriers faced, are societal perceptions of SCI and that it is a competitive workforce<br />
where unemployment is low. Vocational rehabilitation is funded highly by the Government and<br />
it is further supplemented with grants. Rusk Vocational Rehabilitation Services is the largest in<br />
the tri-state area, and one of the largest in America. As with New Zealand, not many vocational<br />
services are embedded in hospitals and this is a unique and sought after skill-set.<br />
Burke - New York, USA<br />
History<br />
Burke Rehabilitation Hospital opened its doors in April of 1915, through the generosity of John<br />
Masterson Burke, a New York City philanthropist.<br />
World War II transformed the field of medical rehabilitation, as the vast number and variety of<br />
injuries suffered, led to an increased emphasis on physical and occupational therapies,<br />
improvements to prosthetic limbs and wheelchairs, and the development of community services.<br />
In 1951, with its strong focus on multi-disciplinary medical rehabilitation, the Foundation<br />
formally became The Burke Rehabilitation Hospital. Today, Burke is a not-for-profit, private<br />
rehabilitation hospital and a leader in the field of medical rehabilitation and research.<br />
Burke’s Approach to Rehabilitation<br />
There is never a ‘one size fits all’ approach at Burke; it’s one of the reasons I chose to visit their<br />
institute. Mapping the patient journey, desired goals to achieve and tailoring the pathway is best<br />
practice and promotes independence and best outcomes for the person, which is what all multidisciplinary<br />
teams work towards.<br />
Group discussions and individual counseling sessions help patients and family members adjust to<br />
circumstances resulting from physical disability, and prepare for a new way of life.<br />
Vocational Services<br />
At Burke Hospital, I observed the acute – rehabilitation setting, there was not a dedicated<br />
vocational service delivered at this centre. I took the opportunity to observe multiple settings<br />
<strong>WCMT</strong> Research Fellowship 14
catering to those with an acquired SCI. Vocational rehabilitation is available post-discharge and<br />
is offered through ACCESS Services across New York State.<br />
The Social Worker assumes a leadership role in planning and preparing for the individual’s<br />
discharge and, as with any rehabilitation facility, the planning and preparation begins when the<br />
individual is admitted to the inpatient Programme, continues during the inpatient stay and<br />
culminates when the team determines that the individual is ready to move to the next step in the<br />
rehabilitation process.<br />
The social worker is also responsible for arranging individuals tutoring for adolescents when<br />
necessary to address the patient’s educational needs. Occupational therapists help patients to<br />
become as independent as possible in their daily activities. This includes getting around in the<br />
home and community, and pursuing work-related and leisure activities.<br />
With this knowledge, I spent time with the social workers and occupational therapists to discuss<br />
patient rehabilitation, as well as vocational support.<br />
The Social workers, whom I met with, had a crucial role to play in the patient journey and<br />
demonstrated a high passion and commitment, to address any patient concerns in the area of<br />
work. They were engaging the injured person on admission and then facilitated a patient and<br />
family meeting within 10 days to provide information and reassurance. If the patient was<br />
working, then they might receive financial aid from the company and possibly a period of sick<br />
leave, however at the time of discharge a person uses personal insurance and/or workers<br />
compensation and can be assessed for eligibility for Medicaid.<br />
A daily patient education programme is run and provides unit solidarity as well as an evolving<br />
community feeling; this, coupled with disciplinary input and essential peer support, fosters a<br />
sense of hope for the future.<br />
Helen Hayes facility provides a transition programme with those patients who are discharging. It<br />
is a 10 bed unit, supporting not only SCI but also traumatic brain injury and increased<br />
independence is an expected outcome and the patient participates 100% in achieving this.<br />
Burke Gym “There are no barriers”<br />
Whilst visiting the Burke Gym, I was introduced to a young man who was excited about his<br />
future, and through his accident had found his passion. He sustained a SCI at the level of C5 as<br />
<strong>WCMT</strong> Research Fellowship 15
the result of a water incident and at the time was a University student. He had returned for three<br />
months of intensive therapy. He instantly struck me as a man with a purpose and joy for life.<br />
Following his SCI, he had returned to university and was<br />
accommodated in the dorms. I asked him if there were any<br />
‘Attitude equals altitude’<br />
barriers moving forward with his career plans, at which time he smiled and responded, “There<br />
are no barriers and you know what, in a few years I’m going to travel to NZ”. He intends to work<br />
in the area of brain injury and is studying Neurological Science.<br />
An old colleague of mine used to say, ‘Attitude equals altitude’, and this young man was a great<br />
example of it in action!<br />
Therapeutic Recreation<br />
In spending time conversing with the Therapeutic Recreational team, I was enthused by the<br />
range of therapy interventions available for patients. The patient has to be referred for the<br />
intervention (medically approved) and the therapists then works with the patient to incorporate<br />
specific interests into the therapy, to achieve optimal outcomes that transfer to real life situations.<br />
Research supports the concept that people with active satisfying lifestyles will be happier and<br />
healthier, ‘Active Body, Active Mind’. The therapy interventions included (but were not limited<br />
to):<br />
1. Relaxation Therapy<br />
a. In relaxation therapy sessions, patients learn stress management techniques that<br />
help to prevent or alleviate a variety of symptoms that may occur with illness or<br />
injury.<br />
2. Group Humour Therapy (Humour is Good for Health)<br />
a. HIGH (Humour Is Good for Health) therapy uses the power of laughter, humour,<br />
and positive attitude to bring about physical and emotional benefits.<br />
3. Complementary Therapy<br />
a. Modalities offered include acupressure, biosonic repatterning, polarity,<br />
reflexology, visualization, massage therapy and body work.<br />
4. Adaptive Yoga<br />
a. Adaptive Yoga follows the same principles as traditional yoga, but also provides<br />
the participant specific instruction in the use of props and modifications for poses.<br />
<strong>WCMT</strong> Research Fellowship 16
5. General Recreation<br />
a. Burke offers general recreation Programmes which may be therapeutic, such as<br />
entertainment, social Programmes, horticulture activities, music, games, crafts<br />
and a variety of other activities.<br />
Paraplegic Centre, Notwill, Switzerland<br />
History<br />
From the moment I stepped onto the train platform in Notwill, I knew there was something<br />
special about this place. Instantly, accessibility was apparent and I learned how the community is<br />
built to support those with a SCI. The Swiss Paraplegic Centre (SPC) in Notwill provides its<br />
patients with an extensive range of world-class treatments, services and medical care in a setting<br />
that supports all areas of wellness. The centre provides individually-tailored, comprehensive<br />
treatment in three phases (acute, reactivation and integration) through the use of very highly<br />
skilled staff and state-of-the-art equipment.<br />
The (SPC) was opened by Dr Guido A. Zäch in 1990; he began his journey in the 1960s and<br />
went on to establish the Swiss Paraplegic Foundation (SPF) in 1975. During my visit, I was<br />
fortunate enough to meet Dr Zäch as he was attending the Paraplegia Athletics which was held<br />
on-site. The SPC is a privately owned clinic, which is acclaimed nationwide, specialising in<br />
primary care, acute treatment, comprehensive rehabilitation and lifelong care of people with SCI<br />
and similar syndromes. The SPC has 140 beds, including an intensive care unit. The annual bed<br />
occupancy is over 99%.<br />
Interesting to note is that 1100 people are employed from 80 vocational backgrounds, speaking<br />
more than 35 different languages.<br />
The specialist clinic is part of the Swiss Paraplegic Group (SPG), which forms an integrated<br />
network for the comprehensive rehabilitation of people with SCI. The network is supported by<br />
the SPF, established in 2000 and has a strong research arm employing over 50 staff.<br />
Notwill’s Approach to Rehabilitation<br />
The aim that the comprehensive team work towards, is to re-establish a patient’s personality and<br />
lifestyle to the fullest possible extent, with a holistic approach to treatment that includes mental,<br />
<strong>WCMT</strong> Research Fellowship 17
physical and social aspects such as career, family and leisure activities; which like Burke aligns<br />
with the Māori model of Health; Te Whare Tapa Whā.<br />
As a unique centre, they offer the patients, services which are geared towards their specific<br />
needs, meeting high ethical standards, scientific and practical demands. The range of services on<br />
offer is significant and ranges from Paraplegiology specialists, vocational rehabilitation through<br />
to Equine therapy; the Centre in my view is truly holistic, resourced and inspiring.<br />
The vocational services include the Vocational Teaching Department, Vocational Workshop &<br />
Technological Learnings and a team of Vocational Consultants. My schedule at SPC, can be<br />
found in Appendix 5 and demonstrates SPC providing exposure to a range of departments; not<br />
only vocational.<br />
Vocational Teachers<br />
The Vocational Teaching department offers in-house educational support to both school and<br />
university students one to two times weekly. Only the main school subjects are taught, however<br />
it does include the range of languages spoken by teachers. The<br />
teaching is available once a patient has mobilised. Factors<br />
considered when entering patients into the vocational teaching<br />
unit are, that they are able and willing, possess capacity to learn<br />
and fatigue and tolerance are making positive progress.<br />
What I found encouraging was that whether it is a school or<br />
university student who is injured, the whole class is invited to<br />
the centre. Students try out wheelchairs, have lunch with staff<br />
and other patients and develop a sensibility around SCI.<br />
Teachers gain the material to educate the class about SCI.<br />
People that are injured whilst in the process of an apprenticeship are also included and are able to<br />
take exams as the teacher will come to the centre, or if possible transport is provided for students<br />
to have a break from the rehabilitation schedule and can attend off-site.<br />
“Whether it is a school or<br />
university student injured,<br />
the whole class is invited to<br />
the centre. Students try out<br />
wheelchairs, have lunch<br />
with staff and other<br />
patients and develop a<br />
sensibility around SCI”.<br />
For adult patients, the vocational teachers aim to get each individual to a skill level higher than<br />
they possessed on admission. For example, a receptionist gaining skills to support moving into<br />
administrative work, or in a case I observed, a lawyer learning a new language. The teachers are<br />
<strong>WCMT</strong> Research Fellowship 18
able to provide formal examinations and reported that this goes a very long way to remove the<br />
fear, if higher learning or complete retraining is required.<br />
Of absolute importance, was connecting everyone involved both in the multi-disciplinary group,<br />
inter-vocational support and external in supporting the person to either return to school, return to<br />
work or to return to an entirely new environment. Job coaching begins early, as does employer<br />
engagement. The teachers expressed the need to look at the practical versus theory post-injury,<br />
commenting that the higher level of injury tetraplegia group provided a greater challenge, as<br />
often more time was required.<br />
Vocational Consulting<br />
Patient X<br />
“In the first moment you came to my bed I could have murdered you because I was thinking<br />
about relationships, life, toilets and my injury. But when I left the hospital I understood why you<br />
came so early; it was necessary and I thank you forever. Initially I couldn’t deal with work issues<br />
if they arose, it would be too much.”<br />
The return to work rate for the Swiss population is 55-60% (in 2012 it was reported at 58%). The<br />
following statements from the vocational consultants attribute to the success of the patients<br />
outcomes and strongly echo our experience at Kaleidoscope:<br />
o We make communication with the employer very early on.<br />
o The patients are consulted about the vocational team contacting their employers.<br />
o Having a vocational consultant early and prioritised, the patients report “It is one problem<br />
less, no need to worry about work.”<br />
o An appointment is made with the employer, initially to visit the hospital and then the<br />
consultants visit the workplace and conduct a worksite assessment, if geographically<br />
possible.<br />
o An objective is to remove the fear of workplace modification costs from the employer.<br />
o A message delivered to the patients is, “we will try and find a solution together; it may be<br />
different now, but there is a future.”<br />
o We link patients with peers in the community working in the same job, if the patient<br />
wishes for this to occur.<br />
<strong>WCMT</strong> Research Fellowship 19
o It is so important to reintegrate the person into their community and provide vocational<br />
services. In saying this, it is equally important is to build self-image, confidence and selfefficacy.<br />
o SCI is normalised and an example of this is school children using the SPC swimming<br />
pool, community groups visiting and tours of the institute and allowing the community to<br />
access the large cafeteria and dine with inpatients.<br />
The funding model in Switzerland is not dissimilar to New Zealand, whereby if it is an accident<br />
the person receives accident insurance, and an injury at work will entitle them to insurance of<br />
incapacitation (90% of salary). For spinal illnesses, the person will receive the pension and an<br />
invalidity benefit.<br />
There is further insurance, whereby if the person is injured by another person i.e. hit by a car or<br />
stabbed, and then they will receive 100% lifetime compensation; however this is a lengthy<br />
process, with lawyers involved, and can be very hard on the patient.<br />
The general unemployment rate in Switzerland is 3%; the government expects and also supports<br />
employers to return disabled persons to work. At the time of discharge, and when a patient is<br />
returning to work, they conduct a work-capacity assessment for a period of three months; in NZ<br />
this is referred to as a ‘work trial’ or ‘graduated return to work’. The vocational consultants<br />
conduct a three month post-discharge reassessment interview, examining how the patient has<br />
adapted to their vocational setting, life adjustment and medical wellness; this is conducted again<br />
at six months post-discharge.<br />
I was encouraged by the conversations and the time I spent with the vocational counsellors to<br />
learn that we essentially operate in parallel, despite being over the other side of the world.<br />
Also, what they value as integral in the ‘early intervention’ work with patients is identical to<br />
Kaleidoscope.<br />
Vocational Workshop and Computer laboratory<br />
I have to be honest and say that upon walking into the workshop and computing area my<br />
immediate comments were “Is that a 3D printer, hold on do you have a CAD machine?” For a<br />
vocational rehabilitation department to have these two pieces of machinery is quite astonishing.<br />
My immediate thought was how fantastic for the patients to leave their rehabilitation trained or,<br />
<strong>WCMT</strong> Research Fellowship 20
on their way to being trained in two highly sought after skill areas; particularly 3D printing. The<br />
computer laboratory area contains a large<br />
array of software and computer training, for<br />
example Dragon Naturally Speaking<br />
software support provided by the Assistive<br />
Technology Department. Patients can learn<br />
Computer Numerical Control training; obtain<br />
CAD software design qualifications and 3D<br />
printing skills. The vocational workshop<br />
offers the opportunity for patients to try<br />
making a vast range of things and it seemed<br />
to me that any and everything was being<br />
achieved, an example is the picture<br />
articulation on the right. The machines are not modified and test the limitations of the person;<br />
particularly hand function.<br />
Stoke Manderville, United Kingdom<br />
History<br />
The National Spinal Injuries Centre (NSIC) is the oldest, and one of the largest spinal injuries<br />
centres in the world. As with the other spinal units I visited, Stoke Mandeville was established to<br />
treat servicemen who had sustained spinal cord injuries as a result of WW2 in 1944; founded by<br />
neurologist Professor Sir Ludwig Guttmann. An ambitious fundraising campaign to create a<br />
purpose built spinal cord injuries centre was launched, following severe flood damage to NSIC<br />
in 1980. Within three years, with the generosity of the public, £10m was raised and the new<br />
facilities opened in 1983.<br />
NSIC offers diagnosis, treatment and rehabilitation for patients with acute spinal cord injuries<br />
and non-traumatic spinal cord lesions of acute onset. Patients are referred from all over the UK,<br />
and from many countries around the world. I was also fortunate to visit the paediatric spinal<br />
ward, where I observed a different setting. The unit was the first accredited paediatric unit in<br />
Europe.<br />
<strong>WCMT</strong> Research Fellowship 21
Stoke Mandeville’s Approach to Rehabilitation<br />
With highly specialised and experienced staff, appropriate facilities and equipment, proven<br />
research based methods and a positive attitude, Stoke Mandeville offers a powerful community<br />
full of possibilities. Possibilities are what it is all about following SCI and what a person can do<br />
as opposed to what they cannot. The ultimate aim of Stoke Mandeville is for the patient to be<br />
safely discharged from the centre, and reintegrated back into family and community life; in a<br />
way that meets their own wishes and needs.<br />
One step closer to achieving discharge and heightened self-awareness and independence is the<br />
pre-discharge rehabilitation ward (St Joseph). Patients transition to St Joseph Ward prior to going<br />
home and have the support and security provided by experienced nursing staff. The ward is more<br />
like a unit and enables patients to be more active in their rehabilitation, as well as having time in<br />
the community. Patients had a full timetable of rehabilitation activities and were encouraged to<br />
try different things; much like the Transitional Rehabilitation Unit based at Burwood Spinal Unit<br />
in Christchurch, NZ.<br />
Vocational Services<br />
There is not a dedicated vocational rehabilitation team at Stoke Mandeville, however all<br />
therapists are encouraged to promote ‘work’ with patients; a cohesive disciplinary team message.<br />
There is a passionate and committed occupational therapist that leads vocational support external<br />
to her primary role and refers patients to an employment programme consisting of:<br />
1. Occupational Therapist<br />
2. Disability Support Services<br />
3. Peer Support Officer (Spinal injuries Association, UK)<br />
4. Vocational Consultant (Spinal injuries Association, UK)<br />
5. Job Plus Careers Advisor<br />
The employment programme runs monthly and includes both inpatients and outpatients<br />
accessing the support. The theme of the programme is ‘Not working, but working on it’. The<br />
vocational support provided at Stoke Mandeville Spinal Unit collaborates with the Spinal<br />
Injuries Association (SIA) UK. I visited the association and spoke to Jamie who at the time was<br />
their vocational outreach co-ordinator; further content is provided below.<br />
<strong>WCMT</strong> Research Fellowship 22
Spinal Injuries Association UK<br />
Jamie (Vocational Outreach Coordinator) at Spinal Injuries Association (SIA) UK commented<br />
that they are about changing employers attitudes to employing people with a SCI; this fits with<br />
my community focus on social expectations that people following SCI can work. Further to this,<br />
that employers can through access to accurate information, see the value of employing someone<br />
with a disability. In the UK however, there is a growing disability confidence from the<br />
community as well as a government initiative supporting this area of work. It is called ‘Access to<br />
Work: Return to Work scheme’ and includes funded transport, a support worker (if required),<br />
assistive technology and work adaptations (which can be very costly). For every £1 spent the<br />
employer can claim back £1.60 for workplace modifications. There are also diversity targets for<br />
companies and these are monitored.<br />
A masterclass is provided to the company regarding employing a person with a disability and<br />
more specific support can be obtained on request. With government pledges available, in some<br />
cases it is still possible in the UK that if a person with a disability applies and meets the<br />
minimum criteria, then it can be a guaranteed interview for the position being recruited.<br />
Vocational Support Clinics<br />
SIA holds regular vocational clinics at a number of Spinal Cord Injuries Centres, including Stoke<br />
Mandeville; each clinic is staffed by the aforementioned team. The purpose of the clinics is to<br />
give the SCI person the best possible advice, for future opportunities for work, education or<br />
volunteering. The clinics are open to inpatients and outpatients.<br />
An interesting resource that was being used in conjunction with other tools was ‘New Leaf’,<br />
which is a job matching tool specifically for SCI. Coincidently in Switzerland, there was a PhD<br />
student developing a similar job matching tool that caught my interest. My interest stems from<br />
my experience of transactional job matching tools that career advisors use, sometimes in<br />
isolation. Without context this is just ‘a tool’ and whilst it can deliver some indicative advice,<br />
further counseling is needed particularly for the SCI group Kaleidoscope supports, as injury is<br />
not taken into consideration. The Swiss resource being developed is by far more complex, and<br />
will look at spinal injury level and neurology, as well as work and interests. This resource set to<br />
be released in approximately 2017.<br />
<strong>WCMT</strong> Research Fellowship 23
Following targeted support, the attendees of the vocational clinics receive an action plan<br />
detailing the short and long term goals that have been established with the support team; patients<br />
centric. There are three, six and 12 month follow ups which generally speaking are milestones to<br />
explore achievements, health and wellness and sustainability of any work outcomes.<br />
Of interest, was discussion regarding embedding a vocational service in the medical model of a<br />
hospital setting; in the UK acute intervention is still reasonably new. Much like in New Zealand,<br />
Jamie identified a growing engagement from spinal trauma centres and the importance of<br />
everyone in the multi-disciplinary team delivering the same message. I was encouraged to hear<br />
that such an astute spinal service at Stoke Mandeville was consistently providing the ‘importance<br />
of work’ message on the wards. With the commitment from the clinical team, the drive of the<br />
occupational therapist leading it and SIA UK input, they are providing regular monthly<br />
vocational clinics.<br />
Both Jamie and I recognised that it takes time to embed a service, provide substantial evidence<br />
based practice, and build skilled vocational counselors that have acute inpatient experience; in<br />
turn developing the programme.<br />
<strong>WCMT</strong> Research Fellowship 24
SECTION TWO - Key Areas to Address<br />
A strategic collaborative approach is needed<br />
In 2014, New Zealand released the ‘Spinal Cord Impairment Action Plan (SCIAP)’ which<br />
promotes “The best possible health and wellbeing outcomes for people with spinal cord<br />
impairment being achieved, which enhances their quality of life and ability to participate in<br />
society”.<br />
The Action Plan, outlines a vision, purpose, priorities and eight overarching objectives to help<br />
ensure the best possible health and wellbeing outcomes for people with spinal cord impairment<br />
(SCI), enhancing their quality of life and ability to participate in society.<br />
In March 2012, ACC and the Ministry of Health jointly led a project to review New Zealand’s<br />
SCI services and develop a national implementation plan for improving them.<br />
The action plan states the following actions to address pertaining to vocational supports:<br />
1. Develop a plan to address gaps in vocational supports using a cost-effective model.<br />
2. Spinal rehabilitation services develop a process to include vocational support in discharge<br />
planning.<br />
3. ACC and the Ministry of Social Development to work together to develop a coordinated<br />
national vocational plan that prevents duplication and addresses gaps in vocational<br />
support for people with SCI.<br />
4. Explore the ACC weekly compensation model and Ministry of Social Development<br />
benefit model to ensure the right incentives are in place, so people can try work options<br />
without fear of loss of compensation or benefit that may prevent them attempting<br />
employment options.<br />
5. Provide specific SCI training for ACC case managers and Needs Assessment Service<br />
coordinators who work with people with SCI to ensure realistic back- to-work planning.<br />
6. Specify minimum skill-set requirements of vocational support services to ensure SCI<br />
expertise.<br />
There is always room to improve, and a collaborative model of service for SCI vocational<br />
rehabilitation is the way forward. This can be facilitated through the knowledge gained during<br />
my Winston Churchill Research Fellowship. Better quality and access to information is needed<br />
<strong>WCMT</strong> Research Fellowship 25
for patients, including those not receiving specialist vocational services, and the people involved<br />
in their rehabilitation. This includes local vocational services (without the serious SCI expertise),<br />
employers, family, case managers and therapists.<br />
Pathway for patients into Kaleidoscope services<br />
For those with a new SCI or illness (with a neurological diagnosis) depending on geographical<br />
location, may be admitted to one of three rehabilitation facilities:<br />
1. Burwood Spinal Unit<br />
2. Middlemore ICU/Acute<br />
3. Auckland Spinal Rehabilitation Unit<br />
Currently, 80% of those admitted are engaged in vocational rehabilitation within three weeks of<br />
admission. The remaining 20% are not engaged, most commonly due to a dual diagnosis of<br />
medium - high brain injury, medical complexities, isolation or other circumstances which require<br />
a period of time before engaging with the service.<br />
Vocational support is currently delivered in the community, complimentary to the acute services<br />
and Kaleidoscope refers to this as restorative work; one patient had been 17 years post-injury not<br />
working. There are a number of ways that people can access vocational support in the<br />
community, but primarily it is through funders ACC and Work and Income NZ (WINZ).<br />
I will never forget the people I met and went onto support, working through Kaleidoscope in<br />
more isolated areas of NZ, especially in their comments when we first met. One patient said, as<br />
the tears flowed, “where have you been all my life? I have wanted help with work and had no<br />
idea of the support or that there are things I could do”. C5/6 Complete Tetraplegic, now a very<br />
successful businessman.<br />
Our philosophy at Kaleidoscope is a holistic approach, but also one of education. Ultimately we<br />
are engaging a person in the area of work; however it is also about educating them on the<br />
readiness and preparation for work and job searching. This, so that in the future they will be able<br />
to use their own internal resource should they wish to change jobs or if they are made redundant<br />
or seek new employment.<br />
<strong>WCMT</strong> Research Fellowship 26
Through my Winston Churchill Fellowship Trust research, I’ve identified a number of areas of<br />
vocational rehabilitation services, to work towards improving. They are:<br />
1. Developing healthcare professionals from non-specialist settings (where required) as well<br />
as local vocational provider knowledge of SCI – Kaleidoscope has the skills and<br />
resources in place to deliver this nationally<br />
2. Master classes for employers – education and a lived client experience (invited<br />
consumer)<br />
3. Promoting a societal expectation that following a SCI, the person will be able to work<br />
4. Collaboration of inpatient – outpatient providers during the discharge planning phase to<br />
enhance the patient journey and provide continuity, specifically in this case vocational<br />
support.<br />
5. Carry out research in the acute vocational rehabilitation setting, a quantitative evaluation<br />
of data collection and emerging themes<br />
6. Supporting clinical colleagues in the implementation of the SCIAP<br />
7. Working with both ACC and the MOH where we can contribute to their education and<br />
vision, as well as add value through planning and preparation support<br />
8. The place of HOPE in vocational services and the maintenance of hope. When engaging<br />
in vocational support in the acute setting, this not only helps to enhance people’s<br />
recovery from illnesses, but also provides opportunities for a positive focus and enhanced<br />
quality of life.<br />
Delivering acute vocational support requires hope and, in many cases, a leap of faith by the<br />
patients. It is embracing the unknown as well as possibilities, building resilience and building a<br />
pathway forward to an altered future.<br />
Community integration<br />
Whilst vocational rehabilitation was my primary objective, it was very closely followed by an<br />
overarching objective to promote and encourage the communities in NZ to expect that people<br />
with disabilities return to/participate in work and the value of it to everyone. My observations in<br />
Notwill were how the Paraplegia Institute is infact the hub of the community. This began with<br />
<strong>WCMT</strong> Research Fellowship 27
the open cafeteria area, in which patients, family, clinicians, schools, sports groups and anyone<br />
from the surrounding community can dine and socialise.<br />
With the exception of ICU, throughout the hospital departments there are posters (in the corridor<br />
areas) with easily understood content, as well as pictorial examples of patients carrying out their<br />
rehabilitation. These serve as references, as well as the 10 stop points on a tour to newly injured<br />
people, family, employers and community groups visiting for education. This enables a<br />
normalisation of sorts in seeing people rehabilitating, and allows people visiting the hospital to<br />
gain an insight into SCI. An example of the community groups which visited the week I was onsite,<br />
were a bowling club, corporate team and a school class. They begin with an introduction to<br />
the institute, followed by the tour, some wheelchair skills and time in a chair, which is then<br />
followed with a final question and answer session. This is a great example of an opportunity to<br />
reach out to the community and give them a little bit of knowledge and raise awareness. The<br />
potential opportunities, such as industry advice and possible employment for patients, as well as<br />
the networks established as a result of this exposure, would serve a great many purposes, but the<br />
primary purpose being ‘community’.<br />
Another example of the community awareness commitment included children’s swimming<br />
lessons being held in the hydrotherapy pool, local people attending the paraplegic athletics<br />
competition and sports activities on-site utilising the extensive facilities available.<br />
As a result of these observations, and in reviewing a programme that Dr. Bernadette Cassidy<br />
developed, aimed at providing school children SCI and disability awareness, we will collaborate<br />
to develop a learning experience. The community SCI Ability Awareness Learning Experience;<br />
will target schools in Canterbury as well as including identified employers. At the time of<br />
submitting this research report the Ability Awareness Learning Experiences are due to<br />
commence in 2016.<br />
<strong>WCMT</strong> Research Fellowship 28
SECTION 3 - Resulting Action<br />
Great Expectations Project – Employers<br />
The evidence is visible – work is good for health and wellbeing. Returning to work or<br />
commencing new employment should be a societal expectation post-injury.<br />
Great Expectations is a new initiative from Kaleidoscope to engage employers. The project aims<br />
to transform attitudes by working with organisations that recognise the opportunity hiring a<br />
person with a disability presents. We will work to support them, when they ask what is possible<br />
when minds are open, accessibility is embraced and they hire a person with a SCI.<br />
The Great Expectations Project encompasses the following:<br />
1. Educational seminars for employers<br />
2. Formulating a business advisory committee<br />
3. Customised organisational information on-site<br />
4. Consumer availability<br />
5. Monthly profiling of patients/quarterly newsletter<br />
One in five New Zealanders has a disability, making up 20% of our population, many of whom<br />
offer a unique set of skills and perspectives that bring value to our organisations, communities<br />
and economy; when the opportunity presents.<br />
Two things that we know for sure at Kaleidoscope are that disabled people make great<br />
employees and that an accessible workplace is safer for everyone. Of the spinal population we<br />
work with, most people require little or no extra support of investment to fulfil their role.<br />
Kaleidoscope has increased the employment rate in SCI from 12.3% of spinal cord injured<br />
patients being employed to 60%, our message to employers is ‘Why not enhance your profile,<br />
increase the statistics and be part of this!’<br />
Education and awareness will be made available to employers either within their organisation or,<br />
as part of a wider community group, in a non-judgmental environment. A benefit being that,<br />
employers will have access, to an untapped labour market which is willing, keen and able; skills<br />
utilisation. Furthermore, employers will gain confidence to employ someone with a SCI, having<br />
the opportunity to ask questions. Previous or successful past patients will be available to enable<br />
employers to hear real life stories and have a discussion following.<br />
<strong>WCMT</strong> Research Fellowship 29
The topics covered will be:<br />
• Basic SCI 101<br />
• Why it is beneficial to employ people with disabilities (SCI) - an accessible workplace is<br />
safer for all staff and having disabled staff means more customers, better served<br />
• Frequently asked questions of an employer<br />
• Accessibility of a workplace<br />
• Invited consumer to share their experience and answer any questions<br />
Figure 1. Benefits to a company when employing a person with a disability<br />
As a result of learning about the BAC that Rusk Hospital developed, Kaleidoscope will also seek<br />
to formulate our own committee. We have created an Employer Network database and will seek<br />
out potential industry leaders to become members of the BAC, as well as interested patient<br />
employers, as time progresses.<br />
<strong>WCMT</strong> Research Fellowship 30
‘Ability’ Awareness Learning Experience<br />
Complimentary to the Great Expectations Project, and an experience which will provide a link<br />
between schools, organisations and the SCI population, is the proposed Ability Awareness<br />
Learning Experience. Educational experiences outside the classroom can enhance, reinforce, and<br />
clarify classroom learning and be rewarding for a workplace to engage in. Exploring the role of<br />
people with disabilities in the community will enable both pupils and employees to have an<br />
appreciation of SCI. But also awareness of what people ‘can do’ and how they do it.<br />
In the current world of the internet, to demonstrate the empowering role of technology in<br />
enabling people with disabilities to lead independent lives is a tremendous opportunity.<br />
The rationale behind the proposed education programme was due to observations made during<br />
this research, conversations with Dr. Bernadette Cassidy about the educational programme she<br />
developed and a long-standing intention of mine to engage the community further. This is<br />
targeting schools and employers at a deeper level.<br />
We have an aging and ever growing diverse and dynamic society. Employers will be able to<br />
visualise how our patients can, without a great deal of difficulty, fit into their environments.<br />
Meanwhile, pupils will learn about the role of people with disabilities in society, explore the<br />
issues, make decisions, and learn how to work co-operatively with others who have an<br />
impairment/disability.<br />
The idea behind this proposal is to enable those in the community to explore changes in societal<br />
attitudes and how these changes, along with the introduction of technology, have specifically<br />
improved the lives of people with disabilities. This innovative experience will provide<br />
participants with a first-hand experience of a learning and research centre set up to help people<br />
with disabilities to live independently.<br />
The programmes activities may feature the following:<br />
• Wheelchair obstacle course<br />
• ‘Driving’ a Hand controlled vehicle – Demonstrated by a staff member<br />
• Observing a simulated car used by the Driving Assessment Team<br />
• Using Co-Writer or Dragon Naturally speaking software (talking word prediction<br />
Programme)<br />
• Using a computer with head mouse (infra-red dot)<br />
<strong>WCMT</strong> Research Fellowship 31
• Informal talks with NZST staff who have a disability<br />
• Feedback on the session, opportunity to ask questions<br />
Patient Workshops – Outreach and extension of service<br />
I have been interested in the availability of either stand-alone workshops or a vocational series of<br />
education for a group environment. At Rusk, I observed this in action and whilst 1:1 vocational<br />
rehabilitation is without question an essential part of the journey, group sessions have potential<br />
to add another dimension to the process.<br />
For our patients, joining a group of unknown people may sound intimidating at first, but the<br />
benefits can be shared experiences of navigating the job search process, a support network and a<br />
sounding board external to the vocational consultants. Diversity is another important benefit in<br />
that people have different personalities and background, and they look at situations in different<br />
ways. By hearing how other people tackle problems and make positive changes, it is<br />
Kaleidoscopes hope that patients will discover a whole range of strategies for facing their own<br />
concerns.<br />
In running the patient work preparation and job search workshops, an added advantage for the<br />
facilitators will be observing patients in a group setting, interacting with others and problem<br />
solving.<br />
Those in the community with a SCI are the priority, and the project aim is to educate and build<br />
confidence, inpatients will be invited during the course of their rehabilitation if appropriate. The<br />
resourcing is in progress and the seminar series will offer the following:<br />
1. Networking – Tapping into the hidden job market<br />
a. Who are your support and work networks?<br />
2. Skills Identification – Know your skills, know your value<br />
3. CV – Purpose and tips for writing your CV<br />
a. Task of starting to formulate a CV, before the following clinic<br />
4. CV Clinic – Complete a CV<br />
5. Job Search – Where do I start?<br />
6. Interviews – Prepare and get the job you want!<br />
7. Self-promotion/advocacy skills – Courageous Conversations<br />
<strong>WCMT</strong> Research Fellowship 32
Conclusion<br />
The key objective of the <strong>WCMT</strong> fellowship was to review selected international vocational<br />
departments in an embedded hospital programme and their resourcing. Furthermore community<br />
support available to patients following discharge from rehabilitation units, and ways to improve<br />
community links and education around SCI. In terms of improving employer education the key<br />
questions presented during the research were:<br />
1. What do you promote as the benefits of employing someone with a disability?<br />
2. At what stage do you engage with an existing employer?<br />
3. What are the typical questions and concerns from employers?<br />
4. Is there funding available to address equipment and accessibility needs?<br />
5. How do you approach employers?<br />
Employment rates after SCI vary widely depending on many variables, particularly however the<br />
measure of employment. By measure of employment, I mean what the analysing person defines<br />
as work, for example paid work, voluntary work, full-time work or paid work more than 5 hours<br />
per week. Statistics also, do not necessarily reflect the complexities that sit alongside the return<br />
to work process.<br />
Characteristics influencing employment after SCI include demographic variables, injury-related<br />
factors (age at injury, level of impairment, functional capacity), employment history or in many<br />
cases a limited history of work, psychosocial issues such as transport, physical health, life skills,<br />
motivational level/expectation to work and not forgetting, very importantly the support systems<br />
available.<br />
It is well reported that those individuals with SCI who are working, experience significantly<br />
better quality of life, sense of purpose and other benefits. However, the barriers to returning to<br />
meaningful work can be daunting and numerous. I have learnt that the most common issues of<br />
the countries I visited were access to transport, housing and flexibility of carers.<br />
Vocational rehabilitation programmes that address these barriers are essential. Vocational<br />
rehabilitation programmes in the acute setting, are even more beneficial to reduce the potential<br />
learned dependency of a person and to bridge the gap between employers and the individual. The<br />
area of acute vocational rehabilitation needs to be a focus of research, to understand, better<br />
communicate and improve vocational rehabilitation outcomes among this population of<br />
individuals with SCI.<br />
<strong>WCMT</strong> Research Fellowship 33
My fellowship will contribute to the patient journey and recognises a ‘whole of person’ holistic<br />
approach, is committed to improving community awareness and support for employers and<br />
ultimately influence attitudes in the area of disability. Initiatives will be actioned in these areas<br />
and an insight has been demonstrated in this document.<br />
The exposure to the vocational settings and support during my fellowship both challenged and<br />
encouraged me. I was encouraged that New Zealand and specifically Kaleidoscope, is delivering<br />
results comparitible to much bigger better resourced programmes. I was challenged to develop<br />
SCI vocational rehabilitation and progress initiatives, but with an acute awareness that<br />
resourcing is a significant problem.<br />
Vocational rehabilitation is an integral part of SCI rehabilitation. There is much that can be done<br />
moving forward; with a commitment to collaborate, improve services and continue to listen and<br />
learn.<br />
<strong>WCMT</strong> Research Fellowship 34
References<br />
ACC and the Ministry of Health. 2014. New Zealand Spinal Cord Impairment Action Plan 2014-<br />
2019. Wellington: ACC<br />
Māori health models – Te Whare Tapa Whā<br />
Retrieved from http://www.health.govt.nz/our-work/populations/Māori-health/Māori-healthmodels/Māori-health-models-te-whare-tapa-Whā<br />
DeJong, G. (1979). Independent Living: From Social Movement to Analytic Paradigm.<br />
Retrieved from https://enablemob.wustl.edu/OT572D-<br />
01/RequiredArticles/IndependentLivingFromSocialMovementtoAnalyticParadigm.pdf<br />
<strong>WCMT</strong> Research Fellowship 35
Appendix 1. Model Explanation of ‘The Kaleidoscope Way’<br />
Model Explanation of ‘The Kaleidoscope Way’ TM<br />
Creation Actions is about clients<br />
regularly taking actions that are<br />
consistent with ‘creating’ their<br />
preferred vocational future and<br />
RTW. This approach promotes<br />
ownership, independence,<br />
responsibility, action & pride in<br />
realising one’s RTW potential.<br />
This approach also has the client<br />
in communication with ‘their<br />
world’ and promote self efficacy<br />
& a diminished reliance on VR<br />
services.<br />
‘The Kaleidoscope Way’ model of<br />
vocational rehabilitation is<br />
fundamentality grounded in the<br />
‘world’ of the client, their hopes,<br />
dreams & aspirations. This<br />
clientcentric approach is supported<br />
by well developed life/career<br />
conversations, utilising the Powhiri<br />
model of engagement it is culturally<br />
sensitive, organic, and fluid (i.e. a<br />
non-linear process). It assumes and<br />
promotes the client as ‘the expert’ of<br />
their own rehabilitation & RTW.<br />
Kaleidoscope has developed<br />
S.W.I.F.T.E.R which is a specific<br />
goal setting tool for SCI clients,<br />
this denotes goals as being:<br />
Stepped, Well-informed,<br />
Idiosyncratic, Fluid, Thorough,<br />
Energising & Resourced. Goal<br />
optimisation works from a<br />
strength based approach of<br />
leveraging off abilities,<br />
opportunities and resources to<br />
overcome barriers to a RTW.<br />
Research & Preparations avails the<br />
client the opportunity to explore<br />
RTW possibilities in a nonthreatening,<br />
explorative &<br />
appreciative manner. RTW Research<br />
& Preparations can continue<br />
alongside other rehabilitation<br />
initiatives & priorities and<br />
progressively lays the foundation for<br />
a well informed, planned, and<br />
executed RTW<br />
‘The Kaleidoscope Way’ TM 2010 ©<br />
‘The Kaleidoscope Way’ TM 2010 ©<br />
<strong>WCMT</strong> Research Fellowship 36
Appendix 2. Return to work in the context of Kaleidoscope<br />
In the language of the ‘rehabilitation trade’, getting work or getting back to work is vocational<br />
rehabilitation. There are many definitions of the rehabilitation process, but for the individual<br />
recovering person it is the outcome that matters most. Success for each person means reinclusion<br />
in society’s mainstream and independence; work in the broadest sense is purposeful,<br />
constructive activity meaningful to the person. I was asked by an ICU specialist recently what I<br />
want to achieve, when meeting people in the acute setting. To this I responded, that it is different<br />
for everyone. However we have a process and number one is respecting the patient, assessing<br />
their needs and recognising where they are at.<br />
Historically, return to work has been a distant goal, was seldom addressed early in the<br />
rehabilitation process, and where information was available, outcomes were poor. At<br />
Kaleidoscope, we promote that vocational rehabilitation runs succinctly with other rehabilitation<br />
initiatives, whilst respecting that no person, injury or journey is the same. All over the world<br />
health services deliver rehabilitation within, what Gerben DeJong (1979), describes as, the<br />
Rehabilitation Paradigm. I learnt rather quickly from my two mentors, that by this he meant that<br />
the process is controlled by rehabilitation professionals. In New Zealand, Professor Alan Clarke<br />
described it as heavily medicalised.<br />
DeJong proposed a shift to what he called the Independent Living (IL) Paradigm, where the<br />
rehabilitation process is controlled by the recovering person (consumer) and based on high<br />
quality information. Recovery is then more likely to be seen for what it really is – learning to get<br />
back into the groove or ‘flow of life’.<br />
The Allan Bean Centre was established in 2001, for research and learning in rehabilitation at<br />
Burwood Hospital. It was built to serve recovering people and their families within the<br />
Independent Living Paradigm of DeJong. The approach has been described by my predecessors<br />
as The New Rehabilitation and encourages the recovering person with his/her family to take<br />
control of the pathway to recovery as soon as possible. Sadly the Allan Bean Centre was<br />
condemned due to the Canterbury Earthquakes, however the culture and purpose remains and a<br />
new space will relaunch in 2016.<br />
<strong>WCMT</strong> Research Fellowship 37
Whilst Kaleidoscope’s core role is supporting a<br />
vocational journey, we cannot expect to move forward<br />
without a foundation and an understanding of each<br />
patient. Where they have come from, what is important to<br />
them; rapport and respect are vital. A Kaleidoscope<br />
patient in 2010 provided this feedback which aligns with<br />
my statement regarding rapport and respect.<br />
“I met Mel from Kaleidoscope and her approach brought<br />
me back to the real world. She used the word work and it actually devastated me. In my mind I<br />
wished that she would go away, but in the conversation we had it wasn’t what I said; but it was<br />
certainly how I felt.<br />
As time has gone on, Mel kept coming back and quietly just worked through some of the issues.<br />
She has given me the opportunity to work through and look at the things I might want to do in the<br />
future; these weren’t necessarily all around work. We talked a lot about my past and we both<br />
had some fun as I recalled some of the things that had happened. I’ve had lots of jobs, done a lot<br />
of things and what this support has done, using the process that Kaleidoscope has in place, has<br />
allowed me to find an area that maybe in the future I can move in to.”<br />
“It’s been hard but it has been<br />
important and as I said the process<br />
that was used and the way it was<br />
presented to me made it real easy<br />
and now I’m leaving<br />
here……..there is something for<br />
me in the future” (Kaleidoscope<br />
patient)<br />
The tools for success include hope, love of life, confidence, self-esteem, excitement of challenge,<br />
high quality information and recognition of the need for hard work and determination. Further to<br />
this is support from professionals, friends and family and guarantee of long term (strategic)<br />
quality improvement through research. For example a patient commented to me recently “I am<br />
not here for a holiday, I am here to work and I am making good progress”.<br />
Vocational Rehabilitation is a process that starts during an individual’s initial admission to<br />
hospital and continues, in many cases, following their return home. It is critical that when<br />
discharged from hospital, there is continuity in their vocational plan and that the person has<br />
access to quality information and support.<br />
“It is never too late to be what you might have been”.<br />
George Eliot<br />
<strong>WCMT</strong> Research Fellowship 38
Appendix 3.<br />
Te Whare Tapa Whā - One model for understanding Māori health and that aligns strongly with<br />
Kaleidoscopes philosophy and operational guidelines is the concept of ‘te whare tapa whā’ – the<br />
four cornerstones (or sides) of Māori health.<br />
Explanation of the model<br />
With its strong foundations and four equal sides, the<br />
symbol of the wharenui illustrates the four<br />
dimensions of Māori well-being.<br />
Should one of the four dimensions be missing or in<br />
some way damaged, a person, or a collective may<br />
become ‘unbalanced’ and subsequently unwell.<br />
For many Māori modern health services lack<br />
recognition of taha wairua (the spiritual dimension).<br />
In a traditional Māori approach, the inclusion of the<br />
wairua, the role of the whānau (family) and the<br />
balance of the hinengaro (mind) are as important as<br />
the physical manifestations of illness.<br />
Taha tinana (physical health)<br />
The capacity for physical growth and development.<br />
Good physical health is required for optimal development.<br />
Our physical ‘being’ supports our essence and shelters us from the external environment. For<br />
Māori the physical dimension is just one aspect of health and well-being and cannot be<br />
separated from the aspect of mind, spirit and family.<br />
Taha wairua (spiritual health)<br />
The capacity for faith and wider communication.<br />
Health is related to unseen and unspoken energies.<br />
The spiritual essence of a person is their life force. This determines us as individuals and as a<br />
collective, who and what we are, where we have come from and where we are going.<br />
A traditional Māori analysis of physical manifestations of illness will focus on the wairua or<br />
spirit, to determine whether damage here could be a contributing factor.<br />
Taha whānau (family health)<br />
The capacity to belong, to care and to share where individuals are part of wider social systems.<br />
Whānau provides us with the strength to be who we are. This is the link to our ancestors, our<br />
ties with the past, the present and the future.<br />
Understanding the importance of whānau and how whānau (family) can contribute to illness<br />
and assist in curing illness is fundamental to understanding Māori health issues.<br />
Taha hinengaro (mental health)<br />
The capacity to communicate, to think and to feel mind and body are inseparable.<br />
Thoughts, feelings and emotions are integral components of the body and soul.<br />
This is about how we see ourselves in this universe, our interaction with that which is uniquely<br />
Māori and the perception that others have of us.<br />
<strong>WCMT</strong> Research Fellowship 39
Appendix 4. Winston Churchill Memorial Trust Fellowship schedule, May 2014<br />
Sunday Monday Tuesday Wednesday Thursday Friday Saturday<br />
4 5 6<br />
7<br />
8<br />
9<br />
10<br />
TRAVEL<br />
CHRISTCHURCH<br />
– NEW YORK<br />
RUSK CLINICAL<br />
AND<br />
VOCATIONAL<br />
RUSK CLINICAL<br />
AND<br />
VOCATIONAL<br />
BURKE<br />
REHABILITATION<br />
HOSPITAL<br />
REST DAY<br />
11<br />
12<br />
13<br />
14<br />
15<br />
16<br />
17<br />
REST DAY<br />
TRAVEL<br />
NEW YORK<br />
- ZURICH<br />
TRAVEL<br />
SWISS<br />
PARAPLEGIC<br />
CENTRE<br />
(Schweizer<br />
Institut fur<br />
Beruffindung)<br />
SWISS<br />
PARAPLEGIC<br />
CENTRE<br />
(Schweizer<br />
Institut fur<br />
Beruffindung)<br />
SWISS<br />
PARAPLEGIC<br />
CENTRE<br />
(Schweizer<br />
Institut fur<br />
Beruffindung)<br />
SWISS<br />
PARAPLEGIC<br />
CENTRE<br />
(Schweizer<br />
Institut fur<br />
Beruffindung)<br />
SWISS SPINAL<br />
INJURIES<br />
ASSOCIATION<br />
18<br />
19<br />
20<br />
21<br />
22<br />
23<br />
24<br />
TRAVEL<br />
ZURICH -<br />
LONDON<br />
REST DAY<br />
STOKE<br />
MANDEVILLE<br />
HOSPITAL<br />
(NSIC)<br />
STOKE<br />
MANDEVILLE<br />
HOSPITAL (NSIC)<br />
SPINAL<br />
INJURIES<br />
ASSOCIATION<br />
UK<br />
Potential<br />
observations at<br />
Headley Court –<br />
Military<br />
Rehabilitation<br />
Centre<br />
Transcriptions<br />
and work<br />
25<br />
REST DAY<br />
26<br />
REST DAY<br />
27<br />
REST DAY<br />
28<br />
TRAVEL<br />
LONDON –<br />
AUCKLAND -<br />
CHRISTCHURCH<br />
29<br />
TRAVEL<br />
LONDON –<br />
AUCKLAND -<br />
CHRISTCHURCH<br />
30<br />
COMPLETE<br />
31<br />
<strong>WCMT</strong> Research Fellowship 40
Appendix 5. Example Schedule – Swiss Paraplegic Centre, Notwill<br />
Date Time Appointment Where<br />
Wednesday, May<br />
14<br />
08.30 Introduction to Swiss Paraplegic Centre Main entrance of the clinic<br />
08.30 - 09.45<br />
Nursing Management – Acute Ward with<br />
the Clinical Nurse Manager<br />
Ward D<br />
09.45 - 10.00 Coffee Break Ward D<br />
10.00 - 12.00 Occupational Therapy Office of Therapies Director<br />
12.00 - 13.00 Lunch time<br />
13.00 - 14.00<br />
Nursing Management – Activities with<br />
student nurses and rounds<br />
Ward D<br />
14.00 - 15.00 Vocational Department Introduction<br />
Institute for Vocational<br />
guidance<br />
15.00 - 16.00 Consultant Paraplegiology Office Dr<br />
Thursday, May 15<br />
09.00 Coffee with the team Restaurant<br />
09.15 - 10.00 Visit of the teaching lessons Vocational guidance<br />
10.00 - 11.00 Vocational counsellor Office 1<br />
11.00 - 12.00 Vocational counsellor Office 2<br />
12.00 - 12.30 Lunch time Restaurant<br />
12.30 – 14.00 Vocational discussion<br />
14.00 – 16.00 Vocational Teacher<br />
Institute for Vocational<br />
guidance<br />
Workshop Vocational<br />
guidance<br />
16.00 – 18.00 Occupational Therapy OT<br />
<strong>WCMT</strong> Research Fellowship 41
Friday, May 16 Time Appointment Where<br />
06.00 – 09.45 Physiotherapy PT<br />
09.45 - 10.00 Coffee Break PT<br />
10.00 – 12.00 Swiss Paraplegic Research GZI<br />
12.00 - 13.00 Lunch time<br />
13.00 – 15.00 Area Manager for Life Guidance Swiss Paraplegic Association<br />
15.00 – 16.00 Short break<br />
16.00 – 17.00 Area Manager of Culture & Leisure Swiss Paraplegic Association<br />
<strong>WCMT</strong> Research Fellowship 42
Appendix 6. Pictorial Fellowship highlights<br />
Left – Right and Top – Bottom Rusk pediatric activity space, myself and both the Director and Manager of Rusk Vocational<br />
Department, Notwill Ward D staff visual representation, Notwill art as viewed from a patient room (representation of a broken<br />
vertebrae), me at Notwill lake, Notwill assistive technology mouse example, handcycles at Burke gym, Notwill institute aerial<br />
view, Notwill patients wheelchair skills on an escalator and lastly a field in Notwill.<br />
<strong>WCMT</strong> Research Fellowship 43