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Services and support within each Local Authority, Jobcentre Plus or Health Board area.

Vocational Rehabilitation

For individuals with illness, injury and disabilities, their condition often acts as a barrier that prevents them from accessing employment.

Vocational rehabilitation is a process that enables individuals with all kinds of health conditions to overcome barriers to accessing, sustaining or returning to employment. It can be defined as 'whatever helps someone with a health problem to stay at, return to and remain in work' and 'is an idea and an approach as much as an intervention or a service' ( Waddell, et al, 2008) or 'a process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation' ( Scottish Executive, 2007).

The aim of vocational rehabilitation is to help people retain or regain the ability to work, rather than to treat an illness or injury. It is now widely recognised that, as well as providing economic benefits, engaging in work or other meaningful activity has health  benefits for the individual, and can help people recover from physical and mental illness. A review of the available evidence by Waddell et al (2008) showed that there is a strong scientific evidence base for many aspects of vocational rehabilitation and there is a good business case for investing in vocational rehabilitation interventions.

Techniques used in vocational rehabilitation may include ( Healthy Working Lives Website):

  • Provision of health advice and promotion, in support of returning to work.
  • Support for self-management of health conditions.
  • Career (vocational) counselling.
  • Individual and group counselling focused on facilitating adjustments to the medical and psychological impact of disability.
  • Case management, referral, and service co-ordination.
  • Interventions to remove environmental, employment and attitudinal obstacles.
  • Job analysis, job development, and placement services, including assistance with employment and job accommodations.

The Individual Placement and Support (IPS) 'place then train' model is also widely used and its core principles include (Centre for Mental Health):

  • Every person with severe mental illness who wants to work is eligible for IPS supported employment.
  • Employment services are integrated with mental health treatment services.
  • Competitive employment is the goal.
  • Personalized benefits counseling is provided.
  • The job search starts soon after a person expresses interest in working.
  • Employment specialists systematically develop relationships with employers based upon their client's work preferences.
  • Job supports are continuous.
  • Client preferences are honored.

In relation to the effective delivery of vocational rehabilitation interventions, Waddell et. al. (2008) suggest the following:

  • Working with employers, as effective vocational rehabilitation depends on communication and coordination between the individual, healthcare, and the workplace.
  • Giving high priority to common health problems, as these account for about two-thirds of long-term sickness absence and incapacity benefits, and many of these conditions can be prevented.
  • Intervening early before the health problem becomes harder and more costly to tackle. Essentially, the longer anyone is off work, the greater the obstacles to return to work and the more difficult vocational rehabilitation becomes.

The Scottish Government recognises the importance of vocational rehabilitation. Co-ordinated, Integrated and Fit for Purpose, the framework for adult rehabilitation, highlights the importance of vocational rehabilitation and sets out a model for service delivery in Scotland. The framework notes that rehabilitation cannot be delivered by health services alone and that an integrated approach across services is required. It has identified a rapid access referral process through which individuals can secure support and specialist advice from a dedicated vocational rehabilitation team consisting of a range of professionals using case management approaches.

The Scottish Government's Health Works strategy recommends that the case management approach to working with clients must be more widely adopted whilst taking a whole person approach which considers wider barriers/needs, such as, housing and money issues.