Julie Phillips
Outreach Occupational Therapist,
Nottingham City Hospital NHS Trust
Tel: 0115 969 1169 ext: 45150
Email: jphillip@ncht.trent.nhs.uk
Summary:
Paul has chosen the title and wants to tell people what happened to him following his brain injury. He tried to regain control of his life himself after being knocked down by a car. It wasn’t until he had lost a few jobs, had his relationship break down and became homeless that he started to realise the devastating consequences of his brain injury. It was only because the Nottingham Traumatic Brain Injury Service know brain injured clients need help at different stages and at different times that they were able to help Paul when he needed it most.
Abstract:
In line with government policy, we aim to help people return to meaningful employment or activity. Most of our clients are of a working age with a normal life expectancy. It is well documented that a high percentage of this population face a prospect of a life time on benefits without specialist help. Paul is typical in that his treatment was carried out in the community and involved liaising with various agencies (the voluntary sector, the employment service, the benefit agency and the housing department) i.e. whatever was most appropriate. This provided a seamless service in line with the recommendations of the National Service Framework for long-term conditions. Paul’s case illustrates the need for a flexible service responsive to individual clients needs.
The increased survival rates of brain injured adults, the general increase in overall employment rates, the Disability Discrimination Act and now the governments desire to reduce the number of people on long term incapacity benefit have increased clients and families expectations of successfully returning to their previous activity status. This has been reflected in the increase in referrals to the Outreach Occupational Therapy service for vocational rehabilitation since April 1999. Return to work is now a priority and we have a team approach to this and work with those who can make it happen. In Paul’s case, this was the Disability Employment Advisor, the work placement provider and now his employer.
Feedback is actively encouraged from clients, carers, employers, disability employment advisors and others we are involved with. Our clients are happy to give us honest feedback. Paul has said that he has nothing to lose by telling us what he thinks. All parties concerned have consistently said how much they value our specialist input. Support is now given to the client and the person dealing with them throughout the return to work process until all parties feel confident to continue without us.
To respond to the increasing need for vocational rehabilitation, the team has developed a co-ordinated approach, increased their links with employers, the employment service and local colleges to ensure their intervention is as timely as possible. We have also changed our discharge criteria enabling clients to self–refer back to the service within a year of discharge without the need for a GP referral, thereby giving the client and their family more choice.Research evidence suggests return to work for severe brain injury can be as low as 25%-35%. In the last 3 years, 76% of clients with moderate to severe brain injury referred to the Occupational Therapist for vocational rehabilitation, have returned to work. This is an improvement, as only 53% of clients returned to work in the previous 3 years, and reflects the team’s specialist co-ordinated approach. Follow–up shows many clients maintain employment, which is also known to be difficult for this client group.
The results and feedback from all concerned, show the value of the increased support given. Paul comments that “the team was always there when I needed them and I wouldn’t have got the job I am now doing without everyone’s help”.
The service is open to all residents that fit the referral criteria and live in the Nottingham area. The service offers individual and group intervention, in a location of the client’s choice, at their convenience wherever possible. This has led to meetings being held in client’s homes, workplaces, and other venues in the community. As brain injury can happen to anyone and affects everyone involved, we use translators where appropriate and liaise with a very wide diverse population consisting of family and friends, employers, volunteer organisations, tutors and other agencies etc.
People have requested more information about brain injury, therefore, we have provided training days for people who are new or inexperienced to brain injury e.g. support tutors from colleges, employment agencies, volunteer bureau staff as well as other health and social services professionals. We also run a quarterly specialist interest group for those who work in this area. Clients have been speakers at these events and have reported finding this a rewarding experience as have the audience!
The co-ordinated specialist approach in helping brain injured client’s return to work or some form of meaningful activity together with coming to terms with their changed circumstances is the best thing about the service. Clients are usually people of working age with a normal life expectancy who often face a lifetime of difficulty without our help. It is equally valuable in helping those who do not return to work adjust to their new situation. A client who is currently working as a volunteer as he is unable to return to work, recently said, “I didn’t choose to live life like this, it was forced upon me, with the teams help, I am now happy with my life”.
