Back2Work: a new model of early vocational rehabilitation for people with spinal cord injury
Vanette McLennan A B D , Pat Dorsett A , Julia Bloom A , Tania Goossen C and Frances Porter C
+ Author Affiliations
- Author Affiliations
A School of Health Sciences and Social Work, Griffith University, Gold Coast, Qld 4222, Australia. Email: p.dorsett@griffith.edu.au; j.bloom@griffith.edu.au
B Menzies Health Institute Queensland, Brisbane, Qld 4101, Australia.
C Spinal Life Australia, Brisbane, Qld 4102, Australia. Email: tgoossen@spinal.com.au; fporter@spinal.com.au
D Corresponding author. Email: v.mclennan@griffith.edu.au
Australian Health Review 46(1) 85-90 https://doi.org/10.1071/AH21069
Submitted: 4 March 2021 Accepted: 29 May 2021 Published: 28 October 2021
Abstract
Objective The aim of this article is to describe the development of a novel evidence-based model of early intervention vocational rehabilitation (EIVR) for people with spinal cord injury (SCI).
Methods An extensive literature review and background study guided the collaboration of experienced practitioners and researchers in developing and evaluating the innovative Back2Work model of EIVR for people with SCI in Queensland, Australia. The program is undergoing longitudinal mixed-methods evaluation to the end of 2023.
Results The model is central to the successful implementation of the EIVR program, delivered by rehabilitation counsellors in the Queensland Spinal Injuries Unit. Back2Work includes a strong focus on maintaining and nurturing the pre-injury occupational bond between injured workers and employers, and aims to create a positive expectation for return to work (RTW) and increase the rate and timeliness of RTW after SCI.
Conclusions The Back2Work program has become an integrated component of the multidisciplinary rehabilitation team, with positive early results in RTW outcomes and additional benefits in participants’ sense of well-being and hope.
What is known about the topic? Vocational intervention after SCI has traditionally been delivered after hospital discharge and considered outside the scope of early intervention approaches. Emerging evidence suggests EIVR, commencing before hospital discharge, can encourage hope and a positive expectancy for employment after SCI, and is showing promising outcomes in supporting people’s quality of life and vocational goals.
What does this paper add? This article details the process and product of developing and evaluating a novel EIVR model for people with SCI. The model underpins the Back2Work EIVR program being trialled in the Queensland Spinal Injuries Unit, an example of this emerging field of practice within the primary rehabilitation setting.
What are the implications for practitioners? The Back2Work program is based on an innovative and evidence-based model of EIVR for people with SCI. The collaborative and empirically driven process of developing, implementing and evaluating the model will be of interest to researchers and practitioners looking to advance practices in vocational rehabilitation after serious injury.
Keywords: early intervention, employment, model, occupational bond, return to work, spinal cord injury, vocational rehabilitation.
References
[1] Dorsett P, Geraghty T. Health-related outcomes of people with spinal cord injury—a 10 year longitudinal study. Spinal Cord 2008; 46 386–91.| Health-related outcomes of people with spinal cord injury—a 10 year longitudinal study.Crossref | GoogleScholarGoogle Scholar | 18180790PubMed |
[2] Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil 2011; 92 411–8.
| A longitudinal study of depression from 1 to 5 years after spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 21353823PubMed |
[3] Kennedy P, Lude P, Taylor N. Quality of life, social participation, appraisals, and coping post spinal cord injury: a review of four community samples. Spinal Cord 2006; 44 95–105.
| Quality of life, social participation, appraisals, and coping post spinal cord injury: a review of four community samples.Crossref | GoogleScholarGoogle Scholar | 16130026PubMed |
[4] Saunders LL, Krause JS, Focht KL. A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord 2012; 50 72–7.
| A longitudinal study of depression in survivors of spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 21808257PubMed |
[5] Hess DW, Ripley DL, McKinley WO, Tewksbury M. Predictors for return to work after spinal cord injury: a 3-year multicenter analysis. Arch Phys Med Rehabil 2000; 81 359–63.
| Predictors for return to work after spinal cord injury: a 3-year multicenter analysis.Crossref | GoogleScholarGoogle Scholar | 10724083PubMed |
[6] World Health Organization & International Spinal Cord Society. International Perspectives on Spinal Cord Injury. Albany, United States: World Health Organization; 2014.
[7] Chan SKK, Man DWK. Barriers to returning to work for people with spinal cord injuires: a focus group study. Work 2005; 25 325–32.
[8] Fadyl JK, McPherson KM. Understanding decisions about work after spinal cord injury. J Occup Rehabil 2010; 20 69–80.
| Understanding decisions about work after spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 19806438PubMed |
[9] Ferdiana A, Post MW, Hoekstra T, van der Woude LH, van der Klink JJ, Bültmann U. Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study. Arch Phys Med Rehabil 2014; 95 2040–6.
| Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 24832572PubMed |
[10] Hills L, Cullen E. A study into the employment trends of individuals treated at a spinal cord injury centre. Int J Ther Rehabil 2007; 14 350–5.
| A study into the employment trends of individuals treated at a spinal cord injury centre.Crossref | GoogleScholarGoogle Scholar |
[11] Anderson D, Dumont S, Azzaria L, Le Bourdais M, Noreau L. Determinants of return to work among spinal cord injury patients: a literature review. J Vocat Rehabil 2007; 27 57–68.
[12] Krause JS, Saunders LL, Acuna J. Gainful employment and risk of mortality after spinal cord injury: effects beyond that of demographic, injury and socioeconomic factors. Spinal Cord 2012; 50 784–8.
| Gainful employment and risk of mortality after spinal cord injury: effects beyond that of demographic, injury and socioeconomic factors.Crossref | GoogleScholarGoogle Scholar | 22547046PubMed |
[13] Krause JS, Terza JV, Saunders LL, Dismuke CE. Delayed entry into employment after spinal cord injury: factors related to time to first job. Spinal Cord 2010; 48 487–91.
| Delayed entry into employment after spinal cord injury: factors related to time to first job.Crossref | GoogleScholarGoogle Scholar | 19935754PubMed |
[14] Chapin MH, Holbert D. Employment at closure is associated with enhanced quality of life and subjective well-being for persons with spinal cord injuries. Rehabil Couns Bull 2010; 54 6–14.
| Employment at closure is associated with enhanced quality of life and subjective well-being for persons with spinal cord injuries.Crossref | GoogleScholarGoogle Scholar |
[15] Krause JS, Kewman D, DeVivo MJ, Maynard F, Coker J, Roach MJ, Ducharme S. Employment after spinal cord injury: an analysis of cases from the model spinal cord injury systems. Arch Phys Med Rehabil 1999; 80 1492–500.
| Employment after spinal cord injury: an analysis of cases from the model spinal cord injury systems.Crossref | GoogleScholarGoogle Scholar | 10569446PubMed |
[16] Murphy GC, Middleton J, Quirk R, De Wolf A, Cameron ID. Predicting employment status at 2 years’ postdischarge from spinal cord injury rehabilitation. Rehabil Psychol 2011; 56 251–6.
| Predicting employment status at 2 years’ postdischarge from spinal cord injury rehabilitation.Crossref | GoogleScholarGoogle Scholar | 21787095PubMed |
[17] Royal Australian College of Physicians (RACP) and the Australasian Faculty of Occupational and Environmental Medicine. Realising the Health Benefits of Work, a Position Statement. RACP; 2010. Available at: https://www.racp.edu.au/docs/default-source/advocacy-library/realising-the-health-benefits-of-work.pdf
[18] Bloom J, Dorsett P, McLennan V. Investigating employment following spinal cord injury: outcomes, methods, and population demographics. Disabil Rehabil 2019; 41 2359–68.
| Investigating employment following spinal cord injury: outcomes, methods, and population demographics.Crossref | GoogleScholarGoogle Scholar | 29726730PubMed |
[19] Dorsett P. The importance of hope in coping with severe acquired disability. Aust Soc Work 2010; 63 83–102.
| The importance of hope in coping with severe acquired disability.Crossref | GoogleScholarGoogle Scholar |
[20] Dorsett P, Geraghty T, Sinnott A, Acland R. Hope, coping and psychosocial adjustment after spinal cord injury. Spinal Cord Ser Cases 2017; 3 17046
| Hope, coping and psychosocial adjustment after spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 28944084PubMed |
[21] Middleton JW, Johnson D, Murphy G, Ramakrishnan K, Savage N, Harper R, Cameron I. Early access to vocational rehabilitation for spinal cord injury inpatients. J Rehabil Med 2015; 47 626–31.
| Early access to vocational rehabilitation for spinal cord injury inpatients.Crossref | GoogleScholarGoogle Scholar | 26034973PubMed |
[22] Bloom J, McLennan V, Dorsett P. Occupational bonding after spinal cord injury: a review and narrative synthesis. J Vocat Rehabil 2019; 50 109–20.
| Occupational bonding after spinal cord injury: a review and narrative synthesis.Crossref | GoogleScholarGoogle Scholar |
[23] Safe Work Australia. The national return to work survey: the role of the employer and workplace. Australia and New Zealand 2013. Safe Work Australia; 2014. Available at: https://www.safeworkaustralia.gov.au/doc/return-work-survey-role-employer-and-workplace-australia-and-new-zealand-2013
[24] Holmes J, Phillips J, Morris R, Bedekar Y, Tyerman R, Radford K. Development and evaluation of an early specialised traumatic brain injury vocational rehabilitation training package. Br J Occup Ther 2016; 79 693–702.
| Development and evaluation of an early specialised traumatic brain injury vocational rehabilitation training package.Crossref | GoogleScholarGoogle Scholar |
[25] Carrougher GJ, Brych SB, Pham TN, Mandell SP, Gibran NS. An intervention bundle to facilitate return to work for burn-injured workers: report from a burn model system investigation. J Burn Care Res 2017; 38 e70–8.
| An intervention bundle to facilitate return to work for burn-injured workers: report from a burn model system investigation.Crossref | GoogleScholarGoogle Scholar | 28009697PubMed |
[26] Sheppard DM, Frost D. A new vocational rehabilitation service delivery model addressing long-term sickness absence. Br J Occup Ther 2016; 79 677–81.
| A new vocational rehabilitation service delivery model addressing long-term sickness absence.Crossref | GoogleScholarGoogle Scholar |
[27] Hilton G, Unsworth CA, Murphy G, Browne M, Olver J. Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord 2017; 55 743–52.
| Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 28290469PubMed |
[28] Johnston DA, Ramakrishnan K, Garth B, Murphy G, Middleton JW, Cameron ID. Early access to vocational rehabilitation for inpatients with spinal cord injury: A qualitative study of staff perceptions. J Rehabil Med 2016; 48 776–80.
| Early access to vocational rehabilitation for inpatients with spinal cord injury: A qualitative study of staff perceptions.Crossref | GoogleScholarGoogle Scholar |
[29] Bergmark L, Westgren N, Asaba E. Returning to work after spinal cord injury: exploring young adults’ early expectations and experience. Disabil Rehabil 2011; 33 2553–8.
| Returning to work after spinal cord injury: exploring young adults’ early expectations and experience.Crossref | GoogleScholarGoogle Scholar | 21592045PubMed |
[30] Dorsett P, McLennan V. Back2Work: Optimising vocational rehabilitation outcomes following spinal cord injury. 2017 Australian and New Zealand Spinal Cord Society Annual Scientific Meeting, Building Bridges, 15–17 November 2017, Brisbane Australia. 2017.
[31] Productivity Commission. Disability Care and Support. Report No. 54. Canberra; 2011. Available at: https://www.pc.gov.au/inquiries/completed/disability-support/report
[32] Queensland Health. Options Paper – Statewide Spinal Cord Injury Health Service Planning Project. Brisbane: Queensland Government; 2015.
[33] Bloom J, Dorsett P, McLennan V. Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries. Spinal Cord Ser Cases 2017; 3 16042
| Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries.Crossref | GoogleScholarGoogle Scholar | 28382213PubMed |
[34] Dorsett P, McLennan V. Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury. J Vocat Rehabil 2019; 50 131–9.
| Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury.Crossref | GoogleScholarGoogle Scholar |
[35] Holt L. Understanding program logic. Melbourne: Department of Health & Human Services; 2013. Available at: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Understanding%20program%20logic
[36] W.K. Kellogg Foundation (WKKF). Using Logic models to bring together planning, evaluation and action: Logic model guide. WKKF; 2004. Available at https://www.wkkf.org/resource-directory/resources/2004/01/logic-model-development-guide
[37] Savaya R, Waysman M. The logic model: A tool for incorporationg theory in development and evaluation of programs. Adm Soc Work 2005; 29 85–103.
| The logic model: A tool for incorporationg theory in development and evaluation of programs.Crossref | GoogleScholarGoogle Scholar |
[38] Bond GR. Supported employment: evidence for an evidence based practice. Psychiatr Rehabil J 2004; 27 345–59.
| Supported employment: evidence for an evidence based practice.Crossref | GoogleScholarGoogle Scholar | 15222147PubMed |
[39] Lloyd C, King R. Implementation of supported employment: what are the implications for clinical services? J Rehabil 2012; 78 25–9.
[40] Ottomanelli L, Barnett SD, Toscano R. Individual placement and support (IPS) in physical rehabilitation and medicine: The VA spinal cord injury experience. Psychiatr Rehabil J 2014; 37 110–2.
| Individual placement and support (IPS) in physical rehabilitation and medicine: The VA spinal cord injury experience.Crossref | GoogleScholarGoogle Scholar | 24912059PubMed |
[41] Sutton BS, Ottomanelli L, Njoh E, Barnett SD, Goetz LL. The impact of social support at home on health-related quality of life among veterans with spinal cord injury participating in a supported employment program. Qual Life Res 2015; 24 1741–7.
| The impact of social support at home on health-related quality of life among veterans with spinal cord injury participating in a supported employment program.Crossref | GoogleScholarGoogle Scholar | 25577499PubMed |
[42] Porteous N, Waghorn G. Implementing evidence-based employment services in New Zealand for young adults with psychosis: progress during the first five years. Br J Occup Ther 2007; 70 521–6.
| Implementing evidence-based employment services in New Zealand for young adults with psychosis: progress during the first five years.Crossref | GoogleScholarGoogle Scholar |
[43] Proyer RT, Ruch W, Buschor C. Testing strengths-based interventions: A preliminary study on the effectiveness of a program targeting curiosity, gratitude, hope, humor, and zest for enhancing life satisfaction. J Happiness Stud 2013; 14 275–92.
| Testing strengths-based interventions: A preliminary study on the effectiveness of a program targeting curiosity, gratitude, hope, humor, and zest for enhancing life satisfaction.Crossref | GoogleScholarGoogle Scholar |
[44] Rapp CA, Saleebey D, Sullivan WP. The future of strengths-based social work. Adv Soc Work 2005; 6 79–90.
| The future of strengths-based social work.Crossref | GoogleScholarGoogle Scholar |
[45] Krause JS, Reed KS. Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation. Spinal Cord 2011; 49 285–91.
| Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation.Crossref | GoogleScholarGoogle Scholar | 20805833PubMed |
[46] Ottomanelli L, Barnett SD, Goetz LL. Effectiveness of supported employment for veterans with spinal cord injury: 2-year results. Arch Phys Med Rehabil 2014; 95 784–90.
| Effectiveness of supported employment for veterans with spinal cord injury: 2-year results.Crossref | GoogleScholarGoogle Scholar | 24316325PubMed |
[47] Lohne V, Severinsson E. The power of hope: patient’s experiences of hope a year after acute spinal cord injury. J Clin Nurs 2006; 15 315–23.
| The power of hope: patient’s experiences of hope a year after acute spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 16466481PubMed |
[48] Perriam A. Wheels in work. Paper presented at the Australia New Zealand Spinal Cord Society Conference (ANZSCoS), Christchurch, NZ; 2008.
[49] Ramakrishnan K, Mazlan M, Julia PE, Abdul Latif L. Return to work after spinal cord injury: factors related to time to first job. Spinal Cord 2011; 49 924–7.
| Return to work after spinal cord injury: factors related to time to first job.Crossref | GoogleScholarGoogle Scholar | 21383761PubMed |
[50] Frieden L, Winnegar AJ. Opportunities for research to improve employment for people with spinal cord injuries. Spinal Cord 2012; 50 379–81.
| Opportunities for research to improve employment for people with spinal cord injuries.Crossref | GoogleScholarGoogle Scholar | 22487953PubMed |
[51] Malec JF, Buffington ALH, Moessner AM, Degiorgio L. A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil 2000; 81 1007–15.
| A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.Crossref | GoogleScholarGoogle Scholar | 10943747PubMed |
[52] National Health and Medical Research Council. National Statement on Ethical Conduct in Human Research (updated). Canberra: National Health and Medical Research Council; 2007.
[53] Fugl-Meyer AR, Branholm IB, Fugl-Meye KS. Happiness and domain-specific life satisfaction In adult northern Swedes. Clin Rehabil 1991; 5 25–33.
| Happiness and domain-specific life satisfaction In adult northern Swedes.Crossref | GoogleScholarGoogle Scholar |
[54] Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Zaslavsky AM. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003; 60 184–9.
| Screening for serious mental illness in the general population.Crossref | GoogleScholarGoogle Scholar | 12578436PubMed |
[55] Bloom JB, McLennan V, Dorsett P. Results from Phase One of an Early Intervention Vocational Rehabilitation Trial for People with Spinal Cord Injury conducted in Queensland, Australia.
[56] Council of Australian Governments. National Disability Strategy 2010–2020; 2012. Available at: https://www.dss.gov.au/our-responsibilities/disability-and-carers/publications-articles/policy-research/national-disability-strategy-2010-2020
[57] Young AE, Murphy GC. Employment status after spinal cord injury (1992–2005): a review with implications for interpretation, evaluation, further research, and clinical practice. Int J Rehabil Res 2009; 32 1–11.
| Employment status after spinal cord injury (1992–2005): a review with implications for interpretation, evaluation, further research, and clinical practice.Crossref | GoogleScholarGoogle Scholar | 19057392PubMed |
