Early vocational intervention - Heliomare

Early intervention in vocational rehabilitation

Heliomare supports children, teenagers and adults with physical or multiple disabilities, traumatic brain injuries (TBI) or autism. The degree of support provided depends on the requirements and the physical and mental abilities of the client. The Early Intervention Network (Foundation) provides services at an early stage of an individual’s absence from work due to illness or disability. They take a multidisciplinary, personalised approach to provide individual and group treatment, guidance and after care. They determine health care or vocational rehabilitation needs, and aim to resume workplace reintegration immediately after the start of rehabilitation.

Aims

to create a suitable rehabilitation programme for individual support, so, clients with different health disorders can get back to work as soon as it is possible with the help of multidisciplinary team and assessment process.
To reduce social exclusion, medical treatment, medicine use and social costs.
prevent the chronicity of complaints and, as a result, the cost to the care system will be reduced in the longer term.
To improve vocational rehabilitation for the unemployed and/or economically inactive population, employees who are (long-term) absent, employees with physical and coping disabilities, people with frequent (para)medical contacts, people with chronic musculoskeletal pain.
to ensure integration between different services are direct contact by phone, emails, physical meetings and online meetings.

In the Netherlands every employer has an occupational physician for the health care of their employees. When an employee is off sick they have contact with the occupational physician. The occupational physician work together with the normal health care institutions and doctors. When an intervention is possible for vocational rehabilitation services the occupational physician refers the client to such a service. Service users can be referred to the service by their employer / General Practitioner or other health professional. Inclusion criteria include being unemployed and/or economically inactive population, employees who are long-term absent, employees with physical and coping disabilities, people with frequent (Para)medical contacts, people with chronicle multifactorial problems. Once the client is referred, there is no waiting list. The targeted time for intervention once the client is referred is 5 days.

Within one week after the consultation by the rehabilitation specialist, the client will have an appointment with a multidisciplinary team. The Early Vocational Rehabilitation (EVR) protocol is a process guideline to facilitate the interdisciplinary rehabilitation team of a rehabilitation center to systematically focus on return to work during an early stage of (inpatient or outpatient) rehabilitation of people with acquired brain injury.The EVR protocol consists of four stages: 1) orientation of the rehabilitation team towards the patient's work; 2) investigating the gap between the patient's abilities and work; 3) work training; and 4) finalizing EVR. Cooperation among all relevant partners from inside or outside the rehabilitation institute is important for maximally adapting the EVR treatment to the individual (work) situation of the person with ABI. CONCLUSION: The EVR protocol is available for implementation in other rehabilitation institutes. Performing a context analysis for each new context in which it is implemented is recommended.

The Quickscan procedure will serve as an instrument of evaluation. This Quickscan, a screening procedure, will consist of a multidisciplinary intake, according to protocol and standardized, questionnaires and measurements of the person involved. The Quickscan is composed of various sub examinations and is administered by professionals, namely a rehabilitation specialist, a psychologist, a physical therapist and a vocational rehabilitation counsellor. The objective of the multidisciplinary assessment is to give an answer to the question whether the rehabilitation can be accelerated by means of a labour-specific intervention. When the examinations have been executed, the rehabilitation specialist and the examiners will confer the matter, each from their own discipline. In this question will be answered whether a labour-specific intervention is indicated or whether the person involved needs additional treatment.

The data of this qualitative intake will be converted into a final report by the case manager. The outcomes of this screening will serve as a basis for assigning interventions for service users advising them within the rehabilitation process. When the examiners think the person involved is indicated for a labour-specific intervention a proposal is made to the company doctor. The proposal consists of the findings of the examinations and the objectives of the advised labour-specific intervention. The proposed programme andthe advised interventions are discussed with the rehabilitation specialist and the company doctor. Mostly the labour specific interventions consist of a work hardening program in which physical training and psychosocial coaching are centralized. After mutual consultation the rehabilitation plan is discussed with the client and employer and is implemented when approved. A case manager coaches the entire process and they are in touch with the employer. Whenever advice is asked for or interventions need to be realized the case manager will support the process. For those clients who have additional needs e.g. clients with communication/cognitive difficulties we actively engage family members in the consultation.

A functional capacity evaluation (FCE) is used to evaluate an individual's capacity to perform work activities related to his or her participation in employment. The FCE process compares the individual's health status, and body functions and structures to the demands of the job and the work environment. An FCE's primary purpose is to evaluate a person's ability to participate in work, although other instrumental activities of daily living that support work performance may also be used. The FCE consists of a battery of standardized assessments that offers results in performance-based measures and demonstrates predictive value about the individual's return to work.

Outcomes:

Improved mental and physical health, increased self-esteem and independence.
Increased work opportunities for the target population.
Vocational rehabilitation strategies based on good practices and experiences from the network’s members.
Members of the network provided with vocational rehabilitation knowledge and skills.
Research and development on vocational rehabilitation carried out.
Improved vocational rehabilitation for other target groups, such as people with brain injury or hearing problems.

Staff and Resources Staff of the program include a rehabilitation doctor and a multidisciplinary team of professionals in the domains of physical, psychological and reintegration. Training facilities include counselling rooms, space for training groups and medical fitness.

Duration 10 -15 weeks, 8 hours a week

Budget The service user’s healthcare provider or health insurance funds the program along with part funding by the service user’s employer. If a service user does not yet have employment only the service user’s healthcare provider or health insurance funds the program.

Partners The vocational rehabilitation project has been recognised as a success story in The Netherlands. The network works with Fit for Work (NL/EU) and consists of 9 rehabilitation centres with 17 locations spread out through The Netherlands.

Other stakeholders Stakeholder include employers, company doctors, rehabilitation team (Rehabilitation doctor and a multidisciplinary team of professionals in the domains of physical, psychological and reintegration) and case managers.

Information campaigns Vocational rehabilitation training and reintegration information. Information sessions about several important re-integration subjects (coping, physical information, re-integration information and law specific information).

Repeated service accessibility Clients can apply for services even after receiving it once and everyone gets an information book.

Monitoring Monitoring is provided for 3 months. At 6- and 12-month questionnaires are given and contact with the patients is provided. Once a client finishes the vocational rehabilitation program they are able
to contact Heliomare again or access it again in the future if they have further difficulties.

Staff and Resources	Staff of the program include a rehabilitation doctor and a multidisciplinary team of professionals in the domains of physical, psychological and reintegration. Training facilities include counselling rooms, space for training groups and medical fitness.
Duration	10 -15 weeks, 8 hours a week
Budget	The service user’s healthcare provider or health insurance funds the program along with part funding by the service user’s employer. If a service user does not yet have employment only the service user’s healthcare provider or health insurance funds the program.
Partners	The vocational rehabilitation project has been recognised as a success story in The Netherlands. The network works with Fit for Work (NL/EU) and consists of 9 rehabilitation centres with 17 locations spread out through The Netherlands.
Other stakeholders	Stakeholder include employers, company doctors, rehabilitation team (Rehabilitation doctor and a multidisciplinary team of professionals in the domains of physical, psychological and reintegration) and case managers.
Information campaigns	Vocational rehabilitation training and reintegration information. Information sessions about several important re-integration subjects (coping, physical information, re-integration information and law specific information).
Repeated service accessibility	Clients can apply for services even after receiving it once and everyone gets an information book.
Monitoring	Monitoring is provided for 3 months. At 6- and 12-month questionnaires are given and contact with the patients is provided. Once a client finishes the vocational rehabilitation program they are able to contact Heliomare again or access it again in the future if they have further difficulties.