Vocational Programming Cara Chp 21 History of Work

Vocational Programming Cara Chp. 21

History of Work Programming in OT • Occupation involves engaging with clear intent in activity that nourishes and sustains one’s relationship to oneself (body, mind, spirit) and one’s relationship to the community • Moral treatment = roots of OT • WWI – OT assisted wounded soldiers to regain self discipline, build morale, obtain training to reenter civilian workforce

History • Vocational Rehabilitation Act – Established rehab as a necessary service to benefit disabled individuals to help them return to employment • OT developed prevocational services – Vocational Rehabilitation Amendment added people with psychiatric and developmental disabilities • Decline of OT during post WWII era

History • 1960’s saw a resurgence of OT due to evaluation practices in industrial therapy – Work programming – OT’s began to practice work related interventions as part of their role • 1950’s and on saw adoption of medical model of dx and tx – Human behavior is a result of biological and physiological – Emphasis on specific modalities and techniques, not person as a whole.

History • In mental health, OT was geared toward craft modalities and projective techniques – Medication management in order to alleviate symptoms to improve func – Maintenance and stability of the condition was considered achieving function • 1970 -1980 – OT increases involvement in work programming for individuals with pyschiatric disabilities

Role Acquisition FOR • Role Acquisition Frame of Reference – Concerned with learning social roles required of the individual in an expected environment. • TX decisions are based on the context • Types of roles and ways an individual adapts to the m are affected by the persons interests and goals. – Utilize learning theories and behavioral approaches • Once a goal is prioritized, those tasks and interpersonal skills needed to maintain the role are acquired by practice and repitition in a reinforcing environment

Cont. • TX – Begins with task skills and interpersonal skills in the context of temporal adaptation – Behavioral changes regarding social roles are acquired thru activities designed to elicit the desired behavior

Expanding Roles of Occupational Therapists • Due to the increase in medications for tx of symptoms, more and more individuals are released back to their communities • OT is part of a community support team designed to reintegrate the person back into the community – ID and learn skills necessary for this • OT’s also address when the person is ready to return to work – Use task analysis in field – Recommend and carry out targeted skill development – Recommend environmental changes to enhance success

Cont. . • Provide employment supports • Apply knowledge of ADA to facilitate compliance with the law such as reasonable accommodations, job analysis, ID of essential functions of the job • Serve the mental health community in: – – – Supported employment Education programs Assertive community tx teams Psychosocial clubhouse Program development community based advocates and educators

New Alliances • Cost effective service in the community is now a priority • New definition of who is your customer! – Those who receive your services – Those who fund services • Allies! • Internal allies – Intragency and interagency coordination provides a vehicle for education within the provider community

Cont… – Services that assist clients to attain functional outcomes such as obtaining a job demonstrate the use of OT to professional peers, admin, and policy makers – Most import customers are the clients and their families whose support of OT carries weight in the community – Community allies • Needs of businesses are priority • OT may suggest reasonable accomodations, such as workstation set up, modification of schedules, assignment sharing, targeted sick leave

Cont. • Employers may be especially drawn to OT clients because the employer knows the client is motivated, supported by a specialist – Receives job skill training, – Facilitate good work habits – Assist with work adjustment

Implementation of Occupational Therapy Services • Assessment – Lengthy assessment followed by facility based transitional jobs prolongs preemployment phase of tx • Alternative work environments may be used due to client goals and concerns, step wise entry into the workplace as a means of assessing performance and predicting success has been discounted – Supported employment where the client is placed in a job of their choice with supports and training in the actual work context is more beneficial • However many are still refered to more traditional transitional employment

Assessment cont… • Integrated employment – Place-then-train – Choose-Get-Keep – Individual Placement and Support Model (IPS) • Traditional Pre-Employment services – Clients are evaluated and assigned to diff types of training jobs prior to receiving assistance with job search, placement and support in mainstream employment

Pre Employment Experiences • Sheltered Employment – Limited to specific disability groups – Pay is prorated and less than minimum wage – Not proven to be an effective conduit to mainstream employment – Effective for work experience, and to perform regular work without intensive supervision • In-House Jobs – Work oriented day tx programs – Clubhouses – Staff supervise and model correct work behavior

Pre-Employment cont. . • Transitional Employment – Temporary community jobs that are arranged between employer and psychosocial rehab agency – Designed to: • Help individual adjust to work • Enhance self confidence • Offer job experience for the resume

Pre-Employment Evaluation • Used to supply info to the team who will be providing job supports • Determine – Deficits – Strenghts – Competencies • Qualities that are associated with good work rehab efforts – – – Persons with work history Motivation to work Seeking entrance to vocational program Ability to get along with others Level of self esteem

Cont. . • Once the client’s deficits are known: – OT can anticipate difficulties in workplace situations – Tailor support strategies – Offer problem solving strategies BEFORE there is a problem on the job – Work with employer to help them understand the client

Purpose of Initial Assessment • Determine competencies in daily life skills • Determine clients readiness for reahab • Tools: – COPS, – Ba. FPE, – Strong Interest Inventory – PACTs – program for assertive community tx • Ongoing vocational assessment

Cont… • ID what is needed for individual to function on a job • Determine service options – Job seeking skills groups – Time management groups – Stress management training – Social security benefits counciling – Referral assistance to enter employment training programs – Work adjustment

Forms of Intervention • Group or individual counciling – Problem solving – Support individual in learning how to manage situations that arise • Money management skills • Applying skills to community – Practice in community – Failure is a teaching moment

Intervention Cont. . • Interventions with the communty – Advocate – Educate • Interventions with employer – Educate employer about needs of client – Means employer knows client has MI • Interventions when the employer is not involved – Client chose not to reveal illness – Interventions done offsite