Vocational Rehabilitation – Expectation Management and its Impacts

In the last article I wrote broadly about what to expect from Vocational Rehabilitation. Now I would like to start dissecting some of the particular intricacies of what Rehabilitation Counsellors do and how Vocational Rehabilitation can assist outcomes.

Let’s start by saying it’s not all about return to work. I know this is a bold statement, but we all agree that that are several steps before one can just “return to work”. Often, we should not even be talking about return to work as this can send clients backwards. I had situations where talking about return to work prematurely has affected how quickly a rapport was built with a particular client. The reason being is that they may feel that you are only following referrers instructions and that you actually don’t care. Although ultimately it is about returning to work, expectation management needs to be outlined first. This is where the fine line occurs between insurance and vocational rehabilitation.

As a Rehabilitation Counsellor, we are guided by the code of conduct and ethics. The first objective is to assess a client against extensive vocational parameters and to establish a baseline. This is called an Initial Needs Assessment. So what you are doing here is learning about your client, which is addressing the paragraph above. I cannot stress enough how important is to obtain a full picture about one’s life domains. I use the term life domains as a term that encompasses the injury and non-injury related matters. Why would you want to know this, you may ask? Well, if you just think about career theories, most of them refer to the life domains to contextualise one’s uniqueness in terms of transferable skills and external influence factors, which shape one’s decision making process, change readiness, motivation, self-efficacy etc. So now you have uncovered lots of issues that need to be addressed first before you start thinking about a return to work. You may have identified substance abuse, police charges, lack of driver’s licence, homelessness, poverty, family problems, lack of transferable skills, high biopsychosocial scores, and the list goes on.

So, knowing the above, I often ask my clients, why are you here do you think? And they reply: “you are supposed to find me a job” or “you are supposed to tell me what job I can do”. This could not be more wrong, I am thinking to myself. “I can never find you a job or tell you what to do, you are ultimately the one who will be judged, hired or fired, not me”. “However, I can prepare you to become job ready”. This is not something that happens overnight and there are a significant and vast number of variables that influence how quickly and how effectively one will become job ready. This should become evident following the Initial Needs Assessment.

You can see the predicament now, the system expects return to work however the referrer is not familiar with the extent of the issues that affect a worker’s job readiness. The worker expects you to find the job, yet you are thinking there are so many issues here before we can make objective decisions. Vocational rehabilitation and career counselling is not about grabbing the first job that is advertised and just going for it. Its practices are backed by science and research. Broadly, the aim of the workers compensation scheme is to achieve “sustainable suitable employment”. The term sustainable is when something is persisting for a period of time. If something is to persist over a longer period of time, there has to be significant interest associated with that particular role.

Take a Social Role Valorization theory. A basic idea of role-valorizing efforts is the notion that the good things any society has to offer are more easily accessible to people who have valued social roles. Conversely, people who have devalued social roles, or very few or marginally valued ones, have a much harder time obtaining the good things of life available to those with valued social status. Therefore valued social roles and the positive status that typically attends them are a key to obtaining the benefits inherent in any given culture1.

So, in determining one’s career or a job goal, Rehabilitation Counsellors’ decisions (and decisions of all stakeholders for that matter) can have a direct influence over changes in one’s life domains which can influence others, thus causing a further social impact and so on. Sustaining an injury often takes the injured worker from that social circle that they belonged. How many times did we hear the phrases “the boss doesn’t want to know me”, and “mates don’t or can’t call me”?

So, in summary, before changing return to work goals or making decisions about one’s career paths, one should think about the socio-economic impact of the decisions that our recommendations may have. Therefore, rushing into decisions without proper assessment and data gathering may have sub-optimal effects on the workers (and stakeholders in general) outcome and life domains. Remember, we are Allied Health Professionals and therefore if we are not comfortable in making the decisions without proper analysis, we need to conduct some serious expectation management with stakeholders. I am aware that there are limited funds and timeframes associated with each referral, therefore the greater need for efficacy invention within our practice. How do we achieve this? The first step is a collaborative approach to claims management upfront and adherence to injury management principles.  

A Rehabilitation Counsellor who can identify, target, and intervene areas of low self-efficacy, is more likely to provide beneficial rehabilitation services and increased chances of successful outcomes2.

If you think that the above article is challenging some views around “standards of practices” take a look at the Chaos Theory of Careers3 which would be very applicable in one’s counselling methodology especially in times of #covid.

The next article will address the Work Hardening strategy as a form of intervention that Rehabilitation Counsellors use.

References:

1https://socialrolevalorization.com/srv-theory/

2Hayes, C., Randall, C., & Buys, N. (2013). The Résumé-Development Process and Its Impact on Job-Search Behaviour. International Journal of Disability Management, 8, E2. doi:10.1017/idm.2012.10

3https://www.routledge.com/The-Chaos-Theory-of-Careers-A-New-Perspective-on-Working-in-the-Twenty-First/Pryor-Bright/p/book/9780415806343

Disclaimer : views expressed in this article are those of my own.