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Annalisa Stoddart Manager Brain Injury Vocational Rehabilitation Services Glasgow. Rehab Scotland – Brain Injury Vocational Rehabilitation Services Aim: To enable people with acquired brain injury to participate in further education/further training and/or employment opportunities.

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Annalisa Stoddart Manager Brain Injury Vocational Rehabilitation Services Glasgow

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Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

Annalisa Stoddart

Manager

Brain Injury Vocational Rehabilitation Services

Glasgow


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Rehab Scotland – Brain Injury Vocational Rehabilitation Services

  • Aim:

  • To enable people with acquired brain injury to participate in further education/further training and/or employment opportunities.

  • This is achieved by working with clients using a multi-disciplinary team approach in order to enable clients to address brain injury related problems which might present barriers and to clarify and test out training/employment goals.


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Introduction

  • Brain Injury – the facts

  • Brain Injury – the effects

  • Case study 1

  • Vocational rehabilitation and supported employment

  • Case study 2

  • Conclusion


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – the facts

  • Approximately 1 million in Britain each year

  • Per year, per 100,000 of the population

    • *10 – 15 severe

    • *15 – 20 moderate

    • *250 – 300 mild

  • One family in every 300 will be affected by the long term effects


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – the causes

  • Road traffic accidents (including bicycles)

  • Assaults

  • Falls

  • Sports/industrial accidents

  • Alcohol


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – prevalence

  • 3:1 male/female ratio

  • 2/3 of head injuries are aged under 30 years old

  • Residence in urban areas where social inclusion predominates

  • Income poverty

  • Unemployment

  • Lack of educational attainment

  • High levels of crime

  • Substance misuse


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – types of injury

  • Primary injury occurs at the moment of impact, being caused by the blow

  • Secondary injury occurs as a result of systemic complications, which are potentially treatable

  • Primary: skull fracture, cerebral contusions, diffuse axonal injury

  • Secondary: intracranial haematoma, brain swelling, infection, raised intracranial pressure, respiratory failure, hypotension, ischaemic brain damage


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – delayed complications

  • Post traumatic epilepsy

  • Hydrocephalus


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – severity

  • Mild head injury (75%): loss consciousness <15 minutes/no loss of consciousness

  • Moderate head injury: loss of consciousness between 15 minutes and 6 hours/post traumatic amnesia up to 24 hours

  • Severe head injury: loss of consciousness >48 hours/post traumatic amnesia>24 hours


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury- disability

  • Thornhill and Teasdale – 2000

  • Study of 3000 people admitted to hospital with head injury

  • Follow up of 1000 at one year post injury

  • 78% of severe head injuries experienced disability

  • 54% of moderate head injuries experienced disability

  • 51% of mild head injuries experienced disability


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – lack of follow up

  • Most head injured receive no follow up after discharge

  • Less than 50% were seen in hospital after discharge

  • Only 28% received any form of rehabilitation

  • Only 15% had contact with Social Work

  • Most common service was physiotherapy


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – physical effects

  • Headaches

  • Paralysis/mobility problems

  • Balance problems

  • Dizziness

  • Epilepsy

  • Reduced stamina

  • Problems with co-ordination

  • Ataxia (shakiness)

  • Dyspraxia (message from brain to limb is blocked)

  • Problems with continence

  • Reduced/increased libido


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury: physical effects

  • Visual impairment

  • Loss of sense of smell

  • Loss of sense of taste

  • Impaired hearing

  • Swallowing problems

  • Dysarthria ( difficulties forming words )


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – cognitive/executive/communication effects

  • Impaired memory

  • Impaired concentration

  • Increased sensitivity to noise/stimuli

  • Reduced speed of information processing

  • Perseveration

  • Confusion/disorientation

  • Lack of insight

  • Difficulties with visual - spatial judgment


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Rigidity of thought

  • Problems with initiation/motivation

  • Problems with planning/organising

  • Difficulties with problem solving and decision making

  • Word finding problems

  • Difficulties understanding language

  • Dyslexia and literacy problems


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – emotional effects

  • Agitation

  • Anger and frustration

  • Anxiety

  • Depression

  • Mood swings

  • Reduced tolerance/increased irritability

  • Loss of feeling/empathy

  • Loss of confidence


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – behavioural effects

  • Agitation/aggression

  • Impulsivity

  • Disinhibition

  • Withdrawal


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Brain Injury – social effects

  • Reduced ability to understand and cope with social interactions

  • Interpersonal/relationship difficulties

  • Impaired communication/social skills

  • Family/relationship breakdown

  • Social isolation

  • Reduced work/educational performance

  • Loss of role/identity

  • Loss of employment/loss of income

  • (less than 30%of head injured people will return to work without specialist rehabilitation and support)


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

Case Study 1 - Injury Details

  • Injury sustained in 1996

  • Male aged 28 years

  • Fall ( 70 Feet )

  • Alcohol

  • Orthopaedic injuries/respiratory and renal complications

  • Diffuse head injury

  • PTA: approximately 6 weeks

  • Length of hospitalisation: 8 weeks


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1 – EFFECTS OF BRAIN INJURY

  • Sleep disturbance and low levels of stamina

  • Visuospatial impairment

  • Word finding problems

  • Disorientation

  • Memory impairment

  • Poor Concentration

  • Executive Dysfunction

  • Slowed information processing

  • Emotional and behavioural problems


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1 –REINTEGRATION

  • Effects of trauma

  • Effects of head injury

  • No information or support

  • Stress of adjustment

  • Stress of reintegration into family,social life, education and work


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: SECONDARY PROBLEMS

  • Reduced ability to self monitor

  • Impaired social skills and relationship difficulties

  • Increased stress and and loss of self confidence

  • Difficulties balancing work and leisure

  • Impaired work performance

  • Reduction in earnings

  • Housing problems

  • Anger/frustration

  • Loss of social/work identity/status

  • Alcohol dependency


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: OUTCOME

  • Exhaustion

  • Psychiatric admission

  • Loss of employment/income

  • Loss of home/independence

  • Loss of role and achievement

  • Family and relationship breakdown

  • Alcohol dependency

  • Increasingly chaotic lifestyle

  • Academic failure


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: Implications for Vocational Rehabilitation

  • Loss of confidence in services and lack of trust

  • Programme had to be reactive rather than proactive initially

  • Vocational re-evaluation rather than retention

  • Need to address secondary psycho-social problems before vocational rehabilitation was possible

  • Lack of insight

  • Family denial


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Case Study 1 – vocational rehabilitation: a multi disciplinary team approach

  • Manager

  • Clinical Neuropsychologist

  • Assistant Psychologist

  • Work Related Social Skills Tutor

  • Employment Liaison Officer

  • Job Coach

  • Occupational Therapist/Job Coach


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: INDIVIDUAL PROGRAMME PLANNING

  • Assessment

  • Induction

  • Introduction to structured environment and activity

  • Brain Injury Awareness Training

  • Training cognitive and executive skills

  • Stress, anxiety and relaxation training

  • Social reintegration and leisure activities

  • Work Related Social Skills Training

  • Individual psychological support and Liaison with Community Psychologist

  • Family information and support

  • Referral to Housing Department

  • Welfare rights advice


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: INDIVIDUAL PROGRAMME PLANNING

  • Vocational profiling

  • Vocational exploration

  • Job Seeking Skills Training

  • Liaison with university

  • Liaison with an architects’ business

  • Setting educational/vocational goals

  • Supported study for diploma thesis in Architecture

  • Study Skills Training

  • Work Placement in an architects’ office, supported by a specialist job coach


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 1: OUTCOME

  • Passed Diploma Thesis in Architecture: June 2001

  • Employed by Architects Office: September 2001


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Vocational rehabilitation and supported employment – ideal model

  • Information, advice and support to client and family

  • Early intervention

  • Employer liaison

  • Community integration

  • Holistic assessment with other agencies, family and client input

  • Neuropsychological/occupational therapy assessment as required

  • Individual programme planning (multi disciplinary approach)


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Vocational rehabilitation and supported employment – ideal model

  • Psychosocial rehabilitation

  • Training in compensatory strategies for physical problems/ stamina building

  • Flexible and realistic vocational profiling and exploration

  • Information technology training

  • Graded work experience placements with job coaches as transitional specialists

  • (place and train model)


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Vocational rehabilitation and supported employment

  • Regular review of work goals

  • Specific vocational training as required/study skills training

  • Job seeking skills training and intensive job search

  • Marketing to employers

  • Ideal job match

  • Back to work benefits advice

  • Transitional/through care support in employment

  • Optimal use of natural supports in the workplace

  • Independence in the workplace/supported employment


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2 - INJURY DETAILS

  • Injury sustained in May 1998

  • Male aged 34 years old

  • Fall down stairs, circumstances unclear

  • Admitted to Glasgow Royal Infirmary.

  • CT brain scan: left subdural haemorrhage with significant mass effect and oedema

  • 2 small intracerebral haematomas in the right and left frontal lobes

  • Transferred to The Southern General Hospital( no surgery – conservative treatment

  • Returned to GRI

  • PTA 2-3 days. Length of hospitalisation, 2 weeks


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2: EFFECTS OF HEAD INJURY

  • Headaches

  • Sleep disturbance and low levels of stamina

  • Dizziness and positional vertigo

  • Impaired memory and poor concentration

  • Slowed information processing

  • Difficulties in initiating, planning and organising tasks

  • Word finding problems

  • Low mood and irritability

  • Increased sensitivity to noise

  • Low levels of motivation

  • High levels of anxiety/panic attacks

  • Low confidence and social isolation


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2: SUPPORT PROVIDED PRIOR TO REFERRAL TO VRP

  • Information regarding head injury and its effects

  • Regular home support visits

  • Allocation of a support worker to assist community integration activities, including travel management

  • Liaison with employer/negotiation of medical retirement

  • Benefits advice and assistance

  • Anxiety management

  • Information about/support to implement compensatory strategies for memory impairment

  • Carer support/information

  • Referral to and assistance to attend The Head Injuries Trust for Scotland

  • Referral to Rehab Scotland, Brain Injury Vocational Rehabilitation Programme


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2: Assessment of needs at referral

  • Dizziness/balance problems

  • Headaches

  • Poor stamina

  • Memory impairment

  • Difficulties with concentration( especially divided attention)

  • Difficulties initiating, planning and organising tasks

  • Anxiety

  • Low mood

  • Low levels of motivation

  • Lack of hope/goals in relation to returning to work


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2: INDIVIDUAL PROGRAMME PLANNING

  • Induction

  • Gradual introduction to a structured, simulated work routine/environment

  • Neuropsychological assessment

  • Brain Injury Awareness Training

  • Cognitive training for memory/concentration problems

  • Rehabilitation strategies for executive problems

  • Stress,anxiety and relaxation training

  • Individual psychology support re anxiety and low mood

  • Work Related Social Skills Training


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

CASE STUDY 2: INDIVIDUAL PROGRAMME PLANNING

  • Social Re-integration and leisure activities

  • Individual Resource Project: Teaching others to play guitar

  • Family information and support (e.g childcare)

  • Client representative training

  • Information Technology Training ( Certificate)

  • Vocational profiling and exploration

  • Specific vocational training in Lifting and Handling

  • 2 Work Experience Placements ( Support Worker)

  • Review of work goal and Job Seeking Skills Training. (Cert)

  • Intensive Job search

  • Outcome: Employment, August 2000 as a concierge with Glasgow City Council, Housing Department


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

The benefits of early intervention, facilitated by an integrated pathway approach which promotes joint working:

  • Case Study 1: Significant gap between brain injury and return to employment (5 years)

  • Case Study 2: Reduced gap between brain injury and employment

  • (2 years)

  • Case Study 1: Significant secondary problems affecting mental health, family relationships and readiness/willingness of client/family for specialist intervention

  • Case Study 2 : Information and support at an early stage facilitated effective intervention, trust in service providers and family involvement/commitment


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Range of employment outcomes

  • Architect – City centre practice

  • Concierge – Glasgow City Council

  • Support worker – Turning Point

  • Support worker – Care Line

  • Warehouse assistant – Index

  • Project Co-ordinator – Glasgow Play Scheme Association

  • Support worker – Key Housing

  • Warehouse assistant – Clothing factory

  • Sports centre assistant – National Sports Centre - Largs


Annalisa stoddart manager brain injury vocational rehabilitation services glasgow

  • Vocational rehabilitation – benefits

  • Cost effective (80% employment/15% further education/training)

  • Addresses specialist problems

  • Empowers

  • Feedback mechanism which captures performance targets

  • Promotes personal/professional development

  • Reduces psychosocial problems

  • Promotes social and economic inclusion


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