Co-operation in vocational rehabilitation : methods in multiprofessional cross-sector group meetings and effects on employment
Year: 2008
Type: dissertation
Abstract: The overall aim of the thesis was to acquire an increased knowledge of \nco-operation between different rehabilitation actors in the provision of \nvocational rehabilitation (VR). One aim was to investigate the \ndifferences in effects on employment between clients rehabilitated \naccording to a systematic multi-professional cross-sector co-operation \nmodel (SMCVR) and clients subjected to conventional co-operation. A \nsecond aim was to investigate the communicative process in the \nrehabilitation group meetings and female clients experiences during the \nVR process. \n \n \n \nThe studies used material collected from two intervention projects, \nenabling natural experimental designs. Fifty-one unemployed clients with \nvarious work limitations, who underwent intervention with SMCVR I model \nduring a period of 18 months, were individually matched into pairs using \nrecords from the Swedish Public Employment Service. Three matched \ncomparison groups, representing the conventional way of co-operation \nbetween VR actors, were formed at local, county, and national levels. A \ndistinctive feature of the SMCVR I model was that the client s \nrehabilitation was planned by multi-professional cross-sector \nrehabilitation groups consisting of the client, a rehabilitation official \nfrom the social insurance office, an occupational therapist from a \nprimary care unit, an employment counsellor from the county employment \noffice and a social worker from the municipal social administration \noffice. The main effect variable was the number of persons in employment. \nANOVA for repeated measures for binary responses and a logistic \nregression model was used. The VR actors involved in the SMCVR II model \nwere a public employer (a municipality), the social insurance office and \nan occupational health service. The material consisted of 22 systematic \nmulti-professional cross-sector rehabilitation group meetings with \nclients who underwent intervention (20 women, 2 men). An observer \nattended each meeting to observe communication; each meeting was \ntape-recorded and subsequently transcribed. The analysis was based upon \nthese transcriptions, using content analysis. \n \n \n \nA larger proportion of clients subjected to this particular form of \ndeveloped co-operation studied (SMCVR I) became employed during the first \n2 years compared with similar clients in neighboring municipalities or \namong those in a national register; the higher employment rate showed a \npeak two years after closure of the intervention; the chance of becoming \nemployed after rehabilitation in the 2-year follow-up was roughly twice \nas high as that in both comparison groups with conventional co-operation. \nThere was a difference between the study group, the national and county \ncomparison groups on 6 measuring occasions over the period from 1 year \nfollowing closure of the intervention to the 6th year after. The logistic \nregression model showed that the clients with mental/social work \nlimitations were at a greater risk of being unemployed after VR than \nclients with somatic work limitations. In the SMCVR II model the topics \ndiscussed primarily concerned the client s situation regarding the field \nof medical and health care, previous and new work, and social insurance \nand none of the professionals dominated the meetings. The clients had the \nhighest percentage of utterances. Clients were allowed ample scope to \naddress their own requirements, thoughts and feelings. Adaptation was a \npervading theme in the discussions during the observations. The \n importance of work for the clients emerged as a sub-theme; positive and \nneutral aspects occurred. The conflict between health and work was an \never-present theme of substantial importance for VR. Support from the \nemployer and fellow workers during the client s return to work was \nimportant. This support appeared as both a positive and a negative force \nin the VR. \n \n \n \nIn conclusion, systematic multi-professional cross-sector co-operation \nwhich can be performed without any changes in law leads to seeing a \ngreater proportion of clients in employment over a long period of time \ncompared with co-operation as usual . It is possible to achieve a \ncreative communicative climate in multi-professional cross-sector \nrehabilitation group meetings, which can favor good results in VR.
Source: Figshare
Author: Björn Jakobsson
Language: English
Subfield: Education
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W175666996