Work with brain injury

Vocational rehabilitation

health professional

The vocational rehabilitation process, as outlined, is developed based on literature research, existing VR protocols in the Netherlands and Flanders, qualitative research, and collaboration with project partners. This methodology integrates principles from two Dutch VR protocols: Early Vocational Rehabilitation and the Round Table methodology. The process is divided into three iterative steps:

Identify the vocational need for help: This step involves clarifying the work-oriented assistance request of individuals with NAH.
Determine the distance to work: Here, the focus is on assessing the person's capabilities and the requirements of the work to determine feasibility.
Reduce the distance to work: This step involves progressively enhancing the individual's ability to work.

Workplace rehabilitation, on the other hand, aims to guide and support injured workers for a safe return to work after an injury.

It involves programs like Supported Employment Programmes, on-the-job training, and collaborative rehabilitation efforts benefiting both workers and employers by facilitating faster recovery, minimal disruption, skill retention, and cost control.
These processes emphasise early intervention, tailored training based on job demands, gradual return to full-work levels, and individualised job-specific training to prepare individuals for suitable work opportunities.
The ultimate goal is to enhance productivity and confidence for a successful return to work

Identify vocational need for help

You identify the vocational need for help, increase the knowledge and empower the person with ABI to consult with relevant stakeholders

Determine distance to work

You determine the work load capacity (individual profile) and the work load (job profile) of the person with ABI and you compare both profiles.

Reduce distance to work

You encourage the person, reflect on challenges and how to compensate for and you coach the person.

Re-integration guidance

You consolidate the present capabilities of the individual with ABI and collaboratively develop a work action plan.

Objectives

The goal of rehabilitation is to enhance the independence of individuals with health conditions and promote their active involvement in society, including workforce participation.

In Belgium, vocational rehabilitation (VR) is an integral part of overall rehabilitation services. This specialised form of rehabilitation targets individuals of working age facing obstacles in labour participation due to health issues, with a focus on enhancing their employment prospects (Escorpizo et al., 2011).

⚠️ Note: Belgium has federal and regional regulations governing labour reintegration and job retention, with various stakeholders involved.

👉 Click on any of the following questions for detailed information on vocational rehabilitation.

Yes, this road map outlines the 'train first, then place' approach.

We are dedicated to a comprehensive approach to VR, focusing on both the individual with ABI and the work environment.

This involves integrating two pathways: the care pathway and the work pathway.
These pathways are interconnected (represented by a lemniscate) and may overlap to varying degrees (indicated by an accordion symbol).
Depending on the severity of the ABI and work demands, some individuals may swiftly return to work while others require a more gradual VR process.

The intersection of the two pathways emphasizes 'early focus on work', highlighting shared responsibility.

Each pathway's distinct steps are detailed, with work (re)integration being dynamic and iterative (illustrated by bidirectional arrows in each pathway).

It is crucial to address work considerations at different stages of the care or treatment pathway, as individuals' needs may evolve over time.
Clear agreement on who will oversee the process is essential due to the personalised nature of work (re)integration (depicted by a dotted line).
Shared responsibility and collaboration among involved parties, including the individual, their family, healthcare providers, the work environment, labor representatives, and intermediaries like NIHDI and health insurance funds, are emphasized.
The use of ICF as a common framework facilitates communication and understanding.
Stakeholder engagement is vital for successful return-to-work planning but requires time and effort.
Acknowledging and accepting the risks associated with returning to work post-ABI aids in assessing the individual's work potential.
Coordination of all care pathway steps is typically managed by the treating physician or reintegration coach.

Indeed, in the Netherlands.

In 2021, the Dutch Association of Rehabilitation Physicians, in collaboration with a multidisciplinary team, crafted the updated guideline on ABI and employment engagement.

The guideline's structure is founded on the individual's stage in the recovery journey. It encompasses the following areas:

Guidance during the acute, recovery, near-to-work, and long-term phases
Prognostication of reintegration
Interventions to facilitate work participation
Insights and guidance on Dutch social security
Information and recommendations for individuals with brain injuries lacking an employer

In this manual, we segment the process of sustainable labor reintegration into three phases.

For each phase, we outline an action plan detailing the involved parties, actions/statements, methods, and objectives. The coordination of all steps within the care pathway is overseen by the treating physician (specialist) and/or the reintegration coach (RI coach) as per Eriksson et al. (2019).

The three phases are as follows:

Early Focus on Work: Following an ABI diagnosis, the treatment team or physician initiates discussions about work promptly to assess the relevance of AGR. This allows for informed decision-making by the individual with ABI regarding their work prospects.
Vocational Rehabilitation: Collaboratively with the individual with ABI, the treatment team formulates work-related queries, evaluates the distance to work, and provides coaching and support to bridge this gap effectively.
Sustainable Workplace Reintegration: Working alongside various stakeholders, including the individual with NAH, preparations are made for their return to work with necessary assistance and ongoing monitoring to enhance the likelihood of a lasting reintegration.

These phases are not prescriptive but rather tailored to individual needs. For instance:

Individuals with mild ABI may not require VR initiation but benefit from informed decision-making and support.
Those facing significant work-related challenges may necessitate VR initiation and collaboration with relevant parties.
Some individuals might require delayed entry into VR due to specific circumstances.

To achieve sustainable reintegration, various options exist:

Returning to their previous role with the same employer.
Resuming their former position with a new employer.
Exploring modified roles within their current workplace in collaboration with the employer and occupational physician.
Seeking adapted positions elsewhere.
Engaging in voluntary work to explore capabilities and capacities while contributing meaningfully and potentially transitioning back to paid employment.

The treatment approach is interdisciplinary and work-oriented.

The care team may include a physiotherapist, occupational therapist, speech therapist, neuropsychologist/psychological consultant, social worker, and a reintegration coach, depending on the impact of the ABI.

They collaborate in an interprofessional manner.
The rehabilitation physician oversees the work-focused treatment team's activities.
Together, considering the job requirements and context, they establish treatment objectives across various disciplines.

A key member of the work-focused treatment team is the reintegration coach or coordinator.

This individual possesses current knowledge of labour reintegration legislation, ABI implications for work functioning, and engages with all stakeholders in the reintegration process.
They implement disability management principles, coordinate procedures, support and guide the individual with ABI throughout rehabilitation, and during assessments involving other stakeholders.

🔀De taak van re-integratiecoördinator kan op verschillende manieren worden ingevuld binnen de zorginstelling:

Een vaste persoon voert deze taken uit voor alle patiënten/revalidanten.
Wisselende personen nemen deze taak op: per patiënt/revalidant kijkt het behandelteam wie het best deze taken opneemt voor deze specifieke persoon.
Indien er binnen het revalidatiecentrum geen afzonderlijke re-integratiecoach is, gaat de behandelend arts zorgactor na of een ander lid van het behandelteam deze taken kan uitvoeren.

Preconditions for Vocational Rehabilitation

The individual requires assistance with work-related needs, indicating a willingness to return to work (paid or unpaid) without immediate readiness.
It is important to note that the vocational assistance request takes priority, allowing for the initiation of VR even in cases of ABI resulting from a workplace accident before consolidation or during temporary disability.
The individual's motivation to engage in the VR process is essential, along with their consent for involving relevant stakeholders.µ
- VR operates within a collaborative framework involving the treatment team, occupational physicians, and health insurance fund advisors.
The individual with ABI should demonstrate sufficient self-reliance in their home environment. Preconditions include:
- Functioning with ABI: Ability to orient oneself in time and space, comprehend commands through various means, and utilize aids if necessary.
- Trainability and learnability: Capability to perform actions or procedures after receiving information, with repeated guidance if needed.
- Availability of rehabilitation sessions for vocational purposes.
These conditions ensure a structured approach to vocational rehabilitation tailored to the individual's needs and abilities.

🤝Collaboration is a key factor in VR

Partnership among the treatment team, workplace, occupational physician, health insurance fund advisor or back-to-work coordinator, and vocational mediators (VDAB and/or GTB) is crucial for effective collaboration.

Early involvement of the work environment, including the employer and occupational physician, is initiated with the individual's consent.

You can outline this collaborative approach to the individual using a consent form, where they authorise consultation with other stakeholders from the treatment team.

Collaboration results in involved stakeholders

The occupational physician possesses knowledge of the individual's health condition, its implications, and the work-oriented rehabilitation objectives. Through the updated reintegration program (Reintegration Program 2.0), the occupational physician can extend an invitation to the individual four weeks post-ABI occurrence as part of their information obligation.

As a healthcare professional, you communicate the impact of the health condition on work performance to the employer. You arrange a meeting with the employer/supervisor/colleague, potentially involving the occupational physician, to:
- Discuss possibilities for returning to work.
- Provide insights into work-related capabilities, anticipated challenges, and opportunities.

💡Tip: Utilise this consultation to gather details on job requirements (tasks, responsibilities), work environment specifics, and cognitive, physical, and emotional expectations. This information can be valuable in the vocational rehabilitation process.

💰Financing

In Belgium, there is no separate approval number or agreement required to start a VR process after an acquired brain injury.

However, if the brain injury is a result of an accident at work, approval from the occupational accident insurance company can be requested for the VR process

Non-European nationals who wish to work in Belgium generally need authorisation to work. This authorisation can be in the form of a work permit or a "single permit," which certifies the right to stay and work in Belgium. The application for authorisation should be submitted to Brussels Economy and Employment, depending on the specific situation and residence status of the individual.

VR: yes or no?

If an individual is unwilling or unable to initiate an VR process (e.g., due to the absence of rehabilitation sessions or logistical challenges in accessing the rehabilitation center), explore alternative options collaboratively. This may involve discussing possibilities such as a pre-return-to-work consultation with the occupational physician or referral to GTB for commencing a standard reintegration process.

In cases where the healthcare institution is unable to provide an VR process, consider referring the individual with ABI to a rehabilitation center that offers this service.

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