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Farewell Everyone!

The author of  ‘Work For All’ blogs Arron Perriam has concluded employment with the NZ Spinal Trust as of 15th July 2011.

A sincere thank you to all of you who have followed this weekly Blog, contributed your ideas, and have been commitment to the most important work of Vocational Resettlement for persons who have a Spinal Cord Injury.

I hope to join you again one day in this journey, until then, keep up the great work, keep serving others, and keep it real! :-) Arron

 

 When did the Creative Genius last visit?

Some of our best ideas come out of the periphery of our eye, the edge of our consciousness, in a brilliant flash of contemplation or creative insight. Creativity can be the result of redirected intentions or a random collisions of thoughts and conversations. Creativity can be the outcome of co-creators, a purposeful collaboration around a specific project or the output of an organic relationship and developing dialogue.

 Whatever form your creativity takes, creativity finds its value in different contexts of life and in different ways, to different people for different reasons. In a sense the context provides the currency or value of creativity.

I believe that returning to work following a spinal cord injury is a creative process. In amongst the explorative and pragmatic vocational processes of finding or returning to work, and in amongst the conversations and contemplations about work, how often does the creative Genius visit? As a foot note; Genius, in ancient Rome was the guiding spirit that ‘brought things into being, created and produced’. When did we last invite the creative Genius into our vocational rehab work to produce and bring about a meaningful return to durable employment?

Reflect on the 10 questions below and ask yourself what impact do your reflections have on your creativity in SCI vocational rehab:

  • When did you last explore the unscripted question with a client?
  • Does not knowing what to do get in your way?
  • How often do you deviate off the prescribed or your own well worn path?
  • Is getting it right an imperative goal for you?
  • How do you view being reasonable or rational verses unreasonable or irrational?
  • How relaxed are you with random conversations and unanticipated events?
  • What is scope of your networks and interests?
  • What do guarantees mean to you? 
  • How do you view failure?
  • Do you generally see multiple or singular work opportunities for/with clients?

Finally, remember to not let our good sense or fear rob us of our creativity in this important work we’re undertaking! By Arron Perriam

 

Is there NO pleasure in work?

 So its 4.30am and I’m in a taxi travelling from my home to the airport for a KCI business trip to Adelaide and the very friendly, but somewhat overly bright & chatty for this time of the morning, taxi driver asks me if this trip is business or pleasure. I get that this isn’t an uncommon question but I was genuinely thrown off guard for a few seconds as I searched for a semi coherent and equally engaging response to his enquiry (at 4.30am!!). What had me a little perplexed was the ‘business or pleasure’ dichotomy.  I mean, yes it was a ‘business trip’ but it was also a pleasure to be doing this business.

 Is it  intriguing that possibly the majority of people still exercise the clear distinction between  ‘Business or Pleasure’ or do I need to be more realistic and concede that most people don’t see their work as a pleasure?  Probably more of a ‘work to live’ paradigm, if you like.

 I don’t know if Confucius ever caught or drove a taxi or not, but I do know that at some time he uttered something about  “Find a job you love, and you will never have to work a day in your life again.”  I also know that with this sort of insight and attitude that I would have loved to have caught a cab, or handcart, with Confucius!

 One of the very positive things I’m observing in Australasia at the moment with the increasing development of early intervention vocational rehab following SCI is the focus on vocational resettlement which is meaningful to the client, as opposed to a simple return to work placement with little regard for the client’s values, motivators, and satisfiers etc.

 Is this type of focus important, is it even realistic or is it a luxury to have a meaningful job, is it any better than the alternative, what is its impact on the timeliness of return to work following SCI,  is the value proposition better or worse for funders of early intervention vocational rehab, and does a return to meaningful work have an impact on return to work durability or sustainability?

 I’m sure there are many other questions around the value of meaningful work which can be explored at another time. What I’m wondering is, do the many decisional fractals which shape one’s life and vocation actually avail us the choice, and/or responsibility, to ultimately draw together in a considered and meaningful way both business & pleasure with a genuine sense of vocation following a SCI? By Arron Perriam

 

Rethinking the Relevance of History

 Many rehabilitation professionals know something about the history of their profession, but how often do people reflect on what this means in terms of the realities of rehabilitation practice today? 

  Approximately 10% of the New Zealand population in 1914-1918 served in the First World War, and nearly 60% of those returned wounded[i].  Previously, of course, there had been people who experienced difficulty or inability to work because of disabling conditions, but the scale of disability resulting from the war had a big impact.  It became a significant societal issue – work disability being described as a ‘problem’ in the media from as early as 1918.  In NZ and many other countries, it was this time and these conditions in which the vocational rehabilitation industry had its beginnings.  By 1930 NZ had the first legislation specifically aimed at vocational rehabilitation (for disabled ex-soldiers).  I would argue that the changes relating to work disability and vocational rehabilitation from 1916-1935 have set the scene for much of our thought and practice in vocational rehabilitation today. 

  Consider this quote from a military medical officer in 1917: “permit men to undertake their trade re-education at the earliest period before they are discharged from the service and while medical treatment can still improve their physical condition

  And this from the Returned Soldiers Association magazine in 1919: “in the interests of the individual … with the help of modern science, the handicapped man can still attain a high degree of usefulness and activity

  How does this compare to ideas that drive vocational rehabilitation today? 

  For similarities: what social, political, cultural, environmental conditions make these ideas compelling, and maintain them as relevant and useable? 

  What is different?  E.g. assuming these quotes are typical of the time, are we more person-centred today?  If so, what does this make possible?  If we have acquired some things, on the flipside, what have we done away with?  What effects does this have?

  These are big questions, but I think it is important to ask big questions to keep the critical dialogue open.  To keep an open mind to the possibilities and constraints that come with doing what we do the way we do it.  As Michel Foucault said: “people know what they do, they frequently know why they do what they do, but what they don’t know is what what they do does”.

  My PhD research aims to investigate ‘what what we do does’ in relation to vocational rehabilitation.  The conditions that allow us to think about and practice specialist vocational rehabilitation the way we can now (which have roots in our history), and the associated opportunities and constraints.

  As my study develops, I would like to contribute to this blog to discuss some of the questions I have proposed here, and for others to give some thought and feedback to this discussion.

  Joanna Fadyl, PhD candidate, AUT University, Auckland.

[i] Figures taken from Melling, J. O. (1952). The New Zealand Returned Soldiers’ Association 1916-1923 (Master of Arts). Victoria University College, Wellington.

 

Hurry Up & Wait – 730 Days!!

 We all know this common dichotomy where people see and experience life’s circumstances as either a ‘glass half full or glass half empty’. What is the impact of such a dichotomy for persons with a spinal cord injury who are being told you have a “2 year window of recovery”?

  Messaging is everything right! If you’re an accountant you would say “the glass is 50% in the red”, a nutritionist might say “there isn’t enough water in there for a person’s daily needs”, a psychologist would probably just ask you, “How does the glass make you feel?”, and we won’t even contemplate what a philosopher might say!

 I believe in the context of SCI rehabilitation our own choice of language and messaging as Rehabilitationists becomes critical as a springboard for another’s potential and capability. Can the potential and capability of an individual be defined solely by a functional independence measure or an Asia score? Or is the potential and capability of an individual defined by their own sense of self, hope, and the internal and/or external resource they possess? Is it a bit of both, or something else all together?

 One women recently inquired, “My husband is C5 incomplete tetraplegic and had his accident just on 2 years ago. He was told the ‘window of functional return’ was about two years and now that we are close to this mark he is nervous that this is the best things will get for him”. This isn’t an uncommon conversation for any of us but it does highlight again the subtle handbrake that some people place on their lives for 730 days, or in other cases people become frantic with activity in the hope that their function will increase, life will improve and independence will be enhanced. Either way the celestial marker forebodes over one’s life like a moon circling the sun for 730 days.

 As Rehabilitationists one of our key responsibilities is to promote living an empowered and independent life in this current moment, with all the resource, hope, function, and ambition one possesses. No more waiting 2 years until a return to work is considered, or training is undertaken, or we start setting meaningful and balanced goals for living.

 I’m told that the post injury experience is different for everyone with different medications, levels of lesion, levels of activity, varying support structures, resourcefulness, hopefulness, co-morbidities, and pre-injury achievements. With such vast individual variances, where did the 2 years come from, and more significantly what is the effect of the ‘2 year message’ on a ‘glass half full verses a glass half empty’ type person?

 What other messaging or language could be adopted by Rehabilitationists that may be provide a superior cornerstone and springboard for independent living? This is a discussion I’d love to be a part of with smarter and more experienced thinkers then I. Anyway as my Grandma use to quote, ‘The positive thinker and hard worker sees the invisible, feels the indefinable, and achieves the impossible’, now that’s what I call choice messaging and language!  By Arron Perriam

 

Stupid things I’ve overheard…

I’m sure we’ve all overheard stupid things said at home or work, for example:

  • “Why are you going to the dentist?”
  • “I can lead you to horsewater, but I can’t make you drink.”
  • “It’s half of one, six dozen of another
  • “Don’t look at me with that tone of voice!”
  • “I’ve lost my car keys!” (response) “Where did you last have them?”

Or in the context of SCI vocational rehab (VR) I’ve heard:

  • “People with a SCI would be great working in call centres!” (from a case manager)
  • “Yes her 2nd floor office is wheelchair accessible”… “is there a lift?”… “no!”
  • “They need to have everything else sorted before they contemplate a return to work” (from a rehab ‘specialist’)
  • “People might be offended if you discuss work during their inpatient stay” (from an insurer)
  • “They’re too busy focusing on their rehab to think about work!” (from an OT)
  • “We have a disability toilet but it’s being used as a store room!” (from an employer)

I’m intrigued and occasionally alarmed by what is accepted as common knowledge or best practice in SCI Voc rehab and yet facilitates at best mediocre return to work outcomes, often an inadequate VR experience for the SCI consumer, and delivers questionable value to purchasers.

 Einstein once said, “Common sense is the sum total of all prejudices acquired by the age of 18.” Once upon a time 99.9% of the population believed the world to be flat, that a phone could never work without a cord and more recently that man will never fly.

 What common held beliefs that are accepted by almost everyone as fact today will be proven as stupidity in the next few years? What kind of technology is required to scramble my atoms and send them for regrouping in foreign lands all in the blink of an eye? Beam me up Scotty! Impossible you say?

 What commonly held beliefs accepted by almost everyone as fact today in relation to SCI VR, early intervention, VR service delivery models, practitioner capability, return to work facilitation etc will be proven as stupidity in the next few years?

 9 years ago Andrew Hall was told by most that acute setting early intervention SCI VR was highly risking, too early to engage, insensitive,  was ill-conceived, misplaced and not likely to successfully proceed!  Thank goodness he rolled back and took a fresh perspective on what might be possible in SCI VR and as a result commenced a SCI VR service which has radically redefined SCI return to work rates in NZ.

 To finish with another thought from Mr Einstein, ‘Logic will get you from A to B. Imagination will take you everywhere.’  Imagine a world where everyday people who happen to have a SCI all have a sublimely supported opportunity to return to meaningful work they love!  Arron Perriam

 

8 tips to help you fail better @ SCI Voc Rehab

Learning to fail successfully is an art! It involves big hairy audacious goals, risk, commitment to action, courage, and the ability to review, adapt and ultimately LEARN!

It’s been said that we all fail, but successful people fail more often and notably learn more from their failure than most.

Warning: If you are adverse to failure then don’t waste your time reading on, just skip to the last paragraph!

Here are 8 tips to help you fail better, with an inevitably positive upside:

  • Discuss a return to meaningful employment and independence immediately after acquiring a  spinal cord injury. Don’t wait 1-2 years for the neurology to ‘settle’ or rehab to be completed
  • Whenever possible, take on specific new projects that promote SCI voc resettlement on new frontiers, with new contacts, and in new work environments
  • Set big hairy audacious goals and make detailed promises about what success looks like and when it will occur, the wholistic benefits, and the value
  • Be outrageously naive, hopeful and optimistic about everyone’s RTW potential and the possibility  of living independent and confident lives 
  • Engage families, employers, networks, clinicians and funders in your RTW facilitation and inspire  them to act in a focused and audacious manner and to fail with you
  •  Be really clear about what the true RTW barriers are and ignore the unlikely and ultimately inconsequential barriers that take your focus away from keeping the main thing the main thing
  •  Concentrate your VR practitioner energy and skill on the aspects of the RTW facilitation that you can influence and ignore other external events that you have no influence over
  •  When you fail be very transparent about it, call it as it is and define specifically what you learned – the same mistake twice is stupidity!

People who blame others for failure will never be good at failing, because they’ve never done it, they don’t learn from it and therefore will never become successful! So, if don’t want to fail (and therein be successful) you can blame others, dodge responsibility, play it safe,  clock in clock out and settle for average.  

However if you’re one of those people involved in SCI Voc Rehab and you feel like you fail often, but you keep at it, you keep evaluating and learning, you keep taking on new opportunities and extending yourself, you keep creating new approaches to RTW facilitation and you fail again, then you are both human, an exceptional failure and success awaits you – keep at it! By Arron Perriam

 

SCI Vocational Rehab & the limits of evidence-based research

Does our increased ability to research now make visible that which was previously overlooked, and are we now giving weight to things merely because we’ve measured them? Or is something important because you measure it, or is it measured because it’s important? I’m not sure.

I understand that basically evidence-based research aims to apply the best available evidence gained from a sound scientific method to inform decision making related to practice? The scientific methodology loosely going something like; establish a thesis, test, collect evidence, and draw a conclusion – it’s all testable and rational right!

With this evidence-based research we can now present the facts and proof and reasonably expect a rational rehab practitioner, clinician, consumer, funder or peer to make an intelligent decision based on the evidence and on what’s proven to be better, right?

In the face of skepticism here’s what I think is the conversation that actually needs to happen before we invest a lot of time, resource and energy in evidence-based SCI VR research: “What evidence would you  the rehab practitioner, clinician, consumer, funder or peer need to see in order to change your mind?” If the honest answer is, “well, actually, there’s nothing you could show me that would change my mind, actions or service,” then you’ve just saved everyone a lot of time, energy and resource.

For example in the 1980’s Apple tried to use evidence to persuade executives and industry to adopt the Mac, they created advertising and undertook studies that proved the Mac was easier and cheaper to support than competitor products, but they failed dismally! What actually changed things for Apple was the persistence of enrollment and the clarion voices of ‘converts’ that progressively turned the tide.

I ask myself ‘What would change her/his mind, what would change the mind of many people resistant to evidence and deliver superior SCI VR throughout Australasia’?  I believe it is the gentle persistence of enrollment and the clarion voices of converts from within the spinal injury community (consumers, clinicians, rehab practitioners, SCI organisations, families etc) and their testimonials which ultimately changes minds.

What I do know is people who are respected in a professional circle who clearly, consistently and gently proclaim that they’ve changed their minds has a ripple effect of influence. For example I have had the privilege of having worked closely to the development of SCI early intervention VR services in New Zealand, Victoria and New South Wales, and in all instances it has initially been the lone voice of a single practitioner who has held a vision, passion and enrollment ability for such SCI VR services who has been the central catalyst for change and service development.

Evidence-based research for research sake or having endless fact-based discussions is useless without first knowing that the ‘market’ is adaptable in response to the evidence and that there are visionary, passionate, and capable people who are committed to progressing superior SCI VR services. By Arron Perriam

 

The New Normal  

 The 4th of September 2010 & 22nd of February 2011 are two dates forever etched into the Cantabrian psyche.

 Many Canterbury businesses were seriously impacted by the second large earthquake which hit Christchurch on the 22nd February. Will these businesses survive? How will they adjust? What will be the impact on the local and national economies? What does the earthquake mean for thousands of Canterbury employees and employers? What work has been permanently or temporarily affected and what new work opportunities will rise out of this catastrophic event? What will be the new normal?

 I have the privilege of working with persons who happen to have a traumatic spinal cord injury (SCI), these are everyday Kiwis or Aussies going about their everyday activities who just happened to stray into that circumstantial realm where ‘shit happens’ and where they are suddenly, without choice, thrust into a new normal, the world of having a SCI. I’m sure this new normal of SCI seems anything but normal, it’s also a forced change into a new world of medical jargon, learning how to mobilize  oneself, learning new adapted ways of sleeping, eating and toileting, and exploring new ways to work. Someone once described it as being hope, fragility and courage learn to coexist.

 As a result of the earthquake, approximately 20 people experienced spinal cord injuries. Is there a loose parallel between learning to live in the new normal after a SCI and the experience of tens of thousands of Cantabrians (or Japanese) caught up in the earthquake? Okay so I accept that the comparison is pretty tenuous, but, I can’t help wonder if there are a few slight similarities for some people within aspects of the trauma experience,  the unanticipated forced change, the need for adaptability, the resilience which is developed and the hopefulness which ultimately carries people forward. What do you think?

 Six weeks post earthquake one can glean a few small insights into the new normal in a city shaken to its bones, but, on the whole uncertainty prevails at the moment. Complete business premises in the city were destroyed, and an already struggling inner city retail network trying to recover from the September quake has been largely dismantled again. Many employees are simply unwilling to ever work in the inner city again. Overall there is gross uncertainty for so many people about their immediate living and employment situation looking forward.  

 There are however also many positive factors and opportunities which have emerged from the earthquake, such as; the generosity and kindness of the human spirit, the hopefulness of everyday people following a tragedy, courageous acts by so many, an emerging new vision for our city, the realignment of our priorities and being drawn closer to family and friends.

The ‘new normal’ might have initially been unwelcomed, but I wonder how long until the new normal graduates to being ‘normal’ again? By Arron Perriam

 

Working with Small Figures in SCI Voc Rehab

‘A useful tool for Career Transition Planning’ – Based on “The Play of Life” method developed by Dr Carlos Raimundo.

Working with Small figures is based on solid theoretical principles and is an expressive and visual technique. It encapsulates the principles supporting the Play of Life Model and theory developed by Dr Carlos Raimundo and expressive techniques used in both Sociometry and Psychodrama. It is a practical method developed to allow an individual (or group) to put thoughts, ideas and situations into a concrete visual form using a stage, small figures and props like the picture above illustrates. This tool is particularly useful when exploring new career options when those with Spinal cord injury cannot return to the job they performed prior to their accident or injury. 

On a board small figures and props are used to depicit a person’s real situation. The stage is set out to visually express thoughts and feelings of issues.  Step by step undesired circumstances are defined and possibilities for change realised. Positive action is required to manifest these changes and then to maintain the new reality of a situation. The use of concretising (setting out) a situation often brings understanding of  situations beyond words and discovers positive  alternatives for dealing with issues and achieving desired outcomes. Some issues that may arise with SCI clients during career transition may  include the following; dealing with the loss of certain tasks pertaining to a previous job, the fear of  people judging a person’s capability given they are in a wheelchair, exploring the concept of new tasks or jobs, finding out what really is possible at work.

The concept of concretisation, when things are set out assist the client to often take a step back from their situation and become the observer of their own behaviour and thoughts. A bigger picture approach to work is seen and often a new perspective is realised.

There are several concepts that underpin this method when working with SCI clients and career transition. Some of them include:

Relationships are key to healing and those healing and personal growths are dependent on interpersonal relationship.

Healing through interaction and action needs to include others whether it is a mentor, wise friend, supportive group or whanau.

When people communicate with each other and participate in social interaction we can be healed by the effect people have on them. What is therefore needed is the skill of discernment in choosing appropriate people with whom to relate and share our life and times.

Secondly that people have a need to find their core values and the certainty that work satisfaction and life will flow when there is meeting of the person and those values.

Lastly that everything is connected and it is difficult to separate work from life. A system thinking approach enables us to see the connections of different aspects of our lives.

Edited by Chris Robson. Excerpts taken from Carlos Raimundo ‘Play of life”professional manual-3rd edition.

 

Great News: It is my tremendous pleasure to announce officially that Melissa Kelly has accepted the position of National Manager for the Kaleidoscope Programme effective 1st April. Mel has worked as a Kaleidoscope Vocational Consultant for the past 4 years and during which time she has made a most significant contribution to the Kaleidoscope programme.

Arron Perriam, the previous Kaleidoscope Manager for past 6 years, will turn his full attention now to continuing the work of Kaleidoscope Consulting International which commenced 2 years ago with the primary goal of  promoting and developing of early intervention vocational services to persons with a spinal cord injury internationally.

 

Part 4 of 4 - Changes to Disability Employment Services in Australia

Benefits and costs

It may be too soon to comment on the March 2010 changes that in theory are providing access to individually tailored employment services whilst also offering greater support to employers. The policy also outlines delivery of funds to support education and training.  If the policy changes are effective, we would expect to see an increase in the uptake of vocational rehabilitation services and related programs, an increase of people into sustained employment outcomes and a decrease in recipients of the DSP. Overall potentially several significant cost benefits.

 Policy Improvements

 The policy however still has room for improvement. There is emerging evidence that suggests early intervention vocational rehabilitation supports positive return to work outcomes following significant injury (www.kaleidoscope.org.nz). Yet it is unclear how soon an individual may be able to access vocational rehabilitation services after a significant injury, and whether services would travel to a rehabilitation setting if the applicant had not completed a JCA. Interfacing of the vocational rehabilitation providers into the inpatient rehabilitation facilities as soon as possible after admission to achieve early intervention can achieve positive expectation setting and planning around returning to meaningful employment.

 A second possible future policy direction may be to offer greater flexibility with the DSP to allow people to return to work, but keep receiving the DSP to a higher threshold (ie more than 15 hours per week). This would act as a greater incentive to work more without impacting on payments and in return allows the individual to build confidence, a sense of purpose and a wage above the poverty line, without fear of losing the safety net of the pension, if something went wrong and they had to cease or decrease their level of employment. There is much debate in public forums about the pros and cons of a DSP, and it would appear that a significant reason for the increase in DSP recipients over the last 10-20 years is that the entitlement is greater than the ‘standard’ pension of Newstart. Have we really done enough to help the people who want to work, but don’t have the capacity to sustain enough work to live on?

Summary

There have been several policy reforms over the last 10 years that have resulted in significant changes to the way vocational rehabilitation services have been delivered to and accessed by people with a disability. For people who have recently sustained a significant injury and resulting impairment, the barriers to accessing services have been overly complicated, with the service itself often unable to meet the specific needs of the job seeker. The most recent policy changes occurred in March 2010, and in writing the services look to be improved. However at this stage it has been too early to see clear outcomes and there are several areas of policy that need further clarification. Possible future policy improvements have been discussed earlier in this paper.  In summary, once again this is a time of change for disability employment services, but hopefully thanks to the recent policy changes, they will be able to deliver more comprehensive and effective programs to the individual when they need it. Everyone has the right to work and the right to feel productive, free of judgment and discrimination, regardless of ability. By Gillean Hilton

References

Budget 2010-2011 Joint Media Release – Assisting jobseekers and people with disability return to work. Retrieved May, 22, 2010 from http://www.deewr.gov.au/Ministers/Gillard/Media/Releases/Pages/Article_100511_174444.aspx

Cripps RA 2006. Spinal cord injury, Australia 2004–05. Injury Research and Statistics Series Number 29. Adelaide: AIHW (AIHW cat no. INJCAT 86)

CRS Australia Our History. Retrieved May, 22, 2010 from http://www.crsaustralia.gov.au/our_history.htm

Disability Online. About Barnone Retrieved September, 19, 2009, from www.disability.vic.gov.au/barnone

Disability Discrimination Act. A brief guide to the Disability Discrimination Act Retrieved May, 22, 2010, from http://www.hreoc.gov.au/disability_rights/dda_guide/dda_guide.htm

Disability Employment Services Review. Policy and review Retrieved May 29, 2010, from http://www.workplace.gov.au/workplace/Publications/PolicyReviews/

Disability Investment Group (2009) The Way Forward: A New Disability Policy Framework for Australia.

Kingdon, J.W. Agendas, alternatives and public policies. (1984) Boston, MA and Toronto: Little, Brown and Company.

Murphy, G., Middleton, J., Quirk, R., De Wolf, A., & Cameron, I.D. (2009) Prediction of employment status one year post-discharge from rehabilitation following traumatic spinal cord injury: An exploratory analysis of participation and environmental variables. Journal of Rehabilitation Medicine, 41: 1074–1079

World Health Organization. Towards a Common Language for Functioning, Disability and Health, Geneva, 2002

 

Part 3 – Changes to Disability Employment Services in Australia

Part 3 of 4:  Do recent policy changes to Disability Employment Services in Australia meet needs of people with a significant, recently acquired disability?

Policy Analysis

There have been several factors that have influenced the course of policy development and implementation of employment services for people with disabilities in Australia. Examination of these factors can be done by exploring policy theory. Using Kingdon’s (1984) policy theory it would be appropriate to say – despite a multifaceted problem, apparently present political will, and varying policy solution – that several actions have been achieved over the last 5 years, but whether the implementation of that policy has actually met the needs of people with an acquired significant disability, is debatable.

The problem:  The DDA (1992) recognises that people with a disability are at a likely disadvantage in society, specifically related to employment, education, transport, access to premises and mental health. The DDA therefore exists to protect people from discrimination based on disability and can be a platform for raising public and political attention. With periodic gains in momentum, such as the recent election of Upper House Parliamentarian Kelly Vincent in South Australia (Kelly is not only the youngest female in to be elected in Australian history but also the first person who uses a wheelchair for mobility), attention can be drawn to the multitude of environmental, physical and societal barriers that can increase the experience of disability and subsequent segregation of people in our society. 

Another facet to the ‘problem’ has been a strengthening economy leading to decreased unemployment. Whilst not a problem in itself, the decreased rate has also revealed a national workforce shortage. Perhaps ironically this workforce shortage is concurrent with a decreasing percentage of people with disability in employment and a rise in the percentage of Australians with the DSP as their primary source of income (ABS 2003 in DIG ‘The Way Forward’ 2009).

Further discussed under Policy Solutions, there have been several aspects to the way disability employment services have been designed, funded and delivered that have been inadequate in achieving optimal employment outcomes for people with a disability

Political will: Political will for policy action and implementation has most likely been motivated by the increasing liability of DSP recipients and probably to a lesser extent the risks of workforce shortages on a currently strong economy. In the report “The Way Forward: A New Disability Policy Framework for Australia” written by the Disability Investment Group (DIG) exploring the prospect of a national disability insurance scheme, the DIG draws on data from the Australian Bureau of Statistics (2003) to write, “In Australia, only 35 per cent of people with disability receive their primary income through a wage, compared with 63 per cent of people without disability.” These statistics are comparable to return to work rates in Australia following a spinal cord injury (Cripps 2005). An improved participation rate in the workforce of people with a disability would not only decrease the government’s pension liability, but would increase annual income and increase the health and wellbeing of those in employment. In the recent released 2010-2011 budget, it was quoted that the improvements to employment services will deliver a saving to Australian taxpayers of $383.4 million over four years to 2014.

Policy solutions: The development and implementation of effective policy to enhance disability employment services appears to have been a little misdirected at times. Job Capacity Assessments were put in place in 2007 to assist people to access the right services. In reality, the JCA became another barrier. The JCA was an additional step in the bureaucratic process to access services and they were often conducted by professionals who did not fully understand the needs of individuals with complex disabilities. Successful navigation of the system was reliant on the individual having sufficient social capital to know how to negotiate and present their needs. (One could argue that an individual with these kinds of skills does not necessarily need employment services!)  The deregulation and capping of service delivery was to promote market share and create healthy competition. In reality it led to the dismantling of specialist services that had previously worked hard to support minority groups with quite specific needs.  These services no longer had the critical mass of a specific client group to warrant their existence. The reality, for example, for an individual with a spinal cord injury, was that not only did they have difficulty getting to a Centrelink service to complete a JCA, but they were not necessarily referred to a vocational rehabilitation service, and if they were, that service may not have an understanding of the complexity of living with a spinal cord injury. Outcomes of vocational rehabilitation programs were also focused on speed to job placements, rather than sustained employment outcomes.

It appears that the dissatisfactory experiences of accessing and utilizing disability employment programs must have been heard – in one way or another – by the policy writers within Department of Employment, Education, and Workplace Relations. Disability lobby groups had been vocal at the time about the barriers to services and likewise the actual providers spoke negatively of their own programs (Disability Employment Services Review 2009).  As noted earlier, reform was proposed in September 2009 as Ministers Arbib and Shorton sought expert input from an Industry Reference Group, and the most recent policy shift rolled into action from March this year. The change to the way services are now accessed and delivered, may be closer to the mark of providing individualised employment support to people with disability. The changes remove the capped service delivery, the necessity to complete a JCA as the only way to seek out services and have put in place a stronger emphasis on sustained employment outcomes. It can be anticipated that removal of these barriers will improve access to vocational rehabilitation services however only time will tell whether these changes will indeed reach the individuals in need, and truly support people back into meaningful employment after significant injury. By Gillean Hilton

 

Part 2 -Changes to Disability Employment Services in Australia

Part 2 of 4:  Do recent policy changes to Disability Employment Services in Australia meet needs of people with a significant, recently acquired disability?

The history of vocational rehabilitation in Australia as we know it today began as the Civilian Rehabilitation Service following the second world war. This later became the Commonwealth Rehabilitation Service and revolved around centre based programs. In the mid 1980’s vocational rehabilitation moved to community based programs to meet the broader needs of a population seeking employment, and as care for people with disabilities was deinstitutionalised. The Disability Discrimination Act of 1992 followed the Disability Services Act of 1986 and both provide the context under which vocational rehabilitation providers such as the present day CRS Australia provide their service.

  • The Disability Discrimination Act (1992) and the work of the Australian Human Rights Commission has been a consistent driving force towards development of government policy that supports people with disabilities to find or return to employment.
  • 1997 saw the privatization of the Commonwealth Employment Service (CES) becoming part of the Job Network (now Job Services Australia). If a recipient of the Disability Support Pension (DSP) you were eligible to receive services through a Job Network provider. Vocational rehabilitation following serious injury and disability was predominantly provided by the Commonwealth Rehabilitation Service.
  • In 2005, led by the Commissioner Graeme Innes AM, the Australian Human Rights Commission commenced a National Inquiry into Employment and Disability with the final report released in 2006. The main recommendation of the inquiry was the establishment of a National Disability Employment Strategy.
  • In 2005 the Howard Government launched it’s Welfare to Work policy, provision of Disability Employment Programs under the Job Network were deregulated, service provision capped and a Job Capacity Assessment (JCA) introduced to channel DSP recipients into services where deemed appropriate.
  • In March 2007 Australia ratifies the Convention on the Rights of Persons with Disabilities.
  • In November 2007, the new Rudd Government indicates support for a National Disability Strategy
  • In September 2008 as part of the Government’s social inclusion agenda the Rudd Government released the ‘National Mental Health and Disability Employment Strategy update: Setting the direction’ report.
  • In September 2009 following extensive involvement of industry representatives the National Mental Health and Disability Employment Strategy and review of Disability Employment Services was released. The review announced changes to the way disability employment programs would be provided (from 1st March 2010) including the removal of capped service delivery, the end user either accessing services via a JCA from Centrelink or approaching the vocational/employment provider directly, and a shift in focus from rapid to sustained employment outcomes.
  • On 3 December 2009 the Australian Government released the report of the Disability Investment Group (DIG) called The Way Forward: A New Disability Policy Framework for Australia. Along with its principal recommendation of a feasibility study into a national disability insurance scheme for Australia, recommendations also referred to better employment opportunities. The DIG had been an initiative of the Parliamentary Secretary for Disabilities and Children’s Services, the Hon Bill Shorten MP.
  • As of March 1st2010, vocational rehabilitation is delivered under Disability Employment Services. For people with an acquired significant disability the policy means:
      • To be eligible they must be between 14 and 16 years of age, be an Australian Citizen or permanent resident, and have medical evidence verifying their reduced capacity to work and/or their need for increased supports. They do not need to be a recipient of a Disability Support Pension.
      • Completion of a JCA must be undertaken at Centrelink, following which a referral would be made to a Disability Employment Services if the applicant deemed eligible,
      • Once accepted into Disability Employment Services (such as vocational rehabilitation), involvement from the agency may continue for up to 18 months, after which they can complete a second JCA if an extension is required.
      • Services offered include access to
        • Workplace Modifications Scheme,
        • funding for retraining,
        • incentives for employers such as wage subsidy
      • If a recipient of the Disability Support Pension, a person can work in open employment for up to 15 hours per week (at minimum wage) without losing their entitlement.

    By Gillean Hilton

 

Part 1 -Changes to Disability Employment Services in Australia

Part 1 of 4:  Do recent policy changes to Disability Employment Services in Australia meet needs of people with a significant, recently acquired disability? By Gillean M Hilton

Over the last decade in Australia there has been an evolution of local political and social movement forces combined with universal human rights that have seen several changes in the way that ‘employment services’ are delivered to and accessed by, people with a disability. Vocational rehabilitation (a provision of employment services) have most recently been delivered under the federal government’s Department of Employment, Education and Workplace Relations and largely driven by the Disability Discrimination Act of 1992. From the institutional perspective of a sub acute inpatient rehabilitation provider, supporting individuals to reintegrate into their communities, including a return to meaningful employment, following a severe traumatic injury resulting in permanent disability is a significant task. This paper will explore whether the recent policy changes will in fact meet the needs of people with a significant acquired disability in returning to or commencing in the workforce.

 As a stakeholder in the policy cycle, sub acute inpatient rehabilitation facilities aim to optimize function in their patients and arm them with the knowledge and know how required to navigate the maze of disability resources and services in the community. For individuals who have experienced significant trauma with resulting permanent disability such as cognitive or physical impairment, navigating that maze can be near impossible. Becoming a worker or returning to employment, is also an aim of rehabilitation, as we continue to understand the importance of work in the adjustment process post significant disability and the resultant improved health outcomes.

 It is well recognised in the literature that predictors of a successful return to employment following a spinal cord injury  (and other acquired disability) are things like pre injury higher level of education, pre injury job requiring high level skills, strong social support network, and a supportive pre injury employer (Murphy, 2009). Inpatient rehabilitation services and Disability Employment Services (particularly vocational rehabilitation providers) must continue to develop and deliver programs that support individuals to increase their skills, strengthen support networks and maintain or build relationships with employers. (Read Part 2 of 4 next week)

 

10 Ways To Screw up the Employer Relationship

1. Create complexity by dealing with multiple managers across departments. Alternatively Liaising consistently with just one or two key decision makers will promote case knowledge & synergize communications.

2. Don’t involve the employer until very late in the return to work process. Alternatively promote the earliest possible contact with the employer after an accident & establish an ongoing schedule & medium for communications

3. Polarize funding issues & create stand-offs between employer & rehab funder responsibilities. Alternatively aim for win win shared responsibility scenarios that work for the employee, employer & rehab funding organisation.

4. Communicate irregularly with employer & provide low quality or irrelevant information regarding return to work or rehabilitation progress. Alternatively ask the employer what info they would most value & the employee what info they most want to convey & make this a central element of all communications.

5. Always talk for & on behalf of the employee. Alternatively coach, support & empower the employee to take responsibility for as much of the employer liaising as is possible.

6. Isolate stakeholders (employer, employee, family, funders, key colleagues, therapists etc). Alternatively create appropriate & timely forums which promote stakeholder collaborations.  

7. Apply subtle or unsubtle job retention pressure on the employer. Alternatively seek the employers commitment to ongoing open & honest communications about all return to work matters.

8. Be rigid about returning to work to the same job description & conditions. Alternatively be flexible and work towards facilitating win win scenarios for both employee & employer.

9. Never pick up the phone & talk to the employer always send formal written communique, emails & lengthy voice messages. Alternatively talk to the employer decision makers & even more importantly listen to what their commitments & concerns might be.

10. Be a ‘know it all’ return to work facilitator! Alternatively, humble thy self  

 

WHY  bother Working after a Spinal Cord Injury?

Somewhere in the depths of my school memory I recall the six letters WWWWWH (What, Where, Why, Who, When, and How) as a guideline for writing a news article. These same five W’s and the H can also be applied to return to work facilitation following a spinal cord injury.

Consider that the What is about returning to satisfying and sustainable employment, Where is defined through thorough job search strategies and labour market opportunity, Who includes you as the consultant, the client, possibly their employer, family or other health practitioners. When is defined where opportunity and readiness come together, whilst How is defined by creating great partnerships and facilitating sound vocational practices.

That just leaves ‘why’. Why work at all? Why bother getting mobilised in the mornings for work? Why organise your personal cares and carers so you can get to work? Why put up with less than ideal accessible infrastructure around your city to get into work? Why would you want to navigate inadequate public transport to get into work? So, Why work at all if you have a spinal cord injury? Ummm, well, err…

Author* Daniel Pink reports on one study, by Adam Grant at the University of Pennsylvania’s Wharton School, who visited a call centre at a large American university, where each night employees made phone calls to alumni to raise scholarship funds.

Grant and his team randomly divided the call centre representatives into three groups. For a few days, before they made calls, people in the first group read brief stories from previous employees about the personal benefits of working in the job – how they developed communication skills and sales know-how that later helped them in their careers.

The second group also read stories before hitting the phones, but theirs were from people who had received scholarships from the funds raised and who described how the money had improved their lives. The aim of these stories was to remind workers of the purpose of their efforts.

The third group was the control group; they read nothing before dialing for dollars. Participants were also told not to discuss what they’d read with the recipients of their calls. Then a month later, Grant measured the performance of the three groups.

The people in the first group, who’d been reminded of the personal benefit of working in a call centre, did no better than those in the control group. Both groups earned about the same number of weekly pledges and raised the same amount of money as they had in the weeks before the experiment.

 However, the people in the second group – who took a moment to consider the significance of their work and its effect on others’ lives – raised more than twice as much money, in twice as many pledges, as they had in previous weeks and significantly more than their counterparts in the other two groups.

In other words, reminding employees about that missing W – the “why” – doubled their performance.

Therefore I suggest to you that if vocational specialists are to facilitate meaningful and sustainable return to work outcomes in partnership with persons with a spinal cord injury, then they will benefit from being very clear about the Why! And remember that’s not your Why as the specialist, but rather the clients Why!  Knowing ‘why’ creates purpose, motivation, significance and meaningfulness.  By Arron Perriam

 *Daniel H Pink, ‘The Surprising Truth About What Motivates US’

 

7 Big Boo Boo’s of Employment Seeking

  1. Ignorance about the impact of Social Media Networks. Recruiters and hiring managers are saying that up to 45 percent of the applicants they review are being rejected because of what they found out about them online. The warning that all social media experts give is: If it’s online ­ it isn’t private
  2. Ineffective use of Social Media Networks. Getting hired today is moving in the direction of being found by employers rather than the traditional approach of applying for work. Employment seekers must learn how to use social media networks effectively
  3. Focusing on advertised positions. At least 80 percent of the employment opportunities are never advertised and employment seekers must learn how to sniff these out.
  4. Too much emphasis on jobs. If the only option you give an employer is to offer you a job, you’re making it hard for them to hire you. This is especially true for small businesses, where most of the action is. Being willing to accept part-time, temporary and contract work ­ without reservations is essential.
  5. Ignorance about marketing. We’re a society that knows how to apply for a job. The challenge for employment seekers today is to become proficient at finding work. Anyone lacking this skill will be unemployed for a long time.
  6. Too much focus on resumes. Employment seekers must learn how to create a variety of tools that are marketing oriented and focused on the needs of the employer.
  7. Living in the past. We keep waiting for the Great Recession to be over and lots of jobs to come back. Its not going to happen. For a growing number of workers the era of the traditional job and all the stability that came with it is over.

By Ron McGowan author of the international bestseller ‘How to Find WORK in the 21st Century’

 

Money = Motivation… Yeah Right!

A study* completed at the Massachusetts Institute of Technology, Cambridge, USA, took a whole group of students and gave them a mix of mechanical and cognitive challenges. They incentivized performance in solving the challenges through a 3 tare monetary rewards process. The results showed that incentivizing and rewarding performance on mechanical challenges increased performance and productivity. However the opposite was true for even the most rudimentary cognitive or creative tasks which showed that providing greater reward for performance actually led to poorer performance.

The study suggested we should pay people enough to take the issue of money off the table but increasing pay beyond that point for anything but mechanical/process based work is pointless.

The science of the study deduced that if we want more engaged employees in the work place that lead to great performance then we need to promote these 3 factors: Autonomy, Mastery & Purpose. Thus what motivates many workers and what ultimately increases their performance is not simply money but rather autonomy, mastery & purpose.

This study and these 3 factors provide an insight into the fundamentals of quality vocational rehabilitation. Our primary role as vocational consultants is to facilitate conversations which explore and promote autonomy, mastery & purpose.

For example following a spinal cord injury having a client maintain employer contact themselves whilst an inpatient is principally superior to introducing a third party consultant to make those calls on their behalf, unless of course invited to do so by the client. Having a client complete their own job research and job search, or summarizing their own vocational activities at case conferences etc  is more likely to promote independence and motivation through creating autonomy, mastery and purpose by way of experience.

The role of the vocational consultant in this instance is to act as the ‘informed partner’ or ‘coach’ rather than the all knowing and all doing expert!

If vocational consultants act as ‘the expert’ and undertake these tasks themselves then they run the risk of disempowering and constraining the growth and motivation of the client.  Some of the consequences of this ‘hand feed’ approach to vocational rehabilitation for the client include; de-motivation, dependency, poor job retention and diminished ownership.  

I like the words of wisdom from Bob Nelson when he said, ‘You get the best effort from others not by lighting a fire beneath them, but by building a fire within’.  By Arron Perriam

*RSA Animates ‘The Surprising Truth About What Motivates Us’

 

Embracing Constraints

Limitations when embraced can drive innovati0n, sharpen one’s focus, and can be the wellspring of creativity, all of which can work for you and become your winning advantage.

Limitations, whether it be, one’s diminished functional capacity following a SCI, a lack of money, being time poor, lacking support or minimal vocational experience, can be purposefully embraced and lead to positive return to work outcomes.

Most people I speak with about return to work following a serious spinal cord injury, including families, friends, allied health staff, physicians, rehabilitation providers and employers etc, often speak of how difficult getting a paraplegic or tetraplegic back to work must be.

As a slight digression and by means of clarification; if you believe facilitating a return to work will be ‘difficult’ following a SCI then you’re probably going to be right.  Conversely if you think facilitating a return to work CAN be achieved then you’re probably are also right!

Secondly, the mental schema that subjectifies persons with Paraplegia or Tetraplegia and associates limitations with weakness or lack of possibilities is somewhat misplaced in my opinion. ‘They’ are NOT paraplegics, ‘they’ are simply everyday people who just happen to have a spinal cord injury and who are forced to address certain limitations and challenges.

Anyway with that slight digression out of the way it’s back to the subject of embracing constraints.

 As a starting point we (Vocational Consultants) could choose to focus on the potential and what is possible, on what is positive and pertinent, rather than the deficits, dilemmas, or difficulties. Sure the deficits, dilemmas, or difficulties exist but they don’t need to become the focus. They are embraced because they are real, because they are the lived experience of the client and because they stimulate our innovation, sharpen our focus in what is possible and they fuel our creativity. If our focus is purely on the limiting factors then a successful return to meaningful employment may never be realised.

As the composer Igor Stravinsky said, “The more constraints one imposes, the more one frees one’s self and the arbitrariness of the constraint serves only to obtain precision of execution.”  Maybe we could accept that less can be more and explore what creative solutions might exist for progressing a return to satisfying and sustainable work. We can acknowledge and partner the client as the expert of their own vocational insights as we research and explore each and every vocational variation and opportunity that is progressively identified.

Limitations are not bad and when embraced serve to drive innovation, sharpen our focus, and promote our creativity. Here’s to embracing constraints as the doorway to new possibility! By Arron Perriam

 

No Know = No Go & No Feel = No Deal!

Nobody needs a fair weather friend, no soldier wants to go into battle chancing you have their back, and no kid wants to grow up hoping their parents love them – they need to know it and they have to feel it!

An individual’s inclination or even ability to act courageously, to take a risk, to purchase a product, or to start a new job can all relate back to their knowing and feeling that they have your authentic support or partnership.

For some people returning to work following a spinal cord injury maybe perceived as risky, it may take some courage, it may be venturing into the great unknown, and it may be a real challenge to one’s confidence.

Whatever the case, the one thing I know for certain is that NO person is going to return to sustainable and satisfying employment of their own volition unless they feel and know that you genuinely have their back!  By Arron Perriam

 

Edited Review of  ‘Foucault and the Government of Disability’

The Question is not what is real, but which reality is important.  Michael Foucault, the prolific French philosopher and sociologist, was all about difference and the means by which people were marginalized in history and by society.

Shelley Tremain, editor of a new reader, ‘Foucault and the Government of Disability’, seeks to articulate through a series of chapters Foucault’s thinking to the debate over the meaning of physical and cognitive difference. 

“Power, that is, its exercise,” Tremain writes in her summary of Foucault’s argument, “perpetually creates knowledge and knowledge constantly includes effects of power.”  It is that insight that informs a chapter by Martin Sullivan, “Subjected Bodies,” about paraplegics in a rehabilitation ward. “I show how the medical power that circulates in a specific facility for the rehabilitation of spinal cord injured people is, in the first instance, directed at producing a certain type of body, a governable, and hence, productive body, and a certain type of subject, namely the paraplegic body subject,” Sullivan says.

Sullivan uses his understanding of Foucault to make sense of interviews with spinal cord injury patients aggrieved by both the nursing care they received and the attitude of physicians supervising that treatment: “Medical power was pervasive, patients had little, if any, meaning input into their rehabilitation regimes.” One patient speaks for the general complaint said: “I was kept in the dark too much. I wanted to know what the future held in store. I feel the patients’ rights were crushed… I resented most of the attitudes that were shown by the trained staff.”

Opinion: Vocational rehabilitation with person’s who have a SCI is a field I am perpetually interested in, and am committed to understanding how we partner individuals, and facilitate vocational activities, in an empowering, clientcentric, inclusive, and ‘consumer as expert’ approach.

As a good friend of mine often quotes from Foucault, “People know what they do; frequently they know why they do what they do; but what they don’t know is what what they do does.”

 I’m sure the last thing any vocational service wants to do is disenfranchises individuals through objective job placement and/or vocational professional acting as the all knowing expert, which I’d suggest is actually a disservice. Disserving vocational activities endorse disability, marginalisation by class and function, and ultimately facilitate a poor standard of return to work outcome. What does what we do, do?

By Arron Perriam 

 Tremain, S. Foucault and the Government of Disability. Ann Arbor, MI: University of Michigan Press, 2007.

http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=3636

http://www.goodreads.com/author/quotes/1260.Michel_Foucault 

  

‘A bird in hand is worth two in the bush’

Surely the writer of this proverb must have been of a slightly pessimist and conservative deposition. The writer suggests there is greater value in keeping what you have rather than to risk losing it by searching for something better – which I get if we’re talking about your life partner, but, carte blanche I’m not convinced.

Taking this proverb into the realm of vocational rehabilitation for persons with a SCI, I’m pretty sure I don’t want anyone who subscribes to this type of thinking being my vocational consultant if I have the bad luck of breaking my neck!

‘A bird in hand is worth two in the bush’ type of vocational consultant might suggest I keep my pre-injury employment and not risk losing that by looking for other work opportunities. But what if my pre-injury job is no longer ideal, desired, vocationally fulfilling or functionally manageable as it previously had been due to my now functional capacity following my SCI?

What is the subtle messaging here? Is it, don’t take a risk, don’t explore the unknown, don’t consider alternative employment options, play it safe, take the slightly easier or more convenient options, or possibly even settle for what might be second best?

On the flip side what if a slightly more resourceful, gunning and optimistic individual managed to effectively secure and protect the ‘bird in hand’ whilst at the same time  exploring how to capture the ‘two in the bush’ – who knows they might end up with three birds in hand!

Consider the possibility that a vocational consultant might look to work with their client with a SCI to keep one’s pre-injury employment options open whilst at the same time working with the client to explore their wider vocational perspectives which could open up alternative employment avenues.

In my experience taking such an approach can have a triple benefit effect, ‘three birds in hand’ if you like; firstly, it may attest to and confirm for the client that their pre-injury employment is indeed the best place for them to return to work, or  secondly it may identify alternative employment options preferred by the client, and thirdly, either way a return to meaningful employment is more likely to be achieved based on a clientcentric approach and quality vocational processes which research reflects leads to more satisfying and durable return to work outcomes.

I was thinking about the ‘a bird in hand is worth two in the bush’ proverb whilst sitting at an outdoor café near the beach on Saturday and the one thing I am certain of is, ‘a bird in the hand is safer than one overhead’! By Arron Perriam

 

Reasons To Work

  1. For the money
  2. To be challenged
  3. For the pleasure/calling of doing the work
  4. For the impact it makes on the world
  5. For the reputation you build in the community
  6. To solve interesting problems
  7. To be part of a group and to experience the mission
  8. To be appreciated

Why do we always focus on the first? Why do we advertise jobs or promotions as being generic on items 2 through 8 and differentiated only by #1?

In fact, unless you’re a drug kingpin or a Wall Street trader, my guess is that the other factors are at work every time you think about your work.  By Seth Godin

 

Don’t be a Muppet!

Do you remember the ‘Muppet Show’ and the two old guys Stalter and Waldorf who shared the balcony box?  I remember their torrent of quips at other muppets, for example, Waldorf says, ‘What do you think of the show so far? Statler replies, ‘it’s great, well it’s ok, actually I don’t like it, it’s rubbish, it’s terrible, get them off, boo!’

I wonder sometimes if the negative commentary around the global economic recession actually feeds itself in a negative downward spiral, much like the commentary of Statler & Waldorf. 

I wonder how often a single bad event or comment cascades into, and creates, complexity, failure or a growing stream of problems.

What about the guy who one day on his way to work has a car accident and ends up in the spinal unit. The doctors tell him you’ll probably never walk again, family, friends and society generally feel sorry for the guy, he’s now considered disabled, he collects disability related welfare or insurance, and before you know it life has spiraled into a completely different world.

Or the vocational consultant who now engages this same guy thinking, ‘this doesn’t look good, this is going to be a real challenge, it’s going to be very hard to find him work given how disabled he is, this is pretty complex, there are going to be so many return to work barriers’. Guess what, if you think this stuff, you’re probably going to be right!

But what if the messaging or our responses were different, even positive? What could the alternative outcome look like? What if those two grumpy old muppets Statler & Waldorf had personality transplants (is that possible for muppets?) and shouted, ‘awesome, that was great, well done, bravo, more’? Maybe then Miss Piggy and Gonzo wouldn’t have had such chips on their little muppet shoulders!

What if the messaging was one of possibility, hope, of positive expectations, a productive future, and a return to a meaningful and satisfying job and life following a serious injury? Would this then have the opposite effect and have circumstances spiral upward, rather than downward?

Sir Ernest Shackleton is one of my all time heroes because when faced with negative and dire circumstances in the extremes of Antarctica he endured the pressure, provided leadership, reassured his men with positive messaging and activity. He then jumped in a dingy and sailed almost 1300km to find help and ultimately rescue his men. It seems the tougher the circumstances got the greater was his resolve and his spiral upward into greatness. By Arron Perriam

 

Process & Product

 ‘Process’ in business can be like the arts, a dynamic, open ended insightful exploration, heightening one’s resourcefulness and creativity towards the development of beautiful ‘products’.

Kids playing in a sand pit and artists understand something of this organic, dynamic and creative process.  Maybe once we all exercised a greater degree of creativity and then at some point we knew we would have to show others our created work, where the writer hands over to the editor and critic and the creative dynamic changes.

It’s that metaphysical  place where created processes morph into product(s), where the created becomes the critiqued, where the insightful exploration becomes the judged, and where one’s open mindedness is opened to the world and one becomes vulnerable.  

In the field of vocational rehabilitation I often talk with people who want to know about the ‘product’ or programme that will deliver the superior return to work outcomes. Bad news first, there isn’t a super product! Good news second, there is balance of dynamic/creative process and proven products that can radically redefine return to work outcomes following a spinal cord injury.

 The trick for the vocational consultant is maybe to stay connected to the ‘client’ in an authentic, dynamic and creative manner and to progressively polish one’s vocational activity with the return to work outcome on the periphery of one’s mind.

At any time when you get too stressed out on external pressures, outcomes, barriers and challenges, give yourself permission to get back into dynamic/creative processes with the ‘client’  where you’ll likely find your inspiration again. Sit in the sand pit, move the sand around, build stuff and knock it down then build again, and you’ll be amazed at what product you might develop and what outcome you might create! Arron Perriam

 

‎50% RETURN TO WORK!!

Kaleidoscope vocational rehabilitation programme in New Zealand is quietly chuffed that in its 7 years of partnering people with a serious spinal cord impairment back into work (BTW that’s work they love!), that for the first time we’ve reached the milestone of 50% of our completed ACC clients having made a successful return to paid work, either part or full time.  Congratulations to those individuals who have made a return to work following their spinal cord injury and to all staff involved over the past 7 years - onward & upward!

 

 RTW Problems verses RTW Constraints

 If you’re a pole-vaulter gravity is a constraint, you would jump a lot higher without it, but sadly gravity is here to stay.

A constraint like gravity must be lived with but a problem is solvable.

Typical ‘problems’ to returning to work may be transportation, carer support flexibility, or building accessibility, but as we know, all of these ‘problems’ can be progressively addressed and eventually overcome with the right support and persistence.

On the other hand there are constraints such as one’s injury level and related functional capacity which may not change and therefore need to be worked around.

 I suggest that learning to distinguish the difference between a constraint and a problem is a key skill when facilitating a return to work following a serious SCI. Prioritizing and shifting one’s attention to the factors that can be addressed rather than those constraints that cannot may well progress  RTW efforts and be more rewarding for all involved.  Arron Perriam

 

Goal Setting

Goal setting is certainly nothing new and has been used in business environments, for sports achievement and in individual lives for thousands of years. Goal setting is simply a simple but structured tool to assist you to achieve that which is important to you. Goal setting can be done well and yield the results you desire and goal setting can also be facilitated extremely poorly and led to frustration or even a sense of failure – let’s try and avoid the latter!

Goal setting which is well grounded and informed by the individual’s values and motivations, skills and experience, hopes and ambitions for the future is more likely to result in a meaningful and durable RTW outcomes. It is important to take all the time necessary to cover the scope of vocational rehabilitation activities required as any short cuts are likely to result in unsatisfying RTW outcomes and/or a poor level of RTW durability.  

There a number of useful goal setting tools that can be utilised, such as SMART goals (Specific, Measurable, Attainable, Revisable, Time-bound). Kaleidoscope use’s ‘S.W.I.F.T.E.R’ which is a goal setting tool built about SCI clients, and stands for goals being; Stepped (or progressive), Well-informed, Idiosyncratic, Fluid (or flexible), Thorough, Energizing & Resourced. SWIFTER ensures that goal setting activities are grounded in the experience of the client, remains flexible throughout the vocational rehabilitation process, are positive and energizing and therefore arguably more likely to be achievable and sustainable.

An aspect of goal setting is to consider is how will these goals be resourced so that they can actually be achieved, as I’d suggest there’s nothing worse than setting goals in place but realistically having no means of realizing them due to resource limitations. Resources may come from the client themselves, their family, the community, an employer, a community or alternative funding source.

Traditionally in vocational rehabilitation goal setting has happened very early in the vocational process, often in the first few ‘interviews’, and before a client and their specific circumstances are more fully understood. Goal setting is going to be more effective when informed by a thorough knowledge of a client’s circumstances, resources, networks, vocational history, ambitions and existing opportunities. Setting goals too early may fulfill reporting requirements but does it progress the best outcomes?

 Having set goals in place it is then critical to involve the other key stakeholders who can support the progressive achievement of those goals, stakeholders can include;  the clients family, their key networks, other rehabilitationists, the employer, key people in the local community, a funder and recruitment specialists. Establishing a collaborative and informed focus on specific RTW related goals in our experience leads to superior goal attainment and more a durable and satisfying RTW experience.

Goals also need to have a degree of flexibility particularly in terms of timeframes and task priorities. If a person with a SCI ends up with a UTI, pressure area or has an up and coming surgical intervention then vocational rehab doesn’t have to stop, but, the timeframe for the task(s) to be undertaken will no doubt have to be adjusted. Sticking belligerently to the goals and applying no flexibility will generally only apply pressure to the individuals involved and  de-motivational.

Stepped or progressive goals are set on a number of different levels. Firstly you create your “big picture” of what you want to do with your life, or if you like, you’re ‘Big Hairy Audacious Goal’ (BHAG). Secondly, you then break these down into the smaller and smaller time bound targets that you attain to reach your lifetime goals. I think the great thing about setting a ‘BHAG’ vocational goals is that it inspires you, and if it inspires you then it will motivate you, particularly on those challenging days, and secondly it may well inspire and motivate others around you to support and resource your goal attainment.

In summary goal setting, done smart, is an essential tool for achieving one’s ambitions, hopes, responsibilities, return to work and dreams in life.  Utilizing goal setting in a flexible, collaborative, inspirational and progressive manner, I believe, is likely to yield superior and satisfying RTW outcomes. As Diana Scharf Hunt said Goals are just dreams with deadlines’ – I kinda like that.  By Arron Perriam

 

The use of the MBTI Instrument in Career Counselling

Self awareness is foundational to careers work.  The MBTI ® (Myers Briggs Type Indicator) instrument, the most widely used personality profile world wide, gives an understanding of self.  It looks at where one gets one’s energy, how one takes in information, how one makes decisions based on that information, and how one prefers to live in the external world.  These are important areas to understand and consider when one is making career choices.  MBTI reveals one’s innate personality characteristics and identifies particular strengths, along with clarity around one’s drivers, motivation and interests, as well as what is more likely to cause stress.   

The reason behind career choices and perhaps future ones may become clearer as it can provide an understanding of those things that are important to you in a job.  Importantly MBTI also validates who you are, and consequently builds confidence and self identity – “it is OK to be me”.  The more understanding one has of self the better decisions one can make and implement effectively. 

In my careers work with Spinal Cord Injury persons I have used the MBTI instrument, with real success. Most people want to have a better understanding of themselves, and clients  report having  found the results of their MBTI fascinating, useful and encouraging.  I am reminded particularly of two young men who both used words such as “wicked” and “awesome”, and were “blown away” by the accuracy of their MBTI feedback. There was a marked improvement in confidence, communication and responsiveness with one person in particular.   These descriptive and specific words not only help build self esteem, but can be useful when writing personal statements in one’s resume or answering personal questions in an interview.

The Myers Briggs Type Indicator instrument identifies and describes 16 distinctive personality types that result from basic preferences of each of the 4 dichotomies below: http://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/

Favorite world: Do you prefer to focus on the outer world or on your own inner world? This is called Extraversion (E) or Introversion (I).

Information: Do you prefer to focus on the basic information you take in or do you prefer to interpret and add meaning? This is called Sensing (S) or Intuition (N).

Decisions: When making decisions, do you prefer to first look at logic and consistency or first look at the people and special circumstances? This is called Thinking (T) or Feeling (F).

Structure: In dealing with the outside world, do you prefer to get things decided or do you prefer to stay open to new information and options? This is called Judging (J) or Perceiving (P).

Your Personality Type: When you decide on your preference in each category, you have your own personality type, which can be expressed as a code with four letters.

For further information about the Myers Briggs Type Indicator instrument http://www.myersbriggs.org/

 By Patti Clark – Kaleidoscope Vocational Consultant

 

Matt’s Story…

My name is Matt and I am currently preparing for work in the Sport and Leisure Industry. I had my accident three months ago when a large stack of steel door frames fell on me at work. My job then was as an Engineering Labourer.

My diagnosis looked bleak when I was told I may never walk again. I was gutted about the impact my injury would have on everyday life for me. I didn’t think I was going to spend all my days being a labourer and in a funny kind of way my accident became an opportunity to get clear about what I really wanted to do for work.
I had always enjoyed working out at the gym and had touched on learning about good nutrition. When I came to the Spinal Unit I learned more about Physiotherapy and the body as I started my rehabilitation programme. This helped me decide I wanted to work within the Health and Fitness Industry and I was determined to get my body to a stage where I could be active.

There are a number of things I have done to prepare for work while I have been in the Auckland Spinal Unit. With the help of Kaleidoscope I explored four different types of Fitness courses I could study and found a distance learning course that enabled me to learn the theory aspects of fitness training while doing my physical rehabilitation. I was keen to study the right course that meant if I wanted to go on to do physiotherapy at a later stage, the course I had studied would be a useful prerequisite. My work goal gave me the determination to apply myself to my physical rehab, knowing I needed to be fit and strong.  An AUT scholarship was applied for to assist me financially if I went straight into physiotherapy   training school next year. Also an opportunity has come up for me to be part of the Fitness staff at my local gym.

Working through the course I have learned a lot of Health & Fitness theory and now I am looking forward to doing some practical stuff. I am really happy with what I have achieved while I have been at the Spinal Unit.  I am about to leave the unit and   I am pleased to say I am upright and walking!  I can’t wait to start my new job in the gym in the near future and get back to spending time with my mates!

 

What are Employers Looking for?

Motivation

Team Work

Willingness

Personal Presentation

Workplace compatibility

Confidence

Commitment

Positive Work History

Expertise

Loyalty

   In a competitive job market there is a strong swing towards employing people who have higher standards or ‘soft skills’. New Zealand employers identified the above list as being what they are looking for when recruiting new employees. Interesting to note that 8 of the 10 qualities listed above relate to soft skills.

 

Interviewing – Pull & Push or Pose & Perceive ?

Disability return to work management has many facets to it and one of the critical facets is being able to create cooperative environments and communications between clients, vocational rehab consultants, employers and families, so that a timely, efficient and effective return to durable employment is achieved by the client.

Cooperation is not normally established in coercion, by applying pressure, asserting one’s RTW obligations or by communicating ultimatums. For most people any sense of being pushed can result in withdrawal, fight back, withholding themselves and/or information, decreased motivation, or resistance. Cooperation and best outcome potential is achieved through mutual understanding, establishing agreements, acknowledgement and partnership. It is also our ability to create artful conversations that are engaging and enrolling of others that assist to bring about change towards a preferred future – and in this context we’re talking about a return to meaningful employment!

One aspect of creating artful vocational conversations is understanding the ‘Pull & Push or Pose & Perceive’ nature of interviewing or interacting with clients. The pull & push method elicits information from the client and then uses this information to push a client in a preferred direction or outcome. The ‘pushing’ isn’t bullying or I’m sure any attempt by the consultant to control a client but even the sense of being pushed and not listened or having control removed can have an adverse impact.  The downside of this pull & push approach is that it can be very transactional and consultant led. The client may catch on to this pull & push interview style and close down the openness of their communications or even feel like they are being coerced or cornered which can be disempowering.

A Pose & Perceive approach to interviewing or interacting with clients is less transactional and throws the communication balance back to the client through a few selective questions. A vocational consultant could pose a scenario or question and have leave the client to respond freely. Pose & perceive interviewing or interactions intentionally focuses on the client whom you are listening to in order to perceive what they saying. This does not mean you necessarily agree with, but rather you understand, what the client is saying. Being a perceptive listener will then enable you to pose another insightful reflection which assists to have the client understand themselves or a situation better, which may inform their own choices and decision making processes.

The key benefit of a pose & perceive approach is that the client remains empowered, does most of the talking, and owns the decisions that are reached. Client empowerment and ownership are two key positives in mastering artful conversations in vocational rehabilitation. By Arron Perriam

 

A Systems Thinking Approach to Working with SCI Clients

 Spinal cord injuries are unplanned crisis events in the lives of those who experience them.  Crisis often changes everything about a person’s life; and when people face career decisions following crisis, considering the whole person is crucial if the outcome is to be meaningful and sustainable.

 People are wholes; they are complex dynamic systems. They armplex in that they are made up of many interactive parts; and because these parts interact with each other they are dynamic also, always being in a state of continuous growth and development.  

 This means that it is difficult to make good career decisions without considering more than just work.  Many things influence an individual’s decision making and these influences differ from individual to individual.  There is no one size fits all answer.  Furthermore, people are creative dynamic beings, and as our lives change we have the ability to adapt and change also.  This dynamic nature of human beings is one factor from which SCI clients derive hope for the future. 

 Systems’ thinking enables a client to become aware of the things that influence them and provides a framework for exploring the impact these influences have upon their life and career decision making.  For example, a personal values or spiritual beliefs may be very important, and if so may influence the type of organisation or employer a person chooses to work for.  Similarly, an SCI client might choose to seek employment in an organisation that openly supports diversity in the workplace. 

 Influences can also be interconnected with each other, for example, keeping healthy maybe of value to a SCI person, so they choose to work a certain number of hours in order to take time to participate in physical fitness on a regular basis.  Maintaining a healthy level of fitness can in return be connected to performing effectively on the job.

 Identifying career influences involves reflective thinking, sharing of stories and making meaning; hence career decision making is not just a ‘one off event’ but rather a process of gaining insight into the interconnectedness of systemic influences on a person’s situation. By Chris Robson

 

How long does it take for someone to RTW following SCI? – Part 2, A Research Perspective

 Okay, so how long should it take for someone to RTW following SCI? Well I think the sooner the better! But hang on, I don’t mean just any old job, or employment for employments sake. I mean the sooner one can get back into the swim of life, get back into doing the things that really matter to them, reclaiming that sense of independence, and making those most valuable contributions to family, work and community – then the better!

 But just how long does it take to RTW and what are the expectations of funders, VR specialists, persons with SCI, their families, health professionals and employers? Let’s face it, the expectations about RTW following SCI are varied amongst these groups. Some want a RTW to be quicker, some want it slower, some don’t think it’s even possible, others don’t want it at all even if it is possible, and some say wait 2 or 3 years post injury before you even consider a RTW.

So with this in mind I think there is real advantage in taking a step back from our own perspectives and taking more wholistic perspective by reflecting on what literature and best practice is suggesting internationally. So to start that conversation…

 According to the work of Eng and Miller1 of those who do find employment post SCI, 44% do so within the first 2 years, increasing to 77% in the first 5 years. How does this sit with your own RTW expectations? Do these figures demonstrate a need for longer timeframes of VR intervention for individuals with a SCI. Interestingly these figures have a strong correlation to those identified in the Kaleidoscope programme, and SCI persons injured in New Zealand over the past 7 years.

 Krause2 looked at factors related to the length of time between SCI onset and RTW among 259 participants with SCI which showed that a RTW was achieved on averaged 4.8 years from the time of SCI onset to their first post injury job and 6.3 years until their first full-time post injury job. How does this sit with your own RTW expectations?

 I think it’s fair to suggest that these RTW figures are also highly subjective to the type and timing of VR intervention that the participants were or were not exposed to – not to mention VR intervention participation criteria, service specialisation or the nature of the RTW measures .

Whilst we are taking a ‘blog bite’ sized look at the duration for a RTW following SCI, there may be value in considering the demographic of those making a RTW.  J. Stuart Krause and Carol A. Anson3 in their research identified that ‘The most successful employment outcomes (of the 362 participants surveyed) were obtained by Caucasian women, persons up to the age of 29 years at injury, participants with incomplete injuries, and participants who had completed at least 16 years of education. The least successful outcomes were observed in minority men, participants age 50 years or older at injury, persons with complete quadriplegia, and participants with fewer than 12 years of education’. Krause & Anson concluded that this pointed to the need for VR professionals to make special efforts to maximize employability after SCI among people with biographic characteristics that place them at greatest risk for unemployment.

 A RTW following SCI has arguably become one of the gold standards of rehabilitation success with an associated link to one’s level of independence and quality of life. Tsaousides & Ashman4, conducted a study looking at the relationship between the perceived importance of work, achievement of return-to-work and improvements in various aspects of health status. One of the things I note from this study was that a RTW is NOT ALWAYS a positive experience leading to improved Quality of Life (QoL), particularly if the RTW is less than optimal in terms of; being hastened or over delayed, if its meaningless or disatisfying work, if the work is over burdensome or unmanageable, or the preceived value of the work to self or others is low.

 If we consider a more general injury piece of researchThe Survey of Ontario Workers With Permanent Impairments’ the world’s largest survey of injured workers we see that following one’s initial RTW that 61% of workers had a subsequent injury related break in work

With this in mind we can clearly see that a RTW following SCI is not a single RTW outcome or quick fix measure of one’s independence or QoL but rather it is a more complex and variable vocational journey.

 So how long should it take for someone to RTW following SCI, 1 – 2 – 4 years? I don’t know but I think that the sooner VR interventions are clientcentric the better. The sooner we make client fulfilment, QoL & independent living the primary goal of a RTW the better. The sooner society believes that a RTW is imminently possible the better. The sooner that clear expectations about one’s potential RTW are established the better. The sooner specialised VR early intervention is initiated with persons with a SCI, their families and employers the better. The sooner that fears, barriers and concerns about a RTW are addressed the better.

 In closing here’s a thought from Stephen, who has a C6/7 SCI… “7 years after my accident I began in a voluntary position which turned into part time employment… I don’t know why I didn’t do it earlier. I used to sleep in until 10 – 11am & struggle to find much to do. I’ve found working in a job I enjoyed  boosted my self-esteem and encouraged me to use my initiative more confidently in all areas of my life. I feel much better about myself and now I’ve built up my own business renting storage units. Don’t sit on your arse, get out & do something! It might be scary but it will make your life so much better”.  By Arron Perriam

 1 Eng and Miller, Rehabilitation: Bedside to Community following SCI

2 Employment after spinal cord injury: Relation to selected participant characteristic

3 Krause JS. Years to employment after spinal cord injury. Med Rehabil. 2003;84(9):1282–9.

 4 Tsaousides, T., T. Ashman, et al. (2008). “The psychological effects of employment after traumatic brain injury: objective and subjective indicators.” Rehab Psychology 53(4): 456-463

 

How long does it take for someone to RTW following SCI?

A Clients Perspective (Part 1)

Do you ever get asked that six million dollar question ‘how long should it take for someone to return to work (RTW) following SCI’? Interestingly four times in the past week I’ve had professionals working in the field of SCI Vocational Rehabilitation (VR), some as vocational consultants and others as case managers, ask this exact question.

I guess some think that it would be useful to be able to state an exact period of time for a specific injury levels as this would give persons with an SCI, their families, employers, service providers, actuaries and case managers all a better platform for planning RTW services.  But really can anyone with any level of confidence actually state a meaningful timeframe for RTW following SCI? It’s a bit like asking, how longs a piece of string? 

I think it’s important to acknowledge the individual uniqueness of each person’s SCI; the complexities, the potential complications, the demographic variables, the pschyco-social issues, one’s interaction with environmental factors, and the multiple transitional considerations. Amongst all of these factors, yes, there will be an optimal time for each individual to make a RTW, however the time to a RTW is so variable that guessing it would be like trying to nail jelly to a wall.

This is a 3 part Blog and will take a quick look at 3 perspectives on ‘how long does it take to RTW following a SCI?’, those being; 1) A Clients Perspective, 2) A Research Perspective and 3) A VR Market Perspective.

SCI VR Clients Perspective… Information gathered through an exit questionnaire from hundreds of Kaleidoscope clients on 1st discharge from spinal unit over the past 7 years indicates that 93.3% of clients were ‘reasonably confident’ to ‘certain’ they would RTW. (52.2% ‘Certain’ of RTW,   17.2% are ‘Pretty Sure’, 23.9% are ‘Reasonably Confident’, 6.7% were ‘Not Very Confident’, and 0% said there was ‘No Chance’ of a RTW). This reflects an encouraging level of client confidence and intentionality about their RTW expectations, the golden question still remains, how long will it take to actually realise that RTW potential? The average timeframe for Kaleidoscope clients to RTW following SCI is 11 months from time of referral, obviously some RTW 2-3 weeks post discharge from spinal unit whilst others we have worked with for a couple of years, including retraining, before a RTW is achieved. In our experience injury severity hasn’t neccessarily been a good indicator of time to a RTW and neither has time since onset of injury. The average of 11 months to a RTW includes both newly injured persons and community based client (‘old-timers’ as we call them) who have an average time out of work of 13 years at time of referral. Kaleidoscope’s experience with newly injured person’s with a SCI who are engaged in early intervention VR from week 1-3 of admission to the spinal unit, and who on first discharge are ‘reasonably confident’ to ‘certain’ of a RTW, they are taking approximately 11 months on average to actually RTW.

I recently spoke to a highly motivated client who was back at the spinal unit for their first reassessment, at 4½ months post discharge, who was on the tail end of a ‘successful’ graduated RTW having been back at work for about 2½ months. He said he was very proud of his RTW achievement but was also very clear about the unforeseen challenges that it had presented him with in terms of the many adjustments required and the initial fatigue. His perspective, or value drivers if you like, was about getting back into work quickly so that he could feel normal, productive and connected again with his mates. Of course the challenge for the VR specialisist was to facilitate this quick RTW in a manner which was safe, sustainnable and satisfying for the client.

Then there was a 2nd client who we worked with for 18 months prior to him making a successful RTW. He was equally motivated, had a similar level of injury, we put as much attention and time into his VR if not more and he had the same VR specialist, they both had supportive employers, he was also of a similar age and educational background. Literature may suggest that given their similar demographic qualities that their chance of making a RTW was also similar, and arguably it was, but yet it took about 14 months longer for the 2nd client.

What were the distinguishable factors that made the time to RTW different for each client? Well it was all the unforeseen influences like the global economic recession and the manner in which that impacted differently on different industries and regions, the 2nd client ended up having to manage additional injury related health matters, the two clients had different levels of resilience and personal resource and adapted at different speeds to life with a ‘disability’, and they worked in different industries which translated to different RTW opportunities.

Two clients which were so similar in many ways, but ended up taking two radically differrent RTW journey’s which required a very different approach and level of considerations from their VR specialist. One thing is for certain, despite how much we might think we know about SCI and RTW, there will ALWAYS be unforeseen influences that will make every client RTW journey unique, challenging and rewarding. The good news is that now both clients are happily in safe, sustainnable and satisfying work they love! The question regarding ‘how long does it take for someone to RTW following SCI – your guess is probably better than mine!  By Arron Perriam

 

Soul Searching

‘Soul Searching’ is more than just a hit song by the great 1980’s Kiwi band the Netherworld Dancing Toys!

 The value in ‘soul searching’, not as in the song but as in one’s sense of vocation, is an important step to take when contemplating where to from here? Who am I? What is my purpose in life?  Why am I here? These are some of the oldest and most profound questions posed throughout human history, and although they are profound and often challenging, the soul searching experience can be both deeply meaningful and highly productive – without the risk of drowning in a pool of introspection.

 Given that our office is about 30m from the Burwood Spinal Unit, we have observed plenty of soul searching by people who’ve sustained a serious spinal cord injury. But by no means is soul searching limited to those who have had their lives drastically interrupted and changed by a SCI. Maybe the interruption or catalyst for others is a redundancy, or a career ambition to take that next step up the corporate ladder, or a search for greater significance in one’s work, or a significant life altering event.

 Stephen Covey who wrote the book ‘7 Habits of Highly Successful People’ said, ‘Find Your Voice and Inspire Others to Find Theirs’. I think this reflects something of the value in finding what you truly love to do, but to achieve this it may well take some degree of soul-searching, exploring and reflection. Finding your sense of self, or ‘your voice’ and having that resonate with your sense of vocation is after all one of the essential habits of highly successful people so I’m convinced that a little soul searching from time to time has some real value.

The relationship between soul searching and vocational transition is a happy marriage and soul searching and RTW following a SCI have an obvious synergy as well. There are benefits in having a framework that facilitates the asking of the right questions of one’s self whilst maintaining a focus for the future, a commitment to making informed decisions and taking actions consistent with one’s self assessment and decision making. Without such a framework one truly does run the risk of pointless introspection.

 Life is a great balancing act so to assist with the ‘soul searching’ experience I’ve noted a few points which cover some of the key areas of one’s life. As a starting point consider how do you view yourself (past, present & future), what are the roles you play or could play, and what’s important to you in the following contexts;

 1)      Your sense of self in terms values, motivations, skills, beliefs, hopes & ambitions

2)       Your family & friends

3)      The community you live in

4)      Your sense of vocation and current work

5)      The recreational  activities and interests you enjoy

6)      Your health, well-being and physical/intellectual/emotional capability

7)      Your financial circumstances and habits

I can’t believe I’m quoting Donald Trump, however he did say in a moment of enlightenment, “Take the pains required to become what you want to become, or you might end up becoming something you’d rather not be.  By Arron Perriam

 

Barriers to a RTW Following SCI – Part 2.

In Part 1 of this two part article I quoted Mark Caine who said A barrier is of ideas, not of things’ and that when we consider the scope and context of RTW ‘barrier factors’ for persons with a SCI, and their experience of those barriers, we can then begin to build, in conjunction with clients, an appropriate and effective reportraire of solutions to those RTW barriers. The question was also asked if identifying and implementing the solutions to RTW barriers was as much about the challenge of our own creativity, thinking, responsibility and problem solving capability as it is about the ‘things’ of the disability itself.

I‘d like to suggest that the scope of most RTW barriers fall into 6 distinct contexts, those being;     Self-concept, Societal, Systemic, Services, Surroundings and Structural or functional capacity.     

A healthy Self-concept is grounded in four key domains of our life; 1) Self-acceptance, 2) Self-responsibility, 3) Self-assertiveness, and 4) Self-purpose. Deficits in these key domains can present as barriers to a future RTW, whilst quality vocational practice will improve a clients self-concept through facilitating; recognition and acknowledgement of strengths, ownership and personal responsibility of vocational activities, clientcentric processes and decision making, and promoting positive expectations, hope and purposefulness.

The Societal context takes into consideration labour market variables, where a client lives geographically, community and industry infrastructures, community resources, expectations and supports, family/whanau/friend beliefs and values. When considering these societal factors we can ask ourselves what opportunities or lack of opportunities, resources, beliefs, infrastructures exist and how might we engage these in respect to facilitating a RTW?

Services, although an integral part of society, I suggest is worth looking at in isolation to society. The type, quality, frequency, and cost of services can be both a barrier and facilitator of a clients RTW. Services can include; medical, social, physical, and vocational rehabilitation or treatment services, equipment services, recruitment services, labour services, technology services, educational institutions and SCI support or advocacy organisations which can all have a bearing on one’s RTW.

Some barriers to RTW are Systemic in nature and change according to the structure, organisation or policies in a particular system. Examples of systemic issues impacting on RTW could include the local or central government politics, regional or global economic recession, and legislative or regulatory frameworks for RTW management or health and safety.

Our Surroundings or environmental factors can often be a significant barrier to RTW in terms of a client’s accessibility, mobility and interactivity with surroundings and technologies, their social confidence, and their community and professional integration.

One of the frequently quoted ‘predictors’ of RTW is level of injury, and the Structural and functional capacity of an individual with a SCI. What is suggested is the higher the level of neurological damage the less likely you are of a RTW, or greater are the barriers to a RTW. I’m not convinced that Structural and functional capacity alone is a great predicator of one’s RTW potential but that is a topic for another time!

Some RTW barriers such as accessibility around the workplace may be easier to address than say systemic issues such as a global economic recession, also consider that some RTW barriers are approached at an individual level whilst others are addressed at a service or systemic level, thus the strategies employed to overcome RTW barriers will be highly subjective and contextual.

I suggest to you that the fundamental issues for responding to  all RTW Barriers, whether they be Self-conceptual, Societal, Systemic, Services, Surroundings or Structural, is to remain solutions focused and open to creative ideas, and to work collaboratively in identifying and implementing barrier solutions and RTW strategies – be sure of course to pepper this with sufficient optimism and a persistent spirit.

 By Arron Perriam 

 

Barriers to a RTW Following SCI – Part 1.

I recently re-read a report prepared by Gregory Murphy and Peter Foreman called ‘Facilitators of and Barriers to RTW’ (June 2006) which I again found to be interesting and insightful.

This Murphy & Foreman report reflects that ‘Work disability and return-to-work are multi-determined outcomes that cannot be accurately predicted just from knowledge of the medical or physical dimensions of the injury or condition’. But rather they identified, ‘a very wide range of determinants of return-to-work’.

Murphy & Foreman identified some of the following factors as central themes to disability RTW facilitation, ‘characteristics of the injured worker, components of particular medical and occupational rehabilitation interventions, physical and psychosocial job characteristics, workplace factors, the insurance or worker’s compensation scheme, broader societal factors such as labour market conditions and the prevailing legal framework have all been shown to have some role to play in influencing return-to-work outcomes independently of the underlying medical condition’.  

Certainly the vocational rehabilitation work that Kaleidoscope has undertaken with persons with serious spinal cord impairment attests to Murphy & Foreman’s findings. The scope and contexts of RTW ‘barrier factors’ seem to me to be immeasurably more significant when facilitating RTW interventions than the predictable ‘demographic variables’ for a RTW such as injury level or age of onset.

Mark Caine once said A barrier is of ideas, not of things! When we comprehend the scope and context of RTW ‘barrier factors’ for persons with a SCI, and their experience of those barriers, we can then begin to build, in conjunction with clients, an appropriate and effective reportraire of solutions to those RTW barriers. So if Mark Caine is correct in asserting that A barrier is of ideas, not of things’ then may be addressing SCI RTW barriers is as much about the challenge of our own creativity, thinking, responsibility and solution solving capability as it is about the ‘things’ of the disability itself.

One thing is for certain, the barriers to a RTW following a SCI can be considerable, but with equal certainty I am convinced that they are not insurmountable. By Arron Perriam 

Part 2 of ‘Barriers to a RTW Following Spinal Cord Injury’ will explore the Scope & Contexts of RTW barriers: Self-concept, Societal, Systemic, Surroundings and Structural or functional capacity

 

10 C’s of Effective SCI Vocational Rehab

Clientcentric… Keeping the client at the very centre of the vocational rehab experience promotes their ownership, empowerment, responsibility, and the opportunity to express independence.  Facilitate vocational rehab from a strength-based model where the client’s strengths are promoted, developed and deployed to affect a future return to work (RTW).

Commence Early…  Create an early expectation of a RTW through commencing the vocational conversation early, ideally in the first 2 weeks post injury, might seem risky to some, but, over 7 years facilitating early intervention vocational rehab with many hundreds of SCI clients we have come to learn that it is a very natural & acceptable conversation to have.

Connection…  There is real value in approaching our contact with clients with a sense of privilege and not so much as a professional right! Remembering the client has entered a new ‘SCI world’ where some of the previous rules for life no longer work, and some new rules for living are being progressively explored and established. Staying connected and responsive to their journey encourages a trusting partnership, affinity and equality of ‘power’ in the partnership.

Communication…  Much of the strength of any vocational rehab experience exists within the quality of the conversations held with a client. One’s ability to appropriately engage a client in conversation, to listen powerfully and to enquire thoughtfully will have the most meaningful bearing on the vocational outcome. A key skill of any vocational consultant is their ability to progressively and naturally develop ‘career conversations’ that led to ‘career actions’ and the desired ‘career outcomes’.   

Concurrency…  No rehabilitation has to happen in complete isolation from another, so keep the career or RTW conversation going concurrent with other rehab initiatives such as physiotherapy, home modifications, whilst securing transportation or procuring financial resources.

Competency…  Possessing specialised SCI knowledge & experience, utilising specific SCI VR resources, and having suitably experienced and capable vocational consultants will facilitate superior client interactions, with more timely and durable RTW outcomes.  Understanding and being able to facilitate considered career conversations and deliver on the processes of vocational resettlement are critical and not the domain of any well-meaning health professional or otherwise.

Customerisation…  Vocational rehab is not a ‘one size fits all’ programme or process  which when applied results in quicker & cheaper RTW outcomes. Every person is unique, every SCI injury is unique, every person takes a unique journey, every employer is unique and every city or country is unique, thus vocational consultants would be well informed to customerize or tailor their approach to vocational rehab.

Collaboration…  Be gone with all the organisational and rehabilitationists silo’s and working in isolation from one another. The role of the vocational consultant is to work collaboratively with clients, and with their approval to communicate closely with their family, the interdisciplinary team, funders, employers and other significant 3rd parties to build a supportive team of well informed stakeholders who are all promoting the clients vocational resettlement.

Creative Solutions…  Partnering with a person to facilitate their RTW can be a complex and challenging undertaking – but totally worth it! Vocational consultants who continue to take responsibility and act innovatively to find RTW solutions to barriers with their client will eventually overcome most, if not all, of the challenges faced – Stick with it, think outside the square and get creative!

Care…  An empathetic style and caring about the client, and the stuff that matters to them, will create a satisfying vocational experience for the client and for no other reason than that – it is important. By Arron Perriam

 

Strength(s)-based Vocational Rehabilitation with Spinal Cord Injury Clients

Strength(s)-based practice honours the capacity all human beings have to learn and grow.  Everything that we have learned so far in our lives has brought us to where we are here and now; and so strength(s)-based vocational rehabilitation with spinal cord injury (SCI) clients involves assisting them to build on the strengths they already have when making new career choices and beginning new jobs.

 The odd thing about our strengths, is that often we do not recognise them.  This occurs for two main reasons:

  •  Firstly, because when we are good at something we often take it for granted, not really realising that other people may find these skills or tasks difficult.
  •  The other reason is that when we have to make changes through no choice of our own, in the case of SCI clients, through physical injury or incapacitation, we get overwhelmed by the change process.  When this occurs it seems we become focussed on what has gone, rather than what remains; and we fail to see that much of what we have learned already can be transferred to new and different situations.

 Strength(s)-based practices challenge the prevalent models of healing in Western society, which typically derive from a reductionist view, focussing on needs, deficits and problems.  In the traditional deficit paradigm, practitioners are trained to recognise patterns of abnormality and pathology, and this focus can communicate a sense of helplessness and failure, reinforce low expectations, create dependency on agency-created solutions and outside resources, and discourage people from moving in the direction of positive outcomes.

 Strength(s)-based vocational rehabilitation with SCI clients is a systems thinking approach, and typically involves:

 Stage One – Encouraging a bigger picture view of what a career is by identifying skills, values, beliefs, influences and career patterns to date.  This creates a holistic picture of the individual, which is bigger than just the jobs they have previously been employed in.         

 Stage Two – Examining the information gathered in stage one to identify the underlying strengths; that can then be reframed as transferable skills.  Sometimes this means becoming aware of preferences for particular environments, styles or activities.  Other times it is about identifying the ‘essence’ of what made previous work satisfying.  

 Stage Three – Developing interdependence.  The purpose of this stage is to make the most of the client’s wider context, in order to achieve their holistic career goals.  This includes their immediate family and friends, their social, professional and community networks.  A systems thinking approach tells us that no one exists in isolation, and our existing networks are the basis for developing support, creating opportunity and developing mutual relationships in order to lead a fulfilling and satisfying life.  By Chris Robson. Kaleidoscope Vocational Rehabilitation Consultant.

 

A Social Discourse of Hope, Possibility, Responsibility & Independence

If you’ve ‘fallen from grace’ and landed yourself in spinal unit, it is quite likely that one’s world has been turned upside down! That which was once normal, familiar, common, or known is now being drastically challenged as medical specialists and rehabilitationists fill one’s days. This sudden, uninvited and traumatic violation of one’s life arguably requires an equally radical and drastic response if one to meaningfully recreate their life.

Our early intervention vocational rehabilitation work is based around partnering people early in their acute admission to a spinal unit to explore & promote their future vocational resettlement. However we’ve come to understand from our 500+ clients over the years that really our essential work is NOT just about getting people back to work, but, rather one of being a social discourse of hope & possibility which facilitates responsibility & independence.

We’re learning that through facilitating timely & quality information exchanges, through encouraging clients to take responsibility for their own rehabilitation and learning, and through engaging clients empathetically that  we begin to observe potential being realised, hopes being articulates, possibilities being explored ,and the progressive strengthening of one’s capacity for independent living. It would seem that the essence our vocational rehabilitation role is one of being within the client’s world  a type of social discourse of hope, possibility & independence.

French philosopher Foucault’s definition of discourse was ‘systems of thoughts composed of ideas, attitudes, courses of action, beliefs and practices that systematically construct the subjects and the explanation of their worlds’.  Foucault coined the phrase ‘power-knowledge’ and stated knowledge was both the ‘creator of power and creation of power’.

I suggest to you that it is this clientcentric  ‘power’ or empowerment, in part catalysed by our discoursive exchanges, which is largely responsible for clients making a successful return to employment or training and living independent lives following a serious spinal cord impairment. By Arron Perriam 

 

 10 TIPS for Vocational Consultants Facilitating a RTW Following a Spinal Cord Impairment

1. Early intervention vocational rehabilitation makes sense and saves cents! Start ‘dreaming & scheming’ about vocational matters as soon as possible after onset of injury to set a positive RTW expectation

2. Whatever the RTW barriers are ALWAYS work towards realising solutions – focus on the individuals & abilities not the disabilities

3. Embrace the individuals sense of hope & possibility throughout the vocational rehab ‘experience’.  The key is to connect the human ‘being’ with their human ‘doing’ - vocation.

4. Take all the time needed to progress towards a sustainable vocational outcome that the client has chosen – and loves! Rushed or forced outcomes are more often than not weak & short outcomes.

5. Communicate as soon as possible & as often as possible with the employer to maintain a constructive level of information flow

6. By permission & along with the client relate collaboratively with their  family, friends and other stakeholders such as, OT/PT’s, HR, case managers, professional networks, supporting organisations etc 

7. Be mindful of creating a vocational ‘experience’ with the client rather than simply following a generic one size fits all vocational rehabilitation process

8. Coach the client to act independently, to be self determined and to take control of their own return to work & rehabilitation

9. Do what you love & love what you do! This applies to both the vocational practitioner and the person with the SCI

10. Remember we have 2 ears & 1 mouth so perhps thats a hint to listening twice as much as we speak. Get very present to the ‘clients world’, and do whatever it takes to serve their RTW expectations.

By Arron Perriam 

 

Ability Optimisation

Having had the privilege of partnering with hundreds of people following their traumatic spinal cord injury (SCI)  to explore their potential for a future return to work, not just any old job, but work they really love, there are very many learning’s that clients have taught me.

One of the key attributes I’ve observed of those persons who have successfully re-created their lives, which for many has included a return to work (RTW)  after a serious SCI is their commitment or focus to optimising their abilities.

As one Maori client so wisely distinguished for me one day when he said,  ‘I don’t have a disability I just have a differability’. He explained that he believes his SCI now requires him to do some stuff very ‘differently’, but,  that he didn’t see that doing things differently than the past was necessarily a disability, but rather a challenge to learn new skills and ways of achieving things important to him.

A critical element of the ‘Kaleidoscope Way’ (model of SCI vocational rehabilitation) is in our ability to facilitate ‘Ability Optimisation’ with those SCI clients we have the privilege of partnering with  in vocational rehabilitation.

‘Ability Optimisation’ works from a strength based model of practice which encourages  vocational consultants,  clients and families to be creative and resourceful in exploring and finding solutions to their diminished functional capacity, barriers to a RTW or societal and systemic barriers.

Here are some of the keys to ‘Ability Optimising’:

Develop and augment retained abilities

Take action right now to act on your abilities!

Focus on capabilities not incapability’s or losses

Think in terms of ‘differability’ rather than ‘disability’

Tap into your primary motivations, hopes & dreams for the future

Identify Interdependence strategies which promote resourcefulness

Encourage exploring collective creative solutions – avoid isolationism

Get clear on ‘what’s at stake’ if you do or do not take responsibility or action

Be strategic & affable in enrolling other people or organisations into your plans 

 By Arron Perriam 

 

“Create your future from your future, not your past” 

 One of our amazing Kaleidoscope team commented to me recently about the importance of vision and the challenge to “Create our future from our future, not our past” .

One of the critical elements of the Kaleidoscope model of vocational rehabilitation and the team we employ is a fundamental commitment and responsibility to taking Creation Actions’ which are consistent with the vocational future & vision that one chooses to create for themselves.

Often after a serious spinal cord injury returning to one’s previous employment is no longer possible due to a drastic change in one’s functional capability. However that can be as bad as the news has to get because I believe case evidence shows us that we all have the intellectual and visual capability, with the right coaching, to envision and choose a vocational future which really does inspire us – and which is achievable, manageable and durable!

As Werner Erhard said, “Create your future from your future, not your past”. I encourage you, or those working with person’s with a SCI, to focus on ‘creation actions’ which everyday take you closer to the vocational future and life which really inspires you.  No matter what the past or present holds, we can choose to take responsibility for and be committed to an inspirational life – right now! By Arron Perriam 

 

‘It took me 10 Years to become an overnight sensation’

I was listening to a radio interview yesterday of a novelist who at one point in the interview made the comments, ‘It took me 10 years to become an overnight sensation’.

This quirky comment got me thinking about the years of hard work, dedication, stamina & focus that it often takes to achieve something ‘sensational’ – yet for many of us all we get to see is the accumulation and result of that hard toil.

Whether it be the challenge of running a successful business, learning to walk, writing a book, being an elite athlete, or returning to work following a serious spinal cord impairment – you are unlikely to be an ‘overnight sensation’ without months or years of hard work, dedication, stamina & focus.

I believe that in the context of SCI vocational rehab that making a return to work IS pretty sensational, although for most people work is a normal everyday activity and is NOT particularly sensational.

Returning back to work after a traumatic spinal injury/illness and managing all the various challenges, building up one’s stamina & capacity for work, remaining focused on one’s goals, acquiring the necessary resources, and applying one’s self to vocational rehabilitation and a return to work over a prolonged period is SENSATIONAL in my view.

And just like the Pantene ad on TV said, ‘It may not happen overnight, but it will happen’. By Arron Perriam 

 

When I Grow Up I’m Gonna be an Astronaut!

Remember those childhood days when we’d declare with great enthusiasm and confidence, ‘When I grow up I’m gonna be an astronaut, or a fighter pilot, a nurse, a lawyer or...’? There is something about being young, naive, idiosyncratic and inexperienced that  has one believe anything is possible and possess a real sense of unrestrained hope for the future.

Partnering with people early following a traumatic accident/illness causing a serious spinal cord impairment (SCI) to explore their return to work (RTW) potential can often have a similar dynamic at play.

A critical element of the Kaleidoscope programme is to create a space through a series of conversations where people with a SCI can again dream of what they’d ‘love to be & do’ in terms of  a RTW.

It never ceases to amaze me what people come up as RTW options when the blinkers come off, the self limiting factors diminish, and freedom is given to dream, hope, exercise choice, and take action congruent with one’s primary motivators and ambitions.

I believe that creating this ‘child like perspective’ within vocational rehabilitation interactions can again open up a new world of possibility, opportunity, achievement, and fulfilment. By Arron Perriam 

 

Enrolment that Moves, Touches & Inspires!

Our ability to create an experience within someone else that moves them, touches them and inspires them, is the act of enrolment, and is catalyst for change, and is the fuel for creating the greatest of possibilities.

 Giving out information, detailed instructions,  or giving a sound bite sized motivational  talk or rev up, or giving someone a metaphorical  ‘kick in the butt’ ,  or having good intentions, or paying someone more money, or threatening someone with a ultimatum,  does not in my experience  ‘enrol’ or move people to change habits, increase performance, or change one’s way of ‘being’.

Very often to ‘move, inspire & touch’ someone, or a business, I suggest we need to tell the story and also listen to one’s story and thereby get in touch with the human factors, reach into a person’s emotion IQ, appeal to one’s sense of value and be transparent in sharing how we ourselves are ‘moved, inspired & touched’ by the story.

Partnering with someone following their serious spinal cord impairment & achieving a return to work is not an act of convincing, cohersing, motivating, or pushing for the return to work outcome. Rather it is about hearing and sharing the stories that do move, touch and inspire and that create a new experience within us that open up hope, possibility, aspirations and action. I believe it is these factors which change lives and are capable of achieving things which might seems very challenging or even impossible!  By Arron Perriam 

 

Myths & the Real Facts for Employers

 Myth 1. Hiring employees with disabilities increases workers compensation insurance rates.

Fact Insurance rates are based solely on the relative hazards of the operation and the organization’s accident experience, not on whether workers have disabilities.

 Myth 2. Providing accommodations for people with disabilities is expensive.

Fact The majority of workers with disabilities do not need accommodations to perform their jobs, and for those who do, the cost is usually minimal. In fact, two-thirds of accommodations cost less than $500, with many costing nothing at all1. And available tax incentives make it even easier for businesses to cover accessibility costs.

1Job Accommodation Network (JAN), a service of the U.S. Department of Labour’s Office of Disability Employment Policy

 Myth 3. The ADA (Americans with Disabilities Act) forces employers to hire unqualified individuals with disabilities.

Fact Unqualified candidates are not protected under the ADA. To be protected from discrimination in hiring, an individual must first meet all requirements for a job and be able to perform its essential functions with or without reasonable accommodations.

 Myth 4. Employees with disabilities have a higher absentee rate than employees without disabilities.

Fact Studies by firms such as DuPont show that employees with disabilities are not absent any more than employees without disabilities.

 Myth 5. Under the ADA, an employer cannot fire an employee who has a disability.

Fact Employers can fire workers with disabilities under three conditions:

  1. The termination is unrelated to the disability or
  2. The employee does not meet legitimate requirements for the job, such as performance or production standards, with or without a reasonable accommodation or
  3. Because of the employee’s disability, he or she poses a direct threat to health or safety in the workplace.

(Source: U.S. Department of Labour, Office of Disability Employment Policy) By Arron Perriam 

 

Spinal Injured Person Returns to Work 40hrs/Wk

 Yesterday one of our very capable & experienced Kaleidoscope Consultants turned to me & shared that one of her clients had RTW & was working 40Hrs/wk, this was following an intensive period of physical rehabilitation following their serious spinal cord injury (SCI). She went on to reflect that although she has had many many clients RTW over the past 3 years, that this is the first client to RTW 40hrs/wk. Naturally we celebrated and are very proud of the achievement of this individual client and happy for them that they have achieved their own goals for a RTW. We took a moment to reflected on the fact that very few persons following a serious SCI actually RTW 40hrs/wk, with many (about 65%) making a long term commitment to part-time work and others working up to about 30-35hrs/wk. Somewhere in our discussions I shared that i think the number of hours work per week achieved, or the milestone of working 40hrs/wk,  is largely irrelevant! My thinking is that the important factor and focus is not about achieving the celestial 40hrs/wk, but, rather about partnering the SCI client to optimise their RTW potential, whether that’s 5hrs/wk or 50hrs/wk.  For one individual with a SCI a RTW of 12hrs/wk may well be equal to another individual making a RTW of 32hrs/wk, when considering their level injury, functional capacity, access to local care/support services, labour market opportunities in their region, transportation, previous work history and skills etc.  In short, our commitment at Kaleidoscope is to celebrate the RTW of ALL clients we have the privilege to partner with, whether they RTW 1hr/wk for 50hrs/wk. To ALL of you who have made a RTW following a SCI or are working towards achieving that goal – you have our utmost respect, well done and keep up the great work!

By Arron Perriam 

 

Creating Unscripted Moments

In the book “Better’, surgeon Atul Gawande suggests that people in positions of responsibility should ask unscripted questions of those for whom they are responsible. On the surface, this seems easy enough.

Naturally the ‘business’ of the day takes over:  people at your door; the phone is ringing; there is a ‘tough’ client to deal with; an overdue report to be written; a referral that hasn’t been approved and your emails keep screaming to be opened.

 An opportunity for us is to not only to make the time to listen but to actively listen with patience and attention. The key thing is, as Gawande says, ‘If you ask unscripted questions, the business begins to feel less like business and may avail moments of real insight & connection!’

Some simple ‘unscripted questions’ :

  1. (Bedside) Thats a lovely photo, is this your family? Tell me about them.
  2. Hey, tell me about your day, how’s it been for you?
  3. I like your shoes, where did you come across them?
  4. Great to see you again, how are you going?
  5. You’re  looking very rested, have you recently been on holiday?
  6. What did you think of the weekends rugby match against…?
  7. How’s the family?

By Arron Perriam 

 

Go M.A.D – Make A Difference!

Amongst all the ‘business’ of running a Vocational Rehabilitation programme throughout New Zealand  it has at times been easy for me to lose focus on the primary motivators for why i love this work so much. I’m motivated by the opportunity to go M.A.D or to ‘Make A Difference’ in the lives of people who happen to have a spinal cord impairment in partnering them into greater independence and meaningful employment- they love!

Sorry to burst your buble but you’re NOT going to make a huge difference all the time, everyday, in everything you do, with everybody you meet.

But let’s say we get focused and aim to make a difference for just 20 minutes each day!  Say, 2o minutes of being really generous to someone, 20 minutes to create a new opportunity, 20 minutes to learn a new skill, 20 minutes of really listening and engaging with someone, 20 minutes today spent doing something special with your child, 20 minutes of being honest and transparent , 20 minutes a day doing exceptional work, dynamic work, work that really matters. 

This means investing 20 minutes a day defeating the lame brain long enough to go M.A.D and make a difference. Imagine what a gift this would be to yourself and to others – and we’d really be making difference.

By Arron Perriam 

 

 ‘Client Focused’

Tim Cook at Apple recentl said, “This is the most focused company I know of, am aware of, or have any knowledge of… We say no to good ideas every day.” Cook then pointed out to analysts that every single product the company makes would fit on the single conference table in front of him. “And we had revenue last year of $40 billion.”

In the course of partenering people with a SCI back to work it is easy, in our experience at least, to fall into the trap of trying to find work opportunities for the client or to try and find solutions for the client or to try and ‘convince’ a client about why a RTW is such a good idea or beneficial.

However this is a subtle & insidious diviation away from a truely client focused service to a focus on achieveing that ever important RTW outcome. Outcomes of course aren’t ‘bad’ as they are the natural and obvious result of quality vocational practice.

With the ‘external’ pressures to achieve faster, more efficient and durable outcomes Kaleidoscope is forever renewing its commitment back to a ‘client focused partnership’ and NOT the ‘outcome focus’ – and there is a differnce.

The client focused service sees the client as the ‘expert’ of their vocational journey/rehab, it understand the privilege of the partnership, it acknowledges the choices and inquiries of the client, it expects the client to take responsibility, it views the client as a responsibility and not a cost liability, or commodity to be gotten back to work!

If it works for Tim Cook & Apple to have a sharply defined ‘product focus’ then its good enough for us to have a sharply defined ‘client focus’ – and with this focus i am highly confident that we will see extraordinary RTW ‘outcomes’ and independent living.

By Arron Perriam 

 

 Empathy (from Seth Godlin Blog)

I have no idea what it’s like to be pregnant. And for most of us, we have no idea what it’s like to have $3 to spend on a day’s food, or $4,000,000 to spend on a jet. We have no idea what it feels like to be lost in a big city, no idea how confusing it is to go online for the first time, no idea what it’s like to own four houses.

Marketers and pundits and writers and bloggers and bosses pretend they are empathetic, but we never can be. Sure, we can try, we can be open to cues and sensitive to clues, but no, we don’t really know.

Being certain about how someone else feels or what motivates them is foolish. Don’t declare that you know exactly why someone made a choice or predict what someone is going to do next, and why. It’s a great parlor trick, but you’re probably going to be wrong. (I think the one universal exception is fear. We all know what it means to be afraid, and fear doesn’t change based on income or gender. The causes change, but the fear remains the same.)

Empathy is a hugely powerful marketing tool if we use it gently, being sure to leave lots of room for error. When we say, “oh, you did that to make a quick buck or you did that because you hate that guy or you did that because you’re a man…” we’ve closed the door to actually allowing people to write their own story and you make it difficult to learn what actually makes them tick. Vocational rehabilitation, in part, is a journey of exporation and is best served through an empathetic approach facilitating the client writing of their own vocational story.

By Arron Perriam 

 

Thoughts on Assessing Vocational Readiness Following SCI

Fixed Assessment is grounded in a ‘logical positivist worldview’ with an emphasis on objective data and logical and rational processes, whereas the Dynamic Assessment I would suggest is grounded in a ‘constructivist worldview’ with an emphasis on holism, personal meaning  and subjectivity.

For example:

Fixed Perspective Assessment is:  

- Environmental factors  

- Functional Capacity   

- Labour market variables  

- Educational history   

- Skills inventory   

- Defined & timely assessment process   

Dynamic Perspective Assessment is:

 - Collaborative Inquiry

- Self determination

- Planned Happenstance

- Hopes, dreams & aspirations

- Relationships/Partnerships

- Emerging & ongoing assessment experience

 By Arron Perriam 

Further details: arronp@burwood.org.nz

 

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