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Improved co-operation in vocational rehabilitation with systematic rehabilitation group meetings.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Karolinska institutet.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
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2002 (English)In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 24, no 14, 734-740 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The present aim was to investigate the communicative pattern in two rehabilitation groups. The rehabilitation group consisted of the client, a supervisor, an employer representative, an occupational health physician, a rehabilitation counsellor from the national social insurance office and a support person. METHOD: Participatory observation of 22 rehabilitation meetings. The communication was tape-recorded and transcribed word for word. The transcripts were coded and analysed both qualitatively and quantitatively. RESULTS AND CONCLUSION: The client made the most utterances in the groups, but most often in the form of answers to questions from the other actors. Following the client, the physician made the next most frequent utterances, most often as questions. The subjects most discussed concerned the client's situation regarding work, health and material support. None of the "professionals" dominated the meetings, although one picture that emerged was that the physician and employer representative played more prominent roles as takers of initiative and as coordinators while the client was more passive than the other actors. The discussions were calm and much latitude was allowed for the participants to put forward their own requirements, thoughts and feelings. The rehabilitation group may be viewed as a meeting place for "experts" and clients. The further management of the rehabilitation was by the actor the client most immediately needed. In this, rehabilitation in the rehabilitation group differs from the "case management" common in the rehabilitation field.

Place, publisher, year, edition, pages
2002. Vol. 24, no 14, 734-740 p.
Keyword [sv]
Arbetslivinriktad rehabilitering, samverkan, observationer
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-1966DOI: 10.1080/09638280210124329ISI: 000178609600006PubMedID: 12452134Scopus ID: 2-s2.0-0037145112Local ID: 826OAI: oai:DiVA.org:miun-1966DiVA: diva2:26998
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2016-10-19Bibliographically approved
In thesis
1. Co-operation in vocational rehabilitation: methods in multiprofessional cross-sector group meetings and effects on employment
Open this publication in new window or tab >>Co-operation in vocational rehabilitation: methods in multiprofessional cross-sector group meetings and effects on employment
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to acquire an increased knowledge of co-operation between different rehabilitation actors in the provision of vocational rehabilitation (VR). One aim was to investigate the differences in effects on employment between clients rehabilitated according to a systematic multi-professional cross-sector co-operation model (SMCVR) and clients subjected to conventional co-operation. A second aim was to investigate the communicative process in the rehabilitation group meetings and female clients’ experiences during the VR process.

 

The studies used material collected from two intervention projects, enabling natural experimental designs. Fifty-one unemployed clients with various work limitations, who underwent intervention with SMCVR I model during a period of 18 months, were individually matched into pairs using records from the Swedish Public Employment Service. Three matched comparison groups, representing the conventional way of co-operation between VR actors, were formed at local, county, and national levels. A distinctive feature of the SMCVR I model was that the client’s rehabilitation was planned by multi-professional cross-sector rehabilitation groups consisting of the client, a rehabilitation official from the social insurance office, an occupational therapist from a primary care unit, an employment counsellor from the county employment office and a social worker from the municipal social administration office. The main effect variable was the number of persons in employment. ANOVA for repeated measures for binary responses and a logistic regression model was used. The VR actors involved in the SMCVR II model were a public employer (a municipality), the social insurance office and an occupational health service. The material consisted of 22 systematic multi-professional cross-sector rehabilitation group meetings with clients who underwent intervention (20 women, 2 men). An observer attended each meeting to observe communication; each meeting was tape-recorded and subsequently transcribed. The analysis was based upon these transcriptions, using content analysis.

 

A larger proportion of clients subjected to this particular form of developed co-operation studied (SMCVR I) became employed during the first 2 years compared with similar clients in neighboring municipalities or among those in a national register; the higher employment rate showed a peak two years after closure of the intervention; the chance of becoming employed after rehabilitation in the 2-year follow-up was roughly twice as high as that in both comparison groups with conventional co-operation. There was a difference between the study group, the national and county comparison groups on 6 measuring occasions over the period from 1 year following closure of the intervention to the 6th year after. The logistic regression model showed that the clients with mental/social work limitations were at a greater risk of being unemployed after VR than clients with somatic work limitations. In the SMCVR II model the topics discussed primarily concerned the client’s situation regarding the field of medical and health care, previous and new work, and social insurance and none of the professionals dominated the meetings. The clients had the highest percentage of utterances. Clients were allowed ample scope to address their own requirements, thoughts and feelings. ‘Adaptation’ was a pervading theme in the discussions during the observations. The ‘importance of work’ for the clients emerged as a sub-theme; positive and neutral aspects occurred. The conflict between health and work was an ever-present theme of substantial importance for VR. Support from the employer and fellow workers during the client’s return to work was important. This support appeared as both a positive and a negative force in the VR.

 

In conclusion, systematic multi-professional cross-sector co-operation – which can be performed without any changes in law – leads to seeing a greater proportion of clients in employment over a long period of time compared with “co-operation as usual”. It is possible to achieve a creative communicative climate in multi-professional cross-sector rehabilitation group meetings, which can favor good results in VR.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet, 2008
Keyword
Rehabiliteringsvetenskap
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-9962 (URN)978-91-7409-122-9 (ISBN)
Public defence
Aulan, Danderyds sjukhus, Stockholm (English)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2009-10-05Bibliographically approved

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