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Q - Employment and Vocation

Despite their differences in delivery, the VR programs (described above) share several commonalities. Primarily, clients work with VR counsellors to set up individualized goals and objectives for employment. During the goal-setting process, the needs of the client are established. Approaches to VR also involve providing opportunities for educational upgrading and job retraining, and connecting clients with employers, based on their work goals and skill set.4 All approaches involve a counselling component, which can address a number of issues related to working with a SCI, including problem-solving skills, independence, practical employment skills and workplace self-management. Lastly, VR counsellors can help to minimize other barriers to employment like transportation, clothing and shelter. Outcome Assessment in Clinical Practice Few outcome measures currently exist to assess progress in SCI vocational rehabilitation. Past practice has mainly focused on assessing employment status, satisfaction with employment, aspirations, and efforts to meet vocational goals.19 In addition, measures are not typically validated and have relied largely on self-assessment (Table 2.0). These measures help VR counsellors to identify ways to customize a program, but may neglect aspects of employment which an individual with SCI finds challenging. VR practice can also draw upon the Canadian Occupational Performance Measure (COPM).20 COPM is a client-centered outcome measure (administered through a semi-structured interview) that enables occupational therapists to identify their clients’ perceived performance in self care, leisure and productivity. The COPM can be used to determine how a VR program should be developed, based on the individual’s perceptions of participation in employment over time.20 More recently, the International Classification of Functioning, Disability and Health (ICF) has been accessed to inform VR assessment, intervention and evaluation. The ICF Core Set for VR was designed for practice-based tools, and built on the domains of the ICF classification system (e.g., body function and structure, activity limitations and participation).16,21 Tools that have been developed for SCI VR practice include: 1) Assessment sheet: Provides an overview of a client’s functioning state, with input from the client and the health professional. 2) Categorical profile: Identifies intervention targets and assesses the level of difficulty in each ICF Core Set domain, before and after a VR intervention. 3) Intervention table: Facilitates the coordination of interventions, roles and resources, within an interdisciplinary team. 4) Evaluation tool: Allows for the assessment and re-examination of a VR program.16,22 The ICF Core Set is a promising tool for the measurement of VR outcomes. However, more work is needed to examine its efficacy in practice. Table 2.0 Outcome Measurements Used in the Assesment of Vocation . Tool/Technique/Exercise TYPE OF ASSESSMENT Interest Hard Skill Soft Skill Transferrable Skills Aptitude Employability/ Job Readiness Validated Test Observational Selfassessment Prove-it X X X X X Mavis Beacon X Barriers to Employment Self-Assessment X X Transferrable Skills Scale X X X X Job Survival and Success Scale X X X CHOICES X X X Self-Directed Survey X X General Aptitude Test Battery X X Wide Range Achievement Test X X Job Success Seminars X X X X Negotiating Behaviour Change – Motivational Interviewing X X Unpaid Work Experience X X X Assistive Technology X X Assessment One-to-One Counselling X X X X EMPLOYMENT AND VOCATION | BODY STRUCTURE AND FNUCTION 181


Q - Employment and Vocation
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