TTERS REHAB Life can change REHAB TTERS in an instant! … · 2015-12-09 · Personal Injury and...

See inside for a new opportunity to earn CEU Credits!

FALL 2010

See inside for a new opportunity to earn CEU Credits!

REHAB REHAB MATTERSMATTERS






Fall Forward

…and more

REINSTALLING

JOY!

OccupationalHazards

Walking in aclient’s shoes

CAVEWASCorner:

An introduction

ETHICALDISCLOSURE

…and more

REINSTALLING

JOY!

OccupationalHazards

Walking in aclient’s shoes

CAVEWASCorner:

An introduction

ETHICALDISCLOSURE

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Fall 2010 1

Offi cial Publication of the Vocational Rehabilitation Association of Canada

Features

Reinstalling Joy Replacing happiness in your life 4

Role Reversal Walking in a client’s shoes 5

Everything You Say Can and Will.... Ethics and psychiatric disability 12

Auto Insurance Reforms A summary 15

Exercise & the Elderly A lesson of life quality and independence 18

Essential Lessons Ensuring trainees have the skills they require 22

Compassion Fatigue An occupational hazard in vocational rehabilitation 22

Glutathione What is it and why is it important? 27

20/20/2 Answer 20 questions for 20 dollars and earn 2 CEU credits 22

Inside Every Issue

A Message from the National President Garry Derenoski 2

Society News The latest VRA developments from across Canada 3

Spotlight on Professionals Dr. J. David Cassidy 6

Advice From the Pros Rosemary Toscani explains two tools for success 8

CAVEWAS Corner An introduction to CAVEWAS 10

Member Pro� le Executive director and psychological associate Arden McGregor 26

ContributorsSherry Bezanson, M. Ed, RCC, RRP

Kate Bird, HBSc, B.Ed

Phil Boswell, MA, B.Ed, HBOR, BA, RRP

Dayna Danson, Hons. B.A.

Jonathan Danson, M.A., Ph. D. Student

Denise Hall, MA, RRP

Bonnie Maguffee, MS, CRC, CVE

Brad S. Moscato, Hons. B.A., LL.B

Neetu Rishiraj, ATC, RRP, PhD

Rosemary Toscani, HBSc CVP, RRP

Fall 2010

PUBLISHED BYVRA Canada

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>>>>>>

EditorDayna Danson

DesignRosanne Byles

Advertising Sales DirectorAudra Lesliet. [email protected] Ferrand Dr. Suite 800Toronto, ON M3C 3E5Tel: 416.340.7707Fax: 416.340.1227Web: www.mcintegrated.com>>>>>

Rehab Matters is published three times a year by VRA Canada. The opinions expressed in this publication do not necessarily re§ ect the policies of the Association.

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British Columbia Society

BC Society held its AGM and Training Day on Friday, September 17th. Two great educational workshops were offered: psychiatrist Dr. Derryck Smith & lawyer Laura Bakan presented on “Doing a Psychiatric Assessment/DSM Report, Medical/Legal Expert Report, and Expert Testimony”; and neuropsychologist Dr. Jeanne Leblanc presented on “Ethics in the Forensic Domain.” The Society was pleased to have National President, Garry Derenoski, attend and he provided an update on the College of Vocational Rehabilitation Professionals and Vocational Services.

Sharon Smith received a meritorious award in recognition of her contribution to the � eld of rehabilitation in BC. Sharon has worked tirelessly and sel� essly on the VRA BC Membership and Marketing Committee, assisted on the Professional Development Committee, and acted in an advisory capacity to the Executive Committee. She has also been our National Representative for three years where she is also a member of the National Board’s Executive Committee. She is always available to discuss the needs of VRA BC and National and is a wealth of information in the � eld of rehabilitation. Sharon holds a Master’s degree in Applied Psychology, has been a member of VRA Canada since 1995, and has worked in the � eld of rehabilitation for over 15 years.

Board of Directors for 2010-2011 are: Shelley Rose (president); Richard Byers (vice-president); Brian Lukyn (treasurer); Audrey Robertson (secretary); Sharon Smith (national board member); Terri McLeod (chair - marketing & membership committee); Zeljka Sila (chair - professional development & education committee); and new board member Lincoln Cundiff.

Overall it was a very successful day, due in large part to the dedicated administrative staff at Support Services Unlimited. Special thanks to Donna Denham, Jenny Aston and Becca Verhaghen.

Ontario Society

This year’s fall conference of VRA Ontario was held at the Courtyard Marriott in Brampton, Ontario, on November 5, 2010. The conference was a great success, with approximately 150 attendees, 10 exhibit booths, and 14 sponsors! The sessions were very interesting and topical, and included speakers from the government, legal, academia, and private sector. Expressions of interest are welcome for speakers and/or topics for upcoming seminars and next year’s conference.

32 Fall 2010

While only a few months have passed since the release of the last issue of Rehab Matters, VRA

Canada has been extremely busy! From June 8-11, we held our National Conference in beautiful Niagara Falls, Ontario, and it went off without a hitch! We had a really wonderful turnout, with hundreds of members and stakeholders attending from all across Canada, and even some from the States.

This year’s list of speakers was particularly notable; Robert Pio Hajjar, Founding Director of IDEAL-WAY,

delivered an inspirational and enlightening speech on his life struggles and triumphs, while Vicki Keith delivered a speech called “Penguins Can Fly” with Jenna Lambert, the � rst female with a physical disability to cross Lake Ontario. Other speakers, such as Brian Hayday (President, Change-Ability), Christine Elliot (MPP, Whitby-Oshawa), and the Honourable Jean Augustine (Fairness Commissioner of the Province of Ontario), all spoke with integrity, passion, and enthusiasm.

We also had the pleasure of having the Lieutenant Governor of Ontario, the Honourable David C. Onley attend the conference. He spoke about the importance of the disabled individual in the workforce, and the dedication and devotion they have for their jobs on a daily basis. It was a powerful, inspiring, and moving speech that was most certainly enjoyed by all!

For a � ipbook of pictures from the 2010 National Conference in Niagara Falls, Ontario, please visit http://vracanada.com/events.php. Next year’s conference will be held from June 21-24, 2011, in beautiful Regina, Saskatchewan. Regina, the capital city of Saskatchewan is located in the southern portion of the province and has a population of approximately 190,000. The city plays host to some of the best festivals and events in the province, and with a variety of things to see and do, the 2011 conference should not be missed! For more on the 2011 conference, please visit http://vracanada.com/.

With the 2011 conference planning underway, it is important to think about the changing face of VRA Canada. Our focus of “Diversity, Disability and Disadvantage” still rings truer than ever, and very much remains at the forefront of our Association. It is essential that each Vocational Rehabilitation Professional continually improves upon him/herself, whether through conferences, classes, seminars, etc. In this issue of Rehab Matters, we are helping you better yourself by offering “20 questions, for 20 dollars, for 2 CEU credits.” The � nal page of the magazine will contain 20 questions based upon articles in the magazine; for $20, you can take the test and potentially earn 2 CEU credits! This is what many associations have been doing, and we have decided to follow suit; after all, Rehab Matters is a professional journal! We think this will be a fun and interesting way to help all of our members continually better themselves.

As always, we are looking for your comments and feedback in regards to Rehab Matters. Input from our readers is highly encouraged, and we would especially like to know if you found the “20 questions, for 20 dollars, for 2 CEU credits” worthwhile and informative. Please send any letters to the editor, comments, questions, suggestions and ideas for upcoming issues to: [email protected].

Enjoy the issue!

VRA CANADAVocational Rehabilitation

Association of Canada

2010/2011 Board of Directors

Garry DerenoskiPresident

Roselle Piccininni Past-President

Sharon Smith Director, British Columbia Society

Tricia MoffatDirecto r, Alberta Society

Nikki Lamb Director, Saskatchewan Society

Laurence HaienDirector, Manitoba Society

Evie CowitzDirector, Ontario Society

Dale MurphyDirector, Atlantic Region

Phillip W. BoswellPresident, CAVEWAS

National Of� ceVRA Canada4 Cataraqui StreetSuite 310Kingston, ON, K7K 1Z7

Tel: 613.507.5530Toll-free: 1.888.876.9992Fax: 888.441.8002

Email: [email protected]: www.vracanada.com

Garry Derenoski, RRP, C.I.P President

Welcome to Your Rehab Matters Magazine

Fall 2010 A Message from the National President Society News

News fromacross the country

Society

MANAGERS, WORK TRANSITION

Hamilton • London • Windsor

Drawing on your proven strengths and extensive experience as a vocational rehabilitation leader, you will manage the planning, development and delivery of work transition services, and provide technical expertise to the team, service delivery staff and workplace parties on work transition assessments, plans, approaches, processes, related WSIB policies, standards and individual work transition plan issues.

WORK TRANSITION SPECIALISTS

Ottawa • Kingston • Kitchener • Guelph • Hamilton • St. Catharines • London • Sudbury • Timmins • Sault Ste Marie • Thunder Bay • Windsor • Toronto

A critical thinker with vocational rehabilitation experience and strong communication and analytical skills, you will assist workers, employers and WSIB Case Managers in facilitating work transition and case resolution at the workplace.

If this is you, please visit our careers page at www.wsib.on.ca to learn more about these opportunities and how to apply by December 3, 2010.

For most of us, joy isn’t a permanent state, but arrives like a visitor with an

armful of gifts and then departs much too soon, leaving dirty dishes in the sink and a sense of empty longing. Many clients, not to mention practitioners, feel deeply discontented with their lives. There is often a restlessness and sense of being incomplete. Many people don’t know how to � nd real joy because they are looking for ful� llment in all the wrong places: in things, people, events, and circumstances outside of themselves that cannot possibly create a true sense of joy. The perfect job or relationship, the well-toned body, a new car or house, these external things are often identi� ed as the goal to bring joy into one’s life.

However, the acquisition of external “things” will never deliver the joy. Joy comes from an authentic connection with ourselves and others, brings delight, and a deep sense that all our needs are truly met. Joy can be de� ned as intense positive feelings and a sense of pleasure that radiates out, spilling over to those close to us. Unfortunately, joy is often the � rst to go for those with chronic medical problems, long absences from work, and

especially if combined with some kind of an existential crisis.

An existential crisis is often provoked by a signi� cant event in the person’s life such as a divorce, health decline, relationship/work challenges, being � red from work, death of a loved one, and empty nest syndrome, to name a few. The result can be a profound sense of meaninglessness, a sense of personal mortality, and is often called a dark night of the soul. Joy has de� nitely left the building. How do we bring joy back into our lives?

Reconnecting with joy is paramount to recovering and ongoing health. It is important and usually inescapable to examine the unwelcome feelings that arrive with the dark night of the soul– whether triggered by illness or a strong dose of western culture conjured by the meaningless pursuit and acquisition of things, rather than soulful connection with ourselves and others– in order to root out the origin. Examine what has changed in one’s life, and what is stuck: “What are MY needs at this time in my life that I’m not addressing?”

Another pitfall is one becoming inappropriately attached to their story—“I will never � nd love again;” “My friends have abandoned me in my time of need;” “This feeling will never change;” “If only I had...” When we get attached to our stories, we bore others, we push them away and we ultimately program ourselves to avoid getting well. It is a trance state. The story is said over and over —“he/she did this, said that, didn’t do this,” etc. What happens is that the teller of the story gets stuck in it and it disables their ability to see themselves, and their health, clearly and their role in the situation. Pain is magni� ed and reinforced every time the story is told.

We’ve all had friends, clients and family members that bore us with their stories. It is the attachment to these recurring thoughts that keep people stuck and unwell, and keeps joy at bay. As a practitioner it is a skill to help a client move beyond their attachment to the story, and thus pain, and set a bearing on a more realistic, and less painful, view of the situation and ultimately a sense of peace within. But unfortunately what often occurs is that the practitioner colludes with the client, fostering a further sense of helplessness and victim stance. It is the rehabilitation practitioner’s role to gently nudge the client toward self-awareness. Guiding the client toward the therapist’s door would be bene� cial, but it could also be as straightforward as pointing out the pattern in a kind but � rm way.

The state of chronic and lasting joy can be created by learning to acknowledge and manage negative emotional states. In fact, inviting them in and learning to sit with the uncomfortable feelings is essential. If we pretend they don’t exist, the feelings will exaggerate. Next, by retelling the story, we move into the future and away from the past that has us mired down. Rather than “my marriage ended because he didn’t give me what I needed”—blame that focuses on things one can’t control, instead retell the story: “my marriage ended due to both of us neglecting our needs,” which takes ownership of the situation and one’s role in it. Or “I have a dif� cult relationship with my administrator because I have unrealistic expectations at work.” This retells the story being accountable and again focuses awareness into the realm that one can control. Ultimately, we can only change our side of the con� ict in any given situation, so acknowledging our role is paramount to reinstalling joy. As

54 Fall 2010

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Reinstalling Joy

How to bring happinessback into your life

By Sherry Bezanson, M. Ed, RCC, RRP

Development

Many people don’t know how to � nd real joy

because they are looking for ful� llment in all the wrong places: in things,

people, events, and circumstances outside of themselves that cannot possibly create a true

sense of joy.

you do this you can focus instead on what one does want: “I need to move toward positive connections with others where both our needs are met.”

Our ego often conspires against us, telling us that we are lacking all that we need, but our true inner core of joy knows better. The ego can be � lled with self-importance and searching for the negatives that tell us that we will never succeed, never truly be happy. Learning to go beyond those limiting beliefs and learning to reinstall joy despite the juncture is essential.

Once you’ve retold your story, the next stage is to train your mind to focus instead on joyful, uplifting thoughts—bathe yourself in moments that brought you joy in the past. If you habitually practise focusing in ways that make you feel joyful, you’ll program joy into the neural pathways of your brain.

When we tune into the essence of joy within us rather than either avoiding pain or seeking joy from external situations we become our own beacon of light. We have an inner smile that can’t be shaken. Sure, getting off the path of joy is predictable, but reinstalling joy can become second nature. By knowing our true needs, seeking to understand the pattern and then moving forward to solutions, we are no longer waiting for others or our situation to bring us to a sense of pleasure. Joy can be reinstalled daily, hourly, or by the minute if need be. Many researchers claim that it takes forty days to change our habits. On the road to joy, and ultimately recovery, that is forty days well spent.

The state of chronic and lasting joy can be created by learning to

acknowledge and manage negative emotional states. In fact, inviting them in and learning to sit with

the uncomfortable feelings is essential.

About the Author

Sherry Bezanson

lives on Vancouver Island and has worked in the counselling � eld for twenty years and rehabilitation consulting for ten years. She has a Master’s in Counselling Psychology from UVIC.

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If there is anyone who can attest to the importance of education in assisting

individuals in a safe and sustainable return to work, it is Dr. J. David Cassidy. With dozens of years of schooling spanning from 1975-2005 behind him, Dr. Cassidy is a professional in the rehabilitation � eld, with expertise in the anatomy, surgery, pathology, epidemiology and chiropractic � elds.

Born in Toronto, Dr. J. David Cassidy attended the University of Toronto, followed by Canadian Memorial Chiropractic College. After practicing chiropractic in Saskatoon, Saskatchewan for a number of years, Dr. Cassidy then went on to complete a BSc in anatomy, an MSc in surgery, a PhD in pathology and a DrMedSc in injury epidemiology. Currently, Dr. Cassidy is the professor in the Division of Epidemiology at the Dalla Lana School of Public Health at the University of Toronto and a Senior Scientist at the Division of Health Care and Outcomes Research at the University Health Network’s Toronto Western Hospital. He is also the Director of the Centre for Research Expertise in Improved Disability Outcomes (CREIDO).

At CREIDO, Dr. Cassidy and his team are currently focused on several areas, including disability prevention in musculoskeletal disorders and after neurotrauma. They are also interested in the relationships between injured

workers and their employers and how to improve the health and productivity of the workforce. In the future, they hope to partner with those that can implement their research � ndings to improve quality of life in those with injuries. In addition, a CREIDO lead investigation found that workers become somewhat dislocated from their working lives and physical abilities when they develop chronic pain. This groundbreaking study, as Dr. Cassidy notes, will “help the CREIDO team understand the injured worker’s perspective and design better interventions to help them return to health and work. The injured worker needs to be a partner in the return to work process and not just a recipient of care.”

Aside from his accomplishments at CREIDO, Dr. Cassidy has a lot to be proud of elsewhere; in his position as the Senior Scientist in the Division of Health Care & Outcomes Research at Toronto Western Research Institute, he has trained students, post-doctoral fellows and young scientists. “I am privileged to have been a mentor to many talented individuals and to see them grow as health scientists,” says Dr. Cassidy.

“All stakeholders, including the injured worker, the injured worker’s coworkers, their supervisors, their employer, their

healthcare workers, their rehabilitation consultants, their family members and their insurance contacts, need to be on side and educated about the main barriers and facilitators concerning safe and sustainable return to work. Often the return to work process breaks down because of a lack of understanding or education with one or more parties in the process. Without a proper understanding or education on the important issues in return to work, the communication between key stakeholders breaks down and then the process stalls, to the detriment of all,” stresses Dr. Cassidy.

Dr. Cassidy also mentions that, in his opinion “it is important to have partnerships between academic centres such as CREIDO and service provider associations such as VRA. CREIDO can provide research expertise and VRA can implement the programs that are necessary to achieve needed results.”

7 Fall 2010 6

Infl uence

SpotlightOn

ProfessionalsCommunication breakdown

By Dayna Danson Hons. B.A.

Focus

Dr. David Cassidy

“Dr. David Cassidy stresses the importance

of education and understanding in the

return to work process.”

Going forward, Dr. Cassidy is a strong

believer in education, and its vital role in the return

to work process.

Iam a student of psychotherapy. I believe strongly in the power of the

therapeutic relationship and of talk-based interventions. More speci� cally, I believe in their ability to positively in� uence the thoughts, emotions and behaviours of both those suffering from psychological disorders and those who are experiencing “everyday” problems. Accordingly, a huge amount of my time is devoted to learning technique, studying, researching and counselling.

Recently, however, I realized that my education and training were missing something. While I was becoming adept at playing therapist, I had no idea what it felt like to be the client. Sure, I did a lot of reading about how clients tend to feel, behave and respond. I spent time role-playing with other students, where I would act as a client and sometimes even divulge real problems. Although these exercises were certainly valuable, I felt as though they lacked the real, raw, uncensored qualities that I imagined were part of the client experience.

The only way to really understand what it’s like to be a client, I reasoned, was to become one. So, a short while ago I began to regularly attend both group and individual psychotherapy sessions with my school’s counselling service. Overall, I got what I expected: space to talk about myself, time to re� ect on my life, and a person to listen, guide, challenge and support. This article could easily be about these qualities and would undoubtedly serve as more evidence that therapy is valuable even for those who do not have clinical psychological disorders. What I am more interested in talking about, however, is what I didn’t expect: the feelings of embarrassment and shame that I experienced walking into the counselling

of� ce, talking to the receptionist and sitting in the waiting room.

It’s not that I thought I should be embarrassed. It’s not that I thought there is any shame in seeking therapy (quite the contrary, actually). It is simply what I felt. I wondered if people saw me walking in and thought I was crazy. I wondered if the nice young woman at the desk thought I was crazy. I wondered if the others in the waiting room thought I was crazy. I had an overwhelming urge to shout out “I’m a doctoral student in psychology... I’m here to learn!” I didn’t, though. I sat there, read my magazine, and slunk towards the counselling room after my name was all-too-loudly called. In the end, I didn’t let my embarrassment stop me from going, but I was close. I was close.

I need no more convincing that the infamous “stigma of therapy” is a potent force. Despite everything I have been taught and my strong conviction that psychotherapy is for the everyman (or everywoman), it was enough to make me squirm. It is hard for me to pinpoint exactly why my mind was at such odds with my gut. I am tempted to blame the media for its portrayals of psychotherapy, or the receptionist for not making me feel more welcome, or my own self-consciousness. In any case, I am left feeling disconcerted. I imagine how powerfully the stigma of therapy must affect those who are reluctant to seek help,

those from other cultures, or those who are mandated to treatment. After all, look what it did to this student of psychotherapy.

Looking into the future, I see a need to more actively and directly address the misguided feeling of shame often associated with seeking professional help. While making services available to individuals who need them is crucial, it is equally important that these individuals feel safe, comfortable and con� dent enough to take advantage of them. To a large degree, this can be fostered by casting therapy as a normal means of addressing the shared human condition, rather than an extreme means of curing human defect. How exactly this should be done is another issue, and one that practitioners can address in their own unique ways.

About the Author

Jonathan Danson is a

doctoral student in Counselling Psychology at the Ontario Institute for Studies in Education of the University of Toronto. Currently, he is completing a clinical practicum in the Work, Stress and Health Program at the Centre for Addiction and Mental Health. He is also involved in research examining the use of supported employment for those with severe mental health issues.

The only way to really understand what it’s like to be a client, I reasoned,

was to become one.

By Jonathan Danson, M.A., Ph. D. Student

Role Reversal

Expelling the stigmaof therapy by walkingin a client’s shoes

98 Fall 2010

clients learn unimanual keyboarding lessons that include using a centred home row. Clients begin with basic � nger positioning and work towards the goal of increased speed and accuracy using the non-dominant hand. Computer skills training in Microsoft Of� ce applications, such as MS Word, is also provided as clients develop pro� ciency in using the computer mouse. Training in other programs is also available depending on the client’s vocational goal, future education plans, and other considerations, and could include training in Dragon NaturallySpeaking, ZoomText, JAWS, and Kurzweil 3000.

Isra successfully completed her 16-week Non-Dominant Hand Training program. When she completed her � nal assessment, she showed signi� cant improvement on most tests, and demonstrated increased strength, dexterity, endurance, and coordination with her trained-dominant left hand. She said that she was increasingly comfortable with using her trained-dominant hand to complete tasks at home. She was proud of the projects she created during art therapy sessions, which included collages, paintings, and working with beads.

Isra requires additional Academic Upgrading before being able to successfully re-enter the workforce. In her Academic Upgrading program, she is able to use her trained-dominant hand to complete all necessary assignments. Isra’s success in the Non-Dominant Hand Training program was due to her motivation and diligence, in addition to the unique, comprehensive nature of this program, which kept her engaged and interested while she transferred dominance from one hand to the other.

Train to Hire: Learning the Skills Needed for a Job

Peter (name changed for con� dentiality purposes) needed assistance after injuring his back. Peter had 18 years of customer service experience, and had worked his way up to being a senior superintendent of buildings with responsibility for dealing with tenants. Peter had the experience but lacked formal education—he had a Grade 11 education and had been unsuccessful in completing college courses. He was more of a “hands-on” person.

Peter needed help. As he had been unsuccessful in the past with education, he needed to try a new route to employment after his injury. After his initial assessment, Peter completed the Train to Hire program, which would

provide him with ongoing support in the workplace as he learned new work tasks.

The Train to Hire program � lls a gap in services offered to employment seekers. While most training programs offered in the � eld deliver on improving clients’ employability outside of the workplace, the Train to Hire program improves clients’ employability at the workplace. Clients are provided with an on-site job coach who attends the placement with the client and provides training on the job.

The work placement is preceded by a four-week employment preparation phase that is expected to maximize each client’s potential for securing paid employment. This phase includes training on a range of topics, including good work habits, interview readiness, cover letter and résumé writing, customer service training, and the experience of a mock interview with feedback session.

For the work placement, clients are only placed with organizations that have legitimate hiring needs in the target vocation. The program can last 12 or more weeks, with ten hours per week of personalized job coaching and on-site training for each client. Throughout the work placement, the employer completes report cards on the client’s work habits and ability to cope with job tasks.

The job coach facilitates the client’s training by identifying skill gaps and developing strategies to address them. In addition to helping the client master job tasks, the job coach will help the client to learn the employer’s proprietary workplace training material, help the client build good working relationships with co-workers and managers, and integrate into the culture of the unique workplace. This support is expected to assist the client in overcoming barriers and maximize success in the work placement.

The Train to Hire program works on the principle that an individual’s likelihood of securing paid employment improves signi� cantly if he/she can successfully integrate into the workplace, learn proprietary material, and master job tasks. As such, clients who bene� t most from this program are ones who already possess suf� cient communication, literacy, numeracy, and technical skills, but would need help in mastering speci� c job demands and integrating into the workplace. Other clients who bene� t from this program are those who learn best through hands-on training in the workplace, and those who need assistance in dealing with barriers

posed by a cognitive impairment or physical disability.

Peter is now in the � nal weeks of his Train to Hire program. With the daily help of a job coach for the � rst several weeks, Peter has mastered most of his job duties and successfully integrated himself into the car dealership where his work placement is occuring. His employer reports he is currently doing very well in the position, and there is a strong likelihood that Peter will be offered a paid position at the end of his placement. Peter’s success in the Train to Hire program is due to the immersive experience of this program, which allowed him to maximize all opportunities to learn the essential skills of the job while having the aid of a supportive job coach.

When an injury occurs, life changes dramatically for the injured

person and his or her loved ones. The body, abilities, and even self-perception change as the injured person attempts to continue living in the same manner as before. Things which were once easy—or even mindless—to do are now chores. Buttoning a sweater becomes a challenge. Remembering short work tasks becomes a burden. Instead of being able to focus on the destination, an injured person must now focus on each and every step.

A main goal after an injury is to help the injured person get back their con� dence, get back some comfort, and get back to work.

On The Other Hand: Training People to Use Their Non-Dominant Hand

Isra (name changed for con� dentiality purposes), injured the elbow of her dominant right arm in a workplace injury. The doctor who treated her injury placed a cast on it instead of operating. This caused further damage.

As a result of her injury, Isra had dif� culty with day-to-day tasks relating to grooming, hygiene, dressing, and household chores. She also was not able to write with her non-dominant hand. Isra attempted to return to work using her non-dominant hand to complete her work tasks. This resulted in a signi� cant amount of strain on her entire left side. Although she reported during her initial assessment that she was not depressed, she did state that she had been placed on anti-depressant medication.

Isra needed to re-learn how to perform activities of daily living and work tasks using her non-dominant hand. After her initial assessment, an intensive

16-week program would train her in developing the use of her non-dominant left hand. The program included hand-strengthening exercises, compensation techniques, perceptual motor exercises, cursive and manuscript handwriting techniques, unimanual computing skills, and keyboarding/keypadding.

Though the idea of transferring dominance from one hand to another is not especially new, specialists worked closely with a kinesiologist, an occupational therapist, and a curriculum development specialist in creating the program, which can take anywhere from 12 to 20 weeks to complete. The program is customized for each client’s individual needs, interests, and vocational goal. All clients are assessed biomechanically and monitored throughout the program by a certi� ed kinesiologist. Clients are assessed on a daily basis through the performance of daily tasks, and tested at intervals to evaluate progress.

The initial focus of the Non-Dominant Hand Training Program is on the development of gross motor hand skills and stamina. Gradually, � ne motor work is introduced as the student’s basic skills improve. Psychomotor skills, such as range of motion, hand-eye coordination, dexterity, strength, and endurance are targeted. The program also incorporates a sequenced series of perceptual motor exercises, primarily consisting of pronation/supination, insertion, compression, scooping, spooning, and mechanical manipulation tasks. With practice, these tasks equip clients with the techniques and con� dence to function more pro� ciently in both their daily lives and their workplaces.

One of the most important aspects of this program is art therapy, which allows students to re� ne their skills while applying them to a creative project. Clients work on projects which directly appeal to their interests; projects completed by clients are as varied as the clients themselves. Projects completed over the years include sketching, painting, modelling with clay, etching, and knitting. This creative approach helps students to elevate their moods, as many who have sustained an injury also suffer secondarily from depression and/or post-traumatic stress disorder.

Another component of this program is the practice of both manuscript and cursive writing, which begins with an orientation to proper pencil-gripping and paper-positioning. The overall goal is to improve writing skills by developing legibility, and allowing for more controlled and � uid writing. Stamina for sustained writing is improved through daily transcription exercises.

As part of their computer training,

Though the idea of transferring dominance

from one hand to another is not especially

new, specialists worked closely with a kinesiologist, an

occupational therapist, and a curriculum

development specialist in creating the program, which can take anywhere

from 12 to 20 weeks to complete.

Other clients who bene� t from this program are those who learn best

through hands-on training in the workplace, and

those who need assistance in dealing with barriers

posed by a cognitive impairment or

physical disability.

On theOther HandFrom struggle to success: two training programs that will bring clients prosperity

in the workplaceRosemary Toscani, HBSc, CVP, RRP

Success

About the AuthorRosemary Toscani is Program

Director and founder of CareerQuest Inc., an organization providing multi-disciplinary training initiatives within southern Ontario. Rosemary is a Certi� ed Vocational Professional whose experience spans 20 years and includes case management, training delivery, and assessment. Find out more about Rosemary and CareerQuest at http://www.careerquestcanada.com

11 Fall 2010

Dear Fellow Colleagues and Readers,

We would like to introduce to you Rehab Matters’ newest section: CAVEWAS CORNER.

As many of you know, CAVEWAS (Canadian Assessment, Vocational

Evaluation and Work Adjustment Society) is a member society of VRA Canada serving in large part to represent and support the professional and developmental needs of vocational evaluators as well as all professional rehab personnel specializing in work adjustment of injured workers and the like. In our continued efforts to stay connected with all of our members and colleagues—and in partnership with Rehab Matters our quarterly publication, we have endeavored to create this new section whose intent it is to keep you informed of matters germane not only to CAVEWAS members, but to related professionals working within the � eld of vocational rehabilitation.

In this section you will � nd current and candid articles authored by CAVEWAS members, non-members (and future members alike) that will share, discuss, and communicate with you developments and changes affecting our membership; amongst them issues of best practice, professional development and designation, as well as industry trends. We hope you will � nd the content in this section stimulating, motivating, and informative and we encourage your ongoing participation and contributions.

Enjoy!

CAVEWAS NATIONAL BOARD of DIRECTORS

If you are a CAVEWAS member, andhave any ideas, opinions, or thoughts relevant to this section and you would like share, discuss, and communicate them in the next issue, please contact: Jeff Cohen at [email protected].

A Question of Certi� cation and Designation

The raison d’être of CAVEWAS is to promote and advance the � eld of Vocational Evaluation and Work Adjustment as a professional discipline. A profession is de� ned as “a calling, vocation or employment requiring specialized knowledge and often intensive academic preparation.” To qualify as a profession, the following characteristics are expected to be present:

One of the biggest challenges facing Vocational Evaluators in Canada is not having certi� cation available that would identify certi� cants as being minimally competent. Some people may argue that the Registered Vocational Professional (RVP) certi� cation might � t the bill. However, the RVP is meant to be an entry level credential that requires a two year college diploma in conjunction with experience. It is often seen as a pre-cursor to the Registered Rehabilitation Professional (RRP) designation which requires an under-graduate degree in conjunction with experience. The gold standard certi� cation for vocational evaluators in Canada and the United States was the CVE (Certi� ed Vocational Evaluator) designation which was developed by the Commission on the Certi� cation of Work Adjustment and Vocational Evaluation Specialists (CCWAVES).

CCWAVES was formed in 1983, following a certi� cation model predicated on a master’s level degree in vocational

evaluation and successful completion of a standardized examination. Other professionals were required to demonstrate candidacy for certi� cation through speci� c courses and years of experience in lieu of a master’s degree in vocational evaluation.

In September 2008, the commissioners of CCWAVES dissolved the organization. The Commission sought a reputable organization to assume responsibility for the renewal and maintenance of the Certi� ed Vocational Evaluation (CVE) credential. In April 2009, CCWAVES negotiated with the Commission on Rehabilitation Counselor Certi� cation (CRCC) to provide oversight and administration of the future renewal and maintenance processes for the CVE designation. Currently there are 49 CVE’s in Canada and that number is declining

and will continue to decline as certi� cants retire or transition out of the industry. New evaluators are entering the profession and searching for a credential that will identify them as being competent and ethical professionals. The CAVEWAS Board has been exploring options towards re-establishing benchmarks and advancing the vocational evaluation and work adjustment profession.

The Vocational Evaluation and Career Assessment Professionals (VECAP) invited CAVEWAS to participate in the 14th National Forum on Issues in Vocational Assessment in Oklahoma City, OK in April. Speci� cally, CAVEWAS was invited to sit on a panel session titled “The Way Forward” to discuss the next steps and future of certi� cation for Vocational Evaluators after the dissolution of CCWAVES. Representatives from the VECAP and Vocational Evaluation and Work Adjustment Association (VEWAA) and CAVEWAS were invited to sit on the panel. Past-president Helga Guthrie represented CAVEWAS at this event and sat on the panel. It should be pointed out that VECAP, VEWAA and CAVEWAS were members of the CCWAVES consortium who were responsible for the CVE designation. Helga was invited to participate in the task force committee

struck by VECAP as they continue moving forward to explore alternative professional credentialing. The focus is to look at the initial results of the survey which some of you had taken part in and to gather additional information and ideas and to plan for next steps.

The other avenue CAVEWAS is investigating is the ABVE (American Board Vocational Expert) certi� cation. The American Board of Vocational Experts is a professional credentialing body established as a not-for-pro� t organization. There are two levels of certi� cation. Fellow status requires three years of documented experience in assessment of vocational capacity and vocational expert forensics in addition to educational and exam requirements. Diplomate status requires seven years of documented experience in the area of assessment of vocational capacity and vocational expert opinion and demonstration of distinguished performance or recognition as avocational expert in addition to the aforementioned requirements.

To be an ABVE Fellow or Diplomate in the U.S. requires a master’s degree or higher. The ABVE board made a concession in attempt to attract Canadian Evaluators by

reducing the educational standard to the Bachelor level given that there are so few Vocational Rehabilitation graduate degree programs in Canada. This is consistent with one of the � ndings from the Joint Task Force on Alternative Certi� cation which was that the CVE was “too elite a credential”. Not that the standard was too high, but coursework was not available to most. (i.e. two of the foundational courses towards the CVE designation, Introduction to Vocational Evaluation and Occupational Analysis, were dropped by many master’s level programs). As you can see, we have some big challenges ahead.

About the AuthorPhil Boswell is a vocational evaluator with

a practice located in the beautiful Comox Valley on Vancouver Island. Currently, Phil is the President of CAVEWAS and sits on the National Board of VRA Canada.

CAVEWASCorner

Canadian assessment,vocational evaluation andwork adjustment society

Phillip W. Boswell President - CAVEWAS, MA, B.Ed, HBOR, BA, RRP

Evaluation

10

One of the biggest challenges facing

Vocational Evaluators in Canada is not having

certi� cation available that would identify certi� cants as being

minimally competent. Some people may argue

that the Registered Vocational Professional

(RVP) certi� cation might � t the bill.

Currently there are 49 CVE’s in Canada and

that number is declining and will continue to decline as certi� cants

retire or transition out of the industry.

• A common body of knowledge

• Benchmarked performancestandards

• A representativeprofessional organization

• An external perceptionas a profession

• A code of ethics with enforcement

• Required training credentials forentry and career mobility

• An ongoing need forskill development

• A need to ensure professionalcompetence is maintained andput to socially responsible uses

12 13 Fall 2010

the vocational rehabilitation counsellor needs to fully understand the impact of the client’s psychiatric disability on his/her functioning in order to provide effective vocational interventions that consider the client’s needs and abilities. By de� nition, the release of diagnostic information provides a quali� ed vocational rehabilitation counsellor with some general parameters for framing questions to the client.

In de� ning “career and employment needs,” the CRCC Code of Ethics states that “rehabilitation counsellors will work with their clients in considering employment that is consistent with the overall abilities, vocational limitations, physical restrictions, psychological limitations, general temperament, interest and aptitude patterns, social skills, education, general quali� cations, and cultural and other relevant characteristics and needs of clients.” As such, information-sharing is fundamental to service planning.

Take the following example. A client who has extreme panic attacks believes that he will be unable to work because he will literally “run” out of the workplace, without warning, due to his anxiety. Knowing this, the vocational rehabilitation counsellor arranges for a job at a worksite that is within walking distance of the client’s home, thus providing him with a sense of security. The vocational rehabilitation counsellor negotiates an agreement with the employer that allows the client to leave the jobsite, without notice, whenever needed.

In addition, both the mental health therapist and the client share information with the vocational rehabilitation counsellor about the history and complexity of the client’s mental health experience. This allows the counsellor to set up the proper pace for entering into the job and to ensure proper planning for after-placement support. The outcome? For nearly two years, the client never accesses the “accommodation” that allows him to leave the jobsite when he wants. He is able to stay and work.

This example illustrates the importance of the intent of the vocational rehabilitation counsellor in seeking disclosure of disability-related information from the referring party and client. It has to be focused on the client’s welfare and career/employment needs in order to establish trust. Intent, a core element of establishing trust (Covey, 2006), needs to be expressly declared at the outset of any relationship

with the referring party and the client. Openly declaring intent increases trust. Vocational Rehabilitation Counsellors can do this by following these steps:

• Express your intent to the referringparty by advising up-front that youwill require medical informationabout the client’s psychiatric historyand current status.

• State that you would prefer to meetwith the client � rst to explain servicesand the purpose of obtaining thismedical information.

• In the � rst client meeting, simplyexplain the services to be offered andhow you intend to use the medicalinformation when provided.

• Let the client consider what youhave shared.

• Provide some printed materials,from sources other than yourself,that discuss the disclosure ofmedical information in vocationalrehabilitation.

• Send this same information to thereferring party. Don’t assume thatthe referring party knows andunderstands what vocationalrehabilitation is all about.

Vignette #1Client: I don’t understand why you want this medical information from me. I don’t want this information shared with others, and I de� nitely don’t want it shared with an employer! What are you going to do [need to understand purpose] with this information? All I want is a job.

Counsellor: How you handle disclosure with employers is often a dif� cult hurdle, and that’s something that I help people explore and decide for themselves. My purpose in requesting medical information [open intent] is to ensure that I know the right questions to ask you and the potential areas to explore so that I can help you move into a job that works for you.

Client: I don’t think that I need help with that. I can get a job and I always get a good paying job, too.

Counsellor: My purpose in obtaining the information is to provide support and guidance that is tailored to your

needs. I don’t need this information if your mental health issues don’t have an impact on you and the job or in the workplace. What’s your view of your needs?Another core element of trust is communicating results. Two questions should be considered in communicating results (Covey, 2006): What results am I getting? How am I getting those results?

Sharing the “how” information is crucial. Although people expect that vocational rehabilitation counsellors will get clients jobs, many would be hard-pressed to explain how this comes about. Vocational rehabilitation counsellors can pique the interest of both referring parties and clients if they explore with them how they get results through the services they provide. Once they understand that vocational rehabilitation is more than teaching “self-marketing 101,” their qualms about releasing medical information are often quickly overcome.

Equally important, by addressing the “what” and expectations about how fast results will be achieved; i.e., this client needs a job fast, serve the client fast. Results in vocational rehabilitation often require time, and all parties need to understand this in order to af� rm theirtrust in results.

Part 2: The Disclosure of Information to the EmployerOnce trust has been established with the referring party and client about disclosure of the psychiatric disability information to the vocational rehabilitation counsellor, and the counsellor has the medical information necessary to deliver effective vocational rehabilitation services, the next hurdle is the disclosure of information to

The ethics of disclosing psychiatric disability within the practice of

vocational rehabilitation is embodied in trust. Do I trust you with this information? Can I trust that you will use it in a manner that is in my/our best interest? Why do you need this information? Do you need to know this information?

The level of trust between a vocational rehabilitation counsellor and client—or among the counsellor, client and employer (or, in some cases, referring party)—has an impact on both the degree of psychiatric disability disclosure and its outcome. Through a series of vignettes, this article will show that, while vocational rehabilitation counsellors must respect boundaries and follow the principle of only asking for and disclosing “need to know” information, there is, indeed, information that we need to know and disclose in order to do our jobs properly—and this can only be done successfully within a context of trust.

Part 1: The Disclosure of information to the VR Counsellor

Because of the less obvious nature of many psychiatric disabilities compared to visible

physical disabilities, referring parties (such as insurance companies and mental health therapists) and clients with psychiatric disabilities have varying opinion on the appropriate degree of disclosure to a vocational rehabilitation counsellor. The vocational rehabilitation counsellor, in turn, must make a decision about whether or not he or she has received suf� cient information to deliver effective services. The vocational rehabilitation counsellor and client must also determine the necessary and appropriate level of disclosure to an employer, which is discussed below.

The decision about whether or not psychiatric disability information can or should be released to a vocational rehabilitation counsellor often rests initially with a referring case manager or mental health therapist. When compared to physical disabilities information, the case manager or therapist is more likely to doubt (or less likely to trust) that a vocational rehabilitation counsellor understands how to use psychiatric disability information. This doubt and lack of trust are like to be unspoken, and often couched as “protecting” the client.

As a result, the vocational rehabilitation counsellor must be vigilant in seeking the information that he/she “needs to know” in a manner that engenders trust. Engendering trust is especially important if the referring party has concerns or implicitly believes that vocational rehabilitation is only a job-search training service and, therefore, has little need for medical information. It is also important when a client is involved in mental health therapy, and the involvement of another party—the vocational rehabilitation professional—is seen as a potential disruption to the therapeutic process.

In these cases, we need to � nd a way to draw the referring party’s attention to our ethical principles with respect to proper levels of disclosure, as set out in, for example, the Commission on Rehabilitation Counselor Certi� cation (CRCC)’s Code of Professional Ethics for Rehabilitation Counselors (2001). The application of these principles can be more fully realized within a conceptual model of trust-building.

The CRCC Code of Ethics says that minimal disclosure—the sharing of only essential information—is the ethical parameter to follow when circumstances demand disclosure of con� dential client information. This principle can also be applied to those referring clients for vocational rehabilitation services. However, this begs the question: What is essential information? This question must be answered with client need and the service to be delivered in mind. According to the “CRCC Ethics Committee Actions” report (CRCC, 2007), “professional disclosure (or lack thereof) is one of the topics that arise most frequently when reviewing unethical conduct complaints lodged about certi� ed rehabilitation counselors.”

If a client is being referred to vocational rehabilitation only to have a résumé written, and neither the client nor the referring party is seeking anything else, then there may be no need to know any medical background. This should be atypical, however, if the client is being referred for vocational rehabilitation services.

If a referring party or client is requesting services, particularly recommendations concerning appropriate alternative job options for a mental health client, then

continued…

In order to effectively help clients with psychiatric disabilities, vocational

rehabilitation counsellors need to know and disclose

certain information. This can only be done successfully within a

context of trust.

Equally important, by addressing the “what” and expectations about how fast results will be

achieved; i.e., this client needs a job fast, serve

the client fast. Results in vocational rehabilitation

often require time, and all parties need to

understand this in order to af� rm theirtrust in results.

EverythingYou Say

Can and Will...The ethics of disclosing

psychiatric disability

By Bonnie Maguffee, MS, CRC, CVE

Trust

1514

an employer. Again the principles of trust need to be incorporated when counselling a client about disclosing to an employer, starting with the core element of intent.

Vignette #2Counsellor: What information about your mental health do you plan to share with the employer and for what reason?

Client: I don’t intend to disclose anything because I know that everything I say can and will be used against me.The purpose of disclosing to an employer is, in some cases, to ensure the safety of the worker and co-workers. Many clients end up in a “pickle” if the employer is unaware of, for example, the side effects of medication that have an impact on their judgment or ability to work at heights. A job can be a perfect match, yet, in an instant, that match can be lost if even one job element is changed. If information is not disclosed up-front, clients in fast-paced work environments may � nd themselves having to resolve the disclosure dilemma at a time when the boss is not in the right frame of mind to “talk.”

Disclosing with “intent” to improve the worker’s job performance, whether done by the worker alone or jointly with the vocational rehabilitation counsellor, is essential. Take the example of a client with bipolar disorder.

The client has learned that avoiding overtime work and being allowed to share responsibilities for projects with others is an effective self-care strategy for coping effectively in the work setting. Yet the client chooses not to disclose this or ask for any workplace accommodations because the job he is going into is a “perfect � t.”

In short order, the client, who is well-suited to the position, outperforms expectations and is offered a job promotion. But, the client knows that the promotion path is what led to poor health management in the past, and he doesn’t want to leave his “perfect � t” position. But how does the client now decline the promotion when he did not disclose anything when he started his “perfect” job? The worker is now in the uncomfortable position of having to backtrack, especially if he shone in the job interview and answered every question perfectly, including those about his willingness to advance within the

company (often with the coaching of the vocational rehabilitation counsellor).

Of course, it is possible to disclose later in a job. Yet many workers in scenarios similar to the one above take one of two routes. They quit due to the pressure, or they try the job without disclosure and crash.

Herein lies the challenge for vocational rehabilitation counsellors: to teach clients that minimal disclosure—revealing only essential information—is the recommended approach, the intent being to protect their health and well-being in the job. The Center for Psychiatric Rehabilitation at Boston University (http://www.bu.edu/cpr/jobschool) has comprehensive online resources that can assist in planning disclosure to an employer. They offer practical tips to help clients and vocational rehabilitation professional effectively manage the second tenet of trust—results.

Results on the job mean the employee delivers what the employer expects. Results in vocational rehabilitation mean the client keeps the job. Disclosing to an employer can help ensure that the intent to keep the job actually occurs. Results can also include effective management of mental health symptoms in a way that builds client con� dence.

A client may share with an employer that she will occasionally miss some days of work due to headaches. The employer accepts this and indicates that the workplace can accommodate this. However, the client’s headaches and missed days occur twice a week, and she also requests time off to attend necessary medical appointments that she assumed the employer would have anticipated. The employer is now disappointed and terminates the employee. The client was missing too much work to deliver the results expected, which the employer perceives as a breach of trust. The

client may also believe that her trust was breached due to the employer not accommodating as agreed and, instead, perceiving the disclosure to be used against her.

This is where the principle of “results” becomes an essential guide to understanding the trust involved with disclosure. The vocational rehabilitation counsellor needs to ensure that, in coaching the client in minimal disclosure or providing minimal disclosure to the employer, the information disclosed is adequate to maintain results.

Conclusions

Disclosure of psychiatric disability to a vocational rehabilitation counsellor from a referring party and/or to an employer works when embraced through a process of trust. Two of the core elements of trust—intent and results—need to be adopted by all parties if disclosure of a psychiatric disability is to unfold in a way that respects the client and the ethical principles set out in the CRCC guidelines on “minimal disclosure” (CRCC, 2001).

Minimal disclosure must include enough information that trust is provable and observable by all those engaged in the relationship. Medical information, particularly psychiatric information, is powerful. Indeed, the ethical disclosure of information occurs when everything that you say, can and will be said with intent to deliver results.

ReferencesCommission on Rehabilitation Counselor Certi� cation (2001). Code of professional ethics for rehabilitation counselors. Retrieved April 25, 2008, from http://www.crccerti� cation.com/pages /30code.html.

Commission on Rehabilitation Counselor Certi� cation (2007). CRCC Ethics Committee Actions. Retrieved April 25, 2008, from http://www,crccerti� cation.com/pages/30 code.html.Covey, S. (2006). The Speed of trust: The one thing that changes everything. New York: Simon & Schuster, Inc.

About the AuthorBonnie Maguffee is the director of R. Work Group,

a vocational rehabilitation services company based in Grand Prairie, Alta. Specializing in the � eld of psychiatric vocational rehabilitation, Bonnie has a master’s degree in rehabilitation counselling and is a Certi� ed Rehabilitation Counselor and Certi� ed Vocational Evaluator.

Fall 2010

Earlier this year, the Ontario government released the New

Regulations for Auto Insurance. The Regulations came into effect on September 1, 2010 (“The New SABS”).

The following is a summary of some of the more signi� cant changes to the accident bene� ts system:

The New SABS has eliminated caregiver bene� ts for non-catastrophic claimants: see Section 13. The caregiver bene� t under the Old SABS provides a bene� t of $250 per week, plus $50 per dependent.

Attendant Care bene� ts for non-catastrophic claimants under the New SABS will be reduced from $72,000 to $36,000 total available bene� ts: see Section 19(3)2. The monthly maximum remains at $3,000. (It will be possible to purchase increases to $72,000 and $6,000 a month.) The bene� t period will still be 104 weeks for non-catastrophic claimants: see Section 20(2). For catastrophic claimants, the monthly maximum under the New SABS remains at $6,000, and the overall limit at $1,000,000.

The New SABS eliminates housekeeping bene� ts for non-catastrophic claims: see Section 23. The Old SABS provides for a maximum of $10,400 (up to $100 per week for 2 years) for housekeeping bene� ts for non-catastrophic claims. Moreover, we must always support our clients in exploring any and all factors that may have a bearing on future decisions. In addition to disability, these may include transportation, � nances and the co-existence of other health conditions.

In a key wording change, the New SABS states that in order to obtain attendant care, caregiver or housekeeping bene� ts,

claimants will need to establish that the bene� t was “incurred” pursuant to Section 3(7) (e).

The $1,000,000 total limit on catastrophic claims remains the same; however, the $100,000 medical/rehabilitation limit on non-catastrophic injuries contained in the Old SABS has been replaced with a $3,500 limit on “Predominantly Minor Injuries” and a $50,000 limit on injuries that fall in the middle category.

Further, these limits now include the cost of assessments by the insured. In other words, an insured can conceivably exhaust a signi� cant portion of his or her medical and rehabilitation limits on assessment expenses, receiving little bene� t for needed treatment or rehabilitation.

It is extremely important to review a claimant’s policy since the Old SABS may still apply, with certain exceptions, to accidents that occur on or after September 1, 2010. changes please contact Howie, Sacks & Henry LLP by telephone at 416-361-5990 or via email at http://www.hshlawyers.com/.

The Medical/Rehabilitation bene� t limits have undergone major changes under the New SABS. The catastrophic versus non-catastrophic

distinction has been replaced with three

categories encompassing three different limits: predominantly minor

injury; not a predominantly

minor injury; catastrophic injury.

AutoInsurance ReformsA brief summary

Current

Brad S. Moscato, Hons. B.A., LL.B

Herein lies the challenge for vocational

rehabilitation counsellors: to teach clients that

minimal disclosure—revealing only essential

information—is the recommended approach, the intent being to protect

their health and well-being in the job.

About the Author

Brad Moscato was admitted to the Law Society

of Upper Canada in 2004, and is a lawyer at Howie, Sacks & Henry LLP in Toronto, Ontario. Brad is the Chair of the New Lawyers Division of the Ontario Trial Lawyers Association, and serves on the Communications Committee of the Brain Injury Society of Toronto (BIST). In addition, he is a member of the Ontario Trial Lawyers Association, the Canadian Bar Association, the Advocates’ Society and the Toronto Lawyers Association.

16 17 Fall 2010

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MEMBERSHIP UPDATES

We are looking for a fun, uplifting and inspiring photo to appear on thecover of the next issue of Rehab Matters, and we need your help!

Dig through your old (or new!) photos and send us a picture of you in the workplace, of you with a client, of you and your co-workers,or of you just being you, and you could win a

$50 gift certifi cate to Best Buy!

Send all photos as a JPEG to [email protected] by February 14, with your name, location, job description and place of employment. Please ensure that ALL individuals included in the photo have given their permission for the photo to be published.

Once all submissions are received, a committee will vote on the best photo, and the winnerwill not only have their photo appear on the cover of the spring issue of Rehab Matters,

but they will also receive a $50 gift certifi cate for Best Buy.

SEND US YOUR PHOTOS!

Dust Off Your Camera and Start Snapping!

18 19 Fall 2010

With aging, there is a gradual loss of functional and cognitive capacity.

This decline can attribute to a decrease in life quality and a loss of our cherished independence. The “million dollar question” that many individuals, such as the authors of “Exercise and the Elderly” have asked, is whether this decrease in functional capacity is a result of the biological aging process, directly related to modern day sedentary lifestyle, or due to chronic disease. Advanced age is something all of us will experience. Life expectancy has soared since the turn of the century.

According to Arehart-Treichel in “Life Expectancy: The Great Twentieth Century Leap,” the average Canadian born in 1900 could not reasonably count on living as many as 50 years, yet a baby born in the year 2000 will probably be able to look forward to, on the average, eighty-� ve years of life. According to Gaitz and Samorajshi in their article entitled “Aging 2000: Our Health Care Destiny,” in 1901, 5% of Canada’s population consisted of people over the age of 65. By 1976, 8.7% were over 65; by 2001, approximately 12% of all Canadians were 65 or older, and by 2025, a projected 32% of Canadians will be over the age of 65.

In Canada, we are becoming an aging society. A big part of this can be attributed to our great advances in the area of health care and social welfare. Through these advancements and other progressions in medical technologies, we are gradually prolonging the life of the average Canadian. As the proportional number of seniors in our society increases, we must consider the increasing cost our older population is placing on the younger and much smaller workforce. This fact becomes even more crucial when one considers the statistics presented by Hogan

that nearly one-half of the population over 65 has some degree of physical disability that has been previously attributed to a natural aging process.

According to Shepard, regular exercise is not only associated with reduced risk of coronary heart disease but also some 50% of what is accepted as the “normal aging decline” (high blood pressure, hyperlipidemia, overweight, etc) can be attributed to sedentary lifestyle and preventable disease processes. Several researchers state that lifelong, moderate levels of exercise is the prescription for increased longevity and, in addition, increased levels of physical function and independent living. O’Brien and Vertinsky, as well as other researchers have stated that regular exercise involvement may be more important to the health of the aging than optimal nutrition and sleep.

Present literature, such as that presented Present literature, such as that presented by Whit� eld MD, Gillett M, Holmes M, et al., states maximal oxygen consumption (VO2max)— the measurable parameter of cardiovascular capacity—decreases with age until it ultimately drops below a threshold needed to perform essential activities of daily living. In addition, medications often utilized by the elderly, such as beta-blockers, can further reduce VO2max. Hagberg et al. have shown that the decrease in maximal heart rate that occurs with aging contributes to the decline in VO2max and this heart rate decline is also related, in part, to decreases in stroke volume and aeteriovenous oxygen (a-VO2) differences with aging. Safe exercise programs for the elderly have illustrated a reversal of this age-related degeneration.

Jessop utilized aquatic exercise and found a 3.4% increase in VO2max after

just � ve weeks of training. During this period, signi� cant increases in the respiratory function were also observed, possibly because of improved strength in respiratory musculature. Jessop summarized: “exercise improved maximum aerobic capacity, increased maximal voluntary ventilation, provided a greater a-VO2 difference and stroke volume, lowered vascular resistance, increased muscle strength, reduced bone loss, increased bone mineral content, decreased body fatness and increased lean body mass, improved glucose tolerance, lowered lipid concentrations and elevated high density lipoprotein concentrations, improved � exibility and improved mental factors and enhanced quality of life.”

Lakka reported that elderly athletes have characteristics representative of inactive adults decades younger. This information gives further support to the idea that a large part of aging is a function of either sedentary lifestyles or as O’Brien and Vertinsky had suggested, “[the physical] decline in aging is a socially reinforced phenomenon.” Furthermore, several researchers have reported that elderly active individuals have shown improvements in psychosocial parameters such as con� dence, self-ef� cacy, life quality, and independence status.

We start to grow old as soon as we are born, and continue to do so until we die. However, we do not notice our steady decline until the hill gets steeper in our � fth or sixth decade. How we treat or perhaps ignore the needs of our bodies throughout our lives will determine our quality of life as we age. The aging process cannot be halted, but can be curtailed so that we preserve our independence and cognitively and physiologically enjoy our “golden years.” As E. W. Walls in the December 1970 issue of “Physiotherapy”

stated: “Nobody has yet died from simply old age.”

About the AuthorNeetu Rishiraj received his PhD from the School of Physiotherapy, University of Otago, NZ. He founded ACTIN Health & Rehabilitation Inc (www.actinhealth.com), a company that assists injured and chronically ill and/or in pain

individuals return to optimal personal and professional well-being. Neetu has been a part-time Faculty Member at various postsecondary institutions in Canada, New Zealand, and the US.

Exercise &The Elderly

A lesson of life quality and independance

By Neetu Rishiraj, ATC, RRP, PhD

EvolutionFrom as far back as 1969, documented bene� ts of exercise for adults include:• Both genders–even the young–are not doing enough vigorous

exercise to keep the blood � owing rapidly through themuscles in adequate amounts, an important key to physical� tness. Thus, physiological aging comes with astonishingrapidity, especially for those who are sedentary.

• In physically active/� t individuals, the nervous system isprepared for action rather than inaction. In general, one canbe trained away from persistent sedentary tendencies andtoward a high sympathetic and vagus tone leading towards adesire for physical activity.

• Strength per pound of body weight increases as a result offorce, speed, and power exercises. Strength is vital to movethe body about continuously in walking, climbing, as well asin daily household activity.

• Bodily movement trains the heart and improves circulation.In movement, stimulation of the sympathetic branches of theautonomic nervous system (ANS) occurs.

• The heart is not a vacuum and cannot suck the blood upfrom the feet and legs when the body is upright. Muscularmovements, involuntary contractions, and wave pulsationforce blood to return to the heart.

• Exercise dilates capillaries. The muscles, heart, spinal cord,brain, lungs, nerves, and organs are saturated by countlessnumber of capillaries. These tiny vessels are controlled bymicroscopic nerves. Exercise stimulates the nerves and causesthem to produce capillary dilation. Thus, the capillaries arenot � xed in size; some may be very narrow but able to expand according to need. Exercise is necessary for theiroptimum effectiveness.

References: 1.Taunton JE, Rhodes E, Donnelly M, et al. Exercise and the elderly. Canadian Family Physician 1992;38:2341-45. 2.Arehart-Treichel J. Life expectancy: the greet twenth century leap. Science and News 1982;12:186-88. 3. Gaitz C, Samorajshi J. Aging 2000: Our health care destiny. Vol. I, Biomedical Issues. New York: Springer-Verlag, New York Inc.,1985. 4. Hogan DB. The bene� ts of exercise in the elderly. Geriatrics 1986;12:8-22. 5.Bacon SL, Sherwood A, Hinderliter A, et al. Effects of exercise, diet and weight loss on high blood pressure. Sports Medicine 2004;34:307-16. 6.Ward S, Lloyd Jones M, Pandor A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007;11:1-160. 7.Shepard RJ. Physical Activity and aging. 2nd ed. Maryland: Aspen Publishing, 1987. 8.Whit� eld MD, Gillett M, Holmes M, et al. Predicting the impact of population level risk reduction in cardiovascular disease and stroke on acute hospital admission rates over a 5 year period--a pilot study. Public Health 2006;120:1140-8. 9. Matson Koffman DM, Goetzel RZ, Anwuri VV, et al. Heart healthy and stroke free: successful business strategies to prevent cardiovascular disease. Am J Prev Med 2005;28:113-21. 10.Lakka TA, Bouchard C. Physical activity, obesity and cardiovascular diseases. Handb Exp Pharmacol 2005;170:137-63. 11.Paffenberger RS, Hyde RT, Wing AL, et al. Physical activity, all-cause mortality and longevity of college alumni. New England Journal of Medicine 1986;314:605-13. 12.Poirier P, Després JP. Exercise in weight management of obesity. Cardiol Clin 2001;19:459-70. 13.O’Brien SJ, Vertinsky PA. Elderly women, exercise and healthy aging. Journal of Women and Aging 1990. 14.Hagberg JM, Park J, Brown MD. The role of exercise training in the treatment of hypertension: An update. Review Article Sports Medicine 2000;30:193-206. 15.Yusuf S, Reddy K, Ounpuu S, et al. Global burden of cardiovascular diseases, part I: general considerations the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104:2746-53. 16.Khan NA, Hemmelgarn B, Padwal R, et al. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2- therapy. Can J Cardiol 2007;23:539-50. 17.Cress MC, Thomas DP, Johnson J, et al. Effects of training on VO2max, thigh strength, and muscle morphology in Septagenatian women. Medicine Science and Sports and Exercise 1991;23:752-58. 18.Jessop D. Non-weight bearing water exercises: changes in cardio-respiratory function in elderly men and women. The University of British Columbia, 1988. 19. Perri S, Templar DI. The effects of an aerobic exercise program on psychological variables in older adults. International Journal of Aging and Human Performance 1985;20:167-72.

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20 21 Fall 2010

Frank had always worked as a general labourer before the accident, but

his back injury put an end to that. To compound matters, the thought of building on a Grade 8 education seemed out of the question. The Chatham, Ontario resident couldn’t sit at a desk for more than 15 minutes at a time, let alone entertain the idea of several years in a classroom. But without the right skills, his job options looked bleak.

He was not alone. According to Human Resources and Skills Development Canada (HRSDC), more than 40% of Canada’s working-age population scores below the minimum level of literacy needed to function in a knowledge-based economy. That merely scratches the surface of the shortfalls in the “Essential Skills” needed for work, learning and life. These nine Essential Skills—reading, document use, numeracy, writing, oral communication, working with others, thinking, computer use and continuous learning—are vital for anyone looking for the tools to learn. They are the abilities which make it possible to understand the new prompts on a computer screen, complete workplace documents, or use a set of measurements to determine a need for supplies.

The Essential Skills Research Project that began in 1994 deserves much of the credit for drawing a clear link between these de� ned skills and speci� c employment goals. Researchers from HRSDC interviewed more than 3,000 workers, all of whom were identi� ed by their employers as satisfactory employees, and used the results to develop 250 Essential Skills Pro� les to cover any National Occupational Classi� cation (NOC) that requires a high school diploma or less.

“In today’s economy, it is more important than ever that Canadians have the skills

they need to succeed in the workforce and build better futures,” HRSDC Minister Diane Finley stated this September. “An educated and skilled workforce is more � exible and has more employment opportunities.”

A focus on Essential Skills certainly changed Frank’s life. After identifying his goal of working in customer service, Career Essentials was, in a matter of months, able to assess his existing skills, help him earn a GED, and re� ne speci� c Essential Skills relating to oral communication, document use and computer use. Combined with his mechanical background, it helped him secure a job with an equipment rental service. But how do training institutions measure the level of skills that adult learners have achieved, and then target training efforts to help them reach an identi� ed career goal as quickly as possible?

One key need was addressed in 2001 when the federal government released Essential Workplace Documents, complete with the pro� les that offered examples of tasks and how they could be applied. The teams at Career Essentials had already developed work-readiness programs that focused on the verbal and written tools of the workplace, including training material that focused on the “numeracy” skills of handling money, taking measurements, and using the basic tools to work with computers or offer customer service.

With the addition of the new Essential Workplace Documents and the de� ned “complexity ratings” to measure the dif� culty of related tasks, it was possible to effectively re� ne the process.

Customized checklists were developed for speci� c NOC codes, guiding instructors throughout the training process to help steer students toward speci� c employment goals or even a subsequent level of training offered through a community college. Workplace-speci� c training tools like these are vital when working with adult learners. Students in an elementary school setting may be willing to learn the 3Rs of reading, writing and arithmetic as an academic exercise, but mature students want to know exactly how the lessons can be applied.

Still, this targeted approach to learning always presented a challenge. Discussions about a trainee’s progress inevitably involved questions about “grade” levels, even though the descriptions were much broader than the needs of a job. For example, someone who is training to be a customer service representative may understand how to calculate the cost of an order, yet struggle with the understanding of topics like trigonometry that are needed to pass a full grade with a broader curriculum. The assessment and grading process required tools of another sort.

While Career Essentials embraced HRSDC’s Essential Skills Online Indicator shortly after it was introduced, it has since added tools including PTP Adult Learning and Employment, CAMERA (Communications and Math Employment Readiness Assessment), and TOWES (Test of Workplace Essential Skills).Career Essentials’ focus on the CAMERA system began with a six-month pilot project in 2008 and evolved into a

unique relationship as certi� ed CAMERA administrators in 2009. This system actually includes three components in the form of tests, curriculum guidelines known as Signposts, and a “workwrite” series of workbooks. In addition, the tests themselves include seven standardized assessments, measuring gains from Essential Skills Levels 1 to 3.

Each CAMERA test includes between 5 and 12 tasks, most of which include a workplace document and multiple

questions, and they are

effective tools when monitoring a trainee’s progress. In Stage 1, an instructor might ask a learner to write a short note asking anyone who lost a cell phone to visit a particular desk. In Stage 2, the learners will need to respond to written prompts. Someone with the goal of becoming a security guard, for example, might be prompted to write a memo discussing why visitors need to register at a front counter, complete with a description of the potential consequences if this procedure is not followed. In Stage 3, the learners might be prompted to read a longer memo with the more complex vocabulary of a speci� c industry, and then answer questions which apply the information in a practical way.

The system’s Signposts offer Career Essentials instructors the tools to develop training material that is truly customized for every learner. The guides were synthesized from more than 800 examples of essential skills, complete with informal assessments that could be used in the classroom. Much of the training curriculum is already in place, yet it still offers instructors the � exibility to introduce job-speci� c documents, such as a spreadsheet that uses the language encountered by a medical secretary.

In situations in which a trainee needs to establish a higher skill level, or receive training in French, Career Essentials has recently begun to administer TOWES tests with the support of Bow Valley College, Durham College, and Ontario’s TOWES distributors at CONNECT. This system measures the skills of reading text, document use and numeracy using the same scale that has been adopted by the International Adult Literacy Survey. Its General Series of training tools can be used in a wide range of situations, while industry-speci� c tests have also

been designed.

TOWES material is particularly valuable for higher-functioning individuals and those in the Career Essentials stream who are preparing for a higher level of education. The tests themselves tend to re� ect a traditional academic approach, in which learners read information and then

choose a favoured answer from a list of multiple-choice options.

Combined, the tools make it possible to clearly identify whether a learner has established the skills that a particular NOC will require. They give instructors the chance to help students like Frank, so they can experience everything that gainful, meaningful employment has to offer.

Essentially, that is the goal of everything we do.

About the AuthorKate Bird founded Career Essentials in

1998 in response to a need for targeted effective skills training for unemployed adults. Career Essentials currently operates out of more than 30 locations across Ontario and has been the recipient of many awards.

EssentialLessons

Essential skills are vital toensure success in any job,

but how can I tell if traineeshave the skills they require?

By Kate Bird, Director, Career Essentials, HBSc. and B.Ed

Knowledge

“In today’s economy, it is more important than ever that Canadians have the skills they need to succeed

in the workforce and build better futures,”

been designed.

for a higher level of education. The tests themselves tend to re� ect a traditional academic approach, in which learners read information and then

Working with people who have been traumatized confronts therapists as

well as patients with intense emotional experiences; it forces them to explore the darkest corners of the mind, and to face the entire spectrum of human glory and degradation. Sooner or later, those experiences have the potential to overwhelm therapists. The repeated exposure to their own vulnerability becomes too intense, the display of the in� nite human capacity for cruelty too unbearable, the enactment of the trauma within the therapeutic relationship too terrifying.—van der Kolk et. Al, 1996

This article focuses on an issue that I believe is important to practitioners, helpers, therapists and anyone in a helping role: the physical and emotional impact of working with clients, particularly those who have been traumatized. Having worked in the � eld of counselling for 25+ years, I have been profoundly affected by work with clients in a number of settings, including alcohol and drug treatment centres, family services agencies and vocational rehabilitation services for

injured and disabled workers.

Often I have carried home with me the details of a stressful encounter with a client or the emotional consequences of working with someone in a tragic or crisis situation. At times, I attributed the impact to personal factors; i.e., to my own inability to manage the effects of my work. Through my research, experience, and personal and professional development, I have reached other conclusions about working with distressed and traumatized clients and the occupational hazards inherent in the work.

Viewing stress and burnout in a new way is a paradigm shift and has led me to the following perceptions: much of what is described as burnout, depression and overwork is situated in what is termed “compassion fatigue,” “secondary traumatic stress” and/or “vicarious traumatisation.” Figley (1995), one of the leading researchers on the subject, suggests that burnout, counter-transference, worker dissatisfaction and related problems mask the issue of compassion fatigue.

According to the evidence, not only are workers unaware of the full impact of work on their personal and professional lives, but employers are also unaware

of, or unwilling to address the issue—perhaps because they do not want to “open � oodgates.” Their interests appear to be better served by making employees responsible for the impact of the workplace on their health and wellness.

This is never more apparent than in the � eld of vocational rehabilitation, in which I have found a lack of literature on the subject. I have witnessed enough of my colleagues suffer, leave their jobs, and take years to recover from the effects of the work. The result is a preventable loss—both personally and professionally.

The Give and Take Vocational Rehabilitation

Vocational rehabilitation consultants work with injured and traumatized individuals and assist in their return to work through case management, counselling, career development and support. They are the “social workers” of insurers, hospitals, unions, workers” compensation systems and non-pro� t organizations. Many of their clients have complex language, cultural, psychological, economic and physical barriers that make this work extremely challenging. They also have the added challenge of working, in or with, insurance organizations that have complex policies, legal adversarial issues and economic limitations. In addition, vocational rehabilitation consultants can be confronted with highly traumatized psychotic, aggressive, violent and suicidal clients. They can be yelled at, verbally abused and unsupported in their workplaces.

These conditions of work are not the exclusive domain of vocational rehabilitation consultants, and my research examined the commonalities among helpers. Whether it’s a vocational

rehabilitation consultant, social worker, mental health worker of therapist, the work is trauma-based. All of these helping professionals are prone to being attacked verbally by a client or to being affected by a worker who can’t return to a job he loves because he lost his � ngers in a work accident, or by a grocery clerk who has been held up at gunpoint, or by a family that has been traumatized by a violent member.

On the other hand, vocational rehabilitation consultants can gain a lot of satisfaction from their work. Assisting someone with a serious injury who has almost given up � nding a new means of livelihood is rewarding.

The catastrophe in the loss of one’s effectiveness as a helper is that stress, burnout, compassion fatigue and/or vicarious traumatization—whatever we call it—serves to impair judgment and decision-making, as well as the ability to operate with compassion. Sharon Salzberg, in Loving Kindness: The Revolutionary Art of Happiness says the following (p. 115):

Compassion enjoins us to respond to pain, and wisdom guides the skilfulness of the response telling us when and how to respond. Through compassion, our lives become an expression of all that we understand and care about and value. To develop a compassionate heart is not an idealistic overlay. It arises from seeing the truth of suffering and opening it.

An Organizational, Not Just Personal, Responsibility

Although there is recognition of the hazards of being a helper, the issue is addressed more as a personal responsibility than an organizational responsibility. Employers have a duty to protect workers and support them in preventing and mitigating the effects of compassion fatigue. Employee assistance programs, long-term disability plans and social assistance safety nets carry the burden of the impact on workers when employers are, more often than not, culpable of not protecting and supporting their employees.

Changes in the workplace generally occur when an issue affects the bottom line or when unions or workers’ advocates act on behalf of the health and wellness of workers to demand change. Unions are only beginning to address these issues with their employers. For example, the Health Sciences Association of B.C., a public-sector health care union, identi� ed the issue of vicarious traumatisation as a serious occupational health and safety risk in the January/February 2003 issue of The

Report, in which authors Kurahashi and Riviere wrote the following (p.4):

In 15 years working in the � eld of women’s counselling, Eberl has seen many co-workers leave the workplace due to what was most likely vicarious traumatisation. “People go off on stress leave, and they sometimes end up leaving the work,” she said. “There’s a high turn-over, and the burn-out just seems to keep happening. Maybe it’s not expected that people can do more than a few years of this kind of work. But I think it’s possible that people can remain in this work for a long time if they have the right kind of environment where they get support, and feel they can be open about these issues as a normal hazard of the workplace.”

Federally, the issue has been recognized by Health Canada in a guidebook written for the agency by Jan Richardson (2001), Guidebook on Vicarious Trauma: Recommended Solutions for Anti-Violence Workers. This comprehensive publication provides tools and resources for anti-violence workers, practitioners, staff and board members working with abused women. Many of the resources are suitable for practitioners in other settings.

Professional, organizational and personal realms are the focus of the guidebook, created with the recognition of the profound effect on the lives of helpers. Strategies outlined in the book for self-caring among all three realms include addressing the ABC’s of vicarious trauma.

These include:

• Awareness: being attuned to one’sneeds, limits, emotions and resources,by heeding all levels of awareness andsources of information—cognitive,intuitive and somatic—and practisingmindfulness and acceptance;

• Balance: maintaining balance amongactivities, especially work, play andrest, which allows for attention to allaspects of oneself; and

• Connection: maintaining connectionsto oneself, to others and somethinglarger in order to offset isolation and increase validation and hope, which breaks the silence ofunacknowledged pain.

Figley (2002) suggests that compassion fatigue is a form of helper burnout that is grounded in chronic lack of self-care. He compares compassion fatigue with simple burnout and counter-transference and offers strategies for psychotherapists to disentangle from their patients and renew themselves. He cites recent studies—such as Meldrum, King and Spooner, in Figley (2002)—that found

27 per cent of professionals working with traumatized individuals were experiencing extreme distress. Overall, 54.8 per cent were distressed, while 35.1 were very or extremely emotionally drained.

He concludes that psychotherapists have to foster much better self-care because the results are disastrous for them and their clients. “Mistakes, misjudgements and blatant clinical errors” serves to alienate counsellors from the profession.

A “Duty to Warn” of Both Hazards and Rewards

Exploring the topic of compassion fatigue, vicarious trauma/secondary traumatic stress and burnout has been rewarding in that is has offered an opportunity to apply the current research to work as a vocational rehabilitation consultant. Although stress and burnout have long been part of the literature, the newer terms assist in further de� ning the impact of the work. The material clari� es de� nitions of the terms and understanding of the implications for occupational health and safety.

It also addresses issues important for educators and supervisors of those in the helping professions. Figley (1995) has indicated there is a “duty to warn” those in the � eld of both the hazards and rewards of the occupation. Many of the researchers cited in the paper indicate a need for further research on the subject. They have suggested that awareness of compassion fatigue is low.

I became aware of the phenomenon in my practicum in a social service setting; however, in vocational rehabilitation settings, awareness is almost nonexistent—even though practitioners are working with many of the same clients and issues as in social service settings. Burnout is generally not attributed to the nature of the clients and the work. It is attributed more to the constraints of the system or to personal inability to cope.

Certainly the problem of compassion fatigue and burnout will continue unabated for helpers unless there is a better understanding of the underlying components and recognition that work with traumatized and distressed individuals is an occupational hazard and not exclusively a personal psychological issue. Employers are responsible for not putting their workers in harm’s way and, to that end, they need to develop strategies within the organization to protect and support their employees.

On an individual basis, helpers need to be aware of their own distress, seek help and develop strategies to alleviate their

CompassionFatigue

An occupational hazard ofvocational rehabilitation

By Denise Hall, MA, RRP

Exposure

Fall 2010 22 23

continued…

The problem of compassion fatigue and burnout will continue

unabated for vocational rehabilitation counsellors

and others in the helping � eld until we recognize that work

with traumatized and distressed individuals is an occupational hazard,

not just a personal psychological issue.

One of the leading researchers on the subject,

suggests that burnout, counter-transference, worker dissatisfaction and related problems

mask the issue of compassion fatigue.

24 25 Fall 2010

symptoms. It will take a great deal of courage on the part of individual practitioners to address their own compassion fatigue, support their colleagues, and advocate for better protection within their organizations.

References

Figley, C. (1995). Compassion fatigue as secondary traumatic stress disorder. An overview. In C. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20). Levitown, PA: Bruner Mazel.

Figley, C. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self care. Journal of clinical Psychology, 58 (11), 1433-1141.

Figley, C. (Ed.) (2002). Treating compassion fatigue. New York: Bruner-Routledge.

Kurahashi Y., & Riviere C. (2003). Psychological hazard 1: Counselors face risk of vicarious traumatization. The Report: Health Sciences Association of BC, 24 (1), 1-4.

Richardson, J.I. (2001). Guidebook on vicarious trauma: Recommended solutions for anti-violence workers. Ottawa, Ont.: National Clearinghouse on Family Violence Health Canada.

Salzberg, S. (2002). Loving Kindness: The revolutionary art of happiness. Boston: Shambhala.

Van der Kolk, B., McFarlane, A. & Turner, S. (1996).The therapeutic environment and new explorations in the treatment of posttraumatic stress disorder. In B. Can der Kolk, A. McFarlane & L Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body and society (pp.537-558). New York: Guilford Press.

About the Author

Denise E. Hall MA, CCC, RRP

is a therapist, career counsellor and vocational rehabilitation consultant in private practice. Her MA is from the Adler School of Professional Psychology, Vancouver campus and she is pursuing a doctorate degree (Psy.D) at Southern California University. Her private practice Dragon� y Counselling and Training Services focuses on Body/Mind therapies, professional burnout, career counselling and life coaching, trauma work and stress and pain management.

Understanding Disability Vocational Evaluation

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More Effective Interviewing Enhancing Responsibility

Rehabilitation Consultant Different Therapies: One Client

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Mission StatementThe Vocational Rehabilitation Association of

Canada is a national association that supports its members in promoting, providing and advocating

for the delivery of vocational/prevocational rehabilitation services for persons with disabilities.

Vision StatementThe Vocational Rehabilitation Association of

Canada is committed to promoting professional excellence in our members, who are recognized by all stakeholders as the experts in the provision of

vocational/prevocational rehabilitation services for persons with disabilities.

26 27 Fall 2010

Arden McGregor fondly

remembers the moment that sparked what would become her lifelong interest in vocational rehabilitation. “When I was a teenager,” Arden

explains, “I became quali� ed as a swim instructor and spent countless hours at the pool. One of my most special memories is of “Anne,” a ten-year-old girl with cerebral palsy. Arden remembers Anne’s longing to learn how to dive. “She had so many challenges in her young life that it would have been easy to write her dream off, and encourage her to work on skills that would be “bene� cial” for her, but diving was her dream. Every moment I could, I helped her. It took almost a year of effort, but in the end, she did it! I will never forget the way her whole face exploded out of the water with the joy she felt having successfully completed her � rst dive. Her exhilaration is forever imprinted on my mind. The thrill I got from being part of her joyful accomplishment changed me.” Despite this rewarding experience occurring many years prior to Arden choosing rehabilitation as her career path, she says she knew at that moment that whatever she would be doing, she would dedicate her life to helping others achieve what was most important to them.

Staying true to her promise, several years later Arden attended York University in her hometown of Toronto, where she studied psychology and then subsequently

earned her M.A. in psychology from the University of Toronto. In her third year of undergrad study, Arden had a placement in the rehab department at Humber Memorial Hospital in Toronto where she had a chance to work � rst hand with individuals struggling to regain their lives after serious injuries and illnesses. “I was excited to be able to come alongside people who were struggling, and encourage, support and guide them along,” Arden says. After receiving her Masters in Psychology, Arden moved to London, ON and began working at Parkwood Hospital’s regional rehabilitation program where she worked with people who had brain injuries, chronic pain and spinal cord injury. While there, Parkwood was awarded ministry funding to start a Brain Injury Outreach Program, something which Arden was excited to be a part of developing. As a founding member of the program, Arden had the opportunity to shape how the program evolved and how it was carried out.

Over the past 20 years working in rehab, Arden says she has grown tremendously. In 2003, when Arden started her own company called Brainworks, she was given the opportunity to advance herself even further by working with a team of like-minded professionals who “always strive for clinical excellence.” At Brainworks, Arden and her team of 40 employees provide client-centered multi-disciplinary rehabilitation services throughout Southwestern & South Central Ontario as well as in the Muskoka region. Arden notes that the success she sees in her clients is what keeps her motivated. “Seeing people achieve goals, resume function, take ownership of their health—for me that is what keeps me going.”

As far as the future of her career goes, Arden hopes to be doing exactly what she’s spent her entire career doing thus far: helping individuals and families impacted by injury and/or trauma achieve their goals and dreams. She notes, however, that the marketplace is changing, and that “funding sources are limiting funds and increasing expectations. Our profession as a whole needs to rise to meet these challenges head on—through client advocacy, � nding creative funding solutions and tightening up of our own work to ensure that our practices are effective and ef� cient.” Right now, Arden’s team is working on taking the knowledge and skills they’ve learned over the years and turning it into an array of creative therapy resources for individuals who have sustained injuries, their families, and their therapists. That way, they are constantly reinventing themselves. “Continuous improvement is what I see for the future of our profession. Keeping ahead of the expectations will allow us to thrive, not just survive,” Arden emphasizes.

ArdenMcGregorExecutive Director and

Psychological Associate

By Dayna Danson Hons. B.A.

Member profi le

“When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot � ght, wealth becomes useless, and intelligence cannot be applied.”

What is Glutathione (GSH)?

Glutathione (GSH) is a small molecule made up of three amino acids, which

exists in every cell of the body. However, glutathione must be generated within the cell from its precursors before it can work effectively in the body. The presence of glutathione is required to maintain the normal function of the immune system. It is known to play a critical role in the multiplication of lymphocytes (the cells that mediate speci� c immunity) which occurs in the development of an effective immune response.

What Does this Mean to You and Me?

Did you know glutathione is the most powerful, prevalent antioxidant in your body? Increasing your glutathione level will naturally increase your energy, detoxify your body and strengthen your immune system. To sustain a healthy, vibrant life free of illness and disease, glutathione is crucial. Our bodies stop producing glutathione at the age of 20 and continue to deplete every decade between 8 to 22%. (See chart below).When Glutathione levels are high you feel good and look good. You � ght off minor illnesses quickly, have plenty of energy, and feel mentally and physically alert.

As individuals in the helping profession, all too often we overlook our own health for the health of others. However, in order to best serve our clientele, we need to make sure we, ourselves are healthy and in the best shape we can be. If we are feeling alert, happy, and healthy, our clients will feel the same. Glutathione can help you feel that way.

Research on Glutathione

Glutathione inhibits and neutralizes the harmful affects of brain injury and trauma, stress, aging, overexertion, illness, infection, toxins, radiation, chemicals and pesticides, loss of energy, and diseased states in the body. Documented scienti� c research proves elevating the body’s Glutathione level leads to better health and energy. As individuals working in the vocational rehabilitation � eld, it is important to keep in mind that Glutathione levels can help ease the effects of harmful and brain injury trauma on our clients. Research completed by Dr.

Robert Keller has shown that individuals who have low levels of glutathione are susceptible to chronic illness. Research shows that GSH levels decline by 8% to 12% per decade, beginning at the age of 20. Levels of glutathione are further reduced by continual stress upon the immune system such as illness, trauma (brain injury), infection, and environmental toxins. As we now know, a lowered immune system can bring about illness and disease. This is a ferocious cycle. While you need glutathione for a productive immune system, a weakened immune system hampers the production of glutathione. Depletion of GSH is caused by prescription medication, poor diet, radiation (microwaves, cell phones), chemicals, pesticides, injury and trauma (i.e. brain injury). All of the other antioxidants

in your body depend on the presence of GSH in your body to function properly.

Conclusion

GSH is the brain’s master antioxidant, and science has veri� ed this. When you add a cell permeable GSH it increases neuronal GSH by 250%. Individuals with an acquired brain injury require high amounts of GSH due to the compromise of injury and trauma to their brain cells. Research has found that GSH through supplementation is needed. Aging and oxidative stress and free radicals deplete GSH. To have strong immune systems we need to have high levels of GSH. Diseases that are related to aging are directly linked to low GSH levels. GSH is the #1 antioxidant to neutralize free radicals and assist the various medical conditions that we know of now.

About the AuthorDeborah started Davwill

Consulting in 1990, a company that assists individuals who have been catastrophically injured with a brain injury to achieve their goals of returning to work, school or autonomy in daily living. She also developed and trademarked the Independent Technical Capacity Evaluation (ITCE™) which is a modality of assessing and implementing modern day technology with adaptive aids and devices to further assist individuals with a better quality of life.

Increasing age and other factors reduce the body’s production and utilizatin of GSH

By Deborah Crowe, RRP, RCSS

Glutathione (GSH)What is it and why is important?

Health

funding sources are limiting funds and

increasing expectations. Our profession as a whole needs to rise to meet these

challenges head on—through client advocacy, � nding creative funding solutions and tightening up of our own work to

ensure that our practices are effective

and ef� cient.

29 Fall 2010

Our comprehensive solutions are tailored to begin and end...The development of a successful career or return to work plan involves the strategic selection of programs and services to be delivered in a timely and economical manner. CareerQuest offers a broad range of comprehensive solutions:

Assessment Services Vocational Skills Training Literacy Upgrading/ESL Workplace Essential Skills Computer Skills Training Employer-based Training Non-Dominant Hand Training Employment Services

Also, CareerQuest Vocational Training Centres, our vocational training branch, is registered as a Private Career College under the Private Career Colleges Act, 2005 and offers certificate and diploma programs.

Our programs and services combine to provide you with complete solutions that are tailored to begin and end exactly where you need them to.

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1. The “stigma of counselling” can belargely addressed by:

A) Teaching individuals that therapy is not for theeveryman/everywoman

B) Casting therapy as a normal means ofaddressing the shared human condition

C) Confi rming all negative portrayals ofpsychotherapy in the media

D) None of the above

2. Which of the following factor(s) contribute(s) tocompassion fatigue:

A) Burnout B) Counter-transferenceC) Worker dissatisfaction D) All of the above

3. What percentage of professionals workingwith traumatized individuals experienceextreme distress:

A) 27% B) 54.8%C) 35.1% D) 16%

4. As noted by Jan Richardson, in her book titledGuidebook on Vicarious Trauma: RecommendedSolutions for Anti-Violence Workers, one of thethree “ABC’s” of vicarious trauma is:

A) Ambition B) BeliefC) Acceptance D) Connection

5. One core element to establishing client trust is:

A) Intent B) FriendshipC) Obedience D) All of the above

6. The level of trust between a vocationalrehabilitation counsellor and psychiatric clientcan directly impact:

A) The level of trust has no impact on eithercounsellor or client

B) The degree of psychiatric disability disclosureand its outcome

C) The amount of time that the client will needassistance from a counsellor


7. The purpose of disclosing a client’s mental

health issues to an employer is:

A) To ensure the safety of the workerand co-workers

B) To make certain that all co-workers know ofthe client’s issues

C) To guarantee that the client receives specialtreatment in the workplace


8. One of the most important aspects of theNon-Dominant Training Program is:

A) Keeping a diary B) Group discussionC) Art therapy D) Team sports

9. To qualify as a profession, which of the followingcharacteristics are expected to be present:

A) A common body of knowledgeB) An external perception as a professionC) An ongoing need for skill developmentD) All of the above

10. In what Year was the Commission on theCertifi cation of Work Adjustment and VocationalEvaluation Specialists (CCWAVES) formed:

A) 1992 B) 1974C) 2000 D) 1983

11. The state of chronic and lasting joy can becreated by:

A) Learning to acknowledge and manage negativeemotional states

B) Pretending negative emotions don’t existC) Only participating in activities that bring you joyD) Relying on pharmaceutical drugs

12. The Train to Hire Program was created to:

A) Help lazy individuals seek and fi nd employmentB) Ensure that clients receive the highest

remuneration possibleC) Improve clients’ employability in the workplaceD) None of the above

13. According to Human Resources and SkillsDevelopment Canada (HRSDC), what

percentage of Canada’s working-age populationscores below the minimum level of literacyneeded to function in a knowledge-based economy:

A) 40% B) 15%C) 85% D) 33%

14. Which of the following is one of the nineessential skills needed for work, learning and life:

A) Numeracy B) Oral communicationC) Reading D) All of the above

15. VRA Canada is celebrating what anniversary?

A) 40 B) 20C) 50 D) 30

16. What is Glutathione?

A) The most powerful, prevalent antioxidantin your body

B) A vitamin that increases brain activityC) A small molecule made up of three

amino acidsD) Both A and C

17. The heart cannot suck the blood up from thefeet and legs when the body is upright.

A) True B) False

18. In 1901, what percent of Canada’s populationconsisted of people over the age of 65:

A) 5% B) 10%C) 15% D) 20%

19. True or False: Disclosure of psychiatricdisability to a vocational rehabilitationcounsellor from a referring party and/or to anemployer works when embraced through aprocess of trust.

A) True B) False

20. Many of the clients of vocational rehabilitationconsultants face which of the following barriers:

A) Language B) CulturalC) Economic D) All of the above

The answers to the following questions are derived from the content within this publication. Each question has a CEU value of .01. If all questions are answered correctly, you will receive 2 CEU credits, for a total of 6 per year. In order to participate in this unique offer, you may go online to www.vracanada.com and � ll out the required information and questionnaire online. Alternatively, you may � ll out the form and quiz below and mail them, along with a cheque in the amount of $20 addressed to VRA Canada. Good Luck!

CEU’s at your Fingertips: Pay $20 and receive 2 CEU credits based on a 100% score.

20 Questions$20 Bucks 2 CEU’S• Earn credits• 2 CEU credits• Easy to do• Just answer correctly

for20$

Name _________________________________________________ VRA Number ________________Email ______________________________

Visa/MC number and expiry date (if not paying by cheque) ___________________________________________________________________

Mailing address: VRA Canada, 4 Cataraqui Street Suite 310 Kingston, ON K7K 1Z7

TTERS REHAB Life can change REHAB TTERS in an instant! … · 2015-12-09 · Personal Injury and...

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Transcript of TTERS REHAB Life can change REHAB TTERS in an instant! … · 2015-12-09 · Personal Injury and...