The Changing Role of Occupational Therapy in Vocational Rehabilitation: Reflections on an Evaluation of Condition Management Programmes
Reagon, Carly, British Journal of Occupational Therapy
In October 2010, the United Kingdom (UK) government announced plans to reform the welfare system for claimants of sickness and disability-related benefits through the implementation of the Work Programme. This new system, due to commence in the summer of 2011, has been designed to simplify existing structures of support, break cycles of benefit-dependency, and provide assistance for people moving into and/or attempting to retain work. The programme is likely to see contributions from the public, private and voluntary sectors, and is designed to be flexible so that providers can meet local needs (Department for Work and Pensions 2010a). The Department for Work and Pensions (2010b) has also emphasised the importance of job outcomes in the new system, and services will be offered incentives to demonstrate sustainable work outcomes. At the time of writing, it is still unclear how the Work Programme will look across the different geographical regions; however, existing schemes such as Pathways to Work and Condition Management Programmes (CMPs) will be, and in many cases already have been, phased out (the majority of CMPs closed in early 2011).
This article discusses the contribution of occupational therapists to the vocational rehabilitation of sickness and disability-related benefit claimants pre-summer 2011, drawing on the findings of an evaluation of three CMPs in Wales (Reagon and Vincent 2010, Reagon 2011). It also considers the question of 'where next?' for occupational therapists working within and beyond this sphere.
Vocational rehabilitation pre-summer 2011
In 2002, New Labour introduced Pathways to Work, a collection of initiatives aimed at moving people from Incapacity Benefit into work (Department for Work and Pensions 2002). One component of this was the Condition Management Programmes, described as:
... short-term, work-focused interventions aimed at helping claimants understand and manage their health condition better, particularly in a working context (Waddell and Aylward 2005, p149).
Following an initial pilot phase, CMPs were gradually rolled out across the UK, with a pronounced difference between those led by the National Health Service (NHS) and those led by the private sector. Although various models have existed, shared characteristics of NHS-led CMPs have included delivery by state-registered clinicians in community venues, referral via Jobcentre Plus, voluntary participation and use of individually tailored intervention programmes (Grove and Harrison 2006). The types of intervention offered by CMPs have also varied, but typically included pain management, stress management, health education, and sessions to challenge negative thinking. Programmes were spread out over a period of several weeks or months and were characterised by their use of cognitive behavioural therapy techniques and the biopsychosocial approach.
Occupational therapists working alongside other health professionals, such as physiotherapists and mental health nurses, have been prominent in the delivery of CMPs across the UK. Of the three CMPs involved in an evaluation by Cardiff University (Reagon and Vincent 2010, Reagon 2011), occupational therapists represented the largest professional group, with over half the qualified staff coming from this background. This supports the argument that the philosophy and skills of occupational therapists are highly compatible with the CMP focus on activity and productivity, the therapeutic relationship, and holistic and biopsychosocial approaches (Armstrong and Woof 2008).
The Welsh evaluation of CMPs and its significance for occupational therapy
An 18-month evaluation of three CMPs in Wales gave evidence to support the use of CMPs with sickness or disability-related benefit claimants (Reagon and Vincent 2010, Reagon 2011). This evaluation used a mixed method research design to collate quantitative data in the form of outcome measurements (n = 244 participants) and qualitative data in the form of in-depth interviews with staff and clients (n = 27). …