The WAVE project - Sweden
Abstract
The Misa WAVE Project is part of a trans-national project, involving agencies from Sweden, Ireland, France, and the Netherlands. The initiative, whose theme was 'Employment and Job Retention, catered specifically for adults of working age with an acquired brain injury (excluding dementia and congenital brain injury). The EU's Employment Community Initiative - Horizon (Disabled) 1995-1997 part funded the project. Although the method of service delivery varied between the project partners, the principles governing delivery were based on the 'Model of Supported Employment'. Inevitably such support involves liaison with the employer and assistance in addressing OHS issues which arise from the retention of an employee with additional needs and for whom special provision may need to be made. However, the primary focus of this initiative is on employability, specifically retention; whatever links to OHS exist are implicit.
Background to the Case
In 1996 alone 68,750 people suffered a brain injury in Sweden, according to "Hjarnkraft", an interest group for people with ABI (Acquired Brain Injury). Legislation exists which confirms the right of those who incur such an injury of a long-term nature to various forms of support and services from the local councils. However, there are only 1,000 adults in the whole country who receive support and services under the legislation but at least double that figure are believed to be entitled to support but are not taking up that right for various reasons. Furthermore, 'daily activity' is a statutory right (ISFS 1993) for people with certain types of disability in Sweden. Misa, a private company that was previously operated by the Jarfalla Municipality, provides such opportunities. It caters for 65 people who are autistic, learning disabled or who have an acquired brain injury (ABI). There are four different units within the company, one of which, established in 1996, deals specifically with acquired brain
In early 1996, Misa's Brain Injury Unit was established and subsequently Misa was contacted by the Swedish EU Programmes Office to participate in a transnational project funded by the EU's Employment Horizon (Disabled) Community Initiative. Agencies from three other European countries are involved, Ireland (the lead partners), France and the Netherlands. Misa's entry into the partnership was rather late - half way through the project's lifetime - and this is reflected in the results Misa had achieved at the time of the evaluation.
The main reason the project was undertaken stemmed from the fact that people with ABI were grouped together with people with learning disabilities in daily activity programmes. There was growing awareness amongst professionals in Sweden that such approaches were inappropriate. Two of the participants in Misa's centres who had ABI had also identified this as a problem for them and advocated a programme that better suited their needs. Their main goal was to gain meaningful employment or to retain their existing employment.
Aims and Objectives
The WAVE project aims to help people with ABI to return to working life with the aid of the Model for Supported Employment. The programme aims to support the participants in either gaining open employment or in the retention of their pre-injury job. The WAVE project has been divided into 2 phases, the first of which has focussed on setting up the new (brain injury) unit, selecting the participants and the employment and training of programme staff. The second phase deals with finding employment opportunities for the participants.
How the Initiative is Organised
This initiative operates within the Jarfalla region and is targeted at adults with a moderate to severe acquired brain injury who wish to return to employment. Individuals with mild brain injury are serviced by other state organisations. Participants on the WAVE programme have already undergone an intensive period of rehabilitation, which included various treatments and therapies. However, the main focus of this rehabilitation is not around vocational issues and the participants have found this frustrating as it as not facilitated them to return to work. The theme of their rehabilitation had beenabout training and acquiring new skills, whereas the theme of the WAVE project is employment and job retention.
The Model of Supported Employment is used as a support structure as it seems to meet the needs of people with ABI (Acquired Brain Injury) in their return to work. This model is defined as:
"Competitive work in integrated work settings for individuals with severe handicaps for whom competitive employment has not traditionally occurred, or for individuals for whom competitive employment has been interrupted or intermittent as a result of a severe disability, and who because of their handicap, need ongoing support services to perform such work."
The WAVE project took an holistic approach to service provision and recognised the need to take account of the individual's life as a whole in planning service provision. Thus, in addition to training in the necessary vocational skills, attention was paid to the domestic circumstances background and leisure activities of the participant. This holistic approach was agreed by all partners in the transnational project to be essential for ensuring the best possible outcomes.
Participants in the WAVE project undergo a series of evaluations and assessments to enable the Project staff develop an 'Individual Programme Plan'. These include medical information obtained following the injury, evaluation of the participants abilities and competencies using, for example, occupational therapy assessment instruments, the individual's self-assessment and the evaluation of others in the participant's social sphere (family, friends, employers, co-workers, health care professionals, et cetera).
The aim of these plans is twofold - they provide the client with ABI with an integrated record of their treatment and rehabilitation, and they also provide for the sometimes disparate staff involved, an integrated record of the clients progress and the types of intervention which have been made.
Stakeholders Involved
Apart from Misa itself, there are 8 principle stakeholders who co-operate in the WAVE Project. These include:
- Two interest organisations for people with ABI (including Hjarnkraft, an interest group for people with acquired brain injury),
- Two Trade Business Associations,
- The Labour Market Institute
- The Rehabilitation Centre for ABI
- The Employment Agency for Young Disabled
- The Jarfalla Municipality.
These stakeholders have come together to support the project in relation to the provision of expertise and support, public relations and to help the clients of the project acquire or maintain employment.
Results Obtained
At the time of the evaluation Misa had not moved to phase 3 of the Model of Supported Employment - the provision of support in the workplace - as none of the participants had secured employment. Misa's late entry into the WAVE project has had implications for them in terms of the results obtained at the time of the evaluation. While other projects had achieved definite progression for their clients (into open employment for example), Misa had not yet achieved these returns although they had been able to place people on a short term/work experience basis. Furthermore, the nature of their target group (people with moderate to severe brain injury) also makes re-integration/retention, more difficult.
Although the Model for supported Employment is familiar throughout Sweden, only a number of select organisations actually employ it. Misa has taken the initiative to start a national organisation for Supported Employment in Sweden (SFSE), which will promote the ethos that all people have the right to be part of a normal working environment.
Results from other countries which were part of the project, but were further advanced than Misa were very encouraging. For example, in Ireland 70 percent of the projects clients returned to some level of paid employment with a further 10 percent entering further education. This is a remarkable success rate for people with disabilities of this type and severity - it should be noted that unemployment rates in excess of 70 percent are typically seen amongst disabled groups.
In addition, the project produced a Handbook on Supported Employment, developed with trans-national partners, which aims to support employers in the reintegration of employees with ABI.
The Role of OHS Services
Occupational health services played no formal role in the project. However, there is no doubt that there are significant areas in which OHS services could play a role. This largely relates to the activities of assessing the capacity of the employee to work and in making adaptation to the workplace and to work itself to take account of the special needs of the employee.
Relationship to Employability
The activities of the Wave project have a clear link to promoting the employability of people with ABI. They do so in a number of ways - the medical rehabilitation activities contribute getting the client fit for work, the training and retraining activities upgrade skills, and the job placement activities actively facilitate the reintegration of the client into either a former or a new workplace.
Assessment of the Case
This case is remarkable in a number of ways. These include:
- The nature of the client group - the fact that the target group for this initiative (people with moderate to severe brain injuries) are among the more difficult cases for rehabilitation makes the success of the overall project remarkable. The methods used - the Model of Supported Employment, the Individual Programme Plan and the combination of services assembled to serve the clients of the project all made a contribution to this success.
- The role of OHS services - Though OHS services did not play a major role in this initiative, there are clear opportunities for them to play a significant, if delimited role in similar initiatives. The specialist services for medical rehabilitation do not fall within the remit of OHS, but the workplace based role of assessment of the individual and of the work environment and the nature of the job are all areas in which OHS could contribute. In addition, OHS services could play a role in monitoring the progress of employees with ABI who have returned to work.
- Relationship to employability - This case is an archetypical example of how rehabilitation can contribute to promoting the employability of even the more severely impaired employees. Its retraining activities, medical rehabilitation elements and job placement features all contribute to improving the employability of one of more difficult target groups for employment.