Back2Work: Early Intervention Vocational Rehabilitation Program & Evaluation

The Back2Work Early Intervention Vocational Rehabilitation Program is an innovative and evidence-based model of early vocational rehabilitation. Being led by Spinal Life Australia and their expert team of vocational rehabilitation counsellors. Back2Work is a collaboration with Griffith University funded by MAIC. 

The evaluation of the Back2Work program, led by senior researchers from Griffith University, has employed a longitudinal prospective design with broad ranging measures of return to work rate, service satisfaction, readiness to return to work, life satisfaction, psychological wellbeing and perspectives on the experience of vocational rehabilitation after spinal cord injury. 79 Back2Work participants have engaged in the evaluation between October 2016 and February 2020. The majority of participants were males with an average age of 43 years; 70% of participant’s injuries were of traumatic origins, with road trauma incidents (30%) and falls (11%) being the most common causes of injury. Participants tended to have incomplete injuries (65%) and/or paraplegia (59%). Most participants lived in major cities (61%), with approximately a third in regional areas and 5% in remote or very remote locations. Most participants (85%) reported being employed in some capacity prior to their injury.

As would be expected, employment participation decreased dramatically immediately post-injury, with 84% of participants not engaged in paid work when discharged from hospital. Between hospital discharge and the 12-month time point, the employment rate increased significantly (p = 0.008) and remained steady thereafter. The Back2Work program has achieved the target of a 30% increase on the baseline employment rate, with a return to paid employment for participants of 50% at 24 months post discharge from hospital. Further gratifying is the finding that almost half the participants had returned to vocational activity within 12 months, including having returned to paid employment (43%) and volunteering (6%).   

While the analysis found no significant effects on employment based on gender, level and completeness of injury, qualifications, FIM score, heritage, region, or marital status, a person’s age was found to be significantly related to their employment status. Employed participants were significantly older (M = 53.89, SD = 10.06) than their unemployed counterparts (M = 39.70, SD = 13.03) at discharge (t(54) = 3.9, p = .003), suggesting a particular vulnerability for young people with spinal cord injury in relation to unemployment. Further, employed participants scored lower on the Kessler10 (K10) psychological distress measure (M = 15.14, SD = 3.93) than unemployed participants (M = 21.76, SD = 7.89) at the 6-month follow-up interview (t(19.38) = -3.17, p = .005), affirming the recognised role of employment in psychosocial wellbeing.  

While overall the quantitative measures of wellbeing have to date not provided robust evidence of Back2Work’s role in perceptions of wellbeing, the Satisfaction Survey and further qualitative data have clearly documented the very positive overall perception of Back2Work and its vocational rehabilitation counsellors as contributing to an enhanced sense of wellbeing. Participants were overwhelmingly positive in their feedback of the Back2Work services, with several very powerful participant quotes highlighting the value of the program. A recurring theme in the qualitative data collected was the impact of Back2Work in promoting a positive attitude and expectancy towards returning to work or study. People’s comments clearly point to their experiences and perceptions of Back2Work as playing an important role in opening up vocational possibilities, promoting positivity, confidence and optimism, and instilling hope. The qualitative findings also affirm the specialist vocational rehabilitation knowledge and services provided by Back2Work as having a complementary role in supporting participants’ mental health at a time when it can be challenged by the extensive stressors involved in recovery.  

All findings considered, the Back2Work Early Intervention Vocational Rehabilitation Program has been successful in improving the rate of return to paid employment, promoting timely return to paid employment, and the retention of pre-injury employment. Given the outcomes of lower reported psychological distress and higher life satisfaction for those who had returned to work, Back2Work has also demonstrated potential for broader positive impact on the lives of people with spinal cord injuries, their families and communities.  

A key recommendation highlighted by this research is the need and justification for broader integration of vocational rehabilitation in hospital-based multidisciplinary teams, ensuring consistent early access to such services for spinal cord injured people. Further longitudinal research, as has been supported by MAIC for an extension of the Back2Work program and evaluation to 2023, will enable stronger empirical evidence of the effectiveness of early intervention vocational rehabilitation in promoting both employment and wellbeing after spinal cord injury.  

The Back2Work project started in 2016 and is funded until 2023. Research for the program is led by Dr Vanette McLennan, Dr Julia Bloom & Dr Pat Dorsett, The Hopkins Centre, Menzies Health Institute Queensland Griffith University.