Workforce Integration: Survivors as Assets In Employment

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By Helen Christians, OT

The following article is a summary of a presentation at the Phoenix World Burn Congress 2015 by Helen Christians, an occupational therapist at Legacy Oregon Burn Center; Alexa Fouche, a mental health therapist at Yamhill County (Oregon) Mental Health; and Butch Haganman, a safety specialist for Indianapolis Power and Light.

Survivor Returning to Work

On June 12, 1996, 28-year-old Butch Haganman, a married father of two, was working on an Indianapolis Power & Light (IP&L) crew that was replacing old lines. Butch was standing on a pole splicing two de-energized power lines back together when a line energized with 7620 volts came into contact with the line Butch had lying on his shoulder. The voltage entered that shoulder and exited through both of Butch’s legs.

Butch was admitted to Richard M. Fairbanks Burn Center at Eskenazi Health in Indianapolis, Indiana, under the care of Dr. Rajiv Sood. Soon after his admission, Butch’s charred left leg was amputated above the knee. He had also sustained penetrating, severe injuries to his left lung, as well as his shoulder and right leg. His wife was informed that he probably would not survive; yet after only 3 months he was discharged home.

In March 1997, 8 months after the accident, Butch returned to work full-time as a dispatcher. He walked with crutches to support his braced right leg and his left above-knee prosthetic leg. He had limited movement of his injured shoulder and tired easily. He had no time for outpatient therapy. Unfortunately his marriage ended leaving him with full custody and care of two young sons.

Butch recalls that while he had successfully returned to work, the job took nearly all the energy he had, leaving little for his sons, which troubled him deeply. After 2½ years as a dispatcher, still needing crutches to walk and tiring easily, Butch negotiated with IP&L for a medical retirement.

Once retired, Butch used his energy to spend time with his sons and exercise. Within 3 months, he no longer needed crutches, was active with his boys, and was able to play golf. He had time to volunteer as a lecturer at electrical safety training sessions. In 2007, after both of his children had graduated from high school, Butch returned to IP&L as a field safety specialist. He has consistently been recognized as an exemplary employee. In 2016, Butch proudly accepted the 2015 AES Global Safety Award at the company’s annual meeting. AES, an international power corporation with 21,000 employees and the parent company of IP&L, had honored Butch with its highest award for safety.

Today Butch has the energy he needs to spend time with his family, enjoy a weekly golf game with his dad, and frequently lecture at electrical safety training sessions, in addition to his normal work duties.

Butch advises survivors who are preparing to return to work to complete their rehabilitation and make sure they are physically and emotionally ready. After his injury, Butch continued to maintain close communication with his managers and volunteered at trainings that supported IP&L. Communication was the key to successful negotiation of his medical retirement, as well as his later successful return to work.

Survivor Seeking Employment

Alexa Fouche was 3 months old in 1959 when the hotplate of a homemade vaporizer caught the ruffles of her bassinet on fire. The flames caused full thickness burns to her face and left hand. There was no designated burn center in San Diego in 1959, but Dr. Moore, who had treated soldiers with severe burns in World War II, was willing to accept Alexa as a patient although he believed it was unlikely she would survive. He amputated her left hand and grafted her face.

Alexa did survive and grew up in a loving, supportive family who treated her like her siblings, but her burn injury was never discussed. Alexa’s parents enrolled her in their neighborhood school when she was 5. She was a strong student and formed close supportive friendships but those friends could not protect her from the teasing and bullying she experienced. She did not learn the skills to explain her burn injury as she began to understand that she looked different than the other children. In high school, as a “mainstreamed” student, she was enrolled in a standard typing class, where her teacher, who taught her to type with one hand, expected her to keep up with her classmates.

Alexa was recognized for her intelligence and encouraged by her parents and teachers to attend college. At age 18, she left home, enrolled in Loyola Marymount College earning an MA in psychology, and became a licensed marriage and family therapist. Throughout her 20’s she had intense psychotherapy and studied Buddhism. Both practices helped her recover from the psychological trauma she had experienced in her childhood.

When others noticed her physical difference, Alexa used an approach similar to the 3-sentence Rehearse Your Response technique taught in the Phoenix Society’s social skills training—she stated calmly and confidently that she was burned as a child, was fully recovered and happy to be alive, and then thanked them for their concern.

After college, Alexa married and had a daughter and twin boys. She established a private practice and worked as a county mental health therapist. She has worked fulltime in county mental health in California and Oregon for the past 25 years. She leads groups and performs assessments of clients with a multitude of diagnoses, consistently receiving excellent job evaluations for her work in mental health.

Alexa says that when interviewing for a job she quickly made it very clear to future employers that she was comfortable discussing her facial difference and loss of her left hand. She assured them that she did not need modifications as she could type 35 words per minute single-handedly, and then proved it. She shared her strengths and the value she could bring to the organization.

Alexa recommends that early in a job interview survivors should not only describe their strengths and potential value to an employer, but also their comfort in discussing their physical differences. She encourages them to use the interview as an opportunity to evaluate the employer and ensure the job is a good fit.

Majority of Burn Survivors Are Employed

What do you do for work? To have an answer to that question means an income but also an avenue for establishing friendships, social roles, and personal identity. Depending on the severity, a burn injury requiring hospitalization will interrupt employment for weeks, months, or even years. Two studies found that 60% to 80% of adult survivors treated at burn units were employed within 1 year.1,2 Another study of 279 survivors found that 90% of burn survivors were employed within 2 years.3 All 3 studies indicate that most burn survivors eventually find employment. Yet many survivors seeking employment or returning to work experience pain, fatigue, hypersensitivity, anxiety, limited movement, and visible scars that can undermine their confidence in their ability to work.

Even though a wound is closed and bandaging no longer necessary, wound healing is not complete. Survivors, family members, and employers may have limited understanding of the complexity of physically and emotionally recovering from burn trauma. Accredited burn centers can provide or recommend mental health counselors, psychologists, occupational therapists, physical therapists, and vocational rehabilitation counselors who can evaluate a survivor’s readiness to return to work, assess the job requirements, prepare for a safe return to work, and communicate with an employer once a survivor gives written authorization.

Burn survivors can develop an “employee attitude” long before they are actually ready to seek or return to work. For the young survivor, it is often associated with the attitudes of their parents and teachers. Alexa, her parents, classmates, and teachers did not have the support of a school re-entry program, such as the Phoenix Society’s The Journey Back, or the tools gained through the Phoenix Society’s social skills training to talk about her facial difference and limb loss. Yet her resilience and the support of family, friends, and teachers and their belief in her ability led to her enrolling in advanced education and successful employment.

For adults, an employee attitude can start soon after discharge when a survivor is barely capable of dressing and bathing themselves. Establishing and modifying a daily schedule that includes a morning wake-up time, needed naps, healthy meals, exercise, and an evening bedtime gets survivors out of bed and in sync with the working world. Dr. Philip Parshley, founder of the Legacy Oregon Burn Center, encouraged his patients to walk every day, even in the Pacific Northwest, using his simple mantra, “You are not made of sugar. Walk even on rainy days.” A gradual increase in daily scheduled activity ensures gains in strength and endurance.

Both Alexa and Butch recognized the importance of communication. For those seeking employment, it is important to initiate and control the discussion about obvious physical difference or physical limitations due to a burn injury, while emphasizing strengths and the ability to successfully complete job tasks.

In the United States a burn survivor who is working with a state-certified vocational rehabilitation program can enhance his or her chance of being hired by informing employers that the company would be eligible for up to $2400 in tax credits if the company employs the survivor for 1 year. Information about tax credits can be found at business/Incentives. State vocational rehabilitation offices can assist survivors in their efforts to find a job and provide employers with information on how to apply for tax credits. Information concerning specific state requirements for certification for tax credits can be found at

As burn survivors consider the timing for their return to work, they should trust their personal convictions about their physical and emotional readiness and not be rushed to return to work too early. When survivors communicate their feelings about readiness for return to work with their burn therapists, doctors, and mental health counselors, they can test their readiness with the support of professionals in a safe environment. Through communication of all involved parties, survivors can plan for a timely, coordinated, safe, and appropriate return to the workplace.

1. Esselman PC, Askey SW, Carrougher GJ, et al. Barriers to return to work after burn injuries. Arch Phys Med Rehabil. 2007;88:s50–s56.
2. Palmu R, Partonen T, Suominen K, Vuola J, Isometsa E. Return to work six months after burn: A prospective study at the Helsinki Burn Center. Burns. 2015;41:1153–1160.
3. Brych SB, Engrav LH, Rivara FP, Ptacek JT, et al. Time off work and return to work rates after burns: systematic review of the literature and a large two-center series. J Burn Care Rehabil. 2001;22:401–405.


Helen Christians is an occupational therapist at Legacy Emanuel’s Oregon Burn Center, located in Portland, Oregon. She has worked with burn survivors for the past 30 years. In 2015 Helen was honored by the American Burn Association as Therapist of the Year.


This story is an excerpt from The Phoenix Society’s® Burn Support Magazine, Issue 2, 2016.  Burn Support Magazine is a tri-annual publication that contains articles on the emotional, psychological, and social aspects of burn recovery.  All Rights Reserved.
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