Work is considered therapeutic and essential for both the physiological survival and psychological well-being of people in contemporary societies (Chan, Reid, Kaskel, Roldan, Rahimi, & Mpofu, 1997; Dawes, Lofquist, & Weiss, 1968; Perrone, Perrone, Chan, & Thomas, 2000). Recognizing the importance of work, vocational rehabilitation professionals such as rehabilitation counselors, have consistently advocated for work as a fundamental human right of people with disabilities (Rubin & Roessler, 1995; Wright, 1980). Thus, the primary goal of vocational rehabilitation is to assist individuals with disabilities gain or regain their independence through employment or some form of meaningful activity and reintegration into society (Parker & Szymanski, 2003; Rubin & Roessler, 1995). The ultimate goals are in preventing potential disability; returning workers with disabilities to gainful employment; introducing individuals with disabilities into the labor force; and keeping workers with illness and disabilities employed (Jenkins, Patterson, & Szymanski, 1998). This is achieved by working collaboratively with the client to understand existing barriers and potentials in order to facilitate the client's effective use of personal and environmental resources; to assist individuals in adapting to the environment; and provide recommendation to change the environments in accommodating the needs of the individual for career, personal, social and community adjustment following disability (Parker & Szymanski, 2003).
Chan et al., (1997) defined vocational rehabilitation as:
"a dynamic process consisting of a series actions and activities that follow a logical, sequential progression of services related to the total needs of a person with a disability. The process begins with the initial case finding or referral, and ends with the successful placement of the individual in employment. Many activities and developments occur concurrently and in overlapping time frames during this process".
Chan et al. also defined the key elements in vocational rehabilitation as: comprehensive; an individualized process with decisions driven by client choice; functions to develop or restore functional capacity; and the outcome goals are functional independence and gainful employment.
Vocational rehabilitation encompasses an array of services designed to facilitate and ease the return to work (Berkowitz, 1990). Typical services include, but are not limited to, vocational assessment and evaluation, vocational training, general skills upgrading, refresher courses, career counseling, on-the-job training program, job search, and consultation with employers for job accommodation and modification. These service delivery processes are not necessarily unique for people with certain disabilities; the intensity, amount, and the delivery modalities may vary depending on the needs of the individual. In addition, other personal, educational, and environmental factors are taken into account in the process.
Diagnostic services and referral
Typically, a vocational rehabilitation client will be referred to diagnostic services such as general and specialty medical examinations, psychological evaluation, and vocational evaluation. The purpose of these diagnostic examinations is to determine functional limitations related to disability; to identify psychosocial, educational, and economic factors that might interact with disabilities to impede ability to work and live independently; to identify the strengths of the client; to develop appropriate vocational goals; and to identify services needed to achieve the client's immediate objectives and long-term vocational rehabilitation goals. Referral is often done when further information is required before a profession is able to derive a vocational rehabilitation planning that is suitable for the individual client. Common referral for further evaluation includes but is not limited to neuropsychological testing, independent psychiatric evaluation, functional capacity evaluation, loss of earning capacity evaluation.
Vocational Assessment and Evaluation
Vocational assessment is defined as the global appraisal of an individual's work/training background, general functional capacities, and social/behavioral characteristics. It usually includes an evaluation of medical factors, psychological makeup, educational background, social behaviors, attitudes, values, work skills and abilities (Chan et al., 1997). Vocational evaluation, on the other hand, is a specific process that involves the appraisal of a person's work related characteristics important for education and training to obtain and maintain employment. It includes a comprehensive review of specific work characteristics, including but not limited to occupational interests, specific job skills, worker traits, general intelligence, temperaments, physical capacities, strength, range of motion, and other work-related functions and aptitudes (Chan et al., 1997). Pertaining to the specificity of vocation evaluation, there are different domains that are imperative in understanding the more global picture of vocational success for individuals with disabilities. Such domains include: personal factors such as personality, interests, intelligence, cognitive capacities, educational achievement, personal adjustment, social adjustment, interpersonal skills, and work-related factors such as work experience, vocational adjustment, vocational aptitudes, and work behaviors. Additionally, situational factors also play an important role in vocational rehabilitation needs and employment outcomes. Such factors include medical, psychiatric, psychological, cultural, social, recreational, vocational, educational and environmental needs.
Since much personal and work-related information needs to be gathered in order to set specific vocational goals and to provide the appropriate intervention, vocational evaluation is an important and continuous process that are done throughout the whole vocational rehabilitation process. While some of the methods and processes described are labeled as "assessment", often such methods are used as part of the information feeding process for the rehabilitation professions for interventions (e.g. recommendations to improve work environments, counseling individuals with disabilities in choosing and adjusting to a job). Because of different levels of severity disabilities, a variety of assessment methods and processes are employed in order to capture a holistic level of information pertaining to the individual being served.
Standardized testing and paper-pencil testing
Standardized testing is defined as an evaluative process in which the procedure of administration and scoring is dictated and followed strictly and consistently for the purpose of comparing with normative samples (American Educational Research Association, American Psychological Association, National Council on Measurement in Education, 1999; Sattler, 2008). Common areas of specific vocational assessment include cognitive (IQ, neuropsychological functions), achievement, aptitude, interest, personality, work values, career beliefs, career decision-making process, career development, and career maturity. Some standardized testing (e.g. IQ, neuropsychological testing and some personality testing) may require advance training in education (Ph.D.s and advance courses in measurements.) Other paper-pencil testing can be administered by professionals with a non-Ph.D. degree (e.g., career beliefs, work values). However, all professions who administer a test, regardless of the levels, should follow the ethical guidelines of assessment in competency (American Educational Research Association, American Psychological Association, National Council on Measurement in Education, 1999). Information on the different types of standardized tests, including the constructs, nature, examples of common inventories used) can be obtained from text (e.g., Bolton, 2001; Mfofu & Oakland, 2010; Ozborn & Zunker, 2006).
The use of work sample approach is often employed, especially for individuals with severe physical and/or cognitive disabilities. This is another standardized vocational testing often used. Smith (1991) defines work sample method as an assessment method to measure the particular job skills by having the individuals demonstrate their competency in a situation that is parallel to that at work under realistic and standardized conditions. Therefore, it is a measure of the aptitude of an individual, i.e., the ability of an individual to learn a particular task or skill. The work sample methods, unfortunately, may not have been a popular tool in contemporary rehabilitation in vocational counseling because this process requires the purchase of specific work samples which could be expensive especially when one requires a wide range of work samples for specific samples of different jobs, and frequent updating may not be feasible (Thomas, 1999). In addition, most traditional work samples tend to focus more on manual work tasks than service-related work tasks. However, the use of work samples still has its value, especially its face validity, and close proximity to a real job task (Lee et al., 2008).
Job analysis (JA) is another commonly employed assessment and vocational process in gathering information and recommending work accommodation in vocational rehabilitation. The process of job analysis focuses on the description of the job but less on the worker's characteristics. Rehabilitation professionals often are required to conduct an in depth interview with a person who is familiar with the nature of the job, or who conducts an actual on-site analysis of the job. A detailed profile of the different essential job tasks required for a particular job is constructed. Examples include job skills, environments, working conditions (e.g., exposure to extreme temperatures, toxins), types of training and education needed (e.g., on-the-job training, specific vocational training, certificates), types, frequency and duration of certain physical activities (e.g., lifting, carrying, sitting, standing, crouching, climbing, smelling, tasting, near vision), and levels of strenuousness (e.g., sedentary, light, heavy). The purpose of a job analysis is to allow the rehabilitation professional to be able to match the compatibility of the particular job to the client, and be able to recommend job modification and accommodations if needed (Weed & Field, 2001).
Situational Assessment and Process
Another method of vocational evaluation or process often employed by rehabilitation specialists is the situational assessment approach. Similar to work samples, situational assessment places an individual with a disability in a simulated work condition and environment that resembles the actual job that the person will be place. This approach focuses on assessment and information gathering on the general employability skills and adaptive work behaviors. This is preferable and considered the most appropriate for people with disabilities, especially those with severe disabilities and limited work histories. It usually requires the rehabilitation professional to conduct observation of the client's work behavior in the simulated situations, and it often takes two or more weeks. Due to the length required for assessment, this method is usually most time-consuming and expensive.
Community-based Assessment and Process
An extension to the situational assessment approach is the community-based vocational evaluation. This is analogous to the situation assessment approach described above, except it is conducted in vivo. This approach assesses in vivo both work personality and skills in a competitive work environment through observation in real life situations. This approach allows the gathering and provision of tremendously useful and functional information, rather than only specific skills, for both the worker as well as the employer. For instance, observing the client performing and interacting with others in a real job situation, allows the professional to identify and develop the strength and effective coping skills of the client. Modification can be done on either the person and/or the environment upon identification of the problem. In addition, teaching can often be done on site, e.g., teach individuals how to acquire social, political or psychological resources to improve their conditions. Therefore, other considerations such as dealing with unexpected workload from supervisor, busy phone calls in relation to the ability of the clients and any potential impact on them.
Transferrable Skills Analysis
Transferrable skills analysis (TSA) is another technique that is commonly used to evaluate the skills of an individual. This is probably most applicable to individuals who have an injury in which their pre-injury skills are compared to the post-injury skills level for job placement. Operationally, transferrable skills are defined as:
"skills that can be used in other work (transferability)…the skills that can be used in other jobs, when the skilled and semi-skilled work activities you did in past work can be used to meet the requirements of skilled and semi-skilled work activities of other kinds of work. Transferability is most probably and meaningful among jobs in which
- the same or less degree of skill is required
- the same or similar tools and machines are used; and
- the same or similar raw materials, products, processes, or services are involved" (Weed, & Field, p.102).
The TSA process is usually used in situations in which the worker has skills that can be transferred to another position that result in a relatively quicker job placement and the return to self-sufficiency for the worker, as compared to a job placement that bears a minimal relationship to existing skills of the worker.
Labor Market Survey
The labor market survey (LMS) is a method of information gathering about particular jobs that are specific to a geographical area for an individual being served. The purpose of conducting a LMS is to look into the placeability factor of employment, i.e., whether clients who have the qualified skills can actually obtain the job. According to Weed and Field (2001), critical questions which can be answered by the information gathered through a LMS include:
- Do jobs of a particular nature exist in the economy?
- If these jobs do exist, are they available locally?
- If such jobs are available locally, were they available within the recent months and would there be further availability in the future?
- If there is availability, are these jobs open to my client?
- What do these job pay, including benefits?
Quite often, rehabilitation professionals identify jobs locally through a variety of resources, including but not limited to the classified advertisement in local newspapers, local job posting centers, personal and professional connections. Such a personal contact has the advantage of asking specific questions (accommodations) that may be specific to the nature of the client's disability, and specific to the particular job and position. The issue of placeability revolves around how difficult it is for a particular client to obtain employment. Many jobs exist in the national economy but the availability may vary day-by-day and hour-by-hour. A properly conducted LMS, therefore, allows information on the frequency of availability of the particular job for the particular client in mind.
Vocational counseling is another area of intervention that can be done with the individuals via discussion and guidance. Vocational counseling can be a process that occurs during the different rehabilitation phases. For instance, in an earlier phase, information gathered from the different assessment processes (standardized and paper-pencil testing) can be used to help the individuals to understand their interests, values, needs, and direction of their vocational pursuit. In addition, vocational counseling can be used to educate the individuals in understanding the availability, specific nature, strengths and limitations of a job requirement (e.g., job analysis, labor market survey, and transferrable skills analysis). Furthermore, another important process is the soft-skills that lead the client to obtain the job. Such soft-skills include the job application process (e.g. resume writing, cover letter writing, interviewing skills, and disability disclosure). Rehabilitation professionals, especially trained in the areas of vocational guidance and counseling, are equipped to provide such interventions directly to their client. At times, such services can be contracted out to services such as groups specifically run to help clients writing resume and group practice in interviewing, and centers that provide support for client to find job postings, having accessibility to a computer, creating a resume and cover letters. In addition, other referral sources can range from subcontracting to a vocational school for short-term vocational training, subcontracting to a community college or university for academic training. As mentioned earlier in the referral section, vocational rehabilitation services do not necessarily offer services that are strictly related to vocational betterment. Other services that improve the overall being and function of the person with the disability can be provided. Such services include physical function restoration (e.g., surgery, prosthesis, or assistive technology); mental function restoration (e.g., psychotherapy); assistive technology and ergonomic consultation (Spitznagel, 2002).
Consultation, Job Accommodations and Modifications
Job accommodation can generally be divided into two broad areas. Administrative accommodation includes the modification of the nature and execution of the job duties (e.g., increasing break times for an individual whose psychiatric condition can be induced by stress; having two individuals performing the lifting and carrying of loads in a construction site for an injured worker with a back injury). Engineering accommodation involves the physical and structural change in the job duties, such as implementing a lifting device for lifting loads in a warehouse, implementing a voice-activated computer for individual with upper limb amputation. Job accommodations are often recommendation by the professional to both the client with the disability and to educate the employer in order to provide reasonable modification for clients to maximize their return to work.
Vocational rehabilitation aims at helping individuals to obtain and to retain a job. A successful placement and vocational rehabilitation outcome indicate job satisfactoriness from the employer and satisfaction from the individual with a disability. Vocational rehabilitation is a multi-disciplinary approach that involves a team effort of professionals in different disciplines who contribute their expertise to improve the well being of the persons with disability so that they can be physical, psychological, social and culturally ready and competent to seek a job and to maintain a job.