VOCATIONAL REHABILITATION



Vocational Rehabilitation 574
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Vocational rehabilitation refers to any programs that seek to restore disabled individuals to their optimal physical, mental, social, vocational, and economic ability. In a legal sense, vocational rehabilitation is a workers' compensation benefit in some states, which involves programs designed to help workers who have become physically or mentally disabled and who can no longer hold the same jobs they had prior to their disabilities. Most vocational rehabilitation programs—whether part of workers' compensation or not—aid the disabled in receiving training for new occupations, locating jobs, retaining jobs, and building permanent careers.

The Social Security Administration defines a disability generally as a limitation in the type or quantity of work someone can perform, stemming from a chronic condition with a duration of six months or more. Hence, this definition includes those who cannot work regularly or at all and are considered "severely disabled" as well as those who must seek new occupations because of their limitations and those who can continue to perform the same job but not the same amount of work.

Both public and private vocational rehabilitation programs exist. Each state has its own joint federally and state-funded vocational rehabilitation program with similar eligibility requirements, policies, and offerings. Eligibility requirements tend to be general and allow anyone with a disability who needs job assistance to take advantage of these programs. In addition, state veterans departments offer analogous services to veterans who became disabled as a result of their military duties. Furthermore, a host of private companies and organizations offer vocational rehabilitation services. These private providers include everything from charitable organizations to insurance companies.

HISTORY OF VOCATIONAL
REHABILITATION

The roots of vocational rehabilitation in America can be traced to the diffuse development of disability-specific workshops in the early 19th century. The first of these was the Perkins Institute, incorporated in Boston in 1829 to train blind individuals for manufacturing jobs. Efforts such as this were few and far between, however, until turn-of-the-century Progressivism strengthened the impetus. Social justice was a key concern of the Progressive political movement, and many forward-looking vocational rehabilitation organizations were established during the era. Some programs, such as Goodwill Industries, the Salvation Army, the Society of St. Vincent de Paul, and the Jewish Vocational Service Agencies, evolved under the sponsorship of religious organizations. Others—such as the groundbreaking Sunbeam Circle (now known as Vocational Guidance and Rehabilitation Services) in Cleveland, Ohio; the National Society for Crippled Children and Adults (also known as the Easter Seals Society) in Elyria, Ohio; and the Red Cross Institution for Crippled and Disabled Men (ICD Rehabilitation and Research Center) in New York City—were the result of private altruism. All these programs have since expanded nationwide.

By far the greatest stimulus to vocational rehabilitation arose after World War I, when the influx of disabled veterans from overseas battlefields proved too much for private institutions to bear. There were philosophical and practical motives for inauguration of the public program of vocational rehabilitation. Soldiers had fulfilled their obligation to the country; the nation owed its disabled veterans the opportunity to return to work and productivity. In this pre-welfare era, private social support was simply not sufficient to support the millions of potential dependents. These factors compelled the passage of the Smith-Hughes Act of 1917, which created the Federal Board for Vocational Education of Veterans. The Soldier Rehabilitation Act of 1918 expanded Smith-Hughes to provide vocational training to disabled veterans. Ratification of the Vocational Rehabilitation (Smith-Fess) Act two years later extended services to disabled civilians. Vocational rehabilitation marked a significant landmark in the thirties, when the passage of the Social Security Act of 1935 established the first permanent base for the federal program.

These various pieces of legislation set up a federal/state cooperative whose budget was evenly shared. States that wanted to participate submitted a plan of action for federal approval and reported annually to the Federal Board for Vocational Education. The state agencies were prohibited from using funds for buildings, equipment, or physical restoration. A network of federal, state, and private agencies evolved through the passage of over a dozen pieces of legislation throughout the ensuing decades. These laws expanded the definition of eligibility and increased the amount of expenditures toward the program. By 1923, 36 states participated in the $1.3 million program. The federal government's role was to set administrative procedures and techniques, provide funding, and promote the program. Responsibility for actual programming fell to the states. In practice, state agencies usually evaluated client eligibility and potential for rehabilitation, provided counseling, and managed job placement. State agencies often contracted with private organizations for medical treatment, physical rehabilitation, and occupational training. In his text Introduction to Rehabilitation, James A. Bitter characterized the public-private vocational rehabilitation partnership as "perhaps the most successful human service program in the United States."

The public vocational rehabilitation program grew dramatically during the late 1950s and throughout the 1960s. Federal expenditures increased from $23 million in 1954 to $600 million by 1970. Funding for buildings, maintenance, and research was permitted, and definitions of eligibility were expanded during the period to include those developmentally disabled by epilepsy, cerebral palsy, and other neurological impairments.

Vocational rehabilitation came to the attention of the business community during the 1970s, when state governments, led by California, began to make it a mandatory part of the resolution of workers' compensation cases. A concurrent nationwide study of on-the-job injuries emphasized the failures of workers' compensation programs and spurred public and union pressure to make vocational rehabilitation part of disability management programs across America. Predictably, many employers resented and resisted vocational rehabilitation as yet another expensive bureaucracy. By the late 1980s, some states, including Georgia, Minnesota, and New Mexico, repealed the requirement. But two circumstances soon converged to make vocational rehabilitation more viable in the eyes of business leaders. By the early 1990s, abuse of the workers' compensation system had pushed annual national costs over $60 billion. Once again, California led the way: stress claims alone increased 700 percent from 1982 to 1992.

Perhaps the most important legislation affecting vocational rehabilitation since 1935 was the 1990 Americans with Disabilities Act (ADA). This mandate built upon the foundation laid by the Rehabilitation Act of 1973, which prohibited federal agencies, programs, and contractors from discriminating against people with disabilities. The ADA also incorporated the nondiscriminatory ideals of the Civil Rights Act of 1964, ruling that "no employer shall discriminate against a qualified individual with a disability because of the disability of such individual in regard to job application procedures, the hiring or discharge of employees, employee compensation, advancement, job training, and other term and conditions of employment." The law requires that all employers, public and private, of more than 25 people make "reasonable accommodations" (in terms of expense and degree of change) for disabled employees. The ADA also dramatically broadened the definition of disability to include any "physical or mental impairment that substantially limits one or more of the major life activities," (including work) a history of having such an impairment, or even the perception of having an impairment.

The combined impact of skyrocketing workers' compensation costs and the legal requirements of the ADA compelled employers and insurers to turn to vocational rehabilitation as a cost containment technique. The alternative was the courtroom, for example: from October 1992 to October 1993, approximately 3,300 cases filed with the Equal Employment Opportunity Commission were concerned with employers' failure to provide reasonable accommodation to disabled workers.

Congress strengthened the right of the disabled to work when it passed the Rehabilitation Act Amendments of 1992. These amendments included the requirements that even the severely disabled receive vocational rehabilitation and that people with disabilities must be given the opportunity to seek gainful employment. Six years later the Rehabilitation Act was reauthorized with the Rehabilitation Act Amendments of 1998. These amendments called for the establishment of the Interagency Committee on Disability Research to encourage and coordinate research projects related to vocational rehabilitation among government agencies and departments. The amendments of 1998 also created the National Institute on Disability and Rehabilitation Research to carry out vocational rehabilitation research within the U.S. Department of Education.

PRACTICAL APPLICATIONS OF
VOCATIONAL REHABILITATION

Aside from the legal requirements of the ADA, there are many practical justifications for the application of vocational rehabilitation. Moreover, there is an ample supply of working-age people with disabilities. The President's Committee on Employment of People with Disabilities reported that there were about 30 million working-age people with disabilities in the United States in 1994. Of these disabled people, about 52 percent or 15.39 million were employed. In contrast, 82 percent of the general working-age population is employed, indicating the additional progress vocational rehabilitation efforts must make to reach a comparable level of employment for the disabled. What's more, a study released by Northwestern National Life in 1994 estimated that more than 25 percent of 25-year-old workers would be disabled for one year before they reached retirement age. In purely economic terms, these individuals represent hundreds of billions of dollars in welfare expenditures and lost productivity every year. In purely human terms, citizens of a democracy such as ours can claim "an inherent right to earn a living," as asserted by Bitter in Introduction to Rehabilitation. Since 1918, vocational rehabilitation has existed as a tool for both cost containment and empowerment.

Vocational rehabilitation can help solve other workplace dilemmas as well. Marriott Corporation, a food service company, turned to vocational rehabilitation as a solution to its problems of high employee turnover and a dwindling labor pool. The company tapped into the largely neglected supply of workers with disabilities through an in-house program called Pathways to Independence. Pathways incorporated job matching, social and occupational training, and ongoing support. The leading fast food chain, McDonald's, initiated its Mc Jobs program in 1981 for similar reasons. The six- to eight-week program recruits, trains, and employs an average of 900 mildly to severely disabled people annually.

Technological innovations have further promoted placement of rehabilitated employees. IBM Corp.'s National Support Center for Persons with Disabilities, for example, opened in 1985. It features more than 800 devices and tools that can ease the transition to work, including voice synthesizers, adapters for people with impaired mobility, and voice-activated computers. Contrary to popular belief, disabled workers are not typically expensive or difficult to accommodate. The President's Committee on Employment of People with Disabilities released a survey in 1996 that indicated 20 percent of workplace modifications cost nothing, and 51 percent cost between $500 and $1, and only 4 percent cost over $5,000. Furthermore, Sears, Roebuck and Co. has noted that 90 percent of its accommodations have cost nothing. The survey by the President's Committee on Employment of People with Disabilities also reported that the average accommodation expenditure was $200 and that for every dollar spent on accommodation of the disabled, companies saved $34 in costs stemming from workers' compensation, insurance, and training.

In addition to the potential bottom-line benefits of vocational rehabilitation, such programs can promote positive employee relations. Communicating the benefits of the program, keeping in contact with workers on disability leave, and establishing light- and alternate-duty occupations can help show all employees that they are valued contributors to a business.

HOW VOCATIONAL REHABILITATION
WORKS

Vocational rehabilitation is a very individualized, goal-oriented process with the ultimate objective of employing its clientele. The delivery of this service is comprised of several steps, including diagnosis, compilation of an individualized written rehabilitation program, counseling and guidance, physical and mental restoration, training, job placement, and postemployment services. Vocational rehabilitation clients are often referred to rehabilitation agencies by schools, hospitals, welfare agencies, and other agencies or organizations, yet many are self-referred or referred by a physician.

Usually at the outset the disabled are assigned a counselor who conducts the diagnosis by gathering various kinds of information to determine eligibility. Diagnosis occurs at several levels. A preliminary diagnostic study determines a prospective client's eligibility for rehabilitation services in the public program. A medical evaluation identifies a client's disabilities and functional limitations. This very vital assessment may incorporate a physical examination as well as investigation of the client's medical and vocational history. A psychological evaluation of mental and emotional abilities and limitations, both historical and current, can also be included. A sociocultural evaluation includes compilation of identifying information; personal, family, and home life histories; educational and work histories; and assessment of personality, habits, and economic situation. The vocational evaluation is an assessment of the client's occupational aptitudes and potential; work history, habits, interests, attitudes, and responsibilities; as well as the tenor of previous work relationships. Finally, the educational evaluation relates the client's skills to his or her vocational potential. It includes information on the level of education (including special areas of interest and achievement), as well as learning capacity and study habits. Clearly, many aspects of the diagnostic study overlap, just as the individual aspects of people's lives converge. The findings of these diagnoses are utilized in the next step, compilation of the individualized written rehabilitation program with the client.

The individualized written rehabilitation program is jointly developed by the rehabilitation counselor and the client (or the client's representative, in the case that the client is unable to contribute to the discussion). At this point, the client and the counselor plan a program of services based on the client's needs and objectives. This "plan of attack" includes:

  1. a justification of the client's eligibility for treatment,
  2. a long-range employment goal,
  3. intermediate goals,
  4. identification of the services necessary to reach those goals,
  5. projected beginning dates for each service and the duration of each,
  6. a procedure and schedule for the evaluation of the individual program.

After the both parties agree to a program of services, the counselor makes arrangements for providing the client with the services needed. The services a client receives may include counseling, education, job placement, physical or mental restoration, career training, and work modification or accommodation.

Counseling and guidance are ongoing aspects of vocational rehabilitation. Called "the synthesizing function of the rehabilitation process," counseling promotes the entire program. Physical and mental restoration works to alleviate the physical or mental conditions that impede a client's fullest potential functioning. This step may include medical, physical, and therapeutic treatment; prosthetics and/or orthotics; occupational or communication therapy; and psychiatry.

There are four types of training that a client of vocational rehabilitation may undergo: personal adjustment training, prevocational training, compensatory skill training, and vocational training. Personal adjustment training refers to the development of prowork attitudes and habits such as dependability, responsibility, and consistency. Prevocational training endows the background knowledge necessary to choose and prepare for occupational skill development. This may include tours of job sites, study of industries, and learning to fill out job applications and use public transportation. Compensatory skill training refers to the development of skills that make up for a disability, i.e., speech or lip reading for the hearing impaired and mobility training for the visually impaired. Vocational training alludes to the development of specific job skills, usually at trade and vocational schools, colleges and universities, rehabilitation facilities, sheltered workshops, and apprenticeship programs, or on the job.

Before entering the job market or receiving job placement services, clients, especially those with severe physical or mental disabilities, may participate in sheltered workshops designed to prepare clients for the competitive labor market. The sheltered workshop is a not-for-profit enterprise that can use the services of workers with restricted abilities and limited skills. Workshops tend to employ the disabled to perform assembly, collating, custodial, mailing, packaging, and telemarketing tasks. These workshops include Goodwill Industries, Citizens Development Center, and Ennis Association for Retarded Citizens, among others.

Job placement is the climax of the entire rehabilitation process. This complicated and underrated step matches client and job. Just as no two work environments are exactly alike, no two vocational rehabilitation clients are exactly alike. Job placement often entails cooperation between the vocational rehabilitation agency and the potential employer, including modification of a job and/or the work environment. Computerization has helped facilitate the placement process. The Occupational Access System is an example of "transferable skills analysis" software. This job-matching software package based on the U.S. Department of Labor's Dictionary of Occupational Titles can help mate a client's skills, work history, and interests with occupations. Databases of adaptive equipment can also facilitate a return to work.

Placement is not the end of the vocational rehabilitation story. Some clients require postemployment services such as continued counseling, supplementary training, health services, assistance with transportation, or other rehabilitation services.

[ April Dougal Gasbarre ,

updated by Karl Heil ]

FURTHER READING:

Bitter, James A. Introduction to Rehabilitation. C.V. Mosby, 1979.

Callahan, Michael J., et al. Keys to the Workplace. Baltimore: Paul H. Brookes Publishing, 1997.

Gice, Jon. "The Relevance of the Americans with Disabilities Act to Workers Compensation." CPCU Journal, June 1992, 79-83.

Heine, Alicia. "Killing Two Birds with One Stone." Business Insurance. 16 May 1994, 33-34.

Jones, David C. "Co. Using Technology in Vocational Rehabilitation." National Underwriter, 8 November 1993, 2, 13.

Levitan, Sar A., and Robert Taggert. Jobs for the Disabled. Baltimore: Johns Hopkins University Press, 1977.

Madeja, Peter C. "Return-to-Work Programs: Employers Should Re-examine Vocational Rehabilitation." Business Insurance, 28 September 1992, 47-48.

Mulcahy, Colleen. "Rehab Saves $35 for Every $1 Spent, Study Finds." National Underwriter, 9 May 1994, 17.

Obermann, C. Esco. A History of Vocational Rehabilitation in America. Arno Press, 1980.

Weiss, Joseph W. The Management of Change: Administrative Logics and Actions. Praeger Publishers, 1986.

Wiley, Carolyn. "Programs that Lead the Way in Enabling People with Disabilities to Work." Employment Relations Today, spring 1992, 31-38.



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Sep 14, 2010 @ 12:00 am
I have been diagnosed with severe spinal stenosis in both upper, and lower spine. I have already had the spinal fusion done on the neck what I need to have done at this time is surgery on the lower back to correct my problem as much as possible and the muscles in my left arm are either atrophied or wasting away. Presently the doctor has instructed me to lift no more than 10 lbs., and I can not walk any further than 4 blocks at the most without suffering sharp pain. I am currently residing in New York. I can still do quite a bit of work with my arms, so I am able to work as far as I am concerned. Since I do have further surgery in the future I need to start looking to the future when I am in recovery. Could you possibly assist me with names, places, people, and programs that can get me started back on the path to rejoining the work force. Any and all assistance is most appreciated.


Thomas Martin

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