Vocational Rehabilitation

Arthritis often cuts short a person’s working life. However, with effective accommodations, a person can often stay in his chosen job or career longer, even if arthritis is making certain activities difficult or impossible. Even when accommodations aren’t enough, retirement doesn’t have to be the only answer. Some people can use vocational rehabilitation services to help them find new forms of employment.

Vocational rehabilitation programs offer a wide range of services to eligible clients, including paying for education and purchasing equipment such as computers and assistive devices. Agency counselors are also trained to make sure the client has taken advantage of all available services, including medical care.

Every state has a vocational rehabilitation agency, supported by state and federal dollars, for helping disabled individuals identify work options. The author of this article is the director of the Disability Assessment Research Clinic (DARC) at the University of Arizona College of Medicine, which maintains a long-standing contract with Arizona’s rehabilitation agency to evaluate clients who are seeking services. The rehabilitation agency in Arizona maintains close relationships with post-secondary institutions, behavioral health agencies, social service agencies, school districts, universities, colleges, and trade schools to ensure that eligible individuals are referred for rehabilitation services.

But even though vocational rehabilitation services are available in every state, physicians often overlook the possibility that some of their patients with arthritis could be trained for less physically demanding jobs when their current jobs become unmanageable.

Rehabilitation counselors

State rehabilitation agencies are staffed with trained rehabilitation counselors. Most hold graduate degrees in vocational rehabilitation, and many state agencies also require aspiring counselors to pass a national certification exam. Coursework for aspiring counselors includes classes in counseling the disabled and in medical and psychological aspects of disease, as well as an internship at an agency in which disabled persons receive services. Counselors often specialize in working with people with specific disabilities, such as mental illness, substance abuse, or hearing loss.

Vocational rehabilitation counselors work closely with physicians and psychologists, because it is critical that the counselor understand the nature of the client’s disability. For people with a progressive disease like arthritis, the extent to which the disease has impaired a person’s hand function, as an example, can be an important guide to the selection of training programs, job modifications, and/or future employment.

Getting the process started

When a person is referred to vocational rehabilitation, the counselor conducts an extensive intake interview. The interview gathers such important information as living arrangements, marital status, the number of children in the home, the client’s level of education, past work experience, and past medical treatment, including any for substance abuse. It is also important to learn whether the client has an arrest record or has served time in prison, because employers are often reluctant to hire people with such a history.

The counselor, as part of the initial workup, will order medical, psychiatric, and formal educational records. The client must sign a release authorizing the counselor to obtain the records. An appropriate specialist who is under contract with the agency will then review the records and inform the counselor of any medical or psychological barriers to employment that must be addressed. The consultants will often recommend additional medical or psychological evaluations. For people with arthritis, a visit to a rheumatologist is often recommended, particularly when a person has not previously seen one.

If a medical or psychological assessment is deemed necessary, the counselor will inquire about the client’s health insurance coverage. When a client has no insurance coverage, the counselor can use agency money to pay for an assessment by an appropriate specialist when he deems it essential to determining whether the client may benefit from services.

Most vocational rehabilitation agencies operate under a mandate from the federal government to serve the most severely disabled first. This is known as “order of service.” Because arthritis is classified as a progressive disease, people with arthritis usually qualify for the program.

There is a close tie between vocational rehabilitation programs and Social Security’s disabilities programs (SSDI/SSI), and when a person applies for such benefits, he is asked whether he has ever been seen by a vocational rehabilitation agency. The application form even asks for the name of the counselor, the dates of services, and the applicant’s current status.

In recent years, under terms of the Federal Ticket to Work program, many persons referred to the state vocational rehabilitation program are already receiving SSDI/SSI benefits. The federal government has determined that some disabled persons on SSDI/SSI may improve or be able to work with accommodations. Unfortunately, DARC has found that many such clients are still severely disabled. A person who receives SSDI/SSI benefits is not obliged to seek vocational rehabilitation services, even if he receives a letter from Social Security recommending he do so. The Ticket to Work program is voluntary. Not applying does not mean losing one’s disability benefits.

A disability evaluation

DARC is under contract with the state’s vocational rehabilitation program to conduct medical, psychological, and physical evaluations of clients seeking vocational rehabilitation services. Specialists review the medical files, and psychologists or vocational evaluation specialists conduct face-to-face assessments lasting four to five hours and utilizing state-of-the-art instruments that match client test results to US Department of Labor standards. (See “Matching Jobs With Job Seekers,” on page 22.)

The DARC model has been developed over a period of 19 years and includes a review of all available information gathered by the counselor. An initial clinical interview is conducted by a specialist who has reviewed the evidence in the case and noted the important features of the client’s history. If the specialist feels additional medical, psychiatric, educational, or psychological consultations are necessary, the counselor is asked to obtain these. In the case of the person with arthritis, when there is no confirming evidence of disability, a consultation with a rheumatologist is arranged.

The initial clinical session is followed by a four- to five-hour face-to-face evaluation by a trained vocational evaluation specialist. The evaluator in the DARC program is a doctoral level rehabilitation counseling psychologist with specialized training in the assessment of the physical, cognitive, psychological, and environmental factors required for successful performance in the competitive jobs found in the Department of Labor databases.

The clinic’s competitive work capacities assessment (CWCA) process, designed to measure all these factors, indicates that 1) diminished cognitive capacities place increased demand on physical capacities; 2) diminished physical capacities place increased demand on cognitive capacities; and 3) diminished cognitive and physical capacities place increased demand on the development of accurate, valid, reliable, work-related information to address an individual’s current work capacity potential.

The CWCA utilizes more than 20 standardized cognitive, physical demands, psychological, and neuropsychological screening assessment instruments (combined with continuous observation) to develop a worker traits profile (WTP) for each individual. That profile, developed by the Department of Labor, includes the 62 primary factors and their factor competency levels required for successfully performing careers in the DOT database.

All cognitive and physical performance results are converted into worker traits profile (WTP) factors and factor levels, and the individual’s final WTP is used to search the Department of Labor databases to identify appropriate jobs, if any, that can be discussed by the individual and his counselor.

Using the assessment outcome

When all the evidence to obtain an opinion from DARC staff is available, a meeting is conducted that includes the rehabilitation counselor, the client, and sometimes family members and other professionals. During the meeting, the evidence is reviewed, and recommendations are made concerning the client’s potential to benefit from vocational rehabilitation services. If it is determined the client has no potential to benefit from these services, and the person is not on any disability benefits, DARC staff work with the client and counselor to apply for SSDI/SSI or other benefits the individual may qualify to receive.

Rehabilitation counselors routinely order specialist examinations, similar to the DARC program, and evaluate that evidence to determine whether a client is likely to be able to find employment. If it is determined that the client would likely benefit from services, a rehabilitation plan is developed. However, the vocational rehabilitation agency must have documentation showing that there are jobs available in the field chosen by the client and counselor.

A review of vocational rehabilitation agency services nationwide shows that while there are differences in the way each agency and its counselors function, most programs are similar to the Arizona program. Because many rheumatology patients can benefit from these services, it is important for professionals like rheumatologists to become acquainted with the vocational rehabilitation program in their geographic area.

Success stories

Millions of benefit dollars can be saved when a person with arthritis can be trained for a job he is physically capable of performing. One success story is Molly, who has juvenile rheumatoid arthritis (JRA) and who utilized vocational rehabilitation services to attend college and law school. Molly is now a successful attorney.

John, who also has JRA, attended medical school and became a pediatrician. After a long career, however, his arthritis affected his hand function severely enough to force him to give up his practice. With training, he was able take a new job as an administrative health-care professional.

Maria, whose rheumatoid arthritis is fairly well controlled, is attending junior college under vocational rehabilitation. She plans to become a forensic technician, working in a law enforcement agency.

Harold, who also has JRA, completed a master’s degree in vocational rehabilitation and worked for many years until his arthritis forced him to retire.

Not everyone who receives vocational rehabilitation services needs to complete college degrees to find suitable employment. State vocational rehabilitation programs pay for course work at technical and trade schools and, by utilizing the services of placement specialists, find suitable jobs for disabled persons on a routine basis, including persons with arthritis.

Often, the counselor will determine that the client could be placed in a less physically demanding job. Utilizing the services of the contract placement specialist, jobs are identified and the client is hired. Large numbers of vocational rehabilitation closures fall into this category.

Steps you need to take

If you are having difficulty performing the duties of your present job because of your arthritis or another medical condition, it would be prudent for you to visit a vocational rehabilitation office in your community. Offices are conveniently located, and self-referrals are encouraged. You can find the location and phone number for an office near you in your local phone book or by searching online for “vocational rehabilitation” or “rehabilitation services.” You may also wish to discuss the possibility with your rheumatologist.

Matching Jobs with Job Seekers

For each career in the US economy, the US Department of Labor has developed a very specific worker traits profile (WTP), utilizing comprehensive job analysis. Presented in the department’s Dictionary of Occupational Titles (DOT), the profile contains the 62 primary factors and the factor competency levels for successfully performing each of the 12,741 jobs in the database.

The Occupational Information Network (O*NET) database, also developed by the Department of Labor, contains the level of importance ratings for each of the more than 300 cognitive and physical performance factors that are important for successfully performing each of the 900-plus careers in the database. The level of importance ratings in O*NET were developed through the use of questionnaires completed by workers in the careers presented in the database.

David Wayne Smith is Director of the University of Arizona Disability Assessment Research Clinic (DARC), part of the Arizona Arthritis Center of Excellence (AAC) at the University of Arizona in Tucson. He thanks Linda Nowland, MS, CRC, a senior counselor with the Arizona Rehabilitation Services Administration, for her review.

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