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Vocational Rehabilitation

Vocational Rehabilitation

BIBLIOGRAPHY

Throughout medical history one can find references to helping individuals to recover from the effects of illness or accidents. Only in the present century, however, have organized national efforts been effectively brought to bear on the problems of integrating physically, mentally, and emotionally disabled persons into the social and economic communities. Societies have only recently assumed responsibility for the assurance of equal opportunities for the large population of disabled persons.

At one point in history, the impaired person was viewed socially as an object to be feared and avoided. His disability was seen in contexts of religious beliefs and superstition. If he could not be purged, charmed, or effectively prayed for, he was ostracized or set apart in some manner. His society accepted no real responsibility for him.

In the nineteenth century society began to pay attention to “cripples” and to consider the mentally aberrant individual as one who suffered from an illness. At this time the pendulum also swung from ostracism to a regard for impaired persons as objects of pity who required custodial treatment (protection and care). Medical disciplines became more and more actively engaged in treatment. As this focus on treatment continued into the beginnings of the present century, however, disability came to be viewed against a background of the concept of the anatomically perfect man. Competence for work and for participation in social activities was determined by whether or not the individual was anatomically whole. Furthermore, attempts at treatment did not go beyond the anatomical defect to include the whole person but were focused on the affected parts and limited to the acute phases of illness.

Modern medicine’s functional concept of disability rejects the focus on anatomical perfection in determining suitability and feasibility for employment and social participation. Instead, treatment and retraining restore as much capacity as possible, continuing posthospital rehabilitation services are utilized, and the individual is encouraged to utilize all of his remaining assets fully.

In short, modern societies have assumed responsibility for helping impaired persons to work out their problems and to assume positions as adjusted participants in social activity. While formal national rehabilitation programs began after World War i, it was the climate provided by World War n, with its problems in rehabilitating returning servicemen, that gave the significant impetus to establishing total large-scale service programs for disabled persons. The emphasis on vocational rehabilitation was increased. In the United States, the federal-state program of rehabilitation, with its many interrelationships with the large network of private and community rehabilitation agencies, was greatly expanded by legislation developed on the premises that individuals require work in order to be truly independent and that, in being successful at work, they will repay to society the costs of their rehabilitation. Vocational rehabilitation became a good investment. At the same time, the intensified vocational emphasis, the focus on broader services, the continuance of services beyond the acute treatment phase, and the focus on working with the whole person instead of merely with his disability, brought new professional workers into rehabilitation. The advent of these new workers, particularly from the social and behavioral sciences, resulted in the development of new and broader concepts of rehabilitation.

Definitions . Any discussion of vocational rehabilitation must be developed in the context provided by definitions of the more inclusive, unmodified term “rehabilitation.” While the legislative and developmental history of the rehabilitation movement points to vocational success as the desired goal, many workers in rehabilitation prefer a broader concept. In large part this results from the fact that current social demands require rehabilitation work not only with the physically disabled but also with such groups as the emotionally disturbed, the dis-advantaged youth, the older worker, the victim of poverty, the unemployed, and the mentally retarded.

The breadth of the field of rehabilitation and the preferences of its professional subgroups make the search for an inclusive and meaningful definition of rehabilitation a frustrating task. It is difficult to accept any one definition. A brief review of the typical definitions, however, will point up common goals and suggest the accepted procedures employed in the process of rehabilitation.

Rehabilitation is most often defined as a process seeking to achieve “restoration of the handicapped to the fullest physical, mental, social, vocational, and economic usefulness of which they are capable” (National Council on Rehabilitation 1944, p. 6). It has also been described as a creative process aiming to define, develop, and utilize the assets of the handicapped individual (Hamilton 1950). Rehabilitation may be seen as a concentration of individual and community resources to restore competitive ability, independence, economic self-sufficiency, and adjustment to work and social life.

The term “handicapped” refers to the effects of losses or the interposition of physical, mental, or emotional barriers. The individual is handicapped with reference to the achievement of personal, social, or work adjustment. While the emphasis in most definitions of rehabilitation is on restoration of the handicapped to some productive and satisfying status, habilitation, or the achievement of productive and independent living for the first time, is also an important goal of rehabilitation.

Some definitions stress achievement by the handicapped individual of the life most useful and satisfying for him. Rehabilitation has been defined as making a handicapped person aware of his potential and then providing the means of attaining that potential. Future developments in legislation and practice are likely to place increasing emphasis on improved independent living for any handicapped individual, even when direct contribution to the labor force or the national economy cannot be expected.

When one examines how professionals perceive their field, it becomes obvious that there are considerable individual differences in the importance they attach to different underlying principles, on such matters as individual dignity, the right to compete, the addition of workers to the labor force, the conservation of manpower, increases in tax yield, decreases in relief expenditures, and the feeling that it is good to help others; some focus on helping people, others on justifying the large expenditure of funds required. Professional affiliations further complicate the establishment of a philosophy of rehabilitation that is acceptable to all workers in the field. This is understandable when one considers the different primary focus of each of the professions involved: to understand behavior, to study groups and the community, to understand family dynamics, and to heal men.

It is accepted that rehabilitation is an interdisciplinary enterprise; the theory and practice of psychology, medicine, and social work contribute in large measure to its efforts. It is felt to be maximally effective when medical, psychological, social work, educational, and employment skills are integrated in a team effort to work with the desires, needs, and unique total handicap of the impaired person.

Whatever definition or philosophy of rehabilitation is favored by a particular person or group, perhaps all would agree that rehabilitation is concerned with practical problems in the lives of individuals; that it deals with past, present, and future individual behavior and with assisting the individual to find an optimal balance which will permit him to live as well as possible within the handicaps imposed by a disabling condition and in a manner consistent with his ability, aptitude, interests, and personality factors; that it involves active interprofessional participation in planning for and with individuals; and that, whenever feasible, it points toward some measure of vocational adjustment as an ultimate goal. Most workers would also agree that the rehabilitation effort would be facilitated by more attention to the development of ways of changing the attitudes of the public and employers (and perhaps of professional workers and their clients) toward the handicapped as a group and toward specific disability classes. Many of the problems of vocational rehabilitation are particularly relevant for psychology and should be amenable to the research approaches of psychologists. It is clear that psychology, as the science of behavior, and its applied specialties of counseling and clinical psychology play a large role in rehabilitation. It is also clear that rehabilitation is a large and viable effort and that it faces increasing social demands.

Incidence of disability . The determination of the numbers of individuals who are disabled and who could profit from rehabilitation services poses many difficult problems. There are many national and international estimates of the disabled population. Some surveys simply rely on respondents’ reports of disability; others focus on illness within a specified time period and include temporary conditions that do not result in residual disabilities. There is also reluctance, varying with the nature of the disabling condition, to disclose the presence of a disability in the respondent or in a member of the respondent’s family. It is not feasible to give complete medical examinations to large numbers of individuals and to extrapolate to the population from these findings. Even if this were feasible, such findings would deal with medically defined disability, which might be something quite different from disability in carrying out the various tasks of the many possible jobs theoretically available to each individual. In any event, it is difficult to determine the potential number of individuals who require, or could profit from, rehabilitation.

The variety of estimates available can be illustrated by surveys conducted in the United States. In the period 1928 to 1931, the U.S. Public Health Service indicated that on the basis of its surveys 3 in 1,000 were handicapped (U.S. Office … 1955). It has since been held that this estimate was much too low. In a national health survey in 1935-1936, the U.S. Public Health Service estimated on the basis of a house-to-house sampling that 11.7 in each 1,000 persons were unable to work, go to school, keep house, or carry on usual activities for one year preceding the survey (U.S. National Institute …1938). In 1949-1950, governmental agency surveys estimated that there were 2,561,000 (outside of institutions) who were disabled, out of a total population of some 150 million individuals (Woolsey 1952). In a carefully controlled sampling study, carried out in 1958 by the Industrial Relations Center of the University of Minnesota, 10 per cent of persons in a state-wide sample indicated that they could not work or participate normally because of a disability (Minnesota, University of … 1958).

In 1954, the Office of Vocational Rehabilitation, U.S. Department of Health, Education and Welfare, estimated that there were two million people in the United States who had a disability and who required rehabilitation services to make them employable (U.S. Office …1954). It was also estimated that 250,000 persons could be added to this number each year. In 1957-1958, the U.S. National Health Survey estimated that there were 24 million individuals outside of institutions, or one in seven persons, with varying degrees of permanent residual effects of disease or injury (U.S. National Health Survey 1959).

It is obvious that accurate and reliable figures are difficult to find. It is, however, believed likely by persons active in the rehabilitation movement that there are now approximately 3 million disabled in the United States who could benefit from rehabilitation procedures and who could move off disability, welfare, and jobless rolls into productive areas (DiMichael 1964).

Organization and financing . Vocational rehabilitation activities are strongly supported by the U.S. Vocational Rehabilitation Administration (VRA), the Veterans Administration, and the Public Health Service. Support is given in the areas of direct service, training, and research. The largest program is the federal-state rehabilitation program administered by the VRA. This program embraces general agencies in the 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands. It also includes separate agencies for the blind in 36 states. These 90 agencies have 750 local offices serving handicapped clients.

Some recent articles (U.S. Office …I960; Vocational Rehabilitation Administration 1964a; 1964b; 1964c) describing the first 44 years of the federal-state rehabilitation program include information which indicates that the rehabilitation effort is a substantial and increasing one. The growing need for application of research knowledge, for use of demonstrated research techniques, and for the devising of new research approaches to meet the growing demands for service and training in rehabilitation is also emphasized.

The record of the federal-state program shows that 523 persons were rehabilitated to gainful employment and satisfying life in the first year of operation (fiscal year 1921). By 1961, the number had risen to 92,501 (see “Special Feature Section” 1960). In 1963 over 110,000 disabled men and women were returned to activity and jobs.

In the present federal-state rehabilitation program, the federal government’s share of the cost averages 62 per cent, the states’ share 38 per cent. In 1921 the federal share was only $93,000, compared to $191,000 for the states. For the fiscal year 1964, federal expenditures totaled $85.7 million, state funds, $53.5 million.

By 1962 federal VRA expenditures for research and demonstration totaled approximately $10 million. Research and demonstration grants had supported some 540 special projects which hold promise of contribution to the solution of rehabilitation problems. The VRA has also supported expansion programs, community projects, state extension and improvement projects, and state agency training grants.

Training. For a decade the VRA has operated a program of training grants to colleges and universities interested in establishing or expanding programs to train professional workers in the fields contributing to rehabilitation. Training programs at the professional level are carried out in the fields of vocational rehabilitation counseling, physical medicine, speech pathology and audiology, prosthetic-orthotic education, occupational therapy, physical therapy, and social work.

The VRA program in vocational rehabilitation counselor training started in 1955, at which time four universities were producing 12 graduates a year. In 1964 the VRA (Vocational Rehabilitation Administration 1964b) was supporting such training at 37 universities and reported that 1,750 individuals had completed the graduate curriculum in vocational rehabilitation counseling. About 60 per cent of these graduates are employed in agencies serving disabled people. In 1967 there were VRA rehabilitation counselor training programs at 63 educational institutions.

All of this activity is directed toward work in rehabilitation settings with disabled clients. Rehabilitation clients may be seen in a number of settings: state rehabilitation agency district offices, state agencies for the blind, rehabilitation centers, workshops for the mentally retarded, state or federal hospitals, institutes for the crippled and disabled, institutes of physical medicine and rehabilitation, and private agencies.

Major rehabilitation centers are concentrated in urban areas and many are affiliated with large universities. Increasing attention is being given to expanding and coordinating rural facilities for serving the handicapped.

Clients and personnel . Rehabilitation clients represent the whole range of physical, mental, and emotional disabilities, and the entire age range. Effort has been concentrated, however, on persons in the labor-force age range. The trend is toward increasing attention to the needs of the older worker and to working with persons over 65. The median age of rehabilitants at acceptance went from 26 in 1945 to 36 in 1958.

In any rehabilitation effort a team of professionals will be found active, whether the team is a formal one in a particular institution or is informally made up of the practitioners of the contributing professions in a community. The professional workers active in the total effort with handicapped persons ordinarily include physicians and/or medical specialists, psychiatrists, clinical psychologists, counseling psychologists or vocational rehabilitation counselors, social workers and/or psychiatric social workers, audiologists, speech therapists, physical therapists, and occupational therapists. Also involved in the rehabilitation program are nurses, placement specialists, employment service representatives, prosthetic appliance specialists, etc. The main planning, service, and research, however, are carried out by professionals from the broad areas of medicine and surgery, the physical medicine specialties, psychology, and social work.

Research . There is much evidence to indicate that rehabilitation workers and rehabilitation psychologists feel the need for research in problem areas relevant to psychology. The report of the 1958 Princeton conference on psychology and rehabilitation (Institute …1959) lists over 300 research proposals gathered from rehabilitation psychologists in a preinstitute survey. Most of these proposals are concerned largely with psychodynamic and psychosocial problems, problems in special disabilities, psychotherapeutic techniques, and psychological evaluation, tests, and techniques. There is also interest in research on problems of motivation and resistance, professional qualifications, competencies, and training, rehabilitation teams and team relationships, rehabilitation and the family, attitudes toward the handicapped, and vocational training and replacement.

In a regional meeting of 15 state rehabilitation directors with psychologists from a state university, the following problem areas were among those mentioned in small group discussions: counseling techniques; criteria—what rehabilitation counseling tries to accomplish; staff evaluation; counselor turnover; client follow-up; client satisfaction; case management standards; definitions of handicaps; employer satisfaction with handicapped employees; handicap stereotypes; and social stereotypes.

These examples indicate simply that the need for research is felt by both rehabilitation personnel and psychologists working in rehabilitation settings. The research interests of psychologists in rehabilitation problems are illustrated in the report of the Miami conference on psychological research and rehabilitation (Conference …1962).

Since the late 1950s the VRA has been establishing regional research institutes to facilitate progress in finding new methods to aid the agencies seeking to rehabilitate vocationally a growing number of clients. Each of these institutes serves a block of state agencies. The first established institutes (Vocational Rehabilitation Administration 1964a; 1964b; 1964c), located at universities, are centering their activities around the following core areas: at Minnesota, methods of improving the work adjustment of disabled persons; at Wisconsin, the professional role of the rehabilitation counselor; at Florida, motivational and personality factors in rehabilitation; at Utah, interpersonal relations in rural rehabilitation; at Northeastern, motivation and dependency. A total of nine regional research institutes is planned. Further information on these institutes is available from the recent literature and from publications of the institutes (see, for example, Dawis et al. 1964; Vocational Rehabilitation Administration 1964a; 1964b; 1964c).

All of the activity in definition, research, training, and service is aimed primarily at improving the lot of clients of the federal-state-supported programs. The goal and the major program objectives of a typical state vocational rehabilitation agency might be formulated as follows:

The goal is to rehabilitate vocationally all physically, mentally, and emotionally handicapped residents at the least possible cost, consistent with the highest standards of quality. In consideration of this goal, the following are the major agency program objectives:

(1) To make available the full range of rehabilitation services, as needed, for all disabled who meet agency eligibility criteria.

(2) To utilize and coordinate community resources, whenever needed, to enhance rehabilitation planning.

(3) To employ a qualified professional staff that is able to rehabilitate a maximum number of disabled individuals at the highest standards of quality.

(4) To encourage community and legislative understanding of vocational rehabilitation in order to secure necessary support and allow for maximum program development.

(5) To explore and develop new methods of rehabilitation programming that will effectively enhance patterns of rehabilitation services for the disabled.

Lloyd H. Lofquist

[See alsoMental Disorders, Treatment of. Other relevant material may be found inBlindness; Clinical psychology; Counseling psychology; Medical personnel, article on Paramedical personnel; Mental retardation, Social work; Workmen’s compensation.]

BIBLIOGRAPHY

There is an abundance of literature on vocational rehabilitation practices and techniques. Representative texts are Allan 1958; Hamilton 1950; Lofquist 1957; Patterson 1958; 1960; Garrett & Levine 1962; and Wright 1960. Activity in conceptualizing the problems of rehabilitation and in research to provide a basis for service is wide ranging and is reported in a number of professional journals. Examples that by no means cover the whole range are Miller 1965, on the psychological impact of coronary artery disease; Gellman & Friedman 1965, on the workshop as a clinical rehabilitation tool; Ritchey 1965, on predicting the success of schizophrenics in industrial therapy; Strong & Insel 1965, on perception of the rehabilitation-counselor role by supervisors; Hartlage 1965, on rehabilitation counseling with psychiatric clients; Abels & Cantoni 1965, on the employability of blind dictaphone operators; Bradley & Stein 1965, on counselor experience and the prediction of rehabilitation client behavior; and Stone 1965, on the measurement of needs of physically disabled college students. Obermann 1965 describes the history of rehabilitation in America, emphasizing early history and the role of the National Rehabilitation Association in the development and support of rehabilitation legislation.

Abels, H. Leola; and Cantoni, Louis J. 1965 Employ-ability of Blind Dictaphone Operators. New Outlook for the Blind 59:33-34.

Allan, W. Scott 1958 Rehabilitation: A Community Challenge. New York: Wiley.

Bradley, Arthur D.; and Stein, Carroll 1965 Counselor Experience and Accuracy of Prediction of Client Behavior: Rehabilitation. Personnel and Guidance Journal 43:1015-1017.

Conference on Research in the Psychological Aspects of Rehabilitation, Miami, 1960 1962 Psychological Research and Rehabilitation: Conference Report. Edited by Lloyd H. Lofquist. Washington: American Psychological Association.

Dawis, Rene V.; England, George W.; and Lofquist, Lloyd H. 1964 Research Frontier: Regional Rehabilitation Research Institutes. Journal of Counseling Psychology 11:185-189.

Dimichael, Salvatore G. 1964 Vocational Rehabilitation: A Major Social Force. Pages 534-555 in Henry Borow (editor), Man in a World at Work. Boston: Houghton Mifflin.

Garrett, James F.; and Levine, Edna S. (editors) 1962 Psychological Practices With the Physically Disabled. New York: Columbia Univ. Press.

Gellman, William; and Friedman, Simon B. 1965 The Workshop as a Clinical Rehabilitation Tool. Rehabilitation Literature 26:34-38.

Hamilton, Kenneth W. 1950 Counseling the Handicapped in the Rehabilitation Process. New York: Ronald Press.

Hartlage, Lawrence C. 1965 Rehabilitation Counseling With Psychiatric Clients. Rehabilitation Counseling Bulletin 9:14-18.

Institute on the Roles of Psychology and Psychologists IN Rehabilitation, Princeton, N.J., 1958 1959 Psychology and Rehabilitation. Edited by Beatrice A. Wright. Washington: American Psychological Association. → See especially Appendix IV.

Lofquist, Lloyd H. 1957 Vocational Counseling With the Physically Handicapped. New York: Appleton.

Miller, Clarence K. 1965 Psychological Correlates of Coronary Artery Disease. Psychosomatic Medicine 27: 257-265.

Minnesota, University of, Industrial Relations Center 1958 A Survey of the Physically Handicapped in Minnesota. Minnesota Studies in Vocational Rehabilitation, No. 6. George W. England and Lloyd H. Lofquist, principal investigators. Univ. of Minnesota Press.

National Council ON Rehabilitation 1944 Symposium on the Processes of Rehabilitation. New York: The Council.

Obermann, C. Esco 1965 A History of Vocational Rehabilitation in America. Minneapolis: Denison.

Patterson, Cecil H. 1958 Counseling the Emotionally Disturbed. New York: Harper.

Patterson, Cecil H. (editor) 1960 Readings in Rehabilitation Counseling. Champaign, 111.: Stipes.

Ritchey, Ronald E. 1965 Predicting Success of Schizophrenics in Industrial Therapy. Journal of Counseling Psychology 12:68-72.

Special Feature Section. 1960 Rehabilitation Record 1, no. 3:3-24. -→ Contains six articles.

Stone, J. Blair 1965 The Edwards Personal Preference Schedule and Physically Disabled College Students. Rehabilitation Counseling Bulletin 9:11-13.

Strong, Donald J.; and Insel, Shepard A. 1965 Perceptions of the Counselor Role Among a Variety of Rehabilitation Counseling Supervisors. Journal of Counseling Psychology 12:141-147.

U.S. National Health Survey 1959 Impairments by Type, Sex and Age, United States, July 1957-June 1958. Washington: U.S. Department of Health, Education and Welfare, Public Health Services, Division of Public Health Methods.

U.S. National Institute of Health 1938 The National Health Survey: 1935-1936. Washington: U.S. Public Health Service, National Institute of Health, Division of Public Health Methods.

U.S. Office of Vocational Rehabilitation 1955 Study of Programs for Homebound Handicapped Individuals. 84th Congress, 1st Session, House Document No. 98. Washington: Government Printing Office.

U.S. Office of Vocational Rehabilitation 1960 A Tide in the Affairs of Men. Rehabilitation Record 1, no. 3:3-12.

U.S. Office of Vocational Rehabilitation, Division of Research Statistics 1954 Number of Disabled Persons in Need of Vocational Rehabilitation. Rehabilitation Service Series No. 274. Washington: Government Printing Office.

Vocational Rehabilitation Administration 1964a Seeking Answers Through Research. Rehabilitation Record 5, no. 4:11-13.

Vocational Rehabilitation Administration 1964b VRA Support of Professional Training. Rehabilitation Record 5, no. 4:28-32.

Vocational Rehabilitation Administration 1964C What State Programs Are Doing. Rehabilitation Record 5, no. 4:3-7.

Woolsey, Theodore D. 1952 Estimates of Disabling Illness Prevalence in the United States. Public Health Monograph No. 4. Washington: U.S. Public Health Service.

Wright, Beatrice A. 1960 Physical Disability: A Psychological Approach. New York: Harper.

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Vocational rehabilitation

Vocational rehabilitation

Definition

Vocational rehabilitation (VR) is a set of services offered to individuals with mental or physical disabilities. These services are designed to enable participants to attain skills, resources, attitudes, and expectations needed to compete in the interview process, get a job, and keep a job. Services offered may also help an individual retrain for employment after an injury or mental disorder has disrupted previous employment.

Purpose

Vocational rehabilitation services prepare qualified applicants to achieve a lifestyle of independence and integration within their workplace, family and local community. This transition is achieved through work evaluation and job readiness services, job counseling services, and medical and therapeutic services. For individuals with psychiatric disabilities, situational assessments are generally used to evaluate vocational skills and potential.

Precautions

Vocational rehabilitation as operated by state agencies is not an entitlement program. Only individuals considered eligible can receive VR services. Eligibility criteria require that an individual be at least 16 years old, unemployed or under-employed, and have a physical or mental disability that results in a substantial barrier to employment, such as psychotic disorders, alcohol and other drug abuse dependence, mental and emotional disorders, attention deficit disorders, specific learning disabilities, and physical and sensory disabilities. In addition, the individual must be able to benefit from VR services. An individual must also need help to prepare for, find, and succeed in paid employment. When resources are limited, individuals with the most significant disabilities must be served first.

Description

Vocational rehabilitation services are based on individual needs and defined as any goods or services an individual might need to be employable, such as assistive technology devices and services. For instance, a person who is blind would need screen reading software to access a computer and people with a cognitive or mental disability might need a talking electronic reminder device programmed to prompt them when it is time to perform certain tasks.

Vocational rehabilitation can be provided by private organizations, but is not typically funded under managed care arrangements. Thus, most people apply to state vocational rehabilitation agencies that are funded through federal and state monies. Typically, state agencies have offices in their state's major cities and towns. State VR agencies do not necessarily offer the same services or deliver services in the same way in every state, so individuals seeking services must learn how to access the VR program in their own state. The federal VR component is administered by the U.S. Department of Education Rehabilitation Services Administration and authorized by the Rehabilitation Act of 1973 as amended in the 1988 reauthorization.

Most vocational rehabilitation services are free for eligible applicants; however, applicants may be asked to use other benefits, such as: insurance, Pell grants or other financial aid for training or higher education, to pay part of program costs.

Best practices in vocational rehabilitation include individual choice, person-centered planning, integrated setting, natural supports, rapid placement, and career development. The term integrated setting refers to placing individuals in usual employment situations rather than making placements into sheltered workshops or other segregated settings. Natural supports are the person's already existing support network, including family members, service providers, and friends, who can help the person reach a goal, such as the employment of their choice. Person-centered planning is a technique in which a plan for a person's future is developed by a team consisting of the person and his or her natural supports, and the team develops a practical plan based on the person's wishes and dreams. Each teammember agrees to perform certain tasks identified in the plan to help the person reach goals. Unfortunately, not all VR programs incorporate all of these best practices.

Preparation

Vocational rehabilitation transition planning services are required for all public and private education students aged 16 and over, who have Individualized Education Plans (IEPs) or Rehabilitation Act Section 504 Plans. Transition services help students make the transition from school to employment, training or higher education. Older individuals who have acquired disabilities and are applying for VR services must undergo medical and psychological assessments at their local VR office to determine the extent of their disabilities, except for individuals receiving SSDI or SSI who are presumed eligible without assessments. Applicants may receive treatment and counseling, if needed, before training and employment. All VR services are described in an applicant's Individualized Plan for Employment (IPE). Applicants may design the IPE either on their own or with the assistance of their assigned VR counselor, usually a person with a master's degree in rehabilitation counseling.

Aftercare

A vocational rehabilitation counselor will assist an applicant gain access to an employment agency to help locate a job. Counselors may provide support (supported employment programs) if applicants need support to keep a job. This support may include job coaching, which includes working with the person in the workplace until the person is comfortable with the work. The counselors also act as resources if a job does not work out by assessing what happened and counseling the person on how to improve performance or change habits that were not perceived favorably in the workplace.

Risks

Applicants may not be satisfied with the pace of progress toward their employment goal through VR or they may not believe their wishes or talents and skills are being taken seriously. Applicants wanting to start their own businesses or engage in telecommuting may not be successful in receiving vocational rehabilitation assistance. Applicants may find that VR counselors tend to recommend low-level and low-paying jobs traditionally recommended for VR applicants, such as food service and janitorial work. Applicants may also be turned away by VR counselors because the counselors decide the applicant's disability is too severe for the person to benefit from VR services. An additional risk for individuals with mental disorders is a usual lack of coordination between VR and mental health systems.

To address these problems in the VR system, the United States Congress passed the Ticket To Work Act. Under this Act, persons with mental or physical disabilities will receive a ticket worth a certain amount of money. They may take this ticket to any private or public entity that provides job training and placement, including state VR programs. The entities providing the employment-related services will be able to redeem the tickets only after the person is gainfully employed for a certain period of time. States are on a staggered schedule to begin implementing the program; persons in the first states started receiving tickets in 2001. All states will be instituting the Ticket to Work Act by 2004.

Normal results

Individuals with mental or physical disabilities will receive the assessments, counseling, training, placement, accommodations and long-term supports needed to allow them to engage in the gainful employment of their choice.

Abnormal results

Individuals with mental or physical disabilities remain unemployed or under employed. More than 70% of people with disabilities are unemployed; for people with mental disorders, that percentage ranges from 70-90%.

Resources

BOOKS

Fischler, Gary and Nan Booth. Vocational Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals. Austin: PRO-ED, Incorporated, 1999.

PERIODICALS

Cook, Judith A. "Research-Based Principles of Vocational Rehabilitation for Psychiatric Disability." International Association of Psychosocial Rehabilitation Services newsletter Connection issue 4 (September 1999). Also available on the Veterans Industry web site: <www.va.gov/vetind/page.cfm?pg=6>.

Harding, Courtney. "Some Things We've Learned about Vocational Rehabilitation of the Seriously and Persistently Mentally Ill." Western Interstate Commission for Higher Education newsletter West Link: Western Health Development in the United States vol. 18, no 2(1997). Also available at <http://www.wiche.edu/mentalhealth/westlink/>.

Lehman, Anthony F. "Vocational Rehabilitation in Schizophrenia." In Schizophrenia Bulletin 21, no. 4(1995): 24-36.

MacDonald-Wilson, K. "Unique Issues in Assessing Work Function Among Individuals with Psychiatric Disabilities." Journal of Occupational Rehabilitation 11, no. 3 (2001): 217-232.

Maronne, J., C. Gandolfo, M. Gold, and D. Hoff. "If You Think Work Is Bad for People with Mental Illness, Then Try Poverty, Unemployment, and Social Isolation." Psychiatric Rehabilitation Journal 23, no. 2 (2000): 187-193.

ORGANIZATIONS

Association for Persons in Supported Employment (APSE) provides a nationwide supported employment network through its national program and state chapters. APSE works to increase supported employment opportunities, educate consumers regarding their rights in supported employment activities and train professionals to create quality supported employment services. APSE, 1627 Monument Avenue, Richmond, VA 23220. Phone: (804) 278-9187. Fax: (804) 278-9377. <http://www.apse.org/>.

The Office of Special Education and Rehabilitative Services' Rehabilitation Services Administration (RSA) web site describes the programs offered, federal law and regulations governing VR programs, and includes a link to all state VR programs and agencies. <http://www.ed.gov/offices/OSERS/RSA/>.

State Rehabilitation Councils. These councils advise and assist state VR programs in preparing state plans for vocational services to promote employment for persons with disabilities and ensure a link between citizen participation and the legislative process. Persons with disabilities or their family members must make up 60% or more of a Council's membership. The Pennsylvania Rehabilitation Council has a web site with links to various state rehabilitation councils at <http://www.parac.org/>. The Pennsylvania Rehabilitation Council can be reached at: Rehabilitation Council Support Project, 1902 Market Street, Camp Hill, PA 17011. Telephone: (717) 975-2004, or toll free: (888) 250-5175. TTY: (877) 827-9974. Fax:(888) 524-9282.

Geoffrey Grimm, Ph.D., LPC

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