Block 6: Work Assessment - The Vocational Rehabilitation Process

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THE VOCATIONAL REHABILITATION PROCESS:

The work assessment process:

Refer to the above scheme. The process consists of:

Referral.
Screening interview and recommendations (if necessary).
Comprehensive work assessment.
Reporting with recommendations to source of referral.

Screening interview:

This is a basic information gathering session aimed at determining the client’s suitability for a work assessment. It is usually done by the assessing O.T.

In most cases, the client is found to be suitable for the assessment and the info gathered in the screening interview is used in planning the assessment according to the client’s individual situation. Common information gathered during the assessment includes:

medical history;
educational level;
a comprehensive work history;
previous skills training;
social history (such as support systems, substance use, financial status);
motivation to work or attend skills training.

A small number of clients are screened out during the interview stage. This is most common when information gathered indicates that the client is a clear candidate for disability benefits or return to work.

Work assessment:

The work assessment is designed to determine the impact that the client’s impairment or disability has on his/her work performance. This is done through observing the client while doing a variety of simulated tasks. The tasks are used to elicit specific work aspects, for example, walking endurance, repeated elbow flexion, tolerance of repetitive work.

The assessment design is specific to each client based on diagnosis, educational level, previous work experience and skills as well as areas of potential development.
The length of the assessment is usually 5 days (at Groote Schuur Hospital) and the clients are seen for 6 hours per day.

Recommendations in the form of future planning with regard to:

eligibility for disability benefits or possible training options;
sheltered placement options, or,
reasonable accommodation, or
open labour market placement is made.

The work assessment aims at determining the client’s work abilities and the matching of this with the demands of the job, which takes place in a particular environment. Recommendations are made to the source of referral regarding placement of the client with or without adaptations to the job, the environment or the worker.

Work abilities:

These are assessed acording to the following criteria;

Work habits:
- for example, personal and social presentation.
Work competence:
- for example, following of instructions,
- task planning, completion, evaluation,
- handling and care of tools, materials.
Work endurance / tolerance.
Work motivation.
Production speed.

Work preparation/reasonable accommodation:

This is one of the possible outcomes of the work assessment. This outcome is used when it is determined that the client should be able to return to work in the open labour market - once he/she had completed a period of work preparation or after the implementation of reasonable accommodation.

Work preparation: This refers to a process where the client is gradually prepared to return to work. This could include endurance training, skills training, gradual re-introduction to the work environment etc. Grading is determined in consultation with the client and the employer (if applicable).

Reasonable accommodations: "Any modification or adjustment to a job or to the working environment that will enable a person from a designated group to have access to or participate or advance in employment" (from the Employment Equity Act).

People with disabilities are identified as a designated group in the Employment Equity Act.

Examples of reasonable accommodations include:-

making facilities at the place of employment accessible;
job restructuring/task re-assignment;
provision of an assistant or support staff;
special equipment or devices.

Training:

In this phase, the client is referred for identified training opportunities. The training is provided by accredited training providers and often takes the form of learnerships.

Work trial:

When a client is ready to be placed into a job they often complete a trial period. The occupational therapist who works with the client will play a largely supportive role and will problem solve in order to resolve any problems that may arise during re-integration into the open labour market.

Work placement:

This is when the client is permanently placed into a position in the open labour market.

Follow-up:

This is often an ad-hoc service, following placement.

Methods of work assessment:

Work tasks are used to determine the client’s work abilities. The client’s work performance is measured against the open labour market standard.

Work samples:

These are all standardised tests used in work assessment. These tests have been devised to determine the client’s current capability and can be used to predict future capability. Examples include Valpar’s Component Work Samples, MODAPTS, the BTE tree etc.

Real work:

If the client is employed at the time of assessment, his/her assessment includes assessing specific components as per job description. Assessment within the actual work environment (work/site visit) is widely used. In this instance, the client is observed while performing his/her job at the place of work. The information gathered by using this method of assessment is a very valuable part of the assessment, because it often highlights the impact that workplace relationships have on the client’s work performance.

Simulated work tasks:

These include all tasks used within the work assessment unit. While it is not always possible to simulate the client’s actual work tasks, it is possible to assess the basic components of the tasks through simulation. For example, if the client was a machinist in a clothing factory, the basic components of his/her job are:

operating a sewing machine;
maintaining a seated position for a full day;
working within a production line;
working neatly and accurately, while maintaining a predetermined work speed;
attaining a certain production standard;
judgement re quality of completed work;
problem solving and independently correcting errors.

The above components can be assessed by identifying and choosing other tasks (available in the work assessment unit) that have the same basic components.

Work / site visits:

Allows for the opportunity to see the worker in their work environment.
Highlights physical and psychological environment (stressors, dimensions, health and safety issues).
Provides the opportunity to identify and evaluate alternative job options.
Allows direct access to co-workers and supervisory staff.
Allows the assessor the chance to try out the job!

Recommentations:

At the end of the process, one of the following recommendations are made:

Work hardening/work preparation.
Open labour market placement.
Reasonable accommodations.
Supported employment.
Medical boarding.