Module 6: Work Assessment - The Vocational Rehabilitation Process

THE VOCATIONAL REHABILITATION PROCESS:

Work Assessment

The work assessment process consists of:

• Written referral including specific purpose for the assessment and all relevant medical information
• Screening interview and recommendations (if necessary).
• Comprehensive work assessment.
• Reporting with recommendations to the referral source.

This is a basic information gathering session aimed at determining the client’s suitability for a work assessment. This could be carried out at primary level prior to referral or at the assessment unit. Information gathered in the screening interview is used in planning the assessment according to the clinent's individual situation. Common information gathered includes:

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

When information gathered indicates that the client is eligible for disability benefits, a comprehensive work assessment is not indicated.

The work assessment is designed to determine the impact that the client’s impairment or disability has on his/her work performance. The assessment design is specific to each client based on the purpose of the assessment, diagnosis, educational level, previous work experience and skills as well as areas of potential development.

Work assessment aims to assess the work ability of the client. This includes:

• Work habits (time-keeping, personal and social presentation, adherence to rules)
• Work competence (following of instructions, task planning, task evaluation, correcting errors, handling tools and materials)
• Work endurance / tolerance (physical and psychological) .
• Work motivation.
• Productivity (speed, quality) .

This is done by:

• Assessing the affected components of functioning using formal assessment methods such as muscle strength testing using the Oxford Scale and fange of movement impairment measured in degrees, etc.



• Simulated work tasks

These include all tasks used within the work assessment unit. While it is not always apossible to simulate the clients'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
• 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.

• Standardised tests for example Valpar Component Work Samples, MODAPTS, Smith Hand Function Test, Jamar Dynamometer, COTNAB, etc.



• Work/site visits This might include assessing a person in his/her actual work environment and to form a clear idea of the person's work requirements and demands of the work environment.

The assessment period at Groote Schuur Hospital is usually 5 days for a duration of 6 hours per day. The duration of the assessment period differes between service providers.

Outcomes of work assessment:

At the end of this process, the following recommendations could be made:

• Work hardening/work preparation
• Skills training
• Work trial
• Employment in the open labour market
• Reasonable accomodations
• Further medical investigation and intervention
• Further rehabilitation (physiotherapy, occupatioanl therapy, speech therapy, etc)
• Protective employment
• Incapacity to work in the open labour market (disability grant)
• Incapacity to perform own or alternative occupation ("medical boarding")

Work hardening/work preparation

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 accomodations

"Any modification or adjustment to a job or to the working environment that will enbale a person from a designated group to have access to, or participate, or advance in employment " (from the Employment Equity Act, 1998). People with disabilities are identified as a designated group in the EE 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.
• adaptations to work environment and/or task

Skills 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.