The following is from an interview with Don Daniels, Vocational Manager at Rainbow Rehabilitation Centers, as he talks about changes in vocational rehabilitation over the years.
Rainbow Visions: Has vocational rehabilitation always been part of brain injury rehabilitation?
Don Daniels: No it hasn’t. In the ’40s and ’50s, you were left on your own. It wasn’t until the ’70s with the strengthening of the role of vocational rehabilitation in medical rehabilitation and when Michigan’s Auto No-Fault law began that more resources for vocational rehabilitation became available.
Vocational rehabilitation became a part of brain injury rehabilitation indirectly. For example, a vocational rehabilitation professional might be called for testimony or to evaluate a person after an injury to determine if that individual could return to work. The vocational professional would then prepare a report of their findings and possibly provide a deposition. Vocational rehabilitation was not originally covered under auto no-fault. Patients/providers sued, and a court determination was made to include vocational rehabilitation under the no-fault law.
Vocational rehabilitation didn’t really take off directly until the ’60s. Then, the golden age of vocational rehabilitation was in the ’80s. That is when more and more insurance companies started using vocational professionals to evaluate a person’s abilities after an injury and determine if they could return to work.
Rehabilitation counselors were some of the first case managers. Vocational counselors performed double duty as case managers because there was such a high demand for both professions. Organizations started springing up to provide the Certified Rehabilitation Counselor (CRC) exam to demonstrate competencies in specific areas of rehabilitation. As the number of people with this specialized certification grew, they petitioned the state to become Licensed Professional Counselors (LPC). With these credentials, one could get a job almost anywhere.
RV: What has changed over the years with vocational rehabilitation?
DD: Changes in rehabilitation have been subtle. When I started, vocational counselors had to perform a Transferable Skills Analysis (TSA). Doing the analysis was how you learned about a client. You would find out their previous work experiences, level of education attained, avocational activities and their physical restrictions as assigned by a physician. The TSA examines all of the skills the client has obtained from all of their jobs and determines if the vocational counselor can find appropriate work based on their experience, physical restrictions and education.
Early on, the tools that were used were the Dictionary of Occupational Titles (DOT) and the current employment outlook report. Forms were used to do a TSA. Counselors would hand draw what looked like a family tree to determine the individual’s capabilities and how much training they may need. This process is now computerized and includes all the data from DOT, employment outlook report and the TSA. You can now enter a person’s work history by Standard Industrial Classification (SIC) code and the program will produce a list of jobs the client could perform. Even so, a lot of time is spent on the phone tracking down available jobs.
RV: Have any laws changed involving vocational rehabilitation?
DD: Yes, laws have changed. For example, the Sobotka Act ruling from the Michigan Supreme Court said that if a person could return to other types of work with current restrictions, their wage loss could be reduced based on what their current earnings could be as determined by job availability and current wages. Insurance companies hired vocational rehabilitation counseling companies to asses a person’s current work capacity and document job availability and wages as part of the reduction in benefits process. Many worker compensation insurance companies used the ruling and vocational evaluations to reduce benefits and set up settlement hearings based on the client’s reduced benefits. The ruling was overturned within a year.
Laws regarding the Licensed Professional Counselor have changed over time, too. Before there was the LPC, vocational counselors had to work under a psychologist for services like mental health counseling. And, just last year, Blue Cross Blue Shield added counselors on their approved list so a LPC could bill them directly. That’s a change we never experienced before. Usually a social worker, for example, had to work under a Ph.D. psychologist for billing purposes. The creation of the LPC is a great benefit.
Terminology has also changed. Early on, when someone couldn’t be competitively employed, they worked in a “sheltered workshop.” While some sheltered workshops still exist, the trend now is “supported employment” with the goal of as much integration as possible. Also, how we look at supported employment is changing as is how we look at vocational success. If we placed somebody in sheltered employment 20 years ago, that was a success. Today success is measured by returning to work in the community.
RV: Has anything remained constant over time?
DD: The one thing that will never change is the need to physically talk with people or pay a visit with an employer regarding an individual seeking employment. Persuasive skills are required to explain why a client would be a good fit and what assistance we could provide to make it easier for the employer to hire the individual. Counselors still have to have personal contact with employers and clients in order to build trust with the clients they serve. These things will never change. But maybe how you do it — using computers and other technology — will change, but personal contact is a necessity.
RV: Why is vocational rehabilitation so important in brain injury rehabilitation?
DD: Because returning to work is the ultimate goal of many individuals with TBI. Having a job can be viewed as returning to normal life.