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