Lecture # 512:
The Vocational Rehabilitation Plan

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

Now that we have looked at all of the various types of information that are needed for knowing a client well, we begin to plan for the job he will try to find. By this time, the client should know his strengths and liabilities. They also know themselves better and the type of work they want to do.

For younger people, occupational choice is varied. For the middle-aged person who loses a job because of an injury, technological changes, or other reasons, there are certain considerations. The choice of a new career should be based on the older person's experience and training. It is best to avoid revolutionary changes in work if their previous work was satisfying. For example, an older person with a job in bookkeeping is not likely to become a sports trainer. He will find a job that relates to his experience. Additionally, adjustment to a vastly different career may become too difficult for him.

Meditate Word By Word On These Verses:
Acts 9:10-19.

Problem Solving Sequence of Rehabilitation
Usually client concerns can be translated into problems that can be solved or decisions to be made between two or more alternatives. The problem-solving and decision-making sequence can be used to help a client solve a problem or make a decision. This sequence can also be taught to a client so that he can use it to solve his own problems in the future without outside help.

The sequence is as follows:

  1. The client must be willing to engage in the process of understanding himself and solving problems.
  2. The problem must be identified clearly or the goal made understandable.
  3. Alternatives to the decision he needs to make are identified.
  4. Pertinent information is collected, either through verbal explanations, research, other instructional aids, or tests.
  5. The resulting data and the results of the various testing is discussed.
  6. The individual's values are considered so that he knows what his priorities are: dislikes and likes, abilities, family situation, social goals, and practical considerations.
  7. Before a decision is made, review of all the previous steps (goals, choices, negative and positive results) is done.
  8. A choice is made and the course of action is devised.
  9. The chosen alternative is tried and evaluated periodically since new information may be discovered or the plan changes.

How will such a sequencing help a client? Our example is Ivan Ivanovich Ivanov, a young man who worked as a builder. This is a brief summary of the personal and vocational assessment. He is 25 years old, married, and has a son. He is physically strong. He lives in a one-room apartment, which he managed to buy in a suburb of Moscow. His family also lives there. He graduated from high school and attended a trade school for builders. He was not much interested in school studies. There have been times when he earned extra money working with a close friend who is a plumber. His wages were 8,000-10,000 rubles every month. At times, he made more money working for different employers.

When he was working, he fell and hurt his back. He did not have surgery, but his doctor said that it would be wise to change his profession. He needs a job where he is not lifting a lot of weight. The doctor recommends a job lifting 10 kilograms (25 pounds) maximum. His doctor has given him exercises to strengthen his back muscles. When looking at his assessment, we find that he did not like school. He always liked working with his hands, which tells us that he works better with things than with people. He did like his co-workers and sometimes they gathered to celebrate birthdays or went fishing together. His interest preference is for mechanical work, using machines, hand tools, and other calibrating instruments.

He has aptitudes for manual dexterity, eye-hand-foot coordination, and spatial concepts. His personal traits include ability to make decisions based on sensory judgment, ability to perform his job even if stressful or somewhat dangerous, and ability to perform work according to a set of procedures. His former job required that he lift 10 kilograms (50 pounds).

His wife works and their child goes to kindergarten. If possible, he wants to continue living in his hometown to be near relatives and his aging parents. His wife wants to have increased salary and a car. She does not necessarily want to move into Moscow. She is sometimes upset when he sits at home and watches television all day. He likes the out-of-doors and fishes with his friends or father when he can, in winter and summer.

He is not happy with the doctor's decision because he feels young and strong, but the back pain is difficult to bear when he has it. He has never done any other type of work since technical school. He sometimes thinks that he should just go back to his former job and bear the pain. The work he did as a plumber used his skills, but was not too interesting for him, but he liked working with his friend. He has never had to search for a job before.

Now,  CLICK HERE, and fill out only questions 1-11 on the form for "Ivan Ivanov," then keep that form open to fill out the rest later. [You can also use this form later to gather information for any client.]

He decides that he will try doing the plumbing job with his friend. He thinks that he may also be able to work in the same construction firm he worked in before. The doctor did not say that he should not bend over. His wife is a little concerned about this part of the job since bending and stooping are frequent when working with pipes. He starts the job and feels a little sore, but not enough to stop working. You see him after one week of work and ask him how he likes the job and how his back feels. He says that the work is all right, although he does not make as much money. His wife is also concerned about the amount of money he makes since they had plans to remodel the apartment and buy a car.

In one month, he is still working with less pain. Since he seems to be tolerating his job, you decide with him that you can discontinue the case.

Written Rehabilitation Plan
When you work with someone, it is good to make a written rehabilitation plan. By writing out what the counselor will do and what the client will do to achieve the final goal, duties of both people are clear. A written plan includes the information on the following form:

Now go back to Form 512a to fill out the rest of the form (questions 12-16) for "Ivan Ivanov."

There are three important tasks in forming the rehabilitation plan:

  1. The first is to identify if there are any obstacles in finding work and what those obstacles are.
  2. Then the client needs to recognize these obstacles and how to solve them.
  3. Finally, there needs to be a way to show that the person is making progress toward his goal.

From our example above, the goal is to return to work with the same level of pay if at all possible within the limits the doctor has set.

Obstacles to returning to work are 1) back pain and 2) limitations set by the doctor. There is nothing we can do to change the limitations set by the doctor. The back pain is a definite obstacle to return to work. The counselor can find out from the doctor or the client what exercises he is to do for how long, number of times per day, and if the exercise program is helping him. If it is not helping, another type of exercise may be needed or heat and massage. It is the client's responsibility to do the exercises and the counselor needs to know, based on the client's report, if they are helping him to feel better.

The limitations set by the doctor need to be clarified. Are these permanent limitations or temporary? Perhaps since our client is young, he may eventually be able to return to his former job after a number of months or years. Since our client wants to work as a plumber, the counselor must know about that job and how much weight a plumber lifts. It will be the counselor's responsibility to do a job analysis of the plumber's job to find out if the doctor agrees that our client can do that job.

The attitude of the wife may be a problem since she has her own goals for their family. She may become angry with him or with their financial status. The counselor may ask about his relationship with his wife. Perhaps they will need to be seen together to talk about her concerns. It is obvious that her desires may have to wait for a while.

To show that progress is being made toward the last goal of returning to work, the counselor documents in writing his contact with the client every week and the progress he is making in his exercises. When the doctor says he can go back to work, the counselor and client discuss when work will begin. In the weeks following, the counselor checks to be sure that the client does not have further problems with pain or other aspects of job. If there are no further problems, the case is closed one month after the client returns to work.