Career Rehabilitation: Integration of Vocational Rehabilitation and Career Development in the Twenty-First Century.

The concept of career rehabilitation, a paradigm that proposes integrating perspectives from vocational rehabilitation and career development, is introduced. Counselors are encouraged to assess how vocational handicaps secondary to a disabling problem can affect a client over his or her "worklife" and to adopt a life-span approach to career decision making of people with disabilities. Four common vocational handicaps are discussed: diminished access to work opportunities, need for workplace accommodations, employer bias in hiring and advancement, and diminished "worklife" expectancy. Counselors testifying in legal forums are encouraged to pursue scholarship on the career development of people with disabilities.

Vocational rehabilitation services in the United States have traditionally emphasized the provision of services for persons with disabilities who have vocational potential and have included vocational evaluation, functional assessment, work hardening and reconditioning, work-capacity evaluation, job-site analysis, job accommodations, job-seeking skills, employer development, employment skill training, job placement, and follow-up services (Tate, Heinrich, Paasuke, & Anderson, 1998). During the twentieth century, vocational rehabilitation emphasized placement--a sometimes formidable task for persons with disabilities. Longer term career planning issues, including issues related to career fulfillment and consideration of the interaction between occupational demands and implications associated with the progression of a disabling problem, often were overshadowed by the imminent focus on returning people with disabilities to the workforce.

Eisenberg (1995) defined disability as the "status of diminished function, based on anatomic, physiologic, or mental impairment that has reduced the individual's actual or presumed ability to engage in any substantial gainful activity" (p. 68). According to the U.S. Department of Education (1998), 18.7% of Americans between the ages of 15 and 64 have a disability. Of those Americans with a disability, 10% have been classified as not having severe disabilities, and 8.7% have been classified as having severe disabilities. President George Bush said, when signing the Americans with Disabilities Act (ADA) passed in 1990, "Let the shameful wall of exclusion finally come tumbling down." Despite the ADA, however, many vestiges of workplace exclusion have persevered, and the previous millennium ended with many alarming statistics about the disparity in career development opportunities between people with disabilities and those who are not disabled. For instance, compared with people without disabilities, people with disabilities are less frequently employed and have lower earnings (U.S. Department of Education, 1998). Only 31% of people with disabilities who were college graduates in 1998 were employed (compared with 85.3% of those who were high school graduates and not disabled), and only 53.4% of people with disabilities with college or graduate degrees participated in the labor force (compared with 90.3% of those without disabilities). Attaining higher levels of education and developing specialized skills seem to be methods for people with disabilities to mitigate their loss of career development opportunities.

Almost a half century ago, Super (1951) provided definitions of career and career development that continue to be frequently cited. He defined career as "a continuous, lifelong process of developing and implementing a self-concept, testing that self-concept against reality, with satisfaction to self and benefit to society" (p. 88).

The self-concept and reality challenges that sometimes confront people with disabilities can have broad implications for career development that lead many people with disabilities to underachievement and inadequate fulfillment. Beyond the obvious humanistic virtues associated with promoting equality in career development opportunities for people with disabilities, there is an acute economic need to harness the talents and potential of all who can contribute to society. This millennium begins with projections of labor shortages, significant need for persons with specialized talents, shrinking percentages of people contributing to the budget of the Social Security Administration, and a growing population of people with disabilities. Improved medical care and public health have helped reduce the death rate and lengthen life expectancy. At the end of the twentieth century, adults 65 years of age and older made up the fastest growing age segment of society (Mitchell & Kemp, 1996). These are but a few of the societ al forces that command the concentration of efforts on the wellspring of virtually untapped and underdeveloped potential promised by the growing population of people with disabilities. I hope that the twenty-first century will bring the dawn of an era when career counselors and vocational rehabilitation counselors merge common aims and work collaboratively to promote career development opportunities for people with disabilities beyond job placement and when they adopt a philosophy of career rehabilitation.

Common Vocational Handicaps

Vocational handicaps secondary to a disabling condition can cause a reduction in physical or cognitive capabilities and psychological functioning that can compromise career development. In addition to the functional deficits caused by a disabling problem, including physical limitations and problems with cognition, career counselors must also consider the psychosocial aspects of disability. For instance, Rohe (1996) reported a study that examined the vocational interests of middle-aged men with traumatic spinal cord injury. The results indicated that, compared with a matched group of individuals without disabilities, individuals with a traumatic spinal cord injury tended to be more introverted, less academically oriented, and primarily interested in physically challenging and action-oriented occupations. Problems such as poor self-image and low self-esteem can develop into tendencies to discount abilities, squelch risk taking, and spawn a self-fulfilling prophecy that reinforces underachievement. Resilience, o r successful adaptation to the type of trauma that can be caused by an injury causing a permanent impairment, has been associated with cognitive capacity and interpersonal attachment (e.g., Matsen & Coatsworth, 1998). Factors such as these should be assessed to identify and harness vocational assets that can offset career-related disabling problems.

Depicted in Figure 1 and discussed in the following section of this article are common vocational handicaps that people with disabilities can experience. In some cases, the handicap may be latent or not become manifest during the career of a person with a disability. Nevertheless, career counselors who provide services to people with disabilities should be aware of the potential impact these vocational handicaps pose.

Diminished Access to Work Opportunities

The U.S. Department of Labor's 1991 Dictionary of Occupational Titles recognized 12,741 occupations in the U.S. workplace. These occupations are categorized by numerous factors, including exertion and skill levels required to perform the various occupations. Individuals with functional limitations--either physical or cognitive--could have their access to viable occupational alternatives diminished.

Consider, for instance, the case of a regional sales manger, with responsibilities for a multistate territory, who sustained a lower back injury. The injury and secondary problems with chronic pain prohibited the manager from pursuing the extensive air travel associated with her job. Because the need to be highly visible in the territory was determined an essential job function and the only way this could be accomplished was by air travel, there was no reasonable accommodation the manager's employer could make. Consequently, because of her inability to perform an essential job function, the manager's employment was terminated. When she sought other employment, the manager found that her disabling problems exempted her from comparable jobs that required physical demands no longer within her capacity. She had lost access to occupational alternatives that were available to her before she became injured.

Loss of access to workplace alternatives can be most profound for individuals who have experienced a diminution in cognitive functioning. For instance, a moderate head injury sustained by an investigator in a traffic accident resulted in residual cognitive deficits that included impairments in short-term memory functioning and sequential thought processing. Although physically intact, the former investigator was no longer capable of performing his prior work or the kind of work in which he had developed considerable expertise. Because of his inability to apply many of the higher order transferable skills

that he had developed during his career to occupational alternatives that had been available to him before he became injured, this individual's access to the labor market diminished significantly.

The implications of loss of access to the workplace can include longer search time between jobs, diminution in competitiveness for employment and career advancement, and loss of ability to pursue employment offering higher levels of compensation. Prevailing conditions associated with the economy and locale may also be relevant considerations in identifying accessible options.

Need for Workplace Accommodations

Although the ADA mandated employers to provide "reasonable accommodations" to qualified individuals with a disability capable of performing the essential functions of a job, questions about when a reasonable accommodation is merited, what constitutes a reasonable accommodation, and when employers are responsible for making reasonable accommodations were widely debated during the 1990s. The ADA establishes parameters to guide employers in considering how to accommodate persons with disabilities but does not prescribe particular accommodations for specific situations (Bruyere & Kim, 1999).

Some employers are unwilling to make job accommodations--regardless of any obligation they may have vis-a-vis the ADA. Other employers may be dismayed about the prospect of extending special conditions, because of concerns about cost or the implications of treating selected employees in a preferential manner. Career counselors can help dispel unfounded notions about what is involved in making reasonable accommodations.

Workplace accessibility is often the most restrictive barrier that people with disabilities encounter. Examples of workplace accommodations to mitigate this problem were suggested by the Equal Employment Opportunity Commission (1992), and included the following:

* Making facilities readily accessible and usable

* Restructuring a job by reallocating or redistributing marginal functions

* Altering when or how an essential job function is performed

* Adopting part-time or modified work schedules

* Obtaining or modifying equipment or adaptive devices

* Modifying examinations, training materials, or policies

* Providing qualified readers and interpreters

* Reassigning to a vacant position

* Permitting use of accrued paid leave or unpaid leave for necessary treatment

* Providing reserved parking for a person with a mobility impairment

* Allowing an employee to provide equipment or devices that an employer is not required to provide

Emerging industries, such as electronic commerce, continue to transform the landscape of today's workplace, potentially offering work environments and work opportunities that allow people with disabilities to pursue their career development in new ways. New and developing technologies, home-based employment, and creative solutions to overcoming barriers that limit people with disabilities from fully accessing the workplace offer the best opportunities for accommodating problems with workplace accessibility.

Employer Bias in Hiring and Advancement

Of course, the existence of laws that prohibit discrimination against people with disabilities does not mean that in everyday practice discrimination in the workplace will cease. People with disabilities are vulnerable to bias by employers in all spheres of their potential employment--including selection, staffing, and advancement and promotion.

The core of discrimination--namely, prejudgment--can unfairly constrict an individual's career development opportunities. Prejudgment of the extent and the degree of a person's disability can occur on both conscious and unconscious levels. On the basis of the appearance of a person with a disability, and perhaps on the basis of some personal or stereotyped information known to an employer about a disabling condition, employers sometimes make attributions about the competence, stamina, capabilities, limitations, and public image of a person with a disability that can have a significant impact on that person's career development. Whether these attributions are accurate is secondary to the potential adverse impact posed to the persons with disabilities.

In general, the more visible the disability, the more likely an individual's disabling problems are to be recognized by an employer and subject to negative prejudgment. Some disabling conditions--such as multiple sclerosis, diabetes, or cancer--may go undetected. However, highly visible disabilities can invite skeptical prejudgment about a person's work potential. Severe disfigurement--such as cosmetic scarring, a burn injury, or amputation--is apt to generate the highest level of bias by employers. Of course, severe disfigurement can also have a deleterious impact on an individual's self-image and self-esteem, consequently altering choices a person with a disability may consider in his or her career decision making.

Diminished Worklife Expectancy

Of all vocational handicaps, the potential for a diminished worklife often poses the greatest threat to an individual's future earning capacity. This tends to be particularly true for younger individuals with a significant disability. Among the factors that most often cause a person's worklife to be prematurely shortened are degenerative changes and complications associated with a disabling problem.

Consider the case of a 39-year-old customer service clerk employed by a government organization. After a serious injury to her dominant hand and wrist that required four surgeries, her employer accommodated her by redeploying her to a telephone-based position, purchasing a telephone headset for her use, and modifying her job responsibilities so that she was no longer required to perform data entry tasks. These accommodations allowed the customer service clerk to remain employed at the same rate of pay she had received before being injured. However, ensuing problems with degenerative arthritis and chronic pain caused the customer service clerk to assume a part-time work schedule 2 years later. Her work career ended at age 43 after she was formally diagnosed with reflex sympathetic dystrophy, a progressively disabling problem that can cause intense pain and loss of function. Accordingly, she was unable to pursue her career development and earn employment income.

Some disabilities, such as some types of spinal cord injuries that cause paraplegia or quadriplegia, are associated with a progressive degenerative course that truncates worklife expectancy. Age 55 tends to be a benchmark year for significant spinal cord injuries. On the other hand, the disabling problems caused by a disease such as multiple sclerosis can remain in remission indefinitely before an exacerbation of symptoms reemerges.

When counseling a client with a possible work disability on midterm and long-term career planning issues, career counselors must be cognizant of potential functional changes that may have an impact on the client over the course of his or her career development. For instance, consider a teenage student diagnosed with narcolepsy, a neurological disorder that causes sleep and fatigue, often at unpredictable times. What level of functioning can this person be expected to have in 15 or 20 years? What types of occupations would be contraindicated because of anticipated problems with sleepiness and attention deficits? What can be done to remediate the type of problems the person will likely encounter in the workplace? Advance planning can be useful in helping clients identify work options and make decisions that will enable them to make career transitions into flexible employment situations, such as home-based employment, that will enable them to maximize their worklife.

Assessment of Vocational Handicaps

Does the presence of a vocational handicap infer that an individual will realize a disruption in career development or imply that an individual will sustain a loss of future earnings? Not necessarily. Rehabilitation professionals recognize that it is possible for a disabling problem to have no or minimal impact on an individual. Frank (1999) recommended that the practice of rehabilitation psychology be viewed as the application of psychological constructs to the care of individuals with chronic health conditions that are often, but not necessarily, disabling. A career rehabilitation mindset, should, however, consider latent vocational handicaps that may ultimately affect an individual. Proactive assessment of both manifest and latent vocational handicaps can prove to be invaluable in helping clients make necessary adjustments to enhance their career development opportunities.

The fundamental aim of vocational rehabilitation is to minimize the potentially adverse impact of a disabling problem by assisting people with disabilities to secure and maintain employment. From a career-rehabilitation perspective that embraces a life-span consideration of the interaction of client-specific career development issues and disabling problems, this can be best accomplished by thoroughly assessing the implications for career development caused by a disabling problem (including anticipated or potential degenerative problems caused by a disabling condition) and then determining how potential career-related problems could be alleviated through interventions such as client motivation, transferring acquired skills to occupations within the individual's capabilities, planning for near-term or later career change, retraining, or ergonomic adaptation. The spirit of career rehabilitation involves embellishing capabilities, maintaining a "can-do" career development outlook, and engaging in creative proble m solving about how to overcome limitations associated with a disabling problem.

Assessment of the impact of a disability on career development is complex and varies among clients. The prognosis for the ability to a make a positive career development adjustment after acquiring a disabling problem varies between individuals with similar demographic characteristics and constellations of disabling problems. In addition to the areas of analysis already discussed, an assessment of how an individual's career development may be affected by a disabling problem should include a consideration of the potential for positive vocational adjustment, the stage of career development (Super, Savickas, & Super, 1996) that had been attained at the onset of disability, and the acquisition and transferability of skills (Field & Weed, 1988) to career opportunities that remain viable. In the case of an individual who has acquired a disability after a period of career development, an analysis of factors such as work propensity, demonstrated earnings history, postinjury efforts to advance career development, and potential reasons for not aggressively pursuing career development (e.g., child care responsibilities, lack of financial need, pending litigation related to the disability, secondary gain of some type) can provide additional insight into the degree to which a potential vocational handicap will affect a person's career development.

Counselors as Forensic Experts and Scholars

Among those people who are most aware of how disabling problems can affect individuals during their career development are counselors who render opinions in litigated matters in which career development issues are in dispute. In this forum, counselors render opinions about an individual's career development potential. Examples of the types of questions posed include the following: What career opportunities may be viable for an experienced millwright who sustained orthopedic injuries that have reduced his functional capabilities to the sedentary level? Is a 52-year-old executive, diagnosed with clinical depression after a suicide attempt and psychiatric hospitalization, capable of returning to work and moving ahead in her career? What viable career opportunities exist for a new nursing school graduate diagnosed with leukemia? In an adversarial context, counselors must consider the unique circumstances associated with cases such as these and the relevancy of the types of vocational handicaps that have been disc ussed in this article.

A qualified opinion rendered during legal proceedings must be able to withstand the scrutiny of intense and hostile cross-examination to be considered credible by a jury or other triers of fact. Attorneys routinely attempt to dispel the testimony of an opposing expert witness by impeachment, a process through which an adverse attorney suggests that the counselor's opinion should be dismissed or given less weight. Examples of techniques used in attempting to impeach an expert witness who is testifying on career issues include suggesting that there are inconsistencies in the counselor's current opinion and opinions previously rendered, implying that the counselor's testimony is subjective and is biased because of a financial incentive, attacking the methodology of the counselor to suggest that conclusions are flawed, and suggesting that the counselor's professional background is somehow deficient.

While authoring this article, I was mindful that among those people likely to compose its readership are attorneys in search of a work sample that could somehow be contorted to impeach me--a counselor who provides testimony on career issues in legal settings--as an expert witness during cross-examination. The existence of this type of thinking is troubling and invites self-censorship. I have actually been discouraged by attorneys from pursuing research investigating the career development of disabled people with warnings that regardless of the results, my work could be used to attempt to discredit my future testimony and damage my career development.

The irony that those individuals who are most knowledgeable about a subject are not so subtly discouraged from pursuing new knowledge and illuminating the broader community is an artifact that transcends human existence. From Socrates's condemnation following his challenges of traditional ways of thinking; through the shunning of Galileo for his research supporting ideas, first promulgated by Copernicus, that the Earth and planets circle the sun; to the early twenty-first century courtroom, the suppression of knowledge by those people threatened by the notion of loss of power or control has been a force. A counselor's obligation is to avoid self-censorship and remain resolute in pursuing scholarship that advances thinking about career rehabilitation.

Conclusion

I recall hearing space shuttle astronaut Norm Thagard speak in 1985 about the impending colonization of space and the associated implications for a new work environment. During his speech, he pondered how weightlessness could transform the workplace as we know it. In a weightless work environment, Thagard postulated, the types of limitations that confront wheelchair users and other individuals with mobility impairments on Earth would be eliminated. Imagine that a highly restrictive vocational handicap prevailing in one environment could be totally eradicated in another environment. Fifteen years later, I continue to recall this concept with a sense of awe and with feelings of inspiration and liberation.

Astronaut Thagard's prophecy will ultimately be fulfilled. New frontiers that allow people with disabilities access to career development opportunities that those people without disabilities take for granted will invariably continue to evolve as they did during the latter years of the twentieth century. As counselors committed to promoting the career development of all people throughout their life span, this sort of vision exemplifies the type of mindset necessary for practitioners of career rehabilitation to adopt.

Michael Shahnasarian is the president of Career Consultants of America, Inc., in Tampa, Florida. Correspondence regarding this article should be sent to Michael Shahnasarian, Career Consultants of America, Inc., 11019 North Dale Mabry Highway, Tampa, FL 33618.

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