Employer-Based Rehabilitation.

This article examines a new methodology in the field of vocational rehabilitation called Employer-Based Rehabilitation. This approach involves conducting as much of the rehabilitation process as possible in the context of real worksites. Special attention is paid to the assessment of functional work skills. Research drawn from systems analysis and cognitive learning provide the theoretical constructs for this approach. The benefits of this approach are twofold. First, in-context assessments produce results that hold a high degree of face validity for the client, thus increasing compliance and follow through. Second, in-context assessments produce results that are durable in the real world of work, leading to positive employment outcomes. The application of employer-based rehabilitation techniques requires specific skill sets, which constitute future professional development suggestions.

As the demands of the labor market change, so must our approach to vocational rehabilitation. Employability in the years ahead means more than having the appropriate functional capacities to do a job--it also means developing the ability to "hit the ground running!"

For many of us who work as rehabilitation consultants, there appears to be a discrepant gap between the shifting demands of the current labor market and the skills and abilities of many of the clients we work with. Some people are going to get left behind. To ensure that it is not our clients who get left behind, we need to think of new vocational rehabilitation strategies to bridge that gap between the labor market and our clients.

One method is to place our clients in the context of the labor market from the very first stages of their rehabilitation process. This means conducting as many of the vocational assessment and training steps as possible in real work settings. This method is called Employer-Based Rehabilitation. It is a straight forward way for both the client and the rehabilitation consultant to find out what it is going to take to compete successfully in today's labor market.

This article examines events that have led to the need for Employer-Based Rehabilitation. Special attention will be paid to the assessment phase of this tested, proven and effective method.

Why Employer-Based Rehabilitation Now?

In the current economy, although we can reliably predict a suitable job match based on transferable skills, interests and functional capacities, it is much harder to predict actual employability, because the labor market itself has become far more complex than ever before.

One example of this challenge was highlighted by The Honourable Cam Jackson in his Discussion Paper on Workers' Compensation Reform in Ontario, Canada (1996). He suggests that increases in Future Economic Loss payments are more a result of adverse labor market conditions than of compensable injuries. Job matches are being made through sound vocational evaluation methods, but "too many workers are having jobs imputed to them that may not exist in the labor market" (Jackson, 1996). As a result, the new Workplace Safety and Insurance Board (WSIB) will focus on enhancing employability through "best practices" measures. The ultimate responsibility for re-employment will be placed with the injured worker and the employer.

There are similar problems in other sectors, such as private insurance companies and municipal income maintenance and provincial vocational rehabilitation (VRS) programs, where return-to-work plans look good on paper, but get stalled in the ever-tightening labor market.

Added to this is the complication of current economic conditions. In response to this, many sectors of the social welfare system have made significant changes. For instance, WSIB has instituted reform measures that reduce the amount of direct rehabilitation services. The new focus is on workplace party self-reliance, accompanied by a stiff set of rights and obligations for both employers and injured workers. Insurance companies are critically examining the monies they pay out for rehabilitation plans, looking for accountability and outcomes. Workfare measures and tighter eligibility requirements have hit the municipal general welfare assistance sector. Provincial VRS programs are reorganizing their entire delivery system. The bottom line is: There is no more money--anywhere.

When vocational rehabilitation services are examined in light of the realities of both the labor market and current economic conditions, the conclusion is clear: Find the shortest route to rehabilitation. Get the client back to work as soon as possible.

Employer-Based Rehabilitation is an approach that can maximize efforts to strengthen the ties between clients and employers. Insurance companies are looking at rehabilitation plans that incorporate "real work" as an aspect of treatment in order to minimize the time the client is out of the labor force; municipal income maintenance programs are emphasizing a "work for welfare" approach in order to tie work to benefits; and vocational rehabilitation is considering how it can refocus its efforts onto job placement services for employable people in order to streamline service delivery. For all of these concepts, Employer-Based Rehabilitation is a method that can solve many of the massive challenges facing our service delivery system in the coming decade.

In-Context Assessments

Vocational rehabilitation can be defined as a series of six identifiable stages: Screening, Diagnostics, Work Evaluation, Adjustment Planning, Work Hardening, and Job Placement (Wright, 1980). The first four stages involve conducting tests and evaluations designed to answer specific assessment questions: "Is this person employable?" "If this person is employable, what jobs is he or she suited for and what do they need to get that job?" "Is there a job like that anyway in this person's local labor market?" and, finally, "What should happen next?" (Lougheed & Hunter, 1994). It is clear that in order to move quickly and effectively through this entire rehabilitation process our ability to predict what a person will be able to do during the assessment stages is paramount (Wright 1980).

In Employer-Based Rehabilitation, one of the most notable features of the assessment phase is that functional work skills testing is conducted in real work environments. This is called an "in-context" assessment.

A brief explanation of systems theory helps to define why "in-context" assessments are effective. Peter Senge (1990), a well-known contemporary author who studies the relationship between human behavior and systems, recently wrote that when people, no matter how different, are placed in the same system (environment), they begin to behave the same and produce the same results. Cognitive learning theorists have known this for some time. Albert Bandura (1977, 1986) labelled this phenomenon "reciprocal interaction," and described it as a process involving the following series of events: a person behaves in a certain way; this causes a response in his/her immediate environment; the person then reacts to the response or cue from his/her environment with another behavior. Simply put, people in the same environment behave in similar ways because they are responding to similar cues.

When you apply this theory to vocational assessments, a fascinating trend emerges. Clients who are placed in the context of real work during their vocational assessment begin, very quickly, to act like workers. They are responding to the same cues as other workers in their environment. When a client is acting like a worker, a number of benefits arise for both the client and the assessor.

1. The client experiences elevated levels of self-esteem, facilitating faster movement through the rehabilitation process. In our culture, work is viewed as a valuable and worthwhile activity. When a client begins to feel like a worker, he/she experiences feelings of self-worth and respect. This is a critical factor in any client's successful rehabilitation (Janis, 1982). In order to move through those six steps in the rehabilitation process, a client must have enough self-esteem to motivate him/herself to make the necessary changes inherent in becoming independent. The development of self-esteem can begin with the real-life experience of being assessed in a workplace.

2. Testing has excellent face validity, facilitating client acceptance and compliance. Face validity is one of the criteria used to measure the effectiveness of a test. It refers to whether the test being administered looks as though it measures what it is designed to measure (Adams-Webber 1996). Testing for work capacities by actually doing real work in real-work environments has a high degree of face validity. This encourages the client to become engaged in the assessment process (Healy, 1990). In addition, test results are viewed in a more favorable light by the client, as there is no mystery as to how those results were produced. This leads to the development of rehabilitation plans which enhance client acceptance and compliance.

3. Both work skills and work behaviors can be assessed, increasing the predictive value of assessment results. Research into employability and job retention indicates that the primary reason people cannot get a job or keep a job is not due to lack of work skills, but rather due to lack of work behaviors (Brown, 1983)--sometimes referred to as associated work skills or soft skills. This has become an even more critical factor in the current labor market. It is hard to assess work behaviors unless a client is actually trying to behave like a worker, and the very best way to get a client to behave like a worker is to place him/her in a work environment where reciprocal interaction will be in effect.

Motivation, Self-Efficacy, and Follow-Through

The necessary mandate of vocational services is to facilitate the fastest return to work possible. This means coming up with realistic answers to the four assessment questions on the previous page--answers that will stand up in terms of both labor market opportunities and client follow-through.

Finding out about local labor market opportunities is a fairly straightforward procedure. Many rehabilitation consultants now routinely conduct a formal labor market analysis as an integral part of any assessment.

Client follow-through is more challenging. To accurately predict the likelihood of client follow-through, it is important to understand what motivates people, and how to capture and use this motivation to propel a client quickly through the entire rehabilitation process.

Research into what motivates people indicates that they will only follow through with activities they believe they are capable of doing (Betz & Hackett, 1981). These beliefs, called "self-efficacy expectations," relate not so much to one's objective skills as to one's beliefs about personal capabilities. When people get pushed into activities that they do not believe they are capable of, they tend to quit in response to even minor difficulties. Many of us working in rehabilitation have had the frustrating experience of working with a client who quits a wonderful job in response to some problem that, in our eyes, appears quite easy to solve. It is likely that self-efficacy beliefs are at work in this situation.

The challenge in Employer-Based Rehabilitation is to define a client's self-efficacy beliefs, and then facilitate an increase in these beliefs. The goal is to help the client achieve a sufficient level of self-efficacy beliefs to move from a position of dependence to one of self-directed behavior during his/her rehabilitation. This is where the unique assessment design of Employer-Based Assessments comes in.

There are two important principles inherent in the design of an Employer-Based Assessment. First, the most effective way to discover a person's self-efficacy beliefs is to have him/her participate in authentic experiences (actual as opposed to simulated activities) and measure his/her own performance (Krumboltz & Thorenson 1961; Bandura, 1986). Second, the most effective way to increase levels of self-efficacy (that is, to facilitate learning, growth and change) is to allow a person to try increasingly demanding activities in an authentic environment (Knowles 1980; Abbey-Livingston & Kelleher, 1988; Senge, 1990).

When these principles are applied to assessment design, the result is a process that involves the systematic tracking of a client's capabilities in response to real work activities. For example, one work environment that has been frequently used as an employer-based test site is the warehouse department of Home Hardware Stores. One of the specific jobs there is pricing flashlight batteries. The process of assessment involves working alongside the client for the entire testing time, completing the same functional activities together. At regular intervals (usually one hour), the assessor and the client stop to examine the functional work demands embedded in the job.

Every job has physical, emotional and cognitive demands (Lougheed, 1996). For instance, for the job of pricing flashlight batteries, the physical demands would include:

* standing on concrete

* lifting under 10 lbs.

* fine motor control.

The emotional demands would include:

* doing repetitive work

* working with others

* working in a chaotic environment.

The cognitive demands would include:

* literacy

* numeracy 

* comprehending instructions.

This partial list illustrates the demands embedded in a job. An important feature of this list is that it is written in everyday language, so the client can understand what the terms mean.

Once this list is completed, the assessor then helps the client to rate his or her own capacity for each identified work demand, using a numerical/descriptive adjective rating scale. Use of such a rating scale is another important feature, because it helps clients to organize and report their observations in a consistent fashion (Colten & Janis, 1982; McCue et. al., 1994; Pruitt, 1986), which, in turn, leads to consistent test results. If physical and emotional baseline scores are incorporated into this process, ongoing tolerance data can also be reported, rounding out the assessment results.

A complete Employer-Based Assessment involves conducting this process in a variety of different worksites (preferably four), in order to gather a broad range of functional work capacities and to increase the reliability of the results (Polster & Lynch 1981).

Final results from all test sites are averaged together and plotted on a graph. The vertical axis of the graph details each specific physical, emotional and cognitive function. The horizontal axis provides a percentage rating for each function in terms of employability.

A number of benefits arise during the Employer-Based Assessment process.

1. The client's self-efficacy beliefs are defined, raising the predictive value of test results. The rating scores themselves give both the client and the assessor insight into the client's self-efficacy beliefs. This is critical when predicting what should happen next. Research indicates that self-efficacy beliefs are the highest predictors of future behavior (Schrauger & Osberg 1981; Brooks 1990).

2. The client develops the potential for independence quickly. As the client goes through the process of repeatedly observing and scoring his/her functional work capacities at real worksites, he/she begins to develop a heightened degree of self-awareness. This is critical from a cognitive standpoint. Research indicates that self-awareness is the first essential step in becoming independent. Once a person develops self-awareness, he/she can develop self-control, and this in turn leads to self-directed change (Bandura, 1986). It is an incremental, step-by-step process. Systematically recording events and personal changes while performing specific activities (Janis, 1982) speeds up the developmental process.

3. Assessment results present a list of transferable skills, which can easily be integrated with a local labor market analysis to produce reliable job matches. The first thing that one notices about the functional demands analysis list is that it looks like a list of transferable skills--and indeed, that is just what it is. By focusing on functional demands rather than on the total job itself, the results of an employer-based assessment can easily dovetail with the traditional job-matching approach, wherein the traits of an individual are matched with the factors of a job (Parsons, 1909). The addition of a local and recent labor market analysis can produce a comprehensive and accurate assessment.

4. The client is engaged and motivated, increasing the likelihood of follow-through. The motivation to act comes from feeling in control and capable (Krumboltz & Thorenson, 1964; Krumboltz & Schroeder, 1965; Abbey-Livingston & Kelleher, 1988).

The design of the Employer-Based Assessment described above casts the client in a powerful position. The shift away from the "test and tell" approach enhances motivation by giving the client the actual experience of being in control and developing his or her own answers (Crites 1981).

Hitting the Ground Running

In order to "hit the ground running," rehabilitation professionals and their clients must be in tune with the realities and demands of the current labor market. As rehabilitation consultants, we can help our client do this by placing them in the context of the real work environment right from the initial stages of their rehabilitation. We can speed up the process by using an assessment design that casts clients in a powerful, strategic position that maximizes their ability to become independent.

In order to maximize our ability to conduct Employer-Based Rehabilitation, we need to learn several new strategies and techniques. Our professional development over the next 5 years should equip us to:

* understand cognitive learning theory and adult learning theory as they relate to the rehabilitation process;

* increase the validity and reliability of single-subject tests in vocational assessments;

* complete an effective functional demands analysis and facilitate client self-scoring of functional capacities; and

* set up worksites in the community and work effectively with employers.

Armed with these new skills, we all have the best chance possible of "hitting the ground running!"

Bibliography

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Ms. Lougheed is president and chief executive officer of Northern Lights Vocational Services. She developed a model for Employer-Based Rehabilitation in 1985. She and her staff have been successfully conducting Employer-Based Assessments and Training throughout Ontario for the past 15 years with clients referred from insurance companies, insurance case managers, Workers' Compensation Board, Vocational Rehabilitation Services, Canada Pension Plan, lawyers, and Human Resources Development Canada. She is also a professional staff trainer and has co-authored and delivered training in vocational assessment skills, understanding the vocational impact of a disability, employability, and self-directed work teams.