Monday, February 13, 2012

The ability paradigm in vocational rehab

The Journal of Occupational Rehabilitation just published “The ‘Ability’ Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program.” This article examines the “grey zone” between ability and disability as it affects vocational rehab for those with permanent disabilities or chronic health conditions in Ontario’s WCB system.

The short of it is that focusing on workers’ abilities in the workplace underestimates the impact of chronic and unstable health on return to work. For example, the impact of medication on workers’ ability to focus or even attend programming poses a significant barrier to program completion, let alone reintegration into the workforce. Further, the medical accommodations required by students to complete the program may not be available in the workplace, meaning program completers may not be able to function in the workplace.

WCB-related incentives (including those associated with experience rating) encourage employers to direct the least capable workers into this program. Specifically, employers are penalized for putting workers into the program (thus kept them at work on modified duties as long as possible). Those workers who were sent to the program tended to be those who could not (or no longer) be accommodated in the workplace. This creates a reverse creaming effect for the program.

The article also discusses the effect of contracting out this service and the complex communication pathways on the ability to providers to know and address the needs of workers. The net effect (and I’m summarizing some) is that workers deemed employable (which is often the point workers’ compensation benefits are reduced or cut off) may have difficulty securing employment after participating in the program because focusing on worker ability tends to ignores important environmental conditions.

-- Bob Barnetson

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