Vocational Theory and Practice

MODELS IN VOCATIONAL REHABILITATION:
Biopsychosocial-Spiritual Model:
The biopsychosocial-spiritual model combines aspects of the medical and social models of disability. It focuses attention on ways to change the person's environment to accommodate limitations of the disabling condition. It also focuses on supporting the person’s medical condition and working through the rehabilitation process. It considers how the biological, psychological, social, and spiritual factors can create barriers to entering or re-entering the workforce.

Environmental-Social Model:
The environmental-social model identifies the problems faced by people with disabilities as a consequence of external factors, such as how information is provided to people or the accessibility of the built environment. This model emphasizes how the external variables can be modified so that a person can function and participate in activities of daily living in their home, community, school, or work life.

Forensic Model:
The forensic model focuses on the medical-legal aspects of disabilities. The goal of this model is to determine a person’s employability and future earning capacity, etc.

Medical Model:
The medical model is concerned with a person’s impairment first and focuses on the impairment as the cause for a person being either able or unable to participate in their community, culture, and society. This model places vocational rehab services within the rehabilitation phase. A person's diagnosis and prognosis are the primary consideration for assisting them with entering or re-entering the workforce. For example, managed care, which is often used by insurance systems, uses a medical model to compare a person’s disability and prognosis with what might be expected in a similar situation with a so-called “typical” person with the same disabling condition.

VOCATIONAL REHABILITATION PROCESS:
The vocational rehabilitation process should start at the onset of disability to be most effective. The following sequential stages or steps are important parts of the process:

1. Intake Interview:
The intake interview takes place after a referral. The purpose is to determine a person's subjective view of their disabling health condition, to collect demographic or identifying information, and to begin to build a counselling relationship based on collaboration, rapport, and trust.

2. Vocational Assessment:
Vocational assessment is a process for determining a person's interests, abilities, aptitudes and skills. It identifies vocational strengths, needs, and career potential. It may use a variety of standardized (e.g., tests) or non-standardized approaches (e.g., interviews, observation). It is part of the vocational guidance process and may result in providing recommendations for training or employment.

3. Initial Vocational Plan:
The initial vocational rehabilitation plan describes the state of the person and any plans for the future. It usually involves reviewing third party information from medical, occupational therapy, physiotherapy, psychological, and/or vocational assessments and reports. The plan may contain sections on data about the client, background info, vocational rehabilitation services and interventions to be provided, results from counselling and tests, documented medical restrictions/limitations, and transferable skills analysis. It describes the client’s strengths and limitations. It also includes a section on vocational profile that incorporates the client's choice of vocational direction. It should demonstrate how this matches with their aptitudes, interests, work restrictions, gainful earnings or wage, education and training requirements, etc.

4. Vocational Rehabilitation Plan:
The vocational rehabilitation plan outlines the steps needed to move a person from their present situation to their chosen vocational goal. It may include activities and interventions such as: job search, resume preparation, interview practice, job development/placement, and formalized education/training, etc. This information should be complete and thorough to justify the chosen vocational direction.

5. Labour Market Research:
Labour market research is used to identify the availability of jobs, earning capacity, long term projections, and requirements, etc. It can also be done prior to creating an initial vocational plan, or as part of the plan.

6. Job Coaching:
In some situations where a person experiences complex or multiple disabling conditions, a direct job placement may be necessary to assist with placing the person into a specific job. A job coaching approach could be used to support the client in learning and mastering the demands and tasks associated with their previous or new job.

7. Directed Job Search:
Directed job search is usually part of the initial vocational plan and involves the client and vocational rehabilitation professional working together to find an appropriate or suitable job placement. This is a more intensive and involved process compared to a person searching for work individually on their own.

8. Job Modification & Accommodation:
A job modification or accommodation may be needed if a person can't return to their pre-disability job or a new job due to the ongoing or chronic health conditions of their disability. It could be made with the employer by modifying the tasks and considering ways to accommodate their limitations.

9. Employability Assessment:
Employability assessment may take place at the end of the return to work process. It makes a determination about a person's present and future capacity within the workforce, which may be used for long-term disability insurance and pension purposes.

10. Life Care Plan:
A life care plan may be beneficial for people who experience chronic or ongoing difficulties related to their disabling condition. This may extend beyond the scope of the vocational rehabilitation process, requiring a plan to address the need for long-term medical treatment or rehabilitation and the associated costs.

TYPES OF DISABILITY DEFINITIONS:
Restrictions and Limitations:
Restrictions and limitations apply to a physical or mental impairment that may restrict a person from fulfilling one or more job responsibilities. This is typically provided by a clinician such as medical doctor, psychologist, or occupational therapist, etc.

Permanent and Temporary Disability:
Permanent disability is used in the insurance industry and in the law. It can mean that because of a sickness or injury, a person has a permanent restriction. On the other hand, a temporary disability means that the person's restrictions or limitations are likely to improve over time so the person can return to their pre-injury/illness capacity.

Total and Partial Disability:
A total disability is when a person is prevented from performing any work at all due to their injury or condition. Partial disability is any type of disability where the person is unable to perform at their full physical capacity.

Maximum Medical Recovery:
Maximum medical recovery means that a plateau in recovery has been reached and it is unlikely that there will be any further significant improvement in the work-related injury/disease.

Permanent Functional Impairment:
A permanent functional impairment is when the person's limitations or restrictions caused by an injury or illness will not change for the foreseeable future.

RETURN TO WORK HIERARCHY
The return to work hierarchy varies depending on the jurisdiction, but the general principle is to return a person with a disability to the most similar type of work they they were doing in their pre- disability occupation. The following steps are considered when following the return to work hierarchy:

1. Return to work in the same position with the same employer.
2. Return to work in a different position with the same employer.
3. Return to work in the same industry with a different employer.
4. Return to work in any position, in any industry with a different employer.
5. Retraining and/or education before returning to work.
6. Return to work in self-employment.

HEALTHCARE PROFESSIONAL ROLES
In British Columbia, there are currently 25 designated health professions regulated under the Health Professions Act and 18 regulatory colleges. The BC Health Regulators consists of 16 member regulatory colleges. An additional college, the BC College of Social Work, is regulated by the Social Workers Act.

Among the 30 practitioner groups overseen by BC’s health regulatory colleges, the following professionals might be encountered within the context of both primary and complementary or integrative multidisciplinary rehabilitation teams:

Acupuncturists & Traditional Chinese Medicine Practitioners:
According to the College of TCM Practitioners and Acupuncturists of BC, these professionals "look at the balance of body, mind, and spirit to determine how to restore the yin-yang balance (qi) and good health. They have extended clinical practice, advanced training, and substantive theoretical knowledge. TCM practitioners and acupuncturists are trained to diagnose various conditions and can help prevent disease and manage certain disorders and imbalances using a range of treatments. Treatment can include acupuncture, cupping, acupressure, herbal medicines, massage, exercise, lifestyle counselling, and other holistic health approaches."

https://www.ctcma.bc.ca/public-protection/what-does-a-tcm-a-practitioner-do/

Audiologists:
According to the College of Speech and Hearing Health Professionals of BC, "Registered Audiologists (RAUDs) are experts in the prevention, identification, assessment, treatment, and (re)habilitation of auditory and vestibular difficulties. Audiologists preserve and (re)habilitate auditory and vestibular functioning in individuals across the lifespan to improve their quality of life and maximize their participation in society."

https://cshbc.ca/registrants/registrant-resources/competency-profiles/

Chiropractic Doctors (chiropractors):
According to the College of Chiropractors of BC, "Chiropractors are licensed primary health care professionals who:
- Diagnose and assess disorders of the spine or other joints of the body, muscles, and the nervous system;
- Treat disorders and conditions of the nervous, muscular and skeletal systems; and,
- Provide advice and counselling on matters related to the condition of the spine or other joints of the body, muscles and the nervous system."

https://www.chirobc.com/about-ccbc/what-is-a-chiropractor/

Counsellors and Psychotherapists:
Counsellors and psychotherapists are not currently regulated in BC by the Health Professions Act. The Federation of Associations for Counselling Therapists in BC (FACTBC) is a society of associations that, in addition to member services, also provide voluntary self-regulation to protect the public. FACTBC says it "is a society of professional associations that represent counsellors and therapists practicing throughout British Columbia. Originally organized informally in 1997 as the Task Group for Counsellor Regulation (Task Group), the Federation was registered under BC’s Society Act in March 2014."

https://factbc.org/about/

The BC Association of Clinical Counsellors says that "Registered Clinical Counsellors (RCCs) are specifically trained to help people improve and maintain their mental health and well-being. RCCs work with many kinds of people: individuals, couples, and families in individual and group settings. Clinical counselling is typically sought when a person experiences challenging situations, thoughts, feelings, or circumstances."

https://bcacc.ca/what-is-counselling/

The Canadian Counselling and Psychotherapy Association says that "Counselling/psychotherapy is the skilled and principled use of relationship to facilitate self-knowledge, emotional acceptance and growth and the optimal development of personal resources. The overall aim is to provide an opportunity for people to work towards living more satisfyingly and resourcefully. While the relationship will vary according to need, it may be concerned with developmental issues, addressing and resolving specific problems, making decisions, coping with crisis, developing personal insights and knowledge, working through feelings of inner conflict or improving relationships with others."

https://www.ccpa-accp.ca/profession-and-regulation/

Dietitians:
According to the College of Dieticians of BC, "Dietitians provide nutrition care along the entire continuum of life – from before conception to end of life. Dietitians actively contribute to the health and wellbeing of British Columbians and are essential members of interprofessional healthcare teams. Dietitians are known for:
- assessing nutritional needs of individuals and groups.
- using a client-centered approach to nutritional counselling.
- designing, implementing and monitoring nutritional care plans and therapeutic diets based on current and relevant scientific, medical and nutrition information.
- disseminating relevant scientific information about food and human nutrition to promote health and assist individuals, groups and communities attain, restore or maintain health.
- managing quality food service operations in healthcare institutions, education facilities, and government agencies."

https://collegeofdietitiansofbc.org/public/

Kinesiologist:
Kinesiologists in BC are not currently regulated by a college under the Health Professions Act, so they have a member association. According to the BC Association of Kinesiologists, "Kinesiology is the scientific study of human movement, performance and function and may also be referred to as 'human kinetics'. The practice of kinesiology applies the science of anatomy, physiology, biomechanics, psychology and neuroscience to human movement and function. Kinesiology employs evidence based scientific research and assessment to assist in the prevention and rehabilitation of injury, lifestyle diseases and other physiological conditions, along with the enhancement of human performance, in environments such as work and sport."

https://bcak.bc.ca/for-the-public/what-kinesiology/

Massage Therapists:
According to the College of Massage Therapists of BC, "A registered massage therapist (RMT) in British Columbia is a health professional regulated by CMTBC under BC’s Health Professions Act. Applicants for registration with CMTBC have completed post-secondary education in clinical applications of health sciences in massage therapy settings, and must meet CMTBC’s rigorous entry-level requirements." It goes on to say: "Like all regulated health professionals, RMTs must practice within their professional scope of practice. For RMTs, this means providing primarily manual, hands-on treatment and assessment in accordance with the definition of “massage therapy” in the Massage Therapists Regulation.

https://www.cmtbc.ca/what-is-an-rmt/

Nurses (LPNs, RNs, RPNs, NPs):
According to the BC College of Nurses & Midwives, "​Licensed practical nurses (LPNs) have successfully completed an entry-level LPN education program and met BCCNM registration requirements. LPNs provide nursing services for the promotion, maintenance and restoration of health and the prevention of illness and injury. LPNs focus on clients with stable or predictable states of health across all stages of life. LPNs practice both autonomously and in collaboration with other health care team members within the LPN Scope of Practice."

​​"Registered nurses (RNs) have successfully completed a BCCNM-recognized entry-level RN education program​ and met BCCNM registration requirements. RNs provide nursing services for the promotion, maintenance and restoration of health and the prevention of illness and injury. RNs practice both independently and in collaboration with other health care team members with a focus on the competencies of the RN Scope of Practice."

"Registered psychiatric nurses (RPNs) have successfully completed a BCCNM-recognized entry-level RPN education program and met BCCNM registration requirements. RPNs provide nursing services for the promotion, maintenance and restoration of health and the prevention of illness and injury. RPNs focus on psychosocial, mental or emotional health across all stages of life. RPNs practice both independently and in collaboration with other health care team members with a focus on the competencies of the RPN Scope of Practice."

"Nurse practitioners (NPs) are registered nurses who have successfully completed a master’s level NP program and met BCCNM registration requirements​. NPs are primary care providers who practice in many settings. NPs assess and treat diseases and disorders by prescribing, ordering diagnostic services and managing results, and consulting and referring with other health care providers. NPs practice in one of three “streams” which include family, adult, or pediatrics, and within the NP Scope of Practice​. NPs often work within multidisciplinary teams that complement each other to improve patient care."

https://www.bccnm.ca/Public/Pages/TypesOfNurses.aspx

Occupational Therapists
According to the College of Occupational Therapists of BC, "Occupational therapists help people improve, maintain, or restore their ability to perform everyday tasks, including:
- Self-care
- Leisure
- Education
- Home management
- Volunteering
- Work
- And much more

https://cotbc.org/public/what-occupational-therapists-do/

Physical Therapists (physiotherapists):
According to the College of Physical Therapists of BC, "Physical therapists are registered healthcare professionals who specialize in how the human body moves. What Can I Expect From a Physical Therapist?
Physical therapists treat people who have a loss of function from health conditions, injuries, or disabilities."

https://cptbc.org/patients/what-is-physical-therapy/

Physicians, Specialists & Surgeons
Physicians may be general practitioners (GPs) and family doctors or specialists who diagnose and treat illnesses and injuries. GPs or family physicians provide primary care, as a patient’s main health care contact and they work with patients to manage their general health over the long term. Whereas, specialists work in medical practices in speciality areas such as cardiology (heart), endocrinology (glands/hormones), gastroenterology (digestion), neurology (nervous system), oncology (cancer), and others like surgeons, who perform operations. Two other important physician specialists who are found on rehabilitation teams include Physiatrists (medical doctor specializing in physical medicine and rehabilitation) and Psychiatrists (medical doctor specializing in emotional and mental health difficulties).

https://www.cpsbc.ca/registrants/standards-guidelines

Psychologists
According to the College of Psychologists of BC, "Most registered psychologists in British Columbia have completed doctoral level study and supervised practice experience or the equivalent. Registered psychologists provide services to manage and enhance the cognitive, behavioural, emotional, interpersonal and physical functioning of individuals or groups of individuals, primarily by applying and using psychological assessment and intervention strategies, including psychometric testing and psychotherapy. As part of this work, psychologists also assess and diagnose behavioural, emotional, cognitive and mental disorders."

https://collegeofpsychologists.bc.ca/public/practice-of-psychology/

Registered Social Workers
According to the BC College of Social Workers, "Social Workers focus on enhancing the well-being of individuals, families and communities within the context of the well-being of society. Social Workers believe in the dignity and worth of human beings. They promote social fairness and equal access and distribution of resources and opportunities. Social Workers help people facing difficult life challenges including mental and physical illness; grief and loss; poverty; discrimination; abuse; addiction; divorce; unemployment; disability and educational problems. Social Workers make assessments and develop intervention plans to connect clients to resources; provide counselling and support services; mediate conflict; advocate for services; and strengthen clients’ capacity to successfully manage their problems."

https://bccsw.ca/faq/what-do-social-workers-do/

Speech-Language Pathologists:
According to the College of Speech and Hearing Health Professionals of BC, a Registered Speech Language Pathologist is a "health profession in which a person provides, for the purposes of promoting and maintaining communicative health, the services of assessment, treatment, rehabilitation and prevention of
(a) speech, language and related communication disorders and conditions, and
(b) vocal tract dysfunction, including related feeding and swallowing disorders;"
It goes on to say that "The scope of practice for Registered Speech-Language Pathologists (RSLPs) involves the assessment, diagnosis, and intervention of speech communication disorders, delays, and differences across the human lifespan."

https://cshbc.ca/bylaws-legislation/scope-of-practice/

REFERENCES:
College of Vocational Rehabilitation Professionals, Board of Directors. 2021-2023. Standards of Practice. College of Vocational Rehabilitation Professionals. https://cvrp.net/wp-content/uploads/129-Approved-Version-02-CVRP-SoPs.pdf

College of Vocational Rehabilitation Professionals, Board of Directors. 2019. Vocational Rehabilitation Competencies. College of Vocational Rehabilitation Professionals. https://cvrp.net/wp-content/uploads/60-Competencies.pdf