This Series consists of three (3) separate articles and is worth tem (10) Credit Hours.  Each article has corresponding questions that can be found be clicking on the "Questions" link.

Article 1: Fixing the Broken Paradigm
Article 2: The Function of Testing in the VE Process
Article 3: Disability Management Components

During introductory remarks to the 16th Annual National Symposium on Workers’ Compensation, National Council on Compensation Insurance (NCCI) President William Hager said, “Unless we get unneeded services and providers out of the workers’ compensa­tion system, that house will come down.”¹   On the same track, Dr. Rochelle Habeck, a rehabilita­tion counselor, educator, and disability management consultant, reminds us that “many providers continue to function from a broken paradigm that can offer limited solutions to work disability and may actually contribute to escalating costs.”² 

And, indeed, the experience of the professional case managers at CEC Associates, Inc., is that workers’ compensation and other disability costs esca­late as a result of dysfunctional disability manage­ment approaches taken by employers.

There are several critical causes:

These are just some of the reasons why workplace disability costs increase when case management is involved.  However, the improper use of case manage­ment should not cause anyone to conclude that case management alone drives costs.  On the contrary, numerous reasons exist for escalating costs in the “broken paradigm” which Habeck invokes.

But we also know that timely, high-quali­ty case management yields results.  Re­covery from workplace injury or illness costs employers substantial sums of money.  A 1994 survey released by Northwestern National Life Insurance, Minneapolis, sug­gested that employers could save as much as $35 for every $1 spent on rehabilitation ser­vices to get injured workers back to work.  Savings come from reduced reserves which companies and their insurers set aside for extended disability payments.  Employer savings increase dramatically, to $96 for every $1 spent if workers could be brought back to their original positions, $46 if brought back to a different position within the same company, and $38 if a new position can be found with a different employer.³

As Habeck also predicts, if case managers are to continue providing the workplace with value-added services rather than additional costs, we must consider a number of work­place issues and dynamics that factor into nearly every rehabilitation case.  To move from that broken paradigm into a new, more effective generation of corporate service, case management professionals must reevaluate some basic industrial rehabilitation concepts.

Proactive Approach

We know that occupational disability is defined as a limitation resulting from physical or mental impairment that affects the amount or type of work an individual is capable of performing.  However, few employers realize that workplace disability is so expensive.  Studies have shown that companies spend an average of 8% of their annual payrolls on all facets of disability.  Researchers have shown that there are direct, indirect, and hidden costs in the equation.  For an organization with a modest $5 million payroll, the average loss attribut­able to disability means a cost of $400,000 per year.

Moreover, most employers do not realize workplace disability can be pre­vented and managed.  As with any organiza­tional problems resulting in substantial costs, members of the organization must take responsibility to manage the problem directly.  Few employers approach disability manage­ment proactively.

Disability management is a planned effort by a well-managed work organization to proactively prevent and manage injuries, illnesses, and other events in the lives of its employees that cause them to lose work time or productivity.  Disability management within organizations requires that the man­agement structure deal with the specific antecedents and consequences of changes in employee health and well being.  Dis­ability management programs (DMPs) must have strong case management and return-to-work components if they are to save companies the substantial direct and indirect costs associated with lost time, injury, and illness.

Analyzing and describing jobs are useful procedures in the rehabilitation of injured workers, and case managers must find a way to install these valuable procedures into the disability management system.  
 

Return to Work versus Light Duty

Of all the important paradigm shifts that have occurred in the processes of injury management and return to work over the past few years, the reformulation of what constitutes viable return to work is one of the most important.  In well-managed com­panies, when employees are injured or ren­dered ill, management representatives accompany the employee to the hospital, make frequent visits to the employee in recuperation both at the hospital and home, and accompany the employee to crit­ical-stage physician appointments.  This, of course, is effective case management.

Moreover, return-to-work assimilation is no longer described as “light duty,” but as transitional duty.  Transition is defined as including phased-in length of workdays, work hardening, job restructuring, and, if needed, retraining for another important job in the company.  To demonstrate the company’s concern for the welfare of injured employees and their families, a com­prehensive support system is delivered throughout the case.  The case managers, for example, are engaged in post-injury or illness, coordination of the health care sys­tem, and facilitation of not only maximum medical improvement but return to gainful activity, which is good for both employ­ee and employer.  Light duty has become an archaic concept and practice in proactive disability management protocols.  
 

Telephone Case Management

Not unlike the obsolescent light duty, telephonic case management has inherent limitations.  Penny-wise and pound-foolish, many insurance carriers, third-party admin­istrators, and self-insured employers have opted for the use of telephonic case man­agement over dispatching a case manager into the field.  However, nobody but direct supervisors and Human Resources personnel should be simply telephoning an injured or ill employee.  Case managers are best used in the field because these professionals are a critically important extension of the employer or organization into the healthcare system.  Case managers communicate, assess, observe, and facilitate the changing status of the injured employee’s functionality.  None of these critical processes can be accomplished by telephone.

It has been shown empirically that case management representatives gathering information over the phone too frequently collect different data than case managers who assess the same problem by direct per­sonal contact and observation.  The effec­tiveness of professional case managers should not be watered down with telephone case management.

Mediation

As a result of their claims for workers’ compensation benefits, injured employees naturally oppose their employers.  And, too often, the reverse is also true.  Even when a claim is “undisputed,” as they say, legal and insurance documents still read, “employee X versus employer Y.”  If suspicion does not hover over a workers’ compensation claim immediately, resistance will exacerbate the torn employer-employee relationship eventually.

Lost time has a way of accruing rather rapidly, particularly in the absence of proac­tive disability management.  Workers’ com­pensation claims breed conflict that too often spills over into games of blackmail and extortion.  Financial settlements become the mech­anism of getting rid of claimants, but not without hidden costs.  A layperson can only imagine what some companies pay to replace trained employees, but the Government Accounting Office reports the average cost as $26,200 per displaced worker.

DMPs should incorporate conflict resolu­tion strategies to decrease tension between employee and employer and to resolve lost-time issues between injured workers and their employers.  Case management pro­fessionals can assist their corporate clients by learning managerial mediation skills and encouraging companies to train managers in conflict resolution strategies.

Team Approach

Disability management teams will get the best results by including representa­tives from various departments of the orga­nization.  Total quality management and team problem solving are as essential to successful disability management program­ming as evolving business practices.  The ideal disability management team may include the case manager, the employee, the physician, the union steward, the claims representative, the safety director or desig­nated disability manager, and the legal rep­resentative.

All these participants are potentially in a critical relationship with the injured worker.  Team members share responsibility for problem identification, brainstorming solu­tions, and team communication, all geared to preventing co-malingering and proactive­ly managing disability.  The case manager may serve as the team leader or as a critical team member.  The message to the work organization and specifically to team mem­bers, however, must be that we will strive to limit any one individual’s continuing lost time.  A team approach is best.  

Upgrade Case Management Skills

Indications are that work organizations are increasing their use of case manage­ment professionals to coordinate and inte­grate a range of social, health, and rehabili­tation services to enhance the functioning and quality of life of employees.  As corpora­tions become increasingly aware of the costs of workplace disabilities and respond with proactive disability management pro­grams, case managers must go beyond the traditional role of advocate and learn the necessary skills to facilitate and maintain corporate DMPs.  These skills involve:

The single most important aspect of disability management is a total commitment to return employees to work.  Otherwise, costs are sel­dom reduced.  

Return to Productivity

Return to real productivity is the goal of disability management and, of course, the resolution of all lost-time situations.  Case management is the keystone of an effective DMP.  Case management has been defined in various ways as long as social work and systematic health care have existed, and new models for case management are evolv­ing.  Karen Kaplan, Director of The National Center for Social Policy and Practice, defines the basic premise of case manage­ment as: “The delivery of the right services at the right time.  Done correctly, case man­agement works because it helps ensure top quality care delivered in a timely fashion.  It allows the use of appropriate specialized services that maximize recovery.”

Case management remains the critical tool linking employer programs and policies with the health care delivery system.  Although managed care has captured the attention of employers and their insurance carriers, it is still case management that serves as the nexus between quality health care (whether “managed” or not) and voca­tional productivity.

Housed in a comprehensive DMP, case management can reduce health care costs and facilitate return-to-work strategies.  A comprehensive DMP includes:

Planning and monitoring these features of a DMP are the responsibility of a select team of employees (and perhaps one or more external resource people,  such as a case manager) who are empowered to design and operate a program to prevent and manage disability costs.  Generally, case managers are key members of the team.

What do case managers need to know in order to serve as members of the disability management team? How do case managers gain access to internal committees oversee­ing disability management?  And how do case managers ensure their continuing service to the workplace?  Case management profession­als must understand aspects of the corporate environment in order to successfully and effectively apply their skills and expertise.  
 

Organizations Are Political Landscapes

Broken paradigms are maintained in large organizations by individuals with vest­ed interests in keeping the status quo.  Insurance carriers or third-party administra­tors, insurance brokers, risk managers, union representatives, human resources managers, health and safety personnel, and operations staff may have a stake in keeping work systems as they are, even if those systems are dysfunctional.

Chances are, however, that a well-man­aged company that properly utilizes case management services will be receptive to the concept of disability management.  Case managers can steer ad hoc disability man­agement committees toward the goal of establishing proactive policies and proce­dures for handling lost time.  Many organiza­tions may wish to establish permanent dis­ability management teams that meet regularly to staff all lost-time cases.  Case managers may indeed lead these teams.

Case managers functioning as external consultants must realize, nonetheless, that helping to develop working alliances within any organization will be their greatest chal­lenge.  A case manager must seek and secure top management support for work­place disability management.  In most cases, this commitment must come from no less than a CEO, a CFO, or a managing board of directors.  Otherwise, the interdepartmen­tal cooperation necessary to develop an effective disability management program will not be realized.
 

Co-Malingering

In an unpublished paper, Ken Mitchell, PhD, a nationally recognized disability management consultant, defines co-malingering as the invisi­ble bond between worker and employer or an agent of either party (e.g., the treating physician and an injured worker can co-malinger; likewise, an injured worker and an enabling case manager can co-malinger).  Mitchell has offered this invaluable con­cept to both work organizations and case managers.  He writes, “Co-malingering is cooperative manipulation.  This manipula­tion can be intentional or involuntary, pas­sive or active, worker-centered or employ­er-centered, limited to a single event or habitual.  Co-malingering is a deception that results in a subversion of a private or public disability compensation system that is designed to protect the employer, employee, and health care provider alike.”

Typically, co-malingering is initiated and maintained by a system of beliefs, learned behaviors, and/or intentions that are applied to specific situations in the work­place, but fail to create an effective, mutual­ly satisfying outcome for employer and employee.

Mitchell concludes, “Co-malingering, while not always the result of an intentional act on the part of either the worker or the employer, is quite often supported and encouraged by the very system it seeks to deceive.”

Any party within the compensation system working with the employee can con­sciously or unconsciously co-malinger.  Rehabilitation personnel, physicians, super­visors, family members, lawyers, and claims personnel are but a few of the individuals who can co-malinger with an injured worker to main­tain the compensation sys­tem.  Workplace policies can also perpetuate co­-malingering.  Perhaps not realizing it, management and labor all too frequently agree on contractual lan­guage that results in co-­malingering.  Requiring that employees be 100% healthy before they return to work is an example of a co-malingering employer policy.  Case managers must recognize that co-­malingering can be a sig­nificant issue in the work­place politics of lost time and disability.  
 

Disability Versus Impairment

“Impairment’ and “disability” are signifi­cant terms in any disability compensation system, and understanding the dissimilarity of meaning between them is critical to an employer’s understanding of disability compensation.

American employers pay far too much for disability in the workplace because key decision-makers either do not comprehend the difference or do not act on the distinc­tion between impairment and disability.  In reality, the same impairment can result in different degrees of disability depending on the specific work situation, the characteris­tics of the worker, and the politics sur­rounding the disability claim.  For example, the amputation of several fingers may leave a machinist totally disabled.  But the same amputation may have little or no effect on a bus driver’s work.  The impairment is the same; the work is different.  Therefore, the disability is different.

Understanding the critical difference between impairment and disability has been liberating for many human resource and risk management personnel.  Charged with the responsibility of returning permanently impaired employees to work, case man­agers and disability managers now facilitate return to work by addressing and ameliorating return-to-work barriers, thereby reducing or totally eliminating disability.  Impairment is a med­ical concept, but disability is an occupational issue.  The work organization can actually manage disability.

Case managers must make sense of this distinction and communicate it effectively to all members of the disability manage­ment team.  If organiza­tions are to reduce the cost of workplace disability and meet the federal requirements of the ADA, the dif­ference between disability and impairment must be operational in return-to-work programs.  
 

Job Descriptions Are Key Tools in Return to Work

The ADA introduced new concepts to employers in terms of realizing the employment potentials of individuals with disabilities.  Two of the most significant concepts are the “essential functions” of a job and “rea­sonable accommodation.”  The process of job analysis and the outcome of job description are two of the most important steps employers might take to develop and maintain effective return-to-work programs.  Case managers must become proficient in job analysis and job description formulation.

Job analysis is the examination of what a worker does, why it is done, how it is done, and the skills and abilities required to per­form the job.  Job analysis produces a systematic and detailed map of how a job is performed, and that map is the essential functions job description.  Once a job analysis is completed, gathered information can be arranged in essential function form.  A complete “essential functions” job description can do the following:

In the early years of private sector insurance rehabilitation, some case man­agers representing for-profit organizations were undoubtedly caught walking with dirty feet in client companies.  Rehab­ilitation counselors and case managers working from broken paradigms co-malin­gered, but rehabilitation case managers also functioned without a vision, and sel­dom with a model better than the reactive one bequeathed by insurance carriers on behalf of insured employers.

Case management is coming of age, however, and with the right tools and prop­er approaches, some case managers can make significant contributions within cor­porate DMPs.  The notion that disability can be proactively managed and prevented by the work organization itself is empowering.  The DMP concept makes it imperative that the case manager play a vital role in injury management and return to work, and func­tion within a framework of common goal-sharing, collaboration, and teamwork.  Notwithstanding Habeck’s alarm over increasing costs in the compensation sys­tem, case managers can encourage and lead client organizations to improve reac­tive and seldom useful injury management methods of the past and move beyond the broken paradigm.  

References:

1. A Summary of Issues Influencing Workers’ Compensation.  Boca Raton, FL: The National Council on Compensation Insurance; 1992.

2. Habeck R.V. “Achieving quality and value in service to the workplace.”  Work Injury Management; 1993; 2:1, 3-4.

3. Back To Work.  Minneapolis, MN: Northwestern National Life Insurance Com­pany; April 1994.

4. Calvin DE, Habeck RV, Kirchner KA.  A Report from the Leadership Forum on Disability Management.  East Lansing, MI: Institute for Rehabilitation and Disability Management of Washington Business Group on Health and Rehabilitation; October 1992.

5. Kaplan K.U. “Recent Trends In Case Management.”  In Encyclopedia of Social Work, 18^th ed. Silver Spring, MD.  
   

The Function of Testing in the Vocational Evaluation Process

By Beth McLaughlin and Jasen Walker, Ed.D.

The primary function of a vocational evaluation professional is to identify an individual’s vocational potential through the utilization of a systematic assessment process.  Through that process, the vocational professional is able to measure, observe, document, and determine an individual’s potential to successfully perform particular forms of work.

In many instances, vocational assessments are used to determine whether an injured (or ill) employer is able to return to work, and if so, to what kind of work.  If return to work is indicated, the outcome of the evaluation will address the critical issues of returning to employment.

The intended outcome of the assessment is to explore vocational options that will be the basis for a viable work re-entry plan.  A return to work is the optimal outcome; however, in a few cases, the outcome may indicate that work at any level may not be practical.  In these instances, treatments or other interventions need to be considered.  In all other cases, the objective is a return to work, with or without an accommodation.

Much, if not most, of the work done in vocational evaluation is based on documentation.  In addition, vocational rehabilitation professionals must rely on the recommendations of physicians in respect to an individual’s physical (or mental) capacities for work.  However, a frequent issue affecting the vocational evaluation process is the basic difference between the concept of “impairment” and “disability.”  Defining an impairment is, of course, within the scope of the physician’s expertise, whereas, defining disability is not.  In terms of a work disability, the person making the decision needs to understand the physical and mental requirements of the specific work task to decide whether the impairment will, with or without a work accommodation, impact the injured worker’s ability to carry out that work.  This expertise on occupational capacity belongs to the qualified vocational professional.

The process used by vocational rehabilitation professionals to accomplish this task is to assess or evaluate the injured worker, with a focus of determining occupational fit.  Good vocational assessment can be accomplished by utilizing the following methods:

However, despite the importance of testing in accurately assessing an individual’s characteristics and abilities, one of the most frequently asked questions are regarding vocational evaluations is, “What is the purpose of vocational testing?”  Many times, persons requesting a vocational assessment question the efficacy of administering a battery of tests.  In general, it is assumed that a person’s ability to perform a job can be determined solely by examining what type of work that individual had performed in the past, and therefore, any documentation beyond that is considered superfluous.  In fact, to the well-trained vocational evaluation professional, work experience plays only a part in assessing a person’s ability to function effectively in a particular job.  Most people fail to understand that occupational success is less dependent on an individual’s work history than is generally believed. 

Because of the wide variations in job descriptions and job demands, the work history alone does not ensure that the individual being evaluated has acquired specific skills.  Moreover, it has been the experience of well-trained vocational evaluators that individuals with particular work histories can possess dramatically different skill sets and worker characteristics.  One could simply perform a "transferability of skills" analysis on the basis of a person's work history.  However, not all longshoremen are simply longshoremen.  Some longshoremen, by virtue of their work experience, need not read or write, and to assume from their work experience alone that they cannot process information requiring reading and writing could potentially be a major assessment error.  To assume that the longshoreman is simply interested in objects and things because he has manually and mechanically unloaded ships and done nothing more in his employment, could also be fraught with miscalculation.  In the 1960s and early '70s, a Seattle, Washington Longshoreman, Harvey Jackins, wrote approximately 10 books and made a seminal contribution to a new form of counseling and psychotherapy called Re-evaluation Counseling.

Because effectively performing a specific job is dependent on several identifiable factors and not necessarily representative of individual’s potentials, vocational testing is an essential part of the evaluation process. Said differently, an individual's having performed a specific job does not yield all information about the person’s vocational capacities, and testing is an essential part of expanding our knowledge of that person’s potentials and alternative job compatibility characteristics.  Testing is designed to determine an individual’s appropriateness for select forms of work by assessing actual abilities, preferences, and suitability for various occupations.  As such, it can be used for a variety of purposes that would include assisting young adults in choosing a career path, helping individuals looking for alternative work, and, as is the case with vocational rehabilitation professionals, aiding persons returning to work after a disabling injury.  The vocational rehabilitation professional is able to accurately carry out test administration by applying knowledge acquired through formal and on-the-job training.

Through thoughtfully structured testing, a complete picture of an individual’s actual abilities and work potentials can be obtained.  More importantly, without comprehensive test data, determining an appropriate occupational match for an individual would be somewhat speculative.  That is, relying on previously acquired skills and/or employment history alone would not allow for a vocational rehabilitation professional to accurately prognosticate an individual’s potential to achieve success in a particular job, because such information would lack critical components to worker success, such as whether the individual possessed the language skills and/or interest to perform that work.

So, what is a test?  A test is a standardized procedure for sampling behavior and describing it with categories or scores.  Standardization is achieved if the procedures for administering the test are uniform from one examiner and setting to another.  Testing yields quantitative data, allowing the examiner to compare the test takers performance with the measured behaviors of others in a normative sample, or larger number of individuals with similar characteristics (i.e. age, education, gender, etc.)  Testing has the potential to provide qualitative data, which is the information about how individuals behave when confronted with particular, generally novel tasks.  Do they become nervous?  Are they able to sustain a particular effort?  Do they ask appropriate or inappropriate questions regarding the nature of the test administered, i.e., Will this identify my arithmetic potential, or Will this test help me get a job as a rocket scientist?  Does the test-taker seem interested or indifferent to the process?  Does the test-taker make a genuine effort, or do they sabotage the testing process?  

There are several factors that should be considered when developing criteria for vocational testing.  Those components would include academic achievement levels, aptitudes, personality characteristics, and occupational interests.  Through gathering data in each of these areas, along with understanding the history of the injured worker, one would be better equipped to successfully match a person to a particular job than relying upon work history alone. 

Academic testing measures an individual's abilities to read, spell, and arithmetically calculate.  In general, these abilities are acquired through the course of formalized schooling.  However, reliance on educational attainment without supplemental academic testing is not recommended because rarely does educational level equate perfectly with actual ability.  Therefore, achievement testing is essential in determining decisively the injured workers basic linguistic and mathematical abilities.    

Aptitudes are an individual’s natural capacity for learning, and aptitude testing is designed to predict an individual’s ability to learn certain skills.  Such skills can include, solving problems visually, understanding mechanical principles, perceiving differences in tabulated data rapidly and accurately, and comprehending written information.  The work that a person is most likely to be successful in is work that involves aptitudinal strengths.  

Personality testing is designed to determine an individual’s specific charaterological traits and can be used to decide what an individual’s temperament might be for a particular type of work.  That is, although a person’s ability to perform a particular type of work is important in job placement, for that individual to have the right temperament to effectively carry out the work on a daily basis is also critical to job success. 

Interest measures will delineate preferences for types of work for a particular individual.  By determining likes and dislikes, work for which a person would most likely find enjoyment can be more specifically described.  Obviously, individuals who enjoy what they do each day will have greater motivation to continue their work and will have a better chance to be successful in performing that work. 

Along with the actual assessment of an individual’s academic achievement, aptitudes, personality, and interests, vocational evaluation also requires making certain that the data obtained are an accurate reflection of the individual being tested.  In determining the validity of test data, one must examine three components that include standard performance level, consistency of performance, and response rate.  Additionally, motivation to perform can be assessed through observation of test-taking behavior.  These three factors, along with perceived level of motivation can be used to assess whether test results gathered are a valid representation of tests-taker’s actual potentials.  

The concept of standard performance level would suggest that examinees should perform at a level fairly consistent with their educational background or same age peers and should perform better on tasks that are more closely aligned with their academic and employment histories.  That is, one would expect that an architect would demonstrate good mathematical and visual problem solving abilities, while an author should possess good language skills.  Standard performance level would also suggest that there should be a correlation between an individual’s intellectual ability and acquired skills. 

Performance consistency suggests that examinees should demonstrate a similar ability level on tests measuring similar skills (e.g., vocabulary, reading comprehension).  That is, individuals should perform in a like manner on measures assessing like skills.  In addition, test data gathered should not show significant variance during the course of test administration occurring at one particular time.  Examinees should demonstrate minimal fluctuation within or between tests assessing similar skills that are administered at one sitting. 

Response rate assumes that examinees should be able to respond to questions on timed (speed) tests at a rate that would place them within a performance range equal to their general ability as long as direct physical limitations are not a factor.  Additionally, examinees should be able to complete untimed measures within the time frame identified in the test manual.   

Along with these three factors, trained vocational evaluators can assess motivational levels through observational information gathered during testing.  Although motivation is generally considered an internal dynamic, how examinees behave while taking tests can provide a significant amount of information about how invested the individual is in performing at an maximal level.   

Obviously, motivation to perform optimally should also be questioned when individuals make statements about their disinterest in the test-taking process or in their performance while working.  Additionally, injured workers invested in their performance should be observed taking time available to check their responses for accuracy.  For example, on a test of spelling ability, an examinee should not comment about believing a response is incorrect without making any effort to change the response.  Moreover, motivation should be questioned in individuals that engage in superficial conversation while working or succumb to possible distractions in the environment, skip or ignore test instructions or example problems, or work in an overly rapid and non-thoughtful manner.  To identify manipulation of test results, some tests, particularly personality measures, are equipped with their own validity scales.   

Vocational rehabilitation evaluations culminate in a comprehensive report (to the employer or referral source) detailing a viable course of action for the employee and/or providing information regarding an individual’s potential to perform particular forms of work.  These reports can be critical in use as the basis for decision making by the employer or as the prima facie evidence in litigation.  

In conclusion, vocational testing is an integral and critical aspect of the vocational evaluation process.  As described above, comprehensive understanding regarding an individual’s occupational potentials involves a careful examination of variables beyond simple physical capacities to work.  Therefore, in order to be effective, vocational assessment must include collection and interpretation of information in the realm of abilities, interests, and personality characteristics.  With the availability of such data, used in combination with an appropriate understanding of essential job functions, work ability decisions can be made with greater reliability and validity.   

For the vocational rehabilitation professional, it is essential that a vocational assessment be carried out in a manner that utilizes direct observation, review of documentation, physician input, client interview data, and standardized testing.  Again, to assume that occupational potential can be accurately ascertained without gathering data that includes academic achievement levels, vocational aptitudes, personality characteristics, and occupational interests, could result in a less than accurate assessment of an individual’s actual capacities to work.  In addition, by relying on limited information, the vocational rehabilitation professional would be increasing the risk of returning an injured worker to an unsuitable position, thus resulting in additional lost time from work as the individual is more likely to fail in adhering to the demands of a particular job.  

Only by completing a thorough assessment of an individual that includes administration of vocational testing can appropriate occupational potentials be determined.  In doing so, the vocational rehabilitation professional can make more accurate decisions regarding an individual’s ability to perform certain types of work and can better prognosticate that individual’s chance of being successful in doing so.  By understanding what an injured worker can do physically, intellectually, and temperamentally, a vocational rehabilitation professional can promote a successful return to work.   

Since the primary function of a vocational rehabilitation professional is to identify an individual’s vocational possibilities, it is essential that a thorough and comprehensive assessment occur.  Only through such as assessment can accurate and complete information regarding an injured worker’s capacity for work be obtained.  Anything less can only make a difficult situation more problematic.    

Understanding Vocational Testing (in the Forensic Vocational/Disability Evaluation Process)

Vocational/disability evaluation in personal injury matters is an effort to explain how medical impairment following personal injury interferes with work functions.  In order to understand how personal injury potentially affects a plaintiff’s capacity to work, one must first appreciate the difference between impairment and disability.  According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Third Edition-Revised), impairment means “an alteration of an individual’s health status that is assessed by medical means,” and disability, “an alteration of an individual’s capacity to meet personal, social or occupational demands,” is assessed by non-medical means.

Medical experts are retained to describe how injury and/or illness alter an individual’s health status.  Vocational experts are assigned with responsibility of determining how the “alteration” of an individual’s health status impacts his/her employment and occupational potentials.  Economic experts assess the long-term financial impact of an individual’s disability.  Vocational disability evaluation is the keystone in the tripartite (medical-vocational-economic) analysis of loss associated with personal injury.  Vocational/disability evaluation is enhanced through the utilization of available methods for measuring an individual’s capacities to learn and work following a change in health status.  

Vocational/disability evaluation is best carried out by certified and/or licensed evaluators who possess training and experience in career assessment, evaluation of individuals with medical impairment, job placement of individuals with occupationally significant medical histories, job analysis, and vocational rehabilitation.  Vocational experts are uniquely qualified to assess the occupational significance of medical impairment and resultant functional limitations.  Few, if any, medical experts are trained in these disciplines, and the physician should not be placed in a position to determine industrial loss of use, economic loss, or any other type of loss arising from vocational disability (American Medical Association).   

Evaluation of occupational loss in personal injury cases is generally conducted by individuals who are Certified Rehabilitation Counselors, Certified Vocational Evaluators, Disability Management Specialists, and/or Clinical Associates or Diplomates of the American Board of Vocational Experts.  In Pennsylvania (as well as in other jurisdictions), competent vocational evaluators generally are licensed as Professional Counselors and/or serve as Vocational Experts for the Office of Hearings and Appeals of the Social Security Administration.

Vocational evaluation in matters of occupational disability is an evolving discipline.  As in any profession, not all vocational experts pursue their discipline with equal rigor or intensity.  Vocational evaluation to determine the impact of medical impairment upon an individual’s employability and wage potentials is an endeavor that requires not only training, experience, and proper credentialing, but a genuine effort to investigate (with a variety of tools) the examinee’s capacities to learn, work, and earn money through gainful activity.  

Vocational/disability evaluation ideally involves a careful review of any and all relevant medical information regarding the person to be evaluated.  The evaluee should participate in a clinical interview – a structured question-answer session – with the evaluator, who would ideally make inquiry and observation regarding the person’s medical background, social history, educational experiences, occupational endeavors, and interview behaviors (i.e. speech articulation, appearance, and ability to comprehend questions).  Generally speaking, this type of interview can last between one and two hours. 

Vocational/disability evaluation, however, also ideally includes administration of a standardized battery of tests, preferably designed to generate information regarding an examinee’s abilities to read, calculate arithmetically, reason in a number of ways, solve novel problems, use language properly, and employ cognitive abilities that could be utilized in work settings.  The test investigation could likely involve administration of occupational interest inventories, work personality questionnaires, and, at times, measures of upper extremity capabilities, both gross motor and fine fingertip.  The vast majority of individuals who have been injured musculoskeletally will be medically limited in terms of their exertional capabilities, and the effort in these types of cases is frequently to determine how well the individual can function in relation to data, people, and inanimate objects.  Moreover, one becomes invested in understanding how well the examinee can process information.  Such an effort requires far more than history taking (vocational interviewing) and so-called “transferability of skills” analysis.  Standardized vocational testing can be, and generally speaking is, an essential component of disability evaluation and residual employability assessment.   

Vocational Testing

Vocational testing is the administration of standardized tests that provide information regarding particular worker characteristics and behaviors.  A test is a standardized procedure for sampling behavior and describing it with categories or scores.  Vocational testing facilitates decision-making in occupational selection and classification of personnel and assists professionals and those being tested in making a career choice.  

Vocational testing with standardized measures has its roots in psychological and mental assessment of “feeble minded” citizenry, including early 20th-century immigrants and World War I army recruits.  Without question, vocational testing has evolved substantially and, of course, not without controversy.  Questions regarding test reliability, cultural and racial bias, the effect of other individual differences, test norms, predictive validity, and proper utilization of test results have challenged psychologists, test manufacturers, and test administrators for decades.  These pressures have continued to shape the field of testing.  Professional, moral, ethical, and social issues have influenced and will continue to influence the development and use of standardized testing.

One of the single most prolific vocational test administrators remains the Department of Defense with its employment of the Armed Services Vocational Aptitude Battery (ASVAB).  The ASVAB is the most widely used paper-and-pencil test in existence and is used by the Armed Services to screen potential recruits and to assign personnel to different jobs and training programs.  More than two million examinees take the ASVAB each year. 

Simply stated, one can more effectively and accurately predict the proper vocational placement of an individual when that individual’s personal history is supplemented by standardized test data.  An effective battery of vocational tests generally includes measurements of interests, abilities, and personality.  This tripartite appraisal allows one to predict if the person will potentially be satisfied with work, possess the abilities or aptitudes to learn and/or perform the work, and manifest personal characteristics to properly “fit” with the job functions required.  Vocational test batteries often investigate other worker characteristics as well.  Nonetheless, investigation of these three areas—interests, abilities, and personality (temperament)—is generally critical.
 

Vocational Testing in Matters of Personal Injury

Vocational testing in personal injury lawsuits provides the forensic examiner with additional data sets that detailed review of documentation and careful history taking cannot provide.  Vocational testing provides information regarding an examinee’s worker characteristics compared to others with whom she/he might compete for a job or particular type of job.  Careful and tactful questioning and a clearly identified work history cannot provide comparable information to that type of investigation that is also supplemented by standardized testing.  Occupational “match” or “fitness” can be enhanced substantially by employing vocational testing as an adjunct to detailed interviewing and observation.

Vocational testing permits the test administrator to formulate a more certain projection of an individual’s capacity to meet the demands of a job description.  Critical requirements of jobs can be matched with an examinee’s performances and results in standardized tests of abilities, interests, and personality.  Moreover, vocational testing can provide predictive information regarding an individual’s capacities to learn and develop new occupational capabilities through on-the-job training or classroom retraining.  

Customary Tests Utilized

Ability, achievement, intelligence, and aptitude testing employed in vocational/disability evaluation are generally designed to measure various behaviors that have application to an individual’s capacities to work effectively with data primarily, objects and things secondarily, and people to some extent.  A measured ability is a determination that the worker characteristic measured and possessed is sufficient to learn and perform a particular task.  According to Webster, an ability is the quality or state of being able; competence in doing; and natural talent or acquired proficiency.  Achievement may be thought of as the present level of an individual’s learning and her/his ability to apply what has been learned.  Intelligence is one’s potential to profit from experience and the capacity to understand or comprehend.  An aptitude is the capacity for learning a given discipline or subject matter.  The value of vocational testing in these areas is self-evident when there is a chance that an individual displaced from an occupation can return to the labor force in a similar or different job.  

Occupational interest testing allows the vocational test administrator to determine what type of work tasks will engage the individual, not necessarily what the individual is able to learn or do.  Discovering what type of jobs this individual will find satisfying is the goal of interest testing.  Without some degree of vocational interest or potential job satisfaction, the examinee will probably not be motivated to maintain a particular type of work or necessarily manifest sufficient effort, particularly in a job that she/he actively dislikes.  

Personality testing in vocational assessment is designed to measure that all-important aspect of occupational fitness, namely, personal characteristics that signal behavioral, social, emotional, and intellectual tendencies distinguishing one individual from another.  Vocational evaluation has long relied upon personality types to create an occupational match based on temperament—a person’s constitution, complexion, or makeup.  Personality traits of special occupational groups have been studied by vocational developmental theorists since the late 1930s.  Every individual inherits a tendency to expend her/his energies in some particular way, and that innate predisposition toward the manner of expending psychic energy, combined with various childhood experiences, molds the general style of an individual, which directly influences the individual’s pursuit and maintenance of a particular form of work.  It is clear that most Tractor Trailer Truck Drivers’ temperaments have common characteristics and School Teachers have different temperaments, but ones in common with other teachers.  Indeed, there are certain personality traits that are more conducive to elementary school teaching than secondary school teaching.  
 

Basic Statistical (and Practical) Considerations for Standardized Testing

The employment of standardized testing involves three basic considerations: Validity, Reliability, and Usability.  Validity is the most important consideration.  Validity of the test concerns what the test measures and how well it does so.  No test can be said to have “high” or “low” validity in the abstract.  Its validity must be determined with reference to the particular use for which the test is being considered.  Content validity involves essentially the systematic examination of the test content to determine whether it covers a representative sample of the behavior domain to be measured.  Content validity is most obviously important in achievement and aptitude tests.  Construct validity is probably the most important type of psychological theory.  With construct validity, there is a prediction of the results that should be obtained if the test is truly valid.  Criterion-related (or predictive) validity indicates the effectiveness of the test in predicting an individual’s behavior in a specified situation.  Based on the predictive validity of the test, one can make inferences from test scores to specific situations (e.g., a high score in Mechanical Reasoning will predict the potential to learn mechanical work).  

Attempting to define the validity of the test, however, will be a futile effort if the test is not reliable.  Reliability of standardized tests refers to the consistency of scores obtained by the same individuals when re-examined with the same test on different occasions, or with different sets of equivalent items, or under other variable examining conditions.  The concept of reliability underlies the computation of the error of measurement (error variance) of a single score, whereby one can predict the range of fluctuation likely to occur in any single individual’s score as a result of irrelevant, chance factors.  Stated simply, by test reliability, one refers to the reproducibility of a set of test results.  A test with high reliability is one that will yield very much the same relative magnitude of scores for a group of people under differing conditions or situations.  Reliability estimates are presented in a numerical coefficient.  A perfect reliability (correlation) coefficient of +1.00 is statistically impossible to obtain with any test, but essentially means that there is a one-to-one (absolute) correlation between scores obtained today with those that would be expected with the same instrument (or different sets of equivalent items) tomorrow.  

Classical test-score theory assumes that each person has a true score that would be obtained if there were no errors in measurement.  However, because measuring instruments are imperfect, the score observed for each person may differ from the person’s ability or characteristic.  The difference between the true score and the observed score results from measurement error.  Measurement error can be a function of various dynamics and sources and is not always a function of test reliability.  Anything that affects scores differently increases the amount of error variance and lowers the reliability and (indirectly) the validity of an instrument.  Examinee motivation, time influence, situation-induced factors (e.g., secondary gain), distortion (cheating or faking), and cultural differences are among the numerous sources of error variance.  

An experienced test interpreter will be able to account for the numerous factors that potentially cause measurement error.  One method of accounting for measurement error is to administer more than one instrument measuring the same behavior, such as arithmetic ability.  Another method is, of course, to review test data gathered by different sources, perhaps at different times, to make comparisons with information from a current assessment.  

Validity is the extent to which a test does the job desired of it; the evidence may be either empirical or logical.  Validity is established to a statistical comparison of scores with values on some outside variable.  Reliability is the reproducibility of a set of scores under differing conditions (i.e., consistency or stability of a measuring instrument necessary for, but not sufficient for, validity). 

Usability is consideration of the many practical factors that are going into the decision to use a particular test.  A longer test may be more reliable, even more valid; however, if there is only a limited time for testing, one may have to compromise with that particular ideal.  Whether the preferred test is too expensive or unavailable can determine the selection of one test over another.  

Vocational Evaluation Test Selection

Vocational evaluation should endeavor to integrate standardized test data from measures of ability, personality, and interest.  The most frequently employed ability measured in occupational assessment is the Vocational Aptitude Battery.  There are several vocational aptitude batteries on the market as well as some that are not readily available to the private practitioner but are nonetheless frequently referenced in military, educational, and employment records.  

Bennett Mechanical Comprehension Test – Designed to measure the ability to understand and perceive the relationship of physical forces and mechanical elements in practical situations, The Bennett Mechanical is considered a valid instrument for what it purports to measure and rates relatively high in terms of simplicity of instructions and responses required.  In many trades and occupations, the understanding of mechanical principles is a prerequisite to successful performance.  Automotive mechanics, plumbers, mechanical engineers, trade school applicants, and persons in many other “hands-on” vocations need to comprehend the basic mechanical principles in order to succeed in their fields.  This test consists of pictures about which the examinee must answer straightforward questions.  The situations depicted emphasize basic mechanical principles that might be encountered in everyday life.  In spite of its psychometric excellence, the Bennett Mechanical is in need of modernization.  

Career Ability Placement Survey – Designed to predict an individual’s potential to learn and/or perform occupations in 14 vocational fields, the Career Ability Placement Survey (CAPS) provides information regarding the test-taker’s Mechanical Reasoning, Spatial Relations, Verbal Reasoning, Numerical Ability, Language Usage, Word Knowledge, Perceptual (clerical) Speed and Accuracy, and dominant-hand Manual Speed and Dexterity.  Highly formulated on the Employee Aptitude Survey and the General Aptitude Test Battery, the CAPS can be administered individually or in a group.  It is easily and rapidly scored.  It has a very high predictive value with a predictive validity coefficient of .97 percent, according to the test makers.  The CAPS also has the advantage of being constructed with the COPSystem Interest Inventory, providing compatibility between aptitude and interest testing.  

Differential Aptitude Test – The Differential Aptitude Test (DAT) was first issued in 1947 to provide a basis for educational and vocational guidance of students in grades 7 through 12.  Subsequently, examiners have found the DAT useful in vocational counseling of young adults out of school and the selection of employees.  The DAT consists of eight independent tests: Verbal Reasoning, Numerical Reasoning, Abstract Reasoning, Perceptual Speed and Accuracy, Mechanical Reasoning, Space Relations, Spelling, and Language Usage.  The reliability of the DAT is generally quite high.  The test manual presents extensive data demonstrating that the validity data predict the DAT to be a good indicator of school grades and performances on other aptitude tests.  

General Aptitude Test Battery – In the late 1930s, the U.S. Department of Labor developed aptitude tests to predict job performance in 100 specific occupations.  In the 1940s, the department hired a panel of experts in measurement and industrial-organizational psychology to create a multiple aptitude test battery to assess the 100 occupations previously studied and many more.  The outcome of this herculean effort was the General Aptitude Test Battery (GATB), widely acknowledged as the premier test battery for predicting job performance.  Unfortunately, the U.S. Department of Labor limits distribution of the GATB to state agencies of Vocational Rehabilitation, Offices of Employment Security, and some public school districts and nonprofit organizations.  

Armed Services Vocational Aptitude Battery – Designed for the Department of Defense, the Armed Services Vocational Aptitude Battery (ASVAB) is administered to more than 1.3 million students each year.  A multiple aptitude battery, the ASVAB was designed for students in grades 11 and 12 and in post secondary schools.  The scores yielded are used in both educational and military settings.  The psychometric characteristics of the ASVAB are excellent, and the test manual and supporting documentation reveal that the ASVAB is a valid predictor of performance during training for a variety of military and civilian occupations.  Like the GATB, the ASVAB is not available to private practitioners, but the data these tests yield should be familiar to vocational experts who will frequently encounter them in educational and military records.   

The Wonderlic Personnel Test – Even though it is described as a personnel test, the Wonderlic is really a group test of general mental ability.  What makes this instrument somewhat of an institution in personnel testing is its format (50 multiple-choice items), its brevity (a 12-minute time limit), and its numerous parallel forms (16 at last count).  The reliability of the Wonderlic is quite impressive, especially considering the brevity of the instrument.  Internal consistency reliabilities typically reach .90, while alternative-form reliabilities usually exceed .90.  Regarding validity, if the Wonderlic is considered a brief test of general mental ability, the findings are also quite positive.  For example, one investigator reports a correlation of .91 between scores on the Wonderlic and scores on the Wechsler Adult Intelligence Scale, generally considered the gold standard in assessing adult mental ability.  

The Minnesota Clerical Test – The Minnesota Clerical Test (MCT) purports to measure perceptual speed and accuracy relevant to clerical work.  The MCT is divided into two subtests: Number Comparison and Name Comparison.  Each subtest consists of 100 identical and 100 dissimilar pairs of digit or letter combinations.  The examinee is required to check only the identical pairs, which are randomly intermixed with dissimilar pairs.  The score depends predominantly upon speed, although the examinee is penalized for incorrect items.  The reliability of the MCT is acceptable, with reported stability coefficients in the range of .81 to .87.  The MCT manual reports studies that are correlated with measures of job performance, measures of training outcome, and scores from related tests.  The job performance of directory assistants, clerks, clerk-typists, and bank tellers was correlated significantly but not robustly with scores on the MCT.  The MCT is also highly correlated with other tests of clerical ability.  
 

Achievement and Intelligence Testing

In particular situations, the vocational/disability evaluator will use measures of achievement and intelligence.  These types of instruments are used to investigate an individual’s capacities to learn and profit from additional education.  Achievement testing, particularly reading achievement, can also provide a preliminary determination as to whether the examinee can indeed read well enough to qualify for additional paper-and-pencil testing.  Intelligence testing can provide information on not only learning potential, but learning style as well.  Not every vocational evaluator is trained or qualified to administer particular intelligence tests.  For example, the Wechsler Adult Intelligence Scale, now in its third edition, is beyond the training and qualifications of most master’s level evaluators.  

Wide Range Achievement Test-Revision3 – The Wide Range Achievement Test-Revision3 (WRAT-R3) is an individually administered achievement test that was designed as an adjunct to tests of behavioral adjustment, intelligence, and aptitude.  Basically, this instrument is used to measure the achievement level or presence of a sensory-motor skills level in learning to read, spell, write, and arithmetically calculate.  

Peabody Picture Vocabulary Test-III – The Peabody Picture Vocabulary Test-III (PPVT-III) measures hearing or perceptive vocabulary, presumably providing a rough estimate of verbal intelligence, and one can use it as a screening instrument or as a supplement to other measures in evaluating learning problems and potentials.  The advantage of the PPVT-III is that it can be administered to a wide range of individuals, ranging from 2.5 years to adult.  

Peabody Individual Achievement Test-Revised – The Peabody Individual Achievement Test-Revised (PIAT-R) is designed to measure school achievement in the areas of mathematics, reading, spelling, general information, and written expression.  The PIAT-R covers a wide range of achievement levels from preschool to post-high school.   

Kaufman Brief Intelligence Test – The Kaufman Brief Intelligence Test (K-BIT) is a “screening” instrument measuring verbal and nonverbal intelligence, consisting of two subtests.  The Vocabulary subtest measures verbal, school-related skills (“crystallized thinking”) by assessing an individual’s word knowledge and verbal concept formation.  The Matrices subtest measures nonverbal and problem-solving skills (“fluid thinking”) by assessing an individual’s ability to perceive relationships and complete analogies.  The K-BIT’s standard scores are normed to permit direct comparisons with global scores earned by an individual on the Wechsler (1974, 1981, 1989) series of scales, the Kaufman intelligence scales, and on achievement batteries (such as the WRAT-R).  The K-BIT is normed for subjects ages 4 to 90, and one of its advantages is that it can be administered in 15 to 30 minutes.  Reliability findings for the K-BIT are exceptionally strong.  The K-BIT manual reports highly supportive validity data from 20 correlational studies.  Although the K-BIT yields standard scores having the same mean and standard deviation as the Wechsler and Kaufman scales, the K-BIT should not be used as a substitute for a comprehensive measure of the intelligence of a child or adult.  

General Ability Measure for Adults – The General Ability Measure for Adults (GAMA) provides an estimate of an individual’s nonverbal intelligence using abstract designs.  Nonverbal abstract figures (rather than verbal content) are used to minimize the effects of knowledge, verbal expression, and verbal comprehension on test scores.  This approach offers the advantage of providing an instrument that is accessible to a wide variety of people with different communication skills and diverse linguistic, cultural, and educational backgrounds.   

Beta III – This instrument is the third edition of the Beta Examination, a rough measure of general intelligence of persons who have difficulty reading or speaking English.  It is designed for use with individuals in the general population ages 16 to 89 years, or with individuals who are non-English speakers, are relatively illiterate, or have language difficulties.  The Beta III consists of five subtests: Coding, Picture Completion, Clerical Checking, Picture Absurdities, and Matrix Reasoning.  The final score is displayed as a nonverbal IQ.  Validity studies report that the Beta III is highly correlated with the WAIS-III.  

Slosson Intelligence Test-Revised - Designed as a screening instrument of intelligence, the Slosson is orally administered to eliminate reading by the test-taker.  Although the Slosson can be administered to illiterate or other clients who may be disadvantaged because of cultural or social status, it should be considered a screening instrument only.

Wechsler Adult Intelligence Scale-III - David Wechsler defined intelligence as the capacity to act purposefully and to adapt to the environment.  Intelligence is, he stated, “the aggregate or global capacity of the individual to act purposefully, to think rationally and to deal effectively with his environment.”.  The Wechsler Adult Intelligence Scale-III (WAIS-III) contains verbal and performance subtests and yields three IQs (Verbal Scale IQ, Performance Scale IQ, and Full Scale IQ).  The WAIS-III also provides index scores for Verbal Comprehension, Perceptual Organization, Working Memory, and Processing Speed.  The WAIS-III is considered the premier standardized test of adult intellectual capacity.  Administration requires considerable training and experience, preferably in earlier versions of the Wechsler tests.