Work and

Occupational
Therapy
OT 460A

Overview:
Define

work
Discuss the ADA
Discuss Work related assessments
FCEs

Define

type of work related programs

History of Work Programming

Key to philosophical base of OT
WWI: OT assisted disabled soldiers to reenter
the workforce
Vocational rehabilitation act of 1920:
reimportation is a necessary service benefit for
disabled individuals transfer
Prevocational services: 1930s
1943: vocational rehabilitation amendment:
people with psychiatric and developmental
disabilities became eligible for benefits

History of Work Programming

1950s: decline in professional interest in work
programming
1960s: resurgence with the emergence of
evaluation practices in industrial therapy
1980s present: work programming progress
beyond specialty within community mental
health practice

Definitions of Work

Physical or mental effort or activity directed toward the

production or accomplishment of something.
A job; employment:
A trade, profession, or other means of
livelihood.
Something that one is doing, making,
or performing, especially as an occupation
or undertaking; a duty or task
An amount of such activity either done or required: a
week's work.

Definitions of Work

The part of a day devoted to an occupation or

undertaking: met her after work.
One's place of employment
Something that has been produced or accomplished
through the effort, activity, or agency of a person or
thing:.

An act; a deed
The transfer of energy from one physical system to
another, especially the transfer of energy to a body
by the application of a force that moves the body in
the direction of the force.

Work
Regardless

of age or disability, all

persons have the right to live and work
in their communities.
Work provides people with a means for
economic independence
Work is critical in the development of
an identity, social relations and a sense
of mastery

The desired outcome of work

for all people includes:
Social inclusion
Personal safety
Economic security
Self sufficiency

Life satisfaction
Development of
relationships
Dignity and respect
Optimum health

Mosey's (1996) Role Acquisition

Frame of Reference
Learning of social roles required of the
individual in an expected environment
Intervention focus is based on an individual's
society and cultural group, current and
expected environment, and conceptualized
role categories
Types of roles and ways individual adapts to
them are affected by interests and goals

Mosey's (1996) Role Acquisition Frame of

Reference
Assumption: behavior influenced by
environment, areas of function are discrete
and can be addressed separately, and
adaptive behavior is learned directly by
experiencing the expected environment
Purposeful activity are used for learning skills
and developing abilities that form the basis of
life role of worker
Involves learning theories and behavioral
approaches

Mosey's (1996) Role Acquisition Frame of

Reference
Worker role is prioritized and necessary task
and interpersonal skills are required by
practice and repetition in a reinforcing
environment
The model relies on motivation and
collaboration with an emphasis on doing in
natural environments
Begins with tasks and interpersonal skills
and behavioral change is acquired through
meaningful activities

The ADA
The Americans with Disabilities Act (ADA) is a
comprehensive civil rights law for people with
disabilities. DOJ enforces the ADA's requirements in
three areas :
Title I: Employment practices by units of State and
local government
Title II: Programs, services, and activities of State
and local government
Title III: Public accommodations and commercial
facilities
ADA Accessibility Checklists

We can help clients:

Define employment objectives
Career exploration
Training, education, may include retraining
Person and environmental assessment
Recommendations for accommodations
Counseling and job placement
Job Coaching/Supported employment
Advocacy for workplace modifications
Be exposed to their rights under ADA
Businesses understand ADA

Assessment of work related

performance include:
Physical

aspects of a persons abilities

Psychosocial issues (including cognitive
abilities) that may affect their ability to
return to previous routines, whether it is at
work or at home.
Analysis of essential functions of a job
Environmental analysis/ modifications
Career exploration if client is unemployed or
needing to change jobs

COPS, COPE, CAPS, SDS, etc

Types of work rehabilitation

programs
Pre-placement/employment screenings
FCE (Functional Capacity Evaluation)
Work Hardening
Work Conditioning
Injury Prevention Training
Job Analysis
Ergonomic Work Site Analysis
Work Simulation
Sheltered Workshops
Supported employment

Supported Employment
Individual placed in a job of choice
Intensive support provided for unlimited
amount of time
Individual placement and support (IPS)
model: combines work experience with
cognitive and social skills training
Evidence indicates that work place-related
social skills can transfer from one place to
another when there is regular follow-up
support

Types of Supported Employment

Sheltered employment: Training and

employment in a segregated environment
mostly for people with developmental and
mental health disorders

Typically have subcontracted jobs from outside

industry and pay for minimum wage

In-house jobs: work oriented date treatment

programs and mental health rehab
clubhouses: Supported employment can be
within a center or a community-based setting

Types of Supported Employment

Transitional

employment: temporary
community jobs based upon members
abilities and endurance; used as work
adjustment, increase self-confidence,
and have job experiences for resumes

OT Evaluations

Pre-employment evaluations: determine

clients strengths and deficits with the objective
of helping to match the client with a job he or
she can be successful in

Jacobs Skills Assessment

Work Environment Impact Scale
Worker Role Interview
California Occupational Preference Survey (COPS)
Valpar

Task Analysis of components

Reporting Patients' Work Abilities: How the Use of Standardised Work

Assessments Improved
Abstract: Reporting patients' work abilities accurately is essential in the
rehabilitation process. Work assessment and rehabilitation require
occupational therapists to be skilled in the use of valid and reliable
assessment tools to support clinical reasoning. The aim of this study was
to ascertain if the use of two standardised work assessments (SWAs)
improved the quality of the information recorded about patients' work
abilities. Case note review using a local standard and audit tool was
carried out before (n = 42) and after (n = 41) use of the Valpar
Component Work Samples and the Worker Role Interview. Anecdotal
evidence was also collected. The results demonstrated an improvement
in the reporting of most of the areas matched against the standard and the
anecdotal evidence was supportive of the use of SWAs. It was concluded
that the use of SWAs by skilled occupational therapists improved the
reporting of patients' work abilities.
British Journal of Occupational Therapy 2004
Volume: 67 Number: 3 Page: 129 -- 132

OT Interventions
Ongoing re-evaluation
Troubleshooting and problem solving
Training job coaches in best, individualized
method for performing the job
Preparatory methods, like sensorimotor
strategies for self-calming or increased
alertness
Purposeful activities to practice parts of the
job
Recommendations for optimal performance
for each job

Purpose of an FCE
Indicates the current level of function, the major
limiting factors which may interfere with the
persons performance of his/her job, and the
Services needed to remediate the identified
rehabilitation problems.
The employer is contacted to ascertain specific
job requirements
On-Site Job Analysis may be performed to
define the critical and essential physical
demands.

FCEs may include:

Strength and flexibility

testing
Material handling ability
such as lifting, carrying,
pushing /pulling
Cardiovascular
assessment (optional)

Injury Prevention Training

Provide instruction in the major benefits of
injury prevention through the development of
proper fitness and improved work methods.
Job specific tasks are used to demonstrate the
application of these techniques.
Topics are customized and can include:

Back care and Body Mechanics

Injury prevention
Ergonomics
Exercise and conditioning

Work conditioning vs.

hardening

Work conditioning

Typically refers to intensive therapy to get people back into

shape
May include exercises to strengthen weak muscles,
cardiac/respiratory endurance, and some work simulation
Usually 3-4hours a day/ 3x per week

Work Hardening

More intensive program usually 6-8 hrs a day/ 5x per week

Work simulation
Education re:

Injury prevention
Advocacy for accommodations

Job site analysis and recommendations for modifications

Work conditioning

all pictures taken from

http://www.summitrehab.org/programs.htm

http://www.summitrehab.org/programs.htm

Disciplines involved in work

programs

Occupational therapy
Physical therapy
Vocational
Rehabilitation
Rehabilitation
Counselor
Workmans comp.
Occupational Health
Nurse/ physician

Risk management/
Occupational/
Employee health
nurse
Insurance company
Case manager
Speech Therapy
Attorneys, disability
adjudicators

Work Simulation/ Assessment

Use of purposeful activity that mimics
movements or processes of work
related tasks
More commonly used with DD
populations where LT vocational training
will be required

Life Care Planning

An essential living document that will project future
needs.
Can be used as evidence at trial to help determine the
award or settlement value of your case.
Can be used as a case management tool for projecting
costs and setting reserves.
Must have experience to understand implications of a
chronic disability/illness
Consulting with multiple disciplines to project costs.
Must understand economics and health care cost
projections