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Physical work capacity evaluation in vocational rehabilitation and its effect on the vocational placement… Cooke, Christopher 1990

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PHYSICAL WORK CAPACITY EVALUATION IN VOCATIONAL REHABILITATION AND ITS EFFECT ON THE VOCATIONAL PLACEMENT OF DISABLED MALE WORKERS by CHRISTOPHER COOKE B.A./B.P.H.E., Queens' U n i v e r s i t y , 1973 B.Ed., Queens' U n i v e r s i t y , 1974 M.P.E., U n i v e r s i t y o f B r i t i s h Columbia, 1977 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION i n THE FACULTY OF GRADUATE STUDIES E d u c a t i o n a l Psychology and S p e c i a l E d u c a t i o n We accept t h i s t h e s i s as conforming t o the r e g u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1990 (§) C h r i s t o p h e r Cooke, 1990 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of' this thesis for financial gain shall not be allowed without my written permission. Department of Educational Psychology and Special Education The University of British Columbia Vancouver, Canada D a t e April 23, 1990 DE-6 (2/88) A b s t r a c t The purpose of t h i s study was t o examine the e f f e c t o f program type and s e l e c t e d p r e d i c t o r v a r i a b l e s on the v o c a t i o n a l placement and f e e l i n g s of s e l f - e s t e e m o f d i s a b l e d male workers. I t was p r e d i c t e d t h a t : (1) a p h y s i c a l c a p a c i t y assessment program (PCA), designed by the i n v e s t i g a t o r , would r e s u l t i n a h i g h e r r a t e o f s u c c e s s f u l v o c a t i o n a l placement than c o n v e n t i o n a l placement t e c h n i q u e s , i n a s h o r t e r p e r i o d of time and w i t h a b e t t e r v o c a t i o n a l match; (2) i n c r e a s e d measures of s e l f - e s t e e m would be e x p e r i e n c e d by the PCA group and a t a more s i g n i f i c a n t l e v e l than c o n v e n t i o n a l v o c a t i o n a l programs; (3) t h e r e would not be a s i g n i f i c a n t i n t e r a c t i o n between the v o c a t i o n a l placement v a r i a b l e s and the independent v a r i a b l e s o f age, degree o f d i s a b i l i t y and i n j u r y type; and (4) t h e r e would not be a s i g n i f i c a n t e f f e c t of s e l e c t e d moderator v a r i a b l e s between groups on the v o c a t i o n a l placement v a r i a b l e s . F i f t y d i s a b l e d workers were randomly s e l e c t e d from the a c t i v e c a s e l o a d s of the V o c a t i o n a l R e h a b i l i t a t i o n Department of the Workers' Compensation Board of B r i t i s h Columbia f o r p a r t i c i p a t i o n i n the study. T h e i r average age was 33.32 ye a r s , and t h e i r average l e n g t h of time on wage l o s s was 245 days. A l l s u b j e c t s were i n j u r e d as the r e s u l t o f an i n d u s t r i a l a c c i d e n t , were no l o n g e r undergoing m e d i c a l t r e a t m e n t , had been c l e a r e d f o r a r e t u r n t o work b u t were s u f f e r i n g from a r e s i d u a l d i s a b i l i t y t h a t p r e v e n t e d them from r e t u r n i n g t o the work f o r c e . S u b j e c t s were randomly a s s i g n e d t o one o f two t rea tment c o n d i t i o n s i n v o l v i n g v o c a t i o n a l c o u n s e l l i n g w i t h j o b s e a r c h t r a i n i n g (JS) and v o c a t i o n a l c o u n s e l l i n g w i t h p h y s i c a l c a p a c i t y assessment (PCA) . F o l l o w i n g c o m p l e t i o n o f the program, s u b j e c t s began j o b s e a r c h a c t i v i t i e s and were m o n i t o r e d f o r a p e r i o d o f 6 months o r u n t i l s u c c e s s f u l v o c a t i o n a l p lacement was a c h i e v e d . Data a n a l y s e s showed t h a t : t h e r e was a s i g n i f i c a n t main e f f e c t between groups f o r succes s i n v o c a t i o n a l p lacement w i t h PCA p l a c i n g more s u b j e c t s than j o b s e a r c h ; t h e r e were no s i g n i f i c a n t d i f f e r e n c e s between groups on measures o f s e l f - e s t e e m f o l l o w i n g c o m p l e t i o n o f the programs; t h e r e was a s i g n i f i c a n t i n t e r a c t i o n e f f e c t o f age, degree o f d i s a b i l i t y and t y p e o f i n j u r y w i t h succes s i n v o c a t i o n a l p lacement and; t h e r e was a s i g n i f i c a n t i n t e r a c t i o n e f f e c t o f s e v e r a l moderator v a r i a b l e s i n c l u d i n g m a r i t a l s t a t u s and l e n g t h o f t ime on wage l o s s w i t h succes s i n v o c a t i o n a l p lacement and t ime t o v o c a t i o n a l p lacement . The r e s u l t s t e n d t o s u p p o r t the use o f p h y s i c a l c a p a c i t y assessment f o r the g u a n t i f i c a t i o n o f i n d i v i d u a l c a p a c i t y t o p e r f o r m work. F u r t h e r , the r e s u l t s sugges t t h a t the use o f PCA i n f o r m a t i o n i n the i d e n t i f i c a t i o n and i i i s e l e c t i o n o f a p p r o p r i a t e v o c a t i o n a l a l t e r n a t i v e s can s i g n i f i c a n t l y enhance the succes s o f v o c a t i o n a l p lacement d i s a b l e d w o r k e r s . Recommendations were made f o r f u t u r e r e s e a r c h . i v T a b l e o f Content s A b s t r a c t i i L i s t o f T a b l e s v i i i L i s t o f F i g u r e s i x Acknowledgements x CHAPTER I : INTRODUCTION 1 1.1 BACKGROUND OF THE PROBLEM 3 1 .1 .1 The Need f o r an I n t e g r a t e d E v a l u a t i o n Format 3 1.2 RESEARCH PROBLEM 9 1.3 QUESTIONS 10 1.4 DEFINITION OF TERMS 13 CHAPTER I I : LITERATURE REVIEW 15 2 .1 THE EMERGENCE OF PHYSICAL CAPACITY EVALUATION . . . 15 2 . 1 . 1 O c c u p a t i o n a l Therapy and Work H a r d e n i n g : A H i s t o r i c a l P e r s p e c t i v e 15 2 . 1 . 2 Work S a m p l i n g , Work S i m u l a t i o n and V o c a t i o n a l E v a l u a t i o n Programs 20 2 . 1 . 3 Paper T e s t i n g 27 2 . 1 . 4 P h y s i c a l C a p a c i t y Assessment Programs . . . 35 2 . 1 . 4 . 1 P r u i t t ' s V o c a t i o n a l E v a l u a t i o n System . . 39 2 . 1 . 4 . 2 The Matheson Work C a p a c i t y E v a l u a t i o n Format 40 2 . 1 . 4 . 3 The B l a n k e n s h i p I n d u s t r i a l R e h a b i l i t a t i o n System 44 2.2 THE DYNAMICS OF UNEMPLOYMENT 46 2 . 2 . 1 Unemployment and t h e P h y s i c a l l y D i s a b l e d . . 47 2 . 2 . 2 Unemployment and Measures o f S e l f - E s t e e m . . 49 2.3 VARIABLES AFFECTING VOCATIONAL PLACEMENT 53 CHAPTER I I I : METHODOLOGY 59 3 .1 OVERVIEW 59 3.2 PURPOSE OF THE STUDY 60 3.3 METHODOLOGY 60 3 . 3 . 1 R a t i o n a l e and E x p e r i m e n t a l D e s i g n 60 3 . 3 . 2 Dependent V a r i a b l e s 62 v 3 . 3 . 3 Independent V a r i a b l e s 63 3 . 3 . 4 M o d e r a t o r V a r i a b l e s 63 3 . 3 . 5 Q u e s t i o n s 64 3 . 3 . 6 Hypotheses 65 3 . 3 . 7 S u b j e c t s and Sampl ing 68 3.4 DEVELOPMENT OF THE TESTING MATERIALS 69 3 . 4 . 1 T a s k / M o d u l e P h y s i c a l C a p a c i t y Assessment Program 69 3 . 4 . 2 Remedia l Therapy P h y s i c a l E v a l u a t i o n . . . . 71 3 .5 DATA COLLECTION 72 3 . 5 . 1 Program A d m i n i s t r a t i o n 72 3 . 5 . 2 Job S e a r c h Program 75 3 .6 SCORING 76 3 . 6 . 1 Success i n V o c a t i o n a l Placement and Time t o V o c a t i o n a l Placement 76 3 . 6 . 2 Type o f V o c a t i o n a l Placement 77 3 . 6 . 3 S e l f - E s t e e m 78 3 .7 QUALITATIVE DESCRIPTION OF UNEMPLOYMENT EXPERIENCE . 78 3.8 DATA ANALYSIS 80 3 . 8 . 1 S t a t i s t i c a l P r o c e d u r e s 80 CHAPTER I V : RESULTS 81 4 .1 STATISTICAL ANALYSES 82 4.2 INDIVIDUAL DIFFERENCES 89 4.3 INTERVIEW INFORMATION AND L I F E L I N E PATTERNS . . . . 91 4.4 SUMMARY OF FINDINGS 99 CHAPTER V : DISCUSSION OF RESULTS 102 5.1 GROUP DIFFERENCES IN VOCATIONAL PLACEMENT VARIABLES 103 5.2 L I F E L I N E CATEGORIES, UNEMPLOYMENT AND S E L F - E S T E E M . 105 5.3 WORKER CHARACTERISTICS IN VOCATIONAL SUCCESS . . . 106 CHAPTER V I : SUMMARY, CONCLUSIONS, IMPLICATIONS, LIMITATIONS AND RECOMMENDATIONS FOR FURTHER RESEARCH I l l 6.1 SUMMARY I l l v i 6.2 CONCLUSIONS 114 6.3 IMPLICATIONS 117 6.4 LIMITATIONS 119 6.5 RECOMMENDATIONS FOR FUTURE RESEARCH 120 REFERENCES 123 APPENDIX A - I . D . TASK F I L E INVENTORY 141 APPENDIX B - SAMPLE TASK SHEET 143 APPENDIX C - INSTRUCTOR'S REPORT FORM 145 APPENDIX D - REMEDIAL THERAPY REPORT FORM 147 APPENDIX E - FUNCTIONAL EVALUATION REFERRAL FORM . . . . 152 APPENDIX F - INDUSTRIAL REPORT FORM 154 APPENDIX G - COOPERSMITH SELF-ESTEEM INVENTORY 159 APPENDIX H - DEMOGRAPHIC DATA 162 v i i L i s t o f T a b l e s I . C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) 83 I I . LERTAP Means, S t a n d a r d D e v i a t i o n s , V a r i a n c e , Cronbach a l p h a and C o r r e l a t i o n o f S e l f - E s t e e m S c o r e s 84 I I I . C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r I n j u r y Type (INJTYPE) f o r i n j u r i e s t o t h e Upper Body 85 I V . C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r Degree o f D i s a b i l i t y (DISABGP) l e s s t h a n o r e q u a l t o 5% 87 V . C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r Age Group (AGEGP) f o r s u b j e c t s g r e a t e r t h a n o r e q u a l t o 30 y e a r s o f age . 88 V I . Summary o f 2-way A n a l y s i s o f V a r i a n c e o f Time t o V o c a t i o n a l Placement (LTIME2VP) by Group Type (GRPTYPE) by M a r i t a l S t a t u s (MARITAL) 90 V I I . Summary o f 2-way A n a l y s i s o f V a r i a n c e o f Time t o V o c a t i o n a l Placement (LTIME2VP) by Group Type (GRPTYPE) by T i m e l o s s (TMLOSSGP) 91 v i i i L i s t o f F i g u r e s F i g u r e 1. Group A L i f e l i n e P a t t e r n . .89 F i g u r e 2. Group B L i f e l i n e P a t t e r n 90 F i g u r e 3. Group C L i f e l i n e P a t t e r n 91 F i g u r e 4. Group D L i f e l i n e P a t t e r n 92 F i g u r e 5. S e l f - E s t e e m S c o r e Improvement by Group . . . .94 i x Acknowledgement In the c o m p l e t i o n o f t h i s d i s s e r t a t i o n , I would l i k e t o e x p r e s s my a p p r e c i a t i o n t o s e v e r a l i n d i v i d u a l s who made the p r o c e s s r e w a r d i n g and w o r t h w h i l e . Foremost , I would l i k e t o thank my t h e s i s committee - D r . D a v i d K e n d a l l , D r . Norm Amundson and D r . R o b e r t Conry - f o r e x t e n d i n g t h e i r h e l p and i n t e r e s t . I would l i k e t o thank the s t a f f o f the V o c a t i o n a l R e h a b i l i t a t i o n Department o f the W o r k e r s 1 Compensat ion Board o f B r i t i s h C o l u m b i a , e s p e c i a l l y M r . Thomas Wharton and M r . Mike Cannings f o r t h e i r a p p r o v a l o f , and s u p p o r t f o r , t h e p r o j e c t . I would a l s o l i k e t o thank M r . K e i t h Mason o f the S t a t i s t i c s Department f o r h i s encouragement and g u i d a n c e t h r o u g h t h e d a t a a n a l y s i s phase . Many thanks t o a l l the s u b j e c t s o f t h i s s t u d y whose j o u r n e y a l o n g t h e r o a d from unemployment t o re-employment p r o v i d e d me w i t h the i n c e n t i v e and the m o t i v a t i o n t o complete t h i s p r o j e c t . F i n a l l y , I w i sh t o thank my w i f e , C a r o l y n f o r h e r p a t i e n c e , s u p p o r t and u n d e r s t a n d i n g t h r o u g h y e t a n o t h e r t h e s i s and my son C h r i s t i a n Anders who f i n a l l y has h i s daddy b a c k , a g a i n , t o p l a y w i t h . x CHAPTER I INTRODUCTION To the a c t i v e l y employed i n d i v i d u a l , work i s a c o m p l i c a t e d environment of d a i l y human a c t i v i t y . In a d d i t i o n t o i t s importance f o r the p r o v i s i o n o f p h y s i c a l sustenance, work a l s o p r o v i d e s us w i t h the i n t a n g i b l e rewards o f s e l f - w o r t h , s t r u c t u r e and b e l o n g i n g t o the community t h a t many of us seek i n an i n c r e a s i n g l y complex world ( C l u t t e r b u c k , 1984). Without work, s t u d i e s have shown t h a t people f e e l the consequences i n both economic and human terms ( F i n l e y and Lee, 1981; K e l v i n , 1981; Rump, 1983). In 1988 i n B r i t i s h Columbia, 192,515 c l a i m s were r e p o r t e d f o r i n j u r i e s s u f f e r e d i n the work p l a c e ; one i n j u r y every 12 seconds. Those i n j u r i e s were of s u f f i c i e n t s e v e r i t y t o r e q u i r e medical treatment and time l o s s from work. Of those c l a i m s accepted, 2,656 r e s u l t e d i n a medical d i s a b i l i t y o f s u f f i c i e n t p r o p o r t i o n t h a t i t r e s t r i c t e d the worker's a b i l i t y t o r e t u r n t o t h e i r p r e - a c c i d e n t v o c a t i o n . The way i n which the d i s a b l e d person responds t o unemployment has been the s u b j e c t of numerous r e s e a r c h a r t i c l e s over the y e a r s . Some s t u d i e s have o u t l i n e d the d i f f i c u l t y e xperienced by the d i s a b l e d person i n s e c u r i n g s u i t a b l e employment (Wi l l i a m s , 1972; Sears, 1975; F l o r i a n , 1978; Acton 1981) w h i l e o t h e r s have found s p e c i f i c b a r r i e r s on the road t o re-employment s u g g e s t i n g a l t e r a t i o n o f the work ex p e r i e n c e (Stone and Sawatzki, 1980). Some r e s e a r c h e r s have d e s c r i b e d f a c t o r s a f f e c t i n g the 1 unemployment experience f o r the d i s a b l e d as s p e c i f i c and unique t o t h i s p a r t i c u l a r sub-group i n our s o c i e t y (Borgen, Amundson and B i e l a , 1987). Understanding the cumulative nature of these f a c t o r s and the subsequent development of a p p r o p r i a t e c o p i n g s t r a t e g i e s f o r a p p l i c a t i o n w i t h i n the o v e r a l l v o c a t i o n a l framework has g r e a t l y a s s i s t e d the r e h a b i l i t a t i o n s p e c i a l i s t i n r e t u r n i n g d i s a b l e d workers t o the work p l a c e (Flamer, 1985). The d e t e r m i n a t i o n of p h y s i c a l work c a p a c i t y has been an e s s e n t i a l element i n the o v e r a l l p r o c e s s of p r e p a r i n g f o r work (Matheson, Ogden, V i o l e t t e and S c h u l t z , 1985). W i t h i n a v o c a t i o n a l context, Matheson (1987) o f f e r s a broad d e f i n i t i o n o f p h y s i c a l work c a p a c i t y as; "The measurement of an i n d i v i d u a l 1 s c a p a c i t y t o dependably s u s t a i n performance i n response t o b r o a d l y d e f i n e d work demands." (p. I 1.) In p a r t i c u l a r i n s t a n c e s where the e x i s t e n c e of a p h y s i c a l d i s a b i l i t y has imposed some l i m i t a t i o n of f u n c t i o n , the nature of t h a t l i m i t a t i o n must be d e f i n e d p r i o r t o the c o n s i d e r a t i o n of s u i t a b l e v o c a t i o n a l a l t e r n a t i v e s . T h i s approach i s w e l l documented i n the l i t e r a t u r e and s p e c i f i c assessment t o o l s have evolved over the y e a r s w i t h formats designed t o meet p a r t i c u l a r needs (Hanman 1958; Gannaway and Sink, 1978; Smith, Cunningham and Weinberg, 1986; Matheson, 1987; Blankenship 1988). T r a d i t i o n a l l y , f u n c t i o n a l c a p a c i t y e v a l u a t i o n programs have been c l i n i c a l l y o r i e n t e d and have been used as a p r e l i m i n a r y s c r e e n i n g t o o l f o r s p e c i f i c t a r g e t p o p u l a t i o n s 2 and as a g e n e r a l d i a g n o s t i c guide t o motor and c o g n i t i v e f u n c t i o n (Makisara and Makisara, 1982; Murphy and Ursprung, 1983; T h i b e a u l t and Blackmer, 1987). Often time consuming and expensive, they have c o n c e n t r a t e d on combinations of motor, c o g n i t i v e and a p t i t u d e components or s u b - t e s t s designed t o e v a l u a t e o v e r a l l v o c a t i o n a l p o t e n t i a l . In the few programs designed t o assess p h y s i c a l f u n c t i o n , the motor component has been one of l i m i t e d scope and s i m u l a t e d a p p l i c a t i o n w i t h some t e s t s r e l y i n g e x c l u s i v e l y on a w r i t t e n component f o r the assessment of f u n c t i o n a l c a p a c i t y (Smith, Cunningham and Weinberg, 1986). Very few a c t i v i t y - o r i e n t e d programs e x i s t t h a t a c t u a l l y r e l a t e p h y s i c a l c a p a c i t y t o s p e c i f i c w o r k - r e l a t e d f u n c t i o n s t h a t have p r a c t i c a l a p p l i c a t i o n t o the work p l a c e . None have the c a p a c i t y t o s i m u l a t e , o n - s i t e , a c t u a l work experiences i n an i n d u s t r i a l s e t t i n g . V o c a t i o n a l c o u n s e l l i n g t echniques, and i n some cases c a r e e r paths, have been chosen based on demonstrated c a p a c i t y f o r work from assessment-oriented programs where minimal f u n c t i o n a l i n f o r m a t i o n i s a c t u a l l y known about an i n d i v i d u a l ' s c a p a c i t y f o r work. 1.1 BACKGROUND OF THE PROBLEM 1.1.1 THE NEED FOR AN INTEGRATED EVALUATION FORMAT At the Workers' Compensation Board of B r i t i s h Columbia, workers who have been l e f t w i t h a r e s i d u a l d i s a b i l i t y as the r e s u l t o f t h e i r i n j u r y or who are having d i f f i c u l t y 3 r e t u r n i n g t o the work f o r c e f o l l o w i n g completion o f medical treatment are r e f e r r e d t o a r e h a b i l i t a t i o n c o n s u l t a n t f o r v o c a t i o n a l c o u n s e l l i n g . The c o n s u l t a n t a s s i s t s the i n j u r e d worker i n the i d e n t i f i c a t i o n and s e l e c t i o n o f v o c a t i o n a l o p t i o n s s u i t e d t o h i s / h e r i n d i v i d u a l needs and w i t h i n the l i m i t a t i o n s imposed by h i s / h e r i n j u r y . Often, t h i s p r o c e s s i n v o l v e s the use of e x i s t i n g , t r a n s f e r a b l e s k i l l s o r the p r o v i s i o n o f a d d i t i o n a l s k i l l s through t r a i n i n g , i n an e f f o r t t o improve the worker's m a r k e t a b i l i t y i n the workplace. Success o r f a i l u r e i n f i n d i n g s u i t a b l e employment may depend on the random s e l e c t i o n o f a l t e r n a t i v e s and, t o some extent, t r i a l and e r r o r when i n d i v i d u a l l i m i t a t i o n s are not known. Approaches t o s o l v i n g v o c a t i o n a l problems v a r y w i t h each i n d i v i d u a l s i t u a t i o n , and a c o n s i s t e n t approach t o the i d e n t i f i c a t i o n and s e l e c t i o n o f s u i t a b l e v o c a t i o n a l a l t e r n a t i v e s does not e x i s t from c o n s u l t a n t t o c o n s u l t a n t . The assumption b a s i c t o the premise o f p h y s i c a l c a p a c i t y e v a l u a t i o n i s t h a t the measurement of r e l e v a n t f u n c t i o n i n a sim u l a t e d environment has d i r e c t a p p l i c a t i o n t o the p r a c t i c a l world o f work (Matheson, 1987). F u r t h e r , i t i s c l e a r t h a t m u l t i p l e s i t u a t i o n a l formats have been designed over the years i n an attempt t o gather i n f o r m a t i o n over a l a r g e c r o s s - s e c t i o n o f work environments or as a g e n e r a l i n d i c a t o r o f work-readiness. In p h y s i c a l c a p a c i t y e v a l u a t i o n , f o u r d i s t i n c t approaches have emerged and come t o prominence i n the l a s t 4 20 y e a r s . These f o u r approaches have been c h a r a c t e r i z e d by N e f f (1966) as the mental or paper t e s t i n g approach, the job a n a l y s i s approach, the work-sample approach and the s i t u a t i o n a l assessment approach. The m a j o r i t y o f p h y s i c a l c a p a c i t y e v a l u a t i o n r e s e a r c h has c o n c e n t r a t e d i n these f o u r b a s i c areas w i t h the emergence of a p l e t h o r a of programs and d e s i g n s . T e s t i n g i n v o c a t i o n a l e v a l u a t i o n u s u a l l y f o l l o w s a h i e r a r c h y o f l o g i c a l implementation. The paper t e s t i n g approach i s used t o i d e n t i f y a b i l i t i e s , a p t i t u d e s and i n t e r e s t s and i s used as a g e n e r a l s c r e e n i n g t o o l f o r v o c a t i o n a l placement. T h i s approach i s u s u a l l y q u i c k and i n e x p e n s i v e and generates data as complex and u s e f u l as the t o o l b e i n g used. S e v e r a l s t u d i e s have e v a l u a t e d the e f f i c a c y of paper t e s t i n g on p r e d i c t i n g p h y s i c a l work c a p a c i t y as w e l l as success a t r e t u r n i n g t o work (Smith, Cunningham and Weinberg, 1986; M o r i a r t y , W a l l s and McLaughlin, 1987; T h i b e a u l t and Blackmer, 1987). Most of the s t u d i e s have shown g e n e r a l i z e d r e s u l t s w i t h s m a l l sample s i z e s and l i m i t e d p r a c t i c a l a p p l i c a t i o n t o a c t i v i t i e s of d a i l y l i v i n g and t o the world of work. Job a n a l y s i s emerged as a product of i n d u s t r y and governmental agencies i n an attempt t o q u a n t i f y the v a r i o u s a s p e c t s of work t o standard u n i t s f o r measurement and e v a l u a t i o n . T h i s approach focuses on the nature o f the t a s k t o be performed r a t h e r than on the human be i n g who i s p e r f o r m i n g i t (Neff, 1966). Although t h i s type of approach 5 was d e s i g n e d t o a n a l y z e a g i v e n k i n d o f work i n t o a s e r i e s o f m a c h i n e - l i k e u n i t s o r e l ements , t h e work o f R o e t h l i s b e r g e r and D i c k s o n (1939) demonstrated t h a t j o b a n a l y s i s had t o be complemented w i t h a t t e n t i o n t o human r e l a t i o n s i n i n d u s t r y t o have any p r a c t i c a l v a l u e . The most w i d e l y used p h y s i c a l c a p a c i t y e v a l u a t i o n programs have c o n c e n t r a t e d on a c o m b i n a t i o n o f w o r k - s a m p l i n g and s i t u a t i o n a l assessment t o e v a l u a t e r e a d i n e s s f o r work ( B l a n k e n s h i p , 1988; Matheson, 1987) . F o l l o w i n g the work o f Snook (1978) and C h a f f i n , H e r r i n and K e y s e r l i n g (1978) on pre-employment s t r e n g t h t e s t i n g and l i f t i n g t a s k s , m u l t i p l e t a s k t e s t i n g has e v o l v e d t o a s o p h i s t i c a t e d l e v e l i n i t s a t tempt t o d e f i n e p h y s i c a l c a p a c i t y f o r work. A r e v i e w o f the l i t e r a t u r e r e v e a l e d t h a t i n c r e a s i n g numbers o f p r e d i c t i v e , s i m u l a t e d t e s t s were emerging i n an at tempt t o d e f i n e d y s f u n c t i o n f o r l i t i g a t i o n purposes r a t h e r than f o r the purpose o f d e f i n i n g a b i l i t y f o r v o c a t i o n a l p lacement ( B l a n k e n s h i p , 1988) . The term p h y s i c a l work c a p a c i t y was s t e a d i l y b e i n g r e p l a c e d by t h e t erm r e s i d u a l d i s a b i l i t y p r o f i l e i n a l i t i g a t i o n o r i e n t e d system which was charged w i t h the r e s p o n s i b i l i t y o f e v a l u a t i n g d y s f u n c t i o n . The emergence o f c l i n i c a l e l e c t r o -d i a g n o s t i c t e s t i n g w i t h s o p h i s t i c a t e d q u a n t i f i c a t i o n programs f u e l l e d t h i s p r o c e s s but p r o v i d e d i n f o r m a t i o n o f m i n i m a l p r a c t i c a l r e l e v a n c e t o the w o r l d o f work ( A y e r o f f and K e r r , 1982; C h a f f i n , 1975; J i a n g , Smith and Ayoub, 1986) . I t i s a t t h i s p o i n t t h a t c a u t i o n s h o u l d be t a k e n 6 a g a i n s t g e n e r a l i z i n g these f i n d i n g s t o a t r u e w o r k i n g e n v i r o n m e n t . A n o t h e r a r e a o f i n t e r e s t has been the impact o f t h e v o c a t i o n a l i n t e r v e n t i o n p r o c e s s on t h e d i s a b l e d i n d i v i d u a l p e r se and on i n d i v i d u a l s a t i s f a c t i o n w i t h v a r i o u s v o c a t i o n a l i n t e r v e n t i o n t e c h n i q u e s . Most r e s e a r c h e r s a g r e e , however, t h a t a c r i t i c a l l o o k s h o u l d be t a k e n a t the way i n which v o c a t i o n a l c o u n s e l l i n g i s i n t r o d u c e d and t h a t approaches s h o u l d v a r y depending on the worker and on t h e d e s i r e d r e s u l t (Ge l lman, 1968; F l a m e r , 1985; L i v n e h , 1989) . F u r t h e r , the impact i n a p r a c t i c a l way o f c u r r e n t v o c a t i o n a l e v a l u a t i o n t e c h n i q u e s on v o c a t i o n a l p lacement has not been c l e a r l y addres sed i n the l i t e r a t u r e . The work o f Gannaway and S i n k (1978), e s t a b l i s h e s a c a u s a t i v e r e l a t i o n s h i p between performance on work sample e v a l u a t i o n and t y p e o f v o c a t i o n a l p lacement . No e m p i r i c a l d a t a e x i s t s , however, i n r e l a t i o n t o s t a t i s t i c a l s u c c e s s r a t e s n o r has any at tempt been made t o c l a s s i f y s u c c e s s f u l v o c a t i o n a l p lacement f o l l o w i n g v o c a t i o n a l i n t e r v e n t i o n t e c h n i q u e s i n terms o f r e l e v a n t demographic f a c t o r s such as age, t y p e o f i n j u r y o r degree o f d i s a b i l i t y . I f our u l t i m a t e g o a l i n the e v a l u a t i o n o f p h y s i c a l c a p a c i t y f o r work i s t o r e t u r n t h e i n j u r e d worker t o g a i n f u l employment, t h e n an a c c u r a t e and o b j e c t i v e t o o l needs t o be d e v e l o p e d . T h i s has prompted a growing number o f r e s e a r c h i n s t i t u t i o n s t o d e s i g n s i m u l a t e d work env ironments and s o p h i s t i c a t e d machinery t o s i m u l a t e p h y s i c a l work demands 7 (Kroemer, 1983; C h a f f i n , 1978). In the v a s t f i e l d o f s i t u a t i o n a l e v a l u a t i o n and work samples, however, o n l y a few s t u d i e s have emerged which have attempted t o r e l a t e e v a l u a t i o n outcomes t o the working environment (Matheson, 1987; Blankenship, 1988). Although the emergence of these new e v a l u a t i o n t e c h n i q u e s has g r e a t l y augmented the d i a g n o s t i c c a p a b i l i t i e s o f i n d u s t r i a l r e h a b i l i t a t i o n , t h e r e has been v e r y l i t t l e r e s e a r c h on the outcomes of these programs i n terms o f v o c a t i o n a l placement and the impact of the p r o c e s s on the i n d i v i d u a l . D e s p i t e agreement by work proponents t h a t the q u a n t i f i c a t i o n of p h y s i c a l work c a p a c i t y i s the f i r s t s t e p i n the d i a g n o s i s of i n d i v i d u a l a b i l i t y f o r work, the e f f e c t i v e n e s s of these programs on the placement of d i s a b l e d workers s t i l l awaits e m p i r i c a l i n v e s t i g a t i o n . U n t i l such time as f o l l o w - u p i n f o r m a t i o n becomes a v a i l a b l e , we can o n l y guess the outcome e f f e c t s of p r e s e n t i n t e r v e n t i o n t e c h n i q u e s . A work-oriented, task-module p h y s i c a l c a p a c i t y assessment program was developed by the i n v e s t i g a t o r f o r the assessment of i n j u r e d workers a t the Workers' Compensation Board of B r i t i s h Columbia C l i n i c i n an attempt t o p r o v i d e c r i t i c a l i n f o r m a t i o n on p h y s i c a l work c a p a c i t y . I t emerged as a d i r e c t r e s u l t of the c l e a r need f o r o b j e c t i v e , a c t i v i t y - b a s e d i n f o r m a t i o n i n o r d e r t o a c c u r a t e l y propose v o c a t i o n a l a l t e r n a t i v e s w i t h i n the f u n c t i o n a l l i m i t a t i o n s imposed by an i n d u s t r i a l i n j u r y . I t s h i f t e d 8 a t t e n t i o n away from the t r a d i t i o n a l focus o f assessment o f d i s a b i l i t y t o a c r i t i c a l a n a l y s i s o f s p e c i f i c f u n c t i o n t h r o u g h demonstrated a b i l i t y . From t h i s a n a l y s i s emerged an o b j e c t i v e p i c t u r e o f f u n c t i o n a l c a p a c i t y w i t h c l e a r l i n k s t o t h e demands o f the w o r k p l a c e . 1.2 RESEARCH PROBLEM The r e s e a r c h problem under taken here was t w o - f o l d . F i r s t , t h e o b j e c t i v e was the development o f a p h y s i c a l c a p a c i t y e v a l u a t i o n format w i t h s t r o n g t i e s t o t h e o b j e c t i v e measurement o f f u n c t i o n th rou gh t a s k s i m u l a t i o n . F o l l o w i n g c o m p l e t i o n and i m p l e m e n t a t i o n o f the program, t h e secondary purpose was t o e v a l u a t e the e f f i c a c y o f the e v a l u a t i o n format on v o c a t i o n a l p lacement . The format was d e s i g n e d under a t a s k - m o d u l e work sample approach and m o n i t o r e d i n a p i l o t program f o r a p e r i o d o f one y e a r . F o l l o w i n g c o m p l e t i o n o f the p i l o t program, the p r e s e n t s t u d y was implemented. Two e x p e r i m e n t a l groups were d e s i g n a t e d t o undergo c o n v e n t i o n a l v o c a t i o n a l r e h a b i l i t a t i o n i n t e r v e n t i o n w i t h one group h a v i n g the a d d i t i o n a l p r o t o c o l o f p h y s i c a l c a p a c i t y assessment . S u b j e c t s were randomly a s s i g n e d t o one o f two e x p e r i m e n t a l groups and m o n i t o r e d f o r a p e r i o d o f s i x months o r u n t i l v o c a t i o n a l p lacement was a c h i e v e d . 9 1.3 QUESTIONS The impact of such an assessment program on v o c a t i o n a l placement c l e a r l y needs t o be d e f i n e d . I f one concedes t h a t the u l t i m a t e g o a l of p h y s i c a l c a p a c i t y assessment i s t o a s s i s t i n the s e l e c t i o n of a c c u r a t e v o c a t i o n a l a l t e r n a t i v e s and i f one sees worker involvement as an important component of t h a t p r o c e s s , then the f o l l o w i n g q u e s t i o n s must be examined; (a) Can an a c t i v i t y - o r i e n t e d , p h y s i c a l c a p a c i t y assessment program t h a t would a c c u r a t e l y r e f l e c t an i n j u r e d worker's p h y s i c a l r e a d i n e s s f o r work be designed and implemented f o r use i n a c l i n i c a l s e t t i n g ? (b) I s t h e r e a d i f f e r e n c e between the two treatment groups as r e p r e s e n t e d by s p e c i f i c v o c a t i o n a l placement tech n i q u e s i n terms of v o c a t i o n a l placement success, time t o s u c c e s s f u l v o c a t i o n a l placement and type of placement? (c) Are t h e r e t r a i t / t r e a t m e n t i n t e r a c t i o n s between the dependent v a r i a b l e s and s e l e c t worker c h a r a c t e r i s t i c s o f i n j u r y type, degree of d i s a b i l i t y and age? (d) What i s the impact of s e l e c t e d moderator v a r i a b l e s i n c l u d i n g time i n medical treatment, p r e - i n j u r y wages, p o s t - i n j u r y wages, language, m a r i t a l s t a t u s e d u c a t i o n and r e h a b i l i t a t i o n c o n s u l t a n t on the dependent v a r i a b l e s ? (e) How w i l l the workers respond t o the two d i f f e r e n t 10 placement t e c h n i q u e s employed i n t h i s s t u d y i n terms o f t h e i r own f e e l i n g s o f s e l f esteem f o r each t r e a t m e n t c o n d i t i o n ? T h e r e a r e s e v e r a l f e a t u r e s o f t h i s s t u d y which d i s t i n g u i s h i t from p r e v i o u s work i n the a r e a . F i r s t , the i n d u s t r i a l p h y s i c a l work c a p a c i t y program i s t a s k - m o d u l e o r i e n t e d w i t h a f i r m b a s i s i n i n d u s t r i a l r e h a b i l i t a t i o n . The d u a l component format o f p h y s i c a l and i n d u s t r i a l e v a l u a t i o n p r o v i d e s more c o n c r e t e , o b j e c t i v e i n f o r m a t i o n on i n d u s t r i a l l y - r e l a t e d p h y s i c a l a b i l i t i e s t h a n was p r e v i o u s l y a v a i l a b l e . Second , the s tudy t a k e s a c r i t i c a l l o o k a t outcome v a r i a b l e s no t p r e v i o u s l y rev iewed i n the r e h a b i l i t a t i o n l i t e r a t u r e w i t h r e s p e c t t o v o c a t i o n a l p lacement f o l l o w i n g p h y s i c a l work c a p a c i t y e v a l u a t i o n v e r s u s c o n v e n t i o n a l p lacement t e c h n i q u e s as w e l l as examining s p e c i f i c worker t r a i t s i n c l u d i n g age, i n j u r y t y p e and degree o f d i s a b i l i t y . T h i r d , t h e p r o c e s s o f v o c a t i o n a l i n t e r v e n t i o n i s e v a l u a t e d from t h e p e r s p e c t i v e o f the d i s a b l e d worker , and i t s impact on t h e human v a l u e s o f s e l f - e s t e e m i s e x p l o r e d . A r e v i e w o f the l i t e r a t u r e e x p l a i n s the development o f t h e p h y s i c a l work c a p a c i t y e v a l u a t i o n concept and the emergence o f the s o p h i s t i c a t e d systems i n use t o d a y . An overv iew i s g i v e n o f the a v a i l a b l e formats w i t h p a r t i c u l a r i n t e r e s t g i v e n t o the t r a i t - c l u s t e r and work sample f o r m a t s . T h i s i s f o l l o w e d by a l o o k a t some s e l f - e s t e e m l i t e r a t u r e and an overv iew o f the human v a r i a b l e s 11 i n v o l v e d w i t h unemployment and d i s a b i l i t y . The impact o f t h e s e f a c t o r s a r e e x p l o r e d w i t h i n the s o c i a l , p s y c h o l o g i c a l and f i n a n c i a l c o n t e x t o f the o v e r a l l p r o c e s s . F i n a l l y , t h e l i t e r a t u r e on v o c a t i o n a l p lacement f o l l o w i n g i n j u r y i s r ev i ewed w i t h r e s p e c t t o p lacement succes s w i t h i n t h e g e n e r a l c o n t e x t o f s e l e c t b iodemographic v a r i a b l e s . The l a c k o f an o b j e c t i v e , i n d u s t r i a l l y - b a s e d e v a l u a t i o n format w i t h w o r k - r e l e v a n t d a t a i s c o n f i r m e d . W i t h i n t h e e x i s t i n g e v a l u a t i o n f o r m a t s , v e r y l i t t l e outcome d a t a i s a v a i l a b l e on r a t e s and succes s o f p lacement s p e c i f i c a l l y f o r d i s a b l e d w o r k e r s . When outcome o r p lacement d a t a i s a v a i l a b l e , i t i s g e n e r i c a l l y p r e s e n t e d w i t h no s p e c i f i c i n t e r p r e t a t i o n f o r s u b j e c t c h a r a c t e r i s t i c s nor i s any r e l e v a n t d a t a a v a i l a b l e on assessment s t r a t e g i e s f o r i n j u r y , d i s a b i l i t y o r age . The p r i n c i p l e s o f the c o n s t r u c t t h e o r y from Amundson and Borgen (1982) on the dynamics o f unemployment a r e e x t r a p o l a t e d t o i n c l u d e not o n l y the p r o c e s s o f v o c a t i o n a l i n t e r v e n t i o n b u t a l s o the human f a c t o r s and outcome v a r i a b l e s a r i s i n g from the s e a r c h f o r employment. The s e l f -esteem and c r i t i c a l i n c i d e n c e r e s e a r c h i s a l s o e x p l o r e d w i t h r e s p e c t t o i t s impact on the d e c i s i o n making p r o c e s s i n o r d e r t o p r o v i d e r e l e v a n t i n f o r m a t i o n f o r the p o s s i b l e outcomes o f t h i s s t u d y . 12 1.4 DEFINITION OF TERMS a. v o c a t i o n a l r e h a b i l i t a t i o n : the pro c e s s o f a c t i v e c o u n s e l l i n g , by q u a l i f i e d p r o f e s s i o n a l s , f o r the purpose o f d e f i n i n g v o c a t i o n a l s u i t a b i l i t y . b. s i t u a t i o n a l assessment: a c l i n i c a l assessment method u s i n g s y s t e m a t i c o b s e r v a t i o n a l t e c h n i q u e s i n e s t a b l i s h e d o r c r e a t e d work environments. c. e v a l u a t i o n : a pro c e s s o f assessment a c c o r d i n g t o a d e f i n e d s e t of c r i t e r i a . d. j o b a n a l y s i s : the s y s t e m a t i c study o f an oc c u p a t i o n i n terms of what the worker does i n r e l a t i o n t o data, people, and t h i n g s ; the methodology and techniques employed and the machines, t o o l s , eguipment, and work a i d s used; the m a t e r i a l s , products, s u b j e c t matter o r s e r v i c e s which r e s u l t and the t r a i t s r e q u i r e d o f the worker. e. p h y s i c a l work c a p a c i t y : the measurement of an i n d i v i d u a l ' s work t o l e r a n c e o r c a p a c i t y t o s u s t a i n performance i n response t o b r o a d l y d e f i n e d work demands. f . s u c c e s s f u l v o c a t i o n a l placement: the l o c a t i o n and a c q u i s i t i o n o f f u l l - t i m e employment f o r renumeration w i t h i n a 6 month time frame from completion of the program. g. time t o v o c a t i o n a l placement: l e n g t h o f time i n days measured as cumulative, c h r o n o l o g i c a l time, t o a maximum of 132 days (6 months), e x c l u s i v e o f weekends and s t a t u a t o r y h o l i d a y s , w h i l e a c t i v e l y l o o k i n g f o r work. h. impairment: medical r a t i n g o f p h y s i c a l , f u n c t i o n a l o r anatomical l o s s based on pre-determined r a t i n g schedules; expressed as a percentage o f a h e a l t h y (100%) e q u i v a l e n t e.g. discectomy, 1 - l e v e l , impairment = 5% of a t o t a l l y f u n c t i o n a l person. i . d i s a b i l i t y : a s o c i a l l y - o r i e n t e d term used t o d e s c r i b e the impact o f impairment on a l l a c t i v i t i e s i n c l u d i n g v o c a t i o n a l , s o c i a l , r e c r e a t i o n a l e t c . j . PCA: s h o r t form d e s i g n a t i o n f o r p h y s i c a l c a p a c i t y assessment; one of the treatment c o n d i t i o n s o f the study i n v o l v i n g a 2-week program of work t o l e r a n c e e v a l u a t i o n i n an i n d u s t r i a l s e t t i n g w i t h i n the Workers' Compensation Board R e h a b i l i t a t i o n C l i n i c . 13 k. J . S . : s h o r t form d e s i g n a t i o n f o r gob s e a r c h program; one o f the t rea tment c o n d i t i o n s o f t h e s t u d y i n v o l v i n g a 3-day program o f j o b s e a r c h and i n t e r v i e w t e c h n i q u e s based on the A z r i n mode l . 1. s e l f - e s t e e m : o v e r a l l l e v e l o f w e l l - b e i n g ; t h e t o t a l i t y o f an i n d i v i d u a l ' s thought s w i t h r e s p e c t t o s e l f - c o n c e p t and s e l f - w o r t h . F o r t h e purpose o f t h i s s t u d y , s e l f - e s t e e m was measured as t h e t o t a l number o f n e g a t i v e and p o s i t i v e r e s p o n s e s as r e c o r d e d by the Coopersmi th S e l f - E s t e e m I n v e n t o r y (1967: s h o r t v e r s i o n ) . m. t a s k : a s p e c i f i c a l l y d e s i g n e d i n d u s t r i a l p r o j e c t w i t h p r e - d e t e r m i n e d p h y s i c a l demands and r e q u i r e m e n t s . n . module: a group o f t a s k s w i t h l i k e components a c c o r d i n g t o s t r e n g t h , d e x t e r i t y e t c . o . l i f e l i n e : a l i n e a r , e m o t i o n a l t ime l i n e between two s e p a r a t e p o i n t s i n t i m e ; f o r t h e purpose o f t h i s s tudy the t ime frame was from d a t e o f i n j u r y t o d a t e o f i n t a k e i n t o the s t u d y ; e m o t i o n a l f l u c t u a t i o n s from a s t eady s t a t e i n c l u d i n g p o s i t i v e and n e g a t i v e v a r i a t i o n s as i n f l u e n c e d by day t o day l i f e e x p e r i e n c e s . p . l i f e l i n e c a t e g o r y : one o f f o u r c a t e g o r i e s o r g r o u p i n g s o f e m o t i o n a l l i f e l i n e v a r i a t i o n ( A - D ) , as d e s c r i b e d i n the s t u d y , based on common c h a r a c t e r i s t i c s and responses t o the l i f e l i n e c h a r t . 14 CHAPTER I I LITERATURE REVIEW 2 .1 THE EMERGENCE OF PHYSICAL CAPACITY EVALUATION 2 . 1 . 1 OCCUPATIONAL THERAPY AND WORK HARDENING: A HISTORICAL PERSPECTIVE One o f the f i r s t documented r e f e r e n c e s t o t h e m e d i c a l l y p r e s c r i b e d use o f work f o r r e m e d i a t i o n was by P h i l i p p e P i n e l i n 1801 i n h i s " T r e a t i s e on I n s a n i t y " ( P i n e l , 1962) . W i t h i n t h e env ironment o f the B i c e t r e Asylum f o r the Insane , P i n e l i n t r o d u c e d work t rea tment on the b a s i s t h a t ; "the o n l y method o f s e c u r i n g h e a l t h , good o r d e r , and good manners, i s t o c a r r y i n t o d e c i d e d and h a b i t u a l e x e c u t i o n the n a t u r a l law o f b o d i l y l a b o u r , so c o n t r i b u t i v e and e s s e n t i a l t o human h a p p i n e s s . " (p.9) Through the i n t r o d u c t i o n o f work t r e a t m e n t programs , P i n e l o b s e r v e d ; " that the r e t u r n o f c o n v a l e s c e n t p a t i e n t s t o t h e i r p r e v i o u s i n t e r e s t s , t o the p r a c t i c e o f t h e i r p r o f e s s i o n s , t o i n d u s t r i o u s n e s s and p e r s e v e r a n c e has always been the b e s t omen o f f i n a l r e c o v e r y . " (p. 12) D u r i n g h i s l i f e t i m e , P i n e l ' s work g r a d u a l l y became w e l l known and a c c e p t e d throughout the m e d i c a l community i n 19th c e n t u r y F r a n c e . The un ique n a t u r e o f h i s work w i t h such an o b s c u r e p o p u l a t i o n , i s o l a t e d by s o c i e t y i n g e n e r a l , r e v e a l e d some s t a r t l i n g i n s i g h t s i n t o the t h e r a p e u t i c use o f work f o r the t r e a t m e n t o f d i s o r d e r s o f the b r a i n . These p r o d u c t i v e , a c t i v i t y programs, c o n c e i v e d and implemented by P i n e l , c o n t i n u e d i n s e v e r a l p s y c h i a t r i c s e t t i n g s t h r o u g h the 1800's i n t o the e a r l y 1900's w i t h the 15 theme o f work the main t h e r a p e u t i c t o o l ( B a l l a r d e t a l , 1986) . As the succes s o f work t h e r a p y grew, t h e s e programs were soon f o l l o w e d by the e s t a b l i s h m e n t o f t h e f i r s t p r o f e s s i o n a l s c h o o l f o r o c c u p a t i o n a l t h e r a p i s t s i n C h i c a g o i n 1915 by E l e n o r C l a r k e S l a g e l ( S l a g e l and Robeson, 1941) . M i l i t a r y and c i v i l i a n c a s u a l t i e s from t h e two W o r l d Wars and t h e i n c r e a s i n g number o f i n j u r e d workers from the m e c h a n i z a t i o n o f N o r t h Amer ican i n d u s t r y , g r a d u a l l y s h i f t e d a t t e n t i o n towards the growing numbers o f d i s a b l e d v e t e r a n s and workers w i s h i n g t o r e t u r n t o the work p l a c e (Matheson e t a l , 1985) . The g e n e r a l response w i t h i n the m e d i c a l community came from o c c u p a t i o n a l t h e r a p y w i t h the development o f s p e c i a l i z e d t rea tment programs such as t h e T o r o n t o and the Delaware C u r a t i v e Workshops and w i t h t h e l a t e r f o r m a l i z a t i o n o f work e v a l u a t i o n programs (Noble , 1937) . W i t h i n these workshops , the o b j e c t i v e became the p h y s i c a l r e s t o r a t i o n and p s y c h o l o g i c a l adjus tment o f i n j u r e d p a t i e n t s (Gleave , 1947) w i t h the u l t i m a t e g o a l o f b r i d g i n g t h e gap between the r e s t o r a t i o n o f p h y s i c a l f u n c t i o n and t h e r e t u r n t o work (Matheson e t a l , 1985) . The concept o f work h a r d e n i n g i n o c c u p a t i o n a l t h e r a p y e v o l v e d d u r i n g the l a t e 1940's and e a r l y 1950's as t h e r e s u l t o f t h e demand f o r o b j e c t i v e i n f o r m a t i o n on work-r e l a t e d t o l e r a n c e s , c r i t i c a l p h y s i c a l c a p a c i t i e s and worker t r a i t s (Holmes, 1985) . Through the i n t r o d u c t i o n and per formance o f graded a c t i v i t y and e x e r c i s e programs t h a t r e f l e c t e d t h e a c t u a l p h y s i c a l demands o f s p e c i f i c j o b s , 16 i n f o r m a t i o n c o u l d be g a t h e r e d on the p a t i e n t ' s a b i l i t y t o p e r f o r m r e p e t i t i v e t a s k s such as l i f t i n g , c a r r y i n g , p u s h i n g , and p u l l i n g o f we ighted o b j e c t s under s i m u l a t e d c o n d i t i o n s ( B a l l a r d , B a x t e r , B r u e n i n g and F r i e d , 1986) . A t t h i s s tage i n i t s e v o l u t i o n , work h a r d e n i n g was b r o a d l y d e f i n e d as a " p r e s c r i p t i v e , p r o d u c t i v i t y development program" t o p r e p a r e t h e worker f o r a r e t u r n t o the demands o f the w o r k p l a c e (Matheson, 1987) . Treatment programs broadened t o i n c l u d e no t o n l y p a t i e n t s w i t h p s y c h i a t r i c d i s o r d e r s but a l s o t h o s e w i t h p h y s i c a l d i s a b i l i t i e s ( B a l l a r d e t a l , 1986) . I t was d u r i n g t h e development o f these t rea tment programs t h a t the e v o l u t i o n o f t h e t e c h n o l o g y and t e r m i n o l o g y which was t o form t h e b a s i s o f the emerging s u b - d i s c i p l i n e t o be known as v o c a t i o n a l e v a l u a t i o n began (Matheson, Ogden, V i o l e t t e and S c h u l t z , 1985) . The demand f o r w o r k - r e l e v a n t i n f o r m a t i o n c o n t i n u e d y e t the f o r m a l i z e d p r o t o c o l s which were l a t e r t o become the frames o f r e f e r e n c e f o r work e v a l u a t i o n were o n l y now b e g i n n i n g t o emerge (Stevens , 1950; L i c h t and Greenwood, 1950; West and McNary, 1956; Reuss , Rawe and S u n d q u i s t , 1958; Wegg, 1960) . The i n t r o d u c t i o n o f s t a n d a r d i z e d work samples and p s y c h o m e t r i c t e s t i n g t o de termine i n d i v i d u a l i n t e r e s t s , a p t i t u d e s , s k i l l s and l i m i t a t i o n s p r o v i d e d y e t a n o t h e r i n f o r m a t i o n g a t h e r i n g t o o l b o t h as an e s t i m a t e o f a b i l i t y and as an e x e r c i s e medium (Rosenberg and Usdane, 1963; Wegg, 1960; Goldman, 1961). W i t h d i v e r s i f i c a t i o n and 17 f o r m a l i z a t i o n o f the p r o c e s s , the program p r o t o c o l s , s o p h i s t i c a t e d t e r m i n o l o g y , equipment and m e d i c a l o r i e n t a t i o n were s l o w l y b e g i n n i n g t o e v o l v e . Throughout t h i s d e v e l o p m e n t a l phase , however, e v a l u a t i o n i n s t r u m e n t s l a r g e l y remained g e n e r a l s c r e e n i n g assessments i n v o l v i n g a t r e a t m e n t component. No d a t a had y e t been c o l l e c t e d on e s t a b l i s h i n g i n s t r u m e n t v a l i d a t i o n nor examiner r e l i a b i l i t y (Smith , 1964) . I t was d u r i n g the m i d - s i x t i e s and s e v e n t i e s t h a t work h a r d e n i n g programs w i t h f o r m a l i z e d approaches t o the t a s k o f t r e a t m e n t and e v a l u a t i o n began t o f i n d t h e i r way i n t o t r e a t m e n t c e n t e r s and e d u c a t i o n a l i n s t i t u t i o n s (Overs , 1968; P a c i n e l l i , 1970; P r u i t t , 1977) . The r o l e o f o c c u p a t i o n a l t h e r a p y w i t h i n v o c a t i o n a l e v a l u a t i o n c o n t i n u e d t o be d e f i n e d (Highbaur-Vandomm, 1981) and t o e v o l v e t h r o u g h t o a m u l t i -f a c e t e d , r e a l i t y based assessment c e n t e r i n g on an i n d i v i d u a l ' s a b i l i t y t o p e r f o r m v a r i o u s p h y s i c a l and p s y c h o l o g i c a l components o f j o b s . Emphasis was a l s o b e i n g put on the p r e d i c t i v e n a t u r e o f p r e v o c a t i o n a l t r a i n i n g ( S o l b e r g and Chueh, 1976) . R e s u l t s from these s t u d i e s showed s i g n i f i c a n t c o r r e l a t i o n s between s u c c e s s f u l per formance i n o c c u p a t i o n a l t h e r a p y and s u c c e s s f u l performance i n p r e - v o c a t i o n a l e v a l u a t i o n programs. The f u r t h e r development o f work h a r d e n i n g programs i n t o the e i g h t i e s i n v o l v e d an i n c r e a s i n g l y s o p h i s t i c a t e d approach t o t h e b a s i c t a s k o f r e s t o r a t i o n o f h e a l t h t h r o u g h f u n c t i o n (Holmes, 1985) . The r o l e o f the "worker" was r e e s t a b l i s h e d 18 i n t h e r e h a b i l i t a t i o n p r o c e s s and work b e h a v i o r (Johnson, 1971; M a t s u t s u y u , 1971; Shannon, 1972) and w o r k - p l a y t h e o r i e s (Tuck, 1983) were i n c o r p o r a t e d i n t o program p h i l o s o p h i e s . Awareness o f the p s y c h o - s o c i a l f a c t o r s i m p a c t i n g on the i n j u r e d worker (Spencer , 1983) and t h e s e n s i t i z a t i o n o f o c c u p a t i o n a l t h e r a p i s t s and e v a l u a t o r s t o t h e s e f a c t o r s , promoted i n d i v i d u a l i z e d approaches t o v o c a t i o n a l e x p l o r a t i o n . Throughout s o u t h e r n C a l i f o r n i a i n t h e 1980"s, a h i g h c o n c e n t r a t i o n o f work h a r d e n i n g programs had been e s t a b l i s h e d by o c c u p a t i o n a l t h e r a p i s t s (Matheson, Ogden, V i o l e t t e and S c h u l t z , 1985) . F r e q u e n t l y , work s i m u l a t i o n d e v i c e s were used t o c o l l e c t i n f o r m a t i o n which a l l o w e d the worker t o a t tempt graded t a s k s t h a t s i m u l a t e d j o b t a s k s (Matheson and Ogden, 1983) and which a l l o w e d e x t e n s i v e e x p l o r a t i o n o f p h y s i c a l t o l e r a n c e s under c o n t r o l l e d , s t a n d a r d i z e d c o n d i t i o n s ( B l a n k e n s h i p , 1988) . A l t h o u g h s t r u c t u r e d and s y s t e m a t i c i n t h e i r s i m u l a t i o n o f p h y s i c a l r e q u i r e m e n t s , the se work s t a t i o n s c o u l d o n l y sample g e n e r a l r e sponses t o g e n e r i c t y p e s o f work and l a c k e d s p e c i f i c , i n d u s t r i a l l y - o r i e n t e d i n f o r m a t i o n . A t b e s t , e v a l u a t o r s c o u l d g a i n a measure o f o v e r a l l a b i l i t y on a l i m i t e d b a s i s w i t h i n a l i m i t e d t i m e - f r a m e . The p r e d i c t i v e n a t u r e o f t h i s t y p e o f t e s t i n g and i t s c o r r e l a t i o n t o j o b - r e l a t e d t a s k s has y e t t o be e x p l o r e d . 19 2 . 1 . 2 WORK SAMPLING, WORK SIMULATION AND VOCATIONAL EVALUATION PROGRAMS S i n c e the development o f the f i r s t r e h a b i l i t a t i o n c e n t e r s i n t h e 1920's , v o c a t i o n a l e v a l u a t i o n systems have been i n e x i s t e n c e i n one form o r another ( B a l l a r d e t a l , 1986) . S i n c e t h a t t i m e , a c c o r d i n g t o N e f f (1966), program development has p r o g r e s s e d a l o n g f i v e d i s t i n c t approaches o r c a t e g o r i e s i n c l u d i n g : (1) p s y c h o l o g i c a l t e s t s ; (2) j o b a n a l y s i s ; (3) work samples ; (4) s i t u a t i o n a l assessment; and (5) j o b t r y o u t . The advantages and d i s a d v a n t a g e s o f each approach has been d i s c u s s e d a t l e n g t h i n the l i t e r a t u r e (Moed, 1960; N e f f , 1966) . Of the f i v e a p p r o a c h e s , work samples appear t o encompass some o f the most c r i t i c a l advantages o f the o t h e r approaches w h i l e a v o i d i n g t h e i r major d i s a d v a n t a g e s (Gannaway and S i n k , 1978) . T h e r e a r e f o u r main t y p e s o f work samples a c c o r d i n g t o t h e i r p h y s i c a l r e q u i r e m e n t s and o r i e n t a t i o n t o the a c t u a l w o r l d o f work. These i n c l u d e a c t u a l j o b samples , s i m u l a t e d j o b samples , s i n g l e t r a i t samples and c l u s t e r t r a i t samples . The m a j o r i t y o f t h e work samples most w i d e l y used a r e o f the s i m u l a t e d j o b sample and c l u s t e r t r a i t sample v a r i e t y . In h i s e x c e l l e n t t e x t on the compar i son o f commerc ia l e v a l u a t i o n sys tems , B o t t e r b u s c h (1982) d e s c r i b e s f o u r main c o n s i d e r a t i o n s o r f a c t o r s an e v a l u a t o r s h o u l d a n a l y z e p r i o r t o s e l e c t i n g a commerc ia l e v a l u a t i o n sys tem. These c o n s i d -e r a t i o n s i n c l u d e the range and t y p e o f j o b s a v a i l a b l e i n t h e l o c a l l a b o u r market , t r a i n i n g o p p o r t u n i t i e s , t h e c l i e n t 20 p o p u l a t i o n and the o v e r a l l purpose o f the e v a l u a t i o n . H a v i n g answered t h e s e q u e s t i o n s , the most a p p r o p r i a t e e v a l u a t i o n system can be chosen t o a d e q u a t e l y a s s e s s a c l i e n t ' s a b i l i t i e s . I t i s not the a u t h o r ' s i n t e n t i o n t o d i s c u s s the r e l a t i v e m e r i t s o f the wide range o f commerc ia l v o c a t i o n a l e v a l u a t i o n systems c u r r e n t l y a v a i l a b l e . F o r t h e p u r p o s e s o f t h i s s t u d y , t h e d i s c u s s i o n w i l l be c o n f i n e d t o t h o s e work samples which d i s p l a y the f o l l o w i n g common c h a r a c t e r i s t i c s : (1) have been d e s i g n e d f o r use w i t h p h y s i c a l l y d i s a b l e d p o p u l a t i o n s ; (2) c o n t a i n m a t e r i a l o r t a s k s which g a t h e r i n d u s t r i a l l y - r e l e v a n t i n f o r m a t i o n ; (3) c o n t a i n t a s k s w i t h a p h y s i c a l t o l e r a n c e component and; (4) a r e most commonly used w i t h i n t h e e v a l u a t i o n community. The I n s t i t u t e f o r the C r i p p l e d and D i s a b l e d i s c r e d i t e d w i t h d e v e l o p i n g the f i r s t work sample b a t t e r y i n 1937 c a l l e d t h e TOWER System ( P r u i t t , 1986) . An acronym f o r T e s t i n g , O r i e n t a t i o n and Work E v a l u a t i o n i n R e h a b i l i t a t i o n , t h e TOWER System i n c l u d e d 93 work samples o r t a s k s w i t h i n 14 b r o a d j o b t r a i n i n g a r e a s (Rosenberg, 1969) . O r i g i n a l l y d e s i g n e d f o r use by p h y s i c a l l y d i s a b l e d p e r s o n s , t h i s system i s now used f o r a l l p e r s o n s w i t h a l l forms o f d i s a b i l i t y . W h i l e each o f t h e 14 a r e a s i s independent , the work samples w i t h i n each a r e a a r e a r r a n g e d i n o r d e r o f c o m p l e x i t y . S i m p l e r t a s k s must be comple ted b e f o r e b e g i n n i n g more complex ones . D e s p i t e the f a c t t h a t the o n l y work per formance f a c t o r s p e c i f i c a l l y l i s t e d i s d e x t e r i t y , the TOWER System exposes 21 t h e c l i e n t t o many d i f f e r e n t t r a i n i n g a r e a s which a r e r e p r e s e n t a t i v e o f a v a r i e t y o f j o b s . The l a c k o f p r e c i s e d e f i n i t i o n s f o r work performance f a c t o r s and c l i e n t b e h a v i o r s and the l a c k o f adequate norms a r e t h e major weaknesses o f the system ( B o t t e r b u s c h , 1982) . In a d d i t i o n , the r e q u i r e m e n t t o f o l l o w w r i t t e n i n s t r u c t i o n s and t h e c o m p l e x i t y o f some o f the e v a l u a t i o n a r e a s r e s t r i c t s i t s a p p l i c a t i o n t o c l i e n t s w i t h lower l e v e l s o f e d u c a t i o n . The p h y s i c a l a s p e c t s o f the TOWER System c o n s i s t o f s e d e n t a r y t o l i g h t work e s p e c i a l l y i n v o l v e d w i t h t h e W e l d i n g (#13) and Workshop Assembly (#14) work samples . Manual d e x t e r i t y i s t h e major p h y s i c a l f a c t o r e v a l u a t e d under s t a n d a r d i z e d t ime norms. Time r e s u l t s a r e r a t e d on a 5 -p o i n t s c a l e based upon the number o f minutes t o c o m p l e t i o n and t h e f i n a l r e p o r t c o n t a i n s work and p e r s o n a l c h a r a c t e r i s t i c r a t i n g s f o r each o f the 14 j o b a r e a s and a n a r r a t i v e r e p o r t . D e s p i t e t h e w idespread use o f the TOWER System, t h e r e a r e no i n d u s t r i a l norms a v a i l a b l e f o r the system and a l a c k o f r e l i a b i l i t y and v a l i d i t y d a t a . In a d d i t i o n , t h e p o p u l a t i o n on which the system was normed has not been d e s c r i b e d i n terms o f sample s i z e nor c h a r a c t e r i s t i c s . M i n i m a l p h y s i c a l t o l e r a n c e i n f o r m a t i o n i s a v a i l a b l e i n terms o f t a s k c o m p l e t i o n and no r e l a t i o n s h i p i s e s t a b l i s h e d between c o m p l e t i o n o f the i n d i v i d u a l t a s k s and t h e p h y s i c a l r e q u i r e m e n t s o f i n d u s t r y (Nef f , 1966) . The O c c u p a t i o n a l A s s e s s m e n t / E v a l u a t i o n System (OA/ES) 22 was p r o d u c e d by a p r i v a t e s e c t o r r e h a b i l i t a t i o n s e r v i c e c a l l e d I n d i v i d u a l i z e d R e h a b i l i t a t i o n Programs i n Long Beach, New Y o r k . The OA/ES was d e s i g n e d f o r use i n a s s e s s i n g v o c a t i o n a l p o t e n t i a l o f l i t e r a t e , w o r k i n g a d u l t s who became d i s a b l e d as the r e s u l t o f an a c c i d e n t o r i l l n e s s , and i s b a s i c a l l y a worker t r a i t assessment which a l s o uses work samples . The work samples a r e c l o s e l y l i n k e d t o t h e D i c t i o n a r y o f O c c u p a t i o n a l T i t l e s (DOT) a l t h o u g h b o t h the a p p a r a t u s t e s t s and the work samples a r e o p t i o n a l . The motor c o o r d i n a t i o n p o r t i o n o f t h e work samples c o n s i s t s o f an a p p a r a t u s t e s t moving d i f f e r e n t s i z e d washers from one b o l t t o a n o t h e r . The f i n g e r d e x t e r i t y and manual d e x t e r i t y a p p a r a t u s i n v o l v e moving s m a l l i t e m s , n u t s and b o l t s from one b i n t o another and from one column t o a n o t h e r . The e y e - h a n d - f o o t c o o r d i n a t i o n i n v o l v e s t h e o p e r a t i o n o f a s m a l l f l e x s h a f t and f o o t c o n t r o l i n a p r e c i s i o n d r i l l i n g t a s k . There a r e n i n e work samples i n c l u d i n g systems p l a n n i n g , f i l e management, o r d e r r e q u e s t p r o c e s s i n g , p r o d u c t i d e n t i f i c a t i o n , g r i n d i n g o p e r a t i o n s , d r i l l p r e s s o p e r a t i o n s , e l e c t r o / m e c h a n i c a l , w e l d i n g and i t i n e r a r y p l a n n i n g . Of these work samples , 5 a r e c l e r i c a l and 4 a r e i n d u s t r i a l l y - o r i e n t e d . The OA/ES system can be f u l l y a d m i n i s t e r e d i n 4 hours and has an e s t a b l i s h e d l i n k w i t h the i n d u s t r i a l l y d e f i n e d p h y s i c a l r e q u i r e m e n t s o f j o b s as s e t out i n the DOT. The a p p a r a t u s t e s t s and work samples e v a l u a t e p h y s i c a l c a p a c i t y and a p t i t u d e on a much b r o a d e r s c a l e t h a n some o t h e r work 23 samples , however c a r e s h o u l d be t a k e n t o a v o i d a p p l y i n g the s p e c i f i c r e s u l t s o b t a i n e d from the i n d i v i d u a l samples t o b r o a d e r t r a d e s c a t e g o r i e s . The w o r k i n g norms s u p p l i e d w i t h t h e sample do not c o n t a i n t ime and q u a l i t y norms and d e s p i t e a c l o s e r e l a t i o n s h i p t o the DOT, the a c t u a l r e l a t i o n s h i p o f t h e work samples and t a s k s t o the p h y s i c a l r e q u i r e m e n t s o f a c t u a l j o b s i s q u e s t i o n a b l e . The S i n g e r System was deve loped by t h e S i n g e r E d u c a t i o n a l D i v i s i o n , C a r e e r Systems o f R o c h e s t e r , New Y o r k . I t was o r i g i n a l l y d e s i g n e d f o r use w i t h s p e c i a l needs p o p u l a t i o n s i n c l u d i n g p h y s i c a l l y hand icapped b u t now has a b r o a d range o f r e h a b i l i t a t i o n and e d u c a t i o n a l a p p l i c a t i o n s . ( B o t t e r b u s c h , 1982) . The V o c a t i o n a l E v a l u a t i o n System (VES) c o n t a i n s 24 work s t a t i o n s i n v o l v i n g v a r i o u s i n d u s t r i a l c a t e g o r i e s . A d m i n i s t r a t i o n o f the work samples i n v o l v e s the c l i e n t l i s t e n i n g t o an i n s t r u c t i o n a l v i d e o and t h e n p e r f o r m i n g a p a r t i c u l a r t a s k . The t a s k i s t h e n checked by the e v a l u a t o r f o r c o m p l e t i o n c r i t e r i a . A l l work samples a r e t i m e d and performance s c o r e s a r e compared t o e s t a b l i s h e d norms. Each u n i t c o n t a i n s 3 t y p e s o f norms i n c l u d i n g p a r t i c i p a n t norms, i n d u s t r i a l norms and m e t h o d s - t i m e -measurement norms (Moors and Reed, 1979) w i t h t h e i n d u s t r i a l norms b e i n g used as the p e r f e c t s c o r e o r 100%. R e s e a r c h e r s have r e p o r t e d m o d e r a t e l y r e l i a b l e t e s t -r e t e s t r e l i a b i l i t y c o e f f i c i e n t s (Cohen and Drugo, 1976) a c r o s s a l l samples o f work t a s k s . In a d d i t i o n , Gannaway and S i n k (1978) r e p o r t e d t h a t 82% o f the VES j o b samples 24 o b t a i n e d c o r r e l a t i o n c o e f f i c i e n t s o f +0.50 o r g r e a t e r i n p r e d i c t i n g employment succes s i n j o b s s p e c i f i c a l l y found i n the o c c u p a t i o n a l group a s s o c i a t e d w i t h the j o b sample . These r e s u l t s may be based on a s t r o n g e r p h y s i c a l r e q u i r e m e n t s l i n k between the V E S , and the r e q u i r e m e n t s o f i n d u s t r y , t h a n any p r e v i o u s work sample sys tem. The V a l p a r System, i n the Component Work Sample S e r i e s (CWS) f o r m a t , was deve loped by V a l p a r I n t e r n a t i o n a l o f T u s c o n , A r i z o n a . I t c o n t a i n s 19 work samples and a l t h o u g h o r i g i n a l l y d e s i g n e d f o r use w i t h the g e n e r a l p o p u l a t i o n , i t has been w i d e l y used w i t h i n d u s t r i a l l y i n j u r e d w o r k e r s . A d a p t a t i o n k i t s t o use VCWS 1 , 2 , 4 , 8 , 9 and 10 w i t h t h e v i s u a l l y i m p a i r e d a r e a v a i l a b l e as w e l l as v i d e o a d m i n i s t r a -t i o n t a p e s f o r the h e a r i n g i m p a i r e d f o r t h e complete VCWS S e r i e s w i t h t h e e x c e p t i o n o f VCWS 14 ( I n t e g r a t e d Peer P e r f o r m a n c e ) . Computer based p r o d u c t s a r e a l s o a v a i l a b l e i n c l u d i n g COMPORT and MESA f o r the p r o d u c t i o n o f i n t e g r a t e d f i n a l r e p o r t s ; a G . O . E . I n t e r e s t Survey and a VA1-SEARCH Employee T a l e n t Bank f o r use i n j o b t r a i n i n g and placement ( B o t t e r b u s c h , 1982) . The VCWS S e r i e s i s based on a t r a i t / f a c t o r approach and samples g e n e r a l worker t r a i t groups as w e l l as s p e c i f i c o c c u p a t i o n a l g r o u p s . They a r e d e s i g n e d t o be a d m i n i s t e r e d i n d i v i d u a l l y and i n d e p e n d e n t l y and can u s u a l l y be comple ted w i t h i n a one hour t ime frame. Norms f o r each o f t h e work samples a r e a v a i l a b l e w i t h i n f o r m a t i o n g a t h e r e d from v a r i o u s s o u r c e s i n c l u d i n g employed w o r k e r s , s k i l l c e n t e r t r a i n e e s 25 and community c o l l e g e s w i t h v a r y i n g sample s i z e s from 50 t o 550. Performance on a l l work samples i s t i m e d and t h e t o t a l t ime i s c o n v e r t e d i n t o p e r c e n t i l e s w i t h 5% i n c r e m e n t s . The Upper E x t r e m i t y Range o f M o t i o n (4 ) , S i m u l a t e d Assembly (8) , Whole Body Range o f M o t i o n (9) and E y e - H a n d -F o o t C o o r d i n a t i o n (11) work samples p r o v i d e o b j e c t i v e , f u n c t i o n a l i n f o r m a t i o n which can be used as a g e n e r a l i n d i c a t o r o f p h y s i c a l t o l e r a n c e . Many o f t h e o t h e r samples , a l t h o u g h p r o v i d i n g e x c e l l e n t g e n e r a l i n f o r m a t i o n , have l i m i t e d r e l a t i o n s h i p t o s p e c i f i c j o b s , o c c u p a t i o n s o r worker t r a i t groups ( B o t t e r b u s c h , 1982) . In g e n e r a l , work samples a r e d e s i g n e d t o a s s e s s a c l i e n t ' s p o t e n t i a l f o r a range o f o c c u p a t i o n a l a r e a s ( P r u i t t , 1986) and a c r o s s a b r o a d m a t r i x o f p h y s i c a l r e q u i r e m e n t s . Of the commerc ia l work samples rev iewed o f s p e c i f i c r e l e v a n c e t o t h i s s t u d y , none c o v e r s t h e worker t r a i t s o r g e n e r a l p h y s i c a l r e q u i r e m e n t s a s s o c i a t e d w i t h t h e f u l l range o f o c c u p a t i o n s . In a d d i t i o n , a l l work samples a r e r e s t r i c t e d t o the s e d e n t a r y t o l i g h t work range l e a v i n g t h e o t h e r s t r e n g t h c l a s s i f i c a t i o n s unsampled. W i t h the e x c e p t i o n o f the the V a l p a r Component Work Sample S e r i e s , none o f t h e c o m m e r c i a l l y a v a i l a b l e work samples were s p e c i f i c a l l y d e s i g n e d t o e v a l u a t e workers i n j u r e d as t h e r e s u l t o f i n d u s t r i a l a c c i d e n t s ( B o t t e r b u s c h , 1982; P r u i t t , 1986) o r i n v o l v e d workers as p a r t o f t h e n o r m a t i v e d a t a c o l l e c t i o n sample . In h i s rev i ew o f 14 c o m m e r c i a l l y a v a i l a b l e work 26 samples , (Walk 1985) found none t o be comprehens ive enough t o be used as a g e n e r a l s c r e e n i n g t o o l f o r a s s e s s i n g a v a r i e t y o f d i s a b l i n g c o n d i t i o n s . In each i n s t a n c e , e i t h e r i n f o r m a t i o n o f r e l e v a n c e t o s p e c i f i c worker t r a i t s o r p h y s i c a l r e q u i r e m e n t s was l a c k i n g , o r the method o f t a b u l a t i n g s c o r e s o r the r e p o r t i n g o f r e s u l t s was i n c o n s i s t e n t . To d a t e , a comprehens ive , i n d u s t r i a l l y -o r i e n t e d e v a l u a t i o n program has no t been d e v e l o p e d t h a t can a s s e s s a b r o a d range o f o c c u p a t i o n a l and p h y s i c a l r e q u i r e m e n t s w i t h i n a g e n e r a l work sample f o r m a t . 2 . 1 . 3 PAPER TESTING The development o f p s y c h o m e t r i c t e s t i n g i n a f o r m a l way began i n the l a t e 1800's and e a r l y 1900 ' s . I t was d u r i n g t h i s p e r i o d t h a t e x p e r i m e n t a l p s y c h o l o g i s t s and o t h e r s began t o c o n c e r n themse lves w i t h t h e i n d i v i d u a l d i f f e r e n c e s o f p e o p l e ( B o r i n g , 1951) and t o d e v e l o p t e s t s t o measure t h e s e i n d i v i d u a l i n t e r e s t s and a b i l i t i e s . I t was d u r i n g t h o s e e a r l y y e a r s t h a t the concept s o f t h e t e s t i n g l a b o r a t o r y , norming , t h e s t a n d a r d i z e d a d m i n i s t r a t i o n o f t e s t s and t h e use o f s t a t i s t i c a l a n a l y s i s were c o n c e i v e d and implemented (Goldman, 1961) . L a t e r , they were t o form the n u c l e u s o f the emerging f i e l d o f p s y c h o m e t r i c t e s t i n g as w e l l as v e r y v a l u a b l e terms o f r e f e r e n c e f o r the development o f the modern work e v a l u a t i o n p r o c e s s ( P r u i t t , 1986) . I t i s not the a u t h o r ' s i n t e n t i o n t o c h r o n i c l e the development o f p s y c h o m e t r i c t e s t i n g and i t s p r e s e n t 27 a p p l i c a t i o n t o the f i e l d o f v o c a t i o n a l e v a l u a t i o n . The r e a d e r i s r e f e r r e d t o Vernon Z u n k e r ' s r e f e r e n c e t o t h e use o f assessment r e s u l t s i n c a r e e r c o u n s e l l i n g (Zunker , 1988) f o r an e x t e n s i v e breakdown o f t e s t development and c u r r e n t t r e n d s . The f i e l d o f p s y c h o m e t r i c t e s t i n g i n g e n e r a l , however, d i d l a y the f o u n d a t i o n f o r t h e emergence o f paper and p e n c i l t e s t s p r e d i c t i v e o f p h y s i c a l c a p a c i t y which m e r i t s some d i s c u s s i o n a t t h i s p o i n t . R e s e a r c h on the p r e d i c t i v e v a l i d i t y o f p h y s i c a l c a p a c i t y t h r o u g h i n v e n t o r i e s and q u e s t i o n n a i r e s i s a r e l a t i v e l y new f i e l d . I t i s o n l y r e c e n t l y t h a t r e s e a r c h e r s have a t tempted t o use i n f o r m a t i o n g a t h e r e d e i t h e r t h r o u g h a paper t e s t i n g f o r m a t , w i t h a minor work s i m u l a t i o n and a c t i v i t y - o r i e n t e d component, o r t h r o u g h computer s a m p l i n g , t o p r e d i c t i n d i v i d u a l c a p a c i t y f o r work. One t e s t used t o more a c c u r a t e l y d e f i n e i n d i v i d u a l l e v e l s o f f u n c t i o n i s the F u n c t i o n a l C a p a c i t i e s E v a l u a t i o n ( F C E ) . T h i s e v a l u a t i o n , when combined w i t h a per formance component, has been used e x t e n s i v e l y not o n l y t o i d e n t i f y i n d i v i d u a l s f o r v o c a t i o n a l i n t e r v e n t i o n ( B a x t e r , 1978; K e s t e r , 1979; S m i t h , Cunningham and Weinberg , 1983) b u t t o a l s o p r e d i c t t h e i r succes s i n r e t u r n i n g t o work. S m i t h , Cunningham and Weinberg (1983) s t u d i e d t h e v a l i d i t y o f t h e FCE w i t h the Smith P h y s i c a l C a p a c i t i e s E v a l u a t i o n (SMITH-PCE) when a d m i n i s t e r e d t o s u b j e c t s by a g u a l i f i e d t h e r a p i s t . They d e f i n e d v a l i d i t y as the a b i l i t y o f a t r a i n e d o c c u p a t i o n a l t h e r a p i s t t o use t h e r e s u l t s o f 28 the e v a l u a t i o n t o p r e d i c t a c c u r a t e l y whether o r not a c l a i m a n t would r e t u r n t o work. The S m i t h - P C E c o n t a i n e d 20 s u b - t e s t s t o measure t h e 20 p h y s i c a l demands t h a t t h e U . S . Department o f Labour s p e c i f i e s f o r j o b s i n t h e n a t i o n a l c o m p e t i t i v e j o b market . Each s u b t e s t c o n s i s t e d o f 3 t o 39 e lements w i t h a t o t a l o f 154 performance i tems f o r the e n t i r e t e s t . Of t h e 125 s u b j e c t s s e l e c t e d f o r t h e s t u d y , o n l y 52 responded w i t h a completed q u e s t i o n n a i r e r e g a r d i n g t h e i r c u r r e n t employment s t a t u s . Comparisons o f e v a l u a t i o n p r e d i c t i o n s t o c u r r e n t employment s t a t u s r e v e a l e d t h a t 86.5% were a c c u r a t e . C h i square a n a l y s i s demonstrated s t a t i s t i c a l s i g n i f i c a n c e a t an a l p h a l e v e l b e t t e r t h a n p = .001 however the l i m i t e d sample s i z e and h i g h number o f nonrespondents l i m i t e d any g e n e r a l i z a t i o n o f the v a l i d i t y o f t h e i n s t r u m e n t . In a f o l l o w - u p r e p o r t (Smith , Cunningham and Weinberg , 1986) t h e a u t h o r s e l a b o r a t e d on t h e i r o r i g i n a l d a t a i n c l u d i n g c l a s s i f i c a t i o n by age, r a c e and gender . U n f o r t u n a t e l y , t h e unequal d i s t r i b u t i o n w i t h i n the e t h n i c and gender c l a s s i f i c a t i o n and the l i m i t e d g e o g r a p h i c d i s t r i b u t i o n o f the sample l i m i t e d any g e n e r a l i z a t i o n o f the f i n d i n g s . F o r m a l i z a t i o n o f a p r e d i c t i v e s c a l e f o r r e t u r n i n g d i s a b l e d workers t o a c t i v e employment emerged as a r e s u l t o f t h e work o f the Menninger F o u n d a t i o n i n the development o f t h e Menninger R e t u r n t o Work S c a l e . H e s t e r , D e c e l l e s and 29 G a d d i s (1986) c o l l e c t e d d e t a i l e d i n f o r m a t i o n on 600 Long Term D i s a b i l i t y c l a i m a n t s who had i n j u r y c l a i m s w i t h a major i n s u r a n c e c a r r i e r . Of the t o t a l sample , h a l f had r e t u r n e d t o work and h a l f had n o t . From t h i s sample , t e n c h a r a c t e r i s t i c s were found t o d i f f e r s i g n i f i c a n t l y . These i tems were t y p e o f d i s a b i l i t y , age, gender , e d u c a t i o n , m a r i t a l s t a t u s , t y p e o f o c c u p a t i o n , a r e a o f r e s i d e n c e , employer t y p e , t y p e o f d i s a b i l i t y s u p p o r t r e c e i v e d and amount o f wage r e p l a c e m e n t . These t e n i tems were t h e n combined t o form t h e Wenninger R e t u r n t o Work S c a l e which was used t o p r e d i c t the l i k e l i h o o d o f a d i s a b l e d p e r s o n r e t u r n i n g t o work w i t h o u t r e h a b i l i t a t i o n a s s i s t a n c e . F o r the t e n v a r i a b l e s i d e n t i f i e d , u n i v a r i a t e compar i sons i n v o l v i n g C h i sguare and t - t e s t were per formed f o r t h e r e t u r n t o work and n o n - r e t u r n t o work subsamples . The v a r i a b l e s showing s i g n i f i c a n t d i f f e r e n c e s were used as i tems on the s c a l e . Each v a r i a b l e was t h e n t r a n s f o r m e d t o a s e t o f s c a l e s c o r e s from 0 t o 10 where each u n i t c o r r e s p o n d e d t o a 10% p r o b a b i l i t y o f r e t u r n t o work. The sum o f the v a r i a b l e s then compr i sed an i n d i v i d u a l • s s c o r e on t h e Menninger RTW S c a l e . The r e s e a r c h r e s u l t s showed s i g n i f i c a n t s e p a r a t i o n between t h o s e who r e t u r n t o work and t h o s e who do n o t . Of t h e 600 s u b j e c t s r e v i e w e d , 89% o f those who s c o r e d 50 o r more p o i n t s r e t u r n e d t o work w h i l e o n l y 18% o f t h o s e who s c o r e d l e s s t h a n 50 e v e r r e t u r n e d . The s c a l e , however, d i d no t c o n t a i n an a c t i v i t y component as a p a r t o f the o v e r a l l 30 assessment n o r any r e l e v a n t f u n c t i o n a l o r m e d i c a l i n f o r m a t i o n on which t o a s se s s i n d i v i d u a l t o l e r a n c e s . I t r e l i e d , i n s t e a d , on the c l a s s i f i c a t i o n o f the i n j u r y o r d i s a b i l i t y g r o u p i n g a c c o r d i n g t o the Merck Manual (Berkow, 1982) as a b a s i s f o r succes s o r f a i l u r e i n r e t u r n i n g t o the work f o r c e . As a g e n e r a l s c r e e n i n g t o o l , the Menninger RTW S c a l e i s a p p r o p r i a t e i n i d e n t i f y i n g t h o s e i n j u r e d workers who may b e n e f i t from v o c a t i o n a l i n t e r v e n t i o n , o r , more i m p o r t a n t l y , t h o s e who may n o t . F o l l o w i n g i d e n t i f i c a t i o n , t h e a p p r o p r i a t e t y p e o f v o c a t i o n a l i n t e r v e n t i o n can t h e n be implemented, i n c l u d i n g p h y s i c a l c a p a c i t y assessment . H e s t e r , D e c e l l e s and S t a n t o n (1988) have a l s o p r o v i d e d some r e s e a r c h on u s i n g the Menninger RTW S c a l e i n d i s a b i l i t y c o s t c o n t a i n m e n t . Through the i d e n t i f i c a t i o n o f a p p r o p r i a t e v o c a t i o n a l i n t e r v e n t i o n c a n d i d a t e s and p r e d i c t i n g the need f o r r e h a b i l i t a t i o n , t h e i r r e s e a r c h g e n e r a t e s a t h e o r e t i c a l c o s t model o f where t o b e s t use r e h a b i l i t a t i o n f u n d s . U t i l i z i n g the I n t e r v e n t i o n Impact Q u o t i e n t ( H Q ) (Hes ter and D e s c e l l e s , 1985) , they have found t h a t e a r l y and a c c u r a t e i d e n t i f i c a t i o n o f r e h a b i l i t a t i o n c a n d i d a t e s can reduce the number o f p e o p l e i n a t h e o r e t i c a l d i s a b i l i t y s u p p o r t system by 26% w i t h s i g n i f i c a n t o v e r a l l c o s t s a v i n g s . The P r e l i m i n a r y D i a g n o s t i c Q u e s t i o n n a i r e (PDQ) was d e s i g n e d by J o s e p h M o r i a r i t y (1981) t o a s s e s s t h e f u n c t i o n a l c a p a c i t y o f handicapped i n d i v i d u a l s i n r e l a t i o n t o e m p l o y a b i l i t y . I t c o n t a i n s e i g h t s u b s c a l e s p r o v i d i n g 31 r e l e v a n t i n f o r m a t i o n on the f o u r major components o f f u n c t i o n a l assessment; c o g n i t i v e , p h y s i c a l / m o t o r , e m o t i o n a l / s o c i a l and d i s p o s i t i o n ( D i l l e r , 1971) . I t was d e s i g n e d t o be a d m i n i s t e r e d q u i c k l y i n a c o u n s e l l o r ' s o f f i c e t o c o l l e c t i n f o r m a t i o n on a c l i e n t ' s c a p a b i l i t y f o r c o m p e t i t i v e work. M o r i a r t y , W a l l s and M c L a u g h l i n (1987) r e p o r t e d s a t i s f a c t o r y t e s t - r e t e s t r e l i a b i l i t y on a sample o f 28 c l i e n t s who were a d m i n i s t e r e d the PDQ i n the a r e a s o f e s t i m a t e o f l e a r n i n g (r=.97) and e m o t i o n a l f u n c t i o n i n g ( r = . 9 1 ) . I n t e r n a l c o n s i s t e n c y as measured by C r o n b a c h ' s c o e f f i c i e n t a l p h a (Cronbach , 1951) demonstrated a c c e p t a b l e l e v e l s o v e r a l l w h i l e c o n t e n t v a l i d i t y and c r i t e r i o n - r e l a t e d v a l i d i t y r e s u l t s s u p p o r t e d i t s use i n p r e d i c t i n g f u t u r e employment. The psychomotor s c a l e , however, appeared t o r e f l e c t t h e c o g n i t i v e more than the p h y s i c a l f u n c t i o n i n g and l a c k e d a c o n c l u s i v e measure o f p h y s i c a l t o l e r a n c e . To d a t e , t h i s component has not been enhanced nor has any f u r t h e r r e s e a r c h been conducted on the use o f the PDQ i n p r e d i c t i n g reemployment. I t does , however, remain an a c c e p t a b l e s c r e e n i n g t o o l i n t h e f u n c t i o n a l assessment o f e m p l o y a b i l i t y . I n t r o d u c e d i n 1979 by Bloomer and W i l l i a m s , t h e Bay A r e a F u n c t i o n a l Performance E v a l u a t i o n (BaFPE) was d e s i g n e d as an o b j e c t i v e measure o f d a i l y l i v i n g a c t i v i t i e s f o r p a t i e n t s w i t h p s y c h i a t r i c d i s o r d e r s . I t has s i n c e been r e v i s e d and v a l i d a t e d on a l a r g e r p o p u l a t i o n w i t h the 32 i n c l u s i o n o f a l a r g e r v a r i e t y o f s u b j e c t v a r i a b l e s ( W i l l i a m s and Bloomer , 1987) . The BaFPE c o n s i s t s o f an i n t e r v i e w and the a d m i n i s t r a t i o n o f a t a s k - o r i e n t e d assessment (TOA) and a s o c i a l i n t e r a c t i o n s c a l e ( S I S ) . The t a s k - o r i e n t e d component encompasses f i v e t a s k s i n c l u d i n g a s o r t i n g t a s k , a money management e x e r c i s e , a home drawing t a s k , b l o c k d e s i g n and t h e t a s k o f drawing a k i n e t i c p e r s o n . T h i b e a u l t and Blackmer (1987) a d m i n i s t e r e d t h e BaFPE t o 60 p s y c h i a t r i c p a t i e n t s who were t e s t e d o v e r a p e r i o d o f 8 months. In a d d i t i o n t o performance s c o r e s , demographic and m e d i c a l i n f o r m a t i o n was a l s o c o l l e c t e d i n c l u d i n g age, gender , m e d i c a t i o n t y p e and amount, e d u c a t i o n , t ime i n h o s p i t a l and t y p e o f t r e a t m e n t . The r e s u l t s showed t h a t the BaFPE c o r r e l a t e d h i g h l y w i t h some o f the WAIS s u b s c o r e s and t h a t t h e r e was a s i g n i f i c a n t r e l a t i o n s h i p between age and per formance on t h e BaFPE (p < .001) and e d u c a t i o n and BaFPE per formance (p < . 0 1 ) . Younger p e o p l e per formed b e t t e r t h a n o l d e r p e o p l e and more h i g h l y educated p e o p l e per formed b e t t e r t h a n l e s s educated p e o p l e . The o t h e r f a c t o r s d i d not show s t a t i s t i c a l s i g n i f i c a n c e . T h e r e was, however, d i s t o r t e d i n f o r m a t i o n on t h e 3 s e p a r a t e s u b s c a l e s o f the TOA c a s t i n g some doubt on the v a l i d i t y o f t h o s e measures . There was a h i g h c o r r e l a t i o n between t h e c o g n i t i v e , performance and a f f e c t i v e components o f the s c a l e s u g g e s t i n g an o v e r l a p p i n g e f f e c t . The i n d i v i d u a l s c o r e s may t h e r e f o r e be m i s l e a d i n g and not pure measures o f f u n c t i o n a l per formance . The r o b u s t n e s s o f t h e 33 f u n c t i o n a l t o l e r a n c e components o f the TOA was a l s o m i n i m a l and d i d not c o n t a i n a wide c r o s s - s e c t i o n o f g e n e r a l p h y s i c a l a b i l i t i e s . In a d d i t i o n , no d a t a i s y e t a v a i l a b l e on t h e c o r r e l a t i o n o f the f u n c t i o n a l performance component o f t h e TOA t o any o t h e r measure o f f u n c t i o n a l a b i l i t y . One o f t h e f i r s t a t tempts t o c o m p u t e r i z e the c o l l e c t i o n o f p h y s i c a l c a p a c i t y i n f o r m a t i o n appeared w i t h the I n v e n t o r y o f P h y s i c a l C a p a c i t i e s P e r c e p t i o n ( I P C P ) . Deve loped by Luc Duva l a t t h e C e n t r e Humaniste D 1 O r i e n t a t i o n e t de C o n s u l t a t i o n i n Quebec ( D u v a l , 1988) , t h i s i n v e n t o r y a l l o w s the r e h a b i l i t a t i o n s p e c i a l i s t t o o b t a i n an i n i t i a l p r o f i l e o f a c l i e n t ' s mode o f p h y s i c a l f u n c t i o n i n g and a c t i v i t y p o t e n t i a l . A v a i l a b l e i n paper t e s t o r c o m p u t e r i z e d f o r m a t , t h e q u e s t i o n n a i r e i s made up o f 95 i tems a l o n g s i x t h e m a t i c s c a l e s i n c l u d i n g c o g n i t i o n and communicat ion , v i s i o n , lower l i m b s , upper l i m b s , g e n e r a l c a p a c i t i e s and e n v i r o n m e n t a l c o n d i t i o n s . The t e s t i s d e s i g n e d f o r a d u l t s w i t h f u n c t i o n a l l i m i t a t i o n s and p r o v i d e s g e n e r a l i n f o r m a t i o n on p h y s i c a l f u n c t i o n i n g and i n d i v i d u a l t o l e r a n c e s . The l e v e l s o f f u n c t i o n a r e c r o s s - r e f e r e n c e d t o the Canad ian C l a s s i f i c a t i o n and D i c t i o n a r y o f O c c u p a t i o n s ; however t h e r e i s no a c t u a l d e m o n s t r a t i o n o f p h y s i c a l c a p a c i t y nor i n d u s t r i a l l y - r e l a t e d work t o l e r a n c e s . To d a t e , no e m p i r i c a l d a t a i s a v a i l a b l e on t h e v a l i d i t y o f t h i s i n v e n t o r y nor on i t s c o r r e l a t i o n w i t h o t h e r measures o f f u n c t i o n a l assessment i n c u r r e n t u s e . 34 2 . 1 . 4 PHYSICAL CAPACITY ASSESSMENT PROGRAMS P h y s i c a l work c a p a c i t y has been s t u d i e d i n g r e a t depth by e x e r c i s e p h y s i o l o g i s t s and c a r d i o l o g i s t s f o r many y e a r s ( C h r i s t e n s e n , 1955; B i n k , 1962; B o n j e r , 1962; A s t r a n d , 1967; D a v i s , F a u l k n e r and M i l l e r , 1969; A s t r a n d and R o d a h l , 1970; Snook, 1 9 7 1 ; ) . W i t h i n t h i s m e d i c a l framework, p h y s i c a l work c a p a c i t y was d e s c r i b e d as the p r a c t i c a l r e s u l t o f t h e t r a n s f o r m a t i o n o f c h e m i c a l l y bound energy i n t o m e c h a n i c a l energy and was measured i n terms o f p h y s i c a l p e r f o r m a n c e . A c c o r d i n g t o A s t r a n d and Rodahl (1970) the o b j e c t i v e s o f p h y s i c a l work c a p a c i t y r e s e a r c h a r e ; "to s t u d y the e f f e c t o f v a r i o u s a c t i v i t i e s and e n v i r o n m e n t a l f a c t o r s on d i f f e r e n t organ f u n c t i o n ; t o i n v e s t i g a t e the c a p a c i t y o f the i n d i v i d u a l t o meet t h e demands imposed upon h i m ; and t o de termine how t h i s c a p a c i t y can be i n f l u e n c e d . " (p. 182) One o f the f i r s t r e c o r d e d p o s i t i o n papers on p h y s i c a l c a p a c i t y e v a l u a t i o n was w r i t t e n by B . Hanman i n 1958 i n t h e New E n g l a n d J o u r n a l o f M e d i c i n e . B u i l d i n g on h i s p r e v i o u s r e s e a r c h i n t h e a r e a s o f p h y s i c a l demands and c a p a c i t i e s a n a l y s i s (Hanman and Kuh, 1944) , o c c u p a t i o n a l i n c a p a c i t y i n workers compensat ion (Hanman, 1948) and j o b - s p e c i f i c p h y s i c a l r e q u i r e m e n t s (Hanman, 194 5) , the a u t h o r d e s c r i b e d a r a t i n g method f o r the e v a l u a t i o n o f p h y s i c a l a b i l i t y which l e d t h e p r i m a r y c a r e p h y s i c i a n ; "toward the e x t e n s i o n o f m e d i c a l p r a c t i c e f u r t h e r i n t o the domain o f man's p h y s i c a l a b i l i t i e s - t o improve upon and be a b l e t o make a more o b j e c t i v e and q u a l i t a t i v e e v a l u a t i o n o f the p a t i e n t ' s c a p a c i t y t o engage i n such a c t i v i t i e s as l i f t i n g , c l i m b i n g and o p e r a t i n g hazardous equipment". (p. 987) 35 Hanman d e v e l o p e d a c h e c k - o f f l i s t o f 80 p e r t i n e n t a c t i v i t i e s and h a z a r d s based on the Manual o f Job A n a l y s i s f o r P h y s i c a l F i t n e s s Requirements d e v e l o p e d by the U n i t e d S t a t e s C i v i l S e r v i c e Commission (1955) . T h i s c h e c k - o f f l i s t was d i v i d e d i n t o two s u b s e c t i o n s ; one d e a l i n g w i t h p h y s i c a l f a c t o r s and t h e o t h e r w i t h e n v i r o n m e n t a l f a c t o r s r e l a t i v e t o a p a r t i c u l a r o c c u p a t i o n . The i n f o r m a t i o n g a t h e r e d t h r o u g h t h i s format p r o v i d e d the p r i m a r y c a r e p h y s i c i a n w i t h a p r o f i l e o f p h y s i c a l a b i l i t i e s and i n d i v i d u a l l i m i t a t i o n s f o r t h e p a r t i c u l a r p a t i e n t under r e v i e w . The form was d e s i g n e d t o be comple ted i n the p h y s i c i a n ' s o f f i c e i n 2-3 minutes as a rough i n d i c a t o r , based on m e d i c a l e x a m i n a t i o n (Hanman, 1958) . A l t h o u g h the P h y s i c a l A b i l i t i e s P r o f i l e was d e s i g n e d t o be j o b - s p e c i f i c , no a c t u a l j o b s i m u l a t i o n o r e v a l u a t i o n o f p h y s i c a l work t o l e r a n c e s e v e r took p l a c e . I n s t e a d , the p r o f i l e was based on the e x t r a p o l a t i o n o f m e d i c a l i n f o r m a t i o n from an o f f i c e e x a m i n a t i o n t o t h e p e r c e i v e d p h y s i c a l r e q u i r e m e n t s o f a p a r t i c u l a r j o b and r a r e l y took i n t o c o n s i d e r a t i o n demonstrated f u n c t i o n a l a b i l i t y o r f a t i g u e . What Hanman's p r o f i l e d i d emphasize , however, was the i d e n t i f i c a t i o n o f p h y s i c a l a b i l i t y w i t h a p o s i t i v e p r o g n o s i s f o r r e t u r n i n g the i n j u r e d worker back t o g a i n f u l employment. U n f o r t u n a t e l y , no d a t a was e v e r p u b l i s h e d on the a c c u r a c y o r p lacement succes s o f t h i s a b i l i t y c l a s s i f i c a t i o n sys tem. A f u r t h e r r e f i n e m e n t o f the r a t i n g and c l a s s i f i c a t i o n 36 concept was p r o v i d e d by Leon K o y l e i n h i s development o f the GULHEMP S c a l e o f measurement d u r i n g h i s work w i t h t h e D e H a v i l l a n d A i r c r a f t C o r p o r a t i o n ( K o y l e , 1965) . O r i g i n a l l y d e s i g n e d f o r use w i t h o l d e r w o r k e r s , t h i s s c a l e p r o v i d e d a match between i n d i v i d u a l f u n c t i o n a l a b i l i t i e s and t h e demands o f s p e c i f i c j o b s and was one o f the f i r s t m u l t i -f a c t o r i a l i n d i c a t o r s o f i n d u s t r i a l work c a p a c i t y . The GULHEMP S c a l e c o n s i s t s o f 7 d i v i s i o n s o f f u n c t i o n which a r e f a c t o r - s p e c i f i c i n c l u d i n g (1) g e n e r a l p h y s i q u e ; (2) upper e x t r e m i t i e s ; (3) lower e x t r e m i t i e s ; (4) h e a r i n g ; (5) e y e s i g h t ; (6) m e n t a l i t y and (7) p e r s o n a l i t y . W i t h i n each d i v i s i o n e x i s t s seven l e v e l s o f f i t n e s s r a n g i n g from c o m p l e t e l y competent ( l e v e l 1) t o incompetent ( l e v e l 7 ) . Competency w i t h i n each d i v i s i o n i s based on i n d i v i d u a l f u n c t i o n i n d e f i n e d areas i n c l u d i n g l i f t i n g , c l i m b i n g , p u s h i n g and p u l l i n g as w e l l as g e n e r a l s t r e n g t h c a t e g o r i e s from s e d e n t a r y t o v e r y heavy . I n f o r m a t i o n g a t h e r e d d u r i n g the c o u r s e o f j o b e v a l u a t i o n on i n d i v i d u a l worker t o l e r a n c e s c o u l d be matched a g a i n s t the a c t u a l p h y s i c a l demands o f a s p e c i f i c j o b . W o r k e r / j o b matches c o u l d t h e n be made e n s u r i n g t h a t t h e worker was w o r k i n g w i t h i n h i s / h e r demonstrated t o l e r a n c e l e v e l s (Matheson, 1987) . The g e n e r a l c a t e g o r i e s and s t r e n g t h l e v e l s f i r s t i d e n t i f i e d by Hanman (1958) and l a t e r expanded by K o y l e i n the GULHEMP S c a l e were t o s e r v e as a f i r m b a s i s f o r the l a t e r development o f the U n i t e d S t a t e s Department o f L a b o r ' s Handbook f o r A n a l y z i n g Jobs (1972) which was t o be 37 f o l l o w e d by t h e D . O . T . (1977) and the Canad ian C l a s s i f i c a t i o n and D i c t i o n a r y o f O c c u p a t i o n s (CCDO) (1987) . The Ranchos Los Amigos H o s p i t a l i n C a l i f o r n i a began the i n t r o d u c t i o n o f o b j e c t i v e p h y s i c a l c a p a c i t y assessment i n the development o f t h e i r c a r d i a c r e h a b i l i t a t i o n programs i n the e a r l y 1970 ' s . Through the i n t r o d u c t i o n o f s i m u l a t e d work t a s k s , m e d i c a l r e h a b i l i t a t i o n teams were a b l e t o a s s e s s and d e v e l o p t r e a t m e n t s t r a t e g i e s f o r i n j u r e d workers who had c a r d i o v a s c u l a r d i s a b i l i t i e s w i t h the aim o f r e t u r n i n g them t o a c t i v e employment ( H a r r i n g t o n e t a l , 1981) . T h i s t e c h n i q u e p r o v e d t o be q u i t e s u c c e s s f u l w i t h t h i s s p e c i f i c p o p u l a t i o n and a l l o w e d a p p r o p r i a t e v o c a t i o n a l d e c i s i o n s t o be made w i t h a c c u r a c y and s a f e t y (Matheson, 1987) . W i t h the i n c r e a s i n g p o p u l a r i t y o f the work sample and m u l t i p l e format t e s t i n g , s t r u c t u r e d , m u l t i - d i s c i p l i n a r y p h y s i c a l c a p a c i t y e v a l u a t i o n programs began t o emerge w i t h s p e c i f i c ( B a x t e r , 1978) and g e n e r a l a p p l i c a t i o n s ( K e s t e r , 1979) t o t h e e v a l u a t i o n o f work p o t e n t i a l . P h y s i c a l c a p a c i t y e v a l u a t i o n became a g e n e r i c d e s c r i p t o r f o r the more s p e c i f i c a r e a s o f work e v a l u a t i o n and v o c a t i o n a l e v a l u a t i o n w i t h work e v a l u a t i o n a s s e s s i n g v o c a t i o n a l s t r e n g t h s and weaknesses t h r o u g h t h e use o f r e a l o r s i m u l a t e d work and v o c a t i o n a l e v a l u a t i o n i n v o l v i n g an i n - d e p t h , i n t e r d i s c i p l i n a r y assessment o f p e r t i n e n t m e d i c a l , p s y c h o l o g i c a l , e d u c a t i o n a l , s o c i a l , e n v i r o n m e n t a l and v o c a t i o n a l f a c t o r s ( K e s t e r , 1979) . Ogden's r e s e a r c h i n t o graded r e h a b i l i t a t i o n programs f o r c a r d i a c p a t i e n t s p r o v i d e d a d d i t i o n a l i n s i g h t i n t o t h e 38 e f f e c t s o f work s a m p l i n g , work s i m u l a t i o n and g r a d e d e x e r c i s e programs i n c a r d i a c r e h a b i l i t a t i o n w i t h the p o s i t i v e r e s u l t s o f a c t i v e r e t u r n t o employment f o l l o w i n g c a r d i a c i n s u l t (Ogden, 1979; 1980; 1981) . A t t h e same t i m e , Matheson was c o n d u c t i n g r e s e a r c h on the p h y s i c a l c h a r a c t e r i s t i c s o f work (Matheson, 1981) which was t o l e a d t o the l a t e r development o f h i s model o f work c a p a c i t y e v a l u a t i o n (Matheson, 1987) a t the Employment and R e h a b i l i t a t i o n I n s t i t u t e o f C a l i f o r n i a . 2 . 1 . 4 . 1 PRUITT'S VOCATIONAL EVALUATION SYSTEM P r i o r t o d i s c u s s i o n o f the Matheson mode l , a b r i e f d i s c u s s i o n on t h e e a r l i e r work o f W a l t e r A . P r u i t t a t the U n i v e r s i t y o f W i s c o n s i n - S t o u t i n the development o f t h e i r v o c a t i o n a l e v a l u a t i o n program i s i n o r d e r . P r u i t t ' s e a r l y work on work sample t h e o r y ( P r u i t t , 1970) and h i s l a t e r t e x t on v o c a t i o n a l e v a l u a t i o n ( P r u i t t , 1977) p r o v i d e d a b a s i s f o r t h e l a t e r e v o l u t i o n o f a more s p e c i f i c p h y s i c a l c a p a c i t y e v a l u a t i o n t h e o r y ( P r u i t t , 1986) . He d e f i n e d t h e f o r m a l s t a g e s o f v o c a t i o n a l e v a l u a t i o n , i n t r o d u c e d g e n e r a l g u i d e l i n e s r e g a r d i n g the development o f o b s e r v a t i o n a l s k i l l s and promoted the use o f work samples and s i t u a t i o n a l assessment which a r e a major components i n the s o p h i s t i c a t e d e v a l u a t i o n programs i n use t o d a y . In a d d i t i o n , P r u i t t p o i n t e d out e r r o r s i n h e r e n t i n the e v a l u a t i o n p r o c e s s which c o u l d a l t e r t h e a c c u r a c y o f the e v a l u a t i o n o r r e n d e r the 39 f i n d i n g s i n a p p r o p r i a t e . These i n c l u d e d s a m p l i n g e r r o r , r a t e r b i a s , e r r o r due t o ambiguous i t e m s , i n t e r p r e t a t i o n e r r o r , v a l i d i t y c r i t e r i a e r r o r and a d m i n i s t r a t i o n e r r o r . P r u i t t emphasized the importance o f v o c a t i o n a l development t h e o r y and t h e concept s o f v o c a t i o n a l l i f e s t a g e s (Super , 1957) i n h i s at tempt t o a p p l y t h e most a p p r o p r i a t e e v a l u a t i o n t e c h n i q u e s t o each i n d i v i d u a l s i t u a t i o n . In o r d e r t o s a t i s f a c t o r i l y p r o g r e s s t h r o u g h t h e v o c a t i o n a l l i f e s t a g e s , P r u i t t was a c u t e l y aware t h a t p e o p l e needed t o have e x p e r i e n c e s i n the deve lopmenta l t a s k s a p p r o p r i a t e t o t h e v a r i o u s v o c a t i o n a l l i f e s t a g e s ( G i n z b e r g , 1952; S a m l e r , 1964; H a v i g h u r s t , 1964; Borow, 1964) and t h a t w i t h i n t h i s g e n e r a l framework v o c a t i o n a l e v a l u a t i o n t e c h n i q u e s c o u l d be a p p l i e d w i t h a c c u r a c y and e f f i c a c y . He a l s o promoted the c o l l e c t i o n o f f u n c t i o n a l i n f o r m a t i o n t h r o u g h s i t u a t i o n a l assessment which he f e l t p r o v i d e d t h e most r e l e v a n t , i n d u s t r i a l l y - o r i e n t e d d a t a w i t h which t o a s s e s s i n d i v i d u a l c a p a c i t y f o r work ( P r u i t t , 1986) . 2 . 1 . 4 . 2 THE MATHESON WORK CAPACITY EVALUATION FORMAT The most w i d e l y used contemporary p h y s i c a l c a p a c i t y e v a l u a t i o n programs e v o l v e d from the work o f two r e s e a r c h e r s ; Leonard Matheson from the Employment and R e h a b i l i t a t i o n I n s t i t u t e o f C a l i f o r n i a (Matheson, 1987) and K e i t h B l a n k e n s h i p from Amer ican T h e r a p e u t i c s o f Macon, G e o r g i a ( B l a n k e n s h i p , 1988) . These two programs r e p r e s e n t t h e c u r r e n t t r e n d i n commerc ia l e v a l u a t i o n programs i n t h e i r 40 h i g h l y s t r u c t u r e d , m u l t i - f a c e t e d formats and t h e i r m u l t i d i s c i p l i n a r y approach t o the d e f i n i t i o n o f p h y s i c a l c a p a c i t y . In h i s e x c e l l e n t t e x t on the s y s t e m a t i c a p p r o a c h t o i n d u s t r i a l r e h a b i l i t a t i o n (Matheson, 1986) , L e o n a r d Matheson d e f i n e d work c a p a c i t y e v a l u a t i o n a s ; "A s y s t e m a t i c p r o c e s s o f measur ing and d e v e l o p i n g an i n d i v i d u a l ' s c a p a c i t y t o dependably s u s t a i n performance i n response t o b r o a d l y d e f i n e d work demands." (p. 1-2) Based on t h e a r e a a s s e s s e d , Matheson d e s c r i b e d an 8 - s tage model o f i n d u s t r i a l r e h a b i l i t a t i o n i n c l u d i n g (1) p a t h o l o g y ; (2) impa irment ; (3) f u n c t i o n a l l i m i t a t i o n ; (4) o c c u p a t i o n a l d i s a b i l i t y ; (5) v o c a t i o n a l f e a s i b i l i t y ; (6) e m p l o y a b i l i t y ; (7) v o c a t i o n a l h a n d i c a p and (8) e a r n i n g c a p a c i t y . Depending on t h e s tage w i t h i n the model , v a r i o u s e v a l u a t i o n t e c h n i q u e s c o u l d be a p p l i e d t o e v a l u a t e o v e r a l l p h y s i c a l work c a p a c i t y . Matheson•s work c a p a c i t y e v a l u a t i o n program made a f u r t h e r d i s t i n c t i o n between the t h r e e concept a r e a s o f m e d i c a l e v a l u a t i o n , v o c a t i o n a l e v a l u a t i o n and p h y s i c a l work c a p a c i t y e v a l u a t i o n e a r l i e r d e f i n e d by K e s t e r (1979) on the b a s i s o f t h e s tages w i t h i n t h e model t h a t impact upon t h e f i n a l , and perhaps the most r e l e v a n t s t a g e , e a r n i n g c a p a c i t y . Through the a d m i n i s t r a t i o n o f s p e c i a l l y d e s i g n e d programs i n c l u d i n g Work T o l e r a n c e S c r e e n i n g , Work H a r d e n i n g , S p e c i f i c V o c a t i o n a l E x p l o r a t i o n , F u n c t i o n a l D i s a b i l i t y Assessment and Job M a t c h , i n f o r m a t i o n i s g a t h e r e d on i n d i v i d u a l t o l e r a n c e s f o r work which u l t i m a t e l y l e a d t o t h e 41 i d e n t i f i c a t i o n o f s u i t a b l e v o c a t i o n a l a l t e r n a t i v e s . A l t h o u g h Matheson ' s program adhered t o an " i n d u s t r i a l model" and emphasized work c a p a c i t y e v a l u a t i o n as a " p r o c e s s ; as a means t o r e s t o r e the p a t i e n t ' s e m o t i o n a l and p h y s i c a l h e a l t h and t o r e t u r n the p a t i e n t t o t h e r o l e o f worker" (Matheson, 1987, p . 1 -3 ) , no s a t i s f a c t i o n o r s e l f - e s t e e m measures were t a k e n . I n a d d i t i o n , most o f the i n d u s t r i a l l y - r e l e v a n t c o n c l u s i o n s were made f o l l o w i n g the a d m i n i s t r a t i o n o f work-s i m u l a t i o n t a s k s . One o f the c e n t r a l f a c t o r s i n Matheson ' s program was t h e ERIC C l u s t e r Work S i m u l a t i o n System. T h i s s e r i e s o f 10 work c l u s t e r s samples i n d i v i d u a l per formance under s i m u l a t e d work c o n d i t i o n s f o r the v a r i o u s s t r e n g t h l e v e l s as o r i g i n a l l y d e f i n e d by Hanman (1951) and l a t e r d e v e l o p e d by F i n e and W i l e y (1971) and M i l l e r , T r e i m a n , C a i n e and Roos (1980) f o r the D i c t i o n a r y o f O c c u p a t i o n a l T i t l e s . F o l l o w i n g c o m p l e t i o n o f one o r more c l u s t e r s , a c r i t i c a l p h y s i c a l demands work shee t was d e v e l o p e d f o r the worker which c o u l d t h e n be matched w i t h the i n d i v i d u a l demands o f s p e c i f i c v o c a t i o n a l o p t i o n s and an a p p r o p r i a t e match made. The C l u s t e r System i n c o r p o r a t e d v a r i o u s a c c e p t e d e v a l u a t i o n t o o l s and s e l f - g e n e r a t e d formats under f o u r main c a t e g o r i e s i n c l u d i n g d e x t e r i t y , work c a p a c i t y e v a l u a t i o n d e v i c e s , work samples and work s i m u l a t i o n d e v i c e s , depending on the i n d i v i d u a l r e q u i r e m e n t s o f the w o r k e r . Examples o f t h e d e x t e r i t y s a m p l i n g d e v i c e s i n c l u d e the C r a w f o r d S m a l l P a r t s D e x t e r i t y T e s t , the M i n n e s o t a Rate o f M a n i p u l a t i o n , 42 t h e Purdue Pegboard and the EAS #9. Work C a p a c i t y E v a l u a t i o n D e v i c e s used i n c l u d e the V e r t i c a l Pegboard , the WEST #4 and t h e BTE S i m u l a t o r . Work Sample e v a l u a t i o n c o u l d i n c l u d e V a l p a r #4 ,8 ,9 ,10 and 16, WEST Bus Bench, and WEST 2 B r i e f T o o l Use w i t h Work S i m u l a t i o n c o n c e n t r a t i n g i n v a r i o u s a r e a s i n c l u d i n g c l e r i c a l , l i g h t i n d u s t r i a l , c r a f t s and s m a l l motor assembly up t o f u r n i t u r e moving and heavy m a t e r i a l s h a n d l i n g . The r e p e a t e d sampl ing p r o c e d u r e s and use o f s i m u l a t e d work env ironments makes the ERIC C l u s t e r System one o f t h e more d i s t i n c t , p r a c t i c a l l y - b a s e d systems a v a i l a b l e t o d a y . Matheson a l s o i d e n t i f i e d a b e h a v i o r a l component o f p h y s i c a l c a p a c i t y e v a l u a t i o n c a l l e d symptom m a g n i f i c a t i o n and d e f i n e d t h r e e d i s t i n c t c l a s s i f i c a t i o n s by g e n e r a l d e s c r i p t i o n . He sugges ted s p e c i f i c s t r a t e g i e s f o r d e a l i n g w i t h workers d i s p l a y i n g symptom m a g n i f i c a t i o n syndrome i n o r d e r t o enhance p a r t i c i p a t i o n i n the i n f o r m a t i o n g a t h e r i n g p r o c e s s and improve the r e l i a b i l i t y o f per formance measures . D e s p i t e the h i g h l y s t r u c t u r e d , m u l t i p l e f a c t o r c h a r a c t e r i s t i c s o f the Matheson work c a p a c i t y e v a l u a t i o n program, t h e system does not i n h e r e n t l y c o n t a i n an i n d u s t r i a l - s p e c i f i c e v a l u a t i o n component. Most o f t h e f u n c t i o n a l and work t o l e r a n c e i n f o r m a t i o n i s o b t a i n e d from work samples , s t r u c t u r e d t e s t s and work s i m u l a t i o n d e v i c e s i n an atmosphere t h a t i s more c l i n i c a l t h a n i n d u s t r i a l i n o r i e n t a t i o n . F o l l o w i n g c o m p l e t i o n o f t h e e v a l u a t i o n p r o c e s s , o b s e r v a t i o n s r e g a r d i n g p h y s i c a l f u n c t i o n a r e t h e n 43 made which a r e t r a n s l a t e d i n t o i n f e r e n c e s on work p e r f o r m a n c e . T h i s i s done w i t h min imal o r no a c t u a l exposure t o t h e r i g o r s o f the work ing env ironment . D e s p i t e t h e i m p r e s s i v e n a t u r e o f the program, t h e r e i s no r e s e a r c h d a t a a v a i l a b l e , e i t h e r from Matheson h i m s e l f o r from o t h e r s u s i n g t h e s e t e c h n i q u e s , on the v o c a t i o n a l s u c c e s s o f workers c o m p l e t i n g t h i s p h y s i c a l c a p a c i t y e v a l u a t i o n p r o c e s s . 2 . 1 . 4 . 3 THE BLANKENSHIP INDUSTRIAL REHABILITATION SYSTEM A s i m i l a r m u l t i - f a c e t e d approach t o p h y s i c a l c a p a c i t y e v a l u a t i o n has been deve loped by B l a n k e n s h i p (1988) i n h i s I n d u s t r i a l R e h a b i l i t a t i o n F u n c t i o n a l C a p a c i t y E v a l u a t i o n (FCE) program. Through a s e r i e s o f s p e c i a l p r o c e s s e s , e v a l u a t i o n p r o c e d u r e s , t e s t s and t e c h n i q u e s , B l a n k e n s h i p a t tempted t o q u a n t i f y i n d i v i d u a l o b s e r v a t i o n s r e g a r d i n g work t o l e r a n c e s . H i s Modular System s a t i s f i e d s p e c i f i c and u n i q u e r e q u i r e m e n t s f o r e v e r y p a t i e n t t h r o u g h the development o f j o b s p e c i f i c and n o n - j o b s p e c i f i c f o r m a t s . W i t h i n the Modular System, B l a n k e n s h i p i n t r o d u c e d v a r i o u s components which r e l y on e s t a b l i s h e d i n v e s t i g a t i v e and t e s t i n g t e c h n i q u e s f o r the c o l l e c t i o n o f f u n c t i o n a l i n f o r m a t i o n . The S t a t i c S t r e n g t h T e s t i n g component r e l i e s on documented p r o t o c o l s o r i g i n a l l y e s t a b l i s h e d by C h a f f i n (1975) and f u r t h e r d e f i n e d by P e t r o f s k y an L i n d (1978) f o r t h e e v a l u a t i o n o f s t a t i c l i f t i n g s t r e n g t h . L i f t / s t r e n g t h r a t i o s a r e e s t a b l i s h e d u s i n g a s t r a i n gauge and c o e f f i c i e n t s o f v a r i a t i o n a r e used t o e s t a b l i s h maximum e f f o r t s . 44 Maximum E f f o r t Dynamic T e s t i n g i n v o l v e s t h e l i f t i n g o f boxes o f v a r i a b l e weight i n v a r i o u s p o s i t i o n s i n o r d e r t o d e t e r m i n e l i f t i n g and c a r r y i n g t o l e r a n c e s as w e l l as p a i n t o l e r a n c e and p o s t u r a l i n f o r m a t i o n . Based on t h e d e s i g n o f manual h a n d l i n g t a s k s proposed by Snook (1978) , s t r e n g t h p e r c e n t i l e s a r e e s t a b l i s h e d f o r each worker and compared t o e s t a b l i s h e d norms f o r v a r i o u s m a t e r i a l h a n d l i n g a c t i v i t i e s and movements. G e n e r a l i n f o r m a t i o n i s a l s o c o l l e c t e d c o n s i s t e n t w i t h t h e c r i t i c a l demands o f i n d i v i d u a l j o b s f o r components i n v o l v i n g l i f t i n g (Snook and C i r i e l l o , 1974; Snook, 1978; Ayoub e t a l , 1983; M i t a l , 1984; Karwowski and Y a t e s , 1986) , c a r d i o v a s c u l a r endurance ( A s t r a n d and R o d a h l , 1970) , g r i p s t r e n g t h and endurance (Niebuhr and M a r i o n , 1987) and t i m e / f a t i g u e r a t i o s f o r n o n - m a t e r i a l s h a n d l i n g ( M i t a l , 1984) . Computer i zed back and e x t r e m i t y t e s t i n g as w e l l as m u s c u l o s k e l e t a l e v a l u a t i o n s a r e a l s o i n c l u d e d as g e n e r a l program components i n c l u d i n g a p a i n e v a l u a t i o n component u s i n g formats deve loped by Melzak (1975), R a n s f o r d and C a i r n s (1976) and Wadde l l (1984). F o l l o w i n g c o m p l e t i o n o f the e v a l u a t i o n p r o c e s s , B l a n k e n s h i p t h e n combined the i n f o r m a t i o n t o e s t a b l i s h an i n d i v i d u a l t o l e r a n c e p r o f i l e from which recommendations can be made r e g a r d i n g a workers a b i l i t y t o s a t i s f y c r i t i c a l work demands o r t o g i v e an i n d i c a t i o n o f o v e r a l l f u n c t i o n . Due t o t h e s p e c i f i c n a t u r e o f the i n f o r m a t i o n c o l l e c t e d , r e s u l t s a r e l i m i t e d i n t h e i r a p p l i c a t i o n t o t h e work s e t t i n g 45 due t o t h e i r l a c k o f r e l e v a n c y t o the a c t u a l p h y s i c a l demands o f t h e j o b . Statements r e g a r d i n g i n d i v i d u a l t o l e r a n c e s f o r work a r e r e s t r i c t e d t o g e n e r a l use as p r e d i c t o r s o f performance i n the absence o f demonstrated c a p a c i t y i n a work s e t t i n g . To d a t e , no e m p i r i c a l d a t a has been c o l l e c t e d on the a c c u r a c y o f p r e d i c t i n g s u c c e s s on the j o b by t h e a p p l i c a t i o n o f c r i t i c a l demands t e s t i n g . I t i s v e r y d i f f i c u l t t o g e n e r a l i z e t h i s t y p e o f f u n c t i o n a l i n f o r m a t i o n t o a s p e c i f i c j o b c a t e g o r y o r j o b c l u s t e r i n the absence o f an i n d u s t r i a l framework. 2.2 THE DYNAMICS OF UNEMPLOYMENT A c t i v e invo lvement i n a work s i t u a t i o n has been d e s c r i b e d by some r e s e a r c h e r s as e s s e n t i a l t o the maintenance o f a h e a l t h y i d e n t i t y ( K e l v i n , 1981; F e a t h e r and D a v e n p o r t , 1981) and f o r the p r o v i s i o n o f b a s i c needs such as s a f e t y , b e l o n g i n g , s e l f - a c t u a l i z a t i o n (Maslow, 1968) and s e l f - e s t e e m (Cohn, 1978) . Important t o t h e maintenance o f human dynamics , work i s needed not o n l y f o r f i n a n c i a l r e a s o n s , but a l s o f o r s o c i a l and p s y c h o l o g i c a l r easons as w e l l (Vargo , 1978; T u c k , 1983) and i s e s s e n t i a l t o t h e v e r y meaning and s t r u c t u r e o f our l i v e s (Ac ton , 1981) . The impact o f j o b l o s s has been w e l l documented i n the l i t e r a t u r e (Amundson and Borgen , 1982; J a h o d a , 1982; Rump, 1983; Tiggemann and W i n e f i e l d , 1984) w i t h the consequences b e i n g measured b o t h i n human and f i n a n c i a l 46 t e r m s . Some o f t h e more s p e c i f i c c h a l l e n g e s f o r t h o s e f a c i n g re-employment f o l l o w i n g a d i s a b l i n g i n j u r y have a l s o been e x p l o r e d (Stone and S a w a t z k i , 1980; Borgen , Amundson and B i e l a , 1986) which has sugges ted some un ique b a r r i e r s b e i n g f a c e d by t h i s group on the r o a d t o re -employment . 2 . 2 . 1 UNEMPLOYMENT AND THE PHYSICALLY DISABLED R e s e a r c h i n t o t h e dynamics o f unemployment f o r t h o s e s u f f e r i n g from a d i s a b l i n g c o n d i t i o n , e i t h e r c o n g e n i t a l o r t r a u m a t i c i n n a t u r e , has r e v e a l e d some i n s i g h t i n t o the t r a n s i t i o n a l p r o c e s s f o r t h i s un ique p o p u l a t i o n . Stone and S a w a t z k i (1980) i d e n t i f i e d s e v e r a l f a c t o r s s p e c i f i c t o t h e d i s a b l e d group which may impact n e g a t i v e l y on t h e re-employment p r o c e s s i n c l u d i n g i n i t i a l employment h a n d i c a p s , management m i s c o n c e p t i o n s and the j o b i n t e r v i e w p r o c e s s i t s e l f . G a r r i t y (1973) and Brown and R a w l i n s o n (1976) no ted t h a t t h e s e l f - p e r c e p t i o n o f d i s a b i l i t y and h e a l t h had a s i g n i f i c a n t impact on p h y s i c a l r e c o v e r y and s u c c e s s f u l r e t u r n t o work f o r t h o s e unemployed as the r e s u l t o f s i c k n e s s o r i n j u r y . T h i s l e d S c h e c h t e r (1981) t o sugges t t h a t d i f f e r e n t i a l work responses e x i s t e d a t g i v e n l e v e l s o f d i s a b i l i t y and a l l o w e d him t o deve lop p r e d i c t o r f a c t o r s i n c l u d i n g sex , age , need t o p r o v i d e f i n a n c i a l s u p p o r t t o o t h e r s , l e n g t h o f p r e - i n j u r y work e x p e r i e n c e and l e v e l o f f u n c t i o n a l c a p a c i t y from which t o p r e d i c t r e t u r n t o work s u c c e s s . 47 Borgen , Amundson and B i e l a (1987) i n t e r v i e w e d a group o f d i s a b l e d , unemployed i n d i v i d u a l s i n an at tempt t o i n v e s t i g a t e and d e s c r i b e t h e i r e x p e r i e n c e o f unemployment and t o compare t h a t e x p e r i e n c e w i t h what had been d e s c r i b e d f o r o t h e r unemployed g r o u p s . U s i n g a p r e v i o u s l y r e p o r t e d s t r u c t u r e d i n t e r v i e w format (Borgen and Amundson, 1984) , i n f o r m a t i o n was g a t h e r e d on p e o p l e ' s e x p e r i e n c e s o f unemployment and the e m o t i o n a l e f f e c t s o f i n c i d e n t s d u r i n g t h e p e r i o d o f j o b l o s s . They were a b l e t o i d e n t i f y f o u r d i s t i n c t p a t t e r n s o f the unemployment e x p e r i e n c e and from t h i s i n f o r m a t i o n g e n e r a t e d graphs which d e s c r i b e d e m o t i o n a l r e a c t i o n s t o unemployment o v e r t i m e . They d e s c r i b e d e m o t i o n a l r e sponses t o j o b l o s s c h a r a c t e r i s t i c a l l y r a n g i n g from d i s c o u r a g e m e n t , w o r r y , a p p r e h e n s i o n and anger g r a d u a l l y c h a n g i n g t o r e a l i s t i c and h o p e f u l e m o t i o n a l r e a c t i o n s f o l l o w i n g t h e i n i t i a t i o n o f j o b s e a r c h a c t i v i t i e s . Most p e o p l e i n a l l the groups had some s i g n i f i c a n t event o r c r i t i c a l i n c i d e n t d u r i n g t h e j o b s e a r c h a c t i v i t y r a n g i n g from s u p p o r t g r o u p s , v o l u n t e e r a c t i v i t i e s , p e r s o n a l events and r e l e a r n i n g which encouraged them t o c o n t i n u e . The i n t e r v i e w s t r u c t u r e i n c l u d e d the c o l l e c t i o n o f i n f o r m a t i o n i n s e v e r a l key areas d e s i g n e d t o group t h e r e s p o n s e s a l o n g g e n e r a l t h e m a t i c l i n e s . T h i s i n c l u d e d q u e s t i o n s i n the a r e a s o f s u p p o r t ( f a m i l y , f r i e n d s ) , s t r u c t u r e ( r o u t i n e , o r g a n i z a t i o n ) , meaning o f l i f e (purpose and c o n t r i b u t i o n ) and f i n a n c i a l s e c u r i t y which emerged as 48 i m p o r t a n t , c o n t r i b u t i n g f a c t o r s i n i n d i v i d u a l r e a c t i o n s t o unemployment. The r e s u l t s o f t h i s s tudy a l l o w e d some c o n c l u s i o n s t o be made r e g a r d i n g the development o f an i n d i v i d u a l i z e d r e a c t i o n t o unemployment r e g a r d l e s s o f d i s a b i l i t y t y p e . They a l s o i d e n t i f i e d s e v e r a l i n t e r n a l f a c t o r s i n f l u e n c i n g i n d i v i d u a l r e a c t i o n s t o unemployment and which c o u l d have p r o f o u n d e f f e c t s on such f a c t o r s as s e l f - e s t e e m and j o b s e a r c h s u c c e s s . T h i s i n f o r m a t i o n a l l o w e d them t o sugges t t h e use o f s p e c i f i c i n t e r v e n t i o n s t r a t e g i e s based on e m o t i o n a l r e a c t i o n s and response c h a r a c t e r i s t i c s o f group membership i n o r d e r t o maximize the p o t e n t i a l f o r s u c c e s s f u l r e t u r n t o work. 2 . 2 . 2 UNEMPLOYMENT AND MEASURES OF S E L F - E S T E E M The concept o f s e l f - e s t e e m i s used i n t h i s s t u d y t o r e f e r t o f e e l i n g s o f s a t i s f a c t i o n a p e r s o n has about h i m / h e r s e l f which r e f l e c t the r e l a t i o n s h i p between t h e s e l f - i m a g e and the i d e a l s e l f - i m a g e ( S i l b e r and T i p p e t t , 1965) . I t has been a s s o c i a t e d w i t h a p e r s o n ' s o v e r - a l l l e v e l o f w e l l - b e i n g and i s an i m p o r t a n t a s p e c t o f a p e r s o n ' s s e l f - c o n c e p t ( S i g a l , 1987) . Coopersmi th (1967) found t h a t p e o p l e w i t h h i g h l e v e l s o f s e l f - e s t e e m demonstrated g r e a t e r c o n f i d e n c e , were more independent , were more p o p u l a r and were a b l e t o expres s themse lves more o p e n l y . Rosenberg (1979) d e f i n e s s e l f - e s t e e m as "the t o t a l i t y o f t h e 49 i n d i v i d u a l ' s thoughts and f e e l i n g s h a v i n g r e f e r e n c e t o h i m s e l f as an o b j e c t . " When v iewed as a dynamic p r o c e s s t h r o u g h o u t t h e l i f e span , s e l f - e s t e e m seems t o i n c r e a s e w i t h age ( S c h l o s s b e r g , T r o l l and L i e b o w i t z , 1978) as t h e d i r e c t r e s u l t o f c o p i n g s t r a t e g i e s accumulated from l i f e e x p e r i e n c e s . The impact o f unemployment on s e l f - e s t e e m has been d i s c u s s e d i n the l i t e r a t u r e from numerous p e r s p e c t i v e s . D e s c r i p t i v e a c c o u n t s o f the e x p e r i e n c e o f unemployment p r e s e n t s a s c e n a r i o o f the unemployed as b o r e d , d e p r e s s e d and l o n e l y . The most c o n s i s t e n t l y noted e f f e c t i s a l o s s o f mora le o r s e l f - e s t e e m , w i t h the i n d i v i d u a l l o s i n g h i s o r h e r s e l f - r e s p e c t and sense o f p e r s o n a l worth (Tiggemann and W i n e f i e l d , 1984) . S e v e r a l a u t h o r s have d e s c r i b e d s u c c e s s i v e s t a g e s i n the g r a d u a l e r o s i o n o f s e l f - e s t e e m due t o unemployment r a n g i n g from i n i t i a l shock , thr ough o p t i m i s m , pes s imism and f i n a l l y t o f a t a l i s m ( H a r r i s o n , 1976) . T h i s c o n d i t i o n d e s c r i b e d by Se l i gman (1975) as " l e a r n e d h e l p l e s s n e s s " may be a b u i l t - i n mechanism t o p r e s e r v e r e m a i n i n g s e l f - e s t e e m and p r o t e c t a g a i n s t f u r t h e r d e p r e s s i o n by r e l i e v i n g s e l f - b l a m e . S h a p i r o (1978) found s i g n i f i c a n t improvement i n measures o f s e l f - e s t e e m f o r unemployed workers f o l l o w i n g i m p l e m e n t a t i o n o f a " s h o r t , i n t e n s i v e j o b s e a r c h program c o u p l i n g f o r m a l i n s t r u c t i o n w i t h hands -on p l a n n i n g and s u p e r v i s i o n o f t h e i r j o b s e a r c h . . . ( thereby) h e l p i n g them ge t a j o b t h r o u g h t h e i r own e f f o r t s " ( S h a p i r o , 1976 p . 50 3 ) . T h i s p e r s p e c t i v e tended t o s u p p o r t t h e p r o c e s s o f p r o -a c t i v e i n t e r v e n t i o n f o r i n d i v i d u a l s who r e q u i r e s p e c i f i c d i r e c t i o n o r who may have reduced l e v e l s o f s e l f - e s t e e m due t o p r o l o n g e d absence from work. Z a n d e r , S t o t l a n d and W o l f e ' s work i n group u n i t y (1960) p r o v i d e s a c o n t e x t from which t o e v a l u a t e r e d u c e d l e v e l s o f s e l f - e s t e e m f o l l o w i n g a s i g n i f i c a n t l o s s . T h e i r f i n d i n g s r e v e a l e d compensatory mechanisms f o r i n c r e a s i n g s e l f - e s t e e m on t h e p a r t o f group members t h r o u g h p s y c h o l o g i c a l w i t h d r a w a l o r group d e p a r t u r e . These c o n c e p t s , when i n t e r p r e t e d w i t h i n the c o n t e x t o f j o b l o s s , sugges t ways i n which s e l f - e s t e e m may be i n f l u e n c e d t h r o u g h such f a c t o r s as group u n i t y , group i d e n t i f i c a t i o n and s e l f - e v a l u a t i o n d u r i n g t h e p e r i o d o f unemployment. The work o f Tiggemann and W i n e f i e l d (1984) on the e f f e c t s o f unemployment on the mood, s e l f - e s t e e m , and l o c u s o f c o n t r o l o f s c h o o l l e a v e r s g e n e r a t e d some i n t e r e s t i n g i n f o r m a t i o n on the young, unemployed p e r s o n . Of s p e c i f i c i n t e r e s t was t h a t p o r t i o n o f t h e i r d a t a t h a t showed t h a t t h e unemployed s c o r e d lower on s e l f - e s t e e m and h i g h e r on d e p r e s s i v e a f f e c t t h a n the employed and t h a t t h e s e p s y c h o l o g i c a l e f f e c t s were d i r e c t l y a t t r i b u t a b l e t o the unemployment e x p e r i e n c e . The r e s e a r c h o f O ' B r i e n and Kabanof f (1979) on the e f f e c t o f unemployment on work v a l u e s , l o c u s o f c o n t r o l and h e a l t h f a c t o r s p r o v i d e d some i n t e r e s t i n g r e l a t i o n s h i p s f o r t h e u n d e r s t a n d i n g o f s e l f - e s t e e m and j o b l o s s . Comparing 51 employed and unemployed w o r k e r s , O ' B r i e n and Kabanof f no ted an i n c r e a s e d number o f r e p o r t e d p h y s i c a l h e a l t h problems among unemployed s u b j e c t s and a s i g n i f i c a n t c o r r e l a t i o n between h e a l t h problems and e l e v a t e d s t r e s s l e v e l s . T h e i r c o n c l u s i o n s , however, were t h a t these p h y s i c a l problems were not t h e cause o f unemployment, but the r e s u l t o f i t , s u g g e s t i n g some deeper r o o t e d p s y c h o l o g i c a l d i s t u r b a n c e . They a l s o found lower work v a l u e s , p e r c e i v e d l o s s o f l o c u s o f c o n t r o l , lower f e e l i n g s o f s a t i s f a c t i o n w i t h l i f e and a g r e a t e r use o f h e l p i n g agents ( t h e r a p i s t s , c o u n s e l l o r s ) f o r p e r s o n a l problems f o r the unemployed g r o u p . A l l o f t h e s e were r e g a r d e d as showing reduced l e v e l s o f s e l f - e s t e e m . The e m o t i o n a l a s p e c t s o f p h y s i c a l d i s a b i l i t y f o l l o w i n g i n d u s t r i a l i n j u r y , and i t s e f f e c t on s e l f - e s t e e m and s e l f -image, i s a d i r e c t l y r e l a t e d a r e a which d e s e r v e s a b r i e f ment ion a t t h i s p o i n t . A c c o r d i n g t o Simon (1971) a l t e r a t i o n o f the body image f o l l o w i n g an i n j u r y can l e a d t o t h e development o f p s y c h o l o g i c a l de fenses t o m a i n t a i n s e l f - e s t e e m and s a t i s f a c t i o n o f needs . These de fenses may m a n i f e s t themse lves i n f e e l i n g s o f anger , d e n i a l , f r u s t r a t i o n and f e a r w h i c h , when combined w i t h t h e r e a l i t y o f j o b l o s s , can c r e a t e s e r i o u s p s y c h o l o g i c a l and e m o t i o n a l o b s t a c l e s t o s u c c e s s f u l r e h a b i l i t a t i o n and v o c a t i o n a l p l a c e m e n t . R e s e a r c h on the a p p r o p r i a t e t i m i n g and a p p l i c a t i o n o f i n t e r v e n t i o n t e c h n i q u e s has shown t h a t the t ime between i n j u r y and i n t e r v e n t i o n i s i m p o r t a n t i n t h a t as more t ime 52 e l a p s e s , the p r o b a b i l i t y o f s u c c e s s f u l v o c a t i o n a l r e h a b i l i t a t i o n d e c r e a s e s (Conley and N o b l e , 1978; L y n c h , 1979) . More s p e c i f i c a l l y , s t u d i e s by F i e r r o and L e a l (1988) have shown t h a t d e p r e s s i o n , s e l f - e s t e e m and dependency a r e s i g n i f i c a n t l y impacted by the l e n g t h o f t ime between onse t o f i n j u r y and r e f e r r a l t o the v o c a t i o n a l r e h a b i l i t a t i o n p r o c e s s f o r t h o s e workers s u f f e r i n g an i n d u s t r i a l i n j u r y . The i m p l i c a t i o n s f o r t h i s t y p e o f r e s e a r c h on t h e p o t e n t i a l f o r e n h a n c i n g s e l f - e s t e e m v a l u e s t h r o u g h the a p p l i c a t i o n o f a p p r o p r i a t e v o c a t i o n a l r e h a b i l i t a t i o n t e c h n i q u e s i n c l u d i n g p h y s i c a l c a p a c i t y e v a l u a t i o n i s a p p a r e n t . 3. VARIABLES AFFECTING VOCATIONAL PLACEMENT S e v e r a l s t u d i e s have d e f i n e d a r e l a t i o n s h i p between c e r t a i n demographic c h a r a c t e r i s t i c s o f d i s a b l e d workers and s u c c e s s i n r e h a b i l i t a t i o n programs . F o l l o w i n g v a l i d a t i o n o f t h e S i n g e r V o c a t i o n a l E v a l u a t i o n System (VES) by Cohen and Drugo (1976) , Gannaway and S i n k (1978) i n v e s t i g a t e d t h e c o r r e l a t i o n between s u b j e c t performance and employment i n s p e c i f i c a l l y r e l a t e d j o b s f o r 117 s u b j e c t s i n t h e Monroe County V o c a t i o n a l R e h a b i l i t a t i o n P r o j e c t . In a d d i t i o n t o t h e p e r f o r m a n c e / p l a c e m e n t r e l a t i o n s h i p , demographic i n f o r m a t i o n on age, r a c e and e d u c a t i o n a l l e v e l was c o l l e c t e d f o r the s t u d y p a r t i c i p a n t s . D e s p i t e t h e f a c t t h a t o n l y 11 o f the 17 VES j o b samples were i n v e s t i g a t e d , the r e s u l t s showed t h a t 82% o f the work 53 samples o b t a i n e d c o r r e l a t i o n c o e f f i c i e n t s o f +0.50 o r g r e a t e r i n p r e d i c t i n g employment succes s i n j o b s found i n the o c c u p a t i o n a l group a s s o c i a t e d w i t h the j o b sample . The most s i g n i f i c a n t o f these c o r r e l a t i o n s was i n t h e C a r p e n t r y and Woodworking (VES #6) and i n the H e a t i n g , A i r C o n d i t i o n i n g and R e f r i g e r a t i o n (VES #7) work samples where a c o r r e l a t i o n o f +1.00 was o b t a i n e d . U n f o r t u n a t e l y , none o f t h e c o r r e l a t i o n c o e f f i c i e n t s i n any o f the groups were s i g n i f i c a n t a t the .05 l e v e l because o f the s m a l l sample s i z e . T h i s s e v e r e l y l i m i t e d any s ta tements r e g a r d i n g p r e d i c t i v e v a l i d i t y . In a d d i t i o n , no d a t a a n a l y s i s was p r o v i d e d f o r t h e age, e d u c a t i o n l e v e l o r r a c e v a r i a b l e s . The l a c k o f s i g n i f i c a n c e due t o the s m a l l sample s i z e presumably a f f e c t e d any i n f e r e n c e r e g a r d i n g t r e n d s i n t h e s e v a r i a b l e s . The work o f Growick and McMahon (1983) c o n c e n t r a t e d on c h a r a c t e r i s t i c s o f o l d e r s u c c e s s f u l v o c a t i o n a l r e h a b i l i t a t i o n c l i e n t s w i t h p a r t i c u l a r a t t e n t i o n t o t h e age group 45 and o v e r . They found t h a t w i t h i n t h i s g r o u p , t h e s u c c e s s f u l VR c l i e n t tended t o be female , m a r r i e d , w i t h l e s s t h a n a h i g h s c h o o l e d u c a t i o n and w i t h a p h y s i c a l d i s a b i l i t y . The m i d d l e age group (30-44) tended t o be male , m a r r i e d , a h i g h s c h o o l g r a d u a t e and w i t h a c l a s s i f i c a t i o n o f b e h a v i o r a l d i s a b i l i t y . The younger , s u c c e s s f u l VR c l i e n t (<30 y e a r s o f age) was male , s i n g l e , w i t h a h i g h s c h o o l d i p l o m a and h a v i n g a d i s a b i l i t y w i t h an e m o t i o n a l / b e h a v i o r a l component. T h i s s t u d y f o l l o w e d e a r l i e r r e s e a r c h by K r a u f t and 54 B o l t o n (1976) who found t h a t age was v iewed as a d e t e r r e n t t o s u c c e s s f u l r e h a b i l i t a t i o n w i t h the t r e n d toward a g r e a t e r l i k e l i h o o d o f s u c c e s s f u l r e h a b i l i t a t i o n outcome f o r the younger age g r o u p . T h i s c o u l d be a t t r i b u t e d , i n p a r t , t o t h e d i m i n i s h i n g work c a p a c i t y o f o l d e r p e r s o n s ( C h r i s t e n s e n , 1955; B o n j e r , 1962; B i n k , 1962; Snook, 1971; P e t r o f s k y and L i n d , 1975) and t o the g e n e r a l r e l a t i o n s h i p between age and f r e q u e n c y o f work d i s a b i l i t y as r e p o r t e d by B l a k e (1981) and Bowe (1983) . H e s t e r , D e c e l l e s and Hood (1986) d e s c r i b e d a r e l a t i o n s h i p between age and r e t u r n t o work f o l l o w i n g i n j u r y i n a s t u d y o f c l a i m a n t s w i t h d i s a b i l i t y i n s u r a n c e c l a i m s . They found t h a t the l i k e l i h o o d o f r e t u r n t o work i s g r e a t e s t f o r workers d i s a b l e d b e f o r e age 35 and t h a t t h e r e t u r n t o work r a t e p r o g r e s s i v e l y d i m i n i s h e s w i t h age . They a l s o e s t a b l i s h e d a c l e a r r e l a t i o n s h i p between age a t t h e onse t o f d i s a b i l i t y and the t ime a p e r s o n spends i n the d i s a b i l i t y s u p p o r t sys tem. Workers i n the 45-54 age group spent the l o n g e s t t ime i n t h e system (4.9 years ) compared t o 2 .9 y e a r s f o r t h e 16-34 age g r o u p . A d d i t i o n a l i n s i g h t i n t o the e f f e c t o f t h e age v a r i a b l e on v o c a t i o n a l p lacement can be found i n the work conducted by Rasch (1979). In c o n t r a s t t o p r e v i o u s s t u d i e s , he found t h a t i t was not o n l y e c o n o m i c a l l y f e a s i b l e b u t a l s o s o c i a l l y d e s i r a b l e t o r e h a b i l i t a t e o l d e r , d i s a b l e d c l i e n t s i n compar i son t o any o t h e r age g r o u p . T h i s r e s e a r c h was s u p p o r t e d by M o r r i s o n , Magel and Brody (1985) who showed 55 t h a t t h e m a j o r i t y o f o l d e r (55-64 y e a r s ) , d i s a b l e d workers t ended t o r e t u r n t o work and , i n f a c t , r e t u r n e d t o t h e i r p r e v i o u s employers and j o b s f o l l o w i n g r e c o v e r y from a d i s a b l i n g i n j u r y . In a d d i t i o n , K i s e r (1972) r e p o r t e d t h a t t h e p r o v i s i o n o f s e r v i c e s t o o l d e r , d i s a b l e d workers was a p r o f i t a b l e inves tment f o r VR programs . M e i e r and K e r r (1976) gave f u r t h e r s u p p o r t f o r t h e p r o v i s i o n o f v o c a t i o n a l r e h a b i l i t a t i o n programs f o r o l d e r w o r k e r s . They showed t h a t i f o l d e r workers a r e p l a c e d p r o p e r l y , they s u s t a i n fewer a c c i d e n t s on the j o b , show g r e a t e r s t a b i l i t y on t h e j o b and l o s e l e s s t ime from work than t h e i r younger c o u n t e r p a r t s . Kennedy (1974) examined c e r t a i n demographic v a r i a b l e s f o r 222 r e h a b i l i t a t e d and 58 n o n - r e h a b i l i t a t e d c l i e n t s i n an at tempt t o d e f i n e those f a c t o r s which d i s c r i m i n a t e d between s u c c e s s and n o n - s u c c e s s i n v o c a t i o n a l r e h a b i l i t a t i o n programs . Of the e l e v e n v a r i a b l e s s t u d i e d i n t h e p r o j e c t , o n l y t h r e e were found t o be s i g n i f i c a n t . S u c c e s s f u l c l i e n t s were found t o have a h i g h e r e d u c a t i o n l e v e l , t y p i c a l l y t o be w o r k i n g a t t h e t ime o f r e f e r r a l and t o not be dependent on some form o f p u b l i c a s s i s t a n c e . T h i s t r e n d r e g a r d i n g f i n a n c i a l a s s i s t a n c e was a l s o i d e n t i f i e d by W a l l s (1977) i n h i s s t u d y o f 200 v o c a t i o n a l r e h a b i l i t a t i o n c l i e n t s . Among t h e f a c t o r s i n v e s t i g a t e d i n c l u d i n g age, gender , d i s a b l i n g c o n d i t i o n and f u l l - t i m e work h i s t o r y , W a l l s found t h a t none were c o n s i s t e n t l y r e l a t e d t o outcome. He d i d f i n d , however, t h a t the g r e a t e r the amount o f b e n e f i t s r e c e i v e d , t h e l e s s l i k e l y was t h e i n c i d e n c e o f s u c c e s s f u l r e h a b i l i t a t i o n . 56 K r a u f t and B o l t o n (1976) a l s o i d e n t i f i e d t h i s t r e n d and n o t e d t h a t c l i e n t s r e c e i v i n g s u p p o r t from f a m i l y members and f r i e n d s and those on some form o f p u b l i c a s s i s t a n c e a t r e f e r r a l were l e s s l i k e l y t o be r e h a b i l i t a t e d . O t h e r r e s e a r c h e r s have a l s o c o l l e c t e d i n f o r m a t i o n on v a r i o u s demographic v a r i a b l e s which i n t h e i r own way have been used as g e n e r a l s c r e e n i n g v a r i a b l e s f o r p r e d i c t i n g outcomes i n v o c a t i o n a l r e h a b i l i t a t i o n programs . E b e r (1966) used a we ighted c o m b i n a t i o n o f v a r i a b l e s f o r the p r e d i c t i o n o f r e h a b i l i t a t i o n s u c c e s s . The r e s u l t s o f h i s i n v e s t i g a t i o n s showed t h a t males , m a r r i e d o r h a v i n g been p r e v i o u s l y m a r r i e d , w i t h an e d u c a t i o n l e v e l o f a t l e a s t 10th grade and employed a t the t ime o f acceptance i n t o t h e program demonstrated g r e a t e r chances o f s u c c e s s . S c h e c h t e r (1981) a l s o i d e n t i f i e d s e v e r a l v a r i a b l e s a s s o c i a t e d w i t h s u c c e s s f u l r e t u r n t o work s t a t u s i n c l u d i n g b e i n g male , h a v i n g g r e a t e r f i n a n c i a l need, a m i l d e r d i s a b i l i t y and a h i g h e r e d u c a t i o n l e v e l . These f i n d i n g s were g e n e r a l l y s u p p o r t e d by the r e s e a r c h o f W r i g h t , Reag le s and Thomas (1973) who i d e n t i f i e d the problem cases f o r v o c a t i o n a l r e h a b i l i t a t i o n t o be l e s s w e l l e d u c a t e d , s i n g l e , h a v i n g a s e v e r e d i s a b i l i t y and r e c e i v i n g some form o f p u b l i c a s s i s t a n c e . The m a j o r i t y o f r e s e a r c h t o date has shown some i n t e r e s t i n g t r e n d s f o r a wide c r o s s s e c t i o n o f v a r i a b l e s which may be used as g e n e r a l i n d i c a t o r s o f s u c c e s s o r f a i l u r e i n v o c a t i o n a l r e h a b i l i t a t i o n programs . The l a c k o f 57 homogeneity i n many o f the samples , s m a l l sample s i z e s and d i v e r s e economic and s o c i o l o g i c a l backgrounds o f t h e s u b j e c t s makes the compar i son o f much o f t h e d a t a d i f f i c u l t (Hes ter e t a l , 1986) . W h i l e i t i s agreed t h a t t h e t r e n d s found f o r some o f the demographic v a r i a b l e s w a r r a n t s t h e i r use as a g e n e r a l s c r e e n i n g t o o l , i t i s the complex i n t e r a c t i o n o f t h e s e v a r i a b l e s , not the s i n g u l a r i n f l u e n c e o f any one i n p a r t i c u l a r , t h a t seems, u l t i m a t e l y t o i n f l u e n c e s u c c e s s . Of a l l the s t u d i e s r e v i e w e d , no i n t e r v e n t i o n t e c h n i q u e was found , e i t h e r e v a l u a t i o n o r t r e a t m e n t o r i e n t e d , whose outcomes were measured i n terms o f s u c c e s s f u l v o c a t i o n a l p lacement . 58 CHAPTER I I I METHODOLOGY 3 .1 OVERVIEW W i t h i n the f i e l d o f i n d u s t r i a l m e d i c i n e , t h e assessment o f i n d i v i d u a l c a p a c i t y f o r work i s r a p i d l y becoming an e s s e n t i a l component o f the v o c a t i o n a l r e h a b i l i t a t i o n p r o c e s s . In p a r t i c u l a r i n s t a n c e s where the p r e s e n c e o f a p h y s i c a l d i s a b i l i t y has imposed some l i m i t a t i o n o f endurance o r f u n c t i o n , t h e n a t u r e o f t h a t l i m i t a t i o n must be d e f i n e d p r i o r t o t h e c o n s i d e r a t i o n o f s u i t a b l e v o c a t i o n a l a l t e r n a t i v e s . From a r e v i e w o f the l i t e r a t u r e , i t i s a p p a r e n t t h a t many s p e c i f i c assessment t o o l s have e v o l v e d o v e r the y e a r s w i t h formats d e s i g n e d t o meet p a r t i c u l a r needs ( P r u i t t , 1977; Gannaway and S i n k , 1978; S m i t h , Cunningham and Weinberg , 1986; Matheson, 1987; B l a n k e n s h i p , 1988) . These contemporary p h y s i c a l c a p a c i t y assessment programs have d e v e l o p e d a h i g h l y s t r u c t u r e d , m u l t i - f a c t o r i a l approach w i t h a d i s t i n c t c l i n i c a l o r i e n t a t i o n . Whether d e s i g n e d f o r use as a p r e l i m i n a r y s c r e e n i n g t o o l f o r s p e c i f i c t a r g e t p o p u l a t i o n s o r as a g e n e r a l d i a g n o s t i c g u i d e t o motor and c o g n i t i v e f u n c t i o n , the absence o f e m p i r i c a l d a t a from an i n d u s t r i a l environment imposes d i s t i n c t l i m i t a t i o n s on the i n t e r p r e t a t i o n o f much o f the d a t a . In o r d e r t o s a t i s f y the demands f o r o b j e c t i v e measures o f f u n c t i o n w i t h i n t h e a c t u a l w o r l d o f work, most programs have a t tempted t o q u a n t i f y s p e c i f i c a c t i v i t y components o f 59 j o b s and have c o n c e n t r a t e d on the assessment o f m u l t i p l e a s p e c t s o f o v e r a l l f u n c t i o n i n s i m u l a t e d env ironments r a t h e r t h a n t h e c o l l e c t i o n o f w o r k - r e l a t e d i n f o r m a t i o n . In most i n s t a n c e s , no e m p i r i c a l d a t a e x i s t s on the e f f i c a c y o f the programs nor on t h e i r impact on r e t u r n i n g i n j u r e d workers t o t h e work f o r c e . V e r y few p h y s i c a l c a p a c i t y assessment i programs e x i s t t h a t e v a l u a t e p h y s i c a l / f u n c t i o n a l c a p a c i t y w i t h i n an i n d u s t r i a l c o n t e x t w h i l e a s s e s s i n g t h e impact o f t h e p r o c e s s o f i n f o r m a t i o n g a t h e r i n g on the u l t i m a t e g o a l o f f i n d i n g work. 3.2 PURPOSE OF THE STUDY The purpose o f t h i s s tudy was two f o l d . The p r i m a r y o b j e c t i v e was t h e development o f an i n d u s t r i a l l y - o r i e n t e d , assessment format f o r the e v a l u a t i o n o f i n d i v i d u a l p h y s i c a l c a p a c i t y t o p e r f o r m work. F o l l o w i n g c o m p l e t i o n and i m p l e m e n t a t i o n o f the e v a l u a t i o n program, t h e secondary purpose was t o e v a l u a t e the e f f i c a c y o f the p h y s i c a l c a p a c i t y assessment program (PCA) on v o c a t i o n a l p l a c e m e n t . 3.3 METHODOLOGY 3 . 3 . 1 RATIONALE AND EXPERIMENTAL DESIGN F o l l o w i n g m e d i c a l t r e a t m e n t , workers w i t h i n t h e B r i t i s h Columbia Compensat ion System who have been l e f t w i t h a r e s i d u a l d i s a b i l i t y as the r e s u l t o f an i n d u s t r i a l i n j u r y o r 60 who a r e h a v i n g d i f f i c u l t y r e t u r n i n g t o t h e work f o r c e a r e r e f e r r e d t o a r e h a b i l i t a t i o n c o n s u l t a n t a f f i l i a t e d w i t h the V o c a t i o n a l R e h a b i l i t a t i o n Department o f the Workers* Compensat ion B o a r d . The c o n s u l t a n t a s s i s t s the i n j u r e d worker i n t h e i d e n t i f i c a t i o n and s e l e c t i o n o f v o c a t i o n a l o p t i o n s s u i t e d t o t h e i r i n d i v i d u a l needs and w i t h i n t h e l i m i t a t i o n s imposed by t h e i r i n j u r y . O f t e n , t h i s p r o c e s s i n v o l v e s the use o f e x i s t i n g , t r a n s f e r a b l e s k i l l s o r t h e p r o v i s i o n o f a d d i t i o n a l s k i l l s t h r o u g h t r a i n i n g , i n an e f f o r t t o improve the w o r k e r ' s m a r k e t a b i l i t y i n t h e work p l a c e . When the s tudy was i n i t i a t e d , an i n t e n s i v e j o b s e a r c h program was a v a i l a b l e t o i n j u r e d workers p r i o r t o s e a r c h i n g f o r a l t e r n a t e employment. T h i s a s s i s t e d i n the i d e n t i f i c a t i o n o f j o b g o a l s and p r o v i d e d j o b s e a r c h s t r a t e g i e s . U n f o r t u n a t e l y , succes s o r f a i l u r e i n f i n d i n g s u i t a b l e employment o f t e n depended on the random s e l e c t i o n o f v o c a t i o n a l a l t e r n a t i v e s and , t o some e x t e n t , t r i a l and e r r o r when i n d i v i d u a l p h y s i c a l t o l e r a n c e s and l i m i t a t i o n s were not known. Approaches t o s o l v i n g v o c a t i o n a l problems v a r i e d from c o n s u l t a n t t o c o n s u l t a n t and no s t a n d a r d i z e d approach t o t h e i d e n t i f i c a t i o n and s e l e c t i o n o f s u i t a b l e o p t i o n s e x i s t e d . The e x p e r i m e n t a l d e s i g n proposed two t r e a t m e n t groups i n a p o s t - t e s t o n l y c o n f i g u r a t i o n . The two t r e a t m e n t groups c o n s i s t e d o f i n j u r y p l u s d i s a b i l i t y w i t h v o c a t i o n a l c o u n s e l l i n g o n l y f o r j o b s e a r c h ( J S ) ; and i n j u r y p l u s 61 d i s a b i l i t y w i t h v o c a t i o n a l c o u n s e l l i n g p l u s p h y s i c a l c a p a c i t y assessment (PCA) . Random ass ignment o f t h e s u b j e c t s t o t h e i r s p e c i f i c t r e a t m e n t groups assumed s i g n i f i c a n c e i n the absence o f any p r e - t e s t i n f o r m a t i o n . In o r d e r t o s i m u l a t e a c t u a l work ing c o n d i t i o n s i n t h e r e h a b i l i t a t i o n s e t t i n g , r e h a b i l i t a t i o n c o n s u l t a n t s were randomly s e l e c t e d f o r i n c l u s i o n i n the s t u d y and asked t o s e l e c t s u b j e c t s f o r p a r t i c i p a t i o n from t h e i r c a s e l o a d s a c c o r d i n g t o t h e p r e - s e l e c t e d c r i t e r i a . S u b j e c t s were t h e n randomly a s s i g n e d , on an a l t e r n a t i n g b a s i s , t o one o f t h e two t r e a t m e n t g r o u p s . Group homogeneity was m a i n t a i n e d by s e l e c t i o n c r i t e r i a which i n c l u d e d comparable t y p e s and degrees o f d i s a b i l i t y , c o m p l e t i o n o f a c t i v e m e d i c a l t r e a t m e n t , a c t i v e r e h a b i l i t a t i o n cases and l i m i t e d age r a n g e . E x c l u s i v e l y male s u b j e c t s were s e l e c t e d f o r the s t u d y due t o o v e r a l l r e d u c e d a v a i l a b i l i t y o f female p a r t i c i p a t a n t s i n t h e compensat ion sys tem. 3 . 3 . 2 DEPENDENT VARIABLES F o r t h e purpose o f t h i s s t u d y , the e f f e c t o f the two v o c a t i o n a l p lacement t e c h n i q u e s was e v a l u a t e d i n r e l a t i o n t o the f o l l o w i n g dependent v a r i a b l e s ; a . v o c a t i o n a l p lacement ( s u c c e s s / f a i l u r e ) b . t ime t o r e t u r n t o work ( c h r o n o l o g i c a l ) c . t y p e o f v o c a t i o n a l p lacement ( a p p r o p r i a t e n e s s ) d . s e l f - e s t e e m (Coopersmith S e l f - e s t e e m Q u e s t i o n n a i r e ) 62 3 . 3 . 3 INDEPENDENT VARIABLES In a d d i t i o n t o the e x p e r i m e n t a l v a r i a b l e s , s e v e r a l independent v a r i a b l e s were s e l e c t e d f o r i n v e s t i g a t i o n i n r e l a t i o n t o t h e i r p o s s i b l e e f f e c t on t h e outcome v a r i a b l e s . C o n s i s t e n t w i t h p r e v i o u s r e s e a r c h i n the f i e l d o f p r e d i c t i v e v a r i a b l e s f o r r e t u r n i n g d i s a b l e d workers t o a c t i v e employment (Gannaway and S i n k , 1978; B o l t o n , 1979; Growick and McMahon, 1983; H e s t e r , D e c e l l e s and G a d d i s , 1986) the f o l l o w i n g v a r i a b l e s were s e l e c t e d f o r i n c l u s i o n i n t h e s t u d y ; a . i n j u r y t y p e (upper body, lower body, sp ine ) b . degree o f d i s a b i l i t y (medica l percentage) c . age (18-45) A l l i n f o r m a t i o n r e l e v a n t t o these v a r i a b l e s was o b t a i n e d from the w o r k e r ' s f i l e s . 3 . 3 . 4 MODERATOR VARIABLES The f o l l o w i n g b iodemographic and moderator v a r i a b l e s were s e l e c t e d f o r i n v e s t i g a t i o n t o de termine t h e e x t e n t t o which they may impact on the outcome v a r i a b l e s . They were s e l e c t e d on the b a s i s o f t h e i r r e l e v a n c y t o the compensat ion p r o c e s s . a . t ime i n m e d i c a l t r e a t m e n t ( i n j u r y t o m e d i c a l p l a t e a u ) b . p r e - i n j u r y wages (monthly s a l a r y ) c . p o s t - i n j u r y wages (monthly s a l a r y ) 63 d . r e h a b i l i t a t i o n c o n s u l t a n t e. m a r i t a l s t a t u s f . language (ESL) g . e d u c a t i o n (years) 3 . 5 QUESTIONS The c r i t i c a l q u e s t i o n s t o be asked i n t h i s s t u d y were f o l l o w s ; a . Can an a c t i v i t y - o r i e n t e d , p h y s i c a l c a p a c i t y assessment program t h a t would a c c u r a t e l y r e f l e c t an i n j u r e d w o r k e r ' s r e a d i n e s s f o r work be d e s i g n e d and implemented f o r use i n an i n d u s t r i a l s e t t i n g ? b . I s t h e r e a d i f f e r e n c e i n the v a r i a b l e s o f s u c c e s s r a t e i n v o c a t i o n a l p lacement , t ime t o v o c a t i o n a l p lacement and t y p e o f v o c a t i o n a l p lacement between t h e two t r e a t m e n t groups as r e p r e s e n t e d by s p e c i f i c v o c a t i o n a l p lacement t e c h n i g u e s ? c . A r e t h e r e t r a i t / t r e a t m e n t i n t e r a c t i o n s between the dependent v a r i a b l e s and s e l e c t worker c h a r a c t e r i s t i c s o f i n j u r y t y p e , degree o f d i s a b i l i t y and age? d . What i s the impact o f s e l e c t moderator v a r i a b l e s such as t ime i n m e d i c a l t r e a t m e n t , p r e - i n j u r y wages, p o s t - i n j u r y wages, l anguage , m a r i t a l s t a t u s , e d u c a t i o n , language and t h e e f f e c t o f the r e h a b i l i t a t i o n c o n s u l t a n t on the dependent 64 v a r i a b l e s ? e. How i s s e l f esteem a f f e c t e d by invo lvement i n e i t h e r o f the two d i f f e r e n t v o c a t i o n a l p lacement t e c h n i q u e s ? f . What i s t h e o v e r a l l r e a c t i o n o f t h e s u b j e c t s i n t h e s t u d y t o t h e i r i n d i v i d u a l e x p e r i e n c e s o f i n j u r y , d i s a b i l i t y and unemployment? 3 . 3 . 6 HYPOTHESES Based on t h e above q u e s t i o n s the f o l l o w i n g hypotheses were f o r m u l a t e d : H y p o t h e s i s 1: S u b j e c t s who r e c e i v e p h y s i c a l c a p a c i t y assessment (PCA) i n a d d i t i o n t o v o c a t i o n a l c o u n s e l l i n g w i l l be more s u c c e s s f u l i n v o c a t i o n a l p lacement , w i l l r e t u r n t o work i n a s h o r t e r p e r i o d o f t ime and w i l l a c h i e v e a b e t t e r v o c a t i o n a l match t h a n t h o s e who do n o t . The i n f o r m a t i o n c o l l e c t e d t h r o u g h p h y s i c a l c a p a c i t y assessment w i l l p r o v i d e t h e r e h a b i l i t a t i o n c o n s u l t a n t w i t h d e t a i l e d and a c c u r a t e i n f o r m a t i o n on a w o r k e r ' s i n d i v i d u a l c a p a c i t y f o r work. T h i s i n f o r m a t i o n w i l l r e f i n e t h e p r o c e s s o f d e f i n i n g v i a b l e o p t i o n s f o r the worker by p r o v i d i n g a more s o p h i s t i c a t e d i n f o r m a t i o n base t h a n t h e t e c h n i q u e p r e s e n t l y i n use which r e l i e s on a r e h a b i l i t a t i o n c o n s u l t a n t ' s knowledge o f the work p l a c e and p r e v i o u s e x p e r i e n c e w i t h s i m i l a r j o b s and t y p e s o f i n j u r i e s . Improv ing t h e w o r k e r ' s chances o f l o c a t i n g a s u i t a b l e j o b 65 w i t h i n h i s r e a l m o f a b i l i t i e s and p h y s i c a l l i m i t a t i o n s by p r o v i d i n g more a c c u r a t e and i n d i v i d u a l i z e d i n f o r m a t i o n s h o u l d enhance s u c c e s s f u l v o c a t i o n a l p lacement and reduce no t o n l y the t ime t a k e n i n a c t u a l l y l o o k i n g f o r work, b u t a l s o p r o v i d e a b e t t e r j o b match f o r the w o r k e r . H y p o t h e s i s 2: S u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) i n a d d i t i o n t o v o c a t i o n a l c o u n s e l l i n g w i l l show a g r e a t e r o v e r a l l i n c r e a s e i n measures o f s e l f - e s t e e m . The PCA program has been s t r u c t u r e d t o be as i n f o r m a t i v e as p o s s i b l e . From the i n t a k e t o the d i s c h a r g e i n t e r v i e w s , i n f o r m a t i o n w i l l be c o n t i n u o u s l y exchanged. S u b j e c t s were t o l d the r e a s o n f o r r e f e r r a l and were i n v i t e d t o p a r t i c i p a t e i n the p r o c e s s . In a d d i t i o n , s u b j e c t s were kept i n f o r m e d o f t h e i r p r o g r e s s throughout t h e assessment and r e c e i v e d a v e r b a l summary o f t h e i r r e s u l t s a t d i s c h a r g e . The assessment format was s t r u c t u r e d t o promote as p o s i t i v e and p r o d u c t i v e an environment as p o s s i b l e t h r o u g h o u t t h e p r o c e s s o f d e f i n i n g i n d i v i d u a l work t o l e r a n c e s . I t i s h y p o t h e s i z e d t h a t w i t h i n such an environment where t h e worker , and the e v a l u a t o r , c o o p e r a t e t o d e v e l o p o p t i o n s f o r t h e f u t u r e , t h a t s a t i s f a c t i o n l e v e l s w i l l be h i g h e r and , a c c o r d i n g l y , s e l f - esteem enhanced as employment o p t i o n s a r e i d e n t i f i e d and d e v e l o p e d . H y p o t h e s i s 3 : Ho: There w i l l not be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between the t y p e o f i n j u r y a s u b j e c t has and the dependent v a r i a b l e s o f succes s i n v o c a t i o n a l p l a c e m e n t , t ime t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r those s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . 66 I t i s assumed t h a t t h e t y p e o f i n j u r y a s u b j e c t has w i l l no t a f f e c t nor c o n t r i b u t e i n any way t o the d i f f e r e n c e s t h a t may be found t o e x i s t between the two t r e a t m e n t groups f o r t h e s e l e c t e d dependent v a r i a b l e s . R e g a r d l e s s o f i n j u r y t y p e , s u b j e c t s s h o u l d e x p e r i e n c e s i m i l a r f e e l i n g s o f s a t i s f a c t i o n and s e l f - e s t e e m from the t r e a t m e n t p r o c e s s e s and a c h i e v e s i m i l a r succes s f i n d i n g t h e a p p r o p r i a t e t y p e o f work i n t h e s h o r t e s t p e r i o d o f t ime p o s s i b l e . H y p o t h e s i s 4: Ho: There w i l l not be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between t h e degree o f d i s a b i l i t y a s u b j e c t has and the dependent v a r i a b l e s o f s u c c e s s i n v o c a t i o n a l p lacement , t ime t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r t h o s e s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . Assuming a c o n s i s t e n t d a t a c o l l e c t i o n f o r m a t , PCA i n f o r m a t i o n c o l l e c t i o n s h o u l d be u n a f f e c t e d by how much a s u b j e c t i s d i s a b l e d as each t a s k and module a r e comple ted a t h i s own speed and w i t h i n h i s l e v e l s o f work t o l e r a n c e . In r e a l i t y , the assessment p r o c e s s s h o u l d c l e a r l y d e f i n e w o r k - r e l a t e d l i m i t a t i o n s i n t h e more s e v e r e l y d i s a b l e d s u b j e c t s . T h i s i n f o r m a t i o n would t h e n be used by t h e r e h a b i l i t a t i o n c o n s u l t a n t i n t h e s e l e c t i o n o f s u i t a b l e v o c a t i o n a l o p t i o n s t a k i n g i n t o c o n s i d e r a t i o n the l i m i t a t i o n s and a b i l i t i e s r e v e a l e d d u r i n g t h e assessment p r o c e s s . C o n s i s t e n t , o b j e c t i v e and r e l i a b l e f u n c t i o n a l i n f o r m a t i o n i s c o l l e c t e d and p r o v i d e d t o each worker c o n s i s t i n g o f an i n d i v i d u a l i z e d p h y s i c a l t o l e r a n c e p r o f i l e . Once i d e n t i f i e d , 67 t h i s i n f o r m a t i o n i s used by the r e h a b i l i t a t i o n c o n s u l t a n t t o match workers w i t h s u i t a b l e employment o p t i o n s . H y p o t h e s i s 5: Ho: There w i l l no t be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between a s u b j e c t ' s age and the dependent v a r i a b l e s o f succes s i n v o c a t i o n a l p l a c e m e n t , t i m e t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r t h o s e s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . Age s h o u l d not a f f e c t t h e c o l l e c t i o n o f assessment i n f o r m a t i o n n o r i n the m a r k e t i n g o f a s u b j e c t once he b e g i n s t o a c t i v e l y l o o k f o r work. S u b j e c t s w i l l be s e l e c t e d i n t h e age range 18-45 t o ensure a s u f f i c i e n t p e r i o d o f t ime l e f t i n t h e i r w o r k i n g l i v e s p r i o r t o r e t i r e m e n t . In a d d i t i o n , t h e s e l e c t e d age range s h o u l d be low enough so as no t t o be a n e g a t i v e f a c t o r f o r those employers l o o k i n g f o r p o t e n t i a l employees . 3 . 3 . 7 SUBJECTS AND SAMPLING To f a c i l i t a t e the p o s t - t e s t o n l y e x p e r i m e n t a l d e s i g n and t o p r o v i d e t h e h i g h e s t power p o s s i b l e t o the p r o c e s s o f c a u s a t i v e i n f e r e n c e , t h e sample (N=50) was s e l e c t e d e x c l u s i v e l y from t h e a c t i v e cases o f the Workers ' Compensat ion Board o f B r i t i s h Columbia V o c a t i o n a l R e h a b i l i t a t i o n Department . W i t h i n t h i s p o p u l a t i o n , the f o l l o w i n g s e l e c t i o n c r i t e r i a were imposed; a . c o m p l e t i o n o f a l l m e d i c a l t r e a t m e n t f o l l o w i n g r e c o v e r y from an i n d u s t r i a l a c c i d e n t . b . i n r e c e i p t o f , o r b e i n g e v a l u a t e d f o r , a permanent 68 p a r t i a l d i s a b i l i t y p e n s i o n as the r e s u l t o f i n j u r i e s s u s t a i n e d . c . c l e a r e d f o r a r e t u r n t o work and p r e p a r i n g t o become a c t i v e l y i n v o l v e d i n t h a t p r o c e s s . d . ma le . e. 18-45 y e a r s o f age. A l l s u b j e c t s were s e l e c t e d by the r e h a b i l i t a t i o n c o n s u l t a n t s h a n d l i n g t h e i r cases f o r i n c l u s i o n i n the s t u d y and were known t o the r e h a b i l i t a t i o n c o n s u l t a n t s p r i o r t o s e l e c t i o n . The e x p e r i m e n t a l d e s i g n assumed e q u a l c e l l s i z e p e r t r e a t m e n t group w i t h each s u b j e c t randomly a s s i g n e d t o one o f two t r e a t m e n t groups on the b a s i s o f the s e l e c t i o n c r i t e r i a . In a d d i t i o n , e q u a l d i s t r i b u t i o n took p l a c e w i t h r e f e r e n c e t o the p r e - s e l e c t e d worker c h a r a c t e r i s t i c s o f i n t e r e s t i n c l u d i n g age, degree o f d i s a b i l i t y and t y p e o f d i s a b i l i t y . 3.4 DEVELOPMENT OF THE TESTING MATERIALS 3 . 4 . 1 TASK/MODULE PHYSICAL CAPACITY ASSESSMENT PROGRAM S u b j e c t s a s s i g n e d t o the e x p e r i m e n t a l group i n v o l v i n g i n j u r y p l u s d i s a b i l i t y w i t h v o c a t i o n a l c o u n s e l l i n g p l u s p h y s i c a l c a p a c i t y assessment (N=25) underwent an i n d i v i d u a l l y d e s i g n e d two week p h y s i c a l work c a p a c i t y program w i t h i n t h e I n d u s t r i a l Department o f the W o r k e r s 1 Compensat ion Board c l i n i c . F o r t h i s e x p e r i m e n t a l group t w e n t y - f i v e s e p a r a t e i n d u s t r i a l t a s k s were d e s i g n e d r a n g i n g 69 from s e d e n t a r y t o v e r y heavy i n t h e i r s t r e n g t h r e q u i r e m e n t s , c o n s i s t e n t w i t h the c l a s s i f i c a t i o n o u t l i n e d i n t h e CCDO (1987) . The t a s k s were d e s i g n e d t o be c a r r i e d out i n a shop s e t t i n g and c o v e r e d a v a r i e t y o f i n d u s t r i a l work env ironments i n a p r o j e c t format (Appendix A ) . T a s k s were l i s t e d i n an i n v e n t o r y format p r i m a r i l y by t h e s t r e n g t h r e q u i r e m e n t s o f l i f t i n g , c a r r y i n g , p u s h i n g and p u l l i n g v a r i o u s we ights and were c l a s s i f i e d from s e d e n t a r y t o v e r y heavy as d e f i n e d i n the CCDO (1987) . O t h e r i n f o r m a t i o n i n c l u d e d a b r i e f d e s c r i p t i o n o f t h e p r o j e c t , the p r o j e c t s e t t i n g , the n e c e s s a r y t o o l s , m a t e r i a l s r e q u i r e d , i n s t r u c t i o n t ime and c o m p l e t i o n t i m e , as w e l l as some comments r e g a r d i n g s p e c i f i c work t o l e r a n c e s (Appendix B ) . The s e l e c t i o n o f t a s k s f o r the development o f i n d i v i d u a l e v a l u a t i o n programs was completed by the v o c a t i o n a l e v a l u a t o r from the t a s k i n v e n t o r y . The t a s k / i n v e n t o r y s e r v e d as t h e b a s i s o f the t a s k / m o d u l e sys tem. A l l t a s k s were c a r r i e d out w i t h i n t h e same shop environment which c o n s t i t u t e d the I n d u s t r i a l Therapy Department . A t a s k was d e f i n e d as an i n d i v i d u a l p r o j e c t w i t h s p e c i f i c s t r e n g t h r e q u i r e m e n t s c o n t a i n i n g one o r more o f the seven f a c t o r s d e f i n e d by t h e CCDO. S e v e r a l t a s k s c o n t a i n i n g t h e s p e c i f i c f a c t o r s o f i n t e r e s t were t h e n grouped t o g e t h e r i n a module t o p r o v i d e a s p e c i f i c measure o f f u n c t i o n f o r t h e f a c t o r under c o n s i d e r a t i o n . F o l l o w i n g c o m p l e t i o n o f the e v a l u a t i o n , s u b j e c t performance f o r each s e p a r a t e t a s k was grouped t o g e t h e r i n modules t o g i v e a f a c t o r - s p e c i f i c , 70 o b j e c t i v e measure o f f u n c t i o n . A l l t a s k s were d e s i g n e d t o s i m u l a t e a c t u a l w o r k i n g c o n d i t i o n s and p h y s i c a l demands o f i n d u s t r i a l j o b s as c l o s e l y as p o s s i b l e . Tasks were c o n s i s t e n t l y a d m i n i s t e r e d and m o n i t o r e d f o r a l l s u b j e c t s by q u a l i f i e d shop i n s t r u c t o r s . P r o g r e s s r e p o r t s were completed by t h e shop i n s t r u c t o r s f o r each s u b j e c t d u r i n g t a s k c o n s t r u c t i o n and s u b m i t t e d t o t h e v o c a t i o n a l e v a l u a t o r f o r r e v i e w (see Appendix C ) . S u b j e c t s were a s s i g n e d t o i n d i v i d u a l programs by t h e v o c a t i o n a l e v a l u a t o r based on demonstrated c a p a b i l i t i e s f o l l o w i n g c o m p l e t i o n o f a p h y s i c a l e v a l u a t i o n t o d e t e r m i n e c r i t i c a l t o l e r a n c e l e v e l s . Over t h e c o u r s e o f t h e two week e v a l u a t i o n , s u b j e c t s were g r a d u a l l y p r o g r e s s e d , as t o l e r a t e d , t h r o u g h more p h y s i c a l l y demanding t a s k s u n t i l maximal demonstrated t o l e r a n c e l e v e l s were a c h i e v e d . 3 . 4 . 2 REMEDIAL THERAPY PHYSICAL EVALUATION F o l l o w i n g the i n t a k e i n t e r v i e w w i t h t h e v o c a t i o n a l e v a l u a t o r and p r i o r t o commencing any t a s k s w i t h i n t h e i n d u s t r i a l shops , a l l s u b j e c t s underwent a two hour p h y s i c a l e v a l u a t i o n c a r r i e d out by a q u a l i f i e d r e m e d i a l t h e r a p i s t . T h i s e x e r c i s e - o r i e n t e d e v a l u a t i o n was d e s i g n e d t o a s s e s s i n d i v i d u a l c r i t i c a l t o l e r a n c e s c o n s i s t e n t w i t h t h e g u i d e l i n e s e s t a b l i s h e d by the CCDO i n the main s t r e n g t h c a t e g o r i e s o f p u s h i n g , p u l l i n g , l i f t i n g and c a r r y i n g as w e l l as seven o t h e r c r i t i c a l f a c t o r s . I n d i v i d u a l per formance 71 t o l e r a n c e s i n t h e s e f a c t o r s were r e c o r d e d i n a s t a n d a r d r e p o r t format (Appendix D) and p r o v i d e d t o t h e v o c a t i o n a l e v a l u a t o r f o r r e v i e w p r i o r t o the development o f the e v a l u a t i o n program. U t i l i z i n g the minimum c r i t i c a l t o l e r a n c e l e v e l s p r e v i o u s l y d e f i n e d by the p h y s i c a l e v a l u a t i o n f o r t h e e i g h t f a c t o r s , i n d i v i d u a l programs f o r each s u b j e c t were t h e n d e s i g n e d u s i n g the t a s k / m o d u l e f o r m a t . 3.5 DATA COLLECTION 3.5.1 PROGRAM ADMINISTRATION S u b j e c t s were r e f e r r e d f o r P h y s i c a l C a p a c i t y E v a l u a t i o n by t h e r e h a b i l i t a t i o n c o n s u l t a n t h a n d l i n g t h e i r case and randomly a s s i g n e d t o the e x p e r i m e n t a l g r o u p . A s t a n d a r d i z e d r e f e r r a l format was used and the s u b j e c t in formed o f t h e assessment i n advance (Appendix E ) . F o r t h i s t r e a t m e n t group c o l l e c t i o n o f a l l p r e - p r o g r a m c r i t i c a l t o l e r a n c e i n f o r m a t i o n i n the Remedia l Therapy P h y s i c a l E v a l u a t i o n was c a r r i e d out by two male r e m e d i a l t h e r a p i s t s w i t h i n t h e t r e a t m e n t gymnasiums a t the W o r k e r s 1 Compensat ion Board o f B r i t i s h Co lumbia C l i n i c . Both t h e r a p i s t s were p r o f e s s i o n a l l y q u a l i f i e d and had many y e a r s e x p e r i e n c e i n p e r f o r m i n g e v a l u a t i o n s o f t h i s t y p e . S u b j e c t s were r e f e r r e d f o r p h y s i c a l e v a l u a t i o n t o the t h e r a p i s t s on an a l t e r n a t i n g b a s i s and t h e e v a l u a t i o n was c a r r i e d out f o l l o w i n g a b r i e f i n t a k e i n t e r v i e w . A l l e v a l u a t i o n s were a d m i n i s t e r e d 72 u t i l i z i n g t h e same e x e r c i s e p r o t o c o l and each s u b j e c t t o o k a p p r o x i m a t e l y 60-70 minutes t o complete the e v a l u a t i o n . R e p o r t s were a v a i l a b l e one day f o l l o w i n g c o m p l e t i o n o f the p h y s i c a l e v a l u a t i o n . F o u r q u a l i f i e d v o c a t i o n a l e v a l u a t o r s were i n v o l v e d i n t h e c o l l e c t i o n o f the p h y s i c a l c a p a c i t y i n f o r m a t i o n from t h e i n d u s t r i a l shops and were a s s i g n e d s u b j e c t s on an a l t e r n a t i n g b a s i s . The v o c a t i o n a l e v a l u a t o r s conducted t h e i n i t i a l i n t a k e i n t e r v i e w s which l a s t e d from 15-30 minutes each f o l l o w i n g the format d e s c r i b e d by P r u i t t (1986) where the purpose o f the program was d i s c u s s e d and the a p p r o p r i a t e shops and a c t i v i t i e s s e l e c t e d . F o l l o w i n g r e c e i p t o f t h e p h y s i c a l e v a l u a t i o n i n f o r m a t i o n , the e v a l u a t o r s d e s i g n e d the i n d i v i d u a l t a s k / m o d u l e programs f o r the s u b j e c t s and p r o v i d e d an o r i e n t a t i o n t o the i n d u s t r i a l shop a r e a s . T h i s p r o c e s s i n v o l v e d a p p r o x i m a t e l y 60 minutes p e r s u b j e c t . F o l l o w i n g c o n f i r m a t i o n o f the program and shop o r i e n t a t i o n , each s u b j e c t began t h e i r i n d i v i d u a l i z e d s t r u c t u r e d work day from 8.30 a .m. u n t i l 4 .00 p . m . S u b j e c t s u n d e r t o o k a s e r i e s o f p r o g r e s s i v e , t a s k - o r i e n t e d p r o j e c t s d e s i g n e d t o e v a l u a t e p h y s i c a l work c a p a c i t y based on a t a s k / m o d u l e format c o n s i s t e n t w i t h the s t r e n g t h and a c t i v i t y f a c t o r s d e s c r i b e d by the CCDO (1987). Each s u b j e c t was encouraged t o work w i t h i n t h e i r own p e r s o n a l t o l e r a n c e l e v e l s and p r o g r e s s was r e c o r d e d on a d a i l y b a s i s by the shop i n s t r u c t o r a s s i g n e d t o each shop on a t a s k a n a l y s i s s h e e t . S u b j e c t s a l t e r n a t e d between s e v e r a l d i f f e r e n t t a s k s w i t h i n a w o r k i n g day w i t h i n 73 s e v e r a l d i f f e r e n t shops w i t h i n d i v i d u a l t a s k s v a r y i n g from a one day p r o j e c t t o two weeks. On a d a i l y b a s i s d u r i n g the c o u r s e o f t h e two week e v a l u a t i o n , the e v a l u a t o r s d i s c u s s e d i n d i v i d u a l s u b j e c t per formance , rev iewed t a s k per formance i n t h e shop s e t t i n g , d i s c u s s e d s u b j e c t per formance w i t h t h e shop i n s t r u c t o r s and accommodated changes i n program r e q u i r e m e n t s as needed. They were a l s o a v a i l a b l e t o answer any q u e s t i o n s which a r o s e d u r i n g the c o u r s e o f the e v a l u a t i o n . F o l l o w i n g c o m p l e t i o n o f the program, t h e e v a l u a t o r s p r o v i d e d each s u b j e c t w i t h a v e r b a l p r o g r e s s r e p o r t d u r i n g t h e i r d i s c h a r g e i n t e r v i e w and completed an i n d i v i d u a l i z e d w r i t t e n f i n a l r e p o r t based on the o b s e r v a t i o n s o f t h e shop i n s t r u c t o r s f o r each t a s k per formed (Appendix F) . T h i s f i n a l r e p o r t was r e t u r n e d t o the r e h a b i l i t a t i o n c o n s u l t a n t w i t h i n 3-4 w o r k i n g days f o r t h e i r r e v i e w . W i t h t h i s i n f o r m a t i o n on i n d i v i d u a l work t o l e r a n c e s , the s u b j e c t then began the t a s k o f l o o k i n g f o r s u i t a b l e work w i t h i n t h e g e n e r a l t o l e r a n c e g u i d e l i n e s o u t l i n e d i n t h e r e p o r t w i t h t h e a s s i s t a n c e o f the r e h a b i l i t a t i o n c o n s u l t a n t f o r a p r e -d e t e r m i n e d p e r i o d o f s i x months. P r o g r e s s i n t h e t a s k o f l o o k i n g f o r work was m o n i t o r e d by the r e h a b i l i t a t i o n c o n s u l t a n t e v e r y two weeks. The shop i n s t r u c t o r s i n v o l v e d i n the c o l l e c t i o n o f i n d i v i d u a l t a s k performance d a t a w i t h i n t h e i n d u s t r i a l shops were q u a l i f i e d tradesmen and t r a i n e d i n t a s k d e t a i l i n g and d a t a c o l l e c t i o n . S t a n d a r d r e p o r t formats were used f o r the 74 c o l l e c t i o n o f a l l t a s k i n f o r m a t i o n (Appendix C) and were p r o v i d e d t o t h e v o c a t i o n a l e v a l u a t o r f o r i n c l u s i o n i n t h e f i n a l r e p o r t immedia te ly f o l l o w i n g c o m p l e t i o n o f the t a s k . 3 . 5 . 2 JOB SEARCH PROGRAM S u b j e c t s a s s i g n e d t o the t r e a t m e n t c o n d i t i o n i n v o l v i n g i n j u r y p l u s d i s a b i l i t y w i t h v o c a t i o n a l c o u n s e l l i n g o n l y were r e f e r r e d on a random b a s i s t o a t h r e e day j o b s e a r c h program conduc ted by a v o c a t i o n a l r e h a b i l i t a t i o n c o n s u l t a n t on a f u l l day b a s i s . R e f e r r a l t o the program was made by t h e r e h a b i l i t a t i o n c o n s u l t a n t h a n d l i n g the case u s i n g an e s t a b l i s h e d r e f e r r a l f ormat . D u r i n g the j o b s e a r c h program, s u b j e c t s were c o u n s e l l e d on the p r o c e s s o f a c t i v e l y l o o k i n g f o r work u s i n g e s t a b l i s h e d and r e c o g n i z e d t e c h n i q u e s ( A z r i n , F l o r e s and K a p l a n , 1975) c o n s i s t i n g o f j o b g o a l i d e n t i f i c a t i o n , i n t e r v i e w t e c h n i q u e s , j o b s e a r c h s t r a t e g i e s and resume w r i t i n g . F o l l o w i n g c o m p l e t i o n o f the t h r e e day program, s u b j e c t s were r e f e r r e d back t o t h e i r r e h a b i l i t a t i o n c o n s u l t a n t s t o b e g i n the t a s k o f l o o k i n g f o r work w i t h a comple ted and updated resume. P r o g r e s s was m o n i t o r e d by the r e h a b i l i t a t i o n c o n s u l t a n t i n charge o f the case d u r i n g t h e p r o c e s s o f j o b s e a r c h e v e r y two weeks f o r a p e r i o d o f s i x months o r u n t i l the s u b j e c t found employment. 75 3 . 6 SCORING 3 . 6 . 1 SUCCESS IN VOCATIONAL PLACEMENT AND TIME TO VOCATIONAL PLACEMENT F o l l o w i n g c o m p l e t i o n o f the t r e a t m e n t programs , each c o n s u l t a n t m o n i t o r e d the p r o g r e s s o f t h e i r s u b j e c t s e v e r y two weeks d u r i n g the p r o c e s s o f a c t i v e l y l o o k i n g f o r work. F o r t h o s e s u b j e c t s i n v o l v e d i n t h e j o b s e a r c h t r e a t m e n t c o n d i t i o n , the p r o c e s s o f a c t i v e l y l o o k i n g f o r work began w i t h i n 3 days o f c o m p l e t i n g the j o b s e a r c h program f o l l o w i n g r e c e i p t o f t h e i r resume. F o r t h o s e s u b j e c t s u n d e r g o i n g p h y s i c a l c a p a c i t y e v a l u a t i o n , a c t i v e j o b s e a r c h began w i t h i n 2 days o f program c o m p l e t i o n f o l l o w i n g r e c e i p t o f t h e f u n c t i o n a l i n f o r m a t i o n by the r e h a b i l i t a t i o n c o n s u l t a n t . Once t h e s u b j e c t began t o a c t i v e l y l o o k f o r work, s u c c e s s i n v o c a t i o n a l p lacement was d e f i n e d i n terms o f a c t i v e l y r e t u r n i n g t o the work f o r c e i n f u l l - t i m e employment f o r r e n u m e r a t i o n . Time t o v o c a t i o n a l p lacement was d e f i n e d as c h r o n o l o g i c a l t ime e l a p s e d u n t i l s u c c e s s f u l v o c a t i o n a l p lacement was a c h i e v e d . The p o t e n t i a l w o r k i n g days p e r month were t a b u l a t e d , e x c l u s i v e o f h o l i d a y s , and r e c o r d e d on a c u m u l a t i v e b a s i s . Those s u b j e c t s not s e c u r i n g employment w i t h i n t h e 6 month t ime p e r i o d r e c e i v e d the maximum r e c o r d e d v a l u e . The t o t a l number o f days t o employment were t a b u l a t e d f o r the two t r e a t m e n t c o n d i t i o n s and were e x p r e s s e d as an mean f i g u r e . 76 3 . 6 . 2 TYPE OF VOCATIONAL PLACEMENT The t y p e o f v o c a t i o n a l p lacement u l t i m a t e l y a c h i e v e d was d e f i n e d as e i t h e r a p p r o p r i a t e , i n a p p r o p r i a t e o r no t a p p l i c a b l e . F o r those s u b j e c t s who u l t i m a t e l y a c h i e v e d s u c c e s s f u l v o c a t i o n a l p lacement , an a p p r o p r i a t e v o c a t i o n a l p lacement was d e f i n e d as a j o b h a v i n g g e n e r a l p h y s i c a l r e q u i r e m e n t s w i t h i n the demonstrated g u i d e l i n e s i d e n t i f i e d d u r i n g p h y s i c a l c a p a c i t y assessment . In a d d i t i o n , s u b j e c t s a c h i e v i n g s u c c e s s f u l v o c a t i o n a l p lacement w i t h i n t h e s i x - m o n t h p lacement r e s t r i c t i o n were m o n i t o r e d f o r 2-4 weeks f o l l o w i n g p lacement as a f o l l o w - u p . I f they were s t i l l w o r k i n g w i t h o u t problem w i t h i n t h i s f o l l o w - u p t i m e - f r a m e , i t was c o n s i d e r e d t h a t a p p r o p r i a t e v o c a t i o n a l p lacement had been a c h i e v e d . I n a p p r o p r i a t e v o c a t i o n a l p lacement was d e f i n e d as s u c c e s s f u l l y s e c u r i n g a j o b t h a t was w i t h i n a s u b j e c t ' s demonstrated c a p a c i t y f o l l o w i n g PCA but w i t h o u t s u c c e s s f u l l o n g - t e r m v o c a t i o n a l p lacement a f t e r the 2-4 week f o l l o w - u p . These f a i l u r e s o r i n a p p r o p r i a t e v o c a t i o n a l p lacements were u s u a l l y due t o t h e p a t i e n t ' s i n a b i l i t y t o t o l e r a t e some s p e c i f i c a s p e c t o f the p h y s i c a l demands o f t h e j o b r e s u l t i n g i n a l a y - o f f due t o i n c r e a s e d symptomatic d i s c o m f o r t o r p h y s i c a l i n c o m p a t i b i l i t y . V o c a t i o n a l p lacement t h a t was n o t - a p p l i c a b l e was r e c o r d e d f o r those p a t i e n t s who were u n s u c c e s s f u l i n a c h i e v i n g v o c a t i o n a l p lacement w i t h i n the s i x - m o n t h 77 t i m e - f r a m e . 3 . 6 . 3 S E L F - E S T E E M I n f o r m a t i o n r e l e v a n t t o f e e l i n g s o f s e l f esteem was measured f o r a l l s u b j e c t s (N=50) i n b o t h t r e a t m e n t c o n d i t i o n s by the Coopersmi th S e l f - E s t e e m I n v e n t o r y ( C o o p e r s m i t h , 1965) p r i o r t o the b e g i n n i n g o f t h e program and f o l l o w i n g c o m p l e t i o n o f the t r e a t m e n t c o n d i t i o n . I t was c o n s i d e r e d c r i t i c a l t o t h e i m p l e m e n t a t i o n o f v o c a t i o n a l c o u n s e l l i n g t e c h n i q u e s t o a s se s s how s u b j e c t s v iewed themse lves w i t h i n the g r e a t e r c o n t e x t o f the two t r e a t m e n t p r o c e s s e s and how t h e s e f e e l i n g s c a r r i e d over i n t o t h e t a s k o f l o o k i n g f o r work. F o r the purpose o f t h i s s t u d y , h i g h s e l f - e s t e e m was t a k e n t o mean t h a t the i n d i v i d u a l had s e l f - r e s p e c t and c o n s i d e r e d h i m / h e r s e l f wor thy . Low s e l f - e s t e e m i m p l i e d r e j e c t i o n , s e l f - d i s s a t i s f a c t i o n and s e l f - c o n t e m p t . The i n v e n t o r y c o n s i s t e d o f 25 i tems answered on a m o d i f i e d f i v e - p o i n t Guttman s c a l e from "always l i k e me" t o "never l i k e me" (Appendix G ) . Responses were t r e a t e d as s c o r e s . 3 . 7 . QUALITATIVE DESCRIPTION OF UNEMPLOYMENT EXPERIENCE In a d d i t i o n t o the Coopersmi th S e l f - E s t e e m I n v e n t o r y d a t a , each s u b j e c t was i n t e r v i e w e d f o r an average o f 60 minutes by t h e r e h a b i l i t a t i o n c o n s u l t a n t h a n d l i n g t h e i r case u s i n g a s t r u c t u r e d i n t e r v i e w format s i m i l a r t o t h a t used by Borgen and Amundson (1984). T h i s approach was d e s i g n e d t o c o l l e c t i n f o r m a t i o n i n the major a r e a o f l i f e e x p e r i e n c e i n 78 r e l a t i o n t o f a c t o r s t h a t change w i t h unemployment. T h i s i n f o r m a t i o n was c o l l e c t e d i n p r e - p r o g r a m and p o s t - p r o g r a m i n t e r v i e w s by the r e h a b i l i t a t i o n c o n s u l t a n t h a n d l i n g the p a r t i c u l a r c a s e . The i n t e r v i e w s t y l e was open-ended and n o n - d i r e c t i v e and was d e s i g n e d t o c o l l e c t i n f o r m a t i o n on i n d i v i d u a l e x p e r i e n c e s i n the a r e a s o f community ( s u p p o r t from f a m i l y , f r i e n d s ) , meaning o f l i f e (purpose and c o n t r i b u t i o n ) , l i f e s t r u c t u r e ( r o u t i n e and o r g a n i z a t i o n ) and f i n a n c e ( s e c u r i t y ) . F o l l o w i n g c o l l e c t i o n and s o r t i n g , t h e i n t e r v i e w i n f o r m a t i o n was d i s c u s s e d w i t h the c o n s u l t a n t s f o r g e n e r a l a c c u r a c y and a u t h e n t i c i t y . F o l l o w i n g a rev i ew o f the p r e - p r o g r a m i n t e r v i e w i n f o r m a t i o n , the 50 e x p e r i e n c e s were compared w i t h each o t h e r and s i m i l a r i n c i d e n t s o r t r e n d s were s o r t e d by t h e p r i n c i p a l i n v e s t i g a t o r i n t o g e n e r a l c a t e g o r i e s based on the s u p p o r t , meaning, s t r u c t u r e and s e c u r i t y h e a d i n g s . The p o s t - p r o g r a m i n t e r v i e w was c a r r i e d out f o r a l l s u b j e c t s t o d e t e r m i n e i f any changes had t a k e n p l a c e i n r e l a t i o n t o the l i f e e x p e r i e n c e f a c t o r s and t o de termine what had c o n t r i b u t e d t o the change. P o s i t i v e h i g h p o i n t s and n e g a t i v e low p o i n t s were noted as w e l l as c r i t i c a l i n c i d e n t s t h a t may have i n f l u e n c e d , o r p e r p e t u a t e d change, were r e c o r d e d f o r each s u b j e c t . S o r t i n g o f the i n c i d e n t s i n t o t h e 4 sugges ted c a t e g o r i e s was c o n f i r m e d w i t h a sample o f s i x r e h a b i l i t a t i o n c o n s u l t a n t s w i t h 85% r e l i a b i l i t y . A l i f e l i n e was c o n s t r u c t e d f o r each s u b j e c t n o t i n g the t ime s e q u e n c i n g o f events throughout the program and how 79 t h e s e event s impacted and a f f e c t e d o v e r a l l f e e l i n g s o f s e l f - e s t e e m . L i f e l i n e s were s o r t e d i n t o 4 major c a t e g o r i e s w i t h a v e r b a l d e s c r i p t i o n and v i s u a l o u t l i n e based on common f a c t o r s i n c l u d i n g c u r v e c h a r a c t e r i s t i c s , s i m i l a r i n t e r v i e w response g r o u p i n g s and p o s t - p r o g r a m esteem s c o r e s . An 88% r e l i a b i l i t y r a t i n g was a c h i e v e d f o l l o w i n g r e v i e w by a p a n e l o f s i x r e h a b i l i t a t i o n c o n s u l t a n t s on the 4 l i f e l i n e c a t e g o r i e s . 3 .8 DATA ANALYSIS 3 . 8 . 1 STATISTICAL PROCEDURES S t a t i s t i c a l a n a l y s i s o f the d a t a was done i n two phases u s i n g t h e L e r t a p 3 P / C V e r s i o n 2.31 (1987 Update) f o r t a b u l a t i o n o f t h e s e l f - e s t e e m d a t a and the S t a t i s t i c a l Package f o r t h e S o c i a l S c i e n c e s V e r s i o n X 3.0 (SPSS, 1988) . The computer used was an IBM 3090 m a i n t a i n e d by t h e Workers ' Compensat ion Board Computing C e n t r e . C h i - s g u a r e and a m u l t i - v a r i a t e a n a l y s i s o f v a r i a n c e (ANOVA) f o r t h e main e f f e c t o f the d i f f e r e n c e between t r e a t m e n t groups (N=50) u s i n g a mixed model ANOVA were a n a l y z e d t o y i e l d the r e s u l t s p r o v i d e d i n T a b l e s I - V I I . The s t a t i s t i c a l s i g n i f i c a n c e ( p r o b a b i l i t y o f t y p e 1 e r r o r ) was d e t e r m i n e d f o r each independent v a r i a b l e and f o r each i n t e r a c t i o n . The F i s c h e r t s t a t i s t i c was t h e n employed as a p o s t - h o c a n a l y s i s t o de termine the l o c i o f s i g n i f i c a n t d i f f e r e n c e s found i n main and i n t e r a c t i o n e f f e c t s . 80 Chapter IV RESULTS The purpose of t h i s study was two-fold. The i n i t i a l objective was the development of an i n d u s t r i a l l y - o r i e n t e d assessment format for the evaluation of i n d i v i d u a l capacity to perform work. Following development and implementation of the evaluation program, the second purpose was to evaluate the e f f i c a c y of the physical capacity assessment program on vocational placement. Based on a review of the l i t e r a t u r e , f i v e hypotheses were formulated s t a t i n g main e f f e c t s and interactions of age, injury type and degree of d i s a b i l i t y . Summaries of the demographic c h a r a c t e r i s t i c s of subjects can be found i n Appendix H. As the d i s t r i b u t i o n of the v a r i a b l e time to vocational placement (TIME2VP) was skewed p o s i t i v e l y to the ri g h t , the natural log of the values was used to normalize the data i n order to make ANOVA an appropriate s t a t i s t i c a l procedure. The r e s u l t s of i n f e r e n t i a l s t a t i s t i c a l t e sts of the hypotheses are as follows; 81 4 .1 STATISTICAL ANALYSES H y p o t h e s i s 1: S u b j e c t s who r e c e i v e p h y s i c a l c a p a c i t y assessment (PCA) i n a d d i t i o n t o v o c a t i o n a l c o u n s e l l i n g w i l l e x p e r i e n c e more f r e q u e n t succes s i n v o c a t i o n a l p lacement (VPSUCCES), i n a s h o r t e r p e r i o d o f t ime (TIME2VP) and w i t h a b e t t e r v o c a t i o n a l match (TYPVP) t h a n those who do n o t . C o n t i n g e n c y t a b l e (2 X 2) and C h i - s q u a r e a n a l y s i s r e v e a l e d a s i g n i f i c a n t main e f f e c t f o r group t y p e (GRPTYPE) a t the .005 l e v e l f o r succes s i n v o c a t i o n a l p lacement (VPSUCCES) w i t h t h e p h y s i c a l c a p a c i t y assessment (PCA) group mean e x c e e d i n g t h a t o f the j o b s e a r c h (JS) group ( T a b l e I ) . Of t h e 25 s u b j e c t s i n the PCA g r o u p , 18/25 o r 72% were s u c c e s s f u l l y p l a c e d w i t h i n 6 months v e r s u s 7/25 o r 28% f o r t h e JS g r o u p . C h i - s q u a r e a n a l y s i s o f t h e e f f e c t o f v o c a t i o n a l match between groups (TYPVP) f a i l e d t o a c h i e v e s t a t i s t i c a l s i g n i f i c a n c e . A n a l y s i s o f v a r i a n c e r e s u l t s f o r t ime t o v o c a t i o n a l p lacement (TIME2VP) u s i n g the n a t u r a l l o g t r a n s f o r m a t i o n o f c u m u l a t i v e t o t a l t ime (days) r e v e a l e d t h a t the e f f e c t o f group t y p e f a i l e d t o a c h i e v e s t a t i s t i c a l s i g n i f i c a n c e . The f i r s t h y p o t h e s i s was, t h e r e f o r e , o n l y p a r t i a l l y s u p p o r t e d . G i v e n t h i s s i g n i f i c a n t main e f f e c t f o r t h e dependent v a r i a b l e f o r succes s i n v o c a t i o n a l p lacement o f p=.005, t h e e f f e c t o f group t y p e on VPSUCCES w a r r a n t s f u r t h e r d i s c u s s i o n . 82 T a b l e I - C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) GROUPTYPE VPSUCCES COUNT 1 2 1 7 18 2 18 7 COLUMN 25 25 TOTAL 50.0 50.0 ROW TOTAL 25 50.0 25 50.0 CHI-SQUARE 8.00000 D . F . 1 SIGNIFICANCE MIN E . F . 0.0047 12.500 VPSUCCESS: 1=SUCCESSFUL 2=UNSUCCESSFUL GROUPTYPE: l=JOB SEARCH 2=PHYSICAL CAPACITY ASSESSMENT H y p o t h e s i s 2: S u b j e c t s who r e c e i v e p h y s i c a l c a p a c i t y assessment (PCA) i n a d d i t i o n t o v o c a t i o n a l c o u n s e l l i n g w i l l show a g r e a t e r o v e r a l l i n c r e a s e i n measures o f s e l f - e s t e e m . T a b l e I I shows the LERTAP a n a l y s i s o f the raw p r e / p o s t - program s e l f - e s t e e m s c o r e s f o r b o t h groups i n c l u d i n g means, s t a n d a r d d e v i a t i o n s , v a r i a n c e and Cronbach a l p h a i n t e r n a l c o n s i s t e n c y s c o r e s . Both groups i n c r e a s e d t h e i r s e l f - e s t e e m s c o r e s d u r i n g the c o u r s e o f t h e program 83 w i t h some s l i g h t v a r i a t i o n s between g r o u p s . S u b j e c t s i n the j o b s e a r c h (JS) group were found t o have lower p r e - p r o g r a m s e l f - e s t e e m mean s c o r e s compared t o the p h y s i c a l c a p a c i t y assessment (PCA) group (87.72 v s 92.68) and h i g h e r p o s t -program s e l f - e s t e e m v a l u e s (96.08 v s 9 5 . 9 6 ) . ANOVA r e s u l t s r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s between groups f o r p r e -program, p o s t - program o r f o r changes i n s e l f - e s t e e m s c o r e s . The second h y p o t h e s i s was not s u p p o r t e d . T a b l e I I - LERTAP Means, S t a n d a r d D e v i a t i o n s , V a r i a n c e , Cronbach a l p h a and c o r r e l a t i o n o f s e l f - e s t e e m s c o r e s N = 50 V a r i a b l e Mean S . D . V a r i a n c e Cronbach a l p h a C o r r e l a t i o n P r e - t e s t 90.20 11.92 142.122 .777 .210 P o s t - t e s t 96.02 11.64 135.367 .819 .005 H y p o t h e s i s 3: There w i l l not be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between t h e t y p e o f i n j u r y a s u b j e c t has and the dependent v a r i a b l e s o f succes s i n v o c a t i o n a l p lacement , t ime t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r t h o s e s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . C o n t i n g e n c y t a b l e (2 X 3) and C h i - s q u a r e a n a l y s i s f a i l e d t o a c h i e v e a s i g n i f i c a n t between groups e f f e c t f o r i n j u r y t y p e on the dependent v a r i a b l e s o f s u c c e s s i n v o c a t i o n a l p lacement and t y p e o f v o c a t i o n a l p lacement 84 a c h i e v e d . ANOVA f o r the e f f e c t o f i n j u r y t y p e on t ime t o v o c a t i o n a l p lacement d i d not r e v e a l any s i g n i f i c a n t d i f f e r e n c e s between g r o u p s . ANOVA f o r the e f f e c t o f i n j u r y t y p e on s e l f - e s t e e m s c o r e s d i d not r e v e a l any s i g n i f i c a n t d i f f e r e n c e s between g r o u p s . C r o s s - t a b u l a t i o n o f succes s i n v o c a t i o n a l p lacement c o n t r o l l i n g f o r i n j u r y t y p e d i d , however r e v e a l a s i g n i f i c a n t i n t e r a c t i o n w i t h group t y p e (p < .05) f o r t h o s e s u b j e c t s w i t h i n j u r i e s t o the upper body (Tab le I I I ) . The t h i r d h y p o t h e s i s was p a r t i a l l y s u p p o r t e d . T h i s e f f e c t w a r r a n t s f u r t h e r d i s c u s s i o n . T a b l e I I I - C r o s s t a b u l a t i o n T a b l e and C h i - s g u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r I n j u r y Type (INJTYPE) f o r i n j u r i e s t o t h e upper body GROUPTYPE VPSUCCES COUNT 1 2 1 3 10 2 7 2 COLUMN 10 12 TOTAL 45.5 54.5 ROW TOTAL 13 59 .1 9 40.9 CHI-SQUARE 4.40157 D . F . 1 SIGNIFICANCE MIN E . F . 0.0359 4.091 85 H y p o t h e s i s 4: There w i l l not be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between t h e degree o f d i s a b i l i t y a s u b j e c t has and t h e dependent v a r i a b l e s o f succes s i n v o c a t i o n a l p lacement , t ime t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r those s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . C o n t i n g e n c y t a b l e (2 X 2) and C h i - s q u a r e a n a l y s i s d i d no t r e v e a l a s i g n i f i c a n t d i f f e r e n c e between groups e f f e c t o f degree o f d i s a b i l i t y on the dependent v a r i a b l e o f s u c c e s s i n v o c a t i o n a l p lacement o r t y p e o f v o c a t i o n a l p lacement . A n a l y s i s o f v a r i a n c e r e s u l t s r e v e a l e d t h a t degree o f d i s a b i l i t y was no t s i g n i f i c a n t i n i t s e f f e c t between groups on t ime t o v o c a t i o n a l p lacement o r s e l f - e s t e e m s c o r e s . C r o s s t a b u l a t i o n o f succes s i n v o c a t i o n a l p lacement by group t y p e c o n t r o l l i n g f o r degree o f d i s a b i l i t y d i d r e v e a l a s i g n i f i c a n t C h i - s q u a r e v a l u e (p = .01) i n d i c a t i n g a r e l a t i o n s h i p w i t h group t y p e f o r t h o s e s u b j e c t s w i t h d i s a b i l i t i e s l e s s t h a n 5% (Tab le I V ) . The f o u r t h h y p o t h e s i s was p a r t i a l l y s u p p o r t e d and w a r r a n t s f u r t h e r d i s c u s s i o n . 86 T a b l e IV - C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r Degree o f D i s a b i l i t y (DISABGP) l e s s t h a n o r e q u a l t o 5%. GROUPTYPE VPSUCCES COUNT 1 2 1 4 9 2 11 2 COLUMN 15 11 TOTAL 57.7 42.3 ROW TOTAL 13 50.0 13 50.0 CHI-SQUARE 5.67273 D . F . 1 SIGNIFICANCE MIN E . F . 0.0172 5.500 H y p o t h e s i s 5: There w i l l not be a s i g n i f i c a n t t r a i t / t r e a t m e n t i n t e r a c t i o n between a s u b j e c t ' s age and the dependent v a r i a b l e s o f succes s i n v o c a t i o n a l p lacement , t ime t o v o c a t i o n a l p lacement , t y p e o f v o c a t i o n a l p lacement and s e l f - e s t e e m f o r t h o s e s u b j e c t s who undergo p h y s i c a l c a p a c i t y assessment (PCA) . C o n t i n g e n c y t a b l e (2 X 2) and C h i - s g u a r e a n a l y s i s d i d no t r e v e a l a s i g n i f i c a n t between groups e f f e c t o f age on the dependent v a r i a b l e o f t y p e o f v o c a t i o n a l p l a c e m e n t . C r o s s t a b u l a t i o n o f succes s i n v o c a t i o n a l p lacement by group t y p e c o n t r o l l i n g f o r age group d i d show a s i g n i f i c a n t C h i - s q u a r e v a l u e (p < .05) (Tab le V ) . A n a l y s i s o f v a r i a n c e r e s u l t s c o n f i r m e d a 2-way i n t e r a c t i o n between group t y p e and 87 age on t ime t o v o c a t i o n a l p lacement . The d i f f e r e n c e , however, was not s t a t i s t i c a l l y s i g n i f i c a n t (p = . 0 6 ) . A n a l y s i s o f v a r i a n c e r e s u l t s d i d not r e v e a l t h a t age was s i g n i f i c a n t between groups i n i t s e f f e c t on s e l f - e s t e e m s c o r e s . The f i f t h h y p o t h e s i s was p a r t i a l l y s u p p o r t e d and does w a r r a n t f u r t h e r d i s c u s s i o n . T a b l e V - C r o s s t a b u l a t i o n T a b l e and C h i - s q u a r e A n a l y s i s o f Success i n V o c a t i o n a l Placement (VPSUCCES) by Group Type (GRPTYPE) c o n t r o l l i n g f o r Age Group (AGEGP) f o r s u b j e c t s g r e a t e r t h a n o r e q u a l t o 30 y e a r s o f age GROUPTYPE VPSUCCES COUNT 1 2 1 3 11 2 8 4 COLUMN 11 15 TOTAL 42.3 57.7 ROW TOTAL 14 53.8 12 46.2 CHI-SQUARE 3.72273 D . F . 1 SIGNIFICANCE 0.0537 MIN E . F . 5.077 88 4.2 INDIVIDUAL DIFFERENCES I n the second p a r t o f t h i s c h a p t e r , i n f e r e n t i a l s t a t i s t i c a l t e c h n i q u e s (ANOVA) a r e used t o r e l a t e s e l e c t b i o d e m o g r a p h i c a l d a t a and moderator v a r i a b l e s t o the outcome v a r i a b l e s and t o the d i f f e r e n c e between g r o u p s . The purpose o f t h i s a n a l y s i s was t o de termine which o f t h e s e f a c t o r s a f f e c t e d the dependent v a r i a b l e s and t o d e t e r m i n e t h e e x t e n t and i n f l u e n c e o f any i n t e r a c t i o n s . Of t h e v a r i a b l e s i n v e s t i g a t e d , m a r i t a l s t a t u s and t i m e - l o s s were found t o be s i g n i f i c a n t l y r e l a t e d t o t ime t o v o c a t i o n a l p lacement (TIME2VP) and t o group (GRPTYPE). Appendix H l i s t s t h e b iodemographic d a t a and moderator v a r i a b l e s t h a t were examined. The average t ime i n m e d i c a l t r e a t m e n t was 245 d a y s . The average l e v e l o f e d u c a t i o n was Grade 11. Of the e n t i r e sample , N=42 o r 84% spoke E n g l i s h as a f i r s t l anguage; N=8 o r 16% spoke E n g l i s h as a second language ; N=18 o r 36% were s i n g l e and N=32 o r 64% were m a r r i e d . O t h e r f a c t o r s i n v e s t i g a t e d were the d i f f e r e n c e i n p r e - i n j u r y s a l a r y and p o s t - i n j u r y s a l a r y f o r t h o s e who a c h i e v e d s u c c e s s f u l v o c a t i o n a l p lacement and t h e e f f e c t o f r e h a b i l i t a t i o n c o n s u l t a n t . M a r i t a l s t a t u s as a d i s c r e e t v a r i a b l e was d i v i d e d i n t o two g r o u p s ; s i n g l e and m a r r i e d . A two way A n a l y s i s o f V a r i a n c e w i t h l o g n o f t ime t o v o c a t i o n a l p lacement (LTIME2VP) as the dependent v a r i a b l e r e v e a l e d a s i g n i f i c a n t r e l a t i o n s h i p between m a r i t a l s t a t u s and l o g n o f t ime t o v o c a t i o n a l p lacement (p = .01) and group t y p e (p = . 0 5 ) . 89 T h e r e was a l s o a s i g n i f i c a n t 2-way i n t e r a c t i o n between group t y p e and m a r i t a l s t a t u s (p = .05) (Tab le V I ) . T h i s r e l a t i o n s h i p i n d i c a t e d o v e r a l l t h a t s i n g l e s u b j e c t s t ended t o be p l a c e d f a s t e r t h a n m a r r i e d s u b j e c t s and t h a t t h i s t r e n d was c o n s i s t e n t f o r those s u b j e c t s i n the PCA group compared t o t h o s e s u b j e c t s i n the j o b s e a r c h g r o u p . Time l o s s as a c o n t i n u o u s v a r i a b l e showed a s i g n i f i c a n t r e l a t i o n s h i p t o t ime t o v o c a t i o n a l p lacement (p = .05) f o l l o w i n g a n a l y s i s o f v a r i a n c e (Tab le V I I ) . As a g e n e r a l i n d i c a t o r , s u b j e c t s w i t h l e s s t ime l o s s from t h e t ime t h e y were i n j u r e d t o t h e t ime they began the program were p l a c e d f a s t e r t h a n t h o s e s u b j e c t s w i t h more t ime l o s s . No e f f e c t f o r group was f o u n d . These were the o n l y two v a r i a b l e s examined t h a t had a s i g n i f i c a n t r e l a t i o n s h i p w i t h t h e dependent v a r i a b l e s . T a b l e VI - Summary o f 2-way A n a l y s i s o f V a r i a n c e o f LTIME2VP by GRPTYPE by MARITAL STATUS Source o f V a r i a t i o n d f Mean F P r o b a b i l i t y (a) Square GRPTYPE 1 5. .976 6. . 183 .021 MARITAL 1 8. .625 8. .923 .007 INTERACTION 1 5. .788 5. .988 .023 GRPTYPE X MARITAL STATUS 90 T a b l e V I I - Summary o f 2-way A n a l y s i s o f V a r i a n c e o f LTIME2VP by GRPTYPE by TMLOSSGP Source o f V a r i a t i o n d f Mean Square F P r o b a b i l i t y (a) GRPTYPE TMLOSSGP 1 1 3.851 7.618 3.214 6.357 .087 .020 INTERACTION GRPTYPE X TMLOSSGP 1 1 1.928 1.928 1.609 1.609 .218 .218 4.3 INTERVIEW INFORMATION AND L I F E L I N E PATTERNS P r e - p r o g r a m i n t e r v i e w i n f o r m a t i o n c o l l e c t e d by t h e r e h a b i l i t a t i o n c o n s u l t a n t s was t r a n s c r i b e d and summarized. These summarized t r a n s c r i p t s were t h e n t r a n s f e r r e d t o r a t i n g shee t s which emphasized g e n e r a l c h a r a c t e r i s t i c s o f t h e s u b j e c t s unemployment e x p e r i e n c e from the d a t e o f i n j u r y t o t h e d a t e o f i n t a k e i n t o the program. Responses were grouped f o l l o w i n g t h e g e n e r a l c a t e g o r i e s o f community ( suppor t from f a m i l y , f r i e n d s ) , meaning o f l i f e (purpose and c o n t r i b u t i o n ) , l i f e s t r u c t u r e ( r o u t i n e , o r g a n i z a t i o n ) and f i n a n c e ( s e c u r i t y ) . S i m i l a r s t o r i e s f o r the 50 s u b j e c t s were grouped t o g e t h e r based on i n t e r v i e w re sponses and were c r o s s - r e f e r e n c e d w i t h l i f e l i n e g r o u p i n g s . F o u r p a t t e r n s (A -D) o f the in jury /unemployment e x p e r i e n c e emerged which mapped i n d i v i d u a l e m o t i o n a l re sponses over t i m e . 91 Group A Group A ( F i g u r e 1) was composed o f 9 p e o p l e : 4 back i n j u r i e s ; one c r u s h e d hand; one e l e c t r o c u t i o n w i t h burns t o t h e f e e t and hands; one m u l t i p l e c l a s s i n j u r y w i t h h i p and knee i n j u r i e s from an MVA; one r o t a t o r c u f f t e a r t o t h e s h o u l d e r and one knee i n j u r y . On ly one s u b j e c t had a t tempted t o r e t u r n t o work s i n c e the i n j u r y w i t h o u t s u c c e s s . A l l s u b j e c t s had e x p e r i e n c e d an i n i t i a l n e g a t i v e r e a c t i o n t o the i n j u r y and had c o n s i s t e n t l y r e p o r t e d n e g a t i v e f e e l i n g s o f e m o t i o n a l b e h a v i o r from d a t e o f i n j u r y t o d a t e o f i n t a k e i n t o the program w i t h some minor f l u c t u a t i o n s . A l l s u b j e c t s had e x p e r i e n c e d s i g n i f i c a n t p h y s i c a l p a i n a t the t ime o f i n j u r y and one s u b j e c t had gone t h r o u g h a d e a t h e x p e r i e n c e . Throughout the r e c o v e r y p e r i o d , a l l s u b j e c t s remained r e a s o n a b l y o p t i m i s t i c r e g a r d i n g t h e i r v o c a t i o n a l o u t l p o k d e s p i t e v a r y i n g degrees o f v o c a t i o n a l c o u n s e l l i n g . A l l s u b j e c t s a d m i t t e d t o b e i n g s l i g h t l y below t h e i r u s u a l l e v e l s o f s e l f - e s t e e m o r opt imism b u t were l o o k i n g forward t o the upcoming programs w i t h a p o s i t i v e o u t l o o k . C o m p o s i t i o n by t rea tment group was t h r e e PCA, s i x J S . 92 (+) E M O T I O N A D E C (") B Time F i g u r e 1 - Group A : L i f e l i n e P r o f i l e A . I n i t i a l r e a c t i o n t o a c c i d e n t / i n j u r y (worry , anger) B . M e d i c a l r e c o v e r y phase ( a n x i o u s , f r u s t r a t e d , hope) C . A c c e p t a n c e o f a c c i d e n t / l o s s ( s t a b l e , encouraged) D. A n t i c i p a t i o n o f j o b s e a r c h o r p h y s i c a l c a p a c i t y assessment ( d o u b t f u l , h o p e f u l , encouraged) E . L i f e l i n e c o m p l e t i o n p r i o r t o program s t a r t Group B ( F i g u r e 2) was composed o f 7 p e o p l e : 3 hand i n j u r i e s i n c l u d i n g an a m p u t a t i o n , l a c e r a t i o n (saw cut ) and b i - l a t e r a l w r i s t t e n d o n i t i s ; one f r a c t u r e d t i b i a / f i b u l a ; one r o t a t o r c u f f t e a r t o the s h o u l d e r ; one back and one elbow i n j u r y . None o f the s u b j e c t s had r e t u r n e d t o work s i n c e t h e i r i n j u r y . A l l had e x p e r i e n c e d an i n i t i a l n e g a t i v e r e a c t i o n t o the i n j u r y f o l l o w e d by a s t e a d y , n e g a t i v e e m o t i o n a l d e c l i n e . None o f the s u b j e c t s i n t h i s group had come t o terms w i t h t h e i r d i s a b i l i t y from an e m o t i o n a l p e r s p e c t i v e and , i n a d d i t i o n , had e x p e r i e n c e d some d i f f i c u l t y w i t h t h e acceptance o f t h e i r c l a i m . S e v e r a l o f Group B 93 t h e s u b j e c t s i n t h i s group had e x p e r i e n c e d m a r i t a l problems s i n c e t h e i r i n j u r y which had impacted s i g n i f i c a n t l y on t h e i r e m o t i o n a l s u p p o r t s t r u c t u r e . One o f t h e s u b j e c t s had l o s t h i s w i f e t o c a n c e r s i n c e h i s i n j u r y and was r a i s i n g h i s two c h i l d r e n a l o n e . Two o f the s u b j e c t s had e x p e r i e n c e d deaths o f f a t h e r s o r mothers and one s u b j e c t had l o s t h i s c h i l d a t b i r t h . A l l s u b j e c t s were e x p e r i e n c i n g worry and a n x i e t y r e g a r d i n g t h e i r v o c a t i o n a l f u t u r e s d e s p i t e v a r y i n g degrees o f v o c a t i o n a l c o u n s e l l i n g and were not o p t i m i s t i c r e g a r d i n g f u t u r e p r o s p e c t s . Group c o m p o s i t i o n was s i x PCA, one J S . 94 (+) E M O T I O N A G (") C B D E F Time F i g u r e 2 - Group B: L i f e l i n e P r o f i l e A . I n i t i a l r e a c t i o n t o a c c i d e n t / i n j u r y (worry , anger) B . M e d i c a l r e c o v e r y phase ( a n x i o u s , f r u s t r a t e d , f e a r ) C . S i g n i f i c a n t l i f e event ( emot iona l u p l i f t ) D. R e f l e c t i o n upon l o s s ( d i s c o u r a g e d , u n c e r t a i n ) E . I n s u l a t i o n from j o b s e a r c h ( a p a t h e t i c ) F . I n t e r n a l i z a t i o n o f r e j e c t i o n ( d e s p a i r , u s e l e s s n e s s ) G . L i f e l i n e c o m p l e t i o n p r i o r t o program s t a r t Group C ( F i g u r e 3) was composed o f 19 p e o p l e : 4 back i n j u r i e s ; 5 knee i n j u r i e s ; 3 s h o u l d e r i n j u r i e s ; one elbow i n j u r y ; one w r i s t i n j u r y ; one b i l a t e r a l f r a c t u r e d os c a l c i s ; one c r u s h amputa t ion t o f i n g e r s on the r i g h t hand; one saw c u t t o t h e l e g ; one an imal b i t e t o the t h i g h and one b u r n t o t h e arm. None o f the s u b j e c t s had r e t u r n e d t o work s i n c e t h e i n j u r y . A l l s u b j e c t s but one had e x p e r i e n c e d an i n i t i a l n e g a t i v e r e a c t i o n t o the i n j u r y and had e n c o u n t e r e d minor day t o day e m o t i o n a l f l u c t u a t i o n s . D e s p i t e some v e r y s e r i o u s and l i f e - t h r e a t e n i n g i n j u r i e s (amputat ion i n j u r y and f r a c t u r e s t o the f e e t ) , none o f the s u b j e c t s i n t h i s Group C 95 c a t e g o r y were o v e r l y concerned r e g a r d i n g t h e i r v o c a t i o n a l f u t u r e and most were c o n f i d e n t about r e t u r n i n g t o work. A l l had r e t u r n e d t o an e m o t i o n a l and s e l f - e s t e e m l e v e l c l o s e t o t h e i r p r e - a c c i d e n t l e v e l and f e l t t h a t i t was s i m p l y a m a t t e r o f t ime b e f o r e they got back t o work. Group c o m p o s i t i o n was 12 PCA, 7 J S . (+) E M 0 T I 0 N (-) B Time F i g u r e 3 - Group C: L i f e l i n e P r o f i l e A . I n i t i a l r e a c t i o n t o a c c i d e n t / i n j u r y (worry , anger) B . M e d i c a l r e c o v e r y phase ( a n x i o u s , f r u s t r a t e d , hope) C . Ongoing m e d i c a l e m e r g e n c i e s / s u r g e r y / r e c o v e r y (hope, anger , f r u s t r a t i o n , e m o t i o n a l r o l l e r c o a s t e r ) D. A n t i c i p a t i o n o f gob s e a r c h ( h o p e f u l , encouraged) E . L i f e l i n e c o m p l e t i o n p r i o r t o program s t a r t 96 Group D Group D ( F i g u r e 4) was composed o f 10 p e o p l e : 3 back i n j u r i e s ; 2 s h o u l d e r i n j u r i e s ; 2 knee i n j u r i e s ; 2 hand i n j u r i e s i n c l u d i n g an amputat ion and one f r a c t u r e d f o o t . None o f the s u b j e c t s had r e t u r n e d t o work s i n c e t h e i n j u r y . D e s p i t e e x p e r i e n c i n g an i n i t i a l n e g a t i v e r e a c t i o n t o t h e i n j u r y , a l l had r e c o v e r e d t o a e m o t i o n a l l e v e l e x c e e d i n g the p r e - i n j u r y l e v e l and had m a i n t a i n e d an o p t i m i s t i c and p o s i t i v e o u t l o o k f o r the upcoming program. Most o f t h e s u b j e c t s i n t h i s group expres sed s a t i s f a c t i o n w i t h t h e i r r e h a b i l i t a t i o n c o n s u l t a n t , w i t h t h e i r m e d i c a l t r e a t m e n t and w i t h t h e i r exposure t o the WCB p r o c e s s . N e a r l y a l l o f these s u b j e c t s d e s c r i b e d a good f a m i l y s u p p o r t s t r u c t u r e and a s t r o n g m a r r i a g e as c o n t r i b u t i n g f a c t o r s t o t h e i r p o s i t i v e o u t l o o k . Group c o m p o s i t i o n was seven PCA, t h r e e J S . 97 B C Time F i g u r e 4 - Group D: L i f e l i n e P r o f i l e A . I n i t i a l r e a c t i o n t o a c c i d e n t / i n j u r y (worry , anger) B . M e d i c a l r e c o v e r y phase ( a n x i o u s , f r u s t r a t e d , hope) C . A c c e p t a n c e o f l o s s and a n t i c i p a t i o n o f j o b s e a r c h ( h o p e f u l , determined) D. S u p p o r t / m a i n t e n a n c e / l e v e l l i n g / s t a b i l i z a t i o n E . A n t i c i p a t i o n o f j o b s e a r c h o r p h y s i c a l c a p a c i t y assessment ( h o p e f u l , encouraged) F . L i f e l i n e c o m p l e t i o n p r i o r t o program s t a r t 98 4.4 SUMMARY OF FINDINGS I n t h e p r e s e n t c h a p t e r , the r e s u l t s o f s u b j e c t s ' s u c c e s s i n a c h i e v i n g v o c a t i o n a l p lacement as w e l l as f e e l i n g s o f s e l f - e s t e e m under two t r e a t m e n t c o n d i t i o n s were a n a l y z e d . C h i - s q u a r e a n a l y s i s showed s u c c e s s i n v o c a t i o n a l p lacement (VPSUCCES) t o be the o n l y s i g n i f i c a n t main e f f e c t f o r t h e d i f f e r e n c e between groups w i t h the s u b j e c t s i n v o l v e d i n p h y s i c a l c a p a c i t y assessment (PCA) b e i n g s u c c e s s f u l l y p l a c e d more f r e q u e n t l y t h a n those i n the j o b s e a r c h program (JS) . E f f e c t s o f group t y p e (GRPTYP) on t y p e o f v o c a t i o n a l p lacement (TYPVP) and t ime t o v o c a t i o n a l p lacement (TIME2VP) were no t f o u n d . There was a s i g n i f i c a n t e f f e c t o f age on s u c c e s s i n v o c a t i o n a l p lacement between groups i n d i c a t i n g t h a t o l d e r s u b j e c t s ( > 30 years ) were s u c c e s s f u l l y p l a c e d more f r e q u e n t l y t h a n younger s u b j e c t s ( < 30 y e a r s ) . T h i s t r e n d was c o n s i s t e n t between groups w i t h the PCA group p l a c i n g more o l d e r s u b j e c t s t h a n younger s u b j e c t s . A s i g n i f i c a n t i n t e r a c t i o n e f f e c t between s u c c e s s i n v o c a t i o n a l p lacement (VPSUCCES) and i n j u r y t y p e (INJTYPE) was found between groups showing t h a t s u b j e c t s w i t h i n j u r i e s t o t h e upper body tended t o be p l a c e d more s u c c e s s f u l l y and t h a t t h i s t r e n d was c o n s i s t e n t f o r the PCA group o v e r t h e j o b s e a r c h (JS) g r o u p . A s i g n i f i c a n t i n t e r a c t i o n e f f e c t was a l s o found between succes s i n v o c a t i o n a l p lacement (VPSUCCES) and degree o f d i s a b i l i t y (DISABGP) between groups w i t h t h o s e s u b j e c t s w i t h a d i s a b i l i t y l e s s t h a n 5% b e i n g 99 p l a c e d more f r e q u e n t l y t h a n t h o s e w i t h a g r e a t e r d i s a b i l i t y . T h i s t r e n d was a l s o c o n s i s t e n t f o r the PCA group o v e r t h e j o b s e a r c h (JS) g r o u p . The p r e d i c t i o n t h a t the PCA program would r e s u l t i n a g r e a t e r o v e r a l l i n c r e a s e i n measures o f s e l f - e s t e e m was not c o n f i r m e d . No s i g n i f i c a n t d i f f e r e n c e s were found between groups f o r p r e - p r o g r a m s e l f - e s t e e m s c o r e s o r f o r p o s t -program s e l f - e s t e e m s c o r e s . The d i f f e r e n c e i n s e l f - e s t e e m s c o r e s was a l s o not s i g n i f i c a n t between g r o u p s . Both g r o u p s , however, r e c o r d e d i n c r e a s e s i n s e l f - e s t e e m v a l u e s d u r i n g t h e c o u r s e o f the program i n d i c a t i n g a p o s i t i v e o v e r a l l e f f e c t ( F i g u r e 5) w i t h t h e j o b s e a r c h group showing t h e most improvement o v e r a l l . 100 95 90 85 80 Pre Post S a m p l e T i m e ~" Job Search ' Physical Capacity F i g u r e 5 : S e l f - E s t e e m S c o r e Improvement by Group 100 E d u c a t i o n , l anguage , c o n s u l t a n t , p r e - i n j u r y wages, p o s t - i n j u r y wages, l e n g t h o f t ime on wage l o s s and m a r i t a l s t a t u s were i n v e s t i g a t e d as p o s s i b l e b iodemograph ic f a c t o r s o r moderator v a r i a b l e s which c o u l d i n f l u e n c e t h e dependent v a r i a b l e s . I t was found t h a t l e n g t h o f t ime on wageloss (TIMELOSS) and m a r i t a l s t a t u s (MARITAL) s i g n i f i c a n t l y a f f e c t e d t ime t o v o c a t i o n a l p lacement . F o r t h e TIMELOSS v a r i a b l e , t h o s e s u b j e c t s w i t h l e s s t ime l o s s were p l a c e d f a s t e r . No e f f e c t f o r group was f o u n d . The m a r i t a l f a c t o r demonstrated a s i g n i f i c a n t 2-way i n t e r a c t i o n w i t h t i m e - l o s s and group t y p e i n d i c a t i n g s i n g l e s u b j e c t s were p l a c e d f a s t e r t h a n m a r r i e d s u b j e c t s o v e r a l l and t h a t s i n g l e s u b j e c t s i n t h e PCA group were p l a c e d f a s t e r t h a n s i n g l e s u b j e c t s i n the j o b s e a r c h g r o u p . These f i n d i n g s w i l l be f u r t h e r d i s c u s s e d i n t h e f o l l o w i n g c h a p t e r . 101 CHAPTER V DISCUSSION OF RESULTS A t t h e Workers ' Compensat ion Board o f B r i t i s h C o l u m b i a , workers who have been l e f t w i t h a r e s i d u a l d i s a b i l i t y as the r e s u l t o f an i n d u s t r i a l a c c i d e n t , and who a r e e x p e r i e n c i n g d i f f i c u l t y i n r e t u r n i n g t o the work f o r c e , a r e r e f e r r e d t o a v o c a t i o n a l r e h a b i l i t a t i o n c o n s u l t a n t f o r a s s i s t a n c e . The c o n s u l t a n t a s s i s t s the i n j u r e d worker i n t h e i d e n t i f i c a t i o n and s e l e c t i o n o f s u i t a b l e v o c a t i o n a l a l t e r n a t i v e s w i t h i n the p h y s i c a l l i m i t a t i o n s imposed by t h e i r i n j u r y . A t the t ime when t h e r e s e a r c h s tudy was i n i t i a t e d , a f o r m a l i z e d j o b s e a r c h program was a v a i l a b l e t o i n j u r e d workers p r i o r t o embarking on t h e i r ques t f o r a l t e r n a t e employment. The j o b s e a r c h program a s s i s t e d i n t h e i d e n t i f i c a t i o n o f j o b g o a l s and p r o v i d e d some j o b s e a r c h s t r a t e g i e s and t e c h n i q u e s . Success o r f a i l u r e i n f i n d i n g s u i t a b l e employment f o l l o w i n g c o m p l e t i o n o f t h i s program o f t e n depended on the random s e l e c t i o n o f v o c a t i o n a l a l t e r n a t i v e s and , t o some e x t e n t , t r i a l and e r r o r when i n d i v i d u a l p h y s i c a l t o l e r a n c e s were not known. No s c r e e n i n g d e v i c e o r s t a n d a r d approach t o the q u a n t i f i c a t i o n o f i n d i v i d u a l t o l e r a n c e f o r work was t h e n a v a i l a b l e t o a s s i s t t h e r e h a b i l i t a t i o n c o n s u l t a n t i n the i d e n t i f i c a t i o n and s e l e c t i o n o f s u i t a b l e v o c a t i o n a l o p t i o n s . I t was sugges ted t h a t the development o f a p h y s i c a l c a p a c i t y assessment program (PCA) f o r the q u a n t i f i c a t i o n o f i n d i v i d u a l work t o l e r a n c e s based on a c t u a l per formance w i t h i n an i n d u s t r i a l s e t t i n g would g r e a t l y a s s i s t t h e 102 r e h a b i l i t a t i o n c o n s u l t a n t i n the s u c c e s s f u l p lacement o f i n j u r e d w o r k e r s . F o l l o w i n g the rev i ew o f the l i t e r a t u r e , q u e s t i o n s were r a i s e d r e g a r d i n g the r e l e v a n c e o f some o f the c o m m e r c i a l l y a v a i l a b l e p h y s i c a l c a p a c i t y assessment programs t o t h e a c t u a l p h y s i c a l demands o f the w o r k i n g w o r l d i n t h e absence o f a d i s c r e t e i n d u s t r i a l component. In a d d i t i o n , v e r y few programs p r e s e n t l y i n use had i n v e s t i g a t e d the e f f e c t o f p h y s i c a l c a p a c i t y assessment on v o c a t i o n a l p lacement (Walk, 1985; S m i t h , Cunningham and Weinberg , 1983) and no s p e c i f i c program i n f o r m a t i o n was a v a i l a b l e on t h e impact o f the p r o c e s s o f p h y s i c a l c a p a c i t y assessment on t h e human v a l u e s o f s e l f - e s t e e m . F o r these r e a s o n s , i t seemed a p p r o p r i a t e t o d e s i g n an i n d u s t r i a l l y - o r i e n t e d p h y s i c a l c a p a c i t y assessment program and e x p l o r e the e f f e c t s o f v a r i o u s f a c t o r s on s p e c i f i c v o c a t i o n a l p lacement and human v a r i a b l e s . 5 .1 GROUP DIFFERENCES IN VOCATIONAL PLACEMENT VARIABLES Success i n v o c a t i o n a l p lacement showed a s i g n i f i c a n t d i f f e r e n c e f o r the t rea tment group u n d e r g o i n g p h y s i c a l c a p a c i t y assessment . E i g h t e e n o f the t w e n t y - f i v e s u b j e c t s i n t h e PCA group o r 72% s u c c e s s f u l l y r e t u r n e d t o work i n s i x months f o l l o w i n g c o m p l e t i o n o f the program compared t o seven out o f t w e n t y - f i v e o r 28% f o r the j o b s e a r c h g r o u p . T h i s compares f a v o r a b l y w i t h the p lacement i n f o r m a t i o n r e p o r t e d 103 f o r t h e S i n g e r System (Gannaway and S i n k , 1978) where a +0.50 c o r r e l a t i o n c o e f f i c i e n t was found i n p r e d i c t i n g employment s u c c e s s i n j o b s s p e c i f i c a l l y found i n the o c c u p a t i o n a l group a s s o c i a t e d w i t h t h e j o b sample . T h e r e i s v e r y l i t t l e o t h e r r e l a t e d r e s e a r c h w i t h which t o compare t h i s f i n d i n g . U s i n g paper t e s t s w i t h a l i m i t e d f u n c t i o n a l component, S m i t h , Cunningham and Weinberg (1983) s t u d i e d t h e p r e d i c t i v e v a l i d i t y o f the F u n c t i o n a l C a p a c i t i e s E v a l u a t i o n (FCE) when a d m i n i s t e r e d w i t h the Smith P h y s i c a l C a p a c i t i e s E v a l u a t i o n (SMITH-PCE) . Comparisons o f e v a l u a t i o n p r e d i c t i o n s t o c u r r e n t employment s t a t u s r e v e a l e d an 86.5% p r e d i c t i o n r a t e d e s p i t e min imal use o f any a c t i v i t y - b a s e d program. H e s t e r , D e c e l l e s and G a d d i s (1986) r e p o r t e d an 89% p r e d i c t i o n r a t e f o r i d e n t i f y i n g p o t e n t i a l r e t u r n t o work s u b j e c t s f o r the Menninger R e t u r n t o Work S c a l e . D e s p i t e the s u p e r i o r i t y o f PCA o v e r j o b s e a r c h on s u c c e s s i n v o c a t i o n a l p lacement , no d i f f e r e n c e was found f o r t h e v a r i a b l e s o f t ime t o v o c a t i o n a l p lacement and t y p e o f v o c a t i o n a l p lacement . Of those s u b j e c t s who a c h i e v e d s u c c e s s f u l v o c a t i o n a l p lacement i n b o t h g r o u p s , t h e r e was no d i f f e r e n c e between the l e n g t h o f t ime i t t ook them t o f i n d work. Most o f the work found by s u b j e c t s i n b o t h groups was a p p r o p r i a t e and w i t h i n t h e i r i n d i v i d u a l work t o l e r a n c e s . T h i s meant t h a t most o f the workers who found employment were s t i l l w o r k i n g 2-4 weeks f o l l o w i n g p lacement . T h e r e a r e s e v e r a l p o s s i b l e e x p l a n a t i o n s f o r t h e 104 s i g n i f i c a n t main e f f e c t o f succes s i n v o c a t i o n a l p lacement and t h e l a c k o f s i g n i f i c a n c e f o r the o t h e r two v a r i a b l e s . One e x p l a n a t i o n r e s t s w i t h the t y p e o f o b j e c t i v e d a t a g e n e r a t e d by the PCA which o u t l i n e s i n d i v i d u a l t o l e r a n c e s f o r s p e c i f i c t y p e s o f work and j o b c o m p a t i b i l i t y . W i t h t h i s i n f o r m a t i o n , the r e h a b i l i t a t i o n c o n s u l t a n t can work w i t h the worker t o a c t i v e l y pursue c o n c r e t e v o c a t i o n a l o p t i o n s on t h e r o a d t o employment knowing t h e i r i n d i v i d u a l t o l e r a n c e s . O p t i o n s t h a t may have been p o s s i b i l i t i e s and which now have been c o n f i r m e d can be q u i c k l y i n v e s t i g a t e d . The j o b s e a r c h p r o c e s s does not p r o v i d e t h i s t y p e o f i n f o r m a t i o n . C o n s u l t a n t f o l l o w - u p s t e n d t o d e c l i n e f o l l o w i n g c o m p l e t i o n o f the j o b s e a r c h program i n t h e absence o f f i r m v o c a t i o n a l o p t i o n s and the en thus iasm g e n e r a t e d by t h e program q u i c k l y s u b s i d e s . U n l i k e the j o b s e a r c h program, worker c o n f i d e n c e and invo lvement i n t h e p r o c e s s o f l o o k i n g f o r work f o l l o w i n g PCA i s enhanced by the knowledge o f i n d i v i d u a l work t o l e r a n c e s and t h e r e i s c o n f i d e n c e i n a b i l i t y t o p e r f o r m the j o b . 5.2 L I F E L I N E CATEGORIES, UNEMPLOYMENT AND S E L F - E S T E E M D e s p i t e the l a c k o f s i g n i f i c a n t d i f f e r e n c e s between groups on measures o f s e l f - e s t e e m , the impact o f t h e o v e r a l l p r o c e s s on i n d i v i d u a l f e e l i n g s o f s e l f - w o r t h d e s e r v e s some m e n t i o n . Both the j o b s e a r c h and PCA programs p o s i t i v e l y i n f l u e n c e d s e l f - e s t e e m . T h i s i n f o r m a t i o n would t e n d t o s u p p o r t the l i t e r a t u r e d e s c r i b i n g reduced l e v e l s o f 105 s e l f - e s t e e m and s e l f - w o r t h t h a t accompany unemployment (Amundson and Borgen , 1982; J a h o d a , 1982; Rump, 1983; Tiggemann and W i n e f i e l d , 1984; H a r r i s o n , 1976; Simon, 1971) and unemployment w i t h d i s a b i l i t y (Stone and S a w a t z k i , 1980; Borgen , Amundson and B i e l a , 1987) . The i n c r e a s e d l e v e l s o f s e l f - e s t e e m f o l l o w i n g the j o b s e a r c h program t e n d t o s u p p o r t t h e p r e v i o u s r e s e a r c h f i n d i n g s r e p o r t e d by S h a p i r o (1978) o f s i g n i f i c a n t improvement i n measures o f s e l f - e s t e e m f o r unemployed workers f o l l o w i n g a s h o r t , i n t e n s i v e program o f j o b s e a r c h w i t h s u p e r v i s i o n . Our f i n d i n g s would t e n d t o s u p p o r t p r e v i o u s e v i d e n c e t h a t an i n t e r v e n t i o n t e c h n i q u e , e s p e c i a l l y w i t h d i s a b l e d groups who a r e unemployed, would r e s u l t i n i n c r e a s e s i n s e l f - e s t e e m . Whether t h i s r e p r e s e n t s an a c t u a l i n c r e a s e , i s the r e s u l t o f d e n i a l o r i s m e r e l y an a r t e f a c t o f t h e t e s t i n g p r o c e s s i s u n c l e a r . The i n t e r v i e w i n f o r m a t i o n and l i f e l i n e c a t e g o r i e s r e v e a l d e t a i l e d i n f o r m a t i o n on i n d i v i d u a l r e a c t i o n s t o i n j u r y , d i s a b i l i t y and unemployment and p l a c e s a s i g n i f i c a n t amount o f importance on the f i n a n c i a l s u p p o r t s t r u c t u r e s o f t h e wage l o s s sys tem. I t a l s o r e v e a l s the s i g n i f i c a n c e o f f a m i l y s u p p o r t s t r u c t u r e s on s e l f - e s t e e m v a l u e s and how c r i t i c a l i n c i d e n t s , b o t h p o s i t i v e and n e g a t i v e , can i n f l u e n c e e m o t i o n a l l e v e l s . 5.3 WORKER CHARACTERISTICS IN VOCATIONAL SUCCESS There was a g e n e r a l tendency i n b o t h groups f o r i n j u r y 106 t y p e , age and degree o f d i s a b i l i t y t o a f f e c t s u c c e s s i n v o c a t i o n a l p lacement . S i g n i f i c a n t v a l u e s were r e c o r d e d f o r a l l measures (p <.05) i n d i c a t i n g some i n t e r e s t i n g g e n e r a l t r e n d s . The l a c k o f r e s e a r c h f i n d i n g s i n the l i t e r a t u r e on t h e e f f e c t o f i n j u r y t y p e on v o c a t i o n a l p lacement makes compar i son o f t h i s i n f o r m a t i o n d i f f i c u l t . The s i g n i f i c a n t i n t e r a c t i o n o f upper l i m b i n j u r i e s w i t h succes s i n v o c a t i o n a l p lacement f o r the PCA group showed t h a t t h o s e s u b j e c t s w i t h i n j u r i e s t o the upper p o r t i o n o f t h e body ( c h e s t , s h o u l d e r s , e lbows, w r i s t s , hands) t ended t o be p l a c e d more f r e q u e n t l y than t h a n those w i t h i n j u r i e s t o o t h e r p a r t s o f t h e body. S e v e r a l e x p l a n a t i o n s a r e o f f e r e d f o r t h i s e f f e c t . F i r s t l y , when compared w i t h i n j u r i e s t o the s p i n e and t o t h e lower l i m b s , the o v e r a l l impact o f upper l i m b i n j u r i e s on g e n e r a l m o b i l i t y i s l e s s s i g n i f i c a n t . M o b i l i t y can s t i l l be m a i n t a i n e d w h i l e r e c o v e r i n g from an upper body i n j u r y and v a r i a t i o n s i n p o s t u r e and a m b u l a t i o n a r e l e s s o b v i o u s . D e s p i t e a m e d i c a l p l a t e a u and r e c o v e r y from i n j u r i e s t o t h e lower l i m b s and back , the r e s t r i c t i o n s t o m o b i l i t y and hence j o b s e a r c h a c t i v i t y from t h e s e t y p e o f i n j u r i e s can be more r e s t r i c t i v e t h a n i n j u r i e s t o t h e upper l i m b s on a l o n g - t e r m b a s i s w i t h r a m i f i c a t i o n s f a r beyond the r e c o v e r y s t a g e . S e c o n d l y , s p i n a l and lower l e g i n j u r i e s , e s p e c i a l l y t o t h e knees and f e e t , t e n d t o d e t e r i o r a t e w i t h t ime due t o w e i g h t - b e a r i n g r e q u i r e m e n t s and a r e prone t o d e g e n e r a t i v e 107 a r t h r i t i s . W i t h the p h y s i c a l r e q u i r e m e n t s o f most p r i m a r y i n d u s t r y j o b s n e c e s s i t a t i n g l o n g hours on the f e e t , t h e s e t y p e o f i n j u r i e s may not t o l e r a t e r e p e a t e d exposures on an ongo ing b a s i s . The e f f e c t o f degree o f d i s a b i l i t y on s u c c e s s i n v o c a t i o n a l p lacement i n d i c a t e d t h a t those workers w i t h a d i s a b i l i t y l e s s t h a n 5% (mild) were p l a c e d more f r e q u e n t l y t h a n workers w i t h more s e v e r e d i s a b i l i t i e s . These f i n d i n g s a r e s u p p o r t e d by the work o f S c h e c h t e r (1981) who c o r r e l a t e d m i l d e r d i s a b i l i t y w i t h s u c c e s s f u l r e t u r n t o work and W r i g h t , Reag le s and Thomas (1973) who i d e n t i f i e d prob lem cases f o r f o r v o c a t i o n a l r e h a b i l i t a t i o n t o be l e s s e d u c a t e d , s i n g l e , h a v i n g a s e v e r e d i s a b i l i t y and r e c e i v i n g some form o f p u b l i c a s s i s t a n c e . These r e s u l t s a r e not c o n s i s t e n t , however, w i t h t h e r e s e a r c h o f W a l l s (1982) who found no s i g n i f i c a n t i n t e r a c t i o n between d i s a b l i n g c o n d i t i o n and s u c c e s s i n v o c a t i o n a l p lacement . Of s i g n i f i c a n c e may be t h e o b s e r v a t i o n t h a t a h i g h e r p r o p o r t i o n o f s u b j e c t s i n b o t h groups had m i l d e r d i s a b i l i t i e s which may have had an impact on t h e o v e r a l l succes s r a t e . I t was p r e d i c t e d t h a t age would not have any e f f e c t on t h e p lacement v a r i a b l e s . The s i g n i f i c a n t s u c c e s s i n v o c a t i o n a l p lacement by group t y p e by age i n t e r a c t i o n i n d i c a t e d t h a t o l d e r s u b j e c t s were p l a c e d more f r e q u e n t l y t h a n younger s u b j e c t s and t h a t t h i s t r e n d was c o n s i s t e n t f o r t h e PCA group o v e r the Job S e a r c h g r o u p . These f i n d i n g s a r e i n c o n t r a s t t o the work o f B o l t o n (1979) who found t h a t age 108 was v iewed as a d e t e r r e n t t o s u c c e s s f u l v o c a t i o n a l p lacement and who i d e n t i f i e d a t r e n d toward a g r e a t e r l i k e l i h o o d o f s u c c e s s f u l v o c a t i o n a l outcome f o r t h e younger age g r o u p . T h i s g e n e r a l t r e n d was a l s o i d e n t i f i e d by H e s t e r , D e c e l l e s and Hood (1986) and was g e n e r a l l y a t t r i b u t e d , i n p a r t , t o t h e d i m i n i s h i n g work c a p a c i t y o f o l d e r p e r s o n s ( C h r i s t e n s e n , 1955; B o n j e r , 1962; Snook, 1971; P e t r o f s k y and L i n d , 1975) and t o t h e g e n e r a l r e l a t i o n s h i p between age and f r e q u e n c y o f work d i s a b i l i t y as r e p o r t e d by B l a k e (1981) and Bowe (1983) . The r e s e a r c h o f Rasch (1979), M o r r i s o n , Magel and Brody (1985) and M e i e r and K e r r (1976) however, s u p p o r t t h e v iew t h a t o l d e r , d i s a b l e d workers t ended t o a c h i e v e s u c c e s s f u l v o c a t i o n a l p lacement and i n f a c t r e t u r n e d t o t h e i r p r e v i o u s employers f o l l o w i n g r e c o v e r y from a d i s a b l i n g i n j u r y . The r e s u l t s from t h i s s t u d y t e n d t o s u p p o r t t h i s t endency towards o l d e r , s u c c e s s f u l v o c a t i o n a l p lacement . The r e a l i t y t h a t employers v a l u e d work f o r c e e x p e r i e n c e g a t h e r e d as the r e s u l t o f age c o u l d be another e x p l a n a t i o n f o r t h e o l d e r age group s u c c e s s r a t e i n v o c a t i o n a l p lacement . In a d d i t i o n , t h e 45 y e a r s o f age upper l i m i t f o r the o l d e r age group meant t h a t t h e s u b j e c t s s t i l l had 15-20 y e a r s l e f t i n t h e i r w o r k i n g c a r e e r s which would a g a i n be v iewed as p o s i t i v e by a p r o s p e c t i v e employer . F i n a l l y , the s i g n i f i c a n t i n t e r a c t i o n between t ime t o v o c a t i o n a l p lacement w i t h m a r i t a l s t a t u s and t i m e - l o s s d e s e r v e s some d i s c u s s i o n . F o r the m a r i t a l s t a t u s v a r i a b l e , s i n g l e s u b j e c t s were p l a c e d more q u i c k l y t h a n m a r r i e d 109 s u b j e c t s and t h i s t r e n d was c o n s i s t e n t f o r the PCA g r o u p . Growick and McMahon (1983) r e p o r t e d a tendency f o r s i n g l e men t o be more s u c c e s s f u l i n v o c a t i o n a l p lacement t h a n m a r r i e d men f o r the <30 age group which would t e n d t o s u p p o r t t h e r e s u l t s found i n the s t u d y . The l e n g t h o f t ime on wage l o s s v a r i a b l e a l s o showed s i g n i f i c a n c e w i t h l e s s t i m e on wage l o s s s u b j e c t s b e i n g p l a c e d f a s t e r . W a l l s (1982) and K r a u f t and B o l t o n (1976) i d e n t i f i e d t h e t r e n d t h a t workers who were r e c e i v i n g some s o r t o f p u b l i c a s s i s t a n c e were l e s s l i k e l y t o a c h i e v e s u c c e s s f u l v o c a t i o n a l p lacement as d i d W r i g h t , Reag le s and Thomas (1973) . T h e i r s u g g e s t i o n as t o the source o f t h i s t r e n d was t h a t t h e r e was l e s s i n c e n t i v e t o s e r i o u s l y l o o k f o r work i f a l t e r n a t e forms o f income were r e a d i l y a v a i l a b l e . Length o f t ime on wage l o s s c o u l d a l s o be r e l a t e d t o degree o f d i s a b i l i t y w i t h t h e more s e r i o u s l y i n j u r e d s u b j e c t s r e q u i r i n g l o n g e r t o r e c o v e r and r e s u l t i n g i n a more s i g n i f i c a n t l e v e l o f d i s a b i l i t y . T h i s r e l a t i o n s h i p was not e v a l u a t e d and may w a r r a n t f u r t h e r i n v e s t i g a t i o n i n the f u t u r e . 110 CHAPTER VI SUMMARY, CONCLUSIONS, IMPLICATIONS, LIMITATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH 6.1 SUMMARY T h i s s t u d y examined the e f f e c t o f two d i f f e r e n t v o c a t i o n a l l y - o r i e n t e d programs on v o c a t i o n a l p lacement and s e l f - e s t e e m o f d i s a b l e d w o r k e r s . One o f the programs was t h e t r a d i t i o n a l method o f v o c a t i o n a l p lacement i n v o l v i n g j o b s e a r c h t r a i n i n g . The o t h e r program i n v o l v e d a r e c e n t l y d e v e l o p e d , i n d u s t r i a l l y - b a s e d , p h y s i c a l work c a p a c i t y e v a l u a t i o n program f o r the assessment o f i n d i v i d u a l t o l e r a n c e f o r work (PCA) . Impetus f o r the development o f the PCA program came from the need f o r o b j e c t i v e p h y s i c a l work c a p a c i t y i n f o r m a t i o n t o a s s i s t i n the placement o f d i s a b l e d w o r k e r s . Of t h e c o m m e r c i a l l y a v a i l a b l e assessment formats c u r r e n t l y i n u s e , none c o n t a i n e d a s u f f i c i e n t i n d u s t r i a l component t h r o u g h t h e a c t u a l s i m u l a t i o n o f work demands, c o n d i t i o n s and env ironments t o be a b l e t o e s t a b l i s h f i r m r e l a t i o n s h i p s t o w i t h t h e a c t u a l work o f work. I n v e s t i g a t i o n o f t h e l i t e r a t u r e r e v e a l e d l i m i t e d e m p i r i c a l d a t a on t h e p lacement s u c c e s s o f t h e s e programs i n terms o f r e t u r n i n g i n j u r e d workers back t o t h e work f o r c e . By t h e i n t r o d u c t i o n o f a p h y s i c a l work c a p a c i t y component t o t h e o v e r a l l p r o c e s s o f v o c a t i o n a l i n t e r v e n t i o n , i t was p o s s i b l e t o examine t h e e f f i c a c y o f t h i s method o f c o l l e c t i n g d a t a on the u l t i m a t e g o a l o f f i n d i n g work and t o e v a l u a t e the e f f e c t o f t h e 111 p r o c e s s o f i n t e r v e n t i o n on o v e r a l l program s u c c e s s . I t was a l s o p o s s i b l e t o e v a l u a t e the impact o f s e l e c t demographic v a r i a b l e s on s u c c e s s i n v o c a t i o n a l p lacement . S e v e r a l b a s i c assumpt ions were made p r i o r t o t h i s s t u d y . The f i r s t was t h a t t h e c o l l e c t i o n o f p h y s i c a l work c a p a c i t y i n f o r m a t i o n , based on demonstrated work c a p a c i t y i n an i n d u s t r i a l s e t t i n g , would have a d i s c r e t e , p o s i t i v e e f f e c t on t h e s e l e c t i o n o f a p p r o p r i a t e v o c a t i o n a l o p t i o n s . When matched w i t h an a g g r e s s i v e j o b s e a r c h , i t was p r e d i c t e d t h a t t h i s i n d i v i d u a l work t o l e r a n c e i n f o r m a t i o n would enhance o v e r a l l chances o f v o c a t i o n a l s u c c e s s . The second assumpt ion came from a rev i ew o f the r e s e a r c h on s e l f - e s t e e m and unemployment. From a rev i ew o f t h i s i n f o r m a t i o n i t was f e l t t h a t v o c a t i o n a l i n t e r v e n t i o n t h r o u g h PCA would p o s i t i v e l y i n f l u e n c e s e l f - e s t e e m measures which would c a r r y o v e r i n t o p r o c e s s o f l o o k i n g f o r work. The e x p e r i m e n t a l d e s i g n p r o v i d e d two t r e a t m e n t c o n d i t i o n s i n v o l v i n g a 3 day j o b s e a r c h program and a 2 week p h y s i c a l c a p a c i t y assessment program. S u b j e c t s were g r o u p e d , f o l l o w i n g r e f e r r a l by the r e h a b i l i t a t i o n c o n s u l t a n t , a c c o r d i n g t o the independent v a r i a b l e s o f age, degree o f d i s a b i l i t y and i n j u r y t y p e . To t e s t t h e h y p o t h e s e s , C h i - s g u a r e a n a l y s i s and a n a l y s i s o f v a r i a n c e were used t o de termine main e f f e c t s and any i n t e r a c t i o n s w i t h the independent and b i o d e m i g r a p h i c v a r i a b l e s . The sample c o n s i s t e d o f 50 male s u b j e c t s s e l e c t e d by t h e r e h a b i l i t a t i o n c o n s u l t a n t s h a n d l i n g t h e i r case and 112 randomly a s s i g n e d t o one o f 2 t r e a t m e n t g r o u p s . The mean age was 33.32 y e a r s , average l e n g t h o f t ime i n t r e a t m e n t was 245 days and a l l s u b j e c t s had m e d i c a l l y p l a t e a u e d from t r e a t m e n t p r i o r t o r e f e r r a l t o the s t u d y . A l l had been l e f t w i t h some form o f r e s i d u a l d i s a b i l i t y as t h e r e s u l t o f t h e i r i n j u r y which p r e v e n t e d them from r e t u r n i n g t o t h e i r p r e -a c c i d e n t employment (1-25%). A l l were a c t i v e l y p r e p a r i n g t o b e g i n t h e t a s k o f l o o k i n g f o r s u i t a b l e employment p r i o r t o r e f e r r a l t o t h e s t u d y . A n a l y s i s o f the d a t a r e v e a l e d a s i g n i f i c a n t main e f f e c t o f group t y p e on succes s i n v o c a t i o n a l p lacement (VPSUCCES) (p = .005) w i t h 72% o f the PCA group and 28% o f t h e j o b s e a r c h group f i n d i n g f u l l t ime employment. No s i g n i f i c a n t e f f e c t was found f o r t ime t o v o c a t i o n a l p lacement o r t y p e o f v o c a t i o n a l p lacement between the g r o u p s . S i g n i f i c a n t i n t e r a c t i o n e f f e c t s were found between group t y p e and s e v e r a l independent and b iodemographic v a r i a b l e s i n c l u d i n g age, i n j u r y t y p e , degree o f d i s a b i l i t y , m a r i t a l s t a t u s and t i m e l o s s . Age produced a g e n e r a l e f f e c t on s u c c e s s i n v o c a t i o n a l p lacement (p - .05) f o r PCA s u b j e c t s o l d e r t h a n 30 y e a r s o f age . A s i g n i f i c a n t i n t e r a c t i o n e f f e c t f o r i n j u r y t y p e and degree o f d i s a b i l i t y between groups was a l s o found w i t h upper l i m b i n j u r i e s and those w i t h a d i s a b i l i t y l e s s t h a n 5% b e i n g p l a c e d more s u c c e s s f u l l y . M a r i t a l s t a t u s and l e n g t h o f t ime on wage l o s s a l s o had s i g n i f i c a n t i n t e r a c t i o n s w i t h t ime t o v o c a t i o n a l p lacement i n d i c a t i n g t h a t s i n g l e s u b j e c t s were p l a c e d f a s t e r t h a n m a r r i e d 113 s u b j e c t s and t h o s e w i t h l e s s t ime on wage l o s s were p l a c e d f a s t e r t h a n t h o s e w i t h more t i m e . F i n a l l y , t h e r e was no s i g n i f i c a n t main e f f e c t between groups f o r measures o f s e l f - e s t e e m . I t was g e n e r a l l y o b s e r v e d , however, t h a t b o t h groups r e c o r d e d s m a l l i n c r e a s e s i n t h e i r s e l f - e s t e e m s c o r e s o v e r the d u r a t i o n o f t h e program. 6.2 CONCLUSIONS In t h e p r e s e n t s t u d y , i t was found t h a t s u b j e c t s who underwent p h y s i c a l c a p a c i t y assessment (PCA) as an a d j u n c t t o w o r k i n g w i t h a r e h a b i l i t a t i o n c o n s u l t a n t i n l o o k i n g f o r s u i t a b l e employment, were s i g n i f i c a n t l y more s u c c e s s f u l a t f i n d i n g work t h a n s u b j e c t s who were i n v o l v e d i n j o b s e a r c h (JS) a l o n e . D e s p i t e min imal compar i son d a t a on v o c a t i o n a l s u c c e s s from o t h e r p h y s i c a l work c a p a c i t y assessment programs (Gannaway and S i n k , 1978) , the h i g h e r v o c a t i o n a l p lacement r a t e f o r those s u b j e c t s i n PCA i s r e a d i l y a p p a r e n t . I t i s a l s o apparent t h a t c e r t a i n b iodemograph ic and moderator v a r i a b l e s i n c l u d i n g age (AGEGRP), degree o f d i s a b i l i t y (DISABGRP), i n j u r y t y p e ( I N J T Y P E ) , m a r i t a l s t a t u s (MARITAL) and t ime on wage l o s s (TIMELOSS) a l s o a f f e c t v o c a t i o n a l p lacement t o some e x t e n t . S e v e r a l b a s i c c o n c l u s i o n s can be drawn from t h e s e r e s u l t s t h a t impact on the o v e r a l l i m p l e m e n t a t i o n o f v o c a t i o n a l i n t e r v e n t i o n and c o u n s e l l i n g t e c h n i q u e s f o r the i n d u s t r i a l l y - i n j u r e d worker . F i r s t , p h y s i c a l c a p a c i t y 114 assessment i n t r o d u c e s a component which augments e x i s t i n g v o c a t i o n a l c o u n s e l l i n g t e c h n i q u e s i n a p o s i t i v e way by more p r e c i s e l y d e f i n i n g i n d i v i d u a l work t o l e r a n c e s . W i t h t h i s i n f o r m a t i o n , the r e h a b i l i t a t i o n c o n s u l t a n t i s a b l e t o s e l e c t a p p r o p r i a t e v o c a t i o n a l a l t e r n a t i v e s c o n s i s t e n t w i t h i n d i v i d u a l l i m i t a t i o n s and a b i l i t i e s t o ensure a b e t t e r v o c a t i o n a l match . PCA s h o u l d be c o n s i d e r e d i n case s where a d i s a b i l i t y p r e v e n t s a worker from r e t u r n i n g t o t h e work f o r c e and when an a c c u r a t e measure o f work c a p a c i t y i s sought t o a s s i s t i n v o c a t i o n a l p l a n n i n g . The second c o n c l u s i o n i s t h a t some v a r i a b l e s o r c h a r a c t e r i s t i c s o f i n j u r e d workers may used as i n d i c a t o r s o f v o c a t i o n a l succes s o r l a c k o f s u c c e s s , when c o n s t r u e d w i t h i n t h e o v e r a l l v o c a t i o n a l framework. These v a r i a b l e s i n c l u d e age , degree o f d i s a b i l i t y , t ype o f i n j u r y , m a r i t a l s t a t u s and l e n g t h o f t ime on wage l o s s . When t a k e n i n d e p e n d e n t l y , t h e s e v a r i a b l e s may not c a r r y s u f f i c i e n t s t r e n g t h t o suggest the i m p l e m e n t a t i o n o f s p e c i f i c v o c a t i o n a l c o u n s e l l i n g t e c h n i q u e s . When c o n s i d e r e d i n c o n c e r t , however, t h e y may be g e n e r a l i n d i c a t o r s o f t r e n d s towards v o c a t i o n a l s u c c e s s o r f a i l u r e and may a s s i s t the r e h a b i l i t a t i o n c o n s u l t a n t i n s e l e c t i n g workers f o r invo lvement i n programs d e s i g n e d t o maximize t h e i r chances o f s u c c e s s . The i d e n t i f i c a t i o n o f some o f these g e n e r a l i n d i c a t o r s , s p e c i f i c a l l y t h e age v a r i a b l e , c o n t r a d i c t s r e s e a r c h i n t h e a r e a o f p r e d i c t o r s o f v o c a t i o n a l succes s which has g e n e r a l l y found t h a t the o l d e r a worker becomes, t h e l e s s l i k e l y a r e 115 h i s / h e r chances o f r e t u r n i n g t o the work f o r c e f o l l o w i n g a d i s a b l i n g i n j u r y ( B o l t o n , 1979; H e s t e r , D e c e l l e s and Hood, 1986) . One e x p l a n a t i o n f o r these f i n d i n g s may r e s t w i t h the o b s e r v a t i o n t h a t e x p e r i e n c e i s a v a l u e d commodity i n an employee and as l o n g as the age v a r i a b l e i s not e x c e s s i v e ( < 45 y e a r s ) , i t i s not a d e t e r r e n t t o an employer i n h i r i n g a d i s a b l e d employee. The o b s e r v a t i o n t h a t s i n g l e workers were p l a c e d f a s t e r t h a n m a r r i e d workers and t h a t i n c r e a s e d l e n g t h o f t ime on wage l o s s n e g a t i v e l y a f f e c t e d v o c a t i o n a l p lacement succes s may be o f g e n e r a l i n t e r e s t when c o n s i d e r i n g t h e s u c c e s s o f r e t r a i n i n g o r v o c a t i o n a l p lacement programs f o r workers w i t h t h e s e p a r t i c u l a r c h a r a c t e r i s t i c s . C e r t a i n l y the l i t e r a t u r e t ends t o s u p p o r t t h e s e g e n e r a l t r e n d s (Growick and McMahon, 1983; W a l l s , 1982; K r a u f t and B o l t o n , 1976) f o r workers w i t h t h e s e common c h a r a c t e r i s t i c s . The r e s u l t s o f t h i s s tudy do need f u r t h e r r e v i e w w i t h r e s p e c t t o the d e t a i l e d a n a l y s i s o f s p e c i f i c b iodemograph ic v a r i a b l e s as a c c u r a t e p r e d i c t o r s o f v o c a t i o n a l s u c c e s s . In a d d i t i o n , f o l l o w - u p s s t u d i e s s h o u l d be conducted t o d e t e r m i n e the a c c u r a c y o f these v a r i a b l e s as l o n g - r a n g e p r e d i c t o r s and whether o r not s i n g l e f a c t o r s o r c o m b i n a t i o n s o f f a c t o r s can p r e s c r i b e succes s o r f a i l u r e f o r d i s a b l e d i n d i v i d u a l s . 116 6.3 IMPLICATIONS I n t h e p r e s e n t s t u d y , d i s a b l e d workers were s u c c e s s f u l l y p l a c e d more o f t e n f o l l o w i n g exposure t o a p h y s i c a l work c a p a c i t y assessment program i n c o n c e r t w i t h v o c a t i o n a l r e h a b i l i t a t i o n c o u n s e l l i n g . In t h e PCA program, c e r t a i n t r e n d s were a l s o apparent w i t h r e s p e c t t o s e l e c t e d worker t r a i t s i n c l u d i n g age, degree and t y p e o f d i s a b i l i t y , m a r i t a l s t a t u s and l e n g t h o f t ime on wage l o s s . On t h e b a s i s o f t h e s e r e s e a r c h f i n d i n g s , the f o l l o w i n g i m p l i c a t i o n s f o r v o c a t i o n a l i n t e r v e n t i o n programs a r e sugges ted : (1) The i n c l u s i o n o f p h y s i c a l c a p a c i t y assessment s h o u l d be c o n s i d e r e d i n v o c a t i o n a l c o u n s e l l i n g programs i n cases where a worker i s l i m i t e d i n r e t u r n i n g t o t h e i r p r e - a c c i d e n t j o b due t o a p h y s i c a l d i s a b i l i t y . More g e n e r a l l y , PCA s h o u l d be c o n s i d e r e d when s p e c i f i c work t o l e r a n c e i n f o r m a t i o n i s sought t o a s s i s t i n t h e i d e n t i f i c a t i o n o f v o c a t i o n a l a l t e r n a t i v e s i n the p r e s e n c e o f some form o f p h y s i c a l l i m i t a t i o n . In the p r o v i n c e o f B r i t i s h C o l u m b i a , v o c a t i o n a l r e h a b i l i t a t i o n s p e c i a l i s t s have e x p r e s s e d a need f o r a s t a n d a r d i z e d approach t o t h e i d e n t i f i c a t i o n and q u a n t i f i c a t i o n o f i n d i v i d u a l work c a p a c i t y . P a r t i c u l a r l y i n cases when e m p l o y a b i l i t y i s l i m i t e d by a f u n c t i o n a l d i s a b i l i t y , i n d i v i d u a l work t o l e r a n c e i n f o r m a t i o n i s c r i t i c a l t o the s e l e c t i o n o f s u i t a b l e i n t e r v e n t i o n t e c h n i q u e s . (2) The r e s u l t s o f the i n t e r a c t i o n e f f e c t o f s p e c i f i c independent v a r i a b l e s w i t h succes s i n v o c a t i o n a l p lacement 117 sugges t t h a t some v a r i a b l e s may be u s e d , on a l i m i t e d b a s i s , as g e n e r a l p r e d i c t o r s o f o v e r a l l v o c a t i o n a l s u c c e s s o r f a i l u r e . More s p e c i f i c a l l y , these p r e d i c t o r v a r i a b l e s may be c o n s i d e r e d by the v o c a t i o n a l c o u n s e l l o r i n t h e d e c i s i o n making p r o c e s s r e g a r d i n g o v e r a l l t ime inves tment o r , i n p a r t i c u l a r c a s e s , f o r the i d e n t i f i c a t i o n o f t h o s e workers who would b e n e f i t most from the a p p l i c a t i o n o f s p e c i f i c i n t e r v e n t i o n t e c h n i q u e s . I t has been sugges ted t h a t some worker t r a i t s may be used as g e n e r a l s c r e e n i n g i n d i c a t o r s t o p r e d i c t o v e r a l l succes s i n v o c a t i o n a l programs ( H e s t e r , D e c e l l e s and G a d d i s , 1986) i n an e f f o r t t o more e f f i c i e n t l y manage v o c a t i o n a l c o u n s e l l i n g r e s o u r c e s . The r e s u l t s from t h i s s t u d y have some i m p l i c a t i o n s i n t h e c o n s i d e r a t i o n o f t h e s e v a r i a b l e s d u r i n g the i m p l e m e n t a t i o n o f v o c a t i o n a l c o u n s e l l i n g t e c h n i q u e s and programs . The r e s u l t s from t h e i n t e r v i e w s and l i f e l i n e d a t a s u p p o r t s the c o n c l u s i o n t h a t d i f f e r e n t in jury /unemployment e x p e r i e n c e s r e q u i r e d i f f e r e n t approaches which has some i m p l i c a t i o n s f o r the d e l i v e r y o f s e r v i c e s . (3) A l t h o u g h the r e s u l t s o f the s e l f - e s t e e m measures d i d not show s i g n i f i c a n c e between g r o u p s , t h e o v e r a l l p o s i t i v e i n c r e a s e i n s c o r e s f o l l o w i n g the i m p l e m e n t a t i o n o f b o t h programs i s e n c o u r a g i n g . U n f o r t u n a t e l y , t h e r e a s o n f o r t h e s e i n c r e a s e s cannot f u l l y be e x p l a i n e d by t h e as sumpt ion o f the p o s i t i v e n a t u r e o f the i n t e r v e n t i o n t e c h n i q u e a l o n e . C o n s i d e r a t i o n must a l s o be g i v e n t o a l t e r n a t e e x p l a n a t i o n s f o r the i n c r e a s e i n c l u d i n g t e s t 118 i n s t r u m e n t a r t e f a c t , e f f e c t o f the t e s t p r o c e d u r e and t h e p o s s i b i l i t y o f " d e n i a l " a f f e c t i n g the measure. W h i l e the j o b s e a r c h program appears t o have had a more p o s i t i v e , o v e r a l l i n f l u e n c e on s e l f - e s t e e m s c o r e s f o l l o w i n g c o m p l e t i o n o f t h e program, t h i s s e l f - e s t e e m "high" does no t appear t o have c a r r i e d o v e r i n t o t h e s u c c e s s i n l o o k i n g f o r work which t h e PCA group e x p e r i e n c e d . F u r t h e r r e s e a r c h may be a p p r o p r i a t e t o i n v e s t i g a t e the n a t u r e and causes o f apparent i n c r e a s e s i n s e l f - e s t e e m f o l l o w i n g j o b s e a r c h t o a s s i s t the v o c a t i o n a l c o u n s e l l o r i n t a k i n g advantage o f t h i s phenomenon. In a d d i t i o n , where a p p l i c a b l e , c o n s i d e r a t i o n c o u l d be g i v e n t o combin ing t h e PCA and j o b s e a r c h programs i n an i n t e g r a t e d format t o f u r t h e r enhance o v e r a l l p lacement s u c c e s s . 6.4 LIMITATIONS (1) The r e s u l t s o f t h i s s tudy a r e l i m i t e d i n t h e i r a p p l i c a t i o n t o d i s a b l e d , male w o r k e r s , 21 t o 45 y e a r s o f age, who have a p h y s i c a l d i s a b i l i t y as the r e s u l t o f an i n d u s t r i a l a c c i d e n t . (2) Success i n v o c a t i o n a l p lacement as a s i g n i f i c a n t main e f f e c t between groups was based on s a m p l i n g f o l l o w i n g p lacement w i t h a 2-4 week f o l l o w - u p . L o n g - t e r m v o c a t i o n a l p lacement f i g u r e s a r e not a v a i l a b l e and t h e e f f e c t o f programs on v o c a t i o n a l p lacement o v e r t ime was no t i n v e s t i g a t e d . 119 (3) The unequa l c e l l s i z e f o r c o n s u l t a n t made i n v e s t i g a t i o n o f t h e e f f e c t o f t h i s v a r i a b l e on v o c a t i o n a l p lacement outcome d i f f i c u l t . The d e c i s i o n was made, however, t o a t tempt t o r e p r o d u c e t y p i c a l r a t h e r t h a n s i m u l a t e d r e f e r r a l p a t t e r n s o f v o c a t i o n a l c o u n s e l l o r s w i t h i n t h e W o r k e r s ' Compensat ion Board i n o r d e r t o make p r a c t i c a l i n f e r e n c e s about the outcomes w i t h r e s p e c t t o u s u a l r e f e r r a l p r a c t i c e s . (4) The r e l a t i v e l y s m a l l sample s i z e o f some o f the s u b - g r o u p s combined w i t h the r e l a t i v e l y l a r g e number o f independent and moderator v a r i a b l e s makes e x t r a p o l a t i o n o f some o f t h e s t u d y outcomes t o the g e n e r a l p o p u l a t i o n d i f f i c u l t . (5) The d i f f e r e n c e i n a c t u a l "time i n t r e a t m e n t " , 3 days f o r t h e Job S e a r c h (JS) group and 10 days f o r t h e P h y s i c a l C a p a c i t y Assessment (PCA) g r o u p , may have had an undetermined e f f e c t on some the outcome v a r i a b l e s . T h i s p o s s i b l e e f f e c t w a r r a n t s f u r t h e r i n v e s t i g a t i o n . 6.5 RECOMMENDATIONS FOR FUTURE RESEARCH (1) T h i s s tudy s h o u l d be r e p e a t e d w i t h a l a r g e r sample s i z e i n o r d e r t o c o n f i r m the g e n e r a l t r e n d s f o u n d . Where p o s s i b l e , s i m i l a r d i s a b i l i t i e s and i n j u r y t y p e s s h o u l d be grouped t o a s s e s s the o v e r a l l impact o f t h e s e v a r i a b l e s on v o c a t i o n a l succes s w i t h a f i n e r v a r i a b l e c l a s s i f i c a t i o n . I n a d d i t i o n , the age group v a r i a b l e s h o u l d be expanded t o i n c l u d e the 45+ range t o g i v e a more r e p r e s e n t a t i v e sample 120 o f t h e w o r k i n g p o p u l a t i o n as w e l l as a b r o a d e r c r o s s - s e c t i o n o f b i o d e m i g r a p h i c v a r i a b l e s . (2) A f o l l o w - u p s tudy on t h i s same sample a t 3 month i n t e r v a l s f o r up t o a y e a r s h o u l d be done i n o r d e r t o e v a l u a t e l o n g - t e r m placement succes s f o l l o w i n g program c o m p l e t i o n . (3) In o r d e r t o g a t h e r a d d i t i o n a l i n f o r m a t i o n on the e f f e c t o f the j o b s e a r c h p r o c e s s on s e l f - e s t e e m , r e p e a t e d measures o f t h e Coopersmi th s e l f - e s t e e m I n v e n t o r y c o u l d have t a k e n p l a c e a t 2 week i n t e r v a l s f o r the 6-month d u r a t i o n o f l o o k i n g f o r work o r u n t i l s u c c e s s f u l v o c a t i o n a l p lacement was r e a c h e d . In a d d i t i o n , o t h e r v a r i a b l e s r e l a t e d t o s e l f -esteem such as l o c u s o f c o n t r o l c o u l d be e v a l u a t e d t o more f u l l y u n d e r s t a n d these chang ing human v a r i a b l e s d u r i n g t h e p r o c e s s o f d i s a b i l i t y , unemployment and j o b s e a r c h . (4) A d d i t i o n a l r e s e a r c h i s needed on t h e impact o f e s t a b l i s h e d assessment programs and formats on v o c a t i o n a l p lacement t o e v a l u a t e the o v e r a l l e f f i c a c y o f t h e s e programs f o r compar i son purposes and f o r program deve lopment . (5) More d e t a i l e d , s t a n d a r d i z e d measurement t e c h n i q u e s s h o u l d be e s t a b l i s h e d f o r the e v a l u a t i o n o f f u n c t i o n i n an i n d u s t r i a l s e t t i n g and normat ive d a t a p u b l i s h e d f o r r e p l i c a t i o n . (6) I t would be o f i n t e r e s t t o examine the impact o f program c o m b i n a t i o n s on v o c a t i o n a l p lacement . The c o m b i n a t i o n o f the o b j e c t i v e , f u n c t i o n a l i n f o r m a t i o n from t h e PCA program w i t h the m o t i v a t i n g e f f e c t o f t h e j o b s e a r c h 121 program may produce more p o s i t i v e program r e s u l t s i n terms o f t h e s u c c e s s i n v o c a t i o n a l p lacement and t ime t o v o c a t i o n a l p lacement v a r i a b l e s . (7) R e p l i c a t i o n o f the s tudy w i t h p r o v i s i o n f o r more r i g i d c o n t r o l o f the r e h a b i l i t a t i o n c o n s u l t a n t v a r i a b l e t o f u r t h e r examine i t s impact on the outcome v a r i a b l e s i s needed. (8) R e p l i c a t i o n o f t h e s tudy w i t h t h e a d d i t i o n o f a female component t o a s s e s s the impact o f gender on s e l e c t e d v o c a t i o n a l p lacement v a r i a b l e s . 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U s i n g assessment r e s u l t s i n c a r e e r  c o u n s e l l i n g . B r o o k s / C o l e P u b l i s h i n g Company, Monterey , C a l i f o r n i a . 139 APPENDICES 140 Appendix A : I . D . Task F i l e I n v e n t o r y 141 ID TASK FILE INVENTORY STRENGTH OTHER , TASK 1 PROJECT . SHOP 1. S 4, 5 6,7 22 PARTS CATAL06UEING STUDY ROOM 2. L 3 4 5,6,7 10 TO REPAIR AND MAINTAIN SMALL ENGINES SMALL MOTOR 3 4 6,7 03 GRADUATED LIFTING AND MATERIALS HANDLING (REPETITIVE) LIFTING PROGRAM 3| 4 6,7,0 09 RE-UPHOLSTER SHALL ITEM: e.g. LIGHT OCCASSIONAL CHAIR UPHOLSTERY 3 4 6,7,8 It TRESTLE TABLE (CEDAR) INSIDE GENERAL 3 4 6,7,8 12 SMALL PROJECTS IN MOOD (TRIVETS.PICTURE FRAMES, HALLBQARDS) CARPENTRY 3 4 6,7,8 14 PATIO TABLE (round, square) INSIDE 6ENERAL 3 4 6,7,8 15 SHEET METAL PRODUCTION DORK 1 (e.g. tool box construction) SHEET METAL SHOP 3| 4 6,7,8 24 CEDAR LAWN CHAIR GENERAL INSIDE 3| 4 7,8 16 CAR/TRUCK OIL AND LUBRICATION AUTOMOTIVE 4, 6 7,8 13 METAL CRIBBA6E BOARD MACHINE SHOP 4, 6 7,8 17 FURNITURE FINISHING NEW AND USED FURNITURE REFINISH 3. N 2, 3 4,5,6,7 01 SMALL BUILDING FRAMING INSIDE GENERAL 3, 4 5,6,7 02 BRAKE JOB AUTOMOTIVE 3 4 5,6,7 07 HEALTH CARE UNIT: To perfori a vide range of duties associated vith LIFTING ongoing patient care specific to the health care field. 3 4 5,6,7 19 FABRICATE A TALL FLOWER POT STAND WELDING 3 4 6,7 04 6RADUATED LIFTING AND MATERIALS HANDLING (REPETITIVE) LIFTING PROGRAM 3 4 6,7 18 REMOVE CEMENT PATIO BLOCKS FROM MOULDS AND STACK. OUTSIDE GENERAL 3 4 6,7,8 25 6ARDEN GATE FABRICATION WELDING 3 4 7 08 GENERAL CLEAN-UP Hultipte 4 6 7,8 21 FIREPLACE SET MACHINE SHOP 4. H 3 4 6,7 05 GRADUATED LIFTING AND MATERIALS HANDLIN6 (REPETITIVE) LIFTING PROGRAM 3 4 6,7 20 CONCRETE POURING AND SURFACING (Patio blocks/ioulds) OUTSIDE GENERAL 5. VH 3 4 6,7 06 GRADUATED LIFTING AND MATERIALS HANDLING (REPETITIVE) LIFTING PROGRAM VARIABLE 3 4 5,6,7,8 23 HEAD INJURY UNIT VARIABLE 142 Appendix B: Sample Task Sheet 143 TASK 24 STRENGTH FACTOR: 2. L OTHER FACTORS: 3,4,6,7,8 SHOP: GENERAL INSIDE TIME: PROJECT: CEDAR LAWN CHAIR TOOLS: Table/radial arm/band saw, drill press, disc/belt sander, planer, jigs. SETTING: Inside - primarily bench level with infrequent floor level work. MATERIALS: Dimensional lumber (2 x 6, 2 x 10), screws, glue, sandpaper. ACTIVITIES: Select materials from storage; lay out and cut to shape/size; smooth surfaces; assemble; final fit and finish sand. INSTRUCTION TIME: .5 hours COMPLETION TIME: 3 hours Attachment : Task requires considerable repetitive hand/arm/shoulder pushing and pulling during hand tool and machine operation. Some shoulder pull down strength required during drill press operation. Varying degrees of forearm supination/pronation and hand grip strength required during drill press operation and while driving screws by hand. Some stooping/squatting required during material handling as well as lumbar spine mobility during assembly phases. Task is performed in a standing position. 144 0 Appendix C: I n s t r u c t o r ' s Report Form 145 I N B T f t U C T O R " E V A U U A T I O N P " 0 « r i T A S K D U R A T I O N T O L E R A N C E O B S E R V A T I O N S T A S K M A N A i j E l - l E N T F O R M O F " C O n P R O r i l S E N O 0 D V I 0 U S D I F F I C U L T Y I I . SOME DirncuLTY i I . C O N S I D E R A B L E D I F F I C U L T Y I I PAIN ORIENTED I I F U N C T I O N A L R E S T R I C T R I C T I O N I I N S U F F I C I E N T S K I L L I WORK A T T I T U D E / A P P L I C A T I O N I T I M E R E Q U I R E M E N T S P R O D U C T / C O M ! ) I T I O N S K I L L L E V E L E X C E L L E N T A L L A S P E C T S 4O0D COMPETITIVE STANOARD F A I R b U t C I A K K E T A B L E U N A C C E P T A B L E / I N C O M P L E T E I J O U R N E Y M A N I L A T E A P P R E N T I C E I E A R L Y A P P R E N T I C E I P O T E N T I A L A P P A R E N T I P O T E N T I A L NOT A P P A R E N T L I t-1 I T A T I O r v l S T a s k w o u l d b * c o » » * * i i A 9 « d o l * w i t h t h * s » d l l i c a t i o n s t \U T j b k u i u t a u a g v A b l • « v » n w i t h g r o s s m o d i f l c a t l o n i I I U O R K P E R F O R M A N C E A T T E N D A N C E p n S M m . E I A T T E N D A N C E A C T U A L I P u n c t u a l i "t >^ N E V E R L A T E I S O M E T I M E S L A T E I USUALLY LATE I L E A V E S E A R L Y I A p p r o a c h C O N S C I E N T I O U S I A T T E M P T S T O M A N A G E A S I N S T R U C T E D I R E L A T E S H E L L T O O T H E R S I U N C O O P E R A T I V E I C A R E L E S S I W A S T E S T I M E A N D M A T E R I A L S 1 O V E R - R E L A T E S T O O T H E R W O R K E R S 1 C O r i n E N T S R E t G E N E R A L B E H A V I O U R S NUHPT .R O r C 0 M 1 . A I N T S 1 I M I L D : R E P O R T E D I N T E N S I T Y M O D E R A T E I S E V E R E ! 1 . . r\ x N o n — v » r b £ P O S T U R E 6 A I T O T H E R B O D Y M O V E M E N T S F A C I A L E X P R E S S I O N S D l « » b l l l t y S - - 1 - . J . C O N S I S T A N T I -INCONSISTANT I C O N S I S T A N T I I N C O N S I S T A N T I J N C T I O I M A L C A P A C I T Y S I G N A T U R E ! Appendix D: Remedial Therapy Report Form 147 ffcZg P h y s i c a l 1 $ J Q Evalmalioflfl T h i s FOIU: I S S P E C I F I C TO ^ "WORKEIXS" Otl H . C . B . V O C A T I O N A L E V A L U A T I O N PP.OGRMIS. NAME NUMBER A G E , The Claimants view o( his functional aitd related probtents "IlwW.CO.diiiical view i i i Evalualora (Iral Impressions J PHYSICAL FINDINGS 148 11 E P T PHYSICAL EVALUATION I name I number ] col o l M1 f^l u l o l o l 9 3= O M H U H Q o M H <J o M M to to 9 r H 'to >CO o X E H H O I - l CO a; LBS lilt heights " n 18" <SB" 10 20 50 100 100" FACTOR 1 S T R E N G T H S LIFTING SECTION LBSx30ft. JO lb 20 lb 50 lb lOOIb I00lb + EACTQR1 | » S T R E N G T H - ? f RA. LEVEL sedentary light medium heavy V, heavy (^) CARRYING SECTION <!!) r RA.LEVEL \ •ILS «P.A.UVfl» 5EDLHTAHY JL 10 i u i i i i 10 35 MEDIUM 39 50 HEAVY 50 5o' VERY HEAVY 50 •'RA.IfVUn ll)S • SEDLNIARV M 3 0 LIGHT 3 0 50 MEDIUM 50 too "HEAVY • )0O i 100 VERY HEAVY too lbs ''fiA.IEVcM-' lbs SEDEfnARY • 3 0 " t i i i i i f 3 0 50 MEDJUM 50 100 HEAVY 100 lot! VERY HEAVY ioo EACTOR 1 (k) ft S T R E N G T H S PULLPUSH SECTION. C___ EACTOR 2 C L I M B . B A L A N C E ^ 149 •fr THIS FORM IS SPECIFIC TO "WORKERS" ON W.C.B. VOCATIONAL EVALUATION PROGRAMS * f EACTOR n® n® O® cai tto<^kne^ i,croiici\cfow|&recl>'ie ' 1 Willi fULL ASSURANCE Posli rpl assurance Is COMPLEIE for, * tepe ilive manipulative actions •••(maxlOlbs) J 3 E X T E H . T Y ( EACTOR .4 H A . P v l D L . I P U G z x o < UJ cr 11 s z < 5 Factor 5 Talkingl^^) Factor. 6. l:learingC3 Factor 7 ^ Vision V_y r EACTOR- 8 in-dependent with visual signals C O O R D I N A T I O N K 150 ft STRENGTH ft I EACTOR 1 LIFTING CARRYING PULLING PUSHING SUCCESS HORIZ'L UP DOWN HORIZ'L UP DOWN (L)ARM ARM BOTH ARMS BOTH ARMS | fAClOR & OOMPQNENf | w 1 RESULTS j . 7 CIIMI1ING.& L BALANCING 2 BODY DEXTERITY 4 HANDLING TALKING 0 HEARING 7 SEEING COORDINATION CLIMBING BALANCING POSITIONS TASKS REACH -MANIPULATE FINGER VISUAL HON VISUAL MAIN ASSESSMENT FACTORS © © © © ® © © ®  MAIN OBJECTIVE RESULT f I I I I I I I Final opinion or recommendation 1 5 1 Appendix E: F u n c t i o n a l E v a l u a t i o n R e f e r r a l Form 152 Vocational Rehabilitation Services Functional Evaluation Referral Name: Injury: Consultant: •The above named worker is referred to this department lor the evaluation detailed below: REMEDIAL THERAPY DEPARTMENT Claim Number: Appointment date: R.T. • I.D. • INDUSTRIAL DEPARTMENT • Assess P:A. status as it correlates to vocational options identified • Assess or confirm capacity for vocational options identified below Assess total P.A. status Job sampling assessment to • including highest possible • demonstrate highest possible strength components functional capacity • Cybex • Skill Level Assessment (comment below) Additional Requirements/Comments: VOCATIONAL OPTIONS IDENTIFIED JJILE CCDQff EA Option 1: Option 2: Option 3: Option 4: Identify critical tolerances: Medical, physical and environmental restrictions: Medical screening: UMA | | AP | | 153 Appendix F: I n d u s t r i a l Report Form 154 Page 1 Name: Claim No.: F U N C T I O N A L E V A L U A T I O N U N I T R E P O R T Evaluation Report Name: Claim No.: Appointment date: Consultant: Date: i i i i i i i i i i i i i i i i i i i i i i i H i ! ! ! ! ! ^ PREAMBLE EVALUATION PLAN 155 Page 2 Name: Claim No.: FINDINGS FACTOR TOLERANCE 156 Page 3 Name: Claim No.: i i i i i i i i i i i i i i i i i i i i i i i i i i H ! ^ J l i j i j i i J j j i g i J j j j i i J j i i H J i J i J i H WORK BEHAVIOUR ATTENDANCE: PUNCTUALITY: Number of times late PAIN BEHAVIOUR VERBAL/NON-VERBAL: BODY MECHANICS: CONSISTENCY: INTERPRETATION WITH CLIENT CONCLUSIONS/RECOMMENDATIONS MAXIMUM FUNCTIONAL CAPACITY AREAS ASSESSED: IN FOLLOWING VOCATIONAL OPTIONS CONFIRMED AS BEING VIABLE: OPTION OPTION OPTION OPTION SPECIFIC TOLERANCES: 157 Page 4 Name: Claim No.: VOCATIONAL RECOMMENDATIONS Direc t access to labour market Access to labour market via. work assessment or TOJ Upgrading course i n s p e c i f i c trade Complete trades t r a i n i n g Other ( s p e c i f y ) : COMMENTS/DISCUSSION ! ! j i ! ! i ! ! i l i ! S l S i i S ! ! i ! i l S S S ! ! j ! i S ! ! j ! ! ! 158 Appendix G: Coopersmith S e l f - e s t e e m Inventory 159 COOPERSMITH SELF-ESTEEM INVENTORY P l e a s e r e a d the f o l l o w i n g l i s t of sentences and d e c i d e whether t h e y ' a r e s i m i l a r or " l i k e y o u " . Use the s c a l e from 1 t o 5 (see below) to d e s c r i b e how you f e e l about each sentence and i n d i c a t e by c i r c l i n g the number b e s i d e the s tatement t h a t b e s t d e s c r i b e s how you f e e l . 1 = always l i k e me 2 = u s u a l l y l i k e me 3 = sometimes l i k e me 4 = seldom l i k e me 5 = never l i k e me Always Never l i k e l i k e me me 1. I o f t e n w i sh I were someone e l s e . 1 2 3 4 5 2. I f i n d i t v e r y h a r d t o t a l k i n f r o n t 1 2 3 4 5 of a g r o u p . 3. There are l o t s of t h i n g s about myse l f 1 2 3 4 5 I ' d change i f I c o u l d . 4. I can make up my mind w i t h o u t too 1 2 3 4 5 much t r o u b l e . 5. I 'm a l o t o f fun to be w i t h . 1 2 3 4 5 6. I get u p s e t e a s i l y a t home. 1 2 3 4 5 7. I t takes me a l o n g t ime t o get used 1 2 3 4 5 to a n y t h i n g new. 8. I 'm p o p u l a r w i t h peop le my own age. 1 2 3 4 5 9. My f a m i l y expec t s too much of me. 1 2 3 4 5 10. My f a m i l y u s u a l l y c o n s i d e r s my 1 2 3 4 5 f e e l i n g s . 11. I g i v e i n v e r y e a s i l y . 1 2 3 4 5 12. I t ' s p r e t t y tough t o be me. 1 2 3 4 5 13. T h i n g s are a l l mixed up i n my l i f e . 1 2 3 4 5 160 14. Other p e o p l e u s u a l l y f o l l o w my i d e a s . 1 2 3 4 5 15. I have a low o p i n i o n o f m y s e l f . 1 2 3 4 5 16. There are many t imes when I ' d l i k e 1 2 3 4 5 to l e a v e home. 17. I o f t e n f e e l upse t about the work 1 2 3 4 5 t h a t I d o . 18. I 'm not as n i c e l o o k i n g as most 1 2 3 4 5 peop le 19. I f I have something t o s a y , I 1 2 3 4 5 u s u a l l y say i t . 20. My f a m i l y u n d e r s t a n d s me. 1 2 3 4 5 21. Most p e o p l e are b e t t e r l i k e d than 1 2 3 4 5 I am. 22. I u s u a l l y f e e l as i f my f a m i l y i s 1 2 3 4 5 p u s h i n g me. 23. I o f t e n get d i s c o u r a g e d a t what I 1 2 3 4 5 am d o i n g . 24. T h i n g s u s u a l l y d o n ' t b o t h e r me. 1 2 3 4 5 25. I c a n ' t be depended upon . 1 2 3 4 5 Name Date * R e p r i n t e d w i t h p e r m i s s i o n o f the a u t h o r 161 Appendix H: Demographic Data 162 APPENDIX D - DEMOGRAPHIC DATA Age: average - 33.32 years Value Frequency Percentage 20 23 24 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 42 44 45 1 2 1 2 3 2 1 3 4 1 2 2 6 6 5 1 2 3 1 1 1 2.0 4.0 2.0 4.0 6.0 4.0 2.0 6.0 8.0 2 4, 4, 12, 12.0 10.0 2.0 4.0 6.0 2.0 2.0 2.0 I n j u r y Type: Category Frequency Percentage Upper Body Lower Body Spine 12 22 16 24.0 44.0 32 . 0 163 3. Degree o f D i s a b i l i t y : V a l u e (%) Frequency P e r c e n t a g e 1 12 24.0 2 7 14.0 3 6 12.0 4 1 2 .0 5 8 16.0 6 2 4 .0 7 2 4 .0 8 2 4 .0 10 2 4 .0 12 1 2 .0 13 1 2 .0 15 1 2 .0 17 1 2 .0 20 2 4 .0 22 1 2 .0 25 1 2 .0 164 4. T i m e l o s s : average - 245 days V a l u e Frequency P e r c e n t a g e 11 1 2 .0 28 1 2.0 31 1 2 .0 43 1 2 .0 45 1 2 .0 68 1 2 .0 85 1 2 .0 108 1 2 .0 111 1 2 .0 125 1 2 .0 131 1 2 .0 143 1 2 .0 160 1 2 .0 164 1 2 .0 166 1 2 .0 169 1 2 .0 174 1 2 .0 175 1 2 . 0 180 1 2 .0 187 1 2 .0 194 1 2 .0 215 1 2 .0 221 1 2 . 0 240 1 2.0 245 1 2 .0 254 1 2 .0 269 1 2.0 284 1 2.0 322 1 2 .0 323 1 2 .0 348 1 2 .0 356 1 2 .0 362 1 2 .0 381 1 2 .0 394 1 2 .0 414 1 2 .0 425 1 2.0 430 1 2 .0 443 2 4 .0 463 2 4 . 0 466 1 2.0 476 1 2.0 482 1 2.0 524 1 2 .0 633 1 2 .0 639 1 2.0 641 1 2 .0 847 1 2.0 165 M a r i t a l S t a t u s : V a l u e Frequency Percentage S i n g l e M a r r i e d 18 32 36.0 64.0 Language: V a l u e Frequency P e r c e n t a g e E n g l i s h ESL 42 8 84 .0 16.0 E d u c a t i o n : average - Grade 11 V a l u e Frequency Percentage 7 2 4 .0 8 6 12.0 10 12 24.0 11 5 10.0 12 20 40.0 13 3 6.0 15 1 2 .0 16 1 2 .0 166 8. Wage D i f f e r e n c e : V a l u e ($) Frequency P e r c e n t a g e -2236.00 •1415.00 •1391.00 -872 .00 -701 .00 -648 .00 -343 .00 -313 .00 -130 .00 -87 .00 .00 96.00 165.00 600.00 814.00 943.00 1217.00 1 1 1 1 1 1 1 1 1 1 8 1 1 1 1 1 1 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 16.0 2 .0 2 .0 2 .0 2 .0 2 .0 2 .0 9. R e h a b i l i t a t i o n C o n s u l t a n t : C o n s u l t a n t # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Frequency 4 2 3 1 4 9 2 4 3 6 4 2 2 1 1 1 1 Percentage 8.0 4 .0 6.0 2 .0 8 18, 4, 8, 6.0 12.0 8, 4, 4, 2 2 2 2 167 

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