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Center for Substance Abuse Treatment. Integrating Substance Abuse Treatment and Vocational Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 38.)

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Integrating Substance Abuse Treatment and Vocational Services.

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Chapter 2—Vocational Programming And Resources

Awareness is growing about the importance of, and in most cases, the necessity of work in the recovery process. Work is central to the existence of adult functioning; in addition to providing the funds needed to live, work supplies status and security for an individual. In most substance abuse treatment models, recovery involves a shift away from substance abuse or dependence behaviors, attitudes, and beliefs to a focus on the establishment of positive life activities and attitudes. Traditionally this involves abstinence, reshaping the personality and cognitions, and developing a strong support network, all aimed at maintaining a recovery process free of relapse. Loss of or failure to adopt a positive vocational identity is a risk-laden situation for most individuals and often leads to depression, poor self-image and self-esteem, and relapse for many.

In addition to the obvious psychological implications of employment, legal and survival implications have emerged for many individuals. Welfare-to-work reforms at the State and national levels now mandate participation in gainful employment for nearly all adults; consequently, most individuals entering recovery must be prepared to seek and obtain employment. This can be a daunting task, both for individuals and substance abuse treatment agencies, many of whom may turn to vocational rehabilitation (VR) services for support and assistance.

This chapter introduces the field of vocational rehabilitation to alcohol and drug counselors and describes the services VR counselors are trained to provide, such as screening and assessment, vocational counseling, referral for training and education, and placement assistance. The chapter lists State and community resources that are useful in placing clients in jobs. In the absence of a VR counselor, the alcohol and drug counselor may have some ideas about what types of resources to use in providing vocational assistance to clients. Chapter 3 discusses issues in vocational rehabilitation from the clinical side.

Vocational Rehabilitation Counseling

Vocational rehabilitation counseling focuses on the process of improving an individual's functioning in primary life areas based on the person's values, interests, and goals. The VR counselor is trained to provide a wide range of vocational, educational, supportive, and followup services (Wolkstein and Spiller, 1998). These services include five essential functions (Schottenfeld et al., 1992):

  1. Providing information to clients about the job market, the skills and experience necessary to obtain and work successfully at a particular job, and the types of stressors and rewards associated with different jobs
  2. Assisting the client with developing a realistic view of her skills, abilities, and limitations
  3. Teaching the client basic problem solving and coping skills
  4. Helping the client to develop or maintain motivation for vocational services and employment
  5. Aiding the client in obtaining educational services, skills training, or the necessary entitlements to obtain education and training (case management)

VR counselors are professionals who have earned a master's degree in VR counseling in a rehabilitation counselor training program offered at nearly 100 universities and colleges across the country. They are trained as counselors with specialization in disability and vocational areas, and they work in a wide spectrum of school- or community-based VR programs. The VR field has long recognized the importance of its involvement in the treatment of substance abuse disorders. Consequently, in addition to their core studies, a significant percentage of rehabilitation counselor training programs include specialty studies in substance abuse disorders as an elective sequence in their programs (Benshoff et al., 1990).

Graduates of VR counselor training programs are eligible to become Certified Rehabilitation Counselors (CRCs) through the national certifying body, the Commission on Rehabilitation Counselor Certification (CRCC). The CRCC is the oldest counselor certification program in the United States, and in 1996 the connection between VR counseling and substance abuse disabilities was given more emphasis. In that year, the CRCC created the Master Addiction Counselor (MAC) certification, which is available to those who are already CRCs. As a result, universities often work with substance abuse treatment programs to cross-train with their students. Accredited rehabilitation counseling programs require their students to complete a minimum of 640 hours of supervised fieldwork under the supervision of a CRC. Students seeking a specialization in substance abuse counseling often complete practice and internships in substance abuse treatment settings.

Vocational evaluators are rehabilitation professionals specializing in assessment, vocational evaluation, and work adjustment, including prevocational readiness. Vocational evaluators may become certified as Certified Vocational Evaluators (CVEs), a national certification offered by the Commission on Certification of Work Adjustment and Vocational Evaluation Specialists (CCWAVES). To earn this certification, individuals must demonstrate proficiency in such areas as vocational interviewing, vocational assessment, and individualized vocational evaluation and planning. A bachelor of science degree in rehabilitation is the minimum qualification for a CVE, although many earn a master's degree in vocational evaluation, thus gaining preparation to provide more specialized services. In addition to learning about assessment, these professionals have studied such topics as assistive technology; group and individual counseling; counseling theories; case management; job analysis; types of disabilities; career planning; job placement techniques, testing, and evaluation; and rehabilitation issues related to particular disabilities, including substance abuse disorders.

Figure 2-1 illustrates how one agency combined vocational services with substance abuse treatment services in a residential treatment facility.

Both the Rehabilitation Act of 1973 and its Amendments and the Americans with Disabilities Act (ADA) of 1992 offer protections and eligibility for benefits and services to individuals with substance abuse disorders. For example, the ADA considers individuals who are in recovery from dependence on alcohol or who are in recovery from illicit drug use to be individuals with disabilities who are entitled to the protections of the Act (Feldblum, 1991). Within certain limitations, these Federal laws entitle those with substance abuse disorders to receive VR services funded by Federal and State governments. (See Chapter 7 for a more detailed discussion.)

Screening and Assessment

Developing a vocational plan for a particular client begins with screening and continues, as necessary, with further assessment. Vocational screening is usually performed during the initial intake process and can be performed by an intake counselor, an alcohol and drug counselor, or a VR counselor. Screening is intended to provide a rough picture of the client's vocational history and potential. It includes a brief vocational and educational history, touching on employment experiences of the individual, including legal and other-than-legal employment, military history, and special skills possessed by the individual. Many individuals with substance abuse histories lack a legal, easily verifiable employment history, but they may have worked in jobs that paid "under the table" and have developed certain job skills in consequence.

In addition to background information, the screening should assess the client's psychological willingness and readiness to enter the workforce. Many individuals who are thrust into employment by welfare reform fail, but not because of poor work skills. More often they fail because they have a poor understanding of workplace rules, regulations, or behaviors. Their failures are traced to absences, tardiness, or an inability to get along with supervisors and coworkers. In some cases, screening will reveal individuals with a positive work history and an ability to enter the workforce; in most other situations a more in-depth vocational assessment may be required. In either situation, the alcohol and drug counselor may wish to consult with a VR counselor in the development of the vocational portion of the treatment plan.

Vocational assessment is a longer, more intensive process aimed at identifying the most optimal vocational outcome for the individual (Power, 1991). It incorporates more in-depth evaluative procedures and examines the complex social, emotional, physiological, and vocational factors contributing to the individual's vocational potential. Vocational assessment should be performed by a trained VR counselor or a vocational evaluator.

When the findings from the screening and assessment process are analyzed, the services the client needs to gain "successful employment" can be identified. The meaning of successful employment is different for each client; it can mean anything from part-time to full-time employment or even volunteer work or vocational skills training. The clinician should not make assumptions and should work closely with the client to develop a treatment plan that includes a vocational component appropriate to the client's needs and abilities. For the plan to be successful, the client must be an active partner in establishing and maintaining the recovery process and must be accountable for his actions and behaviors.

As treatment progresses, the client's abilities and life circumstances can change. These changes can affect the client's capacity for employment, need, or eligibility for resources and her attitude toward employment. The vocational component of the treatment plan is a dynamic process and should be periodically evaluated to determine if (1) the stated goals are still viable and appropriate, (2) further assessment is needed, and (3) any consequent adjustments to the plan are needed. All professionals involved in the client's treatment plan should maintain a close working relationship and a dialog about the client's progress so that appropriate adjustments to the client's treatment plan can be made when necessary. Key clinical issues related to the development of vocational treatment are discussed in Chapter 3.

Screening

Screening allows the alcohol and drug counselor to determine the kinds of vocational services the client needs and to develop an appropriate vocational component to the treatment plan. Screening should accomplish the following (although not to the degree of detail that would be provided through a followup assessment or counseling by a VR counselor):

  • Identify the client's major vocationally related experience and education, as well as associated capacities and limitations.
  • Determine what referrals will help the individual attain appropriate vocational and educational outcomes.
  • Identify the necessary resources to make employment feasible for the individual (e.g., transportation, day care, psychological adjustment, healthy self-esteem).
  • Determine whether further assessment is needed to develop the vocational component of the treatment plan.

In most intake or screening processes, an important task is to review the client's medical records. If the client has not had a recent medical or psychiatric examination, these should be arranged as part of standard intake procedures since medical information has considerable relevance to a client's employability. These examinations can identify a client's limitations that are not otherwise apparent, such as visual and hearing impairments, mental health problems, and hidden coexisting disabilities. It is important to remember that information from a medical or psychiatric examination is confidential and may not be shared with other providers without the client's written consent. See Chapter 7 for a discussion of confidentiality issues.

Screening instruments

An initial screening for vocational issues can be completed by the alcohol and drug counselor. Figure 2-2 contains a sample of the kinds of vocational information that the counselor can gather during this initial screen. Publicly funded alcohol and drug treatment providers are required to use the Federal Minimum Data Set (MDS), also called the Treatment Episode Data Set (TEDS), as part of their intake and discharge procedures. The MDS contains the minimum amount of data that States are required to submit to the Substance Abuse and Mental Health Services Administration (SAMHSA) each time a client enters or leaves publicly funded substance abuse treatment. The TEDS asks about the client's education and employment status.

Assessment

The processes and instruments used for assessment are tailored to the needs of the individual client and should be administered by a trained VR counselor or vocational evaluator. They are based on established career development theories, and the instruments should be able to provide evidence of validation. They also vary according to the following:

  • Method of administration. Some instruments use pen and paper or computer forms; others use more intensive forms of vocational assessment that require observation of the individual to assess skill level and areas of difficulty.
  • The time required for assessment. An assessment can require anywhere from several hours for a typical case to 2 to 6 months for an extended work evaluation. For some clients, extended evaluation of work skills in a simulated work environment is necessary; for others, an evaluation can be accomplished using basic assessment instruments readily accessible to the counselor.
  • Timing of assessment. Generally, extensive job readiness and assessment should be completed within the first 90 days following entrance to treatment; however, some clients need time to allow their bodies to recover from the effects of severe substance abuse.
  • Resources. Assessment resources include both people and organizations with expertise in vocational assessment and are described later in this chapter. Various resources offer different types of assessment that may be helpful for particular individuals.

Functional assessment

Functional assessment is necessary to match clients with work they can perform successfully. Going beyond traditional models of diagnosis or client classification, functional assessment incorporates a broad range of assessment strategies. It aims to identify existing capabilities and limitations, along with the sociocultural or environmental conditions that impede or enhance success for the client. Sound treatment planning dictates that all of the assets and liabilities of the client be considered to develop a holistic plan. Functional assessment provides a more objective measure for evaluating client behaviors and for examining treatment planning outcomes. It is well documented that relapse and recovery failure are linked to vocational and educational failure. Functional assessment is a strategy designed to maximize success and minimize failure; it is not simply a tool to provide a diagnosis or a classification.

The term functional capacities denotes the job readiness of the individual, including skills such as the ability to read, write, relate well to supervisors and coworkers, or use a computer. Functional limitations are those deficiencies that should be addressed by a recovering person and VR counselor when planning to meet short- or long-term vocational goals. Identifying these limitations is important because the extent to which an individual's limitations are a barrier to employment depends in part on her work and living environment. For example, an individual with impaired mobility or who has a visual impairment may not drive and must travel to work by public transportation. But if the client's area is not served by public transportation, then this limitation presents a more serious barrier. Public VR services may assist individuals with impaired mobility or impaired vision to procure transportation for employment, including providing funds to purchase vehicles or convert existing vehicles to make them accessible.

The functional assessment should be performed by professionals well versed in how an individual's skills and interests lead to successful vocational outcomes. Normally, the VR counselor or vocational evaluator fits this description; however, the alcohol and drug counselor often has vital information about a client's level of functioning. In complex cases, functional assessment can be accomplished with input from a multidisciplinary team.

Key functions

A functional assessment evaluates the client's performance of key functions in five areas: living, managing finances, learning, working, and interacting socially. Interventions can then be planned to help the client develop or apply the needed skills.

  1. Living. An assessment in this area helps to determine whether the client has the individual and environmental resources to support the activities of daily living. What is the client's present living condition? Is the individual dependent on someone else to provide basic services such as cooking and cleaning?
  2. Managing finances. Can the individual manage financial activities, such as handling a paycheck, opening a bank account, or living within a budget?
  3. Learning. The purpose of an assessment in this area is to determine the client's educational level and, more important, the client's ability to process new information. Can the client concentrate, remain on task, comprehend spoken and written information, recall information, apply what has been learned, and express what has been learned clearly to others?
  4. Working. The goal of an assessment of this area is to determine whether the client has the skills to maintain a job. Job-keeping behaviors include attendance, punctuality, grooming, response to coworkers, and response to supervision. These kinds of behaviors, rather than the ability to do the job, are a primary cause of job separation (i.e., being fired, quitting) for people with substance abuse disorders (Krantz, 1971).
  5. Interacting socially. The assessment goal is to determine the individual's capacity to engage in functional interpersonal relationships. This includes an ability to accept authority, the willingness to conform to workplace rules and regulations as well as societal norms, and a sense of community responsibility.
Categories of functional limitations

People in recovery commonly have significant functional limitations, some as a result of substance abuse and some associated with coexisting disorders. These limitations can be physical, psychological, or social, and the categories may overlap.

  • Physical. Physical limitations result from impairments of the individual's biological system, including deterioration of the body as a result of substance abuse. Some physical limitations, such as HIV/AIDS, hepatitis, and peripheral neuropathy, are often related to or the result of substance abuse, while others may predate substance abuse. Such conditions must be considered when determining the client's vocational goals. Some limitations may be partially reversible with abstinence.
  • Psychological or emotional. Emotional problems, such as mood disorders, mental health problems, and anxiety, and neuropsychiatric conditions, such as learning disabilities, can affect a client's life functioning. These disorders may require psychopharmacological or behavioral interventions prior to or concurrent with vocational services (Barlow, 1988, 1993; Linehan, 1993).
  • Social. Social limitations affect the individual's capacity to interact productively with others. The heavy use of substances at an early age, a dysfunctional family or neighborhood environment, or neurodevelopmental disorders such as attention deficit/hyperactivity disorder can arrest an individual's social development and maturation. In general, the earlier the individual began using substances, the more likely limitations are to occur. Some recovering substance users also exhibit immature attitudes and behaviors not conducive to employment, such as a "short fuse" or a tendency to reject authority.

A limitation in any of these areas can be considered a challenge to employment or a vocational challenge if it affects the individual's capacity for successful employment.

Six-realm classification system

The areas of assessment have been further refined into a six-realm classification system for functional limitations and capabilities (Livneh and Male, 1993). Assessments using this sophisticated system should be performed by a trained VR counselor. The system can be used to identify and conceptualize limitations, consider remedial strategies, and help the client make an enlightened and appropriate career choice. The six realms are as follows:

  1. Cognitive-processing realm. This realm includes brain dysfunction or diminished cognitive processes (i.e., information processing, memory, intelligence). Individuals with this type of impairment often do better at less complex and more routine jobs that do not require much independent judgment. Also, they can benefit from job coaching and supported employment.
  2. Cognitive-affective realm. This realm includes impairments related to judgment, decisionmaking, motivation, concentration, and staying on task. Persons with serious impairments in this area may have difficulty functioning successfully on the job and are best suited for simple and routine jobs with a minimum of cognitive involvement.
  3. Social-affective realm. Impairments in this area include a limited ability to form or maintain meaningful relationships, as well as problems with social and interpersonal adjustment. Because most jobs require at least some interpersonal relationships, limitations in this area make it very difficult for an individual to sustain employment. Consequently, therapeutic intervention to improve relationship skills is essential prior to placement.
  4. Social-structural realm. Included in this realm are impairments that result from structural or environmental conditions (such as neurological disorders or speech impairments) that may interfere with the capacity to associate or communicate effectively with others. Most of these difficulties can be overcome if the focus is placed on the client's capabilities and appropriate use is made of applicable procedures and technology.
  5. Physical-structural realm. This area is comprised of structural-physical abnormalities resulting from accidents, birth defects, diseases, and injuries. Limitations in this area require close collaboration with medical and physical rehabilitation providers to achieve a positive outcome.
  6. Physical-neurological realm. This realm includes neurological impairments that affect physical functioning, such as those that result from birth defects or traumatic injury. It is important to focus on and use the client's remaining functional capabilities to secure appropriate employment.

Substance abuse can be a direct cause or a result of functional limitations in each of these realms. Because substance abuse is often a coexisting disability, the clinician should be aware of the possibility of impairment in any or all six realms and ensure that adequate assessment has been done to identify such limitations. Because these areas require more comprehensive evaluation of a client's strengths and limitations in several specific functional areas, a trained psychological or VR counselor is needed to make these assessments.

Assessment instruments

A number of assessment instruments are available to gather more in-depth information related to vocational skills, interests, and aptitudes (see Figure 2-3). However, special training in the use of some of the instruments is needed to correctly administer the tests and interpret findings. Descriptions of some of the most commonly used and helpful instruments follow. See Appendix B for information about obtaining these resources.

Vocational interest tools for alcohol and drug counselors

A number of instruments are available to assist in determining vocational preferences and interests. These instruments are based on different theoretical approaches to career counseling. The following are commonly used and can be administered by alcohol and drug counselors to engage the client in the vocational exploration process. See Appendix B for information about where to obtain these resources.

  • The Self-Directed Search. This tool addresses vocational interests in addition to client attributes (Holland, 1985b). It is easily administered and probes the client's dreams, interests, and abilities, yielding a three-letter code that corresponds to suitable occupations. It is available in a variety of languages and in a form for people with low reading levels. Although some training in its use can be helpful for the counselor, the manual provides sufficient instruction to interpret and use results. For the employed client, the tool helps the clinician determine whether the client's current job matches his skills and interests. For the unemployed client, it offers a sense of possible vocational directions.
  • Vocational Preference Inventory Interest Checklist. This inventory considers possible occupations for a client by matching personality types with occupational examples (Holland, 1985b).
  • My Vocational Situation. This tool addresses vocational identity and can be used to measure the effectiveness of career interventions. A simple paper-and-pencil test, it is easy to score and provides immediate feedback (Holland et al., 1980).

Psychometric vocational interest assessment tests

The following tests generally are administered by a trained VR counselor or vocational evaluator because of their complexity of administration or interpretation.

  • USES Interest Inventory (USES II). This self-report instrument measures the respondent's relative strength of interests in 12 categories of occupational activity: artistic, scientific, plants and animals, protective, mechanical, industrial, business detail, selling, accommodating, humanitarian, leading/influencing, and physical performing. It consists of 162 items of three types: job activity statements, occupational titles, and life experiences. The inventory can be used with the general adult population 16 years of age and older (U.S. Department of Labor [DOL], 1981).
  • Work Temperament Inventory. This is a self-report measure of 12 work temperaments and a person's adaptability to these temperaments. The 12 temperaments are directing others, performing repetitive work, influencing people, handling a variety of duties, expressing feelings, making judgments, working alone, performing under stress, attaining precise tolerances, working under specific instructions, dealing with people, and making decisions based on measurable data. It can be completed in about 20 minutes by hand or on a computer form. The computer-generated report will provide a percentile score profile on the 12 work temperament scales and list up to 12 worker trait groups for which the person is suited.
  • General Aptitude Test Battery. DOL developed the GATB as an occupational aptitude test (DOL, 1970). First published in 1947, it measures nine aptitude factors with eight paper-and-pencil tests and four apparatus tests. The aptitudes measured are general learning ability, verbal aptitude, numerical aptitude, spatial aptitude, form perception, clerical perception, motor coordination, finger dexterity, and manual dexterity. Trained VR counselors can administer the entire test battery, which is available to nonprofit organizations through licensing agreements with the U.S. Employment Service (USES), in about 2 1/2 hours. Either individuals or small groups can be tested. The GATB is part of a detailed career assessment and exploration system available to VR counselors. If it is used in conjunction with the USES-II (Droege, 1983) and the Guide for Occupational Exploration (GOE) (DOL, 1979), the VR counselor and client receive the most thoroughly researched occupation data file assembled for the U.S. labor market (Parker and Szymanski, 1998). Not only does it translate aptitude and interests into potential occupations, but it provides information on a series of critical job features, including physical demands, working conditions, specific preparation needed, and required mathematical and language skills. The results can be further organized via computer with the Occupational Report.

Work samples

Assessment approaches abstracted from actual job tasks can be performed to complement psychometric testing. Psychometric tests "are close simulations of actual industrial operation, no different in their essentials from what a potential worker would be required to perform on an ordinary job. Through performance on a work sample, tentative predictions about future performance can be made" (Power, 1991, p. xiv). A number of such systems are available, and they all measure performance across a range of basic job tasks.

An especially useful assessment approach is a computer-based system called the Microcomputer Evaluation Screening and Assessment System (MESA) (Brown et al., 1994; Valpar International Corporation, 1984). The MESA System is designed to "assist in identifying those individuals who are job or training ready, those who are in need of remediation, or those who may need a more comprehensive assessment" (Valpar International Corporation, 1984, p. 67). The MESA System was introduced in 1982, and the full and short forms of the system have been sold to thousands of rehabilitation facilities, schools, private practitioners, Federal programs, and other rehabilitation-related facilities in the United States. Thus, MESA System scores frequently are available to rehabilitation counselors whose clients have completed formal vocational evaluations.

Vocational Counseling

After assessment, individuals need counseling about setting vocational goals and creating short- and long-term plans for achieving those goals. To develop a plan with a client, the factors to consider include (1) the results of assessments, (2) existing training resources in the client's field, (3) employment opportunities in the local area, (4) the feasibility of alternative goals when full-time employment is not an option, and (5) client empowerment to make the necessary decisions.

Client empowerment is a fundamental premise of rehabilitation; it implies an ability to shift away from dependence to independence, a notion consistent with recovery. The very notion of empowerment suggests both the availability of opportunity and the ability to move toward that opportunity through a sequential, developmental process aimed at creating further opportunity. Empowerment is not a foreign notion to drug and alcohol treatment and recovery. The peer self-help movement empowers individuals by focusing on control of what can be controlled and recognition and acceptance that some things (i.e., drugs, alcohol) cannot be controlled. In addition, it empowers clients by creating a mutual support system and by a philosophy of moving away from learned helplessness to taking responsibility for one's own actions and behaviors.

From a rehabilitation perspective, disabilities that disempower individuals are created by attitudes, beliefs, stereotypes, and actual physical barriers in the social, vocational, or personal environment of the individual and are not intrinsic to the person. Truly empowered individuals are as independent as possible across physical, psychological, intellectual, social, and economic dimensions. From a recovery perspective these individuals might be conceptualized as having learned strong recovery skills around impulse control and delayed gratification, self-advocacy, and assertiveness. Empowered individuals are capable of going beyond manipulation of systems and people to an open, honest style aimed at securing and enjoying basic entitled rights.

A five-step approach to career counseling has been described this way (Salomone, 1988):

  1. Understand self.
  2. Understand the world of work and other relative environments.
  3. Understand the decisionmaking process.
  4. Implement career and educational decisions.
  5. Adapt to the world of work/school.

VR counselors are trained to assist clients through these or similar steps to determine vocational goals and plans.

Agreement With and Cooperation With the Plan Process

VR counselors are required to develop an individual plan for employment with each client. Formerly called the individualized written rehabilitation program (IWRP), this plan specifies the goals and objectives agreed to by the client and the agency and spells out the services the State agency will provide (see Appendix G for a sample IWRP). It is a formal document within the VR system and essentially represents the contract between the agency and the client. The principle of free choice strengthens the development and implementation of the plan--the client is presumed to have the ability to choose appropriate, realistic objectives and goals in concert with the VR counselor and is expected to meet specific and reasonable criteria for plan continuation. Consequently, a client enrolled in an educational program may be required to attend a specific number of classes and maintain a passing grade point average; a client enrolled in a vocational training program may be required to attend training regularly and on time. However, clients with substance abuse disorder-related disabilities may encounter policies or regulations not encountered by individuals with other disabilities. These dictates may be formal or informal (i.e., not contained in the agency administrative regulations) and may be operationalized at the State, regional office, or individual counselor level. For example, some agencies may require an individual to demonstrate a period of abstinence prior to eligibility for service, a regional office may require an individual to participate in counseling at a particular counseling center, or a counselor may require participation in a specified number of Alcoholics Anonymous meetings during the rehabilitation process. While these policies and regulations are usually well intended, they often pose a bureaucratic barrier to rehabilitation services. Clients who feel they are being denied services or forced into unneeded service by unreasonable or unfair policies are guaranteed the right to appeal. Each State agency has established an impartial hearing process to resolve cases in dispute.

Other legal or regulatory factors may affect participation in employment plans and treatment plans. Some clients may be required or mandated to perform certain activities by the courts or probation and parole. Welfare-to-work regulations may impose other conditions the client must fulfill. Depending on legal or regulatory factors, alcohol and drug counselors and VR counselors may need to adopt specific strategies to support, guide, and encourage clients as they seek to comply with and meet the demands of the employment plan and external forces.

Prevocational and Ongoing Services

Prevocational services are those that are typically provided before an individual begins the job-seeking process (see Figure 2-4 for examples of prevocational counseling activities). Although some clients already have work-related skills that need to be recovered, updated, or refined through a training process (or rehabilitation), others have no job skills and need to develop them for the first time. Some clients need training in basic life skills, such as how to organize themselves to engage in learning, before they can benefit from vocational training. The term habilitation describes the process of helping these clients acquire the basic skills needed to perform effectively in the workforce. There are several types of services, including life skills training programs, job readiness, work adjustment, and mentoring.

Life skills training prepares clients who have never lived independently to manage the requirements of daily life. Residential programs or halfway houses offer opportunities to gain social and life skills such as cooking, cleaning, time management, money management, grocery shopping, and general household planning. Occupational therapists are frequently the professionals who provide life skills training, when they are available. Otherwise, community support workers or other team members can supply the training.

Job readiness programs help individuals gain the specific skills, attitudes, and motivation needed to obtain and maintain employment. For example, clients learn how to interview for a job and make a positive impression on an employer, how to apply for a job in writing, how to dress, and how to prepare a résumé or work history. These services are provided through job clubs, VR agencies (e.g., Goodwill Industries, State VR agencies), nonprofit or community agencies, federally funded job training programs, or consultants.

Work adjustment is a prevocational support program for people who have never had a job and who need help learning how to work effectively. Clients perform tasks in a simulated work environment with regular evaluations. A work adjustment program should be of limited duration, with a goal of eventual competitive employment. Such programs teach clients new skills and help them learn to tolerate criticism and work well with peers and supervisors. Most work adjustment programs are designed for clients who are mentally retarded, and they have been criticized for frequent failure to lead to competitive employment. Some VR programs also provide specially trained job coaches to assist clients with work adjustment. Work adjustment needs of individuals with substance abuse disorders may be similar to the needs presented by individuals with other types of disabilities, but many substance abuse disorder clients may be offended by or resistant to participating in work adjustment programs. This is especially so if they perceive themselves as having been placed in a setting or with a disability group that is below their operational level. Both VR counselors and alcohol and drug counselors must be sensitive to these feelings in recommending a particular work adjustment site.

Training and Education

Many clients can only meet their employment goals through appropriate education or training. Some perhaps lack literacy. They may have dropped out of high school. Some have a history of chronic underemployment, and others have long-term plans that require advanced knowledge and skills.

The terms education and training are sometimes used interchangeably; however, providers of these services commonly make a distinction between the two. These services, or the referrals for them, are available through State employment services commissions, one-stop centers, schools, employers, VR centers, and colleges and universities.

In general, an educational program provides information and sometimes skills that the participant can use in a variety of settings; there is no clear and specific vocational application. At the end, the participant has learned a subject and may also have developed or honed skills--such as the ability to make a well-reasoned argument--that can be applied in many contexts. For example, a college program leading to a bachelor of arts degree in history is an educational program.

In contrast, a training program, such as the Job Corps, shows the participant how to perform a task and in the process provides information to give the instruction a context. For example, a course where the individual learns to repair computers or to build a database using a particular kind of software is considered training.

It is possible to envision a continuum from "pure" education that has little to do with a particular job (e.g., history) to training that builds skills that can be applied in a variety of jobs (database development) or that is specific to the needs of a particular job (how to use custom-designed software to build a database for a specific job application). Which type of program is most applicable to meeting the client's needs will, of course, depend on the client's goals, timelines, and aptitude for engaging in learning under given conditions. Most secondary school and adult education programs provide a combination of educational and training activities.

This section describes several of the most common kinds of training and education programs that are available to clients. These resources include school-to-work transition programs, on-the-job training, apprenticeship programs, technical schools and colleges, community-sponsored adult education, and colleges and universities.

School-to-Work Transition Programs

School-to-work transition programs provide opportunities for students to broaden their educational, career, and economic opportunities. These programs build on and expand other existing programs of several types, such as technical preparatory, cooperative education, youth apprenticeship, career academics, and schools within schools. These programs have several components:

  • Work-based learning. This includes work experience, job training, workplace mentoring, and instruction in workplace competencies that occur on the worksite.
  • School-based learning. This type of learning includes career counseling, career selection, major program of study, and integrating academics with vocational education.
  • Connecting activities. These include matching students with employers, job placement, continuing education or further training assistance, and linkages with youth development activities and industry.

Most local school systems are directed to provide career exploration and support for all students, beginning in elementary school.

On-the-Job Training

Some employers offer their employees opportunities to gain the necessary skills for a specific job task in a supervised setting. On-the-job training, when available, clearly benefits the employee by providing useful training at no cost; it also benefits the employer by ensuring that the employee is familiar with the company's particular way of doing things.

Through networking with employers and tapping into the knowledge of employment professionals, the clinician can learn which employers in the area train their new employees and under what terms, and then make helpful suggestions to clients. Programs are sometimes available to assist in organizing these experiences, subsidizing the salary through the training period, or providing a tax credit. Alcohol and drug counselors should consult the Job Training Partnership Act (JTPA) and welfare-to-work agencies in their area to see if on-the-job training relationships have already been developed with local employers.

Apprenticeship Programs

Apprenticeship programs offer a structured process for mastering a particular profession, such as carpentry or plumbing. Individuals work side by side with a skilled person. All apprenticeship programs require some classroom work as well.

These programs are organized through unions and employment commissions. State agriculture departments often have apprenticeship programs suitable for farm and greenhouse management positions. An individual must meet certain criteria and often is required to take aptitude and interest tests upon application. It is important for the applicant to have references and experience in entry-level jobs in the field. Of course, a critical component is the employer's willingness to make a commitment to train the individual.

Technical Colleges and Schools

Some schools and colleges offer vocational training in which participants develop and practice the skills needed to meet the requirements of a particular job. Some examples of jobs include computer operator or repairperson, business manager, automotive service technician, nurse's aide, emergency medical technician, beautician, chef, welder, plumber, and veterinary assistant. Usually, technical colleges and vocational schools serve specific groups of occupations, such as technological or human services.

Some schools offer 2-year degree programs that lead to an associate's degree, 1-year diploma programs, or certifications that require less than 1 year. The degree programs often combine technical classes with general education requirements that focus on oral and written communications skills, math skills, research and computer skills, and social/interpersonal skills.

All technical colleges and schools operate under an admissions policy that outlines the requirements for attendance. Some require a high school diploma or general equivalency diploma (GED), whereas others offer remedial education that allows a person to obtain a GED. All such programs require tuition, paid by either the student or another funding source. Some offer financial aid and provide staff members to assist students in the pursuit of such funding. Referring a client prematurely to a technical school can be harmful if the client embarks on the program without the financial support to complete it successfully and defaults on the loan.

Community-Sponsored Adult Education

Some city or county school systems use public schools on evenings and weekends to deliver a range of programs for adults, recent graduates, and young persons who dropped out of school. Many regions have accessible, well-staffed community colleges. These programs often are attractive to young people who do not have enough money to enter extensive training programs. Public schools sometimes offer preparation for GEDs, remedial education programs, and basic courses for adults. Some community programs offer courses in word processing, graphic design, and other skills.

Programs available through community schools and community colleges are often reasonably priced and likely to be accessible by mass transit services. Alcohol and drug counselors should become familiar with the public educational opportunities provided by local schools to assist clients in using these resources.

Colleges and Universities

Colleges and universities offer programs that provide general knowledge and skills that are applicable to many different professions. State-supported schools are likely to have lower tuition fees and generally give priority to State residents.

Some clients who want to attend a college or university have poor academic records because of previous substance abuse or learning problems. Students who are unsure of their academic skills may want to take some courses on a pass/fail basis or register as special students rather than as degree candidates taking a full-time course load. For those who want to demonstrate their qualifications as students to a college or university before applying, taking courses at a less competitive school and doing well in them, then transferring, is a good strategy. Note, too, that clients may wish to pursue a 2-year associate's degree if it is difficult to commit to a 4-year program.

Colleges and universities are required by law to provide support services to students with disabilities, including learning disabilities. This might mean providing accommodations such as assistance in taking class notes or special arrangements for taking tests. However, to receive such services, the student must present documented evidence of a disability requiring the need for the accommodations requested.

Employment Services

The following sections review some of the most commonly used employment and vocational services that could benefit clients recovering from a substance abuse disorder who are seeking employment.

Job-Seeking Skills and Training

Some clients will need help learning how to secure employment because they have never looked for a job, are seeking a different kind of job, or have special problems to address in the job search (e.g., how to handle the existence of a criminal record). Many of the providers identified in this chapter offer assistance in numerous areas, such as the following:

  • How to read and assess want ads. This includes how to determine whether a position is appropriate for the client's interests, skills, and background.
  • How to obtain job leads. This includes using job development programs like those maintained by unions and unemployment offices, the Urban League, and the National Association for the Advancement of Colored People (NAACP), and finding alternative sources for job information, such as networking with friends, and checking job boards in public housing administrative offices, city halls, and the like.
  • How to prepare a résumé that presents the client in the best possible light. Clients who have never written a résumé will need help in distinguishing among types of résumés, knowing which type is appropriate for their skill level, and determining employers' preferences.
  • How to find job information provided on the Internet. The moderately sophisticated client will be able to use information from the Internet in locating suitable opportunities.
  • How to contact employers and make appointments for job interviews. This could include developing a short introductory speech, role-playing its delivery, and learning what types of responses to expect from potential employers.
  • How to fill out job application forms that are legible, highlight the client's skills, and provide the information requested. This also includes discussion of when and how to inform an employer about a substance abuse history.
  • How to interview for a job, including how to dress and how to answer questions related to the client's substance use history, coexisting disability, gaps in employment, or criminal record (see Chapter 7 for more information). Different jobs require different degrees of formality of dress, but cleanliness, grooming, and manners are always important.
  • How to organize and manage time during the job search process so that the client's time is structured and conducive to maintaining abstinence. Being systematic and organized in the job search pays off. This includes expectations for the number of contacts made each week, the best times to contact employers, and working out transportation.

Job clubs, which use a behaviorally based, group-oriented approach, are another source to help jobseekers (see Chapter 4 for more information about job clubs). Meeting daily or weekly, jobseekers help themselves and each other develop and pursue job leads, practice interviewing skills, and receive encouragement. These approaches have proven effective in helping many people achieve their job goals.

Another valuable source for jobseekers is the Internet. Figure 2-5 describes America's Job Bank (AJB), a Web site maintained by DOL in conjunction with State employment offices.

Job Development and Placement Approaches

Effective job development generally requires the VR counselor to provide multiple services, such as networking with employers, establishing relationships with them, and assembling information about employment opportunities for clients. The counselor locates jobs and also provides information to the employer about the client (within the confines of confidentiality). This addresses potential barriers to employment that result from biases and discrimination. VR counselors also conduct outreach to area employers to publicize the availability of individuals with the requisite skills for the job. Participating employers can receive certificates, publicity, or other recognition.

Job development also requires the counselor to become familiar with the local labor market to better guide clients about the types of employment that are available locally. For many States this information is available online. DOL regularly identifies the professions that it projects will expand in the future on its Web site (www.dol.gov) and in its annual publication, Occupational Outlook Handbook. AJB (www.ajb.dni.us) has links to State employment databases, and the Career InfoNet Web site (www.acinet.org) also provides occupational growth projections. This information allows the client to make decisions about a career that will be viable both in the present and in the future.

In the act of job placement, the VR counselor can intervene with the employer on behalf of the jobseeker. The intensity of the placement services varies from case to case, depending on such factors as the client's level of motivation, openness on the part of the employer, and the status of the economy. It requires a skilled professional with the knowledge and abilities to counsel both the client and the employer effectively, as well as to understand the intricacies of recruitment, human resources issues, and job satisfaction (Parker and Szymanski, 1998). Research also indicates that when a job placement plan is developed separately (i.e., in addition to the primary substance abuse treatment plan), counselors are more likely to successfully place their client in a job (Zadny and James, 1977). This may be because separately developing a vocational plan places more emphasis on employment.

Job placement can be completed by an individual consultant or through a program or agency. Also, a number of national computerized services exist to help individuals identify prospective employment suitable to their skills (see Figure 2-5). Most States have online systems that work in a similar way: Employers post job openings, and respondents place résumés and cover letters on file for employers to review.

Supported Work Programs

Supported employment enables people with disabilities who have not been successfully employed to work and contribute to society. The locus of vocational rehabilitation in supported employment shifts from that of a sheltered setting to a real-world job setting. This approach is appropriate for clients with coexisting disorders (e.g., mental retardation, chronic mental illness, traumatic brain injury) that are so severe that they cannot maintain employment without intervention. Common forms of supported employment service delivery include the following:

  • Job coaching. A life skills coach works with the client in a blended staff situation. The coach may go to the client's home or "shadow" the client to get him to work on time. Job coaching is usually used during early phases of employment (i.e., the first 90 days), then discontinued or reintroduced as needed.
  • Enclave or mobile crews. Although this approach has been criticized for isolating rather than integrating workers with disabilities, it is still common. An enclave is a group of individuals who accomplish a set of work tasks at a specific place of employment, sometimes by sharing a single job as a group. Typically, the business pays the service provider, which in turn pays the enclave employees. A mobile crew forms contractual relationships with businesses to perform a service, such as grounds maintenance or housecleaning. A supervisor or counselor oversees a group of clients who perform a job together to ensure work quality.
  • Mentoring . A mentor is an individual who provides support to the client within the work setting. For example, a mentor can be someone who has gone through treatment and now holds a job similar to the client's job.

This arrangement is relatively easy for a residential treatment facility to arrange if the same employers hire clients from the facility. Mentoring can be extremely effective when linked to self-help support groups.

  • Wage subsidy programs. These Federal and State programs provide a subsidy for sheltered employees to encourage employers in the competitive job market to hire them.

Typically, they pay up to one-half the employees' salary for the first 90 days of a job.

Figure 2-6 provides an example of a rehabilitation facility that offers supported work.

Job Retention and Advancement

Once a client has a job, a different set of issues arises. The client needs assistance in identifying relapse triggers that exist on the new job and in resisting the impulse to celebrate by drinking or using drugs for having secured employment. If the client has a disability in addition to a substance abuse disorder, VR counselors may need to help him identify any reasonable accommodations and assistive devices needed to perform required job functions. Individuals sometimes find they need additional education to help them manage their paycheck and household budget or to address other life changes and responsibilities that occur as a result of employment. Counselors should encourage clients to take advantage of their employer's employee assistance program as needed. Treatment programs need to accommodate their newly employed clients by having evening counseling hours and providing onsite child care while clients attend treatment programs.

Some kind of support for the long term must be built into VR programs so that the client avoids boredom, takes advantage of opportunities to advance, and manages crises at work. In addition, today's job market demands that clients be prepared for the possibility of job loss. VR counselors can inoculate clients against the attendant dangers of despair and relapse by working with the clients to develop a career network that identifies alternative strategies and pathways clients can use in the event of job loss or new openings. (See Chapter 3 for additional discussion of clinical aspects of job retention and advancement.)

Overview of Vocational Resources

For referral purposes, it is important for the clinician to be familiar with the local resources available to clients. Some clients will need only education and training to help them prepare for a career or enhance existing qualifications. Others will require a variety of rehabilitation services in addition to training or education. Some will need counseling to help them choose an employment situation that will make the best possible use of their skills and satisfy their own criteria for "successful employment."

The following sections discuss the variety of resources and services that may be available to clients. There will be considerable differences from one region to another in what resources are available, how they are structured, and whom they serve.

However, this discussion is intended to suggest avenues that could be explored to find new sources of vocational assistance.

Employment Resources

Workforce Investment Act

On August 7, 1998, President Clinton signed P.L. 105-220, the Workforce Investment Act of 1998, into law. This legislation consolidates more than 60 Federal programs into three block grants to States for employment, training, and literacy. This reform measure replaces programs currently under the Job Training Partnership Act, the Stewart McKinney Act, the Carl Perkins Act, and the Adult Education and Family Literacy Act. Statewide and local Workforce Investment Boards (WIBs), which will replace Private Industry Councils (PICs), are required to provide employment and training activities to help youths and adults facing serious barriers, such as disabilities (including substance abuse disorders). The activities of the WIBs include disseminating lists of service providers and establishing one-stop delivery systems for the following services:

  • Outreach, intake, and orientation to available services
  • Assessment
  • Job search and placement assistance
  • Career counseling
  • Provision of employment information and forecasts
  • Assistance in finding funding and other support for training and education
  • Followup services

These programs provide job training and other services that are intended to increase employment and earnings, increase educational and occupational skills, and decrease reliance on welfare. Alcohol and drug counselors should be aware of the eligibility requirements and locations of these programs in their areas and refer clients to these services as appropriate. (See Chapter 7 for further discussion of the Workforce Investment Act.)

State employment services commissions

A network of State employment agencies is funded by DOL to offer a variety of services to persons who are eligible to work in the United States. The agency names vary (see Appendix E for a list of the agencies in all States). A central office is usually established in the State capital, and field offices are dispersed in communities to serve people in specific geographic areas.

Typically, they offer the following types of services to those looking for jobs and to employers:

  • Jobseeker services. Such services may include job referral and placement, referral to training, and activities to build skills in the job search process.
  • Job search support. Many State programs have computer-assisted job search capability, which allows jobseekers to reach beyond their immediate community. These databases also can provide assistance with career information. Multimedia systems include computer programs, career information hotlines, microfiche, newspapers, and Internet listings.
  • Employer services. Staff can assist employers by screening and referring applicants for job vacancies.
  • Labor market information. The agency collects, analyzes, and publishes data relating to all aspects of the State's labor market. This information includes current employment statistics, wage information, unemployment rates, and data regarding occupation trends.
  • Unemployment insurance services. The agency collects unemployment taxes from employers and pays unemployment benefits to eligible individuals who have lost a job through no fault of their own.

These State agencies work closely with local government and private employers. Some have WIBs and Employer Advisory Committees. Employer Advisory Committees are local conglomerates that have a function similar to WIBs and are charged, usually by "one-stop" legislation such as the Workforce Investment Act of 1998, with planning, coordinating, and implementing all public economic development and employment services. As a consequence, these organizations also often provide direct links to available Federal, State, and local government jobs. Two government-run case management programs are described in Figures 2-7 and 2-8. Figure 2-9 describes an employment program for ex-offenders in Texas.

State vocational rehabilitation agencies

The Rehabilitation Act of 1973, as amended, authorizes the allocation of Federal funds to establish State VR programs to assist individuals with disabilities in preparing for and securing employment.

Priority is given to people with the most severe disabilities. To be eligible for VR services from a State agency, a person must

  • Have a physical or mental impairment (includes substance abuse disorder) that is a substantial impediment to employment
  • Be able to benefit from VR services in terms of employment
  • Require VR services to prepare for, enter, engage in, or retain employment

This type of agency exists in all States and Territories. Each agency has a central office, which is usually located in the State or Territory capital, and field offices throughout the State or Territory. Counselors may be assigned to specific geographic locations, particularly to ensure coverage in rural areas. Some specialize in providing certain services, such as job placement, or work with a specific population (e.g., those with substance abuse disorders or brain injuries).

State VR offices provide a wide range of services, including vocational counseling, planning, training, and job development and placement. The alcohol and drug counselor can refer a client to a State VR office after the initial assessment phase is completed and the client is ready to benefit from these services. Before accepting the client, the coordinating counselor arranges for further assessments to determine the client's readiness for rehabilitation.

The primary case management and counseling services for the State agency are provided by a rehabilitation counselor. The rehabilitation counselor's responsibilities include (1) assessing the client's needs, (2) developing programs and/or plans to meet identified needs, and (3) providing or arranging for the services needed by the client, which may include job placement and followup services (Parker and Szymanski, 1998).

Once a client is accepted by the agency, rehabilitation legislation mandates the development of an individual plan for employment (IPE)--also known in some States as the IWRP--to identify goals and objectives for employment, as well as a timetable for achievement. It is important for the alcohol and drug counselor to review the plan with the VR counselor to support the client in achieving these goals and identifying potential difficulties. The vocational plan should reinforce the substance abuse treatment plan and make the interagency linkage work as well as possible for the client.

Before referring clients to this type of service, the clinician should first develop a relationship with the assigned VR office, which is likely listed in the phone book in the State government section. Because many VR staff members will need cross-training in substance abuse treatment, each office should have a supervisor who can help determine which counselor should receive the referral.

Clients referred to a State VR agency must call to make an intake appointment. It helps to have psychological and medical evaluations ready, as obtaining documentation of disability is the second step of the process and often the most cumbersome. These evaluations must be signed by appropriate professionals and indicate the type of disability and limitations. Also, any information about a client that is divulged to another agency must be accompanied by a release form signed by the client (see Chapter 7 for a detailed discussion on confidentiality issues). State VR agencies can place clients in precontracted job training programs or provide funding for eligible clients to attend technical or college programs. This funding can enable indigent clients to receive the higher education services that would have eluded them without this support.

Seeking and Securing Funds for Vocational Services

Two recent pieces of legislation will strongly influence the ways that treatment programs seek and secure funds to meet their clients' vocational needs. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 dramatically transformed the means by which public assistance is provided (see Chapter 7 for details on this legislation). The Balanced Budget Act of 1997 provided additional resources to support the goals of the 1996 welfare reform legislation by authorizing DOL to provide welfare-to-work grants to States and local communities. These grants are to be used for transitional employment assistance to move hard-to-employ recipients of Temporary Assistance for Needy Families (TANF) into unsubsidized jobs offering long-term employment opportunities; clients with substance abuse disorders are specifically targeted. The program is mobilizing the business community (largely through local WIBs) to hire welfare recipients and is working with civic, religious, and nonprofit groups to mentor families leaving welfare for work.

Funds can be used by States, PICs, WIBs, and other entities to move eligible individuals into long-term jobs by a number of means, including job retention and supportive services such as substance abuse treatment. Although TANF (and therefore welfare-to-work) funds cannot be used for "medical services" such as detoxification under the care of a physician, a range of substance abuse treatment services can be provided under this funding. In some States, TANF block grant funds have been allocated for substance abuse treatment services, including assessment, residential treatment, and less intensive outpatient programs.

The welfare-to-work legislation is implemented differently in each State, and there is a complex web of political and financial forces that must be understood to access this funding effectively. Scanning the environment to determine the relationships among the welfare agencies, PICs, WIBs, State substance abuse agencies, and other community-based organizations is critical. It is in this context--a complex landscape of shifting ideas about treating substance abuse disorders, changing funding streams, and the blurring of roles and responsibilities between public and private sectors and between Federal and State governments--that substance abuse treatment programs must seek to secure the funds that have been set aside to help chronically unemployed welfare recipients obtain and maintain work.

Program planners should look to the future and budget for one-time expenditure items that will improve vocational outcomes for clients. Such items might include a computer with a package of vocational assessment software. A VR library can be budgeted as a one-time expense although some updating is periodically needed (see Figure 2-10). Additional information on securing funding for expanding current programs and hiring is provided in Chapter 6.

Resources for Veterans

When eligible dependents and survivors are included, nearly one-third of the U.S. population is entitled to veterans' benefits (U.S. Department of Veterans Affairs, 1997). The huge job of administering these benefits belongs to the Veterans Benefits Administration (VBA). The VBA's mission, in partnership with the Veterans Health Administration, is to provide benefits and services to veterans and their families in a responsive, timely, and compassionate manner in recognition of their service to the nation. The benefits include compensation and pensions, housing loans, insurance, and vocational or educational counseling and training. The VBA's educational services have two objectives:

  1. To enable veterans to pursue training or attain higher education for the purpose of adjusting to civilian life, restoring lost educational opportunity, and expanding economic capacity.
  2. To provide educational opportunities to children whose education would be impeded by reason of death or disability of a parent incurred in the Armed Forces; these opportunities are extended to surviving spouses in preparing them to support themselves and their families at a level the veteran could have expected to provide.

Vocational Rehabilitation and Counseling Service programs (VR&C services) primarily serve veterans entitled to benefits under 38 U.S.C., §3100 et seq. VR&C services administer vocational training to certain nonservice-connected veterans awarded disability pensions and educational and vocational counseling to specified classes of beneficiaries (veterans, service members, spouses, widows, and children of disabled veterans). Alcohol and drug counselors should be aware of those clients who are entitled to these benefits and how to access these services. Persons eligible for veterans benefits must apply through the local or regional Veterans Administration office, which can be located through the Federal government pages of the telephone book.

Community-Level Providers

Almost every community has a host of agencies that provide VR services. They offer a variety of services, from job-seeking assistance to employment in a sheltered or supported environment. In some States these agencies are State-certified and funded. In other States they are funded and operated by counties or cities. In many instances, the agencies are private, nonprofit groups funded from a variety of sources to serve a specific group of clients. Eligibility for the services varies according to the policies established by the specific organization and its funding sources. Some serve persons with disabilities who are unable to work in a competitive environment, whereas others focus on youths who are at risk for dropping out of school or need a second opportunity because they already dropped out. Particular populations, such as those in a public housing community, could also benefit from rehabilitation programs targeting their needs. The key is that these services are designed to meet the unique needs of the community.

These organizations receive funding from a number of funding streams--Federal, State, and private (including foundations). The Neighborhood Funders Group is a national association of grantmaking institutions. It has more than 150 member foundations that seek to improve the economic and social fabric of low-income urban neighborhoods and rural communities. Many of their programs fund employment projects that vary from community to community. The local social services agency is a starting point to learn more about these programs.

Community-based rehabilitation centers

Community-based rehabilitation centers offer a range of medical, social, psychological, and technological services to persons with disabilities. They serve a locality, allowing people to undergo rehabilitation and build supports in their own community. They receive funding from State agencies, insurance companies, and nonprofit agencies (e.g., Goodwill Industries). A community-based rehabilitation center's target population varies according to the center's mission but might include persons with a traumatic brain injury, spinal cord injury, and learning disabilities, among others. Referrals to this type of center require coordination with the funding source.

Mental health agencies

Some local mental health agencies have designed vocational services as part of their continuum of care for eligible clients. These services vary and require coordination through the mental health care center or office. Persons who have a mental illness and require supportive services to obtain and maintain employment may be eligible. Some examples of typical programs include job club programs as part of day treatment programs, job coaching for obtaining and maintaining appropriate work behaviors, and supportive employment onsite in a work setting. Alcohol and drug counselors have numerous avenues for finding out about local VR services:

  • State VR department or a local office of the department in a city
  • The Web site for the State VR department
  • Single State Agency for substance abuse prevention and treatment
  • State Department of Labor
  • State or local Workforce Investment Board
  • Local Private Industry Council (a listing is available at www.ttrc.doleta.gov)
  • Local One-Stop Center (a listing is available at www.ttrc.doleta.gov/onestop)
  • Local employment development department
  • Private agencies, such as Goodwill Industries

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