WORK EVALUATIONS AND INTERVENTIONS

Overview of How OT as a Profession Contributes to Work Participation

The distinct value of occupational therapy is to improve health and quality of life by facilitating engagement in occupations. Work is an occupation that includes employment seeking and acquisition, job performance, retirement preparation, and volunteer exploration and participation. Occupational therapy practitioners understand the complex and dynamic interactions of the person, their habits and routines, the work demands, and the context of the work environment. This understanding enables practitioners to develop client-centered interventions to increase health and wellness, prevent disability, and facilitate participation in work activities. Occupational therapy is the only profession that looks at the whole person and provides supports to address client factors (e.g., assistive technology, ergonomics), job demands (e.g., task modifications), and environmental factors (e.g., noise levels, working conditions).

Work is a meaningful occupation that spans nearly all practice settings and populations. Occupational therapy practitioners in all settings should consider the occupation of work for clients from ages 15 to 65+ years. Examples include addressing pre-vocational and job readiness skills in school settings; return-to-work skills in inpatient and outpatient settings; and job accommodations and ergonomic considerations in the workplace.

Occupational therapy practitioners can address work in a variety of environments including, but not limited to:
* Business and industrial environments
* Acute care and rehabilitation facilities
* Mental health facilities
* Sheltered workshops or other vocational programs
* Community settings
* Outpatient clinics
* Hospitals
* Private practice
* Schools
* Public agencies

On-site evaluations and intervention
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Referrals come from a variety of sources requesting on-site work evaluation and intervention (e.g., physicians, case managers, other health care providers, workers’ compensation and long-term disability carriers, vocational rehabilitation agencies, and other private or public agencies) for individuals who are beginning work, desiring to remain at work following injury or disease, or returning to work after an injury or disability. These providers may also request injury prevention and health and wellness services for individuals and groups.
Examples of services provided by occupational therapy include evaluating client performance and function; evaluating work demands; identifying injury risk factors; identifying job accommodations and modifications needed to return to work; and providing work transition services, ergonomic evaluation, and injury prevention services.

Work

Work – An area of occupation that is defined as “Labor or exertion; to make, construct, manufacture, form, fashion, or shape objects; to organize, plan, or evaluate services or processes of living or governing; committed occupations that are performed with or without financial reward” (Christiansen & Townsend, 2010, p. 423).

Work is integral to participation in society, and provides many returns to the worker including economic rewards, meaning, and fulfillment. An adverse work situation can also negatively affect quality of life and well-being. AOTA has identified Work and Industry as a key practice area in the 21st century.

1. Employment interests and pursuits- Identifying and selecting work opportunities based on assets, limitations, likes, and dislikes relative to work (adapted from Mosey, 1996, p. 342).
2. Employment seeking and acquisition- Advocating for oneself; completing, submitting, and reviewing appropriate application materials; preparing for interviews; participating in interviews and following up afterward; discussing job benefits; and finalizing negotiations.
3. Job performance- Performing the requirements of a job, including work skills and patterns; time management; relationships with coworkers, managers, and customers; leadership and supervision; creation, production, and distribution of products and services; initiation, sustainment, and completion of work; and compliance with work norms and procedures.
4. Retirement preparation and adjustment- Determining aptitudes, developing interests and skills, selecting appropriate avocational pursuits, and adjusting lifestyle in the absence of the worker role.
5. Volunteer exploration- Determining community causes, organizations, or opportunities for unpaid work in relationship to personal skills, interests, location, and time available.
6. Volunteer participation- Performing unpaid work activities for the benefit of selected causes, organizations, or facilities.

Occupational therapy practitioners promote success in the workplace by improving the fit between the person, the job tasks, and the environment. They work with employers and employees to adapt or modify the environment or task, facilitate successful return to work after illness or injury, and help prevent illness or injury to promote participation, health, productivity, and satisfaction in the workplace. They may work with children and adults with developmental and intellectual disabilities to help them prepare for work and transition into the workforce. Occupational therapy practitioners also provide services related to ergonomics, accessibility, the aging workforce, and workplace health and wellness issues.

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Categories of Work

5 categories of work (as defined by Code of Federal Regulations)

1. Sedentary work– involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

2. Light work– involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that he or she can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

3.Medium work-

4. Heavy work– involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that he or she can also do medium, light, and sedentary work.

5. Very heavy work<– involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that he or she can also do heavy, medium, light and sedentary work.

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Occupational Therapy Roles in Various Aspects of Work Rehabilitation

Occupational therapists work with employers, workers, and other healthcare professionals or team members to create and implement feasible and individualized intervention plans in the following broad areas. They also evaluate the outcomes of these interventions and make any necessary adjustments.

Acute Injury and Illness Management: The occupational therapist works with the person to determine any gaps between the demands of the job and the individual’s existing performance abilities and remediates or compensates for the differences in a timely manner.

Work Conditioning: The occupational therapist uses a systematic approach to restore the performance skills of workers recovering from long-term injury or illness. There is a focus on restoring musculoskeletal and cardiovascular systems, as well as safely performing work tasks. This is typically achieved through work simulation and individualized interventions to improve physical capacity.

Work Hardening: This approach is similar to work conditioning however, it is multidisciplinary and can involve psychomedical counseling, ergonomic evaluation, job coaching, and/or transitional work services. Persons in work-hardening programs may progress to transitional work programming by actually performing job duties at their place of employment. If necessary, final adaptations and/or reasonable accommodations can be determined during this period of transition.

Functional Capacity Evaluation (FCE): The occupational therapist uses standardized and validated advanced testing in order to (a) determine safe job matches for return to work; (b) determine the level of reasonable accommodations necessary for reinstating an injured worker; and (c) make recommendations regarding future interventions. The results of the FCE may be used by the physician to make a disability rating for insurance purposes.

Environmental Modification: The occupational therapist, together with the worker and the employer, makes recommendations for modifications to the workplace environment to facilitate successful employment performance.

Transitional Work Programs: Transitional work uses the actual work tasks and environments as a form of rehabilitation. After becoming familiar with the individual’s job requirements and measuring the individual’s functional abilities, the occupational therapist determines tasks that the individual can safely and dependably perform at work. The occupational therapist works with the employer to identify environmental and task modifications that will support work performance, and makes detailed recommendations to the treating physician, who releases the individual to modified work within these parameters. Work performance is closely monitored and discussed among the occupational therapist, employer, and individual, and modifications change as the worker develops more skills.