Our highly credentialed vocational rehabilitation and life care plan experts write about topics that are important and relevant to our areas of practice. If you have a vocational or life care planning topic you would like to learn more about, please contact us to request a blog post on that topic.
Suitability of Return to Work Offers
The primary goal after an injury is to return the worker to their pre-injury place of employment. The employer may tender offers of the same, modified, or alternate job that impacts the individual's vocational outlook and employability. It is essential to assess this return's appropriateness and "suitability" based on physical restrictions and job requirements, which is the purview of qualified vocational rehabilitation counselors.
For example, in the case of an offshore tankerman with a work-related knee injury, the employer of injury offered a return to work as an inland tankerman. The physical restrictions outlined by the physician included no lifting greater than 80 pounds, no jumping, occasional climbing of stairs and ladders, and no work on "unstable ground." The vocational expert's opinion was that offshore work involved "rough waters" (unstable ground); however, work as an inland tankerman did not require work on rough waters and was within the medical restrictions assigned by the treating physician. The employer's detailed job description fell within the physical restrictions outlined, so this was considered a suitable job offer.
In another example, a nurse involved in a motor vehicle collision who sustained a low back injury was eventually released for light level work and prescribed narcotic medication for pain control. Her job of injury was classified as medium-level work beyond the restrictions outlined. Her employer offered her an alternative position as an office nurse to accommodate her physical limitations. The vocational expert contacted the employer for more details concerning the job offer and learned that using prescription narcotics would prohibit her from returning to work. This job offer, therefore, was not considered "suitable."
Key actions taken by vocational counselors in determining the suitability of a job offer include:
Obtain a detailed written job description of the job offered, including all the essential functions and job tasks, specific physical requirements, work schedule, and educational requirements.
Conduct an on-site job analysis to personally assess the worksite to obtain and clarify job requirements, physical requirements, and whether any modifications or accommodations can be made by the employer, as necessary.
Use sources such as the Dictionary of Occupational Titles, Selected Characteristics of Occupations, and the Revised Handbook for Analyzing Jobs to clarify and validate physical requirements (exertional and non-exertional), skills, and education required.
Provide a detailed written job description of the job to the treating or consulting physician for approval concerning the individual's physical ability to perform the job with or without modifications.
Provide follow-up services for at least 30 to 60 days once the injured worker returns to employment to offer any assistance necessary to ensure a successful return to work.
A successful return to work of an injured individual is not only of benefit to the injured worker but can greatly assist in determining the value of a wage loss claim. To do so, the vocational consultant should assess the job offer's details to determine if the job is appropriate and suitable for the individual and not merely accept the offer at face value.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Vocational Profile and Alternate Jobs
As vocational consultants, we rely on an individual's vocational profile to analyze the types of alternate jobs they can perform. The vocational profile incorporates multiple factors, including age, education, work history, transferable skills, geographical location, vocational test results (if applicable), and physical/cognitive capabilities or limitations. These factors are analyzed to arrive at a vocational prognosis.
Vocational consultants frequently identify alternate jobs for an evaluee precluded from returning to a position held at the time of the injury. We look closely at the individual's vocational profile to determine the most appropriate, reliable, and realistic alternate jobs that the person can likely perform and are available in the labor market. Essential questions include: Has the person obtained the education requirements for this position? Has the person acquired skills that would transfer to this type of work? Is this type of occupation readily available where this person lives or within a reasonable commutable distance? What are the physical demands of this position, and is the person capable of performing this work?
In addition to these questions, demographic factors can dramatically impact the overall vocational prognosis when assigning alternate jobs. Take, for example, age. An individual's age drives work-life expectancy, which describes the likely time period one can expect to generate realistic earnings when returning to the workforce. For example, if a woman is 25 years old, she will likely have the opportunity to increase earning potential with time, experience, or additional training, which would upgrade her vocational prognosis. On the other hand, if she is 65 years old, she will likely be limited in her time in the labor market and may not reach the potential to earn above starting wages in alternate occupations.
Another vital element of the vocational profile that affects alternate jobs is work history. In vocational rehabilitation, the goal is to return the injured worker to the same or accommodated position with the same employer. If not possible, we look for the same or similar job with a different employer. If that is not possible, we look for related jobs in the same field. And finally, we consider new jobs in a new field. This hierarchy reasons that it will take less time to transition if the new or alternate job more closely approximates the position at the time of injury.
To determine this trajectory, we look to work history. We can glean a trove of information from someone's work history, but most importantly, we can identify the transferable skills they have acquired along their vocational journey. These skills are the key to matching the worker to a suitable alternative job.
To strategize with one of our vocational rehab or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Obtaining Life Care Plan Recommendations from Health Care Providers
Obtaining appropriate Life Care Plan recommendations from treating or consulting providers for present and future care requires specific collaboration. The sources must know the patient's history and be qualified to render opinions about the recommended care. This patient-specific knowledge flows from physical examination, treatment, review of records, research, and experience. Documenting treatment into the future, beyond the acute phase, does not seem to be the norm for many providers. For example, surgeons focus on symptoms and indications for surgery, including pre-operative and follow-up services, too, in essence, "fix" the broken anatomical structure. It may not be clinically significant to document projected future treatments or even inform their patients of likely medical outcomes. Medical documentation's general purpose is to memorialize what has happened or is happening in the immediate future, not to forecast possible long-term consequences.
Litigation or the possibility of testifying in deposition or trial can inhibit the provider's willingness to consult with a Life Care Planner. One concern is the potential exposure to the risk of liability for the treater's opinions. The presence of litigation should not affect a provider's medical care recommendations, but unfortunately, it may. Another hesitation to collaborate with the Life Care Planner is the potential time loss from clinical practice to attend trials and depositions. The provider may feel too busy with their patients to lose revenue while attending legal proceedings. Some of the more elusive consultations are with pediatric medical care projections and medical malpractice cases. There is a natural hesitancy to give recommendations or directly critique other professional colleagues.
Much of the success achieved in consultation depends on the preparation and skills of the Life Care Planner. Disclosure of litigation and a thorough explanation of the provider and planner's roles are essential at the beginning of the process to limit ambiguity and reassure the provider. A consultation with the provider needs to be scheduled in advance, with an estimated time required for the consult. It is best to provide signed consent to release medical information forms and potential questions before the consultation to expedite the process. Consultations and the opportunity to discuss the recommendations are preferred to written questionnaires in certain jurisdictions. The exchange of ideas allows the participants to discuss additional issues or information previously not known. If a provider will not agree to a consultation, the use of a completed, signed questionnaire similarly communicates the importance or the validity of the recommendations.
After the consultation, it is recommended that the Life Care Planner summarize in writing the recommendations provided to ensure accuracy and invite the consultant to review the summary and communicate edits. More complex cases may require more than one consult with the provider to account for the dynamic nature of medical needs. The ultimate goal is to produce a thorough, well-researched Life Care Plan built on strong medical recommendations communicated from the treating providers on a more probable than not basis
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Pediatric Life Care Planning - In Amputation Injuries
When conducting a life care plan for a child with an amputation injury, the specific treatment needs can vary considerably among amputation types and changing needs of the individual because of growth and development through aging. An adult who becomes an amputee as a child will have different needs than those who became an amputee as an adult (Reddick-Grisham, 2004).
One difference when conducting a pediatric life care plan for amputation injuries is bone overgrowth, which can appear until the child reaches skeletal maturity. Therefore, the life care planner will need to consider surgeries to correct bone overgrowth. There could also be complications associated with early onset of degenerative conditions, for example, overuse injuries of the other limb/joints as a result of an amputation. This overuse could result in the need for orthopedic treatment, therapy, or surgeries as the individual ages.
Another main difference between adult and pediatric life care planning is the replacement frequency of prosthetic devices and associated supplies due to the child's growth and development rate. A child will need their prosthesis replaced more frequently than an adult, and this replacement frequency should be considered and included until the child reaches adulthood.
As in all amputation cases, aids for independent function will need to be addressed and included in the life care plan accordingly. For individuals with upper extremity amputations, items such as a toothpaste dispenser, a rocker knife, and a button hook can assist significantly with activities of daily living. Adaptive clothing may also be necessary. Adaptive devices to help the child engage in extracurricular activities may need to be included in the plan.
As the child ages, there will be additional needs to consider, such as vehicle modifications and adaptations, architectural renovations, as well as vocational and educational implications. When aging with an amputation injury, other considerations may include wheelchair needs for long-distance ambulation and the increased need for assistance, including home care or facility care.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Vocational Analysis: Elements in the Process
Vocational Rehabilitation Counselors (VRCs) use the Dictionary of Occupational Titles as a reference text when conducting a vocational analysis. The text categorizes and outlines jobs by several variables that are analyzed by the VRC, including specific vocational preparation (SVP), general educational development (GED), and aptitudes.
The SVP is the typical training or educational time a worker requires to be able to function in an average capacity in that specific occupation. The SVP can range from unskilled to highly skilled. The SVP numbers, from lowest skill to highest skill, include the following:
Short demonstration only
Anything beyond a short demonstration up to one month
One to three months
Three to six months
Six months to one year
One to two years
Two to four years
Four years to ten years
Over ten years
The Dictionary of Occupational Titles also assigns every occupation a GED level for reasoning, math, and language. GED refers to aspects of education required for satisfactory job performance. The reasoning skill levels range from the lowest skill to the highest skill and include the following:
Applying common sense when understanding one to two-step instructions
Applying common sense when following detailed written or verbal instructions
Applying common sense when completing instructions in written, oral, or diagrammatic formats
Using rational systems to solve practical problems with a variety of concrete variables
Using logic and scientific thinking to understand problems, collect information, establish facts, and reach conclusions while dealing with abstract or concrete variables
Using logic and scientific thinking to understand a variety of intellectual and practical problems while dealing with non-verbal symbolism such as scientific equations
The math skill levels also range from the lowest skill to the highest skill and include the following:
Adding and subtracting two-digit numbers, performing simple multiplication and division
Adding, subtracting, multiplying, and dividing all units of measure and having the ability to work with decimals, fractions, ratios, rates, and percentages
Performing basic geometry, algebra, and having the ability to calculate interest, discounts, volumes, weights, and measures
Performing intermediate algebra, geometry, and shop math
Having the ability to perform advanced algebra, basic calculus, and basic statistics
Having the ability to perform advanced calculus, modern algebra, and advanced statistics
The language skill levels also range from the lowest skill to the highest skill and include reading, writing, and speaking. The language skills are based on grade equivalent as follows:
1st to 3rd grade
4th to 6th grade
7th to 8th grade
High school
College/graduate level
The Dictionary of Occupational Titles also assigns an occupation-specific aptitude level. Aptitudes refer to the ability to perform or learn a given work activity, and there are 11 aptitudes measurable in an occupation. The aptitudes are general learning ability, verbal ability, numerical ability, spatial ability, form perception, clerical perception, motor coordination, finger dexterity, manual dexterity, eye/hand/foot coordination, and color discrimination.
These are just a few of the variables analyzed by the VRC when developing a transferrable skills analysis. By understanding the individual’s skill level, general educational development, and aptitude levels of their work history, the Vocational Rehabilitation Counselor is better able to assess future employment options and vocational prognosis.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Establishing Earning Capacity of a Business Owner
Vocational experts typically rely on several sources to help develop opinions regarding one’s earning capacity, including self-reported earnings, statistics, payroll documentation, and tax records. There are situations in which one resource may be a better representation of an individual’s earning capacity. A complicated example is assessing the earning capacity of a business owner. There is no specific reference to statistical wages for business owners when trying to support earning capacity. Therefore, using tax records as a foundation for one’s opinion is often necessary.
The business’ tax documents are studied to determine the gross earnings of the company, along with documented expenses required to operate the business. The documentation should outline business expenses, including materials and supplies, employee compensation and benefits, company vehicles, repairs and maintenance, advertising, rents, depreciation, taxes, and licenses, etc. Assuming the business owner has accurate records, the expenses can be deducted from the gross earnings to develop a reasonable estimate of the profit the business made for that calendar year, and thus earning capacity.
Consider a scenario involving the owner of a small pile driving company whose gross annual earnings are $550,000.00. Business expenses would include employee compensation, pilings, and related materials, rental fees, and maintenance of equipment used to drive the pilings, mortgage or rent for the warehouse and small office, company trucks and fuel, insurance, etc., for a total of $375,000.00. After deductions for expenses, the net income is $175,000.00. The net income may or may not be an accurate representation of the owner’s earnings for that year, depending on several factors, one of which would be whether the owner drew a salary. In that case, his salary plus net income would represent his earnings for the year.
Vocational experts must also consider that people do not always submit proper, accurate, or complete information to the IRS, rendering tax documentation unreliable. As a result, the approximated earnings would be invalid if the vocational expert were to rely solely on tax documents. It is the expert’s responsibility to request the full and accurate tax documentation as support for their opinion on an individual’s earning capacity as a business owner.
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Medication and Work
After an injury and a medical release for work, individuals may continue to take prescription medicines such as muscle relaxers, anti-inflammatories, and pain medications. As vocational experts, we get asked “how” these medications may affect a person’s ability to obtain or maintain employment.
A vocational expert is not a medical expert and must rely on treating or consulting physicians to determine what limitations/side effects, if any, can be expected as a result of medication use. It is the vocational expert’s purview to assess job functions and employment requirements. If a physician limits a person from certain activities because of the side effects of medication, then the vocational expert can determine what jobs can or cannot be performed with or without accommodation.
There are instances when the physician does not specify limitations regarding the medicines and work. The vocational expert could assume that if prescribed narcotics produce sedating effects, it may be unsafe for the individual to operate a vehicle, heavy equipment, or dangerous machinery, and should avoid work at unprotected heights. As responses to medications vary, it cannot be assumed that all individuals are unemployable in any capacity.
Questions to clarify work suitability while taking medication include what effect, if any, do these medications have on this specific individual (e.g., drowsiness, etc.)? What type of job is the person performing or seeking (e.g., assembler, carpenter, etc.)? How often is medication being taken, and can it be taken after work hours? Do certain occupations or professions have legal or statutory restrictions regarding narcotics or related medication use (e.g., registered nurse, crane operator, commercial truck driver, etc.)?
For example, we performed a labor market survey for an individual taking pain medication who was released to work by his physician in a light capacity. Potential employers were contacted based on jobs that were within his physical restrictions and educational experience, including sales clerk, parts clerk, and office assistant. We asked employers whether the use of prescription pain medication would affect his potential hire/employment. Of the four employers contacted with suitable job openings, all reported that this individual would not be precluded from employment consideration because of prescription medication usage if the medication was disclosed upon pre-employment drug screening.
Medication effects vary regarding the impacted functions in jobs available in the labor market. Some medications come with warnings; however, these warnings do not neatly translate to job limitations but are merely cautions. The bottom line is, if a person is taking medication that hinders their ability to perform a job, then the position is not suitable for the worker. If, however, the person taking medication is not negatively affected by the drug, regardless of the cautions and the physician does not restrict the worker, then medication status is not a disabling condition. If there is no danger or risk, then medication is not the objection.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan experts or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Engaging Vocational Rehab and Life Care Planners in a post-COVID World
The recent Covid-19 pandemic has disrupted all our lives to some degree. For many of us, we have been on mandatory lockdown since mid-March forcing some drastic changes in how we work and live. At Stokes & Associates, we have been able to make a smooth transition to a mostly remote workplace, as our testifying experts have been conducting remote video interview evaluations for many years before the current health crisis. As many of you have gotten to know online videoconferencing platforms like Zoom quite well during the recent past, we are hoping to share some of our experiences leveraging technology to provide vocational assessments and life care plan evaluations.
Videoconferencing has been used for many years in the legal system for criminal arraignment hearings, Social Security hearings and other forms of testimony. This method has also been used to deliver medical services more efficiently in the Veterans Administration for many years and has demonstrated a high satisfaction rate among clinicians and patients. Since the Covid-19 pandemic, videoconferencing has become even more ubiquitous. For example, the U.S. Patent and Trademark Office is accommodating video hearings, and municipal offices are conducting marriage license applications via videoconference. The Tennessee Supreme Court heard its first oral arguments via videoconference.
One of the primary components of establishing a trustworthy video link is security. At Stokes & Associates, we exclusively use the Zoom Professional version with HIPAA compliance. Zoom has developed a comprehensive protocol to guarantee maximum privacy and security of the highest caliber to satisfy stringent HIPAA regulations. When we schedule an evaluation appointment, our staff forwards all the necessary documents to be returned electronically via DocuSign, allowing the evaluee to electronically sign paperwork on their mobile device with one click.
The typical methodology for conducting a vocational evaluation is to review medical records, interview the claimant, perform vocational testing, conduct vocational research, and complete the written report. Every step of this usual and customary process is possible using a remote protocol. The interview is conducted online at the claimant's convenience. Because the meeting usually occurs with the claimant in their home, we are also more likely to have the ability to interview a spouse or family member. Vocational testing is conducted online using digital stimulus materials and online response capabilities. We can collect the same achievement and interest data as an in-person interview.
Life care planning evaluations are just as efficient when conducted remotely. Again, seeing the evaluee in their home environment gives additional important information regarding mobility and safety needs. The claimant can provide us with a "virtual tour" of their home by navigating through the atmosphere, allowing us to ask questions about access. Additionally, it is often difficult for clients to remember the exact medications, equipment, and supplies that they use daily when they present for evaluations in our office. By being "in the home" with the client, we can review medication bottles, take screenshots of equipment model numbers, and get a "day in the life" view of what it is like to live at home with a physical impairment.
As testifying experts, we take our methodology very seriously. It is our rigorous reliance on generally-accepted, peer-reviewed evaluation protocols that give us the confidence to educate judges and juries of our findings. Our use of remote assessment has been supported in several state and federal court systems, allowing us to minimize travel expenses and minimize the time required to move from evaluation to final report.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Who develops the best Life Care Plans?
As certified life care planners at Stokes & Associates, we are often asked about our credentials, training, and experience that inform our ability to comment on future medical care expenses. There is an ongoing discussion in the field regarding what specialties produce the highest quality life care plans (rehab counselors vs. rehab physicians vs. nurses, etc). The attached position paper by the International Association of Rehabilitation Professionals – Life Care Planning Section (IALCP) argues that life care planning is open to all who demonstrate the appropriate qualifications, experience, and skill to author a life care plan. A single profession cannot claim superiority over any other. The quality of a life care plan should be judged on the life care plan product and not the profession of the author.
The International Academy of Life Care Planners continues to be the leading organization promoting the transdisciplinary practice of life care planning. That means that it is, and has been, the position of this community that life care planning is a practice open to all those who demonstrate the appropriate qualifications, experience, and skill to author life care plans. There has been some recent concern among some life care planners about who is most qualified to author life care plans.
This paper is a reminder to the community, from the community, that the best life care plans depend on input from a variety of professionals. The life care planner analyzes information from multiple sources to create a consistent, comprehensive document using in-depth knowledge, experience, and clinical skills. It reflects the collaborative coordination of several professionals. There is no single profession that can claim to be the most qualified to do this. Our standards of practice remind us of this through this description of the origins of life care planning. (IALCP, 2015):
IALCP Transdisciplinary Practice Position Paper:
Historical Perspective
The development of an individualized plan of care has always been considered an integral part of the medical and rehabilitation process. This type of plan has historically been used by multiple disciplines. Rehabilitation professionals have created a rehabilitation plan. Nurses developed a nursing care plan. Physicians defined a medical treatment plan, and other professions developed plans specific to their practice. An integrated plan that includes all disciplines and specific costs of care has become an increasingly important aspect of the health care process due to rapid growth in medical technology and an increased emphasis on the cost of care. This process of developing an integrated plan and delineating costs has evolved over an extensive period of time and is now utilized by case managers, counselors, and other professionals in many sectors. These plans are also a valuable tool for rehabilitation planning, service implementation, management of health care resources, discharge planning, educational and vocational planning, and long-term managed care, among other areas.
Transdisciplinary Perspective
Life care planning is a transdisciplinary specialty practice. Each profession brings to the process of life care planning practice standards which must be adhered to by the individual professional, and these standards remain applicable while the practitioner engages in life care planning activities. Each professional works within specific standards of practice and regulatory requirements for his or her discipline to ensure accountability, provide direction, and mandate responsibility for the standards for which he or she is accountable. (I.C)
Further, the standards of practice clearly identify the educational background and professional preparation required (IALCP, 2015):
a. Possesses the appropriate educational requirements in a rehabilitation or health care field as defined by his or her professional discipline.
b. Maintains current professional licensure, provincial registration, or national board certification that is required to practice a professional rehabilitation or health care discipline.
c. Demonstrates that the professional discipline provides sufficient education and training to assure that the life care planner has an understanding of human anatomy and physiology, pathophysiology, psychosocial and family dynamics, the health care delivery system, the role and function of various health care professionals, and clinical practice guidelines and standards of care. The education and training allow practitioners in the discipline to independently perform assessments, analyze and interpret data, make judgments and decisions on goals and interventions, and evaluate responses and outcomes.
Healthy debates continue to flourish around how the best life care plans are developed based on the best methodologies and these conversations only make our practice better. However, these do not and should not result in any single profession claiming superiority over others. The quality of the life care plans should be judged on the life care plan product, not the profession of the author.
Further information on the scope of practice of the most common professions that create life care plans, and the scope of recommendations that they can contribute to future care planning can be found in the Journal of Life Care Planning, Volume 17, Number 1, 2019. The content of this journal clearly exemplifies the necessity of collaborative practice in life care planning.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Pediatric Vocational Assessments
A review of a recent study, “The validity of exploring educational attainment levels and occupational skill and physical strength demand levels of caregivers when evaluating loss of earning capacity in pediatric cases.”
Vocational rehabilitation counselors have specialized training and knowledge needed to assist injured individuals with workforce reentry. The expert opinion of vocational rehabilitation counselors can be valuable to the trier of fact in deciding the damages related to loss of future earning capacity of an injured individual, in both adult and pediatric cases.
In the field of vocational rehabilitation counseling, one generally accepted model for assessing pediatric earning capacity is the PEEDS-RAPEL© Model (Neulicht & Berens, 2005). The PEEDS portion of this model addresses pediatric vocational assessments by evaluating parental and familial occupations and educational attainment, as these factors are thought to be part of a preinjury predictor of educational attainment and career choice of the adult child.
A recent study from Sapp, Remley, and Range (2020) examined evaluee files to compare the relationship between the parent’s educational attainment level, and primary occupation to the adult child’s level of educational attainment, and primary occupation. This study found that there was a positive association between the primary caregiver’s level of educational attainment and the adult child’s level of educational attainment. There was also a positive association between the primary caregiver’s occupational skill level and the adult child’s occupational skill level and between the primary caregiver’s occupational, physical strength demand level, and the adult child’s occupational, physical strength demand level. The findings of this study support the pediatric vocational assessment model, the PEEDS-RAPEL© Model.
When vocational experts are in the position of making recommendations in the vocational assessment of a child, factors such as the caregivers’ educational level, occupational skill level, and occupational, physical strength demand level should be considered. These factors can assist the vocational expert in developing the basis for their vocational opinions in these types of cases (Sapp, Remley, & Range, 2020).
Sapp, L.H., Remley, T.P., Range, L.M. (2020). The validity of exploring educational attainment levels and occupational strength demand levels of caregivers when evaluating loss of earning capacity in pediatric cases. The Rehabilitation Professional, 28(1), 5-14.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Wage Earning Capacity of the Unemployed or Underemployed
Determining wage-earning capacity is a complex task for the rehabilitation consultant. Wage earning capacity references an individual’s ability to work and earn wages, pre-injury versus post-injury. Typically, when determining wage-earning capacity, the individual’s demonstrated earnings are used as a reference if the actual earnings fairly and appropriately represent the individual’s capacity to earn. This is not the case; however if the individual is unemployed or underemployed at the time of injury. The demonstrated wages, or lack thereof, may not appropriately represent the individual’s capacity to earn wages. Examples of this include the individual being previously incarcerated, a downturn in job availability (seen frequently in oilfield industries), or family obligations.
In these instances, it is the vocational rehabilitation consultant’s role to examine the individual’s vocational profile to accurately determine the individual’s capacity to earn wages. The vocational profile of the evaluee consists of age, education, training, work history, vocational test results, the severity of injury or disability, functional capacity, and work-life expectancy. Vocational consultants must also consider employment opportunities available, employment trends, labor market research, employability, and placeability of the individual.
For example, an offshore welder with a 15-year history of earning $130,000.00 per year is laid off due to a lack of available work. He has since found work as a small parts assembler earning approximately $35,000.00 per year. He was then involved in a motor vehicle collision and subsequently required a three-level lumbar fusion. His treating physicians have permanently limited him to a light physical demand level, which falls within his job at the time of injury as a small parts assembler. One may assume that there is no wage loss claim, as he can recapture his earnings at the time of injury. However, his true earning capacity is his demonstrated earnings as an offshore welder, which he can no longer do. At Stokes & Associates, we take great care to ensure a comprehensive and thorough vocational analysis when assessing an individual’s vocational outlook and wage-earning capacity.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Quantifying Work Capacities in Neurocognitive Cases
Consulting with the treating/consultative specialist, such as a neuropsychologist, neurologist, or PM&R physician, helps determine what limitations exist as a result of the specific injury or illness. Psychological and neuropsychological evaluations, if performed, can play a part in delineating an individual’s abilities/limitations. It may not be enough, however, to ask the physician, “what are the limitations of this individual?” but rather, what are the levels of impairment, if any, on various cognitive/mental ability areas of functioning?
The specific responses to the following abilities will assist the vocational expert in assessing an individual’s work capacity/vocational outlook.
remember locations and work-like procedures
understand and remember very short and simple instructions
understand and remember detailed instructions
maintain attention and concentration for 2-hour blocks of time
sustain an ordinary routine without special supervision
perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances
make simple work-related decisions
get along with coworkers or peers without distracting them or exhibiting behavioral extremes
interact appropriately with the general public
accept instruction and respond appropriately to criticism from supervisors
meet deadlines and complete tasks
respond appropriately to changes in the work setting
function independently
We ask physicians to rate their abilities accordingly, such as:
Unlimited or Very Good - ability to function in this area is more than satisfactory, no limitations
Good (mild impairment) - the ability to function is limited but satisfactory, slight limitations
Fair (moderate impairment) - ability to function is seriously limited, moderate limitations
Poor (marked impairment) - unable to function in this area, marked limitations
None (severe impairment) - a significant loss of psychological, physiological, personal/social adjustment, severe limitations
Once specific limitations are outlined, we adjust a person's vocational profile accordingly to reflect the level of functioning including General Educational Development levels (Reasoning, Mathematics, and Language); Specific Vocational Preparation (time required to learn the techniques, acquire the information and develop the facility needed for average performance in a specific job situation); and Temperaments (ability to work in a variety of situations ). Addressing and clarifying the larger scope of a person’s residual cognitive/mental abilities post-injury assists the expert in addressing more comprehensively their vocational outlook and earning potential.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
What's in a Life Care Plan? Part II
In the second part of our What’s In a Life Care Plan series, we add detail to the framework we described in Part I. Discussion will be based in part on the seminal 2018 article in the Journal of Life Care Planning by Johnson and collaborators. The discussion outlines the most recently collected, generally accepted Consensus and Majority Statements derived from over ten years’ worth of professional planning summits.
Projected Evaluations: This section of the life care plan is the primary section where certified Life Care Planners (CLCP’s) are allowed to make recommendations independent of treating or consulting physicians. Johnson et al. (2018) note that “Life Care Planners may request additional data, testing, and evaluation if required.” For example, if during a clinical interview, an evaluee complains of urological symptoms with an onset after the index injury, it is within the CLCP’s purview to include a one-time urology assessment to help inform future care.
Projected Therapeutic Modalities: Inclusive of ongoing treatments, many of which are provided by allied health providers, it is essential that life care plans include the opinions of those providers. Treating and consulting physicians typically outline specific treatment protocols for therapies like physical and occupation therapy. It is sometimes useful to speak to the treating therapist to get their insight regarding some of the nuances the evaluee’s treatment may require. For example, when therapies are anticipated to be ongoing for an extended period or indefinitely. It could be useful to consult with the treating therapist to learn how that treatment may change over time.
Medications: It is no secret that medication costs vary widely and have escalated significantly over time. Although there is no clear consensus on the issue, life care plans should take into consideration the effects that generic medications can have on overall costs. There are varying points of view on this issue. For example, in some instances, life care plans include the exact medication outlined by the prescriber. If the physician recommends the brand name medication, that is what is budgeted, and if they recommend the generic, that is included. In some instances, both generic and brand are included to create a range of expected future costs. The argument for including solely brand name is that this often-higher cost will allow for the use of medications developed in the future that may work better but cost more. Regardless of how they are reported, the issue of brand vs. generic pricing should be incorporated into the plan and readily defensible.
Attendant Care: The assistance an individual needs in the home to safely complete their activities of daily living (ADLs) can be one of the most crucial and potentially most costly sections of the plan. In clearly catastrophic cases where the individual is severely physically limited, it may be easier to identify the amount and intensity of assistance required. But what about the less catastrophic cases where a patient’s wife is helping with dressing, supervising bathing, cleaning, cooking, and transporting the injured individual. These services have value, and it is often easiest to conceptualize by imaging what life would be like if the spouse were to die or leave. Is the man not entitled to the ADL assistance that he did not require pre-injury? Furthermore, do we build in the cost of private hire or agency care? Again, our Consensus statements guide our methodology by noting that “When the life care planner includes home care, both private-hire and agency procured services are options to be considered.”
These are just a few thoughts regarding the intricacies of life care planning. To discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, LPC, LRC
What's in a Life Care Plan?
The International Academy of Life Care Planners (IALCP) defines a Life Care Plan as “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic healthcare needs.” So, what goes into a Life Care Plan?
The following are examples of topics, including medical and vocational needs that are typically found in specific sections of a Life Care Plan.
Projected Evaluations: Projected evaluations include evaluations by physicians or other allied health professionals such as physical therapists, speech therapists, psychologists, neuropsychologists, etc.
Projected Therapeutic Modalities: This section outlines the therapies and treatments that would be rendered to a patient for the medical needs associated with the indexed accident or injury.
Future Medical Care – Routine: This section outlines the regularly occurring visits and treatment with physicians or other allied health professionals on an ongoing basis.
Future Medical Care – Surgeries: Includes planned future surgeries or therapeutic procedures (injections, RFAs), as well as associated costs.
Medications: This section includes current and expected medications over the evaluee’s life expectancy. We typically include costs for brand and generic.
Equipment and Supplies: This section includes current and expected equipment and supplies as prescribed for the patient.
Diagnostic Testing: This section should include any diagnostic testing necessary for a patient as a result of the accident or injury.
Home Care/Facility Care: Supervision via a personal care attendant, RN, LPN, or other health care worker is valued based on number of expected hours of treatment.
Aids for Independent Function and Transportation: These are items that allow a patient to operate as independently as possible and may include transportation needs.
Architectural Renovations and Modifications: Depending on the severity of the injury, there may need to be an assessment for architectural renovations or home modification.
Orthotics and Prosthetics: This section is specific to patients with amputations, as well as bracing needed for increased functional ability.
Potential Complications: In life care planning potential complications should be assessed.
Vocational Assessment: Some Life Care Plans include a Vocational Rehabilitation Assessment.
Although Life Care Plans can vary in structure, these are some of the sections that you would find in a Life Care Plan.
We offer complimentary consultations concerning "hypothetical matters".
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Factors Relevant in the Assessment of Wage-Earning Capacity
The estimation of earning capacity in cases involving personal injury is important and often a complex task for the rehabilitation consultant. The vocational expert’s role is to examine the relevant vocational factors to determine the individual’s pre-injury vs. post-injury capacity to perform jobs and earn wages.
Some of the factors that are relevant in estimating earning capacity include:
Age: The age of the worker is important in determining how long the person will remain in the workforce as well as their wage-earning potential.
Education and Training: The level of education or training of an individual in terms of their knowledge, skills, and abilities.
Work Experience: Past work can be an indicator of potential or transferability of job skills.
Disability and Functional Capacity: Disability is defined as the inability to perform substantial gainful activity due to an impairment. Functional capacity to work is relevant, both pre and post-injury.
Worklife Expectancy: Helps to determine how many remaining years the worker has within the workforce.
Employment Opportunities/Future Trends: This is relevant for making reliable estimates of future employment opportunities and earnings. An understanding of the labor market is critical with respect to estimating future earnings.
Labor Market Surveys: Information regarding jobs in the relevant labor market area, generated by the U. S. Census Bureau as well as from contact with employers.
Employability: Addresses the question of whether a worker is able to be employed within any given labor market, or whether jobs exist in the labor market.
If the individual is unable to return to work at their usual occupation, it is the vocational expert’s role to compare pre-injury earning capacity with the expected post-injury earning capacity. In some cases, the loss of earning capacity is straightforward. For example, consider a 55-year-old truck driver (working as a driver since the age of 19) who was injured in a motor vehicle accident resulting in the inability to work in any capacity. His loss of future earning capacity would likely be based on actual earnings at the time of the injury projected over his remaining work-life expectancy.
Other cases may be less clear. For example, suppose the truck driver also had his 18-year-old nephew in the truck with him. Assume the boy suffered extensive head injuries which rendered him incapable of gainful employment for the rest of his life. Since he had very little work history, estimating a loss of earning capacity is more complicated and may be based on pre-injury vocational goals, age, and educational attainment. Although this example may be an extreme case scenario, many cases do not fit neatly into categories. A vocational expert can help tease out these complicated issues.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Life Care Planning and the Medical Fees Directory
August 19, 2019
It is important for life care planners to obtain appropriate cost information for the recommended treatment in a life care plan while adhering to life care planning tenets and standards. The most common method is to conduct a survey of the recommended treatment and ask for the “billed price” or the cash pay price without discounts. A range of sources is then included in the life care plan. Our policy at Stokes & Associates is to present the results of cost research to ensure that the treatment or service is not being under- or over-funded.
Many life care planners have begun using the Medical Fees Directory published by the Practice Management Information Corporation (PMIC) to obtain the cost information in their life care plans. The purpose of the PMIC is for physicians and providers to compare how their fees rank on a national basis. The text also reports the information can be utilized for negotiation with payers and other purposes. The PCIM did not intend this data to be used in pricing life care plans.
Furthermore, the PMIC provides costs at the 50th, 75th, and 90th percentiles, which are based on national averages and are generally reflective of payor allowables. The costs in a life care plan should be reflective of actual costs within the injured persons’ geographic area, not national averages. The use of the 50th, 75th, and 90th percentiles by the PMIC omits the top 10% and the bottom 50% of cost information A limitation of the resource is that by leaving out the bottom 50% and top 10%, the costs range may not include the treating physician’s cost, or the Usual and Customary Rate (UCR) costs in the patient’s geographic area.
The PMIC provides “GAF – Geographic Adjustment Factor,” which can be used to adjust the UCR by geographic area. For some areas, such as Mississippi, the text provides only one GAF multiplier for the entire state. It is unclear how specific this calculation can be to an individual’s geographic area given that the PMIC only provides one GAF in the entire state. While it is uncertain how reliable the GAFs are if a life care planner utilizes the PMIC, the GAF should be calculated because the costs across geographic regions can vary greatly.
The PMIC cost information is provided per CPT code. Unless the provider gives a specific CPT code(s) of services or the life care planner is extremely well-versed in how CPT codes are utilized, errors can easily occur. This is especially true if the life care planner is researching the cost of surgery, which could have multiple CPT codes, which can also vary by provider. The use of CPT codes could also leave the life care planner vulnerable to being accused of exceeding their scope of practice. For example, a physical therapy evaluation could be one of three CPT codes, each representing a differing level of complexity. Within the description, the level of complexity is determined in part by using “standardized patient assessment instrument and/or measurable assessment of functional outcome.” In choosing one CPT code over another, it could be argued that the life care planner is making a determination that should be reserved for a physical therapist.
At Stokes & Associates, we take great care to ensure that we are using best practices. For that reason, we advocate against relying entirely on published fee schedules for life care planning, such as the PMIC. Using the PMIC, in our opinion, does not give a comprehensive cost analysis and distorts the information presented to the trier of fact, rending the information invalid and unreliable.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Determining Damages in Wrongful Death Claims
In cases involving wrongful death claims, a suit is generally filed on behalf of the decedent’s family members, such as a spouse and/or minor children. As vocational rehabilitation experts, we are generally asked to determine the wage-earning capacity and vocational outlook of the decedent “but for” their untimely death. Completing a vocational analysis in a wrongful death claim differs slightly from other types of cases primarily because of the inability to personally interview the individual. Having a consistent methodology of conducting a vocational assessment and obtaining pertinent information from other sources allows the vocational expert to formulate vocational opinions within reasonable vocational probability. So how do we derive our opinions and conclusions?
The answer lies in relying on a consistent methodology. This includes:
Review of salient records including earnings statements (If the individual had an established work history)
Resume, job applications, and/or employment records (if available)
Education/school records
Although the decedent cannot be interviewed, collateral interviews of other sources can be extremely beneficial which can include family members, close friends, coworkers, and teachers. Multiple sources will assist in “telling the story” and provide an understanding of patterns and milestones in the individual’s career/vocational development.
Important information includes work history and related experience, skills and abilities, specialized training, educational background and/or educational pursuits (may have been in school at the time of death), hobbies/interests, ambitions, vocational goals, plans, and aspirations. If employed at the time of death, it is helpful to have employment/earnings data such as Social Security earnings records or tax returns.
Wage data can be obtained from reliable sources such as the Department of Labor, Bureau of Labor Statistics, the Occupational Employment Survey, as well as labor market research. Ultimately, the goal is to provide reliable vocational opinions based on the generally accepted methodology that provides accurate estimates for future monetary or losses of the decedent’s vocational outlook and wage-earning capacity.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Vocational Rehab and Life Care Plan Hypothetical Scenarios
In providing life care plan and vocational assessments, we are often required to rely on the opinions of treating or consulting physicians regarding the foundation for future medical recommendations or likely physical restrictions that may prevent plaintiffs from returning to their pre-injury occupations. Although the generally accepted methods and standards for practicing life care planners allow us to independently recommend evaluations to obtain additional prognostic information, we are beholden to medical doctors to determine the medical necessity of future surgeries, routine medical treatments, medications, and other life care plan items. Similarly, our decisions regarding an individual’s vocational prognosis not only relies on education, work history, transferrable skills, and vocational interests but are centrally focused on the individual’s residual functional capacity. The ultimate opinion regarding a plaintiff’s post-injury physical demand capabilities is made following a functional capacity evaluation or more typically solely by a treating physician. But what happens if the physician’s opinions aren’t clear or are more nuanced?
It is a well-known principle of law that if expert testimony given in response to hypothetical questions is predicated on a statement of unproven facts, it has no probative value and should not affect the outcome of the case (Brown v. Aetna Casualty & Surety Co., 96 So. 2nd 357, 360; LA App.2nd Cir. 1957). Therefore, it is the court’s prerogative to prevent expert testimony that would unfairly bias the jury. However, when physicians forecast the likely medical course of a plaintiff many years into the future, they often present different scenarios to account for the potential outcomes. For example, the physician who releases an individual to return to work “as tolerated” may claim that at some point in the future (we don’t know when), the person will possibly/probably be unable to continue working. Or, the individual should delay having a proposed spinal surgery until “they can no longer tolerate it.”
Typically, we provide opinions that reach the greater than 50% likelihood threshold. However, physicians, either through deposition testimony or during our consultations may be unable or unwilling to comment on that likelihood, or better than 50% chance threshold. For practical reasons, our reports capture our opinions at a specific moment in time, based on currently available information. Subsequent to our report, additional depositions may be taken where doctors change their opinions, the facts of the individual’s response to health care treatments may change, or the needs of the referral source may change (upcoming mediation, trial date, etc.). For these reasons, it is typical for us to include items and opinions as a hypothetical for informational purposes. In Life Care Planning, this may mean including the cost for a surgery that is not currently recommended with a greater than 50% likelihood but may be contingent on the outcome of yet to be conducted diagnostics or procedures.
It is the court’s purview to decide the probative value of hypothetical scenarios, however, we strive to help educate the trier(s) of fact regarding the likely consequences based on the range of potential scenarios presented by the treating or consulting physicians. When our opinions rely on nuanced or contingent medical opinions, it is our practice to communicate this in the form of clearly delineated hypothetical scenarios with sufficient explanation.
We offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or certified life care planners at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Vocational Rehab Testing and Third Party Presence
When conducting Vocational Rehabilitation Evaluations, we are sometimes asked to have a third-party present for the interview and testing portions of the process. With regards to the testing portion, we must object to a third-party’s presence and the audio/video taping of the testing evaluation (or administration).To do so would violate copyright laws, affect contractual agreements with the publishing companies, violate professional standards and ethics, and potentially invalidate the test results.
The publishers’ standards state that all rights are reserved, including translation, and that no part of the publication may be reproduced or transmitted in any form or by any means without written permission from the publisher including: electronic or mechanical, photocopying and recording, or by any information storage or retrievable system, unless such copying is expressly permitted by federal copyright law. These restrictions apply to recordings made by third-party observers as well.
Additionally, professionals who use the publisher’s tests are responsible for maintaining test security. The Standards for Educational and Psychological Testing indicate that test users have the responsibility to ensure the confidentiality of the test results and testing materials consistent with legal and professional ethics requirements. Furthermore, test content should not be shared with curious non-professionals or made available for public inspection.
Similarly, the Code of Professional Ethics for Rehabilitation Counselors insist that rehabilitation counselors administer tests/instruments according to the parameters described in the publisher’s manuals. When tests/instruments are not administered under standard conditions, as may be necessary to accommodate clients with disabilities or when unusual behavior or irregularities occur during the administration, those conditions are noted in the interpretation, and the results may be designated as invalid or of questionable validity.
Finally, the Code of Professional Ethics for Licensed Rehabilitation Counselors, states that Licensed Rehabilitation Counselors will make reasonable efforts to maintain the integrity and security of tests and other assessment techniques consistent with law, contractual obligations, and in a manner that permits compliance with the requirement of the Code.
Aside from copyright and ethical concerns, studies have reported that the presence of a third-party observer during assessment, particularly, video/audio recording, negatively affects the test performance of the examinee.
Historically in our experience, test publishers have consistently refused to release test items. For the reasons stated above, we are bound by standards and ethics, as well as legal and contractual obligations to object to having a third-party present during testing, allowing audio/video recording of test administration, or releasing the test instruments, or test content.
To strategize with one of our licensed vocational experts or certified life care planners please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Life Care Planning in Pediatric Cases
Although life care planning methodology remains consistent across adult and pediatric cases, there are some unique circumstances the life care planner will likely need to consider when conducting the plan of a child. In pediatric cases, meeting with relevant family members or caregivers could be a significant piece of the process. A home assessment may also be useful and in some cases necessary, in gathering relevant information about the child.
In pediatric life care planning, the family members are often significantly impacted as a result of caring for a child with special needs and adopt roles and responsibilities that would otherwise not be required. For instance, a special needs child may need constant supervision, diapering, or nighttime feedings long after the reasonable demands of childhood requires a caregiver. As the child ages, developmental delays can become more apparent, resulting in an increasing need for care. Although the rehabilitation goal is typically to maintain the individual in their least restrictive environment, long-term living options such as facility care may need to be explored for when the child ages.
During the interview process, the life care planner can obtain critical information from the family regarding the child’s medical history and can begin to assess if there are differences in care needs that have occurred since disability onset. The family interview can also assist in obtaining information regarding the child’s growth and development as well as the child’s ability to perform the age-appropriate activities of daily living. An interview of the family can aid in the gathering of relevant information about the child’s specific treatment, medication, equipment, supplies, transportation, school status, and education needs, as well as the family’s ability to adjust to the child’s disability needs.
When pricing out future costs, depending on the service or item, there may be differences in costs for pediatric services and items which could impact the long-term plan if not adequately priced. The replacement of items may also differ in childhood than in adulthood. For instance, a child’s wheelchair may need to be replaced more frequently than an adult's wheelchair due to the rapid growth spurts of the child. The child’s medication needs can also differ significantly than as an adult. Consultation with relevant caregivers, which often includes physicians, allied health providers or other specialists, could clarify and verify specific differences in the level of care as the child ages.
For more information on methodology, pricing or other cost research related to life care plans, we offer complimentary consultations.
To strategize with one of our licensed vocational experts or certified life care planners please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP