SELECTIVE PLACEMENT FOR THE HANDICAPPED TRAINING PROGRAM instructor's DISCUSSION OUTLINES WAR MANPOWER COMMISSION UNITED STATES EMPLOYMENT SERVICE WASHINGTON,DC. DECEMBER,1943 FOREWORD The material in these Discussion Outlines has been developed through long and successful experience of the United States Employment Service in placing handicapped workers. It has been enriched by the Discussion Guides prepared and effec- tively used for in-service training programs. The entire training program was developed from practical and effective experience. For the development of these Outlines, we wish to express appreciation to the staff of the New York ?.rar Manpower Commission, an agency which has had successful experience in the placement of handicapped workers over a period of years. 7-3040 forward nobu TABLE OF CONTENTS Page Introduction 1 Suggestions for Planning the Course 5 Use of the Instructors Discussion Outline 7 Unit 1-a The Employment Service’s Concern with the Placement of the Handicapped 9 Purpose of training program 13 Survey of the plan for the sessions 14 The new handbook 16 Definition of the handicapped 18 Categories of the handicapped 18 Handicaps requiring selective placement 19 Distinction between physical handicaps and occupational handicaps .. ..... ...... 24 Recent changes in attitude toward handicaps 24 Present concern of Employment Service for placement of the handicapped '. 26 tait 1-b The Physical Demands Analysis as an Interviewer’s Tool . . 31 Recent development of the physical demands technique 36 The physical demands analysis 37 Brief review of job analysis as the basis for physical demands analysis . • ‘ 39 The Physical Demands Analysis Form for a job ... 42 The Physical Capacities Appraisal form $2 Unit 2-a Use of Other Occupational Information Tools in Placement of the Handicapped •■••••••••. ........ 67 Relation of the Physical Demands Analysis to the other occupational information tools 67 Review of the use of occupational information by any interviewer 67 Use of occupational information tools in choosing the general field of work 68 Choosing the proper classification and code •••••..•• 73 Unit 2-b Vocational Aspects of Common Disabilities (l) Hearing and Speech and (2) Orthopedic Disabilities 77 The kind of additional information needed! physical facts and work capacity 82 Sources of such information 83 The aim of the discussions of medical facts in these sessions 84 The most common disabilities 85 Elements needed for placement of any handicapped worker ... 8$ Considerations for uncovering any non-visible handicap .... 86 Hearing and Speech 37 Orthopedic Disabilities Physical facts about orthopedic handicaps in general , . . 105 Arm and hand disabilities 106 Legs and feet HI Back and spinal column n/ 7—3040 contents nobu TABLE OF CONTENTS Page Units 3-a and 3-b Respiratory, Cardiovascular, Miscellaneous Disabilities 123 Respiratory diseases 123 Cardiac disabilities . 129 Vascular diseases 139 Miscellaneous disabilities Hernia ■ UO Stomach ulcers 14.1 Tumors and cancers 14? Diabetes Mellitus 1 ip Venereal diseases U2 Kidney ailments 1 Vi Glandular disturbances 144 Skin diseases 14$ Cosmetic defects 145 Pregnancy 146 Unit 4-a & b Visual Handicaps, Mental Disorders, Neurological Disorders 149 Visual handicaps 153 Mental disorders 160 Neurological disorders 173 Unit 5-a Review of Best Methods for Placement of the Handicapped and Assistance to Those Not Immediately Placeable 187 Review of the elements in the process of placing the handicapped 191. Review of special techniques for uncovering handicaps • • • • 191 Review of best techniques for securing information from applicant 192 Review of the considerations involved in securing medical reports 194 Review of best practices in recording information 195 Review of best techniques for matching physical capacities with the physical demands of jobs 196 Assistance to handicapped workers who are not immediately employable 204 Brief survey of laws relating to the employment of the handicapped ■ . 210 Unit 5-b Special Consideration for the Placement of Handicapped Veterans 213 The veterans as part of the handicapped group 215 Present enthusiasm of employers ... 215 Responsibility of the Public Employment Service ....... 215 The size of the problem 216 Activities of other agencies 217 Present activities of the Public Employment Service on behalf of veterans ..... 218 Role of the placement interviewers in the process of adjusting returned veterans 225 7-3040 contents final nobu 1 TRAINING- PROGRAM FOR SERVING THE HANDICAPPED Vhy Train for Serving the Handicapped? Employment Offices throughout the country are already expanding their work with veterans returning from active service, many of them with physical or mental handicaps. A new tool, the Physical Demands Analysis technique, has been developed for use in the placement of any workers with disabilities and a new handbook for serving the physically and the mentally handicapped has been prepared for countrywide use. This new technique emphasizes what the worker still has, rather than what he has lost. The issuance of a handbook to local office interviewers, however, is not enough. Interviewers specializing in serving the physically handicapped need intensive training on how to do this job effectively. Therefore, the following program has been developed for these inter- viewers. The training materials specifically prepared for the training program include: 1. Instructors Discussion Outlines 2. Trainee’s Casebook 3. Instructor's Casebook (with answers) U, "Selective Placement for the Handicapped" The outlines cover all the material necessary for five days of instruc- tion, Individual state procedures and policies may be discussed on the sixth day, to complete a full week. What are the Objectives of this Program? The objectives of the program are: 1, To develop in interviewers who will he concerned with placing the physically and mentally handicapped: a. An understanding of the work capacities and suitable working conditions for such applicants, and h. An appreciation of the problems involved in their placement. 2. To equip these interviewers with: a. A working knowledge of a tool, the Physical Demands Analysis, for determining the physical activities and environmental conditions of a job and the physical capacities of and the 7-3040 PI of 228 bu-coa-wn most desirable working conditions for an applicant; and b. Basic information about the occupational implications of common handicaps, as presented in the handbook, 'Selective Placement for the Handicapped". What. Specifically, is Covered in this Program? Unit Subject Timing 1-6 The Employment Service's Concern with the Placement of Handicapped Workers (1st morning, lj hours) 1-b The Physical Demands Analysis as an Interviewer's Tool (1st morning and afternoon, hours) 2-a Use of Other Occupational Information Tools in the Placement of the Handicapped (2nd morning," hours) 2-b Vocational Aspects of Common Disabilities: (1) Hearing and Speech (2) Orthopedics (2nd morning and afternoon, hours) 3-a & 3-b Vocational Aspects of Oommon Disabilities: (3) Respiratory, (U) Cardiovascular, (5) Miscellaneous (3rd morning and afternoon, 6 hours) U*-a & H-b Vocational Aspects of Common Disabilities: (6) Visual, (?) Neurological, and (S) Mental (Uth morning and afternoon, 6 hours) 5-a & 5-b Summary of Placement Techniques, Special Considerations for Veterans, and Laws (5th morning and afternoon, 6 hours) 6-»a & 6-b Local Procedures (6th day) Each outline represents a unit of instruction, hut they are not all of the same length because of the way in which the subject breaks. The suggested timing is not intended to be precise, but will serve as a general guide in directing the sessions. It is based on a trial of the outlines conducted in Region II, New York City, in September 19U3, Who is to he Trained? All interviewers specializing in service to the handicapped should receive this training. Included are, of course, interviewers of dis- chargees at Army and Navy hospitals. 7-3040 P2 tin Veterans registered at hospitals before discharge may be returning to any part of the country; their cards precede them to the appropriate local office. Inasmuch as these disabled veterans may appear for service at local offices all over the country, it is important that every employment office have at least one interviewer qualified and trained to do a careful selective placement Job for the physically handi- capped. This program represents specialized training and is to be given to experienced interviewers with a sound knowledge of employment service procedure and the use of employment service tools. What Training Do the Instructors Need? Persons teaching the program should become familiar with it either "by attending an Instructor's Training Conference or by participating as a trainee in the program itself as given by a capable instructor. Essential for every teacher of the program is a knowledge of the Job analysis technique, since the approach to the placement of the handicapped is based upon the physical demands analysis method—an outgrowth of job analysis. 7-a040 P3 nobu 5 Suggestions for Planning the Course 1. Don't try to include more than 12 or 15 trainees in the group— It's difficult to handle a larger number, particularly in such sessions as the practice Physical Demands Analysis. 2. Try to include some guest discussion leaders. Six days of full time instructions by one person is hard on both you and the trainees. You Might Ask To Handle Veterans Employment Representative - Occupational Analyst Rehabilitation Agency Representative Disabled Veterans Physical Demands Analysis If the course is being given to hospital interviewers, you might ask the Commanding Officer of a Navy or Army hospital to describe to the class the general set-up of his hospital. Also a representa- tive from the Red Cross might be invited to describe the work of that organization in the Army ana Navy hospitals. 3. Depending on their availability in the community where the course is being given, visits might be arrangeo, during the course, to hospitals, sheltered workshops, or training schools for the handicapped, 4« Throughout the course, have the trainees refer to the Medical Dictionary, often enough so that it will become a familiar working tool. 5. The sixth day is left for "local procedures." Also this extra time may be used for visits described above or for additional emphasis to subjects, as needed. 7-9040 PB nnKj. 7 USE OF THE INSTRUCTOR'S DISCUSSION OUTLINE The discussion form is used rather than lecture, in order to pro- vide for using the experience and information of the trainees to the best possible advantage. Purposes of the Outline The outline is prepared in this form to serve two purposes: 1. To prepare the instructor: a. By bringing together all the facts and ideas that he must master in order to conduct the unit of instruction, and, b. To organize them for him in an effective learning order. (Effective both for himself and for the subsequent trainees) 2. To provide the instructor with a guide for use on the floor, in the actual conduct of the session - a readily visible reminder of the order of points he must make. Explanation of the Format Each page is presented in two columns: 1. A topical skeleton outline: the left column contains the topical outline which is the skeleton of the essential points to he made, in the order of their desirable presentation. Suggestions to the instructor such as direct questions and suggestions for use of the blackboard, are included parenthetically in the column on the left, and signaled by asterisks. The wording of summaries and transition items, as important links in the session, are also placed in the left column. This skeleton, labeled “Points to be Made," is useful in accom- plishing both purposes of the outline, preparation of the instructor and providing a usable guide. However, its primary usefulness is in the session itself. 2. Pull presentation: the right column contains a complete presenta- tion of the instruction. It is seldom, if ever, consulted during a meeting, except to verify some fact or idea. The materials in the right-hand column can either be presented by the instructor, or drawn from the group by use of questions and other stimulation to discussion. The more that comes from the group, the more effective the session will be. The full wording may serve to suggest manner and tone of presentation to the instructor. 7-3040 P7 bu How to Study the Outline The outlines can he grasped most readily at first reading if they are read section hy section. Each section begins with a Roman Numeral. Start with the topical skeleton outline in the left column and then read through the full presentation of supporting material on the right. Either column can he read independently of the other. 9 Instructor's Discussion Outline THE EHPLOYiiENT SERVICE'S CONCERN WITH THE PLACEMENT OF THE HANDICAPPED Objectives To acquaint interviewers who participate in placing the pt$rsicaliy and the mentally handicapped with the new importance of their field, and with the size of the problem, the categories of handicapped workers, and the responsibility of the Employment Service in their placement. Outline of Main Points: 1, Presentation of the plan of the training course as a whole 2. Survey of the individuals who constitute the "handicapped” among workers 3. Presentation of the categories of handicapped workers 4. Survey of the changing social attitude toward handicaps 5. Exposition of the specific responsibility of the public employment service in placing the handicapped. Training Program for Serving the Handicapped Unit 1-a First Morning (l£ hours) 11 REMINDERS FOR THE INSTRUCTOR First Day 1-a Morning Materials Needed 1. Supply of the handbook, Selective Placement for the Handicapped,11 (1943) for each trainee. 7-3040 Pll nobu ~T~~ Points to be Made Suggested Supporting Material MOTIVATIO N (30 minutes) I. Purpose of training programs I. Interviewers in the Employment Service have become To equip interviewers for increasingly aware of the importance of effective placement of handicapped placement service for or mentally handicapped applicants. A. Present urgent need for A. Two factors in our country*s economic life have -i| utilizing the handicapped emphasized this, problem for us: 1. For war production 1. Urgent need to utilize in the labor market skills of all workers, handicapped or If otherwise. 2. To readjust returning 2. Our participation in the program of returning veterans to productive work the disabled veterans being released from the armed forces. B. Techniques for handicapped B. Techniques involved in placing the physically similar to other placement and the mentally handicapped are the same as - methods, but more detailed those required in other placements, but are more intensively applied. The basic principles of understanding applicants and knowing their requirements are the same. «* • 1. Additional information 1, However, in order to match the two successfully required interviewers must have more detailed informatio . about: * (Ask what additional a. Jobs—in terms of what they demand of the ~ *• information is needed by worker in the way of physical activities the interviewer who works with the handicapped. and working ionditions; b. The vocational effect of handicaps—in t*. | List items on blackboard terms of what working capacity of the 'i' as given.) individual remains unimpaired; and - c. The other sources of help available to handicapped workers in the community, such as rehabilitation and training assistance. 2. "Selective Placement" 2. For convenience, the term "selective placement11 * descriptive term used is used to describe the additional techniques for special techniques used in the placement of handicapped workers. The term may be misleading if it implies that placement techniques for other workers are not "selective." As used in these discussions, the term "selective placement" means merely the set of methods used to meet the special problems of handicapped workers. pi.s k.. Points to be Made Suggested Supporting Material 3. "Selective Placement" a refinement of job analysis and of inter- viewing technique 3. "Selective Placement" for the handicapped thus involves both a refinement of job analysis method, to analyze the exact physical demands of jobs, and a refinement of interviewing technique, to take into account the vocational effect of different disabilities and to provide for getting technical physical information from applicants and from medical reports from physicians. K~- V? £ Stated in still another way, both the handi- capped worker and the job he is being con- sidered for must be scrutinized with special care so that the work capacity of the individ- ual and the physical demands of the job can be matched. d a C. Satisfactions of the interviewer's job C. The job is difficult but challenging. The satis- factions derived from returning a handicapped worker to the labor market more than compensate for additional time and effort required to place him. M * 1, Survey of the plan for the sessions II, This training program introduces use of a new handbook, "Selective Placement for the Handicapped." V Jr A. Specific purposes to be accomplished A. The series is designed: 1. Understanding of inter- viewer's responsibility* 1. To create an understanding of the responsi- bilities of the interviewers for the handi- capped in this placement program; 2. Comprehension of the work capacity of the handi- capped 2. To develop a real comprehension of the work capacity of the physically and mentally handicapped, and how it may be used; and 3. Working knowledge of the tools 3. To develop a working knowledge of tools and techniques which will enable interviewers to place handicapped applicants satisfactorily in productive work. * B. Limitations on the material B. Not all the "answers" can be covered in the sessions, but the survey should provide enough information to enable interviewers to obtain specific information when they need it. 7-8040 P14 bu Points to be Made Suggested Supporting Material C. Topics to be covered: C. This series will cover the following topics; 1. Who are the handicapped? 1. Definitions of who the handicapped are, of what we mean by selective placement, and when it is necessary. 2. The physical demands 2, The most important new tool in the placement analysis as an inter- of the handicapped: the Physical Demands viewer’s tool Analysis—what it is, and how to use it. 3. Vocational aspects of 3. The next four days will be devoted to the most common disabilities common disabilities such as loss of hearing. or sight, speech, or orthopedic impairment. limitations due to heart or lung conditions. and nervous and mental disorders. 4. Special placement tech- 4. The special techniques important for proper niques to be used placement of workers with each handicap will be discussed both at the time we consider the particular handicap, and again in a >- review on the fifth day. 5. Special considerations 5. Some time will be devoted to additional aids foi for veterans A' placing disabled veterans. 6. Other considerations for 6. Problems involved in securing work oppor- working with community tunities for handicapped applicants, as well agencies as what we can do to serve those who are • not immediately placeable and who need training, therapy, or other forms of assis- tance. 7. Local procedures and 7. The last day will be reserved for a review suggestions of the specific procedures by means of < which these techniques will be put in operation in the local employment offices - in your area. D. Time schedule for the D. In general our discussions during the entire discussions week will include three-hour meetings each morning and afternoon, broken by rest periods. Points to be Made Suggested Supporting Material 1 1 :i. Inquiry into the experience III. In order to get as much benefit as possible from ■with the handicapped possessed these discussions, the instructor will need by members of the training information concerning the amount of acquaintance '71 £TOU£ with the subject that is possessed by the particu- v! lar group, so that he can adapt the discussions j * (The instructor should inquire accordingly. -a- from the trainees the length of time that they have devoted to placing handicapped workers, . either in the Employment Serv- ice or in other employment. Note on the blackboard the number of years of such exper- j ience for each individual. and total the amount for the 1 group as a whole.) •i A. All interviewers bring some A. Every placement worker at some time has placed J experience a handicapped worker, so that the question can * not be totally new. B. Even extensive experience B. Even interviewers, who have specialized in work may benefit by review and with the handicapped can benefit from an ' analysis organized review of the field, and from a J consideration of the new approach recently developed and embodied in the new handbook. C. Those with limited exper- C. These training sessions can provide the inter- ience need thorough viewer just beginning to specialize in the work grounding for the handicapped with the necessary framework for developing his professional background and with the minimum data he needs to begin his A work. J f. The new handbook IV. .. Distribute to the trainees I their copies of the handbook ' A. A personal working tool A. The handbook represents a personal working tool for each interviewer. He can keep it in his desk and refer to it either as a source of information in itself or as a lead to other i sources of information he may need in his work. « 7-3040 P16 bu Points to be Made Suggested Supporting Material / B. Its contents B. Ask the group to look through the table of contents. 1. The methods section - 1. The first section includes best current " methods for interviewing and placing the handicapped. 2. The section on individual handicaps 2. The second section gives the minimum of tech- nical information concerning disabilities and handicaps that commonly occur in the population, stressing the vocational aspects of each one and highlighting the work capacity that remains with the individual. 3. Other features, including bibliography 3. Also included in the handbook are useful lists of reference works and magazines of interest to special interviewers. 4. The Physical Demands Analysis section 4. The Physical Demands Analysis section gives the full technical details of physical demands analysis as a refinement of job analysis technique. It shows the interviewer how to analyze a job to determine what it requires of the worker in terms of activities and what working conditions it involves. C. Its use in the sessions as a C. The handbook will be used in these sessions as basic text the basic text. In preparation for each discus- sion, the group will read the information in the handbook on this subject to be covered. 7-t040 Pi7 bu Points to be Made Suggested Supporting Material PRESENTATIO N (60 minutes) Definition of the handicapped (5 minutes) I. The "handicapped” probably cannot be defined, because they are individuals rather than a group. . * (Ask the group to attempt its * owi definition of "who are the handicapped11) 'j A. Handicapped not a distinct group A. Contrary to popular impression, the handicapped are not a distinct group of the population readily distinguishable from normal, people. Perfection, whether piysical, moral, or mental, is a rare thing, if not a theoretical standard which no one actually achieves. B. Everyone limited in some measure B. Every person has limitations in some direction. Some cannot run as fast or calculate as rapidly as others, and yet are not considered ’'different” - for this reason. 1, Disabilities in one function have no effect on others 1, By the same token, a person with a disabled leg may be limited in his ability to walk rapidly, to run, lift or carry, but not in his ability to see, hear, or use his hands. The disability does not limit his intelli- gence and educational achievements, vocational interests and aptitudes, nor need it affect his personality and work habits. 2. Handicapped more like the non-handicapped than different from them * (Example* Ask each trains * to mention one of his own limitations, in order to demonstrate the point that everyone is limited in some degree.) 2. He is like the non-handicapped in more respects 7 than he is different. He has sufficient abilities to enable him to be a useful worker and a useful member of society, provided society 5 itself does not impose artificial restrictions inconsistent with the degree of limitation. • I. Categories of the handicapped (10 minutes) * (Ask what different kinds of * handicaps applicants present in addition to physical limitations.) II. Broadly speaking, there are three categories of the handicapped—physical, mental, and social—who come J to the Employment Service seeking jobs. The last group includes those who find difficulty securing work because of prison records, and those in racial, i religious or other minority groups which are dis- r advantaged by discriminatory attitudes in any given community. 7-3040 Pi8 bu The present series of meetings deals only with the physically and the mentally handicapped. 7-3040 P18 bu Points to be Made . Suggested Supporting Material A. Physical handicaps A. A physical handicap is any physical deficiency * (Ask the group to name cer- peculiarity or impairment which requires an indi- vidual to be selectively placed. Physical tain common handicaps, and defects fall into two broad groups! note them on the board in two lists, (1) visible handi- • caps and (2) non-visible handicaps. Label the lists after they are complete.) 1. Visible handicaps 1. Visible or readily apparent, such as lameness. 2. Non-visible handicaps .spinal curvature, or facial disfigurement, and 2. Not visible or readily discernible, such as . B. The mental handicaps heart trouble, hernia, or arrested tubercu- losis. B. A mental handicap, for purposes of our work, is any mental deficiency, peculiarity or impairment which requires an individual to be selectively 1. Mental defectives placed. There are two different groups of mental handicaps? ( 1. Those whose mentality is under-developed. 2. Mental disorders sometimes called the feeble minded; and 2. Those whose intellectual capacity is not impaired but who are mentally ill. II. Handicaps requiring selective III. Not all handicaps are sufficiently limiting to the placement (20 minutes) individual to make him a problem in placement. It is possible to define in a general way the condi- * (The charts presented on the tions that do require "selective placement,"■ . * next page should be used to - ■ illustrate this discussion.) A. vVhen occupation must be A. Some handicaps prevent a worker from continuing modified or changed his usual occupation and make selective placement necessary even though the applicant loses only a very small part of his total working capacity. 1, Examples Loss of hand 1. This point is clearly demonstrated if we con- by machine operator sider that a sewing machine operator who loses (Use Chart I to show the his right hand has lost none of his mental capacity of the sewing capacity, little if any of his personality, machine operator on the none of his interests, none of his aptitudes, blackboard. Stress the . and a comparatively small portion of his occu- size of the unaffected pational skill. work capacity as shown by the white space.) 7-3040 Pl9 nobu CHART NO. I Effect of Loss of Right Hand on Working Capacity of a Sewing Machine Operator Circle s Total working capacity Shaded portion indicates reduction Slightly reduced Physical capacity Occupa- tional Skills Mental capacity- rPer- £onal- ity Inter- ests Slightly reduced' No other capacities affected CHART NO. - II Effect of Loss of a Leg on the Working Capacity of a Stenographer Circle r Total working capacity Shaded portion indicates reduction reduced Physical capacity Mental capacity Occupa- tional Ski?J.s /Per- sonal- ity In- x terests No capacity affected except physical capad-t: 7-3040 P*1 nobu Points to be Made Suggested Supporting Material B. When the worker would B. Some handicaps do not in any way constitute an encounter "employer occupational handicap insofar as functioning on resistance" * the job is concerned, but they may be so con- sidered by an employer. 1, Examples Stenographer who loses a leg. * (Use Chart II to show the * total work capacity of a stenographer who loses a leg.) 1. For example, a stenographer who loses a leg is not occupationally handicapped, but she might require special assistance to overcome employer resistance. C. When the applicant may aggra- vate his disability or C. i Some handicaps require special consideration to prevent the worker from undertaking work likely jeopardize the health or to aggravate his disability or to cause him to safety of others jeopardize the health or safety of others. 1. Example: Crane Operator with cardiac disorder 1. For example, a crane operator who has developed a severe heart condition cannot continue in his occupation without the danger to the safety of other people. D. When the inexperienced appli- cant is limited in oppor- D. Some handicaps interfere with the vocational oppor tunities of young people and require guidance tunities for entering an toward suitable lines of work. industry, trade, or profes- si on 1. Example; Boy with severe speech disorder 1. For example, a boy with a severe speech dis- order might not be successful in a sales occu- pation, but should be guided into the trades, agriculture, or certain types of clerical work. Summarize; • Thus, only some handicaps require special treatment for employment purposes; (1) Those requiring change in occupations; (2) Those involving possible employer resistance; (3) Those in- volving some jeopardy to health; and (4) Those re- stricting vocational oppor- tunity. I P23 bu Points to be Made ' —— *— Suggested Supporting Material # !V. Distinction between physical handicaps and occupational handi cap s (5 minute s) IV. The foregoing discussion has pointed up the distinc- tion between physical handicaps and occupational 4 handicaps. ✓ A. Occupational handicaps a lack of capacity A. "Vocational” or 11 occupational" handicaps, being terms used inter-changeably, both mean the lack of acquired or potential skill for performance in a given field of activity. B. Physical handicap may not be occupational B. This should not be confused with physical or with' mental handicaps. 1. Examples Deaf printer 1. A deaf printer, for example, is physically but not occupationally handicapped. He has a definite trade in which hearing is not a factor. 2. Some have both handicaps a. Example: Stenographer who loses hearing 2. Iflhile some physically and some mentally handi- capped people are also occupationally handi- capped in that they possess no skills, most of these applicants either have some skills or the ability to acquire them. C. Vocational guidance a sub- stantial part of handicapped C. Just as non-handicapped individuals encounter problems of vocational adjustment requiring guid- work ance or counseling, so do the handicapped. Prob- lems are often intensified by their physical or their mental limitations. Young people especially must be guided into occupations which they can perform successfully without aggravating their disabilities where they can succeed with limited or no use of certain bodily activities. V. Recent changes in attitudes toward handicaps (5 minutes) V. The roots of attitudes toward handicapped people deep in the experience of the race. Mary of the popular attitudes are surrounded in superstition and ignorance. ,, ■ i A. Superstitions underlying social attitudes toward the employment of the handicapped A. Primitive tribes killed or abandoned the crippled and aged who could not provide for themselves, so. as riot to endanger the welfare of the entire group. The early Greeks destroyed the physically imperfect in order to improve standards of physical perfec- tion. In some other societies, a person with a physical or mental handicap was regarded as in disfavor with the diety, if not actually in league with the devil 7-3040 P24 bu Points to be Made Suggested Supporting Material B. Ignorance the fundamental cause of old attitudes B. % Ignorance and inability to understand the causes of abnormalities and diseases led people to seek an explanation in the supernatural. The entire subject, surrounded with fears, was treated as something to be avoided as repugnant. 0. New attitudes based on advances in medical science • C. The development of the sciences of orthopedics in the 19th Century and psychiatry in the 20th Cen- tuiy provided for the correction or improvement of physical and mental defects. These advances in medical science restored many individuals to normal status as self-supporting citizens. The difference between the old "peg leg” and the modern artificial limb is but a single small symbol of the change. 1. Impetus from World Wars I and II 1, Medical knowledge advanced tremendously under the impetus of the work done during the first World War and afterwards. 2. New attitudes toward persons handicapped in the Services 2. The public attitude toward disabilities incurred in a patriotic service has done much to improve the situation of all persons with physical im- pairment. Rotary Clubs and other fraternal organizations assisted in the development of a new attitude by their philanthropies on behalf of the handicapped. 3. Present critical need to. utilize vrorkers 3. At the present time labor shortages compel N employers to tap the reservoir of skill found among handicapped persons who cannot meet the high physical standards of the armed forces. Even home-bound workers are now being utilized by war industry. 4. Demonstrated abilities destroy old misconception 4. The performance of the "handicapped” thus given a chance, frequently amazes employers and de- stroys some of their former misconceptions. D. Persistence of same old ideas B. But deeply grounded social prejudice dies hard. makes placement .lob difficult Employer attitudes still prevent a maximum of i employment opportunities for the handicapped, even though society now recognizes a responsibility for the care and education of the disabled. For this reason, employment service personnel must use spe- cial techniques and expend greater effort in ac- complishing the same placement service for handi- capped groups as for others. 7-3040 pas bu 26 Points to be Made Suggested Supporting Material . ... ... - return from active service. Many of these may be & physically or mentally handicapped and will re- quire the services of trained placement specialists who can expedite their prompt adjustment to a pro- ductive role in their community. 1. A major purpose of the 1. To assure that every community in the country present training finds itself equipped with trained personnel who can use the best new methods for placing handicapped workers to speed the satisfactory 7-3040 P27 bu 28 Points to be Made Suggested Supporting Material return to work of veterans is one of the many purposes of the present nationwide program in these techniques. C. Permanent legal responsi- bilities C. The responsibilities of the public employment service system for continuous service to the handi- capped and to veterans are both specifically cited in the Wagner Peyser Act of 1933 which provides the legal framework for the Employment Service system. II. Need for professional attitude (5 minutes) VII. Success in any kind of placement work requires a measure of professional detachment from the problems of the applicant. A. Necessity for detachment V- A. Work with the physically handicapped makes special demands of the interviewer in this.regard. Your concern for determining the work capacity of individual applicants must be an unemotional one if you are not to defeat your purpose. Pitfalls you must avoid include any manifestation of pity or any other emotional effect that a handicap may have on you personally. B. Importance of human values B. At the same time your concern ?dth human values . must be reflected in your work as it is in any good placement Job. SUMMARY (5 minutes) I. Summary of who is handicapped I. To recapitulate then, we have established an under- standing of the facts that: A. The concept of a handicap is a variable one. B. No individual is totally without limitations. C. Some physical and mental handicaps constitute a barrier to easy employment that reouires the application of additional techniques that we call "selective placement.” D. Every worker considered handicapped retains considerable work capacity that can be utilized. 7_3040 P28 bu Points to be Made Suggested Supporting Material -II. Summary of changed attitudes toward handicaps II. We have discussed the change from early attitudes oi fear and repugnance to present attitudes of under- standing based on facts about the causes of dis- abilities. Ill . Recapitulation of the .employ- ment Service1s Concern III. We have discussed the general responsibility and the specific legal responsibility of public employment service for the placement and proper utilization of ■v IV. handicapped workers. The professional attitude in IV. We have agreed that a placement worker who utilizes the placement of the handi- the additional techniques of "selective placement" p capped for handicapped workers has at once an added responsibility and an added set of satisfactions. To do his job, an interviewer for the iiandicapped must develop the same professional detachment that a doctor requires. He must be acquainted with a H constantly enlarged background of technical infor- mation about handicaps and the way they affect working capacity, but he has the constant satisfac- tion of contributing directly to an important and often delicate adjustment between the unimpaired work capacity of a handicapped applicant and the V* 4* actual physical demands of jobs. % •* Transitionj Interviewers in working with the handicapped have long needed a method for determin- ing precisely what the physi- * cal demands of jobs are. Such a technique has been developed. It will form the -'S*. subject of our discussion f* for the rest of the day and will constitute one of our P most important tools. 7-3040 P20 nobu 31 Training Program forServing theHandicapped Unit 1-b First morning (continued), and First afternoon hours) Instructor* s Discussion Outline THE PHYSICAL DEMANDS ANALYSIS AS AN INTERVIEWEE*S TOOL Objectives To introduce interviewers to the physical demands analysis method as a tool for, determining the physical demands of a job and matching them to the work capacity of an individual applicant. Outline of wain Points: Review of the similarities in all types of place- ment (15 minutes) 2. Introduction of physical demands analysis as an extension of job analysis (5 minutes) 3. Explanation of medical and placement office cooperation in a program based on the Physical Demands analysis (10 minutes) 4. Review of job analysis, as a basis for Physical Demands analysis (40 minutes) 5* Explanation of the use of the two Physical Demands forms (40 minutes) 6* Practice in the preparation of the Physical Demands form for an actual job (60 minutes) 7-3040 P31 nobu Unit 1-b First morning (continued) and First afternoon REMINDERS FOR THE INSTRUCTOR Special Advance Preparation In addition to thorough study of the discussion outline and of the Physical Demands Analysis section of the handbook, the instructor will want to choose the two jobs easily accessible for observation, to be assigned for physical demands analysis study. Materials Needed 1, Supply of Occupational Dictionaries (Vol* I) for each trainee 2, Supply of Job-Analysis Schedule forms for each trainee 3, Supply of the Traineefs Exercise Books for each trainee 4, A copy of the Instructors Exercise Book 5, Supply of Physical Demands Analysis forms for each trainee 6, Supply of 3x$ cards to begin the glossaries 7-3040 P33 nobu 35 *— n Points to be Made Suggested Supporting Material MOTIVATIO N AND TRANSITION - (2D minutes) 4L, 1. Review of the similarities in I. Having established an understanding of who is P placement of the handicapped and the non-handicapped handicapped and why he appears handicapped, we are ready to turn our attention to how to utilize * * * (1$ minutes) (Instructor should develop this entire section ty draw- ing points from the class and noting them on the blackboard.) his skills.by matching his unimpaired work capac- ity with the exact physical demands of jobs. A A. Basic principles the same A. The basic principles are the same for the for both types of placement handicapped as for the non-handicapped, namely, li..s - * * (Ask what the instructor must know about the appli- cant and about the job for non-handicapped placement the matching of the qualifications of the appli- cant with the specifications of the job. How- ever, certain additional facts are needed.for the handicapped, and the techniques for obtain- ing and recording them are the subjects of these sessions. ?> ** 1. The job-analysis basis * (Ask if we have a tool * for organizing our information on any job?) a. Serves for both work history and orders 1, The Public Employment Service has developed a simple technique based on job analysis for analyzing both applicants and job openings in order to match them. / a. For each part of an applicants work history the interviewer discovers what tasks the applicant did, how he did them and what factors were involved in the wav of skill, personal attributes or know- ledge. In addition to using this simple analysis to organize the facts about the applicant, the interviewer uses it to organize the facts about the demands of the job. 5» i b. Based on the questions: WHAT, HOW, WHY, and WHAT IS INVOLVED b. He establishes what the job demands from the worker in the way of tasks, bow the job is done in terms of tools, machines and processes, why the job is done in terms of net result or product, and the factors involved, such as the skills, information, and personal attributes. 7_3040 P35 bu Points to be Made Suggested Supporting Material B. Additional elements for B. For the handicapped, the interviewer needs the placement of the handi- rame information, plus how the applicants capped physical and mental limitations affect his work capacity. * (Ask what further information < * is needed to consider in - placing the handicapped.) 1, Details of remaining work 1. He wants to know what the applicant can do. capacity of the applicant. and how he does it, as these may be modified by his mental and physical capacities. 2. Details of physical demand s 2. Further, he must know in terms of activities of jobs what the job demands of the applicant (use of arms, legs, physical strength) as well as what are the working conditions or environmental stresses, (strain of working with others, noised work, pressure.) ' X 3. Matching must be more . 3. Necessary emphasis upon these two factors con- precise for the handi- stitutes the difference between placing the capped. handicapped and the non-handicapped. Among all workers and all jobs, we find varying degrees ' of physical strength, and mental stamina, offeree - by the worker and demanded by the job. I. Recent development of the II. A fairly recent development of the occupational re- physical demands analysis search program of the United States Employment Service! technique is the physical demands analysis method. A. A refinement of job A. It represents a further extension of job analysis 1 analysis method. In its simplest terms it is an outline for noting exactly what a job involves in the way of activities that a worker must be able to perform and working conditions he must be able ** to sustain. B. Applicable to a worker B. The physical demands outline of activities and or a job working conditions can be used wither to note the conditions and activities possible for a handicapped individual or to note the activities ■+ and working conditions that are part of a given job. Precise matching of the two is thus pos- sible. ■ ■ 7-3040 P86 bu Points to be Made Suggested Supporting Material PR] MENTATION I. The Physical Demands Analysis I. We have said that the physical demands analysis is (5 minutes) an outline for noting both the physical demands of * * feta (The instructor will use the blackboard during this dis- cussion.) A- Meaning of "physical a job and the work capacity of an applicant. A. Throughout our discussions when we use the term demands" "physical demands" we will understand it to mean a combination of two things: the required physi- cal activities plus the required working condi- tions of a job. * (Not© the formula on the 1. Stated as a formula. Physical Demands= Physical * board) Activities / working conditions. B. Meaning of "Work capacity" B. When we use the term "work capacity" it includes * (Note the formula) physical activities possible for an applicant plus working conditions suitable for him. in view of his limitations. 1, Again, as a formula. Work capacity = Physical C. Use of Physical Demands Activities / Working conditions. C. As we examine the method in detail we will see not confined to the handicapped that this approach is valuable also in the place- ment of inexperienced women, the very young, and older workers entering the labor market - in other words, for any placement that requires more than a simple matching of experience with specifications. II. A Physical Demands Program II. The outline now developed for physical demands involving the Interviewer And the Job Analyst, and analysis can be used as a basis for a complete pro- gram in any employment office in any community. Its the cooperating Physician full development involves the participation of the (10 minutes) Employment Service interviewer, the job analyst, (who may be the interviewer or another specialist), and the medical expert (who may be clinic physician A a - The work of a job or a private physician.) A. Logically, the Physical Demands program requires *nAi;yflt in Physical Demands that a job analyst first prepare a Physical De- mands analysis about a particular job. This step TV may be accomplished as part of a complete job study in a plant, or it may take place as a separate study to meet a particular need. 7-3040 P37 bu Points to be Made Suggested Supporting Material B. The medical expert* s part in a Physical Demands program 1 B. By the request of an employment office, a physi- cian reports on the physical capacity of a given applicant, using the Physical Demands outline wherever possible to describe the physical activities applicants can perform and the work- ing conditions suitable for them. C. The interviewer*s work in a Physical Demands Program 1. May include the work of the job analyst 2. May include evaluation of work capacity C. Working from such medical reports, and/or other available information from the applicant, the interviewer can appraise his work capacity and match it with physical demands information about specific jobs. 1. In most communities the interviewer himself will have to prepare his own physical demands analysis of openings that he fills. 2. He may in some situations not be able to ob- tain medical reports in terms of the physical demands outline and may have to translate medical diagnoses into job language to deter- mine exactly what work capacity the applicant has. D. Need for a common D. Successful placement of handicapped workers language almost always involves cooperation between the medical expert and the job expert. The physical- demands analysis provides both with a common language and reduces considerably the possi- bility of misunderstanding. !• Misunderstanding of terms 1. The old terms used by doctors to describe work capacity, such as "light work" for example, are not precise enough to meet the needs of placement workers. E. Wide variations in E. States vary widely in the extent to which they present extent of cooperation with doctors have developed cooperative relations between the employment service and doctors and hospitals in the community. In some States doctors, both private and indus- trial, are accustomed to supplying medical reports to public employment offices. For them, the use of the new plan simply requires addi- tional education in the use of the Physical Demands form. In other, the whole idea of cooperating with the employment service will be a new development. 7-3040 P38 bu #> Points to be Made* Suggested Supporting Material s. \ • * * 1*. 0 I t f* A #«U *•> V > A y F. Importance of securing Medical reports in Physical Demands terms G. Development of local office program i F. Whenever possible, the doctor can make a material contribution to the program if he will himself translate the technical medical terms of the customary report into their occupational meaning as provided for on the Physical Demands form. He is better able than the interviewer to make the translation. G. As Physical Demands analysis forms axe accumu- lated for the various jobs existent in the axea served hy the Employment Office, there will be less need for the interviewer or occupational analyst to go into establishments and observe jobs. In some communities the occupational analysts have been carrying out a program of preparing Physical Demands forms for all jobs in establish- ments which are interested in employing persons having unusual physical limitations. The forms are duplicated and made available to the Employment Service office immediately upon being completed and approved hy the managers of estab- lishments wherein the jobs were observed. The Employment Service interviewer may then only prepare a Physical Abilities Analysis of the applicant, match these qualifications with the Physical Demands analyses available on job open- ings, and then make the referral; assuming, of course, that the applicant meets the job specifi- cation requirements for training and work ex- perience. III. Brief Review of job analysis III. Before taking up the Physical Demands form in detail M as the basis for physical a very short review of the basic elements of job demands analysis analysis will be given in order to assist in under— (40 minutes) standing the physical demands forms. . * (NOTE: If the group has no background whatever in job % analysis and this brief survey is not sufficient, it may be necessary to devote a half f day to a thorough grounding & |' | in job analysis method before proceeding with physical de- P> I mands analysis.) 7-3040 P39 bu Points to be Made Suggested Supporting Material A* Purpose of Job Analysis What is the purpose of any job analysis? A. The purpose of analyzing a job is to obtain a concise picture of the work being performed and to record it in a form that will convey to the totally uninformed reader that same pattern - a snapshot of the job. B. The main points of tech- nique in job analysis * (Ask what are some of the * key points in making a satisfactory job analysis?) B. Certain key points or principles for the making of job analyses carry over to the making of . Physical Demands Analyses. 1. Observing the particu- lar job 1. Jobs by the same title vary widely from place to place, and the tasks the worker will have to perform. Therefore, it is important to observe the particular job the worker is performing. 2. Breakdown of job into component tasks 2. Any job includes a collection of tasks. i a. Example: Major tasks of a re- ceptionist (Note on the board.) a. For example: the major tasks in the job of receptionist might be: (1) Receives and greets clients (2) Ascertains their wants (3) directs them accordingly 3. The job analysis formula for each task: WHAT, HOW, WHT, and WHAT IS INVOLVED 3* Within each task in any job, a formula can be used to describe the job precisely in terms of what the worker does, how he does it, why he does it, and the skills, knowledge and abilities required to do it. a. Example of the receptionist a. For example, the first task of the recep- tionist might be further analyzed into these terms: 7->3040 P40 bu (1) WHAT - receives applicants (2) HOW - By greeting new arrivals verbally from behind a desk or counter (3) WHI - To direct visitors to the proper place and to prevent unwanted inter- ruptions U) WHAT IS INVOLVED - skill in meeting and dealing with people, pleasant manner, agreeable voice, and sufficient intelli genoe to discriminate among numerous possibilities without much close super- vision Any step or task in a job can be analyzed in the same manner. 7-8040 P40 bu Points to be Made Suggested Supporting Material C. The dob analysis form 0. On the job analysis form itself the summary of th ♦(Distribute sample job job always presents in concise form the essential and distinguishing characteristics of the oocu- ♦analysis schedules to pation. point out that the summary .section is pro- Its purpose is to provide a verbal picture of the Tided for noting the job so clearly that any person can visualise the tasks that make up a worker at his task and see clearly the important Job.) characteristics that differentiate this job from all other jobs. It answers the questions of the job analysis formula, WHAT, HOW, WHI, and WHAT IS INVOLVED. 1. Provision for noting un- 1. A job analysis study made for general pur- usual physical strains or poses includes provision for noting any unfavorable surroundings unusual physical strains in the job or any extremely unfavorable surroundings. Thus, the physical demands analysis simply develops further an aspect of job analysis that has always been present. 2. Exercise Not Is «Prac- 2. Exercise Ho. 1 has as its objective giving the tice in Recording a Job trainees practice in analyzing a simple job Summary1' and noting a job summary, as a basis for learn- ♦ (Distribute the Exercise ing how to analyze the physical demands of jobs. ♦ Book, and have the group turn to the first exer- else.) ♦ (Ask the group to note a The description of the job of receptionist contained in the Dictionary of Occupational ♦ job summary for a recep- Titles and Codes reads as follows* tionist- whom they have recently seen at work.) ■RECEPTIONIST - Receives clients or customers coming into an establishment, ascertaining the Individual's wants and directs him accord— • ingly; obtains caller's name and makes arrange- ments for him to see the desired person; directs or shows the caller to his destination in the establishment, keeps a record of of callers, time of call, nature of business, and person called on. May make future appoint- ments. May perform a variety of clerical duties, and other duties peculiar to the type of establishment, such as mounting pictures in frames in a photographic studio, or showing frames for glasses in an opticiaifc office." Answers from the group should in general con- from to this definition. BECSSS FOE LUNCH 7 -8040 P.1 >. Points to 'be Made Suggested Supporting Material PRESENTAT ION (Cont’d) IV. The Physical Demands Analysis form * (Have the group turn to the # Physical Demands Analysis section, and leaf through.) / j IV. The Physical Demands Analysis form, as stated, sup- plies the standard terminology with which to analyze the work capacity of people and the physical demands of jobs. It provides job analysts, employment interviev/ers, industrial personnel interviewers, and medical experts with standard defined terms which each understands. It provides them too with a standard, organized outline for noting the essen- tial facts. V. The Physical -Demands Analysis form for a job * (Have the group turn to the * Physical Demands form for SACK SEWER in the Physical Demands Analysis section. It is reproduced on the fol- lowing, page for the instruc- tor’s convenience. Follow item by item through the instructions for filling in the form.) V. Two forms are used - one for jobs and one for appli- cants. The standard Physical Demands form for analyzing a job will be considered first. Inter- viewers for the handicapped will often make their own Physical Demands analyses, and will need a com- plete understanding of the form. .r A. The ’’Physical Activities" section A. The first important section of the form is "Physical Activities," listing 27 of the most common physical activities such as walking, lift- ing, seeing. 1. Activities the "elements” 1. These are the basic "elements" of the analysis, in the same sense that the word "elements" is used in chemistry. / 2. Standard definitions of activities important (The definitions are re- produced on page 20 of this outline for the con- venience of the Instruc- tor. ) 2. Also as in chemistry, an understanding of the nature of each element is required. Standard definitions for each activity accompany the Physical Demands form in the handbook. Anyone working with the form must be fully ac- quainted with the standard definitions for the activities. • a. "Write-in" spaces provided a. Three spaces are provided for writing in any other activities an analyst may encounter. 7_3 040 P4 2 bu WAR MANPOWER COMMISSION Budget Bureau Ro. 11-tOBB.t Approval Bipirae March |i, 1044 Division of Occupational Analysis and Manning Tables BUREAU OF MANPOWER UTILIZATION . PHYSICAL DEMANDS FORM Job Title SACK SEWER (BARLbY HARVESTING) Occupation*! Code 3~11.10 Dictionary Title SACK SEWERr HAND . ~ Firm Name A Address Z Ranchr Fresnof California Industry Industrial Code 0111 Branch Grain Farming Department Barley Harvesting Company Officer Z. Analyst X Data 7-15-A3 PHYSICAL ACTIVITIES WORKING CONDITIONS Walking Jumping Running Balancing Cl I mb Ing Craw ling Standing Turning Stooping Crouch Ing KneaI Ing Sitting Reaching LIftIng Carrying Throwing Pushing Pulling Hand I Ing Fingering Feel I n g Talking Hearing Seeing Color Vision Depth Perception Working Speed Inside Outside Mot Cold Sudden Temp. Changes Humid Dry Wet Dusty Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration Mechanical Hazard* Moving Object* Cramped Quarters High Pieces Exposure to Burns Electrical Hazards Exp I os I vet Radiant Energy Toxic Conditions Working With Others Working Around Others Working Alone details OF physical activities: y[\xst work rapidly throughout ten hour day, repetitively filling and sewing a sack of barley approximately every Ijj minutes. Turns, stoops, and grasps empty sack, placing it on hooks at mouth of grain chutes (15$). Lifts and bounces sack up and down during sack-filling process which weighs 100-125 pounds when full (25$), Grasps, lifts, and carries filled sack about three steps, walking with balance and care on moving, jerky, harvester platform (10$), Sits and sews filled sack by hand, working with rapid, dexterous movements of fingers, hands, and arms, pulling the twine tight with both hands and pushing sewn sack from platform on to sack chute (50$). Uses little sight during filling and sewing process, relying considerably on a combined sense of touch and muscular discrimi- nation. Climbs eight-foot perpendicular ladder to and from harvester platform twice daily. DETAILS OF WORKING CONDITIONS! Outside, in dry summer heat 95° - 115° F, on moving, jerky, platform of large harvester, riding about eight feet above the ground in a constant heavy dust of earth and straw particles, 'with virtually no contact with fellow workers (100$), DETAILS OF HAZARDS: Possibility of hand cuts from large sharp needle (50$), of hernia from frequent lifting and carrying 100-125 pound sacks of barley (35$), of collapse due to rapid working pace and hot weather (100$), of bruises, sprains, and fractures from falling by slipping on loose ball-bearing-like grain on moving platform floor (50$), of slipping and falling from platform beneath harvester and being crushed to death (50$). Points to be Made Suggested Supporting Material 3. * * * Review of the definitions (Ask members of the group to read each definition aloud. After each one, ask what typical jobs usually involve the acti- vity—noting the sugges- tions as shown at right.) 3. A reading of the definitions will provide the necessary basic information. Each activity can be illustrated on the board as follows: Activity As in the job of 1. Walking Postman 2. Jumping Delivery helper 3. Running Baseball player 4. Balancing Structural iron worker 5. Climbing House painter 6. Crawling Miner 7. Standing Store clerk 8. Turning Cook 9. Stooping Shoe clerk 10. Crouching Auto mechanic 11. Kneeling Charwoman 12. Sitting Chauffeur 13. Reaching Stock clerk 14. Lifting Librarian 15. Carrying Messenger 16. Throwing Rivet passer 17. Pushing Porter IS. Pulling Crane operator 19. Handling Baker 20. Fingering ' Radio assembler 21. Feeling Mica inspector 22. Talking Teacher 23. Hearing Interviewer 24. Seeing Inspector 25. Color vision Textile grader 26. Depth perception Truck driver 27. Working speed Short order cook 4. Exercise No. 2, "Dis- 4. No. 2 has as its objective the high- tinguishing between lighting of the fine distinctions between the definitions of different precise meanings of the definitions—dis tine- activities" tions that are sometimes lost in common usage• 5. Entries in "Activities" 5. The required entries are: section a. "X" before each activity required by the Job. b. "0" before those not required. All activities are to or an "0", be marked with an "X" The "X" will be used however slight the degree 7-8040 P4S b Points to be Made Suggested Supporting Material 6. Two kinds of variation in degree s frequency and intensity 6. All activities will not be present in the same degree. They will vary in terms of frequency (called the "time-consuming factor"), in terms of intensity (called the "energy-consuming factor"), or in some combination of these two. a. Variations in degree expressed under "Details" a. An "X" is used before each required activity regardless of frequency or intensity. Under "Details of physical activities" further along in the form, the analyst makes spe- cific comments concerning the frequency and the intensity of the required activities. 7. Possible, error from describing performance rather than the job itself 7. The analyst must be sure that he records the activities required by the job rather than those that happened to figure in the perform- ance of an individual worker. i a. Example of individual idio^yncracies • a. For example, a certain ARC WELDER may use his sense of hearing to help him maintain the proper arc by listening to the hissing sound it makes. The job itself, however, does not require an ARC WELDER to hear. The important requirement is sight, to determine whether he has maintained the proper arc. Regardless of individual idio- syncracy, therefore, hearing should not be noted as a required activity of a job as ARC WELDER. B. The "Details of Physical ’ B. In the section marked "Details of Physical Acti- Activities" section vities" the frequency and intensity factors of the required activities are to be noted. The relationships between activities are to be brought out here in a specific manner. A few major points serve as guides: 1. Details of equipment and material minimized 1. Concentrate, as far as possible, on the physical activities required, and minimize any reference to details'of equipment and materials. 2. Association of activities as they naturally occur < 2. Since activities are rarely undertaken inde- pendently, it is not necessary to write up each item on the check list separately. a. Example of a flow of related activities a. For example, the worker does not stoop with- out doing something else such as reach. Reaching may in turn involve additional activities, completing the whole cycle of physical requirements for a single opera- tion. Thus, in writing the details of 7-8040 P40 bu Points to be Made Suggested Supporting Material activities, the analyst should brihg out an association and flow of activities, in order to give a complete picture of the physical requirements. b. Example of the para- graph of "Details of Physical Activities" b. The paragraph for SACK SEWER reads: "DETAILS OF PHYSICAL ACTIVITIES: Must work for SACK SEWER, from Physical Demands Anal- ysis section * (The instructor will * read through and com- ment on the paragraph with the group.) rapidly throughout ten hour day, repetitively filling and sewing a sack of barley approx- imately every If minutes. Turns, stoops, anc grasps empty sack, placing it on hooks at mouth of grain chutes (15$). Lifts and bounces sack up and down during sack-filling process which weighs 100-125 pounds when full (25$). Grasps, lifts, and carries filled sack about three steps, walking with balance and care on moving, jerky, harvester platform (10$). Sits and sews filled sack by hand, working with rapid, dexterous move- ments of fingers, hands, and arms, pulling the twine tight with both hands and pushing sewn sack from platform on to sack chute (50$) Uses little sight during filling and sewing process, relying considerably on a combined sense of touch and muscular discrimination. Climbs eight-foot perpendicular ladder to and from harvester platform twice daily," 3. Frequency of activities— a percentage of time 3. The approximate time consumed by each activity should be expressed in terms of a percentage of the total time spent on the job. The example for SACK SEWER shows such entries in parentheses. 4. # * Intensity of activities— measurement of energy (Read items "a" through "g," asking the group to try to locate an instance of each in the paragraph on SACK SEWER.) 4. The intensity of each activity will represent an attempt to measure the energy consumed in terms of either: a. The weight and size of objects lifted, carried, thrown, pushed, pulled and hauled; b. The distance walked, jumped, run, climbed and crawled; c. The acuity required in hearing, feeling, seeing, color vision, and depth perception; d. The dexterity required in fingering; 7-1040 P«t btt Points to be Hade • —— Suggested Supporting Material 5. Special mention where one e. The direction and distance reached; f. The qualities required in talking; or g. The tempo required in working speed. 5. The form is based on the assumption that the member only is required activities require both hands or both legs. Whenever an activity reouires only one member, . that should be specifically stated in order to 6, Similarity to the Job highlight the fact that one alone can do the job. - 6. The similarity between this section on the Summary bn the job Physical Demands form and the Job Summary analysis form section on the job analysis form is evident. 7. Items left blank for Both attempt to give a concise picture of tne b job. The Physical Demands form goes a step further in that it attempts to show exactly what the job means in terms of physical effort. 7. Items 2b, 29, and 30 were left blank for "write-ins11 writing in other activities that might be * (Ask the group if they observed. # have any questions be- * fore proceeding to other sections of the form.) C. The "'/forking Conditions'1 C. The "Working Conditions" section of the form lists i section 27 of the most frequently occurring conditions * (Ask the group to read the that surround jobs, numbered from 51 to 77. Defi- nitions for working conditions accompany the form * working conditions section and are to be found in the handbook. The inter- on the Physical Demands form viewer must be fully familiar with each definition. for SACK SILVER.) 1. Review of the definitions 1. Again, the definitions give the necessary basic *■ (For the convenience of information. Tome of the jobs that might be cited to typify each are: # the instructor they ap- 4 pear in this outline on Dorking Condition As in page 22.) (Ask group to read each 51. Inside - Interviewer 52. Outside - Lineman definition aloud, and have 53. Hot - Boiler tender them mention a job that 54. Cold - Ice box man involves each and note 55. Dudden temperature them on the board.) changes - Butcher 56. Humid - ; toker on boat 57. Dry - Dryer tender 7-3040 P48 bu Points to be Made Suggested Supporting Material Working Condition As in 56. Wet - Fireman 59. Dusty - Cement Mixer 60. Dirty - Threshing hand 61, Odors - Chemist 62. Noisy - Boilermaker 63. Adequate lighting ) - Varies with spe- 64. Adequate ventilation) cific job 65. Vibration - Riveter 66. Mechanical hazards - Drill press operate 67. Moving objects - Structural iron worker 68. Cramped quarters - Subway motorman 69. High places - Bridge worker 70. Exposure to burns - Welder 71. Electrical hazards - Electrician 72. Explosives - Dynamiter 73. Radiant energy - X-Ray technician 74. Toxic conditions - Chemist 75. Working with others - Social worker ■ 76. Working around others - Stenographer 77. Working alone - Timber cruiser 2. Exercise No. 3—"Dis- 2. Exercise No. 3 has as its objective the high- tinguishing between lighting of fine distinctions between defini- definitions of different tions of different working conditions. working conditions" 3. Entries in "Working Con- 3. The required entries are; ditions" section 1. "X" before each working condition to which the worker is required to be exposed 2. "0" before each one to which the worker is not required to be exposed on the particular job All activities are to be marked with an "X" or an "0U. a. Time and danger a. The factors of both time and danger will be expressed under involved to a varying degree in each work- "details" ing condition required by the job. Specific comments in this connection are reserved to be entered in the sections on "details of working conditions" and "details of hazards." 7-3040 P49 bu Points to be Made Suggested Supporting Material D. "Details of Working D. Mo heading entitled "Details of Working Conditions'’ Conditions" section * (Remind the group to * follow through on the sample form for PACK SEWER.) is printed on the Physical Demands form. It is to be written in after "Details of Physical Activi- ties," This provision eliminates waste of space because the details of physical activities will vary considerably in length. 1. The time factor for each working condition 1. In this section you will specifically state the length of time the worker is exposed to the particular working condition, noting the time as a percentage of total time. The entries are made in parentheses at the end of the com- ment . 2. The intensity factor -x- (Read aloud points "a" -x- through "i" at the right, and ask the group to men- tion illustrations of each from the Details of 'Dorking Conditions para- graph for SACK SEDER.) * Tj 2. The intensity of the condition will be described as objectively as possible, using measures wherever feasible. The measures may be of the following kinds: a. The range (in degree) of high or low temperatures; b. The range (in degree) of sudden temperature changes; c. The kind of dust, dirt, odor, wetness, mechanical hazards, moving*objects, exposure to burns, electrical hazards, explosives, radiant energy, or toxic conditions; d. The source of'noise or vibration; e. Whether or not there is adequate lighting and ventilation; f. The size of cramped quarters; g. The height of elevated places; h. Kow much the worker works with others, around others, or alone;' i. Any differences which may occur in the working conditions under different shifts. E. The "Details of Hazards" E. Another heading. Details of Hazards, is to be sec tloii (Again remind the group * to note the sample form.) addeo bo tne form by the analyst directly after the completed section on "Details of Dorking Conditions." 1. Purpose - to highlight harmful conditions 1. The purpose of this section is to point out tne possibilities of injuries to the worker as a result of the hazards inherent in the physical activities and working conditions so that they may be avoided in placement. 7-3040 POO bu Points to be Made Suggested Supporting Material 2. Check list of possible injuries 2. The following list may serve as a guide for determining possible injuries: a. Cuts h. Impairment of sight b. Bruises i. Impairment of hearing c. Burns j. Occupational diseases d. Sprains k. Collapse e. Hernia 1. Electric shock f. Fractures m. Sudden death g. Loss of parts n. Other 3. No attempt to predict degree of possible injury 3. The interviewer should make no attempt to ex- press the degree of possible injury other than to state the length of time the worker is sub- ject to the hazard. .Others who use this infor- mation will determine the degree of possible injury as it concerns specific individuals. 4. The time factor for hazards 4. As in the previous sections, the time factor is expressed as a percentage, in parenthesis, at tne end of each comment. a. Usually corresponds to time of activities or of working condi- tions t a. As a rule, the percentage of time the worker is subject to injury from a physical activit; will correspond to the percentage of time th| worker is engaged in that activity as stated under DETAILS OF.PHYSICAL ACTIVITIES. Like- wise, the percentage of time the worker is subject to injury as a result of exposure to, certain working conditions will correspond t the percentage of time the worker is exposed to that condition as stated under DETAILS OF WORKING CONDITIONS. F. Exercise No. 4—"Review of F. Exercise No. 4 has as its objective assuring that Physical Demands Fora for the trainees understand the purpose of all the PRODUCT j.ON WILDER entries on the physical demands form. * (Have the group turn to the * Physical Demands form for PRODUCTION REDDER on page 13 of the Physical Demands Analysis section. The form is attached for the conven- ience of the instructor.) _ ■* , • • Summary and Transit!oni The Physical Demands Analysis form, then, is essentially an outline for noting the physi- cal activities and working conditions involved in a job— i.e., a Job Description in nhvsi 7_3040 P61 bu Points to be Made Suggested Supporting Material I. The Physical Capacities Appraisal form (using physical demands termi- n°l°gy) VI. A. The identical list of acti- vlties and conditions used A. The identical list of physical activities and working conditions forms the basis for the Physical Capacities Appraisal form now recom- mended. whenever the report can be ootained in tnese terms, the matching job of the placement interviewer is clearly expedited. B. Filled out by cooperating physician, clinic, or hospital (have the group turn to * the Physical Capacities Appraisal form in the Physical Demands Analysis section. A copy is at- tached for the instruc- tor 1s convenience.) B. The Physical Capacities Appraisal form must be filled in by a physician or hospital where pos- sible when a medical report is desired for the proper placement of an applicant. / C. Entries indicate restrie- tions C. To reduce the number of entries necessary, the physician is asked to indicate only the physical restrictions and environmental restrictions or, in other words, the activities and* the conditions forbidden for the applicant. 1. Checked items are those forbidden, to save doc- tor ' s time 1, On a completed for the items not checked are the working conditions or activities that are satisfactory for the applicant. Tnis plan saves the doctor's time and makes for better cooperation. 2. Entries reversed 2. The entries are thus the opposite of those on the Physical Demands form. D. Interviewer may have to fill out form Lf • Vvhen a medical report is not secured from a doctor or a hospital, the interviewer himself must note the physical and environmental restrictions for each handicapped applicant. 1. Usually used as a check list only 7-3040 P62 bu 1. He will probably make the entries directly on the application card, but the entries should be in terms of the physical demands terminology. Best practice requires that the entries corres- pond with the items that appear on the Physical Demands form so that the standard definition for physical activities and working conditions will clearly be indicated. Points to be Made Suggested Supporting Material 2. When applicant's diagnosis is evident 2. In other words, the interviewer uses the items from the list as a guide for making his own notations when the applicant brings his own diagnosis of long-standing complaint with him, or when the medical report is not secured. 3. Danger of attempting a diagnosis 3. At this point the interviewer must particularly guard against any tendency to diagnose the ap- plicant's disability himself. Diagnosis by an interviewer is never possible. APPLICATION (60 minutes) I. Exercise No. 5—"Physical Demands Analysis of a Common Job" I. Exercise No. 3 has as its objective the application of the principles for making a physical demands analysis. * (Supply the group with copies * of the Physical Demands Anal- ysis form for a job. Instruct them to observe carefully a job easily accessible in the neighborhood of the training session.) A. Observation of one of two possible jobs A. The job of ELEVATOR OPERATOR, COUNTER MAN, SHOE SHINE BOY or NEWSSTAND ATTENDANT is usually readil at hand for observation. Definitely assign two among these jobs so that the results can be compared when the group returns. B. Survey of the key points of a good Physical Demands Analysis * (Review the key points ♦ at the right with the group.) B. The key points to be remembered in preparing the forms are: 1. Is the fundamental job analysis a sound one in that WHAT, HOW, WHY and WHAT IS INVOLVED is clearly stated for each task? 2. Are all the items covered by either an X or an 0? 3. In the sections on Details is an effort made to express each item clearly in terms of its intensity? 4. Has an effort been made to estimate the per- centage of time for each item? 7-3040 P69 b«i Points to be Made Suggested Supporting Material I C. Time Allowed: A 5 minutes * (While the group is observ- * ing the jobs agreed upon, the instructor will review the Dictionary definitions for the job chosen and him- self prepare a satisfactory Physical Demands form for the particular jobs.) 5, Is tne proper correspondence between the per- centage of time for a working condition or a physical activity and the percentage of time for a hazard carefully maintained? I. Review of the Sample Physical II. The same Key points listed above should be checked Demands Analysis Forms * (Revie r with the group the as the forms are reviewed. * details for each of the two jobs, stressing the key points of a good form. If the group is large, some analyses should be reviewed individually after >ne * session.) SUM IARY [. Review of the advantages of I. Probable answers will be that the Physical Demands the Physical Demands Analysis Analysis has the following advantages: * (Elicit from the class a rapid A. Approaches objective treatment * review of the advantages of B. Minimizes the need for mention of physical the physical demands analysis of both jobs and workers.) disabilities C. Places emphasis where it belongs upon the physical and environmental aspects of the job rather than on the limitations of the applicant D. Provides a common link for use for the placement worker and the medical worker E. Emphasizes the fact that no job requires all of the physical and mental capacities of human beings. Points to be. Made Suggested Supporting Material II. Reading of introductory section of handbook II. * (if time remains the group might read Section I and Section II of the handbook to resurvey the points made during the day’s discussion.) III. Preparation for second day III. Each day's discussion is necessarily based on information secured in advance. A. Readings A. Ask the group to prepare for the discussion of the next day by reading the following sections in the handbook. Part II, Sections on Hearing, Speech, and Orthopedic Disabilities. Part I, Section III, the Application Process, (omitting Recognizing the Handicapped) and Section V, Preparing Applicants for Employment. i Part I, Section I and Section II, if not already read as described above. B. Development of the GLOSSARY * (Distribute a supply * of blank 3x5 cards.) B. Ask the group to note on 3x5 cards the new tech- nical terms they encounter in the readings—in order to begin the development of a technical glossary. Mention that the use of the Medical Dictionary will be discussed in the next sessioi ▼-*©40 P88 nobu DEFINITIONS OF PHYSICAL ACTIVITIES 1. V.ralking - Moving about on the feet by taking alternate steps, setting one foot before the other without running. 2. Jumping - Projecting the body up, down, or horizontally through the air, pri- marily by the muscular action of the feet and legs. 3. Running - Moving rapidly by using the feet and legs more quickly than in walking 4. Balancing - Yfelking, standing, or running on narrow or slippery elevated sur- faces by maintaining body equilibrium to prevent falling. 5. Climbing - Ascending or descending ladders, scaffolding, poles, ropes, and the like, using hands and arms as well as feet. 6. Crawling - Moving about on the hands and knees or hands and feet 7. Standing - Supporting oneself on the feet and legs in an upright or nearly upright position. S. Turning - Twisting partly around, or revolving completely about a vertical axis, usually involving the spine, trunk, neck and legs. 9. Stooping - Bending the body downward and forward by bending the spine only. 10. Crouching -Bending the body downward and forward by bending the legs and spine. 11. Kneeling - Bending the legs at the knees to come to rest on the knees. 12, Sitting - Resting upon the haunches or lower or posterior extremities of the trank as in occupying a bench, chair, saadle, etc. 13. Reaching - Extending the hands and arms in any direction. 14. Lifting - Raising or lowering an object from one level to another. 15. Carrying - Transporting an object, usually by holding it.in the hands and arms. 16. Throwing - Propelling an object through space by swinging motion of the hand and arm with or without the use of tongs or other devices. 17. Pushing - Exerting force upon an object so that the object moves away from the force, including slapping, striking, kicking and treadle actions. 18. Pulling - Exerting force upon an object so that the object moves toward the force, including jerking. 19. Handling - Seizing, holding, grasping, turning or otherwise working with the whole hand or arm. 58 20. Fingering - Picking, pinching, or otherwise working with the fingers primarily, (rather than v.lth the whole hand or arm, as in handling.) 21. Feeling - Perceiving such attributes of objects as size, shape, temperature or quality, by means of receptors in the skin, typically those of the finger tips. 22. Talking - Expressing or exchanging ideas by means of spoken word. 23. Hearing - Perceiving the nature of sounds by the ear. 24. Seeing - Perceiving the nature of objects by the eye. 25. Color Vision - Perceiving the color of objects by sight. 26. Depth Perception - Perceiving relative or absolute distances of an object from the observer or from one object to another. 27. Working Speed - Rate of speed of the job. Check only when job requires a significantly high rate of working speed. NOTE; "When activities involving the use of the hands and arms and the feet and legs require the use of but one hard and arm and £ut one foot and leg, the analyst is to make specific comments in this connection. 7-3040 P68 bu DEFINITIONS OF WORKING CONDITIONS 51. Inside -* Indoor protection from weather conditions. 52. Outside - Out of doors, or under an overhead covering with slight protection from the weather. 53. Hot - Temperature sufficiently high to cause perceptible bodily discomfort. 54. Cold - Temperature sufficiently low to cause perceptible bodily discomfort. 55. Sudden Temperature Changes - Variations in temperature which are sufficiently marked and abrupt to cause perceptible bodily reactions. 56. Humid - Atmospheric conditions with moisture content sufficiently high to cause perceptible bodily discomfort. 57. Dry - Atmospheric condition with moisture content sufficiently low to cause perceptible bodily discomfort. 58. Wet - Contact with water or other liquids 59. Dusty - Air filled with small particles of any kind such as textile dusts, flour, wood, leather, feathers, etc., and inorganic dust including silica and asbestos, which make the workplace unpleasant or are the source of occupational diseases. 60. Dirty - Contact with, or exposure to dirt,*litter, soiled materials, etc. 61. Odors - Perceptible smells, either toxic or non-toxic. 62. Noisy - Sufficient sound to cause thought distraction or possible injury to the sense of hearing. 63. Adequate Lighting - Sufficient lighting to minimize eye strain. (A zero before this item would indicate that the lighting is either insufficient or excessive. Explain under Details of Working Conditions.) 64. Adequate Ventilation - Sufficient ventilation to cause neither a feeling of suffocation nor exposure to drafts, (A zero before this item would indicate that the ventilation is insufficient or excessive. Explain under Details of Working Conditions.) 65. Vibration - Production of an oscillating or quivering movement of the body or strain on the muscles, particularly of the legs and arms, as from repeated motion, pressure, or shock. 66. Mechanical Hazards - Exposure to mechanical parts involving the rish of cuts, bruises, sprains, fractures, loss of parts, impairment of sight, or sudden death. 67. Moving Qb.iects - Exposure to moving equipment and objects such as overhead cranes, hand and motor driven vehicles, falling objects, etc., which involve the risk of cuts, bruises, sprains, fractures, loss of parts, impairment of sight, or sudden death. 7-9040 P*® *u 68. Cramped Quarters - Workplace where freedom of movement is restricted or where worker cannot maintain an upright position. 69. High Places - Workplace at an elevation above the floor or ground level from which it is possible to fall and be injured. 70. Exposure to Bums - Workplace involving the risk of being burned from hot materials, fire or chemical agents. 71. Electrical Hazards - Exposure to high-tension wires, transformers, bus-bars, or other uninsulated or unshielded electrical equipment which involves the risk of electric shock or sudden death. 72. Explosives - Exposure to explosive gasses, vapors, dusts, liquids, and sub- stances which involve the risk of bodily injury or sudden death. 73. Radiant Energy - Exposure to radio-active substances (radium, uranium, thorium, etc.,) X-Rays, ultra-violet rays, or infra-red rays, which involve the risk of impairment of sight or general or localized dis- abling conditions.) 74. Toxic Conditions - Exposure to toxic dusts, fumes, gasses, vapors, mists or liquids which cause general or localized disabling conditions as a result of inhalation or action on the skin. 75. Working with others - Job requires occupational cooperation with fellow workers, or direct contact with the public. 76. Working around others - Job requires independent occupational effort but in proximity to fellow workers or the public. 77. Working alone - Job requires independent occupational effort and virtually no contact with fellow workers or the public. 7-3040 P60 bu Budget. Bureau No. ll-BOBB.l Approval Bzplras March 11, 1044 WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Division of Occupational Analysis and Manning Tables PHYSICAL DEMANDS FORM Job Title PRODUCTION WELDER Occupational Code A-85.02Q Dictionary Title VOIDER, ARC Firm Name k tddfeee General Motors Corporation. 2700 Tweedy Blvd.. Los Angeles Ordnance & Accessories Manufacturing Tndi.atHai Code 1931 Raaa.h Tanks. Manufacturing Department Welding Company F.G. Douglas Analyst Barry Fag in Date 7-15-A3 Dictionary Title PHYSICAL ACTIVITIES fa I k I n g Jumping Running Balancing Cl I mb Ing Craw ling Standing Tu r/> I ng Stoop Ing Crouch Ing Knea I Ing Sitting Reaching Lifting Carrying Th row In g Pushing Pulling Handling FInger Ing Feel Ing Talking Hearing See Ing Color Vision Depth Perception Working Speed Inside Outside Hot Co I d Sudden Temp. Changes Humid Dry Wet Dusty D I rty Odors Noisy Adequate Lighting Adequate Vant I I at I on Vibration WORKING CONDITIONS MeehanIcaI Hazards Moving Objacts Crampad Quarters High Places Exposure to Burns Electrical Hazards Explosives Radiant Energy Toxic CondItIons Working With Others Working Around Others Working Alone DETAILS of PHYSICAL ACTIVITIES: Stoops, grasps, lifts, and carries 4-0 pound pieces of amor plate (16” x 16” x 1") about $ steps (10$). Pushes plates into steel jig, turning ana reaching in all directions and pushing and pulling hand-operated clamping devices to secure plates in jig preparatory to welding (15$). Climbs and crawls about tank to place where welding is to be done (5$). When welding, crouches and kneels in awkward positions inside tank bodies (25$) and stands and kneels on tank tops (25$), being careful to keep balance. Holds electrode-holder in one hand and steadies its motion by resting hand on other am during welding process (50$), maintaining proper arc by using sight to observe appearance of weld. Pushes and pulls arc welding generator to various desired locations and adjusts control knobs by hand (5$). Handles and uses a light chipping hammer, a portable grinder, a small slag hammer, and such small parts as bolts and brackets both inside and outside tanks (15$). DETAILS OF WORKING CONDITIONS: Works around others inside adequately lighted and ventilated tank plant (100$). Works in cramped quarters inside tank bodies (35$) and on tank tops ten feet above cement floor (30$). Exposed to odors of mildly toxic welding fumes (100$), to loud noises from chipping and grinding operations in plant (100$), to ultra-violet and infra-red radiation from electric arcs (100$), to sharp-edged steel parts and devices (100$), to hot metals and flying sparks (65$), to overhead cranes carrying tank parts (10$), and to vibration from small pneumatic chipping hammer (3$). 62 DETAILS OF HAZARDS: Possibility of developing metal fume fever from mildly toxic welding fumes from manganese steel necessitating a few days sick leave (100%). When worker’s welding hood is raised, possibility of receiving a "flash" of radiant energy from the electric arcs (from welding equipment of own or others) which "sunburns" the eyes and causes temporary blindness (100%). Possibility of injury to the hearing from loud noises (100%), of cuts from sharp edges of steel parts and devices (100%), of burns from hot metals and flying sparks (65%), of injury from overhead cranes (10%), and of bruises, sprains, hernia, and fractures from slipping and falling from tank tops (30%). 63 Instructor's Discussion Outline USE OF OTHER OCCUPATIONAL INFORMATION TOOLS IN PLACEMENT OP THE HANDICAPPED Objective! To acquaint interviewers with the specific uses to be made of occupational information tools (both national and local) in interviewing and referring handicapped workers. Outline of 1. Relation of the physical demands analysis to Main Points: other occupational tools (5 minutes) 2. Brief review of the use of occupational infor- mation tools by any interviewer (10 minutes) 3. Occupational information tools as aids in choosing the field of work (50 minutes) 4. Assigning a classification (20 minutes) 5. Summary of the use of the outline (5 minutes) Training Program for Service to the Handicapped Unit 2-a Second Morning Unit 2-a Second Morning EhJMINDEES FOB TEHJ INSTEUCTOE Special Advance Preparation: The instructor will want to refresh his acquaintance with the items listed below for use in the session. Materials Needed: 1. Supply of the dictionary of Occupational Titles and Codes, Volume I” for each trainee 2. Supply of the National Job Description Volume entitled ”Job Machine Shops” for each trainee 3. Supply of the new 5x8 inch Job Description cards for HOT EhHDEE III 4. Supply of a complete listing of new 5x8 inch Job Descriptions available from the Washington headquarters for each trainee 5. Supply of "Special Aids for Placing Navy and Army Personnel in Civilian Jobs" for each trainee 6. Supply of bulletins on Utilization of Persons Having Physical Limitations 7. Supply of a sample Job Family for each trainee 8. Supply of complete sets of the available National Physical Demands Studies for each trainee 7-3040 P60 nobu- Points to be Made Suggested Supporting Material H0TI7ATK (15 minutes) Halation of the Physical De- «And« Analysis to the other occupational information tools (5 minutes) X. The Physical Demands Analysis Just studied represents the further development or specialized refinement of a body of Information and a set of techniques which is part of the professional equipment of all workers In a public employment service program. This body of information and technique is a set of occupational information tools developed by the USES In Its extensive national research program conducted continuously since the establishment of a unified national service in 1933. A. A gpgglfiljzgsl dCTj.ffgBgRt gf ,1gl? fiBfrlYPig A. As the discussions have already demonstrated, the Physical Demands Analysis method is a specialized refinement or extension of the more fundamental job analysis technique. Accordingly, physical demands technique can be applied only on the basis of a thorough understanding of the job analysis method. B. Other occupational infor- matlon tools useful to the Interviewer for the handi- B. While the physical demands technique and the specific studies of jobs made in terms of physical demands analysis are the most directly useful to the inter- viewer for the handicapped, he can also make extensive use in his job of all the other materials developed as part of the occupational information program. S?ng.y gl %h* v&»- tional Information bv anr interviewer (10 minutes) , * (Ask the group what direct • uses an Interviewer can make of occupational Information tools, and list the sugges- tions on the board.) II. The interviewer for the handicapped necessarily starts from the same basis as any other Interviewer in using occupational tools. A. Clftg«4flraUsa tfrg mg9$ Immediate problem k, A. The most direct use of occupational tools is in con- nection with assigning a classification and code to a worker. The Dictionary of Occupational Titles is used in this process. B. Conversion of skills v. B. Still another use of occupational tools receiving considerable attention at present is that for the conversion of skills developed in experience in one occupation to fill needs in another. 7-1340 P67 bu Points to "be Made Suggested Supporting Material The importance of full use of occupational informa- tion to extend the search for vitally needed skills to meet war time demands has high-lighted their use- fulness in recent months. C. Formulation of meaningful questions in interviewing C. Another important use for occupational information is for guiding the formulation of questions to applicants during the interview. When the interviewer is acquainted with the basic elements of jobs mentioned as part of the appli- work history, he can focus attention along the particular items of information that bear directly on placement. Without an acquaintance with the elements of the job, the interviewer would not know what questions to ask. P. pf mgaQiftggul questions for order-taking and other emnlover contacts D. Similarly, the same background of occupational infor- mation aids the interviewer in formulating the questions he asks in taking an order. The same data about jobs provides the interviewer with a solid basis for discussion with employers on any occasion, such as the field visit or a dis- cussion of a statement of availability. Vocational Guidance B. The interviewer for the handicapped moreover needs the facts about jobs as the basis for the guidance which is part of his job. PEBSBHTA^ ?I0N (80 minutes) I- ?sg, .Qf. ggSttSfitjqnai jfifgraft- tlon tools in choosing the general field of work (60 minutes) I. A. Classification the immedl- ate -practical problem A. The process of matching the physical capacities of a handicapped applicant with the physical demands of jobs actually starts with assigning the proper classification to the worker. The assigning of that classification represents the summation of all the considerations of the interview. 1. Process more extensive 1. While the process of arriving at a classification than that for ordinary applicant for a handicapped worker is the same as that for any worker in its essential elements, the considerations Points to be Made Suggested Supporting Material are often somewhat more extensive in that the inter- viewer must devote more time to a preliminary survey of the general field of work which the applicant's remaining work capacity enables him to perform. 2. Special considera- tions necessary 2. Within that general field of work, the interviewer often exercises considerable creative thought to arrive at a particular job classification or even a particular job opening wherein the applicant's work capacity will match the physical demands of the opening. B. Snecial need for wide infor- mation on occupations * (Ask the group why the in- * terviewer for the handi- capped has a special need for extensive occupational information) B. When an interviewer for the handicapped has before him an applicant with a particular work capacity he must review in his mind the physical’ demands of a wide variety of jobs in order to arrive at a classification. He must therefore know them thoroughly, or he must be able to explore them quickly and readily. 1. Banger of limiting ap- plicant's possibilities 1. Unless the interviewer's occupational information about jobs is constantly widening, there is a real tendency to limit the possibilities in terms of the limitations of the interviewers knowledge. Stated more simply, the interviewer cannot consider a handicapped applicant for jobs whose physical de- mands he himself does not know. A too extensive knowledge of the elements of jobs in physical de- mands terms is thus impossible. 2. Straight job analysis the first step 2. The basic need is for information about the basic elements of jobs, their operations, and processes involved in them. 5. Physical demands analysis the next step 3. i Beyond this basic data, as previously discussed, the interviewer needs to translate the facts about the job into physical demands the job makes of the workers. C. Source of the necessary occupational information ♦ (Ask the group to give the * source of the occupational information and list them on the board) 0 C. List of the sources of occupational information for the use of interviewers for the handicapped should Includes 1. First-hand information and experience, constantly gathered from field visits and observation 2. Information secured from interviewing applicants and talking with employers 3. Definitions in the "Dictionary of Occupational Titles" as a start 7-3040 P69 Ml Points to "be Made Suggested Supporting Material D. How to use the Dictionary D. 4. The National Job Description Volumes 3. The recent 5M3c8n Job Descriptions (and Interviewer Aid) cards 6. The special aids for placing military personnel in civilian Jobs 7. The Job families 8. The national and local physical demands studies 9. Bulletins on Utilization of Persons Having Physical Limitations Volume I of the Occupational Dictionary is itself a as a source of occupational readily available and compact source of a minimum of .) iflfopaatiflfr occupational information about Jobs. It can be used * (Ask the group what gen- as a starting point for considering what Jobs are suitable for an applicant with a given work canacity. * eral use -they can make of the Dictionary for occupy I tional background.) & £. Egy,,1ft usg.thg, Nfi$lgnfiJl„ J.gb E • A source of occupational and industrial information Pg.g.g.riptlsa ▼plymgLS. as. a which is available in every employment office in the source of occupational in- country is that contained in the National Job Descrip- tion Volumes prepared by the USES. ♦ (Distribute the Job de- The Job Machine Shop volume released in 1938 is an * scription volume of Job example of these basic reference tools that has had Machine Shops for April immediate war application. 1928. Review the table of contents on page iv 1. A review of the table of contents shows the with the group and then features included in a Job description volume. allow them to leaf through the volume.) 2. One of the most useful items in the Job descrip- * (Refer the group to the tion volume is the introductory section describing the industry and its processes or procedure (page xiii - l). The photographs and diagrams are suf- ficiently detailed to provide even a layman with an acquaintance with machine shop practice. 3. One example will serve to illustrate how each job * description of ASSEMBLER description can be Used by an interviewer for the on page 11.) handicapped. The description for ASSEMBLER on • • page 11 would give a good start towards under- F. How to use the recent 5x8 F. standing the physical demands of the ASSEMBLER Job. The pictures reflect some of the activities the Job requires such as crouching, and handling. Working conditions are noted in detail in each definition, as are hazards. % The Job description volumes were primarily reference Job description cards tools. More recently Job description cards measuring Points to be Made Suggested Supporting Material 5"x8" have been prepared and released for Jobs im- portant to war production. These become basic desk tools for the interviewer to guide his questioning of applicants and employers and to assist him in treating the Job wherever he comes in contact with it. 1. Physical demands speci- fically included 1. Being more recent, the new 5"x8" Job descriptions include specific mention of physical demands of the Job as well as specific description of work condi- tions and hazards. (Distribute 5"x8" Job descriptions for HOT BENDJiE III.) / / a. HOT BENDER III exem- plifies the kind of information these new Job descriptions in- clude. * (Ask group to turn to * "Physical Demands" section of this Job description. Head and discuss.) . 2. Survey of all available 5"x8" descriptions recom- mended 2. An interviewer for the handicapped can make a good start toward an acquaintance with the physical de- mands of important war Jobs by studying all the available 5x8 Job descriptions and analyzing them for his own applicants. G. How to use "Special Aids for G. Still another source of occupational information, Placing Haw and Army Per- sonnel in Civilian Jobs w the "Special Aids for Placing Havy and Army Personnel in Civilian Jobs," released by the National Headquarters in September 1945. 1. Hature of the aids (Distribute copies of the "Special Aids for Placing Navy Personnel in Civilian Jobs.") 1. These aids are essentially lists of civilian Jobs that are closely related to the principal Army and Navy ratings, with explanation of the physical de- mands of each. , Points to be Made Suggested Supporting Material 2. Example of their use for handicapped veterans 2. One example would show how the aids could -be used to determine if the physical demands and working condi- tions of the Job opening are probably suitable for a Navy man with a physical limitation. For a man with a rating of "Hospital Apprentice, First Class," page 109 of the special aids lists the related civilian occupations. If the applicant had been injured in the back and shoulders and was limited in his ability to do any lifting, the interviewer must locate the civilian Jobs that involve little or no lifting. The section on physical activities and working condi- tions gives information similar to that reviewed for a physical demands form. H. How to use the bulletins on Utilization of Persona Having Physical Limitations as a source of occupational information H. r 1. The special H- series for the physically handi- capped 1. The National Headquarters has prepared a special series of bulletins listing occupations suitable for the employment of persons having specified physical limitations. These group common limitations into eleven categories and cross reference groups of Jobs in certain in- dustries to show where applicants with particular limitations can perform them. 2. Examples #H-16, Occupa- tions in FIRhABMS MA2TU- PACTUHEH (Distribute copies of the sets of bulletins for the handicapped and refer grouj to item H-16) 2. As an example of such a bulletin, that for FIHJtAEMS MANUFACTUEJsHl describes on page 1 the general limita- tions within which the material is to be used, pages 2, 3, and 4 describe the categories of handi- caps, pages 5, 6, and 7 list the Jobs and refer to their suitability for applicants with each of the eleven common handicaps. !• How to use Job families as a source of occupational in- format iog 1. Nature of occupational and industrial Job families I. The review of materials in the ordinary Job families will sometimes suggest occupations related to a handicapped applicant's former employment that do not involve the particular element of work capacity that he has lost through hie disability. Detailed review of the elements of both Jobs concerned is necessary to verify whether or not the lost element of work capacity can be dispensed with in the related Job. Points to "be Made Suggested Supporting Material J. Use of oral trade Questions to aid in placing physically handicapped J. 1. Used more widely for handicapped than non- handicapped • 1. In order to aid in the selection of applicants with physical limitations for referral to jobs, oral trade questions should be used for physically handi- capped workers even when there is no doubt concerniE the applicants occupational classification. 2. Give more information concerning experience and aid in convincing employer of qualif 1 cap- tions 2. The results of administering a set of oral trade questions may provide the interviewer with additions information concerning the applicants experience an may aid in convincing an employer that the physicall handicapped person does have trade information which Summary! Thus, the occupational information available from the National Headquarters or devel- oped in the state can be used as tools by the interviewer for' the handicapped. is possessed by other ‘expert workers in the particu- lar occupation. £. Physical demands information in aptitude test.^atteries * (Mention only in states * where test batteries sire in use.) K. An additional aid for the selection of learners with physical limitations is provided by the Inclusion of physical demands information in aptitude test batteries now issued. This information will serve a an aid in determining whether or not applicants possess the necessary physical requirements for the occupation for which they are being considered. II. Choosing the proper classifica- tion and code »* II. After a full survey of possibilities among broad fields of work, using his resources of occupational information, the interviewer must arrive at a specific classification and code. A. The importance of Individ- ual consideration in das- A. The importance of insistence that the skills and abilities of a handicapped worker must be evaluated on an individual basis has already been stressed. All individuals with the same handicap cannot be classified in the same limited group of occupations because the remaining work capacity, even of workers who have the same handicap, varies over a wide range 7-3040 P78 bu Points to be Made Suggested Supporting Material —r%I Specifically, all one-legged men need not be watch- men nor all blind men broom makers, rug makers or piano tuners. The impossibility of canned lists of occupations for each type of handicap must be under- stood . * • &' B. Remaining Individual work capacity the basis of classification B. Since few handicaps cause the elimination of more than a fraction of an individual’s total abilities, the interviewer's problem in classification is the accurate evaluation of the remaining work capacity. What is left, not what is gone, is the kev to correct classification. **9 C. Basis of classification * (Ask the group upon what ♦ basis the determination is best made*) C. Choosing suitable work for the handicapped is based on the same factors as choosing suitable work for any worker. The factors to be considered are his ex- perience, his training, his aptitudes and his inter- ests, all of which make up his remaining work capacity' and are not nullified by the physical limitation. ‘ 1. Former experience the first criterion 1. As in any placement, one of the most important factors in selecting a suitable occupation for a handicapped applicant is capitalizing upon his nrevious experience. He should be led. if possible, to the occupation followed prior to the disability* 4 V- r 2. iJven remote experience may be helpful 2. If the recent Job is no longer suitable, the appli- cant* mav return to a line of work performed years previously. Items of work history, when analyzed carefully, often show previous Jobs that can be used for the basis of present classifications. u-r 'J » 3. Former Job may load to related work 3. The .iob family technique may be utilized to discover Jobs related to the former occupation which will utilize the remaining work capacity, and at the same time not require the element, eliminated by the disability, that prevents his returning to his former Job. •i D. • titles and codes D. Finally, in order to make the handicapped applicant readily available for selection and referral to Job openings, occupational titles and codes must be assigned him from part II or part IV of the Diction- ary which covers the entry occupational groupings. V? 1 Points to be Made Suggested Supporting Material 1. Primary classification the occupation for which the applicant Is best fitted t 1. As for any applicant, primary classification should reflect the occupation for which he is best generally fitted. Additional classifications should be assigned when abilities not sufficiently covered by the primary classification make it desirable to have the applicant considered for other occupations. >c> 2. Federal practice requires primary classification in vrual occupation c* .'T> 4 2* The USiSS Manual, Section 2520 on Classification Problems, specifies the following: ‘‘The applicant who is no longer able to perform in his usual occupation because of age or physical condition shall be assigned a primary classification in his usual occupation with an additional classifi- cation or classifications for a different kind.of work, provided he is competent to perform it. If no specific classification from Part I can be assigned as an additional classification, the applicant shall be assigned an entry classification.1* This policy is based on the reasoning that in the Interests of uniform classification practice the usual occupation provides the best base for finding out what the applicant can actually do through job family or other techniques. summ kSI I. Reiteration of need for a broad occupational background ■4 I. The interviewer for the handicapped has the same need for an extensive occupational background as has any interviewer. Over and beyond this basic infor- mation, however, he needs further detailed and organized knowledge concerning the physical demands of as many jobs as possible in order to match the work capacity of his applicants to those physical demands on as broad a basis as possible. -sj A. infflr- nation t*re n\wl«ia A. The occupational information available for national and state publications of the employment service provides the nucleus of the necessary information. B. Interviewer1s local studies * B. Interviewers can continuously develop their own professional background in occupational information through the physical demands studies they make of local jobs. 7-3040 P78 bu Points to toe Made Suggested Supporting Material 11. Clftggif^gftiijp.a,.Qfi.ihe canned a reflection of their work capacity, not their II. The toasis of classification of handicapped workers, like the toasis of classification for any worker, is what he can do. Transitions The occupational information needed toy an in- terviewer for the handicapped constitutes one half of the technical information he needs to do his joto. The other half is information concerning the vocational effect of handicaps on work capacity. The following sessions will toe devoted to those facts. • P76 77 Trailing Program for Serving the Handicapped Unit 2-b Second Morning (continued) and Second Afternoon (5 hours) Instructor's Discussion Outline VOCATIONAL ASPECTS OP COMMON DISABILITIES t (1) HEARING AND SPEECH, and (2) ORTHO- PEDIC DISABILITIES. Objectives To introduce an analytic approach to the exact occupational significance of soas of the most widespread disabilities, by presenting physical data about hearing and speech deficiencies and orthopedic disabilities (from the Handbook), and showing how these facts should be used in interview- ing and referring* Outline of Main Ideas * 1. Review of the necessity for additional techniques for placing the handicapped (13 minutes) 2* Explanation of the Interviewer* s need for physical facts as to the precise limitations on the individual*s work capacity, so that he can match them with the precise physical demands of a certain job (13 minutes) 3* The Deaf - (1*5 minutes) a. Physical facts about the deaf, as distinct from the hard of hearing b* Application of the physical facts about the deaf to actual problems in Interviewing and classifying o. Matching their work capacity with physical demands h. The hard of hearing - (83 minutes) a* Physical facts about the hard of hearing b« Application of the physical facts about the hard of hearing to actual problems in interviewing and classifying o. Matching their work capacity with physical demands 5. Workers with speech handicaps - (35 minutes) a* Physical facts about speech disabilities b* Application of physical facts about speech disabilities to interviewing, classifying, and referring such workers c. Matching their work capacity with physical demands 6* Presentation of the extent of orthopedic disability in the popu- lation (5 minutes) 7* Arm and Hand disabilities - (J4O minutes) a. Physical facts b. Application of these physical facts to problems in inter- riawing and classifying workers o. Matching their work capacity with physical demands 8. Leg and foot disabilities - (1*5 minutes) a* Physical facts b. Application of these physical facts to problems of interviewing and classifying workers o* Matching their work capacity with physical demands 9* Bade and spinal disabilities - (35 admites) a* Physical facts b. Application of these physical facts to problems of interviewing and classifying workers c* Matching their work capacity with physical demands REMINDERS FOR THE INSTRUCTOR Unit 2-b Second Morning (continued) and Afternoon Special Advance Preparation A demonstration interview with an applicant with a hearing disability is used as an exercise applying the points presented in this section. The instructor should be prepared to act as the applicant, using the facts as presented in Exercise No. 7 on page 15* The instructor should be acquainted with the local agencies available as sources of technical information, and assistance to those with hearing, speech, and orthopedic handicaps. Materials Needed 1. Supply of blank 3*8 cards on which the group will develop its own Interviewer*s Aids (check lists of key points to be asked and recorded for each disability) 2. Supply of blank application cards, for use by the trainees in completing Exercise No. 7 on page 15 3* Supply of copies of the Medical Dictionary ("The American Illustrated Medical Dictionary", by W.A.Newman Dorland, 18th Edition, W.B. Saunders Co., Philadelphia, 19i|0) or C*The American Pocket Medical Dictionary", by W.A.Newman Dorland, 17th Ed., W.B. Saunders and Co., Philadelphia, 19142) ij.. Supply of 3*5 cards for the trainees to use in developing a glossary of unfamiliar medical terms Point* to be Made Suggested Supporting Material j TRANSITION AND MOTIVATION I. Review of the basic tool* The I. The Physical Demands Analysis Form and how it may Physical Demands Analysis (10 minutes) be used as a basic tool has already been discussed ♦ (Elicit from the group a rapid * listing of the points in the last discussion as below.) * A* Uses of Physical Demands ilnalysTs ♦ What are the uses an inter- ♦ viewer can make of it? A* The Physical Demands Analysis can be used fort 1. Determining the details of physical activities and working conditions a job demands - which we abbreviate in the term. Physical Demands. 2. Establishing clearly the physical activities and environmental conditions suitable for each applicant, which we abbreviate in the term. Work Capacity; 3* Matching these two sets of facts together to assure that a particular job is suitable for an individual applicant. • B* Its advantages B. Some of the advantages of the method are that itj *(Ask what are the ad- vantages of using this type of analysis?) 1. Approaches objectivity of treatment. 2. 3. 5* 6. Stresses capacity, rather than his limi- tations. Places emphasis on physical and environmental aspects of job rather than on handicap. Provides a common language to be used by the job analyst, the personnel worker, and the doctor. Should serve to insure better matching of men and jobs. May be used for the aged, the young, and women. as well as the pnysically and the mentally handicapped. 7_3040 P8l bu - 22 - Points to be Ma.de Suggested Supporting Material 7* Demonstrates that there is no job that requires all the physical and mental capacities of human beings for successful performance. The kind of additional inform©- tion needed* Physical facts on work capacity (20 minutes) A* "Selective placement" - the us© of special additional methods II. A* Wo have established an understanding of what special- ists in work with the handicapped mean bynseloctiv© placement" - the matching of additional information about the exact nature and extent of work capacity and the precis© physical demands of jobs. B. Review of applicants requir- B. We can define in fairly simple terms the applicant ing this additional treatment group whose needs require this special degree of ♦(Elicit from the group and ♦list on the board, to review the points mad© earlier) careful treatment* An applicant is "handicapped" for placement purposes . when he has a permanent or long-lasting condition presenting a deficiency, peculiarity, or impairment which* 1. Requires the applicant to modify or change his ocoupation* ' 2. Makes it more difficult for the applicant to. secure employer acceptance for suitable employ- rnent. • 3* Requires special consideration to prevent the applicant from undertaking work likely to aggravate the disability or cause him to jeopar- dize the health or safety of others. i+. Restricts the opportunities of an inexperienced applicant; ifor entering industry, trade, or pro- fession* C. Physical facts on work oapa- city needed for such appli- cants ♦(Ask what information ♦an interviewer must have about disabilities to do this job) C. These are the applicants for whom careful "selective placement" is necessary. And "Selective Placement" involves* (1) using the exact physical analysis we are now studying, for both the applicant and the job and. (2) a body of technical facts about the nature of the disability the interviewer will most fre- quently encounter, with emphasis on the occupa- tional significance of those facts. 7-3040 P62 bu * * Points to be Made Suggested Supporting Material 1* Constant need for an expanding 1. The information necessary to serve the handicapped technical background intelligently develops with experience. Inter- * viewers must acquire and oontinously add to a back- *> ground of technical information about physical and V mental disabilities and the work capacities of people with these disabilities • III. Sources of such information III. (30 minutesj . A. ’’Selective Placement for the A. Part II of "Selective Placement for the Handi- Handicapped” - 19h3 capped" serves as a beginning in this direction. The material presented does not begin to cover every type of disability found under each heading nor does it give every ramification possible. Its * limitations are recognized and interviewers are urged to supplement that information by other sources • > ♦ (Ask what some of the §■' ♦other sources are) B. The Medical Dictionary 1 B. A modern medical dictionary, such as the’’Amerioan ♦ (Distribute dictionaries and Illustrated Medical Dictionary" is an important part of the equipment of any interviewer working ♦have group thumb through with handicapped applicants. Both its definitions pointing out a few defini- and its pictures will contribute to his background tions, such as the one for of technical knowledge. ► poliomyelitis and for nystagmus) 1. Use as a basis for trans- 1* Unfamiliar terms, especially those appearing in f lating medical language medical reports, can be located in the dictionary.‘ to job language The definitions provide a clue to the vocational aspects or occupational significance of the con- f ditions• tj* . 2. Development of a MEDICAL Interviewers for the handicapped have found the ' '■ GLOSSARY as a learning aid development of their own glossaries of unfamiliar medical terms a practical way to master them. (Distribute a supply of 3x5 cards to each trainee In the course of these discussions and of the * on which to note defini- readings, trainees will find it helpful to note tions of unfamiliar terms) such terms on 3*5 cards and to obtain and write the definitions• Yfoen the cards are pooled and . alphabitized at the end of the course each inter- viewer will have a glossary for reference, and will have at least partly learned the terms for his future use. 7-3040 P83 bu *84 Points to be Made Suggested Supporting Material C# Technical reading C# A list of technical work in the field will be found «! ♦(Have group turn to the end in the Bibliography at the end of the handbook. t ♦of handbook and point out - some of the available mater- ial and where it may be found) D. Sources of technical infor- D# In addition, community agencies are often equipped 4 mat ion in the community to cooperate with interviewers as sources of tech- - ♦(Ask what local agencies ♦might be of help as nioal information. Some sources in this community may be the Tuberculosis and Health Association, the Cardiac Clinics, and others. s our ce s of info rmati on) IV# The aim of the discussions of IV# medical facts in these sessions (lO minutes) A# Limited survey of highlights • r4t, A# For the next three days, we will be considering the from the handbook facts about the most common disabilities, as summer- B# Best possible training! ised in Part II of the handbook. Our discussions will be subject to the same limitations that were mentioned for the handbook itselfs - they cannot be considered exhaustive# V, B# Many questions will occur both in the course of Knowing where to turn for these sessions and in your subsequent work to which* an exact answer we will not have answersf because we are not 1# Impossibility of covering physicians or psychiatrists# 1# During the sessions the instructor will make every complete technical infer- possible effort to obtain sound answers to questions* mation in these sessions. that come up, but if the trainees leave the sessions C# Emphasis on the vocational with a good idea of where to look for the facts they need - whether in the Medical Dictionary or through a medical society, or in a book - the ►' main purpose will have been achieved# C# In every case as we examine the physical data aboi\V meaning of physical facts a handicap, we will be asking ourselves "What do these medioal descriptions mean in job-language? ♦ 1# "What precisely can the worker do?" (in general 1# "What can the worker do?"- the main idea. what are the vocational implications, or aspects' of the particular disability) is the main idea v, to work with. 7-3040 P84 bu - — — ■ — ■ — — Points to be Mad© • 1 Suggested Supporting Material D. Us© of the facts in inter- viewing, classifying, and referring workers f D. As we trace through each disability, we will develo the best methods, or key points, for interviewing such workers, classifying them, and referring them to suitable jobs if possible, or to other sources of help where necessary. B. Caution against any attempt B, No employment interviewer is ever, in a position to at diagnosis* diagnose a disability, information w© will die* cuss cannot in any sense make medical authorities of interviewers - nor is that its purpose. 1. Appraisal of remaining ,L . work capacity the inter- viewer’s function 1 1, The proper function of the interviewer is the appraisal of the remaining work capacity. Often he may have to work without the benefit of medical diagnoses. p: ABSENTATION I* The most common disabilities (5 minutes) i ' ♦(Ask what some of the physical and the mental handicaps that occur most frequently are. List on the board as the group mentions them) -* 1 >♦♦♦ I. Job-seekers may be handicapped by any of the ills the flesh is heir to, but experience points to a comparatively few categories of disability into whicf most handicapped applicants fall. Some of these are Orthopedic disabilities Vision losses Hearing Losses Heart diseases Arrested Tuberculosis Speech defects Hernia, ulcers Nervous and mental disorders 'll. Elements needed for placement of any handicapped worker , f5 minutes) ,, ♦(Ask what you need to know to do a placement job for the handi- r capped.List items on the board as A the group mentions them) II. Whenever an applicant with one of these disabilities wants a job, certain points concerning the disabill; are essential to the placement interviewer to work with. These show the occupational significance of the handicap and guide the interviewer in his work, with such applicants. In general, these are* A, The physical facts, from i_ two sources s A. The physical facts or the characteristics of the handicap, from two sources* !• Information obtainable in the interview* - Key points to look for 1, The information the applicant can give in the interview (and how to get it from him, in- cluding the items to look for or observe), and 7-3040 P86 bu Sb Points to be Made Suggested Supporting Material 2* Medical reports 2* a medical report from a doctor when desirable B* "What to record B* What to record about each handicap to make a use- able picture for placement purposes* C. How to classify C* How to classify such an applicant, in light of his specific work capacity (as shown by the interview v and or the medical report) < D* Matching work capacity end physical demands D* How to match work capacity and physical demands, in order to effect a placement* E. Sources of help for unemploy- able B* How to direct such an applicant to other sources of training or rehabilitation if he is not immediately , employable ♦ Summarizei Consideration will be given to all these points in turn for each of the most common dis- abilities* Hearing loss end speech defects will be taken first since they are the easiest to understand* - III* Consideration for uncovering any Non-visible handicap (l5 minutes) ♦ (Ask for some suggestions that ♦ may help in disclosing any handicap? List on the board as the group mentions items) III* Hearing defects are often in the category of non- visible handicaps. Certain points of technique will help the interviewer to disclose a non-visible handicap. Some of these (not necessarily in order of im- portance) are the following! * A* Careful phraseology < A* Careful phraseology of the question concerning physical condition, such as "Is there any work you cannot do because of your physical condition?*1 ' Could you pass a very rigid physical examination?” I • B* i*F*s in Draft Classification B* Questioning of applicants classified l\F by Seleo- v tiv© Service or those rejected for jobs because of physical examination to determine whether a handicap exists* C* Health Agency record C* Determine the reason for an applicant’s contact with a health agency if such contact is indicated* D* Examination of reason for special classes D* Determine the reason for attendance at any special classes, such as, sight conservation, lip reading, speech correction, ungraded, etc* 7-3040 P8fl bu gf Points to be Made Suggested Supporting Material mm ,J. £. Disparity between age and £. Illness or mental deficiency may be indicated if an school grade applicant was substantially older than the average ■<* at the time of graduation from public school or if **• he had to repeat grades in school. f F. Lack/ of athletic interest F. A physical handicap may be- indicated in a young 1 * applicant if he had no athletic interest in school f' v ( or had limited gym classes. f G. Loss of .iob because of illness G. A physical.disability may be indicated if an appli- cant states that he left a job because his work was f * too heavy or because of absence due to illness. L H. Long unemployment or frequent H. A disability may be indicated if the applicant has I change been unemployed for an unusually long period of tim L or has changed jobs frequently. \ - I. Unexplained refusal of certain I. A handicap may exist if an applicant refuses some types of work particular kind of work or expresses a definite l preference. r J. Vfork below intellectual J. Persons working below apparent intellectual capacity [• •^Summary: Any invisible hand!- may have an invisible handicap such as arrested tuberculosis, hearing impairment, or mental or neurological disorder. k cap such as hearing impairment or caroiac disability will re- * quire special scrutiny of some * of these points. [V. The differences between the two IV. You will recall from the section on hearing in Part categories of hearing cases II of the handbook that hearing handicaps are a fre- % (15 minutes) quent problem. ' * (Survey rapidly the material in First, let us consider the nature of hearing losses w-* the handbook, drawing as much as possible from the group’s in general. ■*> i recollection of their reading.) «► 4 A. Hearing losses the result A. The ear is a delicate mechanism of three parts - V ► V of disease or injury to the outer ear for catching sound, middle ear for •• ear or auditory nerve conducting it, and inner ear for perceiving sound - served by the auditory nerve to the brain. -. Any of these can sustain damage. ¥ B. Speech usually affected B. Speech is affected in most cases of hearing loss. P**. This is easily understood when we realize that speech is learned in the first place by imitating sounds which we hear. Also there is tone and volume of voice change if we cannot hear clearly what we are saying. 7-8040 P87 bu Points to be Made Suggested Supporting Material 1* Example t Trying to speak against a loud noise • I* Consider your own experience when you try to speak ' in competition with a very loud noise. You cannot hear your own voice. You do not know the tone of it' In general, the less the degree of hearing, the more the speech is affected* ' > C• The technical difference be- tween the deaf and the hard of bearing 3. People with hearing losses are known as the Deaf or j the Hard of Hearing* The technical meaning for each' of these terms has become important to handicapped individuals themselves and must thus be understood by interviewers* !• The Deaft no functional hearing, from birth or since infancy* 1* The Deaf have no functional hearing at all* A deaf person nay be born that way or lose his hearing at a very early age (before I4. or 5 years) - before acquiring a vocabulary. a* Speech always affected i a* The deaf cannot hear their own voices at all* Speech, if present, is always affected* « —* b* Some speak mechanically* the orslists b* Some of the deaf have learned to speak mechanically and are called "oralists"* c* Some use sign language o* Some communicate by means of sign language. - d* Others write only d* Others communicate in writing. a, e* Many read lips e* Some individuals in each group may have learn- ed to understand the speech of others by ob- serving their lips in motion. They are called — "lip-readers". 2* The Hard of Hearing - onset after speech. 2* The hard of hearing include those deafened after learning to speak, who can still speak (with some functional hearing left) although their voices may have changed. Most of the hard of hearing have some functional - **• hearing left* They perceive sounds by means of t hearing aids or loud speaking. They may also be lip readers* 3* Exercise No. 6 - "Demon- s-krating the difference between the deaf ancl the hard o£ bearing^ (Hare a trainee read the ex- amples and determine whether the applicant in each case ii deaf or hard of hearing.) 3* The following examples illustrates the difference - - a* Girl of 20, had pneumonia when 8 years old* Wears hearing aid. condition chronic and progressive. Speaks in a low voice but clearly. (Answert Hard of Hearing) » 7-1040 P88 bu Points to be Ma.de Suggested Supporting Material b< » Man age 50» worked 30 years as boilermaker* Has not been able to hear at all for the last 13 years. Cannot use hearing aid* Speaks in loud tones* (Answers Bard of Hearing) 0. > Man, age 25, hearing loss began with meningitis at 3 years of age, Reads lips fairly well; speech difficult to follow except for stray word now and then* Answers most questions by writing. (Answers Deaf) V. Physical facts about the deaf (1$ minutes) 7* Turning now to a consideration of the totallydeaf, we find a strong example of a disability that need not be an occupational handicap* A* Range of abilities as wide as that of persons with normal hearing A* The deaf, like the hearing, vary widely in mechanical and motor ability and they 00spare favorably with the hearing in mechanical ap- titude as well as in native intelligence. B* Good vocational training opportunities for the deaf B. Fine schools for the deaf exist throughout the country. Many deaf people, especially the younge group, have learned to speak and lip-read in these schools. In addition, the schools have equipped them with a good vocational background* 1* Extensive trades training 1* Many have learned such trades as printing, tailoring, sboemaking, wood workings, oonmeroial art, drafting, machine operating, millinery, typing, and cooking* C* Employer enthusiasm C. Employers who once try well trained deaf workers are enthusiastic and call for more* There are 111 deaf workers at the Ford River Rouge Plant* D* Possible psychological dif- ficulties, growing out of isolation > D. The deaf as a group may tend to be sensitive, suspicious, and to feel themselves slighted or ridiculed* The hearing person can understand that if he pictures how lonely he would be if he could not hear the everyday sounds to which he is accustomed* 1* Illustration) experience under hair dryer in beauty shop 1. Beauty parlor examples Recalling the exper- ience of isolation felt when under hair dryer in a beauty shop will serve to demon- strate this feeling to any woman interviewer* 7-3040 P88 bu Points to bo Made Suggested Supporting Material 2* Many individual excep- tions 2* Not all the deaf, of course, present this psychological reaction, so the interviewer must constantly be aware of individual differences. 3• Emphasis on individual differences ♦♦(Ask what can be learned from these exceptions?) 3* This point brings out a principle that is hard to overstress in placing the handicappedt always analyze the particular individual, because generalizations about the disability are mis- leading* • Possibility of other handicaps E* The interviewer should not overlook the possibility of other handicaps such as tuberculosis, stomach ulcers, varicose veins, and other conditions in addition to deafness* 1* Combination of Handicaps always possible *1* The same caution holds true for any handicaps* 1* What is involved in interviewing 71* The problems of interviewing such workers can be the deaf (20 minutes) solves by an understanding of the character is ti os just reviewed* A* Getting the information 1* From the applicant A* Once the fact of hearing limitation is estab- lished, the major difficulty lies in getting the information from the individual* ♦ (Ask what the major diffi- ♦ oulty is) a* Methods of communica- tion slow a* Interviewing the deaf is generally a slow process because of the slow methods of communication necessary* It is extremely important to phrase questions simply and oarefuly in order to elicit the necessary information in the least amount of time* b* Lip-reading ♦(Ask how you can help ♦the lip-reader under- stand what you are say- ing) b* The lip-reader may be assisted by the follow- ing pointst (1) Face the light so that it shows clearly on your lips* (2) Look directly at the applicant rather than down or away* (3) Speak slowly but naturally and enunciate clearly* (J+) Don’t mouth words, because it is a hindrance rather than a help, (5) If the applicant has trouble under- standing a word, repeat the entire 7-3040 POO bu 91 * Points to bo Made Suggested Supporting Material sentence or rephrase the thought. A hard of hearing person gets most of the meaning from the content. . (6) Make sure the applicant understood all instruc- tions (concerning referral, etc.) or advice, by having him repeat the thought for you. 2. From medical reports . only if another handi- cap is present 2. Medical reports are not needed unless there is some handicap present other than the hearing such as arrested tuberculosis, cardiac, or others for which a medical report is normally desired. ♦ B. Recording the information - Introduction of the Inter- viewing aid. B. Recording the additional information on the appli- cation card is the next point of technique to be discussed. 1* The significant points ♦(Distribute application ♦cards to each trainee. Ask them to listen to the descriptions of two appli- cants in turn, and note what they consider the key points about each.) 1. A few examples will bring out the kind of infor- mation we want to record about an applicant with a hearing limitation. Example as A boy 22 years old, congenitally deaf, mus*b communicate by writing and sign language, and has difficulty reading lips only understanding short, simple phrases. Uses only very simple language in the interview. (►Have the group read their ♦answers, and discuss the reasons for putting down each point. From the responses obtained above, ask the group to con- clude the significant pointsf to be recorded for all deaf applicants and list on the ' board. The group should then prepare - a 5*8 card as IJfTERVTBVflNG AID for the deaf, noting in the key points at the right.) Example bs Girl, 17. deaf due to scarlet fever at 2 years of mge, reads lips, good command of writing English, speech slightly hard to under- stand, no athletic interests because of heart con- dition. From these examples, we can conclude that the key points for deafness are* (1) Congenital, or causes by disease (2) If disease, at what age? (3) Read Lipef How well? Oralises - How Veil? (10 Written English satisfactory? (5) Any other handicaps? 2. inhere information should be recorded] "Spec- ial informati on" , and "Box B* 2. Section 12, on the front of the application card (Handicap) should road "Deaf". 7-3040 bu Points to be Made Suggested Supporting Material The section on ”special information” on the back should contain such recordings as examples given above• / Box B on the card should be tabbed a distinctive color* 3« Style of recording* two separate paragraphs 5* To increase the usefulness of the notations on the card the best practice is to note the purely descriptive items (using the INTER- VIEWER’S AID as a check-list) in one paragraph, and the interviewer’s recommendations as to suitable work in another paragraph* II* Matching the work capacity of the deaf with the physical demands of .lobs (10 minutes) VII* Determining work capacity and suitable working conditions for the deaf is the same as for any other handicapped worker* A» Trade or skill the determih- ing factor A* Placement will depend largely upon the skill which the deaf person has acquired* Skills taught them at their specialized schools are suoh that they do not require speech or hear- ing* B* Physical Demands analysis will show dangers B* If the interviewer has used the physical de- mands approach in the application process to note down what the applicant can and cannot do, he can subject the job opening to the same scruity, and specifically match work capacity with the physical demands* !• Sound warnings not safe 1* The interviewer should chock exposure to mechanical hazards which have only audi- tory warnings of danger* C* Immunity to sound distrac- tions C* The deaf have been particularly satisfactory in jobs where the amount of noise might be distracting to hearing persons* # Transition* These sure some of the more important points to consider for the deaf. The hard of hearing will now be examined in the same way. • 3040 P93 bu ■r v Points to be Made Suggested Supporting Material VlllsPhysical facts about the Hard VIII. The hard of hearing, as distinct from the totally I of Hearing (10 minutes) deaf, present similar problems, but their situa- tion is sufficiently different to warrant separate consideration. A. Wide individual variations A* Great individual differences are found amoung the f ■><* 6. Speech involvement possible Ba hard of hearing, both concerning the nature and extent of their handicap, and of their working capacity. The degree of hearing loss will vary greatly from applicant to applicant, and may affect one or both ears. Speech may or may not be affected. Some hard-of- v hearing persons tend to speak in a low Voice, some in a whisper, some with a flat expressionless tone some, of course, normally. s C. Other handicaps possible C. The possibility of other physical handicaps, such ■ * vt as cardiac condition or tuberculosis, should not be overlooked. & D. Occasional reluctance to Da Some hard of hearing workers are not aware of or rv-v- acknowledge handicaps do not wish to admit their disability and there- fore present additional problems in placement. L Ba Possible personality prob- lems similar to those of £ a Some develop personality problems similar to those of the deaf. Difficulty of adjustment to the L r the deaf handicaps seems to increase with the age of onset of the hearing loss. t » What is involved in inter view- IX. - i] ag the hard of hearing ( 20 minutes) p-.r< ■* *- A • Getting the information \ 1# From the applicant A* 1. *■ '■’I St & * r* %r a a Procedure same as for the deaf a. Some hard of hearing applicants may not admit or know of their difficulty. If in doubt, the interviewer can determine by covering his lips as ho speaks, or by bending his head down. If an impairment is evident, to facil- itate a successful interview the interviewer should follow the same procedure for speaking 7-3040 P93 bu Points to be Made Suggested Supporting Material b. Importance of hearing aid b. Hearing aids can restore a good measure but perhaps not all of a person's hearing ability. Aids are subject to mechanical failure at times (the battery goes dead, or the cord breaks), causing an impression that the wearer does not benefit from his aid. (1) Variations in efficiency of aids (1) The interviewer, in order not to misjudge the applicant, should question him closely * as to how much service he gets from his aid. How well it serves him for conversational purposes is gauged in the interview itselfi How well it serves him for sound heard from > a distance may be evaluated by his answer to the question "Can you use your aid in the movies?" "How far back can you sit?" 2. From medical reports wherever disease is involved 2* When hearing loss is due to disease, a medical report may be secured, in physical demands terminology whenever possible. Note on the board the entries from the sample Physical Capacities Appraisal forms for William P., and Henry K., and discuss them with the group• If not on this form, the report should at least show the prognosis or probable future course. Two sample medical reports, (see next two pages) * in physical demands terminology, will serve to bring out the kind of medioal facts the placement worker needs to know about the hard of hearing. a. Doctor to mark the negative elements a. The doctor oan use the form to mark the activi- ties and the working conditions that are not advised for the worker. b. Use the Medical Dictionary to trans- late the diagnosis b. Frequently the interviewer will have to consult s the Medical Dictionary in order to understand the diagnosis given. (Have trainees look up the diagnosis in the two samples) r « H c. Remarks often direc- ted to working con- ditions c. In the "Specific Remarks" section, the details of woiking conditions and activities to be avoided oan be noted. The more informed the examining physician concerning job situations, the more helpful these remarks can be. 7-3040 P04 bu WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Budget Bureau No. ll-AOBB.l Approval Expiree March gi, 1044 SAMPLE NO. 1 Division of'OccupatI on a I Analysis and Manning Tah I as PHYSICAL CAPACITIES APPRAISAL Name _William F. Age Sex Height Weight ■ ° PHYSICAL ACTIVITIES WaIkIng Jumping Running Balancing Cl I mb Ing Craw ling Standi ng Turning Stoop Ing Crouch I ng Kneel I ng Sitting Reaching Lifting Carrying Throwing Pushing Pulling Handling Fingering Feel I ng Talking Hearing See I ng Color Vision Depth Perception Working Speed Inside Outside Hot Cold Sudden Temp. Changes Humid Dry Wet Du s t y Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration WORKING CONDITIONS Mechanical Hazards Moving 0 b ject s Cramped Quarters High Places Exposure to Burns Electrical Hazards Explosives Radiant Energy Toxic CondItIons Working With Others Working Around Others Working Alone details OF PHYSICAL ACTIVITIES: Blank space = Full capacity; / = Partial capacity; X = No capacity. May lift, carry, handle, push or pull up to pounds per Jhour May engage in activities numbered up to 2/3 of work period May engage in activities numbered up to l/3 of work period Sight: Hearing: : Others:. DETAILS OF WORKING CONDITIONS: Diagnosis; Catarrhal otitis media Prognosis: Guarded - chronic Specific Remarks; May work in noisy surroundings but should not use hearing aid -then. 55, 56, 5B, 59 should be avoided because of possible colds. Very loud bell or lights needed on machine he uses. Date_ 194 Physi cian imE NO. 2 Jse Medical Pictionary WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Budget Bureau Ro. ll-BOM.l Approval Expire* larch |i, 104< Division of Occupational Analysis and Manning Tables PHYSICAL CAPACITIES APPRAISAL Name Henry K. Age cex Height ’•’eight WORKING CONDITIONS Walking Jumping Running Balancing Cl 1 mb 1ng Crawl Ing Standing Turning Stoop i ng Crouch I ng Kneeling Sitting Reaching Lifting Carrying PHYSICAL ACTIVITIES Th row I ng Pushing Pulling Handling Fingering Feel I n g Talking Hearing See i ng Color Vision Depth Perception Working Speed Inside Outside Hot Cold Sudden Temp. Changes Humid Dry Wet Dusty Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration Mechanical Hazards Moving Objects Cramped Quarters High Places Exposure to Burns Electrical Hazards Explosives Radiant Energy Toxic Conditions Working With Others Working Around Others Working Alone Details OF PHYSICAL ACTIVITIES: Blank space = Full capacity; / = Partial capacity; X = No capacity. May lift, carry, handle, push or pull up to pounds per hour May engage in activities numbered up to 2/3 of work period May engage in activities numbered _____ up to l/3 of work period Sight: _ ___ Hearing: _____ __ ___ Others: DETAILS OF WORKING CONDITIONS: Diagnosis; Purulent labyrinthitis (inner ear disturbance) Prognisis; Poor Specific Remarks: No noisy surroundings. May find bending head over work all day uncomfortable. Occasional dizzy spells - avoid high place. Has no hearing aid but might benefit by one. Elec- trical hazard need be avoided only if he is wearing a hear- ing aid and the hazard might damage it. Date 194 Physi clan Points to be Made * Suggested Supporting Material d. Interviewers may have to supply all job- implications d* In many cases, however, the interviewer him- self will have to draw from the diagnosis all the implications with regard to jobs* e* Medical reports may not be obtainable e* in this connection, it should be recalled that the Employment Service must extend placement services to the worker even if he ■will not or oonnot obtain a medical report* Moreover, in many communities, medical re- ports will not be obtainable, and in such situations the interviewer must work on the basis of his own best appraisal of the appli- cant 9 s oapa c ity • Recording the Info mat ion B* !• The significant points ♦(Have the trainees de- ♦ velop an INTERVIEWING AID for the Hard of Hearing during this discussion*) 1* When an applicant is hard of hearing, the impor- tant points are sligtly different from the key entries for the deaf For the hard of hearing they ares (1) Cause (2) Age of onset, prognosis (3) Type (inner, middle ear, etc*) (ll) Extent of impairment (5) Uses an aid? How well does it work? (6) Conditions to bo avoided (7) Reads lips? Does speaker have to raise voice? How much? 2* Where information should be recorded 2* These points should be noted in "Special Infor- mation", just as for the deaf* A tab in Box B to denote a handicap, and a notation "hard of hear- ing" in item 12 are also required. 3* Style the same as for any handicap 3* As for any handicap, a paragraph of recommenda- tions should follow the descriptive comments* RECES 3 FOR LUNCH 7-3040 P99 bu Points to b© Made Suggested Supporting Material PRESENTATI ON (Continued) X* Matching ttj© work capacity of the hard oi* hearing to the physical demands or jobs* (15 minutes) X* A* The Physical Demands Form the key A# A Physical Demands analysis will form the basis for matching what a hard of hearing applicant can do with what a given job requires. B. Wide Variations in Work Capacity What are some of the vari- ations? B. Great variations occur among the hard-of- hearing in relation to their hearing losses and the conditions under which they can work. 1* Some avoid damp 1. You will recall from reading the handbook that those with hearing losses due to sinus or catarrh should possibly avoid dampness#, humidity and great temperature variations* 2* Some avoid noise 2. Persons with nervous deafness find noise very irritating. Noisy surroundings may be perfectly suitable for middle ear impair- ments but highly undesirable for persons with nerve deafness or otosclerosis* This group finds noise very fatiguing. 3* Abilities vary 3. There will be much variation in native ability and previously acquired skills among the hard of hearing as among persons without losses* C* Possibilities for mechan- leal aids on the joh C* In addition to hearing aids, there are many ways of minimizing a hearing loss* Telephones any- where in the nation can be equipped with ampli- fiers* In some cases incoming calls can be signaled by flashing lights rather than by a bell* Similarly, lights can often be substi- tuted for warning bells on machinery* D* Principles of classification D* The hard of hearing, like all applicants, must be classified to reflect the full range of their useable skills. I* Assisting the hard of hearing applicant to become employable (5 minutes) XI* % A* Organizations for the hard of for aid ' A* If he an applicant is not ready for work because lacks a skill or his handicap needs to be 101 L - Points to be Made Suggested Supporting Material t > 1 L B. The Vocational Rehabilita- tion agency for training k reduced he may be referred for the reduction of the handicap to the Vocational Rehabilita- tion Service or other organization for the hard of hearing. They will extend advice on the type of hearing aid to secure, test hearing, and offer classes for lip reading B. He may be referred for training to the usual training classes in the community or to the Vocational Rehabilitation Agency. JXIL Exercise No. 7 - "Demonstration XII. Exercise No. 7 has as its objective the appli- L Interview for a Hearing Handicap" cation of principles for interviewing;, and (&5 minutes) high-lighting the best points of technique. X Transition and Summary: As will | become evident in the other dis- emissions this week, this same m pattern of approach can be used r to examine the data about any disability, and to survey their < application to interviewing and placing such workers. The next general group of disa- bilities we will consider are those of speech. to ■ - - ■ - - XHI. Physical facts about sneech XIII.Defects of speech may be sufficiently serious disabilities (5 minutes) to constitute a handicap. _ A. Definition: Any unfavor- A. Speech defects have been defined as wany W able characteristic which speech characteristics which unfavorably diverts attention divert the attention of the listener from the speech of the speaker." B. Causes: Organic or emotional B. These defects may arise from organic faults. such as cleft or deformed palate, hare lip. » * tenseness of chest muscles as in some forms of spastic paralysis, etc., or from emo- tional disturbances which result in stuttering C. Poor motor coordination C. Some speech defects reflect poor motor sometimes involved coordination and the interviewer should r question and observe the applicant further. Points to be Made Suggested Supporting Material UY. Interviewing workers with IIY. With speech difficulties, the interview is a speech disabilities particularly important source of data. A# Getting the information A* 1. From the applicant 1. Communication is again a problem a. Importance of ease a. If the speech defect is stuttering, stammering, or other impairments due to nervousness, the interviewer should make every effort to put the apolieant at ease. An applicant with speech handicap such as stuttering is under a nervous strain at the employment office. b. Simple questions with brief answers b. The interviewer can start with simple questions that can be answered with brief statements. He should not appear impatient or pressing. He will usually find the applicant responding with less difficulty as the interview continues. 2. Medioal reports not necessary 2. Speech defects are sufficiently obvious not to require medical reports unless other handicaps are present. B. What to record B. The key points to be recorded about all (Elicit from the group the key points about speech defects that should be re- corded for such worker, and hare them note the facts on another INTERYIEWING AID. ) workers with speech defects are the following* 1. Nature of the defect 2. Cause - (whether organic, emotional or the like)- if the applicant volunteers this information. 3. Accompanying nervous manifestations where present - (grimaces, fluttering of hands, etc.) XV. Matching the work capacities of workers with speech handi- XV. The factors to be matched for speech defects are likewise fairly obvious. Clearly a person caj ?s with physical demands of with seriously impaired speech should not be - Jfi >s. (S minutes) referred to jobs which require rapid, constant talking, or frequent contact with many new people. 7.3040 Ptoa bn Points to be Made Suggested Supporting Material A. Public contact jobs A* For example, a girl who stammers should probably generally not suitable not be guided into work as sales girl, recep- tionist, or telephone operator* She will do much better as a file clerk, bookkeeper,, er machine operator where constant talking or frequent contact with new people is not re- quired* XVI. Assisting the applicant with a speech handicap to XVI. Decom© employable”"" (5 minutes) • A* Community agencies A* Interviewers should be acquainted with agencies in the community where persons with speech ♦ (The instructor should ♦ mention the appropriate local agencies*) defects can go to improve their condition* Points to be Made Suggested Supporting Material SUMMIT f (5 minutes) — I* Review of the use of physical facts in interviewing and place*- merit I* In examining three separate groups of handicapped workers, the deaf, the hard of hearing, and those with speech defects, we have seen how the place- ment worker can use a refinement o'f the job ana- lysis approach to do a professional matching job and provide for the utilization of the consider- able skills of persons considered handicapped* A* Analysis of physical facts about precise work oapaoi- ties x-i A* We have reviewed the kind of facts that are y needed and how they can be analyzed. B. Establishment of key points of necessary information B* We have developed interviewing aids for those three handicaps that will serve as constant reminders of the key points to be obtained* C* Matching facts of work capa- city with the precise physical demands of jobs C* We have developed together the methods for translating technical terminology on handicaps into its exact occupational meaning* * Transition: The same proce- ♦ dure will be followed throughout these sessions, in that for each disability, the group will review rapidly the physical facts and then proceed to work through their application to actual inter- viewing and referral® 7-3040 P104 bu Points to be Made Suggested Supporting Material PRESENTA TION (Cont »d.) I. Physical Facts about Orthopedic Handicaps in General (5 minutes) I. 1 A* Extent of such disa- bility A# Nation-wide experience has shown that ortho* pedic disabilities are those that occur most frequently among workers. The importance of knowing the extent to which orthopedics can work effectively is hard to ovor-emphasize, because they represent so large a group of the potential working force. 5. Types* May affect any part of the skeleton B. They include all types of defect, impairment, or peculiarity of the skeletal structure, (muscle, bone and joint) of the body which ♦ (Ask what an orthopedic affect ability to feel or move or both. Some a disability is). • examples would be the restricted use of an arm or leg due to infantile paralysis or other disease, spinal curvatures, amputations or absence of all or parts of a limb# Parts of the body usually affected in ortho- pedic handicaps are arms and hands, legs and feet, back and shoulders# C# Readily visible C. Orthopedic handicaps, being visible, are the most easily recognised. Some may be evidenced only in movement, while others are structural# D. Chief causes 1* Accident 2# Congenital Mal- formations 3. Disease D. The causes are the following: 1# Two-thirds of all orthopedic handicaps are due to accident or injury sustained in industry, at homo, or in public places. 2# A small percentage of orthopedic disabilitie were present at birth. 3. One-third of all orthopedic handicaps are caused by disease. Medical reports are desirable for some but not all defects due to disease. The interviewer should familiarize himself with the circumstances under which they are desired. 7-3040 P105 bu 106 Points to be Made Suggested Supporting Material II* Physical Facts About handicaps of the Arms and hands (10 minutes) II* (This material, being taken ♦ from the handbook, should * be reviewed rapidly by the instructor)• A* Arms and Hands A* We will consider first arm and hand disabilitlet 1» Amputations or absence of some or all parts I 1. Many of these involve amputations or ab- sence of members. a* Arm a* In general, the more that remains of the hand or arm the more use there is of the member. The shorter the arm stump the more difficult it becomes for an indi- vidual to balance the body. Persons with high amputations may develop com- pensating posture curvatures to retain balance. An amputation below the elbow usually leaves the person with greater capacity than does an amputation above the elbow. . - b* Hands and fingers b. Not all amputations of fingers render an applicant physically handicapped. (1) Loss of fingers not always a handicap (1) Manual workers with only partial amputation of one or two fingers (but not of the thumb) are not handicapped if they have a trade and expect to oontinue in it. (Example: woodworking machine operator) (2) Examples of what to note (2) interviewers should note carefully which hand is affected, which fingers are missing and to what extent (1st, 2nd joint). Loss of a thumb is a considerable handicap. The thumb counteracts and supports the fingers in such actions as fingering (pinch- ing, grasping, holding), pushing, pulling, carrying, throwing and lifting. 3040 P106 Du 107 Points to be Made Suggested Supporting Material (3) Even loss of thumb not always seriously restric- tive (3) These activities may be limited but not necessarily eliminated because the thumbless hand can still grasp some objects between fingers and palm so as to push, pull, throw, etc., or the other hand may be trained to perform these functions. (4) Artificial appli- ances for appearance and use (4) Artificial arms or hands are worn for the sake of appearance rather than use, since none have yet been contrived which both look and func- tion like the human hand. Appli- ances which can increase the func- tional capacity of an individual are hook shaped. (a) May equip worker for a job (a) Equipped with this appliance, applicants can perform jobs such as welding where the work is held firmly by the hook and the normal hand manipulates the torch. (b) May not bo helpful (b) Those lacking a hand below the wrist rarely use appliances since the wrist movement re- maining gives some dexterity and an appliance would only be a hindrance. c. Other disabilities of arms and hands c. Other disabilities of the shoulders, arms and hands are a tremor (shaking), rigidity, (stiffness), flaccidity (flabbiness), dwarfing (small), enlarge- ment of the joints, twisting, wasting of some parts, or additional appendage. I .What is Involved in Inter- viewing Workers with Arm and Hand Disabilities (20 minutes) III. A. Getting the information A* 1* From the applicant 1. For arm and hand disabilities, the points are the following: a. Signature a. Some orthopedic conditions not clearly visible will be evident when the appli- cant tries to write his signature on an application card b. Manner of walking b. Watch the applicant as he approaches the desk, since some conditions can be con- cealed by the way an applicant carries his coat, newspaper or pocketbook, or the way he leaves his hand in his pocket. c. Direct questions and demonstrations c. In questioning applicants with orthopedic defects the interviewer must exercise to the full his professional skill. He must be able to discuss the work limi- tations of the disability as freely as a physician might and with as little em- barrassment. d. Importance of a professional atti- tude d. After establishing a friendly an unem- barrassed rapport, the interviewer should feel free to ask the applicant to discuss his capacity, and even to demonstrate movement possible to him. e. Demonstration of capacities e. Some of these will be whether he can; (1) Move his arms over head - out to side front, back and down (2) Bend arm at elbow (3) Rotate and bend wrist (4) Flex all or some fingers (5) Touch thumb to each finger on a hand (6) Close fist 2. Medical reports for certain conditions 2. Medical reports are desirable only if the condition is due to tuberculosis of the bone arthritis, or if the amputation has recently occurred and person is still under medical care. A medical report is desirable in cases of osteomyelitis if the condition is recurrent and in cases of muscular dystrophy if the applicant cannot adequately describe his capacity. B. What to record B. The key points to remember and record for arm and Hand disabilities are the following; 109 Points to be Made Suggested Supporting Material y (During this discussion elicit from the group the key points to be recorded about persons with arm and hand limitations and de- velop an INTERVIEWER * S AID for arm and hand defects.) !• Amputations of arms 1. Amputations of arms. a. When lost arm and why b. Where amputation comes o. Any problem of balance d. How much can he use stump (to hold package under arm, or hold down work or back up work) e. Any artificial limb, how well used f. Condition of stump g. General physical condition h. Whether ambi-dextrous. 2. Amputations of hands or fingers 2. Amputations of hands or fingers a. Exact parts amputated b* When, why o. Remaining capacity - how much fingering, handling, etc. t 3. Other arm and hand disabilities 3. Other disabilities. (Tremor, rigidity, flaccidity, dwarfing, twisting, wasting, etc.) a. Describe b. Cause c. Time of onset, prognosis d. Capacity loft for handling (lift arm overhead, out to side) fingering e*Conditions to be avoided (dampness, if disability is due to arthritis, etc*) C. Example of what to record C. The application card for William Gray, pre- ♦ ♦ (Refer the group to the application card ih Exercise No* 8) santed as part of Exercise No. '§, Ts an exampl of what might be recorded for an arm amputatio (It will be used later to apply all the con- siderations for arm disabilities*) 7-3040 P109 bu Points to be Mad© Suggested Supporting Material V, Matching the Work Capacity of Workers with Arm Limitations with the Physical Demands of Jobs (10 minutes} rv. A# Importance of individual consideration A. Again, individuals, even those with identical , amputations, will vary considerably in ultimate capacity because of the other factors (attitude, adaptability, former skills, etc.) that enter the picture. B. Significant working conditions * (Ask what working ♦ conditions are important to check.) B. Wet, slippery floors may be a particular hazard for those with precarious balance, and we have seen that persons with disabilities arising from arthritis should avoid wet, cold sur- roundings, or those subject to sudden temper* ature changes. Other conditions that might require evaluating ares hot, humid (both of which may affect comfort in wearing artificial appliances), vibration, mechanical hazards, moving objects, cramped quarters, high places. C. Exercise No* 8s C. Exercise No. 8 has as its objective practice in "Classifying a worker with determining suitable occupational codas and an arm handicap ancl choosing suitable work” noting any work limitations or special con- siderations involved in proper placement and guidance. V* Assisting the Worker with an Orthopedic Handicap to become Employable (5 minutes) V. Many different kinds of aid and training are offered to persona with orthopedic handicaps. Private and public agencies supply prosthetic appliances and work training. Among these are; ♦ (Local agencies must be ♦ included in this discussion) A* Private agencies \ A. Private agencies Rotary dubs Kiwannis Clubs Societies or Associations for Crippled Children National Foundation for Infantile Paralysis Other Local philanthropic organizations (Lisirr 7-3040 P110 b.. • — Points to be Made Suggested Supporting Material B. Public agencies B. Public agencies Vocational Rehabilitation agency Hospitals and Institutions Schools and other local agencies (List) r '!• Physical Facts About Orthopedic Disabilities of the Legs and Feet (10 minutes) VI. A Second category of orthopedic disabilities are those of the legs and feet* Many of the consider- ations for such disabilities are the same as those for arms* (Review rapidly) * A. Two groups: Absence of parts and other impair- ments f A. As is the case with arm handicaps, leg disa- bilities may be grouped in two categories: (1) absence of all or part of the limbs due to amputation, or (2) impairment or other peculi- arity caused by disease or present at birth. B* Amputations: B. 1* Not all represent handicaps i 1* Not all amputations or absence of parts result in a handicap. The loss of one or two toes (with the exception of the big toe) when there is no resulting effect on balance, does not constitute a problem in placement* 2, Higher amputations present more serious handicap ' 2. Other factors being equal, the higher the amputation the more difficult is the power of locomotion even with a well fitted appli- ance. 3, Artificial appliances for use, not appearance 3* Artificial legs are f or use rather than appearance* They can be built with toe, ankle and knee action so the person skillful in the use of his appliance loses as little action as possible. a. Work opportunity improved by artificial legs a. Workers with artificial legs have greater opportunity than those using one or two crutches* Some people with limbs attached below the knee may even be without a perceptible limp* Others who do not ad- just as well may have a marked limp or even use a cane in addition* 7-3040 Pill bu 112 , C. Other disabilities of hips and legs C. !• Kinds of disabilities 1. Other disabilities of the hips and legs are rigidity (stiffness), flaccidity (flabbiness or weakness), tremor (trembling), warping, enlargement of joints, twisting and wasting of some parts. The section on neurological disorders should be consulted for additional information. Flat feet or fallen arches should be considered a handicap only when the person has to stand or walk for long periods of time. [I.What is Involved in Inter- viewing Workers with Leg Disabilities (10 minutes) VII. A* Getting the information A. 1* From the applicant What do you observe? 1 1. Items to observe about leg disabilities are readily evident. For the most part, leg disabilities are easily recognized either as the applicant approaches the desk or in the way he stands or sits. a. Degree of limping a. The interviewer should note carefully the degree of limping, if any, (slight, moderate, marked) or any other peculi- arity of gain (scissor walk, walking on toes, etc.) b. Prosthetic appliances b. Prosthetic appliances, braces, shoes, cane , crutch, etc., should also be noted. 2. Prom medical reports 2. Medical reports are desirable under the same circumstances as for arm and hand disabili- ties; desirable only if the condition is a recent amputation, requiring medical care, or tuberculosis, or arthritis or osteomye- litis. a* Translating medical reports into job lan- guage a. From the medical report such as that for Henry Mount, who has a leg disability, (see Exercise No. 9), tke interviewer must translate the occupational meaning of the medical facts. (Refer the class to ♦ a typical medical ♦ report for orthopedic condition involving the.leg as presented in Exercise No# 9 for for Henry Mouni) For example, the medical fact that the activities of kneeling and crawling are forbidden for Henry Mount means occupa- tionally that he oan no longer work at his old trade of linoleum layer, but must be guided into and trained in new work# B# THhat to record ' B. The key points to be recorded are very similar to those for arm and hand handicaps# C# Examples of What to record (Refer the group to typical application cards for each of the two kinds of leg and foot disabilities, as pre- sented in Exercise No# 9 for Salvatore Donato and Henry Mount • ) I “ C# The application cards for Salvatore Donato and Henry Mount, presented! as part of Exereise No# 9, are examples of what to record for leg disabilities# ♦ VlII#Matohihg the work capacity of workers with leg limitations VIII# with the physical demands of jobs (20 minutes) ♦(Ask what physical demands items ♦are important in placement of applicant with leg limitations#) • A# Activities the significant factors A# Allowing for individual differences, the interviewer will evaluate the following items for leg limitations: walking, jumping, running, balancing, climbing, crawling, standing, turning, stooping, crouching, kneeling, sitting (which may he difficult for some persons with stiff knees, especially if they have to sit in cramped quarters) reaching, throwing, lifting, (these last three included if person must lift, throw or reach while standing)# Carrying, pushing, pulling# B# Significant working B# Hot, humid, (both affect comfort in wearing conditions ♦ (Ask what working conditions ♦ should be checked#) artificial limbs, braces), wet (slippery), vibration, mechanical hazards, moving objects, cramped quarters and high places, are the important working conditions# C# Exercise No# 9, "Classifying a worker with a leg disability C# Exercise No# 9, has as its objective the appli- tion of principles for classification, and of considerations for placement of workers with and ohoosing suitable work Points to be Made Suggested Supporting Material X# Physical facts about handicaps of the back and the spinal column (10 minutes) IX. ♦ (This material, being taken * from the Handbook, should be reviewed rapidly by the in- structor ) • / A. Spinal Curvatures A. The spinal column is the fundamental part of axial skeleton. It supports the visceral organs and transmits the weight of all of these parts of the body to the pelvis and lower limbs. 1* Some an appearance handicap only 1. Some curvatures, acquired in early child- hood, may be a handicap in appearance only, if no functional ability has been lost and no support (corset, brace) is needed. 2. Visible evidences • 1 2. Evidence of curvature visible to an inter- viewer is any of the followings a. Protrusion of spinal column (technically called kyphosis and colloquially called, hump-back). b. Uneven shoulders, one being wider and higher than the other. c. Uneven waistline or hips, one side being larger than the other# d. Head apparently resting on shoulders, with neck not showing, (b, c, d, are lateral curvatures or scoliosis) B. Back sprains or disabilities B. Other types of back disabilities are: 1. Wry neck, limiting turning 1. Wry neck (torticollis) is a contracted stat' of the muscles of the neck, usually fixing the head in an unnatural position and limit? ability to turn head. It may arise from rheumatism or spasm of muscles. Evaluatior of work capacity for an applicant with wry neck should include an estimate of how well or fast he can turn (he may learn to turn body if he cannot turn head). 7-3040 P114 bu Points to be Made Suggested Supporting Material 2. Arthritic stiffening necessitating avoidance • of unfavorable conditions 2. Stiffening of the spine due to arthritic changes will necessitate elimination of jobs with conditions which would aggravate the arthritis, (dampness, sudden temperature changes, humidity). 3. Lumbar Sprains, limiting twisting movement, lift- ing and involving carry- ing, pushing, pulling, throwing 3. Lumbar region sprains affect the waistline area, which is sensitive to every muscular action of the body. These sprains especially if unrelieved by belts, may lower capacity for weight-moving activities considerably. Sudden twisting or wrenching of a joint whereby ligaments tear or are separated from their ’’mooring” is knows as a sprain. What is involved in interviewing X. workers with back and spinal column limitations (10 minutes) A* Getting the information A. 1. From the applicant 1. During the interview the applicant can be asked to describe the extent to which his activities are limited. Many of these limi- tations Trill be clearly evident. 2. From medical reports 2. Medical reports are desirable in conditions for certain conditions of Tuberculosis, or arthritis, or any disease actually undergoing treatment. a. Translating medical reports to job language a. The typical medical report for the spinal disability of Helen Walters presented as part of Exercise No. 10 must be trans- lated to its occupational meaning. ♦ Refer the group to ♦ the typical medical report for a spinal condition, presented for Helen Walters as part of Exercise No. 10. Specifically this means that the limita- tions on physical activities (1-10, 12, and 14-18,) and working conditions, would lead into jobs that alternate sitting and standing. This is an example of an ideal medical report, with full "Remarks” from the doctor to guide the interviewer. B# What to record 1 B. The key points to remember and record for S£i .nal disabilities are the following: Points to be Made Suggested Supporting Material ♦(During this discussion ♦elicit from the group key- points to be recorded and develop and INTERVIEWING AID for spinal disabili- ties.) (1) Description (left shoulder high, wider than right, etc.) (2) Cause, date of onset, prognosis (3) Appliances used (4) Capacity for bending, kneeling, carrying, etc. (5) Other disabilities (6) Conditions to be avoided 1. Examples of what to record 1. The application card for Helen Walters, presented as part of Exercise No. 10 serves as an example of what to record. (Refer the group to the typical application card for the spinal limitation, that for Helen Walters, presented as part of Exercise No. 10.) I.Matching work capacity of applicants with spinal limitations with the physical demands of jobs {10 minutes) XI. i What physical demands items are important to consider? A. Activities, the key factor A. Certain specific activities are often restricted to workers with spinal limitations. This may be standing, sitting, lifting, carrying, pushing* pulling, throwing, walking, jumping, running, balancing, turning, crouching, kneeling. 1. Other functions may be involved 1. A curvature cramps the organs, including heart and lungs, and may be accompanied by internal disorders. ;t B. Significant working conditions B. Workers with spinal limitations may have to avoid cramped quarters, vibration, sudden temperature changes, dampness or humidity. n ft(140 Pll6 tU Points to be Made Suggested Supporting Material ♦(Ask what working conditions ♦are important to check.) C. Exercise No. 10 C. Exercise No. 10 has as its objective the a worker application of the principles for classifying with a spinal handicap, and and placing workers with spinal limitations. choosing suitable work" SUMMARY Repetition of the elements in placement for any dis- ability (5 minutes) I. Our consideration of hearing, speech and ortho- pedic handicaps have followed the same pattern: A. The physical facts. B. What is involved in interviewing for the part- icular handicap including getting the inform- ation from the applicant or from medical re- ports and recordings C. Considerations for matching the work capacity with the physical demands of jobs. Preparation for third day A. Reading B. Development of the Glossary II. A. Ask the group to prepare for the discussion for the next day by reading Part II, Sections on respiratory, cardiovascular, and miscel- laneous disabilities, in the handbook. B. Remind the group to continue the development of their glossary of new terms they encounter in the readings or the discussions, using the medical dictionary. Instructor1s Discussion Outline VOCATIONAL ASPECTS OP COMMON DISABILITIES (3)RESPIRATOHY, (U) CARDIOVASCULAR, DISABILITIES Objective: To survey the important facts about three more groups of disabilities (from the Handbook), shoving how these facts can be used in interviewing and referring. Outline Of Main Ideas: 1. Review of the facts needed to high-light the vocational aspects of any disability (5 minutes) 2. Respiratory Disabilities (90 minutes) - a. Physical, facts about respiratory disabilities b. Application of these facts about respiratory disabilities to actual problems in interviewing and classifying c. Matching work capacity with physical demands 3* Cardiovascular disabilities (120 minutes) a. Physical facts about cardiovascular disabilities b. Application of these facts about cardio- vascular disabilities to actual problems in interviewing and classifying c. Matching work capacity with physical demands Miscellaneous Disabilities a. Physical facts about these miscellaneous disabilities b. Application of these facts about these miscellaneous disabilities to actual problems in interviewing and classifying c. Matching work capacity with physical demands Training Program for Serving the Handicapped Units and 3b Third Morning end Afternoon Units 3a and 3^ Third Morning and Afternoon REMINDERS IDR THE INSTRUCTOR Special Advance Preparation: Exercise No. 12 on Page 10 is an interview with an applicant with a cardiac handicap* with the instructor acting the part of the worker. The instructor will want to "become familiar with the necessary facts. Materials Heeded: 1, Supply of "blank ’’Physical Capacities Appraisal” forms for each trainee to use in Exercise No. 12 2. Supply of "blank application cards for each trainee to use in Exercise No. 15 Points to be Made Suggested Supporting Material TRANSITION AND MOTIVATION I. Review of the items needed to highlight the vocational aspects of any disability * (Ask the group to recall * the items needed to do a placement job for a hand- icapped worker and list them on the board as the group mentions them,) i % I, The group will recall that according to the previou discussions, the elements in our process are the following: A, The physical facts, including; 1. Information obtainable from the applicant in the interview, and the key points to look for. Medical reports from physicians. 3. What to record about the disability. C, How to classify the actual work capacity, D, How to match work capacity and the physical demands of jobs, E, Sources of help, such as, training or other assistance for the unemployable. — w s a. i ENTATION I. Physical facts about respiratory disabili- ties A, Having to do with the lungs B, Hard to recognize because not visible I. A, Respiratory disabilities are those which have to do with the lungs and with breathing. Among them are tuberculosis, silicosis, asthma, chronic bronchitis, pulmonary emphysema, pulmonary empyema* and bronchiectasis. B, Because these disabilities are not visible, the interviewer must exercise considerable skill and ingenuity in order to uncover them. Many applicants with chronic or arrested diseases of the lungs are loathe to adm.it it for fear they will not be employed. 7 3040 P123 bu Points to "be Made Suggested Supporting Material il. What is involved in inter- viewing aioplicents with respiratory disabilities I2O ninutes) II. A, Getting the information A, Respiratory disabilities, being invisible, require all the techniques suggested for invisible handicaps. 1. Proa the applicant * (Ask the group to * recall the techni- ques for invisible handicaps) 1. Particularly diplomatic questioning is re- quired in order to draw from the applicant the facts about illness of this kind. All the points of technique mentioned earlier may be helpful. 2. Prom medical reports - always for pulmonary tuberculosis 2. The interviewer should secure a medical report in order to safeguard the public. Not only is a report desirable for appli- cants known to have pulmonary tuberculosis, but also for those who state that they have had a rib operation (thoracoplasty) without admitting tuberculosis. a. May be from clinic a. Reports may be secured from a clinic or doctor to which the applicant reports regularly. b. Recent examina- tion desirable b. Reports should be based on an examination within the last three months. Ideally, the reports should be in. terms of physical capacity and suitable working conditions, using the physical demands analysis form. c. Contents (if not in PD form) * (List on the * board) c. If a report in physical demands terms is not obtainable, the report should at least state: The state and stage of the disease How long it has been inactive Condition of the suutum Number of hours of work possible per day (1) Li?4- of stages *- (List on the board) (l) Some doctors will refer to the stage of the disease as minimal (l), moderately advanced (ll), or advanced (III) indicat- ing the extent of involvement of the lung. 7 an-tn P124 bu Points to be Made Suggested Supporting Material r d. Only certain cases employable d. Only these applicants are considered employable who are in the quiescent, apparently arrested, arrested or ap- parently cured status, with negative sputum. e. ibllow-np necessary e. Pulmonary tuberculosis cases are among those that often require follow-up after placement to assure that the work is not likely to lead to a recurrence. (1) Usually after one month (1) The follow-up interview, usually scheduled for a month after place- ment, should verify details of phy- sical activities and conditions. B. What to record B, The key points to remember and record for r ? ' r ' * * (During this discus- sion elicit from the class the key points to be record- ed and develop an INTERVIEW1 S AID for respiratory disabilities) 1 J 1. Example of what to record * (Refer the group to the application card for a worker with respiratory handicap, presented in Exercise No, 11 for Martin Borden) respiratory disabilities are the following: State (arrested or quiescent) and inactive since date SputucTTnegative or positive) Number of hours of work possible per day Prognosis Capacity remaining Conditions to be avoided 1. The application card for Martin Borden in Exercise No, 11 typifies good entries for a respiratory disorder. \ .. ... Matching the work capacity of applicants with respi- ratory limitations with tiie p!hysical demands of the .job, (10 minutes) III. * (Ask what physical * demands items are important to consider) 7-3040 P126 bu Points to "be Made Suggested Supporting Material A. New concents of A. Recent studies based on wide samplings have canaci ty begun to change the thinking about physical capacities and working conditions of ex- tuberculous individuals. 1. Wide variations in possible conditions !• Allowing for individual differences and the length of time the condition has been inactive, some such people have success- fully performed in jobs ranging from light to very heavy, and under conditions rang- ing from dry air and stable temperature to high humidity and great heat, (Those doing heavy work or working under not-so-desirable conditions tend to be persons yho have had tuberculosis many years ago and had only light cases.) 2. Pree silica the only dangerous dust 2, There is no scientific evidence to show that presence of dusts, other than silica dust in a free state, predisposes one to pulmonary tuberculosis, although other respiratory ailments may develop, depending on the irritant. 3* Old restrictions now modified 3. Thus, some of the former restrictions imposed on old tuberculosis cases may be unnecessary where the individual has good personal hygiene and reports for periodic chest X-rays, Bi Ibrmer occupation first choice B. It is generally preferable to place the appli- cant in his previous occupation if his capacity and the working conditions permit. If a change of occupation is required, work should be sought which utilizes as many of the elements and conditions of past experience as he can still handle, to minimize anxiety and fatigue in learning a new job in new surroundings. c. Close personal contact may be forbidden c. Because an ex-tuberculous person may have a reactivation of the disease for some time be- fore he or anyone else becomes aware of it, doctors sometimes disapprove of jobs involving close personal contact with others, such as barbering, teaching, or attending children. However, cases that have been arrested for a long time, cases with consistent history of negative sputum, or more recent cases subject to close and frequent medical check-up are now considered employable in these jobs. 7-3040 PI 26 bu Points to be Made Suggested Supporting Material D. Physical Activities D, Activities to be checked are; walking, .lumping. running, climbing, crawling, standing, turning. *(Ask what physical stooping, crouching, reaching, carrying, lifting * activities items are pushing, pulling, bending. (These may be more important to consider) limited in thoracoplasty cases.) S. Significant working E. Working conditions that may be harmful are the conditions presence of silica dust in a free state, tern- perature changes, wetness, humidity and heat. What working conditions Other dusts should probably be avoided because are important to check? they lead to other chest conditions such as bronchial congestion. F. Sheltered work for E, Sheltered workshops exist in some communities applicants not employ- for the ex-tuberculous. Workers may be employed able full time for less than a standard day or they may be employed on jobs where production standards ♦ (The Instructor should are low, permitting them to earn until such * mention the name and time as they regain their health sufficiently address of any shelter- to maintain production standards or v;ork full ed workshops in the time. area and suggest that , interviewers visit (Some of the local shops should be mentioned them.) here) G-. Respiratory diseases G-. Silicosis is defined as Pneumoconiosis, result- other than tuberculosis ing from the inhalation of the dust of stone. sand, or flint containing silicon dioxide or certain silicates; grinders* disease. It results in the formation of fibrous tissue in the lungs. 1. Silicosis 1. Silicosis is discovered most freouently among workers engaged in mining, quarrying, •* (Ask group to find ceramic manufacturing, tunnel construction. * Silicosis in the blasting and foundry work. Medical Dictionary) a* Significant a. Such applicants must work in surrounding working con- free from silica dust. ditions b. Medical report b. A medical report is desirable to verify desirable the diagnosis of silicosis. (NOTE; If this disability is common in the local community, an example should be cited here.) 7-3040 P127 hit Points to be Made Suggested Supporting Material 2* Asthma 2. Asthma is an interference with the free flow ' a* Significant work- ing conditions * (List on the * hoard) b, Medical report desirable 3. Chronic Bronchitis of air in and out of the lungs. a. Workers with asthma must be placed in surroundings free of the specific ir- ritant, which may be feathers, flour, certain chemicals, certain plant pollens. While capacity and type of surroundings will vary among individuals, most asthmatics should probably avoid: | • (1) Sudden changes of temperature (2) Bast and fumes (3) Poorly ventilated places (4) Exposure to dampness and cold (5) Excessive fatigue. b. A medical report is desirable with all cases of asthma in order to ascertain the type and the cause wherever possible | so that the specific irritant can be avoided. 3. Chronic bronchitis is a long-continued in- a. Significant work- ing conditions b, Medical report desirable Pulmonary Emuyeraa flammation of the bronchial tubes, while acute bronchitis is an inflammation of short duration. } a. Persons subject to acute attacks of bronchitis are not regarded as physically ( handicapped since attacks are usually of short duration. After recovery the applicant may return to his regular employment. b. A medical report, however, should be secured in the same terms as for asthma, l\ and the general limitations will also tend to be similar. U, Pulmonary empyema is an accumulation of pus 5. Pulmonary Emphysema in the lungs. The work capacity of appli- cants with Pulmonary Empyema will very con- A siderably depend upon the extent of the disease and the after effects. 5. Pulmonary Emphysema is a swelling due to the presence of air in the tissues. A medical report is desirable to show the extent of thi? disease. The more complicated cases may - require sedentary work. 7-3040 P128 bu Points to be Made Suggested Supporting Material • 6, Bronchiectases 6. Bronchiectases is a dilation of the bronchia. Workers v.'ith this disease may sometimes be cautioned against working with and around others. Standards for such patients and their employability are similar to those of ex-tuberculous patients. H, Hew Lung Therapy H. Treatments with which the interviewer may well be acnuainted are: 1. Thoracoplasty 1, Thora.coplasty: plastic surgery or operative repair of defects of the chest. 2. Pneumo-thorax 2, Pneumo-thorax: the artificial injection of nitrogen gas, for the purpose of collapsing and immobilizing the lung for treatment, I, Exercise Ho, 11 "Classifying Workers with Respiratory Die- abilities end Choos- ing Suitable Work" I. Exercise Ho, 11 has as its objective the appli- cation of the principles for classifying workers with respiratory disabilities. IV. Physical facts about applicants with cardiac disabilities. (5 min- utes) IV, Cardiac diseases are those affecting the heart. A, A freauent non- visible handicap A. Among the non-visible handicaps of workers coming to the Employment Service, the diser.sos of the are among the most frequent. B, Disease of young and old B. Heart Disease, contrary to belief, affects both young and old. If a. cardiac person takes care of himself, and works within thq limits of his endurance at a suitable job, the years of his working life should be long. In addition, most cases coming to the Employment Service are of the rheumatic type, the gro\ip for which generally the best prognosis can be given. V. What is involved in inter- vi ewing appli cant s wi th cardiac disabilities! (50 minutes) V. 7-3040 P129 bu Points to Ido Hade Suggested Supporting Material A, Getting the Information • A. 1* Prom the applicant * (Ask the group to * repeat some of the techniques for non- visible handicaps) \ 1. Identification of cardiac difficulties will depend upon use of the seme interviewing techniques discussed for respiratory dis- eases and hearing, such as examining school record, draft classification, and the like. 2. Prom medical reoorts 2. Medical reports may he secured for applicants who indicate a heart condition. This report should show: Cause Specific impairments (each of which give rise to different sets of limitations) and Work capacity left, preferably in physical demands terminology. a* American Heart Association classification often used a. In some areas, where clinics and doctors are familiar with the classification of organic heart disease devised by the American Heart Association, the report can be based on this classification. There are two: The functional grouping is based on certain physical factors, and vpon the amount of activity a person can or thinks he can perform v.'ithout developing shortness of breath (mouth breathing) and pain in the chest. The therapeutic grouping is virtually the doctor1* prescription for the amount of physical activity which is permissible. It is based both on the amount of effort possible without discomfort and also upon the nature and severity of the organic defects and the prognosis. Obviously then,’ therapeutic classifications are more significant for good selective placement. b, The meaning of American Heart Association classifications b. 7-3040 Pi30 bu Points to be kade Suggested Supporting Materialx *(Have interviewers * turn to Workbook and review briefly together the mean- ing of Functional and Therapeutic classification) (1) Functional Clas s ification (1) The Functional classifications are: I - no limitation Class I* Patients with cardiac disease and no limitation of physical activity. Ordinary physical activity does not cause discomfort. Patients in this class do not have symptoms of cardiac insufficiency, nor do they ex- perience anginal pain. II - slight limitation Class II. Patients with cardiac disease and slight limitation of physical activily* They are comfortable at rest. If ordinary physical activity is undertaken, discomfort results in the form of undue fatigue, palpitation, labored breathing or anginal pain. III - marked limitation Class III. Patients with cardiac disease and marked limitation of physical activity* They are comfortable at rest. Discomfort- in the form of undue fatigue, palpitation, labored breathing or anginal pain is caused by less than ordinary activity. IV - complete limitation Class IV. Patients with cardiac disease who are unable to carry on any physical, activity without discomfort. Symptoms of cardiac insufficiency, or of the anginal syndrome, are present, even at rest. If any physical activity is undertaken, discomfort is increased. (2) Therapeutic Classification (2) The Therapeutic Classifications are: A - no restriction Class A. Patients with cardiac disease whose physical activity need not be restricted. B - no severe effort Class B. Patients with cardiac disease whose ordinary physical activity need not be restricted, but who should be advised against unusually severe or competitive efforts. 7-3040 P131 bu Points to be Made Suggested Supporting Material ' C - moderate restriction even in ordinary- activity Class C, Patients with cardiac disease whose ordinary physical activity should be moderately restricted. . D - marked restriction Class D, Patients with cardiac disease whose ordinary physical activity should be markedly restricted. E - complete rest Class £• Patients with cardiac disease who should be at complete rest, confined to bed or chair. (Review with the group the two sample medical reports on follow- ing pages) v { Possible: Indicates presence of certain cardiac symptoms which while insufficient to warrant a diagnosis, still indicate caution in placement* f c, Translating Medical reports to job language c. The "specific remarks" section interprets the real meaning of the functional and therapeutic classification in a fully made out medical report. (1) Examples of medical reports in terms other than those of the physical demands analysis *(Read the reports * at right, and ask whether each applicant needs selective place- ment) (1) Doctors frequently insist on limiting their reports to terms to which they are accustomed. Some typical medical reports might be the following! (a) Diagnosis - Possible heart disease Prognosis - Undetermined 1 Specific Remarks - none (answer: Not in need of selective placement if over 25 years ofage} ’( II (b) Diagnosis - Coronary Heart Disease III-D Prognosis - Guarded Specific Remarks: none made by doctor . | (Answer: Im most States, the appli- cant is not employable except possibly doing certified home J work a few hours per day, > 7-3040 P132 bu 133 WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Budget Bureau Mo. 11-1008.1 Approval Kxplree March 01, 1044 Division of Occupational Analysis and Manning Tables PHYSICAL CAPACITIES APPRAISAL CARDIAC Name John Kane Age 31 5ex Height height Walking % Jumping Running Balancing Cl I mb In g Craw ling Standing Turning Stooping Crouching Kneel In g Sitting Reaching Lifting Carrying PHYSICAL ACTIVITIES Throwing Pushing Pul I i n g Handling Fingering Fee ling Talking Hearing Seeing Color Vision Depth Perception Working Speed Inside Outside Hot Cold Sudden Temp. Changes Humid Dry Wet Dusty Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration WORKING CONDITIONS Mechanic*! Hazards Moving Objects Cramped Quarters High Places Exposure to Burns Electrical Hazards Explosives Radiant Energy Toxic CondItIons Working With Others Working Around Others Working A I on* DETAILS OF PHYSICAL ACTIVITIES: Blank space = Full capacity; / - Partial capacity; X - Mo capacity. Way lift, carry, handle, push or pull up to pounds per hour May engage in activities numbered up to 2/3 of work period May engage in activities numbered up to l/3 of work period Sight: Hearing: Others: DETAILS OF WORKING CONDITIONS: Diagnosis: Rheumatic Heart Disease - II B Prognisis: Fair Specific Remarks: Should stoop only intermittently to avoid straining chest muscles. Should do only occasional reaching, lifting, carry- ing, throwing, pushing, pulling. Lifting all right if not done too often. Can lift any weight which does not make him gasp for breath. Should avoid environmental items checked to avoid colds. Date 194 Physician WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Budget Bureau Bo. 11-lOIB.l Approval Bzplrea March |i, 1B4< Division of Occupational Analysis and Manning Tables PHYSICAL CAPACITIES APPRAISAL CARDIAC Name Bill Bovd Age Sex Height Weight WORKING CONDITIONS Walking Jumping .Running Balancing Cl I mb Ing Craw ling Standing Turning Stooping Crouching Kneel I n g Sitting Reach Ing L 1 f 11 n g Carrying PHYSICAL ACTIVITIES Throwing Push I ng Pulling Handling Fingering Feel I n g Talking Hearing Seeing Color Vision Depth Perception Working Speed Inside Outside Hot Cold Sudden Temp. Changes Humid Dry Wet Dusty Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration Meehan leal Hazards Moving Objects Cramped Quarters High Places Exposure to Burns Electrical Hazards Explosives Rad I ant Energy Toxic CondItIons Work f ng Wlth Others Working Around Others Working Alone details OF PHYSICAL ACTIVITIES: Blank space = Full capacity; / = Partial capacity; X = No capacity. May lift, carry, handle, push or pull up to pounds per hour May engage in activities numbered up to 2/3 of work period May engage in activities numbered _ up to l/3 of work period Sight: _ _ Hearing: Others: DETAILS OF WORKING CONDITIONS: Diagnosis: Congenital Heart Disease II C Prognisis; Guarded Specific Remarks; Eliminate entirely 2,3,4. Should not have to work at great speed. May walk and stand intermittently for 2-3 hours per day, but seated work would be best. Extremely little and infreouent lifting, carrying, throwing, pushing, pulling (best not to handle more than 10 lbs.) Should avoid conditions which might set up colds and thus tax heart. Should avoid mechanical hazards, noise, vibration, radiant energy, toxic conditions and any others which cause worry and strain on a Job. Date 194_ Physician Points to be Made Suggested Supporting Material - (c) Diagnosis - Rheumatic Heart Disease IB Prognosis - Good - Mitral insufficiency (Answer: Needs Selective placement) Is (2). Interviewer must interpret (2) All such reports must be translated to physical demands terminology by the interviewer himself. ** B. What to Record * (Elicit from the * group the key points to he re- corded and develop an INTERVIEWER* S AID for cardiac disabilities) B. The key points to remember and record for cardiac disabilities are the following; Cause or type (heart disease due to hardening of the arteries or rheumatic fever or the like). Classification (if used by the doctor, since the interviewer never attempts to diagnose this classification himself). Capacity remaining Working conditions to be avoided Prognosis RECESS 50R LUNCH n. Matching the work, capacity VI. of applicants with cardiac diseases with the physical demands of the ff1ob (20 minutes) What physical demands are important to consider? | A, Activities—the key factor A Certain specific activities for worker with cardiac limitations should be carefully evaluated. Among these ere; Crawling, running, climbing; shortness of breath bl in these activities will indicate how much of each he can do. i! Lifting; how much and how often can person lift without getting tired. Walking; how far end long can he walk without fatigue? Reaching, pushing, nulling; how often can he reach forward? Points to be Made Suggested Supporting Material B, Working conditions to be avoided B. Working conditions to be avoided include; High places, mechanical hazards:are undesirable on the whole for cardiacs with any limitation* Bust: mitral cases, at least, should probably avoid dusty occupations because they induce coughs and catarrh, so favoring bronchial congestion to which these persons ©re parti- cularly susceptible* The handbook gives details for avoiding tempera- 1 ture changes and wetness for rheumatic heart disease and for avoiding stooping and bending for hypertensive heart disease* C, Secondary factors often important c. Also, since cardiacs must avoid anxiety, worry h and irritation such as may arise in hazardous or unpleasant working conditions they should avoid occupations involving such factors as mechanical and electric hazards, toxic fumes, explosives and exposure to burns, etc* 1, Transportation to and on the job 1. Secondary factors that will have to be analyzed for cardiacs will be time and transportation to and from job, presence or absence of elevators in the building and the like. i B, Use of the Classifications B. With the classification as a guide and some knowledge of limitations gleaned from the foregoing descriptions, the interviewer will have to choose suitable work (until such time as doctors make out reports in specific terms of physical activities and suitable working conditions), to 1. May determine whether or not placeable 0 1* ibr example, the applicant classified C may be able to work only a few hours a day, and then only near hone so that traveling is minimized* Class III is not placeable ex- cept perhaps in sections where certified home work is permitted and the work can be brought to the individual or where applicant can work fairly near home. Individuals in III-C are doubtfully employable and will have to be especially carefully evaluated. i • | t 7-3040 P138 bu —— ■ I — —— .. . .. ..— Points to 'be Made Suggested Supporting Material 2. Often figure in vocational guidance E, Exercise No. 12 2, Those under 25 with potential or possible heart disease will be accorded selective placement in order to guide them into occu- pations where there will be no undue strain on the heart. E, Exercise No. 12 has as its objective the appli- Classifying the worker with a cardiac disahili- ty and choosing suitable work cation of the principles for cardiac limitations. I.Vascular Diseases VII, Vascular Diseases are conditions affecting the (l5 minutes) A, Varicose Veins arteries and the veins which interfere with the proper circulation of the blood. A. The most common vascular disease is Varicose 3, Thrombo-angiitis Veins, Since the degree of severity varies, applicants with varicose veins will be considered handi- capped only when the condition constitutes a problem in placement as defined elsewhere. Obviously, the standing, walking, climbing, crawling capacity of such individuals may be lowered, 3, Obliterans is usually known Obliterans C, Phlebitis D, Essential Hypertension as Buerger's Disease. Work capacity level of persons with amputations due to Buerger's disease treated under orthopedic handicaps. Continuous walking and standing and other activities that may be performed while walking or standing (pushing, carrying, etc.) may be greatly limited even before amputation, be- cause of intermittent pain, C, Phlebitis is a disease whose limitations are similar to those of Varicose Veins. D, Essential Hypertension is a variable condition and occurs with a high degree of frequency, chiefly among people over UO years of age. Arterial hypertension can exist with or without heart disease. It is desirable to secure medical reports for all applicants reporting high blood pressure to check on the possibility of cardiac involvement. Points to be Made Suggested Supporting Material Till, Miscellaneous Disabilities (70 minutes) VIII, Grouped together as "Miscellaneous” are 10 disabilities sufficiently common to warrant some discussion, but not occurring frequently enough to be treated in the detail devoted to other handicaps. A. Hernia . 1 A. Hernia is the first of these disabilities. 1. Physical facts 1, Hernia is the term given to any protrusion of a loop or knuckle of an organism or tissue through an abnormal opening. The handicap is common among men, found less frequently in women, j 2, Medical reports only if under treatment 2, Medical reports are desirable in hernia cases only if the applicant is under treatment, has had recent treatment, or if the applicant reports a condition that would seem susceptible of improvement j by medical attention. 7 a. Translating medical reports into job lang- uage, (Refer ♦the group to the ♦medical report for Thomas Ander- sen which is pre- sented as part of Exercise No, I-?) I | 1' 3. Matching physical capacity and suit- able working condi- tions 3. 1 I a. Selective place- ment not always necessary a. Selective placement is rendered only . those engaged in fairly strenous non- sedentary work, or those whose occupar-JJ tions seem suitable to their condition but who are being rejected by employers1 by means of restrictive pre-employment examinations. Some who do sedentary work (such as truck drivers) involv- ing great use of legs (as in jamming foot down on pedal) may also require selective placement. Clerical workers,-} however, would not. Points to be Made Suggested Supporting Material b, Some require opera- tion before place- ment b. Applicants with irreducible hernia, (one which cannot.be placed back in its natural cavity) are not placeable until they have either secured a support or undergone operation. c, Limitations hard .to establish c. Limitations imposed on an applicant with hernia are hard to determine. He must be guided in most instances by the amount of pain induced by the work he does. Some find relief in the wearing of a belt or truss. The condition is fre- quently successfully overcome by an operation before the age of *40, d. Activities the key factor d. If a medical report is secured, it is desirable to know the work capacity in terms of prolonged standing, walking, running, lifting, carrying, throwing, oushing, pulling, reaching, climbing, stooping, crawling and the like. e. Exercise Ho. 1^ e. Exercise No. 13 has as its objective the application of the principles just "Classifying a worker discussed. with a hernia and recommending; suitable work" B, Stomach Ulcers B. Stomach ulcers sre open sores of the lining of the stomach. 1. Work capacity 1. They may require medical reports if the applicant is currently under treatment. a. Activities £t« Stooping, kneeling, crawling, climbing. may be unlimited for mild cases, partially or totally limited for severe cases. Pushing, pulling, lifting, carrying. throwing, jumping, may be carried on to slight or moderate degrees depending on the individual. Heavy pushing, lifting, etc. may tend to be the exception rather than the rule, particularly if the appli- cant is on a very bland, mild diet. 7-3040 P141 Points to be Made Suggested Supporting Material 2. Working conditions 2. a. Odor a. Certain odors may be distasteful to some individuals and cause further gastric upset. b. Regular meals and rest b. The frequency and regularity with which the applicant has to eat may require the interviewer to check such secondary job factors as: Shifts (day jobs usually better) Meal hours Rest ueriods (time to get food if needed) Eating facilities c. Vibration '•‘V c. Vibration may be harmful. C. [Tumors pud Cancer c. A tumor is a morbid enlargement. 1, Medical report desirable 1. Medical reports may be secured for all applicants who state they have a tumor or a cancer in order to show whether or not they are employable. 2, Work capacity and work limitations i 2. No generalization can be made here but a determination will have to be made on an individual basis. D. Diabetes Mellitus D. Diabetes mellitus is a disease of metabolism marked by an excess of sugar. 1, Medical reports 1. Medical reports may be secured. 2. Work capacity 2. Work capacity will vary greatly among these applicants and must be determined upon an individual basis. E, Venereal diseases E. Venereal diseases are certain diseases such as syphilis and gonorrhea which are contracted by sexual intercourse or other contact with infected persons or may be of congenital!, origin. Public confidence in venereal disea.se control will be maintained only if employers do not discriminate against job seekers with syphilis and other venereal diseases. 1, Medical reports 1, Medical reports will determine if the applicant is in an infectious stage. 7-3040 P142 bu Points to be Made Suggested Supporting Material 2. Work capacity and working conditions 2. a. Infectious stage - the critical factor a. If the applicant is in an infectious stage he is unemuloyable until such time as he becomes non-infectious. (l) Treatment rapid / ft (l) Treatment is rapid and this period nay be short. It may be wise there- fore, to get a second reuort in 3 or U weeks. Execution; Arrplicants with gonorrhea may be allowed to vurk if under suecial. medical observation during the administration of sulfa- nilamide drugs. (2) Non-infectious may not need selective placement (2) If uerson is non-infectious (and no cardiac or other permanent damage has ensued) he is employable and does not even require selective placement. (3) Special cautions for syphilis - (3) Workers with syphilis, however, in any of its stages, should never be employed in areas of toxic exposure. The late manifestations of syphilis are to be handled according to the body system most severely affected, e.g, heart disease, nervous disease. 3. What to record (During this discussion elicit from the class the key points to he recorded, and develop an INTERVIEWER1S AID for venereal diseases. Note on the blackboard! 3. Try to avoid use of terms indicating venereal disease, (syphilis, gonorrhea) since they may stigmatise the applicant in the eyes of some interviewers working with his applica- tion. In this case the following might suffice; Date - Reuort requested Date - Reuort received - Dr. R, Jones - non-infectious - not handicapped* or Date; Report received - Dr. R. Jones - infectious but . under treatment - unable to work now - new report to be secured in 4 weeks. U, Other considerations k. The interviewer should be familiar with State and local health laws concerning venereal disease, and with community agencies to which applicants might be referred for treatment. Points to be Mfi.de Suggested Supporting Material F, Kidney Ailments F. 1, Medical report necessary 1. Medical report is desirable for kidney ail- ments. 2, Working capacity 2. Working capacity will tend to b© lowered for continuous standing and activities per- formed while standing (pushing, pulling, lifting, carrying, throwing, reaching). a. Toxics dangerous a. As far as working surroundings ©re con- cerned, exposure to toxic conditions will be carefully investigated to avoid sub- stance which might aggravate a kidney condition. Some toxic substances which might aggra- vate a kidney condition are: Aniline . . Benzol and tulnol'2' Carbon disulphide Chlorinated hydrocarbons Lesd and its compounds Mercury and its compounds Nitrobenzol and other nitro compounds of benzol and its homologs Eadio-active substances and X-rays Turpentine, G. Glandular Disturbances 1. Thyroid disturbances 1. Among the more common glandular disturbances are thyroid ailments and those which cause abnormality of size. < a. Medical reports are desirable in thyroid cases. a. Medical reports / b. Working conditions b. The following physical demands items „ should be considered. Working speed - undue pressure may aggra- fj vate the condition. Sitting - One who is very nervous may be unable to sit for long periods. Feeling, fingering, handling - Limitation' will depend on extent of tremors, if anyl Points to be Made Suggested Supporting Material • Lifting, carrying, pushing, pulling, throwing - Limitations will depend on degree of emaciation, if any, Working with or around others, or alone: Degree of contact with others will enter into picture of mental pressure appli- cant can take. Exposure to cold and sudden temperature changes; Dependent on how much apolicant sweats. 2, Abnormality of size a. No medical report b, Working conditions 2. Midgets and dwarfs can either capitalize on their lack of height by seeking work in cramped auarters which present no problem to them or they can minimize their lack of height by standing on platform or box or by sitting on raised chair. a. A medical report is not necessary. b. Their reaching capacity should be evaluated for any manipulative or machine tending jobs, 5br giants, the limitations are reversed and interviewers will try to find jobs in which height is an advantage. H. Skin Diseases 1. Medical reports desirable H. 1. The interviewer mpyr secure medical report to determine whether the skin condition is contagious or infectious and v/hat the specific irritant is. I. Cosmetic Defects 1. Appearance handicaps only r •* • Cosmetic defects refer to appearance handicaps. V/hen appearance handicaps are also functional, such as loss of arm or thickened neck as in goiter, they are discussed elsewhere in this series. 1, Cosmetic defects are considered limitations only for those seeking jobs involving public contact. Among these 'defects are vivid large birth marks or scars on the face or hands, distortion of features, absence of all hair or eyebrows. Points to be Made Suggested Supporting Material J, Pregnancy J, Although the labor market rerely necessitates the recruitment or employment of pregnant women, many of them find it necessary to work, Basic requirements governing the selective placement of pregnant women are detailed here as a guide. 1, Working conditions 1, In general, pregnant women can follow their usual occupations, unless these involve heavy lifting, hard labor, continuous standing, a good sense of body balance, or are characterized by hazards of severe injury, or exposure to toxic substances. a* Hours a. They should not work on night shifts between 12 P,M. end 6 A,M, and not more than S hours a day, with regular rest periods provided, or hS hours a week. b. ilo employment 6 v;eeks before delivery b. They should not be employed 6 weeks be- fore delivery or for about U weeks after birth. c. Lav; suecifies time after delivery c. Many State Laws specify the number of weeks after delivery in which women should not be employed. Interviewers should become acquainted with the regulations for their States,. Points to be Made Suggested Supporting Material SUMMARY I, Reiteration of the importance I. We have traced through the considerations for of recognizing handicaps > non-invisible • three groups of common handicaps, which are largely non-visihle. The important point to remember for all of them is the same as for any handicap, namely, that the unimpaired work capacity remaining with the individual, after all due attention lias been given to the effect of his disability, is the important item for consideration in placement work. II. Preparation for A, Readings B. Glossary the day II. In preparation for the kth day, ask the group to read the following sections in the handbook; A, Part two - Visual handicaps, mental disorders and neurological disorders. B. Remind the group to continue the development of the glossary on 3 x 5 cards. Instructors Discussion Outline VOCATIONAL ASPECTS OF COMMON DISABILITIES: (6) VISUAL HANDICAPS, (?) MENTAL DISORDERS, (8) NEUROLOGICAL DISORDERS Obj ective: To continue the presentation of facts about common disabilities, tracing their application to interviewing, classifying, and referring for three more important groups of handicaps. Outline of Main Points: 1. Brief review of the additional steps necessary in the process of placing handicapped workers (5 minutes) 2. Workers with visual handicaps (115 minutes) a. Facts about visual handicaps b. Application of the medical facts to actual problems in interviewing and classifying c. Matching their work capacity with physical demands 3. Workers with mental handicaps (90 minutes) a. The two types of mental handicaps b. tacts about mental defectives c. Application of the facts to actual problems in interviewing and classifying d. Matching their work capacity with physical demands e. tacts about mental disorders f. Application of the facts to actual problems in interviewing and classifying g. Matching their work capacity with physical demands 4. Workers with neurological disorders (30 minutes) a. Medical and vocational facts about neurologi- cal disorders b. Application of the medical facts to actual problems in interviewing and classifying c. Matching their work capacity with physical demands Training Program for Serving the Handicapped Unit 4a and 4b 4th Morning and Afternoon 7-8040 P149 nobu Unit Ab and 4b Fourth Morning and Afternoon RtiJIKDLRb FOR THE INSTRUCTOR Materials Needed; 1, Supply of application cards Points to be Made Suggested Supporting Material TRANSITION A m p i IVATIOE Brief review of the additional stems necessary for the place- ment of handicapped workers (5 minutes) ('without noting items on the L board, ask the group to repeat the additional facts and items of information ner.ded to do a placement job for the handi- capped.) I. The group will recall that according to the previous discussions, the kinds of facts needed are the following: i A. The physical facts, including: 1. Information obtainable in the interview and the key points to look for. 2. Medical reports from physicians. B. What to record about the disability. C. How to classify the actual work capacity. D. How to match work capacity ana thd physical demands of jobs. E. Sources of help, such as training or other assistance, for -those not immediately placeable. Transition: The group is ready to continue the same kind of approach to three other common groups of handicaps - the vis- ual, the mental, and the neurological • PRESET TATIJN Physical facts about visual handicaps (30 minutes) I. Vision handicaps cover a wider range of defects than is commonly realized. A. Extent of handicap depends noon percentage of sight retained, and upon prognosis A. The necessity for selective placement for persons with defects of vision depends upon the percent- age of sight a person retains in one or both eyes. The prognosis of the condition may also figure in the me.tter. 1. Better eye the criterion 1. Generally, the residual sight in the better eye is taken as the criterion for selective placement. 2. Various types of impairment ■ 2. The loss of vision mey consist of (l) a loss of clarity with which an object is perceived, (2) distance at which it may be perceived, (3) the range of the visual field, (total area perceived when both eyes are focussed straight ahead) or, (A) inability of two eyes to act in unison. a. Diseases of the eye a. Diseases of the eye may have a prognosis of mot-sible blindness, dome of them are: Points to be Made Suggested Supporting Material scleritis, glaucoma, retinitis, optic atrophy, and some inflammations of the middle coat of the eye. b. Defects in the muscle • b. Structural defects may also warrant selec- tive placement. Very far-sighted applicants will require selective placement; Some cases of extreme near-sightedness (myopia) also require it since all strenuous activi- ties such as lifting, pushing, pulling, jumping or running which might detach the retina are ruled out for such persons f 3* Disease or structure may be cause 1 \ * \ 3. Reduction in the efficiency of one‘s sight then, may be due to disease, defects in the external muscle, or defects in the shape of the eye. B. The blind - B. The "blind" must be carefully defined. Some "blind" can "see"; in fact, some might not even be called blind by the uninitiated. !• Work opportunities expand- ed by mass production 1, Mass production methods have increased the opportunities open to the blirfd and near-blind because many industrial processes have been simplified and routinized. 2, Work capacities vary 2. Work capacities of the blind will vary as much from individual to individual as will capaci- ties of those with normal sight. 3, Other senses sometimes acute 3. Some blind persons, however, develop more highly the sfenses of touch, smell, or hear- ing in compensation. Their capacity may thus be increased. Transition: The blind will be discussed in detail later in the session. What is involved in interview- ing workers with visual handi- caps II. A. Securing the information 1. From the applicant A. 1. Some questions concerning limitation of sight can be answered by the applicant himself. If additional information is desired medical reports may be secured. 7«O40 P16* btt Points to be Hade Suggested Supporting Ivjaterial 2. Medical reports desirable 2. If medical reports are desired they should be secured from recognized opthalmologists, oculists or physicians specializing in the disease of the eye. a. Physical demands terminology especial- ly important a. Again, this information should be in physical demands terminology as far as possible and should show diagnosis, cause, acuity and field of vision ana prognosis (inducing whether condition is arrested or progressive). b. Report not necessary in some cases of re- moval of an eye b. No report is necessary for applicants who have had an eye removed because of a pen- etrating wound, if vision in the remain- ing eye is good. c. Blindness in one eye without removal may indicate a report is desirable. • c. Reports are aesirable for those who have not had a removal, because of the danger of sympathetic blindness developing in the remaining eye. d. Medical report desir- able in case of disease d. When applicants lose the sight of an eye due to disease (with or without subse- quent removal of the eye) a medical report is desirable because an incipient condition may exist in the other eye no matter how long ago the applicant had the disease. B. Translating medical reports . B. Since most medical reports will use the terms to job language; Introauc- tion of the Snellen Tables (Have the group turn to the Snellen Table in the hand- book. ) of ha it the Snellen Table, the interviewer for the ndicapped needs a thorough understanding of • 1. Snellen Table based on normal vision at 20 feet , 1. You have all had your eyes tested by reading a chart on the wall. The Snellen Table is based on readings from these charts. The charts are reaa at 20 feet. That is what 20 on the left side of the table means. 2. Measure both corrected and uncorrected vision 2. They can be used to measure both uncorrected and corrected vision. 3. The "blind" as defined 20/200 3. If the person can read only the top line of the chart his vision is said to be 20/200. In other words he can read at 20 feet what a normal person can read at 200 feet. His vision is so bad that he is considered to be blind. Points to be Made Suggested Supporting Material 4. The industrially blind 20/l00 " A. If a person can read the first two lines his vision is 20/100. In other words he can read at 20 feet 7;hat a normal person can read at 100 feet. His vision is so poor that he is considered to be 11 industrially blind." 5. Vision bad enough to require selective place- ment, 20/70 5. If a person can read the top 3 lines his vision is 20/70 - he can read at 20 feet what a normal person can read at 70. His sight constitutes a problem and he requires selec- tive placement. Persons with vision of 20/20 to 20/60 constitute no proDiem in placement unless corrected from 20/400. 6. Percentage of vision from conversion table 6. If you want to know the percent of vision of someone with 20/60 sight, for' example, con- sult the conversion table at the right of the Snellen Table and you will find it to be 69*9% of -normal vision. A person 20/140 vision according to the Snellen Table has 34.2$ normal vision. 7. Example of medical report in physical demands terminology 7. A typical medical report on a visual handicap in physical demands terminology might be the following; Alan, 35 years of age, miniature painter. Diagnosis; High mvooia, bi-lateral Prognosis; Progressive Specific Remarks - Should stop doin* close eye work of his present occupation. New occupation should not involve heavy lifting, pushing, pulling, throwing, reaching, and he should not be exposed to vibration. C. What to record C. The key points to be remembered and recorded for * (During this discussion * elicit from the group the key points to be recorded about persons with visual handicaps and develop and INTERVIEWER*& AID for visual handicaps.) visual handicaps are the following; (1) Nature of disability, cause, prognosis (2) Eye chart measurement (20/100, 20/200, etc.) (3) Special points to check Field, of vision affected? Depth perception affected? Sensitivity to toxics? (4) Conditions to be avoided. # 1. Examples of what to record *(Refer the group to the application card for a visual handicap. 7-3040 PlOO bu Points to be Made Suggested Supporting Material p ‘ - 1 - • 1 ■ that for a visual handi- cap, that for Jeanne Rogers, presented as part of Exercise No. 15) \ > 11. Matching the work capacity of the visually handicapped with III. The key to the placement process for these handi- caps lies again in determining the degree of the physical demands of .lobs limitation. . .That physical demands items are important to consider? A. Divisions by depcree of handicap A*. Visually handicapped workers can be grouped into categories as follows; I \l 20/20 to 20/60 - no problem of placement 20-70 to 20/800 - require selective placement 1. The "legally blind" 20/200 or less 1. Within this group 20/100 to 20/800 are industrially blind. Among the industrially blind, those measuring 20/200 to nil are termed "legally blind." 3. ’< ork suits ble for certain decrees of vision B. While definite lists of jobs suitable for cer- tain handicaps are never practical, ranges of type of work can be helpful. 1. Wide choice of jobs for 20/70 - 20/100 1. For workers having a corrected vision of 20/70 to 20/100 in the better eye, the range of possible jobs is very wide. Only such jobs as engraving, requiring close and continuous use of the eyes on a fixed point, might prove unsuitable. 2. Jobs for 20/100 to 20/200 those not re- pairing inspection 2* Those whose corrected vision in the better eye is between 20/100 and 20/200 can fill jobs in which vision is required primarily for guiding movements of the body rather than for inspecting materials or objects. a. Examples of suitable laundry jobs Sr, * a. For example, suitable laundry jobs would be SHAKER or FOLDER in flat work finish- ing department of a laundry, or BODY FRESSER of shirts or blouses or PACKER, WRAPPER, or SHIPPER. b. Examples of laundry jobs probably unsuit- able b. The same worker would probably not be Suitable for jobs as INSPECTOR, HAND FINISHER, or FOLDER, WEIGHER. .6040 P187 btt Points to be Made Suggested Supporting Material 3. Special considerations for those whose vision falls below 20/120 3. Within this group, workers whose corrected vision in the better eye is worse than 20/120 cannot work continuously with written materials as in stenography or bookkeeping. Tyring from copy might be difficult for one whose vision is less tiian 20/100. a. Other clerical jobs possible a. Other clerical jobs, such as duplicating- machine operator, or dictaphone operator, might be more suitable. b. Most outdoor jobs may be unsuitable , \ ) b. Most outdoor jobs - skilled, semi-skilled or unskilled - may be unsuitable. Work- ers in a construction gang, for example, may trip over something on the ground, stumble into a ditch, or get hit by a moving object. c. Need for protection increased with de- gree of loss c. As the visual loss approaches the thresh- old of industrial blindness, it becomes increasingly desirable thrt the person work either in a confined area (factory machine operator, salesman) or in outdoor environment not involving danger, (greenhouse, dairy or poultry farras.) 4. Work for the blind - 20/200 to nil in the better eye 4-. The definition of the blind includes those with traveling vision (ability to get about without a guide). Thus, any evaluation of a "blind" person must touch virtually every item in the physicsl demands schedule. Important working conditions are: adequate lighting. mechanical hazards, moving objects, cramoed Quarters, high places, exposure to burns, electrical hazards, ex- plosives, radiant energy and working: with or around others. / 0, Special considerations for diseases of the eve C. Special care will have to be exercised in evaluating the physical activities possible to those whose vision has been impaired slightly by disease, since vision is often important in guiding movement of the body and the hands. 1, Activities to be checked 1. Activities to be checked are; walking, running, jumping, climbing, balancing, crawling, stooping, reaching, throwing, pushing, for example, as well as simple seeing. They should be limited in varying degrees for those whose field of vision has been cut. Points to be Made Suggested Supporting Material 1 2. Working conditions to be checked 3. Importance of individ- ual prognosis for guidance purposes ! D. Special considerations for loss of vision in one eye E. Lxercise No. 1L. "Deter- 2. Exposure to moving objects should be care- fullv examined. Exposure to toxic condi- tions may make the optic nerve more vulner- able (as in exposure to lead fumes). Vision itself may be good but may not extend in all directions. 3. The individual prognosis must enter into any evaluation of capacity, because some sighted applicants must be guided into occupations they will be able to follow if they lose all vision (as may happen in scleritis, glaucoma, retinitis, optic atrophy, and some inflammations of the mid- dle coat)• Even where ultimate blindness is not the prognosis, the interviewer may have to distinguish between what an appli- cant can do, and what he should do. The latter tends to be less than the former. / D. Vision in only one eye, when loss of vision in other eye has been recent, may cause temporary loss of ability to judge distance. The ability may be re-acquired. During the interim period, such persons should avoid jobs as chauffeur, train operator, camouflage designer, and other jobs involving mechanical hazards, moving objects which may come from the wrong side., or depth perception. E. Exercise No. 1L has as its objective practice mining whether workers in determining whether or not workers with with visual limitations visual limitations reouire selective placement. need selective placement" (60 minutes) F. Exercise No. 15. "Recoin- F. Exercise No. 15 has as its objective provoking mending special placement consideration of the possibilities for special considerations for a worker with a visual limitation" (20 minutes) RECESS FC arrangements on the job to enlarge the employ- ment possibilities of workers with visual limitations. )R LUNCH 160 Points to be Made Suggested Supporting Material PRlbEl/ ’ATION (cont'd) V. Two tvoes of mental handicaps (5 minutes) IV, Mental handicaps may be said to fall into two groups * (Ask the group to recall the * two types, from their reading in the handbook) A. The mental defectives A. The mental defectives are those whose intellec- tual capacity is limited, usually from birth - those who are termed morons and idiots. B. Mental disorders B. People with mental disorders are those whose emotions and attitudes are not normal even though intellectual capacity may be very great. C. VJide difference in problems C, The problems of placement of the two types of handicapped workers differ widely. • Facts about mental defectives (10 minutes) V. The mental defective group will be considered first. A. Difficulties increase with severity of limitations * (Ask the group to recall * some jobs requiring very little intellectual capacity.) A. Many persons who are termed "mental defectives" because their intelligence falls markedly below the average are able to make good adjustments in society. However, those falling very far below normal often meet with difficulties, particularly at work. B. "Mental aee" and 1.0. the usual measure B. The usual measure of mental capacity is the Intelligence Quotient, or comparison of the mental age ana the chronological age of the individual. The I.Q. score of 100, attained when the mental age and chronological 'age are 'the same, is the norm usually cited. C, Certain low mentalities not necessarily a handicap in placement C. Applicants with low grade mentalities need not be considered handicapped if they have already found their occupational niche. 1. Guidance only may be needed 1. Inexperienced applicants in this group will need to be directed to simple repetitive jobs until they have built up work experience, Points to be M~de Suggested Supporting Material VI. ffihat is invol/ed in inter- viewing mental defectives (15 minutes) VI. A. Getting x,*.e information from the applicant A. The interviewer should try to get' as much objective data on an applicant as possible before labeling him mentally sub-normal. 1. Other causes possible for apparent dullness. 1. For example; Poor hearing, or another handicap rather than mental dullness may cause an applicant to give answers that are apparently irrelevant. 2. Indications of low intelligence 2, Several possible indications of markedly low-intelligence, however, can be used ty an interviewer. Among these may be; &. ungraded classes in school b. police or mental institution record c. rejection from service in the armed forces. 3- Such factors not always an indication of limi- tation 3. The factors listed above are not in them- selves indicative of severe mental limita- tions, but when coupled with incoherence and inattention during the interview, they may signal a mentally defective condition. B. Medical reports not necessary B. i Medical reports are seldom if ever necessary for mentally limited workers who are looking for jobs. VII. Matching the work capacity VII . A proper matching of the work capacity and the of mentally limited appli- cants with the physical de- demands of the job is particularly important for this group of workers. Jobs can be found that require almost any of the grades of limited intelligence found in the population, but care must be exercised to keep the demands of the job from exceeding the abilities of the individual. mands of jobs (5 minutes) A. Working conditions to be checked A. Particular attention must be paid to the following factors; 1. 2. Ability to work with or around others Danger from mechanical or electrical hazards which the applicant may not under- 3. stand Excessive work speed that may exceed his capacity. 7-8040 P181 bu Points to be Made r Suggested Supporting Material B. Importance of greater supervision B. Usually, the lower the mental age of a worker « the closer and more competent the supervision he requires. C. Other handicaps may also be present C. With mental limitation as with other handicaps a worker may have several disabilities in combination. 1 D, Exercise No. 16, "Class!- D. Exercise No. 16. has as its objective the appll* lying a mentally limited cation of principles for the mentally limited, * worker with another bandi- and demonstration of tne possibility of other cap." handicaps in combination. VIII. Facts about mental disorders / VIII, Mental disoroers present perhaps a more comoli- * (Ask the group to repeat the * definition) cated placement problem. Mental disorders are - defined as conditions in which the emotions and attitudes of the individual are not normal. A. General description - a peculiarity of behavior A, They are characterized by marked peculiarity . of behavior, such as excessive excitement, great sadness, confused conversation, hear- ing of imaginary voices, unfounded fixed suspicions or ideas not susceptible to reason.^ B. Frequently of temporary nature, cured when cause is removed B. Mental disorders may better be understood, when we recall that abnormal mental attitudes are in many instances relieved when the con- dition causing the aggravation is removed. C, Universality of mental strains C. Every person is subject to major emotional stress during his life time. Among these loss by death of family or friends, dis- | appointment in love, financial difficulties or loss of job security. 1. Everyone susceptible 1. Most people are able to stand these emo- tional strains, but under too great pressure anyone can become so upset that his behavior is not normal. 2, Example of Anxiety Neurosis , 2. An example of a Navy case history will illustrate this point. A Lieutenant stationed in the Mediterranean was recently released from the ?Javy with a diagnosis of Anxiety Neurosis. He had a mother, a wife, and a few month’s old baby at home. His mother had to be hospitalized with a serious heart condition. His wife contracted pneumonia. There vvas no other member of the family at home, or to take care of the baby. This man worried so 7-8040 P162 bu Points to be Made Suggested Supporting Material intensely over the family situation that h< was unable to do hi s military work satis- . factorily, and release from duty became necessary. However, as soon as he was home and was able wo make satisfactory arrangements for the care of his family, his mental condition cleared up. b. Releases from armed forcesfor mental illness D. Many of the men being released from the armea forces with a blue discharge marked "Section VIII" have been subject to strains of this sort. With such veterans, as well as with similar civilian patients, doctors seek to find the cause of the abnormal mental attitude. 1. Many cases return to normal 1. In many instances, doctors are able to clear up the disorder, and the person becomes perfectly capable of returning to normal work. 2. Importance of sound attitude toward dis- charge for mental reasons 2. The importance of preventing the attach- ment of any stigma to men discharged foi this reason is impossible to overstress. a. Most entirely cured in civil life a. Most of these discharges indicate tha the individual was not adequate to military life - a very different thin from civilian life. b. Confidential treat- ment b. Popular attitudes toward mental dis- orders require that extreme care be taken to prevent members of the com- munity from learning; technical reason for this type of discharge from the armed services. Interviewers from the Imployment Service must not dis- * close information of this nature in their possession. (l) Danger of unvrarra nted stigma (l) Otherwise, veterans entirely cured and functioning in a nor- mal manner would be disadvantaged by the persistence of the stigma attached to mental illness. 7-8040 P103 fcu Points to be Made Suggested Supporting Material E. General social attitude toward mental disorders E. 1. New and experimental field 1. Selective placement of applicants with mental disorders is a new and experimental field. Our body of information is limited, but the Employment Service is building up experience similar to that now amassed for the 'element of the physically handicapped 2. lov; c nge in-social attitude 2. The interviewer working with the mentally handicapped must constantly remember that social attitudes change slowly. The traditional attitude toward the mentally sick is one of fear, impatience, or even anger. 3. The present enlightened medical practice 3. New frontiers in psychiatry and constantly improved medical practices frequently make possible complete cures. k. Importance of work as therapy In many of these cures a satisfactory work adjustment is an important factor. 5. Interviewer*s profes- sional attitude f 5. Interviewers, as professional workers, must overcome any attitude of fear toward Job seekers v/ith mental disorders. They need a constantly enlarging background of facts of the nature of the mental disorders and the kinds of work in which many of these applicants will satisfactorily perform. F. Classifications of the F. Doctors have established many classifications mentally ill which attempt to describe the entire popula- tion on the basis of mental health. Any attempt to classify human beings will result in considerable overlapping. One system has proved especially useful, however. !• Michigan Industrial 1. This system is the one advised by the Mental Health Council classification V Michigan Industrial Mental Health Council, The classifications are: a. The nsychotic b. The osvchoneurotic c. The chronic maladjusted d. The normal 2, Psychotics and psy- choneuro tics require selective placement 7-8040 PI84 bu Only people who fall within the first two classifications are considered sufficiently liandicapped to require tne service of an interviewer who specializes in the addi- tional techniques necessary for the handicapped. Points to be Made Suggested Supporting Material a. Principles for determining need for selective placement a. Some guiding principles for determining which persons with mental disorders need selective placement are: * (l) Experience may- be determining (l) An applicant with little or no experience subsequent to release from a mental hospital is handi- capped . An applicant with satisfactory work experience subsequent to discharge need not be considered handicapped if his behavior in the office seems normal. (2) Behavior in the office a clue (2) Those who never were institutiona- lized or treated but are known to be mentally ill, through draft status or discharge from the armed forces, are not considered handi- capped if they have had a satis- factory work record and behavior in office seems normal. (3) Employer re- strictions may necessitate selective placement (3) In areas where employers categori- cally restrict the hiring of workers with mental problems, workers will be considered, handicapped because of employer attitude. G. Attributes of the psychotic G, 1. Definition: require hospitalization 1. The psychotic person is one with a seriousr totally disorganizing complaint which requires hospitalization. These individ- uals usually do not realize they are ill. They are sent to mental institutions when the disorganization becomes marked, and released when their symptoms diminish or disappear. 2. Two important psychoses 2. The two most important types of psychoses are: schizophrenic (dementia praecox) and manic depressive. 3. Characteristics of the schizophrenic 3. Schizophrenic means split personality (from the Greek "schizo", meaning cut or split). 7.$040 Pi®® Points to be Made Suggested Supporting Material a. Retirement to world of delusion a, A schizophrenic is a shy, retiring type of person who withdraws from reality to the world of a .delusion. Here he assumes a more dominating personality such as the King, the President, Queen Elizabeth, etc. b. May lack energy / b. Some schizophrenics lack physical and mental energy and can engage only in menial work with a minimum of thinking, action or feeling. c. May be abnormally suspicious c. Some blame others, are constantly sus- picious, and think other people are conspiring to hurt them. Some of this latter type may be able to conceal their condition ana make good workers when not acutely troubled. A. Characteristics of the manic depressive A» The manic depressive type is characterized ly alternating periods of exultation and depression. a. Complete cure possible a. Manic depressives can be completely cured. About 50$ of the cures have no recurrence, particularly if the illness started after the age of 35. Recovered patients not handicapped t Those who have recovered should not be considered handicapped if they have had a steady work record since discharge from the hospital and if the behavior in the employment office seems normal. b. Early onset may create permanence of handicap b., However, if a medical report shows that the illness started at adolescence and has recurred at intervals, the applicant is considered handicapped. H. Attributes of the psycho- H. The psychoneurotic are people with minor dis- neurotic orders of the mind causing only partial disorganization. 1. Extent - 5-10$ of the population 1. Psychoneurotics constitute 5$ to 10% of the population at any one time. 2. Recovery variable 2. The prognisis varies widely. Some recover entirely, some become chronic psycho- neurotics, some may develop a full-fledged psychosis. 7.1040 Pi«« Points to be Made Suggested Supporting Material 3. Those with fears and compulsions a. Frequently job seekers 3. • IIP Psychoneurotics are constantly beset by \t fears, (of high places, of riding on wheel- or of being shut in) or they may be victim of compulsions and decisions which make life uncomfortable and social relations a constant £rial. 'Some examples of compulsions are those affecting people who are compelled repeat- edly to perform an overt physical act (such as washing of hands) or some mental act (such as counting by 7 whenever they see that number)• a. Most such psychoneurotics never get int an institution. Tney are the group most frequently met in placement situ- ations. Their disability very often does not prevent them from doing a good job. Thus they are employable if they can control their actions and not appear inattentive or remain away from work too frequently. a. Those who convert men- tal conflict into physical complaint a. Work capacity var- ies with part affected A* Still another group of psychoneurotics convert a mental conflict into a physical complaint, usually located in the gastro- intestinal tract. a. Work capacity for such applicants must be evaluated in terms of the part of the body affected and attitude of the worker toward his ailment. For exam- ple, a neurasthenic who has kidney complaint, may be limited in lifting:, nulling, pushing. and similar activi- ties, not because he has any serious illness of these parts, but because he thinks he has. 5. Those who fear imminent death 5. Still another group have spells during which they feel death is imminent. During this period they must sit or lie down. People with this form of the illness tend to dramatize themselves so that the spells are more apt to‘occur in the presence of an audience. The necessary physical information on psy- choneurotics of this kind will include data on the frequency and duration of the spells as well as an evaluation of how wel] the applicant can work with other people around*. Points to be Made Suggested Supporting Material f IX, What is involved in interview- ing workers with mental dj - orders IX. >* A, Securing information A. * 1. From the applicant 1. In interviewing the mentally ill, the inter-J viewer should always speak quietly and main- tain great calm. He should never express surprise at what the applicant says no matter how startling the revelation or the apparent threat to himself, ■> a. Importance of undivided attention to the individual a. An important point or technique is to act in such a way that the applicant feels that he himself is the only interest that'* the interviewer has at the moment. b. Some points to observe b. Some of the characteristics which may be observed during the interview and that may indicate mental illness are irritabil- ity, over-aggressiveness, pronounced excitement, marked suspicion, and con- fused. conversation. 2. From medical reports i A medical report is importsnt because no applicant should be considered handicapped because of a mental disorder except on the basis of a medical report. Medical reports should be secured if possible for psychotic and psychoneurotic applicants. J a. Typical medical report a. A typical medical report is that of Mary Vance (attached). (Read to the group typical medical re- port for a psycho- neurotic applicant. Mary Vance.) •j , •p B. What to Record B. 1. Technical terms avoided 1. On the application card, the use of technical terms such as those in this discussion are probably best avoided. a. Notations reflect the interviewer’s observa- tions a. Rather than use the name of the psychosis or the .psychoneurosis, the interviewer will make his notations in terms of the applicant's relations with others. 7 .9040 P*08 bu Points to be Made Suggested Supporting Ivlaterial a b, Example of notations for a schizophrenic b. For example: If a medical report diag- noses a person as schizophrenic, his appearance to the interviewer is probably retiring, shy, or withdrawn. These observable attributes should be recorded on the card. 2. Institutional record to be noted / 2. If he has been in an institution, the card can carry the fact that he had a nervous breakdown, the time it occurred and that he is sufficiently recovered to seek work. 3. Cause stated by doctor 3• Any cause that the doctor has been able to determine should be clearly stated, as for example: "Had nervous breakdown upon death of wife." - 4. Specie! irritants U* Any particular irritant that upsets the applicant should appear on the application card as a condition to be avoided. X. I.t tcainF the work capacity of X. a noli cents with mental handi- cans to the physical demands / of .icbs A. I'nviroruv.ent an important factor A. Successful placement of the mentally handicapped depends largely upon finding the proper working environment for the individual. Generalizations other than this cannot be made. 1. Importance of individual attention 1, Each case must be considered incividually vrith full weight given to the recommendations in the medical report. B. t.'any mentally ill place- able > B. If the particular mental illness does not indi- cate any violence toward others or toward him- self, a mentally sick person may work satis- factorily, provided his peculiarities are known and understood by his fellow workers. ■c- > 1. Assistance available from social agencies in some communities 1. Wherever possible, placement interviewers should work very closely with psychiatric social workers in the community. 2. Some on "parole" may work 2. Persons on "parole" or on "leave" from mental institutions may be placed if medical report so indicates. 7-3040 P109 nobu 171 WAR MANPOWER COMMISSION BUREAU OF MANPOWER UTILIZATION Budget Bureau Bo. li-MOBB.t Approval Kzplrea March gi, IB Division of Occupational Analysis and Manning Tables PHYSICAL CAPACITIES APPRAISAL Name Mary Vance Age 32 Sex Height Weight WaIkIng Jumping Running Ba I anc I ng Cl I mb Ing Craw ling Standing Turning Stoop Ing Crouch Ing Kneel Ing Sitting Reaching Lifting Ca rry I ng PHYSICAL ACTIVITIES WORKING CONDITIONS Th'row I ng Pushing Pulling Hand I Ing Fingering Feel I n g Te Iki ng Hearing Seeing Color Vision Depth Perception Working Speed Inside Outside Hot Cold Sudden Temp. Changes Humid Dry Wet Dusty Dirty Odors Noisy Adequate Lighting Adequate Ventilation Vibration MochsnItsI Hazards Mov1ng Obj acts Crtmptd Quart* rs High PI acts Exposure to Burns Electrical Hazards Exp losIvas Radiant Energy Tox I c Cond111ons Working With Others Working Around Others Working Alone details OF physical ACTIVITIES: Blank space = Full Capa city; / = Partial capacity; X = No capacity May lift, handle, push or pull up to pounds per hour May engage in activities numbered up to 2/3 of work period May engage in activities numbered up to l/3 of work period Sight! Hearing: _____ Others: DETAILS OF WORKING CONDITIONS; Diagnosis: Conversion hysteria ‘manifested by numbness and weakness of left leg. Prognosis; Fair Specific Remarks: Can walk and stand more than she thinks but change to seated work at this time might be of therapeutic value. Date _ 194- Ptysician Points to be Made Suggested Supporting Material XI. Exercise No. 17 - classifying and recommending work for the mentally ill (15 minutes) XI. Exercise No. 17 has as its objective the applica- tion of the principles for placing the mentally ill, with special reference to veterans. * Transition: The next category * of handicaps, neurological dis- orders, is quite separate from the ones just considered. XII. Neurological Disorders (5 minutes) XII. • A. Nature of the nervous system A. The nervous system is the all-important messenger service of the body. Nerves carry impulses from outside stimuli to the brain and from the brain to the muscles. Thus the nerves govern sensation and motion. B. Diseases of the nerves B. Damage to the nerves causes a neurological disorder, which may be one of many types, ranging from epilepsy to neuritis. * (Ask the group to * name some neurological disorders) * Transition; The following * sections of the discussion will concentrate upon the most significant aspects of certain neurological dis- orders that frequently occur among workers. Each one will be described briefly and the most essential points for placement workers will be noted. XIII. Neuritis XIII A. Physical facts **(Ask the difference * between neuritis and neuralgia) A. Neuritis is inflammation of a nerve, usuaily resulting in loss of reflexes, function or sensation. (Neuralgia is simply acute pain in the nerve, with no loss.) Neuritis can result from infectious diseases, injury, alcholism, or poisoning. 1. Prognosis: Good 1. It has a high rate of cure, although the condition may last from 6 montns up to 2 years before being cured. Points to be Made Suggested Supporting Material 2. Type of loss 2. Persons with neuritis may lose their sense suffered of touch in the fingertips-, or the loss may extend up to the hands. Pain may accompany this loss. If there is an involvement of the motor nerves, the muscles in the arms / and legs may become weak, some even com- pletely paralyzed. 3. Neuritis of the 3. Bell's palsy is neuritis of the motor face (Bellfs Palsy) nerve supplying the face, which should clear up in a few days or weeks. If it takes longer, residual symptoms (twisted mouth, one eyelid closed, etc.) may limit function or constitute an appearance handicap. B. Information to be secured B# * !• From the applicant 1. The interviewer will check pertinent items among the following: a. For arms a. Feeling, fingering, handling, and all other activities involving use of the hands (pushing:, pulling, reaching, carrying, lifting, throwing) if hands are affected. b. For legs b. Walking, jumping. running. kneeline, standing. crouching, if the lees are particularly affected. c. For torso c. All the foreeoine and stooping, running, balancing, if the torso is affected. 2. From medical reports only rarely 2. Medical reports are seldom necessary. CIV. Encephalitis XIV. A. Physical facts A. Encephalitis is an infectious but not con- tagious inflammation of the brain. The cause is unknown, and it affects young and old. 1. Prognosis; Poor 1. Prognosis is poor. Less than 20$ die, but 60 - 70$ show permanent ill-effects. 2. Manifestations left 2. The ill-effects may be any of the following: tics, spasms, rhythmic, tremors, clamping jaws, chorea (St. Vitus* dance movements) nystagmus, narcolepsy (sudden attack of sleep), some forms of psychoses, conduct disorders, or catatonia. ■ t— Points to be Made Suggested Supporting Material '■i. 3. May be employable 3. In spite of these.possibilities those who recover are often placeable. B, Securing the information B • 1. From the medical reports if possible 1. While many post-encephalitics are employ- able, medical reports are desirable to show how much working capacity is left. C. Work capacity shows wide variations C . There are no generalized work limitations for post-encephalitics, since residual effects vary widely. i-v. Multiple Sclerosis XV. v A. Physical facts A. Multiple sclerosis is a disease marked by hard- ening occurring in sporadic patches throughout the brain or spinal cord or both. It is incur- able, slowly progressive, but at an irregular pace, and may last many years. It is sometimes known as Lou Gehrig's disease. V i 1. Manifestations 1. It is accompanied by some or all of the 'following symptoms; Weakness, incoordina- tion, jerking movements of legs, and especi- ally of the arms, abnormal mental exaltation, scanning speech, nystagmus, even temporary attacks of blindness, double vision, or blocked out fields of vision. 2, Not always employable 2. These individuals are not always employable. B. Securing the information B. 1. From the medical reports if possible 1. Medical reports are desirable to show whether the applicant is employable, and if he is, just how much he may be permitted to do. - f C. Work capacity varies with symptoms C. Working capacity will be evaluated in terms of items pertinent to the applicant's particular symptoms (e.g. where field of vision is impaired, check activities where eyes are used to guide bodilv movement - reaching, stooping, walking, etc • 7-8040 P176 l>u Points to be Made Suggested Supporting Material I. Epilepsy XVI. A. Physical facts A. Epilepsy is a disease marked by sudden loss of con- sciousness, brief or prolonged, usually but not always accompanied by convulsions. Epilepsy usuall; develops before puberty or before the age of 20. It may come after 45 due to arteriosclerosis of the brain, or at any age as a result of injury or illness (encephalitis, meningitis, effects of toxins such as alcohol or lead, or of brain hemor- rhages in whooping cough). 1. Total cure rare, but good life expectancy 1. Chances of total cure are slight (10$) but life expectancy is good. 2. Two types of attack 2. Attacks are of two types: a. Grand mal (1) May be violent a. Grand mal (major epilepsy): convulsions fol- lowed by coma or loss of consciousness. Some have a warning or aura of attack either a day or a few minutes before, others have no warning at all. The attack may be quite violent, causing the person to fall, perhaps crying out involuntarily as he does do, or \ to become rigid, then jerk about uncontrol- lably, After the convulsions, the person may fall into a deep sleep, or may just wander around until the spell passes. b. Petit mal (1) Usually very brief b. Petit mal (minor epilepsy): the person sud- denly becomes helpless. Neither fall nor convulsions occur as a rule, and the auras T such as described under grand mal are rare. The attack lasts a few seconds. It may con- sist simply of yawning violently, or staring straight ahead, or some parts of the body may start to twitch. Loss of consciousness is not very deep. Petit mal may,vafter many years, develop into grand mal. c. Epileptic equivalents c. Epileptic equivalents (or psychic seizures) are disturbances of consciousness without convulsive movements. In this type the person performs an act without purpose and without recollection afterwards. 3. Possible personality- effects 3. between attacks, some epileptics suffer intel- lectual and character changes. They may tend to become unsocial, selfish, irritable, and to suffer memory defects. 7-8040 P170 Du Points to be Made Suggested Supporting Material The reason is not hard to find. Parents of young epileptics tend to spoil them for fear of "bringing on a fit"; playmates tag them with unkind names like "jerky" or "dopey," Adult epileptics nervously fear they will lose their jobs and friends when they have an attack. u. Common misapprehen- sions : importance of understanding true facts A. If society could lose its superstitious fears about epilepsy, an important step forward would be taken. Some of the facts that might enlighten people are; a. Very few congenital idiots b. Many geniuses c. Constant improve- ments in treatment i a. Only a small oroportion of eoileotics are congenital idiots. In fact 60 - S0% are normal mentally. b. Some have become vary famous people: Julius Caesar, Peter the Great of Russia, Byron, Dostoyevski, Flaubert, Swinburne, de Maupassant, Paganini. c. New scientific methods of treatment are constantly being evolved. These diminish the severity of attacks or ward them off almost entirely. They cannot yet, how- ever, be said to cure epilepsy, since attacks return if medication is stopped, just as happens to the diabetic who forgets his insulin. B. Securing the information B. 1. From medical reports if possible 1. Medical reports are desirable for applicants who state they have epilepsy. Some appli- cants however will attempt to conceal this fact. Medical reports if secured should be in physical demands terminology. In addi- tion they should indicate; a. type, frequency and duration of attack b. whether applicant gets an aura of warn- ing c. how long applicant takes to sleep off final stage of spell, if he goes through this phase at all. d. whether spell occurs at any set time of day or night (thus an epileptic with night seizures only is a pretty good bet for day work)• e. whether any mental deterioration has resulted. Points to be Made Suggested Supporting Material 2. From the applicant 2. The interviewer should be on the alert for references to "spells,” "fainting,” or "attacks" or expressions of fear or dis- taste for work with moving machinery, espec ially when coupled with an erratic work history. Occasionally, an applicant will present visible evidence of a recent attack in the form of bruised parts of the face, or a scarred tongue. C. .Matching the work capacity of eoilectics to the chvs- ical demands of the .iobs C. A number of factors can be described to guide the proper placement of epileptics. 1. May be unemployable if spells are frequent 1. Epileptics who have very frequent seizures at unpredictable hours ore unemployable. The type of spell alone is not a determin- ing factor, for a person with grand mal who has only one seizure in three years is certainly cacable of working. 2. The importance of working conditions 2. Working conditions as a whole co not aggra- vate attacks unless wne history of a case shows seizures came when the person was under mental stress aue to job pressure, some working conditions, however, most epileptics should avoid because of the Ganger of injury curing an attack. a. Hazards a. These are: mechanical hazards, moving ob.iects. high daces, exposure to burns, and crammed quarters. b. Aura may be a partial protection. \ b. Even these conditions need not be entirely eliminated for those epileptics who get sufficient warning of an attack to leave their work and lie down some- where in the plant. About half of all epileptics get such an aura but it nay not be reliable and there is always the possibility of a seizure with no aura. 3* Importance of individ- ual consideration 3. Epileptics must be judgea individually. Some have seizures many years apart; some have them only at night. 4,. Desirability of place- ment in pairs ; 4-. Experience :*as demonstrated the desirabil- ity of placing epileptics in pairs, so that one may attend the other (by piecing an object between the back teeth to prevent biting the tongue, or putting a pillow or folded coat under the head) in case of a seizure. 7-3040 PITS Points to be Made Suggested Supporting Material 5. Safeguard of others 5. In general, epileptics should be placed where they will not injure others should they liave an attack. •XVII. Spastic Paralysis - (a form of Cerebral Palsv) XVII. A. Physical facts A. Spastic paralysis is marked by rigidity of the muscles and heightened tendon reflexes in many parts of the body. It may be due to \ . a brain lesion suffered at birth, or to ■ poisoning or accidents to the cardiovascular 6 . system (as in apoplexy). 1. May be confined to small area, or general 1. While some persons have only a mild spas- ticity confined to just a few parts of the * body, others may have more marked and wide-spread paralysis, even to a point i4* where they become totally unemployable. 2. Manifestations. 2. borne of the outward evidences of spastic usually in combin- paralysis are: speech defects, grimaces, * I - ation head movements, hand tremors (spastic handwriting is easily identified by its shakiness and uneven character), awkward position of arms, of limbs and defective gait (scissor walk, walking on tip toes, shuffling, etc.) A spastic usually has a combination of some rather than all of the above char- acteristics. Some may have head and ► facial defects only, others may have just 1 arm and leg disabilities.# * 3. Erroneous idea that 3. Because of their facial contortions and they are mentally speech difficulties, spastics have erron- defective eously been labelled mentally defective in the past. Only a relatively small number are so affected, however. Many are ' s very bright and achieve a good deal through sheer will power. B. Securing information B. - 1. From the applicant 1. The interviewer can check certain informa- tion in the course of the interview. Key b points for him to observe will depend upon the part of the body affected by the disease. ISO Points to be Made Suggested Supporting Material a. Key points for legs important i a. For legs, the interviewer can observe the gait as the applicant approaches desk. Observation plus questioning should reveal how much standing, walk- ins. running, stooping, turning, crouch- ing. kneeling, crawling, climbing, balancing, .lumping, if any. he can do. His balance may be precarious depending on degree of disablement. High or cramped working places, exposure to mechanical hazards and moving ob.iects may be ruled out. b. Points for hands b. For arms, the interviewer can have v applicant demonstrate ability to finger, handle, lift and carry objects by sign- ing his name, picking up and unbending a given number of clips, lifting all the interviewer*s dictionaries and manuals and placing them on another part of the desk. Tj c. Points for speech c. The interviewer should observe the applicant*s speech carefully for clarity. 2. Prom medical reports only rarely •• 2, A medical report for an applicant who has suffered with spastic paralysis from child- * hood is usually unnecessary, as most of the activities can usually be evaluated in the employment office. XVIII. Other types of Cerebral Palsy XVIII. ( A. Athetosis A. Another type of spastic paralysis is atheto- sis. This condition, too, is usually caused by a birth injury but its effects are flaccidity of muscles rather than tenseness. \ # 1. Never deteriorate mentally 1. Athetoids grimace more than spastics but never deteriorate mentally. y B. "Strokes" of paralysis B. Many strokes are a form of cerebral palsy. 1. Medical report desir- able to determine employability 1. Medical reports are desirable to determine whether or not the applicant is employ- able, If he is employable, the report should show what the residual effects are and how they limit work capacity. Thus spastic paralysis of certain parts (head, arms, or legs, or any combination) may be a residuum of a stroke. 7.8040 P180 %• Po ints to be Made Suggested Supporting Material 2. Paralysis of one-half of the body 2. Hemiplegia (paralysis of one-half of the body from head to foot) is an illustration C. Parkinson's disease (Shaking palsy) 3. Parkinson's disease or shaking palsy (paraly- sis agitans) is a disease of late life, progressive in character and marked by mask- like facial appearances, tremor, slowing of voluntary movements, a tendency to walk quickly, peculiar posture and muscular weakness. 1, Example of what to record for a neuro- logical disorder 1. The application card for John Main, on following page, typifies the entries for a worker with shaking palsy. **■ ■ (Read typical appli- cation card for a worker with shaking oalsy, that for John Main. Note the signif- icant points on the blackboard.) • SUI £IARI I. Reiteration of the importance of a widening technical back- I. The survey of common handicaps just concluded gives the bare minimum of information an inter- ground viewer needs for specializing in the placement of the handicapped. A. Experience and personal A. Experience in the work itself will constantly > effort vdden the interviewer's background. He must, however, develop his own range of information by constant reading just as the physician does to keep abreast of medical developments. B. * tion B. While the placement worker uses medical infor- mation in a comparatively limited way, being interested only in its occupational implica- tions, he can never have too much accurate data about disabilities and diseases. At the same time he must constantly guard against allowing his technical background to lead him to attempt diagnosis. XI. Reiteration of the importance II. One point is paramount in a proper understanding pf individual consideration of the materials covered in this discussions Individual consideration of each worker in terms of what he can do and each job in terms of what it requires, is the only proper basis for place- ment of handicapped workers. 7-1040 P181 noba tlSES-611 (10-12) APPLICATION CARD WAR MANPOWER COMMISSION UNITED STATES EMPLOYMENT SERVICE 16-3188*2-1 EMPLOYMENT RECORD 7-3040 P 184 >bu Points to be Made Suggested Supporting Material A. No "canned” job lists possible A. It is impossible to predict in advance that a certain handicap should be matched with a certain job. An effective matching can only be done on an individual basis. III. Preparation for the fifth ML III. A. General summary of place- mcnt technicues * A. The next discussions will be devoted to 'a general review of methods found effective in the placement of handicapped, without regard to any particular disabilities. Much of the material will cover points of technique al- ready considered as individual, handicaps were discussed. B. Points for veterans B. Special considerations affecting the place- ment of veterans will be stressed. C. Readings C. In preparation for the discussion the group should read sections, in the Handbook on Disabled Veterans and on Laws and consider • • any questions they want to bring up in +' course of the session. 7-3040 FlSBnobu Instructors Discussion Outline REVIEW OF BEST METHODS FOR PLACEMENT OF THE HANDICAPPED AND ASSISTANCE TO THOSE NOT IMMEDIATELY PLACEABLE Objective: To review the best methods for placement of the handicapped, as previously presented in the earlier discussions; and to present the other sources of assistance available to handicapped workers not immediately employable. Outline of Main Points: 1. Brief review of the elements in the application and placement process for the handicapped (5 minutes) 2. Review of best techniques for uncovering handicaps (15 minutes) 3. Review of best techniques for securing information from applicants (30 minutes) 4* Review of the considerations involved in securing medical reports (45 minutes) 5. Review of the best practices in recording information (10 minutes) 6. Review of best techniques in matching physical capacities with the physical demands of jobs including the use of occupational information and techniques for persuading employers to hire the handicapped (40 minutes) 7, Presentation of the possibilities for handicapped workers not immediately employable (40 minutes) 8, Brief survey of laws relating to the employment of the handicapped (10 minutes) Training Program for Serving the Handicapped Unit 5-a Fifth Morning (3 hours) Afternoon (l{ hours) 7-3040 P187 nnhu Unit 5~a Fifth Morning REMINDERS FOR THE INSTRUCTOR The section on agencies concerned with rehabilitation may well be conducted by a representative of the State Bureau of Rehabilitation. Such arrangements will have to be made well in advance of the session. Materials 1, Any State or local laws or ordinances. 2. Lists of agencies operating locally, in the form of directories if possible. 7-3040 P189 nn* Points to be Made Suggested Supporting Material TRANSITION AND MOTIVATION (5 minutes) X. Reiteration of necessity for I. During these sessions the special additional tech- . r1 , special additional techniques for the handicapped niques and information necessary for the proper placement of the physically and the mentally handi- capped have been reviewed. * * - As each special disability was considered the points of technique involved in placing such applicants wer treated one by one. a. Review of the elements in II. A listing of the steps in the process of placing the 1 f the process of placing the handicapped handicapped will probably include the following titles: f * (Ask the group to list the Uncovering a handicap 1 steps in the placement of the handicapped, and note the items on the board as they are mentioned*) A* Puroose of this session— A recapitulation of Securing information from applicants and from medical reports Classification Matching work capacities with physical demands methods PRESE NTATION i. £ * r i t & i r Review of Special Techniques for Uncovering Handicaps (15 minutes) (This point and the following points concerning the place- ment process can probably be developed by means of ques- tions to the group, with the instructor noting the responses briefly on the board where appropriate. The information itself has all been presented in the preceding discussions.) I. Following are the points of good technique that will probably be mentioned by the groups A. Careful phraseology of the questions concerning physical condition, such as "Is there any work you cannot do because of your physical condi- tion?” "Could you pass a very rigid physical examination?" B. Questioning of applicants classified A-F by Selective Service or those rejected for jobs because of physical examination, to determine whether a handicap exists. C. Reason for an applicant's contact with a health agency, if such contact is indicated. D. Reason for attendance at any special classes, such as, sight conservation, lip reading, speech correction, ungraded, etc. 7-3040 P191 bu Points to be Made Suggested Supporting Material E. Illness or mental deficiency may be indicated if an applicant was substantially older than the average at the time of graduation from public ■ i school or if he had to repeat grades in school. F. A physical handicap may be indicated in a young applicant if he had no athletic interest in school or had limited gym classes. i i G. A physical disability may be indicated if an applicant states that he left a .lob because the work was too heavy or because of absence due to illness. 1 H. A disability may be indicated if the applicant has been unemployed for an unusually long period 1 • of time or has changed fobs freauently. I. A handicap may exist if an applicant refuses some particular kind of work or expresses a [ definite preference. J. Persons working below apparent intellectual capacity may have an invisible handicap such as arrested TB, hearing impairment, or mental or neurological disorder. - - J I. Review of best technique for securing information from applicant (30 minutes) II. t ' i ■ 5 * (Chart on the board two * lists of Flood and bad interviewing techniques as mentioned by the group) A, Good techniques A. Probable answers for good interviewing - techniques. ' 1. Securing as complete information as possible about the handicap. r - 2. Let the applicant realize that his work qualifications in relation to his handicap are of major concern. \ 7 3040 PtPa bu 193 Points to be Made -* - - - - - - Suggested Supporting Material 1 3. Tell applicant that we refer to jobs on the basis of ability to perform. K* Have a matter of fact approach — no senti- * . mentality nor repugnance. 5. Be considerate but not sentimental. 6. Be aware of the fact that the applicant may w try to oversell or undersell himself. r 7. Use test batteries and references from previou employers to assist in getting exact informa- J' tion about the applicant’s work capacity. 8. Frequent re-interviews are desirable in order to know the applicant better. / cr B. Bad interviewing B. Probable responses for bad interviewing tech- techniques niques. 1. Over-emphasis on the handicap. 2. Thinking chiefly in terms of work limitations. > 3. Any sentimentality. 4. Pity. 5. Fear in attitude toward the applicant. C. Exercise No, 18 "Group practice in phrasing C. The instructor will raise six problems listed in Exercise No. 18 orally with the group, and note questions for interviewing" on the board in two lists the good techniques (20 minutes) and the bad techniques for the six problems, in * order to provide practice in phrasing questions L' for interviewing. -3040 P193 bu Points to be Made Suggested Supporting Material II, Review of the considerations involved in securing medical reports (4-5 minutes) III. r A. Handicaps and medical reports A. For the following disabilities, medical reports are always desirable: ■* (Ask what types of handicaps * on which a medical report is always desirable.) Cardiac disease Silicosis Rheumatic fever Varicose veins High blood pressure Pleurisy , Injuries to the back Multiple Sclerosis Arteriosclerosis Muscular dystrophy Chronic internal disorders Epilepsy Osteomyelitis Mental disorders Bronchiectasis Venereal diseases Arthritis Eye diseases Rheumatism Defective vision Chorea Total blindness Flat feet Encephalitis Asthma Emphysema Bronchitis Thrombo-angiitis Skin disease Tuberculosis of Empyema the bone Pulmonary TB B. Disabilities for which a medical report is sometimes desirable * (Ask for what disabilities * a medical report is some- times desirable) On the follov.ing disabilities a medical report is desirable only if the applicant is under treatment or has had recent treatment or if the > disability is progressive or involves a condi- tion ?»hich might be improved by medical atten- tion : Spinal injuries Cerebral palsy > Amputations |j Hernia i Poliomyelitis Blindness of sometimes C. Source of medical reports * (Ask where we secure * medical reports) \ V C. Physical information is secured from the appli- cant. Medical information is secured from a doctor who attended him. The doctor may be a private practitioner, hospital staff doctor, or] he may be attached to any agency cooperating with the Employment Service, such as the Bureau of Vocational Rehabilitation, the State Com- mission for the Blind, Selective Service Boardsf the Army and the Navy, etc. 7-3040 P194 bu - - Points to be Made Suggested Supporting Material r- D. Use of the "Physical D. When information about the disability is secured Capacities Appraisal" form from the applicant only, the interviewer uses the as a check list Physical Capacities Appraisal as a check list fo questioning the applicant about those items most closely related to his stated or apparent dis- ability. i .. Confidential nature of E. Hospitals or other agencies frequently require f. medical data the applicant's permission before information will be released. This requirement can be met i * (Ask if information by sending to the hospital a waiver which the - * secured in a medical applicant signs. p- report must be kept > confidential) 1. Definite understand- 1. A definite understanding is necessary as to >~ ing necessary when the Employment Service may release medical'information secured in a report, to * whom it may be released and under what circum- m stances is required. 2. Discretion necessary 2. Interviewers should exercise great discretion 9 ■ in discussions with in discussing the contents of a report with applicant any applicant. If the applicant has requested information we might ask him what the doctor told him, instead of giving out information that we have. We should never give him the report as given to us. F. Exercise 19* "Determining F. Exercise No. 19 has as its objective practice in when medical reports are determining when medical reports are desirable. desirable" tV. Review of best oractices in IV. Much of the additional technical information secured S> re cording information about the handicapped would be lost if it were not v , (10 minutes) properly recorded. S / [ Standard practices of recording are all designed to improve the use that can be made of the notations. 7-3040 Pi 05 bu Points to be Made Suggested Supporting Material A, Minimum information about A, Probable responses? the handicap on the application card A review of all the INTERVIEWING AIDS will dis- close that the following information should * (Ask the group what appear on the application card: * information must appear on the application card 1, The name of the disability, (i.e.f cardiac about any handicap, and condition) should be stated except in mental develop the list of items disorder cases and venereal disease. on the board) s 2. The approximate date the disability was received, and if pertinent, the cause of the disability should also be recorded, 3. Whether the condition is progressive or non- progressive should be stated. A. The extent of the disability should be described, 5. It should be shown positively how much the individual is able to walk, stand, lift, grip, hold, reach, etc. To illustrate; "Left leg amputated above knee, can walk slowly but for long periods when wearing limb"; "Right arm disabled, stiff at elbow, flexed at 4-5° angle, can grasp, and finger." /. Review of best techniques for V. We have said that the process of matching physical matching physical capacities capacities with the physical demands of jobs starts with the physical demands of with assigning the proper classification to the jobs (60 minutes) worker. It involves consulting the available occu- pational information about jobs to discover suitable work and that also involves techniques for persuad- ing employers to hire workers whom they might not otherwise recognize as capable of performing. Often it requires an element of counseling to prepare the worker himself for a new kind of work or to adjust his attitude toward a particular job. Each of . these items will be discussed in turn. 7-3040 P190 bu Points to be Made Suggested Supporting Material A. Determining the proper classification A* When a handicapped applicant is found to be employable on the basis of his current skills and capacity, the interviewer is challenged to uncover jobs that the man can fit* 1. Importance of a wide background of occupa- tional information 1* To do this, then, the interviewers must know the physical demands of a wide variety of jobs or must be able to find out about those demands quickly and readily. 2. Sources of occupational information * (Note the sources on the * board as the group sug- bests items) 2. A list of the sources of occupational infor- mation for the use of interviewers for the handicapped should include: a. First-hand information and experience, constantly gathered from field trips and observation. b. Information secured from interviewing applicants and talking with employers. c. Definitions in the "Dictionary of Occupational Titles," as a start. d. The National Job Description Volumes. e. The recent 5 x 8 job description and interviewer aid cards. f. The special aids for placing military personnel in civilian jobs. g. The job families. h. Bulletins on utilization of persons having physical limitations. i. The national and local physical demands studies. 3. How to use the occupa- tional materials 3, a. The physical Demands studies a. The actual physical demands studies, whethe prepared nationally or prepared in the state or by the interviewer, himself, are of course, the best tools because they carry the information to the fine point necessary for the placement job for the handicapped. 7-3040 Pl97 bu Points to be Made Suggested Supporting Material b. The other occupa- tional publications b. The definitions in the Dictionary and the various types of job descriptions supply necessary background information to the interviewer. He must himself carry it one step further and examine the demands of an individual job before he can make extensive use of the data in placing applicants. A. The importance of indi- vidual considerations in classifying A. As background it cannot be emphasized too frequently that the skills and abilities of the handicapped worker must be evaluated on an individual basis. All individuals with the same handicap cannot be classified on the same limited groups of occupations. It is impossible to suggest wholesale, general occupational classifications for each type of handicap. People with the same handicap differ widely in potential ability. 5. Emphasis on remaining individual capacity 5. We have already stressed the principle that few handicaps cause the elimination of more than a*fraction of an individual1s total abilities. In classifying the applicant or placing him, it is not what is gone (the handicap), but what is left (the principal capacity) that counts. 6, Principles of classi- fication *(Ask, "Upon what do we * base the determination of a suitable field of work for the handi- capped applicant?") 6. Choosing suitable work for the handicapped is based on the same principles as choosing suit- able work for any applicant. Factors to be considered are his experience, his training, his aptitudes and his interests which are not influenced or nullified ty the physical limi- tation. a. The importance of former experience a. As in any placement one of the most impor- tant principles in selecting a suitable occupation for a handicapped applicant is to capitalize upon his previous experience, leading him, if possible, to the occupation followed prior to the disability. 7-3040 P198 bu 199 Points — to be Made Suggested Supporting Material b. Remote experience may be helpful b. If the recent job is no longer suitable, the applicant may return to a line of work done years previously. Work history must thus be studied carefully to determine if elements of previous jobs can be used as a basis for present employment. c. ■ The importance of job family to analyze kind of work c. The job family material can be particularly helpful in analyzing experience accumulated on former jobs and relating it to occupa- tions with physical demands of the differ- ent nature. 7. Assignment of a particu- lar title and code 7. After his discovering the broad field in which the applicant’s potentialities are greatest, the interviewer must aid the applicant to determine the occupations with- in that field in which the impairment of certain functions will not limit his per- formance. a. Use of the Dictionary of Occupational Titles including the entry classifications a. To make the applicant readily available for selection and referral to actual jobs, occupational titles and codes must be assigned from Part I, Part II, Part IV of the Dictionary, and the occupational groupings for entry applicants. The use of the entry classifications in Part IV of the Dictionary and in the occu- pational grouping manual is especially helpful in view of the large number of both experienced and inexperienced appli- cants whose classifications must be based on potential abilities rather than on demonstrated experience. The proper classification of a handi- capped applicant is difficult to overstress because it amounts to summarizing the con- clusions reached in the interviewing process. 7-3040 P199 bu Points to be Made Suggested Supporting Material B. Assisting the applicant to develop a work plan B. The process involves a large element of cooper- ative planning between the applicant and the interviewer. The active participation of the applicant must be listed in the working out of his occupational classification. 1* May lean heavily on the interviewer 1. Disabled persons often lean heavily on the interviewer for the selection of a job plan and fail to develop the self-reliance that is necessary for the solution of their problems* 2. Importance of explain- ing the underlying reasons 2. Unless the reasons for a particular classifi- cation are clear to an applicant and he accepts them because he has had a part in their choice, he may distrust classifications assigned and fail to cooperate with the inter- viewer. C. Securing the acceptance * (Ask, "What are some of * the techniques for inter- esting an employer in using a handicapped person?") C. After using the approach to the placement of the handicapped based on work capacities that we have been discussing, the interviewer is in a strong position to persuade employers to employ workers considered handicapped. The interviewer is justified in making a special, effort to secure an opportunity for a handicapped applicant when he is convinced that the applicant can do the job. Some good points of technique are the following: 1. Stress qualifications always before disability 1. Describe exactly what a man can do on the job and then say that the fact that the man has a severe limp in no way limits the calibre of the work he can do. 2. Use specific name of disability 2. A better mental image is produced if the interviewer used the specific name for a disability, such as "cardiac" or "hard of hearing" rather than a general term like "handicapped" or "disabled." The specific disability is less likely to arouse prejudice than the general picture aroused by the vague term which may conjure up a far more severe limitation. 7-3040 P200 bu Points to be Made Suggested Supporting Material 3. Using specific individ- ual as example 3. The initial approach to an employer is better made for a specific individual or group of Individuals than for a type of worker in general. By using a specific individual the interviewer can demonstrate actual ability to do a particu- lar job by applying the physical demands analysis to the job and to the workerfs capacity. A. Stress advantages of the handicap A. Stress any advantages of the handicap for the particular job, such as use of the deaf in noisy places, and the like. Emphasize that disabled persons usually put forth more effort, are less likely to leave, lose less time, and seem to be less prone to accidents. Use of references from previous employers is often helpful. Refer only suit- able applicants. 5. Overcome specific objec- tions with facts 5. Many employment offices have had conspicuous success in demonstrating the capacity of blind workers, and the deaf, and these can be cited. * (Ask: "What are some of * the common objections to using the handicapped?") a, "Insurance rates" Some of the common objections to using the handicapped and the way they can be answered, are the following: a. The idea that the employment of handicapped means higher cost and compensation insurance rates. This objection is not valid because all available studies indicate that handi- capped groups are not as liable to accident as the non-handicapped, probably due to the greater caution exercised by handicapped workers to avoid accidents. Moreover, most State laws do not result in higher insurance costs. The interviewer must be familiar with the appropriate laws for the State. 7-3040 P201 Du Points to be Made Suggested Supporting Material b. "Sick benefits and life insurance" b. Employment of handicapped will strain plan for sick benefits or group insurance. This objection is not valid because no studies ever indicated that the handicapped are more liable to illness or injury than the non-handicapped. Western Electric studies of absenteeism of handicapped and non- handicapped workers shows the handicapped with lower percentage of sick leave. Life insurance rates are based upon age and sex rather than physical condition. c. "Frequent illness" c. The handicapped are frequently absent because of weather conditions or illness and cannot be depended upon to work regular hours. This objection can be met with the same points mentioned above and moreover an employer of a handicapped person who is referred on the basis of a medical report is actually better protected than he would be had he hired a non-handicapped person without medical examination. d. "Efficiency" d. Disabled persons are not as efficient as normal workers. This objection can be met by stressing the fact that the handicapped are referred only to jobs where they can compete satisfactorily with the non-handi- capped. e. "Difficulty of shift- ing" 0. Handicapped workers cannot be shifted as easily to other jobs in slack times. The answer to this question requires informa- tion on what "the other jobs" are. If the other jobs have the same physical qualifi- cations, the handicapped can be transferred to them. f. "Objections of fellow employees or customers" f. Other employees object to the handicapped or customers object to asking the handi- capped for service. This objection is an expression of the traditional attitude that has long denied handicapped people an equal opportunity to develop their capacities. Objection of fellow employees is more theo- retical than factual. Handicapped workers 3040 P203 bu Points to be Made Suggested Supporting Material have repeatedly demonstrated that if they have a normal attitude toward work, their fellow employees can work with them without strain. The sales manager of a very success- ful New York department store uses a cane, but finds no difficulty in his relations with staff or with customers. «• •- "Special attention" g. Crippled persons expect special attention, advantages and consideration. This objv>c- tion must be met with an individual discus- sion of the .personality of an applicant. References from former employers or from employees help to«break down this objection for handicapped people who have developed self-reliance and no longer need supervision. h. "Need to provide for h. Firm cannot employ other handicapped workers ovm disabled employees" because it provides for its own employees who become disabled. This objection can be met by stressing that referrals are on the basis of qualifications and ability to compete. Further, if a general policy of this kind were adopted, no person handi- capped before his first employment or between jobs, would ever find his place in industry. i. L , ’ "Physical examination" i. The entrance physical examination rules out all physical disabilities. This objection can be met ty stressing the fact that appli- cants referred are physically capable of meeting all the demands of the job, A physical examination that automatically eliminates all but perfect specimens greatly reduces the available labor supply. Promotion of opportuni- ities for the handicapped D. Work for the handicapped often involves active solicitation of job openings for particular applicants. Leads can be secured from applica- tion cards which show firms that have utilized handicapped workers, from employer order cards, from interviews with applicants and employers and from advertisements in the papers. * (Ask how leads to new * employers for the handi- capped may be secured) Every means of solicitation can be employed appropriately at some time. Telephone solicitation for individual applicants is probably the most widely used. 7-3040 P203 bu Points to be Made Suggested Supporting Material 1. Exercise No. 20 "Suggesting Promotion- al activities for appli- cants already classified” 1. Exercise No. 20 has as its objective pro- viding practice in suggesting promotional steps on behalf of certain applicants. RE ’CESS FOR LUNCH' r ’RESENTATION (continued) I. Assistance to handicapped VI. In addition to the handicapped who are employable ir workers who are not imraedi- terras of their current skills, there are three othel ateiy employable groups - those ?7hose handicaps constitute a complete disability, those whose handicaps require training or rehabilitation before placement, and those whose handicaps make them unable to compete in the current labor market. 1 A service can be rendered to each group by the employment office. A. Those not able to compete A. When the applicant is so limited that he cannot in the labor market meet the normal conditions of industry he is considered unplaceable. Usually such persons have a combination of handicaps involving lacks in experience, education, training, personality and the like, as well as the physical or mental limitation. • Sometimes they may be able to work eight hours a, day, but they may be unable to meet employer requirements in production. 1. Size of "Unplaceable group" varies with labor market 1. The size of the "unplaceable group" is naturally variable. In times of economic depression the group of the "unplaceable" will be larger than that remaining when expanding labor demand absorbs less-and less-efficient workers. A 2. *- -a- Employment office service to the "unplaceable" (Ask what can be done for these so-called "unplace- ables) 2. Since our maximum effort must be directed toward the workers who are able to compete in the current labor market, comparatively littL assistance can be given to the "unplaceable," however, the interviewer can suggest assistant other than employment. 7-3040 P204 tu Points to be Made Suggested Supporting Material 3, Sheltered work shops 3. Some non-profit work-places provide jobs for individuals who cannot compete with the non- handicapped, or who have been unable to secure jobs in industry. a. Different community agencies a. Sheltered shops exist in some communities for tuberculosis patients, the blind, and persons with mental disorders. Workers may be employed for less than a standard day or they may be employed on jobs where production standards are low. / Describe any sheltered workshops in the community. b. Therapeutic value b. This service is provided for its therapeutic effect in the treatment of handicaps or for the purpose of determining physical capacity. A person may ngraduate" from sheltered shop into industry by recovering sufficient working capacity to compete again, or labor scarcity in the community may make it necessary to use these workers in regular production. 4-. Homework Because the giving out of work by employers to be done at home by workers has been abused in the past, homework tends to be discouraged t>y strict legislation in many States. In some communities, hov;ever, because of labor shortage, some war employers are giving out homework under special dispensation. a. Need for statutory information a. The interviewer should be sure to know all of the Federal, State and local regula- tions regarding ho/aev/ork in the community. b. Points to be checked b. The interviewer will check whether the applicant must provide means to pick up the work or whether it is delivered to him, and emphasize to the applicant that he is expected to earn the legal hourly minimum. " 3040 P205 bu Points to be Made Suggested Supporting Material B. Those placeable after some rehabilitation * (Note: The instructor may * provide for having this part of the training session conducted by a representative of the Bureau of Rehabilitation) B, In order to be prepared for the best opportuni- ties a handicapped applicant should be restored to as great a degree of physical or mental health as possible and equipped with some par- ticular skills* Physical restorations may be made by medical or surgical care or by some artificial appliance to aid, support, or replace a sensory function or body part, (hearing aids, spinal braces, artificial limbs) Both private and public agencies in the community help to restore handicapped people to physical or mental health and/or to equip them with some particular skill. 1. Private agencies 1. * (Note: The instructor * should have available the names of the agen- cies operating locally) * (Ask the group to name * local agencies) a. Special agencies a. Typical examples of agencies interested in problems of the handicapped are the National Society for Crippled Children, and its local affiliates, the National Tuberculosis Association, Leagues or Associations for the Hard-of-hearing, National Foundation for Infantile Paralysis and organizations providing special servi- ces to the blind, or cardiacs, or other specific types. b. Fraternal groups and service clubs b. Fraternal organizations, veteran groups, and service clubs, give special assistance to the handicapped, both in securing employment and in financing general educa- tion or vocational training. Physical and vocational rehabilitation, including prosthetic appliances, are sometimes made possible through their assistance. The American Red Cross provides services for the handicapped in many cities. c. Clinics and hospitals c. Medical services are available in many cities through local hospitals and clinics* 7 3040 P206 bu Points to be Made Suggested Supporting Material d. Advantages of coop- eration with private agencies * (Ask the group to men- * tion some of the advan- tages of cooperation) d. Some of the advantages of cooperation with private agencies are the following: (1) Medical aid, artificial appliances, or vocational counseling may be secured for applicants not immediately placeable, (2) Information concerning physical handi- caps and work limitations may be secured from their professional personnel. (3) They may be able to suggest suitable occupations for difficult placement problems among the handicapped. • (4) Detailed information may be available through their past contact with certain applicants. (5) In some cases, arrangements may be made to secure medical information or medical records through specialized agencies, (6) They may assist in locating job oppor- tunities and in placing handicapped applicants. (7) Cooperation with them should increase community recognition and good will for the Employment Service. 2. Public Agencies * (NOTE; The instructor * will again need a local list) 2. The public agencies available to work with the Employment Service include the following: a. Hospitals: institu- tions a. Hospitals and institutions for physical restorations and occupational therapy. Cooperation between the hospitals and insti- tutions and the Employment Service is en- tirely voluntary. Medical social workers and doctors act as consultants in many States. b, Schools b. Schools (including special schools for war training) teach specific occupational trades or professions to the handicapped. 7-3 040 P207 bu Points to be Made Suggested Supporting Material c. The Bureau of Rehabili- tation: The most impor- c. Each state now has a special bureau respon- sible for the vocational rehabilitation of tant single service for training and rehabilita- tion the physically handicapped. In some States a separate agency for the blind handles the rehabilitation of the blind. When States meet the necessary requirements, Federal funds are made available for use in re- habilitating individuals disabled in indus- trial accidents or from some other causes, such as disease or congenital defects. The 194-3 amendments include service to war- disabled civilians. This law permits the use of Federal funds for such purposes as: (i) Medical examination. m (2) Corrective surgery or therapeutic treatment which will reduce a handicap. (3) Necessary hospitalization incidental to the foregoing. U) Transportation, occupational licenses, tools and equipment. (5) Prosthetic appliances essential to obtaining or retaining employment. (6) Maintenance during training. • (7) Cost of retraining. (1) Functions of the Bureau (1) Functions of the Bureau include: (a) Physical restoration, including medical treatment and prosthesis if needed to obtain or retain employment. (b) Counsel and advice on selection of suitable occupations. This may include testing. (c) Arrangements for vocational train- ing (Note: the Bureau itself does not train. Rather it places the client in suitable training with proper agencies.) 7-3040 P208 bu Points to be Made Suggested Supporting Material (d) Placement (e) Other services, such as establishing a person in his own business^ (2) Eligibility for training * (Ask who is * eligible for training) m (2)A person must be of employable age and unless specific exceptions are made, a resident of the State in which the serv- ice is provided. The physical handicap must be permanent and of such nature that training, re- training or other service is necessary to overcome a handicap before he can enter suitable employment on a full- time basis after training. (3) Working relation- ships between the Employment Service and the Bureau of Rehabilitation (3) The Employment Service refers to the Bureau of Rehabilitation potential applicants for their service, renders placement service to people trained through the Bureau of Rehabilitation, and supplies the Bureau with current labor-market and other information. The Bureau of Rehabilitation refers their applicants to the Employment Service for placement and cooperates with it on problems of employability, work capacity, suitable occupations, etc d. Agencies for the Blind d. State commissions for the blind or other authorized State agencies are designated as the licensing authority for blind persons who operate stands in Federal and other public building. (1) Extensive coop- eration on volun- tary basis '( (1) They work with the Commission of Edu- cation and the Bureau of Rehabilitation in training, placing, and supervising blind persons. They also rehabilitate them through medical or surgical treat- ment. Working agreements between the agencies and the Employment Service are voluntary. The Employment Service re- lies to a large extent on the advice of the personnel of the commission in the placement of the blind. 7-3040 P200 bu 210 Points to be Made Suggested Supporting Material e. Agencies for the deaf e. In addition to school for the deaf, some States also have a special service to assist them in getting employment. 3. Developing community agency cooperation on the basis of mutual aims 3, In order to discharge the full legal respon- sibilities of the Employment Service for the placement of the handicapped, every employment interviewer should work toward the development of an active cooperation between the Employ- ment office as a placement agency, and the other agencies in the community that offer service of any kind to the handicapped, A recognition that the aims of these agencies and of the Eaployment Service are mutual aims will lead to a day-to-day cooperation. a. Basis of coop- eration a. Any cooperation between two agencies requires that the employees of each clearly understand the functions and responsibil- ities of the other. The better acquainted the employees are with the methods and forms in use in all the agencies, the more in- telligent the use that can be made of their resources. b, Methods of exchanging information b. Some of the means that can be used to maintain cooperative relationships are exchange of visits, exchange of speakers* and .ioint conferences. c. Specific procedures c. Specific cooperative procedures which involve medical reports, clearance of job openings and exchange of technical infor- mation can often be worked out. Brief survey of laws relating to the employment of the handi- VII. Without attempting to mention in detail all the laws affecting the employment of the handicapped, this capped / section will sketch the nature of those laws. For reference, summaries of the most important laws appear in the handbook. A, Federal laws A. Federal laws affecting the employment of the handicapped are the following: 1, Vocational rehabilitation (discussed previ- ously). Points to be Made - Suggested Supporting Material 2. Social Security Act. 1937 (Aid to dependent children, child health services, services for crippled children, public health services, and aid to the blind.) W1 3. Randolph Sheppard Act, 1936 (concerning arrangements for the blind to operate stands in Federal buildings.) . A. Wage and Hour Regulations. As a rule inter- viewer should avoid placement of the disabled at lower than the standard wage rates. Some- times, however, sub-minimum rates may be necessary when the disabled person cannot compete with others on a production basis. Provision has been made in the law for inter- pretation to be made by the Wage and Hours Division as to when the sub-minimum rates may be paid. 5. Civil Service Regulations - Labor shortages -r have caused Civil Service regulations regard- ing the employment of the handicapped to be liberalized. Final determination has been left to the appointing officials. B. State laws * (The instructor must * supply the facts of the appropriate local laws and ordinances.) B. Interviewers for the handicapped will need currently accurate information on State laws concerning workmen1s compensation, rehabilita- tion, homework and employment of special handi- capped groups such as the blind, the deaf, etc. C. Local laws and ordinances Sfansitiom The over-all survey completed has covered a general picture of best methods k°th for placing the handi- CaPped on the basis of their capacity and directing to other sources of help necessary. Specific attention can now be directed to the special problems handicapped workers who are also war veterans - a constantly enlarging and important group of Workers. 7-3040 P211 nobu Instructor1s Discussion Outline SPECIAL- CONSIDERATION FOR THE PLACEMENT OF HANDICAPPED VETERANS Objective: To develop an understanding of the responsibility of the interviewer for the placement of handicapped veterans. Outline of Main Points; 1. The responsibility of the public employment service (10 minutes) 2. Survey of the size of the problem of placement for returning veterans (15 minutes) 3. Survey of the work of other agencies in the field (30 minutes) Review of Employment Service activities on hehalf of veterans (U5 minutes) 5. Presentation of the role of the placement interviewer in the process of adjusting the returned veteran who is handicapped (15 minutes) 6. General summary of the Job (20 minutes) May be used to conclude the entire urogram on the sixth day. Training Program for Serving the Handicapped Unit 5-b Fifth Afternoon (ij* hours) Points to be Made Suggested Supporting Material MOxIVATIO N (10 minutes) I. The Veterans as Part of the nandicanned Group I. Veterans of World War II are constantly increasing as a percentage of the physically and tne mentally • ♦ / A. heturning grouo handicapped workers of the country. A. Returning them to productive employment is a • already sizeable problem of considerable magnitude in all communities now. B. Continued post-war B. It will continue to grow in size and importance i importance throughout the war and during tne post war years. C. Both men end now C. Both men and women disabled veterans now returning oeing released want to contribute to the winning oi the war and want to use tneir work capacity to be economically self-sufficient. . D. Inexperienced young people in the grouu B. Included in the veteran group are workers under 21 years of age whose war service entitles them [ ' to oe classified as veterans, but whose rela- tively limited work experience may make employ- ment counseling necessary. ll. Present Enthusiasm of Employers II. Because veterans are not likely to be called to service, employers are now receptive to hiring such applicants. A. Turnover and morale A. Because they are not liable to be called for r factors military service (being largely in Selective Service - classification 1-C), the employment of servicemen tends to keep down turnover. Moreover, the presence of Veterans in a plant has been found beneficial to morale in war production plants. I L B. Possible change post-war • 3. A changed attitude is possible when the war ends, however, returning able-bodied veterans to the labor market. Rendering the most effec- tive possible selective placement to the disabled veterans now, and of constantly educating employers in the proper use of the work capacities of the handicapped, is a major responsibility. ■n. Responsibility of _the HI. Not only is the Public Employment Service legally Public Employment Service required by its fundamental legislation to offer service specifically to veterans and specifically Points to be Made Suggested Supporting Material to the handicapped, but also in a large social sense, the Public Employment Service is the logical source of placement service for men returning from war duty, and again seeking their place in the economy. PRESENTATION The Size of the Problem (15 minutes) I. On December 1, approximately 30»000 to 35»000 service men and women were being discharged from Army and Navy hospitals for disability reasons. As the war progresses, the figure may grow with a higher percentage of battle casualties. A. All types of handicaps represented *(Ask what some of the * handicaps presented may be.) A. These veterans will have the full range of physical and mental disabilities. In order to place these men and women, the interviewer will be challenged to make use of his total knowledge of jobs, their working conditions and what they demand physically and mentally of workers, ft* well as how to evaluate the working capacities of the workers themselves. 1. Examples: - All the way from orthopedics to deafness 1, Examples could be cited, ranging all the way from amputation handicaps through cases of psychoneurosis, to hearing limitation from the din of battle. B, Discharge papers no indication of the exact nature of the handicap. B, Veterans' discharge papers contain no definite medical information. Naval and Military authori- ties have purposely done this since they are unwilling to broadcast generally what is the matter with the veteran. Because of social attitudes which we have dis- cussed in previous sections, general knowledge of these handicaps might prevent employers from using the veterans. 1. Reasons in the handbook (Hare the group turn to Section VII of Part I of the Handbook, and follow the official reasons for discharge.) 1, Por our own information, general indications of the reasons officially cited by the Army for discharge appear In Section VII of Part I of the Handbook. As given by the War Depart- . ment on the back of the discharge form itself, they appear in the following terms: Section II means disabled. Section V means dependency. Section VIII means general lack of suitability for military life. 7-3040 P216 tou Points to be Made « Suggested Supporting Material • A yellow paper represents a dishonorable discharge, and such individuals do not have veteran status* (The employment service, however, has the same responsibility for giving service to these men as to all other civilians.) 2. Information confiden- tial 2. For the reasons we have discussed, all the information concerning discharge must be kept confidential for the protection of the applicant. II# Activities of Other Agencies (30 minutes) II# Many other agencies are actively concerned with assistance to disabled veterans. Interviewers for the handicapped require an understanding of the relationship between these agencies and the Employment Service* A# The Veterans* Adminis- A* The Veterans1 Administration gives free re- tration: Retraining training to veterans with an employment handi- cap due to a service-connected disability. li also handles claims for pensions, and admin- isters the hospitals for veterans. B# The Selective Service E. Selective Service assists all Veterans in- System: Return to former employment eluding the disabled to return to their former employers if they desire. If they were unem- ployed at induction or wish to change occupa- tions, Selective Service refers them to the Employment Service. C. The armed forces C. The armed forces will cooperate with the Em- ployment Service in the following ways: 1# Supply occupational information on service assignments 1. Information regarding Jobs performed in each branch of the armed forces is re- leased to the Employment Service upon re- quest. 2# Arrange interviews in hospitals 2. Staff members of the Employment Service interview hospitalized men and women about to be discharged from the armed forces. This program will be discussed in detail ■as part of the work of the Employment Service proper. D* The Civil Service Commission: Special preference D# The Civil Service Commission establishes eli- gible lists for Jobs giving preference to honorably discharged veterans having service- connected disabilities (in existence at the time preference is claimed.) 218 Points to be Made Suggested Supporting Material 1. Some State preferences 1. Some State Civil Service Commissions have similar arrangements for preference* (Describe any State provision.) IH.Present Activities of the III.The Public Employment Service in every State is Public Employment Service on Behalf of Veterans actively concerned with developing and extending its service to returned veterans, as part of its (45 minutes) legal and its general responsibilities. A. This training program part of our veterans A. This nation-wide training program is to a considerable extent the reflection of a reoog- work nation that staff members of the Public Em- ployment Service will require special equip- ment to enable them to render effective ser- vice to men and women who find themselves handicapped because of their military service. B. Veterans * Employment B. Every employment service has in its organi- Service and the Veterans* Ropresenta- tives 1 zation a formal provision for service to veterans• The Veterans* Employment Service is part of the regular Employment Service and is respon- sible for developing employment opportunities for war veterans including disabled veterans. It functions as a liaison between disabled veterans and existing services for the handi- capped within the employment office. It main- tains a representative in each local employ- ment office. 1. Close cooperation with interviewers serving the handi- capped 1. The veterans' representatives in local employment offices necessarily work closely with the interviewers serving the handi- capped. C. Employment Service representatives in C. Representatives of the Employment Service interview at the hospitals those to be dis- veterans* hospitals charged from the armed forces. Complete information is secured concerning pre-service employment, armed service occupations, and physical capacity (from medical records or in consultation with doctors.) 1. Effect of this plan on morale 1. By making practical and concrete the government's concern for the disabled vet- eran's prompt and effective return to in- dustry, this program has already contri- tributed enormously to morale. pais *>u Points to be Made Suggested Supporting Material 2, Importance of full 2, These completed applications are then i and accurate appli- sent to the employment office in the area cation cards where the veteran wishes to work. Many interviewers trained in this course may be assigned to the taking of registrations in hospitals. Since these cards will be used Ml by placement workers who did not originally v' r * - take the registrations, the importance of making them full, accurate, and readily , understandable, cannot be overstressed. 3* Proper use of physical 3, Many of the cards taken under this pro- • demands approach can cedur© up to thl s date have not proved r minimize short- useable for placement purposes. The comings physical demands analysis terminology pro- vides an interviewer with a real tool to do V a thorough job of analyzing the work capacity of veterans in hospitals and should improve the effectiveness of the procedure. D. Regular placement acti- D. In general, it can be said that the activities vities on behalf of handi- of the placement service on behal !* of dis- capped veterans abled veterans are the same as those for per- sons handicapped under other circumstances, ex- cept that special openings may be secured for L* them by veterans’ representatives or represent- atives of the Selective Service System. They may also receive the benefit of Veterans’ pre- vt. | ference in Civil Service jobs, 1 X ' C$pte: the If there are interviewers class who will be inter- jewing dischargees 'in Army and Navy hospitals, the following training. . on sections 8700-8774 of the *ES Manual, should be included, , may be covered at this point in k® course, or on the sixth day ✓ "Local Procedures"• Because local variations the instructor have to develop this outline completely, based on practices ** the particular hospitals served. assign sections 8700-8774 of the . • Manual for advance reading. OAi A CO Id K„ Points to be Made Suggested Supporting Material E* Kit of Reference Materials E, 1# Describe Kit of Reference Materials (Possibly Dis- tribute Parts of it to trainees) 1. (See Section 8721 USES Mianual for sugges- tions ) 2. Obtaining List of Patients Approved for Discharge 2. Army - CDD List (Certificate of Certified Disability) Navy - Survey List 3. Scheduling Interviews 3. a b •Inform of purpose of interview in advance. •Allot time for each interview 4. Notifying Dischargees to Report for Interview 4. Method varies by hospitals 5. Records of Scheduled In- terviews 5. 3x5 card 6* Dischargees for Whom Regis- trations Should not be Taken ♦(Ask what individuals should ♦not be registered) 6. a. Those who definitely intend to go back to their old jobs* b. Those who definitely intend to go back to school and who do not want the ser- vices offered. c. Those who for any other reason do not want the services offered by the program. d. Those who cannot name a specific desti- nation as a city or coramuni'by. 7, General Information to be Given Dischargee 7. a. Selective Service Reem- ployment Rights a, (See USES Manual, Section 8741) b, (Ask what agencies or or- .♦ ganizations can advise vet- ♦ erans about pensions and ot] benefits and services.) ler b. Veterans' Administration,Red Cross Office of Vocational Rehabilitation, Unemployment Compensation Agency, American Legion, Disabled American Veterans, Veterans of Foreign Wars, Reemployment Conmitteeman of local Selective Service Boards 221 Points to be Made Suggested Supporting Material 8. Obtaining medical records 8. a. Reiterate importance of interpreting medical reports in physical de- mands terms a. b. Examine before or after interview — Concerning interpretation of information, consult hospital medical authorities. 9. All hospital registrations will be taken on Form 511. (If Form USES-511 is not in use in the State - Include here detailed ihstruction and practice in its preparation - See Section 8744, USES Manual) (For States where Form USES- 511 is in use, stress the following additional instruc- tions for filling out appli- cation cards in hospitals) a. Address * (Ask what address is * entered.) * (Ask what is done if the applicant does not want to receive a notice at the address given.) 9. a. Enter in pencil the address of the aooli- cant at his destination. Write "See Comments" after the address, and under "Comments" explain that a call-in notice should not be mailed, but that the card should be held until the applicant comes into the office. b. Occupational Titles and Codes * (Ask how instructions * for this section for hospital interviews differ from other inter- views .) b. * If the card is going to be sent to a local office other than the one serving the hospi- tal, enter the occupational titles and codes in pencil. c. Willing to Leave City * (Ask what city this * refers to.) c. The city which is the applicant's destina- tion. d. Veteran d. Enter "Yes." * (Ask what entry is made * here.) 0 Points to be Made Suggested Supporting Material e. Education and Training *(Ask what military education * and training is entered here) e. (l) regular training, such as an air- craft mechanics course (2) any correspondence courses, (The United States Armed Forces Insti- tute at Madison, Wisconsin has re- cords of correspondence courses taken by military personnel.) f. Dates *(Ask what is entered as the * first date in the column) f. The date the application card is filled out. g- Employment Record *(Ask where you record the * applicant's army occupation) -*(Ask what you record under * "Name of Employer" "Address" and "Kind of Business" for an anajr occupation) g. Describe first before pre-service employment is recorded. Enter the name of the branch of the serv ice and leave blank the items for "Ad- dress" and "Kind of Business." h. Special Information Enter physical capacity information as described throughout this course. (Review if desirable) h. / i. Signature of Interviewer i. The signature of the interviewer *(Ask what additional informa- * tion is entered) should be followed by the name of the hospital. j- Coding Hospital Registrations *(Ask bow you indicate that * the card was taken at an army or navy hospital) In selective factor block "A", enter F for female, M for male, *(Ask how you show that the * applicant is a veteran of World War II) j • Code either "A" or "N" in the next to the last selection factor block in the upper right corner of the face of the card. Enter the code "WWII" in the last selection factor block. Points to be Made Suggested Supporting Material 10. Practice in filling out card. 10. Distribute blank salmon colored Forms USES 511. Read a typical case and ask each trainee to record information on the card. Collect, review, and discuss cards to determine whether above instruc- tions for filling out card were understood. If desirable, repeat practice. 11. Use of "Special Aids in Placing Military Personnel in Civilian Jobs" 11. (It may be desirable to give these interviewers more intensive training on the use of these "Aids." See "Training Suggestions for Introduc- ing Special Aids for Placing Navy Personnel.") 12. Inform about jobs in Federal Service and Veterans Preference 12. • *(Ask what you do if the appli- * cant is interested in govern- ment employment) • b. Enter a notation unaer "Comments" on the card. If he is interested in a job in the locality, inform him of any Civil Service openings available at the local office and tell him to report to the local office as soon as he is discharged. 13. Make special arrangements to secure names of all doctors and dentists approved for discharge. ■*(Ask what you do after inter- * viewing a doctor or dentist about to be discharged who hasn't decided uoon the com- munity where he intends to practice) 13. Send the following information by air- mail immediately to the headquarters of tlie Procurement and Assignment Service in Washington: a. Name, specifying whether MD or DDS b. Address where he may be reached the following 10 days c. Former place of practice or position, if any • d. States in which he is licensed to oractice T-a1 Points to be Made Suggested Supporting Material e. Type of practice in which he is in- terested and places desired as future location. f. Exact date of discharge, if possible, or approximate date of discharge. g. Opinion of individual as to when he will be able to practice. h. Opinion, if possible, of medical officer in hospital as to physical and mental condition of individual, on when he will be able to practice. *(Ask what you tell a doctor *or dentist who knows defi- nitely where he is going to locate.) Request him to get in touch with the Chairman of the Procurement and Assign- ment Committee in the State to wiiich he is going. 14-, Bring qualified dischargees to attention of National Roster 14. a. Make duplicate copy of USES-511 b. Airmail to National Roster c. On original card note under "Comments" that duplicate has been forwarded to Roster. *(Ask what you do if you are a Civil Engineer who wants to be placed in the same city where he's being discharged.) First attempt to place him in an essen- tial activity which will fully utilize his critical skill. If he cannot be so placed, airmail the duplicate Form USES-511 to the National Roster. 15. Give a Veteran's Introduction Card to each dischargee inter- viewed . 15. a. Distribute sample cards a. 16. Routing hospital registrations 16. • • *(Ask where you route registra- nt ion cards for a. Dischargees who are going to another community in the State a. Mail directly to the local office serving that conununity. (Enter date mailed as second date in "Date" column.) 3040 P224 bu Points to be Made Suggested Supporting Material b. Dischargees who are going to b. Mail directly to the Veterans’ Employ- another State ment Representative in the State of destination. 17. State VER forwards cards within 17. State VER enters the date such cards are - 2A hours mailed as the second date in the column headed ”Dates” on the face of the Form USES-511. 18. Speed necessary in routing cards 18. If veteran arrives at local office before card reaches it: *(Ask why speed is necessary in hospital registration a. Registration has no value cards.) b. Hampers local office placement efforts c. Unfavorable impression on veteran. 19. Registration of veterans at 19. isolated points. a. Registration through regular itinerant *(Ask what methods can be used service. *-in registering veterans at isolated points.) b. Registration through special itinerant service. c. Special handling of individual cases by the use of Service Officers of veterans organizations, or similar trained per- sons, to register the veteran. d. Self-registration and mailing of registration card. 20. Mass registration may be arranged at discharge points in case of mass discharges. K Hole of the placement interviewers in IV. Our responsibility for effective placement the process of adjusting returned of returning veterans highlights the public veterans nature of the interviewer’s job to a greater degree than perhaps any other group of workers. The disabled veterans' right j to considerate and effective treatment in the employment agency operated by the Gov- eminent he has served is clear. Every citizen, veteran or non-veteran, handi- capped or non-handicapped, is similarly entitled to courteous and efficient place- ment service from his Public Employment Agency. 7-3040 P226 bu Points to be Made Suggested Supporting Material A. War service only under- scores their rights as citizens A. But the recency and the dramatic nature of the service and sacrifice of disabled veterans cannot fail to bring home to every interviewer the nature of his responsibility toward such workers. B. Newness of the handicap may affect worker's attitude B. Many handicapped soldiers, because of the recency of their disabilities, will present psychological difficulties more intense than those of other handicapped workers who may have had time to begin adjusting to their difficulties. The circum- stances under which soldiers suffered, and handi- caps, may also affect their psychological attitude Interviewers will require all their skill and experience to counsel handicapped veterans and assist them toward a satisfactory job adjustment. uramary: Specifically, our esponsibility is to use the best vailable methods for analyzing heir remaining work capacities nd for securing for the individ- als an opportunity for produc- ive work and a new adjustment o the community they have de- ended * 1 SUMMARY (20 minutes) , Compensations of the job of placing the handicapped I. These sessions have stressed the fact that the job of placing the physically and the mentally handi- capped is a stimulating one, recuiring mastery of all the methods of professional placement. (Ask the group to mention * some of the compensations of the job, as the train- ing program has reviewed it.) Some of its compensations are that: (Note: This Section may be used after local pro- cedures are discussed on the sixth day, as a for- mal conclusion to the program.) 7_3040 P326 bu Points to be I/'ade Suggested Supporting Material A* Utilizing of labor supply A. It affords the interviewer an opportunity to serve the war effort directly by making avail- able an important additional source of labor supply. B* Adjustment -of individ- uals B. It enables the interviewer to use his skills directly in achieving the satisfactory and productive adjustment of workers who might otherwise become dependent upon other pe pie or upon the community for support. C* Service to Veterans C. An important part of this factor will continue to be the offering of a needed service to war veterans• I. Vvhat is Involved in the II* These sessions have stressed the difficulties Job of Placing the Handi- inherent in the job* Three of the major elements capped involved in it are: ♦ ♦ (Ask the group to name the three major types of inform- ation, and/or skill which they need to do their jobs*) A* Analytical knowledge of jobs A. The interviewer must have a constantly in- creasing knowledge of occupations and that knowledge must be analytical, in that it sped- fies what each job requires physically and mentally - what we have called the physical demands approach. B* Technical knowledge about disabilities and how they affect work capacity B. The interviewer must have a constantly widening technical knowledge of mental and physical dis- abilities and how they affect work capacity. t C* Necessary background in psychology C. The interviewer for the handicapped needs a much better than average understanding of human relationships and human motivations, not only for working with the applicants but also for working with the employers wrho hire them* To be effective, he must be a public relations man with employers and with other agencies in the community* tl •Continuous self-training III*Continuous study and development of background will add much to the interviewer's effectiveness and his satisfactions in his work. Points to be Made Suggested Supporting Material IV* Professional stature of the job IV. In the true sense then, the work of the inter- viewer who engages in placing physically and mentally handicapped is professional in nature. Its demands are great but its satisfactions and opportunities for growth are greater. 228