A primary goal of rehab is for you to be able to work, if at all possible. Rehab staff want to foster your opportunity to return to your previous or some other kind of job. The anticipation of returning to a productive role in the world can increase your motivation to participate in rehab.

You will work with a vocational counselor--sometimes known as vocational rehabilitationist--who might be employed by the rehab center, assigned by the insurer, or hired as a contractor by your State Vocational Rehabilitation agency. Vocational Rehabilitation (Voc Rehab) is a government program that exists at both state and federal levels. Legislation dating as far back as 1917 has authorized money to help injured workers get back to work. Your insurer might also have vocational rehab services and funds to offer you. If you get back to work, they figure you will not require as much expensive continuing healthcare or long-term disability benefits.

Counselors you work with will have varying loyalties, depending on who employs them. Those loyalties can limit their effectiveness, as attorney, quadriplegic, and disability activist Deborah Kaplan of the World Institute on Disability notes:

The Voc Rehab system is sometimes helpful, often not. And very frustrating, very bureaucratic, very rigid. These days, they don't want to spend much money per client. You have to be a fairly sophisticated user of government entitlement services to get anywhere with rehab, unless you happen to luck into a good counselor who is genuinely trying to facilitate life. Counselors usually want to put you into a community college, get you a trade and say that they rehabilitated you. If you get a job, they have succeeded, whether you keep it or not.

The hard truth is that your State Voc Rehab agency will generally work with you only when they consider you employable. How that gets defined might be up to the particular case worker you encounter. This man with advanced muscular dystrophy reports:

I went to their office, did the entire intake process, interviewed with a case worker, but nothing ever came of it. They said they would call me, but never did. I talked to other disabled people more familiar with the workings of the California rehab system, who told me the reason they probably didn't follow up is because they considered a person with MD in his late thirties a "bad risk." That is, I would probably die before I would work enough to make the money spent on me worth it. As cold as this may sound, I believe it to be true. I've heard about this type of thing many times before.

State Vocational Rehabilitation services are getting tighter these days. There has been greater demand on these programs, in part due to the increasing number of repetitive strain injuries resulting from computer use in offices. In some states, legislation limits the money that can be spent for a given case--this limited amount can be small if you need an education and adaptive tools such as a computer or a modified vehicle.

You always have the chance to advocate for yourself. For instance, you don't have to accept the first counselor who is assigned to you. If there is someone in the rehab facility to organize your vocational rehab, she might work harder on your behalf because she has no association with the funding source. When a counselor is doing her job well, she does the following:

• Takes a history of your past job experience and skills
• Learns about your medical status and prognosis
• Considers how your disability affects your ability to return to previous work
• Evaluates new career possibilities and make suggestions to see what interests you, if your previous work is not possible
• Surveys the job market to help identify realistic options
• Explores sources and means of funding, if you require training or education
• Coaches you on job seeking and interview skills
• Advises you and your employer on possible modifications and accommodations that make it possible for you to perform the job

Vocational counselors want to make the most of your physical and psychological rehabilitation, accomplished with hard work by you and the rehab team. They want to make a smooth transition to work or to education, and take best advantages of your accomplishments in rehab.