Who Deserves to be Overlooked? (Within the Vocational Rehabilitation Client Population)

First draft (in progress): Jan. 5, 2015

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“The difficulties of firing incompetent social workers, especially from public agencies, are too well-known to require extensive discussion. Many agencies rationalize or accept poor performance in terms of a worker's personal emotional situation. I have seen workers commit the most gross acts, miss work, and otherwise not perform. The only comment their supervisor made was that the worker was having a difficult time in analysis. Finally, social work's problems with evaluation are legion.” [Harris Chaiklin, “Honesty in Casework Treatment,” 1973, p. 273; full citation below]

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1) Categories of VR Clients that are "Overlooked" or Under-served

The title phrase "Who Deserves to be Overlooked? (Within the Vocational Rehabilitation Client Population)" was chosen to be deliberately provocative. All would agree that there is no person in this population who “deserves” to be overlooked – though all would agree that there are individual clients as well as classes of clients that are inadvertently (rather than deliberately) overlooked. Yet, as I will argue, there are indeed categories of clients that are quite deliberately treated as undeserving by a great number of Vocational Rehabilitation practitioners. There are, of course, excuses and ideological “justifications” available to be proffered for the bias that occurs.

It is natural that the seemingly “most needy” and “endangered” cases would attract special attention and given priority, and that those cases perceived by practitioners as requiring only slight attention would be categorized as lower in priority. It is also an obvious fact that the total population of persons in need of Vocational Rehabilitation services exceeds the resources that are currently in place. But there is a great hazard inherent this state off affairs. There is an incentive to de-prioritize classes of clients and this incentive can very well lead to unjust and superficial interpretation of case types resulting in improper marginalization of such classes or case types leading to direct and substantial harm to clients that fit the category in question. Further, incompetence of practitioners and even overt bias by them can be allowed free reign to treat certain types of clients dismissively when they fall into the "low priority" segment of the client demographic.

This article argues that there exist widespread problems in the attitudes and perceptions of a large share of Vocational Rehabilitation practitioners that create de facto categories of clients that are in effect are misunderstood and misidentified as having slight needs for VR services and even treated as persons presenting what is erroneously considered as pathological mindsets when in fact the very mindset that is deemed improper or abnormal should rather be seen as positive, healthy and normal.

In brief, the claim presented here is that social work practitioners are liable in many instances to exacerbate the very problems they are charged with offering solutions to. In particular the issue of stigma is discussed here with the argument given that the client who is classed as “disabled” under a variety of systems (including Social Security disability) is often caused to have his or her stigmatization (in the perception of others as well the client’s own) by the Vocational Rehabilitation process.

2) Vocational Rehabilitation: Stigma Below the Surface

The problem of stigmatization has long been recognized as a serious barrier for persons with disabilities, interfering their chances of becoming both socially integrated and financially self-sustaining. A 2002 academic article describes the problem succinctly:

“Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people. Although research has gone far to understand the impact of the disease, it has only recently begun to explain stigma in mental illness.” [Patrick W Corrigan And Amy C Watson, “Understanding the impact of stigma on people with mental illness,” World Psychiatry. 2002 Feb; 1(1): 16–20.]

One might be surprised to hear the claim that what we might can “non-serious” mental illnesses carry a damaging stigma in certain contexts as well, which prevent successfully adaptive or recovering and recovered persons with diagnoses of kinds that are not permanently undermining of productivity from re-entering the workforce and re-establishing financial independence.

3) Stigma Expansion

Stigma expansion is the result of the inappropriate influence on a client through the actions and behaviors of uninformed, unqualified, incompetent and/or even pathological [note C, below] social workers on clients. Stigma expansion results in worsening of both institutional stigma (the reinforcement of social and economic barriers) as well as the destructive phenomenon known as “self-stigma.”

Disability classification is, as we can all understand, a stigma. VR professionals are aware that stigma is itself a barrier that can be overcome only when perception is altered.

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4) Categories of Stigma Expansion

Here are several types of bias against VR clients by VR practitioners that have been observed by the author.

►Ambition – A client's desire to maximize the use of proven and demonstrable aptitudes is met with barriers, such as responses of superficial assessments, using, unjustifiably and incorrectly when not based on careful and appropriate testing and interviewing) such boilerplate labels as "grandiose," "pretentious," "unrealistic," and in the context of the popular "social justice" ideology, as signs of "undeserved privilege" and politically incorrect "entitlement."

►Intrinsic aptitude (talent, IQ, generalist abilities) – An authoritarian and overly bureaucratic mindset, common among government and "not for profit" employees, prompts the reinforcement of the fallacy that "credentials" and resume-backed experience are the definitive and exclusive proofs of capability and vocational potential. The It is a simpleminded notion – and a shockingly common one – that academic achievement correlates with the “taking” of a certain number of college credits combined with passing exams resulting from test-cramming and memorization skills, without having, however, authentic and deep understanding and enduring learning (which, by definition involves permanent devotion to learning backed by personal curiosity and real aptitude).

►Nuanced critical thinking – in a VR client is regarded as a sign of eccentricity and prompts less qualified social workers to reach for autism spectrum diagnoses out of confusion and lack of comprehension of high cognitive competence ("fluid intelligence").

►Standards – A VR client having strong work ethic, high standards of quality and execution, and using careful detailed descriptions in order to insure accurate communication of work requirements, are taken by many social workers (who are very frequently notably lacking in careful and professional standards and in providing, timely, properly documented and properly measured good quality results) are often treated with the same response as those described in the "Ambition" entry above.

5) Conclusion

It seems necessary to clearly identify and label the VR practice problem (or group of related problems) that is touched on in this article in order to counteract the VR practitioners’ inclination to engage in the “overlooking” mindset described here – a mindset based on prejudice and ignorance – which not only bars VR clients from receiving appropriate and timely services that produce objectively desirable results but also increases the clients objectively observable stigma (poor prospects for suitable, “maximizing,” employment), but also can exacerbate self-stigma, leading to loss of trust, withdrawal, and increased loss of self-esteem.

The distrust that is fostered in the heart of the client through experiences in the VR process is most likely, it goes without saying, liable to deepen distrust for the social welfare system in general and, when a client has repeatedly experienced poor treatment from incompetent and sometimes even hostile and openly biased (through the bias may be of a “politically correct” variety) from several practitioners, the client may develop extreme responses such as alienation, profound pessimism, alienation, withdrawal, and may even develop novel anti-social attitudes that previously did not exist or that are of a regressive (relapse) nature reversing previous gains in personal development (such as successful therapeutic gains).

The newly coined labels used here ("overlooked," "stigma expansion") are merely provisional first thoughts, meant only as a vehicle to assist in pointing to the problem under discussion, to give a focused image allowing the argument to be put forth clearly, and to facilitate its exploration and description. In other words, this is a first look at a question that may well be improved upon and elaborated by others who may offer better terms and a better description and analysis.

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NOTES:

Quotations from professional publications:

A) From Corrigan et al, 2014

[Patrick W. Corrigan, Benjamin G. Druss, and Deborah A. Perlick, “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care,” APA (Association for Psychological Science), Aug. 1, 2014]

http://www.psychologicalscience.org/index.php/publications/mental-illness-stigma.html

Self-stigma – These displays of discrimination can become internalized, leading to the development of self-stigma: People with mental illness may begin to believe the negative thoughts expressed by others and, in turn, think of themselves as unable to recover, undeserving of care, dangerous, or responsible for their illnesses. This can lead them to feel shame, low self-esteem, and inability to accomplish their goals. Self-stigma can also lead to the development of the “why try” effect, whereby people believe that they are unable to recover and live normally so “why try?” To avoid being discriminated against, some people may also try to avoid being labeled as “mentally ill” by denying or hiding their problems and refusing to seek out care. [Corrigan et al, Aug. 2014]

Structural stigma (i.e., stigma that is part of social and institutional policies and practices) presents additional large-scale barriers to mental care by undermining opportunities for people to seek help. A lack of parity between coverage for mental health and other health care, lack of funding for mental health research, and use of mental health history in legal proceedings, such as custody cases, all present structural reasons that people might not seek treatment. [Corrigan et al, Aug. 2014]

An intriguing comment on the above: “Will overcoming associated stigma produce meaningful results if the majority of “professional” care providers continue to be ineffective at best and incompetent at worst? Please. The field is full of flakes who need treatment as much or more than their clients / patients. I have been a CADC since the late ’80s, an MFT since the late ’90s, and a Psy.D. since the late ’00s. I have spent way too much time cleaning up messes made by others, many of whom graduated from waaaaaay less than ethical degree mills. Unless or until the “profession” catches up with the late Arthur Deikman et al, I don’t see this changing.” [Comment by Not Moses on September 5, 2014 @ 12:21 pm]

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B) From Official Proceedings, National Conference on Social Welfare, 1973:

Pages 272-73: Goode's analysis of the social utility of incompetence notes several factors that increase the protection of ineptitude. External factors are: (1) a high demand for people to fill a role; (2) a low supply of people to fill a role; (3) a sociopolitical structure that keeps demand low; and (4) an organizational structure in which incompetence does not reduce the administrative head's power. [8] Social work fits this paradigm. It is chronically short of qualified people to fill its budgeted positions. Except for certain subgroups in our society, the social worker's job is not a highly valued position. The political structure does little to expand the demand for social work. And few agency heads have ever lost their positions because they had incompetent staff; conflict with the board is a more likely reason. According to Goode, the following internal processes lead to the support of incompetence:

1. The inept create a floor that protects the mediocre.

2. It is difficult to replace personnel, even the incompetent, and this gives them bargaining power.

3. There are a variety of social circumstances in which less than optimum output is acceptable.

4. "The less able are protected more in those types of performances that are difficult to evaluate." [9] [notes 8 & 9; William J. Goode, "The Protection of the Inept," American Sociological Review, XXXII (1967), 5-19.]

Here too, social work closely conforms to the model. Social work is an oversupervised profession. The usual standard of one supervisor for as few as five workers not only testifies to the inability of these workers to perform independently but means that many of the most experienced workers do not see clients. Direct service is the core of any profession, and its most competent practitioners should be thus engaged. This is not the case in social work. The difficulties of firing incompetent social workers, especially from public agencies, are too well-known to require extensive discussion. Many agencies rationalize or accept poor performance in terms of a worker's personal emotional situation. I have seen workers commit the most gross acts, miss work, and otherwise not perform. The only comment their supervisor made was that the worker was having a difficult time in analysis. Finally, social work's problems with evaluation are legion.

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p. 274 – This discussion began with talking about honesty in treatment and ends with talking about competence. The reason is that honesty in treatment is the basis on which the profession can build competence. Goode notes that "person professions" require mutual trust to accomplish their task and that to establish this trust requires professional autonomy.12 Clients and workers must be freed from the rigid bureaucratic structures and false behavioral slogans which protect the incompetent. When honesty returns to treatment, competent professionals will have little difficulty in demonstrating effectiveness. The clients will tell us and they will show us by their behavior.

[Harris Chaiklin, “Honesty in Casework Treatment,” pp. 266-274, in: Official proceedings of the annual meeting: 1973; National Conference on Social Welfare., National Conference of Social Work (U.S.), National Conference of Charities and Correction (U.S.), Conference of Charities and Correction (U.S.), Conference of Charities (U.S.), Conference of Boards of Public Charities (U.S.), American Social Science Association.]

http://quod.lib.umich.edu/n/ncosw/ACH8650.1973.001?rgn=main;view=fulltext

C) From: “Pathological or Inept Social Workers,” Direct Social Work Practice,  2013.

“Despite educational preparation, some practitioners demonstrate behavior that lacks the basic tenets of a helping relationship, for example, a lack of empathy or being in tune with those seeking their help; a lack of genuine and authentic concern; a lack of appreciation of different beliefs, lifestyles, and values. Their inept behavior may be attributed to anxiety, a lack of skill or experience, dealing with a problem beyond their scope of practice, or an inability to build collaborative relationships with clients. Ineptness and ethical practices on the part of social workers, such as abrasive, egotistical, controlling, judgmental, demeaning, patronizing, or rigid behavior can cause an appropriate negative reaction from clients. In these interactions, clients’ reactions can become a cycle of escalating conflict. For instance, a practitioner demeans an individual, an individual reacts, and so forth. It is not unusual for the professional to attempt to control by exerting his or her power and authority, which of course tends to cause another reaction from the client. Being habitually late or unprepared for appointments, appearing to be detached or disinterested, and under-involved are further indicators of troubling behavior. Most people will react to behavior that they view as disrespectful or unprofessional. In many cases, a practitioner would not tolerate similar behavior in a client.

“Ineptness is a serious concern which calls for corrective behavior on the part of the practitioner, through supervision, skill development, or self-reflection. Pathological behavior on the part of the social worker in which there is a sustained pattern of repeated errors, insensitive behaviors can cause psychological damage to clients.”

[Dean Hepworth, Ronald Rooney, Glenda Dewberry Rooney, Kim Strom-Gottfried, Direct Social Work Practice: Theory and Skills, 9th Edition (Brooks/Cole Empowerment Series), Brooks/Cole, 2013, pp. 556-7] (emphasis added)

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