Attachment E_Report Templates.docx

Report Templates

Contents

Service Group A: Initial Assessments/Evaluations

Complete Initial Evaluation

A-1 Complete Initial Evaluation: The Initial Assessment shall provide the VR&E counselor with sufficient information about the Veteran’s prior education, work history, military experience, and the vocational impact of disabilities in relation to the work environment/requirements to support a determination of entitlement. The initial assessment shall also provide collaborative vocational exploration; analysis of transferable skills; evaluation of interests, aptitudes, and abilities; exploration of labor market conditions; and collaboration with the Veteran in the development of a draft rehabilitation plan leading to determination of feasibility to achieve a vocational goal, entry into suitable employment, and/or maximum independence in the community. The VA may order portions of an initial assessment as listed below, and the Contractor must meet the specified timeframes. Note that combined services below do not equal an initial assessment, but represent some aspects of the entire assessment. The average number of hours to complete an initial assessment is eight (8).

Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Name of Evaluator:

· Date of Assessment:

· Location of Assessment:

Veteran History / Demographics

This section will develop and provide information on the Veteran’s background in order to identify those factors that helped to shape his or her vocational personality and current circumstances. This section will provide a complete understanding of the Veteran’s current vocational needs. The information provided will be used by a VA counselor to determine whether an employment handicap exists, the existence of a serious employment handicap and information on the feasibility of attaining a vocational objective. Additionally, this information will be used in developing a plan that will outline the services the Veteran will require to overcome any such employment handicap. Supportive documents may be requested and included in the file, such as college transcripts, DD Form 214, resumes, etc. The items below are not an exhaustive list. The counselor should use his or her professional judgment and further develop any areas that are relevant to the vocational evaluation.

Presentation

· Did the Veteran arrive on time?

· What was his or her appearance and behavior?

· Was rapport easily established?

· Was the Veteran cooperative & willing to answer all questions in an open manner?

· Did the Veteran have difficulty completing any necessary paperwork?

Current Family & Living Situation

· Current address and phone number(s)

· How long has the Veteran resided in the area? What reasons brought the Veteran to the area? Does he/she plan on staying?

· Marital status. Number of prior marriages, if divorced

· Number and ages of children

· Does the Veteran’s spouse work outside of the home? If yes, list occupation, employer & salary.

· Does the Veteran have dependable transportation? What are the Veteran’s reasons for applying for vocational rehabilitation services?

· Are there any disincentives to vocational rehabilitation success, such as medical treatment eligibility, individual unemployability status, an active Workman’s Compensation claim or Social Security Disability Income (SSDI)?

· Is there any negative legal history to include arrests, incarceration or bankruptcies?

Educational Background

· Did Veteran graduate from high school? If yes, when & where? Does Veteran have a GED? When?

· What kind of grades did Veteran receive in school? If grades were low, why?

· What were the Veteran’s most Favorite subject and least favorite subject?

· Did the Veteran enjoy school? If not, why not?

· Did Veteran participate in any extracurricular activities or clubs?

· Has the Veteran received vocational training? What kind, when? Are these skills transferable? If yes, how, and relate to the labor market. If no, why not? Does the Veteran possess or need any certifications or licenses?

· Is there a history of a learning disability or special education classes?

· College information – transcripts or grade reports.

· Is Veteran currently enrolled in school? If yes, where and for what degree program? What is the reported GPA?

· Has the Veteran had his or her military experience evaluated for possible college credit? If yes, how much credit was awarded and by which school?

· Is the Veteran eligible for any other VA educational program such as Montgomery GI Bill (MGIB), Veterans Educational Assistance Program (VEAP), or Post 9-11 GI Bill effective 8-1-09?

· Has the Veteran ever used any of his or her VA educational benefits?

· Has the Veteran ever completed any on-line classes?

· Does the Veteran own his or her own computer?

· What is the Veteran’s computer skill level, and what applications is he/she familiar with?

Military History

· When and where did the Veteran join the military?

· Branch of service; highest rank achieved; date of discharge

· Type of discharge. If medical separation – how much severance pay was received?

· Job title(s) and description of duties. Include any duty positions.

· Favorite and least favorite assignment

· Is the Veteran a current member of the National Guard or a Reserve unit? Do they plan to join.

Work History

· What is the Veteran’s employment background before the military and since leaving the military?

· Is the Veteran currently employed? If so, what is their job title, employer, salary, job duties?

· Is the job consistent with the Veteran’s interests, aptitudes and abilities?

· Does the job aggravate any of the Veteran’s disabilities? If so, please elaborate.

· Has the Veteran missed any time from their current job? If so, how much and why?

· Does the Veteran have documentation of this, or can he/she obtain it if needed?

· Has the Veteran requested any special accommodations in order to perform their job duties?

· If unemployed, he or she registered with the State Workforce Office?

· Is the Veteran receiving unemployment compensation?

· What job search activities has the Veteran completed?

· Does the Veteran have any transferable job skills? If so, what are they?

· Can the Veteran return to work with a former employer? If not, why not?

· Could the Veteran return to work in the same job with another employer if accommodations were made? What accommodations are needed?

· Does the Veteran have well-developed job seeking skills and a resume?

Transferable Job Skills

· Include a transferable skills analysis based on current industry standards.

· Are there any unexplained gaps in employment? If so, please explain.

· What vocational skills and other personal attributes has the Veteran acquired?

· Does the Veteran have good verbal communications skills? If not, please elaborate, i.e., speech impediment, or heavy foreign accent?

· Would the Veteran make a good interview impression? If not, why not?

· How motivated does the Veteran appear to be in seeking and maintaining employment?

Financial Situation

· What are the Veteran’s financial resources? List current sources of income for Veteran and spouse, i.e., retirement pay, VA disability, unemployment compensation, SSDI, child support, military severance pay, etc.).

· Is the Veteran able to meet his or her monthly financial obligations on current level of income? If not, why not? How much extra each month will he or she need?

· Will the Veteran have to work if approved for a training program?

· Has the Veteran ever filed for bankruptcy? If yes, when, amount and what type of chapter?

Disabling Conditions: Functional Strengths & Weaknesses

This section should discuss the functional, social, and vocational impairments caused by the Veteran’s service connected and non-service-connected conditions. Include any negative attitudes toward the disabled that the Veteran has experienced. Information will include whether the Veteran has overcome or compensated for any limitations such as “learned to write with nondominated hand following injury.”

Physical & Mental Disabilities

· List the Veteran’s service-connected disabilities, history of injury or disease.

· Is the Veteran’s condition improving, worsening, or is it stable?

· Do any of the conditions fluctuate so as to cause absenteeism or reduced work performance?

· Has Veteran been laid off or fired from employment? What reason for the dismissal did the employer give? What is the subjective assessment of the reason he or she was fired or laid off from his or her point of view?

· Has the Veteran been unemployed for a lengthy period of time? Why?

· Can the Veteran explain his or her mental health diagnosis and HOW it affects him or her? Is the Veteran willing to openly discuss his or her current and past mental health issues? When was the onset of the illness? Are there any known triggers or situations he or she avoids?

· Does the Veteran have a history of substance abuse? Has he or she been in treatment? Elaborate.

· If diagnosed with TBI, has the Veteran received treatment or tests? If so, what treatment or tests?

· Does the Veteran use a PDA or similar device? For what reason?

Medications

· List medications the Veteran is currently taking.

· Is the Veteran working with medical providers to get medications adjusted?

· Are there recent changes in the Veteran’s medication

· If he or she is not taking prescribed medications, what is the reason?

Psychosocial Adjustment

· How does the Veteran feel about his or her disabilities and their limitations?

· Does the Veteran admit to anger, frustration or similar problems?

· If so, what kind of problems has this caused in the Veteran’s family, work or social life?

· What does he or she do to control these types of problems?

· Is he or she on medication for these problems?

· Is the Veteran getting better or worse? What exacerbates the problem(s)?

· If the Veteran has a TBI, then has he or she had a Neuropsychological evaluation? Is one needed?

· What are the Veteran’s sleep patterns?

· Do medications or lack of sleep interfere with early morning functioning? How?

· Who or what are the Veteran’s social support systems?

· Has the Veteran received in-patient treatment? For what? When?

· Is the Veteran active in any religious, social or other organizations?

· Does the Veteran volunteer with any organization?

· What are the Veteran’s hobbies or leisure time activities?

Current Treatment

· What treatment does the Veteran currently receive other than medication?

· Is the Veteran scheduled to undergo any future surgeries? If so, when, and how long would be the recovery period be?

· Is the Veteran being treated by the local VA Medical Center? If not, by whom? How do we contact his or her primary care provider, VA or civilian?

· Does the Veteran participate in AA or a similar group? PTSD Group? Has he or she refused to participate.

Functional Limitations

· How is the Veteran limited in function as a result of his or her disabilities?

· What prosthetics or assistive devices does the Veteran utilize to overcome functional limitations?

· Has the Veteran had to relearn activities or learn to use a different body part?

· What kinds of work activities or work environments would aggravate the Veteran’s conditions?

· How severe is each limitation?

· How well does the Veteran compensate for or avoid the limitation?

· What corrections or adaptations have been made or could be made to improve residual abilities?

· Does the Veteran’s disability cause a negative employer attitude even when the functional limitation is minimal? If yes, please describe.

· Does the Veteran need or use any prosthetic devices or sensory aids?

Summary

Provide a synthesis of the information above outlining a well-reasoned approach to overcoming the identified problems. This may include recommendations for additional assessments prior to developing a long-term vocational goal. Some examples of this are: Neuropsychological Evaluation, Functional Capacity Evaluation, Work Adjustment training, Work Hardening training or a vocational evaluation that includes work tasks. Strengths should be identified and how or what the Veteran overcame as well as the Veteran’s support system. Information in the summary should help reveal the personal characteristics of the Veteran and include the Veteran’s attitude toward family, friends, employment, and life in general.

Assessment of Interests, Aptitudes and Abilities

This section will identify the assessment instruments used, state the results, and provide impressions of the Veteran’s vocationally significant personality traits. Assessment results will be used during the rehabilitation planning process to identify the need for remediation or basic skills. The possibility of a learning disability should also be discussed, if identified.

Testing Instruments Used – List each instrument separately.

· Enclose materials from all administered tests.

· Explain the purpose of each test.

· Explain results of each test as they relate to the Veteran’s stated interests, aptitudes, abilities and functional limitations.

· Explain the vocational significance of each test result to include any recommendations for remediation or basic skills classes.

Vocational Exploration This section should address the Veteran’s stated and measured interests, aptitudes and functional limitations as they relate to the selection of a suitable vocational goal.

Career Goals

· What are some appropriate vocational goals (including the Veteran’s stated goal) which match the Veteran’s interests, aptitudes, and abilities for which there is a reasonable labor market?

· What is his other stated vocational objective? What is the reason they chose this Vocational Goal?

· How much experience, training and knowledge does the Veteran have regarding the stated vocational objective? Is it a realistic expectation that they could reach the goal?

· How well does the stated career field match with the Veteran’s personality and temperament?

· If the Veteran’s SCD would be aggravated by the self-chosen vocational objective, state how the job would aggravate his or her disabilities based on job duties.

· Could the Veteran work in the self-chosen vocational objective with accommodations? What accommodations would he or she need?

· Could the Veteran work in the vocational objective if selective job placement were provided?

· Identify jobs where the Veteran could work with selective placement.

· What training would be necessary for the Veteran to gain an entry-level position in the field?

· Identify possible service providers and training establishments.

· Will the Veteran need any remediation?

Labor Market Information

· Are the Veteran and Contractor able to identify employers who hire people to work in his chosen vocational objective within commuting distance from his home? If not, is the Veteran willing to relocate?

· Does the Veteran have a good understanding of the scope of duties for the selected career field and the career ladder?

· Discuss possible uses for completed education and training. What industries or employment opportunities exist for a person who has completed the training for this goal?

· List any materials used during the vocational exploration process i.e., Occupational Outlook Handbook, college catalogs, Department of Labor statistics.

Summary & Recommendations

This section should contain a summary of the services provided. It may also include the need for further vocational exploration services, and the counselor’s overall impression of the Veteran. If the Veteran’s disabilities appear to be so severe that rehabilitation through employment is not likely at this time, the counselor should so state and identify services that may either increase the Veteran’s independence or better prepare him for employment in the future. Through collaboration with the Veteran in the development of a draft rehabilitation plan leading to determination of feasibility to achieve a vocational goal, entry into suitable employment, and/or maximum independence in the community. A draft rehabilitation plan, including a vocational goal, intermediate objectives to achieve the goal, facilities identified to provide services if applicable, estimated timeframes for starting and completing each objective, and any other relevant details will be prepared for review by the VA Vocational Rehabilitation Counselor.

Signature/credentials of Rehabilitation Counselor

Transferable Skills Analysis

A-3 Transferable Skills Analysis – Shall include an analysis of the Veteran’s current physical capacity, along with worker traits, intellectual level and personal characteristics shown by testing as well as the Veteran’s work and educational history in comparison to the characteristics and demands of specific jobs. The Analysis shall also outline transferable skills for direct employment or skills that may be built upon for future employment. The average time to complete a transferable skills analysis is two (2) hours.

Narrative Format (may include, but not limited to)

· Contractor company name/address/phone:

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Name of Evaluator:

· Date of Assessment:

Location of Assessment:

A Veteran is considered to have skills that can be used in other jobs, when the skilled or semiskilled work activities he/she did in past work can be used to meet the requirements of skilled or semi-skilled work activities of other jobs or kinds of work. This depends largely on the similarity of occupational significant work activities among different jobs.

The transferability of a Veteran’s skills is most probable and meaningful among jobs in which the same or a lesser degree of skill is required (Specific Vocational Preparation), the same or similar tools and machines are used (Work Fields), and the same or similar raw materials, products, processes or services are involved (Materials, Products, Subject Matter, and Services).

The Transferable Skills Analysis will be based on the following U.S. Department of Labor publications: D.O.T. (Dictionary of Occupational Titles), C.O.J. (Classification of Jobs), GOE (Guide for Occupational Exploration), SOC (Selected Characteristics of Occupations defined in the Dictionary of Occupational Titles) and the O*NET. Software programs based on these publications/references will be considered acceptable resources for completing the analysis.

Transferable Job Skills

· Include a transferable skills analysis based on current industry standards.

· Are there any unexplained gaps in employment? If so, please explain.

· What vocational skills and other personal attributes has the Veteran acquired?

· Does the Veteran have good verbal communications skills? If not, please elaborate, i.e., speech impediment, or heavy foreign accent?

· Would the Veteran make a good interview impression? If not, why not?

· How motivated does the Veteran appear to be in seeking and maintaining employment?

Signature/credentials of Rehabilitation Counselor

Vocational Evaluation

A-2 Vocational Evaluation: Shall include medical, educational, and vocational history, including identification of functional capacity for work, barriers to employment, and assessment of transferable skills; vocational testing to include assessment of academic functioning, interests, aptitudes, and abilities and review the test analysis, results, and implications with the veteran. The average number of hours to complete a vocational evaluation is five (5).

Suggested Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone:

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Name of Evaluator:

· Date of Assessment:

· Location of Assessment:

Veteran History / Demographics This section will develop and provide information on the Veteran’s background in order to identify those factors that helped to shape his or her vocational personality and current circumstances. This section will provide a complete understanding of the Veteran’s current vocational needs. The information provided will be used by a VA counselor to determine whether an employment handicap exists, the existence of a serious employment handicap and information on the feasibility of attaining a vocational objective. Additionally, this information will be used in developing a plan that will outline the services the Veteran will require to overcome any such employment handicap. Supportive documents may be requested and included in the file, such as college transcripts, DD Form 214, resumes, etc. The items below are not an exhaustive list. The counselor should use his or her professional judgment and further develop any areas that are relevant to the vocational evaluation.

Presentation

· Did the Veteran arrive on time?

· What was his or her appearance and behavior?

· Was rapport easily established?

· Was the Veteran cooperative & willing to answer all questions in an open manner?

· Did the Veteran have difficulty completing any necessary paperwork?

Current Family & Living Situation

· Current address and phone number(s)

· How long has the Veteran resided in the area? What reasons brought the Veteran to the area? Does he/she plan on staying?

· Marital status. Number of prior marriages, if divorced

· Number and ages of children

· Does the Veteran’s spouse work outside of the home? If yes, list occupation, employer & salary.

· Does the Veteran have dependable transportation? What are the Veteran’s reasons for applying for vocational rehabilitation services?

· Are there any disincentives to vocational rehabilitation success, such as medical treatment eligibility, individual unemployability status, an active Workman’s Compensation claim or Social Security Disability Income (SSDI)?

· Is there any negative legal history to include arrests, incarceration or bankruptcies?

Educational Background

· Did Veteran graduate from high school? If yes, when & where? Does Veteran have a GED? When?

· What kind of grades did Veteran receive in school? If grades were low, why?

· What were the Veteran’s most Favorite subject and least favorite subject?

· Did the Veteran enjoy school? If not, why not?

· Did Veteran participate in any extracurricular activities or clubs?

· Has the Veteran received vocational training? What kind, when? Are these skills transferable? If yes, how, and relate to the labor market. If no, why not? Does the Veteran possess or need any certifications or licenses?

· Is there a history of a learning disability or special education classes?

· College information – transcripts or grade reports.

· Is Veteran currently enrolled in school? If yes, where and for what degree program? What is the reported GPA?

· Has the Veteran had his or her military experience evaluated for possible college credit? If yes, how much credit was awarded and by which school?

· Is the Veteran eligible for any other VA educational program such as Montgomery GI Bill (MGIB), Veterans Educational Assistance Program (VEAP), or Post 9-11 GI Bill effective 8-1-09?

· Has the Veteran ever used any of his or her VA educational benefits?

· Has the Veteran ever completed any on-line classes?

· Does the Veteran own his or her own computer?

· What is the Veteran’s computer skill level, and what applications is he/she familiar with?

Military History

· When and where did the Veteran join the military?

· Branch of service; highest rank achieved; date of discharge

· Type of discharge. If medical separation – how much severance pay was received?

· Job title(s) and description of duties. Include any duty positions.

· Favorite and least favorite assignment

· Is the Veteran a current member of the National Guard or a Reserve unit? Do they plan to join.

Work History

· What is the Veteran’s employment background before the military and since leaving the military?

· Is the Veteran currently employed? If so, what is their job title, employer, salary, job duties?

· Is the job consistent with the Veteran’s interests, aptitudes and abilities?

· Does the job aggravate any of the Veteran’s disabilities? If so, please elaborate.

· Has the Veteran missed any time from their current job? If so, how much and why? Does the Veteran have documentation of this, or can he/she obtain it if needed?

· Has the Veteran requested any special accommodations in order to perform their job duties?

· If unemployed, he or she registered with the State Workforce Office?

· Is the Veteran receiving unemployment compensation?

· What job search activities has the Veteran completed?

· Does the Veteran have any transferable job skills? If so, what are they?

· Can the Veteran return to work with a former employer? If not, why not?

· Could the Veteran return to work in the same job with another employer if accommodations were made? What accommodations are needed? Does the Veteran have well-developed job seeking skills and a resume?

Financial Situation

· What are the Veteran’s financial resources? List current sources of income for Veteran and spouse, i.e., retirement pay, VA disability, unemployment compensation, SSDI, child support, military severance pay, etc.).

· Is the Veteran able to meet his or her monthly financial obligations on current level of income? If not, why not? How much extra each month will he or she need?

· Will the Veteran have to work if approved for a training program?

· Has the Veteran ever filed for bankruptcy? If yes, when, amount and what type of chapter?

Disabling Conditions: Functional Strengths & Weaknesses

This section should discuss the functional, social, and vocational impairments caused by the Veteran’s service connected and non-service-connected conditions. Include any negative attitudes toward the disabled that the Veteran has experienced. Information will include whether the Veteran has overcome or compensated for any limitations such as “learned to write with nondominated hand following injury.”

Physical & Mental Disabilities

· List the Veteran’s service-connected disabilities, history of injury or disease.

· Is the Veteran’s condition improving, worsening, or is it stable?

· Do any of the conditions fluctuate so as to cause absenteeism or reduced work performance?

· Has Veteran been laid off or fired from employment? What reason for the dismissal did the employer give? What is the subjective assessment of the reason he or she was fired or laid off from his or her point of view?

· Has the Veteran been unemployed for a lengthy period of time? Why?

· Can the Veteran explain his or her mental health diagnosis and HOW it affects him or her? Is the Veteran willing to openly discuss his or her current and past mental health issues? When was the onset of the illness? Are there any known triggers or situations he or she avoids?

· Does the Veteran have a history of substance abuse? Has he or she been in treatment? Elaborate.

· If diagnosed with TBI, has the Veteran received treatment or tests? If so, what treatment or tests?

· Does the Veteran use a PDA or similar device? For what reason?

Medications

· List medications the Veteran is currently taking.

· Is the Veteran working with medical providers to get medications adjusted?

· Are there recent changes in the Veteran’s medication?

· If he or she is not taking prescribed medications, what is the reason?

Psychosocial Adjustment

· How does the Veteran feel about his or her disabilities and their limitations?

· Does the Veteran admit to anger, frustration or similar problems?

· If so, what kind of problems has this caused in the Veteran’s family, work or social life?

· What does he or she do to control these types of problems?

· Is he or she on medication for these problems?

· Is the Veteran getting better or worse? What exacerbates the problem(s)?

· If the Veteran has a TBI, then has he or she had a Neuropsychological evaluation? Is one needed?

· What are the Veteran’s sleep patterns?

· Do medications or lack of sleep interfere with early morning functioning? How?

· Who or what are the Veteran’s social support systems?

· Has the Veteran received in-patient treatment? For what? When?

· Is the Veteran active in any religious, social or other organizations?

· Does the Veteran volunteer with any organization

· What are the Veteran’s hobbies or leisure time activities?

Current Treatment

· What treatment does the Veteran currently receive other than medication?

· Is the Veteran scheduled to undergo any future surgeries? If so, when, and how long would be the recovery period be?

· Is the Veteran being treated by the local VA Medical Center? If not, by whom? How do we contact his or her primary care provider, VA or civilian?

· Does the Veteran participate in AA or a similar group? PTSD Group? Has he or she refused to participate.

Functional Limitations

· How is the Veteran limited in function as a result of his or her disabilities?

· What prosthetics or assistive devices does the Veteran utilize to overcome functional limitations?

· Has the Veteran had to relearn activities or learn to use a different body part?

· What kinds of work activities or work environments would aggravate the Veteran’s conditions?

· How severe is each limitation?

· How well does the Veteran compensate for or avoid the limitation?

· What corrections or adaptations have been made or could be made to improve residual abilities?

Does the Veteran’s disability cause a negative employer attitude even when the functional limitation is minimal? If yes, please describe.

· Does the Veteran need or use any prosthetic devices or sensory aids?

Assessment of Interests, Aptitudes and Abilities

The report will identify the assessment instruments used, state the results, and provide impressions of the Veteran’s vocationally significant personality traits. Assessment results will be used during the rehabilitation planning process to identify the need for remediation or basic skills. The possibility of a learning disability should also be discussed, if identified.

Testing Instruments Used – List each instrument separately.

· Enclose materials from all administered tests.

· Explain the purpose of each test.

· Explain results of each test as they relate to the Veteran’s stated interests, aptitudes, abilities and functional limitations.

· Explain the vocational significance of each test result to include any recommendations for remediation or basic skills classes.

Summary

Provide a synthesis of the information above outlining a well-reasoned approach to overcoming the identified problems. This may include recommendations for additional assessments prior to developing a long-term vocational goal. Some examples of this are: Neuropsychological Evaluation, Functional Capacity Evaluation, Work Adjustment training, Work Hardening training or a vocational evaluation that includes work tasks. Strengths should be identified and how or what the Veteran overcame as well as the Veteran’s support system. Information in the summary should help reveal the personal characteristics of the Veteran and include the Veteran’s attitude toward family, friends, employment, and life in general.

Signature/credentials of Rehabilitation Counselor

Vocational Exploration

A-4 Vocational Exploration: A collaborative effort between counselor and client that considers transferable skills, impact of disability condition and residual functioning, vocational testing results, labor market conditions and demands, assistive technology and job modifications, need for services to improve independence in the home and community, and other factors. Note that testing and transferable skills analysis may be required as a part of this package in some cases. Vocational Exploration shall result in the joint development of a draft rehabilitation plan (IWRP, IEEP, and IEAP). The average time to complete a vocational exploration is four (4) hours.

Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Name of Evaluator:

· Date of Assessment: Location of Assessment:

Vocational Exploration

This section should address the Veteran’s stated and measured interests, aptitudes and functional limitations as they relate to the selection of a suitable vocational goal.

Career Goals

· What are some appropriate vocational goals (including the Veteran’s stated goal) which match the Veteran’s interests, aptitudes, and abilities for which there is a reasonable labor market?

· What is his other stated vocational objective? What is the reason they chose this Vocational Goal?

· How much experience, training and knowledge does the Veteran have regarding the stated vocational objective? Is it a realistic expectation that they could reach the goal?

· How well does the stated career field match with the Veteran’s personality and temperament?

· If the Veteran’s SCD would be aggravated by the self-chosen vocational objective, state how the job would aggravate his or her disabilities based on job duties.

· Could the Veteran work in the self-chosen vocational objective with accommodations? What accommodations would he or she need?

· Could the Veteran work in the vocational objective if selective job placement were provided?

· Identify jobs where the Veteran could work with selective placement.

· What training would be necessary for the Veteran to gain an entry-level position in the field?

· Identify possible service providers and training establishments.

· Will the Veteran need any remediation?

Labor Market Information

· Are the Veteran and Contractor able to identify employers who hire people to work in his chosen vocational objective within commuting distance from his home? If not, is the Veteran willing to relocate?

· Does the Veteran have a good understanding of the scope of duties for the selected career field and the career ladder?

· Discuss possible uses for completed education and training. What industries or employment opportunities exist for a person who has completed the training for this goal? List any materials used during the vocational exploration process i.e., Occupational Outlook Handbook, college catalogs, Department of Labor statistics.

Summary & Recommendations

This section should contain a summary of the services provided. It may also include the need for further vocational exploration services, and the counselor’s overall impression of the Veteran. If the Veteran’s disabilities appear to be so severe that rehabilitation through employment is not likely at this time, the counselor should so state and identify services that may either increase the Veteran’s independence or better prepare him for employment in the future.

Signature/credentials of Rehabilitation Counselor

Vocational Testing (Individual & Group)

A-5(a) Vocational Testing (individual): Whenever Vocational Testing (individual) is required it shall include assessment of academic functioning, interests, and aptitudes. Scored, interpreted test results and raw test materials shall be provided to the VA along with relevant testing related behavioral observations within seven (7) calendar days of testing. The average number of hours to complete a vocational evaluation is three (3) hours.

A-5(b) Vocational Testing (group): Additional veterans may be added, under this service, to referral A-5(a) above, for the purpose of constituting a group testing session. Additional veterans added shall be priced at a per-veteran rate for testing materials, scoring and document preparation only. The cost of time for proctoring the tests will have been included in the cost of the service A-5(a) above. Referrals under this service will only be made as an add-on to a referral for Service A-5(a). The average number of hours to score and document testing results for additional veterans is one (1) hour per veteran. Scored, interpreted test results and raw test materials shall be provided to the VA along with relevant testing related behavioral observations within seven (7) calendar days of testing. Group size shall not exceed 12.

Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone:

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Name of Evaluator:

· Date of Assessment: Location of Assessment:

Assessment of Interests, Aptitudes and Abilities The report will identify the assessment instruments used, state the results, and provide impressions of the Veteran’s vocationally significant personality traits. Assessment results will be used during the rehabilitation planning process to identify the need for remediation or basic skills. The possibility of a learning disability should also be discussed, if identified.

Testing Instruments Used – List each instrument separately.

· Enclose materials from all administered tests.

· Explain the purpose of each test.

· Explain results of each test as they relate to the Veteran’s stated interests, aptitudes, abilities and functional limitations.

· Explain the vocational significance of each test result to include any recommendations for remediation or basic skills classes.

Service Group B: Case Management

Intensive Case Management

B-2 Intensive Case Management - This category of services includes Veterans who need substantial assistance to achieve rehabilitation goals and/or those in short term rehabilitation programs, such as certificate training programs, extended evaluation programs, etc. Personal contact must be made on a frequent basis to ensure close monitoring of progress and quick response to need for services, interventions, or referrals. At least one personal contact per month (no more than 30 days between each meeting) must be face-to-face. Monthly reports will also document on-going intervention as needed. The average hours per month to provide intensive case management is two (2).

Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone:

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Dates Seen:

· Counselor:

This section’s content includes current rehabilitation services activities, progress toward successful completion of the goals and objectives, assessment of progress through in-person meetings, objective progress reports, subjective input by the Veteran and/or family members, and other appropriate input depending upon the rehabilitation service setting. It will also present personal, socio-economic, family, and medical issues that the Chapter 31 participant is experiencing.

The services report will address circumstances that affect the Chapter 31 participant’s ability to succeed with his or her goals, and will identify resources that will improve successful completion of the rehabilitation plan.

Review of Plan

The report narrative will be expansive enough to comprehensively address the overall plan, progress toward goals and objectives, incremental accomplishments, any urgent needs for additional services, complications that may interfere with the plan’s progression, and subjective input from the Veteran. Refer requests to change plan goal, and/or incremental objectives to the VR&E Vocational Rehabilitation Counselor.

· Plan Goal

· How do the provided services contribute to the accomplishment of the objectives?

· Progress toward accomplishing objectives (fragment, unclear) What is the anticipated completion date?

· Facility – rehabilitation, medical, assessment programs

· Change in enrollment status (increase/decrease in rate of pursuit)

· Readiness to return to plan (following a period of interruption)

· Supply/equipment needs

· Transportation

· Legal issues that may interfere with progression

· Physical or mental health issues that may interfere with progression

Personal

The report narrative will document the Veteran’s contact information and address personal issues the Veteran is experiencing.

· Confirm mailing and e-mail address, phone number, and any updates/changes.

· Change in dependents – (if Ch 31 subsistence allowance is payable, follow procedures for adding/removing dependents)

· Change in address

· Overall living arrangements o Satisfactory/unsatisfactory – explain with details

· Housing accommodations – use of VHA HISA grant; use of VBA Special

· Adapted Housing grant; community resources for accommodations o In-house assistance – schedule, provider, service (i.e., home health, personal care attendant, etc.)

· Does the Veteran feel safe in his/her home and community – explain with details

· alert VR&E of any potential danger situation

· Is the Veteran experiencing any personal or family adjustment problems?

· Is the Veteran encountering any physical stamina or strength problems?

· Is the Veteran experiencing any memory, concentration or communication problems?

· Does the Veteran require help in moving around in his/her home and/or community?

· Does the Veteran feel a need, and have the interest and the ability to improve his/her level of physical activity and personal fitness?

· Is the Veteran socially isolated?

· Does the Veteran wish to be more socially active?

· Are there any architectural barriers in the Veteran’s home?

· Other

Financial

The narrative scope of report will identify any financial issues that may affect the Veteran’s ability to participate in a program of rehabilitation and/or live independently. It will identify state, federal, and community resources to mitigate financial problems. It will assess need for more in-depth financial counseling assistance and available resources.

· Sufficient finances to pay for housing, food, utilities, commuting, childcare, etc.

· Sufficient finances to support lasting maintenance costs of assistive technology or accommodation devices

· Other

Medical

This report will address the impact of service-connected and non-service-connected disabilities on the Veteran’s ability to progress toward goals and objectives. It will identify the need for referral for medical support services (VA Medical Center), and identify the need for rehabilitation support and/or accommodations.

· Need for medical/psychiatric care

· Urgent medical needs

· Rehabilitation medicine needs (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, etc.)

· Accommodation needs o Available through training institution o Available through medical facility o Available through rehabilitation facility

Recommendation

A timely report is necessary to ensure that Chapter 31 participants receive all of the rehabilitation resources they are entitled to. Needs that are identified during the monthly and annual rehabilitation assistance meeting must be documented and communicated to VR&E Vocational Rehabilitation Counselors as quickly as possible to ensure that the Veteran’s benefits are administered in a timely and accurate manner, that vendor payments are made on schedule, and that support services are acquired when needed.

The case management report should include any specific recommendation for VA follow-up i.e., tools, equipment, specific licensure/certification, uniforms, subsistence allowance, personal follow-up, support services referrals. Additionally, information regarding vendor (school/training facility/service provider, etc.) costs and payments will be addressed in the narrative. Specific documents will be attached to the report, and VR&E will be notified of any issues requiring immediate VA action. The assessment from case management will include recommendations regarding accomplishment of objectives; interruption from the plan, and reasons for interruption such as relocation, medical, and other issues that arise and impact the Veteran’s Chapter 31 services. Issues requiring action by VA must be referred immediately. If the Veteran has completed all goals, or as many as he/she will be able to complete, provide a recommendation for case closure as “Rehabilitated” to the VR&E Vocational Rehabilitation Counselor.

Signature/credentials of Rehabilitation Counselor

Interrupt Follow-Up Services

B-3 Interrupted Follow-Up Services – This category of services is provided to Veterans who need ongoing follow-up services during a period of medical or other interruption to ensure that service needs are met. Frequency of contact is dictated by Veteran needs and circumstances. This level of service requires a minimum of at least one monthly verbal contact (no more than 30 days between each contact). More frequent contact by phone and/or e-mail is recommended. Face-to-face contacts are preferred, but not required. If attempts to provide verbal and/or face-to-face contact are unsuccessful, documentation will reflect follow-up by mail and other appropriate avenues. Billing for this package will be considered if the file demonstrates sufficient effort for follow-up; however, failure of the Veteran to cooperate must be staffed with the VA at least monthly for consideration of payment beyond the first 30 days when the Veteran is not cooperating. The average number of hours per month to provide follow-up services is one (1).

Narrative Format (shall include, but is not limited to)

· Contractor company name/address/phone:

· Referral Source:

· Veteran Name:

· VA File (Last 4):

· Address:

· Dates Seen:

· Counselor:

This section’s content includes current rehabilitation services activities, progress toward successful completion of the goals and objectives, assessment of progress through in-person meetings, objective progress reports, subjective input by the Veteran and/or family members, and other appropriate input depending upon the rehabilitation service setting. It will also present personal, socio-economic, family, and medical issues that the Veteran is experiencing.

The services report will address circumstances that affect the Veteran’s ability to participate in rehabilitation programming, and will identify resources that will improve successful completion of the rehabilitation plan.

Review of Plan

The report narrative will comprehensively address the overall plan, progress toward goals and objectives, incremental accomplishments, any urgent needs for additional services, complications that may interfere with the plan’s progression, and subjective input from the Veteran. Refer requests to change plan goal, and/or incremental objectives to the VR&E Vocational Rehabilitation Counselor.

· Plan Goal

· How do the provided services contribute to the accomplishment of the objectives?

· Progress toward accomplishing objectives (fragment, unclear)

· What is the anticipated completion date?

· Facility – rehabilitation, medical, assessment programs

· Change in enrollment status (increase/decrease in rate of pursuit)

· Readiness to return to plan (following a period of interruption)

· Supply/equipment needs

· Transportation

· Legal issues that may interfere with progression

· Physical or mental health issues that may interfere with progression

Personal

The report narrative will document the Veteran’s contact information and address personal issues the Veteran is experiencing.

· Confirm mailing and e-mail address, phone number, and any updates/changes.

· Change in dependents – (if Ch 31 subsistence allowance is payable, follow procedures for adding/removing dependents)

· Change in address

· Overall living arrangements o Satisfactory/unsatisfactory – explain with details

· Housing accommodations – use of VHA HISA grant; use of VBA Special Adapted Housing grant; community resources for accommodations o In-house assistance – schedule, provider, service (i.e., home health, personal care attendant, etc.)

· Does the Veteran feel safe in his/her home and community – explain with details

– alert VR&E of any potential danger situation

· Is the Veteran experiencing any personal or family adjustment problems?

· Is the Veteran encountering any physical stamina or strength problems?

· Is the Veteran experiencing any memory, concentration or communication problems? Does the Veteran require help in moving around in his/her home and/or community?

· Does the Veteran feel a need, and have the interest and the ability to improve his/her level of physical activity and personal fitness?

· Is the Veteran socially isolated?

· Does the Veteran wish to be more socially active?

· Are there any architectural barriers in the Veteran’s home?

· Other

Financial

The narrative scope of report will identify any financial issues that may affect the Veteran’s ability to participate in a program of rehabilitation and/or live independently. It will identify state, federal, and community resources to mitigate financial problems. It will assess need for more in-depth financial counseling assistance and available resources.

· Sufficient finances to pay for housing, food, utilities, commuting, childcare, etc.

· Sufficient finances to support lasting maintenance costs of assistive technology or accommodation devices

· Other

Medical

This report will address the impact of service-connected and non-service-connected disabilities on the Veteran’s ability to progress toward goals and objectives. It will identify the need for referral for medical support services (VA Medical Center), and identify the need for rehabilitation support and/or accommodations.

· Need for medical/psychiatric care

· Urgent medical needs

· Rehabilitation medicine needs (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, etc.)

· Accommodation needs

· Available through training institution

· Available through medical facility

· Available through rehabilitation facility

Recommendation

A timely report is necessary to ensure the Veteran receives all of the rehabilitation resources needed.