✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on July 11, 2025.
Vocational rehabilitation programs tailor services to the needs and goals of the individual. Services may include:
- Assessment and evaluation
- Counseling and guidance
- Training and education
- Job placement and support
Ticket to Work and government programs
Federal and state governments have eligibility-based career development programs to help individuals with disabilities acquire skills, attitudes, and resources needed to obtain and keep a job. To be eligible, federal regulations require an individual be disabled and able to benefit from vocational rehabilitation services. The disability must be a physical or mental impairment that is a substantial barrier to employment. Those receiving Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) are presumed eligible unless their disabilities are too severe for them to benefit from vocational rehabilitation (defined as being unable to achieve employment).
For clients aged 18-64 who currently receive Social Security benefits based on disability under the SSDI and/or SSI programs, returning to work could mean losing their Medicare and/or Medicaid benefits. The voluntary Ticket to Work Program allows them to maintain their benefits while working and also provides expanded options for accessing employment services, vocational rehabilitation services, and other support services needed to enter, maintain, and advance employment. The program’s goal is to eliminate the individual’s need for Social Security disability cash benefits while maintaining their Medicare and/or Medicaid benefits.
Workers’ Compensation Vocational Rehabilitation
After a work-related injury, the goal is for the worker to achieve maximum medical improvement and to return to work as soon as possible. The return-to-work options are evaluated in the following order:
- Same job, same employer
- Modified job, same employer
- Different job, same employer, using transferable skills
- Same job, different employer
- Different job, different employer, using transferable skills
- Training for a different job with the same or different employer
- Self-employment
Work hardening and work conditioning
Work hardening is an individualized, highly structured program designed to help workers return to their pre-injury work in a safe and timely manner. It focuses on work endurance by progressively increasing tolerance with conditioning exercises, including strengthening and flexibility exercises, cardiovascular conditioning, spine and joint stabilization exercises, and job task training such as pushing, pulling, bending, twisting, or lifting. A job analysis or on-site observation of the worker’s job may be performed to identify goals related to job functions. Work hardening is multidisciplinary and can include physical therapists, occupational therapists, psychologists, and vocational specialists.
Work conditioning is designed to restore systemic neurological, cardiopulmonary, and musculoskeletal functions to enable the injured worker to return to work. This includes strength, mobility, range of motion, endurance, motor control, power, and aerobic capacity/endurance. It is done under the direction of a physical therapist in a therapy setting. Work conditioning differs from work hardening in that the focus is not on specific tasks the client must perform (for example, lifting a 20-pound box and placing it on a shelf) but rather on building the strength required to lift anything.
Transitional work duty
TWD allows injured employees to return to productive work with their employer while under the care of rehabilitation professionals. The employer creates a value-added temporary position based on the employee’s knowledge and skills. The work must conform to the restrictions the employee’s treating physician puts in place. Only employees with temporary injuries who will eventually be able to return to their regular full-time duties are eligible for TWD.
This article shares a portion of the information covered on this topic in CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025). For more details on this topic and Workers’ Compensation, purchase your copy at CCMCertificationMadeEasy.com
