22 RCB 44:1 pp. 22-29 (2000) Primary and Secondary Labor Markets: Implications for Vocational Rehabilitation David Hagner, University of New Hampshire, Institute on Disability This article reviews theoretical and empirical work in labor economics and the sociology of work relating to the segmentation of the labor market into a primary and a secondary sector and examines the implications for vocational rehabilitation. Demand-side and supply-side factors associated with labor market segmentation and movement of workers from the secondary to the primary sector are reviewed. Transition into primary sector employment is explored as an important aspect of career development for individuals with disabilities. Recommendations for working toward this goal are offered for job development, job analysis, and job training and support. One of the central purposes of vocational rehabilitation (VR) is to assist people with disabilities in securing and maintaining employment consistent with their aptitudes, interests, and education (Rumrill & Roessler, 1999). Despite the wide diversity in these domains among rehabilitation consumers and the vast array of employment opportunities available throughout a vibrant and expanding economy, rehabilitation consumers are employed in a surprisingly narrow range of jobs. In an analysis of 103,417 successfully rehabilitated individuals, Walls and Fullmer (1997) found that the top five occupations held by consumers of all disability types achieving competitive employment through the state-federal VR system were janitor, chef/cook, attendant, porter/cleaner, and kitchen worker. Together, these five occupations accounted for more than 20% of all rehabilitants. Although these are growth occupations, they are primarily low paying and seldom offer benefits (Meisenheimer, 1998). Moreover, the authors noted that many of the occupations most frequently held by rehabilitated individuals require relatively little training and minimal skill levels. The employment outcomes for individuals in supported employment are particularly restricted. Shafer, Banks, and Kregel (1991) found that about 87% of VR-supported employees worked in only two types of work fields: food service (48.7%) and custodial (35.4%). The remaining occupations represented were benchwork (4%), stock handling (4%), laundry work (3%), groundskeeping (1%), and all other jobs combined (4%). These work fields clearly represent the lowest paid jobs in the economy (Meisenheimer, 1998). Some of the difficulties may lie with an emphasis in rehabilitation counseling on one-time job placement for consumers and the relatively small amount of time typically devoted to career development assistance (Gilbride, Stensrud, & Johnson, 1994; Vandergoot, 1987). Pumpian, Fisher, Certo, and Smalley (1997) and Rumrill and Roessler (1999) emphasized that the VR program needed to address career development for individuals with disabilities through a sequence of stages, beginning with exploration and advancing through establishment and maintenance phases. Rumrill and Roessler cautioned, "If clients do not complete exploration tasks satisfactorily, they may become fixed in secondary labor market positions with little future" (p. 27). Walls and Fullmer (1997) noted, "The interaction of client aptitude and choice, )pro-ed Copyright © 2000. All rights reserved. Volume 44, No. 1 (Fall 2000) 23 training and related services, and the conditions of the labor market dictates a set of strictures that determine vocational achievement" (p. 23). What is the "secondary labor market," and in what ways does segmentation of the labor market into primary and secondary sectors affect employment outcomes? Despite widespread use of terms such as secondary labor market, no discussion of issues related to labor market segmentation has appeared in rehabilitation literature. This article outlines the current status of theoretical and empirical work on this topic and examines the implications for the practice of rehabilitation counseling. Dual Labor Markets Doeringer and Piore (1971) and Berger and Piore (1980) are generally credited with developing the theory of dual or segmented labor markets. The theory holds that the labor market is not a single arena but is segmented into two tiers or sectors. In the upper or primary sector, workers enjoy relatively high wages, fringe benefits, satisfactory working conditions, and employment security. Primary sector workers have reasonably equitable workplace policies, and workers receive raises and promotions, or they move to more desirable jobs with another company as their skills and knowledge increase. Additionally, primary sector jobs tend to offer some degree of worker autonomy. In the secondary sector, wages are low, benefits are minimal or nonexistent, work conditions are less desirable, lay-offs and periods of unemployment are more probable, and supervision styles and work rules can be somewhat more harsh or arbitrary. Workers seldom experience any degree of autonomy. Secondary jobs also tend to be concentrated in the least prestigious occupations in the economy, such as those uncharitably referred to as "food and filth" jobs. The rate of turnover in these jobs tends to be high. The critical feature of labor market segmentation is that workers in the secondary sector tend to become stuck in that sector after a time, unable to bridge the gap and rise into the primary sector even as they continue to gain work experience. According to dual market theory, a barrier to movement is built into the structure of the labor market, making it difficult for long-term secondary workers to advance to the primary sector. Empirical Evidence Dual labor market theory was controversial when first proposed, but a substantial body of research, begun in the mid-1980s, has been overwhelmingly supportive of a dual or segmented view of the labor market. Reviews of this work can be found in Lang and Leonard (1987) and Saint-Paul (1996). Several representative studies, including some recent research not included in these reviews, are briefly summarized below. Using a sample of 1,696 workers, Dickens and Lang (1985) tested the prediction that workers receive a lower return on education in the secondary sector. They found that the relationship between education and earnings was best represented by a two-cluster model representing the two labor market sectors. In the primary sector, workers received an average increase of 6% in wages for each year of schooling, although in the secondary sector the return from a year of education was only about 1%. In a further study of the impact of education on earnings, Sakamoto and Chen (1991) selected a sample of 346 secondary sector workers and 573 primary sector workers between the ages of 25 and 27. With ethnicity and geographical variables controlled, wages were about 20% higher for a given level of education in the primary sector than in the secondary sector. Moreover, there was a positive linear relationship between level of education and level of earnings in the primary sector, but in the secondary sector, wage levels were largely independent of education levels, with the exception of those few secondary workers with very high levels of education. Secondary workers are less able to "cash in" on the education they have obtained. Graham and Shakow (1990) studied the relative influence of age and skill level on wage differences for 176 employees in the primary sector and 139 employees in the secondary sector. In the primary sector, age and skill were significant positive predictors of wage differences, but in the secondary sector the degree of relationship between differences in these two variables was not statistically significant. In the primary sector, age had 14 times as great an influence on wages, and skill level had 8 times as great an influence on wages as in the secondary sector. These findings further support the hypothesis that two different wage determination mechanisms are at work in two different market sectors. Krueger and Summers (1988) investigated whether compensation differences in the two sectors could be accounted for by forms of compensation other than wages, such as fringe benefits or perks. They found that taking these forms of compensation into account actually exacerbated differences in compensation across every occupational group. What about the possibility that the lower return on education, experience, and skill in the secondary sector might be offset by relatively better working conditions? Graham and Shakow (1990) examined the relative degree of job risk across groups based on actuarial data (death statistics), employer injury records, and surveys of hazardous working conditions by occupation. Actuarial risk and job- Copyright © 2000. All rights reserved. 24 Rehabilitation Counseling Bulletin related injury were both higher in the secondary group. The secondary group was also higher on 9 of 15 measures of exposure to hazardous working conditions. Thus, it appears that secondary sector jobs involve greater rather than fewer risks, and poorer rather than better working conditions than primary sector positions. Moreover, within the primary group, increases in risk were correlated with wage increases, but risk differences had an insignificant effect on wage differences in the secondary group. To test whether secondary jobs are less stable than primary jobs, Theodossiou and Yannopoulos (1998) examined the unemployment records of 902 employees over a 6-year period. During this time period, individuals whose previous job had been in the primary sector were unemployed an average of 25 months (median = 12), whereas those previously employed in the secondary sector were unemployed for an average of 35 months (median = 24), a statistically significant difference. Finally, empirical evidence has supported the hypothesis that workers tend to become "stuck" in the secondary labor market. Using a statistical modeling procedure, Waddoups and Assane (1997) analyzed monthly data on the primary versus secondary sector jobs of 279 young men working for a 7-year period. When these researchers plotted the probability of a secondary sector worker at one point in time advancing to a primary sector job in the future, the curve that best fit their data approximated an inverted "U," with a midpoint of about 3 years. According to their data, for approximately 3 years, when gender, age, education, and ethnicity were controlled, secondary labor market experience increased the probability of obtaining a primary sector job. But after 3 years, duration in the secondary market became a negative factor that increasingly reduced the probability of a job offer in the primary sector. Qualitative research methods have reached similar conclusions. Wial (1991) studied secondary-to-primary sector mobility by means of interviews with 30 men, ages 17 to 35. Of this group, 50% never held a primary job, 20% obtained their first primary job between the ages of 17 and 19, 17% transitioned to the primary sector between the ages of 20 and 24 and 13% between the ages of 25 and 29. No transition to the primary sector occurred in the 30 to 35 age group. In summary, empirical research in labor economics and the sociology of work supports the theory that the labor market is segmented into (a) a primary sector, where compensation tends to rise with increases in worker skill, experience, and education, and (b) a secondary sector, where compensation is uniformly low and there is little return for gains in skills, experience, or education. The risk of injury and the probability of job loss are higher in the secondary sector, and workers who remain in the secondary sector are, after a time, increasingly less able to make the transition to a primary sector job. Explanatory Theories The secondary labor market is not merely another name for the low end of the employment spectrum. Any labor market will have better paying and more desirable jobs, as well as the reverse. An explanation of labor market segmentation must account for (a) how an economic equilibrium can persist in which differences in worker ability and risk affect worker compensation differently in different job market sectors, and (b) why there is a large and relatively impermeable jump from the secondary to the primary sector rather than a gradual continuum. There was some initial resistance to the acceptance of dual labor market theory due to the lack of an obvious explanatory mechanism. Wages and other compensation for labor in a market economy were traditionally assumed to be determined by two variables: productivity and risk (Saint-Paul, 1996). Workers who produced more were assumed to command higher compensation. Other elements being equal, workers with more skills, experience, and education produce more. So, over time, a worker's level of compensation should increase. Second, taking on greater risks ("disutilities," economists call it)—working at great heights, for example, or around toxic materials—was assumed to require greater compensation. But as research began to show that this simplistic assumption did not hold, explanations advanced to account for the creation and maintenance of a segmented market. These include both demand-side and supply-side explanations. Demand-Side Explanations Palley (1994) and Reynolds (1987) attributed sector differences primarily to differences in size and profitability across companies. More wealthy and profitable companies can devote more resources to employee compensation than less wealthy and profitable companies. Also, Reynolds noted that wealthier firms tend to be larger companies with internal career ladders. Employees can move out of entry-level positions as the company becomes aware of their productivity and skill potential. In contrast, more uncertainty and risk is involved in hiring applicants from outside the firm. In addition, larger employers can invest more resources in employee training and development. In their initial formulation, Doeringer and Piore (1971) attributed labor market segmentation to demand volatility differences across industries. When customer demand is uncertain or fluctuates widely, firms benefit from having one pool of stable, committed workers (the primary workers) and another pool of workers who can be hired and let go at lower cost in response to volatility (the secondary workers). The relative size of each sector is also a function of volatility. The more easily a firm can predict Copyright © 2000. All rights reserved. Volume 44, No. 1 (Faü 2000) 25 future demand, the higher the percentage of its workers in the primary sector, and vice versa. This relationship may explain in part why many secondary market jobs are in the service sector of the economy, because it is generally more volatile (Saint-Paul, 1996). Picard (1993) viewed segmentation as a by-product of differences in the type of labor required in different employment situations. According to this explanation, some jobs in the economy by their nature involve only a few skills. Performing those jobs does not help an employee to build a repertoire of transferrable skills that can serve over time as the foundation or stepping-stone for a move up into the primary sector. Reiter (1991) referred to the skills required in secondary jobs, such as fast-food work, as "mini-skills." Others (e.g., MacDonald & Sirianni, 1996) referred to such jobs as "deskilled." According to this view, workers become stuck in the secondary labor market by virtue of the fact that their work experience does not render them more marketable over time, whereas primary sector workers keep accumulating more transferrable skills through their work. To explain the "deskilling" of certain jobs, a concept known as the "efficiency wage" has been proposed by Shapiro and Stiglitz (1984) and Bulow and Summers (1986). According to this concept, labor market segmentation arises out of two different ways employers can respond to the problem of monitoring workers to ensure that they are doing their assigned work. Some jobs are easily observed and monitored by management. Other jobs are inherently more autonomous, and closely monitoring this kind of work would be very costly. Instead, some employers raise the compensation level of workers in those jobs up to the "efficiency wage," the wage level that in effect reimburses workers for doing some of their own self-monitoring. This higher compensation also makes the penalty for getting caught shirking (unemployment or a secondary job) more costly than the employees are willing to bear. Other employers solve the monitoring problem in a completely different way, paying engineers and others to redesign as many jobs as possible so that the autonomy is removed from workers, and they can be easily monitored. Another way of understanding this intriguing explanation is by distinguishing between work processes and work outcomes. Secondary labor market workers are responsible for carrying out work processes correctly. For example, a fast-food worker may be responsible for removing a basket of french fries from the fryer every time a buzzer sounds. Reiter (1991) explained, "Obedience is primary; there is a great deal of control along with a myriad of rules and regulations" (p. 129). Management has structured the business so that the sum of these "mini-skills" results in the desired production. In the primary labor market, workers are responsible to a greater degree for the achievement of work outcomes or results, with some discretion over how to achieve those results. Oversimplifying the situa- tion somewhat, we might say that primary sector managers tend to monitor the achievement of outcomes, not merely the carrying-out of processes. Supply-Side Explanations Another group of explanations emphasizes differences in the workers seeking employment—not differences in skills or abilities but in variables such as motivation or life circumstances. Reiter (1991) noted that many secondary jobs are occupied by workers interested in flexible, part-time, temporary, or otherwise "casual" employment arrangements. Casual labor force participation creates instability in the labor supply. More casual workers are compensated at a lower rate, and employers have less reason to invest in their training. Wial (1991) noted that over time, many secondary workers develop work habits characteristic of a more casual, less committed participation in the labor force. Workers can become stuck in jobs without benefits for the simple reason that they may be unable to simultaneously maintain their employment and search for a better job (Picard, 1993). Without the benefit of paid time off, being unemployed is a necessary condition for putting serious effort into a job search, and workers whose pay is low to begin with can ill afford to be unemployed. When unemployment does occur, the need for quick reemployment virtually guarantees that the employee must take another high-turnover secondary job. The resulting gaps in work history may also decrease the worker's attractiveness to a primary employer. Even when there are no differences in work stability, supply-side theorists believe that primary sector employers respond to applicants differently depending on the length of their work experience in the secondary sector (Al-brecht & Vroman, 1992; Gottfries &. McCormick, 1995). Extensive job experience in the secondary market acts as a signal to these employers that an applicant may have few work skills or poor motivation. As a result, the probability of a job offer in the primary sector eventually starts to decrease over time, following the inverted U probability distribution found by Waddoups and Assane (1997). Supply-side and demand-side explanations reinforce one another, and Bailey and Waldinger (1991) and Palley (1994) noted that the complete explanation for labor market segmentation is probably a complex interaction among many factors. In any hiring situation, an employer and an employee must each assess whether or not the other party is worth the investment. Employer investments in compensation and training only pay off if workers are reliable and committed. Employee investments in education and skill development only pay off if employers can be made aware of them and are willing to reward them. A combined explanation looks at the situation from each perspective. Copyright © 2000. All rights reserved. 26 Rehabilitation Counseling Bulletin From the employer's perspective, some jobs can be routinized so that complex skills or autonomy are not required; workers can be monitored closely so that a company, if it chooses, need only pay the "bargain basement" labor rate for carrying out routine processes, not the premium "efficiency wage" for achieving outcomes. Some companies make this choice. Other companies are in sectors of the economy so volatile or are so marginally profitable that they cannot invest in employee training or benefits. Still other companies cannot obtain information about which prospective employees are most worth the investment of time, money, and other resources. This may be because some companies are too small to have their own internal career ladder or because they cannot reliably predict which applicants are likely to be committed, consistent, and motivated workers. From the employee perspective, initial experience and work skills are gained through entry-level work in the secondary sector. But workers can reach a point of diminishing returns, where the additional gain from a deskilled job becomes insignificant or even counterproductive. Beyond this point, continued employment in the secondary sector becomes a negative signal to a primary employer. Increasingly unable to yield an adequate return on further job experience and unable to devote serious attention to searching for another job, some workers find themselves stuck in the secondary labor market. Implications for Vocational Rehabilitation The central aims of vocational rehabilitation are for consumers to achieve self-sufficiency and be able to support themselves through earned income. From this perspective, terminal placement of a consumer in a secondary sector job is problematic in several respects: Wages in the secondary sector are not high enough to allow an individual to dispense with the need for additional unearned income, and secondary jobs provide fewer benefits, are less safe, and offer less employer support and less job security. According to dual labor market theorists, secondary sector workers can expect little job-related training, few transferrable skills, and more difficulty advancing beyond the beginning stages of career development. Rumrill and Roessler (1999) have advocated increased attention in the rehabilitation process to assist the consumer in establishing a career rather than achieving and maintaining one job placement. They suggested that guidelines for closure should include qualitative criteria regarding job type and quality. Pumpian et al. (1997) recommended that replacement services be considered an essential component of supported employment, a response not merely to job failure but to an individual's aspirations for career growth. Some research has explored exceptions to the general pattern of labor market segmentation and movement out of the secondary labor market. These studies may offer some clues as to how the primary labor market may be accessed more effectively in vocational rehabilitation. Wial (1991) studied sector mobility and identified patterns characteristic of those workers who successfully made the transition to a primary job. And Bailey and Waldinger (1991) studied the special case of ethnic enclave job markets (the urban neighborhoods of many cities referred to with ethnic names such as "Chinatown"). These markets do not follow the typical segmented pattern. Even entry-level, low-wage jobs operate like a primary market. Skill development is common, wage increases are tied to skill increases, and workers experience consistent upward mobility into better jobs. These findings—as well as an analysis of the interplay of factors governing labor market segmentation—suggest several rehabilitation counseling strategies to increase consumer access to the primary labor market. Networking Approaches to Job Development In Wial's (1991) study, consumers with primary jobs— whether as their first employment experience or after a period in the secondary sector—attributed their success in large part to personal contacts. An individual with a neighbor, relative, or acquaintance who was already established in a primary job was often able to use this contact to learn about upcoming openings and sometimes put in a good word to facilitate hiring. Similarly, Bailey and Waldinger (1991) found that personal ties within ethnic enclave labor markets facilitated secondary-to-primary sector advancement. Entry-level jobs led quickly and reliably to better jobs in ethnic enclave markets because network contacts provided employers with more reliable information about a prospective worker than a "cold" application could provide. In addition, personal relationships are the basis for on-the-job training in these firms. A networking approach to job development, such as developing job leads from canvassing a job seeker's network of acquaintances, neighbors, and family members, as well as the personal networks of rehabilitation service staff, can assist rehabilitation consumers in accessing primary jobs. In a national survey of placement practices, Fesko and Temelini (1997) found that of six identified placement strategies, the networking or personal contact strategy resulted in the highest consumer wages. Assessing Advancement-Potential Job Characteristics Jobs in the secondary sector vary considerably, with some jobs providing a better foundation for the transition to a Copyright © 2000. All rights reserved. Volume 44, No. 1 (Feil 2000) 27 primary job than others. Through job analysis and employer negotiations, rehabilitation counselors can assess the advancement-potential characteristics of a job and build them in or nurture them within a company whenever possible. Autonomy. An employee in a job involving some degree of autonomy, including self-monitoring and problem solving, will be able to demonstrate the achievement of work outcomes rather than merely carry out highly regulated work processes. This job can then be a stepping-stone to a more responsible job. Any worker, regardless of severity of disability, can learn to exercise control over some aspects of a job. Supported employment staff in particular should avoid using a task-analysis training methodology that is so rigid that it unnecessarily contributes to the deskilling or mini-skilling of job tasks and should allow some flexibility when teaching a job (Hagner, 1992). Training and Supervision. Specific provisions for training at a company will enhance employee skill development. Beyond simple monitoring, high quality supervision, such as a supervisory style that is personal enough so that a subordinate's strengths and interests can be noted and capitalized on, will result in greater employee growth over time and greater supervisor awareness of skills. Counselors and placement personnel can assess the training and supervision practices of a company and may be able to consult with employers to make improvements in these areas. Employees with disabilities can discuss their training and supervision requirements with employers and request accommodations if necessary to ensure that a job uses existing skills and offers opportunities to build new ones. Promotion Process. Entry-level employees in jobs with clear advancement opportunities are less likely to remain at the entry level. Companies that provide such opportunities are often larger companies with internal career ladders. In smaller companies, job analysis can sometimes identify tasks for developing specific, marketable skills that can be added once an employee masters the initial assigned tasks. For example, a supported employee working as a housekeeper in a nursing home added assisting with bingo 1 evening per week to her job to gain experience in facilitating group activities. Follow-Along Career Development Assistance When a rehabilitation consumer begins employment in a secondary sector job, employment follow-along should be offered, either as a postemployment service (in competitive employment) or as part of ongoing support (in supported employment), focusing initially on job maintenance but shifting after a time to career development. Even successful and satisfied employees can continue to explore and learn about other opportunities. For example, one employment specialist noticed that a consumer working as a supermarket bagger had begun speaking in Spanish to the Spanish-speaking customers. The specialist set up some informational interviews for the consumer to explore higher-paying jobs with a bilingual focus. Follow-along employer contacts should include discussion of advancement and/or job enlargement possibilities once basic tasks have been mastered and can also include employer consultation regarding job training (for example, to include more autonomous task elements). Follow-along employee contacts should include assisting the employee in identifying noteworthy work accomplishments and periodically updating his or her resume, and also assisting, as needed, with communicating to the supervisor a desire for more responsibility or an interest in learning new aspects of the job. An important focus of instruction for supported employment specialists to consider is in the area of self-monitoring and self-instruction. Recent research (Agran & Moore, 1998) has shown that individuals with severe disabilities, once assumed capable of only routine jobs with no autonomous elements, can learn effective problem-solving and self-direction skills. Repeated Job Development Secondary sector jobs have value in the early stage of a career, but after a consumer has received the benefits of initial adjustment to the world of work that these jobs provide, additional job search assistance should be available. This process may need to be repeated several times until an individual is established in a primary sector job. Many consumers can take the lead in their own job search, perhaps after receiving job-seeking skills instruction or with the assistance of a job club or job search peer support. It is important, however, that counselors verify retention of job-search skills over time and make additional training available. Job-search skills, like any infrequently used skills, may weaken over time. Obtaining the more desirable primary jobs often requires more sophisticated resume preparation, network expertise, or interview skills than entry-level jobs. In fact, job-seeking skills training may paradoxically be most useful not prior to initial job placement but after an individual is successfully employed to pave the way for movement into other positions more consistent with his or her true career aspirations. The key strategies for facilitating access to primary jobs are summarized in Figure 1. Obviously, an individual highly satisfied with his or her secondary job (and aware that other options and assistance are available) should not be forced to change Copyright © 2000. All rights reserved. 28 Rehabilitation Counseling Bulletin Job Company, Consumer. Start Date Is the job in the primary sector? _Are wages well above the statutory minimum? _Are fringe benefits provided? _Are working conditions pleasant and safe? _Is the job stable, and is company turnover low? _Are work rules and policies fair and communicated clearly? YES NO Does the job have advancement potential? _Is some degree of worker autonomy built in or possible? _Does the company have a comprehensive on4h&Job training program? _Is employee supervision of high quality? _Does the company have a career ladder, or are there job enlargement options? Service Provision: Ongoing Support (supported) or Post-Employment Services (competitive) Consult with employer re: training and advancement Assist employee with requesting promotion, new duties, etc. Teach self-instruction and self-monitoring. Follow along to verify advancement. Help identify transferrable skills and accomplishments. Continue with career exploration. Assist in keeping resume updated and in refining job search skills. Reintroduce job development as needed, emphasizing a networking approach. figure 1. Worksheet for determining access to primary sector jobs. jobs. But neither should an individual be forced to end his or her career growth at the point where most people begin theirs or lose a job in order to qualify for further assistance. Conclusion A review of literature in labor economics and the sociology of work suggests that labor market segmentation ex- erts an important influence on employment outcomes and that careful attention to the forces of labor supply and demand may be necessary to avoid unnecessarily restricting career opportunities. For consumers of rehabilitation services, as for other job seekers, movement out of the secondary sector is not simply a matter of personal development through stages of career growth. A range of variables, including individual career self-awareness and development; individual skills, abilities, and interests; and external factors, such as employer attitudes, all affect ca- Copyright © 2000. All rights reserved. Volume 44, No. 1 (Fall 2000) 29 reer outcomes. Rehabilitation counselors must also be aware of the role that structural features of the labor market can play and should employ specific strategies to assist individuals with disabilities to advance out of the secondary sector and into the primary sector. Jenkins and Strauser (1999) have argued for an expansion of the rehabilitation counselor's role and a concomitant expansion of the content of personnel preparation programs in the field of rehabilitation to content areas of direct relevance for assisting individuals to obtain employment. The applicability of information from the fields of labor economics and the sociology of work to the process of career development gives added force to this recommendation. about the author David Hagner, PhD, is rehabilitation projects director with the New Hampshire Institute on Disability and codirector of the New England Regional Continuing Education Program for Community Rehabilitation Personnel. 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