The art and science of teamwork: enacting a transdisciplinary approach in work rehabilitation

Teamwork, collaboration and interprofessional care are becoming the new standard in health care, and service delivery in work practice is no exception. Most rehabilitation professionals believe that they intuitively know how to work collaboratively with others such as workers, employers, insurers and other professionals. However, little information is available that can assist rehabilitation professionals in enacting authentic transdisciplinary approaches in work practice contexts. A qualitative study was designed using a grounded theory approach, comprised of observations and interviews, to understand the social processes among team members in enacting a transdisciplinary approach in a work rehabilitation clinic. Findings suggest that team members consciously attended to a team approach through nurturing consensus, nurturing professional synergy, and nurturing a learning culture. These processes enabled this team to work in concert with clients who had chronic disabilities in achieving solution focused goals for returning to work and improving functioning. Implications for achieving greater collaborative synergies among stakeholders in return to work settings and in the training of new rehabilitation professionals are explored.     

Enhancing parental power and flexibility in the transition from welfare to work

Recent welfare reforms in the United States shifted the emphasis from income maintenance to preparation for employment. Many families receiving welfare benefits have members with disabilities, which can complicate the process of transition into the workforce. Rehabilitation professionals have a unique set of skills, expertise and experiences which could enhance work transition outcomes for welfare recipients. This purpose of this article is to (a) familiarize rehabilitation professionals with welfare reform changes in the United States, (b) summarize the experiences of families affected by those changes who participated in a recent study, and (c) present a service delivery model to enhance parental power and flexibility based on rehabilitation principles.     

How can cooperation between rehabilitation professionals in rehabilitation planning be improved? A qualitative study from the employer's perspective

Research shows that there are often problems with cooperation between rehabilitation professionals within vocational rehabilitation. The aim of this study was to describe employers' experiences of how cooperation between different rehabilitation professionals can be improved in a vocational rehabilitation planning process. Ten employers who had sent their employees to vocational rehabilitation at a rehabilitation centre in the north of Sweden during 2000 and 2001 participated in the study. Qualitative interviews were performed and analysed by thematic content analysis. The employers' cooperation with clients could be improved by a focus on clients' needs and participation in the rehabilitation process. The employers cooperation with Social Insurance companies could be improved by, 1) early prevention and intervention, 2) knowledge of each other's roles, responsibilities and opportunities and 3) priority making. The employers' cooperation with rehabilitation professionals could be improved by, 1) early identification of rehabilitation needs and goals and early rehabilitation and, 2) increased focus on own responsibilities from each part in the process.     

Mismatch of school desks and chairs by ethnicity and grade level in middle school

The purpose of this article is to introduce the cross-disciplinary competency standards for work-related assessments, why they are needed and how they have been developed in New South Wales (NSW). Cross-disciplinary competency standards communicate the benchmarks for effective performance of work-related assessments. They outline what is expected of rehabilitation professionals, including the ability to apply and transfer competence across different conditions and workplace contexts. Outcomes in occupational rehabilitation are affected by the efficacy of the work-related assessments performed, which is dependent upon competent, clinical decision-making by rehabilitation professionals. However, in Australia, work-related assessment practice is not governed by universally accepted competency standards or by any competency-based training/education and assessment system. To enhance professional practice, WorkCover NSW has developed cross-disciplinary competency standards for work-related a ssessments. The competencies provide (i) quality standards for professional workplace training and development, (ii) benchmarks for assessing the competence of rehabilitation professionals, (iii) a framework for evidence-based practice, (iv) benchmarks for measuring service quality and (v) "real world" learning outcomes and assessment criteria for professional education programs.     

A Qualitative Study of the Perceptions of Individuals with Disabilities Concerning Health and Rehabilitation Professionals

This paper examined the perceptions of persons with disabilities concerning their interaction with health and rehabilitation professionals. Data were collected and analysed with grounded theory methods, and resulted in a typology and a thematic analysis that found that: (a) most persons who perceived themselves to be disadvantaged by social oppression or stigma were also dissatisfied with health and rehabilitation professionals; and (b) those persons who de-emphasised the impact of disability either reported satisfaction with health and rehabilitation professionals or perceived their own efforts as being the primary factor in their ability to live with disability. The perceptions of respondents were, in most instances, mediated by dominant gender stereotypes.     

The Recovery Approach to Rehabilitation: Implementation in Supervision

The recovery approach to psychiatric rehabilitation has introduced a new set of challenges, enabling consumers to set goals and redefine their role in obtaining them. This has revolutionized the management of the relationship between service providers and consumers. In the present paper, we suggest that one of the important ways to supervise professionals interested in internalizing the recovery approach is to implement its major principles in the supervision work itself. The paper draws on intersubjective therapy concepts and guiding principles, which emphasize the development of the professional–consumer relationship in which the consumers' sense of agency can be respected and promoted. The principles we suggest here which may underlie supervision are: (1) clients or supervisees, with their own decisions and interests, are at the center of the rehabilitation therapy and supervision; (2) mutuality in the rehabilitative/supervisory relationship and ongoing discussion of the interactants' power and authority; and (3) the promotion of positive and empowering narratives and self-perceptions in the process of rehabilitation/supervision.     

An historical overview of Australia's largest and oldest provider of vocational rehabilitation--CRS Australia

CRS Australia, the largest and oldest vocational rehabilitation provider in Australia, is examined over its 60-year history. The Australian government located CRS initially in the Department of Social Security, and subsequently in the Department of Community Services however, its establishment required a complexity of policy and range of skills that were not found in one arm of government alone and required cooperation from many government departments. A disagreement between the government and the medical profession about the purpose and control of rehabilitation features in the early history of CRS Australia. Factors such as greater involvement of people with disabilities and government inquiries led to a move from a centre-based to a community-based approach to vocational rehabilitation in the 1970s. CRS Australia is a large employer of health and human service professionals and has played a significant part in the development of these professions in Australia. In recent years, CRS Australia has provided greater business accountability to government and the broader Australian community. CRS Australia's role as an expert vocational assessment agency and vocational rehabilitation provider is expected to continue as welfare reform progresses in Australia.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Building employer capacity to support employees with severe disabilities in the workplace

Vocational rehabilitation has increasingly emphasized individualized community employment for individuals with severe disabilities. Early approaches were highly controlled by rehabilitation professionals, but research has shown that high levels of professional support can be intrusive, and that businesses are more able to participate in the support process than was initially assumed. This article summarizes recent developments leading to a new generation of partnership approaches that support and build the capacity of employers to successfully employ individuals with severe disabilities. Four innovative approaches--a consultation model of employer support, the development of business consortia, expanding diversity programs, and directing service funding to employers or coworkers--are described and the implications for rehabilitation services are outlined.     

Transition and the community college: a Career Keys model for students with disabilities

Transition models are needed that address multiple phases in the postsecondary education of students with disabilities. These models must first address the recruitment of high school students with disabilities for community colleges through career exploration experiences that help students clarify their educational and vocational interests and relate those interests to a two-year postsecondary program. Students with disabilities then need a comprehensive service program while attending community college to help them identify accommodation needs in classroom and workplace environments and develop the skills to request such accommodations from their instructors and employers. With this skill base, they are well prepared to initiate the next transition in their lives, that is, the movement from the community college to a four-year educational institution or to employment. Programs are needed to facilitate this transition, such as a placement planning seminar involving rehabilitation professionals and employers and an accommodation follow-up assessment with students in their new educational and employment settings. The "Career Keys" model describes how to deliver the services needed in each of these critical transition phases.     

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.     

Rural Lesbians and Gays

Abstract

The author examines rural helping professionals' perceptions of lesbian and gay consumers and the effects their perceptions have on the provision of services to this population, including the tensions that result when helping professionals' perceptions hinder their acceptance of gay and lesbian consumers. This article uses reports from helping professionals to supplement the discussion. This article challenges helping professionals to evaluate their perceptions of gay and lesbian social service consumers which may hinder their accepting these consumers so that practitioners may gain full acceptance of their gay and lesbian service consumers.     

Content validation on the Work Performance Rating Scale for sheltered workshop workers

The purpose of this study was to revise the content of the Work Performance Rating Scale (WPRS) as a valid assessment tool for sheltered workshop workers. A focus group of 11 sheltered workshop workers was recruited to collect their opinions about the relevance of the WPRS from the service users' perspectives. A panel of 23 frontline practitioners who had experience in using various work assessment instruments provided at their work setting was recruited to review the content of the WPRS. A 14-item amended version of the WPRS with five new items added was proposed based on the opinions of service users, frontline practitioners, and the concept of the Minnesota Theory of Work Adjustment (MTWA). An expert panel of 12 professionals at the senior level from various vocational rehabilitation settings was recruited to comment on the content validity of the 14-item amended version of the WPRS. The expert panel agreed that the amended version of the WPRS was related to the concept of job satisfactoriness which could be used to assess the work performance of sheltered workshop workers. Thus, the use of the MTWA for improving the content validity of the WPRS to assess the employability of sheltered workshop workers was supported by the findings of the study.     

A Critical Analysis of the Social Work Literature on Disabilities

Abstract

The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twenty-five categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.     

Visibility,Immobility and Stigma: Young People's Use of Sexual Health Services in Rural Areas†

Teenage pregnancy has become a major policy issue, for which young people are often publicly held solely responsible. However, a combination of factors substantially increases the risks of conception faced by young people engaging in early sexual activity. This article reports the main findings of a study of teenage pregnancy in linked seaside and rural areas, focusing on the experiences and perceptions of young people living in rural localities. They identify the issues of immobility, visibility and attitudes of stigma as affecting their ability to access sexual health services. The young people highlighted issues for service and policy development and the behaviour of professionals, both within schools and from sexual health services. Education, social and health services and the voluntary sector have important roles to play in responding to their needs.     

Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Services for the underserved. A nurse-managed center for the chronically mentally ill

1. A university-based, nurse-managed center for the chronically mentally ill enhanced the experiences of baccalaureate nursing students with this underserved population. 2. The course objectives included psychosocial rehabilitation for chronic illness and provided a good fit between client's needs, course objectives, and the behavioral-ecological model. 3. The project positively changed the attitudes of nursing students. Changing attitudes of professionals and motivating student interest toward the chronically mentally ill is an imperative for meeting their needs.     

Isn’t that why you were hired?

Human service organizations seek bilingual professionals to meet the social and linguistic needs of their increasingly limited English proficient (LEP) clientele. As a result, bilingual professionals often find themselves having to meet overwhelming service delivery expectations. This paper reports on a qualitative study about the work experiences of 27 court employees within a judicial system in the Eastern United States. The study found that bilingual professionals encounter challenges because of their language skills. At the intersection of these challenges are microaggressions that manifest in the judicial system, adversely affecting them professionally and personally.     

An ecological approach to facilitate successful employment outcomes among people with multiple chemical sensitivity

Many adults with multiple chemical sensitivity (MCS) must prematurely exit the workforce because of the severity of their MCS symptoms, the resulting disability stigma, and their unmet needs for on-the-job accommodations. To help individuals with MCS continue working or re-enter employment, rehabilitation professionals must understand the barriers resulting in unemployment and implement interventions to reduce or remove those barriers. In this article, the Ecological Model of Career Development is presented as a scheme for identifying barriers and implementing rehabilitation interventions to improve the employment outcomes among people with MCS.