Work injury rehabilitation and the tendency to return to work of workers with injuries in Mainland China

This paper aims to describe the current situation of the work injury rehabilitation system in China with its drawbacks, especially relating to the employment services for workers with injuries and bringing up the topic of the need for more work to attempt to construct a modern work injury occupational rehabilitation system: perfecting the administration mechanism of policy, establishing an occupational rehabilitation pattern with Chinese characteristics, establishing the socialization service network as the core of occupational rehabilitation and establishing a practical professional team and academic communication platform. These creative thoughts may shed light on the development of the work injury rehabilitation system as well as the return to work for workers with injuries in China.     

Multiple sclerosis and employment barriers: a systemic perspective on diagnosis and intervention

Although they have a recent work history, 70 to 80% of adults with multiple sclerosis are unemployed following their diagnosis. This high rate of unemployment constitutes a great loss of potential to the American economy. To help individuals with multiple sclerosis (MS) return to work or retain employment, rehabilitation professionals must understand the barriers resulting in unemployment and implement interventions to reduce or remove those concerns. In this article, Hershenson's systemic model of rehabilitation counseling is presented as a diagnostic scheme for identifying barriers to employment. Counselor consultation on barrier removal via reasonable accommodation is presented as one example of a rehabilitation intervention consistent with the systemic diagnostic model.     

When elevators were for pianos: an oral history account of the civilian experience of using wheelchairs in Canadian society. The first twenty-five years: 1945-1970

In 1945 Canadian World War II veterans with spinal cord injury were among the first Canadians to have access to medical rehabilitation programs, the Everest and Jennings folding, self-propelled wheelchair and automobiles with hand-controls. A previous paper, Going back to Civvy Street (Tremblay, 1996) described how the veteran pioneers used these new opportunities to return to full participation in civilian life. Drawing on oral history and archival research, this paper examines the experiences of Canadian civilians with spinal cord injury as they tried to follow the veterans' example. It discusses the strategies these pioneers used to overcome obstacles, such as stairs and curbs, as well as providing examples of their experiences in finding housing, education and employment. The paper reviews the responses individuals received from their fellow citizens and highlights the limited recognition of architectural barriers in an era when elevators were for pianos!     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

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.     

Effectiveness of problem solving skills in case management on return to work for workers with injuries

The present study aims to explore the case management model by using problem solving skills in assisting workers with injuries in returning to work. A total of five workers with injuries were enrolled and there were four stages during the whole case management process including a medical rehabilitation stage (stage I), a compensation stage (stage II), a return to work stage (stage III) and a follow-up stage (stage IV) respectively. Case managers provided services by using problem solving skills to tackle the problems which workers with injuries may encounter during all four stages. Outcome measurement showed one case return to the same company same job, two returns to different companies and different jobs, the others have self employed work. This study suggested that case management using the problem solving skills of occupational rehabilitation was beneficial to workers with injuries on return to work.     

Employment after spinal cord injury: the impact of government policies in Canada

The British Columbia Paraplegic Association (BCPA) sought a research partnership to evaluate where its activities should be focused. A survey of members with disabilities of the BCPA included questions on employment and identified three priorities related to employment. These were the need for assistance in finding appropriate work, the impact of policies of government and insurance agencies, and attitudes of employers. This paper examines the social and political environment related to employment following spinal cord injury in British Columbia, Canada. There is no coherent set of goals underlying government employment and income programs in Canada. Incremental development of particular employment and income programs during the 20th century led to a patchwork of policies and programs, which deal with people differently according to the cause of their disability. Federal and provincial governments have attempted to educate employers and reduce barriers to employment of those with disabilities by focusing on anti-discrimination legislation and individual rights (e.g. the Employment Equity Act and the Canadian Human Rights Act). However, people with disabilities face non-accommodating environments, inadequate income support, lack of opportunities and little political influence which stem from an unfair distribution of societal resources, not from discrimination. Joint efforts of the BCPA and other disability organizations are likely to have the most impact on legislative changes.     

Logging injuries in Louisiana: nature,trends, and rehabilitation considerations

Logging is a dangerous occupation, as documented through reported injuries and fatalities. Accidents in the logging industry account for pain, suffering, employee turnover, and high insurance costs. Worker injuries and high insurance costs, in addition to other factors, may be minimized and reduced through safety education and improved logging practices. Furthermore, the injured logger, or logger with a disability may return to logging or other employment through development of viable medical and vocational rehabilitation planing. This article addresses the economic impact of logging, reviews logging injuries, describes a safety program designed to reduce logging injures, discusses rehabilitation considerations for specific injuries, and outlines particular reemployment prospects for loggers with disabilities.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

Going Back to Civvy Street: a historical account of the impact of the Everest and Jennings wheelchair for Canadian World War II veterans with spinal cord injury

In February 1945, the Canadian government agreed to provide the Everest and Jennings folding, self-propelled wheelchair to all World War II veterans with spinal cord injury. These wheelchairs replaced wooden and wicker invalid wheelchairs that were usually assigned to hospital wards rather than to individuals. Veterans with spinal cord injury were among the first group of Canadians to use these wheelchairs to participate in community life. By 1947, Canadian veterans had demonstrated that it was possible to return to education, employment and leisure activities using a wheelchair. Drawing on oral history interviews and archival research, this paper provides an account of the introduction of folding, self-propelled wheelchairs into Canada following World War II. It discusses the impact of these wheelchairs on the life experiences of veterans, and outlines the strategies used by these early pioneers to live and work in communities that had neither expected nor planned for individuals using wheelchairs.     

HIV/AIDS and return to work: a literature review one-decade post-introduction of combination therapy (HAART)

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000-950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the US, issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns. The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.     

Enterprising? Disabled? The status and potential for disabled people’s microenterprise in South Korea

This article explores the position, potential and scope for self-employment and microenterprise for disabled South Koreans. The chronic barriers experienced in disabled people gaining paid work suggest that self-employment and enterprise might offer a good alternative to paid work. The self-determined nature of running a microenterprise has been shown to connect with disabled people who may not conform to standardised notions of body and brain that underpin many mainstream work contexts. Despite this promise, several barriers continue to beset disabled people’s access to micro-enterprise activity; barriers ranging from Confucian precepts, to employment protections that are geared largely towards paid employment and to the lack of training, finance and business support for disabled people starting up and sustaining microenterprise in Korea. The extension of legal protections, meaningful start-up subsidies, better business support and bridges between paid work and microenterprise are all seen as important policy correctives that would better support disabled people.     

Mental health service users' experiences of returning to paid employment

Research into mental health and employment has focused largely on people who are unemployed. This paper reports the experiences of 20 clients of employment support agencies who had succeeded in returning to work. A number of barriers to getting back to work were identified, but receiving employment support could enable people to overcome them. There was consistency with previous studies of factors associated with high and low levels of job satisfaction. Even those participants who were less satisfied with their jobs identified benefits and none described any negative effects. The quality of the employment support provided was important, including advice and counselling during the job search, enabling informed choice about disclosure and support in work. Job retention targets are required for funding programmes in addition to placement targets. Further research into the timing and processes of disclosure and into occupational health screening processes would be helpful.     

Potential Assistance for Disadvantaged Workers: Employment Social Enterprises

By integrating a business mission into a transitional jobs program, employment social enterprises (ESEs) provide temporary work and a supported work environment to reduce the barriers facing disadvantaged workers while generating revenue to cover production costs. This study uses surveys of workers in and financial statements from seven ESEs to provide information for three sets of complementary analyses: a pre-post analysis examines changes in employment between the time a person starts ESE work and about one year later; a case study uses propensity score methods to compare changes in employment between ESE workers and similar people who did not work in an enterprise; and a cost-benefit analysis estimates the potential value of ESE jobs. Results suggest that individuals have close to 21% gain in employment one year after starting ESE work; taxpayers gain at least $0.42 for every dollar spent on an ESE job; the return to society of developing an ESE is at least 34%; and the social returns to converting a profit-driven business into an ESE exceed 100%. Although the study cannot control for many of the factors that would allow estimation of causal impacts, it provides some of the first preliminary evidence of the value of the ESEs’ public-private approach to increase workforce skills and employment and stabilize lives of individuals with employment barriers.     

Spinal Cord Injury

ABSTRACT

This article provides an overview of spinal cord injury (SCI) that is useful and informative for social workers and other health care professionals who work with this population. Social workers new to the specialty of spinal cord injury must expand their knowledge base of this chronic injury. Social workers contribute to the rehabilitation process through assessment, education, and discharge planning. This article also may be used to inform persons with spinal cord injury and their families and to encourage them to engage in dialogue about SCI in the earliest stages of treatment and rehabilitation.     

Assistive technology and employment: experiences of Californians with disabilities

For people with disabilities, work remains the best route to independence and enacting one's own choices. Assistive technology (AT) is often crucial in removing barriers to employment, and in enabling workers with disabilities to work more productively. A participatory action research project known as Community Research for Assistive Technology surveyed people with disabilities using Independent Living Centers throughout California, in part to identify barriers to employment and study use of job-related AT to overcome such barriers. Across disability groups, disability itself was cited as the primary barrier to employment, with potential loss of benefits and lack of education cited as secondary barriers. A majority of working respondents reported using assistive technology (such as adapted telephones, wheelchairs, magnifiers, and adapted computer equipment) or services to perform job functions. The vast majority of those using job-related AT reported substantial benefits to their productivity and self-esteem. Employees' requests for AT as a workplace accommodation were granted more often than not, but many other employees had to pay for their own workplace AT.     

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.     

Perspectives on workplace disability management: a review of the literature

Work-related musculoskeletal injuries represent a major source of work disability. While many employers recognize the importance of workplace disability management approaches and are assuming greater responsibility for preventing and minimizing work-related disability, questions about the effectiveness of these interventions exist. The purposes of this article are to: 1) describe the essential components of workplace disability management programs related to musculoskeletal injuries; 2) review the literature on disability management practices based on research evidence by focussing on workplace-based interventions and the role of the workplace; and 3) provide recommendations for disability management in the prevention and reduction of disability, and the rehabilitation of injured workers with musculoskeletal work injuries. The literature suggests that employer participation, a supportive work climate and cooperation between labour and management are crucial factors in facilitating return to work. Given the complexity of the disability management process and the numbers of individuals involved, it is essential that all workplace parties work together to achieve the goal of safe and early return to work.     

Consumer participation in the employment rehabilitation process: contextual factors and implications for practice

Rehabilitation models of practice have emerged that offer persons' with disabilities opportunities to have an active role in the work entry or re(entry) process. Despite the growth and interest in empowering client involvement in practice, consumer views on the determinants of participation are not fully understood. Thus, consumer feedback on using a self-directed approach to employment rehabilitation was elicited to identify factors integral to their participation in the process. Focus groups were conducted with 35 adult consumers with developmental, mental health, physical and learning disabilities to gain insights into their involvement in a participatory approach to find employment. Content analysis of data revealed barriers and facilitators, which hindered or enabled consumer involvement in the vocational service process. This article discusses the importance of considering issues across the rehabilitation system, practice and lived contexts when implementing participatory approaches in vocational rehabilitation settings.     

Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers

This study examined the perspectives of people with psychiatric disabilities and employment service providers regarding factors that most directly help or hinder consumer efforts to obtain and maintain employment. Forty-four adults with serious mental illness (SMI) (consumers) and 30 providers participated in 12 focus groups across Massachusetts. We began both consumer and provider groups by posing two broad questions: 1) what factors most help people with SMI get and keep jobs (facilitators), and 2) what factors most prevent people with SMI from getting and keeping jobs (barriers)? Data were analyzed qualitatively and both person and environmental factors were highlighted. Among facilitators, participants agreed that quality consumer-provider relationships and individualized employment services are most instrumental in helping consumers achieve employment goals. Participants identified a range of environmental barriers, including issues related to the service system, entitlement programs, non-human resources, and social stigma. Implications for services are discussed.