Successful Vocational Rehabilitation for Individuals with Significant Mental Disabilities

ABSTRACT

Individuals with significant mental disabilities (SMD) frequently have scattered work histories (Finch, 1997; Tan, 1996). Often the SMD consumer is unable to find competitive employment or, if a job is secured, termination repeatedly ensues because of impaired interpersonal skills, faulty behaviors such as the inability to interact with coworkers, inadequate follow-through such as not reporting to work, and poor hygiene (Tan, 1996). The services provided to SMD consumers in this study were designed to address a cadre of support needs that would foster job retention and increase the number of successful employment closures. This cross-sectional exploratory study sampled 211 SMD consumers who received vocational rehabilitation support services through a vocational rehabilitation center in Columbus, Ohio. The SMD consumers sampled experienced both successful and unsuccessful employment closures.     

Internal locus of control and vocational rehabilitation

In previous studies, internal locus of control (ILC) has been pointed out as a key factor for return to work after vocational rehabilitation. The aim of the current study was to gain a deeper understanding of the concept of ILC in a Swedish vocational rehabilitation context. The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational rehabilitation. A first bi-variate analysis showed that ILC was positively associated with physical functioning and general health, and negatively associated with bodily pain. The analysis also showed that women, more than men, reported high internal locus of control. After a second multivariate analysis, only bodily pain remained associated. It is concluded that there exist a strong and negative association between bodily pain and internal locus of control. Clients with severe pain often also suffer from low internal locus of control. This should be kept in mind when providing vocational rehabilitation.     

Survey of state vocational rehabilitation counselor roles and competencies in assistive technology

The delivery of assistive technology (AT) within the state and federal vocational rehabilitation systems in the United States has been developing and refining itself over the last twenty years. Many challenges have been confronted in an attempt to use this relatively new service to increase the employment options and success for individuals with disabilities. In this process, the rehabilitation counselor serves as a critical player in the planning and delivery of AT as it articulates with other rehabilitation services. This study investigated counselor views regarding their role and competence in providing AT services and devices to individuals with disabilities throughout the state of Wisconsin. The results of the survey indicated, in general, that counselors find AT to be a cost-effective service that can increase employment related outcomes. As with other service areas, the counselors' role in AT service delivery involves coordinating, purchasing and following up on services. Interestingly, while counselors expressed confidence in performing these overall functions, they reported a lack of confidence in identifying the need for AT services. Without a comfort level to make this determination, benefits from the implementation of AT may be quite limited. Results suggest that intervention is needed to improve counselors' abilities to make decisions regarding AT services.     

Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Going beyond vocational rehabilitation as a training of skills: return-to-work as an identity issue

In western welfare states, labour participation is increasingly considered a vital aspect of taking part in society. Vocational rehabilitation programmes are intended to support people in the process of returning to work. These programmes pay much attention to the skills that clients need to develop in order to return to work. We argue, however, that vocational rehabilitation is more than the acquirement of skills, and that further attention should be paid to clients’ ‘identity work’ processes. Based on 45 life-stories, we present an analysis of the identity work expressed by people with a work disability in the Netherlands. We describe ‘separative’, ‘integrative’, and ‘pending’ processes of identity work. The presented typology can help vocational rehabilitation professionals become more sensitive to clients’ processes, and supports more inclusive vocational rehabilitation.     

Prepared for Practice? Graduating Social Work Students' Reflections on Their Education,Competence and Skills

The paper encompasses the views of 13 Swedish graduating social work students on their education, competence, skills and expectations for their future roles as social workers. It presents the findings of the first phase of a longitudinal study where students in Sweden and Australia are followed from university and during the first 18 months in the profession. A qualitative methodology was employed and semi-structured interviews were conducted with the students just prior to graduating. The most salient theme was the strong wish for more time in contact with the field. All of the students would have preferred at least one additional period of field placement. A strong wish for clarity, particularly in relation to understanding what it means to practise social work, emerged. Although most of the graduates talked about their self-development and described themselves as having become more critical and more self-confident, they perceived themselves as more or less unprepared for most social work positions and expected to receive considerable support and guidance in their workplaces. The proportion of theoretical and research courses in comparison to the teaching of practice skills and field placements within Swedish social work education is discussed.     

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.     

Conceptions of Immigrant Integration and Racism Among Social Workers in Sweden

Drawing on 22 qualitative interviews with social workers in Sweden, this article analyzes how social workers conceive immigrant integration and racism and tackle racism within their institutions and the wider Swedish society. The majority of the white social workers framed integration in relation to cultural differences and denied or minimized the role of racism in structuring their services and the ethnic relations in Sweden. In contrast, social workers with immigrant backgrounds were less compromising in discussing racism and assumed it as a problem both for themselves as institutional actors and as immigrants in everyday life and institutional settings. Social institutions in Sweden have been important actors in endorsing equality and accommodating differences. However, it is of paramount importance for social justice-minded social workers to identify and unsettle those structures and discourses that enable racist and discriminatory policies and practices against those groups who are not viewed as “core” members of the Swedish society. The absence of anti-racist social work within Swedish social work is primarily related to the idea of color-blind welfare universalism that is assumed to transcend the particularity of the needs, experiences, and perspectives of different groups in Sweden. While integration is envisioned and framed as a political project of inclusion of non-white immigrants, it tends to become a political device through which hierarchies of belonging are constructed. Following such conception of integration, cultural/religious differences and equality are framed as conflicting where cultural conformity underpinned by assimilationist discourses becomes a requirement for political, social, and economic equality.     

Project Employ: engineering hope and breaking down barriers to homelessness

The homeless population in the US has dramatically increased in the past two decades. People who are homeless often lack skills sets such as stress management and social skills, independent living skills, and skills for vocational and leisure engagement. Best practice vocational education and training programs for individuals who are homeless recognize that success in the worker role often hinges on a person's capacity to manage day-to-day living. Life skills and pre-employment training are essential components of vocational programs but no more important than interpersonal skill development including anger management, developing self esteem and motivation, building goal setting capacity, and skills for money management, personal budgeting and self-advocacy. These areas of performance have all been traditionally included in occupational therapy's domain of practice. This article describes Project Employ, a grant funded supportive employment program that has grown out of collaboration between Duquesne University's Department of Occupational Therapy and Bethlehem Haven, an emergency shelter and residential recovery program and primary service provider for homeless people in Pittsburgh, Pennsylvania. The purpose of this article is to describe the history, structure and outcomes of Project Employ.     

Canonical correlation analysis of residential and vocational outcomes following psychiatric rehabilitation

This analysis uses canonical correlation techniques to explore client outcomes following psychosocial rehabilitation services in two rehabilitation areas: vocational and residential. At issue are the ways in which these two outcomes are affected by a series of eight client characteristics and service delivery features. The overarching question is the effectiveness of the program in establishing independence vocationally and residentially, and whether the same set of factors influences these two outcomes for persons with mental illness. Subjects were 212 ex-clients of a psychosocial rehabilitation agency who were working six months after leaving the program. The analysis derived two canonical functions both of which were significant. Canonical loadings and cross loadings indicated that client level of functioning and program tenure loaded most strongly with residential status on the first canonical variate while education loaded most strongly with salary on the second. These results support the notions that different predictors account for the variance associated with different outcomes following psychosocial rehabilitation. Discussion of the relevance of strong predictor variables highlights ways they can impact program design. Finally, the usefulness of canonical correlation in longitudinal program evaluation research is explored.     

Assistive technology outcomes in work settings

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.     

Content validity and utility of the Assessment of Work Performance (AWP)

In the area of work rehabilitation, many decisions about future interventions for the client are based on the results of various kinds of assessments. Therefore, it is important that the assessment instruments used are adequate, useful, and reliable. The purpose of this study was to investigate the content validity and utility of the instrument Assessment of Work Performance (AWP) which is used to assess an individual's observable (working) skills during work performance, i.e. how efficient and appropriate a client performs a work activity. A questionnaire was answered by 67 respondents who used the AWP in various work rehabilitation settings in Sweden. The result indicates content validity and utility for the AWP that supports further testing of the instrument.     

The reproduction of gender: housework and attitudes towards gender equality in the home among Swedish boys and girls

The housework Swedish girls and boys age 10 to 18 do, and their attitudes towards gender equality in the home are studied. One aim is to see whether the work children do is gendered and if so, whether they follow their parents', often gendered, pattern in housework. A second aim is to see whether children's attitudes are influenced by their parents' attitudes and practices. When it comes to issues like these, Sweden is of special interest because in 1995, Sweden was appointed the most gender equal country in the world by the United Nations. The data used were the Swedish Child Level of Living Survey 2000 (see http://www.sofi.su.se/LNU2000/english.htm), a data set that includes extensive first-hand information from both children and their parents. The results indicate that girls and boys in two-parent families are more prone to engage in gender atypical work the more their parent of the same sex engages in this kind of work. The fact that girls still do more housework than boys in all families independent of, among other things, the parental division of housework and the mother's educational level indicates that housework to some extent signifies gender also to children. However, no clear relation is found between the parents' division of work and the child's attitude towards gender equality in the home. Neither is there any clear relation between the parents' attitude towards gender equality in the home and the children's attitude to the same topic.     

Priorities and determinants of priorities of Swedish social workers

Priority setting is an integrated part of social work, in Sweden as well as internationally. In this article we explore Swedish social services and how social workers make priorities and what these priorities involve. By use of regression analysis we also study what circumstances are of importance for allocative precedence and what impact different distributive principles have. One primary result is that priorities are made frequently by social workers—mostly on what cases to work with next and how much time to spend on every client. Another somewhat expected result is a manifest area bias, suggesting that respondents tend to see to the interests of their own professional domain. The principle of need proved to be the most important of the distributive principles studied, while principles of capacity to benefit and economy were more endorsed by officials working with elderly and disabled than those in other sectors.     

Development and pilot trial of a web-based job placement information network

The purpose of this project was to develop and pilot a web-based job placement information network aiming at enhancing the work trial and job placement opportunities of people with disabilities (PWD). Efficient uses of information technology in vocational rehabilitation were suggested to help improve PWD employment opportunities and thus enable them to contribute as responsible citizens to the society. In this preliminary study, a web-based employer network was so developed to explore Hong Kong employers' needs and intentions in employing PWD. The results indicated that Hong Kong employers generally agreed to arrange work trials for PWD whose work abilities match job requirements. They also expressed that they would offer permanent job placements to those PWD who showed satisfactory performance in work trials. The present study evidenced that using an information network could expedite communications between employers and job placement services, and thus job placement service outcomes. It is hoped that a job placement databank could thus be developed through accumulating responses from potential employers.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

精神残疾群体的社会保障需求与供给:现状、问题与发展建议

精神残疾人多生活困难,构成社会最为弱势的群体。本文采用实地研究与文献研究的方法,对精神残疾人的社会保障需求与供给进行专门考察。研究发现,精神残疾群体的主要需求包括治疗、基本生活支持、康复、长期照护与监管以及社会参与。对此,我国政府已通过多项社会保障制度安排予以回应,基本满足了精神残疾人的基本生活与治疗需求,但还存在社区康复服务匮乏、替代性照护服务供给不足、就学、就业难等问题。基于以上发现,本文认为精神残疾人的基本生存权虽得到较好保障,但是对其发展权和参与权依然关注不足。原因在于当前精神残疾人社会保障存在三个不平衡:经济保障与服务保障发展的不平衡,医疗服务与社会服务发展的不平衡,以及卫健、民政、残联不同部门能力与投入的不平衡。针对这些问题,笔者对未来政策的完善提出了参考建议。     

Ethnic Enclaves,Networks and Self‐Employment among Middle Eastern Immigrants in Sweden

The proportion of immigrants from countries in the Middle East living in Sweden has increased since the 1970s, and it is a well‐known fact that immigrants from the Middle East suffer from low earnings and high rates of unemployment on the Swedish labour market. There are often great hopes that self‐employment will enable immigrants to improve their labour market situation. Further, in Sweden as in many other countries, the question of whether the existence of ethnic enclaves are good or bad for immigrants’ earnings and employment opportunities has also been widely debated. This paper presents a study of the extent to which Middle Eastern ethnic enclaves and networks in Sweden enhance or hinder immigrants’ self‐employment. The results show that the presence of ethnic enclaves increases the propensity for self‐employment. Thus, immigrants in ethnic enclaves provide their co‐ethnics with goods and services that Swedish natives are not able to provide. The results also show that ethnic networks seem to be an obstacle to immigrant self‐employment. One explanation is that an increase in network size implies increased competition for customers among self‐employed immigrants. The question of whether ethnic enclaves are good or bad for the integration of immigrants into the labour market has been widely debated. The results of this paper provide us with information about the integration puzzle. Ethnic enclaves seem to enhance self‐employment propensities among Middle Eastern immigrants in Sweden.     

Co-production and Service Quality: The Case of Cooperative Childcare in Sweden

This article compares results from a study of service quality in cooperative and municipal preschools. The parent cooperative and municipal childcare represents two different schools of thought with regard to service quality. The municipal services have a strong tradition of professionalism in which user participation is not allowed to interfere with the qualified work performed by trained professionals. The parent cooperatives have another tradition in which service quality is developed in a dialogue between users and staff while they co-produce the services together. The former tradition is the dominant one in the Swedish welfare state while the latter is an exception. The conclusion of the article is that service quality is better in the parent cooperative childcare in spite of the widespread assumption in Sweden that service quality is close to synonymous with professionalism.     

Emergency department social work in the UK and Sweden: evaluation by older frequent emergency department attenders Kuratorsarbete på akutmottagning i förenade kungadömet Storbritannien och Sverige: en utvärdering utifrån brukarperspektivet hos äldre mångbesökare på akutmottagningen

Social work based in hospital emergency departments (EDs) in Sweden and the UK reflects a wider European social/health care policy trend. A key focus is on diverting older frequent ED attenders from ‘inappropriate’ hospital re-attendance or emergency admission, because of social care problems. However, previously there has been no evaluation of the significance of ED social work for health and well-being, from the standpoint of older frequent ED attenders themselves. In a preliminary way, our paper provides this through drawing on a small scale Swedish/UK study. Its comparative account of service user feedback underscores the importance of ED social work as a facet of European social work. It indicates that ED social work contributes to the quality of care within emergency departments, acts as a key access point to social services, and can promote both short and longer-term health. At the same time, some serious shortcomings emerge. These include under-developed referral systems, and limitations to community based services following ED social work assessment, which reflect the under-resourcing of social care provision in both countries. Moreover, service users’ experience in both Sweden and the UK reveals the risk of ED social work with older frequent ED attenders being used as a substitute for follow-up medical/nursing care when that is also required.