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.     

Issues in Career Decision Making for Workers With Developmental Disabilities

Persons with developmental disabilities are not usually given the opportunity to make meaningful choices concerning career options. There are, however, five types of partial involvement in career decision making they may experience. Counselors have considered client expressions of occupational preferences prior to deciding on appropriate vocational goals, have merely asked workers to sign a prepared rehabilitation plan, or—at the highest level of client participation—have involved workers and their families in team planning meetings. Several recommendations for both systemic and personal interventions to facilitate career decision-making by workers with developmental disabilities are discussed.     

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.     

The empowerment of people with disabilities through qualitative research

The purpose of this article is to explore the use of qualitative research in vocational rehabilitation as a means of empowering people with disabilities to (a) take greater control of their lives and (b) directly inform public policy and vocational rehabilitation service delivery. After exploring various definitions of the construct empowerment, we provide a rationale for the use of qualitative research as an empowerment mechanism based on (a) philosophies espoused by leaders of the independent living movement, (b) disability legislation, and (c) a multi-constituency call for more consumer involvement in research. We then describe empirical properties of various qualitative methodologies that lend themselves to consumer empowerment. The article concludes with several examples of qualitative approaches to scientific inquiry from the rehabilitation literature that include many of the empowerment aspects described herein.     

Developing Children's Participation: Lessons from a Participatory IT Project

The United Nations Convention on the Rights of the Child, advances in the sociology of childhood and the consumer rights movement have placed the spotlight on children's rights in society, challenging those working with children to examine how they share power and ensure that children's views are taken on board. While childrens’ service practitioners are broadly supportive of the concept of participation and there are numerous examples of how children's participation has been realised in practice, many are unsure where to begin due to the range of options, considerations and challenges associated with participatory work. This article describes and analyses the process used by Barnardos in developing and implementing a participatory approach in a children's IT project in Galway City, Ireland. The process employed, the challenges encountered and the added value the participatory approach brought to the project are outlined. Finally, four broad lessons emerging from the experience are discussed, namely, that a clear framework and reflective practice is valuable that good participatory work is inextricably linked with good project management; that small efforts at participatory work can increase capacity and appetite for further work; and that there is a role for informal approaches in the context of a formal participatory framework. © 2006 The Author(s) Journal compilation © 2006 National Children's Bureau.     

Recreational planning: an important component of career counseling for people with disabilities

Participation in recreational activities is a critical component of the career development process, providing opportunities for individuals to explore their interests and to develop work-related skills. Recreational participation also offers a healthy outlet for dealing with job-related and other life stressors. People with disabilities are often excluded from participation in recreational activities because of a multitude of barriers. This exclusion can seriously impede the career development of these individuals. This article explores the importance of recreational planning as part of the vocational rehabilitation process. The authors define inclusive recreation and discuss the implications of recreational planning in the various phases of rehabilitation.     

Women with disabilities making the transition back to work: Psychosocial barriers and interventions

The economic impact of disability on employment, earnings, and education appears to be more devastating for women than for men. Women with disabilities who are making the transition either back into the workforce or into the workforce for the first time often face barriers that are unique to this population. Many researchers have described women with disabilities as having a "double disadvantage" that results in social and psychological barriers to their transition back to work. The purpose of this article is to help vocational and career development programs better address the psychosocial needs of women with disabilities by (a) describing key psychosocial barriers faced by women with disabilities in their transition back to work and (b) providing career development strategies designed to ease this transition process for women with disabilities and enhance their employment outcomes.     

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.     

‘The AISH review is a big joke’: contradictions of policy participation and consultation in a neo‐liberal context

Responsive and appropriate disability policy is ideally developed through the participation of individuals with disabilities. Using a case study methodology, we have examined the policy review process for a disability income programme in Alberta, Canada. We examined questions of participation and consultation and compared individual and agency involvement. Participation was characterized by sustained interactions with government, face‐to‐face collaboration and transparency. Consultation involved short‐term interactions by invitation only, limited input and was more typical in policy construction. In this study individual involvement was more likely to be consultative, while agency involvement was more participatory. In terms of policy outcomes, neither model was more effective. Instead, the government adhered to its original intent, responding in terms of neo‐liberal ideals of independence and autonomy.     

Career Rehabilitation: Integration of Vocational Rehabilitation and Career Development in the Twenty‐First Century

The concept of career rehabilitation, a paradigm that proposes integrating perspectives from vocational rehabilitation and career development, is introduced. Counselors are encouraged to assess how vocational handicaps secondary to a disabling problem can affect a client over his or her “worklife” and to adopt a life‐span approach to career decision making of people with disabilities. Four common vocational handicaps are discussed: diminished access to work opportunities, need for workplace accommodations, employer bias in hiring and advancement, and diminished “worklife” expectancy. Counselors testifying in legal forums are encouraged to pursue scholarship on the career development of people with disabilities.     

Community participation and inclusion: people with disabilities defining their place

Disability‐related public policy currently emphasises reducing the number of people experiencing exclusion from the spaces of the social and economic majority as being the pre‐eminent indicator of inclusion. Twenty‐eight adult, New Zealand vocational service users collaborated in a participatory action research project to develop shared understandings of community participation. Analysis of their narratives suggests that spatial indices of inclusion are quiet in potentially oppressive ways about the ways mainstream settings can be experienced by people with disabilities and quiet too about the alternative, less well sanctioned communities to which people with disabilities have always belonged. Participants identified five key attributes of place as important qualitative antecedents to a sense of community belonging. The potential of these attributes and other self‐authored approaches to inclusion are explored as ways that people with disabilities can support the policy objective of effecting a transformation from disabling to inclusive communities.     

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.     

What rehabilitation counselors should know to assist Social Security beneficiaries in becoming employed

The 1999 Ticket to Work and Work Incentive Improvement Act (TTWWIIA) has opened new employment opportunities for vocational rehabilitation professionals. The legislation minimized longstanding disincentives in the return to work efforts of beneficiaries collecting Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Although some of these key disincentives have been eliminated, rehabilitation counselors working with this population will find some interesting new challenges posed by this population. This article will outline the Social Security Administration's SSI/SSDI programs and process for applying; characteristics of beneficiaries; and information regarding the psychological and physiological aspects of beneficiaries with psychiatric disabilities and musculoskeletal disorders.     

Disability and participation in the professions: examples from higher and medical education

Learners with disabilities remain under-represented in higher education and courses, such as medicine, that grant access to ‘the professions’. National and professional legislation, policy and guidance have changed over the last few decades in response to reforms in the way disability is viewed and valued by society. Principles of equal rights and equality of opportunity inform the negotiation of widened participation in the professions. However, drawing on the example of medical education, it is possible to see that widening participation agendas may be insensitive to the needs of learners with disabilities. Analysing the development of practice and policy from a participation perspective suggests that tokenism may have played a role in deprioritising the voices of individuals with disabilities, rendering policy disconnected from the needs of marginalised groups. The concept of participatory parity may provide an opportunity to readdress this misrepresentation.     

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.     

Reflections on doing participatory research in health: participation,method and power

The author has reflected on her experience in facilitating three participatory research (PR) projects to identify key issues surrounding participation, method and power. The three PR projects in health, all undertaken in the same region in southeast Australia, assessed the needs of women who have experienced breast cancer, evaluated an Indigenous healthy lifestyle programme and developed and documented a model of coordinated care by a consumer group. In particular, the three participatory projects suggested that participants do not always want to maximise their own participation and may prefer external researcher involvement – relationships, confidentiality, anonymity and time‐impacted perspectives of participation. In one study, quantitative methods were selected and time and previous knowledge of research shaped participants' selection of method. In the projects, power relations were complex and issues of negotiation, inclusion, quality of research, agendas, roles and integrity are discussed. The lessons learned here are that participatory researchers can be open to differing levels of participation and methods while also comfortable with sharing decision‐making in research, even if it alters the research outcome.     

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.     

Disability stigmatization as a barrier to employment equity for legally-blind Canadians

Canada has expressed a strong commitment to the rights of its citizens against discrimination, including those with disabilities. A question remains whether Canadians with disabilities are able to practice these rights. Our mixed-methods study sheds light on the situation of one important sub-group of people with disabilities – those who are legally blind. Our survey results show that the labour-force participation rate for this population is very low compared with those without disabilities, and also lower than the rate for persons with other disabilities. Legally-blind working-age Canadians have significantly higher rates of unemployment and underemployment, and perceive major barriers to employment. In-person interviews reveal the negative impact of one major barrier – disability stigmatization – on accessing meaningful employment and other societal assets. We discuss the implications of these findings and suggest policy directions.     

The use of photovoice with people with intellectual disabilities: reflections,challenges and opportunities

Photovoice is part of the growing use of participatory research approaches with people with intellectual disabilities. In this paper we explore the process, opportunities and challenges associated with the use of photovoice with people with intellectual disabilities, illustrated through a research project entitled ‘This Is Me’. Photovoice requires researchers to share power and control in the research process and to tolerate uncertainty. Large investments in time and money are also required. These challenges, however, are outweighed by the benefits of the use of photovoice with people with intellectual disabilities. Photovoice creates a space where people with intellectual disabilities can meaningfully participate and exert control in the research process, and as such is an empowering experience. As a participatory research approach, photovoice is accessible and offers the opportunity for people with intellectual disabilities to develop new skills, confidence and experience inclusiveness in their own terms.     

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.