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.     

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.     

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.     

Transition strategies for youths with sensory impairments: Educational,vocational and independent living considerations

Students with sensory impairments comprise a heterogeneous group that is often underserved by rehabilitation and other social services. This underserved status has been attributed to poor interagency collaboration and eligibility issues, the low incidence nature of these disabilities, and the shortage of trained professionals to address the specialized needs of these individuals. This article examines important educational and vocational characteristics of this population to assist rehabilitation professionals in supporting more effective transitions into employment and other adult roles. Specific transition considerations include unique learning challenges, assessment issues, assistive technology, and accommodations. The article concludes with strategies for transition planning, community integration, and evaluating transition outcomes.     

Broadening opportunities for job seekers with disabilities: strategies to effectively provide assistive technology in One-Stop centers

The Workforce Investment Act (WIA) of 1998 mandates that partners in the One-Stop Career Center (One-Stop) system be prepared to serve a diverse customer base, including job seekers with disabilities. For many such individuals, effective service delivery depends in part on the existence of appropriate and efficient assistive technology (AT) options. This article presents challenges experienced by One-Stop partners related to AT provision as well as strategies for providing effective AT support. Findings from case study research conducted in several One-Stops across the country revealed three strategies that have enhanced employment services and addressed barriers. These are (a) an accurate assessment of AT needs, (b) staff training and practice using the equipment, and (c) the ability to make the most of limited financial resources. Implications for the most efficient ways to provide AT options are discussed.     

Speech recognition software as an assistive device: a pilot study of user satisfaction and psychosocial impact

The purpose of this study was to gather data concerning the psychosocial (quality of life) impact of speech recognition software on individuals with physical disabilities and to identify how satisfied these individuals were with this software as a computer access method. Two standardized questionnaires, the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) were administered to ten participants with physical disabilities who received speech recognition software following an assistive technology evaluation. The results of this study indicated that 90% of the participants were quite satisfied with speech recognition software as an assistive device and that the software had a somewhat positive psychosocial impact on their lives. Four themes emerged concerning what the participants liked most about the software: 1) the software provided a method of access when they were not previously accessing a computer, 2) the software increased independence, 3) the software made computer use more efficient, and 4) the software provided a choice or flexibility in computer access. Although this study demonstrated that these speech recognition software users are generally satisfied with the software and it has had a positive impact on their life, it also suggests that there is a need to examine the role of training on satisfaction and successful use of the software.     

When considering vocational rehabilitation: describing and comparing the Swedish and American systems and professions

Rehabilitation of functionally impaired in Sweden and the United States is compared and contrasted. Found is that there are fundamental differences in strategies. The Swedish system most often uses a medically oriented multidisciplinary team approach. The US system most often uses a single individual, the vocational rehabilitation counselor, to work with functionally impaired in helping them return to work. Emphasized is that a vocational rehabilitation counselor uses a unique array of skills that is not duplicated in Sweden by a single profession. Suggested is that a single person with a range of skills can more economically provide vocational rehabilitation services to those with functional impairments; whether this is practical for Sweden is yet to be determined. In contrasting the two systems it was evident that the US system has been in operation for a much longer time and that the Swedish system is maturing. Noted is that the governments of both countries are feeling pressure regarding funding of vocational rehabilitation. This is affecting the level and quality of services. The authors advocate wider contact between Swedish and US university-level training programs in rehabilitation. Felt is that each system has strengths and knowledge that can be used to benefit the other.     

Order of selection in vocational rehabilitation: implications for the transition from school to adult outcomes for youths with learning disabilities

Interagency cooperation between special education and vocational rehabilitation (VR) is central to ensuring the continuity of services to young adults with disabilities who are in transition from school to adult living. However, the interface between special education and VR may be complicated by order of selection, an equally binding mandate in federal VR policy to provide priority services to individuals with the most severe disabilities. Because students with learning disabilities are typically perceived as having mild rather than severe disabilities, these youths are most at risk for falling through the cracks in the service landscape once they leave the school setting in states where the VR agency is implementing an order of selection procedure. This article identifies and discusses common impediments to collaborative transition planning for students with learning disabilities that may be intensified when the state VR agency is operating under an order of selection plan. Recommendations are provided to facilitate greater interagency cooperation among schools and VR agencies so that transition planning and implementation for students with learning disabilities is not subverted as a result of the order of selection mandate.     

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.     

Creating employment opportunities for people with disabilities in healthcare: the Bristol Employment Collaborative

Unemployment is a significant problem among working-age adults with disabilities. The Bristol Employment Collaborative (BEC), one of five Regional Employment Collaboratives in Massachusetts, brings together State agencies, community employment service providers, educational institutions, local businesses, economic development organizations, and people with disabilities to design and implement regional strategies to enhance employment opportunities and outcomes for people with disabilities. Launched in 2009, BEC has developed an innovative model to train people with disabilities to become personal assistance services workers, a healthcare occupation with high demand. The case study describes the strategic planning process undertaken by BEC partners to develop a certificate program to be offered by the local community college. The first class enrolled in September 2010 and graduated ten weeks later. Innovative approaches such as the one being pursued and developed by the BEC could help address both unemployment for people with disabilities and the labor shortages in the healthcare sector.     

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.     

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.     

Prospective role for telemedicine as a communication tool for rural rehabilitation practice

The current trend of cost containment in health care has prompted a search for innovative methods of providing the best quality care at the lowest possible cost. One method that has received much attention is the use of telemedicine to conduct evaluations at rural locations. There has been much research conducted in the area of telemedicine for radiology, and some other medical specialties, however there has been very little research examining the utilization of telemedicine for allied health, vocational rehabilitation, and Assistive Technology evaluations. In addition to providing an overview of telemedicine service delivery history and mechanisms, results of a focus group are discussed, and specific applications for the field of vocational rehabilitation are considered.     

Putting technology to work: Users' perspective on integrating assistive technology into the workplace

This qualitative study examined the experiences of people with disabilities who use assistive technology in open employment. This study aims to describe and understand the factors the participants perceived as important in integrating technology into the workplace, as well as the barriers encountered in the process. Fifteen people with a range of acquired and congenital disabilities as well as their employers (8) or co-workers (4) were interviewed. The interviews were transcribed and analyzed. Nud*ist Version 4(R) was used for data management. Emergent themes related to the integration of assistive technology were software compatibility, Information Technology (IT) and product support, and the interaction between technology and the work environment. Participants also reported on the impact of technology on their performance and comfort at work, as well as dealing with people and processes in the workplace. By identifying the issues and support strategies for technology users in the workplace, appropriate measures can be implemented to ensure that the spirit of disability discrimination legislation is realized.     

Enhancing the quality of life of a client with severe developmental disabilities through the application of assistive technology. A case study

This paper describes a structural sequential process aimed to enhance the quality of life of a 29 year old man through the application of assistive technology (AT). The client had life-long severe multiple disabilities, showed increasing fragility and decreasing functional abilities that resulted, among other problems, in a problem with toileting. The process involved a thorough assessment and evaluation of the client, his physical, cognitive and perceptual skills involved in the performance of the task, requirements of the task, the technology, and the task environment. A clinical reasoning model for the provision of AT was applied during the process to identify the functional deficits of the client with respect to the problematic task. The approach enabled a multidisciplinary team of university-affiliated professionals including physical and occupational therapists, an ergonomist, a rehabilitation engineer and care providers in an institution for developmentally disabled people to determine the primary attributes of a technological intervention. The process resulted in the selection of an appropriate piece of AT followed by its modification and adaptation in order to address the specific needs of the client. The client's toilet use was improved in a manner that ultimately contributed to enhancing the quality of his life. Projections for further improvements of the quality of life of the client in this institution were also discussed.     

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.     

全国辅助器具服务网络建设研究

经过多年的建设,我国已建立了主体多元的辅助器具服务网络体系,主要由残联系统、民政系统、医疗系统和社会化的辅助器具网络组成。受管理体制的影响,分属于不同系统的辅助器具网络存在资源整合度不高、规模小、专业化水平不高、服务覆盖面小、定位定性不准确等问题。下一步辅助器具服务网络建设的重点工作包括:将残联系统辅助器具网络打造成中心化的辅助器具适配服务机构,加强县级及以下辅助器具机构的建设,提升基层辅助器具服务机构的能力,开拓社区资源,打造社区辅助器具资源平台。     

CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals

The Collaborative Demonstration Program for Homeless Individuals is providing an opportunity for several community agencies in the United States to explore innovative intervention and treatment strategies to address the needs of homeless people with co-occurring (mental illness and substance abuse) disorders. This cooperative agreement, funded jointly by the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT), is a $3 million project supporting programs in various community agencies to develop, document, and evaluate programs for persons who are homeless with co-occurring disorders to be used as models in other communities. The program models include: Assertive Community Treatment, Psychosocial Rehabilitation, Therapeutic Community, and an integrated treatment model. The first phase of the two-phase project funded 16 programs in the U.S. to develop manuals within their primary treatment modalities for homeless people with co-occurring disorders. For Phase II of the project, six of the 16 model programs were competitively selected to demonstrate program impact through formal program evaluation efforts. The data derived from the various projects will be compiled into a compendium of information for state agencies and community service providers throughout the U.S.     

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.