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.     

Children with Hydrocephalus and Spina Bifida in East Africa: Can family and community resources improve the odds?

Hydrocephalus and spina bifida are life-threatening conditions that often result in severe disabilities. Risks are much reduced by immediate surgery and careful management, but neither has been available for most of the sub-Saharan African population. This paper traces the growth of solutions and some socio-cultural resources that historically have supported family and community care for children with severe disabilities, mainly in Tanzania, and nearby Uganda, Kenya, Malawi, Zambia and Zimbabwe. Some community-based rehabilitation (CBR) work with children with spina bifida and hydrocephalus is described, and challenges to the CBR approach are noted from the increased survival of people with disabilities requiring complex care. More appropriate information, recognition of indigenous knowledge, enlistment of community resources and financial assistance are needed to enhance the lives of East Africans with hydrocephalus, spina bifida and other severely disabling conditions.     

Good Intentions - Unpredictable Consequences

A commendable degree of success has been achieved in relocating people with learning disabilities from residential institutions into ordinary community settings. Nevertheless, a challenging task remains if people with all levels of learning disabilities are to be enabled to become meaningfully involved in ordinary community activities. The author argues that a structured day service has a vital role to play in this process, but that, unless the underlying problems that have continued to frustrate the development of a coherent national day care strategy are objectively reappraised and addressed, the true potential of the 'care in the community' policy will not only never be realised, but could actually become imperilled. This paper offers evidence to support the view that current policy trends are based on normalisation theories that, although sound and commendable in principle, have been misunderstood and misused. Consequently, the premises upon which these policy trends are based are fundamentally flawed.     

Promoting Self Determination for Persons with Developmental Disabilities

As community inclusion efforts continue to develop, the recognition of the capacity and rights of persons with cognitive and learning difficulties to participate in planning their own programs has been increasingly acknowledged by providers. This paper presents a needs assessment which was conducted with a small group of people with disabilities, to ascertain their perspectives on community integration for the purpose of social and recreational activity. Anchored on acknowledgment of the rights of people with disabilities to exercise self determination, a focus group methodology was used to provide the opportunity for the client group to have a voice in developing their own recreation opportunities.     

Involving People with Disabilities in Volunteer Roles

Abstract

According to the 2002 National Health Interview Survey, 33.7 million non-institutionalized Americans have limitations in usual activities. A recent poll on community participation found that, overall, people with disabilities have lower rates of community participation compared to those without disabilities. An analysis of that same poll concluded that people with disabilities continue to be treated as second class citizens by being excluded from the mainstream of everyday life. Social role valorization theory proposes creating and supporting socially valued roles for people who are kept at a social distance. It is through these valued social roles that they gain equal access to other opportunities that society has to offer. One such socially valued role is that of a community volunteer. Volunteer activities can foster a social environment where people with disabilities are seen as credible coping individuals. This paper reports the results of a survey of twenty-six community agencies which regularly use volunteers. The purpose of the survey was to identify barriers to volunteer opportunities for people with disabilities and to explore openness to methods to remove the barriers through community collaborations.     

Personal assistance in Sweden

This article provides an overview of the Swedish personal assistance program for persons with severe impairments, introduced in 1994. The personal assistance program makes it financially possible for people with severe disabilities to appoint a personal assistant, by themselves or through a provider, to create support adapted to the individual and to optimize the person's influence over how the support is arranged. The article describes how the reform has increased the opportunity for people with severe disabilities to choose their own way of living. Overall, the personal assistance has enhanced the quality of life for people with severe disabilities and their families.     

A Response to Disability in 1986 and Beyond: A Report of the Royal College of Physicians

The article attempts a radical critique of the recent report published by the Royal College of Physicians, which established that there are serious shortcomings in the services provided for people with disabilities. The author disputes that the development of more medical services in medical environments would be in the interests of disabled people. He proposes instead a partnership between the medical profession and autonomous structures democratically created by people with disabilities. This would lead to the development of responsive and non-intrusive services that enable people to live independently in the community.     

Intellectual disabilities,violent conflict and humanitarian assistance: advocacy of the forgotten

This article examines the experiences of people with intellectual disabilities in violent conflict who have been neglected in practice and academia. Such invisibility, combined with the disabling impact of society, their low priority, and the nature of their impairments, results in a disproportionately negative impact of conflict on people with intellectual disabilities. Drawing on a wide range of sources, including humanitarian workers, this article examines their experiences and analyses how much consideration has been given to people with intellectual disabilities in humanitarian assistance policy and practice in light of their increased need and vulnerability. Lack of awareness and recognition of their diverse experiences can result in their needs failing to be adequately met, which compounds their disproportionately negative experience of conflict. It is important to finally start paying attention in order to ensure their inclusion in humanitarian responses.     

The Effect of Social Work Education and Self-Esteem on Students' Social Discrimination of People with Disabilities

Social work education on disability content has become more important due to political changes in the last two decades. The United States protected people with disabilities from discrimination in community and employment settings with the enactment of the Americans with Disabilities Act of 1990. These changes have empowered people with disabilities to become more independent; however, social workers primarily fulfill roles as case managers, and often make decisions for people with disabilities. This is not consistent with the empowerment perspective embedded in the disability movement. Most social work schools have minimal courses covering disability content. Previous research and the Self-Esteem Hypothesis indicate that social work education, social proximity to people with disabilities, self-esteem and other demographic characteristics are associated with social discrimination, or attitudes, toward people with disabilities. Social work students (n = 73) participated in a survey in the last semester of their program to assess how these characteristics were associated with their attitudes towards people with disabilities. A multiple linear regression revealed that social work education preparedness to work with people with disabilities, an MSW education, self-esteem, and having a friend with a disability were significantly associated with students' social discrimination towards people with disabilities.     

The employment situation of people with disabilities in Lebanon: challenges and opportunities

This article presents the findings of a study on the employment situation of people with disabilities in a rural region in Lebanon. The study was conducted as one of the activities of a community development project that saw the establishment of a job centre for people with disabilities. The majority of the study's 200 paricipants were unemployed, and many had never been employed. Other participants were mostly self-employed, with many of them working from home. The article discusses obstacles to finding and keeping a job and ends with recommendations for change at the level of community intervention, policy and research.     

The Woodwork Effect in Medicaid Long-Term Services and Supports

This paper examines annual real per capita Medicaid long-term services and supports (LTSS) expenditures (in 2010 $) over the period 1995 to 2010. Medicaid community LTSS expenditures increased substantially. If that trend constituted a woodwork effect, expenditures on institutional services should have declined more slowly than community expenditures increased, resulting in total expenditures increasing over time. Such a woodwork effect is observed for the population with intellectual and developmental disabilities (IDD) but not for the non-IDD population, composed of persons with disabilities other than IDD, including older persons. During this time period, the goals for serving people with IDD changed; institutional and community cost-neutrality rules were relaxed (and with that concerns over a woodwork effect), and instead goals of community involvement and participation were emphasized for all eligible persons. For the non-IDD population, tighter adherence to cost-neutrality rules and controls over nursing home reimbursements may have helped avoid a woodwork effect as community expenditures increased. With the passage of the Americans with Disabilities Act in 1990, goals have changed for people with disabilities of all ages, and the notion of a simple trade-off between institutional and community service costs that constitutes the woodwork effect must be complemented with a much broader idea of cost analysis that values independence and community participation for people with disabilities of all ages.     

Issues of Risk Practice and Welfare in Learning Disability Services

This article focuses on risk management in services for people with learning disabilities. It identifies the issue of risk as central to many historical and current care practices. It illustrates this through three examples that raise questions of risk in relationship to people with learning disabilities: on community care, alcohol and sexuality. It concludes that risk has often been negatively associated with danger, but that sensitive risk management has the potential to improve or maintain the quality of care services.     

Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. DESIGN AND METHODS: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS. RESULTS: New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA). IMPLICATIONS: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

How Far to Gay? The Politics of HIV in Learning Disability

This paper examines work in sexual health and HIV prevention in services for people with learning disabilities from a political stance associated with the rehomosexualisation of AIDS in Britain. Arguments are made for the re-homosexualisation of AIDS in services for people with learning disabilities, based on evidence of where HIV risk lies in relation to men with learning disabilities who have sex with men. This provides an opportunity to critically review approaches and responses to HIV risk assessment and risk management in services for people with learning disabilities, with reference to the assumptions which underpin practice and issues of sexual identity. The case is made for a more radical sexual politics in learning disability to help combat HIV and to provide more realistic approaches to service commissioning and safer sex education. Pointers for service development and key areas where the re-homosexualisation of AIDS can inform practice and resource development are also provided.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

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.     

Social enterprises as enabling workplaces for people with psychiatric disabilities

In recent years, western governments influenced by neoliberalism have emphasized paid work as a key route to social inclusion and community participation for people with psychiatric disabilities. Although paid work can offer many rewards, access to mainstream employment for people with psychiatric disabilities is difficult as they continue to encounter discrimination and a lack of workplace accommodation. One response to these challenges has been the creation of social enterprises as ‘alternative spaces’ of employment for people with psychiatric disabilities. On the basis of interviews with key informants from 21 different social enterprises across Ontario, Canada, this paper critically analyzes the strategies used by organizations to create jobs that are both accommodating for people, but also conducive to the ongoing success of the business.     

Difficulties in Shifting from Individualistic to Socio-political Policy Regarding Disability in Canada

An individualistic conception of disability has been replaced by a socio-political definition. The socio-political model implies that disability stems from the failure of the social environment to adjust to the needs of people with disabilities rather than from the inability of disabled individuals to adapt to societal demands. This paper will examine the extent to which Canadian policies have changed to embrace this new definition. There has been some progress in policies related to shelter, transportation and recreation. However, policies related to income and employment are still individualistic in nature because policy change in these areas requires a major shift in governmental approach to unemployment and fundamental reform of the Social Assistance system. In a period of high unemployment, people with disabilities are viewed as surplus labour, and the Canadian government has found that high unemployment is politically tolerable. Obstacles to an increase in income support include a strong work ethic, the philosophy that social assistance benefits should be less than could be earned in the work-force, and the private insurance and litigation industries which benefit from the current income system. Other barriers to change are the lack of power of disabled groups and the dominance of professionals.