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.     

Work functioning: a conceptual framework

Adequate and reliable methods for evaluation of clients with work disabilities are crucial for both the individuals who are assessed and for society as a whole. Sound and precise work assessments are needed to guide clients to suitable interventions using a minimum of rehabilitation resources. Occupational therapy literature contains evidence that work function assessments are complex and that there is confusion over work assessment concepts. Therefore, further development and evaluation of adequate concepts and theoretical models within the area of work assessment is needed. This article proposes a conceptual framework for different dimensions of work functioning and points out important factors for work assessment. The concepts proposed and defined in the article are: work functioning, work participation, work performance, and individual capacity.     

Disability and job stress: Implications for vocational rehabilitation planning

Because people with disabilities often experience an increased risk for physical and psychological complications of job stress, vocational rehabilitation professionals must be able to (a) identify individual and work-environmental risk factors for job stress and (b) design appropriate interventions to minimize those risk factors. The purpose of this article is to (a) present two models of occupational stress, (b) examine factors common to each of these models that are associated with employee health and well-being, and (c) suggest implications for rehabilitation planning.     

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.     

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.     

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.     

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.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.     

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.     

Assessment of vocational opportunities and continuing job placement for persons with mental disabilities: factors indicating levels of necessary support

We determined primary factors in allocating support for vocational opportunities and continuing job placement for clients with mental disabilities. The study analyzed 29 items regarding work attitudes and vocational skills for 70 clients as assessed by the Tokyo Metropolitan Rehabilitation Center for the Physically and Mentally Disabled. The evaluations were performed using the situational assessment approach with a 3-point support scale system assigned through observation of behavior. The results of these evaluations placed 35 clients in employment groups (A and B) and 35 clients in a sheltered workshop group (C). The data was analyzed by multivariate analysis. Predictions of success and functional differences among the groups were indicated by the data. Differences were found among the three groups in work attitudes and skills such as "self-direction" and "directions for social participation". Out of the 35 clients currently employed, 11 were recognized as needing ongoing assistance from supported employment offices. For the supported employment group (B), the major work attitudes and skills for which they required continuous services for maintaining stable jobs were 'emotional stability' and 'learning of working skills and accomplishment of work.' In a previous study, the major differences between the competitive employment group (A) and the sheltered workshop group (C) were in areas of 'responsibilities,' 'goals for life,' 'motivation for the work and understanding of contents for work,' and 'safety during work.' Our study supports these findings. In addition, transition from the sheltered workshop to supported employment required training to improve skills and support for 'responsibilities,' 'goals for life,' 'participation in leisure activities and community-based activities,' and 'preparation and cleaning for work.'     

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.     

The Political Economy of Special Educational Needs in Britain

This article raises questions as to how far young people regarded as having special educational needs or disabilities are prepared for participation in the economy. It focuses on those aspects of the further education curriculum that emphasises skills, and the development of National Vocational Qualifications which emphasise competences. Those with special educational needs or disabilities are part of a larger group of young people to be 'managed' as a workforce if there is work, and all are urged that the way to find employment is by constant investment in the self by the acquisition of skills and competences. The article contends that those labelled as special will find more difficulty in collecting meaningful skills and competences, and those in charge of new accreditation systems have made it clear that few concessions will be offered to this group.     

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.     

Evidence-Based Practice in Social Work: Challenges and Opportunities for Clinicians and Organizations

Evidence-based practice (EBP) is increasingly emphasized in social work, yet effective approaches for translating research evidence into social work practice remain elusive. Despite a growing body of evidence describing effective interventions with a variety of populations, social workers continue to encounter substantial challenges with incorporating knowledge gained from these intervention studies into their routine practice with clients. This paper presents the current research outlining the known barriers and promoters to using EBP in social work clinical practice. Because social workers practice within the context of organizations, we consider the barriers that exist at both the individual and organizational levels that affect clinical social work practice. In addition to addressing the various challenges to incorporating research evidence into practice, we will also discuss a variety of emergent opportunities accompanying the move toward EBP that can be leveraged by clinicians in their social work practice with clients.     

Rehabilitation Through Work? Disability and the Productivist Road to Participation in the East of Germany1

Abstract Drawing on secondary data and interviews, this paper traces the economic and socio‐cultural roots of contemporary policies to promote full participation of people with disabilities in mainstream German society. Underlying such policies and related practices has been a concept of rehabilitation through work that evolved within a context of labour shortages, Protestant work ethics, and German welfarism at the beginning of the 20^th century and that has yielded rather ambiguous consequences. I argue this elective affinity among economic, cultural, and socio‐political imperatives has undermined potentials for integration and self‐actualization of people with disabilities. Not only was rehabilitation subordinated to a productivist logic and provoked forms of ill‐paid or even forced labour; rehabilitation policies and measures have also been part of a system of social governance that effectively helped to segregate the “able” from the “unable” and that promulgated an ethos of productivism. Significantly, this essentially utilitarian ethos – which rendered health and rehabilitation into a social obligation and valued each wo/man according to his/her fitness and motivation to contribute to socio‐economic development – evolved within capitalism but was equally pronounced in East Germany under state‐socialist rule. Contrary to the egalitarian principles of both “socialist humanism” and “Western enlightenment”, policies and practices trans‐societally focussed on the promotion of those who could – potentially at least – contribute to the regime of industrial production. As the example of East Germany demonstrates, social participation through paid work remains incomplete, at best, and provokes further segregation – even in times of severe labour shortages. The paper concludes that notwithstanding contemporary rhetoric, rehabilitation through work has remained a central pillar of contemporary welfare policies. In times of unbroken structural unemployment, the productivist paradigm and ensuing policies have become increasingly problematic – not only for the inclusion of people with disabilities. Experiences with the productivist modes of participation and with rehabilitation in East Germany suggest a post‐productivist paradigm of inclusion that seeks participation beyond paid work.     

Social work with people with disabilities in Croatia: a qualitative study

In conducting this study, the authors aimed to gain insight into social work with people with disabilities. Due to the lack of research in this field, qualitative methodology was applied. Using semistructured interviews, data were collected about 30 respondents: 10 people with disabilities, 10 parents of people with disabilities, and 10 social workers who work in the public sector with people with disabilities. Analysis of the results revealed characteristics of approaches to social work, knowledge and skills used in working with people with disabilities, difficulties related to specific work with clients, and the position of the profession in society.     

Do it yourself. Medication management for community based clients

1. Nurses in mental health-care settings have many opportunities to influence and promote health-care behaviors through the use of long-term education programs for their clients. 2. Acquisition and mastery of client-centered medication management skills increases the likelihood of client participation in treatment at the community level. 3. Psychiatric impairment among clients may require modification of usual teaching strategies. A variety of approaches enhances the success of an education program for this client population. 4. Psychiatrically impaired clients have the right to information and education. Nurses need to continue to develop skill with regard to patient education for this challenging group.     

Challenging the Image: the involvement of young people with disabilities in volunteering and campaigning

Much of the debate about young people with disabilities focuses on the difficulties these young people experience and their needs in terms of service provision. Rarely is there a focus on the positive contribution that disabled young people themselves make to society. The paper describes research which aimed to highlight the contribution that young people with disabilities make to their communities, by focusing on their participation in volunteering and campaigning. A national survey of disabled young people's participation was undertaken, as well as two case studies of particular projects. The paper describes the range of voluntary and campaigning activities being undertaken by young people with disabilities, highlights the effects of participation on the young people and those around them, and identifies issues for organisations wishing to enable more young people with disabilities to participate in this way.     

Strategies to Foster the Career Development of People with Disabilities

Abstract

This paper addresses career development strategy within the context of social work practice in rehabilitation and disability. The author outlines the career development needs of people with disabilities and identifies contemporary ways of thinking about career development. Four specific career development tactics are discussed involving the provision of vicarious experiences, identification and appreciation of performance accomplishments, verbal persuasion to support appropriate risk-taking, and emotional arousal that facilitates the expression of feelings and the motivation to act. These tactics are promising avenues for strengthening vocational and career self-efficacy with the aim of helping people with disabilities to augment their career maturity and increase their personal flexibility.