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Vivyn Mathew Junior Consultant (PSW) DPNR
Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function. Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap is a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex and social and cultural factors) for that individual
“Rehabilitation is the process of helping a person to reach the fullest physical, psychological, social, vocational, avocational and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitations and desires and life plans.”
According to ILO (1955), vocational rehabilitation is defined as a stage in the continuous and coordinated process of social rehabilitation whose aim is to prevent or minimize the functional , physical, psychological, socio- cultural or economic consequences of disability of different types and origin.
(Allen. 1996) . Vocational Rehabilitation is a process that assists individuals with impairments to overcome their handicaps to employment and to return to work at their maximum physical and intellectual capacities at or near their previous earning level.
by providing them with the skills and attributes necessary for them to return to open paid environment .Vocational Rehabilitation A range of intervention that aim to improve the quality of life and functional capacity of people who are subject to social exclusion by virtue of their disabilities.
Stemmed from hospital-based programs which suggested that work activities in the hospital could increase self-esteem and functioning and could ultimately accelerate discharge (Bond & Boyer. . 1988).
sheltered workshops and outpatient halfway houses geared toward vocational training and rehabilitation (Black. 1988) .The era of deinstitutionalization began in the 1950’s at a time when vocational programs first began to implement hospital-based.
Principles of vocational rehabilitation . hence they need support/ back up.Vocational rehabilitation represents but one of the many services. Need for medical care and social support must be acknowledged Need for an adequate array of vocational options for mentally ill Illness of these individuals may at times interfere with work.
Strive to do no harm to patients by expecting either too much or to little of them Ensuring sufficient compensations lie pay and other benefits Attention should also be paid to economic conditions in the larger society outside mental health agency .Principles of vocational rehabilitation Need for realistic expectations.
Why Vocational Rehabilitation? Work plays a number of important roles in human behavior. Consonant with the stress – vulnerability – coping – competence model of chronic mental disorders. the ability to work is an important indicator of psychiatric rehabilitation .
Prevocational training ( Train n place) Assumes that people require a period of preparation before entering into competitive employment Can include sheltered workshops. transitional employment. skills training. work crew. .Types of VR 1.
2. on the job training from job coaches A variant of this is IPS Individual Placement and Model . Supported employment (Place n train) Places people directly into competitive employment without extended period of preparation. provides time unlimited.
There are 6 principles for this programme Developed by Becker in 1994 Competitive employment in work settings Clients are expected to take job directly instead of waiting period Rehab is an integral part of mental health treatment Services are based on client choices and preferences Assessment is continuous and based on real life experiences Follow up support is continued indefinitely .
Cook and Razzario ( 2000) Use of Situational Assessment Competitive or supported employment Rapid placement Ongoing vocational support Tailoring job developmentts and support to the client’s individual preferences Addresses economic disincentives .
when they are actively engaged in productive work activities . even a voluntary / sheltered job – is a significant predictor of sustained remission for chronic mental patients Decrease in psychiatric symptoms. have shown that holding a job. Stein and Test. 1980.
one at Mumbai and other at Hyderabad for assessing vocational and psychological needs of the handicapped persons and to render rehabilitation assistance to them. . In 1968 an agreement was signed between the Government of India and the Government of USA for setting up of two Vocational Rehabilitation Centres.
Vocational Rehabilitation Centres have been set up under MINISTRY OF LABOUR & EMPLOYMENT DIRECTORATE GENERAL OF EMPLOYMENT AND TRAINING .
the more recent approach. 1997). is based on placing people directly into employment and providing training and support to help these individuals sustain employment (Bond et al. .Current Trends earlier programs emphasised training in sheltered and transitional work settings before placement in unsupported work settings.. namely supported employment.
VOCATIONAL REHABILITIONISTS Knowledge : Principles of counseling Theories of vocational counseling Career development Psychometric testing Vocational assessment Medical and psychosocial aspects of disability Community resources Legislation Supervised fieldwork .
functional limitations. work capacities Vocational interview Determination of labour market data .Vocational Rehabilitation Process INTAKE Receipt and review of referral information Description of impairment.
Vocational Rehabilitation Process EVALUATION Vocational assessment Establishment of tentative goals PLANNING Vocational exploration Selection of targeted job goals Labour market survey .
vocational or on – thejob training .Vocational Rehabilitation Process TRAINING (if necessary) Evaluation of training resources Educational.
Vocational Rehabilitation Process JOB PLACEMENT: Job seeking skills training Job placement Employer consultation Job modification Job coaching Follow up .
Vocational Rehabilitation Process RELATED SERVICES Assistance with benefit entitlement Identification and co ordination of support services Architectural and vehicular modifications Tools and equipments Referral for family and social services .
Continuum of Rehabilitation Services Work skills assessment Work adjustment Job skill training Sheltered employment Transitional employment Job finding Job maintenance .
Adjustment to the Work Experience Attendance and punctuality Personal hygiene and grooming Use of leisure time on the job Accepting job related compliments and criticism Following specific instructions Helping co workers Prioritizing tasks Requesting help from co workers .
Adjustment to the Work Experience Requesting help from co workers Following rules Initiating and responding to conversation Initiating request for special needs Interacting with supervisors. customers and other authority figures .
When to Refer For Vocational Rehabilitation??? Whenever it becomes clear that the person will not be capable of resuming regular. or alternate duties with their employers . modified .
What to Expect From a Vocational Rehabilitation Program??? An individualized job plan based on initial assessment and client’s needs .
economic loss etc) Factors Affecting Vocational Rehabilitation . REALITY FACTORS: Timing of referral Medical condition Educational and vocational background Personal and family background Systems (litigations.
Factors Affecting Vocational Rehabilitation BEHAVIOURAL FACTORS: Denial Fixation on reliving past events Blaming others Avoidance of responsibility for own recovery Dependency Anger or depression Overprotection by caregivers Identification of self by job roles Symptom magnification/ malingering .
Research shows that between 41% and 77% of people with mental illness terminate their supported jobs within 6 months (Gervey et al. employment outcomes continue to be poor for this target group. Thus. despite the increase in the number of programs to prepare people with mental illness for work. 1995.. Becker & Drake. . 1996).
Griffith (1974) : Low success rate of vocational rehabilitation in persons with schizophrenia McCathy and Latz ( 1980) : more success in paid jobs in the community .
Botton and Roessler (1986) – poor functioning with prominent negative symptoms Santer and Nevid (1991) – Significant functional improvement following work skill training in Schizophrenia .
.Silverstein et al(1991) – association between work dysfunction and improved pre-marital cognitive perceptual functioning Fabian (1992) – Association between employment and quality of life.
Becker and Associates (1996) – better outcome with preferred employment fields .5 years period.Harrow et al (1997) – Less than 20% employment of Schizophrenia patients with a mean of 7.
Schizophrenia vs Other psychiatric Illness Most of the studies point towards patients with schizophrenia having poorer work functioning than patients with other psychotic and non psychotic illness The reason for this could be non availability of modern neuroleptics Lack of social skills and cognitive impairment .
57% were still in paid employment at the end of 12 months (Littrell. case management and transitional employment placements. 1991) .1995) Work functioning also improved PWS who received work skills training in comparison with PWS who did not receive training (Sauter n Nevid. Studies when comparing PWS receiving clozapine.
and advocacy to help their employers have appropriate expectations Sweetland et al ( 2007) . or by altering the demands of the job PwMS highlighted the need for counselling to help them. managing performance and managing expectations Performance difficulties could be managed either by treating symptoms.Neurological Disorder Study was done with People with MS They identified two key needs. by changing the environment.
. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility.Traumatic Brain Injury To study the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI).
A successful medical rehabilitation may end unsuccessfully because of the failure to return to work. which influences RTW outcomes in ways that make prediction difficult . both economic and psychosocial. injury factors. post injury impairments. personal and environmental factors in TBI patients. with profound consequences to the individual and family. There appears to be a complex interaction between pre-morbid characteristics.
Shams et al. 2007 . psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW Several medical.
The only handicap is a closed mind .
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