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Sectoral Session C-1 Tuesday, September 6 14:00-15:30

INNOVATIVE METHODS OF VOCATIONAL ASSESSMENT OF DISABLED PERSONS

Chairperson: Mr.Tsutomu Ikeda Director, Department of Vocational Evaluation and
Work Preparation, The National Kibikougen Vocational
Rehabilitation Center for the Disabled (Japan)
Co-chairperson: Mr. Gerlof Hoekstra Director, Dutch Council of the Disabled (The Netherlands)

INNOVATIVE METHODS OF VOCATIONAL EVALUATION OF DISABLED PERSONS

TSUTOMU IKEDA
The National Kibikogen Vocational Rehabilitation Center, Japan


For many years, the ILO's Vocational Rehabilitation Recommendation (No. 99) of 1955 has served as the international standard in establishing vocational rehabilitation services in many countries. The ILO document "Basic Principles of Vocational Rehabilitation" provides the basic concepts of services required in every aspect of the vocational rehabilitation process. More recently, the ILO adapted a new Recommendation (No. 168) in order to meet changing situations throughout the world. It is now necessary to create services which respond to newly emerging needs as well as improve existing measures.

However, the situation of vocational rehabilitation and its effects may vary widely among various countries. Vocational rehabilitation is predominantly influenced by social environment. This consists of many factors including social awareness of humanity, the economic and industrial situation, the labour market, national policies and service systems. Different types of disabilities also necessitate different approaches by vocational rehabilitation. These differences of social environment and of types of disabilities constantly create new problems needing to be solved. This also applies to the area of vocational evaluation.

With regard to techbique, the effect of the multidisciplinary approach to vocational evaluations has now been widely recognized. In the development of vocational evaluation methods, psychological assessment was introduced at on early stage, and then occupational therapy has been contributing greatly to the abservation of behavion. More recently, industrial art of human engineering into this area made more accurate and effective approaches possible.

For the last twenty to thirty years, Japan has mostly depended on Western countries for its development of vocational evaluation techniques. Many practical techniques have been introduced and we have acquired a great amount of knowledge and information concerning vocational evaluation. At the same time, however, it is realized that evaluation techniques developed in foreign countries with different cultural backgrounds will, need to be applied in a way that suits our own country's culture. Just the large number of exports from Japan are next welcomed in the world today, Japan needs control on mere import of any style of vocational rehabilitation techniques from other countries. What is more important for further development of vocational rehabilitation in all countries is to exchange experience and information with each other and apply them so as to meet the needs of their own peoples. This will help to plan and develop services for tomorrow.

Finally, I assume the theme of this session, "the Innovative method", will include not only particular evaluation techniques but also a series of evaluation methods and evaluation systems utilizing social resources.


ASSESSMENT IN THE WORKPLACE

J.K.WAAL
The Social Insurance Institution, Rehabilitation Department, Helsinki, Finland


Assessment of the abilities of the disabled person in a positive sense is the starting point of rehabilitation. The importance of the assessment stage has increased in recent years since the diagnostic methods have become more sophisticated and accurate and, most of all, the meaning of disability as an environmental problem has been accepted. The disability is not in the person but in the interaction between the person and his/her environment. Accordingly, not only must we assess the disabled person but also the environment and the totality of person-environment fit.
The technological development in working life as well as in rehabilitation methods has made it very urgent to find new ways of assessment, rehabilitation planning and implementation of plans.
When we are talking about assessment in the working place we must utilize all the new methods in ergonomics and adult education. We must bear in mind that we are dealing with problems of labour market and with problems of adult human beings.
From these two requirements follow the background conditions to any useful assessment in the field of rehabilitation. The goal of rehabilitation is the integration of a disabled person into an existing work situation. The technical demands of the job are only one factor, and there are plenty of others. The organization of the workplace, the attitudes of the associates and foremen, the norms and roles of the working community, the career possibilities and on-the-job education and so forth.
The one factor that is very often forgotten is the individual who has a disability. We usually concentrate on the impairment and the disabilities and handicaps it may cause. But we must remember that the disabled person is a grown-up individual personality with his/her own ways of acquiring new knowledge and skills. More than ever we must think of rehabilitation as adult education.
The Finnish Social Insurance Institution provides vocational rehabilitation to both young persons with disabilities and to people with working life experience but who have encountered difficulties due to long-term illness or some impairment of function.
The main methods of rehabilitation are vocational/professional education in all possible forms, economic support to small enterprises owned and run by people with disabilities, and providing technical aids to employed persons. Rehabilitation plans are made with clients in the local offices of Social Insurance Institution all over the country (in more that 450 offices). The assessment of the rehabilitation potential - of the person and the environment - is a very crucial step in this process.
The necessary assessment to backup the rehabilitation plans and the implementation is done in many ways: the traditional methods of vocational guidance, special work clinics, and medical and psychological assessment are used, but they have been found inadequate. The new methods include assessment of the practical work in a real workplace in real working situations. Video technology is very useful in this context, since it provides a sense of practical feedback with one's own experiences.
With a stepwise video technique one can mix rehabilitation with adult education, rehabilitation with training of work skills. A very fortunate consequence of this is that rehabilitation is not seen as a special methods for handicapped persons but something which has lot of common with the most advanced ideas of on-the-job training and career advancement.
Rehabilitation is a learning experience in many ways. The assessment stage gives all the parties concerned important information on possibilities and snags of the situation, but also a broad picture of new learning by a person and his/her environment.
I will now present the outlines of two rehabilitation cases in which a broad assessment of the situation was combined with planning and implementation of rehabilitation programmes using modern computer technology.
First is the case of 32-year old blind woman who had worked ten years as a telephone operator and was now being made redundant due to technological changes. In cooperation with the Finnish Association of the Visually Handicapped and the Vocational School for the Visually Handicapped the Social Insurance Institution prepared a rehabilitation programme which consisted of designing a suitable computer equipment, working station and appropriate training of working skills. The total costs of the programme were $ 14 000.
Second is the case of 37-year old student of architecture working on his diploma. He was totally paralyzed in a diving accident. The necessary computer equipment was planned in a research-and-development project for environmental mastery through computer technology. His future plans were to start a private planning firm with the assistance of his wife. The total costs of the programme were $ 24 000.
The assessment of rehabilitation needs and the planning of a suitable programme must adapt to requirements of working life. The future career of persons with disabilities should also determine the direction of rehabilitative actions. The most flexible solution is to combine individual rehabilitation programmes with company-wide training programmes. On a wide perspective one might say that every manpower programme of a country or an enterprise should carry a strong flavour of rehabilitation.


RECENT ADVANCES IN THE ABILITY AND REQUIREMENT PROFILES - EAM SYSTEM
(ERTOMIS ASSESSMENT METHOD SYSTEM)

K. A. JOCHHEIMand E. MITTELSTEN SCHEID
Ertomis Stiftung - Gemeinnutzige Gesellschaft zur Forderung von Wissenschaft M.B.H.
Wuppertal, F.R.G.


Rehabilitation in its first phase around 1900 aimed at reintegration of disabled people into gainful employment by selection of vocations with reduced demands on muscle power and endurance, but with sufficient ability in manual dexterity and intellectual capacity. Some model institutions in Europe were hosting an orthopedic clinic, a special school and a vocational training center for relevant vocations, and served also as a center for first employment of war veterans after World War I. Methods for the assessment of the residual abilities of disabled people have been developed by interdisciplinary approaches.
Traditionally clinic oriented physicians describe impairment and subsequent limitations instead of residual abilities and resulting from them an Ability Profile which can be compared with a Requirement Profile of a job. Careful screening both in USA and Europe produced but a limited number of the latter kind of approaches, successfully applied in practice: 1944 US-Manpower-Committee Report - 1946 USA Clark D. Bridges - 1964 FRG T. Hettinger - 1972 USA US-Handbook of Analyzing Jobs - 1980 Geneva CH P. Wood International Classification of Disabilities and Handicaps - 1981 FRG K.A. Jochheim/ E.Mittelsten Scheid "Abilities and Requirement Profiles" - 1985 FRG Bavarian Motor Factory, Munich - 1982 USA Fleishman's California Report "Human Performance and Productivity" - 1985 NL Timmer, Dutch Social Insurance System. Inconsistance and lack of covering the whole spectrum of abilities are shortcomings of some of the systems.
The most comprehensive system has been developed by a multidisciplinary approach by K.A. Jochheim - E. Mittelsten Scheid et al. 1981 ff. realistic assessment of Abilities of the operator and requirements of the work he/she is to do, have been developed and 64 items carefully selected by a multidisciplinary approach and minutely defined. The system has been testrun in various industries, in rehabilitation centers, in vocational training centers, etc. - and is currently undergoing a testrun by an occupational physicians center in a German industrial region comprising 179 industrial companies, employing 27000 people, incl. approximately 2000 disabled. We will present this system and the latest results.
The problem of vocational integration respectively re-integration of disabled people into gainful employment asks for a system built on carefully selected basic abilities and requirements - in order to permit the finding of an optimum job for a disabled applicant. The EAM-System was designed with a set of basic functions respectively basic requirements. It was easily understood by employers, employees and trade-unions - as well as by rehabilitation specialists. It thus closed the gap of communication between the four parties. The lack of such a system has frequently hampered the job finding.
Four working groups (physicians, psychologists, vocational trainers and ergonomists from industry) have tried to select a set of items each for the assessment of such "basic functions" resp. "behavioural patterns" available to disabled people (Abilities) and required for jobs to be performed (Requirements). The four sets have then be integrated into one set of 64 items - carefully defined for "rating". The medical set of items and the rating system have been modified so as to coincide to a great extent with the ICIDH. The WHO-ICIDH-System included some items related to impairment and to daily living. EAM-System items have been limited to disability- resp. job-related items applicable to all kinds of disabilities and to all kinds of work.
The 64 items have been grouped into 7 groups: 1.) Functions of the upper and lower limbs - 2.) Basic postures and movements - 3.) Functions of the sense organs - 4.) Psychologically-based abilities and behavioural patterns - 5.) Communication functions - 6.) Tolerance of environmental factors - 7.) Others.
Each item has been carefully defined in a manner understandable by both scientists and practitioners in production, services and administration. The definitions are available in both English and German. In accordance with the definitions each item has to be carefully "assessed" and "rated" in one of the five grades - for both the "Ability Profile" and the "RequirementProfile" as per Foil 1. Most of the "ratings" have to be assessed by well trained expert "judgement" - they cannot be "measured". Assessment requires a uniform concept of "normal/full", "slightly"- "moderately"- "substantially"- and "severely"-reduced ability resp. requirement. As mentioned before it is easily understood by practitioners in industry, services and administration as well as by rehabilitation specialists.
Basis for the Ability Profile is a medical examination with an entensive evaluation of the personal history of the client, including the educational and vocational background as well as the present social and health status. The physical examination follows the routine procedure of occupational physicians incl. the tests of hearing and vision. Some functions like weight lifting, stair climbing and endurance e.g. on a bicycle could be easily demonstrated on the spot.
In cases of impaired psychic functions or behavioural patterns a psychologist has to carry out a more comprehensive psychological examination by the means of standardized tests - measuring intellectual capacity, memory, concentration, reaction time, as well as personality scores (Foil 2).
The aspect of work behaviour requires a careful observation of the client for a longer period of time by a vocationally skilled observer - in Reha-centers by an occupational therapist using standardized work samples. In an industrial setting a foreman or personnel manager might evaluate the performance of the client adequately. (Foil 3).
The three aspects will then have to be integrated into the 64 items of the Ability Profile (AbP). Discrepancies between the assessment by psychologist, occupational physician and personnel manager/ ergonomist will have to be discussed and straigthened out between the experts concerned.
The assessment of a Requirement Profile on the side of the assessor requires an experienced analyst and evaluator of working procedures and a specific qualification in abstract thinking, since he/she has to observe the job to be performed without taking into consideration the person who is just doing the job. The analyst has to observe carefully every detail of the work procedure. Furthermore he/she has to ask coworkers and foremen about environmental conditions - not permanently visible on the spot. Everyone of the 64 items has to be analysed and rated according to the definitions of the Abilities and Requirements:

Grade 0 No disability, full ability available - required
Grade 1 Slightly reduced ability available - required
Grade 1.5 Moderately reduced ability available - required
Grade 2 Substantially reduced ability available - required
Grade 3 Severely or no ability available - required

It is essential to observe the whole work flow. The factor of mobility, muscle strength and repetitiveness should be taken into consideration. Special problems such as compensation of a disability by the use of aids, tolerance of hazardous substances etc. have to be listed under "Comments" at bootom of sheet.
The "Ability Profile-Sheet" and the "Requirement Profile-Sheet" are almost identical: both contain the same 64 items, space for the ratings and a columne for the "Comment" (Foil 4 and 5). The Ability Profile (AbP) is printed on a transparent foil, the Requirement Profile (RpP) is printed on a white sheet of paper. The comparison of the AbP with the RqP is easily possible by overlaying the AbP over the RqP. Since rating is entered in the AbP by a X (cross) whereas the rating on the RqP is entered by an o (circle) you can easily see 1. whether the X and the o cover eachother, 2. whether the cross appears to left of the circle indicating "underdemand"or 3. whether the cross appears to the right of the circle - indicating "overdemand" = requirement higher than ability. Since "optical comparison" of the AbP with the RqP is a tedious process, ERTOMIS has developed software for computer-comparison and processing of the results. Over-demands of no more than 1 grade should be reconsidered by the experts responsible for hiring personnel.
The above mentioned field-study - as a test on the validity, reliability and interrator-reliability of EAM-System is performed by an occupational physicians center at Siegen FRG - supported by ERTOMIS Foundation. The center normally takes health care for the 27000 employees of 179 firms - in particular of the appr.2000 disabled persons employed - which represent a quota of 7.4 % - as compared with the legal quota of 6 %. The project compares the results of the routine examinations of the AbP of the appr. 2000 disabled employees with the RqP of the appr. 2000 jobs they are doing at the moment of the AbP-examination.
Simultaneously the center continues the normal examination of the "Problem Cases" i.e. employees, including the disabled but mostly non-disabled, having some health problems with their job. The results of both the "Routine Cases" as well as the "Problem Cases" are fed into the computer for comparison of the AbP with the RqP. So - ultimately we may come out with 2.-3000 cases of AbP/RqP-comparisons in hand.
We have so far 148 "Routine Cases" and 156 "Problem Cases" processed. Of the 156 Problem Cases: 25.0 % problem not related to work. - 14.7 % transfer to other job recommended.- 87 % successful. - 9.0 % adaptation of work place recommended - successful. - 25.6 % modification of work procedure recommended, successful.
Of the 148 Routine Cases: 35.1 % no overdemand. - 21.6 % overdemand avoided by various measures inplant. - 40.6 % want to remain at their usual work place regardless of some overdemand.
Result of the Field-Study: 1.) Job related sufferings could have been avoided if EAM-System would have been used from the begin of employment. 2.) Optimizing efficiency of employment of disabled people. 3.) Prolonged lifespan at gainful employment possible by current placement on appropriate jobs. 4.) Planning of individual rehabilitation program for each impaired and/or disabled person in hospital and rehabilitation center. 5.) Improving work place design. 6.) alias.
The comprehensive EAM-System could do a lot in helping disabled people in what they desire most: To find their way to gainful employment - to become financially independent from private and public support - and ultimately to become socially independent - and no longer "socially" or otherwise "handicapped".


ON-THE-JOB EVALUATION SERVICES BY EMPLOYMENT REHABILITATION CENTERS IN JAPAN

FUMINORI YAMADA
The Japan Association for Employment of the Disabled, Tokyo, Japan


1 Current Situation of Vocational Evaluation in Japan

Vocational evaluation/assessment services are conducted in many institutions not only in the field of vocational rehabilitation, but also in social welfare, mental health and education throughout Japan. Special organizations for vocational evaluation are Employment Rehabilitation Centers for the Disabled(ERCs), in the field of vocational rehabilitation. Popular vocational evaluation methods which have been used in these centers are Interviews, Examinations of Client's Records and Tests. Work Samples, Situational Assessment and On-the-Job Evaluation(OJE) have begun to be introduced recently.

2 Outline of ERCs

The most popular vocational evaluation institutions are ERCs. These centers were established from 1972 to 1982 (one center in each prefecture) by the Japan Association for Employment of the Disabled(JAED). Now there are 47 ERCs in Japan. The centers work closely with Public Employment Security Offices and other related organizations, and carry out the following services based on the Law for Employment Promotion, etc. of the Disabled:

  1. for the disabled......the vocational evaluation, vocational guidance, work preparation training and vocational course;
  2. and for the employers......advice and other aids for matters relating to the employment and management of the disabled.


The total number of the clients in fiscal year 1987 was about 53,000. This includes 11,000(21%) physically disabled people, 35,000(66%) mentally retarded people, and 7,000(13%) mentally disabled and others. Recently, the number of mentally retarded people among the clients has been increasing.

3 System of Vocational Evaluation Methods in ERCs

Figure 1 shows the system of vocational evaluation methods in ERCs.

  1. Interviews & Surveys are the two most often used basic evaluation methods.
  2. Psychological & Physiological Tests are olso often used, because most of them are standardized and quantified. Thus we can easily get objective information in a short time.
  3. The Work Sample Method is an evaluation method using real or simulated work. Two kinds of work samples are implemented in ERCs. One is the Japanese Version of the Micro-TOWER System, developed by the International Center for the disabled of the United States; and another is the original work sample developed by the JAED.
  4. OJE is the most direct form of work evaluation, in which the clients' vocational abilities are evaluated through actual work at the job site.

FIGURE 1.

4 Outline of OJE

Traditionally vocational evaluation was done mainly by interviews and psychological tests in the centers. However, these methods were insufficient for vocational rehabilitation counselors to accurately evaluate the vocational ability of the severely disabled. Therefore, OJE was introduced to solve these problems. It is conducted at enterprises in accordance with the following general guidelines.

  1. Subject.........Any client whom the ERC finds it necessary to evaluate (actually more than half of the clients are mentally retarded people).
  2. Evaluation...Work ability, work habits and socialization tendencies of the subject are evaluated by a counselor on the basis of behavioral observation by an employer at the cooperationg enterprise.
  3. Duration......Up to 3 weeks.
  4. Salary.........Salary is not payed to the client. But 780 yen per day is payed to the employer as a fee for using the facilities.

5 The Existing State of OJE and its Future

OJE has been used since 1982 as the most effective evaluation method in ERCs. It provides the opportunity for clients to acquire work experience, and the opportunity for counselors to more accurately evaluate the vocational ability of the disabled. The total number of OJE clients in 47 ERCs in fiscal year 1987 was about 540 (11 clients per ERC). Although OJE is an improvement over the traditional methods, I think it is necessary for us to try to make it more effective as follows:

  1. Increasing the Number and Quality of Cooperating Enterprises;
    The success of OJE depends on cooperation by enterprises, so we need have many cooperating enterprises near ERCs in order to use OJE at anytime.
  2. Increasing Counselor's Abilities of Vocational Evaluation;
    OJE is one of the evaluation methods. Its results depend on how it is used by counselors. I think it will be neccessary to try to increase their abilities of vocational evaluation.
  3. Discussion of How to Use OJE.
    In order to make OJE satisfactory with the limited staff and budget, I think it will be necessary to discuss what method would be best.

SELF EVALUATION AND CRITERION REFERENCED APPROACHES TO VOCATIONAL ASSESSMENT OF ADULTS WITH DISABILITIES

D.MCANANEY
Rehabilitation Institute, Dublin, Ireland


INTRODUCTION: In 1983 the Rehabilitation Institute established a National Training College for adults who were disabled but who were capable of higher level training. The College offered training in a wide variety of areas including Electronics, Draughting, Computer Applications and Business Studies. The client population included individuals with both physical and psychiatric disabilities. A Vocational Assessment Unit was also established to provide a service to the College. The procedure adopted by this Unit differs in two major respects from many other vocational assessment approaches. Firstly, the Assessment tools used are criterion referenced rather than normed instruments and secondly, clients' own self-evaluations play an important role in the process. An analysis of a cohort of clients who participated in assessment and training indicates that these approaches are not only just as effective as other procedures but also satisfy the needs of disabled adults more completely.

Theoretical Premise
Norm referenced tests by their nature have a number of drawbacks when they are applied to a client population with many divergent disabilities. Firstly, they are biased both in terms of the norm group which is often not disabled and usually from a different country and also in terms of items used which often discriminate against various disability groups by confounding speed and accuracy in one total score. A good example of this type of test is the General Aptitude Test Battery (U.S. Dept. of Labour, 1982). Secondly, the broad range individual differences from Cerebral Palsy, through Amputation to Schizophrenia, make up a population which cannot be considered homogeneous and thus this important basic assumption of norm referenced test is seriously violated. Thirdly, the results of normed tests are general in nature and items are selected so as to be insensitive to short term change. Thus, results can neither be used to plan specific rehabilitation objectives nor to monitor progress over a period of rehabilitation. Fourthly, and most importantly, normed instruments, including commercial work samples (Botterbusch, 1980), have little predictive validity in terms of employability at the end of rehabilitation. This is particularly true of a psychiatric population (Watts, 1983, Griffiths, 1977). These weaknesses of normed testing are well documented by Popham (1978). Finally, from the clients' point of view the results of normed tests are quitc often meaningless. There is little point in telling a twenty five year old individual that he or she has a reading age of 8 years when what is really required is whether or not he or she can read a computer manual. Percentiles are equally hard to interpret for the lay person.

Criterion referenced instruments, because they compare an individual's performance to the requirements of a specific task or domain of tasks, rather than to the performance of other individuals, can avoid many of the problems associated with normed tests. There is no cultural or item biase, they do not assume homogeneity of variance, they are sensitive to short term change, they directly indicate rehabilitation needs and results are easily interpretable by clients. A well constructed criterion referenced test which is based upon an indepth and valid task analysis is probably more suited to the vocational assessment of disabled adults than a norm referenced test.

The use of criterion referenced tests also provides clients with the opportunity to more fully participate in their own assessment. Clients can be asked to rate their performance on a task under a number of headings and these ratings can be directly compared with the results of the test. This not only provides clients with directly relevant and understandable feedback about their performance but also provides an indication of how realistic their own self ratings were. In order to evaluate the effectiveness of these two assessment techniques a random sample of individuals, who had fully particpated in assessment and training in Roslyn Park National Training College, were selected and assessment results were compared to final outcomes of rehabilitation.

SUBJECTS: 50 subjects who had attended the Vocational Assessment Unit between January and December 1985 were selected for the analysis. 29 subjects had successfully completed secondary education while the rest had left school by the age of 15 years. 25 subjects had been identified as needing remedial input in English and 28 required input in Maths. While all subjects were of at least average ability according to the Ravens Standard Progressive Matrics, 24 were definitely above average. There were 21 subjects with physical disabilities, 12 with sensorial disabilities and 18 with psychiatric disabilities. These figures are roughly proportional to figures for the College as a whole and in preliminary analyses none of these variables were significant in predicting either employment or response to rehabilitation.

METHOD: The assessment procedure in Roslyn Park has three stages. Stage I is designed to gather information about educational and cognitive factors as well as clients' career interests. Stage II focuses on the technical and social skills of clients and is based on a series of course samples which are designed to represent the content of each course and Stage III is a confirmatory assessment during which clients who have achieved adequate criteria levels on Stages I and II participate fully on a course for a trial period.

The main focus of the present analysis is the Stage II assessment. During Stage II clients are trained to evaluate their own performance under a number of headings. These headings include Technical aspects such as Speed, Accuracy, Logical Work Method and Manual Dexterity as well as Non-Technical areas such as Social Integration, Independence and Suitability of Environment. They rate themselves on a 3 point scale representing (1) Inadequate, (2) Questionable and (3) Adequate. Course instructors report the results of Course samples under the same headings and using a similar scale. They also report subjective impressions of the Non-Technical areas. In this way clients can be shown how their own ratings differ from those of the course instructors.

The dependent variables for the current analysis were: (1) Criterion Results:- the average number of questionable areas reported after course sampling. (2) Self Evaluations:- the average number of questionable areas reported by clients after course sampling. (3) Difference Ratings:- the difference between criterion results and self-evaluations.

The independent variables for the analysis were (1) Response to Rehabilitation:- this was derived from end of course ratings of competence. The variable had two levels 1. Little or Questionable Response and 2. Adequate Response.(2) Discharge Rating:- This was derived from placement information. This variable also had two levels, 1. Placement to employment/further education and 2. Medical discharge/other (including unemployed).

There were two covariates included in the analysis. These were estimates of social functioning derived from group discussion. One was a self evaluation and the other was the facilitator's evaluation. It was felt that social functioning might well mask the effects of other variables and thus it was decided that the variance due to these variables be partialled out.

RESULTS AND DISCUSSIONS:- 2 multivarate analyses of covariance were performed with two dependent variables; Criterion Results and Self Evaluation. The independent variables were Response to Rehabilitation and Discharge Rating respectively. In the first analysis, the two dependent variables significantly predicted Response to Rehabilitation (Multivariate F5.500, P <.01). In the second analysis there was no significant multivariate effect. Thus the results of criterion tests and self evaluations were significantly related to Response to Rehabilitation but not to ultimate placement.

To clarify the position the variables were subdivided into technical and non-technical aspects. In addition, analyses were carried out using the Difference Ratings, Instructor Ratings, during Stage III assessment and results from the General Health Questionnaire. These results are presented in Table 1. From this table it can be seen that Clients self evaluations are good indicators of the way they will respond to rehabilitation but not to whether they will return to employment. In addition, it would seem that the non-technical aspects of assessment are more effective in predicting employment than the technical aspects. This is supported by the fact that the General Health Questionnaire was significantly related to employment. Finally, the fact that the difference in ratings had the strongest relationship with response to rehabilitation suggests that the interaction between Instructor and Client is an important factor to take into account.

CONCLUSION:- It is important to emphasise that a significant number of clients rated the assessment process in Roslyn Park as being very relevant (Chi-Square 21.00 P <.001). Further, it would have been impossible to allow the same level of client participation if the process had used Norm Referenced and standardised tests. On the other hand, the proces was also effective in identifying those clients who responded well to rehabilitation. The inclusion of Non-Technical Factors in vocational assessment is clearly an important aspect of the process as it can identify those more likely to gain employment. Thus the use of criterion referenced tools and self evaluation techniques can provide a dignified and effective vocational assessment procedure that fulfils both the requirements of the organisation and the needs of the adult client with a disability.

Table 1 Relationship between Non-Normative Vocational Assessment Tools,
Response to Rehabilitation and Discharge Ratings.

INDEPENDENT VARIABLE
DEPENDENT VARIABLES Response to
Rehabilitation
Discharge
Rating
Technical Criterion P=.053 Ns
Self P=.026 Ns
Non-Technical Criterion Ns P=.039
Self P=.038 Ns
Difference in Ratings P=.020 Ns
General Health Questionnaire Ns P=.044
STAGE III Assessment Ns P=.045

(1) General Aptitude Test Battery, U.S. Department of Labour, Manpower Administration, Intran Corporation, Minneapolis, 1982.

(2) K.F. Botterbusch, A comparison of commercial vocational evaluation systems., Materials Development Center, University of Wisconsin, Stout, 1980.

(3) F.N. Watts, Employment, In F.N. Watts and D.H. Bennett (Eds.) Theory and Practice of Psychiatric Rehabilitation. New York, Wiley, 1983.

(4) R.D.P. Griffiths, The prediction of psychiatric patients' work adjustment in the community., British Journal of Social and Clinical Psychology, Vol.16, pp.165-173, 1977.

(5) W.J. Popham, Criterion Referenced Measurement., Englewood Cliffs ; N.J., Prentice Hall, 1978.

(6) J.C. Raven, J.H. Court and J.Raven, Manual for the Raven's Progressive Matrices and Vocabulary Scales., London, H.K. Lewis, 1979.


Sectoral Session C-2 Thesday September 6 14:00 - 15:30

NEW APPROACHES TO THE EMPLOYMENT OF DISABLED PERSONS AND THE IMPACT OF NEW TECHNOLOGY

Chairperson: Herr. Dir. Hubertus Stroebel Bundesarbeitsgemeinschaft fur Rehabilitation(F.R.G.)
Co-chairperson: Prof. Yoshimi Yokomizo The School of Science and Engineering, Waseda University (Japan)

NEW APPROACHES TO THE EMPLOYMENT OF DISABLED PERSONS AND THE IMPACT OF NEW TECHNOLOGY

HUBERTUS STROEBEL
Bundesarbeitsgemeinschaft fur Rehabilitation, F. R. G.


I am deeply grateful to the generations before us. From them we have inherited a wealth of knowledge and many discoveries. The list of achievements is long, from the mastery of fire to the discovery of printing right up to micro-electronics. Technology shapes our lives.

When we look at the impact of technology on the employment of disabled persons, we find that technology facilitates the employment of disabled persons. machinery alleviates heavy physical work. Technical aids are able to compensate for functional losses. However, everything is in a state of flue. We are currently living in a time of technical revolution. It affects everyone, disabled and able-bodied alike. The World of work is being permanently changed by small and large computers, automations, microprocessors and the methods developed from them. The chances and risks that this signifies in terms of the employment opportunities for disabled persons remains to be clarified. First and foremost, it is a question of improving the chances of integration of the disabled in the general labour market by means of vocational qualification. In order to achieve this, training has to be orientated towards the technical development of the labour market. Qualifications tailored to the requirements of the labour market have long been the best passport to employment as has been realized, and is still recognised, in developing countries. However, the increasing demands of the professional word reach their limitations when we demand too much of disabled people. In this respect, technological progress hinders the integration of disabled persons in the world of work. Given this situation, a political solution is the only suitable instrument with which to achieve employment under protected conditions. Without protected jobs, we shall not be able to achieve the integration of the disabled in working and professional life in the future either.


A NEW MODEL TO ORGANIZE SHELTERED EMPLOYMENT

GERHARD LARSSON
President, C.E.O. Samhall, Tullinge, Sweden


Sweden, with more than 8 million inhabitants, has for a long time aimed at a high employment degree. 79,2% of the women in Sweden in the working age of 20-60 have jobs. The corresponding figure for men is 86,0%. The unemployment rate is low, only about 2% the last years. The consequence of this is also that disabled people must have a work. Otherwise they easily will be outside the community. A physical disabilitity will limit the possibility to utlilize public communications and a mental handicap will often make it hard to participate in organizations for other people etc. A work is not only a way to earn one's living, but also the basis for taking part in the community and living among other people.

We have above all two kinds of support from the Swedish government to give disabled people an opportunity to work. One is what we call wage subsidies. 43.000 occupationally handicapped people have a work with a private or public employer because the government pays a part of their wage costs (25-90%). The other support from the government came in the eighties when a special company - or rather a group of companies - was established with the task to give jobs to occupationally handicapped, who have not the opportunity to work in the regular labour market with wage subsidies. The group of companies - Samhall - has had the responsibility for all sheltered workshops in Sweden since 1980.

Before that time the sheltered workshops belonged to over 100 principals, such as county concils, local communities, the National Labour Market Board and private organizations. Because of that there were a number of reasons to coordinate the activities in a new organization: a more evenly geografic distribution; work for people with severe handicaps; less internal competition; more accentuated sense of business; reduction of costs through coordination of production and marketing.

During these circumstances the Swedish Parliament decided to establish the new organization-The Samhall Group - in the same manner as an ordinary group with a parent company and subsidiary companies. The Group was also set up free from outside authorities as an own independent organization. The subsidiary companies will cover each county in Sweden (=24), and have the responsibility for all sheltered employment in the country.

Samhall, the parent company, is responsible for the over all management, financing and coordination of the group enterprises.

The task of the Samgall Group is to create meaningful and developing jobs for disabled people where the needs are. The implementation of this business idea is measured in three target areas. All these three areas are equally important and are being constantly measured:

  • the number of job opportunities for the occupationally handicapped;
  • the number of employees within the group who were able to find jobs elsewhere in the labour market as a result of developmental measures,;
  • the economic result, our aim being to reduce the need for state compensation;

Means to achieve these aims are production of goods and services.

The employment service, run by the state is respsonible for the recruitment. We have no minimum work capacity stipulated. However, to be an employee in our group you have to be on half time job at least.

As far as I know it is unique in the world that one organization has the responsibility of all sheltered employment in the country. We are also rather unique about the wages. We have conditions as in other industry, based on agreements between Samhall and the regular trade unions on the national level. It is no piece-work. The wages refers to the job reguirements based on a simplified job evaluation procedure. The level of the wages is in general 90% of the wages paid within the ordinary Swedish industry.

We want to offer meaningful and developmental jobs. We do that mainly by producing goods in several different industrial sectors. It is no therapy! We are for example the biggest producer in Sweden of furniture and also the biggest employer in the textile industry. Further, about 10% of the jobs today is in the service field as data programming, tourism, shops and infotech services.

Our output of goods and services has to respond the market demands. We produce goods and services in free competition with other enterprises. The prices are set in accordance with accepted business principles. The state-grants are needed to cover the additional cost compared with other companies. The greater part (65%) of the output is based on subcontracts with other industrial companies. We compete on equal terms with other companies. Over 20% of our total sales revenue refers to direct ant indirect exports. In four countries abroad we have our own selling-companies. Typical export products include indoor furniture, workshops fittings and sport and leasures articles. To Japan we export pinewood furniture, roller-skies and gifts.

We have three concepts to organize jobs. First we have 330 own factories, which are situated in areas where other industry is located. The next concept is inbuilt workshops or so called enclaves. In the future this number is planned to increase. An enclave consists of a cooperation between Samhall and usually a private company - the partner. In such an enclaves the Samhall Group is the employer, but the employees work in the partners workshop. We are responsible for personnel development and occupationally health service. Normally we also provide work supervision. Our partner is responsible for offering tasks adopted to the ability of the employees. Our partner purchases raw material and market the result of the production. Our partner pays for the benefit he receives, either by a percentage of the wage-costs or by payment related to production results. The third concept is contract work. It is a form that means that the work is carried out in our partners workshop by our employees. So far it is similar to in-built workshops. The difference is that in the concept of contract work, we also are responsible for achieving production goals. It is up to us to decide the number of employees and what employees. Contract works today are eg in the fields of cleaning and packaging, restaurant-service. Today we have 15 such contract works with 400 employees.

You may understand of these that our goal is to normalize the job-situation as in regular industry and service. The disabled person will do his job at his own ability in normally a lower speed. We will give technical and other support. But we will produce goods and service with equipment as in other industry and our working-places will as much as possible be integrated with other companies.

Today the Samhall group has 34.000 employees, of which 29.000 with different forms of disabilities. Roughly about 48% have physical disabilities, 32% mental retardation and another 20% sociomedical problems, for example drink and drug problems. This last group I also think we are a little unique in Sweden to count in among disabled persons. In all our own factories and the enclaves people with different disabilities are integrated.

Personnel development is a fundamental part of the Samhall Group's operational idea. Personnel development measures are aimed, among other things, at giving the employees greater selfconfidence and self-esteem. Some of the many personnel development measures which the Group organizes are: Individual development plans; introductory training; basic skills training; bilateral workshop planning - a method of enabling all employees to influence and take part in the planning of the enterprise; planned job rotation; management and leadership development; work environment and occupational health services; inter-employee supportive activities; target measures on behalf of different groups of handicapped persons. As I mentioned in the beginning one target area is transitions to other employment. It means that employment with the Samhall Group is not just intended to provide jobs for the occupationally handicapped. It must also enhance the prospects of the individual finding employment elsewhere.

When the Group began in 1980, transitions were about 300 per annum, which was just over 1% of personnel strength. Since then the number of transitions has risen steadily, amounting in this year to 1.100 persons or over 4% of our personnel strength. The rising number of transitions can be viewed as a result of the Group's emphasis on personnel development.

The group turnover for 1987/88 is forecasted to about 1.000.000.000 US$. 48% of the income is derived from our own sales and 52% from a grant decided by the parliament. This makes 15.000 US$ sales revenue and 16.500 US$ state support for every occupationally handicapped employee. In fixed prices we have succeded to reduce this state grant with about 5.000 US$ since 1980, which will give us good support from the parliament. Each year we will give an offer to the government about how many disabled we think we can offer job and to which price in average per job. The government does their consideration and give a proposal to the parliament, which take the decisions on our condition for next year in this two measures.

Through the new organization with a group of companies with the responsibility for all sheltered employment in Sweden since 1980 we have, compared to earlier, got; -a more evenly geografic distribution of sheltered employment all over the country; -a good and fixed income for the disabled person;
- meaningful jobs and more jobs for people with severe handicaps;
- a more accentuated sense of business and a good harmony with other companies in Sweden;
- more disabled people transfered to other jobs after a time in the Samhall Group
- now over 1.100 a year;
- a good coordination of production and marketing. For the government it means that we during our eight years have run the Group with 3.000 million SEK cumulative cheaper than if we should have had the same organization as before 1980.

I therefore dare to tell you that our new model in Sweden with an overall responsibility over the country in a business-like organization for all sheltered employment has been an important step forward against fullfilling the right of all disabled people who wish a job also can get that. Our new model is in the same time a more integrated and normalized way to get a job than earlier for severe disabled when the possibilities doesn't exist in the regular labour market. As you probably have understood in Sweden we first use resources to find possibilities in regular market by different support from employment service where wage subsidies are the most important. But it isn't enough. Therefore a society, wanting to help all disabled to work, need a complement like Samhall, where the employees feel they do an important and inquired work with conditions similar to those in other companies. But they must also know, if there is possibility to have a job in regular market, they shall take that and the free place another disabled with bigger need may be recruited instead. I'm sure the needs of jobs for disabled will increase in the future. More disabled expects jobs because they today, more often, have got education, but also because in our culture the job is important not only for income but also for belonging to the community. In the same time the attitude specially towards intellectually and soci-medical disabled are negative among employers and other employees. Above that the demands of ability in the 90:ies industry is increasing. Therefore we need a good complement to organize meaningful jobs for disabled people in the 90:ies. The Samhall Group is one solution or model.


HEALTH AND HUMAN SERVICES ROBOTICS LABORATORY

K. G. ENGELHARDT
Carnegie University, Pennsylvania, U.S.A.


In the Health and Human Services Robotics Laboratory (HHSR Lab), researchers are exploring and designing systems based on robotic and Artificial Intelligence technologies. The major goals of this research are to gain basic knowledge of human/system integration, facilitate research that will contribute to the evolution of robots in the service of humans, help improve the quality of and options for health care delivery services through the application of advanced technologies, and develop innovations that will increase the independence of both caregivers and patients.

Human factors, the functional and cognitive capabilities of the persons for whom these systems will be designed, are the focus of research in the HHSR Lab.

Current lab activities focus on research associated with the design, development, and interactive evaluation of hybrid systems:

  • Smart Home. Artificial Intelligence and robotics are being integrated to create a caring, forgiving home environment for individuals with disabilities as well as non-disabled persons. This research is directed toward keeping disabled and vulnerable elderly persons independent and in their own homes longer. The Smart Home environment will also engender a therapeutic, rehabilitative life space for all ages and abilities. The Smart Home environment includes a flexible Automated Nutrition System (ANS) which incorporates a robotic manipulator to assist in meal storage, retrieval, delivery, preparation, and clinical nutrition management.
  • Robotic Vocational Workstation (RVW). Work is underway to create a voice controlled robotic workstation that can be utilized by individuals with upper limb dysfunction, enabling them to perform employment related tasks. The RVW will work interactively with a disabled individual to provide note-taking, document preparation, programing, telephone management, and correspondence capabilities independently. The workstation will also provide access to remote systems detabases, computer networking bulletin boards, as well as personal computer-based software packages.
  • Mobilanguage: Basic research on human/system integration. The challenge of the Mobilanguage research is to optimize effectiveness and efficiency of voice i/o in the operation of mobile robots. Human preference, natural language interfaces, planning, and error recovery strategies are being investigated during the development of a command and control vocabulary for both autonomous and guided vehicles.
  • Cognitive Retraining and Reminding. Interactive voice technologies, in cognitive related tasks, are being researched to aid persons with memory disorders. These systems will provide assistance for persons with strokes, amnesia, and have the potential for serving closed head injury patients.
  • Informed Alerting. Basic research of human "action perception" is in progress. The perceptions of health care professionals are being analyzed systematically, using protocol analysis.

TECHNOLOGICAL INNOVATION AND DISABLED PEOPLE

KIGEN MIWA
Fujitsu Ltd., Japan


1) Characteristics of the Japanese Economy

Japan's economy is changing. The structure of her industry is also changing. Having aggressively adopted technical innovations in the past, Japanese corporations have now begun shifting low value added activities to overseas locations. Policies of internationalization, development and design work are being implemented in Japan, whilst manufacturing operations are being shifted overseas.

This has caused a need for reorganization of job assignments within Japanese corporations. However, whilst a system of "lifetime employment" continues to be observed, changes in job assignments internally will create the need to deploy employees whose skills have become redundant, to other sectors which are short of manpower.

There is a difference between this practice and that of European and American enterprises. There, employees in positions that become unnecessary are dismissed, and employees with the new, required skills are hired.

Also, in Japanese firms, freshmen are hired upon graduating from school and trained internally so that they may acquire required skills. As these skills improve they are deployed or promoted to new positions.

The same goes for the disabled undergoing job re-training programs. However, there are many cases where job re-training programs for the nondisabled are not appropriate for the disabled to learn necessary skills. Therefore, a disabled person might first take a re-training course, and then an OJT (on-the-job training) program tailored to their specific needs and disability, to ensure their job suitability and satisfaction. There are many Japanese enterprises that have eagerly adopted the benefits of technological innovations, which would also have the knowhow to employ and re-train disabled people.

2) The Merits of Technological Innovation

There are numerous cases in which technological innovation has contributed to expanding opportunities for employment and social involvement.

a) Working at Home:- With the advent of networks and workstations, it has become possible to work at home and to avoid commuting.

In Japan, with its population problems and commuting inconvenience, the possibility of working from home would enhance employment opportunities for people with certain types of disabilities.

b) Voice input/output:- Software for disabled people has been developed. In Japan "OS-TALK" voice software is available, which is capable of having a voice read out inputted data. This is sold not only by welfare organizations, but by Fujitsu - one of the top-ranked computer manufacturers.
Furthermore, voice input/output technology is now available cheaply due to the advent of the super LSI with large capacity memory functions. This is indeed invaluable for persons with limb and visual disabilities.

c) Accessibility Guidelines for Electronic Equipment:- The U.S. government has determined the "Electronic Equipment Accessibility Guidelines" to enable people to use electronic equipment in spite of any handicap.
The Japanese government has made no moves in this direction yet, but private concerns are exerting efforts to conform to these guidelines. "OS-TALK" is one example of such efforts.

3) Technological Innovations - Some Problems

With the above changes taking place in Japan's economy, emphasis has shifted from employing new, lowly-skilled workers, to instead upgrading the skills of those already employed.
Demand for newly recruited employees is sluggish. But the demand would be strong for disabled people who have undergone vocational training at public institutions and schools, thereby gaining high-level skills demanded by employers.
In view of the latest developments in technological innovation, a review of curricula at vocational training institutions is urgently required.

At the same time, measures need to be considered for those people unable to attain the minimum re-training skills even after having undergone in-house vocational training. A thorough review and revision of training courses is required, not only within corporations but also at public vocational training institutions.

4) Conclusion

Technological advances will continue on into the future. These must be harnessed in order to develop disabled peoples' abilities. In this respect, electronics is a field offering much potential for extending assistance to such persons.

I. Changes in the Industrial Structure of Japan


Sectoral Session C-3 Tuesday, September 6 14:00-15:30

INTEGRATING REHABILITATION WITH SOCIAL SECURITY SYSTEMS

Chairperson: Prof. Monroe Berkowitz Bureau of Economic Research, Rutgers University (USA)
Co-chairperson: Dr. Kumiko Terayama Tokyo Metropolitan College of Allied Medical Sciences (Japan)

INTEGRATING REHABILITATION WITH SOCIAL SECURITY SYSTEMS

MONROE BERKOWITZ
Professor of Economics, Rutgers University,USA


Our most recent estimates.of disability expenditures in the United States for 1986 are $169.4 billion, about 4% of our total Gross National Product. This number represents our best estimates of total spending by both the public and the private sectors on disability programs for all persons ages 18-64.

The total represents an increase since 1980 when total spending was $98.5 billion or about 3.6% of GNP and a substantial increase since 1970 when we were spending about 1.9% of GNP.

However, in 1970, we were spending about 5.4% of those expenditures on disability related matters on what we have called direct services. These are funds spent not on cash benefits or medical care but money spent on rehabilitation and other direct services designed to return workers to the labor force or otherwise help them.

Although amounts for rehabilitation increased from 1970 to 1980 and from 1980 to 1986, these direct services formed a smaller and smaller proportion of total disability expenditures. In 1970, we spent about 5.4% of the disability dollar on rehabilitation and other direct services. By 1980, the proportion had shrunk to 3.5% and by 2.1%

I raise the question with you: why do we spend so little on rehabilitation?

I would suggest several answers.

We are not really convinced that rehabilitation is a cost effective mechanism. In spite of all the rhetoric, we are not sure that spending an additional dollar on rehabilitation will save a dollar of benefits.

There may be other reasons. Would it not seem logical that the programs which pay the cash benefits, programs such as workers' compensation and the disability or invalidity programs would be in the forefront of seeing to it that their beneficiaries or the applicants for their program's benefits received rehabilitation?

Rehabilitation International has received a grant from the United States Social Security Administration to study this problem and we are meeting here today to explore several aspects of the integration of rehabilitation with social insurance programs.

We are looking at nations throughout the world to learn how individual countries go about the business of trying to bring together two rather different systems, with different histories, culture and orientation,. This is not an easy task. Among the problems are the following:

Potential candidates must be identified, recruited and selected,

The candidate must be willing to enter or reenter the labor market with all of the implications of such a move for continued benefits - both cash and medical.

Services must be available with a minimum of interference and in sufficient time. These services might be guidance, training, education or placement, as well as medical restorative services.

These are problems common to any rehabilitation systems. Overriding all of these problems in many countries is the question of whose responsibility it is to seek out and promote the use of available resources for rehabilitation.

There are several actors on the scene and the cast of characters will differ depending on the country under consideration.

There is first and foremost the affected person. The informed person might seek out these services without the aid of any intervening agency.

There are separate rehabilitation agencies.

The social insurance authorities are the actors we are most interested in. Their attitude might be that they are there to pay benefits and nothing more; that rehabilitation is some other agency's responsibility.

In addition there are the medical authorities and the labor market authorities each of which may be concerned with rehabilitation.

Lastly, there may be a host of private agencies concerned with rehabilitating people.

In many countries, there is no agreement about the respective role of each of these actors. All may be on the stage at once, and perhaps each is acting in a different play.

Our project is designed to examine the systems in place in various countries, to determine if we can identify any innovation in organization for rehabilitation or in any of the models used. These models may deal with incentives, with work evaluation, with placement, or with any of the other aspects of the field.


REHABILITATION INNOVATIONS IN THE UNITED STATES' SOCIAL SECURITY PROGRAM

D. RUST
Associate Commissioner for Disability, U.S. Social Security Administration, U.S.A.


This paper will discuss the social security program in the U.S.A., and the new and innovative program we are undertaking to promote employment opportunities for persons who apply for and receive disability benefits...firstly, some background information about the Social Security Administration's (SSA's) disability program.

The disability program is a fundamental part of the overall U.S. Social Security Program which provides retirement, survivor and disability benefit payments to more than 40 million persons each month.

1) The Social Security Disability Program:

110.8 million insured workers
2.8 million worker beneficiaries
1.3 million dependents
$20.6 billion cash benefits paid
$8.2 billion Medicare benefits paid
$508/ month average paid to disabled worker

The disability program provides Federal disability insurance for American workers and their families and for low income persons who have limited attachment to the workforce.

In 1987, 110.8 million workers, or 4 out of 5 workers aged 21-64, were protected by Social Security disability insurance. SSA has two disability programs. They are the Social Security disability insurance (Title II) and Supplemental Security Income (Title XVI) programs.

The Social Security Disability program was established in 1955. The first cash benefits were paid in 1957. Under Title II of the Social Security Act, workers earn their disability protection by working in Social Security-covered employment or self-employment. Under Title II, benefits are paid from the Federal Disability Insurance trust fund monies without regard to the person's income from other sources such as private insurance, savings or investments.

Additionally, $8.2 is paid in Medicare benefits. Medicare provides health insurance coverage for people who have been eligible to receive Social Security benefits for two or more years.

2) Supplemental Security Income (Title XVI) Disability

The original Social Security disability insurance contained no provisions for those individuals who had not worked on a fairly regular basis before they became disabled. Provisions were made for this part of the population when the Supplemental Security Income program was created as part of the Social Security Amendments of 1972. The 1972 Amendments replaced existing Federal-State programs for needy people age 65 or over, or who were blind or disabled. These are the statistics:

4.4 million recipients (elderly, blind and disabled)
2.9 million disabled/blind recipients
$9.4 billion (Federal) benefits paid to blind/disabled
$287/ month average (Federal) benefit paid to blind/disabled person

The Supplemental Security Income disability program is a welfare program in which eligibility is determined by a "Needs" test based on income and assets. SSI recipients must meet disability program eligibility standards. These recipients generally are eligible for Medicaid - a Federal Health insurance program for persons who are financially needy.

3) Disability Defined

There are a number of differences between the two disability programs that we administer. However, the legal definition of Social Security disability applies to both of these programs.

Disability, for Social Security and Supplemental Security Income, is defined as the inability to engage in any substantial gainful activity by reason of:

- Any medically determinable physical or mental impairment
- Which can be expected to result in death OR
- Which can be expected to last at least 12 consecutive months

As you can see, this definition doesn't recognize partial disability. Also it is not strictly a medical decision.

4) SSA Vocational Rehabilitation Program

In addition to providing income and health protection, the Social Security disability program has the objective of assisting disabled persons to obtain self-sufficiency, particularly through employment. SSA has for many years referred disability beneficiaries to vocational rehabilitation agencies in each State which provide services for the disabled. The State programs operate under the U.S. Department of Education. Thus, SSA and the Department of Education cooperate in providing vocational rehabilitation services for Social Security disabled beneficiaries.

5) Innovations to Promote Employment Opportunities for the Disabled.

The widespread development of significant improvements in medical rehabilitation, vocational rehabilitation and rehabilitation engineering technology now make it possible for increasing numbers of the disabled to return to work.

Because of the increasing development of improved rehabilitation and employment services for the disabled, SSA is engaged in a new and innovative program to promote employment opportunities for persons who apply for and receive disability benefits.

The program involves working with applicants and beneficiaries, public and private sector providers of rehabilitation and employment services, private employers, trade unions, physicians and SSA staff to effectively assist disabled persons to secure employment. The new SSA initiative involves three major strategies:

- New work incentive policies
- Improved public awareness of work incentives, and available vocational rehabilitation and employment services, and
- A national program of demonstration projects designed to develop innovative, efficient and cost-effective methods of serving Social Security beneficiaries.

These strategies will lead to a systematic program to assist many more disabled persons toward self-sufficiency through employment. In successful cases, this effort will reduce or eliminate disabled peoples dependence on Federal benefits.

6) Work Incentives

Recent legislation has broadened Social Security work incentives for disabled beneficiaries.

For beneficiaries who work despite a severe disability, the following apply:

- Trial work period
- Extended period of eligibility
- Disregard of short work attempts
- Deduction of subsidy and impairment related work expenses in determining if earnings are SGA
- Medicare extension
- Possibility of returning to rolls without serving a new waiting period for disability benefits and Medicare

An individual receiving Social Security disability benefits can have a 9-month trial work period during which time he or she can test their ability to work while continuing to receive their full monthly benefits.

If the individual continues employment beyond nine months, there is a 39-month period during which cash payments can be reinstated for any month the individual cannot work. Health insurance benefits are received during this extended period.

There are also special provisions in the Supplemental Security Income program which permit recipients to work and receive a portion of their benefit payment.

If earnings rise above a certain level, cash benefits cease but the individual continues to receive health insurance benefits.

Supplemental Security Income recipients may set aside a portion of their income to pursue activities leading to self-support (PASS), while continuing to receive benefit payments.

These broadened work incentives are already resulting in more persons testing their ability to work, and additional work incentives are being tested in our national demonstration program.

7) Public Awareness Campaign

SSA is currently conducting a major public awareness campaign to inform our beneficiaries, the numerous vocational rehabilitation and employment service organizations, physicians, employers, insurance firms and other organizations about our employment initiatives. We are also using modern marketing techniques to test effective communication approaches for these audiences.

We have conducted a major training program for our national and local field staff and designated work incentive specialists in each of our 1,200 field offices throughout the country.
Finally, we are developing a variety of print and video materials describing our work incentive and vocational rehabilitation programs for widespread national distribution.

By reaching out to service providers we hope to encourage new local programs to assist our beneificiaries return to work.

8) Research Demonstration Program

SSA has initiated a major nationwide research demonstration program to test new and innovative vocational rehabilitation and employment strategies.

This program responds directly to a statutory requirement and to recommendations of a recent national Disability Advisory Council. This Council strongly emphasized the need for new programs to assist Social Security disabled beneficiaries to obtain employment.

The Research Demonstration Program involves an open national competition where organizations submit proposals based on demonstration and research priorities established by SSA. These proposals are evaluated based on objective criteria. Selection of the projects is made by the Commissioner and executive staff of SSA.

9) Key Areas

In conducting demonstrations, SSA is focusing attention on four key areas where additional information is needed to develop an effective, ongoing vocational rehabilitation or employment program:

  • Early intervention to provide information on the availability and effectiveness of vocational rehabilitation, employment assistance and work incentives early in the disability application process;
  • Enhanced client assessment to provide rapid and reliable evaluation of rehabilitation potential;
  • Streamlined and coordinated referral to match disabled people with appropriate vocational rehabilitation service providers and expedite referral for employment services;
  • The coordinated intervention and management of services to assure that services achieve their goals, are efficient and cost-effective.

10) Research Demonstration Program Projects

Through the Research Demonstration Program, we are conducting forty projects in twenty-seven States throughout the U.S., and we expect to begin forty to fifty projects in the near future.

In developing information in key programmatic areas, the projects include:

  • Use of computer systems to identify and evaluate rehabilitation and employment potential and match beneficiaries with appropriate employment assistance;
  • The coordination of referral and vocational rehabilitation services;
  • Methods of financing private sector vocational rehabilitational services and use of cost containment and cost management techniques;
  • Comprehensive employment services using case management;
  • New uses of rehabilitation engineering and technology to assist beneficiaries' return to work;
  • State-of-the-art methods for measuring functional capacity;
  • Specialized studies of impairments, such as traumatic brain in jury;
  • Client directed rehabilitation and employment programs;
  • New methods of communicating to better link beneficiaries with appropriate service providers; and
  • Methods to encourange training to lead to permanent employment.

The Research Demonstration program will provide SSA with the information necessary to develop and implement a systematic and cost-effective program to assist disabled beneficiaries toward self-sufficiency through employment

11) Concluding Remarks

* SSA views assisting disabled people to achieve employment as a major goal.

* Through new initiatives, we are expanding opportunities and encouraging disability beneficiaries to use their abilities to the fullest.

* The new work incentives, communication strategies and demonstrations being implemented are providing valuable information which will be used to assist beneficiaries to re-enter the workforce.

* Our goal is to continue our efforts in conjunction with those of programs throughout the U.S., both public and private, to improve the quality of life for people with disabilities.

* In working toward this goal, we will continue to draw upon the knowledge of the international community.

* Likewise, as we gain greater knowledge and experience that can benefit other nations, we will share that information with all interested parties.


REHABILITATION SERVICES AND SOCIAL SECURITY IN JAPAN

KENJI ITAYAMA
Professor, Japan College of Social Work, Tokyo, Japan


The Goal of Rehabilitation Policies for the Disabled

To realize "full participation and equality" of disabled people.

Thus, policies have two aims:

i) Planning and promotion of programs necessary for effective realization of medical, educational, vocational and social rehabilitation for each disabled person.

ii) The planning and promotion of programs necessary to improve various existing systems which have been preventing realization of "full participation and equality" of disabled people.

The Development of Rehabilitation Policies in Japan

A) No professional provision was made for any disabled person until 1940. Up until then they may have been eligible for public assistance under certain "poor laws" (mainly the Daily Security Law).

B) With the enactment of the "Law for the Welfare of the Physically Handicapped" in 1949, various types of rehabilitation measures came into being. The overview of enacted legislation is as follows:

i) Legislation enacted regarding different types of disabilities. (1940's - 1960's): Enactment of laws regarding the physically disabled (1949), the psychiatrically disabled (1950), and the mentally retarded (1960).

ii) Coordinating legislation. (1970's): e.g. The Fundamental Law for Measures concerning Mentally & Physically Handicapped Persons (1970) which coordinated various types of assistance. The School Education Act of 1979 provided a compulsory education system for mentally and/or physically disabled children in special schools.

iii) Development of comprehensive rehabilitation measures (1980's). Various types of legislation have been passed consistently to increase measures for comprehensive rehabilitation and "full participation and equality" are offered by professionals in the vocational rehabilitation fields.

Social Security Measures to increase Comprehensive Rehabilitation

A) After the International Year of Disabled Persons (1981) the government set up the "Long Term Action-Plan concerning Measures for Disabled Persons" (March 1982). At the mid-point of the Decade for Disabled Persons (1987) this was evaluated and updated. Thus was formed "Major Measures for the Latter-Half of the International Decade of Disabled Persons".

"Major Measures..." focused on the following areas:

a) Development and publicity

b) Health and medical care

c) Education and upbringing

d) Vocational rehabilitation and employment

e) Social welfare

f) Living environment

g) Sport, leisure and cultural activities

h) International cooperation: exchange of disabled people; assisting developing countries.

Note: The government has established the Headquarters for Measures for Disabled Persons (covering thirty-seven ministries).

B) Social Security Systems which Support Rehabilitation Provisions.

1) Health and Medical:
i) Treatment for general and particular diseases.
a) Insurance systems for specific occupational groups:
- Employee's Insurance Law (1922, PL 70)
- Worker's Compensation Insurance Law (1947, PL 50)
b) Insurance covering a total community:
- National Health Insurance (for the self-employed)(1958, PL 192)
- Law for the Health of the Aged (1982, PL 80)
c) Medical system for specific diseases:
- Mental Health Law (1950, PL 123)
- Leprosy Prevention Law (1953, PL 214)
d) Medical care provision via public funding:
- Public Assistance Law (1950, PL 144)
- Law for the Welfare of the Physically Handicapped (1949, PL 283)
ii) Legislation for administering health and medical services.
Medical Service Law (1948, PL 205)
Law for Public Health Centers (1947, PL 101)
Law for Physical Therapists and Occupational Therapists (1965, PL 13)
Law for Prosthetists (1987, PL 61)
2) Education:
Law for School Education (1947, PL 26)
Law for Encouraging Attendance at Schools for the Blind, the Hard of
Hearing and the Mentally and Physically Disabled (1954, PL 144)
Japanese Law for Scholarship Association (1944, PL 30)
3) Vocational and Employment:
Employment Security Law (1947, PL 141)
Vocational Training Law (1969, PL 64)
The Physically Handicapped Persons Employment Promotion Law (1960, PL 123)
4) Social Welfare:
Social Welfare Services Law (1951, PL 45)
Child Welfare Law (1947, PL 164)
Law for the Welfare of Physically Handicapped Persons (1949, PL 283)
Law for the Welfare of Mentally Retarded Persons (1960, PL 37)
Law for the Welfare of the Aged (1963, PL 133)
Law for Special Aid to Wounded and Sick Retired Soldiers (1963, PL 168)
5) Income Security:
Daily Life Security Law (1960, PL 144)
National Pension Law (1959, PL 141) Employees' Pension Law (1959, PL 115)
6) Daily Life and Environment:
Public Housing Law (1951, P 193)
Road Traffic Law (1960, PL 105)
Road Traffic Safety Equipment Facilities Law (1966, PL 45)
Disabled Persons' Discount Fares Regulation (1952, Public Notice 121)
Mail Law (1947, PL 165)
Income Tax Law (1965, PL 33)
Commodity Tax Law (1962, PL42)

Governmental Budget concerning Provisions for Disabled People.

(Unit: Million Yen)
Name of Ministry 1982 1988 (B/A)
(A) (B)
1. Prime Minister's Office 24 24 1.00
2. Police Agency 86 94 1.09
3. General Affairs Agency 190,514 192,219 1.01
4. Ministry of Justice 0 60 -
5. Ministry of Foreign Affairs 0 14 -
6. Ministry of Education 107,789 116,265 1.08
7. Min. of Health & Welfare 1,000,924 1,611,119 1.61
8. Min. of International Trade and Industry 599 275 0.46
9. Ministry of Transport 14 9 0.64
10. Min. of Posts and Telecommunications 1,327 294 0.22
11. Ministry of Labour 17,060 39,625 2.32
12. Ministry of Construction 448 400 0.89
13. Ministry of Home Affairs 0 5 -
Total 1,318,785 1,960,403 1.49
Note: Government subsidy rates vary from 10/10 to 1/3.

THE NEW ZEALAND ACCIDENT COMPENSATION CORPORATION'S EXPERIENCE WITH REHABILITATION AND RETURN TO WORK

J.T.CHAPMAN
Accident Compensation Corporation, Wellington, New Zealand


The Accident Compensation Corporation is a statutory organization that administers a comprehensive, no-fault social insurance scheme for victims of unintentional injury. Every person unintentionally injured in New Zealand and, in certain circumstances, a resident injured outside of the country, is covered for 24 hours a day, regardless of fault, circumstances, place or time of injury. As from 1 April 1974, when the scheme commenced, there is no civil right, either at common law or under any statute, to claim damages for unintentional injury. In administering the scheme, the Accident Compensation Corporation is charged with promoting injury prevention throughout New Zealand, and with helping injured persons to regain their rightful place in society by providing them with rehabilitation assistance and financial compensation.

The Corporation does not rehabilitate injured persons. It's role is to help the injured to rehabilitate and habilitate themselves. For a number of inter-locking reasons, the Corporation has taken a pragmatic approach both to exercising and developing its rehabilitation role.

In the first place, the Corporation is obliged to concentrate on the accident disabled. Some 140,000 claims for unintentional injury are received each year by the Corporation. Approximately 10% of these claimants would require some rehabilitation assistance for varying periods of time, with the claim files for about half of this group being closed within a year. This sub-set of the accident disabled is but a tiny fraction of the population of disabled in New Zealand, estimated to b3 416,000 persons with a physical disability that has been present for one month or more. A little over half of that group are estimated to be handicapped, that is, having a substantial loss of functional ability that markedly restricts everyday living. In addition a further 70,000 persons are estimated to have a mental disorder causing disability, and over 60% of these persons would be handicapped.

Secondly, the rehabilitation scene in New Zealand is characterised both by a proliferation of agencies and organizations with little or no co-ordination between them, and by the absence of a national policy for the disabled. There are over 100 voluntary organizations providing a range of particular services and facilities to handicapped persons, while several Government agencies and numberous Hospital Boards also play important and often dominant roles. The existence of these diverse avenues for help is no guarantee that an injured person knows about them, or is capable of getting the best available help from them. Furthermore, there is a tendency for the rehabilitation process of be provider-driven thus creating a debilitating feeling in the injured person that everyone "wants a piece" of him or her, but nobody sees the injured as complete persons or ever canvesses their views on, or presents them with a total picture of, the rehabilitation process.

Finally, the accident compensation legislation is heavily weighted towards payment of compensation benefits and the system is claims-driven. The general public perceive the Accident Compensation Corporation as an administrator of monetary benefits and, indeed, expect this orientation which is enshrined in the very titles, "Accident Compensation Corporation" and "Accident Compensation Act".

Given those constraints, the Corporation has developed a reasonably successful role in rehabilitation. The Corporation is primarily a user of existing resources and services though it may, where necessary, financially assist with housing alterations, motor vehicle adaptations, retraining programs, the provision of special equipment for daily living and, where appropriate, assistance towards self-employment.

The Corporation's 50 rehabilitation co-ordinators help injured clients assess their needs, so that personal and informed choices can be made, and then direct the clients towards the most appropriate resources or services. If need be, the rehabilitation co-ordinators will themselves make the connections between injured clients and services, but the emphasis is on helping clients to help themselves. Individual programmes, worked out by the co-ordinators in conjunction with the injured clients and their families, comprize several stages and end with confirmation that the clients have been rehabilitated in accordance with the agreed programs.

So as to ensure that early referrals for rehabilitation are made, the Corporation has established Client Service Groups in all its 24 district offices. These groups comprise compensation and rehabilitation personnel, and it is to the senior client services officer and rehabilitation co-ordinator within each such group that all rehabilitation referrals are initially made. Staff have been trained in referral criteria which list priorities such, for example, as sexual assult, head injuries, spinal injuries, burns and so forth. It is corporate policy that the identification of rehabilitation requirements, and an appropriate decision on the rehabilitation process suitable for the individual case, be made within two days of the lodgement of a claim. Where rehabilitation assistance is required, then personal contact will be made with the injured client within three days of the decision to assist having been made.

Injured clients must personally take responsibility for job seeking. The rehabilitation co-ordinators, though not actively involved in job placement, are conduits for the vocational rehabilitation assistance available from the Corporation. Such assistance includes negotiating with an employer about an injured employee's job; advising employers and injured clients on the availability of "make-up" pay; planning for clients to undertake work trials; assisting clients to obtain retraining; advising employers on possible assistance for work place modifications; arranging with employers for the provision of temporary alternative employment; referring clients to assessment and retraining services. In some cases it may be appropriate to provide financial assistance to get a client into self-employment.

Rehabilitation co-ordinators have taken initiatives at local levels to help enhance the employability of their clients. One such initiative has been the establishment of Job Clubs.

Given that Job Club members tend to be among the hard core of the unemployed, the Job Club's success rate of about 60% finding employment is a notable achievement. In another initiative, rehabilitation co-ordinators helped establish a "New Directions Course" at two local Community Colleges. The course runs for 12 weeks, is initially aimed at those clients who have been 12 months or more on accident compensation benefits, and teaches interpersonal skills, leadership and self-assertion together with a range of job skills from retailing to computers.

These local initiatives will, in time, be promoted beyond the initial district or region. This grass roots approach is quicker to launch than some national program originating in Head Office, has local commitment, and can readily be shelved if results sought are not achieved. The Corporation's experience has highlighted the necessity of being responsive to its clients' needs, and it believes that this is best achieved by relinquishing central control and by developing and positively encouraging local input and response. The Corporation has already made the transition from a centralized to a decentralized organization providing services to injured clients as near as possible to their home locations. In order to assist its Regional Managers to develop programs which will draw on local resources to meet local needs, the Corporation has appointed Regional Rehabilitation Advisers. These Advisers provide a national resource for Regional Managers and also help them form a link with district managers, rehabilitation co-ordinators, clients and local services.

As a user of services, the Corporation continues to take initiatives in promoting inter-agency co-operation and rationalization of services. Two recent initiatives, for example, have been a joint approach with the Department of Social Welfare to provide attendant care to all disabled, and the determination of criteria for the joint allocation of funds to support services for survivors of sexual assualt and physical abuse. Consideration is being given to paying a fee to the Department of Labour when they place injured clients in employment, and the Corporation is also considering a joint pilot scheme with the Department of Labour for placement of clients through a private enterprise operation. The Corporation continues to make positive use of its financial grants system to encourage development of more sophisticated and quality rehabilitation services. Recent examples include financial assistance to help establish a Diploma Course in Rehabilitation studies; to set up university posts in rehabilitation medicine; to establish a human factors/orthotics laboratory; to support the concept of a Diploma in musculo-skeletal medicine; to assist in the promotion of housing design for the elderly and the disabled; and to initiate research in a range of relevant areas.

The range and structure of the compensation benefits themselves are viewed by the Corporation as measures to enhance rehabilitation, though it is a difficult task to generate this positive perception in the minds of the public. The Corporation is empowered to meet the reasonable costs incurred by clients for home help and attendant care; for transport to work when injuries prevent clients from using their normal methods of transport. There is also the broad category of medical and related expenses that can be met by the Corporation. These include doctors' and specialists' fees and, where referrals are made by a doctor, fees from related medical professionals such as physiotherapists, optometrists, chiropractors, occupational therapists, podiatrists, psychiatrists or clinical psychologists, acupuncturists and osteopaths. Certain expenses incurred through private hospital treatment may also be met by the Corporation. Post-accident financial security is provided by the payment of weekly earnings-related compensation available for as long as the incapacity to earn remains. There is provision, in cases of permanent incapacity, for making permanent pensions the quantum of which can not subsequently be reduced, though it may be increased. Finally lump sum awards can be made, both to earners and non-earners, for permanent damage to bodily functions and for the effect of injury on life style. The awards are in addition to other compensation benefits and a client may be eligible for both awards.

The Corporation's pragmatic approach to rehabilitation has been in response to the prevailing rehabilitation scene in New Zealand. it is a primary objective of the Corporation to assist in creating a national initiative for all disabled that will eliminate both gaps in and duplication of services through co-ordination at all levels of rehabilitation services and resources.

There is also the problem created by the inherent conflict within the compensation structure itself. There must be certainty of compensation so as to minimize any barrier to rehabilitation, while at the same time there must be financial incentives to get well and back to productive work. This tension is highlighted by the present economic climate in the country. Unemployment in New Zealand is increasing. Even if this was not the case, vocational rehabilitation can not be viewed by the Corporation as a singleminded end in itself. Within the comprehensive compensation scheme, the worker or earner is neither more nor less important than the housewife, the elderly or an injured child. Those who cannot be placed in vocations still merit attention and so positive self-images and social rehabilitation cannot be considered as just secondary goals.

The existing legislation is under review and hopefully this inherent tension will be lessened in any rewrite. Finally the Corporation believes that a shift, in its computer and physical records, from a claims-file system to a person-based approach would enhance its rehabilitation effort. The information requirements and policy implications of such a shift are presently being examined.

The Corporation's input to rehabilitation will continue to stem from the premise that it's role is to help the injured to rehabilitate and habilitate themselves.


NEW DEVELOPMENTS IN THE SOCIAL SECIRITY SYSTEM IN THE NETHERLANDS

THE PLACE OF THE HANDICAPPED PERSON IN SOCIETY FROM THE VIEWPOINT OF THE NEW TRENDS IN VOCATIONAL LEGISLATION

MARTIEN W.J. MENKEN
Ministry of Social Affairs and Employment, The Hague, The Netherlands


In fact, "realize your limitations" might and should be the motto of this meeting, and I hope to be able to demonstrate the validity of this phrase both for the disabled persons as well as for society as a whole and more specially from the legislative point of view.

I mentioned the ability to recognize one's limitations.

  • If these problems are to be dealt with in a scientific manner, they must also be considered from more than one point of view, for example by sociologists, psychologists etc. But we are limited here to just myself, and my reflections based on my personal experience and daily work as a policy officer of the Department for Social Provisions of the Dutch Ministry of Social Affairs and Employment.
  • The second limitation concerns the type of subject as indicated above. It will, therefore, be necessary, to restrict the oral representation to the most important aspects of the topics. The more detailed paper in writing will serve as background document for the discussions and the proceedings.

In 1947 an attempt was undertaken through legislation to improve the labour market position of the handicapped through the Disabled Persons Employment Act which came into force on 1 January 1948. Under this Act employers were obliged to employ a minimum of 2% handicapped workers. The Act, however, never functioned to the degree that was expected of it. Practice demonstrated that the statutory definition of the concept of a less able-bodied worker is not precise enough and not flexible engough. It was partly because of this that there were no opportunities of insisting on or encouraging compliance with the Act.

This act will therefore shortly be replaced by the Handicapped Workers Employment Act (WAGW).

The WAGW originally included a uniform quota which was 5% just as in the Disabled Persons Employment Act. This however has been replaced by the following:

  • a commitment imposed upon employers (organizations) and employees organizations to take steps, preferably in mutual consultation, to ensure that the handicapped are integrated or reingrated into working life;
  • a quota to be imposed by general administrative order between 3 and 7% if during the first few years that the WAGW is in force too little or nothing is done with regard to the integration or reintegration of the handicapped into working life. This will be done after a recommendation has been made by the advisory bodies referred to in the WAGW. For industry these are the SER (Socio-Economic Council) and the SVr (Social Security Council). The SER only makes a recommendation on a measure if this will cover a major section of industry or if more general problems are imvolved.

Amendments have been made to the WAGW after checking it against less far-reaching legislation. The cabinet has opted for this in order to lighten the burden of industry. The latter has brought about a stengthening of the economy. I should point out that although amendments have been made the principles of the bill have been retained. These principles related to the right to personal development and equal opportunities for the handicapped as well as the reduction in the number of those entitled to benefit.

Many people and probably many among you too, think that the WAGW only means an obliatory quota. I should point out however, that together with and following on from the WAGW, a coordinated package of measures and instruments is provided which are concerned with three key points of reintegration policy, namely:

  1. Reduction of the actual and supposed obstacles external to the handicapped person himself.
  2. Reducing the actual and supposed obstacles of the handicapped person himself.
  3. The coordination and intensified application of existing measures and instruments and those improved under the WAGW.

The most important actual obstacle external to the handicapped person is the lack of jobs for the handicapped.

To remove this obstacle it is being proposed that the two sides of industry be obliged to take steps to promote integration and re-integration and that a percentage quota be imposed by general administrative order if they do not adequately meet this commitment.

The quota scheme laid down in the WAGW displays similarities with the German arrangement which is equally applicable to government and industry, not specified by category of handicapped person or occupation and coupled with a levy. The West German scheme differs in that the standard quota of 6% applies there with the possibility of raising this percentage for government employers. If this quota is not met employers have to pay 100 DM per month to a special fund for every vacant job for a handicapped person. A review of the act which leaves the level of the percentage otherwise unchanged is being dealt with at the moment.

For your information I shall refer to integration and reintegration measures in various countries.

France has already had a quota system for some considerable time which comprises a standard quota of 3% and an additional quota for the benefit of war victims. In France employers who fail to meet the quota can be fined, the fine is a percentage of the minimum wage. A review and simplification of the system is being worked on at the moment.

Italy, too, has a quota scheme which, however, because of the special provisions with regard to war victims is fairly unclear to us.

Belgium only has a quota of 3% with regard to newly recruited personnel in public service. Moreover there is the possibility of agreements of partners to collective labour agreements in branches of industry being declared binding.

In Ireland the recommendation that 3% handicapped people be employed only applies to government service. Spain has a 2% quota and Greece a 7% quota for the government.

In the latter country proposals are being prepared which will mean that the quota also applies to private industry.

A quota of 3% was introduced in the United Kingdom as far back as the second world war. Implementation of the quota has never been optimal and has been lax for some time. At the end of 1984 the British government and central organizations of employers and employees agreed on a code of good practice which will be used in employing handicapped people.

There is also legislation in this field in the United States albeit that it concentrates more on equal opportunities and anti-discrimination. Japan has a more detailed quota system with a scheme subdivided by branch of industry. The objectives vary in numbers and degree. Employers who do not meet their commitments pay a contribution to improve the position of the handicapped. Furthermore employers can be given grants towards the costs incurred for the benefit of the handicapped.

I should also like bring your attention to the fact that the Commission of the European Communities has drawn up a draft recommendation which will have to be dealt with in the Council after a recommendation has been made by the European Parliament and the Economic and Social Committee. The draft recommendation does not contain any direct call to institute a quota scheme but nevertheless suggests that steps be taken which would mean achieving percentage objectives for companies with more than 20 employees. A quota system is one of the possibilities. Moreover there are plans to recommend that annual reports be made on the results achieved in integrating handicapped people.

From this overview we might conclude that quota systems are widely spread and should be accepted throughout the world. Nevertheless, as I stated earlier, these systems provoke more and more discussion. Still, in the Netherlands a new quota system has very recently been enacted. How come?

Our earlier system, dating back from 1947, had a very much non-compulsory character, and it didn't work. Also in other countries one sees that a policy without the right tools cannot bear much effect.

Both under prosperous and negative economic conditions one needs a quota system to confront handicapped and non-handicapped employees with one another. Only then the conditions for true integration in the labor process can be obtained.

And more over there are strong reasons for extra measures towards disabled people concerning the less material side of their existence.

The great merit of the system is that it attacks by means of one mechanism both barriers to the employment of the disabled at once - the shortage of jobs and the shortage of financial resources to underpin rehabilitation services. It is also fundamental to the system that it refers to severely disabled people and applies to both public and private employers.

Yet there is no evidence that Member States are planning to create from nothing a quota system on German lines, or to adapt and strengthen their present quota system on the German model. The opinion is often expressed that any such initiative would be counterproductive in present economic circumstances when so many nondisabled workers are unemployed. In the United Kingdom it has been decided, after considerable debate, not to abolish a quota system which is generally regarded as unsuccessful. Instead there has been created alongside it a new official but voluntary Code of Good Practice on the Employment of Disabled People, certainly intended to be the cornerstone of future policy and practice. In the Netherlands also a new approach with some similar characteristics can be seen in measures now before the Parliament, as I already told you.

Three verbs characterize the relationship between the individual and work: must, can and may.

Individuals must work; participation in the working process can therefore be required of everyone, handicapped people included. Whether a person in fact can do something depends on his abilities. Whether he in fact may work, is allowed to work, has in our society received too little attention, has even been bought off with an allowance. With all that entails.

But rehabilitation must reflect events in society. Good therapeutic help, opportunity to learn social skills and the reduction of conflicts which impede personal and social development are necessary of rehabilitation to succeed. Laws and practical impediments intervene between dreams and deeds for handicapped people just as for anyone else wishing to take part in the working process.

For this reason I should like to add a few more points:

  1. "being occupied" should in itself be regarded as real work;
  2. acceptance of a handicap must be learned as soon as possible;
  3. vocational guidance must be taken very seriously;
  4. the handicapped person must himself participate in the decisions that are taken; all too often the elderly handicapped particularly have never learned to put their needs and wishes clearly into words;
  5. a thorough realization of one's own limitations, but also of one's abilities, is a minimal requirement if one is to be a real partner in any discussion.

I hope that I have succeeded in demonstrating:

  1. the relativity of being handicapped
  2. the relativity of disability in the family
  3. how Dutch society endeavours to provide the means to enable such families and the handicapped to integrate.

I trust you will forgive me if I seem to have made a number of propositions in a rather cryptic statement. In general, I can summarize them as follows.

  • In view of the democratic principle that all men are born equal, in the sense that the dignity and importance of the individual transcend differences in ability, one should see these persons first and formost as persons and not treat them as pathetic and under-privileged creatures. The word "pathetic" should be dropped immediately.
  • One should be fully aware of the nature of the disability and the consequent limitations, and make every effort to stimulate those faculties which are fully present.
  • Disability is more of a (socio) psychological problem than a technical problem. One should therefore take full account of the person's psychological background.
  • To be handicapped is an existential fact: an aspect ("problem") inherent to life, which will never be definitely solved. In this case, that aspect is having to live with a physical form which deviates from what is regarded as normal, with all the resultant implications.
  • In the approach to the handicapped one will have to seek the balance between an excessively indifferent attitude (as if nothing was the matter) and an excessively solicitous attitude (because they miss so much in life).

It is precisely in the modern world where everything and everybody seems to be in a rush, where nobody seems to have any time for anybody else and where we seem doomed to become the victim of self over-estimation in many ways. The handicapped person, I feel, has an extremely important role to play as he forces others to realize the limitations of their existance.

If we assume that for the development of the handicapped person's personality it is best that he should realize what he is able to do and that he should direct his system of values accordingly, and furthermore that he should accept his disability as a reality, then here there is a vital task for all who take part in the care of the handicapped. To be privileged to help the handicapped, to see not what they lack but what qualities they possess and what they can achieve, in short to teach them to see that life can be meaningful for the handicapped, that is a thing which is of inestimable importance.

I hope these views can be a contribution to a better understanding of those who are in some respects the less privileged in life, expecially towards the labor market.


Title:
16th World Congress of Rehabilitation International No.7 P.281-P.318

Publisher:
The Organizing Committee of 16th World Congress of Rehabilitation International

Month,Year of Publication:
Jun,1989

To access/retrieve this document:
Japanese Society for Rehabilitation of Persons with Disabilities
1-22-1, Toyama, Shinjuku-ku, Tokyo 162-0052, Japan
Phone:03-5273-0601 Fax:03-5273-1523