Lesson 10: Vocational Rehabilitation


Attention


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify the important characteristics of both formal and informal work culture
  • Identify strategies for how to teach formal and informal workplace culture
  • Identify illness and financial barriers that make work a challenge for people with MI

Teaching

Employment is an essential adult activity

  • Promotes self-confidence
  • Income
  • Identity
  • Self-esteem
  • Status
  • Persons with servere mental illness rarely get to experience the positive results of having a regular job.

Stigma

Barriers created by Stigma

  • Employer’s personal understanding/experience with mental illness
  • Beliefs about the abilities that persons with mental illness have
  • Negative self-beliefs about a person’s own ability

Misguided Service

Barriers created by Misguided Service

  • Overly concerned about stress, symptomology, medication and rehospitalization
  • Protection from failure
  • Preparation in a non-competitive environment
  • Formation of low self-expectations

Lack of Vocational Experience

Barriers created by a Lack of Experience

  • Limited understanding and identity as a “worker”
  • Lack of understanding of culture of the work place
    • Formal structure
    • Informal structure
  • Poor vocational planning and decision making (what job roles have they experienced and thus imitate?)
  • Less knowledge of skills, interests, and preferences
  • Services may be measured by duration of job rather than a match

When I worked in rehabilitation services it was often observed that although a person with a disability may have had the skills to do the job, they did not have the skill, or were not invited, to join in the informal structure of the job. The informal structure is where a lot of "orientation" to "how things are done here" is done. It is the "hidden" culture of the organization and it is key to both doing the job well and to feeling comfortable and a part of the work place community.

Individuals unable to access the informal structure (hanging out after work, having lunch together, etc.) can become isolated, frustrated, and miss key aspects of job expectations that are communicated primarily through this structure.

Psychiatric Disability

Barriers created by Psychiatric Disability

  • Episodic and cyclical nature of disability
  • Low self-esteem, lack of confidence, fear of failure, anxiety
  • Medication effects
    • Side effects
    • Main effects
    • Stigma

Possible Loss of Benefits

Barriers created by Possible Loss of Benefits

  • SSI, SSDI, SS, and Medicaid are based on “poverty” and “employment status”
  • Some programs have graded exit (SSI) others are “all or none” (SSDI)

In my own owrk this was probably the most significant barrier that I have ever come across. Many of the individuals that I had as clients would have gladly tried to work (they were bored!) but were very afraid of losing thier benefits which were so important in keeping them well (paid for doctors, medication, and sometimes their housing!)

Vocational Services

Features of Effective Vocational Services

  • Practitioner
    • Demonstrate respect to the client and his or her barriers
  • Process
    • Comprehensive and Responsive to changes in needs
  • Programs
    • Real Work for Real Pay

Principles for effective Vocational Services

  • Consumer choice
  • Integrated services
  • Natural supports
  • Rapid placement
  • Job accommodations
  • Seamless services
  • Employer education

Vocational Rehabilitation (The Federal Initiative)

Timeline of Developments in VR

  • 1920-creation of Vocational Rehabilitation as a service
  • 1943-expanded to include MR and MI
  • 1960s-expanded to include SSDI recipients
  • 1973-Rehabilitation Act (established Rehabilitation Services Administration)-prioritized “most severe”-funding to states-created the IWRP
  • 1970s-access for MI improved with the establishment of Community Support Programs
  • 1986-redefinition of the Rehab Act-defined supported employment and funds
  • 1992-refinement of the Act-emphasis on consumer choice, and mandated a “presumption of employability” for all

American’s with Disabilities Act

  • 1990
  • Protect from discrimination in five areas (employment, transportation, telecommunications, public accommodation, and the business of local and state government)
  • “Qualified Applicant”
  • “Essential Functions”
  • “Reasonable Accommodation”

Making the distinction between an essential ad non-essential function of the job is the key to understanding the priciples of the ADA. ADA protects individuals from being discriminated when it comes to non-essential aspects of the job. At KVCC some students have been sick and in the hospital and have missed class. While it may be up to the instructor on how to handle that situation, it is not a guarantee by the ADA that an accommodation must be made because "attending class" (at least in a live class setting) is an essential part of the "job" of being a "student".

Vocational Service Modalities

Transitional Employment

  • TE job is acquired from the employer
  • Staff learn the job
  • Place people in the job

Fairweather Lodges

  • Persons with mental illness live and work together in member-run businesses

Hospital Based Work Programs

Job Clubs

Sheltered Workshops

Affirmative Industries

  • Owned by the agency
  • “Clean Sweep”

Supported Employment

  • Place-train approach
  • Attend day programs or simulated work environments
  • Choose-Get-Keep model

Job Coaching

  • Often a part of SE
  • Career planning and development
  • Potential careers and market factors
  • 42 job coach contacts to create one job

Assessment

Possible Class Discussion

Discuss circumstances (illness and financial barriers) under which it would not be advisable to have someone go to work. What are the potential solutions to these problems?

Lesson 10 Quiz

  1. As best as you can describe it, what would you hope to do to assist a client in developing an awareness of the formal and informal cultures of a worksite?