vocational rehab for persons with multiple disabilities

Vocational Rehabilitation for Persons with Multiple

Disabilities

Presented by

R. Narasimham

Chairman, Expert Committee for

Developing Courses in

Vocational Rehab & Allied subjects

(Rehabilitation Council of India)

Concept Paper on Vocational Rehabilitation at Statelevel workshop on

“Needs & Deeds of adults with multiple disabilities”

15th September 2011

Types of Multiple DisabilitiesDifficult to categorize as all sorts of permutations and combinations of physical and intellectual disabilities are seen with varying possibilities and different residual abilities.

Learning and teaching methodologies change accordingly.

Capacity to acquire academic and daily living skills also differ

Vocational skills therefore have to be designed to suit residual abilities. No authentic information is available on the incidence of Multiple Disabilities 2VR for MD - NIEPMD

I.L.O. Vocational Rehabilitation (Disabled)Recommendations ( 1955 & 1983)

the term vocational rehabilitation means that part of the continuous and coordinated process of rehabilitation which involves the provision of vocational services, such as vocational guidance, vocational training and selective placement, designed to enable a disabled person to secure and retain suitable employment (UNCRPD implies Progress also)

Vocational Rehabilitation is the most tangible of all rehab measures that result in psychological and social well being and an inclusive atmosphere.

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Concept of Vocational Rehabilitation

The Concept of Vocational training & rehabilitation itself has come in just about 40 – 45 years ago in India. Even among the Developed Nations the concept dates back to the end of Second World War (1945)

Focus has always been on medical or surgical intervention and education

While teaching and learning are disability oriented, do not forget that the jobs are not created for the disabled, nor are they designed to suit the disabled.

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Paradigm Shift from disability to job

• While it is true that medical, therapeutic and learning is influenced by the impairment, jobs are not so.

• Any Voc Rehab worker has to understand the needs of the employer and the job requirements.

• Jobs have to be modified or job operations have to be identified to suit the abilities of the person & not the other way.

• Job analysis is fundamental to vocational rehab.

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Doctors & Rehab team – Shift from Medical Model

Disabled Person – Shift to Social Model

What is Job analysis? Job analysis is a systematic approach to

defining the job role, description, requirements, responsibilities, evaluation, etc.

It helps in finding out required level of education, skills, knowledge, training, etc for the job position.

It also depicts the job worth i.e. measurable effectiveness of the job and contribution of job to the organization.

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Job Analysis – How?Job Analysis – How?How do you stitch a button ?Mark, Hold a needle, Mark, Hold a needle, Thread the needle, Thread the needle, Hold the button, Hold the button, insert needle with insert needle with thread into cloth & thread into cloth & button, pull out, button, pull out, repeat for a few repeat for a few times, tie the end, times, tie the end, cut the threadcut the thread. .

Now that is job analysis.We talked of tasks, jobs of Assistant to We talked of tasks, jobs of Assistant to tailor & Assistant to Domestic Wireman tailor & Assistant to Domestic Wireman & occupation of Tailor & Wireman & occupation of Tailor & Wireman

How do you fix a Switch Board ?Mark, Cut, place the Mark, Cut, place the Switches and screw Switches and screw them. In the process, them. In the process, use the saw to cut, use the saw to cut, hold the switches in hold the switches in place, put the place, put the screws, hold the screws, hold the Screw Driver and Screw Driver and turn it clockwise till it turn it clockwise till it is firm is firm


Task Analysis We discussed in detail about the Job analysis. We saw different

tasks performed to complete a job. What are different parameters required for

performing each of the tasks efficiently? You need to have different qualities for Threading the needle

and fixing the Board Each task calls for certain physical

requirements, education, training, intelligence, psychomotor coordination, decision making (Intelligence & experience) and so on…….

Analyzing & identifying the required parameters is task analysis. Task analysis is the natural concomitant to

job analysis.


Job Analysis Job analysis is needed to decide on the exact

work tasks on which a disabled could be optimally employed.

Job Analysis is one of the basic techniques for job identification or job development or client-oriented job.

A job may be defined as a collection of tasks performed by a worker in a single establishment.

A task is defined as one activity that requires exertion of human effort - mental or physical - for a specific purpose.

An occupation (as we find in the National Classification of Occupations – More than 2500 Occupations) is defined as a group of similar jobs found in various establishments.

It may be pointed out that even though the jobs may be similar there are different variables, which affect placement effort.


Job Variables - 4 Ms & 4 SsJob Variables - 4 Ms & 4 Ss

Methods - Sewing by Hand, Machine etc…

Materials - Sewing m/c operator Silk Vs Canvas

Machines - Printing m/c Platen Vs Large automated m/c

Measurement- varied Speed accuracy Precision

Specialization - One man Shop Vs Plant

Surroundings - Carpenter Inside Vs Outside

Special Assignments - Personal Assistant , Combination of jobs

Selected tasks - Clerk-cum-Typist Combination of work tasks

Vocational Evaluation

Functional ability despite impairment Capacity to withstand physical,

mental and emotional strain associated with the occupation

Identify areas where the possibilities to enhance vocational potential

Identify the vocational needs of the pwmd

Assess skills Assess potential for retraining for re-

employment Assess work environmental

modification to suit the individual11VR for MD - NIEPMD


RANGE OF EVALUATIONRANGE OF EVALUATIONEvery job has certain attributes and can be performed efficiently only when the person has abilities. This is assessed primarily through subjective-objective assessment techniques and procedures.

S --- SKILLK --- KNOWLEDGEA --- ABILITY (to work)P --- PHYSICAL CAPACITYA --- APTITUDET --- TRAITS(Personality)I --- INTERESTS


Job SelectionJob Selection

Work tolerance Stress

Aspirations Future Prospects

Socioeconomic Status Status

Experience Experience

Training Training

Education Education

Personality Traits Interpersonal relations

Aptitude Aptitude

Intelligence Intelligence

Physical potential Physical Requirements

Disabled personSkilled Semi-Skilled Un-Skilled

IndividualJob

Issues in Vocational

Training Major issue - educational attainment

both for vocational training & economic rehabilitation

For example : Only 484 Schools for the Deaf all over India.

We do not have any facility for the pwmd other than NIEPMD

Difference of opinion in teaching methodologies for different disabilities and inadequate training of regular teachers to deal with disabilities under SSA

Communication – verbal, written and mobility to reach Institutions

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Vocational Counseling & Adjustment Training

Counseling on Employment MarketCounseling on Employment MarketParent CounselingBehaviour modification Adjustment Training in operations to Adjustment Training in operations to

make the disabled employable for short make the disabled employable for short periodsperiods

Entrepreneurship Development ProgramPre Recruitment TrainingPre Recruitment TrainingWorker Education Custom made skill development as Custom made skill development as

required by the employer or the pwmdrequired by the employer or the pwmdRetraining of persons with recently acquired

disabilities 15VR for MD - NIEPMD


Preparing for VRPreparing for VR

Job Training: Identify the job profile. Assess the capacity and match the job to the individual. Train them to suit the job.

Training in Institute: Break down the job operations into simple work tasks, repeat the skill training constantly so that the person is able to recall the skill.

On-the-job training: To provide job orientation, names, locations, hours and wages, supervisor, other employees, work uniform etc.

Group Rehabilitation programs Development of basic skills for specific

employer requirements Setting up supported employment services

such as Cooperatives, Home bound employment and job specific sheltered employment involving the parents/guardians

Open employment

Means an employment status where the person is not employed in protective atmosphere but is competing with others in securing and retaining a job on a full time basis.

Right to opportunity for competent employment of the pwd

Organized Sector/ Formal sector Only 7% of the Work Force covering Govt., PSU, Local Administration and registered under the Factories Act etc…..

Unorganized Sector/ Informal Sector 93% all others. Most of our placement is in the unorganized sector

As per National Commission on Unorganized Sector 79% of the 395 million get less than Rs 20 per day as wages.


Supported Employment

The supported employment may at times be a final solution to the placement of the particular person

Mainly to be a source of inculcating work behaviour, work environment & function towards attaining production targets.

Function as a nursery to target regular employment

Creating community awareness of abilities of the disabled & community participation

Advocacy18VR for MD - NIEPMD

Self Help Groups

Identification of the persons with disabilities in the geographical area

Meeting of the Persons with disabilities along with their parents/families.

Assist in choosing a leader or a representative from among the pwd,

His/her job would be to contact Employers, collect raw-materials, give back the finished products to the employers, collection and distribution of payment etc.

Leader/representative may be rotated once in two years or three years as their group feels.

Liabilities /Assets/ profits equally distributed among members


Cooperative Cooperative is a formal Self Help

Group with an elected leader Accounts etc are to be maintained

as per Rules Annual inspection by the Coop

Authorities Allocate certain percentage of

money for administration Job orders to be varied and

equitable distribution among members

Major part of remuneration to be paid to the members



Remedial programs Focus on diminishing or solving to a great

extent the issues faced by the PWMD Evaluation & continuous evaluation basic to

all remedial programs Programs should be individualized Depends on degree of disability/retardation Duration of inactivity, specific difficulties

noticed first, speed of change, attitude of client, parents, fear of activity

Should be within the clients capability but offer a challenge

Activities to be graded to increase the clients capability

Effort required and/ or the time spent on type of activity must increase.

Check lists and records should be maintained for future guidance

Examples of Compensatory Strategies for Behavior

Work Behaviour Vocational Impact Compensations/accommodations/modifications/strategies

Has difficulty following through on instructions from others

Completing job applicationsJob promotionsLoss of jobLow self-esteem

Identify learning/working stylesProvide instructions in preferred learning style mode

(auditory/visual/tactile); Provide feedback/ supervisionProvide special assistive aids, accommodations, etc. prescribed to meet individualized needs

Has difficulty sustaining attention in tasks or play activities

Difficulty following multi-step

Instructions; Increases risk for accidents for certain jobs; Increases risks for mistakes on-the-job

Break tasks into short segmentsGradually extend activities into longer units; Schedule breaks between tasks; Arrange environment to block visual/auditory distractions; Use earphones to block sound


Has difficulty working independently

Problems in jobs such as sales where you need to be a self-starter; Problems in helping professions; Problems in jobs requiring travel from supervised work setting

Develop a structured and clearly defined task; Work close to peer or supervisor; Help the consumer identify and practice his/her preferred learning/work style

Displays disorientation to time Impact job success if pwd is frequently late; Problems with professions where schedules and appointments are required

Use pocket calendarDevelop written schedule for daily work or independent living routines; Use watch alarm or beeper to cue

Has difficulty using public transportation

Frequent absences or tardiness increase risk of losing job

Have pwd ride the bus with counselor or peerTeach specific transportation skills required



Takes longer to do job than others

Rules out production jobsRules out assembly jobsIrritates other co-workers who work faster; Problems with jobs having deadlines

Allow extra lead timeGradually decrease practice time while maintaining or increasing job demands; Use a timer to set pace and cue

Has difficulty following oral instructions

Failure to complete work assignments, Problems with attendance/ punctuality Aggravates supervisorSafety may be a factor

Develop a list of written instructions, Provide diagrammatic instructions Provide hands on task demonstrations

Has difficulty following written instructions

May fail to complete work assignments, Difficulty completing job applicationsDifficulty with jobs requiring interpretation of written material

Tape instructionsGive oral instructionsProvide hands on task demonstration




Job Induction

Prepare the pwmd for employment:

Education Skill level Adjustment Training Prepare for

interview Introduce employer Work Personality Job Selection

Prepare the Employer

Job Analysis Job Development Job Identification Job Engineering Job Tryout Follow up Adjustment Case closure

Skills of pwd

Madhuri has challenged the world around her with her strength, passion for painting and her head-pointer. Having no control over her body except the head-pointer, which she uses strapped on her forehead ?

Madhuri paints boldly and daringly. She has been awarded the Outstanding Calcuttan Award for her achievements which include a degree from the Spastics Society of Eastern India in Commerce and a diploma in Computer Application.


More skills Narasimhalu is severely Orthopedically impaired, and is also afflicted with un -suppressible enthusiasm.

He is an accomplished painter with a unique sense of colour. He won the second prize in painting for his water colour on paper in the South Zone Region.

He has also done a computer course in Basic Computer Applications and HTML.

He uses his foot and toes to operate the mouse and key board


Seeing is believing!!!!

Severely disabled

person assembling

Electronic

components on a

Printed Circuit

Board


Severe disabilities Remember – Key to reducing inequality is not charity or

philanthropy but innovation and empowerment Telework situation where fact – to – face contacts are minimal

would suit some of those with severe disabilities. By eliminating obstacles to communication the disability may

give rise to broader employment avenues and assimilation of the pwmd.

The persons with severe disabilities could be helped to network with others in the community, country and the world for companionship and wage earning.

Remember the National Commission on Unorganized Sector, which constitutes the major chunk of work force – 79% of the 395 millions get less than Twenty Rupees per day. If we can help the pwmd get at least this amount, we are doing some service 29VR for MD - NIEPMD

Community Based Vocational Training (CBVT)

The Author had the opportunity to introduce Community Based Vocational Training in rural areas suited to the local employment markets as early as 1988.

Hundreds of such training programs were carried out, in all sorts of occupations – electrical, mechanical, agricultural, floriculture, mushroom culture, garments, screen printing and so on for less educated rural pwd.

We can design programs to suit a small group of persons with similar and multiple disabilities.


Suitable Occupations?

All jobs are suitable and no job is suitable

A few components of each job can be performed

Analyze each job Identify operations List out simple to complex

tasks Train the candidates


Rehab Programs - Goals Remember!!! The rehabilitation program is not

designed to cope with emergencies; its goal is to assist persons with disabilities to attain the best possible vocational adjustment, not the most expedient – nor the most convenient.

Vocational rehabilitation is not a quick – fix solution, where the persons with disabilities gets rehabilitated as soon as they arrive.

Jobs are not readily available – jobs are not made for the disabled, and the persons with disabilities himself is not fully ready for placement. In a majority of pwd approaching institutions – almost 95%, do not possess any vocational or employable skill.

Among the pwmd almost none has any vocational skill.

The institution takes proactive role in creating suitable facilities for evaluating the individual and placement. 32VR for MD - NIEPMD

R. NarasimhamConsultant

(Vocational Rehabilitation)# 5, Gokulam Colony

West MambalamChennai - 600033

Phone: 044 – 42614181Mobile: 9840714181

Email- r n s i m h a m @ g m a i l. c o mWebsite: www.aidthedisabled.org


Thank You

vocational rehab for persons with multiple disabilities

Health & Medicine

job analysis job analysis

job requirements

job variables

job development

job role

contribution of job

job worth

job position