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PubMed2002

An historical overview of Australia's largest and oldest provider of vocational rehabilitation--CRS Australia.

CRS Australia, the largest and oldest vocational rehabilitation provider in Australia, is examined over its 60-year history. The Australian government located CRS initially in the Department of Social Security, and subsequently in the Department of Community Services however, its establishment required a complexity of policy and range of skills that were not found in one arm of government alone and required cooperation from many government departments. A disagreement between the government and the medical profession about the purpose and control of rehabilitation features in the early history of CRS Australia. Factors such as greater involvement of people with disabilities and government inquiries led to a move from a centre-based to a community-based approach to vocational rehabilitation in the 1970s. CRS Australia is a large employer of health and human service professionals and has played a significant part in the development of these professions in Australia. In recent years, CRS Australia has provided greater business accountability to government and the broader Australian community. CRS Australia's role as an expert vocational assessment agency and vocational rehabilitation provider is expected to continue as welfare reform progresses in Australia.

Australia↗
PubMed2003

Gender differences in a sample of vocational rehabilitation clients with TBI.

Because traumatic brain injury affects between 1.5 and 2 million individuals per year and results in long term vocational and financial difficulties, there is growing interest in determining those factors that predict successful outcomes for specific groups of individuals with TBI. An NIH consensus panel on TBI has suggested that women are one group that needs more attention, particularly given the studies indicating that men and women experience different cognitive [14], emotional [19], and vocational outcomes following TBI [5]. The current study evaluated differences in injury severity, demographics, neuropsychological abilities, and vocational and financial outcomes for 78 persons with TBI (55 male, 23 female) who received services from a state Vocational Rehabilitation Division (DVR). Despite similar injury severity, neuropsychological and demographic characteristics, more men (43.6%) received Maintenance services from MO-DVR than women (21.7%). Of note, only 4.4% of the women were successfully employed through DVR, compared to 23.6% of the men. In addition, 73.9% of the women had services terminated after being accepted by DVR but before services were initiated, compared to 56.4% of the men. The significance of these results is discussed, as are the limitations of the current project.

Adult↗
PubMed1979

[Attitudes of gainfully employed persons towards the vocational and social integration of the physically disabled (author's transl)].

Within the framework of a representative survey 1879 gainfully employed persons - trainees, workers, employees and supervisors - were asked about their attitudes towards the vocational and social integration of the physically disabled. The article describes the following results: 1) The majority of those who responded, particularly workers in subordinate positions, were of the opinion that firms, management and co-workers were rather unwilling to accept the physically disabled as competitive and equal employees and colleagues. 2) With regard to their personal attitudes there was a striking contrast: a high general support of the vocational resettlement on the one hand and a considerable resistance against the disabled's complete vocational and social integration on the other. 3) The degree of social distance was strongly dependent on the social situation and the type of the disability. 4) The rejection of the physically disabled seems to be mainly influenced by the following determinant psychological factors: a) the assumption that they are to blame for their disabilities b) the negative image of the disabled's personality traits, vocational performance abilities and their occupational behaviour.

Adolescent↗
PubMed2005

When considering vocational rehabilitation: describing and comparing the Swedish and American systems and professions.

Rehabilitation of functionally impaired in Sweden and the United States is compared and contrasted. Found is that there are fundamental differences in strategies. The Swedish system most often uses a medically oriented multidisciplinary team approach. The US system most often uses a single individual, the vocational rehabilitation counselor, to work with functionally impaired in helping them return to work. Emphasized is that a vocational rehabilitation counselor uses a unique array of skills that is not duplicated in Sweden by a single profession. Suggested is that a single person with a range of skills can more economically provide vocational rehabilitation services to those with functional impairments; whether this is practical for Sweden is yet to be determined. In contrasting the two systems it was evident that the US system has been in operation for a much longer time and that the Swedish system is maturing. Noted is that the governments of both countries are feeling pressure regarding funding of vocational rehabilitation. This is affecting the level and quality of services. The authors advocate wider contact between Swedish and US university-level training programs in rehabilitation. Felt is that each system has strengths and knowledge that can be used to benefit the other.

Humans↗
PubMed2006

[Morbidity and early retirement among teachers at vocational schools].

AIM OF THE STUDY: Teachers at vocational schools often feel overburdened and emotionally exhausted. The aim of our study was to gather new evidence-based information on the type and extent of the morbidity spectrum and health-related early retirement of teachers at vocational schools, using objective parameters and larger numbers of cases. METHODS: In a prospective total assessment (the entire state of Bavaria) over the period of 1996-1999 all official medical examinations among teachers of vocational schools in the public health centres were evaluated with regard to premature unfitness for work. The analysis included for example socio-demographic/occupational factors, the morbidity spectrum, assessment of performance, rehabilitation and a comparison of the prevalence rates of psychiatric disorders and rehabilitation among disabled teachers of various types of schools in Bavaria ("Erlanger Lehrerstudie"). The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics. RESULTS: Of the 451 teachers studied, 31% (n=138) were women and 69%(n=313) were men. The median age was 56 years (range: 29-62 years). 70% (n=314) of the teachers were assessed to be unfit for work. The main reasons for early retirement were psychic and psychosomatic illnesses (F-ICD10) which made up 53% of the cases. Among the psychiatric diagnoses, depressive disorders (43%) and burnout syndrome (16%) dominated. The most frequent somatic diseases were muscular/skeletal disorders (M-ICD10) in 13% of cases, then cardiovascular disorders (I-ICD10) in 7% and malignant tumours (C-ICD10) in 7% of cases. In the gender-based analysis the relative frequency of psychiatric disorders (58% vs. 50%) and malignant tumours (15% vs. 3%--difference of statistical significance) was higher in women than in men, while the prevalence of cardiovascular (3% vs. 9%) and muscular/ skeletal disorders (6% vs. 16%--difference of statistical significance) was lower in women than in men. 63% (n=198) of the teachers assessed unfit for work had participated in at least one medical rehabilitation measure before early retirement. CONCLUSIONS: The main reason for early retirement of teachers at vocational schools is mental ill health. Beyond this fact there is a striking gender difference in the psychic and somatic morbidity. Measures of prevention and intervention would have to focus on mental health at the workplace and also take gender aspects into consideration.

Adult↗
PubMed1990

[Psychological-therapeutic activities in a facility for vocational rehabilitation--experiences and findings from a questionnaire].

Results of a questionnaire survey on the psychological services available at the vocational retraining centres in West Germany, together with the authors' long years of experience as rehabilitation psychologists in vocational retraining centres, show that psychological-therapeutical work in vocational rehabilitation has gained increased importance. Attention is drawn to the existing cooperation and role conflicts, with a simultaneously developing consolidation and acceptance of psychological competence of service within the rehabilitation centres. In order to cope with the psychological problems of rehabilitation faced at present and in the future, there must be a demand for strengthened stream-lining of the accompaniment of the vocational concept of qualification, for institutional endeavours regarding innovation and further training, as well as the putting into practice of cooperative organization, and of interdisciplinary and general exchange of experience, which has long been called for during the studies of the psychology of rehabilitation. Practical experience confirms the urgency of multiprofessional team- and case-supervision for effective therapeutical plans of action and controls.

Germany, West↗
PubMed1979

Vocational development and adjustment of adolescents with cystic fibrosis.

Adolescents with cystic fibrosis were compared with normal adolescents of the same age and educational grade on several measures of vocational development and adjustment. The cystic fibrosis group in ages 12--16 and in grades 7, 8, and 9 scored lower than their normal counterparts in measures of vocational and educational plans, and were less realistic than normals in considering their limitations and financial constraints. In contrast, the cystic fibrosis group at nearly all age and grade levels scored significantly higher on strength of commitment to vocational choice, work values, and awareness of occupational information. Compared to 4 additional handicapped groups already studied, adolescents with cystic fibrosis scored favorably. They not only plan to work but also hold strong work values compared to normals. Rehabilitation programs should emphasize preparation for a career and the development of educational and vocational plans while the adolescent is still in high school.

Adolescent↗
PubMed1995

Effectiveness of daily living abilities (DLA) as a tool for evaluating vocational competencies: study of non-disabled workers aged 45 and over.

A questionnaire survey was conducted on 28-55 items of daily living abilities (DLA) linked to 13 basic vocational competencies such as memory, learning, planning, judgement, muscular power and concentration covering a total of 505 non-disabled blue collar male workers aged 45 and over. Results of the survey were as follows, (1) The 457 subjects were grouped into five groups ranging from normal to unsound groups according to the degree of DLA; (2) The reduction of DLA has directionality to two factors, memory and muscular power; (3) DLA provide clues for aging; (4) Among basic vocational competencies, muscular power showed the highest performance with a small standard deviation, while concentration scored low points with a large standard deviation (p < .05); (5) No age difference was found in planning ability, coordination, muscular power, physical tolerance, manual dexterity, and sense of equilibrium, while subjects aged 65 or over showed significantly low figures for learning ability, agility and concentration (p < .05); Since the findings showed various characteristics of vocational competencies and the aging process precisely in blue collar workers aged 45 and over, we assumed that the DLA survey is one of the alternatives for evaluating workers vocational competencies.

Activities of Daily Living↗
PubMed1996

[Ready for the year 2000. The Federation of German Vocational Rehabilitation Centers has revised the fundamental concepts].

The Federation of German Vocational Retraining Centres have recently completed a fundamental revision and update of their conceptual approach, adjusting it to the technological advances at hand as well as to a changing labour market. Novel educational concepts offer broader space for accommodating the needs of individual rehabilitees and for enhancing their competence, technical, methodological and social, in terms of present-day, wholistic rehabilitation. New approaches are being implemented, the vocational training centres opening up for new groups (such as one-parent families) and offering rehabilitation programmes on a non-residential basis as well. Further-training schemes have been devised to ensure that disabled people, too, have access to the current state-of-the-art. An indispensable part of vocational rehabilitation programmes also in the future, the Specialized Services of the vocational retraining centres are going to adapt to the changing situation as well.

Combined Modality Therapy↗
PubMed1997

[Is the governmental vocational rehabilitation program too ambitious?].

The Norwegian government has stressed the importance of supporting vocational training for clients with health problems in order to secure their active participation in the labour force. On average, 35,000-40,000 people were referred from the National Insurance Scheme to the Directorate of Labour to take part in vocational rehabilitation projects in 1995. The majority of the vocationally handicapped are young. Three out of four have a poor educational background, and close to 70% have health problems, mainly in the form of chronic musculoskeletal pain or psychiatric illness, usually depression and anxiety-states. So far, the success of the rehabilitation seems to be rather limited, since approximately 40% of the clients were referred back to the Insurance Scheme. They were considered unfit for training because of impaired health. Another 40% of the cases were considered fully or partly successful. Clients with psychiatric illness seem to be particularly difficult to rehabilitate to vocational activity.

Adult↗
PubMed1997

[Improving the transition between medical and vocational rehabilitation].

In the framework of medical rehabilitation measures, cardiac patients' physical capacity was evaluated from an occupational medicine perspective, through vocational assessment in the workshops of a vocational retraining centre. Recommendations for vocational reintegration were derived on that basis, available at the end of the rehab measure for presentation to the financially responsible agency as a proposal for immediate implementation. The potential for actual realization of these proposals is further enhanced on account of preparatory clarification of the patients' motivational tendencies in individual and group talks. The vocational assessment performed not least provided an opportunity for strengthening the chronically ill patients' self-confidence regarding their return to work life.

Cardiac Rehabilitation↗
PubMed2002

[Regional networking of medical and vocational rehabilitation-- the bad Krozingen model].

Regional networking facilitates flexible and individual integration of vocational programmes in medical rehabilitation. We present a pilot project of Theresienklinik II in cooperation with the Education centre for occupation and health (Bildungszentrum Beruf und Gesundheit) in Bad Krozingen. Orthopaedic and cardiac patients who are in danger to lose their capacity to work, participate in an integrated vocational reorientation programme during extended medical rehabilitation. The aim of the pilot project is an early assessment of motivation, work hardening, aptitude and interest, in order to accelerate vocational retraining and reintegration. Within one year 30 patients participated in the programme. Presented are the contents and course of the pilot project. First results show a high patient satisfaction with the programme.

Adult↗
PubMed2004

The impact of vocational services and employment on people with HIV/AIDS.

The perceptions of vocational services and the impact of employment among 25 individuals with HIV/AIDS diagnoses were explored through a qualitative study. Participants who ranged in age from 22 to 58, represented diverse ethnic backgrounds and were at various stages of the employment process. The key themes that emerged from the data fell into three main areas: (a) personal impact of vocational services, (b) programmatic qualities of vocational services, and (c) impact of employment. Factors that influenced each of these themes and the implications for rehabilitation counselors are discussed.

Adult↗
PubMed1991

[Individual rehabilitation planning in the vocational rehabilitation of mentally ill young people].

For many young people, their aspiration for an environmentally compatible, and societally meaningful, field of activity is very marked and reflects the values they hold. Vocational rehabilitation should be oriented accordingly, and take up the motivational potential implied. The more accurate the knowledge of previous vocational experience, motivations, attitudes toward work, and of the subjective difficulties in coping with work-related requirements, the more detailed can vocational rehabilitation planning be devised. The potential is increased by a concept that is guided by insights from the psychology of work and emphasizes individual rehabilitation planning as well as follow-along developmental counselling. Assessment of 52 individual service instances for mentally ill youths and young adults, of Berlin-Kreuzberg, revealed an appropriate placement quota of 67%. The developmental course taken in the individual cases shows that satisfactory long-term outcomes can be achieved through careful entry diagnostics, individual rehabilitation planning, ongoing developmental counselling, selective educational intervention, industrial try-outs, as well as stabilizing aftercare.

Adaptation, Psychological↗
PubMed1989

[Vocational aptitude and inclination--aspects of their assessment and evaluation in rehabilitation].

The task of appraising aptitudes and inclinations accompanies a rehabilitee and the rehabilitation workers involved for the entire duration of an occupationally-focussed rehabilitation measure. Explicitly so in vocational guidance measures, it aims at obtaining a sound basis for decision-making in view of vocational reorientation. Responsibility for this decision in the last analysis rests with the rehabilitee himself, an aspect that abolishes any strict separation of aptitude and inclination in predicting outcome in the context of occupational perspectives. Being the decision-making agent, the rehabilitee must therefore be offered typical situational fragments of a possible educational and vocational future, intended on the one hand to inform him of occupational alternatives and, on the other, to provide initial experience. The rehabilitation worker's role in this process requires a client-centered stance in terms of information provider and trusted agent, which is to help avoid an adverse exams climate evolve in this momentous decision-making phase. Psychological testing, from this angle, should be used merely as a supplementary means. The approach outlined for appraisal of individual potentials requires intensive teamwork, not least also in view of verifying individual capacity.

Aptitude Tests↗
PubMed1995

[An integrated concept for vocational rehabilitation of brain injured patients--a catamnestic study of occupational outcome 1 to 2 years later].

Presented is a vocational reintegration concept for clients following craniocerebral trauma and other acquired brain damage. Close dovetailing of vocational and therapeutic measures is advocated, as it is mostly the neuropsychological disorders or problems in behaviour and emotional experience that stand in the way of returning to work. A work experience and adjustment setting holds particularly great potential for addressing these difficulties in a day-to-day life-related, remedial manner. Another focus is follow-up care of those clients who have returned to competitive employment. These clients are called on regularly at their workplace by programme vocational guidance/vocational assessment staff; necessary adaptations are carried out, difficulties dealt with, and possible solutions sought jointly with the employer. A catamnestic study was undertaken to verify how many of the clients included in the programme had achieved long-term resettlement. It was found that the great majority of those who had returned to their former job, have retained their employment some one to two years later, with most of them working at a lower level than before the event. Clients unable to return to their former employer had mostly been pensioned despite the presence of partial working capacity.

Adolescent↗
PubMed2005

The implications of memory profiles in schizophrenia on vocational and neuropsychological functioning.

Studies in schizophrenia suggest that verbal learning and memory may distinguish three subgroups of patients: an unimpaired memory profile group and two groups that have memory profiles similar to those seen in cortical and subcortical dementias. Using the Hopkins Verbal Learning Test, Revised edition (HVLT-R), this study attempted to differentiate patients into three memory profile groups and to examine the validity of these groups with respect to vocational outcomes and neuropsychological functioning. Results from this study replicated previous findings and extended them by demonstrating a link to vocational outcome. In addition, the proportion of patients in each group closely resembled that obtained in previous studies. Specifically, the relatively unimpaired memory group (42%) showed overall better memory and neuropsychological performance than the two impaired groups, the subcortical group (38%) showed impaired recall but intact recognition and deficits in visuospatial functioning, and the cortical group (20%) showed deficits in recall, recognition, and sustained attention/executive functioning. There were no clinical differences between the three groups, but both the unimpaired and subcortical groups increased the number of hours worked following a vocational rehabilitation program. Given these differences, more research is warranted to explore the effect of memory impairment subtypes on vocational outcome measures.

Adult↗
PubMed2006

An audit of the UK national cancer referral guidelines for suspected oral mucosal malignancy.

BACKGROUND AND OBJECTIVE: This study aimed to assess the effectiveness of the UK National Guidelines for identifying patients with potentially malignant oral disease which were introduced in 2000. DESIGN: Retrospective audit. SETTING: The oral medicine unit in a university teaching hospital in London. METHODS: All new referrals over a one year period were retrospectively reviewed in a departmental audit to evaluate guideline effectiveness. Reasons for referral and final diagnosis were compared in a randomly selected sub-population. RESULTS: Four hundred and eighty-seven of 901 new patients referred were classified as having potentially malignant disease from the referral letter. In a randomly selected subgroup of 241 patients, 18 actually had malignant (8) or dysplastic lesions (10). Of 75 patients referred with a persistent oral ulcer, only nine were actually malignant or dysplastic. Eight of 116 patients referred with a white patch and none with red patches were found to have dysplastic or malignant lesions. The criteria failed to identify three carcinomas and two severely dysplastic lesions (15% of the malignant or dysplastic lesions). All of the latter had been referred by primary care physicians with orofacial pain of unknown cause. CONCLUSIONS: UK National Guidelines discriminate poorly between potentially malignant and other oral mucosal disease.

Adolescent↗