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PubMed1998

Vocational training and beyond--listening to voices from a void.

This paper is written from the viewpoint of a doctor who has recently undergone general practice vocational training, and has first-hand experience of some of the opportunities, difficulties, and uncertainties facing doctors at this stage of their careers. The literature on vocational training and the issues concerning young doctors are explored in the light of concerns that recruitment into general practice is falling, that registrars may feel lost in a 'void' at the end of training, and that the 'new world' of post-training work brings problems for many new general practitioners (GPs). Instead of a traditional partnership, one of the authors (RB) chose a salaried, educationally oriented introduction to inner-city general practice. Some innovative, educational schemes, which are aiming to improve the appeal of general practice, are discussed.

Career Mobility↗
PubMed1998

A survey of the views of vocational dental practitioners on continuing professional education.

The Faculty of General Dental Practitioners (UK) has been leading the debate on a career pathway in general dental practice for a number of years. Little work has been done to establish the views of young dentists on the ideas behind a career pathway and on vocational training. This paper describes a questionnaire survey of 77 recently qualified dentists in the Thames region. The results show that there is great satisfaction with vocational training (76.4%) among the respondents even if it were not compulsory, that the majority would not welcome a summative examination at the end of a two-year training period and that nearly all thought it was right that postgraduate education for dentists should be compulsory. Of respondents 66% felt that dentists with postgraduate qualifications should be given a higher salary while over 70% felt that specialisation would become more important in the future. Young dentists are very much in favour of postgraduate education but do not want a rigid career pathway laid down for them.

Attitude of Health Personnel↗
PubMed1991

[Occupational training measures for adolescents with asthma and allergy: one-year vocational education].

The "Förderungslehrgang" in our asthma center is a special training program for adolescents handicapped by asthma or allergic diseases who are therefore not able to start apprenticeship. The course takes one year. Besides vocational guidance and tryout of different occupations, medical and psychological diagnostics are performed. Medical service is provided all day, and a hospital with emergency unit is within the area. Though 41% of the participants did finish school without any qualified graduation after their compulsory school attendance, 79% were able to start apprenticeship after the course.

Adolescent↗
PubMed1986

[Vocational integration of disabled patients--perspectives and recommendations in changing labor market conditions].

Current labour market developments, i.e. decreasing manpower demands, aggravation of selection, will in the years ahead confront vocational rehabilitation policy, too, with important decisions in terms of expanded service provision or intensified selectiveness. Short-term economic, labour market-oriented cost-benefit considerations will in this process be opposed by longer-term, education and social policy ones. The risk of lasting ruptures occurring between the employment-possessing population and the long-term unemployed, or those in highly jeopardized jobs, with the new social inequities thus generated, will in particular have to be given attention in future decision-making.

Cost-Benefit Analysis↗
PubMed1988

[The professional field of the psychologist in vocational training--results of a survey].

A questionnaire inquiry was carried out with the Psychological Services of the Vocational Training Centres in the Federal Republic of Germany, directed at their fields of work and their position within the facility. The Psychological Services invariably are involved in the admission procedure, and counselling as well as therapeutic work, individual and in groups, have become a firmly established focus alongside their traditional diagnostic tasks. Aspects of supervision are increasingly being used as new methods of personnel development. Though staffing has improved since 1977, great variations still exist between the various centres, and our findings clearly point out the gaps in service provision related with lower client/psychologist ratios. Following introduction and consolidation of the Psychological Services, a phase of re-orientation seems to be under way, with special attention to focus on interactional processes within the facilities, on implementation of rehabilitation objectives, and on entry of clients with chronic mental impairment.

Adolescent↗
PubMed1993

Management of work disability. Resources for vocational rehabilitation.

OBJECTIVE: To review the state-federal vocational rehabilitation (SF-VR) system and its utilization by persons with rheumatic conditions. METHODS: SF-VR system instruction manuals, and literature on rheumatology rehabilitation, work disability, and rehabilitation counseling were reviewed. National and Massachusetts state SF-VR system data on persons with "arthritis and rheumatism" were analyzed. RESULTS: The SF-VR system is used by a small proportion of persons with rheumatic diseases. Fifty-two percent of clients with arthritis are employed after receiving services. CONCLUSION: Although evidence indicates that VR services for persons with rheumatic conditions improves their chances for reemployment, the SF-VR system is underutilized.

Disability Evaluation↗
PubMed1994

Rehabilitative day treatment vs. supported employment: I. Vocational outcomes.

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

Adolescent↗
PubMedDate not supplied

Programming for efficiency: the effects of motion economy on vocational tasks for adults with severe and profound mental retardation.

Principles of motion economy were assessed with two vocational tasks for two adults with severe to profound mental retardation. Study 1 assessed task acquisition by comparing two tasks (collating three pages, bagging three ribbons), one task trained using the standard job site task analysis, the other trained using a motion economy-based task analysis (requiring less total distance movement to task completion) in two alternating treatments designs. Study 2 assessed task fluency by examining the effects of the motion economy-based task analysis on collating and bagging separately across the same two adults in four reversal designs. Neither task analysis was superior overall in acquisition (Study 1), but once each task was mastered, the motion economy-based task analysis enhanced fluency across both tasks for both participants (Study 2). The use of distance movement as a parameter of response efficiency is discussed when targeting job performance, productivity, and preference.

Adult↗
PubMedDate not supplied

Use of self-operated auditory prompts by workers with moderate mental retardation to transition independently through vocational tasks.

The use of single- and multiple-word self-operated auditory prompting systems by five school-age workers with moderate mental retardation to independently transition between an ordered chain of tasks was examined in two vocational settings. The effectiveness of single- and multiple-word self-operated auditory prompts was assessed using an alternating treatment design within a multiple probe across settings. Analysis of the data revealed a significant effect on the number of independent task changes made by workers when using the single- or multiple-word auditory prompting system. When prompting systems were compared with one another, no significant differences were found in the number of independent task changes made by workers. Self-operated auditory prompts served as the stimulus control for desired behavior, they were effective for teaching workers with moderate mental retardation to manage their own task change behavior, and their use generalized across settings without additional training.

Activities of Daily Living↗
PubMed2001

[Occupational choice and biography - biographical diagnostics as an approach to accessing the individual's perceptual horizons and resources in the context of vocational rehabilitation].

This contribution is focused on the core tenet that the process of choice of occupation must encompass in its everyday routines the disabled person's biography, his or her life experiences, biographical self-appraisals as well as action orientations. Unless this is achieved, its professional strategies and interventions will remain prone to missing, or even counteracting, the biographical resources as well as thinking and perceptions of its clients. Biographical Diagnostics is presented here as a method seeking to access the individual in the process of choice of occupation in an understanding manner. It constitutes a new concept in terms of a biography-based, hermeneutic case approach conceived for implementation in the everyday routines of vocational rehabilitation. Two case examples serve to explicate the method of Biographical Diagnostics and set out the relevancy of a biographical orientation in the process of occupational choice.

Adult↗
PubMed2005

[Capability to work in vocational rehabilitation of the severe mentally ill: initial predictors and change after six months].

OBJECTIVE: Persons with severe mental illnesses often need additional vocational rehabilitation in order to gain or regain an adequate capability to work. The objective of this paper is the assessment of work capability and its development throughout the rehabilitation process, as well as clarification of its correlating variables, and predictors. METHOD: We present data obtained at two different points in time (at rehabilitation program intake and at the six month mark of being in the program) from a sample of 117 rehabilitants. Capability to work was assessed by using the adapted German version of the Work Personality Profile (WPP), called the Arbeitsfähigkeitenprofil (AFP). Additionally, sociodemographic, intellectual, psychopathological, and subjective quality of life measures were examined. RESULTS: The AFP sum score revealed a significant change after six months' participation in the rehabilitation program. More precisely, for the subscales "capability to learn" and "communication skills", a significant increase was obtained, whereas "social adaptation" showed a non-significant improvement. CONCLUSION: Our results show that the rehabilitants' "capability to work" had improved at the six month mark of the rehabilitation program. It appears that baseline variables of the AFP subscales at program intake were largely related to psychopathology and subjective quality of life measures. Sociodemographic parameters, educational level, and attention measures were associated with work capability improvement after six months.

Adult↗
PubMed1997

Vocational perspectives and neuromuscular disorders.

The present study analyses the actual occupational situation, vocational handicaps and past labour career of a group of about 1000 Dutch patients suffering from a neuromuscular disorder (NMD). On the basis of the likelihood of a substantial employment history and sufficient numbers of patients, four types of NMD were selected: dystrophia myotonica (DM), hereditary motor and sensory neuropathy, (HMSN), spinal muscular atrophy (SMA) and myasthenia gravis (MG). Results show that a labour career is in reach of most NMD patients, even for those with severe limitations. It is concluded that physical limitations seem not to be decisive in that respect. The loss of the quality of communication, the loss of mental abilities and the effect of the diseases on the facial expression, as with some DM patients, are also important for chances on the labour market. Though the labour participation of NMD patients tends to decrease after the age of 34, the availability of work adaptations makes it possible to prolong the labour career. Analysis of the actual work situation of NMD patients shows that both disorder-related limitations and work characteristics play an important role in the amount of physical work problems encountered. It is argued that physical labour has to be regarded as generally unsuitable for NMD patients. This has implications for the sort and level of education to be attained by NMD patients. Career counselling as a focus point for the choice of an educational programme may improve labour market opportunities as well as quality of employment of NMD patients. Allowing for and accepting the possible effects of the disorder in the work situation are considered to be important in respect to labour participation and work satisfaction of workers with NMD. Reducing time pressure demands and increasing the freedom to organize one's work, are measures to be given especial consideration.

Adult↗
PubMed2003

An evaluation of a brief functional analysis format within a vocational setting.

We conducted and compared both brief and extended functional analyses of disruptive behaviors for 3 individuals with developmental disabilities who attended a vocational training program. Results demonstrated that the brief assessment identified the function of 2 of the 3 participants' disruptive behavior compared to the extended assessment.

Adult↗
PubMed1996

Team-building in vocational rehabilitation: the Horizon Telecentre project.

This report concerns an ambitious project which created a functionally independent team of young people with physical disabilities who had no previous experience of employment. The aim of the project was to expand the training opportunities for people with disabilities through the provision of team-building. The team was brought together in order to run a self-financing office bureau business in Athens, providing services to the local community. This project intended to find an innovative alternative to sheltered workshops, which are not found in Greece. A systemic and developmental approach to team-building was explored. The approach consisted of work-hardening, education, experiential learning, and providing the physical structures necessary for self-employment. The paper describes the approach with examples, and includes an evaluation by the trainees. The paper also identifies the importance of including a team-building approach within vocational rehabilitation.

Persons with Disabilities↗
PubMed1997

A survey of vocational rehabilitation counselors concerning American Indian and Alaska Native clients with alcohol and other drug abuse disorders.

Vocation rehabilitation (VR) counselors in states where many American Indians reside were questioned about the characteristics of their American Indian clients with alcoholism or drug abuse problems, and the kinds of services that were provided to them. A total of 124 counselors from 14 states responded to the survey. Twenty-seven of these respondents were employed in tribally operated VR projects in nine states.

Adult↗
PubMed1975

Vocational diagnosis through assessment of functional limitations.

Diagnosis in rehabilitation counseling requires a relatively precise delineation of client assets and liabilities. This is essential in establishing direction for counseling efforts; it can also aid in evaluating counseling effectiveness by providing a means of grouping cases according to difficulty or types of problems. This paper identifies the disadvantages of present systems of medical and psychiatric diagnoses for these vocational counseling purposes. It discusses some of the methodological issues involved in establishing a new system for recording client problems. The paper also introduces a brief, yet comprehensive inventory of functional limitations which has been developed in the Counseling Psychology Service of the Department of Physical Medicine and Rehabilitation at the University of Minnesota.

Disability Evaluation↗
PubMed2005

Back to work: vocational issues and strategies for Canadians living with HIV/AIDS.

Much has been written since the first appearance of HIV/AIDS in 1981 about its effects on the Canadian health care and social services systems. However, researchers have given limited attention to issues of entry or re-entry to the competitive job market for HIV positive individuals. The emergence of highly active antiretroviral therapies (HAART) has allowed a significant number of persons who are HIV positive to experience a major recovery in health and energy. This increase in physical health has in turn led to a re-examination of the possibility of returning to former types and levels of activity, including the prospect of going back to work or entering the competitive workforce for the first time. The purpose of this paper is to outline some of the issues and concerns that impact HIV positive individuals' attempts to return to or enter the competitive workforce, particularly those relating to disability policies and public insurance. Data from in-depth interviews with a sample of people living with HIV/AIDS (PHAs) are used to help illustrate the disconnect between these policies and the lived experiences of PHAs. Also discussed are the opportunities for Canadian policies and practices to employ a functional definition of disability and a philosophy of early intervention in vocational rehabilitation.

Adult↗
PubMed1990

[Vocational rehabilitation of psychiatrically handicapped people].

The article describes the working concepts of "Lankwitzer Werkstätten", a facility for vocational rehabilitation of persons with (chronic) mental illness. The working concept of this sheltered workshop is crafts- and service-oriented. Some 60 rehabilitees and sheltered workshop employees work in four small "shops". Work structures and everyday organization are somewhat unusual in that they follow general labour market conditions as closely as possible. In their working structures, the sheltered workplaces usually do not differ from workplaces in small crafts enterprises of the general labour market. As far as remuneration is concerned, the workshop is in a position to at least envisage levels of pay that will ensure independence from social assistance supplements if the facility's technical equipment can be kept current and work planning made more efficient. Within the limits of the legal possibilities, and making the most of them, both the diagnostic-prognostic benefits of the entry procedure in the work training process as well as the placement opportunities for rehabilitees in the general labour market are being utilized, with occasionally very successful outcomes.

Chronic Disease↗