Industrial Rehabilitation

Employment of Persons with Disabilities

Learning outcomes:
By the end of this session, the learner will be able to
1. Discuss disability and employment using different models of disability;
2. Discuss other concepts regarding rehabilitation and employment of persons with
disabilities;
3. Discuss accommodations in the workplace for persons with disability;
4. Discuss pertinent legislation for employment of persons with disability in the Philippines.

References:
1. Kisner, C., Colby, L.A., & Borstad, J. (2018). Therapeutic Exercise Foundations and Techniques
(7th ed.). Philadelphia, USA: F.A. Davis Company.
2. Braddom, R. L. Physical Medicine & Rehabilitation. Philadelphia, USA: Elsevier Saunders.
3. DeLisa, J. A., & Frontera, W. R. DeLisa's Physical Medicine & Rehabilitation: Principles and
Practice. Philadelphia, USA: Lippincott Williams & Wilkins.
4. National Council on Disability Affairs website: https://www.ncda.gov.ph/disability-laws/
5. Comcare Australia. (2019). Rehabilitation Case Manager Handbook.
https://www.comcare.gov.au/about/forms-
publications/documents/publications/rehabilitation/05373_CMG_RCM-
handbook_v20acc.pdf
6. Kregel, J. and Dean, D.H. (ed.) (2002). Achievements and challenges in employment services
for people with disabilities: the longitudinal impact of workplace supports monograph.
http://www.worksupport.com/Main/downloads/dean/shelteredchap3.pdf.

I. Introduction:
 Functioning is a universal human experience, in which body, person, and society are
intertwined.
 Over the life span, people may experience a variation in the level of functioning
associated with congenital disorders, injuries, acute and chronic health conditions,
and ageing.
 The experience of a limitation of functioning or disability is part of the human
condition.
 Work plays a central role in life, and is a common source of self-identify and
financial independence in American society.
 PWD are more likely to be unemployed or underemployed, and have lower-
than-average salaries (Braddom).
 In a USA study, 2/3 of working age Americans with disabilities are unemployed,
although many of these wanted to work.
 Disablement is associated with poverty (Braddom). In the USA, 21% of PWD
were living in poverty compared to 10% among non-PWD. PWD group reported
lower median incomes compared to non-PWD.
 Direct expenditures due to disability contribute to impoverishment:
o Medical and personal care,
o Architectural modifications,
o Assistive technology,
o Institutional care,
o Income support.

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  In the end, disablement imposes direct and indirect monetary costs to the individual
and to society.
 Since the beginning, a major goal of “rehabilitation” in the USA has been to help
people with disabilities become productive members of society through the activity
of “holding a job”.
 Vocational rehabilitation (VR) programs have been specifically designed to promote
work opportunities for people with disabilities.

II. Disability and Employment

A. The ICF-Model (Kisner, Colby & Borstad, 2018)
 The International Classification of Functioning, Disability, and Health (ICF) was
introduced in 2001.
 It is considered a biopsychosocial model, where environmental factors and personal
factors are integrated into the concept of functioning and disability.
 This model does not focus on the disability or on the disease, but is takes a neutral
approach to the human experience and relates to the components of health and
functioning, experienced by all people, not just people with disabilities.
 This model also includes both environmental and personal factors that influence
how people with or without disability live and participate in society

1. Health Conditions: acute or chronic diseases, disorders, or injuries or circumstances

such as aging, pregnancy, or stress that have an impact on a person’s level of function.
2. Functioning and Disability:
 Body Functions and Structures: physiological functions and/or anatomical parts
of the body, which may occur at the cellular, tissue, or body system level.
o Physical therapists typically provide care and services to patients with
impairments associated with the musculoskeletal, neuromuscular,
cardiovascular/pulmonary, and integumentary body systems when
movement is compromised.

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 o Direct/Primary Impairments versus Indirect/Secondary Impairments:
Impairment arises directly from the health condition or may be the result of
pre existing impairments.
o Composite impairments: impairment resulting from multiple underlying
causes and arising from a combination of primary and secondary
impairments
 Activity: the execution of a task or action by an individual
 Participation: the involvement of the individual in a life situation, as measured
against social standards.
 Functioning is characterized by positive interactions that are defined by the
integrity of body functions and structures and the ability to perform activities and
participate in life situations.

3. Contextual Factors:
 Environmental Factors: factors that are outside of the individual, but every feature
of the physical, social, and attitudinal world have either a facilitating or hindering
impact on functioning and disability.
 Personal Factors: internal factors are unique to the individual and may include
characteristics such as race, gender, family background, coping styles, education,
fitness, and psychological assets.

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 B. Effects of Disability (Hershenson, 1990)
 Four Areas Addressed by
Rehabilitation to Promote Coping:
1. Assets & Skills
o Restore, replace or
compensate for lost assets
and skills
2. Self-image
o Reintegrate self-image
3. Goals
o Reformulate goals rendered
unattainable
4. Environment
o Restructure environment to
eliminate barriers

C. Risk Factors to a Successful Return to Work (Comcare Australia, 2019):

 Circumstances that, when present, can act as a barrier to the rehabilitation
process, and impede an early or successful return to work.
1. Clinical Factors
 Serious diagnosis/pathology
 Co-morbidity
 Failure of treatment
2. Mental Health Factors
 Mental health disorder, including anxiety or depression
 Personality disorders
 Medication and alcohol misuse
3. Psychosocial Risk Factors
 Beliefs about pain and injury
 Unhelpful coping strategies
 Failure to answer patients’ and families’ worries
4. Social Factors
 High demand/low control
 Unsupportive management style
 Poor social support from colleagues
 Perceived time pressure
 Lack of job satisfaction
 Work that is physically uncomfortable
5. Others
 Threats to financial security
 Litigation and disputes over liabilities

III. Rehabilitation and Employment for PWDs

A. History of Vocational Rehabilitation (U.S.A.)
World War 1 and World War 2
 1918 Soldiers Rehabilitation Act
o Assist veterans obtain employment, Vocational Rehabilitation
 1920 Smith-Fess Act
o Expand coverage of Vocational Rehabilitation to civilians

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 o Rehabilitation Services only for Physical Disabilities
 1939 – 1940s (World War II)
o Labor shortage proved that persons with disabilities are able to work

Expansion of Vocational Rehabilitation Services

 1943 Bardon-Lafollette Act
o Expand coverage of Vocational Rehabilitation Services to mentally and
visually-challenged persons
 1954 Vocational Rehabilitation Act Amendments
o Tertiary training for Rehabilitation Counsellors
 1973 Rehabilitation Act
o Consumerism and empowerment
o Prohibit discrimination in hiring process
o Accessibility standards in buildings and transportation
 1974 Rehabilitation Act Amendments
o Independent Living Centers (ILCs) and services
 1990 Americans with Disabilities Act
o Social and economic integration of persons with disabilities;
o Prohibit discrimination against them in employment, public services,
transport, accommodation and telecommunications

B. Vocational Development and Onset of Disability

 Vocational development: values and skills gained through training and experience,
accumulated throughout life
 Vocational choices: decisions made by the individual regarding career and
vocational pursuits
 Vocational Development/Vocational Choices are influenced by:
o Internal factors: e.g. Ability, Intelligence, Interests
o External factors: e.g. Family, Labour Market, Financial Needs

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C. The Hierarchy of Return to Work (Comcare Australia, 2019)
1. Same job (same duties), same employer
 Similar job (modified duties), same employer
2. New job (different duties), same employer
3. Same job (same duties), new employer
 Similar job (modified duties), new employer
4. Different job (different duties), new employer

D. Vocational Rehabilitation
 Vocational rehabilitation is the managed process that provides an appropriate level
of assistance, based on assessed needs, necessary to achieve a meaningful and
sustainable employment outcome.

1. Aptitude-Matching (Braddom)
o Vocational assessment and testing are performed to determine the client’s
visuo-spatial perception, eye-hand coordination, motor coordination,
dexterity, level of general intelligence, achievement, aptitudes, interests, and
work skills.
o Performance in these tests are then compared or matched against a list of
essential aptitudes grouped by occupation, and a job search is undertaken.
o Training programs, transportation and other assistance may be provided.
o Competitive employment means full time or part time work in the open
labor market which pays minimum wage or higher.

2. Sheltered Employment Programs (Kregel and Dean):

o Designed to assist individuals who for whatever reason are viewed as not
capable of working in a competitive employment-setting in their local
community.
o Often used to refer to a wide range of segregated vocational and non-
vocational programs for individuals with disabilities.
a. Sheltered Workshops (Braddom)
o Typically a public non-profit organization which pays subminimum
wages to persons with diminished earning capacity.
o Can provide job experience and income, but rarely leads to competitive
integrated employment.
b. Day Programs (Braddom)
o Meant to provide supervised vocational activity for persons with severe
disabilities (usually those with mental retardation or mental illness).
o Not designed for transition into competitive and integrative
employment.
o Provides supervised day activities while the caretakers of these persons
work or perform their own activities, in facilities that serve only persons
with disabilities
c. Home-Based Programs (Braddom)
o Programs where persons with severe disabilities can perform a variety
of simple jobs in the home-setting.
o Also not designed for transition into competitive and integrative
employment.

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 Disadvantages of Sheltered Employment Programs (Kregel and Dean):
o Fails to provide meaningful employment (e.g. low wages, dependence on
subsidies/financial assistance)
o Tends to isolate PWDs from the community, and does not lessen the
obstacles to employment for PWDs (e.g. reinforce low expectations and
negative public attitudes towards PWDs)
o Unlikely for PWDs to progress into competitive employment.
3. Projects with Industry (Braddom)
o Collaborative programs where employers design and provide training
projects for specific job skills in cooperation with rehabilitation agencies,
with the end-goal of competitive employment for the participants.
4. Transitional versus Supported Employment (Braddom)
o Transitional employment requires short-term provision of support,
supported employment provides continued support for the person.
o Aside from on-the-job training, support may include counseling and
assistance with housing, transportation, and other non-work related
activities.
o Consists of providing job placement, training and support services necessary
to help persons move into supported or independent employment, including
earning minimum wages which are subsidy-free.

o Four Models of Supported Employment (Braddom):

1. Enclave Model: a small group of PWDs working in an integrative job
site.
2. Mobile Work Crew: small group of workers with a supervisor,
travelling from job to job.
3. Small Business/Entrepreneurial Model: creating a new business
which may also employ non-PWDs.
4. Job Coach Model: a coach provides supportive services to the
individual at the job site.

5. Independent Living Centers (ILC) (Braddom)

o ILCs strive to increase both physical and programmatic access to housing,
employment, transportation, communities, recreational facilities, and social
and health services.
o Traditionally, provided avocational services, such as housing, independent
living skills, advocacy, and peer counseling
o The ILC movement has evolved since the 1970’s, and now provides
avocational as well as vocational services (e.g. small business model,
employing PWDs as peer counselors, etc).

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  The more severe the disability, the more intensive the support and services have to
be.
 Provision of vocational rehabilitation services to persons with disabilities requires a
diversity of strategies.

IV. Workplace Accommodations

 The general philosophy these days is to provide equal employment opportunities to
qualified individuals with disabilities.
 A qualified individual with disabilities is one who can perform the essential
functions of the job with or without reasonable accommodation.
 “Reasonable Accommodations” may include improving worksite accessibility,
equipment modification, work schedule modification, or provision of interpreters.
 Technological advances have been recognized as a means of expanding
opportunities of PWDs, helping them overcome environmental barriers, enhance
functional capacities, and maximize independence.
o Use of appropriate technology can improve mobility, communication, and
independent living skills among PWDs
o Assistive Technology (AT) are any item, piece of equipment or product
system, whether acquired off the shelf, modified or customized, that is used
to increase, maintain, or improve functional capabilities of individuals with
disabilities.
o AT can range from “low-technology” devices (canes, crutches) to “high-
technology” devices such as motorized wheelchairs.
o AT has contributed to employment of PWDs through “normalization” (PWD
must adapt to becoming “nondisabled”) and “empowerment”(PWD can
make their own decisions and enjoy a fuller integration into the community).
o However, most of the advances in AT has been focused on the individual
who must select and learn to use the assistive device. In contrast, the
concept of “universal design” refers to the design of products to be usable by
all people, without the need for individual adaption or specialized design.

V. Philippine Laws Regarding Employment for PWDs.

 Republic Act 7277: Magna Carta for Disabled Persons (1992)
https://www.ncda.gov.ph/disability-laws/republic-acts/republic-act-7277/
o Aims to support the integration of PWD into the mainstream of Philippine
Society
o Amendment of 2013:
 Mandating that at least 1% of all positions in government shall be
reserved for PWDs
 “Encourages” private corporations to also reserve 1% of all
positions for PWDs
 https://www.ncda.gov.ph/disability-laws/republic-acts/republic-
act-no-10524-an-act-expanding-the-positions-reserved-for-persons-
with-disability-amending-for-the-purpose-republic-act-no-7277-as-
amended-otherwise-known-as-the-magna-carta-for-persons/
 Civil Service Commission(CSC) (for public sector)
o Memorandum Circular No.7 series of 2014 encourages government agencies
to observe RA 7277 and give equal opportunities for PWD.

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 o https://www.ncda.gov.ph/disability-laws/csc-memorandum-circular-no-7-
series-of-2014/
o Memorandum Circular No.41 series of 1998 extends to public sector
employees who acquired incapacity as a result of accident or sickness in the
workplace, wherein government employees who sustained work-related
injuries are entitled to rehabilitation leave for up to six (6) months.
 Executive Order 417 (2005) directing the implementation of the economic
independence program for PWDs.
(https://www.ncda.gov.ph/disability-laws/executive-orders/executive-order-no-
417/)
o This legislation enjoins all national agencies to support the enhancement of
social and vocational skills capabilities of PWDs; development of a national
social preparation program especially for entrepreneurs with disabilities;
and implementation programs to promote co- organizing and development
among PWDs. This will facilitate the reintegration of PWDs into the
mainstream society.
 Batas Pambansa Blg 344 (1983): “An Act to Enhance the Mobility of Disabled
Persons by Requiring Certain Buildings, Institutions, Establishments and Public
Utilities to install Facilities and Other Devices”
https://www.ncda.gov.ph/disability-laws/implementing-rules-and-regulations-
irr/irr-of-bp-344/
o Set minimum requirements and standards to make certain infrastructures
accessible to PWDs.

Why should we study about concepts and intervention strategies

regarding employment for PWDs?
 …Because we believe in, and actively promote a society in which persons with disability or
disadvantage share equally in the opportunities and benefits that society has to offer.
(Australian Society of Rehabilitation Counsellors) tomas2022

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