Vocational Rehabilitation and Employment: From Principles to Practice

Technical Background Paper

Debra A. Perry
Senior Specialist in Vocational Rehabilitation
International Labour Office
East Asia Multidisciplinary Team

I. Introduction

The paper begins with a review of the basic challenge of vocational rehabilitation. Since no consensus about a global model, per se, exists, the paper uses the ILO Convention related to vocational rehabilitation as a close approximation. From the regional perspective, it reviews the training and employment targets that are part of the Program of Action related to the Asian and Pacific Decade of Disabled Persons. The practice of vocational rehabilitation is examined from the context of three global issues: the disability movement, the changing workplace, and the needs of rural and urban impoverished communities. Each of these issues has far-reaching implications for the practice of vocational rehabilitation well into the 21^st Century.

II. The Challenge

The global and regional challenge related to vocational rehabilitation is formidable. Here are the facts:

• Globally, there are 600 million people with disabilities¹ and 386 million of them are of working age².
• In the Asia Pacific Region alone there a 370 million disabled people and 238³ million of them are of working age.
• Most live in communities that exclude them from many training and educational institutions and as well as the workplace, which tends to be inaccessible or inhospitable to their special requirements.
• Many people with disabilities are also excluded from virtual Internet communities and resources, not only because of the digital divide but also due to online environments that do not accommodate their needs.
• Most disabled people are not concerned about computers, however. With just over 5 percent of the world's population using the Internet⁴, the percentage of disabled people with access is extremely small.
• Strong links between disability and poverty⁵ result in people with disabilities being one of the poorest and most marginalized sectors of the population. Women with disabilities are particularly vulnerable.
• People with disabilities are less likely to have an education or the life skills needed for success. (Only 5 percent of disabled people in Asia are reported to have access to an education⁶.)
• Their unemployment rate is usually double that of the general population and often as high as 80 percent.⁷
• In developing countries and throughout the Asia Pacific Region most disabled people (an estimated 80 percent) reside in rural communities where their access to services, resources, and employment opportunities are most limited.
• Compounding all the demographic and environmental access issues are attitudinal barriers resulting from negative stereotypes and paternalistic assumptions about people with disabilities and their needs.
• The result of these barriers is exclusion and the costs of exclusion are high. A recent World Bank report estimates the global loss to gross domestic product as being between US$1.37 trillion to US$1.94 trillion. For example, for Thailand the figures were between 2.4 and 3.4 billion USD.⁸
• The human cost in terms of individual suffering and lost opportunity is unknown. We have no idea how many Stephen Hawkings⁹ or Saori weavers have been lost to the world due to exclusion.

III. Part of the Response: Vocational Rehabilitation Services

The challenge warrants a multifaceted response. From the vocational perspective, vocational rehabilitation is a cornerstone feature of the response. However, for vocational rehabilitation services to be successful, they must be part of a total disability policy initiative and a plan of action that addresses all barriers faced by disabled people. Such a plan of action has been outlined in several United Nations documents as well as the Asian Pacific Decade of Disabled Persons, which recognize the rights of people with disabilities to full participation in society. A person with a disability cannot operate a business if they never learned to read or count because they could not go to school. Nor can a skilled technician work in the lab if he or she is unable to negotiate the stairs with a wheelchair. Barriers to employment cannot be addressed piecemeal but must be part of a total inclusion programme. With that said, let us return to a more focused discussion of vocational rehabilitation services in particular.

The ILO Perspective of Vocational Rehabilitation

One way that the ILO works to achieve its mission to improve the situation of human beings in the world of work is by establishing international standards. These standards are promoted through its conventions. When a country ratifies a convention, it makes a commitment to abide by the Convention's standards. The ILO also makes formal recommendations related to workplace issues that are not binding but which contain guidance that countries can follow. One Convention and two recommendations relate directly to vocational rehabilitation. Other conventions deal with issues of concern to people with disabilities.

The Vocational Rehabilitation and Employment (Disabled Persons) Convention No. 159 and the accompanying Recommendation No. 168, embody the current ILO perspective on vocational rehabilitation. Together, they offer a general framework for implementing vocational rehabilitation policies and programs. According to the Convention, vocational rehabilitation services, such as vocational guidance, training, and selective placement should be part of a continuous and coordinated rehabilitation process. The purpose of these services is to "enable a disabled person to secure, retain and advance in suitable employment and thereby further such person's integration or reintegration into society."10 Note that the emphasis of services is on suitable employment and furthering integration. From the ILO perspective, the value of vocational rehabilitation services should be measured against these two criteria.

• Do the services result in or further a person's chance at suitable employment?¹¹
• Does the activity increase the likelihood of further integration and/or reintegration into society?

Both are important evaluation criteria and you can use them to evaluate the value and appropriateness of particular vocational rehabilitation services, activities and outcomes.

The ILO defines a disabled person as an "individual whose prospects of securing, retaining or advancing in suitable employment are substantially reduced as a result of a duly recognized physical or mental impairment."¹² There are many types of physical or mental impairments that cause disability or a loss of functioning. Many such disabilities could effect employment; some are visible and others are invisible. People often first think of someone in a wheelchair or who has lost a limb when disability is mentioned. Other disabilities result from blindness or visual impairments, deafness or hearing impairments, and intellectual impairments resulting from mental retardation, birth defects, or brain injuries. Still other disabilities may be related to speech impairments, neurological difficulties affecting modes of learning (learning disabilities), or may be caused by back injuries, heart disease, accidents, seizure disorders or brain injuries.

The Convention addresses both policy and action. From the policy perspective the Convention calls for

• the development of a national policy on vocational rehabilitation;
• inputs from employers, labour unions, and people with disabilities in its formation;
• coverage for all categories (types) of disabled people;
• equal opportunity and treatment of disabled workers as compared to workers generally; and
• the goal of moving disabled workers into the open labour market.

The action provisions call for

• the delivery and evaluation of vocational rehabilitation services such as vocational guidance, training, placement, employment and other services;
• the use and adaptation of existing services provided to general workers whenever possible and appropriate; and
• the training of staff and provision of qualified personnel to carry out services.

Although not specifically identified in the Convention, the following services are steps in the process:

• Outreach and Identification
• Assessment
• Individualized Planning
• Vocational Guidance
• Vocational Training
• Adaptive/Support Services
• Employment Services
• Job Placement
• Follow-Up

While vocational training and employment services are the focus of this paper, each step of the vocational rehabilitation process is important to the final outcome, employment.

The ILO Recommendation¹³ accompanying the Convention offers further guidance with regard to implementing vocational rehabilitation services and ensuring access to employment. Some of the recommended actions include the following:

• Start vocational rehabilitation as early as possible in a person's total rehabilitation plan.
• Refrain from viewing special positive measures aimed at realizing equality of opportunity and treatment for disabled persons as discriminating against other workers.
• Create job opportunities for people with disabilities through measures such as developing cooperatives, providing financial incentives to employers, etc.
• Remove architectural, communication and transportation barriers.
• Provide special support services, aids and assistive devices as needed.

The Recommendation also provides guidance and action related to the process of providing equal access and treatment, specifically with regard to engaging the community and all the social partners, including people with disabilities and their organizations in the development and implementation of policy. It elaborates further on staff training needs, government responsibilities, coordination within government agencies and offices, and the need for vocational rehabilitation schemes with social security systems. Although written in 1983, the Convention and Recommendation offer a framework of action that still applies today. Seventy-one countries have ratified the Convention; six are in the Asia Pacific Region.¹⁴

In summary, a supportive vocational rehabilitation policy framework, developed with input from all constituents, is needed to support the process of vocational rehabilitation. This process involves delivering services that provide disabled people with the skills and services they need to move into employment.

Employment and Training Targets of the Asia-Pacific Decade of Disabled Persons

The Asia Pacific region includes half of the world's population. They live in countries at very different levels of social and economic development. Thirteen countries are among the world poorest and are listed as Least Developed Countries; other countries like Japan and Australia have large advanced economies. While there is no accepted regional model that addresses such diversity, more than 39 countries are signatories to the Proclamation of the Asian and Pacific Decade of Disabled Persons. The Decade activities seek to attain the full participation of people with disabilities in their societies. The Decade's Plan of Action established targets in 12 policy areas. The specific 14 targets related to the training and employment policy area are of most interest to this discussion. Although they do not have the structure of a model, they reflect regional consensus of the direction for vocational rehabilitation. The targets specifically call for

• Development of a collaborative body that will ensure the provision of relevant skills training
• Actions to make mainstream training programmes accessible
• Measures to ensure equitable participation in rural and urban poverty alleviation and income generating schemes
• Better curricula and support services so that people with disabilities can participate in vocational training
• National targets for placement and policies to facilitate them
• Development and implementation of self-employment schemes to include entrepreneurship training, access to loans, etc.
• Provision of training and employment opportunities for people with extensive disabilities or those who need a supportive environment and the use funds for this specific purpose (two targets)
• Identification and fulfillment of annual, gender-equitable targets for training and job placement that apply to all government ministries, and
• Establishment of a monitoring and evaluation body to ensure effective enforcement of training and employment policy and legislation.

Additional targets identify a plan of action for a regional research programme and for establishment of an international clearinghouse to identify, gather, and disseminate information related to employment and training for people with disabilities.

The targets emphasize the following crucial points:

• Training and services must be relevant to current market place conditions.
• All training, employment and related programmes should be accessible and open to disabled persons.
• Services must accommodate those with the most extensive services and needs.
• Targets should be used for accountability and evaluation purposes.

Achieving these targets will require a concerted effort on the part of governments and include targets and inputs from many ministries. Together, the ILO Convention, Recommendation and regional Decade Targets provide a list of guiding principles for the delivery of vocational rehabilitation services. The remainder of this paper describes how these principles can be put into action. Current global trends and developments that influence disabled people and the workplace illustrate their value.

III. Applying Principles to Practice

Vocational rehabilitation does not exist in a vacuum; it must change and adapt to meet the fluid demographic, socioeconomic, and political contexts of real world situations. Major trends have an impact on the practice of vocational rehabilitation. Three particularly significant trends affect practice today and serve as a context for examining the application of vocational rehabilitation principles. These are the shifts

1. From charity to civil rights: The impact of the disability rights movement and related influences
2. From an industrialized to a knowledge economy: The impact of ICT and globalization on the workplace, and
3. From centralized to community based services: The impact of rural and impoverished urban community needs.

The disability rights movement and related influences

At one time, services to people with disabilities were almost exclusively the purview of charitable and non-governmental organizations. Now international bodies and many governments have recognized that disabled people should have equal rights and treatment. Not all countries have made the shift however, the disability rights movement and other influences have had a positive influence in this direction and on the availability and practice of vocational rehabilitation.

The disability rights movement began in industrialized countries during 1960s and it has since spread throughout the world. Most countries now have organized disability advocacy organizations that wield various degrees of influence with governments. In many countries such movements have lobbied and been successful in realizing passage of legislation calling for equal rights and treatment for people with disabilities as well as different forms of legislated policy to encourage mainstreaming and employment of disabled persons. Examples of such legislation include laws promoting non-discrimination in employment systems and/or quota systems requiring that employers reserve a certain percentage of job for disabled persons or incur fines. Since the 1970s many international initiatives have also promoted equal rights for people with disabilities.¹⁵

A significant philosophical and perceptual shift from the medical to social model of disability accompanied the disability rights movement. According to the medical model, disability was seen as a medical problem. Like sick people, disabled people were seen as needing care and/or "fixing." Custodial institutions and later, services aimed at "fixing" disabled people or curing them of their disadvantages (e.g., "adjustment services") were society's response. In contrast, the evolving social view of disability recognizes society and the environment as the cause of disadvantages that limits disabled people. The need to "fix" the disabled person switched to the need to "fix" the environment. For example, if a person who uses a wheelchair is unable to get into a school building, the mobility limitation does not cause of the disadvantage (i.e., lack of a access to an education), the stairs (and policies that allow the stairs to exist without an alternative) are the cause. This distinction is important because it shifts the burden of accommodation from the disabled person to the society, or more specifically, the government.

A growing body of research that recognizes the staggering socioeconomic costs related to exclusion and disability dependence has developed over the past 20 years and supports the disability rights movement. The welfare state, the provision of social protection instead of employment services, separate vocational training facilities, separate workplaces in the form of sheltered workshops or production facilities are all examples of exclusionary programs with high price tags. In developed countries, many of these costs began to skyrocket contributing to the socioeconomic argument for vocational rehabilitation.

In the late 1980s, population demographics resulted in labour shortages in countries as diverse as the United States and Mauritius. Some countries began to promote the idea of tapping disabled workers, the "hidden" labor pool. As some disabled people gained access to resources, they became consumers of goods and services. The business argument for inclusion further buttressed the civil rights, philosophical and socioeconomic reasons.

One final civil rights development that is important to the discussion of vocational rehabilitation is the inclusion of all categories of disabled persons within the context of disability rights and vocational rehabilitation practices. People with intellectual impairments, mental health problems, brain injuries, and others are now included under the disability umbrella.

The implications of the shift from charity to civil rights for the delivery of vocational rehabilitation and employment services follow.

1. Training and employment services should be inclusive and mainstreamed; workplaces should be accessible and hospitable to disabled persons.

Persons (1983 to 1992). The Decade brought worldwide attention, if not conclusive action, to the issues of disability. The Asia Pacific Region, recognizing that more work needed to be done, took the unprecedented action of calling for a regional Decade (1992 to 2002), which introduced specific targets of action. In 1994, the United Nations Standard Rules for the Equalization of Opportunities for People with Disabilities called for states to recognize that people with disabilities had the same rights and obligations as others, including the right to productive and gainful employment.

As noted by the ILO Convention and Decade targets, disabled people, whenever possible, must be included in mainstream services. This means that such services may need to be adapted, including make physical environments accessible, providing information in alternative formats to reach the blind and visually impaired, deaf and hard of hearing, and people with learning or intellectual impairments. Similarly, workplaces need to be adapted to accommodate all types of disabled people and services such as disability awareness training can be effective in removing attitudinal barriers. Effective policies, appropriated incentives, and trained personnel are required to achieve these outcomes.

Example: Cambodia's Disability Resource Team, assists the integration of trainees with disabilities into mainstream vocational training by facilitating their acceptance, by providing support services, and by training teachers in disability awareness and methods of accommodating disabled persons. Using programmeme resources, the team facilitates the removal of architectural barriers as well.

With regard to integrating the workplace, Singapore's BIZLINK Ltd., which provides a range of training and employment services for people with disabilities, use reverse integration to ensure that its production centres produce quality work and does not segregate disabled workers. It employs nondisabled workers to work alongside disabled workers to compete contract work for commercial industries.

2. Disabled People should be included in all aspects of service planning and delivery

People with disabilities need a voice and choice with regard to the vocational rehabilitation process. On an individual level, this means that disabled people should participate in decision making about their vocational goals and how to achieve them. Vocational guidance and empowerment training will facilitate people with disabilities becoming active partners instead of passive recipients of services. In designing service delivery programs, people with disabilities should be consulted about best approaches. And finally, with regard to service programs, people with disabilities should be included in evaluation and satisfaction surveys. On a policy level disabled people should be represented on all policy-making bodies. Examples of such involvement exist throughout the region.

3. New populations require new approaches to vocational rehabilitation

As new populations are included under the vocational rehabilitation umbrella, new approaches to vocational rehabilitation are required. For example, in trying to mainstream people with intellectual impairments into the workplace, the use of job coaches or workplace-based trainers was introduced as part of supported employment approaches. Job coaches and supported employment techniques are now being used with other populations such as people with traumatic brain injuries and those with mental health problems. For people with various types of physical and sensory disabilities, high and low methods of job accommodation help them access jobs that they might otherwise be incapable or unable to perform.¹⁶

Example: Hong Kong's New Life Psychiatric Center provides a range of services to meet the varying individual needs of ex-mental patients. These include activity centres, sheltered workshops, and supported and open employment. All workers receive wages and can move into more and more demanding work situations, including placement in supported employment programs with job coaches.

4. Creative, cost-effective and high quality approaches must be identified to meet the growing demands for services that has resulted from the disability rights and related influences

The introduction to this paper described the enormity of the need among people with disabilities for vocational rehabilitation services. The need continues to grow and creative, cost-effective and high quality approaches must be identified to meet it. Mainstreaming is one solution, but cannot be the sole strategy as mainstreamed vocational training programs, for example, are already overtaxed with high numbers of school-leavers. Other methods must be identified and implemented on a large scale. For example, with regard to training, on-the-job, workplace and apprenticeship training can defray costs related to creating new programs, building new schools, and maintaining updated equipment. As already noted, supported employment, job coaches and other work-based models are also appropriate for use with diverse disability groups who learn best by example and by doing. Informal apprenticeships, community based training and peer training, described later in this paper offer additional training alternatives.

Example: In many Asian countries, the garment industry is a major source of new jobs. Existing sewing programs, oriented to self-employment, use manual sewing machines. Program budgets cannot accommodate the costs of industrial equipment for training purposes. NGOs are working directly with employers, to train people with disabilities on-the-job. According to such models, employers agree to hire trainees once they acquire the necessary competencies.

The Impact of ICT and Globalization on the workplace

Another major influence on vocational rehabilitation practice, one that primarily influences the formal urban sector, results from the global shift in economic activity. Towards the end of the 20th Century, the economic basis began its shift from the industrial age to the information age. In the industrial age, the machine was the basis of productivity, the worker manipulated or served the machine, and material was the product. In the information age, the person is the basis of productivity, the machine serves the worker, and information is the product.¹⁷ Advances in technology and specifically the introduction and accessibility of the computer and other forms of information and communications technology (ICT) made this shift possible. ICT has also contributed to globalization, or the entry of more and more countries into world trade.

These changes have had nothing short of a revolutionary impact on the global order. They have resulted in a workplace that is more highly competitive than ever before. In order to succeed, today's business must be leaner (flattened structure, less hierarchical, fewer employees), meaner (more efficient, productive and competitive), and smarter (greater use of technology, better human resource management and constant learning) in order to survive. As a result of these major global developments, the formal workplace of the 21st Century has some of the following features:

• It requires "knowledge" workers who have the ability to think critically and use technology.
• People skills as well as technological skills are important.
• English language skills are increasingly important. (Consider the fact that currently 75 percent of all Internet information is produced only in the English language.¹⁸)
• Workers, as the basis of a successful business, must be flexible and have a variety of skills, so that the business can rapidly respond to the changing needs of the marketplace.
• Jobs require higher levels of education and continuous learning.
• More tasks are outsourced, resulting in redundancy and less protected work situations as well as opportunities for small business start-ups.
• Less formal and alternative work structures, such as teleworking and temporary employment are more commonplace.

While some jobs are being automated, the new technologically based economy is opening up opportunities for job creation and a net jobs gain could result.¹⁹ Nevertheless, this new networking workplace is both positive and negative for people with disabilities.

On the positive side, the new workplace and technological advancements

• Favor certain groups of people with disabilities. For example, those with physical disabilities who have access to an education, will find that technology and knowledge-based jobs can level the playing field.
• Present innovations in assistive technology and distance learning that can reduce barriers faced by people with disabilities in accessing services and employment, (although access to these technologies may still be denied to many because of infrastructure deficiencies, prohibitive costs, etc.).

On the negative side, the new workplace

• Challenges certain groups of people with disabilities, especially those with intellectual impairments who cannot access high skill jobs, or those with certain types of mental health impairments who may have difficulty with constant change and flexibility demands.
• May exclude others because of standard online environments and software design. For example, graphical user interfaces can exclude people with visual impairments and video voice streaming and other non-captioned audio techniques that exclude deaf people.
• Demands good basic skills and constant skills upgrades, which places people with disabilities, who are likely to be poor and lack access to education and training, at a real disadvantage.
• Could lead to further exclusion of people with disabilities and other poor and marginalized groups if action is not taken to remedy the digital divide and the trends toward redundancy, outsourcing and other developments that result in increasingly large numbers of workers becoming more vulnerable.

What are the implications of globalization, the introduction of ICT and the changing workplace on the vocational rehabilitation of people with disabilities? They are numerous for urban sector and the formal workplaces, especially in cities like Bangkok, which are hubs for international business activities.

1. Vocational rehabilitation providers should consider employers, as well as people with disabilities, customers of rehabilitation services. Partnerships with employers should be developed whenever possible

Dealing with employers as customers and meeting their needs for qualified workers ensures that people with disabilities have the relevant skills they need to compete and succeed in today's job market. Staying current about workplace needs is best accomplished by developing direct marketing or partnership relationships with employers. These can be facilitated by personal visits to enterprises to build relationships, conduct job analyses, develop job opportunities, and follow-up on job placements. Formal employers advisory groups are a particularly effective and structured approach.

Example: In Cambodia, the National Council of Disabled Persons is working with a group of employers who are organized into a Business Advisory Council (BAC). The BAC provides timely advice about current job opportunities and labour market needs. It also provides important linkages to other employers and employer associations. The BAC informs vocational training programs about skill and competency requirements and provides job placement assistance. The BAC, which began it activities in January 2001 yielded more than 70 jobs and on-the-job training opportunities for people with disabilities during its first month.

In Hong Kong, China the government operated Vocational Training for Disabled People section of the Vocational Training Council organized a consultative committee that includes employers to review job skill requirements and estimate projected job openings so that the programs can meet demands without flooding the market.

2. Vocational rehabilitation providers must assure that disabled people have access to high demand skills, including those related to technology

While many disabled people do not have access to ICT jobs, as a group disabled people must not be excluded from this growing and high wage sector of the economy. Currently, cutting-edge computer skills can provide ready entry into the workforce in most cities in the Asia Pacific Region. (According to data from Europe, computer skills are almost a necessity for employment, with 70 percent of the European Union labour force engaged in technology intensive work.²⁰) Vocational rehabilitation and vocational training providers must provide ICT skills training, either directly or through contracting with mainstream and private providers. Because of the costs involved in purchasing and maintaining equipment and software, which require regular upgrades, the latter solution could be more cost-effective.

Example: The longstanding and successful electronics, computer programming, and computer business courses at Pattaya's Redemptionist Vocational School for the Disabled is but one example of effective ICT vocational training that results in high placement rates and good jobs for disabled people. Tanzania in the mid-1990s offers a particularly creative example of how to overcome barriers to providing technology training. Lacking any public training program in computer skills, a vocational rehabilitation program used donor funds to place computers in the classrooms of a commercial technology training school, which then incorporated people with disabilities into existing classes on a no-fee basis.

3. Vocational training programs need to incorporate "soft" skills, literacy, and English language training into curricula and encourage lifelong learning.

Securing jobs and succeeding in the global job marketplace may require more than occupational or technical skills. Literacy training, job seeking and even English language skills as well a training in "soft" generic work skills, like how to communicate on the job, work on a team, or solve problems are particularly important to people with disabilities who may lack exposure to life experiences that build such skills. Training programs need to provide such skills along with opportunities and encouragement for lifelong learning.

Example: MaryKnoll's Wat Than training facility in Phnom Penh is developing a topnotch computer training program with input from local employers who also provide job site visits to their workplaces. The curriculum includes training in basic literacy skills prior to entering computer training, which is supplemented by English language classes. Other local NGOs offer training in self-esteem, goal setting and job seeking skills.

4. Quality programs must be assured so that people with disabilities can compete in the workplace

People with disabilities and employers require quality, responsive services. Methods for ensuring quality include developing skills and competencies among vocational rehabilitation personnel, instituting management information and quality control systems, assuming a multisectoral approach to providing services, conducting follow-up and outcomes studies, administering and analyzing customer satisfaction surveys, and exploiting the use of technology.

Example: Many employment services use technology to match workers to jobs, ensuring a quick response for employers and easy tracking and reporting capabilities for evaluation and follow-up services. Newly instituted follow-up studies are pointing to vocational training inadequacies in many programs; regular monitoring of such data is used to evaluate strategies introduced to overcome the deficiencies.

Meeting the needs of rural and impoverished urban communities

The job opportunities available to most people with disabilities in developing countries are in stark contrast to the technology-based workplace just described. While vocational rehabilitation principles have relevance to their situations, standard practices may not. Most vocational rehabilitation services and models are the result of large-scale programs initiated by developed countries. They emerged in response to post-war needs to reintegrate disabled soldiers into mainstream society. Developing countries have adopted and adapted many of these services, in spite of the fact that such countries have

• fewer resources and less well developed infrastructures;
• different cultural and social attitudes about disability;
• greater emphasis on family and community as support and service vehicles;
• less developed formal economic sectors, requiring that many people learn and earn in the informal sector; and
• a higher incidence of people with disabilities living in rural areas.

While developing countries can and should learn from international experience, they must adapt models and services to their contexts. In doing so, it is likely that new approaches will emerge, such as the Gremeen Bank approach of microloans for small business development and community based rehabilitation. In the reverse situation, these developing country models are being adapted by some industrialized countries.²¹ Diverse countries must have diverse vocational rehabilitation practices to accommodate its impoverished urban and remote rural areas. This requires adopting a more decentralized, community services orientation. The implications of this approach follow.

1. Policy makers and service providers must consider a broad spectrum of employment options and outcomes and organize or provide the services to realize them.

Not every one who works or earns an income has a job. In fact, employment in many communities means self-employment, contributing to a family-owned business, earning income from the production of handicrafts, or participating in community owned and operated production cooperatives. In applying standard vocational rehabilitation concepts from industrialized countries to the developing world, vocational goals and objectives must reflect these local realities. Vocational rehabilitation services must also reflect and facilitate realistic outcomes. In some communities, this may mean that poverty alleviation strategies may be more appropriate then employment and training or that employment specialists may to engage in job creation or provide business start-up support. Vocational trainers and instructors may need to focus on business development in addition to traditional job skills. Support services and follow-up may be crucial to long-term successful outcomes in these situations.

Examples: Cambodia's Disability Resource Team offers an excellent example of how service outcomes and service delivery mechanisms needed to adapt to local communities realities. First organized to encourage participation of people with disabilities at government-operated provincial training centres, follow-up indicated that graduates were not getting jobs. It became clear that training was not enough and jobs were scarce. Graduates needed loans and assistance in developing small scale, village-level businesses based on the vocational skills they acquired. In collaboration with a local NGO, the Team began to offer the needed services, including loans and provided long-term follow-up and support with increased non-traditional employment as a result.

2. Program designers and service providers must develop service delivery methods and systems based on an assessment of local needs, community norms, and local strengths

Community assessment is critical to developing appropriate vocational rehabilitation responses in rural and impoverished urban areas, especially when informal employment opportunities are the most viable employment outcomes. Such assessments should include a broad range of factors and techniques. Some of these include engaging community leaders and people with disabilities in the assessment process, evaluating the impact of local barriers and opportunities, examining related social service delivery systems for integrated service delivery approaches, evaluating local market opportunities for goods and services, identifying community strengths and weakness, considering cultural and local attitudes about disability, and analyzing local norms, standards and indigenous approaches to employment and training.

Vocational rehabilitation responses must be based on such assessments and include multisectoral approaches that fully exploit all existing resources and expertise. Vocational training should be based on local marketplace assessments so that people with disabilities can use the skills they develop to earn a living without leaving their villages and communities. The ILO community based training (CBT)²² model offers guidelines for this approach.

Example: Success Case Replication (SCR) methodology is based on informal apprenticeships or person-to-person training, which reflects traditional community approaches to skill transfer. The model, which has been field tested in eight Asian countries, identifies village level "success cases", that is, people who have successful, replicable businesses, (with market capacity, access to local raw materials and life-sustaining net returns), who are also willing to train others. A practical, "hands-on" training program is designed and trainees are matched to training situations. Program operators provide necessary supports and supervision. 23

3. People with disabilities and their families should be actively engaged in vocational rehabilitation efforts.

Ideally, all vocational rehabilitation efforts should include a family orientation and the inclusion of people with disabilities as partners in the rehabilitation process. However, in developing country settings, and especially in poor communities where institutional and government support may be minimal, family and community based models, such as community based rehabilitation program and self-help groups may be the only viable approaches.

Example: CBR program that rely on local extension program and the training of community and family members to delivery services are excellent examples of methodologies that engage community and family members in rehabilitation efforts. Self-help groups that stimulate and encourage income generation, like the training and income generating sewing circles organized by disabled women in the Laos Disabled Persons Association offers a self-help example. Other Asian based examples include community banks organized by rural disabled people, with help from NGOs, to provide loans.

4. Nontraditional service providers should be encouraged to participate in delivering services to people with disabilities.

While inclusion should be the norm in all settings, it is critical in resource-poor rural and urban communities. Similarly, nontraditional providers of services to people with disabilities should be encouraged and assisted by government and more traditional providers to deliver services related to vocational rehabilitation.

Example: The Food and Agriculture Organization (FAO) has been active in many countries to promote opportunities for rural disabled people. In Ubon Ratchathani, in Eastern Thailand, the FAO established a mushroom training project for disabled people at the Vocational Training Center with strong support from the Department of Public Welfare. Graduates have been able to establish mushroom productions centers in their villages after training. Other FAO projects in the region engage people with disabilities in blacksmithing, greenhouse management, and small implement making.

5. Personnel charged with the delivery of vocational rehabilitation services must be flexible and have diverse skills.

Providing vocational rehabilitation services at the community level requires skills in community development assessment, collaboration, training, and resource management and organization development. Strategy needs and services will be locally determined requiring that personnel have flexible and have diverse skills. They must be willing and able to assume multiple roles, much like the knowledge workers in the global economy. Responsible ministries and government agencies should assure adequate training for staff working at the community level.

Summary

The first part of this paper reviewed the basic vocational challenge rehabilitation and international and regional standards designed to address it. The second part of the paper discussed the realities of applying standards and principles in real world settings within the context of two major global developments, the changing workplace and the disability rights movement. Finally, it examined some of the implications of offering services in remote rural and impoverished urban settings.

This paper supports the efficacy of vocational rehabilitation principles like equal access and treatment and involvement of people with disabilities in the design and delivery of service, regardless of whether the setting is fast paced urban center or a remote rural community. It also demonstrates however, that policies, programs and practitioners must be flexible and ever mindful not only of the needs of people with disabilities but the marketplace in which they work. Such mindfulness can result in the development of new, more effective approaches and models to assist people with disabilities access suitable and integrated employment. In conclusion, vocational rehabilitation principles and models provide useful and important guidance that can inform creative responses to the every changing needs of people with disabilities, the workplace and community.

References

Albright, A. and Neufeldt, A. Disability and Self-directed Employment; Business Development Models, 1998.

Bennell, P. Employment and Training Papers 43; Learning to change: Skills development among the economically vulnerable and socially excluded in developing countries,1999.

Cummings, S.I. Paper presented; Human Resource Development (HRD) Conference, Ministry of Human Resources, Malacca, Malaysia, 2000.

Drucker, P.F. Post-Capitalist Society, New York: Harper Collins Publisher, Inc., 1993

Elwan, A. Poverty and Disability; A Survey of the Literature, 1999.

Economic and Social Commission for Asia and the Pacific (ESCAP). Cost-Effective Employment Promotion for the Rural Poor, A Report on a joint ESCAP/FAO Project, 2000.

Food and Agriculture Organization (FAO). Report of the Round Table Meeting on the Integration of Disabled People in Agricultural and Agro-Industry Systems, Bangkok, 1997

International Labour Office (ILO). Committee on Employment and Social Policy; Governing Body; GB.273/ESP/3; 273^rd Session, Geneva, 1998.

• Committee on Employment and Social Policy, Governing Body; GB.274/ESP/1; 274th Session, Geneva, 1999.
• Community Based Training for Employment and Income Generation, Vocational Training Systems Management Branch, ILO Geneva, International Training Centre, ILO Turin, no year
• Decent Work; International Labour Conference; 87th Session, Geneva, 1999.
• Vocational Rehabilitation and Employment of Disabled Persons; International Labour Conference; 86th Session, 1998.
• World Employment Report; Life at work in the information economy, 2001.
• Workers Education; Newsletter of The Workers Education Project for Indonesia, 2000.

Metts, R.L. and Metts, N. Self-Employment Strategies for People with Disabilities in Kenya and the United States, Switzer Monograph, National Rehabilitation Association, 1996.

Metts, R.L. Disability Issues, Trends and Recommendations for the World Bank, 2000.

Murray, B. Opening Keynote, Employment for People with Disabilities in the Pacific Region: International Labour Organization Perspective, Pacific Perspectives for the Employment of Persons with Disabilities in the 21^st Century, Guam, 1998.

Murray, B. Paper presented; Vocational training for people with disabilities; Building on experience in Asia and the Pacific, International Seminar on Work and Employment Options in the Twenty-First Century; Rio de Janeiro, 2000.

Orsini, J.B. Success Case Replication, A manual for increasing farmer household income, Poverty alleviation through market generated rural employment, Bangkok, 2000

Perry, D. The Information Age: What it Means for Business and Vocational Rehabilitation, Switzer Monograph, National Rehabilitation Association, 1995.

Reguera, L. ILO Reference Paper; Vocational Training for Persons with Disabilities; An ILO Perspective, Seoul, Korea, April 1999.

Rehabilitation International. The Vocational Commission & the Commission on Organization and Administration, Auckland, New Zealand, 1996.

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