Professional Rehabilitation of Persons with Disabilities

Prof. dr Emira Švraka, MD, PhD

University of Sarajevo

Faculty of Health Studies

Work as Important Role in Life

Work plays an important role in life. It is logical to assume that it should play

an equally important role in the lives of most adults with developmental

disabilities.

The Medical Model

The medical model is being challenged:

It is known that for more people with disabilities, the major source of

disadvantage is not the disabling condition itself but the way that

society defines and responds to that disability.

Employment Models

1. Sheltered Workshops

2. Supported Employment

3. Self-Employment

Sheltered Workshops

Most often the work done in Sheltered Workshops is contract work.

Many different kinds of work:

collating, stuffing envelops, labeling, mailing,woodworking, printing, janitorial work,

clerical work, crafts, ceramics, sewing and recycling.

Disadvantages of Workshops

1. The work in Sheltered Workshops is often simple, repetitive work.

2. People in Workshops almost always receive very little pay.

3. People in Workshops have little choice – either about the people with whom they work or about

the kind of work thay do.

4. In an environment where everyone has a developmental disability, other people are likely to

have low expectations.

Disadvantages of Workshops

5. In an environment where there are low expectations,people are less likely to

learn.

6. People learn from others around them; segregated environments provide fewer

opportunities for learning.

7. People in Sheltered workshops learn the skills thay need to be a worker in the

community.

Disadvantages of Workshops

8. Workshops are not effective in enabling people to get jobs.

9. Whwn people with developmental disabilities are kept in sheltered workshops, the community gets the message that thay belong there rather than in

regular work places in the community.

10. As a result of all of the above, sheltered workshops create and sustain low expectations

and reinforce devalued status. Thay makeit more likely that people with developmental disabilities

will be treated poorly within society.

Supported Employment

Supported employment programs work in reverse.

Thay help aperson find a job and than they provide the training and support that is

necessary to ensure success. Instead of a train-then-place approach, thay use a place-then-train-and-support approach.

Supported Employment

Supporeted employment is more than simply a new strategy for preparing people for the world

of work. It reflects a fundamental change in phylosophy.

It says that the opportunity to work in the community is a right, not a privilege for which one has to prove one’s readiness, and that

service providers have an obligation to ensure that the needed support are provided.

Supported Employment

Supported employment includes paid work in ordinary, inclusive business environments, with

regular support provided, as required. As much as possible, the goal is for the supported

employee to be a regular employee, with supervision, training, and support provided by

employer and co-workers.

Success in the workplace

Success in the workplace does not only depend on the individual’s ability to

acquire specific work skills but also on having the skills necessary for daily living.

Supporeted employess may need assistance in learning nonwork routines: buying lunch at the company cafeteria,

learning to use the time clock, traveling to and from work by public transit.

Advantages

Overall, supported employees are earning more than thay earned in shaltered workshops,

sometimes at rates of pay that are wll above the legalminimum wage.

The studies have indicated that in general, people who are in successful supported employment

programs are proud of working in the community, enjoy the work thay do, and get along well with

their co-workers. They say thay prefer working in the commnunity

to working in a sheltered workshops.

Advantages

Employers who have hired people with developmental disabilities usually say

that they are good workers:

They work hard, learn new skills, are well liked, an are an asset to the workplace.

Self-Employment

Self-employment refers to a situation in which someone (person with a

developmental disability) is not an employee but works for him, or herself.

This might mean, for example, that the person is an independent contractor, doing specific tasks for someone else in return for

pay.

Self-Employment

The work people with developmental disabilities do through self-employment is

most lekily to be similar (or identical) to what thay did in the sheltered workshops and/or to involve such things as cleaning and recycling

activities. Family and friends may provide a great deal

of support that is not funded.

Social inclusion

People with developmental disabilities should not be forced to work.

Where is not possible to assist people to become employed, it is necessary to do everything possible to enable them to

participate in activities that promote valued participation and social inclusion.

Growth and development, contribution, and interaction with the broader community are

essential.

Epilepsy and Employment

The majority of adults with uncontrolled seizures are unemployed or underemployed – that is

employed in jobs well below their level of competence.

There are 3 parts of the problem:

1. driving,

2. public seizures and

3. disclosure.

Driving

In most contries, driver’s licences are revoked after the first seizure.

People with intractable epilepsy, however, are seldom seizure free for a

period as long as a year. Most of them will never legally drive

again; therefore, they cannot take any job that requires driving or that can only be

reached by car.

Public seizures

People are often fired if they experience seizures at work.

Even when the laws in meny countries forbid firing for conditions such as epilepsy,

employers terminate employees with public seizures by using some other pretext.

Disclosure

People with seizures fear that they will not be hired if they disclose their problem to

potential employers. They also fear that they will be fired later if

they do not. Being able to work and earn a stable income

are major concerns for adults with intractable epilepsy.

Community Based Rehabilitation in B&H

CBR (Community Based Rehabilitation) is strategy for rehabilitation, equal possibilities

and social integration of all persons with disabilities.

CBR program is implementing with joint effort of persons with disabilities, their

families, community and related health, educational and social institutions.

Community Based Rehabilitation

Before the 1992, medical rehabilitation in Bosnia and Herzegovina had been provided at the level of institutions, usually after the hospital or ambulant

treatments. Model of Community Based Rehabilitation (CBR),

which practically tested in all parts of Bosnia and Herzegovina, suggests numerous advantages

when compared to the previous period, until 1992.

Re/habilitation

ZAPOŠLJAVANJEZAPOŠLJAVANJE

PROFESIONALNAREHABILITACIJA

PROFESIONALNAREHABILITACIJA

OBRAZOVANJEOBRAZOVANJE

PEDAGOŠKOPSIHOLOŠKA

SLUŽBA

PEDAGOŠKOPSIHOLOŠKA

SLUŽBA

UDRUŽENJAUDRUŽENJA

CBRMENTALNO ZDRAVLJE

CBRMENTALNO ZDRAVLJE SLUŽBE

ZASOCIJALNI

RAD

SLUŽBE ZA

SOCIJALNI RAD

KONSULTATIVNASPECIJALISTIČKA

SLUŽBA

KONSULTATIVNASPECIJALISTIČKA

SLUŽBA

ORTOTIKA I

PROTETIKA

ORTOTIKA I

PROTETIKA

BALNEOKLIMATOTERAPIJA

BALNEOKLIMATOTERAPIJA

OKUPACIONATERAPIJA

OKUPACIONATERAPIJA

KUĆNAFIZIKALNA TERAPIJA

KUĆNAFIZIKALNA TERAPIJA

FIZIKALNATERAPIJA

FIZIKALNATERAPIJA

RE/HABILITACIJARE/HABILITACIJA

OBITELJI

DIJETE

OBITELJI

DIJETE

Professional rehabilitation in B&H

Professional rehabilitation is part of rehabilitation persons with disability, which

enables to complete professional and social integration.

We don’t have developed system of professional orientation of proper professions

for person with disability, concerning his or her disposition, disability form and remaining

level of professional capability.

Cerebral Palsy Association of Federation of Bosnia and

Herzegovina Cerebral Palsy Association of Federation of Bosnia and

Herzegovina is established at 17. October of 2011.

Cerebral Palsy Association members are:

1. Association of persons with cerebral palsy of the Canton of Sarajevo,

2. Association of persons with cerebral palsy and dystrophy from the town Goražde,

3. Association of parents of children with cerebral palsy, micro and hydro cephalous “Palm of the hand” from the town Zenica

4. and Association of persons with Cerebral palsy and other disabilities (Sapna).

Inclusion of persons with CP

17 000 000 people worldwide have CP! Starting in 2012. september 4, will be World

Cerebral Palsy Day! Cerebral Palsy Association of Federation of Bosnia

and Herzegovina named whole 2013. year as Inclusion of Persons with CP Year, to replace a

life of passivity with a life of creative self-determination.

October is CP Awareness Month in FB&H and the 17th of October is a special day to honor persons

with CP.

Cerebral Palsy Day in FB&H

Starting in 2011. October 17, is Cerebral Palsy Day in Federation of B&H, to make a difference in the lives of

those living with cerebral palsy and their families!

Fond for professional rehabilitation and employment of persons with disability in

Federation of B&H

Secretary of the Cerebral Palsy Association of FB&H is sociologist (person with CP) and

she is employed for this year, thanks to Project of Fond for professional rehabilitation and employment of persons with disability in

FB&H (Fond). Fond is working from 2010. year.

Association of persons with cerebral palsy of the Canton of Sarajevo

Six members of Association are employed (4,3 % of 140 adults), three female and three

male. All of them have high education.

President of the Association graduated law, and other five are medical doctor, journalist,

sociologist, pharmacist and translator.

Art workshopwww.art-radionica-cdp.tripod.com

Art workshop of the Association of persons with cerebral palsy of the Canton of Sarajevo consists

of 9 female members, 7 with CP and 2 with paraplegia.

Middle age is 37,7 years; two youngest members are 27 years old, and oldest one is 58 year old.

Five members use wheelchairs (3 with CP and 2 with paraplegia), one cane, and three of them are

walking independently.

Spastic CP and use of mobility assistance

Spastic CP Use of mobility assistance Total

Wheel chair CaneTripod

Independent walking

Triparesis 3 1 1 5

Hemiparesis 1 1

Paraparesis 1 1

Total 3 1 3 7

Spastic CP and education of Art Workshop members

Spastic CP Education Total

Elementary school

Special elemntary

school

Secondary school

Triparesis 3 1 1 5

Hemiparesis 1 1

Paraparesis 1 1

3 1 3 7

Cerebral Palsy

The first challenge begins with learning to cope independently from one’s parents.

Other important issues include development of friendships, career

planning, emotional and sexual relationships, and marriage.

It is known that persons with CP have more difficulty finding satisfying

relationships and making career plans.

Conclusion

People with CP can lead active lives and make a valuable contribution to society.

It is necessary to reduce the numbers of sheltered workshops, and develop supported employment and self-employment, in other to reduce segregation of persons with disabilities

and give support to social inclusion.

References

1. Sandys J. Work and Employment for People with Intellectual and Developmental Disabilities. In: A Comprehensive Guide of Intellectual & Developmental Disabilities. Edited by Brown I. and Percy M. Paul.H.

Brookes. Publishing Co. 2007 p.527-545

2. Burnham W. M. Epilepsy. In: A Comprehensive Guide of Intellectual & Developmental Disabilities. Edited by Brown I. and Percy M. Paul.H.

Brookes. Publishing Co. 2007 p.287-294

Thank you!