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									   American Rehabilitation
Counseling Association (ARCA)
 50th Educational Conference


   Tampa, Florida U.S.A.
     November 2007

                                1
The Status of Rehabilitation Counseling Services Across
  the Globe

Rapporteurs/Coordinators:

   David Hershenson, Ph.D.
        Professor Emeritus, University of Maryland-College Park
   Irmo Marini, Ph.D.
        University of Texas, Pan America
   Daniel Wong, Ph.D.
        East Carolina University




                                                                  2
               International Panel
Nicholas Buys, Ph.D.
       Griffith University, Australia
Hal Cain, Ph.D.
       Queens University, Canada
Kane Hattori, Ph.D.
       Kobe City College of Nursing, Japan
Gail Kovacs
       Vocational Rehabilitation Association, United
       Kingdom



                                                       3
              International Panel
Li Jian Jun, MD
Qiu Zhouying, Ph.D.
Shi Hongmei
    China Rehabilitation Research Center, China
Ming-Hung Wang, Ph.D.
Ming-Yi Wu, Ph.D.
    Taiwan Rehabilitation Association, National Kaohsiung Normal
    University, Taiwan




                                                               4
               International Panel
Jun Yaeda, Rh.D.
   University of Tsukuba, Japan
Dal Yob Lee, Ph.D.
   Taegu University, Korea




                                     5
Rehabilitation Counselling in Australia




                                          6
       Voc Rehab Counselling Services

Vocational rehabilitation counselling services are
  provided in several systems
• Social security - Federal
• Workers compensation - State
• Motor accident – State



                                                 7
            Provision of VR services
• Range of disciplines include:
   –   Rehabilitation Counsellors
   –   Occupational therapists
   –   Psychologists
   –   Physiotherapists
   –   Social workers
• Range of titles:
   –   Injury manager
   –   Rehabilitation coordinator
   –   Rehabilitation case manager
   –   Disability employment worker
• Training is usually a tertiary degree in one of the
  behavioural sciences or allied health

                                                        8
    Status of Rehabilitation Counselling

• Rehabilitation Counselling profession exists in
  Australia
• Small numbers
• RC degree programs exist at Bachelors and/or
  and Masters level at 7 universities No
  registration or licensure
• Two professional bodies – RCAA & ASORC
                                                    9
    Status of Rehabilitation Counselling

Rehabilitation Counselling Association of
Australasia is of the view that voc rehab
counselling services should be provided by
professionals with specific tertiary training in
rehabilitation counselling




                                                   10
 National legislation and policies
• Federal Government avoided issue of which
  professions should deliver VR services
  – Focussed more on outcomes rather than which
    profession does the work


• State Governments more prescriptive in
  workers comp
  – Queensland has Table of Costs specifying which
    professions can deliver what services and at
    what cost

                                                  11
  Role of Rehabilitation Counsellors
• Role depends on system and employer
• VR services for social security recipients – case
  manage from intake through to job placement
• Occupational rehab services in workers comp and
  motor accident:
   – Full program
   – Case coordination only
   – Specific services such as vocational evaluation or job
     placement
• Disability employment services
   – Job placement and retention

                                                              12
   Use of ICF in Rehabilitation
Limited to date – main areas of use:

– Data collection
– Research - measure of therapy outcomes
– Classification system
– Identification of support needs
– Education


                                           13
    Challenges for RC profession
• Deprofessionalisation of VR services
• Lack of recognition by governments
• Governments want outcomes – not
  interested in who delivers services
• Small numbers
• Professional body lacks resources to lobby




                                               14
  Challenges to providing services
• Fragmentation of service delivery system
• Ongoing employer reluctance to hire
• Aging population and increase in chronic
  conditions
• Lack of services in rural and remote areas
• Multiple service delivery systems
• Lack evidence base to guide practice


                                               15
    Best outcomes & practices
• Social security recipients:
  – Demand side approaches

• Workers compensation recipients:
  – Employer-based disability management programs
  – Key stakeholders (doctors, employers, insurers, workers)
    fully engaged
  – Provision of suitable return to work duties
  – Focus on psychosocial issues not just medical issues
  – Build healthy organisations with positive workplace
    cultures
  – Reduce common law access

                                                               16
 Similarities/Differences with US
• Currently undertaking a study of RC
  competencies in Australia

• Limited studies to date indicate role and
  function is similar

• US has stronger focus on forensic rehab,
  possibly because more litigious


                                              17
• THANKS!




            18
Responses in context of Canada:
   Rehabilitation Counselling

              Hal. M. Cain, Ph.D., CRC
                Queen’s University
                   Kingston, ON
 Rehabilitation Counselling Association of Canada




                                                    19
          Professional disciplines providing
         vocational rehabilitation counselling
                       services?
• a variety professional disciplines including, but not
  limited to:
   –   occupational therapy
   –   social work
   –   psychology
   –   nursing
• a few practitioners specifically trained in counselling
  but fewer trained in rehabilitation counselling


                                                            20
      Official professional title of this
       “professional”/“discipline”?
• there is no “official” professional title in Canada
   – many practitioners call themselves “Rehabilitation
     Consultants”
   – others adopt job titles, including “Rehabilitation
     Counsellor,” as set by various employers and employment
     settings
• “Rehabilitation Counsellor” and “Vocational
  Rehabilitation Counsellor” included in the National
  Occupational Classification (NOC)

                                                               21
         training or academic credential
                     needed?
• no particular level or academic training specified
• in the NOC, under the category of “Family, Marriage
  and Other Related Counsellors”
   – a “master’s degree in counselling, mental health, or
     related social service field is usually required”
   – however, the NOC also indicates that, “An undergraduate
     degree or college diploma in a social science is required for
     certain areas of counselling.”



                                                                 22
        national legislation, policy and/or
             regulation to support?
• no stand-alone legislation or policy in at the national level in
  Canada
• however, non-discrimination and rights laws are integrated
  into various legislation, such as the Canadian Charter of
  Rights and Freedoms
• some federal funding and policy is given in support of
  disability related issues – largely administered at a provincial
  level
• disability / rehab legislation and policy exists at the provincial
  and territorial level


                                                                   23
rehabilitation services guided by the
   classifications of disabilities?


• The International Classification of
  Functioning, Disability, and Health (ICF) is
  used for classification of disabilities in
  Canada.


                                                 24
                role and function?

• role and function of rehabilitation counsellors
  in Canada is very similar to that of
  rehabilitation counselors in the U.S.
• rehabilitation counsellors do
  assessments/evaluations, manage cases,
  provide counselling, provide expert testimony,
  conduct research, etc.


                                                    25
        type of services rehabilitation
             counselors provide?
• rehabilitation counsellors in Canada provide a
  variety of services depending on the setting
• these services include, but are not limited to:
  – case management
  – vocational evaluation
  – career/vocational counselling
  – employment training.



                                                26
     challenges of this profession?
• some of the challenges for rehabilitation
  counselling in Canada are the same as in the
  U.S.
  – few lay people and not many allied rehabilitation
    professionals know what rehabilitation counselling
    is about
  – issues of professional identity within the
    profession


                                                     27
 challenges of this profession? (continued)
• major specific challenges for rehabilitation
  counselling in Canada
  – lack of rehab counsellor education programs (only
    one at this time)
  – credentialing issues: loss Canadian Certified
    Rehabilitation Counsellor (CCRC) & no regulation
    of counselling in Canada except in Québec.



                                                    28
    challenges of providing vocational
    & psychosocial services to persons
            with disabilities?

• widely accepted, typically supported, and
  largely available
• depending of province or territory, may be
  funding and procedural issues that pose a
  challenge for service providers

                                               29
    best outcomes (e.g., employment
      outcome) and best practices?

• Best outcomes in Canada are based on
  community integration, in general, and
  sustained employment.
• “Best practice” includes a whole-person
  approach.


                                            30
variables that play a major role in the
     voc rehabilitation process?


• no major socio-demographic variables play
  a role in the vocational rehabilitation
  process in Canada
• in addition, everyone has equal access and
  protected from discrimination based on
  gender, age, and socio-economic, etc.
                                               31
               role and function:
            United States v. Canada?
• the role and function of rehabilitation
  counsellors in Canada are very similar to that
  of rehabilitation counselors in the U.S.
• differences in settings impact particular role
  and functions depending on the focus or
  mission of these various settings



                                                   32
               role and function:
            United States v. Canada?
                          (continued)
• a major difference is the settings in which
  rehabilitation counselling is practiced
  – In the U.S., the majority of rehabilitation
    counsellors appear to work in state/federal
    systems (public sector)
  – In Canada rehabilitation counsellors work more in
    the private sector (for-profit and not-for-profit).



                                                      33
Rehabilitation and Disability in China


                                          Li Jian Jun, MD
                                     Qiu Zhuoying, Ph.D.
                                       Shi HongMei, M.S.
                     China Rehabilitation Research Center
                                    Beijing, China 100068

                                                     34
Rehabilitation for People with Disabilities in China: Approaches and Development


Background Information on China
History
   China is the one of the
   world’s most ancient
   civilizations with a
   recorded history of nearly
   4,000 years.

UNDP Human
Development Index
   According to the Human
   Development Report 2005
   (UNDP), China's Human
   Development Index (HDI)
   value in 2003 was 0.755,
   ranking 85th worldwide.


                                                                           35
Rehabilitation for People with Disabilities in China: Approaches and Development


Population & Natural
population growth rate

  Fifth national census on
  1 Nov 2000 by NBS

  Total Population:
  1,295,330,000.

  Population growth
  rate: less than 10 per
  thousand.

                                                                           36
 Rehabilitation for People with Disabilities in China: Approaches and Development


Statistics of Disability and Birth Defects
Disability statistics in China
UN estimates: 10%
population with disability

In 1996, China Disabled
Persons Federation (CDPF)
estimated 60 million
disabled persons in China.

About 5% of the total
population has some type of
a diagnosed disability.
                                                                            37
Rehabilitation for People with Disabilities in China: Approaches and Development




    Composition of Disability
     Vision disability                                8 770 000
     Hearing and speech disability                   20 570 000
     Intellectual disability                          11 820 000
     Physical disability                               8 770 000
     Psychiatric disability                           2 250 000
     Multiple disabilities and other disabilities     7 820 000




                                                                           38
Rehabilitation for People with Disabilities in China: Approaches and Development

Laws, Policies and Coordination Mechanism
of disability and rehabilitation in China
Laws and regulations on rehabilitation,
education and protection for children
    LAW OF THE PEOPLE'S REPUBLIC OF
    CHINA ON THE PROTECTION OF
    DISABLED PERSONS
    People with disabilities have the right to
    rehabilitation, education and social life
National Rehabilitation Office
Regulations and policies of
rehabilitation
    Rehabilitation for All

                                                                           39
  Rehabilitation for People with Disabilities in China: Approaches and Development



  Rehabilitation and Disability System
• Administrative System
   – State Council
   – Ministries
   – CDPF
• Professional Institutions
   – Hospitals
   – Rehabilitation Centers at national, provincial and other
     local levels
   – Rehabilitation Stations (clinics) at grass-root level
   – Social Services Institutions


                                                                            40
Rehabilitation for People with Disabilities in China: Approaches and Development



        Rehabilitation for All
   Policy:

       The ministries of Health, Civil Affairs, Finance, Public
       Security, Education and China Disabled Persons’
       Federation had issued Comments on the Rehabilitation
       for People with Disabilities on August 24, 2004

   Total Target: Rehabilitation for All by the year of 2015

   Assessment Indexes: Baseline survey



                                                                           41
Rehabilitation for People with Disabilities in China: Approaches and Development


 Rehabilitation Delivery System
  Public Health System
      Primary care:
        • Neonatal care: Early diagnosis and treatment, referral services
      Secondary care: Rehabilitation treatment and surgery
      Tertiary care: Rehabilitation Departments
  National Rehabilitation Networks
      National, Provincial, cities
      PT, OT, ST and others
  Rehabilitation services by non-governmental
  organizations (NGOs)
  Community Based Rehabilitation (CBR)
                                                                            42
 Rehabilitation for People with Disabilities in China: Approaches and Development



Institution and hospital-based services for
people with disabilities


   Early screening and diagnosis

   PT, OT, ST and other rehabilitation services

   Psychosocial support



                                                                             43
Rehabilitation for People with Disabilities in China: Approaches and Development



Community-based rehabilitation (CBR)
     Concept
         CBR has been defined as a strategy in communities for the
         rehabilitation, equalization of opportunities, and social integration
         of people with disabilities (ILO, UNESCO, and WHO, 1994;
         UNICEF, and the Ministry of Education and Science, Spain, 1994).
         Home-based and model center-based approaches.
     CBR for Disabled Children and their families
         to encourage children with disabilities to attend public schools
         with the goal for them not be limited by different social
         expectations, negative attitudes and environmental constraints.
         to mobilize local resources to enable people with disabilities and
         their communities to create their own solutions to eliminate
         barriers and create programs for rehabilitation.


                                                                              44
Rehabilitation for People with Disabilities in China: Approaches and Development


         Prevention to Disability
National Action Plan

    In 2002, Ministry of Health and CDPF issued a National
    Action Plan for Improvement of Quality of Health for the
    Population and Reduction of Birth Defects and Disability
    (2002-2010).
    Reduce 0.8-1 million congenital birth abnormalities per
    year.
    40% coverage of reproductive health services for all women.

Established a System of Rehabilitation Services
Publicity and advocacy of knowledge and methods
    for disability prevention.
                                                                           45
   Rehabilitation for People with Disabilities in China: Approaches and Development


            National Work Programmes

National Work Programmes on Rehabilitation for all
People with Disabilities


Key National Rehabilitation Projects (2001-2005)

Main and update advances in rehabilitation for
children and youth with disabilities (1988-2002)


                                                                              46
 Rehabilitation for People with Disabilities in China: Approaches and Development


National Work Programmes on Rehabilitation
for People with Disabilities
 National Work Programme for children rehabilitation
    The rehabilitation programmes had been integrated into National
    Disability-related Development Programmes
 National Work Programme 1991-1995—rehabilitation
    Hearing and speech training for deaf children, surgery and rehabilitation
    for children and youth with polio and cataract
 National Work Programme 1996-2000—rehabilitation for low
 vision, mental retardation, physical disability, development of
 assistive devices, and prevention to disability.
 National Work Programme 2001-2005-rehabilitation
    establishment of rehabilitation system for children, national days for eye
    care, ear/hearing care and prevention to shortage of Iodine, etc.


                                                                             47
Rehabilitation for People with Disabilities in China: Approaches and Development

Key National Rehabilitation Projects
(2001-2005)
  Key Rehabilitation Projects
       Functional training and assistive devices for children
       with low vision 0.1 million
       Hearing and speech training for deaf children 0.8
       million
       Rehabilitation for CP 0.2 million
       Rehabilitation for MR 0.8 million
Other projects:
       Orientation walking/mobility training for the blind
       Rehabilitation for children with autism
       Assistive devices and services
       Community Based Rehabilitation (CBR)

                                                                           48
            Current state of rehabilitation
                       in China
• 60 million disabled people, only 8 million received
  rehabilitation services
• Rehabilitation goal: By 2015, every disabled person will
  receive rehabilitation services
• Rehabilitation institutions: 24 at provincial level, 608 at city
  level, 3044 at community level
• Professionals: 18,000 rehabilitation doctors, 300,000 PT, OT &
  ST.
• It is vital for the development of rehabilitation to train
  professionals at different levels

                                                              49
   Rehabilitation Medicine and Related
                Education
• Research oriented medical
  school

• Diploma, B.S., M.S., Ph.D.
  education

• On-job training of
  rehabilitation medicine
  education nationwide

• Accreditation of
  professionals

                                         50
     Rehabilitation and Disability Research
• International Cooperation
   – WHO-ICF
   – ILO-Vocational Rehab.
   – Rehabilitation Counseling with ECU
   – Cooperative Project with others

• National Project
   – Development of database of rehabilitation
   – National System of Assessment and evaluation of Disability
   – National System of Disability and Health for persons with disabilities
   – National System of Survey and Monitoring of Disability
   – Clinical Rehabilitation for Stroke patients
   – Clinical Rehabilitation for Spinal Cord Injury



                                                                              51
Rehabilitation for People with Disabilities in China: Approaches and Development


The Challenges of Rehabilitation for
People with Disabilities in China
Basic rehabilitation needs
Social and economic development, rehabilitation and
education
   Economic development
   Categories of disability
   Urban and rural development
   Shortage of facilities and resources
   Low capacity of services
Poverty rate among people with disabilities
High-tech rehabilitation
Human resource development in rehabilitation
                                                                           52
   Rehabilitation for People with Disabilities in China: Approaches and Development

The Strategies of Rehabilitation for People with Disabilities in China
  To develop and mobilize social recourses nationwide.

  To enhance rehabilitation practices for people in rural areas.

  To develop rehabilitation interventions and therapies for people with different
  types of disabilities in different levels.

  Early detection, early intervention, early rehabilitation, early education and
  continuing training.

  To enhance the enrollment rate for children and youth with disability in
  education to improve their physical and intellectual functions, social and
  vocational skills.

  To provide special support for people with disabilities and their families who
  live in poverty.

  National Work Programme for next 5-years, coordination, management and
  implementation.                                                                  53
THANK YOU




            54
Rehabilitation Counseling in
   Japan




                               55
• In Japan, the "Vocational Counselors" for individuals
  with disabilities provide vocational rehabilitation
  counseling services.

• The official professional title of this
  “professional”/“discipline” is "Vocational Counselors
  for the Disabled".




                                                          56
• Those who pass the national exam by the
  Ministry of Health, Welfare, and Labor will be
  the candidates to become "Vocational
  Counselors for the Disabled" after receiving
  one year OJT at National Institute of
  Vocational Rehabilitation, NIVR, in Japan.




                                                   57
• To support this type of rehabilitation services:

• ”Law for Employment Promotion, etc. of the
  Disabled”




                                                 58
• In addition to utilizing the International
  Classification of Functioning, Disability, and
  Health (ICF), Japan has its own classification
  system for the physical, intellectual, and
  psychiatric disabilities.




                                                   59
• Type of services rehabilitation counselors provide in
  Japan

  Case Management, Vocational Counseling and
  Guidance, Planning IPE, Coordinating VR Services,
  Job Development with Job Coaches, Job Placement,
  Providing Employer Assistance, Evaluation and
  Follow-up Services, etc.



                                                          60
• One of the challenges in Japan is how we can
  systematize the full collaboration among vocational
  rehabilitation, special education, and social work, to
  work for the benefits of persons with
  disabilities. Many individuals with disabilities have
  fallen into other types of service systems of
  education, welfare, and employment, and did not
  receive the adequate services they really need and
  deserve.



                                                           61
• Little research has been conducted in the
  employment outcomes of rehabilitation
  services in Japan. Not everyone who has a
  disability gain full time competitive
  employment. Many individuals with
  disabilities work at sheltered workshops and
  community workshops.



                                                 62
• Family involvement, community participation,
  and professional qualification are important
  variables contribute to the rehabilitation
  success in Japan.




                                             63
64
  Vocational Rehabilitation
Association / United Kingdom

                 Gail Kovacs
                 Vice Chair

        Working Together to Get
           People Working
                                  65
 Vocational Rehabilitation Counselling
• Vocational Rehabilitation Association (VRA)


• Case Management Society of the UK (CMSUK)


• British Assoc. of Supported Employment
  (BASE)


• British Association for Brain Injury CM
  (BABICM)
                                                66
• Others
         The Host Report
• A consultation survey and report of UK
  Employment & Disability Practitioners
  2001

• David Parsons – HOST Policy Research

• Department for Work & Pensions, VRA,
  ENTO

• An occupational and functional review
                                           67
         Host Core Occupations
• Medical and healthcare – at or after medical / emotional
  stabilisation


• Work profiling and preparation – assessment and skill
  development


• Placement and brokerage – interface between preparing for and
  securing work


• Workplace access – effective access to work


• Workplace integration and retention – consultancy, specialist
  advice and technical support                                    68
      Professional Disciplines?

                        • Psychologists (clinical
• Occupational Health
                          and occupational)
  Physicians / Nurses
                        • Cognitive Behaviour
• Other Nurses
                          Therapists
• VR Counsellors
                        • Ergonomists
• Occupational
                        • Social Workers
  Therapists
                        • Employee Assistance
• Physical Therapists
                          Counsellors
• Psychiatrists
                        • Unregulated Health
                          Practitioners

                                                    69
          Professional Title?

• Occupational Health   •   Job Brokers
  Advisors              •   Placement Specialists
• Medical Case          •   VR Specialists
  Managers              •   Vocational Trainer
• Vocational CMs        •   Job Coach
• VR Consultants        •   Vocational Assessor
• VR Counsellors        •   Job Profiler
• VR Planners
                        •   Workplace Analyst
• Advocate

                                                    70
The Occupational Constituency –
       Core Occupations
•   Medical and Healthcare        - 300 to 400
•   Work preparation              - 3,450
•   Placement /brokerage          - 1,800
•   Workplace access              - 150 to 250
•   Workplace integration & retention - 3,750

• Total =                         9,600
                                                 71
The Occupational Constituency –
     Non-Core Occupations
•   Medical and Healthcare        - 58,000
•   Work preparation              - 122,900
•   Placement /brokerage          - 24,200
•   Workplace access              - 29,000
•   Workplace integration & retention -
    465,000

• Total =                         699,100
                                              72
    Training Requirements?

• Medical and Healthcare - As Regulated
  Health Practitioners
• Work preparation        - Nil
• Placement /brokerage    - Nil
• Workplace access        - Nil
• Workplace integration & retention - Nil



                                            73
      Academic Credential?

• Medical and Healthcare - As Regulated
  Health Practitioners
• Work preparation        - Nil
• Placement /brokerage    - Nil
• Workplace access        - Nil
• Workplace integration & retention - Nil



                                            74
      Qualification breakdown

•   Occupational health certificate / dip   = 22%
•   Social Work                             = 5%
•   VR diploma / certificate                = 7%
•   Disability Management dip / degree      = 4%
•   Occupational Psychology                 = 4%
•   Clinical and other Psychology           = 6%
•   Miscellaneous vocational training       = 8%
•   Occupational Therapy                    = 6%
•   Other                                   = 15%
•   and no qualifications                   = 27%
                                                    75
    Host Recommendations
• To develop competence based, practice-
  led and professionally oriented
  qualifications for VR.

• To develop an infrastructure to support
  world class training in the UK. This
  includes certificate, diploma and masters
  levels.

• To identify, develop and accredit
  assessors and trainers.
                                              76
    Host Recommendations
• To review:

- Additional public funding
- The contribution of evidence-based
  practice
- The development of Centres of
  Excellence
- The role of demonstrator projects
- A potential evaluation strategy.
                                       77
                Legislation
• Health and Safety at Work Act
  1974 (HSWA)

• Disability Discrimination Act
  (1995)

• Data Protection Act 1998

• Management of Health and
  Safety at Work Regulations
  (1999)

• Employment Act 2002             78
  Case Manager or Counsellor

• Both fall under the broader VR Scope
  of Practice much of which was
  adopted from the Commission for
  Rehabilitation Counsellor
  Certification (CRCC)

• Professional Scope vs Individual
  Scope                                  79
             Scope of Practice
The process is interdisciplinary by nature,
  and may involve functional, bio
  psychosocial, behavioural and / or
  vocational interventions. The techniques
  utilised within the process may include
  but are not limited to:
• Assessment and appraisal

• Goal setting and intervention planning
                                           80
            Scope of Practice
• Provision of health advice and promotion,
  in support of returning to work

• Support for self management of health
  conditions

• Career (vocational) counselling


                                          81
              Scope of Practice
• Individual and group counselling focused
  on facilitating adjustments to the medical
  and psychosocial impact of disability

• Case management, referral and service
  coordination

• Programme evaluation and research
                                          82
            Scope of Practice
• Interventions to remove environmental,
  employment, and attitudinal obstacles

• Consultation services among multiple
  parties and regulatory systems




                                           83
            Scope of Practice
• Job analysis, job development, and
  placement services, including assistance
  with employment and job
  accommodations; and

• The provision of consultation about and
  access to rehabilitation technology.

                                            84
      Recent Achievements
• The definition

• The Scope of Practice

• The Standards of
  Practice

• The FAQ                   85
  The Challenges for the Profession
• Putting teeth into the Standards
• Working together as Associations to advance
  the field
• Working with Regulated Health Practitioners’
  Associations and Colleges (UK Rehab Council)
• Developing professional education and training
  that meets the need and is fit for purpose

                                                 86
The Challenges for the Profession
• Elevating the skills of existing practitioners
• Encouraging funders and referral sources to
  select providers who adhere to Standards /
  codes
• Introducing UK Certification / accreditation
• Overcoming negative terminology
• Maintaining momentum
• Financing our efforts                            87
         Statutory Benefits
• Statutory Sick Pay
• Incapacity Benefit
• Income Support (disability premium)
• Industrial Injuries Disablement Benefit
• War Disablement Pension
• Disability Living Allowance
• Working Tax Credit
• Severe Disablement Allowance
                                            88
The Challenges for Service Provision
• Educating the Stakeholders
• Restoring a solid reputation
• Building trust in what we do
• Demonstrating the business case
• Getting acceptance for non-UK
 based research and best practices
                                       89
The Challenges for Service Provision
• Gaining acceptance of standardised
 assessments
• Gaining acceptance of customised
 services – time and cost factors




                                       90
     Best Outcomes / Practices
• Job retention (prevention and safety)
• Condition management programmes
• Work entry and sustainability
• Workplace wellbeing / health
 promotion


                                          91
      Variables playing a role
• A culture of inactivity
• Non-mandatory services
• Doing “to” and “for” clients instead
 of “with”
• The lack of job matching
• “Projects” instead of “programmes”
                                         92
     Similarities with the U.S.
• History and evolution of VR
• Case Management model
• Various functions
• Various work environments
• ?????

                                  93
     Differences from the U.S.
• Case Manager and VR Counsellor not
 as distinct
• Lack of professional status
• Lack of certification / accreditation
• Lack of training and education
• Lack of objective assessment first
                                          94
      Differences from the U.S.
• Lack of acceptance as part of a multi-
 disciplinary team
• A long way to go to being a
 sustained profession




                                           95
                    Thank You

   gail.kovacs@btinternet.com

www.vocationalrehabilitationassociation.org.uk
                                                 96
Vocational Rehabilitation
  Counseling in Taiwan

      Presenters:
Ming-Hung Wang, Ph.D., CRC
 Ming-Yi Wu, Ph.D., OTR/L


                             97
                     Topics
•   Population Served by the System
•   Laws
•   Services and Resources
•   Profession and Practices
•   Challenges




                                      98
Population Served by the System




                                  99
      Population of Individuals with
               Disabilities
• 2007
   All population in Taiwan: 23 millions
   Individuals with disabilities: 4.37% of all
    population; about one million
   Working ages (15~65 y/o) disability population:
    0.6 millions (60%)
   PWD Employment rate: 27%




                                                      100
       Classification of Disability
• The present classification of disability is based on
  disability types.

• However, the newly promulgated Protection Act for
  Rights and Interests of Physically and Mentally
  Disabled Citizens suggests a classification based on
  the ICF framework in order to focus on the service
  needed.




                                                         101
Laws




       102
      Laws - National Legislation
• To protect the legal rights, interests, and livelihood of
  people with disability, secure their opportunity to
  participate in the social life fairly, consolidate the
  governmental and private resources, plan and
  implement all measures of assistance and welfare,
  the Physically and Mentally Disabled Citizens
  Protection Act was amended in 1997.




                                                         103
      Laws - National Legislation
• On July 11, 2007, the PMDCPA had been amended to
  the Protection Act for Rights and Interests of
  Physically and Mentally Disabled Citizens to further
  manifest the spirits of protecting their rights instead
  of protecting the persons.




                                                       104
         Laws - National Legislation
•    The Protection Act for Rights and Interests of Physically and
     Mentally Disabled Citizens consists of the following chapters:
    1.   General Principles
    2.   Rights and Interests of Medical Treatment and Rehabilitation
    3.   Rights and Interests of Education
    4.   Rights and Interests of Employment
    5.   Rights and Interests of Supported Services
    6.   Rights and Interests of Economic Security
    7.   Rights and Interests of Protective Services
    8.   Penal Provisions
    9.   Supplementary Provisions




                                                                        105
                   Quota System
• According to The Protection Act for Rights and
  Interests of Physically and Mentally Disabled Citizens
      Public organizations with employees more than 34 must
       hire 3% of workers who have disabilities.
      Private companies with employees more than 67 must hire
       1% of workers who have disabilities.




                                                            106
                         Laws - Regulation
• Under the guidance of the Protection Act, regulations had
  been draw up to provide VR services for people with disabilities,
  such as:
      Regulations of Professionals Recruitment and Training of the
       Employment Institution for Individuals with Disabilities
      Regulations of Professionals Recruitment and Training of the Vocational
       Training Institution for Individuals with Disabilities
      Regulations of Employment Evaluation of Individuals with disabilities
      Regulations of Allowance for the Assistance Equipment for the
       Employment of Individuals with Disabilities
      Regulations of Management and Utilization of the Employment Fund for
       Individuals with Visual Impairments
      Standards for the Establishment of Employment Service Institutions for
       Individuals with Disabilities



                                                                          107
                        Laws - Regulation
   Standards for the Establishment of Employment Service Institutions for
    Individuals with Disabilities
   Rules of the Infrastructure of the Vocational Training Institutions and
    Allowances for Individuals with Disabilities
   Regulations of Allowance for the Vocational Training for Individuals with
    Disabilities
   Regulations of Establishment of Shelter Factories and Rewards for
    Individuals with Disabilities
   Standards for the Arrangement of Infrastructure and Personnel of the
    Shelter Factory for Individuals with Disabilities
   Regulations for Subsidizing and Awarding Employers for Hiring Unemployed
    Workers
   Regulations of Loan Allowance for Business Creation of the Handicapped



                                                                        108
Services and Resources




                         109
      Official Professional Title
• Based on the task performed, the professional
  titles can be:
  − Supervisor
  − Case Administrator/Manager (new)
  − Vocational Evaluator
  − Employment Service Staff
  − Vocational Training Counselor



                                              110
            Roles and Functions

• Roles:                     • Functions:
   –   Case Manager            – IWRP development
   –   Evaluator               – Vocational-related
   –   Job Developer             Assessment
   –   Counselor               – Direct Employment
   –   VR Team Coordinator       Services
                               – Counseling


                                   (CHING-CHIANG CHEN )
                                                      111
        Services and Resources
• Vocational Rehabilitation Services
  – Job placement
  – Job training
  – Supported employment
  – Sheltered workshop
  – Vocational evaluation
  – Assistive technology and job accommodation



                                                 112
          Resources - Employment
• Five national employment services centers
   – Job placement and administration supervision
• Local counties and city employment services centers
   – Job placement and administration supervision
• None profit organizations
   –   Training
   –   Job Placement
   –   Supported Employment
   –   Sheltered Workshop


                                                    113
   Resources - Vocational Evaluation
• Local vocational evaluation centers
   – Every county and city
   – Direct vocational evaluation
• Three vocational evaluation resources centers
   –   Research
   –   Development of instruments
   –   Supports for vocational evaluators
   –   Training courses




                                                  114
Individuals with Disabilities Served by
        Employment Services


• In 2006
  – Employment Centers: 33,000
  – Sheltered Workshop: 2,000
  – Supported Employment: 1,400
  – Vocational Training: 40,000
  – Vocational Evaluation: 1,600


                                      115
Profession and Practice




Graduate Institute of RC, NKNU
                                 116
           Professional Disciplines
• Before 2002
• Not a specific academic discipline is intended to train
  professionals for vocational rehabilitation counseling services.
• Employment service staffs and Vocational training counselor
  came from:
   – Untrained volunteers
   – Individuals with high school diplomas
   – College graduates from areas such as Social work, occupational
     therapy, psychology, special education, human resource, labor
     relations, etc.




                                                                      117
            Training Credential
• Some training hours in advance or work experiences
  are required for those college graduates from other
  disciplines to work as vocational evaluators and case
  managers.




                                                      118
    Professional Disciplines and
       Academic Credential
• After 2003
• the Department of Higher Education, Ministry of
  Education had funded three universities to establish
  master level graduate programs on rehabilitation
  counseling.
   − National Changhua University of Education (2003)
   − National Kaohsiung Normal University (2004)
   − National Taiwan Normal University (2004)
• Graduates from these three programs will obtain a
  degree of master of science in RC.

                                                        119
         Professional Association
• In 2004, Taiwan Vocational Rehabilitation Association
  has been established by university professors and
  practitioners. The major missions are:
   – Publish the Taiwanese Journal of Rehabilitation Counseling
     (research articles)
   – Improve vocational rehabilitation services
   – Get funding and support for vocational rehabilitation
     counseling study from the government
   – Advocate for VR counseling Profession




                                                             120
         Best Outcomes/Practice
•    Thought there is little evidence-based research to support
     for best practice of rehabilitation counseling in Taiwan, we
     have taken some efforts to make sure the people with
     disabilities will receive quality services.

    1.    There are regulations to define the qualifications for setting up
          institutes that provide VR services.
    2.    There are regulations to define the qualifications of professionals
          who can perform VR services.
    3.    There are plenty of on-the-job training opportunities for the VR
          professionals to better themselves.
    4.    There are annually or biannually program evaluations to oversee the
          quality and quantity of the VR services.


                                                                          121
    Variables Affecting the VR Process
• Major variables could be:

   – Limited employment services resources in rural areas
   – Employers’ negative attitudes toward individuals with
     disabilities, particularly mental Illness
   – Lack in development of good work personality for
     individuals with disabilities
   – Family/societal values: protection vs. independent
   – Less trained employment service practitioners




                                                             122
                  Challenges
Same discipline of                Different disciplines of
professionals working in          professionals working for
                            vs.
different settings                different job functions

Master’s degree graduates         College graduates with
from rehabilitation               short-term training
                            vs.
counseling programs               courses

Job placement services            Job placement services
need “qualified”                  do not need qualified
                            vs.
professionals                     professionals

                                                           123
       Welcome to Taiwan




The First Asian-Pacific Vocational Rehabilitation Conference
          in Kaohsiung, Taiwan, November 2005.                 124
•




    125

								
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