“Good jobs in United States are not easy to come by” (Wehman, 146, 2011). United States has been going through a financial crisis for a period of 70 year, with unemployment rates standing at 9% and underemployment approximated to be over 18%. Vocational rehabilitation, under the State-Federal program, means `any good or service` necessary to render any disabled individual employable (Stolov & Clowers, 1981). This makes vocational rehabilitation not to be limited to specific counseling with regard to job selection or job placement. Therefore, vocational rehabilitation includes the full range of medical and allied health services which, when delivered, are expected to remove a sufficient number of disability problems to allow for employment to result. Many problems face the intellectually disabled because most of the times they are excluded from certain disciplines.
French historian once argued that to examine the integration of persons with intellectual disability into the society is a method more critical, even more militant, than to address it in terms of exclusion (Calson, 2001). In a theoretical context, the traces of intellectual disability in psychological literature raise critical questions. Why and how do psychologists integrate the intellectual disabled into their work?
The concept of intellectually disabled people is one that has taken a positive change over the years. Gone are the days when the intellectually disabled used to be regarded as a taboo in the society. The disabled person has needs and demands that have to be satisfied by the community he lives in just like any other person. According to Emerson, Hatton, Thompson & Parmenter (2004), necessary knowledge should be generated to the societies in order for them to address the disadvantages faced by individuals with intellectual disabilities. Enough research lacks concerning the plight of the intellectually disabled in the society. Available research addresses issues that are tangential or irrelevant to the social situation of the individuals with intellectual disabilities and most people in the society choose not to implement the little knowledge that has been generated (Emerson, Hatton, Thompson & Parmenter, 2004). All the potential failings should be addressed.
The needs of the intellectually disabled people can be met on realizing that their exceptionality has to be catered for by the society and by addressing itself to the intellectually disabled individual differences in their areas of exception. This research paper will touch upon the issues of intellectually disabled in the main historical developments from 1950 to 1990. French historian once argued that to examine the integration of persons with intellectual disability into the society is a method more critical, even more militant, than to address it in terms of exclusion (Calson, 2001). In a theoretical context, the traces of intellectual disability in psychological literature raise critical questions. Why and how do psychologists integrate the intellectual disabled into their work?
Nevertheless, researchers and educators widely accept that intellectually disabled individuals must go through vocational rehabilitation in order for them to be employable. In Bandura`s social learning theory, learning is given the status of an intervening variable, a variable that stands between some stimulus in the environment and some response or performance on the part of an individual. Learning is not observed directly but is rather inferred from observation of a reflection of the amount learned.
After almost three decades of increased emphasis on the employability of the intellectually disabled persons, these people continue to suffer from disproportionately high level of unemployment and underemployment (Langone & Gill, 1986). A relationship between the specialists and employers may serve to improve the effectiveness of vocational programs options, ultimately improving the employability of the intellectually disabled. According to the research conducted by Burge, Kuntz & Lysaght (2006), on the views of people on the employment of intellectually disabled persons, 87 % of the respondent belief that hiring of intellectually disabled persons would not affect the workplaces negatively. The research established that the major obstacle to increased inclusion is lack of training programs for the intellectually disabled prior to job placement (Kuntz & Lysaght, 2006).
Positive development was seen in 1964 when the (IASSID) was formally constituted (Emerson, Hatton, Thompson & Parmenter, 2004). Prior to the period between 1950 and 1990, the issues of intellectual disability were not taken seriously compared with the issues concerning other disabilities. The disabled persons have been excluded from public jobs rather than provide them with programs that might improve their standard of living and competence.
There have been a number of significant changes over the years regarding the definition of intellectual disability. Previously, advanced definitions negatively described those with subnormal intelligence and therefore adversely affected the concerned individuals. These included terminologies like imbecile, idiot and moron. They used to be concise and clear-cut with little room for debate. It was then almost firmly believed that a person with subnormal intelligence could not function meaningfully in the society. The term `mental retardation` was seen as a derogatory term and was replaced by `intellectual disability` in many parts of the world (Parmenter, 2011).
Self-advocacy groups are the ones which have played a key role in changing the language used when referring to the intellectually disabled persons and their condition too. They argue that some terms are used to demean the intellectually disabled persons because of the implicit negative connotations (Parmenter, 2011). They even dismiss the term `disability` implying that the term is less than normal. Despite the growth in research, the gap between the research recommendations and practices continues to widen (Emerson, Hatton, Thompson & Parmenter, 2004). In the period between 1950 and 1990 there was a significant development in research in the matters concerning intellectual disability. There was growing demand for applied research to meets the needs of the intellectually disabled persons (Emerson, Hatton, Thompson & Parmenter, 2004). In addition, “in today`s society, the corrosive power of stigma no longer holds the sway it once did for individuals with intellectual disability” (Harris, 2010).
Self-advocacy groups further suggest that intellectual disability should not be regarded as a disability, but rather “as a syndrome of the same group as dementia” (Savador-Carulla & Bertelli, 2008). A considerable progress has been made in recognizing and treating intellectual disabilities and the medical and mental health problems that may accompany them (Harris, 2010). Advancement of diagnosis facilities has made it possible to diagnose the problem early enough such that the treatment is started before becoming serious.
Try Another Approach
According to Godley (1980), Marc Gold`s Try Another Way Approach is not a replacement of other methods of training, but rather an additional method. The procedures presented in this approach are treated as technology of training, where tasks are broken down into teaching units thus developing a step-by-step approach of learning the whole process. In resenting his approach, Marc Gold separates acquisition and performance (Godley, 1980). The approach concentrates primarily on evaluation of intellectually disabled persons. Marc Gold ignored the problem of intellectual disability and looked for a different definition from the one that had been adopted by authors. He defined the condition by what the society should do about it.
In 1972, Marc Gold debunked the myth that adults with severe or profound mental disability could not learn complex tasks by demonstrating that disabled adults could learn to assemble bicycle brakes when provided with systematic instructions and task-oriented adaptations (Conrad & Serlin, 2006). Acquisition and performance of vocational tasks by the intellectually disabled persons has been on the increase in the past three decades (O`Neill & Bellamy, ). Intellectual disability implies no restriction to the person`s potential to learn to perform a certain task conclusively. There has been many reported cases where the intellectually disabled have acquired vocational skills. However, little effort has been made to establish whether those skills have been acquired through teaching procedures. From 1990, researchers on intellectual disability have developed and tested a number of theories and developed new approaches to curriculum development such as the top-down curriculum that enabled children and adults to become more active participants in their community (Conrad & Serlin, 2006).
Social Learning theory
The social learning theory received widest acceptance because it completely interpreted social learning. Experienced responses and observation of the effects of other people`s behavior makes learning take place (Chowdhury, 2006). In explaining the theory of Social Learning, Bandura incorporated four processes Motivational, motor reproduction, attention, and retention. The social learning theory is attributed to A. Bandura. The social learning theory emphasizes on the importance of positive environment in the molding of behavior.
According to Berk (2010), many theorists “acknowledge that development has both universal features and features unique to each individual and his or her contexts.” Theories contribute enormously to enrich people`s understanding of intellectual disability. These theories resemble the tools of the builder, where sometimes the screwdriver is the most appropriate tool, or the saw, and at other times the hammer. An understanding of social learning theories is essential in everyday life.
For the social learning theorists, performance is the result of constant interaction between the individual and surrounding variables with the environmental conditions shaping behavior through the process of learning an individual`s performance in turn, shapes the surroundings. Therefore, individuals and situations influence each other equally. In order to forecast behavior, there is need to determine how the characters of a person interact with the characteristics of the circumstances. Social learning is sometimes called modeling because individuals model their behavior after that of others.
According to social learning theory, individual differences in behavior result mainly from variation in the kind of learning experiences encountered in life. Some behavior patterns are acquired through direct experience – the individual becomes rewarded or punished for doing a certain thing. However, there are other responses that an individual acquires without direct reinforcement. According to Bandura, reinforcement is not necessary for learning to take place. However, it can facilitate learning by focusing the learner`s attention in the appropriate direction.
Social learning theories concede that an individual`s reaction in a given circumstance depends on particular characteristics of the circumstance, and the reinforcement received in the past for similar behavior in similar situations. Due to the fact that not all social behaviors are rewarded, people learn to discriminate between those contexts in which certain behavior is appropriate and those in which it is not. As a result of consistent rewards for the same response in many different situations, generalization takes place whereby the same behavior occurs in a variety of settings.
The social learning theory also recognizes differences in cognitive development and social learning experiences as a factors that interacts with situational conditions to influence behavior. Social learning theory has contributed to the understanding that human actions are reactions to specific environments and has, thus, led researchers to focus on how environment controls an individual`s behavior and can be changed to modify behavior. At the same time, this theory is criticized for its view that personality is not stable over situations.
However, “there is a disagreement among researchers and educators as to the role of psychological theories and their applications” (Blake & Pope, 2008) such as Bandura`s theory. In most of the theories, learning is given the status of an intervening variable, a variable that stands between some stimulus in the environment and some response or performance on the part of an individual. Learning is not observed directly but is rather inferred from observation of a reflection of the amount learned.
Vocational rehabilitation, under the State-Federal program, means `any good or service` necessary to render any disabled individual employable (Stolov & Clowers, 1981). This makes vocational rehabilitation not to be limited to specific counseling with regard to job selection or job placement. Therefore, vocational rehabilitation includes the full range of medical and allied health services which, when delivered, are expected to remove a sufficient number of disability problems to allow for employment to result.
According to Nehama, Dakar, Stawski, Szor (2006), the population of the people with intellectual disability is on the increase. Due to their special characteristics such as linguistic limitations and the need for a familiar and steady environment, the intellectually disabled persons require special therapeutic consideration. Around the globe the treatment of the intellectually disabled is not tailored to their needs because in most cases they receive the treatment from general psychiatric outpatient clinics and hospitals. This situation is very common in many countries including the United States. The prevalence of mental illness is four or five times higher in the people suffering from intellectual disability as compared to the general population (Nehama, Dakar, Stawski, Szor, 2006).
Stolov & Clowers (1981) point out that “the Rehabilitation Act of 1973 which emphasized on the severely disabled, found many vocational rehabilitation agencies ill prepared.” Most of the counseling staff in the rehabilitation centers has little knowledge and the skills such that they are not able to deal with the vocational rehabilitation of the intellectually disabled. Training courses are lacking in many countries around the world.
According to Langone & Gill (1986), professionals who specialize in rehabilitation of the intellectually disabled persons continue to raise their concerns due to the high unemployment rates among the intellectually disabled persons. Therefore, in order to assist the intellectually disabled to enter the job market, there has to be more appropriate vocational rehabilitation initiatives which have to be designed cooperatively by the educators and vocational rehabilitation specialists. Many problems face the intellectually disabled because most of the times they are excluded from certain disciplines. However, “if these barriers are pinpointed, rehabilitation professionals can develop strategies and they can also design vocational programs for the intellectually disabled persons” (Langone & Gill, 63, 1986). The greatest barrier to successful vocational rehabilitation is that the present strategies fail to translate the vocational components into workable plans. Some of the strategies include developing sampling procedures that can aide in identifying appropriate vocational program goals, assessing the present levels, and the establishment of criteria that can be used to judge the program success.
The other task confronting the rehabilitation professional team is to arm the target person with skills that are targeted at the job opportunity he is likely to take. On the other hand, the rehabilitation specialists should pool their resources and knowledge to conduct a community needs assessment designed specifically with a given disabled individual`s strengths and weaknesses in mind (Langone & Gill, 1986). The intellectually disabled persons usually lack a solid experiential base, with the deficit being traced to a limited exposure to a variety of life role situations. Therefore, before an individual is enrolled into a job, he must be introduced to various vocational options. In the absence of career education, a planned exploration sequence through vocational rehabilitation programs and community work study placements can help develop their interests.
Supported employment has offered opportunities for intellectually disabled persons who otherwise could not have a chance in the mainstream employment. Integration of intellectually disabled with the general public will serve to increase the contact of both parties. Corporations are cited as the critical source of employment in the United States (Siperstein, Romano, Mohler, & Parker, 2006). For instance Walgreens is leading the other multinationals in hiring people with intellectual disabilities (Wehman, 146, 2011).
Treatment and Management of Intellectual Disability
Doing an accurate diagnosis of intellectual disability is essential for proper treatment to be done. Individuals with intellectual disability are prone to developing side effects or body reacting to drug therapy. Therefore, it is very important to avoid needless pharmacological management and to use minimal doses of drugs. In most cases detection of stress factors and designing appropriate behavioral or personal interventions may be the management of choice most cases of intellectual disability require a mix of pharmacological and behavioral treatments. In view of this difficulty, there is a need for exceptional training in the psychiatry of intellectual disability.
At the beginning of the 20th century there was a popular trend in the Western world to isolate people living with intellectual disability by placing them in the institutions. The second half of 20[th] century saw a fundamental change in the attitude underlying support of intellectually disabled persons taking place (Nehama, Dakar, Stawski, Szor, 2006). The extensive implementation of the principle of normalization in health and social services led to modification of attitudes and to the introduction of community based support groups. Currently people with intellectual disability generally receive a lot of support from the social services, while intellectually disabled persons having mental disorder normally receive treatments from psychiatric centers. Individuals suffering from intellectual disability and mental disorders were found to have dual diagnosis. Nehama, Dakar, Stawski, Szor (2006) point out that, this is a special group that is both very complicated to treat and has comparatively few resources but often falls between the cracks, as many government arms decline to take responsibility for them and refer them to one another.
There is one disadvantage associated with placing the intellectually disabled persons in the vocational rehabilitation center because it encourages dependence and separateness of people with intellectual disability (Nehama, Dakar, Stawski, Szor, 2006). The disease and the patient`s psychology are in dynamic interaction. Changes in the basic disease can affect the patient`s psychology, and changes in the patient`s psychology can influence and alter the extent of the disease, particularly its complications. Therefore, it is important to consider the environment that the intellectually disabled person is being placed. Stolov & Clowers (1981) point out the importance of surrounding environment of the disabled person.
In an individuals environment there are two components which are in dynamic interaction the social sphere (the individual`s home, family unit, social responsibilities, and interpersonal contacts) and the vocational sphere (the place of work, the breadth of responsibilities, and the financial and personal rewards, and also the vocational and recreational pursuits) (Stolov & Clowers, 1981). Alterations in the vocational sphere can modify the patient`s disease and the level of psychological performance. Stolov & Clover (1981) state that, “the removal of disability is achieved through therapeutic attacks on the disease, through enhancement of the patient`s psychology, and through direct modification of vocational environmental factors.”
There is some evidence that intellectually disabled person with IQ scores ranging from 60 to 70 make better progress in vocational rehabilitation center while those at levels ranging from 70 to 80 tend to perform even better (Heller, 1982). One of the significant advantages the intellectually disabled person is in the area of social adaptability. Whereas the intellectually disabled persons tend to be isolated and rejected by peers in the regular setting, they are accepted by their peers in the special setting such as the vocational rehabilitation center. However, this serves to segregate them from the other population to where they are conscious of their low status.
It should be noted that vocational rehabilitation centers can easily be transformed into the dumping ground for the intellectually disabled. A rehabilitation center should be a facility for the management of patients and clients with intellectual disability problems. In many cases, these rehabilitation institutions are associated with general hospitals and clinics. However, they may be `free standing`. On the other hand, most rehabilitation centers are only outpatient facilities making it impossible for them to handle a wide range of problems (Stolov & Clowers, 1981). The medical vocational rehabilitation is where, at first, the medical services are intense and vocational services are minimal, but as time progresses, the intensity of medical services is decreased and the intensity of vocational services is increased. However, the medical services are never decreased to zero because they are usually required to maintain the achieved goals. After job placement or independent living is achieved, the intensity of vocational services decreases.
When coming up with employment adaptations for the mentally retarded in general, there has been a marked tendency to neglect the needs of the severely and profoundly retarded. Most profoundly retarded individuals lack expressive language, cannot care for their personal hygiene and most of the time exhibit undesirable behavior that makes it difficult to adapt to the working environment. The learning adaptations are therefore aimed at dealing with these problems. An individual who is initially trained on the basic skills may need limited assistance and supervision. The initial training may involve being helped to recognize names of common objects among others. They should also be encouraged to respond to commands and directions which are reinforced through gestures. After the initial training, the intellectually disabled person should be able to listen and respond using gestures, words or phrases.
Intellectually disabled persons who have mental illnesses but are determined to increase their job prospects are often stalled in their working environments because of difficulties in their mental skills, such as the awareness of what their job entails, being focused, learning and recalling what they have learned, responding to environmental demands in real time, making plans ahead and finding solutions to problems and challenges. In addition to intellectual disability limiting the ability of an intellectually disabled person to function well in the work environment, cognitive disability is an obstacle that hinders the intellectually disabled persons from receiving maximum benefits of vocational rehabilitation, which may also include among others, supported employment. The efforts to increase the knowledge in the intellectually disabled persons have produced positive results and consistent gains have been realized in many work settings. Many governments are currently focusing on mixing the vocational rehabilitation and cognitive remediation in order to enhance the way intellectually disabled persons function at work.
According to (O`Neill, 1978), preliminary results from four available research studies where vocational programs and cognitive remediation were combined were very encouraging, projecting progress in both cognitive and efficiency at the work environment. The approach used in the four research studies differ greatly. The characteristics of the participating disabled persons, the models of vocational rehabilitation, and other methods of incorporating cognitive and vocational therapies also differ considerably. There is a visible difference in the key components for combining the vocational rehabilitation, and the cognitive remediation indicate the need to conduct more research in order to raise significant questions about the necessity of formulating more programs that cater for the intellectually disabled.
The activists who push for the rights of intellectually disabled persons continue to push for higher levels of integration. The research provided caregivers and policymakers with awareness of potential sources of support and challenges which must be considered in vocational rehabilitation. (Burge, Kuntz & Lysaght, 2006). As efforts of the activists continue, further research on various barriers should be conducted. Therefore, in order to assist the intellectually disabled to enter the job market, there has to be more appropriate vocational rehabilitation initiatives which have to be designed cooperatively by the educators and vocational rehabilitation specialists. The research may also guide the stakeholders towards addressing many real challenges to realize inclusive employment for intellectually disabled persons.
The intellectually disabled persons have underlying mental pathological problems. Therefore, in order for the employers to change the surface behavior that may manifest itself, the individual should be helped to overcome underlying mental conflicts believed to have been acquired during the development of the individual. The emphasis is on building an individual-employer relationship in which the intellectually disabled person feels accepted and not threatened due to his/her condition.
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Vocational Rehabilitation of the Intellectually Disabled