Putting participation into practice: An ethnographic study of sheltered workshops in the Netherlands and Portugal.

Full participation is recognized as fundamental for the inclusion and wellbeing of people with intellectual disabilities. Only few studies have identified subjective meanings of participation from the perspective of people with intellectual disabilities themselves. Three cross-cutting themes that arise in the few studies that have are choice, social interaction and making a contribution. This ethnographic study of sheltered workshops in the Netherlands and Portugal takes this body of work a step further by investigating to what extent the ideal of participation is put into practice in such a way that it indeed contributes to these three elements. By including contrasting cases, it scrutinizes different ways of institutionalizing participation and the consequences this bears for the lived experiences of people with mild intellectual disabilities. The results show that there is a tension between choice on the one hand, and social interaction and making a contribution on the other.

[Health Care Use by Intellectually Disabled People: A Cross-Sectional Study in three Sheltered Workshops]. / Inanspruchnahme der gesundheitlichen Versorgung von Menschen mit geistiger Behinderung, eine Querschnittstudie in 3 Werkstätten.

STUDY OBJECTIVE: People with intellectual disabilities have a lower life expectancy and more frequent comorbidities than the general population and have unmet health needs. Insufficient medical care is suspected to be one reason, for which little data is available in Germany. The study therefore focuses on the question of how people with intellectual disabilities make use of medical care, including screening and preventive measures. METHOD: In a cross-sectional study in 3 workshops for people with intellectual disabilities, the use of health care was surveyed by means of questionnaires from their relatives. The evaluation was carried out descriptively and by means of inferential statistics comparing participants with the general population as well as within the group of participants for socio-demographic differences. RESULTS: Almost all 181 participants (participation rate 19.3%) had a family doctor. In comparison to the general population, the participants made more frequent use of the services of general practitioners and the care provided by numerous other specialist areas. They made less frequent use of screening for colon, breast, cervix and prostate and more frequent use for skin cancer and general check-up. Dental check-ups and preventive measures showed no difference. Participants living in institutional settings made more use of the regular services than those living with relatives or alone. Participants with a migration background were less aware of care services. CONCLUSIONS: The results do not show any indications of a general undersupply of health care. Participation in cancer screening with more complex examinations should be encouraged, especially for people with mental disabilities living alone or with relatives. Those with a migration background and their families should be specifically informed.

Metal exposure of workers during recycling of electronic waste: a cross-sectional study in sheltered workshops in Germany.

OBJECTIVES: In Germany, the initial step of electronic waste (e-waste) recycling frequently takes place in sheltered workshops for physically and mentally handicapped workers (Werkstätten für behinderte Menschen (WfbM), in german language). E-waste recycling involves a potential risk of exposure to toxic metals. Therefore, we assessed the occupational exposure of recycling workers to toxic metals to identify potential health risks and insufficient protective measures. METHODS: We used a combined air- and bio-monitoring approach to determine exposure of recycling workers to toxic metals. Air and urine samples were collected in five sheltered workshops in Germany and were analysed for their content of aluminium, antimony, arsenic, beryllium, cadmium, chromium, cobalt, mercury and nickel. Results were compared to German and international occupational limit values and to metal exposures of workers in conventional e-waste recycling firms. RESULTS: Exposure of recycling workers in five German sheltered workshops to the studied metals and their compounds was below German and international occupational limit values across all facilities studied considering both air and urine samples. Workers in the present study were not exposed to higher amounts of toxic metals than workers in conventional e-waste recycling firms. CONCLUSION: This is the first study on toxic metal exposure of recycling workers in sheltered workshops. The results of this study revealed a low occupational exposure of e-waste recycling workers to toxic metals in this type of enterprises. Current work methods and safety measures provide the workers with adequate protection.

Development and validation of an instrument to assess work support needs of adults with intellectual disabilities in sheltered employment.

BACKGROUND: The Work Support Profile (WSP) is a brief assessment instrument that enables staff supporting adults with disabilities to provide calibrated and individualized support for specific work tasks. This paper sought to examine the psychometric properties of WSP for people with disabilities. METHOD: A pilot study was conducted with 239 sheltered workshop employees diagnosed mainly with intellectual disability to explore the structure of this assessment tool, and provide initial evidence of its psychometric properties. Subsequently, a larger-scale study captured a nationwide profile of 761 sheltered workshop employees with intellectual disability. RESULTS: Across both studies, factor analyses yielded a conceptually acceptable 5-factor structure with 33 items accounting for approximately 65% of the variance. Furthermore, the reliability, convergent and discriminant validity of WSP can be considered adequate. CONCLUSION: Results provide preliminary evidence that WSP is a psychometrically adequate tool for assessing the work support needs of adults with disabilities on given work tasks.

The compatibility of employment-based contingency management and vocational services at the Department of Veterans Affairs.

The Department of Veterans Affairs (VA) provides vocational rehabilitation services for veterans with substance use disorders in programs such as Compensated Work Therapy (CWT). For some veterans, these services include regular monitoring and wages for work in prevocational settings. Independently of these services, the availability of a highly effective intervention for substance use disorders called contingency management (CM) has been rapidly increasing at the VA. CM involves the provision of material incentives such as prizes, vouchers, or money contingent upon verification of drug abstinence via toxicology screening. An employment-based version of CM has been demonstrated to be as effective as other forms of CM. Under this version of CM, access to paid employment or paid job training is the incentive. This employment-based CM could be used in conjunction with CWT or other vocational rehabilitation services used at the VA. The implementation of CM in such settings would increase access to CM for veterans and would be highly likely to improve substance use treatment outcomes among those receiving the service. This intervention might also improve key behavioral outcomes related to obtaining and maintaining competitive employment. VA officials in charge of employment-based treatment programs such as CWT should seriously consider integrating CM into their programs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Cultivating Passion through Collaborative Art: A Dialogic Exploration of Disability, Storytelling, and Social Change.

This essay explores the role of art and storytelling in organizing expressive and vocational opportunities for individuals with developmental disabilities. Passion Works is a non-profit organization that fosters collaborative art-making among people with differing abilities. Guided by an asset-based approach titled the Creative Abundance Model, the studio challenges deficit-based narratives that guide traditional programming in sheltered workshops for individuals with developmental disabilities. The studio functions as an incubator of discovery, a process central to fostering individual well-being and social change.

Difficult entry and return to the labor market: on the professional (re)integration of people with disabilities and chronic health conditions in Poland (The PATHWAYS research project)

Objectives: The objective of this study is to present the barriers existing in Poland to professional integration and reintegration of people with chronic diseases, including mental health conditions, and discuss them on the basis of expert opinions and in comparison with the situation in other European countries. Material and Methods: The research methodology was based on a mixed-methods approach, including literature review, in-depth expert interviews, and a survey (based on a structured questionnaire) performed with experts. Results: The mapping of policies, systems and services facilitating the integration and reintegration of people with chronic diseases in Poland, as well as expert opinions, made it possible to identify many barriers regarding access to support, such as an obligation to have a certificate of disability, and a system of certification by 2 institutions. There are also barriers regarding the support itself, including problems with subsidies and with professional (re)integration services. Conclusions: Poland has a multi-level and multi-sector system of public institutions, which should provide support for people with disabilities and chronic diseases. Nevertheless, the research conducted in Poland indicates an insufficient implementation of the existing solutions. Int J Occup Med Environ Health. 2019;32(4):475­88

Differences in subjective quality of life of people with a schizophrenia diagnosis between participants in Occupational Therapy Workshops and those working in a Sheltered Employment Establishment. / Róznice w subiektywnej jakosci zycia osób z diagnoza schizofrenii pomiedzy uczestnikami Warsztatów Terapii Zajeciowej a osobami pracujacymi w Zakladzie Pracy Chronionej.

OBJECTIVES: The research objective was to compare the course of illness among patients with schizophrenia undergoing rehabilitation in Occupational Therapy Workshops (OTW) or employed in the Vocational Development Center "Pensjonat u Pana Cogito" (VDC), with particular focus on quality of life (QoL), and to analyse the relations between QoL and general, social, and cognitive functioning, psychopathological condition and insight in the two groups. METHODS: The sample comprised 52 subjects (VDC = 25 and OT = 27). The following tools were used: the LQoLP (for quality of life assessment) by Oliver, the PANSS, GAF, and SOFAS scales, the MoCA, RAVLT and RHLB cognitive tests, and the insight questionnaire "My thoughts and feelings". RESULTS: Differences were found between the groups, to the VDC group's advantage, in such areas of subjective QoL as: family relationships (p . 0.05), somatic health (p . 0.05) and selfesteem (p . 0.05). In the VDC group, QoL correlated negatively with symptoms of distress and positively with overall insight into symptoms, while in the OTW group it correlated negatively with cognitive function and positively with insight as a reaction to information from others. CONCLUSIONS: For people with schizophrenia obtaining and retaining employment in a VDC translates into better outcomes in important areas of quality of life such as family relationships, overall health, and self-esteem. Poorer QoL was associated with the severity of symptoms, in particular depressive symptoms. People employed in the VDC benefited to a greater extent from autonomous control of symptoms, while among the OTW group an important role was played by others.

Factors impacting employment for people with autism spectrum disorder: A scoping review.

The aim of this study is to holistically synthesise the extent and range of literature relating to the employment of individuals with autism spectrum disorder. Database searches of Medline, CINAHL, PsychINFO, Scopus, ERIC, Web of Science and EMBASE were conducted. Studies describing adults with autism spectrum disorder employed in competitive, supported or sheltered employment were included. Content analysis was used to identify the strengths and abilities in the workplace of employees with autism spectrum disorder. Finally, meaningful concepts relating to employment interventions were extracted and linked to the International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder. The search identified 134 studies for inclusion with methodological quality ranging from limited to strong. Of these studies, only 36 evaluated employment interventions that were coded and linked to the International Classification of Functioning, Disability and Health, primarily focusing on modifying autism spectrum disorder characteristics for improved job performance, with little consideration of the impact of contextual factors on work participation. The International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder are a useful tool in holistically examining the employment literature for individuals with autism spectrum disorder. This review highlighted the key role that environmental factors play as barriers and facilitators in the employment of people with autism spectrum disorder and the critical need for interventions which target contextual factors if employment outcomes are to be improved.

Sick leave and work-related accidents of social workers in Germany: an analysis of routine data.

PURPOSE: The study aimed to explore the prevalence of sick leave and the risk of work-related accidents among German social workers and to describe causes and time trends in sick leave and accident claims. METHODS: A retrospective analysis of routine data was carried out. Aggregated sick leave data of 195,100 social workers from four health insurance funds and 3037 accident claims of social workers from an accident insurance institution were analysed. Causes of accidents were examined by statistics of the German Social Accident Insurance (DGUV). Sick leave rates per 100 insured person-years were calculated. Relative risks (RR) of accidents were calculated in a multivariate analysis for three occupational groups (social workers and therapists, caregivers in sheltered workshops and teachers in residential institutions) and compared to other health and welfare service workers. RESULTS: Mental disorders caused about one-fifth of the sick leave days of social workers. Sick leave due to mental disorders slightly increased in 2015 compared to 2012 (+ 3% and + 18%). Among the three subgroups of social workers, caregivers in sheltered workshops (RR 1.30; 95% CI 1.14-1.49) and teachers in residential institutions (RR 1.41; 95% CI 1.17-1.70) were at an increased risk of accidents at the workplace. Accidents were mostly caused by slipping (30%) and by violence (22%). CONCLUSIONS: This study confirms that sick leave of social workers is frequently caused by mental disorders. Future studies could further examine differences between practice fields, long-term effects of work hazards and effective workplace interventions.

Job satisfaction among disabled people in the sheltered workshop: Differential analysis.

This paper analyses job satisfaction and differences in factors affecting it among workers with an intellectual disability and mental illness (MI) depending on their work regime [special employment regime (SER) or occupational service (OS)]. To do so, answers were analysed from 874 participants on a Job Satisfaction Scale used in sheltered workshops in Spain. The results indicate that job satisfaction among workers with intellectual disability and MI in both the SER and the OS regimes is high, with the highest job satisfaction deriving from the Items of communicating problems to resolve them. The lowest levels of job satisfaction are related to the opportunity to take decisions and participate at work. In the majority of the Items analysed, no differences were found on the basis of the age groups considered nor the gender of the participants.

Work activity in the process of recovery - an interpretive phenomenological analysis of the experiences of people with a schizophrenia spectrum diagnosis. / Aktywnosc zawodowa w procesie zdrowienia ­ interpretacyjna analiza fenomenologiczna doswiadczen pacjentów ze spektrum schizofrenii.

OBJECTIVES: Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. METHODS: Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). RESULTS: Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. G oing to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget. CONCLUSIONS: This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.

Do inclusive work environments matter? Effects of community-integrated employment on quality of life for individuals with intellectual disabilities.

More individuals with an intellectual disability now possess prerequisite skills and supports necessary for successful work force integration than did previous generations. The current study compared quality of life of community-integrated workers with those participating in sheltered vocational workshops and adult day care programs. We considered numerous indices of quality of life, including inclusion and community participation; satisfaction within professional services, home life, and day activities; dignity, rights, and respect received from others; fear; choice and control; and family satisfaction. Our data revealed several important differences in quality of life across daytime activities; participants involved in community-integrated employment tended to be younger, indicated a greater sense of community integration, and reported more financial autonomy than did those who participated in adult day care programs and sheltered workshops. However, individuals reported no differences in overall satisfaction across daytime activities. We discuss generational differences across employment status as well as possible explanations to account for high levels of satisfaction across daytime activities.

The Learning of Difficult Visual Discriminations by the Moderately and Severely Retarded.

A procedure to effectively and efficiently train moderately and severely retarded individuals to make fine visual discriminations is described. Results suggest that expectancies for such individuals are in need of examination. Implications for sheltered workshops, work activity centers and classrooms are discussed.

Development of vocational training systems for patients with intellectual disability in Poland.

BACKGROUND: The problem of employment of people with intellectual disabilities is present in many countries. The literature on this topic draws attention to the fact that the improvement of the situation in this area is conditioned by changes in government policies, practices of employers and adequate preparation to undertake professional duties by persons with intellectual disabilities. OBJECTIVE: The objective of this review was to explore the changes in vocational rehabilitation forms in Poland. RESULTS: As one of the ways to solve this problem since 1991 in Poland the so called Workshops of Vocational Therapy have been created. According to the regulations the Workshops were designed for adults with intellectual disabilities, aged over 16 years with a total incapacity of gaining an employment, for which occupational therapy was a form of social rehabilitation. The further step in this process was the establishment of Vocational Activation Centers, with which high hopes were associated. They were expected to be an intermediate link in the creation of career paths from rehabilitation forms ultimately to open labor market. In practice it turned out that the creation of these Centers in Poland has been too slow. CONCLUSIONS: This raised the necessity to change the attitude from the concept of matching the participant to work and to the new environment, which frequently ends as a trauma, to the concept of matching jobs to people. New initiatives and new rehabilitation programs are developed based on this attitude.

Proxy and self-reported Quality of Life in adults with intellectual disabilities: Impact of psychiatric symptoms, problem behaviour, psychotropic medication and unmet needs.

Proxies often underestimate the subjective Quality of Life (QoL) of adults with intellectual disability (ID). However, little is known about the reasons for these differences. Accordingly, the purpose of the present study is to, firstly, compare the self-reported QoL of adults with ID with proxy reports from staff of sheltered working and housing facilities, and, secondly, to identify possible differences of the impact of four potential predictor variables. Data of 102 adults with ID were collected as part of the MEMENTA study ('Mental health care provision for adults with ID and a mental disorder'). Results show that self-report QoL scores ranged from 72.6 to 86.8. Both proxies consistently reported lower QoL scores and agreement between self and proxy ratings was predominantly poor. Unmet needs and psychotropic medication were identified as the most important predictors of reduced self-rated QoL, whereas an increase of psychiatric symptoms, problem behaviours, and psychotropic medication best predicted the reduced QoL proxy ratings. To conclude, proxies still have to strive for a more holistic approach in surrogate QoL assessments and according to adults with ID, service providers should focus on a reduction of unmet needs and psychotropic medication to further improve QoL.

From Blue to Green: The Development and Implementation of a Therapeutic Horticulture Program for Residents of a Battered Women's Shelter.

The delivery of therapeutic services to clients is influenced by service providers' understanding of the "fit" of a specific program with their service mandate as well as their perceptions of the potential benefits of the program. This article discusses the development and implementation of a therapeutic horticulture (TH) program at a battered women's shelter that serves 17 counties in Central Kentucky. Through semistructured interviews, we gauge the shelter staff's perceptions of the relationship of the TH program to the shelter's overall mission; their sense of the program's benefits for residents, for the shelter as a community organization, and for themselves; and their concerns about the TH program. We consider how these findings may impact future programming at the shelter, and we discuss plans for further evaluation of the TH program in terms of its impact on shelter residents' long-term outcomes.