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

Estudio de adecuaciones y adaptaciones de puesto de trabajo en ámbito sanitario, período 2014-noviembre 2015 / Adaptation study of disabled health care workers during 2014 to november 2015

Objetivo: Evaluar los casos de ADPT informados por el SPRL durante el año 2014 y hasta noviembre del año 2015. Cuando un trabajador presente especial sensibilidad o especiales necesidades o restricciones (salud), puede, según Ley 31/1995 de Prevención de Riesgos Laborales(1) artículos 25- 26, acceder a adecuación de puesto de trabajo (ADPT) o cambio del mismo si no fuera posible(2). Material y Métodos: Se evalúan las ADPT informadas por el Servicio de Prevención Mancomunado de Grupo, Hospital Universitario Infanta Leonor, Madrid(3), durante 2014 y 2015 (hasta noviembre) por centros, unidades, sexo, categoría y motivo; con programa SPSS. Resultados: El mayor número fue a mujeres, coincidiendo con su mayor tasa de población. Según causa, destaca la gestación (concuerda con edad y sexo de plantillas), seguida de trastornos músculo-esqueléticos y salud mental. Por categoría, hay mayor incidencia en Auxiliares de Enfermería y, según servicio, en urgencias. Conclusiones: Conocer las causas prevalentes permite establecer programas específicos para cada organización y favorecer el desarrollo de su actividad, consiguiendo protección, integración y desarrollo profesional del trabajador (AU)

Objective: Evaluate the cases of ADPT reported by the SPRL during the year 2014 and until November of the year 2015. Law 31/1995 on Occupational Health and Safety’ articles 25 and 26(1) enable a worker with special sensitivities or health problems to request an adaptation of workplace (AW) or a change if this adaptation is not possible(2). Material and Methods: All AW cases requested by the Hospital Universitario Infanta Leonor' Occupational Health Service, Madrid(3) during 2014 - November 2015 were evaluated by workplace, departments, sex, professional status and adequacy reason, with SPSS program Results: The largest number was of women, because the population rate. The causes were mainly due to pregnancy followed by musculoskeletal disorders and mental health.The professional category with highest incidence was among Health Care Assistants. By department, it was Emergency. Conclusions: Knowing the more prevalent causes allows us to establish specific programs for our organization and thus promote the development of the activity in the workplace, getting the protection to the affected workers and their integration and professional development (AU)

[Restructuring of the specialized job market for people with disabilities through legislative reform of the Rehabilitation Act--consequences for the workshops for the disabled]. / Neustrukturierung des Sonderarbeitsmarkts für Menschen mit Behinderung durch die Reform des Reha-Rechts--Folgen für die Werkstatt für Behinderte.

The legal basis for employment of people with disabilities in sheltered Workshops for the Disabled (Werkstätten für Behinderte, WfB) had hitherto been shaped by the 1961 Federal Social Assistance Act, the 1969 Employment Promotion Act, the 1974 Severely Disabled Persons Act with the related Workshop Ordinances of 1980 and 1996. The Act on Combating Unemployment of Severely Disabled Persons, effective as of Oct. 1, 2000 has now created a new legal foundation, which also is aimed at enhancing Workshop employees' horizontal mobility into the general job market, inter alia providing for access to Supported Employment arrangements and for availability of selective placement and support services (Integrationsfachdienste, IFD) throughout Germany. These Services also are intended as points of contact in the counselling of severely disabled school leavers in relation to placement opportunities in competitive jobs and/or integration projects or firms. Discussed from a legal perspective are the differences in sociolegal respects between such projects for severely disabled persons and employment in Workshops for the Disabled, as well as implications for the Workshops' own economic activity, also making reference to the forthcoming Book 9 of the Social Code.

Licensure of sheltered-care facilities: does it assure quality?

In California, licensure was intended to assure a minimum level of quality in sheltered-care facilities for the mentally ill population. This longitudinal study relates characteristics of facilities, their residents, and communities to subsequent licensure and considers differences between licensed and unlicensed facilities at follow-up. Initial interviews were completed in 214 facilities in 1973 six months before the implementation of the California Residential Facilities Licensing Act. Follow-up interviews occurred in 1985. Results indicate that although licensure occurred with greater frequency among facilities serving the most disabled population, licensure neither predicts nor has as its apparent consequence the development of higher-quality facilities. An alternative approach to quality assurance is offered.

[Patients with severe multiple handicaps in workshops for the handicapped--a project of the Berlin Workshops for the Handicapped GmbH (BWB) 4 December 1989 to 31 May 1990]. / Schwerstmehrfachbehinderte in Werkstätten für Behinderte--Ein Projekt der Berliner Werkstätten für Behinderte GmbH (BWB) in der Zeit von 4.12.1989 bis 31.5.1990.

A project had been carried out at Berliner Werkstätten für Behinderte GmbH (BWB) aimed at integrating cerebral palsied persons with very severe, multiple disability in a workshop for the disabled. Client workshop readiness had been determined on the criteria of social capacity, extraordinary care need at the workplace, and economic viability of work. The project, planned to last 6 months, had to be discontinued because the 9 disabled persons included in this programme refused to cooperate after a short period of time.

[Legal contract of workshops for handicapped people--a wish or reality?]. / Der gesetzliche Auftrag der Werkstätten für Behinderte--Wunsch oder Wirklichkeit?

In August 1990, the "Werkstättenverordnung" (the Workshops for the disabled ordinance) has been in force for ten years. Concluding a lengthy historical development, it describes an utopia seeking to implement the opportunity for personal growth and for economically viable productive activity, even-handedly and concurrently, for all disabled people covered (excepting those with very severe disablement). In everyday practice, such notions are confronted with major obstacles: growing demand; poor transition into other employment, terminal workshop employment instead; problems with performance requirements, with the dependence from customers, and with remuneration issues; insufficient promotional services for learning disabled clients whose labour performance is essential to the workshops; adjustment problems of clients with mental illness within the workshop; counting of alternative service attendants toward the staffing plan; unsolved civil and labour law issues relative to contracts involving mentally retarded persons; protection against dismissal, clients' right to freely choose the workshop, their co-determination and the rights of their relatives; the need for special educational qualification of workshop and group senior staff who have to face up to the expectations and difficulties in the day-to-day running of the workshops.

Vocational and social learning of people with severe disabilities in sheltered employment.

In addition to prevocational centres for young people with disabilities about to enter the labour market and vocational training centres for older persons, the Federal Republic of Germany provides a network of sheltered workshops for those who are unable or unlikely to work under competitive conditions. This paper describes the programme for persons in the latter category, based on applications of learning theory, provided at the sheltered workshop in Detmold, Westphalia. It also reports various steps which have been taken to evaluate and refine the two-fold approach to training developed at this centre, based on job analysis and detailed appraisal of workers' social and psychological characteristics, and to apply that approach to persons with a wider range of disabilities.

[Questions regarding demarcation in occupational therapy]. / Abgrenzungsfragen zur Arbeitstherapie.

Work therapy (Arbeitstherapie) has become an intermediate link between medical and vocational rehabilitation. It is distinct from insurable employment primarily in that it is guided by a medical treatment plan directed at the rehabilitative needs of the patient. Delimitation problems as against insurable employment mostly occur due to the requirement that the work therapy setting should be realistic. This entails a risk of abuse. Where work therapy is provided in practice, greater note should be taken of today's degree of differentiation in vocational rehabilitation, which has made available a great many avenues so that direct provision of vocational measures to the patient may be more meaningful. Preparatory vocational rehabilitation services may be considered if the patient's working capacity needs to be improved and is amenable to goal-directed enhancement. It is not necessary that this should occur in courses. It, rather, can also be done through individual measures. And it is moreover possible to include general education goals in an occupation-related manner.