The traditional approach to helping disabled people into work has had little success, and it is evident that something fundamental needs to be changed. For example, the official unemployment rates for disabled people are always at least twice that of their non-disabled peers—often higher. The numbers of disabled people not working often approach 70% (in the United States, United Kingdom, Canada). Disabled people are more likely than their non-disabled peers to live in poverty; for example, in the United Kingdom two-thirds of the 6.2 million disabled citizens have only state benefits as income.

These problems are compounded by the fact that rehabilitation services are often unable to meet employer demand for qualified applicants.

In many countries, disability is not generally defined as an equal opportunities or rights issue. It is thus difficult to encourage corporate best practice which positions disability firmly alongside race and gender as an equal opportunities or diversity priority. Proliferation of quotas or the complete absence of relevant legislation reinforces employer assumptions that disability is primarily a medical or charity issue.

Evidence of the frustrations created by inadequacies inherent in the present system can be seen in growing pressure from disabled people themselves for legislation based on civil rights and/or employment rights, such as exists in the United States, Australia, and, from 1996, in the United Kingdom. It was the failure of the rehabilitation system to meet the needs and expectations of enlightened employers which prompted the UK business community to establish the Employers Forum on Disability.

Employers’ attitudes unfortunately reflect those of the wider society—although this fact is often overlooked by rehabilitation practitioners. Employers share with many others widespread confusion regarding such issues as:

• What is a disability? Who is and who is not disabled?

• Where do I get advice and services to help me recruit and retain disabled people?

• How do I change my organization’s culture and working practices?

• What benefit will best practice on disability bring my business—and the economy in general?

The failure to meet the information and service needs of the employer community constitutes a major hurdle for disabled people wanting work, yet it is rarely addressed adequately by government policy makers or rehabilitation practitioners.

Deep-Rooted Myths that Disadvantage Disabled People in the Labour Market

Non-governmental organizations (NGOs), governments, indeed all those involved in the medical and employment rehabilitation of persons with disabilities, tend to share a set of deep-rooted, often unspoken assumptions which only further disadvantage the disabled individuals these organizations seek to help:

• “The employer is the problem—indeed, often the adversary.” It is employer attitudes which are often blamed for the failure of disabled people to find jobs, despite the evidence that numerous other factors may well have been highly significant.

• “The employer is not treated either as a client or a customer.” Rehabilitation services do not measure their success by the extent to which they make it easier for the employer to recruit and retain disabled employees. As a result, the unreasonable difficulties created by suppliers of rehabilitation services make it difficult for the well-intentioned and enlightened employer to justify the time, cost and effort required to effect change. The not-so-enlightened employer has his or her reluctance to effect change more than justified by the lack of cooperation from rehabilitation services..

• “Disabled people really cannot compete on merit.” Many service providers have low expectations of disabled people and their potential to work. They find it difficult to promote the “business case” to employers because they themselves doubt that employing people with disability brings genuine mutual benefit. Instead the tone and underlying ethos of their communication with employers stresses the moral and perhaps (occasional) legal obligation in a way which only further stigmatizes disabled people.

• “Disability is not a mainstream economic or business issue. It is best left in the hands of the experts, doctors, rehabilitation providers and charities.” The fact that disability is portrayed in the media and through fund-raising activities as a charity issue, and that disabled people are portrayed as the natural and passive recipients of charity, is a fundamental barrier to the employment of disabled people. It also creates tension in organizations that are trying to find jobs for people, while on the other hand using images which tug at the heartstrings.

The consequence of these assumptions is that:

• Employers and disabled people remain separated by a maze of well-meaning but often uncoordinated and fragmented services which only rarely define success in terms of employer satisfaction.

• Employers and disabled people alike remain excluded from real influence over policy development; only rarely is either party asked to evaluate services from its own perspective and to propose improvements.

We are beginning to see an international trend, typified by the development of “job coach” services, towards acknowledging that successful rehabilitation of disabled people depends upon the quality of service and support available to the employer.

The statement “Better services for employers equals better services for disabled people” must surely come to be much more widely accepted as economic pressures build on rehabilitation agencies everywhere in the light of governments’ retrenchment and restructuring. It is nonetheless very revealing that a recent report by Helios (1994), which summarizes the competencies required by vocational or rehabilitation specialists, fail to make any reference to the need for skills which relate to the employers as customer.

While there is a growing awareness of the need to work with employers as partners, our experience shows that it is difficult to develop and sustain a partnership until the rehabilitation practitioners first meet the needs of the employer as customer and begin to value that “employer as customer” relationship.

Employers’ Roles

At various times and in various situations the system and services position the employer in one or more of the following roles—though only rarely is it articulated. Thus we have the employer as:

• the Problem—“you require enlightenment”

• the Target—“you need education, information, or consciousness raising”

• the Customer—“the employer is encouraged to use us in order to recruit and retain disabled employees”

• the Partner—the employer is encouraged to “enter into a long term, mutually beneficial relationship”.

And at any time during the relationship the employer may be called upon—indeed is typically called upon—to be a funder or philanthropist.

The key to successful practice lies in approaching the employer as “The Customer”. Systems which regard the employer as only “The Problem”, or “The Target”, find themselves in a self-perpetuating dysfunctional cycle.

Factors outside the Employer’s Control

Reliance on perceived employer negative attitudes as the key insight into why disabled people experience high unemployment rates, consistently reinforces the failure to address other highly significant issues which must also be tackled before real change can be brought about.

For example:

• In the United Kingdom, in a recent survey 80% of employers were not aware they had ever had a disabled applicant.

• Benefits and social welfare systems often create financial disincentives for disabled people moving into work.

• Transport and housing systems are notoriously inaccessible; people can look for work successfully only when basic housing, transport and subsistence needs have been met.

• In a recent UK survey, 59% of disabled job seekers were unskilled compared to 23% of their peers. Disabled people, in general, are simply not able to compete in the labour market unless their skill levels are competitive.

• Medical professionals frequently underestimate the extent to which a disabled person can perform in work and are often unable to advise on adaptations and adjustments which might make that person employable.

• Disabled people often find it difficult to obtain high quality career guidance and throughout their lives are subject to the lower expectations of teachers and advisers.

• Quotas and other inappropriate legislation actively undermine the message that disability is an equal opportunities issue.

A legislative system that creates an adversarial or litigious environment can further undermine the job prospects of disabled people because bringing a disabled person into the company could expose the employer to risk.

Rehabilitation practitioners often find it difficult to access expert training and accreditation and are themselves rarely funded to deliver relevant services and products to employers.

Policy Implications

It is vital for service providers to understand that before the employer can effect organizational and cultural change, similar changes are required on the part of the rehabilitation provider. Providers approaching employers as customers need to recognize that actively listening to the employers will almost inevitably trigger the need to change the design and delivery of services.

For example, service providers will find themselves asked to make it easier for the employer to:

• find qualified applicants

• obtain high quality employer-oriented services and advice

• meet disabled people as applicants and colleagues

• understand not just the need for policy change but how to make such change come about

• promote attitude change across their organizations

• understand the business as well as the social case for employing disabled people

Attempts at significant social policy reforms related to disability are undermined by the failure to take into account the needs, expectations and legitimate requirements of the people who will largely determine success—that is, the employers. Thus, for example, the move to ensure that people currently in sheltered workshops obtain mainstream work frequently fails to acknowledge that it is only employers who are able to offer that employment. Success therefore is limited, not only because it is unnecessarily difficult for the employers to make opportunities available but also because of the missed added value resulting from active collaboration between employers and policy makers.

Potential for Employer Involvement

Employers can be encouraged to contribute in numerous ways to making a systematic shift from sheltered employment to supported or competitive employment. Employers can:

• advise on policy—that is, on what needs to be done which would make it easier for employers to offer work to disabled candidates.

• offer advice on the competencies required by disabled individ-uals if they are to be successful in obtaining work.

• advise on the competencies required by service providers if they are to meet employer expectations of quality provision.

• evaluate sheltered workshops and offer practical advice on how to manage a service that is most likely to enable people to move into mainstream work.

• offer work experience to rehabilitation practitioners, who thus gain an understanding of a particular industry or sector and are better able to prepare their disabled clients.

• offer on-the-job assessments and training to disabled individuals.

• offer mock interviews and be mentors to disabled job seekers.

• loan their own staff to work inside the system and/or its institutions.

• help to market rehabilitation agencies and promote policies, organizations and disabled job seekers to other employers.

• offer customized training whereby they become directly involved  in  helping  disabled  individuals  to  acquire  specific job-related skills.

• participate on management boards of rehabilitation agencies or set themselves up in an informal advisory capacity to national policy makers or suppliers.

• lobby alongside rehabilitation providers and disabled people for better government policies and programmes.

• advise on the services and products they require in order to deliver best practice.

Employer as Customer

It is impossible for rehabilitation practitioners to build partnerships with employers without first acknowledging the need to deliver efficient services.

Services should emphasize the theme of mutual benefit. Those who do not passionately believe that their disabled clients have something of real benefit to contribute to the employer are unlikely to be able to influence the employer community.

Improving the quality of service to employers will quickly—and inevitably—improve services for disabled job-seekers. The following represents a useful audit for services wishing to improve the quality of service to the employer.

Does the service offer employers:

1. information and consultancy regarding:

• business benefits which result from employing disabled persons

• possible applicants

• access to the services and the nature of services offered

• models of policy and procedures proven successful by other employers

• legal obligations

2. recruitment services, including access to:

• suitable applicants

• job coaches

3. pre-screening of applicants as per employer expectations

4. professional job analysis and job modification services, able to advise on job restructuring and the use of technical aids and adaptations in the workplace, both for existing and potential employees

5. financial support programmes which are well marketed, appropriate to employer requirements, easy to access, efficiently delivered

6. information and practical help so that employers can make the worksite more physically accessible

7. training for employers and employees regarding the benefits of employing people with disabilities generally, and when specific individuals have been employed

8. work-experience services which provide the employer with relevant support

9. work habituation or employee-orientation services to include job coaches and job-sharing schemes

10. post–job offer support for employers to include advice on best practice in the management of absenteeism and presentation of work-related impairments

11. advice for employers on career development of disabled employees and on meeting the needs of underemployed disabled employees.

Practical Steps: Making it Easier for the Employer

Any system of services which aims to help disabled people into training and work will inevitably be more successful if the needs and expectations of the employer are adequately addressed. (Note: It is difficult to find a term which adequately encompasses all those agencies and organizations—governmental, NGOs, not for profit—which are involved in policy making and service delivery to disabled people seeking work. For the sake of brevity, the term service or service provider is used to encompass all those involved in this entire complex system.)

Close consultation over time with employers will in all likelihood produce recommendations similar to the following.

Codes of practice are needed which describe the high quality of service employers should receive from employment-related agencies. Such codes should, in consultation with employers, set standards which relate both to the efficiency of the existing services and to the nature of services offered—This code should be monitored via regular surveys of employer satisfaction.

Specific training and accreditation for rehabilitation practition-ers in how to meet the needs of employers is required and should be a high priority.

Services should recruit people who have direct experience of the world of industry and commerce and who are skilled in bridging the communication gap between the not-for-profit and profit-making sectors.

Services themselves should employ significantly more disabled people, thus minimizing the numbers of non-disabled intermediaries dealing with employers. They should ensure that disabled people in various capacities have a high profile in the employer community.

Services should minimize the fragmentation of education, marketing and campaigning activities. It is particularly counterproductive to create a milieu characterized by messages, posters and advertising which reinforces the medical model of disability and the stigma attached to particular impairments, rather than focusing on the employability of individuals and the need for employers to respond with appropriate policy and practice.

Services should collaborate to simplify access, to services and support, for both the employer and for the disabled person. Considerable attention should be given to analysing the client journey (with both employer and disabled person as client) in a way that minimizes assessments and moves the individual speedily, step by step, into employment. Services should build on mainstream business initiatives to ensure that disabled people are given priority.

Services should bring employers together routinely and ask their expert advice regarding what has to be done to make services and job candidates more successful.

Conclusion

In many countries, the services designed to help disabled people into work are complex, cumbersome and resistant to change, despite the evidence decade after decade that change is required.

A fresh approach to employers offers enormous potential to transform this situation significantly by radically altering the position of one key protagonist—the employer.

We see business and government engaged in a wide-ranging debate regarding the way in which relationships between stakeholders or social partners must inevitably change over the next 20 years. Thus employers launch the European Business against Social Exclusion Initiative in Europe, major companies join together to re-think their relationship with society in the UK in “Tomorrow’s Company”, and the Employers Forum on Disability becomes only one of various UK employer initiatives aimed at addressing issues of equality and diversity.

Employers have much to do if the issue of disability is to take its rightful place as a business and ethical imperative; the rehabilitation community in turn needs to take a fresh approach which redefines working relationships between all stakeholders in a way that makes it easier for employers to make equal opportunities a reality.

Back

Raymond Hétu

* This article was written by Dr. Hétu shortly before his untimely death. His colleagues and friends consider it one memoriam to him.

Although this article deals with disability due to noise-exposure and hearing loss, it is included here because it also contains fundamental principles applicable to rehabilitation from disabilities arising from other hazardous exposures.

Psychosocial Aspects of Occupationally Induced Hearing Loss

Like all human experience, hearing loss caused by exposure to workplace noise is given meaning—it is qualitatively experienced and evaluated—by those whom it affects and by their social group. This meaning can, however, be a powerful obstacle to the rehabilitation of individuals suffering from occupationally induced hearing loss (Hétu and Getty 1991b). The chief reasons, as discussed below, are that the victims of hearing loss experience perceptual barriers related to the signs and effects of their deficiency and that the manifestation of overt signs of hearing loss is highly stigmatizing.

Communication problems due to the distorted perception of hearing

Difficulties in hearing and communication resulting from occupationally induced hearing loss are usually attributed to other causes, for example unfavourable conditions for hearing or communication or a lack of attention or interest. This erroneous attribution is observed in both the affected individual and among his or her associates and has multiple, although converging, causes.

1. Internal ear injuries are invisible, and victims of this type of injury do not see themselves as physically injured by noise.
2. Hearing loss per se progresses very insidiously. The virtually daily auditory fatigue due to workplace noise suffered by exposed workers makes the timely detection of irreversible alterations in hearing function a matter of the greatest difficulty. Individuals exposed to noise are never aware of tangible deteriorations of hearing capacity. In fact, in most workers exposed daily to harmful levels of noise, the increase in the auditory threshold is of the order of one decibel per year of exposure (Hétu, Tran Quoc and Duguay 1990). When hearing loss is symmetric and progressive, the victim has no internal reference against which to judge the induced hearing deficit. As a result of this insidious evolution of hearing loss, individuals undergo a very progressive change of habits, avoiding situations which place them at a disadvantage—without however explicitly associating this change with their hearing problems.
3. The signs of hearing loss are very ambiguous and usually take the form of a loss of frequency discrimination, that is, a diminished ability to discriminate between two or more simultaneous acoustic signals, with the more intense signal masking the other(s). Concretely, this takes the form of varying degrees of difficulty in following conversations where reverberation is high or where background noise due to other conversations, televisions, fans, vehicle motors, and so forth, is present. In other words, the hearing capacity of individuals suffering from impaired frequency discrimination is a direct function of the ambient conditions at any given moment. Those with whom the victim comes into daily contact experience this variation in hearing capacity as inconsistent behaviour on the part of the affected individual and reproach him or her in terms like, “You can understand well enough when it suits your purpose”. The affected individual, on the other hand, considers his or her hearing and communication problems to be the result of background noise, inadequate articulation by those addressing him or her, or a lack of attention on their part. In this way, the most characteristic sign of noise-induced hearing loss fails to be recognized for what it is.
4. The effects of hearing loss are usually experienced outside of the workplace, within the confines of family life. Consequently, problems are not associated with occupational exposure to noise and are not discussed with work colleagues suffering similar difficulties.
5. Acknowledgement of hearing problems is usually triggered by reproaches from the victim’s family and social circles (Hétu, Jones and Getty 1993). Affected individuals violate certain implicit social norms, for example by speaking too loudly, frequently asking others to repeat themselves and turning the volume of televisions or radios up too high. These behaviours elicit the spontaneous—and usually derogatory—question, “Are you deaf?” from those around. The defensive behaviours that this triggers do not favour the acknowledgement of partial deafness.

As a result of the convergence of these five factors, individuals suffering from occupationally induced hearing loss do not recognize the effects of their affliction on their daily lives until the loss is well advanced. Typically, this occurs when they find themselves frequently asking people to repeat themselves (Hétu, Lalonde and Getty 1987). Even at this point, however, victims of occupationally induced hearing loss are very unwilling to acknowledge their hearing loss on account of the stigma associated with deafness.

Stigmatization of the signs of deafness

The reproaches elicited by the signs of hearing loss are a reflection of the extremely negative value construct typically associated with deafness. Workers exhibiting signs of deafness risk being perceived as abnormal, incapable, prematurely old, or handicapped—in short, they risk becoming socially marginalized in the workplace (Hétu, Getty and Waridel 1994). These workers’ negative self-image thus intensifies as their hearing loss progresses. They are obviously reluctant to embrace this image, and by extension, to acknowledge the signs of hearing loss. This leads them to attribute their hearing and communication problems to other factors and to become passive in the face of these factors.

The combined effect of the stigma of deafness and the distorted perception of the signs and effects of hearing loss on rehabilitation is illustrated in figure 1.

Figure 1. Conceptual framework for incapacity from handicap

When hearing problems progress to the point that it is no longer possible to deny or minimize them, individuals attempt to hide the problem. This invariably leads to social withdrawal on the part of the worker and exclusion on the part of the worker’s social group, which ascribes the withdrawal to a lack of interest in communicating rather than to hearing loss. The result of these two reactions is that the affected individual is not offered help or informed of coping strategies. Workers’ dissimulation of their problems may be so successful that family members and colleagues may not even realize the offensive nature of their jokes elicited by the signs of deafness. This situation only exacerbates the stigmatization and its resultant negative effects. As Figure 1 illustrates, the distorted perceptions of the signs and effects of hearing loss and the stigmatization which results from these perceptions are barriers to the resolution of hearing problems. Because affected individuals are already stigmatized, they initially refuse to use hearing aids, which unmistakably advertise deafness and so promote further stigmatization.

The model presented in Figure 1 accounts for the fact that most people suffering occupationally induced hearing loss do not consult audiology clinics, do not request modification of their workstations and do not negotiate enabling strategies with their families and social groups. In other words, they endure their problems passively and avoid situations which advertise their auditory deficit.

Conceptual Framework of Rehabilitation

For rehabilitation to be effective, it is necessary to overcome the obstacles outlined above. Rehabilitative interventions should therefore not be limited to attempts to restore hearing capacity, but should also address issues related to the way hearing problems are perceived by affected individuals and their associates. Because stigmatization of deafness is the greatest obstacle to rehabilitation (Hétu and Getty 1991b; Hétu, Getty and Waridel 1994), it should be the primary focus of any intervention. Effective interventions should  therefore  include  both  stigmatized  workers  and  their circles of family, friends, colleagues and others with whom they come into contact, since it is they who stigmatize them and who, out of ignorance, impose impossible expectations on them. Concretely, it is necessary to create an environment which allows affected individuals to break out of their cycle of passivity and isolation and actively seek out solutions to their hearing problems. This must be accompanied by a sensitization of the entourage to the specific needs of affected individuals. This process is grounded in the ecological approach to incapacity and handicap illustrated in figure 2.

Figure 2. Model of restrictions due to hearing loss

In the ecological model, hearing loss is experienced as an incompatibility between an individual’s residual capacity and the physical and social demands of his or her environment. For example, workers suffering from a loss of frequency discrimination associated with noise-induced hearing loss will have difficulty detecting acoustic alarms in noisy workplaces. If the alarms required at workstations cannot be adjusted to levels significantly louder than those appropriate for people with normal hearing, the workers will be placed in a handicapped position (Hétu 1994b). As a result of this handicap, workers may be at the obvious disadvantage of being deprived of a means to protect themselves. Yet, simply acknowledging hearing loss puts the worker at risk of being considered “abnormal” by his or her colleagues, and when labelled disabled he or she will fear being seen as incompetent by colleagues or superiors. In either case, workers will attempt to hide their handicap or deny the                                                                                                                             existence of any problems, placing themselves at a functional                                                                                                                         disadvantage at work.

As figure 2 illustrates, disability is a complex state of affairs with several interrelated restrictions. In such a network of relationships, prevention or minimization of disadvantages or restrictions of activity require simultaneous interventions on many fronts. For example, hearing aids, while partially restoring hearing capacity (component 2), do not prevent either the development of a negative self-image or stigmatization by the worker’s entourage (components 5 and 6), both of which are responsible for isolation and avoidance of communication (component 7). Further, auditory supplementation is incapable of completely restoring hearing capacity; this is particularly true with regard to frequency discrimination. Amplification may improve the perception of acoustic alarms and of conversations but is incapable of improving the resolution of competing signals required for the detection of warning signals in the presence of significant background noise. The prevention of disability-related restrictions therefore necessitates the modification of the social and physical demands of the workplace (component 3). It should be superfluous to note that although interventions designed to modify perceptions (components 5 and 6) are essential and do prevent disability from arising, they do not palliate the immediate consequences of these situations.

Situation-specific Approaches to Rehabilitation

The application of the model presented in Figure 2 will vary depending on the specific circumstances encountered. According to surveys and qualitative studies (Hétu and Getty 1991b; Hétu, Jones and Getty 1993; Hétu, Lalonde and Getty 1987; Hétu, Getty and Waridel 1994; Hétu 1994b), the effects of disability suffered by victims of occupationally induced hearing loss are particularly felt: (1) at the workplace; (2) at the level of social activities; and (3) at the family level. Specific intervention approaches have been proposed for each of these situations.

The workplace

In industrial workplaces, it is possible to identify the following four restrictions or disadvantages requiring specific interventions:

1. accident hazards related to the failure to detect warning signals
2. efforts, stress and anxiety resulting from hearing and com-munication problems
3. obstacles to social integration
4. obstacles to professional advancement.

Accident hazards

Acoustic warning alarms are frequently used in industrial workplaces. Occupationally induced hearing loss may considerably diminish workers’ ability to detect, recognize or locate such alarms, particularly in noisy workplaces with high levels of reverberation. The loss of frequency discrimination which inevitably accompanies hearing loss may in fact be so pronounced as to require warning alarms to be 30 to 40db louder than background levels to be heard and recognized by affected individuals (Hétu 1994b); for individuals with normal hearing, the corresponding value is approximately 12 to 15db. Currently, it is rare that warning alarms are adjusted to compensate for background noise levels, workers’ hearing capacity or the use of hearing protection equipment. This puts affected workers at a serious disadvantage, especially as far as their safety is concerned.

Given these constraints, rehabilitation must be based on a rigorous analysis of the compatibility of auditory perception requirements with residual auditory capacities of affected workers. A clinical examination capable of characterizing an individual’s ability to detect acoustic signals in the presence of background noise, such as the Detectsound^TM software package (Tran Quoc, Hétu and Laroche 1992), has been developed, and is available to determine the characteristics of acoustic signals compatible with workers’ hearing capacity. These devices simulate normal or impaired auditory detection and take into account the characteristics of the noise at the workstation and the effect of hearing protection equipment. Of course, any intervention aimed at reducing the noise level will facilitate the detection of acoustic alarms. It is nevertheless necessary to adjust the alarms’ level as a function of the residual hearing capacity of affected workers.

In some cases of relatively severe hearing loss, it may be necessary to resort to other types of warning, or to supplement hearing capacity. For example, it is possible to transmit warning alarms over FM bandwidths and receive them with a portable unit connected directly to a hearing aid. This arrangement is very effective as long as: (1) the tip of the hearing aid fits perfectly (in order to attenuate background noise); and (2) the response curve of the hearing aid is adjusted to compensate for the masking effect of background noise attenuated by the hearing aid tip and the worker’s hearing capacity (Hétu, Tran Quoc and Tougas 1993). The hearing aid may be adjusted to integrate the effects of the full spectrum of background noise, the attenuation produced by the hearing aid’s tip, and the worker’s hearing threshold. Optimal results will be obtained if the frequency discrimination of the worker is also measured. The hearing aid-FM receptor may also be used to facilitate verbal communication with work colleagues when this is essential for worker safety.

In some cases, the workstation itself must be redesigned in order to ensure worker safety.

Hearing and communication problems

Acoustic warning alarms are usually used to inform workers of the state of a production process and as a means of inter operator communication. In workplaces where such alarms are used, individuals with hearing loss must rely upon other sources of information to perform their work. These may involve intense visual surveillance and discreet help offered by work colleagues. Verbal communication, whether over the telephone, in committee meetings or with superiors in noisy workshops, requires great effort on the part of affected individuals and is also highly problematic for affected individuals in industrial workplaces. Because these individuals feel the need to hide their hearing problems, they are also plagued by the fear of being unable to cope with a situation or of committing costly errors. Often, this may cause extremely high anxiety (Hétu and Getty 1993).

Under these circumstances, rehabilitation must first focus on eliciting explicit acknowledgement by the company and its representatives of the fact that some of their workers suffer from hearing difficulties caused by noise exposure. The legitimization of these difficulties helps affected individuals to communicate about them and to avail themselves of appropriate palliative means. However, these means must in fact be available. In this regard, it is astonishing to note that telephone receivers in the workplace are rarely equipped with amplifiers designed for individuals suffering from hearing loss and that conference rooms are not equipped with appropriate systems (FM or infrared transmitters and receptors, for example). Finally, a campaign to increase awareness of the needs of individuals suffering from hearing loss should be undertaken. By publicizing strategies which facilitate communication with affected individuals, communication-related stress will be greatly reduced. These strategies consist of the following phases:

• approaching the affected individual and facing him or her

• articulating without exaggeration

• repeating misunderstood phrases, using different words

• keeping as far away from sources of noise as possible

Clearly, any control measures that lead to lower noise and reverberation levels in the workplace also facilitate communication with individuals suffering from hearing loss.

Obstacles to social integration

Noise and reverberation in the workplace render communication so difficult that it is often limited to the strict minimum required by the tasks to be accomplished. Informal communication, a very important determinant of the quality of working life, is thus greatly impaired (Hétu 1994a). For individuals suffering from hearing loss, the situation is extremely difficult. Workers suffering from occupationally induced hearing loss are isolated from their work colleagues, not only at their workstation but even during breaks and meals. This is a clear example of the convergence of excessive work requirements and the fear of ridicule suffered by affected individuals.

The solutions to this problem lie in the implementation of the measures already described, such as the lowering of overall noise levels, particularly in rest areas, and the sensitization of work colleagues to the needs of affected individuals. Again, recognition by the employer of affected individuals’ specific needs itself constitutes a form of psychosocial support capable of limiting the stigma associated with hearing problems.

Obstacles to professional advancement

One of the reasons individuals suffering from occupationally induced hearing loss take such pains to hide their problem is the explicit fear of being disadvantaged professionally (Hétu and Getty 1993): some workers even fear losing their jobs should they reveal their hearing loss. The immediate consequence of this is a self-restriction with regard to professional advancement, for example, failure to apply for a promotion to shift supervisor, supervisor or foreman. This is also true of professional mobility outside the company, with experienced workers failing to take advantage of their accumulated skills since they feel that pre-employment audiometric examinations would block their access to better jobs. Self-restriction is not the only obstacle to professional advancement caused by hearing loss. Workers suffering from occupationally induced hearing loss have in fact reported instances of employer bias when positions requiring frequent verbal communication have become available.

As with the other aspects of disability already described, explicit acknowledgement of affected workers’ specific needs by employers greatly eliminates obstacles to professional advancement. From the standpoint of human rights (Hétu and Getty 1993), affected individuals have the same right to be considered for advancement as do other workers, and appropriate workplace modifications can facilitate their access to higher-level jobs.

In summary, the prevention of disability in the workplace requires sensitization of employers and work colleagues to the specific needs of individuals suffering from occupationally induced hearing loss. This can be accomplished by information campaigns on the signs and effects of noise-induced hearing loss aimed at dissipating the view of hearing loss as an improbable abnormality of little import. The use of technological aids is possible only if the need to use them has been legitimized in the workplace by colleagues, superiors and affected individuals themselves.

Social activities

Individuals suffering from occupationally induced hearing loss are at a disadvantage in any non-ideal hearing situation, for instance, in the presence of background noise, in situations requiring communication at a distance, in environments where reverberation is high and on the telephone. In practice, this greatly curtails their social life by limiting their access to cultural activities and public services, thus hindering their social integration (Hétu and Getty 1991b).

Access to cultural activities and public services

In accordance with the model in Figure 2, restrictions related to cultural activities involve four components (components 2, 3, 5 and 6) and their elimination relies on multiple interventions. Thus concert halls, auditoriums and places of worship can be made accessible to persons suffering from hearing loss by equipping them with appropriate listening systems, such as FM or infrared transmission systems (component 3) and by informing those responsible for these institutions of the needs of affected individuals (component 6). However, affected individuals will request hearing equipment only if they are aware of its availability, know how to use it (component 2) and have received the necessary psychosocial support to recognize and communicate their need for such equipment (component 5).

Effective communication, training and psychosocial support channels for hearing-impaired workers have been developed in an experimental rehabilitation programme (Getty and Hétu 1991, Hétu and Getty 1991a), discussed in “Family life”, below.

As regards the hearing-impaired, access to public services such as banks, stores, government services and health services is hindered primarily by a lack of knowledge on the part of the institutions. In banks, for example, glass screens may separate clients from tellers, who may be occupied in entering data or filling out forms while talking to clients. The resulting lack of face-to-face visual contact, coupled with unfavourable acoustic conditions and a context in which misunderstanding can have very serious consequences, render this an extremely difficult situation for affected individuals. In health service facilities, patients wait in relatively noisy rooms where their names are called by an employee located at a distance or via a public address system that may be difficult to comprehend. While individuals with hearing loss worry a great deal about being unable to react at the correct time, they generally neglect to inform staff of their hearing problems. There are numerous examples of this type of behaviour.

In most cases, it is possible to prevent these handicap situations by informing staff of the signs and effects of partial deafness and of ways to facilitate communication with affected individuals. A number of public services have already undertaken initiatives aimed at facilitating communication with individuals suffering from occupationally induced hearing loss (Hétu, Getty and Bédard 1994) with results as follows. The use of appropriate graphical or audio visual material allowed the necessary information to be communicated in less than 30 minutes and the effects of such initiatives were still apparent six months after the information sessions. These strategies greatly facilitated communication with the personnel of the services involved. Very tangible benefits were reported not only by clients with hearing loss but also by the staff, who saw their tasks simplified and difficult situations with this type of client prevented.

Social integration

Avoidance of group encounters is one of the most severe consequences of occupationally induced hearing loss (Hétu and Getty 1991b). Group discussions are extremely demanding situations for affected individuals, In this case, the burden of accommodation rests with the affected individual, as he or she can rarely expect the entire group to adopt a favourable rhythm of conversation and mode of expression. Affected individuals have three strategies available to them in these situations:

• reading facial expressions

• using specific communication strategies

• using a hearing aid.

The reading of facial expressions (and lip-reading) can certainly facilitate comprehension of conversations, but requires considerable attention and concentration and cannot be sustained over long periods. This strategy can, however, be usefully combined with requests for repetition, reformulation and summary. Nevertheless, group discussions occur at such a rapid rhythm that it is often difficult to rely upon these strategies. Finally, the use of a hearing aid may improve the ability to follow conversation. However, current amplification techniques do not allow the restoration of frequency discrimination. In other words, both signal and noise are amplified. This often worsens rather than improves the situation for individuals with serious frequency discrimination deficits.

The use of a hearing aid as well as the request for accommodation by the group presupposes that the affected individual feels comfortable revealing his or her condition. As discussed below, interventions aimed at strengthening self-esteem are therefore prerequisites for attempts to supplement auditory capacity.

Family life

The family is the prime locus of the expression of hearing problems caused by occupational hearing loss (Hétu, Jones and Getty 1993). A negative self-image is the essence of the experience of hearing loss, and affected individuals attempt to hide their hearing loss in social interactions by listening more intently or by avoiding overly demanding situations. These efforts, and the anxiety which accompanies them, create a need for release in the family setting, where the need to hide the condition is less strongly felt. Consequently, affected individuals tend to impose their problems on their families and coerce them to adapt to their hearing problems. This takes a toll on spouses and others and causes irritation at having to repeat oneself frequently, tolerate high television volumes and “always be the one to answer the telephone”. Spouses must also deal with serious restrictions in the couples’ social life and with other major changes in family life. Hearing loss limits companionship and intimacy, creates tension, misunderstandings and arguments and disturbs relations with children.

Not only does hearing and communication impairment affect intimacy, but its perception by affected individuals and their family (components 5 and 6 of figure 2) tends to feed frustration, anger and resentment (Hétu, Jones and Getty 1993). Affected individuals frequently do not recognize their impairment and do not attribute their communications problems to a hearing deficit. As a result, they may impose their problems on their families rather than negotiate mutually satisfactory adaptations. Spouses, on the other hand, tend to interpret the problems as a refusal to communicate and as a change in the affected individual’s temperament. This state of affairs may lead to mutual reproaches and accusations, and ultimately to isolation, loneliness and sadness, particularly on the part of the unaffected spouse.

The solution of this interpersonal dilemma requires the participation of both partners. In fact, both require:

• information on the auditory basis of their problems.

• psychosocial support

• training in the use of appropriate supplemental means of communication.

With this in mind, a rehabilitation programme for affected individuals and their spouses has been developed (Getty and Hétu 1991, Hétu and Getty 1991a). The goal of the programme is to stimulate research on the resolution of problems caused by hearing loss, taking into account the passivity and social withdrawal that characterize occupationally induced hearing loss.

Since the stigma associated with deafness is the principal source of these behaviours, it was essential to create a setting in which self-esteem could be restored so as to induce affected individuals to seek out actively solutions to their hearing-related problems. The effects of stigmatization can be overcome only when one is perceived by others as normal regardless of any hearing deficit. The most effective way to achieve this consists of meeting other people in the same situation, as was suggested by workers asked about the most appropriate aid to offer their hearing-impaired colleagues. However, it is essential that these meetings take place outside the workplace, precisely to avoid the risk of further stigmatization (Hétu, Getty and Waridel 1994).

The rehabilitation programme mentioned above was developed with this in mind, the group encounters taking place in a community health department (Getty and Hétu 1991). Recruitment of participants was an essential component of the programme, given the withdrawal and passivity of the target population. Accordingly, occupational health nurses first met with 48 workers suffering from hearing loss and their spouses at their homes. Following an interview on hearing problems and their effects, every couple was invited to a series of four weekly meetings lasting two hours each, held in the evening. These meetings followed a precise schedule aimed at meeting the objectives of information, support and training defined in the programme. Individual follow-up was provided to participants in order to facilitate their access to audio-logical and audioprosthetic services. Individuals suffering from tinnitus were referred to the appropriate services. A further group meeting was held three months after the last weekly meeting.

The results of the programme, collected at the end of the experimental phase, demonstrated that participants and their spouses were more aware of their hearing problems, and were also more confident of resolving them. Workers had undertaken various steps, including technical aids, revealing their impairment to their social group, and expressing their needs in an attempt to improve communication.

A follow-up study, performed with this same group five years after their participation in the programme, demonstrated that the programme was effective in stimulating participants to seek solutions. It also showed that rehabilitation is a complex process requiring several years of work before affected individuals are able to avail themselves of all the means at their disposal to regain their social integration. In most cases, this type of rehabilitation process requires periodic follow-up.

Conclusion

As figure 2 indicates, the meaning that individuals suffering from occupationally induced hearing loss and their associates give to their condition is a key factor in handicap situations. The approaches to rehabilitation proposed in this article explicitly take this factor into account. However, the manner in which these approaches are applied concretely will depend on the specific sociocultural context, since the perception of these phenomena may vary from one context to another. Even within the sociocultural context in which the intervention strategies described above were developed, significant modifications may be necessary. For example, the programme developed for individuals suffering from occupationally induced hearing loss and their spouses (Getty and Hétu 1991) was tested in a population of affected males. Different strategies would probably be necessary in a population of affected females, especially when one considers the different social roles men and women occupy in conjugal and parental relations (Hétu, Jones and Getty 1993). Modifications would be necessary a fortiori when dealing with cultures which differ from that of North America from which the approaches emerged. The conceptual framework proposed (figure 2) can nevertheless be used effectively to orient any intervention aimed at rehabilitating individuals suffering from occupationally induced hearing loss.

Furthermore, this type of intervention, if applied on a large scale, will have important preventive effects on hearing loss itself. The psychosocial aspects of occupationally induced hearing loss hinder both rehabilitation (figure 1) and prevention. The distorted perception of hearing problems delays their recognition, and their dissimulation by severely affected individuals fosters the general perception that these problem are rare and relatively innocuous, even in noisy workplaces. This being so, noise-induced hearing loss is not perceived by workers at risk or by their employers as an important health problem, and the need for prevention is thus not strongly felt in noisy workplaces. On the other hand, individuals already suffering from hearing loss who reveal their problems are eloquent examples of the severity of the problem. Rehabilitation can thus be seen as the first step of a prevention strategy.

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Occurrence and Uses

Palladium (Pd) occurs in nature with platinum or gold, as the selenide. It is found in nickel sulphide ores and in the minerals stibiopalladinite, braggite and porpezite. The concentration of palladium in the Earth’s crust is 0.01 ppm.

Palladium has been used in gold, silver and copper alloys in dentistry. Alloys are also used for bearings, springs and balance wheels in watches. Palladium is used as a catalyst in the manufacture of sulphuric acid. In powder form it serves as a catalyst in hydrogenation. The sponge form is used for separation of hydrogen from a mixture of gases. Silver alloys are used for electrical contacts. Palladium (II) complexes have been studied as antineoplastic drugs.

Palladium chloride (PdCl₂·2H₂O), or palladous chloride, is used in photography toning solutions and for the manufacture of indelible ink. It is an agent used for transferring pictures to porcelain, for electroplating watch parts, and for finding leaks in buried gas pipes. Palladium chloride is associated with copper chloride in catalyzing the production of acetaldehyde from ethylene.

Palladium oxide (PdO), or palladous oxide, is used as a reduction catalyst in the synthesis of organic compounds. Palladium nitrate (Pd(NO₃)₂) is used in the separation of halides. Palladium trifluoride (PdF₃) is an active oxidizing agent.

Hazards

Studies indicate cases of allergy and contact dermatitis caused by palladium in dental alloys and fine jewellery. In one study palladium-based alloys were associated with several cases of stomatitis and oral lichenoid reactions. In this same study palladium allergy occurred mainly in patients with a sensitivity to nickel. Palladium chloride produces dermatitis and allergic skin sensitization in workers exposed daily. In addition, it should be regarded as an eye irritant. Palladium hydroxide was used in the past to treat obesity by injection; this form of treatment gave rise to localized necrosis and was discontinued.

Safety and Health Measures

Correct exhaust ventilation is necessary when working with palladium and its compounds. Good personal hygiene, proper protective clothing and medical surveillance are important measures in preventing the risks associated with sensitization. Adequate sanitary facilities must be provided.

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* Portions of this article have been adapted from Shrey and Lacerte (1995) and Shrey (1995).

Employers are faced with increasing societal and legislative pressure to integrate and accommodate people with disabilities. Increasing workers’ compensation and health care costs are threatening the survival of business and draining resources otherwise allocated to future economic development. Trends suggest that employers can be successful in the effective management of injury and disability problems. Impressive disability management programme models are prominent among employers that assume control and responsibility for injury prevention, early intervention, injured worker reintegration and worksite accommodation. Current disability management practice in industry reflects a paradigm shift from services provided in the community to interventions occurring at the worksite.

This article offers an operational definition of disability management. A model is presented to illustrate the structural components of an optimal worksite-based disability management programme. Effective disability management strategies and interventions are outlined, including key organizational concepts that strengthen service delivery and successful outcome. This article also includes a focus on joint labour-management collaboration and the use of interdisciplinary services, which are considered by many to be essential to the implementation of optimal disability management programmes in industry. Promoting respect and dignity between workers with disabilities and the professionals who serve them is emphasized.

Definition of Disability Management

Disability management is operationally defined as an active process of minimizing the impact of an impairment (resulting from injury, illness or disease) on the individual’s capacity to participate competitively in the work environment (Shrey and Lacerte 1995). The basic principles of disability management are as follows:

• It is a proactive (not passive or reactive) process.

• It is a process that enables labour and management to assume joint responsibility as proactive decision-makers, planners and coordinators of workplace-based interventions and services.

• It promotes disability prevention strategies, rehabilitation treatment concepts, and safe work return programmes designed to control the personal and economic costs of workplace injury and disability.

Successfully managing the consequences of illness, injury and chronic disease in the workforce requires:

• an accurate understanding of the types of injury and illness that occur

• the employer’s timely response to the injury or illness

• clear administrative policies and procedures

• the effective utilization of health care and rehabilitation services.

Disability management practices are based on a comprehensive, cohesive and progressive employer-based approach to managing the complex needs of people with disabilities within a given work and socio-economic environment. Despite rapidly escalating costs of injury and disability, rehabilitation technologies and disability management resources are available to facilitate immediate and recurrent savings among business and industry. Disability management policies, procedures and strategies, when properly integrated within the employer’s organization, provide the infrastructure which enables employers to effectively manage disability and continue to compete in a global environment.

Controlling the cost of disability in business and industry and its ultimate impact on employee productivity is not a simple task. Complex and conflicting relationships exist between employer goals, resources and expectations; the needs and self-interests of workers, health care providers, labour unions and attorneys; and the services available in the community. The ability of the employer to participate actively and effectively in this relationship will contribute to the control of costs, as well as to the protection of the worker’s sustained and productive employment.

Disability Management Objectives

Employer policy and procedure, as well as disability management strategies and interventions, should be designed to accomplish realistic and attainable objectives. Disability management programmes at the worksite should enable the employer to:

• facilitate control of disability issues

• improve corporate competitiveness

• reduce work disruptions and unacceptable lost time

• decrease incidence of accidents and magnitude of disability

• reduce illness and disability duration (and costs)

• promote early involvement and preventive interventions

• maximize use of internal (employer) resources

• improve coordination and accountability, with respect to external service providers

• reduce human cost of disability

• enhance morale by valuing employee physical and cultural diversity

• protect the employability of the worker

• ensure compliance with reintegration and employer equity legislation (e.g., Americans with Disabilities Act of 1990)

• reduce adversarial nature of disability and litigation

• improve labour relations

• promote joint labour-management collaboration

• facilitate direct worker involvement in planning

Essential Disability Management Conceptsand Strategies

Both labour and management have vested interests in protecting the employability of workers while controlling industry’s injury and disability costs. Labour unions want to protect the employability of the workers they represent. Management wants to avoid costly worker turnover, while retaining productive, reliable and experienced employees. Research suggests that the following concepts and strategies are important when developing and implementing effective worksite-based disability management programmes:

Joint labour-management involvement

Disability management requires employer and union involvement, support and accountability. Both are key contributors in the disability management process, participating actively as decision-makers, planners and coordinators of interventions and services. It is important for both labour and management to assess their joint capacities for responding to injury and disability. This often requires an initial analysis of joint strengths and weaknesses, as well as an assessment of the resources available to properly manage accommodation and return-to-work activities among workers with disabilities. Many unionized employers have successfully developed and implemented on-site disability management programmes under the guidance and support of joint labour- management committees (Bruyere and Shrey 1991).

Corporate culture

Organizational structures, worker attitudes, management intentions and historical precedents contribute to the corporate culture. Prior to developing a disability management programme in industry, it is important to understand the corporate culture, including the motivations and self-interests of labour and management regarding injury prevention, worksite accommodation and injured worker rehabilitation.

Injury and disability patterns

Disability management programmes in industry must be customized to address the unique patterns of injury and disability in the employer’s workforce, including types of impairments, ages of workers, lost-time statistics, accident data and costs associated with disability claims.

Interdisciplinary disability management team

Disability management requires an interdisciplinary disability management team. Members of this team often include employer representatives (e.g., safety managers, occupational health nurses, risk managers, human resources personnel, operations managers), labour union representatives, the worker’s treating physician, a rehabilitation case manager, an onsite physical or occupational therapist and the worker with a disability.

Early intervention

Perhaps the most important principle of disability management is early intervention. Rehabilitation policy and practice among most disability benefit systems recognizes the value of early intervention, in light of compelling empirical evidence resulting from disability management research over the past decade. Employers have substantially reduced disability costs by promoting early intervention concepts, including the systematic monitoring of workers with work restrictions. Early intervention strategies and programmes for an early return to work result in decreased lost time, increased employer productivity and decreased workers’ compensation and disability costs. Whether the disability is work related or not, early intervention is considered to be the primary factor upon which the foundation of medical, psychosocial and vocational rehabilitation is established (Lucas 1987; Pati 1985; Scheer 1990; Wright 1980). However, the successful management of disability also requires early return to work opportunities, accommodations and supports (Shrey and Olshesky 1992; Habeck et al. 1991). Typical early-return-to-work programmes in industry include a combination of disability management interventions, facilitated by an employer-based multidisciplinary team and coordinated by a skilled case manager.

Proactive interventions at individual and work environment levels

Disability management interventions must be directed at both the individual and the work environment. The traditional approach to rehabilitation often ignores the fact that occupational disability may originate as much from environmental barriers as from the worker’s personal traits. Workers dissatisfied with their jobs, supervisor-worker conflicts and poorly designed workstations rank high among the many environmental barriers to disability management. In short, to maximize rehabilitation outcomes among injured workers, an equally balanced focus on the individual and the work environment is needed. Job accommodations, as required under the Americans with Disabilities Act and other employment equity legislation, often expand the range of transitional work options for an injured worker. Redesigned tools, ergonomically correct workstations, adaptive devices, and work-schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks (Gross 1988). These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.

Benefit plan design

Employee benefit plans often reward workers for remaining disabled. One of the strongest negative forces impacting on unacceptable lost time and associated costs is economic disincentives. Benefit plans should not create an economic disincentive to work, but should reward workers who have disabilities for returning to work and remaining healthy and productive.

Return-to-work programmes

There are two basic ways to reduce disability costs in industry: (1)prevent accidents and injuries; and (2) reduce unnecessary lost time. Traditional light duty programmes in industry have been less than fully effective in returning injured workers to their jobs. Employers are increasingly using flexible and creative work return transition options and reasonable accommodations for workers with restrictions. The transitional work approach enables employees with disabilities to return to work before they fully recover from their injuries. Transitional work typically includes a combination of temporary assignment to modified work, physical conditioning, safe work practices education and work adjustment. Reduced lost time through transitional work translates into lower costs. The injured worker is enabled to perform temporary alternative productive work while gradually transitioning back to the original job.

Promotion of positive labour relations

Relationships between workers and work environments are dynamic and complex. Compatible relationships often lead to job satisfaction, enhanced productivity and positive labour relations, all of which are mutually rewarding for the worker and the employer. However, relationships characterized by unresolved conflicts can lead to mutually destructive consequences for workers and employers. Understanding the dynamics of person-environmental interactions in the workplace is an important first step in resolving injury and disability claims. The responsible employer is one that supports positive labour relations and promotes job satisfaction and worker involvement in decision making.

Psychological and social aspects of disability

Employers need to be sensitive to the psychological and social consequences of injury and disability and the overall impact of work disruption on the worker’s family. Psychosocial problems that are secondary to the initial physical injury typically emerge as lost work time increases. Relationships with family members often deteriorate rapidly, under the strain of excessive drinking and learned helplessness. Maladaptive behaviours resulting from work disruption are common. However, when other family members become adversely affected by the consequences of a worker’s injuries, pathological relationships within the family emerge. The disabled worker undergoes role changes. Family members experience “role change reactions”. The once independent, self-supporting worker now takes on a role of passive dependency. Resentment abounds when the family is disrupted by the presence of an ever-demanding, sometimes angry and often depressed individual. This is the typical outcome of unresolved labour relations problems, fuelled by stress and ignited by litigation activity and intense adversarial proceedings. Although the relationship among these forces is not always understood, the damage is usually profound.

Accident prevention and occupational ergonomics programmes

Many employers have experienced significant reductions in accidents by establishing formal safety and ergonomics committees. Such committees are typically responsible for safety surveillance and monitoring risk factors such as exposures to dangerous chemicals and fumes, and establishing controls to reduce the incidence and magnitude of accidents. More frequently, joint labour-management safety and ergonomics committees are addressing problems such as repetitive motion injuries and cumulative trauma disorders (e.g., carpal tunnel syndrome). Ergonomics is the application of technology to assist the human element in manual work. The overall objective of ergonomics is to fit the task to humans in order to enhance their effectiveness in the workplace. This means that ergonomics aims at:

• eliminating or minimizing injuries, strains and sprains

• minimizing fatigue and overexertion

• minimizing absenteeism and labour turnover

• improving quality and quantity of output

• minimizing lost time and costs associated with injuries and accidents

• maximizing safety, efficiency, comfort and productivity.

Ergonomic interventions can be considered preventive as well as rehabilitative. As a preventive approach, it is important to analyse ergonomically jobs that cause injuries and to develop effective ergonomic modifications that prevent future work disabilities. From a rehabilitation viewpoint, ergonomic principles can be applied to the jobsite accommodation process for workers with restrictions. This may involve exerting ergonomic administrative controls (e.g., rest periods, job task rotation, reduced work hours) or by ergonomically engineering the job tasks to eliminate re-injury risk factors (e.g., changing the table height, increasing illumination, repackaging to reduce lift loads).

Employer responsibility, accountability and empowerment

Employer empowerment is a basic principle of disability management. Except for the worker with a disability, the employer is the central figure in the disability management process. It is the employer who takes the first step in initiating early intervention strategies subsequent to an industrial accident and injury. The employer, being intimately familiar with work processes, is in the best position to implement effective safety and injury prevention programmes. Likewise, the employer is best positioned to create work return options for persons with lost-time injuries. Unfortunately, history has revealed that many employers have relinquished control and responsibility for disability management to parties external to the work environment. Decision making and problem solving, as relates to the resolution of work disability, have been assumed by insurance carriers, claims managers, workers’ compensation boards, physicians, therapists, case managers, rehabilitation professionals and even attorneys. It is only when employers become empowered in disability management that the lost-time trends and associated costs of workplace injury are reversed. However, employer empowerment over disability costs does not occur by chance. Not unlike persons with disabilities, employers often become empowered upon recognition of their internal resources and potentials. It is only with a new awareness, confidence and guidance that many employers are able to escape the relentless forces and consequences of workplace disability.

Case management and return-to-work coordination

Case management services are necessary to facilitate the development and implementation of disability management strategies and return-to-work plans for workers with disabilities. The case manager serves as a central disability management team member by functioning as a liaison between employers, labour representatives,  injured  workers,  community  health  care  providers and others. The case manager may facilitate the development, implementation and evaluation of an on-site transitional work or worker retention programme. It may be desirable for an employer to develop and implement such programmes, in order to: (1)prevent work disruptions among employees with medical impairments that effect work performance; and (2) promote a safe and timely return to work among impaired workers on medical leave, workers’ compensation or long-term disability. In the administration of an on-site transitional work programme, the case manager may take on direct rehabilitative responsibilities, such as: (1)objective worker evaluations; (2) classification of the physical job demands; (3) medical surveillance and follow-up; and (4) planning for placement in an acceptable permanent modified-duty option.

Disability management policy and procedure: creating expec-tations among supervisors, labour representatives and workers

It is important for employers to maintain a balance between worker and union expectations and the intentions of managers and supervisors. This requires joint labour-management involvement in the development of formal disability management policies and procedures. Mature disability management programmes have written policy and procedure manuals that include mission statements reflecting the interests and commitments of labour and management. Written procedures often delineate the roles and functions of internal disability management committee members, as well as the step-by-step activities from the point of injury to the safe and timely return to work. Disability management policies often define the relationships between the employer, health care providers and rehabilitation services in the community. A written policy and procedures manual serves as an effective communication vehicle among the various stakeholders, including physicians, insurance carriers, unions, managers, employees and service providers.

Enhancement of physician awareness of jobs and work environments

A universal problem in work injury management involves the lack of employer influence over the physician’s return-to-work determination. Treating physicians are often reluctant to release an injured employee to work with no restrictions prior to a full recovery. Physicians are often asked to make return-to-work judgements without adequate knowledge of the worker’s physical job demands. Disability management programmes have been successful in communicating with doctors regarding the employer’s willingness to accommodate workers with restrictions through transitional work programmes and the availability of temporary alternate duty assignments. It is essential for employers to develop functional job descriptions that quantify the exertional demands of job tasks. These tasks can then be reviewed by the treating physician to make a determination of the compatibility of the worker’s physical abilities and the functional demands of the job. Many employers have adopted the practice of inviting doctors to visit production sites and work areas to increase their familiarity with job demands and work environments.

Selection, utilization and evaluation of community services

Employers have realized substantial savings and improved work return outcomes by identifying, utilizing and evaluating effective medical and rehabilitation services in the community. Workers who become ill or injured are influenced by someone to make treatment provider choices. Poor advice often leads to extended or unnecessary treatment, higher medical costs and inferior results. In effective disability management systems, the employer takes an active role in identifying quality services that are responsive to the needs of workers with disabilities. When the employer “internalizes” these external resources, they become a vital partner in the overall disability management infrastructure. Workers with disabilities can then be guided to responsible service providers that share mutual return-to-work goals.

Utilization of independent medical evaluators

Occasionally an injured worker’s medical report fails to substantiate objectively the worker’s alleged impairments and medical restrictions. Employers often feel that they are held hostage to the treating physician’s opinions, particularly when the doctor’s rationale for determining the employee’s work restrictions are unsubstantiated by objective medical tests and measurable assessments. Employers need to exercise their right to independent medical and/or physical capacity evaluations when evaluating questionable disability claims. This approach requires that the employer take the initiative to explore objective and qualified medical and rehabilitation evaluators in the community.

Essential Components of an Optimal Disability Management System

An employer’s foundation for an optimal disability management system  has  three  major  components  (Shrey  1995,  1996). First, a worksite-based disability management programme requires a human  resource  component.  A  major  part  of  this  component  is the development of the employer’s internal disability management team. Joint worker-management teams are preferred, and they often include members representing the interests of labour unions, risk management, occupational health and safety, employer operations and financial management. Important criteria for the selection of disability management-team membership may include:

• resourcefulness—familiar with employer’s operations, labour relations, internal/external resources and corporate culture

• influence—able to initiate change within management decision-making process

• leadership—earns respect among workers, supervisors and senior management

• creativity—ability to design proactive interventions that work, despite obstacles

• commitment—professional views that are consistent with disability management mission and principles

• motivation—both self-motivated and able to motivate others towards programme goals and objectives

Gaps often exist with respect to the assignment and delegation of responsibilities for resolving disability problems. New tasks must be assigned to ensure that the steps from injury to work return are properly orchestrated. The human resource component includes knowledge and skill supports or training which enable managers and supervisors to perform their designated roles and functions. Accountability is essential, and it must be built into the organizational structure of the employer’s disability management programme.

The second component of an optimal disability management system is the operations component. This component includes activities, services and interventions which are implemented at the pre-injury, during injury and post-injury levels. Pre-injury operations components include effective safety programmes, ergonomic services, pre-placement screening mechanisms, loss prevention programmes and the development of joint labour-management committees. A strong pre-injury operations component is oriented towards injury prevention, and it may include health promotion and wellness services such as weight loss programmes, smoking cessation groups and aerobic conditioning classes.

The during-injury level of an optimal disability management system includes early intervention strategies, case management services, formalized transitional work programmes, worksite accommodations, employee assistance programmes and other health services. These activities are designed to resolve the disabilities that are not prevented at the pre-injury level.

The post-injury level of an optimal disability management system includes worker retention services. Worker retention services and interventions are designed to facilitate the worker’s adjustment to work performance within the context of the worker’s physical or mental restrictions and environmental demands. The post-injury  level  of  a  disability  management  system  should also include programme evaluation, financial management for cost-effectiveness, and programme enhancements.

The third component of an optimal disability management system is the communications component. This includes internal and external communications. Internally, the operational aspects of the employer’s disability management programme must be consistently and accurately communicated among employees, managers, supervisors and labour representatives. The policies, procedures and protocols for return-to-work activities should be communicated through labour and management orientations.

External communications enhance the employer’s relationship with treating physicians, claims managers, rehabilitation service providers and workers’ compensation administrators. The employer can influence an earlier return to work by providing treating physicians with functional job descriptions, job safety procedures and transitional work options for injured workers.

Conclusions

Workplace disability management and transitional work programmes represent a new paradigm in the rehabilitation of workers with illnesses and injuries. Trends reflect a shift in rehabilitative interventions from medical institutions to the worksite. Joint labour-management initiatives in disability management are commonplace, creating new challenges and opportunities for employers, unions and rehabilitation professionals in the community.

The interdisciplinary members of the worksite-based disability management team are learning to harness existing technologies and resources within the work environment. The demands on employers are essentially limited to their creativity, imagination and  flexibility to  adapt  disability  management  interventions  to the work environment. Job accommodations and temporary non-traditional job options expand the range of transitional work alternatives for workers with restrictions. Redesigned tools, ergonomically correct workstations, adaptive devices and work schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks. These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.

Protecting the rights of injured workers is an important component of disability management. Every year thousands of workers become disabled through industrial accidents and occupational diseases. Without transitional work options and accommodations, workers with disabilities risk discrimination similar to that faced by other individuals with disabilities. Thus, disability management is an effective advocate tool, whether advocating for the employer or the person with a disability. Disability management interventions protect the employability of the worker as well as the economic interests of the employer.

The profound impact of rapidly escalating workers’ compensation costs will be experienced worldwide by business and industry throughout the next decade. Just as this crisis offers a challenge to industry, disability management interventions and transitional work programmes create an opportunity. With a decreasing labour pool, an ageing workforce and increased worldwide competition, employers in industrialized societies must seize the opportunities to control the personal and economic costs of injury and disability. An employer’s success will be determined by the extent to which he is able to shape positive attitudes among labour and management representatives, while creating an infrastructure supportive of disability management systems.

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Gunnar Nordberg

Occurrence and Uses

Osmium (Os) is found almost exclusively in osmiridium, a natural alloy consisting of osmium and iridium, and in all platinum ores. The major ore deposits are located in the Urals, Canada and Colombia, with less important ores in Australia and in Alaska, California and Oregon in the United States.

Osmium alloys readily with the other platinum metals and with iron, cobalt and nickel. It also forms brittle intermetallic compounds with tin and zinc. One of the distinctive features of osmium is the ease with which it forms osmium tetroxide (OsO₄). Osmium powder always has the characteristic odour of its tetroxide because even at normal temperatures it oxidizes in air to OsO₄, even if only to a slight degree. The tetroxide is extremely volatile and has an unpleasant odour, from which the name of the element was derived (osme=odour). It is a powerful oxidizer and is easily converted to osmium dioxide (OsO₂) or even to metallic osmium. With alkalis it forms unstable compounds such as OsO₄·2KOH. When heated, osmium readily forms osmium disulphide (OsS₂). The fluorides OsF₄, OsF₆ and OsF₈ are also formed. Various chlorides are formed when osmium is treated with chlorine at high temperatures. With carbon monoxide, it forms carbonyls. It also forms a number of compounds with the complex anion containing osmium, as for example ammonium osmium hexachloride ((NH₄)₂OsCl₆).

Osmium is used as a catalyst in the synthesis of ammonia and in the hydrogenation of organic compounds. As an alloy with indium it is used for the manufacture of compass needles and fine machine bearings. It is found in the parts of watch and lock mechanisms and in fountain pen points. Osmium tetroxide, sometimes incorrectly termed osmic acid, is used as an oxidizing agent, particularly for converting olefins to glycols. The chloro-osmiates are used in place of gold salts in photography.

Hazards

The metal is innocuous, but persons engaged in its production are exposed to the effects of vapours from acids and chlorine. Osmium tetroxide vapours are poisonous and extremely irritating to the eyes even at low concentrations, causing weeping and conjunctivitis, and to the upper respiratory system, causing bronchitis, bronchial spasms and difficulty in breathing, which may last for several hours. Longer exposure can result in damage to the cornea, blindness, disturbances of the digestive system and inflammatory disorders of the lungs and kidneys. Upon contact, it discolours the skin green or black and causes dermatitis and ulceration.

Safety and Health Measures

During the production of osmium, local exhaust ventilation should be provided and the apparatus should be sealed if gaseous chlorine is used. An enclosed ventilated area or hood is necessary in order to control the release of osmium tetroxide vapours into the work environment and prevent eye and respiratory irritation. Exposed workers should wear protective clothing, hand protection, gas-tight chemical safety eye protection and appropriate respiratory protective equipment. Containers must be stored in naturally ventilated premises. The vapour has a pronounced and nauseating odour which should serve as a warning of toxic concentration in the air, and personnel should leave the polluted area immediately. Determination in air and blood is possible by colourimetry of the complex with thiourea.

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Gunnar Nordberg

Occurrence and Uses

Niobium (Nb) is found together with other elements including titanium (Ti), zirconium (Zr), tungsten (W), thorium (Th) and uranium (U) in ores such as tantalite-columbite, fergusonite, samarskite, pyrochlore, koppite and loparite. The largest deposits are located in Australia and Nigeria, and during the last few years extensive deposits have been discovered in Uganda, Kenya, Tanzania and Canada.

Niobium is widely used in the electrovacuum industry and also in the manufacture of anodes, grids, electrolytic condensers and rectifiers. In chemical engineering, niobium is used as a corrosion-proof material for heat exchangers, filters, needle valves and so on. High-quality cutting tools and magnetic materials are made from niobium alloys. Ferroniobium alloy is used in thermonuclear appliances.

Niobium and its refractory alloys are utilized in the field of rocket technology, in the supersonic aircraft industry, interplanetary flight equipment and in satellites. Niobium is also used in surgery.

Hazards

During the mining and concentration of niobium ore and processing of the concentrate, the workers may be exposed to general hazards, such as dust and fumes, which are typical for these operations. In the mines, the action of dust may be aggravated by exposure to radioactive substances such as thorium and uranium.

Toxicity

Much of the information about the behaviour of niobium in the body is based on studies of the radioisotope pair ⁹⁵Zr-⁹⁵Nb, a common nuclear fission product. ⁹⁵Nb is the daughter of ⁹⁵Zr. One study investigated cancer incidence among niobium mine workers exposed to radon and thoron daughters and found an association between lung cancer and cumulative alpha-radiation.

Intravenous and intraperitoneal injections of niobium (radioactive) and its compounds showed a fairly uniform distribution through the organism, with a tendency to accumulate in the liver, kidneys, spleen and bone marrow. The elimination of radioactive niobium from the organism can be hastened appreciably by the injection of massive doses of zirconium nitrate. After intraperitoneal injections of stable niobium in the form of potassium niobate, the LD₅₀ for rats was 86 to 92 mg/kg and for mice 13 mg/kg. Metallic niobium is not absorbed from the stomach or intestines. The LD₅₀ of niobium pentachloride in these organs was 940 mg/kg for rats, while the corresponding figure for potassium niobate was 3,000 mg/kg. Niobium compounds administered intravenously, intraperitoneally or per os produce a particularly pronounced effect on the kidneys. This effect can be attenuated by preventive medication with ascorbic acid. Oral intake of niobium pentachloride furthermore causes acute irritation of the mucous membranes of the gullet and stomach, and liver changes; chronic exposure during 4 months causes temporary blood changes (leukocytosis, prothrombin deficiency).

Inhaled niobium is retained in the lung, which is the critical organ for dust. Daily inhalation of niobium nitride dust at a concentration of 40 mg/m³ of air leads within a few months to signs of pneumoconiosis (while there are no noticeable signs of toxic action): thickening of the interalveolar septa, development of considerable amounts of collagenous fibres in the peribronchial and perivascular tissue, and desquamation of the bronchial epithelium. Analogous changes develop upon intratracheal administration of niobium pentoxide dust; in this case dust is found even in the lymph nodes.

Safety and Health Measures

Atmospheric concentrations of the aerosols of niobium alloys and compounds that contain toxic elements such as fluorine, manganese and beryllium, should be strictly controlled. During the mining and concentration of niobium ore containing uranium and thorium, the worker should be protected against radioactivity. Proper engineering design including adequate ventilation with fresh air is necessary to control dust in mine air. In the extraction of pure niobium from its compounds by powder metallurgy, the workplaces must be kept free from niobium dust and fumes, and workers must be protected against chemicals such as caustic alkalis and benzene. In addition, regular medical examinations which include lung function tests are recommended.

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As a rule disabled people have far fewer opportunities for occupational integration open to them than does the general population, a situation confirmed by all available data. However, in many countries political initiatives have been developed to improve this situation. Thus we find, for example, legal regulations requiring business enterprises to employ a specific percentage of disabled people, as well as—often in addition to this—financial incentives for employers to hire disabled people. Moreover, recent years have also seen the creation of services in many countries providing support and assistance to disabled people making their way into working life. The following contribution aims to describe these services and their specific tasks in the context of vocational rehabilitation and the integration of disabled people into employment.

We are concerned with services which become active, providing advice and support, during the rehabilitation phase—the preparatory phase prior to the disabled person’s entry into working life. Whereas support services used to limit themselves almost exclusively to this area, modern services have, in view of the continued existence on a global scale of employment problems of the disabled, turned their attention increasingly towards the stages dealing with placement and integration in an enterprise.

The increase in importance achieved by these services for the promotion of occupational integration has come about not least by growing community-based rehabilitation activities and, from a practical viewpoint, ever more numerous and successful approaches to the social integration of the disabled into the community. The continuing tendency towards the opening and overcoming of care institutions as mere places of confinement for disabled individuals has made the occupational and employment requirements for this group of people really visible for the first time. We are thus confronted with a growing variety of these support services because the growing demand for the integration of all disabled people into the community brings with it an increase in the associated tasks.

Rehabilitation and Integration

Only when disabled people are integrated into the community is the real aim and purpose of rehabilitation actually achieved. The objective of vocational rehabilitation programmes thus ultimately remains the finding of a job and hence participation in the local labour market.

As a rule, measures for medical and vocational rehabilitation lay the foundations for the (re)integration of disabled persons into working life. They aim to put the disabled individual in a position to be able to develop his or her own abilities in such a way that a life with no, or with a minimum of limitations in society at large becomes possible. The services which are active in this phase and which accompany the disabled person during this process are termed rehabilitation support services. Whereas one used to be able to assume that a completed course of medical rehabilitation and a well-founded vocational rehabilitation were, if not guarantees, then at least key factors for occupational integration, these elementary conditions are no longer adequate in view of the changing situation on the labour market and the complex requirements of the workplace. Of course solid vocational qualifications still form the basis of occupational integration, yet under today’s conditions many disabled people require additional assistance in looking for work and in integration into the workplace. The services active during this phase can be summarized under the name employment support services.

Whereas medical and vocational rehabilitation measures take as their primary point of departure the disabled persons themselves, and attempt to develop their functional capacities and vocational skills, the main emphasis of the employment support services lies on the side of the working environment and hence on the adaptation of the environment to the requirements of the disabled individual.

General Perspectives for Vocational Integration

In spite of the importance of the support services it should never be forgotten that rehabilitation should never, in any phase, be a merely passive form of treatment, but a process actively directed by the disabled person. Diagnosis, counselling, therapy and other forms of support can at best be an aid in the pursuit of self-defined objectives. Ideally the task of these services is still to outline the various options for action available, options which disabled people should ultimately decide for themselves, as far as possible.

Another no less significant parameter for occupational integration is to be seen in the holistic character which should be a hallmark of this process. That means that rehabilitation should be comprehensive and not just deal with the overcoming of impairment. It should involve the whole person and provide him or her with support in finding a new identity or in coping with the social consequences of disability. The rehabilitation of disabled people is in many cases far more than a process of physical stabilization and the extension of skills; if the course of rehabilitation is to run successfully and satisfactorily it must also be a process of psychosocial stabilization, identity formation and integration into everyday social relationships.

An important area of work for support services, and one which is unfortunately all too often ignored, is the field of the prevention of serious disabilities. For working life in particular it is crucial that rehabilitation and employment services are open not just to people who are already disabled but also to those who are threatened by disability. The earlier the reaction to a commencing disability, the sooner that steps towards occupational reorientation can be taken, and the earlier that serious disabilities can be avoided.

These general perspectives for vocational rehabilitation also provide an outline of the essential tasks and parameters for the work of the support services. Furthermore, it should also be clear that the complex tasks described here can best be fulfilled by the interdisciplinary collaboration of experts from various professions. Modern rehabilitation can thus be seen as cooperation between the disabled person and a team of professional trainers as well as qualified medical, technical, psychological and educational personnel.

Medical Rehabilitation

Medical rehabilitation measures usually take place in hospitals or in special rehabilitation clinics. The task of the support services in this phase consists of initiating first steps towards coping psychologically with a disability which has been suffered. However, occupational (re)orientation should also take place as soon as possible, practically at the patient’s bedside, since the construction of a new vocational perspective often helps to lay decisive motivational foundations which can also facilitate the medical rehabilitation process. Other measures such as motor and sensory training programmes, physiotherapy, movement and occupational or speech therapy can also contribute during this phase towards accelerating the natural regenerative process and reducing or avoiding the creation of dependencies.

The decision concerning the vocational perspectives of a disabled person should under no circumstances be taken from a purely medical point of view by a doctor, as is unfortunately still often the case in practice. The basis of any decision on the vocational future of a disabled person should be formed not just by deficits which can be medically diagnosed but rather by existing abilities and skills. The rehabilitation support services should therefore undertake together with the disabled person an extensive review of the client’s vocational background and an inventory of potential abilities and existing interests. Building on this an individual rehabilitation plan should then be drawn up which takes into account the potentialities, interests and requirements of the disabled person as well as the potential resources in his or her social environment.

A further area of work for the rehabilitation support services in this phase lies in the counselling of the disabled person with regard to any technical assistance, equipment, wheelchairs, artificial limbs, and so on which may be required. Use of this kind of technical assistance may at first be accompanied by rejection and refusal. Should a disabled person fail to receive the proper support and instruction during this initial phase, he or she may run the risk of the initial rejection escalating into a phobia which may later make it difficult to obtain the full benefit of the apparatus in question. In view of the wide variety of technical assistance nowadays available, the choice of such equipment must be made with the greatest care, tailored as far as possible to the individual needs of the disabled person. Ideally the selection of technical equipment required should also take into account both the disabled person’s vocational perspective and—as far as possible—the demands of the future workplace, given that the latter will also determine the purpose which the technical assistance must fulfil.

Vocational Rehabilitation

In the ILO “Convention (159) concerning vocational rehabilitation and employment (disabled persons)” adopted in 1983, the purpose of vocational rehabilitation is considered “as being to enable a disabled person to secure, retain and advance in suitable employment and thereby to further such person’s integration or reintegration into society”.

The past 30 years have seen rapid developments in vocational rehabilitation services for disabled persons. They include vocational assessment, which aims to get a clear picture of the person’s potential abilities; orientation courses to help the person to restore lost confidence in his or her abilities; vocational guidance, to develop a (new) vocational perspective and to choose a certain occupation; vocational training and retraining opportunities in the chosen field of activity; and placement services, designed to assist the disabled person in finding employment adapted to his or her disability.

A disabled person’s (re)entry into employment usually takes place via individual or combined vocational rehabilitation programmes, which can be carried out in different locations. It is the task of the rehabilitation support services to discuss with the disabled person whether the vocational qualification measure should be carried out in a mainstream institution for vocational training, in a specialized institution for vocational rehabilitation, by making use of community-based facilities or even directly in a normal workplace. The latter option is especially suitable when the previous job is still available and the workplace management have demonstrated their readiness in principle to rehire their former employee. However, in other cases cooperation with a regular workplace may already be a recommended option during the course of the vocational training, given that experience has shown that such cooperation also improves the chances of the participant subsequently being taken on by the firm. Thus in the case of vocational training in a vocational rehabilitation centre, it goes without saying that the support services should undertake the task of assisting disabled people in the search for possibilities of on-the-job practical training.

Of course these options for carrying out vocational rehabilitation measures cannot be seen separately from certain parameters and conditions which vary from country to country. Furthermore, the actual decision on the location of the vocational rehabilitation activity also depends on the kind of work envisaged and the type of disability, as well as on the disabled person’s social environment and the natural support potential available within it.

Wherever vocational rehabilitation takes place, it remains the task of the rehabilitation support services to accompany this process, to discuss together with the disabled person the experiences gained and to further extend the individual rehabilitation plan, adapting it to new developments as necessary.

Employment Support Services

Whereas medical and vocational rehabilitation in many countries can count on the support of a more or less extensive system of institutional settings, a comparable infrastructure for the promotion of the integration of disabled people into employment does not as yet exist even in some highly industrialized countries. And although various countries do have a number of quite successful models, some of which have been in existence for a number of years, employment services in most countries, with the exception of certain approaches in Australia, the United States, New Zealand and Germany, still do not form an integral part of national policy for disabled persons.

While the placement of disabled people into employment is an obligatory part of general labour administration in many countries, in view of the growing number of unemployed these institutions are less and less in a position to fulfil their obligations to place disabled people in work. This is exacerbated in many cases by a lack of appropriately qualified staff capable of doing justice to the abilities and wishes of the disabled person as well as to the requirements of the world of work. The creation of employment support services is also a reaction to the increasing lack of success of the traditional “train and place” approach implicit in institutionalized vocational rehabilitation. In spite of elaborate and often successful medical and vocational rehabilitation measures, integration into employment without additional assistance is becoming increasingly difficult.

It is at this point that the requirement for specific employment support services expresses itself. Wherever such services have been installed, they have been met by enormous demand from disabled persons and their families. This kind of service is particularly necessary and successful at the institutional interfaces between schools, rehabilitation institutions, sheltered workshops and other facilities for disabled persons on the one hand and the workplace on the other. However, the existence of employment support services also reflects the experience that many disabled people also require support and accompaniment not just in the phase of placement in employment, but also during the adjustment phase in the workplace. A number of larger firms have their own, internal employee assistance service, responsible for the integration of newly employed disabled people and for maintaining the jobs of disabled workers already employed.

Tasks of Employment Support Services

The primary intervention focus of the employment support services is on the critical threshold of entry into working life. Generally speaking, their task consists of creating links between the disabled person and the firm in question, that is, with the direct superior and future colleagues in the workplace.

Employment support services must on the one hand provide support for the disabled person in finding work. This takes place by means of self-confidence and (video supported) job interview training and assistance in the writing of letters of application, but also and primarily in placement in on-the-job practical training. All experiences have shown that such practical on-the-job training forms the most important bridge into the firm. Where necessary the services accompany the disabled person to job interviews, providing assistance with official paperwork and in the initial adjustment phase in the workplace. Lack of capacity means that most employment support services are unable to provide support beyond the confines of the workplace. However, in theory such support is also undesirable. To the extent that further assistance in the private sphere, whether psychological, medical or life-skills related in nature, is also required, it is usually provided by referral to the appropriately qualified facilities and institutions.

On the other hand, with regard to firms, the most important tasks of the support services consist initially of motivating an employer to take on a disabled person. Although many firms do have broad reservations about employing disabled people, it is still possible to find firms prepared to enter into continual cooperation with vocational rehabilitation facilities and employment support services. Once such a general readiness for cooperation has been identified or established, it is then a case of locating suitable jobs within the firm. Before any placement in the firm, there should of course be a comparison of the requirements of the job with the abilities of the disabled person. However, the time and energy occasionally spent in model projects which use supposedly “objective” procedures to compare differentiated ability and requirement profiles in order to work out the “optimal” job for a specific disabled person, usually bears no relation to the chances of success and the practical efforts involved in actually finding the job. It is more important to turn disabled persons into the agents of their own vocational development, since in terms of psychological significance we cannot place too high a value on the involvement of the persons concerned in the shaping of their own vocational future.

Placement approaches already elaborated attempt to build on detailed analyses of organizational structure and working procedure by making suggestions to the firm regarding the reorganization of certain working areas and hence to create work opportunities for disabled people. Such suggestions can include a reduction in certain working requirements, the creation of part-time work and flexible work times as well as the reduction of noise and stress in the workplace.

Employment support services also offer to assist firms in applying for public subsidies, such as wage subsidies, or in overcoming bureaucratic hurdles when applying for state grants for technical compensation for disability-related limitations. However, support for the disabled person in the workplace must not necessarily be only of a technical nature: people with visual impairment may under certain circumstances require not only a Braille keyboard for their computer and an appropriate printer, but also someone to read aloud for them; and persons with hearing impairment could be assisted through a sign-language interpreter. Sometimes support in acquiring the qualifications required for the job or in social integration into the firm will be necessary. These and other similar tasks are often undertaken by an employment support services worker designated as a “job coach”. The individualized support provided by the job coach decreases over time.

People with mental or psychiatric disabilities usually require a step-by-step integration with a gradual increase in work requirements, working hours and social contact, which has to be organized by the support services in cooperation with the firm and the disabled person.

For every form of support the maxim applies that it must be tailored to the individual requirements of the disabled person as well as harmonized with the firm’s own resources.

The Example of Supported Employment

Supported employment for persons with disabilities is a concept in which wage subsidies for the firms involved and individualized support services for disabled persons are connected with each other in order to achieve full integration into working life. This concept is particularly widespread in Australia and New Zealand, in various European countries and in the United States. It has so far primarily been used for the workplace integration of mentally and psychiatrically disabled people.

Employment support services undertake the placement of disabled people in a firm, organize the financial, technical and organizational support required by the firm and provide a job coach who accompanies the job-related and social integration of the disabled person into the firm.

The employer is thus relieved of all normally anticipated problems related to the hiring of disabled persons. As far as possible and necessary, the employment support services also undertake the required adaptations in the workplace and the disabled person’s immediate working environment. Occasionally it will be necessary for the applicant to receive additional training outside the firm, although instruction usually takes the form of on-the-job training by the job coach. It is also the job coach’s task to orient the colleagues and superiors in the technical and social support of the disabled person, since the aim in principle is to gradually reduce the professional assistance of the employment support service. It is, however, absolutely necessary that in the case of acute problems the employment support service should be present to provide continual assistance to the extent required. This means that support both for the disabled person and for the employer, the superior and colleagues, must be individualized and correspond to specific needs.

Cost-benefit analyses of this approach carried out in the United States have shown that although the initial integration phase is very intensive in terms of support provided and hence costs, the longer employment lasts, the more this investment is also justified from a financial point of view, not just for the disabled person, but also for the employer and the public budget.

Placement of disabled people by supported employment approaches is most common in relatively undemanding jobs, which tend to run the risk of being eliminated. The future of the supported employment approach will be decided not just by developments in the labour market but also by the further development of the concept.

Challenges for the Future of Employment Support Services

The following sections contain descriptions of a number of critical points whose significance for the further development of the concepts and for the practical work of employment support services should not be underestimated.

Networking with Vocational Rehabilitation Facilities and Firms

If employment support services are not to miss the mark in terms of what is actually required, a central task everywhere will be to create organic links with the existing vocational rehabilitation facilities. Integration services with no links to rehabilitation facilities run the risk—as experience has shown—of functioning primarily as instruments of selection and less as services for the vocational integration of disabled persons.

However, support services require not only networking and cooperation with vocational rehabilitation facilities, but also and more importantly, a clear positioning with regard to cooperation with firms. Under no circumstances should employment support services function merely as counselling services for disabled persons and their families; they must also be active in work-finding and placement services. Proximity to the labour market is the key to access to firms and ultimately to the possibilities of finding employment for disabled individuals. If these services’ access threshold to the firm is to be maximized, they must be situated as close as possible to actual economic activity.

Connections Between Qualification, Placement and Employment

An important part of all vocational integration efforts, and hence a central challenge for employment support services, is the coordination of vocational preparation and qualification with the requirements of the workplace—an aspect often still neglected. As justified as a criticism of the traditional “train and place” model may be, in practice just to first place and then provide training in the required skills is not enough either. Working under today’s conditions means not only having the so-called secondary working virtues at one’s disposal—punctuality, concentration and speed—but also a number of technical qualifications which are always required and which must already be present before employment can be started. Anything else would be asking too much, both of the persons to be placed and of the firms prepared to take them on.

Mobilizing Natural Support

The chances of the successful vocational integration of disabled people into the labour market increase with the possibility of organizing help and support, either in parallel to the work process or directly in the workplace. Especially in the initial adjustment phase it is important both to assist the disabled person in coping with the demands of work and also to provide support for those who make up the working environment. This form of accompanying assistance is usually provided by the employment support services. The integration of a disabled person will be all the more successful in the long term, the more this kind of professional help can be replaced by a mobilization of natural support in the firm, whether by colleagues or superiors. In a project recently carried out in Germany for the mobilization of natural support by so-called foster workers in the workplace, 42 disabled people were successfully integrated in the course of 24 months; over 100 firms were asked to participate. The project showed that few employees had the required level of knowledge and experience in dealing with disabled people. It thus appeared to be of strategic importance for the employment services to develop a conceptual framework in order to organize the replacement of professional support and the mobilization of natural support in the workplace. In the UK for example, employees prepared to act as foster workers for a certain time receive recognition in the form of a small financial reward.

Success Orientation and User Control

Finally, employment support services should also offer their own employees incentives to go into firms and bring about the placement of disabled people, for it is on these placement efforts within the firms that the central focus of the services must lie. Yet the placement of disabled people can be secured in the long term only when the funding of the employment support services and their employees is to a certain extent related to their success. How can service employees be motivated in a continual way to leave their institution, only to undergo the frustration of rejection in the firms? The placement of disabled people in employment is a difficult business. Where is the impetus to come from to battle doggedly and constantly against prejudice? All organizations develop their own interests, which are not necessarily in accord with those of their clients; all publicly funded institutions run the risk of becoming divorced from the needs of their clients. For this reason a corrective is required which creates general incentives—not just for employment support services but also for other social facilities—in the direction of the desired result.

A further necessary modification of the work of publicly funded social facilities consists of the users and their organizations having a say in matters relating to them. This culture of participation should also find an echo in the concepts behind the support services. In this context the services, like all other publicly funded institutions, should be subjected to regular control and evaluation by their clients—their users and their families—and last but not least by the firms cooperating with the services.

Concluding Remarks

Which and how many disabled persons can ultimately be integrated into the labour market by the activities of vocational rehabilitation and employment support services cannot be answered in the abstract. Experience shows that neither the degree of disability nor the situation on the labour market can be regarded as absolute limitations. The factors determining development in practice include not just the support services’ way of working and the situation on the job market, but also the dynamics arising within institutions and facilities for disabled persons, when this kind of employment option becomes a concrete possibility. In any case, experiences from various countries have shown that collaboration between employment support services and sheltered facilities tends to have considerable effect on the internal practices within these facilities.

People need perspectives, and motivation and development arise to the extent that perspectives exist or are created by new options. Important as the absolute number of placements realized by the employment support services is, of equal importance is the opening up of options for the personal development of disabled people made possible by the very existence of such services.

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The Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No. 159) and Vocational Rehabilitation and Employment (Disabled Persons) Recommendation, 1983 (No.168),  which  supplement  and  update  the  Vocational  Rehabilitation (Disabled) Recommendation, 1955 (No. 99), are the principal reference documents for a social policy on the issue of disability. However, there are a number of other ILO instruments which explicitly or implicitly make reference to disability. There are notably the Discrimination (Employment and Occupation) Convention, 1958 (No. 111), the Discrimination (Employment and Occupation) Recommendation, 1958 (No. 111), the Human Resources  Development  Convention,  1975  (No. 142)  and  the Human Resources Development Recommendation, 1975 (No.150)

In addition, important references to disability issues are included in a number of other key ILO instruments, such as: Employment Service Convention, 1948 (No. 88); Social Security (Minimum Standards) Convention, 1952 (No. 102); Employment Injury Benefits Convention, 1964 (No. 121); Employment Promotion and Protection against Unemployment Convention, 1988 (No. 168); Employment Service Recommendation, 1948 (No. 83); Labour Administration Recommendation, 1978 (No. 158) and Employment Policy (Supplementary Provisions) Recommendation, 1984 (No. 169).

International labour standards treat disability basically under two different headings: as passive measures of income transfer and social protection, and as active measures of training and employment promotion.

One early objective of the ILO was to ensure that workers receive adequate financial compensation for disability, in particular if it was caused in relation to work or war activities. The underlying concern has been to ensure that a damage is adequately compensated, that the employer is liable for accidents and unsafe working conditions, and that in the interest of good labour relations, there should be fair treatment of workers. Adequate compensation is a fundamental element of social justice.

Quite distinct from the compensation objective is the social protection objective. ILO standards which deal with issues of social security look at disability largely as a “contingency” which needs to be covered under social security legislation, the idea being that disability can be a cause of loss of earning capacity and therefore be a legitimate reason to secure income through transfer payments. The principal objective is to provide insurance against loss of income and thus guarantee decent living conditions for people deprived of the means of gaining their own income due to impairment.

In a similar way, policies which pursue a social protection objective tend to provide public assistance to people with disabilities not covered by social insurance. Also in this case the tacit assumption is that disability means incapacity to find adequate income from work, and that a disabled person has therefore to be the responsibility of the public. As a result, disability policy is in many countries predominantly a concern of the social welfare authorities, and the primary policy is that of providing passive measures of financial assistance.

However, those ILO standards which deal explicitly with disabled persons (such as Conventions Nos. 142 and 159, and Recommendations Nos. 99, 150 and 168) treat them as workers and put disability—quite in contrast to the compensation and social protection concepts—in the context of labour market policies, which have as their objective to ensure equality of treatment and opportunity in training and employment, and which look at disabled people as being part of the economically active population. Disability is understood here basically as a condition of occupational disadvantage which can be and should be overcome through a variety of policy measures, regulations, programmes and services.

ILO Recommendation No. 99 (1955), which for the first time invited member States to shift their disability policies from a social welfare or social protection objective towards a labour integration objective, had a profound impact on law in the 1950s and 1960s. But the real breakthrough occurred in 1983 when the International Labour Conference adopted two new instruments, ILO Convention No. 159 and Recommendation No. 168. As of March 1996, 57 out of 169 member States had ratified this Convention.

Many others have readjusted their legislation so as to comply with this Convention even if they have not, or not yet, ratified this international treaty. What distinguishes these new instruments from the former ones is the recognition by the international community and by employers’ and workers’ organizations of the right of disabled persons to equal treatment and opportunity in training and employment.

These three instruments now form a unity. They aim to ensure active labour market participation of disabled people and thus to challenge the sole validity of passive measures or of policies which treat disability as a health problem.

The purposes of the international labour standards which have been adopted with this objective in mind can be described as follows: to remove the barriers which stand in the way of full social participation and integration of disabled people in the mainstream, and to provide the means to promote effectively their economic self-reliance and social independence. These standards oppose a practice that treats disabled people as being outside the norm and excludes them from the mainstream. They object to the tendency of taking disability as a justification for social marginalization and for denying people, on account of their disability, civil and workers’ rights which non-disabled people enjoy as a matter of course.

For the purpose of clarity we may group the provisions of international labour standards which promote the concept of the right of disabled people to active participation in training and employment into two groups: those which address the principle of equal opportunity and those which address the principal of equal treatment.

Equal opportunity: the policy goal which lies behind this formula is to ensure that a disadvantaged population group has access to the same employment and income-earning possibilities and opportunities as the mainstream population.

In order to achieve equal opportunity for disabled people, the pertinent international labour standards have established rules and recommended measures for three types of action:

• Action  to  empower  the  disabled  individual to  achieve  the  level of competencies and abilities required to take advantage of employment opportunity and to provide the technical means and the required assistance which would enable that individual to cope with the demands of a job. This type of action is what essentially constitutes the process of vocational rehabilitation.
• Action which helps to adjust the environment to the special needs of disabled persons, such as worksite, job, machine or tool adaptations as well as legal and promotional action which helps to overcome negative and discriminatory attitudes that cause exclusion.
• Action which ensures disabled people real employment opportunities. This includes legislation and policies which favour remunerative work over passive income support measures, as well as those which entice employers to employ, or to maintain in employment, workers with a disability.
• Action which sets employment targets or establishes quotas or levies (fines) under affirmative action programmes. It also includes services by which labour administrations and other bodies may assist disabled people to find jobs and to advance in their careers.

Therefore, these standards, which have been developed to guarantee equality of opportunity, imply the promotion of special positive measures to help disabled people make the transition into active life or to prevent unnecessary, unwarranted transition into a life reliant upon passive income support. Policies geared to establish equality of opportunity are, therefore, usually concerned with the development of support systems and special measures to bring about effective equality of opportunities, which are justified by the need to compensate for the real or presumed disadvantages of disability. In ILO legal parlance: “Special positive measures aimed at effective equality of opportunity … between disabled workers and other workers shall not be regarded as discriminating against other workers” (Convention No. 159, Article 4).

Equal treatment: The precept of equal treatment has a related but distinct objective. Here the issue is that of human rights, and the regulations which ILO member States have agreed to observe have precise legal implications and are subject to monitoring and—in case of violation—to legal recourse and/or arbitration.

ILO Convention No. 159 established equal treatment as a guaranteed right. It furthermore specified that equality has to be “effective”. This means that conditions should be such as to ensure that the equality is not only formal but real and that the situation resulting from such treatment puts the disabled person into an “equitable” position, that is one which corresponds by its results and not by its measures to that of non-disabled persons. For example, to assign a disabled worker the same job as a non-disabled worker is not equitable treatment if the worksite is not fully accessible or if the job is not suited to the disability.

Present Legislation on Vocational Rehabilitation and Employment of Disabled Persons

Each country has a different history of vocational rehabilitation and employment of disabled persons. The legislation of member States varies due to their different stages of industrial development, social and economic situations, and so on. For example, some countries already had legislation on disabled persons before the Second World War, deriving from disability measures for disabled veterans or poor people at the beginning of this century. Other countries started to take concrete measures to support disabled persons after the Second World War, and established legislation in the field of vocational rehabilitation. This was often expanded following the adoption of the Vocational Rehabilitation of the Disabled Recommendation, 1955 (No. 99) (ILO 1955). Other countries only recently started taking measures for disabled persons due to the awareness created by the International Year of Disabled Persons in 1981, the adoption of ILO Convention No.159 and Recommendation No. 168 in 1983 and the United Nations Decade of Disabled Persons (1983–1992).

The current legislation on vocational rehabilitation and employment of disabled persons is divided into four types according to different historical backgrounds and policies (figure 1).

Figure 1. Four types of legislation on rights of persons with disabilities.

We must realize that there are no clear divisions between these four groups and that they may overlap. Legislation in a country may correspond not only to one type, but to several. For example, the legislation of many countries is a combination of two types or more. It seems that the legislation of Type A is formulated in the early stage of measures for disabled persons, whereas the legislation of Type B is from a later stage. The legislation of Type D, namely the prohibition of discrimination because of disabilities, has been growing in recent years, supplementing the prohibition of discrimination on the basis of race, sex, religion, political opinion and so on. The comprehensive nature of legislation of Types C and D may be used as models for those developing countries which have not yet formulated any concrete legislation on disability.

Sample Measures of each Type

In the following paragraphs, the structure of legislation and measures stipulated are outlined by some examples of each type. As measures for vocational rehabilitation and employment of disabled persons in each country are often more or less the same, regardless of the type of legislation in which they are provided for, some overlaps occur.

Type A: Measures for disabled persons on vocational rehabilitation and employment which are provided for in general labour legislation such as employment promotion acts or vocational training acts. Measures for disabled persons may also be included as part of comprehensive measures for workers in general.

The characteristic of this type of legislation is that measures for disabled people are provided for in the acts which apply to all workers, including disabled workers, and to all enterprises employing workers. As measures on employment promotion and employment security for disabled persons are basically incorporated as part of comprehensive measures for workers in general, the national policy gives priority to internal rehabilitation efforts of enterprises and to preventive activities and early intervention in working environments. To this end, working environment committees, which consist of employers, workers and safety and health personnel are often set up in enterprises. The details of the measures tend to be provided for in regulations or rules under the acts.

For example, the Working Environment Act of Norway applies to all workers employed by most enterprises in the country. Some special measures for handicapped persons are incorporated: (1) Passageways, sanitary facilities, technical installations and equipment shall be designed and arranged so that handicapped persons can work in the enterprise, as far as possible. (2) If a worker has become handicapped in the workplace as a result of accident or sickness the employer shall, as far as possible, take the necessary measures to enable the worker to obtain or retain suitable employment. The worker shall preferably be given an opportunity to continue his or her former work, possibly after special adaptation of the work activity, alteration of technical installations, rehabilitation or retraining and so on. The following are examples of action that must be taken by the employer:

• procurement of or changes to technical equipment used by the worker—for instance, tools, machinery, and so on
• alterations to the workplace—this could refer to alterations to furniture and equipment, or to alterations to doorways, thresholds, installation of lifts, procurement of wheelchair ramps, repositioning of door handles and light switches, and so on
• organization of the work—this could involve alteration of routines, changes in working hours, active participation by other workers; for instance, recording on and transcribing from a dictaphone cassette
• measures in connection with training and retraining.

In addition to these measures, there is a system which provides employers of handicapped persons with subsidies concerning the additional cost to adapt the workplace to the worker, or vice versa.

Type B: Measures for disabled persons which are provided for in special acts which deal exclusively with vocational rehabilitation and employment of disabled persons.

This type of legislation usually has specific provisions on vocational rehabilitation and employment dealing with various measures, while other measures for disabled people are stipulated in other acts.

For example, the Severely Disabled Persons Act of Germany provides for the following special assistance for disabled persons to improve their employment opportunities, as well as vocational guidance and placement services:

• vocational training in enterprises and training centres or in special vocational rehabilitation institutions
• special benefits for disabled persons or employers—payment of application and removal costs, transitional allowances, technical adaptation of workplaces, payment of housing costs, assistance in acquiring a special vehicle or additional special equipment or in obtaining a driving licence
• the obligation for public and private employers to reserve 6% of their workplaces for severely disabled persons; compensation payments must be paid in respect of the places not filled in this manner
• special protection against dismissal for all severely disabled persons after a period of six months
• representation of the interests of severely disabled persons in the enterprise by means of a staff counsellor
• supplementary benefits for severely disabled persons to ensure their integration into occupation and employment
• special workshops for disabled persons who are unable to work on the general labour market because of the nature or severity of their impediment
• grants for employers of up to 80% of the wage paid to disabled persons for a period of two years, as well as payments in respect of the adaptation of workplaces and the establishment of specified probationary periods of employment.

Type C: Measures for the vocational rehabilitation and employment of disabled persons which are provided for in comprehensive special acts for disabled persons linked together with measures for other services such as health, education, accessibility and transportation.

This type of legislation usually has general provisions concerning the purpose, declaration of policy, coverage, definition of terms in the first chapter, and after that several chapters which deal with services in the fields of employment or vocational rehabilitation as well as health, education, accessibility, transportation, telecommunications, auxiliary social services and so on.

For example, the Magna Carta for Disabled Persons of the Philippines provides for the principle of equal opportunity for employment. The following are several measures from chapter on employment:

• 5% of reserved employment for disabled persons in departments or agencies of the government
• incentives for employers such as a deduction from their taxable income equivalent to a certain part of the wages of disabled persons or of the costs of improvements or modifications of facilities
• vocational rehabilitation measures that serve to develop the skills and potentials of disabled persons and enable them to compete favourably for available productive and remunerative employment opportunities, consistent with the principle of equal opportunity for disabled workers and workers in general
• vocational rehabilitation and livelihood services for disabled people in the rural areas
• vocational guidance, counselling and training to enable disabled persons to secure, retain and advance in employment, and the availability and training of counsellors and other suitably qualified staff responsible for these services
• government-owned vocational and technical schools in every province for a special vocational and technical training programme for disabled persons
• sheltered workshops for disabled individuals who cannot find suitable employment in the open labour market
• apprenticeship.

Furthermore, this act has provisions concerning prohibition of discrimination against disabled persons in employment.

Type D: Measures for prohibition of discrimination in employment on the basis of disability which are provided for in a comprehensive special anti-discrimination act along with measures for prohibition of discrimination in areas such as public transportation, public accommodation and telecommunications.

The feature of this type of legislation is that there are provisions which deal with discrimination on the ground of disability in employment, public transportation, accommodation, telecommunications and so on. Measures for vocational rehabilitation services and the employment of disabled people are provided for in other acts or regulations.

For example, the Americans with Disabilities Act prohibits discrimination in such important areas as employment, access to public accommodations, telecommunications, transportation, voting, public services, education, housing and recreation. As for employment in particular, the Act prohibits employment discrimination against “qualified individuals with a disability” who, with or without “reasonable accommodation”, can perform the essential functions of the job, unless such accommodation would impose “undue hardship” on the operation of the business. The Act prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training and other terms, conditions and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits and all other employment-related activities.

In Australia, the purpose of the Disability Discrimination Act is to provide improved opportunities for people with a disability and to assist in breaking down barriers to their participation in the labour market and other areas of life. The Act bans discrimination against people on the grounds of disability in employment, accommodation, recreation and leisure activities. This complements existing anti-discrimination legislation that outlaws discrimination on the grounds of race or gender.

Quota/Levy Legislation or Anti-discrimination Legislation?

The structure of national legislation on vocational rehabilitation and employment of disabled persons varies somewhat from country to country, and it is therefore difficult to determine which type of legislation is best. However, two types of legislation, namely quota or levy legislation and anti-discrimination legislation, seem to emerge as the two main legislative modes.

Although some European countries, among others, have quota systems which are usually provided in the legislation of Type B, they are quite different in some points, such as the category of disabled persons to whom the system is applied, the category of employers on whom the employment obligation is imposed (for example, size of the enterprise or public sector only) and the employment rate (3%, 6%, etc.). In most countries the quota system is accompanied by a levy or grant system. Quota provisions are also included in the legislation of non-industrialized countries as varied as Angola, Mauritius, the Philippines, Tanzania and Poland. China is also examining the possibility of introducing a quota system.

There is no doubt that a quota system that is enforceable could contribute considerably to raising the employment levels of disabled persons in the open labour market. Also, the system of levies and grants helps to rectify the financial inequality between the employers who try to employ disabled workers and the ones who do not, while levies contribute to accumulating valuable resources that are needed to finance vocational rehabilitation and incentives for employers.

On the other hand, one of the problems of the system is the fact that it requires a clear definition of disability for recognizing qualification, and strict rules and procedures for registration, and therefore it may raise the problem of stigma. There may also be the potential discomfort of a disabled person being at a place of employment where he or she is not wanted by the employer but is merely tolerated to avoid legal sanctions. In addition, credible enforcement mechanisms and their effective application are required for quota legislation to achieve results.

Anti-discrimination legislation (Type D) seems to be more appropriate for the principle of normalization, ensuring disabled persons equal opportunities in society, because it promotes employers’ initiatives and social consciousness by means of environmental improvement, not employment obligation.

On the other hand, some countries have difficulties in enforcing anti-discrimination legislation. For example, remedial action usually requires a victim to play the role of complainant, and in some cases it is difficult to prove discrimination. Also the process of remedial action commonly takes a long time because a lot of complaints of discrimination on the basis of disability are sent to courts or equal rights commissions. It is generally admitted that anti-discrimination legislation has still to prove its effectiveness in placing and maintaining large numbers of disabled workers in employment.

Future Trends

Although it is difficult to forecast future trends in legislation, it appears that anti-discrimination acts (Type D) are one stream which both developed countries and developing countries will consider.

It seems that industrialized countries with a history of quota or quota/levy legislation will watch the experience of countries such as the United States and Australia before taking action to adjust their own legislative systems. In particular in Europe, with its concepts of redistributive justice, it is likely that the prevailing legislative systems will be maintained, while, however, introducing or strengthening anti-discrimination provisions as an additional legislative feature.

In a few countries like the United States, Australia and Canada, it could be politically difficult to legislate a quota system for disabled people without having quota provisions also in relation to other population groups that experience disadvantages in the labour market, such as women and ethnic and racial minority groups currently covered by human rights or employment equity legislation. Although a quota system would have some advantages for disabled people, the administrative apparatus required for such a multicategory quota system would be enormous.

It appears that developing countries which have no disability legislation may choose legislation of Type C, including a few provisions concerning prohibition of discrimination, because it is the more comprehensive approach. The risk of this approach, however, is that comprehensive legislation which cuts across the responsibility of many ministries becomes the affair of a single ministry, mostly that responsible for social welfare. This may be counterproductive, reinforce segregation and weaken the government’s ability to implement the law. Experience shows that comprehensive legislation looks good on paper, but is rarely applied.

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F. William Sunderman, Jr.

Nickel (Ni) compounds of interest include nickel oxide (NiO), nickel hydroxide (Ni(OH)₂), nickel subsulphide (Ni₃S₂), nickel sulphate (NiSO₄) and nickel chloride (NiCl₂). Nickel carbonyl (Ni(CO)₄) is considered in a separate article on metal carbonyls.

Occurrence and Uses

Nickel (Ni) comprises 5 to 50% of the weight of meteorites and is found in ores in combination with sulphur, oxygen, antimony, arsenic and/or silica. Ore deposits of commercial importance are principally oxides (e.g., laterite ores containing mixed nickel/iron oxides) and sulphides. Pentlandite ((NiFe)₉S₈), the major sulphide mineral, is commonly deposited in association with pyrrhotite (Fe₇S₆), chalcopyrite (CuFeS₂) and small amounts of cobalt, selenium, tellurium, silver, gold and platinum. Substantial deposits of nickel ores are found in Canada, Russia, Australia, New Caledonia, Indonesia and Cuba.

Since nickel, copper and iron occur as distinct minerals in the sulphide ores, mechanical methods of concentration, such as flotation and magnetic separation, are applied after the ore has been crushed and ground. The nickel concentrate is converted to nickel sulphide matte by roasting or sintering. The matte is refined by electrowinning or by the Mond process. In the Mond process, the matte is ground, calcined and treated with carbon monoxide at 50 °C to form gaseous nickel carbonyl (Ni(CO)₄), which is then decomposed at 200 to 250 °C to deposit pure nickel powder. Worldwide production of nickel is approximately 70 million kg/year.

More than 3,000 nickel alloys and compounds are commercially produced. Stainless steel and other Ni-Cr-Fe alloys are widely used for corrosion-resistant equipment, architectural applications and cooking utensils. Monel metal and other Ni-Cu alloys are used in coinage, food-processing machinery and dairy equipment. Ni-Al alloys are used for magnets and catalyst production (e.g., Raney nickel). Ni-Cr alloys are used for heating elements, gas turbines and jet engines. Alloys of nickel with precious metals are used in jewellery. Nickel metal, its compounds and alloys have many other uses, including electroplating, magnetic tapes and computer components, arc-welding rods, surgical and dental prostheses, nickel-cadmium batteries, paint pigments (e.g., yellow nickel titanate), moulds for ceramic and glass containers, and catalysts for hydrogenation reactions, organic syntheses and the final methanation step of coal gasification. Occupational exposures to nickel also occur in recycling operations, since nickel-bearing materials, especially from the steel industry, are commonly melted, refined and used to prepare alloys similar in composition to those that entered the recycling process.

Hazards

Human health hazards from occupational exposures to nickel compounds generally fall into three major categories:

1. allergy
2. rhinitis, sinusitis and respiratory diseases
3. cancers of the nasal cavities, lungs and other organs.

The health hazards from nickel carbonyl are considered separately, in the article on metal carbonyls.

Allergy. Nickel and nickel compounds are among the most common causes of allergic contact dermatitis. This problem is not limited to persons with occupational exposure to nickel compounds; dermal sensitization occurs in the general population from exposures to nickel-containing coins, jewellery, watch cases and clothing fasteners. In nickel-exposed persons, nickel dermatitis usually begins as a papular erythema of the hands. The skin gradually becomes eczematous, and, in the chronic stage, lichenification frequently develops. Nickel sensitization sometimes causes conjunctivitis, eosinophilic pneumonitis, and local or systemic reactions to nickel-containing implants (e.g., intraosseous pins, dental inlays, cardiac valve prostheses and pacemaker wires). Ingestion of nickel-contaminated tap water or nickel-rich foods can exacerbate hand eczema in nickel-sensitive persons.

Rhinitis, sinusitis and respiratory diseases. Workers in nickel refineries and nickel electroplating shops, who are heavily exposed to inhalation of nickel dusts or aerosols of soluble nickel compounds, may develop chronic diseases of the upper respiratory tract, including hypertrophic rhinitis, nasal sinusitis, anosmia, nasal polyposis and perforation of the nasal septum. Chronic diseases of the lower respiratory tract (e.g., bronchitis, pulmonary fibrosis) have also been reported, but such conditions are infrequent. Rendall et al. (1994) reported the fatal acute exposure of a worker to inhalation of particulate nickel from a metal arc process; the authors stressed the importance of wearing protective equipment while using metal arc processes with nickel wire electrodes.

Cancer. Epidemiological studies of nickel-refinery workers in Canada, Wales, Germany, Norway and Russia have documented increased mortality rates from cancers of the lung and nasal cavities. Certain groups of nickel-refinery workers have also been reported to have increased incidences of other malignant tumours, including carcinomas of the larynx, kidney, prostate or stomach, and sarcomas of soft tissues, but the statistical significance of these observations is questionable. The increased risks of cancers of the lungs and nasal cavities have occurred primarily among workers in refinery operations that entail high nickel exposures, including roasting, smelting and electrolysis. Although these cancer risks have generally been associated with exposures to insoluble nickel compounds, such as nickel subsulphide and nickel oxide, exposures to soluble nickel compounds have been implicated in electrolysis workers.

Epidemiological studies of cancer risks among workers in nickel-using industries have generally been negative, but recent evidence suggests slightly increased lung cancer risks among welders, grinders, electroplaters and battery makers. Such workers are often exposed to dusts and fumes that contain mixtures of carcinogenic metals (e.g., nickel and chromium, or nickel and cadmium). Based on an evaluation of epidemiological studies, the International Agency for Research on Cancer (IARC) concluded in 1990: “There is sufficient evidence in humans for the carcinogenicity of nickel sulphate and of the combinations of nickel sulphides and oxides encountered in the nickel refining industry. There is inadequate evidence in humans for the carcinogenicity of nickel and nickel alloys.” Nickel compounds have been classified as carcinogenic to humans (Group 1), and metallic nickel as possibly carcinogenic to humans (Group 2B).

Renal effects. Workers with high exposures to soluble nickel compounds may develop renal tubular dysfunction, evidenced by increased renal excretion of β₂-microglobulin (β₂M) and N-acetyl-glucosaminidase (NAG).

Safety and Health Measures

A general protocol for health surveillance of workers exposed to nickel was proposed in 1994 by the Nickel Producers Evironmental Research Association (NiPERA) and the Nickel Development Institute (NiDI). The key elements are as follows:

Pre-placement assessment. The goals of this examination are to identify pre-existing medical conditions that may influence hiring and job placement, and to provide baseline data for subsequent functional, physiological or pathological changes. The assessment includes (i) detailed medical and occupational history, focusing on lung problems, exposures to lung toxins, past or present allergies (particularly to nickel), asthma and personal habits (e.g., smoking, alcohol consumption), (ii) complete physical examination, with attention to respiratory and skin problems and (iii) determination of the respiratory protective equipment that may be worn.

Chest x ray, pulmonary function tests, audiometric tests and vision tests may be included. Skin patch testing for nickel sensitivity is not routinely performed, because such tests could possibly sensitize the subject. If the organization conducts a biological monitoring programme for nickel-exposed workers (see below), baseline nickel concentrations in urine or serum are obtained during the pre-placement assessment.

Periodic assessment. The goals of periodic medical examinations, typically performed annually, are to monitor the worker’s general health and to address nickel-associated concerns. The examination includes the history of recent illnesses, symptom review, physical examination and re-evaluation of the worker’s ability to use the respiratory protective equipment required for particular tasks. Pulmonary symptoms are assessed by a standard questionnaire for chronic bronchitis. Chest x ray may be legally required in some countries; pulmonary function tests (e.g., forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) are generally left to the physician’s discretion. Periodic cancer detection procedures (e.g., rhinoscopy, nasal sinus x rays, nasal mucosal biopsy, exfoliative cytological studies) may be indicated in workers with high-risk exposures in nickel refining.

Biological monitoring. Analyses of nickel concentrations in urine and serum samples may reflect the recent exposures of workers to metallic nickel and soluble nickel compounds, but these assays do not furnish reliable measures of the total body nickel burden. The uses and limitations of biological monitoring of nickel-exposed workers have been summarized by Sunderman et al. (1986). A technical report on analysis of nickel in body fluids was issued in 1994 by the Commission on Toxicology of the International Union of Pure and Applied Chemistry (IUPAC). The National Maximum Workplace Concentration Committee (NMWCC) of the Netherlands proposed that urine nickel concentration 40 µg/g creatinine, or serum nickel concentration 5 µg/l (both measured in samples obtained at the end of a working week or a work shift) be considered warning limits for further investigation of workers exposed to nickel metal or soluble nickel compounds. If a biological monitoring programme is implemented, it should augment an environmental monitoring programme, so that biological data are not used as a surrogate for exposure estimates. A standard method for the analysis of nickel in workplace air was developed in 1995 by the UK Health and Safety Executive.

Treatment. When a group of workers accidently drank water heavily contaminated with nickel chloride and nickel sulphate, conservative treatment with intravenous fluids to induce diuresis was effective (Sunderman et al. 1988). The best therapy for nickel dermatitis is avoidance of exposure, with special attention to work hygienic practices. Therapy of acute nickel carbonyl poisoning is discussed in the article on metal carbonyls.

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Most persons with disabilities who are of working age can and want to work, yet they often encounter major obstacles in their quest for access to and equality in the workplace. This article highlights the principal issues concerning the inclusion of persons with disabilities in the world of work, with reference to social policy and human rights concepts.

First, the overall extent and consequences of disability, as well as the extent to which disabled persons have traditionally been excluded from full participation in both social and economic life, will be described. Human rights concepts will then be presented in terms of a process to overcome the obstacles to equitable employment faced by persons with disabilities. Such obstacles to full participation in the workplace and national life are often due to attitudinal and discriminatory barriers, rather than to causes relating to one’s disability. The end result is that persons with disabilities often experience discrimination, which is either deliberate or is a result of inherent or structural barriers in the environment.

Finally, a discussion of discrimination leads to a description of ways in which such treatment may be overcome through equitable treatment, workplace accommodation and accessibility.

Extent and Consequences of Disability

Any discussion of social policy and human rights concepts about disability must begin with an overview of the global situation persons with disabilities face.

The exact extent of disability is subject to wide interpretation, depending upon the definition used. The United Nations Disability Statistics Compendium (1990) (also referred to as the DISTAT Compendium) reports results of 63 surveys of disability in 55 countries. It notes that the percentage of disabled persons is between 0.2% (Peru) and 20.9% (Austria). During the 1980s, approximately 80% of disabled persons lived in the developing world; due to malnutrition, and disease, disabled persons form approximately 20% of the population of these nations. It is not possible to compare the percentage of the population that is disabled as reflected in various national surveys, due to the use of different definitions. From the overall but limited perspective provided by the DISTAT Compendium, it may be noted that disability is largely a function of age; that it is more prevalent in rural areas; and that it is associated with a higher incidence of poverty and lower economic status and educational attainment. Moreover, statistics consistently show lower labour-force participation rates for persons with disabilities than for the population in general.

With respect to employment. a graphic description of the situation faced by persons with disabilities was given by Shirley Carr, a member of the Governing Body of the ILO and a past president of the Canadian Labour Congress, who noted during a parliamentary forum on disability held in Canada in 1992 that disabled persons experience a “cement ceiling” and that “Disabled persons suffer from the three ‘U’s: under-employment, unemployment and under-utilization”. Unfortunately, the situation persons with disabilities face in most places in the world is at best like what exists in Canada; in many cases, their circumstances are far worse.

Disability and Social Exclusion

For a variety of reasons, many persons with disabilities have historically experienced social and economic isolation. However, since the end of the Second World War, there has been a slow but steady movement away from segregating disabled persons from the general population, and away from the view that “the disabled” need care, philanthropy and charity. Persons with disabilities are increasingly insisting on their right not to be excluded from the workplace but rather to be treated in an inclusive manner, equitable to other, non-disabled members of society, including the right to participate as active members of the economic life of the nation.

Disabled persons should participate fully in the labour force because it makes economic sense for them to have the opportunity to engage in remunerative employment to the fullest extent of their capacities, instead of drawing social assistance. However, disabled persons should first and foremost participate in the mainstream of the labour force and thus national life because it is ethically and morally the correct thing to do. In this regard, one is mindful of the remarks of the UN Special Rapporteur Leandro Despouy, who stated in his report to the Economic and Social Council of the United Nations (1991) that “the treatment given to disabled persons defines the innermost characteristics of a society and highlights the cultural values that sustain it”. He goes on to state what is, unfortunately, not obvious to all, that:

persons with disabilities are human beings—as human as, and usually even more human than, the rest. The daily effort to overcome impediments and discriminatory treatment they regularly receive usually provides them with special personality features, the most obvious and common are integrity, perseverance, and a deep spirit of comprehension in the face of a lack of understanding and intolerance. However, this last feature should not lead us to overlook the fact that as subjects of law they enjoy all the legal attributes inherent in human beings and hold specific rights in addition. In a word, persons with disabilities, as persons like ourselves, have the right to live with us and as we do.

Disability and Societal Attitudes

The issues raised by the UN Special Rapporteur point to the existence of negative societal attitudes and stereotypes as a significant barrier to equitable workplace opportunities for persons with disabilities. Such attitudes include the fear that the cost of accommodating persons with disabilities in the workplace will be too high; that persons with disabilities are not productive; or that other vocational trainees or employees and customers will be uncomfortable in the presence of persons with disabilities. Still other attitudes relate to the assumed weakness or sickness of persons with disabilities and the impact this has on “their” ability to complete a vocational training programme or to succeed in a job. The common element is that they are all founded on assumptions based on one characteristic of a person, the presence of a disability. As noted by the Province of Ontario (Canada) Advisory Council for Disabled Persons (1990):

Assumptions about the needs of persons with disabilities are often premised on notions about what the person cannot do. The disability becomes the characterization of the whole person rather than one aspect of the person.… Incapacity is seen as a generalized condition and tends to incorporate notions of incompetence.

Disability and Empowerment: The Right of Choice

Inherent in the principle that persons with disabilities have the right to participate fully in the mainstream of the social and economic life of the nation is the notion that such individuals should be empowered to exercise free choice as to their vocational training and choice of occupation.

This basic right is set forth in the Human Resources Development Convention, 1975 (No. 142) (ILO 1975), which states that vocational training policies and programmes shall “encourage and enable all persons, on an equal basis and without discrimination whatsoever, to develop and use their capabilities for work in their own best interests and in accordance with their own aspirations”.

Learning to make choices is an intrinsic part of personal development. However, many individuals with disabilities have not been given the opportunity to make meaningful selections concerning their choice of occupational training and placement. Persons with severe disabilities may lack experience in skills needed to identify personal preferences and to make effective choices from a series of options. However, the lack of self-direction and power is not related to impairments or limitations. Rather, as noted above, it is often due to negative attitudes and practices. Often, disabled persons are presented with options that are artificially preselected or restricted. For example, they may be pressured to participate in a vocational training course that happens to be available, without other options being seriously considered. Or the “choices” may merely be the avoidance of undesirable alternatives, such as agreeing to live in a group setting or with roommates not of one’s choice, to avoid even more unpleasant situations, such as having to live in an institution. Unfortunately for many disabled persons, the chance to express a vocational interest, to choose vocational training options or to seek a job is often determined by a person’s disability label and other people’s assumptions about the capabilities of the individual. This lack of choice also frequently stems from a historical attitude that as involuntary users of the social welfare system, “beggars can’t be choosers”.

This issue is of great concern. Research has shown that the degree of influence which individuals have on decisions that affect their working lives has a significant impact on job satisfaction, and hence on the success of integration strategies. Every person, notwithstanding the severity of his or her disabilities, has the right and ability to communicate with others, express everyday preferences, and exercise at least some control over his or her daily life. Inherent in liberty is the right to have freedom of vocational choice, the necessary training based on available technology, and respect for and encouragement to work. For disabled persons at all levels of severity and ability, including those who have intellectual and psychosocial disabilities, making choices is key to establishing one’s identity and individuality. It must also be recalled that it is part of the human experience to make mistakes and to learn from them.

It must be stressed again that disabled persons are human beings. It is a matter of basic respect of human dignity to provide disabled persons with opportunities to make those decisions in life that non-disabled persons routinely make.

Disability and Social Justice: The Issue of Discrimination

Why have negative stereotypes developed and how do they relate to discrimination? Hahn (1984) notes the apparent contradiction between the vast sympathy displayed toward individuals with disabilities and the fact that, as a group, they are subjected to patterns of discrimination more severe than any other recognized minority. This can be explained by the fact that persons with disabilities often display physical and behavioural characteristics that set them apart from the non-disabled population.

Without these identifiable physical differences, disabled persons could not be subjected to the same processes of stereotyping, stigmatizing, bias, prejudice, discrimination, and segregation that plague every minority group. Moreover, when such traits are coupled with adverse social labelling, the effects of discrimination are compounded.

Hahn also suggests that there is a positive correlation between the amount of discrimination experienced by persons with disabilities and the visibility of their disability.

The key, then, for persons with disabilities to attain equitable treatment in society and the workplace is the reduction and elimination of negative attitudes and stereotypes which result in discriminatory behaviour, coupled with the institution of practices and programmes that accommodate the special needs of disabled persons as individuals. The remainder of this article explores these concepts.

What Is Meant by Discrimination?

In the course of our lives, we “discriminate” on a daily basis. Choices are made concerning whether to go to the cinema or the ballet, or whether to buy the more expensive article of clothing. To discriminate in this sense is not problematic. However, discrimination does become troublesome when negative differentiations are made on the basis of immutable characteristics of persons, or groups of persons, such as on the basis of disability.

The International Labour Conference adopted a definition of the discrimination which is contained in the Discrimination (Employment and Occupation) Convention, 1958 (No. 111):

For the purpose of this Convention, the term “discrimination” includes—

(a) any distinction, exclusion or preference made on the basis of race, colour, sex, religion, political opinion, national extraction or social origin, which has the effect of nullifying or impairing equality of opportunity or treatment in employment or occupation;

(b) such other distinction, exclusion or preference which has the effect of nullifying or impairing equality of opportunity or treatment in employment or occupation as may be determined by the Member concerned after consultation with representative employers’ and workers’ organisations, where such exist, and with other appropriate bodies.

Three Forms of Discrimination

The above-noted definition is best understood in light of the three forms of discrimination that have arisen since the end of the Second World War. The following three approaches, first conceptualized in the United States, have now received widespread acceptance in many countries.

Evil motive or animus

Initially, discrimination was seen strictly in terms of prejudicial treatment, that is, harmful acts motivated by personal antipathy towards the group of which the target person was a member. These acts consisted of deliberate denials of employment opportunities. It was necessary to prove not only the act of denial, but also a motive based on prejudice. In other words the definition was based upon the evil-motive, mens rea, or state-of-mind test. An example of such discrimination would be an employer indicating to a disabled person that he or she would not be hired because of fear of negative customer reaction.

Differential treatment

During the 1950s and in the mid-1960s after the passage of the Civil Rights Act, agencies in the United States came to apply what is called the “equal protection” concept of discrimination. In this approach discrimination was seen to cause economic harm “by treating members of a minority group in a different and less favourable manner than similarly situated members of the majority group” (Pentney 1990). Under the differential treatment approach, the same standards are seen to apply to all employees and applicants without the need to demonstrate discriminatory intent. Discrimination in this context would include requiring disabled employees to undergo a medical examination to receive group health insurance benefits when such examinations are not required for non-disabled employees.

Indirect or adverse effect discrimination

Although the differential treatment model of discrimination mandates that employment policies and practices be equally applied to all, many superficially neutral requirements, such as education and testing, had unequal effects on various groups. In 1971, the United States Supreme Court dealt with this issue by articulating a third definition of employment discrimination in the famous case Griggs vs. Duke Power. Prior to the passage of the Civil Rights Act, Duke Power discriminated against Blacks by restricting them to the low-paying labour department. After passage of the legislation, completion of high school and successful completion of aptitude tests were made prerequisites to transfer out of the labour department. In the candidate catchment area, 34% of Whites but only 12% of Blacks had the necessary education. In addition, while 58% of Whites passed the tests, only 6% of Blacks were successful. These requirements were imposed despite evidence that showed that employees without these qualifications, hired before the policy change, continued to perform satisfactorily. The Supreme Court struck down the educational and test requirements that screened out a greater percentage of blacks, on the grounds that such practices had the consequence of excluding Blacks and because they bore no relationship to job requirements. The intent of the employer was not at issue. Rather, what was important was the effect of the policy or practice. An example of this form of discrimination would be the requirement to pass an oral examination. Such a criterion might have an adverse impact on deaf or orally impaired candidates.

Equal versus Equitable Treatment

The model of adverse impact or indirect discrimination is the most problematic for persons with disabilities. For if disabled persons are treated the same as everyone else, “how can it be discrimination?” Central to an appreciation of this concept is the notion that to treat all people the same is, sometimes, a form of discrimination. This principle was most eloquently put forth by Abella in her report (Canada Royal Commission 1984), when she noted:

Formerly, we thought that equality only meant sameness and that treating persons as equals meant treating everyone the same. We now know that to treat everyone the same may be to offend the notion of equality. Ignoring differences may mean ignoring legitimate needs. It is not fair to use the differences between people as an excuse to exclude them arbitrarily from equitable participation. Equality means nothing if it does not mean that we are of equal worth regardless of the differences in gender, race, ethnicity, or disability. The projected, mythical, and attributed meaning of these differences cannot be permitted to exclude full participation.

To underscore this notion, the term equitable is used increasingly, as opposed to equal treatment.

Disability and the Environment: Accessibility and Workplace Accommodation

Flowing from concepts of adverse impact discrimination and equitable treatment is the idea that in order to treat persons with disabilities in a non-discriminatory manner, it is necessary to ensure that the environment and workplace are accessible, and that efforts have been made to reasonably accommodate the individual workplace requirements of the disabled person. Both concepts are discussed below.

Accessibility

Accessibility does not just mean that a building entrance has been ramped for use by wheelchair users. Rather it requires that persons with disabilities are provided with accessible or alternative transportation systems to allow them to get to work or school; that sidewalk curbs have been lowered; that Braille indications have been added to elevators and buildings; that washrooms are accessible to persons who use wheelchairs; that carpets whose pile density provides an obstacle to wheelchair mobility have been removed; that visually impaired persons are provided with technical aids such as large-print manuals and audiocassettes, and hearing-impaired persons are provided with optical signals, among other measures.

Reasonable workplace accommodation

Equitable treatment also means that attempts should be made to reasonably accommodate the individual needs of disabled persons at the workplace. Reasonable accommodation can be understood as the removal of barriers which prevent persons with disabilities from enjoying equity of opportunity in vocational training and employment. Lepofsky (1992) notes that accommodation is:

tailoring of a work rule, practice, condition or requirement to the specific needs of an individual or group.… An accommodation can include such steps as an exemption of the worker from an existing work requirement or condition applicable to others.… The litmus test of the accommodation’s necessity is whether such a measure is needed to ensure that the worker can fully and equally participate in the workplace.

Actually, the list of possible accommodations is theoretically endless, since each disabled person has specific needs. Moreover, two persons who experience the same or similar disabilities may have quite different accommodation needs. The important thing to recall is that accommodation is based on the needs of an individual, and the person requiring the adjustments should be consulted.

However, it must be recognized that there are circumstances in which, despite the best of intentions, it is not possible to reasonably accommodate persons with disabilities. Accommodation becomes unreasonable or an undue hardship:

• when an individual cannot perform the essential elements of a job, or cannot complete the essential or core elements of the training curriculum

• when to accommodate the individual would result in a risk to health and safety either to the person concerned, or to others, which outweighs the enhancing of equality for disabled persons.

In ascertaining the risks to safety and health, consideration must be given to the willingness of a disabled person to accept the risk that providing the accommodation would engender. For example, it may not be possible for a person who must wear an orthopaedic prosthesis to use safety boots as part of a training programme. If no other safety footwear can be found, the requirement to use the boots should be waived, if the individual is prepared to accept the risk, based on an informed decision. This is known as the doctrine of dignity of risk.

Determination must be made as to whether accommodation poses a serious risk to persons other than the disabled individual, based on the accepted levels of risk tolerated within society.

Assessments of the degree of risk must be made on the basis of objective criteria. Such objective criteria would include existing data, expert opinions and detailed information about the employment or training activity to be undertaken. Impressions or subjective judgements are not acceptable.

Accommodation also is an undue hardship when the costs would substantially adversely affect the financial viability of the employer or training facility. However, many jurisdictions provide funds and grants in order to facilitate modifications that promote the integration of disabled persons.

Disability and Social Policy: Obtaining the Viewpoint of Disabled Persons’ Organizations

As already observed, persons with disabilities should have the inherent right of choice in all aspects of life, including vocational training and occupational placement. This implies, at the level of the individual, consulting with the person concerned as to his or her wishes. Similarly, when policy decisions are made by the social partners (employers’ and workers’ organizations and government), voice must be given to organizations that represent the views of persons with disabilities. Simply put, when considering vocational training and employment policies, persons with disabilities individually and collectively know their needs and how best to meet them.

In addition, it should be recognized that while the terms disability and persons with disabilities are often used generically, individuals who have physical or motor impairments have accommodation and vocational training needs that are different from those of people with intellectual or sensory impairments. For example, while ramped sidewalks are of great benefit to wheelchair users, they may present formidable obstacles to blind people who may not be able to ascertain when they have placed themselves in danger by leaving the sidewalk. Hence, the views of organizations that represent persons with various types of disabilities should be consulted whenever contemplating policy and programme changes.

Additional Guidance Concerning Social Policy and Disability

Several important international documents provide useful guidance on concepts and measures concerning equalization of opportunities for persons with disabilities. These include the following: the United Nations World Programme of Action Concerning Disabled Persons (United Nations 1982), the Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No.159) (ILO 1983) and the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities (United Nations 1993).

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