Rehabilitation and Development of People with Disabilities

Rehabilitation and Development of People with Disabilities

Braille MonitorMay-June 1986
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Rehabilitation and Development of People with Disabilities
An International Perspective on Some
Present Challenges and Future Prospects
by Rami Rabby,
Consultant in Human Resources
Presented at the
Vocational Rehabilitation Seminar
Bogota, Colombia, October 2, 1985
(This address was printed in Vital
Speeches of the Day, December 1, 1985.)
May I begin by expressing my deepest
appreciation to Mr. S.I. Niwa, Chief of
Vocational Rehabilitation Branch of the
International Labour Office, for inviting
me to present this paper. I am
particularly gratified that he asked me
to do so at a vocational rehabilitation
seminar which is run in conjunction with
the Abilympic, an event which, perhaps more than any other international disability-related
event, is designed to
highlight and focus the world's attention
on the abilities of disabled people
rather than their inabilities, their
skills and strengths rather than their
shortcomings and weaknesses, and their
innate capacity for producing and contributing
rather than their culturally
perceived role of draining resources and
seeking assistance.
Having lost my sight completely at the age of eight, while living in Israel, I
underwent my initial training as a blind
person in residential schools for blind
children, and specifically at Worcester
College for the Blind, in Worcester,
England.
At that school the teaching staff took
great pains to inculcate into me and my
fellow schoolmates not only the assumption
that, as a group, we were as competent
as normal, sighted children of the
same age but also the expectation that
we must compete on a genuinely equal
footing with those sighted children.
Whether in academic examinations or in
athletic competitions with the sighted,
it was made absolutely clear to us that,
while our operating methods and techniques
might be different from those of
our sighted counterparts, the performance
goals and standards which were set
for us might be strictly and uniformly
maintained, for the blind and sighted
alike.
So, for example, whereas when taking
public examinations, all examination
questions were given to us in Braille
rather than in print, and whereas we
were each required to dictate our essays,
calculations, and translations to
an amanuensis, we all took those examinations
at exactly the same time as all
sighted students in England did, and
were given no extra time to speak of,
just because we were blind. Similarly,
whereas in rowing races against sighted
crews, our cox (or navigator) would call
out the required rhythm for our oar
strokes (something which the members of
the sighted crew, who can watch each
other's movements, do not normally ask
their cox to do), we were always expected
to win and were given no allowances
whatsoever.
It was only after I graduated from the
relatively safe and carefree environment
of the residential school for the blind
that I began to encounter what I later
came to recognize as the principal problem
facing people with disabilities -- namely, the negative attitudes, prejudicial
treatment, and outright discrimination
of a society which tends to consider
the disabled as helpless, incompetent,
unsafe, and necessarily dependent.
While I was at Oxford University
studying French and Spanish, I applied
for an Assistant Teacher position at a
lycee in Lyon, France, only to be rejected
because the school principal
could not conceive how a blind person
would be able to find his way safely
throughout the building, which was then
undergoing remodeling and renovation.
After graduating from Oxford University,
I applied to many British companies for
a management trainee position in personnel
administration, and was repeatedly
rejected because, so I was told, "No
blind person has ever done this before,"
until I finally was offered a management
traineeship by the Ford Motor Company of
Britain. When I applied to study in the
United States for a master's degree in
business administration, many American
business schools told me that a blind student would not be able to cope with
the case study method of management
education, which involved in-class analysis
of business problems. However, the
University of Chicago Business School did accept my application. Then, when I
arrived in the United States and tried
to check into New York City's Grand
Central YMCA for my first night, the
manager refused to let me have a room
because, he said, his insurance company
would not cover him for the added risk
which would inevitably be incurred by
having a blind person on the premises
overnight.
These experiences of mine, as well as
countless similar experiences of my
fellow disabled, impelled me, 17 years
ago, to join the National Federation of
the Blind of the United States, and
convinced me that the most effective
remedy for society's negative notions
and behavior toward people with disabilities
lay in the hands of disabled
people themselves. Certainly, each one
of us individually can do much to demystify
the phenomenon of disability in
the public's mind and to educate those
around us to our essential normality.
However, it is through collective action--in the legislatures, in the
courts, in the communications media and,
perhaps most importantly, amongst ourselves--that
I believe we can achieve
the greatest results.
I have given you this selective account
of my own background for a purpose. Very
often at international
gatherings concerned with the rehabilitation
and development of the disabled,
it is claimed that the disabled in the
industrialized nations are far better
off than the disabled in the developing
nations. While, it is always admitted,
there may exist "pockets of poor conditions"
in the industrialized countries,
the disabled in those countries are
generally in a class by themselves and
bear no comparison with the disabled in
the developing countries.
Of course, in one sense it is very
true. There is no doubt that in the
industrialized nations the level of
social security disability benefits, for
example, is much higher than it is in
the developing nations; public funding
of disability prevention measures is
much greater; government expenditures
for social services are far higher; and
a much larger proportion of these nations'
tax base is spent on education
and training of the disabled, employment-related
technological devices,
library services, special transportation
arrangements, special housing accommodations,
etc. From the point of view of
these overall financial and statistical
yardsticks, the industrialized nations
are considerably better able to demonstrate
a social obligation toward people
with disabilities, to create special
programs to take care of these human
casualties, and to discharge the community's
responsibility to the less
fortunate within it.
What I would question, however, is
whether those overall financial and
statistical measures have anything to do
with genuine rehabilitation and development,
and whether disabled individuals
in the industrialized countries do, or
should, ever stop to ponder how much
happier their lot may be when compared
with the lot of disabled individuals in
the developing countries. After all,
what does it matter to disabled Scandinavians,
for example, that they receive
rich government disability benefits if the private sector employers in the
Scandinavian countries refuse, as is so
often the case, to hire them just because
they are disabled, even though
they may be well qualified? What does
it matter to disabled West Germans that
they are sent for training in impressive
rehabilitation centers if at the conclusion
of the training, West German employers
refuse, as is so often the ease,
to hire them and prefer instead to take
the alternative offered to them by the
government--that is, to pay a levy for
the provisions of yet more training
services for the disabled and the building
of yet more rehabilitation centers?
What did it matter to me that I had a
bachelor's degree from Oxford University
when I was excluded from so many American
business schools who told me that a
blind person would not be able to cope
with the ease method of study used in
their master's degree programs? What
does it matter to those disabled Britons
employed in sheltered workshops that
they are holding entry level manual jobs
when so many of them are qualified for
professional level and intellectually
more demanding occupations?
The point is that disabled individuals
in the industrialized nations measure
their progress not against the progress
of disabled individuals in far off developing
countries but rather against
the progress of their non-disabled
counterparts in their immediate environment.
The point is that the proper
criterion for successful rehabilitation
is not simply whether disabled individuals
are employed or not, but rather the
extent to which they are employed in
accordance with their potential as whole
persons without regard to the disability,
and the degree to which they
assume a positive attitude toward their
disability, avoid lowering their expectations,
adopt a healthy self-image, and
refrain from using their disability as a
convenient excuse and a cop-out for not
at least trying to achieve what others
with the same disability have achieved.
When progress by the disabled is
measured in these terms, and when rehabilitation
is viewed in this light, we
can surely see that the frustrations are
no smaller and the process of self
development and rehabilitation is no
less taxing for the disabled individual
in the industrialized nation than they
are for the disabled individual in the
developing nation. To the international
researcher and analyst of public policy
and social programming for the disabled,
there may seem to be a vast gulf between
the United States and Latin America,
between Europe and Africa, between
Canada and the Middle East, between
Australia and the Indian subcontinent,
and between New Zealand and Southeast
Asia; but to disabled persons in all
those countries and continents, it is
the immediate context that counts, and
to every disabled person, the wall of
prejudice and the lack of self
fulfillment are equally devastating. It
is not surprising, therefore, that the
International Labour Office was able, in
June of 1983, to adopt its Convention
159 --(on vocational rehabilitation and
employment of disabled persons)--and to
make it applicable and meaningful to all
countries and to people with disabilities
everywhere.
If we are to understand what true
rehabilitation is, we must begin by
understanding the substantive difference
between the word "disabled" and the word
"handicapped." It is my contention that blindness, deafness, or paraplegia, for
example, are personal characteristics,
just like being black, young, female,
Colombian, Jewish, Spanish-speaking,
college-educated, etc. Each of these
personal characteristics necessarily
describes only one facet of one's individuality.
Being deaf no more defines a
whole person than does being Colombian
or Moslem or female. Why then are
blindness, deafness, or paraplegia generally
regarded as "handicaps" while
being Colombian or Moslem or female are
not?
Actually, every one of our personal
characteristics--physical, mental, or
otherwise--can be either a limitation,
or an advantage, or be of no consequence
whatsoever, depending on what specific
objective we are trying to achieve, at
any particular time. So, for example,
blindness may preclude a blind person
from looking at the stars but not preclude
him from studying the theory of
astronomy; similarly, being male may
preclude a man from giving birth to a
child, but not preclude him from raising
that child. The real handicap confronting
the disabled arises when myths,
misconceptions, and negative attitudes,
including both the public's and those of
the disabled themselves, restrict their
opportunities and stunt their motivation
far beyond the relatively narrow limitations
imposed by their disabilities.
Just as John F. Kennedy would probably
not have been elected President of the
United States before 1960 because of his
Catholicism, so people with disabilities
suffer tremendous prejudice and discrimination
in employment, education, housing,
and other life activities because
of society, including the disabled themselves,
so often believes that a disability
is all-embracing and totally
crippling.
This conception of people with disabilities
as essentially normal and
equal members (each having his/her advantages
and disadvantages and his/her
assets and liabilities) of a pluralistic
and multi-faceted society removes that
artificial distinction between the
"handicapped," on the one hand, and
"non-handicapped," on the other, which
is implied in that terribly condescending
but very often quoted phrase, "Those
less fortunate than we." This conception
also helps us view disability more
broadly, as a social phenomenon alongside
sex, race, or ethnic origin and not
merely as a clinical phenomenon for
which only a medical cure is possible.
If the real handicap facing people
with disabilities is the tendency to
assume that if one is disabled, one is
necessarily helpless, dependent, and
capable of equal productivity; then it
follows logically that the first and
primary goal of rehabilitation is to
help the client de-condition his mindset
and rid himself of any negative
notions, self-doubts, insecurities, or
lack of motivation which may be associated
with the presence of the disability.
A second, though no less important,
purpose of rehabilitation is to
train the client in those practical
"disability" skills, those alternative
techniques which will enable him to
circumvent his limitations and to live
and work as independently and productively
as his non-disabled counterpart.
Included among these skills (but by no
means limited to them) are, for example:
(a) for the blind, efficient Braille
reading, use of a white cane for easy
and confident mobility, and fluent operation of a speech output computer; (b)
for the deaf, proficiency in sign language
or lip reading and the effective
use of a hearing aid; and (c) for paraplegics,
quadraplegics, amputees, and
people with cerebral palsy, easy manipulation
of a wheelchair, mouth stick, and
one-handed typewriter or computer keyboard.
The
appropriate atmosphere for effective
rehabilitation to take place should
be one of constant tension, with the
rehabilitation teacher or instructor
continually "pushing" the client, urging
him to do more, to do better, to learn
new skills, to try new activities and
experiences, to test his limits, to
accomplish what he may not have originally
thought possible, given his disability,
and always to do so intensively
and independently, using a problem
solving approach rather than simply
following the rehabilitation teacher's
instructions. This atmosphere and this
regimen are essential for the client if
he is to come to believe emotionally as
well as intellectually that he is a
competent first-class citizen who, with
the use of alternative techniques and a
positive self-concept, is able to participate
fully in and contribute equally
to the economic and social life of his
community. On the other hand, a relaxed
atmosphere and an easy-going regimen can
only lead to passivity, discouragement,
submissiveness, and a gradual slide into
a life of comfortable dependency where
the disabled client would rather have
others do for him what he could, with
training and motivation, so easily and
willingly do for himself.
The third, and again no less important,
objective of rehabilitation is to
bring the client to a clear understanding
of how society's stereotyped attitudes
toward the disabled, and categorical
assumptions about them, often result
in discriminatory treatment and how he,
as a disabled victim of such prejudice,
can counter it both on an individual
basis as well as collectively as a member
of a self-help organization of people
with disabilities.
In providing rehabilitation services
to people with disabilities, it is crucial
that both administrators and professionals
always be on the lookout for
any negative messages which they may
inadvertently be sending to their
clients. For example, at a rehabilitation
and training agency serving the
deaf, it would be appropriate for a
significant number of competent deaf
individuals to be appointed to the agency's
governing body. Otherwise,' there
is a clear danger that deaf clients of
the agency would subconsciously assume
that if one is deaf, one is necessarily
not intelligent nor politically savvy
enough to handle matters of policy,
finance, and fund raising or make decisions
regarding sensitive issues of
personnel management. Similarly, at a
center or hospital providing services to
paraplegics, quadraplegics, and amputees
it would be appropriate for qualified
individuals who have those same disabilities
to occupy senior executive and
professional positions. All too often
this is not the case, either in the
developing or in the industrialized
nations. One particularly outstanding
example of a negative message conveyed
by rehabilitation professionals themselves can be found in the blindness
rehabilitation system. Throughout the
world 99.9 percent of agencies serving
the blind do not permit otherwise qualified blind persons to train blind
clients in the effective use of a white
cane. The assertion is that it would be
unsafe for a blind person to do so,
Yet, in the United States three progressive
and enlightened agencies for the
blind have proved, beyond a shadow of a
doubt, that blind persons can train
blind clients in cane travel skills, and
that they can do so safely and effectively.
The experience of one of these
agencies was reported in the May and
July, 1985, issues of The New Beacon, a
magazine of the Royal National Institute
for the Blind, in England. Unjustified
concern for safety, as in this instance,
has unfortunately triggered a good deal
of prejudicial and discriminatory treatment
of all disability groups. We would
do well to take a second look at our
attitudes on this issue and, I hope,
modify our thinking and practice accordingly.
Four
more brief points should be made
about the nature of effective rehabilitation.
First,
whenever possible, disabled
clients undergoing rehabilitation should
be trained in groups rather than individually.
Most newly disabled individuals
naturally find the onset of disability
a very frightening and isolating
experience. If it can be arranged for
them to progress through their training
in the company of others who are struggling
with the same predicament, they
will inevitably gain comfort and inspiration
from the mutual exchange of
ideas, sharing of experiences, commonality
of emotions and interests, and
joint problem solving. Together, they
will reinforce each other's self
confidence and, most importantly, they
will know that they are not alone.
This, too, is why rehabilitation clients
should always be encouraged to join
organizations of people with disabilities
and participate fully in their
activities. In a very real sense, the
best rehabilitation takes place when
people with disabilities interact among
themselves, make their own decisions,
and administer their own membership
organizations; in other words, when they
are in control of their own lives.
Second, every effective rehabilitation
program should make full use of what, in
the terminology of the social sciences,
are called "role models." These are
successfully employed disabled people
who have already completed their rehabilitation
and achieved a normal,
productive, and contributing status in
the community. Either through formal
lectures or in informal discussions,
these role models cannot help but provide
encouragement to the rehabilitation
clients and naturally serve as tangible
proof to newly disabled individuals of
what they could, with training and motivation,
become.
Third, in recent years, particularly
in the industrialized nations, there has
surfaced a tendency to look to today's
high technology (and specifically to
computer technology) as a panacea for
all the ills of the disabled. Just
listen for a few moments to some of
these computer advocates, and you might
think that no disabled person ever
achieved anything of note, either in the
workplace or outside it, before the
advent of the computer. Clearly, this is
not true. At the heart of the rehabilitation
process has always been, and will
continue to be, the breaking down of the
disabled individual's internal attitudinal
barriers and psychological insecurities which I have described earlier.
In the workplace the computer, like any
other machine, is a tool which can assist
marvelously in carrying out certain
operations rapidly and efficiently, but
it is nothing more than that! Actually,
I believe that in one sense the computer
presents a real danger to people with
disabilities. We must be extremely
careful not to be deceived into thinking
that, in the future, the only jobs for
which disabled people may be qualified
are those which bind them, segregated
and isolated, to a computer. In the
past and still today we have tended to
channel paraplegics into stationary
desk-bound occupations, the blind into
manual or telephone-related occupations,
and the deaf into graphic arts work or
noisy printing press operations. It is
high time that we began to view workers
with disabilities as whole persons, able
to fill jobs that require great mobility,
heavy interaction with non-disabled
colleagues, and intensive, face-to-face
contact with the general public.
Fourth, and again in recent years,
there has been a tendency in some industrialized
nations for rehabilitation
professionals to refer disabled clients
for work to prospective employers too
early and, in effect, to expect the
employer to participate actively in the
final stages of the rehabilitation process.
I believe this is an unhealthy
development. Employers certainly do
have a responsibility to reach out and
make a special effort to recruit qualified
disabled workers, to make reasonable
accommodations to workers' disabilities,
and to instruct their non
disabled personnel how to treat disabled
candidates and employees in a receptive
and nondiscriminatory manner. However,
private sector employers, certainly, are
in the business of manufacturing products
and selling services at a profit,
and should only be expected to consider
job-ready clients for employment. Disabled
workers should be permitted to
enroll in all the regular skills training
programs offered by employers to
their non-disabled employees, but they
should not be referred to employers
before they are attitudinally ready for
work and before they have perfected the
"disability" skills which will enable
them to compete on an equal footing with
their non-disabled counterparts.
Whenever government policy-makers and
social programmers discuss rehabilitation,
sooner or later the question is
asked: "Is rehabilitation economically
beneficial?" Numerous studies have been
conducted comparing the benefits and
costs of rehabilitation. Most of these
studies list the following as benefits:
a. Discounted present value of all
direct wages and salaries paid to the
disabled person following rehabilitation;
b. All fringe benefits paid to the
disabled person following rehabilitation;
c. All
public assistance payments
saved because of the disabled person's
rehabilitation;
d. Value of all household tasks performed
after working hours by the disabled
person; and
e. Value of all increases in productivity
by the family of the disabled
person, which result from his/her
assuming a share of household tasks.
The studies list the following as
costs:
a. All direct and indirect costs incurred
by the agency providing the rehabilitation service;
b. All direct and indirect costs incurred
by parties other than the agency.
(For example, the costs incurred by the
prospective employer in removing architectural
barriers or purchasing specialized
equipment prior to the date of
employment.)
c. Value of public assistance payments
received by the disabled person during
rehabilitation;
d. Value of wages, salaries, and
fringe benefits foregone by the disabled
person during rehabilitation; and
e. Costs for rehabilitation services
incurred by the disabled person himself/herself.
Even
though these studies invariably
conclude that the benefits of rehabilitation
outweigh its costs, my own
interest in these economic models for
rehabilitation is frankly little more
than academic. The real issue is a
broader social and human one. Since I
believe that people with disabilities
represent appreciating assets rather
than disposable commodities, it seems
axiomatic to me that society should
invest public and private resources in
the disabled so that they may have the
opportunity to achieve their fullest
potential as human beings and to contribute
as equals to the growth and
advancement of their communities. In
this respect the purpose of rehabilitation
is surely no different from that of
any educational, instructional, or
training endeavor.
However, this does not mean that I
have no concern for the cost effectiveness
of rehabilitation programs and
services. Actually, there is one area
of rehabilitation service delivery where
in recent years there has been, I believe,
tremendous wastage of resources.
I am referring to the purchase of assistive
devices in general and to the
growing interest in employment related
and education related computer equipment
in particular.
Faced with an ever-increasing rate of
technological change and development,
many rehabilitation professionals have
not been able to keep pace with the
constant flow of new products into the
market, let alone be in a position to
intelligently evaluate the appropriateness
and usefulness of this or that
device for specific client needs and
situations. As a result, many counselors
have often been pressed, on the
basis of a quick demonstration or a
salesman's promises, into purchasing
computerized and other devices which,
after actual testing in the workplace or
in the educational setting, were found
not to serve their intended purpose. At
times the myth that "the more technologically
sophisticated it is, the better
it is," is so captivating that both the
rehabilitation professional and the
client opt for a "high tech" solution to
a work related or study related problem
where a "low tech" or even a "no tech"
alternative would have been just as
effective, if not more so.
In addition, manufacturers of high
technology devices for the disabled have
tended, quite naturally, to go to market
with integrated computer systems that
are "specifically designed for the
disabled'--systems which (given the
relatively small market involved) are
usually very expensive. Quite often the
very functions claimed by the manufacturers
for these "specially designed"
systems could have equally well been
performed, with perhaps minor adaptations by much less expensive, off-the
shelf components bought from a regular
retailer who serves the mass market,
Unfortunately, the vast majority of
rehabilitation agencies do not possess
the technological expertise required to
know either what off-the-shelf items are
available on the market of how they
might be adapted for effective use by
people with disabilities.
Finally, I would like to express a
hope and a wish about future Abilympic
events.
As I said at the beginning
paper, the idea behind the Abilympic is
the most exciting I have encountered in
international work with people with
disabilities. More than any other event
it shows disabled people engaged in
activities which are not only income- producing for themselves but which add
to, rather than take away from, the
gross national product of the countries
they represent.
Since this, I believe, is only the
second Abilympic in history, it is natural
that the skills demonstrated in the
contests tend to be either manual,
machine-based, sedentary, or performed
in isolation from other workers. Let us
make a special effort to include in the
next Abilympic contests which will highlight
people with disabilities also
practicing professional level and administrative
skills, skills which require
mobility and intensive contact with others.
For example, why should we not consider
contests which will demonstrate
teaching skills, selling skills, the
persuasive skills of lawyers who argue
cases in court, mathematical computation
skills, the leadership skills involved
in the chairmanship of meetings, public
speaking skills, writing skills, the
problem-solving skills involved in the
mediation and settlement of disputes
among workers, interpreting and translating
skills, and automobile driying
skills, to mention just a few.
All these skills are already practiced
by people with disabilities, and not
only in the industrialized nations.
Their inclusion in the next Abilympic
will serve to motivate and inspire disabled
people everywhere, will educate
and enlighten prospective employers to a
wider range of abilities among the disabled,
and will demonstrate the ultimate
in full participation and integration of
people with disabilities in the workplace
and in society.(back)(contents)(next)