2005 Conference Proceedings

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Gaylon Ponder
AAC Consultant
Words+, Inc.


Many people with physical disabilities require assistive technology to talk or write in order to seek meaningful employment. Because so few have been successful as employable adults, our society has shifted focus toward "Early Intervention." This approach better prepares them for educational opportunities. More recently programs like "Vocational Evaluation" and "Transition" have been funded and implemented. The vocational counselor associated with these programs is now involved when the student requiring vocational-rehabilitation-placement services reaches age 14. The basic concept is: intervention is needed before they become adults.

The presentation integrates technology and case discussions with short client videos. It provides the audience with information about what can be expected from assistive technology programs. New information is provided about the role of vocational counselors including goals and the rules they must follow. The presentation also includes methods for matching job descriptions with technology for specific client abilities so education and training can focus on goals more meaningful than data entry and supportive workshops.

This presentation will focus on the group of people who are severely limited by physical impairments, but have reasonably good cognitive abilities. This is a group that is often not placed in employment at all, or is misplaced in a sheltered workshop attempting to perform manual labor they are not physically capable of doing.

Funding is also discussed. Funding is much easier after high school if the vocational-rehabilitation counselor is already involved and understands how assistive technology will help find employment for the client.

The speech pathologist should probably be the team coordinator for the client at this formative stage.


This introduction is intended to help describe the problem faced by the client and team at the point the client is supposed to enter the work force. Research supports the conclusion that many people with severe physical disabilities are cognitively capable of learning, but are not being taught properly. Other research supports the easily understood concept that they must be taught earlier in life. Hence the "Early Intervention" programs came into existence. Still the students finish high school and do not go to work. Further research indicated that vocational-rehabilitation counselors needed to be more involved in the process at an earlier stage. Thus, the "Transition Program" was incorporated.

It is easy to find cognitively capable people who cannot find employment. They are nonverbal, cannot write normally and use wheelchairs. There are meetings, often called "staffings", held daily across the country for these people who have finished high school and have begun the quest for a career. The main issues remain fairly constant for the most part, but get addressed as though they are new and specific to the particular client.

Part of the reason for this is there are so few people with the specific combination of characteristics in any geographical location that the assessment team doesn't have broad enough experience to guide the process. The speech pathologist, occupational therapist, vocational counselor, and social worker each have a large number of clients and experiences to draw from. But each team member may have limited experience with the specific conditions of cognitively capable yet severely physically impaired, nonverbal-wheelchair using adults seeking entry into the workforce. Often it is the team member's first such client.

The common issues mentioned above are identified and discussed in the meetings are:

1. No job experience (Therefore no career direction)
2. No job skills
3. Special needs (Feeding, toileting, transportation, etc.)
4. Poor education (Spelling, grammar, writing, reading, math, certificate of completion instead of diploma, etc.)
5. Potential jobs available

The most common team decisions and recommendations during these staffings are:

1. Further assessment (Vocational, interests, educational, intelligence, etc)
2. Remedial training (Structured programs to prepare for GED, improve writing skills, etc.)
3. Field trips (Visits to job sites to see what kinds of jobs interest them)

These recommendations rarely lead to long-term meaningful employment in more than a low skill, low pay position. These decisions further complicate the situation for clients who have spent much of their lives under assessment only to be told that they are deficient in many areas. One such client said, "I am so tired of them testing me to see if I have a brain!"

It is very common for the team to discuss problems that aren't necessarily related to job skills. Transportation is common example. Transportation only becomes an issue after the person has a potential job and cannot get to and from work. Another common example is the potential loss of income/benefits for the client if they do become successfully employed. This can be very demoralizing for the client and the team. It can lead to an attitude of "Why try?" even before all of the details are fully explained or explored.

Sidetracking for a moment to help explain why the Transition Program is needed. Consider the following typical scenario that occurred for many years, and is still fairly common:

A student like the ones described in the introduction to this document finished high school and was referred to a vocational counselor. The vocational counselor was competent at placing people with a variety of disabilities. For instance, the counselor:

1. Had placed people who had job skills but were injured. They had to be retrained because they no longer had the same physical abilities.
2. Had placed people who had been rehabilitated from drug or alcohol abuse.
3. Had placed people with emotional or behavioral disorders who needed direct supervision.
4. Had placed people who were cognitively impaired or mentally retarded (the two are often incorrectly used interchangeably) but had good physical abilities, in safe low skill manual labor jobs with strict supervision.
5. Had placed wheelchair users who could talk and write, and who may have already developed other job skills before injury, in jobs requiring these skills.

But the counselor really hadn't dealt with a cognitively capable client who couldn't talk or write, and who used a wheelchair. The first hurdle may have been to get the counselor to believe that the client wasn't cognitively impaired since the client couldn't talk. The counselor may have said that if the client could talk the counselor would be able to place them. The speech pathologist may have informed the counselor that if the client had an augmentative communication device, the client could talk. The counselor may have bought such a device for thousands of dollars and found out that what the speech pathologist called talking, and what the counselor had in mind were two entirely different things. Weeks or months later the result came back down to "No Job Experience" and "No Job Skills".

Someone identified, and correctly so, that the vocational counselor needed to be involved in the process before the client finished high school. Then the counselor would be able to better help prepare the student for entry into the vocational placement program.

The Transition program can help in the following ways:

1. The vocational-rehabilitation (VR) counselor has a chance to guide the development of employment skills through education, before the student seeks entry into the job market.
2. The VR counselor has a responsibility to make sure the student is prepared, and employable.
3. The teachers have better guidance concerning what skills the student will need in order to find a job, and a responsibility to teach it.
4. Vocational evaluations can help guide the education process.

Before implementation of the Transition Program, the school system seemed to believe it was the vocational counselor's job to find employment for the disabled client upon completion of high school. The vocational counselor seemed to believe it was the education system's job to prepare the client to enter the work force. The federally funded Transition Program is intended to bridge the gap so the two systems work together toward the common goal.

There is still need for improvement. Better understanding the roles of the various members of the team can help make the system work. A better understanding by all of the team members of the resources available to each member, and ultimately to the client, can also help make things better. But in order for the system to work, the client must receive job skill training before finishing high school so the client can bring something to the table for the team to use.

Food for Thought!

The most common reason a person, any person, does not get a particular job is: "Doesn't possess the skills required to do the job."

The most common reason a person, any person, gets fired is: "Poor pragmatics." (Doesn't show up on time, doesn't get along with customers or fellow workers, isn't safe, doesn't stay on task, etc.)

Where do we learn pragmatics? From our social peers, fellow students, fellow workers, etc.

Is it likely that a cognitively capable, physically impaired, non-verbal wheelchair user will develop proper pragmatics in a special-needs room with people who are cognitively and behaviorally impaired, where the expectation is to learn "life skills," not "job skills?"

General Requirements for Employment

1. Cognitive Ability to think, reason, remember (learn), self-edit, stay on task, etc.
2. Physical Ability to manipulate work materials. These may be materials, conversation, communication, equipment, electronic information, etc.
3. Visual skills to perform work related tasks, work safely, follow written instructions, etc.
4. Auditory Skills perform Work related tasks, work safely, follow verbal instructions, etc.
5. Pragmatic Skills to get to work, be dependable, be presentable, not distract others, work independently, interact correctly, etc.
6. Job Skills so they can perform assigned tasks.

Typical Characteristics of our Clients with Severe Physical Disabilities

1. Cannot speak normally causing unfamiliar listeners have difficulty understand them, or they may have to use augmentative-communication equipment to talk.
2. Cannot easily manipulate physical objects, take notes, or perform manual labor.
3. Use a wheelchair to move around workplace. This may require workplace modifications.
4. Need assistance with some daily activities like getting dressed, transportation, feeding, etc.

Note that these characteristics often do not indicate reduced cognitive ability. They often do indicate reduced physical ability. They often do not indicate reduced visual or auditory ability. They sometimes indicate reduced pragmatic skills.

These characteristics almost always result in reduced, or non-existent job skills. The primary reason these clients are not employed is the lack of job skills.

Students without severe physical disabilities are able to participate in a variety of activities during their school years. Generally they naturally choose some basic behavior patterns and interests that guide their future career path. Some stereotypical examples:

1. One child pays attention to anything physical including sports, shop classes, etc., but doesn't study well.
2. One child is a social butterfly, making friends and carrying conversation easily.
3. One child is very intellectual and interested in arts, writing, reading, etc.
4. One child is very intellectual and is interested in science, math, physics, etc.
5. One child is very helpful, nurturing, patient and caring.

When these children finish school they will likely choose careers that match with these basic behavior patterns. Some will choose construction, logging, paving, roofing, fishing, and wouldn't want to be "trapped" in an office. Others will choose low skill manual labor or jobs that require repetitive use of technical skills such as machine work, electrical work, plumbing, assembly, etc. Some will become doctors, nurses, lawyers, or teachers. There will be some draftsmen, engineers, and scientists. Others will use their people skills to become salesmen or business managers. And the list goes on and on with more than 12,700 different job descriptions available.

The school systems realize that not every student is going to choose, or be able to choose, to go to college. In these cases special skilled labor curriculums are developed. Some students enter work-study programs and reduce their focus on advanced academics. Others focus on advanced academics and plan for college, or work in jobs where more advanced education is required. Those who choose work-study often enter a career path relying on physical skills. They tend to learn some specific skills and apply them repeatedly during their employment. Some examples of these jobs are electricians, carpenters, auto-body repairmen, welders, machinists, tellers, clerks, stockers, firemen, farmers, foresters, etc. Some of the careers require more physical or mental skills than others, but most rely heavily on the ability to perform physical manipulation of objects.

The important point is that the students described in the introduction can't wander through all of the experiences and choose the ones that they want to. For instance a child with who depends on a power wheelchair for mobility, and has poor fine-motor skills cannot choose to perform manual labor for a career. He or she might want to, but it is not physically practical. These children are ruled out of over 9,000 jobs that require the skilled use of coordinated muscles. Yet, they didn't get ruled out of working out of doors, or using technical skills. They didn't get ruled out of working with people, science, math, sports, etc. They just cannot expect to succeed vocationally relying only on their physical efficiency as their source of productivity. But, they don't know this. They are kids and they are relying on adults to guide them correctly at early ages before they are capable of contemplating career plans.

There is not a person attending this conference who depends primarily on their physical skills to provide their income. Some other people do, and get paid quite well for it. It is a life choice. The people at this conference chose a more technical skill-related career path. They may (or may not) enjoy some of the physical activities required of them to perform their jobs. They may have very physical hobbies, but they do not rely entirely on their physical skills to perform their work. Children who are soon to become adults and enter the work force and who cannot talk, walk, write, etc., also cannot rely only on their personal ability to physically manipulate work materials as their only career path. Therefore they must use their cognitive abilities and the assistive technology and support available to them during their formative years in order to develop the job skills necessary for employment.

Even though they may not be eligible for all of the jobs listed in the directory, there are still many good jobs available for people who use assistive technology to help them participate in educational activities, perform work related tasks, communicate, move about the room, etc. What are these jobs?

Job descriptions

There are several resources available that provide job descriptions. Vocational counselors often use these resources to help determine an appropriate job for a particular client. JobGenie is the example used for this paper. JobGenie has a website link that allows a review of the possibilities. Unfortunately the jobs are listed alphabetically, and searching through 12,740 listings manually is very time consuming, and somewhat boring. It would be wonderful if we could list client characteristics and the database would sort itself accordingly. Even so, spending a little time going through the list can reveal some opportunities for a particular type of client. Just a few examples are presented here. This is not intended by any means to be the complete list. The intent is to make the reader aware of the resource and provide guidance as to how to conduct the search.

One recommended process is:

1. Identify the client's abilities.
2. Look for jobs that rely on these abilities.
3. Carefully review job descriptions to look for ways to overcome physical requirements by restructuring the job.
4. Identify and document the assistive technology that will be needed for the client to perform the job.
5. Identify and document the training that the client will need in order to prepare for the job.
6. Revise the abilities list, and all other lists, as the search reveals unexpected opportunities.

The home page for the JobGenie website is included next.

This information is also available as a government published document consisting of three large volumes of printed text, and it is actually easier to examine in print since it is easier to visually scan rather than going link by link to see the job description on screen. Most Vocational Rehab Counselors and libraries have access to these publications.

There are other websites providing access to this information. Providing this information here is not intended to recommend this particular website. A search for Job Descriptions will reveal many choices.

The underlying question is:

What kinds of jobs are available for my client with severe physical disabilities?

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