Integrated Programmes for Handicapped Adolescents and Adults

Roy I. Brown

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367627720
• eBook ISBN: 9781000225884
• Topic: Education
• Subtopic: Adult Education

First published in 1984, Integrated Programmes for Handicapped Adolescents and Adults explores the need to develop integrated programmes for adolescents and adults with developmental disabilities.

Whilst the training models and concepts examined largely relate to formal areas of education, such as reading, mathematics, and writing, the book also pays close attention to social education skills, including home management, budgeting, meal preparation, and the development of positive familial relationships.

Integrated Programmes for Handicapped Adolescents and Adults presents a number of projects from different parts of the world, with an emphasis on linking research and practice.

Chapter One THE FIELD OF DEVELOPMENTAL HANDICAP - THE DEVELOPMENT OF REHABILITATION EDUCATION

Roy I. Brown

INTRODUCTION

Rehabilitation Education, for the purposes of this book, is defined as the treatment and. training of individuals through the intervention of a variety of social and psychological strategies to improve the learning and performance of handicapped persons. It is important that the principles of training be recognised in this education for we are not simply talking about counselling and welfare. We are concerned with the processes and principles which constitute programming and are necessary for the permanent change of behaviour in a positive direction. The aim is to assist individuals to maintain themselves effectively in a quality life-style within society without undue support from the social welfare system, in terms of monetary aid or special conditions. There is also, we believe, a body of knowledge which emanates from psychology, education and social work practice that can provide an effective means of support and help for a wide range of handicapped individuals of all ages.

It is the detailed application of the findings in tnese areas to regular practice, which constitutes the field of rehabilitation education. It uses curricula and techniques which are essentially behavioural. It has relevance to occupational- and physio-therapy and to medicine, but it must be regarded as one branch of a multidisciplinary approach which can be effective in terms of the training of handicapped persons. Unlike our traditional ideas of education it does not just apply to children. This particular volume is dedicated to the application of the model and the concepts to adolescents and adults. It can be applied in the formal areas of education such as reading, math and writing. It also applies to social educational skills including home management, budgeting, a recognition of money and the application of time concepts. It is relevant to home-living skills, including the purchasing of clothes, the appropriateness of one's dress, preparation of meals, but also involves the development of positive relationships between members of the family. In the area of leisure time it relates not only to how time is spent at home, but how one receives exercise and activity to enhance human development. It applies to the knowledge one gains of one's community and the use one can make of that community in dealing with quality of life. All these areas relate to self interest, the development of positive self concept, and attitudes that the handicapped person has about the society around him. It improves his motivation and, hopefully, in its broadest sense, changes society around him, to be more tolerant of handicap and assists society to modify its approach towards handicapped persons.

This book examines approaches towards the training and treatment of adolescents and adults who are developmentally handicapped. Specifically, it concentrates on mental handicap and it is particularly concerned with an area which we may now define as rehabilitation education. A thesis of the book is that the principles of education in the field of rehabilitation, including aspects of psychology and social work, apply, in general terms, to all levels of handicap and types of handicapping conditions. The principles seem to relate to very severely retarded persons as well as mildly mentally handicapped individuals. Many of the principles apply to visual impairment and auditory handicap, while some of the problems of social disadvantage and social decline in the elderly may also be remediable through the application of the principles outlined in the specific chapters. The levels of programming may differ, but for too long we have ignored the common ideas and concepts which underline the different areas of rehabilitation.

In some countries, rehabilitation is separated from the area of habilitation. The former represents the reintroduction of individuals into society after training, whereas habilitation is reserved for the initial introduction into society of individuals handicapped from birth. Such differences seem to us to be unnecessary, and in many ways undesirable, for they do not appear to be associated in any marked way with different principles. It is argued that the labelling system, so employed, produces artificial barriers between personnel working in these areas. It restricts communication and collaboration between agencies which should be sharing resources. We believe much is to be gained by regarding the total field as one of rehabilitation. We use the word here for convenience. In order to develop the field clearly and effectively, we believe it is necessary to use the same principles, very often the same techniques, though it is recognised that the level of application may differ. The fractionating of the field, which has occurred between rehabilitation and habilitation, is a disservice to the community of handicapped persons and will continue to do harm until personnel in the field recognize their common aims and loyalties to an area which we have chosen to define as Rehabilitation Education.

Rehabintation has, in the past, been seen as a province of medicine and allied medical professions, such as physiotherapy and occupational therapy. In recent years psychology has also played an important role in the training and treatment of individuals with handicaps, and the field of special education has developed as a province for teachers with specialist knowledge of learning processes in handicapped youngsters.

In many parts of the world education is provided for individuals who intend to spend their professional lives working with handicapped adults, and dealing with social, vocational and home-living aspects of programmes. Yet these developments are of recent origin and many countries have still not developed adequate training programmes for personnel who work with developmentally handicapped adults and adolescents.

Attention is directed towards the types of services handicapped persons need, as well as the types of personnel training which is required to meet some of those needs. A brief history of rehabilitation services is provided, current philosophical models examined, and the need for new systems of rehabilitation discussed, together with the implications these have for the training of personnel.

REHABILITATION OVER TIME

At the present time we function in a period of training and integration of handicapped persons, and yet already we are beginning to see a movement towards a climate of reinstitutionalisation. This change of atmosphere relates to the political and economic context in which training and integration takes place, but the fact that such change' is possible appears to relate to the fact that we have few well-trained personnel available for the development and application of effective training programmes. This means that once handicapped people are placed in the community, they do not receive the types of support and help that are necessary in order to maintain them effectively within the community. For example, it is still believed that once an individual has been through some form of training programme, only rudimentary follow-up services are necessary. It is also relevant that as one form of institutionalisation is dealt with another appears. For example, in Canada there is growing concern over the simplistic and rigid models of care provided for many pre-school children in nursery systems. It appears we have not learned the lessons provided by those concerned with early environmental stimulation and our welfare and educational systems are not providing adequate standards and models for such care.

The thrust of this book is that long-term programmes to help people adapt to ever changing environments are critical to the maintenance of individuals in the community. Sadly, when individuals are misplaced or deteriorate within the community, we are apt to cite the limitations of the individuals themselves rather than the lack of service which exists within the training and educational system that we have provided. It is suggested that only when we look to these shortcomings will we indeed begin to answer some of the longer term implications of rehabilitation.

AN HISTORICAL PERSPECTIVE

The history of services for handicapped people shows the development of a gradual awareness of handicapped persons as individuals within a complex background of behaviour and causation. It is only in the last 20 or so years that we have moved away from a model of institutionalised care for handicapped persons and begun to recognise the importance of integrating such people into the surrounding community. Yet it would be unwise to forget that the development of institutions as places of relief and shelter were developed for benign rather than malevolent reasons. All systems, as they become outmoded and outdated, stagnate and cease to provide the type of treatment and care that is required in contemporary society. We would do well to remember this, since the particular forms of treatment and training that we provide at this point in time will very quickly be seen as inappropriate, in some degree, to the future system of education and treatment that is required.

The idea of heterogeneous performance, with varied baselines of behaviour, is of recent origin and reinforces a view of individualised treatment. That this is not fully grasped is shown in our facile models of integration and normalisation. It is only now that we see that most mentally handicapped people suffer from a variety of contributing causation rather than suffering from a specific condition. This is true of many of the handicapping conditions. Intellectual impairment amongst visually impaired individuals and those with hearing loss is common, and likewise in cerebral palsy it is likely that there will be some loss of intellectual function. Many people with mental handicap have problems of motor and auditory impairment. These conditions, then, are not clear cut, and the intellectual loss that is present arises from a mixture of environmental and inherited causes. Yet it was not so long ago that individuals with so-called specific conditions (e.g., mental retardation, epilepsy, blindness) were categorised separately. The treatment of such individuals is still often seen as a separate function and some administrative systems still insist on the use of test material, such as intelligence measures, to classify and predict performance. Such individuals were segregated and for the most part, placed in institutions for particular diagnostic groups. Poor laws provided other institutional settings where the variety of indigent and socially disadvantaged persons could be maintained. Quite frequently such places, though of poor standard by today's criteria, provided care in country areas, away from the industrial communities with their associated diseases, and in environments where food was available.

The standards of treatment varied. There were progressive ideas concerning treatment in some institutions. During the 19th century the possibility of individuals being provided with some work and earning wages for their labor was not unheard of. Some charitably-disposed agencies were run by less optimistic individuals who believed treatment should include castration for handicapped people, who were bound, in their view, to produce handicapped children, were a drain on the economy of society. It is important to recognise that such negative views were held at a time when others held benign views. It is inappropriate to think that the concepts of integration and normalisation are merely features of today's approach. During the 19th century there were practitioners who, in effect, advocated the normalisation of environments and progressive social and educational treatment for handicapped persons (Sloan and Stevens, 1976). Further, the work of Itard and Seguin (Ball, 1970) examined individually handicapped persons in some detail, thus foreshadowing the specific programme approaches of today which are linked to baseline assessment.

Immediately following the Second World War, most intervention with mentally handicapped individuals was provided through the medical system by nurses who, after training, received a mental deficiency nursing diploma. They provided care, support and some training to handicapped persons. Special schools were provided, some offering day programmes, others residential programmes. But for most young adults the service provided was either through the parent with the individual living at home, or through institutional involvement provided in private homes or agencies, sheltered workshops, and the institutional hospital system.

In Britain, after World War II, psychological services began to develop and a few experimental and demonstration units were provided to see to what extent handicapped persons were able to learn to work on simple tasks of an industrial or semi-industrial nature. It had become recognised during the war that many mentally handicapped individuals could work very effectively in a wide range of jobs. From our vantage point it is apparent that changes in services were directed, not from any concern to meet the needs of the individual, but by necessity as national economic and political considerations. Demand for labour, and particularly male labour, in Britain opened up the possibility of employing handicapped people to carry out certain jobs. It was only later that it was realised, on a wider basis, that there was a need to change the system in relation to handicapped persons so they could learn and thereby enter society. This perhaps exemplifies a primary requirement of change in this field. Societal needs are prime determinants of change, and although rehabilitation may be seen as desirable by parents and professionals, change is unlikely to occur until parents, professionals and politicians are working together. Vet our trainers of special educators and school and clinical psychologists are rarely taught how to manage political and social variables to the advantage of their clients.

There are, of course, many other relevant factors, not least of which are the growth and motivation which occur with many handicapped youngsters. Many, who are handicapped as young children, have minimal handicaps by the time they become young adults. In some cases the discrepancy resulted from a misuse or misapplication of assessment materials, such as intelligence tests, during childhood. Persons of average or above average ability became diagnosed as mentally retarded. We also know that a large proportion of mentally handicapped people, during their late teens and early 20s, grew towards normality in terms of cognitive ability, thus providing opportunities for learning and work, which might not have been available to them at an earlier age. The advent of better assessment and training devices in the area of vision and hearing handicap meant that individuals became susceptible to teaching methods which were not possible earlier. For example, the use of the optacon for those with visual impairment and the use of the inductive loop system for the hearing impaired have provided significant benefits.

However, it should be noted that the process of change was also through intervention of particular kinds. The development of vocational training in sheltered workshops, in institutions and, more recently, within the school system provided opportunities for some training.

On the other hand, workers such as Gold (1978), have argued that much of what occurred was not training, but merely exposure of individuals to work-like situations. Unfortunately this is still largely the preferred programme method. However, a number of agencies have developed vigorous training programmes, although it is true that the training is often of a primitive nature, being what we shall later describe as concrete. Material provided was frequently small part assembly work, where an individual carried out a particular job in a particular way at a particular time. This was found to be inadequate in terms of rehabilitation effectiveness and some workers, like Gunzburg (1968), demonstrated the importance of social education. According to a wide range of writers (e.g. Gunzburg, 1968; Brown & Hughson, 1980; Parmenter, 1983) the major failures in the adult's ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• PREFACE
• 1. THE FIELD OF DEVELOPMENTAL HANDICAP - THE DEVELOPMENT OF REHABILITATION EDUCATION
• 2. PROGRESS IN THE ASSESSMENT AND PREDICTION OF VOCATIONAL COMPETENCE IN THE RETARDED
• 3. PREPARING THE MILDLY INTELLECTUALLY HANDICAPPED ADOLESCENT FOR EMPLOYMENT AND INDEPENDENT LIVING: A RESEARCH REVIEW
• 4. ACTION RESEARCH - WORKING WITH ADULT TRAINING CENTRES IN BRITAIN
• 5. REHABILITATIVE MODELS AND RESIDENTIAL PROGRAMME SERVICES
• 6. BEHAVIOURAL AND EMOTIONAL ASPECTS OF TRAINING FOR ADOLESCENTS AND ADULTS WHO ARE DEVELOPMENTALLY HANDICAPPED
• 7. INTERPERSONAL RELATIONSHIPS: SELF-ESTEEM, SEXUAL INTIMACY, AND LIFE-LONG LEARNING
• 8. TRANSITION FROM SCHOOL TO ADULT LIFE
• 9. REHABILITATION EDUCATION - SOME FUTURE DIRECTIONS
• INDEX
• AUTHOR INDEX