Defining the Future of Disability Employment Through the Lens of Person Centred Practice.

In 2015 in my submission to the DES Framework Review I wrote the following opening statement regarding person centred practice in disability employment.

“Any review of the current program needs to start with defining what the program is about. At present the program suffers in that it is presented as a person-centred program to support people with disability enter the workforce, yet when examined against accepted definitions of person-centred practices, the program fails to satisfy even the most generous definitions of person-centred practice, as illustrated by the following comments.

Amado and McBride (2002) developed a framework for human services that propose to provide long term support for people with disabilities should support

• People to discover and move toward a more desirable future.
• Protect and promote five valued experiences: sharing ordinary community places and activities, contribution, expanding relationships, being treated with respect and having a valued social role, and choice.
• Offer needed help in ways that support and strengthen community competence.

Stirk and Sanderson (2012) noted that person-centred practice is a philosophy of practice that goes to the heart of the culture of a service organisation. Schalock and Verdugo (2012) made the point that individuals receiving services will have their own unique view of what a person-centred service is.

Collectively, these positions highlight the difficulties that the current program has in relation to being person-centred. It fails due to not having a clear vision and guidelines that allows service providers to alter their culture to reflect the notion that a person-centred practice is defined by the unique method that it delivers individualised service to a person with a disability.

The program of the future must clearly articulate to service users and staff what a person-centred program is, how it will operate, what the program can and will do, have sufficient flexibility to meet client expectations and provide a framework that allows staff to operate in a truly person-centred way.”

Nearly a year later reflecting on this, I wonder how many people with a disability have been engaged in the process of defining a new system of disability employment practice? Some time ago a friend of mine noted that the issue with person centred practice is that the minute you try to manualise it, it fails. Given that how person centred a program is has a large subjective element based on the recipients experience of the system, I wonder if the solution to person centred practice in disability employment lays in two areas; how an organisation responds to the individual and how we assess the outcome?
How do we achieve this? From the organisation perspective possibly the solution is found in proper training in person centred practice and the actual planning methodology, followed by a comprehensive review of current practice to ensure that procedures reflect staff understanding. Granted it might require some changes in the way that the organisation operates, but it shouldn’t conflict with compliance measures and it has the potential to improve client engagement with the process.

Measuring outcomes will require a new paradigm. The current system of star ratings isn’t a true outcome reflection in any system that reflects clients, but is simply a guide to who plays the system effectively. It doesn’t measure quality in outcome and the impact of the employment achieved or whether it is valued by the client. Yes, you could mount a case that clients are excited about getting a job, but what about in six week or six months time. What about the impact of the clients new found employment on the other aspects of the clients life? There’s probably a pervasive argument that it’s not part of the DES program or concern, but if I continue to fall out of jobs and require ongoing investment to start the process again, then clearly we have a problem that hasn’t been identified.

I would argue that an outcome measure that examines and measures social inclusion and social cohesion, along with quality of employment is a better measure of a program that affords a person centred approach and better guide for clients in a system that allows clients to choose their DES provider. Yes by all means measure compliance, which really is an audit exercise, but a system that offers itself as person centred would and should measure client factors in order to define success. The more we understand the client equation, then the less likely clients are to fall out of employment.

Something to ponder!

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About Peter Smith

Disability practitioner at Praxis Disability Consulting, PhD researcher - Sydney Medical School, Research affiliate - Centre for Disability Studies, Sydney. Lecturer in Counselling and Case Management - ACAP. Counsellor and Psychotherapist at Praxis Counselling and Therapy. Interests: Disability employment, person centred practice, self determination theory, existential therapy, personal counselling
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