Comparison of the German and American systems of rehabilitation.

Comparison of the German and American Systems of Rehabilitation 

The comparison of the German and American systems of rehabilitation must be made within the philosophic premises as well as the economic differences of two nations. One of the major premises of the American system is that people with disabilities have the right to choose their own destiny. The rehabilitation system provides people with disabilities opportunities to choose an occupation which is comensurate with their abilities, aptitudes, and interests, and which leads to competitive employment in the community or to supported employment, defined as "competitive work in an integrated work setting for individuals who, because of their handicaps, need ongoing support services to perform that work" (Federal Register, 1987). The American system was designed originally to provide counseling and guidance, vocational training, and job placement to meet the needs of persons with industrial accidents, physical disabilities, and primarily ambulatory impairments. Gradually, it was expanded to include persons with emotional illness, mental retardation, severe physical disability, traumatic brain injury, and developmental disability. As each new disability group was brought into the network of rehabilitation services, creative mechanisms had to be developed to meet each group's needs. Frequently services have not developed fast enought to meet the needs of new groups pressing at the door.

The successful integration of persons with severe disabilities, including developmental disabilities has been enhanced by a variety of innovative community based programs, such as supported work in unsubsidized competitive employment, transitional employment which helps persons with severe disability to try work in a competitive setting for six months while being subsidized and supported by a job coach, and long term supported employment with ongoing emotional and vocational support by a job trainer. Individuals who formerly would have spent their lives in institutions are working in the community.

The movement toward integration, however, has not been exacted without a price. The fragmentation of services for housing, jobs, recreation and special education has resulted in inadequate services for many disabled persons in the United States (Goldberg, 1984). The provision of employment services in an integrated work site does not resolve the problem of social isolation while off the job. Similarly, integration of handicapped with non-handicapped children in the regular classroom may result in social isolation of the child with a disability or less intensive educational preparation. Mainstreaming is insufficient when a local school system fails to provide necessary academic and technical aids for children with disabilities, or when the community fails to provide the required social and recreational outlets for students with disabilities. In order to understand the differences between the two systems, it is necessary to provide some details about the German system.

Federal Republic of Germany

The Federal Republic of Germany emerged as a separate independent political entity in 1949 as a consequence of the partition of Germany at the end of World War Two. Under stable political and economic conditions several pieces of social legislation were enacted. The Federal Social Assistance Act of 1961 defined the rights of every citizen in a social and democratic state for financial and social assistance, including assistance to blind persons, alcoholics, drug addicts, the homeless, sickness and maternity assistance, hospital treatment to mitigate the effects of chronic illness, aid for persons with tuberculosis, and assistance to aged persons to maintain them within their community (Flamm, 1974).

The basic law governing the rehabilitation system, enacted on April 29, 1974, and amended in 1976 and 1986, provides a comprehensive, multi-disciplinary system of interlocking institutions embracing medical, educational, social, and vocational training institutions (Jochheim, 1984). Prevention, detection, and early treatment of disability has been recognized as part of the rehabilitation of persons with disabilities. The person with a disability undergoing occupational training is provided with social security insurance to cover his/her material needs. This assistance enables the trainee to maintain his standard of living, thereby encouraging him to seek training (Greza, 1984).

There is a multiplicity of institutions that serve the disabled population. The inpatient management of persons with disabilities is the task of hospitals which apply modern rehabilitative techniques such as physiotherapy, speech, occupational therapy, and work therapy. The physician is the key member of the rehabilitation team and formulates the rehabilitation plan with the advice and consultation of psychologists and social workers. In addition to hospitals for acute care, there are rehabilitation centers for medical and occupational rehabilitation. These institutions lie halfway between acute care management and the occupational institutions of rehabilitation which serve training or retraining. Measures of rehabilitation are implemented from the time the patient is confined to bed to the time of aftercare. Adults with psychiatric disabilities are also treated in day clinics and evening clinics. In the day clinics patients are provided with diagnosis and treatment in a homelike atmosphere. Evening clinics are available for persons who are living for a limited time in the hospital and who require medical, nursing, and social therapy while attending work during the day. Patient clubs are available for persons with disabilities and their relatives and friends who need support in a warm environment (Rehabilitation of Disabled, 1984).

Housing for Persons with Disabilities

Adults with disabilities may live in special living quarters (Wohnheim) which serve the physically handicapped, the psychiatrically disabled, the mentally retarded, and persons requiring geriatric care. The inhabitants require no intensive medical treatment. These living quarters are located throughout the Federal Republic, and are often connected with the system of sheltered workshops and occupational training centers. The Wohnheim make possible the transition from school to occupational training center, and provide geriatric housing for the elderly disabled person who wants to continue to work in sheltered employment. The social needs of persons with disabilities are met in a warm, trusting, supportive institution (Rehabilitation of Disabled, 1984).

Special Education and Rehabilitation of Children

The education and rehabilitation of children with disabilities is complex. The system begins with social pediatric institutions and early "promotion" places, which consist of medical therapies and pre-school evaluation. There are special kindergartens for children from age four, who are not sufficiently prepared for normal school due to their impairments. The special kindergarten serves the development of personal and social skills through the promotion of sensory, motor, intellectual, spiritual, and aesthetic capacities. In one model kindergarten in Bonn, there is an integrated setting for handicapped and non-handicapped children (Greza, 1987).

From special kindergarten children with disabilities are advanced to special schools (Sonderschule), where they are given instruction similar to that which exists in the general school system. In the Federal Republic of Germany, school age children with learning disabilities or emotional maladjustment may be assigned and maintained in Sonderschule. Mainstreaming the child into normal schools has not been very successful due to the philosophical objections of the staff of the normal school. The staff resists lowering intellectual standards to embrace pupils with lower intellectual capacities. It is more likely that a child with physical limitations and average intellectual capacities would be accepted in a normal school. Children remain in special school until the tenth grade. They are eligible to obtain their high school diploma (Hauptschulabschluss), which is equivalent to the diploma granted by a normal school. The diploma leads to further education, including an occupational training center, or to a workshop for the handicapped. Children who cannot achieve their diploma may receive an intermediate or final school leaving certificate, which permits them to obtain work. The process of transition between special school and work is an ingenious, creative, well funded system for the rehabilitation of adolescents with disabilities. Although there are drawbacks due to segregation, variable labor markets, and mixed population of mild, moderate, and severe handicaps, the transition process works well in the Federal Republic of Germany.

Transition From School to Work

Under the basic law governing the rehabilitation system, there are 37 occupational training centers (Berufsbildungswerke) throughout the Federal Republic of Germany. In a training center a student typically chooses a course of training which he/she follows for three years. The student receives training suited to his aptitude and handicap in accordance with the basic law for training. The completed training leads to a final examination which qualifies a student for a recognized occupation or an occupation for which special training and examination is maintained for a disabled person. The objective of training is the Ausbildungsabschluss, a training certificate, which qualifies the student to enter over 400 occupations (Occupational Training Centers, 1984).

The training is frequently connected with boarding school accommodations. Trainees live, work, and play in the same environment. This arrangement has the advantage of providing socialization and opportunities for recreation while the trainee is attending occupational courses. Although the specific training programs differ from one another, all provide work testing during which the aptitude for a particular field is tested. In the next step, the student is assigned to a specific occupation in which the student is trained intensively. While the training is going on, there is academic instruction in the school, in order that the practical and academic knowledge are combined and may complement one another. After the training certificate is obtained, the student may find work with the help of an employment counselor who visits the training center. Although the majority of students are adolescents or young adults, there are some middle aged persons who come to the center for retraining.

In periods of high employment 75% of students from the occupational training center at Neckargemund, for example, were placed in employment. During a period of recession employment declined to 50%, but with the help of a trained employment specialist, the placement rate has risen to former levels (H.J. Fichtner, Pesonal Communication, June 3, 1987).

Sheltered Workshops

Workshops serve persons with disabilities who need occupational training prior to entering the labor market and who cannot be absorbed in the competitive labor market. Persons who remain in workshop production, earn an average of DM 200 per month (U.S. $120) whereas the average wage in the Federal Republic of Germany is DM 2,000 per month (U.S. $1,200). Sheltered workshop employees may get free room and board (Wohnheim) in apartments financed by the local government.

After an initial test of four weeks to determine what type of training is suitable for the applicant, he/she is placed in work training. The training may last for two years, after which the trainees may find a job with the help of an employment counselor who comes from the local public employment office or may enter production at the workshop. Many employees choose to remain in the workshop, especially in periods of recession. In addition, there is a special program of occupational advancement of persons with severe disability who must change occupations in mid-career (Berufliche Forderung) (GWK Workshop, 1986).

Labor Market Conditions

After many years of steady economic growth (8% annually in the 1950's, 5% in the 1960's, 3% in the 1970's), there have been periods of stagnation and decline. Some of the demand associated with postwar reconstruction came to an end in the 1970s. This development, combined with the oil shock of 1974 and the competition from Japanese goods, slowed down the economy. Some companies merged, as they did in the United States, into larger concentrations of capital and human resources, in an effort to meet world wide competition. Despite these maneuvers unemployment rose to over 8% in 1987, as more workers with highly developed skills sought employment. The children of this baby boom are graduating from school and are seeking jobs in a labor market with slower growth.

The German educational system, moreover, achieves a very high standard of academic and technical excellence, which results in a surplus of highly skilled workers in need of employment. The agricultural sector requires permanent subsidies in order to keep people on the farms. Only 6% of the population remains employed in agriculture, mostly on family owned farms. In addition, this highly trained work force has been forced to compete with large influx of "guest workers" who were brought into Germany after World War II from other countries, especially Turkey, Italy, and the Middle East.

When the German economy was growing, there was less difficulty in finding jobs for marginal employees with physical and mental disabilities. Occupational training centers were built in the 1970s and 1980s when government funds were plentiful and employment opportunities were good. The question facing welfare and rehabilitation administrators is whether the economy can absorb a large portion of the disabled population in periods of stagnation or slow growth, as more workers with highly developed skills seek employment.

Comparison of the Two Systems

The German system of well funded medical, educational, vocational, and social institutions works well within German culture, where students are more disciplined, orderly, and willing to accept the advice of parents, teachers, and employment counselors. Trainees at one of the 37 occupational training centers choose, train for, and get an occupation that is offered to them. Usually, the occupational offerings depend upon the available training areas in the specific center. After earning a "qualification," a certificate of achievement, the trainee is ready for work.

In the United States occupational choice is more diverse and less restrictive. A client of a state rehabilitation agency is evaluated for vocational potential. The whole array of occupations is available to him/her, but in reality the opportunity for training depends on the student's abilities and the available jobs in the competitive labor market. Moreover, the completion of a vocational training program does not guarantee a job or future employment success. A formal degree or certificate is not a requirement for most occupations, with the exception of licensed programs and skilled crafts such as plumber or electrician. Freedom of occupational choice must pay a price in terms of less certain employment.

There are five important lessons to be learned from the German rehabilitation system. First, the German system provides for nearly every need of students with disabilities. This model demonstrates the effectiveness of providing educational, vocational, housing, and recreational services within one institution. Second, the educational system is linked with the medical institutions which provide acute care, short term care, and chronic rehabilitation. Within the occupational training center, medical consultation and therapies are available. In contrast, the American system of rehabilitation is more fragmented. In the United States schools, housing, transportation, and employment are governed by a network of agencies with different policies, federal and state regulations. These services need to be coordinated in order that persons who are placed on jobs can find living and recreational opportunities nearby. Third, the German experience of providing social supports while persons with disabilities undergo training is relevant to American programs of supported employment. Social and financial supports up to DM 140 (U.S. $84) monthly for each student is given. Free housing is provided for students who cannot live independently either on account of the severity of their disability or because of limited opportunities to socialize outside their living apartments. Although social support is given, it does not lead to integrated work with non-handicapped persons or to integrated social situations with non-handicapped persons. In the United States, supported employment programs are built for individuals who require ongoing support while working in integrated work sites. However, unless the community is willing to support these programs with financial aid, housing, and recreational opportunities, they cannot succeed. Fourth, the German experience of placing students with disabilities in the competitive labor market worked well during a period of economic recovery and prosperity. When the economy declined the employment of students with disabilities at occupational training centers declined. In the United States the history of employment of persons with disabilities has been similar to that of the Federal Republic of Germany. When there is an economic downturn, employment of persons with disabilities declines. One implication of these two systems is that a large percentage of workers with disabilities will need alternative placement in times of hardship. Therefore, it is imperative that we do not dismantle the system of private and public sheltered workshops that have been established in the United States. There must be a fall back position in times of stress. Fifth, the impact of the two systems, American and German, is difficult to compare in terms of outcomes. The trainees in the Berufsbildungswerke are guaranteed employment in the labor market when they obtain a "qualification." Many trainees remain in sheltered workshops when jobs are not available. In the United States trainees must find work after completing training.

Conclusions

The German system is a good example of a coordinated network of rehabilitation services in which persons with disabilities can satisfy their basic needs in or near the same setting. Consequently, persons with disabilities can lead fully satisfying social lives while working at productive jobs.

The American system is an example of many, independent rehabilitation services functioning in a creative way with many different approaches, innovations, and models. The major limitation is that services tend to be uncoordinated, fragmented, and guided by different authority. Persons with disabilities must seek services from many agencies in order to satisfy their needs. But the German system, too, has limitations. Persons with learning disabilities may be segregated in large training centers for three years before placement in the community. Some adults with vocational impairment may work in sheltered centers for most of their lives without social contact with non-disabled persons, except in the form of supervisors.

A combination of the best components of both systems is required to meet the needs of children and adults with disabilities. Whereas the German system provides comprehensive social, recreational, and work opportunities in a mini-society of disabled persons, the American system provides greater opportunity for persons with disabilities to pass into the general society. Community based programs can work effectively only when the requisite medical, social, recreational, and vocational programs are in place. Both systems can learn from each other in implementing the goal of bringing persons with disabilities toward social and vocational integration in the community.