Vocational rehabilitation in South Korea: historical development, present status, and future direction.

Since the 1980s, vocational rehabilitation in South Korea has developed rapidly as one of the country's fastest growing social service areas. Due to South Korea's rapid economic growth during the 1960s and 1970s, the South Korean government could afford to expand social services to include rehabilitation services for people with disabilities. The efforts of international organizations such as the United Nations (UN) and the Economic and Social Commission of Asia and Pacific (ESCAP) to enhance the well being and quality of life of people with disabilities living in developing and underdeveloped countries also worked as a catalyst, promoting and facilitating growth within vocational rehabilitation in South Korea (Kwon, 1997)

Despite remarkable progress, there still exist many problems and limitations in the delivery of South Korean vocational rehabilitation services, in large part as a consequence of these services' short history. In the United States, the formal provision for providing public vocational rehabilitation to people with disabilities has evolved since the Soldier's Rehabilitation Act in 1918 (Rubin & Roessler, 2001). By contrast, in South Korea the acknowledged rights of people with disabilities, legislative initiatives, facilities, and service systems necessary for providing vocational rehabilitation to people with disabilities have developed only since the early 1950s. In this paper, we present a historical overview, describe current situations and problems, and future directions for better improvement of vocational rehabilitation in South Korea.

Historical Overview of Vocational Rehabilitation in South Korea

Beginnings: 1953 to 1976

The South Korean program of rehabilitation for people with disabilities was introduced following the 1950 Korean Conflict. Unfortunately, at the time there were neither adequate government programs nor facilities to provide support for the many disabled soldiers and civilians (Park, 2001). In 1953, the South Korean government converted a wounded veterans' recuperation home in Tong-nae, Pusan, into the National Rehabilitation Center. This conversion was assisted by the United Nations' South Korea Reconstruction Agency (UNKRA) and Rusk, who was the Chairman of the American South Korean Foundation (AKF) and a professor of Rehabilitation Medicine at New York University. The Center was the first rehabilitation center with modern facilities and technologies established in all of Asia and was staffed by a team of rehabilitation personnel dispatched by the UN. The Center's programs included (a) medical evaluation and treatment of veterans with disabilities; (b) development, manufacturing, and distribution of up-to-date assistive devices and prostheses; and (c) vocational training and placement. Eventually, the Center's programs expanded to include rehabilitation of civilians with disabilities (South Korea Research Meeting for Asian-Pacific Decade, 1997).

In 1954, Rusk sent South Korean medical doctors to New York University to train in rehabilitation medicine. Rusk also facilitated the development the South Korean Society for Rehabilitation of Disabled Persons (KSRD) and sponsored KSRD's affiliation with Rehabilitation International (RI), thus helping South Korea keep abreast of international development on disability and rehabilitation issues. His interest in and contribution to the rehabilitation of persons with disabilities in South Korea was so significant that to this day he is called a pioneer in the South Korean rehabilitation community (Jeon, 2000).

In the 1960s, many medical doctors who had been trained in the United States in orthopedic surgery, rehabilitation medicine, and other specialties returned to South Korea and helped create orthopedic and rehabilitation departments in major hospitals. Soon thereafter, resident training programs were developed in these specialty fields. A junior college for training physical therapists was established in 1964 (South Korea Research Meeting for Asian-Pacific Decade, 1997). The rapid development in medical rehabilitation services due to the urgent need for physical restoration of people wounded during the Korean Conflict did not, however, lead immediately to the establishment of other rehabilitation service programs, such as vocational services and psychosocial support. The social instability, political turmoil, and economic difficulties following the Korean Conflict meant that the government had no opportunity to develop a national policy for people with disabilities. Instead, between 1960 and 1970, national policy focused almost exclusively on economic growth; social welfare policies addressing public health requirements and economic pension plans for disadvantaged people, including people with disabilities and veterans, made very little progress.

Regulation and Development: 1977-1988

Prompted by the UN's actions to declare the Rights of the Mentally Retarded in 1971 and to adopt the Declaration of the Rights of the Disabled Persons in 1975, the South Korean government enacted the Promotion of Special Education Act in 1977. This regulation promoted normalization, mainstreaming, inclusive education, early education, and individualized education, thus improving the educational opportunities for people with disabilities, which in turn allowed them to develop their own abilities, to live more independently, and to contribute to their communities (Kim, 1995). It was the first legal policy established in South Korea for the rehabilitation of people with disabilities. Since then, the Act has been amended several times in the aforementioned concepts to further enhance special education in South Korea (Shin, 2000).

Comprehensive vocational rehabilitation services for people with disabilities in South Korea, spurred on by the rapid economic growth during 1960s and 1970s and the external influence of international organizations like the UN, began in the early 1980s. This was an important period in terms of history of rehabilitation policy development for people with disabilities. Cha (1994), a former Minister of the Korean Ministry of Health and Welfare, named the following three factors as instrumental in forming the groundwork for development of vocational rehabilitation policies for people with disabilities: (1) the national movement for better quality of life for people with disabilities, (2) the government's balanced investment across societal needs, including rehabilitation, and (3) international influences such as the UN's International Year of Disabled Persons in 1981.

The UN's appeal and the social needs in the area of rehabilitation motivated South Korea's enactment of The Disability Welfare Act in 1981, which delineated the government's responsibility for the protection of disability rights and included provisions for prevention of disability; medical, vocational, social, and educational rehabilitation; and economic assistance. The Division of Rehabilitation, which implements rehabilitation policies, was founded at this time in the Ministry of Health and Social Affairs (the predecessor of the Ministry of Health and Welfare). Simultaneously, the South Korean government began a national survey project and created a database of demographics on people with disabilities to support effective and systematic rehabilitation policies.

The 1988 Paralympic Games, held in Seoul concurrently with the 1988 Summer Olympic Games, increased public awareness of disability issues and facilitated further development of rehabilitation services in South Korea (South Korea Research Meeting for Asian-Pacific Decade, 1997). In 1988, a Special Committee on the Welfare for People with Disabilities was established as a presidential advisory committee to address Cha's three factors, noted above. Although it was only a temporary committee, it was the first presidential committee dealing explicitly with disability issues and presented a special report to the President on comprehensive measures for disability welfare and rehabilitation of people with disabilities

A Period of Progress and Transition: 1989 to 1990

The Revision of the Disability Welfare Act in 1989 promoted expanded the scope of rehabilitation services and resulted both in the conversion of many segregated custodial residential facilities into integrated and community-based facilities and the creation of new rehabilitation centers. Consequently, South Koreans with disabilities gained increased accessibility to a wide range of services, and a number of rehabilitation counseling, evaluation, medical rehabilitation, vocational rehabilitation, and social adjustment training programs were developed and employed at these rehabilitation centers to fill the increased needs (Jeon, 2000).

South Korean National Assembly then passed the Employment Promotion Act for People with Disabilities of 1990, which has been considered the turning point in addressing employment issues for people with disabilities in South Korea (South Korea Research Meeting for Asian-Pacific Decade, 1997). The Act included various measures to increase employment of people with disabilities, including an obligatory employment system (a quota system), requiring companies or government organizations with 300 or more employees to maintain a level of at least 2% people with disabilities among their staff. Fines are imposed when these obligations are neglected. Conversely, when more people with disabilities are employed than is required by law, a subsidy is offered to the employer. In 1990, this incentive system prompted the development of a new administrative organization under the Ministry of Labor, the South Korean Employment Promotion Agency for the Disabled (KEPAD), which plays a similar role to the Division of Vocational Rehabilitation in the United States (Kang, 1997).

Period of Settlement: 1991 to the Present

Although the 1990 Employment Promotion Act for people with disabilities has historical importance as the first South Korean law regarding employment promotion for people with disabilities, many limitations on expansion of employment opportunities for persons with disabilities persist (Oh, 2001). First, the strongest type of employment promotion of the Act was the 2% quota system. However, while the Act clearly outlined the responsibilities of private enterprises to sustain the 2% employment for persons with disabilities rule, similar regulation of central and local governments was vague. This made it difficult to question government organizations when they did not employ people with disabilities in the proportions indicated by the Act. As a consequence, private enterprises were often uncooperative in providing employment opportunities for people with disabilities, complaining that government organizations unfairly transferred the responsibility to employ people with disabilities to the private sector. Moreover, the 1990 Employment Promotion Act for people with disabilities excluded people with mental retardation, developmental disabilities, and cerebral palsy who required intensive vocational rehabilitation planning, because in practice the Act focused solely on vocational rehabilitation of people with physical disabilities or mild mental disabilities (Kim, 1999).

These problems inspired a 1999 amendment of the 1990 Employment Promotion Act for people with disabilities. The 1999 amendment includes the implementation of the "Supported Employment", "Diversified Sheltered Workshop", "Financial Aids for Small Businesses who hire people with disabilities", "Double Count System", and "Codified Responsibility of 2% Obligatory Employment for People with Disabilities" in government organizations. In the "Double Count system", hiring a person with severe disabilities is comparable to the hire of two employees, providing a financial incentive to employers. The severity of disabilities depends on nationwide disability category in South Korea. Also, "Codified Responsibility of 2% Obligatory Employment for People with Disabilities" in government organizations intends to demonstrate the leadership role of the government, and in turn will encourage compliance in the private sector. Finally, new legislation entitled the "Employment Promotion and Vocational Rehabilitation Act for People with Disabilities" incorporating these recommendations was passed by the South Korean National Assembly in December 1999; it has been enforced since July 1, 2000 (Oh, 1999; Oh, 2001).

The Service Delivery System and the Current Situation of Vocational Rehabilitation

Two governmental bodies, the Ministry of Labor and the Ministry of Health and Welfare, are involved in vocational rehabilitation service delivery in South Korea. In 1990, the South Korean Ministry of Labor established a Disabled Employment Division (Kwon, 1997), and it established the South Korean Employment Promotion Agency for the Disabled (KEPAD), a pivotal agency with the exclusive responsibility to enhance the nationwide vocational rehabilitation for the people with disabilities. KEPAD currently has one Employment Development Institute (EDI), thirteen Branch Offices scattered nationwide, four Vocational Evaluation Centers (VEC), and three Vocational Training Institutes (VTI) (http://www.kepad.or.kr/sub07-03.htm). KEPAD, EDI, VEC, and VTI are public organizations under the fiscal control of the Ministry of Labor.

In 1997, the South Korean Ministry of Health and Welfare divided its Rehabilitation Division into two subordinate divisions, the Rehabilitation Service Division and the Disability Policy Division. The purpose of the division was to manage more efficiently the increasing responsibilities for developing and improving national policies and delivery systems for disability services due to changes in socio-economic conditions such as economic growth, industrialization, and the ever-increasing demand of people with disabilities for welfare and rehabilitation (Kwon, 1997). The Ministry of Health and Welfare manages 35 Community Vocational Rehabilitation Centers, which coordinate the vocational rehabilitation services such as vocational counseling and guidance, vocational evaluation, vocational adjustment training, job placement, follow-up, and supported employment.

Additionally, the Ministry of Health and Welfare expanded the concept of sheltered workshops to include five specialized types of facilities: independent work facilities, sheltered work facilities, work activity facilities, vocational adjustment training facilities, and products marketing facilities for the products made by people with disabilities. Taken together, these facilities were designed to address the various vocational rehabilitation needs for competitive employment of persons with different levels and severities of disability. (Korean Ministry of Health & Welfare, 2001). Independent work facilities provide minimum wage employment for people with disabilities who are unable to find permanent employment because of social barriers. People with disabilities can both work and live at these facilities until they are hired in competitive employment, Sheltered work facilities are segregated facilities, providing people with disabilities who face physical barriers to competitive employment with employment opportunities. Work activity facilities provide people with the most severe disabilities with vocational services such as basic Activities for Daily Living (ADL) or basic job task training. Vocational adjustment training facilities provide specialized vocational training in specific areas such as mechanical, computer, electrical, or packing: the area of specialization depends upon the facility. Products marketing facilities promote product marketing, marketing counseling, marketing information and provide a specialized marketplace for products made by people with disabilities. Comparison of these facilities in terms of eligibility, type of integration and employment, and wage is presented in Table 1.

Although South Korea has been developing her own unique service delivery systems, there are some problems in terms of duplications of services. Moreover, other problems occur because each ministry works as a separate entity and tends to compete rather than cooperate with each other. For example, the Ministry of Labor and the Ministry of Health and Welfare compete for funding in each yearly budget. Another problem is that the outcome reports compiled by each Ministry are designed not to maximize total service-delivery efficiency and efficacy but to encourage further development of their own service programs, even as such programs overlap with those provided by the other Ministry. Obvious opportunities for specialization, such as having the Ministry of Labor specialize in vocational evaluation centers while the Ministry of Health & Welfare specializes in vocational training, are missed because the two Ministries do no cooperate. Figure 1 illustrates vocational rehabilitation service delivery and interagency cooperation of each Ministry. The lack of cooperation of the two Ministries and duplication of services are also illustrated.

[FIGURE 1 OMITTED]

Inefficiencies occur because the two Ministries provide the same services. This results in deterioration of service quality because a limited number of vocational counselors provide too many different kinds of vocational rehabilitation services including counseling, job placement, job development, vocational evaluation, and supported employment. Ultimately the problem stems from insufficient regulation: both the Ministry of Labor and the Ministry of Health and Welfare are responsible for providing vocational rehabilitation services, but the specific roles and functions of each ministry are not clearly defined.

The U.S. shows one way to achieve a cooperative system in vocational rehabilitation counseling. The Division of Vocational Rehabilitation provides qualified vocational counseling to people with disabilities and cooperates with the private sector of vocational rehabilitation agencies in terms of education, evaluation, and placement via service procurement. The Division of Vocational Rehabilitation in the U.S. provides intensive vocational counseling for its clients and purchases job placement, supported employment, or vocational evaluation services from the private rehabilitation sector. By contrast, while the Korean Employment Promotion Agency has job placement developers or supported employment developers as personnel, the private sector in South Korea also have those personnel: cost-effectiveness is needed in terms of cooperation and administration. Figure 2 illustrates vocational service delivery in the U.S., and how the Division of Vocational Rehabilitation cooperates with private sector of rehabilitation and other inter-division of the Department of Workforce Development.

[FIGURE 2 OMITTED]

Although there may be many reasons why the employment situation of the South Koreans with disabilities did not improve in spite of changes in policy and government programs, some are especially apparent. First, the regulations and policies have been superficial or perfunctory, lacking the enforcement that makes the laws more than mere recommendations. Strong disciplinary action by the government against violators has been a rarity. Second, local governmental systems are immature. Local autonomy systems in South Korea were instituted only in 1995 (Choi, 1995). Even if the central government develops national vocational rehabilitation policies relatively successfully, local governments have limited effective delivery channels to meet the objectives of the policies. They rarely have staff trained to handle rehabilitation programs for people with disabilities. Therefore, comprehensive and systematic improvements in the government body must be established so that a variety of services can reach individuals with disabilities at every community level (Cha, 1994). Third, many South Korean rehabilitation facilities have been established without proper development of programs and professional manpower. A shortage of specialized manpower impedes development and success of vocational rehabilitation programs. Only four universities provide a Rehabilitation Counseling program, and the system of legal certification of vocational rehabilitation counselors was enacted only four years ago (Park, 2003). Therefore, the majority of rehabilitation personnel currently working in vocational rehabilitation facilities have an educational background in social welfare and social work rather than in rehabilitation counseling or vocational rehabilitation.

Oh (1998) stated that the quality of vocational rehabilitation services depends heavily upon the professionalism of rehabilitation personnel who deliver the services. Szymanski and Parker (1989), Szymanski (1991), and Szymanski and Danek (1992) revealed that the rehabilitation counselor's skill and knowledge relate directly to the outcome of increased employment opportunities for clients In regards that, the lack of a qualified and sufficient educational system is one of the most unfortunate barriers to ensuring the employment and civil rights of people with disabilities. South Korea must upgrade the quality of vocational rehabilitation personnel by providing appropriate educational and professional development opportunities to prepare practitioners better to function effectively in this important profession (Cha, 1994; Lee, 1998).

Suggestions for Future Directions

Although the South Korean government has focused its attention on establishing legislation in support of people with disabilities and has achieved remarkable progress in a relatively short period of time, people with disabilities in South Korea are still struggling to achieve independence in their vocational lives. The reasons can be traced to the short history and the lack of understanding of cultural differences in application when vocational rehabilitation was introduced to South Korea. The vocational rehabilitation personnel of South Korea, drawn as they were from a variety of other disciplines and professions, could not manage to pending problems because the immediate needs of vocational rehabilitation exceeded their ability. This burden might be a universal problem in developing countries intending to develop rehabilitation services in a comparatively short span of time. This suggests that international exchange with Western countries with successful, sophisticated vocational rehabilitation systems in place might be the optimal way for such programs in South Korea (and other developing countries) to develop.

First, international academic events such as seminars, conferences, and workshops on vocational rehabilitation are needed in South Korea for contribution of public awareness of disability and rehabilitation issues and upgrade the quality of services provided by rehabilitation personnel. Second, the exchange of students and scholars in the vocational rehabilitation field would help to infuse in-depth knowledge and techniques in all areas of vocational rehabilitation into the South Korean system. Selected South Korean students can be encouraged to study abroad, especially in the United States, in order for them to learn the latest theories and techniques and contribute to program and personnel development upon their return to South Korea. The establishment of sisterhood relationships or the expansion of scholarship opportunities would enable student exchanges. The exchange of noted scholars in the vocational rehabilitation field would further contribute to South Korea's advancement in this domain. Third, implementation of distance continuing education programs like those developed in the United States would help overcome the inadequate training of a large portion of rehabilitation personnel currently working in South Korean vocational rehabilitation facilities who, because of the lack of academic programs in South Korea's educational system, have never been schooled specifically in disability or vocational rehabilitation. In the U.S., various distance continuing education programs specific to vocational rehabilitation have been developed. The National Clearinghouse of Rehabilitation Training Materials (NCRTM) operated by Oklahoma State University lists some of the vocational rehabilitation-related distance learning continuing educational programs (http://www.nctrm.okstate.edu). Fourth, learning assistance programs and translation systems could be developed to assist the rehabilitation personnel in South Korea who lack proficiency in English to participate in distance continuing education programs. Fifth, the South Korean government should support international exchange systematically because a fruitful international relationship contributes to the mutual interests and contribution in future development among all participating nations. Also academics in South Korea should contribute to mutual development and contribution through further research in international exchange, looking at ways to make it a two-way support system.

Conclusion

South Korea has achieved much in vocational rehabilitation over a short period of time. However, South Korea has also gone through a trial-and-error period such as the overlapped service delivery system, and legal recommendations rather than legal regulations. The American Model, the most developed country in the area of vocational rehabilitation, was introduced at the end of Korean Conflict and when other social events were occurring such as including economic development, political changes, social needs, international Paralympics, UN's announcement for the rights of people with disabilities and legislations.

With the historical review of vocational rehabilitation in South Korea and suggestions for future direction, another purpose of this paper is to found a cornerstone for following researches which trace reciprocal interaction among a variety of factors, as noted above. This brief overview of the history, current state, and suggestions for future development via international exchange of vocational rehabilitation in South Korea is not sufficient to address all the problems in the system. Chang (1998) states that all kinds of social science--including psychology, anthropology, political science, economy, and others--are related organically. Social science, including rehabilitation, seeks both to understand complex social phenomena and to deal with social needs and problems. Vocational rehabilitation cannot be considered independently of economic and societal forces that influence it. Policy making such as legislations also reflects a country's own culture, and other countries have different social histories, economies, and political and societal contexts.

Thoughtful elaboration of vocational rehabilitation history of South Korea in terms of cultural context should be followed. The comprehensive comparison between the Korean Employment Promotion Agency for the Disabled and the Division of Vocational Rehabilitation in the areas of service delivery, existing services and programs, organization, personnel, and originality could be beneficial. Different cultural recognition of vocational independence or social attitude toward people with disabilities deserves additional research.

South Korean vocational rehabilitation history reflects the effect of knowledge introduction from other countries, interaction between imported cultures and own culture, and positive or negative outcomes in application. The authors hope that this review of the South Korean experience can be the initial manure for sophisticated, contextualized future researches, and the readership to enjoy this historical review of South Korean vocational rehabilitation. Also the authors hope that this article of the South Korean historical review can contribute to many countries developing vocational rehabilitation, and guide them in a more constructive direction so that they can avoid the same errors.

Table 1. Comparison of vocational rehabilitation facilities under
Ministry of Health and Family Services

                      Who is eligible       Type of integration

  Independent        People physically           Separated
Work Facilities         capable of
                        competitive
                  employment, but facing
                  socially difficulties.

Sheltered Work    People facing moderate         Separated
  Facilities         physical barriers
                      to competitive
                        employment

 Work Activity     People with the most          Separated
  Facilities        severe disabilities
                          barring
                        employment

  Vocational            All people               Separated
  Adjustment               with
   Training            disabilities
  Facilities

                           Wage             Type of employment

  Independent           Alternative             Employment
Work Facilities       employment for
                    minimum wage until
                  clients get competitive
                        employment

Sheltered Work          Depends on              Employment
  Facilities          agency's gross
                        of product

 Work Activity              No                   Training
  Facilities

  Vocational                No                   Training
  Adjustment
   Training
  Facilities

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Kil-sung Oh

Hanshin University

Jeong Han Kim

University of Wisconsin-Madison

David A. Rosenthal

University of Wisconsin-Madison

John W. Lui

University of Wisconsin-Stout

Kil-sung Oh, Hanshin University, South Korea. Email: [e-mail].