ARTICLE

Assessing Employment Needs of BulgarianYouths with Intellectual Impairments

Liliya Todorova, MSc (Biology), BSc (OT)

ABSTRACT. This paper illustrates how the Model of Human Occupa-tion provided a conceptual framework to inform the development of awork-related program for Bulgarian youths with intellectual impairmentswho are also socially disadvantaged. The paper describes the process ofconducting a needs assessment guided by this model. Information wasgathered on participants from the target group to create a holistic pro-file of their strengths and challenges/barriers. This information, in turn,was used to identify key needs which will guide next steps in programdevelopment.

Mrs. Liliya Todorova is a senior assistant professor and vice dean of the Facultyof Kinesitherapy at the University of Rousse in Bulgaria and the manager of the firstBachelor program in Occupational Therapy in Bulgaria. She is a board member andvice president of ENOTHE (European Network of Occupational Therapy in HigherEducation) responsible for Central and Eastern European countries.

Address correspondence to: Liliya Todorova, University of Rousse, Faculty ofKinesitherapy, 8 Studentska Str., 7017 Rousse, Bulgaria (E-mail: litod@ru.acad.bg).

Occupational Therapy in Health Care, Vol. 22(2–3), 2008Available online at http://www.haworthpress.com/web/OTHCC© 2008 by Informa Healthcare USA, Inc. All rights reserved.

doi: 10.1080/07380570801989473 77

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KEYWORDS. Needs assessment, employment, learning disabilities,model of human occupation

INTRODUCTION

Although the role of occupational therapists has been defined inBulgaria’s National Strategy for Equal Opportunities of Disabled People(2003), the profession’s potential contributions to Bulgarian society re-main largely unknown and unexplored. In order to assure their place inthe changing labor and health context, occupational therapists in Bul-garia must present evidence of the worth of their services. This taskrequires sound reasoning, based on occupational therapy theory andresearch.

Bulgaria is a postcommunist country. Massive political changes, includ-ing the democratization and transition from socialist economy to a market-oriented economy culminated in Bulgaria joining the European Union in2007. Alongside progressive developments, a breakdown of previous so-cial, agricultural, and industrial structures resulted in high unemploymentwhich is now one of the most serious issues facing Bulgarian society.Persons with intellectual impairments in Bulgaria form 11% of all unem-ployed persons with disabilities (Bulgarian Association of Persons withIntellectual Disabilities [BAPID], 2001).

In 2006, a project was initiated with the long-term aim of develop-ing an occupational therapy program to address employment for youthswith intellectual impairments who also were socially disadvantaged. Theseyouths are graduates from a special vocational training at the ProfessionalSchool for Industrial Technologies (PSIT) that provides a 2-year voca-tional training program in cooking, locksmithing, and sewing for students,aged 15 to 18. Nonetheless, after graduation most of these youths remainunemployed.

This paper illustrates how the Model of Human Occupation (MOHO)was used to conduct an assessment of students needs related to employ-ment. MOHO has been used as a framework for developing a widerange of programs (Kielhofner, 2008). When this model is used as aframework for program development, four basic steps are undertaken:needs assessment, program planning, program implementation, and pro-gram evaluation (Braveman & Kielhofner, 2006). This paper describesthe first step in this process. Needs assessment requires a comprehen-sive understanding of the strengths and challenges faced by the targetpopulation.

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Todorova 79

Theoretical Framework: The Model of Human Occupation

MOHO was chosen as the most appropriate conceptual practicemodel for guiding this program for the following reasons. First, thismodel provides a comprehensive framework for understanding barriersto employment (Kielhofner et al., 1999). Second, MOHO has been suc-cessfully utilized as a framework for understanding the problems of dis-abled workers and for developing work-related services (Kielhofner et al.,1999, 2004; Mentrup, Neihaus, & Kielhofner, 1999; Paul-Ward, Brave-man, Kielhofner, & Levin, 2005). Third, MOHO addresses the multifac-torial influences on work behavior (Kielhofner et al., 1999; Kielhofner,2008; Mentrup, Neihaus, & Kielhofner, 1999). Fourth, the model providesa wide range of resources (i.e., assessments, intervention protocols, caseexamples) for application in work-related services. Fifth, MOHO has a sub-stantial evidence base relevant to work related services (Lee & Kielhofner,2007).

Conducting the Needs Assessment

In conducting the needs assessment, we focused on second-year studentswho would be graduating: those without family support who were mostin need of employment and those who had work-related skills that wouldincrease their chances of securing employment.

Fifteen students gave consent to participate in the needs assessment.They ranged in age from 17 to 21 years old (mean age = 18 years). Twelvewere female (80%) and three were male (20%). Nine of the students wereBulgarian (60%); three were Turkish (20%); and three were Roma (20%).Seven students (47%) came from intact families, five (33%) lived withsingle parents, and three (20%) had no relatives and lived in an orphanage.Most students had mild to moderate intellectual impairments or learningdisabilities that restricted their school achievements and functional skills;one of them had Down syndrome.

Gathering information for the Needs Assessment

Information concerning the students’ volition, habituation, and perfor-mance capacity was collected through observation during students’ practi-cal training, interviews, proxy reports from teachers, family members, andsupervisors, and self-report questionnaires. Interviews were conducted innumerous short discussions with only three or four students. This format

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made the participants feel safe and relaxed, was more accessible giventhe students’ intellectual impairments, and gave them the opportunity tocompare their experiences and perceptions. In order to accommodate thestudents’ intellectual impairments, the questionnaires used clear, simple,and short checklists.

Students completed a translated and culturally adapted Interest Check-list (Kielhofner & Neville, 1983) indicating their past and present interestsas well as their present and anticipated future participation in interests. Stu-dents also completed the Ideal Employment Exercises (Merdjanova, 2001),which asked them to prioritize from a list the five most important qualitiesof work and to describe the kind of persons with whom they would andwould not like to work. The teachers at the school completed a translationof the Functional Behavior Profile (Baum & Edwards, 2000) to character-ize students’ overall capacity to engage in tasks, social interactions, andproblem solving.

Information exploring the environment’s potential impact on employ-ment was gathered through an Internet search concerning statistical data,surveys, and services for people with learning disabilities. Additionally, ameeting was carried out at the local employment agency to gain insightinto the characteristics of the open labor market in Rousse and the servicesoffered by the agency.

INTERPRETING THE INFORMATION

MOHO was used as a framework to conceptualize the occupationalproblems and challenges faced by the students. They are discussed next inthe categories of Volition, Habituation, Performance Skills, and Environ-ment.

Volition

The personal causation of most participants is characterized by an unre-alistic sense of their abilities, by a lack of self-confidence, and by limitedexpectations for future work success. Many students (especially those fromthe orphanage) have only a vague idea of the world of work and lack experi-ences and opportunities to test their abilities. Most feel externally controlledby parents, teachers, or supervisors. They recognize that they may havechallenges meeting some work demands such as speed and that they needa supportive social environment (i.e., good-hearted and tolerant people).

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Todorova 81

Values

The students’ main reasons for being employed are to be useful, achieveindependence, have social contacts, and contribute to family incomes.Those without families must find jobs, because at the age of 18 they mustleave the orphanage and live on their own. They all, especially those ofTurkish and Roma backgrounds, have strong ties and sense of obligationto family. Social contacts are important to them because after graduationthey face the possibility of social isolation. They are responsible studentsand value honesty, clarity, goodness, decency, and loyalty. Most wouldprefer a work position in the service or manufacturing sectors and theywant opportunities to learn new things, have security, and experience asupportive environment.

Interests

The students’ interests are mainly related to leisure (i.e., listening tomusic, dancing and going for a walk) and homemaking (i.e., chores andcooking). Few students (except three girls who express interest in obtainingtraining in hairdressing) are able to state clear vocational interests.

Habituation

The daily routines of the participants are normally divided betweenschool and family/home obligations. Besides school activities, studentsusually help with house chores and look after younger siblings. The mainroles shaping their attitudes and actions are student, family member, andfriend. They have appropriate hygiene and grooming habits to support theirroles. Most of them are not able to organize their routine in a productiveway when it is not structured for them.

Performance Skills

The students exhibit motor skills adequate for most work-related tasks.The majority of the students have mild and moderate learning disabilitiesthat limit their process and communication/interaction skills. Although allof them can independently perform simple tasks, most need assistancein the form of instructions, reminding, supervision, or physical supportwith more complex tasks. Students require longer time to complete work

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82 OCCUPATIONAL THERAPY IN HEALTH CARE

because they perform at a slower pace. Most participants express a strongdesire to communicate with others. They easily engage in conversation, ex-press interests, and share thoughts and opinions; and show respect to peers,teachers, and unknown people during interactions. However, students usu-ally do not initiate the interactions. To an extent, skill limitations are alsorelated to lack of opportunities to develop skills and others’ low expecta-tions for performance. Knowledge related to reading, writing, and math islimited.

Environment

The open labor market in Rousse is very unstable. Although new busi-nesses are always emerging, many fail. Most available jobs are in theprocessing industry (food and dressmaking) and public services. A greatnumber of people without disabilities compete with the disabled for a lim-ited number of positions. Employers are uncomfortable with the perceivedrisk of hiring disabled people. Even when jobs are available to people withdisabilities through government incentives, employers are still reluctantto make necessary adaptations to the workload or the work environment.Officers at the employment agency acknowledge that they lack informationabout the work capacity of disabled jobseekers and would have difficultyknowing how to match them to jobs. Although 80% of the students havefamilies, very few can provide students support to search for jobs. Almosthalf of the parents are single, and nearly all experience financial difficultiesand social disadvantage.

Characterization of Students’ Circumstances and Identificationof Needs

Using MOHO allowed a holistic characterization of students’ circum-stances as shown in Table 1. As the table also illustrates, this led to thestructured identification of key needs. This information will be criticalduring the next stage of program development, service identification anddevelopment. Additionally, the processes and instruments used to gatherinformation for this needs assessment will be used in the program to cre-ate a standardized process for generating individualized student vocationalprofiles.

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Todorova 83

TABLE 1. Key Strengths, Weaknesses, and Needs for Service

Strengths Challenges/barriers Needs for service

VolitionPersonalcausation

-Awareness of the needfor a supportiveenvironment

-Unrealistic sense ofabilities and lack ofconfidence for work

-Experiences that buildawareness ofcapacities, andincrease confidence forwork

-Practice to assert/negotiate needs forsupport

Values -Values of being usefuland independent,having social contacts,and contributing tofamily incomes

-Strong personal values-Value a secure andsupportive workenvironment

-Pressure on some tosupport themselves at age18

-Support to progresstoward desired goalsand manage stresses

-Help to find appropriateand supportive workcontexts

Interests -Variety of leisure anddomestic interests

-Work interests generallynot well defined

-Experiences withdifferent kinds of worktasks and contexts

-Training in areas ofinterest

HabituationHabits -Have existing routines

and habits for self-care-Difficulty structuring time -Training/practice in

time managementRoles -Have experiences

fulfilling a variety ofroles

-Lack of work-roleexperience

-Experience in actualwork contexts

Performanceskills

-Adequate motor skills -Some problems withprocess andcommunication/interactionskills

-Limited math and literacyskills

-Targeted skills training

Environment -Unstable labor market-Competition with personswithout disabilities forlimited jobs

-Reluctance of employers tohire and/or accommodatedisabled workers

-Employment officers lackof information to placedisabled persons

-Lack of family support forjob seeking

-Identify niches wherestudents would bemost competitive

-Education andconsultation foremployers

-Education andconsultation foremployment officers

-Job seeking support

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DISCUSSION

This paper illustrated how the Model of Human Occupation provideda conceptual framework to inform the development of a work relatedprogram by guiding a needs assessment. Information was gathered onparticipants from the target group to create a holistic profile of theirstrengths and challenges/barriers. This information, in turn, was used toidentify key needs which will guide next steps in program development.

REFERENCES

Bulgarian Association for Persons with Intellectual Disabilities (BAPID). (2001). Hu-man rights for persons with intellectual disabilities—-country report for Bulgaria.Retrieved June 20, 2005, from http://bapid.com

Baum, C. M., & Edwards, D. F. (2000). Documenting Productive Behaviors: Usingthe Functional Behavior Profile to Plan Discharge Following Stroke. Journal ofGerontological Nursing, 26(4), 34–43.

Braveman, B., & Kielhofner, G. (2006). Developing evidence-based occupationaltherapy programming. In B. Braveman (Eds.), Leading and managing occupationaltherapy services: an evidence-based approach (pp. 215–244). Philadelphia: F.A.Davis.

Kielhofner, G. (2008). Model of Human Occupation: Theory and application (4th ed.).Baltimore, MD: Lippincott, Williams &Wilkins.

Kielhofner, G., Braveman, B., Baron, K., Fisher, G., Hammel, J., & Littleton, M.(1999). The Model of human occupation: Understanding the worker who is injuredor disabled. Work: A Journal of Prevention, Assessment, & Rehabilitation, 12, 3–12.

Kielhofner, G., Braveman, B., Finlayson, M., Paul-Ward, A., Goldbaum, L., &Goldstein, K. (2004). Outcomes of a vocational program for persons with AIDS.American Journal of Occupational Therapy, 58, 64–72.

Kielhofner, G., & Neville, A. (1983).The modified interest checklist. Chicago, IL:Model of Human Occupation Clearinghouse, University of Illinois at Chicago.

Lee, J., & Kielhofner, G. (2007). A synthesis of available evidence concerning theModel of Human Occupation in vocational intervention. Manuscript submitted forpublication.

Mentrup, C., Neihaus, A., & Kielhofner, G. (1999). Applying the Model of humanoccupation in work-focused rehabilitation: a case illustration. Work: A Journal ofPrevention, Assessment, & Rehabilitation, 12(1), 61–70.

Merdjanova, Y. (2001). Naruchnik po profesionalno konsultirane (In Bulgarian) [Aguide to vocational consulting]. Sofia: Sofia University Publishing House.

Paul-Ward, A., Braveman, B., Kielhofner, G., & Levin, M. (2005). Developing em-ployment services for individuals with HIV/AIDS: Participatory action strategiesat work. Journal of Vocational Rehabilitation, 22, 85–93.

Received: 08/13/2007Revised: 11/10/2007

Accepted: 11/10/2007

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