Mental retardation

Semistructured interviews were conducted with 16 Israeli adolescents and young adults with mild mental retardation to examine their perceptions of the world of work. A consensual qualitative strategy of analysis (C. E. Hill, B. J. Thompson, & E. N. Williams, 1997) yielded 4 domains (Definitions of Work, Reasons for Working, Self-Awareness, Knowledge About the World of Work) and 12 categories. Although respondents showed strong willingness to participate in the world of work, they had little information regarding this realm. Implications are discussed for career development programs programs targeting young persons with mental retardation and community and family involvement in such programs.

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Work plays a central role in adult life, crucially affecting self-concept and wellness. Participation in the world of work signifies that one is a vital and constructive member of society, and involvement in the mainstream labor force fulfills both individual and societal expectations (Super, 1990). Therefore, when measuring the success of the rehabilitation system for individuals with mental and physical disabilities, who are at risk for exclusion from the mainstream, job placement may be the most important goal of rehabilitation (Pumpian, Fisher, Certo, & Smally, 1997). The major challenges facing the field of rehabilitation regarding persons with mental retardation are the expansion of employment opportunities and the preparation of qualified workers (Walls & Fullmer, 1997).

Nonetheless, job placement alone does not suffice within the dynamic world of work, which requires job transitions as an integral part of career development, especially for persons with disabilities (Pumpian et al., 1997; Shafer, Banks, & Kregel, 1991). Follow-up research on graduates of the special education system in the United States as well as in Israel has indicated that despite the importance of work for this population and despite efforts to provide job placement for persons with disabilities, up to half of these graduates are unemployed ("Disability Employment Awareness Month," 1997; Reiter & Planizky, 1996). A developmental approach may address this need by assisting individuals over the long term, from early education through supported employment programs that have a role in job placement, initial training, and an extended period of stabilization (Bloom, 1993; Mank, Cioffi, & Yovanoff, 1998; Sandow, Olson, & Yan, 1993). Such a lifelong approach should rely on knowledge of career development theory and research and should uphold a value approach that facilitates work as an integral part of life quality for persons with mental retardation. The present exploratory study attempted to expand general knowledge regarding perceptions of work and the career needs of adolescents with mild mental retardation in Israel, thus supporting the value approach, which emphasizes individual life quality.

A Value Approach

Many changes have emerged in recent years regarding definitions of mental retardation and treatment available to individuals with mental retardation. A value approach that is based on a lifelong developmental model and on the concept of normalization has replaced the traditional approach, which advocated protective treatment and institutional care (Zimerman & Warschausky, 1998). In Israel, as in other Western countries, the special education system is approaching integration (Rand & Reichenberg, 1994). The 1988 Israel Law of Special Education meaningfully expanded the responsibility of public authorities toward persons with disabilities, emphasizing the obligation to integrate such individuals into normal educational and life settings. This newer approach emphasizes the rights of individuals with mental retardation to obtain a high quality life, not merely a "normal" life (Brown et al., 1996; Giangreco & Cloninger, 1993). Life quality refers to a fit between a person's beliefs, needs, and preferences on the one hand and that person's environment on the other (Schalock, Strak, & Snell, 1994). For individuals with disabilities, there is a correlation between quality of life and the degree to which needs are met in relation to the individual's environment (Neumayer & Bleasdale, 1997).

In the value approach, the person with mental retardation is viewed as a developmental organism who has a right to occupational and social participation. In line with this approach, Western society is becoming more aware of its responsibility to enable such persons to express and satisfy day-to-day personal preferences and to fulfill their potential at every stage of development (for a review, see Lancioni, O'Reilly, Campodonico, & Mantini, 1998). Empirical studies have indicated that allowing individuals with disabilities to satisfy their own preferences may promote their achievement and their quality of life (Bambara, Koger, Katzer, & Davenport, 1995; Favell, Realon, & Sutton, 1996; Felce & Perry, 1995; Panagos & DuBois, 1999). In response to the widely accepted normalization principle, current educational systems for adolescents tend to encourage independent behavior in their students with mental retardation; however, these systems rarely teach skills that are connected with life quality such as making choices, planning for the future, autonomy, professional self-concept, motivation to work, empowerment, and personal responsibility for one's life (Dillon, 1993; Zimerman & Warschausky, 1998). Most existing programs teach simple manual tasks, an approach that does not incorporate the students' needs or preferences. Despite widespread recognition of the need for career development services and programs, these areas do not receive priority in most educational facilities, and this is especially true for special education (Munson, 1994).

In sum, there is a gap between the well-accepted rights for occupational normalization and the low rates of employment among persons with mental retardation ("Disability Employment Awareness Month," 1997). Among the possible explanations for this are the lack of available career development interventions that include life quality skills and the scarce theoretical knowledge about career development in this population. According to the value approach, career development programs for persons with mental retardation can be of optimal benefit if such programs are based on research that directly involves persons with mental retardation and explores their preferences, needs, and knowledge regarding the world of work. However, we were unable to identify research that focused on the perceptions of persons with mental retardation regarding the world of work. Atkinson (1989) demonstrated that persons with intellectual disability could contribute to research by responding capably to interview questions and commenting on their lifestyles. Such responses regarding conceptions of work may provide crucial knowledge for the design of appropriate career programs for this population.

Career Development and Mental Retardation

Career development has been described as a complex, lifelong process of developing and implementing occupational self-concepts (Super, 1992). The extensive body of research on general career development processes has been criticized for its disregard of large segments of the population and for its failure to account for structural and cultural factors (Fitzgerald & Betz, 1994). The relations between career development and disabilities, especially mental disabilities, constitute an area that is sorely neglected by career researchers and theorists (Conyers, Koch, & Szymanski, 1998; Henderson & Szymanski, 1992). The limited information on career development processes in the lives of persons with disabilities has been focused on populations with learning disorders or with physical disabilities (for a review, see Enright, Conyers, & Szymanski, 1996). The few existing studies suggest a complex set of relations between disability and career development (Szymanski & Hanley-Maxwell, 1996). For some individuals, the presence of disability may have little influence on their career development and life plans; for others, the same type of disability may profoundly affect their experiences, self-esteem, and career aspirations (Szymanski & Hanley-Maxwell, 1996). A person's careerrelated reactions to disability depend on the interaction between various individual, social, and environmental factors, such as interests, beliefs, gender, family, self-efficacy, educational background, socioeconomic status, and culture (Szymanski, Henderson, Enright, & Ettinger, 1996).

Students with mild mental retardation in Israel generally attend special schools until they are 21 years old. They then enter one of four alternative environments that are similar to those in other Western countries: sheltered workplaces, supported employment, rehabilitation day centers, or unemployment at home (Reiter & Planizky, 1996). In sheltered workshops, persons with mental disabilities are trained in the fixed, known standards and norms of a specific workplace, and they are given the opportunity to learn a small range of simple manual tasks. In supported employment programs, a supervisor accompanies the person with disabilities in his or her new workplace until the person becomes familiar with the work and coworkers (Wehman, Moon, Everson, Wood, & Barcus, 1988). Of these two occupational options, sheltered workshops are more common than the costly supportive employment setting that is based on long-term individual supervision. Rehabilitation centers, on the other hand, generally provide occupational therapy and social activities, and like unemployment at home, do not offer vocational normalization. There are reasons that most graduates of the special education system attend rehabilitation day centers or remain at home, unemployed. For example, few developmental educational models exist that are rooted in the normalization principle and that are implemented from the early years of schooling; there is also a shortage of occupational programs, such as supported employment, for individuals with disabilities ("Disability Employment Awareness Month," 1997; Reiter & Planizky, 1996).

In line with a normalization-promoting value approach, we conducted an exploratory study in which we interviewed 16 Israeli adolescents with mild mental retardation regarding their views on the world of work. We examined participants' knowledge concerning work and occupations as well as their personal occupational preferences and interests. Results of the study were expected to expand theoretical knowledge of career development for this population and to formulate a basis for planning career development programs. We used a qualitative inquiry method because of its usefulness for exploring phenomena that are not clearly defined and also to bypass these participants' possible deficient capacities for responding to quantitative inventories (Biklen & Mosely, 1988; Denzin & Lincoln, 1994). The consensual qualitative research method of analysis (Hill, Thompson, & Williams, 1997) was used because of its systematic, rigorous study of the open-ended responses of a small sample (Pearson & Bieschke, 2001).

Method

Participants

Participants were 16 (10 male, 6 female) adolescents and young adults with mild mental retardation (IQ range, 60-70); participants were between 14 and 22 years old (M = 17.2, SD = 5.3). All participants attended special education high schools in central Israel and lived in neighborhoods of middle socioeconomic status. Over the 3 years prior to the study, these participants had all been a part of a group that met twice weekly in joint activities at a centrally located social activity club for persons with mental disabilities. This social club is a private institution that offers afternoon educational services for persons with learning disabilities and with mental retardation.

Measure

An in-depth semistructured interview was conducted to obtain extensive data on each participant's knowledge and interest regarding the world of work. Seven questions were developed on the basis of Super's (1992) description of career development and on the components of career development programs. According to Super's concept of career, needs, values, and interests are major personality variables that influence career development, in interaction with social policy (e.g., labor market) and self-concept. In line with that theory, five questions were developed to determine the participants' values, needs, interests, and self-concept: "How do you define work? Why do people work? Would you like to work and why? Is there any particular occupation with which you would like to be involved? Why do you want to work in this occupation?" Two other questions addressed familiarity with the labor market: "What kind of occupations do you know? How should one behave at work?" These seven questions could also be divided into two areas: (a) the world of work ("How do you define work? Why do people work? What kind of occupations do you know?") and (b) attitudes and interests regarding the world of work ("Would you like to work and why? Is there any particular occupation with which you would like to be involved? Why do you want to work in this occupation? How should one behave at work?").

In line with the semistructured format, the interviewer presented each question in the same order to all participants but also followed up on important ideas.

Procedure

Research team. The widespread use of a team in qualitative research (e.g., see Pearson & Bieschke, 2001) offers the benefit of interpreting results according to participants' unique characteristics. The four female members of the research team of this study included the first author (an assistant professor in a counseling department), two graduate students in counseling education who had earned a bachelor's degree in special education, and a doctoral student in special education who was familiar with qualitative methods. The first three members of the team conducted the analysis, and the fourth member served as the auditor, who reviewed the analyses and provided feedback.

Data collection. Each in-depth semistructured interview was conducted individually in the social activity club that all participants attended. The interview lasted from 120 to 180 minutes, including breaks and the time needed to clarify or respond to a question. The trained interviewer was a female counselor who had been working with the group at the club for 3 years. Participants were approached by the interviewer and were asked for consent to participate in this research, and they were informed that they could stop the interview at any time or refuse to answer specific questions without repercussion. The interviews were audiotaped and transcribed carefully by the interviewer.

Identification of domains and core ideas. Each transcript was independently read by the three team members (excluding the auditor) and initially coded for primary content domains in line with the domains underlying the interview questions. The three team members then collaboratively discussed their coding outcomes, refining and modifying the contents of their original domains and adding new ones to reflect their new joint understanding of the interview responses. As the final domains were identified, each team member independently assigned participants' statements to the different domains for each of the transcripts. In a subsequent team meeting, these personal interpretations were discussed until consensus was reached for each statement. The final four domains were Definitions of Work, Reasons for Working, Self-Awareness, Knowledge About the World of Work.

After achieving consensus on the domains found in each transcript, the three team members identified core ideas (categories) within each domain. Adapting Hill et al.'s (1997) criteria, the team assessed the general versus typical versus variant level of support among the participants for each category. Categories were coded as "general" if they were found in every transcript (100%), as "typical" if they appeared in half or more (50%-99%) of the transcripts, and as "variant" if they applied to 20%-49% of the transcripts. Categories that applied to 19% or fewer of the transcripts were omitted from the analysis.

The research team's auditor, who did not participate in the aforementioned analyses, reviewed the identified set of four domains and 12 core idea categories. The team reviewed the auditor's feedback, discussed the points raised, and made some modifications.

Results

Table 1 presents the four domains, the 12 categories identified within the different domains, and each category's frequency (i.e., general, typical, or variant) among the participants.

Definitions of Work

Three categories emerged from participant responses to the "grand tour" (Hill et al., 1997) question: "How do you define work?"

In the first category of this domain, outcomes of work (Category 1a), participants defined work as a process that leads to specific outcomes. This category demonstrated a general frequency. All participants expressed the view that work is something people do in order to obtain something: "Work is to earn money" (Participant 2), "Work is to bring food home or to buy a car" (Participant 10), or "Work is when you get very tired" (Participant 12).

It was also typical for participants (11 out of 16) to define subjective attitudes toward work (Category 1b): "Work is fun, it puts me in a good mood" (Participant 5); "Work is interesting, I won't be bored" (Participant 8).

In the third variant category, participants' definitions (4 out of 16) referred to the workplace (1c): "Work is where people go every day to work" (Participant 1); "Work is the place to work, like a bakery" (Participant 16).

Reasons for Working

The second domain referred to participants' responses to the following interview questions: "Would you like to work? Why?" When asked if they wanted to work, each of the 16 participants answered affirmatively.

With regard to their reasons for wanting to work, three categories were identified. Participants typically (13 out of 16) cited money (2a): "Because I want to earn money, for sure" (Participant 9); "Of course, I need to save money to buy things, for food, so I have to work" (Participant 11). Another typical reason given by 9 of the 16 participants was the desire for enjoyment and company (Category 2b). These participants explained that they wanted to work so that they could enjoy life and avoid loneliness: "I want to work. I want to be a teacher. It is fun to be a teacher. I will enjoy it very much" (Participant 12); "I do not want to be alone, I want to work. It is not good not to work--we need friends" (Participant 7); "If I'm not working, I stay home all day, and it is very boring" (Participant 3). A third variant category also emerged for this domain. Four participants cited learning and self-improvement as a reason for working: "I will learn many new things, and it is very interesting. At work you learn a lot" (Participant 5); "If I stay at home, I will learn nothing, and I will not improve" (Participant 12).

Self-Awareness

In reply to the question "Is there any particular occupation you would like to perform?" all participants except 1 (Participant 1) responded affirmatively and named a specific occupational choice. For these 15 respondents, three categories emerged regarding the reasons for their occupational choice, in response to the question "Why do you want to work in this occupation?" One typical category cited by 12 participants was interest in or enjoyment of a specific occupation (3a): "I love football so I want to be a football player" (Participant 10); "I want to be a preschool teacher because I love babies" (Participant 11). Another category mentioned by 14 of the respondents was skill in a specific occupation (3b): "I know how to put boxes away--I can do it. I can work in the supermarket" (Participant 8); "I am very good at computers. The teacher and my parents told me. I want to work in computers" (Participant 16). In the last variant category in this domain, personal awareness of disability (3c), 4 of the participants considered their disability in reference to their occupational choice: "I don't know about that. My parents say I cannot be a preschool teacher. I love it, but I have to learn ... I don't know" (Participant 11); "I want to be a soldier, but they will not let me because I'm not like everyone else" (Participant 8).

Knowledge About the World of Work

In response to the question "What kind of occupations do you know?" all participants, with the prompting of the interviewer, were able to mention an average of five different types of occupations. Frequently mentioned occupations included carpenter, doctor, teacher, singer, mechanic, and shoemaker.

Three categories were identified as corresponding to the domain of Knowledge About the World of Work. One typical category (for 10 out of 16) was parents as a source of knowledge and motivation regarding work (4a): "My parents want me to work; they think it is important. They tell me I have to work" (Participant 4); "Yes, I know many occupations because of my mother. She teaches me a lot" (Participant 13); "My father used to work in this, and he told me about it" (Participant 5). In a second typical category, 13 participants noted the importance of learning as a means to obtaining a job or occupation (4b). These respondents expressed the belief that anyone can achieve anything if they study it: "Oh yes, everybody can work at any occupation they like. You just have to learn" (Participant 6); "If he wants to be a carpenter and is not good at carpentering, he will learn. He can be a carpenter if he learns well" (Participant 8); "Yes, everyone can learn everything they want. You can learn to work from television, from your parents, from your teacher" (Participant 12).

The last category in this domain, behavior at work (4c), was elicited by the interview question, "How should one behave at work?" In this typical category, 14 participants mentioned that workers must arrive on time, be clean, and behave nicely: "You have to come on time to work and be nice to your friend. You have to dress nice" (Participant 9). They also expressed the wish that people would be kind to them at work and would not insult them or yell at them: "I have to come on time to work and no shouting. I want them to behave nicely to me, not to insult me" (Participant 10).

In sum, the adolescents in this research viewed work as a source of income (1a, 2a), and they were all motivated to work after graduation (2). They knew very little about different occupations (4), but they had already chosen an occupation (3) and could explain their choice (3a-3c). They were also aware that interest and ability are central variables in career decision making (3a, 3b). None of the participants viewed work as a source of belonging, self-confidence, or as a challenge, all of which are primary variables in the "normalization" concept.

Discussion and Conclusions

In accordance with the normalization concept, which emphasizes the right to life quality for persons with mental disabilities (Brown et al., 1996; Giangreco & Cloninger, 1993), the current study explored perceptions of work among adolescents and young adults with mild mental retardation. Employment for persons with mental disabilities has been viewed as a key, if not the primary, outcome of rehabilitation and of attempts to implement the normalization concept (Platt, 1995). Interviews in the present study demonstrated the participants' strong willingness to be involved in the world of work and the little information they had regarding crucial aspects of this important aspect of life, such as familiarity with various occupations and awareness of the normalizing benefits of employment.

The qualitative material drawn from the interviews can provide several central guidelines for designing career development programs to target adolescents with mental retardation; these guidelines would parallel the four domains that emerged in this study. With regard to the first domain, Definitions of Work, the current findings demonstrated that adolescents with mild mental retardation viewed the world of work predominantly as a source of earning money and avoiding loneliness. These outcomes underscore the need to expand these young people's perceptions about work and the need to familiarize them with different aspects and benefits of participation in the workforce, such as self-confidence, belonging, or challenge. Students can be taught the diverse outcomes of participation in the world of work through specially designed lessons in the curriculum as well as activities that can be incorporated in other lessons. With teachers' guidance and supervision, students can interview parents and other relatives about their work values and about the benefits of work participation. Teachers, supervisors, inspectors, secretaries, caretakers, and other employees/professionals who work in the school can be asked to meet with the students and explain their reasons for and the benefits of working. Moreover, currently employed young adults with mental retardation can meet with these students and share their work experiences and the benefits of working. To further expand students' knowledge, role playing and group discussions may be conducted following such meetings, and short stories may be used concerning students who are wondering whether or not to participate in work after graduation and their arguments as to why they should participate. During such activities, teachers, family members, and interviewees should be instructed to encourage students' participation in the world of work, emphasizing benefits such as company, enjoyment, and the challenge of working. Early education programs that stress the different aspects and benefits of work may increase students' motivation to look for work after graduation and to view participation in the workforce as a natural life development. Burkhead and Cope (1994) described the potential impact of career maturity on the career development of persons with disabilities, citing motivation to work as one of the five dimensions of career maturity.

The second domain to be included in career development programs was Reasons for Working. Information regarding different occupations constitutes another dimension of career maturity, which may contribute to the development of personal career orientations and aspirations (Lapan & Kosciulek, 2001). The extremely small number of occupations mentioned by the participants in this study highlighted the need to expose adolescents with mental retardation to various occupations and jobs. The unique characteristics of individuals with mental retardation (e.g., difficulty concentrating and memory difficulties) call for the use of diverse materials such as games, including computer games; films that depict different occupations; or flash cards (e.g., matching the name of a job with the worker or with particular tools or skills). Another important method would allow students to visit a range of neighborhood workplaces and to accompany different workers in each location, thus allowing students to observe various occupations in their neighborhoods, such as the supermarket, bank, and kindergarten. As in any career development program, these young people should learn to classify occupations according to different categories, for example social, investigative, and health-related occupations (Holland, 1973).

Fostering Self-Awareness, the third domain, is an important objective for any career development program (Zunker, 1990) and may also affect the career development of individuals with disabilities (Evenson & Evenson, 1983). Including training in this domain may improve the match between a prospective occupation and the person's interests, competencies, and limitations. The interviews in our study revealed that these adolescents often considered personal interests and abilities when thinking about an occupation (e.g., "Because I love it" and "Because I am good at it"). However, respondents' disabilities were seldom mentioned in their perceptions regarding the world of work, pinpointing the need for programs to integrate the consideration of the disability during the career-planning process. Identification of interests and abilities can be achieved during learning and play activities, with teachers encouraging students to ask themselves: What do I like to do? What activities am I good at? What are the things I cannot do? These questions become more important when students are familiar with different occupations and their unique skills. The teacher should mediate the relations between the students' preferences and the demands of different occupations. If students visit workplaces, individual discussions should be conducted to determine what each student personally liked and disliked about a specific place and the extent to which the student felt comfortable and competent in each environment.

The final domain, Knowledge About the World of Work, should include exercises and activities that are relevant to job seeking and to appropriate behavior with work colleagues. Participants typically emphasized the importance of "behaving nicely" at work and arriving on time. These behaviors and skills should be extended, with a focus on teaching individuals with disabilities how to conduct themselves in different work situations, including how to handle conflicts. These goals can be achieved in role-play activities, which provide a safe, teacher-mediated environment in which to learn assertiveness skills as well as how and whom to ask for assistance.

Further research should examine the influence of career development programs on related variables such as career maturity and work values among persons with mental retardation. Researchers would do well to develop unique measures that are sensitive to the heterogeneity of this population (Conyers et al., 1998). Such tools may contribute to existing models concerning the career development of persons with disabilities (e.g., Szymanski & Henderson, 1998). These quantitative measures would also address some of the current study's limitations: the unique small sample and the data analysis method used (i.e., the qualitative method). These characteristics indicate that there is a need to conduct similar research in other countries, ensuring that qualitative methods focus on rich descriptions and not generalizations. The absence of quantitative data regarding correlations between participants' conceptions and other individual variables (e.g., gender, psychological profile, self-esteem, self-efficacy) is another limitation of the study. Finally, this study was further limited because the second author served as both researcher and content analyst.

Other programs should consider involving parents and community organizations in efforts to enhance the quality of life of this population. The family plays a major role in the work success of people with mental retardation (Hitchings, Natelle, & Ristow, 1999). Parents and other family members can encourage and help the adolescent with mental retardation to seek a job and to work. The participants' fears of ridicule at work (Category 4c) suggest the need for interventions that target the behavior of many groups, including employers, individuals with disabilities and their families, educators, and public policy makers (Roessler & Schriner, 1991). The important role of parents in the adolescents' view of the world of work (4a) accentuates the need for vocational counselors to involve the family in the prospective employee's career development program (Hitchings et al., 1999; Lapan & Kosciulek, 2001). Not only can special programs for parents be developed, but parents may also become directly involved in the range of career intervention programs that the school conducts. The community should also be closely involved in career programs for students with mental retardation, in order to find businesses to welcome these students for visits and to hire them after graduation. Policy makers can help obtain community involvement through massive advertising of this valuable concept of life quality for people with disabilities, as well as tax discounts and other economic privileges for companies that participate in this important project.

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Rachel Gali Cinamon and Limor Gifsh, Counseling Department, School of Education, Tel Aviv University. The authors express their appreciation to Dee B. Ankonina for her editorial assistance. Correspondence concerning this article should be addressed to Rachel Gali Cinamon, School of Education, Tel Aviv University, Ramat Aviv 69978, Israel (e-mail: cinamon@post.tau.ac.il).

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