Vocational skill training programs for persons with intellectual disability (PID) and trainers' perspective during and post vocational skill training

Abstract

Background:

Employment is one of the primary goals of persons with intellectual disabilities (PID). Employment can lead to positive psychosocial and economic benefits for people with ID, but people with disabilities are not afforded this opportunity to contribute to society through work due to multiple challenges, as well as the transition from vocational skill training to getting employed for PID is more challenging.

Materials and Methods:

Seven vocational skill trainers were chosen from the seven vocational skill training centres offering skill training for PID and located in urban Bengaluru were selected using a purposive sampling design for this study. The trainers were interviewed to understand their perspectives on challenges during and post vocational training for PID.

Results:

Training offered to PID in several vocational centres ranged from unskilled to semi-skilled. A range of barriers including gaps in awareness and knowledge of the various training programs for PID challenges associated with their transition after training, unique challenges in placing the trained PID into external organizations, stigma, and attitudinal barriers associated with disability are described to be influencing the skill training of PID and their subsequent employment.

Conclusion:

Skill training offered for PID across the centres with significant challenges while providing the training and supporting their transition into the community for employment. The challenges of the PID need to be studied at a broader level through including all the stakeholders.

Introduction

Employment is one of the primary goals of persons with intellectual disabilities (ID). Employment can lead to positive psychosocial and economic benefits for people with ID, including a sense of purpose, opportunities for new friendships, health, and better quality of life,[1,2] but people with disabilities are not afforded this opportunity to contribute to society through work[3] due to multiple barriers. Barriers such as difficulties in learning, stigmas, and lack of access to social environments are additional obstacles that predispose this section of the individuals to remain dependent on their families or government programs, with no real possibility of social and financial development field.[4] These barriers and engaging them in employment can be addressed through vocational skill training programs,[4] as persons with ID require additional efforts due to their limited abilities.[5] Vocational skill training seems to be an efficient tool for the appropriate training and gainful employment of people with ID.[5,6]

Over the past few decades, legislative policies and nongovernmental organization involvement have brought tremendous changes to enhance the participation of disabled people in vocational skill training and employment; at the same time, the transition from vocational skill training to getting employed for persons with ID is more challenging than for other people since their functional limitations and essential supports needed vary according to disability severity.[7] Hence this study has been carried out to understand the challenges in the transition phase from vocational skill training to employment. Also, the researchers believe that the findings would help to address effectively at the primary level as most of the time, there would be delay in getting treated or identifying the problem at the appropriate age, putting the PID in special education or facilitating in skill training and appropriate employment.

Materials and Methods

This study was reviewed and approved by the institute's ethics committee (NIMHANS/DO/BEH.Sc.Div./2019-20). This study used an explorative design, and it was conducted from December 2019 to January 2020 in Bengaluru, India. To conduct the in-depth interviews, the researcher prepared an interview script based on the review of the literature, inputs from the research guides and practical experience. The interview script was evaluated by two mental health professionals who have experience in psychiatric rehabilitation services (one psychiatric social worker and one psychiatrist). They examined each question to check whether they were measuring the challenges during and post vocational skill training, and the interview script was modified accordingly. A total of 10 vocational skill training centre trainers were selected per the study's inclusion criteria, and using a purposive sampling technique, seven organization vocational trainers were accepted to give in-depth interviews. Vocational trainers involved in vocational training and having experience were approached from the seven organizations, which were located in Urban Bengaluru, Karnataka.

The qualitative in-depth interviews were audio recorded, transcribed into process recording, coded, and manually derived themes and subthemes. The first author carried out the thematic analysis, and the themes and subthemes were verified by the research guides (second and third authors).

Results

Based on the research question, the results are presented in the following sequence: 1) sociodemographic details of participants; 2) various vocational programs which the vocational skill training centres are being offered; 3) challenges faced during skill training for persons with intellectual disabilities as reported by the skill trainers; 4) challenges associated with postskill training and placement reported by skill trainers.

Sociodemographic profile of the participants

All the participants were women; their age ranged from 26 years to 50 years; all the participants had education qualifications of the above graduation; and 85.7% of the participants had more than 10 years of experience.

Various vocational skill programs being offered by the vocational skill training centres

To explore and understand the various vocational skill training programs being offered by the skill train centres, the researcher visited in person all the vocational skill training centres and observed the skill training programs; the skill training programs suggest that skill training at most vocational skill training centres ranged from unskilled to semi-skilled [Table 1]. Data emerged in qualitative interviews with vocational skill trainers.

Table 1.

Various vocational skill programs being offered by the vocational skill training centres

Name of organization	A number of programs are being offered at the vocational skill training centre	Vocational training is provided for PID.
Amba	2	Data entry, Artificial Intelligence Face Mapping
Seva in action	4	Training in Car washing, Hospital assistant staff, Retailing, and Digitalization (computer work).
Grow Foundation	1	Package course provide (Basics of English, communication skills, mathematic skills, reasoning, and computer training)
Nithya Saadhana	4	Training in Electronic parts sub assembles, Office Assistant, Computer: data processing, Paper bag making.
The Association for Mentally Challenged (AMC)	8	Training in Weaving doormat, Candle making, making Diya's, paper bags, training in tailoring, carpentering, gardening, and computer.
Dharithree Trust	6	Training in Soap oil making, Diya paintings, Paper covers, Making bags, Candle making, Agricultural work: poultry, gardening, and dairy products
Amogh	6	Training in Computer basics, Bag making, Leaf cups, and paper plates making (eco-friendly), loom weaving, Making art gifts, Diya products, and Paper bags.

Challenges during vocational skill training facilitation

The participants (vocational skill trainers) expressed a total of six themes and subthemes when asked about the various challenges during skill training facilitation to PID. The themes included (1) Behavioural problems of PID subthemes: aggression towards trainers, aggression against other trainees, significant mood variations, poor motivation; (2) Associated mental health and medical problems: comorbid mental health problems, physical health issues, poor attention span interfering with skill imparting; (3) level of education: poor or no ability to read and to learn from text resources; (4) the family support system of PID: poor family support and encouragement, family members awareness, misconceptions, and knowledge gaps; (5) issues related to trainers: lack of availability of experienced skill trainers to impart skill training to PID, challenges with retaining the skill trainers at centres; (6) vocational skill training methodology: poor or nonavailability of standardized training material, manuals and curriculums for skill training for PID, lack of any formal recognition and certification for skill training imparted these centres [Table 2].

Table 2.

Challenges during vocational skill training facilitation

Themes	Subthemes	Quotes/description
Behavioural problems of PID	➢ Aggression towards trainers	‘Initial few months of the trainee joining the organization, most of the time, we observed behavioural issues. Which are like hitting the other trainees and orally abusing the vocational trainers sometimes we notice demanding behaviour also. Apart from that during class time, these people do not pay attention and disturb other trainees’. (Mrs. B. Seva in action organization).
	➢ Aggression against other trainees
	➢ Significant mood variations,
	➢ Poor motivation
Associated mental health and medical problems	➢ Comorbid mental health problems	‘Here we have one of the challenges during skill training is other comorbid illness like mental illness behavioral issues and other physical health issues so these problems are led them to not get interested into vocational training or not able to involve effectively’. (Mrs. B, Seva in action)
	➢ Physical health issues
	➢ Poor attention span interfering with skill imparting
Level of education	➢ Poor or no ability to read and to learn from text resources	‘We observed that their attention time is very less and do not put concentration during class time and needs to be taught multiple times. So its effect on their training’. (Mrs. D, Nitya Sadana organization)
The family support system of PID	➢ Poor family support and encouragement	‘We have seen a majority of family members, who do not involve during skill training programs. And also they underestimate that these people cannot do anything. Also noticed that family members are discriminating their children abilities and strengths without understanding them’. (Mrs. G, Amogh organization)
	➢ Family member's awareness, misconceptions, and knowledge gaps
Issues related to the trainers	➢ Lack of availability of experienced skill trainers to impart skill training to PID.	‘One of the major problems is employee's retention, sometimes whoever joined here leaving the organization because of various reasons which are salary, job satisfaction, job security etc., and sometimes not getting skilled trainers or other professionals and suitable persons’. (Mrs. F, Dharthree trust organization)
	➢ Challenges with retaining the skill trainers at centres
Vocational skill training methodology	➢ Poor or non-availability of standardized training materials, manuals, and curriculums for skill training for PID	‘We can see that there are no proper guidelines; recommendations are available. Also, there are not much research regards to vocational rehabilitation for these people (PWID) in terms of how to facilitate vocational programmes, which course is useful and facilitate employment opportunities also one of the challenges. Suppose if we have adequate information or research findings it would help to the practitioners to deliver the best services’. (Mrs. G, Amogh organization)
	➢ Lack of any formal recognition and certification for skill training imparted at these centres

*Other appropriate quotes have been provided in the supplementary file Table 1

Challenges postskill training and at workplace

The participants (vocational skill trainers) expressed a total of two themes and subthemes when asked about the various challenges postskill training and at workplace. The themes included (1) transitional challenges for PID: limitations in opportunities for PID, challenges in adapting to the new workplace and environment (2) workplace continuation and retention challenges: employers' attitudes, low wages, absenteeism and leaves for PID at workplace, poor or little support from the families of PID, medical and mental health problems of PID, and systemic challenges [Table 3].

Table 3.

Challenges postskill training and at workplace

Theme	Subtheme	Quotes/description
Transitional challenges for PID	a. Limitations in opportunities for PID	‘Hmm….it's a great challenge than providing training. We have approached many of organizations and companies but not able to get or provide opportunities, and they are not ready to give a chance to show their (PID) abilities. But few organizations only are able to understand and giving opportunities, but we need to convince them multiple times’. (Mrs. B, Seva in action)
	b. Challenges in adapting to the new workplace and environment
Workplace challenges and retention challenges	a. Employer's attitudes	‘Because of employers, negative perceptions the majority of the time PID are being not recruited. At outside employers think that PID cannot do any work, misunderstanding their abilities, concerning PID's behavior and legal aspects. So we need to convince them multiple times to facilitate opportunities, but it's still difficult’. (Mrs. B, Seva in action)
	b. Low wages.	‘Providing job is a great task, but sometimes these people (PID) are abruptly dropping from the job without information to the higher authority, when we get back to them (PID) about the reasons behind that, they reported that they are not able to adjust to the new environment, getting less salaries, not getting adequate support from the employers and family sometimes having fear and stigma’. (Mrs. C, Grow foundation)
	c. Absenteeism at workplace
	d. Poor or little support from the families of PID
	e. Medical and mental health problems of PID.
	f. Systemic challenges

*Other appropriate quotes have been provided in the supplementary file Table 2

Discussion

This study was focused on understanding the challenges of PID during skill training and postskill training from the perspective of vocational skill trainers. Although the study has limitations, it provides useful insights into understanding the various challenges for PID during vocational skill training and postskill training. The in-depth interviews helped the researchers to identify various challenges, which prevented to facilitate successful vocational skill training and postskill training for PID. Vocational skill training is one of the important steps for the PID vocational skill development, it helps them to get into employment, and satisfaction[4] as employment will help them to attain financial independence, but there are some hidden challenges to getting into employment at various levels.

1. Challenges during vocational skill training facilitation

   Our results show the potential challenges at the training level for PID, which prevents the PID from enhancing their vocational skills.

   • 1.1 Behavioural problems of PID

     The results indicated that many participants reported that potential challenges at skill training were behavioural problems. PIDs are said to have behavioural problems in the form of aggression, violence and stereotypes and might lead to injury to self or to others.[8] The results indicate that behavioural problems hinder the PID from getting into effective vocational skill training, safety-related issues and restrictive social participation.

     This theme was matched with prior studies also which reported that these behaviours are detrimental not only to the person himself who exhibits such behaviour but pose a challenge to their teachers and others too.[8]

   • 1.2 Associated mental health and medical problems

     PID have more health problems than the general public; mental disorders and physical health conditions are more prevalent in PID.[9] So, these mental and physical health problems may impact their vocational training and lead to poor motivation and less attention span.

   • 1.3 Level of education

     Results show that PID will have less ability to read and write from the resources, and their level of understanding is also a challenge due to their impaired cognitive abilities, and they require extra time and support.[10] So, it clearly shows that PID is required extra support during skill training.

   • 1.4 The family support system of PID

     Poor social support is another great challenge, and it plays a key role in the development of the individual. The current study results noticed that PIDs are not getting adequate support from their family members and experiencing discrimination, underestimating their abilities by the family members. It might be due to family members' poor knowledge, attitude and perception towards their PID and family members' perceived stigma and rejection by other members in their community.[11]

   • 1.5 Issues related to the trainers

     Vocational skill training requires adequate and qualified human resources, but in results, it is said that vocational skill training centres were not able to get qualified skill trainers and not retaining into the same organization due to meagre salaries, which hampers in providing quality services to the PID.

   • 1.6 Vocational skill training methodology

     Providing appropriate skill training plays a crucial role in getting a job and sustaining the same, but when it comes to poor or non-availability of standardized training, in our results, it was noticed that there were challenges in terms of facilitation of lack of adequate training, lack of standardized training materials, manuals, and curriculums for skill training for PID and lack of any formal recognition and certification for skill training imparted at these centres.[12]

2. Challenges postskill training and at workplace

   In the second objective of the study, the researchers tried to look at postskill training challenges from the perspective of vocational skill trainers which they encounters in their day-to-day practice.

   • 2.1 Transitional challenges for PID

     A majority of the participants who participated in the study revealed that they experienced one of the biggest barriers followed by skill training was employment for PID. It was reported that most of the time facilitating job for PID is challenging task rather facilitating skill training as there were limited opportunities for PID. Due to lack of effective adaption of the inclusive policy and measures, there are limited opportunities for persons with PID, it can be addressed effectively thorough coordination between the educational system and the labour market in terms of facilitate higher levels of employment.[13]

   • 2.2 Workplace and retention challenges

     Transition from skill training to employment and retaining in the employment for PID is not always easy without systemic support as they may experience the following challenges at employment; dismissive and discouraging attitudes from the employer,[14] not support from the colleagues, unable to retain in the job due to less salaries and feeling undervalued in their role,[14] frequent absenteeism due to health issues[12] and lack of support from the family members.[12] Retaining in job and other challenges can be addressed with through effective mechanism of supported employment and job coaches,[13] it would help to bridge the gap between employee and employer.

Strengths

One of its kinds of study is to investigate the experiential accounts of vocational trainers to persons with ID in an urban setting in the Indian context. Information on the range of vocational trades offered for training to persons with ID and the degree of challenges in the training, transition and placement of persons with ID elicited in this study can offer a better understanding of issues to be addressed to the professionals who work at primary care level and professionals working for the employment of persons with ID. This study informs us about the challenges related to the limitations in available skill training options at the selected centres and the need for strengthening the systemic support for a better employment prospect for trained persons with ID.

Limitations

These observations are based on selected centres in Bangalore metro city, so applicability of the findings to other contexts is challenging. Whereas more than two-thirds of all persons with disabilities in India reside in rural settings, challenges observed in this study have limits their applicability to rural locations where a large number of vocational trades are related to agriculture or family trades with less formal work schedules. This study has not explored the perspectives of persons with ID and their family caregivers and if there have similar or different opinions on these issues.

Conclusion

Selected vocational trades which fall under unskilled or semi-skilled categories are being offered for the skill training of persons with ID at vocational training centres. A range of challenges related to the behavioural problems of persons with ID, competencies of skill training personnel themselves, lack of availability of standard curriculums and training materials to persons with ID in the selected trades, attitudinal barriers of employers and poor support from family caregivers at times are observed as important challenges in the skill training and placement of persons with ID. This study offers us a better understanding of the barriers in the skill training and placement of persons with ID in urban settings from the perspective of skilled trainers. It would help the professionals and vocational counsellors while discussing and planning the vocational rehabilitation of persons with ID.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Supplementary information

Supplementary Table 1.

Challenges during vocational skill training facilitation

Challenges related to persons with ID
Subthemes	Content of sessions	Quotes of experts
Behavioural problems of PID	Majority of the participants had reported that initially, they would notice behavioural issues among the persons with Intellectual disability who are admitted in vocational centres. They typically reported behavioural issues such as anger outburst towards the office staff or vocational instructor, and other co-trainees, physically and verbally abusing the staff and co trainees, inattention, demanding behaviour and sadness.	‘Initial few months of the trainee joined the organization, most of the time, we observed behavioural issues. Which are like hitting the other trainees, and orally abusing the vocational trainers sometimes we notice demanding behaviour also. Apart from that during class time, these people do not pay attention and disturb other trainees’. (Mrs.B. Seva in action organization)
Readiness for skill training and placement	Few organization participants described that some of the trainees with ID do not come regularly for the training, so sometimes they forget what they learnt in the previous class.	‘Sometimes we have a problem that these people do not come regularly for the training so it will impact on other day work or sometimes they may forget what they learnt in the previous class'. (Mrs. F, Dharithree trust)
Co morbid medical health conditions	Majority of the organization respondents described that some of the people with ID have other comorbid illness which are mental illness, behavioural issues, sexual urges etc., so these issues are affecting their training.	‘Here we have one of the challenges during skill training is other comorbid illness like mental illness behavioral issues and other physical health issues so these problems are led them to not get interested into vocational training or not able to involve effectively’. (Mrs. B, Seva in action)
Having no formal schooling or exposure to special school settings	Participants reported that in some cases, these people do not have basic formal or special education which they felt that not having any formal or special education is a barrier to train them in the vocation centres.	‘We have seen some people that those who are having formal or special education and those who are not having, training the people who are having either basic formal education or special education is easy. Suppose if anyone is trained in ADLS, and IADL's would learn quickly’. (Mrs. E association for the mentally challenged)
Learning competencies of PID	Participants delineated that most of the time persons with ID are not able to put interest nor actively involve during either training period or in the class.	‘We observed that their attention time is very less and do not put concentration during class time and needs to be taught multiple times. So its effect on their training’. (Mrs. D, Nitya Sadana organization)
Challenges related to the Family caregivers of Persons with ID
Poor family support and encouragement	Participants explained that due to lack of parent's involvement during skill training, PWID is not able to involve more in skill training. Also, participants reported that parents are not giving guidance and/or practicing and not monitoring at home and discriminating against their children's abilities.	‘We have seen a majority of family members do not involve during skill training programmes. And also they underestimate that these people cannot do anything. Also noticed that family members are discriminating their children abilities and strengths without understanding them’. (Mrs.G, Amogh organization)
Family members awareness, misconceptions, knowledge gaps	Participants described that one of the barriers during skill training was the lack of understating about their children's disability and lack of proper guidance about where to go and what to do.	‘I have seen some cases that family members were not aware of their children disability and thinking that it will (disability) go away by itself during adulthood’. (Mrs. G, AMBA organization)
Challenges related to the Environment including the place of training
Availability of skill training personnel to impart skill training to PID	Participants reported that sometimes they have difficulty to get trained professionals (vocational instructors, and allied professionals) because of their high salary expectations, lack of skills or experience, and not service-oriented. Sometimes human resources retention is also a problem. The participant reported that if anyone gets any opportunity at outside, they are just leaving the existing job without informing to the higher authority.	‘One of the major problems is employee's retention, sometimes whoever joined here leaving the organization because of various reasons which are salary, job satisfaction, job security etc., and sometimes not getting skilled trainers or other professionals and suitable persons’. (Mrs.F, Dharthree trust organization)
Lack of standardized and accessible skill training curricula, manuals and materials	Participants had described that there were not adequate guidelines, research and recommendations available to practice or deliver the vocational skills to the consumers. Also, they reported that though there are existing literature and additional sources available, it's not helpful to the current scenario and also Participants expressed that the existing traditional teaching method is not helping them (PWID) to understand as well as they reported that these people (PWID) require more practical exposure	‘We can see that there are no proper guidelines; recommendations are available. Also, there are not much research regards to vocational rehabilitation for these people (PWID) in terms of how to facilitate vocational programmes, which course is useful and facilitate employment opportunities also one of the challenges. Suppose if we have adequate information or research findings it would help to the practitioners to deliver the best services’.
		(Mrs.G, Amogh organization)
		‘Traditional teaching method is not helping them to understand the concept or useful; they require more practical exposure or demonstration teaching so that it will help them to understand easily and will not forget whatever they learnt’. (Mrs.F, Dharthree trust)

Supplementary Table 2.

Challenges postskill training and at workplace

Challenges During Transition and Placement
Sub-Themes	Content of sessions	Quotes of experts
Limitations in opportunities	Majority of the participants reported that they were facing a lot of difficulties to provide employment opportunities once these people (PWID) finished their course/training. They also reported that at outside private organizations or companies are not giving opportunities to show their (PWID) abilities.	‘Hmm….it's a great challenge more than providing training. We have approached many of organizations and companies but not able to get or provide opportunities, and they are not ready to give a chance to show their (PWID) abilities. But few organizations only are able to understand and giving opportunities, but we need to convince them multiple times’. (Mrs.B, Seva in action)
Employer's altitudinal barriers	Participants reported that the majority of the employers are having the wrong perception towards these people (PWID) such as their abilities, behaviour, legal rights concerning the public view.	‘Because of employers, negative perception the majority of the time PWID are being not recruited. At outside employers think that PWID cannot do any work, misunderstanding their abilities, concerning about PW ID's behavior and legal aspects. So we need to convince them multiple times to facilitate opportunities, but it's still difficult’. (Mrs.B, Seva in action
Adaption to new work place by PID	Participants informed that sometimes these people are not able to retain in the job due to various factors which are stigma, not able to adjust to the new environment, fewer salaries, comorbid illness, not getting support from the employers and family members.	‘Providing job is a great task, but sometimes these people (PWID) are abruptly dropping from the job without information to the higher authority, when we get back to them (PWID) about the reasons behind that, they reported that they are not able to adjust to the new environment, getting less salaries, not getting adequate support from the employers & family sometimes having fear and stigma’.
		(Mrs.C, Grow foundation)
Challenges post their placement at a work place
Low wages	Participants described that majority of the time, these people (PWID) are given meagre salaries which sometimes are not helping them to fulfil their basic needs.	‘Employers providing a job is a great task, and expecting a minimum salary is a mirage. But we have seen some cases that if anyone has good skills and experience, they are getting a good salary’.
		(Mrs.C, Grow foundation)
Medical issues of PID	Respondents stated that sometimes due to their comorbid illness such as physical health issues, mental health issues and behavioural issues not able to adjust at the workplace. So this is also one of the barriers to sustaining at work.	‘Sometimes, one of the challenge to sustain in the job is a co-morbid illness. Because of these issues, people are quitting the job’.
		(Mrs.D, Nitya sadhana organization)
Absenteeism at work place	Participants informed that sometimes persons with intellectual disability stop going for work due to low wages, new environment, not able to get adequate support from the employers and co-employees.	‘Providing job is a great task, but sometimes these people (PWID) are abruptly dropping from the job without information to the higher authority, when we get back to them (PWID) about the reasons behind that, they reported that they are not able to adjust to the new environment, getting less salaries, not getting adequate support from the employers & family sometimes having fear and stigma’.
		(Mrs.C, Grow foundation)
Poor support from family	Participants described that majority of the time; these people are not getting adequate support from their family members and family members are not identifying/recognizing their abilities, and discriminating.	‘From our side, we are trying to help these people, but at the family level, we noticed that family members have high expectations from these people, sometimes not recognizing their abilities and discriminating that they cannot do anything also though they are employed in any company, family members are not helping them if they have any issues. (Mrs.B, Seva in Action)
		‘Since the childhood of these people must be influenced by family members or others. If anyone would help them so they will realize that what they should do and would help them to take right decisions regards to their future. Majority of the time, these people do not know what to do even after their training is over’.
		(Mrs.E, The association for the mentally challenged)
Poor systemic support	Participants described that govt has to take many other initiatives to provide employment opportunities like facilitating opportunities based on their abilities rather than their qualification. As if they want to apply for any govt. Jobs, they are not able to do it because of the qualification criteria. They also reported that the reservation is not helping them, step into govt. Jobs because of the education qualifications.	‘Govt. so far has done something good but it's not helping them to all the people to get into jobs though they have adequate skills. One thing is, the govt must facilitate jobs based on their abilities rather than their qualification because they cannot complete basic education. Also govt. must take the decision that private firms and companies also should give an opportunity to the disabled people. Also govt must think to facilitate govt vocational rehabilitation centres. And creating small scale industries’. (Mrs.G, Amogh)
		‘We must appreciate the govt for facilitating reservation for these people but at the reality they are not able to get it. Suppose for any govt. job at least they must have some education qualification, but these people cannot complete a minimum 10th standard. Though they finish it through distance education, it will not help them. So govt. must think alternatively like facilitating jobs based on their abilities rather than based on their education’. (Mrs.G, Amogh organization)