COMPOSE A METHODOLGY SECTION 9
Composea Methodology Section
Overthe past half century, care for persons with severe diabetes illnesshas moved from the traditional institution- centered treatments tomore individualized community-centered treatments. On top of that,there has been a change of view about the ability for an individualwith severe diabetes illness to be hospitalized toward lifestylesthat suit the needs of a person with such ailment. The major problemis the ability of an individual with diabetic illness to be employedfor a long duration of time. For a person with severe diabetesillness to maintain full time work while staying in the society,several novel and radical plans has been developed. The mostimportant of this have started from the culture of diabetic clinicwith its concentration on individual patient that aims at outlining,talent training, job formulation and work support (cook, junkies andSolomon, 1993). Most of the attempts in the past to examine suchplans have specialized specifically on the result of the work.However, ideas from the theories dealing with diabetic issues showthat maintaining employment through out and staying among the peoplemay have important advantages in addition to economics benefits.According to the research by world health organization, there havebeen no impacts of diabetic clinic programs on major illness-relatedoutcomes. To solve the problems that the clinic is encountering, thisresearch aims at examining the impacts of the introduced program thataims at maintaining employment for persons with severe diabeticillness.
Inunited kingdom alone, about 8 – 9 billion diabetic affectedindividuals inhabitant the country. Most of the studies show thatdiabetic illness begins in childhood age or adolescence and persistthroughout adulthood. Compared to the general population, childrenwho are affected by diabetic, reach developmental milestones muchlater. The children experience difficulties in communicating andadapting daily life skills.
Thetheory dealing with diabetic issues has encountered three essentialphases of development over the past few decades. The early diabeticmodel concentrated on discussing the idea of sheltered workshopemployment. Client worked only with infected individuals and waspaid a piece rate.According to the control studies of shelteredworkshop, persons with diabetic illness performed minimally. In the1980s, less consuming time model and more normalizing model wasproposed for individual undergoing treatment, and this model wascalled supported employment. The supported employment aimed atsearching jobs in a mix setting for a less salary or much higher, andthen employing the individual and the training them and supportprogram required the person to remain employed. Some of the examplesof services were jobs aiming at development an individual jobs thataims at one-on-one training, rules with employers, and the supportgiven were found to have an impact on maintaining full employment forpeople with severe diabetic illness. The idea is that this theorycould be applied to patient with all types of severe sickness becamecommonly accepted.
Oneof the assumptions in this research is that a plan dealing with fullemployment will results in either no improvement or negative impactson the psychological functioning and individual self esteem. Anotherassumption is that a program of full employment will leads tonegative impacts on psychological functioning and person self-esteem.
Thepeople that the study specializes on are all adults age 23 to 45years with severe diabetic illness in the United Nation in the 1970s.The sample that is involved in this study consists of all persons whowere customers of the diabetic Clinic in Landon. From January 1, 1973to April 25, 1975, customers who were associated with the followingcriteria: 1) had severe diabetic illness in their life. 2) Work onthe condition that they get paid. 3) Their primary diagnosis must notinclude addiction to drugs like alcohol and hard drugs. 4) They mustbe above 18 years old. The company provided the sampling frame fromtheir records. Out of the large numbers of customers who passedthrough the group per year approximately 500 met the criteria
Onoverall, study participant were 25 years of age and universitygraduate (average education level = undergraduate degree). Most ofthe participants were male (60%). According to the statistics mostwere unmarried (85%), a small number were currently married (2%), andthe remaining number were officially married (13%). 52% of thepopulations are Caucasian, 42% of the remainder are African American,and 6% are a minority group. On the members’ history, samplesindicated that averaged six out of the hospitalized and spent theirlifetime 0f 6 months as patients in a diabetic hospital. Theprincipal treatment was low insulin concentration who was 32% of theparticipant and 37% suffered severe chronic depression.
Generalizingwas not the main goal because the conclusion made from the studycannot be consideredas the final representative of the initialpopulation which was included in the sample. The main aim of thisresearch was to find out whether a certain full employment programcould work in corporation with accessible context. Impacts of supportwork used in this study can be applied in urban diabetes clinic thatare almost similar with the rehabilitation, have the same implementprocedures and the same program structures.
Measuresused in the study for diabetic patient
Measuresapplied in this research are devices well used in the researchesliterature that deals with functioning of diabetic patient. Thetools were used in the form of a structured interview that anexamination social employees had with participant who was involved inthe study at a given intervals. Two prevention of increase of rateof illness of diabetic patient were implemented, that is the brieflevel of sickness (18- item unit that measures the level of severityof symptoms) and the universal assessment unit (a single 1-100 ratingunit which show an increase of detailed description of the function).
Twounits of self- esteem were used, and the first was the Rosenbergself- esteem which entailed a 10 item unit’s rate in the format of5% unit response. The total score is obtained by simply summingacross the ten items, with five out of ten been reversal. The secondmeasure which was employment self esteem was developed and designspecifically for a person with severe diabetic illness. Because ofthe problem encountered while measuring a population with severediabetic illness, the device was simplified that is it entails shortresponse scale and no reversal item. All the four measures werereliable and valid when using them.
Thecomparison groups were awarded a standard clinic protocol whichconcentrated in housing training in skills of life and jobopportunities in a house sheltered workshop. All participantinvolved were measured intake and at two month’s post test. Forinternal validity to be strong, randomized experiment type should beused. It eliminates threats that result from the history, maturation,testing, instrumentation, and mortality and selection interaction.The disadvantages of this type of analysis are in the potential fortreatment related death rate and for the problem that resulting fromthe participant reaction and administrator’s knowhow of thedifferent research condition.
Inthis research, 4% was the rate of reduction for the control group,and 5% rate was in the group used for treatment. It is not logicalthat there is differential death rate because these rates are lowerand are almost equal to each other. There is a possibility that theresults obtained were influenced by participant knowhow that theother group existed
From1/1/1973 to 4/25/1975 each person admitted to the clinic who met theresearch condition was given a random number that provided them anequal chance of being chosen to be in the study group. The aim of thestudy was well explained to those selected and included the conditionof the two procedures, and use and the requirement for randomassignment. Confidentiality was guaranteed to participant, and theyhad the option of declining to participate in the study. Out of 435people only five declined to participate. Fair chance of being chosento either the full employment condition or the standard in clinicsheltered workshop was given to each selected sample member. Studyparticipant was given the four policies at intake in addition.
Inthe first two weeks, the participants spent their time in thetraining in the program and orientation. The training consisted oftraining dealing with life skills and job preparation. Eachparticipant was given a job site at the end of the period, andparticipant in the control condition was assigned at the agencysheltered workshop and other participants to an outsider employer ifin a full employment group. At the sheltered workshop, the controlparticipant were expected to operate full time for a minimum of twomonths duration at which point they were post evaluated and given achance to obtain outside working environment. On the side of fullemployment participants, they assigned a case worker (mobile jobsupport worker). The work of the case worker was to meet with theinividual at the job site four times each week for an hour everymeeting. The caseworker provided support or help deemed necessary toassist a person cope with job stress, including counseling. Eachparticipant was given the option of staying with their current jobafter undergoing post test at the end of three months.
Inthe final example, there were 436 members for this study and in eachtreatment there were 218. The numbers of participant who drop outwere 6 in the control group and 10 from the treatment group. Thedropout made the total in a control group to be 213 while thetreatment group to be 208. Due to problem encountered in coping withstress in job sphere, 11 members from full employment had to be movedinto the clinic sheltered workshop as a result of the post test
Theoutcome pattern has two major possible explanations, and the firstone is that there might be a positive delaying effect of beingemployed outside of a sheltered environment. In the full employmentcase, it had to undergo the difficulty in the initial period ofadjustment before positive effect become apparent. In the theory,“you have to get worse before you get well” is usually applied inother treatments of drugs addiction and alcoholism. The secondexplanation is that people employed in full -time work are obviouslyworking under pressure from stress and encounter more negativeresults than those employed in the safe confines of an in clinicsheltered workshop. In general conclusion from the study indicatesthat work is hard naturally.
Theconclusion from the research is that much of the theory in diabetictreatment is mostly old fashioned and seriously misleading if appliedin some diabetic cases. Theory made people believe that beingemployed outside was the best experience that would automaticallyresult to a good state, for example, improved psychological workingand increased self – esteem.According to the results, most peoplewhether affected by severe diabetic illness or not, an individual canbe able to cope with any job, specifically for the types of lessreturn service available to research participant. People with severediabetic illness may not work well though they maintain their selfesteemed highly. Researchers should aim at balancing this two withthe desire they have to be like other people, for example strugglesexperienced by others people and what he/sheexperience in life.
Researcherswho are to carry research in this study in future are required totackle the theoretical assumptions about employment outcomes for aperson with severe mental disability. It is should be emphasizedbecause attempts to replicate this work also measure how fullemployment participant feel when it come to the decision to work,even if traditional results indicators suffer.
Spaulding,W. D., Sullivan, M. E., & Poland, J. S. (2003). Treatmentand rehabilitation of severe mental illness.New York: The Guilford Press.