UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Tuberculosis rehabilitation in British Columbia and Alberta : a comparative analysis of publicly and… Doxsee, Harold Robertson 1961

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1961_A5 D6 T8.pdf [ 3.98MB ]
Metadata
JSON: 831-1.0106031.json
JSON-LD: 831-1.0106031-ld.json
RDF/XML (Pretty): 831-1.0106031-rdf.xml
RDF/JSON: 831-1.0106031-rdf.json
Turtle: 831-1.0106031-turtle.txt
N-Triples: 831-1.0106031-rdf-ntriples.txt
Original Record: 831-1.0106031-source.json
Full Text
831-1.0106031-fulltext.txt
Citation
831-1.0106031.ris

Full Text

TUBERCULOSIS REHABILITATION IN BRITISH COLUMBIA AND ALBERTA A Comparative Analysis of P u b l i c l y and P r i v a t e l y - Sponsored Programmes, I960. by HAROLD ROBERTSON DOXSEE Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OP SOCIAL WORK i n the School of S o c i a l Work Accepted as conforming to the standard required f o r the degree of Master of S o c i a l Work School of S o c i a l Work 1961 The U n i v e r s i t y of B r i t i s h Columbia I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r a n a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l m a k e i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s m a y b e g r a n t e d b y t h e H e a d o f my D e p a r t m e n t o r b y h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t b e a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , V a n c o u v e r 8 , C a n a d a . D a t e i i i ABSTILk R e h a b i l i t a t i o n of the handicapped as a r e s u l t of tuber-c u l o s i s i s a most involved and complex process. In Canada today, the organization of r e h a b i l i t a t i o n services f o r tuber-culous persons v a r i e s from province to province. In some provinces the r e h a b i l i t a t i o n services are handled e x c l u s i v e l y by the p r o v i n c i a l health departments; i n other provinces the programmes are the r e s p o n s i b i l i t y of the p r o v i n c i a l tuberculosis a s s o c i a t i o n s ; i n s t i l l other provinces, r e h a b i l i t a t i o n of the tuberculous i s to a considerable extent a j o i n t e f f o r t by voluntary and governmental agencies. This t h e s i s examines the programmes f o r the tuberculous which are offered under public auspices i n the province of B r i t i s h Columbia by the D i v i s i o n of Tuberculosis Control, and under private auspices i n the province of Alberta by the A l b e r t a Tuberculosis Association. The purpose of the study i s to review the concept of r e h a b i l i t a t i o n , and to determine i f differences of s i g n i f i c a n c e e x i s t between the two programmes. The necessary material was compiled by a s e r i e s of selected interviews with personnel involved i n the operation of t u b e r c u l o s i s r e h a b i l i t a t i o n services i n Alberta and B r i t i s h Columbia; analysis of annual reports of agencies i n both provinces d i r e c t l y concerned i n providing these services; and, by drawing upon the writer's own s t a f f experience i n one of these programmes. The scheme of analysis u t i l i z e s the following headings: (a) sponsorship and administration (b) f a c i l i t i e s and personnel (c) r e h a b i l i t a t i o n s e r v i c e s , and (d) co-ordination. The study reveals measurable differences i n the two programmes selected, and these are reviewed. The major difference between the programmes i s i n terms of organizational structure. In B r i t i s h Columbia, a composite programme c o n s i s t i n g of two s p e c i a l i z e d departments i s i n operation; one o f f e r i n g vocational r e h a b i l i t a t i o n services and the other welfare services. The Alberta programme i n contrast, integrates vocational r e h a b i l i -t a t i o n and s o c i a l services, but has a smaller professional s t a f f . The extent to which differences can be d i r e c t l y a t t r i b u t e d to d i f f e r e n t auspices i s doubtful; and there i s room f o r f u r t h e r research. There i s evidence, however, of need f o r more p r o f e s s i o n a l l y trained s o c i a l workers i n comprehensive r e h a b i l i -t a t i o n programmes. iv ACKNOWLEDGEMENTS I wish to express my appreciation to Mr. Lester MacDonald, Mrs. M. T i t t e r i n g t o n , and Mr. Edward Thiessen who provided me with a great deal of information f o r t h i s study. P a r t i c u l a r l y , I wish to thank Dr. Charles McCann and Dr. Leonard C. Marsh, of the School of S o c i a l Work, Uni v e r s i t y of B r i t i s h Columbia, f o r t h e i r excellent c r i t i c i s m and d i r e c t i o n throughout the preparation of t h i s t h e s i s . i i Chapter 1. TABLE OP CONTENTS Tuberculosis R e h a b i l i t a t i o n Programme i n Canada Page The organization of r e h a b i l i t a t i o n services i n Canada. Group to be studied and purpose of study. The nature of tuberculosis and i t s treatment. The aims of r e h a b i l i t a t i o n i n t u b e r c u l o s i s . R e h a b i l i t a t i o n services f o r the tuberculous i n Canada: (1) E a r l y development and p r o v i n c i a l organization (2) Federal government p a r t i c i p a t i o n . Method of study , Chapter 2. B r i t i s h Columbia: A Publicly-Sponsored Programme Sponsorship and administration. F a c i l i t i e s and personnel. C l i e n t s . R e h a b i l i t a t i o n s e r v i c e s : ( l ) V o c a t i o n a l counselling (2) Vocational t r a i n i n g (3) Job placement (4) Follow-up (5) Welfare services 14 Chapter 3. A l b e r t a : A Privately-Sponsored Programme Sponsorship and administration. F a c i l i t i e s and personnel. C l i e n t s . R e h a b i l i t a t i o n s e r v i c e s : ( l ) C o u n s e l l i n g (2) Vocational t r a i n i n g (3) Job Placement (4) Welfare services (5) Follow-up 26 Chapter 4. Indications f o r the Future A comparison of the r e h a b i l i t a t i o n processes i n the programmes f o r tuberculosis i n B r i t i s h Columbia and Alberta. Personnel i n r e l a t i o n to programme auspices. Co-ordination i n the two programmes. Conclusion 41 Appendices: A. Sample Record Forms B. Bibliography TABLES AND CHARTS IN THE TEXT  Tables Vocational T r a i n i n g Completed by Discharged Tuberculosis Patients i n B r i t i s h Columbia f o r the Years 1957, 1958, 1959 16 Occupations of Tuberculous Patients P r i o r to H o s p i t a l Admission i n B r i t i s h Columbia 19 Occupations of Discharged Tuberculosis Patients From Alberta Sanatoria P r i o r to H o s p i t a l Admission 32 Table I Table II Table I I I TUBERCULOSIS REHABILITATION! IN BRITISH COLUMBIA AND ALBERTA CHAPTER I TUBERCULOSIS REHABILITATION PROGRAMMES IM CANADA Since World War II r e h a b i l i t a t i o n services f o r the handicap-ped i n Canada have experienced considerable expansion. 1 This i s r e f l e c t e d i n increased a c t i v i t y by voluntary health and -welfare o organizations, amid through f e d e r a l and p r o v i n c i a l l e g i s l a t i o n . One of the manifestations of t h i s growth has r e s u l t e d i n the recognition of the need f o r comprehensive programmes of r e h a b i l i -t a t i o n . Moreover, there has been considerable emphasis on i n t e g r a t i o n of the v a r i e t y of services which e x i s t f o r the numerous c i v i l i a n d i s a b i l i t y groups, as well as on co-ordination of these s e r v i c e s . Much of the impetus f o r these developments ha© been due to the outgrowth of the Conference on the R e h a b i l i t a t i o n of the P h y s i c a l l y Handicapped which was held i n Toronto i n 1951-This n a t i o n a l Conference was c a l l e d by the f e d e r a l government on the i n i t i a t i v e of the M i n i s t e r of Labour , to discuss new approaches of providing a u n i f i e d and co-ordinated programme of r e h a b i l i t a t i o n services i n Canada. An Interdepartmental Committee, representing the Departments of Labour, National Health and Welfare, and Veterans A f f a i r s was set up to arrange f o r such a conference, and i n v i t a t i o n s to attend the conference and p a r t i c i -pate i n i t were extended to a l l p r o v i n c i a l governments, medical a s s o c i a t i o n s , o f f i c e r s of n a t i o n a l organizations i n t e r e s t e d i n 1 Canada, Department of National Health and Welfare, Research and S t a t i s t i c s D i v i s i o n , R e h a b i l i t a t i o n Services In  Canada, Part I, pp. 19-23. 2 I b i d . , pp. 20-23. 2 the r e h a b i l i t a t i o n of s p e c i f i c groups of the handicapped; u n i v e r s i t i e s ; and i n d i v i d u a l s who were engaged d i r e c t l y or i n -d i r e c t l y i n the f i e l d of r e h a b i l i t a t i o n . When the conference was held, i n a d d i t i o n to the ministers and deputy ministers of the above-mentioned f e d e r a l departments, over two hundred delegates and observers were present, representing a l l the provinces and numerous n a t i o n a l , p r o v i n c i a l , c i v i c and l o c a l organizations. Recommendations made at t h i s conference set i n motion a s e r i e s of developments designed to f a c i l i t a t e co-operative planning and the expansion of s p e c i a l i z e d services i n order to bring comprehensive r e h a b i l i t a t i o n services to Canada's c i v i l i a n d i s a b l e d . 1 Probably the most s i g n i f i c a n t r e s u l t of t h i s h i s t o r i c a l conference was that i t brought about formal, j o i n t , federal-prov-i n c i a l p a r t i c i p a t i o n i n a n a t i o n a l r e h a b i l i t a t i o n programme, with the co-operation of the many voluntary agencies which were involved i n the r e h a b i l i t a t i o n f i e l d . As i t e x i s t s today, i n accordance with both f e d e r a l and p r o v i n c i a l l e g i s l a t i o n , the programme i s organized through each province which arranges f o r the co-ordination of r e h a b i l i t a t i o n services within i t s own boundaries. However, at the f e d e r a l l e v e l there i s the o v e r a l l co-ordination of the programme, the p r o v i s i o n of c o n s u l t a t i o n s e r v i c e , the administration of f e d e r a l grants and assistance, and the exchange of information between various parts of the country, a l l authorized by means of f e d e r a l l e g i s l a t i o n . Dr. A l l a n Roeher, Co-ordinator of R e h a b i l i t a t i o n f o r Saskatchewan, speaking at the Eighth World Congress, International Society f o r Welfare of C r i p p l e s , Mew York, i n August, 196o, summarized the progress of r e h a b i l i t a t i o n i n Canada during the 1 For reports of speeches delivered at the conference, minutes of the working committees named to submit s p e c i f i c recommendations; and the regulations which were adopted at the concluding session, the reader i s r e f e r r e d to Proceedings, Conference on the R e h a b i l i t a t i o n of the P h y s i c a l l y Handicapped, Toronto, Ontario, February 1, 2, 3 , 1951 . 3 past twenty years with the f o l l o w i n g statement: Stimulated by a high l e v e l of economic prosperity public support f o r health and welfare developments, the t r a d i t i o n a l blend of voluntary-governmental endeavour i n the areas of health and s o c i a l services has been evident i n the evolution of r e h a b i l i t a t i o n s e r v i c e s . There i s growing public opinion that t h i s sharing of r e s p o n s i b i l i t y should p e r s i s t i n the future even though governments are undertaking the major f i n a n c i a l burden. In many areas, voluntary organizations continue to lead i n the p r o v i s i o n of r e h a b i l i t a t i o n services to c i v i l i a n s , among the v i s u a l , auditory and p h y s i c a l l y impaired, and those with heart disease, epilepsy, a r t h r i t i s , rheumatism and paraplegia, although most programmes are a s s i s t e d d i r e c t l y or i n d i r e c t l y by public funds. Governments, on the other hand, tend to provide major support f o r education and vocational t r a i n i n g ; development of treatment f a c i l i t i e s f o r the tuberculous, mentally i l l and retarded; hospital-centred r e h a b i l i t a t i o n f a c i l i t i e s ; and formal co-ordination programs. Industry supports the re-establishment of i n d u s t r i a l c a s u a l t i e s 1 through p u b l i c l y managed Workmen's Compensation Boards. In view of the heightened i n t e r e s t i n r e h a b i l i t a t i o n f o r the handicapped i n Canada today, a study of the patterns of service i n t h i s f i e l d i s timely. The Group to be Studied and Purpose of Study In the present study, the concern i s with the r e h a b i l i t a t i o n of a s p e c i f i c d i s a b i l i t y group — the tuberculous. To be more e x p l i c i t , the purpose of t h i s study i s to examine two r e h a b i l i -t a t i o n programmes f o r the tuberculous, each operating under d i f -ferent auspices i n d i f f e r e n t provinces, i n an attempt to determ-ine what e f f e c t auspices have on the structure of the programme and the q u a l i t y of the services offered. The programmes which w i l l be reviewed include the one i n Alberta operated under the private auspices of the Alberta Tuberculosis Association, and the public programme i n B r i t i s h Columbia operated by the D i v i s i o n of Tuberculosis Control, Department of Health Services and Hospital 1 Roeher, G.A.; " R e h a b i l i t a t i o n Progress and Needs i n Canada", S o c i a l Worker, Vo l . 29, No. 1, January 1961, pp. 15-16 4 Insurance. By examining the two programmes, an attempt w i l l be made to determine what differences e x i s t and assess these differences i n r e l a t i o n to programme auspices. Some of the questions which t h i s t h e s i s w i l l t r y to answer are: What i s the r e l a t i o n s h i p , i f any, between programme auspices and f a c i l i t i e s ? S i m i l a r l y , what i s the r e l a t i o n s h i p between programme auspices and personnel? Do s t a f f r e q u i r e -ments vary i n r e l a t i o n to programme auspices? Are there d i f f e r e n c e s i n the co-ordination of r e h a b i l i t a t i o n services f o r the tuberculous under each programme? Does the r o l e of the s o c i a l worker vary according to the auspices i n a pro-gramme of tuberculosis r e h a b i l i t a t i o n ? Are there differences i n c r i t e r i a f o r r e h a b i l i t a t i o n of i n d i v i d u a l s with tuber-c u l o s i s as a r e s u l t of d i f f e r e n t auspices? In order to provide the reader with some frame of reference regarding the s p e c i f i c area of t h i s i n q u i r y , the present chapter w i l l proceed with a b r i e f review of the nature of t u b e r c u l o s i s , i t s treatment, and a concise outline of the general organization of r e h a b i l i t a t i o n services i n Canada f o r the tuberculous. The Mature of Tuberculosis and i t s Treatment Tuberculosis i s an i n f e c t i o u s disease caused by the tubercle b a c i l l u s which may attack every t i s s u e of the human body, although the lungs are most vulnerable. Following a primary childhood i n f e c t i o n , the occurrence of the disease i n adolescence and adulthood depends on the lowering of resistance by malnutrition, fatigue or other disease conditions, or upon massive i n f e c t i o n . An absolute cure f o r the disease has not yet been achieved. Cases can often be arrested and made quiescent by means of bed r e s t , d i e t , chemo-therapy and surgery. Even though the i n t r o d u c t i o n of a n t i -b i o t i c s has considerably reduced the length of i n - h o s p i t a l treatment f o r t u b e r c u l o s i s , treatment of the disease i s s t i l l g enerally conceded to be of a long-term nature. The achievement 5 of quiescence i s a very gradual process and i t often requires many months, and i n some cases, even years of treatment. 1 Tuberculosis diagnosed early, known as minimal disease, usually responds well to treatment. Par advanced tuberculosis requires a longer period of treatment, and because of lung o destruction, the patient may be l e f t a respiratory cripple. With the average case, d i s a b i l i t y from tuberculosis i s less apparent than from crippling diseases and accidents. It i s potential rather than actual, since the d i s a b i l i t y consists of a voluntary imposed r e s t r i c t i o n of the mode of l i f e calculated to maintain the arrested state of the disease and prevent relapse. The need to r e s t r i c t the expenditure of energy has an obviously important bearing on the selection of an occupation by the patient when he i s medically able to return to work. Sanatorium care i s s t i l l the basic treatment to which a l l other forms of treatment are added. The sanatorium provides the proper setting for the various phases of the treatment including rest, isolation of infectious cases, and the education of the patient to a different mode of l i f e which w i l l enable him to safeguard his regained health and protect others. The Aims of Rehabilitation i n Tuberculosis Rehabilitation isuan integral part of the treatment for the tuberculous patient. Dr. James E. Perkins, the Managing Director of the National Tuberculosis Association states that "rehabilitation services are i n integral part of the comprehensive 1 The Annual Report of the Division of Tuberculosis Control, Department of Public Health, Province of Alberta, discloses that for the year ending March 3 1 , I960, the average number of days per patient i n Alberta Sanatoria was 222. 2 See Diagnostic Standards and Classification of  Tuberculosis, National Tuberculosis Association, lew York, I960. 6 treatment and, lacking rehabilitation services, no program of i tuberculosis control i s i n proper balance." The goal of rehabilitation i s to restore the disabled person to useful l i v i n g i n his community. Rehabilitation i n tuberculosis i s the restoration of the tuberculous to the f u l l e s t physical, mental, so c i a l , vocational and economic usefulness of which they are capable. The process of tuberculosis rehabilitation commences at the point of diagnosis and i s continuous throughout medical care and some part of the post discharge period, i n most cases. The process i s complete when the patient attains a satisfying l i f e and i s operating at the top level of his t o t a l capacities. Certain factors and conditions, such as the personality of the patient, his family, and his community, often create blocks to effective rehabilitation and these d i f f i c u l t i e s need to be surmounted, removed, or avoided. The rehabilitation o f f i c e r and the social worker assist the patient with these problems, in conjunction with hospital staff from other disciplines. Not to be disregarded i s the part played by the community as a whole i n this process. Community knowledge and understanding of the job which must be done are necessary. Successful accomplish-ment i n rehabilitation demands sound planning by and active participation of a l l community health and welfare agencies as well as interested individuals — including the patient who i s the important traveller. Vocational adjustment i s not the whole story. True rehabilitation i s only achieved when the disabled individual i s as secure — personally, soc i a l l y , and economically — as i t i s possible for him to be. 3 1 A Guide for the Development of Rehabilitation Programs i n  Tuberculosis Associations, National Tuberculosis Association,, New York, 1956. Preface, p. i i i . 2 "Proceedings of the Conference on the Rehabilitation of the Tuberculous, March 4-6, 1946, Washington, D.C." as quoted i n Keifer, Norvin C , Present Concepts of Rehabilitation i n  Tuberculosis, National Tuberculosis Association, New York, 1948. p. 17. 3. A Guide for the Development of Rehabilitation Programs  in Tuberculosis Associations, op. c i t . , p. 3. 7 Rehabilitation Services for the Tuberculous i n Canada 1. Early Development and Provincial Organization Today i n Canada, the organization of tuberculosis rehabilitation services varies from province to province. 1 In some provinces the rehabilitation services are handled exclusively by the provincial health departments; i n other provinces the programmes are the responsibility of the provincial tuberculosis associations, while i n other provinces rehabilitation of the tuberculous i s to a considerable extent a joint effort by voluntary and governmental agencies. Like many other services for the tuberculous, the rehabilitation services were largely i n i t i a t e d by voluntary organization or provincial tuberculosis associations, some of which were later incorporated into public programmes. In 1942 the Sanatorium Board of Manitoba introduced the f i r s t comprehensive programme of counselling, retraining and job place-ment for ex-sanatorium patients, and this has been the blueprint for tuberculosis rehabilitation programmes i n other Canadian 2 provinces. The Alberta Tuberculosis Association had a programme in operation i n 1947, and about the same time, a programme i n some of the sanatoria i n B r i t i s h Columbia was organized by the B r i t i s h Columbia Tuberculosis Society. The B r i t i s h Columbia programme, however, was later incorporated into the provincial programme •3 offered by the Division of Tuberculosis Control. The advent of the Tuberculosis Control Grant, which was one 1 Rehabilitation Services i n Canada, Part I, op. c i t . , pp. 204-210. 2 See Cunnings, T.A.J.:"Rehabilitation of the Tuberculosis Patient — the Manitoba Programme", Canadian Journal of Public  Health, Voi. 3 5 , Mo. 4 , A p r i l 1944, pp. 137 - 143 . 3 Rehabilitation Services i n Canada, Part I, loc. c i t . pp. 206 - 207. 8 of the Federal Health Grants introduced i n 1948, considerably stimulated the development of v o c a t i o n a l r e h a b i l i a t i o n programmes f o r the tuberculous, and by 1955 schemes were operating i n nearly every province. In several provinces the programmes remain under private auspices, or i n some cases voluntary agencies receive p r o v i n c i a l grants to subsidize the costs programmes. In a l l provinces, v o c a t i o n a l r e h a b i l i t a t i o n i s c l o s e l y co-ordinated with the c i v i l i a n r e h a b i l i t a t i o n programme, under the d i r e c t i o n of the T Co-ordinator of R e h a b i l i t a t i o n f o r each province. 2 . Federal Government P a r t i c i p a t i o n The major areas i n which the f e d e r a l government i s involved i n the r e h a b i l i t a t i o n of tuberculosis patients are: (a) Services f o r Indians and Eskimos; (fe) P r o v i s i o n of the Tuberculosis Control Grant; (c) Schedule "R" of the Canadian Vocational T r a i n i n g Scheme; (d) F e d e r a l - p r o v i n c i a l co-ordination; (e) Job Placement. (a) Services f o r Indians and Eskimos In Canada disenfranchised Indians and the Eskimos remain a f e d e r a l r e s p o n s i b i l i t y and most tuberculous natives receive t r e a t -ment i n f e d e r a l h o s p i t a l s operated by the Department of National Health andWelfare. An extensive programme of r e h a b i l i t a t i o n services f o r the handicapped Indian and Eskimo groups i s s i m i l a r l y provided under f e d e r a l government auspices. Services f o r the Indians are administered by the Indian A f f a i r s Branch of the Department of C i t i z e n s h i p and Immigration i n co-operation with the Indian and Northern Health Services of the Department of p National Health and Welfare. The Welfare D i v i s i o n of the Depart-ment of Northern A f f a i r s and National Resources administers •5 r e h a b i l i t a t i o n services f o r the tuberculous Eskimos. These programmes w i l l not be included i n the present study. 1 I b i d . " P r o v i n c i a l Co-ordination and Administration," pp. 31 - 34 . 2 I b i d . , see Chapter 4 "Indians" pp. 132 - 139. 3 I b i d . , see Chapter 4 "Eskimos" pp. 139 - 144 9 (b) Tuberculosis Control Grant The Tuberculosis Control Grant, established as one of the National Health Grants i n 1948 by the federal government, provides the cost of rehabilitation services to sanatorium patients and the re-establishment of discharged patients on a shareable basis with the provinces. In the f i s c a l year 1958-1959 an amount of 4 160,000 was provided i n Tuberculosis Control Grants for nearly 1 a l l the provinces. The l a t i o n a l Health Grant also provides for professional training of rehabilitation personnel under the Medical Rehabili-tation Grant which i s entirely chargeable to the federal govern-ment. This grant covers formal training for rehabilitation officers and social workers i n tuberculosis hospitals. (c) Schedule "R" of the Canadian Vocational Training Scheme One of the most important structures of the provincial rehabilitation programmes i s the vocational training programme for disabled c i v i l i a n s carried out under Schedule "R" of the Special Vocational Training Agreement which i s administered by 2 the federal Department of Labour. This joint federal-provincial scheme, introduced in 1954, provides for the training or retraining of disabled persons to f i t them for gainful employment in suitable occupations. The scheme i s administered by each province and there i s an equal sharing of costs with the federal government. Schedule "R" has provided considerable amounts for the vocational training of ex-tuberculous adults, since i n most provinces this group has formed the largest single d i s a b i l i t y group. Persons who had tuberculosis, or other respiratory conditions, comprised 30 percent of the closed rehabilitation cases i n 1958 - 1959 reported to Mr. Ian Campbell, the national Co-ordinator of C i v i l i a n Rehabilitation. 1 Ibid., p. 210. 2 This agreement was renewed A p r i l 1, 1959 with a l l provinces except Quebec for a five-year period as authorized by the Canadian Vocational Training Co-ordination Act of 1942. 3 Rehabilitation Services i n Canada, Part I, loc. c i t . , p.210. 10 (d) F e d e r a l - P r o v i n c i a l Co-ordination Since 1952, the C i v i l i a n R e h a b i l i t a t i o n Branch of the Department ofLabour, which i s responsible f o r co-ordination of r e h a b i l i t a t i o n services at the f e d e r a l l e v e l , has been under the d i r e c t i o n of a National Co-ordinator. This Branch maintains l i a i s o n with i n t e r n a t i o n a l agencies, programmes i n other countries, other f e d e r a l agencies concerned with r e h a b i l i t a t i o n , p r o v i n c i a l co-ordinators, and l o c a l organizations across Canada. I t acts as a c l e a r i n g house f o r information on r e h a b i l i t a t i o n , supplies consultation and advice to the provinces, and administers grants i n a i d f o r the co-ordination and development of p r o v i n c i a l r e h a b i l i t a t i o n s e r v i c e s , i n c l u d i n g r e h a b i l i t a t i o n of the tuber-culous. I t has been previously mentioned that i n each province, v o c a t i o n a l r e h a b i l i t a t i o n f o r tuberculous persons i s co-ordinated with the c i v i l i a n r e h a b i l i t a t i o n programme under the d i r e c t i o n of a p r o v i n c i a l Co-ordinator of Rehabilitation. There i s an equal sharing of costs by the f e d e r a l and p r o v i n c i a l governments f o r the s a l a r i e s of the p r o v i n c i a l co-ordinators. (e) Job Placement The National Employment Service, established i n 1940 through f e d e r a l l e g i s l a t i o n , i s generally responsible f o r employment services throughout Canada. Since 1943, the National Employment Service has operated a Special Placement Section, which was set up to provide employment co u n s e l l i n g and s e l e c t i v e placement services to persons f i r s t entering employment, to persons d i s -charged from c o r r e c t i o n i n s t i t u t i o n s , and persons with mental or p h y s i c a l handicaps. At present there are Special Placement Sections i n a l l of the l a r g e r National Employment Service o f f i c e s across the country. R e f e r r a l s to these o f f i c e s are frequently made by tuberculosis r e h a b i l i t a t i o n agencies f o r r e g i s t r a t i o n and 1 I b i d . , s e c t i o n " P r o v i n c i a l Coordination and Administration" pp. 31 - 34. 11 assistance i n job placement of discharged tuberculosis p a t i e n t s . In some provinces, the Department of Labour, which administers the National Employment Service, has recently provided s p e c i a l placements l i a i s o n o f f i c e r s . This, i n the author's estimation, has provided f o r increased community co-ordination of job place-ment services as well as improved follow-up services f o r tuberculous persons. Method of Study Keeping t h i s introductory material i n mind, Chapter 2 of t h i s study w i l l s p e c i f i c a l l y examine the programme f o r the r e h a b i l i -t a t i o n of the tuberculous i n B r i t i s h Columbia. In a s i m i l a r manner , Chapter 3 w i l l inquire i n t o the tuberculosis r e h a b i l i -t a t i o n programme operating i n the province of A l b e r t a . The d e s c r i p t i o n and analysis of both the public programme i n B r i t i s h Columbia and the programme operating i n Alberta under private auspices w i l l be s p e c i f i c a l l y concerned with the f o l l o w i n g p r i n c i p l e areas: (1) Sponsorship and administration; ( 2 ) F a c i l i t i e s and Personnel; (3) C l i e n t s p a r t i c i p a t i n g i n the programme; and (4) R e h a b i l i t a t i o n Services provided. A comparison summary of the main features of the two programmes, i n c l u d i n g a review of the strengths and l i m i t a t i o n s of each programme, w i l l be presented i n Chapter 4. An attempt w i l l be made to determine where there i s need f o r improvement i n the operation of each programme, and some suggestions w i l l be recommended which might possibly contribute toward more e f f e c t i v e programmes of tuberculosis r e h a b i l i t a t i o n . A few words need to be s a i d about sampling as i t r e l a t e s to t h i s study. No claim i s made that the two programmes selected are representative or t y p i c a l of Canada as a whole. The tuber-c u l o s i s r e h a b i l i t a t i o n programmes i n B r i t i s h Columbia and A l b e r t a were purposely selected f o r t h i s study p r i m a r i l y because of the contrast i n sponsorship between the two programmes. Coupled with t h i s i s the f a c t that both programmes commenced formal operations 12 at approximately the same time, both under private auspices; however, the programme i n B r i t i s h Columbia i s now operated p u b l i c l y , while the programme i n Al b e r t a continues to operate under private auspices. Another s i g n i f i c a n t f a c t o r , which has a d i r e c t bearing on the basis of s e l e c t i o n f o r programmes discussed i n t h i s study, i s the author's intimate a s s o c i a t i o n with the programme i n Alberta. For the past f i v e years, the author has been a member of the s t a f f of the R e h a b i l i t a t i o n D i v i s i o n , Alberta Tuberculosis Association, and at the present time he i s completing post-graduate studies i n S o c i a l Work at the U n i v e r s i t y of B r i t i s h Columbia. This has provided the author an opportunity to become f a m i l i a r with the r e h a b i l i t a t i o n services i n B r i t i s h Columbia offered through the D i v i s i o n of Tuberculosis Control and compare these with the r e h a b i l i t a t i o n services f o r the tuberculous i n A l b e r t a . I t should be mentioned at t h i s point that any conclusions a r r i v e d at i n t h i s study w i l l r e l a t e only to the programmes examined herein; however, i n some cases, c e r t a i n c r i t i c i s m s and recommendations may be applicable to other tuberculosis r e h a b i l i t a t i o n programmes operating throughout Canada. Several d i f f i c u l t i e s were encountered i n the preparation of t h i s study. As a r e s u l t of geographic distance, some communication d i f f i c u l t i e s were evident and the delay i n return correspondence created temporary postponement i n the compiling of m a t e r i a l . Another delay r e s u l t e d midway through study when the tuberculosis r e h a b i l i t a t i o n programme i n B r i t i s h Columbia underwent some reorganization i n administration which necessitated the rescheduling of several interviews with personnel concerned. Much of the research material f o r t h i s study was acquired through extensive analysis of annual reports of the various organizations, agencies, and p r o v i n c i a l departments i n A l b e r t a and B r i t i s h Columbia which are d i r e c t l y concerned with the p r o v i s i o n of r e h a b i l i t a t i o n services to the tuberculous. However, 13 the main method of research used i n securing f a c t u a l and s t a t i s t i c a l information has been selected interviews with personnel from the agencies discussed. A group of pertinent questions about a l l aspects of the p r o v i n c i a l r e h a b i l i t a t i o n programme f o r the tuberculous was prepared and used as an outline f o r interviews held with the D i r e c t o r of R e h a b i l i t a t i o n and the S o c i a l Service Department Casework Supervisor of the D i v i s i o n of Tuberculosis Control i n B r i t i s h Columbia. The schedule of interviews included s i x interviews with the D i r e c t o r of R e h a b i l i -t a t i o n , three interviews with the Casework Supervisor of the S o c i a l Service Department, and one interview with the Co-ordinator of R e h a b i l i t a t i o n f o r the province of B r i t i s h Columbia. As a r e s u l t of the distance f a c t o r , a s e r i e s of personal I interviews could not be arranged with key personnel i n the . Alberta programme. The author has l a r g e l y c a l l e d upon hi s own j personal knowledge of the programme together with extensive : correspondence material provided by the Director of R e h a b i l i t a t i o n , • Alberta Tuberculosis Association, i n response to questions which the author forwarded to him. j Supplementary information has also been acquired f o r t h i s study from the recent documents, R e h a b i l i t a t i o n Services i n  Canada, Parts I and I I , which were prepared by the Research and S t a t i s t i c s D i v i s i o n , Department of National Health and Welfare, j Ottawa. I CHAPTER 2 BRITISH COLUMBIA: A PUBLICLY-SPONSORED PROGRAMME Sponsorship and Administration R e h a b i l i t a t i o n services f o r the tuberculous i n B r i t i s h Columbia have been administered since A p r i l 1949 by the p r o v i n c i a l D i v i s i o n of Tuberculosis C o n t r o l . 1 The B r i t i s h Columbia Tuberculosis Society, a voluntary agency, i n i t i a t e d a programme of r e h a b i l i t a t i o n f o r patients i n the p r o v i n c i a l sanatoria by appointing a r e h a b i l i t a t i o n o f f i c e r on a f u l l - t i m e basis i n 1947. Following the int r o d u c t i o n , i n 1948, of the Tuberculosis Control Grant, one of the Mational Health Grants, the p r o v i n c i a l D i v i s i o n of Tuberculosis Control assumed respon-s i b i l i t y f o r the t r a i n i n g and r e h a b i l i t a t i o n of tuberculous p a t i e n t s . The R e h a b i l i t a t i o n Department i s e s s e n t i a l l y f o r the purpose of v o c a t i o n a l r e h a b i l i t a t i o n and job placement; any s o c i a l case-work or r e l a t e d welfare services are provided by the S o c i a l Service Department of the D i v i s i o n of Tuberculosis Control. Whereas the Dir e c t o r of R e h a b i l i t a t i o n i s d i r e c t l y responsible to the Director of the D i v i s i o n of Tuberculosis Control, who i n turn i s responsible to the Deputy M i n i s t e r of the Health Services Branch, the Case-work Supervisor of the So c i a l Service Department i s responsible to the Deputy M i n i s t e r of S o c i a l Welfare. This i s due to the fa c t that the s t a f f of the S o c i a l Service Department are on loan 1 The D i v i s i o n of Tuberculosis Control was connected with the Health Branch of the Department of Health and Welfare; however, since 1959 when t h i s Department was separated i n t o two departments, the Department of Health Services and Hosp i t a l Insurance, and the Department of S o c i a l Welfare, the D i v i s i o n of Tuberculosis Con-t r o l has operated under the Health Branch of the Department of Health Services and Hosp i t a l Insurance. 15 to the D i v i s i o n of Tuberculosis Control and t h i s service i s chargeable to the Department of S o c i a l Welfare. The vocational r e h a b i l i t a t i o n programme operated by the D i v i s i o n of Tuberculosis Control i s financed as f o l l o w s : (1) The s a l a r i e s of the p r o f e s s i o n a l s t a f f ( R e h a b i l i t a t i o n O f f i c e r s ) and the stenographic s t a f f are e n t i r e l y chargeable to the Federal Health Grant. In a d d i t i o n , t r a v e l l i n g expenses f o r r e h a b i l i t a t i o n personnel up to a maximum of 600 .00' per year, c e r t a i n in-sanatorium v o c a t i o n a l courses f o r patients, t u i t i o n fees up to a maximum of 500.00 f o r r e h a b i l i t a t i o n candidates who are unable to q u a l i f y under Schedule "R" of the Canadian Vocational T r a i n i n g scheme, transportation (bus f a r e ) f o r ex-sanatorium patients i n Greater Vancouver who con-tinue t h e i r academic studies at Willow Chest Centre during t h e i r convalescence, and some trade manuals and text books are also covered by the Federal Health Grant. Under the Medical R e h a b i l i t a t i o n and Children's Grants, also part of the Federal Health Grant, p r o v i s i o n i s made f o r the p r o f e s s i o n a l t r a i n i n g of personnel i n tuberculosis r e h a b i l i t a t i o n . The p r o v i n c i a l health department i s reimbursed one hundred percent on t h i s type of p r o j e c t . (2) Most p o s t - h o s p i t a l vocational t r a i n i n g i s provided under the Canadian Vocational T r a i n i n g scheme. , which i s administered by the p r o v i n c i a l department of Education. In some cases Federal Health Grant funds and also private funds may be used f o r v o c a t i o n a l t r a i n i n g of tuberculous persons* 16 The following table i l l u s t r a t e s how vocational training i s financed for discharged tuberculosis patients. TABLE . I Vocational Training Completed By Discharged Tuberculosis Patients i n B r i t i s h Columbia For The Years 1957, 1958, 1959 Funds Provided By: Year 1957 1958 1959 Schedule "R" (C.V.T.) 20 26 18 Federal Health Grant 8 9 8 B.C. Tuberculosis Society 3 2 5 Other Societies or Service Clubs 3 3 1 Totals 34 40 34 (3) For special projects, such as trade tools, special clothing or transportation for ex-patients to location of employment, the Rehabilitation Department has access to limited private funds from the B r i t i s h Columbia Tuber-culosis Society and community service clubs. These funds are used only where there i s no budget for public funds. During the 1959-60 f i s c a l year the t o t a l expenditure for tuberculosis rehabilitation services chargeable to the Federal Health Grant only, was approximately * 2 2 , 0 0 0 . 0 0 , according to the Director of Rehabilitation. In addition, the Rehabilitation Department expended approximately 500.00 from private funds. In 1957-58, federal grants to the provincial Division of Tuber-culosis Control for i t s rehabilitation service totalled 12,640 A l l vocational training for ex-patients under the Canadian 1 Source: Director of Rehabilitation, Rehabilitation Department, Division of Tuberculosis Control. 2 Canada, Department of National Health and Welfare, Research and Statistics Division, Rehabilitation Services i n Canada, Part II, p. 213. 17 Vocational Training programme i s charged to the Department of Education. F a c i l i t i e s and Personnel The Division of Tuberculosis Control operates two sanatoria, the Willow Chest Centre and Pearson Tuberculosis Hospital, both in Vancouver. A l l hospital treatment for tuberculosis persons 1 i n B r i t i s h Columbia i s received in these institutions. The combined capacity of these hospitals i s 342 (Willow Chest Centre 90, and Pearson Hospital 252). Rehabilitation offices are located i n both institutions, with the Director of Rehabili-tation having his headquarters at the Willow Chest Centre. At the present time there are two rehabilitation officers, including the Director, offering vocational rehabilitation services to in-sanatorium and discharged patients. Two steno-graphers are also on staff. The stenographer at the Rehabilita-tion Office at Willow Chest Centre divides her services between the Rehabilitation Department and the Social Service Department. An elementary teacher and a high school teacher are provided by the Division of Tuberculosis Control. The Social Service Depart-ment has three qualified social workers who assist in providing a co-ordinated and comprehensive rehabilitation programme for the tuberculous. The primary functions of the rehabilitation officers are to offer vocational counselling to tuberculous patients in hospital, as well as to ex-sanatorium patients; arrange for vocational training where feasible, and assist in finding employ-ment for discharged patients who are medically f i t for work. Also, much of the work of the rehabilitation officers i s devoted to l i a i s o n service with the Workmens Compensation Board, the Department of Veterans Affairs, and the numerous other 1 Princess Margaret Children's Village, formerly known as the Preventorium, which i s financed by private donations and a provincial government grant, offers treatment services to children up to the age of f i f t e e n years who have tuberculosis. Disenfranchised Indians in the province are treated for tuber-culosis i n federal government hospitals operated by the Department of National Health and Welfare. 18 community resources. There are no formal job descriptions outlined nor are there any s p e c i f i c p r o f e s s i o n a l q u a l i f i c a t i o n s required f o r r e h a b i l i t a t i o n o f f i c e r s . The D i r e c t o r of R e h a b i l i t a t i o n commented that i t i s preferable f o r p r o f e s s i o n a l r e h a b i l i t a t i o n personnel to have graduated from a u n i v e r s i t y , with majors i n the s o c i a l sciences f i e l d . Acceptable experience i n other f i e l d s of work such as personnel work, however, may be accepted i n l i e u of formal u n i v e r s i t y t r a i n i n g . Personal c h a r a c t e r i s t i c s of the worker i n r e l a t i o n to the type of work involved are taken into consideration. The present D i r e c t o r of the depart-ment holds a Bachelor of Arts degree. The s t a f f of the R e h a b i l i t a t i o n Department are p r o v i n c i a l c i v i l servants and therefore come under the c l a s s i f i c a t i o n and salary plan of the C i v i l Service Commission. C l a s s i f i c a t i o n of R e h a b i l i t a t i o n O f f i c e r s are Grade I I , which includes the D i r e c t o r of R e h a b i l i t a t i o n , and Grade I. The s t a f f enjoy the usual government employee b e n e f i t s , such as pension plan, group medical plan, s i c k leave, and holidays with pay. C l i e n t s R e h a b i l i t a t i o n services are a v a i l a b l e to any tuberculous patient or ex-patient who i s considered a resident of B r i t i s h Columbia. Vocational c o u n s e l l i n g services are offered to high school students i f required, and vocational r e h a b i l i t a t i o n services are u s u a l l y confined to those patients between the ages of 16 and 65 years. The D i r e c t o r of R e h a b i l i t a t i o n estimates that during I960 approximately 575 tuberculous persons benefitted from services received from the R e h a b i l i t a t i o n Department. Patients making use of these services are u s u a l l y r e f e r r e d by the doctors i n the sanatoria or by d i r e c t r e f e r r a l from the S o c i a l Service Department. Occasionally discharged patients w i l l present themselves requesting r e h a b i l i t a t i o n s e r v i c e s . 19 Recent s t a t i s t i c s reveal that i n B r i t i s h Columbia there i s an increasing number of older persons being admitted to the sanatoria f o r treatment, whereas only four or f i v e years ago, tuberculosis was most prevalent i n the age group from twenty to twenty-nine years.^ Combined with t h i s trend toward older patients i s the f a c t that i n the sanatoria i n B r i t i s h Columbia the r a t i o of male patients to female patients i s at present 2 approximately three to one. As the male i s u s u a l l y the bread-winner, the demand f o r vocational r e h a b i l i t a t i o n services and job placement remains co n s i s t e n t l y high. As a r e s u l t of the present depressed economic s i t u a t i o n i n B r i t i s h Columbia, with i t s high unemployment rate s , the demand f o r r e h a b i l i t a t i o n services i s exceedingly high i n the patients who, p r i o r to admission to hos-p i t a l , were u n s k i l l e d labourers or unemployed. The f o l l o w i n g table w i l l indicate how s i g n i f i c a n t t h i s group i s i n r e l a t i o n to the t o t a l in-sanatorium patient population. TABLE I I Occupations of Tuberculous Patients P r i o r to Hospital Admission i n B r i t i s h Columbia 3 Occupation C l a s s i f i c a t i o n Number of Patients Children, Students, Housewives, Retired and Pensioners 119 S k i l l e d Trades 20 Business Owners, Farmers 7 Professional 6 C l e r i c a l , Salesmen 6 U n s k i l l e d , Labourers and Unemployed 96 Total Patients i n Hospital January 31 , 1961 254 1 B r i t i s h Columbia, Department of Health Services and Hospital Insurance, Health Branch D i v i s i o n of Tuberculosis Control. Annual Report, 1959, p. 5. 2 I b i d . p. 5. Male in-sanatorium population 75.9$ female 24.2$. 3 Source: S o c i a l Service Department, D i v i s i o n of Tuberculosis Control. Patients i n Willow Chest C entre and Pearson Hospital as of January 31, 1961. 20 R e h a b i l i t a t i o n Services (1) Vocational Counselling The R e h a b i l i t a t i o n O f f i c e r provides the patient or ex-patient, seeking r e h a b i l i t a t i o n s e r v i c e s , with information regarding jobs and t r a i n i n g opportunities, and a s s i s t s the patient to r e l a t e h i s a b i l i t i e s and phys i c a l c a p a c i t i e s to occupations i n the community so that a f e a s i b l e vocational choice can be made. Extensive use i s made of occupational information which the R e h a b i l i a t i o n O f f i c e r has a v a i l a b l e , as well as knowledge of the educational, t r a i n i n g , and placement f a c i l i t i e s e x i s t i n g within the community f o r implementing a suita b l e r e h a b i l i t a t i o n plan. In addition, psychometric t e s t i n g i s provided the R e h a b i l i t a t i o n Department f o r i t s c l i e n t s by the Youth Counselling Service i n Vancouver, which i s one of the member agencies of the Greater Vancouver Community Chest. Comprehensive reports are forwarded to the R e h a b i l i t a t i o n O f f i c e r s which help them to i n t e r p r e t the various aptitude, i n t e r e s t , p e r s o n a l i t y and a b i l i t y t e s t s to which the tuberculous c l i e n t s have submitted. By means of t h i s c o u n s e l l i n g process, the patient or ex-patient i s a s s i s t e d i n making a r e a l i s t i c a p p r a i s a l of h i s occupational p o t e n t i a l i t i e s , and with the help of the r e h a b i l i t a t i o n o f f i c e r i s encouraged to form a plan i n keeping with h i s t r a i n i n g , aptitudes, i n t e r e s t s , p h y s i c a l c a p a c i t i e s and f i n a n c i a l and s o c i a l r e s p o n s i b i l i t i e s . (£) Vocational T r a i n i n g I f i t i s f e a s i b l e , from both a medical and a v o c a t i o n a l l y r e h a b i l i t a t i v e point of view, some patients are encouraged to embark on voca t i o n a l t r a i n i n g i n the h o s p i t a l while undergoing treatment. This programme i s direc t e d by the R e h a b i l i t a t i o n O f f i c e r i n co-operation with the medical and nursing s t a f f s . The R e h a b i l i t a t i o n O f f i c e r arranges f o r various correspondence courses which the patient can undertake i n the h o s p i t a l . 21 Although t e c h n i c a l l y not coming under the category of vocational t r a i n i n g , the academic i n s t r u c t i o n provided by the high school teacher could he considered as a form of pre-vocational t r a i n i n g , and i s considered by the personnel of the R e h a b i l i t a t i o n Department as an e s s e n t i a l phase of the r e h a b i l i t a t i o n process. The R e h a b i l i t a t i o n Department ..also arranges f o r post-discharge v o c a t i o n a l t r a i n i n g f o r tuberculous persons. Upon the recommendation of the D i r e c t o r of R e h a b i l i t a t i o n , ex-patients who might benefit from vocational t r a i n i n g are r e g i s t e r e d with the o f f i c e of the p r o v i n c i a l Co-ordinator of R e h a b i l i t a t i o n , which i n B r i t i s h Columbia i s also connected with the Department of Health Services and Hospital Insurance. According to Mr. C.E. Bradbury, the Co-ordinator of R e h a b i l i t a t i o n , approximately twenty-five percent of a l l persons r e f e r r e d to h i s o f f i c e f o r t r a i n i n g under Schedule "R" of the Canadian Vocational T r a i n i n g scheme are tuberculous r e f e r r a l s from the R e h a b i l i t a t i o n Department of the D i v i s i o n of Tuberculosis Control. In addition to the Canadian Vocational T r a i n i n g scheme, the Federal Health Grants o f f e r l i m i t e d assistance f o r vocational t r a i n i n g purposes when there i s not coverage by Schedule "R". P r i m a r i l y , these funds have been used to send tuberculous persons, who lack the academic requirements f o r vocational t r a i n i n g courses to "cram schools". These "cram schools" o f f e r accelerated high school courses which prepare the student f o r w r i t i n g of Department of Education examinations. There are two such schools operating p r i v a t e l y i n Vancouver, of which the R e h a b i l i t a t i o n Department has made frequent use f o r pre-vo c a t i o n a l t r a i n i n g and job placement purposes. Table I, page 16, i n d i c a t e s the t o t a l number of tuberculous persons who completed vo c a t i o n a l t r a i n i n g during the years 1957, 1958 and 1959. 22 (3) Placement Much of the fundamental step of job placement i n the rehabilitation process i s handled by the Rehabilitation Officers. Mr. L.•MacDonald, the Director of Rehabilitation for the Division of Tuberculosis Control, stated that his department was directly responsible for the securing of twenty jobs for former patients during I960. Extensive use i s also made of the Special Placements Section of the National Employment Service i n finding suitable employment for discharged tuberculosis patients. To complement this service i n B r i t i s h Columbia, there i s a Special Placements Liaison Officer who i s attached to the office of the provincial Co-ordinator of Rehabilitation. Many of the referrals from the Rehabilitation Department, Division of Tuberculosis Control, are directed through the l i a i s o n o f f i c e r , and this has improved the job- placement service for patients i n the outlying areas of the province. The costs of providing the position of the l i a i s o n officer are borne by the federal government through the National Employment Service. In addition.to straight job placement, selective measures such as training-on-the-job programmes under the Canadian Vocational Training scheme are sometimes arranged. Under such a programme the discharged patient earns while he learns his new trade or job, and his salary, which i s at least the minimum wage, i s provided jointly by his employer and Canadian Vocational Training on a sl i d i n g scale basis during the training period. Some examples of the T.O.«J.'s, as they have come to be known, in which ex-sanatorium patients have been placed are watch-repairing, printing, glovemaking and e l e c t r i c 1 shaver repair work. 1 The reader i s referred to a discussion of the topic of training-on-the-job programmes i n Notes Based on Discussions at  the Western Provinces Rehabilitation Workshop, Banff School of  Fine Arts, October 12-14, I960. Theme: "A Discussion, of Current Problems in Effecting Successful Rehabilitation Services; C i v i l i a n Rehabilitation Branch, Department of Labour, Ottawa,196Q p. 7. 23 The D i r e c t o r of the R e h a b i l i t a t i o n Department, D i v i s i o n of Tuberculosis Control, commented that i t i s d i f f i c u l t at present to f i n d training-on-the-job placements; i t i s easier to secure str a i g h t job placements. (4) Follow-up Services The R e h a b i l i t a t i o n Department generally considers r e h a b i l i -t a t i o n as being complete when the i n d i v i d u a l has been s u c c e s s f u l l y employed from three to s i x months; however, t h i s c r i t e r i o n i s d i f f i c u l t to conform to, and, i n e f f e c t , does vary with the i n d i v i d u a l case. The D i r e c t o r stated he prefers to attach no set period of time f o r a case i n determining when i t i s "closed". No s p e c i f i c follow-up programme i s adhered to by the R e h a b i l i t a t i o n Department. P r i m a r i l y , the Department makes use of the medical f i l e s of the former patients, which indicate t h e i r progress and employment each time they return to the c l i n i c f o r a medical review. A summary of the r e h a b i l i t a t i o n services provided the patient i s placed on the patient's medical f i l e s ( S e e Appendix A). Also, through the assistance of the Special Placements L i a i s o n O f f i c e r , the R e h a b i l i t a t i o n Department i s able to maintain f a i r l y e f f e c t i v e follow-up of discharged patients who received r e h a b i l i t a t i o n s e r v i c e s . (5) Welfare Services Although i t operates within the framework of the D i v i s i o n of Tuberculosis Control, the S o c i a l Service Department i s part of the medical s o c i a l work services provided by the Department of S o c i a l Welfare. The S o c i a l Service Department has a f u l l time pr o f e s s i o n a l s t a f f of three, i n c l u d i n g a Casework Super-v i s o r , who acts as the administrator of the Department, and two caseworkers. One s o c i a l worker i s assigned to the Willow Chest Centre, where service i s offered to both i n - h o s p i t a l and c l i n i c p a t i e n t s , and one s o c i a l worker i s assigned to the Pearson Tuberculosis H o s p i t a l , where the caseload consists e n t i r e l y of in-sanatorium patients. The Supervisor c a r r i e s a 24 case load at Pearson Hos p i t a l where the main o f f i c e s of the So c i a l Service Department are located, but she spends regular hours each week at Willow Chest Centre, where the headquarters of the D i v i s i o n of Tuberculosis Control i s l o c a t e d . Fundamentally, an interdepartmental r e f e r r a l procedure i s the basis of bringing the service of the S o c i a l Service Depart-ment to those patients who require help with s o c i a l , emotional, or economic aspects of t h e i r i l l n e s s . Most r e f e r r a l s are i n regard to f i n a n c i a l problems of the patient and h i s family, but various other problems are often revealed during interviews. The Department handles a wide range of d i f f i c u l t i e s common to a generalized case load. These d i f f i c u l t i e s are p r e c i p i t a t e d or aggravated by tu b e r c u l o s i s , an i l l n e s s which u s u a l l y requires long-term treatment i n h o s p i t a l . The Casework Supervisor, Mrs. M. T i t t e r i n g t o n , stated that the monthly active caseload i s i n excess of 100 cases, most of which include arranging f o r S o c i a l Allowance or other forms of f i n a n c i a l assistance f o r patients and t h e i r f a m i l i e s , p r o v i s i o n of Comforts Allowances f o r in-sanatorium patients who are e l i g i b l e to receive i t , and working with the large number of aged tuberculous persons, i . e . arranging f o r boarding home or nursing home care. In ad d i t i o n to t h i s i s the serious problem of the high incidence of problem drinkers and a l c o h o l i c s i n the male in-sanatorium population. The S o c i a l Service Department r e l i e s on community resources to help with psycho-social problems of patients and t h e i r f a m i l i e s , and there i s continual communication with the Greater Vancouver public and private s o c i a l and health agencies, as well as with the Department of S o c i a l Welfare o f f i c e s through-out the province. Concise recordings of S o c i a l Service a c t i v i t y are placed on the medical records of the patients f o r the information of treatment personnel (see j o i n t S o c i a l Service Department and R e h a b i l i t a t i o n record sheet i n Appendix A); and the s o c i a l 25 workers hold frequent i n t e r s t a f f d i s c u s s i o n i n regard to 1 planning f o r the patients. Those patients who are considered to require v o c a t i o n a l r e h a b i l i t a t i o n services are r e f e r r e d by the S o c i a l Service Department to the R e h a b i l i t a t i o n Department, and a l i a i s o n service i s maintained to produce a comprehensive programme of tuberculosis r e h a b i l i t a t i o n . 1 B r i t i s h Columbia, Department of S o c i a l Welfare, Annual  Report, I960. Part ¥ "Medical S o c i a l Work Services, D i v i s i o n of Tuberculosis Control", pp. 92-93. CHAPTER 3 ALBERTA: A PRIVATELY-SPONSORED PROGRAMME Sponsorship and Administration The R e h a b i l i t a t i o n D i v i s i o n of the Alber t a Tuberculosis Association has provided r e h a b i l i t a t i o n services f o r tuber-1 culous persons i n the province of Alber t a since 1947- At that time a f u l l time D i r e c t o r of R e h a b i l i t a t i o n was appointed i n order to expand and i n t e n s i f y a programme embracing occupational counselling, v o c a t i o n a l t r a i n i n g i n and out of the sanatoria, and job placement d i r e c t i o n and assistance. According to the D i r e c t o r of R e h a b i l i t a t i o n , i n more recent years the r e h a b i l i t a t i o n programme has undergone a change from one o f f e r i n g s t r i c t l y v o cational r e h a b i l i t a t i o n services to a more comprehensive r e h a b i l i t a t i o n programme in c l u d i n g some s o c i a l casework services and r e l a t e d welfare services f o r i n -sanatorium p a t i e n t s . This tuberculosis r e h a b i l i t a t i o n programme i s completely financed by means of private funds, and complements the t r e a t -ment and case-finding services f o r the tuberculous provided by the D i v i s i o n of Tuberculosis Control of the p r o v i n c i a l Depart-ment of Public Health. The Alberta Tuberculosis Association i s a voluntary health agency incorporated under The So c i e t i e s Act (1924) Alber t a , a f f i l i a t e d with the Canadian Tuberculosis Association, and i s financed s o l e l y through the sale of Christmas Seals sponsored by the Kinsmen Clubs i n Edmont-on, Calgary, Lethbridge, Medicine Hat, Drumheller, Banff and Grand 1 Treaty Indians receive tuberculosis treatment and r e h a b i l i t a t i o n services under f e d e r a l government auspices. See Chapter I "Services f o r Indians and Eskimos", p. 8. 27 Pr a i r i e ; Rotary Clubs in Red Deer, High River and Cardston; and the Lions Club i n Vulcan, Alberta. The receipts for the 1959-60 Christmas Seal Sale campaign it in Alberta totalled 240,149.55, and during the f i s c a l year which ended February 29, I960, the t o t a l expenditure of the Rehabili-tation Division of the Alberta Tuberculosis Association was * 1 *22,118.37. This amount includes salaries but excludes the costs of post-sanatorium vocational training carried out by the Canadian Vocational Training scheme which are chargeable to the provincial Department of Education. The line of authority i n the operations of the Rehabili-tation Division i s from the Board of Directors of the Alberta Tuberculosis AssocJation, to the General Secretary, to the Director of Rehabilitation and then to the rehabilitation counsellors. Since the patients who are i n receipt of r e h a b i l i -tation services are i n provincial sanatoria,, the professional rehabilitation staff are indirectly responsible to the medical superintendents of the hospitals, as well as to the Director of the Division of Tuberculosis Control. The Director of Rehabili-tation emphasized that there i s a relationship existing between the Division of Tuberculosis Control and the Alberta Tuberculo-sis Association which has led to a programme of co-operation i n the fight against tuberculosis; this has been particularly evident in the f i e l d of rehabilitation for the tuberculous. F a c i l i t i e s and Personnel A rehabilitation office i s provided for the Rehabilitation Division of the Alberta Tuberculosis Association, by the Division of Tuberculosis Control, Department of Public Health i n each of the two sanatoria which i t operates — the Aberhart Memorial Sanatorium in Edmonton, with a capacity of 295 beds, and the Baker Memorial Sanatorium in Calgary, with 300 beds. Operating from these offices, the rehabilitation counsellors 1 Alberta Tuberculosis Association Annual Report, Edmonton, I960. 28 o f f e r a v a r i e t y of r e h a b i l i t a t i o n services to tuberculous patients and ex-patients. Fundmentally, the r e h a b i l i t a t i o n counsellor a s s i s t s i n the adjustment of the in-sanatorium patient to h i s disease by attempting to a l l e v i a t e economic, voc a t i o n a l , and s o c i a l problems so that maximum benefit may be derived from medical care and treatment. The s t a f f of the R e h a b i l i t a t i o n D i v i s i o n i s comprised of a D i r e c t o r of R e h a b i l i t a t i o n , who has h i s headquarters at the Aberhart Memorial Sanatorium, Edmonton, a r e h a b i l i t a t i o n counsellor at the Aberhart Memorial Sanatorium, a r e h a b i l i t a t i o n counsellor at the Baker Memorial Sanatorium, Calgary, and a high school teacher i n each of the sanatoria. In addition, one, and sometimes two, part time teachers are employed to provide i n s t r u c t i o n i n elementary E n g l i s h . The D i v i s i o n of Tuberculosis Control provides three teachers f o r c h i l d r e n i n the elementary grades, up to and i n c l u d i n g Grade IX. There are no s p e c i f i c requirements as to the formal t r a i n i n g necessary f o r the p o s i t i o n s of r e h a b i l i t a t i o n coun-s e l l o r , although u n i v e r s i t y graduation with s p e c i a l i z a t i o n i n the s o c i a l sciences i s preferred, according to the job d e s c r i p t i o n f o r r e h a b i l i t a t i o n counsellor af the A l b e r t a Tuber-c u l o s i s Assocation. This t h e o r e t i c l background apparently i s necessary " i n acquiring a knowledge of p e r s o n a l i t y develop-ment and the nature of s k i l l s , a b i l i t i e s , i n t e r e s t s and aptitudes, 1 as well as the s c i e n t i f i c methods of measuring them." In l i e u of formal t r a i n i n g , previous experience i n r e l a t e d types of work may be accepted. Minimum t r a i n i n g time f o r experienced workers depends upon the type of past experience and t r a i n i n g , and upon personal c h a r a c t e r i s t i c s of the counsellor. 1 Job Analysis Schedule, " R e h a b i l i t a t i o n Counsellor", Alb e r t a Tuberculosis Association, Edmonton, 1955. 29 At present, two of the three r e h a b i l i t a t i o n counsellors with the R e h a b i l i t a t i o n D i v i s i o n are u n i v e r s i t y graduates, and one of these also has acquired p r o f e s s i o n a l t r a i n i n g i n S o c i a l Work. A l l three have had f i v e or more years experience i n r e h a b i l i t a t i o n work with the tuberculous, and as a r e s u l t , each r e h a b i l i t a t i o n counsellor has a thorough knowledge of tuber-c u l o s i s and other ph y s i c a l d i s a b i l i t i e s i n r e l a t i o n to work capacity, and a knowledge of techniques of placement of the p h y s i c a l l y handicapped. The Alberta Tuberculosis Association has no formal salary schedule f o r p r o f e s s i o n a l personnel i n the R e h a b i l i t a t i o n D i v i s i o n , and s a l a r i e s are p r i m a r i l y determined on the basis of t r a i n i n g , experience, and length of s e r v i c e . The s t a f f can take advantage of c e r t a i n employment b e n e f i t s , i n c l u d i n g holidays with pay, a pension plan, and group coverage f o r Blue Cross. C l i e n t s Any person r e s i d i n g i n Alberta who has had t u b e r c u l o s i s , or i s undergoing treatment f o r the disease, with the exception 1 of t r e a t y Indians, i s e l i g i b l e to apply f o r r e h a b i l i t a t i o n services from the R e h a b i l i t a t i o n D i v i s i o n , A l b e r t a Tuberculosis Association. The request may be f o r welfare assistance and counselling, v o c a t i o n a l counselling, v o c a t i o n a l t r a i n i n g , or assistance i n l o c a t i n g employment. Ex-patients are frequently r e f e r r e d to the R e h a b i l i t a t i o n D i v i s i o n by s o c i a l and health agencies or by physicians, when voca t i o n a l r e h a b i l i t a t i o n services are required. The age range f o r t h i s s p e c i f i c type of service i s 16 to 65 years. However, welfare counselling and r e l a t e d services are a v a i l a b l e to in-sanatorium patients of a l l ages, who are i n need of t h i s type of s e r v i c e . 1 See footnote 1 p. 26. 30 Services f o r ex-patients are u s u a l l y on a r e f e r r a l basis, but on occasions, ex-patients may personally request such services from the r e h a b i l i t a t i o n counsellors. In-hospital c l i e n t s are r e f e r r e d to the R e h a b i l i t a t i o n O f f i c e r by h o s p i t a l personnel, i n some cases; however, u s u a l l y the i n i t i a l contact with the patient i s made by the r e h a b i l i t a t i o n counsellor s h o r t l y a f t e r the patient's admission to h o s p i t a l . An i n i t i a l card index, containing each new sanatorium admission,is set up i n each sanatorium by the r e h a b i l i t a t i o n counsellor, using the f i l e s of the medical records o f f i c e of 1 each i n s t i t u t i o n . In ad d i t i o n to name, address, age, r a c i a l o r i g i n , date and place of b i r t h , and occupational h i s t o r y , t h i s card index contains the c l a s s i f i c a t i o n of the patient's disease as defined i n the Diagnostic Standards and C l a s s i f i c a t i o n of  Tuberculosis of the National Tuberculosis Association. The weekly medical conference i s attended by the r e h a b i l i t a t i o n counsellor, at which time he obtains the diagnosis of new pati e n t s , t h e i r prognosis (good, f a i r , or poor) and t h e i r work tolerance prognosis (W.T.P.), which i s an estimate by the doctors of the pat i e n t s ' capacity f o r work a f t e r treatment has been completed. Such a prognosis a s s i s t s the r e h a b i l i t a t i o n counsellor to give i n t e l l i g e n t advice to the patient as to the d i r e c t i o n h i s r e h a b i l i t a t i o n plans should take both i n and out of the sanatorium. Depending upon how the patient responds to medical treatment, i t i s possible f o r the work tolerance prognosis to change. In order that the reader might better understand the s i g n i f i c a n c e of the work tolerance prognosis and i t s r e l a t i o n to c l i e n t e l i g i b i l i t y f o r r e h a b i l i t a t i o n s e r v i c e s , the following c l a s s i f i c a t i o n system and code used by the R e h a b i l i -t a t i o n D i v i s i o n i s provided: ••1 See Appendix "A", Patient Index Card, R e h a b i l i t a t i o n D i v i s i o n , Alberta Tuberculosis Association. 31 W.T.P. 4 indicates the patient should have the physical a b i l i t y to return to fulltime, normal work which entails a f a i r l y substantial expenditure of energy. W.T.P. 3 designates fulltime, light work — of a sedentary nature, i.e., office work, machine tending. W.T.P. 2 designates part-time, light work. Similar to W.T.P.3 above, but not on a fulltime basis. W.T.P. 1 indicates that the patient w i l l not l i k e l y be able to do any more than look after his own requirements. W.T.P. 0 indicates that i f the patient survives, he w i l l l i k e l y require continuous nursing care. For obvious reasons only the f i r s t three categories are considered when selecting patients for vocational rehabilitation. It should also be mentioned, that i t i s generally considered by medical and rehabilitation personnel, that discharged tuber-culous patients should not attempt heavy^manual labour following their return to employment.^ Other c r i t e r i a are evident in the selection of clients i n the programme for rehabilitation of the tuberculous in Alberta. Generally, children aged 15 years and under, for whom i t i s compulsory to attend school, and housewives, unless they are self-supporting or request specific services following admission to sanatorium, are not seen by the rehabilitation counsellors for an i n i t i a l admission interview. Selection of clients for vocational rehabilitation services i s primarily made on the 1 In recent years, there have been some differences of opinion as to the types of work in which the discharged tuber-culosis patient should be employed. Dr. B. McKone states i n his study ("Rehabilitation i n Tuberculosis", A Seven and Eight Year Follow-up, Canadian Medical Association Journal, Vol. 77> October 15, 1957, pp. 761-765) that with time and adequate treatment, including rehabilitation, any type of employment i s possible for the tuberculous, even for those who were treated before chemotherapy was available. 32 basis of the information gathered during the admission inter-view and ensuing interviews by the rehabilitation counsellor, as well as the diagnosis, prognosis and work tolerance prog-nosis of the patient. ' If the patient i s l i k e l y to benefit from rehabilitation service, a case study i s set up and contact i records are kept on a registration form. Highschool students who are admitted to hospital are encouraged to continue with their academic studies when medical permission i s granted. Mr. E.J. Thiessen, the Director of Rehabilitation, stated that i n recent years the Rehabilitation Division has been primarily directing i t s efforts toward the vocational r e h a b i l i -tation of that group of patients who, prior to admission to hospital, were unskilled labourers and/or unemployed. Table III reveals that this i s a significant group i n number in terms of the total in-sanatorium population: TABLE III Occupations of Discharged Tuberculosis Patients Prom Alberta Sanatoria Prior to Hospital Admission Occupation Classification Number of Patients Children, Students, Housewives, Pensioners and Retired 353 Skilled Trades 60 Business Owners 21 Farmers 56 Professional 31 C l e r i c a l 49 Unskilled, Labourers, & Unemployed 163 Total 733 1 See Appendix "A" Patient Registration Form, Rehabilitation Division, Alberta Tuberculosis Association. 2 Patients discharged from Aberhart Memorial Sanatorium Edmonton, and Baker Memorial Sanatorium, Calgary, March 1, 1959 to February 29, I960. Source: Rehabilitation Division, Alberta Tuberculosis Agsociationi 33 The D i r e c t o r of R e h a b i l i t a t i o n states that an accurate o v e r a l l caseload f i g u r e i s d i f f i c u l t to report, inasmuch as many patients often meet with the r e h a b i l i t a t i o n counsellors on a short term and casual basis f o r advice or consultation. Often t h i s type of interview i s d i f f i c u l t to s t a t i s t i c a l l y record. He estimates, however, that the general caseload f o r each of the two R e h a b i l i t a t i o n O f f i c e s would be i n excess of 100 cases per month. This f i g u r e would also include ex-patients as well as in-sanatorium p a t i e n t s . A group of patients i n Alber t a sanatoria of s p e c i a l concern to r e h a b i l i t a t i o n personnel as well as public health o f f i c i a l s i s the Metis. The term "Metis" denotes the large c u l t u r a l group of c i t i z e n s i n Alberta who are part Indian, and who have neither adjusted to the culture of the white man nor are accepted by that of the Indian. The majority of the Metis reside i n the northern areas of the province and some l i v e i n the "Metis Colonies" which are administered by the Metis R e h a b i l i t a t i o n Branch of the p r o v i n c i a l Department of Public Welfare. The Metis are predominantly employed as seasonal labourers i n the f i s h i n g , lumbering and farming i n d u s t r i e s , and some are involved i n trapping and the construction industry. The Metis f a m i l i e s are u s u a l l y large and often several f a m i l i e s l i v e together i n a single dwelling. Poor l i v i n g conditions and a low l e v e l of education generally e x i s t among the group. As a r e s u l t of environmental, c u l t u r a l , and hereditary f a c t o r s , there i s an exceptionally high incidence of tube r c u l o s i s among the Metis, and also a high rate of readmission to the sanatorium. This group constitutes approximately one-quarter of the t o t a l 1 in-sanatorium population i n Alberta. The . R e h a b i l i t a t i o n D i v i s i o n of the Alberta Tuberculosis Association devotes considerable time i n a s s i s t i n g the Metis 1 According to the Annual Report of the D i v i s i o n of Tuberculosis Control 175 patients were of Metis o r i g i n out of a t o t a l of 733 patients discharged from Alberta sanatoria from March 1, 1959 to February 29, I960. 34 patients and ex-patients to obtain welfare assistance, and i n providing the Metis with vocational r e h a b i l i t a t i o n services wherever f e a s i b l e . E f f e c t i v e r e h a b i l i t a t i o n , however, i s d i f f i c u l t to achieve with the Metis due to environmental, c u l t u r a l and educational f a c t o r s . It i s not the i n t e n t i o n of t h i s study to s p e c i f i c a l l y deal with the problems i n v o l v i n g the Metis patient with tuber-c u l o s i s ; t h i s i s an area f o r f u r t h e r research. Recently, the Alberta Tuberculosis Association provided a sub s t a n t i a l grant to the Research Department of the U n i v e r s i t y of Alber t a f o r the purpose of making an extensive research study of the Metis mode of l i f e , i n an e f f o r t to determinethe means whereby the educational and vocational opportunities of the Metis may be improved. R e h a b i l i t a t i o n Services (1) Counselling This fundamental phase of the r e h a b i l i t a t i o n process i s ava i l a b l e to any patient or ex-patient, and may involve vocational guidance, co u n s e l l i n g i n r e l a t i o n to s o c i a l and 1 economic problems, or both. Using both bedside and o f f i c e interviews the r e h a b i l i -t a t i o n counsellor obtains information about the patient's educational, employment and t r a i n i n g background, and the patient's s p e c i a l i n t e r e s t s , personality t r a i t s and a t t i t u d e s . At the same time, the counsellor secures information about the f i n a n c i a l condition of the patient, h i s s o c i a l background, and family and personal r e s p o n s i b i l i t i e s . I t i s considered by the prof e s s i o n a l s t a f f of the R e h a b i l i t a t i o n D i v i s i o n that evaluation of the patient i s an e s s e n t i a l part i n the coun-p s e l l i n g process. Each counsellor i s s k i l l e d i n the adminis-t r a t i o n and i n t e r p r e t a t i o n of various psychometric t e s t s which 1 See "Welfare Services" discussed l a t e r i n t h i s chapter. 2 Alberta Tuberculosis Association, Annual Report, 1956. 35 help to reveal the patient's intelligence, interests, person-a l i t y and aptitudes. From the author's own experience in the programme, i t can he stated that extensive vocational information i s provided for the patient, including descriptions and nature of jobs, s k i l l s required, length of training and preparation involved; places where preparation and training may be secured, educational and physical requirements, working conditions and a v a i l a b i l i t y of placement. The patient i s assisted i n making choices based on increased knowledge of himself and the work being considered; i t then may be possible for him to commence preparation while he i s i n the sanatorium. In some cases, in-sanatorium coun-selling i s combined with actual employer v i s i t s whenever medical permission i s obtained. The Director of Rehabilitation reported that this not only has provided more accurate information about specific jobs, but also several job oppor-tunities have arisen as a direct result. In review, the rehabilitation counsellor establishes the groundwork for the patient's future vocational adjustment by stimulating the patient to think positively about his eventual return to the community and employment, and also by early evaluation of the patient's educational and occupational back-ground, his problems and his needs. (2) Vocational Training Vocational training is usually instituted after the patient has completed medical and surgical treatment and has been dis-charged from hospital. However, in recent years, more con-sideration has been given to the p o s s i b i l i t i e s of pre-vocational training while the patient i s s t i l l i n the sanatorium. This training i s provided both at the bedside and in the classrooms as soon as medical permission i s given. The high school teacher in each hospital provides instruction in both academic courses (Grade X to XII) and 36 commercial courses which are arranged i n conjunction with the Correspondence Branch of the Department of Education. Basic E n g l i s h i n s t r u c t i o n i s also provided f o r some of the Metis patients and those who are recent immigrants. According to personnel of the R e h a b i l i t a t i o n D i v i s i o n , the r e s u l t s have been s a t i s f a c t o r y , and t h i s type of i n s t r u c t i o n has as s i s t e d i n l a t e r v o c a t i o n a l adjustment of many of these patients. Various other correspondence courses are arranged f o r patients such as d r a f t i n g , blue-print reading, radio and t e l e -v i s i o n . In addition, s p e c i a l arrangements have been made with the p r o v i n c i a l Apprenticeship Board, f o r patients who, p r i o r to admission to sanatorium were i n apprenticeship trades, to continue with the t h e o r e t i c a l part of t h e i r course studies. Courses of i n t e r e s t are a v a i l a b l e f o r the housewives i n the sanatorium, although these are not f o r voca t i o n a l purposes but rather they are aimed at improving homemaking s k i l l s . The D i r e c t i o n of R e h a b i l i t a t i o n reports that these are not as much i n demand as the p r a c t i c a l dressmaking courses, conducted by the Singer Sewing Machine Company, which are paid f o r by the Alberta Tuberculosis Association and arranged j o i n t l y by the R e h a b i l i t a t i o n D i v i s i o n and the Occupational Therapy departments. Singer provides q u a l i f i e d i n s t r u c t r e s s e s and each course consists of ten cl a s s e s . About f i f t y women in c l u d i n g Metis housewives take advantage of t h i s course each year. Post-hospital v o c a t i o n a l t r a i n i n g i s p r i m a r i l y arranged by the r e h a b i l i t a t i o n counsellors who formally recommend ex-patients who can benefit by such t r a i n i n g to the o f f i c e of the p r o v i n c i a l Co-ordinator of R e h a b i l i t a t i o n . In Alberta, the o f f i c e of the p r o v i n c i a l Co-ordinator of R e h a b i l i t a t i o n comes under the Department of Public Welfare. I f the persons are accepted and q u a l i f y under Schedule "R" of the Canadian Vocational Training scheme, p r o v i s i o n i s made f o r a small monthly l i v i n g allowance during the t r a i n i n g period at a recognized school. In c e r t a i n cases, where required, i n t e r e s t -37 free loans from the Alberta Tuberculosis Association Christmas Seal funds may also be granted to supplement the Canadian Vocational T r a i n i n g allowances. Where former patients who are recommended f o r vocational t r a i n i n g are unable to q u a l i f y f o r the Canadian Vocational Training programme, the Alberta Tuberculosis Association may provide the e n t i r e cost of sending these persons to approved schools or t r a i n i n g centres f o r the required t r a i n i n g . Some of the f a c i l i t i e s which the R e h a b i l i t a t i o n D i v i s i o n has u t i l i z e d f o r t h i s type of t r a i n i n g are McTavish Business College, and the R e h a b i l i t a t i o n Centres i n Edmonton and Calgary of the R e h a b i l i t a t i o n Society of A l b e r t a f o r the Handicapped. Vocational t r a i n i n g courses most frequently undertaken by discharged tuberculous persons include barbering, hairdressing, nursing aide t r a i n i n g , commercial courses ( i n c l u d i n g typing, shorthand, record keeping, bookkeeping, etc.) draughting, and t e c h n i c a l courses i n the s k i l l e d trades. During I960 a t o t a l of twenty-four tuberculous persons completed t r a i n i n g under the d i r e c t i o n and services of the R e h a b i l i t a t i o n D i v i s i o n of the Alberta Tuberculosis Association. (3) Placement Within the programme offered by the R e h a b i l i t a t i o n D i v i s i o n , job placement assistance and guidance consists of helping the ex-patient develop a job-seeking programme using a l l a v a i l a b l e sources of jobs. These include r e f e r r a l to the Special Placements Section of the National Employment Service o f f i c e s , f o l lowing up suitable opportunities i n the employment columns of l o c a l newspapers, d i r e c t r e f e r r a l s as a r e s u l t of employer contacts, and r e f e r r a l s from t r a i n i n g schools. Pat-i e n t s and ex-patients are helped i n the techniques of w r i t i n g l e t t e r s of a p p l i c a t i o n , employment interviews, and personality development. 38 Mr. Thiessen, the Director of R e h a b i l i t a t i o n , reports that i t i s easier to f i n d employment f o r those persons who have t r a i n i n g or who have completed t r a i n i n g since discharge from h o s p i t a l ; however, as a r e s u l t of the present economic s i t u a t i o n there has been a reduction i n the number of persons taking t r a i n i n g i n recent years, and an upward trend f o r imme-diate placement of ex-patients. This has r e s u l t e d i n the r e h a b i l i t a t i o n counsellors devoting considerably more time to job-seeking and placement s e r v i c e s . Wherever possible training-on-the-job placements are arranged, but i t appears that t h i s type of opportunity i s becoming i n c r e a s i n g l y more d i f f i c u l t to l o c a t e . During I960, no training-on-the-job placements were arranged by the R e h a b i l i t a t i o n D i v i s i o n . Mr. Thiessen reports that i n I960 the R e h a b i l i t a t i o n D i v i s i o n was involved e i t h e r d i r e c t l y or i n d i r e c t l y i n the placement of 142 tuberculous persons. Of t h i s t o t a l , 68 of the placements were s p e c i a l c r e d i t s to the j o i n t e f f o r t s of the r e h a b i l i t a t i o n counsellors and Special Placements Section of National Employment Service. The remaining placements were i n most cases a t t r i b u t a b l e to job counselling on the part of the R e h a b i l i t a t i o n D i v i s i o n personnel. (4) Welfare Services S o c i a l casework services and r e l a t e d welfare services f o r patients i n the p r o v i n c i a l sanatoria are provided by the R e h a b i l i t a t i o n D i v i s i o n of the A l b e r t a Tuberculosis Association. It i s f e l t by the D i r e c t o r and the r e h a b i l i t a t i o n counsellors that the welfare and s o c i a l problems become involved i n a comprehensive r e h a b i l i t a t i o n process. The D i r e c t o r and the two r e h a b i l i t a t i o n counsellors, one of whom; i s p r o f e s s i o n a l l y trained i n S o c i a l Work, have become s k i l l e d i n dealing with the many welfare problems found among the tuberculous patients. They have a thorough knowledge of the community resources which they can c a l l upon f o r r e f e r r a l . 39 To complement this service by the Rehabilitation Division in the c i t i e s of Edmonton, Calgary and Lethbridge, are the Kinsmen Nurses from the Nursing Services Division of the Alberta Tuberculosis Association. These public health nurses, who operate from the Tuberculosis Cl i n i c s , make home v i s i t s to a l l the families of sanatorium patients who reside i n the above-mentioned c i t i e s , and i n the course of their duties, assist needy cases with clothing, vitamin supplement and free milk for families where there are children. They also act as an information link and referral service for the Rehabilitation Division. The rehabilitation counsellors assist patients whose families require welfare assistance, in making application for Mother's Allowance, and make referrals to city, municipal, and provincial welfare agencies to expedite such assistance. They also help patients and ex-patients who qualify for D i s a b i l i t y Pensions, Old Age Assistance, Old Age Security and other pensions and benefits. The general caseload for welfare services, which in I960 involved a total of 326 cases, included those of child welfare, War Veterans Allowance and Department of Veterans Aff a i r s , nursing home and boarding home placement for the aged, joint cases with the Alcoholism Foundation of Alberta as well as the previously mentioned public assistance and pensions cases. About twenty-five percent of this total caseload involved welfare services for Metis patients. The Alberta Tuberculosis Association, being limited i n finances to the Christmas Seal Fund, i s unable to undertake any measures of providing financial assistance for welfare purposes, but i t has been able to relieve distress in a variety of ways under the direction of the personnel of the Rehabilita-tion Division. In needy cases, where children have been exposed to tuberculosis, milk and vitamin supplement i s 40 provided through the Christmas Seal fund as a preventive measure. This i s provided free of charge, on the recommen-dation of any Public Health nurse or doctor. Where a husband who has tuberculosis i s l i k e l y to be severely r e s t r i c t e d f o r the r e s t of h i s l i f e , the R e h a b i l i t a t i o n D i v i s i o n w i l l con-side r t r a i n i n g the wife f o r suitable employment to take over the r o l e of breadwinner, i f t h i s plan appears f e a s i b l e . Therefore, by r e f e r r a l , d i r e c t assistance, counselling and encouragement on the part of the personnel of the R e h a b i l i t a t i o n D i v i s i o n , the economic and s o c i a l hardship as a r e s u l t of t u b e r c u l o s i s i s i n some measure reduced. (5) Follow-up Services Tuberculous persons who have received v o c a t i o n a l r e h a b i l i t a t i o n services are not u s u a l l y removed from the "registered" caseload u n t i l a f t e r twelve months of successful employment, but t h i s , of course, v a r i e s somewhat from one case to another. Mr. Thiessen, the D i r e c t o r of R e h a b i l i t a t i o n , states i t i s d i f f i c u l t to a f f i x a s p e c i f i c period of time as to when a person i s considered " r e h a b i l i t a t e d " . With a disease l i k e t u b e r c u l o s i s , there i s always the p o s s i b i l i t y of exacerbation. Follow-up i s often d i f f i c u l t , but wherever possible, periodic contact i s maintained, u s u a l l y f o r a year subsequent to discharge, because sometimes i t i s necessary to relocate ex-patients i n other jobs before they may be regarded as r e h a b i l i t a t e d . These follow-up measures are u s u a l l y accom-plished through personal contact with the discharged patient, h i s family, or h i s employer, and more extensively through use of the medical f i l e s i n the sanatoria which record p e r i o d i c a l medical reviews of the patient. Some use i s also made of the Special Placements Section of National Employment Service and the various s o c i a l agencies i n the community. CHAPTER 4 INDICATIONS FOR THE FUTURE Having examined each programme i n d i v i d u a l l y i n Chapter 2 and Chapter 3, t h i s chapter w i l l include a comparative analysis of the r e h a b i l i t a t i o n processes, personnel, and co-ordination of the two r e h a b i l i t a t i o n programmes f o r the tuberculous. An examination w i l l be made of the differences between the programmes and the implications which stem from d i f f e r e n t auspices. The Processes of Tuberculosis R e h a b i l i t a t i o n (1) Counselling and Evaluation I t i s apparent that counselling services form the ground-work of the r e h a b i l i t a t i o n process i n both the programme of r e h a b i l i t a t i o n f o r the tuberculous i n B r i t i s h Columbia and the one i n Alberta. However, i n the R e h a b i l i t a t i o n Department of the D i v i s i o n of Tuberculosis Control i n B r i t i s h Columbia the counselling service i s only of a vocational nature. The patient i s u s u a l l y r e f e r r e d to the r e h a b i l i t a t i o n o f f i c e r f o r v o c a t i o n a l r e h a b i l i t a t i o n s e r v i c e s , consequently counselling i s s e l e c t i v e . In the Alberta programme, however, the coun-s e l l i n g process i s more i n c l u s i v e , c o n s i s t i n g of a psycho-s o c i a l evaluation of the patient, i n most cases. This appears to be explained i n part by the f a c t that the r e h a b i l i t a t i o n counsellors i n the Alberta sanatoria r o u t i n e l y interview the patients f o l l o w i n g t h e i r admission rather than wait f o r r e f e r r a l s . This provides the opportunity f o r the e a r l y establishment of a patient-counsellor r e l a t i o n s h i p . The r e h a b i l i t a t i o n counsellor i s then i n a p o s i t i o n to a s s i s t the patient who needs help with s o c i a l and economic problems, as well as provide vo c a t i o n a l c o u n s e l l i n g . The p o s s i b i l i t y of 42 duplication of service i s thereby minimized, and at the same time this procedure eliminates the necessity of the patient having to repeat his story to various professional staff members. Rehabilitation personnel in both programmes are constantly in contact with medical staff of the sanatoria i n order to discuss proposed rehabilitation plans for the patients, and to provide medical personnel with information regarding the patients which may have a bearing on the patients': response to treatment and their eventual recovery. Neither programme holds regular or formal rehabilitation conferences with medical s t a f f , and i t i s suggested that formal rehabilitation dis-cussions with medical staff at regular intervals might provide more constructive planning i n rehabilitation work with tuber-culous persons. (2) Vocational Training Extensive use of the Canadian Vocational Training scheme, particularly Schedule "R", i s made by both tuberculosis rehabilitation programmes. In addition, high school academic instruction i s offered students who are undergoing treatment i n tuberculosis hospitals i n B r i t i s h Columbia and Alberta. The significance of programme auspices becomes apparent in some of the alternate vocational training programmes for the tuberculous, including both in-sanatorium and post-sanatorium training. In the government sponsored tuberculosis r e h a b i l i -tation programme i n B r i t i s h Columbia, costs of correspondence courses for in-sanatorium patients, and the provision of necessary text books, manuals, and certain tools and equipment may be included under the Federal Health Grant. Furthermore, in most cases, the costs of pre-vocational preparation in high school academic studies for discharged patients at schools offering accelerated programmes ("cram schools") may be covered similarly by the Health Grant. Funds from the Federal Health Grant also may be used for the training of discharged 43 patients who are unable to q u a l i f y under Schedule "R" of the Canadian Vocational T r a i n i n g scheme. In Alberta, because the tuberculosis r e h a b i l i t a t i o n programme i s operated under private auspices, i t does not meet the standards established f o r f e d e r a l g r a n t s - i n - a i d . Therefore, the costs of putting i n t o operation alternate scheme^ s i m i l a r to those mentioned above, have to come from the private funds of the Alberta Tuberculosis Association i t s e l f , which u s u a l l y requires authorization by the Board of D i r e c t o r s . In some instances i n t e r e s t - f r e e loans may be provided the c l i e n t s , on the recommendation of the D i r e c t o r of R e h a b i l i t a t i o n . When the c l i e n t has completed h i s t r a i n i n g and has become s e l f -s u f f i c i e n t , i t i s expected he w i l l repay the loan, although there i s no written agreement and the c l i e n t i s never b i l l e d regarding the loan. By means of t h i s procedure the ex-patient, i n the opinion of the writer, gains a sense of r e s p o n s i b i l i t y ajid f e e l s he i s a c t i v e l y p a r t i c i p a t i n g i n h i s own r e h a b i l i t a t i o n . At the same time, he understands that h i s loan repayment i s added to the funds avai l a b l e f o r other tuberculous persons who wish to r e h a b i l i t a t e themselves through vocational t r a i n i n g programmes. The advantage of the public r e h a b i l i t a t i o n programme, which can draw upon the Federal Health Grant f o r the p r o v i s i o n of alternate v o c a t i o n a l t r a i n i n g services, l i e s i n the f a c t that with funds r e a d i l y a v a i l a b l e there are not as many l i m i t a t i o n s i n the s e l e c t i o n of c l i e n t s f o r t r a i n i n g as found i n the private programme. This writer believes that f e d e r a l l e g i s l a t i o n should be modified to cover voluntary programmes such as that operating i n A lberta. (3) Job Placement Due to the grave unemployment s i t u a t i o n which presently e x i s t s , placement of discharged tuberculosis patients i n work 44 p o s i t i o n s has become extremely d i f f i c u l t . Consequently, the d i r e c t o r s of both programmes report that the r e h a b i l i t a t i o n counsellor or o f f i c e r has had to become more s k i l f u l i n t h i s process of r e h a b i l i t a t i o n with the concomitant that he has found himself devoting more and more time to the endeavour of job placement. In 1944, Mr. Jack Cunnings, who was at that time the Di r e c t o r of R e h a b i l i t a t i o n , Sanatorium Board of Manitoba, made the f o l l o w i n g observation: "We can give the ex-patient the opportunity to t r a i n f o r a job and thus place himself i n a p o s i t i o n to compete f a i r l y i n the labour market. I f employment i s a v a i l a b l e , we can d i r e c t him i n t o avenues of work i n which he i s not v o c a t i o n a l l y handicapped or discriminated against because of former i l l n e s s . But we cannot undertake to solve the general problem of unemployment, and i f i t happens at any time that a considerable number of people are unemployed, we must expect that some tuberculosis ex-patients w i l l be among t h e i r number." 1 The above remarks are pertinent at the present time and need to be s e r i o u s l y taken i n t o consideration i n attempting to secure employment f o r tuberculous persons and others who are p h y s i c a l l y handicapped. In B r i t i s h Columbia, the R e h a b i l i t a t i o n Department of the D i v i s i o n of Tuberculosis Control extensively r e l i e s upon the Special Placements Section of the National Employment Service to secure employment f o r i t s c l i e n t s . Undoubtedly, t h i s service has been enhanced since the appointment of a s p e c i a l placements o f f i c e r who i s connected with the p f f i c e of the p r o v i n c i a l Co-ordinator of R e h a b i l i t a t i o n . The R e h a b i l i t a t i o n D i v i s i o n of the Alberta Tuberculosis A s s o c i a t i o n also u t i l i z e s the Special Placements Section of the National Employment Service. The customary procedure has 1 Cunnings, T.A.J.: " R e h a b i l i t a t i o n of the Tuberculosis Patient — The Manitoba Programme", Canadian Journal of Public Health, V o l . 35, No. 4, A p r i l 1944. pp. 142-143. 45 been to r e f e r discharged tuberculosis patients who are seeking employment to the Special Placements Section of the National Employment Service f o r r e g i s t r a t i o n . In the experience of the writer there are often lengthy delays before the ex-patient has been placed due to the demand f o r t h i s service and. also s t a f f l i m i t a t i o n s . In an attempt to get around t h i s problem, tube r c u l o s i s r e h a b i l i t a t i o n counsellors have found i t expedient to devote more time to d i r e c t l y securing employment f o r d i s -charged tuberculous persons. This has, of course, resulted i n a reduction of the time that the r e h a b i l i t a t i o n counsellors devote to c o u n s e l l i n g in-sanatorium p a t i e n t s . A d d i t i o n a l q u a l i f i e d personnel i n the Special Placements Section of National Employment Service would a s s i s t i n the easing of t h i s s i t u a t i o n . In a d d i t i o n , • the p r o v i s i o n of s p e c i a l placements l i a i s o n o f f i c e r s by the National Employment Service, p a r t i c u l a r l y i n the metropolitan areas of Edmonton and Calgary, would be b e n e f i c i a l not only to the r e h a b i l i t a t i o n programme f o r the tuberculous but also other disabled groups. Mr. MacDonald, D i r e c t o r of Tuberculosis R e h a b i l i t a t i o n f o r B r i t i s h Columbia, mentioned that a way i n which job place-ment services f o r discharged tuberculosis patients i n B r i t i s h Columbia could be made more e f f e c t i v e would be to have a r e h a b i l i t a t i o n o f f i c e r appointed by the B r i t i s h Columbia Tuber-c u l o s i s Society, a voluntary agency, who would work i n co-operation with the r e h a b i l i t a t i o n personnel of the public programme. The voluntary agency, according to Mr. MacDonald, i s i n a better p o s i t i o n to e f f e c t pressure upon the National Employment Service to improve i t s f a c i l i t i e s f o r job placement of handicapped persons. (4) Welfare Services Welfare services f o r tuberculous persons are not provided by the R e h a b i l i t a t i o n Department, D i v i s i o n of Tuberculosis Control i n B r i t i s h Columbia; these services are offered by the S o c i a l Service Department which i s administered by the 46 Department of S o c i a l Welfare. The R e h a b i l i t a t i o n Department concentrates on vocational r e h a b i l i t a t i o n services. This tends to indicate s p e c i a l i z a t i o n of services within the programme as a whole. In comparison, the programme i n Alberta appears to be more integrated and at the same time more generalized inasmuch as the counsellors of the Alberta Tuberculosis Association's R e h a b i l i t a t i o n D i v i s i o n provide welfare counselling and r e f e r r a l services as well as vocational r e h a b i l i t a t i o n services f o r the tuber c u l o s i s patients i n the p r o v i n c i a l sanatoria i n Alb e r t a . Prom the author's experience, the welfare services i n the Alberta programme, as offered by the r e h a b i l i t a t i o n counsellors, appear l i m i t e d to "environmental" and occ a s i o n a l l y "supportive" casework, as a r e s u l t of personnel l i m i t a t i o n s and large case loads. The S o c i a l Service Department i n the B r i t i s h Columbia programme, with a s t a f f of three q u a l i f i e d s o c i a l workers perhaps can provide, where i t i s required, more intensive case-work s e r v i c e . The D i r e c t o r of R e h a b i l i t a t i o n f o r the Alber t a Tuber-c u l o s i s Association, Mr. Thiessen, o f f e r s the suggestion that by s e l e c t i n g c l i e n t s on a more c r i t i c a l b a s i s , thereby reducing the active case load, i t i s l i k e l y that more intensive casework service could be provided. This i s a p o s s i b i l i t y ; however, the author believes that there i s a great need f o r the addition to the s t a f f of the R e h a b i l i t a t i o n D i v i s i o n , of two or three p r o f e s s i o n a l l y trained s o c i a l workers who could provide the necessary casework services f o r patients i n the sanatoria. This would mean an expansion of services rather than the development of a separate S o c i a l Service Department. I t i s possible that the Department of Public Health could a s s i s t the A l b e r t a Tuberculosis Association i n t h i s endeavour by covering part of the expenditures required f o r s a l a r i e s of ad d i t i o n a l personnel. 47 (5) Follow-up Services Wherever possible, each programme maintains some fo l l o w -up contact with discharged tuberculosis patients who received vocational r e h a b i l i t a t i o n s e r v i c e s . Usually t h i s i s a d i f f i c u l t procedure to formally carry out by the professional s t a f f due to the requirements of time involved i n such a c t i v i t y , and also as a r e s u l t of the non-concern of many ex-patients once they are re-est a b l i s h e d . Both programmes u t i l i z e information about the employment of discharged patients which i s placed on t h e i r medical f i l e s at regular medical re-examinations, or as a r e s u l t of c l i n i c a l follow-up by the Central R e g i s t r i e s of the respective D i v i s i o n s of Tuberculosis Control. The B r i t i s h Columbia programme haa also benefitted i n t h e i r follow-up services from information provided by the s p e c i a l placements l i a i s o n o f f i c e r about d i s -charged tuberculosis patients who were as s i s t e d i n job place-ment . The use of s p e e i a l placement l i a i s o n o f f i c e r s i n Alber t a would also be an asset to the follow-up services of the r e h a b i l i t a t i o n programme f o r the tuberculous i n that province. Personnel i n Relation to Programme Auspices Sponsorship of the tuberculosis r e h a b i l i t a t i o n programmes i n A l b e r t a and B r i t i s h Columbia appears to have l i t t l e e f f e c t on the q u a l i f i c a t i o n s that are desired f o r pro f e s s i o n a l personnel. Both programmes prefer that the r e h a b i l i t a t i o n counsellors or o f f i c e r s are u n i v e r s i t y graduates having majored i n the s o c i a l sciences. A l l of the S o c i a l Service Department personnel i n the B r i t i s h Columbia programme have formal t r a i n i n g i n S o c i a l Work. In the Alberta programme, one member of the pr o f e s s i o n a l s t a f f has S o c i a l Work t r a i n i n g . It would seem that a fundamental necessity f o r a compre-hensive r e h a b i l i t a t i o n programme, such as that offered by the Alberta Tuberculosis Association, i s well q u a l i f i e d personnel. 48 As to what the best formal preparation for the professional a c t i v i t y involved i n this kind of programme i s , Mr. Edward Dunlop has stated, "Rehabilitation counsellors should have a l l the s k i l l s of the professionally trained social worker and his work must be based upon the well-known social case-1 work principles." Under the Medical Rehabilitation Grant, rehabilitation personnel in the B r i t i s h Columbia programme are e l i g i b l e to receive formal training, including social work training. The cost of such training; i s wholly borne by the federal govern-ment. The Alberta programme operating under private auspices, i s not e l i g i b l e to receive this federal grant-in-aid. The rehabilitation personnel of the publicly operated tuberculosis programme i n B r i t i s h Columbia are provincial c i v i l servants, which entitles them to a formal job c l a s s i f i -cation and salary schedule. This i s in line with good personnel management practices. The Alberta Tuberculosis Association has not established a formal salary schedule for the Rehabilitation Division. Co-ordination This study has pointed out in Chapter 2 and Chapter 3 that rehabilitation services for the tuberculous in B r i t i s h Columbia and Alberta are co-ordinated with the c i v i l i a n rehabilitation programmes, which are under the direction of the Co-ordinator of Rehabilitation for each province. The public programme for tuberculosis rehabilitation i n B r i t i s h Columbia registers a l l cases with the office of the Co-ordinator of Rehabilitation. The fact that both programmes come under the same government department provides closer co—ordination i n the rehabilitation of tuberculous persons. 1 Dunlop, Edward. "Can We Develop a Programme of Rehabilitation for A l l ? " Canadian Conference on Social Work, Proceedings of the Tenth Biennial Meeting, Halifax, N.S., 1946. p. 153. 49 In Alberta, usually only those tuberculous persons recommended by the Rehabilitation Division for Canadian Vocational Training are registered with the provincial Co-ordinator of Rehabili-tation. During the preparation of this thesis, an administrative reorganization i n the tuberculosis rehabilitation programme i n Br i t i s h Columbia has been taking place which can be considered as a further step in co-ordination of rehabilitation services for the tuberculous. In January 1961, the Director or Rehabili-tation for the tuberculous was assigned to the staff of the Co-ordinator of Rehabilitation. This change involved a move from the Division of Tuberculosis Control to the newly created Division of Registry and Rehabilitation of the Health Branch, Department of Health Services and Hospital Insurance. It i s expected that such a move w i l l f a c i l i t a t e the further co-ordination of present f a c i l i t i e s , particularly i n the areas of vocational training and job placement. Conclusion,' The determination of responsibilities of public and private agencies i n the health and welfare f i e l d has continually commanded the interest of those involved in organizing and operating these services. Social work literature has contrasted public and private auspices as they relate to health and wel-fare services, and various writers have described the strengths of each. According to Wilensky and Lebeaux^ the major differences are: (1) the a b i l i t y of the private agency to operate in a more flex i b l e and experimental way than the public agency; and (2) the clientele of the private agency i s usually limited by the interest and resources of the group voluntarily supporting i t , while the public agency offers service to a l l 1 Wilensky, H.L. and Lebeaux, C.N. Industrial Society  and Social Welfare, Russel Sage Foundation, New York, 1958. See particularly Chapter VII, "Welfare Auspices and Expenditures", pp. 148-167. 50 members of the group meeting the requirements indicated by the statement of p o l i c y or the p a r t i c u l a r t e s t of need. Other differences e x i s t between public and private auspices but t h i s discussion w i l l only focus upon those mentioned above. The reader i s cautioned that any questions r a i s e d as a r e s u l t of these differences can be answered here only on the basis of the two selected programmes i n t h i s study. This study has revealed that differences do e x i s t between the tuberculosis r e h a b i l i t a t i o n programme operating p u b l i c l y i n B r i t i s h Columbia and the private programme i n operation i n Alberta. These differences include the i n t e g r a t i o n of vocational r e h a b i l i t a t i o n and s o c i a l services i n the Alberta programme i n contrast to the separate departments o f f e r i n g s p e c i a l i z e d services i n the B r i t i s h Columbia programme; the use of more resources f o r voca t i o n a l t r a i n i n g of tuberculous persons i n B r i t i s h Columbia than i n Alberta; the greater number of pr o f e s s i o n a l personnel involved i n the comprehensive programme i n B r i t i s h Columbia than i n Alberta; and the clo s e r and more e f f e c t i v e co-ordination of tuberculosis r e h a b i l i t a t i o n services i n B r i t i s h Columbia than i n Alberta. A number of f a c t o r s may account f o r these d i f f e r e n c e s , such as l o c a l conditions, experience of personnel, attitudes of leaders and public o f f i c i a l s , and possibly auspices of the programmes. However, the extent to which these differences are due to auspices cannot be d e f i n i t e l y determined. In many ways the programme i n Alberta i s s i m i l a r i n i t s operation to that i n B r i t i s h Columbia. An example which reveals the private programme of the Alberta Tuberculosis Association having the c h a r a c t e r i s t i c of a public programme i s the f a c t that R e h a b i l i t a t i o n D i v i s i o n does not r e s t r i c t i t s c l i e n t e l e . Nevertheless, i f i t desired to do so, the agency could be more s e l e c t i v e i n i t s intake. In summary, i n the development of r e h a b i l i t a t i o n services f o r tuberculous persons i n B r i t i s h Columbia and i n Alberta, 51 the d i f f e r e n c e s i n auspices of the two programmes seem to have the greatest s i g n i f i c a n c e i n terms of t h e i r organizational structure. The programme i n operation i n B r i t i s h Columbia appears to be a composite, c o n s i s t i n g of two departments within the D i v i s i o n of Tuberculosis Control. Vocational counselling, t r a i n i n g , and job placement services are provided by the R e h a b i l i t a t i o n Department, while the S o c i a l Service Department attempts to meet the s o c i a l , emotional, and economic needs of the p a t i e n t s . In contrast, the R e h a b i l i t a t i o n D i v i s i o n of the Albert a Tuberculosis Association functions as a singl e integrated u n i t to o f f e r i t s c l i e n t s both vocational r e h a b i l i -t a t i o n services and the r e l a t e d welfare services, which are generally acknowledged to be e s s e n t i a l i n a comprehensive r e h a b i l i t a t i o n programme. Further research i n the area of tuberculosis r e h a b i l i -t a t i o n i n r e l a t i o n to programme auspices seems indicated; such work could t e s t the impact of d i f f e r e n t programmes upon service to c l i e n t s . As a f i r s t step, such studies might include a d e s c r i p t i v e analysis of a l l of the p r o v i n c i a l programmes i n operation i n Canada, as well as the f e d e r a l programme. APPENDICES 53 APPENDIX A Page 54 D i v i s i o n of Tuberculosis Control S o c i a l Service Department and R e h a b i l i t a t i o n Summary Sheet. Page 55 Alberta Tuberculosis Association R e h a b i l i -t a t i o n D i v i s i o n Index Card. Page 56 Alberta Tuberculosis Association, R e h a b i l i -t a t i o n D i v i s i o n R e g i s t r a t i o n Form. SOCIAL SERVICE DEPARTMENT AND REHABILITATION N A M E R E C O R D N o A L B E R T A T U B E R C U L O S I S A S S O C I A T S O N REHABILITATION DIVISION Name Pat. No Address Date of Admission. Age Date of Birth Racial Origin Birthplace Marital Status Education Occupations Diagnosis Prognosis W.T.P 0.T Remarks ALBERTA TUBERCULOSIS ASSOCIATION REHABILITATION BRANCH Name Patient No Address Age Nationality Birthplace Marital Status Next of Kin and Address. Dependents Education Occupational History. Medical History Previous Treatment Diagnosis on Admission Treatment Diagnosis on Discharge D.O.A D.O.D D.O.T. Sputum Status W.T.P Psychometric Tests 57 APPENDIX B BIBLIOGRAPHY (a) General References Canada, Department of National Health and Welfare, Research and Stat i s t i c s Division, Rehabilitation Services i n Canada, Part I, General Review. The Department, Ottawa, I960. (Health Care Series, Memorandum No. 8). Cunnings, T.A.J., "Rehabilitation of the Tuberculosis Patient -the Manitoba Programme", Canadian Journal of Public Health, Volume XXXV, Number 4, April 1944. Diagnostic Standards and Classification of Tuberculosis, National Tuberculosis Association, New York, I960. A Guide for the Development of Rehabilitation Programs i n Tuberculosis Associations, National Tuberculosis Association, New York, 1956. Kiefer, Norvin C , Present Concepts of Rehabilitation in  Tuberculosis; A Review of the Literature 1938-1947, National Tuberculosis Association, New York, 1948. Roeher, G. Allan, "Rehabilitation Progress and Needs i n Canada", Social Worker, Volume 29, Number 1, January 1961. Wile,nsky, Harold L. and Lebeaux, Charles N., Industrial Society  and Social Welfare, Russell Sage Foundation, New York, 1958. (b) Specific References Alberta, Department of Public Health, Annual Report, 1959. Queen's Printer, Edmonton, I960. Alberta Tuberculosis Association, Annual Reports 1948 - I960. Alberta Tuberculosis Association, Edmonton, 1948 - I960 (mimeographed). B r i t i s h Columbia, Department of Social Welfare, Annual Reports, 1959 - I960. Queen's Printer, Victoria, I960 and 1961. B r i t i s h Columbia, Division of Tuberculosis Control, Department of Health Services and Hospital Insurance, Annual Report, 1959. The Department, Victoria, I960. (mimeographed). 58 Canada, Department of National Health and Welfare, Research and Statistics Division, Rehabilitation Services i n Canada, Part II, Provincial and Local Programs. The Department, Ottawa, 1959. (Health Care Series, Memorandum No. 9) Canada, Department of Labour, C i v i l i a n Rehabilitation Branch, Notes Based on Discussions at the Western Provinces Rehabilitation Workshop, Banff School of Pine Arts, October 12 - 14, I960. Theme: "A Discussion of Current Problems i n Effecting Successful Rehabilitation Services". The Depart-ment, Ottawa, I960, (mimeographed). McKone, B., "Rehabilitation i n Tuberculosis: A Seven and Eight Year Follow-up", Canadian Medical Association Journal, Volume 77, (October 15, 1957). 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0106031/manifest

Comment

Related Items