Employment Support
Multidisciplinary Teamwork

The ONCE Model for Attending to the Needs of Blind and Visually Impaired People in Spain

by Aurella MILLAN PEREZ





The ONCE as a Social Entity

The ONCE is a non-profit-making Public Law Corporation that was born in 1938 to serve as an associative movement of blind people, with the goal of improving their living conditions and general well-being. Under the guidance of the Spanish State, yet with administrative autonomy, its objectives are oriented towards promoting personal autonomy and ensuring the social and labour integration of all blind and visually impaired citizens.

Upon its creation, by delegation of the Public Administration, the ONCE assumed responsibility for providing the specialised services required by these people (rehabilitation, education, employment, personal autonomy, etc.). To make this possible, it was granted the concession of a lottery system, denominated the "pro-blind coupon", as a way of financing these services. Moreover, and what is more important, the blind and visually impaired thus acquired the capacity to manage and direct the entity themselves.

At present, the ONCE has over 63,000 blind and visually impaired affiliate members and 59,200 workers (in the whole of the ONCE Group), of whom 15,200 are blind or visually impaired, 19,000 have non-visual disabilities and 25,000 have no disability; its budget this year for the Social Services sector comes to 157 million Euros. It also has 270 Centres distributed all over Spain from where these services are provided and the sale of the exclusive lottery is administered.

The ONCE Business Corporation (CEOSA) was created in 1993 with the goal of promoting and consolidating the Entity's economic activity. This was to be achieved through participating in, promoting and administering profitable companies that generate employment and contribute towards achieving the labour integration of people with visual impairments or other disabilities. In the year 2001, CEOSA had a turnover of 748 million Euros. The different activities of the ONCE Business Corporation are carried out mainly in sectors such as construction, tourism, real estate promotion and administration, security and cleaning, together with other interests in the food, insurance, urban furniture and physiotherapy sectors.

The ONCE Foundation for Social Cooperation and the Integration of People with Disabilities is the most patent expression of the Spanish blind population's commitment to cooperation and solidarity with the other disabled groups. It undertakes its work, aimed at improving the living conditions of this population group, in those areas where achieving effective equality of opportunities can make their integration in society a reality: training and employment, overcoming barriers of all kinds, promoting cooperation and sport for disabled people. Between 1988 and 2001, the total number of jobs and occupational places created reached 43,000 and over 66,500 training activities were carried out. In addition, action has been taken to improve accessibility in 594 towns and cities.

The ONCE also demonstrates its solidarity through its collaborations with the principal international organisations of blind and visually impaired people. Most noteworthy is the FOAL (ONCE Foundation for Solidarity with the Blind People of Latin America), created in 1998. Its activities, which will benefit over four million people, are basically oriented towards the development of educational and training programmes, rehabilitation, furthering employment opportunities and typhlological advances.

Now, before going into greater detail on the operation of the Multidisciplinary Teams within the ONCE, specifically the support they lend to foster the work insertion of the blind and visually impaired, I shall offer a brief analysis of the main characteristics of the blind and visually impaired population in Spain.


To summarise the most distinctive features of this population group, we could underscore the following:

    - Progressive aging throughout the age structure (at this moment in time, 39% of our blind and visually impaired citizens are 65 or over and they represent 48% of the new members of the ONCE).

    - Increased number of people with functional residual vision for tackling daily life (75.4%), compared to those suffering blindness (24.6%).

    - High level of labour occupation and wide variety of jobs carried out by these people. Thus, the unemployment rate within the Spanish population as a whole (11%) is far superior to that of the blind and visually impaired (5%).


The simple explanation for this state of affairs is the major importance of the sale of the lottery (the cupón), as the principal route to labour integration for the blind and visually impaired. As a result, of the ONCE members in employment, 83% are lottery sellers, 8% are technical-administrative personnel within the ONCE and 9% work outside the ONCE (as operators, physiotherapists or in some other professional sector).

However, the sustained drive the ONCE maintains in the employment area is leading to a continuous increase in the numbers of blind and visually impaired persons involved in labour activities unrelated to sales of the lottery. For instance, in the year 2002, 12% more blind and visually impaired people were employed in private companies, public administrations and other organisations outside the ONCE Group; and a further 8% have opted for self-employment. Moreover, it is worth mentioning the training and retraining schemes for the work insertion of the blind and visually impaired, some of them within the framework of European Union programmes (Horizon and Leonardo). Particularly noteworthy are those actions undertaken in order to boost the possibilities of low qualified workers gaining access to the job market and the significant increase in individual job training grants.

Finally, the presence of other disabilities, especially among the youngest and most elderly age groups, is also a highly relevant characteristic (18% of all blind and visually impaired persons are afflicted by another disability - physical, mental or hearing - in addition to their visual impairment).




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Social Services Model and Infrastructure for Attending to the Needs of Blind and Visually Impaired People - Multidisciplinary Teams

The ONCE service provision system is structured along two complementary lines: the Specialised Centres and the Multidisciplinary Teams, which have the human resources (approximately 2,500 professionals, included management personnel and administrative support - over 400 people), together with the material and technical resources that can guarantee the constant innovation and updating of the technological and methodological aspects of the social services.

The Multidisciplinary Teams have the goal of bringing the provision of services right to the locality where the beneficiaries live and doing so in an effective way, optimising resources to the full.

These teams, made up of different professionals (teachers, psychologists, social workers, rehabilitation specialists, opticians, ophthalmologists, sociocultural and sporting events organisers, typhlotechnology instructors, specialists in the production of Braille and audio media, etc.), are located in practically every provincial capital, thus covering the whole of Spain.

The basic purpose of these Teams is to develop the processes oriented towards attaining the objective of full social and labour integration for the blind and visually impaired, while ensuring their effectiveness within their respective area in every aspect of their application.

These Teams will be the elements responsible for pointing out the best way to cover the needs detected and put into practice the overall policies of the ONCE in this field.

Basically, the professionals in the Multidisciplinary Teams most directly involved in the employment services are the following:

    - Head of the Social Services Department, who will act as Coordinator.

    - Psychologist, whose area of work entails: studying the blind community, career guidance, selection, training proposals, study of possible jobs, detection of retraining needs, follow-up etc.

    - Typhlotechnical Instructor, whose area of work entails: ergonomic study of workplace, adaptation of workstations, installation of required adaptations, supervision and adjustment of their operation, follow-up, evaluation of new material, etc.

    - Social Worker, whose area of work entails: information to employers, employment search, control and maintenance of the census, detection of job seekers, general information to users of the service, follow-up, etc.

    - Basic Rehabilitation Specialist, whose area of work entails: detection of basic rehabilitation/qualification needs, support in those aspects of personal autonomy relating to the social and professional integration of the blind and visually impaired, etc.

The system the ONCE currently uses to bring the social services closer to the blind and visually impaired has proved to be an absolute revolution in the provision of services in Spain. It is complemented by the activities of the nationwide inter-sectorial specialised centres: 5 Educational Resources Centres, 1 Rehabilitation Centre, 1 Centre for Research, Development and Typhlotechnical Application, 2 Centres and 33 territorial units for bibliographic production, 1 School for Guide Dogs and 1 Physiotherapy College.




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The ONCE Specialised Social Services Model: a Comprehensive Top-Quality Response to the Needs of Blind and Visually Impaired People

Those entities - both public and non-governmental - dedicated to the provision of social services to disabled people in Spain are currently subjecting their operational policies and systems of attention to extensive review.

Over the past decade, there has been a radical transformation, characterised by tremendous dynamism. Within the ONCE itself, for example, there has been an outstanding degree of expansion and professionalisation of the services offered. Add to this, the considerable increase in membership or the modification of its characteristics, as outlined above. Likewise, in the external context, significant transformations have also taken place that affect the ONCE's model for service provision; among these, we could mention the increase in social resources, the integration and normalisation policies or technological development.

In this sense, attending to the principles of quality and on the basis of the conceptual framework set out by the World Health Organisation, that places greater emphasis on an individual's potential (activity and social participation) than on their disability or handicap, the ONCE has recently implemented their new Model of Social Services.

As a result, the ONCE's provision of specialised social services is guided by the following principles:

    - Equality, as regards access to services and the treatment of all users.

    - Initial institutional orientation, by means of generic information on the ONCE. This addresses both its associative nature, encouraging active participation in the organisation, and its nature as an institutional service provider, guiding and motivating users as regards demanding and using these services.

    - Active participation on the part of users, in the identification of their needs and interests and, therefore, in their attention process.

    - A comprehensive identification of, and integral attention to, their needs (through the preparation of an individualised attention plan for each person. This plan will envisage their concrete needs, the services to be received, the professionals who will intervene and the general objectives pursued and will specify when and where the different services will be provided).

    - An interdisciplinary approach, through coordinated teamwork of the different professionals involved.

    - Personalised attention, reinforcing the figure of the case coordinator, a duty assumed by the professional whose intervention is the top priority for that person.

    - Continuous improvement of the quality of attention provided, assessed on the basis of the benefits and results obtained by the user and of their satisfaction with the services received.

The objective and the raison d'être of the organisation/service should be to respond adequately to user needs related to their blindness or visual impairment. That is to say, the service in itself has no meaning; rather, it is a question of satisfying the users' needs, needs that are ever-changing, yet predictable. Therefore, the service should revolve around the central premise: achieving the satisfaction of the blind and visually impaired citizens, by promoting their personal autonomy and their social and labour integration.

It is necessary to generate indicators that provide both knowledge of the results of the policies applied, for planning and administration purposes, and feedback on the different elements involved in the service provision process. This should be conceived as an element of improvement - not merely a control element - and will enable:

    1. Improvements in the application of resources (optimisation).

    2. Decisions to be taken in accordance with needs.

    3. Improvements in efficiency.

    4. And so on.


In this way, the provision of Social Services - the overriding, priority goal of the ONCE - is oriented towards covering the needs of its users in two fundamental aspects:

    Personal autonomy, with specific interventions relating to:

      1. Personal acceptance of the visual impairment.

      2. Optimisation of visual functions.

      3. Orientation and mobility.

      4. Personal care and domestic chores.

      5. Communication and access to information (Braille and the new technologies).


    Social integration by way of:

      1. Educational attention.

      2. Employment.

      3. Cultural and sport promotion.

      4. Support for basic social welfare.


We shall now define the Employment Support Services, as well as the infrastructure and professionals involved in their operation. We can define three support services in the employment field:

    A) Detection and guidance as regards employment demands:

      - Detection will consist of promoting all the necessary actions that lead to the recruitment, in the corresponding field, of those blind and visually impaired persons either seeking employment or already integrated in the labour market.

      - Using this information, a census will be drawn up of the blind and visually impaired population, divided into four major categories:

        a.Blind and visually impaired seeking employment, classified according to their qualifications.

        b.Blind and visually impaired in active employment, classified by activity sectors.

        c.Blind and visually impaired undergoing training.

        d.Blind and visually impaired in active employment, seeking a better job.

      - Each team must apply the systems or techniques necessary to assess the individual, with a view to discovering: their motivation with regard to the labour world, aptitudes for carrying out a certain profession, level of autonomy, etc. They can then be offered guidance and advice on the professional field that is most suitable for their skills and possibilities.

      - Once an assessment has been made of the users' situation, they can then be offered guidance, either directly towards a certain professional activity, or towards some specific form of training for a certain job or work experience placements, etc.


    B) Guidance as regards the compilation of employment offers:

      - The Teams will carry out actions that lead to the detection of job openings - by way of direct visits to companies, meetings with managers of diverse activity sectors and arranging collaboration agreements. Moreover, they will boost the degree of participation of the ONCE at trade fairs and expositions, technical seminars, etc.

      - All offers of work will immediately be passed on to any users seeking employment who fit the requirements.

      - In the event that any offer is not taken up, it will be incorporated into the Central Job Vacancies List and will be passed on to other Employment Promotion Teams.

      - The Multidisciplinary Teams will undertake informative actions to disseminate knowledge of certain aspects related to hiring disabled workers: fiscal benefits, subsidies from the Public Administration, adaptation of the workplace, etc.


    C) Guidance on the professional adjustment between supply and demand:

      - Each Team will detect the training or retraining needs of the professionals in active employment, both on a collective and individual basis, including those of a typhlotechnical nature.

      - Participation will be promoted in professional work experience placements in companies, as a measure prior to employment. The best possible use will be made of the regulation in force at each moment in time, as well as of programmes run by other Institutions for the same purpose. A study will be made of the Centres or Companies that potentially offer greater recruitment possibilities after the finalisation of such placements.

      - In the attention offered to all blind and visually impaired job seekers, preference will be given to rehabilitation programs, with a view to them reaching the greatest possible level of autonomy.

      - At each Centre, a Job Vacancies List will be generated, with the goal of collating and tailoring the job offers. Drawing up this Job Vacancies List will be accomplished by drawing on both public and private sources, such as the Spanish National Employment Institute, Autonomous Communities, Town Councils, Associative Entities, Private Companies, the ONCE Corporation, other public bodies, etc.

Starting from the user's perspective, the ONCE lays down certain conditions of quality, or standards of attention, according to which those services, resources and aids are planned, organised, provided and evaluated.

Such standards should be understood to constitute a set of principles, methods and strategies that will help the Institution to mobilise, integrate and involve each and every one of the groups and people that form part of it in the task of attaining the highest possible quality in their services and, consequently, in satisfying the needs of the users.




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Provision of the Service

The direct attention of the service provided by the ONCE must conform to the following standards:

    - When a user requests a service or becomes a member of the organisation, the corresponding response must be forthcoming in the minimum possible period of time. In accordance with their particular characteristics, each user will receive comprehensive orientation as regards the norms, regulations, rights and responsibilities, services and resources available, contact telephone numbers, etc.

    - The results of the assessment are used to develop jointly with the user a flexible, individualised attention plan. This plan must be understood and accepted by the user.

    - A Multidisciplinary Team coordinated approach is guaranteed, thus ensuring a plan that will cover, in an integrated fashion, all user needs arising from their blindness or visual impairment.

    - Periodically, evaluations are carried out to assess progress in the attainment of objectives. These results are shared with the user and used to make readjustments to the individualised plan.

    - The techniques and situations relating to intervention, training or teaching are selected according to the abilities, aspirations, interests and resources of the user, and focused in such a way as to assist in transferring to their personal environment the acquired knowledge and skills.

    - The techniques, methods and procedures relating to the professionals' intervention must respond to ethical and deontological norms, professional standards, the most up-to-date knowledge and the most effective practices.

    - Individual records or histories are kept of the cases duly attended. There exists a written protocol, which determines the manner in which such records may be filed and accessed and their confidentiality ensured.

    - The follow-up activities are planned prior to the termination of the service and are used to assess the generalisation of what has been learnt and, should the need arise, to identify the need for further attention.


On this basis, therefore, it will prove necessary to adapt the operation of the Multidisciplinary Teams and Specific Centres offering direct attention, so that their organisation falls into line with the philosophy, objectives and processes inherent in the new social services model. Thus the participation, responsibility and motivation of both users and professionals must be boosted, to the level that corresponds to them.




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Description of the Process of Attention offered by the Professionals:

    A) Information on the ONCE Membership Process.

    At this point, the following professionals intervene:

      - The Administrative Personnel inform, in a descriptive manner, on the conditions required for membership of the ONCE.

      - The Department Head takes charge of supervising the contents and presentation of the information furnished - to ensure it is clear and direct - and of attending, either personally or delegating the task to the social worker, to those cases that may present special characteristics.

      - The Social Worker who carries out the above functions, in the case of being delegated by the Head of the Social Services Department.


    B) Process of Individualised Attention Planning.

    The purpose of this process is to ensure the adequate adaptation of the attention plan and the relevant services to best suit user needs arising from their blindness or visual impairment. Their active participation is sought in the identification of these needs. At this stage, users are offered support and initial orientation, their social needs are identified and an individualised attention plan is prepared. In this process, the following professionals intervene:

      - Social Workers who provide guidance, understanding and advice, regarding the emotional responses and possible concerns of users and their families, with respect to their living conditions. They explain and motivate the user regarding the purpose and objectives of this initial evaluation; they evaluate or determine the user's needs by means of a methodology based on a personal interview and the incorporation of the information already available (medical, ophthalmologic, etc.); together with the user, they assess which person(s) within their family or close circle could collaborate in the evaluation/attention process; they complete the above information, where necessary, with the specialised assessment of other professionals and draw up an initial proposal of services required.

      - The Department Head will be the one who assesses this initial proposal of services, compiles complementary information or seeks the addition of an assessment from other professionals where appropriate and assigns the user a particular professional or "Case Coordinator", thus ensuring:

        1. The sequenced, integrated and multidisciplinary application of the attention plan.

        2. The updating of the user's record, through the incorporation, by the professionals in attendance, of the pertinent information related to the services and resources provided.

        3. A response to any queries, suggestions or complaints on the part of the user, as well as to any others from other social agents such as the family, other professionals, representatives from the institution or from external institutions, etc.

        4. The continuous adjustment of the plan to the particular objectives and needs of the user;

      - Designate the case coordinator, striving to fulfil, fundamentally, the following criteria:

        1. That the professional in question intervenes in the individualised attention plan for the user.

        2. This professional will also operate from the service deemed most relevant or significant for the user's needs.

        3. And, finally, designate the rest of the professionals who will intervene in the individualised attention plan.

      - The Case Coordinator will take charge of: drawing up the individualised attention plan; presenting the Department Head with the proposed plan for approval: informing the user on his/her functions and duties as case coordinator, as well as on the channels and procedures available for optimising activities designed to support, coordinate and improve the attention provided or resolve any doubts and difficulties; and facilitating the understanding and acceptance on the part of the user of the individualised attention plan, as well as the assumption of an active role in its execution.



    C) Process of Service Provision.

    The purpose of this process is to ensure an interdisciplinary approach and a coordinated execution of the different interventions that go to make up each individualised attention plan, with a view to covering the user's needs in an integrated, effective fashion. At this stage, two professionals intervene:

      - The Case Coordinator periodically reviews, together with the intervening professionals, the individualised attention plan, making the necessary adjustments and coordinating its final evaluation; together with the user, he/she assesses the execution of the individualised attention plan, as well as the results obtained; and informs the Department Head of any change or pertinent modification in the user's individualised attention plan, as well as any complaints or claims that may arise.

      - The Department Head approves any substantial modifications or changes in the individualised attention plan; uses the evaluations from the different attention plans to improve the quality of the services offered by the Centre; and heeds any suggestions or complaints made, either by the blind or visually impaired users themselves, or by their relatives, by the "case coordinator" or by the professionals in attendance.

    Besides the intervention of the Multidisciplinary Teams in providing this employment service, on November 27th 1997 the ONCE constituted the Employment Committee for Members of the ONCE. Its principal goal is the execution of all kinds of joint programmes between the ONCE Foundation, the ONCE Business Corporation and the ONCE itself, in order to ensure the coordination of training and employment projects for the blind and visually impaired. Formed jointly by Teams from the ONCE Foundation, the ONCE Business Corporation and the ONCE, it takes charge of coordinating, fomenting and promoting employment both within and outside the ONCE structures, as well as carrying out research that could boost job opportunities. It also seeks to improve the qualifications of those blind and visually impaired workers seeking job or a better job, encouraging self-employment, analysing existing job opportunities and determining which are most suitable for blind workers.

    Among other actions, we must underscore the publication of training opportunities by the ONCE Foundation, ONCE Business Corporation and ONCE; the promotion of professional work experience placements; direct training aids; development of ideas and advice on setting up small companies (self-employment); carrying out a study of the labour market (list of the most demanded professions in the marketplace); selection of the profiles for professions that can be occupied by blind and visually impaired workers; proposals for the creation of jobs for the blind and visually impaired, after analysing the different causes that impede their work insertion.

    In parallel to these actions, great strides have been made in the fields of dissemination and informing, training and raising awareness among the different agents involved (the blind and visually impaired, employers, unions, etc.).

    As a conclusion, the bottom line is that the social services blind and visually impaired people receive in Spain - and therefore their quality of life - have reached such a level that we are in a position to affirm that, while it is necessary to continue making progress, their personal autonomy and social and labour integration are today a reality.




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