New Considerations for Employers Regarding Workplace
Integration: The Impact of Communication Disorders
Integration: The Impact of Communication Disorders
by Jacques Barrette Ph.D, Linda J. Garcia Ph.D. and Chantal Laroche Ph.D.
The aim of the present research was to examine with the help of manufacturing and service industry employers,
the factors that may prevent the occupational integration of persons experiencing communication disorders.
The identification of adjustment strategies that may be implemented by employers in order to facilitate the
workplace integration of such persons was also an objective. The information was collected by using focus
group and nominal group techniques and then analyzed on the basis of whether the barriers originated with the
individual, the organization or society. The qualitative differences were recorded according to whether the
participating employers were from the manufacturing or service industry. The results showed that many barriers
differ according to the industry sector and that the majority of barriers pertain to the nature of the work.
Recommendations regarding strategies to eliminate such barriers for persons with a communication disorder were
Current and upcoming technological change will make communication
an increasingly pervasive feature of the workplace environment.
In the past, the manufacturing sector provided a major part of
job opportunities (e.g., manufacturing plant). However, today's
workplace is shifting away from these types of jobs, as service
industry positions are growing at full speed. Over the next ten
years, the labour market, which is currently based on the secondary
sector , is expected to become a job market dominated by services
and communication technologies (Kutscher, 1992). The service industry
will likely provide 90% of all new jobs, many of which will be
related to customer services (Carey & Franklin, 1992). This technological
revolution is forcing individuals to retrain in the service industry
where communication is an important ability. This new workplace
must and will have to provide for the effective management of
disability and handicap situations. In fact, it is already faced
with several new handicap situations resulting from the specific
demands of service industry positions. For example, health problems
related to the intensive use of computers (e.g., eyesight) are
Although less known, communication disorders may also lead to
situations of handicap in the workplace. A communication disorder
is defined as an impairment in the ability to receive, transmit,
process and understand verbal and non-verbal concepts as well
as systems of graphic symbols (American Speech-Language-Hearing
Association, 1995). A communication disorder may be experienced
at the level of hearing, language and/or speech. Its range may
vary from light too severe and the disorder may be congenital
or acquired. In 1986, a survey indicated that 30% of Canadians
with disabilities experienced language-related (6%) and hearing-related
(24%) problems (Statistics Canada, 1990). However, the 1986 survey
did not necessarily identify individuals with more subtle communication
disorders, such as problems of comprehension not related to hearing,
such as those resulting from a stroke or cranial trauma or such
problems as stuttering (Johnson, 1987). Nonetheless these groups
may experience difficult situations with occupational reintegration.
Considering how important communication has become in the workplace,
one may reasonably think that persons with a communication disorder
are likely to experience an additional difficulty when they are
reinstated in their job or reintegrate the labour market. They
could be particularly disadvantaged with respect to the administration
of disability programs. The service industry runs the risk of
becoming a source of frustration and stress, and of generating
situations of handicap and discrimination. For individuals with
a communication disorder, the workplace may involve several major
challenges. First of all, many communication disorders, such as
hearing disorders, are invisible at first glance. Their invisible
nature prevents them from being taken into account when it comes
to workplace adjustment, such as is seen in workplace modification
for users of wheelchairs. Moreover, the lack of visibility along
with the small amount of research in this field make it extremely
hard for human resource management professionals, who are responsible
for staff hiring, work organization and disability management,
to be familiar with these types of handicaps.
Persons experiencing a communication disorder are often faced with the challenge of finding, either by their own
means or with the help of professionals (speech language pathologists, and audiologists), strategies to overcome or avoid the
barriers that prevent them from being full and active members of the working community. However, the challenge of work reintegration
does not only rest on the shoulders of persons with communication disorders or on the professionals that assist them. Employers
also have a vital role to play in this respect. They have the responsibility and the legal obligation to create a work environment
free of discriminatory barriers by adapting their management processes and workstations and by providing reasonable accommodation
(Garcia, Barrette & Laroche, 1999). This responsibility is extremely important as it involves substantial costs when it is ignored
or poorly managed.
It is estimated that disability management costs have increased by 35% since 1986 (Shrey & Lacerte, 1997). Given the importance
of communication disorders in society and the preponderance of necessary communication-dependent skills, one may logically think
that a substantial portion of these costs will be allocated to the management of disabilities related to communication disorders.
However, the non-reinstatement of persons with a disability does not only have a major monetary impact. The ineffective management
of disabilities produces negative effects such as the deterioration of the incumbent¹s health, lower productivity, the dissatisfaction
of colleagues and manager, the reinforcement of prejudices with respect to the alleged lack of productivity associated with disabled
persons, to name only a few. The absence of effective management programs would also be likely to have a discriminatory impact on
some groups based on their type of functional limitations (Rice & Kroll, 1994).
For the past few years, many researchers have attempted to better understand the challenges experienced in the workplace by
persons with a communication disorder (Black-Schaffer & Osberg, 1990; Carriero, Faglia, & Vignolo, 1987; Ezrachi, Ben-Yishay,
Kay, Diller, & Rattock, 1991; Felsenfeld, Broen & Mcgue 1994; Garcia, Barrette & Laroche, 2000; Hétu, Getty, & Waridel, 1994;).
These authors stated that a wide range of factors confronting persons with a communication disorder could affect their chances of
being reinstated in their job or their chances of being considered fairly in organizational processes such as staffing and performance
review. This literature suggests that such barriers be related to the work environment, job requirements, working conditions,
psychosocial relations and certain human resource management policies and systems.
As far as the work environment is concerned, one may argue that
the widespread use of communication equipment (phone sets, telephone
answering service, computers) and the physical layout of the work
premises (e.g., open space office) create barriers that hinder
work integration. Moreover, with respect to employment, the new
forms of work organization (e.g., self-managing and partially
self-managing groups) could prove to be obstacles likely to make
it harder for persons with communication disorders to adapt to
the workplace. On this subject, Rolland and Belin (1991) think
that extrinsic factors (the lack of adaptation of work environment)
impede the reintegration of persons experiencing language disorders.
Interactions with customers, colleagues and the supervisors could
turn out to be an additional difficulty for persons affected by
certain disorders, thus creating barriers at the social level.
Hetu, Getty and Waridel (1994) showed that subjects suffering
from hearing loss feared triggering negative perceptions and had
a tendency to isolate themselves in order to conceal their disability.
In his work, Rice (1995) showed that social alienation was a factor
affecting employment accessibility for stutters. Likewise, Rolland
and Belin (1991) showed that obstacles related to social acceptance
jeopardized the occupational reinstatement of persons experiencing
language disorders as a result of a stroke.
Several studies indicate that persons with communication disorders
were likely to be perceived negatively by those around them (Hetu,
Getty & Waridel, 1994; Kalinowski, Stuart, Armson & Lerman, 1996;
McKinnon, Hess & Landry, 1986). Negative biases against persons
with communication disorders could be especially significant during
the selection interview.
Once on the job, these persons must confront the internal promotion
system. In fact, current research indicates that employment status
and a decrease in advancement opportunities would be a major challenge
for persons with communication disorders (Felsenfeld, Broen &
McGue, 1994; MacLeod-Gallinger,1992; Rice & Kroll, 1994).
Historically, the workplace integration problems experienced
by persons with a functional limitation were attributed to the
person, i.e. his/her personal characteristics (education, motivation,
physical and mental skills, etc.). However, current models stress
the interaction between the person and his work environment (Fougeyrollas
et al., 1999). These models enable researchers to identify incompatibilities
and explain them according to whether the limitations are associated
with the individual or the environment. Once the incompatibilities
have been identified, the authors specify if the solution requires
a modified environment, the use of technological aids or the treatment
of the individuals functional limitations. In these models, and
particularly in the Disability creation process model (Fougeyrollas
et al., 1999), the handicap is not perceived as inherent to the
individual but rather as a situation that could occur as a result
of the interaction of both Personal Factors and Environmental
In such a model, the Environmental Factors may range from physical
factors such as noise to social factors such as the attitude of
co-workers. For example, a person suffering from hearing loss
could find that e- mail is a work facilitator, whereas the phone
set is a barrier. According to this viewpoint, some persons with
a communication disorder such as hearing loss, could experience
a situation of handicap if they were required to use a phone set
to perform their work, whereas other persons with the same functional
limitation could feel hey are fully participating in the work
environment if they were able to use e-mail. The objective of
this research is twofold; (1) to describe barriers to the workplace
integration of persons with a communication disorder, and (2)
to identify which accommodation strategies could be implemented
by the employer in order to facilitate the workplace integration
of such persons.
Six areas of communication disorders were considered as part
of the study: (1) speech disorders (e.g., dysarthria) include
problems associated with speech clarity and may be evidenced through
a nasal voice, monotonous speech, difficulty in producing clear
sounds, long sentences and in some cases the need to use an electronic
communication device; (2) stuttering is a disorder affecting speech
fluency and may take various forms such as the repetition of portions
of words, the lengthening of sounds, the insertion of sounds,
syllables or phrases; (3) total laryngectomy involves the absence
of vocal cords and the use of an alternative method for communicating
(e.g., artificial larynx); (4) aphasia is a language disorder
associated with a brain lesion, further to a stroke for example,
and may lead to problems such as a difficulty to find words, word
substitution, telegraphic speech, reading and writing problems;
(5) hearing disorders refer to problems with receiving an auditory
message, which may result mainly in a difficulty to hear certain
sounds, to understand speech surrounded with noise or to locate
sound sources, and may be accompanied by buzzing in the ears;
(6) voice disorders include problems related with voice quality
such as a hoarseness, excessive aspiration, voice loss or a voice
which does not match either the age or the sex of the person speaking
(excessively high or low pitch).
This project involved interviewing 22 employers (13 women, 9
men) from the private and public sectors in 4 small groups of
which two groups came from the manufacturing sector and two from
the services sector. Eleven participants were 41-50 years old,
six were 31-41 and five were 51-60. Twelve of them were from the
service industry and ten from the manufacturing industry. Participants
from the manufacturing sector were interviewed separately from
participants in the services sector. All the participants have
held positions with management responsibilities within their Human
Resources Department. Their average experience was 15 years. Employers
were identified through the local business community and a Montreal-based
consultant. These employers were selected based on the following
criteria: (a) their size, i.e. more than 400 employees, in order
to ensure a minimum staff turnover within the organization, (b)
the almost equal representation of the manufacturing and service
industries with a view to obtain a sufficiently broad range of
reference jobs, (c) the presence of a Human Resources professional
with at least 5 years of experience in the field in order to get
a perception based on a variety of experiences from each participant.
Data collection combined the focus group approach aimed at retrieving
perceptions (Brotherson, 1994; Morgan, 1988) with the nominal
group approach aimed at selecting and weighing the major barriers
(Brunelle, Drouin, Godbout & Tousignant, 1988). As employers could
be unfamiliar with communication disorders, they were shown a
video on the various communication disorders. This session was
followed by a question period. During the session, posters describing
the features of each communication disorder provided participants
with a practical reference, as needed. In line with the project
objectives, the first task asked of participants was to identify,
based on their actual experience, the workplace barriers which
they perceived as being likely to generate difficult communication
situations and prevent the hiring or integration of persons with
communication disorders. In focus groups, participants identified
numerous barriers that hinder or prevent workplace integration
or reinstatement, as well a wide range of strategies or concrete
means to bypass or lessen those barriers.
Upon arriving, participants, who were seated around the table
in-groups of 4 to 7, were invited to read an information letter
on the project, and to complete a consent form and a biographical
questionnaire. Each 3-hour session was recorded on an audio tape
(Sony Conference, Model BM-246) to enable researchers to return
to the source at a later time, if needed, in order to check the
understanding of certain barriers and strategies, the meaning
of which may not have been fully understood. Participants were
informed of the purpose of the recording and told that the tapes
would be destroyed once the project had been completed. The permission
to record and use only their first name was obtained after these
explanations were given.
Identification of Barriers and Strategies
Phase 1: Exploring Barriers. Once the purpose of the research
was explained to participants, they were invited to share their
perceptions with respect to workplace barriers that generate difficult
communication situations and may prevent persons with a communication
disorder from being hired or integrated. These employers were
encouraged to reflect on the existing barriers in their own work
environment. Each barrier was written down on a flip chart as
soon as it was mentioned, and we regularly ensured that the words
matched the ideas being expressed. This process continued until
no more ideas were found (approximately 1 hour). In order to trigger
the discovery of additional barriers, 2 job descriptions, taken
from the Canadian Classification and Dictionary of Occupations
(CCDO 1989), (e.g., police officer and travel agent) were presented
and read aloud. This was followed by the collection of barriers
perceived on the basis of these descriptions. During this exercise,
participants had to imagine themselves as employers for these
jobs. These descriptions were selected based on the variety of
the communication tasks required and the fact they were easy for
everyone to understand. Once the barriers had been described and
numbered, the facilitator eliminated, with agreement from the
group, all the redundant barriers. The employers produced a final
list containing 27 to 34 barriers, depending on the groups.
Phase 2: Identifying Major Barriers. The second task was to identify
the major barriers among all those listed. The nominal group procedure
was used to select and weigh the most important barriers. With
respect to the nominal group technique, Brunelle et al., (1988)
indicate that the number of final elements to be selected, barriers
in this case, depends on the number of distinct statements provided
by the group, i.e. 9 elements when more than 22 statements have
been identified. In order to perform this task, each subject received
a number of cards equal to the number of barriers to be selected,
and had to individually write down the number of the barrier selected
and its rank (e.g., 9, most important, to 1, least important).
Each participant selected their own subset of barriers and ranked
them from 1 to 9. In this way, each participant had a say in both
the chosen barriers and their importance. Afterwards, the results
were compiled for all the participants within the group and the
barriers that received the highest scores were retained.
Phase 3: Identifying Strategies. The third task was to identify
the strategies or means that could be implemented in order to
help overcome the barriers retained during Phase 2. Each barrier
was listed in the upper part of the flip chart and the strategies
were noted down under the relevant barrier as they were mentioned.
Participants were encouraged to suggest strategies for all the
persons concerned (employees, employers, professional practitioners).
A four-step classification process was used to extract the major
points that attracted the attention of participants and to turn
the information into interpretable data.
Step I: The goal of the first step was to extract from the data
a list of preliminary categories under which the barriers could
be grouped (e.g., interview process). A first list was produced
based on the preliminary definitions originating in part from
Fougeyrollas et al., (1999) environmental factors. Afterwards,
fifty barriers among those that were not retained at the previous
stage were selected randomly and classified by three evaluators
familiar with the research project. These 50 barriers represented
a sampling of the range of possible different environmental obstacles
to integration. When a barrier could not be classified in a category
or was disputed, it was noted and the category was reworked by
research group members who were not involved in the previous evaluations.
This step allowed us to verify to which extent the preliminary
categories (e.g., electronic tools, interview process, etc.) were
operational before classifying the final obstacles selected by
the respondents. Once these categories were identified and improved,
classification of the chosen barriers was much more systematic.
Step II: At this stage, the classification system obtained at
Step I was checked once again by the same three evaluators, who
reclassified the same 50 barriers, presented randomly this time.
Step III: Afterwards, the new classification was adjusted based
on the results of Step II, and all barriers (n= 33) selected as
the most important were then classified by 4 evaluators familiar
with this research. Any barrier that was not classified under
the same category by 3 out of 4 evaluators was reclassified by
2 additional evaluators whose final decision had to bring a consensus.
While this long classification process was taking place, Fougeyrollas
and his associates (1999) published an experimental questionnaire
concerning the measurement of environmental factors. It then became
clear that the data extracted from this study could be more useful
if the barriers were classified under neutral environmental factor
categories. This made it possible to contribute to the enhancement
of the model developed by Fougeyrollas et al., (1999) through
the identification of other environmental factors that include
barriers affecting persons with communication disorders but also
possibly person with other types of functional limitations. Thus,
the use of this neutral classification enabled us to incorporate
our results into a model with greater potential of being generalised.
For example, several barriers mentioned by the employers were
related to their expectations regarding employee performance (e.g.,
high employer expectations, increased work productivity, increased
expectations related to speed, etc.). These types of barriers
were grouped under a factor called "expectations related to productivity".
By grouping the barriers belonging to the same type under a single
neutral label, it became possible to evaluate the factors on a
barrier to facilitator continuum. This entire set of neutral factors
forms what we call the neutral final classification.
Step IV: At this step, the barriers judged most important were
classified by the three authors according to the neutral final
classification. The classification process led to the creation
of two major categories (organizational and social factors). Table
1 lists the barriers for each category of factors.
The participants identified 136 strategies to eliminate or bypass
barriers, i.e. 53 for the manufacturing sector and 83 for the
service sector, which were then classified on the basis of the
neutral final classification. The results of this study present
the barriers identified under each factor by all participants
as well as the major strategies suggested.
Table 1: Most important obstacles mentioned by the groups
American Speech-Language-Hearing Association. (1995). ASHA's
consumer conscience. ASHA Reports, May, 14.18.
Barrette, J. & Haccoun, R. (1995). La precision de l'evaluation
du rendement: une vérification de la theorie de Wherry. Revue
canadienne des sciences de l'administration, 12(4), 325-339.
Beukelman, D.R., Kraft, G.H. & Freal, J. (1985). Expressive communication
disorders in persons with multiple sclerosis: A survey. Archives
of Physical Medicine and Rehabilitation, 66, 675-677.
Black-Schaffer, R.M. & Osberg, J.S. (1990). Return to work after
stroke: Development of a predictive model. Archives of Physical
Medicine and Rehabilitation, 71, 285-290.
Brotherson, M.J. (1994). Interactive focus group interviewing:
a qualitative research method in early intervention. Topics in
Early Childhood Special Education, 14 (1), 101-118.
Brunelle, J., Drouin, D., Godbout, P. & Tousignant, M. (1988).
La supervision de l'intervention en activité physique. Montréal
: Gaetan Morin.
Canadian Classification and Dictionary of Occupations (C.C.D.O)
(1989). Gouvernement du Canada, Ministere des Approvisionnements
et Services. Classification Canadienne des Professions, 9 th.
Ed. Ottawa, Canada, Canadian Government Publishing Center.
Canadian Human Rights Commission. (1997). Employeur sans obstacles.
Internet: www.chrc.ca /barrier/index.htm.
Carey, M.L. & Franklin, J.C. (1992). Outlook - 1990-2005. BLS
Bulletin 2402. (Washington, D.C.: US) Department of labour, Bureau
of labour statistics.
Carriero, M.R., Faglia, Z. & Vignolo, L.A. (1987). Resumption
of gainful employment in aphasics: preliminary findings. Cortex,
Ezrachi, O., Ben-Yishay, Y., Kay, T., Diller, L. & Rattock, J.
(1991). Predicting employment in traumatic brain injury following
neuropsychological rehabilitation. Journal of Head Trauma Rehabilitation,
Felsenfeld, S., Broen, P.A. & Mcgue, M. (1994). A 28-year follow-up
of adults with a history of moderate phonological disorder: Educational
and occupational results. Journal of Speech and Hearing Research,
Fougeyrollas, P., Cloutier, R., Bergeron, H., St. Michel, G.,
Cote, J., Cote, M., Boucher, N., Roy, K., & Remillard, M.B. (1999).
The Quebec Classification: Disability Creation Process. Lac St-Charles,
P.Q.: International Network on the Handicap Creation Process.
Fougeyrollas, P., Noreau, L. & St Michel, G. (1997b), Measure
of the quality of the environment, ICIDH Environmental Factors
International Network, 9(1), 32-39.
Garcia, L.J., Barrette, J. & Laroche, C. (1999). Towards a social
model on the integration of persons with human communications
disorders into the work place. International Journal of Practical
Approaches to Disability, 23(3), 14-23.
Garcia, L.J., Barrette, J. & Laroche, C. (2000). Perceptions
of the obstacles to work reintegration for persons with aphasia.
Aphasiology, 14, (3), 269-290.
Getkate, M., Hausdorf, P. & Cronshaw, S.F. (1992). Transnational
validity generalization of employment tests from the United States
to Canada. Canadian Journal of Administrative Sciences, 9(4),
Hétu, R., Getty, L. & Waridel, S. (1994). Attitudes towards co-workers
affected by occupational hearing loss II: focus group interviews.
British Journal of Audiology, 28, 313-325.
Jackson, D.N., Peacock C.P. & Smith J.P. (1980). Impressions
of personality in the employment interview. Journal of Personality
and Social Psychology , 39(2), 294-307.
Johnson, R. (1987). Return to work after severe head injury.
International Disability Studies, 9, 49-54.
Kalinowski, J., Stuart, A., Armson, J.,. & Lerman, J.W. (1996).
Speech clinicians and the general public's perceptions of self
and stutterers. Journal of Speech-Language Pathology and Audiology,
Kutscher, R.E. (1992). Outlook 1990-2005: major trends and issues.
Occupational Outlook Quarterly, 36(1), 2-5.
Macleod-Gallinger, J.E. (1992). The career status of deaf women:
a comparative look. American Annals of the Deaf, 137, 315-325.
Mckinnon, S.L., Hess, C.W. & Landry, R.G. (1986). Reactions of
college students to speech disorders. Journal of Communication
Disorders, 19, 75-82.
Morgan, D.L. (1988). Focus groups as qualitative research. Qualitative
research methods. Volume 16. New Park, California: Sage Publications.
Nester, M.A. (1984). Employment testing for handicapped persons.
Public Personnel Management Journal, 13, 417-434.
Rice, M. & Kroll, R. (1994). A survey of stutterer's perceptions
of challenges and discrimination in the work place. Proceedings
of the First World Congress on Fluency Disorders, 2, 559-562.
Rice, M. (1995). Work place experiences of people who stutter.
Paper presented at the meeting of the World Conference of the
International Fluency Association, Linkoping, Sweden.
Rolland, J. & Belin, C. (1991). L¹aphasique et le monde du travail.
In J. Ponzio, D. Lafond, R. Degiovani & Y. Joanette (Eds.) L'aphasique
(pp. 195-211). Montréal: Edisem, Inc.
Shrey, D.E. & Lacerte, M. (1997). Principles and practice of
disability management in industry. GR Florida, Press Inc.
Statistics Canada. (1990). Highlights: Disabled Persons in Canada.
The Health and Activity Limitation Survey, Ottawa, Catalogue #
Jacques Barrette, Ph.D.
University of Ottawa
School of Management
136 Jean Jacques Lussier
Canada K1N 6N5
Linda J. Garcia, Ph.D.
Audiology and Speech-language Pathology Program
University of Ottawa
University of Ottawa Institute on Health of the Elderly
Chantal Laroche, Ph.D.
Audiology and Speech-Language Pathology Program
School of Rehabilitation Sciences
Faculty of Health Sciences
University of Ottawa
45 Smyth road, # 3062
Canada, K1H 8M5
tel: (613) 562-5800 #3066
fax: (613) 562-5428
This project was funded by the Social Sciences and Humanities
Research Council of Canada and the Status of Disabled Persons
Secretariat, Grants No. 817-95-1004. This project was also supported
by and carried out in partnership with the following organizations:
Quebec Telephone, The National Bank, The Canadian Human Rights
Commission, the Montreal Association of Laryngectomees, Canadian
Voice Care Foundation, Canadian Hard of Hearing Association, the
Canadian Hearing Society, the Canadian Association for People
who Stutter, Canadian Association of Speech-Language Pathologists
International Journal of Disability, Community &
Volume 1, No. 1 Canada