Correlates of vocational outcomes of youth with co-occurring mental illness and substance use disorders: Evidence from a vocational rehabilitation program

There are many differences between state and local special education programs and the state-federal vocational rehabilitation (VR) program. The differences are highlighted through discussion of the history of the state-federal VR program, differing definitions of individuals with disabilities (used in VR and special education), operation of the VR program, and funding differences and resultant differences in evaluation standards between VR and special education programs. Recommendations are made to effect productive interaction between special education and state-federal VR agencies.

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.

The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program. Data were from 450 Social Security Disability Insurance beneficiaries with psychiatric disabilities enrolled in a multisite study of supported employment. Earnings over two years were used to calculate provider payments under two reimbursement formulas used in the Ticket program. Only a quarter of service recipients (26 percent) reached earnings levels that would have triggered provider payments under the first reimbursement formula. Only 4 percent would have completed their trial work period and left the rolls, generating payments under the second formula. The current provider payment systems of the Ticket to Work program do not reflect the reality of rehabilitation for individuals with severe mental illness. Reforms should take into account outcomes of return-to-work services for this population.

Persons with disabilities (PWDs) are disproportionately unemployed, underpaid, and underemployed despite their desire and capacity to work. The U.S. federal/state vocational rehabilitation (VR) program, under the supervision of the Rehabilitation Services Administration (RSA), is charged with providing services to assist eligible PWDs (VR consumers) in achieving employment. Despite research showing that VR consumers closed to self-employment (vs. non-self-employment closures) have better outcomes, self-employment is often considered as a last resort. Moreover, some evidence suggests self-employment (like non-self-employment) outcomes are associated with VR consumers’ gender and racial/ethnic identity. The objective of this study was to determine trends of case closures in self-employment among PWDs within the VR program from 2011–2013 to 2017–2019 and to examine the effects of gender and race/ethnicity on self-employment outcomes. Variables of interest were obtained from RSA’s Case Service Report (RSA-911) data set for 2011, 2012, 2013, 2017, 2018, and 2019. Data were recoded and analyzed. The number of closures in self-employment declined significantly. Weekly earnings in self-employment increased. Time from application to closure in self-employment decreased. Differences in VR self-employment outcomes by race/ethnicity and gender were noted. Efforts should be made to increase competency in self-employment of VR counselors and promote self-employment within the VR program.

Objective: Transition-aged young adults (TAYA) with disabilities face high rates of unemployment and underemployment. Although assistive technology (AT) services can improve em­ployment outcomes in state vocational rehabilitation (VR) programs, they remain underutilized with notable disparities. This study examined how sociodemographic factors and their interactions predict the receipt of AT services for TAYA with disabilities. Methods: A retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report from fiscal years 2017–2019 was conducted. The sample included 271,698 cases reporting a disability, aged 18–24, and eligible for VR services. Multiple logistic regression analysis was used to examine the main and interaction effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. Results: Results indicated that less than 3% of TAYA with disabilities in the study sample received AT services. Characteristics associated with a lower likelihood of receiving AT services included being unemployed, from a minority group, having a significant disability, being older, having cognitive or mental health conditions, and not being enrolled in post-secondary education (PSE). Discussion and Conclusion: Findings suggest that AT services are underutilized, particularly for TAYA with cognitive and mental disabilities, those not enrolled in PSE, or those who are unemployed. These findings highlight the need for targeted efforts to enhance VR AT services to support employment transitions. Increasing AT training in rehabilitation educational programs and in-service training may improve service utilization. Future research should focus on evidence to support AT use in vocational settings and on developing guidelines for employment transitions.

This study examined data provided by the US Department of Education's Rehabilitation Services Administration (RSA) in an effort to evaluate the relationship between (a) demographic variables and vocational rehabilitation (VR) services and (b) the employment outcomes of transition-age youth with traumatic brain injuries. Not applicable. Data for 1546 transition-age youth (ie, 16-25 years of age) with traumatic brain injuries were examined. Purposeful selection of multivariate logistic regression was employed to analyze the data. Not applicable. Receipt of more VR services at higher expenditure levels over shorter periods of time was related to case closure in successful competitive employment status. Also, higher levels of education at the time of enrollment in the VR program (ie, bachelor's degrees or higher); nonreceipt of social security disability benefits at the time of enrollment in the VR program; and receipt of VR services such as occupational/vocational training, job search, job placement, on-the-job support, maintenance, and information/referral were associated with competitive employment outcomes. Client demographic and VR service-related variables significantly predict competitive employment outcomes for transition-age youth with traumatic brain injuries. Vocational rehabilitation services should focus on the specific interventions that are most closely associated with successful rehabilitation.

Background Helping young adults with mental illnesses attend college will increase their chances of being employed with benefits, which can pave the way for a successful career and a middle-class life. Objective This study sought to examine whether receiving vocational rehabilitation (VR) services of four-year college or university training would lead to improved employment outcomes for young adults with mental illnesses. Methods Based on the Rehabilitation Services Administration (RSA)-911 data, a propensity score matching technique was employed to create a comparison group of young adults with mental illnesses who did not receive college or university training and a treatment group of those who did. The quasi-experimental design investigated differences in the employment outcomes between the two groups. Results Analyses revealed that the group who received college or university training was more likely to be engaged in competitive integrated employment upon exit from the VR program than the matched comparison group who did not receive the training. Participants with mental illnesses who received college or university training and had secured competitive integrated employment at the time of exit not only had significantly higher hourly wages and worked more hours per week than did non-college or university training recipients, they were also more likely to obtain employer-subsidized health insurance benefits. Conclusions College and university training is positively related to employment outcomes for young people with mental illnesses. Implications for state VR counsellors are discussed.

Purpose Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. Materials and Methods This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education’s Rehabilitation Services Administration’s Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. Results For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. Conclusions Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

Purpose Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services. Materials and methods This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report from fiscal years 2017–2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data. Results Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all p < .001). Conclusion The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided. IMPLICATIONS FOR REHABILITATION Increasing assistive technology (AT) training in counsellor education and offering more AT training for in-service rehabilitation counsellors to increase their competence to serve individuals with diverse disabilities, particularly those with cognitive and mental disabilities. Counsellors should be encouraged to use a team approach to ensure the most effective AT solutions are provided, and improve access to age-appropriate AT for younger individuals. Counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, and develop effective means for educating less-informed individuals about the benefits of AT, and recognise the limited access of minority groups to receive services within vocational rehabilitation programs.

Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge. An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System - Veterans Integrated Services Network. Multivariable logistic regression analyses showed psychological empowerment (confidence in one's ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed. Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study's ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans' successful reintegration into the workforce and society).

Use of Psychoactive Substances and Health Care in Response to Anxiety and Depressive Disorders

Background: Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS). Objective: The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits. Methods: We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression. Results: A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes. Conclusion: VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.

The present study's objective was to assess the extent of collaboration between VR programs and MH programs that serve this age group and to identify interorganizational factors associated with collaboration levels. Participants were 100 key informants from VR, and child mental health (CMH), transition-age youth MH (TAYMH), and adult mental health (AMH) programs in communities that received federal funding to improve services for TAY with or at risk of SMHC. Participants completed web surveys that queried four interorganizational factors and employed a modified social network analysis methodology to assess collaboration levels. The interorganizational factor, depth of knowledge, had a strong and consistent association with collaboration levels. There was little difference in MH-VR collaboration levels between MH programs serving different age groups. However, VR programs and CMH programs had both lower depth of knowledge of each other and lower collaboration levels, compared to TAY and AMH programs. Collaboration between VR and MH programs is instrumental to making sure that TAY with SMHC receive appropriate career development and employment services. Increasing the depth of knowledge that programs have about each other may enhance collaboration and appears particularly needed between VR and CMH programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Randomized Controlled Trial of a Supported Employment Program for Persons With Long-Term Mental Illness in Hong Kong

ABSTRACTEmployment has consistently proven to increase treatment retention and lead to sustained recovery among individuals with substance and alcohol use disorders; however, rates of employment remain low for this group and the utilization of employment services by treatment professionals continues to be quite limited. Employment is listed as a primary goal in treatment plans; therefore, employment specialist (i.e., Vocational Rehabilitation Counselors) and treatment professionals should work in tandem to assist in the realization of this goal. Vocational rehabilitation provides a number of specialized services, which serve to increase the likelihood of obtaining gainful employment. Addiction professionals generally identify these services as ancillary, but should recognize the importance of offering them throughout the entire treatment and recovery process. This study utilized employment data obtained from the Rehabilitation Services Administration for 2010–2014 and sought to identify trends associated with services that predict a greater likelihood of obtaining employment. Utilizing regression analyses, results pinpoint two services, on-the-job supports and job placement assistance, which most consistently predicted successful employment outcomes. A discussion of these services and the importance of integrating employment services throughout the treatment process is included in this study as well.