Division Of Vocational Rehabilitation Research Articles

Have We Responded to the Call? A 25-Year Follow-Up on Multicultural Rehabilitation Counseling

Twenty-five years ago, a group of rehabilitation scholars called out the numerous areas lacking multiculturalism representation in the rehabilitation field. Areas included our Code of Professional Ethics, educational standards, professional organizations, and the Division of Vocational Rehabilitation. Each area held grave limitations 25 years ago, but how have they adapted since then? This article dives into each area identifying the key progress made in the last 25 years, along with improvements still needed to adequately include multiculturalism in our field. Specific implications for future education, advocacy, and practice are provided.

Identifying Best Practices for Long-Term Success in Supported Employment

Supported employment (SE) and customized employment are key services designed to assist individuals with significant cognitive and psychosocial disabilities successfully obtain and maintain employment. The Wisconsin Division of Vocational Rehabilitation (DVR) sought to better understand whether individuals receiving SE through the public VR program returned for further employment assistance following successful case closure. Patterns in service delivery between non-return and return consumers were identified and can be used to inform best practices in serving these populations. Several types of services (e.g., On-the-Job Training) were determined as significantly associated with one’s return to VR, indicating that consumers with significant disabilities may return for further services following successful case closure. DVR counselors should be aware that consumers achieving successful supported employment outcomes may need additional or continuous disability-specific or job-related training and support.

Editorial: Promoting Readiness of Minors in Supplemental Security Income (PROMISE) Within Wisconsin’s Division of Vocational Rehabilitation

Editorial: Promoting Readiness of Minors in Supplemental Security Income (PROMISE) Within Wisconsin’s Division of Vocational Rehabilitation

Stages of Change Scale to Measure Work Readiness of Transition-Age Youth With Disabilities: A Promising Approach

The experience of transitioning into adulthood is a critical phase in life. The navigation of government benefits adds further complexity that can affect employment outcomes for youth with disabilities. Some individuals hesitate to work out of fear to losing access to monetary, disability, and related health care benefits. However, using available work incentives while pursuing employment and career paths can provide opportunities to work and address poverty without forgoing needed services. The Wisconsin Promoting Readiness of Minors in Supplemental Security Income (PROMISE) research grant aimed to positively change youth readiness to work through the use of Motivational Interviewing, work incentive benefits counseling, financial capability building, shifting expectations, and help in navigating transition resources. To measure the impact on readiness to work, 126 transition-age youth receiving supplemental security income (SSI), 188 of their family members, and 411 Division of Vocational Rehabilitation (DVR) counselors working with the youth and families completed a modified Stages of Change Scale survey. Results indicated that youths’ work readiness and positive feelings about work significantly increased from baseline to follow-up, along with an increase in employment rates. The implications of these findings highlight the utility of incorporating the stages of change theory into the design and implementation of services and supports to increase work readiness for youth with disabilities in transition.

Vocational outcomes of state vocational rehabilitation clients with traumatic brain injury: A review of the Missouri Model Brain Injury System Studies

Although there is considerable research on the vocational outcomes of individuals with traumatic brain injuries (TBI), there has been minimal research on the characteristics of persons with TBI who seek services from state vocational rehabilitation services. Such research is deemed critical given the significant number of individuals who request such services, as well as the significant federal and state costs associated with these programs. The current article reviews a series of studies completed collaboratively between the University of Missouri-Columbia and Missouri Division of Vocational Rehabilitation (DVR). Information is reported regarding the typical demographic, injury severity, and neuropsychological characteristics of DVR clients with TBI, as well as the most common DVR services provided to them and their vocational outcomes (i.e., successful, unsuccessful). Studies are reviewed which indicate that the provision of specific DVR services predict successful vocational outcomes, although traditional medical and neuropsychological variables do not. Additional studies are reviewed which examine the impact of gender, race, age, geographic location (i.e., rural vs. urban), and concomitant disabilities on vocational outcomes. Results indicate the importance of considering environmental and social factors when providing vocational rehabilitation services to clients with TBI, and that specific DVR services can lead to successful vocational outcomes regardless of TBI severity. Implications for future clinical services and research are presented.

Predictors of success for state vocational rehabilitation clients with traumatic brain injury

Johnstone B, Vessell R, Bounds T, Hoskins S, Sherman A. Predictors of success for state vocational rehabilitation clients with traumatic brain injury. Arch Phys Med Rehabil 2003;84:161-7. Objectives: To determine the characteristics of individuals with traumatic brain injury (TBI) who request state vocational rehabilitation services and to determine the best predictors of their successful vocational outcomes. Design: Observational study. Setting: Vocational services data from the Missouri Division of Vocational Rehabilitation (DVR). Participants: Seventy-eight individuals with TBI who requested services from the Missouri DVR. Interventions: Not applicable. Main Outcome Measures: Demographic, injury severity, neuropsychologic variables, vocational services offered, and vocational status at time of case closure (successful, unsuccessful, services interrupted, no services provided). Results: Individuals requesting DVR services were primarily men (71%), white (82%), single (47%), of low average intelligence (Wechsler Adult Intelligence Scales[ndash ]III full scale IQ score, 84.8), and of limited education (11.8y). The majority experienced a significant TBI (ie, 66% were hospitalized after their TBI; 56% reported loss of consciousness; 37% reported posttraumatic amnesia; 32% reported multiple TBIs; avg time since injury, 9.2y). At DVR case closure, 17% were rated as being successfully employed, with nearly all working in industrial, service, or clerical positions (2 in a sheltered workshop, 1 in a professional position). Stepwise logistic regressions indicated that delivery of DVR services (ie, vocational guidance and counseling, on-the-job training) predicted vocational outcome and demographic, injury severity, and neuropsychologic variables did not. Conclusions: DVR clients have multiple impairments that affect them several years postinjury; the provision of DVR services may be more important in determining vocational outcomes than traditional medical, psychologic, and demographic variables. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Race differences in a sample of vocational rehabilitation clients with traumatic brain injury

Objective : To evaluate race differences in demographics, injury severity, and vocational outcomes for persons with TBI. Participants : Seventy-five individuals with TBI (13 African American, 62 Caucasian) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a 2-year period. Measures : Demographics (i.e. age, race, level of education), injury severity (i.e. LOC, PTA, length of hospitalization, neuropsychological test scores), VR services provided (e.g. transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs unsuccessfully employed; cost per case). Procedure : All participants completed a standard neuropsychological evaluation and completed VR services (i.e. were followed from enrolment to case closure). Hypotheses : African Americans and Caucasians would not differ in demographics or injury severity, although fewer African Americans would be successfully employed through DVR. Analyses : Chi-squares and non-parametric MANOVAs to evaluate race differences in terms of demographics, injury severity, vocational services provided and vocational outcomes. Results : As hypothesized, there were few race differences in demographics or injury severity, although African Americans received significantly more transportation services (62 vs 21%). Contrary to hypotheses, there was no difference in the number of successfully employed African Americans (23%) vs Caucasians (18%). Conclusions : African Americans and Caucasians with TBI achieve similar vocational successes if they receive state VR services

Adolescents with Meningomyelocele

The multiple physical and health problems that the child with myelodysplasia brings to adolescence have been described in some detail. The variations from the normal ranges of adolescent development, which this group of patients show, will exaggerate some of the problems of social and emotional adjustment, and the growth and hormonal changes of adolescence may exacerbate such problems as hydrocephalus, renal insufficiency, and scoliosis. Fortunately, not all of the problems are experienced by each patient and they do not occur suddenly and simultaneously but rather extend over the patient's life. Some of the problems can be minimized by the type of care undertaken in the child's earlier years. The complications of gross cephalomegaly due to untreated hydrocephalus and the risk of early death due to renal failure in those patients with treated hydrocephalus have now virtually disappeared for children who survive to the age of adolescence. It is realistic to think that improvements in stabilization of the spine and management of the bladder will as markedly reduce those serious complications in infants and young children now entering treatment programs. Unfortunately, no matter how much progress there is in the medical and surgical management of children with meningomyelocele, they will still have the problems of paraplegia. Our task, then, is to communicate to their families what previous patients have taught us about these problems: how to avoid unnecessary secondary complications and how to assist the children and other family members in their continual growth and development. With early emphasis on having the child develop appropriate self-care skills, we are seeing fewer children enter their adolescence still dependent upon adults for toileting and for care to prevent decubiti. The physician who has been caring for a child with myelodysplasia from early infancy, who is familiar with the family's ability to cope, and who is well informed about the patient's condition should be the best health guide through adolescence. Unfortunately, the complex nature of the early medical-surgical problems often side-tracks the family from local medical care. Current ease of telephone communication makes it possible to offer the consultation of the speciality clinic to the local physician and every effort should be made to establish and maintain primary care resources and responsibility in the local community. In some communities, there will be a pediatrician, in others a family physician, public health nurse, or visiting therapist. Probably the most effective advocate in lobbying for societal changes that will allow all of our citizens to reach their potential will come from those directly involved. Programs such as the Special Olympics and wheelchair sports, and volunteer groups that provide activities socially appropriate for this age group, need to be supported and expanded. Increased assistance under the Developmental Disabilities Act, which mandates educational programs for the physically handicapped as well as for retarded individuals, will help meet the special requirements of this population. Vocational counseling through such agencies as the Division of Vocational Rehabilitation is available in most states, and most involved professionals are aware that such counseling needs to be extended to younger age groups and mesh with early educational planning. Social workers and public health personnel should directly assist the young patient in obtaining funds for continued medical care, driver's training, and housing through such programs as Social Security Insurance, Medicaid, and special loans for housing for the physically disabled. Attachment to a citizen advocacy group, such as the Spina Bifida Association of America (343 S Dearborn Ave, Chicago, IL 60604), will afford the support of a large network of individuals who have already solved many of the problems and who will be most responsive to the need for further active involvement in improving the welfare of all handicapped persons.

Adolescents with Meningomyelocele

The multiple physical and health problems that the child with myelodysplasia brings to adolescence have been described in some detail. The variations from the normal ranges of adolescent development, which this group of patients show, will exaggerate some of the problems of social and emotional adjustment, and the growth and hormonal changes of adolescence may exacerbate such problems as hydrocephalus, renal insufficiency, and scoliosis. Fortunately, not all of the problems are experienced by each patient and they do not occur suddenly and simultaneously but rather extend over the patient's life. Some of the problems can be minimized by the type of care undertaken in the child's earlier years. The complications of gross cephalomegaly due to untreated hydrocephalus and the risk of early death due to renal failure in those patients with treated hydrocephalus have now virtually disappeared for children who survive to the age of adolescence. It is realistic to think that improvements in stabilization of the spine and management of the bladder will as markedly reduce those serious complications in infants and young children now entering treatment programs.Unfortunately, no matter how much progress there is in the medical and surgical management of children with meningomyelocele, they will still have the problems of paraplegia. Our task, then, is to communicate to their families what previous patients have taught us about these problems: how to avoid unnecessary secondary complications and how to assist the children and other family members in their continual growth and development. With early emphasis on having the child develop appropriate self-care skills, we are seeing fewer children enter their adolescence still dependent upon adults for toileting and for care to prevent decubiti.The physician who has been caring for a child with myelodysplasia from early infancy, who is familiar with the family's ability to cope, and who is well informed about the patient's condition should be the best health guide through adolescence. Unfortunately, the complex nature of the early medical-surgical problems often side-tracks the family from local medical care. Current ease of telephone communication makes it possible to offer the consultation of the speciality clinic to the local physician and every effort should be made to establish and maintain primary care resources and responsibility in the local community. In some communities, there will be a pediatrician, in others a family physician, public health nurse, or visiting therapist.Probably the most effective advocate in lobbying for societal changes that will allow all of our citizens to reach their potential will come from those directly involved. Programs such as the Special Olympics and wheelchair sports, and volunteer groups that provide activities socially appropriate for this age group, need to be supported and expanded. Increased assistance under the Developmental Disabilities Act, which mandates educational programs for the physically handicapped as well as for retarded individuals, will help meet the special requirements of this population. Vocational counseling through such agencies as the Division of Vocational Rehabilitation is available in most states, and most involved professionals are aware that such counseling needs to be extended to younger age groups and mesh with early educational planning. Social workers and public health personnel should directly assist the young patient in obtaining funds for continued medical care, driver's training, and housing through such programs as Social Security Insurance, Medicaid, and special loans for housing for the physically disabled. Attachment to a citizen advocacy group, such as the Spina Bifida Association of America (343 S Dearborn Ave, Chicago, IL 60604), will afford the support of a large network of individuals who have already solved many of the problems and who will be most responsive to the need for further active involvement in improving the welfare of all handicapped persons.

Editorial

Editorial Teachers and other professionals in the field of deafness are well aware that there have never been residential treatment facilities available for those youth who were severely psychologically disturbed. This gaping absence of services has been devastating to deaf children (and their families) needing help for mental illness. After all these years of nothing, Michigan has finally made a breakthrough. The Hawthorn Center (Northville, Michigan 48167), long an outstanding residential treatment center for children, has over the last decade worked closely with the Michigan School for the Deaf and other programs in the state. Through this consultation their staff saw a need for services. In response they have developed an inpatient and outpatient mental health program for deaf youth at the Center. Unfortunately, Hawthorn takes only Michigan residents. However, in trying to share with others the principles they use in working with mentally ill deaf youth, the Center has developed a film on their work (available through Mr. Jim Haring of the Center). St. Elizabeth's Hospital (Washington, D.C. 20032) has an inpatient treatment program for mentally ill deaf adults. It has taken some deaf adolescents due to the lack of treatment alternatives for these youth. The new program in Connecticut may offer services to youth in that state, and Maryland now has an outpatient service for deaf mentally ill patients. BUDGET CHAOS AND DEAFNESS The chaos which has characterized the development of the upcoming federal budget leaves most of us unclear about the ultimate effects the process will have on deaf people. The Rehabilitation Services Administration funds for longterm training in deafness were cut some 33% for fiscal year 1980 which was a greater reduction than that experienced for any other rehabilitation discipline. For example, the corresponding budget for blindness was only cut 1.5%. Unfortunately, federal budgetary and policy decisions in both education and rehabilitation are frequently made by bureaucrats or politicians who have no in-depth knowledge of deafness . The capriciousness of the process was vividly revealed in the Atlantic Monthly's article on David Stockman. LEGAL ISSUES The argument over who should pay for interpreting services for deaf college students continues to rage. A New Jersey Federal Court recently ordered the State Division of Vocational Rehabilitation, not Kean College, to pay in the case of Ruth Shomstein. Cases such as this illustrate another dimension of federal fiscal irresponsibility. When laws such as PL 94-142 and the V.R. Act of 1973 are passed dictating massive services without consideration of costs, the end result is money wasted. For example, if the Maryland Division of Vocational Rehabilitation (DVR) had to pay for interpreting services for all deaf college students in Maryland who requested interpreters, funds otherwise spent on more needy deaf clients would have to be diverted to college students. Until some coherent funding is developed for PL 94-142 and the V.R. Act of 1973, we will continue to have a situation in which federally passed legislation promises the "world" to handicapped people. At the same time expanding rights and services are being guaranteed by this gradiose legislation, the money to fund them is either not appropriated or else it is taken from existing funds for other already established programs for disabled persons. Whereas, the established programs had ways to set priorities which helped assure that the money was spent wisely, the court decisions growing out of PL 94-142 and the V.R. Act of 1973 make no pretense of even considering the economic effects of the verdicts. Thus, there is no prioritizing , only arbitrary court decrees which depend on who decided to litigate. It is ironic that the politicians and bureaucrats who conceive such irresponsible patently ridiculous financial foundations for legislation and programs for the disabled would never consider comparable plans for their own personal finances or the finances of their businesses. For handicapped children and adults the end result is that what sounds wonderful when enacted into law turns out to be a set of promises minus the collateral needed for implementation. Would it not be better to have more realistic legislation appropriately funded than the current deception of promising everything while appropriating for little or none of what is...

A Pilot Course to Assist Blind Potential Teachers

A pilot three-credit course for blind students considering becoming teachers was offered by Illinois State University in cooperation with the Illinois Division of Vocational Rehabilitation. The goal of enhancing the probability of the students’ successfully entering the teaching profession was pursued through practicum experiences, a Practical Approaches Laboratory, mock lessons, materials preparation workshop, lecture-demonstrations, mock interviews, conferences, and exercises in problem-solving.

State-Federal Rehabilitation Program

This is the testimony of Craig Mills, Director Florida Division of Vocational Rehabilitation, presented to the Select Subcommttee on Education of the Committee on Education and Labor, U.S. House of Representatives.

Evaluation of nutritional status of selected hospitalized patients

Serum albumin, extractable protein per hair root, levels of vitamin A, C, and E, hemoglobin, hematocrit, and body weight were analyzed in 51 hospital employees, 144 patients whose hospitalization was supported by the Division of Vocational Rehabilitation, and 351 more seriously ill patients on the medical service of a referral hospital. There was a significantly increased frequency of low levels of each nutritional parameter in the hospitalized patients compared with the control group of employees, with 12 to 24% of the Vocational Rehabilitation patients and 17 to 45% of the medical service patients showing findings below the lower limits of normal. Analysis of the findings in patients in various diagnostic categories showed the highest frequency of evidence of malnutrition in those with alcoholic liver disease and the lowest frequency in patients admitted for complications of diabetes mellitus. Relatively selective deficiencies were found in some other groups; for example, the highest frequency of low ascorbic acid levels (42%) was found in patients with peptic ulcer disease. Comparison of protein/hair root findings with serum albumin concentration showed a similar level of sensitivity but greater specificity of the former determination in reflecting tissue protein deficiency.

MEASURING AGENCY ATMOSPHERE AND COUNSELOR STYLE

A preliminary questionnaire designed to measure confrontive counseling styles was given to 101 counselors from the state division of vocational rehabilitation (DVR) and the state employment service (ES). The responses were analyzed to see which items discriminated between agencies and between the counselors' sexes, ages, levels of education, and number of years with the agency. There were 13 significant (p = .01) items and they are described and discussed.

Journey toward literacy: Case study of a disabled reader

But this student was a serious, highly motivated young man of average ability. The vocational agency finally placed him in a dental mechanics shop. He liked this, was ambitious to learn and advance. He wanted to be a "top gold man" — and he knew he needed more reading. In order to fill the reading gap which might have interfered with job advancement, the Division of Vocational Rehabilitation paid his tuition fees for some time. Later he paid them himself.

Employment of the Mentally Retarded

A survey was made of the records in the state office of the Division of Vocational Rehabilitation to determine the extent to which educable retarded youth found employment on jobs for which they were trained in the Texas statewide Cooperative Program of Special Education in the public schools. Records for a 26 month period provided the data. A total of 1127 (787 male and 341 female) out of 1405 (977 male and 428 female), or 80.2 percent, secured employment on a job for which they were trained. The difference between male and female students was less than 1 percentage point.

The Self‐Concept of Welfare Recipients

Do persons receiving welfare feel differently about themselves and others than persons who are not welfare recipients? Does duration of time on welfare have any bearing on these feelings? To answer these questions the writer compared 2 groups of clients who were receiving services from the Division of Vocational Rehabilitation, using a number of scales that reflected attitudes regarding self and others. One group consisted of clients who were on welfare at the time of application for rehabilitation services and the other group consisted of those who were not. The welfare group was further broken down into 3 groups on the basis of the duration of time that they had been on welfare. No differences were found between any of the groups on self‐concept, self‐acceptance, ideal‐self or concept of others. Some variables that might be masking the hypothesized differences, thus accounting for the present findings, are discussed.

Predicting Rehabilitation Success with the MMPI and Demographic Data

The purpose of this investigation was to assess the value of selected demographic and personality variables in the prediction of rehabilitation success of handicapped individuals. Demographic data and MMPI scores of 79 clients who had been served by a state Division of Vocational Rehabilitation (DVR) were used as predictor variables in a multiple‐regression analysis. An attempt was made to predict three criteria: occupational level, upward mobility, and closure status. The multiple correlations for each of the three regression equations approached significance at the .05 level. Correlations significant at the .05 level, were found between age at onset, age at time of application, type of disability, and education, for one or more of the criteria. Significant beta weights were obtained for age at time of application, IQ, and the Mf, K, and Pd scales from the MMPI.

Vermont Pilot Study on Industrial Homework

The Pilot Study here described is a direct outgrowth of the Workshop on Industrial Homework (representing thirty-one states) held in Washington, D. C., in March 1954, under the joint sponsorship of the American Foundation for the Blind, National Industries for the Blind, and the Office of Vocational Rehabilitation. At the close of these sessions, the sponsoring agencies were asked to activate the findings of the workshop through a demonstration pilot study preferably in a rural location. It was also stipulated that such a study be integrated so as to serve all disabilities. At the request of the Department of Welfare, Division of Services for the Blind, and the Department of Education, Division of Vocational Rehabilitation, of the State of Vermont, the AFB and NIB consented to sponsor the pilot study of industrial homework in that state, in conjunction with the OVR, and carried it through as here set forth.