Vocational Rehabilitation Practice Research Articles

Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study

Purpose Chronic mental illness disrupts the ability to work, often resulting in the need for vocational rehabilitation in which occupational therapists play a role. Namibia does not have an occupational therapy vocational rehabilitation practice framework for service users with chronic mental illness. This study explored the contextual factors that should be considered for a vocational rehabilitation practice framework in Namibia. Materials and methods A qualitative collective case study design was utilized. In-depth interviews were conducted with nine mental health service providers that were purposively selected from two study sites. An inductive thematic analysis of data was done using ATLAS.ti. Results The need for collaborative advocacy for service users to raise awareness and engage stakeholders such as family members, employers and policy makers was highlighted. Vocational rehabilitation resources needed include sheltered workshops, financial resources and trained human resources. Recognition that vocational rehabilitation services are too limited to meet the needs of mental health service users. A vocational rehabilitation policy and strategy is required. Supported employment and self-employment are potential strategies that should be considered. Conclusion Vocational rehabilitation for service users with chronic mental illness is limited in Namibia and there is a need to collaboratively improve the service.

Tailored vocational rehabilitation for people with a work disability pension in The Netherlands; an in-depth data analysis of the content and outcomes of vocational rehabilitation trajectories of the Social Security Institute

Purpose People with a work disability pension receive vocational rehabilitation (VR) services from the Dutch Social Security Institute (SSI) in order to facilitate return-to-work (RTW). The SSI offers tailored VR existing of two trajectories (aimed at getting fit for work or aimed at returning to work). The purpose of this study is to describe the current practice of VR. This includes a description of client characteristics, RTW barriers and the intensity, duration, content and the outcomes of the offered trajectories. Materials and Methods We analyzed data from 197 clients that were randomly selected from clients who attended a VR trajectory between 1 January t 2017 and 31 December 2018. Data were obtained from the SSI registration databases and client files. Results Both VR trajectories at the SSI have a different aim, but in practice the content of the VR interventions often overlaps. Around half of both trajectories reached their goal. Reasons for unsuccessful trajectories were that the client did not find work or barriers were more complex than initially assessed. Conclusions The SSI delivers tailored VR to the specific needs of the client, however substantiations for why a certain VR intervention is offered are limited. Guidelines are needed to support professionals.

Using Narratives of Immigrant Clients to Confront Grief: Supporting Autonomy in Vocational Rehabilitation

Narrative counseling, narrative interviewing, or storytelling is a therapeutic approach to treating individuals with mental health conditions that is client-led. The approach can also employ the power of recall to reconstruct one’s story and oneself through reframing. In this article, we explore the possibility of employing narrative counseling in vocational rehabilitation settings, with immigrants with disabilities experiencing grief through loss and migration. Autonomy, cultural relevance, and trauma-informed care present the rationale for consideration and further exploration of narrative counseling in vocational rehabilitation research, teaching, and practice.

Workforce Participation as a Differential Indicator of Satisfaction With the Employment Situation Among Latinx With Multiple Sclerosis: Implications for Vocational Rehabilitation Professionals in the COVID-19 Era

PurposeThis study aimed at examining differences in satisfaction with the employment situation between employed and unemployed Latinx with multiple sclerosis (MS) in the United States (N = 148).MethodParticipants in this study responded to a national survey of the employment and community living concerns of people with MS. Multivariate analysis of variance and a follow-up univariate analysis of variance were conducted to compare the group differences.ResultsThe analyses revealed statistically significant between-group differences in satisfaction ratings on items pertaining to personal and environmental resources and fair treatment, but no significant between-group differences in response to items related to legal rights.ConclusionThe findings in this study confirmed our a priori expectation that satisfaction ratings regarding the overall employment situation among Latinx Americans with MS would vary as a function of their workforce participation status. Implications for future research and clinical practice in vocational rehabilitation in the COVID-19 era are discussed.

Tutorial: The Speech-Language Pathologist's Role in Return to Work for Adults With Traumatic Brain Injury

Return to work (RTW) is a major life participation metric used for persons with a traumatic brain injury (TBI). Speech-language pathologists (SLPs) have clinical expertise in the cognitive-communication aspects of TBI. This clinical focus article aims to support the clinical practice of SLPs by summarizing key interprofessional vocational rehabilitation (VR) models and illustrating the role of the SLP throughout the RTW process with a case study. This clinical focus article was written by the Academy of Neurologic Communication Disorders and Sciences TBI Research Group along with a VR expert. Authors engaged in deliberative, agenda-based discussions beginning with a literature review based on previous systematic studies. Discussions explored relevant VR and SLP practices. This clinical focus article presents key VR models in parallel with SLP assessment and treatment to illustrate best practice patterns in an RTW field with a dearth of SLP-specific literature. We summarize general VR approaches and four evidence-supported VR models for adults with TBI. We highlight how a model of interprofessional assessment can assist with planning and communication of important work-related concerns. We illustrate how the chronological model of work return can assist with developing goals and planning treatment. SLPs play an important role in identifying, managing, and collaborating with an RTW team following TBI. A working knowledge of VR models can assist with improving the dialogue between SLPs and VR professionals and can inform practice when working with persons with TBI who have work return as a goal.

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

AbstractYouth with co-occurring mental illness and substance use disorders are at higher risk for vocational rehabilitation exclusion. This study aimed to (a) explore the personal factors associated with vocational outcomes of youth with co-occurring mental illness and substance use disorders and (b) highlight services that have shown the greatest promise for this population in the state-federal rehabilitation program in the United States. Our analytic sample was extracted from the Rehabilitation Services Administration’s Case Service Report data set for 2013, 2014, and 2015 fiscal years. Multiple regression analyses results identified personal factors such as gender, race/ethnicity, level of education, and severity of disability as predictors of the achievement of competitive employment, hours worked, and income. The receipt of vocational rehabilitation services such as job search support, job placement assistance, vocational training, and on-the-job support are significantly associated with the achievement of competitive employment, higher work hours, and income. These finding have implications for vocational rehabilitation practice as they highlight who is at higher risk for poor outcomes, effective services, and additional factors to consider when working with youth with co-occurring mental illness and substance use disorders.

Supporting people experiencing a burn injury to return to work or meaningful activity: Qualitative systematic review and thematic synthesis

Qualitative studies contain in-depth information about facilitators and and barriers to to successful rehabilitation. This systematic review synthesised findings across qualitative studies to inform vocational rehabilitation practices for people who have experienced burn injury. PRISMA guidelines were used to determine inclusion criteria for the review and develop a comprehensive search strategy. Four databases were searched and results screened. Included studies investigated experiences of return to work (RTW) or meaningful activity in a burn injury population. Quality of included articles was examined using the CASP framework for qualitative research. Thematic synthesis was used to analyse the qualitative results. Six studies met inclusion criteria. Five analytic themes were identified regarding experiences of vocational support and ability to RTW after burn injury: addressing the complex impact of burn injury; personal connections as vital support; skilled and specialised healthcare as central to RTW; value of knowledge; and considering the work environment. No included studies investigated meaningful activity other than paid work. Findings support structured vocational rehabilitation, psychological interventions, social support, intensive rehabilitation and patient, clinician and workplace education as key in facilitating RTW after burn injury. Additionally, coordinated care is likely to improve vocational outcomes. Research is needed on supporting return to meaningful activity.

Correlates of Obtaining Employment among Veterans Receiving Treatment for Severe PTSD in Specialized Intensive Programs.

Severe Post-Traumatic Stress Disorder (PTSD) has been identified as a significant impediment to employment. However, little is known about correlates of employment recovery after a period of not working among veterans with severe PTSD treated in specialized intensive treatment programs. This study examines rates and correlates of transitioning from not being employed at admission to working four months after discharge using national Veterans Health Administration (VHA) program evaluation data on veterans engaged in specialized intensive PTSD treatment (N = 27,339). Results suggest that only 5.68% of the sample made the transition to employment while 10.6% lost employment, 8.9% worked both at admission and following discharge, and 74.9%, did not work either at admission or following discharge. Multinomial regression analysis found that compared to other groups, veterans who became employed were younger, less likely to receive service-connected disability payments, and experienced a significantly greater reduction in PTSD symptoms. Findings from this study highlight that this distinct population has very poor employment outcomes and deserves more attention, and that reducing PTSD symptoms can lead to improved employment outcomes. Efforts to integrate evidence-based vocational rehabilitation practice into residential PTSD treatment targeting PTSD symptoms is encouraged.

Back2Work: a new model of early vocational rehabilitation for people with spinal cord injury.

Objective The aim of this article is to describe the development of a novel evidence-based model of early intervention vocational rehabilitation (EIVR) for people with spinal cord injury (SCI). Methods An extensive literature review and background study guided the collaboration of experienced practitioners and researchers in developing and evaluating the innovative Back2Work model of EIVR for people with SCI in Queensland, Australia. The program is undergoing longitudinal mixed-methods evaluation to the end of 2023. Results The model is central to the successful implementation of the EIVR program, delivered by rehabilitation counsellors in the Queensland Spinal Injuries Unit. Back2Work includes a strong focus on maintaining and nurturing the pre-injury occupational bond between injured workers and employers, and aims to create a positive expectation for return to work (RTW) and increase the rate and timeliness of RTW after SCI. Conclusions The Back2Work program has become an integrated component of the multidisciplinary rehabilitation team, with positive early results in RTW outcomes and additional benefits in participants' sense of well-being and hope. What is known about the topic? Vocational intervention after SCI has traditionally been delivered after hospital discharge and considered outside the scope of early intervention approaches. Emerging evidence suggests EIVR, commencing before hospital discharge, can encourage hope and a positive expectancy for employment after SCI, and is showing promising outcomes in supporting people's quality of life and vocational goals. What does this paper add? This article details the process and product of developing and evaluating a novel EIVR model for people with SCI. The model underpins the Back2Work EIVR program being trialled in the Queensland Spinal Injuries Unit, an example of this emerging field of practice within the primary rehabilitation setting. What are the implications for practitioners? The Back2Work program is based on an innovative and evidence-based model of EIVR for people with SCI. The collaborative and empirically driven process of developing, implementing and evaluating the model will be of interest to researchers and practitioners looking to advance practices in vocational rehabilitation after serious injury.

Phase II of the SGA Project: Development of the coordinated team approach intervention

BACKGROUND: The SGA Model Demonstration tested a coordinated team approach to determine whether a combination of vocational rehabilitation practices improve earnings outcomes of clients who also receive Social Security Disability Insurance. OBJECTIVE: This paper describes Phase II of the development of the intervention. METHODS: Researchers and policy fellows conducted site visits, interviewed personnel from 8 State Vocational Rehabilitation agencies and related partners, drafted a proposed intervention and submitted it for review to a Delphi panel. RESULTS: Delphi ratings supported the proposed intervention as likely leading to improved earnings outcomes and recommended that the SGA Project develop training, technical assistance, and capacity building activities to support implementation. CONCLUSION: The SGA Project invested 2 years developing an intervention by examining administrative data, consulting national experts, interviewing SVRAs directors and more than 100 practitioners across eight SVRAs. Pacing metrics were built into a team approach that included a vocational counselor, work incentives counselor, and a job development/job placement specialist with a business relations focus.

Psychometric Validation of a Measure Assessing Functional Limitations of Students With Disabilities: An Adaptation of the World Health Organization Disability Assessment Schedule 2.0

The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) has been used to assess functional impairments in various disability populations and has been shown to be applicable to the youth population. The purpose of the study was to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule II–Youth Version (WHODAS-Y). Results of the study revealed a two-factor solution, including the socio-cognitive index and self-care index. The WHODAS-Y measurement appears to be a reliable and valid measure of function impairment in transition-age youth with disabilities in a community setting. This assessment tool can be integrated in vocational rehabilitation practices and guide rehabilitation counselors in identifying needs and facilitators related to education and employment-related services, as well as understanding health care needs in youth with disabilities.

The difference model of disability: A change in direction for vocational rehabilitation practice

AbstractVocational rehabilitation provides guidance and support to individuals with disabilities entering the workforce. Employment plans include considerations of goals, the job market, and pre-existing or trainable skills on the part of job seekers. This process also includes an understanding of the social forces that affect employment goals. Current models of disability include the medical, social, and embodiment models. Each is cognitively based and assumes an element of responsibility or blame, that is, respectively, focused on the individual with a disability, the community, or a combination of these two factors. The difference model of disability offers an alternative understanding of disability by providing an affect-based framework that eliminates the premise of blame. This conceptualization of disability provides a new approach to vocational rehabilitation.

Utilizing the ICF to Enable Evidence-Based Practice Among Vocational Rehabilitation Counselors

The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) provides an appropriate framework for conceptualizing cases within vocational rehabilitation (VR) programs. VR counselors can improve service delivery by using the framework and tools of the ICF, including the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the ICF Checklist 2.1, and the ICF Core Sets. VR counselors can more readily begin the initial step of evidence-based practice (i.e., formulating well-defined, answerable questions) by using the ICF framework and its tools to identify and categorize common barriers and facilitators among VR consumers. The ICF framework and its tools are described in relation to their potential utilization in VR practice. In addition, specific case examples are given, describing how VR counselors can incorporate ICF perspectives and tools into their practice. The authors briefly describe training resources, future directions, and other considerations for the use of the ICF in VR settings.

An instrument to measure perceptions of people with disabilities regarding the application of international vocational rehabilitation standards.

This study aimed to create a valid and reliable instrument to measure people with disabilities' perceptions regarding the extent of application of international standards issued by the Council of Europe, International Labour Organization, and the International Classification of Functioning, Disability and Health in vocational rehabilitation centers in the Basque country, Spain. The instrument items were selected from international recommendations and conventions issued by the International Labour Organization, Council of Europe, International Classification of Functioning, Disability and Health, and a vocational rehabilitation literature review. The instrument was translated from English to Spanish, and the content validity index of an expert panel survey was used to assess content validity. For the Spanish version of the instrument, internal consistency reliability, confirmatory factor analysis and factor analysis were examined with 186 people with disabilities in 10 vocational rehabilitation centers in the Basque country. The coefficient alpha estimate was 0.945, indicating excellent internal consistency. Three factors were identified: job-related services, aims of vocational rehabilitation center, and vocational rehabilitation guidance. The instrument appears to have good validity and reliability but requires further validation. Support is provided for its use in both English and Spanish. Implications for vocational rehabilitation practice and suggestions for future research are provided.

A Conflict of Interests: A Motivational Perspective on Special Interests and Employment Success of Adults with ASD.

A course of action often suggested in an attempt to improve employment outcomes of adults with autism spectrum disorder, is to match between special interests and job opportunities. In this commentary, we propose that the match may be more complicated than it seems, possibly overseeing more pressing employment needs that should be answered such as: the job's characteristics, labor market demands, and stress resulting from job expectations. Self determination theory of motivation is suggested as a lens through which the association between special interests and a paying job can be examined, highlighting important considerations that hold the potential to increase employment success. Recommendations for new research directions and vocational rehabilitation practice are discussed.

An Organizational Case Study of a 5-Year Development Project to Promote Cognitive Support Technology Use, Academic Success, and Competitive Employment Among Civilian and Veteran College Students With Traumatic Brain Injuries

Project Career was a 5-year interdisciplinary development initiative funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). The project merged cognitive support technology (CST) with best practices in vocational rehabilitation to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injuries (TBIs). Project staff conducted assessments of students' needs relative to assistive technology, academic achievement, and career preparation; provided CST training to 146 students; matched students with mentors; provided vocational case management; delivered job development and placement assistance; and maintained an electronic portal regarding academic accommodations and career resources. A single-group, quasi-experimental analysis revealed that Project Career students significantly improved their psychological outlook on their education and their careers, academic performance, persistence toward degree completion, and prospects for competitive careers after graduation. Project Career provides a national model based on best practices for helping postsecondary students with TBI to attain their academic and career goals.

Career Adaptability, Self-Determination, and Life Satisfaction: A Mediational Analysis With People With Substance Use Disorder

Living a satisfying life is an important goal for people with substance use disorder (SUD). However, making decisions about the future, imagining future scenarios, and setting and attaining goals related to that future after treatment is a complex task. As several studies have shown, people with SUD experience multiple barriers to designing their future life at the individual, program, and social support levels. Using a life design approach, the aim of this study was to investigate the role career adaptability and self-determination play in life satisfaction for adults with SUD. More specifically, a partial mediation model focused on career adaptability and life satisfaction through enhanced self-determination was tested in a sample ( n = 134) of people with SUD. Findings suggest that career adaptability is indirectly related to life satisfaction, mediated by self-determination. These results have important implications for practice in vocational rehabilitation and career counseling for people with SUD.

Restructuring Plan of Vocational Rehabilitation Practices System from the Convergence Perspective of Lifelong Education for Persons with Developmental Disabilities

본 연구는 교육 분야에서 발달장애인을 대상으로 활발히 부각되고 있는 평생교육 융합 차원에서 인접 분야인 직업재활의 실천체계를 정립하는 데에 목적을 두었다. 이를 위한 주요 연구 내용으로는 ‘범주적 기반의 직업재활 실천체계’, ‘교육과정적 기반의 직업재활 실천체계’, ‘전문인력 수행역량 기반의 직업재활 실천체계’와 같이 세 가지로 구성되었다. 연구 내용을 연구 결과화시키기 위해 문헌 탐색과 전문가 회의를 상호 병행한 연구 방법이 구성되었다. 먼저, ‘범주적 기반의 직업재활 실천체계’에 있어선 평생교육의 범주를 광의 차원의 평생교육과 미시 차원의 성인계속교육으로 분류 구성하여 직업재활의 실천체계와 협업할 수 있는 범주화를 제시하였다. 이를 통해, 직업재활의 실천체계가 평생교육의 한 가지 범주로써 정립될 수 있는 방안을 제고하였으며, 이후에 제시할 교육과정적 기반 및 전문인력 수행역량 기반의 직업재활 실천체계 정립의 기초적 여건을 마련하였다. 다음으로, ‘교육과정적 기반 직업재활 실천체계’에서는 직업재활을 비롯한 평생교육 및 특수교육 분야의 변별적인 실천기능을 중심으로 교육과정의 차원에서 상호 협업화될 수 있는 절차적 방안에 중점을 두었으며, 이에 따라 직업재활 분야와 평생교육 분야(특수교육 포함) 간의 교육과정적 기반 체제를 각각 비교과와 교과로 연계화하였다. 또한, 이런 기반 체제 가운데 직업재활 분야가 발달장애인의 성인생활 관련 성과 지표를 구축하여 평생 및 특수교육 분야의 역량기반 교과교육과정을 지원해야 할 절차 역시 제시하였다. 마지막으로, ‘전문인력 수행역량 기반의 직업재활 실천체계’에서는 직업재활 분야와 평생교육 분야(특수교육 포함) 간에 실천기능의 변별화를 반영하는 취지에서 전문인력 대상을 상호 독립적으로 제시하였으며, 이에 따른 수행역량 역시 연계적이고 변별적으로 제시하였다. 이상의 결과가 활성화 및 현실화되기 위해 수반되어야 할 몇 가지의 조건을 중심으로 논의 및 제언하였다.The purpose of this study is to seek a plan to restructure the vocational rehabilitation practices system from the convergence perspective of lifelong education for persons with developmental disabilities. To achieve the objective, the study set category based vocational rehabilitation practices system model, curriculum based vocational rehabilitation practices system model, and professional competency based vocational rehabilitation practices system model. Also, data was analysised and specialists meetings according to the definition of the three types. This study discussed the grounding principles for the above proposals to be realized, as well as the accompanying conditions in the to vocational rehabilitation practices system from the perspective of lifelong education for persons with developmental disabilities and study results in interconnection. By doing so, this study presented suggestion on future Plans by focusing on the functional meaning and value of vocational rehabilitation practices system and lifelong education for persons with developmental disabilities.

A framework for improving the effectiveness of evidence-based practices in vocational rehabilitation

BACKGROUND: Vocational rehabilitation for people with severe mental illnesses has reached a critical stage in its development of evidence-based practices. A recent meta-analysis has suggested that good program quality measured by fidelity scales is necessary but not sufficient to achieve good employment outcomes. It is likely therefore that there are other aspects of program implementation quality that are not addressed by the current scales.OBJECTIVE: The aim of this study was to identify new dimensions of program quality potentially applicable to improving the effectiveness of evidence-based vocational rehabilitation.METHODS: A review and synthesis of the theoretical and empirical literature in the broader science of psycho-social program implementation was conducted to identify the core dimensions which could be applied to evidence-based vocational rehabilitation.RESULTS: Twenty reviews and four single studies identified the common dimensions of a generic implementation framework. Empirical findings from eight of these, and 19 additional papers built a conceptual framework for improving evidence-based practices in vocational rehabilitation. The resulting framework consists of nine dimensions of implementation quality and twenty-three contextual factors.CONCLUSIONS: This conceptual framework will assist program funders, researchers, practitioners, and policymakers to consider a wider range of program influences to advance the science and practice of vocational rehabilitation for people with severe mental illness.

Policy barriers to evidence-based practices in vocational rehabilitation for people with psychiatric disabilities in New Zealand.

Most working-age adults with psychiatric disabilities are not employed yet are interested in being in employment. This goal is achievable for the majority who are interested, with the help of international evidence-based practices in vocational rehabilitation. However, these practices are not widely available in developed countries. To identify whether, and how, the availability of evidence-based vocational rehabilitation is linked to government policy. A systematic examination of New Zealand's economic and social policy context to understand how it facilitates or hinders evidence-based vocational rehabilitation for people with psychiatric disabilities. The New Zealand policy context is currently hindering the availability of evidence-based vocational rehabilitation for people with psychiatric disabilities. Whilst policy reform has commenced, it has not yet translated into a purchasing framework free of policy conflicts and barriers. Consequently, the proportion of people with psychiatric disabilities not employed and not participating in the labor market is increasing. Adopting the policy adjustments identified could expand the availability of evidence-based vocational rehabilitation, reducing the disparity between individual vocational goals and actual labor force activity. This in turn could have national social and economic benefits through reduced welfare dependence, reduced health service utilization, and increased labor force participation.