Vocational Rehabilitation Process Research Articles

Healthcare professionals’ perceptions of the contributions of rehabilitation coordinators to patients in Swedish psychiatric care: a qualitative descriptive study

BackgroundRehabilitation coordinators have gradually been introduced into Swedish psychiatric care to support individuals on sick leave to return-to-work or enter work.AimTo explore healthcare professionals’ perspectives on the contributions a rehabilitation coordinator can make to patients in psychiatric care.Materials and methodsA descriptive qualitative design was used, and data were collected through interviews. Twelve healthcare professionals in psychiatric care participated in individual semi-structured interviews. Data were analysed using thematic analysis.ResultsAn overarching theme evolved: “The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process”, based on two themes: (1) “Adaptations and support based on the patient’s needs” and (2) “Rehabilitation coordinator efforts as relevant for care”. The themes, in turn, consist of six subthemes.ConclusionsThis study showed that healthcare professionals perceived employment as important for patients’ health and well-being. Therefore, the rehabilitation coordination efforts were not only seen as beneficial for addressing patients’ challenges and needs in managing the vocational rehabilitation process but also as an integral part of the patient’s care.

Unraveling the factors influencing engagement in vocational rehabilitation services among transition-age Hispanic youth: An exploratory study

BACKGROUND: Prior research has investigated the engagement process of vocational rehabilitation (VR) consumers yet limited understanding about transition-age Hispanic youth VR consumers remains. OBJECTIVE: This exploratory cross-sectional study evaluated the factors predicting VR engagement among transition-age Hispanic youth with disabilities who have received pre-employment transition services (pre-ETS). METHOD: Descriptive, bivariate correlation, and stepwise logistic regression analyses were conducted in this study. A total of four categories of independent variables (sociodemographic, contextual, theoretical, and pre-ETS related) were selected to investigate their relationship with VR engagement. RESULTS: Findings revealed that education level, living with family, perceived social support from friends, perceived stigma from others, VR counselors’ ability to speak Spanish, competence, vocational outcome expectancy, and number of pre-ETS received were among the significant predictors of VR engagement, with the final model explaining a total of 87.6% of the variance. CONCLUSION: Findings of this study can help inform practices and policies to bridge the gap surrounding the service delivery and utilization of VR services among transition-age Hispanic youth with disabilities.

Contemporary vocational rehabilitation strategies for people with advanced cancer: A literature review and conceptual framework

BACKGROUND: People with advanced cancer constitute an emerging vocational rehabilitation (VR) consumer population. OBJECTIVE: Following an overview of the nature and needs of Americans who have advanced forms of cancer, the authors present strategies to meet the service and support needs of these individuals across the phases of the VR process. METHODS: The authors present the sequential stages of the VR process, including implications for working with advanced cancer survivors during each stage. RESULTS: The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to self-care and symptom management regimens is emphasized throughout the article. CONCLUSION: Growing numbers of people worldwide are surviving advanced cancers for longer periods of time than ever before, which makes them an emerging disability population and rehabilitation clientele.

Social representations of gender and their influence in Supported Employment: employment specialists’ experiences in Sweden

Purpose Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists’ (ES) social representations of gender in relation to work and VR and how these social representations influence the ES’s work in the VR process according to SE. Methods The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups. Results Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system. Conclusion Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities. IMPLICATIONS FOR REHABILITATION Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR. Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR. Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

Identifying the knowledge, skills, and barriers for self-employment

BACKGROUND: While self-employment is a viable and beneficial employment strategy for people with disabilities, there seems to be considerable variation in how state rehabilitation agencies support self-employment. Because of this variation, research is needed to identify the critical elements for facilitating self-employment. OBJECTIVE: The purpose of this study is to gather information from vocational rehabilitation counselors about what they believe are the knowledge and skills essential to facilitating self-employment and the barriers to business ownership throughout key phases of the vocational rehabilitation process, including (a) application and intake, (b) plan development and service delivery, and (c) employment and closure. METHODS: A Delphi method with three iterations was used to identify information from VRCs and managers about what they believe are the knowledge, skills, and barriers when facilitating self-employment and business ownership during the vocational rehabilitation process. RESULTS: Respondents rated 15 knowledge and skill items for the application and intake domain, 19 knowledge and skill items in the plan development and service delivery domain, and 12 knowledge and skill items in the employment and closure domain. Respondents also rated three barriers for application and intake, six plan development and service delivery barriers, and three barriers were rated in employment and closure. CONCLUSION: The VRCs identified a wide range of knowledge and skills and barriers across each area of the rehabilitation process. More research should be conducted to further operationalize the skills and proficiencies for self-employment.

Providing quality employment services to people living with asthma in the vocational rehabilitation program: A model for meeting the needs of an emerging clientele.

With incidence and prevalence rates of asthma diagnoses steadily increasing in the United States and worldwide over the past 30 years, people with asthma are an emerging vocational rehabilitation (VR) consumer population. This article describes the job acquisition and return to work considerations facing employees with asthma. Following an overview of the etiology, incidence, prevalence, and career development implications of this chronic respiratory disease, the authors present career preparatory and return to work recommendations to meet the needs of Americans with asthma across the phases of the VR process. The importance of access to quality healthcare, lifestyle, and environmental modifications to promote respiratory health, employer consultation, workplace accommodations and universal design, and interface with medical and mental health professionals is emphasized throughout the article. Asthma is an emerging disability that disproportionally affects people of color and people who live in poverty. Rehabilitation professionals must be prepared to meet the needs of this growing and diverse clientele as people with asthma seek assistance from the VR program in acquiring, maintaining, and advancing in meaningful, satisfying employment.

The role of occupational therapy in providing vocational rehabilitation for inflammatory arthritis: A scoping review protocol.

Inflammatory arthritis (IA) significantly impacts people's ability to continue in work roles, despite advances in medical management. Employment is acknowledged as important for health and wellbeing. Facilitating work participation and employment reduces social welfare dependence for income, minimising societal cost. Internationally, pathways and processes are developing to maintain people with acquired conditions in the workplace. Occupational Therapy supports this process, with its biopsychosocial approach, giving a framework to consider the complex dynamic of a person's vocational rehabilitation (VR) needs. A scoping review framework was chosen to explore the diverse VR process and emerging focus on Occupational Therapy's role in providing VR for the IApopulation. The methodological framework for scoping reviews will be used to guide the process and structure of the scoping review. A search strategy will be implemented in all the major peer reviewed databases along with grey literature repositories for English language studies. Study selection will use the PRISMA-ScR flow chart against an agreed eligibility criteria by two independent reviewers. Data extraction from the final selection will be mapped out using tables and a supporting descriptive review reflecting on the original scoping review aim and objectives completed. Findings will be disseminated at all levels and in various formats to bring them to the attention of clinicians, researchers and policy makers as VR pathways are established and prioritised for the early IA population.

TRAINING PENSION AS A BENEFIT FROM SOCIAL INSURANCE SUPPORTING THE PROCESS OF VOCATIONAL REHABILITATION SELECTED PROBLEMS AND CONTROVERSIES

This article presents and evaluates Polish normative solutions regarding the training pension as a benefit from the general social insurance system, intended to support the implementation of the vocational rehabilitation process. The essence and purpose of vocational rehabilitation in terms of international documents and Polish law were presented, and the role assigned to the training pension in the process of implementation of this rehabilitation was indicated. It also shows the shortcomings of the legal provisions in force in Poland and the adopted organizational and financial solutions, which meant that, contrary to expectations, the role of the indicated cash benefit from social insurance in supporting the implementation of the vocational rehabilitation process is negligible.

Development and validation of the Illinois Brief Functioning Inventory

BACKGROUND: Individuals with disabilities experience disruptions in life participation at the onset or exacerbation of a disability. The multiple dimensions of functioning impacted go beyond the symptoms of a disabling condition and assessing an individual’s level of functioning is a critical first step of a strengths-based rehabilitation approach. With functioning playing an important role in the vocational rehabilitation process, it would be important to have an assessment tool that can be used to measure an individual’s level of functioning. OBJECTIVE: The purpose of this study was to examine the psychometric properties of the Illinois Brief Functioning Inventory (IBFI), a scale developed to measure the multi-dimensional nature of functioning as it relates to vocational rehabilitation, career development, and employment of people with disabilities. METHODS: Factor analysis, including exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), was used to determine and validate the underlying dimension of IBFI. RESULTS: Overall, the study findings indicate strong psychometrics for a 26-item instrument comprised of five meaningful subscales identifying functioning across physical, cognitive, and emotional dimensions. CONCLUSION: The results of this study provide initial psychometric support regarding the IBFI as an instrument that can be used to identify an individual’s current level of functioning.

Emerging vocational rehabilitation strategies for people with diabetes mellitus.

People with diabetes mellitus constitute an emerging vocational rehabilitation (VR) consumer population. The objective of this article is to (a) describe the characteristics and needs of Americans with diabetes mellitus, (b) examine the often devastating effects that this highly prevalent disease of the endocrine system has on employment and career development, and (c) suggest strategies that rehabilitation professionals can use to improve VR services and outcomes. Following an overview of the etiology, incidence, prevalence, and impact of this high incidence endocrinological disease, the authors present strategies to meet the service and support needs of Americans with diabetes mellitus across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to self-care and symptom management regimens is emphasized throughout the article. Diabetes mellitus is an emerging disability that can affect people of any age, one that disproportionally affects people of color and people who live in poverty. Rehabilitation professionals must be prepared to meet the service needs of this growing clientele.

The outcomes of a vocational rehabilitation and mentorship program in unemployed young adults with acquired brain injury.

Persons with disabilities are at risk for unemployment with negative long-term consequences. This study aimed to explore the process and outcomes of a novel vocational rehabilitation (VR) program based on the concept of mentorship. Observational, retrospective study including unemployed young adults with acquired brain injury (ABI) taking part in a VR program including assessment, training, individual counselling and mentor support from volunteering professionals. Adherence to the program and work status were registered and at follow-up all patients were invited to complete a general questionnaire and EuroQol 5D. 49 patients started the program, with 41 completing the follow-up. Median age was 31 years and 19 were male. Median duration of the program was 8 months. At follow-up, 9 patients had acquired paid employment, 7 with the support of a mentor; 6 of whom were bothered by health problems at work. Nine patients left the program prematurely, with insufficient financial support for continuation being the primary reason for withdrawal (n = 6). A VR program including a mentor may be a promising program for patients who are unemployed at onset of ABI. Lack of financial support to complete the program and concurrent health problems were found to hamper the process and outcomes of the program, respectively.

Targeted motivational interviewing techniques assist the process of verbal de-escalation in vocational rehabilitation

BACKGROUND: In response to a request for training by a state vocational rehabilitation unit on verbal de-escalation for staff, the authors searched the literature on de-escalation best practices specifically in the context of vocational rehabilitation. There was a paucity of literature on the topic. To meet the training request for the state vocational rehabilitation staff, the authors paired the psychometrically validated English Modified De-Escalating Aggressive Behaviour Scale (EMDABS) best practices with motivational interviewing (MI) techniques to support verbal de-escalation. OBJECTIVE: The objective of this article is to describe the best practices of the EMDABS and how certain MI techniques and attitudes can support verbal de-escalation efforts by staff in the vocational rehabilitation process. METHODS: The authors searched literature on de-escalation best practices specifically in the context of vocational rehabilitation. RESULTS: The authors found the psychometrically validated EMDABS best practices paired with MI techniques are potential useful tools to support verbal de-escalation in the process of vocational rehabilitation. CONCLUSION: MI techniques and the EMDABS best practices are useful tools for vocational rehabilitation and employment services staff. Research is needed regarding the applicability of these techniques and practices across the full range of vocational rehabilitation clients.

The Effect of Introductory Training on the Use of Motivational Interviewing in Vocational Rehabilitation

The purpose of this study was to assess whether introductory motivational interviewing (MI) training could affect the perception of the participant’s ability to use MI as part of the vocational rehabilitation process. Two previous studies demonstrated introductory MI training could have a positive effect on the rehabilitation professional’s attitude toward the use of MI, and counselor and consumer engagement. The results of this study suggested that an introductory MI training can have a positive impact on a participant’s confidence to use MI and the underlying principles, and decrease the perception of personal and organizational barriers to the use of MI in vocational rehabilitation.

Patients views on which return-to-work outcomes should be prioritised: A nominal group technique focus group

Objective Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods Nominal group technique focus group with trauma patients. Results Focus group participants ( n = 6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return to work, using SMART (specific, measurable, achievable, relevant and time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, rather than change outcomes of vocational rehabilitation. Conclusions The range of outcomes identified by trauma patients highlights the complex process of return to work and the need for vocational rehabilitation evaluations to incorporate a broader range of outcomes. Measures of the process of vocational rehabilitation are also important to trauma patients and should be included in such evaluations.

Consumer-Centered Vocational Rehabilitation Strategies for Stroke Survivors: Implications for the Post-Coronavirus Era

In this article, we describe stroke survivors as an emerging vocational rehabilitation (VR) clientele. Following an overview of the incidence, prevalence, and impact of stroke, the authors present strategies to meet the service and support needs of Americans with stroke across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and implications of the Coronavirus pandemic is emphasized throughout the article.

Double Burden of Disability and Poverty: Does Vocational Rehabilitation Ease the School‐to‐Work Transition?

Poor young people more often face health difficulties, (learning) disabilities, and are overrepresented in special schools. Consequently, youth from poor households disproportionately frequently participate in disability‐specific programs aiming to improve their educational levels and labor market opportunities. They face a double burden of disability and poverty. In our study, we look at poor and non‐poor youth with disabilities (YPWD) who participate in vocational rehabilitation (VR) and whether VR helps them (a) in transitioning into employment and (b) in leaving poverty. We examine the association between the receipt of initial basic income support (BIS) as a poverty indicator, later labor market outcomes, and earned vocational qualification using administrative data. We make use of a sample of all persons accepted for VR in 2010 (N = 36,645). We employ logit models on VR attendees’ labor market outcomes three and five years after being accepted for VR as well as on their earned vocational qualifications. Beside initial poverty status, we control for educational level, type, and degree of disability and program pattern during the VR process. Our findings show that YPWD from poor households have a decreased likelihood of a vocational certificate and employment. Additionally, they are more likely to receive BIS than young people not from poor households and thus more likely to remain poor. In conclusion, VR seems to support poor YPWD less in their school‐to‐work transitions. Thus, disability‐specific programs should be more tailored to the social situations of participants, and counsellors should be more sensitive to their social backgrounds.

Identifying Racial Differences in Vocational Rehabilitation Services

The literature on racial differences in vocational rehabilitation (VR) services has not been updated for over a decade. Using the 2017 individual-level U.S. national RSA-911 data, supplemented with the 2017 American Community Survey and publicly available information from the Kaiser Family Foundation, we investigated racial differences at each step of the VR process—application, eligibility, service provision, and employment outcomes at closure. At the first step, application, White individuals with disabilities were less likely to apply than their African American, American Indian/Alaska Native, and Hispanic counterparts, and more likely to apply than their Asian counterparts. For the remaining three steps, the results were inverted: the White subgroup had higher eligibility rates, service rates, and employment rates than the African American, American Indian/Alaska Native, and Hispanic subgroups, and lower rates than the Asian subgroup. These findings suggest that racial and ethnic differences continue to exist in the VR process despite several legislative acts and policy efforts. Within each racial and ethnic minority group, we also found large variation in application rates and employment rates across states, which indicates a need for developing performance measures and standardized guidelines for state VR agencies to better serve individuals with disabilities from racial and ethnic minorities.

Effect of VR for education to promote the social participation of people with cognitive disorders caused by acquired brain injuries

Brain injuries will often result in some form of permanent damage and lead to disorders such as cognitive and behavioural problems. Although treatments are available, it is likely that the patient and their family will have to learn to live with the disorder and the patient may face challenges related to workplaces and care networks. Ultimately, this can result in the patient retreating from society, which can be damaging to mental health. Professor Tamami Aida, Mejiro University, Japan, is a Director at the Japanese non-profit organisation Minna no centre Omusubi which seeks to make better, more inclusive lives for people with long-term brain injuries. Aida is currently working on a project to help different people involved in the care and treatment of those with acquired brain injuries (ABI). A key focus is educating stakeholders on the process of vocational rehabilitation (VR), which is the end goal of a long process from initial brain injury representing a return to work. She has created informative materials to enlighten stakeholders on the needs of ABI patients and the process of VR, including a video that explains VR and highlights the necessary input of those involved in the care of ABI patients. Ultimately, Aida wants to ensure that people with ABI have a suitable framework to rebuild their lives.

P077 Upskilling rheumatology therapists in work rehabilitation: an evaluation of the Workwell training programme

Abstract Background/Aims Keeping people with arthritis working is an important goal of rehabilitation. Rheumatology therapists may provide work advice to employed patients but conducting a structured work assessment and providing vocational rehabilitation (VR) is unusual. As part of a VR trial, we developed a VR training course (Workwell). The course consisted of 3 elements: a pre-training self-study module (reading on ergonomics and activity analysis; activity analysis of at least 2 videos of people working; observing people working); a 2-day training course (how to conduct a structured work interview (the Work Environment Survey: WES); case studies; planning work interventions; practical workshops about VR strategies and solutions; addressing disclosure; writing reports); followed by a 1:1 one hour telephone call practising conducting the WES with a trainer, developing a treatment plan, and individual feedback. A “Workwell Solutions Manual” was also provided for use in practice, with information on legislation, patient booklets and work solutions linked to problems identified in the WES. Our aim was to evaluate therapists’ views about the course and its impact. Methods All therapists attending the Workwell course were asked to complete questionnaires pre- and post-training. These included: knowledge of and confidence in providing VR (measured on a 0-4 scale of very limited to excellent); the Evidence Based Practice Attitude Scale (EBPAS); and views about course content and duration. Results Three courses were delivered: 32/40 attendees completed pre-and-post training questionnaires. All were occupational therapists (OTs): 30 women and 2 men; 2 NHS Band 5, 15 Band 6, 11 Band 7 and 4 Band 8; with 11 (SD 7) years’ experience in Rheumatology. Median scores of Knowledge of: VR; the VR process; VR strategies; relevant legislation and policies; and Confidence in: conducting a work assessment; and identifying work solutions, significantly increased from 1 (limited: IQR 1-2) to 3 (good: IQR 2-3) (p < 0.001). Total EBPAS scores did not change. However, Openness sub-scale scores did (i.e. extent to which willing to use new research -based interventions): Pre 2 (moderate: IQR2-3) to Post 3 (great: IQR 3-3): p = 0.04. Most (i.e. 26-30) considered very/extremely relevant: the pre-training self-study; conducting the WES and case studies; practical workshops (workstation assessment; upper limb strategies; load handling; environment; disclosure); and the post-training 1:1 practice WES, treatment planning and feedback. The training about using the WES (roleplay by trainers; case studies and 1:1 telephone practice) was considered the most beneficial aspect. Of the 21 commenting on course length, 16 considered it about right and 5 wanted longer. Conclusion The 2-day VR course, plus 2 days self-study, led to significant improvements in knowledge and confidence in delivering VR amongst attending OTs. Work is a key component of OT. This training course could help expand work services in Rheumatology to keep patients working. Disclosure A. Hammond: None. S. Woodbridge: None. R. O'Brien: None. A. Ching: None. J. Parker: None.

Multiple sclerosis in the COVID-19 era: Vocational rehabilitation strategies to meet the needs of a growing and immune-vulnerable clientele

BACKGROUND: This article describes people with multiple sclerosis (MS) as an emerging vocational rehabilitation (VR) clientele. OBJECTIVE: Following an overview of the incidence, prevalence, and impact of MS, the authors suggest strategies to meet the employment and career development needs of Americans with MS across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, and interface with medical and mental health professionals is emphasized throughout the article. CONCLUSION: Implications related to the COVID-19 pandemic are discussed.