Successful Vocational Rehabilitation Research Articles

Identifying factors that promote successful vocational rehabilitation case closure: Comparison of individual characteristics, VR experiences and state economic conditions

BACKGROUND: Despite the series of public policies being implemented to strengthen vocational rehabilitation (VR) services, individuals with disabilities remained at the substantial deficit in employment outcomes compared with individuals without disabilities. OBJECTIVE: We aimed to examine effects of vocational rehabilitation services on the employment outcomes for people with disabilities while accounting for individual characteristics and state economic conditions. Findings had implications for VR program improvement. METHOD: We used the RSA-911 data covering cases from 2015 to 2017, in addition to state unemployment rate and poverty rate in 2017 to address the research questions. A logistic regression model was estimated with Generalized Estimating Equations to predict the probability of successful case closure by individual demographic characteristics, number of VR services received, and state economic conditions. RESULTS: State economic conditions were not associated with employment outcomes among VR participants. Being female, Black, having physical disabilities, and not having a job at application were disadvantageous in employment outcomes. The more varieties of vocational services that individuals received, the higher odds of successful case closure. CONCLUSIONS: VR services have significant beneficial impact on individual employment outcomes. The strongest beneficial impact may be achieved by providing a combination of different types of services that are designed to help individuals find or sustain employment.

Effects of work experiences on the post-school employment outcomes of youth with disabilities: A study of one state vocational rehabilitation agency’s transition program

BACKGROUND: The Oklahoma Department of Rehabilitation Services provided eight years’ worth of de-identified data on transition-aged clients to be examined in this study. OBJECTIVE: This study presents information on the predictive impact of work experiences, age at time of application for vocational rehabilitation (VR) services, and priority group category of eligibility on successful VR case closure (i.e., achievement of competitive integrated employment). METHODS: Using logistic regression, the extant data were analyzed (consisting of 8,966 participants). RESULTS: Results indicated age, priority group category, gender and racial identification were each statistically significant predictors of achieving a successful VR case closure. Work experience as a predictor was not found to predict outcomes. Among work experiences, Project SEARCH was the only work experience to significantly predict successful employment outcomes. Individuals achieving higher rates of competitive integrated employment tended to be in the less severe priority category of eligibility, older, and those who identified as male and who identified as White. CONCLUSIONS: Findings inform special education and VR in considering the possible factors behind the results, examining data further, and potentially changing existing programs, policies, and practices or creating new ones to increase the employment outcomes of transition age clients.

Successful vocational rehabilitation innovations: Building a better toolbox

BACKGROUND: Kentucky Office of Vocational Rehabilitation (OVR) and Minnesota Vocational Rehabilitation Services (VRS) successfully participated in a randomized control trial of an intervention designed in partnership with more than 100 VR personnel and twenty state VR agencies to identify effective practices for increasing earnings outcomes of Social Security Disability Insurance (SSDI) beneficiaries receiving VR services. OBJECTIVE: This paper introduces articles in the Special Issue to tell the story of the SGA Model Demonstration from design, testing, and impact evaluation. METHODS: The SGA Model Demonstration began reviewing administrative data, collecting expert opinion, and exploring current practice in eight state VR agencies. After an eighteen-month period of capacity building, two state VR agencies randomized local offices and implemented a rapid coordinated team approach. RESULTS: State VR agencies are successfully participating in rigorous research activities including model demonstrations with experimental designs. CONCLUSIONS: Model demonstrations that include experimental designs are effective strategies to improve knowledge and build a better practitioner toolbox to advance employment outcomes of VR clients.

Vocational rehabilitation in northern Sweden. III. Aspects of life satisfaction

Levels of global (1 item) and domain-specific (8 items) life satisfaction were explored at the commencement of vocational rehabilitation and two years later in a consecutive series of subjects who were partly or completely vocationally disabled with a diagnosis of bodily impairment. At the onset of vocational rehabilitation, global life satisfaction (satisfaction with life as a whole) and satisfaction derived from performance- and provider-related (instrumental) domains of life were significantly lower than satisfaction derived from socio-emotional (expressive) facets of life. The eight domain-specific items of life satisfaction described a characteristic three-factor pattern (76% of variance) which resembled quite closely that of non-impaired subjects, one factor being expressive. The other two factors were instrumental and separated recreative from vocational domains of satisfaction. Successful vocational rehabilitation resulted in increases in vocational satisfaction. For those subjects who were successfully rehabilitated, satisfaction with other instrumental aspects of life and with life as a whole also increased. The results indicate that successful vocational rehabilitation leads to increased social well-being.

Considerations in developing a specialized epilepsy employment program: A sponsor's playbook

Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.

Manager perspectives on workers’ return to work after cancer treatment

Abstract Background Due to improved cancer treatment, the survival rate of cancer is increasing Unfortunately, many cancer survivors suffer from serious late effects because of this treatment. Therefore, more and more cancer survivors with reduced work ability are, and will in the future be, in work. To include this group of workers in working life is a challenge for the society in general and for the enterprises in particular. The aim of this study was to investigate managers’ experiences regarding cancer survivors’ return to work (RTW). Methods We performed qualitative individual in-depth interviews with nine managers who had experience with workers who needed adaptations at work after cancer treatment. The interviews were transcribed in verbatim and thematically analyzed in accordance with guidelines for stepwise deductive-inductive analysis (Tjora, 2016). Results All managers emphasized the importance of taking good care of workers with serious diseases and to adapt work according to their work ability. The managers tried to follow the Work Environment Act and guidelines given by the Norwegian Labor and Welfare Administration but they experienced that the guidelines did not fit well with the needs of the cancer survivor and/or the enterprise. A good RTW process was dependent on an open dialog that was initiated early in the RTW trajectory to establish a sense of safe situation for both the cancer survivor and the company. A good RTW process could only be established if the colleagues of the survivor gave their support to both the survivor and the manager. In addition, it was of great importance that the needs of the cancer survivor had to be balanced by the production needs of the enterprise. Conclusions Managers need support from health personnel and social security agencies to support cancer survivors to retain work. Key messages Cancer survivors need adaptations at work. Managers are crucial in securing a successful vocational rehabilitation of cancer survivors.

Personal and Contextual Factors Associated With Successful Vocational Rehabilitation and Employment Outcomes

Some individuals with disabilities have relatively better labor outcomes than others. If vocational rehabilitation (VR) counselors can better understand what factors are correlated with positive outcomes, they could better identify what clients are at risk for poor outcomes and then intervene early to improve chances for success. Unfortunately, until recently VR survey and administrative data have had insufficient information to investigate these questions. We use a survey of 932 Ohio VR clients combined with administrative earnings data to examine the barriers and facilitators associated with employment and earnings outcomes. The survey data are from the 2014 Survey of Disability and Employment, a survey of VR applicants in three states. We compare VR case status and earnings through 2016, by demographics, functional limitation status, employment history and attitudes, and reasons stated for not working in the survey. We find that about 25% of survey respondents exited the program employed or had at least one quarter of average monthly earnings above the Social Security Administration’s substantial gainful activity amount. Pain, depression or anxiety, longer duration of job separation, personal and familial attitudes about work, and not working because of personal and health reasons were associated with poorer outcomes among survey respondents.

Increasing Successful Vocational Rehabilitation Outcomes for Individuals with Substance Use Disorders

Employment is essential during the treatment and recovery process for individuals with substance use disorders. As such, rehabilitation counselors play a vital role in ensuring the success of these consumers by offering services that increase the likelihood of employment. State and federal vocational rehabilitation programs can offer any of 19 services to consumers and by identifying services offered to those with substance use disorders who have been rehabilitated successfully, counselors can make a concerted effort to incorporate them when most appropriate. As a replica of a study conducted over 10 years ago, the current study seeks to determine if the services identified as increasing successful employment outcomes using data from 2005 still hold true today especially since gainful employment remain low for this population. After effective services are identified, one may then determine how to best incorporate these services into the overall Individual Plan for Employment (IPE) to better assist those with substance use disorders (SUDs). Rehabilitation Services Administration (RSA) 911 datasets were analyzed for years 2010-2014, and chi-square analyses identified five services as increasing the probability of successful case closure (i.e., employment): 1) job placement, 2) on-the-job supports, 3) maintenance, 4) job search, and 5) other. Descriptions of each service are provided as well as suggestions for application and implementation.

Predictors of Successful Vocational Rehabilitation Closure among Individuals with Substance and Alcohol Use Disorders: An Analysis of Rehabilitation Services Administration Data 2010–2014

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.

Public provision of postsecondary education for transition-age youth with mental health conditions.

We examine the role of state vocational rehabilitation (VR) agencies (SVRA) in providing postsecondary education support to transition-age youth with and without mental health conditions (MHC) to provide insights into who receives such supports and the association between the receipt of postsecondary education support and successful VR exits. We used data from SVRA administrative records (fiscal years 2002 through 2013) for a secondary analytical approach that relied on descriptive and regression methods, resulting in the identification of 436,883 VR youth clients who applied from 2002 to 2004. Linear regression models examined the relationships between youth demographic and service characteristics and each of 4 binary outcomes derived from the administrative records: (1) receipt of VR services, (2) receipt of college support (conditional on receiving services), (3) receipt of vocational training support (conditional on receiving services), and (4) exiting with employment. SVRAs had a wide range in the provision of postsecondary education support to clients with MHC, from almost none receiving such supports to more than half. VR youth clients with MHC were less likely than those without MHC to have received any VR services or college support. Receipt of postsecondary education support was positively associated with being employed at the time of VR exit, and the associations for those with MHC were not statistically different from those without MHC. SVRAs have the potential to play a large role in the provision of postsecondary education support. Although those who received postsecondary education support were more likely to be employed at the time of VR exit, the provision of that support came at a cost-the high financial costs of that type of support relative to other services offered by SVRAs, as well as the opportunity cost of the client's time. (PsycINFO Database Record

Toward a successful vocational rehabilitation in adults with disabilities: Does residential arrangement matter?

ABSTRACTThe objective of this study was to assess whether successful vocational rehabilitation (that is, obtaining employment) among people with disabilities was affected by residential arrangement. Five groups of residential placement were considered: individuals living in a private residence, community or group residential, correctional and rehabilitation facilities, nursing home/mental health facilities, and homeless/shelter/other type of residential arrangement. The study involved a total of 46,570 vocational rehabilitation consumers aged 18 to 65 at referral in a Midwestern state. Statistical modeling was performed using quasibinomial logistic regression. It was found that compared to individuals living in private residences, those in correctional or rehabilitation facilities were at increased odds of successful rehabilitation, whereas those living in homeless/shelter/other residential arrangement and those living in nursing homes/mental health facilities were in significantly decreased odds of being rehabilitated. Individuals living in community or group residential, however, had no statistical difference in vocational rehabilitation outcomes compared to individuals living in private residences. The implications for rehabilitation research and practice are discussed.

Determinants of outcome of vocational rehabilitation.

Information regarding the determinants of successful vocational rehabilitation (VR) is scarce. Investigate whether sex, duration, quality of life and financial circumstances influence the success of VR. The study group consisted of 519 participants (293 women, 56%), who finished VR in the period 2000-2014. The group was divided into the following subgroups: dropouts, unsuccessful and successful VR. Data were collected by questionnaire. Income had the most impact on whether the outcome was successful. Having supplemental income when entering the VR program increased the likelihood of a successful conclusion, odds ratio (OR) 5.60 (95% CI; 2.43-13.59) (p < 0.001), being on sick leave OR 5.02 (95% CI 1.93-13.79) (p < 0.001) or rehabilitation pension OR 1.93 (95% CI 1.07-3.52) (p < 0.03). The participants in the successful sub-group were older (p < 0.06) and stayed in rehabilitation longer (p < 0.001), compared to those who were unsuccessful. However, the effect on OR was limited: 1.03 (95% CI 1.01-1.06) and 1.04 (95% CI 1.02-1.07), respectively. For this sample, supplemental income appears to be the most important factor for a successful rehabilitation outcome. Checking financial status at the beginning of the rehabilitation process could minimize financial strain and increase the likelihood of success.

The experiences of occupational therapists regarding the use of the Model of Occupational Self Efficacy.

Studies exploring the views of occupational therapists about the vocational rehabilitation models of practice related to individuals with brain injury are limited. The views of occupational therapists regarding the use of vocational rehabilitation are important in the development of successful vocational rehabilitation programmes. The aim of the study was to explore and describe the experiences of occupational therapists regarding the use of the model of occupational self-efficacy. Five occupational therapists participated in the study. The research study was positioned within the qualitative paradigm specifically utilizing an exploratory and descriptive research design. In order to gather data, semi-structured interviews were conducted with each participant. Two themes emerged from the findings of the study. One theme reflected the barriers related to the use of the model, i.e. Theme one: Challenges related to the use of the model. The second theme related to the enabling factors related to the use of the model, i.e. Theme two: The model as an enabler of work skills. The findings of this study indicated that the Model of Occupational Self Efficacy (MoOS) is auseful model to use in retraining the work skills of an individual with brain injury. The participants in this study could maintain employment in the open labour market for aperiod of at least 12months and it improved their ability to accept their brain injury as well as adapt to their worker roles. The MoOS also provides a framework for facilitating work integration.

Individuals With Disabilities in Self-Employment Through Vocational Rehabilitation

Since the passage of the Rehabilitation Act of 1973, federal and state governments have played a significant role in the employment of individuals with disabilities. In the present study, one aspect of that relationship was analyzed—individuals with disabilities who received vocational rehabilitation (VR) services to become self-employed. The authors utilized a two-level hierarchical generalized linear modeling to analyze national data from the Rehabilitation Services Administration for fiscal years 2008–2012. Among several significant ( p &lt; .001) predictors of successful VR self-employment case closure across the years, ethnicity had the largest effect, followed by gender. Although the findings from this study build on those from a previous study, conclusions about the predictors are tentative. Nevertheless, the findings add to a sparse literature on VR self-employment of individuals with disabilities, and the authors discuss the study’s implications for researchers and VR and provide suggestions for further research.

Relevance of Personality Factors for Successful Vocational Rehabilitation

The Main purpose of vocational rehabilitation is occupational reintegration of clients into the job market who have lost their job or whose job is threatened because of a handicap or chronicl illness. With regard to existing evidence for the relevance of personality factors for work performance and job achievement, the present study investigated the influence of participants' personality factors on a successful reintegration after a retraining program in a vocational training center over 2 years. A central research objective was to identify prognostic personality factors for successful vocational integration. In this longitudinal study 15 vocational training centers participated at 3 time points of measurement (T1, T2 and T3). Data gathering was based on rehabilitants' self-reports (standardized questionnaires: SVF, BSW, SPR, CSES) about personality aspects. First data collection started at the beginning (T1) and a second survey was conducted at the end of the training 2 years later (T2). Based on the data at measurement points T1 and T2, 4 prognostic models were computed (binary logistic regression analysis) and evaluated, examining the differenzial influence of several scales and items on direct reintegration after completing the vocational retraining and reintegration status 6 months later (T3). As expected, different variables turned out to be relevant for occupational integration at the end of the training program and 6 months later. Correspondingly other variables appeared to be relevant for occupational reintegration at T1 and at T2. At the end of the vocational training program, approximately 24% of the participants had a job. With respect to direct reintegration, regression analysis revealed that vocational self-efficacy (R(2)=0,175) and self-evaluation were relevant (R(2)=0,383). Approximately 70% of the participants had gotten a job 6 months later. Several stress coping strategies (R(2)=0,170), estimation of the own reintegration prognosis and aspects like vocational center contextual factors (R(2)=0,280) appeared to be relevant for reintegration 6 months later.

Lupus: Vocational aspects and the best rehabilitation practices

BACKGROUND: Lupus (systemic lupus erythematosus; SLE) is a chronic autoimmune disorder, and is usually diagnosed initially in early to middle adulthood, which is the prime career-building phase of individual’s life. Persons with lupus report considerable financial burden not only because of healthcare costs but also because of compromised ability to engage in paid work due to illness as lupus can have a significantly negative impact on a person’s work participation, including loss of employment and reduced working hours. Rehabilitation counselors must be knowledgeable about the critical physical and psychosocial impacts of the illness and potential employment problems that the illness may cause. With this knowledge base, rehabilitation counselors can better assist individuals with lupus with obtaining and maintaining employment, economic independence, and balancing their life demands with their changing health care needs. OBJECTIVE: This paper first provides an overview of lupus and functional limitations that it may impose, followed by relevant vocational rehabilitation interventions, including workplace accommodations and education. CONCLUSIONS: We emphasize consumer advocacy, anticipatory coping and illness management, accommodations on the job, and need of active involvement of employers in problem solving as key elements of successful vocational rehabilitation for people with lupus.

Berufliche Rehabilitation nach Laryngektomie

Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation. Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6). Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues. Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.

Professionals' perceptions of and views about vocational rehabilitation for people with psychiatric disabilities

One of the challenges agencies and professionals face is to enable people on sick leave to be successful in their vocational rehabilitation. The objective of this study was to explore and analyze some professionals' perceptions of and views about vocational rehabilitation among people with psychiatric disabilities. Eight professionals from four different agencies (social services, the employment service, the social insurance office, and a psychiatric outpatient setting) working in the area of vocational rehabilitation for people with psychiatric disabilities. Eight in-depth interviews were conducted. The data collected was analyzed using qualitative content analysis together with an interpretive approach. The results suggested the respondents were in consensus regarding that which they considered to facilitate or enable successful vocational rehabilitation. Intensive support over a long period of time and a holistic view that takes into account the habits and routines of daily life outside of work as well as the social and psychological aspects of individuals during their rehabilitation processes were considered to be just as crucial to the vocational rehabilitation process as training in the workplace. These professionals dealt with a complex vocational rehabilitation system; they felt that their organizations' directives and inability to collaborate successfully with other authorities restricted their scope of action and hindered their exercise of good practice.

Tätigkeitsbereiche von Beratungsfachkräften in der beruflichen Rehabilitation: Empirische Befunde einer explorativen Befragung in Deutschland

In the light of far-reaching demographic and sociopolitical changes, the demand for rehabilitation counseling experts increases. Internationally scientific research has long recognised the importance of professional support for successful vocational rehabilitation of people with illnesses and disabilities. In Germany, however, there has been a lack of systematic research in this field. The present exploratory study aims to fill this gap by investigating the status quo of rehabilitation counselors' vocational fields of activity in Germany. The study was conducted anonymously as an online-survey. An international questionnaire which covers a wide range of tasks that can play a role in the day-to-day work of rehabilitation counseling experts was used. Within the project it was translated into German and adapted to the German rehabilitation system. 217 rehabilitation counselors completed the survey. Socio-demographic information and information concerning the participant's working biography were evaluated descriptively. To analyze the questionnaire data, principal component analysis was undertaken. The majority of respondents indicated to be performing tasks from different fields of activity in their daily routine. The essential and main field of activity though appeared to be the individual work with the client. Managerial tasks on an organizational level turned out to be less important. Furthermore, it became clear that the terms the respondents used to name their qualification and their current job title varied in a confusing way. This implicates that it was not always possible to infer from the job title of a person to their actual vocational tasks. Moreover, the participants expressed that they see a need for action concerning their vocational training as well as their professional tasks. German rehabilitation counseling experts can be characterized as "generalists" who cover different fields of activity in their daily routine. Their main activity is the individual work with the client while managerial tasks play a lesser role yet. A further differentiation of the vocational tasks indicating a higher degree of specialization as it can be found in related American or Australian studies does not emerge. The take-over of managerial tasks on an organizational level is not necessarily associated with the use of the term "management" in a person's job title. These results can be explained partly by the relatively new sociopolitical changes in Germany. These changes include the introduction of a regulation in 2004 (§ 84 Social Code Book), which obliges employers to prevent and manage disability at the company level. Still different studies show various problems concerning the comprehensive implementation of this regulation. The participants see urgent needs for action concerning the clarification of structures and responsibilities in their companies as well as more networking and a better publicity for their profession. With regards to the training, respondents desired more practical exercises and case studies. Further research in this field is needed.

ICF Core Set for vocational rehabilitation: results of an international consensus conference

Purpose: Vocational rehabilitation (VR) programs aim to facilitate work participation. However, there is no universal framework to describe the functioning of individuals who participate in VR. The objective of this paper is to report on the Core Set for VR based on the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO). Methods: A formal decision-making and consensus-based process was conducted based on the evidence from four preparatory studies. Twenty-three international experts chosen by WHO Region and expertise in VR attended the consensus conference. Results: Ninety ICF categories were included in the comprehensive Core Set (activities and participation = 40, environmental factors = 33, body functions = 17), while the brief Core Set included 13 second-level categories (activities and participation = 6, environmental factors = 4, body functions = 3). Conclusions: The expert opinion and evidence-based Core Set could serve as an international standard for what to measure and report concerning functioning of individuals in VR. The Core Set could also provide a common language among clinicians, researchers, insurers, and policymakers in the implementation of successful VR. Further testing and validation studies are encouraged.Implications for RehabilitationVocational rehabilitation is a multidisciplinary and multi-stakeholder process, which aims to reduce or eliminate the burden of work disability and facilitate work participation.The International Classification of Functioning, Disability and Health (ICF) provides a framework to describe and measure the functioning of individuals who are in a vocational rehabilitation program.The ICF Core Set for vocational rehabilitation provides us with a list of functioning domains in our effort to examine vocational rehabilitation or return-to-work outcomes and the multiple factors associated with vocational rehabilitation.The ICF Core Set for vocational rehabilitation can be used in clinical rehabilitation setting and rehabilitation research, and further steps to ensure the robust measurement, documentation, and reporting of the Core Set in rehabilitation are being planned.