Vocational Rehabilitation Outcomes Research Articles

Vocational rehabilitation service usage and outcomes for transition-age youth with serious mental health conditions

BACKGROUND: The postsecondary vocational outcomes of students with mental health disabilities (MHD) are poor and vocational rehabilitation factors contributing to better outcomes have not been identified. OBJECTIVE: Characterize demographic, service use and service outcome differences between youth with MHD and youth with other disabilities from state vocational rehabilitation agencies (SVRA) and identify factors predicting service use and service outcomes within youth with MHD. METHODS: Data were from 2015–2017 Rehabilitation Services Administration-911 case closure files. The sample consisted of 14–24-year-old SVRA applicants. Cross-disability characteristics, service use and outcomes were compared. Within youth with MHD, multivariate analyses examined factors contributing to having an Individual Plan for Employment (IPE) and successful case closure (i.e., with employment). RESULTS: Youth with MHD were underrepresented, older at application and were less likely to have IPEs and successful closures than youth in other disability groups. Within youth with MHD, application age and SVRA characteristics were the strongest predictors of having an IPE. Education and employment status at application strongly predicted successful closure. CONCLUSION: Youth with MHD, as in previous cohorts, continue to have lower service use and successful SVRA outcomes. Efforts are needed to increase their connection to SVRAs at younger ages. Youth with MHD without employment at application may need additional supports to achieve successful closures. Addressing several SVRA performance characteristics may improve their service use and outcomes.

‛Until you're in the chair and executing your role, you don't know': A qualitative study of the needs and perspectives of people with stroke-related communication disabilities when returning to vocational activity.

People with communication disability after stroke experience low rates of return to vocational roles. Vocational rehabilitation is recommended; however, there are no clear guidelines informing vocational rehabilitation for people with communication disability. Understanding the needs and experiences of this population is critical to improving vocational stroke rehabilitation outcomes. This study aimed to: (1) investigate the experience of vocational rehabilitation for people with communication disability after stroke, (2) identify gaps and, (3) provide preliminary recommendations for tailored service delivery. Seven participants with an identified communication impairment following stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample, n = 34). To address the study aims, a qualitative design was employed. Semi-structured, in-depth interviews were conducted and analysed using thematic analysis. Data were integrated with demographic and intervention audit data to contextualise participant experiences, identify vocational rehabilitation gaps and inform preliminary recommendations. Participants were five men and two women aged 24-69 years whose communication profiles included difficulties with auditory comprehension and information processing, reading comprehension, thinking, executive function and self-regulation, as well as difficulties with verbal and written expression. Vocational rehabilitation was perceived as beneficial but participants identified gaps including limited access to psychological and peer-based support during early rehabilitation, limitations to accessing specialist vocational rehabilitation programs, barriers to accessing ongoing rehabilitation after resumption of vocational activity, and limited preparedness for the degree of impact that their communication changes had on execution of vocational roles and responsibilities. Vocational environments are communicatively demanding and people living with acquired communication difficulties face a range of vocation-related participation barriers even when communication difficulties are mild. Greater emphasis on evaluating the vocational communication environment and targeted communication training and preparation for colleagues within the workplace is recommended to reduce barriers faced. Interdisciplinary rehabilitation, inclusive of psychological care, may support working-age stroke survivors to recognise and acknowledge changes in their communication function, lead to improved engagement in the rehabilitation process, and ensure early identification of factors likely to influence successful return-to-vocational activity. What is already known on the subject Stroke is common amongst people of working age yet fewer than half of stroke survivors will return to pre-stroke vocational roles. Communication difficulties affect anywhere between 24% and 45% of people after stroke and include changes to language abilities, motor speech, vision, hearing and cognition. This group experiences much lower rates of return to vocational roles when compared to people with stroke who do not have a concomitant communication difficulty. Vocational rehabilitation is recommended. However, currently there is limited evidence to inform vocational rehabilitation guidelines for people with stroke and communication difficulties. Achieving a successful return to vocational activity is associated with improved life satisfaction for people with communication difficulties after stroke and is a key research priority for this population. What this study adds This study investigated the experiences of people with communication difficulty after stroke who reported a goal of returning to pre-stroke vocational activity. Data associated with types of interventions received, the experiences and perceptions of vocational rehabilitation, and experiences of returning to vocational activity were analysed to identify core rehabilitation needs and develop preliminary recommendations to inform future vocational rehabilitation guidelines for this population. What are the clinical implications of this work? The present study provides preliminary evidence that people experiencing communication difficulties after stroke require a more integrated rehabilitation pathway. During early stages of vocational rehabilitation psychological and peer-based support is indicated to support adjustment to changed communication function and to enable productive goal setting and engagement in rehabilitation. Clinicians need to complete a detailed analysis of the vocational communication environment and consider the communication activities involved in the individual's future vocational duties in order to plan meaningful rehabilitation. A multidisciplinary approach is required and additional training for clinicians is indicated to support clinicians to work collaboratively within the vocational setting.

Pre-employment transition and vocational rehabilitation services: Experiences in response to Vermont’s work-based learning program

BACKGROUND: State vocational rehabilitation (VR) agencies offer pre-employment transition services (pre-ETS) and other VR services to high school students, but the literature has not documented differences in pre-ETS use by individual characteristics or across individual services. OBJECTIVE: We describe variation in how high school students used services from the Vermont VR agency and how a demonstration program emphasizing work-based learning experiences affected that use. METHOD: The study uses a descriptive approach to explore patterns in youth’s pre-ETS and VR services and outcomes two years after enrolling in a demonstration program. It compares youth with access to demonstration services (the treatment group) to those using usual services (the control group). RESULTS: Among all control group youth, more than half only used pre-ETS during a 24-month period, while about one-quarter used VR services and the remainder used no services from the VR agency. In contrast, nearly all treatment group youth used some VR services, with a majority (59 percent) using both VR services and pre-ETS. Control group youth who used pre-ETS and VR services differed from those who did not use these services by gender, disability type, employment, and service receipt characteristics; treatment group youth had fewer such differences. Earnings outcomes did not vary in consistent or interpretable ways. CONCLUSION: The findings demonstrate how an intervention designed to promote work-based learning experiences increased pre-ETS and VR use and decreased subgroup differences in service utilization. VR administrators might consider collecting information on potentially eligible students to increase access to and use of services.

A framework to support early team-based provision of vocational rehabilitation for adults with acquired brain injury

Purpose Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation. Materials and Methods The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five. Results The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features. Conclusion The framework has the potential to translate to other similar service contexts.

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.

Effects of supported employment on the competitive integrated employment outcomes of transition age and young adults with intellectual disabilities: A non-experimental causal comparative study

BACKGROUND: Supported employment has long been recognized as one of the most effective services for individuals with the most significant disabilities in achieving competitive integrated employment (CIE) outcomes. OBJECTIVE: This study examined the effect of supported employment interventions on the employment outcomes of transition-age youth and young adults with intellectual disabilities served by state vocational rehabilitation agencies using a propensity score matching (PSM) approach. METHODS: We conducted a non-experimental causal comparative study with PSM to create a treatment group (n = 2162) and a comparison group (n = 2191) using the Rehabilitation Services Administration Case Service Report database (Program Year 2018). Chi-square test and t-test were used to analyze the differences between the treatment and control groups on employment outcomes, hourly wage and hours worked per week. RESULTS: Results demonstrated that transition-age youth and young adults with intellectual disabilities who received supported employment were more likely to achieve CIE, earn higher wages, and work longer hours weekly than the control group. CONCLUSION: These findings suggest that supported employment is an effective service for enhancing the vocational rehabilitation outcomes of transition-age youth and young adults with intellectual disabilities and provides valuable information for policy makers, health care providers, rehabilitation counselors, and educators.

The Impact of the Workforce Innovation and Opportunity Act on Agency-Level Vocational Rehabilitation Outcomes for Adults and Youth With Blindness and Low Vision

The purpose of this study was to evaluate the impact of the U.S. Workforce Innovation and Opportunity Act (WIOA) on outcomes (competitive employment rates and median earnings) for adult and youth vocational rehabilitation consumers with blindness or low vision (B/LV) and to determine whether impacts differed by agency type. We utilized RSA-911 data to create two agency-level longitudinal datasets, one for youth and one for adults, with 6-year pre-WIOA and 3-year post-WIOA periods. Data were analyzed using discontinuous growth modeling to assess longitudinal changes in agency-level outcomes through the inclusion of variables representing WIOA and subsequent change in response to WIOA. After WIOA, both youth and adult agency-level competitive employment rates decreased significantly for consumers with B/LV, with a larger impact on youth, and median earnings increased. Results document that the impact of WIOA on agencies varied widely. Separate agencies had a significant decrease in adult competitive employment rates for consumers with B/LV and a significant increase in median earnings compared with combined agencies. Overall, the influence of WIOA on B/LV consumer outcomes appears to be mixed at best, and the effect is surprisingly similar for youth and adults.

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.

Predicting program outcomes for vocational rehabilitation customers: A machine learning approach

BACKGROUND: The Vocational Rehabilitation (VR) program provides support and services to people with disabilities who want to work. OBJECTIVE: Approximately one-third of eligible VR customers are employed when they exit the program. The remainder either exit without ever receiving services or without employment after receiving services. In this study, we explore how customer characteristics and VR services predict these outcomes. METHODS: We examined VR case level data from the RSA-911 files. Machine learning techniques allowed us to explore a large number of potential predictors of VR outcomes while requiring fewer assumptions than traditional regression methods. RESULTS: Consistent with existing literature, customers who are employed at application are more likely to exit with employment, and those with mental health conditions or low socioeconomic status are less likely to exit with employment. Some customers with low or no earnings at application who are not identified in prior studies are more likely than others to have poor program outcomes, including those with developmental disability who are under 18, customers without developmental or learning disabilities, and customers who do not receive employment or restoration services. CONCLUSIONS: VR counselors and administrators should consider implementing early, targeted interventions for newly identified at-risk groups of VR customers.

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.

Vocational Rehabilitation and Labor Market Outcomes: Evidence from World War I Veterans

AbstractThis article uses a linked sample of World War I Army veterans from the state of Missouri to study the impact of vocational rehabilitation on labor market outcomes for men wounded and disabled during the war. Veterans’ military service abstracts are linked to the 1940 US Census and a subset are linked to rehabilitation records. This creates a new dataset that contains information on military service, rehabilitation, and labor market outcomes. I find that 70 percent of veterans that were both wounded in action and disabled when discharged from the army participated in the rehabilitation program. These same veterans had significantly better labor market outcomes, which can be attributed to the rehabilitation program under certain assumptions.

Rural and Urban Counties in Idaho: Differences in Vocational Rehabilitation Service Delivery and Outcomes

The Idaho Division of Vocational Rehabilitation (IDVR) sought to learn whether differences in VR service delivery and employment outcomes were present among consumers residing in urban and rural areas of the state. Case data for participants who had an Individualized Plan for Employment (IPE) signed and in place with the agency between 7/1/2017 and 6/30/2020 were examined to identify differences in employment outcomes and service delivery by county. A total of 7,235 cases were examined, 5,963 (82%) of which were residents of urban areas and 1,272 (18%) were from rural counties. Specific evaluation questions examined differences between these two groups regarding types of services provided to VR participants and length of time between initial IPE signature and service received. Analysis of administrative data indicated that training services were provided at a higher rate to participants in rural counties, whereas job search assistance, assessment, transportation, and maintenance services were provided at a higher rate to participants in urban counties. The overall successful case closure rate for urban (41.42%) and rural participants (41.80%) was comparable.

Differential vocational rehabilitation service patterns and outcomes for transition-age youth with specific learning disabilities: Implications in the COVID-19 era

BACKGROUND: It is essential to ensure that youth with specific learning disabilities (SLD) receive an appropriate type and amount of vocational rehabilitation (VR) services to facilitate their entrance to employment and career development. METHODS: In this study, the chi-squared automatic interaction detector (CHAID) analysis and multivariate logistic regression analysis were used to investigate the relationship among demographic variables, VR services, and employment outcomes for transition-age youth with SLD. RESULTS: Results indicated that age, gender, race, educational level, and cash benefits from the Social Security Administration were significant predictors of employment outcomes for transition-age youth with SLD. After controlling for the effects of demographic variables, job and training related services had significant relationships with employment outcomes. Most notably, job placement, occupational/vocational training, and on-the-job support services had the strongest relationships with competitive employment outcomes. CONCLUSION: These findings support the effectiveness of job-related services and supported employment for transition-age youth with SLD. Implications for future research and practice in the wake of the COVID-19 pandemic are discussed.

A tool to measure work adjustment in the post-pandemic economy: The Illinois work adjustment scale

OBJECTIVE: This article introduces the Illinois Work Adjustment Scale (IWAS) and sets out to confirm the internal validity of the IWAS as well as determine if there are meaningful dimensions among the items of the IWAS that can be further defined as instrument subscales. METHODS: In order to meet these objectives, a survey of 738 individuals, all of whom self-reported as having disabilities, was conducted online. RESULTS: As a result of this survey and exploratory and confirmatory factor analyses, the IWAS was reduced from a 26-question scale to an 18-question scale consisting of two meaningful subscales, Work Context and Work Capacity. Significant and meaningful correlations between the two subscales indicate that Work Context and Work Capacity are related to the broader concept of work adjustment and assess unique aspects of work. CONCLUSION: The IWAS has the potential to be applied to facilitate positive career development and vocational rehabilitation outcomes for people with disabilities and chronic health conditions. This is of greater importance now as the COVID-19 crisis has significantly impacted the economy and workforce, leaving those with the greatest barriers to employment such as individuals with disabilities and chronic health conditions further marginalized and disconnected from work.

Vocational Rehabilitation and Labor Market Outcomes: Evidence from World War I Veterans

This paper uses a linked sample of all World War I Army veterans from the state of Missouri to study the impact of vocational rehabilitation on labor market outcomes for men wounded and disabled during the war. Veterans’ military service abstracts are linked to 1940 United States Census and a subset are linked to rehabilitation records. This creates a new dataset that contains information on military service, rehabilitation, and labor market outcomes. I find that 70% of veterans that were both wounded in action and disabled when discharged from the Army participated in the rehabilitation program. These same veterans had significantly better labor market outcomes, which can be attributed to their eligibility for and participation in the rehabilitation program under certain assumptions.

Do short-term changes in funding improve Vocational Rehabilitation outcomes? Evidence from the ARRA

Do short-term changes in funding improve Vocational Rehabilitation outcomes? Evidence from the ARRA

Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury

BACKGROUND: An exploratory baseline study was conducted to ascertain the state of play in the field of spinal cord injury, vocational rehabilitation and employment in Queensland, Australia. OBJECTIVE: The aim of this study was to establish the rate of return to work and better understanding of vocational expectations and the vocational rehabilitation culture in the Queensland Spinal Injuries Unit, prior to the introduction of an early vocational rehabilitation intervention for people with spinal cord injury. METHODS: A mixed methods approach was utilised, involving administration of either an online survey tool or paper questionnaire to people who had sustained a spinal cord injury within the preceding three years. Statistical analysis of the quantitative data and thematic analysis of the qualitative free-text data was undertaken with the 34 eligible responses. RESULTS: The findings demonstrate a dramatic change in the rate of employment following spinal cord injury, and a lack of vocationally focused support whilst participants were undergoing in-patient rehabilitation. CONCLUSIONS: The study indicates a return to work rate of approximately 35%, and provides support for an individualised vocational rehabilitation intervention, fully integrated into the multidisciplinary spinal injuries unit rehabilitation program.

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.

State-Level Variation in Vocational Rehabilitation Service Use and Related Outcomes Among Transition-Age Youth on the Autism Spectrum.

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014-2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.