Vocational Rehabilitation Outcomes Research Articles

Competitive Employment for People With Autism

Differences in rates of case closure, case service cost, hours worked per week, and weekly wage between customers with autism closed successfully in competitive employment and supported employment were found using the Rehabilitation Service Administration national database of 2001. Using logistic regression, customer demographic variables related to successful competitive employment included age, years of education, and presence of a secondary disability. Case service variables related to successful competitive employment included job finding, job placement, and maintenance. Of customer demographic variables related to successful supported employment, White customers were more likely to be closed successfully. Job placement was the case service variable related to successful supported employment. Implications for rehabilitation professionals and for future research on vocational rehabilitation outcomes with customers with autism are provided.

Development and Validation of the Chinese Version of Indiana Job Satisfaction Scale (CV-IJSS) for People with Mental Illness

Job satisfaction has been increasingly regarded as an important outcome of vocational rehabilitation programs among people with mental illness. Chinese measures of job satisfaction for individuals with mental illness are however extremely scarce. The aim of this study was to translate the 32-item Indiana Job Satisfaction Scale to Chinese. By means of the expert panel method, the culturally relevant 28-item Chinese Version of Indiana Job Satisfaction Scale (CV-IJSS) was then finalized. A validation study among a group of 125 individuals with mental illness showed that the scale had acceptable psychometric properties. Coefficient alpha of the total score was 0.81 with subscales ranging from 0.63 to 0.87. Test re-test reliability as measured by ICC was 0.77 for the total score and ranged from 0.54 to 0.72 for the subscales. Factorial analysis yielded a four factor solution (general satisfaction, job ambiguity and stress, advancement and security, and job recognition) accounting for 44% of the total variance. The factor solution had similarities as well as differences when compared with the Indiana Job Satisfaction Scale. The differences are discussed in the light of cultural differences. Relationship between scores of CV-IJSS and work performance, quality of life and self-esteem was positive in general which may act as evidence to its concurrent validity. The Chinese Version of Indiana Job Satisfaction Scale is ready for use by rehabilitation professionals to assess vocational rehabilitation outcome for individuals with mental illness in Hong Kong and other Chinese societies. Directions for further studies are suggested.

The Counseling Function in Vocational Rehabilitation

This paper presents a five stage counseling process and describes its relationship to the rehabilitation process as experienced by vocational rehabilitation consumers. It is argued that professional counseling methods in the context of a helping relationship can facilitate and enhance vocational rehabilitation outcomes.

Work resumption or not after rehabilitation? A descriptive study from six social insurance offices

The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.

Traumatic Brain Injury and Rehabilitation Outcomes: Does the Working Alliance Make a Difference?

This study investigated the impact of the working alliance on vocational rehabilitation outcomes for individuals with traumatic brain injury. The working alliance is defined as collaboration between the client and counselor supported by the development of an attachment bond as well as a shared commitment to the goals and tasks of counseling. Research supports the relationship between the working alliance and positive counseling outcomes. This study extends previous research and considers the relationship between working alliance and employment, job satisfaction, and view of future employment prospects for 49 vocational rehabilitation clients with traumatic brain injury. Results showed a relationship between the working alliance and employment outcomes and future employment prospects but not job satisfaction. Implications for rehabilitation counselors are discussed.

Comparing Employment Outcomes of Vocational Rehabilitation Consumers with Hearing Loss to Other Consumers and the General Labor Force

This study was an examination of four different aspects of employment (i.e., major occupational category, earnings, projected job growth, and transferable skill levels) that can be used to evaluate vocational rehabilitation (VR) outcomes beyond successful closure. Comparisons were made among VR consumers with hearing loss (the target group), VR consumers with other disabilities, and the general labor force. Results indicated few differences between the two VR consumer groups, but differences between both consumer groups and the general labor force were found across all employment outcome areas. A clear finding of this study was that more successfully closed VR consumers are employed in lower skill jobs than are members of the general labor force.

Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI

To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency. 78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period. Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case). All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas. Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs. Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas. Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas.

Counselors' Multicultural Competencies and Vocational Rehabilitation Outcomes in the Context of Counselor—Client Racial Similarity and Difference

This investigation explored the relationship between rehabilitation counselors' multicultural competency and vocational rehabilitation (VR) outcomes in the context of counselor—client racial similarity and difference for individuals with disabilities who were served in a large northeastern state VR agency. The results demonstrated significant main effects as well as complex interaction effects among client race, counselor race, and counselor multicultural competency in relation to rehabilitation rate and vocational training rate. Thus, clients from different racial groups experienced different outcomes in the VR process in this agency as a function of the counselors' race and multicultural competency. The current findings are discussed in relation to previous studies of VR service equity for persons with disabilities from underrepresented groups, and recommendations for future research are provided.

Supported employment: Disparities in vocational rehabilitation outcomes, expenditures and service time for persons with traumatic brain injury

This study examined differences in closure status, occupational placements, weekly earnings, hours worked each week, expenditures, and time in rehabilitation for persons with traumatic brain injury (TBI) based on the provision of supported employment services. Participant race, education level, age, marital status, gender, prior work experience, and disability severity were controlled for all dependent variables but occupational placements. Participants were 1,073 public vocational rehabilitation clients with TBI whose cases were closed in the Southeastern United States. Seventy eight participants received supported employment services during the vocational rehabilitation process. Significant differences were found in closure status when comparing consumers who received supported employment services to those who did not. Most competitively employed participants in both groups were working in miscellaneous occupations at case closure. For competitively employed consumers, significant differences were found in weekly earnings, hours worked per week, and expenditures when comparing the two groups.

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

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

On prediction of vocational rehabilitation outcome at a Swedish employability institute.

The main objective of this investigation was to identify a set of variables usable in early outcome prediction of vocational rehabilitation. On commencement of rehabilitation at an employability institute, data were sampled using structured interviews and checklists. Two years later the subjects were followed up by telephone interviews. The study sample was all unemployed with a somatic disorder as the cause of vocational disability, admitted from October 1995 to December 1996 (n = 149). Of these 109 (73%) agreed to participate. Initially, data on demography, symptoms, expectations/beliefs about future capacity for gainful employment and sense of coherence (as an indicator of coping resources) were sampled. At follow-up the subjects' vocational situations were recorded. At follow-up, 40% were working or employable. Among the about 30 variables included, logistic regression showed that having a relatively high belief in vocational return (odds ratio, OR: 4.6, CI: 1.4-15.4), having a relatively high sense of coherence (OR: 3.5, CI: 1.5-8.4) and having a relatively high educational level (OR: 2.6, CI: 1.1-6.3) were significant predictors of positive outcome. In this sample, socio-psychological and educational aspects were far more predictive of outcome than were medical circumstances.

Rehabilitation Outcomes, Expenditures, and the Provision of Assistive Technology for Persons with Traumatic Brain Injury

This study examined differences in public vocational rehabilitation outcomes (i.e., closure status and weekly earnings) and expenditures for persons with traumatic brain injury (TBI) based on the provision of assistive technology. The sample consisted of 1,145 consumers with TBI whose cases were closed in a southeastern state. Thirty of these consumers received assistive technology during the vocational rehabilitation process. Significant differences were found in closure status and vocational rehabilitation expenditures for consumers with TBI when comparing those who were provided assistive technology with those who were not. No significant differences in weekly earnings were found when comparing the two groups.

Effects of disability compensation on participation in and outcomes of vocational rehabilitation.

The authors sought to determine the relationship between receipt of disability compensation and participants' success in a vocational rehabilitation program. Administrative data for 22,515 individuals who participated in the Veterans Health Administration compensated work therapy program between 1993 and 1998 were analyzed. Six dependent variables were compared between participants who were receiving disability compensation and those who were not: duration of participation in compensated work therapy, number of hours worked per week, mean hourly earnings, total income from compensated work therapy, dropout rate, and competitive employment status at discharge. Regression equations were determined for each dependent variable to assess associations with the degree of disability, the amount of disability compensation, and the type of compensation program. Participants who were receiving disability benefits worked fewer hours in compensated work therapy each week, earned less income, had a higher dropout rate, and were less likely to be competitively employed at discharge. The amount of compensation and the type of program were modestly but significantly associated with participation in compensated work therapy and with outcome. Unintended effects of disability compensation programs discourage full participation in vocational rehabilitation and result in poorer rehabilitation outcomes.

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Postsecondary Education Services and Employment Outcomes within the Vocational Rehabilitation System

This article examines provision of postsecondary education services by the Vocational Rehabilitation (VR) system to eligible individuals with disabilities nationwide. The results of a secondary analysis of elements of the RSA-911 database from the Rehabilitation Services Administration in FY 1997 are discussed. The extent to which individuals within the VR system receive postsecondary education services is compared to the rate of individuals with and without disabilities participating in postsecondary education in the general population. An association between receipt of postsecondary services and VR outcomes is examined. Findings show that receiving postsecondary education services has little effect on the rate of successful closures in the VR system. Individuals receiving postsecondary education services from VR do show higher rates of competitive employment and improved employment outcomes including higher earnings and greater number of hours worked per week. Differences in receipt of postsecondary education services by disability type and the policy implications are discussed.

The impact of psychosocial 'markers' on the outcome of rehabilitation

Purpose : The aim of this study was to identify substantial psychosocial events-'psychosocial markers' (PMs) in the clients files and to correlate the PMs to the outcome of the rehabilitation, in order to find out whether this information had any impact on the outcome of vocational rehabilitation (VR). Method : Three-hundred and seventy-two individuals were included, being an object of a VR measure during 1993-1994. All were impaired by either disc hernia back pain syndrome or other diseases of the loco-motor system. The PM was defined as any psychosocial loaded information of the person's life situation, not immediately related to the original set of medical problems. Results : Twenty-seven PMs were identified among men and 36 for women. Alcohol related problems dominated for men and private life related problems for women. Only approximately 25% of the PM concerned work related matters. After 3 years the OR (odds ratio) for full disability pension was 2.6 (n.s.) for men with the PM and 4.3 (p < 0.05) for women. The outcome was independent of background factors such as unemployment, blue-collar work and low education. Conclusions : The PM was found to be an important and independent factor to impact the outcome of rehabilitation in women.

Vocational rehabilitation outcomes of veterans with substance use disorders in a partial hospitalization program.

The authors examined factors that influenced the employment rates of 529 veterans with severe alcohol and other substance use disorders who were being treated at an addictions partial hospitalization program. The employment rate was significantly higher for veterans who completed the hospitalization program, participated in a Veterans Industries work-for-pay program, and received drug-free supportive housing.

Vocational Assessment for Individuals with Schizophrenia: An Alternative Approach

Individuals with psychotic disorders, such as schizophrenia, have been found to have less successful vocational rehabilitation outcomes than other disability groups. A contributing factor may be that existing traditional vocational assessment methods and tools simply lack characteristics that would make them most useful for individuals with schizophrenia. Specific symptomatology present in the schizophrenic disorders interferes with the individual's ability to properly complete traditional assessment tools. Alternative methods of assessment are therefore needed for individuals with schizophrenia to get the most benefit from the vocational rehabilitation process and reach their vocational potential. A five-stage model is proposed which attempts to address issues that arise during the vocational assessment process for people with schizophrenia.

Relationships between social competence, psychopathology and work performance and their predictive value for vocational rehabilitation of schizophrenic outpatients

Earlier studies suggest that social competence has a higher predictive value for vocational outcome than psychopathology. These studies, however, show methodological shortcomings, including the fact that the instruments used for assessing social competence, psychopathology and work performance are strongly interrelated. The present study, involving a population of 34 chronically schizophrenic outpatients enrolled in a vocational rehabilitation program, was conducted in order to determine: (1) how closely the Role Play Test, the Positive and Negative Syndrome Scale and the Work Behavior Assessment Scale are related to each other; and (2) whether social competence is a better predictor of work performance and outcome of vocational rehabilitation than psychopathology. Factor analysis has revealed that the instruments are interrelated, mainly in the dimensions of negative symptoms, social relationships, non-verbal measures of social competence and conceptual disorganization. In backward regression analyses, psychopathological indicators proved to be the best predictors of work performance both cross-sectionally as well as in the longterm course. In the traditional two-syndrome model of schizophrenic psychopathology only negative symptoms were left in the regression model. In a four-dimension model the disorder of relating and the conceptual disorganization dimension were the best predictors. Differences between disorder of relating and social competence, assessed by the Role Play Test, are discussed here as well as the implications of this study for rehabilitation.

Vocational Rehabilitation in Shizophrenia

Schizophrenia exacts a heavy toll on a person's capacity to work, and a variety of vocational rehabilitation interventions have been developed over the past few decades to enhance the vocational capacities of persons with this disorder. The research literature on outcomes of vocational rehabilitation during the era of deinstitutionalization for persons with schizophrenia is reviewed. Most vocational rehabilitation programs have a positive influence on work-related activities, but most have failed to show substantial and enduring impacts on independent, competitive employment. Recent advances in supported employment suggest that vocational rehabilitation offers greater promise than do transitional and sheltered employment approaches. Vocational rehabilitation intervention may also exert positive influences on such clinical outcomes as medication compliance, symptom reduction, and relapse.