Vocational Rehabilitation Program Research Articles

The COVID-19 pandemic’s influence on employment outcomes of veterans enrolled in VA healthcare vocational rehabilitation

BACKGROUND: Employment has been shown to be the fourth most commonly reported need for veterans and their families, and unemployment rates have ranged from 1–69% dependent on the mental health diagnosis. Complications from the COVID-19 pandemic have had a significant impact on psychological functioning, and social isolation has led to increased psychiatric symptoms. Vocational rehabilitation is an intervention provided to Veterans in an attempt to remove barriers to employment while also increasing involvement in gainful work activity. OBJECTIVE: The purpose of the current study was to examine the impact that COVID-19 has had on employment rates at discharge for veterans with mental health disorders participating in a VHA vocational rehabilitation program. METHODS: An outcome-based, summative program evaluation design was used to assess the quality of Veterans served (2016-2021) at a vocational rehabilitation program served at a medical center located in VISN 12 of the U.S. Department of Veteran Affairs. RESULTS: Findings showed that veterans with Bipolar and Psychosis were less likely to discharge with employment (not considering COVID-19). CONCLUSION: No significant meaningful differences existed in employment rates when comparing pre/post March 2020 (official start of COVID-19 pandemic) for veterans with psychiatric diagnoses.

Promoting quality career pathways for individuals with disabilities through the public vocational rehabilitation program

BACKGROUND: Career Pathways initiatives in Vocational Rehabilitation (VR) have emerged as a crucial strategy for enhancing quality employment outcomes among individuals with disabilities. This paper conducts a comprehensive examination of the integration of Career Pathways within VR, emphasizing its significance in aligning vocational goals with evolving labor market demands. OBJECTIVE: Drawing from the innovative Career Pathways initiatives introduced by the Rehabilitation Services Administration (RSA), this paper addresses the RSA Career Pathways Demonstration Initiatives from 2015 to 2019 alongside the ongoing Disability Innovation Fund-Career Advancement Initiative Model Demonstration Project. The paper also discusses the strengthening of Career Pathways through the development of high-quality Individualized Plans for Employment and program evaluation. METHODS: This study utilized a modified exploratory case study approach to examine past and present career pathways initiatives in state VR agencies. Data were gathered from publicly available documentation and archival records, focusing on 12 cases from two national initiatives: the RSA Career Pathways Demonstration Initiatives (2015–2019) and the Disability Innovation Fund-Career Advancement Initiative Model Demonstration Project (2021–2026). RESULTS: The study reveals a substantial, positive impact on employment outcomes for individuals with disabilities through Career Pathways in VR programs, facilitated by the integration of adaptable pathways, individualized planning, and program evaluation.

Customized employment for transition-age youth in state vocational rehabilitation program PY2017 - PY2020: Analysis of service outcomes and related factors

BACKGROUND: Customized employment (CE) is positively correlated with competitive integrated employment (CIE) outcomes and potentially supports transition-age youth in achieving sustainable employment. OBJECTIVE: This study examines the employment outcomes and related factors for transition-age youth with disabilities who received CE services through state vocational rehabilitation agencies (SVRAs) and their vendors from program year 2017 to 2020. METHODS: Employing a combination of descriptive analysis, binary logistic and multiple regression, chi-square tests, and t-tests, the study investigates the demographics, potential barriers, and vocational rehabilitation (VR) services received by the research sample using the RSA-911 dataset. RESULTS: The sample comprised 672 individuals with a mean age of 22.30 years. The most prevalent barrier to employment among CE participants was long-term unemployment, while Supplemental Security Income (SSI) was the most common social security benefit. Furthermore, only 13.2% of transition-age youth achieved CIE status, compared to 30.1% of adults. The key predictors of employment outcomes, including CIE status, weekly earnings, and working hours were identified. CONCLUSION: The research reveals significant differences in employment outcomes between transition-age youth and adult VR consumers. These insights emphasize the necessity for SVRAs to consider a range of factors, including demographics, potential employment barriers, and the effects of various VR services, to increase the CE service effectiveness for transition-age youth.

Self-Perceived Interpersonal Problems Among Long-Term Unemployed Individuals, and Vocational Rehabilitation Programs (In)ability to Change Them.

Self-perceived interpersonal problems can challenge one's access to the work market, making it harder to attain and keep a job while adding to the distress of being outside of the labor market. In this study, we compared the self-perceived interpersonal problems among long-term unemployed individuals taking part in vocational rehabilitation programs (VRPs) (N = 220) with those of the general population. In addition, we examined whether their self-perceived interpersonal problems changed while taking part in the VRPs. We found that participants report significantly higher levels of self-perceived interpersonal problems as measured by the Inventory of Interpersonal Problems (IIP), especially with regard to feeling cold/distanced, socially inhibited, vindictive/self-centered, and non-assertive. The participants did not report a significant decrease in self-perceived interpersonal problems after being part of VRPs for one year. These results are relevant as they may inform interventions targeted this population aimed at increasing employability and/or individual well-being. Importantly, the findings may be viewed as a reflection of both social and individual processes. Long-term unemployed individuals' tendency to feel insufficiently engaged may reflect difficulty with keeping up with a job market in constant change.

Return to Work in Breast Cancer Patients following an Interdisciplinary Rehabilitation Program in a Community-Based Cancer Rehabilitation Center: A Pilot Study.

Despite curative treatment and discharge from acute hospital settings, breast cancer patients often have cancer- and treatment-related morbidity which impairs them from returning to work. Hence, the role of community-based return to work rehabilitation programs is important to help these patients transition back to work. This was a retrospective cohort study involving patients with breast cancer conducted at a community-based cancer rehabilitation center. Patients were involved in an interdisciplinary vocational rehabilitation program involving physiatrists, occupational therapists, physiotherapists and social workers. We recruited 63 patients for this study cohort, with 46 (73.0%) patients ≤ 60 years old. After undergoing the rehabilitation program, there were 37 (58.7%) participants who successfully returned to work. These participants returned to work at either within 6 months (27.0%), 12 months (29.7%) or 24 months (43.2%) after enrollment into the program, with a majority enrolling in white collar jobs. Multivariate regression analysis revealed that significant negative factors for return to work were advanced stage of cancer (p = 0.004), along with clinically significant fatigue, measured on the Brief Fatigue Inventory (p < 0.001). However, perceived work ability (p = 0.020) was found to be a positive factor.

Exploring the Benefits of Vocational Activity for People with Schizophrenia Spectrum Disorder in Norway

AbstractVocational activity holds many benefits for people with severe mental illness. The purpose of the present study is to explore potential benefits of vocational activity on self-esteem and benefits as described by employment specialists. Data from 148 adults with schizophrenia spectrum disorders participating in a comprehensive vocational rehabilitation program was collected as part of the Job Management Program (JUMP) study. Assessments were conducted at inclusion, post intervention (10 months) and 2 years after inclusion. Multiple regressions and mixed between-within subjects analysis of variance were applied to assess potential effects of vocational activity on self-esteem as measured by the Rosenberg Self-Esteem Scale. One hundred and twenty-one reports submitted by the employment specialists post intervention were assessed through a qualitative approach based on thematic analysis. Statistical analyses indicate that vocational activity might be beneficial for self-esteem. Qualitative analysis indicate that vocational activity may provide opportunities for experiencing capability, achievement, and positive social interaction, and be beneficial for well-being, self-confidence, and self-esteem. Vocational activity may be beneficial for well-being and self-esteem among people with schizophrenia spectrum disorders. Statistical analysis indicate that vocational activity may have a positive effect on self-esteem, and there was a non-significant trend indicating that competitive employment may be particularly favourable. However, more research is needed regarding potential differences in effect between types of vocational activity.

Vocational rehabilitation applicants, the services they receive, and their employment outcomes

BACKGROUND: The U.S. Vocational Rehabilitation (VR) program helps people with disabilities gain or improve employment. However, previous research into program outcomes has primarily focused on subsets of participants with specific diagnoses instead of the full population. OBJECTIVE: We chronicled the population’s personal characteristics, services received, and program outcomes to inform hypotheses about relationships between personal characteristics, services, and program outcomes. METHODS: These characteristics were analyzed for all 572,490 adult cases that closed between 2017 and 2018. Descriptive statistical distributions compare the applicants with their two subgroups: participants and non-participants. RESULTS: Seven of the 20 primary impairment categories encompassed 78%of applicants. Sixty-three percent of applicants completed an individualized plan for employment (IPE) and became participants. Eighty-five percent of participants and 43%of non-participants received VR services. Half of VR participants exited unemployed and 44%achieved competitive integrated employment (CIE). Two-thirds of non-participants exited before developing their IPE mostly because they either lost interest in VR or VR lost the ability to talk to them. CONCLUSION: The results describe variables that can potentially affect program enrollment and program outcomes. Future work assessing VR should consider these variables when evaluating services that are most impactful to exiting employment.

Return to work post spinal cord injury through a comprehensive rehabilitative program: A case series

Context Spinal cord injury (SCI) can impair bodily functions and limit an individual’s ability to maintain or gain steady employment. Vocational rehabilitation programs have been shown to effectively facilitate individuals with a SCI to return to work, however, further research is needed on the implementation, outcomes, and feasibility of such programs including with the integration of healthcare. Objective The objective of this single-group study was to assess the effectiveness of a comprehensive vocational rehabilitation program, as measured by improvements in employment, work confidence, life satisfaction, and quality of life for individuals with a SCI. Methods Four individuals with a SCI participated in the vocational rehabilitation program. Participants were assigned responsibilities within their department of interest and attended weekly meetings with the vocational rehabilitation team to address barriers, discuss resources and education, and set professional goals. Completion of pre and post-test assessments was required to evaluate the program’s impact on participants’ work readiness and overall well-being. Results Each participant worked with an interdisciplinary team on an individualized work-plan (over 100 h of employment) with necessary accommodations for successful rehabilitation. Participants reported beneficial changes in multiple post-program assessment categories including physical, social, and emotional functions, with all reporting a general improvement in physical strength upon completion of the program. Conclusion Our findings suggest that a comprehensive vocational rehabilitation program can be effective in facilitating individuals with SCI to gain greater functional independence and confidently pursue employment. Further studies are crucial to advance the knowledge required to implement a successful rehabilitative program.

Pressing the right button—labour market odds for youth with mental illness

ABSTRACT Mental disorders threaten the chances of finishing secondary school and can hinder the school-to-work transitions of afflicted youths. Earlier onset depression predicts the chronicity, recurrence, and severity of episodes throughout life. Using rich, objective mental health data and a battery of variables covering personal and family characteristics, we investigate the impact of Norway’s vocational rehabilitation programmes on youths aged 18–23 who are registered as unemployed. Our results indicate that the impact vary with mental health in adolescence, a variable often unavailable in such analyses. Separate analyses for age group 19–21 and 20–23 show that the younger ones with previous diagnosed mental disorders were likely to pursue further education after participating in programmes providing work practice; those with no earlier diagnosed mental disorders were prone to pursue ordinary education after completing a training programme. For the older age cohorts, aged 20–23, vocational rehabilitation programmes seem counterproductive, irrespective of programme type and of whether they were diagnosed with mental health problems in adolescence or not.

Can cognitive inflexibility reduce symptoms of anxiety and depression? Promoting the structural nested mean model in psychotherapy research

ABSTRACT Objective To estimate the causal effect of executive functioning on the remission of depression and anxiety symptoms in an observational dataset from a vocational rehabilitation program. It is also an aim to promote a method from the causal inference literature and to illustrate its value in this setting. Method With longitudinal (four-time points over 13 months) data from four independent sites, we compiled a dataset with 390 participants. At each time point, participants were tested on executive function and self-reported symptoms of anxiety and depression. We used g-estimation to evaluate whether objectively tested cognitive flexibility affected depressive/anxious symptoms and tested for moderation. Multiple imputations were used to handle missing data. Results The g-estimation showed a strong causal effect of cognitive inflexibility reducing depression and anxiety and modified by education level. In a counterfactual framework, a hypothetical intervention that could lower cognitive flexibility seemed to cause improvement in mental distress at the subsequent time-point (negative sign) for low education. The less flexibility, the larger improvement. For high education, the same but weaker effect was found, with a change in sign, negative during the intervention and positive during follow-up. Discussion An unexpected and strong effect was found from cognitive inflexibility on symptom improvement. This study demonstrates how to estimate causal psychological effects with standard software in an observational dataset with substantial missing and shows the value of such methods.

Describing pathways for return to work following spinal cord injury

BACKGROUND: Spinal cord injury (SCI) frequently occurs in working-aged adults. Following SCI, return to work (RTW) is complex. OBJECTIVE: To describe RTW pathways for people with SCI in New Zealand. METHOD: Data from interviews of people with SCI were analysed using conventional content analysis and themes were developed. These themes were used to develop a graphic that described RTW pathways. RESULTS: Three groups of participants were identified: those who had returned to work, those who would work when they were ready and those where work seemed too far off. Among the first two groups, the themes of constantly recalibrating expectations, having a supportive employer, control/autonomy over work role, exploring options, maintaining hope and knowing work will be there when I am ready, were prevalent. For participants where work seemed too far off, two themes, I don’t know if I can work and rehabilitation is my priority, were identified. The resulting model highlighted that RTW pathways following SCI are complex and non-linear. CONCLUSION: While RTW may be reasonably straightforward for some, for others it can be more circuitous and difficult to navigate. Therefore, vocational rehabilitation programmes should consider where the individual is on the RTW pathway and provide appropriate individualised interventions.

The effectiveness of the model of occupational self-efficacy in improving the quality of life and self-efficacy beliefs in individuals living with schizophrenia: A pre- and post-intervention pilot study

BACKGROUND: Individuals diagnosed with schizophrenia often experience major limitations in returning to work despite participating in rehabilitation programs. OBJECTIVE: The aim of the study was to determine whether individuals who were diagnosed with schizophrenia experienced improved return to work rates, quality of life and self-efficacy beliefs after participating in an intervention program that utilizes the Model of Occupational Self-Efficacy (MOOSE). METHOD: Nine (n = 9) individuals who were diagnosed with schizophrenia participated in the study. The research study specifically utilized a pre- and post-intervention research design. In order to gather data from the participants, the WHO Quality of Life Questionnaire and Self-Efficacy Questionnaires were used to determine whether the individual living with schizophrenia’s quality of life and self-efficacy beliefs improved after participating in a vocational rehabilitation program. RESULTS: All participants in this study presented with an improvement in Return-to-Work Rates, Self-Efficacy Beliefs and Quality of Life scores. The results of the study revealed a 100% return to work rate, a statistically significant effect of the intervention (i.e., MOOSE) on Self-Efficacy beliefs, measured using the Generalized Self-Efficacy Scale, F(1, 8) = 6.606, p = 0.03.*. CONCLUSION: The findings of this study indicated that MOOSE is a useful model to facilitate the return to work of individuals living with schizophrenia. It is also suggested that cognitive rehabilitative activities, life skills and work skills training in a real work environment be included as part of the vocational rehabilitation program.

The effects of employers’ disability and unemployment insurance costs on benefit inflows

In Finland, large firms are partially liable for the costs of disability and unemployment benefits paid to their former workers. To estimate the effects of such cost liabilities, we exploit a reform that extended this cost-sharing to cover a new group of blue-collar workers. We show that experience rating in disability insurance reduces inflows to sickness and disability benefits and increases participation in vocational rehabilitation programs, whereas employers’ unemployment insurance costs reduce excess layoffs of older workers who can qualify for extended unemployment benefits until retirement age. We find no evidence of spillover effects: employers’ cost liabilities in one benefit type do not affect inflows to other types of the benefits.

The Arab minority of East Jerusalem: An exploratory study of vocational rehabilitation in mental health.

The Arab population of East Jerusalem with serious mental illness (SMI) is an ethnic and health status minority that has unique employment issues. Vocational rehabilitation offered to this population is guided by standard regulations that are grounded in knowledge obtained from Western communities on the employment enablers, while negligible research was done to investigate relevance of these enablers for the Arab population. The study aims to examine the previously well-established association between motor, cognitive, and emotional personal factors, occupation features, environmental characteristics, and vocational outcomes of job satisfaction and performance among the Arab population of East Jerusalem with SMI. Twenty-three men and women, aged 23-58, from this minority group who had received vocational rehabilitation participated in this cross-sectional study. They completed standard assessments of motor and cognitive skills, self-efficacy, work-environment suitability, and job satisfaction. Employers then rated their level of functioning at work. No correlation was found between the outcome measurements and most of the personal factors and environmental characteristics (p > 0.05), except for an association between job satisfaction, work self-efficacy, and work control. No expected differences were found between vocational rehabilitation programs in the variables of interest (p > 0.05). The disparity from well-established patterns of association between enablers and employment outcomes reveals unique characteristics of the investigated population and suggests the impact cultural issues has on vocational rehabilitation. The findings raise an urgent call for an in-depth investigation of the complex phenomenon of employment in this population to support sustainable employment benefits and recovery journey.

Job Satisfaction and Receiving Prosocial Workplace Behaviors Among Rehabilitation Counselors

Job satisfaction represents how an employee evaluates their job as favorable to unfavorable. Job satisfaction is widely studied because it can affect how an employee thinks, feels, and behaves in relation to their job. There is evidence that a supportive work environment tends to have outcomes that are more positive for the individual employees and the organization in general. While the rehabilitation counseling supervisor is a source of support (e.g., supervisor shows that they value counselor’s contributions; supervisor supports counselor decisions; supervisor trusts counselor to try new things), supervisors are often tasked with many duties in addition to their critical role of supervision and rehabilitation counselors may experience barriers to receiving support from supervisors. The purpose of this study was to explore the relationship between job satisfaction and support, in the form of prosocial behaviors from individuals in their organization (e.g., one member of an organization helping another complete a task; one member of the organization conveying actions of respect towards another; one member of the organization listening to anxiety and fears at work of another). Among the sample of rehabilitation counselors employed in the state vocational rehabilitation program studied, results indicate that rehabilitation counselors who received support from their supervisor and support from others in the organization reported the highest levels of job satisfaction. For counselors receiving low levels of support from their supervisor, receiving support from others in the organization seemed to make up for lack of support from the supervisor in terms of job satisfaction. In terms of job satisfaction, results indicate it is critical for rehabilitation counselors to receive support from individuals in the workplace in some capacity.

Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation.

The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center. A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board. Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%). VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.

“I’ve still got a job to go back to”: the importance of early vocational rehabilitation after stroke

Purpose Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. Method Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. Results Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. Conclusions Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs.

Effect evaluation of a vocational rehabilitation program for young adults with chronic physical conditions at risk for unemployment: A controlled clinical trial

Background The work participation of young adults with chronic physical conditions lag behind compared to healthy age-mates. ‘At Work’ is a vocational rehabilitation intervention provided by occupational therapists, that supports them for entering the competitive labour market after graduating post-secondary education. Aim To evaluate the effects of ‘At Work’ on self-efficacy, work-ability and employment status as compared to usual care. Materials and methods In total, 88 young adults were included in a multicentre controlled trial; 49 entered ‘At Work’, 39 received usual care. GEE-analyses were applied. Results Scores on all outcome measures substantially improved over time in the intervention group, but no significant effects were found as compared to the control group. The effect on general self-efficacy showed a positive trend in favour of the intervention group. Conclusions and significance Unlike previous study results pointing to positive outcomes of At Work’, the current study did not support the effectiveness of this program on work-related self-efficacy, work-ability and paid employment, as compared to usual care. Yet, we did find an indication for positive intervention effect on general self-efficacy, which is known to be an important capacity to achieve social participation.

Trauma-Responsive Vocational Rehabilitation Services

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

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.