Vocational Rehabilitation Services Research Articles

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.

“Every day you are working you have to prove it”: Navigating the costs of work and ableism with visual impairment

BACKGROUND: People with visual impairment often need many items that their sighted counterparts do not, such as assistive devices, transportation services, and other disability-related goods and services. Acquiring these items represents a major barrier to the employment of people with visual impairment. OBJECTIVE: This study aimed to explore the nature of disability-related employment costs as they relate to engagement in the labor market of people with visual impairment. METHODS: The research consisted of a qualitative analysis of interviews and focus groups with 15 visually impaired adults from the New York metro area. RESULTS: What emerged were the costs of accessing and maintaining employment— particularly related to meeting the expectations of expediency in the modern world— in areas like communication and transportation. These costs interacted with perceived ableism in the labor market and created a climate of job scarcity and anxiety, which came at additional cost to participants who felt stuck in low-paying work. CONCLUSIONS: Further research is needed on the impact of perceived ableism and disability-related employment costs, and on decreasing barriers to programs that may ameliorate these costs, such as vocational rehabilitation services. Such research would inform policy interventions geared toward enhancing disabled people’s participation in the labor market.

Associations of Mortality Outcomes With Employment Status at Discharge From VA Vocational Rehabilitation Service Programs.

The authors evaluated associations between employment at discharge from Veterans Health Administration Vocational Rehabilitation Service (VR) programs and suicide and other causes of death. For veterans receiving VR between October 1, 2005, and September 30, 2014 (N=78,293), proportional hazards analyses were used to test associations of employment with suicide, drug overdose, and external and natural cause mortality rates over 1 and 5 years postdischarge and through December 31, 2019. The analyses were adjusted for clinical and sociodemographic characteristics and propensity for employment. Of the veterans, 94.1% had a psychiatric diagnosis, and 35.5% were employed at VR discharge. In proportional hazards analyses, employment was associated with lower mortality rates through 1 year (suicide, hazard ratio [HR]=0.54; overdose, HR=0.70; external causes, HR=0.62; and natural causes, HR=0.51) and 5 years postdischarge (overdose, HR=0.72; external causes, HR=0.81; and natural causes, HR=0.72). Through December 31, 2019, employment was associated with lower risks for overdose (HR=0.80) and death by external (HR=0.81) and natural (HR=0.80) causes. Employment at VR discharge was associated with lower mortality risk among veterans with psychiatric diagnoses.

The Influence of Demographics and Workforce Innovation Opportunity Act (WIOA) Employment and Training Services on Employment Outcomes for Teenagers Receiving Supplemental Security Income (SSI) and Their Parents

Transition age youth with disabilities and their families can access a variety of Workforce Innovation Opportunity Act (WIOA)-funded employment and training services. This study evaluated the impact of these services on youth and parent employment outcomes. These services were coordinated as part of the Wisconsin Promoting Readiness of Minors in SSI (PROMISE) federal demonstration grant. Youth with disabilities receiving Supplemental Security Income (SSI) benefits were randomly assigned to ‘usual’ services, including those available through school and vocational rehabilitation (VR) transition services, or ‘enhanced’ case management and transition services through the Wisconsin PROMISE demonstration. Parents who consented to participate could receive educational, employment, and financial self-sufficiency services and support through the Family Service Plan (FSP) connected to the youth’s PROMISE VR case. Youth and parents could also choose to receive WIOA Title I and Title III employment and training services, as well as Youth Apprenticeship, available through the Wisconsin Department of Workforce Development’s Division of Employment and Training (DET). A hierarchical logistic regression analysis demonstrated that VR services predicted higher youth employment rates and DET services predicted higher youth and parent employment rates. A linear regression analysis demonstrated that PROMISE services predicted higher youth wages and DET services predicted higher youth and parent employment wages. Findings suggest the coordination of employment-focused services across programs leads to increases in employment outcomes. Limitations and implications are discussed regarding the relationship between VR services, DET employment and training services, and employment outcomes.

An Assessment of Collaborations Between Centers for Independent Living and Vocational Rehabilitation Agencies Around Transition-Age Youth

Centers for independent living (CILs) and vocational rehabilitation (VR) agencies offer transition services that many youth with disabilities could benefit from, but little is known about the existence of and potential for collaborations between these agencies. In this study, we examined data from VR agencies to assess their relationships with CILs involving transition-age youth at the national and state levels, focusing on two types of collaborations: referrals from CILs to VR agencies and VR youth’s use of CIL services. Although many CILs and VR agencies do work together, their relationships vary, and these collaborations reflect only a small fraction of VR youth who are transition age. Further, for each collaboration type, the VR youth involved in these collaborations differ from other people who apply for or use VR services in terms of their characteristics and service use patterns. The findings point to opportunities for greater collaboration between CILs and VR agencies. They also indicate a need for more research to understand the optimal formats and contexts for such collaborations and the criteria for effectively promoting them at the person and agency levels.

Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review.

This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care. To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury. We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included. In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work. Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.

The Impact of Pre-Employment Transition and Individualized Vocational Rehabilitation Services on Employment Outcomes for Youth With Disabilities

Despite increased attention by policymakers to improve postsecondary employment outcomes, rates of entry into the competitive workforce for transition-age youth with disabilities continue to lag behind their peers without disabilities. The passing of the Workforce Innovation and Opportunity Act of 2014 provided increased opportunities for transition-age youth with disabilities to prepare for the world of work through coordinated service delivery between schools and state vocational rehabilitation (VR) agencies, including work-based learning, an established predictor of competitive employment. The current study uses the Rehabilitation Services Administration’s Case Service Report (RSA-911) data between the fiscal years 2017 to 2020. Multiple logistic regression was used to identify predictors associated with successful employment among 15,295 transition-age youth with disabilities who received both Pre-ETS and individualized VR services. Findings indicate discrepancies between the most effective and most frequently provided services. Implications for future policy, practice, and research are discussed.

Demographic and Vocational Rehabilitation Service Correlates of Employment Outcomes in People With Substance Use Disorders During COVID-19

This study examined the demographic and vocational rehabilitation (VR) service correlates of employment outcomes (achievement of competitive employment, hourly wage, and weekly hours) among individuals with substance use disorders (SUDs) during the COVID-19 pandemic, using the Rehabilitation Services Administration Case Services Report (RSA-911) database for fiscal year 2020. Data from 9,536 individuals were analyzed. Hierarchical logistic regression and hierarchical linear regression analyses revealed that multiple demographic and VR service variables were significantly associated with achievement of competitive employment, hourly wage, and weekly work hours at exit. Particularly, having a vocational training license/certificate, employment at Individualized Plan for Employment, and having an associate or bachelor’s degree were the strongest demographic correlates of more positive employment outcomes; while short-term job supports, maintenance, and other services were the strongest VR service correlates of more positive employment outcomes. Implications of the findings were discussed to promote VR service outcomes for people with SUD in the postpandemic era.

Role of social medicine within the German Federal Employment Agency

Social medicine deals with the interrelationships between health and society-as across-sectional subject within medicine and abridging subject at the interfaces to other specialist disciplines. In the public and within the health system, social medicine still does not receive the attention it should be given, despite to its medical and socioeconomic importance. Asignificant proportion of social medicine specialists in Germany work as experts for social security providers. Using the example of the Medical Specialist Service ("Ärztlichen Dienstes", ÄD) of the German Federal Employment Agency ("Bundesagentur für Arbeit", BA), the medical tasks in social medicine are outlined. About 350 full-time medical employees nationwide as well as other contracted physicians support the specialists of the employment agencies and job centers to integrate those seeking training, jobs and employees with health restrictions into the labor market or maintaining an existing integration. In each individual case, they assess the extent of the health restrictions, the performance/earning ability, the suitability for training and professions as well as the requirement and type of vocational rehabilitation services. The ÄD's approximately 500,000 expert opinions each year are not only of far-reaching importance for the BA's affected customers, but also contribute to the responsible, effective, and accurate use of social system resources.

Tailored vocational rehabilitation for people with a work disability pension in The Netherlands; an in-depth data analysis of the content and outcomes of vocational rehabilitation trajectories of the Social Security Institute

Purpose People with a work disability pension receive vocational rehabilitation (VR) services from the Dutch Social Security Institute (SSI) in order to facilitate return-to-work (RTW). The SSI offers tailored VR existing of two trajectories (aimed at getting fit for work or aimed at returning to work). The purpose of this study is to describe the current practice of VR. This includes a description of client characteristics, RTW barriers and the intensity, duration, content and the outcomes of the offered trajectories. Materials and Methods We analyzed data from 197 clients that were randomly selected from clients who attended a VR trajectory between 1 January t 2017 and 31 December 2018. Data were obtained from the SSI registration databases and client files. Results Both VR trajectories at the SSI have a different aim, but in practice the content of the VR interventions often overlaps. Around half of both trajectories reached their goal. Reasons for unsuccessful trajectories were that the client did not find work or barriers were more complex than initially assessed. Conclusions The SSI delivers tailored VR to the specific needs of the client, however substantiations for why a certain VR intervention is offered are limited. Guidelines are needed to support professionals.

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

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

The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision.

Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined. A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem. Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI. To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.

Demographic covariates and vocational rehabilitation services as predictors of employment outcomes of people with physical disabilities: a hierarchical logistic regression analysis

Purpose Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. Materials and Methods This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education’s Rehabilitation Services Administration’s Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. Results For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. Conclusions Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

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.

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.

Sequences of vocational rehabilitation services in Germany: a cohort study

BackgroundThis study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences.MethodsWe used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences.ResultsOur sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services.ConclusionsMultiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education.Trial registrationGerman Clinical Trials Register DRKS00009910, registration 25/01/2016.

Should older adults who have been injured at work be encouraged to return to work?: A study on life satisfaction of older adults with experience in industrial accidents

Work is generally defined as a positive factor in the lives of older adults. However, older adults who have experienced a industrial accidents need to also consider whether they want to work, as they face the double burden of disability and aging. Current rehabilitation services for injured workers focus on return to work without considering the life cycle. The purpose of the study was to determine whether returning to work affects life satisfaction in older adults and to discuss appropriate service directions. The data used to examine this are from the third year of the second cohort of the Panel Study of Workers’ Compensation Insurance. Participants were divided into three groups: Group 1 (under 55, 1,176 participants), Group 2 (from 55 to 64, 1,036 participants), and Group 3 (65 or older, 611 participants). Multiple regression analysis was conducted to examine the impacts of demographic variables (sex, marriage), care and health variables (treatment duration, self-rated health status, disability grade), economic variables (earned income, unearned income, employment status), rehabilitation service (vocational and psychosocial rehabilitation services), and psychosocial variables (self-esteem, social relationship) on life satisfaction. Returning to work and income were found to have no positive impacts on older adults’ life satisfaction. Better self-rated health, higher self-esteem, and good social relationships all had positive effects on life satisfaction among older adults. For the under-65 cohort, a number of factors contributed to life satisfaction, including income, employment, high self-esteem, etc. Indiscriminately encouraging injured older adults to return to work does not always make sense. There is a need to focus on sustainable health and psychosocial services in the community. This study demonstrates the importance of taking a non-work approach with injured older adults who have the dual characteristics of being both old and disabled.

Predicting competitive integrated employment outcomes of Asian American vocational rehabilitation Clients: A national study

AbstractPurposeThe current study investigated the relationships between demographic variables, cash benefits, vocational rehabilitation (VR) services, and employment outcomes of Asian Americans VR clients.MethodsThe data were extracted from the most recent Rehabilitation Service Administration database (RSA‐911). Among 17,278 case services records, 5784 clients met the inclusion criteria. Chi‐square automatic interaction detector and logistic regression analyses were employed to investigate the employment outcomes.ResultsThe results indicated that Asian American clients who have completed a bachelor's degree or more do not receive disability‐related benefits, and those who received more VR services were more likely to achieve competitive integrated employment (CIE). In addition, VR counseling and job placement services were significant predictors of employment outcomes.ConclusionsThese findings provide valuable insights into the factors influencing CIE among Asian American VR clients with disabilities. The results further underscore the importance of VR professionals possessing cultural competence to effectively serve a diverse clientele.

Breaking stigma: enhancing sexual health literacy for heterosexual men with mental health conditions through a psycho-educational group intervention

ABSTRACT This pilot study evaluated a novel psycho-educational group intervention addressing sexuality and intimacy issues among male heterosexual individuals with mental health conditions. Despite the universal need for fulfilling relationships, stigma and lack of support often distort views and promote high-risk behaviors in this population. A cognitive-behavioral framework was used in a six-session program to enhance knowledge and promote healthy sexuality among six participants recruited from an integrated vocational rehabilitation service center in Hong Kong. Quantitative pre- and post-testing alongside qualitative observations revealed that participants significantly improved their understanding of relationships, communication skills, and ability to identify safe practices. Limitations included the small, exclusively heterosexual male sample and evaluation methods. As sexuality is an important yet under-researched topic impacting this population’s quality of life, these findings suggest structured group interventions may equip individuals with adaptive tools for intimacy. However, larger trials with expanded curricula are needed to validate this approach.

Vocational Rehabilitation Counselors’ Perspectives on Rehabilitation Success

Vocational rehabilitation (VR) agencies often encounter challenges to help persons with disabilities successfully attain their employment goals. This study was conducted to understand how VR counselors define “success” and what practices they deem to be most successful. Ninety-one VR counselors from a Midwestern state were asked to write about a typically successful case from their caseload. Participants were asked to describe the demographic characteristics of the counseling recipient, the rehabilitation goals, whether the consumer received support from family and/or community members, the counseling outcomes, services provided, and best practices that could lead to positive outcomes. Case summaries were content analyzed to identify how “success” is defined by VR counselors. Findings revealed that 74% of the cases were related to a successful employment outcome, 30% to an educational outcome, and 33% to an independent living outcome. Several best practices for serving VR customers were identified. Counselors have clear perceptions about their successful clients, and they may use those perceptions when engaging with their clients. Implications for VR service provision are discussed.