Vocational Rehabilitation Services Research Articles

Vocational rehabilitation services and career readiness for individuals with intellectual disability in Saudi Arabia

Successful vocational rehabilitation (VR) programs facilitate a smooth transition to work. However, finding and maintaining a job is still a challenge for individuals with disabilities for various reasons, including job readiness. Given that teachers are involved in delivering VR services to adolescents with disabilities, the purpose of this study was to examine teachers’ perspectives on VR services provided to individuals with intellectual disabilities (ID) in their educational institutions in Al-Kharj city to prepare them to transition to employment. Teachers’ perspectives on VR programs for students with ID are vital in identifying the current state of the services provided and directing future efforts in the field of secondary transition. A descriptive approach was employed to achieve the study’s purpose, and a survey was designed and used, reaching 89 respondents. The findings revealed that teachers believe that services provided in VR programs prepare individuals with ID to transition to work. The study also showed statistically significant differences between teachers’ responses concerning services provided according to years of experience and institution type. Implications for future research and practices are discussed.

Assessing teachers' beliefs and practices regarding vocational rehabilitation services for individuals with intellectual disabilities.

This study investigates UAE teachers' beliefs and practices regarding vocational rehabilitation (VR) services for individuals with intellectual disabilities. The study used a descriptive survey methodology with a 30-item Likert scale questionnaire. The sample size consisted of 121 VR teachers in the Emirate of Abu Dhabi. The data was analyzed using Fisher's exact test and the Chi-square test. Male teachers (P<0.0063) and diploma in special education holders (P<0.0272) were significantly good at career counseling, while female teachers and bachelor's in education degree holders were good at vocational training (P<0.0039 and P<0.0001, respectively) and placement (P<0.0006 and P<0.001). Educators with 1-5 and 6-10 years of experience had more positive beliefs and practices than their more experienced counterparts in terms of VR services. VR instructors have an important role in improving the results and opportunities for people with intellectual disabilities, and their empowerment and professional development should be endorsed.

Pathway to Trauma-Informed Rehabilitation Counseling: Vocational Rehabilitation Counselors’ Training Experiences and Use of Trauma-Relevant Knowledge in Daily Practice

The compelling evidence regarding the prevalence and profound impacts of traumatic experiences on individuals with disabilities underscores the need to establish trauma-informed service environments within vocational rehabilitation (VR). In an initial endeavor towards cultivating trauma-informed service, this study investigates the VR counselors’ professional training experiences in the topical areas of trauma. Further, the applicability of the Technology Acceptance Model (TAM 2) is examined in elucidating the utilization of trauma knowledge by VR counselors in their practices. A needs assessment focusing on trauma training was distributed to 169 VR counselors to measure their trauma-related training history and utilization of trauma knowledge in practices. Path analysis was employed to examine the relationship between training experience and the actual use of trauma knowledge in counseling based on the TAM 2 framework. Participants reported having 9.71 hours of post-graduate training. Path analysis suggested adding three additional paths to the original research model, explaining how post-graduate training leads to the use of trauma knowledge in VR service through perceived ease of use, usefulness, attitude toward using, and behavioral intention. The profession of rehabilitation counseling needs to incorporate more trauma-related training into its practice, education, and research to better serve individuals with disabilities and improve the effectiveness of services.

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.

Efficacy of a Culturally Adapted Emotion Recognition Training Program in Improving Facial Emotion Recognition in Persons with Schizophrenia

Background: Facial emotion recognition (FER) deficits are being considered as core features of social cognitive deficits in schizophrenia, associated with socio-occupational dysfunction. Social cognition intervention programs have been shown to improve these deficits; however, there are no such intervention strategies in India. In this study, we aim to examine the efficacy of Training of Affect Recognition – Indian Version (TAR-IV) to enhance the FER abilities of people with schizophrenia. Methods: In an open-label experimental design, 36 participants with schizophrenia underwent 12 sessions of TAR-IV as an add-on to treatment as usual (TAU), while 29 participants with schizophrenia continued TAU (pharmacological treatment with or without occupational therapy and vocational rehabilitation services). Clinical and functional assessments were done using the positive and negative syndrome scale (PANSS) and socio-occupational functioning scale. Emotion recognition abilities were assessed on the tool for recognition of emotions in neuropsychiatric disorders at baseline, post-intervention, and follow-up (two to three months post-intervention). Results: The intervention group showed significant improvements in FER ( P = .001) and socio-occupational functioning ( P = .008) after receiving the TAR-IV, which remained significant at two months follow-up. A lower age of onset and poorer neurocognitive function at baseline predicted greater changes in emotion recognition ability following the intervention. Conclusions: This study demonstrated the efficacy of TAR-IV, the Indian adaptation of social cognition intervention, in improving emotion recognition abilities and socio-occupational functioning in patients with schizophrenia. These findings need to be replicated in randomized controlled trials.

Academy NExT: New and Exciting Transitions—A Residential Summer Program for Individuals With Disabilities

Academy New and Exciting Transitions (NExT) was developed to serve participants who have an Individualized Education Program or 504 ages 15–21 in a residential program grounded in high-interest activities that include vocational and technical programs. The focus of the summer program was to develop communication, interview skills, and career exploration across a wide variety of vocational and technical careers that required minimal to substantial postsecondary training. Academy NExT is part of preemployment transition activities funded through a collaborative effort with Vocational Rehabilitation Services and the Workforce Innovation Opportunity Act. The article presents an overview of the program and outcomes based on qualitative findings.

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.

A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

BackgroundTo explore how a vocational rehabilitation (VR) intervention can be integrated within existing healthcare services for people with multiple sclerosis (MS) in the United Kingdom (UK) National Health Service (NHS).MethodsData from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research and an intervention logic model.ResultsFour themes were identified relating to the structure of current NHS services, how to improve access to and awareness of VR services, the collaboration between internal and external networks, and the benefits of integrating VR within the NHS services. Participants identified several implementation barriers such as poor links with external organisations, staffing issues, and lack of funding. To overcome these barriers, participants suggested enablers such as technology (e.g., apps or online assessments) and collaboration with third-sector organisations to reduce the pressure on the NHS.ConclusionSignificant organisational changes are required to ensure a successful implementation of a VR intervention within current NHS services. Despite this, the NHS was seen as a trustworthy organisation to offer support that can optimise the health and professional lives of people with MS.

Factors Related to Employment of Transition-Age Youth With Intellectual Disability

This study examined the relationship between demographic factors and disability type and employment in transition-age individuals with intellectual disabilities who received state vocational rehabilitation services. The study conducted a cross-sectional secondary data analysis of the Rehabilitation Services Administration 911 dataset with an inclusion sample of 39,060 youth. Results indicated that race, ethnicity, gender, education level, and disability type correlated with employment. Specifically, individuals of transition age who were Black, Hispanic, female, had an intellectual disability, and had not completed high school were less likely to be employed than their counterparts who were White, non-Hispanic, male, had a disability other than intellectual disability, and had completed at least high school. These findings were consistent with the previous research. The authors posited that such research going forward would benefit from more studies utilizing primary data collection, mixed-methods designs, more discernment among modifiable and nonmodifiable demographic factors, and using an intersectionality lens to understand the cumulative effect of factors associated with disadvantage or marginalization (i.e., race and ethnicity) on employment in this population.

The prevalence and influencing factors of remunerative employment in people with chronic spinal cord injury in a middle-income country: Analysis of the Thai International Spinal Cord Injury Community Survey database

BACKGROUND: Remunerative employment (RE) is one of the optimal rehabilitation goals for people with spinal cord injury (SCI). However, there has been no study systematically determine the RE status and its related factors in Thais with chronic SCI. OBJECTIVE: To cross-sectionally determine RE statuses and their influencing factors in Thais with chronic SCI. METHODS: Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The prevalence of RE and related work status were described. RESULTS: Of 223 individuals with chronic SCI whose age was less than 60 years included in this study, 79 (35%) were remunerative employed. Most of them (41, 54%) were self-employed. The most common reason for unemployment was related to health conditions or disabilities. Education year, attending vocational rehabilitation service, and admission≥2 times per year were independent influencing factors of RE with an odds ratio of 1.090, 2.534, and 0.418, respectively. CONCLUSION: Since education and vocational rehabilitation were the modifiable positive influencing factor of employment, educational and vocational rehabilitation programs should be formally established and universally applied together with medical rehabilitation to increase the prevalence of RE in people with SCI in Thailand.

Peer mentor contributions to an early intervention vocational rehabilitation specialist service following trauma: A qualitative study

BackgroundPeer mentors have a role in facilitating the participation, health and well-being of people who have had a traumatic injury. Few studies have explored the involvement of peer mentors in an early intervention vocational rehabilitation (EIVR) service following trauma. ObjectiveThis study aimed to explore the experience of implementing peer support within the context of an EIVR service from the perspectives of the peer mentors themselves, the vocational therapists supervising them, and the patients that received peer mentoring. MethodsSemi-structured interviews were conducted with twenty participants from three groups: peer mentors (n = 4); vocational therapists (n = 3); and patients who received the EIVR intervention (n = 24). Data were thematically analysed. ResultsThree themes were identified: The value of peer input in an EIVR service, The facilitators impacting the value of peer involvement as part of the EIVR service, The challenges impacting peer input as part of an EIVR service. ConclusionsThe inclusion of peer mentors early after major traumatic injury was a unique and valuable addition to the EIVR service. Offering peer support early on in rehabilitation enabled patients to gain a sense of hope for their future, and the expectation that returning to work was a realistic option. The careful selection of peer mentors, and ensuring they receive adequate preparation and ongoing supervision are vital to support their well-being during the intervention. Aiming to match peer mentors with similar injuries and work backgrounds to patients is an important contributor to the likely ongoing engagement of the mentee with the mentor.

Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial

BackgroundModerately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma.MethodsROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants’ self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere.DiscussionThis trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS.Trial registrationISRCTN: 43115471. Registered 27/07/2021.

Facilitators and barriers to employment for people with physical disabilities: A cross-sectional study

BACKGROUND: There is increasing evidence that employment, or the lack thereof, affects an individual’s health. Consequently, employment provides people with physical disabilities (PWPD) with financial independence, enhances their well-being and self-worth, and facilitates a sense of purpose. People with physical disabilities often retain job skills and motivation to return to work after acquiring a disability. Their vocational rehabilitation and job accommodation needs likely differ from people with disabilities resulting from developmental, sensory, cognitive, and mental health conditions. To better target the needs of PWPD and improve vocational rehabilitation services, it is crucial to identify the modifiable factors that influence their employment outcomes. OBJECTIVE: This research aimed to examine systematically the client-, employer-, and context-related facilitators and barriers to employment experienced by PWPD. METHODS: We recruited to this cross-sectional study, PWPD from the Midwestern United States who returned to work after injury or illness. An online survey collected data on demographic characteristics and educational history; disability and functional status; supports, facilitators and barriers to employment; and job information and accommodations. RESULTS: 347 working-age PWPD completed the survey; at the time of survey completion, 270 were working and 77 were not. People with physical disabilities who reported social support and encouragement at work were more likely to be working than respondents who did not. Negative attitudes of supervisors and colleagues, inaccessible work environments, and inflexible work schedules were barriers to employment. Important reasons for working included financial needs, a sense of purpose, and self-worth. CONCLUSIONS: Results provide insights into the importance of social supports in the work environment. Novel approaches are needed to develop supportive relationships with supervisors and coworkers.

Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study

Purpose Chronic mental illness disrupts the ability to work, often resulting in the need for vocational rehabilitation in which occupational therapists play a role. Namibia does not have an occupational therapy vocational rehabilitation practice framework for service users with chronic mental illness. This study explored the contextual factors that should be considered for a vocational rehabilitation practice framework in Namibia. Materials and methods A qualitative collective case study design was utilized. In-depth interviews were conducted with nine mental health service providers that were purposively selected from two study sites. An inductive thematic analysis of data was done using ATLAS.ti. Results The need for collaborative advocacy for service users to raise awareness and engage stakeholders such as family members, employers and policy makers was highlighted. Vocational rehabilitation resources needed include sheltered workshops, financial resources and trained human resources. Recognition that vocational rehabilitation services are too limited to meet the needs of mental health service users. A vocational rehabilitation policy and strategy is required. Supported employment and self-employment are potential strategies that should be considered. Conclusion Vocational rehabilitation for service users with chronic mental illness is limited in Namibia and there is a need to collaboratively improve the service.

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.

장애인 보호작업장 성과분석 및 발전방안 연구

The purpose of this study is to evaluate the operational performance of the Social Purpose Enretprise for PwDs, commissioned and operated by Jeonyoung, a social welfare corporation, over the past five years based on effectiveness and efficiency, and to compare international trends and evidence-based research results related to employment of the disabled. As a study to present the direction and revitalization plan of this project as a basis, the research method is to evaluate the operational performance of the Social Purpose Enretprise for PwDs over the past four years based on effectiveness and efficiency, and to this end, quantitative evaluation, cost/benefit analysis, we looked at the flow of vocational rehabilitation services, including social employment, and the changing environment of the labor market in each country through analysis, and based on this, the operational direction and activation plan presented in the research results are summarized as follows. In order to provide more social employment opportunities and quality human resource management functions for people with disabilities who have unique occupational characteristics, it is necessary to expand the capacity and operation of the facility and secure and operate a space separate from the disabled welfare center. In addition, in order to further improve the quality of service for users of Social Purpose Enretprise for PwDs, improvements are needed to establish individualized employment plans and case management for individualized plans and implementation, and trainees' training allowances are not calculated as profits from production activities. The state or local governments must come up with a plan to provide support in accordance with the National Lifelong Vocational Skills Development Act. Lastly, there is a need to support the current operating corporation so that it can continue to operate the facility, and improvements are needed to re-establish the goal of Local Government's welfare policy for the disabled.