Vocational Rehabilitation Services Research Articles

Provision of Mental Health Services in the Veterans Health Administration: A Nationwide Comparison With Other Providers.

Public interest in developing a national health care system has grown in the United States, but so have concerns that a large system would provide poor care. The Veterans Health Administration (VHA) is the largest national U.S. health care system, and several of its performance measures have been compared with those of non-VHA organizations. However, few studies have compared VHA's overall provision of mental health care services, and this study aimed to fill this gap. Using 2018 National Mental Health Services Survey data, the authors examined the differences in provision of 45 treatment modalities, specialized services, and dedicated programs between self-identified VHA facilities (N=459), non-VHA facilities that serve only adults (N=3,671), and non-VHA facilities that serve all ages (N=6,378). Self-identified VHA facilities offered more services (including more treatment modalities, specialized services, and dedicated programs) (mean±SD=24.2±8.9 services) than both non-VHA adult-only facilities (15.4±6.8; Cohen's d=1.11, p<0.001) and non-VHA all-ages facilities (17.1±6.6; Cohen's d=0.90, p<0.001). Notably, VHA facilities were more likely to offer electroconvulsive therapy and telemedicine. VHA facilities were more likely to offer integrated primary care, chronic illness management, supportive housing, vocational rehabilitation, and psychiatric emergency services, among others. Last, VHA facilities were more likely to offer dedicated treatment programs for patients identifying as lesbian, gay, bisexual, or transgender, as well as for patients with posttraumatic stress disorder, traumatic brain injury, or dementia. VHA facilities offer no fewer and possibly more comprehensive mental health services per facility than do non-VHA facilities, possibly because VHA represents an integrated and centralized health system.

Fatal Injuries in the Health Care and Social Assistance Industry, Census of Fatal Occupational Injuries, 2011 to 2019.

This study aimed to describe the characteristics of workers in the health care and social assistance industry who experience fatal occupation injuries and the nature of these injuries. Fatal occupational injury rates were calculated for workers in the health and social assistance industry according to age, sex, race ethnicity, industry, and year. There were 1224 fatalities among workers in the health care and social assistance industry, resulting in a rate of 6.7 fatalities per 1,000,000 worker-years. The rate of fatal injuries was highest among older workers, men, and Black and White workers. The highest number of fatal injuries was transportation and violent incidents. The highest mortality rates were in the vocational rehabilitation services industry. These findings can be useful for identifying methods for intervening and preventing fatal injuries among workers in the health care and social assistance industry.

332 Vocational rehabilitation services for people with cystic fibrosis: Predictors of employment outcomes

332 Vocational rehabilitation services for people with cystic fibrosis: Predictors of employment outcomes

AHP를 이용한 장애인직업재활시설 운영 개선 방안에 관한 연구

본 연구는 장애인직업재활시설 운영상의 문제점을 검토하고 그에 따른 대안을 제시하여 장애인직업재활시설의 운영 개선방향 모색을 목적으로 한다. 이를 위해 장애인직업재활시설 시설장과 종사자, 정책담당자와 공무원, 학계 전문가 50명을 대상으로 AHP 조사를 실시하였으며, 47명의 자료를 최종분석에 활용하였다. 분석결과, 첫째, 1계층에서는 ‘복지체계’(0.703)가 ‘시장체계’(0.297)보다 중요도가 높게 나타나 1순위로 도출되었다. 둘째, 2계층의 경우 1순위로 ‘보호고용서비스(0.282)’, 2순위 ‘전이서비스(0.151)’, 3순위 ‘판매(0.055)’, 4순위 ‘생산(0.055)’순으로 나타났다. 셋째, 3계층의 경우 1순위 ‘재활계획수립(0.047)’, 2순위 ‘훈련관리 및 직업관리(0.041)’, 3순위 ‘사회적응훈련(0.040)’, 4순위 ‘지원고용(0.039)’, 5순위 ‘취업 후 적응지원(0.039)’ 순으로 나타났다. 이러한 결과를 바탕으로 질적 향상 및 발전을 담보하기 위한 장애인 직업재활시설의 운영개선방안을 제시하였다.

Impact of a summer work experience program on employment outcomes for youth who are blind or have low vision

BACKGROUND: Work experience programs are a common element of work-based learning for youth with disabilities under the Workforce Innovation and Opportunity Act, but few studies have focused on the effectiveness of these programs for youth who are blind or have low vision (B/LV). OBJECTIVE: The purpose of this study was to examine the impact of a vocational rehabilitation (VR) agency-sponsored summer work experience program on employment outcomes for transition-age youth with B/LV. METHODS: In this retrospective cohort study, we used propensity score matching to analyze de-identified case records obtained from a VR agency. Participants were 14 to 24 years old at VR application and had a primary or secondary disability of blindness, visual impairment, or deaf-blindness. The matched sample (N = 302) included 151 youth who participated in the program and 151 youth who did not participate. RESULTS: Summer work experience participants were more likely to obtain competitive employment at VR case closure than non-participants. Work hours and hourly earnings did not differ significantly between the two groups. CONCLUSIONS: These findings support the association between paid community-based work experiences and future employment for B/LV youth who receive VR services.

Job retention: Perspectives of individuals with blindness and low vision

BACKGROUND: People with blindness and low vision (BLV) encounter many obstacles in retaining employment. Recent legislation has refocused vocational rehabilitation (VR) efforts toward job retention and career advancement among persons with disabilities. OBJECTIVE: We investigated the skills, including technology, and other issues that influenced job retention among persons with BLV to gain in-depth knowledge that is not typically available using survey methods or secondary data sources. METHODS: Intensive interviews using a semi-structured protocol were conducted with 11 persons with BLV and an employment history. Interviews were transcribed, summarized by major themes, and approved by participants. A qualitative software program assisted in further coding, identifying additional themes, and organizing participants’ information. RESULTS: Participants recommended that others with BLV be proficient in assistive technology use, develop networks, and be persistent in achieving goals. Participants had positive and challenging experiences with technology, employers, and the VR service delivery system. Participants reported stress associated with their jobs and concern about their workplace efficiency. CONCLUSIONS: Results suggest that job retention continues to be problematic for persons with BLV. Service delivery systems should explore policies and services that support job retention. Further research concerning job stress, assistive technology, and workplace efficiency is needed.

플랫폼 기반의 정신장애인 직업재활서비스 가능성 탐색

This study aims to explore the possibility of expanding vocational rehabilitation services by examining the experience of applying general qualitative research to the experience of attempting vocational rehabilitation services. Focus group interviews were implemented for four vocational rehabilitation service providers. As a result of the study, 6 main themes and 21 sub-themes were derived. Major topics are‘Agonizing over social change and the limitations of vocational rehabilitation services and recognizing the need for new services development’, ‘Gradually attempting platform-based vocational rehabilitation services from the traditional method’, ‘Developing a support method suitable for platform environment’, ‘Providing various options to respond to the needs of the mentally disabled’, ‘Witnessing the mentally disabled people creating new identities through platform work’, ‘Giving tasks to expand vocational rehabilitation services using the platform’. Based on this, the implications and suggestions of vocational rehabilitation services using the platform were presented.

A Study on the Factors Influencing the Types of Injured Workers' Return to the Job: Focusing on Comparison between Return to the original workplace and the Re-employment

본 연구의 목적은 산재근로자를 대상으로 직장복귀 형태에 영향을 미치는 요인을 인구학적 요인, 산재 관련 요인, 경제적 요인, 심리정서적 요인, 재활서비스 요인으로 구분하여 살펴보는 것이다. 본 연구는 산재보험 패널조사의 2019년 데이터를 사용하였으며, 원직장복귀자 781명, 재취업자 1,097명, 그리고 미취업자 927명을 최종 연구대상으로 하였고, 다항 로지스틱 회귀분석을 실시함으로써 직장복귀 형태 에 영향을 미치는 요인들을 분석하였다. 분석결과, 우선 미취업을 기준으로 원직장 복귀에 대한 다항 로지스틱 회귀분석을 실시한 결과, 연령대, 학력, 혼인상태, 요양기간, 현재업무수행능력, 사회경제적지 위, 자아존중감, 자기효능감, 직업재활서비스가 원직장 복귀에 유의한 영향을 미쳤다. 다음으로 미취업 을 기준으로 재취업에 대한 다항 로지스틱 회귀분석 결과, 연령대, 요양기간, 현재업무수행능력, 자아 존중감, 자기효능감, 직업재활서비스가 재취업에 유의한 영향을 미치는 것으로 나타났다. 본 연구결과 를 토대로 산재근로자의 성공적인 직장복귀가 이루어질 수 있도록 원직장 복귀 가능성을 향상시킬 수 있는 실천적 및 정책적 방안들을 제시하였다.The purpose of this study is to examine the factors affecting the type of return to work for injured workers by dividing them into demographic factors, industrial accidents- related factors, economic factors, psychological factors, and rehabilitation service factors. The study used data from the Panel Study of Worker's Compensation Insurance in 2019, and the factors affecting the type of return to work were analyzed through multinomial logistic regression analysis. First of all, as a result of a multinomial logistic regression analysis on returning to the original workplace based on unemployment, age group, level of education, marital status, nursing period, current work performance ability, socioeconomic status, self-esteem, self-efficacy, and vocational rehabilitation services had a significant effect on returning to the original workplace. Next, as a result of multinomial logistic regression analysis on re-employment based on non-employment, age group, nursing period, current work performance ability, self-esteem, self-efficacy, and vocational rehabilitation services had a significant effect on re-employment. Based on the results of this study, practical and policy measures were suggested to improve the possibility of returning to the original workplace so that injured workers can successfully return to work.

Facilitating a Warm Handoff in State Vocational Rehabilitation Service Delivery

Individuals living with SMI have historically been underserved in State VR service delivery. Integration of evidence-based case management, supported employment, and appropriate VR counselor education and training may lead to improved employment outcomes for this population. The “warm handoff” approach has been recommended by VR researchers, but to date has not been clearly defined or described in the literature as it specifically relates to psychiatric rehabilitation and the provision of integrated mental health services within VR service delivery. This article defines the warm handoff approach and provides examples of how this approach can be utilized in State VR service delivery. Recommendations for implementation of a warm handoff approach within the State VR service delivery system are provided as well as suggestions for VR counselor training. Further research of evidence-based practices including warm handoff referrals for individuals with SMI within the VR service delivery system is encouraged.

A Randomized Controlled Trial of an Employment Program for Veterans Transitioning from the Military: Two-Year Outcomes

BackgroundMilitary personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. Many veterans seek help finding employment, but few veteran employment programs have been rigorously studied. Transitioning veterans generally have access to Local Community Resources (LCR), which include the Veterans Health Administration vocational rehabilitation services, the state-federal Vocational Rehabilitation program, and the Department of Labor’s American Job Centers. By contrast, the innovative National Career Coach Program (NCCP) offers intensive career coaching and financial incentives for working.MethodsThis study used a randomized controlled design to compare the NCCP and LCR approaches for 208 transitioning service members (recent or pending transition). Researchers conducted interviews by telephone every four months for two years. Outcomes included earnings, months worked, and standardized self-report measures of health and well-being.FindingsAt two-year follow-up, significantly more NCCP participants had worked in paid employment than LCR participants (95% vs. 83%). NCCP participants averaged $2568 in monthly earnings compared to $1865 for LCR participants, thus averaging $16,872 more total income per participant over the two-year period. Employment outcomes significantly improved between Year 1 and Year 2. NCCP participants also reported significantly greater improvements in both physical and mental health compared to LCR participants. Average monthly earnings correlated with changes in health outcomes.ConclusionsVeterans receiving multi-faceted employment services early in the transition from the military showed sustained benefit over a two-year period with increased earnings over time and improved mental and physical outcomes. Positive employment outcomes may have contributed to improved health outcomes.

Bulletin: New Model State Plan for Vocational Rehabilitation Services for Deaf People.

Bulletin: New Model State Plan for Vocational Rehabilitation Services for Deaf People.

Integrating services to improve the return-to-work process in depression or anxiety: results from a three-arm parallel randomized trial

IntroductionDepression and anxiety are very frequent and associated with high societal costs, much suffering and functional impairment. Employment is essential and pivotal recovery after sick-leave. In many countries, health care interventions are delivered separately from vocational rehabilitation services. This fragmented placement of interventions often implies lack of coordination, creating despair among sick-listed persons.ObjectivesThe aim of this trial was to investigate an integrated mental health care and vocational rehabilitation intervention to improve and hasten the return-to-work process among people sick-listed with anxiety or depression.MethodsIn this RCT, participants were randomly allocated to A) integrated interventions (INT), B) improved mental health care (MHC) or B) service as usual (SAU). Primary outcome was time to return-to-work during 12-month. Secondary outcomes were time to return-to-work at 6-month follow-up; levels of anxiety, depression, stress symptoms and social and occupational functioning at 6-month follow-up; and return-to-work measured as proportion in work at 12-month follow-up.Results631 individuals randomized. INT showed higher proportion in work compared with both SAU and MHC at the 12-month follow-up. We found no differences regarding return-to-work time at either the 6- or 12-month follow-up. No differences in symptoms between SAU, MCH or INT were detected, but MHC and INT showed lower scores on Cohen’s perceived stress scale compared with SAU at 12-month follow-up.ConclusionsAlthough INT did not hasten return-to-work, it yielded higher proportion in work compared with MHC and SAU.DisclosureNo significant relationships.

Identifying vocational rehabilitation outreach and service training priorities: A national survey from diverse perspectives

BACKGROUND: This article summarizes the results of a needs assessment survey project presented at the 2021 National APSE Virtual Conference. This research was conducted by the Vocational Rehabilitation Technical Assistance Center for Quality Employment (VRTAC-QE), a Technical Assistance Center funded by the Rehabilitation Services Administration, U.S. Department of Education. OBJECTIVE: The purpose of the survey was to determine technical assistance and training needs of state VR counselors in four practice domains: (a) outreach services, (b) pre-employment transition services, (c) vocational rehabilitation services, and (d) employment services. METHODS: A national survey was conducted among 229 state vocational rehabilitation agency (SVRA) professionals, including directors, staff, and VR counselors, and 92 professionals in community-based rehabilitation agencies (CBRA), allowing a comparison of the relative importance ratings of the two groups. RESULTS: The ratings of both SVRA and CBRA professionals were generally aligned, but with some significant differences, as discussed in more detail in Tansey et al. (in press). CONCLUSIONS: The priorities identified through this survey will support the development and implementation of technical assistance activities that are responsive to the needs of SVRA professionals providing vocational rehabilitation to persons with disabilities and increasing the capacity of these agencies to promote quality employment outcomes.

Targeted motivational interviewing techniques assist the process of verbal de-escalation in vocational rehabilitation

BACKGROUND: In response to a request for training by a state vocational rehabilitation unit on verbal de-escalation for staff, the authors searched the literature on de-escalation best practices specifically in the context of vocational rehabilitation. There was a paucity of literature on the topic. To meet the training request for the state vocational rehabilitation staff, the authors paired the psychometrically validated English Modified De-Escalating Aggressive Behaviour Scale (EMDABS) best practices with motivational interviewing (MI) techniques to support verbal de-escalation. OBJECTIVE: The objective of this article is to describe the best practices of the EMDABS and how certain MI techniques and attitudes can support verbal de-escalation efforts by staff in the vocational rehabilitation process. METHODS: The authors searched literature on de-escalation best practices specifically in the context of vocational rehabilitation. RESULTS: The authors found the psychometrically validated EMDABS best practices paired with MI techniques are potential useful tools to support verbal de-escalation in the process of vocational rehabilitation. CONCLUSION: MI techniques and the EMDABS best practices are useful tools for vocational rehabilitation and employment services staff. Research is needed regarding the applicability of these techniques and practices across the full range of vocational rehabilitation clients.

Demographic Covariates, Vocational Rehabilitation Services, and Employment Outcomes of Working-Age Adults with Anxiety Disorders: A Multivariate Logistic Regression Analysis.

PurposeThis study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes.MethodsData for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services.ResultsThe results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome.ConclusionsIn the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning.

기초자치단체의 직업재활정책과 전달체계에 관한 연구

The purpose of this study is to present the direction of the vocational rehabilitation policy and the improvement plan of the vocational rehabilitation delivery system of local governments. To this end, the regional vocational rehabilitation policy and delivery system of the United States, the United Kingdom, and Germany and the vocational rehabilitation policy and delivery system of local governments in Korea were reviewed. This study thus conducted a focus group interview with 11 vocational rehabilitation experts working in local A.&#x0D; As a result of the study, vocational rehabilitation in the United States, the United Kingdom, and Germany focused on pursuing welfare through work, customized services considering the individual characteristics of people with disabilities, establishing an integrated service of welfare and labor, and securing accessibility and vocational rehabilitation services with rehabilitation professionals. On the other hand, the vocational rehabilitation policy in Area A did not reflect the characteristics of people with disabilities and regions, and the service system was divided, resulting in insufficient performance. In addition, it was analyzed that it is urgent to improve of disability awareness in the community and establish a control tower for vocational rehabilitation policies. It was suggested to establish an initial service provision function and an intervention role system for vocational rehabilitation services, design a customized conditional welfare system considering regional characteristics and the types of disabilities, revitalize the Welfare Committee for the Disabled, and reflect policy agendas.

Work-Related Interview Skills Training for Persons Served by Vocational Rehabilitation Agencies in Four States

PURPOSEThis study explored the acceptability and practicality of implementing a Direct Skills Teaching (DST) approach to increase job interview preparation for individuals who were receiving state vocational rehabilitation (VR) services in four states.METHODCounselors-in-training facilitated a four-session curriculum teaching “Presenting Qualifications” during job interviews to 137 individuals in 25 groups settings. Pre- and post-group 10-item questionnaires of skill acquisition, and a post-group satisfaction survey with open-ended questions were administered. Descriptive statistics and a nonparametric Wilcoxon signed rank test were used for data analyses.RESULTSAll 10 items of the pre- and post-group questionnaire comparisons yielded significant improvement in the skill of “Presenting Qualifications” after group intervention. The satisfaction survey also indicated the positive experiences of participants.CONCLUSIONSThe findings demonstrate the feasibility of a structured DST curriculum in teaching job interview skills to people with disabilities (including transition age youth) served by state VR agencies.

Understanding vocational rehabilitation service access among adolescents and young adults in foster care

ABSTRACT Using mixed methods, this study examined vocational rehabilitation (VR) access for foster youth with disabilities through child welfare agencies in Illinois. First, one agency completed a process mapping exercise to document VR referral practices. Second, agencies (N = 26) across the state completed surveys about knowledge and use of VR. Only 50% of agencies assessed employment needs at intake, and although 71% of agencies were familiar with the Division of Rehabilitation Services (DRS)-funded VR, only 39% made referrals. Increased collaboration across child welfare agencies and DRS is needed to ensure vulnerable youth are effectively connected to disability-specific employment services supporting economic stability into adulthood.

Asian Americans’ Perceived Knowledge of State Vocational Rehabilitation Services for People With Mental Illness

Given the significant role of employment on independent living and well-being among individuals with disabilities, such as those with mental illness, it is important to examine the experiences of racially and ethnically diverse cultural groups, including Asian Americans. However, little research has focused on Asian Americans with disabilities in the rehabilitation counseling field. This study examined knowledge of state vocational rehabilitation (VR) services and the perceived importance and likeliness of receiving VR services in a sample of 315 Asian Americans. Survey questions were developed to ask participants’ perceived importance of receiving various VR services provided within state VR agencies and the likeliness of receiving or recommending each service if they or their family members had a mental illness. The results showed that most participants were not familiar with state VR services. Although slightly different patterns were identified in the participants’ importance and likeliness ratings, the top important and preferable service was diagnosis and treatment. The information gathered in this study has important implications for crafting culturally sensitive and effective outreach and marketing strategies in Asian American communities.

Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with stress-related disorders: results from a randomized trial.

ObjectiveStress-related disorders are common, associated with substantial individual suffering, and place a large economic burden on society. While treatment appears to be able to reduce symptoms, evidence of interventions to improve vocational outcomes is flimsy. Lack of integration of vocational rehabilitation and healthcare services has been suspected to be a major potential barrier in return-to-work (RTW) processes; therefore, we aimed to test the effectiveness of such integration.MethodsWe randomized participants who were on sick leave for ≥ 4 weeks with a stress-related disorder. They were allocated to (i) service as usual (SAU), (ii) improved mental healthcare (MHC), or (iii) integrated interventions (INT). The primary outcome was RTW rates measured at 12 months. Secondary outcome were RTW rates measured at 6 months, proportion in work at 12 months, and levels of stress, anxiety, depression, and functioning at 6 months.ResultsWe included 666 participants. On the primary outcome and almost all other vocational outcomes, SAU was superior to both INT and MHC. MHC and INT did not differ on any vocational outcome. On several symptom scales, MHC showed lower values than SAU, whilst INT did not differ from the two other groups.ConclusionBoth the INT and the MHC intervention lowered RTW rates compared with SAU, and thereby yielded a worse outcome. However, the MHC group showed a tendency towards having lower symptom levels compared with those in the SAU group; accordingly, the SAU group is not unequivocally superior. MHC and INT showed no general differences.