Vocational Rehabilitation Support Research Articles

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.

중증장애인 직업적응훈련 서비스에 대한 현장 실무자 인식에 관한 연구: 중증장애인직업재활지원사업 수행기관을 중심으로

중증장애인 직업적응훈련 서비스에 대한 현장 실무자 인식에 관한 연구: 중증장애인직업재활지원사업 수행기관을 중심으로

Factors Associated With Resilience Among People With Spinal Cord Injury in the Community Setting

Objectives: The present cross-sectional study was done to acknowledge the level of resilience, its association with quality of life (QoL), community integration, and demographic/injury-related variables, and identify the determinants that affect resilience among spinal cord injury individuals living in the community. Methods: The data were collected from 108 participants using the convenience sampling method. A demographic/injury-related questionnaire was used to identify the characteristics of the participants. The CD-RISC10, World Health Organization quality of life-BREF (WHOQOL-BREF), and community integration questionnaire-revised (CIQ-R) were used to measure resilience, QoL, and community integration. Association between resilience and independent variables was examined through Pearson’s correlation and Point-Biserial correlation, whereas, univariate and multivariate linear regression analyses were applied to identify the influence of the demographic/injury-related factors that contribute to resilience, and independent t-test and ANOVA were employed to identify the determinants that affect resilience. Results: Almost 78% of participants had a moderate-to-high level of resilience. In multivariate analysis, gender, marital status, and profession were found to be statistically significant. Among these predictors, employment had a higher beta value (β=0.684, P=0.026), which signifies its importance in evaluating resilience. Significant associations were established between resilience, QoL domains, community integration, and demographic variables, which included marital status, duration since the injury, and frequency of going out. Discussion: The present research brings attention to the significance of using appropriate interventions, such as vocational rehabilitation support as well as awareness about the injury to help strengthen resilience and reintegration amongst SCI individuals into their communities. A further longitudinal study is recommended to determine predictive factors of the dynamic nature of resilience over time.

The role of habilitation services in the lives of children and adolescents with visual impairments

Previous research suggests that children and adolescents with visual impairment may face several challenges in their academic learning and socio-emotional development due to restricted mobility, feelings of loneliness, and dependency on others. Habilitation services attempt to provide support with respect to many of these challenges that may positively impact on well-being and mental health, such as enabling independence in daily tasks, participation in social activities, and developing self-confidence. The literature also shows that individuals who have received educational and vocational rehabilitation support report higher quality of life and more positive self-esteem. Therefore, the primary focus of this study was on the rehabilitation, recreational opportunities, and educational resources provided by vision habilitation services for children and adolescents with visual impairments. The role that these services may play in school and daily life, as well as in the socio-emotional development of children and adolescents with visual impairments was also examined. This research covers the perspectives of professional staff, parents, children, and adolescents and considers both the immediate and potential long-term benefits of these services. The findings of the study highlighted the positive impact that this support has on children and adolescents’ independence, personal-safety, and self-confidence. The findings also indicated the positive impact of this support on the mental health of their families and benefits of providing continued support and expanding these habilitation and recreation services.

Evaluating the Long-Term Effectiveness of the SGA Enhanced Services Model in Kentucky: A Follow-Up Study on the SGA Demonstration Project

During federal fiscal year (FY) 2016 and 2017, the Kentucky Office of Vocational Rehabilitation (KY OVR) implemented the Substantial Gainful Activity (SGA) Project, providing enhanced services to Social Security Disability Insurance (SSDI) recipients who also applied for services through the general Vocational Rehabilitation (VR) agency. Short-term evaluative efforts revealed that consumers receiving enhanced services were more likely to be competitively employed, achieving slightly higher earnings and in a shorter period. This longer-term follow-up study indicated promising results, noting sustained differences in wages and time to employment. Higher wages and a faster path to employment can positively impact the economic outcomes of individuals receiving SSDI benefits through innovative VR service and support models.

Exploring employment following traumatic brain injury in persons who completed an insurer funded vocational rehabilitation program in Australia

Purpose To extend the authors’ previous research by investigating the maintenance of work performance over time and the long-term experience of employment following traumatic brain injury (TBI). Materials and methods Semi-structured interviews were conducted with a sample of 72 individuals with predominantly severe TBI, up to 10-years post-injury. Thematic analysis of transcribed interviews was conducted. Results Four key themes were identified: brain injury influences on work performance and long-term employment; factors optimising long-term employment; and need for compromise and acceptance, which all impacted the final theme, quality of life outcome. While TBI-related difficulties such as fatigue, cognitive, and emotional difficulties still impacted work many years post-injury, work modifications and employer and vocational rehabilitation (VR) support were important factors optimising long-term employment. The timing of return to work (RTW) was also an important and potentially modifiable factor influencing work performance, which appeared to have long-term effects on the maintenance of employment. Support for acceptance of altered career goals is needed. Conclusion Findings support the need for early VR to facilitate employer contact, to maximise adjustment and preparation time before RTW, to educate both employees and employers and to implement work modifications to support continuing employment after TBI. Implications for rehabilitation The maintenance of employment following TBI is of critical importance for financial independence, psychological and social well-being, and improved quality of life. Injury-related difficulties still impact work performance many years after injury requiring individuals with TBI to continue working in modified roles and for reduced hours over the long-term. Ongoing VR and employer support is needed to facilitate long-term work modifications and compensatory strategies to support work performance. Early VR involvement to facilitate employer contact and maximise adjustment and preparation time before returning to work is necessary to avoid the negative and potentially dire consequences of returning too early. Psychological support to facilitate acceptance of role changes and career compromises is also important.

Employment Consequences of COVID-19 on “Long-Haul” Survivors

Research ObjectivesCoronavirus (COVID-19) is an infectious disease that can cause long-lasting adverse consequences after recovery. COVID-19 can also result in functional limitations that affect daily activities and work capacity. Individuals with these lasting complications are known as long haulers. The demand for vocational services and post-acute rehabilitation is increasing and has become urgent. To address the need, we aimed to describe the challenges that individuals recovering from COVID-19 encounter when returning to work and the experiences of the healthcare professionals who assist them throughout that process.DesignQualitative research with focus groups.SettingOutpatient and vocational rehabilitation (VR) clinics affiliated with a Midwest rehabilitation center.Participants4 VR counselors and 4 rehabilitation physicians who serve clients recovering from COVID-19.InterventionsNot applicable.Main Outcome MeasuresNot applicable.ResultsUncertain COVID-19 recovery trajectory and unpredictable outcomes, various long-lasting symptoms, and disease complications were the three frequently mentioned challenges when returning to work. To support long haulers in regaining employment, VR counselors and physicians communicated with employers, helped clients adjust to COVID-19-related challenges, provided individualized VR support, and helped obtain or short- or long- term disability benefits. Physicians expressed uncertainty in working with patients with COVID-19 due to the unknown disease and its infectiousness. Counselors recommended various job accommodations including modifying workplace policies, flexible scheduling, changing workplace environment, and modifying job responsibilities. Both physicians and counselors recommend support groups and policy changes.ConclusionsLong haulers experience persisting physical, cognitive, and emotional consequences of COVID-19 infection requiring rehabilitation therapies and job accommodations. We provide recommendations to guide rehabilitation professionals in helping long haulers return to work.Author(s) DisclosuresThe authors have no conflict of interest to declare.

Present conditions and development plan for customized employment for the severely disabled: Based on vocational rehabilitation center project

이 연구는 중증장애인의 고용확대 및 유지를 위해 이루어지고 있는 중증장애인 맞춤식 고용의 현황을 살펴보고 활성화 방안을 마련하는 데 목적이 있다. 이를 위해 현장중심 직업재활센터사업의 현황 분석과 사업담당자 심층면담을 실시하였다. 그 결과 사업 활성화를 위해서는 첫째, 현장중심 직업재활센터사업의 정체성 확립이 필요하며 둘째, 중증장애인직업재활지원사업과 연계하거나 통합을 고려할 필요가 있으며 셋째, 공공분야 장애인 일자리 방향성을 맞춤식 접근을 통해 안정된 일자리사업으로 재설계할 필요가 있으며 넷째, 전문인력과 훈련지원인의 자격기준의 개선과 전문성 향상을 위한 교육기회가 제공되어야 하며 다섯째, 다양한 직무지원과 사업주 지원방안이 개발되고 지원될 필요가 있으며, 마지막으로 최소한의 인력과 지원서비스를 위한 예산, 훈련수당 지원 등의 근본적인 지원확대가 필요한 것으로 나타났다.The purpose of this study is to establish a vocational rehabilitation center for persons with disabilities. For this purpose, we analyzed the current status of field - oriented vocational rehabilitation center project and conducted in - depth interviews with project managers. As a result, it is necessary to establish the identity of business-centered vocational rehabilitation center project in order to revitalize the business. Second, it is necessary to integrate with the vocational rehabilitation support project for persons with disabilities or to consider integration. Third, it is necessary to redesign the job direction for the disabled in the public sector into a stable job business through a customized approach. Fourth, education opportunities should be provided to improve the qualification standards of professional workers and training supporters and to improve their professionalism. Fifth, various job support and employer support schemes need to be developed and supported. And finally, funding for minimum manpower and support services, and support for training allowances.

Experiences with and Knowledge of Non-suicidal Self-Injury in Vocational Rehabilitation Support Staff

This study examined experiences with and knowledge of non-suicidal self-injury (NSSI) among a multistate sample of 111 vocational rehabilitation (VR) support staff. Over 80% of support staff reported working with clients who had expressed thoughts or behaviors related to NSSI, with over 15% doing so at least once a month. However, only about a quarter (27.0%) reported having received training on NSSI. Participants generally scored well on three true/false NSSI knowledge items but also demonstrated some gaps in knowledge. Support staff commonly work with individuals with NSSI in VR settings but may benefit from additional training and support in this area.

Experiences with and Knowledge of Non-suicidal Self-Injury in Vocational Rehabilitation Support Staff

This study examined experiences with and knowledge of non-suicidal self-injury (NSSI) among a multistate sample of 111 vocational rehabilitation (VR) support staff. Over 80% of support staff reported working with clients who had expressed thoughts or behaviors related to NSSI, with over 15% doing so at least once a month. However, only about a quarter (27.0%) reported having received training on NSSI. Participants generally scored well on three true/false NSSI knowledge items but also demonstrated some gaps in knowledge. Support staff commonly work with individuals with NSSI in VR settings but may benefit from additional training and support in this area.

"I Honestly Would Not Have Known What to Do": An Exploratory Study of Perspectives on Client Suicide Among Vocational Rehabilitation Support Staff.

Despite the high prevalence of suicide both overall and among people with disabilities in particular, little research has explored suicide in the context of the vocational rehabilitation (VR) system or in counseling support staff in general. We analyzed the responses of 14 VR support staff who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a perceived lack of and desire for more training regarding suicide, seeking and receiving suicide training outside of VR, and a perceived lack of resources for working with suicidal clients. Responses also underscored the heavy emotional impact of working with these clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR support staff with resources and training for addressing suicide in their client populations.

Psychometric Properties of Two Self-Report Suicide Assessment and Intervention Competency Measures in a Sample of Vocational Rehabilitation Support Staff

We analysed the psychometric properties of two published self-report suicide assessment competency rating scales – the Suicide Competency Inventory (SCI) and the Suicide Competency Assessment Form (SCAF) – in a sample of 93 public-sector vocational rehabilitation support staff from six states in the United States. Both measures demonstrated very good to excellent internal consistency in our sample. Exploratory factor analysis with principal axis factoring indicated the SCI loads on a two-factor model in this sample, as opposed to the three-factor model proposed by the measure's authors. The SCAF loaded on a single factor, consistent with the theoretical model proposed by the original authors. The SCI and SCAF were highly correlated with each other, providing initial evidence of convergent construct validity. These results provide initial support for the use of these measures as a reliable and valid means of assessing perceived suicide assessment competency in vocational rehabilitation support staff.

Support Persons' Perceptions of Giving Vocational Rehabilitation Support to Clients With Acquired Brain Injury in Sweden.

The aim of this article is to explore the perception of being a support person for clients with acquired brain injury undergoing vocational rehabilitation. Nine support persons, identified by clients with brain injury, were interviewed. Interviews were analyzed using qualitative content analysis, resulting in 3 themes for assisting the client: commitment, adaptation, and cooperation. Within each theme, multiple dimensions were identified, reflecting the complexity of vocational rehabilitation following acquired brain injury. Commitment built on social relations is linked to sustainability of support. The included support persons' role was especially valuable in contexts where adaptation and cooperation were required.

A 5-year follow-up study of users of benzodiazepine: starting with diazepam versus oxazepam.

Drug dependency may develop during long-term benzodiazepine use, indicated, for example, by dose escalation. The first benzodiazepine chosen may affect the risk of dose escalation. To detect possible differences in benzodiazepine use between new users of diazepam and oxazepam over time. This 5-year prescription database study included 19 747 new benzodiazepine users, inhabitants of Norway, aged 30-60 years, with first redemption for diazepam or oxazepam. Individuals starting on diazepam versus oxazepam were analysed by logistic regression with sex, age, other drug redemptions, prescriber's specialty, household income, education level, type of work, and vocational rehabilitation support as background variables. Time to reach a daily average intake of ≥1 defined daily doses (DDD) over a 3-month period was analysed using a Cox proportional hazard regression model. New users of oxazepam had a higher risk for dose escalation compared with new users of diazepam. This was true even when accounting for differences in sociodemographic status and previous drug use (hazard ratio [HR] 1.33, 95% confidence interval = 1.17 to 1.51). Most doctors prescribed, according to recommendations, oxazepam to individuals they may have regarded as prone to and at risk of dependency. However, these individuals were at higher risk for dose escalation even when accounting for differences in sociodemographic status and previous drug use. Differences between the two user groups could be explained by different preferences for starting drug, DDD for oxazepam being possibly too low, and some unaccounted differences in illness.

A state comparison of vocational rehabilitation support of youth with intellectual disabilities' participation in postsecondary education

In this study a secondary data analysis was conducted using the Rehabilitation Services Administration's 911 dataset. The findings provide an update on the role of Vocational Rehabilitation in promoting participation in postsecondary education for individuals with intellectual disabilities, by providing data that focuses on youth with intellectual disabilities in comparison with youth with other disabilities, and by highlighting differences across states nationwide (i.e., postsecondary education status upon exiting the VR system). Overall, this study showed that state VR programs play an important role in assisting youth with intellectual disabilities to participate in postsecondary education, although to a lesser extent than youth with other disabilities. Findings indicated that youth with intellectual disabilities were substantially less likely to participate in postsecondary education while in the VR system compared to youth with other disabilities, their participation varied substantially across states, and participation remained static, nationally, between 2006-2010, despite positive trends in several state VR programs.

A sociological perspective on “the unmotivated client”: public accountability and professional work methods in vocational rehabilitation

Purpose: This study aims at a sociological understanding of the concept of (un)motivation in order to provide clues for improving vocational rehabilitation (VR) support. Method: (Un)motivation is understood as the product of the interaction between clients and professionals in an institutional context. To gain better understanding of this construction of (un)motivation, in depth-interviews are held with 14 VR professionals. Based on the stories professionals told about their professional practices, we analysed the ways in which they guide their clients during their VR path within the institutional context of the Dutch welfare state. Results: “The unmotivated client” is a judgment that arises in the interaction between professional and client if the institutional goals of VR are not achieved. Two work methods are distinguished in which this judgment takes shapes in various ways, namely “Professional as a Signpost” and “Professional as a Personal Guide”. Conclusions: Professionals work in a dichotomous public accountability framework with a strong focus on labour participation. This causes professionals to look for ways out of VR paths in which labour participation is not achieved. The construction of “the unmotivated client” is such a way out. An alternative way out is to explicitly value clients’ (intermediary) achievements.Implications for RehabilitationIn vocational rehabilitation (VR) there exists the risk that a perceived lack of motivation is only considered a personal problem in stead of a social issue.Reconsideration of the public accountability framework of VR may lead to more inclusive VR support in which a differentiated concept of participation is valued.Lessons can be drawn from the articulation of achievements made in VR paths that are now considered unsuccessful.For more inclusive VR support, the specific situation and situated needs of clients need to be taken as a starting point instead of a primary focus on the final goal of labour participation.

Charity Profile – The Shaw Trust: vocational rehabilitation support

While most patients working with therapists will have a successful return to their previous job following ill health or a personal injury, others may need a new direction, or even complete career change ,and require one to one support in finding new or alternative employment.

Sustaining employment after vocational rehabilitation in acquired brain injury

Purpose. To explore factors affecting sustaining employment in people with acquired brain injury (ABI). Method. A multiple case study approach using semi-structured interviews in eight cases (29 individuals). Each case included an individual with ABI, a family member, a job coach and a co-worker (triangulation). The eight individuals with ABI had completed vocational rehabilitation and were purposively selected based on whether they had sustained employment (4) or not (4). Results. Similarity between pre-injury work or leisure interest and post-injury work, unconditional motivation, insight and the ability to cope with cognitive and behavioural sequelae were beneficial in sustaining employment. Post-injury instances of poor cognitive or behavioural function did not necessarily affect sustained employment. The vocational rehabilitation programme was beneficial in building up confidence, providing continued follow up and providing co-worker ‘twins’ in the work place. Employers with a personal experience of disability helped individuals with ABI to sustain employment. Conclusions. Similarities between pre-injury work or leisure interests and post-injury work improved motivation. Factors associated with sustained employment were insightful, unconditional, internal motivation providing an ability to cope, confidence provided by ongoing vocational rehabilitation support through job coaches, supportive co-workers and employers with a personal experience of disability. People with ABI can be outstanding employees.

Successful Vocational Rehabilitation for Individuals with Significant Mental Disabilities

ABSTRACT Individuals with significant mental disabilities (SMD) frequently have scattered work histories (Finch, 1997; Tan, 1996). Often the SMD consumer is unable to find competitive employment or, if a job is secured, termination repeatedly ensues because of impaired interpersonal skills, faulty behaviors such as the inability to interact with coworkers, inadequate follow-through such as not reporting to work, and poor hygiene (Tan, 1996). The services provided to SMD consumers in this study were designed to address a cadre of support needs that would foster job retention and increase the number of successful employment closures. This cross-sectional exploratory study sampled 211 SMD consumers who received vocational rehabilitation support services through a vocational rehabilitation center in Columbus, Ohio. The SMD consumers sampled experienced both successful and unsuccessful employment closures.