Vocational Rehabilitation System Research Articles

Improving Work Participation Outcomes Among Unemployed People with Mental Health Issues/Mental Illness: Feasibility of a Stigma Awareness Intervention.

As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation. The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed. The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma. The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine. The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

STEM Career Pathways for Transition-Age Youth With Disabilities

Background:Although there is an increasing demand for workers in STEM fields, people with disabilities are underrepresented in STEM educational programs and related occupations. Among those who achieved competitive integrated employment after serving under an Individualized Plan for Employment (IPE) by the state-federal vocational rehabilitation (VR) system, only 5.3% of individuals with disabilities were engaged in STEM jobs/careers during the years 2017–2019. Of those with an employment outcome in STEM fields, 8,348 (40.9%) were transition-age youth aged 14–24.Objective:Using Rehabilitation Service Administration (RSA-911) data for the fiscal years from 2017 to 2019, the current study investigated the characteristics of transition-age youth with disabilities aged 14–24 in the state-federal VR system that predicted employment outcomes in STEM fields.Methods:A logistic regression analysis was used to examine the associations between individual characteristics and STEM career attainment.Findings:Results illustrated that gender, race, living arrangement, and the receipt of general assistance/SSI/SSDI/TANF predicted employment outcomes in STEM fields.Conclusions:The research findings provide support for the understanding of demographic characteristics of transition-age youth with disabilities successfully closed in STEM jobs/careers after serving under an IPE. A discussion of the strategies and interventions associated with promoting career development and decisions toward the STEM field for transition-age youth with disabilities is provided.

The Impact of Organizational Factors and Professional Identity on Turn Over Intent in State Vocational Rehabilitation Agencies

Turnover of staff is an ongoing concern in the state-federal vocational rehabilitation (VR) system. To better understand employee turnover intent, a multiple regression analysis was conducted using professional identity and organizational factors (e.g., pay, work tenure) as predictor variables. An internet-based survey solicited counselor perceptions regarding professional identity, turnover intent, and job satisfaction. Respondents ( n = 351) described their level of satisfaction relevant to several workplace conditions (co-workers, job in general, work assignments, pay, promotion, and supervision), and their current level of professional identity. The outcome variable representing current or future turnover intent was whether participants were actively looking for a new position or planning to look for a new position in the next 5 years. Results indicated that a little over one third of current counselors would look for a new position in the coming year, with half of current counselors seeking a new position within 5 years. Findings suggest that turnover in state-federal VR settings exceeds the national average of 19%. Purposeful pre-hire considerations, goodness of fit, motivation factors (i.e., opportunities for promotion), and hygiene factors (i.e., caseload size, supervision, and pay) identified in this study should be elements of a state-federal VR agency’s plan to mitigate turnover intent.

Persons With Disabilities in Self-Employment Served by the Federal/State Vocational Rehabilitation System: Differences Between 2011–2013 and 2017–2019

Persons with disabilities (PWDs) are disproportionately unemployed, underpaid, and underemployed despite their desire and capacity to work. The U.S. federal/state vocational rehabilitation (VR) program, under the supervision of the Rehabilitation Services Administration (RSA), is charged with providing services to assist eligible PWDs (VR consumers) in achieving employment. Despite research showing that VR consumers closed to self-employment (vs. non-self-employment closures) have better outcomes, self-employment is often considered as a last resort. Moreover, some evidence suggests self-employment (like non-self-employment) outcomes are associated with VR consumers’ gender and racial/ethnic identity. The objective of this study was to determine trends of case closures in self-employment among PWDs within the VR program from 2011–2013 to 2017–2019 and to examine the effects of gender and race/ethnicity on self-employment outcomes. Variables of interest were obtained from RSA’s Case Service Report (RSA-911) data set for 2011, 2012, 2013, 2017, 2018, and 2019. Data were recoded and analyzed. The number of closures in self-employment declined significantly. Weekly earnings in self-employment increased. Time from application to closure in self-employment decreased. Differences in VR self-employment outcomes by race/ethnicity and gender were noted. Efforts should be made to increase competency in self-employment of VR counselors and promote self-employment within the VR program.

Collaboration among vocational rehabilitation and mental health leaders: Supporting the vocational success of transition-age youth with serious mental health conditions

BACKGROUND: The ability of vocational rehabilitation, adult mental health and child mental health service systems to collaborate regarding the employment and career development goals of transition-age youth has not been explored nor has attention been paid to strategies that would increase this collaboration. OBJECTIVE: This qualitative study asks leaders from these three systems to describe collaborative activities that support better vocational services for transition-age youth with serious mental health conditions and discuss barriers and facilitators to collaboration. METHODS: Qualitative interviews were conducted with 39 formal and informal leaders in vocational rehabilitation (n = 16), child mental health (n = 13), and adult mental health (n = 10) systems as part of a larger study of interorganizational relationships. RESULTS: A primary barrier was lack of knowledge about the services and policies of each other’s systems. Another barrier was differences in philosophy about employment and the special needs of transition-age youth with mental health needs. CONCLUSIONS: In addition to specific activities that would encourage greater interaction across three systems, results underscore the need for the child mental health system and vocational rehabilitation system to increase their involvement with and knowledge about one another. This would include training child mental health providers about employment and career development services, vocational rehabilitation providers about the role of mental health in the youngest workers, and both being involved in transition-planning that directly addresses vocational goals and support needs.

The Influence of State-Level Contextual Factors on State/Federal System Vocational Rehabilitation Employment Outcomes for Persons With Traumatic Brain Injury

The purpose of this exploratory study was to develop a preliminary understanding of the influence of state-level contextual factors predictive of employment outcomes for the U.S. State/Federal Vocational Rehabilitation System (State VR) participants with traumatic brain injury (TBI). Participants were 5,213 individuals with TBI with Individualized Plans for Employment closed during federal Fiscal Year 2016. A four-step hierarchical logistic regression model (5.6% explained variance) containing five demographic, three state-level economic, six state TBI service climate, and nine State VR service variable expenditures correctly classified 57.0% of cases as attaining or not attaining an employment outcome at closure. Significant predictors associated with an employment closure were (a) education, veteran status, and presence of a secondary area of disability impairment; (b) state-level per-capita income; (c) State VR specialized acquired brain injury (ABI)/TBI service and state TBI Implementation Partnership grant funding; and (d) State VR service expenditures on diagnosis and treatment, occupational or vocational training, on-the-job training, job readiness training, transportation, maintenance support, and benefits counseling. The practice, policy, and research implications of these findings are presented.

Appraisal of Washington State workers' compensation-based return-to-work programs and suggested system improvements: A survey of workers with permanent impairments.

Following a work-related permanent impairment, injured workers commonly face barriers to safe and successful return to work (RTW). Examining workers' experiences with the workers' compensation (WC) system could highlight opportunities to improve RTW outcomes. Objectives included summarizing workers': (1) appraisal of several WC-based RTW programs, and (2) suggestions for vocational rehabilitation and WC system improvements to promote safe and sustained RTW. In telephone interviews, 582 Washington State workers with work-related permanent impairments were asked whether participation in specified WC-based RTW programs helped them RTW and/or stay at work. Suggestions for program and system improvements were solicited using open-ended questions; qualitative content analysis methods were used to inductively code responses. Most respondents reported positive impacts from RTW program participation; for example, 62.5% of vocational rehabilitation participants reported it helped them RTW, and 51.7% reported it helped them stay at work. Among 582 respondents, 28.0% reported that no change was needed to the WC system, while 57.6% provided suggestions or critiques. Reduce delays/simplify process/improve efficiency was the most frequent WC system theme-mentioned by 34.9%. Among 120 vocational rehabilitation participants, 35.8% reported that no change was needed to vocational rehabilitation, while 46.7% (N = 56) provided suggestions or critiques. More worker choice/input into the vocational retraining plan was the most frequent vocational rehabilitation theme-mentioned by 33.9%. This study's findings suggest that there is substantial room for improvement in workers' experience with the WC system. In addition, injured workers' feedback may reflect opportunities to reduce administrative burden and to improve worker health and RTW outcomes.

State-level differences in public vocational rehabilitation closures among transition-aged youth with traumatic brain injury

AbstractThis study aimed to understand state-level variation in participation in the State/Federal Vocational Rehabilitation (State VR) System in the United States among transition-aged youth (persons under the age of 22 years at application for State VR services) with traumatic brain injury (TBI) in Federal Fiscal Year 2016. A weighted least squares regression analysis was conducted to determine the relationship of state-level population size, unemployment rate, and per-capita income to the number of State VR closures in each state for transition-aged youth with TBI. Population size and per-capita income significantly predicted closures, while there was no relationship between closures and unemployment rate. Research is needed that further explores and explains state-level disparities in participation among transition-aged youth with TBI.

Brief Report: Participation Among Transition-Aged Youth With Traumatic Brain Injury in the State/Federal Vocational Rehabilitation System

This study aimed to understand the level of participation among transition-aged youth with traumatic brain injury (TBI) in the state/federal Vocational Rehabilitation (VR) system in the context of the Workforce Innovation and Opportunity Act (WIOA). Case closures, case duration, and case expenditures in federal fiscal years (FYs) 2014, 2015, and 2016 were examined among transition-aged youth (i.e., state VR clients under the age of 22 years at application) with TBI, autism spectrum disorder (ASD), and intellectual disability (ID), using a nonexperimental and descriptive design. A disproportionate number of transition-aged youth with ASD and ID had closed state VR cases compared with transition-aged youth with TBI. Alternatively, there were greater state VR case duration levels and case service expenditures for persons with TBI compared with those with ASD or ID. The disproportionate participation with state VR was consistent among these three groups via eligibility for services under the Individuals with Disabilities Education Act. This article highlights areas of attention concerning transition-aged youth with TBI and will hopefully stimulate future dialogue, research, and policy development concerning participation with State VR for this population.

Phase I development of the SGA Model: Use of administrative data and expert opinion to identify key components of the SGA Model

BACKGROUND: The SGA Model Demonstration tested a coordinated team approach that integrated specific components of vocational rehabilitation services to determine if the model would increase earnings outcomes of Social Security Disability income beneficiaries who sought VR services in Kentucky and Minnesota. OBJECTIVE: This paper provides details on the first phase of development of the SGA intervention. METHODS: Researchers combined a Delphi process, key informant interviews, and administrative data review to identify practices that were high priority for inclusion in the model. RESULTS: Researchers reached a consensus on the high priority components to construct a testable intervention under the control of the vocational rehabilitation system. CONCLUSIONS: The SGA Project team identified three practice domains to guide an intensive case study for Phase II development of the intervention. These included pacing of services, work incentives counseling, and strategies for employment service delivery.

Home Economics, “Handicapped Homemakers,” and Postwar America

In the two decades following World War II, a loose network of home economists at colleges and universities across the United States turned their attention to homemaking methods for women with physical disabilities. Often in consultation with physically disabled homemakers, these home economists researched and designed assistive devices, adaptive equipment, and work simplification techniques for use in the home. Their efforts signaled a new field of study, “homemaker rehabilitation,” which helped to enlarge the broader vocational rehabilitation system beyond its historic focus on male veterans and wage earners while also expanding the boundaries of home economics itself. Home economists’ work with disabled homemakers both bolstered and challenged postwar domesticity, middle-class gender roles, and able-bodied normalcy. Calling attention to these contradictions reveals much about how home economists engaged with and understood disability and how their work intersected with burgeoning movements for disability rights.

Rehabilitation scholarship program: A solution to personnel shortages in the vocational rehabilitation system

Rehabilitation scholarship program: A solution to personnel shortages in the vocational rehabilitation system

"It's Awful When We Get It Wrong": An Exploratory Qualitative Study of Vocational Rehabilitation Counselors' Perspectives on Suicide.

Despite the high prevalence of suicide among people with disabilities, little research has explored suicide in the context of the vocational rehabilitation (VR) system. We analyzed the responses of 27 VR counselors who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a desire for more training on suicide and the experience of seeking and receiving suicide training and experience outside of VR. Responses also underscored the heavy emotional impact of working with suicidal clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR counselors with resources and training for addressing suicide in their client populations.

An exploration of Asian Americans in the state vocational rehabilitation system by disability type.

The limited amount of information available on Asian Americans with different types of disability in vocational rehabilitation (VR) system has been a major obstacle to developing appropriate policies and practices. Using the Rehabilitation Service Administration data (RSA-911), this study investigated the associations between demographic characteristics, VR service patterns, and employment outcomes of Asian Americans. Whether the relationships differed by type of disabilities (i.e., sensory/communicative, physical, cognitive, and psychiatric disabilities) among Asian Americans was also examined. A series of chi-squared tests, one-way analysis of variance (ANOVA), and logistic regression were conducted to examine the associations and differences among demographic characteristics, service patterns, and employment outcomes across four major disability groups. Each disability group showed different service patterns that indicate unique consumer needs, individualized services and supports to be delivered in a culturally sensitive manner. Along with the demographic profiles of Asian Americans, factors significantly associated with competitive employment in each group were identified. This explorative study's finding implies VR practitioners' need to understand individual needs by disability type as well as characteristics of Asian culture, and need to develop and implement effective strategies and services to assist this population.

Responding to an Emerging Need in Rehabilitation Counselor Education: Development of a Cognitive Disabilities Certificate Program

Overview:The article describes the development of a Cognitive Disabilities Certificate Program (CDC) in a Council for the Accreditation of Counseling and Related Educational Program accredited Rehabilitation Counselor Education (RCE) program. Specific areas addressed includes the CDC’s administrative foundations, curriculum design, student outcomes, sustainability activities, and future directions.Methods:The CDC program was established in 2009 with a training grant from the Rehabilitation Services Administration. The CDC requires 18 units of post-baccalaureate coursework and training activities focused on cognitive disabilities.Results:From Spring 2009 through Spring 2017 semesters, 42 students attained the CDC certificate. CDC graduates currently work in settings serving persons with cognitive disabilities in the State/Federal Vocational Rehabilitation System, the U.S. Department of Veterans Affairs, post-secondary student support offices, and community-based rehabilitation provider agencies.Conclusion:The CDC program provides RCE programs a model approach for establishing specialized training to meet emerging rehabilitation needs among persons with cognitive disabilities.

"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.

Vocational Rehabilitation Service Patterns: An Application of Social Network Analysis to Examine Employment Outcomes of Transition-Age Individuals With Autism

Young adults with autism spectrum disorder (ASD) face poor employment outcomes following transition from school to adult life. Social network analysis is a useful approach for examining service patterns associated with employment success for this population. An advantage of this approach is its focus on the interdependence of variables rather than individual predictors. This study applies network methodology to examine the relations between vocational rehabilitation services and young adults with ASD to predict employment status. Using the Rehabilitation Services Administration (RSA-911) data set, participants included 2,219 individuals with ASD between the ages of 16 and 24 served by the public vocational rehabilitation system and closed as either competitively employed or not employed. A two-mode network was constructed such that a relation was defined for each service an individual received. Results from a core-periphery analysis indicated that of the 22 services available, core services included assessment, counseling/guidance, job placement, on-the-job support, job search support, and transportation services. Follow-up analyses suggested that the greater number of these six core services an individual received, the better the employment outcome. Findings highlight that these services should be viewed as interconnected and suggest a set of six core services that may be particularly beneficial for this population.

Implementation of Customized Employment Provisions of the Workforce Innovation and Opportunity Act Within Vocational Rehabilitation Systems

Effectively integrating provisions of the Workforce Innovation and Opportunity Act (WIOA) into public Vocational Rehabilitation (VR) systems will require extensive effort at both the organizational and system levels. This article presents information on WIOA provisions, enacted in July of 2014, that affect public VR systems plus rationale, strategies, and tools for implementing these provisions in a manner that promotes quality and sustainability. Both “ideal” implementation methods and “pragmatic” methods are presented based on the experience of one state’s efforts to incorporate customized employment strategies into its VR system to benefit customers who have not been successful at achieving a competitive, integrated employment outcome through traditional VR strategies.

Factors associated with consumer engagement and satisfaction with the Vocational Rehabilitation program

BACKGROUND: The Vocational Rehabilitation (VR) system spends approximately $365 million annually to serve consumers who disengage from services and drop out of the program. OBJECTIVE: Better understanding of the factors leading to premature exit might help VR better organize and deliver services to increase engagement. METHODS: VR consumers provided four waves of longitudinal data at six month intervals about their VR experiences and satisfaction. Almost half of the respondents felt that progression through VR services was too slow. Overall satisfaction with services was associated with the pace of service delivery, rates of contact between the counselor and consumer, and satisfaction with the counselor. Of those exiting the VR program over the study horizon (n = 162), 35% left because they met their goals, 34% because they were dissatisfied with services, and 30% for personal reasons. CONCLUSION: This study sets the stage for further evaluation and model testing of VR practices to reduce premature exit. Practice modifications might include changes to the rates, timing and structure of contacts between counselors and consumers. Even a nominal increase in consumer engagement and retention could have significant outcomes for the VR system and consumers.

Recovery-Oriented Vocational Rehabilitation Services for Individuals With Co-Occurring Psychiatric Disabilities and Substance Use Disorders

Purpose:In this article, we examined how individuals with co-occurring psychiatric disabilities and substance use disorders encounter numerous challenges when it comes to the vocational rehabilitation (VR) process.Method:A comprehensive review of the literature demonstrated barriers to service delivery (e.g., access to services, exclusionary eligibility requirements) and hindrances to VR planning (e.g., lack of training of VR counselors, lack of work-related skills) which all serve to create obstacles through which they must navigate. This article provides a brief overview of (a) the challenges that these individuals face in treatment and VR and (b) general considerations for providing more recovery-oriented VR services to increase their participation in the VR process, facilitate recovery, and improve VR outcomes.Results:Our review highlighted that VR participation and successful outcome rates among this group as a whole are much lower than the rates of those with other types of disabilities. Researchers have suggested a myriad of strategies that have proven advantageous when working with these individuals all of which serve to increase rates of sustained recovery and employment success.Conclusion:Additional research is still needed to substantiate the barriers to service delivery for this underserved VR population, evaluate how to implement more recovery-oriented practices within the VR system, and determine if such changes do indeed lead to improved outcomes for consumers with co-occurring disabilities.