Background The number of older working-age adults with disabilities (OWAD) seeking services from State Vocational Rehabilitation Agencies (SVRAs) has increased as individuals remain in the workforce longer and experience disability later in life. However, VR research and practice have largely focused on new employment acquisition rather than employment retention, particularly for individuals approaching retirement age. Objective This study examined differences in VR service utilization, employment outcomes, and expenditures between employment retention and job acquisition pathways for OWAD. Method Secondary analysis of Rehabilitation Services Administration (RSA-911) data from PY 2017–2023 was conducted for individuals ages 50–69 who received VR services and exited the program. Outcomes were compared by age group and employment status using descriptive and inferential analyses. Results The proportion of VR applicants ages 50–69 increased steadily, reaching nearly one-third of all applicants by 2023. Older adults were more likely to be employed at IPE development and to exit VR in competitive integrated employment with lower expenditures needed for job retention. Conclusion Retention-focused strategies emphasizing early intervention, accommodations, and employer engagement may improve employment outcomes of older workers while containing costs, supporting a shift in VR approaches.

Background Vocational Rehabilitation (VR) Returners are individuals who receive services, have their case closed, and later return for additional services. This understudied group is critical for improving service delivery and resource allocation. Objective We examined demographic and case factors predicting return to VR services, compared employment outcomes between returners and one-time consumers, and identified VR services linked to competitive employment outcomes. Method Using Rehabilitation Services Administration (RSA-911) data (2017–2024), we identified 110,061 returners (6.8%). Logistic regression models examined predictors of return and service types associated with competitive employment; linear regression models compared continuous employment outcomes (weekly hours and wages) between returners and one-time consumers. Results Individuals receiving public benefits showed higher return rates, with benefit receipt accounting for initial racial disparities. Black and American Indian individuals were more likely to receive benefits; Hispanic individuals less likely. Returners achieved higher employment rates but worked fewer hours at lower wages. Job Placement Assistance and Diagnosis and Treatment were positively associated with employment outcomes. Conclusion VR return patterns reflect intersections of benefit receipt, disability characteristics, and structural constraints. Returners’ higher employment rates but lower wages and hours suggest strategic workforce participation, highlighting the need for longitudinal, career pathway approaches in VR service delivery.

Multiple sclerosis (MS) is a chronic neurologic disease that primarily affects adults of working age. Symptoms related to the disease can lead to unemployment and challenges in the workplace. This study aims to review the challenges related to work life in actively working adult patients with MS, and investigate the relationship of these challenges with disease-related factors such as cognitive, emotional, and physical disability, as well as the coping strategies employed. One hundred fifty patients with a definitive diagnosis of relapsing-remitting multiple sclerosis (RRMS) were included in the study. We evaluated fatigue, cognition, mood, extremity functions, disability, and coping strategies for difficulties at work. In our study, as patients' cognitive levels decreased, their scores on psychological/cognitive barriers, physical barriers, and total barriers increased. We found a negative correlation between work-related difficulties and patients' cognitive levels. As patients' scores on depression, fatigue, and hopelessness tests increased, their scores across all work-related barriers also increased. This study highlights the importance of evaluating the clinical symptoms, work-related challenges, and coping strategies in the follow-up of working patients with MS. Therefore, we suggest prioritizing adaptive coping and vocational rehabilitation to mitigate work-related difficulties.

Understanding the diverse vocational functioning profiles of individuals with disabilities is crucial for effective, person-centered practice in vocational rehabilitation. To identify latent profiles of vocational functioning on the basis of Work Rehabilitation Questionnaire (WORQ) scores of individuals with disabilities in Turkey and to investigate demographic predictors of profile membership. Cross-sectional study using online survey methods. Online data collection. A total of 522 adults (67.8% male), ages 18-64 yr, literate, and possessing a health report confirming a disability rating of more than 40% were recruited. Latent profile analysis was used to identify distinct vocational functioning profiles. Multinomial logistic regression examined predictors of profile membership. Latent profiles were derived from participant scores on the WORQ subdomains: Emotion, Cognition, Dexterity, and Mobility. Predictors included gender, education, and work experience. Three distinct latent profiles were identified: Class 1 (n = 199), with the lowest scores across all subdomains; Class 2 (n = 83), with higher Emotion and Cognition scores but lower Dexterity and Mobility scores; and Class 3 (n = 240), with higher Dexterity and Mobility scores but lower Emotion and Cognition scores. Prior work experience significantly predicted membership likelihood between profiles (p = .031). Individuals with disabilities exhibit distinct vocational functioning profiles, highlighting significant heterogeneity beyond diagnostic labels. These findings underscore the need for individualized assessment and intervention in vocational rehabilitation, tailoring approaches to profile characteristics. The profiles can guide goal setting and intervention planning, although further research is needed to explore links with specific diagnoses and employment outcomes. Plain-Language Summary: Understanding the different work-related strengths and challenges people with disabilities face is important to help them succeed in employment. This study identified three common patterns, or profiles, of individuals with disabilities on the basis of their self-reported emotional, thinking, physical movement, and fine motor skills related to work. One group had lower scores overall, another had stronger emotional and thinking skills but weaker physical skills, and the third had stronger physical skills but weaker emotional and thinking skills. Knowing these profiles can help occupational therapists tailor vocational rehabilitation programs to better meet each person's specific needs, focusing on the areas in which they need the most support to find and keep meaningful work.

Objective: This study analyzed trends in the year of treatment completion in patients with occupational hand injuries using the second and third PSWCI cohorts. Methods: This retrospective cohort study included 1,967 patients with occupational hand injuries from the PSWCI. To examine baseline trends, frequency analyses of the demographic factors, occupational injuries, vocational rehabilitation, and job characteristics were conducted. To analyze the changes in characteristics according to the closure year of workers’ compensation treatment, data from 2017 and 2022 were compared using the chi-square test. Results: In 2022, among individuals who completed workers’ compensation treatment, the proportions of those aged 60 years or older, unmarried, and with a college education or higher increased. In this group, work-related diseases increased, and the treatment duration was longer. No significant differences were observed in vocational rehabilitation. The proportion of hand injuries in the first workplace decreased. Whereas hand injuries increased in the first two month of employment. Conclusion: This study identified changes in the characteristics of patients with occupational hand injuries, indicating the need to strengthen hand injury prevention education and improve workers’ compensation medical delivery systems to enhance effective hand therapy and facilitate return to work.

This study investigated whether response characteristics on the Star–Wave Test (SWT) differ according to levels of anxiety and depression among juvenile delinquents. The participants were 118 adolescents residing in a vocational juvenile rehabilitation facility located in city G. The assessment tools included the Star–Wave Test (SWT) and standardized anxiety and depression scales. Data were analyzed using frequency analysis and one-way analysis of variance (ANOVA). The results indicated the following. First, an examination of the Star–Wave Test (SWT) response characteristics among juvenile delinquents revealed that, in terms of drawing style, the pictorial style was most prevalent (42.4%). For spatial structure, disharmonious configurations were most frequently observed (52.5%). In the domain of spatial symbolism, separation between sky and sea appeared with the highest frequency (46.6%). Regarding object symbolism, moon imagery (32.2%) and thunder/lightning motifs (38.1%) were most prominent. Second, the analysis of differences between Star–Wave Test (SWT) response characteristics and anxiety scores among juvenile delinquents revealed a statistically significant effect in the domain of object symbolism. Third, the depression levels of juvenile delinquents showed statistically significant differences depending on the type of drawing style and spatial symbolism. The findings of this study hold both theoretical and practical significance in that they demonstrate how the emotional vulnerability of juvenile delinquents is differentially manifested in specific components of their projective drawing responses.

Ideological and political education within the curriculum (Curriculum Ideology and Politics) is a vital approach to fulfilling the fundamental task of "fostering virtue through education" and remains a focal point in current vocational education reforms. Under the background of the "New Double High-Level Plan" construction, there is an urgent need to promote the deep integration of professional courses with ideological and political education for Rehabilitation Therapy Technology majors. As a core course in this major, Musculoskeletal Disease Rehabilitation possesses strong professional and humanistic characteristics, making it an effective carrier for such integration. Based on this course, this paper aims to shape students' "medical benevolence," temper their "craftsmanship spirit," and enhance their comprehensive literacy. It explores a teaching path that unifies professional instruction with value guidance, aiming to cultivate high-quality rehabilitation therapy professionals who possess both moral integrity and technical skills.

Large case volumes have been related to work-related stress among vocational rehabilitation (VR) counselors, leading to ineffective counseling services. Using recent survey data of VR counselors linked with their clients’ records, we examined the impact of counselors’ case volume on clients’ employment outcomes at the exit of counseling programs. The overall successful closure rate (clients being employed) was 33%, and the high-quality closure rate (clients obtaining full-time or living wage jobs) was 23.5%. A nonlinear pattern was observed between counselors’ case volume and clients’ employment outcomes. Counselors with a moderate case volume (36–50 cases closed per year) had the highest successful closure rate compared with either lower or higher case volume groups. After adjusting for both clients’ and counselors’ characteristics, counselors with 51–75 cases closed per year had a 3.6% lower overall closure rate ( p = .03) and a 3.4% lower high-quality closure rate ( p = .02) than those with 36–50 cases per year. State VR agencies should be conscientious about counselors’ case volume to prevent turnover of counselors. Counselors need proper training in caseload management to ensure the best counseling services.

The aim of this study was to examine how the COVID-19 pandemic affected return to work (RTW) after vocational rehabilitation. Particular attention was paid to whether pandemic-related changes in the likelihood of RTW could be observed overall and in relation to individual vulnerability characteristics.The study was based on administrative data from the German Pension Insurance (n=28,779; 2018-2021). Three cohorts were included in the analysis: a reference cohort (rehabilitation and RTW before the pandemic), pandemic cohort 1 (RTW during the pandemic), and pandemic cohort 2 (rehabilitation and RTW during the pandemic). The probability of RTW was analyzed first descriptively and then again using logistic regression models, with adjustments made for relevant covariates. Additionally, interactions between the cohort variable and vulnerability characteristics (i. e., previous receipt of unemployment benefits I or II) were examined.Descriptive results showed lower RTW rates in both pandemic cohorts compared to the reference cohort. After adjustment, the decline was less pronounced, indicating the importance of individual characteristics and contextual factors - particularly labor market conditions. In the adjusted model, no statistically significant difference remained for pandemic cohort 1 relative to the reference cohort, whereas the gap for pandemic cohort 2 was reduced but not fully eliminated. Interaction analyses further indicated that barriers to RTW were amplified under pandemic conditions: rehabilitees with prior unemployment saw a further decrease in predicted probabilities of RTW in pandemic cohort 2 compared to before the pandemic.Overall, pandemic-related conditions made the transition back to working life after vocational rehabilitation more difficult. Individuals with pre-existing labor market disadvantages were particularly affected, pointing to an intensification of social inequalities under crisis conditions. To counteract such effects in the future, stronger linkages between vocational rehabilitation and labor market integration should be established.

Transition from medical to vocational rehabilitation not only mark the change from one institution or programme to the next, but are also biographically significant and vulnerable phases for the rehabilitants. The organisation of this transition is therefore of great importance. The present study analyses transitions from medical to vocational rehabilitation from the perspective of four research projects. The article addresses key hurdles, control mechanisms and subjective experiences in the transition process.The data basis comprises qualitative interviews, focus groups, document analyses, as well as standardised and open questionnaire surveys in various vocational rehabilitation institutions (BFW and BTZ) and medical rehabilitation institutions. The evaluation was conducted using a combination of qualitative content analysis (Kuckartz, Mayring), grounded theory (Glaser & Strauss), and descriptive statistical methods.The results can be grouped into four thematic focus areas that chronologically describe the transition process: 1) the path to vocational rehabilitation, 2) information and support for vocational rehabilitation, 3) access to and referral to vocational rehabilitation, and 4) the start of and arrival in vocational rehabilitation. It became evident that the transitions were characterized by institutional fragmentation, information deficits and unclear responsibilities. It was often the case that individuals seeking vocational rehabilitation services did so on an opportunistic basis, or through their own personal initiative. The coordination of counselling services was suboptimal, and the formal referral processes appeared to lack transparency and were sometimes arbitrary. Vulnerable groups, such as those grappling with addictions or other mental health problems, were particularly susceptible to the impact of these barriers. However, there were documented instances of successful transitions, particularly when early, continuous counselling was provided, and individual circumstances were given due consideration.Successful transition management requires clear responsibilities, standards for counselling and referral, and better integration of medical and vocational rehabilitation. It is crucial to integrate institutional routines within the rehabilitants' biographies.

The article studies the types and content of social services provided by a specialized career counselor to persons with disabilities in the employment mechanism. It was emphasized that relevant services are provided only to registered unemployed persons with disabilities. A distinction is made between general and personalized information and counseling, as well as professional information and counseling as components of professional orientation. It was concluded that the professional orientation of people with disabilities at the stage of choosing a direction of study for obtaining vocational or higher education will contribute to their effective employment, taking into account individual characteristics and the state of the labor market. The significant role of profiling as an innovative technology in the activities of social services has been identified. Examples of various models of such profiling in foreign countries are given. A comparative analysis of legislative definitions of the same concept in various Laws of Ukraine was conducted. It was concluded that the list of social services and their concepts, enshrined in various Laws of Ukraine, should be unified. It was emphasized that it is necessary to harmonize the Laws of Ukraine «On Employment of the Population», «On Compulsory State Social Insurance in Case of Unemployment», «On Rehabilitation of Persons with Disabilities». Legislative definitions should be universal and enshrined in the basic law regulating the relevant sphere of relations. All definitions related to the sphere of employment should be enshrined in the Law of Ukraine «On Employment of the Population». Legislative definitions of vocational guidance, vocational training, vocational rehabilitation, and vocational selection need to be revised. The argument is based on the need to establish a standard for employment of people with disabilities: the priority areas for search are areas of work within the profession that a person would choose if they did not have a disability at all. It is justified that vocational training as a form of professional rehabilitation should be provided to persons who have lost contact with the labor market or persons who need additional protection. Everyone else needs to be provided with access to vocational education. The author argues that in the employment search procedure for a person with a disability, the «roadmap» is an individual employment plan. It is the basis for monitoring employment as a comprehensive social service in the field of employment of a person.

Medical rehabilitation, while fulfilling the tasks of preventing disability of the population, is characterized not only by its humanistic, but also by its crucial economic importance as a means of preserving and increasing human capital. Based on the analysis of scientific publications on the research topic in peer-reviewed scientific journals, carried out using general scientific methods of analysis, synthesis, structuring and grouping of information, the paper shows that the world experience in organizing medical rehabilitation is characterized by some common solutions: a variety of rehabilitation treatment facilities that allow providing rehabilitation care in the right volume and as close as possible to the place of residence patient; widespread rehabilitation at home and at the community level; great attention to the payback of rehabilitation measures and the allocation of vocational rehabilitation as a leading area. At the same time, in Russia, the current state of the medical rehabilitation system is the result of prolonged spontaneous development in the absence of a unified theoretical, regulatory and organizational framework. This causes both its problems: lack of methodological unity and continuity of rehabilitation programs and institutions; insufficient material and technical equipment and staffing of rehabilitation institutions; the eclectic variety of forms and methods of organization of medical rehabilitation, along with the underdevelopment of its outpatient link, and others; as well as the most relevant areas of development.

Since individual placement and support (IPS) emerged as the premier evidence-based vocational rehabilitation for people with serious mental illness (SMI) in the early 2000s, several groups around the world have extended IPS to new disability groups. This review examines the rigorous evidence for five new populations: adults with early psychosis, common mental disorders, substance use disorders, posttraumatic stress disorders, and severe medical conditions. This review updates the employment outcome findings from six recent systematic reviews of controlled trials of IPS for new populations using an electronic search. Using meta-analyses, the overall odds ratio (OR) and 95% confidence intervals (CI) for IPS-control differences in employment rate were calculated for RCTs of three new populations. The search identified 19 controlled trials of IPS for new populations, including 9 published since 2019. Meta-analyses yielded ORs of 3.39 (95% CI: 2.11-5.46, p < .0001, N = 393) for 5 studies of adults with early psychosis, 1.42 (95% CI: 0.96-2.09, p = .08, N = 1728) for 5 studies of adults with common mental disorders and 1.88 (95% CI: 1.13-3.15, p = .02, N = 1830) for 5 studies of adults with substance use disorders. Two studies each of veterans with posttraumatic stress disorders and patients with serious medical conditions had a mix of small and large ORs. IPS, the only vocational rehabilitation intervention with robust employment results, has been extended to several new populations with generally positive employment outcomes in controlled trials. However, poor implementation, small sample sizes, and other methodological problems limited the overall quality of this literature.

IntroductionThe German vocational rehabilitation and participation system is highly complex due to fragmented legal responsibilities and institutional structures. To address this and improve labor market inclusion for people with severe disabilities, Single Contact Points for Employers [Einheitliche Ansprechstellen für Arbeitgeber (EAA)] were established in 2022. The EAA are legally mandated, provider-independent entities that support employers in hiring and retaining employees with disabilities. The article analyzes the network structure of the EAA within the vocational rehabilitation and participation system, how the structure is evaluated, and which partners are most relevant to the EAA.MethodsA network analysis was conducted through egocentric network maps (N = 20) with EAA consultants, online surveys of EAA consultants (N = 18), and their key network partners (N = 123). Additionally, N = 7 guided expert interviews (5 with employers, 2 with EAA supervisors) and three focus groups of 3–6 people each (1 with EAA consultants, 1 with EAA supervisors, and 1 with network partners) were analyzed using qualitative content analysis to assess the structure and quality of cooperation.ResultsThe EAA work closely with policy actors from the vocational rehabilitation and participation system who provide advice and services for participation in work, such as Integration Services, Employment Agencies, and Specialist Agencies. These collaborations are characterized by mutual information exchange and generally positive cooperation. Actors from the economy, civil society, and academic sector are underrepresented in the EAA's overall network. Employers’ associations were rarely named as key partners, and civil society organizations were absent.DiscussionThe EAA's strong integration into policy networks underscores their institutional relevance. However, their limited ties to economic and civil entities suggest a constrained capacity for innovation. This pattern reflects both the strengths of their legal mandate and the challenges of acting independently within a highly structured system. Expanding their relational scope could foster more holistic solutions for inclusive employment.

Clients with chronic mental illness face multiple psychological, social, and economic challenges in securing and maintaining employment. While studies have confirmed the positive role of employment in improving their functioning, an effective vocational empowerment model tailored to their needs remains a research gap. Therefore, this study aimed to develop a vocational empowerment model for clients with chronic mental illness. This qualitative study was conducted within the interpretive paradigm using the grounded theory approach based on Strauss and Corbin's methodology. Data were collected through semi-structured interviews with 25 chronically mentally ill clients with work experience, following the principle of theoretical saturation. The data were analyzed using open, axial, and selective coding. The developed model consists of five key components: (1) Causal conditions (self-management, motivation, attitude, and agency): (2) Contextual factors (social and institutional support, environmental opportunities, and challenges); (3) Intervening factors (economic and social factors); (4) Strategies (personal development, spiritual support; and (5) Outcomes (personal and occupational well-being) CONCLUSION: The findings suggest that a combination of social support and individual empowerment can significantly enhance the employment sustainability of these clients. Vocational empowerment for clients with chronic mental illness requires a multi-dimensional approach, including self-management training, creating supportive infrastructures, reforming employment policies, and implementing psychosocial interventions. The findings of this study can contribute to designing supportive programs and informing macro-level policies for vocational rehabilitation of clients with chronic mental illness.

Abstract Background Early Supported Discharge (ESD) is an evidenced based international model of best practice for stroke patients (National Stroke Strategy, 2022-2027). The National Clinical Guidelines for Stroke (2023), stipulate that patients with mild to moderate impairments post stroke should be offered ESD. The purpose of this occupational therapy (OT) service review is to evaluate current practices and to identify quality improvement opportunities to enhance OT service delivery. Methods A retrospective data analysis was conducted over a six-month period, encompassing Q4 2024 and Q1 2025. Data was gathered from secure ESD OT logbooks and OT statistics, focusing on key metrics including referral numbers and performance indicators. The analysis also examined the most frequent OT interventions delivered, number of onward referrals, and quality improvement opportunities. Results Between October 2024 and March 2025, 30 referrals were accepted by the OT service. Of these referrals, 64% were aged over 65 years. Initial contact was made within 24 hours of discharge for 74% of referrals. The primary OT interventions delivered, listed from most to least frequent, included fatigue management, cognitive rehabilitation, activities of daily living, upper limb, return to driving, perceptual retraining, community access, vocational rehabilitation, and vision rehabilitation. Following ESD, 30% of patients required onward referral to community-based stroke services. Conclusion The following areas for quality improvement were identified;

Background This conceptual paper uses data from the Cuyahoga County Board of Developmental Disabilities (Cuyahoga DD) to examine this organization's Community Workforce Development program and the Employment Collaborative of Cuyahoga County (ECCC) put in place to successfully provide service to people with developmental disabilities. The history of this collaborative process involving the Cuyahoga DD, community-based organizations, governmental agencies, as well as non-profit organizations was explored. Further, the development of vocational rehabilitation (VR) trends towards business engagement (BE) and the dual customer approach have been discussed as they contribute to a successful intervention strategy. Objectives The authors analyzed the Cuyahoga DD's collaborative strategy developed to ensure community engagement in increasing IDD employment in the region. Methods This is a conceptual paper using a qualitative methodology that enabled the authors to describe, illustrate, and analyze the collaborative process to make suggestions for improvement and sustainability. Results The alternative approach to the Community Workforce Development contributed to the improvement and sustainability of employment service supports based on local collaboration and community engagement. Conclusion The application of the initial business model with minimum resources resulted in challenges that have been successfully addressed in the subsequent alternative approach to employment service support.

ObjectiveThis study aimed to adapt the Chronic Illness Job Strain Scale (CIJSS) into Turkish and evaluate its validity and reliability in individuals with rheumatologic conditions.MethodsThe CIJSS was culturally adapted following Beaton’s protocol. Construct validity was assessed using Rasch analysis. Concurrent validity was examined through correlations with work-related [Work Limitation Questionnaire-Short Form (WLQ-SF), Rheumatoid Arthritis Work Instability Scale (RA-WIS), Work Productivity and Activity Impairment General Health V2.0 (WPAI-GH)] and health-related [Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Impact of Disease (RAID)] measures. Test–retest reliability was assessed 2 weeks later.ResultsThe CIJSS demonstrated high internal consistency (Cronbach’s α = 0.96) and excellent test–retest reliability (Spearman’s r = 0.886; ICC(2,1) = 0.88). The scale met Rasch model requirements for fit. Significant correlations were observed between the CIJSS total score and the WLQ total score (r = –0.61), WPAI scores (r = 0.19–0.47), HAQ (r = 0.33), and RAID (r = 0.61), supporting concurrent validity.ConclusionsThe Turkish CIJSS is a valid, reliable, and culturally appropriate tool for assessing job strain in individuals with inflammatory arthritis. It can support both clinical assessment and vocational rehabilitation planning for Turkish-speaking populations.

Background: Stroke incidence remains high in South Africa. Access to rehabilitation services is critical for stroke survivors to successfully reintegrate back into the community. This study aimed to explore the factors that influence stroke survivors' reintegration into the community to inform contextually relevant rural rehabilitation processes. Methods: A sequential, explanatory mixed-method research design was used. Quantitative data were collected through a file audit of 15 participants. The qualitative data were sourced through semi-structured interviews with 15 purposively selected stroke survivors and three rehabilitation team members. The five themes identified were stroke survivors' meaningful occupations, enablers for community reintegration, barriers to community reintegration, stroke survivors' and caregivers' perceptions on rehabilitation processes for improved stroke rehabilitation. Work was the most affected occupation reported, followed by socialisation and the least affected was Basic Activities of Living (BADL) and Instrumental Activities of Daily Living (IADL). Facilitators included accessibility to assistive devices, positive attitude and community support of the rehabilitation team. Main barriers were residual impairments and limited hospital resources. Conclusion: Early intervention, provision of assistive devices and continued community interventions strengthen the stroke survivors' reintegration into the community. Implications for practice: Work is the most affected occupation in stroke survivors, followed by socialisation and the least affected were BADLs and IADLs Continued support to the stroke survivors and caregivers through support groups in the community is needed to increase awareness of stroke sequelae, caregiver relief and fostering social participation Return to work rehabilitation for stroke survivors should include a routine vocational rehabilitation programme that is individually structured to assist the stroke survivors to adapt to the work routine Occupational therapist should also initiate vocational training such as entrepreneurial skills and subsistence agriculture in collaboration with other sectors such as the Department of Agriculture, to assist the stroke survivors and their caregivers to support their families.

The role of socioeconomic and structural vulnerability risk factors in employment outcomes for individuals with Schizophrenia and other psychotic disorders.