IntroductionResearch on the effectiveness of vocational rehabilitation has often focused on small and selected groups of rehabilitees, lacked proper controls, or not captured dynamic changes in work ...participation. Using rich nationwide data on vocational rehabilitees and their matched controls, we examined long-term changes in work participation before and after vocational rehabilitation to assess its effectiveness.MethodsWe used representative Finnish register data to examine 2692 recently employed individuals with histories of musculoskeletal- and mental-related work disability who started vocational rehabilitation in 2008–2010 at age 30–55 (intervention group), and 2692 propensity score matched non-rehabilitees who otherwise met the same criteria (control group). Matching was performed based on sociodemographic and work-related factors, work disability diagnosis, and three-year labour market history. We used generalised estimation equations to examine differences in the proportion of time spent at work between periods of three years before and three years after rehabilitation among the intervention and control group and the difference in these differences (DID).ResultsAmong those with 105+days of work disability in the preceding three-year period, vocational rehabilitation resulted in significant percentage point gains in work participation, with the total DID across the disease groups and genders being 9.2 (95% confidence interval 7.3–11.1). The gains tended to actualise immediately after rehabilitation. No gains were observed among those with shorter preceding work disability.ConclusionsVocational rehabilitation after musculoskeletal- and mental-related work disability showed only shorter-term effectiveness on work participation and only among those with longer work disability histories. The effectiveness of alternative and complementary interventions to vocational rehabilitation should be investigated.
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ...generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.
Vocational Rehabilitation (VR) services and outcomes for individuals with and without psychiatric disabilities served in the State VR service-delivery system have been researched for over 40 years ...with strong evidence that disparities between these groups have persisted over time. We conducted a comparison of services and outcomes based on cases available within the 2016 Rehabilitation Services Administration 911 data set that had a primary disability coded, N = 502,134; these cases included all cases with a primary psychiatric disability coded, n = 159,843, and cases with all other primary disabilities coded, n = 342,291. Individuals with primary psychiatric disabilities were (a) nearly a third of all cases captured in State VR agency data (b) more likely to have their case closed prior to receiving VR services under an Individualized Plan for Employment (IPE), and (c) less likely to be closed successfully employed than clients with other primary disability types after receiving vocational services under an IPE. Based on these findings, we provide recommendations to provide in-service and pre-service education and training to VR counselors that will improve the services offered to this population, and to more effectively collaborate with county and local agencies that are providing evidence-based practices such as the Individualized Placement and Support model of employment.
Both neurocognition and negative symptoms have demonstrated strong links to functional outcomes, such as work functioning, among those with severe mental illness (SMI). Prior models have suggested ...that reduced neurocognition 1) precedes or predicts greater negative symptoms and 2) indirectly influences functional outcomes via its impact on negative symptoms. The current study sought to also test a divergent model: whether greater negative symptoms predict reduced neurocognition and indirectly influence work functioning through their impact on neurocognition. Both models were tested using cross-sectional and prospective data spanning 20-years in a sample of 277 people with a SMI with psychotic features. Results showed that both models were supported in cross-sectional analyses. However, in prospective models predicting work functioning, only the models examining the indirect influence of negative symptoms on work functioning (7.5 to up to 20-years later) through neurocognition demonstrated significant mediation (i.e., a significant indirect effect); further, higher negative symptoms significantly predicted lower prospective neurocognition, while lower neurocognition did not significantly predict greater prospective negative symptoms. Although cross-sectional data were consistent with prior models, our prospective models offered greater support for a putative causal pathway running from negative symptoms to neurocognition—rather than the reverse—to work functioning. Findings have implications for mechanisms contributing to longitudinal work functioning and suggest that targeting negative symptoms prior to neurocognition could be more beneficial for long-term work outcomes.
The literature on racial differences in vocational rehabilitation (VR) services has not been updated for over a decade. Using the 2017 individual-level U.S. national RSA-911 data, supplemented with ...the 2017 American Community Survey and publicly available information from the Kaiser Family Foundation, we investigated racial differences at each step of the VR process—application, eligibility, service provision, and employment outcomes at closure. At the first step, application, White individuals with disabilities were less likely to apply than their African American, American Indian/Alaska Native, and Hispanic counterparts, and more likely to apply than their Asian counterparts. For the remaining three steps, the results were inverted: the White subgroup had higher eligibility rates, service rates, and employment rates than the African American, American Indian/Alaska Native, and Hispanic subgroups, and lower rates than the Asian subgroup. These findings suggest that racial and ethnic differences continue to exist in the VR process despite several legislative acts and policy efforts. Within each racial and ethnic minority group, we also found large variation in application rates and employment rates across states, which indicates a need for developing performance measures and standardized guidelines for state VR agencies to better serve individuals with disabilities from racial and ethnic minorities.
To ascertain the feasibility and acceptability of delivering a job retention vocational rehabilitation intervention MSVR for people with multiple sclerosis (pwMS) in a community setting. Secondary ...objectives included determining whether MSVR was associated with changes in quality of life, fatigue, mood, cognition, workplace accommodations, work instability, work self-efficacy, and goal attainment.
Single-centre mixed-methods feasibility case series.
15 pwMS and three employers received 8.36 (SD = 4.48) and 1.94 (SD = 0.38) hours of MSVR respectively over three months. The intervention predominantly addressed managing cognition, fatigue, and negotiating reasonable accommodations. Four healthcare professionals were recruited to clarify clinical information.
The intervention was feasible to deliver, and there was a significant positive impact on goal attainment immediately following MSVR (t(14) = 7.44, p = .0001, d = 1.9), and at months 3 (t(13) = 4.81, p = .0001, d = 1.28), 6 (t(11) = 4.45, p = .001, d = 1.28), and 12 (t(9) = 5.15, p = .001, d = −2.56). There was no impact on quality of life, fatigue, mood, cognition, workplace accommodations, work instability, and work self-efficacy. In post-intervention interviews, participants reported that MSVR was acceptable. Four themes were derived regarding the context, employer engagement, empowerment through knowledge, and intervention components and attributes.
It was feasible and acceptable to deliver MSVR. Participants better understood their MS, became more confident managing problems at work and attained their work-related goals.
IMPLICATIONS FOR REHABILITATION
People with multiple sclerosis (MS) experience problems at work because of the interaction between symptoms and environmental factors (e.g., co-workers' attitudes).
Vocational rehabilitation for people with MS and their employers should be tailored in terms of content and intensity.
People with MS can be empowered at work by learning about MS and how their symptoms fluctuate over time.
Understanding legal responsibilities and examples of accommodations at work can be beneficial for employers.
BACKGROUND: Kentucky Office of Vocational Rehabilitation (OVR) and Minnesota Vocational Rehabilitation Services (VRS) successfully participated in a randomized control trial of an intervention ...designed in partnership with more than 100 VR personnel and twenty state VR agencies to identify effective practices for increasing earnings outcomes of Social Security Disability Insurance (SSDI) beneficiaries receiving VR services. OBJECTIVE: This paper introduces articles in the Special Issue to tell the story of the SGA Model Demonstration from design, testing, and impact evaluation. METHODS: The SGA Model Demonstration began reviewing administrative data, collecting expert opinion, and exploring current practice in eight state VR agencies. After an eighteen-month period of capacity building, two state VR agencies randomized local offices and implemented a rapid coordinated team approach. RESULTS: State VR agencies are successfully participating in rigorous research activities including model demonstrations with experimental designs. CONCLUSIONS: Model demonstrations that include experimental designs are effective strategies to improve knowledge and build a better practitioner toolbox to advance employment outcomes of VR clients.
Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ...ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation.
The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five.
The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features.
The framework has the potential to translate to other similar service contexts.
PDF
