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.
Purpose: Youth with disabilities have lower rates of enrollment and completion of post-secondary education compared with youth without disabilities. The objective of this systematic review is to ...understand the best practices and components of post-secondary transition programs for youth with disabilities.
Method: Systematic searches of six international databases identified 18 studies meeting our inclusion criteria (youth with a disability, aged 15-30; focusing on post-secondary education program or intervention, published from 1997 to 2017). These studies were analyzed with respect to the characteristics of the participants, methodology, results, and quality of the evidence.
Results: Among the 18 studies, 2385 participants (aged 13-28, mean 17.7 years) were represented across three countries (US, Canada, and Australia). Although the outcomes of the post-secondary transition programs varied across the studies, all of them reported an improvement in at least one of the following: college enrollment, self-determination, self-confidence, social and vocational self-efficacy, autonomy, social support, career exploration, and transition skills. The post-secondary transition programs varied in duration, length, number of sessions, and delivery format which included curriculum-based, online, immersive residential experience, mentoring, simulation, self-directed, technology-based, and multi-component.
Conclusions: Our findings highlight that post-secondary transition programs have the potential to improve self-determination, transition skills, and post-secondary outcomes among youth with disabilities.
Implications for rehabilitation
Post-secondary education interventions have a beneficial influence on post-secondary and related transition outcomes in youth with disabilities.
Clinicians and educators should consider having multiple components, involving several sessions that include a curriculum, immersive college residential experience, mentoring, and/or simulations in their interventions for optimum program outcomes.
More research is needed to explore the types of interventions that work best for whom and the optimal age (including exploring the socio-demographic characteristics), setting, and delivery format.
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.
There has been a consistent shortage of qualified rehabilitation counselors employed by the state vocational rehabilitation (SVR) program. Using a mixed methods approach that involved an online ...survey of executive directors or designates (n = 40) (Study 1), followed by a semi-structured interview from this initial sample (n = 19) (Study 2), this investigation examined barriers and strategies pertaining to counselor recruitment and retention. We found that the primary reasons why counselors leave the SVR program included low salaries, excessive paperwork and insufficient career/promotional opportunities. Outside of retirements, counselors who leave SVR seek similar positions with other public agencies, non-profit rehabilitation settings, and to a less extent, proprietary rehabilitation/private consulting practice. In terms of reasons why counselors remain with SVR, the primary explanations were attributed to a commitment to agency mission and vision, inherent rewards working as a counselor and employment benefits received (e.g., medical, insurance, time off). Interestingly, while 33 strategies were used to promote counselor retention, nearly two-thirds of those were ones where directors were either unaware if they existed or if they existed, how well they were implemented. As far as retention strategies, directors believed that employment benefits, flexible work hours, training and development opportunities, equipment, training and software investment and telework are contributory factors. A list of recommendations to improve recruitment and retention is described to help alleviate the critical shortage of SVR counselors and retain those currently working. Keywords: Recruitment, retention, vocational rehabilitation counselors
PURPOSEGender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment ...specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE. METHODSThe qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups. RESULTSFive themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system. CONCLUSIONSocial representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.IMPLICATIONS FOR REHABILITATIONGender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.
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.
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.
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.
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