Vocational Rehabilitation Services and Employment Outcomes for People with Disabilities: A United States Study

Introduction This study examined the effect of vocational rehabilitation services on employment outcomes of people with sensory/communicative, physical, and mental impairments in the United States. Methods The sample frame includes 5,000 clients for each of the three disability groups whose cases were closed as either rehabilitated or not rehabilitated by state vocational rehabilitation agencies in the fiscal year 2005. The dependent variable is employment outcome. The predictor variables include a set of personal history variables and vocational rehabilitation service variables. Results Sixty-two percent of the clients in this study were gainfully employed after receiving vocational rehabilitation services. Individuals with sensory/communicative impairments had the highest success rate (75%) compared to 56% for the physical impairments group and 55% for those with mental impairments. Logistic regression analyses identified job placement, on-the-job support, maintenance, and other services (e.g., medical care for acute conditions) as significant predictors of employment success across all impairment groups. In addition, diagnostic and treatment (D&T) services (odds ratio [OR] = 1.57; 95% CI: 1.35–1.82) and rehabilitation technology services (OR = 1.97, 95% CI: 1.67–2.33) were found to uniquely contribute to employment outcomes for the sensory impairments group as well as the physical impairments group (D&T services: OR = 1.31, 95% CI: 1.15–1.48; RT services: OR = 1.41, 95% CI: 1.13–1.75), but not the mental impairments group. Substantial counseling was associated with employment outcomes for the physical (OR = 1.16, 95% CI: 1.02–1.32) and mental impairments groups (OR = 1.18, 95% CI: 1.03–1.35). Miscellaneous training (OR = 1.31; 95% CI: 1.09–1.49) was specifically associated with employment outcomes of the mental impairments group. Conclusion This study provides some empirical support documenting the association between vocational rehabilitation services and employment outcomes of people with disabilities.     

Future Directions in Employment,Occupational Rehabilitation,and Disability: Introduction to the Special Section

Purpose From an array of disciplinary perspectives, the articles in this special section examine opportunities and challenges in the economic, social, and civic participation of individuals across the spectrum of disabilities. Methods At multiple levels of analysis, the contributors consider employment law and policy frameworks, occupational and vocational rehabilitation strategies, and corporate practices in support of the full and equal inclusion of people with disabilities in society. Results and Conclusions The implications for policymakers, public and private sector stakeholders, and occupational rehabilitation professional are presented to help inform future policies, practices, and strategies to improve employment outcomes for people with disabilities.     

Employment Specialist Competencies for Supported Employment Programs

Purpose Supported employment (SE) programs are evidence-based programs offered to people with severe mental illness to facilitate obtaining and keeping competitive work. However, significant variations in individuals’ vocational success may be partly explained by differences in their employment specialists’ competencies. Aim The main objectives of this study were to develop a questionnaire measuring the behaviors, attitudes and knowledge of employment specialists working in SE programs and to link specific competencies to vocational outcomes. Methods A total of 153 employment specialists working in Canadian and Dutch supported employment programs completed the Behaviors, Attitudes, and Knowledge in Employment Specialists (BAKES) questionnaire and provided information about their clients’ vocational outcomes. Results Exploratory Factor Analyses results found 90 items over 12 subscales (e.g., Relationships with employers and supervisors). Regression analyses indicated that the two most useful subscales for predicting vocational success were: (1) Relationships with employers and supervisors, and (2) support and client-centered approach. Conclusion Employment specialists require specific competencies to help people with severe mental illness obtain and maintain competitive employment. Validating the BAKES will better define the broad range of competencies expected for this position, and this tool may facilitate training of employment specialists.     

State Rehabilitation Services Tailored to Employment Status Among Cancer Survivors

Purpose. Previous analyses of vocational rehabilitation services for unemployed cancer survivors indicated that counseling and guidance, job search assistance, and job placement services are significantly associated with increased odds for employment. However, many cancer survivors with jobs to return to may require vocational interventions that are different from unemployed cancer survivors. It is unclear whether the public rehabilitation system provides vocational services that are based on the work status of cancer survivors rather than providing the same set of services for all cancer survivors. This study examined whether differences in the types of services were indeed based on the employment status of those with a history of cancer at the time of application. Methods. Administrative data on 1,460 cancer survivors were obtained through the US Rehabilitation Services Administration Case Service Report (RSA-911) dataset for fiscal year 2007. Data on demographic characteristics and vocational service patterns were extracted and analyzed. Multiple discriminant analysis was used to identify differential services received by cancer survivors based on employment status at time of application for vocational rehabilitation services. Results. Results of the multiple discriminant analysis indicated one significant canonical discriminant function, with Wilks’s λ = .92, χ ²(19, N = 1,456) = 114.87, p < .001. The correlations between the discriminating variables and the significant canonical discriminant function were highest for diagnoses and treatment (?.526), job placement (.487), transportation (.419), job search (.403), vocational training (.384), job readiness (.344), university training (.307), and rehabilitation technology (?.287). The group centroids along the significant discriminant function (the distance of each group from the center of the canonical function) indicated that the employed applicant group (?.542) and the unemployed applicant group (.153) can be differentiated based on vocational rehabilitation services received, with the employed applicant group receiving primarily diagnostic and treatment services and rehabilitation technology/job accommodation services, while the unemployed applicant group received more vocational training, job seeking skills training, and job placement services. Conclusions. Employed cancer survivors who are at risk of losing their job and unemployed cancer survivors who are looking for a job receive different vocational services tailored to needs, suggesting that state vocational rehabilitation services for cancer survivors is responsive to individual client needs.     

Communities of Practice to Improve Employment Outcomes: A Needs Assessment

Purpose Communities of practice (CoPs) offer a promising strategy to improve communication among various professionals committed to advancing employment outcomes for people with disabilities. CoPs also provide a tool for professionals to share knowledge and resources related to the Americans with Disabilities Act and job accommodations. Methods The current study conducted four focus groups with human resource (HR) professionals and vocational rehabilitation professionals to fully assess the need for this CoP. Coding and memoing were the two data analysis strategies employed in this study. Results Results indicate a strong interest in developing a CoP to assist with employment concerns for people with disabilities. Conclusions HR professionals report a need for current, relevant information on this topic, and participants outline guidelines for developing the CoP and building useful content areas.     

People into Employment: supporting people with disabilities and carers into work

Carers and people with disabilities are two disadvantaged groups at risk of social exclusion. Work is an important route to social inclusion, but carers and people with disabilities are under-represented in the work force. The present paper reports key findings from a new study that evaluated People into Employment (PIE), a pilot employment project in the north-east of England designed to support people with disabilities, carers and former carers in gaining mainstream work. The study aimed to identify what clients, partner agencies and employers perceived to be PIE's most important services, its strengths and areas where there was scope for further development. The study collected quantitative and qualitative data at the mid-point and at the end of the project through two questionnaire surveys, and interviews with PIE clients, the project development officer, partner agencies and employers. Drawing on the 'pathway model', the findings show that PIE's interventions included mobilising, matching, mediating and supporting activities. Key ingredients in PIE's success include: tailor-made job-search activities and training; adjusting the pace at which people move towards sustained employment; recognising and responding to the differing needs of people with disabilities, carers and former carers; confidence boosting; accompanying clients to job interviews; good job matching; and ongoing practical and emotional support for both clients and employers. Rudimentary calculations suggest that the cost per job to the project is less than the cost per job for large national projects. Overall, these findings illustrate how access to employment via flexible job-search services geared up to the local labour market can successfully promote social inclusion for carers and people with disabilities.     

Introduction to Demand-Side Factors Related to Employment of People with Disabilities

Introduction Demand-side employment research can play an important role in advancing the knowledge base of occupational rehabilitation. Research contributes to theory building and provides the foundation for empirically supported interventions that can improve the return-to-work success of injured workers and/or the overall labor force participation rate of people with disabilities. Methods In this article, we present our rationale for developing this special section on demand-side factors related to employment of people with chronic illness and disability. We discuss the important relationship between employer practice factors and hiring and retention of people with chronic illness and disability. We highlight in this paper some of the exciting new findings reported in the articles contained in this special section as well as some recent demand-side employment and disability research. Conclusion We intend for this special section to stimulate thinking and discussion about Incorporating demand-side strategies in vocational rehabilitation and return-to-work interventions for people with disabilities and work injuries.     

Vocational Rehabilitation of Transition-Age Youth with Disabilities: A Propensity-Score Matched Study

Objective To investigate the employment outcomes of vocational rehabilitation (VR) services for youth with disabilities in a targeted, enhanced, and contract-based secondary transition program as compared to the traditional VR transition services. Methods A population-based study was conducted on 4422 youth with physical, intellectual, learning, mental and hearing disabilities aged 14–21 at application and whose case was closed after receiving VR transition services in a Midwestern state. Selected youth were classified into either targeted secondary transition program (START) or non-START treatment group. The employment outcomes of the groups were compared using propensity-score matching procedures. Results 2211 youth with disabilities in each treatment group were successfully matched based on demographic characteristics, types of disabilities, existence of severe functional limitations, and year of referral. The overall rehabilitation rate was 57 % [95 % confidence interval (CI) 56–59 %], where the START group rate was 61 % (95 % CI 59–63 %) and the non-START group 53 % (95 % CI 51–55 %). The propensity-score matched odds ratio (OR) was 1.40 (95 % CI 1.24–1.58; p < 0.001). Subgroup analyses showed that the odds of rehabilitation in youth with disabilities were consistently higher when they were in START as compared to non-START (OR ranged from 1.27 to 1.92 with p < 0.05 except for the Hispanic subgroup). Conclusion The results suggest that VR services in a targeted, enhanced, and contract-based secondary transition program are more effective in transitioning youth with disabilities to employment than the regular VR transition services.     

A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities

Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.     

Employment advice in primary care: a realistic evaluation

Every organisation in the UK is affected by mental distress and ill‐health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.     

What Types of Jobs Do People with Disabilities Want?

Introduction Do non-employed people with disabilities want to work, and if so, what types of jobs do they want? Researchers seeking to explain the low employment rate among people with disabilities have focused primarily on skill gaps, employment disincentives from disability income, accommodation mandates, and (to a lesser extent) employer attitudes and unwelcoming corporate cultures. There has been little attention paid to the attitudes of non-employed people with disabilities. Methods This paper uses the 2006 General Social Survey, a representative national survey of US adults that has disability information and a special supplement on worker preferences, to examine the above question. Results We find that, relative to their non-disabled counterparts, non-employed people with disabilities are (a) as likely to want a job but less likely to be actively searching, (b) as likely to have prior job experience, and (c) similar in their views of the importance of income, job security, and other valued job characteristics. The results, which vary little by type of impairment, indicate that the low employment rate of people with disabilities is not due to their reluctance to work or different job preferences. Conclusion Combined with evidence that a large share of new jobs can be performed by people with disabilities, the findings point toward the value of dismantling barriers to employment facing many people with disabilities.     

Work Environment-Related Factors in Obtaining and Maintaining Work in a Competitive Employment Setting for Employees with Intellectual Disabilities: A Systematic Review

Background People with an intellectual disability value work as a significant part of their lives, and many of them want to participate in regular paid employment. Current estimates show that the number of people with ID who have some form of paid employment are very low, ranging from 9 to 40 % across different countries, despite legislations. This review examines papers published in the past 20 years in an attempt to answer the following research question: ‘What work environment-related factors contribute to obtaining or maintaining work in competitive employment for people with an intellectual disability?’ Method The databases of PubMed, PsycINFO, CINAHL, Embase and Web of Science were searched for relevant papers published between 1993 and 2013. All papers were independently screened by two researchers. Methodological quality of the studies was evaluated, and data on work environment-related factors stimulating employment for people with intellectual disabilities were extracted and grouped into categories. Results A total of 1932 articles were retrieved. After extensive screening for relevance and quality, 26 articles were included in this review. Four themes/categories with work environment-related factors that could influence work participation were distinguished. Five studies were conducted on employers’ decisions and opinions. Eight focused on job content and performance, and eight on workplace interaction and culture. Five studies evaluated support by job coaches. Conclusion Despite ongoing legislation to promote participation of people with intellectual disabilities in the paid workforce, research in this area is still extremely scarce. In the past 20 years, very few studies have focused on work environment-related factors that can enhance competitive work for people with intellectual disabilities. This review shows that relevant work environment-related factors for obtaining and maintaining work in competitive employment include supporting the employers by paying specific attention to: employer’s decisions, job content, integration and work culture and job coaches.     

Unique Issues in Assessing Work Function Among Individuals with Psychiatric Disabilities

With the admission of people who experience psychiatric disabilities in the state–federal vocational rehabilitation system and the Social Security disability rolls in the 1960s, assessment of their capacity to work has been a major concern. Given the rising rates of claims for psychiatric disability in both the public and the private sectors, and the disappointing employment outcomes of people with psychiatric disabilities compared to those with other disabilities, there have been numerous initiatives to accurately assess their employment potential. Historically, such assessment within the Social Security Administration has relied upon evaluation of a person's medical impairment, but numerous studies suggest a weak relationship between measures of psychiatric diagnosis or symptoms and work outcome. Efforts have been undertaken to identify valid and reliable methods of assessing the ability of people with psychiatric disabilities to work. The authors review (a) methods of assessing work function for this population, and (b) the literature on predictors of work functioning and the nature of psychiatric disability, and suggest implications for disability determination policies and for future research.     

Motivational Orientation of People Participating in Vocational Rehabilitation

Purpose The task of vocational rehabilitation is to support the employee’s chances of continuing in working life. The study aimed to examine the motivational orientation of people participating in vocational rehabilitation and to find out what characteristics of the clients, their life situation, and their beliefs and perceptions were associated with it. Methods A mail questionnaire was answered by 839 rehabilitation clients who had received an affirmative rehabilitation decision under the earnings-related pension scheme 12 months earlier (response rate 67 %). Two variables depicting motivational orientation were formed, i.e., motivation for continuing in working life and motivation for participating in vocational rehabilitation. Logistic regression analyses were applied in examining the factors associated with each motivation variable. Results The results indicate that the two motivational orientations can be regarded as partly separate and partly overlapping constructs. The rehabilitation clients’ motivational orientations were associated with their experiences and their perceptions on environmental factors and future possibilities, both those that precipitated the application for rehabilitation and those that are important in their current life situation and their perceived future possibilities. Conclusions In the planning of individual rehabilitation processes there is a clear need to sort out what factors may hide behind the client’s weak contextual or situational motivation. In the course of the rehabilitation process, it is important to discuss these factors in order to alleviate the clients’ uncertainty towards change and enhance their motivation to participate in rehabilitation and re-think their future prospects of returning to work.     

Employment as a health determinant for working-age,dually-eligible people with disabilities

BackgroundIndividuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research.ObjectiveThis study examined the relationship of employment to health and quality of life among people with disabilities.MethodsSelf-reported survey data and secondary claims data analyses of 810 Kansans ages 18–64 with disabilities who were dually-eligible for Medicare and Medicaid; 49% were employed, with 94% working less than 40 hours per week. Statistical analyses included ANOVA for differences between the employed and unemployed groups' health status, risk scores, and disease burdens; chi-square analyses for differences in prevalence of health risk behaviors and differences in quality of life by employment status; and logistic regression with health status measures to determine factors associated with higher than average physical and mental health status.ResultsFindings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less. Employment, even at low levels, was associated with better health and health behaviors as well as lower costs. Participants reported being discouraged from working by medical professionals and federal disability policies.ConclusionsAlthough cause–effect cannot be established from this study, findings strongly support changes to provider practices and federal disability policy to support employment at all levels for people with disabilities.     

Disability at Work: A Look Back and Forward

Purpose This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, linking the disparities to employee attitudes. Methods Analyses use the 2006 General Social Survey to connect disability to workplace disparities and attitudes in a structural equation model. Results Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Conclusion Prior research and the present findings show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.     

Examination of Veterans Affairs Disability Compensation as a Disincentive for Employment in a Population-Based Sample of Veterans Under Age 65

Purpose Concerns that disability benefits may create disincentives for employment may be especially relevant for young American military veterans, particularly veterans of the recent wars in Iraq and Afghanistan who are facing a current economic recession and turning in large numbers to the Department of Veterans Affairs (VA) for disability compensation. This study describes the rate of employment and VA disability compensation among a nationally representative sample of veterans under the age of 65 and examines the association between levels of VA disability compensation and employment, adjusting for sociodemographics and health status. Methods Data on a total of 4,787 veterans from the 2010 National Survey of Veterans were analyzed using multinomial logistic regressions to compare employed veterans with two groups that were not employed. Results Two-thirds of veterans under the age of 65 were employed, although only 36 % of veterans with a VA service-connected disability rating of 50 % or higher were employed. Veterans who received no VA disability compensation or who were service-connected 50 % or more were more likely to be unemployed and not looking for employment than veterans who were not service-connected or were service-connected less than 50 %, suggesting high but not all levels of VA disability compensation create disincentives for employment. Results were similar when analyses were limited to veterans who served in Iraq and Afghanistan. Conclusions Education and vocational rehabilitation interventions, as well as economic work incentives, may be needed to maximize employment among veterans with disabilities.     

A Test of the Occupational Matching Hypothesis for Rehabilitation Clients with Severe Mental Illness

Purpose This study compared job matching rates for clients with severe mental illness enrolled in two types of employment programs. Also examined was the occupational matching hypothesis that job matching is associated with better employment outcomes. Methods The study involved a secondary analysis of a randomized controlled trial comparing evidence-based supported employment to a diversified placement approach. The study sample consisted of 187 participants, of whom 147 obtained a paid job during the 2-year follow-up. Jobs were coded using the Dictionary of Occupational Titles classification system. Match between initial job preferences and type of job obtained was the predictor variable. Outcomes included time to job start, job satisfaction, and job tenure on first job. Results Most occupational preferences were for clerical and service jobs, and most participants obtained employment in these two occupational domains. In most cases, the first job obtained matched a participant’s occupational preference. The occupational matching hypothesis was not supported for any employment outcome. The occupational matching rate was similar in this study to previous studies. Conclusions Most clients who obtain employment with the help of evidence-based supported employment or diversified placement services find jobs matching their occupational preference, and most often it is a rough match. Occupational matching is but one aspect of job matching; it may be time to discard actuarial classification systems such as the Dictionary of Occupational Titles as a basis for assessing job match.