Translating Research into a Seamless Transition Model

Authors: 
Luecking, R. G. & Fabian, E. S.
Year Published: 
2015
Publication: 
Career Development and Transition for Exceptional Individuals
Volume: 
38
Number: 
1
Pages: 
4-13
Publisher: 
Sage
Background: 

This Research focuses on the implementation of a model for delivering seamless transition services based on the National Collaborative on Workforce and Disability/Youth(NCWD/Y) Guideposts. This research shares how this model has been applied in 11 of the 24 school districts in Maryland for special education populations.

Purpose: 

The purpose of this research is to provide preliminary data on the model‚ early impact on students transitioning to careers.

Setting: 

School districts in Maryland.

Sample: 

This study looked at eleven county-wide school districts in Maryland.

Data Collection: 

This study is a descriptive analysis.

Control: 

This study had no control.

Findings: 

This study provides early indication that the model has potential to be applied across disability categories as well as demographically diverse school systems. It also it has the potential to serve as a practice framework that alleviates barriers known to impede federal transition policy.

Conclusions: 

The model presented in this research potentially offers a defined pathway to employment, postsecondary education, and careers for youth with disabilities who are transitioning from public secondary education.

URL: 
https://www.michigan.gov/documents/mdhhs/Lueckings_Seamless_Model_511755_7.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Exploring Differences in the Content of Job Interviews between Youth with and without a Physical Disability

Authors: 
Lucca, A. M., Henry, A. D., Banks, S., Simon, L., & Page, S.
Year Published: 
2015
Publication: 
PLOS ONE
Volume: 
10
Number: 
3
Publisher: 
PLOS ONE
Background: 

This study looked at the similarities and differences among youth with disabilities on a mock job interview compared to their typically developing peers. Understanding the content of job interviews may highlight areas where individuals with disabilities perform differently than those with typical development and how these areas may present barriers to employment.

Purpose: 

The purpose of this research is to inform employment readiness programs and educate employers about the potential challenges associated with this recruitment method for those with disabilities.

Setting: 

This study is part of a larger, multi-method, cross-sectional observational study on employment readiness among youth with disabilities.

Sample: 

Employers and employment counselors (n = 19), and youth (n = 31) were interviewed for this study.

Data Collection: 

This study recruited youth through the use of advertisements at a pediatric rehabilitation hospital and community centers. Information packages were also sent to youth who were thought to meet the inclusion criteria.

Control: 

There was no control for this study.

Findings: 

The study found several similarities and differences between youth with disabilities and typically developing youth. For youth with disabilities, differences in job interview answers included: (1) disclosing their condition; (2) giving fewer examples related to customer service and teamwork skills; (3) experiencing greater challenges in providing feedback to team members and responding to scenario-based problem solving questions; and (4) drawing on examples from past work, volunteer and extracurricular activities.

Conclusions: 

Clinicians and educators should help youth recognize their marketable skills and how to highlight those skills in an interview. Employers should recognize that the experiences of youth with disabilities may be different than typically developing youth.

URL: 
http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0122084&type=printable
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Current Opinion in Psychiatry

Authors: 
Bond, G. R. & Kukla, M.
Year Published: 
2008
Publication: 
Current Opinion in Psychiatry
Volume: 
21
Number: 
4
Pages: 
362-369
Publisher: 
Wolters Kluwer Health/Lippincott Williams and Wilkins
Background: 

Researches continue to examples predictors of employment among three types of variables: patient characteristics, environmental characteristics, and interventions. Provision of supported employment is the strongest predictor of competitive employment among patients with schizophrenia. Patent characteristics show modest association with employment outcomes; environmental factors are presumed to have major influences, but have been little studied.

Purpose: 

Researchers continue to study factors that are relatively easy to study rather than those that are powerful and meaningful from a public health perspective. Truly critical factors are first, disability, insurance, and employment regulations that discourage most people from trying to work, and second, failure to align finances and organization of services with evidenced based practices." Article reviews current literature on the various factors being researched that impact employment outcomes for patients with schizophrenia.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The study sample was recently published studies examining predictors of competitive employment for patients with schizophrenia.

Data Collection: 

Literature search included a combination of strategies,, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.

Control: 

There were no comparison or control conditions.

Findings: 

Implementing supported employment services with high fidelity to the IPS model clearly improves competitive employment outcomes.

Conclusions: 

According to the published literature, the single best predictor of competitive employment for patients with schizophrenia is supported employment. Despite numerous studies seeking to identify patients characteristics predicting employment, the reported findings have been generally unimpressive. Many factors influencing employment outcomes continue to be understudied, including societal and cultural factors, access to supported employment, regulatory factors, and criminal justice involvement.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18520741
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Barriers to Employment for Transition-age Youth

Authors: 
Nuechterlein, K. H., Subotnik, K. L., Turner, L. R.,Ventura, J., Becker, D. R., & Drake, R. E.
Year Published: 
2016
Publication: 
Administration and Policy in Mental Health
Volume: 
44
Number: 
3
Pages: 
354-358
Publisher: 
Springer
Background: 

Youth with developmental and psychiatric disabilities face substantial vocational challenges, even after receiving employment services. This study examined employment barriers for 280 transition-age youth with disabilities enrolled in supported employment in eight community rehabilitation centers.

Purpose: 

Youth with disabilities encounter many barriers to employment. Awareness of these barriers may help employment programs anticipate challenges and develop strategies.

Setting: 

Eight Programs in the evaluation of the Illinois Balancing Incentive Program supported employment project.

Sample: 

The sample of the current study consisted of 280 youth with developmental and psychiatric disabilities from 8 of the 10 programs in the evaluation of the Illinois Incentive Program.

Data Collection: 

Responses from eight Individual Placement Support programs (four serving youth with developmental disabilities and four serving youth with psychiatric disabilities) were aggregated.

Control: 

There was no control for this study.

Findings: 

Common barriers for youth with developmental disabilities were lack of work experience, transportation problems, cognitive problems, disengagement from the IPS program, and lack of social skills. Common barriers for youth with psychiatric disabilities were transportation problems, failure to engage in the IPS program, poor control of psychiatric symptoms, and lack or work experience.

Conclusions: 

Though both groups benefited from Individual Placement Support programs, addressing common barriers is imperative. Transportation problems, lack of work experience, engagement issues, and lack of family support were barriers present in both groups.

URL: 
https://link.springer.com/article/10.1007/s10488-016-0773-y
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes

Authors: 
Bai, M. I., Sattoe, J. N. T., Schaardenburgh van, N. R., Floothuis, M. C. S. G., Roebroeck, M. E., & Miedema, H. S.
Year Published: 
2017
Publication: 
Child: Care, Health and Development
Volume: 
43
Number: 
1
Pages: 
114-125
Publisher: 
Wiley Online Library
Background: 

This study explores the barriers and facilitators that young adults with physical disabilities experienced while finding and maintaining employment after an intervention program that supports work participation.

Purpose: 

To ascertain the participant-perceived beneficial attributes of the program and participants' recommendations for additional components.

Setting: 

Semi-structured interviews with former intervention participants, which were recorded and transcribed.

Sample: 

Young adults with disabilities (n= 19) that formerly participated in the study.

Data Collection: 

Data was extracted from the clients' charts and logged in a digital data extraction form. The following background characteristics were reviewed from the charts: age, gender, medical diagnosis, educational level and type of education.

Intervention: 

At Work' is a multidisciplinary vocational rehabilitation intervention for young people with physical disabilities. It aims to provide support for finding and maintaining regular employment after finishing post-secondary education.

Control: 

There was no control for this study.

Findings: 

Physical functions and capacities, supervisor's attitude, self-esteem and self-efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self-promoting skills and disclosure skills through job interview-training, increased self-esteem or self-efficacy through peer-support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the program.

Conclusions: 

Findings suggest that programs supporting work participation should provide real-world experiential opportunities that allow young adults with physical disabilities to develop new insights, self-efficacy and life skills.

URL: 
http://onlinelibrary.wiley.com/doi/10.1111/cch.12407/full
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: Two-Year outcomes

Authors: 
Rosenthal, D. A., Dalton, J. A. & Gervey, R.
Year Published: 
2007
Publication: 
Psychiatric Services
Volume: 
58
Number: 
3
Pages: 
325-333
Publisher: 
American Psychiatric Association
Background: 

Experimental studies have robustly demonstrated the effectiveness of the Individualized Placement and Support (IPS) model of supported employment services for people with severe mental illness, and several studies of real-world implementation have shown significant cross-sectional correlations between employment success and fidelity to the IPS model. Experiences with IPS programs have stimulated broad efforts to disseminate evidence-based practices. Although multiple dissemination efforts are underway, analyses on the benefits of efforts to disseminate IPS have been on cross-sectional and site-level data, rather than on longitudinal information on individual clients. To implement IPS in health care systems with limited previous experience, sustained and individualized training programs may be needed to realize potential client benefits. Few studies have demonstrated that IPS, or other evidence-based practices for that matter, can both be implemented in a system that lacks prior experience with the model and yield outcomes for comparable cohorts that are superior, over several years, to those of a comparison group for which this intervention was not available.

Purpose: 

This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).

Setting: 

The setting included 9 Veterans Administration Programs for Homeless Veterans.

Sample: 

A total of 308 veterans were recruited during phase 1, starting in January 2001, when IPS was still unavailable anywhere in the VA. An additional 321 veterans were recruited in phase 2, starting in July 2001, after the IPS employment specialist had been hired and trained, and were invited to participate in IPS for at least two years. Follow-up data collection continued through March 2005.

Data Collection: 

Participants in phase 1 were compared with participants in phase 2 on baseline characteristics by using chi square tests and t tests. All available participants were included in all analyses whether or not they were currently participating in IPS. Mixed models were then used to compare outcomes between the phases over the two-year follow-up period, controlling for baseline differences, using the MIXED procedure of SAS, with the alpha set at <.05.

Intervention: 

Training began with a one-day, on-site, face-to-face orientation for both employment specialists and other VA mental health staff that was led by a social worker with experience training IPS specialists and conducting IPS fidelity ratings. For the duration of the project regular teleconferences continued providing weekly individual case reviews for the first three months, monthly individual case review conferences, and monthly conference calls with all nine employment specialists jointly. A review of ratings of model fidelity at six, 12, and 18 months after program implementation was also performed with a modified version of the IPS fidelity scale. Training was provided by a social worker with extensive experience disseminating the IPS model in other research projects. He was assisted by a VA occupational therapist with experience in supported employment. Monthly conference calls were also held with administrators responsible for program implementation at each site.

Control: 

Phase 1 control group did not receive IPS services. Comparison was made with Phase 2 group who did receive IPS services.

Findings: 

Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. (Psychiatric Services 58:325—333, 2007)

Conclusions: 

A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

URL: 
http://www.nchv.org/images/uploads/Implementation_of_Supported_Employment_for_Homeless_Veterans_With_Psychiatric_or_Addiction_Disorders-Two-Year_Outcomes.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

"Cancer survivorship and work: Symptoms, supervisor response, co-worker disclosure and work adjustment"

Authors: 
Rabren, K., Dunn, C., & Chambers, D.
Year Published: 
2007
Publication: 
Journal of Occupational Rehabilitation
Volume: 
17
Number: 
1
Pages: 
83-92
Publisher: 
Springer
Background: 

Advances in medicine have increased people's survivorship from cancer and their ability to work both during and after treatment. However, the impact that diagnosis and treatment has on psychosocial factors that may impact an individual's ability to work is not fully understood.

Purpose: 

This purpose of this study was to explore the impact of symptoms, work adjustments, and disclosure of one's disability to supervisors and co-workers on employment both during and after treatment.

Setting: 

The study was conducted in the United Kingdom via mailed questionnaire.

Sample: 

The participants were 328 cancer survivors. Forty five types of cancer were represented and categorized into the eight areas representing the cancers' site. This included: breast, colorectal, genital, head and neck, lymph, prostate, melanoma and other. Treatments included: oral medication, surgery, chemotherapy and radiotherapy. The majority of the participants were female (77%). The age range was between 18 to 68 years. Participants worked in a range of occupations with the majority or 54% working in skilled/operational-non manual.

Data Collection: 

A 33 item questionnaire was used to gather information about demographics, information about cancer, symptoms associated with cancer and its treatment, disclosure of cancer at work, and work supports. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment

Intervention: 

Interventions included disclosure of disability and various types of work accommodations, particularly flexible scheduling and paid leave for all medical appointments.

Control: 

There was no control or comparison condition.

Findings: 

Thirty percent of the sample continued to work during treatment. There were no significant differences between cancer groups, type of treatment received or age groups. Flexibility with work arrangements, and disclosure were factors related to working during treatment. Working during treatment was also associated with difficulties managing fatigue. Forty two percent of the respondents returned to work following treatment. Factors related to return to work following treatment included: difficulties managing fatigue, managing the stress of cancer, managing physical changes associated with cancer, receiving advice from their doctor about work and return to work meeting with their employer.

Conclusions: 

The study adds to the scant literature on experiences of cancer survivors. Further research is needed to better understand ways to assist survivors with return to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17318459
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Developing evidence-based supported employment services for young adults receiving public mental health services

Authors: 
Pryce, J., Munir, F., & Haslam, C.
Year Published: 
2009
Publication: 
New Zealand Journal of Occupational Therapy
Volume: 
56
Number: 
1
Pages: 
34-39
Publisher: 
Zealand Association of Occupational Therapists Inc.
Background: 

Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts.

Purpose: 

This report describes the application of an evidence-based practice fidelity measure to monitor the effectiveness of an expanding supported employment program for youth adults with first episode psychosis.

Setting: 

The setting was 4 demonstration sites where employment staff co-located within an early intervention psychosis team.

Sample: 

The study sample was made up of 134 individuals. Sixty four percent were diagnosed with first episode psychosis, and received services from a community based early intervention psychosis team.

Data Collection: 

The IPS Fidelity scale was applied to each site. Data was collected and scored consistent with the Fidelity Scale directions.

Intervention: 

The intervention was the Individual Placement and Support (IPS)model of supported employment. This is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

Both low and high scoring fidelity items helped identify practical ways to further develop evidence-based practices at each site.

Conclusions: 

Fidelity strengths and weaknesses can be identified that have implications for other sites in terms of what employment consultants can most constructively do in context of the restraints of their immediate environment.

URL: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Using telehealth interventions to prevent pressure ulcers in newly injured spinal cord injury patients post-discharge. Results from a pilot study

Authors: 
Porteous, N., & Waghorn, G
Year Published: 
1999
Publication: 
International Journal of Technology Assessment in Healthcare
Volume: 
15
Number: 
4
Pages: 
749-755
Publisher: 
Cambridge Journals
Background: 

Spinal cord injuries (SCIs) are rare but catastrophic occurrences. They produce permanent changes in sensory and motor function and physical impairments that restrict mobility, often completely. Although definitive statistics are lacking, studies estimate the incidence of spinal cord injuries to range from 30 to 50 cases per million people. Because of the profound physiological impact of SCIs, those affected are at increased risk for secondary health problems. Pressure sores or ulcers have been identified as one of the most common problems.

Purpose: 

The purpose of this study was to determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge.

Sample: 

The sample included 37 individuals with newly acquired spinal cord injury.

Data Collection: 

All three groups were surveyed every 2‚Äì3 months about doctor, hospital, and emergency room visits, calls to the Shepherd Center helpline, ulcer occurrences and characteristics, and employment status. Data on participant characteristics were analyzed using the Kruskal-Wallis rank sum test and k-sample chi-square tests for continuous and categorical variables. Outcome data were analyzed using Friedman‚ test to investigate response differences for multiple treatments applied to a series of subjects.

Intervention: 

The intervention was Telehealth care services. This included video intervention and telephone support.

Control: 

The comparison condition was standard care.

Findings: 

The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment.

Conclusions: 

Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10645116
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model

Authors: 
O'Brien, L.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
13
Pages: 
765-783
Publisher: 
Taylor & Francis Ltd
Background: 

Employment outcomes post traumatic brain injury (TBI) result in a financial and social burden. In addition, unemployment may impact the individual's quality of life and emotional well being. The ability to predict vocational outcome using evidenced based guidelines can assist with rehabilitation planning, development of vocational support services and the role adjustment of the individual with a TBI and his or her family members.

Purpose: 

A review of the literature to identify key variables associated with positive employment outcomes post TBI can pave the way for future research and the development of rehabilitation practices.

Data Collection: 

Eighty five studies were identified between 1980 and 2003 that reported on factors associated with employment outcomes post TBI. Among those fifty studies met the inclusion criteria for the second stage review. The criteria used to evaluate and rate the quality of methodology for each study was adapted on guidelines by Sherer 2002 and Pengel et. al. 2003.

Intervention: 

The review highlights demographic, injury and neuropsychological factors associated with return to work. It also examines interventions that focus on modifying the social environment in addition to emotional and metacognitive factors. A conceptual model is presented that outlines the factors associated with employment outcomes.

Control: 

No control or comparison

Findings: 

The most consistent predictors and indicators of employment outcomes included premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. The authors note that although the presence of specific characteristics may be a predictor for failure to return to work the absence of a factor does not guarantee return to work.
There is little evidence to support cognitive rehabilitation. The most successful programs target problems with motivation and emotional disturbance. Interventions to modify the social environment need to occur on multiple levels. A person's preferences for employment impact job retention. Supported employment has been described however, further evaluation of outcomes is needed. At a policy level a major barrier exists in the current service delivery system in which individuals do not have access to long term rehabilitation or specialized vocational support. Changes in public policy and funding could improve service delivery. Developing disability management programs may also assist those at risk for chronic unemployment post TBI.

Conclusions: 

The review of literature reported that the level of empirical support for employment outcome was greatest for: premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. Future research is needed to determine the role of metacognitive, emotional and social environment factors that can be modified with various interventions. Interventions need to be evaluated to determine evidenced based practices.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15371049
NIDILRR Funded: 
Peer Reviewed: 
Yes