An analysis of evidence-based best practices in the public vocational rehabilitation program: Gaps, future directions, and recommended steps to move forward

Authors: Leff, S., Cook, J., Gold, P. l., Toprac, M., Blyler, D., Goldberg, R., McFarlane, W., Shafer, M., Allen, E., Allen, E., Camacho-Gonsalves, T., & Rabb, B.
Year Published 2014
Publication Journal of Vocational Rehabilitation
Volume 41
Number 1
Pages 147-163
Publisher Journal of Vocational Rehabilitation

People with disabilities face high rates of unemployment and underemployment. The rate is about double (12.9%) for individuals with disabilities versus (6.1%) rate for people without disabilities. This is true, despite the fact that billions of dollars have been spent by the state-federal vocational rehabilitation program to combat the problem. The vocational rehabilitation program needs to find ways to improve employment outcomes for people with disabilities. The evidence based practice movement has started to influence rehabilitation counseling practices. Using research to inform best practices should help those charged with improving the effectiveness of vocational rehabilitation services and outcomes. Identifying promising practices and gaps in the evidence based practice research will lead to recommendations for future research and knowledge translation efforts to improve vocational rehabilitation service delivery practices.


The purpose of the review was to identify emerging and promising vocational rehabilitation service delivery practices that can improve work outcomes for people with disabilities.


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


As a systematic review, this study included studies with various populations of vocational rehabilitation clients.

Data Collection

As a systematic review, this study included studies with a variety of data collection methods.


This is a systematic review. The review had no control or comparison conditions.


Rehabilitation counselors in state vocational rehabilitation agencies use some services that are supported by strong scientific evidence. These include: counseling, skills training, and supported employment. Several researchers have also investigated the overall effect of state vocational rehabilitation services.
In addition, promising practices have been identified by four state case studies that resulted from research by the Rehabilitation Research and Training Center on Evidenced Based Practices in Vocational Rehabilitation. From this work, a number of promising practices, that are currently used by state vocational rehabilitation emerged. Related to organizational and management, best practices included: advocacy, culture leads to innovation, outcome focused business models, advanced information technology, collaborative partnerships that enhance results, staff training and development. Transition from school to adulthood, individual placement and supported employment model, workplace specialized skills training, benefits counseling and workplace supports were identified as clinical service delivery promising practices.

The research team reviewed, analyzed and discussed the findings from this and other studies to identify gaps in research and make recommendations about future directions.
These included investigating the Human Service Value Curve framework to identify where human service agencies fall and move beyond the use of the basic regulatory collaborative business model towards a integrative/generative business model. In terms of the gaps in research there is a need to convene a panel of scholars, policymakers and administrators representing business, management, human service administration, vocational rehabilitation, and information technology fields. This panel would identify essential features of an integrative/generative business model for leadership and management in state vocational rehabilitation. Research is also needed to develop and validate an effective diffusion of innovation measure in vocational rehabilitation agencies. Instead of relying on old business systems vocational rehabilitation needs to investigate advanced health technologies aimed at becoming more consumer rather than professional centric. Research is needed about how to recruit, retain and engage vocational rehabilitation professionals to provide customized and effective services based on innovations and communication technologies. Some of the evidenced based practices identified have not been comprehensively evaluated. Using the International Classification of Functioning, Disability and Health (ICF) model to develop a systematic vocational rehabilitation agenda may allow researchers to quickly identify and validate best practices that can be integrated into state vocational rehabilitation practices. Knowledge translation is gaining recognition in the field. The Knowledge to Action framework may prove useful. Knowledge Translation should be bidirectional and participatory in nature. Embedding such methods into future research and program evaluation should promote continued collaboration between researchers and practitioners and transfer research findings to practice. It should also help improve outcomes, including relationships with employers. And again, providing evidenced based tools and practices to vocational rehabilitation counselors and administrators to improve employment outcomes for individuals with disabilities will result from Knowledge Translation.


Most of the work in vocational rehabilitation for the past 50 years has been descriptive in nature. Future research should be aimed at identifying evidenced based practices. More intervention studies are needed about employment and other related outcomes of rehabilitation. More replication and extensions of prior research are needed to build on what is known and inform policies and practices.

Outcomes Other
NIDILRR Funded Yes
Research Design Systematic reviews and meta-analysis
Peer Reviewed Yes