Asian

Populations:

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Research Design:

Mixed methods

Quasi-experimental

Peer Reviewed:

Yes

The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury

Authors:

Ottomanelli, L., & Lind, L.

Year Published:

2004

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

68-72

Publisher:

Elsevier

Background:

Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.

Purpose:

The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.

Setting:

The setting included communities and two district vocational rehabilitation offices in the state of New York.

Sample:

The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (i.e.. black and Asian). Related to education, close to half (48%) had not completed high school.

Data Collection:

The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000‚ÄìSeptember 30, 2001) and 2002 (October 1, 2001‚ÄìSeptember 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (i.e., case status 26) were compared with unsuccessful closures (i.e., case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.

Intervention:

All participants went through the initial VR procedures for eligibility determination and development of an individualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.

Control:

Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.

Findings:

Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.

Conclusions:

The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15083424

Disabilities:

Populations:

Traumatic brain injury (TBI)

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Effectiveness of vocational rehabilitation following acquired brain injury: Preliminary evaluation of a UK specialist rehabilitation programme

Authors:

Nachreiner, N. M., Dagher, R. K., McGovern, P. M., Baker, B. A., Alexander, B. H., & Gerberich, S. G.

Year Published:

2006

Publication:

Brain Injury

Volume:

Number:

Pages:

1119-1129

Publisher:

Informa Healthcare

Background:

Individuals with Acquired Brain Injury have difficulties with returning to work. Studies show only around 30% returning to work.

Purpose:

The purpose of the study is to determine the effectiveness of a vocational rehabilitation programme in assisting individuals with Acquired Brain Injury with returning to work or other meaningful activity.

Setting:

Three Brain Injury Centres based across the United Kingdom.

Sample:

Participants included 232 individuals with ABI who were discharged from the program between January 2000 and December 2002. The majority were males (82%) and 12% were females. The mean age was 33 years with a range from 17 to 62 years. The majority of injuries were TBI (62%). The date of a person's' injury and enrollment in the programme. ranged from 7 months to 35.5 years. And at the time of injury the majority of individuals has been employed (70%). At the time of entry into the program 92% of the participants were receiving an Incapacity Benefit and regarded as unemployable.

Data Collection:

Data was gathered using administrative databases and other records located at the three centres. Job roles were classified using the UK standard occupational classification system. Data on outcomes was classified into one of the following: paid competitive work, education and training, voluntary work, discharge to other services, client withdrew and discharged for other reasons.

Intervention:

Participants engaged in a vocational programme that included a per-vocational rehabilitation phase that provided intensive basic cognitive rehabilitation and in-site vocational trails phase. Afterwards, a supported job search and job coaching was offered to assist individuals with gaining work along with follow up support for up to 5 years.

Control:

There was no control or comparison condition.

Findings:

Upon exiting the programme, 41% of the participants had secured paid competitive employment; 16% were volunteering and 15% had entered a training or education. Among the remaining 28%, 15 % were discharged due to medical or rehabilitation programmes to deal with other issues and 13% withdrew. There was no formal cost analysis of the effectiveness of the intervention.

Conclusions:

A total of 72% of those enrolled in the programme left to start a meaningful activity with 41% securing work. Vocational rehabilitation seems effective in assisting individuals with ABI with returning to work.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/17123928

Disabilities:

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Intellectual disabilities

Peer Reviewed:

Yes

Ex-post-facto analysis of competitive employment outcomes for individuals with mental retardation: National perspective

Authors:

Morgan, L., Leatzow, A., Clark, S., & Siller, M.

Year Published:

2004

Publication:

Mental Retardation

Volume:

Number:

Pages:

253-262

Publisher:

American Association on Mental Retardation

Background:

Employment outcomes have often been used as a benchmark of vocational rehabilitation success. Not until the Rehabilitation Act of 1973, were states required to target individuals with significant disabilities for services using an order of selection process. Because of the functional differences that exist between individuals with mild, moderate and significant cognitive disabilities, rehabilitation counselors must be aware of the types of services most needed and those services that more often result in high quality employment outcomes for each target group.

Purpose:

The purpose of this study was to provide a snapshot to generate new knowledge that rehabilitation counselors can apply to enhance competitive employment outcome placements for individuals of varying abilities. In addition, the purpose of the study was to identify disparities in the proportions of competitive job placements between individuals with mild, moderate, and significant cognitive disabilities.

Setting:

This study included individuals with disabilities served by multiple vocational rehabilitation agencies in various settings.

Sample:

The study sample included all consumers with cognitive disabilities closed into Status 26 during fiscal year 1998 in the RSA-911 national database maintained by the Rehabilitation Services Administration. This included a total of 28,565 consumers: mild (n = 17,033, 60%), moderate (n = 9,784, 34%), severe/profound (n = 1,748, 6.1%).

Data Collection:

The data was obtained from the individual client closure reports and RSA-911 national data tape, provided by the Rehabilitation Services Administration (RSA). The authors used two tests of statistical significance: chi-square and logistic regression analysis. Chi-square analysis was conducted for type of mental retardation and work status at closure. In addition the authors conducted a post hoc pairwise comparisons (2 x 2 chi-square) for mild by moderate, mild by severe/profound and moderate by severe/profound. To guard against Type I errors, the authors used the Bonferroni technique, which resulted in an adjusted alpha of .003. Then, the authors used logistic regression analysis to evaluate the linear relationship between vocational rehabilitation services and work status at closure. Then, chi-square tests were used to evaluate the proportions of significant vocational rehabilitation services received by consumers with mild, moderate, or severe/profound cognitive disabilities. Then, the relationship between type of cognitive disability and work status at closure were evaluated for consumers who received vocational rehabilitation services. Those consumers who had not received VR services were then eliminated from the sample. The desktop version of SPSS for Windows, version 11.5 was used in this analysis.

Intervention:

The intervention was vocational rehabilitation services.

Control:

There was no control or comparison condition.

Findings:

The majority of the individuals in the population were Caucasian (73%). Assessment, adjustment, counseling, job-finding services, and job-placement services were received by 81%, 34%, 78%, 60% and 58%, respectively. Analysis of the data found that 8%5 of the participants were closed into competitive jobs following vocational rehabilitation intervention. Consumers with mild mental retardation were significantly more likely to achieve competitive jobs when compared to those with moderate or severe/profound cognitive disabilities. In addition, individuals with moderate cognitive disabilities were significantly more likely to be placed into competitive jobs compared to those with severe/profound disabilities. The odds of obtaining competitive employment for consumers who received job placement services was 2.05 times the odds for those not receiving those services. The odds of obtaining competitive employment for consumers who received counseling were 1.52 times the odds of those who did not receive counseling. The odds of obtaining competitive employment for consumers who received business and vocational training were 2.14 times the odds of those who did not. However, consumers with mild mental retardation were provided with business and vocational training at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. Consumers with moderate mental retardation were no more likely to receive counseling services than those with mild cognitive disabilities. However, consumers with severe/profound cognitive disabilities were less likely to receive counseling services than those with mild/moderate disabilities. Consumers who received job placement services with mild cognitive disabilities achieved competitive jobs at a significantly higher proportion than those with moderate or severe/profound mental retardation. In addition, consumers with moderate cognitive disabilities were significantly more likely to achieve competitive jobs than individuals with severe/profound disabilities. Consumers with mild cognitive disabilities who received business and vocational services achieved competitive jobs at a significantly higher proportion than those with moderate and severe/profound cognitive disabilities. Consumers with mild disabilities who received counseling achieved competitive jobs at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. In addition, consumers with moderate cognitive disabilities were more likely to achieve competitive employment when compared to consumers with severe/profound disabilities.

Conclusions:

Consumers with Moderate or severe/profound cognitive disabilities were closed into competitive employment at a significantly lower rate than those with mild cognitive disabilities. Consumers who were provided with business and vocational training, counseling, and job-placement services were significantly more likely to achieve competitive jobs. A significantly lower proportion of these services were provided to consumers with severe/profound cognitive disabilities.

The authors concluded that the significantly higher proportion of consumers with mild cognitive disabilities achieving competitive employment could be related to the specific services they more often receive. Perhaps consumers with mild disabilities are more likely to be provided job-placement services as opposed to those with severe/profound cognitive disabilities. The authors ask the questions: Why do consumers with mild or moderate cognitive disabilities more likely to receive job placement and counseling services compared to those with severe/profound disabilities? They propose that too much attention may be given to assessment/testing results and other nonrelevant dimensions that could prohibit the provision of effective services. They also propose that there may be a subjective belief that places a lesser value on the overall potential of individuals with significant cognitive disabilities. Counselors may believe that consumers with severe/profound cognitive disabilities are more difficult to place. Their expectation of successful employment outcomes may result in less significant placement efforts for this population.

The authors state that their findings raise questions that could not be answered through the RSA-911 database. The database does not provide information on reasons for the provision of certain services to consumers with mild, moderate, or severe/profound cognitive disabilities. The database does not contain information on Counselors' perceptions of service effectiveness or how they provide the specific services. Finally, the small proportion of individuals with severe/profound cognitive disabilities raises an important question about the decision-making process counselors use to determine if a consumer can benefit from vocational rehabilitation services.

URL:

https://www.ncbi.nlm.nih.gov/pubmed/15230653

Disabilities:

Populations:

American Indian or Alaska Native

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Work, recovery and comorbidity in schizophrenia: A randomized controlled trial of cognitive remediation

Authors:

McHugo, G., Drake, R., & Becker, Dl.

Year Published:

2009

Publication:

Schizophrenia Bulletin

Volume:

Number:

Pages:

319-335

Publisher:

Oxford University Press

Background:

A common theme that cuts across all definitions of recovery is work. Work is valued by most and it enables on to make a contribution to society and offers the promise of liberating consumers from financial dependence on others. In recent years, a recovery paradigm has emerged that offers a guiding vision for self-empowerment, treatment, and rehabilitation for individuals with schizophrenia and comorbid problems such as: cognitive impairment,9 substance abuse,10 and medical disorders. This study addressed the impact of comorbidity on recovery of work functioning and response to vocational rehabilitation, described strategies for minimizing its effects, and provided data from a new study targeting the problem of cognitive impairment in order to improve employment outcomes.

Purpose:

The purpose of the study is to evaluate the impact of adding cognitive remediation to vocational rehabilitation to determine the impact on comorbid substance abuse and medical disorders on work outcomes and response to the treatment program.

Setting:

The study took place in a vocational rehabilitation program associated with an urban medical center.

Sample:

The study included 34 participants who were 18 years or older, had severe mental illness, expressed an interest in work, had a history of being fired or quitting employment prior to locating new work. Participants received either vocational rehabilitation plus cognitive retraining or Vocational rehabilitation only.
In both groups, the majority of subjects were male (61% and 56%) black (61% and 63%) and had never been married (78% and 75%). The primary diagnosis was Schizophrenia (75% and 60%) and most had a comorbid disorder (67% and 81%). The mean age of the group members was (46 and 42 years).

Data Collection:

Referrals were made by therapists and work services personnel. Those interested had a baseline assessment scheduled. Consumers were not paid for assessments. Following completion of the assessments, consumers were randomized to either vocational rehabilitation alone (VR) or vocational rehabilitation and cognitive remediation (VR and CR)using a computer program. The examiners compared the groups at baseline on the demographic, clinical, and cognitive measures using t-tests (continuous variables) and v2 analyses (categorical variables). Next they computed the percentage of consumers who were exposed to the cognitive remediation program, as completing 6 or more cognitive remediation sessions, the average number of sessions completed, and the number of weeks to complete them.

Then to evaluate changes over the treatment period in cognitive functioning and clinical variables, they performed a series of analyses of covariance (ANCOVAs), with the cognitive/symptom measures at posttreatment as the dependent variables, the cognitive/ symptom measures at baseline as the covariate, and treatment group as the independent variable. Finally they looked at work outcomes. Because continuous work outcomes were highly positively skewed, main treatment effects were evaluated by performing Mann-Whitney U tests comparing the 2 treatment groups on wages earned and hours and weeks worked. To evaluate whether substance abuse directly influenced vocational outcomes or interacted with treatment group, separate analyses were performed for current drug-use disorder and alcohol-use disorder. For these analyses, the work variables were log transformed to minimize skew. For each series of analyses, analysis of variance were performed with current drug-use disorder (or current alcohol-use disorder), treatment group, and their interactions as the independent variables and the work outcomes as the dependent variables. The main effect for drug-use disorder (or alcohol-use disorder) in these analyses was a test of whether the disorder had an overall impact on vocational outcomes, whereas the drug-use disorder (or alcohol-use disorder) by treatment group interaction effect was a test of whether the outcomes of the treatment groups differed significantly as a function of the disorders.

Intervention:

The intervention was adding cognitive remediation to a hybrid vocational rehabilitation program that combined paid internship jobs with supported employment.

Control:

Participants were randomly assigned to either vocational rehabilitation alone or vocational rehabilitation and cognitive remediation using a computer-generated randomization program.

Findings:

Statistical tests comparing consumers assigned to VR only or VR and CR indicated no significant differences in any demographic, diagnostic, or baseline clinical or cognitive performance measures.

The results of the ANCOVAs comparing changes over time in cognitive functioning and symptoms between consumers who received cognitive remediation and those who did not were summarized. Significant improvements favoring cognitive remediation were found for several cognitive measures. Results of the Mann-Whitney U tests comparing work outcomes for the 2 groups indicated that the VR and CR group worked significantly more internship weeks and hours and earned more wages than the VR-only group.

The VR and CR group also worked significantly more weeks than VR only, and there was a trend for them to earn more wages, although hours
worked did not differ between the groups. Number of weeks or hours of competitive work did not differ between the 2 groups nor did wages earned. Overall rates of competitive rates were 39% for the VR and CR group vs 31% for the VR-only group, which did not differ significantly. Analyses of relationship of substance-abuse disorder and medical comorbidity focused on total (log transformed) hours worked for each vocational outcome. Alcohol-use disorder was marginally significantly related to total hours worked with the absence of current alcohol-use disorder associated with more hours worked compared with the presence of an alcohol-use disorder. Drug-use disorder was also related to total hours worked, with absence of current drug-use disorder associated with more hours worked compared with the presence of a drug-use disorder.

There were no interactions between either alcohol or drug-use disorder and treatment group, suggesting that the addition of cognitive remediation to vocational services was just as helpful in the consumers with a substance-use disorder as those without. A similar analysis of total hours worked comparing consumers with high levels of medical comorbidity to those with low levels indicated that both the main effect for medical comorbidity and the interaction with treatment group were not significant. Thus, consumers with higher medical comorbidity burden appeared to have comparable vocational outcomes compared with those with less such burden. For the VR-only group, Spearman correlations between overall cognitive performance at baseline and total work over the study period were significant for total hours worked and wages earned and marginally significant for number of weeks worked, whereas for the VR and CR group, none of these correlations were significant Thus, cognitive performance at baseline was more predictive of work in the study for those in the control group than those in the cognitive remediation group.

Conclusions:

Providing cognitive remediation in addition to vocational rehabilitation can improve cognitive functioning and employment outcomes for individuals with severe mental illness. Comorbid substance abuse impacts work outcomes while medical comorbidity does not. More research is needed to evaluate the impact of comorbidity and their interaction on treatment. More research is needed to evaluate the impact of comorbidity on work functioning in VR and its interaction with cognitive remediation.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19269925

Disabilities:

Populations:

American Indian or Alaska Native

Outcomes:

Randomized Controlled Trials (RCTs)

Return to work

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial

Authors:

McGurk, S. R., Mueser, K. T., & Pascaris, A.

Year Published:

2007

Publication:

American Journal of Psychiatry

Volume:

164

Number:

Pages:

437-441

Publisher:

American Psychiatric Publishing

Background:

Supported employment has been repeatedly demonstrated to improve competitive work outcomes in people with severe mental illnesses such as schizophrenia and bipolar disorder (1). Although strong research supports the effectiveness of supported employment, and efforts are underway to increase access to these programs (2, 3), not all participants benefit from supported employment. Specifically, across most studies between 20% and 40% of patients do not find jobs (4‚Äì8), and of those who do, many have brief job tenures that end unsuccessfully, such as being fired for poor work performance. These findings have stimulated efforts to address illness-related impairments that may limit the effectiveness of supported employment for some individuals with severe mental illness.

Purpose:

To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.

Setting:

The setting was supported employment programs and various places of employment.

Sample:

The sample included patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City. The eligibility criteria was severe mental illness as by the State of New York Office of Mental Health, current unemployment, desire for employment, enrollment in supported employment, history of at least one unsatisfactory job ending (getting fired from a job held less than 3 months or walking off a job without another job in place), and willingness and capacity to provide informed consent.

Data Collection:

Employment outcomes were aggregated by computing the total number of jobs, hours worked, and wages earned over the entire follow-up period. Potential interactions between site, treatment group, and work were evaluated by performing an analysis of variance (ANOVA), with site and treatment group (supported employment with cognitive training or supported employment alone) as the independent variables and the total number of jobs worked as the dependent variable. A chi-square analysis was conducted to compare the two treatment groups on percentage of patients who obtained work over the course of the follow-up period. Additional analysis was also done to address a variety of data factors.

Intervention:

Patients with severe mental illness N=44 and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2‚Äì3 years.

Control:

The comparison condition was supported employment only.

Findings:

Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2‚Äì3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone.

Conclusions:

The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.

URL:

http://www.coalitionny.org/the_center/resources/cognitive_remediation/documents/CogTrainingAmJPsychiatry0307.pdf

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

Increase in hours worked

Increase in tenure

Return to work

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

SESAMI* study of employment support for people with severe mental health problems: 12-month outcomes

Authors:

Schoenbaum, M., Unützer, J., McCaffrey, D., Duan N., Sherbourne, C., & Wells, K.

Year Published:

2009

Publication:

Health & Social Care in the Community

Volume:

Number:

Pages:

151-158

Publisher:

Blackwell Publishing Ltd.

Background:

Individuals with severe mental illness are underrepresented in the workforce in the United Kingdom. A welfare to work policy was implemented. Guidelines recommend using evidenced based practices, the Individual Placement and Support model, to help people with mental health issues with gaining and maintaining work. It is important to understand what is currently going on to improve existing practices.

Purpose:

This study was undertaken to learn about factors associated with successful employment and the impact of work on individuals with mental illness.

Setting:

Six British agencies that specialized in providing services to individuals with mental illness.

Sample:

One hundred and eighty two individuals with mental health problems participated in the study. Follow up interviews were conducted with 85% of this sample. The majority or 84% were White British or European. Ages ranged from 22 to 67 years with an mean of 42 years. About a third, or 32% reported depression, 25% anxiety, 25% schizophrenia, hallucinations or hearing voices, 14% bipolar and 4% other in response to being asked to describe his or her condition. Fifty five percent of the participants were unemployed, 29% were unemployed, 9% were in work placement and 5% in sheltered work.

Data Collection:

The study questionnaire included the following measures. The Empowerment Among Users of Mental Health Services Scale; the Herth Hope Index, Perceived obstacles to work; and behaviours indicating nearness to the labour market. This questionnaire was usually completed during an approximately one hour face to face interview. The first was completed at baseline and another at follow up (12 months later).Statistically significant differences were tested. Analysis of variance was also used. SPSS 15.0 was used to analyze all data.

Intervention:

The intervention was supported employment in the United Kingdom.

Control:

There was no comparison or control group.

Findings:

Eighty two percent of those working at baseline were employed one year later. Twenty five percent of those individuals who were unemployed were assisted with gaining work during this time. Financial satisfaction and self esteem increased among those who went to work. In addition, there was a tendency to work part-time.

Conclusions:

Those who worked reported multiple benefits. The evidence from this study should inform service planning and the Individual Placement and Support model should be implemented in England.

URL:

https://www.researchonline.org.uk/sds/search/taxonomy.do%3Bjsessionid=948B7FBF03C6A71157E4FD25729AE479?action=document&ref=A20206&pager.offset=140&taxonomy=GIN

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Vocational rehabilitation service patterns related to successful competitive employment outcomes of persons with spinal cord injury

Authors:

Martin, D. J., Arns, P. G., Batterham, P. J., Afifi, A. A., & Steckart, M. J.

Year Published:

2008

Publication:

Journal of Vocational Rehabilitation

Volume:

Number:

Pages:

1-13

Publisher:

IOS Press

Background:

It is well documented in the literature that the employment rate of people with spinal cord injuries (SCI) decreases drastically after their injuries. Because of the importance of work to the physiological and psychological health and well being of persons with a disability, considerable research efforts have been devoted to studying the employment problems of persons with a spinal cord injury. Over a half of a million individuals are served by state vocational rehabilitation agencies each year, making it possible to study a large number of persons with SCI who are living in the community.

Purpose:

To examine the effect of demographic, work disincentives, and service variables on employment outcomes of persons with spinal cord injury in state vocational rehabilitation agencies.

Setting:

This study included individuals with SCI served by multiple vocational rehabilitation agencies in various settings.

Sample:

10,901 persons with spinal cord injury whose cases were closed either as employed (54%) or not employed (46%) by state vocational rehabilitation agencies in the fiscal year 2001.

Data Collection:

An ex post facto design, using data mining as a statistical analysis strategy. Data was taken from the RSA-911 report for all the persons with SCI closed by State Vocational Rehabilitation agencies in 2001. A chi-squared automatic interaction detector (CHAID) based data mining analysis was used to identify the strongest associations between predictors (VR services) and the outcome variable (employment outcomes).

Intervention:

The interventions were the range of Vocational Rehabilitation Services received by the study sample of persons with a Spinal Cord Injury. These services included, but were not limited to, rehabilitation engineering, personal assistance services, assistive technology services, job placement, counseling and guidance, and assessment services.

Findings:

The CHAID data mining analysis revealed that job placement services, work disincentives, and case expenditures as the most important predictors of employment outcomes. In addition, physical restoration, substantial counseling, and assistive technology services all led to positive employment outcomes. Importantly, the CHAID analysis segmented the sample into 45 mutually exclusive homogeneous end groups, with a wide range of employment outcomes. The CHAID analysis indicated that demographic variables interacted with rehabilitation services to affect employment outcomes.

Conclusions:

The results confirmed substantial counseling, assistive technology, and job placement and support services are important to the return-to-work success of persons with SCI.

URL:

http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00399

Populations:

American Indian or Alaska Native

Native Hawaiian / other Pacific Islander

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Traumatic brain injury (TBI)

Peer Reviewed:

Yes

The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury

Authors:

Marini, I., Lee, G. K., Chan, F., Chapin, M. H., & Romero, M. G.

Year Published:

2013

Publication:

Brain Injury

Volume:

Number:

Pages:

1016-1025

Publisher:

Informa Healthcare

Background:

Individuals who sustain traumatic brain injuries face a myriad of cognitive and other disabilities post injury. Deficits in executive functioning are one of the major problems that impact work. Psychosocial educational interventions and computer assisted training have helped some individuals learn to problem solve. Virtual reality may also be a useful tool.

Purpose:

This study explored whether or not participants with artificially intelligent VR based vocational problem solving skill training would show better problem solving skills and employment outcomes, than those who received conventional psychosocial program.

Setting:

The training modules were developed at a University lab in Hong Kong. Where the study took place was not clear.

Sample:

The study sample included 40 people from Hong Kong with mild (N=20)and moderate (N=20) traumatic brain injury. Participants were randomly assigned to one of the two study groups.

Data Collection:

The Wisconsin Card Sorting Test and the Tower of London Test were administered to participants. In addition, the Vocational Cognitive Rating Scale was completed by the participant's case manager or supervisor of a rehabilitation facility or center. After the pretest each participant started either the virtual or psychosocial training. The content and structure of the two programs were similar. Each included an introduction to training objectives, training in specific vocational skills and practice and a review of those skills. The virtual program was interactive in nature. The psycho educational vocational training system included a training manual and was delivered under the guidance of a trainer. Post test were also conducted on the previously cited measures. Information about the participants employment status was collected at one, three and six month intervals. Statistical analysis were performed using SPSS for Windows Version 17.

Intervention:

The intervention was an artificial intelligent virtual reality-based vocational problem solving training program. Participants took part in 12 sessions that lasted 20 to 25 minutes each.

Control:

The control condition was traditional psycho-educational training.

Findings:

There was no significant differences in the participants in screening criteria or baseline of outcomes between the virtual training and psycho education program. Those who participated in the virtual training showed improvements in selective cognitive functioning. However, the training did not transfer to functional real world outcomes, as indicated by limited success in vocational outcomes. The virtual training was more cost effective than workshop based training.

Conclusions:

Virtual reality training may improve memory functioning and have other applications for vocational rehabilitation. More research is needed.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/23662639

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models

Authors:

Magura, S., Blankertz, L., Madison, E., Friedman, E., & Gomez, A.

Year Published:

2006

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1406-1415

Publisher:

American Psychiatric Association

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. One of the highlights of this approach is rapid job placement which does not necessitate a need for job readiness training or sheltered work. Some individuals have used this approach to gain work but do not maintain employment. Some individuals do not need the intensity of services offered in a SE approach, but may benefit from a clubhouse approach.

Purpose:

This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).

Setting:

The setting included a number of different job sites across 5 states and DC where individuals with mental illness received supported employment services. Services were provided by 5 different experimental programs that adopted the individual placement and support model of supported employment.

Sample:

The participants included 310 individuals with mental illness who were unemployed, 18 years of age or older and who did not have a diagnosis of severe mental retardation. Each person was randomly assigned to the ACT or the Clubhouse programs. Most participants were white males with a schizophrenia diagnosis.

Data Collection:

The research measures included participant characteristics and employment. Control variables included: age, severity of psychiatric symptoms, severity of physical health problems and active substance use. Gender was also added.
Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale. Physical health problems were measured through PANSS probes, Medicaid claims, and interviews. Substance abuse was identified through records, reports and interviews. Two motivational control variable were collected related to interest in working at baseline and match of random assignment to participant preference. The programs kept the same service logs and other records.
The data analysis plan included benchmark comparisons of program performance by using published outcome data from exemplary SE programs. A comparison of ACT and clubhouse outcomes was completed using a services of hierarchical regression analyses.

Intervention:

The intervention was the Individual Placement and Support(IPS)model of supported employment delivered through Assertive Community Treatment programs.

Control:

There was no control condition as supported employment has already been identified as an evidenced based practice. Comparison services were delivered through Clubhouse programs.

Findings:

The results included a comparison with benchmark employment outcomes. Club house participants had higher earnings and hours worked as compared to participants in exemplary supported employment programs. Earnings and work hours for ACT participants was greater than two of those programs. A comparison of ACT and clubhouse outcomes found ACT program had better service engagement. There was no difference in time to obtain a first job. Club house participants were employed longer and for more hours and earned more than than ACT participants. Background variables were predictive of receipt of job search services, which predicted higher employment rates. Wage was an incentive for employment success. A few participants in transitional employment, had about the same job tenure as other participants.
ACT participants received services faster than clubhouse participants. The strong integration of vocational and clinical services, provided by ACT, appeared to be especially helpful to participants with co-occurring disorders.

Conclusions:

The authors concluded that adding supported employment into multiservice programs like ACT and clubhouses, is a way to provide more services to individuals with mental illness, without compromising quality of those services. Although, a cost analysis was not presented, it is suspected that this may also be a cost effective approach to providing supported employment services.

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759891/

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