Disparities in vocational rehabilitation services and outcomes for Hispanic clients with traumatic brain injury: Do they exist?

Authors: Davis L. L., Leon A. C., Toscano R., Drebing C. E., Ward L. C., Parker P. E., Kashner T. M., & Drake R. E.
Year Published 2007
Publication Journal of Head Trauma Rehabilitation
Volume 22
Number 2
Pages 84-94
Publisher Lippincott, Williams and Wilkins Inc.

Individuals with traumatic brain injury have poor employment rates. State vocational rehabilitation agencies serve the largest number of individuals with disabilities and are a vocational programming option for individuals with TBI. Hispanics are becoming the largest ethnic group in the US. As a result, rehabilitation counselors (RCs) are now working with increasingly larger numbers of clients from racial and ethnic minority backgrounds. Because of these changing demographic trends and the federal government‚ concerns about racial bias in VR services, VR disparities research has increased in recent years.


The purpose of the study was to take a look at disparities in vocational services for individuals with traumatic brain injury who are Hispanic.


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


The sample included 5,831 eight European American and Hispanic clients.

Data Collection

Data extracted from the RSA-911 data were analyzed using SPSS 13.0. Logistic regression analysis was used to examine the effect of work disincentives, demographic characteristics, and service patterns on rehabilitation outcomes. Odds ratios were computed to determine whether there was any disparity in the provision of VR services for Hispanic clients with TBI as compared to Whites.


There was no control or comparison group.


The study looked at the employment outcomes between European American and Hispanic clients. In FY 2005, 2961 European Americans with TBI (55%) were closed in status 26 (competitive employment) and 2443 (45%) were closed in status 28 (unemployment). In comparison, 214 Hispanics with TBI (49%) were closed in status 26 and 223 (51%) were closed in status 28. The study also examined the effect of demographic and case service variables on employment outcomes. Significant predictors included: sex, age, education, receiving work disincentives and co-occurring alcohol or other drug abuse. The following VR services were found to be statistically significant as they improved the odds of obtaining competitive employment: substantial counseling, university training vocational training, job search assistance, job placement assistance, on-the-job support, maintenance, and assistive technology.

Most notably, clients who received job placement assistance and on-the-job supports were twice as likely to be successfully employed. In addition, transportation was found to be a significant risk indicator. Those who needed transportation services during the rehabilitation process had a reduction in odds of obtaining competitive employment. Hispanic clients who had work disincentives, who needed a comprehensive assessment to determine service needs, and who received physical or mental rehabilitation services had significantly lower odds of obtaining employment than did European American clients who received the same services And those in either group who did not need these services. Conversely, Hispanic clients who received technical assistance services were five times more likely to become competitively employed. There was no significant difference between European American and Hispanic clients in their odds of receiving substantial counseling, university training, job search assistance, job placement assistance, and assistive technology services. Hispanic clients were 1.5 times more likely to receive vocational training than were European American clients; 1.6 times more likely to receive transportation services than were European American clients ; and were times more likely to receive maintenance services than were European American clients. However, Hispanic clients had a reduction in odds of receiving on-the-job support services than did European American clients, the most significant predictor of successful employment outcomes.


The study concluded that there is no major disparity in VR services for Hispanic clients with the exception of providing on the job support services. Additionally the same is true for employment outcomes after taking factors such as pre service employment status, gender, age, and education. Hispanics do seem to have more risk factors than European American clients. However, VR counselors seem to be providing appropriate services to this group.

URL http://www.ncbi.nlm.nih.gov/pubmed/17414310
Disabilities Traumatic brain injury (TBI)
Populations Hispanic or Latino | White / Caucasian | Male & Female
Outcomes Employment acquisition | Return to work
NIDILRR Funded Yes
Research Design Observational
Peer Reviewed Yes