Predictors of successful return to work from HIV-related disability

Authors: 
Drake, R. E. & Bond, G. R.
Year Published: 
2004
Publication: 
Journal of HIV/AIDS and Social Services
Volume: 
3
Number: 
3
Pages: 
89-96
Publisher: 
Journal of HIV/AIDS and Social Services
Background: 

Many individuals with HIV/AIDS experience periods of unemployment as their physical symptoms increase. However, some in treatment do continue or return to employment.

Purpose: 

The purpose of this study was to compare a sample of individuals with HIV/AIDS who successfully return to employment and those that do not. The factors included disease-related factors and service-related factors.

Setting: 

The setting was an HIV/AIDS primary care clinic of a large, university-affiliated hospital.

Sample: 

The study sample consisted of 135 patients whose records indicated that they had successfully regained employment following disease-related job loss. A matched cohort of individuals with HIV/AIDS who had not regained employment was selected as a comparison group.

Data Collection: 

The data consisted of patient clinical records related to HIV/AIDS treatment and symptoms and services delivered. Statistical analyses consisted of descriptive statistics and analysis of variance (ANOVA).

Intervention: 

The majority of predictor variables were related to HIV/AIDS, such as CD4 cell count and length of time in treatment. However, the effects of one intervention were also included, the provision of mental health services.

Control: 

A matched comparison group was selected consisting of individuals with HIV/AIDS who had not returned to work following disease-related job loss.

Findings: 

Substance use disorders were more prevalent in those who had not achieved return to work. Those who had returned to work were more likely to have received mental health assessment and treatment.

Conclusions: 

Mental health services may serve as a gateway to return to work for many individuals with HIV/AIDS. In addition, identifying patients who are already being treated by the mental health team in order to assess their desire and ability to return to work is an important first step in increasing the effectiveness of a return to work program.

URL: 
http://www.tandfonline.com/doi/abs/10.1300/J187v03n03_07?journalCode=whiv20
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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.
Background: 

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.

Purpose: 

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

Setting: 

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

Sample: 

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.

Intervention: 

The intervention was various vocational rehabilitation services.

Control: 

There was no control or comparison group.

Findings: 

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.

Conclusions: 

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
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Effectiveness of vocational problem-solving skills on motivation and job-seeking action steps

Authors: 
Coviello, D. M., Zanis, D. A., Wesnosik, S. A., & Domis, S. W.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2309-2324
Publisher: 
Informa Healthcare
Background: 

In a previous study, a Vocational Problem Solving Skills (VPSS) intervention was not a significant independent predictor of employment, but other factors such as length of previous work experience, age, and baseline motivation level (described in methods) were significant. In this follow up study the examiners took a look at the potential impact of the VPSS intervention on motivation and intermediary job seeking activities.

Purpose: 

This study examined the impact of a vocational problem solving skills (VPSS) intervention to increase motivation and action step activities that lead to employment for methadone maintained treatment clients. The hypothesis were as follows: those who receive the VPSS intervention will develop greater motivation to work than those in the control condition; the VPSS group will participate in more job-seeking activities compared with the control group; motivation to work during the intervention period will predict employment at the 6-month follow-up; and job-seeking activities during the intervention will also predict 6-month employment outcomes.

Setting: 

The study took place at two community-based methadone treatment centers.

Sample: 

Sixty two subjects were randomized to the VPSS condition and 47 were randomized to the time and attention control condition. The average age of participants was 44 and the majority (61%) were black and (60%) male. Sixty-one percent had a high school diploma/GED and two-thirds reported a marketable skill or trade. The overwhelming majority or (92%) received some form of public welfare.

For those who reported receiving employment income it was reported as off the books and consisted of day work of fewer than 10 h per week. There were no significant differences between the VPSS and control conditions on any of the baseline measures.

Data Collection: 

Data was collected using the Addiction Severity Index (ASI) and a Vocational Motivational Assessment Checklist (VMAC). The VMAC measures the behavioral actions to obtain employment and a person's perceived motivation to obtain a job. Both were administered to get baseline and 6 months later. The VMAC was also completed on a biweekly basis over the 12-week intervention period.

Intervention: 

The intervention related to Vocational Problem Solving Skills (VPSS) consisting of 10 counseling and educational sessions designed to (1) help clients understand why they want to work, (2) help clients understand how to overcome personal employment barriers, (3) set realistic employment goals, (4) identify internal and external resources to locate employment opportunities, and (5) take appropriate actions to secure employment. Fourteen methadone treatment counselors from two methadone treatment programs (MMTPs) were trained in the cognitive problem solving intervention. Afterwards they participated in weekly sessions to ensure continued adherence to the delivery of
the VPSS intervention. The control condition consisted of a similar cognitively based intervention aimed at drug use. The same 14 counselors delivered the intervention to both VPSS and control clients.

Control: 

Participants had random assignment to either the treatment or control group.

Findings: 

The study revealed that there were no differences by condition in the level of motivation to secure employment and the number of job seeking activities. Whereas, the motivation to work and number of action steps did predict gaining employment for the entire sample.

Conclusions: 

The intervention did not increase motivation and job seeking activities.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603006
NIDILRR Funded: 
Peer Reviewed: 
Yes

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness

Authors: 
Cook, J. A., Lehman, A. F., Drake, R., McFarlane, W. R., Gold, P. B., Leff, H. S., ... & Grey, D. D.
Year Published: 
2005
Publication: 
Archives of General Psychiatry
Volume: 
62
Number: 
5
Pages: 
505-512
Publisher: 
American Medical Association
Background: 

The majority of people with chronic mental illness are unemployed. Research shows that a supported employment (SE) model approach to vocational rehabilitation for people with chronic mental illness establishes SE as an evidence-based practice and more effective than "services as usual or unenhanced services" (p. 505).

Purpose: 

This study tested three hypotheses:
1. The experimental group receiving SE services would be better able to to achieve competitive employment than those in the comparison group (work 40 or more hours per month and higher monthly earnings).
2. Differences between experimental and control groups would increase over time
3. experimental group would achieve greater outcomes regardless of demographics and receipt of disability income

Setting: 

Eight study sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.

Sample: 

People "with severe and persistent mental illness receiving outpatient psychiatric services" (p. 506). Additional requirements included:
- 18 years old
- willing and able to provide informed consent
- unemployed at time of entry into the study

The criteria for "severe and persistent mental illness based on diagnosis, duration, and level of disability as established by the federal Center for Mental Health Services" were met (p. 506). The total number of participants was 1648, and 1273 were included in the study analysis.

Data Collection: 

Data were collected at intake and every 6 months for the entire 24-month period using the Positive and Negative Syndrome Scale. In addition, two sites used the DSM-IV at study enrollment, while other sites extracted information from clinical records.

Public disability income beneficiary status was monitored bi-annually, as well as "self-rated level of functioning, marital status, and educational attainment" (p. 507). Sites also collected labor force data, such as weekly earnings and hours worked, job duties, eligibility for health and sick leave benefits, and level of integration in the workplace. Sites reported on amount of vocational and psychiatric services received each month.

Intervention: 

Supported employment interventions were offered, which consisted of:
1. integrated services by "a multidisciplinary team that met 3 or more times per week to plan and coordinate employment interventions with case management and psychiatric
treatment" (p. 506)
2. Clients were placed in competitive jobs, which paid at least minimum wage, and were socially integrated (not set aside for people with disabilities)
3. Jobs were developed based on client preferences
4. Job search began as soon as client entered program and moved as rapidly as the client wanted
5. Ongoing vocational supports were readily available throughout the study period (supports did not fade once employment was obtained)

Several sites developed additional interventions, including the Individual Placement and Support model, the Program of Assertive Community Treatment vocational model, as well as services designed to "enrich clients' natural supports" (p. 507).

Control: 

Four sites maintained services as usual; 2 sites used a "weaker version" of the experimental condition; and one site compared two pre-existing vocational models.

Findings: 

The experimental groups achieved competitive employment (55%), worked 40 hours or more per month (51%), and had significantly higher earnings ($122/month) than the control groups (34%, 39%, and $99/month, respectively). These outcomes increased significantly over time.

Conclusions: 

The experimental programs yielded higher and more positive effects than "services as usual" (p. 510). This advantage increased over time.

URL: 
http://www.worksupport.com/kter/documents/pdf/ResultsofMultisiteRandomziedTrial.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

The Employment Intervention Demonstration program: Major findings and policy implications

Authors: 
Cook, J. A., Leff, H. S., Blyler, C. R., Gold, P. B., Goldberg, R. W., Mueser, K. T., Toprac, M. G., McFarlane, W. R., Shafer, M. S., Blankertz, L. E., Dudek, K., Razzano, L. A., Grey, D. D., & Burke-Miller, J.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
31
Number: 
4
Pages: 
291-295
Publisher: 
American Psychological Association
Background: 

The Employment Intervention Demonstration program was a "multi-center study designed to generate knowledge about effective approaches for enhancing employment among adults with severe mental illnesses" (p. 291).

Purpose: 

This article describes the study design, models tested, and study participants.

Setting: 

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

Sample: 

The study participants included 1273 people with chronic mental illness at seven sites.

Data Collection: 

This article summarizes findings of published articles about EIDP. "For pre-existing models, fidelity was assessed via established measures; the EIDP also developed and administered a cross-site measure of adherence to supported employment principles and practices" (p. 292).

Intervention: 

Supported employment programs were implemented and followed for two years.

Control: 

Control groups received services as usual.

Findings: 

Supported employment models were more effective than services as usual. In addition, Experimental condition subjects were
more likely to be competitively employed (55% of experimental versus 34% of control participants), work 40 or more hours per month (51% versus 39%), and have higher earnings ($i22/month vs. $99/month) despite controlling for demographic, clinical, and work history confounds. And, the advantage that the experimental group clients had over the comparison group increased over time.

Conclusions: 

Supported employment models are effective and their value increases over time, indicating that the effects achieved are sustainable. These models work in diverse settings, different geographical areas, and for a variety of clients.

URL: 
http://www.worksupport.com/kter/documents/pdf/EIDPMajorFindingsandPolicyImplications.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effects of local unemployment rate on vocational outcomes in a randomized trial of supported employment for individuals with psychiatric disabilities

Authors: 
Cook, J. A., Razzano, L. A., Burke-Miller, J. K., Blyler, C. R., Leff, H. S., Mueser, K. T., Gold, P. B., Goldberg, R. W., Shafer, M. S., Onken, S. J., McFarlane, W. R., Donegan, K., Carey, Kaufmann, C., & Grey, D. D.
Year Published: 
2006
Publication: 
Journal of Vocational Rehabilitation
Volume: 
25
Number: 
2
Pages: 
71-84
Publisher: 
IOS Press
Background: 

Research confirms that workers with disabilities have high unemployment rates. Among this group, less is known about barrier to employment for individuals with psychiatric disabilities, especially those who receive vocational rehabilitation services. Information about this could help improve service delivery.

Purpose: 

This study examined the impact of unemployment rates on the outcomes of individuals with psychiatric disabilities who were participating in supported employment services.

Setting: 

The setting was multiple community job sites across 7 states where individuals with psychiatric disabilities went to work.

Sample: 

Participants include 1,273 individuals with psychiatric disabilities from seven states, who were randomly assigned to experimental supported employment (51%) or services as usual(49%) for 24 months. There were approximately equal numbers of males and females. About 50% of the group were non minority. The median age of the participants was 38 years and around one third (35%) had a less than a high school education. The most prevalent diagnosis was schizophrenia (31%) followed by schizoaffective disorder, major depression and bipolar disorder. Almost all participants were prescribed medications at baseline.

Data Collection: 

Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven counties in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.

Intervention: 

The intervention was the Individual Placement and Support Model of supported employment for individuals with mental illness.

Control: 

The control was typical vocational rehabilitation services.

Findings: 

Participants residing in areas with low unemployment rates who received evidenced based Supported employment services had consistently better outcomes than all others. This included those who received evidence based supported employment services in areas with high unemployment. The study condition and employment rate were significant predictors of both competitive employment and working 40 or more hours a month.

Conclusions: 

Evidenced based supported employment can help improve the effects of high unemployment on work outcomes for individuals with psychiatric disabilities. The labor market influences employment outcomes for individuals with psychiatric disabilities who are participating in vocational rehabilitation programs. Individuals who reside in areas with high unemployment rates are likely to have poor outcomes if they do not receive high quality supported employment services.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00344
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Do sheltered workshops enhance employment outcomes for adults with autism spectrum disorder?

Authors: 
Cimera, R., Burgess, S., & Wiley, A.
Year Published: 
2012
Publication: 
Autism
Volume: 
16
Number: 
1
Pages: 
87-94
Publisher: 
Sage
Background: 

Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.

Purpose: 

This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.

Setting: 

The study took place in sheltered workshop settings and a variety of businesses.

Sample: 

The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.

Data Collection: 

Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.

Intervention: 

The intervention was sheltered work.

Control: 

Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.

Findings: 

Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.

Conclusions: 

Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.

URL: 
http://aut.sagepub.com/content/16/1/87
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

State rehabilitation services tailored to employment status among cancer survivors

Authors: 
Cimera, R. E.
Year Published: 
2014
Publication: 
Journal of Occupational Rehabilitation
Volume: 
24
Number: 
1
Pages: 
89-99
Publisher: 
Springer Science + Business Media New York
Background: 

Studies have shown that certain vocational rehabilitation services are associated with return to work for unemployed patients with cancer. These include: counseling and guidance, job search assistance, and job placement. Patients who have a job return to post disability may require different interventions to assist them with return to work.

Purpose: 

The purpose of this study was to determine whether differences in the types of services were based on the employment status of those with a history of cancer at the time of application.

Setting: 

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

Sample: 

Data on 1,460 people who had cancer were extracted from the Rehabilitation Services Administration Case Service Report.

Data Collection: 

Data on demographics and vocational services were analyzed. Multiple discriminant analysis was used to identify different services used by cancer survivors who were unemployed and those who were employed.

Intervention: 

There were multiple vocational rehabilitation services interventions. This included: assessment, diagnosis and treatment of impairments, vocational rehabilitation counseling and guidance, college or university training, occupational vocational training, on the job training, basic academic remedial or literacy training, job readiness training, disability related, augmentative skills training, miscellaneous training, job search assistance, job placement assistance, on the job supports, transportation services, maintenance services, rehabilitation technology, technical assistance services, information and referral services and other services.

Control: 

There was no control or comparison condition.

Findings: 

Vocational rehabilitation service plans can be individualized to meet the employment status and needs of cancer survivors.

Conclusions: 

Cancer survivors have the potential to return to work. Services received by cancer survivors who were unemployed and those who were at risk of losing their job received different services from state vocational rehabilitation services. This suggests that services were tailored to meet individual client needs. Vocational rehabilitation services are a resource to assist cancer survivors with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23504487
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation

Authors: 
Catty, J., Lissouba, P., White, S., Becker, T., Drake, R., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschback, J., Wiersma, D., & Burns, T.
Year Published: 
2006
Publication: 
NeuroRehabilitation
Volume: 
21
Number: 
4
Pages: 
279-293
Publisher: 
IOS Press
Background: 

A number of cognitive, physical, and psychosocial impairments can occur following a TBI. These deficits can have a profound effect on daily functioning including an individual's ability to work. This may raise significant challenges for vocational rehabilitation professionals when helping individuals with TBI to prepare, obtain, and maintain competitive employment. Given the prevalence of TBI and the young age of many survivors, vocational rehabilitation will be needed. Professionals serving these individuals need to be prepared to develop appropriate rehabilitation plans. To be effective, they need to be familiar with TBI and the current research that looks at what impacts successful vocational outcomes. This may help facilitate the best use of limited funds for the vocational rehabilitation of persons with TBI. There are limitations in the research to date and more research is needed.

Purpose: 

The purpose of this study was to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns through an analysis of the Rehabilitation Services Administration (RSA) case service report (RSA-911) data on employment outcomes of persons with traumatic brain injuries (TBI) for fiscal year 2004.

Setting: 

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

Sample: 

The sample included 7,366 individuals with TBI whose cases were closed by state vocational rehabilitation agencies as employed or not employed in the fiscal year (FY) 2004.

This included 4,862 men (66%) and 2,504 women (34%). The majority or 78% were European Americans. The average age of participants was 37 years. Thirteen percent had co-commitment disabilities (psychiatric or substance abuse). Seventy six percent had a high school degree or more education. The average time between applying to eligible for VR services was a month and a half. The average time between eligibility and case closure was 30 months. Case expenditures averaged $4,238.

Data Collection: 

A data mining technique, exhaustive chi-squared automatic interaction detector (CHAID), was used to analyze. In the current study, exhaustive CHAID was used to build classification trees. This technique uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (e.g., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the employment outcome variable. The degree of differentiation is depicted sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation clients could be identified based on their demographic characteristics, work disincentives, and service patterns in terms of their observed levels on the outcome variable. The statistical software SPSS Answer Tree 2.0 was used to conduct the exhaustive CHAID analysis. The alpha level for all statistical tests was 0.01. This study corrected for the number of statistical tests within each predictor using a Bonferroni feature in the Answer Tree software.

Intervention: 

The interventions included various vocational rehabilitation services. This included job search assistance, job placement assistance, and on-the-job support services for individuals with TBI.

Control: 

There was no control or comparison condition.

Findings: 

The employment success rate for the entire sample was 50%. The employment success rate for persons with TBI is somewhat lower than the 55% rate for
the overall sample of vocational rehabilitation clients closed in FY 2004. European Americans had higher competitive employment rates than other groups. Clients with co-occurring psychiatric disabilities had a lower employment rate than those without psychiatric disabilities . Clients who had work disincentives also showed significantly poorer employment outcomes than those without disincentives. In terms of education, clients with a bachelor or higher educational degree had the highest competitive employment rate as compared to those with less education.

Case expenditure was related to outcomes, with more money spent on clients who were closed as successfully rehabilitated. Clients who were successfully rehabilitated also required less time in the rehabilitation process than unsuccessfully rehabilitated clients. Clients who received the following vocational rehabilitation services on-the-job training, job readiness training, miscellaneous training (e.g., GED or high school training needing to diploma), job search assistance, job placement assistance, on-the-job supports, maintenance, rehabilitation technology, and/or other services (e.g., occupational licenses, tools and equipment, and initial stocks and supplies) had significantly higher competitive employment rates than those who did not receive such services. Overall, the results indicated that the TBI clients could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.

Conclusions: 

Several vocational rehabilitation clinical practice guidelines came from the results of this study. First, the study underscore the importance of considering job placement and workplace support services in the vocational rehabilitation of persons with TBI. Unfortunately, job placement assistance and on-the job supports were found to be significantly underutilized by rehabilitation counselors in serving their TBI clients. Second, this study highlights the influence of disincentives on employment outcomes. Increased emphasis appears needed in the education of rehabilitation counseling students and practitioners on the importance of benefits counseling services and to encourage rehabilitation counselors to discuss this important service with consumers early in the rehabilitation planning process. Third, co-occurring psychiatric disabilities were found to significantly affect employment outcomes. This finding underscores the importance for rehabilitation counselors to (a) appropriately assess the emotional and psychological functioning of those served and to provide mental health counseling (b) increase knowledge about evidence-based mental health practices, and (c) to utilize the various interventions that have been found successful in diminishing psychiatric symptoms in the rehabilitation process. Finally, the very low incidence of co-occurring substance abuse disorders identified in this study (3%) is unusual, given research has indicated that about 50% to 66% of TBI clients had a history of alcohol and other drug abuse. This may be under reported. Rehabilitation counselors, need better education and training in substance abuse assessment and treatment within the context co-occurring disabilities.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17361045
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Working it out: Development and testing of a multimedia, vocational education program

Authors: 
Campbell, K., Bond, G., & Drake, R.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2525-2558
Publisher: 
Marcel Dekker Inc.
Background: 

Employment is a ongoing problem for individuals with substance dependency. Their vocational needs are unmet. Earlier studies have shown a positive correlation between employment and retention in treatment. Despite evidence about the value of addressing employment issues in treatment, the service delivery system does not address these needs. Welfare reform has increased expectations for substance abuse beneficiaries to gain employment. Due to shorter stays and funding cuts more programs primarily focus on substance use. Employment and work problems are not given priority. A multimedia interactive computer program may offer a cost effective way to address employment problems.

Purpose: 

The study hypothesis was that an interactive and tailored multimedia presentation of vocational rehabilitation information would be more effective than a general printed package of information and work book in reducing the severity of employment problems.

Setting: 

The study took place in residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico.

Sample: 

One-hundred and ninety-four (194) individuals who received residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico participated in the study. The average age of participants was 37 years and the majority or 64% were men. About 43% were from a minority group.

Data Collection: 

The measures included the Addiction severity index-multimedia version (ASI-MV), Social adjustment scale-self report (SAS-SR), Employment questionnaire, Treatment services review and Satisfaction questionnaire. Around 75% of the sample completed 3 or more CD-ROM sessions. These participants completed a satisfaction questionnaire after each session and at the end entire course. Follow up assessment was scheduled 6 month from baseline. Subjects completed SAS-SR and Employment Questionnaire. They were also contacted by telephone to complete a follow up to the ASI.

Intervention: 

The intervention included: Working It Out CD-ROM, a multi-session, computer based, self-administered, vocational education and intervention program for clients in substance dependency treatment programs.

Control: 

There was a comparison between the group that received the intervention and the control group members. The control group members used the Looking for Work Printed Package booklet along with a workbook with information on: facing fears, why work?, coping with job-related stress, job-finding skills (writing a resume, networking, interviewing, etc.), caring for oneself and the job, and what to say about ones recovery.

Findings: 

The study demonstrated that a multimedia vocational rehabilitation program that is self-administered, interactive, and tailored to clients employment status and motivation can be used in a substance dependency treatment program. The study did not find significant differences over the use of printed versus multimedia material. However, clients reported enjoying using the computer program and found the experience more relevant to their particular concerns.

Conclusions: 

The multimedia Working It Out program can be effectively used by clients who are in substance dependency treatment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603013
NIDILRR Funded: 
Peer Reviewed: 
Yes