Other

Systematic reviews and meta-analysis

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs

Authors:

Lacaille, D., Sheps, S., Spinelli, J. J., Chalmers, A., & Esdaile, J. M.

Year Published:

2009

Publication:

Rehabilitation Psychology

Volume:

Number:

Pages:

175-163

Publisher:

American Psychological Association

Background:

Individuals with severe mental illness have a desire to work. however, they often face many barriers. The Working Alliance which is a collaborative working relationship within a counseling relationship has been a key element in therapeutic outcomes and has become linked to positive outcomes in psychiatric rehabilitation programs. Research has shown that a good working relationship between a person with mental illness and his service provider can improve symptoms, enhance medication compliance, improve quality of life and global functioning. More research on the working alliance in vocational rehabilitation services is needed. This study is a secondary analysis of data that was collected in a randomized control trial comparing to vocational models the Individual Placement and Support (IPS) model and the Diversified Placement Approach (DPA).

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 was two vocational programs that provided employment services to individuals with severe mental illness.

Sample:

Two hundred individuals were randomly assigned to the IPS or DPA model of supported employment in the parent study. The sample in this study included 91 (45 in the DPA and 46 in IPS). Most were men (61). The mean age was 38.9 years. About half (49.4%) had a schizophrenia-spectrum disorder. The majority or (63.7%) had more than a 12 year education. Most (81.3%) had prior work histories.

Data Collection:

Individuals were randomly assigned to DPA or IPS. Afterwards they were followed for two years. Objective data related to paid employment outcomes was collected through quarterly participant interviews. Data pertaining to the predictor variable, working alliance were collected by participant interviews every 6 months for individuals who were working at the time.
Demographic variables were measured by the Uniform Client Data Inventory and work history by the Employment and Income Review at baseline. Psychiatric symptoms were assessed at baseline and semiannual periods using the Positive and Negative Symptom Scale. Employment outcomes included total duration of paid work and mean paid job tenure. A scale was developed to measure working alliance. It included items related to emotional support, instrumental/informational support, frequency of performance feedback, stressfulness of the relationship, how critical the vocational worker was to the client and the person's overall satisfaction with the relationship.
Fidelity to the IPS or DPA model tenants were assessed every 6 months for both sites where individuals received services.
Stepwise hierarchical multiple regression analysis were run to determine relationships between the working alliance and employment outcomes. Baseline variables were controlled for and were entered into the regression model. Related to the number of days of paid work and job tenure applicable covariates were entered.
The working alliance variable was added in the second step of the regression analysis. Zero order correlates were also run. Independent t test was used to determine differences between IPS and DPA on working alliance.

Intervention:

The intervention was the Working Alliance where a person with a disability received emotional support, assistance, and more.

Control:

The comparison condition was low or no working alliance.

Findings:

The first hypothesis stating that the working alliance would be positively associated with employment was not confirmed. The second hypothesis that individuals would have a stronger working alliance with their vocational workers in IPS was confirmed.

Conclusions:

The finding that there is a lack of associations between working alliance and employment outcomes is not in alignment with previous literature. Evidenced based supported employment appears to lead to better relationships than the DPS approach. Additional research is needed.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19469605

Disabilities:

Emotional disturbance

Populations:

Hispanic or Latino

Black / African American

White / Caucasian

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Hearing impairment, work and vocational enablement

Authors:

Krupa, T

Year Published:

2008

Publication:

International Journal of Audiology

Volume:

Number:

Pages:

S124-S130

Publisher:

Informa Healthcare

Background:

Employment is considered one of the major life areas. An increasing number of individuals with hearing loss are seeking help with occupational problems and need individualized employment supports.

Purpose:

This paper describes a recently developed vocational enablement protocol (VEP) addressing the specific needs of those with hearing loss in the workforce.

Setting:

The setting was an Audiological Center in a University Medical Center, in Amsterdam.

Sample:

The study sample include 86 patients with hearing loss aged 19-64 years.

Data Collection:

Data from the VEP was collected and discussed in a board multidisciplinary team.

Intervention:

Vocational enablement protocol (VEP)
evaluation of the work situation and problems from both the patient's and the professionals perspective, including an assessment of the auditory demands at the workplace</li>
diagnostic examination of the individual's auditory profile
assessment of the an individual's coping abilities
an examination of the workplace
recommendations for an enablement plan an options available
written report
Implementation of the recommendations

Control:

There was no control or comparison condition.

Findings:

Recommendations were made by the multidisciplinary team in the following areas: hearing aid (re)fitting, communication training, environmental modifications, psychosocial counseling, assistive listening devices, re-delegation of assignments, restructuring of time schedules, further medical examination, occupations retraining, hearing protection.

Conclusions:

This program may be regarded as a step forward in the management of people with hearing loss who experience problems as work, but there is still room for improvement. There is no scientific evidence available for the effectiveness and efficiency of the recommendations proposed.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19012121

Disabilities:

Hearing impairments

Populations:

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Research Design:

Qualitative

Peer Reviewed:

Yes

An effective community-based mentoring program for return to work and school after brain and spinal cord injury

Authors:

Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E.

Year Published:

2012

Publication:

NeuroRehabilitation

Volume:

Number:

Pages:

63-73

Publisher:

IOS Press

Background:

Individuals with traumatic brain injury (TBI), spinal cord injury (SCI), and other neurological disorders often have severe disabilities impacting their ability to return to previous activities and return to work is limited. There is an ongoing need for education and vocational rehabilitation systems to work together to improve outcomes for youth and young adults with disabilities.

Purpose:

The purpose of this article was to present information on a community-based mentoring program for young adults, ages 16 - 26 years with a recently acquired TBI, SCI, and other neurological disorders. The two objectives of this study were to 1) to demonstrate continuing increased in standardized measures of community integration from the time of enrollment in the program to the time of exit, and 2) improve the percentage of youth and adults who successfully access post-secondary education or employment opportunities.

Setting:

The setting was various community sites in California.

Sample:

The study sample included 131 individuals with TBI, SCI, or other neurologic disabilities recruited between 2005 and 2010. The majority were individuals with TBI or SCI with one individuals dually diagnosed with TBI and SCI (0.8%) and 8.4% with other disabilities to include other neurological disabilities. The majority were male (67.9%). The mean age was 20.3 years. Participants were primarily Hispanic (42%) or Caucasian (36.3%) with the remaining Asians (10.7%) or African American (4.6%). In addition, there were 121 trained "mentors" who were a minimum of two years post injury and had "a high level of acceptance and successful integration into the community". This included working or post-secondary education. Most were working (57%) while 30% were attending school, and 13% were retired.

Data Collection:

Assessment was conducted a minimum number of four times: at enrollment, three months after entry, and every three months thereafter until attempted entry to post-secondary education or employment. In addition, each mentor and mentee completed a questionnaire which documented satisfaction with the relationship. Finally, the program used standardized assessments to include the Disability Rating Scale to include Employability and Level of Functioning, the Participation Index of the Mayo-Portland Adaptability Inventory, version 4, the Supervision Rating Scale, the Craig Handicap Assessment and Reporting Technique Short Form, and the Diener Satisfaction with Life Scale. A successful transition was as the individual remained in the post-secondary education or employment environment.

Data were collected by mentors and project staff. Formal assessments were collected by trained research assistants. Mentors submitted meeting logs documenting when, where, and topics discussed. Data were stored in an Access database and descriptive and inferential analyses were conducted using SPSS. Pre and post test program scores on standardized outcome measures were compared by paired T-tests.

Intervention:

A mentoring program was developed called the "Back on Track to Success Mentoring Program." The goal of the program was to improve the ability of youth/young adults with disabilities to navigate through the services and programs available to individuals with disabilities. In addition, the goal was to increase the rate of return to work and post-secondary education. Each of the program participants were matched with a "mentor" who had training on a specific curriculum and refresher sessions throughout the entire program. Mentor/mentee relationships were required to have a minimum of three contacts per month in-person, telephone, or electronic mail methods.

Control:

No comparison condition.

Findings:

A total of 89 mentees were successfully matched with community-based mentors and participated in the program through to completion. Of this number 77 completed the entire program. Of this number 42 (54.5%) were considered program successes and 35 (45.5%) were considered program failures. Of the 42, 69% returned to school and 13 became employed (31%). For program successes, significant CHART subscale increases were seen for Cognitive Independence and Mobility. For program "failures" no statistically significant changes were seen in CHART subscale scores. For program successes, there were also significant improvements seen in the M2PI, the DRS, and SRS. For failures there were improvements seen in DRS but these were not statistically significant.

Conclusions:

Overall, findings suggest that mentoring can be beneficial toward achieving the goals of post-secondary education, employment and community independence for individuals with disabilities; specifically those with traumatic brain injury, spinal cord injury and other neurological disorders.

URL:

http://content.iospress.com/articles/neurorehabilitation/nre00775

Disabilities:

Populations:

Transition-age youth (14 - 24)

Hispanic or Latino

Asian

Black / African American

White / Caucasian

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Yes

Research Design:

Observational

Peer Reviewed:

Yes

Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention.

Authors:

Vlasveld, M. C., Anema, J. R , Beekman, A. T. F., van Mechelen, W., Hoedeman, R., van Marwijk, H. W. J., Rutten, F. F., Hakkaart-van Roijen, L., & van der Feltz-Cornelis, C. M.

Year Published:

2014

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

42-51

Publisher:

Springer Science+Business Media New York

Background:

Employment leads to more independence as an adult. Many youth with physical disabilities have difficulty gaining and maintaining employment. This may result in a reduced quality of life.

Purpose:

The purpose of the study was to examine how occupational performance of participants of a vocational rehabilitation intervention changed over time. More specifically, it looked at work, self care and leisure. The researchers also looked at the differences between individuals who were employed and those who remained unemployed after the vocational rehabilitation intervention.

Setting:

The setting was an outpatient rehabilitation clinic for young adults located in Rotterdam, the Netherlands.

Sample:

Participants include eleven young adults with physical disabilities; six male and five females. Their mean age was 22 years prior to the intervention. Three individuals had cerebral palsy, 2 had muscular disease, 2 had traumatic brain injury and the remainder had other types of physical disabilities. The amount time participants had spent looking for work ranged from Five of the participants had not yet looked for work while 2 had been looking for more than 2 years.

Data Collection:

Demographic data was collected. Severity of physical limitations was categorized using scores on the Physical Functioning scale of the MOS Short-Form General Health Survey. Occupational performance was explored at baseline and one year later using semi structured interviews. The Canadian Occupational Performance Measure (COPM), an interview, was used to assess self perception of work performance in the areas of self care, productivity and leisure over time. The Occupational Performance History Interview II (OPHI-II) was used to assess aspects of occupational adaptation: occupational identity, competence and setting. Results were summarized using descriptive statistics. Sores on the COPM subscales and the OPHI-II scales were calculated. Qualitative data from the COPM and audio taped OPHI-II were summarized and categorized into the 3 occupational performance categories: self care, leisure and work productivity. Narrative were classified as regressive, stable or progressive. Differences between pre and post intervention scores on COPM and OPHI-II were tested using Wilcoxon signed rank test. Demographics between the employed and unemployed groups were compared using the Mann-Whitney U test. Non-parametric test were used. Data was analyzed using SPSS 16.0.

Intervention:

The intervention was "At Work?! This is a multidisciplinary vocational rehabilitation intervention that was designed for young adults with physical disabilities, who are entering the labor market, and is geared towards improving abilities to achieve employment. The year long intervention brought rehabilitation and vocational services into a group program that included individuals assessments and coaching.

Control:

There was no control group. The participants served as their own controls.

Findings:

The participants expressed fewer problems after the intervention. Additionally, they showed improved in work performance, self care and leisure. An increase in satisfaction with these improvements was also reported. Occupational identify, competence and overall scores on the OPHI II also increased. The demographic characteristics of the individuals who did not gain employment were not difference from the group that was employed. The unemployed experienced difficulties in all three areas of occupational performance prior to the intervention and more difficulty in the work setting. Post-intervention, their levels of occupational identity, competence and settings were like those of employed persons. Participants showed improved occupational performance post intervention. The unemployed participants appeared to catch up during the intervention but had not achieved employment within one year.

Conclusions:

Young adults with physical disabilities, showed improved occupational performance in work, self care and leisure and were more satisfied with their performance after participating in a one year multidisciplinary vocational rehabilitation intervention. Those who did not go to work faced problems in all three areas at pre-intervention. The goal of employment and the intervention appeared to motivate participants to solve problems related to work, self care and leisure. There is a need for interventions aimed at improving work participation by address problem across the three areas. Young adults who go to work may benefit from ongoing coaching to help address new problems.

URL:

http://link.springer.com/article/10.1007%2Fs10926-013-9446-9

Disabilities:

Populations:

Transition-age youth (14 - 24)

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Research Design:

Single group

Quasi-experimental

Peer Reviewed:

Yes

Traumatic brain injury and employment outcomes: Integration of the working alliance model

Authors:

Kitchiner, N. J.

Year Published:

2008

Publication:

Work

Volume:

Number:

Pages:

309-317

Publisher:

IOS Press

Background:

Polytrauma includes a complex constellation of symptoms that may involve an array of interrelated cognitive, physical, and psychological symptoms. According to the United States Veteran Health Administration, polytrauma is an injury to the brain in addition to other body parts or systems resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability. Although problems post traumatic brain injury (TBI) can be challenging many of these individuals remain employable. Rehabilitation specialists assisting persons with TBI with return to work need to understand treatment protocols that could enhance the relationship with the individuals and thereby enhance their employment outcomes.

Purpose:

This paper provided a brief review of the return to work literature and presented Bordin's working alliance model. A case example was used to illustrate the model.

Setting:

The setting for the study was an In/Outpatient Rehabilitation Center.

Sample:

The paper presents one case study.

Data Collection:

The case study provides a brief overview of the meetings between the client and his rehabilitation counselor.

Intervention:

The intervention was the Working Alliance Model of Rehabilitation. Some limited research has highlighted the working alliance model‚ benefit in working with participants for whom issues of inclusion, empowerment, and promotion of autonomy have become central to the definition of a healthy counseling relationship. One of the main benefits of the model is its dynamic, collaborative orientation. In essence, the sense of ownership a participant gains given the model‚ central tenet of shared power and decision making within the professional relationship provides a solid rationale for using this model in rehabilitation settings.

Control:

No comparison condition.

Findings:

A treatment and rehabilitation program was developed for the individual with TBI using the Work Alliance model. This included: obtaining a neuropsychological evaluation, transitioning level of care to a day treatment program, continuing to work with his rehabilitation counselor using the Work Alliance model to construct realistic return to work plan and refer him to case manager to monitor his behavioral and psychological needs.

Conclusions:

The model may be able to strengthen the relationship between a person with TBI and a rehabilitation specialist.

URL:

http://content.iospress.com/articles/work/wor00785

Disabilities:

Populations:

Veterans

Outcomes:

Intellectual disabilities

NIDILRR Funded:

Research Design:

Case reports

Peer Reviewed:

Yes

Enhancing self-determination in job matching in supported employment for people with learning disabilities: An intervention study

Authors:

Kissinger, D. B.

Year Published:

2002

Publication:

Journal of Vocational Rehabilitation

Volume:

Number:

Pages:

125-135

Publisher:

IOS Press

Background:

Self determination helps individuals with disabilities take an active role in their lives. There is a growing body of research indicating how self determination can be used to assist individuals with disabilities who are using supported employment to assist them with work. Some research indicates increases in autonomy among individuals using supported employment who learn self determined behaviors.

Choosing a job of one‚ own may enhance a person‚ success at work and overall career progression. People who choose their own jobs may select work that matches personal preferences. They may also be more motivated to do the job which can enhance job retention. In order to choose a job, job seekers in supported employment, must become aware of the possibilities. They must also learn about their abilities and work preferences. Research is needed to measure the impact of self determination training on adults with disabilities who want to go to work.

Purpose:

The purpose of this study was to measure the impact of a two phase self-determination package for adults with learning disabilities entering the job market for the first time.

Setting:

The setting was two agencies that offered supported employment in South Wales and 20 job sites that offered a variety of tasks. Each participant was required to attend 3 job tasters for six sessions or 2 job taster sessions in each of three job types. Job tasters are short (4 hours), unpaid, time limited work experiences in the workplace. They allow individuals with disabilities to sample a variety of job duties and work cultures.

Sample:

Forty individuals aged 19 to 52 years participated in the study. Each person had a label of mental retardation (referred to as LD in UK). The majority or 78% were attending adult training centers at the time of referral. One person dropped out of the study and 4 were involved in the pilot study. Twelve job seekers took part in the baseline phase, 12 in Intervention 1 and 11 in Intervention 2. More than half of the participants were rated as requiring only minimum assistance in daily living activities. A small number required regular personal care and close supervision. All were capable of interpreting picture prompts as a mean to communicate.

Data Collection:

Observations were conducted on the second, fourth and sixth job taster sessions along with the reviews by each participants. Responses on key variables were recorded using continuous frequency counts throughout each taster session and review. Job review forms were also a source of data, providing information on accuracy of recall and consistency with choice. Job seeker independence was calculated by dividing the frequency of job coach assistance by the duration in minutes of each observation. Job tasters and reviews were measured separately. The extent to which job coach question required job seekers to express preferences and self appraise performances on tasks were also recorded. All questions were recorded under 3 sub categories: those asked in yes or no, open ended and option formats. Three types of job seeker responses were coded. The consistency of job preferences was measured by agreement between ratings of enjoyment of a task during the job taster review and an overall rating in response to the question: how much did you enjoy your job. Reliability was obtained for all key observational variables and was represented by the extent of agreement between observers. Observational data was analysed using the SPSS statistical package for Windows. A one-way ANOVA was used to evaluate the extent of change resulting from the introduction of Interventions 1 and 2, using a critical region of p < 0.01.

Intervention:

During baseline staff received no specific instructions on how to conduct the job tasters. There were two interventions. Intervention 1 was an introduction to self determination and systematic taster reviews. Job coaches received a day of training on self determination. Then a written questionnaire was provided for job coaches to evaluate the job seekers job performance, likes and dislikes etc... If the jobseeker could read he or she completed the questionnaire. Job coaches were also encouraged to use open ended and option questions and avoid yes/no formats during job taster sessions and reviews. During reviews job coaches were assisted by a profile form. Intervention 2 included the introduction of a pictorial job review profile. A second one day training was conducted 4 months after intervention one. Job coaches were encouraged to assist job seekers with completing the job review independently. For those who could not read a pictorial questionnaire was used. Those who could read and write were given the option of writing their responses to the questions if preferred.

Control:

Comparison conditions were individuals with no intervention.

Findings:

Intervention 1 led to a reduction in job coach assistance during taster sessions and reviews. Intervention 2 led to a further drop in job coach assistance during reviews. The results also indicated that job seekers were coming up with and expressing personal preferences that were consistent with statements they made earlier.

Conclusions:

The interventions seemed to work on a practical level. Job coaches were able to adopt the approaches. Participants with mild and moderate learning disabilities were able to complete pictorial job reviews with no or minimal prompting. More research is needed.

URL:

http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00152

Disabilities:

Specific learning disabilities

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Vocational intervention in first-episode psychosis: Individual placement and support v. treatment as usual

Authors:

Kilsby M. S., & Beyer, S.

Year Published:

2008

Publication:

The British Journal of Psychiatry

Volume:

193

Number:

Pages:

114-120

Publisher:

Royal College of Psychiatrists

Background:

Unemployment has economic, social and health implications for individuals with first episode psychosis and schizophrenia. The Individual Placement and Support model of supported employment shows promise for individuals with chronic mental illness. However, there are no randomized controlled trials on use of this approach to assist individuals with first episode psychosis with employment.

Purpose:

The aim of this study was to look at the effectiveness of the Individual Placement and Support model of supported employment for young people with first episode psychosis.

Setting:

The setting included a variety of places of employment.

Sample:

The study sample was made up of 41 individuals, between the ages of 15 and 25 years, with first-episode psychosis.

Data Collection:

Both groups were assessed at baseline and 6 months after the conclusion of the intervention. Data about demographics, symptoms, diagnosis and functioning was collected for all participants using a variety of measures. These included the Brief Psychiatric Rating Scale, Structured Clinical Interview for the DSM-IV Axis One Disorders, The Quality of Life Scale and Social and Occupational Functioning Assessment Scale. The Supported Employment Fidelity Scale Implementation questions were used to assess the fidelity of the program. Statistical analysis was conducted using SPSS version 14 for Windows.

Intervention:

The intervention was six months of the Individual Placement and Support model of supported employment along with typical treatment as usual.

Control:

The control condition was typical treatment as usual.

Findings:

Participants in the Individual Placement and Support group had better outcomes. These included level of employment, hours worked per week, jobs acquired, and length of time employed. Twenty three participants in the intervention group went to work as compared to only 3 in the control group. The intervention group also reduced reliance on welfare benefits.

Conclusions:

The Individual Placement and Support Model has the potential to assist individuals with first episode psychosis with employment. More research is needed.

URL:

http://bjp.rcpsych.org/content/193/2/114

Disabilities:

Emotional disturbance

Outcomes:

Wages

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

Authors:

Kidd, S. A., Boyd, G. M., Bieling, P., Pike, S. & Kazarian-Keith, D.

Year Published:

2009

Publication:

Cochrane Database of Systematic Reviews

Volume:

Number:

Pages:

1-22

Publisher:

John Wiley & Sons, LTD

Background:

Multiple sclerosis is described as a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.

Purpose:

The purpose of the study is to evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in patients with M.S.; and to evaluate the cost effectiveness of these programs.

Setting:

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

Sample:

Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (subtypes of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity.

Data Collection:

Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.

Intervention:

Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls.

Control:

There are no comparison on control conditions.

Findings:

Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a competitive employment in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labor force; (b) for altering work ability' by improving participants confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.

Conclusions:

There was inconclusive evidence to support VR for patients with MS However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigor of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

URL:

http://onlinelibrary.wiley.com/store/10.1002/14651858.CD007256.pub2/asset/CD007256.pdf;jsessionid=DB8AF3AB7E7D7D9A9280998D0E812DCD.f03t01?v=1&t=imnmwg11&s=378f4ad624105aa799bc84c37a0ca5d3c51082c5

Populations:

Outcomes:

Systematic reviews and meta-analysis

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Project SEARCH for youth with autism spectrum disorders: Increasing competitive employment on transition from high school

Authors:

Wehman, P., Schall, C.M., McDonough, J., Kregel, J., Brooke, V., Molinelli., A., Ham, W., Graham, C. W., Riehle, J. E. Collins, H. T., & Thiss, W.

Year Published:

2013

Publication:

Journal of Positive Behavior Interventions.

Volume:

Number:

Pages:

144-155

Publisher:

Hammill Institute on Disabilities and Sage

Background:

Transition from school to work for youth with ASD is an ongoing problem for the public education system. Teachers also struggle with their attempts to match the strengths of a particular student to a job. Project SEARCH is a transition program for youth with disabilities. In this model students rotate through full day internships in businesses to gain work and related skills that may lead to an employment offer for some.Others have a positive work experience to highlight as they apply for jobs in their communities.Project SEARCH helps facilitate the transition from school to work.

Purpose:

The purpose of this study was to determine how a Project SEARCH approach would work for youth with ASD.

Setting:

The student internships took place in a large hospital.

Sample:

Two case studies were presented for two young men with ASD. A 19 year with autism and a 20 year old with Asperger Syndrome as well as severe scoliosis.

Data Collection:

The following data demographics, internship characteristics, job coach interventions was collected for each young man.

Intervention:

The intervention was Project SEARCH model along with some specific ASD supports.

Control:

There was no control or comparison condition.

Findings:

One young man participated in internships in the hospitals' radiation, engineering and infection control departments. His performance improved over time and he was offered a job in the infection control department working 20 hours and week and earning $9.14 an hour.The other young man participated in internships in the Coronary Care Unit, Biomedical Durable Equipment, and Intensive Care Unit (ICU). His abilities also improved during the internships. After completing the internships he was offered a job working 20 hours a week in the ICU earning $9.14 per hour.

Conclusions:

A Project SEARCH approach appears to be an effective way to assist youth with ASD with transition from school to work. This study was part of a larger study researching the use of Project SEARCH model to serve youth with ASD. The results from this larger study should help shed light on this topic.

URL:

http://pbi.sagepub.com/content/early/2012/10/11/1098300712459760

Disabilities:

Autism Spectrum Disorder

Populations:

Male

Black / African American

White / Caucasian

Transition-age youth (14 - 24)

Outcomes: