"Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI" | Knowledge Translation for Employment Research Center

Authors:	Johnstone, B., Vessell, R. Bounds, T., Hoskins, S., & Sherman, A.
Year Published	2003
Publication	NeuroRehabilitation
Volume	18
Number	3
Pages	197-203
Publisher	IOS Press
Background	After TBI many individuals experience difficulties with returning to work and if financially eligible turn to federally funded state vocational rehabilitation (VR) programs for services. Although billions of taxpayer dollars are spent on VR services each year, little is known about their effectiveness. Few studies have been published on the vocational outcomes of persons with TBI who utilize state VR programs. More research is needed about individuals with TBI who receive state VR services in order to identify problems, develop appropriate services, and improve vocational outcomes. There are few published studies regarding persons with TBI in rural areas. Furthermore, the published research specifically on the vocational outcomes of persons with TBI in rural areas is essentially non existent with only one study identified on this topic.
Purpose	The purpose of the study was to evaluate differences in demographics, injury severity, and vocational outcomes for individuals with TBI based on whether that resided in a rural vs. urban environment. It was hypothesized that individuals from rural and urban areas would not differ in demographics, that rural individuals would have greater injury severity based on previous studies, and that rural individuals would receive fewer VR services and have a lower rate of successful employment.
Setting	The setting for the study was vocational rehabilitation agencies in Missouri.
Sample	The study included 78 individuals with TBI who had completed services from the Missouri Division of Vocational Rehabilitation (VR). The majority or 71% were male. Eighty percent were Caucasian. Demographic and injury severity data was reported by rural (N=28) and urban status (N=50). For the rural group, the mean age was 37; mean years of education was 12, and mean years post injury was 8 for the rural group. Mean number of hours in coma was 241 hours, mean days of post traumatic amnesia was 53 and mean days of hospitalization was 53 days. For the urban group, the mean age was 36; mean years of education was 12, and mean years post injury was 11 for the rural group. Mean number of hours in coma was 96 hours, mean days of post traumatic amnesia was 25 and mean days of hospitalization was 33 days.
Data Collection	Each participant was administered a standard neuropsychological evaluation used as part of a statewide VR protocol. Information about demographic and psychosocial variables was obtained by the evaluating psychologist. Self-report information regarding duration of loss of consciousness (LOC), posttraumatic amnesia (PTA), and hospitalization was obtained from most clients because medical records were not routinely available for review. Information from Missouri DVR was obtained on each participant, including the specific services provided, the vocational status of the participant at case closure, and the financial cost of the case to DVR. Vocational outcome was determined using standard DVR categories, including: 1) successfully closed, 2) closed, no services provided, 3) closed, services interrupted, and 4) unsuccessfully closed. Rural and urban status was determined by definitions used by the US Office of Management and Budget (OMB). Data analysis included Chi-squares, Fisher‚ Exact tests, Wilcoxon Rank Sums test, and MANOVAs.
Control	A comparison was made between two groups of individuals with TBI; those living in rural versus urban settings.
Findings	There were no remarkable differences between the groups in terms of demographics. People residing in urban areas received significantly more maintenance funds, transportation services, and on-the-job training, than those living in rural settings. Additionally these individuals had more case service dollars expended on them. Finally, although statistically non-significant, individuals from urban areas were successfully employed at VR case closure, compared to those from rural areas.
Conclusions	The results suggest that rehabilitation professionals and vocational counselors should focus on possible environmental factors that limit the successful vocational outcomes of individuals with TBI in rural areas. VR counselors need to focus on environment factors that limit vocational outcomes for those living in rural areas. They need to find creative ways to address difficulties associated with limited resources in rural environments like transportation , locating vocational training settings, and developing job opportunities. VR counselors also need to better determine why many of their rural clients with TBI discontinue services after they are deemed eligible to receive them. This information can help them develop strategies to increase their client retention.
URL	http://www.ncbi.nlm.nih.gov/pubmed/14530584
Disabilities	Traumatic brain injury (TBI)
Populations	Male & Female \| Black / African American \| White / Caucasian \| Rural \| Urban
Outcomes	Employment acquisition \| Return to work
NIDILRR Funded	Yes
Research Design	Observational
Peer Reviewed	Yes

Year Published

2003

Publication

NeuroRehabilitation

Volume

18

Number

3

Pages

197-203

Publisher

IOS Press

Background

After TBI many individuals experience difficulties with returning to work and if financially eligible turn to federally funded state vocational rehabilitation (VR) programs for services. Although billions of taxpayer dollars are spent on VR services each year, little is known about their effectiveness. Few studies have been published on the vocational outcomes of persons with TBI who utilize
state VR programs. More research is needed about individuals with TBI who receive state VR services in order to identify problems, develop appropriate services, and improve vocational outcomes. There are few published studies regarding persons with TBI in rural areas. Furthermore, the published research specifically on the vocational outcomes of persons with TBI in rural areas is essentially non existent with only one study identified on this topic.

Purpose

The purpose of the study was to evaluate differences in demographics, injury severity, and vocational outcomes for individuals with TBI based on whether that resided in a rural vs. urban environment. It was hypothesized that individuals from rural and urban areas would not differ in demographics, that rural individuals would have greater injury severity based on previous studies, and that rural individuals would receive fewer VR services and have a lower rate of successful employment.

Setting

The setting for the study was vocational rehabilitation agencies in Missouri.

Sample

The study included 78 individuals with TBI who had completed services from the Missouri Division of Vocational
Rehabilitation (VR). The majority or 71% were male. Eighty percent were Caucasian.
Demographic and injury severity data was reported by rural (N=28) and urban status (N=50). For the rural group, the mean age was 37; mean years of education was 12, and mean years post injury was 8 for the rural group. Mean number of hours in coma was 241 hours, mean days of post traumatic amnesia was 53 and mean days of hospitalization was 53 days. For the urban group, the mean age was 36; mean years of education was 12, and mean years post injury was 11 for the rural group. Mean number of hours in coma was 96 hours, mean days of post traumatic amnesia was 25 and mean days of hospitalization was 33 days.

Data Collection

Each participant was administered a standard neuropsychological evaluation used as part of a statewide VR protocol. Information about demographic and psychosocial variables was obtained by the evaluating psychologist. Self-report information regarding duration of loss of consciousness (LOC), posttraumatic amnesia (PTA), and hospitalization was obtained from most clients because medical records were not routinely available for review.

Information from Missouri DVR was obtained on each participant, including the specific services provided, the vocational status of the participant at case closure, and the financial cost of the case to DVR. Vocational outcome was determined using standard DVR categories, including: 1) successfully closed, 2) closed, no services provided, 3) closed, services interrupted, and 4) unsuccessfully closed. Rural and urban status was determined by definitions used by the US Office of Management and Budget (OMB). Data analysis included Chi-squares, Fisher‚ Exact tests, Wilcoxon Rank Sums test, and MANOVAs.

Control

A comparison was made between two groups of individuals with TBI; those living in rural versus urban settings.

Findings

There were no remarkable differences between the groups in terms of demographics. People residing in urban areas received significantly more maintenance funds, transportation services, and on-the-job training, than those living in rural settings. Additionally these individuals had more case service dollars expended on them. Finally, although statistically non-significant, individuals from urban areas were successfully employed at VR case closure, compared to those from rural areas.

Conclusions

The results suggest that rehabilitation professionals and vocational counselors should focus on possible environmental factors that limit the successful vocational outcomes of individuals with TBI in rural areas. VR counselors need to focus on environment factors that limit vocational outcomes for those living in rural areas. They need to find creative ways to address difficulties associated with limited resources in rural environments like transportation , locating vocational training settings, and developing job opportunities. VR counselors also need to better determine why many of their rural clients with TBI discontinue services after they are deemed eligible to receive them. This information can help them develop strategies to increase their client retention.

URL

http://www.ncbi.nlm.nih.gov/pubmed/14530584

Disabilities

Traumatic brain injury (TBI)

Populations

Male & Female | Black / African American | White / Caucasian | Rural | Urban

Outcomes

Employment acquisition | Return to work

NIDILRR Funded

Yes

Research Design

Observational

Peer Reviewed

Yes