Social capital, employment and labor force participation among persons with disabilities

Authors: 
Burke, R. V., Allen, K. D., Howard, M. R., Downey, D., Matz, M. G., & Bowen, S. L.
Year Published: 
2015
Publication: 
Journal of Vocational Rehabilitation
Volume: 
43
Pages: 
17-31
Publisher: 
IOS Press
Background: 

The author begins by giving examples of human capital, social capital, and economic capital. Previously, disability policy research has focused very little on social capital and its relationship to labor force participation. Measuring social capital can include measurements on social reciprocity, levels of trust, and participation in community events. In the United States, people with disabilities have typically been shown to have lower social capital than their non-disabled counterparts.

Purpose: 

The author provides three hypothesis. First, that people with disabilities have lower levels of social capital than those without a disability. Second, people with disabilities in the labor force have higher levels of social capital than those not in the labor force with similar characteristics. Third, people with disabilities in the labor force who are employed will have higher levels of social capital than those individuals with a disability who are unemployed.

Setting: 

The Current Population Survey (CPS) collects employment statistics in the United States on a monthly basis for adults aged 18 and older.

Sample: 

Data from the 2010 CPS supplement on demographic data and labor force participation, restricted to those ages 25-61, resulted in an unweighted N of 67,009 (weighted N of 151,902,123). Gender of participants was relatively even with 49.31% male and 50.69% female. The sample was predominately White (80.00%) non-Hispanic (84.68%). Only 7.95% of participants reported a disability. The majority (73.85%) of participants were employed.

Data Collection: 

Data was collected on a monthly basis from the 2010 supplement of the CPS survey.

Intervention: 

There was no intervention.

Control: 

There was no control group.

Findings: 

The first two hypothesis were confirmed. Specifically, individuals with a disability had lower social capital than those without a disability. Additionally, people with disabilities who are part of the labor force were considered to have higher social capital than those who were not in the labor force. The third hypothesis, that people with disabilities who were in the labor force and employed would have greater levels of social capital than those who were not, was not supported by the data.

Conclusions: 

These data show that there is a divide between individuals with a disability and those without in regards to social capital. There was less of a distinction between employed people with disabilities and those who were not participating in the labor force in levels of social capital. To address these discrepancies, policymakers, advocates, and service providers should support innovative approaches to increasing social capital among those with a disability.

URL: 
https://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr751
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Variations in social capital among vocational rehabilitation applicants

Authors: 
da Silva, C. E., Romero, M. G., Chan, F., Dutta, A., & Rahimi, M.
Year Published: 
2017
Publication: 
Journal of Vocational Rehabilitation
Volume: 
46
Pages: 
187-194
Publisher: 
IOS Press
Background: 

The authors examine the intricacies of individual and community level social capital. Specifically, the relationship between social capital and state vocational rehabilitation (VR) agencies interaction with individuals with disabilities. Previous research reveals that people with disabilities will typically have lower levels of social capital than their non-disabled counterparts. However, this relationship has not been shown to be causational.

Purpose: 

The goal of this work is to examine how social capital varies by employment status for VR applicants. It is also hypothesized that levels of social capital would vary by employment status for VR applicants when controlling for disability and individual characteristics.

Setting: 

In 2014 and 2015 Mathematica Policy Research collected survey data from applicants to the New Jersey Division of Vocational Rehabilitation Services, the Mississippi Department of Rehabilitation Services, and Opportunities for Ohioans with Disabilities.

Sample: 

2,804 surveys were completed. After cleaning data with missing social capital information, 2639 cases remained. The sample was relatively split between male (49.9%) and female (50.1%) participants. Half (50.5%) identified as non-Hispanic white, with 37.5% identifying as non-Hispanic black, with age ranging from 25-34 (22.6%) to as high as 55-65 (18.7%) years old. Less than 57% of applicants reported having access to someone who could help with financial concerns.

Data Collection: 

Data collection was done across three state VR agencies. Social capital was measured by looking at four questions including if applicants had anyone that they could rely on for help: 1. finding a job 2. borrowing money to pay an urgent bill, 3. with transportation to get to work urgently, and 4. help with a serious personal crisis.

Intervention: 

No intervention was presented.

Control: 

There was no control or comparison condition.

Findings: 

Both hypothesis were confirmed. Additionally, disability type, employment status, and perceived health had an effect on social capital. Overall, younger, healthier, employed, and less severely disabled individuals were shown to have higher rates of social capital than their counterparts. This remained true across all four social capital questions.

Conclusions: 

This work confirms that there is a strong link between employment status and social capital. As social capital has shown to be lower for individuals with severe disabilities, it would be beneficial for state VR agencies to pay close attention to supporting this community. Similarly, those individuals with a disability onset age of 25 or older could benefit greatly from additional support.

URL: 
https://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr854
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Attachment and Employment Outcomes for People With Spinal Cord Injury: The Intermediary Role of Hope

Authors: 
Blonk, R. W., Brenninkmeijer, V., Lagerveld, S. E., & Houtman, I. L.
Year Published: 
2017
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
60
Number: 
2
Pages: 
77-87
Publisher: 
SAGE
Background: 

Compared to people without disabilities, people with spinal cord injury (SCI) have significantly lower employment rates. There are approximately 270,000 people in the United States living with a SCI. Recently, industrial/organizational (I/O) psychology has focused on adopting positive psychological approaches to work related behaviors. Positive organizational behavior (POB) and I/O psychology findings indicate that attachment and hope are related to important vocational variables.

Purpose: 

This study explores the relevance of attachment and hope for vocational rehabilitation (VR), in relation to full time employment, for individuals with SCI. More specifically, this study aims to a) examine the relationship between attachment, hope, and full-time employment for individuals with SCI, and b) to examine the mediation effect of hope on the relationships between attachment and full-time employment for individuals with SCI.

Setting: 

Participants were recruited from SCI advocacy organizations, specifically through newsletters. Data were collected via an anonymous online survey.

Sample: 

Participants (N =84) ranged from 21 to 64 years of age (M= 47.05,SD= 10.72). There were 57 males, and 26 females in the sample, with one participant not responding to the gender question. Participants were predominantly Caucasian (88.1%), with 48 participants reporting being unemployed (57.2%) and 23 participants reporting full-time employment (27.4%). A large majority of participants (85.5%) reported completing some post-secondary education.

Data Collection: 

Employment was coded as binary, employed full time or not employed full-time. The Attachment Style Questionnaire (ASQ, Feeney, Noller, & Hanrahan, 1994) was used to measure attachment. The Trait Hope Scale (THS; Snyder et al., 1991) was developed as a 12-item instrument to score total hope, pathways thoughts, and agency thoughts.

Intervention: 

There was no intervention.

Control: 

There was no control group.

Findings: 

Results indicate that attachment and hope were significantly related and predictive of full-time employment. Hope was also a significant mediator between attachment and full-time employment.

Conclusions: 

Vocational rehabilitation counselors should strive to maintain and enhance positive time perspective for individuals with secure attachment. Individuals with low agency/low pathways experience increased barriers to the goal pursuit process and would benefit from increased direction.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/0034355215621036
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Barriers to and Facilitators of Employment among Americans with Multiple Sclerosis: Results of a Qualitative Focus Group Study

Authors: 
Bolton, B. F., Bellini, J. L., & Brookings, J. B.
Year Published: 
2016
Publication: 
Journal of Rehabilitation
Volume: 
82
Number: 
2
Pages: 
59-69
Publisher: 
National Rehabilitation Association
Background: 

Multiple sclerosis (MS) is a complex and chronic neurological disease. There are approximately 450, 000 people living in the United States who have been diagnosed with MS. These people can experience a wide variety of symptoms including fatigue, mobility problems, visual impairments and much more. Due to these symptoms employment retention and acquisition can be challenging.

Purpose: 

This research focuses on two primary questions. One, what are the most commonly reported barriers and facilitators to employment that are identified by people with MS? Two, what are the most commonly reported employment information and resource needs reported by people with MS?

Setting: 

Participants were recruited from five stakeholder groups of people with physical disabilities. These groups included the National MS Society, United Spinal Cord Injury Association, World Institute on Disability, United Cerebral Palsy, and National Centers for Independent Living.

Sample: 

Participants in this study were 25 predominantly Caucasian (n=18, 72%) females (n=19, 76%) between 18 and 64 years of age.

Data Collection: 

Telephone focus groups were conducted and provided transcripts for the research team to analyze using NVivo 10 using a conventional qualitative content analysis approach.

Intervention: 

The research team developed a focus group protocol for this study that was delivered over the phone.

Control: 

There was no control group.

Findings: 

There were three main themes (and additional sub-themes) as a result of this research. Participants reported facing future uncertainty, feeling a sense of loss, and discussed issues related to navigating the workplace.

Conclusions: 

Vocational Rehabilitation counselors would benefit by increased knowledge around the issues that people with MS face in the workplace, especially in the area if disclosure.

URL: 
http://www.worksupport.com/documents/116767876.pdf
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: Two-Year outcomes

Authors: 
Rosenthal, D. A., Dalton, J. A. & Gervey, R.
Year Published: 
2007
Publication: 
Psychiatric Services
Volume: 
58
Number: 
3
Pages: 
325-333
Publisher: 
American Psychiatric Association
Background: 

Experimental studies have robustly demonstrated the effectiveness of the Individualized Placement and Support (IPS) model of supported employment services for people with severe mental illness, and several studies of real-world implementation have shown significant cross-sectional correlations between employment success and fidelity to the IPS model. Experiences with IPS programs have stimulated broad efforts to disseminate evidence-based practices. Although multiple dissemination efforts are underway, analyses on the benefits of efforts to disseminate IPS have been on cross-sectional and site-level data, rather than on longitudinal information on individual clients. To implement IPS in health care systems with limited previous experience, sustained and individualized training programs may be needed to realize potential client benefits. Few studies have demonstrated that IPS, or other evidence-based practices for that matter, can both be implemented in a system that lacks prior experience with the model and yield outcomes for comparable cohorts that are superior, over several years, to those of a comparison group for which this intervention was not available.

Purpose: 

This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).

Setting: 

The setting included 9 Veterans Administration Programs for Homeless Veterans.

Sample: 

A total of 308 veterans were recruited during phase 1, starting in January 2001, when IPS was still unavailable anywhere in the VA. An additional 321 veterans were recruited in phase 2, starting in July 2001, after the IPS employment specialist had been hired and trained, and were invited to participate in IPS for at least two years. Follow-up data collection continued through March 2005.

Data Collection: 

Participants in phase 1 were compared with participants in phase 2 on baseline characteristics by using chi square tests and t tests. All available participants were included in all analyses whether or not they were currently participating in IPS. Mixed models were then used to compare outcomes between the phases over the two-year follow-up period, controlling for baseline differences, using the MIXED procedure of SAS, with the alpha set at <.05.

Intervention: 

Training began with a one-day, on-site, face-to-face orientation for both employment specialists and other VA mental health staff that was led by a social worker with experience training IPS specialists and conducting IPS fidelity ratings. For the duration of the project regular teleconferences continued providing weekly individual case reviews for the first three months, monthly individual case review conferences, and monthly conference calls with all nine employment specialists jointly. A review of ratings of model fidelity at six, 12, and 18 months after program implementation was also performed with a modified version of the IPS fidelity scale. Training was provided by a social worker with extensive experience disseminating the IPS model in other research projects. He was assisted by a VA occupational therapist with experience in supported employment. Monthly conference calls were also held with administrators responsible for program implementation at each site.

Control: 

Phase 1 control group did not receive IPS services. Comparison was made with Phase 2 group who did receive IPS services.

Findings: 

Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. (Psychiatric Services 58:325—333, 2007)

Conclusions: 

A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

URL: 
http://www.nchv.org/images/uploads/Implementation_of_Supported_Employment_for_Homeless_Veterans_With_Psychiatric_or_Addiction_Disorders-Two-Year_Outcomes.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

Authors: 
Rose J., Saunders K., Hensel, E., & Kroese, B. S.
Year Published: 
2004
Publication: 
Psychiatric Bulletin
Volume: 
28
Number: 
8
Pages: 
281-284
Publisher: 
Royal College of Psychiatrists
Background: 

Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.

Purpose: 

The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Setting: 

The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George‚ Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.

Sample: 

The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.

Data Collection: 

Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included:
• demographic variables: age, gender, ethnicity;
• clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator.
Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.

Intervention: 

A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.

Control: 

There was no control or comparison condition.

Findings: 

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying good implementation

Conclusions: 

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

URL: 
http://pb.rcpsych.org/content/28/8/281
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness

Authors: 
Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P.
Year Published: 
2003
Publication: 
The Journal of Nervous and Mental Disease
Volume: 
191
Number: 
3
Pages: 
139-144
Publisher: 
Lippincott, Williams and Wilkens
Background: 

Supported employment is an evidenced based practice that assists individuals with mental illness with gaining and maintaining employment. One of the major barriers to work are disability payments offered by the Social Security Administration and the Veterans Administration. A few studies have shown that the amount of public income is negatively associated with employment, involvement with vocational rehabilitation services and income received from employment. There are no studies related to to the impact of disability benefits on employment of those individuals who receive intensive case management services.

Purpose: 

The purpose of this study was to explore the relationship between income from public support, participation in Intensive Psychiatric Community Care and employment among veterans with severe mental illness.

Sample: 

The sample included 520 veterans with severe mental illness who were randomly assigned to either IPCC or standard care. Prior to entering the study the majority or 87.5% were receiving at least one form of public payment. The average amount was nine hundred and fifty five dollars.
At the 12 month follow up interview, most of the sample 91.2%) were classified as non workers. There were few differences on baseline and demographic and mental health status. There was a significant difference between workers and non-workers on the amount of public income received in the month prior to baseline assessment, with non workers receiving more money.

Data Collection: 

Demographic and mental health status were obtained through participant interviews at baseline and one year out. Symptom severity was measured using the Brief Psychiatric Rating Scale. Alcohol and drug use were examined using scores from the Addiction Severity Index. Functional status was assessed using the Global Assessment Scale. Fidelity to the IPCC Model was measured using the Dartmouth Assertive Community Treatment scale. A liberal measure was used to determine employment. In the data analysis, only composite scores were examined. Bivariate analyses were used to examine differences between demographic and mental health status variables. Multivariate logistic regression was used to look at the contribution of the independent variable.

Intervention: 

The intervention was Intensive Psychiatric Community Care (IPCC).

Control: 

The control condition was standard care.

Findings: 

Public support levels were inversely related to employment. Symptom severity did not appear to be an independent barrier to work.

Conclusions: 

Previous analyses of this study did not look at infrequent outcomes like employment. However, there is value in doing so as the results revealed the impact of assertive case management on employment outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12637839
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of post-high school employment among young adults with disabilities

Authors: 
Reif, S., Horgan, C., Ritter, G., & Tompkins, C.
Year Published: 
2002
Publication: 
Career Development for Exceptional Individuals
Volume: 
25
Number: 
1
Pages: 
25-40
Publisher: 
Sage
Background: 

Employment status is one of the most frequently researched outcomes following school exit for young adults with disabilities. Reported employment rates have been low, particularly for full-time employment. Factors related to transition success have also been investigated.

Purpose: 

The purpose of this study was to examine data from the Alabama Transition Initiative related to student outcomes. The aim was to identify school, student, and program related variables that contributed to successful employment after school.

Setting: 

The study settings were 37 of Alabama‚ 128 public school systems. These school systems served as the state‚ demonstration sites for its transition systems change project. They were selected through ATI‚ annual competition for transition mini-grants to enhance their transition programs through implementation of a set of best practices and participation in the Alabama Student Tracking System.

Sample: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Data Collection: 

Data for this study were obtained through the Alabama Student Tracking System and a follow-along survey one year post school exit related to participation in employment, postsecondary education, and other adult activities. Data analysis was a hierarchical logistic regression analysis.

Intervention: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Control: 

There were no control or comparison groups.

Findings: 

The follow-up survey found that 73% of former students were employed one year following school exit. Employment outcomes were better for those who were male, with learning disabilities, from urban school systems. Related to the interventions, having a job at school exit was a significant predictor of post-school employment, but assistance from VR or MH/MI services were not.

Conclusions: 

These findings suggest that students with disabilities can benefit from paid work experiences while in high school. In addition, females in rural settings need better transition planning and programs.

URL: 
http://cde.sagepub.com/content/25/1/25.refs?patientinform-links=yes&legid=spcde;25/1/25
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Developing evidence-based supported employment services for young adults receiving public mental health services

Authors: 
Pryce, J., Munir, F., & Haslam, C.
Year Published: 
2009
Publication: 
New Zealand Journal of Occupational Therapy
Volume: 
56
Number: 
1
Pages: 
34-39
Publisher: 
Zealand Association of Occupational Therapists Inc.
Background: 

Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts.

Purpose: 

This report describes the application of an evidence-based practice fidelity measure to monitor the effectiveness of an expanding supported employment program for youth adults with first episode psychosis.

Setting: 

The setting was 4 demonstration sites where employment staff co-located within an early intervention psychosis team.

Sample: 

The study sample was made up of 134 individuals. Sixty four percent were diagnosed with first episode psychosis, and received services from a community based early intervention psychosis team.

Data Collection: 

The IPS Fidelity scale was applied to each site. Data was collected and scored consistent with the Fidelity Scale directions.

Intervention: 

The intervention was the Individual Placement and Support (IPS)model of supported employment. This is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

Both low and high scoring fidelity items helped identify practical ways to further develop evidence-based practices at each site.

Conclusions: 

Fidelity strengths and weaknesses can be identified that have implications for other sites in terms of what employment consultants can most constructively do in context of the restraints of their immediate environment.

URL: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model

Authors: 
O'Brien, L.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
13
Pages: 
765-783
Publisher: 
Taylor & Francis Ltd
Background: 

Employment outcomes post traumatic brain injury (TBI) result in a financial and social burden. In addition, unemployment may impact the individual's quality of life and emotional well being. The ability to predict vocational outcome using evidenced based guidelines can assist with rehabilitation planning, development of vocational support services and the role adjustment of the individual with a TBI and his or her family members.

Purpose: 

A review of the literature to identify key variables associated with positive employment outcomes post TBI can pave the way for future research and the development of rehabilitation practices.

Data Collection: 

Eighty five studies were identified between 1980 and 2003 that reported on factors associated with employment outcomes post TBI. Among those fifty studies met the inclusion criteria for the second stage review. The criteria used to evaluate and rate the quality of methodology for each study was adapted on guidelines by Sherer 2002 and Pengel et. al. 2003.

Intervention: 

The review highlights demographic, injury and neuropsychological factors associated with return to work. It also examines interventions that focus on modifying the social environment in addition to emotional and metacognitive factors. A conceptual model is presented that outlines the factors associated with employment outcomes.

Control: 

No control or comparison

Findings: 

The most consistent predictors and indicators of employment outcomes included premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. The authors note that although the presence of specific characteristics may be a predictor for failure to return to work the absence of a factor does not guarantee return to work.
There is little evidence to support cognitive rehabilitation. The most successful programs target problems with motivation and emotional disturbance. Interventions to modify the social environment need to occur on multiple levels. A person's preferences for employment impact job retention. Supported employment has been described however, further evaluation of outcomes is needed. At a policy level a major barrier exists in the current service delivery system in which individuals do not have access to long term rehabilitation or specialized vocational support. Changes in public policy and funding could improve service delivery. Developing disability management programs may also assist those at risk for chronic unemployment post TBI.

Conclusions: 

The review of literature reported that the level of empirical support for employment outcome was greatest for: premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. Future research is needed to determine the role of metacognitive, emotional and social environment factors that can be modified with various interventions. Interventions need to be evaluated to determine evidenced based practices.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15371049
NIDILRR Funded: 
Peer Reviewed: 
Yes