The Influence of State-Level Contextual Factors on State/Federal System Vocational Rehabilitation Employment Outcomes for Persons With Traumatic Brain Injury

The purpose of this exploratory study was to develop a preliminary understanding of the influence of state-level contextual factors predictive of employment outcomes for State/Federal Vocational Rehabilitation System (State VR) participants with traumatic brain injury (TBI). Participants were 5,213 individuals with TBI with Individualized Plans for Employment closed during Federal Fiscal Year 2016. A four-step hierarchical logistic regression model (5.6% explained variance) containing five demographic, three state-level economic, six state TBI service climate, and nine State VR service variable expenditures correctly classified 57.0% of cases as attaining or not attaining an employment outcome at closure. Significant predictors associated with an employment closure were (a) education, veteran status, and presence of a secondary area of disability impairment; (b) state-level per-capita income; (c) State VR specialized acquired brain injury (ABI)/TBI service and state TBI Implementation Partnership grant funding; and (d) State VR service expenditures on diagnosis and treatment, occupational or vocational training, on-the-job training, job readiness training, transportation, maintenance support, and benefits counseling. The practice, policy, and research implications of these findings are presented.

Vocational Rehabilitation and Labor Market Outcomes: Evidence from World War I Veterans

This article uses a linked sample of World War I Army veterans from the state of Missouri to study the impact of vocational rehabilitation on labor market outcomes for men wounded and disabled during the war. Veterans’ military service abstracts are linked to the 1940 US Census and a subset are linked to rehabilitation records. This creates a new dataset that contains information on military service, rehabilitation, and labor market outcomes. I find that 70 percent of veterans that were both wounded in action and disabled when discharged from the army participated in the rehabilitation program. These same veterans had significantly better labor market outcomes, which can be attributed to the rehabilitation program under certain assumptions.

Työeläkekuntoutuksen vaikuttavuuden kehittäminen ja työkykyajattelu

Artikkelissa tarkastellaan työeläkelaitosten rahoittaman ammatillisen kuntoutuksen eli työeläkekuntoutuksen toimivuutta ja kehittämistä työeläkelaitosten asiantuntijoiden haastatteluiden perusteella. Viimeaikaiset tutkimustulokset työeläkekuntoutuksen vaikuttavuudesta ovat herättäneet keskustelua erityisesti työpaikalla tapahtuvien lyhytaikaisten toimien kustannustehokkuudesta. Tätä taustaa vasten artikkelin painopiste on asiantuntijoiden esiin nostamissa kehittämisajatuksissa. Aineisto muodostuu työeläkelaitosten kuntoutusasiantuntijoiden ja vakuutuslääkärien haastatteluista. Aineisto sisältää kuusi laajaa haastattelua, joissa oli yhteensä 15 haastateltavaa. Menetelmänä käytetään temaattista sisällönanalyysia. Tutkimuksen teoreettinen viitekehys muodostuu erilaisista työkyvyn edistämisen malleista. Keskeisenä kehittämisen kohteena haastatteluissa pidettiin ensinnäkin panostamista työn muokkaamiseen työkokeilujen aikana ja erilaisiin jatkotoimenpiteisiin niiden jälkeen. Toiseksi työkokeiluja pidempiaikaisemmat kuntoutustoimenpiteet,kuten työhönvalmennus ja koulutus, nähtiin usein järkeviksi vaihtoehdoiksi kestävien työllisyysvaikutusten näkökulmasta. Kolmanneksi kuntoutuksen työllisyysvaikutuksia saattaisi haastattelujen perusteella parantaa erityisesti työeläkejärjestelmän, Kelan ja työvoimapalvelujen yhteistyön tiivistäminen. Artikkeli osoittaa, minkälaisiin työkyvyn edistämisen malleihin haastateltavien esittämät kehittämisideat kytkeytyvät. Abstract Improving the effectiveness of vocational rehabilitation under the earnings-related pension scheme and the concept of work ability. Study based on interviews with experts from earnings-related pension providersIn this interview-based article we examine the effectiveness of vocational rehabilitation financed by earnings-related pension providers and its development. Recent studies on the efficiency of vocational rehabilitation have raised discussions particularly on the cost-efficiency of short-term rehabilitation at the workplace. The focal area of this article is thus on the development ideas presented by the experts. The data is based on interviews with rehabilitation experts at earnings-related pension providers and insurance physicians. The dataset consists of six extensive interviews with a total of 15 interviewees. The data is analysed using thematic content analysis. The theoretical framework of the study consists of various models of work ability. As key areas that require improvement the interviewees pointed out adjusting work tasks during work try-outs and taking various further actions after completing work try-outs. Second, longer-lasting rehabilitation measures, such as job coaching and training, were increasingly seen as viable options to achieve sustainable employment effects. Thirdly, based on the interviews, the employment effects of vocational rehabilitation may be improved through, in particular, closer co-operation between the earnings-related pension system, Kela and employment services. The article shows which types of models of work ability the development ideas of the experts are connected to. Key words: vocational rehabilitation, work ability, effectiveness, co-operation, experts, interview study

Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with depression or anxiety: results from a three-arm, parallel randomised trial

ObjectiveThe aim of this study was to investigate an integrated mental healthcare and vocational rehabilitation intervention to improve and hasten the process of return-to-work of people on sick leave with anxiety and depression.MethodsIn this three-arm, randomised trial, participants were assigned to (1) integrated intervention (INT), (2) improved mental healthcare (MHC) or (3) service as usual (SAU). The primary outcome was time to return-to-work measured at 12-month follow-up. The secondary outcomes were time to return-to-work measured at 6-month follow-up; levels of anxiety, depression, stress symptoms, and social and occupational functioning at 6 months; and return-to-work measured as proportion in work at 12 months.Results631 individuals were randomised. INT yielded a higher proportion in work compared with both MHC (56.2% vs 43.7%, p=0.012) and SAU (56.2% vs 45%, p=0.029) at 12-month follow-up. We found no differences in return-to-work in terms of sick leave duration at either 6-month or 12-month follow-up, with the latter being the primary outcome. No differences in anxiety, depression or functioning between INT, MHC and SAU were identified, but INT and MHC showed lower scores on Cohen’s Perceived Stress Scale compared with SAU at 12-month follow-up.ConclusionsAlthough INT did not hasten the process of return-to-work, it yielded better outcome with regard to proportion in work compared with MHC and SAU. The findings suggest that INT compared with SAU is associated with a few, minor health benefits. Overall, INT yielded slightly better vocational and health outcomes, but the clinical significance of the health advantage is questionable.Trial registration numberNCT02872051.

Correlates of vocational outcomes of youth with co-occurring mental illness and substance use disorders: Evidence from a vocational rehabilitation program

Youth with co-occurring mental illness and substance use disorders are at higher risk for vocational rehabilitation exclusion. This study aimed to (a) explore the personal factors associated with vocational outcomes of youth with co-occurring mental illness and substance use disorders and (b) highlight services that have shown the greatest promise for this population in the state-federal rehabilitation program in the United States. Our analytic sample was extracted from the Rehabilitation Services Administration’s Case Service Report data set for 2013, 2014, and 2015 fiscal years. Multiple regression analyses results identified personal factors such as gender, race/ethnicity, level of education, and severity of disability as predictors of the achievement of competitive employment, hours worked, and income. The receipt of vocational rehabilitation services such as job search support, job placement assistance, vocational training, and on-the-job support are significantly associated with the achievement of competitive employment, higher work hours, and income. These finding have implications for vocational rehabilitation practice as they highlight who is at higher risk for poor outcomes, effective services, and additional factors to consider when working with youth with co-occurring mental illness and substance use disorders.

New approaches to the question of training for the system of comprehensive rehabilitation and habilitation of disabled

The article reveals the issues of personnel training for the formation of a system of comprehensive rehabilitation and habilitation of disabled / disabled children, early assistance to children and their parents, accompanied living, social and vocational rehabilitation, psychological rehabilitation, technical means of rehabilitation of disabled people. The purpose and main task of our research is to study the issues of personnel training from the standpoint of regulatory, scientific, methodological and practice-oriented support. The presented materials are relevant and significant at the present time. In the light of the modernization of federal and regional legislative acts, the need to provide quality assistance to persons with disabilities is increasing, which in turn requires the training of highly qualified personnel. The materials of the article use statistical data on the needs of all constituent entities of the Russian Federation in the preparation of their leaders and leading specialists for the implementation of these types of activities. The study analyzes the need for training personnel for the education system, health care, and social protection. The value of the materials presented will make it possible to develop new technologies and approaches to the personnel training system. The areas of work given in the article are of great practical value and indicate that the technologies offered by Saint-Petersburg Postgraduate Institute of Medical experts, employees are effective and can be multiplied on the territory of the Russian Federation. In the process of further research, it is planned to develop professional standards for specialists in the education system, health care and social protection in the field of comprehensive rehabilitation and habilitation of disabled people / disabled children, early assistance to children and their parents, accompanied by living, social and vocational rehabilitation, psychological rehabilitation, technical means of rehabilitation disabled people.

Effectiveness of Virtual Reality on Employment Training for Young Adults with Autism and Intellectual and Developmental Disabilities: A Systematic Review

The purpose of this study was to conduct a systematic review of the effectiveness of virtual reality on vocational rehabilitation for young adults with autism and intellectual and developmental disabilities (IDD). An electronic search was conducted among peer-reviewed English journals published from 1994 to 2018. Databases included CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, PsycINFO, Web of Science, EBSCO, and Scopus. Six primary studies employing group experimental (Gersten et al., 2005) or single-subject design (Horner et al., 2005) or pre-post design met the inclusion criteria. Each study was assessed for the presence and clarity of quality indicators according to Reichow et al.’s (2008) framework and definition. Results suggested that the use of virtual reality in vocational rehabilitation for young adults with autism and intellectual and developmental disabilities (IDD) “have established evidence-based practice”. Limitations, as well as implications for future research, practices, and policy, are discussed.

Vocational Rehabilitation Professionals’ Perceptions of Facilitators and Barriers to Return to Work: A Qualitative Descriptive Study

This is a qualitative descriptive study of professionals’ perceptions of facilitators and barriers for returning to work for women on long-term sick leave due to musculoskeletal pain and/or common mental disorder who participated in a vocational rehabilitation project. Data were collected through semi-structured interviews with 13 purposefully selected professionals from the Swedish Social Insurance Agency, the Swedish Public Employment Service, the health care services, and the municipal services. The interviews were analyzed with a manifest content analysis. The main facilitators were the close cooperation between the professionals and the individual support that was offered to the project participants. The main barriers were differences among the stakeholders’ missions and goals, limitation in project duration and within the labor market, and the project participants’ personal factors. These results emphasize the importance of cooperation between the professionals from the various stakeholders and focus on the individual’s resources and needs. The study highlights the value of including health care professionals in vocational rehabilitation to benefit from their specific knowledge of the target group and their strengths and needs. Moreover, the study highlights the need to incorporate collaboration with employers and align with the local labor market in the development of vocational rehabilitation interventions.