Abstract
Digital career literacy encompasses the skills needed to find and maintain employment in the modern job market. Unfortunately, many state vocational rehabilitation (VR) professionals report feeling unprepared to help their consumers with digital career literacy tasks. To address this gap, we developed and tested five training webinars with VR professionals in Montana, Alabama, and Washington. We randomly assigned VR offices to intervention or control group. VR professionals in the intervention group received access to the training webinars. We collected survey data at baseline and 4 months after the intervention’s conclusion (n = 136). A repeated measures ANOVA showed significant group by factor effects in counselor preparedness to use online tools during the VR process (intervention group: M1 = 24.41, SD1 = 7.62; M2 = 28.76, SD2 = 7.27; control group: M1 = 25.94, SD1 = 8.64; M2 = 27.21, SD2 = 9.14); F(1, 124) = 5.957, p = .016. A McNemar nonparametric test indicated that more VR professionals in the intervention group reported using LinkedIn at the 4-month follow-up, as compared with the control group (p = .039). There were no significant changes in use of other online tools. This may relate to administrative policies that do not provide clear guidelines for using online tools in the counseling process.
Keywords
Since its inception, vocational rehabilitation (VR) has helped people with disabilities find job opportunities and prepare for their careers (Elliott & Leung, 2005). Beginning as a program exclusively for injured World War I veterans (Elliott & Leung, 2005), VR now serves people with diverse disabilities (Rehabilitation Act of 1973, 2015). Just as the population VR serves has evolved since the early 20th century, so has means for connecting people with employment. In particular, the advent of online job boards and social media sites in the late 1990s has reshaped the employment landscape.
The importance of the Internet for finding and securing employment is highlighted in a recent Pew Research Center survey concluding that among people who reported looking for employment in the last 2 years, 90% researched job opportunities online and 84% applied for a job online (A. Smith, 2015). Furthermore, among the 65% of Americans who used social media, 35% said they used it to research job opportunities and 21% applied for a job they first learned about on a social media platform (A. Smith, 2015). Other benefits of using the Internet during job search may include decreasing the job search time and improving starting wages (Kuhn & Mansour, 2014).
Just as job seekers use the Internet of find and secure employment, businesses use it to recruit talent, screen potential hires, and improve their brand (Wolf, Sims, & Yang, 2015). A 2016 survey of hiring managers found that 43% used social media or search engines to screen job applicants, and 36% of respondents who used the Internet to learn more about a candidate indicated they screened out a potential hire because of information found online (Society for Human Resource Management, 2016).
Similarly, 256 hiring managers, human resource professionals, and recruiters across the United States, concluded that among decisions to reject an applicant were based on concerns about the candidate’s lifestyle (58%), inappropriate comments and text written by the candidate (56%), and unsuitable photos, videos, and information (55%; Cross-Tab: Transforming Market Research, 2010). A literature review did not turn up more recent or comprehensive surveys evaluating employer use of search engines to screen applicants, but in general, employers appear to give more weight to bad information than good information (Roth, Bobko, Van Iddekinge, & Thatcher, 2016). References to alcohol and drug use and poor spelling and grammar give a negative impression to future employers and posts about volunteer activities or family tend to be viewed favorably (Bohnert & Ross, 2010; Schawbel, 2012).
Despite the emphasis on using Internet platforms for screening job candidates, there is little evidence that information found online accurately predicts whether or not an applicant will be a good hire (Roth et al., 2016). Kluemper, Rosen, and Mossholder (2012) concluded that it is possible for independent evaluators to come to the same conclusion about key personality traits when reviewing information found on social media platforms. However, they could make no prediction about whether or not that person would be a successful employee. Furthermore, social media sites tend to encourage a culture of exaggeration that may not be representative of the applicant’s actual behavior (Buffardi & Campbell, 2008; W. P. Smith & Kidder, 2010).
To conceptualize the increased role of the Internet for finding and obtaining employment, Hooley (2012) coined the term, digital career literacy. Digital career literacy is defined as, “the ability to use the online environment, to search, to make contacts, to get questions answered, and to build a positive online reputation” (Hooley, 2012, p. 5). It is founded on the intersection of the concepts of informational and digital literacies and career management skills. Information literacy describes the ability of the individuals to find, access, and utilize new information. Digital literacy applies the concept of information literacy to the digital environment and can be described as an individual ability to use digital tools, create online content, and interact effectively online (Hooley, 2012). Finally, career management skills are the lifelong skills people need to manage and develop their careers and include a host of competencies from mastering academic, occupation, and general employability skills to developing positive interpersonal skills (Hooley, Watts, Sultana, & Neary, 2012).
Given the increased prevalence of the Internet in everyday life, most people report confidence with a variety of digital career literacy tasks from searching for jobs to designing an online resume (A. Smith, 2015). However, there are some notable exceptions. Thirty percent of people who had a high school diploma or less did not feel confident creating a professional resume or highlighting their employment skills on the Internet. These statistics were mirrored among people who were not currently working for pay—28% said they did not feel comfortable creating a professional resume online, and 27% said they did not feel confident highlighting their employment skills online (A. Smith, 2015). Together, these statistics reflect a gap in digital career literacy that further marginalizes an already disadvantaged population (Hooley, 2012; Newman, Browne-Yung, Raghavendra, Wood, & Grace, 2016).
Many VR consumers represent the population of people who are not working for pay and who have a high school diploma or less (Hayward & Schmidt-Davis, 2003; Rehabilitation Services Administration, 2013). VR professionals could play an important role in addressing poor employment outcomes exacerbated by the digital divide, however, many state VR professionals report being unprepared to help because of structural and knowledge barriers (Goe & Ipsen, 2016). A survey of 1,432 VR professionals concluded that nearly 40% of respondents were blocked from using social media at work and many reported feeling unprepared to help with a variety of digital career literacy tasks such as helping consumers improve their online reputation. Younger VR professionals reported feeling more prepared than older VR professionals. However, some of the differences in preparedness scores were mediated with training about using social media during the VR process but only 37% (n = 538) of the sample indicated that they received any training to use online job boards or social media sites (Goe & Ipsen, 2016).
Lack of training and preparedness to use online platforms to help people find employment is mirrored in studies of other career service agencies. Osborn and LoFrisco (2012) found that among 161 career centers on university campuses in the United States, many respondents were hesitant to use social media because they did not understand how it worked. This same study reported that respondents primarily used social media for communicating information. This finding represents a limited view of the potential use of social media as a career tool. A qualitative study of 16 career services practitioners in Finland and Denmark explored the potential of social media use by asking respondents how they currently use social media in their practices. They found that although many practitioners reported using social media primarily for sharing information or for one-to-one communication, some discussed using it as an interactive workspace and as a space to renegotiate the relationship between the provider and the job seeker (Kettunen, Vuorinen, & Sampson, 2015).
The diversity of uses and reported unpreparedness to use these tools in providing career services highlights a need for more training for career service professionals. Other helping professions, particularly mental health counseling, have already started addressing this issue. Beginning in the early 2000s, mental health professionals began exploring ways to train counselors about online therapy using online learning platforms (Anthony, 2015; Jones & Stokes, 2009). However, one of the biggest challenges of training professionals about using online tools in their practices is that the Internet is constantly evolving. As Anthony (2015) points out,
Courses need to be updated constantly to keep up with the new issues that emerge for clients on a seemingly daily basis and the wealth of information that practitioners need to be aware of—ethically, practically and theoretically—is both overwhelming and confusing. (p. 38)
VR professionals are beginning to consider the impact online tools have on the counseling process and on the counselor–consumer relationship. This is evidenced by the 2017 Commission on Rehabilitation Counselor Certification (CRCC) code of ethics outlining how technology and social media should be used during the counseling process. It includes information about guaranteeing the accessibility of online platforms and only viewing consumers’ social media platform with consent and whether it is relevant to the rehabilitation counseling process (CRCC, 2016).
This study begins a conversation about whether or not an online training can better prepare VR counselors to help their consumers with digital career literacy skills to find and maintain employment. The focus of this study was not to evaluate an overly prescriptive training, because best practices and platforms are always evolving, but rather to explore whether an online training can increase preparedness to use online tools during the VR process.
We identified two primary hypotheses.
Method
Research Design
We invited three state VR agencies in Washington, Montana, and Alabama to participate in the study. These states were recruited based on their willingness to release staff time to participate in the intervention and to allow employees access to social media sites while at work. According to their 2015 state plans, Alabama Department of Rehabilitation Services employed a total of 188 rehabilitation counselors, field supervisors, and specialists; Montana Vocational Rehabilitation and Blind Services employed 47 counseling staff and 24 field support staff; and Washington Division of Vocational Rehabilitation employed 126 VR counselors.
Each state agency provided a list of all the VR offices in their state along with the name and contact information of each employee working in those offices. Research staff numbered each office and randomly assigned offices to an intervention or control group using a random number generator. We randomized offices, rather than individuals, to reduce the chance of contamination between the intervention and control group. All VR professionals in both the control and intervention groups (N = 400) were invited to take an online survey about their use and perceptions of social media and online job boards at baseline and 4 months after the interventions conclusion. We chose the 4-month follow-up time to accommodate the rapidly evolving nature of digital career literacy tools. The 4-month follow-up time allowed VR professionals to complete the training and practice what they learned, while being short enough to ensure that training elements were still relevant.
VR professionals in offices assigned to the intervention group were invited to attend the series of five live training webinars. Each of the five training webinars was 1.5 hr long, and training topics rotated on a weekly basis for a total of 5-week training period. Live trainings were offered at various times over the course of the week to encourage attendance and accommodate work schedules. Intervention participants also had access to recorded versions of the training if they were unable to attend live webinars. Control group participants did not have immediate access to the webinar series, but were offered access to a recorded version after the 4-month data collection period ended. Online trainings were delivered via Adobe Connect and were live captioned.
Recruitment
We invited all VR professionals (including counselors, field supervisors, and specialists) from state VR agencies across Montana, Alabama, and Washington to participate in the research study. Of these, 201 were assigned to the control group and 199 were assigned to the intervention group. Initially, we relied on Qualtrics to distribute and match baseline and 4-month follow-up surveys based on participant email addresses. This strategy did not work because state firewalls blocked Qualtrics solicitations. Instead, VR directors in participating agencies forwarded survey and training webinar links to their employees.
Intervention
The online training was informed by a baseline survey about counselors training and preparedness to use digital career literacy tools with their consumers (Goe & Ipsen, 2016). Kristen Jacoway Beasley from Career Design Coach developed and delivered the training with input from research staff, state VR professionals, and state VR consumers. Mrs. Jacoway Beasley is a state VR counselor, author, and experienced trainer in digital career literacy, and she has delivered trainings to state VR agencies across the country. Mrs. Jacoway Beasley drafted an outline for four of the five training webinars. The fifth training webinar focused on the Talent Acquisition Portal (TAP) and was developed by the Counsel of State Administrators of Vocational Rehabilitation. TAP is an online job board available exclusively for state VR counselors. It is a subscription-based service where employers can advertise job vacancies and view the resumes of state VR consumers. The intervention content was reviewed by three current and past VR consumers via a telephone focus group, and with the National Employment Team Points of Contact (NETPoC, n = 80) through an email solicitation.
The training outline was well received and reaffirmed the need for training on the use of online tools during the VR process. Based on feedback, additional content was added about the accessibility of mobile and desktop social media applications and talking with consumers about their online identity even if their parent agency restricts access to social media on state computers. Table 1 presents an outline of the training topics.
Topics Covered in Each of the Five Live Training Webinars Presented as Part of the Online Career Development Training.
Note. VR = vocational rehabilitation; TAP = Talent Acquisition Portal.
Measures
To test our research hypotheses, we developed an online survey similar to one used in a larger study of 1,437 VR professionals about their use and perceptions of social media and online job boards during the VR process (Goe & Ipsen, 2016). The survey included 47 items. However, many questions were branching so not all respondents answered all the questions. Questions asked about the use and access to online job boards and social media sites while at work, preparedness to use online job boards and social media sites, and perception of using online platforms during the VR process. The baseline survey was identical to the 4-month follow-up survey and was administered using Qualtrics.
Use of social media
One item asked respondents to endorse all the social media sites they use while at work including Facebook, LinkedIn, Twitter, YouTube, Pinterest, Instagram, other, and none. The remaining items asking about social media use only asked about Facebook and LinkedIn, the two most popular social media sites. Respondents indicated how frequently they used (daily, weekly, monthly, less than monthly, and never) both Facebook and LinkedIn while at work.
A series of 12 items asked about how respondents used Facebook and LinkedIn at work. These questions focused on maintaining relationships with consumers, connecting with businesses, and maintaining relationships with other VR counselors.
Preparedness
A series of nine items evaluated how prepared VR professionals felt to help their consumers with a variety of digital career literacy tasks. Items ranged from the basic, “how prepared are you to help consumers research job opportunities online,” to the more complex, “how prepared are you to help your consumer develop an online professional brand.” See Table 2 for a complete list of all nine preparedness items.
Results of a Series of Wilcoxon Signed-Ranks Test Evaluating Preparedness of Participants in the Control and Intervention Groups to Complete a Variety of Different Online Job Development Tasks With Their Consumers.
Note. MD1 = median at baseline; MD2 = median at the 4-month follow-up; a score of 1 = very unprepared; a score of 5 = very prepared.
Perception
To understand VR professionals evolving attitudes about digital career literacy, we asked five questions about their perception of these tools. These questions focused on privacy, the counselor/consumer relationship, ethics, and policy. See Table 3 for a complete list of the perception items.
Results of a Wilcoxon Signed-Ranks Tests Evaluating Participants in the Control and Intervention Groups.
Note. MD1 = median at baseline; MD2 = median at the 4-month follow-up; a score of 1 = strongly disagree; a score of 5 = strongly agree. VR = vocational rehabilitation; HIPAA = Health Insurance Portability and Accountability; ADA = Americans with Disabilities Act.
Study Participants
At baseline, 258 people completed the survey, and at follow-up, 211 respondents completed the survey. Although we asked for unique phone numbers as a way to match pre- and postsurveys, we could only match data for 136 respondents due to shared phone lines resulting in a final overall response rate of 34% (n = 136). Of these, 73 (53.7%) were assigned to the intervention group and 63 (46.3%) were assigned to the control group. Reported data analyses include the 136 respondents who provided pre- and posttest data. A series of chi-square analyses indicated that there were no statistically significant differences between people who only completed the baseline survey and people who completed both surveys in terms of age, agency they worked for, duration of employment, or job title.
At baseline, participants worked as counselors (n = 106, 78%), supervisors (n = 11, 8.0%), employment consultants (n = 9, 6.6%), or other (n = 9, 6.6%). Half of the participants had worked in their position for six or more years (n = 68, 50.4%), and the remaining worked 4 to 5 years (n = 24, 17.8%), 2 to 3 years (n = 21, 15.6%), 1 year (n = 8, 5.9%), or less that 1 year (n = 14, 10.4%). Participants reported being 18 to 29 (n = 9, 6.6%), 30 to 49 (n = 75, 55.1%), 50 to 64 (n = 49, 36.0%), and 65+ (n = 3, 2.2%) years of age. Most participants reported serving a mixed rural/urban caseload (n = 70, 51.4%). More than half of the sample reported being blocked by their parent agency policies from using one or more social media sites while at work (n = 70, 51.4%). At baseline, a chi-square analysis indicated that there were no significant differences between the control and intervention groups in terms of age, agency of employment (Montana, Alabama, or Washington), duration of employment, and rural/urban caseload.
Results
Attendance
At follow-up, 69 intervention participants attended one or more trainings (94%). Of these, 49 attended five trainings (67%), 14 attended four trainings (19%), three attended three trainings (4%), one attended two trainings (1%), two attended one training (3%), and four did not attend any training (6%). We created a variable for dosage by collapsing the number of sessions attended into three categories: (a) attended no trainings; (b) attended one, two, or three trainings; and (c) attended four to five trainings. Chi-square analyses did not show any significant demographic differences based on training dosage.
Social Media Use
At baseline, respondents in both the intervention and control groups indicated that LinkedIn (30.9%, n = 42), Facebook (23.5 %, n = 32), and YouTube (16.9%, n = 23) were the three most popular social media sites used for work. Less than 10 people reported using Twitter, Instagram, Pinterest, or other social media sites at work. We combined these individual items to create a new variable for the total number of social media sites used. At baseline, the intervention group reported an average social media use score of .89 (n = 73) and the control group reported an average social media use score of .76 (n = 63). Both groups showed more social media use at follow-up (M = 1.0 and .87, respectively). Observed differences were not significant.
We conducted nonparametric tests to look for differences in pre- and posttest use of LinkedIn, Facebook, or YouTube, the most commonly endorsed social media platforms. The McNemar test statistic for independent and dependent dichotomous variables indicated that significantly more people in the intervention group used LinkedIn at follow-up (p = .039). No significant difference in use was observed at follow-up in the control group (p = .289).
Participants who indicated they used Facebook and LinkedIn at work described how frequently they used these platforms to perform various tasks within the VR process. The 11 items had three response options: (a) routinely, (b) occasionally, and (c) rarely/never. At baseline, 23.5% (n = 32) said they used Facebook and 30.9% (n = 42) said they used LinkedIn for work. At follow-up, 25.7% (n = 35) said they used Facebook and 33.8% (n = 46) said they used LinkedIn. Because of the small number of respondents using Facebook and LinkedIn, we collapsed routinely/occasionally into a single response to create a dichotomous variable and ran a series of chi-square analyses to look at differences in how use changed at follow-up. At baseline, there were no significant differences in use between the intervention and control groups. At follow-up, a chi-square analysis indicated that significantly more participants in the intervention group used Facebook to stay in contact with other VR counselors (χ2 = 4.361, p = .036) and to assess a consumer’s online reputation (χ2 = 4.80, p = .031). For LinkedIn, more people in the intervention group used it to develop relationships with local employers (χ2 = 4.945, p = .028).
Preparedness
Respondents rated nine questions about their preparedness to help consumers with a variety of digital career literacy tasks on a five-point scale from one being very unprepared to five being very prepared. Responses were not normally distributed, so we used nonparametric statistics to evaluate baseline to follow-up comparisons. The nonparametric Wilcoxon signed-ranks test indicated that people in the intervention group felt significantly more prepared to help consumers with seven of the nine digital career literacy tasks. Respondents in the control group showed significant improvement on one of the nine items. Table 2 displays preparedness results for the intervention and control groups.
We combined nine preparedness items to create an overall preparedness score at baseline and follow-up with scores ranging from 9 to 45. A repeated measures ANOVA indicated that overall preparedness scores for people in the intervention group (M1 = 24.41, SD1 = 7.62; M2 = 28.76, SD2 = 7.27) improved significantly compared with the control group (M1 = 25.94, SD1 = 8.64; M2 = 27.21, SD2 = 9.14); F(1, 124) = 5.957, p = .016.
Perceptions of Online Career Development Tools
We evaluated VR professional perceptions of the importance of digital career literacy during the VR process with five items rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). At follow-up, a nonparametric Wilcoxon signed-ranks test indicated that people in the intervention group showed higher agreement ratings on three statements indicating that their perception of digital career literacy has improved. Control group participants did not show any significant change in their agreement. Table 3 displays these results.
Discussion
The results of the study partially confirm the study hypotheses. A series of nine questions evaluated how prepared counselors felt to help consumers with different digital career literacy tasks (see Table 2). The intervention group felt significantly more prepared on seven of the nine items. Respondents did not show improvement on two items including researching job opportunities online and posting resumes to online job boards or resume websites. Both these items focused on online job boards. It is possible that state VR professionals may have already felt comfortable using these tools. Online job boards are essentially the modern iteration of newspaper classifieds and the skills needed to use them may be more accessible to VR professionals (Goe & Ipsen, 2016). On a third item, changing consumers’ privacy settings on social media sites, respondents showed significant improvements in both the control and intervention groups. It is unclear why this significant change occurred in both groups. One explanation is continued media attention surrounding privacy on social media sites.
Interestingly, preparedness did not necessarily translate into use. With the exception of LinkedIn, there were no significant changes in social media use. The significant change in LinkedIn use is noteworthy. Following Session 1, participants were asked to create a LinkedIn account and Session 2 was devoted to optimizing that account. Given the intensive focus of the training on LinkedIn, it is not surprising that LinkedIn use changed significantly. The potential relationship between directing VR professionals to create a LinkedIn account and using LinkedIn for work may suggest that VR administrators need to encourage the adoption of digital career literacy tools to increase VR professional’s competency. A good first step might be unblocking social media sites, because more than half (53%, n = 70) of the respondents indicated that they could not access one or more social media sites while at work.
Although the number of social media users did not change significantly from baseline to follow-up, how users engaged with social media at work did. At both baseline and follow-up, the two most frequently cited reasons for using Facebook and LinkedIn focused on staying connected with consumers for both the intervention and control groups. At follow-up, however, significantly more people in the intervention group reported using Facebook to stay connected with other VR professionals and to assess a consumer’s online reputation. Significantly more respondents at follow-up reported using LinkedIn to connect with local businesses. The different uses of Facebook and LinkedIn largely reflect their intended use. Facebook encourages users to provide personal updates about their lives and provides a space where online blunders, in terms of inappropriate photos or posts, are more likely to occur. LinkedIn, however, is designed as a professional social networking site where employers and business professionals communicate about job-related topics.
Using LinkedIn to connect with employers is encouraging. Recent legislation directs VR agencies to help employers hire and retain skilled workers with disabilities and LinkedIn may be a good platform for helping VR agencies achieve this directive. However, although the popular media lauds LinkedIn as an important tool for connecting with employers, there has been little effort to quantify this assumption in the academic literature. Although LinkedIn is a promising platform, VR agencies and researchers should consider quantifying their efforts and documenting best practices going forward.
Together the results of this study are promising because they suggest the training helped VR professionals see the value of social media as a digital career literacy tool rather than simply another strategy for tracking down consumers they have lost touch with. This is reflected again in improved perceptions of digital career literacy tools. Participants in the intervention group showed significantly improved perceptions on two items: (a) I understand how employers might discriminate against consumers based on information they find on social media sties and (b) I am aware of my ethical obligations as a VR counselor. Again, this reflects the ability of a tailored training to improve VR professionals understanding of digital career literacy.
Implications for Rehabilitation Counselor Training
As is evidenced by strong attendance in the intervention sessions, VR professionals seemed interested in learning about online career development. Furthermore, this study demonstrates that online training can increase their preparedness to use online tools. However, social media platforms are constantly changing and there is a need for ongoing training opportunities. Future research should consider the best ways to reach VR professionals on an ongoing basis that addresses the evolving nature of social media platforms. This study suggests that brief online training may be a good platform for reaching VR professionals.
This training was delivered in the fall of 2015, prior to the publication of the new CRCC code of ethics (CRCC, 2016). The new code includes more direction on how social media and other online tools should be used during the counseling process. In particular, the CRCC code states that VR counselors should only view consumers’ social media profiles with the expressed consent of the consumer and only if it is “relevant to the rehabilitation counseling process” (CRCC, 2016, p. 32). Future training about digital career literacy for VR counselors should thoroughly review the CRCC code of ethics.
Although attending a training about online career development increased preparedness to use these tools, preparedness did not translate into use. One factor that may have contributed to this outcome is the short time frame for follow-up. Learning about a practice and becoming proficient and confident with it are different. Future research should focus on how to encourage the adoption and incorporation of tools into practice. This may include involving VR administrators and making changes at the policy level. One policy level change that may greatly influence use is allowing VR professionals to access social media sites at work and to encourage continuing education on the topic.
Study Limitations
The primary limitation of this study is the sample size. We ended up with a smaller sample than expected because of a technical error resulting in an inability to match data for pre- and posttest survey respondents. In addition, more respondents in the intervention group than the control group responded to the survey. Although the difference was not significant, it may have resulted in some response errors.
To reduce threats to external validity, we randomized local VR offices, rather than individuals, to the intervention or control group. This limited the chance of the control group’s exposure to intervention materials. However, it is possible that discussions about intervention material occurred across offices. This could partially explain some of the unexpected changes in control group behavior such as significantly improved confidence in their ability to advise consumers’ about privacy settings on social media sites.
Conclusion
VR professionals are interested in using online tools to help their consumers reach their employment goals. However, state VR professionals report feeling unprepared to help consumers navigate the nuances of these tools. The research presented here demonstrates that brief and focused online training is convenient for state VR professionals and can improve their preparedness to use online career development platforms. However, in this study, preparedness did not necessarily translate into use. This may be explained by lack of policies at the administrative level, encouraging the adoption of online career development tools in VR counseling practice. Online career development tools will likely play an increasingly important role in finding employment and advancing careers. VR agencies across the country will need to think about how to address this new competency as they train current and future generations of VR professionals.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by Grant H133B130028 from the National Institute on Disability, Independent Living, and Rehabilitation Research within the Administration on Community Living, U.S. Department of Health and Human Services.
