Vocational outcomes of people with alcohol abuse/dependence who received state vocational rehabilitation services

Abstract

BACKGROUND: Vocational rehabilitation for people with alcohol abuse/dependence can help individuals access and maintain employment, and further enhance physical and psychological health and well-being.

OBJECTIVE: To examine demographic and rehabilitation service patterns affecting employment outcomes of consumers with alcohol abuse/dependence in state vocational rehabilitation agencies.

METHODS: The sample included 7,798 persons (74% men and 26% women) with alcohol abuse/dependence who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2009. Mean age of participants was 40.1 years (SD = 10.2). The dependent variable was employment outcome. The predictor variables include a set of demographic variables and vocational rehabilitation service variables.

RESULTS: The chi-squared automatic interaction detector (CHAID) analysis indicated that counseling and guidance services significantly enhanced competitive employment outcomes. The study also revealed the underutilization of job related services for assistance in finding employment, gaining employment, and retaining employment (e.g., job search assistance, job placement, and on-the-job supports). Also, an underutilization of training type services such as on-the-job training, miscellaneous training, occupational/vocational, and college or university training were revealed in serving consumers with alcohol abuse/dependence.

CONCLUSIONS: The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, rehabilitation service patterns, and competitive employment rates ranging from a low of 41% to a high of 76%, and these differences can be explained by rehabilitation service patterns.

Keywords

Vocational rehabilitation alcohol abuse substance abuse RSA 911 employment outcomes CHAID

1 Introduction

Consumers who have alcohol abuse/dependency disabilities face unique barriers during the vocational rehabilitation process. One of the greatest potential barriers that a person with alcohol abuse/dependence faces during the rehabilitation process is the continued abuse of the actual alcohol and potential misuse of other substances (Platt, 1995). Hence, continued support after alcohol treatment is crucial “to prevent the exacerbation of the condition or relapse” (Glenn et al., 2011, p. 15). When consumers begin vocational rehabilitation, generally after some type of treatment, they are operating within “the existence of a chronic, complex, psychological and behavioral disorder” that is associated with excessive and compulsive drinking (Britten, 1984, p. 47). Furthermore, because alcohol abuse/dependence is “chronic in nature...recovery can be a lifetime challenge” (Glenn et al., 2011, p. 8). In turn, the very nature of a “chronic” and “complex” disorder coupled with the psychological and emotional difficulties can interfere with vocational functioning (Schottenfeld, Pascale, & Sokolowski, 1992) and can add layers of complexities and challenges to the VR process. Vocational rehabilitation programs are able to enhance the recovery of people with substance abuse disabilities (Hitchen, 2001), yet policy makers have also long understood that substance abuse issues can negatively impact the entire VR service delivery process (Glenn et al., 2011). There are many complications associated with alcohol abuse/dependence.

1.1 Vocational rehabilitation and alcohol abuse/dependence

Vocational rehabilitation consumers at risk of alcohol-abuse relapse may face difficulties in any or all of the following areas: gaining employment, retaining employment, and finding employment that will match skills, education, and experience (Schottenfeld et al., 1992). Furthermore, people who are returning to work after maintaining sobriety may be worried about being able to handle the demands of employment while staying sober. After employment has commenced, difficulties with attendance, staying organized, concentrating, handling day-to-day stress, meeting deadlines, and maintaining stamina throughout the day can all be ongoing issues (Batiste, 2005a; 2005b; Walls, Moore, Batiste, & Loy, 2009).

Financial issues may affect attaining proper work attire, though there may be greater financial issues than just having the proper clothes for work. For instance, the inability to afford adequate shelter, including a safe place to sleep and shower, and the need for adequate food are other financial concerns. Another major barrier to attaining and maintaining employment may be lack of funds for transportation and related expenses such as car payments, repair expenses, and gas. A study by Hollar (2008) found that transportation expenses may be a particular barrier for consumers with substance abuse disorders. In other studies, transportation needs for employment have emerged “as a significant issue for VR consumers in general” (Hayward & Schmidt-Davis, 2003a; Hayward & Schmidt-Davis, 2003b). To further complicate matters, people who have alcohol abuse/dependence issues oftentimes have legal issues and may not be allowed to drive a car (so transportation again may be an issue), or have other parole obligations to meet.

A person who has abused alcohol for a prolonged period of time may have many challenging and exacerbating medical conditions, and may lack the ability to pay for needed medical care. These issues can have an effect on employment through “susceptibility to accidents and injuries, high levels of sick time use, frequent absences/tardiness, irregular performance, difficulty learning new tasks, deficits in gross motor functioning, intoxication on the job” (Glenn et al., 2011, p. 16). To illustrate, once on the job, research has shown that there has been a negative impact of substance abuse disorders on employment in the areas of workplace accidents, extended sick times, and worker’s compensation claims (Glenn & Keferl, 2008; Janikowski, Cardoso, & Lee, 2005). Furthermore, people who have alcohol abuse/dependency issues oftentimes have a poorer self-esteem, “which has been rationalized by denial, excuses, and related external manifestation” (Britten, 1984, p. 47).

1.2 Employment outlook and alcohol abuse/dependence

For VR consumers with abuse/dependency disabilities, “the early months after completion of the treatment center program are crucial” for vocational rehabilitation to occur (Britten, 1984, p. 48). Consumers with alcohol abuse/dependence may “lack a career plan and have unrealistic goals” (Bakken, 2005, p. 9). To further complicate matters, lack of education and/or training (Platt, 1995), a gap in work history, a lack of skills and/or professional work references, and legal records/issues can pose significant challenges to attaining and maintaining employment. The Vocational Rehabilitation public program whose primary directive is to assist individuals with disabilities to successfully obtain and maintain competitive employment (Bolton, Bellini, & Brookings, 2000), consistent with their strengths, resources, priorities, concerns, abilities, and capabilities (Dowdy, 1996) is ideal to assist these individuals to attain and maintain employment.

There have been several studies that have examined vocational rehabilitation outcomes for individuals with substance use disorders (Chronister et al., 2008; Hollar, 2008; McAweeney et al., 2008; Walls et al., 2009). Although a few studies have explored vocational rehabilitation outcomes for consumers with substance abuse disabilities, an even smaller amount of research has examined alcohol abuse/dependence disabilities exclusively. Alcohol abuse/dependency pose unique challenges for vocational rehabilitation counselors because of both the range of factors that facilitate the use and the “host of issues that inhibit the acquisition and maintenance of sobriety” (Cardoso, Wolf, & West, 2009, p. 39). Furthermore, alcohol abuse/dependence disabilities may remain hidden in the intake process and never be considered as a secondary disability. Rehabilitation counselors are often not equipped to address the wide array of concerns presented by this population (Moore & Keferl, 2008).

A number of studies have examined employment outcomes for varying disability groups subsequent to receiving state VR services, including specific learning disabilities (Gonzalez, Rosenthal, & Kim, 2011) orthopedic disabilities (Chan et al., 2006), and spinal cord injury (Marini et al., 2008), and individuals with sensory/communicative, physical, and mental impairments (Dutta et al., 2008). The aforementioned authors concluded that public support, adequate transportation, counseling, assistive technology, and job placement were indicative of successful employment outcomes. The purpose of this study was to explore the predictive relationships of consumer characteristics and service delivery patterns in order to determine factors influencing employment rates for state vocational rehabilitation consumers with alcohol abuse/dependence as the primary cause of disability.

2 Method

2.1 Participants

The data for this research were extracted from the Rehabilitation Service Administration Case Service Report (RSA-911) fiscal year (FY) 2009 dataset. The RSA-911 data consist of demographic data and services received by individual consumers served, in addition to employment outcomes. The cases with the Primary Disability Cause Code 02 “alcohol abuse/dependence” were extracted from the RSA-911 data for this analysis. The disabling impairments secondary to alcohol abuse/dependence included in this study were cases with psychosocial impairments (i.e., interpersonal and behavioral impairments, and difficulty coping), and other mental impairments comprised the majority of cases. The sample included 7,798 consumers with alcohol abuse/dependence as the primary cause of disability. The consumers were predominantly male (73.8%). Mean age of consumers was 40.14 years (SD = 10.16). It is noteworthy that the age range 25–54 or 85.1 percent comprised the majority of the sample. Most of the consumers had a severe disability (94.6%), while 422 (5.4%) had a non-severe disability. The majority of the sample were European American (57.4%), while 32.8% African American, and 6.2% were Hispanic. Of the five racial groups, Native American 206 (2.69%) and Asian American were the smallest 54 (0.7%). Most of the consumers had completed a high school education, 46.4 percent of sample having reported being a high graduate or having earned an equivalency certificate, while 23.0% reporting having no high school diploma, 0.8% reporting having a special education certificate/diploma, and 12.7% having completed either an associate’s degree or technical school or a bachelor’s degree or greater. With respect to employment, approximately 85.5% of the sample was not employed at application, while 14.5% was employed at application. The average duration between application and acceptance for services was 1 month (SD = 1.31), the average duration between eligibility and case closure was 21.03 months (SD = 20.64), and the average number of services received was 4.35 (SD = 2.117). The average case expenditure was $2,416.14 (SD = $3,616.25).

2.2 Selection of variables

The primary goal of public vocational rehabilitation is the attainment or retention of competitive employment for individuals who were determined eligible for vocational rehabilitation services. Accordingly, the criterion variable for this study was the vocational rehabilitation outcome, a categorical variable with two levels (competitively employed and not competitively employed). For data analysis, individuals closed as competitively employed are coded as “1” and individuals closed as not competitively employed are coded as “0.”

The predictor variables included two sets of variables: demographic variables, and rehabilitation service variables. The demographic variables included gender (male or female), race/ethnicity (European American, African American, Hispanic/Latino, Native American, or Asian American), disability type (alcohol abuse/dependence), age (16–24, 25–34, 35–44, 45–54, and 55>), and education (special education, less than high school, high school graduate, associate’s degree, and bachelor’s degree or greater). Relative to the rehabilitation service variables, there are 22 rehabilitation service variables available in the RSA-911 dataset. However, this study examined 13 of these variables. Specifically, chi-square statistics were computed for each of the 22 rehabilitation service variables to determine if a significant relationship existed between the rehabilitation service variable and the employment outcome (dependent variable). Variables withp ≤ 0.05 are considered indicators of a significant effect of the independent variable on the dependent variable. The p-value is compared to selected alpha level (0.05 in this case) and, if smaller, the correct interpretation would be that the independent variables reliably predict successful employment outcome. Conversely, if the p-value is greater than 0.05, interpretation would be that the independent variable does not reliably predict successful employment outcome. Accordingly, the results of the chi-square analysis reduced the rehabilitation services. In short, of the 22 rehabilitation service variables, 13 were significantly related to the outcome variable and selected for this study. Table 1 summarize the results of cross-tabulation with chi-square analysis.

The following rehabilitation service (coded as 1 = Yes, 0 = No) variables were found to be statistically significantly associated with an employment outcome: vocational rehabilitation counseling and guidance, assessment, diagnosis and treatment, job placement assistance, other services, maintenance, job search assistance, information and referral services, miscellaneous training, occupational and vocational training, on-the-job supports, college/university training, and on-the-job training.

2.3 Statistical analysis

Descriptive and inferential analyses were conducted using SPSS. Exhaustive CHAID was used to build classification trees. CHAID uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (i.e., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the outcome variable. The degree of differentiation is illustrated sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation consumers could be identified in terms of their observed levels on the outcome variable. The alpha level for all statistical tests was controlled at the 0.05 level, corrected for the number of statistical tests within each predictor, using a Bonferoni correction (Kosciulek, 2004).

A decision tree was built to represent those demographic variable combinations most likely to result in different probabilities of employment outcomes. The exhaustive CHAID analyses addressed the following research question: What consumer demographic characteristics and service delivery patterns predict the likelihood of successful employment outcomes for consumers with alcohol abuse/dependence?

3 Results

3.1 Descriptive statistics

The competitive employment rate (successful outcome) for the overall sample (N = 7,798) used in this analysis was 54.8% (4,277 of 7,798), with 45.2% not employed (unsuccessful outcome). Notably, the success employment rate for this sample of consumers was appreciably higher (55%) than the overall employment rate (30.7%) of people with disabilities in the general population. Women demonstrated a marginally higher competitive employment rate (56.2%) than men (54.4%); Hispanic had higher competitive employment rates (60.0%) than African American (54.7%), European Americans (54.5%), Native Americans (52.9%), and Asian Americans (51.9%). For this study, “success employment rate” is operationalized by the number of consumers (N = 7,798) closed competitively employed having received rehabilitation services to attain or maintain employment. Table 2 summarizes employment rates of consumers by gender, race, age, education level, and severity of disability.

3.2 Data mining results

Results from the Exhaustive CHAID analysis revealed a risk of false classification of 41.73% and a risk of 42.2% for cross-validation. The overall correct classification accuracy of 58% is a slight improvement over the base rate of 55% (i.e., the employment rate of the sample). In general, the predictors were better at predicting vocational rehabilitation consumers who were closed as competitively employed (85.5% accuracy) than for predicting those who were closed as unemployed (25.2% accuracy). The decision tree included four levels and segmented the sample into 14 subgroups, with employment rates ranging from a low 41% to a high of 76%. Of the predictor variables used in this study, the exhaustive CHAID analysis identified the following variables as the most likelihood predictors for a successful employment outcome for consumers with alcohol abuse/dependence: vocational rehabilitation counseling and guidance, job supports, assessment, on-the-job training, job placement, other services, and maintenance. The most significant predictor of employment outcomes was vocational rehabilitation counseling and guidance. Consumers who received vocational rehabilitation counseling and guidance services (n = 3,004) had a significantly higher competitive employment rate (58%) compared to 49% of consumers who did not receive this service (n = 1,273). For this study, relative to consumer demographics, it is noteworthy that gender, race and ethnicity, age, and educational level are not statistically significant predictors for a successful employment outcome for consumers with alcohol abuse/dependence.

Figure 1 shows the left side split of the decision tree depicting competitive employment rates of the sample of participants who received vocational rehabilitation counseling and guidance services, while the right side split of the decision tree depicting competitive employment rates of the sample of participants who did not receive vocational rehabilitation counseling and guidance services. The successful employment rates are indicated at each level.

3.3 Predicting successful employment outcomes

The gains chart presented in Table 3 shows the top six subgroups found to have approximately 1.0 (or higher) times the likelihood of competitive employment of the overall sample. These groups’ competitive employment rates range from 56% to 76% which are a significant improvement over the base rate of 55%. The following is a description of the six subgroups that had the highest likelihood for successful employment for consumers with alcohol abuse/dependence.

3.3.1 Node 8

This group represents 260 consumers with an employment rate at 76% who had received vocational rehabilitation counseling and guidance (e.g., personal adjustment counseling), job supports (e.g., job coaching, follow-up and follow-along), and assessment (e.g., trial work periods). These 260 individuals represent 3.3% of the vocational rehabilitation consumers in the overall sample. Of these 260 consumers, 198 found competitive employment after receiving services, representing 4.6% of all consumers who were closed as successfully rehabilitated in the overall sample. An index score of the ratio of these two percentages indicates the comparison between the proportions of consumers who were employed in this group as compared to the proportion of consumers who were employed in the overall sample. For this group, the index score was 138.8% (4.6/3.3) and reveals that the proportion of consumers who found competitive employment in this group is approximately 139% better than the competitive employment rate for the overall sample.

3.3.2 Node 10

This group represents 155 consumers who had received the following services: vocational rehabilitation counseling and guidance, and on-the-job training (e.g., training in specific job skills by a prospective employer). Of these 155 consumers, 115 found competitive employment after receiving services, representing 2.7% of all consumers who were closed as successfully rehabilitated in the overall sample. The competitive employment rate for this group was 74% and the index score was approximately 135% better than the employment rate of the overall sample.

3.3.3 Node 14

This group represents 269 consumers with an employment rate at 68% who had received job placement (e.g., referral to a specific job), and maintenance (e.g., monetary support for food, shelter, and clothing). However, no vocational rehabilitation counseling and guidance services was provided for individuals in this group. Of these 269 consumers, 182 found competitive employment after receiving services. The group represented 3.4% of the overall sample and 4.3% of all employed people in the sample. The index score was 123% and reveals that the proportion of consumers who found competitive employment in this group is approximately 123% better than the competitive employment rate for the overall sample.

3.3.4 Node 7

This group represents 405 consumers who had received the following services: vocational rehabilitation counseling and guidance, and job support services. However, no assessment services was provided for individuals in this group. Of these 405 consumers, 252 found competitive employment after receiving services, representing 5.9% of all consumers who were closed as successfully rehabilitated in the overall sample. The competitive employment rate for this group was 62% and the index score was approximately 113% better than the employment rate of the overall sample.

3.3.5 Node 13

This group represents 448 consumers with an employment rate at 58% who had received job placement services. However, no vocational rehabilitation counseling and guidance services and maintenance services was provided for individuals in this group. Of these 448 consumers, 258 found competitive employment after receiving services. The group represented 6% of the overall sample and 6% of all employed people in the sample. The index score was 105% and reveals that the proportion of consumers who found competitive employment in this group is approximately 105% better than the competitive employment rate for the overall sample.

3.3.6 Node 9

This group represents 4,364 consumers who had received the following service: vocational rehabilitation counseling and guidance. However, no job support services, and on-the-job training services was provided to this group. Of these 4,364 consumers, 2,439 found competitive employment after receiving services. The group represented 56% of the overall sample and 57% of all consumers who were closed as successfully rehabilitated in the overall sample. The competitive employment rate for this group was 56% and the index score was approximately 101% better than the employment rate of the overall sample.

With regard to the subgroups that had significantly lower employment rates, there is one subgroup that merits discussion. Specifically, Node 11 represents 1,505 consumers with an unemployment rate at 59%. The consumers in this group did not receive vocational rehabilitation counseling and guidance services nor did they receive any other rehabilitation services prior to case closure. This group experienced the lowest employment rate of 41% and the index score was 130% indicating that their unsuccessful employment rate was 1.3 times higher than the average of the overall sample.

4 Summary of findings

The purpose of this study was to explore two sets of variables: consumer demographic variables, and rehabilitation service variables. The data mining approach explores the predictive relationships of consumer characteristics and service delivery patterns upon vocational rehabilitation outcomes for consumers with alcohol abuse/dependence, and examines successful and unsuccessful case closures specific to this target population. The exhaustive CHAID analysis results revealed vocational rehabilitation counseling and guidance, on-the-job supports, assessment, on-the-job training, job placement assistance, other services (e.g., occupational licenses, tools and equipment), and maintenance services (e.g., monetary support for food, shelter, and clothing) as important predictors of employment outcomes and for segmenting the sample into mutually exclusive homogeneous end groups.

An interesting finding emerged regarding consumer demographics. The CHAID analysis demonstrated that an interaction among consumer demographics – gender, race and ethnicity, age, and educational level were not statistically significant predictors of an employment outcome for this population. This finding is noteworthy as prior research has demonstrated that consumer demographics may play a central role in predicting successful employment outcomes. For instance, in the area of race and ethnicity minorities were less likely than European Americans to be accepted into the VR system, receive fewer services, receive fewer cost expenditures, were not as likely to attain a successful case closure, and were more likely to have their cases unsuccessfully closed due to failing to cooperate (LeBlanc & Smart, 2007; Martin, 2010; Rosenthal et al., 2005; Wilson et al., 2001). In addition, studies demonstrated that age, education, and gender have also influenced employment outcomes in vocational rehabilitation. In a selective review of 75 articles from 1987 to 2005, Crisp (2005) ascertained that younger and better-educated vocational rehabilitation consumers had more successful employment outcomes. In another study, results concluded that gender outcomes among a similar group of individuals with traumatic brain injury in disability severity, neuropsychological functioning, and demographic characteristics found that only 4.4% of women had a successful employment versus 23.6% of men (Bounds et al., 2003).

An important finding from this analysis was the central role of vocational rehabilitation counseling and guidance, job placement assistance, and on-the-job support services for persons with alcohol abuse/dependence in predicting employment outcomes. The most observable indicator of successful employment outcome was vocational rehabilitation counseling and guidance. Individuals who received counseling and guidance (n = 3,004) had a greater probability of achieving a successful employment outcome (58%) than individuals who did not receive counseling and guidance (49%). This finding is consistent with the rehabilitation literature that shows substantial vocational rehabilitation counseling and guidance to be central to the success of consumers with co-occurring mental health problems (Catalano et al., 2006), physical impairments, individuals with visual impairments aged 65 years or older (Dutta et al., 2008), and traumatic brain injury (Cardoso et al., 2007).

Another important finding from this analysis was the central role of job placement services and on-the-job support services in predicting employment. Individuals who received job placement services had a significantly higher competitive employment rate (61%) than individuals who did not receive job placement services (44%). This find is noteworthy as the individuals who received this service were not recipients of counseling and guidance and therefore appeared to greatly benefit from referrals given by the rehabilitation counselor to specific jobs. With regard to on-the-job support services, individuals who received on-the-job support services had a significantly higher competitive employment rate (68%) than individuals who did not receive on-the-job support services (57%). Overall, these finding are consistent with the rehabilitation literature that shows that job placement services and on-the-job services have a strong relationship to employment outcomes (Catalano et al., 2006; Cardoso et al., 2007; Chan et al., 2006; Rosenthal et al., 2007).

However, while this study found that job placement services and on-the-job support services significantly enhanced employment outcomes, it is noteworthy that job related services for assistance in finding employment, gaining employment, and retaining employment was also significantly underutilized, with only 11% of the consumers in this sample receiving on-the-job supports, 30% job search assistance, and 43% job placement assistance. Chan et al. (2006) posit that the limited usage of job related services may be due to the various models of job placement and the diverse philosophies that bring about these approaches.

5 Implications for rehabilitation counseling practice

First and foremost, an analysis of the RSA-911 dataset for the fiscal year 2009 revealed a small number of consumers (n = 7,798, 1.32%) with alcohol abuse/dependence as the primary cause of disability received vocational rehabilitation services when compared to the overall sample served (588,970). It is conceivable that many individuals with alcohol abuse/dependence disabilities do not need vocational rehabilitation. Nevertheless, a discrepancy between the number of adults with alcohol abuse/dependence and the number who receive vocational rehabilitation services may be suggestive that many adults who are eligible for vocational rehabilitation services are not receiving them. To illustrate, in many state and federal vocational rehabilitation agencies, priority for vocational rehabilitation service has been based on the order of selection process in which the most severe disabilities are served first. Thus, individuals with alcohol abuse/dependence are not prioritized in the order of selection process and, therefore, may not qualify to receive VR services right away due to the lesser severity of their disability (i.e., fewer functional limitations). The implication for navigating through the vocational rehabilitation system is to ensure that the impact on major life activities (employment) is substantiated through the rehabilitation counselor’s documentation of the individuals’ disability. As vocational rehabilitation counselors become more aware of the severe physical and mental impairments caused by alcohol abuse/dependence, it is hopeful that more individuals will be classified as severely disabled and will thus be served in the vocational rehabilitation program.

Additionally, some programs have implemented contracts, sobriety waiting periods (Moore et al., 2008) and screening procedures before services would be rendered which may inadvertently impact consumers with alcohol abuse/dependence. For instance, the waiting period leaves the person with the alcohol abuse/dependence issue vulnerable, as “Creating additional delays and waiting periods may threaten a consumer’s motivation to follow through with seeking services” and in turn the consumer’s symptoms become exacerbated and he/she is not able to maintain sobriety (p. 16). In addition, some state VR agencies have separate screening procedures to monitor alcohol/drug abuse. These screens can also create another barrier – the screen may turn out positive for a substance, thus jeopardizing the participation in services. Glenn and Keferl (2008) suggest that these results “should be interpreted without bias” (p. 41). Overall, these program level barriers may impact vocational rehabilitation for people who have alcohol abuse/dependence (Platt, 1995).

Research suggests that 25% of VR applicants may have an active substance abuse disorder at the time of their application (Moore & Keferl, 2008). Therefore, at the practitioner level, counselors may not be screening for alcohol abuse/dependence. It may be that vocational rehabilitation counselors may have varying levels of training and knowledge in their work with consumers with substance abuse disorders (Glenn & Keferl, 2008; Ong et al., 2008). With that said, there is considerable evidence of training needs on initial screening, plan development, and service delivery practices among VR counselors working with consumers with substance abuse disabilities (Leahy, Chan, & Saunders 2003; Ong et al., 2008; Glenn & Keferl, 2008).

A second implication in this study highlights the importance of understanding the unique needs of consumers with alcohol abuse/dependence in vocational rehabilitation. Due to the chronic and complex nature of alcohol abuse/dependency, relapse may be very common. Furthermore, vocational rehabilitation consumers who have alcohol/dependency disabilities oftentimes face many challenges throughout the VR process. They may experience interpersonal and behavioral deficits, and difficulty coping. For instance, in the area of employment, lack of interpersonal skills, such as work habits and attitudes and social communication may impede the person from interacting positively and working effectively with others. Consequently, the person may not maintain employment. A specific rehabilitation service which may address the interpersonal and behavioral deficits is job readiness training. A person may also experience legal, financial, and medical issues, in addition to contributing societal and familial issues, which may further impede the process of attaining and maintaining employment. Accordingly, persons with alcohol abuse/dependence may need on-going psychosocial support, help in navigating social interactions, and counseling specific to personal adjustment, and medical, family, or social issues.

The third implication that this study provided was insight into the needs of consumers with alcohol abuse/dependence who are at the greatest risk for poorer vocational outcomes. In the present study, vocational rehabilitation counseling and guidance were important VR services for this consumer group as were job placement assistance and on-the-job supports. However, this study suggests the importance of a comprehensive assessment prior to initiating services to determine the nature and scope of VR services to be included in the Individual Plan for Employment (IPE). Specifically, there appears to be an underutilization of specific rehabilitation services which may address the aforementioned areas of concern or deficits. For example, job readiness training (18% received job readiness training), may prepare an individual for the world of work by addressing the following areas: appropriate work behaviors, social communication, getting to work on time, appropriate dress and grooming, and increasing productivity. Also, there was an underutilization of training type services with only 3% of the consumers in this sample receiving on-the-job training, 9% college or university training, 12% occupational/vocational, and 13% miscellaneous training (e.g., GED). This find is noteworthy as rehabilitation counselors need to better understand that some individuals may experience hardships in meeting the demands of the world of work due to lack of marketable skills or the lack of job-related academic skills.

The fourth implication that this study provided was insight into consumers closed as competitively employed and not competitively employed without having received a vocational rehabilitation service. This finding is noteworthy as one of the requirements stipulates that prior to closing a consumer as competitively employed (i.e. Status 26, competitively employed) services provided under an individual plan for employment (IPE) have contributed to the achievement of the employment outcome. Conversely, an individual is not competitively employed (i.e. Status 28, not competitively employed) when the consumer exits the vocational rehabilitation program without an employment outcome, after receiving services. A third category for case closure is status 30. A case is closed in status 30 after the development of the IPE but prior to the implementation of vocational rehabilitation services. With that said, it would appear that 14% (n = 619) of the consumers closed competitively employed were miscoded, while 25% (n = 886) of the consumers closed not competitively employed were also miscoded. In short, these consumers closed competitively employed (i.e., status 26) and closed not competitively employed (i.e., status 28) should have been closed in status 30 as the IPE was developed but services did not ensue. This find illustrates how unknown number of errors may be present despite the Rehabilitation Services Administration’s 18 different cross-checks to reduce the potential for error.

6 Future research and conclusion

The results of this study suggest the need for additional research in several areas. First, a study addressing the current screening mechanisms that VR counselors employ to determine if a consumer has a primary or secondary disability in alcohol abuse/dependence is warranted. Also, how counselors address primary/secondary disabilities (other than alcohol abuse/dependence) that qualify a consumer for VR services in VR remains understudied. Second, further exploration of training needs among counselors that work with consumers with alcohol and/or substance abuse could provide insight into mechanisms to enhance outcomes.

A third area for future research addresses the variance between operating procedures for VR agencies across states. Some agencies have adopted the practice of implementing contracts, upholding sobriety waiting periods, and screening procedures (at in-take and during receipt of VR services). While other agencies take the approach that, until the consumer fails to make progress, there may be no identified abuse issue. Moore and Keferl (2008) stated that despite more than 30 years of the implementation of various policies and approaches for addressing VR consumers who have substance use disorders, there is still a lack of effective policies and practices that have wide adoption within the state-federal VR system (Moore & Keferl, 2008). Consistent screening procedures would be more effective for VR counselors to utilize at intake to ascertain if there is an alcohol and/or substance abuse issues.

People with disabilities experience much lower employment rates than people who do not have disabilities. A recent U.S. Bureau of Labor Statistics (BLS) Employment Situation report estimated that the employment rate of people with disabilities is at 18.0% versus a rate of 63.9% for people who did not have any disabilities (BLS, 2010). The vocational rehabilitation system helps people with disabilities to access and maintain employment; furthermore, the annual successful case closure rate for consumers with disabilities is approximately 60% (Rosenthal, 2005). However, employment rates for consumers with substance abuse, including alcohol abuse, tend to be significantly less (Hollar, 2008). It is important to better understand what factors may be affecting employment outcomes for consumers with alcohol abuse/dependence as alcohol abuse/dependence is so prevalent in our society today – nearly, 25% of VR applicants may have an active substance abuse disorder at the time of their application (Moore & Keferl, 2008).

The results of this study found that the VR consumers with alcohol abuse/dependence who received vocational rehabilitation counseling, job placement services, and on-the-job supports significantly increased successful employment outcomes. It is important for state-federal agencies to work together to develop concrete reform for the applicants and consumers who have alcohol abuse/dependence and seek the aid of the vocational rehabilitation counselor and agency.

7 Limitations

A limitation to this study is that it utilized the RSA-911 data, which is an archival dataset and thereby employs an ex post facto design. Thus, none of the variables could be manipulated, additional variables could not be included; thus, causality could not be inferred by this investigation. Furthermore, this study does not generalize to other populations or settings outside of the alcohol abuse/dependence group within VR. A second limitation to this study is that all information in the RSA-911 dataset is recorded by vocational rehabilitation counselors throughout various stages in the VR process. Type of disability is entered before an eligibility decision is made, and then wage and occupation data are entered when the case is closed. “Thus, it is possible that, if counselors do not consult the case file to verify which services were delivered and relied solely on memory data could be incorrect” (Chan et al., 2006). Furthermore, errors of data input may have been entered by the counselors accidentally. To address the aforementioned errors, the Rehabilitation Services Administration developed 18 different cross-checks to reduce the potential for this error. However, even with the cross-checks being utilized, an unknown number of errors may be present, although these errors are assumed to be random, and no systematic bias should result with this data. A third limitation to this study is that the statistical criteria do not show every significant relationship. Attention is given to the relationships that are important, and may not be able to be replicated in other samples.

Conflict of interest

The authors have no conflict of interest to report.

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