A call for a national evidence-based programs and practices registry in vocational rehabilitation

Abstract

BACKGROUND: As the volume of evidence-based practices (EBPs) in vocational rehabilitation (VR) reaches a critical mass and leaders in the field recommend the need for a systematic and rigorous evaluation process that legitimizes and the effectiveness of those practices, a national registry in VR is clearly needed.

OBJECTIVE: The purpose of this paper is to provide the underlying rationale for the creation and maintenance of a user-friendly registry that would secure and support vocational service provision to improve employment outcomes and the quality of life of individuals with disabilities.

METHODS: Collaboration from various entities is necessary to ensure the resources and credibility required for a project of this magnitude. All stakeholders should participate in the process of specifying what should be included in the registry and how they would use it.

RESULTS: A registry would be a valuable vehicle for providing empirically-supported VR services and information to practitioners, educators, researchers, policy-makers and the public. It would allow for better-informed choices and potential cost savings.

CONCLUSIONS: A registry containing effective VR practices is a perfect complement to the National Clearinghouse of Rehabilitation Training Materials and answers an important call from the VR community.

Keywords

Evidence-based practice vocational rehabilitation knowledge translation service provision

1 Introduction

The inception and evolution of vocational rehabilitation (VR) services have revolved around governmental requirements and accountability for almost a century, dating back to the first federally funded VR program through the Soldier’s Rehabilitation Act of 1918 (PL 65–178). More recently, the Workforce Innovation and Opportunity Act (WIOA, 2015) was updated and signed by the president. This law represents a renewed commitment to workforce development projects and is aligned with the Rehabilitation Act of 1973 (United States Department of Labor, 2016). With a recent Executive Order released on September 15, 2015, President Obama clearly specified that governmental policies and programs should be a reflection of the current behavioral insights available and that information on programs and choices should be provided in a timely and effective manner. Unfortunately, state VR agencies have shown only minimal effectiveness in demonstrating and publicizing the field’s continued relevance and positive outcomes for consumers (Leahy, Chan, & Lui, 2014; Oswald, Huber, & Workman, 2015; Sherman et al., 2014).

Based on the national attention to evidence-based practices (EBPs) and lack of wide-spread acknowledgement of service effectiveness, stringent accountability measures imposed by the government, other funding streams and professional ethical standards now require upfront evidence for program design selection and quantifiable cost-benefit analyses of participant outcomes (Brannon, 2010; Burker & Kazukauskas, 2010; NIDRR, 2013; Sherman, 2010; Yates, 2013). A review of the literature in the field published over the past few decades reveals a steady increase in outcomes research demonstrating the positive impact of specific interventions in VR services (Bolton, Bellini, & Brookings, 2000; Dean et al., 2014; Fleming et al., 2013; Glasner-Edwards & Rawson, 2010; Leahy et al., 2014; O’Neil, Mamun, Potamites, Chan, & Cardoso, 2014; Pruett et al., 2008) and in other rehabilitation-related areas (Bond, 2004; Huber et al., 2009; Marshall & Lockwood, 1998; Workman et al., 2012). Research investigating high performing programs to determine promising practices are building the foundation necessary to establish an EBP in VR (Anderson et al., 2014; Del Valle et al., 2014; Lui, Anderson et al., 2014; Oswald et al., 2015; Sherman et al., 2014).

1.1 Purpose

As the volume of EBPs in rehabilitation reaches a critical mass, a comprehensive, user-friendly vehicle for evaluating, sustaining and disseminating such information to practitioners, educators, researchers, policy-makers and the public will be necessary and advantageous. Demonstrating the effectiveness of various VR practices justifies continued and/or increased funding and increased access by individuals with disabilities to vocational rehabilitation programs (Brannon, 2010; Leahy et al., 2014; Lui et al., 2014; Oswald et al., 2015; Sherman et. al., 2014; Tansey et al., 2014). The purpose of this paper is to provide a cogent rationale for the creation and maintenance of a user-friendly registry that would ultimately improve employment outcomes and the quality of life of individuals with disabilities.

1.2 Elements of a registry

A registry is a searchable, virtual repository of vetted information established through professional guidelines, criteria, and standards for EBPs (Campbell Collaboration, 2015; Cochrane Collaboration, 2015; Workman et al., 2014; Yates, 2013). A registry allows for better informed decision making in areas ranging from policy development, funding support and treatment and service selection (Oswald et al., 2015; Yates, 2013). By providing one centralized resource for all rehabilitation stakeholders (practitioners, researchers, students, consumer and families, and governmental entities), a registry on EBPs will provide a one-stop dissemination opportunity for interested parties to locate and review VR service programs that have demonstrated effectiveness through outcomes data (Goldman et al., 2001).

1.3 Examples of professional EBP registries

There are numerous health and social science-related registry-type entities in specific areas such as prevention, medicine, criminal justice, and education. The Substance Abuse and Mental Health Services Association (SAMHSA) Center for Substance Abuse Prevention (CSAP) developed the National Registry of Effective Programs and Practices (NREPP) (Gorman, 2002; Hallfors, Pankrantz, Hartford, 2007; Petrosino, 2003; Society for Prevention Research, 2004; SAMHSA, 2009). Sherman (2010) stated that NREPP “reports on interventions’ descriptive characteristics, strength of evidence and readiness for dissemination. It is designed to support services providers by: promoting informed decision making, disseminating timely and reliable information regarding interventions, allowing access to descriptive information about interventions, and providing peer-reviewed ratings of outcome-specific evidence across several dimensions” (2010, pg. 3). SAMHSA’s mission is to reduce the impact of substance abuse and mental illness in America (SAMHSA, 2009) partly through prevention practices.

Several registries are available in other areas concerned with prevention (Glasner-Edwards & Rawson, 2010). The Office of Juvenile Justice & Delinquency Prevention (OJJDP) has worked to develop “Effective Family Programs for Prevention of Delinquency” in collaboration with SAMHSA. OJJDP also disseminates model programs that are effective in reducing adolescent violent crime, aggression, delinquency and substance abuse via the Blueprints Project out of the Center for the Study and Prevention of Violence at the University of Colorado (Biglan & Ogden, 2008). The Guide for Community Prevention Services, created by the Community Preventive Services Task Force with support from the U. S. Department of Health and Human Services and Centers for Disease Control and Prevention, provides a toolbox of information on the effectiveness and program features of interventions that have been vetted through a scientific, systematic review process (The Guide to Community Preventive Services, 2013). Features of the toolbox guide users in how to assess and evaluate programs, plan interventions, engage stakeholders, implement interventions and create sustainability in programs. The Best Practices Registry, through the Suicide Prevention Resource Center funded by SAMSHA, also provides a structure and process for evaluating and disseminating EBPs (Suicide Prevention Resource Center, 2015).

Established in 2002, the Institute of Education Sciences (IES), housed in the Department of Education, provides a “What Works Clearinghouse” consisting of effective educational interventions, including systematic reviews on secondary transition interventions. The clearinghouse is designed to review and disseminate summary information on practices, programs and policies in order to assist educators, policymakers, researchers, and the public with a central and trusted source of scientific evidence of what works in education (What Works Clearinghouse, 2015).

Specifically for children and youth with disabilities, the Council for Exceptional Children published standards for EBPs in special education (Council for Exceptional Children, 2014). Recently, researchers at the University of North Carolina-Charlotte received $12.5 million in grant funding across five years from the U.S. Department of Education’s Office of Special Education Programs to establish a national transition center for students with disabilities which include a registry to provide EBP information related to VR and transition services.

Finally, there are two global efforts that systematically review research related to health care, education, crime and justice, social welfare, and international development. During the past 20 years, the Cochrane Collaboration has helped to transform the way health decisions are made by providing informed choices about treatment. The Cochrane Collaboration (2015) is internationally recognized as the benchmark for high-quality information about the effectiveness of health care. Similarly, the Campbell Collaboration is an international research network that prepares, maintains and disseminates systematic reviews. This systematic and rigorous approach to research synthesis improves the knowledge base for decisions on policy and practice (Campbell Collaboration, 2015).

1.4 The time is now

In 2010, the National Institute on Disability and Rehabilitation Research (NIDRR) funded a Rehabilitation Research and Training Center (RRTC) on Evidence-Based Practice in VR (RRTC-EBP VR). Funding for the RRTC reflects the priority and importance of establishing and organizing EBP in VR. The overall purpose of the RRTC was to conduct evidence-based research and to provide practitioners with knowledge, tools and practices that can improve employment rates and quality of employment for people with disabilities (Leahy et al., 2014; RRTC, 2015). The RRTC was a partnership among researchers and trainers at five major universities and the Council of State Administrators of Vocational Rehabilitation (CSAVR).

One of the RRTC studies involved a comprehensive multiple case study of state VR agencies policies, procedures, practices and structural elements related to employment services that lead to successful outcomes. Results from this study were reported in a special issue of the Journal of Vocational Rehabilitation (2014) entitled “Evidence-Based Best Practices in the Public Vocational Rehabilitation Program that Lead to Employment Outcomes.” Articles contained in this special issue represent qualitative and quantitative data from 29 leaders and administrators, 56 mid-level managers and 469 counselors in four state VR agencies (Leahy et al., 2014). Identified results from this study, and others conducted by the RRTC on EBP, can be a starting point to gather interventions that potentially could be evaluated and deposited in the proposed registry.

In sum, in light of the recent Presidential Executive Order (2015), funding priorities (NIDRR, 2010), the most recent special issue on EBPs through the Journal of Vocational Rehabilitation (2014), and Table 1 below, which presents a fraction of the available peer-reviewed journal articles over the past nine years supporting the need for an EBP registry in VR, the time to create, streamline and sustain a user-friendly registry that would secure and support vocational service provision is now.

2 Method

2.1 Framework

In order to develop and implement an EBP registry in the VR community, collaboration from various entities is necessary to ensure the resources and credibility required for a project of this magnitude. However, it is imperative that one organization needs to “take the lead” by providing knowledgeable professionals having the time and resources necessary to develop the registry, the technical support to maintain it, and the project oversight to continuously improve it. Funding and approval from a federal rehabilitation agency, similar to SAMSHA supporting NREPP, would ensure the financial and political support needed to successfully create a registry.

In the process of creating a registry, it is critically important to ensure a shared purpose, clear goals and objectives and to secure commitment to an agreed-upon process. All stakeholders should participate in the process of specifying what should be included in the registry and how they would use it. A necessary priority early on must be on determining agreed upon definitions related to EBPs and standards for the submission, evaluation, and retention of practices (Campbell Collaboration, 2015). Several EBP definitions and formats, including criteria for inclusion and assigning levels of “rigor” used by various registries, organizations and professionals are available and may be adapted to meet the needs of the rehabilitation community (Brannon, 2010; Cooney et al., 2007; Institute of Medicine, 2001; Glasner-Edwards & Rawson, 2010; Sackett et al., 1996). In addition, a foundation for the development of standards for improving and evaluating rehabilitation outcomes research is already available (McAweeney & Crewe, 2000; McAweeney, Forchheimer, & Tate, 1997; Ottenbacher, 1989; Ottenbacher & Barrett, 1991; Ottenbacher, 1995; Oswald et al., 2015). The final element necessary to success is a strong board of rehabilitation researchers, agency professionals, and consumers to inform and guide the registry. Together, a user-friendly registry can be created to meet the needs of various stakeholders within the VR community (Oswald et al., 2015).

3 Results

3.1 Benefits of a VR registry

A rehabilitation registry will create a centralized location for rehabilitation professionals, students, educators, researchers, consumers and families, policy-makers, and funding organizations to locate information on available programs/services as well as evidence related to specific populations on the intended outcomes (Burker & Kazukauskas, 2010; Graham et al., 2013; Oswald et al., 2015; Yates, 2013). With an effective information dissemination strategy, VR agencies and members of WIOA centers will not only have the knowledge and process outlined for how to evaluate their current services and develop their programs into EBPs but will also have a direct pathway to market such programs to rehabilitation counselors, consumers, and additional funding streams. As well, researchers will be able to more easily identify which areas still require additional investigation in order to facilitate collaboration and the development of additional EBPs (Cochrane Collaboration, 2015).

Beyond information sharing, a registry will provide the tools to evaluate EBPs so that all rehabilitation stakeholders can make decisions based on empirical evidence. Legislative, funding and service selection decisions can be informed by past performance of service providers that have been professionally vetted based on empirical evidence and clinical relevance. VR agencies will be able to justify difficult decisions when determining which services to offer based on strong supporting evidence related to intended outcomes, populations served, and contributing factors (such as geographic location, personal characteristics of a population, and other predictive variables). Students and instructors will profit from the availability of a medium that clearly outlines the purpose, process and options within EBPs for use in teaching/learning various strategies and techniques, and produce a cohort of future rehabilitation professionals with the knowledge and skills necessary to evaluate programs and more effectively inform consumers of their options (Burker & Kazukauskas, 2010).

Perhaps, potentially the greatest asset of a registry of effective VR practices is the complement it could provide to the National Clearinghouse of Rehabilitation of Rehabilitation Training Materials (NCRTM) maintained by New Editions and supported by the Rehabilitation Service Administration (RSA) (NCRTM, 2015). The clearinghouse facilitates and provides the sharing of training and educational materials for VR professionals and the VR community. These training activities support the RSA’s leadership role in developing skilled VR personnel (NCRTM, 2015). A VR registry could be an extremely useful, valuable and complementary entity to assist VR professionals serve their consumers. The combination of the clearinghouse and a VR registry is another benefit that has a plausible cost savings to VR agencies and funders of VR practices.

4 Conclusion

Providing timely and appropriate information on effective VR services must be a high priority for the rehabilitation profession in order to meet governmental pressures to demonstrate the necessity and efficacy of the field and to assist practitioners, educators and policymakers in planning for more effective service-provision. A rehabilitation registry has the ability to provide the framework required to evaluate and disseminate EBPs to various VR stakeholders (CIHR, 2012; Graham et al., 2013; Oswald et al., 2015). Overall, a rehabilitation registry would provide benefits to the VR community, similar to NREPP and the addictions and mental health communities, including the ability to: “offer ‘one stop’ convenience for those seeking quick information on the interventions listed; provide concise descriptions of the interventions; rate the strength of evidence measured against defined and accepted standards for scientific research; and present a practical information, formatted and categorized for easy access” (Sherman, 2010, p. 9).

Conflict of interest

The authors have no conflict of interest to report.

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