Journal of Vocational Rehabilitation

The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n=1,273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixed-effects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes.

Community work experience and coordinated transition services are recognized as key factors in successful school-to-work transitions for young people with disabilities. However, although federal law now mandates transition assistance, such services are not consistently available. Consequently, youth with disabilities often miss out on opportunities to develop the work habits, communication skills and attitudes that employers look for when making hiring decisions.

In this article we describe the Project SEARCH High School Transition Program, an employer-based intervention for high school students with significant disabilities whose main goal is competitive employment. The program combines real-life work experience with training in employability and independent living skills. Individualized placement assistance is provided as an integral part of the program. The hallmark of this demand-side model is complete immersion in the workplace. This facilitates a seamless integration of classroom instruction and on-the-job training and support that cannot be achieved with occasional workplace visits or simulated work environments. The program also demonstrates a novel collaborative approach that brings the education system, employers, and rehabilitation services together in unique ways to create a productive and comprehensive transition experience for students.

Objective: To investigate the effect of traumatic brain injury (TBI) and concomitant disabilities on vocational outcomes.

Design: Non-experimental, prospective analysis of adults who qualified for services with the Missouri Division of Vocational Rehabilitation (MDVR) based on a history of TBI.

Participants: 139 MDVR clients with non-acute TBI, followed from enrollment until case closure, who were divided into 5 groups (TBI only; TBI + orthopedic injury; TBI + seizure; TBI + psychological disorder; TBI + learning disability).

Main outcome measures: Demographic characteristics; injury severity; neuropsychological functioning; and employment status at case closure.

Analyses: Multivariate analysis of variance and non-parametric methods were used to evaluate differences in outcome variables between the TBI Only and other 4 groups.

Results: Statistically non-significant trends between the groups suggested less successful employment outcomes for persons with TBI and concomitant psychological disorders (11%) and learning disabilities (8%) vs. persons with orthopedic injuries (23%), seizure disorders (32%), or TBI only (26%).

Conclusions: Concomitant psychological and learning disabilities, compared to concomitant physical disabilities, are associated with greater employment difficulties for persons with TBI. VR clients with psychological and learning disorders may require additional services/interventions to enhance their vocational outcomes.

Working-age adults with severe disabilities face many barriers to reaching their employment potential. One important barrier is the concern that working will result in the loss of Medicaid benefits, which cover many needed healthcare services for people with disabilities at little or no cost. Now offered by over 30 states, Medicaid buy-in programs address this concern by allowing people with disabilities to retain Medicaid while they work and increase earnings. Prior reports of buy-in programs have not examined whether work outcomes vary with characteristics of buy-in enrollees. Using data from a statewide survey of Massachusetts buy-in program members, we found type of disabling condition to predict three work outcomes: current work status of all members; annual earnings over $10,000 among currently working members; and future work intentions of currently non-working members. Members with developmental or psychiatric disabilities were generally more likely to work but had lower earnings than other members. Members with a physical disability were generally less likely to work than other members, but when working tended to have higher earnings. Those with co-occurring psychiatric and physical disabilities had the poorest work outcomes. Across all conditions, few members had earnings at levels consistent with economic self-sufficiency. Policy and practice implications are discussed.

This article explores the career aspirations of thirty individuals with severe psychiatric disabilities who had been employed from 3 to 33 years. We included people in the study who had been hospitalized as adults or had been determined eligible for Social Security Disability benefits due to a psychiatric disability and were currently employed for pay at least 18 hours per week. Some had received assistance from vocational rehabilitation agencies; others had not. Through in-depth interviews, we examined how they view career development and how they set and obtain their long term goals. We found that the sample fell into two groups based upon their attitudes about the future and their employment aspirations over the next five years. Group One, consisting of 17 participants, said they wanted to change jobs or move ahead in their careers and had developed strategies to obtain their specific employment or career goals. The remaining 13 participants, those in Group Two, wanted to remain in the same position or obtain a similar job. We describe the factors Group One participants considered in establishing their career goals and the reasons why Group Two participants wanted to keep their current employment.

In the scope of performing forensic work, rehabilitation counselors may discover serious weaknesses in breath of knowledge, adherence to acceptable practices, or general ethics in the work of other vocational counselors. In the field of rehabilitation counseling, ethical code standards mandate confronting a counselor directly prior to making a formal complaint. This mandatory action may be omitted or ignored because of awkwardness, fear of retaliation, or simple ignorance of this requirement. Case-in-point examples of unethical behaviors requiring confrontation are presented. Multiple legal precedence illustrations demonstrate potential need for rehabilitation counselors to be involved in the ethical resolution process. In this article, sample templates of letters are provided to aid the rehabilitation counselor to confront via written format the counselor performing unethically.