Journal of Vocational Rehabilitation - Volume 23, issue 2
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Journal of Vocational Rehabilitation will provide a forum for discussion and dissemination of information about the major areas that constitute vocational rehabilitation.
Periodically, there will be topics that are directed either to specific themes such as long-term care or different disability groups such as those with psychiatric impairment. Often a guest editor who is an expert in the given area will provide leadership on a specific topic issue. However, all articles received directly or submitted for a special issue are welcome for peer review. The emphasis will be on publishing rehabilitation articles that have immediate application for helping rehabilitation counselors, psychologists and other professionals in providing direct services to people with disabilities.
Original research articles, review articles, program descriptions, and case studies will be considered for publication. Ideas for special topical issues are welcomed as well.
Abstract: Alternate funding arrangements such as personal budgets and vouchers have the potential to allow consumers to re-direct service system funding towards their desired outcomes, including employment. Voucher and personal budget systems typically include methods to provide person-centered planning and decision support. Facilitated decision-making systems allow consumers to reclaim lost confidence. The act of directing, with decision support as needed, one's own services counterbalances the disempowering effects of mental illness and its treatment.…Decision support services related to personal budgets and vouchers can assist consumers to negotiate for positive employment outcomes. The Dollars and Sense Individual Career Account project in New Hampshire and the KEYS to Employment Project in Oklahoma described in this paper are two successful experiments in alternate funding arrangements for individuals with a psychiatric disability. Both projects were based on the assumption that to change the system, the consumer/customer, must be in charge of financial resources.
Abstract: Background. To help mitigate empirically-identified shortcomings in Supported Employment (SE) outcomes for consumers with severe mental illness in Indiana (e.g., few long-term placements), Vocational Rehabilitation Services (VRS) and the Indiana Division of Mental Health and Addictions (DMHA) proposed the implementation of a results-based funding (RBF) system, in which providers received payment only when clients successfully attained each of 5 employment milestones. The current study presents the results of a multi-site controlled trial…of RBF vs. a traditional fee-for-service (FFS) model. Method. The sample included 122 (RBF=81, FFS=41) consumers of SE (52% schizophrenia, 35% mood disorder). Assessments of clinical and life outcomes were conducted quarterly across 12 months. Results. Those served in RBF were more likely to attain all milestones collectively, and to have a completed person-centered plan and attain 9-months of employment, specifically. There were few differences between those in RBF and FFS on non-milestone employment variables (e.g., job match, wages) or clinical measures (e.g., quality of life, functioning). Conclusions. RBF produces better overall vocational outcomes, specifically, higher rates of completion of a person-centered plan and retention of employment for 9 months. However, improvements with RBF were limited to those specified and did not generalize to vocational areas not targeted by the milestones (e.g., wages, benefits) or to changes in other life domains typically valued by psychiatric rehabilitation.
Keywords: Supported employment, vocational rehabilitation, performance based contracting, severe mental illness, treatment outcomes
Abstract: As State budgets tighten, Vocational Rehabilitation (VR) Agencies and Community Rehabilitation Providers face a daunting challenge to collaboratively craft methods to improve the efficiency and effectiveness of community-based employment services while preserving consumer informed choice. Results Based Funding methods push service systems in the direction the consumer chooses by creating incentives for consumer valued outcomes. Alternatively, hourly funding can push in the wrong direction, with incentives for more service activity, thereby unintentionally…generating outcome interference for both the provider and the customer. Milestone funding systems have been shown to improve outcomes for consumers while simultaneously increasing the number of successful rehabilitations for the VR agency. Service providers have successfully learned to shift the focus of their work from process and activities to outcomes and results. This article discusses the key elements that make a Milestone or Results Based funding strategy successful.
Abstract: This article describes telework and its use as an accommodation for employees with disabilities. Potential barriers to using telework as an accommodation are presented, as well as potential funding sources for technology. Two case studies of successful accommodation through telework are presented.
Abstract: Nationally, participation in sheltered/segregated programs continues to exceed participation in community-integrated employment for many individuals with significant disabilities. However, a number of community rehabilitation programs have evolved from providing services and supports that maintain individuals in segregated settings to a primary, at times singular focus on providing supports to individuals in community-integrated, inclusive employment settings. This paper briefly reviews the factors influencing this evolutionary process for community rehabilitation programs. It provides detailed…examples of the organizational change process with two specific community rehabilitation programs, the Cobb and Douglas Counties Community Services Boards in Georgia and HPS, Helping People Succeed, Inc. in Florida. The core mission of both programs is to support consumer directed employment outcomes. The organizational change descriptions are accompanied by stories about individuals who are now working in inclusive employment opportunities after receiving supports through these programs.