Journal of Vocational Rehabilitation - Volume 34, issue 2
Purchase individual online access for 1 year to this journal.
Price: EUR 145.00
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: This article presents initial findings from the national DMIE evaluation, which used random assignment to test whether a program of enhanced health and employment supports for working adults with potentially disabling conditions can reduce the likelihood of applying for federal disability benefits and improve employment retention. Analyses are based on a total of 4,054 participants in demonstrations from four states (Hawaii, Kansas, Minnesota, and Texas). The demonstration was effective in reducing applications to federal disability programs 12 months after enrollment using combined data from the two largest state demonstrations (4.8 percent in the treatment group versus 6.9 percent in the…control group). Evidence of short-term impacts on monthly hours worked was mixed across the states. Although these initial findings suggest modest positive effects of an early intervention program, longer term effects should be examined in future studies.
Keywords: Early intervention, disability, employment, random assignment, program evaluation
Abstract: The national Demonstration to Maintain Independence and Employment (DMIE) projects examined whether providing comprehensive and coordinated health and employment services could help people with significant mental, physical and/or chronic health issues remain employed and independent of government benefits. Four states implemented interventions using different models that shared a person-centered approach. This paper describes how DMIE interventions were defined and implemented, compares models developed by states, and identifies factors that facilitated and/or limited their success.
Keywords: Person-centered planning, employment, case-management, navigation, life coaching, wellness, disability, chronic conditions, mental health
Abstract: Uninsured working adults with chronic mental, behavioral and physical health conditions may have greater difficulty in accessing needed health care due to health care costs and crowded public health systems. Untreated medical conditions can lead to poorer health, which is linked to loss of employment and eventual applications for and receipt of federal benefits such as Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI). The Working Well study was designed to determine whether a coordinated set of health benefits and employment supports could help low-income, working adults maintain their employment and remain independent of publicly funded disability assistance. Patients…from the Harris County Hospital District, a large public health system providing indigent care in the Houston metroplex, were recruited and randomized to the intervention (N = 904) and control (N = 712) groups. The Working Well case management intervention included health navigation, employment/vocational supports, expedited appointments, free medications, and no co-pays for medical visits. Participant outcomes were measured through surveys, health claims data, and state agency employment data. Intervention group participants reported greater access to care, greater likelihood of outpatient medical visits and less likelihood of receiving SSI/SSDI benefits. These findings suggest that public health care systems can provide disability prevention programs, improve access to care and reduce reliance on publicly funded disability assistance.
Keywords: Public health systems, disability, chronic health conditions, employment, early prevention, case management, health care navigation
Abstract: Without access to needed health and employment support services, working individuals with serious mental illness risk developing long term dependence on federal disability programs. Minnesota's DMIE intervention aimed to prevent or delay the disability progression by providing working persons with mental illness a comprehensive set of health, behavioral health, and employment support services, coordinated through a navigator. Potentially eligible study participants were identified through analyses of the Minnesota MMIS using an algorithm targeting mental health service and pharmacy utilization. The eligible sample was stratified and randomly assigned to the intervention (n = 1,257) or control (n = 300) group. Data…sources included MMIS, other administrative data, and navigator encounter data to capture utilization of health, mental health, employment support services, and other public services, as well as annual earnings. Participants also completed an annual survey. Multivariate analyses found that individuals in the intervention group had greater access to health and mental health services, greater improvements in functioning, and were significantly less likely to report applying for SSDI at the end of 12 months of enrollment. Multivariate analyses focusing only on individuals in the intervention group demonstrated that participants who engaged with their navigator had better mental health status and were significantly less inclined to apply for SSDI after 12 months of the intervention. Study findings are important because SSDI beneficiaries with psychiatric disabilities are the fastest-growing, largest, and most costly disability group in the SSDI program.
Keywords: Serious mental illness, disability, employment, earlier intervention, navigation, employment support services, program evaluation, random assignment
Abstract: Health conditions that prevent individuals from working full time can restrict their access to health insurance. For people living in the 35 states that offer high-risk pools, coverage is available but premiums are 125–200% of standard rates. Additionally, high cost-sharing means enrollees often defer needed care because they must pay large amounts out of pocket. Lack of access may lead to poor health outcomes and disability. The Kansas DMIE investigated whether improving insurance coverage for such a group would improve their health status and reduce their risk of transition to full Social Security disability. Half of the 508 participants received…enhanced benefits and nurse case management, the other half received usual risk pool coverage. Outcomes were measured through telephone surveys, focus groups, and claims analysis. Utilization of services increased and health status stabilized for the intervention group, while health status of the control group significantly declined. These findings have broad implications because some plans to be offered under the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) have similarly high out-of-pocket costs. Considering the long-term cost of full disability, providing adequate health insurance benefits for individuals at high risk of disability may be cost effective.
Keywords: High-risk pool, disability, chronic condition, health care, employment
Abstract: Many working adults with diabetes face barriers to effective disease self-management and consequently are at risk for deteriorating health, job loss, and dependence on public assistance. The Hawaii Live Healthy Work Well project examined how individuals with diabetes (a potentially disabling condition) perceived life coaching and person-centered planning as an intervention to maintain employment and manage chronic health issues. For one year, 108 participants received life coaching, using goal setting as a central activity. Based on administrative and survey data, participants' perceived usefulness and value of life coaching in relation to their diabetes, health status, and employment was coded and…analyzed. Participant and coach perceptions of the challenges people with diabetes face in managing their health and work are discussed. Participants reported high satisfaction with the intervention and demonstrated high goal attainment. Although more research is needed, life coaching may be a viable tool to assist people with diabetes to maintain their employment and health. Employers and other providers may want to explore life coaching as an early intervention for employees with diabetes and other chronic conditions such as obesity.
Keywords: Diabetes, life coaching, employment, goal setting