Journal of Vocational Rehabilitation - Volume 42, 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: BACKGROUND: Chronic illness has become an increasing concern in the U.S. in recent years. The Vocational Rehabilitation (VR) program serves clients with chronic illness, and less is known about this population as compared with other subgroups. OBJECTIVE: The purpose of this study was to provide descriptive information on VR clients who report the cause of their primary impairment to be chronic illness. This group was compared with clients reporting a primary impairment due to other sources. METHODS: RSA-911 data were analyzed to determine the extent of observed differences between VR clients presenting with primary disability due to chronic illness compared…with primary disability due to other causes in personal demographics, service patterns, and results of services. RESULTS: Clients in the chronic illness group were more likely to be older, have achieved a higher level of education, and be employed at application. They were also more likely to receive diagnosis and treatment or rehabilitation technology as a service. On average, their cases were longer and more expensive than the comparison group. CONCLUSION: VR agencies might consider additional counselor training and exploration of the needs of this sub-group to gain a better understanding of effective services and associated costs of this distinct population.
Abstract: BACKGROUND: After extensive review of existing measures, it was deemed that a brief self-report instrument that measures the functioning difficulties and limitations of people with MS in and around their home should be developed. OBJECTIVE: The purposes of this study were to develop an instrument that can measure the degree of difficulty in functioning that people with multiple sclerosis (MS) experience within their residence and to test the psychometric properties of the newly developed scale. METHODS: To test the factorial validity of the Home Functioning Scale, both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were utilized in a…cross-validation approach in this study. RESULTS: The new scale captured three functioning difficulty components: (1) functioning needed to take care of oneself at home, (2) functioning needed to conduct house work and house maintenance, and (3) functioning needed to carry out one's own medical needs and treatment at home. Unlike many other scales in the field, this measure is not disease or symptom-specific, but task-oriented and site-specific. CONCLUSION: The use of the scale can be instrumental to rehabilitation counselors and allied health practitioners in the field.
Abstract: BACKGROUND: The impact of arthritis on employment results from disease severity and symptoms, loss of function, high physical demands at the workplace, commuting problems, and low educational level. As a result of these factors, identifying effective vocational rehabilitation interventions to retain and/or restore employment for this population is crucial. OBJECTIVE: The purpose of this study is to identify demographic and vocational rehabilitation service predictors of employment outcomes for people with chronic arthritis. METHODS: Data for 4,281 individuals with arthritis were extracted from the Rehabilitation Services Administration's (RSA) Case Service Report (RSA-911) database. Multivariate logistic regression analysis employing the purposeful selection…approach was utilized to investigate predictors of competitive employment. RESULTS: After controlling for demographic covariates, clients who received counseling and guidance, occupational/vocational training, job search, job placement, on-the-job support, other services and maintenance services were more likely to attain competitive employment. Clients who were younger, white, and had higher level of education were more likely to attain competitive employment. Clients who received SSI/SSDI and had co-existing depressive and/or other mood disorders were less likely to attain competitive employment. CONCLUSIONS: Vocational rehabilitation services have significant positive impact on employment outcomes for people with arthritis. Despite the evidenced positive impact of vocational rehabilitation services, many people with arthritis are not aware or do not utilize state vocational rehabilitation services. Collaboration between rehabilitation and other health professionals promoting the use of vocational rehabilitation services to improve employment outcomes for people with arthritis is needed.
Abstract: BACKGROUND: Adults with multiple sclerosis experience high rates of unemployment post-diagnosis even though they continue to have considerable employment potential. OBJECTIVE: The purpose of this study is to identify factors predictive of unemployment among adults with multiple sclerosis and to recommend interventions that increase the probability of full and part-time employment. METHODS: Responding to a national survey of the employment concerns of Americans with multiple sclerosis (MS), participants in this study consisted of 1,839 members of nine National Multiple Sclerosis Society (NMSS) chapters representing 21 states and Washington, DC. RESULTS: The sample included 397 men (22%) and 1,436 women (78%).…Older (average age of 54) White (76%) individuals, the majority were unemployed (59%) but well educated (98% were high school graduates, 46% were college graduates). Findings from multinomial logistic regression analyses underscore the complexity involved in predicting who will and will not maintain full and part-time employment while coping with the physical, cognitive, psychological, and support system challenges of multiple sclerosis. CONCLUSION: Younger, better educated individuals with less severe MS and greater financial security were more likely to be involved in full or part-time employment. Early intervention efforts at the worksite are suggested as one means to enable adults with MS to maintain their employment.
Abstract: BACKGROUND: Multiple sclerosis (MS) is frequently associated with symptoms that lead to mobility restriction and functional limitations, and for many this results in an altered capacity to safely and independently function within their residence. Although assistive technology devices and residential modifications can significantly ameliorate the impact of limited mobility, little is known about their use and prevalence in the US. This article presents the first national assessment of the prevalence of residential assistive devices and modifications among Americans with MS. OBJECTIVE: The objectives of this study were to evaluate the prevalence of, and level of need for, housing modifications and…devices among Americans with MS, the typical means of payment for these adaptations, and the demographic and clinical characteristics associated with their possession. METHODS: In order to achieve a representative national survey, a sample of 5082 adults with MS was randomly selected from the membership of the North American Research Committee on Multiple Sclerosis patient registry and selected chapters of the National Multiple Sclerosis Society in states in which the NARCOMS registry had lower representation. RESULTS: A relatively small number of changes made up the majority of the modifications and devices that people used or reported needing. Five of the six most prevalent modifications involved the bathroom. Changes to promote accessibility were primarily paid for the person with MS. Generally, people who reported greater degrees of mobility limitation or disability had an increased likelihood of having made housing modifications. CONCLUSION: Continued attention to the issue of accessible housing for Americans with MS is necessary, and there remains a significant and frequently unmet need for accessibility modifications and devices.
Abstract: BACKGROUND: Research with young adult cancer survivors has found that they are often lacking appropriate career development skills. As a result, they are often disconnected with the labor market and deal low levels of career readiness, low career self-efficacy, and higher rates of under and unemployment. OBJECTIVE: The purpose of this article is to describe a multi-domain model that provides a framework for conceptualizing the career development of young adult cancer survivors. METHODS: This study utilized a comprehensive review of the literature to develop a theoretical based conceptual model. RESULTS: The model emphasizes the interaction of contextual and career development…domains to improve participation in the areas of work, society, community, and home. CONCLUSION: A brief discussion of potential implications regarding research, service and policy are offered with the overall goal of conceptualizing career development as a public health intervention for young adult cancer survivors and other young adults with chronic health conditions.
Abstract: BACKGROUND: It is clear that the chronic progression of diabetes, as well as other socio-environmental factors, act as barriers to individuals seeking to maintain employment. Long-term employment outcomes of people with diabetes can be improved by providing customized interventions to help individuals retain their current employment. OBJECTIVE: This investigation examined differential vocational rehabilitation (VR) service patterns between two groups of clients with diabetes, those who were employed at the time of application and those who were unemployed. METHODS: Quantitative descriptive research design using multiple discriminant analysis (MDS). Participants included 5,427 individuals with diabetes whose VR cases were closed in Fiscal…Year 2011. RESULTS: MDS revealed that the employed applicants group had higher propensities than the unemployed applicants group to receive assessment, diagnosis and treatment, counseling and guidance, rehabilitation technology, and on-the-job supports as part of the VR process. The unemployed applicants group had higher propensities to receive occupational/vocational training, job readiness, job placement, and other services. CONCLUSION: These differential service patterns suggest that the client's employment status at the inception of his or her VR program is taken into close consideration during the case planning and goal-setting phases of the VR process. Implications for future research and VR service delivery are discussed.