The impact of employment on quality of life for adults with brain injury

BACKGROUND: Employment is associated with greater quality of life (QOL) for people with disabilities. Yet, for individuals with traumatic brain injury (TBI), the benefits of work are not often realized, given high rates of unemployment. OBJECTIVE: This study examined the unique impact of psychosocial variables and employment status (working vs. not working) on self-reported QOL among adults with TBI. METHODS: Participants included 116 adults with TBI between the ages of 18-65, recruited through state brain injury associations in the United States to complete an anonymous online survey. Hierarchical regression analysis was used to examine the incremental impact of psychosocial variables (sense of community, social support, social network, and problem-solving confidence) and employment status on QOL controlling for age and symptom severity. RESULTS: In the final model, employment status, informal and formal support network ties, problem-solving confidence, sense of community, and emotional support explained 59%of the variance in QOL, which is considered a large effect size. Employment status uniquely explained 5%of the variance in QOL. CONCLUSIONS: Findings support the positive benefits of work for adults with TBI. Rehabilitation services that emphasize vocational considerations and employment supports are needed to impact work status and ultimately QOL for individuals with TBI.

Examining barriers and strategies for effective professional or interagency collaboration in secondary transition

BACKGROUND: For young adults with disabilities, post-high school outcomes in employment, higher education, and independent living are markedly worse than their peers without disabilities. As a result, legislation and research aimed at supporting transitioning students has increased. Further, numerous initiatives that better support youth and families have been implemented at the state and local level. Collaboration within and across service delivery systems has been identified as a critical aspect of transition planning and supports; however, evidence-based research related to the implementation and effects of collaborative partnerships is limited. OBJECTIVE: In the current study, we identify transition professionals’ perceptions of collaborative factors that facilitate and inhibit collaboration. METHOD: This study utilizes a single-state survey research design to examine the viewpoints of transition professions, specifically educators, Vocational Rehabilitation professionals, and community supports providers. RESULTS: Variance in perceptions were found among participant role groups. Specifically, educators as a whole report that time and workload barriers affect their ability to collaborate effectively. Further, findings indicate that ensuring individual collaborative team member responsibility is perceived as an effective strategy. CONCLUSIONS: These findings may be applied to technical assistance providers when developing team-level evaluations to monitor current levels and support needs of collaborative transition planning teams.

Service needs assessment of employment-related soft skills for transition age youth with disabilities

BACKGROUND: Work-related soft skills can be an important factor for successful employment outcomes, particularly for individuals with disabilities. OBJECTIVE: This study conducted a survey on the needs of important work-related soft skills for employment success of transition age youth with disabilities. METHODS: 183 participants included 27 individuals with disabilities, 32 family members of individuals with disabilities,35 disability service providers, 47 disability advocates and 42 employers, completed surveys to identify a list of soft skills by importance for transition age youth with disabilities to succeed at work. RESULTS: All five groups noted the top two skills: asking for help and responding to feedback, as most important. Employers also rated interview skills as third most important skills, while the other four groups advocated requesting for accommodations and negotiating conflicts as the third and fourth most important skills. CONCLUSIONS: Findings indicated soft skills being critical to work success for transition age youth with disabilities, with some skills potentially being more important. Vocational counseling implications were discussed.

Determinants of employment outcomes of transition-age youth with depressive disorders

BACKGROUND: Transition-age youth (TAY) with depressive disorders struggle with finding and retaining gainful employment. Thousands of these youth enroll in the state-federal vocational rehabilitation (VR) program each year to improve their employment outcomes. However, there is a dearth of information on the factors that facilitate or impede their success in the program. OBJECTIVE: The study aims to shed light on the demographic characteristics and vocational rehabilitation services and their association with successful employment and earnings of TAY with depressive disorders in the state-federal VR program. METHOD: The sample comprised of 4,772 participants drawn from the Rehabilitation Services Administration dataset. Regression analyses were employed to examine the effects of demographic characteristics and vocational rehabilitation services on successful employment and earnings. RESULTS: Results indicated that employment outcomes varied by demographic characteristics such as race/ethnicity, severity of disability and level of education. Also, certain VR services had significant positive or negative relationships with successful employment and earnings. CONCLUSIONS: Highlighting the promise of the state-federal programs for supporting TAY with depressive disorders to successfully participate in the labor market, findings from this study expand upon the literature by suggesting practices and services for optimizing employment potentials of this population.

Workplace discrimination allegations and outcomes involving caucasian Americans, African Americans, and Hispanic/Latinx Americans with multiple sclerosis: A causal comparative analysis

BACKGROUND: Although African Americans and Hispanic/Latinx Americans with multiple sclerosis (MS) frequently cite workplace discrimination as a major concern, the specific nature of this discrimination is not yet well understood. OBJECTIVE: The purpose of this study was to investigate racial/ethnic differences in allegations of workplace discrimination by Caucasian, African American, and Hispanic/Latinx American individuals with MS. METHODS: The United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database was used to describe and compare the frequency and characteristics of discrimination allegations filed by people with MS in the three race/ethnicity groups. Quantitative analyses, including a one-way analysis of variance and Chi-square tests, were used to examine 2009–2016 Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints. These complaints were received by the EEOC from people with MS who identified themselves as Caucasian, African American, and Hispanic/Latinx American (N = 3,770). RESULTS: Both African Americans and Hispanic/Latinx Americans tended to encounter discrimination at a younger age than Caucasian Americans. African American and Hispanic/Latinx American charging parties were more likely to be women than were Caucasian charging parties. The size and location of employers against whom allegations were filed varied significantly among the three racial/ethnic groups. The EEOC was more likely to resolve allegations in the charging parties’ favor when the allegations were filed by Caucasians. CONCLUSION: The present study revealed modest but significant differences in the workplace discrimination experiences of the three groups under study. More research is needed to determine why racial/ethnic status bears on the discrimination experiences of Americans with MS.

MS JobSeek: A pilot randomized controlled trial of an online peer discussion forum for job-seekers with multiple sclerosis

BACKGROUND: Peer-facilitated interventions have been successfully used in chronic disease management. Less is known about their application in vocational rehabilitation. OBJECTIVE: To pilot-test an online peer discussion forum to improve exploration of employment options in job-seekers with long-term multiple sclerosis (MS). METHODS: Twenty-nine persons with relapsing/progressive MS (4–27 years since diagnosis) were recruited online and randomly assigned to an 8-week discussion forum led by peers and a moderator –MS JobSeek (n = 14), or an active control group (n = 15). Forum engagement and user satisfaction were examined, as were pre-post self-evaluations of job search behaviour, efficacy, and quality of life. RESULTS: A high (43%) attrition rate was noted, although intervention completers acknowledged and valued online mentors’ guidance and expertise. Group and time effects were not significant (p < 0.05), with both MS JobSeek and control participants reporting positive (e.g., increase in job search activities) and negative (e.g., lowered self-efficacy) change. CONCLUSIONS: The pilot findings suggest that online peer support is feasible, however more can be done to promote peer-to-peer communication. Recommendations for improving forum engagement and satisfaction in a future controlled trial, including strategies to better support mentees’ individualised needs, are offered.

Treatment and provider choice in worker injury rehabilitation: A systematic literature review

BACKGROUND: In the face of significant costs for injured worker rehabilitation and its impact on society, ongoing examination of how rehabilitation is carried out is warranted. OBJECTIVE: To review recent studies that explored the impact of the worker’s choice in terms of provider and treatment on the outcome for the worker in injury rehabilitation. METHOD: A systematic literature review was conducted using searches through electronic databases, with studies retrieved then subjected to a quality appraisal. RESULTS: Nineteen studies were eligible for inclusion. Studies reviewed found that choice of provider or treatment generated more positive outcomes for workers, and workers preferred a treatment provider familiar with their care. The worker’s ability to exercise choice was affected by conflict with other stakeholders and misalignment of expectations. The relationship between choice and costs was unclear, sometimes conflicting. CONCLUSIONS: The impact of treatment and provider choice on outcomes for workers remains unclear. The worker’s ability to choose may be hampered by systemic constraints, access to preferred providers, misalignment of stakeholder expectations, and the worker’s ability to engage in decision making. Greater worker engagement in their rehabilitation could potentially reduce costs as well as improve psychosocial outcomes.

Barriers to work-based learning experiences: A mixed methods study of perceptions from the field

BACKGROUND: Work-based learning experiences (WBLEs) are significantly associated with improved postschool employment outcomes for students with disabilities; however, little is known about the specific barriers affecting implementation of WBLEs. OBJECTIVE: The purpose of this study was to identify community-and school-related barriers to implementing WBLEs. METHODS: This study used a mixed methods approach to analyze survey data from 170 secondary transition staff providing WBLEs to students with disabilities in three states. RESULTS: Findings provided a broader understanding of critical barriers as perceived by transition staff implementing WBLEs, including limited availability of resources, transportation, and lack of willing employers. CONCLUSIONS: Collaborative partnerships between vocational agencies and school districts have the potential to address some of these barriers and improve the delivery of employment supports and WBLEs in an effort to help students achieve their postschool employment goals.

Returning to work after acquired brain injury: A mixed method case study

BACKGROUND: Vocation is a meaningful area of rehabilitation after Acquired Brain Injury (ABI). There is a discrepancy between the number of individuals with an ABI who feel able to work and those who are employed in Ireland. Research suggests that Vocational Rehabilitation (VR) programs enhance Return to Work (RTW) outcomes after ABI, however existing literature is limited. OBJECTIVE: This study explores the experience of engaging in VR post ABI, and its impact upon work self-efficacy. METHODS: A mixed methods case study design was selected to represent the individuality of ABI presentations. Participants completed a qualitative interview at VR follow up (N = 2) and the Work Self-Efficacy Inventory at pre/post VR. RESULTS: Four overarching themes emerged including Stigma, Adjustment, Support and Readiness. RTW challenges included fatigue, accepting support, adjusting to work and stigma. RTW benefits included routine, pride in work, skills development, and empowerment. Wilcoxon signed rank indicated that work self-efficacy scores mildly improved post VR. CONCLUSIONS: This research may inform VR Programs and offers pragmatic clinical implications based on the data. Future research should consider the role that readiness plays in facilitating RTW. Limitations include sample size, a lack of longitudinal data and control group.

Effects of the COVID-19 pandemic on college students with intellectual disabilities

BACKGROUND: The lived experiences of adults with intellectual disability (ID) during the Coronavirus Disease 2019 (COVID-19) need to be considered when developing and implementing support for maintaining the quality of life outcomes for this population. OBJECTIVE: This study was conducted to capture and analyze adults’ lived experiences with ID during the COVID-19 pandemic. METHODS: A qualitative study with focus groups was conducted that included two groups of adults with ID; graduated (N = 4) and enrolled (N = 5) students from a postsecondary education (PSE) program. Questions were formulated based on societal feature areas that may be affected during unplanned historical events. Data were analyzed utilizing Vivo coding. RESULTS: Four themes (employment, daily living, social, well-being) and eleven subthemes emerged during the interviews. Participants described the impact of COVID-19, such as learning, and implementing new procedures in the workplace, taking on increased responsibilities at home, and the uncertainty of their future. CONCLUSIONS: Findings indicated the need for support for adults with ID to be established before unplanned events to maintain their outcomes as productive members of society. Implications include the need for increased support from immediate support systems.