A "win-win" perspective on workplace accommodations: RETAIN Kentucky's self-advocacy guide to promote successful return to work and stay at work outcomes for workers with disabilities.

BACKGROUND: Research has long documented the low cost and effectiveness of most workplace accommodations to enable qualified people with disabilities to seek, secure, and maintain employment. OBJECTIVE AND METHOD: RETAIN Kentucky's return to work and stay at work intervention involves focused training for participants on requesting needed accommodations from their employers. RESULTS: In this article, we describe the win-win approach to reasonable accommodations, which serves as the basis for helping Kentuckians with disabilities identify and request on-the-job supports to aid in their efforts to remain in the workforce. CONCLUSIONS: Workers with disabilities are more likely to stay in the workforce and continue making valuable contributions to the national and global economies if they have effective accommodations and other employment supports available to them.

Personal, health and function, and career maintenance factors as determinants of quality of life among employed people with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an intrusive disease that significantly affects labor force participation. OBJECTIVE: This study examined the extent to which factors at the personal, health and function, and environmental/career maintenance levels contribute to the predictability power for quality of life among employed people with MS. METHOD: Participants consisted of 523 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. These individuals were employed at the time of the survey, and they were primarily middle age (average age of 48 years) and Caucasian (74%). RESULTS: The final hierarchical multiple regression model explained 54 percent of the variability in participants' quality of life scores, although none of the hypothesized personal/demographic predictors were significant. Participants who perceived better overall health and lower levels of stress, who experienced less severe cognitive and mobility-related MS symptoms, and who expressed stronger job-person matches and higher levels of job satisfaction reported higher quality of life scores than did other participants. CONCLUSIONS: The findings underscore the complexity involved in predicting perceived quality of life among employed people with MS. Implications of these findings for future research and clinical practice are discussed.

Patterns in perceived employment discrimination for adults with multiple sclerosis.

Using multiple correspondence analysis, data from the US Equal Employment Opportunity Commission (1992-2003) were examined for types and patterns of allegations of discrimination filed by adults with multiple sclerosis (MS) under Title I of the Americans with Disabilities Act (ADA). Women comprised the majority of the Charging Parties (n=687, 67%), and most of the Charging Parties were White (n=769, 76%). The total number of allegations studied (N=3,668) was divided into two datasets, specifically 1,142 occurring separately and 2,526 occurring as part of a multiple allegation set. The four most frequent allegations were related to discharge, reasonable accommodation, terms and conditions of employment, and harassment. Multiple correspondence analysis indicated that a 5 axis model was required to explain approximately 50% of the variance in allegation patterns, and no charging party or employer characteristics were related to the axes. Axis themes derived from perceived discrimination on the part of employers included threats to retention (2 axes), employer hostility, informal or formal employer actions, and barriers to career mobility. Results supported the need for rehabilitation counseling interventions to help adults with MS identify and address precipitants to discharge (involuntary termination) or constructive discharge (voluntary termination in response to an untenable work situation).

An ecological approach to facilitate successful employment outcomes among people with multiple chemical sensitivity.

Many adults with multiple chemical sensitivity (MCS) must prematurely exit the workforce because of the severity of their MCS symptoms, the resulting disability stigma, and their unmet needs for on-the-job accommodations. To help individuals with MCS continue working or re-enter employment, rehabilitation professionals must understand the barriers resulting in unemployment and implement interventions to reduce or remove those barriers. In this article, the Ecological Model of Career Development is presented as a scheme for identifying barriers and implementing rehabilitation interventions to improve the employment outcomes among people with MCS.

Gender as a differential indicator of the employment discrimination experiences of Americans with multiple sclerosis.

Information from the Integrated Mission System of the United States Equal Employment Opportunity Commission (EEOC) was used to investigate the employment discrimination experiences of women and men with multiple sclerosis (MS). Spanning the years 1992 to 2003, the EEOC database included 3,663 allegations of discrimination filed by 2,167 adults with MS. With respect to women and men with MS, the researchers examined the comparability of a) demographic characteristics; b) industry designations, locations, and size of employers; c) the nature of discrimination alleged; and d) the legal outcome or resolution of those allegations. On average, women and men with MS were in their early forties, with the majority of both groups being Caucasian. Both women and men were most likely to allege discrimination related to discharge and reasonable accommodations, although women were more likely to file harassment charges than men. Men with MS were more likely to allege discrimination regarding hiring and reinstatement. Women with MS were more likely to file allegations against employers in the service industries, and men were more likely to file allegations against employers in the construction, manufacturing, and wholesale industries. No gender differences were found in the geographic distribution of allegations. Both groups had comparable rates of merit closures (23% vs. 27%) as a result of the EEOC's investigatory process. Implications for rehabilitation counseling and employer-oriented interventions are discussed.

Qualitative case studies of professional-level workers with traumatic brain injuries: A contextual approach to job accommodation and retention.

BACKGROUND: Traumatic brain injury (TBI) is a multi-systemic disability that causes a wide range of difficulties with personal and social functioning. METHODS: Four individuals with TBI participated in an evaluation of barriers to their continued employment following graduation from college. A trained interviewer completed the Work Experience Survey (WES) in teleconsultation sessions with each participant. RESULTS: Researchers applied a qualitative case study research design. Participants reported a wide range of difficulties in performing essential functions of their jobs (3 to 24) that have the potential to significantly affect their productivity. Career mastery problems reflected outcomes associated with TBI such as 'believing that others think I do a good job' and 'having the resources (e.g., knowledge, tools, supplies, and equipment) needed to do the job.' Indicative of their wish to continue their current employment, participants reported high levels of job satisfaction. CONCLUSIONS: The WES is a cost-effective needs assessment tool to aid health and rehabilitation professionals in providing on-the-job supports to workers with TBI.

Quality of life among people with multiple sclerosis: Replication of a three-factor prediction model.

BACKGROUND: This article presents a replication of Rumrill, Roessler, and Fitzgerald's 2004 analysis of a three-factor model of the impact of multiple sclerosis (MS) on quality of life (QOL). The three factors in the original model included illness-related, employment-related, and psychosocial adjustment factors. OBJECTIVE: To test hypothesized relationships between QOL and illness-related, employment-related, and psychosocial variables using data from a survey of the employment concerns of Americans with MS (N = 1,839). METHODS: An ex post facto, multiple correlational design was employed incorporating correlational and multiple regression analyses. RESULTS: QOL was positively related to educational level, employment status, job satisfaction, and job-match, and negatively related to number of symptoms, severity of symptoms, and perceived stress level. The three-factor model explained approximately 37 percent of the variance in QOL scores. CONCLUSIONS: The results of this replication confirm the continuing value of the three-factor model for predicting the QOL of adults with MS, and demonstrate the importance of medical, mental health, and vocational rehabilitation interventions and services in promoting QOL.

The employment concerns of Americans with multiple sclerosis: Perspectives from a national sample.

BACKGROUND: The recent rehabilitation literature does not include a thorough assessment of the employment concerns of people with MS. OBJECTIVE: This article presents descriptive findings from a national survey of the employment concerns of Americans with multiple sclerosis (MS; N = 1,924), representing nine chapters of the National Multiple Sclerosis Society. METHODS: Respondents were asked to evaluate 38 employment concerns items on two dimensions, importance and satisfaction, for the purpose of identifying strengths and weaknesses in the employment policies and practices affecting the labor force participation of people with MS. RESULTS: Results revealed a total of 32 employment strengths and six employment weaknesses. CONCLUSIONS: In spite of a jobless rate of more than 60 percent, people with MS were satisfied with the majority of employment concerns. Implications of these findings for rehabilitation policy and service delivery are examined.

Patterns in workplace accommodations for people with multiple sclerosis to overcome cognitive and other disease-related limitations.

BACKGROUND: Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited. OBJECTIVE: To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using work accommodations. METHODS: Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions. RESULTS: Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations. CONCLUSION: This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci.

Multiple sclerosis and employment barriers: a systemic perspective on diagnosis and intervention.

Although they have a recent work history, 70 to 80% of adults with multiple sclerosis are unemployed following their diagnosis. This high rate of unemployment constitutes a great loss of potential to the American economy. To help individuals with multiple sclerosis (MS) return to work or retain employment, rehabilitation professionals must understand the barriers resulting in unemployment and implement interventions to reduce or remove those concerns. In this article, Hershenson's systemic model of rehabilitation counseling is presented as a diagnostic scheme for identifying barriers to employment. Counselor consultation on barrier removal via reasonable accommodation is presented as one example of a rehabilitation intervention consistent with the systemic diagnostic model.

Perceived strengths and weaknesses in employment policies and services among people with multiple sclerosis: results of a national survey.

More than 1,300 individuals with multiple sclerosis (MS) responded to an employment concerns survey. The results from this survey served as the topics of discussion for seven focus groups including people with MS and service providers in four states. Recommendations to improve the employment outcomes of people with MS that emerged from these discussions clustered in three areas: employment policies and practices, Social Security benefits, and healthcare. Strategies for preserving strengths in employment supports for people with MS clustered in two areas, access to respectful service providers and personal control.

Specialized housing and transportation needs of adults with multiple sclerosis.

This study evaluated the specialized housing, transportation, and resource needs and barriers of adults with MS. Information pertaining to barriers and barrier removal strategies related to housing and transportation issues for adults with MS was gathered as part of a national survey of a randomly selected and representative sample of 5082 adults with MS, in cooperation with affiliate chapters of the National Multiple Sclerosis Society (NMSS) and the North American Research Committee on Multiple Sclerosis (NARCOMS). This article presents a qualitative analysis of participants' responses to questions addressing: (a) barriers to obtaining specialized housing and adapted transportation for individuals with MS, (b) factors contributing to maintenance of an independent lifestyle, and (c) information and referral resources pertinent to obtaining specialized housing and adapted transportation. The results provide the first assessment of these issues on a national scale and underscore the need for increased access to professional consultation, financial resources, and housing modification information and resources to enable persons with MS to obtain the specialized housing needed to maintain maximal independent lifestyles.

Measuring return to work.

BACKGROUND: It is argued that one of the factors limiting the understanding of return to work (RTW) following work disability is the use of measurement tools that do not capture a complete picture of workers' RTW experiences. To facilitate the investigation of RTW, the current authors proposed a developmental conceptualization of RTW, which argues for an expanded awareness that encompasses four phases: off work, work reintegration, work maintenance and advancement. This paper reports on work undertaken with the aim of operationalizing the conceptualization. METHODS: A review of the RTW and related literature, with databases searched including PubMed, EconLit, and PsycInfo. We began by extracting details of RTW instruments used by previous researchers. We then interpreted these within the context of the phases of RTW. Using the International Classification of Functioning, Disability, and Health (ICF) to inform our thinking and coding structure, we conceptualized phase-based RTW outcomes and categorized them as 'tasks and actions', 'contextual' or 'process driven'. Iteratively, we reviewed existing instruments for their use as measures of RTW. Where gaps in instrumentation were found, the wider vocational and career assessment literature was searched for instruments that could be adapted for use in RTW research. RESULTS: Results indicate that, although numerous research instruments have been used to assess RTW, within the scientific literature some important dimensions of RTW lack instrumentation. In particular, we found that outcomes such as goal setting, motivation, expectation, job seeking, work maintenance, and career advancement require operationalization. Amongst the outcomes had been operationalized, we found considerable variation in conceptual development and application. CONCLUSIONS: The lack of consistency and comprehensiveness of RTW measurement is one of the factors compromising the advancement of the field of RTW research. It is suggested that a more complete and psychometrically sound array of research instruments, grounded within a commonly adopted paradigm, would further the understanding of RTW and the factors affecting it.

Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns.

INTRODUCTION: Satisfaction with return-to-work (RTW) outcomes is dependent on many factors, including a clear exposition of what people define as a "good outcome" and the information they use to determine if such an outcome has been achieved. This paper defines the key stakeholders involved in the RTW process and discusses the need to understand their motivations, interests, and concerns. METHODS: A review of the literature and discussions with RTW researchers conducted by a multidisciplinary group of academic researchers. RESULTS: Our analysis suggests that RTW stakeholders can share the goal of a successful RTW; however, this consensus has to be viewed in light of other, sometimes competing, goals and the environments in which stakeholders operate. CONCLUSIONS: It is suggested that more clearly articulating and operationalizing stakeholders' perspectives will allow researchers to advance the understanding of RTW interventions and outcomes.

A developmental conceptualization of return to work.

INTRODUCTION: Although return to work (RTW) is a phenomenon that has been researched for many years, our ability to understand and improve outcomes is still limited. As an avenue for advancing the field, this paper presents an alternative way of thinking about RTW. METHOD: The conceptualization was constructed based on a review of the literature and the comments of RTW and workers' compensation researchers. RESULTS: RTW is presented as an evolving process, comprising four key phases: i.e., "off work," "work re-entry," "retention," and "advancement." In addition, multiple phase-specific outcomes that may be used to evaluate RTW success are advanced. CONCLUSION: Broadening thinking about RTW to take into consideration the complexities of its developmental nature holds promise for understanding and improving RTW, as it not only clarifies the importance of incremental milestones, but also facilitates intervention choice and evaluation.

Transition and the community college: a Career Keys model for students with disabilities.

Transition models are needed that address multiple phases in the postsecondary education of students with disabilities. These models must first address the recruitment of high school students with disabilities for community colleges through career exploration experiences that help students clarify their educational and vocational interests and relate those interests to a two-year postsecondary program. Students with disabilities then need a comprehensive service program while attending community college to help them identify accommodation needs in classroom and workplace environments and develop the skills to request such accommodations from their instructors and employers. With this skill base, they are well prepared to initiate the next transition in their lives, that is, the movement from the community college to a four-year educational institution or to employment. Programs are needed to facilitate this transition, such as a placement planning seminar involving rehabilitation professionals and employers and an accommodation follow-up assessment with students in their new educational and employment settings. The "Career Keys" model describes how to deliver the services needed in each of these critical transition phases.