The impact of customized employment on the competitive integrated employment outcomes of transition age youth with intellectual and developmental disabilities: A randomized controlled trial study.

BACKGROUND: Customized employment (CE) is recognized in the Workforce Innovation and Opportunity Act (2014) as a strategy for promoting competitive integrated employment. However, the existing body of evidence supporting CE is mainly descriptive rather than experimental research. OBJECTIVE: This study examined the impact of CE on the employment outcomes, hours worked per week, and wages of transition-age youth with intellectual and developmental disabilities. METHOD: The outcomes of transition-age youth participating in a CE intervention were compared to those receiving treatment-as-usual using a randomized controlled trial design. RESULTS: Participants receiving CE were significantly more likely to secure competitive integrated employment than controls who received treatment-as-usual. Participants in the intervention and control conditions earned similar wages. Participants in the control condition worked more hours per week than those in CE. CONCLUSION: The findings from this study demonstrate the effectiveness of CE to assist transition-age youth with intellectual and developmental disabilities in obtaining competitive integrated employment, but future research is needed to examine factors impacting weekly hours and wages of participants in CE.

Demographic covariates and vocational rehabilitation services as predictors of employment outcomes of people with physical disabilities: a hierarchical logistic regression analysis.

PURPOSE: Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. MATERIALS AND METHODS: This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education's Rehabilitation Services Administration's Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. RESULTS: For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. CONCLUSIONS: Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

The alarmingly low employment rate among PwPD significantly impacts their psychological, financial, social, and overall health well-being in the U.S.Vocational rehabilitation services, including workplace support, technology assistance, VR counseling, and job placement support, are pivotal in facilitating employment for PwPD.PwPD who received workplace support exhibited nearly six times higher odds of attaining employment compared to those without such assistance.PwPD who received technology support experienced four times higher odds of achieving employment in contrast to those without technology assistance.

Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives.

The purpose of this study was to examine the social validity of five different evidence-based and emerging pathways to employment (i.e., supported employment, customized employment, internships, apprenticeships, and postsecondary education) from the perspective of multiple stakeholders. A Delphi method was used to determine whether stakeholders are in consensus regarding the accessibility, affordability, acceptability, efficacy, and the cost-benefit ratio of these interventions. Findings indicated that all pathways were deemed socially valid via stakeholder consensus except for apprenticeships, which could not be determined as a result of limited stakeholder knowledge and experience with the pathway. Future efforts to improve employment outcomes for people with intellectual and developmental disabilities (IDD) should focus on better training for service providers and increased access to services.

Effects of Customized Employment on the Independence of Youth With Intellectual and Developmental Disabilities.

Participation in work during school is a known predictor of postsecondary employment for transition-age youth with intellectual and developmental disabilities (IDD). Recent research has demonstrated the benefits of work on skill development in major life domains. The purpose of this study was to examine the impact of customized employment on the support needs of youth with IDD with a significant disability compared to those receiving treatment as usual. Findings indicated significant increases in independence in three specific domains for the treatment group versus control on the Supports Intensity Scale-Adult Version, including Home Living, Employment, and Protection and Advocacy. Findings suggest a therapeutic effect of work activities on growth and development in important life domains. Implications for future research, policy, and practice are discussed.

Effects of a 9-Month Military-Base Internship on the Competitive Integrated Employment of Military Dependent and Connected Youth with ASD.

This waitlist-controlled cluster randomized clinical trial presents the results of PS + ASD for military dependent and connected youth with ASD. Following earlier findings regarding PS + ASD, this study expands upon that previous work by including a new population, military dependent and connected transition aged youth with ASD. Findings indicate that military dependent and connected youth who participated in PS + ASD gained competitive integrated employment at 60% despite the impact of the COVID-19 pandemic and economic downturn. In addition, these youth worked a mean of 24.42 h weekly and earned an average hourly wage of $9.38 at one year post baseline while the waitlist control group participants did not gain CIE. In addition, by 18 months, 58.3% of participants gained positions in federal employment. Implications of the study are discussed.

The impact of competitive integrated employment on economic, psychological, and physical health outcomes for individuals with intellectual and developmental disabilities.

BACKGROUND: Although competitive integrated employment (CIE) has been established as a goal of employment research, policy, and practice for individuals with intellectual and developmental disabilities, the secondary benefits of CIE are rarely discussed. AIMS: The purpose of this systematic review was to analyze and synthesise research related to the association between CIE and improved economic, psychological health, and physical health outcomes for individuals with intellectual and developmental disabilities. MATERIALS & METHODS: Our review searched peer-reviewed literature from seven electronic databases and screened 1110 peer-reviewed articles based on inclusion criteria established following PRISMA guidelines. RESULTS: Our search procedures produced a final sample of 17 studies. DISCUSSION: Implications of these findings for future research, policy, and practice are provided. CONCLUSION: Our findings showed strong evidence associated with economic outcomes of CIE, moderate associated with psychological health outcomes, and limited evidence related to physical health outcomes.

Current Life Experiences in Veterans with Limb Loss: A Description of Survey Methods and Summary Results.

PURPOSE: To present the methods and summary findings of a nationwide survey on the current life experiences of Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) Veterans with limb loss. METHODS: A questionnaire was sent to Veterans with items covering sample demographics, summaries of health status, prosthesis usage and fit, employment experience, and use and satisfactions with support services and providers. RESULTS: 158 Veterans completed the survey. Approximately 40% perceived their overall status, function and problems related to the prosthesis as "Average". 58% wore a prosthesis over 10 hours per day and 74% did not use additional walking aids. Approximately 75% had at least "Moderate" pain and residual limb health problems. 37% were employed though conditions often changed. Over 80% used healthcare, mental health counseling and education services. The Departments of Defense and VA were primary service providers. CONCLUSIONS: Respondents generally exhibited satisfactory life experiences. Results suggest a positive current status despite challenges that could impair health, functioning and quality of life. Support services were available as needed. Satisfaction with services and providers varied.

Evaluating the Effect of Work Incentives Benefits Counseling on Employment Outcomes of Transition-Age and Young Adult Supplemental Security Income Recipients with Intellectual Disabilities: A Case Control Study.

Purpose Work incentives benefits counseling (WIBC) can be a strong facilitator contributing to improved employment outcomes for individuals with intellectual disabilities (ID) by providing information about how income may affect disability benefits eligibility. The purpose of this study is to evaluate the effect of WIBC as a VR intervention to improve on employment outcomes and earnings of transition-age youth and young adults with ID who are Supplemental Security Income benefits recipients using a propensity score matching analysis approach. Propensity score matching using logistic regression analysis and the nearest neighbour method was conducted to equalize the treatment (received WIBC) and control groups (not received WIBC) on the six prominent demographic covariates. The treatment group had higher rates of employment, higher hourly wages than the control group, while the treatment group worked less hours per week than the control group. Methods Propensity score matching using logistic regression analysis and the nearest neighbour method was conducted to equalize the treatment (received WIBC) and control groups (not received WIBC) on the six prominent demographic covariates. Results The treatment group had higher rates of employment, higher hourly wages than the control group, while the treatment group worked less hours per week than the control group. Conclusions Findings of the present study can be used by policy makers, transition specialists, rehabilitation counselors, and other disability service providers to increase employment outcomes and earnings for individuals with ID through WIBC services. Future research and practice implications are provided.

Company Characteristics, Disability Inclusion Practices, and Employment of People with Disabilities in the Post COVID-19 Job Economy: A Cross Sectional Survey Study.

Purpose In the post coronavirus disease 2019 (COVID-19) recession economy, rehabilitation counselors, transition specialists, and other disability service providers must redouble their efforts to connect with employers to create employment opportunities for people with physical and mental impairments. The purpose of the present study was to investigate company characteristics and effective disability inclusion practices that are related to employment of people with disabilities. Methods Four hundred sixty-six employers completed a demographic questionnaire and the Disability Inclusion Profiler. Results Results indicated company characteristics and disability practices were positively related to employment of people with disabilities. Conclusions Findings of the present study can be used by transition specialists, rehabilitation counselors, and other disability service providers to engage and connect with employers to increase employment opportunity for people with disabilities in the post COVID-19 economy. Future research and practice implications are provided.

Competitive Integrated Employment for Youth and Adults with Autism: Findings from a Scoping Review.

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

The Effect of Business Internships Model and Employment on Enhancing the Independence of Young Adults With Significant Impact From Autism.

This article presents findings from a multisite randomized clinical trial measuring the impact of employment on independence in 18 to 22 year old youth with significant impact from autism spectrum disorder (ASD). The treatment condition was Project SEARCH plus ASD Supports (PS+ASD) where 73.4% of participants gained competitive integrated employment (CIE) within 1 year of graduation compared to control participants who acquired CIE at 17%. Within group analysis revealed that PS+ASD participants demonstrated improvement in all domains whereas control group participants demonstrated improvement in one domain only. Between groups analysis indicated that participants in PS+ASD demonstrated nominally better rates of improvement than control group participants at graduation and 1-year follow-up. Results provide evidence that employment provides therapeutic benefits to individuals with ASD.

Competitive Integrated Employment for Youth and Adults with Autism: Findings from a Scoping Review.

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-site Randomized Clinical Trial.

This study reports the results of a multi-site, parallel block randomized clinical trial to expand the previous findings regarding the implementation of Project SEARCH plus ASD Supports (PS + ASD) on employment outcomes upon graduation from high school. Participants were 156 individuals with significant impact from ASD between the ages of 18-21. There was a significant difference between treatment and control groups with 73.4% of the treatment group acquiring competitive employment at or above minimum wage by 1-year after graduation compared to 17% of the control group for whom data was provided. At 1-year, employed treatment group participants worked an average of 21.2 h per week (SD = 9) for a mean hourly wage of $9.61 per hour (SD = $1.55).Clinical Trial Registration: clinicaltrials.gov Identifier: NCT03560453.

Helping High School-Aged Military Dependents With Autism Gain Employment Through Project SEARCH + ASD Supports.

INTRODUCTION: Youth with autism spectrum disorder (ASD) face high rates of unemployment, with unique challenges for military-dependent and -connected youth with ASD. This paper reports preliminary findings from Year One of a randomized waitlist controlled trial investigating the efficacy of the Project SEARCH + ASD Supports (PS + ASD) intervention model for military-dependent and -connected youth with ASD. METHODS: Treatment group participants (n = 6) participated in internships at a military installation in the southeastern United States; waitlist group participants (n = 8) received special education transition services at their local high schools. Employment outcome data were collected at 12 months for both groups. RESULTS: Fourteen unique internship experiences were developed across seven business partner organizations on the military installation during Year One. Five of six PS + ASD treatment group participants obtained competitive integrated employment for an overall employment rate of 83.3%. Four of the positions were federal jobs. None of the waitlist group participants obtained competitive integrated employment during the same period. CONCLUSIONS: Initial results are promising and suggest that the PS + ASD model may help to meet the transition needs of military-dependent and -connected youth with ASD and the employment needs of local military communities.

Reintegrating Veterans with Polytrauma into the Community and Workplace.

This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.

Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A Review of the Literature.

Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature exploring the impact of amputation upon a person's functioning and inclusion in the workplace. Methods Medline, CINAHL, and PsycINFO were searched using keywords related to amputation, employment and community reintegration. Eligible studies were published since 2000 and one of the following study designs: randomized controlled trial, non-randomized controlled trial, retrospective study, prospective study, concurrent cohort study, or cross sectional study. Studies for civilians with amputation as well as service members and Veterans with amputation were considered for inclusion. Results The search identified 995 articles, 25 of which met inclusion/exclusion criteria and were included in the review. While strong evidence for correlations and predictors of outcomes after amputation were limited, multiple factors were identified as contributing to physical functioning and employment after amputation. Conclusions Outcomes after amputation can vary widely with many potentially inter-related factors contributing. The factors identified may also serve to inform the development of interventions aiming to improve functional performance and reintegration after amputation. Furthermore, the review highlights the need for more high quality prospective studies.

Evaluating the effectiveness of Facebook to impact the knowledge of evidence-based employment practices by individuals with traumatic brain injury: A knowledge translation random control study.

BACKGROUND: Individuals with traumatic brain injury (TBI) experience difficulty with obtaining and maintaining employment post-injury. Although vocational rehabilitation (VR) can be one option to provide individuals with TBI support and services to lead to successful employment outcomes, information about these services can be difficult and confusing to navigate. Providing information on evidence-based employment practices to individuals with TBI through social media could be an effective approach. OBJECTIVE: The objective of this study was to compare the effect of a knowledge translation (KT) strategy and the use of a secret Facebook group, on the knowledge of evidence-based employment research by individuals with traumatic brain injury (TBI). METHODS: The study used a randomized pretest-posttest control group design. Sixty individuals with TBI were recruited through clubhouse programs in the state where the authors resided as well as through support groups nationally for individuals with TBI, and were randomly assigned to one of two groups. Both groups received information on evidence-based employment practices for individuals with traumatic brain injury (TBI) over a three month period. One group received the information via participation in a secret Facebook group while the comparison group received information as an "e-news" email blast. Participants were assessed pre- and post-intervention with a Likert-scale instrument designed to measure knowledge of evidenced-based employment information for TBI. RESULTS: Both groups gained a significant amount of knowledge between baseline and post-intervention. However, there were no significant differences between groups in knowledge gained at post-intervention. CONCLUSION: While the study did not identify the most effective means of delivering information to individuals with TBI, it does provide some guidance for future KT research.

Educational and Vocational Issues in Traumatic Brain Injury.

This article describes some of the current issues related to return to school and employment for individuals with traumatic brain injury. A strong, collaborative partnership between an individual's health care providers and key stake holders is essential to a smooth transition back to school or work. Ways to improve current practices and ensure more timely and appropriate educational and employment services and supports for individuals with traumatic brain injury are described. Some recommendations on areas for future research are also offered.

Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism.

The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism Spectrum Disorder Supports. A randomized clinical trial compared the implementation of Project SEARCH plus Autism Spectrum Disorder Supports with high school special education services as usual. Participants were 49 high-school-aged individuals between the ages of 18 and 21 years diagnosed with an autism spectrum disorder and eligible for supported employment. Students also had to demonstrate independent self-care. At 3 months post-graduation, 90% of the treatment group acquired competitive, part-time employment earning US$9.53-US$10.66 per hour. Furthermore, 87% of those individuals maintained employment at 12 months post-graduation. The control group's employment outcomes were 6% acquiring employment by 3 months post-graduation and 12% acquiring employment by 12 months post-graduation. The positive employment outcomes generated by the treatment group provide evidence that youth with autism spectrum disorder can gain and maintain competitive employment. Additionally, there is evidence that they are able to advance within that time toward more weekly hours worked, while they also displayed increasing independence in the work setting.