Individual Placement and Support for persons with alcohol and drug addiction in a Swedish context (IPS-ADAS): study protocol for a randomised controlled trial.

BACKGROUND: Employment is a vital source for experiencing well-being and lowering the risk of long-term social marginalisation and poverty. For persons with alcohol and drug addiction, it may also improve sobriety. However, the unemployment situation for this group reflects the knowledge gap in effective interventions to support employment. While Individual Placement and Support (IPS) is recognised as evidence-based supported employment for those with serious mental health problems, no scientific evidence for the target group of addiction exists to date. The aim of the present IPS for Alcohol and Drug Addiction in Sweden (IPS-ADAS) trial is to study whether IPS has an effect on gaining employment for this group. METHODS: The IPS-ADAS trial is a multisite, pragmatic, parallel, and single-blinded, superiority randomised controlled trial (RCT). Participants (N = 330) will be randomly assigned (1:1) and participate in IPS plus treatment as usual within Addiction Services (IPS + TAU) or Traditional Vocational Rehabilitation (TVR) available plus TAU (TVR + TAU) for 12 months. The principle of intention-to-treat (ITT) will be applied. The hypothesis is that a significantly larger proportion of IPS + TAU participants will be employed for > 1 day (primary outcome), reach employment sooner, work more hours and longer periods of time, and have a higher income as compared to TVR + TAU participants at 18-month follow-up. We further anticipate that those who benefit from IPS + TAU will use less alcohol and drugs, experience better health, and use less care and support, including support from the justice system, in comparison to TVR + TAU participants, at 6, 12, and 18 months. A supplementary process evaluation, using the IPS Fidelity Scale (25 items) and adhered interviews will address delivery and receipt of the IPS as well as contextual hinders and barriers for coproduction and implementation. Working age (18-65), willingness to work, unemployment, participation in an information meeting about the RCT, treatment for addiction diagnosis, and being financially supported by welfare, constitute eligible criteria. DISCUSSION: A primary study on the effectiveness of IPS on employment for the new target group of addictions will add to the international IPS knowledge base and inform national policy to include the underrepresented group in working life. TRIAL REGISTRATION: WHO International Clinical Trials Registry Platform ISRCTN10492363. Registered on 14 August 2023.

The ROCK trial-a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol.

INTRODUCTION: Most cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care. METHODS AND ANALYSIS: The ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA. DISCUSSION: The ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest. TRIAL REGISTRATION: ClinicalTrials.gov NCT05173740. Registered on May 2018.

Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health.

Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.

Evaluation of Active Labor Market Policy Reform: Employment Outcomes of Vocational Rehabilitation Services.

PURPOSE: The purpose of this study is to examine the effect of the Estonian active labor market reform in 2016, which introduced a new policy concerning vocational rehabilitation services. As a research question, we investigate how such services may have affected the employment outcomes of people with mental and/or physical impairments. METHODS: Our sample includes 9244 people from 2016 to 2020, with a mean age of 46 years. Due to multiple entries to the services, we have more than 11,000 cases with over 100,000 monthly observations. We use propensity score matching in combination with fixed effects panel regressions to analyze how the completion of the scheduled rehabilitation plan affected monthly employment duration. RESULTS: Our findings indicate that completing the rehabilitation service results on average in 2.6 months longer post-rehabilitation employment, compared to matched individuals who discontinued the service. This effect was larger when already employed and male participants entered the service, while weaker effects were observed in the case of individuals with only mental disabilities. CONCLUSIONS: Overall, we conclude that while completing the scheduled rehabilitation plan has a positive effect on employment outcomes, still maintaining employment status seems to remain a challenge, based on the relatively modest effect sizes. Thus, we question the economic arguments behind the reform.

[Social Support for Patients with Higher Brain Dysfunction in the Chronic Phase].

Higher brain dysfunction inhibits social rehabilitation in patients with stroke or brain injuries. First, magnetic resonance imaging should be performed in the acute phase to predict higher brain dysfunction in the chronic phase. Second, patients' complaints should be carefully considered. Vocational rehabilitation is provided after medical rehabilitation from various sources. Information for social support is provided. The homepage of the National Rehabilitation Center for Persons with Disabilities is a resource for such information. We plan vocational rehabilitation for such patients. We provide medical certificates, such as that required to file for disability pension, because economical support is crucial. Peer support should also be provided to patients and their families. Recovery from higher brain dysfunction occurs gradually over a prolonged period. Therefore, patients should be offered continuing treatment on an outpatient basis in the chronic phase.

VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey.

Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.

Bridging the gap: Hospital to workplace.

BACKGROUND: Work-oriented neurorehabilitation to return to competitive employment after a serious neurologic illness or injury is an interdisciplinary process that begins as soon as pathology has stabilized. OBJECTIVE: This bimonthly column provides narratives of anonymized clients in situations that challenge their return-to-work. Each case study is designed for postgraduate education about tools and methods that are appropriate to consider in similar situations. METHODS: Through case studies of adults attempting to return to safe and dependable competitive employment, real-world issues are explored that occur at the interface between the client and their employer. RESULTS: The current case describes Structured Task Self Appraisal (STSA), a forensic rehabilitation method to collect self-report baseline information concerning the client's job-relevant functional limitations. STSA guides return-to-work rehabilitation services. CONCLUSION: Information concerning the core tasks and important abilities of the client's target occupation that are immediately available in O*NET can be analyzed in a structured manner to provide the workplace context for rehabilitation.

Critical elements in the experience of virtual reality job interview training for unemployed individuals with serious mental illness: Implications for IPS supported employment.

OBJECTIVE: Individuals with serious mental illness (SMI) who re-enter the labor market after extended unemployment may benefit from exposure to job interview training. This study explored the processes and perceived benefits of preparing for interviews using Virtual Reality Job Interviewing Training (VR-JIT) among employment specialists (ESs) and clients within the individual placement and support (IPS) model of supported employment. METHOD: This study analyzed secondary qualitative data from a randomized controlled trial (RCT) of VR-JIT including qualitative focus groups comprised of IPS employment specialists (n = 11) and IPS clients (n = 13), semistructured interviews with IPS employment specialists (n = 3), and semistructured interviews with IPS clients (n = 3). Additionally, semistructured interviews with IPS employment specialists (n = 8) who naturalistically implemented VR-JIT at four community mental health agencies independent of the RCT. All focus group and interview data were analyzed using grounded theory methodology. RESULTS: Three main processes were viewed by employment specialists (and their clients) as beneficial for individuals with SMI receiving IPS with VR-JIT: (a) exposure to a simulated interview in a safe environment; (b) practicing and receiving job interviewing feedback; and (c) improved confidence and motivation in job seeking. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: VR-JIT improved IPS participants' confidence in job seeking through proposed mechanisms of exposure to a simulated job interview and repetition and practice of job interview skills. These critical elements indicate that VR-JIT has the potential to improve IPS client engagement particularly with those who have had prolonged periods of unemployment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study.

STUDY DESIGN: Qualitative study using realist review. OBJECTIVES: To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation. SETTING: New Zealand Spinal Unit. METHODS: People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods. RESULTS: We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work. CONCLUSIONS: To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment. SPONSORSHIP: This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

Effect evaluation of a vocational rehabilitation program for young adults with chronic physical conditions at risk for unemployment: A controlled clinical trial.

BACKGROUND: The work participation of young adults with chronic physical conditions lag behind compared to healthy age-mates. 'At Work' is a vocational rehabilitation intervention provided by occupational therapists, that supports them for entering the competitive labour market after graduating post-secondary education. AIM: To evaluate the effects of 'At Work' on self-efficacy, work-ability and employment status as compared to usual care. MATERIALS AND METHODS: In total, 88 young adults were included in a multicentre controlled trial; 49 entered 'At Work', 39 received usual care. GEE-analyses were applied. RESULTS: Scores on all outcome measures substantially improved over time in the intervention group, but no significant effects were found as compared to the control group. The effect on general self-efficacy showed a positive trend in favour of the intervention group. CONCLUSIONS AND SIGNIFICANCE: Unlike previous study results pointing to positive outcomes of At Work', the current study did not support the effectiveness of this program on work-related self-efficacy, work-ability and paid employment, as compared to usual care. Yet, we did find an indication for positive intervention effect on general self-efficacy, which is known to be an important capacity to achieve social participation.

Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support.

Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.

Assessing work speed using MODAPTS: A tool for occupational therapists.

BACKGROUND: The importance to be able to work is recognised as one of the United Nation's Sustainable Development Goals. Occupational therapists working in vocational rehabilitation require cost effective, valid, and reliable tests that offer flexibility during the work evaluation process. The use of self-developed work samples standardized using Modular Arrangement of Predetermined Time Standards (MODAPTS) as an objective measure of work speed could meet this need. OBJECTIVE: Evaluate the face, content, and criterion validity of MODAPTS work samples to assess work speed. METHODS: We conducted a quantitative cross-sectional, descriptive study. Occupational therapists completed electronic surveys to evaluate face and content validity. We evaluated criterion validity during a multiphase process that involved a realist synthesis, online survey, and comparing MODAPTS to Methods Time Management (MTM) time standards using three work samples that measured work speed. RESULTS: MODAPTS had good face validity for measuring work speed. We also confirmed the content and criterion validity of codes used to analyse basic movement and handling of smaller and larger articles as well as other body actions. CONCLUSION: MODAPTS demonstrated adequate face, content and criterion validity of tasks involving basic movements, handling of articles and other body actions.

Effective Teams in Vocational Rehabilitation: An Exploration of Complexities and Practice in Aotearoa-New Zealand.

PURPOSE: Vocational rehabilitation (VR) involves complex skills, and often inter-disciplinary teams need to work effectively to meet the needs of stakeholders. Research highlights important influences on effective teamwork, including funding systems, team structure, policies and procedures, and effects of professional hierarchies. This qualitative study aimed to explore these issues in-depth including how factors interact to produce problems and solutions. We focused on identifying challenges and opportunities for VR teams working in the Aotearoa-New Zealand context which may also be transferrable to other settings. METHODS: Qualitative descriptive instrumental case study involving focus groups and interviews with two VR teams (n = 14). Teams worked in musculoskeletal injury and were geographically diverse. Reflexive thematic analysis was used to analyse the data. RESULTS: Analysis constructed three overarching themes: Having the Power, Being Human, and VR is Not for Everyone. Achieving trusting relationships within the team was paramount. This was achieved through seeing everyone as equal, and as human. Equality within the team was particularly important for professionals that occupied different positions of power in a wider professional hierarchy. VR specialist skills (experience and postgraduate qualifications) were often under-recognised, leading them to have little power in VR decision making processes. VR professionals also experienced competing demands between client needs and business drivers. CONCLUSION: Findings offer detail of processes teams engage in to create effective team relationships and manage systemic factors to facilitate positive outcomes. Additionally, findings highlight opportunities in decision-making processes for VR medical certification that may increase job satisfaction and better utilize skills and expertise.

Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: study protocol for a cohort randomised controlled trial with embedded economic and process evaluations.

BACKGROUND: Around one-third of workdays lost in Norway are due to musculoskeletal conditions, with persistent (chronic) pain being the most frequent cause of sick leave and work disability. Increasing work participation for people with persistent pain improves their health, quality of life, and well-being and reduces poverty; however, it is not clear how to best help unemployed people who have persistent pain to return to work. The aim of this study is to examine if a matched work placement intervention featuring case manager support and work-focused healthcare improves return to work rates and quality of life for unemployed people in Norway with persistent pain who want to work. METHODS: We will use a cohort randomised controlled approach to test the effectiveness and cost-effectiveness of a matched work placement intervention featuring case manager support and work-focused healthcare compared to those receiving usual care in the cohort alone. We will recruit people aged 18-64, who have been out of work for at least 1 month, had pain for more than 3 months, and want to work. Initially, all (n = 228) will be recruited to an observational cohort study on the impact of being unemployed with persistent pain. We will then randomly select one in three to be offered the intervention. The primary outcome of sustained return to work will be measured using registry and self-reported data, while secondary outcomes include self-reported levels of health-related quality of life and physical and mental health. Outcomes will be measured at baseline and 3, 6, and 12 months post-randomisation. We will run a process evaluation parallel to the intervention exploring implementation, continuity of the intervention, reasons for participating, declining participation, and mechanisms behind cases of sustained return to work. An economic evaluation of the trial process will also be conducted. DISCUSSION: The ReISE intervention is designed to increase work participation for people with persistent pain. The intervention has the potential to improve work ability by collaboratively navigating obstacles to working. If successful, the intervention may be a viable option for helping people in this population. TRIAL REGISTRATION: ISRCTN Registry 85,437,524 Registered on 30 March 2022.

Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial.

Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.

Development and evaluation of an online vocational program for veterans with legal convictions and psychiatric illness.

PURPOSE: We describe the development and pilot evaluation of an online vocational rehabilitation program, the About Face Online System (AFOS), for veterans with a history of felony convictions and either mental illness and/or substance use disorders. METHOD: Phase One was the development and acceptability testing of the online system. Phase Two was a small, randomized trial comparing the likelihood of obtaining employment among people using the AFOS, compared to people receiving a self-directed hardcopy manual, after 6 months. RESULTS: In Phase One, 17 veterans provided feedback as the system was being developed. The final system allows veterans to receive education on vocational reintegration skills, watch short videos describing the techniques, and communicate with a vocational staff member via chat features. Veterans found the AFOS to be as acceptable as a hardcopy manual that covered similar material. In Phase Two, 38 veterans with a history of felony convictions and either mental illness or substance use disorder were randomized to receive the AFOS or a hardcopy manual. After 6 months, people randomized to the AFOS were more likely to obtain employment than people randomized to the hardcopy manual. CONCLUSION: An online vocational program may help veterans who cannot attend traditional in-person vocational services to successfully obtain employment.

Implementing a combined individual placement and support and vocational peer work program in integrated youth mental health settings.

AIM: To describe the implementation and outcomes of a combined individual placement and support (IPS) and vocational peer work program for young people with mental ill-health. METHODS: This uncontrolled pilot study co-located IPS workers and vocational peer workers within two integrated youth mental health services (provided to clients aged 15-25 years old). Employment outcomes included job placements (working 15 hours or more per week in a paid competitive job in the open employment market) and sustained employment (employed for at least 26 weeks). Participants who required additional assistance also received peer work. RESULTS: Of the 326 young people enrolled, 195 (59.8%) achieved competitive employment, including 157 (48.2%) in funder-approved placements. Among those in approved placements, 87 (55.4%) achieved sustained employment. For the 116 participants additionally receiving vocational peer work, 54 (46.6%) worked in funder-approved placements, of whom 27 (50.0%) achieved sustained employment. Among 210 participants who did not receive peer work, 103 (49.0%) worked in funder-approved placements, of whom 60 (58.3%) achieved sustained employment. CONCLUSIONS: The program achieved positive vocational outcomes and good fidelity to the IPS model. Approximately half of young people had employment placements, with a relatively high proportion maintained over time. The similar proportion of placements for those who did and did not receive peer work was encouraging given the IPS team determined that the former group needed additional support. Recommendations include upskilling the workforce, a data linkage system to obtain placement evidence, and using implementation science methodologies to understand how IPS programs are successfully embedded. This demands a coordinated effort between governments and funders, policymakers, services, and professional bodies.

The Impact of Work Incentives Benefits Counseling on Employment Outcomes: A National Vocational Rehabilitation Study.

BACKGROUND: Millions of Americans receiving Social Security Administration (SSA) disability benefits aspire to work and reduce reliance on disability benefits, but find the rules about entering or rejoining the workforce too complex or confusing and fear that working will cause loss of important benefits. PURPOSE: A case control study was conducted to investigate the impact of receiving work incentives benefits counseling (WIBC) on employment outcomes, and its relationship with demographic covariates for U.S. vocational rehabilitation (VR) clients who are SSA disability benefit recipients. METHOD: Data for this study were extracted from the Rehabilitation Service Administration (RSA-911) database. Mahalanobis distance matching procedures were used to match clients who received WIBC with those who did not receive it. Chi-square independence tests and independent samples t tests were used to compare receipt of WIBC and employment outcomes based on the demographic variables. Additionally, chi squared automatic interaction detection (CHAID) analysis was used to divide VR clients into homogeneous groups based on the covariates. RESULTS: Clients who received WIBC were more likely to obtain competitive integrated employment (CIE). Impairment type, referral source, long-term employment and education level were significantly associated with CIE for clients who received WIBC. Additionally, VR clients with sensory/communicative impairments and low-income status were less likely to receive WIBC. CONCLUSION: Modifying VR structure to be more inclusive; understanding of stigma; and increasing the functioning, psychological well-being and self-efficacy of VR clients might improve employment outcomes.

The impact of impairment, socio-demographic and environmental factors on spinal cord injury survivors' ability to return to work.

BACKGROUND: Re-employment of spinal cord injury survivors (SCIS) has been positively related to better community integration. The identification of the determining factors and their impact on return to work (RTW) of SCIS would be helpful in improving the RTW rate. OBJECTIVE: The aim of this study was to identify the factors determining RTW and explore their impact on RTW. METHODS: An adapted Work Rehabilitation Questionnaire Self-Report questionnaire was used to elicit sociodemographic information and work-related characteristics of the participants. Sixty-eight participants with a premorbid worker status completed the questionnaires which were sent via mail, email and hand delivery. Descriptive and inferential statistical analyses were performed. RESULTS: At the time of the survey 70.6% of the participants were not re-employed. The inferential statistical analysis indicated that time since injury and re-employment, receiving medical attention due to complications, vocational intervention, supervisor's support, family support and government support were significant factors of RTW. The results showed no significant differences in RTW by most of the sociodemographic factors. Only two percent of the participants indicated vocational planning and intentions. CONCLUSION: The significant impact of vocational and injury characteristics suggests that vocational rehabilitation services are urgently needed to support SCIS in returning to their worker role. Returning to work is a significant outcome of SCI rehabilitation.

Examining psychosocial factors associated with receiving workplace accommodations among people with disabilities.

BACKGROUND: People with disabilities experience challenges in obtaining workplace support including job accommodations. OBJECTIVE: This study examined the impacts of psychosocial factors affecting the likelihood of an employee with disability receiving an accommodation and subsequent effects on job satisfaction and job performance. METHODS: This study recruited 596 participants from multiple national and state agencies serving persons with disabilities in U.S. A mediation model was conducted to examine the impacts of psychosocial factors (i.e., self-efficacy, positive affect, negative affect, workplace support, Americans with Disabilities Act (ADA) knowledge, accommodation knowledge, and work goal) on receiving accommodation, and the impacts of receiving accommodations on job satisfaction and job performance. The indirect effects of the psychosocial factors on job satisfaction and job performance via receiving accommodations were examined using the Delta method. RESULTS: Among all the examined direct effects, only the effect from workplace support to receiving accommodations and the effect from receiving accommodations to job satisfaction were significant. Nevertheless, indirect effects were non-significant, indicating that all the psychosocial factors had no indirect effect (via receiving accommodation) on job satisfaction and job performance. CONCLUSION: The findings reveal the significance of workplace support on employees' likelihood of receiving accommodations, and subsequent association between accommodation receipt and job satisfaction. Rehabilitation professionals need to provide adequate training to employers to facilitate inclusive and supportive workplace environments.