Catherine Ipsen

Health, Secondary Conditions, and Employment Outcomes for Adults With Disabilities

This study used data (N = 3,076) from the Behavioral Risk Factor Surveillance System to explore the relationship between employment and health behaviors for individuals with physical disabilities. Results from a binary logistic regression model, with employment as the dependent variable, show that exercise increased the probability of employment by 8.4% after controlling for participant demo-graphics, severity of disability, and secondary health conditions. These results speak to the importance of health promotion for people with disabilities who desire employment.

Disability and health behavior change

OBJECTIVE/HYPOTHESIS We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Planned Behavior, Social Cognitive, and Transtheoretical) to consider how these theories conceptually apply to people with disabilities. METHODS We identified five common constructs across HBC theories and examined how these commonalities fit within the International Classification of Function (ICF). RESULTS Four of the HBC constructs appear to be Personal Factors within the ICF, while the fifth represents Environmental Factors. CONCLUSIONS Using the ICF framework to understand disability and HBC, we propose that including a sense of meaning as another personal factor will further develop HBC theories that lead to more effective HBC interventions for people with disabilities.

A Financial Cost—Benefit Analysis of a Health Promotion Program for Individuals With Mobility Impairments

People with disabilities make up approximately 20% of the U.S. population but account for 47% of total medical expenditures (Max, Rice, & Trupin, 1996). Health promotion programs represent one strategy for both improving health and containing medical costs for this population. This study examined the financial net benefits of the Living Well with a Disability health promotion program from the perspective of a third-party payer. Net benefits were defined as reductions in health-care utilization costs minus program implementation costs. The study sample consisted of 188 people with physical disabilities who completed the Living Well health promotion program. Health-care cost outcomes were collected using a 2-month retrospective recall of health-care services multiplied by Medicare unit cost estimates. The net benefits for the first 6 months postintervention were

Self-Employment for People With Disabilities: Enhancing Services Through Interagency Linkages

2,631 per person for the entire cohort and

Building the Case for Delivering Health Promotion Services Within the Vocational Rehabilitation System

127 per person for a trimmed data set. The results suggested positive financial benefits and provide grounds for further research about third-party payer support of health promotion programs for individuals with physical disabilities.

Developing Methods for Grading the Accessibility of a Communality’s Infrastructure

In 2001, an exploratory survey was distributed to more than half of all Small Business Development Centers (SBDCs) across the United States to identify how SBDCs and Vocational Rehabilitation (VR) agencies interact to provide self-employment services to people with disabilities and to evaluate how these agencies might further this collaborative relationship. Despite a low percentage of SBDCs that have formal interagency agreements with state VR agencies (8%), the majority of respondents (93%) felt that it was “very important” to have VR assistance for disability issues. SBDC respondents who had formal state interagency agreements or an informal local agreement with the VR agency reported higher rates of referrals between the two agencies, more experience serving people with disabilities in self-employment, and more preparedness to meet the needs of clients with disabilities. Data from this study indicate that SBDCs may be willing partners in the development of cross-agency support for people with disabilities who desire self-employment.

Experiences of Rural Vocational Rehabilitation Clients Who Leave the System Prematurely: A Qualitative Exploration.

Research studies report a negative relationship between employment and secondary conditions. Access to health promotion programs to manage secondary conditions, however, is limited for people with disabilities due to employment, financial, and insurance barriers. Vocational rehabilitation (VR) is one possible delivery point to overcome these barriers and improve access. To build the case for VR delivery, this article compares VR clients to Living Well health promotion program participants, who successfully reduced their secondary conditions. At baseline,VR (n = 162) and Living Well (n = 188) participants reported similar health promoting lifestyle behavior ratings and similar severity ratings across many secondary conditions. In addition, the VR group experienced similar rates of limitation from secondary conditions over time, indicating that their health was not improving in the absence of a health promotion intervention. Because health promotion programs can reduce secondary conditions, this research supports continued exploration of health promotion delivery within the VR system.

Working well with a disability: health promotion as a means to employment.

AbstractFor people with disabilities, accessibility is a critical aspect of infrastructure that influences their health, quality of life, and ability to participate in community life. Currently, no standard methods exist for assessing a community’s accessibility or for accumulating such data across communities. ASCE’s report card on the status of America’s infrastructure offers a framework for collecting and aggregating data on accessibility, and for using it to advocate for community improvement. In the present study, an assessment for estimating a community’s accessibility was developed and pilot tested. The feasibility of the assessment method was tested by observing 297 randomly selected businesses in a city. Aggregated across nine access categories, the city scored 3.32 on a four-point scale, the equivalent of a grade of “B” on ASCE’s scale. However, 28 (10%) businesses met “access failure” criteria—having at least one barrier that precluded access to a person using a wheelchair. On average, infrastr...

The Use of Telecommunication to Deliver Services to Rural and Urban Vocational Rehabilitation Clients

Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employment outcomes than clients who stay in services. The authors conducted this study to learn about factors leading to premature exit by rural VR clients. Results will inform survey development for a large longitudinal study on this topic. The authors content coded 27 qualitative telephone interviews with former rural VR clients who exited the system prematurely. Reported reasons for premature exit included (a) discrepancies between services provided and services desired, (b) unmet counselor expectations, (c) counselor—client relationship problems, (d) health issues, (e) limited job opportunities, (f) work disincentives, and (g) slow service speed. VR might reduce premature exits by helping clients better understand the VR process, including the types of VR services offered and associated counselor expectations.

Self-Employment for People with Disabilities in the United States: A Recommended Process for Vocational Rehabilitation Agencies.

PURPOSE/OBJECTIVE The purpose of this study was to test the utility of the Working Well with a Disability health-promotion program with vocational rehabilitation (VR) clients. Health-promotion interventions have been shown to reduce limitation from secondary conditions, which can be a significant barrier to labor force participation among people with disabilities. The state and federal VR system represents a potential access point for delivery of health-promotion activities. RESEARCH METHOD/DESIGN A total of 297 VR clients participated in a randomized trial of the Working Well health promotion program. Control and intervention participants provided baseline and four waves of quarterly follow-up data. Data were analyzed with repeated-measures ANOVA. RESULTS Intervention-group participants who attended over half of the Working Well sessions reported significantly lower rates of limitation from secondary conditions over the 1-year study span, F(1, 124) = 4.11, p = .004. Control-group participants also experienced significantly lower rates of limitation, but pre- to postdifferences were less dramatic, F(1, 308) = 4.19, p = .006. CONCLUSIONS/IMPLICATIONS Overall, health data indicated that the Working Well program may be particularly helpful to VR clients with higher rates of secondary health conditions and may represent one strategy for overcoming barriers to employment.