Jennifer Sánchez

Gender Differences in Vocational Rehabilitation Service Predictors of Successful Competitive Employment for Transition-Aged Individuals with Autism

As males and females with autism spectrum disorder (ASD) experience different symptomology, their needs for vocational rehabilitation (VR) are unique as they transition into adulthood. This study examined the effects of gender differences in VR service predictors on employment outcomes for transition-aged individuals with ASD. A total of 1696 individuals (857 males and 839 females) were analyzed from a sample of RSA-911 data of FY 2011. Hierarchical logistic regression analyses were conducted. Results revealed both gender-independent VR service predictors (with job placement and on-the-job supports more beneficial for both genders) and gender-specific predictors of employment (with counseling and guidance, job search assistance, and other services more beneficial for the male group). This study provides support for individualized gender-specific VR services for people with ASD.

Differential vocational rehabilitation service patterns related to the job retention and job placement needs of people with diabetes

BACKGROUND: It is clear that the chronic progression of diabetes, as well as other socio-environmental factors, act as barriers to individuals seeking to maintain employment. Long-term employment outcomes of people with diabetes can be improved by providing customized interventions to help individuals retain their current employment. OBJECTIVE: This investigation examined differential vocational rehabilitation (VR) service patterns between two groups of clients with diabetes, those who were employed at the time of application and those who were unemployed. METHODS: Quantitative descriptive research design using multiple discriminant analysis (MDS). Participants included 5,427 individuals with diabetes whose VR cases were closed in Fiscal Year 2011. RESULTS: MDS revealed that the employed applicants group had higher propensities than the unemployed applicants group to receive assessment, diagnosis and treatment, counseling and guidance, rehabilitation technology, and on-the-job supports as part of the VR process. The unemployed applicants group had higher propensities to receive occupational/vocational training, job readiness, job placement, and other services. CONCLUSION: These differential service patterns suggest that the client’s employment status at the inception of his or her VR program is taken into close consideration during the case planning and goal-setting phases of the VR process. Implications for future research and VR service delivery are discussed.

Assessing Vocational Rehabilitation Engagement of People With Disabilities: A Factor-Analytic Approach

The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) in a sample of state vocational rehabilitation (VR) service consumers. A total of 277 individuals with disabilities were recruited from Alaska, Kentucky, Florida, Michigan, New Mexico, Texas, Utah, and Wisconsin. The measurement structure of the VRES was evaluated using exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis results support a one-factor measurement structure of the VRES. Confirmatory factor analysis results also indicated a good model fit for the one-factor measurement model. Internal consistency reliability (Cronbach’s α) for the scores on the VRES was computed to be .94. VR engagement was found to be associated with working alliance, vocational self-efficacy, internal motivation, and VR outcome expectancy in the expected direction. The VRES is a brief, reliable, and valid instrument for assessing VR engagement and contributes to the use of self-determination as a paradigm for improving motivation and engagement of people with disabilities receiving services from state VR agencies.

Relationships between World Health Organization "International Classification of Functioning, Disability and Health" Constructs and Participation in Adults with Severe Mental Illness.

Purpose: To examine the World Health Organization International Classification of Functioning, Disability and Health (ICF) constructs as correlates of community participation of people with severe mental illnesses (SMI). Methods: Quantitative descriptive research design using multiple regression and correlational techniques was used to analyze 193 persons with SMI. Results: This study examined the unique relationships between each of the ICF constructs and participation in a series of simultaneous regression analyses. Age, schizophrenia/schizoaffective diagnosis, insight, self-care activity, social competency, and social support from friends were significant predictors of participation when compared to variables in the same ICF constructs. In addition, these significant ICF predictors of participation were entered in a hierarchical regression, and only insight, social competency, and social support from friends were found to be significant predictors of participation after controlling for the effect of other ICF variables. Conclusion: In this ICF model, insight, social competency, and social support from friends were found to be associated with participation and mediated the individual contributions of types of psychiatric disabilities and self-care activity to participation. Rehabilitation practitioners should focus on interventions that increase these factors for people with SMI. Rehabilitation researchers should continue to use the ICF as a model from which to predict participation in specific life activities (e.g., employment) for people with SMI. Continued application and validation of the ICF model could positively impact recovery-oriented outcomes for individuals with SMI.

Effect of college or university training on earnings of people with disabilities: A case control study

OBJECTIVE: To examine the effect of college or university training on earnings of individuals with disabilities receiving services through the public vocational rehabilitation system. METHODS: A non-experimental case-control study design. Data for 178,290 individuals closed as successfully rehabilitation in fiscal year 2011 were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database. RESULTS: Propensity scores were estimated based on demographic variables using the classification and regression tree (CART) method, which yielded six homogeneous subgroups, ranging from high propensity to received college or university training as a vocational rehabilitation intervention to low propensity to receive such service. Individuals who received college/university training had higher weekly earnings than those who did not, and had the greatest benefit for young adults; White, Asian, or Native American women with physical impairments; and people with mental impairments. CONCLUSION: College or university training should be considered as a viable and beneficial option to improve employment outcomes and job quality for individuals with disabilities.

Predictors of perceived social effectiveness of individuals with serious mental illness.

Objective: Social effectiveness continues to play a critical role in recovery of people with serious mental illness (SMI), with greater social effectiveness predicting many positive life outcomes. Despite the abundance of literature supporting the relationship between perceptions and behavior, little is known about predictors of perceived social effectiveness of individuals with SMI. Methods: The purpose of this study is to examine the predictors of perceived social effectiveness of individuals with SMI. Cross-sectional data of 192 participants with SMI recruited from four psychiatric rehabilitation clubhouses in 2 states in the South and Midwest regions of the United States were used for this study. Self-report data on category of psychiatric disabilities, psychiatric symptoms, cognition, insight, educational attainment, empathy, interpersonal interactions and relationships, self-stigma, disability acceptance, and perceived social effectiveness were collected and analyzed using multiple regression analysis (MRA). Results: MRA yielded a regression model that accounted for 56% of the variance in perceived social effectiveness, which is considered a large effect size. Controlling for all other factors, mood disorder, educational attainment, empathy, interpersonal interactions and relationships, and disability acceptance were found to be significant predictors of perceived social effectiveness of persons with SMI. Conclusions and Implications for Practice: Practitioners should consider determining points of intervention and targeting specific elements that enhance perceived social effectiveness.

Predicting quality of life in adults with severe mental illness: Extending the International Classification of Functioning, Disability, and Health.

PURPOSE/OBJECTIVE The International Classification of Functioning, Disability and Health (ICF) framework was used to investigate person-environment contextual factors, mental functioning, activity limitations, and participation as predictors of quality of life (QoL) in adults with severe mental illness (SMI). RESEARCH METHOD/DESIGN A quantitative descriptive design using multiple regression and correlational analyses was used. One hundred ninety-four individuals with SMI from 4 community-based mental health agencies in 2 states from Southern and Midwestern regions of the United States participated in the study. The criterion variable was QoL. Predictor variables comprised the ICF constructs: (a) demographics, (b) personal factors, (c) environmental factors, (d) mental functioning, (e) activity limitations, and (f) participation. RESULTS A majority of participants were White (60.3%) and not employed (59.8%). Half of them received Social Security Disability Income and/or Supplemental Security Income (50.0%). Correlations between QoL and the predictor variables ranged from small to large (r = .01 to .63, respectively). The final regression model accounted for 58% of the variance in QoL. After controlling for other factors, social competency, social support, societal stigma, psychological distress, cognitive dysfunction, activity limitations, and participation were found to be significant predictors of QoL in adults with SMI. CONCLUSIONS/IMPLICATIONS The study supports the use of the ICF to predict QoL for adults with SMI. Evidence-based treatments focused on increasing social competence, social support, and participation should be developed to promote rehabilitation outcomes and overall QoL.

Personal and environmental contextual factors as mediators between functional disability and quality of life in adults with serious mental illness: a cross-sectional analysis

PurposeTo examine personal and environmental contextual factors as mediators of functional disability on quality of life (QOL) in a sample of individuals with serious mental illness (SMI).MethodsA cross-sectional analysis of 194 individuals with SMI (major depressive disorder = 38.1%; bipolar disorder = 35.6%; schizophrenia spectrum disorder = 25.8%) recruited from four psychosocial rehabilitation clubhouses was undertaken to test a multiple regression model assuming that personal (i.e., resilience, social competence, and disability acceptance) contextual factors and environmental (i.e., family support, support from friends, and support from significant others) contextual factors would mediate the relationship of functional disability on QOL. The bootstrap test for multiple mediators was then used to test for the significance of the indirect effects functional disability on QOL through the mediators.ResultsIn the simple regression model, functional disability had a strong relationship with QOL; however, after introducing the potential mediators, its effect was significantly reduced indicating partial mediation effects. The final regression model yielded a large effect, accounting for 44% of the variance in QOL. Controlling for all other potential mediating factors, social competence, disability acceptance, family support, and support from friends were found to partially mediate the relationship between functional disability and QOL. Bias-corrected bootstrap procedure results further supported the mediation model.ConclusionsThe findings from the study provide good support for the inclusion of person–environment contextual factors in conceptualizing the relationship between functional disability and QOL for individuals with SMI.

Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain.

Objective: To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. Method: Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. Results: Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. Conclusions and Implications for Practice: The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation.

Employment predictors and outcomes of U.S. state-federal vocational rehabilitation consumers with affective disorders: A CHAID analysis

BACKGROUND This study examined the demographic and rehabilitation service variables affecting employment outcomes of people with affective disorders receiving services from U.S. state-federal vocational rehabilitation (VR) agencies. METHODS An ex post facto design, using data mining as a statistical analysis strategy, was used to analyze the Rehabilitation Services Administration Case Service Report (RSA-911) for the fiscal year 2011. The sample included 44,960 customers with affective disorders who were closed either as successfully employed (Status 26) or not employed (Status 28) by their VR agency. The dependent variable is employment outcome. The predictor variables include a set of personal characteristic variables and rehabilitation service variables. RESULTS The chi-squared automatic interaction detector (CHAID) data mining analysis results indicated that job placement services, on-the-job supports, and job search assistance services were significant predictors of successful employment outcomes for individuals with affective disorders. LIMITATIONS The study used data from the RSA-911 database. Causality cannot be inferred due to the use of archival data. CONCLUSIONS Employment should be viewed as a viable treatment outcome for individuals with affective disorders. Rehabilitation professionals should advocate for their clients to receive VR services, including job placement services, on-the-job supports, and job search assistance services in order to maximize their employment and mental health outcomes.