Timothy N. Tansey

Organizational and cultural factors that promote creative best practices in the public rehabilitation program: Findings from a four-state multiple case study

The state-federal vocational rehabilitation system is tasked to demonstrate accountability for employment outcomes of persons with disabilities. State VR agencies have sought to evaluate existing practices, and in areas that existing practices leave room for improvement, create the conditions for innovation to occur. The purpose of this article is to identify promising organizational and cultural factors that appear to promote best practices in the public vocational rehabilitation program. A multi-stage study utilizing the Consensual Qualitative Research (CQR) was conducted involving four high performing state VR agencies to discover emerging and promising organizational practices leading to improvements in employment outcomes of people with disabilities. The comprehensive examination revealed specific organizational practices, culture and structural elements that encourage and support the development of innovative, effective service delivery practices. Given the complexity of service provision and the increasing demand for successful outcomes, VR agencies must develop organizational cultures that facilitate transformational learning by employing evidence-based practices that lead to successful outcomes for agency consumers.

Promising best practices that lead to employment in vocational rehabilitation: Findings from a four-state multiple case study

The state-federal vocational rehabilitation (VR) program has been challenged to demonstrate the effectiveness of VR services provided to eligible consumers. State-federal VR agencies are under pressure to develop a foundation of evidence-based practices that lead to competitive employment outcomes for people with disabilities. This article provides a qualitative analysis of the organization structural elements and service delivery practices related to the provision of effective best practices that enhance employment outcomes for individuals with disabilities. Using a Consensual Qualitative Research (CQR) approach, a multi-stage qualitative analysis of four high performing state VR agencies was conducted to identify promising organizational and service delivery practices that facilitate employment outcomes. Twenty-nine practices were identified as being supportive of the successful outcomes of persons with disabilities being served by these agencies. The identified practices reflect unique and similar service patterns across the four VR agencies studied. Practices were divided into Promising Organizational Practices and Promising Service Delivery Practices. The culture of an organization is an important factor in the development and sustainability of innovative practices. Best practices reconsider traditional rehabilitation counselor roles and offer new methods for delivering services. Rigorous research and program evaluation are required to identify which practices will ultimately constitute evidence-based practices.

An analysis of evidence-based best practices in the public vocational rehabilitation program: Gaps, future directions, and recommended steps to move forward

As an epilogue to this special issue, this article provides a brief overview of the research undertaken by the Rehabilitation Research and Training Center on Evidence-Based Practice in Vocational Rehabilitation (RRTC-EBP VR) in Phase II of their studies, and what was learned from the comprehensive review of the literature (e.g., Fleming, Del Valle, Kim & Leahy, 2013) and multi-state case studies in terms of promising practices in state VR agencies (Leahy et al., 2013). Gaps identified in EBP research that hinders the implementation of efficacious, effective, and efficient services based on the best scientific evidence are discussed, and finally, recommendations for future research directions and knowledge translation initiatives that will improve the effectiveness of VR service delivery practices are provided.

Social-cognitive predictors of readiness to use evidence-based practice: A survey of state vocational rehabilitation counselors

Evidence-based practice (EBP) is receiving increased attention from vocational rehabilitation (VR) professionals as the demand for accountability in rehabilitation and healthcare systems expands. The purpose of the current study was to determine the level of understanding VR professionals have of EBP with specific attention to perceived self-efficacy, outcome expectancy, barriers, and readiness to use evidence in current practice. Data were collected from 396 rehabilitation counselors, who were recruited from four state VR agencies. Results indicate self-efficacy and outcome expectancy were positively associated with readiness to use EBP, and agency barriers and personal barriers were negatively related to readiness to use EBP. These social- cognitive predictors accounted for 44% of the variance in the stages of change scores, and outcome expectancy was the most significant predictor after controlling for the effect of perceived self-efficacy and barriers. To increase EBP among rehabilitation counselors, efforts should focus on increasing self-efficacy and outcome expectancy of EBP.

Career development of young adult cancer survivors: A conceptual framework

BACKGROUND: Research with young adult cancer survivors has found that they are often lacking appropriate career development skills. As a result, they are often disconnected with the labor market and deal low levels of career readiness, low career self-efficacy, and higher rates of under and unemployment. OBJECTIVE: The purpose of this article is to describe a multi-domain model that provides a framework for conceptualizing the career development of young adult cancer survivors. METHODS: This study utilized a comprehensive review of the literature to develop a theoretical based conceptual model. RESULTS: The model emphasizes the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. CONCLUSION: A brief discussion of potential implications regarding research, service and policy are offered with the overall goal of conceptualizing career development as a public health intervention for young adult cancer survivors and other young adults with chronic health conditions.

Methodological application of multiple case study design using modified consensual qualitative research (CQR) analysis to identify best practices and organizational factors in the public rehabilitation program

A multiple case study design, using modified consensual qualitative research (CQR) methodological elements for data analysis, was used to explore emerging and promising practices among four state vocational rehabilitation programs. One hundred fifty-eight counselors, mid-level managers, and leaders participated in semi-structured interviews to help identify both organizational and service delivery practices associated with successful employment outcomes in the public Vocational Rehabilitation (VR) program. Conducting comprehensive, multiple case studies is time and resource intensive and can therefore be difficult to replicate. However, the eclectic methodology utilized for this study resulted in rich results that will be helpful in informing rehabilitation research, practice, and policy.

Psychometric Validation of the Brief Resilience Scale in a Sample of Vocational Rehabilitation Consumers

Existing research has indicated an association between resilience and psychosocial adjustment to disability. The purpose of this study was to validate the Brief Resilience Scale (BRS) in a sample of vocational rehabilitation (VR) consumers. Participants were 277 individuals with disabilities receiving state VR services. Findings support the identification of two factors in the BRS, labeled succumbing and resilience by the researchers. The succumbing factor was positively associated with reporting of depression while the resilience factor was associated with well-being. Implications for practice in state VR agencies are provided.

Mediators of the Relationship Between Core Self-Evaluations and Life Satisfaction in Individuals With Spinal Cord Injuries

The objective of this study was to test a meditational model of the relationship between core self-evaluations (CSE) and life satisfaction in persons with spinal cord injuries. A quantitative descriptive design using multiple regression analysis was used. Two hundred forty-seven persons with spinal cord injuries participated in the online study. Hope, perceived health, autonomy, and social support were found to partially mediate the relationship between CSE and life satisfaction. CSE affected life satisfaction by first increasing hopeful thinking, positive health perceptions, a sense of autonomy, and support from others in persons with spinal cord injuries. Future research should explore the development of interventions to increase CSE to increase the positive variables that affect life satisfaction in individuals with spinal cord injuries.

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.

Testing an integrated self-determined work motivation model for people with disabilities: A path analysis.

Objective: Individuals with disabilities are more likely to live in poverty, have more health issues, and be less likely to be employed than their same-aged peers. Although these issues may be attenuated by vocational rehabilitation services, amotivation and ambivalence to employment can limit the readiness of persons with disabilities to engage in these services. Drawing on self-efficacy, self-determination, and stages of change theories, the purpose of this study was to develop and test an integrated self-determined work motivation model for people with disabilities. Method: Participants included 277 people with disabilities recruited through vocational rehabilitation agencies across 8 states. Path analysis was used to evaluate the contribution of functional disability, self-determination, and social efficacy variables in a hypothesized integrated self-determined work motivation model. Model estimations used maximum likelihood estimation and model-data fit was examined using several goodness-of-fit indices. Results: The initial path analysis indicated a less than optimal fit between the model and the observed data. Post hoc model modifications were conducted based on examination of the critical ratios and modification indices and theoretical consideration. The respecified integrated self-determined work motivation model fit the data very well, &khgr;2/df = 1.88, CFI = .99, and RMSEA = 0.056. The R2 for the endogenous variables in the model ranged from .19 to .54. Conclusions: Findings from this study support the integrated self-determined work motivation model in vocational rehabilitation as a useful framework for understanding the relationship among functioning levels, self-determination and self-efficacy factors, vocational rehabilitation engagement, and readiness for employment.