Article Details

Research Database: Article Details

Citation:  Gamble, D.& Moore, C.L. (2003). Supported employment: Disparities in vocational rehabilitation outcomes, expenditures, and service time for persons with traumatic brain injury. Journal of Vocational Rehabilitation, 19 (1), 47-57.
Title:  Supported employment: Disparities in vocational rehabilitation outcomes, expenditures, and service time for persons with traumatic brain injury
Authors:  Gamble, D.& Moore, C.L.
Year:  2003
Journal/Publication:  Journal of Vocational Rehabilitation
Publisher:  IOS Press
Full text:  http://proxy.library.vcu.edu/login?url=http://iospress.metapress.co...   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported
Research design:  Database mining

Structured abstract:

Background:  Traumatic Brain Injury impacts a person's BI physical, cognitive, psychological, and behavioral abilities. Experiencing difficulties in a number of these areas simultaneously is not unusual. These problems make gaining and maintaining work difficult for many individuals with TBI. Individuals also face environmental and attitudinal barriers, antiquated, or limited vocational assistance, and social isolation. As a result of these and other difficulties individuals with TBI have poor return to work rates. Most individuals with TBI who were working prior to injury do not return to work post injury at the same level, for the same pay, or at the same number of hours per week. Due to low employment and retention rates supported employment has emerged as an intervention strategy to assist individuals with severe TBI with employment.
Purpose:  There is limited research on the differences in vocational rehabilitation (VR) outcomes and costs of services for individuals with TBI. This study compared closure status, occupational placements, weekly earnings, hours worked, expenditures, and service time for VR clients with TBI who received supported employment services to those who did not. The following research questions were addressed: (1) Are there significant differences in closure status for VR consumers with TBI based on the provision of supported employment services? (2) Are there significant differences in closure status by supported employment for VR clients with TBI when controlling for race, education level, age, marital status, gender, prior work experience, and disability severity? (3) Are there differences in occupational placements between competitively employed VR clients with TBI who received supported employment services and those who did not? (4) Are there significant differences in weekly earnings, hours worked each week, expenditures, and service time between competitively employed VR consumers with TBI who received supported employment services and those who did not? (5) Are there significant differences in weekly earnings, hours worked each week, expenditures, and service time by supported employment for competitively employed VR clients with TBI when controlling for race, education level, age, marital status, gender, prior work experience, and disability severity?
Setting:  This study included individuals with TBI served by multiple vocational rehabilitation agencies in various settings.
Study sample:  The study included 1,073 individuals with TBI who received vocational rehabilitation services from a southeastern state and whose cases were closed in competitive employment and non-rehabilitated statuses from October 1992 through September 2000. The majority of the individuals or (89%) were classified as having a severe disability. Most(78%) were European American. Seventy percent were male. The mean age was 35 years. The mean education grade-level was 11.52. The majority(91%) had no previous work experience.
Intervention:  The intervention was supported employment services.
Control or comparison condition:  The comparison was individuals with TBI who did not receive Supported employment services.
Data collection and analysis:  Data was collected from the Rehabilitation Administration (RSA)-911 database. RSA requires VR agencies to collect information on each case they close. The database includes information on a number of factors including major disabling condition, demographic characteristics, services provided, and outcomes achieved. Two and three-way cross-tabulation and chi-square procedures were utilized to answer the first and second research questions. Descriptive statistics (i.e., frequencies and percentages) were used to answer the third research question. A Multivariate Analysis of Variance (MANOVA) was utilized to answer the fourth research question.
Findings:  Of the participants,(48.6%) were competitively employed at closure. Only (7.3%) were provided supported employment services. Among those 78 individuals who were provided supported employment services,(67.9%) were closed in competitive employment, whereas only (47%) of the individuals who were not provided supported employment services were competitively employed at the time of closure. This difference was significant. Case expenditures for those who received supported employment services were twice as much as expenditures for their counterparts who were not provided these services. However, supported employment led to higher rates of competitive employment which seem to justify the costs. No significant differences were found for participants who were white, minority, young, single, or married. There was homogeneity in the types of jobs where the individuals went to work. Occupational placements for both groups of competitively employed consumers in this study were comparable. Individuals who did not receive supported employment earned more money and worked more hours than those who did. The collective findings of this and previous studies support the argument that sustained efforts must be made to advance supported employment outcomes for VR consumers with severe disabilities. Mean VR expenditures for competitively employed consumers who received supported employment services were greater than mean expenditures for those who did not receive supported employment services. Notably those who received supported employment services spent less time in rehabilitation than the other group.
Conclusions:  The study supports the following conclusions: (a) Supported employment can assist individuals with TBI with employment;(b) sustained efforts are required to improve wages earned and hours worked by supported employees with TBI; (c) supported employment is expensive; and (d) there is no predictive relationship between the provision of supported and service time cost. Supported employment may be underutilized with individuals with TBI. VR professionals should learn more about how this service option can enhance employment outcomes for individuals with TBI.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Race: American Indian or Alaska Native
Race: Asian
Race: Black / African American
Race: White / Caucasian
Interventions:  Supported employment
Vocational rehabilitation
Outcomes:  Return to work