Article Details

Research Database: Article Details

Citation:  Johnstone, B., Price, T., Bounds, T., Schoop, L.H.,Schootman, M., & Schumate, D. (2003). Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI. NeuroRehabilitation, 18 (3), 197-203.
Title:  Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI
Authors:  Johnstone, B., Price, T., Bounds, T., Schoop, L.H.,Schootman, M., & Schumate, D.
Year:  2003
Journal/Publication:  NeuroRehabilitation
Publisher:  IOS Press
Full text:  http://content.iospress.com/articles/neurorehabilitation/nre00191   
Peer-reviewed?  Yes
NIDILRR-funded?  Yes

Structured abstract:

Background:  After TBI many individuals experience difficulties with returning to work and if financially eligible turn to federally funded state vocational rehabilitation (VR) programs for services. Although billions of tax payer dollars are spent on VR services each year, little is known about their effectiveness. Few studies have been published on the vocational outcomes of persons with TBI who utilize state VR programs. More research is needed about individuals with TBI who receive state VR services in order to identify problems, develop appropriate services, and improve vocational outcomes. There are few published studies regarding persons with TBI in rural areas. Furthermore, the published research specifically on the vocational outcomes of persons with TBI in rural areas is essentially non existent with only one study identified on this topic.
Purpose:  The purpose of the study was to evaluate differences in demographics, injury severity, and vocational outcomes for individuals with TBI based on whether that resided in a rural vs. urban environment. It was hypothesized that individuals from rural and urban areas would not differ in demographics, that rural individuals would have greater injury severity based on previous studies, and that rural individuals would receive fewer VR services and have a lower rate of successful employment.
Setting:  The setting for the study was vocational rehabilitation agencies in Missouri.
Study sample:  The study included 78 individuals with TBI who had completed services from the Missouri Division of Vocational Rehabilitation (VR). The majority or 71% were male. Eighty percent were Caucasian. Demographic and injury severity data was reported by rural (N=28) and urban status (N=50). For the rural group, the mean age was 37; mean years of education was 12, and mean years post injury was 8 for the rural group. Mean number of hours in coma was 241 hours, mean days of post traumatic amnesia was 53 and mean days of hospitalization was 53 days. For the urban group, the mean age was 36; mean years of education was 12, and mean years post injury was 11 for the rural group. Mean number of hours in coma was 96 hours, mean days of post traumatic amnesia was 25 and mean days of hospitalization was 33 days.
Intervention:  The intervention was vocational rehabilitaton services.
Control or comparison condition:  A comparison was made between two groups of individuals with TBI; those living in rural versus urban settings.
Data collection and analysis:  Each participant was administered a standard neuropsychological evaluation used as part of a statewide VR protocol. Information about demographic and psychosocial variables was obtained by the evaluating psychologist. Self-report information regarding duration of loss of consciousness (LOC), posttraumatic amnesia (PTA), and hospitalization was obtained from most clients because medical records were not routinely available for review. Information from Missouri DVR was obtained on each participant, including the specific services provided ,the vocational status of the participant at case closure, and the financial cost of the case to DVR. Vocational outcome was determined using standard DVR categories, including: 1) successfully closed, 2) closed, no services provided, 3) closed, services interrupted, and 4) unsuccessfully closed. Rural and urban status was determined by definitions used by the US Office of Management and Budget (OMB). Data analysis included Chi-squares, Fisher’s Exact tests, Wilcoxon Rank Sums test, and MANOVAs.
Findings:  There were no remarkable differences between the groups in terms of demographics. People residing in urban areas received significantly more maintenance funds, transportation services, and on-the-job training, than those living in rural settings. Additionally these individuals had more case service dollars expended on them. Finally, although statistically non-significant, individuals from urban areas were successfully employed at VR case closure, compared to those from rural areas.
Conclusions:  The results suggest that rehabilitation professionals and vocational counselors should focus on possible environmental factors that limit the successful vocational outcomes of individuals with TBI in rural areas. VR counselors need to focus on environment factors that limit vocational outcomes for those living in rural areas. They need to find creative ways to address difficulties associated with limited resources in rural environments like transportation , locating vocational training settings, and developing job opportunities. VR counselors also need to better determine why many of their rural clients with TBI discontinue services after they are deemed eligible to receive them. This information can help them develop strategies to increase their client retention.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Race: Black / African American
Race: White / Caucasian
Rural and remote communities
Urban
Interventions:  Vocational rehabilitation
Outcomes:  Employment acquisition
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