This pilot randomized controlled trial examined whether a brief, family-led cognitive behavioral therapy and motivational interviewing intervention improved employment motivation among adults with intellectual disabilities. Intellectual disability is characterized by limitations in intellectual functioning and adaptive behavior, originating before age 18; it involves challenges in conceptual, social, and practical skills that affect everyday functioning. Fifty-two adults with moderate intellectual disability were randomly assigned to either an intervention ( n = 26) or a fact sheet control condition ( n = 26). Employment motivation was measured using the adapted Work Readiness Scale at pretest and posttest. An analysis of covariance compared posttest scores while controlling for baseline motivation. Results indicated a significant group effect on posttest motivation, F (1, 49) = 53.36, p < .001, with higher adjusted motivation scores for the intervention group. The intervention effect was large (partial η 2 = .52), and the model explained most of the variance in posttest scores (adjusted R 2 = .96). Participants in the intervention group scored an adjusted 3.48 points higher on posttest motivation than those in the control group (bootstrapped 95% CI [2.70, 4.28]). Overall, the intervention was associated with significantly greater motivation for employment.
Theories of rehabilitation counseling have enriched our understanding of individual responses to chronic disease and disability for nearly a century. Nevertheless, despite its prevalence and profound psychosocial impact, alopecia areata (AA) remains underrecognized in rehabilitation and health literature. This research aims to investigate the role of different coping styles on relationship-related and subjective quality-of-life outcomes among individuals with AA, considering Livneh’s conceptualization of psychosocial adjustment and adaptation as a guiding framework. The cross-sectional survey included 275 participants registered through national and international AA advocacy groups. Participants provided demographic and condition-specific data, completed the COPE Inventory to assess a range of coping styles, and answered the Alopecia Areata Quality of Life Index (AA-QLI). Hierarchical linear regression analyses were used to examine the predictive effect of coping styles on AA-related quality of life, statistically controlling for demographic and clinical factors. Suppression of competing activities, behavioral disengagement, and mental disengagement were found to be salient predictors of reduced relationship satisfaction and heightened subjective distress related to AA. The findings provide evidence that individual coping styles influence quality-of-life outcomes among people with AA, highlighting the importance of considering coping strategies in psychological support and intervention, and in future research.
Our purpose was to identify factors related to discontinuing employment prior to working two full years after the onset of spinal cord injury (SCI), addressing the knowledge gap related to job retention beyond the traditional 90-day probationary period. Adult participants with traumatic SCI ( n = 2,253) completed a self-report measure of employment history. We used a probit model that simultaneously estimated predictors of post-SCI employment obtaining and retaining employment through 2 years. There was a decreased probability of obtaining post-SCI employment with older age, fewer years since SCI onset, more severe SCI, fewer years of education, employment in production/transportation/material moving and greater barriers related to SCI/job fit, motivation/confidence, and resources. The highest probability of job loss was observed among women, those with lower post-SCI earnings, and employment in sales, or service occupations. Only health barriers were significantly related to maintaining employment. Vocational counselors need to emphasize placement in managerial and professional occupations that carry more income to minimize job loss by 2 years. Poor health must be considered in establishing realistic and attainable employment goals.
The goal of the current studies was to create a psychometrically valid and reliable quantitative measure of experienced ableism that can be used by individuals with a variety of disabilities, both visible and invisible. The researchers developed the Experienced Ableism Scale utilizing qualitative interviews and flexible coding with 21 adults with various disabilities and exploratory factor analysis with a separate sample of 300 disabled individuals to test the resulting measure. The qualitative interviews yielded 23 items, which were put into a measure using a 4-point Likert scale. Exploratory factor analysis resulted in a two-factor structure, with subscales for Exclusion (12 items) and Work of Disability (11 items). The psychometric results were very strong, including good convergent validity, excellent reliability for the total measure and both subscales, and a significantly normal distribution of scores. The current studies resulted in a 23-item scale with good psychometrics in the initial quantitative sample. The scale has numerous clinical and research implications, including demonstration of the importance of the emotional and functional labor disabled people put in to avoid and/or cope with ableism.
The introduction of pre-employment transition services (Pre-ETS) brought the promise of improved competitive integrated employment outcomes for students with disabilities; however, research reveals a lack of consistency and questions about the quality of Pre-ETS implementation. This manuscript describes a pilot Model Demonstration Project (MDP) to comprehensively support Pre-ETS providers in their preparation, planning, and service delivery. We present the steps of the MDP through the perspective of two Pre-ETS providers participating in two MDP sites during the 2023 to 2024 and 2024 to 2025 school years. Providers believed that the components of the MDP assisted with their knowledge attainment, Pre-ETS planning, and overall service delivery, with particular emphasis on trainings and the collaborative service delivery meeting. Providers believed their participation in the project deepened their understanding of Pre-ETS and facilitated increased collaboration with other professionals. We offer implications and recommendations for future research and practice for developing a model to support providers’ provision of Pre-ETS.
Transition-age youth with disabilities are a critical population targeted by the United States Vocational Rehabilitation (VR) system, particularly following the Workforce Innovation and Opportunity Act (WIOA). Yet little is known about how these youth allocate their time while participating in VR and how different patterns of participation relate to subsequent labor market outcomes. Using linked administrative records from a state VR agency and unemployment insurance wage data ( n = 5 , 875 ), we analyze short-term and long-term employment and earnings in relation to time spent during VR in employment, receiving funded services, and waiting for services. On average, participants spend 11.6 quarters in VR, with 42% of this time in employment, 20% receiving services, and 40% waiting for services. We find that more time spent employed during VR is associated with higher employment rates, shorter unemployment spells, and increased earnings up to 2 years after program exit. Return on investment analysis indicates that program efficiency peaks around seven quarters, after which diminishing returns emerge due to rising opportunity costs, which can be mitigated with work-based learning during VR. These results highlight the importance of integrating work-based learning opportunities into VR to improve long-term employment outcomes and economic returns.
Individuals with spinal cord injury (SCI) are at elevated risk for depression, yet little is known about how those with SCI and depressive symptoms experience acceptance and commitment therapy (ACT). This qualitative study explored the lived experiences of 13 adults within 5 years post-injury who completed an 8-week, therapist-guided, videoconference-delivered ACT program, using semi-structured interviews. Using interpretative phenomenological analysis, two overarching themes and six subthemes emerged. Theme 1, personal growth and resilience, reflected enhanced emotional well-being, practical coping strategies, empowerment through values-based goal setting, and strengthened social connections. Theme 2, program optimization and sustained impact, captured participants’ appreciation of a structured yet adaptable format, an empathic therapeutic relationship, and between-session accountability, which fostered consistency, motivation, and reduced isolation. Participants reported continued use of worksheets, summaries, and guided videos after program completion, emphasizing their role in sustaining ACT skills, and suggested refinements such as streamlined materials and SCI-specific examples. Convergence was evident in reports of improved mood, mindfulness, and values-based engagement, whereas divergence appeared in depth of change, delivery preferences, and brief increases in pain awareness during mindfulness. Overall, videoconference-delivered ACT was perceived as acceptable, feasible, and beneficial, supporting psychological flexibility and functional re-engagement in adults with SCI and depressive symptoms.
Adults with blindness or low vision have lower employment rates and higher unemployment rates than the general population, highlighting the need for interventions to reduce employment barriers and improve outcomes. This study examined whether The Job Search Blueprint, a job search intervention, improves job search outcomes, mental health outcomes, and employment for blind and low vision adults compared to an information-only control group. In this two-group, parallel longitudinal randomized controlled trial, 86 participants (ages = 18-72, 69.8% female) were assigned to either the intervention or control group. Data were collected at pretest, 1-month posttest, 6-month follow-up, and 18-month follow-up. Data analysis involved linear mixed models for job search outcomes (knowledge, behavior, self-efficacy) and mental health outcomes (anxiety, depression), and chi-square tests for employment. The intervention group had greater improvements in job search knowledge and anxiety than the control group at posttest, with knowledge gains maintained at 6-month follow-up. The intervention did not have significant effects on the other outcomes. These findings suggest The Job Search Blueprint can increase knowledge and reduce anxiety, but addressing barriers and improving employment outcomes may require a more comprehensive approach. Future research with larger samples, additional measures, and tailored approaches is necessary to better understand and enhance the intervention's effectiveness.
While counseling professionals have placed increasing focus on intersectional identities and marginalization, disability-particularly within clinical supervision-has often been overlooked. In response, the American Rehabilitation Counseling Association (ARCA) established a Task Force in 2022 to explore best practices for supervising supervisees with disabilities. The ARCA Task Force conducted an a priori conceptual content analysis and Delphi study with subject matter experts (N = 30) comprising clinical supervisors (n = 23) and disabled supervisees (n = 7) to identify the knowledge, attitudes, and skills for effective clinical supervision with supervisees with disabilities. Results showed no statistically significant differences among most items, indicating alignment between clinical supervisor panelists and supervisee panelists regarding the importance of the identified guidelines. However, some expert opinions differed, with statistical significance (p <= .05) between clinical supervisors and disabled supervisees on three guidelines, suggesting that these aspects were considered more important by disabled supervisees than supervisors.
This study examined the mediating role of psychological inflexibility in the relationship between resilience and marriage satisfaction among parents of children with developmental disabilities in a Turkish sample using Bayesian structural equation modeling (BSEM). Data were collected from 420 participants using the Acceptance and Action Questionnaire-II, the Connor-Davidson Resilience Scale, and the Marriage Life Scale. Results supported the hypothesized model with adequate fit (PPP = .48), with psychological inflexibility partially mediating the relationship between resilience and marriage satisfaction. Resilience was negatively associated with psychological inflexibility (beta = -.73, 95% CI [-0.78, -0.68]), and psychological inflexibility was negatively related to marriage satisfaction (beta = -.31, 95% CI [-0.40, -0.22]). The indirect effect of resilience on marriage satisfaction through psychological inflexibility was significant (beta = .23, 95% CI [0.16, 0.30]). Gender differences were examined, with results suggesting similar structural patterns across genders, though males showed slightly higher levels of resilience and marriage satisfaction. The findings highlight the importance of psychological inflexibility as a mechanism through which resilience influences marriage satisfaction in parents of children with developmental disabilities.
According to the 2023 National Survey on Drug Use and Health (NSDUH), approximately 48.7 million U.S. adults ages 18 and older (18.85%) experienced a substance use disorder in the past year. Employment is increasingly recognized as a critical public health intervention for individuals recovering from addiction. This study aimed to examine the extent to which demographic factors and vocational rehabilitation (VR) services predict competitive integrated employment (CIE) among prime working-age adults in addiction recovery. Using secondary data from the Rehabilitation Services Administration Case Service Report (RSA-911), the authors employed hierarchical logistic regression analysis to examine associations between demographic covariates, VR services, and CIE. Results indicated that low income and limited education were negatively associated with CIE, while men had higher odds of achieving CIE than women. Several VR services, including short-term support, maintenance service, other services, supported employment, job placement, job readiness, and VR counseling, were positively associated with CIE. These findings highlight empirically supported VR services that rehabilitation counselors can leverage to develop data-driven Individualized Plans for Employment and deliver evidence-based interventions aimed at improving employment outcomes for people recovering from addiction.
This study evaluated the usability of Ready for Wages, an asynchronous online training platform that prepares juvenile service professionals to deliver employability social skills curricula to justice-involved youth. Using a convergent parallel mixed-methods design, 33 professionals (11 Cognitive Lab, 22 asynchronous) completed the System Usability Scale (SUS) and provided qualitative feedback through cognitive interviews and open-ended surveys. The training platform achieved an excellent usability score (M = 89.39, SD = 8.32). No significant differences emerged between cognitive-lab and asynchronous groups, t(18.44) = .60, p = .554, d = .23, though there were differences in those who had prior experience with the curriculum and those who did not, t(10.75) = -3.44, p = .006, d = 1.07. Qualitative themes converged with quantitative results, highlighting ease of navigation, utility of embedded teaching tips, and the need for printable materials and greater content diversity. Findings suggest that Ready for Wages offers a scalable, low-cost, and highly usable training solution for implementers. Implications for rehabilitation counseling practice include extending access to professional development in correctional facilities and supporting workforce reentry outcomes for youth.
This study examined the relationship between psychiatric symptom severity and psychosocial adaptation to serious mental illness (SMI) and investigated the mediating role of optimism, self-stigma, and coping within the framework of the Disability Centrality Model (DCM). A Qualtrics survey consisting of measures of psychosocial adaptation to SMI, psychiatric symptom severity, coping, self-stigma, and optimism was disseminated through identified community entities. A total sample of 300 adults with SMI completed the survey. Correlational analyses and parallel mediation analysis were conducted. Results indicated that optimism, self-stigma, and coping collectively fully mediate the relationship between symptom severity and psychosocial adaptation to SMI, with the full model accounting for 62.4% of the variance. Among the mediators, self-stigma demonstrated the strongest indirect effect. Findings underscore the importance of DCM-informed mechanisms, namely, maladaptive identity centrality, positive expectancies, and behavioral coping strategies, in shaping psychosocial adaptation outcomes. Rehabilitation professionals should target self-stigma, cultivate optimism, and strengthen adaptive coping to support successful psychosocial adaptation to SMI.
Employment has been linked to improved outcomes for individuals with substance use disorders (SUDs) and/or psychiatric disabilities, including successful treatment completion, higher recovery rates, and better quality of life. This study aims to explore employment outcomes for veterans with SUDs and/or schizophrenia and other psychotic disorders enrolled in state-federal vocational rehabilitation programs. The Rehabilitation Services Administration Case Service Report secondary dataset (program years 2020-2022) was used. A machine learning approach was applied using a Least Absolute Shrinkage and Selection Operator (LASSO) regression model. Forty-seven potential covariates were entered into the model, and variable selection was determined automatically by the algorithm through a stepwise regression process, rather than manually choosing which variables to include (avoiding selection bias). The final model identified 23 potential predictors and was refined through multivariable logistic regression to eight significant variables. Veterans (n=2,957) were significantly more likely to be employed if they received the short-term job support service (OR = 7.24, p<.01), supported employment services (OR = 5.06, p<.01), maintenance services (OR = 7.81, p<.01), and measurable skill gains-skills progression (OR = 5.39, p<.01) compared to those who did not receive the services. Employment was also linked to the source of disability. Veterans with ADHD were more likely to find employment, with an odds ratio of 2.15 (p = .03). In contrast, veterans diagnosed with Schizophrenia and other psychotic disabilities (co-occurring with SUDs) were less likely to be employed, with an OR of 0.70 (p < .01). Findings underscore the effectiveness of specific, evidence-based vocational rehabilitation services, such as short-term job supports, supported employment, maintenance services, and skill development, for veterans with SUDs and/or psychiatric disabilities. These results emphasize the importance of targeted service delivery within state-federal vocational rehabilitation programs and highlight the need for additional research to refine and tailor existing services to better support veterans pursuing employment or new career paths.
The purpose of this study was to examine the relationship of the 24 character strengths in Peterson and Seligman's character strengths model with the 4 value changes in Beatrice Wright's theory of disability acceptance. Two hundred seventy-four individuals with disabilities completed an online survey. SPSS was used to conduct four regression analyses-one for each of the four subscales of the Multidimensional Acceptance of Loss Scale (MALS). The 24 character strengths, which were measured by the Values in Action Inventory-72 (VIA-72), were entered in one block as predictors of each of the value changes associated with disability acceptance. Collectively, the 24 character strengths significantly predicted each of the 4 value changes in Wright's theory, as measured by the MALS. Many of the individual character strengths were significantly associated with the value changes. Therefore, character strengths appear to enhance disability acceptance in people living with disabilities. The results provide support for the development of character strengths interventions for people with disabilities.
People with disabilities (PWD) encounter societal barriers that impact their well-being, particularly due to stigma and systemic discrimination. Whether a disability is congenital or acquired can shape how individuals experience these challenges, influencing their psychological adjustment and coping mechanisms. Stigma, enacted by others and internalized by PWD, can undermine the emotional, social, and physical health of PWD, limiting their ability to flourish. Disability severity adds further nuance to these experiences, influencing the challenges PWD face in accessing resources and social inclusion. This study examined how disability onset moderates the effects of stigma and disability severity on well-being, using the PERMA model. In total, 221 participants with either congenital or acquired disabilities were assessed for overall well-being, negative emotions, health, and loneliness. Hierarchical regression analyses revealed that enacted stigma and self-stigma were associated with poorer well-being outcomes, including higher negative emotions, poorer health, and greater loneliness. Disability onset moderated the relationship between self-stigma and well-being, with individuals with acquired disabilities showing stronger negative associations between self-stigma and well-being and health. These findings underscore the importance of addressing both stigma and disability severity in rehabilitation counseling, particularly by tailoring select interventions to the onset of disability. Implications for rehabilitation counseling practitioners are discussed.
We used a survival model to identify the relationships of demographic, educational, and disease factors with predicted work life expectancy (WLE) after multiple sclerosis (MS). Self-report data were collected from 1320 MS participants who identified MS as a specialty hospital in the Southeastern USA, 977 of whom reported being employed for at least 1 year after diagnosis. A Cox survival model was generated to identify factors associated with WLE, which reflects the number of years employed after MS diagnosis and the hazard of departure from the labor force (i.e., job loss) for those still employed. In the multivariate model, race, age, and multiple disease factors were significantly associated with the hazard of employment loss. Non-Hispanic Blacks had a greater hazard of job loss compared with non-Hispanic whites. Age was inversely related to job loss. Of the disease factors, cognitive limitations and MS severity were most likely related to the hazard of job loss. The findings suggest the need for targeted interventions to enhance WLE, particularly for non-Hispanic Blacks and those with more severe MS symptoms, including cognitive impairments. The distribution of WLE by characteristic helps identify the targets for job retention.
The objective of this study was to investigate the impact of COVID-19 on vocational rehabilitation (VR) program enrollment rates and employment rates at discharge for those with substance or alcohol use disorders (SUDs or AUDs) within the VA health care system. An outcome-based, summative program evaluation design (retrospective, secondary analysis) was used to measure quality assurance/quality improvement of a VR program located in Veterans Integrated Services Network (VISN) 12 between 2016 and 2021. After participants were excluded, 923 veterans (population) were analyzed. Veterans with AUDs had reduced post-COVID era employment rates, and these rates were significantly lower for veterans with active or inactive (in-remission) AUDs. Rise in post-COVID era Veteran Health Administration (VHA) VR program enrollment was disproportionately higher for veterans with SUDs than AUDs (overall). The lack of a significant interaction between SUD, AUD, and COVID-19 suggests that while SUDs play a vital role in employment outcomes, the impact remained consistent regardless of the pandemic, emphasizing the persistent struggle faced by veterans with substance-related disorders.
Purpose: This study examined whether demographic factors influence disparities in resources supporting employment (RSE) and employment outcomes among people with disabilities (PWD). Methods: The study included 920 working-age, community-dwelling individuals with multiple sclerosis, muscular dystrophy, spinal cord injury, or postpolio syndrome. Zero-inflated multilevel Poisson regression models were used to assess the effects of RSE on employment outcomes (employment status and working hours for pay) and disparities in RSE (awareness and level of availability). The primary reason for not working was analyzed in relation to demographic factors. Results: Although greater RSE availability was associated with lower unemployment, PWD with lower education or household income reported reduced access to these resources. Significant three-way interaction effects among education, household income, and RSE on employment were observed. People with disabilities with lower education and household income were more likely to cite health limitations and reliance on disability pensions as reasons for not working. Conclusion: Marginalized PWD have reduced access to RSE, which in turn adversely affects employment outcomes, particularly among those with lower education and household income. Promoting equitable employment opportunities requires targeted allocation of RSE that addresses the unique barriers faced by marginalized PWD based on education and income.
