Background Multiple Sclerosis (MS) is characterized by a set of physical and cognitive symptoms, multiple barriers to employment, and an employment rate well below the general population. It is important to identify the dimensions of barriers to employment after MS as a step in streamlining vocational counseling and promoting optimal employment outcomes. Objective Our purpose was to identify the underlying dimensions of perceived barriers to employment for people with MS. Method A 31-item self-report instrument was administered to 1,263 adults with MS identified from a specialty hospital in the southeastern USA. Exploratory principal axis factor analysis with varimax rotation was applied to 31 items to identify the underlying themes. Results Three themes emerged from exploratory factor analysis (RMSEA = 0.055). The first theme aligns with fatigue and health related factors, which accounted for a majority of the variance in the model (40% of variance). The second theme aligns with participants’ motivation or interest in employment (20% of variance). The final theme corresponds to job/disability fit and access, including difficulties with attendant care and wheelchair accessibility (18% of variance). Conclusion These factors offer vocational counselors a concise set of barriers to employment to consider with vocational planning, supports, and placement.
Background Fatigue, pain, and weakness are common across chronic conditions and may restrict employment; however, their relationship to employment outcomes remains unclear. Objective To examine the association between general physical debilitation (GPD) and competitive integrated employment (CIE) among vocational rehabilitation (VR) clients with chronic conditions. Method We analyzed 2019 U.S. Rehabilitation Services Administration (RSA-911) data for clients with arthritis, cancer, multiple sclerosis, or Parkinson's disease. Propensity score matching balanced covariates between GPD groups, and generalized estimating equations estimated associations with CIE. We conducted exploratory stratified analyses after a significant GPD × disease group interaction. Results Among 5,921 participants, GPD was not associated with CIE overall (OR = 1.00; 95% CI, 0.86 to 1.16). However, an interaction between GPD and disease group indicated heterogeneity. Among individuals with cancer, GPD was associated with lower employment (adjusted RD = −9.0%; 95% CI, −18.0% to −1.0%). Negative trends were observed for multiple sclerosis (RD = −2.0%) and Parkinson's disease (RD = −13.0%), whereas arthritis showed a trend toward higher employment (RD = 4.0%). Conclusion The association between GPD and CIE may differ across disease groups, suggesting that physical symptom burden does not uniformly influence employment outcomes and may depend on clinical and workplace contexts.
Background Veterans in the United States represent a distinct population that faces numerous challenges resulting from their military service, significantly affecting their reintegration into civilian life. Objective This study aimed to examine how the history of homelessness and criminal justice involvement are associated with competitive integrated employment outcomes among veterans with disabilities. Methods This study used a secondary data analysis of national vocational rehabilitation (VR) case records from the U.S. Department of Education's Rehabilitation Services Administration Case Service Report (RSA-911). The analytic sample included 10,934 veterans with disabilities ( M age = 44.48, SD = 16.64). Results The final logistic regression model was statistically significant, χ²(11) = 2147.604, p < .001, and accounted for 25% of the variance in competitive integrated employment according to the Nagelkerke R ². Adding ex-offender status and homelessness in the final block produced a statistically significant but modest improvement in model fit. Ex-offender status was associated with 20.0% lower odds of competitive integrated employment at exit, OR = 0.80, 95% CI [0.69, 0.93]. Homelessness was associated with 37.5% lower odds of competitive integrated employment, OR = 0.63, 95% CI [0.48, 0.82]. Conclusion Homelessness and justice involvement were statistically significant predictors of competitive integrated employment among veterans with disabilities. However, their incremental contribution to model fit was modest after accounting for sociodemographic characteristics, disability-related factors, and VR service utilization. The findings support integrated vocational rehabilitation approaches that address employment, disability-related needs, housing instability, and barriers associated with justice involvement.
Background Supported employment programs have enhanced job placement and retention for autistic individuals and people with an intellectual disability; however, there is limited understanding of the supports that facilitate long-term career advancement, and the experiences associated with it. Methods A scoping review was undertaken, involving systematic searches across six databases: Scopus, PsycINFO, Embase, MEDLINE, CINAHL, and Business Source Ultimate, guided by a structured search strategy. Eligible articles were subsequently coded and analysed to identify overarching themes and key points. Objective To answer the research question: “What does the literature say about the use of career planning practices to facilitate career advancement for autistic individuals and people with an intellectual disability?” Results Fifteen relevant studies revealed six key points: 1) autistic individuals and workers with an intellectual disability consistently desire career progression; 2) persistent barriers impede advancement; 3) progression is possible despite these barriers; 4) effective job coaching supports advancement; 5) positive workplace relationships and inclusive cultures improve outcomes; and 6) advancement requires individualized planning beyond traditional pathways. Conclusions Career progression for autistic individuals and people with an intellectual disability is achievable; however, supported employment practices must evolve to better facilitate long-term career goals and advancement, promoting meaningful workplace inclusion.
Background Vocational rehabilitation (VR) is crucial for individuals with substance use disorders (SUDs). The interplay between employment and SUD recovery is intricate, and VR agencies can significantly improve employment prospects and overall wellness. Objective This overview consolidates findings from systematic reviews focused on VR interventions aimed at improving employment outcomes for individuals with SUDs. Method Following PRISMA guidelines, we conducted a comprehensive search of electronic databases (2014–2025) for systematic reviews on VR interventions for SUDs. Six reviews (69 unique studies, N = 11,236 participants) met the inclusion criteria. Data were synthesized narratively. Results Supported employment models—particularly Individual Placement and Support (IPS) and Comprehensive Employment Support (CES)—demonstrated the strongest evidence, improving employment rates (e.g., IPS achieved 76% competitive employment at 12 months vs. 28% in standard care). Key barriers included fragmented service systems, employer stigma, and sobriety requirements, while facilitators involved integrated care, rapid job placement, and individualized support. Significant gaps included limited long-term data, demographic underrepresentation, and inconsistent outcome measures. Conclusion VR interventions for SUDs should prioritize evidence-based, person-centered models (e.g., IPS) alongside policy reforms to address systemic barriers. Future research must standardize metrics, extend follow-up periods, and include diverse populations to ensure equitable access and efficacy.
Background: This article presents insights from a healthcare professional in Aotearoa New Zealand who specialises in supporting police officers returning to duty following musculoskeletal injuries. Objective: The study highlights the importance of culturally responsive rehabilitation practices that are aligned with the principles of Te Tiriti o Waitangi, with particular attention to addressing the unique needs of Maori officers who face systemic inequities and equity faced by female officers. Method: This research was conducted by a healthcare professional in the context of a Master's degree programme. The approach is grounded in professional expertise and includes qualitative and practice-based analyses. Results: It identifies potential gaps in current return-to-work procedures that may overlook cultural factors, potentially contributing to ongoing health disparities. Furthermore, the research notes that female officers are frequently assigned emotionally demanding responsibilities during their recovery period, often irrespective of their psychological readiness. Conclusion: The findings recommend adopting a comprehensive, context-sensitive approach that respects cultural iden-tity and individual circumstances, ultimately aiming to enhance recovery outcomes for officers from diverse backgrounds.
Background Vocational rehabilitation counselors and policymakers need to better understand barriers to employment, not just related to the initial transition to employment, but to the length and quality of employment throughout the entire work lifecycle. Objective Our purpose was to identify the relationships of four types of barriers to employment with work life expectancy (WLE) among participants with spinal cord injury (SCI). Method Using self-report data, we applied a survival model to identify hazard of departure from the labor force, as a function of demographic, SCI, and socioeconomic characteristics, veteran status, and the four types of barriers to employment. Results Hazard of loss of employment and reduced WLE were associated with each of four types of barriers to employment, when considering one factor at a time. The four sets of barriers were: health considerations, poor job fit, low motivation/confidence, and lack of resources. When considering all factors simultaneously, all remained significant, except lack of resources. The findings identified relative importance of each type of barrier in relation to hazard of job loss and WLE. Conclusion Vocational rehabilitation counselors may utilize the findings to explore barriers to employment and diminished WLE among those with SCI.
Background Workers with disabilities are more likely to have lower earnings, work part time or in service occupations compared with adults without disabilities. Studies typically examine disability as a dichotomy (with or without severe functioning difficulties). Objective This article extends the literature by describing differences in work conditions not often examined (work schedule inflexibility, job security and benefits) among U.S. workers ages 18-64 with varying severity of functioning difficulties. Method Using the 2021 National Health Interview Survey (NHIS), logistic regression models predicted associations between functioning and work conditions for workers ages 18-64, controlling for individual characteristics, geography, full time work status, and occupation. Results Adults reporting any functioning difficulties had higher odds of experiencing work schedule inflexibility and perceived job insecurity, and lower odds of access to paid sick leave than those reporting no difficulties. Workers with the most severe functioning difficulties received less advance notice of work schedule than other workers. Conclusion Work conditions differ for workers by level of functioning difficulties. Studies comparing only those with and without severe functioning difficulties may understate associations between functioning difficulties and work conditions. Understanding differences in work conditions by severity of functioning difficulties may inform efforts to improve outcomes for workers with disabilities.
Background Work Based Incentives Planning has shown itself to be beneficial. Objective This exploratory study tested a model where benefits planning services are provided, with an emphasis on state and local benefits, before a job offer to Colorado DVR consumers receiving federal, state, and/or local benefits. Method A total of 12,527 Colorado DVR records of persons who were active for DVR services and had reached eligibility between 7/1/2021 and 12/31/2023, were deemed eligible for the study and analyzed. Results We found that 80% of the Benefits Planning Group were in the Most Significant Disability DVR prioritization category vs 67% in the No Benefits Planning Group. While the Benefits Planning Group were significantly less likely to have a successful DVR closure (competitive integrated employment) than the No Benefits Planning Group, the Benefits Planning Group did have a significantly higher change in hourly wages and work hours from plan to close than the No Benefits Planning Group. Those in the Intensive Benefits Planning Group had a significantly higher rate of competitive integrated employment than those in the Not Intensive Benefits Planning Group. Conclusion The benefits planning approach tested is promising. The dose of benefits planning is also important.
Background: Dementia prevalence is rising globally, and more people experience symptoms while still employed. Fear of stigma and job loss often leads to premature retirement, despite evidence that brain-stimulating activities like work may slow cognitive decline. Continued employment benefits well-being, economic productivity, and reduces healthcare costs. Yet, vocational rehabili-tation for people with dementia is underdeveloped, and knowledge on supporting work retention is limited. Objective: To explore the perceived needs and challenges associated with regaining or maintaining employment for peo-ple with dementia, as understood by both those living with the conditions and key interest-holders. Method: As part of the Danish project Meaningful And Dignified Employment for People with Dementia (MADE), two World Caf & eacute; workshops were conducted with 11 participants: people with dementia, relatives, employers, specialists, and representatives from user organizations. Data was analyzed using inductive content analysis. Results: Three themes emerged: 1) Breaking the silence by challenging stigma, 2) Promoting inclusion through workplace diversity, and 3) Reimagining vocational rehabilitation. Findings highlight the need for inclusive practices, structural changes, and individualized support. Conclusion: Inclusive employment requires reducing stigma, addressing systemic barriers, and shifting from deficit-focused to integration-focused strategies to keep people with dementia active in the workforce.
Background Workplace dignity for employees with disabilities in Kingdom of Saudi Arabia (KSA) faces challenges despite legislative progress, with limited research on employers’ views across sectors and organizational contexts. Objective To examine employers’ perceptions of workplace dignity protection for employees with disabilities in KSA. Method The study employed a descriptive-analytical methodology using a 23-item questionnaire that assessed four dimensions: accommodations and facilities, justice and inclusivity, communication and participation, and healthcare and well-being. Data were collected from 180 employers randomly sampled from the public and private sectors. The sample included various employment fields (education, industry, sales, construction) and institution sizes (large, medium, and small). Data were analyzed using appropriate statistical methods. Results Analysis revealed generally positive employer perceptions toward dignity protection requirements. Accommodations and facilities received the highest emphasis, followed by justice and inclusivity, communication and participation, and healthcare and well-being. Significant variations were found based on the employment sector, the field of employment, and institution size, with larger organizations typically showing more comprehensive protection measures. Conclusion The findings underscore the need for enhanced employer awareness, clear dignity protection policies, and targeted training programs, particularly for small and medium-sized enterprises. This study contributes to understanding workplace dignity for disabled employees in KSA and offers practical recommendations for improving their labor market integration.
Background: The emergence and accessibility of generative artificial intelligence (AI), such as ChatGPT, has facilitated opportunities for use of AI among vocational rehabilitation (VR) counselors and employment specialists for support in job development and recommendations for people with disabilities. Objective: This study examined potential biases of ChatGPT in its responses to prompts requesting specific job recommendations for case vignettes based on specific disability types. Method: ChatGPT 4o mini was probed for job placement recommendations for seven disability types and a no disability control across vignette conditions that varied by gender and level of case detail. Results: Several significant differences between disability and vignette condition regarding average income level and categorization of jobs emerged. Notably, individuals with intellectual disabilities and those with serious mental illness were suggested occupations with lower salaries. Vignettes with intellectual disability showed a higher proportion of restricted job types compared to every other disability type explored in this study. Further, salaries were lowest when individual interests were omitted from the profile, while high salaries were observed when little to no information was included in the vignette. Alternatively, low salaries were observed for individuals with intellectual disabilities across all conditions. Conclusion: Overall, these findings suggest the need for careful and thoughtful use of AI tools among VR counselors and employment support providers.
Background: Adults who are blind or have a visual impairment (BVI) continue to experience significantly lower rates of competitive integrated employment (CIE) than their peers without disabilities. Postsecondary education and vocational rehabilitation (VR) career services are important supports, yet their combined influence on CIE for individuals with BVI has not been examined using recent national data. Objective: This study identifies factors associated with CIE among prime working-age adults with BVI by examining demographic and socioeconomic factors, postsecondary education, and VR career services. Methods: Secondary analysis of U.S. Rehabilitation Services Administration Case Service Report data from PY 2022-2023 was conducted. The sample included 7,956 adults ages 25-54 with BVI who received VR services. Hierarchical logistic regression assessed variables associated with CIE in three steps: demographic and socioeconomic variables; postsecondary education; and VR career services. Results: Overall, 52.4 percent of participants achieved CIE. Postsecondary education nearly doubled employment odds. VR career services, including counseling, job placement, short-term supports, and supported employment, were strongly associated with employment, while long-term unemployment, low income, SSI/SSDI receipt, and secondary disability decreased the likelihood of employment. Conclusions: Postsecondary education and individualized VR services are jointly associated with higher CIE outcomes. Expanding access to intensive career services may further strengthen employment pathways.
Background: Individuals with ADHD are at elevated risk for occupational impairment, yet little is known about the contextual factors that support workplace well-being in this population. Objective: This study is among the first to examine the role of work climate, fair ADHD policies, high-quality supervision, and non-work social support in predicting key occupational outcomes. Method: Participants were 100 adults with ADHD (51% male), ages 19-30 (M = 26.61, SD = 2.28), all employed fulltime. They completed measures of ADHD symptoms, occupational contextual supports, and work outcomes (job satisfaction, work motivation, income). Results: Controlling for medication status, sex, and age, hierarchical regression analyses indicated that perceptions of fair ADHD policies predicted all three outcomes. A positive work climate was associated with higher work motivation, although moderation analyses revealed that this benefit diminished as ADHD symptom severity increased. High-quality supervision was linked to greater work motivation, and non-work social support was associated with higher job satisfaction. Conclusion: Overall, findings suggest that organizations fostering equitable treatment and opportunities for employees with ADHD may help mitigate occupational risks and promote better outcomes. Results further highlight the importance of contextual and systems-level supports in optimizing occupational functioning for adults with ADHD.
Background People with learning disabilities (LDs) are a large and growing segment of the American and global disability communities, but they tend to underutilize vocational rehabilitation (VR) services.Objective This article presents a contextual career development framework, the Illinois Work and Well-Being Model (IW2M), as an intervention schematic that can be applied to facilitate positive VR outcomes for people with LDs.Methods The framework encompasses the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home.Results A case study is used to illustrate how the framework can be used in VR assessment, case planning, and service delivery.Implications A discussion of implications regarding VR practice and research is offered, with the overall goal of reinforcing career development as the foundation of VR services for people with LD and other disabilities.Conclusions VR professionals can use the health, function, and career development framework to provide responsive, goal-oriented, and customer-directed services that lead to a wide range of positive outcomes for VR participants with LD.
Background Despite all the measures taken and the progress made in occupational health and safety, work accidents remain widespread and have serious multidimensional negative effects on employees, employers, and society.Objective This study aimed to explore the lived experiences of individuals in T & uuml;rkiye who lost their jobs following work-related accidents, focusing on their psychosocial struggles, vocational rehabilitation needs, and the challenges they faced during the return-to-work process.Methods A qualitative research design with content analysis was employed. Purposive sampling was used to recruit 20 participants who had experienced a work accident and subsequent job loss. Data were collected through in-depth, semi-structured interviews and analyzed using thematic analysis with MAXQDA 2020.Results Four core themes emerged: (1) experiences after work accident, (2) transformation of the close circle, (3) challenges in back-to-work process, and (4) thoughts and expectations about the future. The findings highlighted deep psychosocial impact and the critical role of family, faith, and professional support in coping.Conclusion Comprehensive back-to-work programs must be integrated into social policy and vocational rehabilitation strategies in T & uuml;rkiye to promote social inclusion and psychological recovery of individuals who lost their jobs due to work accidents.
Background Delayed return-to-work is common after serious injury. Vocational rehabilitation (VR) supports people to return to/remain in work. We developed training for occupational therapists (OTs) and clinical psychologists (CPs) to deliver a VR intervention (Return to Work After Trauma-ROWTATE) to UK trauma patients within a large-scale randomised controlled trial.Objectives Evaluate the training, OT/CP competence and confidence to deliver ROWTATE, attitudes/confidence in evidence-based practice (EBP).Methods Competency was assessed through Team Objective Structured Clinical Examination and two tasks (management plan, employer letter). Intraclass correlation coefficients (ICCs) estimated inter-rater reliability. Questionnaires measured EBP attitudes (EBPAS-36) and confidence (EPIC) pre and post-training and confidence in ROWTATE delivery post-training. Semi-structured interviews captured training experiences and confidence.Results 47 OTs and 16 CPs completed training. Competency scores were high (OT range=27.5-37.5; CP range=28.5-37; maximum=38). Inter-rater reliability was moderate (OT ICC=0.56, 95%CI 0.18,0.77; CP ICC=0.73, 95%CI -0.22,0.93). EBPAS-36 scores were high pre and post-training with no significant increase post-training. OT confidence in applying evidence (P = 0.01) and evaluating effect of their actions (P = 0.04) increased significantly post-training. OTs and CPs had high confidence (80-100% across questions) in delivering ROWTATE.Conclusions VR training resulted in high competency scores, improvements in EBP confidence and high confidence in delivering ROWTATE.
Background With prevalence rates of cardiovascular disease (CVD) on the rise across the globe, people with CVD are an emerging vocational rehabilitation (VR) consumer population.Objective This article provides recommendations for working with people who have CVD across the phases of the VR process.Method Following an overview of the etiology, incidence, prevalence, and career development implications of CVD, the authors present direct service and advocacy recommendations for VR professionals.Results The importance of access to quality healthcare, lifestyle and environmental modifications to promote heart and circulatory health, employer consultation, workplace accommodations and universal design, and interface with medical and mental health professionals is emphasized throughout the article.Conclusions Rehabilitation professionals must be prepared to meet the needs of this growing and diverse clientele as people with CVD seek assistance from the VR program in acquiring, maintaining, and advancing in meaningful, satisfying employment.
Background:Technical Assistance (TA) can be an effective implementation science tool to address barriers to incorporating evidence-based practices in behavioral health. This project evaluated an Enhanced-Online TA Response (E-OTAR) model intended to build system capacity for enhancing employment outcomes for adults with serious mental health conditions. Methods:E-OTAR consisted of 40-80 hours of tailored virtual sessions over 12-24 months across 15 sites nationwide using web-based technologies. Qualitative and quantitative measures were used to assess facilitators, barriers, and outcomes. Results:TA utility was rated highly in areas of shared information/resources, goal development and refinement, and amount of virtual contact. Sites reported enhanced capacity through increased knowledge and improvements in agency coordination, referrals, and expectations. Acceptability of the virtual nature of the TA and other model facilitators and barriers are presented. Conclusion:The project developed an online TA model, offering a relatively low-cost method for assisting organizations to develop capacity for enhancing services. The E-OTAR model is a feasible option and works effectively when sites have an active local team, clear goals, and a continued system-wide commitment to employment outcomes. As virtual TA is likely to burgeon, there is a need to incorporate structured needs analysis and evaluation tools.
Background Employment provides not only financial support but also fosters independence for individuals with disabilities. Maintaining employment is particularly critical as it is associated with improved self-worth and psychological well-being.Purpose This study examines job retention outcomes among individuals with visible and invisible disabilities, focusing on the role of vocational rehabilitation (VR) services in supporting these individuals' long-term employment.Method The study has a sample of 53,316 individuals with disabilities. The descriptive statistic was used to identify the sample. A chi-square test of independence was conducted to examine the relationship between disability visibility (visible vs. invisible) and job retention outcomes at six and twelve months. To explore the predictor role of VR services, a logistic regression analysis was employed, using the RSA-911 dataset.Results The analysis highlights that individuals with invisible disabilities tend to have lower job retention rates at six and twelve months compared to those with visible disabilities. Although both positive and negative predictors were identified in VR services, they accounted for only 1% of the variance in job retention outcomes.Conclusion Findings are discussed relative to prior literature, and recommendations are provided for practice, research, and policy.
