Introduction People with visual impairments who are not in the workforce experience mental health concerns that may be related to their nonparticipation in the workforce. This study reports comments from people with visual impairments about their mental health to provide service providers with insight into those concerns. Methods People with visual impairments participated in semistructured interviews about their lack of participation in the workforce. A research team coded and categorized participants’ responses. Comments concerning their mental health emerged from the data and were further coded and analyzed. Results Only some of the participants experiencing mental health concerns were diagnosed with or receiving treatment for mental health disorders. Some concerns were associated with adjustment to visual impairment, while others were related to socialization issues, employment status, or multiple stressors. Discussion People with visual impairments typically experience multiple risk factors for mental health disorders. Mental health issues may be undiagnosed or untreated and can impair participation in rehabilitation activities. Social support can promote positive mental health. Implications for Practitioners Practitioners can explore multiple avenues to address mental health among people with visual impairments. Practitioners can refer people with visual impairments to qualified mental health providers and local, online, or telephone support groups. Service providers may also educate and support people with visual impairments and family members about adjustment to visual impairment and positive mental health coping mechanisms. Service providers should be educated on promoting positive mental health and recognizing mental health risk factors.

Background:A large portion of the population of people with visual impairments are neither working nor looking for work. Mentoring and self-employment are two strategies to encourage workforce participation, but little is known about whether people with visual impairments who are out of the labor force were offered or were interested in these options. Objective:We explored whether participants were interested in or had been offered mentoring or self-employment assistance to encourage their participation in the workforce. Methods:Thirty participants with visual impairments and out of the labor force were interviewed about their thoughts and experiences regarding mentoring and self-employment. A qualitative software program assisted in coding responses, identifying themes, and organizing demographics. Results:Participants tended to be interested in but did not have access to mentors. Some participants explored self-employment opportunities and even more were interested in it, but few were offered it as an employment option by a vocational rehabilitation provider. Most participants were interested in learning more about self-employment job opportunities and how income earned through self-employment might influence other benefits. Conclusions:Opportunities to support people with visual impairments in locating mentors or engaging in self-employment appear under-utilized. Participants in this study appeared interested in receiving support from a mentor and learning more about self-employment options. Efforts to improve the labor force participation rate among people with visual impairments should include assistance in finding mentors to promote adjustment to blindness and becoming employed and exploring opportunities for self-employment. Vocational rehabilitation agencies should consider examining their policies and practices to promote greater access and use of these strategies to bring people with visual impairments into the labor market.

BACKGROUND: Approximately half of people with vision impairments are not employed or looking for work. Many of these people have additional health or disability concerns, but little is known about those concerns or other reasons they are out of the workforce. OBJECTIVE: We investigated employment barriers impacting labor force participation among people with vision impairments, their perceptions of their skills and training needs, and the impact of not working on their economic status. METHODS: Thirty people with vision impairments who were not in the labor force participated in exploratory interviews conducted using a semi-structured protocol. We used a qualitative software program and multiple researchers to code the interviews, identify and analyze themes, and organize participants’ information. RESULTS: Employment barriers included concerns about health and disability, employer attitudes, transportation, training needs, economics, age, and lack of support. Some participants wanted to work now or in the past but were unable to find employment that accommodated their needs and generated a salary that made it economically worthwhile. CONCLUSION: Participants appear to need assistance identifying career paths leading to economic security, training for these careers, locating affordable transportation, and working with employers to gain workplace accommodations. Providing support and encouraging family support may positively influence interest in employment.

Introduction: Job satisfaction research has focused on the general population or specific careers. Little attention has focused on the job satisfaction of persons with visual impairments, particularly using standardized measures of job satisfaction. This study examined how relationships with colleagues and supervisors, opportunities for advancement, and employee demographics predict job satisfaction for employees with visual impairments. Methods: Researchers analyzed data from 195 employed participants from a larger study on job retention and career advancement. The Brief Job Satisfaction Measure II measured job satisfaction, and predictor variables focused on relationships with colleagues and supervisors, promotion opportunities, and demographics. Researchers used multiple linear regression to identify predictors of job satisfaction. Results: Individuals with visual impairments had high job satisfaction if they believed colleagues treated them the same as sighted colleagues and had supervisor support. Underemployed individuals with visual impairments experienced lower job satisfaction. Employees who identified their race as other, those who experienced vision loss after their first job, and participants with an additional disability had higher job satisfaction. Discussion: Social interactions with colleagues and supervisors contributed to the job satisfaction of employees with visual impairments. These interactions may make employees with visual impairments feel comfortable asking for workplace accommodations and more integrated into the workspace. While income was not a predictor of job satisfaction, underemployment was, indicating that individuals with visual impairments may not have achieved their maximum vocational potential. Implications for Practitioners: Individuals with visual impairments and service providers should look for opportunities to promote social interactions at work. Training co-workers and supervisors about working with persons with visual impairments and accommodations could be beneficial. Vocational rehabilitation counselors should also ensure program participants have employment opportunities that are both economically sustainable and commensurate with their interests and abilities.

BACKGROUND:Approximately half of the people who are blind or have low vision in the U.S. are not in the labor force, yet we know little about their characteristics or reasons for being out of the labor force. OBJECTIVE/HYPOTHESIS:The objective of this study was to compare people with blindness or low vision who reported being unable to work to those out of the labor force for other reasons, unemployed, and employed, and investigate characteristics that differentiate these groups. METHODS:Our sample of people with blindness or low vision was selected from the Behavioral Risk Factor Surveillance System to compare people who reported being unable to work to those in other employment groups utilizing multinomial logistic regression. RESULTS:The majority of people out of the labor force reported they were unable to work. People unable to work were likely to have low income, more chronic health conditions, days with poor physical health, and functional disabilities than all other groups. They were also more likely to have access to health care than other groups and were more likely to be male and uncoupled compared to those out of the labor force for other reasons. CONCLUSIONS:People who reported being unable to work had more chronic health and functional disability issues. Because being out of the labor force puts one at economic risk, further research is indicated to assess policy issues and strategies that might identify employment options that accommodate people with blindness or low vision and additional health issues and disabilities.

Introduction: The Workforce Innovation and Opportunity Act of 2014 reinforced the state federal vocational rehabilitation program's commitment to job retention and career advancement for persons with disabilities. We continue to have limited information about what job-related skills are most helpful to persons with visual impairments in retaining or advancing in employment. Method: Descriptive statistics and logistic regression were used to investigate the association between current employment status and skills among persons with visual impairments who had a competitive employment history. Data were from a national volunteer survey of persons with visual impairments born between 1950 and 1991. Snowball sampling methods generated the sample. Results: Persons with professional licensure or certificates were more than twice as likely to be employed as those who did not possess these qualifications. Employed participants were less likely to need job-related training to find or keep a job. Discussion: Though additional research to explore the relationships between skills and employment is indicated, persons with visual impairments should be encouraged to explore and pursue job skills training and professional licensure or certification in fields compatible with their career goals. Implications for Practitioners: Even persons with a work history may need additional job skills training to continue employment. Professional licensure or certification may be of value in obtaining employment, but persons with visual impairments may need support to obtain those credentials. Careful career planning to promote positive employment outcomes should include research about the credentials associated with employment goals.

Persons with visual impairments (VI) have a high nonparticipation rate in the labor force. Information about factors influencing their labor force participation could provide insight into how to increase employment rates. We selected persons with VI from the Survey of Income and Program Participation to investigate factors that differentiate persons out of the labor force (OLF) for chronic health or disability reasons from those employed and those OLF due to other reasons. Persons with VI and OLF for chronic health or disability reasons were more likely to have additional disabilities; have physical, mental, or other health limitations to work; and receive Supplemental Security Income or Social Security Disability Insurance. Compared with those employed, people with VI and OLF for chronic health or disability reasons appear to have multiple characteristics indicating poorer health, lower education attainment, and greater financial insecurity. Compared with those OLF due to other reasons, people with VI and OLF for chronic health or disability reasons were less likely to be female but more likely to receive food assistance and to indicate disadvantaged health status. These results suggest that skills to accommodate vision disability or health conditions are essential to employment or further education, and additional education may expand vocational options. Benefits counseling, encouragement, and careful career planning may assist persons with VI in moving toward financial independence.

BACKGROUND: People with blindness and low vision (BLV) encounter many obstacles in retaining employment. Recent legislation has refocused vocational rehabilitation (VR) efforts toward job retention and career advancement among persons with disabilities. OBJECTIVE: We investigated the skills, including technology, and other issues that influenced job retention among persons with BLV to gain in-depth knowledge that is not typically available using survey methods or secondary data sources. METHODS: Intensive interviews using a semi-structured protocol were conducted with 11 persons with BLV and an employment history. Interviews were transcribed, summarized by major themes, and approved by participants. A qualitative software program assisted in further coding, identifying additional themes, and organizing participants’ information. RESULTS: Participants recommended that others with BLV be proficient in assistive technology use, develop networks, and be persistent in achieving goals. Participants had positive and challenging experiences with technology, employers, and the VR service delivery system. Participants reported stress associated with their jobs and concern about their workplace efficiency. CONCLUSIONS: Results suggest that job retention continues to be problematic for persons with BLV. Service delivery systems should explore policies and services that support job retention. Further research concerning job stress, assistive technology, and workplace efficiency is needed.

Introduction: This study utilized data from the 2014 Survey of Disability and Employment (SDE) to examine personal characteristics that influenced employment after disability onset for people who are visually impaired (i.e., those who are blind or have low vision). Method: The selected sample from the SDE data set included 131 individuals who are visually impaired, had disability onset after age 14 years, and worked before their disability onset. Logistic regression was used to examine working after disability onset associated with age at disability onset, years since disability onset, gender, race, education, receipt of government disability benefits, self-reported health, encouragement received to work, additional disabilities, and the interaction between age at disability onset and years since disability onset. Results: Persons who were female, received government benefits, and had multiple disabilities were less likely to work after disability onset; persons who had more sources of encouragement were more likely to work after disability onset. Age at disability onset interacted with time since disability onset; as age increased, odds of working after disability onset increased but only for persons who had their disability for at least 4 years. Discussion: Persons with newly acquired disabilities may need time to adjust to their disability and learn new skills that allow them to continue employment. Information about how employment may influence receipt of government benefits would be helpful to persons evaluating their options regarding continuing employment. Implications for practitioners: A person who has not worked after recent disability onset may be adjusting to life with a disability and may return to work in the future. Encouragement to work from both service providers and family members made a meaningful difference in employment retention after disability onset, and this is an area that vocational rehabilitation professionals can influence.

Introduction: Employed applicants for vocational rehabilitation need timely services to improve the likelihood of their successful job retention or career advancement. Little research exists that examines timeliness of services among employed applicants, particularly for applicants with visual disabilities. This study investigated time from vocational rehabilitation application to a signed Individualized Plan for Emplolyment (IPE) for employed applicants with visual disabilities. Method: The sample of 5,096 competitively employed vocational rehabilitation applicants from the FY2015 RSA-911 report was combined with survey responses from 51 vocational rehabilitation agencies about services to persons with visual disabilities. Multilevel modeling was used to examine effects of state-level and individual-level characteristics and cross-level interactions on the length of waiting time from vocational rehabilitation application to signed IPE. Results: The time from application to IPE was shorter for employed applicants with visual disabilities who received services from separate vocational rehabilitation agencies compared to that of combined vocational rehabilitation agencies. Employed vocational rehabilitation applicants with visual disabilities waited longer if they were younger, non-White, or received disability benefits. Official job-retention policies in state vocational rehabilitation agencies appeared to reduce the delay of IPE implementation for persons with secondary disabilities, for applicants who received disability benefits, and for persons who worked more hours per week. Discussion: Additional research to determine how vocational rehabilitation can provide services to employed persons as soon as possible after application is indicated, particularly for persons applying to combined agencies. Implications for practitioners: Vocational rehabilitation providers should explore ways to expedite service delivery, particularly for persons who are younger, non-White, or receiving disability benefits. Implementing official vocational rehabilitation policies for addressing job-retention and career-advancement cases may be one avenue to expedite services to some employed applicants.

A national survey of state vocational rehabilitation agencies serving consumers who are blind or have low vision investigated agency policies and procedures regarding job retention and career advancement and potential changes associated with Workforce Innovation and Opportunity Act (WIOA) legislation concerning those services. WIOA regulations addressing job retention and career advancement appear consistent with existing policies in some states but present challenges for others. Agency representatives were more likely to report policy changes were made or were being considered regarding career advancement than for job retention. Less than one-third of agency representatives expressed concern about the financial impact of providing career advancement services.

BACKGROUND: Negative employer attitudes have been identified as a major barrier to employment for people who are blind or visually impaired, yet we know little about what influences employer attitudes toward this population. OBJECTIVE: The purpose of the study was to replicate an earlier study of predictors of employer attitudes towards people who are blind or visually impaired as employees, utilizing a larger sample of employers and including additional predictor and control variables. METHODS: An online survey was conducted with a national sample of hiring managers, resulting in a usable sample of 379. Multiple regression was utilized to identify predictors of employer attitudes. RESULTS: Five variables significantly predicted employer attitudes: having hired someone in the past, knowledge about how work tasks can be accomplished, belief in knowledge, having a relationship with vocational rehabilitation (VR), and being female. Although communication with VR had a strong association with employer attitudes, having hired functioned as a mediator of the relationship between it and employer attitudes, indicating that communication with VR may influence employers' hiring decisions. CONCLUSION: VR professionals should interact with employers as much as possible to encourage the hiring of people who are blind or visually impaired. Going beyond initial contacts to developing relationships is important.

Introduction: Recent U.S. legislation supports vocational rehabilitation efforts to maximize employment and community integration of persons with disabilities by providing job retention and career advancement services. The study presented here investigated employed persons with visual disabilities who applied for vocational rehabilitation services. Methods: The sample included 4,499 competitively employed vocational rehabilitation applicants from the FY2015 RSA-911 report. Logistic regression was used to identify consumer characteristics and vocational rehabilitation services associated with losing competitive employment. Results: Employed applicants tended to receive assessment, counseling and guidance, diagnosis and treatment, and rehabilitation technology. Characteristics that put employed applicants at increased risk of losing their jobs included being female, having a secondary disability, working fewer hours, having less education, or having a previous unsuccessful vocational rehabilitation employment outcome. There was a significant interaction between vocational rehabilitation case length and age: those served for longer periods were more likely to lose employment, particularly older consumers. Consumers who received short-term on-the-job support, diagnosis and treatment of impairments, or rehabilitation technology services were more likely to retain competitive employment. Discussion: When developing rehabilitation plans for employed applicants, counselors may identify and attempt to provide services to address factors that put consumers at an increased risk of losing employment. Part-time employment at application is one risk factor that requires increased attention. Implications for practitioners: Prompt service delivery is an important factor in facilitating job retention. Increased efforts to maintain consumer contact and motivation may influence the likelihood of job retention among employed applicants.

The purpose of this study was to investigate agencies' response to and their perceived impact of two specific changes associated with the Workforce Innovation and Opportunity Act (WIOA): 15% budget allocation for pre-employment transition services (pre-ETS) and elimination of the homemaker closure. Representatives from combined and separate agencies serving consumers with blindness and low vision in all 50 states and the District of Columbia participated in a telephone survey to provide information about the agency's response to these changes. Separate agencies were more likely to experience a challenge with the pre-ETS requirement, but were less likely to be impacted by the elimination of homemaker as a closure status. A concern for all agencies was the yet-to-be-determined impact on services to consumers over age 21.

BACKGROUND:Approximately one-third of the working age population of persons with visual disabilities is employed. Recent federal legislation stressed the importance of VR services to assist employed persons with disabilities retain or advance in employment, but we know little about employed VR appl icants. OBJECTIVE:This study sought to identify and contrast characteristics and services received by VR consumers with visual disabilities based on employment status at application. METHODS:VR cases from fiscal year 2015 were analyzed using logistic regression. The sample included 4,586 competitively employed applicants and 9,643 unemployed applicants. RESULTS:Competitively employed applicants tended to be White non-Hispanic, older, more educated, and less likely to have non-cognitive disabilities. Competitively employed applicants tended to receive on-the-job supports, rehabilitation technology, counseling and guidance, technical assistance, and diagnosis and treatment. CONCLUSIONS:Competitively employed applicants with visual disabilities have different characteristics and service patterns from unemployed applicants. VR counselors can anticipate applicants’ service delivery needs based on their employment status while considering individual goals and circumstances. Future research regarding job retention for competitively employed applicants who are blind or have low vision appears warranted.

A collective case study approach was used to examine factors influencing job retention of persons with vision loss after employment. Ten participants provided information regarding how job modifications, job restructuring, training/retraining, organized labor, transportation, motivation, and their employers and coworkers impacted their job retention. Computer technology was a major positive influence for most participants. Print access and technology were a source of stress for most participants.

BACKGROUND: Many people who are blind or visually impaired face difficulties with transportation due to their inability to drive. Accordingly, transportation is widely considered a barrier to employment for people who are blind or visually impaired, and transportation selfefficacy is a factor that may minimize the impact of this barrier. OBJECTIVE: The aim of this study was to examine transportation self-efficacy and its association with employment among working-age adults with visual impairments who were nondrivers. METHOD: This study included data from 327 people who participated in a national transportation survey of individuals with visual impairments. A multiple logistic regression analysis was conducted to predict full-time employment based on transportation self-efficacy and other factors. RESULTS: Factors predicting full-time employment included census region, severity of vision loss, and years of education. Interaction effects indicated that odds of employment generally increased as transportation self-efficacy increased; however, the effect of self-efficacy was dependent upon age and age at onset of visual impairment. CONCLUSIONS: Transportation self-efficacy was an important predictor of employment, particularly for younger people and for those who experienced significant vision loss more recently. Vocational rehabilitation counselors and other service providers can provide support to consumers to increase their transportation self-efficacy.

Introduction: This study provides descriptive information about drivers with low vision and transportation issues, including their own self-imposed driving restrictions. Methods: An electronic survey administered online in late 2013 to early 2014 obtained data from 592 adults with visual impairments. Of those, 17 had a valid driver's license. These 17 provided information about their employment, activity limitations, public transportation use, services received, and transportation self-efficacy. Results: Approximately half of the low vision drivers were employed. Most had not received vocational rehabilitation or orientation and mobility (O&M) services. Most drivers limited their night driving and over 70% noted that transportation problems limited their participation in entertainment or leisure activities. Most drivers had access to public transportation, but did not frequently use it. Drivers were generally confident in their ability to perform transportation-related tasks, although overall, drivers using bioptic devices tended to be more confident. Drivers who did not use bioptic devices were least confident in arranging a fair price for daily transportation to work with a driver. Discussion: Drivers with low vision who limit their activities and employment due to transportation issues may not be receiving the vocational rehabilitation or O&M services that could help them compensate for these limitations. Further research examining the behaviors and service needs of low vision drivers is indicated, particularly for younger drivers. Study limitations include the small sample size, non-probability sampling method, and electronic data collection. Implications for practitioners: Low vision drivers may benefit from evaluation by O&M specialists and vocational rehabilitation providers to determine if additional services are needed. Persons with low vision should be informed about evaluation for bioptic devices, and vocational rehabilitation providers should network with bioptic providers and other professionals to obtain referrals of persons with low vision who are not yet vocational rehabilitation recipients.

Introduction This study evaluated transportation-related stress and factors predicting stress among persons with visual impairments. Methods Participants with visual impairments completed electronic surveys rating their stress levels experienced when completing various walking and public transportation tasks. They also indicated activities they avoided due to transportation stress. Results Higher stress was reported for navigating unfamiliar bus routes, walking in urban areas without sidewalks, and walking in unfamiliar places. Significant predictors of walking stress were age, years since vision loss, dog guide use, physical limitations, and frequency of public transportation use. Significant predictors of public transportation stress were age, orientation and mobility (O&M) training, physical limitations, and frequency of public transportation use. Most-avoided activities due to transportation-related stress were entertainment or leisure activities and visiting family and friends. Discussion Unfamiliar situations and unpredictable environments were associated with higher stress. Frequent public transportation use and longer time since vision loss predicted lower stress, which indicates that increased and varied experiences may affect transportation-related stress. Older persons and persons with physical limitations had more transportation-related stress. Social activities, which are important in managing stress, were most frequently avoided due to transportation stress. Implications for practitioners O&M instructors should keep in mind that providing varied experiences and longer training is indicated for persons with high stress, particularly for older persons, and those with recent vision loss or physical limitations. Everyone involved in the rehabilitation process should remember that building relationships with consumers, encouraging public transportation use, participating in support groups, and overcoming travel barriers for social activities may help reduce transportation stress.

espanolIntroduccion: El objetivo de este estudio era identificar las necesidades y los desafios de las personas mayores con perdida sensorial dual (perdida combinada de audicion y vision) y determinar las prioridades a la hora de entrenar a familiares, proveedores de servicios comunitarios y profesionales que trabajan con este colectivo. Metodologia: 131 personas con perdida sensorial dual de entre 55 y 99 anos participaron en una encuesta disenada para recopilar informacion sobre sus principales necesidades, los desafios asociados a la perdida sensorial y los requisitos de formacion de las personas con las que interactuan. Los resultados se analizaron con estadisticas descriptivas y se hicieron comparaciones entre personas con aparicion temprana y tardia de perdida sensorial. Resultados: Las necesidades identificadas con mayor frecuencia fueron: transporte, formacion tecnologica, ayuda para hacer los recados y mejora de la comunicacion. Se determino que los profesionales medicos eran los prestadores de servicios que mas formacion necesitaban en cuanto a perdida sensorial dual. La mayoria de los participantes contesto que sus vecinos, sus amigos y familiares tambien necesitan formacion. Se notaron algunas diferencias entre las personas, dependiendo de la edad en que habia hecho aparicion la perdida sensorial. Discusion: Las necesidades del grupo variaron dependiendo de la edad de aparicion de la perdida sensorial: las necesidades de las personas con aparicion temprana de una o ambas perdidas sensoriales se centraban sobre todo en el transporte y la formacion tecnologica, mientras que aquellos con perdida sensorial dual de aparicion tardia estaban mas interesados en recibir informacion sobre productos para mejorar la audicion o la vision y en mejorar su capacidad de comunicacion con los familiares. Aspectos de aplicacion practica profesional: La formacion tecnologica es una de las necesidades mas importantes de este colectivo, aunque no siempre sea abordada por los prestadores de servicios, ya que puede contribuir a una mejora global de la calidad de vida al ampliar las opciones de comunicacion y reducir la sensacion de aislamiento. Los profesionales de la salud son un objetivo importante en cuanto a formarles sobre como interactuar con personas con perdida sensorial dual. EnglishIntroduction: The purpose of this study was to identify the needs and challenges of seniors with dual sensory loss (combined hearing and vision loss) and to determine priorities for training family members, community service providers, and professionals who work with them. Methods: Individuals (N = 131) with dual sensory loss between the ages of 55 and 99 years participated in a survey designed to collect information about their most important needs, challenges encountered associated with sensory losses, and the training requirements of the people who interact with them. Results were analyzed with descriptive statistics, and comparisons were made between persons with early and late onset of sensory loss. Results: The most commonly identified needs were transportation, technology training, assistance with errands, and improved communication. Medical providers were identified as the service providers who most need training about dual sensory loss. A majority of respondents thought their local community members, friends, and family also need education. Some differences were noted based on age of onset of sensory losses. Discussion: Needs differed by age of onset group: needs of participants with early onset of one or both sensory losses focused on transportation and training to use technology, while needs for those with later onset focused on information about devices to improve hearing or vision and better ability to communicate with family. Implications for practitioners: Training to use technology is an important area of need that may not always be addressed for this population by service providers, but it may contribute to overall improved quality of life, since it has the potential to improve communication options and reduce feelings of isolation. Health care providers are an important group to target for education regarding how to interact with people with dual sensory loss.