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 Diabetes affects over 38 million U.S. adults and is linked to higher absenteeism, presenteeism, early retirement, and workplace discrimination. Despite ADA protections and evidence that reasonable accommodations dramatically improve outcomes, workers with diabetes underutilize them, primarily due to stigma, fear of retaliation, and a daunting accommodation request process.Objectives and Methods This article first presents a detailed occupational and demographic profile of diabetes, showing disproportionate impact on racial/ethnic minorities; individuals who are overweight or obese; those in shift-based or physically demanding jobs; and those with mobility limitations, neuropathy, and vision impairment.Results A composite worker, Brendan (a 48-year-old Hispanic warehouse associate), illustrates how these factors intersect to deter disclosure and accommodation requests. The manuscript then introduces the Win-Win Approach-a non-adversarial, seven-step framework-and provides a step-by-step case example contrasting effective versus ineffective communication when Brendan requests private space and refrigeration for insulin administration.Implications and Conclusions By offering replicable strategies, the article equips workers, employers, and rehabilitation professionals to increase accommodation utilization, reduce stigma, and achieve better health and employment outcomes.

Background: The purpose of this study was to increase the body of knowledge regarding the workplace discrimination experiences of individuals with disabilities residing in the Pacific and Northwest regions by exploring their allegations filed under Title I of the Americans with Disabilities Act (ADA).Objective: The goals of this article are to describe region- and state-level patterns in workplace discrimination and to provide valuable information to stakeholders to better understand and address job discrimination within their respective areas of practice.Methods: The Integrated Mission System database documents every available closed allegation of job discrimination under the ADA. Data for each state include overall frequencies and proportions. Data are presented as respective national and regional rankings for comparison purposes. Descriptive and nonparametric statistics were obtained for each of the five specific research questions.Findings: Variables selected for study include the frequency of allegations, the impairment of the charging party, alternative prongs of the ADA definition of disability, the nature of the unlawful discrimination alleged (known as issues), and the outcome of the Equal Employment Opportunity Commission investigation (known as merit or nonmerit). These are presented in tables for ease of comparison. Finally, the next steps in research and other possibilities for knowledge translation are discussed.Conclusions: Results reveal meaningful variation in ADA Title I workplace discrimination patterns across PNW states, highlighting the importance of state-specific context in understanding these experiences. These findings support the need for targeted policy, training, and advocacy efforts, as well as continued research to inform strategies that reduce workplace discrimination for individuals with disabilities.

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.

Research Objectives As survival rates for advanced cancer improve, individuals living with this condition represent a growing and underserved population within vocational rehabilitation (VR) services. This literature review and conceptual framework aim to (a) describe the unique characteristics and needs of individuals with advanced cancer, (b) examine the impact of the disease and its treatment on employment and career development, and (c) provide practical, evidence-informed strategies for rehabilitation professionals to support this population throughout the VR process. Design The authors conducted a comprehensive review of literature on cancer survivorship, employment outcomes, and VR practices, focusing on individuals diagnosed with advanced or metastatic cancer. Drawing from empirical studies, clinical guidelines, and conceptual models, the review synthesizes findings relevant to each phase of the VR process: outreach and eligibility determination, assessment and planning, counseling and guidance, job development and placement, and job retention and follow-up. Setting N/A Participants The review included studies involving participants with “advanced,” “metastatic,” or “late-stage” cancers to explore the impact of these diagnoses on employment. Interventions N/A Main Outcome Measures The primary outcome was to understand how advanced cancer affects individuals’ ability to work and engage in career development. Results Key findings highlight the complex interplay of medical, psychosocial, and vocational challenges faced by individuals with advanced cancer. These include physical symptoms (e.g., fatigue, pain), cognitive impairments, stigma, financial distress, and existential concerns. Despite these barriers, many individuals express a strong desire to remain employed, citing work as a source of identity, normalcy, and financial necessity. The review emphasizes the importance of individualized case planning, interdisciplinary collaboration, and employer engagement. Effective strategies include flexible scheduling, workplace accommodations, mental health screening and referral, and education on legal protections such as the Americans with Disabilities Act (ADA). Findings from the comprehensive literature review suggest a holistic, consumer-centered approach to VR that integrates medical, psychological, and vocational supports. Increased outreach to healthcare providers and employers, culturally sensitive communication, and the use of community resources were common recommendations. Special attention is given to the role of stigma and bias in the VR process, the role of mental health in this population as they pursue employment, developmental needs of younger and older adults, as well as the impact of the COVID-19 pandemic on cancer diagnosis and employment trends. Conclusions In conclusion, individuals with advanced cancer are an emerging disability population. Tailored VR strategies and inclusive workplace practices are essential to support their employment goals and enhance quality of life.

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.

BACKGROUND:The incidence and prevalence of autism have been increasing dramatically over the past several decades. Autistic individuals report significant difficulties initiating and maintaining their careers. OBJECTIVE:This article reviews the employment concerns of autistic workers and suggests a collaborative strategy for implementing on-the-job accommodations with employer cooperation. METHODS:This narrative literature review draws upon existing research by the authors and other investigators. RESULTS:The win-win approach to workplace accommodations has the potential to improve job acquisition and retention outcomes for autistic workers. CONCLUSIONS:Vocational rehabilitation professionals must prepare autistic clients to request and implement needed on-the-job supports, utilizing existing resources like the Job Accommodation Network at West Virginia University.

Background: Research documents the substantial difficulties that people with mid-career acquired disabilities experience in their quest to remain in the labor force. Method: This article, the first in a series of five, provides an overview of five states' approaches to comprehensive workforce development services for people with acquired disabilities in Kansas, Kentucky, Ohio, Minnesota, and Vermont. Results: Return-to-work and stay-at-work services were most effective when delivered in collaboration with health care systems, state-level workforce development entities, and employers. Implications: Implications for state-level and national-level return-to-work and stay-at-work policies are discussed. Conclusion: The U.S. Department of Labor's investment in five large-scale workforce development initiatives built considerable infrastructure in those states toward the ultimate end of increasing the number of workers with disabilities in the national labor force.

Background The COVID-19 pandemic and the Black Lives Matter movement revealed American society's unconscious bias and systemic discrimination against Black/African Americans and other minority groups, including people with disabilities. These disparities are particularly pronounced for individuals with intersecting identities, such as race, gender, disability, and poverty, leading to racism and ableism. Method This case-control study investigated racial disparities in acceptance rates for state vocational rehabilitation (VR) services among applicants with schizophrenia. Utilizing the U.S. Department of Education Rehabilitation Services Administration (RSA-911) dataset for the program year 2018, we compared acceptance rates between Black/African American and White American VR applicants with schizophrenia. Propensity score matching (PSM) was performed to create a White applicant with schizophrenia (control, n = 2,971) group and a black applicant with schizophrenia (treatment, n = 2,971) group with similar demographic characteristics to control selection bias. Results Our findings indicated no significant difference in VR acceptance rates between the two groups: 73.7% for Black/African Americans with schizophrenia and 72.4% for White Americans with schizophrenia. Conclusions This outcome contrasts with previous studies that suggest racial bias still exist in state VR services. Our findings may indicate that, when selection bias is controlled, acceptance rates for VR services between White Americans and Black/African Americans with disabilities may be comparable. This study contributes to the ongoing dialogue on racial equity in disability services, and it presents an alternative research method for conducting racial difference studies in VR.

Background: The purpose of this study was to increase the body of knowledge regarding the workplace discrimination experiences of individuals with disabilities residing in the New England and Northeastern regions (NENR) of the United States by exploring their allegations filed under Title I of the Americans with Disabilities Act (ADA) across the universe of data from 1992 through 2016. Objective: Describe region-and state-level patterns in workplace discrimination and provide valuable information to stakeholders to better understand and address the issues within their respective areas of practice. Methods: Using population-level data from the Equal Employment Opportunity Commission's Integrated Mission System database, we analyzed every closed employment discrimination allegation filed under Title I of the ADA from January 26, 1992, through December 31, 2016. Descriptive statistics were obtained for each state within the NENR, with comparisons made on national and regional scales. Findings: The study presents state-level data across variables such as allegation type, charging party disability type, alternative prong allegations, and merit status of investigation outcomes. The results are organized into tables for ease of comparison, and suggested discussion questions for future exploration are provided. Conclusion: This study reveals notable variation in ADA Title I discrimination allegations across Northeastern states, highlighting the role of state-level factors in shaping workplace experiences. Findings offer actionable insights for policymakers, advocates, and service providers seeking to advance workplace inclusion and equity for individuals with disabilities across the region.

BACKGROUND: People with advanced cancer constitute an emerging vocational rehabilitation (VR) consumer population. OBJECTIVE: Following an overview of the nature and needs of Americans who have advanced forms of cancer, the authors present strategies to meet the service and support needs of these individuals across the phases of the VR process. METHODS: The authors present the sequential stages of the VR process, including implications for working with advanced cancer survivors during each stage. RESULTS: The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to self-care and symptom management regimens is emphasized throughout the article. CONCLUSION: Growing numbers of people worldwide are surviving advanced cancers for longer periods of time than ever before, which makes them an emerging disability population and rehabilitation clientele.

People with multiple sclerosis (MS) often have to cope with high levels of stress. Lazarus and Folkman’s (1984) stress–appraisal–coping theory emphasizes the relationship between the individual and the environment, suggesting that a stress response is highly influenced by individual appraisal processes. This study aimed to evaluate constructs of Lazarus and Folkman’s stress–appraisal–coping theory and positive human traits as predictors of perceived stress in a sample of 477 adults with MS. Hierarchical regression analysis was used to determine the incremental variance in perceived stress accounted for by demographic covariates, functional disabilities, challenge appraisal, and positive human traits. Core self-evaluations, challenge appraisal, limitations in social/cognitive functioning, agency hope, and age were significant predictors in the final model, accounting for 68% of the variance in perceived stress scores (R2= .68,f2= 2.13; large effect size). Core self-evaluations and challenge appraisal were the strongest predictors of perceived stress. The findings from this study will help rehabilitation professionals develop empirically supported stress management and well-being interventions, enabling people with MS to cope effectively with stressors and challenges and improve their health and well-being.

BACKGROUND: In order to overcome obstacles to entry and inclusion in the workplace, individuals with disabilities engage in various impression management strategies to present themselves as the socially acceptable ‘ideal employee.’ OBJECTIVE: This study expands on previous disclosure research by asking individuals with disabilities to share their experiences of identity management and workplace challenges. METHODS: We leveraged qualitative research techniques to explore the reciprocal impact of workplace treatment and disclosure. RESULTS: Impression management emerged as an especially salient aspect of participants’ disclosure decisions, and participants used an array of impression management tactics. Some employees with disabilities described positive experiences; however, we also learned that impression management can present unique challenges that may outweigh potential benefits. CONCLUSION: Our findings affirm that managing the image we project can be remarkably complicated and effortful when having a disability. This paper concludes with implementation recommendations for vocational rehabilitation counselors and human resource practitioners.

The rehabilitation counseling profession, as an essential career, has been facing unforeseen and unprecedented complications as a result of the coronavirus-19 pandemic. As practitioners were required to begin completing their work virtually or using telehealth modalities, it became apparent that may be gaps in preparation for such a shift. It is as yet unknown what implication these changes have on employment rates of people with disabilities, in addition to other markers for independence (e.g., independent living). Implications of the sudden shift to virtual practice are especially of interest following the changes to the comprehensive system of personnel development legislated by the Workforce Innovation and Opportunity Act reauthorization of 2014. Decreased educational requirements may lead vocational rehabilitation (VR) employees to navigate a national crisis without the essential knowledge domains required for qualified provider status. The current study asked VR personnel to indicate their comfort and preparedness in various areas, in light of the pandemic and virtual service provision ( N = 88). Items were assessed at three levels: Counselor, Agency, and Client. Taken together, the results indicate that the sample feels able to maintain evidence-based services, and that supervisors have been regularly available during this uncertain time. Implications for rehabilitation researchers, supervisors, and educators are discussed.

BACKGROUND: Workers with learning disabilities (LD) report many barriers to employment, including discrimination on the part of employers. OBJECTIVE: To compare the workplace discrimination experiences of workers with LD to those of people with other disabilities. METHOD: The comparison of the two groups, people with LD and people with other disabilities, concerned three factors: Characteristics of Charging Parties, prominent issues involving the nature of the discrimination allegation, and the outcomes of EEOC investigations at the time of case closure. An ex post facto, causal-comparative quantitative design was used to examine allegations closed following the ADA Amendments Act of 2008 (ADAA). RESULTS: Results revealed statistically significant differences in characteristics of the Charging Parties in the two groups. The LD group was significantly younger, more Caucasian, and more male than general population disabilities (GENDIS). The LD group was less African American, Latina/o, or Asian than GENDIS. Regarding the nature of allegations, the substance of allegations made by the LD group was more likely to involve matters of disability harassment, discipline, hiring, constructive discharge, training, and promotion. The LD group was less likely to file allegations involving reasonable accommodation, assignment, and layoff. CONCLUSION: Workers with learning disabilities experience high rates of employment discrimination, and the types of discrimination they experience are different than those experienced by people with other disabilities.

BACKGROUND: Research has long documented the low cost and effectiveness of most workplace accommodations to enable qualified people with disabilities to seek, secure, and maintain employment. OBJECTIVE AND METHOD: RETAIN Kentucky's return to work and stay at work intervention involves focused training for participants on requesting needed accommodations from their employers. RESULTS: In this article, we describe the win-win approach to reasonable accommodations, which serves as the basis for helping Kentuckians with disabilities identify and request on-the-job supports to aid in their efforts to remain in theworkforce. CONCLUSIONS: Workers with disabilities are more likely to stay in the workforce and continue making valuable contributions to the national and global economies if they have effective accommodations and other employment supports available to them.

BACKGROUND: Helping young adults with specific learning disabilities (SLD) attend college increases their chances of joining the workforce, which helps protect them from the negative effects of unemployment. OBJECTIVE: This study examined whether receiving vocational rehabilitation (VR) services of four-year college or university training would lead to improved employment outcomes for young adults with SLD. METHODS: Using the Rehabilitation Services Administration (RSA)-911 database, a propensity score matching technique was employed to create a comparison group of young adults with SLD who did not receive college or university training for a treatment group of those who did. The quasi-experimental design investigated differences in the employment outcomes between the two groups. RESULTS: Findings revealed that the group who received college or university training was more likely to obtain competitive employment upon exit from the VR program than the matched comparison group who did not receive the training; youth with SLD who received college or university training and had secured competitive employment at the time of exit also had significantly higher hourly wages and weekly working hours than their counterparts in the comparison group. CONCLUSION: College and university training is positively related to employment outcomes for young people with SLD. Implications for state VR counselors are also discussed.