Accepted Manuscript Title: Vocational Rehabilitation Service Patterns and Employment Outcomes of People with Epilepsy Author: Connie Sung Veronica Muller Jana E. Jones Fong Chan PII: DOI: Reference:
S0920-1211(14)00174-0 http://dx.doi.org/doi:10.1016/j.eplepsyres.2014.06.016 EPIRES 5178
To appear in:
Epilepsy Research
Received date: Revised date: Accepted date:
1-2-2014 19-5-2014 13-6-2014
Please cite this article as: Sung, C., Muller, V., Jones, J.E., Chan, F.,Vocational Rehabilitation Service Patterns and Employment Outcomes of People with Epilepsy, Epilepsy Research (2014), http://dx.doi.org/10.1016/j.eplepsyres.2014.06.016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Sung 1 Running head: VR SERVICES AND OUTCOME IN EPILEPSY
Vocational Rehabilitation Service Patterns and Employment Outcomes of
cr
ip t
People with Epilepsy
2
Hunter College, City University of New York
University of Wisconsin School of Medicine & Public Health University of Wisconsin-Madison
Ac ce
pt
ed
4
M
3
Michigan State University
an
1
us
Connie Sung1, Veronica Muller2, Jana E. Jones3, Fong Chan4
Corresponding Author: Connie Sung, Ph.D. Department of Counseling, Educational Psychology and Special Education Michigan State University 620 Farm Lane, Room 460 East Lansing, MI 48824 Phone: 517-353-1638 Fax: 517-353-6393 Email: [email protected]
Page 1 of 21
Sung 2 SUMMARY
This study aimed to examine the association between vocational rehabilitation (VR) services and
ip t
employment outcomes of people with epilepsy (PWE), after controlling for demographic covariates. Data was retrieved from the Rehabilitation Services Administration Case Service
cr
Report (RSA-911) database for fiscal year (FY) 2011. Multivariate logistic regression was used to predict employment outcomes of PWE. Of the 2,030 previously unemployed PWE who
us
received services, 884 (43.5%) achieved successful competitive employment. Results indicate
an
that higher education level and cost of VR services consumed were positively related to successful employment. In contrast, having co-occurring anxiety/depression, receiving cash
M
benefits, or increasing time spent in the VR system were negatively associated with employment. Eight specific VR services (e.g., education, vocational training, and job search and placement
ed
assistance) were also found to be significant predictors of employment. Services provided by state VR agencies were proven to be beneficial in improving employment outcomes. PWE
pt
should be encouraged to pursue VR services to increase the chances of attaining employment.
Ac ce
Health care providers should also become familiar with the array of VR services.
Key Words: Epilepsy; vocational rehabilitation; employment outcomes
Page 2 of 21
Sung 3 Vocational Rehabilitation Service Patterns and Employment Outcomes of People with Epilepsy INTRODUCTION
ip t
Employment is fundamental for the physical health, psychological well-being, and quality of life of people with and without disabilities, including people with epilepsy (PWE) (de
cr
Boer, 2005; Dutta et al., 2008). As the fourth most common neurological disorder, epilepsy
us
affects nearly 2.2 million people in the United States, and more than 65 million people worldwide (Bishop & Chiu, 2011; Institute of Medicine, 2012). While most PWE want to and are
an
able to work, employment is rather a “revolving door” for them, due to seizure-related issues (Smeets et al., 2007). Despite numerous employment-related services PWE can access, their
M
employment rate is considerably low and has not changed substantially during the last three decades (Bishop & Chiu, 2011; Smeets et al., 2007), and most experience difficulties in
ed
obtaining and maintaining competitive employment (Bishop, 2004; Collings & Chappell, 1994). With the unemployment rate of PWE at least two times greater than that of the general
pt
population, as well as higher than those with other disabilities (Carroll, 1992; Chaplin, 2005;
Ac ce
Clarke et al., 2006; Theodore et al., 2006). PWE are generally underemployed, and receive lower earnings (Bishop & Chiu, 2011; Fisher & Schachter, 2000; Smeets et al., 2007), which in turn can lead to depression, anxiety, substance abuse, low self-esteem, and poor quality of life (Dutta et al., 2008). In addition, the annual national costs associated with epilepsy are estimated to be between $11.1 and $12.5 billion (Bishop et al., 2000; Engel & Pedley, 1997). There is no single factor (e.g., seizure severity) that contributes to employment barriers faced by PWE (Clarke et al., 2006; Smeets et al., 2007); rather they are the result of a set of personal, functional, financial, psychosocial, and environmental factors and their complex
Page 3 of 21
Sung 4 interactions (Thorbecke & Fraser, 1997). The literature indicates that the employment challenges for PWE, such as age, education, cognitive impairment, and early onset of the disorder, though under explored, have consistently been associated with lower employment rates (Hauser &
ip t
Hesdorffer, 1990; Yagi, 1998). Other contributing factors include socioeconomic status (Bautista & Wludyka, 2007), attitudes and beliefs of employers (Bishop, 2002); job types and working
cr
conditions, workplace discrimination (Hawley, Roessler, & McMahon, 2012), and disability-
us
related benefits. Despite the psychosocial benefits of working, VR services that address many of these aspects are not typically included in medical rehabilitation programs for people with
an
chronic illness and disability (Hauser & Hesdorffer, 1990). In addition, research on identifying effective vocational interventions and service delivery models that facilitate work for PWE,
M
increase job retention, and promote employment outcomes have received relatively less attention than those focused on identifying barriers to employment. Nevertheless, a multidisciplinary
ed
approach, vocational assessment, and rehabilitation have been identified as critical in helping to ease their work participation (Tate et al., 2005).
pt
The state-federal VR program has played a critical role in helping PWD find and secure
Ac ce
employment, and allocates more than US$2.5 billion dollars annually to fund VR agencies across the states (U.S. Government Accountability Office, 2005). It aims to provide services, ranging from assessment and diagnosis to job training and placement (Parker & Patterson, 2012), to people whose impairments or disabilities have hindered their ability to seek, obtain, or retain competitive employment, and/or these services (see Table 1). The VR program has been effective in achieving its primary objective, with the overall employment rate for people with disabilities (PWD), after receiving VR services, to be around 50-60% (Bolton et al., 2000). According to the Rehabilitation Services Administration’s (RSA) Case Service Report (RSA-911) database, a total
Page 4 of 21
Sung 5 of 322,968 cases were closed as either successfully rehabilitated, with 55.5% placed in competitive employment, or unsuccessfully rehabilitated, with 45.5% not able to find competitive employment after receiving VR services. Despite research findings highlighting the
ip t
potential benefits and need for VR services, the employment level of PWE (43.5%) was lower when compared to other developmental disability groups in the fiscal year (FY) 2011. However,
cr
the associations between each vocational intervention and the employment outcomes of PWE are
us
not well understood. _______________________ Insert Table 1 About Here
an
_______________________
The purpose of this study was to examine the effect of demographic variables and VR
M
services on employment outcomes for PWE who received services from the state-federal VR program using a large national dataset. Data was retrieved from the U.S. Department of
ed
Education’s RSA-911database, which contains demographic data on all individuals who receive services from state VR agencies in the United States. A multifactorial approach to evaluate how
pt
demographic variables and specific VR services affect employment outcome can further hone
Ac ce
existing interventions as well as develop new ones that are effective for this population (Hauser & Hesdorffer, 1990; Mount et al., 2005). The specific questions addressed were: 1. How do demographic variables and the provision of cash or medical benefits affect the employment outcomes of PWE after receiving VR services? 2. Which vocational rehabilitation services are directly related to employment outcomes of PWE who received services from state VR agencies?
Page 5 of 21
Sung 6 METHODS Participants Data were extracted from the archival database provided annually to RSA by state VR
ip t
agencies across the country. The dataset (RSA-911 FY 2011 data) released by RSA at the time of this study were used for the analyses. In FY2011, there were data for 2,030 previously
cr
unemployed PWE whose cases were closed as either successfully rehabilitated, with 43.5% were
us
placed in competitive employment, or unsuccessfully rehabilitated, with 56.5% not able to find competitive employment after receiving VR services. The demographic characteristics and the
an
case service information are presented in Table 2.
_______________________ Insert Table 2 About Here
M
_______________________ Study Design and Method
ed
The dependent variable was competitive employment. The RSA-911 manual defines competitive employment as employment in an integrated setting, self-employment, or
pt
employment in a state-managed Business Enterprise Program (BEP) that is performed on a full-
Ac ce
time or part-time basis, and compensated at or above the minimum wage. Unsuccessful outcome refers to clients who were not working after completing their VR program. Three sets of predictor variables were used: demographic characteristics, work disincentives, and VR services. The first set of predictor variables included gender, age at application, race/ethnicity education level, co-occurring psychiatric conditions and cognitive impairments, duration and costs of services. The second set of predictor variables included receipt of government, medical, or cash benefits. The third set of predictor variables included each of the types of VR services (see Table 1 for description).
Page 6 of 21
Sung 7 Data Analyses Data were analyzed using SPSS 22.0. Hierarchical logistic regression analysis was performed to examine the effect of demographic covariates, work disincentives, and VR service
ip t
patterns on employment outcomes (employed/unemployed) of PWE. RESULTS
cr
Descriptive Statistics
us
After receiving VR services, a total of 884 clients (43.5%) were competitively employed. Refer to Table 2 for demographic characteristics and case service information. There were no
an
significant age or gender differences between the employed and unemployed groups (p>0.05). In terms of race/ethnicity, the ratio of European American clients in the employed group at closure
M
was higher than that in the unemployed group (χ2(1, N=2030)=19.46, p
S0920-1211(14)00174-0 http://dx.doi.org/doi:10.1016/j.eplepsyres.2014.06.016 EPIRES 5178
To appear in:
Epilepsy Research
Received date: Revised date: Accepted date:
1-2-2014 19-5-2014 13-6-2014
Please cite this article as: Sung, C., Muller, V., Jones, J.E., Chan, F.,Vocational Rehabilitation Service Patterns and Employment Outcomes of People with Epilepsy, Epilepsy Research (2014), http://dx.doi.org/10.1016/j.eplepsyres.2014.06.016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Sung 1 Running head: VR SERVICES AND OUTCOME IN EPILEPSY
Vocational Rehabilitation Service Patterns and Employment Outcomes of
cr
ip t
People with Epilepsy
2
Hunter College, City University of New York
University of Wisconsin School of Medicine & Public Health University of Wisconsin-Madison
Ac ce
pt
ed
4
M
3
Michigan State University
an
1
us
Connie Sung1, Veronica Muller2, Jana E. Jones3, Fong Chan4
Corresponding Author: Connie Sung, Ph.D. Department of Counseling, Educational Psychology and Special Education Michigan State University 620 Farm Lane, Room 460 East Lansing, MI 48824 Phone: 517-353-1638 Fax: 517-353-6393 Email: [email protected]
Page 1 of 21
Sung 2 SUMMARY
This study aimed to examine the association between vocational rehabilitation (VR) services and
ip t
employment outcomes of people with epilepsy (PWE), after controlling for demographic covariates. Data was retrieved from the Rehabilitation Services Administration Case Service
cr
Report (RSA-911) database for fiscal year (FY) 2011. Multivariate logistic regression was used to predict employment outcomes of PWE. Of the 2,030 previously unemployed PWE who
us
received services, 884 (43.5%) achieved successful competitive employment. Results indicate
an
that higher education level and cost of VR services consumed were positively related to successful employment. In contrast, having co-occurring anxiety/depression, receiving cash
M
benefits, or increasing time spent in the VR system were negatively associated with employment. Eight specific VR services (e.g., education, vocational training, and job search and placement
ed
assistance) were also found to be significant predictors of employment. Services provided by state VR agencies were proven to be beneficial in improving employment outcomes. PWE
pt
should be encouraged to pursue VR services to increase the chances of attaining employment.
Ac ce
Health care providers should also become familiar with the array of VR services.
Key Words: Epilepsy; vocational rehabilitation; employment outcomes
Page 2 of 21
Sung 3 Vocational Rehabilitation Service Patterns and Employment Outcomes of People with Epilepsy INTRODUCTION
ip t
Employment is fundamental for the physical health, psychological well-being, and quality of life of people with and without disabilities, including people with epilepsy (PWE) (de
cr
Boer, 2005; Dutta et al., 2008). As the fourth most common neurological disorder, epilepsy
us
affects nearly 2.2 million people in the United States, and more than 65 million people worldwide (Bishop & Chiu, 2011; Institute of Medicine, 2012). While most PWE want to and are
an
able to work, employment is rather a “revolving door” for them, due to seizure-related issues (Smeets et al., 2007). Despite numerous employment-related services PWE can access, their
M
employment rate is considerably low and has not changed substantially during the last three decades (Bishop & Chiu, 2011; Smeets et al., 2007), and most experience difficulties in
ed
obtaining and maintaining competitive employment (Bishop, 2004; Collings & Chappell, 1994). With the unemployment rate of PWE at least two times greater than that of the general
pt
population, as well as higher than those with other disabilities (Carroll, 1992; Chaplin, 2005;
Ac ce
Clarke et al., 2006; Theodore et al., 2006). PWE are generally underemployed, and receive lower earnings (Bishop & Chiu, 2011; Fisher & Schachter, 2000; Smeets et al., 2007), which in turn can lead to depression, anxiety, substance abuse, low self-esteem, and poor quality of life (Dutta et al., 2008). In addition, the annual national costs associated with epilepsy are estimated to be between $11.1 and $12.5 billion (Bishop et al., 2000; Engel & Pedley, 1997). There is no single factor (e.g., seizure severity) that contributes to employment barriers faced by PWE (Clarke et al., 2006; Smeets et al., 2007); rather they are the result of a set of personal, functional, financial, psychosocial, and environmental factors and their complex
Page 3 of 21
Sung 4 interactions (Thorbecke & Fraser, 1997). The literature indicates that the employment challenges for PWE, such as age, education, cognitive impairment, and early onset of the disorder, though under explored, have consistently been associated with lower employment rates (Hauser &
ip t
Hesdorffer, 1990; Yagi, 1998). Other contributing factors include socioeconomic status (Bautista & Wludyka, 2007), attitudes and beliefs of employers (Bishop, 2002); job types and working
cr
conditions, workplace discrimination (Hawley, Roessler, & McMahon, 2012), and disability-
us
related benefits. Despite the psychosocial benefits of working, VR services that address many of these aspects are not typically included in medical rehabilitation programs for people with
an
chronic illness and disability (Hauser & Hesdorffer, 1990). In addition, research on identifying effective vocational interventions and service delivery models that facilitate work for PWE,
M
increase job retention, and promote employment outcomes have received relatively less attention than those focused on identifying barriers to employment. Nevertheless, a multidisciplinary
ed
approach, vocational assessment, and rehabilitation have been identified as critical in helping to ease their work participation (Tate et al., 2005).
pt
The state-federal VR program has played a critical role in helping PWD find and secure
Ac ce
employment, and allocates more than US$2.5 billion dollars annually to fund VR agencies across the states (U.S. Government Accountability Office, 2005). It aims to provide services, ranging from assessment and diagnosis to job training and placement (Parker & Patterson, 2012), to people whose impairments or disabilities have hindered their ability to seek, obtain, or retain competitive employment, and/or these services (see Table 1). The VR program has been effective in achieving its primary objective, with the overall employment rate for people with disabilities (PWD), after receiving VR services, to be around 50-60% (Bolton et al., 2000). According to the Rehabilitation Services Administration’s (RSA) Case Service Report (RSA-911) database, a total
Page 4 of 21
Sung 5 of 322,968 cases were closed as either successfully rehabilitated, with 55.5% placed in competitive employment, or unsuccessfully rehabilitated, with 45.5% not able to find competitive employment after receiving VR services. Despite research findings highlighting the
ip t
potential benefits and need for VR services, the employment level of PWE (43.5%) was lower when compared to other developmental disability groups in the fiscal year (FY) 2011. However,
cr
the associations between each vocational intervention and the employment outcomes of PWE are
us
not well understood. _______________________ Insert Table 1 About Here
an
_______________________
The purpose of this study was to examine the effect of demographic variables and VR
M
services on employment outcomes for PWE who received services from the state-federal VR program using a large national dataset. Data was retrieved from the U.S. Department of
ed
Education’s RSA-911database, which contains demographic data on all individuals who receive services from state VR agencies in the United States. A multifactorial approach to evaluate how
pt
demographic variables and specific VR services affect employment outcome can further hone
Ac ce
existing interventions as well as develop new ones that are effective for this population (Hauser & Hesdorffer, 1990; Mount et al., 2005). The specific questions addressed were: 1. How do demographic variables and the provision of cash or medical benefits affect the employment outcomes of PWE after receiving VR services? 2. Which vocational rehabilitation services are directly related to employment outcomes of PWE who received services from state VR agencies?
Page 5 of 21
Sung 6 METHODS Participants Data were extracted from the archival database provided annually to RSA by state VR
ip t
agencies across the country. The dataset (RSA-911 FY 2011 data) released by RSA at the time of this study were used for the analyses. In FY2011, there were data for 2,030 previously
cr
unemployed PWE whose cases were closed as either successfully rehabilitated, with 43.5% were
us
placed in competitive employment, or unsuccessfully rehabilitated, with 56.5% not able to find competitive employment after receiving VR services. The demographic characteristics and the
an
case service information are presented in Table 2.
_______________________ Insert Table 2 About Here
M
_______________________ Study Design and Method
ed
The dependent variable was competitive employment. The RSA-911 manual defines competitive employment as employment in an integrated setting, self-employment, or
pt
employment in a state-managed Business Enterprise Program (BEP) that is performed on a full-
Ac ce
time or part-time basis, and compensated at or above the minimum wage. Unsuccessful outcome refers to clients who were not working after completing their VR program. Three sets of predictor variables were used: demographic characteristics, work disincentives, and VR services. The first set of predictor variables included gender, age at application, race/ethnicity education level, co-occurring psychiatric conditions and cognitive impairments, duration and costs of services. The second set of predictor variables included receipt of government, medical, or cash benefits. The third set of predictor variables included each of the types of VR services (see Table 1 for description).
Page 6 of 21
Sung 7 Data Analyses Data were analyzed using SPSS 22.0. Hierarchical logistic regression analysis was performed to examine the effect of demographic covariates, work disincentives, and VR service
ip t
patterns on employment outcomes (employed/unemployed) of PWE. RESULTS
cr
Descriptive Statistics
us
After receiving VR services, a total of 884 clients (43.5%) were competitively employed. Refer to Table 2 for demographic characteristics and case service information. There were no
an
significant age or gender differences between the employed and unemployed groups (p>0.05). In terms of race/ethnicity, the ratio of European American clients in the employed group at closure
M
was higher than that in the unemployed group (χ2(1, N=2030)=19.46, p
