Experiences of participating in a vocational rehabilitation program in Singapore

PURPOSE

The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process.

MATERIALS AND METHODS

This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively.

RESULTS

Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants' experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants.

CONCLUSION

The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants' return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work.Implications for rehabilitationMulti- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients.VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work processVR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goalsVR service providers should address concurrent or future concerns that could impact on their clients' ability to return to or remain at work.

Participant Engagement in Supported Employment: A Systematic Scoping Review

Purpose This study aimed to synthesise the available knowledge on how participant engagement in supported employment (SE) interventions is presented, defined, and conceptualised. We also aimed to develop a working definition of participant engagement in SE based on the results of our study. Methods This systematic scoping review was conducted following the PRISMA extension for scoping reviews. The following databases were systematically searched: EBSCO, SCOPUS, Social Care Online, and JSTOR. We included peer-reviewed publications in English based on empirical studies. Results Sixteen articles met the inclusion criteria and were included in the final analysis. Thematic framework analysis resulted in three themes conveying the concept of participant engagement: self-determined choice, empowerment, and collaboration/working alliance. We suggest that participant engagement in SE is an active multifaceted process that involves the empowerment of participants, participants' exercise of self-determined informed choice, and their collaboration with SE practitioners in a working alliance. Conclusions Participant empowerment, self-determined choice, and collaboration are important aspects of participant engagement in SE. The study results will appeal to SE practitioners and make significant contributions to the broader field of other vocational services supporting people in (re-)entering the competitive labour market.

Persons With Disabilities in Self-Employment Served by the Federal/State Vocational Rehabilitation System: Differences Between 2011–2013 and 2017–2019

Persons with disabilities (PWDs) are disproportionately unemployed, underpaid, and underemployed despite their desire and capacity to work. The U.S. federal/state vocational rehabilitation (VR) program, under the supervision of the Rehabilitation Services Administration (RSA), is charged with providing services to assist eligible PWDs (VR consumers) in achieving employment. Despite research showing that VR consumers closed to self-employment (vs. non-self-employment closures) have better outcomes, self-employment is often considered as a last resort. Moreover, some evidence suggests self-employment (like non-self-employment) outcomes are associated with VR consumers’ gender and racial/ethnic identity. The objective of this study was to determine trends of case closures in self-employment among PWDs within the VR program from 2011–2013 to 2017–2019 and to examine the effects of gender and race/ethnicity on self-employment outcomes. Variables of interest were obtained from RSA’s Case Service Report (RSA-911) data set for 2011, 2012, 2013, 2017, 2018, and 2019. Data were recoded and analyzed. The number of closures in self-employment declined significantly. Weekly earnings in self-employment increased. Time from application to closure in self-employment decreased. Differences in VR self-employment outcomes by race/ethnicity and gender were noted. Efforts should be made to increase competency in self-employment of VR counselors and promote self-employment within the VR program.

The tripartite efficacy beliefs model in vocational rehabilitation: Implications for working alliance and client engagement

BACKGROUND: Given the importance of working alliance to client engagement and outcomes in vocational rehabilitation, there is a need to better understand predictors of the client counselor relationship. Research has shown the tripartite efficacy model as a way of understanding working alliance in various contexts but has never been examined in vocational rehabilitation. OBJECTIVE: This study evaluates the relationship among tripartite efficacy beliefs constructs (self-efficacy, other-efficacy, and relation-inferred self-efficacy [RISE]), working alliance, and engagement for 350 clients receiving state vocational rehabilitation services. METHODS: Researchers used a path analysis to assess the hypothesis that the tripartite efficacy model would predict client engagement through its impact on working alliance. RESULTS: The hypothesized model had a close fit. Other-efficacy and RISE beliefs had significant positive direct effects on working alliance and indirect effects on client engagement. Self-efficacy had a significant negative direct effect on working alliance and client engagement. CONCLUSIONS: The study supports the tripartite efficacy beliefs model as a way of better understanding client perceptions of working alliance in vocational rehabilitation.

An instrument to measure perceptions of people with disabilities regarding the application of international vocational rehabilitation standards

This study aimed to create a valid and reliable instrument to measure people with disabilities' perceptions regarding the extent of application of international standards issued by the Council of Europe, International Labour Organization, and the International Classification of Functioning, Disability and Health in vocational rehabilitation centers in the Basque country, Spain. The instrument items were selected from international recommendations and conventions issued by the International Labour Organization, Council of Europe, International Classification of Functioning, Disability and Health, and a vocational rehabilitation literature review. The instrument was translated from English to Spanish, and the content validity index of an expert panel survey was used to assess content validity. For the Spanish version of the instrument, internal consistency reliability, confirmatory factor analysis and factor analysis were examined with 186 people with disabilities in 10 vocational rehabilitation centers in the Basque country. The coefficient alpha estimate was 0.945, indicating excellent internal consistency. Three factors were identified: job-related services, aims of vocational rehabilitation center, and vocational rehabilitation guidance. The instrument appears to have good validity and reliability but requires further validation. Support is provided for its use in both English and Spanish. Implications for vocational rehabilitation practice and suggestions for future research are provided.

Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

Personal and Contextual Factors Associated With Successful Vocational Rehabilitation and Employment Outcomes

Some individuals with disabilities have relatively better labor outcomes than others. If vocational rehabilitation (VR) counselors can better understand what factors are correlated with positive outcomes, they could better identify what clients are at risk for poor outcomes and then intervene early to improve chances for success. Unfortunately, until recently VR survey and administrative data have had insufficient information to investigate these questions. We use a survey of 932 Ohio VR clients combined with administrative earnings data to examine the barriers and facilitators associated with employment and earnings outcomes. The survey data are from the 2014 Survey of Disability and Employment, a survey of VR applicants in three states. We compare VR case status and earnings through 2016, by demographics, functional limitation status, employment history and attitudes, and reasons stated for not working in the survey. We find that about 25% of survey respondents exited the program employed or had at least one quarter of average monthly earnings above the Social Security Administration’s substantial gainful activity amount. Pain, depression or anxiety, longer duration of job separation, personal and familial attitudes about work, and not working because of personal and health reasons were associated with poorer outcomes among survey respondents.