The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision

Purpose

Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined.

Patients and Methods

A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem.

Results

Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI.

Conclusion

To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.

What Predicts Job Quality of Vocational Rehabilitation Consumers Who Are Blind or Have Low Vision?

The Workforce Innovation and Opportunity Act emphasizes promoting high-quality, competitive employment for people served by vocational rehabilitation (VR), but few studies have assessed VR consumers’ job quality. The purpose of this study was to investigate job quality and factors that predict the job quality of VR consumers with blindness or low vision (B/LV), taking into consideration their employment status at application. We utilized RSA-911 data of VR consumers with B/LV who were closed in competitive employment during 2015, creating two separate hierarchical linear models to predict job quality for VR consumers (a) who were employed at application and (b) who were not employed at application. We investigated individual-level (consumer personal characteristics and VR services) and state/agency-level predictors. Job quality and some predictors of job quality differed by employment status at application, although the strongest predictors (education level at application, gender, benefit receipt at application, receipt of a bachelor’s or higher degree) were consistent across the models. While several additional individual-level variables were significantly associated with job quality, their effect sizes were very small. With the exception of advancing education to a bachelor’s degree or higher while receiving services, consumer characteristics at application were the primary determinants of their job quality.

Factors Related to Employment Outcomes for Vocational Rehabilitation Consumers with Visual Impairments: A Systematic Review

Introduction:

The purpose of this article was to conduct a systematic review of peer-reviewed studies on factors related to employment in consumers who are visually impaired using Rehabilitation Services Administration (RSA-911) Case Service Report data.

Methods:

We used database, hand, and ancestral search strategies to systematically identify peer-reviewed studies published between 1990 and August 2018 where researchers used RSA-911 data to address the target question. All included articles were coded by two reviewers for study and participant characteristics, quality indicators, and outcomes.

Results:

Nine articles consisting of 14 analyses were included. Twelve analyses concerned employment outcomes; two concerned earnings. Researchers in most studies used large samples of 3,000 or more consumers and used multivariable analyses, most commonly multilevel logistic regression. Factors that consistently predicted lower employment across studies included presence of a secondary disability and legal blindness; higher education level consistently predicted higher employment, as did earnings and self-support at vocational rehabilitation application. Few analyses included state- or agency-level variables or specific vocational rehabilitation services.

Discussion:

These results indicate that certain groups of vocational rehabilitation consumers with visual impairments may be at greater risk of unsuccessful closures; researchers should examine specific strategies that may improve outcomes in these groups. These results also highlight the importance of education in securing employment among people with visual impairments. Researchers should examine state- and agency-level variables that may affect outcomes as well as the effects of specific services on outcomes. Additionally, researchers should analyze factors that may affect employment quality as well as employment outcomes.

Implications for practitioners:

Practitioners who are working with visually impaired people who do not have a postsecondary degree should encourage and assist their clients in obtaining one; practitioners may also wish to provide more targeted support for consumers from potentially high-risk subpopulations.

A Systematic Review of Factors Related to Employment Outcomes for Adults with Visual Impairments

Introduction:

The purpose of this study was to conduct a systematic review of survey-based research on predictors or correlates of employment outcomes for individuals with visual impairments (i.e., those who are blind or have low vision).

Methods:

We used a three-pronged systematic search process to identify quantitative, English, peer-reviewed articles published from 1990 to August 2018 that included analyses of factors related to employment in American adults with visual impairments. We coded all included articles for sample parameters, participant characteristics, quality indicators (QIs), and study outcomes.

Results:

Thirteen articles were included in the review. The majority of studies met few, if any, QIs. Education level, braille reading medium, and attending integrated or public schools were significantly associated with employment outcomes in most analyses in which those variables were included. Other demographic and disability-related variables were generally not associated with employment or yielded inconsistent results across studies. Psychosocial, service, and miscellaneous variables were included less frequently and were generally not associated with employment or yielded mixed results, with a few exceptions.

Discussion:

Based on our quality indicator ratings, there were consistent methodological weaknesses in this body of literature. Small samples ( N = 200 or fewer) were prevalent across studies, which limits both generalizability and statistical power. Use of nonrepresentative and nonnational samples further limits generalizability of the results, and a lack of longitudinal studies hinders our ability to draw causal inferences. More high-quality employment research is needed, particularly in the areas of braille, transportation self-efficacy, and other psychosocial factors.

Implications for practitioners:

Despite the methodological issues identified in the included studies, results support findings from other systematic reviews regarding the importance of educational advancement for individuals with visual impairments. Practitioners should encourage individuals with visual impairments who do not have college degrees to explore options for postsecondary education.