Acceptance rates in state-federal vocational rehabilitation of clients with brain injury: Is racial disparity an issue?

Risk factors for failure to enter vocational rehabilitation services among individuals with disabilities

PURPOSE

To investigate the risk factors for failure of individuals with disabilities to enter the vocational rehabilitation (VR) programme, including the cases where they had been formally accepted but were yet to receive any service.

METHODS

We used prospective cohort data from a Midwestern US state, and analysed 126,251 and 94,517 individuals, respectively, for acceptance and admission into VR services. Statistical analysis was conducted using Poisson regression models with robust variance estimator.

RESULTS

Individuals with blind/visual disability, had prior history of employment, and who received public support tended to have lower risks of non-acceptance and non-admission. Being non-White, at higher education, ever/currently married, and with physical/orthopaedic disability appeared to increase the risks of both outcomes. The adjusted relative risk of non-acceptance was 0.58 (95% confidence interval: 0.52, 0.64) if the individuals had 4 or more functional limitations as compared with those with fewer limitations. This factor was not significant for VR admission.

CONCLUSION

Disability factors, demographic determinants, and certain miscellaneous characteristics were associated with the risks of non-acceptance and non-admission into VR. Implications for Rehabilitation Individuals with disabilities are more likely to be unemployed than the population without disabilities, and they are thus more prone to adverse health effects of unemployment. Vocational rehabilitation (VR) is a proven intervention to improve employment outcomes among individuals with disabilities. Our study indicates that the complexity of the selection process for entering VR and various factors beyond disability may prevent individuals to benefit from the VR programme. Rehabilitation programme authorities need to monitor and simplify the selection process into VR services and, together with rehabilitation practitioners, promote a selection process that pays careful attention on the factors that are related to individual risk of failure for entering VR.

An examination of Maori tamariki (child) and taiohi (adolescent) traumatic brain injury within a global cultural context

OBJECTIVE

This paper provides a pragmatic review of the literature to describe the size and shape of Māori tamariki (child) and taiohi (adolescent) traumatic brain injury (TBI) and highlight issues pertinent to psychiatrists. A review of the literature describing cultural aspects of international TBI research further contextualises these findings.

METHODOLOGY

Literature searches using the words indigenous, ethnic, culture, native, native American, native Alaskan, native Hawaiian, Māori, aboriginal, traumatic brain injury, rehabilitation, paediatric, disparities and epidemiology were undertaken. Reference lists were also examined.

RESULTS

The literature is adult-centric and selected papers are summarised. Significant gaps in the literature were found. Recent local epidemiological studies describe Māori tamariki and taiohi as being significantly over-represented in TBI populations, with poorer outcomes including higher mortality rates. International research shows evidence of 'minority' culture being a risk factor for certain causes of injury and a differential rehabilitation service response.

CONCLUSIONS

These findings are important for psychiatrists working with Māori. They underscore the importance of asking effectively about possible TBI history. Implications for future research to address literature gaps are evident. Kaupapa Māori rangahau (research) could be used to explore application of tikanga Māori (cultural lore) in prevention, rehabilitation and psychiatric management.