Background Supported Employment (SE) and Customized Employment (CE) are vocational rehabilitation services designed to support individuals with significant disabilities to achieve competitive integrated employment. Both services target individuals for whom employment has historically been difficult to obtain. but they differ in implementation. These differences may lead to varying employment outcomes, such as occupation types, wages, and hours worked. Objective This study analyzes FY17-FY21 RSA-911 data to compare the outcomes at exit for individuals receiving SE and CE vocational rehabilitation services. Methods Propensity score matching was used to create comparable SE and CE samples to (a) examine the prevalence of CE and SE services within vocational rehabilitation programs, (b) describe exit patterns among individuals receiving these services, and (c) identify differences in employment outcomes. Results A smaller proportion of individuals receiving CE exited into competitive integrated employment compared to those receiving SE. However, CE participants were more likely to enter self-employment and a broader range of occupations, indicating that CE may provide more personalized and flexible employment options. Conclusion This analysis highlights disparities in the use and outcomes of CE and SE services within state vocational rehabilitation programs.
Alister Munthali, Arne Eide, Stine H. Braathen
et al.
Background: Malawi, like other developing countries, is not prepared to adequately address the health needs of older persons.
Objectives: This article explores challenges older persons experience in accessing health care.
Method: This article is based on data from two large. Conducted in Blantyre, Phalombe, Dowa and Rumphi Districts, the EquitAble study examined self-reported barriers. The GeoHealthAccess study examined geographical barriers, conducted in Blantyre and Phalombe. A sub-sample of 338 (17%) older persons of the 1991 respondents in the EquitAble study is used in this article. Respondents were asked to identify factors that made it difficult for them to access health care. Sixty-six in-depth interviews and two focus group discussions with older persons were conducted to obtain in-depth information about barriers to accessing health care.
Results: Barriers experienced by older persons in accessing health care included being unable to pay to for services at fee paying health facilities; failure to pay for transportation; long distances to health centres; mountainous terrains; having severe rheumatism; living alone; poor attitudes of health workers; and shortage of staff, medicines and equipment.
Conclusion: To address these challenges, there is need to have adequate health workers with knowledge of diseases and conditions experienced by older persons and the introduction of outreach health services targeting them.
Contribution: Poverty at individual level and health system factors are major barriers to accessing health care by older persons. There is a need for the development and implementation of strategies to better improve access for older persons.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Background: Despite the transformation initiatives, the inclusion of people with disabilities in sports remains a challenge. Athletes with disabilities (AWDs) in low- and medium-socioeconomic countries are still being left behind, including in South Africa. They are facing various challenges.
Objectives: This study aimed to explore barriers and facilitators to sports participation and the needs of AWDs.
Method: This was a qualitative study design based on semi-structured interviews. Interviews were conducted with South African Paralympians. Permission was obtained from a physical disability association. Ethical clearance was issued by the University of the Witwatersrand Human Research Ethics Committee. An interview schedule with predetermined questions was used to guide the interviews. Interviews were held face-to-face or online from 20 min to 30 min per interview. All participants gave consent. The data were transcribed verbatim and analysed in themes deductively.
Results: A total of 23 athletes participated, 12 of which were females and 11 were males. Participants were mostly Africans (n = 23) with a mean age of 26 years. All had over 5 years of sporting experience. Barriers included: Social stigma, a lack of disability awareness, limited opportunities to participate in sports; limited access to resources and services. Facilitators included: health; belonging; fulfilment, winning, and support from loved ones.
Conclusion: Results showed a need to scale up disability inclusion, especially regarding the rendering of healthcare services and making resources available.
Contribution: This article provides knowledge that may be useful as a baseline for developing a suitable intervention for AWDs.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Lizahn Cloete, Zusange Shweni, Leah-Jade Finnucane
et al.
Background: Barriers to occupational therapy (OT) treatment in low- to middle-income countries (LMICs) are not well documented, posing challenges for ensuring treatment accessibility.
Objectives: This study focuses on at-risk children aged 0–17 years in LMICs, a vulnerable population facing unique and often overlooked barriers to accessing OT treatment. Given that low-income countries account for 85% of the world’s population, it is imperative to ensure that vulnerable children living in these regions receive adequate attention and resources to support their development and well-being.
Method: This study explored the barriers to the accessibility of OT treatment for at-risk children in LMICs. Following the JBI Manual for Evidence Synthesis – 2024 edition, a search of CINAHL, PubMed, Scopus, PsycINFO and Web of Science yielded eight eligible studies. Records were screened first by title and abstract, and then by full text. All included studies were published within the last 10 years with a focus on at-risk children and/or adolescents who received OT treatment in LMICs.
Results: A shortage of trained professionals is presented as the most common barrier limiting access to OT. Other barriers included limited government funding, lack of resources that impeded the delivery of treatment, social stigma and cultural attitudes, and lack of knowledge and awareness about OT.
Conclusion: Further research is required to explore ways to address these barriers to improve access to OT services.
Contribution: Identified barriers can facilitate actions to increase accessibility to OT interventions for at-risk children in LMICs, with the goal of improved health outcomes and greater social inclusion.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Akbar Banari, Alireza Aghaz, Arash Shahriyari
et al.
Objectives: COVID-19 was triggered by the severe acute respiratory syndrome coronavirus-2, leading to a pandemic. The risk of developing dysphonia and dysphagia amongst COVID-19 patients is considered to be high.
Methods: In this prospective study, 150 patients affected by COVID-19 admitted to the intensive care unit (ICU) and the ward of Firoozgar Hospital in Tehran, Iran, were analyzed. Dysphagia and dysphonia were evaluated according to the swallowing impairment score and the consensus auditory-perceptual evaluation of voice (CAPE-V). Also, the quality of life (QoL) was measured using the Persian version of the voice handicap index, the swallowing QoL and the Persian version of the dysphagia handicap index (DHI).
Results: A total of 150 COVID-19 patients (mean age: 59.64±17.87 years and 54.3% male; 75 admitted patients to the ICU and 75 patients admitted to the ward) were evaluated. A total of 115(77%) patients with COVID-19 were experiencing dysphagia, and the prevalence of dysphagia did not vary meaningfully between the two sets. According to the swallowing QoL, the QoL of the two groups was meaningly different (P<0.05). Also, the QoL of patients admitted to the ICU was lower than those admitted to the ward. A total of 91(61%) COVID-19 patients had dysphonia and dysphonia prevalence was significantly varied among the two groups (P<0.05). Investigating the relationship between dysphagia severity, dysphonia severity, and age showed a significantly positive correlation (P<0.01). However, the length of stay had a positive correlation only with the severity of dysphonia (P<0.05). Also, a negative correlation was found between swallowing QoL, dysphagia severity, and dysphonia severity (P<0.01).
Discussion: Dysphagia and dysphonia were prevalent among COVID-19 patients and more common in older patients. Early evaluation is required for timely and efficient intervention to avoid further complications and to progress their QoL.
Medicine, Vocational rehabilitation. Employment of people with disabilities
Background: Literature reveals high prevalence of neck disability in Pakistani population, and limited translated tools are available in Urdu language. Therefore, due to unavailability of screening tools in national language of Pakistan people usually remain unaware regarding the significance of early screening regarding any disease.
Objective: To Translate and validate the Copenhagen neck functional disability scale in Urdu language.
Methodology: This cross sectional study was conducted at Physical Therapy Department of Haider Hospital in Multan. A total of 75 participants aged between 18 to 40 years of both gender with nonspecific neck pain for minimum 12 weeks were included. Initially, two independent professionals made two forward translation into Urdu language. Then, these translations were synthesized into single translation. The synthesized translated version was translated backward into English language. The expert reviewed the synthesized translated version and backward translated version and approved the translated final synthesized version. The psychometric properties test included internal consistency validity (Cronbach’s alpha), test-retest reliability (ICC 2, 1), and concurrent validity (correlation with Numeric pain rating scale and Neck disability index).
Results: The mean The Cronbach’s alpha for Copenhagen neck functional disability scale Urdu version (CNFDS-U) was 0.76 showing good internal consistency. The test-retest reliability determined with intraclass correlation coefficient ICC (2, 1) was 0.84 (95% CI; 0.74 to 0.90, P< 0.001). Test-retest mean scores correlation was r = 0.86 (P < 0.001). The Pearson’s correlation coefficient between CNFDS-U and NDI was r = 0.65 (P<0.001). The Pearson’s correlation coefficient between CNFDS-U and NPRS was r = 0.60 (P<0.001).
Conclusion: The Urdu translated version of Copenhagen neck functional disability scale showed high internal consistency, excellent test-retest reliability, and good concurrent validity.
Vocational rehabilitation. Employment of people with disabilities, Therapeutics. Psychotherapy
Maram Fahaad Almufareh, Samabia Tehsin, Mamoona Humayun
et al.
Intellectual disability (ID) poses formidable challenges to individuals in acquiring knowledge and performing daily activities. This condition often stems from a variety of factors, such as congenital birth defects, genetic conditions, or acquired injuries, profoundly impacting crucial aspects like speech, mobility, social understanding, and adaptive skills. To address these challenges effectively, early intervention and specialized education play pivotal roles in providing children with intellectual disabilities the necessary support for their development. In this context, Artificial intelligence (AI) emerges as a highly promising tool capable of facilitating effective communication for individuals with intellectual disabilities. AI technology offers personalized communication support, aids in early diagnosis, and provides configurable therapies tailored to the needs of those with intellectual disabilities. Moreover, AI’s contributions extend to enhancing the overall well-being of these individuals, empowering them to achieve greater independence and improved quality of life. Various treatment and support services, such as early intervention programs, special education, and vocational programs, play vital roles in fostering the growth and fulfillment of those with intellectual disabilities, enabling them to thrive in the society. The integration of AI technologies holds tremendous potential to further augment the lives of individuals with disabilities. AI-based applications, including real-time captioning, sign language translation, robotic assistance, virtual reality, and brain–computer interfaces, are transformative tools that promote inclusivity and independence for individuals with intellectual disabilities, paving the way toward a more accessible and empowering future.
Vocational rehabilitation. Employment of people with disabilities
Daniel Mont, Lena Morgon Banks, Ludovico Carraro
et al.
The impact of disability on people’s lives is often underestimated because the extra costs of living with a disability are not accounted for. This paper analyzes several different methodologies for estimating those costs and explores their usefulness in designing inclusive social policies. For example, one approach is to measure what is currently being spent, while another is to estimate what would need to be spent for equal participation. These can be measured using statistical techniques or through a more qualitative methodology. Each of these methods has its advantages and disadvantages. The paper concludes with recommendations for which methodology fits which purpose, and how they can be used together to obtain a full accounting of the extra costs incurred by people with disabilities.
Vocational rehabilitation. Employment of people with disabilities
OBJECTIVE To explore the association between socio-demographic, health, functional independence and environmental variables with engagement in paid work, for people with spinal cord injury (SCI). DESIGN Self-reported, cross-sectional Australian data from a large international SCI survey. SETTING Community-based. PARTICIPANTS 1,189 working age people with SCI (18-67 years), or aged >67 years and engaged in paid employment. Respondents were community-based and at least 1-year after injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Employment and work integration variables. Bayesian penalized regression was used to determine associations between 23 predictor variables and engagement in paid work. RESULTS Most participants (87%) were employed pre-injury, with 39% in paid employment at the time of the survey. Participants who attained a Master/doctoral degree (OR = 3.01, 95% CrI = 1.63, 5.44) and those married (OR = 1.68, 95% CrI = 1.13, 2.49) were more likely to be engaged in paid work. Females (OR = 0.55, 95% CrI = 0.37, 0.81), people receiving a disability pension (OR = 0.17, 95% CrI = 0.13, 0.24) and older participants (OR = 0.75, 95% CrI = 0.63, 0.90) were less likely to be in paid work. Working participants identified hardships including problems completing their work (60%) and accessing the workplace (32%); as well as unmet needs relating to assistive devices required for completing their work (50%). CONCLUSIONS Findings from the current study can assist in directing resources to subgroups within the SCI population who need greater assistance or intervention related to employment outcomes, including through vocational rehabilitation services/programs. Unmet needs and workplace issues expressed by employed individuals identify gaps in work integration and satisfaction that could affect employment sustainability that need to be addressed. TRIAL REGISTRATION Not applicable.
Background: Stammering is a speech fluency disorder categorized by repetitions, prolongations and blocks that interrupt the normal flow and forward movement of speech. The Fluency shaping techniques including Easy Onset and Pantomiming treatment are commonly used techniques for the management of stuttering. Objective: To compare the effectiveness of Pantomiming and easy onset method for the treatment of blocks in stammering in school aged children. Material & Method: A randomized control trial (NCT04813588) was conducted in hospitals of Rawalpindi and Islamabad. The Convenient sampling technique was used for data collection from National Institute of Rehabilitation Medicine (NIRM). The sample size was n=16, randomly divided in Easy onset (n=8) and Pantomiming (n=8) through lottery method. The schools going children and adolescent between 6-18 years of both genders with mild to moderate stammering with blocking symptoms were included. The severity of stuttering was assessed with real time analysis of speech fluency. The data was analysed at the baseline and after three months of intervention. The non-parametric tests were applied for within and between group analyses. Results: The mean age of the participants was 10.38±5.290 years. A total n=11 were males and n=5 were females. When compared both groups, there was no significant difference between Easy onset and Pantomiming technique {MR=9 vs MR=8, U=28, p=0.535} in the management of stuttering after three months of intervention. Conclusion: The easy onset and pantomiming techniques are equally effective in improving the blocking in stuttering. Keywords: Blocks, easy onset, fluency shaping, pantomiming, speech therapy, stammering, stuttering
Vocational rehabilitation. Employment of people with disabilities
Saba Karamat, Aruba Saeed, Fizah Mahnoor Khan
et al.
Objective: To compare the effects of task-based mirror therapy and Repetitive Facilitation Exercise on upper limb function in post stroke patient. Methodology: A randomized controlled trial was conducted in Pakistan Railway general hospital, Rawalpindi. The duration of this study was from 10th July to 31st December 2019. Non-probability purposive sampling technique was used with n=50 male and female subacute and chronic post-stroke patients between 40-50 years. The patients with Modified Ashworth Scale <3 and the first-ever stroke was included. The participants were randomly divided by the sealed envelope method into mirror therapy group (n=25) and Repetitive Facilitation Exercise group (n=25). The Upper extremity functional index (UEFI) was used to assess the functional impairment in individuals with upper limb dysfunction, Fugl Meyer (FMA-UE) for assessment of activity in post stroke patients, “Wolf Motor Function Test (WMFT) for upper extremity performance and functional capability” and Brunnstrom recovery scale (BRS) for motor function of the upper limb was used in a post stroke patient. All the patients were assessed at baseline than after 3 weeks and again after 6week for interventional session of 30 min,3 days of the week. Data were analyzed through SPSS version 23. Results: The mean age of Group A (MT) was 50.97±6.741 and 49.76±12.66 of Group B (RFE). After 6 weeks of intervention between groups analysis of Task-based mirror therapy showed significant improvement in mirror therapy group as compare to Repetitive Facilitation Exercise group ,for upper extremity functional index scores(p<0.001) but for motor assessment(FMA-UE), Wolf Motor Function Test (WMFT) and for stroke recovery (Brunnstrom) no statistically significant difference (p≥0.05) was found. Within-group analysis of both groups showed statistically significant results in all variables (p<0.001). Conclusion: Mirror therapy and Repetitive facilitation Exercise both were found to be effective in improving upper limb motor functions of acute stroke patients. However, Mirror therapy has shown significant effects in upper extremity functional index. Keywords: Mirror therapy, Physical therapy, Repetitive Facilitation Exercise, Stroke, Upper extremity.
Vocational rehabilitation. Employment of people with disabilities
BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version is a generic self-report instrument measuring perceived individual functioning and disability. Studies suggest that the WHODAS 2.0 12-item version may exhibit a varying factor structure and psychometric properties depending upon the disability group studied. OBJECTIVE: The objective of this study was to examine the measurement structure and psychometric properties of the WHODAS 2.0 12-item version in a community sample of individuals with multiple sclerosis (MS). METHODS: Participants included 256 individuals with MS. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and concurrent validity analysis were used to psychometrically validate the measure. RESULTS: Results of the EFA suggest that the WHODAS 2.0 12-item version exhibits a two-factor structure in persons with MS (self-care functioning and social and cognitive functioning). These results were confirmed with the CFA (with modifications). Concurrent validity analysis revealed that the factors were significantly associated with relevant psychosocial variables in the expected directions. CONCLUSIONS: The WHODAS 2.0 12-item version may provide valuable information for vocational rehabilitation counselors to better support people with MS as they work toward their psychosocial and employment goals.
Hamidreza Mokhtarinia, Mahta Rafinia, Akram Shahbazi
et al.
Objectives: instruments and methods evaluate addiction to the Internet, mobile, and smartphone use. Subject-reported outcome measures, such as the Smartphone Addiction Scale (SAS) assess such addiction. The objectives of this study were to cross-culturally adapt the SAS into Persian (SAS-Pr) and to evaluate the properties of reliability and validity in the Persian setting.
Methods: The English version of the SAS was translated into Persian according to the published guidelines, using forward-translation, synthesis, back translation, consolidated consensus translations from an expert committee, and in pilot-testing. The pilot trial was performed with recruited medical students (n=50) with an interview used to determine the comprehensibility, readability, understandability, interpretation, and cultural relevance of the questionnaire. A further sample of medical students (n=100) was recruited for test-retest reliability performed at baseline and 7-14 days later, using the intraclass correlation coefficient (ICC2,1) and internal consistency using Cronbach’s α.
Results: The translation of SAS-Pr was achieved with minimum difficulty. During this process, item 15 was revised and in items 24 and 25, the “telegram” phrase was added. The participants found the comprehensibility, readability, understandability, interpretation, and completeness of the questionnaire conclusive. Furthermore, high levels of test-retest reliability (ICC2,1=0.81) and internal consistency (α=0.948) were obtained.
Discussion: The SAS-Pr adaptation was successful and the translated version showed promising positive psychometric properties. The SAS-Pr can be applied in research settings and in identifying Persian-speaking people at risk of addiction to the smartphone.
Medicine, Vocational rehabilitation. Employment of people with disabilities
BACKGROUND: Many adults with Autism Spectrum Disorders (ASD) are unemployed or underemployed. OBJECTIVE: The study was designed to evaluate vocational status of adults with ASD, determine barriers to employment, evaluate current government vocational services, and determine possible methods to improve employment of adults with ASD. METHODS: An original online vocational survey was completed by 172 participants across Arizona. RESULTS: Some participants were employed without supports (28%) or with supports (9%), in center-based (4%) or group-based (5%) employment, and 16% were in school. A high percentage were unemployed (40%), with some looking for work (27%) and some not (13%). The major barriers to employment were being unable to get past interviews (59%), not knowing what jobs to apply for (39%), not knowing what they wanted to do (22%), having difficulty keeping a job (22%), and transportation (28%). Vocational Rehabilitation services received reasonable ratings of client satisfaction, but only 20% of VR clients reported that VR services helped (9%) or somewhat helped (11%) of them find a job. CONCLUSIONS: Underemployment and unemployment are major problems for adults with ASD, and multiple barriers to their employment are identified. Based on the survey, recommendations are provided on how to help adults with ASD find and maintain employment.
Background: While a number of research studies have endeavoured to understand students with disabilities’ experience in higher education and have recommended ways to effectively support student success, the role of parental support has been neglected. Many studies have been hampered by a limited understanding of students with disabilities and have, in particular, underestimated students’ ‘access to economic, social and cultural forms of capital’ that caring parents provide.
Objectives: This article seeks to explore students with disabilities’ experiences of parental support in the South African higher education context. The research question guiding this article is: What forms of economic, social and cultural capital do parents and extended families provide to students with disabilities to enable them to succeed in higher education?
Method: In-depth semi-structured individual and focus group interviews were conducted with 17 students with disabilities at two universities of technology. The interview transcripts were thematically analysed with a view to understanding Pierre Bourdieu’s forms of capital that parents provided.
Results: The study found that while parents are not always able to provide material support, they offered rich and varied forms of social and cultural capital that enabled students with disabilities’ academic success.
Conclusion: Given that parental support plays an important role in the success of students with disabilities, and this role changes as these students become more independent, this study recommends the need for universities to also pay more attention to involving parents in the education of the former. It is hoped that putting in place appropriate forms of parental involvement can create a conducive environment for universities to provide inclusive education holistically.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
BACKGROUND: The Workforce Innovation and Opportunity Act of 2014 (WIOA) modified the definition of supported employment to include customized employment. Because customized employment emphasizes meeting the business needs of employers, it seems critical that the employment specialist understand how to effectively engage employers during the customized employment process. OBJECTIVE: Because there is limited research on employer perspectives regarding hiring people with intellectual and developmental disabilities using the customized employment process, this study sought to identify the perceptions of employers about barriers and facilitators to the customized employment process. METHODS: A standardized open-ended focus group interview method (Patton, 1990) using semi-structured “stem questions” was used to learn about employer perceptions of customized employment. RESULTS: Ten employers representing a variety of small to large businesses participated in the focus groups. Five major themes emerged related to employer perceptions of customized employment including: business need, networking, communication, training, and financial. CONCLUSION: To improve the customized employment process, employment specialists must be trained to effectively engage with employers during discovery and negotiation. Employment specialists need targeted training on making the business case for customizing a job for persons with intellectual and developmental disabilities.