Academic journal article The Journal of Rehabilitation

A Structural Equation Model of Vocational Rehabilitation Services: Predictors of Employment Outcomes for Clients with Intellectual and Co-Occurring Psychiatric Disabilities

Academic journal article The Journal of Rehabilitation

A Structural Equation Model of Vocational Rehabilitation Services: Predictors of Employment Outcomes for Clients with Intellectual and Co-Occurring Psychiatric Disabilities

Article excerpt

The estimated prevalence of people with intellectual disabilities (ID) make up about 1% or 2.5 million of the total United States (U.S.) population (Equal Employment Opportunity Commission [EEOC], 2011). However, state and regional prevalence rates of this specialized population vary widely (Centers for Disease Control and Prevention [CDCP], 1996). For example, states within East South Central and South Atlantic regions (i.e., Alabama, Kentucky, Mississippi, Tennessee, West Virginia, North Carolina, and South Carolina) have been found to have the highest prevalence rates of ID, whereas Pacific and Mountain regions (i.e., Alaska, California, Hawaii, Oregon, Washington, Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming) the lowest (CDCP, 1996).

People with serious mental illness (SMI) equate to 6% or 1 in every 17 Americans of the U.S. population (National Alliance of the Mentally 111 [NAMI], 2011). People with ID or SMI have also been historically under-employed and placed into segregated or "sheltered" work settings without the same competitive and integrated employment opportunities afforded to mainstream society (Rubin & Roessler, 1995). Individuals with ID also have more severe disabilities, require more services, and are less likely to be competitively employed than other disability groups (Olney & Kennedy, 2001). Further, employment rates for both individuals with ID or SMI continue to be drastically low compared to people without disabilities despite the fact that both individuals with ID and psychiatric disabilities want to work (Jahoda, Kemp, Riddell, & Banks, 2008; Bond & Campbell, 2008).

Individuals with cognitive disabilities have an employment rate of just over 28% compared to almost 78% for individuals without disabilities (Erickson, Lee, von Schrader, 2010, March 17). Yamaki and Fujiura (2002) provide a slightly lower estimate in their study that found just under 28% of adults with ID were employed compared to about 75% of the general U.S. population. In another estimate, the EEOC (2011) reports an employment rate of 31% for individuals with ID. From 1995 to 2005, Migliore and Butterworth (2008) found that adults with ID were under-employed, lacked an income at a level of financial self-sufficiency, and worked fewer hours per week. Working age adults with SMI have an even lower employment rate that has consistently been reported to be about 25% (Baron & Salzer, 2002).

Given these discrepancies in work rates as well as the historical nature of these populations being underrepresented in the U.S. competitive labor force compared to the general public (Degeneffe, 2000), it can be expected that employment rates for individuals who experience a dual diagnosis or co-occurring diagnosis of both ID and SMI are even lower. However, there is very little data to get an accurate estimate of the prevalence and service outcomes for this population (National Association of State Mental Health Program Directors [NASMHPD], 2004). In one estimate, the National Association of the Dually Diagnosed (NADD) (2011) has projected that about 30-35% of individuals with ID have a co-occurring psychiatric disorder. Using the EEOC's (2011) national ID population estimates of about 1% or 2.5 million of the total U.S. population, 30-35% would roughly equate to about 750,000 to 875,000 Americans in the U.S. with ID and co-occurring psychiatric disabilities.

Dual diagnosis or individuals with ID and co-occurring psychiatric disabilities is generally defined as " ... the coexistence of the symptoms of both intellectual or developmental disabilities and mental health problems" (NADD, 2011, "What is dual diagnosis?," para.l). More specifically, ID (previously known as Mental Retardation (MR)) is defined as " ... a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. …

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