Vocational Services Research: Recommendations for Next Stage of Work

By Drebing, Charles E.; Bell, Morris et al. | Journal of Rehabilitation Research & Development, January-February 2012 | Go to article overview

Vocational Services Research: Recommendations for Next Stage of Work


Drebing, Charles E., Bell, Morris, Campinell, E. Anthony, Fraser, Robert, Malec, James, Penk, Walter, Pruitt-Stephens, Laura, Journal of Rehabilitation Research & Development


INTRODUCTION

Scientific efforts to advance the practice of vocational rehabilitation (VR) for adults with the full range of disabilities have made remarkable progress over the past two decades. The number of published evaluations of vocational interventions has grown at an encouraging pace, and though the number of clinical trials has been fairly small, it is steadily increasing. Moreover, the level of methodological and statistical sophistication has improved substantially. To a significant extent, these trends have been driven by research studies seeking to carefully evaluate the use of the Individual Placement and Support model of supported employment (IPS SE) for adults with psychiatric disorders. There have been more than 20 clinical trials of IPS SE over the past 20 years, and more than 25 percent of all empirical evaluations of vocational services (VS) published in 2009 represent evaluations of IPS SE. These efforts have coincided with growing agreement among policymakers, clinicians, and researchers that clinical programming should be guided by principles of evidence-based practice (EBP) [1-2]. While IPS SE is one of the practices with a sufficient evidence base to be included on the list of EBPs, relatively few of the range of common vocational interventions have been the focus of controlled trials. Of those that have been, the populations studied have typically been a subset of the disability groups using VS.

As VS research matures, it is necessary for the field to review its progress and identify any important gaps in measurement and methodology that may hamper its ability to answer key questions. Moreover, articulating larger strategic issues may help direct future research toward particularly relevant and compelling concerns. To encourage progress, we have identified (1) ways to increase consistency in measurement of employment outcomes, (2) emerging patterns and lingering gaps in the range of variables and measures commonly used in VS research, (3) broader methodological patterns and needs in the area of study design and sampling, (4) interventions that warrant additional study, and (5) broad strategies to increase the overall amount and quality of VS research. We make recommendations in each of these five areas. These recommendations vary in terms of the audience they are relevant to and the potential benefit they may produce. Given these variations in focus, audience, and potential benefit, we have not tried to prioritize them in terms of importance but instead offer them all as potential ways to enhance different aspects of current research. Note that this article is not intended to be a comprehensive review of the literature, measures, or methodology in VS research. Instead, we have tried to highlight trends in the literature and make recommendations for the field as it moves forward. In particular, the final section of this article focusing on broad strategies for enhancing research could easily include extensive discussion of each strategy--an approach that is beyond the scope of this article.

COMPETITIVE EMPLOYMENT OUTCOMES AND MEASURES

As a field, VS profits from the relative luxury of having a single primary outcome: competitive employment. Competitive employment is defined by the Department of Labor (DOL) as work in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting and for which an individual is compensated at or above the minimum wage [3]. While the stated goals of vocational interventions may be framed in a range of ways, the overall objective for most is to help participants obtain and maintain their own competitive job in the community.

The singular focus on competitive employment as the primary outcome of VS and as a key outcome for rehabilitation should continue for a number of reasons. Deterioration in functioning in competitive employment is a central element in the definition of disability (see the World Health Organization's International Classification of Functioning, Disability, and Health [4]), as evidenced by its central use in the compensation determination processes. …

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