Facilitators and Barriers to Employment Among Veterans with Spinal Cord Injury Receiving 12 Months of Evidence-Based Supported Employment Services

Cotner, Bridget A.; Njoh, Eni; Trainor, John K.; O'Connor, Danielle; Barnett, Scott D.; Ottomanelli, Lisa

doi:10.1310/sci2101-20

Cited by 18 publications

(9 citation statements)

References 24 publications

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“…Income support was often tied to other benefits like medical entitlements or housing, which people cannot afford to lose [40]. Some people navigated this by working in part-time jobs which they were overqualified for so they could earn lower wages that did not interfere with benefits or medical cover [33,41,42]. However, even working part-time, some people found themselves with decreased financial security as a consequence of gaining employment [33].…”

Section: Thematic Synthesis: Socio-cultural Context and Experiences Trying To Gain And Maintain Paid Workmentioning

confidence: 99%

“…Within the workplace, even when accessibility was made possible through devices, malfunctioning of technologies such as lifts impacted on job accessibility [43]. Transportation to work was often problematic, particularly for people with a spinal cord injury [20,42], multiple sclerosis, cerebral palsy [20], and traumatic brain injury [44] due to restrictions on ability to drive. To be a viable opportunity, a potential job needed to be geographically accessible and able to be reached within a reasonable amount of time [20].…”

Section: Accessibility Of the Workplace And The Work Environmentmentioning

confidence: 99%

“…To be a viable opportunity, a potential job needed to be geographically accessible and able to be reached within a reasonable amount of time [20]. The necessity of using public transport or relying on friends and family introduced concerns regarding timeliness and reliability, particularly for those who resided in rural areas [20,42,43]. In the face of transport challenges, some people opted to look for roles where they could work from home [42].…”

Section: Accessibility Of the Workplace And The Work Environmentmentioning

confidence: 99%

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Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis

Fadyl

Levack

Reed

2020

Disability and Rehabilitation

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Purpose: An interplay of complex issues influence opportunities to gain paid work for people living with long-term conditions, but there are patterns that traverse the various contexts. Synthesising findings across qualitative studies can inform vocational rehabilitation approaches. Methods: Public consultation and PRISMA guidelines were used to develop a protocol and comprehensive search strategy. Seven databases were searched and results screened against inclusion criteria. Included studies investigated either lived experiences of gaining paid work while living with a long-term condition or the socio-cultural factors affecting opportunities for paid work. Findings were extracted from included studies and then analysed using thematic synthesis. Results: Sixty-two studies met inclusion criteria. Identified themes demonstrate that people living with long-term conditions need access to support through the different stages of gaining paid work. This can include considering the benefits and risks of having paid work and negotiating needs in the workplace prior to and during employment. Positive experiences for workers and employers were influential in changing attitudes about the work-ability of people living with long-term conditions. Conclusion: Findings emphasise the interplay between socio-cultural norms and the constraints experienced in trying to gain work. Appropriately targeted support can unlock possibilities that are otherwise hindered by these norms. ä IMPLICATIONS FOR REHABILITATIONPositive experiences of paid work for people living with long-term conditions and those who employ them are important for stimulating future opportunities. "Informal" or alternative routes into paid work are experienced as more successful in contending with discrimination. Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job. Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work.

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Section: Thematic Synthesis: Socio-cultural Context and Experiences Trying To Gain And Maintain Paid Workmentioning

confidence: 99%

Section: Accessibility Of the Workplace And The Work Environmentmentioning

confidence: 99%

Section: Accessibility Of the Workplace And The Work Environmentmentioning

confidence: 99%

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Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis

Fadyl

Levack

Reed

2020

Disability and Rehabilitation

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“…11 It has been previously recommended that integration of VR services in the context of the SCI medical team can help facilitate employment outcomes. 12 To address the suboptimal employment outcomes of individuals with SCI in Australia, 13 a pilot early intervention VR program, called InVoc, was carried out in the spinal units across the state of New South Wales (NSW), Australia. The primary objective of this early intervention trial was to improve employment outcomes (to be measured prospectively at 1 and 2 years).…”

mentioning

confidence: 99%

Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions

Ramakrishnan

Johnston

Garth

et al. 2016

Topics in Spinal Cord Injury Rehabilitation

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Background: A pilot early-intervention vocational rehabilitation program was conducted in Sydney, Australia, over a 2-year period. It was postulated that the early provision of integrated vocational rehabilitation services in the hospital settings for newly injured individuals would be well received and result in better employment and psychosocial health outcomes. Objective: The objective of this qualitative inquiry was to examine the perspectives of program participants who had completed the intervention about the timeliness, perceived value, and critical elements of the early intervention. Methods: A convenience sample of participants was selected by accessibility; participants were interviewed individually after discharge using a semi-structured approach. Transcripts of the interviews were created via audio recordings; interviews were transcribed verbatim, and the contents were analyzed thematically. Results: Thirteen participants aged from 19 to 60 years with varying levels of impairment and vocational backgrounds were interviewed from 7 to 21 months post injury. Overall, the early introduction of vocational rehabilitation services was well received and viewed positively. Emerging themes include sense of direction and distraction, advocacy, and support, with "hope" (early after injury) emerging as the overarching theme. Criticisms voiced about the program were that it was offered too early in the intensive care unit and there were competing interests and information overload in the early recovery phase. Conclusions: Vocational rehabilitation provided during inpatient rehabilitation appears appropriate, important, and valuable from patients' perspective. Early engagement results in feelings of hope and encourages patients to see the possibility of returning to work or education very early after injury, and it allows rehabilitation to be directed accordingly.

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“…Time for Employment), a prospective, multisite study conducted from August 2010 through March 2015, evaluated longitudinal employment, quality of life, and economic outcomes of a large cohort of veterans with SCI receiving medical and rehabilitation care at geographically diverse SCI centers in the Veterans Health Administration (VHA) (https://clinicaltrials.gov/ct2/show/ NCT01141647) (Figure 1). 15,16 All veterans who met inclusion criteria were invited to participate in an in-person baseline interview to provide information on employment, health, and quality of life. Inclusion criteria included age between 18 and 70 years, medically and neurologically stable, enrolled in VHA care, and having an SCI caused by trauma, compression, infection, or localized inflammatory processes.…”

Section: Promote (Predictive Outcome Model Overmentioning

confidence: 99%

Relationship Between Comorbidities and Employment Among Veterans with Spinal Cord Injury

Goetz

Ottomanelli

Barnett

et al. 2018

Topics in Spinal Cord Injury Rehabilitation

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To determine the relationship between medical and mental health comorbidities in a large cohort of veterans with spinal cord injury (SCI). Data were collected from interviews and electronic medical records of veterans with SCI ( = 1,047) who received care at 7 geographically diverse SCI centers within the Department of Veterans Affairs across the country (https://clinicaltrials.gov/ct2/show/NCT01141647). Employment, medical, functional, and psychosocial data underwent cross-sectional analysis. Lack of any documented mental health diagnosis correlated strongly with being employed at the time of enrollment. No single comorbidity was associated with employment at enrollment, but an increased number of medical and/or mental health comorbidities ("health burden") were associated with a decreased likelihood of employment at the time of enrollment. Further investigation is needed to clarify whether comorbidity severity or combinations of specific comorbidities predict rehabilitation outcome, including employment.

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Facilitators and Barriers to Employment Among Veterans with Spinal Cord Injury Receiving 12 Months of Evidence-Based Supported Employment Services

Cited by 18 publications

References 24 publications

Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis

Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis

Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions

Relationship Between Comorbidities and Employment Among Veterans with Spinal Cord Injury

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