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Substance Abuse and Vocational Rehabilitation – the Elephant in the Room: Research, Policies, & Exemplary Practices

Substance Abuse and Vocational Rehabilitation – the Elephant in the Room: Research, Policies, & Exemplary Practices. Factors that Contribute to Unsuccessful Case Closures among Consumers of Vocational Rehabilitation Services

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Substance Abuse and Vocational Rehabilitation – the Elephant in the Room: Research, Policies, & Exemplary Practices

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  1. Substance Abuse and Vocational Rehabilitation – the Elephant in the Room:Research, Policies, & Exemplary Practices Factors that Contribute to Unsuccessful Case Closures among Consumers of Vocational Rehabilitation Services David Hollar, PhD*, Mary McAweeney, PhD**, and Dennis Moore, EdD** *University of North Carolina School of Medicine **SARDI, Department of Community Health, Wright State University School of Medicine Wednesday, October 17, 2007

  2. Importance of the Problem • According to NIDRR, approximately 54 million Americans live with a disability • Estimated 10-20% of individuals with disabilities report a substance use/alcohol and other drug (SUD/AOD) disability • 14.0% RSA 911 Database • 10.8% LSVRSP (Primary/Secondary SUD) • $450 million in treatment costs per year

  3. SUD Serious Barrier to Employment • Already, persons with disabilities in general are significantly un-/under-employed compared to all working-age American adults. • SUD/AOD represents a genuine disability that further impacts this employment disparity D. Moore & L. Li (1997). Am J Addictions. GE Jones (1997). Hum Res Mgt Rev 7:55-76

  4. LSVRSP • Longitudinal Study of Vocational Rehabilitation Services Programs • Jan. 1995 – Jan. 2000 • N = 11,401 participants • 40 VR Offices in 32 states • Cornell University ILR School, Employment and Disability Institute • RTI International, Research Triangle Park, NC

  5. Vermont New Hampshire Rhode Island New Jersey Delaware Louisiana North Dakota South Dakota Nebraska Kansas New Mexico Arizona Nevada Colorado Wyoming Montana Hawaii Alaska States Not Represented

  6. LSVRSP Sampling • Random Sample of Clients 25% applying to VR 50% accepted & receiving services 25% exiting after receiving services • Client, Counselor, Administrator Interview Data

  7. Client Data • Demographics – baseline & quarterly • Work History – baseline • Functional Status – baseline & closure • Satisfaction – baseline & annually to closure • Annual followup – after closure • Services received – baseline & quarterly • Counselor interview – baseline & study end

  8. VR Clients in General Competitive Employment more likely if: Higher gross motor function Higher cognitive function Working at VR application Higher Earnings at most recent job prior to VR Greater knowledge of different jobs Greater knowledge of job nonmonetary benefits RTI Analyses (part 1) BJ Hayward, H. Schmidt-Davis. LSVRSP Final Report 1. RTI, May 2003.

  9. VR Clients in General Competitive Employment less likely if: Disability was vision, mental illness, or MR Disability was significant or most significant Receiving SSI or SSDI They were older RTI Analyses (part 2) BJ Hayward, H. Schmidt-Davis. LSVRSP Final Report 1. RTI, May 2003.

  10. Positives: Gross function Knowledge jobs Obtain AT device Negatives SSI/SSDI Never worked Predictors – Receipt of Services BJ Hayward, H. Schmidt-Davis. LSVRSP Final Report 1. RTI, May 2003.

  11. Positives: Disability – Vision, Hearing, MR, Orthopedic Gross function Self esteem Obtain AT device # Dependents Negatives SSI/SSDI Never worked Non-white Lack of post-secondary education Predictors – Employment BJ Hayward, H. Schmidt-Davis. LSVRSP Final Report 1. RTI, May 2003.

  12. Positives: Gross function Cognitive function Working at appl. Recent earnings Knowledge jobs Nonmonetary benefits Negatives Disability – Vision, Mental Illness, MR SSI/SSDI Age Predictors – Competitive Employment BJ Hayward, H. Schmidt-Davis. LSVRSP Final Report 1. RTI, May 2003.

  13. Study Limitations • Sampling • No clear criteria for SUD/AOD diagnosis • Missing data

  14. Study Focus • Persons with Primary or Secondary SUD/AOD Diagnosis • Case Closures: 26 – With employment 28 – Without employment following IPE services 30 – Without employment before IPE services

  15. Study Questions (1-3) • What are the reasons identified by consumers and counselors for unsuccessful case closures? • Can unsuccessful cases be meaningfully categorized by whether or not SUD may have been a factor in the closure? • Do unsuccessful cases differ by whether or not SUD was officially identified or hidden in the VR system?

  16. Study Questions (4-6) • Do the perspectives of the counselor and client differ regarding reasons for closure? • Do reasons for closure differ between persons who are 28 and 30 closure status? • Do persons who are unsuccessfully closed find work through other means?

  17. Methods • Software – SPSS v11.3 and v15.0 • Analyses Chi-square – polychotomous variables ANOVA – continuous variables

  18. Independent SUD/AOD status Closure status Entry status Dependent Client attitudes Counselor attitudes Services received Job information Variables

  19. Consumers/Clients No jobs available Need more services Not ready to work NS Counselors Unable to locate client* Client refused services Failure to cooperate* Significant for 28 Closures (Χ102 = 49.2, p=.000) Significant for 30 Closures (Χ122 = 57.1, p=.000) What are the reasons identified by consumers and counselors for unsuccessful case closures?

  20. Can unsuccessful cases be meaningfully categorized by SUD as a factor in the closure?

  21. For all closure types, persons with SUD were proportionately more likely to be referred to VR by… Rehab Facility Hospital Persons without SUD… Educational institution Self-referral (Χ82 = 47.9, p=.000) Referral Sources

  22. Do unsuccessful cases differ by whether or not SUD was officially identified or hidden in the VR system? • There were no significant differences across closure status and SUD status based upon their receiving counseling for SUD. • Considerable missing data. • Results suggestive, but not proven, that much SUD may be “hidden” to VR

  23. Do the perspectives of the counselor and client differ regarding reasons for closure?

  24. Do reasons for closure differ between persons who are 28 and 30 closure status? • No • Χ52 = 6.75, p=.240 • 28 closures more likely to state that there were no jobs available, not ready to start working.

  25. Do persons who are unsuccessfully closed find work through other means? • 26 closures successfully found work, but… • 26 and 28 closures with SUD go through significantly more jobs than corresponding closures without SUD. • (F1,3317 = 25.7, p=.000) for 26 closures • (F1,1468 = 26.7, p=.000) for 28 closures

  26. Demographic Comparisons

  27. Therefore, males were more likely to experience SUD across closure categories. Additionally, African-Americans had disproportionately higher SUD for 26 and 28 closures. Χ32 = 39.2, p=.000 for 26 closures Χ32 = 25.8, p=.000 for 28 closures Demographics

  28. Additional Findings • Persons with primary diagnoses of ADHD (43.2%), mental illness (45.5%), physical disabilities (50.6%), SUD/AOD (51.3%), and learning disabilities (51.4%) had the lowest successful 26 closure rates.

  29. Other Observations • Clients with SUD significantly more likely to be: Divorced or Separated Less Education Never received Special Education Services

  30. Financial Assistance • Like the RTI analysis, 26 closures were more likely with clients not receiving SSI or SSDI, although differences versus 28/30 closures were not significant. • Clients with SUD were less likely than clients without SUD to be receiving SSI/SSDI.

  31. Transportation • 26 and 28 closure clients with SUD were significantly more likely to report transportation as a major problem or somewhat of a problem in getting a job. • Χ22 = 16.0, p=.000 for 26 closures • Χ22 = 19.6, p=.000 for 28 closures

  32. Conclusions (part 1) • There appears to be a disconnect between counselor and clients with respect to compliance with VR services, although this could be due to variable inconsistencies in the database. • SUD is high among 28 closures, indicating a need for SUD-related services in VR. • Counselors need to be attentive to underlying SUD issues in client evaluation.

  33. Conclusions (part 2) • Sources of referral may be a concern, with many persons with disabilities and SUD comorbidities tending not to refer themselves for VR programs. • Persons with SUD may need assistance in employment stability, given their tendency to go through multiple jobs post-closure. • The SSI/SSDI issue for persons with SUD seems to be supported.

  34. Transportation to Employment • Lack of transportation appears to be a significant factor limiting employment for persons with disabilities, including persons with SUD. • This is a central topic for HP2010, Disability and Secondary Condtions.

  35. Demographic Issues • Males and African Americans seem to be at heightened risk for SUD. • Individuals with less education or who may have been missed for special education services in schools may be at risk for poor VR outcomes. • Divorce/separation issues in VR outcomes.

  36. Policy Implications • Need for more comprehensive VR service delivery, even with already large caseloads. • Disability-specific level counseling • Improved client tracking and contacts • Transportation needs • Possibility of hidden SUD/AOD issues • Higher education, reading and math proficiencies good predictors for success.

  37. Community Integration and Jobs • Address these issues within the context of NIDRR and RSA recommendations for Community Integration for persons with disabilities, including: • Assessing individual goals and potential • Assessing individual’s beliefs/perceptions • Assessing individual’s activities/behaviors NIDRR (2006). Long-range plan for fiscal years 2005-2009. Federal Register 71(31):8166-8200.

  38. Target Systems • Incorporate the policy implications from this R&D/Knowledge Translation work to Service Delivery. • Target system: VR Services • Provide improved counselor and client support for improved VR outcomes. • Interagency communication/coordination. ML Campbell (2003). Understanding the government-wide shift in accountability. NIDRR AT Act Webcast, Oct. 22. NIDRR (2006). Logic Model.

  39. Outcomes • Short Term Outcomes: Measurable changes in client participation in VR services and levels of satisfaction with services. • Long-Term Outcomes: Higher 26 closures across all categories of persons with disabilities. ML Campbell (2003). Understanding the government-wide shift in accountability. NIDRR AT Act Webcast, Oct. 22. NIDRR (2006). Logic Model.

  40. Thank You! • David Hollar, PhD David_Hollar@med.unc.edu • Mary McAweeney, PhD Mary.McAweeney@wright.edu • Dennis Moore, EdD Dennis.Moore@wright.edu

  41. Substance Abuse and Vocational Rehabilitation – the Elephant in the Room:Research, Policies, & Exemplary Practices Factors that Contribute to Unsuccessful Case Closures among Consumers of Vocational Rehabilitation Services David Hollar, PhD*, Mary McAweeney, PhD**, and Dennis Moore, EdD** *University of North Carolina School of Medicine **SARDI, Department of Community Health, Wright State University School of Medicine Wednesday, October 17, 2007

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