title: Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI.
abstract: OBJECTIVE
  To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency.
  
  
  METHODS
  78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period.
  
  
  METHODS
  Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case).
  
  
  METHODS
  All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas.
  
  
  METHODS
  Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs.
  
  
  RESULTS
  Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas.
  
  
  CONCLUSIONS
  Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas.
authors.affiliation: Department of Health Psychology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA. john-stoneg@health.missouri.edu
authors.forename: Brick
authors.initials: B
authors.lastname: Johnstone
authors.forename: Terrie
authors.initials: T
authors.lastname: Price
authors.forename: Thomas
authors.initials: T
authors.lastname: Bounds
authors.forename: Laura H
authors.initials: LH
authors.lastname: Schopp
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Duane
authors.initials: D
authors.lastname: Schumate
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D004651:Employment; D005260:Female; D006078:Government Programs; D006801:Humans; D008297:Male; D008923:Missouri; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D012050:Rehabilitation, Vocational; D012424:Rural Population; D016896:Treatment Outcome; D014505:Urban Population