title: A prospective study to examine the influence of secondary health conditions on vocational rehabilitation client employment outcomes.
abstract: BACKGROUND
  Adults with disabilities experience a variety of secondary health conditions that have a negative association with employment. Vocational rehabilitation (VR) provides one possible access point for providing health promotion activities to help clients manage these conditions.
  
  
  OBJECTIVE
  To build the case for providing health promotion services in the VR setting, this research assesses how secondary health conditions impact employment closures over time for VR clients. Specifically, we hypothesize that higher rates of secondary conditions will be negatively associated with employment outcomes at 18 months.
  
  
  METHODS
  VR clients with physical disability (n = 162) provided longitudinal data at baseline and at 6, 12, and 18 months. Two binary logistic regression models used self-report data to predict employment outcomes. The first model used explanatory variables measured at baseline or prior to receiving VR services, and the second model measured variables after 18 months in the VR program. Both models included variables to control for demographic characteristics, disability severity, baseline employment, and receipt of social insurance payments. The second model also included variables to account for VR services received.
  
  
  RESULTS
  Both models showed that higher reported rates of secondary conditions were associated with lower probabilities of employment (p = .012; p = .022). The expanded model also showed that receipt of counseling services through VR increased the probability of employment (p = .04) and that receipt of medical services through VR reduced the probability of employment (p = .02).
  
  
  CONCLUSIONS
  VR can improve client employment outcomes through expanded counseling and guidance services or possibly through improved access to health promotion programming that helps clients manage secondary health conditions.
authors.affiliation: The University of Montana Rural Institute, Missoula, MT 59812, USA. ipsen@ruralinstitute.umt.edu
authors.forename: Catherine
authors.initials: C
authors.lastname: Ipsen
authors.forename: Tom
authors.initials: T
authors.lastname: Seekins
authors.forename: Nancy
authors.initials: N
authors.lastname: Arnold
mesh_terms: D000328:Adult; D003376:Counseling; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004651:Employment; D005260:Female; D006293:Health Promotion; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012050:Rehabilitation, Vocational; D057566:Self Report