title: Vocational rehabilitation in spinal cord injury: what vocational service activities are associated with employment program outcome?
abstract: BACKGROUND
  Designing effective vocational programs for persons with spinal cord injury (SCI) is essential for improving return to work outcome following injury. The relationship between specific vocational services and positive employment outcome has not been empirically studied.
  
  
  OBJECTIVE
  To examine the association of specific vocational service activities as predictors of employment.
  
  
  METHODS
  Secondary analysis of a randomized, controlled trial of evidence-based supported employment (EBSE) with 12-month follow-up data among 81 Veteran participants with SCI.
  
  
  RESULTS
  Primary activities recorded were vocational counseling (23.9%) and vocational case management (23.8%). As expected, job development and employment supports were the most time-consuming activities per appointment. Though the amount of time spent in weekly appointments did not differ by employment outcome, participants obtaining competitive employment averaged significantly more individual activities per appointment. Further, for these participants, job development or placement and employment follow-along or supports were more likely to occur and vocational counseling was less likely to occur. Community-based employment services, including job development or placement and employment follow-along or supports as part of a supported employment model, were associated with competitive employment outcomes. Office-based vocational counseling services, which are common to general models of vocational rehabilitation, were associated with a lack of employment.
  
  
  CONCLUSIONS
  Vocational services that actively engage Veterans with SCI in job seeking and acquisition and that provide on-the-job support are more likely to lead to employment than general vocational counseling that involves only job preparation.
authors.affiliation: VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida ; Department of Rehabilitation and Mental Health Counseling, University of South Florida , Tampa, Florida.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ottomanelli
authors.affiliation: VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida ; VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Barnett
authors.affiliation: Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond, Virginia ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Lance L
authors.initials: LL
authors.lastname: Goetz
authors.affiliation: Office of Research & Development, Department of Veterans Affairs, Tuscaloosa VA Medical Center , Tuscaloosa, Alabama.
authors.forename: Richard
authors.initials: R
authors.lastname: Toscano
mesh_terms: D000328:Adult; D019090:Case Management; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D012050:Rehabilitation, Vocational / Q000379:methods*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013997:Time Factors; D014728:Veterans; D014830:Vocational Guidance
keywords: Veterans; employment; rehabilitation; social reintegration; spinal cord injury; supported; unemployment; vocational; vocational services