title: Expanding vocational retraining options for injured workers: An experiment in worker choice.
abstract: BACKGROUND
  An innovative self-directed vocational retraining alternative (Option 2) has been offered to eligible Washington State injured workers since 2008.
  
  
  OBJECTIVE
  We aimed to describe: (1) how frequently Option 2 was selected and by whom, (2) the extent to which Option 2 workers used their reserved retraining funds, and (3) how worker satisfaction and employment outcomes for Option 2 workers compared with those of workers undergoing traditional vocational retraining.
  
  
  METHODS
  Five-year cohort study involving workers' compensation data, state wage files, and two worker surveys.
  
  
  RESULTS
  Fewer than 25% of Option 2 workers used their retraining funds. Retraining fund use was associated with better employment outcomes. Workers who were older, whose preferred language was not English, or who had lower pre-injury wages or less education, were least likely to use Option 2 retraining funds. Many workers chose Option 2 because they thought the approved traditional retraining plan was not a good fit for them.
  
  
  CONCLUSIONS
  Self-directed retraining may benefit workers who have the ability, resources, and motivation to independently identify and complete retraining. Additional efforts may be needed to ensure that traditional retraining plans are well-suited to workers' circumstances, and to identify and remove barriers to use of reserved retraining funds.
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Sears
authors.affiliation: Division of Health Services Management & Policy, The Ohio State University College of Public Health, Columbus, OH, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wickizer
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Schulman
mesh_terms: D002755:Choice Behavior; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D060051:Occupational Injuries / Q000534:rehabilitation*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012050:Rehabilitation, Vocational / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D062707:Return to Work / Q000706:statistics & numerical data*; D014861:Washington
keywords: Vocational rehabilitation; employment outcomes; quality improvement; return to work; workers’ compensation