title: Risk factors for failure to enter vocational rehabilitation services among individuals with disabilities.
abstract: OBJECTIVE
  To investigate the risk factors for failure of individuals with disabilities to enter the vocational rehabilitation (VR) programme, including the cases where they had been formally accepted but were yet to receive any service.
  
  
  METHODS
  We used prospective cohort data from a Midwestern US state, and analysed 126,251 and 94,517 individuals, respectively, for acceptance and admission into VR services. Statistical analysis was conducted using Poisson regression models with robust variance estimator.
  
  
  RESULTS
  Individuals with blind/visual disability, had prior history of employment, and who received public support tended to have lower risks of non-acceptance and non-admission. Being non-White, at higher education, ever/currently married, and with physical/orthopaedic disability appeared to increase the risks of both outcomes. The adjusted relative risk of non-acceptance was 0.58 (95% confidence interval: 0.52, 0.64) if the individuals had 4 or more functional limitations as compared with those with fewer limitations. This factor was not significant for VR admission.
  
  
  CONCLUSIONS
  Disability factors, demographic determinants, and certain miscellaneous characteristics were associated with the risks of non-acceptance and non-admission into VR. Implications for Rehabilitation Individuals with disabilities are more likely to be unemployed than the population without disabilities, and they are thus more prone to adverse health effects of unemployment. Vocational rehabilitation (VR) is a proven intervention to improve employment outcomes among individuals with disabilities. Our study indicates that the complexity of the selection process for entering VR and various factors beyond disability may prevent individuals to benefit from the VR programme. Rehabilitation programme authorities need to monitor and simplify the selection process into VR services and, together with rehabilitation practitioners, promote a selection process that pays careful attention on the factors that are related to individual risk of failure for entering VR.
authors.affiliation: a Division of Epidemiology and Biostatistics , School of Public Health, University of Illinois at Chicago , Chicago , IL , USA.|b Department of Disability and Human Development , College of Applied Health Sciences, University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: F L Fredrik G
authors.identifier: http://orcid.org/0000-0002-2730-8836
authors.initials: FLFG
authors.lastname: Langi
authors.affiliation: b Department of Disability and Human Development , College of Applied Health Sciences, University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Fabricio E
authors.identifier: http://orcid.org/0000-0002-5473-1234
authors.initials: FE
authors.lastname: Balcazar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D004522:Educational Status; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015146:Midwestern United States; D044469:Racial Groups; D012050:Rehabilitation, Vocational; D012307:Risk Factors; D055815:Young Adult
keywords: Disability; Poisson regression; acceptance; admission; vocational rehabilitation