The Long Term Impact Of Vocational Rehabilitation

The aim of this review was to provide an evidence base for policy development on vocational rehabilitation - defined as whatever helps someone with a health problem to stay at, return to and remain at work. The focus was on adults of working age, the common health problems that account for two-thirds of long-term sickness (mild/moderate musculoskeletal, mental health and cardio-respiratory conditions) and work outcomes (staying at, returning to and remaining in work). Data from some 450 scientific reviews and reports were included in evidence tables. The review demonstrates that there is a strong scientific evidence base for many aspects of vocational rehabilitation, a good business case for it and more evidence on cost-benefits than for many health and social policy areas. Generic and condition-specific findings are reported, and practical suggestions offered for the differing types of people affected by health problems. Vocational rehabilitation should be a fundamental element of government strategy to improve the health of working age people.

It gives us great pleasure to write the preface to this book, the second in the series of monographs produced by the European Academy of Rehabilitation Medicine. No part of medicine, no clinical intervention, is complete without thinking about its effect on the person’s life and the quality thereof. One of the most powerful determinants of this is work; a source not only of income, but of satisfaction and a sense of purpose and worth. The Academy, founded in 1969, is composed of senior European doctors spec- lising in Rehabilitation and Physical Medicine. It meets regularly to discuss matters of importance in the field, including teaching, research and ethical matters. It recognises that the ability of the speciality and of related ones to decrease dependency and increase autonomy and quality of life needs to be better known. Hence the production of these monographs. They will help readers access a vast amount of literature on the practice of rehabilitation and its effectiveness. They should be particularly useful to young doctors preparing for the European Boards certification in Physical and Rehabilitation Medicine as they are authoritative and cover subjects in depth. Topics covered in the series range from basic sciences to the most applied areas.

A study gathered information on the estimated population eligible to be served by the federal-state vocational rehabilitation (VR) program. It contrasted those accepted and those not, described services clients received, and evaluated the program's outcomes. The study found that, in national surveys in the 1980s, 14-18 million people reported work limitations that made them potentially eligible for VR, but a much smaller group was actually served by the state-federal VR program: in any one year, 5-7 percent of those potentially eligible. Those accepted were generally similar to those who applied, except that those accepted were much more likely to be classified as having a severe disability. Most VR clients received only modest services. Less than half received any type of education or training services, the total value of purchased services averaged only $1,573 per client, and just under half received purchased services costing less than $500. States purchased more services for clients with physical than with mental disabilities, more for clients with severe than with nonsevere disabilities, and more for White clients than for Black, Hispanic, or American Indian clients. Evaluation of long-term outcomes found that rehabilitants' gains in employment and earnings faded after about 2 years. (Appendixes include a list of major disabling conditions of VR clients, racial differences on variables, regression analyses for long-term outcomes, 19 references, and a glossary.) (YLB)