Background:Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. Objective: The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. Methods: Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. Results: Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. Conclusions: Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes.
Children's physical activity (PA) may be determined, in part, by environmental influences such as access to diverse and safe places to play. As part of the development of a community-based PA program, a PA asset assessment was conducted in two low-income urban neighborhoods that support elementary schools serving minority youth. Resources were rated using an adapted version of the Physical Activity Resource Assessment (PARA), a multi-dimensional instrument that rates various venues on their features, amenities, and incivilities. Seventy-one child-centric venues (e.g., parks, playgrounds, community centers, sports facilities, fitness centers, etc.) were assessed within a three-mile radius of each school. Community member feedback via interviews with parent-child dyads revealed issues (e.g., bullying) not captured by the PARA that can influence venue use. Whereas the PARA can be a useful needs assessment and program planning tool for community-based PA programs, supplementing PARA data with community-based input may reduce contextual error in program development.
Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.
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