Accessible Poster Content: Factors Associated with Premature Exit from Vocational Rehabilitation Services

The following is an accessible version of content in the poster “Factors Associated with Premature Exit from Vocational Rehabilitation Services” by Catherine Ipsen and Rebecca Goe, from the Research and Training Center on Disability in Rural Communities, part of the Rural Institute for Inclusive Communities at the University of Montana.

STUDY DESCRIPTION

Premature Exit from Vocational Rehabilitation (VR)

The VR program spends approximately $365 million annually to serve consumers who disengage from services and drop out of the program (RSA-911 data). These dropouts are premature exits and account for approximately 50% of VR caseloads.

Premature exits include cases closed to:

  • “unable to locate or lost contact”
  • “refused services or further services”
  • “failure to cooperate”

Study Design

  • Conducted a prospective study to explore exit reasons.
  • Study participants (n = 355) were newly enrolled in the VR program.
  • Collected four waves of data at 6 month intervals to track progression through VR and dropout as it naturally occurred.

Theoretical Background and Study Hypotheses

Attachment to VR depends on dimensions of engagement including consumer-counselor relationship, delivery pacing, and reinforcement.

Consumer-Counselor Relationship

  • Working Alliance – shared goals, tasks, and bonds between the consumer and counselor improves outcomes (Lustig, et al., 2002).

Delivery Pacing

  • Engagement in the VR process capitalizes on short-term motivation to achieve a goal.

Reinforcement

  • Reinforcement in terms of consumer-counselor contact is provided frequently and early in the process to engage the consumer and build relationship.

Measures

Counseling Satisfaction Scale (CSS-12) – 12 items to measure 4 counseling dimensions

  • Relationship: respects, listens, understands, responds
  • Meeting Quality: productive, informative, comfortable
  • Professionalism: follow-through, understands job market
  • Responsiveness: makes time to meet, returns phone calls, returns emails

Delivery Pacing – single item

  • Progress through services is too slow, at a good pace, or too fast

Satisfaction with VR services – single item

  • Rated on four point Likert-type scale from dissatisfied to satisfied

Counselor-Consumer Contact Rates – 2 items

  • Face to face meetings in the last six months
  • Conversations by phone or email in the last six months

Reason for Exit – 12 choices classified into three groups

  • Personal Reasons (e.g. concerns about losing benefits, health issues, family issues, substance use issues, transportation barriers, moved)
  • Dissatisfied with Services (e.g. not receiving desired services, VR stopped contacting me, problems with counselor, process taking too long)
  • Met VR Goals (e.g. got a job, received desired services)

RESULTS and IMPLICATIONS

TABLE 1: REASON FOR EXIT/PERCENT

This table lists the 13 stated reasons for exit and the percentage of individuals who indicated each reason. Because individuals could select more than one exit reason, the percentages add to more than 100 percent.

The reasons and their percentages are as follows: I got a new job, 30 percent; I was not receiving the services I desired, 28 percent; VR stopped contacting me, 20 percent; The VR process was taking too long, 18 percent; My health stopped me from continuing services, 12 percent; I received the services I desired, 12 percent; I became discouraged with job opportunities in my community, 12 percent; I was having problems with my counselor, 11 percent; I could not find transportation to appointments or to a job, 9 percent; I moved out of the area, 9 percent; Family issues stopped me from continuing services, 7 percent; I did not want to risk losing my benefits, 5 percent; and Other, 17 percent. 

Reasons for Exit Classifications

  • We classified reason for exit into three groups including personal reasons, dissatisfied with services, and met goals.
  • Because individuals could select more than one exit reason, we created a hierarchy where “met goals” trumped “dissatisfied with services” trumped “personal reasons”

For example, if consumer endorsed “got job” and “having problems with counselor,” exit reason was classified as met goals

Relationship

  • Reason for exit was influenced by overall satisfaction with counseling.
  • Using a global counselor satisfaction score (CSS-12), we found significant between-subjects effects based on exit reason.

TABLE 2: REASON FOR EXIT/COUNSELOR SATISFACTION

This table compares counselor satisfaction scores based on reason for exit.  Consumers who left for dissatisfied with services reasons, had a mean counselor satisfaction score of 2.8 and SD of 0.99. Consumers who left for personal reasons had a mean score of 3.3 and SD of 0.90, and consumers who left for a met goals reason had a mean score of 3.6 and SD of 0.55.  Between group differences were significant, with a p value less than or equal to 0.05.

Delivery Pacing

  • Almost half felt VR pacing was “too slow”
  • Results were consistent across time periods
  • At any time point, only 1-3% felt services were too fast
  • Reason for exit varied based on feelings about delivery pacing

TABLE 3: REASON FOR EXIT/SERVICES TOO SLOW/ RIGHT PACE

Fifty percent of consumers who exited the program for personal reasons rated service delivery as “too slow” as compared to 50 percent who rated it as “about the right pace.” Seventy-one percent of consumers who exited the program for dissatisfied with services reasons rated service delivery as “too slow” as compared to 29 percent who rated it as “about the right pace.” Twenty-eight percent of consumers who exited the program for met goals reasons rated service delivery as “too slow” as compared to 72 percent who rated it as “about the right pace.”  Differences were statistically significant for people who exited for dissatisfied with services and met goals reasons.

Reinforcement

  • Satisfaction with VR was shaped by frequency of counselor-consumer contact for both face to face visits and conversations by phone or email.

TABLE 4: SATISFACTION WITH VR

Satisfaction with VR services was shaped by frequency of counselor-consumer contact for both face-to-face visits and conversations by phone or email in four time periods of the study.

At Time 1, satisfaction with VR services was associated with increases in face to face visits (p less than or equal to 0.000) and phone/email visits (p less than or equal to 0.001).  The average number of face to face visits by satisfaction ratings were 1.89 visits for dissatisfied, 2.14 visits for somewhat dissatisfied, 2.62 visits for somewhat satisfied and 3.49 visits for satisfied.  The average number of phone/email conversations by satisfaction ratings were 1.73 conversations for dissatisfied, 2.41 conversations for somewhat dissatisfied, 3.52 conversations for somewhat satisfied and 3.71 conversations for satisfied.

At Time 2, satisfaction with VR services was associated with increases in face to face visits (p less than or equal to 0.039) and phone/email visits (p less than or equal to 0.012).  The average number of face to face visits by satisfaction ratings were 1.15 visits for dissatisfied, 1.74 visits for somewhat dissatisfied, 2.67 visits for somewhat satisfied and 2.85 visits for satisfied.  The average number of phone/email conversations by satisfaction ratings were 1.25 conversations for dissatisfied, 3.19 conversations for somewhat dissatisfied, 2.54 conversations for somewhat satisfied and 3.17 conversations for satisfied.

At Time 3, satisfaction with VR services was associated with increases in face to face visits (p less than or equal to 0.012) and phone/email visits (p less than or equal to 0.007).  The average number of face to face visits by satisfaction ratings were .58 visits for dissatisfied, 1.95 visits for somewhat dissatisfied, 1.41 visits for somewhat satisfied and 2.53 visits for satisfied.  The average number of phone/email conversations by satisfaction ratings were 0.79 conversations for dissatisfied, 1.90 conversations for somewhat dissatisfied, 2.24 conversations for somewhat satisfied and 2.12 conversations for satisfied.

At Time 4, satisfaction with VR services was associated with increases in face to face visits (p less than or equal to 0.180) and phone/email visits (p less than or equal to 0.019).  The average number of face to face visits by satisfaction ratings were 0.84 visits for dissatisfied, 1.47 visits for somewhat dissatisfied, 2.06 visits for somewhat satisfied and 1.79 visits for satisfied.  The average number of phone/email conversations by satisfaction ratings were 0.77 conversations for dissatisfied, 1.71 conversations for somewhat dissatisfied, 2.53 conversations for somewhat satisfied and 2.31 conversations for satisfied.

Discussion

More engagement during the VR process may reduce exit from the VR program.

  • Increased contact rates create additional opportunities for developing a strong counselor-consumer Working Alliance.
  • Cost neutral communication channels (such as email, phone, or video conferencing) may be effective engagement strategies for rural communities.

Faster service delivery may improve engagement with VR services.

  • Compressing upfront services may help consumers become engaged in the VR process since most drop out occurs in the first six months.
  • Data analysis from 48 VR agencies indicated that less time taken to develop an Individualized Plan of Employment was associated with higher rates of competitive employment closures (Ipsen & Swicegood, 2015).

Even a small increase in consumer engagement could result in significant financial and employment outcomes.

  • Using 2012 RSA-911 data, a 5% increase in retention rates could save approximately $16.3 million and result in an additional 6,650 employment outcomes.

References

Lustig, D. Strauser, D., Rice, N, & Rucker, T. (2002).  The relationship between working alliance and rehabilitation outcomes. Rehabilitation Counseling Bulletin, 46(1), 25-33.

Ipsen, C. & Swicegood, G. (2015).  Rural and urban differences in VR case mix, delivery patterns, and employment outcomes.  Rehabilitation Research Policy and Education 29(4), 349-370.

Rehabilitation Services Administration (RSA). (2012). RSA 911 Case Services Report [Data File].  Washington, DC: RSA

Acknowledgements

We wish to acknowledge the contributions of Bethany Rigles and Casey Ruggiero to this research.

This research was supported by grant H133B080023 from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).  The opinions expressed do not necessarily represent the policy of the Department of Health and Human Services or the endorsement of the United States federal government.