Empirical Evidence Supporting the Effectiveness of Vocational Rehabilitation

Abstract

Vocational rehabilitation (VR) services can be found in the public sector (e.g., state VR agencies), private not-for profit sector (e.g., Goodwill Industries), and private-for-profit sector (e.g., insurance-based rehabilitation). In each of these sectors, VR personnel are asked to provide assessment, counseling, job development and placement or case management services for persons with disabilities. Thus, despite the sector, all VR personnel utilize similar assessments or interventions for similar outcomes (i.e., competitive employment). Since we have this commonality with assessment and interventions, we also have a commonality of problems. Particularly, how do we, as VR professionals, know that the assessment we use are valid or that the vocational interventions we provide are effective? Or, how sure are we that these assessments and interventions are the best available? Difficult questions like these have been asked of many of the health care professions for decades. Many working in these fields have conducted research to show that their profession has desired outcomes and that one intervention works better than others for a given issue. In many instances, the federal government and insurance companies require this type of information before they will consider payment or funding for a given test or treatment. This type of professional accountability originally began with medicine (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996) and became in such demand that the Cochrane Collaboration (www.cochrane.org), a non-profit organization, was founded for the sole purpose of collecting and disseminating evidence-based health care information. This wave of empirical evidence for health care has permeated to affect social and behavioral professionals including rehabilitation (Schlosser, 2006). For years the efficacy of psychotherapy was called into question (c.f., Eysenck, 1957). This assault contributed to the pioneering development of the meta-analytic technique to determine whether psychotherapy does have positive effects (Smith & Glass, 1977). However, the question posed by Paul (1967), What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances? (p. 111) remains largely unanswered. Mental health organizations have begun to make strides to address these issues. The American Psychological Association is incorporating EBP within the profession of psychology (APA Presidential Task Force on Evidence-Based Practice, 2006) as are clinical social workers (Thyer, 2002). On the contrary, little systematic review of the efficacy of VR interventions has been published in the rehabilitation literature. The paucity of comprehensive outcome research may already be having a negative consequence on the VR profession. During the past several years, several states have removed mandatory VR from their workers' compensation statues. One can only speculate what would be the case if research had convincingly shown VR to be an effective approach in returning injured workers back to work and hence reducing the costs associated with work injuries. It is likely that VR professionals will soon have to effectively delineate the evidence for their interventions and assessments. This article's intent is to introduce the concept of EBP and then describe the outcomes research as it pertains to the various VR sectors. Finally, there will be recommendations for additional research to better establish EBP in the VR field. Definition of Evidence-Based Practice Evidence-based practice can be defined as a total process beginning with knowing what clinical questions to ask, how to find the best practice, and how to critically appraise the evidence for validity and applicability to the particular care situation (Chronister, Cardoso, Lee, Chan, & Leahy, 2005). The best evidence then must be applied by a clinician with expertise in considering the patient's unique values and needs. …