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R-5: Does VR Effectively Support Community Living?


Project Description

Text for Fact Sheet:
How Do Vocational Rehabilitation Outcomes Vary Among
Different Types of Living Arrangements?

Study Purpose: Why It Matters

Vocational rehabilitation (VR) for people with disabilities provides them with access to employment, playing a vital role in maintaining an individual’s independence and participation in the community.

Current evidence on how effective VR services are for people in various types of living arrangements does not exist. This study examined the relationship between employment outcomes for people with disabilities and their type of living arrangement. With this new data, we may find ways to improve the outcomes of VR for people living in all types of arrangements.

Where We Looked: The Data

The data were extracted from the virtual case management dataset of a Midwestern state (Illinois) VR agency that included 50,729 clients referred to the agency between January 2004 and June 2010. Of these clients, 46,456 had information appropriate for the analysis.

We considered these categories of living arrangement for people with disabilities in VR:

1.  Private residence
2.  Community group home
3.  Facility/institution: Including rehabilitation facility, mental health facility, substance abuse treatment facility and nursing home
4.  Other: Including adult correctional facility, halfway house, homeless shelter and other

What We Learned

The findings indicated that types of living arrangements are associated with rehabilitation status, hourly wage and hours worked per week. (See Figures descriptions below for more information.)
 
•  As compared to clients living in a private residence, clients living in community group homes tend to have a lower chance of getting an hourly wage at an average rate or higher. They also have a lower chance of working during the week for a number of hours considered average or higher among all clients. The clients in community group homes, however, are not significantly different from those in private residences in terms of rehabilitation status.

•  Clients who reside in a facility/institution are less likely to get vocationally rehabilitated (to be successfully employed) compared to clients in a private residence. In addition, the former group is less likely to work each week for an average number of hours or higher.

•  Clients who come from correctional/homeless shelters and any other type of living arrangement have a higher likelihood of vocational rehabilitation and are more likely to have worked at average hours or higher per week when they are contrasted to those from a private residence. Yet these clients are less likely to receive an hourly wage that falls within the average rate or higher as compared to the clients in the private residence group.

Figures

(See the PDF for graphics.) In the three figures that follow, the left axis reads: Community Group Home; Facility/Institution; Correctional/Shelter/Other. The bottom axis reads: Adjusted Odds Ratio (OR).


Figure 1: "The Odds of Being Rehabilitated Among Different Types of Living Arrangement as Compared to a Private Residence."
Figure 1 shows that the clients in correctional/shelter/other types of living arrangement are more likely to receive rehabilitation than those in private residence. The clients in a community group home and facility/institution, on the other hand, seem to have less chance of getting rehabilitated, but we cannot conclude this with confidence because the interval line of their estimate crosses over the vertical dashed line. 

Community Group Home (Odds Ratio or OR = 0.95, LL = 0.86, UL = 1.05), Facility/Institution (OR = 0.84, LL = 0.69, UL = 1.02), Correctional/Shelter/Other (OR = 1.66, LL = 1.45, UL = 1.90);
(OR = odds ratio, LL = lower limit, UL = upper limit)

Figure 2
In Figure 2, the clients in community group home and in correctional/shelter/other types of residence are clearly worse off than those in private residence in terms of earning higher hourly wage ($9.18 or more). We cannot conclude with confidence the situation for the clients in a facility/institution, since the interval line of the group's estimate crosses the indicator line (the vertical dashed line).

Community Group Home (OR = 0.53, LL = 0.45, UL = 0.64), Facility/Institution (OR = 1.04, LL = 0.77, UL = 1.41), Correctional/Shelter/Other (OR = 0.47, LL = 0.37, UL = 0.60); (OR = odds ratio, LL = lower limit, UL = upper limit)

Figure 3
Figure 3 reveals that when it comes to obtaining relatively longer hours of work per week, the clients in a community group home and those in a facility/institution are worse off than the clients in private residence. In contrast, the clients in correctional/shelter/other types of living arrangement have a higher chance (or are better off) than those in a private residence to work longer hours per week.

Community Group Home (OR = 0.37, LL = 0.32, UL = 0.43), Facility/Institution (OR = 0.70, LL = 0.53, UL = 0.93), Correctional/Shelter/Other (OR = 2.73, LL = 2.25, UL = 3.32); (OR = odds ratio, LL = lower limit, UL = upper limit)

Notes on the figures (see PDF for graphics):
- The vertical dashed line helps indicate which situation is desirable (right side) and which one is not (left side). If the interval line of one group's estimate crosses over this dashed line, the result is considered not conclusive or not significant. That is, we cannot conclusively say that this group is better off or worse off.
-The odds value represents the chance of having a desirable outcome (rehabilitation, higher hourly wage and more working hours per week). The odds ratio compares the chance of having the outcome against not having it. Adjusted odds ratio is an odds ratio calculated after taking into account other factors, such as age, gender, race and so on.
-An adjusted odds ratio of more than one indicates a tendency toward a better situation. In contrast, an adjusted odds ratio of less than one indicates a tendency for worse situation.
-The “whiskers” on either side of the dot show the spread of odds ratio values in the majority of clients. If the whiskers do not cross the dashed vertical line of value one, then the odds ratio value is considered significant.


Project Investigtors at the University of Illinois at Chicago:
Fabricio E. Balcazar, PhD, Principal Investigator
Ashmeet Oberoi, MSc, MA
Sean Cariño, MPH 
F. L. Fredrik G. Langi

The Research and Training Center on Community Living is funded by a grant from the National Institute on Disability and Rehabilitation Research, award number H133B060018.

Produced by:
Research and Training Center on Independent Living (RTC/IL)
The University of Kansas 
4089 Dole Center 
1000 Sunnyside Ave.
Lawrence, KS 66045-7561
Ph 785-864-4095
TTY 785-864-0706 
FAX 785-864-5063
rtcil@ku.edu
© April 2013


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