Mental retardation

For most adults, employment is the means by which they obtain economic self-sufficiency, a route to social identification, and a source of personal networking. Thus, employment is a critical factor associated with independence and community integration. According to Kiernan (2000), competitive employment is a way in which individuals support their lifestyles, develop friendships, and identify themselves as individuals. Competitive jobs allow vocational rehabilitation (VR) consumers to acquire transferable skills as well as earn higher wages (Moore, 2001a). However, consumers with mental retardation have yet to fully realize those benefits.

For many years, sheltered workshops were viewed as an ideal work setting for persons with mental retardation (Moore, 2001b). Although these settings have advanced previous concepts of employment for persons with mental retardation, they may not afford such persons an opportunity to become economically self-sufficient (Whitehead & Marrone, 1986). Additionally, sheltered workshop environments do not allow persons with mental retardation the opportunity to develop peer networks involving persons other than those with disabilities (Kiernan, 2000). Therefore, a sheltered workshop is less satisfactory as an outcome than competitive employment.

Various mediating variables affect the interests and outcomes for competitive employment for persons with disabilities, particularly those with mental retardation. An individual's ability to obtain and maintain competitive employment is influenced by the individual, his or her significant others, as well as types of VR services provided (Moore & Schroedel, 2000). Each of these variables interacts to either limit or increase the quality of employment opportunities. Devieger and Trach (1999) found that personal and parental involvement in the vocational rehabilitation process most often resulted in employment outcomes associated with self-employment and continuing education for consumers with mental retardation.

Conversely, school and agency personnel are factors inversely associated with employment outcomes of persons with mental retardation. Specifically, the efforts of school and agency personnel may be less effective for successfully transitioning students with mental retardation from school to work. School and VR agency personnel may not utilize best practices for transitioning students with mental retardation from school to competitive work. For example, individualized education plans (IEPs) for students with mental retardation are required for such students who are 16 years of age. Lichtenstein and Michaelides (1993) found, in a case study on school to work transition, that many students with mental retardation do not participate in their own IEP meetings. Moreover, the researchers reported that many IEPs for students with mental retardation stated goals addressing vocational education, job training, and post-secondary outcome. However, no short term objectives or even timelines were associated with the goals. Findings in a study by Devieger and Trach (1999) revealed that school and agency efforts most often resulted in sheltered employment.

Studies (i.e., Schalock, Kiernan, & McGaughey, 1993; Wehman, Kregel, & Seyfarth, 1985) have investigated the rates at which consumers with mental retardation achieve competitive lobs versus sheltered workshop employment. Schalock et al. (1993) found that a majority of participants were employed within a sheltered workshop setting. More specifically, 45% of the sample was employed in a sheltered workshop, 41% in a day activity, 9% in supported employment, 3% in time-limited training, and only 2% in competitive jobs.

Researchers (i.e., Moore, 1998; Moore, Feist-Price, & Alston, in press; Moore, Flowers, & Taylor, 2000) have likewise examined the impact of several consumer and service variables on level of income (i.e., weekly earnings at closure) for persons with mild and moderate mental retardation. For example, Moore (1998) and Moore et al. (in press) reported that race was not significantly associated with level of income. However, in regard to vocational rehabilitation (VR) services, Moore (1998) and Moore et al. (2000) reported that those consumers who were provided with business and vocational training as well as maintenance services achieved higher levels of income. It should also be noted that both studies were based on the RSA-911 database representing fiscal year 1997 (October 1, 1996 through September 30, 1997).

Although studies on work status at closure (i.e., Schalock, Kiernan, & McGaughey, 1993) and level of income (i.e., Moore et al., 2000) exists for persons with mental retardation, there is relatively little applied empirical research focusing on the relationship between consumer characteristics (i.e., gender, race, psychiatric disability), VR services, and work status at closure (i.e., competitive job or non-competitive jobs). Therefore, the purpose of this study was to investigate the relationship between consumer and service variables and the rehabilitation outcomes as measured by work status at closure and level of income. More specifically the following research questions were addressed:

a) Are gender, race, secondary psychiatric disability, business and vocational training, adjustment training, on-the-job training, transportation, maintenance, and job placement significantly related to rehabilitation outcome as measured by work status at closure (i.e., competitive job or other setting)?

b) Are gender, race, secondary psychiatric disability, business and vocational training, adjustment training, on-the-job training, transportation, maintenance, and job placement significantly related to rehabilitation outcome as measured by level of income?

Method

Sample

The population for this study included 838 African American and Caucasian consumers with mild (major disability code = 530) and moderate (major disability code = 532) mental retardation closed into status 26 (i.e., successfully rehabilitated) by a state VR agency in a mid-western state during fiscal year 1997 (Oct 1, 1996 through September 30, 1997). A random sampling technique was used to select 30% (n = 253) of the 838 cases for analysis. The total sample (n=253) was utilized to evaluate the relationship between gender, race, secondary psychiatric disability, VR services and rehabilitation outcome as defined by work status at closure and level of income.

Data Collection

The principal investigator submitted a formal request for consumer case records to the Rehabilitation Services Administration, U.S. Department of Education, and was provided the national RSA-911 database records for fiscal year 1997. The current study was based upon records representing a mid-western state that were extrapolated from the obtained national RSA-911 database. The database is a comprehensive, standardized system of statistical reporting on the complete rehabilitation process for every individual coming into contact with that process, for first referral to final closure (Rehabilitation Services Administration, 1995). Consumers who are closed rehabilitated (status 26) are further coded within one of six specific work status at closure categories: competitive employment, extended employment, self-employment, state-agency-managed business enterprises, home-maker, and unpaid family worker. Because this study sought to evaluate consumers on the basis of whether they obtained competitive jobs or not, cases which were not closed into the competitive employment category were collapsed into the non-competitive jobs category. As a result, there were two categories of the work status at closure criterion: competitive employment and non-competitive employment. One criterion for competitive employment is a minimum competitive wage. Since consumers who are self-employed may not earn a minimum competitive wage, self-employment was not included in the competitive employment category. In short, including self-employment in the competitive employment category would have further broadened the operational definition of competitive employment and perhaps compromised the worthiness of the current study.

Data Analysis

Because one criterion variable under consideration was recorded on a nominal measurement scale (i.e., work status at closure) and the other an interval scale (i.e., level of income), we conducted two types of statistical analyses: logistic regression and multiple linear regression analyses. Based upon Cohen and Cohen's (1983) approach, logistic regression was the most appropriate analysis for evaluating the relationship between two or more predictor variables and a dichotomous criterion variable (i.e., work status at closure). Multiple linear regression analysis was selected as the most appropriate for evaluating the relationship between any two or more predictor variables and an interval criterion variable (Bordens & Abbot, 1999; Cohen & Cohen, 1983). Logistic regression analysis uses the explanatory variables (i.e., gender, race, secondary psychiatric disability, VR services) to predict the probability that the response variable will take on a given value. Multiple linear regression analysis uses the explanatory variables to predict the mean of the continuous response variable at any specified set of values for the explanatory variables. The Statistical Package for the Social Sciences, logistic regression and multiple linear regression procedures (SPSS, 1989), were used in these calculations.

Results

Participants

All members of the sample were classified by the state rehabilitation agency as having one of the following primary disabilities: (a) mild mental retardation or (b) moderate mental retardation. Fifty-three percent of the participants were males. Of the total sample, 13% (n=32) of participants were African American and 87% (n=221) were Caucasian. Other racial and ethnic members of under-represented groups were not included in the analysis because of low incidence in the sample. Interestingly, 15% of the sample possessed a secondary psychiatric disability while the other 85% did not report the presence of a secondary psychiatric disability.

VR Services

Rehabilitation service variables, unlike consumer characteristics, are not relatively fixed and can be manipulated to produce better rehabilitation outcomes (Schwab & DiNitto, 1993). Operational definitions for such services follow as outlined in the Rehabilitation Services Administrations' Information Reporting Manual for the Impact Reporting System (RSA-911) (pp. 33-35). Business and vocational, or non-collegiate post-secondary education, includes training in business/commercial school or a vocational/trade school. Training in the business/commercial school or college would prepare individuals for work in the areas of office practice, typing, word processing, bookkeeping, accounting data processing, etc. Maintenance services are provided to cover additional costs incurred by consumers while they are undergoing rehabilitation services. On-the-job training occurs when a consumer works for wages while simultaneously learning skills of a job.

Transportation is any service provided or arranged for by the State agency to enable individuals to arrive at appointments for assessment, medical services, training, or any other rehabilitation service, as well as to permit consumers to get to work. Adjustment training helps consumers adjust to a particular situation hindering their ability to work. Included would be work conditioning, developing work tolerance, mobility training, remedial training, literacy training, lip reading, Braille, etc. Finally, job placement services are rendered when individuals are referred to and are hired by employers.

Very few of the sample received either business and vocational training, on-the-job training, maintenance, or adjustment training (see Table 1). In contrast, transportation and placement, services were received by larger percentages of the sample, with placement services being the most frequent service provided (66.8%).

Work Status at Closure

First, the distributions of the predictor variables were examined. Ideally, those variables should exhibit an equal (50/50) distribution. Although distributions of 80/20 are appropriate for logistic regression analyses, variables with distributions greater than 80/20 (e.g., 95/5) should be excluded from the procedure (Cohen & Cohen, 1983). Thus, similar to procedures implemented in studies conducted by Bullis, Davis, and Johnson (1995), Moore (2001 a), Moore et al. (2000) and Moore (in press), predictor variables with distributions greater than 95/5 were in fact excluded from analysis. Because they did not meet this criterion, business and vocational training and on-the-job training were excluded from further analysis. Second, phi correlations among gender, race, secondary psychiatric disability, maintenance, transportation, adjustment training and placement were calculated. Intercorrelation among the independent variables ranged from .00 to .26. These values were sufficiently low to conclude that there was no multicollinearity among the independent variables.

A one-step or simultaneous logistic regression analysis addressed Research Question 1 by investigating the linear relationship between gender (men=0, females=1), race (African American=0, Caucasians=1), secondary psychiatric disability (no=0, yes=1), maintenance (no=0, yes=1), transportation (no=0, yes=1), adjustment training (no=0, yes=1), job placement (no=0, yes=1) and rehabilitation outcome as measured by work status at closure (non-competitive jobs=1 and competitive jobs=2). The statistical analysis for the relationship between the service variables and work status at closure revealed the following results: Of the seven predictor variables entered into the logistic regression, only job placement ([r.sup.2] = .04, Wald = 9.88, p= .007, B = 1.07) was identified as being positively associated with achieving competitive jobs (see Table 2).

Although partial correlations for the relationship between job placement and competitive jobs appear to be minimal in statistical terms, small effect sizes for such relationships (i.e., [r.sup.2] = .04) can be important (Prentice & Miller, 1992). Practically speaking, in this mid-western state and within the ranges of the variables studied, having received job placement services appears to make an important difference with respect to achieving competitive jobs. On the other hand, results suggested that transportation ([r.sup.2] = .03, Wald = 7.43, 12 = .006, B = -.95) and adjustment ([r.sup.2] = .03, Wald = 8.58, p = .001, B = -1.79) were inversely related to achieving competitive employment. That is, consumers who were provided with transportation and adjustment were more likely to achieve noncompetitive jobs.

Income

Participants' income ranged from $0 to $500 (m = $113.72) per week (SD = $78.57, median = $95; mode = $95). Excluding the extreme values (0$ and $500 per week), the average wage per week was $112.63 (n = 251). A one-step multiple linear regression analysis addressed Research Question 2 by investigating the relationship between gender (men=0, females=1), race (African American=0, Caucasians=1), secondary psychiatric disability (no=0, yes=1), maintenance (no=0, yes=1), transportation (no=0, yes=1), adjustment training (no=0, yes=1), job placement (no=0, yes=1) and rehabilitation outcome as measured by level of income. Of the seven variables entered into the multiple regression equation, none were significant predictors of higher levels of income (see Table 3). That is, no statistically significant differences were noted for achieving higher levels of income based on gender, race, the presence of a secondary psychiatric disability or whether or not consumers received maintenance services, transportation, adjustment training, or job placement services.

Discussion and Implications for Rehabilitation

The results of the current study identified job placement as a service that was positively associated with achieving competitive jobs though not with level of consumer income. Specifically, those consumers with mild/moderate mental retardation who were provided with job placement services were slightly more likely to achieve competitive jobs when compared to those who did not receive such services. The importance of providing job placement services and the subsequent positive impact on employment outcomes are well documented throughout the empirical rehabilitation outcome literature. For example, Moore (2001 c) reported that 84% of those consumers who were provided with job placement services were closed successful compared to approximately 70% of those consumers who did not received such services. Specific to persons with mild/moderate mental retardation, Moore et al. (2000) found that consumers who received job placement services were more likely to achieve closure success when compared to those consumers who were not provided with such services.

With the benefits of providing such services in mind, the researchers discuss the following implications for current rehabilitation practice. First, VR counselors might consider informing consumers with mild/moderate mental retardation of the availability of job placement services by incorporating such information in their individualized plans for employment. This action might enhance the numbers of such consumers who achieve competitive jobs.

One traditional model of job placement utilized by rehabilitation counselors and job placement specialist for persons with mental retardation is supported employment (Szymanski & Parker, 1996; Trochim, Cook, & Setze, 1994). The goal of supported employment is to "successfully" place persons with severe disabilities, including those with mental retardation (Trach & Rusch, 1989). The supported employment model uses a place-then-train approach in which the emphasis is first on locating an integrative setting, then placing the consumer and providing training and support needed to maintain competitive employment. Tabulations based on the current RSA-911 database indicated that only 49% (n=123) of participants with mild or moderate mental retardation received supported employment. Although such supported employment services are typically reserved for persons with severe/profound mental retardation, rehabilitation counselors might consider identifying more consumers with mild/moderate mental who could benefit from supported employment vis-a-vis job placement.

Implications for Future Research

Because this study was limited to a mid-western state, the results cannot be generalized to other geographical locations that differ in regard to population and ecology. From a population validity standpoint, the population of consumers with mild and moderate mental retardation may differ in terms of the socio-economic level of their families from state to state. From an ecological perspective, one must use caution when generalizing findings to those states that do not have a similar economy (e.g., Mississippi) or similar unemployment rate.

This study lacked any measure of the quality of each service provided, thus future research is needed that utilizes measures of quality of services received. For example, instead of an archival study, one might actually go out to the rehabilitation service agencies and perform direct face-to-face interviews with consumers receiving certain services. The researcher(s) might then survey consumers about the quality of the service they received. Variables that can be used as indicators of quality of services might include whether services were: (a) provided in a timely manner, (b) conducted for a duration appropriate for the consumer's rehabilitation need, and (c) coordinated effectively. Future research questions may be:

(a) Is quality of rehabilitation services significantly related to rehabilitation outcome as measured by work status at closure?, and

(b) Is quality of rehabilitation services significantly related to rehabilitation outcome as measured by level of income?

The tremendous differences in functional capabilities between persons with mild and moderate mental retardation warrant further attention as such differences could limit the current findings external validity. Categories of mental retardation take into account an individual's physical and social development, and correspond roughly to IQ scores (American Association on Mental Retardation, 1992). Individuals with mild mental retardation, those with rough scores between 53 and 70, are able to learn academic and prevocational skills with some special training. Persons with moderate mental retardation, those with rough scores of 36 to 52, are able to talk and take care of their own basic needs, to learn functional academic skills, and to undertake semiskilled work under sheltered employment. One could argue that individuals with moderate mental retardation may require more or different types of services when compared to persons with mild mental retardation. The composition of the current sample (i.e., persons with mild and moderate mental retardation) might not provide data that accurately identify the service needs of each individual group. As such, future researchers could address worthy questions regarding rehabilitation outcomes by evaluating rates of competitive employment either for persons with mild mental retardation or moderate mental retardation.

The current study evaluated the relationship between gender, race, the presence of a secondary psychiatric disability, VR services, and rehabilitation outcomes as defined by work status at closure and level of income, for persons with mild and moderate mental retardation. However, persons with severe mental retardation were not included in the study. Therefore, researchers may wish to replicate the current study with the population of persons with severe mental retardation. Research questions addressed could be:

(a) Are gender, race, psychiatric disability, business and vocational training, adjustment training, on-the-job training, transportation, maintenance, and job placement significantly related to rehabilitation outcome as measured by work status at closure (i.e., competitive job or other setting)?

(b) Are gender, race, psychiatric disability, business and vocational training, adjustment training, on-the-job training, transportation, maintenance, and job placement significantly related to rehabilitation outcome as measured by income?

In the current study, gender, race, secondary psychiatric disability, and some VR services were not found to be significantly associated with work status at closure or level of income. However, due to minimal variability within some variables (e.g., maintenance and adjustment), such findings are plausibly a result of too many Type II errors. That is, results may have indicated a finding of non-significance when in fact relationships are statistically significant. If a sample representing 50% of consumers who received maintenance and 50% of consumers who were not provided with maintenance were compared, findings might indicate that such services are significantly associated with work status at closure. Therefore, readers should use caution when attempting to draw conclusions based on the current non-significant findings, as these variables (i.e., gender, race, secondary psychiatric disability, maintenance, and adjustment) could otherwise prove to be powerful discriminators of competitive jobs and level of income.

References

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Corey L. Moore, Rh.D., CRC, Associate Professor, Graduate Program in Rehabilitation Counseling, Langston University, 4205 North Lincoln Blvd., Oklahoma City, OK 73105.

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