Affiliations: [a] University of Montana, Rural Institute for Inclusive Communities, Missoula, MT, USA
| [b] Partnership Health Center, Missoula, MT, USA
Correspondence:
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Address for correspondence: Catherine Ipsen, University of Montana, Rural Institute for Inclusive Communities, 241 Corbin Hall, Missoula, MT 59812, USA. Tel.: +1 406 243 4562; Fax: +1 406 243 2349; E-mail: Catherine.ipsen@mso.umt.edu.
Abstract: BACKGROUND:Results-based funding models can improve Vocational Rehabilitation (VR) client employment outcomes, but evidence suggests that gaps in services occur when provider risk is not compensated. OBJECTIVE:The purpose of this qualitative study is to learn how VR agencies deliver and pay for job development and placement services, the factors that shape decision-making, and the outcomes of such decisions. METHODS:Administrators from 40 VR agencies identified informants to take part in qualitative interviews about how their agency delivers, contracts, and pays for job development services. Interview notes were analyzed to identify themes and dimensions in the data. RESULTS:Gaps in provider services exist in rural communities, where provider risk is increased due to economic, transportation, and delivery barriers. Strategies to overcome barriers focused on expanding available providers by lowering requirement for provider entry, increasing recruitment activities by the VR agency, reducing financial risk in the form of incentives, tiered payments, and shared funding models, and increasing agency capacity and support. CONCLUSIONS:Strategies for effective VR service delivery are shaped by multiple factors and choice points at the agency level. A deeper understanding of the intended and unintended consequences of service delivery models is an important contribution to informed decision-making.
Keywords: Vocational Rehabilitation, service delivery, rural, disability, results-based-funding
