Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI

Article type: Research Article

Authors: Johnstone, Brick^{a; *} | Price, Terrie^b | Bounds, Thomas^a | Schopp, Laura H.^a | Schootman, Mario^c | Schumate, Duane^d

Affiliations: [a] University of Missouri-Columbia, Columbia, MO, USA | [b] The Rehabilitation Institute, Kansas City, MO, USA | [c] Washington University, St. Louis, MO, USA | [d] Division of Vocational Rehabilitation, Columbia, MO, USA

Correspondence: [*] Address for correspondence: Brick Johnstone, Ph.D., Department of Health Psychology, DC046.46, Columbia, MO 65212, USA. Tel.: +1 573 882 6290; Fax: +1 573 884 4540; E-mail: johnstoneg@health.missouri.edu

Abstract: Objective:To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency. Participants:78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period. Measures:Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case). Procedure:All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas. Analyses:Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs. Results:Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas. Conclusions:Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas.

Keywords: traumatic brain injury, vocational rehabilitation, rural

DOI: 10.3233/NRE-2003-18303

Journal: NeuroRehabilitation, vol. 18, no. 3, pp. 197-203, 2003