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Returning to Work After Spinal Cord Injury: Research Raises Expectations for Newly Injured

By Carolann Murphy, PA

For people with disabilities, the value of being employed goes beyond the financial gains afforded by salary and benefits. They view employment as important to their personal identity and self-esteem, and as a pathway to inclusion in society as well as the workplace. The majority are striving to work, according to Kessler Foundation's 2015 National Employment and Disability Survey, including people disabled by spinal cord injury, a group with employment rates much lower than for people with other types of disabilities. Their prospects for employment are complicated by short rehabilitation stays, the growing caseloads at state vocational rehabilitation agencies, and lack of follow up post-rehabilitation.

Returning to work despite the challenges to engaging in competitive employment helps individuals adjust to living with spinal cord injury.  For many, working normalizes life after spinal cord injury, identifying the person as an active participant in society, and lessening the focus on their disability. Evidence supports other benefits, including higher levels of community integration, independence, and satisfaction with life, and greater longevity. By adapting a model of vocational resource facilitation developed for people with traumatic brain injury, a team of researchers and clinicians at Kessler Institute for Rehabilitation are achieving remarkable success in helping people with spinal cord injury maintain their jobs or find new ways to apply their skills and experience to the workplace.

At Kessler, the employment rate at one year post-injury is 36% for individuals with traumatic spinal cord injury, reported Adria De Simone, MS, CRC, LAC, CWIC, the projects' vocational resource facilitator. "Compared with 2011-2016 data from the federally funded Spinal Cord Injury Model System database, this represents a 125% improvement over national data," she said, "and a 71% improvement over the rate reported locally by the Northern New Jersey Spinal Cord Injury System."

The key element of this demonstration project, funded by the Craig H. Neilsen Foundation, is the dedicated on-site vocational resource facilitator, according to John O'Neill, PhD, the project's lead investigator and director of the Center for Disability and Employment Research at Kessler Foundation. "Incorporating vocational planning during in-patient rehabilitation makes a difference in employment outcomes," stated Dr. O'Neill. "By introducing this concept early, the facilitator can help explore options and facilitate any necessary referrals, and coordinate with New Jersey Division of Vocational Rehabilitation Services (NJDVRS)."

Meeting routinely with the clinical team helps the facilitator connect with eligible participants and supports an individualized person-centered approach to vocational planning. Another important aspect is two-year follow up by the facilitator, which increases the likelihood of individuals returning to work, and smooths the transition from medical to community-based services.  
"Because of the success of the project, NJDVRS is funding the ongoing project—the first step toward sustainability," noted Dr. O'Neill. Other rehabilitation facilities are interested in the significant outcomes at Kessler. "The goal is to have these kind of services available to all newly injured individuals," he summarized. "That will increase the impact of this research, and make a real difference in the lives of people with spinal cord injury."