Building the case for delivering health promotion services within the Vocational Rehabilitation system

Several research studies report a negative relationship between employment and secondary conditions that could be reduced or managed through improved health promoting behaviors and self-management practices. Access to health promotion programs, however, is limited for people with disabilities due to employment, financial, insurance, and environmental barriers. Vocational Rehabilitation provides one possible delivery point for overcoming these barriers and improving access.

This paper builds the case for delivering health promotion activities within the Vocational Rehabilitation program by (1) exploring how VR clients compare to another disability group that reduced their secondary conditions through participation in the Living Well with a Disability health promotion program; (2) understanding how health limitations and behaviors change over time for VR clients, in the absence of a health promotion intervention; and (3) investigating the relationship between baseline health factors and downstream employment outcomes for VR clients.

At baseline, VR (n=162) and Living Well (n = 188) respondents reported similar severity ratings across many secondary conditions and had similar ratings of health promoting lifestyle behaviors. Follow-up analyses showed that, in the absence of an intervention, limitations from secondary health conditions were non-systematic over time for the VR group. A binary logistic regression model indicated that baseline total sum of secondary conditions was the only significant predictor of employment at 18 months, after controlling for demographic characteristics, disability severity, and economic indicators.

Because secondary conditions can be ameliorated through health promotion programming, this research supports continued exploration of health promotion delivery within the VR system.