Evaluation of an innovative vocational rehabilitation pilot program in Washington State

Background and Objective: Vocational rehabilitation programs administered through workers' compensation have been widely criticized for their inefficiency and failure to produce desired outcomes. To improve the performance of the Washington State workers' compensation vocational rehabilitation program, the Department of Labor and Industries (L&I) initiated a 5.5-year pilot program in 2008. Authorized through legislation (ESSB 5920), this pilot introduced fundamental changes in the vocational rehabilitation system aimed at enhancing efficiency and improving worker outcomes. The evaluation report will be delivered to the Legislature in December 2012 and will inform decisions regarding permanent continuation of the pilot program. Methods: Four data sources were used: (1) L&I's administrative databases, (2) Employment Security Department employment/wage data, (3) baseline interviews of 361 workers found eligible for retraining, and (4) outcome interviews of 360 workers conducted 4-6 months after claim closure. Cox proportional hazards and Poisson models compared system efficiency under the pilot program to a pre-pilot baseline period. Results: Compared with baseline, several processes were more efficient under the pilot: (1) repeat vocational referrals for the same service dropped by >20% (p<.01), (2) retraining plans were developed and submitted to L&I for review more promptly (HR=2.2; p<.001), (3) there was a reduction in plans with delayed review (baseline=6.6%, pilot=1.9%; p<.001), (4) overall duration from plan development referral to retraining decreased (HR=1.52; p<.001), and (5) duration from plan completion to claim closure decreased (HR=1.49; p<.001). Conclusion: Preliminary evidence suggests that the pilot program enhanced system efficiency. Data regarding employment and satisfaction outcomes will soon become available.