Vocational Rehabilitation in Multiple Sclerosis: A Process Perspective.

TitleVocational Rehabilitation in Multiple Sclerosis: A Process Perspective.
Publication TypeJournal Article
AuthorsFraser RT
JournalJournal of Spinal Cord Medicine

Background/Method: Project 4 at the University of Washington Multiple Sclerosis Rehabilitation Research and Training Center involves the collection of comprehensive demographic, psychosocial, and neuropsychological profile data on 200 consecutive clients with multiple sclerosis (MS) referred for vocational rehabilitation services. Profiles were developed for those who remain engaged with the program and early program leavers or dropouts. Discriminating variables included higher rates of external support for the dropouts and a lack of even part-time employment at program entrance. At approximately midpoint in this 5-year study, data were reviewed on 3 active subgroups to include those in process, job placement candidates, and those securing placement. Subgroups of those placed will also be reviewed: self-placements, placement assistance only, and job site support. Conclusion: A number of service needs really need to be met for this population: comprehensive and targeted financial counseling with regard to their subsidy or disability insurance context; self-management strategies related to depression, fatigue, and anxiety; and expanded timelines in the vocational rehabilitation process due to the complexity of their disability. In relation to placement options, there is a marked need for “stimulating” part-time and also home-based work activity with job site accommodations needed with some frequency—chiefly procedural or “low tech” assistive equipment. Throughout the vocational rehabilitation process, there is a significant subgroup experiencing frustration in not achieving job goals of higher complexity, chiefly due to their cognitive difficulties (as reviewed by Clemmons). Non-paid job tryouts, stipended AmeriCorps, and other options are reviewed in an effort to assist these clients to emotionally absorb and adjust to their limitations.

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