Journal of Rehabilitation Research & Development (JRRD)

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Volume 48 Number 5, 2011
   Pages 597 — 608

Abstract —  Cognitive impairment as barrier to engagement in vocational services among veterans with severe mental illness

Maureen K. O'Connor, PsyD, ABCN;1-2* Lisa Mueller, PhD;1 Alice Van Ormer, PhD;1 Robert Drake, PhD;3 Walter Penk, PhD;1 Robert Rosenheck, MD;4 Alicia Semiatin, MA;1 Charles E. Drebing, PhD1

1Bedford Department of Veterans Affairs (VA) Medical Center, Bedford, MA; 2Boston University School of Medicine, Boston, MA; 3Dartmouth Medical School, Hanover, NH; 4VA Connecticut Healthcare System, West Haven, CT; and Yale School of Medicine, New Haven, CT

Abstract — Vocational services (VS), particularly supported employment models, have clear advantages for assisting adults with severe mental illness (SMI) in returning to the workplace, but a majority of eligible individuals with SMI do not receive any type of VS. The reasons for nonparticipation in VS remain poorly understood, and the potential contribution of cognitive impairment as a barrier to entry has not been explored. The present study uses a pathways-to-care design to examine the specific contribution of cognitive functioning to entry into VS among veterans with SMI. We examined 179 veterans with both SMI and un- or underemployment who completed a work history, the Pathways To Care Inventory, and the Trail-Making Test, Part B. Analysis revealed that veterans with SMI and moderate to severe cognitive impairment took significantly longer to progress through pathways-to-care than those with SMI and mild or no cognitive impairment. These results suggest that identifying veterans with SMI and cognitive impairment early and providing them with integrated and adjunct services may help them navigate VS.

Clinical Trial Registration:; NCT00223834, "Pathways to Vocational Rehabilitation: Enhancing Entry and Retention";

Key words: cognitive functioning, cognitive impairment, integrated services, pathways-to-care, return to work, severe mental illness, supported employment, treatment entry, vocational disability, vocational services.

View HTML  ¦  View PDF  ¦  Contents Vol. 48, No. 5
This article and any supplementary material should be cited as follows:
O'Connor MK, Mueller L, Van Ormer A, Drake R, Penk W, Rosenheck R, Semiatin A, Drebing CE. Cognitive impairment as barrier to engagement in vocational services among veterans with severe mental illness.
J Rehabil Res Dev. 2011;48(5):597-608.

Last Reviewed or Updated  Wednesday, May 25, 2011 2:51 PM

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