Catherine Ipsen - Academia.edu (original) (raw)

Papers by Catherine Ipsen

Frontiers in Rehabilitation Sciences

PurposeThe purpose of this study is to parse out differences between unmet need and perceived nee... more PurposeThe purpose of this study is to parse out differences between unmet need and perceived need for health care services among rural and urban adults with disabilities in the United States. While unmet need focuses primarily on environmental factors such as access to health insurance or provider availability, perceived need relates to personal choice. This distinction between unmet and perceived need is largely ignored in prior studies, but relevant to public health strategies to improve access and uptake of preventive care.MethodsUsing Wave 2 data from the National Survey on Health and Disability, we explored rural and urban differences in unmet and perceived health care needs among working-age adults with disabilities for acute and preventive services.FindingsAlthough we found no significant differences in unmet needs between rural and urban respondents, we found that perceived needs for dental care and mental health counseling varied significantly across geography. Using logis...

When it comes to planning, meeting accommodation needs, and accessibility issues, people with dis... more When it comes to planning, meeting accommodation needs, and accessibility issues, people with disabilities are at a disproportionately high risk during times of crisis compared to those without. Additionally, many people with disabilities are immunocompromised and are at a greatest risk of serious complications and death due to infection from COVID-19. This survey was launched in April of 2020 to look further into how people with disabilities have been experiencing the COVID-19 pandemic, how their daily lives have been impacted, and how and where they were accessing information on best practices and early recommendations by various information sources. We were particularly interested in learning about differences among people with disabilities in both urban and rural areas in the United States. To collect this information, we launched a survey on Amazon MTurk, which is a common platform for recruiting participants in hard-to-reach populations within social science and human subjects...

Data from the 2009 Rehabilitation Services Administration Case Services Report (RSA 911) indicate... more Data from the 2009 Rehabilitation Services Administration Case Services Report (RSA 911) indicate that approximately 50% of Vocational Rehabilitation (VR) consumers leave the system prematurely. Premature exits include case closures related to lost contact with the consumer due to inaccurate address, disconnected phone or consumer relocation (17.4% of cases); consumer refusal to continue services (17.2% of cases); or consumer failure to cooperate (15% of cases).

Disability and Health Journal, 2019

Background: Social isolation has been compared to smoking in terms of risk to public health. Some... more Background: Social isolation has been compared to smoking in terms of risk to public health. Some groups are at particularly high risk for these feelings, including people with disabilities and rural residents. Few studies have considered the potentially compounding effects of disability status and rural residency. Objective: To evaluate how reported satisfaction with social participation and perceived isolation relate to the health of rural and urban people with disabilities, and to consider whether number of disabilities, living arrangement, and employment status were associated with differences in reported satisfaction with social participation and perceived isolation. Methods: This observational, cross-sectional analysis utilized data from working-age adults with disabilities (n = 1246) collected by the Collaborative on Health Reform and Independent Living (CHRIL). Results: There were significant associations between reported health and measures of satisfaction with social participation and perceived isolation (all ps < .001). Increased number of disability issues, not being employed, and living with at least one other person were associated with reduced satisfaction with social participation (ps < .01), and number of disability issues and not being employed were associated with increased perceived isolation (ps < .01). Urban residents reported feeling more isolated (ps < .05) and there were multiple predictor x geographic residency (rural versus urban) interactions. Conclusion: These results underscore the importance of considering geography as a factor in understanding satisfaction with social participation and perceived isolation and how these factors relate to health in people with disabilities.

Journal of Disability Policy Studies, 2006

This study used data (N = 3,076) from the Behavioral Risk Factor Surveillance System to explore t... more This study used data (N = 3,076) from the Behavioral Risk Factor Surveillance System to explore the relationship between employment and health behaviors for individuals with physical disabilities. Results from a binary logistic regression model, with employment as the dependent variable, show that exercise increased the probability of employment by 8.4% after controlling for participant demo-graphics, severity of disability, and secondary health conditions. These results speak to the importance of health promotion for people with disabilities who desire employment.

Frontiers in Rehabilitation Sciences

PurposeThis paper investigates how life events such as injuries, health insurance coverage, geogr... more PurposeThis paper investigates how life events such as injuries, health insurance coverage, geography, and occupation contribute to mobility disability rates over time. Findings can inform policies and practices to address factors that may contribute to disability in rural and urban areas.MethodsWe utilized 27 waves of the National Longitudinal Survey of Youth (NLSY) data from 1979 to 2016 to explore how past injury, occupation, health insurance coverage, and rurality predicted mobility impairment at ages 40 and 50 using regression analysis.FindingsRural respondents reported significantly higher rates of mobility impairment at age 40 and age 50 relative to people living in urban areas, and were more likely to report injury, work in high exertion occupations, and experience several pain-related health conditions. Using logistic regression and controlling for race and education, we found that people had higher odds of experiencing mobility impairment at age 40 if they reported a broke...

In 1991-92, the Research and Training Center on Rural Rehabilitation (RTC: Rural) evaluated 45 st... more In 1991-92, the Research and Training Center on Rural Rehabilitation (RTC: Rural) evaluated 45 state Vocational Rehabilitation (VR) agencies' policies and procedures regarding self-employment for people with disabilities. Based on this analysis, researchers developed and broadly disseminated a model VR self-employment policy (Arnold & Seekins, 1994) and were successful in their efforts to have self-employment included as an employment outcome in the 1998 Reauthorization of the Rehabilitation Act. In 2002, RTC: Rural investigated state policies again to see how they had changed and what trends had developed over the intervening decade. Researchers requested a copy of state self-employment policies and procedures from each of 82 departments of Vocational Rehabilitation in the 50 states and the District of Columbia. Although our original study excluded visual services agencies, the current study included them, plus general VR and combined VR/visual services agencies. Fifty-four state agencies responded for a 65.9% response rate. Two researchers conducted independent reviews of the policies and procedures and compared them to RTC: Rural's recommended model policy. They evaluated the changes in states' self-employment policies and procedures to determine whether the states had adopted the model policy. Researchers found that VR agencies are now more open to selfemployment outcomes. As self-employment for people with disabilities became more accepted over the past 10 years, several VR agencies revised their self-employment policies and procedures. Return to Table of Contents Results We commend state agencies for the changes in their self-employment policies and procedures. Of the 54 policies received: 32 (59%) were developed since the 1998 Reauthorization of the Rehabilitation Act. Current policies are more positive towards selfemployment than those reviewed in 1992. State policies address an average of 6.6 components, compared with 3.7 components in 1992. "Developing a business plan" is the most commonly included component (96%) and "follow-up" is the least-included component (54%). In 1992 just one policy addressed all eight model components; now 17 policies do (11 agencies participated both times). Similarly, in 1992 four policies included seven components; now 15 do (12 agencies participated both times). Many agencies have developed self-employment programs and published manuals for counselors, checklists, and consumer resources such as fact sheets and planning guides. Agencies have developed or use services or programs developed specifically to assist people with disabilities develop successful businesses. Previously, many policies contained negative statements about selfemployment, but now only one policy contains negative statements. There are many methods for funding a self-employment plan. Some state plans don't address cost. Some use a sliding scale, and several have differing funding levels and requirements (e.g., the amount requested may determine whether a business plan is required or may determine how a plan is reviewed). Others set a funding limit but allow exceptions. The term "initial stocks and supplies" (Rehabilitation Act Amendments of 1998) is variously interpreted: some states set no limits; some set monetary limits; and some set chronological limits (e.g., 1 month, 6 months, etc). Just over half (54%) of respondents follow a business after it has opened. Return to Table of Contents Policy Recommendations Based upon the RTC: Rural model self-employment policy and the 2002 policy analysis, we recommend the following: 1. State policies should include consumer training related to selfemployment. 2. State policies should include follow-up, to both help the consumer and to protect the state's/consumer's investments. 3. Rehabilitation Services Administration should either define "initial stocks and supplies" or allow individual states to include their own definitions in self-employment plans. If the Rehabilitation Act is not amended to define "initial stocks and supplies" and funding levels, states should implement a means test (Rehabilitation Act Amendments of 1998; U.S. National Archives and Records Administration, 2002, Archive, C.F.R. Title 34, Volume 2, Part 361, Section 361.50.) so they can set limits based on consumers' resources. 4. Rehabilitation Services Administration should allow state VR plans to specify the level, conditions, and amount of investment the state will make in a self-employment enterprise. 5. VR programs should assist with the development of viable nonprofit businesses. Such businesses can be developed and evaluated in the same manner as a for-profit business. Return to Table of Contents

inclusion in Theses, Dissertations, Professional Papers by an authorized administrator of Scholar... more inclusion in Theses, Dissertations, Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more

National Institutes ofHealth. (1999). Mechanisms underlying secondary conditions in mobility diso... more National Institutes ofHealth. (1999). Mechanisms underlying secondary conditions in mobility disorders.

American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jan 24, 2015

The aim of this study was to examine how the construct of happiness is related to pain intensity,... more The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (χ10 = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: β = -0.13, P < 0.001) and on distress (indirect effect: β = 0.10, P = 0.01). Happiness showed a significant direct effect on pain intensity (β = -0.20, P < 0.001). A third model exploring the happiness components meaning, pleasure, and engagement fitted well (χ4 = 9.65, P = 0.05, ...

Rehabilitation Psychology, 2012

The purpose of this study was to test the utility of the Working Well with a Disability health-pr... more The purpose of this study was to test the utility of the Working Well with a Disability health-promotion program with vocational rehabilitation (VR) clients. Health-promotion interventions have been shown to reduce limitation from secondary conditions, which can be a significant barrier to labor force participation among people with disabilities. The state and federal VR system represents a potential access point for delivery of health-promotion activities. A total of 297 VR clients participated in a randomized trial of the Working Well health promotion program. Control and intervention participants provided baseline and four waves of quarterly follow-up data. Data were analyzed with repeated-measures ANOVA. Intervention-group participants who attended over half of the Working Well sessions reported significantly lower rates of limitation from secondary conditions over the 1-year study span, F(1, 124) = 4.11, p = .004. Control-group participants also experienced significantly lower rates of limitation, but pre- to postdifferences were less dramatic, F(1, 308) = 4.19, p = .006. Overall, health data indicated that the Working Well program may be particularly helpful to VR clients with higher rates of secondary health conditions and may represent one strategy for overcoming barriers to employment.

Journal of Disability Policy Studies, 2006

People with disabilities make up approximately 20% of the U.S. population but account for 47% of ... more People with disabilities make up approximately 20% of the U.S. population but account for 47% of total medical expenditures (Max, Rice, & Trupin, 1996). Health promotion programs represent one strategy for both improving health and containing medical costs for this population. This study examined the financial net benefits of the Living Well with a Disability health promotion program from the perspective of a third-party payer. Net benefits were defined as reductions in health-care utilization costs minus program implementation costs. The study sample consisted of 188 people with physical disabilities who completed the Living Well health promotion program. Health-care cost outcomes were collected using a 2-month retrospective recall of health-care services multiplied by Medicare unit cost estimates. The net benefits for the first 6 months postintervention were 2,631perpersonfortheentirecohortand2,631 per person for the entire cohort and 2,631perpersonfortheentirecohortand127 per person for a trimmed data set. The results suggested positive financial...

Rehabilitation psychology, Jan 15, 2014

Purpose/Objective: To determine how age and distress are associated in individuals with disabilit... more Purpose/Objective: To determine how age and distress are associated in individuals with disabilities, and how happiness and its components (meaning, pleasure, and engagement) mediate or moderate this relationship. Research Method/Design: These were cross-sectional analyses of survey data from 508 community-dwelling adults with a variety of self-reported health conditions and functional disabilities. Measures included the Orientations to Happiness Questionnaire and items from the Behavior Risk Factor Surveillance System. Results: Greater distress was associated with lower global happiness in both mediation and moderation models. The mediation model showed that middle-aged participants (age: 45-64) scored lowest in global happiness, and the effect of age on distress was partially mediated by happiness. None of the happiness components mediated the relationship of age on distress. The moderation model showed a significant interaction effect for age and global happiness on distress, whe...

Rehabilitation Counseling Bulletin, 2011

Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employme... more Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employment outcomes than clients who stay in services. The authors conducted this study to learn about factors leading to premature exit by rural VR clients. Results will inform survey development for a large longitudinal study on this topic. The authors content coded 27 qualitative telephone interviews with former rural VR clients who exited the system prematurely. Reported reasons for premature exit included (a) discrepancies between services provided and services desired, (b) unmet counselor expectations, (c) counselor—client relationship problems, (d) health issues, (e) limited job opportunities, (f) work disincentives, and (g) slow service speed. VR might reduce premature exits by helping clients better understand the VR process, including the types of VR services offered and associated counselor expectations.

Rehabilitation Counseling Bulletin, 2009

Research studies report a negative relationship between employment and secondary conditions. Acce... more Research studies report a negative relationship between employment and secondary conditions. Access to health promotion programs to manage secondary conditions, however, is limited for people with disabilities due to employment, financial, and insurance barriers. Vocational rehabilitation (VR) is one possible delivery point to overcome these barriers and improve access. To build the case for VR delivery, this article compares VR clients to Living Well health promotion program participants, who successfully reduced their secondary conditions. At baseline,VR ( n = 162) and Living Well ( n = 188) participants reported similar health promoting lifestyle behavior ratings and similar severity ratings across many secondary conditions. In addition, the VR group experienced similar rates of limitation from secondary conditions over time, indicating that their health was not improving in the absence of a health promotion intervention. Because health promotion programs can reduce secondary con...

Disability and Health Journal, 2011

We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Pla... more We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Planned Behavior, Social Cognitive, and Transtheoretical) to consider how these theories conceptually apply to people with disabilities. We identified five common constructs across HBC theories and examined how these commonalities fit within the International Classification of Function (ICF). Four of the HBC constructs appear to be Personal Factors within the ICF, while the fifth represents Environmental Factors. Using the ICF framework to understand disability and HBC, we propose that including a sense of meaning as another personal factor will further develop HBC theories that lead to more effective HBC interventions for people with disabilities.

Community Development, 2006

The Citizen‐Led Economic Development Project facilitates a leadership role in rural economic deve... more The Citizen‐Led Economic Development Project facilitates a leadership role in rural economic development for people with disabilities and agencies that serve them. If people with disabilities and human service agencies are involved in economic development ...

Australian Journal of Career Development, 2003

Self-employment is an important employment option for people with disabilities. It provides flexi... more Self-employment is an important employment option for people with disabilities. It provides flexibility, the ability to work non-traditional hours and to address issues associated with an illness or disability. It particularly addresses accessibility, communication, or transportation barriers for people with disabilities. It is especially useful in rural areas where there are few employers and consequently few employment opportunities. But self-employment is not for everyone, not every business idea is sensible, and not every proposed business is feasible. Rehabilitation agencies and counsellors that work with people with disabilities wishing to start a business usually are operating in unfamiliar territory. For the most part, rehabilitation counsellors are counsellors, not business developers. This article presents a process developed to assist rehabilitation agencies and counsellors to work with a client who wants to start a business. The process was developed after extensive rese...

Frontiers in Rehabilitation Sciences

PurposeThe purpose of this study is to parse out differences between unmet need and perceived nee... more PurposeThe purpose of this study is to parse out differences between unmet need and perceived need for health care services among rural and urban adults with disabilities in the United States. While unmet need focuses primarily on environmental factors such as access to health insurance or provider availability, perceived need relates to personal choice. This distinction between unmet and perceived need is largely ignored in prior studies, but relevant to public health strategies to improve access and uptake of preventive care.MethodsUsing Wave 2 data from the National Survey on Health and Disability, we explored rural and urban differences in unmet and perceived health care needs among working-age adults with disabilities for acute and preventive services.FindingsAlthough we found no significant differences in unmet needs between rural and urban respondents, we found that perceived needs for dental care and mental health counseling varied significantly across geography. Using logis...

When it comes to planning, meeting accommodation needs, and accessibility issues, people with dis... more When it comes to planning, meeting accommodation needs, and accessibility issues, people with disabilities are at a disproportionately high risk during times of crisis compared to those without. Additionally, many people with disabilities are immunocompromised and are at a greatest risk of serious complications and death due to infection from COVID-19. This survey was launched in April of 2020 to look further into how people with disabilities have been experiencing the COVID-19 pandemic, how their daily lives have been impacted, and how and where they were accessing information on best practices and early recommendations by various information sources. We were particularly interested in learning about differences among people with disabilities in both urban and rural areas in the United States. To collect this information, we launched a survey on Amazon MTurk, which is a common platform for recruiting participants in hard-to-reach populations within social science and human subjects...

Data from the 2009 Rehabilitation Services Administration Case Services Report (RSA 911) indicate... more Data from the 2009 Rehabilitation Services Administration Case Services Report (RSA 911) indicate that approximately 50% of Vocational Rehabilitation (VR) consumers leave the system prematurely. Premature exits include case closures related to lost contact with the consumer due to inaccurate address, disconnected phone or consumer relocation (17.4% of cases); consumer refusal to continue services (17.2% of cases); or consumer failure to cooperate (15% of cases).

Disability and Health Journal, 2019

Background: Social isolation has been compared to smoking in terms of risk to public health. Some... more Background: Social isolation has been compared to smoking in terms of risk to public health. Some groups are at particularly high risk for these feelings, including people with disabilities and rural residents. Few studies have considered the potentially compounding effects of disability status and rural residency. Objective: To evaluate how reported satisfaction with social participation and perceived isolation relate to the health of rural and urban people with disabilities, and to consider whether number of disabilities, living arrangement, and employment status were associated with differences in reported satisfaction with social participation and perceived isolation. Methods: This observational, cross-sectional analysis utilized data from working-age adults with disabilities (n = 1246) collected by the Collaborative on Health Reform and Independent Living (CHRIL). Results: There were significant associations between reported health and measures of satisfaction with social participation and perceived isolation (all ps < .001). Increased number of disability issues, not being employed, and living with at least one other person were associated with reduced satisfaction with social participation (ps < .01), and number of disability issues and not being employed were associated with increased perceived isolation (ps < .01). Urban residents reported feeling more isolated (ps < .05) and there were multiple predictor x geographic residency (rural versus urban) interactions. Conclusion: These results underscore the importance of considering geography as a factor in understanding satisfaction with social participation and perceived isolation and how these factors relate to health in people with disabilities.

Journal of Disability Policy Studies, 2006

This study used data (N = 3,076) from the Behavioral Risk Factor Surveillance System to explore t... more This study used data (N = 3,076) from the Behavioral Risk Factor Surveillance System to explore the relationship between employment and health behaviors for individuals with physical disabilities. Results from a binary logistic regression model, with employment as the dependent variable, show that exercise increased the probability of employment by 8.4% after controlling for participant demo-graphics, severity of disability, and secondary health conditions. These results speak to the importance of health promotion for people with disabilities who desire employment.

Frontiers in Rehabilitation Sciences

PurposeThis paper investigates how life events such as injuries, health insurance coverage, geogr... more PurposeThis paper investigates how life events such as injuries, health insurance coverage, geography, and occupation contribute to mobility disability rates over time. Findings can inform policies and practices to address factors that may contribute to disability in rural and urban areas.MethodsWe utilized 27 waves of the National Longitudinal Survey of Youth (NLSY) data from 1979 to 2016 to explore how past injury, occupation, health insurance coverage, and rurality predicted mobility impairment at ages 40 and 50 using regression analysis.FindingsRural respondents reported significantly higher rates of mobility impairment at age 40 and age 50 relative to people living in urban areas, and were more likely to report injury, work in high exertion occupations, and experience several pain-related health conditions. Using logistic regression and controlling for race and education, we found that people had higher odds of experiencing mobility impairment at age 40 if they reported a broke...

In 1991-92, the Research and Training Center on Rural Rehabilitation (RTC: Rural) evaluated 45 st... more In 1991-92, the Research and Training Center on Rural Rehabilitation (RTC: Rural) evaluated 45 state Vocational Rehabilitation (VR) agencies' policies and procedures regarding self-employment for people with disabilities. Based on this analysis, researchers developed and broadly disseminated a model VR self-employment policy (Arnold & Seekins, 1994) and were successful in their efforts to have self-employment included as an employment outcome in the 1998 Reauthorization of the Rehabilitation Act. In 2002, RTC: Rural investigated state policies again to see how they had changed and what trends had developed over the intervening decade. Researchers requested a copy of state self-employment policies and procedures from each of 82 departments of Vocational Rehabilitation in the 50 states and the District of Columbia. Although our original study excluded visual services agencies, the current study included them, plus general VR and combined VR/visual services agencies. Fifty-four state agencies responded for a 65.9% response rate. Two researchers conducted independent reviews of the policies and procedures and compared them to RTC: Rural's recommended model policy. They evaluated the changes in states' self-employment policies and procedures to determine whether the states had adopted the model policy. Researchers found that VR agencies are now more open to selfemployment outcomes. As self-employment for people with disabilities became more accepted over the past 10 years, several VR agencies revised their self-employment policies and procedures. Return to Table of Contents Results We commend state agencies for the changes in their self-employment policies and procedures. Of the 54 policies received: 32 (59%) were developed since the 1998 Reauthorization of the Rehabilitation Act. Current policies are more positive towards selfemployment than those reviewed in 1992. State policies address an average of 6.6 components, compared with 3.7 components in 1992. "Developing a business plan" is the most commonly included component (96%) and "follow-up" is the least-included component (54%). In 1992 just one policy addressed all eight model components; now 17 policies do (11 agencies participated both times). Similarly, in 1992 four policies included seven components; now 15 do (12 agencies participated both times). Many agencies have developed self-employment programs and published manuals for counselors, checklists, and consumer resources such as fact sheets and planning guides. Agencies have developed or use services or programs developed specifically to assist people with disabilities develop successful businesses. Previously, many policies contained negative statements about selfemployment, but now only one policy contains negative statements. There are many methods for funding a self-employment plan. Some state plans don't address cost. Some use a sliding scale, and several have differing funding levels and requirements (e.g., the amount requested may determine whether a business plan is required or may determine how a plan is reviewed). Others set a funding limit but allow exceptions. The term "initial stocks and supplies" (Rehabilitation Act Amendments of 1998) is variously interpreted: some states set no limits; some set monetary limits; and some set chronological limits (e.g., 1 month, 6 months, etc). Just over half (54%) of respondents follow a business after it has opened. Return to Table of Contents Policy Recommendations Based upon the RTC: Rural model self-employment policy and the 2002 policy analysis, we recommend the following: 1. State policies should include consumer training related to selfemployment. 2. State policies should include follow-up, to both help the consumer and to protect the state's/consumer's investments. 3. Rehabilitation Services Administration should either define "initial stocks and supplies" or allow individual states to include their own definitions in self-employment plans. If the Rehabilitation Act is not amended to define "initial stocks and supplies" and funding levels, states should implement a means test (Rehabilitation Act Amendments of 1998; U.S. National Archives and Records Administration, 2002, Archive, C.F.R. Title 34, Volume 2, Part 361, Section 361.50.) so they can set limits based on consumers' resources. 4. Rehabilitation Services Administration should allow state VR plans to specify the level, conditions, and amount of investment the state will make in a self-employment enterprise. 5. VR programs should assist with the development of viable nonprofit businesses. Such businesses can be developed and evaluated in the same manner as a for-profit business. Return to Table of Contents

inclusion in Theses, Dissertations, Professional Papers by an authorized administrator of Scholar... more inclusion in Theses, Dissertations, Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more

National Institutes ofHealth. (1999). Mechanisms underlying secondary conditions in mobility diso... more National Institutes ofHealth. (1999). Mechanisms underlying secondary conditions in mobility disorders.

American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jan 24, 2015

The aim of this study was to examine how the construct of happiness is related to pain intensity,... more The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (χ10 = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: β = -0.13, P < 0.001) and on distress (indirect effect: β = 0.10, P = 0.01). Happiness showed a significant direct effect on pain intensity (β = -0.20, P < 0.001). A third model exploring the happiness components meaning, pleasure, and engagement fitted well (χ4 = 9.65, P = 0.05, ...

Rehabilitation Psychology, 2012

The purpose of this study was to test the utility of the Working Well with a Disability health-pr... more The purpose of this study was to test the utility of the Working Well with a Disability health-promotion program with vocational rehabilitation (VR) clients. Health-promotion interventions have been shown to reduce limitation from secondary conditions, which can be a significant barrier to labor force participation among people with disabilities. The state and federal VR system represents a potential access point for delivery of health-promotion activities. A total of 297 VR clients participated in a randomized trial of the Working Well health promotion program. Control and intervention participants provided baseline and four waves of quarterly follow-up data. Data were analyzed with repeated-measures ANOVA. Intervention-group participants who attended over half of the Working Well sessions reported significantly lower rates of limitation from secondary conditions over the 1-year study span, F(1, 124) = 4.11, p = .004. Control-group participants also experienced significantly lower rates of limitation, but pre- to postdifferences were less dramatic, F(1, 308) = 4.19, p = .006. Overall, health data indicated that the Working Well program may be particularly helpful to VR clients with higher rates of secondary health conditions and may represent one strategy for overcoming barriers to employment.

Journal of Disability Policy Studies, 2006

People with disabilities make up approximately 20% of the U.S. population but account for 47% of ... more People with disabilities make up approximately 20% of the U.S. population but account for 47% of total medical expenditures (Max, Rice, & Trupin, 1996). Health promotion programs represent one strategy for both improving health and containing medical costs for this population. This study examined the financial net benefits of the Living Well with a Disability health promotion program from the perspective of a third-party payer. Net benefits were defined as reductions in health-care utilization costs minus program implementation costs. The study sample consisted of 188 people with physical disabilities who completed the Living Well health promotion program. Health-care cost outcomes were collected using a 2-month retrospective recall of health-care services multiplied by Medicare unit cost estimates. The net benefits for the first 6 months postintervention were 2,631perpersonfortheentirecohortand2,631 per person for the entire cohort and 2,631perpersonfortheentirecohortand127 per person for a trimmed data set. The results suggested positive financial...

Rehabilitation psychology, Jan 15, 2014

Purpose/Objective: To determine how age and distress are associated in individuals with disabilit... more Purpose/Objective: To determine how age and distress are associated in individuals with disabilities, and how happiness and its components (meaning, pleasure, and engagement) mediate or moderate this relationship. Research Method/Design: These were cross-sectional analyses of survey data from 508 community-dwelling adults with a variety of self-reported health conditions and functional disabilities. Measures included the Orientations to Happiness Questionnaire and items from the Behavior Risk Factor Surveillance System. Results: Greater distress was associated with lower global happiness in both mediation and moderation models. The mediation model showed that middle-aged participants (age: 45-64) scored lowest in global happiness, and the effect of age on distress was partially mediated by happiness. None of the happiness components mediated the relationship of age on distress. The moderation model showed a significant interaction effect for age and global happiness on distress, whe...

Rehabilitation Counseling Bulletin, 2011

Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employme... more Vocational rehabilitation (VR) clients who leave the system prematurely experience worse employment outcomes than clients who stay in services. The authors conducted this study to learn about factors leading to premature exit by rural VR clients. Results will inform survey development for a large longitudinal study on this topic. The authors content coded 27 qualitative telephone interviews with former rural VR clients who exited the system prematurely. Reported reasons for premature exit included (a) discrepancies between services provided and services desired, (b) unmet counselor expectations, (c) counselor—client relationship problems, (d) health issues, (e) limited job opportunities, (f) work disincentives, and (g) slow service speed. VR might reduce premature exits by helping clients better understand the VR process, including the types of VR services offered and associated counselor expectations.

Rehabilitation Counseling Bulletin, 2009

Research studies report a negative relationship between employment and secondary conditions. Acce... more Research studies report a negative relationship between employment and secondary conditions. Access to health promotion programs to manage secondary conditions, however, is limited for people with disabilities due to employment, financial, and insurance barriers. Vocational rehabilitation (VR) is one possible delivery point to overcome these barriers and improve access. To build the case for VR delivery, this article compares VR clients to Living Well health promotion program participants, who successfully reduced their secondary conditions. At baseline,VR ( n = 162) and Living Well ( n = 188) participants reported similar health promoting lifestyle behavior ratings and similar severity ratings across many secondary conditions. In addition, the VR group experienced similar rates of limitation from secondary conditions over time, indicating that their health was not improving in the absence of a health promotion intervention. Because health promotion programs can reduce secondary con...

Disability and Health Journal, 2011

We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Pla... more We conducted a review of four health behavior change (HBC) theories (Health Belief, Theory of Planned Behavior, Social Cognitive, and Transtheoretical) to consider how these theories conceptually apply to people with disabilities. We identified five common constructs across HBC theories and examined how these commonalities fit within the International Classification of Function (ICF). Four of the HBC constructs appear to be Personal Factors within the ICF, while the fifth represents Environmental Factors. Using the ICF framework to understand disability and HBC, we propose that including a sense of meaning as another personal factor will further develop HBC theories that lead to more effective HBC interventions for people with disabilities.

Community Development, 2006

The Citizen‐Led Economic Development Project facilitates a leadership role in rural economic deve... more The Citizen‐Led Economic Development Project facilitates a leadership role in rural economic development for people with disabilities and agencies that serve them. If people with disabilities and human service agencies are involved in economic development ...

Australian Journal of Career Development, 2003

Self-employment is an important employment option for people with disabilities. It provides flexi... more Self-employment is an important employment option for people with disabilities. It provides flexibility, the ability to work non-traditional hours and to address issues associated with an illness or disability. It particularly addresses accessibility, communication, or transportation barriers for people with disabilities. It is especially useful in rural areas where there are few employers and consequently few employment opportunities. But self-employment is not for everyone, not every business idea is sensible, and not every proposed business is feasible. Rehabilitation agencies and counsellors that work with people with disabilities wishing to start a business usually are operating in unfamiliar territory. For the most part, rehabilitation counsellors are counsellors, not business developers. This article presents a process developed to assist rehabilitation agencies and counsellors to work with a client who wants to start a business. The process was developed after extensive rese...