8/9/2017. A study of quality employment outcomes among individuals with multiple sclerosis. Acknowledgement

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1 8/9/17 A study of quality employment outcomes among individuals with multiple sclerosis James S. Krause, PhD Melinda Jarnecke Karla S. Reed Medical University of South Carolina Health, Employment, and Longevity Project Acknowledgement Information for this product was developed for the Rehabilitation Research and Training Center (RRTC) on Employment of People with Physical Disabilities at Virginia Commonwealth University (VCU). The contents of this presentation were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number RT35). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. Our Program of Research Study Purpose Beyond Days: Quality Employment Throughout the Work Life Cycle Multiple sclerosis Spinal cord injury Other (e.g., TBI, epilepsy) Our purpose is to identify employment outcomes after multiple sclerosis (MS), among a cohort of participants who have been identified through a specialty hospital in the Southeastern United States. In this presentation, we emphasize employment outcomes at 3 months and 12 months after the diagnosis of MS, as well as at the time of the study. We also emphasize the role of work values and employment. Emphasis is on quality outcomes. Labor Participation Model Background MS affects approximately 2.3 million people worldwide. Most people are diagnosed between the ages of and, during what is usually the prime of career development (Kalb, 12; National MS Society, 16; Super, 19). Despite the benefits of employment to quality of life and well-being, people with MS report some of the highest rates of unemployment among groups of individuals with severe and chronic disabilities (Doogan & Playford, 14). 1

2 8/9/17 Background Qualitative Stage Our study uses a combination of qualitative and quantitative methods. The qualitative stage used open-ended focus groups to identify themes and patterns of the employment experience. This portion of the study is complete and reported in the literature. In our quantitative stage, we obtained self-report assessments to identify factors that relate to the most successful outcomes. 8 focus groups with 4-9 participants each, totaling 74 participants: o Mean age = o Mean age at diagnosis = o Avg. time (in years) since diagnosis = o Percentage female = 79.7% o Percentage currently employed = 57.7% Groups followed a semi-structured format lasting 2-3 hours. Groups were recorded and transcripts later entered into NVivo for text analysis. Quantitative Methods Self-report Assessment based on the LPM Target response rate = 1, Current response rate = 1,324 Participants met the following eligibility requirements: o 18+ years old o <65 years of age at the time of diagnosis o Physical disability from MS Data collected through mail-in and web assessments Expansive coverage of outcome areas emphasis on quality outcomes o Participation indicators o Quality indicators Linked with national datasets in terms of how questions are asked (allows some comparisons with national data) From pre-diagnosis to status at follow-up Focus throughout the working age range Participant Demographics Employment Rates N = 1324 (of entered data) Current age = Age at diagnosis = Years post-diagnosis = Years of education = Employed at 3 months Employed at 1 year Currently employed 2

3 8/9/17 Income of those Currently Employed Participant Demographics 1 <$25, $25,- 49,999 $,- 74,999 $75,- 99,999 $,- 124,999 >$125, Course of MS: o 72.6% = relapsing-remitting o 7.% = primary progressive o 8.6% = secondary progressive o 1.7% = progressive relapsing o 1.1% = do not know Employment Rates by Diagnosis Characteristics of Those Employed 1 RR PP SP PR 3 months 12 months Current Years of education Age Years since diagnosis RR = relapsing remitting; PP = primary progressive; SP = secondary progressive; PR = progressive relapsing Employment Considerations (even if unemployed or retired) Factor Analysis Employment Considerations/Work Values 1 items from qualitative themes Principle access factor analysis Varimax rotation Considerations o Relatively low sample size o Ten variables o Eigenvalues > 1. 3

4 8/9/17 Rotated Factor Matrix Employment Considerations Factor 1 2 Salary.132 (.689) Health insurance.92 (.676) Opportunities for advancement.291 (.664) Recognition of performance.436 (.486) Social connections (.6).222 Enjoyment from working (.6).193 Opportunities for helping others (.759).11 Feeling better about self (.783).131 Staying busy (.664).2 Others share the workload (.).269 Not Very Salary Health insurance Opportunities for advancement Recognition of performance Social connections Enjoyment from working Opportunities for helping others Feeling better about self Staying busy Others share the workload Not Salary Very 1 Not Health Insurance Very 1 Opportunities for Advancement Not Very 1 Recognition for Performance Not Very 4

5 8/9/17 1 Not Social Connections Very 1 Not Enjoyment from Working Very 1 Opportunities for Helping Others Not Very 1 Not Feeling Better about Self Very 1 Not Staying Busy Very 1 Not Others Share Workload Very 5

6 8/9/17 Employment Satisfaction (current employment) Employment Satisfaction at Current Main Job Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied Salary Health insurance Opportunities for advancement Recognition of performance Social connections Enjoyment from working Opportunities for helping others Feeling better about self Staying busy Others share the workload Comparison of Satisfaction Between Item Sets Satisfaction with Salary Dissatisfied (1-3) very dissatisfied, dissatisfied, neutral Satisfied (4-5) satisfied, very satisfied Satisfaction with Health Insurance Satisfaction with Opportunities for Advancement 6

7 8/9/17 Satisfaction with Recognition of Performance Satisfaction with Social Connections Satisfaction with Enjoyment from Working Satisfaction with Opportunities for Helping Others Satisfaction with Feeling Better about Self Satisfaction with Staying Busy 7

8 8/9/17 Satisfaction with Others Sharing Workload Intentions Moving Forward Future Work Plans Implications: Vocational counselors/vr Highly Unlikely Unlikely Neutral Likely Highly Likely Factor 1 Reduce your workload Change to less demanding type of work Continue working about same hours Factor 2 Give up work due to voluntary retirement Give up work due to involuntary retirement Give up work due to health or disability Factor 3 Change your job Take on more responsibility Have career advancement Employment rates decreased from 3 months post diagnosis, over time: need to focus on sustaining employment. Salary and insurance are the most highly related considerations with employment status: need to consider quality of employment to promote employment rates. Other considerations (e.g., helping others, feeling good about work) are frequently cited as to the individual while it is to consider all job needs on an individual basis, meeting these needs will not necessarily result in better employment rates. Having job retention will not necessarily result in equal satisfaction, so effort needs to be made to optimize working conditions. to consider both job needs (considerations) and satisfaction with these areas. Additional Analyses to Come Future Research Current findings reported in this webcast barely scratch the surface of the analyses that will be conducted. Data can be compared on several parameters to that of data collected by Dr. Rumrill using participants from the MS Society. Findings will be compared with people with SCI using a similar methodology. We are in the process of developing a publication that will summarize the data on both employment considerations/needs and satisfaction with these areas, emphasizing the discrepancy between needs and satisfaction. Multiple quality indicators will be the focus of econometric modeling, including both indicators of participation in employment (i.e. quantifying employment by time individual works over the course of their work life) and their subjective evaluations of these outcomes. Need to breakdown better disability future research to help us understand variation within the larger national surveys of employment Need for more (relatively) large data collections with substantial detail in both the predictors of employment outcomes and the diversity of employment outcomes Longitudinal studies of employment outcomes after MS and other conditions (the current study was only cross-sectional) Application of quality employment model to other conditions Intervention studies to improve outcomes 8

9 8/9/17 Contact Information Concluding Remarks Questions on this presentation should be directed to the corresponding author: Dr. James Krause Requests for accommodations or questions on the VCU-RRTC should be directed to Dr. Katherine Inge, Project Director or ( ). For more information on the VCU-RRTC, please visit The VCU-RRTC is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran's status, political affiliation, or disability. 9