Rehabilitation, education, and employment: A multi-dimensional, risk-informed analysis of service coordination for adolescents and young adults in Illinois with a spinal cord injury

Employment after spinal cord injury (SCI) is associated with improved quality of life. However, post-SCI employment rates are disturbingly low, with estimates ranging from 12-35%, compared to national rates of 63% for persons without disabilities. Unemployment is a particular concern for adolescents and young adults (AYAs), who comprise nearly 40% of new SCIs. This population often has limited pre-injury employment experience to support work participation after SCI. Meanwhile, increased independence, peer relationships, academic, and career pursuits are key developmental goals. Difficulty gaining and maintaining employment after SCI is associated with several factors, including poor health, higher levels of impairment, limited education and work experience, insufficient workplace accommodations, and disincentives resulting from disability income programs. Remarkably, many of these factors can be addressed by existing, evidence-based services, including task-specific training to advance function, individualized educational plans for school participation, vocational rehabilitation (VR), and workplace accommodations. Still, post-SCI employment rates remain low, and there is limited data on access to services for individuals with SCIs, particularly during transitions from acute care to community-based education and employment. It is likely that poor coordination between health, education, and VR programs contributes to low employment rates. Thus, we hypothesize that gaps in coordination among health, education, and VR services inhibit access, utilization, and ultimately, employment outcomes for this population. The objective of this fellowship proposal is to obtain input from key stakeholders, including AYAs with SCI, their parents or caregivers, healthcare providers, education liaisons, and VR counselors, to generate a blueprint of how services function and to conduct a multi-dimensional, risk-informed analysis of ways that AYAs gain access to education and emplo