The Development of an Instrument to Assess the Psychosocial

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					The Development of an Instrument to Assess the Psychosocial Variables in the Design for an

                   Experiment and Demonstration in Early Intervention:

                 A Summary of Years I and II Work Completed by UIUC


              Chrisann Schiro-Geist, Ph.D.and Emer D. Broadbent, JD, Ph.D.

                          Standard SSA Acknowledgement here




                                            1
                                              Abstract

This paper documents a pilot study which examines the existence of psychosocial factors that
influence the likelihood that disability benefit applicants will successfully rejoin the work force,
should early interventions in return to work programming be implemented. This study has
collected information on psychosocial factors as expressed by surveyed disability services
applicants during intake. It is anticipated that the data will demonstrate correlations between
attitudes and return to work that may be replicated in larger scale demonstration studies. The
goal of the project is to create a brief attitudinal instrument that will successfully identify
applicants with disabilities having “better-than-average” return to work potential.




                                                  2
  The Development of an Instrument to Assess the Psychosocial Variables in the Design for an

                       Experiment and Demonstration in Early Intervention:

                     A Summary of Years 1 and 2 Work Completed by UIUC

                                            Introduction

        The application for disability benefits is the end of a long road for most people. They

may have collected workers’ compensation or short-term disability benefits as a result of

functional limitations. Some applicants may have collected benefits from a long-term disability

program and participated in one or more rehabilitation-type programs. Referrals to these

programs may have come from administrators, from a benefit program, or the applicant may

have received services from a program under the Workforce Investment Act. Often an

application for Social Security Disability Insurance (SSDI) is made only after the above

interventions have failed to return the person to work.

        The purpose of the application made to the Social Security Administration (SSA) is

essentially for cash benefits and not for rehabilitation services. In addition to seeking a

dependable income, the individual may be seeking other tangibles such as comprehensive

healthcare, so that medical concerns may be addressed as needed. An important question at the

heart of this project is whether, at the time of application for SSDI benefits, it is possible to alter

perspectives of all parties and to persuade the applicant to participate willingly in a return to

work (RTW) program.

        Under the Ticket to Work and Work Incentives Improvement Act (Public Law 106-70,

December 1999), SSA was given authority to conduct experiments and demonstrations to test the

idea that the RTW record for potential applicants to the SSDI program could be improved by an

early intervention demonstration project (EIDP) and the provision of RTW services as close to




                                                   3
disability onset as possible. This Early Intervention (EI) would be implemented within the

context of innovative demonstration models. EI and the provision of effective RTW services

represent a distinct shift from the traditional Social Security disability paradigm in the United

States.

          Results from a pilot study which was preliminarily successful in the recognizing of

practice-based psychosocial predictors are reported in this document. These psychosocial factors

may prove to be predictive of success in return to work efforts, similar to that documented in

larger quantitative studies. Reporting on the development of a predictive instrument may be

argued as premature since a major purpose of the instrument is to support a larger quantitative

study not yet in the field. The authors believe, however, that this study and its results have their

own intrinsic value, even though the quantitative research has not progressed to its next step. We

could find no other reported research that has attempted such a large scale study of this kind.

          In order to demonstrate that the RTW record for potential applicants to the SSDI program

could be improved by early intervention, SSA asked the Disability Research Institute (DRI), its

grantee at the University of Illinois at Urbana-Champaign (UIUC), to create a model

dissemination. The purpose of the EIDP is to develop reliable and accurate methodologies for the

identification of SSDI applicants “with impairments that reasonably may be presumed to be

disabling” and for whom early intervention would facilitate successful RTW. As these applicants

have severe disabilities, it is expected that work in the national economy may be feasible if more

sophisticated adaptive technologies and innovative rehabilitation and job placement services are

provided. It is expected also that, without these necessary services, these applicants will not

return to work.




                                                  4
       The DRI, in collaboration with the State University of New Jersey, Rutgers, under the

direction of Dr. Monroe Berkowitz, devised a method for identifying SSDI beneficiaries who

are highly likely to be adjudicated as beneficiaries. The Rutgers research team of health

economists created and is preparing to implement the Early Intervention (EI) model service

delivery systems in select pilot states. For its part, DRI was asked to create a brief (not more

than five item) instrument identifying psychosocial variables that could help predict RTW

potential of applicants. It is believed that these variables may help to identify applicants who

have better-than-average motivation to participate in RTW activities.

       Under the Ticket to Work and Work Incentives Improvement Act, the SSA was given

authority to conduct experiments and demonstrations to test the idea that the return to work

record for potential applicants to the Disability Insurance program could be improved by EI and

the provision of return to work services. Within the contexts of these demonstrations, services

could be offered to applicants for benefits, representing a distinct change from the current law

and practice where services would be available through trust funds previously available only for

beneficiaries.

       This demonstration project attempts to design an early intervention program with two

primary objectives: First, selecting likely eligible applicants for SSDI benefits to participate in a

RTW Program and second, developing models that will assist these individuals in their RTW.

The purpose of this stage of the project was to design a strategy for identifying those applicants

“with impairments that reasonably may be presumed to be disabling” and for whom early

intervention would facilitate their successful RTW.

       During year one of this project, the DRI designed and tested a 38-item instrument to

identify 25 client-motivation and attitude-toward-work indicators. Several alternative




                                                  5
approaches for data collection were considered in creating this instrument. Making use of

existing information on applicants (available through regular application documents) was

considered. Researchers also considered supplementing the information collected in the standard

application process with survey material that addressed the applicant’s human capital, past

experience with RTW programs as well as motivation to RTW. These screening criteria

included demographic variables, education and training, past experience with RTW programs,

and motivational factors related to respondents’ perceptions of themselves with respect to

internal and external variables.

       The researchers determined (with the support of SSA staff) that creation of focus groups

consisting of stakeholders in the SSDI application process which would identify indicators of

motivation to return to work would be the most suitable approach. Initial questionnaire items

having to do with motivation to work, and attitudes toward work were offered to six focus

groups consisting of stakeholders in the SSDI application process. The focus groups were

formed to select questions which, based on professional literature, as well as the group members’

professional and real-life experience, were believed to be likely to predict applicants’ RTW

motivation. The focus groups utilized to develop the instrument consisted of groups from people

with disabilities, VR service providers from a large urban community, medical and psychological

consultants from the regional Disability Quality Branch of Social Security, claims

representatives experienced in the initial application process for SSDI, experienced adjudicators

from the Disability Determination Service of SSA, and administrative law judges and staff

attorneys directly involved in the appeal process. Transcripts from these focus groups were

reviewed and comments from them are summarized throughout this report




                                                6
       The overall objective was to identify which of the items might be most likely to predict

whether or not an applicant for SSDI would choose to be involved in an RTW program. A

model instrument using twenty such predictive questions, drawn from the clinical literature, for

assessing vocational rehabilitation clients was created by one of the consultants to this project

(Kundu, 1983). Through group process, the focus groups expanded the number of questions they

believed were likely to be predictive of motivation to return to work in the case of SSDI

applicants from the original 20 to the 38 items which ultimately made up the instrument which

has been tested by this process.   The instrument was pilot tested on 94 disability adjudicators

from the Illinois Disability Determination Services (DDS). It demonstrated moderately high

correlation with the ordinal ranking of likelihood of RTW factors that were built into a set of

four hypothetical case studies, representing “typical” SSDI applicant characteristics. The

indicators were grouped into seven factors that accounted for 69% of the variability in the overall

outcomes of these four hypothetical cases.

       During year two, the instrument was administered to 760 applicants to the Iowa Division

of VR in order to further test their predictive validity. The analysis of these data allowed DRI

researchers to identify 5 items (the number of questions which would be allowed to be included

in instruments which are to be administered to SSDI applicants by the Rutgers group) which had

the highest correlation with cases in which the individual was deemed likely by VR counselors to

have success in return to work efforts by VR counselors. The development and testing of the

instrument is described in this paper.

                                         Review of Literature

       Employment of people with disabilities is the key justification for funding of the State-

Federal VR system (NIDDR Long Range Plan, 2001) and is gradually becoming one of the main




                                                  7
goals of Social Security Administration’s SSDI program (Social Security Administration, 2002).

More than eight decades have elapsed since the incorporation of the Smith-Fess Act of 1920,

establishing the state-federal rehabilitation program in the U.S. to address the vocational,

psychosocial, and financial needs of Americans with disabilities. Almost a quarter of a century

has elapsed since the authorization of the Rehabilitation Act Amendments of 1978, recognizing

the independent living needs of civilians with disabilities. Although the country has experienced

unprecedented economic growth during this period (Johnson & Williamson, 2002), the dream of

obtaining and maintaining gainful/satisfactory employment with opportunities for career building

has remained largely unfulfilled for persons with disabilities (Asbury, Walker, Stokes &

Rackley, 1994; O’Day, 1999; Scotch, 1999).

       The literature on employment among those with disabilities indicates that they experience

lower labor force participation rates, higher unemployment and higher rates of part-time

employment than persons without disabilities (Yelin, 1997). The high unemployment and

underemployment rate of persons with disabilities is an ongoing and seemingly insurmountable

problem (NIDDR Long Range Plan, 2001). In fact, labor force participation of those with

disabilities has declined since the 1980s (O’Day, 1999). Currently, 52% of those with

disabilities are unemployed and 55% of the same population is women (U.S. Bureau of Census,

2000). The numbers are even higher for those from diverse cultural backgrounds.

       At present, the Social Security Administration (SSA) remits more than $1 billion per

week in cash payments to individuals with disabilities on Supplemental Security Income (SSI)

and SSDI (SSA, 1999). Other than providing income security, these programs do not contribute

to enhancing employability and promoting long-term financial independence of SSI and SSDI




                                                 8
beneficiaries. This has been noted as being a function of SSA’s continued focus on efficiency,

equity, and administrative simplicity as opposed to providing work incentives (O’Day, 1999).

       The major issues complicating the problem have been: (a) the eligibility criteria requiring

the applicant to demonstrate inability to engage in substantial gainful employment; (b) the time

spent to become eligible as opposed to initiating rehabilitation immediately after the onset of the

disability; (c) loss of medical coverage; (d) ambiguous and confusing rules regarding work

incentives; (e) inefficiency of the state-federal rehabilitation system to provide appropriate

services leading to long-term and successful case closures; and (f) lack of incentives to hire

employees with disabilities (Bassi, 1995; Schaffer, 1991, O’Day, 1999).

                                  Predictors of Return to Work

       According to the National Institute on Disability and Rehabilitation Research (NIDRR;

1993) and Trupin, Sebesta, Yelin and LaPlante (1997), the factor of disability, combined with

gender, age, race, and/or secondary disability, places a person at a severe labor market

disadvantage.. Researchers in VR have addressed issues related to RTW, but largely in

conjunction with job placement activities (Geist & Calzaretta, 1982; McMahon, Matkin,

Mahaffey, & Gianforte, 1983; Murphy & Salomone; 1983; Shaffer, Hill, Seyfarth, & Wehman,

1987; Vandergoot, 1987). Most of this research was completed over a decade ago. In addition,

the question of what factors optimize the engagement of persons with disabilities in competitive

employment remains vaguely answered.

       During the past four decades, there has been considerable interest in assessing the

effectiveness of VR services and subsequent employment outcome as a function of various

factors affecting service delivery. These factors include: work history, education, race/ethnicity,

functional limitations, and vocational training (Feist-Price, 1995; Friedlander & Burtless, 1995;




                                                  9
Kundu, 1983; Neenan & Orthner, 1996; Worral & Vandergoot, 1982). Bolton, Bellini, and

Brookings (2000) further support these investigations by identifying the following personal

factors as being significantly related to eventual employment. These factors include: age,

education, marital status, financial assistance, family income at time of referral, and employment

status. Since most of these studies have used data generated by large administrative databases

that relied on demographic and economic indicators of vocational success, the psychosocial and

environmental aspects of rehabilitation outcome remain under-investigated (Moffitt, 1992).

        Marini and Reid (2001) remind the reader of the significance of time since disability

onset, (particularly if this parallels the time since the individual last worked), in its effect on the

likelihood of the worker subsequently returning to work. They report that “the statistical

probability of an individual returning to gainful employment decreases with each month away

from work, with only 50% of injured workers returning to gainful employment within the first 6

months of injury. For those workers whose injuries prevent them from returning to work during

the first year post onset, approximately 25% might be expected to return to the workforce” (p.

37).

        The literature cited above, including that published after the implementation of the

Americans with Disabilities Act of 1990, does not address individuals’ attitude and motivation

related to RTW efforts. Many practitioners in the field of job placement evaluate an individual’s

attitudes towards work and motivational/psychosocial factors as most critical in determining not

only the ability of a person with severe disability to attempt RTW activities, but also to be

indicative of his/her ability to sustain substantial gainful activity (SGA). SGA is critical to the

success of the Ticket to Work Program and to the SSA in evaluating the effectiveness of EI

activities




                                                   10
       DRI researchers examined the clinical attitude scales that were reviewed and presented

promoted by Cook, et.al (1994) for relevance to the project. These scales, the Employment

Readiness Scale (ERS), the Thresholds Work Attitudes Scale (TWAS) and the Instrumental Role

Dysfunctional Attitude Scale (IRDAS) were presented in the 1994 work as being relevant and

useful to practitioners who are collecting attitudinal information from clients with psychiatric

disabilities. Although Cook points out particular strengths of each of the instruments, among

them face validity and concurrent validity with employment measures, she also notes that each of

these instruments is flawed by not having research or theoretical bases, one of them demonstrates

a negative tone which may impede transmission of information from client to service provider,

and she declares another being too hard to administer. While these studies are valuable

precursors to the work that DRI has accomplished here, they are neither reliable nor valid tools

to be used in research. The purpose of the current DRI research activity is to create (unlike the

scales explored by Cook) a predictive instrument which is documented to be both reliable and

valid. In addition, Cook and colleagues feature a number of other practice-based and practice-

focused vocational assessment and prediction protocols that are utilized in clinical settings.

These include several detailed survey instruments that are presented as useful for administration

as part of vocational assessment procedures. They also cite a list of clinical-wisdom-based

positive and negative indicators of job readiness, but report that such items are not supported by

systematic empirical evidence. Documentation of some of these characteristics as valid

indicators of job readiness, or as indicators of the likelihood of success in return to work efforts

could make such scales, and indicators like them, valuable tools which support continued

research into the discovery of indicators of success in the return-to-work assessment effort.




                                                 11
       Related work regarding the validation of successful clinically based assessments of

mental health and related issues, Finn & Martin (1997) as well as Meyer, Finn, Eyde,

et.al.,(2001) present compelling information from the health care industry in support of the

assertion that psychological test validity is comparable to medical test validity. Psychological

assessments are documented as important contributors to multi-method assessment activities

yielding a more comprehensive assessment. An expansion of efforts to validate vocational

practice-based predictive assessment against more traditional quantitatively-based methodologies

could provide results similar to those found in the area of psychological and medical assessment.

Therefore, the development of the current instrument is more likely to be a step toward a valid

prediction of the potential to return to work than relying only upon a clinical assessment by a

service provider assigned to work with a client on early intervention..

       A review of some of the work of DiClemente and associates (Carbonari, DiClemente &

Sewell, 1999; Connors, Donovan & DiClemente, 2001; DiClemente, Bellino & Neavins, 2000),

which pertains to motivational change in substance users, implies the need for post assessment

intervention in the early intervention demonstration activities. The predictive psychosocial

instrument created by the UIUC team, , will allow return-to-work specialists to prioritize service

delivery applicants motivationally ready for return to work activities and to demonstrate the level

of motivation of other applicants

       Several studies demonstrate the value of investigating the effects of person-centered

variables, such as attitude toward work and internal locus of control (Duvdevany & Rimmerman,

1996), functional and marital status, disability appraisals, depression, length of pre-injury

employment (Ashworth, 1999), human capital (Danziger, Kalil, & Anderson, 2000), program

participation (Bound, & Waidmann, 2002), race, gender, age, education (Bound, Schoenbaum, &




                                                12
Waidmann, 1995), and job skills and education (Berkowitz & Johnson, 1974), on successful

employment outcome of consumers with disabilities. In a longitudinal tracking study using

hierarchical multiple regression, Neenan and Orthner (1996) found that length of time in receipt

of services explained 3% (R2 = .03) of the variance in post-program earnings, demographic

characteristics accounted for an additional 4% (R2 = .07) of the variance, attitude toward work

and welfare resulted in an additional 5% (R2 = .12) of the variance, human capital stock

accounted for an additional 7% (R2 = .19) of the variance, personal and social strength resulted in

an additional 3% (R2 = .22) of the variance, and human capital enhancement accounted for an

added 2% (R2 = .24) of the variance. Similar accountability for outcomes measured for

motivation and locus of control could similarly be related to successful participation in RTW

efforts.

           Many researchers have described the power that persons with disabilities who have an

internal locus of control (LOC) possess over their medical condition and resulting functional

limitations and therefore over their subsequent rehabilitation prognosis (see for example: Evans,

1991; Martz, Livneh, & Turpin, 2000; Kempen, van Sonderen & Ormel, 1999; Moore,

Stambrook, & Wilson, 1991; Partridge and Johnston, 1989; and Haerkaepaeae, Jaervikoski,

Mellin, Hurri, et. al., 1991). As internally oriented individuals are proactive and eager to change

their life style, internal LOC is often considered an influential factor in preventing secondary

conditions (Johnston, Morrison, Macwalter & Partridge, 1999; Schultz, Heckhausen, & O’Brien,

1994). It also assists in the development of self-esteem required to promote the potential for

self-reinforcement and better employment and/or rehabilitation outcome. Therefore, an

individual’s subjective perception of him/herself is considered one of the most

significant/influential variables in preventing psychosocial morbidity (depression, anxiety,




                                                  13
negative self-perception) that affect prognosis (Arraras, Wright, Jusue, Tejedor, & Calvo, 2002;

Morrison, Johnston, & Walter, 2000; Macleod, & Macleod, 1998; Fowers, 1994; Martz, Livneh,

& Turpin, 2000).

       In some cases however, an internal frame of reference can become a disadvantage. This

occurs when repeated efforts of a client to improve/cure the health condition fails, e.g., a failure

to control diabetes mellitus despite engagement in the treatment. This lack of control may lead

to feelings of helplessness or defeat in one’s capacity to manage the disability. Such feelings of

impotence may perpetrate the deterioration of health conditions and decrease motivation to

achieve the fullest functional potential (Lowery & DuCotte, 1976).

       According to Wehmeyer, Kelchner, and Richards (1995), irrespective of disability status,

employment is one of the primary avenues to achieving independence and a sense of

empowerment. On the other hand, the most essential component of independence and

empowerment is self-determination. Self-determination is defined as the ability to act as the

principal causal agent of one’s life and make choices free from external influence. The various

constituents of self-determination are: decision making; problem solving, goal setting and

attaining; self-observation, evaluation, and reinforcement; internal locus of control; positive

perception of own efficacy and outcome expectancy; self-awareness; and self-knowledge. The

above attributes, products of a life long learning process, are determinants of successful

fulfillment of adult responsibilities, one of which is obtaining and retaining gainful employment.

       Some of the environmental factors that significantly affect the level of self-determination

are living arrangement and primary caregiver. Individuals living with family and other

supervised facilities generally exhibit lower levels of self-determination (Wehmeyer & Bolding,

1999; Wehmeyer & Bolding, 2001; Pennell, 2001; Saloviita & Aberg, 2000; Stancliffe, 2001).




                                                 14
Individuals with disabilities, particularly those with congenital and severe disabilities, often have

limited opportunities to acquire these characteristics. Not surprisingly, it has been found that

members of the above population frequently report low levels of efficacy/outcomes expectancy,

and rarely engage in behaviors desirable to succeed in the world of work (Bandura, 1997). The

result is often failure in assuming adult social responsibilities, being un- or under-employed, and

leading socially isolated lives (Chadsey-Rusch, Rusch, & O’Rielly, 1991; Hasazi, Gordon, &

Roe, 1985; Stilington, Frank, & Cooper, 1989). However, those who consider themselves to be

their own primary caregiver had a high capacity for self-determination and in turn self-efficacy

and were found to have secured satisfactory employment (Wehmeyer, Kelchner, & Richards,

1995). Moreover, attitude towards one’s disability significantly predicts employment success

and community re-integration (Marhold, Linton, & Melin, 2002; Shaw, Segal, Rolatajko, &

Harburn, 2002; Herbert and Powell, 1989). This is a critical factor if the individual’s primary

disability is socially stigmatized such as HIV/AIDS and substance abuse (Asbury, Walker,

Maholmes, Green, & Belgrave, 1994).

                                              Purpose

       Prediction is a fundamental concern for the professionals in human service fields.

Identification of predictors early in the VR process is an important but complex task (Kundu,

1983; Parker & Szymanski, 1997). Several researchers have attempted to develop a model for

differential service delivery based on client characteristics (see for example: Bellini, Neath, &

Bolton, 1995; Young & Murphy, 2002; Shaw, Segal, Polatajko, & Harburn, 2002; Lynch, 1981).

       In order to construct a model for facilitating synthesis of consumer data to optimize

vocational outcomes, researchers have traditionally adhered to statistical prediction methods

(Kundu, 1983). The advantages of statistical prediction were efficient synthesis and integration




                                                 15
of data, increased prediction and criterion reliability, generation of precise probability estimates,

and standardization of prediction procedures across individuals.

       The effects of the following on rehabilitation prognosis/outcome demand further research

(Evans, 1991; Hagen & Davis, 1995; Kundu, 1983; Neenan & Orthner, 1996):

           1. attitudinal variables such as work related values, family history of receipt of

               welfare, attitudes towards welfare, locus of control, and work motivation; and

           2. human capital characteristics such as self-esteem, personal/social strengths, life

               experiences affecting perception of labor force, and professional competency; and

           3. effects of rational choice theory that suggests that individuals face economic

               choices and evaluate them according to their preferences, selecting the option that

               offers the greatest utility/satisfaction.

                                            Methodology

       This preliminary investigation of factors is designed to distinguish those applicants for

SSDI who, if screened as likely to receive benefits with appropriate EI, may also be able to

return successfully to the workforce. The portion of the study reported here consists of: (a)

employing a qualitative methodology to investigate demographic and psychosocial factors that

may aid in the selection of candidates for involvement in EI assistance and (b) administering the

resulting instrument to applicants in a state VR agency and quantitatively analyzing the data.

       The qualitative portion of the research was conducted with the active support of the SSA

administration. A research instrument was designed specifically for this project, based upon a

review of relevant clinical research (Evans, 1991; Feist-Price, 1995; Friedlander & Burtless,

1995; Kundu, 1983; Lowery & DuCotte, 1976; Neenan & Orthner, 1`996; Worral & Vandergoot,

1982). Initially, the 20-item instrument addressed two categories of psychosocial factors as they




                                                   16
relate to the employment of people with disabilities. The Attitude and Opinion Survey

Instrument and the Locus of Control Questionnaire. The former asked respondents to consider

various social and situational factors with regard to their implications for the individual’s

employment. The latter asked items related to the individual’s general disposition toward their

capacity to influence outcomes in their lives.

       Six different types of focus groups were convened to give practice and real life input to

the process of selecting appropriate questions to ask: people with disabilities, VR service

providers from a large urban community, medical and psychological consultants for the regional

Disability Quality Branch of Social Security, claims representatives experienced in the initial

application process for SSDI, experienced adjudicators from the Disability Determination

Service of SSA, and administrative law judges and staff attorneys directly involved in the appeal

process. Each focus group met once and was held for approximately 90 minutes. Discussants

received an introduction to the project and signed Institutional Review Board (IRB)-approved

consent forms before participating. An overview of both the research group and the Early

Intervention (EI) project was presented, as well as a brief introduction to the psychosocial issues

and other questions connected to the EI project. Six to eight volunteers were solicited for

participation in each group, with co-facilitators directing the review of the materials provided

and the subsequent discussion. These focus groups reviewed both the standard SSA application

materials and the psychosocial research instruments being designed for this project.

       The primary emphasis for this phase of the project was on identifying specific

information from the standard SSA application materials that might be helpful in identifying

suitable participants for this early RTW intervention. Focus group facilitators asked participants

to examine the following data sources that are currently used to collect information by SSA at




                                                 17
intake: SSA FORM 3367 – Field Office Report, SSA FORM 3368 – Disability Report: Adult,

and SSA FORM 3369 - Work History Report.

        Each group was also asked to address the following questions:

   1.      What variables should be considered in the selection of participants to include in this

           study from among the “presumably disabled” applicants?

   2.      What types of benefits need to be offered to participants in this study?

   3.      What are the types of services that would be considered effective in optimizing RTW

           efforts?

        It was anticipated that some of the psychosocial variables of interest would not be

identified in the forms customarily used in the SSA application process. Consequently, the

research instrument was designed for this project and was presented for discussant review and

comment. The expectation was that, with the expertise of these stakeholders, the research

instrument could be distilled so that it would impose minimal additional effort for either the

applicant or SSA staff.

        Participants in the focus groups were asked to respond to a preliminary list of 20 self-

report statements, not currently available to the SSA regarding the attitude and motivation of an

applicant. The instrument titled which was created with the aid of their group input, “Attitude

and Opinion Survey,” is presented in Appendix A. The items in the survey were created as a

result of the review of the literature related to RTW for persons with disabilities (Kundu, 1983).

After review by the focus groups of stakeholders involved in various aspects of the Social

Security Disability process, the two questionnaires were consolidated into one, 38-item

question, reformatted to a Likert scale design to aid the efficiency of respondent participation.

While some of the original items were dropped, other pertinent items were added to the final




                                                 18
questionnaire. The additional items were added in response to stakeholder feedback concerning

factors considered critical to a determination of those persons with disabilities who were likely to

return to work and those who were not likely to return to work. Focus group participants drew

on their practice experience as they reported on the items and underlying attitudinal and

motivational characteristics presented. They were also asked about self-report statements which

they believed might help the researchers to make accurate identification of SSDI applicants who

would be good candidates for the demonstration project.

       Using hypothetical case study scenarios (based on fact patterns from actual clients –

which were, of course, altered sufficiently to protect the clients’ identity) believed to represent

“typical” characteristics of SSDI applicants, the 38-item instrument was tested by 94 disability

adjudicators of the state DDS. The instrument was determined to be comprehensive but

somewhat cumbersome in its administration due to the large number of items. Stakeholders

suggested that substantial reduction in length of the instrument should be attempted. In addition,

before the instrument could be used on actual SSDI applicants, it would be necessary to test the

instrument on real, rather than hypothetical, clients.

       The goal was to have reliable, valid information and a revised instrument available for

use in the EIDP pilot study. This was accomplished by: (a) testing the 38-item instrument on

actual SSDI beneficiaries who qualify for and are participating in a RTW program; and (b)

identifying the feasibility of streamlining the 38-question instrument into a reliable, predictive

shorter instrument which may be implemented in EIDP’s pilot projects.

       The attempt to streamline the instrument was designed to make it easier to administer

while retaining acceptable reliability and validity in identifying client motivation and attitude-

toward-work indicators (Appendix A). DRI provided training to mid-western state VR agency




                                                 19
staff in administration of the 38-item instrument and, subsequently, to collect data from the VR

consumers. After data were collected, VR staff members opined on the likelihood of trial return

to work efforts of their clients. This completed the project’s Year 2 research.

       It is believed that successful SSDI beneficiaries would most likely have the psychosocial

characteristics (client motivation and attitude-toward-work) that are sufficiently similar to those

of successful applicants for benefits It would then be reasonable to test part of the “Psychosocial

Eligibility” process on successful SSDI benefit recipients as a method of analyzing the

instrument’s reliability in predicting successful RTW activities and in identifying likely ways to

streamline the data collection instrument.

                                         Data Collection

       The VR staff was successfully recruited from the state agency. They were provided with

comprehensive guidelines to ensure the use of informed choice by the client in electing to

participate in the study. An informed consent document was administered to potential

participants before their inclusion in the study. Potential respondents were instructed that

participation in the research would have no influence on their application process. They were

given the option of completing the instruments themselves, having a VR staff clerical person

assist them, or they also had the option of having the VR counselor assist. Approval of the

administration process was granted by the UIUC Institutional Review Board In order to support

the data collection process, DRI agreed to develop web-based data collection methodologies.

That is, the text of the 38-question instrument was made available to the VR agency staff

electronically for use as part of their intake procedure. A toll-free number was made available

for the VR agency staff support in the data collection process for answering questions and

providing other needed support.




                                                 20
       The data collection segment of this part of the research was limited to 5 months. Data

were collected from 760 applicants for services and were transferred electronically to a central

receiving location where they were anonymously stored and analyzed. Demographic

information regarding disability and work history was also collected with the cooperation of the

state agency – with provisions made to separate identity of the applicant from the information

collected. One hundred eighty of the respondents from this group were identified as receiving

SSDI benefits and 97 were found to be receiving SSI benefits. Follow-up evaluations were

completed by the VR counselors on 602 of these initial applicants which yielded complete data

files for each of these respondents. Of the 602 clients with complete survey information

available, 100 were identified by the VR counselors (after six months) as being unlikely to be

eligible for benefits. This identification of applicants as unlikely to be eligible for SSDI benefits

was based on the VR counselors knowledge of facts concerning the applicants (awareness of the

applicants’ actual return to full or part time work, enrollment in school, etc.) which actions

would disqualify them for receipt of SSDI benefits, or their own practice-based judgment. Four

hundred seventy-five of these 602 valid instruments received were identified as having sufficient

information available on them to make an appraisal of their likelihood of trying to return to

work. It is hoped that continuation of the research during the coming year will allow follow-

along data to be collected in regard to respondents’ actual participation in RTW activities and

their success indicators in job placement. This data will serve to confirm whether or not the VR

counselors were accurate in their estimation of client RTW success.

                                              Results
Focus Groups

       The focus groups were able to identify numerous factors from the SSA forms customarily

administrated to applicants for SSDI benefits that are believed to be helpful in determining likely



                                                 21
participants in an EIDP. Further quantitative investigation of these factors and their power in

identifying applicant potential for RTW is warranted.

       Both the literature and the observations of focus group participants support the notion

that a significant part of the VR puzzle lies with various psychosocial factors not addressed in the

customary SSA application documents. Consequently, refinement of an instrument that

concisely addresses these key issues in a parsimonious manner is desired. More information

about the following was endorsed as important in identifying applicants who would be

candidates for an EI: applicant’s social support system, pre-morbid functioning, involvement in

litigation, satisfaction with medical treatment, persistence with treatment since onset of

disability, belief in one’s employability, experience of close family members with public

assistance programs, expression of willingness to return to work, training that would lead one

back to work, and feelings about former employer. As mentioned previously, this information

could be secured either in the course of a face-to-face interview or in a confidential survey.

Under either condition, this information would not be included as part of the applicant’s formal

application file for SSDI benefits.

       Focus group participants consistently endorsed the need for direct contact with the

applicant at the initial stages of application to SSA and the need for forms to be completed fully.

Participants also endorsed the need for training and education of intake workers, applicants and

the community at large with respect to re-conceptualizing their expectations of SSDI as a

transitional rather than on-going benefit program. It is believed that, in order for EI to be

helpful, investigators must ensure a certain level of education about the opportunity to RTW and

the EI process. Since some of this information may be counter-intuitive to the applicant’s

expectations, direct instruction appears to be essential.




                                                 22
       Several focus group discussions addressed the inherent response dilemma for the

applicant. On one hand, they are applying for benefits based upon the severity of their disability

and their diminished employability. On the other hand, they are seeking participation in RTW

programming that implies an intent and belief in their ability to return to substantial gainful

employment. It was noted that the latter expression might indeed influence a negative decision

to the individual’s application for benefits. Therefore, the participants urged that the applicant be

guaranteed in writing, throughout the design of this program, that their responses to the

psychosocial survey be kept confidential and never be part of the official SSA application file.

       From all discussions concerning EI, the need for specific education and training of SSA

staff and the community at large were confirmed. Both in individual training and in the course

of public information announcements, certain areas need to be addressed. For all involved, these

issues would include the following: re-defining the concept of SSDI as an “as needed” rather

than permanent benefit, clarifying the significance of ensuring that forms are completed

thoughtfully and completely and educating all stakeholders in the process about the incentives

for return to work. Some of the public information could ultimately be relayed through

television and print media, as well as posters and televised infomercials in the waiting areas of

the SSA offices.

       The group also suggested efforts to ensure equivalent access to these opportunities by

persons of minority status, including provision of instruments written in the individuals’ native

language, and counselors who spoke the clients’ native language.

Formulation of a Brief Attitude Index

       The second phase of this investigation involved the administration of the 38-item attitude

surveys to state VR agency applicants. It was believed that these individuals would approximate




                                                 23
the characteristics of those applicants for SSDI benefits that will be of ultimate interest in this

project. The preliminary findings of the data collected for the second phase of this project are

presented and implications are discussed in this document.

       In order to comply with the need to provide only five questions for inclusion on the

instrument to be used in the pilot activities carried out by the Rutgers based EIDP group, DRI

assessed the feasibility of refining and shortening the instrument based on analysis of data

collected. (Table 1) To this end, data were collected, assembled and analyzed. Also, and

participants were categorized by the VR agency staff according to the staff’s perceived

likelihood of RTW. This categorization was made six months after client intake in a two-step

procedure asking first “Based on your BEST judgment, is this person likely to TRY to return to

work? (yes = 1, no = 0) and second, asking for an estimate of the level of confidence in this

assessment.

       Table 2 provides a step-by-step summary of the data analysis that was employed in

recommending a five-item attitude index for the pilot study. In Step 1, the researchers selected

only those cases viewed by counselors as having a positive probability of being awarded Social

Security benefits. Out of 602 cases, the rehabilitation counselors eliminated 100 individuals

identified as not likely to qualify to receive Social Security benefits. These persons’

identification as unlikely to qualify to receive benefits was based on the individual counselor’s

judgment of each applicant’s probability to return to work based on information, including the

counselor’s awareness of that person’s actual return to work, his/her not having followed through

with the application procedures, and so forth. This was the first step in the selection process.




                                                  24
Table 1. Summary of Steps in Data Analysis


Step                                   Analysis Description

 1     Selected cases that counselors believed would be eligible for
       SSI/SSDI
 2     Declared zero as missing value for attitude items
       Recoded "try" to return to work to yes = 1, no = -1
 4     Weighted by "certainty" (not at all sure = 1 to extremely confident
       = 5) to compute "return"
 5     Eliminated cases coded as "not at all confident" on certainty from
       the "try" variable.
 6     Performed Stepwise Discriminant Analysis on "Try". This identified
       8 items that entered the discriminant function when (at each step) the
       variable that minimized the sum of the unexplained variation for all pairs
       of groups was entered.
 7     Performed Stepwise Regression on "return" with probability for entry
       of .05 and removal of .10     This identified 10 variables that explained 50%
       of the variance in "return"
 8     Noted that the same 8 items identified in step 6 were identified in step 7
 9     Examined Bivariate correlations between "return" and 11 items
10     Noted that 5 of these statistically significant items had bivariate
       correlations with correlation coefficients larger than .10
11     Reversed coding on items 28, 13, 21, and 14
12     Computed index by adding items 28, 13, 22, 21 and 14.
13     Crosstabulated this index with the counselor's dichotomous estimate
       of the likelihood that the individual would try to obtain work.




                                                  25
     Table 2

     Discriminant Analysis Summary on “Try”
                                                                                                          Residual
         Step         Entered                                   Question                                  Variance
          1           QUES 28        I could handle a part-time job, but not a full time job.                   .912

          2           QUES 13        A disability check is the best way that I can be certain                   .879
                                     of having a reliable income.
          3           QUES 22        I have been looking for work.                                              .858

          4           QUES 24        Since I can’t return to my old job, there really isn’t                     .843
                                     anything else that I could do to make a living.
          5          QUES 21         I cannot work as fast as other workers.                                    .824

          6           QUES 12        I expect that my disability will continue to get worse.                    .814

          7          QUES 14         I am afraid that if I go back to work, I will lose                         .805
                                     coverage for the medical care that I need.
          8           QUES 25        I want to go back to work.                                                 .796

     Note. At each step, the variable that minimizes the sum of the unexplained variation for all pairs of groups is
     entered.
          1 Maximum number of steps is 76.
          2 Maximum significance of F to enter is .05.
          3 Minimum significance of F to remove is .10.
     F level, tolerance, or VIN insufficient for further computation




       The missing value codes of the remaining 502 cases were edited prior to data analysis

with zero declared a missing value for each of the 38 attitude items. The variable “Try”, which

summarizes counselors’ perceptions of whether or not each individual applicant was likely to try

to return to work was then recoded to “No” = - 1 and “Yes” = + 1. Next a stepwise discriminant

analysis was performed on the dichotomous variable “Try” after first eliminating those cases

coded as “not at all confident” on the confidence variable. This analysis identified 8 items



                                                        26
(Table 2) that loaded sufficiently on the discriminant function when the variable that minimized

the sum of the unexplained variation for all pairs of groups was added. The maximum

significance of F to enter was set at 0.05 and the maximum F for removal at 0.10.

       A separate, but analogous multivariate analysis of the data was performed as a way of

“triangulating” this analysis. In this second approach, the “Try” variable was multiplied by the

weight of responses to the question “How confident are you in this opinion?” with “not at all

confident” weighted as 1 and “extremely confident” weighted as 5. The purpose of this

computation was to try to maximize the usefulness of the available information through creation

of a new continuous variable “return” with a range of – 5 to + 5 in which a score of –5

represented the VR counselors’ strongest conviction that a client would not try to return to work

and +5 the strongest conviction that a client would try to return to work. Thus, this analysis

added information about degree of confidence in the prediction of attempt to return to work that

was not available using only the dichotomous measure of expected outcome. This new “return”

variable was then employed as the dependent variable in a stepwise multiple regression analysis.

This approach was analogous to the discriminant analysis described in the paragraph above in

that variables entered the equation based upon degree of independent correlation with the

outcome variable. Given the lack of an a priori empirical or theoretical reason to enter variables

systematically, such an approach is appropriate to identifying a subset of variables that is best

correlated with the outcome variable. This parallel approach to the discriminant analysis

identified 11 of the 38 items as significant predictors of RTW. These 11 items included all 8

items identified in the discriminant analysis.

       Bivariate correlations between these eleven items and the “return” variable were then

examined. Five items with the largest correlations (all <.10) with “return” were selected and




                                                 27
these items recoded so that higher scores represented a higher predicted likelihood of RTW

(Table 3). These items are the firve questions preliminarily recommended for inclusion in the

pilot studies. An additive index with a theoretical range from 5 (lowest possible predicted

likelihood) to 25 (highest possible predicted likelihood) was calculated. The observed values of

this index actually ranged from 5 to 21.

       These index scores were then cross-tabulated with the dichotomous “try” variable. Scores

in the lowest range of the index (5-10) were found to be strongly associated with rehabilitation

counselors’ predictions that the individual would be unlikely to try to RTW. Additionally, 79 of

the 100 individuals with low scores on this 5-item attitude index were classified by the

rehabilitation counselors as unlikely to RTW. The majority of individuals with index scores in

the 11 to 14 range were also classified by rehabilitation counselors as unlikely to RTW, although

the correlation was weaker in this range. The majority of individuals with scores of 15 or higher

were classified by rehabilitation counselors as likely to RTW. Table 6 provides the frequency of

client responses to each of the 38 questions on a likert scale separated into “yes” and “no”

categories. Table 7 provides percentages of client responses to each of the 38 questions on a

likert scale separated into “yes” and “no” categories.. The responses are separated based on

counselors’ projections of their likelihood to try to return to work.

       There are several ways in which these attitude items might be combined with other

variables identified by the Rutgers EI team in order to assess the appropriateness of each

applicant for the pilot project. One important task to be performed before the pilot studies are

carried out a decision on is the refinement of the language in the questions to be administered.

Under the direction of the UIUC Survey Research Laboratory, and at the suggestion of pervious

reviewers, the five tested items have been expanded into six items (see Table 4) so additional




                                                 28
analysis of these items will need to be completed before incorporation into the pilot instrument.

Whatever method is selected however, the DRI strongly advises that an index score



Table 3: Recommended Index Items


                                         Strongly        Agree   Neutral    Disagree     Strongly
                                         Agree                                           Disagree
1 (28). I could handle a part-time       1               2       3          4            5
        job but not a full time job.
2 (13). Disability benefits are the      1               2       3          4            5
        best way that I can be
        certain of having a reliable
        income.
3 (22). I have been looking for          5               4       3          2            1
        work.
4 (21). I cannot complete as much        1               2       3          4            5
        work as other people in an
        eight hour work day.
5. (14). I am afraid that if I go back   1               2       3          4            5
        to work, I will lose coverage
        for the medical care that I
        need.


be calculated and reported for each participant in the pilot study. In that manner, the study can

verify the correlation between the index score and actual attempts to RTW. During the months

ahead, the DRI hopes to have the opportunity to continue to follow the participants of the mid-

western VR agency to measure actual RTW in the hopes of devising a set of questions based

upon actual RTW, rather than rehabilitation counselors’ intuitive predictions. However, in the

short term it is suggested that the items listed in Table 2 be included to compute a brief additive

attitude index for use by the Rutgers team in their pilot study. Tables 5 and 6 (Appendix B) show

the analyses completed to deliver the minimalist instrument at this point in time. Table 1 presents

the steps in the analysis (refer to Tables 5 and 6, Appendix B, for analysis data).




                                                    29
Discussion

       This research and its results show meaningful promise to become useful to the

rehabilitation educator and practitioner. The field has long sought a methodology for

determining psychosocial predictors of successful RTW efforts. The developed instrument will

provide a way for rehabilitation educators to expose their students to tools which may be used in

their practices. As it is used, the instrument may help practitioners be better able to determine

which clients are the “best bets” for job placement. In a climate of diminishing financial

resources, more effective and accurate predictors are crucial to placement decision making. In

addition, the research will provide an important piece in the support for the implementation of

the “Ticket to Work” legislation.

       This paper reported findings of the first two phases of the investigation. The first phase

of this investigation employed focus groups to identify appropriate and necessary information for

selection of individuals from the applicant pool and to identify existing or needed sources of

information that could aid in this process. Focus group members, representing diverse

stakeholders in the disability adjudication system, reviewed both existing SSA forms and a

proposed survey. The survey was designed to assess psychosocial and motivational factors that

might portend success questions and was based upon review of the research literature.

       Focus groups identified work history, history of SSDI applications, and type of limitation

as crucial information that was contained in existing forms. There was consensus that existing

federal forms contained insufficient information to accurately identify the best candidates for

early intervention. The focus group members identified a number of items that were contained in

the proposed survey instrument that they endorsed as relevant to the identification of appropriate

applicants, and also suggested additional items that had not been included. Based upon findings




                                                 30
from pilot test administration, a refined attitude survey was recommended as an adjunct to

existing federal forms in order to enhance optimal selection of those SSDI applicants most likely

to succeed in an early RTW program. Collection of actual client return-to-work status will

provide an additional evaluation of the accuracy of counselor prediction, and will thus aid in the

creation of a reliable and valid prediction instrument.

       In the second phase of the study, the original 38-item instrument was minimized to create

a five-item instrument in the additive additive index per the request of the Rutgers team. The

five items were selected based on their statistical probability to predict likelihood of return to

work efforts on the part of applicants.   After receipt of valuable input from the Rutgers team

and staff from the University of Illinois at Chicago’s Survey Research Laboratory, the language

of these five items was refined to yield six items with more focused language for the instrument

to be administered during the pilot studies. With language refined and when validated by pilot

studies, the shortened index has a high likelihood of becoming a dependable measure of

psychosocial indicators of RTW. It is believed that the predictive value of the within-question

concepts will be preserved with revisions while providing functional benefits which may be

useful in followup measurement activities.

       In the next phase of the research, DRI/UIUC collaborators desire to have every

participant in the three-state pilot study receive and respond to the five-questions (which will

have been edited from the existing six items which resulted from reconstruction of the questions)

found to have the highest likelihood of being predictive of motivation to return to work. This

production of questions will satisfy the request by the Rutgers team to make a brief contribution

to the complete pilot instrument. The UIUC group has identified five/six indicators which

appear to be the most predictive of motivation to return to work of the 38 items tested. Since




                                                  31
Table 4: Recommended Index Items (Revised)

                                       Strongly        Agree   Neutral      Disagree    Strongly
                                       Agree                                            Disagree
I could handle a part-time job.        1               2       3            4           5
I could handle a full-time job         1               2       3            4           5
A disability check is the best way     1               2       3            4           5
       that I can be certain of
       having a reliable income
I have been looking for work.          1               2       3            4           5
I am not able to do as much as         1               2       3            4           5
       other workers in an eight
       hour day.
I am afraid that I’ll lose my          1               2       3            4           5
       medical coverage if I go
       back to work


there appear to be at least ten other questions which showed promise of predictability of RTW

efforts, the DRI/UIUC researchers would also like to have the opportunity to administer the 38-

item instrument to a small (at least 100 randomly selected participants from each of the three

pilot states) in the demonstration. This would allow a more complete analysis of the predictive

instrument.

       According to Berkowitz, Englander, Rubin, and Worral (1975), “If we can forecast

outcome with 10% more accuracy than we are doing now both the savings in costs and benefits

to client and society would be substantial” (p. 125). Overall, it appears that the instrument being

developed bears a promise to successfully determine the psychosocial eligibility of innumerable

SSDI/SSI beneficiaries for EI services geared to facilitate RTW.

       After reviewing the literature on motivational change, and its lack of valid and reliable

instruments to predict motivation, the UIUC team is even more confident of the fact that in these

first two years of work, we have created a psychosocial predictive instrument which will be of

use to the Early Intervention Demonstration Project. With the activities to be completed in year


                                                  32
3, the project will have developed a reliable and valid predictive instrument for future return-to-

work activities, and the potential for supporting a model for motivational intervention which has

been long needed in the field.

       In summary, we believe we have created a brief instrument which promises to be a

statistically reliable and valid instrument which may predict motivation to return to work of

applicants for Social Security Disability benefits. The team believes that, after consultation with

the UIUC Survey Research Laboratory, the revised questions have gained the face validity such

an instrument demands. In complement with the other application procedures produced for the

Early Intervention Demonstration program designed by our colleagues at Rutgers, this brief

instrument will provide needed additional features to the screening process, and will, we hope,

be found to be generalizable to other return to work projects in the future.




                                                 33
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                                                41
                                                            Appendix A

ATTITUDE AND OPINION INSTRUMENT THIS INFORMATION IS FOR RESEARCH PURPOSES ONLY and
WILL NOT BE PART OF YOUR SSDI APPLICATION

Case ID #_____________________

                                                                            Strongly   Agree   Neutral   Disagree   Strongly
                                                                            Agree                                   Disagree
1. Traveling to a job would be very hard
2. If I could work, I would earn more than I would get on disability
3. There are not a lot of good jobs in this town.
4. I’ve worked hard and I deserve to be on disability.
5. Going to work would just complicate my life.
6. No one else in my family has ever applied for disability or workers
      compensation
7. Trying to work could cause me to have pain
8. I am needed to care for others at home
9. I could work if employers would modify the job. (job tasks, work
      hours, standing, sitting)
10. I have skills or hobbies that might help me earn some extra money to
      go with a disability check.
11. I don’t have the training and experience for the kind of jobs that I
      could do with my disability.
12. I expect that my disability will continue to get worse.
13. A disability check is the best way that I can be certain of having a
      reliable income.
14. I am afraid that if I go back to work, I will lose coverage for the
      medical care that I need.
15. I do not know how I could find time to get my medical care if I had a
      full time job.
16. My last regular job was very satisfying to me.



                                                                 42
                                                                                Strongly   Agree   Neutral   Disagree   Strongly
                                                                                Agree                                   Disagree
17. I do not want to depend on a disability check for the rest of my life.
18. Other members of my family have received assistance from the
      government, e.g. TANIF, public assistance, SSI.
19. I think that I could find work if I could develop some new job skills.
20. I don’t have the concentration needed to hold a job.
21. I cannot work as fast as the other workers
22. I have been looking for work.
23. I am involved in a lawsuit.
24. Since I can’t return to my old job, there really isn’t anything else that
      I could do to make a living.
25. I want to go back to work.
26. I would be willing to become involved in training that would lead
      me back to work.
27. I think that I could get a job but I don’t know if I could keep it.
28. I could handle a part-time job, but not a full time job.
29. I am angry with my former employer
30. I don’t have much say in what happens to me.
31. I have supervised others at work
32. I can easily reach my counselor during office hours.
33. I am sure to find a job with some help or vocational rehabilitation.
34. I read, write, and speak English well.
35. I was satisfied with my previous job.
36. I have changed jobs frequently.
37. I have been involved in a work-related lawsuit.
38. I have been involved in a disability-related lawsuit.




                                                                     43
                   Appendix B

     Table 5. Stepwise Regression Summary on “Return”


             V ar iables in the Analysis

                                    F to      Wi l ks '
S tep              T ol eranc e   Rem ove    Lam bda
1        QUE S28         1.000     44.614
2        QUE S28          .863     23.587         .934
         QUE S13          .863       9.090        .903
3        QUE S28          .857     20.068         .904
         QUE S13          .856     10.633         .884
         QUE S22          .989     10.206         .883
4        QUE S28          .824     14.371         .877
         QUE S13          .843       8.175        .864
         QUE S22          .986     10.956         .870
         QUE S21          .917       7.105        .862
5        QUE S28          .805     17.149         .867
         QUE S13          .840       8.923        .850
         QUE S22          .830     16.988         .866
         QUE S21          .914       7.790        .848
         QUE S25          .804       7.394        .847
6        QUE S28          .796     18.998         .857
         QUE S13          .788     12.367         .844
         QUE S22          .830     16.923         .853
         QUE S21          .905       9.049        .837
         QUE S25          .792       8.915        .837
         QUE S12          .874       6.543        .832
7        QUE S28          .795     19.350         .847
         QUE S13          .784     13.398         .836
         QUE S22          .830     16.755         .842
         QUE S21          .905       8.975        .827
         QUE S25          .792       8.606        .826
         QUE S12          .873       6.037        .821
         QUE S8           .984       4.937        .819
8        QUE S28          .757     13.717         .825
         QUE S13          .748       9.123        .816
         QUE S22          .828     15.650         .829
         QUE S21          .905       8.566        .815
         QUE S25          .792       8.801        .815
         QUE S12          .862       7.230        .812
         QUE S8           .970       6.087        .810
         QUE S14          .795       5.538        .809
9        QUE S28          .745     11.452         .812
         QUE S13          .747       9.095        .808
         QUE S22          .826     14.530         .818
         QUE S21          .905       8.497        .807
         QUE S25          .597     12.916         .815
         QUE S12          .855       6.092        .802
         QUE S8           .969       5.598        .801
         QUE S14          .785       6.507        .803
         QUE S26          .662       4.153        .798
10       QUE S28          .737     12.695         .806
         QUE S13          .728     10.903         .803
         QUE S22          .825     14.706         .810
         QUE S21          .875     10.463         .802
         QUE S25          .591     11.132         .803
         QUE S12          .843       4.778        .791
         QUE S8           .967       5.132        .792
         QUE S14          .785       6.596        .794
         QUE S26          .655       5.016        .791
         QUE S24          .789       4.297        .790
11       QUE S28          .704       9.088        .791
         QUE S13          .713       8.719        .790
         QUE S22          .822     15.522         .804
         QUE S21          .830       7.055        .787
         QUE S25          .588     12.020         .797
         QUE S12          .839       5.304        .784
         QUE S8           .965       5.521        .784
         QUE S14          .774       5.230        .784
         QUE S26          .650       5.731        .785
         QUE S24          .789       4.407        .782
         QUE S27          .726       4.129        .782



                                                     44
Table 6. Correlation of Index Score with “Try”
Table 7

Descriptive Table of Responses (Number of responses by Category)

                                                      Likely
                                                        to                   Strongly                        Strongly
                     Question                                  Respondents            Agree Neutral Disagree
                                                      return                  Agree                          Disagree
                                                     to work
                                                      Yes          499         47      74     115     147      116
1. -Traveling to a job would be very hard.
                                                      No           103         12      32      26      22       11

2. -If I could work, I would earn more than I         Yes          492         211    123     103      39       16
would get on disability.                              No           101          37    24       26       8       6

                                                      Yes          497         103    138     125      90       41
3. -There are not a lot of good jobs in this town.
                                                      No           100          24    26       22      21       7

4. -I have worked hard and I deserve to be on         Yes          493         42      79     171     107       94
disability.                                           No           101         10      16      31      27       17

                                                      Yes          497         16      24     54      182      221
5. -Going to work would just complicate my life.
                                                      No           101         3        9     14       32       43

6. -No one else in my family has ever applied for     Yes          494         133    118     65      114       64
disability or workers compensation.                   No           100          16    28      18       23       15

                                                      Yes          500         39     118     90      132      121
7. -Trying to work could cause me to have pain.
                                                      No           102         9      28      32       22       11

                                                      Yes          493         36      75     86      157      139
8. -I am needed to care for others at home.
                                                      No           101         10      17     16       31       27

9. - I could work if employers would modify the       Yes          486         88     157     124      67       50
job. (Job tasks, work hours, standing, sitting).      No           100         18     27       29      16       10



                                                         46
10. –I have skills or hobbies that might help me   Yes    489   81   188   112   75   33
earn some extra money to go with a disability      No     101   17   34     32   13   5
check.




                                                     47
Table 7 (Continued)

Descriptive Table of Responses (Number of responses by Category)

                                                     Likely to
                                                                           Strongly                            Strongly
                    Question                         return to Respondents          Agree Neutral   Disagree
                                                                            Agree                              Disagree
                                                       work
11. -I don’t have the training and experience          Yes        493        90     121     107       115        60
for the kind of jobs that I could do with my           No         102        16      36     28        15          7
disability.

12. -I expect that my disability will continue         Yes        493        68     120     143       102        60
to get worse.                                          No          99        17      29     27        13         13

13. - A disability check is the best way that I        Yes        493        34     118     123       131        87
can be certain of having a reliable income.            No         102        11      25     21        27         18

14. -I am afraid that if I go back to work, I will     Yes        488        31     64      148       148        97
lose coverage for the medical care that I need.        No         102        13     17      25        31         16

15. -I do not know how I could find time to get        Yes        481        11     61      131       179        99
my medical care if I had a full time job.              No         101         5     13      27        36         20

16. -My last regular job was very satisfying to        Yes        495       124     184     90        58         39
me.                                                    No         103       23       32     23        12         13

17. -I do not want to depend on a disability           Yes        487       234     147     64        27         15
check for the rest of my life.                         No         101       47       35     13        5           1

18. - Other members of my family have                  Yes        487        51     121     73        121        121
received assistance from the government, e.g.          No         100        17      34     17        17          15
TANIF, public assistance, SSI.
19. -I think that I could find work if I could         Yes        488       200     211     54        17          6
develop some new job skills.                           No         102       38       38     18        6           2


                                                             48
Table 7 (Continued)

Descriptive Table of Responses (Number of responses by Category)

                                                   Likely to
                                                                              Strongly                        Strongly
                      Question                     return to    Respondents            Agree Neutral Disagree
                                                                               Agree                          Disagree
                                                     work
20. -I don’t have the concentration needed to        Yes           493          15      44     109     185      140
hold a job.                                          No            102          5       18      26      35       18

21. – I cannot work as fast as the other             Yes           490          30     133     119     130       78
workers.                                             No            101          13     26       23      32        7

22. -I have been looking for work.                   Yes           488          127    167     97       71       26
                                                     No            102           31    31      21       13        6

                                                     Yes           483          11      23     50      145      254
23. –I am involved in a lawsuit.
                                                     No            101          4       5      9        29       54

24. -Since I can’t return to my old job, there       Yes           487          20      33     80      189      165
really isn’t anything else that I could do to        No            101          4       10     21       35       31
make a living.

                                                     Yes           486          238    167     65       8        8
25.-I want to go back to work.
                                                     No             98           46    42      8        2        0

26.-I would be willing to become involved in         Yes           489          266    169     45       8        1
training that would lead me back to work.            No            101           50    44      5        2        0

27. - I think that I could get a job but I don’t     Yes           489          50     124     97      126       92
know if I could keep it.                             No            101          13     32      23       24        9

28. - I could handle a part-time job, but not a      Yes           489          53     102     117     112      105


                                                           49
full time job.                                       No        101         13     27      27       20        14
                                                    Yes        486         28     55      84      150       169
29. – I am angry with my former employer.
                                                    No          99         8      6       18       37        30


Table 7 (Continued)

Descriptive Table of Responses (Number of responses by Category)

                                                  Likely to             Strongly Agree Neutral Disagree   Strongly
                   Question                       return to Respondents  Agree                            Disagree
                                                    work
30. – I don’t have much to say in what              Yes        487       24      47      73      177        166
happens to me.                                      No         100       3       17      11       42         27

                                                    Yes        484       124     179     60       82        39
31. – I have supervised others at work.
                                                    No         100        16      34     12       27        11

32. -I can easily reach my counselor during         Yes        480       105     209    145       16         5
office hours.                                       No          99        19      47     27       3          3

33. - I am sure to find a job with some help or     Yes        489       175     228     78       6          2
vocational rehabilitation.                          No         101        37      45     16       3          0

                                                    Yes        490       274     152     27       31         6
34. -I read, write, and speak English well.
                                                    No         103        51      38     5        6          3

                                                    Yes        490       113     193    103       53        28
35. -I was satisfied with my previous job.
                                                    No         100        24      35     18       15        8

                                                    Yes        484       56      114     86      134        94
36. -I have changed jobs frequently.
                                                    No         103       17       23     24       24        15
37. - I have been involved in a work-related        Yes        482        8      39      50      131        254


                                                          50
lawsuit.                                      No         101   3    3    5    36    54
38. - I have been involved in a disability-   Yes        482   12   30   43   131   266
related lawsuit.                              No         102   3    5    4     35    55




                                                    51
Table 8

Descriptive Table of Responses (Percentages by Category)

                                                      Likely
                                                        to                   Strongly                        Strongly
                     Question                                  Respondents            Agree Neutral Disagree
                                                      return                  Agree                          Disagree
                                                     to work
                                                      Yes         499          9.4    14.8   23.0     29.5     23.2
1. -Traveling to a job would be very hard.
                                                      No          103         11.7    31.1   25.2     21.4     10.7

2. -If I could work, I would earn more than I         Yes         492         42.9    25.0   20.9     7.9       3.3
would get on disability.                              No          101         36.6    23.8   25.7     7.9       5.9

                                                      Yes         497         20.7    27.8   25.2     18.1      8.2
3. -There are not a lot of good jobs in this town.
                                                      No          100         24.0    26.0   22.0     21.0      7.0

4. -I have worked hard and I deserve to be on         Yes         493          8.5    16.0   34.7     21.7     19.1
disability.                                           No          101          9.9    15.8   30.7     26.7     16.8

                                                      Yes         497          3.2     4.8   10.9     36.6     44.5
5. -Going to work would just complicate my life.
                                                      No          101          3.0     8.9   13.9     31.7     42.6

6. -No one else in my family has ever applied for     Yes         494         26.9    23.9   13.2     23.1     13.0
disability or workers compensation.                   No          100         16.0    28.0   18.0     23.0     15.0

                                                      Yes         500          7.8    23.6    18      26.4     24.2
7. -Trying to work could cause me to have pain.
                                                      No          102          8.8    27.5   31.4     21.6     10.8

                                                      Yes         493          7.3    15.2   17.4     31.8     28.2
8. -I am needed to care for others at home.
                                                      No          101          9.9    16.8   15.8     30.7     26.7

9. - I could work if employers would modify the       Yes         486         18.1    32.3   25.5     13.8     10.3
job. (Job tasks, work hours, standing, sitting).      No          100         18.0    27.0   29.0     16.0     10.0



                                                         52
10. -I have skills or hobbies that might help me   Yes    489   16.6   38.4   22.9   15.3   6.7
earn some extra money to go with a disability      No     101   16.8   33.7   31.7   12.9   5.0
check.




                                                     53
Table 8 (Continued)

Descriptive Table of Responses (Percentages by Category)

                                                     Likely to
                                                                           Strongly                            Strongly
                    Question                         return to Respondents          Agree Neutral   Disagree
                                                                            Agree                              Disagree
                                                       work
11. -I don’t have the training and experience          Yes        493       18.3    24.5   21.7       23.3       12.2
for the kind of jobs that I could do with my           No         102       15.7    35.3   27.5       14.7        6.9
disability.

12. -I expect that my disability will continue         Yes        493       13.8    24.3   29.0       20.7       12.2
to get worse.                                          No          99       17.2    29.3   27.3       13.1       13.1

13. - A disability check is the best way that I        Yes        493        6.9    23.9   24.9       26.6       17.6
can be certain of having a reliable income.            No         102       10.8    24.5   20.6       26.5       17.6

14. -I am afraid that if I go back to work, I will     Yes        488        6.4    13.1   30.3       30.3       19.9
lose coverage for the medical care that I need.        No         102       12.7    16.7   24.5       30.4       15.7

15. -I do not know how I could find time to get        Yes        481       2.3     12.7   27.2       37.2       20.6
my medical care if I had a full time job.              No         101       5.0     12.9   26.7       35.6       19.8

16. -My last regular job was very satisfying to        Yes        495       25.1    37.2   18.2       11.7        7.9
me.                                                    No         103       22.3    31.1   22.3       11.7       12.6

17. -I do not want to depend on a disability           Yes        487       48.0    30.2   13.1       5.5        3.1
check for the rest of my life.                         No         101       46.5    34.7   12.9       5.0        1.0

18. - Other members of my family have                  Yes        487       10.5    24.8   15.0       24.8       24.8
received assistance from the government, e.g.          No         100       17.0    34.0   17.0       17.0       15.0
TANIF, public assistance, SSI.
19. -I think that I could find work if I could         Yes        488       41.0    43.2   11.1       3.5        1.2
develop some new job skills.                           No         102       37.3    37.3   17.6       5.9        2.0


                                                             54
Table 8 (Continued)
Descriptive Table of Responses (Percentages by Category)

                                                   Likely to
                                                                              Strongly                        Strongly
                    Question                       return to    Respondents            Agree Neutral Disagree
                                                                               Agree                          Disagree
                                                     work
20. -I don’t have the concentration needed to        Yes           493          3.0     8.9   22.1     37.5     28.4
hold a job.                                          No            102          4.9    17.6   25.5     34.3     17.6

21. – I cannot work as fast as the other             Yes           490          6.1    27.1   24.3     26.5     15.9
workers.                                             No            101         12.9    25.7   22.8     31.7      6.9

22. -I have been looking for work.                   Yes           488         26.0    34.2   19.9     14.5      5.3
                                                     No            102         30.4    30.4   20.6     12.7      5.9

                                                     Yes           483          2.3     4.8   10.4     30.0     52.6
23. –I am involved in a lawsuit.
                                                     No            101          4.0     5.0    8.9     28.7     53.5

24. -Since I can’t return to my old job, there       Yes           487          4.1     6.8   16.4     38.8     33.9
really isn’t anything else that I could do to        No            101          4.0     9.9   20.8     34.7     30.7
make a living.

                                                     Yes           486         49.0    34.4   13.4     1.6       1.6
25.-I want to go back to work.
                                                     No             98         46.9    42.9    8.2     2.0       0.0

26.-I would be willing to become involved in         Yes           489         54.4    34.6    9.2     1.6       0.2
training that would lead me back to work.            No            101         49.5    43.6    5.0     2.0       0.0

27. - I think that I could get a job but I don’t     Yes           489         10.2    25.4   19.8     25.8     18.8
know if I could keep it.                             No            101         12.9    31.7   22.8     23.8      8.9

28. - I could handle a part-time job, but not a      Yes           489         10.8    20.9   23.9     22.9     21.5
full time job.                                       No            101         12.9    26.7   26.7     19.8     13.9


                                                           55
                                            Yes        486   5.8   11.3   17.3   30.9   34.8
29. – I am angry with my former employer.
                                            No          99   8.1    6.1   18.2   37.4   30.3




                                                  56
Table 8 (Continued)

Descriptive Table of Responses (Percentages by Category)

                                                  Likely to             Strongly Agree Neutral Disagree   Strongly
                   Question                       return to Respondents  Agree                            Disagree
                                                    work
30. – I don’t have much to say in what              Yes        487       4.9      9.7   15.0     36.3       34.1
happens to me.                                      No         100       3.0     17.0   11.0     42.0       27.0

                                                    Yes        484       25.6    37.0   12.4     16.9        8.1
31. – I have supervised others at work.
                                                    No         100       16.0    34.0   12.0     27.0       11.0

32. -I can easily reach my counselor during         Yes        480       21.9    43.5   30.2     3.3        1.0
office hours.                                       No          99       19.2    47.5   27.3     3.0        3.0

33. - I am sure to find a job with some help or     Yes        489       35.8    46.6   16.0     1.2        0.4
vocational rehabilitation.                          No         101       36.6    44.6   15.8     3.0        0.0

                                                    Yes        490       55.9    31.0    5.5     6.3        1.2
34. -I read, write, and speak English well.
                                                    No         103       49.5    36.9    4.9     5.8        2.9

                                                    Yes        490       23.1    39.4   21.0     10.8       5.7
35. -I was satisfied with my previous job.
                                                    No         100       24.0    35.0   18.0     15.0       8.0

                                                    Yes        484       11.6    23.6   17.8     27.7       19.4
36. -I have changed jobs frequently.
                                                    No         103       16.5    22.3   23.3     23.3       14.6

37. – I have been involved in a work-related        Yes        482       1.7     8.1    10.4     27.2       52.7
lawsuit.                                            No         101       3.0     3.0     5.0     35.6       53.5

38. - I have been involved in a disability-         Yes        482       2.5     6.2     8.9     27.2       55.2
related lawsuit.                                    No         102       2.9     4.9     3.9     34.3       53.9




                                                          57
                                                                                           TRYN * INDEX Crosstabulation

                                                                                                                INDEX
                                 5.00     6.00     7.00      8.00      9.00      10.00     11.00     12.00       13.00     14.00     15.00     16.00     17.00     18.00     19.00     20.00    21.00    T otal
T RYN -1.00     Count                 5        6        10        13        17        27        28        28          21        21        15        12        12         7         2        2                226
                % within TRYN      2.2%     2.7%     4.4%      5.8%      7.5%     11.9%     12.4%     12.4%        9.3%      9.3%      6.6%      5.3%      5.3%      3.1%       .9%       .9%            100.0%
                % within INDEX   100.0%   100.0%    90.9%     72.2%     81.0%     81.8%     70.0%     66.7%       61.8%     60.0%     39.5%     40.0%     40.0%     24.1%     16.7%     28.6%             56.9%
         1.00   Count                                    1         5         4         6        12        14          13        14        23        18        18        22        10        5        6       171
                % within TRYN                         .6%      2.9%      2.3%      3.5%      7.0%      8.2%        7.6%      8.2%     13.5%     10.5%     10.5%     12.9%      5.8%      2.9%     3.5%   100.0%
                % within INDEX                       9.1%     27.8%     19.0%     18.2%     30.0%     33.3%       38.2%     40.0%     60.5%     60.0%     60.0%     75.9%     83.3%     71.4%   100.0%    43.1%
T otal          Count                 5        6        11        18        21        33        40        42          34        35        38        30        30        29        12        7        6       397
                % within TRYN      1.3%     1.5%     2.8%      4.5%      5.3%      8.3%     10.1%     10.6%        8.6%      8.8%      9.6%      7.6%      7.6%      7.3%      3.0%      1.8%     1.5%   100.0%
                % within INDEX   100.0%   100.0%   100.0%    100.0%    100.0%    100.0%    100.0%    100.0%      100.0%    100.0%    100.0%    100.0%    100.0%    100.0%    100.0%    100.0%   100.0%   100.0%




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