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Comparison of VR Outcomes for Clients with Mental Illness across System Indicators

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Originally published: 12/2008

Research to Practice
Institute for Community Inclusion
University of Massachusetts Boston
Issue 47
December 2008

Introduction

The argument that people with psychiatric disabilities cannot work is an empty one, as anecdotal and research data have shown (Bond, 2004). Recently, there has been a plethora of information on evidence based employment strategies, prominently connected with the research on the Individual Placement and Support (IPS) model associated with Drake and colleagues at Dartmouth College (Drake, 1998). Historically, much of the pressure to produce employment outcomes for this group of people fell on the public vocational rehabilitation system. However, with the advent of greater attention in the last decade paid to Recovery, evidence based practices, mental health transformation, attempts to solve Medicaid disincentives issues, etc. there has been much more emphasis devoted to this aspect of psychiatric services coming more under the purview of community mental health. As Rapp et al (2005, p.351) noted: "The bedrock of policy makers' efforts is the establishment and codification of client outcomes. They are the ends for which the service system is designed and for which consumers, providers and others work. 'Achieving consistently positive outcomes is at the heart of Evidence Based Practice' (Goldman & Azrin, 2003, p. 901)." Yet overall employment outcomes for people with serious mental illness have not increased significantly. Nationally less than 25% of adult public mental health consumers are employed at any level according to a variety of research data and reporting streams (SAMHSA, 2006).

While there is general consensus that the employment outcomes for people with mental illness remain unacceptably low in terms of social change (Hall, Graf, Fitzpatrick, Lane, & Birkel, 2003; Marrone, 2007), three key issues stand out prominently among many in addition to this consistent lack of systemic success. One, beyond the assumption of "competitive employment" in integrated settings in the community there is no common definition of employment (more precisely "successful employment") used in many studies. Two, no clear objective data currently exists to provide an overarching measure of employment outcomes. There are several indicators such as the Center for Mental Health Services Uniform Reporting System (National Outcome Measures or NOMS), Rehabilitation Services Administration administrative services statistics (RSA 911), information from the Center for Mental Health Services (CMHS) Mental Health Transformation Grants (MHTG) and Supported Employment system change projects through the Johnson and Johnson/ Dartmouth Community Mental Health program collaboration. But they are not directly comparable in understanding systemic success in terms of enhancing employment outcomes. Three, different states and different public systems within those states, e.g., Vocational Rehabilitation (VR) and Mental Health (MH) measure the characteristics of the clients served very differently. Some MH agencies are only open for service to people with serious and persistent mental illness; others assist people with other diagnosable mental illnesses. VR agencies use functional criteria not diagnostic labels and many restrict services to those with the most significant disabilities.

Given this lack of comparability it still would prove useful to examine larger employment system results in light of these separate measures. Thus policy formulators and researchers can begin to highlight possible avenues for closer coordination and analysis. Focusing on how outcomes from these data sets vary by states' involvement with a variety of system transformative efforts is illustrative but not probative. Cause and effect cannot be inferred because the information available is from different time frames and not necessarily from the same groups, other than the broad category of "people with mental illness". As noted earlier, standards used to judge employment vary (VR requires a minimum of 90 days working to achieve a successful closure; the MH state NOMS data has no duration requirement). Some research investigations undertaken look at tenure (Salyers, Becker, Drake, Torrey, & Wyzik, 2004); but there is no consistent state recording format using length of employment. Therefore, care must be taken to avoid judging the relative success or failures of these respective interventions in light of the following numerical tabulations provided. In addition to the figures regarding employment outcomes, we have offered some data that may merit further investigation in relation to clients with mental illness served. There is no similar national data regarding access to employment services within mental health systems overall, though the NAMI TRIAD report (Hall, et al, 2003) reports 28% of their adult mental health survey respondents had received "supported employment" services and Dartmouth researchers have postulated that perhaps even less than 5% of clients of public mental health systems have access to rigorously defined evidence based supported employment programs (Bond & Drake, 2008).

Despite these limitations and caveats the statistics noted would underline areas for further, more rigorous research. This is a call for more effort to understand if and how system change efforts improve employment outcomes, what influences outcomes, and how administrative data can be used to evaluate progress toward a compelling goal. Such endeavors may assist in demonstrating impact of the various interventions that have been and continue to be made by many advocates to create systems and structures that positively affect employment outcomes for people with serious mental illness beyond the more demonstrable improvements that have occurred at the program level across the country and even overseas. The statistics below have been compiled by the Institute for Community Inclusion (ICI) from data supplied through both the RSA 911 for fiscal year 2007 (ending 10/1/07) and the CMHS URS (NOMS) for fiscal year 2006 (ending 10/1/06- the last year available).

We draw attention to particular states in Tables 1 through 7 in the Appendix either because they have received federal MHTG funds or are part of the Johnson and Johnson – Dartmouth Community Mental Health Program collaboration for system change in Evidence Based Supported Employment or both. As explained earlier, the data is not directly comparable nor can it be used independently for causative calculations or project evaluation. Nonetheless it is worthwhile for researchers to begin to examine whether patterns begin to emerge in the one area of VR outcomes for people with mental illness that can be correlated with broader system change efforts engendered through mental health. These states are either:

While the tables are focused primarily on employment outcomes another aspect of these ongoing quality improvement efforts is often to improve access to VR. The J & J- Dartmouth project has as one clear goal furthering supported employment through collaboration between Mental Health and VR systems. Therefore, we have included tables that reflect the percentage of all closures through the RSA 911 system that are those with mental illness. These are crude but nonetheless important figures to examine in determining whether people with psychiatric disabilities are receiving the full array of employment services for which they should be eligible.

The figures essentially present a mixed picture of outcomes with no consistent pattern. High achievement states in terms of VR successful closures do not necessarily line up in the same order in terms of the SAMHSA NOMs data (Smith & Bhattarai, 2008). States that have long tenures in system change initiatives through the J & J - Dartmouth projects (e.g., OR) do not achieve better outcomes in either the RSA or NOMs data sets than states that have only recently been involved (e.g., MN). States with MHTG grants are neither consistently high nor low performers in these calculations. States that have both also fall within the high and low ends of these numbers. The evidence is incontrovertible that faithful emulation of research based employment principles leads to programs achieving improved supported employment fidelity for people with serious mental illness (Drake, Becker, Goldman, & Martinez, 2006; McGrew & Griss, 2005). Nevertheless, there is as of yet no compelling statistical formulation that buttresses the notion that such program design attention creates systems of employment leading to better outcomes or even greater access to vocational rehabilitation services for people with mental illness at a statewide level.

Some questions that a review of this information presented in Tables 1 through 7 below we would hope inspire further scientific inquiries about include:

References

Bond, G. R. & Drake, R. E. (2008). Predictors of Competitive Employment Among Patients with Schizophrenia. Current Opinion in Psychiatry. 21(4): 362-369.

Bond, G. R. (2004). "Supported Employment: Evidence For An Evidence-Based Practice." Psychiatric Rehabilitation Journal 27(4): 345- 354.

Drake, R. E. (1998). "A brief history of the individual placement and support model." Psychiatric Rehabilitation Journal 22(1): 3-8.

Drake, R. E., D. R. Becker, Goldman, H.H., Martinez, R. (2006). "Best Practices: The Johnson & Johnson--Dartmouth Community Mental Health Program: Disseminating Evidence-Based Practice." Psychiatric Services 57(3): 302-304.

Hall, L.L., Graf, A.C., Fitzpatrick, M.J., Lane, T., and Birkel, R.C. (2003). Shattered Lives: Results of a National Survey of NAMI Members Living with Mental Illnesses and Their Families. TRIAD Report. Arlington, VA: NAMI.

Marrone, J. (2007) Behavioral Healthcare. Left Out of the Economy. June, 2007

McGrew, J. H. and M. E. Griss (2005). "Concurrent And Predictive Validity Of Two Scales To Assess The Fidelity Of Implementation Of Supported Employment." Psychiatric Rehabilitation Journal 29(1): 41-49.

Rapp, C., Bond, G., Becker, D., Carpinello, S., Nikkel, R., & Gintoli, G. (2005). The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Mental Health Journal, 41, 347-363.

Salyers, M. P., Becker, D.R., Drake, R.E., Torrey, W.C., & Wyzik, P. (2004). "A Ten-Year Follow-Up of a Supported Employment Program." Psychiatric Services 55(3): 302-308.

Smith, F.A.. and Bhattarai, S. (2008). Persons Served in Community Mental Health Programs and Employment. DataNote Series. Boston, MA: ICI. Note XVII. Boston, MA: Institute for Community Inclusion.

Substance Abuse and Mental Health Services Administration. 2006. National Outcome Measures. Rockville, MD: SAMHSA Available at: www.nationaloutcomemeasures.samhsa.gov/outcome/EmpProfile.asp?Yr=2006&p_state=US&MH_employProfile=ag&outcome=6&cType=Bar&OutputType=memory

Comments

Prior to publication, the senior author, Joe Marrone, contacted two colleagues with whom he is in frequent contact for comments on the material. One is a preeminent researcher in the field of evidence-based practice and employment and the other is a senior state mental health system administrator. He felt that their responses merited inclusion as a stimulus to further discussion on this topic, which may lead in the future to more accurate and representative data collection and subsequent program evaluation. While Mr. Marrone had some added thoughts he offered in answer to their critique he did not wish to create a point–counterpoint in this final section and chose to let the brief and their reactions speak for themselves. The remarks below summarize both of their respective thoughts and are edited for brevity and clarity, not content. Both contacts have reviewed these comments prior to publication and feel they are accurate representations of their thoughts upon reading the material.

"The obvious problem in your analysis is that the data displays contain a trivial number of individuals with mental illness. When you compare these numbers to the National Comorbidity Study or other national surveys for the actual number of people with schizophrenia and other psychiatric disorders, then the obvious question becomes, is this the number of people VR is serving? Or, in the last table—is this all who are being served in mental health programs? Or is this all a data reporting problem? Until we are assured that the numbers are valid and all the states are playing by the same rules (in terms of reporting), the Garbage In Garbage Out rule applies. I don't believe this tells us much at all about J&J or Transformation or state differences. Alternatively, if these numbers are accurate, then the real story is not the variation between states, but the low numbers nationally, as compared to those who could benefit."

Most states do "not have the needed resources to actually measure hardly anything with much precision at a state level… actual outcome measurement would be a good thing to spend money on." "… does the whole mess correlate to the economic conditions in the state or local area? … And if nothing correlates to anything, then all we DO have is the ability to march program by program, person by person, on the long weary path."

Appendix

Date Sources: 2007 Rehabilitation Services Administration (RSA) 911: Tables 1 through 6

2006 Center for Mental Health Services (CMHS) Uniform Reporting System: Table 7

Notes on this appendix:

To draw attention to states that are recipients of CMHS Mental Health Transformation Grants, participants in the Johnson and Johnson – Dartmouth Community Mental Health Program or both we use symbols next to the state abbreviation. States with a "*" displayed next to it are recipients of CMHS Mental Health Transformation Grants. States with a "†" displayed next to it are participants in the Johnson and Johnson – Dartmouth Community Mental Health Program. Delaware is included in this group. States with a "‡" displayed after it received Mental Health Transformation Grants AND participated in the Johnson and Johnson – Dartmouth Community Mental Health Program study.

The mental illness category includes anyone who had a primary impairment to employment designation of psychosocial (code 18 in the RSA 911) and a cause of impairment code of either anxiety disorders (code 04), depressive or other mood disorders (code 15), Mental Illness not listed elsewhere (code 24), or Personality Disorders (code 29).

The schizophrenia category includes anyone who had a primary impairment to employment designation of psychosocial (code 18 in the RSA 911) and a cause of impairment code of schizophrenia (code 33).

The tables on pages 5 and 6 include all closures from VR regardless of impairment and cause of impairment designation.

Table 7 displays information for all persons with a known employment status who received community mental health services in 2006.

Table 1. Successful VR Closures with Mental Illness (MI) as a Percentage of All VR Closures with MI

Number of Successful Closures - Status 26 (A)

Total Number of Closures - All Statuses (B)

Percentage of all Closures who were Successful Closures (A/B)

SC†

1,574

3,019

52.1

AL

413

811

50.9

AS

1

2

50.0

UT

912

1,850

49.3

VT†

354

861

41.1

PR

350

857

40.8

GA

420

1,067

39.4

ID

383

1,082

35.4

WY

122

346

35.3

DE†

124

353

35.1

VA

481

1,378

34.9

DC†

33

96

34.4

NJ

562

1,651

34.0

NH

86

254

33.9

NY

1,615

4,882

33.1

AR

206

628

32.8

RI

158

485

32.6

NE

74

228

32.5

PA

1,401

4,316

32.5

FL

1,758

5,529

31.8

SD

139

439

31.7

CO

254

805

31.6

KY

941

2,994

31.4

IL†

562

1,933

29.1

MN†

480

1,680

28.6

WV

152

536

28.4

AK

42

149

28.2

ND

126

451

27.9

MA

818

2,964

27.6

CA

1,354

5,077

26.7

NM*

123

464

26.5

TX*

1,072

4,049

26.5

OR‡

237

897

26.4

AZ

303

1,167

26.0

MD‡

251

974

25.8

KS†

345

1,376

25.1

NV

55

221

24.9

HI*

139

562

24.7

NC

704

2,928

24.0

IN

436

1,833

23.8

MI

393

1,682

23.4

OK*

228

1,038

22.0

CT‡

117

535

21.9

TN

328

1,496

21.9

LA

179

842

21.3

MT

133

626

21.2

MO‡

536

2,569

20.9

WI

297

1,456

20.4

OH‡

717

3,577

20.0

IA

330

1,823

18.1

ME

88

615

14.3

WA*

237

1,881

12.6

MS

9

78

11.5

GU

0

3

0.0

VI

0

1

0.0

MP

0

0

--

Total

23,152

79,416

29.2

Table 2. Successful VR Closures with Mental Illness (MI) as a Percentage of All VR Closures with MI with an Employment Plan in Place

Number of Successful Closures - Status 26 (A)

Closures with an Employment Plan in Place - Statuses 26 and 28 (B)

VR Rehabilitation Rate (%) (A/B)

PR

350

479

73.1

UT

912

1,265

72.1

AL

413

644

64.1

KY

941

1,485

63.4

SC†

1,574

2,484

63.4

WY

122

193

63.2

RI

158

252

62.7

MO‡

536

868

61.8

ID

383

621

61.7

GA

420

690

60.9

SD

139

230

60.4

DE†

124

206

60.2

MN†

480

798

60.2

VT†

354

588

60.2

DC†

33

55

60.0

OR‡

237

396

59.8

NE

74

128

57.8

WV

152

263

57.8

CO

254

442

57.5

NH

86

150

57.3

NJ

562

983

57.2

KS†

345

607

56.8

ND

126

223

56.5

TN

328

588

55.8

IL†

562

1,028

54.7

NV

55

101

54.5

MT

133

245

54.3

NY

1,615

2,986

54.1

CA

1,354

2,561

52.9

AR

206

394

52.3

AS

1

2

50.0

FL

1,758

3,515

50.0

NM*

123

246

50.0

WA*

237

478

49.6

VA

481

977

49.2

MA

818

1,666

49.1

TX*

1,072

2,213

48.4

AK

42

89

47.2

PA

1,401

3,008

46.6

IA

330

729

45.3

AZ

303

677

44.8

LA

179

405

44.2

OH‡

717

1,630

44.0

CT‡

117

268

43.7

IN

436

1,019

42.8

ME

88

206

42.7

NC

704

1,780

39.6

MI

393

996

39.5

HI*

139

363

38.3

MD‡

251

659

38.1

WI

297

847

35.1

OK*

228

681

33.5

MS

9

32

28.1

GU

0

0

--

MP

0

0

--

VI

0

0

--

Total

23,152

44,439

52.1

Table 3. Successful VR Closures with Schizophrenia as a Percentage of All VR Closures with Schizophrenia

Number of Successful Closures - Status 26 (A)

Total Number of Closures - All Statuses (B)

Percentage of all Closures who were Successful Closures (A/B)

VI

1

1

100.0

NH

34

68

50.0

VT†

51

103

49.5

SC†

78

183

42.6

AL

123

321

38.3

ID

91

245

37.1

WY

26

71

36.6

VA

159

442

36.0

NJ

252

735

34.3

SD

40

121

33.1

UT

58

176

33.0

PR

61

186

32.8

NY

550

1,756

31.3

WV

30

98

30.6

IL†

191

639

29.9

MD‡

94

315

29.8

OR‡

36

122

29.5

GA

88

300

29.3

AK

9

31

29.0

CO

41

143

28.7

TN

177

632

28.0

PA

326

1,169

27.9

NM*

25

92

27.2

KY

90

347

25.9

MA

174

678

25.7

ND

18

70

25.7

FL

231

913

25.3

WI

103

410

25.1

MN†

123

493

24.9

IN

118

486

24.3

RI

25

105

23.8

AZ

64

271

23.6

AR

49

214

22.9

CA

330

1,512

21.8

KS†

60

277

21.7

MI

73

340

21.5

DE†

27

126

21.4

NC

205

957

21.4

MT

29

137

21.2

MO‡

229

1,101

20.8

NV

9

44

20.5

ME

43

214

20.1

CT‡

34

173

19.7

OH‡

164

850

19.3

IA

74

392

18.9

DC†

6

32

18.8

TX*

102

566

18.0

HI*

33

198

16.7

OK*

27

179

15.1

LA

23

165

13.9

MS

4

29

13.8

WA*

55

412

13.3

AS

0

1

0.0

GU

0

4

0.0

MP

0

0

--

NE

0

0

--

Total

5,063

19,645

25.8

Table 4. Successful VR Closures with Schizophrenia as a Percentage of All VR Closures with Schizophrenia with an Employment Plan in Place

Number of Successful Closures - Status 26 (A)

Closures with an Employment Plan in Place - Statuses 26 and 28 (B)

VR Rehabilitation Rate (%) (A/B)

VI

1

1

100.0

VT†

51

74

68.9

NH

34

50

68.0

ND

18

28

64.3

SD

40

63

63.5

MT

29

52

55.8

ID

91

164

55.5

PR

61

110

55.5

NJ

252

467

54.0

SC†

78

145

53.8

OR‡

36

68

52.9

MO‡

229

434

52.8

WY

26

50

52.0

WV

30

58

51.7

TN

177

343

51.6

UT

58

114

50.9

NM*

25

50

50.0

NY

550

1,123

49.0

MN†

123

256

48.0

AL

123

259

47.5

AK

9

19

47.4

IA

74

156

47.4

GA

88

186

47.3

IL†

191

405

47.2

VA

159

342

46.5

KY

90

194

46.4

WA*

55

120

45.8

KS†

60

139

43.2

AR

49

114

43.0

OH‡

164

383

42.8

CA

330

791

41.7

RI

25

61

41.0

DE†

27

66

40.9

CO

41

101

40.6

ME

43

107

40.2

FL

231

584

39.6

IN

118

300

39.3

NV

9

23

39.1

NC

205

527

38.9

PA

326

871

37.4

CT‡

34

92

37.0

MD‡

94

254

37.0

WI

103

280

36.8

MA

174

483

36.0

AZ

64

179

35.8

TX*

102

302

33.8

MI

73

250

29.2

DC†

6

21

28.6

MS

4

14

28.6

LA

23

85

27.1

OK*

27

114

23.7

HI*

33

149

22.1

AS

0

1

0.0

GU

0

0

--

MP

0

0

--

NE

0

0

--

Total

5,063

11,622

43.6

Table 5. Successful VR Closures (All Disability Categories) as a Percentage of All VR Closures

Number of Successful Closures - Status 26 (A)

Total Number of Closures - All Statuses (B)

Percentage of all Closures who were Successful Closures (A/B)

AL

7,802

13,698

57.0

VI

38

71

53.5

MS

4,544

9,609

47.3

SC†

9,066

19,275

47.0

VT†

1,557

3,393

45.9

NH

1,213

2,651

45.8

AS

32

70

45.7

UT

3,156

7,286

43.3

PA

11,228

27,059

41.5

ID

2,211

5,392

41.0

CT‡

1,446

3,604

40.1

VA

4,474

11,221

39.9

DE†

863

2,242

38.5

WY

696

1,828

38.1

AR

2,656

7,009

37.9

NJ

4,672

12,460

37.5

MI

7,965

21,482

37.1

GA

4,545

12,289

37.0

KY

5,440

14,751

36.9

NE

1,587

4,380

36.2

SD

960

2,699

35.6

FL

12,315

34,677

35.5

WV

1,587

4,509

35.2

PR

2,590

7,382

35.1

NV

1,161

3,329

34.9

AK

529

1,529

34.6

ND

893

2,588

34.5

NY

13,863

40,255

34.4

CO

2,509

7,404

33.9

IN

5,046

14,933

33.8

CA

13,282

39,474

33.6

OH‡

8,988

27,259

33.0

NM*

1,747

5,307

32.9

TX*

12,409

37,872

32.8

OR‡

2,984

9,236

32.3

RI

745

2,304

32.3

IL†

5,603

17,534

32.0

MA

4,062

12,681

32.0

LA

2,375

7,560

31.4

MN†

2,583

8,344

31.0

KS†

1,853

6,249

29.7

GU

21

73

28.8

TN

2,828

9,830

28.8

MD‡

3,097

10,841

28.6

OK*

2,218

8,050

27.6

AZ

2,096

7,660

27.4

NC

6,970

25,514

27.3

MO‡

4,536

16,697

27.2

MT

912

3,369

27.1

IA

2,254

8,421

26.8

DC†

575

2,189

26.3

ME

881

3,571

24.7

HI*

577

2,385

24.2

MP

39

170

22.9

WI

3,165

15,811

20.0

WA*

2,003

12,712

15.8

Total

205,447

600,188

34.2

Table 6. Successful VR Closures (All Disability Categories) as a Percentage of All VR Closures with an Employment Plan in Place

Number of Successful Closures - Status 26 (A)

Closures with an Employment Plan in Place - Statuses 26 and 28 (B)

VR Rehabilitation Rate (%)(A/B)

VI

38

44

86.4

GU

21

25

84.0

AS

32

40

80.0

PR

2,590

3,310

78.2

UT

3,156

4,349

72.6

MS

4,544

6,393

71.1

AL

7,802

11,286

69.1

NH

1,213

1,775

68.3

MO‡

4,536

6,660

68.1

WY

696

1,027

67.8

KY

5,440

8,047

67.6

ND

893

1,337

66.8

OR‡

2,984

4,549

65.6

ID

2,211

3,378

65.5

VT†

1,557

2,377

65.5

DE†

863

1,323

65.2

NJ

4,672

7,166

65.2

SC†

9,066

13,980

64.8

MP

39

61

63.9

NV

1,161

1,820

63.8

SD

960

1,507

63.7

CO

2,509

3,984

63.0

TN

2,828

4,492

63.0

WV

1,587

2,521

63.0

CT‡

1,446

2,302

62.8

MN†

2,583

4,111

62.8

FL

12,315

19,830

62.1

NE

1,587

2,569

61.8

KS†

1,853

3,038

61.0

OH‡

8,988

14,885

60.4

VA

4,474

7,425

60.3

NM*

1,747

2,901

60.2

AR

2,656

4,428

60.0

IL†

5,603

9,347

59.9

RI

745

1,244

59.9

IA

2,254

3,768

59.8

DC†

575

972

59.2

AK

529

896

59.0

LA

2,375

4,030

58.9

NY

13,863

23,557

58.8

GA

4,545

7,783

58.4

PA

11,228

19,246

58.3

CA

13,282

22,837

58.2

IN

5,046

8,669

58.2

MT

912

1,576

57.9

TX*

12,409

21,515

57.7

ME

881

1,587

55.5

WA*

2,003

3,633

55.1

MI

7,965

14,542

54.8

MA

4,062

7,650

53.1

AZ

2,096

3,977

52.7

MD‡

3,097

6,206

49.9

NC

6,970

14,287

48.8

OK*

2,218

5,066

43.8

WI

3,165

7,533

42.0

HI*

577

1,647

35.0

Total

205,447

344,508

59.6

Table 7: Total number of individuals served in a Community Mental Health Program (CMHP) Individuals in CMHPs who are employed, and the percentage of individuals served who are employed (2006)

Number of Individuals with a Known Employment Status Served in CMHPs (A)

Individuals Served in CMHPs Who are Employed (B)

Percentage of Individuals Served Who are Employed (B/A)

WY

11,481

5,457

48

AK

1,325

585

44

NH

11,631

4,942

42

AZ

83,759

31,569

38

ND

11,644

4,362

37

KS†

36,399

12,090

33

NE

21,123

6,900

33

VT†

11,194

3,701

33

MN†

42,722

13,592

32

NJ

257,548

82,571

32

CO

39,753

11,925

30

AR

39,666

11,516

29

IA

1,387

401

29

WI

14,069

3,949

28

UT

25,428

6,724

26

NM*

23,235

5,859

25

CT‡

33,617

8,167

24

DE†

3,962

965

24

ID

10,550

2,494

24

HI*

4,937

1,154

23

IL†

117,184

27,240

23

IN

53,493

12,531

23

NC

163,184

37,322

23

NV

14,735

3,432

23

OH‡

94,859

22,227

23

RI

17,071

3,937

23

VA

72,733

17,065

23

NY

345,677

77,116

22

GA

85,681

16,241

19

KY

85,871

16,479

19

MI

124,490

23,054

19

OK*

34,122

6,438

19

TN

7,911

1,518

19

FL

162,206

28,586

18

MS

51,811

9,160

18

WV

34,321

6,222

18

AL

73,341

12,110

17

OR‡

34,556

5,876

17

SC†

52,921

9,119

17

TX*

134,560

22,651

17

DC†

7,436

1,156

16

MA

19,518

2,689

14

MD‡

38,171

5,524

14

ME

12,857

1,624

13

LA

38,029

4,415

12

WA*

65,009

7,028

11

CA

196,058

15,729

8

PA

55,315

4,416

8

MO‡

-- Data Not Available --

MT

-- Data Not Available --

SD

-- Data Not Available --

Total

2,878,550

619,828

22

For more information, contact:

Joe Marrone
Institute for Community Inclusion
UMass Boston
100 Morrissey Boulevard
Boston, Massachusetts 02125
503-331-0687 or 617.287.4300 (ICI main number)
617.287.4350 (TTY)
joseph.marrone@gmail.com or ici@umb.edu

This document is a product of the Vocational Rehabilitation Research and Training Center, and was funded, in part, by a grant (Grant No. H133VO70001B) from the National Institute on Disability and Rehabilitation Research (NIDRR) and the Rehabilitation Services Administration (RSA). The opinions contained in this paper are those of the author and do not necessarily reflect those of NIDRR, RSA or any other office or agency of the U.S. Department of Education.