A state of the science conference from the Rehabilitation and Research Training Center on Employer Practices Related to Employment Outcomes among Individuals with Disabilities. This two-day event highlighted the research findings from the Employer Practices Rehabilitation Research and Training Center at Cornell University ILR School's Yang-Tan Institute. It was a great success! Check back for reports and proceedings of the conference.
Arun Karpur trained as a medical doctor and an epidemiologist, he currently serves as Research Faculty at Cornell University's School of Industrial and Labor Relations in the Employment & Disability Institute. His research focuses on examining the role of employment and community engagement in eliminating health and health disparities among people with disabilities. In addition, he leads several program evaluation efforts in impact assessment and cost-effectiveness analysis informing policy-makers and practitioners of various educational and vocational rehabilitation programs for people with disabilities. He has led quantitative data collection and multi-level program evaluation efforts of large multi-site transition to adulthood demonstration program in NY State and nationally. He has been trained by Institute of Educational Sciences (IES) in Group Randomized Clinical Trial designs in program and public policy research. He also serves as a research collaborator with the University of Texas Medical Branch, Galveston, TX on an NIH funded initiative on Large Datasets in Rehabilitation Research.
Barbara L. Kornblau, JD, OTR, FAOTA, is the Director of Health Learning for the National Blood Clot Alliance. An occupational therapist, an attorney, a certified pain educator, a certified case manager and a person with a disability, Kornblau is a former Robert Wood Johnson Health Policy Fellow for Senator's Harkin and Rockefeller. She organized stakeholders to work to include people with disabilities in the Affordable Care and its implementing regulations and founded the Coalition for Disability Health Equity. She is a Past President of the American Occupational Therapy Association. She has litigated cases under the Americans with Disabilities Act involving discrimination in employment and health care services. Kornblau has presented nationally and internationally, and is widely published. A former Dean, and Professor of Occupational Therapy, Public Health, and Law, her current academic appointment is in the Occupational Therapy Program at Florida A&M University.
John Hough, Ph.D., is a Statistician at the CDC National Center for Health Statistics (NCHS), in Hyattsville, Maryland. John works in the NCHS Classifications and Public Health Data Standards Section. His portfolio at NCHS is specifically related to Disability Statistics, with an emphasis on implementing the International Classification of Functioning, Disability and Health (ICF). Dr. Hough began his work in the Department of Health and Human Services in 1996 as a postdoctoral fellow in Prevention Effectiveness methods at CDC. John has also served as a Health Scientist at CDC's Birth Defects Center in Atlanta, and as an Epidemiologist at the NIH National Institute on Alcohol Abuse and Alcoholism in Bethesda. Since 2006, John has served as one of the co-chairpersons of the federal Interagency Subcommittee on Disability Statistics, until this year with David Keer and today with Dr. Meredith Miceli, both from NIDRR. The ISDS is one of the subcommittees of the federal Interagency Committee on Disability Research.
Arun Karpur, along with panelists Barbara Kornblau and John Hough, discuss this study focused on the relationship between health benefits and employment outcomes for individuals with disabilities. Utilizing existing nationally restricted-access secondary data sets, we observed that access to employer-paid health insurance reduced job-mobility among employees with disabilities and led to longer work-tenure. This research demonstrates the value of offering health insurance in retaining qualified employees with disabilities. The findings of the Cornell research, in light of upcoming changes in health insurance policies as a result of the Patient Protection and Affordable Care Act, are discussed.
I hope this question doesn't get into how many angels are dancing on the head of a pin? But could you talk a little bit more, Arun, about the issue of needing to see a specialist, as a factor in your research? Because, you know, sometimes I hear a good practice is somebody should see a dermatologist or a cardiologist once a year, to take a look at that person.
Does that constitute a need? I don't know. But it might be for some as a checkup. But would that then impact on your analysis? I'm kind of curious about what, how that impacts your research.
Thank you for the question. So the needing to see specialists was utilized as a variable to indicate the higher burden of health impairment at the individual level.
And the way that data was collected is, in the survey individuals were asked whether you had a need to see specialists over the past 12 months. And I understand that the perception of needing to see specialists might be different than actual need. But we were limited in terms of the information we had regarding specific diagnosis. So the ICD-9 codes that were available were also based on the self-reported health related situations.
So they did not go beyond one certain stage to provide a differentiation between two individuals who might say that they have diabetes. That there's a possibility the other person might have diabetes with a foot ulcer, or the first person might have just diabetes diagnosed more recently.
So it was hard to kind of decide for that in the dataset, in terms of trying to have a differentiation between these heterogeneous populations.
So the way we used that is that we utilized this variable wherein people said that they had diabetes, and they had a need to see a specialist, as one group, compared to that person who might have said that they have diabetes, and they have no need to see a specialist.
But from a very practice perspective, yes, the final analysis of differentiating those who say they have a need from those who actually have a need is necessary. But it was not possible in the context of our current research.
I was wondering if you thought with the implementation of the ACA that you might start to see mobility between states, given the differences in the exchanges, or the lack thereof? And whether that would have an impact in looking at the mobility among jobs?
I think that's a good area for research. Because I would say, without having any research, but just sort of gut reaction, yes. Because, you know, I just told a client of mine in Florida that he should move to New York.
You know, that's the bottom line. There's no expansion of Medicaid. He's not getting benefits. If he moves to New York he'll get benefits, and it won't be as expensive. So I think that's going to end up happening.
I wanted to ask a question to Arun about, you didn't look at people that have recently retired. But many people that recently retire, retire because of disability issues. So I didn't know whether you track that at all because a lot of people will take early retirement due to those issues.
And then I do want to make a comment, and underscore what John spoke about, with the seamless environment. That's exactly what most of us in the disability and the aging community talk about universal design.
And if you have a universal design, seamless environment, you don't have to worry most of the time about how to accommodate people with disabilities or others.
And then you don't have to worry about people disclosing, because it's a seamless, welcoming, inclusive environment. So I like that fact that you said that. And I loved your analogies that you brought to bear. It was very, very insightful.
In response to your question regarding retirement and its relationship to disabilities, no, we have not looked into that because it was a little bit outside the scope of our current inquiry.
But it's an important consideration knowing the fact that there are many more people who are leaving the workforce as a result of the new onset of a disability.
And their lack of ability to either have a health insurance that can support their newly found needs, or the workplace that can accommodate their needs, is something that needs to be studied in future research.