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Disparities in Earnings from Gainful Employment after Spinal Cord Injury:

Environmental Factors and Job Accommodations

Submitted to the National Institute for Disability and Rehabilitation Research (NIDRR) of the Office of Special Education and Rehabilitative services (OSERS) United States Department of Education.

Despite a large body of research on factors predictive of return to employment after spinal cord injury (SCI), practically no research has addressed work-related earnings. The threefold purpose of this study is to identify biographic and educational characteristics that are related to attributable differences in earnings both after SCI and in the general population, the association of policy-relevant environmental factors and unmet job accommodations with post-SCI earnings, and the association of earnings and unmet job accommodations with quality of life. Existing data from a large-scale follow-up study of 1,568 participants will be analyzed with input from experts in three areas: rehabilitation research, health econometric analysis, and consumer-based participatory action research (PAR). We will use a multistage iterative process of stakeholder input and data analysis, with consumer-based activities facilitated by two individuals with SCI who have held nationally recognized positions in consumer affairs.  

We will develop a general predictive model of earnings that accounts for the probability of employment and earnings among those employed. This regression model will allow us to isolate three primary components related to work and earnings: employment status, conditional earnings (earnings among those employed), and unconditional earnings ($0 for those unemployed). Attributable differences are due to fixed factors that cannot be changed, but that may have implications for policy change (e.g., race, gender, injury severity).  Of more direct relevance, we will evaluate policy-relevant factors that may direct relevance for policy change, including the five environmental factors from the Craig Hospital Inventory of Environmental Factors and six job accommodations (our focus is on unmet accommodations—those needed but not provided) in relation to earnings. Lastly, we will identify the extent to which earnings and unmet job accommodations relate to quality of life and other outcomes central to life after SCI.

Consumer panels facilitated by a nationally recognized leader who has SCI will make recommendations for analyses, review the findings, add interpretations, and evaluate the ongoing progress and ultimate success of the project.  This study will be cost-effective and will identify key information related to disparities in earnings, as well as quantify the importance of specific environmental factors in relation to earnings.  The results will guide policy change, lead to new directions for future research, and empower consumers to advocate directly for their needs to promote greater employability, earnings, and a greater quality of life.

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