Eduardo del Rosario, PhD, FNP-BC, Published in Health Care Transitions

Young adults with cerebral palsy (CP) have lower employment rates compared to young adults in general, as the face challenges and external barriers posed by their condition. Understanding the factors that impact employment can help direct transition planning and improve employment outcome. 

The WFCPC's Family Nurse Practitioner, Eduardo del Rosario, PhD, FNP-BC, has published an article in Health Care Transitions on The State of Employment in the United States Among Young Adults with Cerebral Palsy. The article is based on a study aimed to articulate features that are key to achieving employment for adults with CP. Dr. del Rosario's clinical expertise is in the lifespan care of individuals with CP, but his acumen is in working holistically with patients, families, and the healthcare system to manage this complex multi-layered condition.

We caught up with Dr. del Rosario to learn more on the background and findings of the study. Also find the full paper here.

1) What led you to research on this topic?

When we were developing a Healthcare Transition program at my previous institution in 2015, we learned from the emerging adults survey that employment is “very important” to them. This led to working with vocational rehabilitation specialists, community outreach, and the development of social participation programs for the adolescents e.g., use of public transportation, attending events at public spaces. Through the process, I witnessed the many possibilities beyond healthcare and the positive impacts to the individual, family, and society. Even though these impacts are hard to account, they are very humanizing. So, when I was planning for my PhD dissertation a former research colleague, whom I worked closely, suggested “why not looked at employment?” The rest is history….

2) From this study, what are the main predictors of employment for young adults with CP?

Briefly, employment probability increases for participants, ages 18 to 30, who were slightly older at the time of their program completion and received career and supportive services from the VR (vocational rehabilitation) program. Specifically, the early 20s were more often employed than their younger counterparts. Career services are tailored interventions, such as job coaching, referral services, and placement assistance associated with a participant’s unique needs when searching and continuing employment. Counseling on work, income, and disability benefits under career services was provided to participants who were unclear of employment's financial effect on their disability, aids and entitlements, and uninformed of this service. Similarly, supportive services address what is needed: monetary backing, technology, personal assistance, and other unique services to sustain a participant in a VR program and to obtain and maintain employment. In contrast, employment probability decreases being Hispanic/Latino, having basic skills deficiency and low level of literacy.

3) The study examined patterns through the International Classification of Functioning, Disability, and Health (ICF) model. What were the key findings based on disability classification and function?

Using the ICF Model, the key findings were concepts of Participation (Employment), and environment (VR program) and personal factors (ethnicity, age, being Hispanic and Latino, and having low literacy and deficient basic skills).

4) Were you surprised with the findings on the transitional age group?

Yes and No.

Yes, I was surprised by the low employment rate and continued racial disparity. For instance, the persistent low employment rate of about 30% among adults with CP since early 2000 despite employment law amendments, considerably more whites participated in the VR program than all other races combined, and the lopsided employment outcome among Hispanics/Latinos with disabilities as compared to whites. Further, few among the employed individuals reported post-secondary education or beyond despite available extensive VR services.

No, I was not surprised because the study’s federal dataset is not specific to CP but, at best, inclusive of them. Plus, not all individuals with CP in every state were included in the dataset. There is no data among the VR-eligible participants from private institutions, including education and healthcare systems, who did not rely on state vocational rehabilitation funding.

5) How can healthcare providers help direct employment outcomes for people with CP?

First, a mandate on education at all levels of healthcare professions regarding pediatric-onset disability as a lifetime condition is fundamental. For all healthcare providers, promote every chance for daily activities and participation in society that will foster self-management and independence. The CP specialists to partner with other healthcare teams and inform non-healthcare academics, community programs, business sectors, and lawmakers to create opportunities to uplift the individual's function and capabilities to become independent in society.

Healthcare providers involved in the healthcare transition of CP have a responsibility to acknowledge CP as the most common lifelong disability, globally, without a cure. Each patient is an individual with unique needs who can achieve their full potential. The adults living with CP are increasing and individuals and families lack the skills to navigate the available healthcare transition services, and worse if non-English speaking. The inadequate lifespan care knowledge and the siloed services in healthcare transition are prevalent. Understanding these core issues and the employment factors can help guide healthcare transition planning for emerging adults with CP. 

Most importantly, the future progress of policies on employment among CP or the disability population depend on our rigorous research and collaboration through a wide-ranging discipline such as arts, finance, business, architecture, engineering, information technology, sociologists, and population health, to name a few. Research must be rooted in humanization to eliminate factors that restrict employment opportunities among individuals with CP or any disability.

Health Care Transitions

Health Care Transitions is an open access, international, and interdisciplinary scientific journal that advances health care transition (HCT) research, scholarly inquiry, and dissemination of clinical practice exemplars and innovations. HCT has emerged as a distinct field of interdisciplinary specialty science and practice. The mission of this journal is to advance the science and practice of HCT that improves health and psychosocial outcomes for all adolescents and young adults-those with special health care needs, developmental disabilities, intellectual disabilities, mental health conditions, as well as adolescents without long-term conditions.