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BACKGROUND: Spinal cord injury (SCI) is associated with unacceptably high unemployment rates that are impacted by the environment in which employment and vocational activities take place. To improve employment outcomes, we must continue to gather data allowing us to evaluate the effectiveness of policies and programs associated with successful employment from the perspective of persons with disabling conditions. OBJECTIVE: Identify key components of programs and federal and state level polices which support employment outcomes, as perceived by individuals with SCI who have worked since injury. METHODS: Qualitative approach using six focus groups at two sites. All participants (N = 44) had been employed at some point since injury. A semi-structured interview format asked questions about policies and program related factors influencing job attainment, maintenance, and advancement following SCI. Narratives were extracted into themes falling into the overlapping categories of policies, programs and awareness. RESULTS: Within programs, five themes emerged characterizing components of programs perceived to be significant in supporting employment: (1) support for education, (2) development of job seeking skills, including skills assessment; (3) job placement; (4) practical experience, and (5) instrumental support. Within policies, two themes were extracted related to policies focused on individuals and policies focused on changing the environment. Finally, within the category of awareness, themes reflect the importance of personal connections and self-advocacy. CONCLUSIONS: Policies and programs are not static factors but change and differ based on how they are understood, implemented, and reacted to in different places and by different groups. Researchers, program developers, and policy makers should consider how persons with SCI from diverse backgrounds and levels of impairment perceive and are supported by the varying programs and policies in their particular institution, region or state.

Perceptions of policies and programs and their impact in supporting employment among individuals with spinal cord injury