"Cancer survivorship and work: Symptoms, supervisor response, co-worker disclosure and work adjustment"

Authors: 
Rabren, K., Dunn, C., & Chambers, D.
Year Published: 
2007
Publication: 
Journal of Occupational Rehabilitation
Volume: 
17
Number: 
1
Pages: 
83-92
Publisher: 
Springer
Background: 

Advances in medicine have increased people's survivorship from cancer and their ability to work both during and after treatment. However, the impact that diagnosis and treatment has on psychosocial factors that may impact an individual's ability to work is not fully understood.

Purpose: 

This purpose of this study was to explore the impact of symptoms, work adjustments, and disclosure of one's disability to supervisors and co-workers on employment both during and after treatment.

Setting: 

The study was conducted in the United Kingdom via mailed questionnaire.

Sample: 

The participants were 328 cancer survivors. Forty five types of cancer were represented and categorized into the eight areas representing the cancers' site. This included: breast, colorectal, genital, head and neck, lymph, prostate, melanoma and other. Treatments included: oral medication, surgery, chemotherapy and radiotherapy. The majority of the participants were female (77%). The age range was between 18 to 68 years. Participants worked in a range of occupations with the majority or 54% working in skilled/operational-non manual.

Data Collection: 

A 33 item questionnaire was used to gather information about demographics, information about cancer, symptoms associated with cancer and its treatment, disclosure of cancer at work, and work supports. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment

Intervention: 

Interventions included disclosure of disability and various types of work accommodations, particularly flexible scheduling and paid leave for all medical appointments.

Control: 

There was no control or comparison condition.

Findings: 

Thirty percent of the sample continued to work during treatment. There were no significant differences between cancer groups, type of treatment received or age groups. Flexibility with work arrangements, and disclosure were factors related to working during treatment. Working during treatment was also associated with difficulties managing fatigue. Forty two percent of the respondents returned to work following treatment. Factors related to return to work following treatment included: difficulties managing fatigue, managing the stress of cancer, managing physical changes associated with cancer, receiving advice from their doctor about work and return to work meeting with their employer.

Conclusions: 

The study adds to the scant literature on experiences of cancer survivors. Further research is needed to better understand ways to assist survivors with return to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17318459
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Developing evidence-based supported employment services for young adults receiving public mental health services

Authors: 
Pryce, J., Munir, F., & Haslam, C.
Year Published: 
2009
Publication: 
New Zealand Journal of Occupational Therapy
Volume: 
56
Number: 
1
Pages: 
34-39
Publisher: 
Zealand Association of Occupational Therapists Inc.
Background: 

Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts.

Purpose: 

This report describes the application of an evidence-based practice fidelity measure to monitor the effectiveness of an expanding supported employment program for youth adults with first episode psychosis.

Setting: 

The setting was 4 demonstration sites where employment staff co-located within an early intervention psychosis team.

Sample: 

The study sample was made up of 134 individuals. Sixty four percent were diagnosed with first episode psychosis, and received services from a community based early intervention psychosis team.

Data Collection: 

The IPS Fidelity scale was applied to each site. Data was collected and scored consistent with the Fidelity Scale directions.

Intervention: 

The intervention was the Individual Placement and Support (IPS)model of supported employment. This is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

Both low and high scoring fidelity items helped identify practical ways to further develop evidence-based practices at each site.

Conclusions: 

Fidelity strengths and weaknesses can be identified that have implications for other sites in terms of what employment consultants can most constructively do in context of the restraints of their immediate environment.

URL: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Using telehealth interventions to prevent pressure ulcers in newly injured spinal cord injury patients post-discharge. Results from a pilot study

Authors: 
Porteous, N., & Waghorn, G
Year Published: 
1999
Publication: 
International Journal of Technology Assessment in Healthcare
Volume: 
15
Number: 
4
Pages: 
749-755
Publisher: 
Cambridge Journals
Background: 

Spinal cord injuries (SCIs) are rare but catastrophic occurrences. They produce permanent changes in sensory and motor function and physical impairments that restrict mobility, often completely. Although definitive statistics are lacking, studies estimate the incidence of spinal cord injuries to range from 30 to 50 cases per million people. Because of the profound physiological impact of SCIs, those affected are at increased risk for secondary health problems. Pressure sores or ulcers have been identified as one of the most common problems.

Purpose: 

The purpose of this study was to determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge.

Sample: 

The sample included 37 individuals with newly acquired spinal cord injury.

Data Collection: 

All three groups were surveyed every 2‚Äì3 months about doctor, hospital, and emergency room visits, calls to the Shepherd Center helpline, ulcer occurrences and characteristics, and employment status. Data on participant characteristics were analyzed using the Kruskal-Wallis rank sum test and k-sample chi-square tests for continuous and categorical variables. Outcome data were analyzed using Friedman‚ test to investigate response differences for multiple treatments applied to a series of subjects.

Intervention: 

The intervention was Telehealth care services. This included video intervention and telephone support.

Control: 

The comparison condition was standard care.

Findings: 

The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment.

Conclusions: 

Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10645116
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model

Authors: 
O'Brien, L.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
13
Pages: 
765-783
Publisher: 
Taylor & Francis Ltd
Background: 

Employment outcomes post traumatic brain injury (TBI) result in a financial and social burden. In addition, unemployment may impact the individual's quality of life and emotional well being. The ability to predict vocational outcome using evidenced based guidelines can assist with rehabilitation planning, development of vocational support services and the role adjustment of the individual with a TBI and his or her family members.

Purpose: 

A review of the literature to identify key variables associated with positive employment outcomes post TBI can pave the way for future research and the development of rehabilitation practices.

Data Collection: 

Eighty five studies were identified between 1980 and 2003 that reported on factors associated with employment outcomes post TBI. Among those fifty studies met the inclusion criteria for the second stage review. The criteria used to evaluate and rate the quality of methodology for each study was adapted on guidelines by Sherer 2002 and Pengel et. al. 2003.

Intervention: 

The review highlights demographic, injury and neuropsychological factors associated with return to work. It also examines interventions that focus on modifying the social environment in addition to emotional and metacognitive factors. A conceptual model is presented that outlines the factors associated with employment outcomes.

Control: 

No control or comparison

Findings: 

The most consistent predictors and indicators of employment outcomes included premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. The authors note that although the presence of specific characteristics may be a predictor for failure to return to work the absence of a factor does not guarantee return to work.
There is little evidence to support cognitive rehabilitation. The most successful programs target problems with motivation and emotional disturbance. Interventions to modify the social environment need to occur on multiple levels. A person's preferences for employment impact job retention. Supported employment has been described however, further evaluation of outcomes is needed. At a policy level a major barrier exists in the current service delivery system in which individuals do not have access to long term rehabilitation or specialized vocational support. Changes in public policy and funding could improve service delivery. Developing disability management programs may also assist those at risk for chronic unemployment post TBI.

Conclusions: 

The review of literature reported that the level of empirical support for employment outcome was greatest for: premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. Future research is needed to determine the role of metacognitive, emotional and social environment factors that can be modified with various interventions. Interventions need to be evaluated to determine evidenced based practices.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15371049
NIDILRR Funded: 
Peer Reviewed: 
Yes

Methods of a multisite randomized clinical trial of supported employment amount veterans with spinal cord injury

Authors: 
Ownsworth, T., & McKenna, K.
Year Published: 
2009
Publication: 
Journal of Rehabilitation Research & Development
Volume: 
46
Number: 
7
Pages: 
919-930
Publisher: 
Department of Veterans Affairs
Background: 

Baseline data revealed that 65% of the study sample of veterans with spinal cord injury (SCI) who were seeking employment had never been employed postinjury. Nearly half (41%) of this group had received some type of prior vocational rehabilitation. This rate is consistent with veterans with SCI reported for samples in the community of individuals with SCI.

Purpose: 

This article compares evidence-based supported employment (SE) with conventional vocational rehabilitation for veterans with SCI. The researchers hypothesis was that evidence-based supported employment when compared with conventional vocational rehabilitation will significantly improve competitive employment outcomes. The secondary hypothesis was that evidence-based supported employment for veterans with SCI would be more cost-effective than standard care.

Setting: 

The study took place at multiple competitive employment sites versus standard vocational rehabilitation care at various Department of Veterans Affairs medical SCI centers.

Sample: 

Veterans with spinal cord injury consisting of 95% males with an average age of 48.3 years. More than half of the subjects were white, 35.3% African American, 5% Hispanic.

Data Collection: 

All subjects were followed for 12 months with face-to-face interviews every three months to collect data on primary employment variables and secondary outcomes measured. After this initial 12 months, the follow-up period was extended to 24 months at all sites including telephone interviews every three months. MANCOVAs were used to determine treatment group differences over time on the outcome variables (employment index, perceived barriers to employment, level of disability, quality of life, depression, and sustaining care needs), controlling for specified covariates. This included study site, sex, and age.

Competitive employment was as a primary outcome measure and measured every three months. Competitive employment is "community jobs that pay at least minimum wage (directly by the employer to the employee) that any person can apply for, including full-time and part-time jobs." General rehabilitation outcomes were measured at baseline and 3-month follow-up interviews. Standardized measures used included 1) Alcohol Use Disorders Identification test, 2)The Craig Handicap Assessment and Reporting Technique (CHART), 3) VR-36 that measures health-related quality of life in veterans, and 4) The Quick Inventory of Depressive Symptomatology Self-Report.

Demographic variables were also collected such as age, sec, race/ethnicity, employment history, previous levels of income, educational background, legal history, lifetime employment history, vocational services history, duration of SCI, level of SCE, and type of family structure.

Intervention: 

The Spinal Cord Injury Vocational Integration Program uses the principles of evidence-based supported employment. The program integrates vocational services into the SCI continuum of healthcare. The SE principles include 1) integrated treatment, 2) rapid engagement, 3)competitive employment, 4) belief that success is possible regardless of severity or type of disability, 5) ongoing support, 6) veteran preferences, 7) community-based services, and 8)personalized benefits counseling. The investigators spent 4 to 6 months recruiting and hiring staff to provide the evidence-based SE services. All vocational rehabilitation counselors (VRCs) have master's degrees and are certified rehabilitation counselors. Training consisted of 3-day workshop taught by VA faculty. VRCs received ongoing instruction and coaching by a co-investigator who has more than 30 years experience in vocational rehabilitation (VR).

Control: 

The study design was a randomized clinical trial that consisted of an experimental group and a comparison group. Interventional-site subjects were randomized to either the experimental group or the comparison group. Observational sites were selected based on similarity to the intervention site facilities with regards to subjects, communities, and VAMC culture. The observational sites were included because the researchers were considered that veterans and staff at the four intervention sites might be vicariously influenced by veterans and staff involved with the implementation study.

Findings: 

The findings of this study were preliminary. The final enrollment count for the study was 301 subjects. At the time of this publication, 93 participants had reached study completion. Some of the challenges faced included exhausting the study pool earlier than expected, staff turnover, and slow process of culture change within the centers.

Conclusions: 

This article discussed the methods of an ongoing randomized clinical trial of VR approaches among veterans with SCI. Strengths of the study design include repeated measures to evaluate employment across time, inclusion of benefits-counseling, and ongoing fidelity monitoring of the treatment conditions. Before the study, the researchers concluded that there was a lack of attention to identifying or addressing vocational issues in the treatment setting. A culture change occurred such that providers began to introduce and explore the topic. In this study, the recruitment relied on clinical providers' willingness to broaden their definition of rehabilitation to include vocational issues. The preliminary baseline data from this sample showed that the majority (72%) had never been employed postinjury.

URL: 
http://www.rehab.research.va.gov/jour/09/46/7/Ottomanelli.html
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effectiveness of supported employment for veterans with spinal cord injuries: Results from a randomized multisite study

Authors: 
Ottomanelli, L., Goetz, L., McGeough, C., Suris, A., Sippel, J., Sinnott, P., Wagner, T. H., & Cipher, D. J.
Year Published: 
2012
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
93
Number: 
5
Pages: 
740-747
Publisher: 
Elsevier
Background: 

Unemployment for individuals who have sustained a spinal cord injury is a serious problem. Ottomanelli et al report that the average rate of paid employment for individuals post SCI is approximately 35%. The rate of individuals returning to work post injury has been cited as even lower at only 12% returning to their preinjury jobs. In 2004, the Veterans Health Administration implemented an initiative to apply evidence-based supported employment to veterans with serious mental illness (SMI). This article is one of the first multisite, randomized controlled trials of supported employment versus standard vocational rehabilitation care for veterans with spinal cord injury (SCI).

Purpose: 

The purpose of this research was to examine whether supported employment is more effective than "treatment as usual" in returning veterans to competitive employment after spinal cord injury.

Setting: 

SCI centers in the Veterans Health Administration. Sites were selected based on location in a metropolitan geographic region, adequate economic and industrial development, strong management and leadership support at the medical center, available subject pool, and existing public transportation system.

Sample: 

A total of 201 Veterans with a spinal cord injury between the ages of 18 and 65 who received medical and/or rehabilitation health care services at 1 of the 6 participating VA Medical Centers were included in the study. Only veterans who were not employed, or were employed earning less than the level of substantial gainful activity as by Social Security were included in the study.

Data Collection: 

The main outcome measure was competitive employment in the community. Data was collected through subject interviews, chart extraction of sociodemographic information, medical and psychiatric information, Social Security benefits. Veterans were assessed using the Veterans RAND 36-item Health Survey, Quick Inventory for Depressive Symptomatology - Self-Report, and Craig Handicap Assessment and Reporting Technique. In addition, the IPS Fidelity Scale was used to measure the adherence to the SE model.

Power analysis pre study indicated that a total of 126 subjects were needed. Statistical analysis on the data included Student t test or Wilcoxon rank-sum tests, the Pearson chi-square test or Fisher exact test where appropriate. Effect sizes calculated for employment outcome data included rate ratios, and Cohen's d for continuous data, and Cramer's v for categorical data where appropriate. Analyses were performed with SAS version 9.2.

Intervention: 

The intervention consisted of a supported employment vocational rehabilitation program called the "Spinal Cord Injury Vocational Integration Program." This program was designed to "adhere as closely as possible" to the evidence-based supported employment model for individuals with mental illness.

Control: 

Subjects were randomly assigned at the intervention sites to the supported employment(SE) condition or the treatment as usual-interventional site (TAU-IS). In observational sites where there was no SE program veterans were enrolled in a nonrandomized TAU condition.

Findings: 

Veterans in the SE group were 2.5 times more likely than the treatment as usual group-interventional site and 11.4 times more likely than the treatment as usual-observation site group to obtain competitive employment.

Conclusions: 

Supported employment as a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.

URL: 
http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1189&context=publichealthresources
NIDILRR Funded: 
Peer Reviewed: 
Yes

Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services

Authors: 
Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., Barnett, S. D., Cipher, D. J., Lind, L. M., Dixon, T. M., Holmes, S. A., Kerrigan, A. J., & Thomas, F. P.
Year Published: 
2009
Publication: 
The Journal of Spinal Cord Medicine
Volume: 
32
Number: 
5
Pages: 
503-531
Publisher: 
American Paraplegia Society
Background: 

Unemployment is a serious problem for individuals with spinal cord injury (SCI). According to the authors, unemployment for the population of SCI individuals is ten times greater than the general population. In addition, return to preinjury jobs has been reported as very low for this group of individuals.

Purpose: 

The purpose of this study was to provide a comprehensive summary of the literature regarding predictors of employment, the benefits, and barriers.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The sample consisted of 60 articles that reported on employment rate of individuals with spinal cord injury.

Data Collection: 

Authors identified 579 articles and reviewed to determine presence of reported employment rates. Of these, 60 articles were found to include employment rates for individuals with SCI. These articles were reviewed to identify critical factors related to employment after spinal cord injury.

Intervention: 

The intervention was evidence-based supported employment and traditional vocational rehabilitation.

Control: 

There were no comparison or control conditions.

Findings: 

Results indicated that the average rate of any employment after SCI was approximately 35%. The review of literature indicates that there are 11 factors associated with employability of individuals with SCI. This includes education, type of employment, severity of disability, age, time post injury, sex, marital status, social support, vocational counseling, medical problems associated with SCI, employer role, environment, and professional interests. Individuals with college backgrounds are more likely to return to work. Being younger at the time of injury is associated with the best employment outcomes. The probability of employment after SCI improves with increasing time since injury. Race is also associated with obtaining employment after SCI. Individuals who are white are more likely to be employment than those from minorities. Evidence-based supported employment seems to be the most applicable model for assisting individuals with SCI in restoring meaningful employment.

Conclusions: 

Characteristics associated with employment include demographic variables, injury-related factors, employment history, psychosocial issues and disability benefit status. Evidence-based supported employment practices seem to be the most applicable model for assisting individuals with SCI in restoring meaningful employment. Control studies are needed to test this conclusion.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792457/
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Achieving a successful and sustainable return to the workforce after ABI: A client-centered approach

Authors: 
Phillips, V. L., Temkin, A., Vesmarovich, S., Burns, R., & Idleman, L.
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
5
Pages: 
465-478
Publisher: 
Informa Healthcare
Background: 

Acquired brain injury (ABI) can be caused by cerebrovascular accident, trauma (such as assault or motor vehicle accident), tumors, hypoxia, infection or degenerative conditions and is a common occurrence [1]. It may result in significant disability and, in people of working age, limit their ability to join or return to the workforce.

Purpose: 

The aim of this study was to describe the services provided (including assessments, interventions and post-job placement support) and outcomes achieved by CRS Australia‚ Victorian ABI team and compare and contrast this with other models.

Setting: 

The study setting was a rehabilitation service organization in Australia.

Sample: 

The study sample consisted of 27 individuals with ABI who had received rehabilitation services at CRS Australia. The sample was randomly selected from cases that had been closed in the previous year with an employment outcome. Additional characteristics of the sample are not provided.

Data Collection: 

A data extraction method was used to audit patient information relevant to the study. Team members were also asked to indicate which of 17 vocational rehabilitation strategies they used with their clients and to rate each in terms of effectiveness in achieving a successful job placement. which of five post job-placement strategies (email to client, weekly or fortnightly phone calls to client, weekly or fortnightly phone calls to employer, support/counseling outside client‚ work hours and regular scheduled workplace visits) they used and to evaluate their perceived effectiveness.

Intervention: 

The intervention is described as client-centered practice. Each client is allocated to a Rehabilitation Consultant (RC) with whom they work one-to-one, wherever possible, throughout the duration of services. Active client involvement in the negotiation of individual rehabilitation plans is standard practice in all cases and clients are informed of their rights, responsibilities and the complaints handling mechanism at the earliest opportunity. Specific interventions are tailored to the individual and can include vocational counseling, skills training, cognitive retraining, job seeking, interview preparation, work behavior coaching, and post-employment services.

Control: 

There was no control or comparison condition. Outcomes for the study group were compared to those of other models.

Findings: 

Of the patient files audited, 42% were placed in professional, managerial, office or administrative work, two were placed in a trade-qualified job, eight were placed in semi-skilled positions, and four were placed in unskilled labor. Of the clients who had jobs to return to (n=10) all returned to their previous role or a similar job following a graded return with professional/clerical jobs figuring highly (50%; n=5). Those clients who did not have a job to return to (n=17) were placed in similar roles to their pre-injury employment, with seven placed in a professional role, six placed in semi-skilled work and four placed in unskilled labor positions. Half were employed more than 13 weeks.

Conclusions: 

The CRS Australia model resulted in higher than average employment outcome rates for this population (50% working at award wage for more than 13 weeks, compared to Australian ABI population estimates of 28–46.5%). This study shows that the CRS Australia model has been successful with people with mild, moderate and severe impairment following an ABI and significantly less time-intensive and therefore less costly than other models.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17522986
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury

Authors: 
Ottomanelli, L., & Lind, L.
Year Published: 
2004
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
85
Number: 
2
Pages: 
68-72
Publisher: 
Elsevier
Background: 

Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.

Purpose: 

The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.

Setting: 

The setting included communities and two district vocational rehabilitation offices in the state of New York.

Sample: 

The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (i.e.. black and Asian). Related to education, close to half (48%) had not completed high school.

Data Collection: 

The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000–September 30, 2001) and 2002 (October 1, 2001–September 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (i.e., case status 26) were compared with unsuccessful closures (i.e., case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.

Intervention: 

All participants went through the initial VR procedures for eligibility determination and development of an individualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.

Control: 

Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.

Findings: 

Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.

Conclusions: 

The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15083424
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training

Authors: 
O'Neill, J. H. , Zuger, R. R., Fields, A.,Fraser, R., & Pruce, T.
Year Published: 
2003
Publication: 
Community Mental Health Journal, 39(4), 333-347.
Volume: 
39
Number: 
4
Pages: 
333-347
Publisher: 
Springer Science+Business Media
Background: 

High unemployment rates are found in people with long-term mental health problems although they want to work. Various approaches to increasing access to work have been described. Currently evidence favors the individual placement and support (IPS) model. Here the aim is to help patients obtain open employment with a minimal period of pre-vocational training; a place-train approach rather than vice versa. Once a job or training place has been obtained as much support as possible is given with the aim of retaining the position. This model is gaining increasing recognition in the United States and a Cochrane review concluded that it was more effective than pre-vocational training in helping people with severe mental illness return to work. However mental health services in Europe have been slower to prioritize this issue.

Purpose: 

To investigate the impact of training Community Mental Health Team members in the practice of Individual Placement and Support on the vocational status of long-term patients.

Setting: 

Subjects were recruited from ten Community Mental Health Teams of a large London Mental Health Trust. Subjects were eligible for inclusion if they had been in continuous contact with their Community Mental Health Team for at least one year and were unemployed. All subjects were
over the age of 16. Males over 65 and females over 60 (normal retirement age) were excluded from the study.

Sample: 

Six Community Mental Health Teams received vocational training by a work co-coordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified.

Data Collection: 

Data were entered into SPSS for windows version 10 and cleaned using logical searches. The data were analyzed without adjustment for the cluster design. This was because the inter-cluster correlation coefficient (ICC) was 0.00148, which leads to a design effect of 1.01. The small ICC means that individual behavior is only affected to a minor degree by cluster membership, meaning that the cluster design has little overall effect. To test any effect of the intervention the categorical variables were analyzed using tests and continuous variables were analyzed using independent t-tests. A stratified chi-square analysis was conducted to allow for differences between the groups at baseline. When examining factors associated with return to work differences within categories were compared using the z-test. For all statistical tests a significant p-value was set at 0.05.

Intervention: 

This was a randomised controlled trial of the effect of training of Community Mental Health Team members on the vocational needs of long-term patients. The training and provision of information was by a Consultant Clinical Psychologist specialising in vocational rehabilitation (RP)and a work coordinator with experience in supported employment. The unit of randomization was the team rather than the patient. Local Research Ethics Committee approval was obtained for the study, which did not require written consent from individual patients.

Control: 

The control condition was high quality standard Community Mental Health Team care.

Findings: 

There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome.

Conclusions: 

Training in Individual Placement and support at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful Individual Placement and Support.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12908647
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes