The effects of primary care depression treatment on patients' clinical status and employment

Authors: 
Schonebaum, A., Boyd, J., & Dudek, K.
Year Published: 
2002
Publication: 
Health Services Research
Volume: 
37
Number: 
5
Pages: 
1145-1158
Publisher: 
John Wiley & Sons, Inc.
Background: 

Effective treatment of depression could thus have major public health benefits. Yet despite availability of efficacious treatments, that is, antidepressant medications and psychotherapies, and of national practice guidelines, rates of appropriate treatment for depression remain low nationally, particularly in primary care where only about a quarter of depressed patients receive appropriate care.

Purpose: 

The goal of this study was to evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.

Setting: 

The study was conducted in six diverse, non academic managed primary care organizations. Forty-six of 48 primary care practices and 181 of 183 clinicians participated. Practices were matched into blocks of three clusters, based on factors that might affect baseline quality of care or intervention response: clinician specialty mix, distribution of patient socioeconomic and demographic characteristics, and presence of onsite mental health clinicians.

Sample: 

Study staff screened 27,332 consecutive patients in participating practices over five to seven months. Patients were eligible if they intended to use the clinic during the next twelve months and screened positive for depression, using items from the World Health Organization's twelve-month Composite International Diagnostic Interview. Patients were positive if they reported at least one week of depression in the last 30 days, plus two weeks or more of depressed mood or loss of interest in pleasurable activities or persistent depression over the year.

Data Collection: 

Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.

Intervention: 

Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. One intervention supported the same nurses to provide six or twelve months of medication follow-up (randomized at the patient level) through telephone contacts or visits, and the other intervention trained local therapists in group and individual Cognitive Behavioral Therapy. These therapists were available to intervention patients at reduced copay. All patients could have other types of psychotherapy for usual copays.

Control: 

Usual care practices only received written depression treatment guidelines by mail. In all intervention conditions, patients and providers made their own treatment decisions and use of intervention resources was optional.

Findings: 

At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.

Conclusions: 

Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464020/
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A comparison of competitive employment outcomes for the clubhouse and PACT models

Authors: 
Secker, J., & Membrey, H.
Year Published: 
2006
Publication: 
Psychiatric services
Volume: 
57
Number: 
10
Pages: 
1416-1420
Publisher: 
Psychiatric Services
Background: 

The unemployment rate among individuals with severe mental illness is high, ranging from 67 to 85 percent. Many studies focus on job placement rates without considering job retention. Supported employment programs vary a lot and no single definition exists. Furthermore, the rapid placement guideline may mean that a lack of job readiness may be impacting an individual's success at work. The clubhouse model to employment may be able to help individuals gain and maintain work at higher rates than other approaches.

Purpose: 

The goal of this study was to determine if a clubhouse model could achieve and maintain employment rates comparable to the Program of Assertive Community Treatment model of supported employment.

Setting: 

The study was conducted in Western Massachusetts Genesis Club.

Sample: 

The study sample included 177 individuals who data was collected over a four year time period. All had a diagnosis of bipolar disorder, depression or schizophrenia and were 18 years of age or older. They were not screened for work readiness and interest in work was not required.

Data Collection: 

After acceptance into the study the Positive and Negative Syndrome Scale was conducted. Interviews were also conducted at baseline and then every 6 months over two and half years. Questions related to symptoms, jobs, hospitalizations and more. Program staff tracked job information. Employment data was also provided by staff or through interviews with participants. Each participant was followed for the study period or until he or she exited services. Time based analyses compared weekly employment and job placement rates for participants in each group. Binary employment outcomes were analyzed with generalized estimating equations of the Genmod procedure in SAS with a logit link function. Another group of job based analyses was also conducted to examine average job duration, hours and wages to compare outcomes from participants in the two groups. Spearman rank-order correlations between job duration, hours and wages were estimated to identify potential covariates in the hours and wages test model.

Intervention: 

The intervention was Supported Employment services delivered through Club Houses.

Control: 

The control was Supported Employment services delivered via Program of Assertive Community Treatment (PACT).

Findings: 

The PACT model had a 14% higher job placement rate than the clubhouse model. Participants in either approach maintained weekly employment levels at or exceeding other published reports. On average participants in more than 2 jobs during the study period and worked 20 hours a week. Clubhouse participants remained employed 2 months longer than individuals in PACT, which resulted in a 66% difference in duration.

Conclusions: 

No difference was found in job placement rates between clubhouse and PACT participants over two and half years. Clubhouse participants remained employed for more weeks and earned slightly higher wages than participants in PACT.

URL: 
http://www.fountainhouse.org/sites/default/files/C.%20Schonebaum%20article.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work

Authors: 
Siporin, S. and Lysack, C.
Year Published: 
2003
Publication: 
Health Education Research
Volume: 
18
Number: 
2
Pages: 
207-215
Publisher: 
Oxford University Press
Background: 

In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work.

Purpose: 

This study draws on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific objectives were:
(1) To identify a sample of employment support service users who had retained open, competitive employment for 12 months or longer.
(2) To identify a sample where employment had broken down after a period of less than 12 months employment.
(3) To explore the experiences of both groups from their own perspective.
(4) To explore the perspectives of the other key individuals involved, including employment project workers and workplace managers.
(5) To identify factors associated with the success or breakdown of supported employment on the basis of the accounts obtained.

Setting: 

The study was conducted at five project sites in England. Of the five projects, two were based in geographically and demographically diverse areas of outer London (Projects A and B), one operated in a semi-rural area of southeast England (Project C), and one in an urban area of the southeast (Project D). The fifth project (Project E) was based in a Midlands city.

Sample: 

Clients of the five projects who had current or recent experience of open employment were invited to a meeting at their project where the research and what would be involved was explained. As a result of the meetings some clients decided not to take part because they had not disclosed their mental health problems at work, while others who were currently employed had not yet been in their job for a year. These clients therefore withdrew from the study. In total, 10 male clients and seven female clients did take part. Eleven clients had been able to retain open employment for 12 months or longer, while the other six clients jobs had ended within 12 months for reasons they themselves saw as problematic.

Data Collection: 

With participants permission, the interviews were tape recorded and transcribed verbatim. A staged analysis was then carried out. Initially, each job was treated as a case and the 17 cases were divided into jobs that had been retained and jobs that had broken down. Data relating to each case (i.e. the client‚, project worker‚ and manager‚ accounts of a job) were then grouped under broad categories according to whether they related to employment support, workplaces or service users personal circumstances. Data within each category were analysed to generate subcategories within each main category, e.g. workplace factors relating to managers, colleagues and conditions of employment. These were then compared across cases in order to identify those factors that were associated with job retention and job breakdown. As noted earlier, in this article we focus on clients accounts of those factors relating to the workplace.

Intervention: 

Since the aim was to explore clients perceptions of their employment experiences, a semi-structured interview schedule was developed to enable each participant to tell the story of the job concerned from its beginning in the assessment and preparation stage leading up to the job, through its development to its end or to the present time in the case of ongoing jobs. The schedule explored key events during each stage of the job, including client first meetings with their manager and colleagues, their induction, and subsequent significant developments identified by participants themselves. Throughout the interview, participants feelings and attitudes, their accounts of factors which had either positive or negative effects, and their views about what else might have been helpful were explored. Questions were also included to obtain background data, including clients employment and mental health history. The interviews varied in length from 40 min to just over 3 hour.

Control: 

There was no control or comparison condition.

Findings: 

Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however natural supports of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. Themes from the findings might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.

Conclusions: 

On the basis of this study, four organizational initiatives in particular might help to ensure that workplaces are mentally healthy, both for mental health service users starting or returning to work, and for other employees:
Ensuring that a formal period of induction, of sufficient length, is routine practice for all new employees. For many jobs, induction will need to include formal training geared to the employee‚ pace of learning, opportunities to observe colleagues work and the explicit identification of sources of support for tackling problems that arise.
Embedding attention to employees ongoing development in routine workplace practice through formal supervision and appraisal procedures.
Team building aimed at creating a welcoming workplace where difference is accepted and employees strengths are valued.
Training and other learning opportunities, e.g. action learning sets, for managers, covering mental health and safety at work, team building, and individual staff management. Opportunities to explore the boundaries between a friendly, supportive approach and ensuring that work is completed would be particularly valuable, as would training in techniques for providing constructive criticism for employees.

URL: 
http://her.oxfordjournals.org/content/18/2/207.full
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Quality of life and supported employment: A case study of three women with developmental disabilities

Authors: 
Staines, G., L., Blankertz, L., Magura, S., Bali, P., Madison, E. M., Spinelli, M.,Horoqitz, E., Guarino, H.,Grandy, A., Fong, C., Gomez, A., Dimun, A., & Friedman, E.
Year Published: 
2004
Publication: 
The American Journal of Occupational Therapy
Volume: 
58
Number: 
4
Pages: 
455-465
Publisher: 
The American Occupational Therapy Association Inc.
Background: 

Programs aimed at enhancing the quality of life for individuals with disabilities are on the rise. This includes work. To understand the impact of new models of vocational training, it may be instructive to look at sheltered work, the long standing model. The job coach model of supported employment helps individuals with disabilities work in the community. The case for a positive relationship between supported employment and quality of life is not well understood. Research aimed at understanding a person's experiences with supported employment and other factors that impact quality of life may identify whether or not the consumers' needs are really being met.

Purpose: 

The purpose of this study was to better understand the experience of supported employment and a wide range of other factors that affect quality of life for people with developmental disabilities.

Setting: 

The setting for the study included various employment settings where each participant worked as a member of an enclave.

Sample: 

The study included nine participants. Three women with developmental disabilities, three job coaches and either a family member or group home manager for each. All women were white, and able to make their own decisions including informed consent. The women had previously worked at a sheltered workshop and were currently working in a enclave of 8 to 10 adults that was supervised by a job coach. The most frequent type of work performed by the enclave included cleaning at various places and entry level food services.

Data Collection: 

Open-ended interviews and on site observations were used to collect data. The interviews were guided by a script and recorded. Afterwards they were transcribed. The women were also observed while working as a member of an enclave. On site field observations lasted about 2 hours. The job coaches and family members were also interviewed. The data was analyzed using a constant comparative method. All interview and observational data were reviewed and coded. Some quotes were also selected to serve as exemplars of each woman's quality of life experience.

Intervention: 

The intervention was supported employment services.

Control: 

There was no control or comparison condition.

Findings: 

The three women preferred enclave work over the workshop setting. The participants indicating satisfaction with work assignments and relationships with others in the enclave. Policies and regulations like social security, impacted quality of life.

Conclusions: 

People with developmental disabilities can and do form their own opinions when give the opportunity. Professionals must be in tune with this fact and find ways to help make sure consumer voices are heard.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15315252
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Efficacy of the customized employment supports(CES) model of vocational rehabilitation for unemployed methadone patients: Preliminary results

Authors: 
Strickland, D., Coles, C., & Southern, L.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2261-2285
Publisher: 
Informa Healthcare
Background: 

Methadone-maintained patients experience great difficulty with gaining and maintaining competitive employment due to personal barriers and limited vocational services. Federal and state policy reforms require substance users to obtain work or risk losing public benefits. Innovative vocational rehabilitation models need to be tested in order to improve employment outcomes for patients enrolled in addiction treatment programs.

Purpose: 

The purpose of the study was to evaluate a Customized Employment Supports (CES) model designed to improve employment outcomes for unemployed methadone-maintained patients.

Setting: 

The study was implemented at two sites in Manhattan. One is a free-standing methadone clinic operated by Greenwich House, a nonprofit social services agency. The other methadone clinic is operated by Harlem Hospital but is located separately from the hospital.

Sample: 

The study eligibility criteria for methadone patients included the following: unemployed or remarkably underemployed; stabilized on an appropriate methadone dose; negative urine toxicologies for both opiates and cocaine for last 4 tests; absence of any condition that would preclude working (e.g., serious mental illness, developmental disability, severe physical health problem, or time-intensive dependent care responsibilities) and willingness to participate and be randomly assigned to either the innovative vocational program or the clinic‚ existing vocational counseling program. The participants included at total of 135 patients: 79 at Greenwich House's methadone clinic and 56 at the Harlem Hospital's methadone clinic. Participants were randomly assigned to either the customized employment supports vocational model or the clinic's standard vocational program. The final sample included 55 in the experimental group and 66 in the control or a total of 121 patients. Some of the key characteristics of the overall sample at baseline included the following: male (58%); minority group (68%); mean age 44 years (s.d.¬º8.8 years); high school graduate/GED (65%); no paid job within last 6 months (60%); unemployed at study entry (100%); ever arrested (81%); rates own overall health as excellent, very good, or good (62%), but reports having trouble standing for long periods (67%), climbing stairs (73%) and lifting a medium weight (90%); received prior treatment for substance misuse (67%) and mental health problems (53%); has attended some form of 12-step program (79%); and has received public assistance benefits in the past year (82%).

Data Collection: 

The study collected data on patient employment and behaviors from the following sources: baseline interviews of patients prior to before random assignment; patient follow-up interviews at 6, 12, and 18 months later using the same procedure as the baseline but adding measures about the intervention; review of vocational activities log kept by both CES and standard counselors as well as employment documentation. The employment measures drew on and integrated information from these sources since no single source was completed using the combined ordinal outcome measure, the initial analysis was a cross-tabulation of the highest level of vocational activity attained by study condition using the combined ordinal outcome measure. Next, cross-tabulations were conducted between experimental condition and four separate indices of vocational outcomes. Pearson chi square provided the tests of statistical significance across the board. Since the hypotheses involving vocational outcomes were directional predictions (i.e., better outcomes were predicted for the experimental group), single-tailed significance tests were reported. Four dichotomous measures of vocational activities, which constitute the outcome measures for this analysis, were obtained at baseline and at 6-month follow-up: 1. Whether the patient attained any paid job in the previous 6 months. 2. Whether the patient attained a competitive job in the previous 6 months. 3. Whether the patient attained an informal job in the previous 6 months. 4. Whether the patient participated in any other socially constructive, vocationally relevant activity in the previous 6 months. The three basic vocational measures (i.e., competitive, informal, constructive activity) were not significantly associated with each other (p>0.05). To provide a single overall index of vocational outcomes, they were combined into a four-level, ordinal measure of highest level of vocational attainment: 1. Attained a competitive job (highest). 2. Attained an informal job. 3. Performed constructive activity other than paid employment. 4. None of the above (lowest).

Intervention: 

The intervention, the Customized Employment Supports (CES) model, is designed to help patients overcome these employment barriers and attain paid work as soon as possible. The model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients and enhance their self-efficacy. Methods used to help patients increase their self-efficacy included: role modeling, persuasion, and minimizing emotional arousal.

Control: 

The participants were randomized into intervention and control groups.

Findings: 

Consistent with the study‚ main hypothesis, the experimental group achieved significantly higher levels of vocational activities than the comparison group during the 6-month follow-up. Each of the four measures of vocational outcomes was also evaluated individually. Compared with the standard vocational services group, patients in the CES program were significantly more likely to have obtained any form of paid employment, competitive employment, and informal employment. However, the two groups did not differ significantly on engaging in constructive vocational activities other than paid work.

Conclusions: 

The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. More research is needed.

URL: 
http://www.tandfonline.com/doi/abs/10.1081/JA-200034618?journalCode=isum20
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Job tips: A transition to employment program for individuals with autism spectrum disorders

Authors: 
Taylor, J. l., McPheeters, M., Sathe, N.A., Dove, D., Veenstra-VanderWeele, J. & Warren, Z.
Year Published: 
2013
Publication: 
The Journal of Autism and Developmental Disorders
Volume: 
43
Number: 
10
Pages: 
2472-2483
Publisher: 
Springer
Background: 

Shattuck et al. (2012) reported that youth with an ASD are uniquely at risk for negative post-school outcomes, as indicated by the fact that while only 55 % of those with an ASD are employed in the 6 years beyond high school, 86 % of those with a speech or language impairment, 94 % of those with a learning disability, and 69 % of those with an intellectual disability have found employment.

Purpose: 

The current study evaluated the effectiveness of a treatment package comprised of a web-based interviewing skills program (JobTIPS) and virtual reality practice on responses to employment interview questions by adolescents with high functioning autism and Asperger‚ Disorder.

Setting: 

The setting was a University Research Center.

Sample: 

The study sample included 22 youth who were between the ages of 16–19 years old.

Data Collection: 

An Interview Skills Rating Instrument was developed by researchers. The first scale was Response Content: A 10 item scale that measures the content of the participant's response to 10 interview questions. The second scale: Response Delivery: 20 items that measure behaviors related to greetings and farewells (handshakes, eye contact, verbal greeting, verbal expression of appreciation at end of interview), as well as the non-verbal behaviors (body positioning, facial expressions) that accompany verbal responses during the actual interview questioning period.

Intervention: 

Internet based transition program

Control: 

Services as usual

Findings: 

The results of the study suggest that youth with ASD who completed the Job TIPS training program showed significant improvement in their job interviewing skills when compared to the control group. The program was more effective in teaching content rather than delivery skills. Participants were able to produce more appropriate verbal responses to interview questions following intervention, but the features that accompany those responses did not improve to the same degree.

Conclusions: 

The findings demonstrate that a web-based training program can be effective as an intervention method to improve employment related interviewing skills for individuals with ASD.

URL: 
http://link.springer.com/article/10.1007%2Fs10803-013-1800-4
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A systematic review of vocational interventions for young adults with autism spectrum

Authors: 
Test, D.W., Mazzotti, V.L., Mustian, A.L., Fowler, C.H., Kortering, L., & Kohler, P.
Year Published: 
2012
Publication: 
Pediatrics
Volume: 
130
Number: 
3
Pages: 
531-538
Publisher: 
American Academy of Pediatrics
Background: 

Not much is known about effective vocational interventions to assist individuals with ASD. Yet, that population is rapidly growing. Programs and interventions to serve youth are not well understood. The lack of information impacts successful transition to work.

Purpose: 

The purpose of this systematic review of the literature was to assess the effectiveness of vocational interventions for individuals with ASD who are 13 to 30 years old.

Setting: 

The studies that were reviewed were undertaken in various locations and settings in the US, UK, Spain and Germany.

Sample: 

Multiple databases and reference lists were searched to find relevant studies that were published between 1980 and 2011. Afterwards, each study was examined against an inclusion criteria developed by an expert panel. Data about sample, intervention characteristics, assessment techniques, and outcomes, were evaluated and an overall quality and strength of evidence rating was assigned to the included studies according to a specific criteria. The final sample consisted of 5 studies involving young adults with autism.

Data Collection: 

Characteristics of study participants and interventions were summarized. Descriptive statistics were used to report study outcomes. No meta analysis was conducted.

Intervention: 

The studies reviewed looked at a variety of vocational interventions which involved identifying and implementing work supports for young adults with ASD.

Control: 

There were no comparison or control conditions.

Findings: 

Only five studies, related to on the job supports and employment and vocational interventions were found. All of these received a poor quality rating by the reviewers which may be due to the fact that this is a new area of research. The studies included one non randomized trial that looked at the impact of supported employment versus sheltered work settings for 55 young adults with autism. A related study from the same researchers looked at the effect of supported employment versus sheltered work on the cognitive development of 44 young adults with autism. Two cohort studies and one cross sectional study reported on the influence of vocational interventions on independent living outcomes.

Conclusions: 

There is very little evidence about vocational interventions for individuals with ASD. High quality research is needed. Supported employment may be a promising intervention however much more research is needed.

URL: 
http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-0682
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Evidence-based secondary transition predictors for improving post-school outcomes for students with disabilities

Authors: 
Texler, L. E., Texler, L. C., Malec, J. F., Klyce, D., & Parrott, D.
Year Published: 
2009
Publication: 
Career Development for Exceptional Individuals
Volume: 
32
Number: 
3
Pages: 
1-22
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Post secondary school outcomes for youth with disabilities are poor. For example, the National Longitudinal Transition Study 2 Wave 3 data indicated students continue to live with their parents, did not attend post secondary education and had high rates of unemployment as compared to their non disabled peers, after exiting school. The National Secondary Transition Technical Assistance Center had been identifying evidenced based practices to help improve these and other outcomes. The Council for Exceptional Children was also looking for evidenced based practices in Special Education.

Purpose: 

The purpose of this study was to conduct a systematic review of the secondary transition correlational literature using recommended quality indicators to identify in-school predictors of improved post school outcomes for students with disabilities.

Setting: 

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

Sample: 

One hundred and sixty two articles were identified for review. Sixty three passed an analyses and were passed on for further review. Among these, 35 were excluded which left 28 articles for comparison against a quality of evidence checklist for correlational research. This resulted in 22 articles for final review. Three were exploratory studies and the others were a priori studies related to students with disabilities.

Data Collection: 

The remaining studies were examined for the following: population, sample size, predictor variables, postschool outcome variables, type of statistical analysis used, relationships among variables, significance levels, and data that allowed for calculation of effect sizes. It was not possible to extract conclusions across studies, so the researchers chose to convert significant relationships to standardize effect size measures to allow comparisons. Various conversions were calculated.

Intervention: 

The interventions were various transition practices.

Control: 

There were no comparison or control conditions.

Findings: 

A review of the literature identified 16 evidence-based in school predictors of post-school outcomes. These include: career awareness, community experiences, exit exam requirements/high school diploma status, inclusion in general education, interagency collaboration, occupational courses, paid employment/work experience, parental involvement, program of study, self advocacy/self determination, self-care/independent living skills, social skills, student support, transition program, vocational education and work study. Some negative findings were also found. Two studies reported negative relationships between secondary transition predictors and one or more post school outcomes. Among the 16 predictor categories: inclusion in general education, paid employment and work experience, self care/independent living, and student support improved outcomes in all 3 post school outcome areas.

Conclusions: 

The results from this review provide information to help practitioners improve post school outcomes for students with disabilities. Combining knowledge gained from this review with evidenced based instructional practices should provide state and local education agencies with a foundation to improve programs and thereby increase post school outcomes.

URL: 
http://sites.bu.edu/miccr/files/2015/03/Evidence-based-secondary-transition-predictors-for-improving-post-school-outcomes-for-students-with-disabilities.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes

Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury

Authors: 
Tsang H. W, Fung K. M., Leung A. Y., Li S. M., & Cheung W. M.
Year Published: 
2010
Publication: 
Journal of Head Trauma Rehabilitation
Volume: 
25
Number: 
6
Pages: 
440-446
Publisher: 
Lippincott, Williams and Wilkins Inc.
Background: 

Brain injury has a negative impact on return to work. Past research indicates improved employment outcomes with an integrated medical/vocational case coordination system.

Purpose: 

The researchers hypothesized that individuals with brain injury who receive resource facilitation (RF) will have greater success with return to work and participation in community and home activities.

Setting: 

The setting was a large acute rehabilitation hospital, located in the Midwest.

Sample: 

The sample size included 23 individuals with brain-injury and their caregivers. To be included in the study those with brain injury had to meet the following criteria: injury in the last 12 months or less, 18 to 60 years of age, ability to speak English, had been employed and/or had been enrolled in school for 2 years prior to the injury, had a goal to return-to-work or school and had a caregiver who was willing to participate in the study.

Data Collection: 

Participants were given O-Log and the C-Log, as part of their clinical examination in the acute rehabilitation center prior to enrollment to determine the initial severity of cognitive impairment. Ratings on the Participation Index of the Mayo- Portland Adaptability Inventory (M2PI) were obtained for 11 RF participants and 11 controls before the intervention and at 6-month follow-up.

Intervention: 

All participants received standard follow up. Those assigned to the experimental group also received resource facilitation through a facilitator who was charged with assisting them with returning to work.

Control: 

Participants were assigned to either a resource facilitation group N=12 or regular follow up control conditions N=11.

Findings: 

Resource facilitation can improve work outcomes. Those who received resource facilitation were more engaged in vocational services. It also had a positive impact on participants involvement in community and home activities. Resource facilitation does not appear to affect depression.

Conclusions: 

Six months of resource facilitation, provided soon after patient discharge from acute rehabilitation, may have a powerful impact on employment post brain injury and community participation. More research is needed.

URL: 
http://journals.lww.com/headtraumarehab/Abstract/2010/11000/Prospective_Randomized_Controlled_Trial_of.6.aspx
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Workforce re-entry for people with HIV/AIDS: Intervention effects and predictors of success

Authors: 
Martin, D., Chernoff, R., & Buitron, M.
Year Published: 
2006
Publication: 
Work
Volume: 
27
Number: 
3
Pages: 
221-233
Publisher: 
IOS Press
Background: 

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent. Little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work.

Purpose: 

The purposes of this study were to (1) identify factors predicting workforce re-entry among a group of participants in a workforce-reentry demonstration project for people with HIV/AIDS; and (2) determine whether an intervention designed to help people with HIV/AIDS return to work was successful.

Setting: 

Participants were recruited from community-based service agencies in the southern region of Los Angeles County, CA. The intervention was coordinated by the Career Transition Center (CTC) in Long Beach, CA but was delivered at various local centers. The CTC offers an array of services, including resume writing, guided and self-directed job search, vocational counseling, job training and job placement.

Sample: 

A total of 235 participants were recruited into the workforce reentry demonstration project from local community agencies. Entry criteria included the following: (1) an HIV/AIDS
diagnosis, (2) disabled/unemployed (exceptions to this were individuals working part time under the table or volunteering), (3) receiving medical care for their HIV/AIDS conditions, (4) enrolled in an HIV/AIDS case management program, and (5) contemplating workforce re-entry. The mean age was 40, and was predominantly males who were sexually active with other males.

Data Collection: 

Program participants and comparison respondents completed questionnaires that included demographic questions, measures of income and income source, health indices, an interview and a questionnaire related to current and prior employment status. Descriptive statistics were calculated for all variables. Chi-square tests were used to compare the intervention group with the comparison group for categorical variables and a combination of t-tests and Wilcoxon rank-sum tests were used for continuous variables.

Intervention: 

The intervention tested was a work re-entry program that included vocational assessments, counseling, case management, job search assistance, and job placement. In addition, tuition assistance was provided for training through independent training institutions and local community colleges.

Control: 

Fifty-one comparison respondents were recruited from the same community agencies as the intervention participants. These individuals met the same requirements as intervention participants with the exception that they were not seeking to re-enter the workforce. They were not provided with an alternative treatment.

Findings: 

Of the 235 enrolled participants, 172 completed at least one follow-up. Of this group, 90 were in some form of work at baseline, but 46 stopped working at some time later in the study and their time to return to work was reset to start at the time that they stopped working. Participants in the intervention condition were more likely to return to work than those in the comparison group. In addition, men, those in relatively poor health, those receiving either Social Security or state disability income and those with higher incomes at baseline were less likely to return to work.

Conclusions: 

The study provides evidence for the efficacy of return to work services for individuals with HIV/AIDS. Those who completed the intervention were more likely to return to work and to return to work more quickly. Although lengthier interventions may be needed for some individuals with HIV/AIDS seeking workforce re-entry, the ?findings suggest that even limited assistance may be useful to individuals seeking to return to work following a period of disability.

URL: 
http://content.iospress.com/articles/work/wor00565
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes