Work, rehabilitation and mental health

Authors: 
McGuire, A. B., Bond, G. R., Clendenning, D. R., & Kukla, M.
Year Published: 
2000
Publication: 
Journal of Mental Health
Volume: 
9
Number: 
2
Pages: 
199-210
Background: 

Unemployment rates are high for individuals with psychiatric problems. Not working also has a negative impact on mental health. New services have evolved to assist people with mental health problems with employment particularly in the United States. The United Kingdom is moving in this direction. A key player is Northern Ireland which provides Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services for people with mental health issues.

Purpose: 

This study evaluated the ACCEPT services for individuals with mental health problems during their first 12 to 18 months of operation.

Setting: 

The setting included four ACCEPT centers.

Sample: 

Sixty three people participated in the study. Demographic data was presented on 74 who started the study but later 11 dropped out. Those data indicate about half or 53% were female. Mean age for men was 38 and women 36 years. Forty three percent of the men were single, and 41% of the women. A little over half of the men or 51% had a primary diagnosis of neurotic depression. The majority or 44% of the women had the same diagnosis.

Data Collection: 

An ACCEPT intake form provided a profile of the trainees. The Lancashire Quality of Life Profile was used to obtain information on perceived quality of life. A Goal Attainment Form documented the trainees top five goals or objectives. Participant views about ACCEPT quality of services was gained using an Client Evaluation Form. A Stakeholder Questionnaire was also used. T-Tests were used to examine pre and post training differences in the mean LSS scores.

Intervention: 

The intervention was Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services. It includes a combination of psychosocial rehabilitation and job training.

Control: 

There was no control or comparison conditions. The study used a pretest/posttest design.

Findings: 

Pre and post training assessment revealed improvements in the participants satisfaction with employment status, religion and purpose of life, social relationships and overall well being. Minor psychiatric problems also decreased after training. Participants reported positive views about ACCEPT services. At the close of the study around 50% of the participants were employed or either engaged in volunteer work or a work experience.

Conclusions: 

Mental health professionals play and important role in work oriented programs. Interagency collaboration is critical. These types of programs can contribute to therapeutic outcomes for individuals with mental health problems.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/09638230050009195
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Single group
Peer Reviewed: 
Yes

Analyzing vocational outcomes of individuals with psychiatric disabilities who received state vocational rehabilitation services: A data mining approach

Authors: 
Roush, S.
Year Published: 
2007
Publication: 
International Journal of Social Psychiatry
Volume: 
53
Number: 
4
Pages: 
357-368
Publisher: 
Sage
Background: 

Poor vocational rehabilitation outcomes are seen for those with psychiatric disabilities; 80% to 85% are unemployed nationally. The authors claim that a lack of research into vocational rehabilitation services and outcomes is the cause for the high unemployment rates.

Purpose: 

The purpose of the study is to examine factors that affect vocational outcomes in the vocational rehabilitation process for people with psychiatric disabilities who received state Vocational Rehabilitation (VR) services.

Setting: 

The Rehabilitation Services Administration FY 2001 Case Service Report (RSA-911)was analyzed using data mining. This study included individuals with psychiatric disabilities served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Participants in the study included only individuals who had a status code of 26 (working) or status code of 28 (not working).

Data Collection: 

The Exhaustive Chi-Square Automatic Interaction Detector (CHAID) data mining technique was used. The technique requires the use of categorical values; therefore, age and education (continuous variables) were recoded into categories. Decision trees "were used to generate rules for the classification of this dataset" (p. 360). SPSS AnswerTree 2.0 statistical software was used for the data analysis.

Intervention: 

The independent variables were: gender, age, race, severity of disability, education, benefits, rehabilitation services provided.

Control: 

The dependent variable included were the status codes 26 or 28.

Findings: 

Those who were receiving job placement and counseling services, did not receive any government benefits, attended special education in high school, graduated from high school or had college experience, and received comprehensive assessment and vocational training were the most likely to be employed. Those who did not receive job placement services but did receive counseling, restorative and transportation services, and government benefits were the most likely to remain unemployed.

Conclusions: 

An increase in the number of persons diagnosed with a psychiatric disability is expected as services are provided by public rehabilitation services rather than community-based services. Rehabilitation professionals should be made aware of the unique challenges and trained in the use of the Individual Placement and Support model.

URL: 
http://www.worksupport.com/kter/documents/pdf/AnalyzingVocationalOutcomes.pdf
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes

The Menu Approach to supported employment for individuals with severe and persistent mental illness: Outcomes in an Oregon community based program

Authors: 
Salyers, M. P., Becker, D. R., Drake, R. E.,Torrey, W. C., & Wyzik, P. F.
Year Published: 
2009
Publication: 
Work: A Journal of Prevention, Assessment and Rehabilitation
Volume: 
31
Number: 
1
Pages: 
45-51
Publisher: 
IOS Press
Background: 

The employment rate for individuals with severe mental illness is poor. This is despite the fact that they have expressed an interest in work. The supported employment model developed to serve people with developmental disabilities has been adapted to serve this group. One approach is the Individual Placement and Support model of supported employment. Another one is the Menu Approach. The Individual Placement and Support approach has been thoroughly investigated and has been deemed effective. The Menu Approach has not.

Purpose: 

The goal of this study was to evaluate outcomes of a Menu approach to assist individuals with Mental Illness with gaining and maintaining employment.

Setting: 

The setting was a variety of employment sites located in the Pacific Northwest where individuals with mental illness worked.

Sample: 

The sample was taken from individuals with severe mental illness who were served by the program from 2000 to 2006. This resulted in a total of 140 people that met the study criteria.

Data Collection: 

Abacus program records were reviewed to identify individuals served during the established time frame. Then rates of successful employment and trends were identified. To ensure confidentiality each participant was randomly assigned a number during data analysis. General demographics was collect from records. Records were reviewed by the primary investigator and a graduate student. Other data collected from the file review related to employment outcomes and whether or not ongoing support was accessed. Reliability was checked using cross referencing and strengthened by having the student randomly code one fourth of the data which was compared to the primary investigators coding. Coded data was entered into the Statistical Package for the Social Sciences 15.0. The package calculated statistics that were used to develop and describe program employment outcomes.

Intervention: 

The intervention was a menu-based Supported employment approach provided by the Abacus Program, that works cooperatively with the State's Office of Vocational Rehabilitation Services.

Control: 

There was no control condition. There was a pre/post comparison only.

Findings: 

Among the 140 participants there were 83 reports of successful employment. The majority of those who went to work or 82% received ongoing support services. The mean number of weeks to obtain employment was 13.9. Job search services varied from behind the scenes help to job development. Most positions were entry level. The average number of months employed was nine. The most frequently reported reason for not going to work was client choice (40.4%); followed by physical medical issues (17.5%).

Conclusions: 

The Menu Approach lead to positive employment outcomes. Additional research is needed to determine if these outcomes were exclusive to the Abacus program or can be replicated.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19923675
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Other
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes

A ten-year follow-up of a supported employment program

Authors: 
Schene, A., Koeter, M., Kikkert, M., Swinkels, J., & Crone, P.
Year Published: 
2004
Publication: 
Psychiatric Services
Volume: 
55
Number: 
3
Pages: 
302-308
Publisher: 
American Psychiatric Association
Background: 

Supported employment is considered to be an evidence-based practice for people with psychiatric disabilities. The rate of competitive employment within supported employment programs is three times higher than those in other programs.

Purpose: 

The purpose of the study was to review the outcomes of supported employment 10 years after an initial demonstration project.

Setting: 

The setting included two rural rehabilitative day centers in New Hampshire that became Individual Placement and Support model centers.

Sample: 

The sample included 20 participants in the 1990 Lebanon group and 24 participants in the 1992 Claremont group; a total of 36 were in the follow-up study 10 years later.

Data Collection: 

A semi-structured interview was developed, which included open-ended questions. Open-ended questions were transferred into structured ratings

Intervention: 

The intervention was the Individual Placement and Support (IPS) model of supported employment.

Control: 

There was no control or comparison condition.

Findings: 

Seventy percent of the participants had had some type of competitive employment. Eighty eight percent (N=17) were employed at the time of the study.

Conclusions: 

The study concluded that supported employment is a viable option for people with psychiatric disorders. Further study is needed to determine is self-sufficiency is a realistic goal given that many people don't consider self-sufficiency as a goal to reach when obtaining competitive employment.

URL: 
http://www.worksupport.com/kter/documents/pdf/A10yearfollowupofSupportedEmployment.pdf
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Other
NIDILRR Funded: 
Not Reported
Research Design: 
Qualitative
Observational
Peer Reviewed: 
Yes

Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation

Authors: 
Schneider, J., Slade, J., Secker, J., Rinaldi, M., Boyce, M., Johnson, R., ... & Grove, B.
Year Published: 
2007
Publication: 
Psychological Medicine
Volume: 
37
Number: 
3
Pages: 
351-362
Publisher: 
Cambridge Press
Background: 

Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome.

Purpose: 

The purpose of the study was to determine the cost-effectiveness of the addition of OT to treatment as usual (TAU).

Setting: 

Study was conducted as part of the Programme for Mood Disorders of the Department of Psychiatry on the Academic Medical Centre in Amsterdam.

Sample: 

The study sample included 62 adults. The inclusion criteria were: age above 18 years, major depressive disorder, single episode or recurrent, without psychotic features, no history of psychos, manic, hypo-manic or cyclothymic features, no history of alcohol abuse or dependence, and additional criteria.

Data Collection: 

Treatment effect of OT was tested using the t test for continuous measures and the chi-squared test for categorical variables. For longitudinal analysis, the generalized estimating equations method for dichotomous outcomes and a generalized linear model approach for continuous outcomes was used.

Intervention: 

Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (outpatient psychiatric treatment) or TAU plus OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months.

Control: 

Treatment as usual was the standard outpatient treatment for depression. This consisted of clinical management and antidepressants, if indicated and accepted by patients, according to standard treatment algorithm.

Findings: 

The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75.5% probability of being more cost-effective than TAU alone.

Conclusions: 

Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness

URL: 
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22007000440
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Other
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
Peer Reviewed: 
Yes

SESAMI* study of employment support for people with severe mental health problems: 12-month outcomes

Authors: 
Schoenbaum, M., Unützer, J., McCaffrey, D., Duan N., Sherbourne, C., & Wells, K.
Year Published: 
2009
Publication: 
Health & Social Care in the Community
Volume: 
17
Number: 
2
Pages: 
151-158
Publisher: 
Blackwell Publishing Ltd.
Background: 

Individuals with severe mental illness are underrepresented in the workforce in the United Kingdom. A welfare to work policy was implemented. Guidelines recommend using evidenced based practices, the Individual Placement and Support model, to help people with mental health issues with gaining and maintaining work. It is important to understand what is currently going on to improve existing practices.

Purpose: 

This study was undertaken to learn about factors associated with successful employment and the impact of work on individuals with mental illness.

Setting: 

Six British agencies that specialized in providing services to individuals with mental illness.

Sample: 

One hundred and eighty two individuals with mental health problems participated in the study. Follow up interviews were conducted with 85% of this sample. The majority or 84% were White British or European. Ages ranged from 22 to 67 years with an mean of 42 years. About a third, or 32% reported depression, 25% anxiety, 25% schizophrenia, hallucinations or hearing voices, 14% bipolar and 4% other in response to being asked to describe his or her condition. Fifty five percent of the participants were unemployed, 29% were unemployed, 9% were in work placement and 5% in sheltered work.

Data Collection: 

The study questionnaire included the following measures. The Empowerment Among Users of Mental Health Services Scale; the Herth Hope Index, Perceived obstacles to work; and behaviours indicating nearness to the labour market. This questionnaire was usually completed during an approximately one hour face to face interview. The first was completed at baseline and another at follow up (12 months later).Statistically significant differences were tested. Analysis of variance was also used. SPSS 15.0 was used to analyze all data.

Intervention: 

The intervention was supported employment in the United Kingdom.

Control: 

There was no comparison or control group.

Findings: 

Eighty two percent of those working at baseline were employed one year later. Twenty five percent of those individuals who were unemployed were assisted with gaining work during this time. Financial satisfaction and self esteem increased among those who went to work. In addition, there was a tendency to work part-time.

Conclusions: 

Those who worked reported multiple benefits. The evidence from this study should inform service planning and the Individual Placement and Support model should be implemented in England.

URL: 
https://www.researchonline.org.uk/sds/search/taxonomy.do%3Bjsessionid=948B7FBF03C6A71157E4FD25729AE479?action=document&ref=A20206&pager.offset=140&taxonomy=GIN
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Asian
Other
Outcomes: 
Other
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes

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: 
Emotional disturbance
Populations: 
Hispanic or Latino
Black / African American
White / Caucasian
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
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: 
Emotional disturbance
Populations: 
Male & Female
Other
Outcomes: 
Increase in tenure
Wages
Other
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
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: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Employment acquisition
Increase in tenure
NIDILRR Funded: 
No
Research Design: 
Single group
Case reports
Qualitative
Observational
Peer Reviewed: 
Yes

Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

Authors: 
Malec, J. F.
Year Published: 
2010
Publication: 
Social psychiatry and psychiatric epidemiology
Volume: 
45
Number: 
1
Pages: 
1-8
Publisher: 
Springer
Background: 

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.

Purpose: 

The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.

Setting: 

The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.

Sample: 

The study sample consisted of consecutive new referrals (age 17–35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was as the presence of psychotic symptoms (clinically delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken antipsychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly ).

Data Collection: 

Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice

Intervention: 

The intervention represents a locally derived modification of the supported employment model. It is consistent with the model in that the service is embedded within the mental health team. Choices are based on individual preference, competitive employment is a major aim, and follow on support indefinite. Where it differs is in the greater emphasis on education (necessary in view of the typical developmental age of onset of first episode psychoses) and use of a broader approach, beyond just rapid job placement, to address specific areas of vocational functioning in the early stages of recovery (for example rebuilding confidence and structuring time).

Control: 

There was no control or comparison condition.

Findings: 

The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not.

Conclusions: 

This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

URL: 
http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1
Disabilities: 
Emotional disturbance
Populations: 
Black / African American
White / Caucasian
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes