Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong

Authors: 
Foley, K., Pallas, D., Forcehimes, A. A., Houck, J. M., Bogenschutz, M. P., Keyser-Marcus, L., & Svikis, D.
Year Published: 
2005
Publication: 
Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong
Volume: 
25
Number: 
4
Pages: 
359-368
Publisher: 
IOS Press
Background: 

Chronic illness has a major impact on the psychological, familial, social, and vocational aspects of a person's life. It often leads to pain, intense emotional upheaval, financial constraints, illness concealment, and a change in personality. In a competitive labor market such as that of Hong Kong, the chance for persons with chronic illness to gain new employment is not high.

Purpose: 

This study aimed to analyze the ability of the Patient Retraining and Vocational Resettlement (PRAVR) program to enhance the vocational outcomes of individuals with chronic illness, and to study the socio-demographic factors associated with successful vocational outcome.

Setting: 

The setting was Patient Retraining and Vocational Resettlement program in Hong Kong.

Sample: 

The study sample included 548 individuals with various types of chronic illness who enrolled in the Patient Retraining and Vocational Resettlement program between 1995 and 2003.

Data Collection: 

Socio-demographic data and their employment outcome after a six-month job skills retraining and job settlement service were collected for analysis.

Intervention: 

The intervention was supported employment services.

Control: 

There was no control or comparison condition.

Findings: 

The Patient Retraining and Vocational Resettlement program is able to enhance the vocational outcomes of people with chronic illness in Hong Kong. The factors which were found to relate to successful employment were unique to the local situation.

Conclusions: 

Further studies should explore these factors.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16340113
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Use of vocational rehabilitative services among adults with autism

Authors: 
Leahy, M. J., Chan, F., Lui, J., Rosenthal, D., Tansey, T., Wehman, P., Kundu, M., Dutta, A., Anderson, C. A., Valle, R.D., Sherman, S., & Menz, F. E.
Year Published: 
2009
Publication: 
Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.
Volume: 
39
Number: 
3
Pages: 
487-494
Publisher: 
Springer
Background: 

Individuals with autism can have complex and significant impairments that hinder their ability to gain and maintain employment. The United States Vocational Rehabilitation (VR) System is set up to maximize the employment outcomes of individuals with disabilities by providing a variety of services. There is limited research on how existing services may assist individuals with autism with employment. Among those studies most do not report favorable results. More information is needed on how to improve access to services and enhance employment outcomes for individuals with autism.

Purpose: 

The purpose of the study was to examine VR services for individuals with autism. More specific, the researchers examined if adults with ASD were more likely to be denied services as compared to adults with other impairments; costs of VR services for adults with autism as compared to adults with other impairments and whether individuals with autism achieved the goal of competitive employment at the time of case closure.

Setting: 

This study included individuals with autism served by multiple vocational rehabilitation agencies in various settings.

Sample: 

The dataset included 382,221 adults who were served by state vocational rehabilitation and had their cases closed in 2005 for reasons other than death or because they were determined not to need vocational rehabilitation services. There were 37 causes of disability in the dataset. The authors sorted them into the following categories: autism spectrum disorder (n=1,707); mental retardation (n=30,728); specific learning disabilities (n=33,155)and all others were combined into other impairments (n=316,471).

Data Collection: 

Data on individuals receiving vocational rehabilitation services were obtained from the US Department of Education‚ Office of Special Education and Rehabilitative Services. This included demographic variables, impairment cause, types and cost of services paid for by the Rehabilitation Services Administration, reasons for closure, and competitive employment status. There were three dependent variables. The first indicating whether the case was closed because the rehabilitation service provider believed that the individual‚ disability was too significant to benefit from services. The second was the total dollar amount the state VR agency spent on services. The third was whether individuals
achieved competitive employment by the time of case closure. Bivariate associations between impairment cause and all other variables were estimated using means, medians and ANOVA for expenditure data, and frequencies and chi square tests for all other variables.

Intervention: 

The intervention was various types of services provided by states' vocational rehabilitation agencies that led to competitive employment. This included services like: assessment and diagnosis, counseling, job search assistance, assistive technology,
and on-the-job training.

Control: 

There was no control or comparison condition.

Findings: 

The results revealed the following. First, relative to other individuals served by the vocational rehabilitation system, individuals with ASD were more likely to be denied services because it was believed that their disability was too severe for them to benefit from services. Second, among those who received services, people with ASD received a more expensive set of services than those with other impairments, although their service costs did not differ from individuals with mental retardation. And lastly, competitive employment rates among people with ASD did not differ from those with Specific Learning Disabilities or Mental Retardation, and were much higher than those of people with other impairments. Post hoc analyses seems to reveal that their employment is associated with on the job supports.

Conclusions: 

Many individuals with autism can work. Individuals with autism and their families should seek out supports. Vocational rehabilitation should emphasize employment. Policy makers should examine ways to ensure individuals with autism have access to supports needed to make work a reality.

URL: 
http://link.springer.com/article/10.1007%2Fs10803-008-0649-4#/page-1
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Generalisability of the individual placement and support model of supported employment: results of a Canadian randomized controlled trial

Authors: 
Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.
Year Published: 
2006
Publication: 
British Journal of Psychiatry
Volume: 
189
Number: 
1
Pages: 
65-73
Publisher: 
The Royal College of Psychiatrists
Background: 

Studies conducted in the United States have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

Purpose: 

The purpose of this study was to determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

Setting: 

The study was carried out at a teaching psychiatric hospital in Montreal, Canada. The hospital provides psychiatric treatment and rehabilitation services to people who live within a geographical sector in the south-west of Montreal. In addition to one central facility, which provides in-patient as well as various outpatient services, the hospital operates seven satellite out-patient clinics and a vocational rehabilitation center located about 1 mile from the main facility.

Sample: 

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).
To be included in the study, individuals had to:
1. Be between 18 and 64 years of age;
2. Have a diagnosis of schizophrenia-spectrum disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychosis not otherwise specified), bipolar disorder, or major depression;
3. If their principal diagnosis was one of major depression, be classified as disabled due to mental illness by the provincial welfare system;
4. Express interest in competitive employment; and
5. Be unemployed at the time of signing the consent form.

Data Collection: 

Baseline comparisons

In order to assess baseline equivalence of the groups, proportions of categorical variables at baseline were compared according to initial group assignment using 2-tests. Values of continuous measures were compared using either the t-test or, for non-normally distributed variables, the (non-parametric) Mann-Whitney U-test.

Vocational outcomes

Intention-to-treat analyses were conducted first, including all individuals and time periods for which we had data. Groups were compared on measures pertaining to any paid work (competitive or not) and competitive work only.

Intervention: 

Individual Placement and Support (IPS) 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: 

Clients assigned to the control group were invited to an interview at the hospital's vocational rehabilitation centre. There they were given an opportunity to sign up for one of the many vocational services normally available. These included sheltered workshops, creative workshops, a client-run boutique and horticultural programmes. Job-finding-skills training, as well as psychosocial interventions administered through two day-treatment centres, were also available. None of these programmes had competitive employment as their immediate goal.

In addition, clients could be offered a social integration measure, that is a Quebec government programme that offers clients part-time work in competitive settings, in exchange for a Can $120 top-up to their monthly welfare cheque and a free public transport pass. Finally, clients could also be referred to a non-profit community agency that sought to place clients either in competitive jobs or in government-subsidized adapted businesses, in which wages equal or exceed the legal minimum wage but where the majority of jobs are reserved for people who have disabilities. This agency was not integrated with clinical services, nor did it provide ongoing support to clients, two hallmarks of supported employment.

Findings: 

Over the 12 months of follow up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P < 0.001). They averaged 126 h of competitive work, v. 72 in the control group (P < 0.001).

Conclusions Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Conclusions: 

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalized to settings in other countries.

URL: 
http://www.pandora.com/station/play/650824915812121606
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis

Authors: 
Latimer, E. A., Lecomte, T., Becker, D. R., Drake, R, E., Duclos, I., Piat, M., Lahaie, N., St-Pierre, M. S., Therrien, C., & Xie, H.
Year Published: 
2004
Publication: 
Arthritis Care & Research
Volume: 
51
Number: 
5
Pages: 
843-852
Publisher: 
American College of Rheumatology
Background: 

Work disability is a common consequence of rheumatoid arthritis (RA). This is particularly significant because RA affects individuals during their prime working years and had major financial implications for the individual and society at large.

Purpose: 

To define work-related factors associated with increased risk of work disability (WD) in people with rheumatoid arthritis (RA).

Setting: 

The setting was the Arthritis Society, British Columbia and Yukon division.

Sample: 

A total of 581 individuals answered the questionnaire.

Data Collection: 

Questionnaires were mailed to all RA patients who used a province-wide arthritis treatment program between 1991 and 1998 (n = 1,824). The association between risk factors and WD ( as no paid work due to RA for at least 6 months) was assessed using multiple logistic regression analysis, controlling for significant sociodemographic and disease-related variables.

Intervention: 

The intervention was an arthritis treatment program.

Control: 

There was no control or comparison condition.

Findings: 

Work survival analysis revealed a steady rate of WD starting early, with 7.5%, 18%, and 27% work disabled at 1, 5, and 10 years, respectively. Significant determinants in multiple logistic regression were physical function (Health Assessment Questionnaire), pain (visual analog scale), and 6 work-related factors: self employment, workstation modification, work importance, family support toward employment, commuting difficulty, and comfort telling coworkers about RA.

Conclusions: 

Work disability occurs early in RA. Novel work-related factors were identified, which are potentially modifiable, to help RA patients stay employed.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15478162
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Approaches to improving employment outcomes for people with serious mental illness. Work accommodation and retention in mental health

Authors: 
Kukla, M., & Bond, G. R.
Year Published: 
2011
Publication: 
Journal of Mental Health
Volume: 
20
Number: 
4
Pages: 
368-380
Publisher: 
ISSN
Background: 

Certain models of vocational service have been shown to be effective in establishing persons with mental health problems back into employment. The individual placement and support (IPS) model has the widest evidence base in studies conducted in North America. Evidence from North America has led to an increasing interest in the use of IPS in the UK. Employment is dependent on economic and social factors which are often country specific.

Purpose: 

This review examines the evidence of the effectiveness of the IPS model of supported employment within the United Kingdom. The study conducted a systematic review of the literature to answer the principal research question: What is the evidence of effectiveness of the IPS model of supported employment within the United Kingdom?

Setting: 

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

Sample: 

The majority of the population was patients recruited from community mental health teams, including an early intervention in psychosis service. Psychotic illness was the largest diagnostic group in the four studies that reported diagnostic categories.

Data Collection: 

Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV):
1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter.
2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter.
3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.

Intervention: 

Individual Placement and Support (IPS) 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: 

The evidence base for the effectiveness of IPS within a UK context is small. There is promising evidence, including from a high quality RCT, that IPS is more effective than conventional training and place vocational rehabilitation in placing people into competitive employment. However, the quality of the evidence was generally weak. Several studies lacked adequate controls, meaning potential confounding factors were not controlled for.

Conclusions: 

This study has highlighted the need for better quality evidence on the effectiveness and application of IPS in the UK, preferably using an RCT approach. Where controlled trials are not feasible, good quality naturalistic evaluations could improve the evidence base. Evaluation should focus on the nature, quality and occupational level of the employment gained and the length of time employment is sustained. Examining both service (e.g. time from entry into service to employment) and patient factors (e.g. previous vocational history, motivational factors) would add to evidence. Integration of the IPS intervention with mental health teams, positive attitudes to competitive employment among staff and motivational assessment of clients may improve placement rates.

URL: 
http://link.springer.com/chapter/10.1007/978-1-4419-0428-7_11#page-1
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational reentry following TBI: An enablement model

Authors: 
Kramer, S. E.
Year Published: 
2000
Publication: 
The Journal of Head Trauma Rehabilitation
Volume: 
15
Number: 
4
Pages: 
989-999
Publisher: 
Lippincott Williams & Wilkins, Inc.
Background: 

Environmental factors are at the heart of many performance problems after traumatic brain injury (TBI). This vulnerability negatively affects the ability of the patient to generalize treatment gains made in an artificial clinic environment to more naturalistic settings like home and work. It also impacts the rehabilitation professional's ability to predict the performance of a patient in these and other real world settings. Rehabilitation efforts that make patient environmental interactions part of the treatment plan will increase generalization and predictability. Rehabilitation efforts should include data-based definitions of the environment(s) within which each individual can best function. Also important is a focus on the tasks that he or she can perform within those environment(s). When a discharge goal is to return to work, rehabilitation efforts must include: identifying job settings where enabling environments can be established and providing ongoing support to the individual in the job situation should the environment change. More research is needed on the use and benefits of an environmentally focused treatment model.

Purpose: 

The purpose of this paper was twofold. First it described a treatment program for individuals with brain injury that focuses heavily on patient-environment interactions, both during treatment and after discharge and provide illustrative case examples.

Setting: 

The interventions took place in the clinical setting and the individuals' places of employment.

Sample: 

The study examined the experiences of three individuals with TBI who received varying levels of support to return to work. More specific, they demonstrate how treatment environments were initially configured and then modified during treatment as the patients returned to work. The case studies were selected from an overall sample of 57 individuals with TBI. All three patients had extremely severe neurocognitive dysfunction.

Data Collection: 

No specific data was collected or analyzed. Three case studies illustrated three interventions to help individuals with TBI with returning to work.

Intervention: 

The three interventions were part of an environmentally focused treatment model. Preliminary steps for each involved a) contacting an employer about a patients return to work for those employed at the time of injury or if the person was not employed or does not want to return to work a job developer gets involved to develop work options in an environment where the person is most likely to optimally perform and b) a rehab staff member conducts a job site visit in order to gain an understanding of environmental factors that may impact success on the job.

The first intervention teaches a patient to structure environments. Clinic staff make an initial job site visit and may have some ongoing contact with the employer, but the patient has primary responsibility for structuring the work environment. The second intervention is reserved for a patient who is incapable of assuming primary responsibility for structuring his own environments. Therefore, the rehabilitation staff play a major role in developing an enabling environment. This makes vocational placement easier. The third intervention involves creating a highly structured work environment for a extremely compromised patient, by educating the family throughout the rehabilitation process. The family then supplies the ongoing structure and limits distractions, as necessary, to maximize the person's performance.

Control: 

No comparison condition.

Findings: 

It is clear that the successful vocational re-entry depicted in these cases required close attention to each patient's specific strengths and weaknesses as they related to specific environmental factors, especially the levels and types of structure and distraction that were inherent in the environment. It seems that specialized, individualized treatment that focuses on the patients' strengths and weaknesses and on environmental factors, like the degree of structure and distractions, can enable return to work for individuals with severe TBI.

Conclusions: 

Environmental factors impact the ability of individuals with TBI to return to work. Individualized treatment that focuses on how structure and/or distractions impact work performance can be used to help individuals with TBI return to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10876171
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

An effective community-based mentoring program for return to work and school after brain and spinal cord injury

Authors: 
Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E.
Year Published: 
2012
Publication: 
NeuroRehabilitation
Volume: 
31
Number: 
1
Pages: 
63-73
Publisher: 
IOS Press
Background: 

Individuals with traumatic brain injury (TBI), spinal cord injury (SCI), and other neurological disorders often have severe disabilities impacting their ability to return to previous activities and return to work is limited. There is an ongoing need for education and vocational rehabilitation systems to work together to improve outcomes for youth and young adults with disabilities.

Purpose: 

The purpose of this article was to present information on a community-based mentoring program for young adults, ages 16 - 26 years with a recently acquired TBI, SCI, and other neurological disorders. The two objectives of this study were to 1) to demonstrate continuing increased in standardized measures of community integration from the time of enrollment in the program to the time of exit, and 2) improve the percentage of youth and adults who successfully access post-secondary education or employment opportunities.

Setting: 

The setting was various community sites in California.

Sample: 

The study sample included 131 individuals with TBI, SCI, or other neurologic disabilities recruited between 2005 and 2010. The majority were individuals with TBI or SCI with one individuals dually diagnosed with TBI and SCI (0.8%) and 8.4% with other disabilities to include other neurological disabilities. The majority were male (67.9%). The mean age was 20.3 years. Participants were primarily Hispanic (42%) or Caucasian (36.3%) with the remaining Asians (10.7%) or African American (4.6%). In addition, there were 121 trained "mentors" who were a minimum of two years post injury and had "a high level of acceptance and successful integration into the community". This included working or post-secondary education. Most were working (57%) while 30% were attending school, and 13% were retired.

Data Collection: 

Assessment was conducted a minimum number of four times: at enrollment, three months after entry, and every three months thereafter until attempted entry to post-secondary education or employment. In addition, each mentor and mentee completed a questionnaire which documented satisfaction with the relationship. Finally, the program used standardized assessments to include the Disability Rating Scale to include Employability and Level of Functioning, the Participation Index of the Mayo-Portland Adaptability Inventory, version 4, the Supervision Rating Scale, the Craig Handicap Assessment and Reporting Technique Short Form, and the Diener Satisfaction with Life Scale. A successful transition was as the individual remained in the post-secondary education or employment environment.

Data were collected by mentors and project staff. Formal assessments were collected by trained research assistants. Mentors submitted meeting logs documenting when, where, and topics discussed. Data were stored in an Access database and descriptive and inferential analyses were conducted using SPSS. Pre and post test program scores on standardized outcome measures were compared by paired T-tests.

Intervention: 

A mentoring program was developed called the "Back on Track to Success Mentoring Program." The goal of the program was to improve the ability of youth/young adults with disabilities to navigate through the services and programs available to individuals with disabilities. In addition, the goal was to increase the rate of return to work and post-secondary education. Each of the program participants were matched with a "mentor" who had training on a specific curriculum and refresher sessions throughout the entire program. Mentor/mentee relationships were required to have a minimum of three contacts per month in-person, telephone, or electronic mail methods.

Control: 

No comparison condition.

Findings: 

A total of 89 mentees were successfully matched with community-based mentors and participated in the program through to completion. Of this number 77 completed the entire program. Of this number 42 (54.5%) were considered program successes and 35 (45.5%) were considered program failures. Of the 42, 69% returned to school and 13 became employed (31%). For program successes, significant CHART subscale increases were seen for Cognitive Independence and Mobility. For program "failures" no statistically significant changes were seen in CHART subscale scores. For program successes, there were also significant improvements seen in the M2PI, the DRS, and SRS. For failures there were improvements seen in DRS but these were not statistically significant.

Conclusions: 

Overall, findings suggest that mentoring can be beneficial toward achieving the goals of post-secondary education, employment and community independence for individuals with disabilities; specifically those with traumatic brain injury, spinal cord injury and other neurological disorders.

URL: 
http://content.iospress.com/articles/neurorehabilitation/nre00775
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The relationship of cognitive retraining to neurological patients' work and school status

Authors: 
Kolakowsky-Hayner, S. A., Wright, J., Shem, K., Medel, R., & Duong, T.
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
11
Pages: 
1097-1107
Publisher: 
Informa Healthcare
Background: 

The goals of cognitive retraining are to help patients: ameliorate difficulties in cognitive functioning, develop ways to compensate for those problems and improve their awareness and appreciation of how neurobehavioural strengths and difficulties impact and generalize to the home and community. Cognitive training has been viewed as a holistic
milieu-oriented approach for people with brain injuries. However, there is considerable scepticism about the benefits of this approach from both healthcare workers and insurance companies. High quality research is needed to on how the effectiveness of cognitive retraining.

Purpose: 

The purpose of the study was to explore the relationship of cognitive retraining performance to discharge productivity status. The hypotheses were:
1)Work/school status at discharge will be related to Working Alliance ratings, Cognitive Retraining scores and CRBC ratings;
2) Better Working Alliance scores will be associated with better scores on the CRBC with regard to Use of Compensatory Strategies, Seeing the Big Picture and Independence in Scoring and Record Keeping

Setting: 

The study took place in a neurorehabilitation therapy department in a large healthcare center located in Arizona.

Sample: 

The study examined scores on Cognitive Retraining tasks and variables associated with those task and return to work or school outcomes for 101 patients who had participated in neurotherapies at a large medical center in Arizona within a seven year time span. This included patients who had participated in either or both the Work or School Re-entry programmes and by the time of discharge had completed 4 study Cognitive Retraining tasks. The majority of participants were male (63%). The mean age of participants was 35 years with an average of 14 years of education. Around 64% had sustained traumatic brain injury, 22% had cerebrovascular accident and the remaining 14% had other causes of brain injury. Around 59% of the sample had Glasgow Coma Scale data. The majority or 71% had severe brain injuries.

The majority or 86% of the participants had a primary goal of return to work and the remaining had the goal of return to school. Among those with the return to work goal the majority or 71% had been in both the Work Re-entry and Home Independence programmes. Of those who planned to return to school, the majority or 79% attended the School Re-entry and Home Independence programmes.

Data Collection: 

Cognitive retraining data was taken from participants' Cognitive Retraining charts. More specific, this included: initial, last, best and mean scores for each of the four study tasks. Data on process variables associated with the tasks came from the Cognitive Retraining Behaviour Checklist completed by the person's primary therapist. Scores on Working Alliance came from patient charts. Information on participant's employment and/or school status also came from the chart.

Intervention: 

The intervention included several types of combination of programmes designed to assist individuals with returning to work or school post brain injury and/or improve independent living.

Control: 

No comparison condition.

Findings: 

The majority or (82.2%) of the sample returned to paid work or school. Better performance on two cognitive retraining tasks related to information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications. Selected process variables related to the patients' behavioural approach to cognitive retraining tasks were associated with better work/school outcomes. Positive working alliance ratings related to their behavioural approach to cognitive retraining tasks.

Conclusions: 

The information provided should help clinicians fine-tune Cognitive Retraining interventions to help patients achieve their maximal level of functioning.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17952711
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Three year follow-up study of an integrated supported employment for individuals with severe mental illness.

Authors: 
Tsang, H. W., Chan, A., Wong, A., & Liberman, R. P.
Year Published: 
2010
Publication: 
Australian and New Zealand Journal of Psychiatry
Volume: 
44
Number: 
1
Pages: 
49-58
Publisher: 
PubMed
Background: 

Persons experiencing severe mental have traditionally experienced high rates of unemployment. The Individual Placement and Support model is an evidenced based practice effective in assisting persons with severe mental illness achieve employment outcomes at a rate higher than traditional approaches.

Purpose: 

The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) program, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS program on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years.

Setting: 

Non government organizations and day hospitals in Hong Kong in association with the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Sample: 

One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong.

Data Collection: 

Study participants were randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up.

Intervention: 

Individual Placement and Support (IPS) 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: 

The comparison condition was traditional vocational rehabilitation.

Findings: 

After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive.

Conclusions: 

The long-term effectiveness of the ISE program in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20073567
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness.

Authors: 
Twamley, E. W., Narvaez, J. M., Becker, D.R. Bartels, S. J., & Jeste, D. V.
Year Published: 
2009
Publication: 
Journal of behavior therapy and experimental psychiatry
Volume: 
40
Number: 
2
Pages: 
292-305
Publisher: 
Elsevier B.V.
Background: 

The traditional vocational rehabilitation (TVR) services adopt a step-wise approach which offers pre-vocational training at the beginning of the service. In Hong Kong and mainland China, participants usually undergo a prolonged period of preparation before seeking competitive employment. Rates for competitive employment are usually less than 20%. As TVR is the most common form of vocational rehabilitation in Hong Kong, it was important to local service development to benchmark innovative interventions against standard interventions. IPS is an evidence-based rehabilitation service that includes job development and placement, on-going employment supports, coordination of vocational services with multidisciplinary treatment teams, indefinite services and the opportunity for choice of jobs by participants. PS is less than optimal in clients' maintaining their jobs, with 50% of those employed experiencing job terminations by the six-month follow-up. Over a longer follow-up period, considerably fewer than half of the participants in IPS are working during any single month. In the current study, IPS was amplified by the addition of work-related, social skills training (WSST) together with ongoing supports in the community for aiding generalization of social skills in the workplace following the integrated supported employment (ISE) protocol.

Purpose: 

The purpose of this study was to examine the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment.

Setting: 

The setting included community mental health programs which offered a range of rehabilitation services.

Sample: 

The study sample was 163 participants from community mental health programs which offered a range of rehabilitation services. The recruitment was based on the following selection criteria: (1) suffering from SMI (operationally as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent major depression, or borderline personality disorder); (2) being unemployed; (3) willing and cognitively competent to give informed consent; (4) lacking obvious cognitive, learning and neurological impairments as determined by mental status exam; (5) completed primary education; and (6) expressing a desire to work.

Data Collection: 

Data collection involved the following: Employment Outcome Checklist (EOC) assessed their employment outcomes such as the number of job interviews attended, the number of jobs obtained, number of hours per week worked, and salary received from each of the jobs that were obtained . The 21-item Chinese Job Stress Coping Scale (CJSC) assessed the coping strategies of participants when faced with job stress, using a five-point response scale ranging from 1 (hardly ever do this) to 5 (almost always do this). The coping dimensions included help seeking, positive self-appraisal, work adjustment, and avoidance. The Chinese Job Termination Checklist (CJTC) is the Chinese version of the Job termination Scale.

Intervention: 

A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). The ISE participants joined the ISE program which integrated IPS and WSST. The eight principles of IPS also applied to this intervention. The 10-session WSST consisted of a structured program to teach participants job interview skills, basic conversation and social survival skills for effective communication with supervisors, co-workers and customers.

Control: 

Individual Placement and Support (IPS) 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.Traditional Vocational rehabilitation services that clients received included sheltered workshop and supported employment.

Findings: 

After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

Conclusions: 

The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

URL: 
http://www.sciencedirect.com/science/article/pii/S0005791608000852
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NIDILRR Funded: 
Peer Reviewed: 
Yes