Male | Knowledge Translation for Employment Research Center

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

Authors:

Pryce, J., Munir, F., & Haslam, C.

Year Published:

2009

Publication:

New Zealand Journal of Occupational Therapy

Volume:

Number:

Pages:

34-39

Publisher:

Zealand Association of Occupational Therapists Inc.

Background:

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

Purpose:

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

Setting:

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

Sample:

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

Data Collection:

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

Intervention:

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

Control:

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

Findings:

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

Conclusions:

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

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/

Disabilities:

Emotional disturbance

Populations:

Male

Native Hawaiian / other Pacific Islander

White / Caucasian

Outcomes:

Employment acquisition

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

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

Authors:

Porteous, N., & Waghorn, G

Year Published:

1999

Publication:

International Journal of Technology Assessment in Healthcare

Volume:

Number:

Pages:

749-755

Publisher:

Cambridge Journals

Background:

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

Purpose:

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

Sample:

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

Data Collection:

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

Intervention:

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

Control:

The comparison condition was standard care.

Findings:

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

Conclusions:

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

URL:

http://www.ncbi.nlm.nih.gov/pubmed/10645116

Populations:

Male

Outcomes:

Other

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Assistive technology and computer adaptations for individuals with spinal cord injury

Authors:

Assistive technology and computer adaptations for individuals with spinal cord injury

Year Published:

2004

Publication:

NeuroRehabilitation

Volume:

Number:

Pages:

141-146

Publisher:

IOS Press

Background:

Spinal cord injury (SCI) commonly occurs when individuals are forming their vocational goals, resulting in low post-injury employment rates and higher costs to society. Individuals with SCI who are employed have improved quality of life. Assistive technology, often available at modest cost, can help individuals with SCI to compensate for functional limitations, overcome barriers to employability, enhance technical capacities and computer utilization, and improve ability to compete for gainful employment.

Purpose:

Studies have shown that return to work for individuals after a spinal cord injury are low. Other studies have shown that individuals with SCI who are employed report a better quality of life. One barrier to returning to work is a decreased scope of work skills due to physical limitations from the SCI. The purpose of this study was to demonstrate the successful return to work of three individuals with SCI using assistive technology and computer adaptations.

Setting:

One individual received his evaluation in an acute rehabilitation center. One individual was evaluated at his workplace. The other setting for the third case study was not specified in the article.

Sample:

Three males with SCI ages 23, 27, and 41. All three had cervical level injuries to include C3, C6, and C7.

Data Collection:

Each individual received a computer accommodation evaluation that guided the selection of the assistive technology.

Intervention:

Computer accommodation evaluation by the State Vocational Rehabilitation Department by a rehabilitation engineer and occupational therapist. All individuals were provided with computer accommodations as recommended by the evaluations. Each of the three participants received individualized accommodations.

Control:

There was no control or comparison condition.

Findings:

Assistive technology can help individuals with SCI to compensate for functional limitations, overcome barriers to employability, enhance technical capacities and computer use, and improve ability to compete for employment.

Conclusions:

The authors conclude that an important goal for SCI rehabilitation includes maximizing vocational potential including the evaluation and application of computer and assistive technology.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15201473

Populations:

Black / African American

Outcomes:

NIDILRR Funded:

Research Design:

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:

Number:

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‚Äì19 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

Disabilities:

Autism Spectrum Disorder

Populations:

Male

Outcomes:

Other

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Psychological treatment of three urban fire fighters with post-traumatic stress disorder using eye movement desensitisation reprocessing (EMDR) therapy

Authors:

Klonoff, P. S., Talley, M. C., Dawson, L. K., Myles, S. M., Watt, L. M., Gehrels, J. & Henderson, S. W.

Year Published:

2004

Publication:

Complementary Therapies in Nursing and Midwifery

Volume:

Number:

Pages:

186-193

Publisher:

Elsevier

Background:

Due to the nature of their work, which can be extremely traumatic, firefighters are at increased risk of developing mental health problems. Providing adequate mental health services can often take time, leaving the individual without supports and remaining disabled and off work.

Purpose:

The purpose of this paper is to describe the partnership between the South Wales fire service and a NHS department of liaison psychiatry and the rapid psychological treatment provided to traumatized personnel.

Setting:

The setting was a mental health center, in South Wales, United Kingdom.

Sample:

This article describes three cases in which all suffered with PTSD and were treated with Eye Movement Desensitization Reprocessing therapy.

Data Collection:

The study looks at three case studies

Intervention:

The intervention was Eye Movement Desensitization Reprocessing therapy.

Control:

There was no control or comparison condition.

Findings:

All three individuals benefited from a short time in treatment and were able to return to work or work with less trauma.

Conclusions:

Eye Movement Desensitization Reprocessing therapy appears to be a potentially useful psychological treatment for PTSD.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15279860

Disabilities:

Emotional disturbance

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Occupational categories and return to work after traumatic brain injury: A multicenter study

Authors:

Wallace, C. J., & Tauber, R.

Year Published:

2006

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

1576-1582

Publisher:

Elsevier

Background:

A number of researchers have indicated that postinjury return to work rates are a function of pre-injury job classifications. However, these and other job category studies have conflicting findings, differing methodology and small sample sizes. This makes it difficult to determine if this is a significant and unique predictor that impacts return to work rates. Due to poor post injury employment rates for individuals with TBI knowing the relation between pre-injury occupational category and return to work could improve employment outcomes.

Purpose:

The purpose of the study was to find out if pre-employment occupation was a significant and unique predictor of return to work for individuals with TBI.

Setting:

The setting was 17 NIDILRR funded TBI Model Systems Projects (TBIMS) located across the United States.

Sample:

The sample size was 1,341 individuals with TBI who had data in the TBIMS national database including one year follow up data. The majority of the sample were males (77%) and white (69%). Most had sustained an injury that would be considered moderate to severe.

Data Collection:

Data was collected at TBIMS rehabilitation centers that include a wide array of services. Hospital records and admission and discharge FIM instrument used to evaluate level of independence were used to collect medical information. Annual telephone interviews were attempted to collect follow up information at month 10 and 14 post-injury. If this was not successful, a questionnaire via mail and/or an interview with significant other was completed.

Intervention:

The intervention included an array of return-to-work services.

Control:

There was no control or comparison condition.

Findings:

Individuals who held professional and managerial jobs were more likely to be working during the one year follow up. Approximately, 33% of those who had worked in manual labor jobs were working at follow up with a slightly improved rate among those in skilled labor positions.Severity of injury was not predictive. However, the following variables: preinjury job category, education level, hospital LOS and discharge FIM total score were predictors. Additional analysis, clearly supported that job category predicts return to work outcomes beyond using educational level obtained prior to injury alone.

Conclusions:

Preinjury occupational factors influence return to work post injury for individuals with TBI. Given that individuals, who were worked as manual laborers prior to injury had the poorest return to work rate, this group may have a greater need for vocational services. More research is needed to better understand return to work rates and evaluate possible strategies to improve employment outcomes.

URL:

http://www.msktc.org/publications/detail/1732

Disabilities:

Traumatic brain injury (TBI)

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Project SEARCH for youth with autism spectrum disorders: Increasing competitive employment on transition from high school

Authors:

Wehman, P., Schall, C.M., McDonough, J., Kregel, J., Brooke, V., Molinelli., A., Ham, W., Graham, C. W., Riehle, J. E. Collins, H. T., & Thiss, W.

Year Published:

2013

Publication:

Journal of Positive Behavior Interventions.

Volume:

Number:

Pages:

144-155

Publisher:

Hammill Institute on Disabilities and Sage

Background:

Transition from school to work for youth with ASD is an ongoing problem for the public education system. Teachers also struggle with their attempts to match the strengths of a particular student to a job. Project SEARCH is a transition program for youth with disabilities. In this model students rotate through full day internships in businesses to gain work and related skills that may lead to an employment offer for some.Others have a positive work experience to highlight as they apply for jobs in their communities.Project SEARCH helps facilitate the transition from school to work.

Purpose:

The purpose of this study was to determine how a Project SEARCH approach would work for youth with ASD.

Setting:

The student internships took place in a large hospital.

Sample:

Two case studies were presented for two young men with ASD. A 19 year with autism and a 20 year old with Asperger Syndrome as well as severe scoliosis.

Data Collection:

The following data demographics, internship characteristics, job coach interventions was collected for each young man.

Intervention:

The intervention was Project SEARCH model along with some specific ASD supports.

Control:

There was no control or comparison condition.

Findings:

One young man participated in internships in the hospitals' radiation, engineering and infection control departments. His performance improved over time and he was offered a job in the infection control department working 20 hours and week and earning $9.14 an hour.The other young man participated in internships in the Coronary Care Unit, Biomedical Durable Equipment, and Intensive Care Unit (ICU). His abilities also improved during the internships. After completing the internships he was offered a job working 20 hours a week in the ICU earning $9.14 per hour.

Conclusions:

A Project SEARCH approach appears to be an effective way to assist youth with ASD with transition from school to work. This study was part of a larger study researching the use of Project SEARCH model to serve youth with ASD. The results from this larger study should help shed light on this topic.

URL:

http://pbi.sagepub.com/content/early/2012/10/11/1098300712459760

Disabilities:

Autism Spectrum Disorder

Populations:

Male

Black / African American

White / Caucasian

Transition-age youth (14 - 24)

Outcomes:

Employment acquisition

Increase in hours worked

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Return to work for individuals with TBI and a history of substance abuse.

Authors:

Wehmeyer, M. L., Palmer, S. B., Smith, S. J., Davies, D., & Stock, S.

Year Published:

2000

Publication:

NeuroRehabilitation

Volume:

Number:

Pages:

71-77

Publisher:

IOS Press

Background:

Substance abuse can be a problem for any person. However, it is more prevalent among individuals with disabilities than society in general. Individuals with substance abuse problems often have trouble gaining and maintaining work. Among those disability groups demonstrating a prevalence of substance abuse are individuals who survive traumatic brain injury (TBI).When individuals have a dual diagnosis of substance abuse and disability like TBI the treatment of both conditions becomes more complex. This may increase the possibility of medical complications and heighten the the symptoms of the disability for the person. It can also decrease the effectiveness of interventions designed to assist a person with employment post TBI. Research that specifically examines strategies or models that enhance employment rates of persons with TBI and substance problems is scant. Supported Employment is one return to work strategy for individuals with severe TBI and substance abuse problems

Purpose:

The purpose of this paper is to describe how substance abuse can be addressed within the context of a vocational rehabilitation program that provides supported employment services to individuals with severe TBI and substance abuse problems.

Setting:

The setting was a place of employment in Virginia.

Sample:

A case study illustrate how a man with a long history of substance abuse and a TBI gained and maintained work using a supported employment approach.

Data Collection:

Information was collected from the employment specialist who worked with individual described in the case study through face to face interview. In addition, case file information including daily notes were reviewed.

Intervention:

The individualized model of supported employment. In this approach a vocational rehabilitation professional known as an employment specialist or job coach analyzes the jobseeker's personal vocational strengths and
support needs; meets with employer's to develop jobs; provides on the job support to help the new hire learn the job and offers ongoing follow up services and case management throughout the person's job tenure.

Control:

There was no control or comparison condition.

Findings:

The individual described in the case study remained employed for over one year at the time of publication. The employment specialist took on a variety of roles in response to his needs. Roles included: providing feedback and encouragement, on the job site new skills training including designing and implementing compensatory strategies, ongoing support and case management.Employment specialists will need training and ongoing education to effectively support individuals with TBI and substance abuse histories. Lack of transportation remains a barrier to work and impacts the ability to get to substance abuse treatment (ie. AA meetings). Repeated efforts may be needed to assist individuals with successfully returning to work. Furthermore, many programs do not serve individuals with active substance abuse, so these people do not get help.

Conclusions:

Substance abuse further complicates TBI and return to work. Supported employment providers need to provide a mix of services that are career oriented and unique to a person‚ specific needs and circumstances.Individualized support should include assisting a person with issues outside of work, particularly those that may negatively impact employment or substance abuse treatment.

URL:

https://www.ncbi.nlm.nih.gov/pubmed/11455083

Disabilities:

Traumatic brain injury (TBI)

Populations:

Male

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Case reports

Peer Reviewed:

Yes

Supported employment: Randomized controlled trial

Authors:

Ipsen, C., Seekins, T., & Arnold, N.

Year Published:

2010

Publication:

British Journal of Psychiatry

Volume:

196

Number:

Pages:

401-410

Publisher:

Royal College of Psychiatrists.

Background:

There is evidence from North American trials that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.

Purpose:

The purpose of the study was to investigate the effectiveness and cost-effectiveness of Individual Placement and Support in the United Kingdom.

Setting:

Individuals with severe mental illness in South London were randomized to IPS or local traditional vocational services.

Sample:

Participants were recruited from community mental health teams in two boroughs of South London. Inclusion criteria were that participants should be receiving outpatient or community psychiatric care from local mental health services, have severe mental illness (duration of illness over 2 years, global assessment of functioning (GAF)8 score of 60 or less, and a diagnosis of a psychotic or chronic affective disorder), aged 18‚Äì65, able to read and speak English to a high enough standard to give informed written consent, to have been unemployed for at least 3 months.

Data Collection:

All data were analyzed using SPSS for Windows (version 15.0). The primary and secondary hypotheses were tested on the whole group. For comparing groups, t-tests and ?2-tests were used to compare means and proportions respectively, unless the data were highly skewed, in which case non-parametric tests were used. Logistic and linear regression models were also fitted including potential confounding variables: (grouped) age, gender, ethnic group, educational level, symptomatology and diagnosis. All data were analyzed in groups as randomized, whether or not receiving an intervention (i.e. intention-to-treat). Data were compared for those followed up with those not followed up, overall and by each treatment arm.

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 control condition (treatment as usual) involved existing psychosocial rehabilitation and day care programmes available in the local area. Each service employed, on average, 7 vocational staff, had a median of 58 places available to clients (range 6‚Äì3000) and 79% of services received referrals from clinical teams. A range of courses were offered, most commonly pre-employment preparation (e.g. interview skills, curriculum vitae coaching and application form practice), computers/information technology and confidence building/motivation.

Findings:

Two hundred and nineteen participants were randomized, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95‚Äì1.93, P = 0.15), nor in secondary outcomes.

Conclusions:

There was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/20435968

Disabilities:

Emotional disturbance

Populations:

Male

Black / African American

White / Caucasian

Outcomes:

Employment acquisition

NIDILRR Funded:

Research Design:

Randomized Controlled Trials (RCTs)

Peer Reviewed:

Yes

When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD

Authors:

Hagner, D., Cloutier, H., Arakelian, C., & Brucker, D.

Year Published:

2003

Publication:

Cognitive and Behavioral Practice

Volume:

Number:

Pages:

333-346

Publisher:

Association for Advancement of Behavior

Background:

Accidents within the workplace affect a large number of individuals each year. The most frequently studied traumas have involved victims of combat,physical and sexual assault, natural disaster, and motor vehicle accidents. (p.333)

Purpose:

The purpose of this study is to examine the efficacy of adding an imagery-based, cognitive restructuring component to the treatment of two victims of work-related injuries suffering from PTSD who failed to improve from prolonged exposure alone.

Setting:

The study took place in individual treatment sessions provided by the senior author.

Sample:

This article reviews 2 case studies of individuals receiving Imagery Rescripting and Reprocessing Therapy (IRRT) in addition to Prolonged Exposure (PE).

Data Collection:

The BDI, IES, State-Trait Anxiety Scale, and the WMS-R Digit Span Subtest were administered at pre and post-treatment, and again at 1-month, 3-month, and 6 month follow-ups. SUDS ratings were recorded throughout each treatment session as well as at intake, post treatment, and each of the follow-ups.

Intervention:

The intervention was Imagery Rescripting and Reprocessing Therapy (IRRT) and Prolonged Exposure (PE).

Control:

There was no control or comparison condition.

Findings:

Imagery Rescripting and Reprocessing Therapy appeared to facilitate and foster a significant cognitive shift, which resulted in successful emotional processing and an immediate alleviation of PTSD symptoms. (p.343)

Conclusions:

Prolonged exposure is more likely to be an effective PTSD treatment when fear is the primary emotion and avoidance is the primary coping strategy. An imagery based cognitive-restructuring treatment (IRRT) is likely to be an effective PTSD treatment when non-fear emotions are primary.

URL:

http://www.sciencedirect.com/science/article/pii/S1077722903800512

Disabilities:

Emotional disturbance

Populations:

Outcomes:

NIDILRR Funded:

Research Design: