Randomized clinical trail of brief eclectic psychotherapy for police officers with post traumatic stress disorder

Authors: 
Gewurtz, R. E., Cott, C., Rush, B., & Kirsh, B.
Year Published: 
2000
Publication: 
Journal of Traumatic Stress
Volume: 
13
Number: 
2
Pages: 
333-347
Publisher: 
Wiley
Background: 

Post-traumatic stress disorder (PTSD) is quite common and often disabling. PTSD has serious long-term morbidity, and effective treatments are urgently needed.

Purpose: 

The purpose of this study was to assess the effectiveness of Brief Eclectic Psychotherapy (BEP) in a sample of police officers with PTSD.

Setting: 

The setting for the study was the Department of Psychiatry at the Academic Medical Center of the University of Amsterdam.

Sample: 

The study sample included 42 patients with PTSD. 22 were randomly assigned to the treatment group and 20 to the wait-list control group.

Data Collection: 

Psychometric assessments were conducted by trained research psychologists at four points in time: one week before the start of treatment, one month after the start, four months after the start and three months after termination.

Intervention: 

Individual psychotherapy, 60 minute sessions over 16 weeks. BEP course which included psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual.

Control: 

The control group was waitlisted and told they would receive treatment in 7 months. They were monitored by a non-assessor psychologist in the interim.

Findings: 

At post test and at follow-up BEP had produced significant improvement in PTSD, in work resumption and in comorbid other conditions.

Conclusions: 

Further research is needed to see if BEP will be effective for other traumatized populations and if the effects of treatment will be long term.

URL: 
http://link.springer.com/article/10.1023%2FA%3A1007793803627#page-1
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Preliminary assessment of a prototype advanced mobility device in the work environment of veterans with spinal cord injury

Authors: 
Coviello, D. M., Zanis, D. A., & Lynch, K.
Year Published: 
2004
Publication: 
NeuroRehabilitation
Volume: 
19
Number: 
2
Pages: 
161-170
Publisher: 
IOS Press
Background: 

Many environments are not accessible to individuals that use wheelchairs for ambulation.

Purpose: 

The purpose of this study was to collect data on the potential for the Independence 3000 IBOT Transporter to improve employment satisfaction of veterans who use wheelchairs to work.

Setting: 

Various offices made up the setting.

Sample: 

Subjects were recruited from the Washington Office of the Paralyzed Veterans of America. Four male veterans with traumatic spinal cord injury were selected to participate in the study.

Data Collection: 

Observations were made by trained clinicians and participants responded to a survey.

Intervention: 

The intervention was the use of the IBOT in the work setting to hold eye-level discussions with colleagues, climb stairs, ascend steep ramps, and negotiate curbs.

Control: 

There was no control or comparison condition.

Findings: 

Half of the users felt that the IBOT would help them at work and all users felt it should be made available to veterans who use wheelchairs.

Conclusions: 

A larger study should be conducted to determine if the IBOT affects work performance and the ability to return to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15201475
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Factors affecting employment following spinal cord injury: A qualitative study

Authors: 
Charbonneau, A., Bruning, W., Titus-Howard, T., Ellerbeck, E., Whittle, J., Hall, S., Campbell, J., Lewis, S., & Munro, S.
Year Published: 
2001
Publication: 
Rehabilitation Psychology
Volume: 
46
Number: 
4
Pages: 
400-416
Publisher: 
Educational Publishing Foundation
Background: 

Results from the University of Michigan Model Spinal Cord Injury Care Systems database indicate that, even though 59% of persons with spinal cord injury (SCI) are employed before injury, the majority (75%) are not employed at follow-up after injury.

Purpose: 

The purpose of the study was to examine factors influencing successful return to work following spinal cord injury (SCI).

Setting: 

The setting included a variety of rehabilitation programs.

Sample: 

Six employed and 6 unemployed persons with SCI were matched based on education, race, age, gender, time since injury, and level of function.

Data Collection: 

This was a qualitative research design. Interviews were used to collect data.

Intervention: 

Interviews were conducted regarding work history, family life, impact of disability, role models, barriers to employment, and satisfaction with vocational rehabilitation services received.

Control: 

A comparison was made between employed persons to unemployed persons.

Findings: 

Psychological and environmental factors were found to be the strongest moderating variables affecting employment. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation.

Conclusions: 

Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI. A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI.

URL: 
http://psycnet.apa.org/psycinfo/2001-05160-003
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Tablet-based video modeling and prompting in the workplace for individuals with autism

Authors: 
Burke-Miller, J., Razzano, L. A., Grey, D. D., Blyler, C. R., & Cook, J. A.
Year Published: 
2013
Publication: 
Journal of Vocational Rehabilitation
Volume: 
38
Number: 
1
Pages: 
1-14
Publisher: 
IOS Press
Background: 

The number of adults with autism closed by Vocational Rehabilitation remains low. Employment rates for this group is the lowest for individuals with intellectual disabilities. For instance, the National Longitudinal Transition Study-2 reported that at two years post high school, only 28% of individuals with autism were employed (including competitive, supported, or sheltered employment).

Purpose: 

This article presents the findings from a preliminary study testing computer software across a range of employment settings for young adults with autism.

Setting: 

The study took place in a manufacturing and shipping warehouse in a Midwestern city.

Sample: 

The study sample included four young men ages 19 to 28, with autism spectrum disorder. One young man was Asian American and the other three were European American. All were unemployed; three lived with their parents; one lived in a community-based group home.

Data Collection: 

Participants were asked to complete a shipping task that involved an average of 73 steps. The percentage of task steps completed correctly was calculated by dividing the number of relevant completed steps by the sum of relevant completed and relevant not completed steps and multiplying by 100.

Intervention: 

A task analysis of the job was completed within the shipping department of the large manufacturing and shipping warehouse. The actual task was rental box shipping, which was reported as the most challenging of the shipping tasks due to the number of complex steps. A 13 minute, 10 second video was produced that depicted job responsibilities for the shipping tasks. This video had recorded voice overs to guide the user. The shipping task was then edited into 36 segments so that users could view portions of the task at a time. This video was loaded onto a software program called, VideoTote that was designed for an Android platform and made available to the study subjects on a Samsung Galaxy Tablet. The software was designed with universal design features.

Control: 

This study was a single subject design, the subjects were their own controls.

Findings: 

Results from this study suggest that the combination of video modeling during pre-employment training and on-the-job video prompting was helpful for individuals with autism when completing a complex shipping task.

Conclusions: 

The current study provides preliminary evidence that use of the tablet-based VideoTote software was an effective video modeling and prompting intervention for individuals with ASD in competitive employment. The results suggest that for some individuals with autism, job coaches likely will remain necessary.

URL: 
http://www.scholars.northwestern.edu/pubDetail.asp?t=pm&id=84873177849&
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Difficulties with multitasking on return to work after TBI: A critical case study

Authors: 
Boycott, N., Schneider, J., & McMurran, M.
Year Published: 
2010
Publication: 
Work
Volume: 
36
Number: 
2
Pages: 
207-216
Publisher: 
IOS Press
Background: 

Cognitive functioning is a strong predictor of success at work. Every job requires a specific set of cognitive skills. Multitasking requires a person to switch between several concurrent tasks, requiring the application of a variety of cognitive strategies to succeed without errors. After a traumatic brain injury (TBI) a person may have problems processing cognitive information. This is one of the leading reasons for loss of work among individuals with mild TBI. People who return to work after injury have reported increased cognitive demand with associated stress. Occupational rehabilitation providers have noted organizational and planning of complex or multiple work tasks difficult for high functioning individuals post TBI. The difficulty seemed to not only stem from cognitive problems but also the ability to apply cognitive strategies on the spot or situations with increased cognitive load. While neuropsychological evaluations may prove useful in helping determine potential cognitive capacity to return to work, there are some limitations to its usefulness. Some believe that sampling work behaviors through observation or client and employer interview may be a much better way to obtain accurate evaluation of cognitive work demands for individuals who are attempting to return to work after TBI.

Purpose: 

The study examines the use of the Perceive, Recall, Plan, Perform@WORK:Questionnaire/interview with category rating response format, by an employer to determine information processing strategy application difficulties.

Setting: 

The study took place at a telemarketing company.

Sample: 

A thirty year old man who sustained a TBI nine months earlier. His Glascow coma score was 9/15 and he experienced post traumatic amnesia for 21 days post injury.

Data Collection: 

The participant's employer was interviewed by an occupational therapist using the PRPP@work questionnaire/interview format. The participant's case manager was also present to provide background information, and to corroborate interview data from other assessment sources like client observation and interview.

Intervention: 

A case study method using the PRPP at work questionnaire/interview format.

Control: 

There was no control or comparison condition.

Findings: 

The employer did not perceive that the employee with TBI, was adequately applying cognitive information strategies in any of the four areas (perceive, recall, perform, plan) to meet job requirements. The findings indicated specific areas of information processing strategy strengths and weaknesses during work performance as categorized by PRPP@WORK Employer Questionnaire/Interview.

Conclusions: 

More research is needed. A measure of mental effort should be included in future studies assessing a person's ability to apply cognitive information processing strategies in multitasking work environments. While it is not possible to generalize the findings to the broader population of individuals with TBI the findings contribute to targeting future research in the area of improving multitasking work behaviors. The PRPP@WORK may have potential to offer useful information about the capacity of a person to engage in complex information processing for multitasking work performance post TBI.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20634614
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of vocational recovery among young people with first-episode psychosis: Findings from a randomized controlled trial

Authors: 
Baksheev, G. N., Allott, K., Jackson, H. J., McGorry, P. D., & Killackey, E.
Year Published: 
2012
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
35
Number: 
6
Pages: 
421-427
Publisher: 
American Psychological Association
Background: 

A substantial body of knowledge has demonstrated the benefits of the Individual Placement and Support (IPS) model among persons diagnosed with schizophrenia. The IPS model is a form of supported employment that is based on seven key principles, including a focus on securing competitive employment positions, attending to consumers' preferences, and integration with mental health treatment teams (Becker & Drake, 2003). Limited work, however, has examined whether vocational intervention in the early phase of psychosis might also lead to improved vocational outcomes. This is important to consider more fully as the first 5 years following psychosis onset is thought to be a critical period during which the peak levels of disability associated with psychosis emerge (Birchwood & Fiorillo, 2000).

Purpose: 

The purpose of this study was to examine demographic and clinical predictors of vocational recovery among young people with first-episode psychosis who participated in a randomized controlled trial (RCT) investigating the effectiveness of the supported employment model among this population.

Setting: 

The setting was a public mental health clinic in Melbourne Australia.

Sample: 

The study sample included 41 individuals aged 17-25 with mental illness.

Data Collection: 

The study compared Individual Placement and Support and treatment as usual with treatment as usual alone. A series of logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors on vocational recovery.

Intervention: 

The intervention was individual placement and support with regular treatment.

Control: 

The comparison was treatment as usual.

Findings: 

The main finding was that demographic and clinical factors did not significantly predict vocational recovery in the final multivariate analysis. Vocational recovery was solely predicted by participant group. That is, participants who were randomized to receive IPS were over 16 times more likely to secure a competitive employment position or participate in an educational activity during the follow-up period when compared with participants who were randomized to treatment as usual.

Conclusions: 

It is critical that vocational services are introduced as part of an evidence-based, multidisciplinary approach in routine clinical care at early psychosis services. Further replication of these findings is indicated with a larger sample, particularly with the addition of cognitive training interventions to further improve vocational outcomes for young people with first-episode psychosis.

URL: 
http://psycnet.apa.org/journals/prj/35/6/421/
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A collaborative follow-up study on transition service utilization and post-school outcomes

Authors: 
Baer, R. M., Flexer, R. M., Beck, S., Amstutz, N., Hoffman, L., Brothers, J., Stelzer, D., & Zechman, C.
Year Published: 
2003
Publication: 
Career Development for Exceptional Individuals
Volume: 
26
Number: 
1
Pages: 
7-25
Publisher: 
Sage
Background: 

In spite of nearly 20 years of research on postschool outcomes, local schools rarely use these data to drive their improvement efforts. A number of school-based activities have been shown to improve post-school employment, such as employment experiences and community-based learning; however, in many schools these activities have not been adopted.

Purpose: 

The purpose of this study was to examine characteristics related to transition service utilization and postsecondary outcomes, and identify program- and student-related variables that best predicted full-time employment.

Setting: 

Settings were multiple school systems in Ohio.

Sample: 

The study sample consisted of 140 randomly selected former special education students who had exited school in either 1997 or 2000. Dropouts were excluded because they could not be tracked. The sample was 59% male, with the majority having educational diagnosis of either learning disability (49%) or intellectual disability (28%); however, most disability diagnoses were in the sample.

Data Collection: 

Data for the study were collected through two main sources: School records and a postschool survey. The survey collected information regarding employment, postsecondary education, independence, and other areas of adult life. Bivariate correlations were run between student-related variables, program-related variables, and postschool outcomes. A logistic regression model was developed to predict work and postsecondary education outcomes from student characteristics and secondary participation.

Intervention: 

The interventions that were assessed included those that have been found in prior research to be associated with post school employment: Work experiences while in school, inclusion in the general academic program, and participation in vocational or work/study programs.

Control: 

The comparison condition in the study was not having received the interventions.

Findings: 

Related to employment, the logistic regression analysis showed that vocational education, work study participation, attending a rural school, and having a learning disability were the best predictors of full-time employment after school exit. Participation in work/study and vocational education each increased the likelihood of employment two-fold. However, other school-based vocational services, such as job shadowing, career fairs, in-school jobs, etc. were not predictive of post-school employment.

Conclusions: 

Work/study and vocational education may be significantly correlated with postschool outcomes because they screen out students with more severe disabilities, but also may have been due to work/ study and vocational programs being more comprehensive and better integrated into the general curriculum than other school-based services. The finding that other work-related school programs were not correlated with positive postschool outcomes may have been because they were uncoordinated with the student area of study.

URL: 
http://cde.sagepub.com/content/26/1/7.refs?patientinform-links=yes&legid=spcde;26/1/7
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Impact of a vocational counselor on employment-related outcomes among methadone patients

Authors: 
Appel, P. W., Smith, R., Schmeidler, J. B., & Randell, J.
Year Published: 
2000
Publication: 
Evaluation and Program Planning
Volume: 
23
Number: 
4
Pages: 
437-448
Publisher: 
Elsevier Science Ltd.
Background: 

There were ongoing concerns from New York state government about the steady decline in the rate of employment among methadone maintenance treatment (MMT) patients. One effort to try and change that trend was the VENUS project. The project was designed to identify obstacles to the provision and use of vocational–educational (v–e) services in MMT programs, and then, to evaluate selected remedial interventions. The VENUS project implemented the role of a vocational integrator‚ to enhance the use of v-e resources in routine MMT clinic operations and removed welfare disincentives for patients. The vocational integrator increased v-e participation by patients while the removal of the welfare disincentive to employment was associated with a small decline in patient v-e involvement. Another initiative was to improve patient v-e participation and employment by placing a full-time vocational rehabilitation counselor (VRC) in an MMT clinic. The objective was to provide on-site v-e services and improve v-e outcomes.

Purpose: 

The purpose of this paper was to summarize results of the intervention. The overall objective was to show how patient involvement in v-e can be enhanced by having a full time on site VRC integrated into daily operations.

Setting: 

The settings were two adjacent methadone treatment clinics affiliated with a hospital in Jamaica, Queens, New York

Sample: 

The sample size in the MM intervention clinic was 364 patients. Earlier admissions comprised 68% of Clinic 1 patients. Two-thirds of this group were male; 57% were Black; and median age was 33 years. Median time in treatment for the early admissions was 33 months. The sample size in the comparison clinic was 358 patients.

Data Collection: 

Aggregate data regarding v-e services offered to patients were obtained from reports submitted monthly state substance abuse office. This provided information on the volume and type of service activities provided throughout the study period. In addition the VRC provided individual service information on each person served. Data on individual service delivery and monthly patient v-e status provided project implementation and outcome data.

In Clinic 1; v-e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. Vocational-educational services increased significantly in Clinic 1 and declined in Clinic 2. Logistic regression of factors involved in staying or becoming vocationally involved (vocationally involved refers to working full- or part-time, or being enrolled in education/training) vs. staying or becoming vocationally uninvolved among patients in Clinics 1 and 2 were conducted. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v-e change and that VRC services contributed significantly to v-e change among patients not working at admission.

For the first and second hypotheses, a repeated measures of motivation to find employment and of eight job-seeking activities for the two intervention groups were compared using linear, mixed-effects models. The third and fourth hypotheses were analyzed using multinomial logistic regression analysis. For the third hypotheses a total motivation score was calculated by summing the motivation scores across the six time points of the 12-week intervention. For the fourth hypotheses, a total job seeking score was calculated by summing the number of job search activities over the 12-week intervention period.

Intervention: 

The intervention was in-house vocational rehabilitation counseling. Intervention and comparison groups were not matched or assigned. One setting delivered the intervention and the other provided standard treatment.

Control: 

Intervention and comparison groups were not matched or assigned.

Findings: 

Having a VRC in a MM clinic increased v-e activity and outcomes. Results show increases in average number of counseling sessions, assessments conducted, v-e plans developed, and in the number of patients involved in counseling and pre-employment groups/workshops each month. Referrals for education, training and employment increased.

Conclusions: 

The examiners concluded that having a VRC in a MM clinic has a positive impact by increasing patient v-e activity and employment outcomes. It is also cost effective. Greater emphasis should be placed on employment and training of MM patients to improve employment outcomes.

URL: 
https://www.researchgate.net/publication/4763062_Impact_of_a_vocational_counselor_on_employment-related_outcomes_among_methadone_patients
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Multidisciplinary rehabilitation for subacute low back pain: Graded activity or workplace intervention or both?: A randomized controlled trial

Authors: 
Anema, J. R., Steenstra, I. A., Bongers, P. M., de Vet, H. C. W., Knol, D. L., Loisel, P., & van Mechelen, W.
Year Published: 
2007
Publication: 
Spine
Volume: 
32
Number: 
3
Pages: 
291-298
Publisher: 
Lippincott Williams & Wilkins, Inc.
Background: 

Low back pain (LBP) is the most common and expensive musculoskeletal disorder in industrialized countries. LBP is frequently associated with persistent or recurrent disability and absence from work. High costs are mainly due to sick leave and disability. Effective interventions for LBP are needed to prevent long-term disability and promote early and safe return to work.

Purpose: 

To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).

Setting: 

The setting was Dutch occupational health services and physiotherapy centers.

Sample: 

Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100).

Data Collection: 

Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.

Intervention: 

The interventions were workplace assessment, work modifications, and case management.

Control: 

The comparison was usual care.

Findings: 

Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2–2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3–0.6; P < 0.001) and functional status. Combined intervention had no effect.

Conclusions: 

Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17268258
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation

Authors: 
Allaire, S. A., Li, W., & LaValley, M. P.
Year Published: 
2003
Publication: 
Arthritis & Rheumatism
Volume: 
48
Number: 
11
Pages: 
3212-3218
Publisher: 
American College of Rheumatology
Background: 

Health-related job loss is a major consequence of rheumatic diseases. Incidence rates can be expected to increase because the portion of the US workforce that is 55 years of age and older is increasing. Vocational rehabilitation is one approach to addressing health-related job loss. However, there is a shortage of studies evaluating the effectiveness of vocational rehabilitation with this population.

Purpose: 

The purpose of this study was to evaluate the efficacy of vocational rehabilitation provided as primary prevention, using randomized controlled trial of vocational rehabilitation provided to persons with rheumatic diseases who were at risk for job loss, but while they were still working.

Setting: 

The primary setting for the study consisted of multiple workplaces in eastern Massachusetts. Some study components were conducted in participants' homes, state vocational rehabilitation agency offices, and public meeting places (i.e., libraries, restaurants, etc.).

Sample: 

Participants were 242 employed persons with a rheumatic disease who were at risk for job loss and who resided in eastern Massachusetts. Recruitment was carried out through rheumatologists, who sent letters about the study and a screening form to their patients who had a diagnosis of rheumatoid diseases. Participants were randomized into the treatment and control groups. Participants were overwhelmingly white females.

Data Collection: 

Information about job characteristics included the title and three main duties of participants primary job and the physical demands and autonomy of these jobs. Job type was classified according to 12 main categories in the Dictionary of Occupational Titles. Information about demographic, disease, and job characteristics was collected at baseline. The main outcome was time to the first of either permanent job loss, consisting of permanent disability or retirement, or temporary job loss. The demographic and disease characteristics of the experimental and control groups were compared by unpaired t-test or chi-square test. Poisson regression was used to analyze the counts of permanent and temporary job losses.

Intervention: 

The intervention consisted of vocational rehabilitation services designed to promote job retention. The intervention consisted of 3 components: job accommodation, vocational counseling and guidance, and education and self-advocacy. Service duration was from 5 to 9 months.

Control: 

Control group participants were mailed copies of the same pamphlets and flyers about how to manage health-related employment problems and available resources that the experimental group participants received.

Findings: 

At 48 months of follow-up, only 25 permanent and temporary job losses combined occurred in the experimental group, compared with 48 in the control group. Of permanent job losses, 12 occurred in the experimental group and 22 in the control group. Of temporary job losses, 13 occurred in the experimental group versus 26 in the control group. Beginning 12 months post-intervention, a greater percentage of experimental group participants than control group participants remained employed with no job loss. The difference between the groups increased
at 18 months and was sustained over 42 months.

Conclusions: 

Vocational rehabilitation interventions have the capacity to reduce job loss due to rheumatic disease and the high indirect costs associated with rheumatic diseases. Also, because the intervention was relatively brief and the effect persisted over 3.5 years of follow-up, it should be an inexpensive intervention to deliver.

URL: 
http://cicoach.com/pdf/ReductionofJobLossforpersonswithRheaumaticDiseasesthroughVocationalRehab.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes