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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

There was no control or comparison condition.

Findings: 

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

Conclusions: 

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

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

Vocational rehabilitation service patterns related to successful competitive employment outcomes of persons with spinal cord injury

Authors: 
Martin, D. J., Arns, P. G., Batterham, P. J., Afifi, A. A., & Steckart, M. J.
Year Published: 
2008
Publication: 
Journal of Vocational Rehabilitation
Volume: 
28
Number: 
1
Pages: 
1-13
Publisher: 
IOS Press
Background: 

It is well documented in the literature that the employment rate of people with spinal cord injuries (SCI) decreases drastically after their injuries. Because of the importance of work to the physiological and psychological health and well being of persons with a disability, considerable research efforts have been devoted to studying the employment problems of persons with a spinal cord injury. Over a half of a million individuals are served by state vocational rehabilitation agencies each year, making it possible to study a large number of persons with SCI who are living in the community.

Purpose: 

To examine the effect of demographic, work disincentives, and service variables on employment outcomes of persons with spinal cord injury in state vocational rehabilitation agencies.

Setting: 

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

Sample: 

10,901 persons with spinal cord injury whose cases were closed either as employed (54%) or not employed (46%) by state vocational rehabilitation agencies in the fiscal year 2001.

Data Collection: 

An ex post facto design, using data mining as a statistical analysis strategy. Data was taken from the RSA-911 report for all the persons with SCI closed by State Vocational Rehabilitation agencies in 2001. A chi-squared automatic interaction detector (CHAID) based data mining analysis was used to identify the strongest associations between predictors (VR services) and the outcome variable (employment outcomes).

Intervention: 

The interventions were the range of Vocational Rehabilitation Services received by the study sample of persons with a Spinal Cord Injury. These services included, but were not limited to, rehabilitation engineering, personal assistance services, assistive technology services, job placement, counseling and guidance, and assessment services.

Findings: 

The CHAID data mining analysis revealed that job placement services, work disincentives, and case expenditures as the most important predictors of employment outcomes. In addition, physical restoration, substantial counseling, and assistive technology services all led to positive employment outcomes. Importantly, the CHAID analysis segmented the sample into 45 mutually exclusive homogeneous end groups, with a wide range of employment outcomes. The CHAID analysis indicated that demographic variables interacted with rehabilitation services to affect employment outcomes.

Conclusions: 

The results confirmed substantial counseling, assistive technology, and job placement and support services are important to the return-to-work success of persons with SCI.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00399
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

There was no control or comparison condition.

Findings: 

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

Conclusions: 

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

URL: 
http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Paid internships and employment success for youth in transition

Authors: 
Luftig, R. L., & Muthert, D.
Year Published: 
2000
Publication: 
Career Development for Exceptional Individuals
Volume: 
23
Number: 
2
Pages: 
205-221
Publisher: 
Sage
Background: 

Most recent extensive national longitudinal studies of school leavers with disabilities show employment rates lagging significantly behind their non-disabled peers. There is a considerable body of research literature that supports the value of work experience as a critical educational intervention for improving post-school employment. To maximize effective educational interventions, including the use of work-based learning and paid employment experiences, it is necessary to examine specific individual characteristics, strategies, and circumstances that promote or deter successful employment outcomes.

Purpose: 

The purpose of this study was to assess the efficacy of a standardized, multi-site, community-based employment internship program developed by the Marriott Foundation for People with disabilities, called Bridges...From School to Work. The study also examines the relationship of various participant and programmatic variables to transition outcomes for participating youth.

Setting: 

The settings for the study consisted of multiple workplaces engaged in the Bridges program with the Marriott Foundation. During the study, Bridges operated in Montgomery County, MD; Fairfax County, VA; Washington, DC; Los Angeles, CA; San Francisco, CA; Atlanta, GA; and Chicago, IL.

Sample: 

The sample for this study includes 3,024 special education high school students who participated in one of the 10 Bridges projects. There was relatively equal distribution for males and females. Participants were largely minority group members (81%). Students had an array of disabilities but were predominantly learning disabled (57.1%), intellectually disabled (17.8%), and emotionally disabled (14.8%). Disability severity ratings were 41.0% mild, 38% moderate, and 21.0% severe.

Data Collection: 

Referral data for Bridges includes demographic, disability, and previous educational/employment histories. Additional data come from a placement data form, an internship log, an internship completion form, and a follow-up questionnaire. Follow-up data collection occurs at 6, 12, and 18 months after internship completion. The data instruments were standardized across all 10 sites. Data analysis consisted of descriptive results for internship performance, and the exploration of the relationship between predictor and outcome variables at each of the three periods using logistic regression procedures.

Intervention: 

The Bridges program consists of three phases: (a) pre-vocational orientation program (two to three weeks); (b) pre-vocational preparation skills training (two to four weeks); and (c) internship placement and support. The internship is a paid work experience whereby a student intern spends a minimum of 12 consecutive weeks performing work tasks in a community employment setting. The employer pays the wages and benefits for the student, but the employer and the student are under no obligation to continue the employment relationship beyond the internship period.

Control: 

There was no comparison condition.

Findings: 

Employment status at six months post-internship was not different across gender, race, or primary disability. Work behaviors during the internship were highly predictive of post-school employment at 6 and 12 month follow-up intervals. 68% of those contacted were employed at six months. Enrollment in postsecondary education was the most frequently cited reason for not working (43%), followed by not being able to find work (21%). A small percentage (13%) cited not wanting to work as the reason for unemployment.

Conclusions: 

Findings of this study demonstrate the efficacy of structured work experiences for youth with disabilities in secondary school. Students in the paid internship showed better short-term outcomes regardless of demographic factors and educational placement factors. However, at long-term follow-up the employment rate had declined, indicating a need for sustained employment support services.

URL: 
http://cde.sagepub.com/content/23/2/205.full.pdf+html
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Chemical dependency treatment and employment outcomes: results from the 'ADATSA' program in Washington State

Authors: 
Luecking, D. M., & Luecking, R. G.
Year Published: 
2000
Publication: 
Drug and Alcohol Dependence
Volume: 
60
Number: 
2
Pages: 
151-159
Publisher: 
Elsevier
Background: 

In 1987, the Washington State legislature passed the Alcohol and Drug Abuse Treatment and Support Act (ADATSA), creating a program for indigent adults deemed unemployable and incapacitated as a result of their addiction. This legislation was designed to provide treatment instead of the traditional public assistance/cash grants available.

Purpose: 

The purpose of the study was to examine the relationship between chemical dependency treatment and subsequent earnings.

Setting: 

The setting included multiple methadone treatment centers in Washington State.

Sample: 

2195 clients were referred to an ADATSA assessment center and determined to be financially eligible for assistance. Of those assessed, 1537 individuals were found to be clinically eligible for treatment and 1228 entered treatment.

Data Collection: 

All data came from secondary sources, as there was no direct contact between researchers and clients. Data on earnings came from the wage and hour file collected by Washington State's Department of employment Security.

Intervention: 

There were three phases of treatment: primary, reintegration, and aftercare. In primary care, addiction was addressed and information and tools needed to recover were provided to patients. In the reintegration phase, patients were aided in moving from a structured treatment setting to independent living. In aftercare, they were provided continued support to maintain sobriety in an unstructured setting.

Control: 

There was no comparison or control condition.

Findings: 

Clients who completed their plan of treatment earned more than those who did not. Those clients who received vocational services, in addition to completing treatment, earned more than those who completed treatment only.

Conclusions: 

This study shows that clients once deemed "unemployable" can become productive.

URL: 
https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-4-45.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Evaluation of an individual placement and support model system

Authors: 
Luchansky, B., Brown, M., Longhi, D., Stark, K., & Krupski, A.
Year Published: 
2004
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
27
Number: 
3
Pages: 
251-257
Publisher: 
Hogrefe Publishing
Background: 

Individuals with severe mental illness have high rates of unemployment. The Individual Placement and Support(IPS) model of supported employment has demonstrated superior employment outcomes as compared to other conditions (ie. day treatment, sheltered work and counseling)through a number of randomized control trials. It is important to find out if this approach can be effectively implemented with fidelity in the field and yield similar results.

Purpose: 

The purpose of this study was to conduct a retrospective evaluation of the employment outcomes of individuals who were involved in a Services for Employment and Education (SEE) program, based on the IPS model, in Massachusetts over a 4 and half year period of time.

Setting: 

The setting included a number of employment sites in Massachusetts where individuals with mental illness who received supported employment services worked.

Sample: 

Participants were 90 individuals who enrolled in the program from 1995 to 1999. The majority were Caucasian (90%) and male (65.7%). The mean age was 42 years with a range from 21 to 65. The majority (66%) had schizophrenia or another psychotic disorder and were receiving disability benefits. Over three quarters or (77.8%) had never been married.
The mean total score on work readiness was 1.33 and annual clinical contact hours was 23.62; the mean Clinical Evaluation of Risk and Functioning score was 39.62.

Data Collection: 

An independent retrospective evaluation of the SEE employment outcomes was conducted. In addition, the SEE program fidelity was assessed using the IPS Fidelity scale.
Data was selected from three major sources. Demographics, days in program, number of jobs held previously and self rating of "work readiness were collected from the SEE program records. The SEEIS database provided data related to each job obtained (i.e.. start and end date, hours worked, wages etc...) and services received (i.e.. benefits counseling, assistance with job related problems and workplace supports, disclosure of disability etc.... Behavioral health program records provided treatment plan information, clinical contact hours and diagnosis. The case management services client tracking system had information about the person's level of functioning at program exit.

Intervention: 

The intervention was, the Services for Employment and Education program, a modification of the Individual Placement and Support Supported Employment Model.

Control: 

There was no control or comparison group.

Findings: 

SEE participants held 196 jobs. The majority or 35.4% were service jobs. This was followed by 28.6% in marketing or sales, 20.9% were operator, fabricator, or technical jobs and 10.2% were professional, administrative or managerial in nature. The average number of hours worked per week was 16 with a range of 1 to 40 hours. One third of the jobs required 20 or more hours per week.
Wages ranged from $4.75 to $12.00.
Participants frequently received job related supports like benefits counseling, problem solving and on the job support on issues like negotiating changes in schedule, conflicts with coworkers and changes in management.
Support was also offered to assist individuals with disclosing their disability in order to receive reasonable accommodation.
Individuals in non professional jobs quit or were fired from their jobs more often than those who were not.
Eighty two percent of participants held at least one job. The mean was 2.69 positions with a range from 1 to 10. There were no significant differences between those who did and did not obtain work.
On average it took around 3.5 months for participants to secure employment. The average amount of time worked per job was a little more than 11 months.
Employment outcomes were related to education level which was correlated with more highly educated individuals working more total hours across all types of jobs. Participants who had higher self rated work readiness scores remained employed longer than those with lower rates. Also those with more active days in SEE and more employer accommodations remained employed longer. However, those who receive more on the job supports tended to work less hour and earn lower wages. Overall the SEE program had good fidelity to the IPS model.

Conclusions: 

The majority of participants gained and maintained employment. The model had high IPS fidelity and had outcomes similar to and in some areas superior to the Supported employment and IPS model programs. Programs that follow a evidenced based employment model are more likely to have positive outcomes.

URL: 
http://psycnet.apa.org/journals/prj/27/3/251/
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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

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

Supported employment for young adults with autism spectrum disorder: Preliminary data

Authors: 
Wehman, P., Schall, C., McDonough, J., Molinelli, A. Riehle, E., Ham, W., & Thiss, W.
Year Published: 
2012
Publication: 
Research & Practice for Persons with Severe Disabilities
Volume: 
37
Number: 
3
Pages: 
160-169
Publisher: 
Tash Publishing
Background: 

There is extremely limited information about using a supported employment approach to assist individuals with autism with gaining and maintaining employment in the community. Among the few studies that do exist, most are descriptive in nature. More research is needed.

Purpose: 

This study took a close look at the work histories of individuals with ASD over a 23 month period of time. The purpose was to examine the effects of supported employment in assisting them with employment.

Setting: 

The setting included a variety of different workplaces. This included: health care field, retail, recreational and educational field, food service and janitorial industry.

Sample: 

Thirty three individuals with ASD were included in the study. Each was referred for supported employment services by a vocational rehabilitation counselor. The majority were white (76%) and males (76%). The average age of participants was 22 years old. Seventy percent of the individuals reported a secondary disability. All participants had received a high school diploma or equivalency diploma. Around 40% had some college. Over 90% had either no or short intermittent work histories. More than three fourths had high social interaction support needs. Notably close to a third or 13 individuals had participated in a extended work internship at a hospital that was modeled after the Project SEARCH approach.

Data Collection: 

Employment specialist traced actual time spent either directly or indirectly working for the person with ASD across various types of supported employment interventions. This included developing a vocational profile about the person served, developing a job, job site training, and long term supports to enhance job retention. All data were stored in password protected database. The employment specialist's intervention time and participant outcomes were aggregated across the group of participants and over time.

Intervention: 

The intervention was individualized supported employment services. This is an approach that supports one person at a time with gaining and maintaining work in a real job for real pay in the community.

Control: 

There was no control. Due to the exploratory nature of the study no comparison group was used.

Findings: 

Twenty seven or 82% of those served went to work in an entry level occupation. They earned between $7.25 and $10.50 per hour.Mean hours worked was 23 per week.The average intervention time for various interventions was as follows:completing a job seeker profile was about 9 hours; job development around 30 hours (notably some of the individuals went to work where they interned which reduced the hours needed to develop a job); job site training and support 107 hours; and long term support 27 hours.

Conclusions: 

An individualized supported employment approach can assist individuals with ASD with gaining and maintaining employment. More research is needed.

URL: 
http://rps.sagepub.com/content/37/3/160.full.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes