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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

Baseline comparisons

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

Vocational outcomes

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

Intervention: 

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

Control: 

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

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

Findings: 

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

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

Conclusions: 

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

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

The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs

Authors: 
Lacaille, D., Sheps, S., Spinelli, J. J., Chalmers, A., & Esdaile, J. M.
Year Published: 
2009
Publication: 
Rehabilitation Psychology
Volume: 
54
Number: 
2
Pages: 
175-163
Publisher: 
American Psychological Association
Background: 

Individuals with severe mental illness have a desire to work. however, they often face many barriers. The Working Alliance which is a collaborative working relationship within a counseling relationship has been a key element in therapeutic outcomes and has become linked to positive outcomes in psychiatric rehabilitation programs. Research has shown that a good working relationship between a person with mental illness and his service provider can improve symptoms, enhance medication compliance, improve quality of life and global functioning. More research on the working alliance in vocational rehabilitation services is needed. This study is a secondary analysis of data that was collected in a randomized control trial comparing to vocational models the Individual Placement and Support (IPS) model and the Diversified Placement Approach (DPA).

Purpose: 

This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).

Setting: 

The setting was two vocational programs that provided employment services to individuals with severe mental illness.

Sample: 

Two hundred individuals were randomly assigned to the IPS or DPA model of supported employment in the parent study. The sample in this study included 91 (45 in the DPA and 46 in IPS). Most were men (61). The mean age was 38.9 years. About half (49.4%) had a schizophrenia-spectrum disorder. The majority or (63.7%) had more than a 12 year education. Most (81.3%) had prior work histories.

Data Collection: 

Individuals were randomly assigned to DPA or IPS. Afterwards they were followed for two years. Objective data related to paid employment outcomes was collected through quarterly participant interviews. Data pertaining to the predictor variable, working alliance were collected by participant interviews every 6 months for individuals who were working at the time.
Demographic variables were measured by the Uniform Client Data Inventory and work history by the Employment and Income Review at baseline. Psychiatric symptoms were assessed at baseline and semiannual periods using the Positive and Negative Symptom Scale. Employment outcomes included total duration of paid work and mean paid job tenure. A scale was developed to measure working alliance. It included items related to emotional support, instrumental/informational support, frequency of performance feedback, stressfulness of the relationship, how critical the vocational worker was to the client and the person's overall satisfaction with the relationship.
Fidelity to the IPS or DPA model tenants were assessed every 6 months for both sites where individuals received services.
Stepwise hierarchical multiple regression analysis were run to determine relationships between the working alliance and employment outcomes. Baseline variables were controlled for and were entered into the regression model. Related to the number of days of paid work and job tenure applicable covariates were entered.
The working alliance variable was added in the second step of the regression analysis. Zero order correlates were also run. Independent t test was used to determine differences between IPS and DPA on working alliance.

Intervention: 

The intervention was the Working Alliance where a person with a disability received emotional support, assistance, and more.

Control: 

The comparison condition was low or no working alliance.

Findings: 

The first hypothesis stating that the working alliance would be positively associated with employment was not confirmed. The second hypothesis that individuals would have a stronger working alliance with their vocational workers in IPS was confirmed.

Conclusions: 

The finding that there is a lack of associations between working alliance and employment outcomes is not in alignment with previous literature. Evidenced based supported employment appears to lead to better relationships than the DPS approach. Additional research is needed.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19469605
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment for middle-aged and older people with schizophrenia.

Authors: 
Twamley, E. W., Padin, D. S., Bayne, K. S., Narvaez, J. M., Williams, R. E., & Jeste, D. V.
Year Published: 
2008
Publication: 
American Journal of Psychiatric Rehabilitation
Volume: 
11
Number: 
1
Pages: 
76-89
Publisher: 
Routledge
Background: 

Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work. However, very few vocational rehabilitation programs target older clients with psychiatric illness.

Purpose: 

This study examined employment outcomes among adults with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation.

Setting: 

The setting was an outpatient clinic in San Diego, California and various places of employment.

Sample: 

The study sample included 50 participants,30 men and 20 women who were 45 years or older, had a DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder, and were receiving their psychiatric care at an outpatient clinic. Twenty subjects were diagnosed with schizophrenia, and 30 were diagnosed with schizoaffective disorder. They were referred by state vocational rehabilitation.

Data Collection: 

The following techniques were used t-tests, chi-square, logistic regression, and repeated measures ANOVA to analyze the data. Alpha for significance was set at p < .05, and all tests were two-tailed. Cohen's d effect sizes to provide estimates of the magnitude of effects was also calculated.

Intervention: 

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

Conventional vocational rehabilitation programs use a train-then-place approach, emphasizing prevocational training classes and volunteer, transitional, or trial employment before seeking competitive work (i.e., employment in the community at prevailing wages).

Findings: 

Compared with Conventional Vocational Rehabilitation, Individual Placement and Support resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not.

Conclusions: 

These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19212460
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Work rehabilitation for middle-aged and older people with schizophrenia: a comparison of three approaches

Authors: 
van den Hout, J. H. C., Vlaeyen, J. W. S., Heuts, P. H. T. G., Zijlema, J. H. L., & Wijnen, J. A. G.
Year Published: 
2005
Publication: 
The Journal of Nervous and Mental Disease
Volume: 
193
Number: 
9
Pages: 
596-601
Publisher: 
Lippencott, Williams, and Wilkins
Background: 

There are increasing numbers of middle-aged and older people with schizophrenia-spectrum disorders, most of whom are unemployed. Across all age groups, rates of paid employment among people with these disorders are less than 15%. Yet the potential benefits of employment (e.g., increased income, activity, structure, socialization, and self-esteem) could improve symptoms, everyday functioning, and overall health. Many older people with severe mental illness (SMI) want to work. However, work rehabilitation programs usually do not target older patients, and no published studies have addressed work rehabilitation specifically in middle-aged and older people with SMI.

Purpose: 

To examine employment outcomes among middle-aged and older clients with schizophrenia in three work rehabilitation programs that varied in their emphasis on conventional vocational rehabilitation (train-then-place) versus supported employment principles (place-then-train). We analyzed retrospective data from 36 veterans receiving VA Wellness and Vocational Enrichment Clinic (WAVE) services and prospective data from a randomized controlled trial of 30 subjects receiving Department of Rehabilitation/Employment Services (DOR) or Individual Placement and Support (IPS).

Setting: 

Study settings were three separate programs: (a) the VA San Diego Healthcare System's Wellness and Vocational Enrichment Clinic (WAVE), (b) the Department of Rehabilitation/Employment Services (DOR), and (c) IPS. The WAVE Clinic provides conventional vocational rehabilitation (CVR) with some elements of SE. The DOR provides CVR services, as do most of the federally funded state agencies across the United States.

Sample: 

Participants were 40 years of age or older and had DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder made by their treating psychiatrists and confirmed by a diagnostic chart review by trained research staff. Exclusion criteria were alcohol or substance dependence within the past month and presence of dementia or other major neurological disorders.

Data Collection: 

All participants were classified as working (including volunteering) at any point in the study or nonworking for the analyses. Three IPS subjects and three DOR subjects decided not to pursue work and dropped out of the prospective study, but these subjects were included in the analyses. We used analysis of variance, [chi]2, and logistic regression techniques to analyze the data. All variables were distributed normally. The [alpha] for significance was set at p < 0.05, and all tests were two-tailed.

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: 

Two Comparison Conditions:
(1) WAVE: The WAVE Clinic assists veterans in achieving work readiness by providing prevocational classes and job contracts with various community employers. WAVE services are consistent with CVR, but unlike most CVR programs, the vocational services are integrated with psychiatric services.
(2)Department of Rehabilitation: In San Diego, vocational rehabilitation services for clients with mental illness are contracted to an organization called Employment Services. Individuals first become DOR clients and are then referred to Employment Services. To become a DOR client, the individual must first attend an orientation session and then attend an intake appointment with a DOR counselor. Following the intake appointment, the DOR has 60 days to determine eligibility for services.
Once eligibility has been approved, clients are referred to Employment Services and assigned a vocational counselor (a bachelor's-level or master's-level provider with a typical caseload of 35 clients). Job development and job coaching are provided by additional staff members. The DOR uses a train-then-place approach; individuals receive job readiness coaching and attend pre-vocational classes before their job search begins.

Findings: 

Across interventions, half the subjects obtained volunteer or paid work. IPS participants, those with schizophrenia (versus schizoaffective disorder), and those with more education were more likely to work or volunteer. Rates of volunteer or paid work were 81% in IPS, 44% in WAVE, and 29% in DOR. Rates of competitive/paid work only were highest in IPS (69%), followed by DOR (29%) and WAVE (17%).

Conclusions: 

Although they are typically written off as having little potential to return to work, especially paid work, middle-aged and older people with severe mental illnesses can obtain employment. Furthermore, they are more likely to do so in the context of a supported employment intervention than with traditional vocational services.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16131942
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Secondary prevention of work-related disability in nonspecific low back pain: Does problem-solving therapy help? A randomized clinical trial.

Authors: 
van der Klink, J. J. L., Blonk, R. W. B., & Schene, A. H.
Year Published: 
2003
Publication: 
The Clinical Journal of Pain
Volume: 
18
Number: 
2
Pages: 
87-96
Publisher: 
Lippincott
Background: 

Indirect costs such as absenteeism and disability pensions make up about 90% of the economic burden of low back pain (LBP).Moreover, total costs of back pain are not normally distributed.A relatively small group of patients with chronic LBP, approximately 10% to 25%, is responsible for about 75% of the economic burden of LBP. The development of effective interventions to prevent chronic work disability is high priority.

Purpose: 

This article describes a secondary preventive intervention developed against the background of a biopsychosocial model of pain. The aim of this study was to determine whether Problem-Solving Therapy (PST) had value as an adjunct to behavioral graded activity in reducing number of sick days and facilitating return to work in employees with a new episode of sick leave due to LBP.

Setting: 

The study setting was an unnamed rehabilitation center in the Netherlands.

Sample: 

Study subjects were employed patients who were recently absent due to LBP, referred to the study by general practitioners, occupational physicians, or rehabilitation physicians. Eligibility criteria for study subjects were as follows: Age between 18 and 65 years, LBP for more than 6 weeks, on sick leave with LBP but no longer than 20 weeks, and no more than 120 days of sick leave during the last year.

Data Collection: 

Work status information was collected one week before the intervention, a half year after the intervention, and one year after the intervention. The classification was as follows: (1) 100% return-to-work; (2) part-time return-to-work; (3) no return-to-work; (4) 100% disability pension as a result of back pain; and (5) 100% disability pension not as a result of back pain. Sick leave data were obtained from employers. Other data included demographic information, measures of pain and functional impairment, and job satisfaction. Differences in work status were assessed by means of chi-square tests regarding work status one week before the intervention, and 6 and 12 months after the intervention. Multiple linear regression analyses were conducted to test whether days of sick leave differed by treatment condition.

Intervention: 

PST is a cognitive behavioral therapy in which problem-solving skills are taught. The PST-model describes 5 steps to solve problems: (1) problem orientation, (2) problem definition and formulation, (3) generation of alternatives, (4) decision making, and (5) implementation and evaluation. The treatment consisted of 19 half-day sessions over the course of 8 weeks, given in small groups of, at most, 5 patients. In the course of the program the team of therapists had three meetings with individual patients. During these meetings, aids and impediments toward goal achievement and return to work were discussed. Two months after the final treatment session, a booster session was planned in which treatment components were summarized and individual developments were discussed in the group.

Control: 

Two treatment conditions were compared: graded activity plus problem-solving therapy (GAPS) and graded activity plus group education (GAGE). Group education was included in both groups.

Findings: 

There were no significant differences between treatment conditions before treatment. Six months after the intervention, most patients (73%) had a full return-to-work in both conditions. Seven percent versus 19% of patients did not return to work at 6-month follow-up in GAPS and GAGE conditions, respectively, which was not significant. The percentage of patients with 100% return-to-work after one year is 85% versus 63% in GAPS and GAGE conditions, respectively. At one-year follow-up more patients in the GAGE condition received disability pensions, as compared with patients in the GAPS condition (23% vs. 10%, respectively).

Conclusions: 

The results show that PST had supplemental effects, which became apparent 12 months after termination of the program. The introduction of problem-solving techniques, especially in a population of employees at risk for developing chronic disability, may be a promising innovation.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12616178
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Reducing long term sickness absence by an activating intervention in adjustment disorders: A cluster randomized controlled design.

Authors: 
van Erp, N., Giesen, F., van Weeghel, J., Kroon, H., Michon, H., Becker, D., McHugo, G., & Drake, R.
Year Published: 
2003
Publication: 
Occupational and Environmental Medicine
Volume: 
60
Number: 
6
Pages: 
429-437
Publisher: 
Williams and Wilkins
Background: 

Sickness leave is generally considered as a major source of societal costs in Western countries. With the increase in mental workload of the past decades, the fraction of psychological problems related to occupational stress has increased rapidly. These problems are also reported in the literature as emotional distress or stress related disorders.

Purpose: 

To compare an innovative activating intervention with care as usual (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesized that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration.

Setting: 

The study was conducted at Royal KPN, a private company providing postal and telecom services.

Sample: 

The study sample included 192 people who were on sick leave.

Data Collection: 

Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis.

Intervention: 

The intervention was a graded activity approach based on a three stage model resembling stress inoculation training.

Control: 

The control condition was care as usual.

Findings: 

At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels.

Conclusions: 

The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740545/
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effect of job maintenance training program for employees with chronic disease - a randomized controlled trial on self-efficacy, job satisfaction, and fatigue.

Authors: 
Varekamp, I., Verbeek, J. H., de Boer, A., & van Dijk, F. J. H.
Year Published: 
2011
Publication: 
Scandinavian Journal of Work and Environmental Health
Volume: 
37
Number: 
4
Pages: 
288-297
Publisher: 
Europe PubMed Central
Background: 
Many employees with a chronic disease manage their work well, but others are hampered in job performance due to health complaints, physical or cognitive limitations, pain, fatigue, or medical requirements. Attention has been paid to efforts that help employees to stay at work. A review of empowerment-based interventions aimed at job maintenance shows that there is limited evidence that these are effective at enhancing self-efficacy, implementation of work accommodations, and job maintenance.
Purpose: 
The objective of this study was to evaluate the effect of a group-based empowerment training program to assess its efficacy in solving solve work-related problems and consequently lessen psychological distress and fatigue.
Setting: 
The study was conducted in multiple workplaces in the Netherlands.
Sample: 
The study group consisted of 122 participants, 64 of whom were allocated to the training group and 58 to the control group. The mean age was 46 years. Women, higher-educated persons, and individuals working in the service sector were over-represented. Eligibility for the study was determined by a self-reported chronic physical disease, a paid job, and experiencing problems at work. Workers with predominantly psychiatric conditions were excluded; however, people with a chronic physical disease with depressive feelings were not excluded.
Data Collection: 
Primary outcome measures were (1) self-efficacy in solving work- and disease-related problems, (2) fatigue, and (3) job dissatisfaction. A situation-specific self-efficacy questionnaire was developed for data collection. Secondary outcome measures included (1) job maintenance, (2) work-related problems, (3) quality of life, (4) acquired work accommodations, (5) burnout, and (6) worries about work. Continuous outcome measures were analyzed at baseline and follow-up with the two-way mixed between-within subjects analysis of variance using general linear models.
Intervention: 
The empowerment training program focused on solving work-related problems. First, work-related problems were explored and clarified; second, communication at work was addressed; and third, solutions were developed and realized. The group-training program had one trainer and eight participants and consisted of six three-hour sessions every two weeks, with a seventh session two months after the sixth. This was combined with three individual counseling sessions.
Control: 
There was no control or comparison condition. Control group members were not restricted to any protocol.
Findings: 
After 24 months, self-efficacy increased and fatigue decreased significantly more in the experimental than the control group. Job satisfaction increased more in the experimental group but not significantly. Job maintenance was 87% in the experimental and 91% in the control group, which was not a significant difference. It was noted that many participants in the control group also undertook actions to solve work-related problems.
Conclusions: 
The authors conclude that empowerment training can increase self-efficacy and help to reduce fatigue complaints, which could lead to more job maintenance. Better understanding of ways to deal with work-related problems is needed to develop more efficient support for employees with a chronic disease.
URL: 
http://dare.uva.nl/document/2/78154
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Multidisciplinary collaborative care for depressive disorder in the occupational health setting: Design of a randomised controlled trial and cost-effectiveness study

Authors: 
Vocational rehabilitation of participants with severe substance use disorders in a VA Veterans Industries Program
Year Published: 
2008
Publication: 
BMC Health Services Research
Volume: 
8
Number: 
99
Pages: 
63-72
Publisher: 
BioMed Central
Background: 

Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other healthcare professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD.

Purpose: 

The purpose of the study was to apply a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost) effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting.

Setting: 

The setting is an occupational health program in the Netherlands.

Sample: 

The study sample includes 126 patients with major depressive disorder.

Data Collection: 

Data will be collected by means of questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Primary outcome measure is reduction of depressive symptoms, secondary outcome measure is time to RTW, tertiary outcome measure is the cost effectiveness.

Intervention: 

Trans-mural collaborative care model including Problem Solving Treatment, workplace intervention, antidepressant medication and manual guided self-help.

Control: 

There was no comparison or control group.

Findings: 

The study is 4 years and ongoing.

Conclusions: 

The high prevalence and burden of MDD, the high level of sickness absence among people with MDD and the negative consequences of prolonged sickness absence for patients as well as society contribute to the relevance of this study. Purpose of this study is to not only reduce depressive symptoms, but also to achieve an earlier, long-lasting RTW.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2390533/
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational intervention in first-episode psychosis: Individual placement and support v. treatment as usual

Authors: 
Kilsby M. S., & Beyer, S.
Year Published: 
2008
Publication: 
The British Journal of Psychiatry
Volume: 
193
Number: 
2
Pages: 
114-120
Publisher: 
Royal College of Psychiatrists
Background: 

Unemployment has economic, social and health implications for individuals with first episode psychosis and schizophrenia. The Individual Placement and Support model of supported employment shows promise for individuals with chronic mental illness. However, there are no randomized controlled trials on use of this approach to assist individuals with first episode psychosis with employment.

Purpose: 

The aim of this study was to look at the effectiveness of the Individual Placement and Support model of supported employment for young people with first episode psychosis.

Setting: 

The setting included a variety of places of employment.

Sample: 

The study sample was made up of 41 individuals, between the ages of 15 and 25 years, with first-episode psychosis.

Data Collection: 

Both groups were assessed at baseline and 6 months after the conclusion of the intervention. Data about demographics, symptoms, diagnosis and functioning was collected for all participants using a variety of measures. These included the Brief Psychiatric Rating Scale, Structured Clinical Interview for the DSM-IV Axis One Disorders, The Quality of Life Scale and Social and Occupational Functioning Assessment Scale. The Supported Employment Fidelity Scale Implementation questions were used to assess the fidelity of the program. Statistical analysis was conducted using SPSS version 14 for Windows.

Intervention: 

The intervention was six months of the Individual Placement and Support model of supported employment along with typical treatment as usual.

Control: 

The control condition was typical treatment as usual.

Findings: 

Participants in the Individual Placement and Support group had better outcomes. These included level of employment, hours worked per week, jobs acquired, and length of time employed. Twenty three participants in the intervention group went to work as compared to only 3 in the control group. The intervention group also reduced reliance on welfare benefits.

Conclusions: 

The Individual Placement and Support Model has the potential to assist individuals with first episode psychosis with employment. More research is needed.

URL: 
http://bjp.rcpsych.org/content/193/2/114
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Rehab rounds: Supplementing supported employment with workplace skills training.

Authors: 
Wang, P., Simon, G., Avorn, J., Azocar, F., Ludman, E., McCulloch, J., Petukhova, M., & Kessler, R.
Year Published: 
2004
Publication: 
Psychiatric Services
Volume: 
55
Number: 
5
Pages: 
513-515
Publisher: 
American Psychiatric Publishing
Background: 

Supported Employment for persons with serious and persistent mental illness has been termed Individual Placement and Support. In two randomized controlled trials clients who received Individual Placement and Support services were more likely to obtain at least one job in the competitive sector and to work more hours, and to have a higher total income than their counterparts who received more traditional types of vocational rehabilitation. However, individual placement and support did not improve the length of time the employed participants kept their jobs.

Purpose: 

The purpose of this report is to present the preliminary results of a randomized comparison of the workplace fundamental skills module's effects on job retention, symptoms, and community functioning when coupled with individual placement and support.

Setting: 

The setting was a community mental health center and various places of employment.

Sample: 

The study sample included 42 individuals with a diagnosed mental health disorders.

Data Collection: 

Data was collected about job acquisition, hours worked, wage and job retention.

Intervention: 

The intervention was Work skills training and Individual Placement and Support.

Control: 

The control condition was Individual Placement and Support only.

Findings: 

Thirty-four individuals, 17 in each group were employed during the project. There was no significant difference in the hours worked or the earnings for the two groups. The control group held significantly more jobs than the group receiving both modalities indicating there was significantly more job turnover in the group that received individual placement and support only.

Conclusions: 

The most relevant finding from the study was the greater job retention among the participants who received the combination of individual placement and support and the workplace fundamental skills module.

URL: 
https://www.researchgate.net/publication/8576628_Rehab_Rounds_Supplementing_Supported_Employment_With_Workplace_Skills_Training
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
No