A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders

A qualitative study of a recovery capital assessment tool in alcohol and drug treatment facilities: Perspectives from social work professionals

The ambition to translate the concept of recovery capital (RC) from research to practice has entailed operationalisations of RC to measure progress and outcomes of alcohol and other drug (AOD) treatments.At the same time, the role played by standardisation in social work organisations is known to be a complex matter, and research suggests that the implementation of standardisation should be carried out with caution. By examining the need for a RC assessment tool in a Swedish AOD treatment context, this paper contributes to the discussion on the use of assessment tools for measuring treatment progress and outcome in AOD treatments, as well as interrelations between standardisation aims and social work professionals. Four group interviews with employees at AOD treatment facilities were conducted in Stockholm, Sweden. The interviewees were presented with an example of an RC-based assessment tool and asked to review the applicability of the tool in their daily work. The findings provide insights on the applicability of specific assessment list items, as well as general observations on the complex relationship between standardisation and discretion in social work. The findings suggest that professionals will ultimately rely on their knowledge and experience, and act accordingly to support the service user, regardless of any manual or standardisation that regulates their work.

External context in individual placement and support implementation: a scoping review with abductive thematic analysis

BACKGROUND

Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS).

METHODS

The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses.

RESULTS

Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level.

DISCUSSION

Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research.

TRIAL REGISTRATION

Open Science Framework.

"I Felt Supported by the Peers in My Group": Analyzing Experiences of Youths with Mental Health Challenges of a Supported Employment Program in Canada

PURPOSE

The objectives of this study were to gain an understanding of the experiences of youths with mental health conditions who have undergone a 16-week supported employment program (SEP) conducted in an urban centre in Canada.

METHODS

Focus groups and individual semi-structured interviews were used to capture the experience of youths who had completed the program. Youths were eligible if they were aged 19 to 30 years diagnosed with a mental illness and enrolled in the program. Purposeful sampling was used to recruit participants. Thematic analysis was conducted to analyze the data. Primary codes were organized and mapped onto Donebedian's Structure-Process-Outcome Model.

RESULTS

Altogether, 34 participants, aged 17 to 30 years old, described their experiences participating in this 16-week supported employment program. Participants' experiences of this program and with employment were categorized into four main themes focusing on the (1) structure of program, (2) process of care (3) outcomes of program, and (4) improvements to the program.

CONCLUSION

Overall, the experience of a supported employment program was perceived as valuable, with unexpected benefits of the program beyond employment including the establishment of routine, friendship, and self-confidence. The proposed model can be used as a structure for monitoring and evaluating SEP.

Work Patterns and Support Needs of People with Serious Mental Illness

People with serious mental illness (SMI) are frequently unemployed, despite their willingness to work. Several employment interventions approaches have proven efficacy; however, work integration rates for people with SMI continue to be low. In total, 145 participants with a SMI completed a survey, answering questions regarding their personal information, work history, whether they received supports towards work integration, and their functional level. In addition, clinical records were accessed to verify and complete clinical history. A quantitative descriptive approach was used to analyze the data. No significant differences were found between those who were working and who were not, based on age, gender, educational level, living situation, and suicide risk. Those who were working presented higher levels of functional capacity than those who were not working. Factors associated with employment outcomes continue to remain unclear, adding value to the role that the different supports towards work integration may have.

Neuropsychological predictors of vocational rehabilitation outcomes in individuals with major depression: A scoping review

BACKGROUND

Major depression is one of the leading causes of disability and limited capacity to work. Neuropsychological impairment is a common symptom in acute and remitted major depression and is associated with poor psychosocial functioning. This scoping review aimed to identify research on the role of neuropsychological functioning in outcomes of vocational rehabilitation programs in individuals with depression.

METHODS

We report on the conduct of this pre-registered (https://osf.io/5yrnf) scoping review in accordance with PRISMA-ScR guidelines. PubMed and PsychInfo were systematically searched for English or German research articles published between 1990 and September 2021 that studied objective neuropsychological tests as predictors of vocational rehabilitation interventions and included participants with depression.

RESULTS

The systematic literature search yielded no studies that specifically targeted subjects with major depression. However, eight articles published since 2016 were included in the review, analyzing data from five trials that evaluated the effectiveness of supported employment in North America and Europe in severe mental illnesses. An estimated 31% of the total number of participants included (n = 3,533) had major depression. Using a variety of cognitive tests and covariates, seven articles found that neuropsychological functioning - especially global cognition scores, verbal and visual learning and memory - significantly predicted vocational outcomes of rehabilitation programs.

CONCLUSION

Despite a lack of studies specifically targeting major depressive disorder, the identified literature suggests that higher baseline neuropsychological functioning predicts better vocational outcomes of supported employment programs in individuals with depression. In clinical practice, additional neuropsychological modules during return-to-work interventions might be helpful for vocational outcomes of such programs.

YESS: A feasibility study of a supported employment program for youths with mental health disorders

OBJECTIVE

In Canada, employment/education support is rarely embedded as a component of mental health service delivery. This study describes a supported education/employment program (SEP) that integrates both clinical and community mental health services. The main objectives were to estimate the feasibility of a 5-week SEP among youths aged 17-24 with mental illness and to estimate the extent to which participation in this program improved employment and mental health outcomes.

METHODS

This was a single cohort study. Feasibility outcomes assessed were demand, acceptability, practicality, integration, adaptation, and effectiveness. These were assessed through recruitment and retention rates, recording patterns of missing data, and examining differences between completers and non-completers. Appropriateness of the outcome measures was assessed through the strength of the association between the outcome measures at baseline. Effectiveness of the program was assessed through employment and as measured using MyLifetracker (MLT), Satisfaction with Life Scale (SWLS), and the Canadian Personal Recovery Outcome Measure (CPROM).

RESULTS

A total of 110 youths with a mean age of 20.6 (SD: 2.2) were recruited. At 5 weeks, 82 (74.5%) of participants remained in the program. Of the people who completed the program, 56.1% were women, 76.6% were in stable housing and 64.1% had depression. Approximately 60% of non-completers used two or more services and were in at-risk housing. More than 25% of participants improved on the patient-reported outcomes. Scores on these measures were moderately to highly correlated with each other. Employment rates varied and corresponded to the waves of the COVID-19 pandemic in Canada.

CONCLUSION

Results showed that this program was feasible and there was high demand for SEP during the COVID-19 pandemic but gaining employment remained difficult. Educational or employment outcomes, measured over a short period, may not be adequate. Instead, individualized and patient-reported outcome measures may be more appropriate for SEP programs.

Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review

Introduction

Employment programmes for people with mental illness vary widely in range, but nonetheless all share the same objectives of restoring or initiating vocational roles to promote recovery in psychosocial rehabilitation. The current interventions available usually focus on the specific vocational outcomes of the intervention rather than focusing holistically on the client’s needs.

Method

This review aimed to examine the effectiveness of intervention programmes and determine the best intervention for schizophrenia and other severe mental illness, considering both vocational and non-vocational outcomes. Searching five databases – CINAHL, Medline via Ovid, Scopus, OT Seeker and Web of Science – a total of 3108 studies was identified; 24 met the selection criteria and were reviewed. Interventions were categorised into five major programmes of supported employment, integrated supported employment, vocational rehabilitation, cognitive intervention and virtual reality-based vocational training.

Results

Integrated supported employment was found to be the most effective approach for a vocational outcome. However, evidence concerning non-vocational outcomes of employment programmes and the use of cognitive training remains unclear.

Conclusion

Clinicians are advised to consider the needs and preferences of the client before selecting the best intervention programme. More research is needed to determine the applicability and the efficacy of intervention programmes.

The Ontario Disability Support Program Work Exit Process: Parallels to a Hostage Negotiation

There is a lack of empirical data on the experiences of people with mental illness (PMI) who transition from welfare to work and how policy programs are designed to facilitate this outcome. We explore the factors that facilitate or hinder PMI from exiting disability income support programs in Ontario, Canada. Drawing on a grounded theory approach, we examine the process of exiting the Ontario Disability Support Program (ODSP). Data were collected from semi-structured interviews with current and former recipients with mental illness, service providers who support current and former recipients, and ministry staff. A metaphor for the work exit process emerged with four embedded themes: (a) picking yourself back up, (b) breaking the rules to get ahead, (c) stabilizing illness for employment success, and (d) displaying resiliency and resourcefulness for successful exits. The main finding is that system supports are not the determining factors in a successful transition. Rather, participants describe how recipients exit for employment by leveraging personal resources to successfully transition off income support benefits. A system redesign is needed to address the inherent tension between social and health programs if the policy intent is to promote successful welfare-to-work transitions for PMI.

Barriers and facilitators to the implementation of individual placement and support (IPS) for patients with offending histories in the community: The United Kingdom experience

Introduction

We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting.

Method

In-depth interviews were conducted with clinical staff ( n = 11), patients ( n = 3), and employers ( n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria.

Results

Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support.

Conclusions

Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings.

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.

Fidelity scales and performance measures to support implementation and quality assurance for first episode psychosis services

AIM

The purpose of this paper is to review fidelity and outcome measures which can be used to support broad implementation of first episode psychosis services and ensure quality of existing services. First episode psychosis services use a combination of evidence-based practices to improve the outcome of a first episode of psychosis and the early stages of schizophrenia. Now that there is an established international evidence base to show that they are effective, efforts are being made to make such services widely available as a routine part of health care.

METHODS

We provide an overview of the literature from the perspective of an expert task force that was commissioned to report to the board of the International Early Psychosis Association IEPA. First, we examined the evidence-based components that underpin first episode psychosis services and identified common elements. Next, we reviewed the availability of fidelity measures and outcome indicators, finally we reviewed how broadly these services are delivered internationally, and the barriers to ensuring broad access to quality services.

RESULTS

There is a growing consensus about the elements required to deliver effective services. Fidelity scales and performance measures are available to assess quality, access, and outcome. First episode psychosis services are variably offered in high-income countries and rarely with attention to access and quality of services. Several strategies to promote implementation are identified.

CONCLUSIONS

Fidelity scales and outcome measure are valuable resources to support widespread implementation and quality assurance for first episode psychosis services.

Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study

OBJECTIVE

Young adults living in single room occupancy (SRO) hotels, a form of low-income housing, are known to have complex health and substance problems compared to their peers in the general population. The objective of this study is to comprehensively describe the mental, physical, and social health profile of young adults living in SROs.

METHODS

This study reports baseline data from young adults aged 18-29 years, as part of a prospective cohort study of adults living in SROs in Vancouver, British Columbia, Canada. Baseline and follow-up data were collected from 101 young adults (median follow-up period 1.9 years [IQR 1.0-3.1]). The comprehensive assessment included laboratory tests, neuroimaging, and clinician- and patient-reported measures of mental, physical, and social health and functioning.

RESULTS

Three youth died during the preliminary follow-up period, translating into a higher than average mortality rate (18.6, 95% CI 6.0, 57.2) compared to age- and sex-matched Canadians. High prevalence of interactions with the health, social, and justice systems was reported. Participants were living with median two co-occurring illnesses, including mental, neurological, and infectious diseases. Greater number of multimorbid illnesses was associated with poorer real-world functioning (ρ = - 0.373, p < 0.001). All participants reported lifetime alcohol and cannabis use, with pervasive use of stimulants and opioids.

CONCLUSION

This study reports high mortality rates, multimorbid illnesses, poor functioning, poverty, and ongoing unmet mental health needs among young adults living in SROs. Frequent interactions with the health, social, and justice systems suggest important points of intervention to improve health and functional trajectories of this vulnerable population.

Work Accommodations and Natural Supports for Employees with Severe Mental Illness in Social Businesses: An International Comparison

Little is known about the types of work accommodations and natural supports that are useful for people experiencing severe mental illness working in social businesses. We conducted an exploratory, descriptive and cross-sectional investigation in Australia, Canada and Italy to study the nature of work accommodations and natural supports available in social businesses. Study findings are drawn from survey responses of a convenience sample of 90 employees with self-reported psychiatric disabilities. Results showed that, regardless of the country, social businesses provide many work accommodations and natural supports, especially those linked to schedule flexibility and support, while work accommodations related to training and schedule flexibility were linked to longer job tenure. Overall, this study advances our knowledge about the spectrum of work accommodations and natural supports that are available in social businesses for people with severe mental illness. Also, it highlights the type of work accommodations that are likely to support this population to sustain employment.

[Mental disorders and participation in the labor market: a multicenter national study in Brazil]

The objective was to explore the relationship between labor market participation and patient characteristics in a representative sample of 2,475 adults admitted to 26 Brazilian mental health institutions (15 Centers for Psychosocial Care and 11 hospitals). Socio-demographic, clinical, and behavioral characteristics were obtained with structured interviews. Multinomial regression was used. Increased likelihood of temporary absence from the work market was associated with female gender, single, divorced, or widowed conjugal status, lack of stable housing, and history of first admission or treatment before the age of 18. Increased likelihood of permanent absence from the labor market was associated with older age. Temporary or permanent leave from work was directly associated with low schooling, lifetime hospitalizations, and diagnosis of severe mental disorder and inversely associated with alcohol and drug use. The occupational vulnerabilities identified in the study raise the debate on specific policies for the mental health sector.

Predictors of Acquisition of Competitive Employment for People Enrolled in Supported Employment Programs

This study aims at assessing the relative contribution of employment specialist competencies working in supported employment (SE) programs and client variables in determining the likelihood of obtaining competitive employment. A total of 489 persons with a severe mental illness and 97 employment specialists working in 24 SE programs across three Canadian provinces were included in the study. Overall, 43% of the sample obtained competitive work. Both client variables and employment specialist competencies, while controlling for the quality of SE programs implementation, predicted job acquisition. Multilevel analyses further indicated that younger client age, shorter duration of unemployment, and client use of job search strategies, as well as the working alliance perceived by the employment specialist, were the strongest predictors of competitive employment for people with severe mental illness, with 51% of variance explained. For people with severe mental illness seeking employment, active job search behaviors, relational abilities, and employment specialist competencies are central contributors to acquisition of competitive employment.

Individual placement and support in Sweden - a randomized controlled trial

BACKGROUND

Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden.

AIMS

To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect.

METHODS

A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024.

RESULTS

One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this.

CONCLUSIONS

IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

Psychosocial well-being construct in people with severe mental disorders enrolled in supported employment programs

The main purpose of this prospective study is to validate the construct of psychosocial well-being (PSWB) for people with severe mental disorders enrolled in Supported Employment (SE) programs. This paper also aims to assess the impact of job acquisition on PSWB after obtaining competitive employment. A two-phase study approach was used and 231 individuals with severe mental disorders enrolled in SE programs who took part in both phases. The shortened versions of the Psychological Well-Being Scale (Keyes et al. in J Personal Soc Psychol, 82(6):1007-1022, 2002; Ryff and Keyes in J Personal Soc Psychol 69(4):719-727, 1995) and the Social Well-Being Scale (Keyes in Soc Psychol Q 61(2):121-140, 1998) were used. The PSWB's multidimensionality construct was confirmed. The results of repeated measure ANOVA analyses revealed that job acquisition, as well as, being involved in a work-seeking process increase the PSWB of people with severe mental disorders. Employment specialists might find clinical utility in using this validated tool for assessing PSWB in their clients with severe mental disorders. In a recovery oriented approach to psychiatric services and SE programs, clinicians and employment specialists should continue to encourage their clients in their work integration process even though they may not all obtain competitive employment quickly.

Employment specialist competencies for supported employment programs

PURPOSE

Supported employment (SE) programs are evidence-based programs offered to people with severe mental illness to facilitate obtaining and keeping competitive work. However, significant variations in individuals' vocational success may be partly explained by differences in their employment specialists' competencies. Aim The main objectives of this study were to develop a questionnaire measuring the behaviors, attitudes and knowledge of employment specialists working in SE programs and to link specific competencies to vocational outcomes.

METHODS

A total of 153 employment specialists working in Canadian and Dutch supported employment programs completed the Behaviors, Attitudes, and Knowledge in Employment Specialists (BAKES) questionnaire and provided information about their clients' vocational outcomes.

RESULTS

Exploratory Factor Analyses results found 90 items over 12 subscales (e.g., Relationships with employers and supervisors). Regression analyses indicated that the two most useful subscales for predicting vocational success were: (1) Relationships with employers and supervisors, and (2) support and client-centered approach.

CONCLUSION

Employment specialists require specific competencies to help people with severe mental illness obtain and maintain competitive employment. Validating the BAKES will better define the broad range of competencies expected for this position, and this tool may facilitate training of employment specialists.

[Psychological barriers to professional inclusion of people with mental disabilities]

Mental health in the workplace today are ubiquitous and cause significant dysfunction in organizations (turnover, absenteeism, presenteeism, early retirement, long sick…). Statements of professional unfitness for depression is of particular concern. The human and financial costs associated with the support of mental disability is important, in France it is estimated to 14 billion euros. Mental disorder in the workplace also has a significant impact on the individual. If not always leads to actual inability to work, it usually causes, from the disclosure of the disorder, professional inequalities related to perceived environmental work disability. Therefore, this type of public remains largely on the sidelines of a stable occupation and all forms of recognition and undergo disqualifications and some forms of exclusion. Instead of saving, the workplace can promote relapse and even constitute a real obstacle to improving health. These exclusionary behavior result in persistent employment resistance in France and elsewhere, especially because of the prejudice of employers. These resistances persist despite legal obligations in this regard (e.g. in France: Law of 11 February 2005 on Equal Rights and Opportunities). To address the issue of sustainable professional inclusion (recruitment, integration and job preservation) of people with mental disabilities, studies are especially developed for the rehabilitation in the workplace of this public or accompanying us in their professional reintegration into protected workplaces. We propose a reflection on the adaptation of knowledge about psychological processes of hiring discrimination in the particular employment situation of people with mental disabilities in ordinary workplaces. Researches on social representations, stereotypes and prejudices applied in the workplace help to understand the negative attitudes and resistance to the hiring of people with mental disabilities despite regulations. Representations of professional efficiency, cognitive bias in social perception, personological expectations and responsibilities about the success of the employment integration of new employees strongly impact the hiring and integration behaviors of actors of the company. Nevertheless, the influence of the organizational context was highlighted in the researches in psychology of organizations. Recruitment and integration practices implemented by organizations, the procedures used to recruit (procedural justice) and the quality of interpersonal treatment of individuals (interpersonal justice) are essential elements of socialization. Disability is recognized as a particularly salient dimension and effective in activating cognitive processes biased. Individual and/or collective courses of action as persuasive communication, suppression and dilution of stereotypes, self-regulation of prejudice, intergroup contact and the sharing of values, affirmative action, promoting diversity, are proposed to modify these psychological barriers. However, their effectiveness is moderated by various individual factors such as the level of prejudice of actors, their previous work experience of disabled workers, their commitment to the values promoted by the organization for example, or organizational and structural factors such as the characteristics of the organization, the degree of formalization of hiring procedures, social policy of the organization and how it is conveyed and received by workers… These studies support the conclusion that the process of professional inclusion of public considered as "non-standard" is complex. These tracks remain to be tested under the mental disability taking into account the type of company and characteristics of actors that constitute them.

Supported employment for persons with serious mental illness: current status and future directions

The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.

Beliefs of Vocational Rehabilitation Counselors About Competitive Employment for People With Severe Mental Illness in Belgium

Vocational rehabilitation (VR) counselors do not always focus on competitive employment for people with severe mental illness (SMI). Based on the Theory of Planned Behavior (TPB), this study examines how three types of VR counselors (i.e., gatekeepers, case managers, and specialists) vary in their underlying beliefs about competitive employment. VR counselors ( N = 286) from Belgium completed an online TPB survey measuring behavioral, normative, control, and self-efficacy beliefs. Differences in beliefs were analyzed by one-way ANOVAs and post hoc comparisons using Bonferroni correction. Results indicate that counselors differ in their beliefs regarding competitive employment for people with SMI. Specialized counselors are stronger convinced that competitive employment results in latent benefits (e.g., increased integration and self-confidence). In contrast, gatekeepers consider income as the most recurrent and positive effect. The more specialized VR counselors are, the more often they perceive significant others valuing competitive employment and the more often they may comply with these norms. Finally, specialized counselors experience fewer barriers, more control, and more self-efficacy in dealing with problems compared with less specialized counselors. The differences in beliefs determining the focus on competitive employment may result in a lack of an integrated approach. Training, outcome feedback, and intersectoral communication can enhance consistency between different VR services.

Perspectives on Employment Integration, Mental Illness and Disability, and Workplace Health

This paper reviews the literature on the interplay between employment integration and retention of individuals diagnosed with mental health and related disability (MHRD). Specifically, the paper addresses the importance of an integrative approach, utilizing a social epidemiological approach to assess various factors that are related to the employment integration of individuals diagnosed with severe mental illness. Our approach to the review incorporates a research methodology that is multilayered, mixed, and contextual. The review examines the literature that aims to unpack employers’ understanding of mental illness and their attitudes, beliefs, and practices about employing workers with mental illness. Additionally we offer a conceptual framework entrenched within the social determinants of the mental health (SDOMH) literature as a way to contextualize the review conclusions. This approach contributes to a holistic understanding of workplace mental health conceptually and methodologically particularly as practitioners and policy makers alike are grappling with better ways to integrate employees who are diagnosed with mental health and disabilities into to the workplace.

Work reintegration for veterans with mental disorders: a systematic literature review to inform research

BACKGROUND

Some veterans, and especially those with mental disorders, have difficulty reintegrating into the civilian workforce.

PURPOSE

The objectives of this study were to describe the scope of the existing literature on mental disorders and unemployment and to identify factors potentially associated with reintegration of workers with mental disorders into the workforce.

DATA SOURCES

The following databases were searched from their respective inception dates: MEDLINE, EMBASE, Cumulative Index Nursing Allied Health (CINAHL), and PsycINFO.

STUDY SELECTION

In-scope studies had quantitative measures of employment and study populations with well-described mental disorders (eg, anxiety, depression, posttraumatic stress disorder, substance-use disorders).

DATA EXTRACTION

A systematic and comprehensive search of the relevant published literature up to July 2009 was conducted that identified a total of 5,195 articles. From that list, 81 in-scope studies were identified. An update to July 2012 identified 1,267 new articles, resulting in an additional 16 in-scope articles.

DATA SYNTHESIS

Three major categories emerged from the in-scope articles: return to work, supported employment, and reintegration. The literature on return to work and supported employment is well summarized by existing reviews. The reintegration literature included 32 in-scope articles; only 10 of these were conducted in populations of veterans.

LIMITATIONS

Studies of reintegration to work were not similar enough to synthesize, and it was inappropriate to pool results for this category of literature.

CONCLUSIONS

Comprehensive literature review found limited knowledge about how to integrate people with mental disorders into a new workplace after a prolonged absence (>1 year). Even more limited knowledge was found for veterans. The results informed the next steps for our research team to enhance successful reintegration of veterans with mental disorders into the civilian workplace.

Job acquisition for people with severe mental illness enrolled in supported employment programs: a theoretically grounded empirical study

INTRODUCTION

The main purpose of this study was to test a conceptual model based on the theory of planned behaviour (TPB) to explain competitive job acquisition of people with severe mental disorders enrolled in supported employment programs.

METHODS

Using a sample of 281 people with severe mental disorders participating in a prospective study design, the authors examined the contribution of the TPB in a model including clinical (e.g., severity of symptoms), psychosocial (e.g., self-esteem) and work related variables (e.g., length of time absent from the workplace) as predictors of job acquisition. Path analyses were used to test two conceptual models: (1) the model of job acquisition for people with mental illness adapted from the TPB, and (2) the extended TPB including clinical, psychosocial, and work related variables recognized in the literature as significant determinants of competitive employment.

RESULTS

Findings revealed that both models presented good fit indices. In total, individual factors predicted 26% of the variance in job search behaviours (behavioural actions). However, client characteristics explained only 8% of variance in work outcomes, suggesting that environmental variables (e.g., stigma towards mental disorders) play an important role in predicting job acquisition. About 56% (N = 157) of our sample obtained competitive employment.

CONCLUSION

Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.

Organizational analysis of Canadian supported employment programs for people with psychiatric disabilities

Supported employment (SE) is widely considered to be the most effective intervention for helping people with psychiatric disabilities integrate into the competitive workforce. While fidelity to principles and standards of evidence-based SE, i.e., the Individual Placement and Support model, is positively associated with vocational outcomes, studies have revealed significant heterogeneity in SE programs implemented in Canada. This qualitative study thus aimed to shed light on organizational and contextual factors influencing SE implementation in three Canadian provinces (British Columbia, Ontario and Quebec). The study adopted several key concepts from the field of organizational studies (e.g., coalitions, archetypes, isomorphism) to guide data collection and analysis. Overall, 20 SE programs provided by 15 different agencies were examined. Findings revealed that agencies' exposure to different institutional pressures, their interactions and relationships with other groups and organizations, as well as their values, beliefs and ideologies played determining roles in shaping the evolution of SE services in each province.

Vocational, social, and cognitive rehabilitation for individuals diagnosed with schizophrenia: a review of recent research and trends

A growing body of evidence suggests that social and vocational interventions effectively enhance social and vocational functioning for individuals with schizophrenia. In this review, we first consider recent advances in vocational and social rehabilitation, then examine current findings on neurocognition, social cognition, and motivation with regard to the impact these elements have on rehabilitation interventions and outcomes. A critical evaluation of recent studies examining standalone treatment approaches and hybrid approaches that integrate components such as cognitive remediation and skills training reveals several ongoing challenges within the field. Greater understanding of the differential impact of various approaches, methods that may increase the magnitude of treatment effects, and the generalization of treatment effects to community functioning are among crucial areas for future research. Overall, these treatments hold promise in improving psychosocial functioning and helping individuals with schizophrenia acquire important life skills.