Employment predictors and outcomes of U.S. state-federal vocational rehabilitation consumers with affective disorders: A CHAID analysis

The Impact of Work Incentives Benefits Counseling on Employment Outcomes: A National Vocational Rehabilitation Study

BACKGROUND

Millions of Americans receiving Social Security Administration (SSA) disability benefits aspire to work and reduce reliance on disability benefits, but find the rules about entering or rejoining the workforce too complex or confusing and fear that working will cause loss of important benefits.

PURPOSE

A case control study was conducted to investigate the impact of receiving work incentives benefits counseling (WIBC) on employment outcomes, and its relationship with demographic covariates for U.S. vocational rehabilitation (VR) clients who are SSA disability benefit recipients.

METHOD

Data for this study were extracted from the Rehabilitation Service Administration (RSA-911) database. Mahalanobis distance matching procedures were used to match clients who received WIBC with those who did not receive it. Chi-square independence tests and independent samples t tests were used to compare receipt of WIBC and employment outcomes based on the demographic variables. Additionally, chi squared automatic interaction detection (CHAID) analysis was used to divide VR clients into homogeneous groups based on the covariates.

RESULTS

Clients who received WIBC were more likely to obtain competitive integrated employment (CIE). Impairment type, referral source, long-term employment and education level were significantly associated with CIE for clients who received WIBC. Additionally, VR clients with sensory/communicative impairments and low-income status were less likely to receive WIBC.

CONCLUSION

Modifying VR structure to be more inclusive; understanding of stigma; and increasing the functioning, psychological well-being and self-efficacy of VR clients might improve employment outcomes.

Job retention for people with bipolar disorder: A qualitative analysis

At least half of people with bipolar disorder, whose global prevalence is greater than 1% of the general population, do not have a stable occupation. The objective of this study is to identify the factors perceived by bipolar people as having an impact on retention in employment. Semi-directed individual interviews were offered to subjects with bipolar disorder, of working age, who had been seen by three different hospital departments in the south of France. These people had to be medically stable and have at least one occupational experience. Each interview was recorded and transcribed manually and then analyzed according to a thematic classification of verbatims. Nineteen people participated in the interviews. Three major themes identified were classified into intrinsic (working routine and working environment) and extrinsic (external aids) factors for the bipolar person. The majority believe that working regular hours is a balancing factor. For everyone, night work and stress factors can lead to relapses. All stressed the need to destigmatize the disease. Most believe that it is necessary to develop employment support organizations specific to mental illnesses. This research helps to inform people with bipolar disorder about the occupational factors that help balance their condition. Personalized multidisciplinary care pathways involving occupational medicine must be developed in order to promote the balance of the disease and job retention.

Determinants of compulsory hospitalisation at admission and in the course of inpatient treatment in people with mental disorders-a retrospective analysis of health records of the four psychiatric hospitals of the city of Cologne

BACKGROUND

We aimed to identify differences in predictors of involuntary psychiatric hospitalisation depending on whether the inpatient stay was involuntary right from the beginning since admission or changed from voluntary to involuntary in the course of in-patient treatment.

METHODS

We conducted an analysis of 1,773 mental health records of all cases treated under the Mental Health Act in the city of Cologne in the year 2011. 79.4% cases were admitted involuntarily and 20.6% were initially admitted on their own will and were detained later during the course of in-patient stay. We compared the clinical, sociodemographic, socioeconomic and environmental socioeconomic data (ESED) of the two groups. Finally, we employed two different machine learning decision-tree algorithms, Chi-squared Automatic Interaction Detection (CHAID) and Random Forest.

RESULTS

Most of the investigated variables did not differ and those with significant differences showed consistently low effect sizes. In the CHAID analysis, the first node split was determined by the hospital the patient was treated at. The diagnosis of a psychotic disorder, an affective disorder, age, and previous outpatient treatment as well as the purchasing power per 100 inhabitants in the living area of the patients also played a role in the model. In the Random Forest, age and the treating hospital had the highest impact on the accuracy and decrease in Gini of the model. However, both models achieved a poor balanced accuracy. Overall, the decision-tree analyses did not yield a solid, causally interpretable prediction model.

CONCLUSION

Cases with detention at admission and cases with detention in the course of in-patient treatment were largely similar in respect to the investigated variables. Our findings give no indication for possible differential preventive measures against coercion for the two subgroups. There is no need or rationale to differentiate the two subgroups in future studies.

Determinants of employment outcomes of transition-age youth with depressive disorders

BACKGROUND: Transition-age youth (TAY) with depressive disorders struggle with finding and retaining gainful employment. Thousands of these youth enroll in the state-federal vocational rehabilitation (VR) program each year to improve their employment outcomes. However, there is a dearth of information on the factors that facilitate or impede their success in the program. OBJECTIVE: The study aims to shed light on the effects of demographic characteristics and vocational rehabilitation services on successful employment and earnings of TAY with depressive disorders in the state-federal VR program. METHOD: The sample comprised of 4,772 participants drawn from the Rehabilitation Services Administration dataset. Regression analyses were employed to examine the effects of demographic characteristics and vocational rehabilitation services on successful employment and earnings. RESULTS: Results indicated that employment outcomes varied by demographic characteristics such as race/ethnicity, severity of disability and level of education. Also, certain VR services had significant positive or negative relationships with successful employment and earnings. CONCLUSIONS: Highlighting the promise of the state-federal programs for supporting TAY with depressive disorders to successfully participate in the labor market, findings from this study expand upon the literature by suggesting practices and services for optimizing employment potentials of this population.

Factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS): A study on persons with serious mental illness living in the community

OBJECTIVES

Resilience, the ability to bounce back from a stressful situation, is a valuable asset for aiding adults with serious mental illness (SMI) in navigating the recovery process. People with SMI experience stress, including traumatic experiences at disproportionate rates. The purposes of this study were to examine the factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS) among adults with SMI living in the community.

DESIGN

A cross-sectional survey design was used. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlational analyses were employed.

METHODS

Three hundred fifteen adults with SMI were recruited for two studies (Sample 1, n = 122; Sample 2, n = 193) from three states. All participants completed the BRS along with nearly identical positive psychology- and psychopathology-related measures.

RESULTS

EFA revealed the BRS was unidimensional and explained 61.20% of the variance. Results from seven CFA models suggested a bifactor structure for the BRS, which fit the data best. Internal reliability of the BRS was computed to be within acceptable ranges (α = .87, ω = .90). The BRS was positively correlated with measures of positive coping and life satisfaction, providing convergent validity. Divergent validity was supported by negative correlations between the BRS and measures of psychiatric symptoms, succumbing, and self-stigma.

CONCLUSIONS

The BRS is a valid measure that can be used by clinical and research professionals to assess levels of resilience in adults with SMI at baseline and across time.

PRACTITIONER POINTS

The Brief Resilience Scale (BRS) was developed to measure a person's ability to bounce back from stressful situations. The BRS was examined in adults with serious mental illness living in the community. The BRS presented a bifactor structure measuring resilience (an outcome) and correlated with positive psychology- and psychopathology-related measures. The BRS can be used by practitioners to assess levels of resilience in their clients at baseline and over time to evaluate the effectiveness of therapeutic interventions.

Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study

The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.

Testing Kumpfer’s Resilience Model Among Adults With Serious Mental Illness

Having a serious mental illness (SMI) is often associated with significant adversities, and people respond differently to adversities. The existing research supports that people with SMI can achieve and maintain positive life outcomes despite experiencing adversities. Resilience, the ability to cope with (or bounce back quickly from) crisis, can help buffer the negative effects of various types of adversities, including chronic illness and disability, and facilitate the psychosocial adaptation process to SMI. Kumpfer’s resilience model, a person-process-context framework, has been widely used to conceptualize, and assess for, resilience in various populations, including people with chronic illnesses and disabilities. However, the research in resilience among people with SMI is very limited. The purpose of this study was to empirically assess the utility of Kumpfer’s resilience model and its proposed predictive components for conceptualizing the adaptation process to SMI. One hundred forty-four participants completed a Qualtrics survey containing demographic questions and a series of validated instruments representing the major components of Kumpfer’s resilience model. Hierarchical regression analysis was used to analyze the data, and the final model explained 71% of the variance of the dependent variable—adaptation to disability. Avoidance coping, internalized stigma, and optimism were significant independent predictors of adaptation to disability. This study supports the utilization of Kumpfer’s resilience model to conceptualize the adaptation to disability process among people with SMI. Implications for rehabilitation counseling practices are discussed.

Predictors of employment in people with moderate to severe mental illness participating in a randomized controlled trial of Individual Placement and Support (IPS)

BACKGROUND

Many people with moderate to severe mental illness have a desire to obtain ordinary employment. To aid further development of health and social services for this group, the aim of this study was to examine candidate modifiable and prognostic markers of employment, and moderating effects of group allocation in a clinical trial.

METHOD

The sample consists of 327 patients in treatment for mental illness, randomized to Individual Placement and Support (IPS) or treatment as usual (TAU) as part of a clinical trial. Psychosocial and demographic baseline characteristics were included as predictors in log binary regression analyses with employment 18 months after inclusion as the outcome, and group allocation as the moderator (IPS or TAU).

RESULTS

Directive emotional support and non-directive instrumental support seemed to positively predict employment, but effects were small. Involuntary hospitalization seemed to be a strong negative predictor of employment. Group allocation did not moderate any main effects.

CONCLUSION

Interpretation of the findings suggest that attention should be given to certain aspects of health and social services provided to this target group, and in particular the effect of receiving appropriate types of social support. The findings are novel because social support and involuntary hospitalization do not seem to have been included in previous predictor studies. The results from this study identify new topics for research on employment outcomes for this population.

Predicting Recovery in Individuals With Serious Mental Illness: Expanding the International Classification of Functioning, Disability, and Health (ICF) Framework

People with psychiatric disabilities experience significant impairment in fulfilling major life roles due to the severity of their mental illness. Recovery for people with serious mental illness (SMI) can be a long, arduous process, impacted by various biological, functional, sociological, and psychological factors which can present as barriers and/or facilitators. The purposes of this study were to: (a) investigate the International Classification of Functioning, Disability, and Health (ICF) framework’s ability to predict recovery in adults with SMI and (b) determine to what extent the ICF constructs in the empirical model explain the variance in recovery. Participants ( N = 192) completed a sociodemographic questionnaire and various measures representing all predictor and outcome variables. Results from hierarchical regression analysis with six sets of predictors entered sequentially (1 = personal factors-demographics, 2 = body functions-mental, 3 = activity-capacity, 4 = environmental factors, 5 = personal factors-characteristics, and 6 = participation-performance) accounted for 75% (large effect) of the variance in recovery. Controlling for all factors, by order of salience, higher levels of significant other support, education, executive function impairment, and social self-efficacy; primary, non-bipolar SMI diagnosis; greater resilience; lower levels of explicit memory-health impairment, affective self-stigma, and cognitive self-stigma; being younger; fewer self-care limitations; less severe psychiatric symptoms; and being unemployed and unmarried were found to significantly predict recovery. Findings support the validation of the ICF framework as a biopsychosocial recovery model and the use of this model in the development of effective recovery-oriented interventions for adults with SMI. Clinical and research implications are discussed.

The Assessment of Recovery Capital (ARC) predicts substance abuse treatment completion

Recovery from addiction requires various personal and environmental resources. The purposes of this study were to determine if the Assessment of Recovery Capital (ARC) scores measured at admission could predict substance abuse treatment (SAT) completion and to identify personal and environmental factors associated with ARC scores. Participants (N = 2265) comprised clients entering a Midwestern SAT facility (August 2015 - June 2017). Logistic regression was used to predict SAT completion using ARC scores. Nonparametric group comparisons were used for personal and environmental covariates. ARC scores significantly predicted successful SAT completion (OR = 1.05, 95% CI = 1.04, 1.05, Wald z = 12.9, p < 0.001). Employment had a positive relationship with ARC scores (Kruskal-Wallis χ² = 215.96, df = 8, p < 0.001). ARC scores varied according to primary substance (Kruskal-Wallis χ² = 101.10, df = 6, p < 0.001); alcohol and marijuana showed the highest scores and heroin the lowest. ARC scores decreased as number of problem substances increased (Kruskal-Wallis χ² = 70.57, df = 2, p < 0.001, r_S = -0.163, p < 0.001). Living arrangement was also significant (Kruskal-Wallis χ² = 146.36, df = 8, p < 0.001); clients who were homeless had the lowest ARC scores. A number of personal and environmental covariates were associated with the ARC scores and potentially with the outcome. After adjustment, the ARC remained a strong predictor of SAT completion. The ARC should be used in SAT facilities to guide treatment decisions and to create individualized treatment plans for clients.

A retrospective analysis of determinants of involuntary psychiatric in-patient treatment

BACKGROUND

The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment.

METHODS

We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID).

RESULTS

Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered.

CONCLUSIONS

We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.