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Kinn LG, Davidson L, Oedegaard KJ, Langeland E. Struggling with Fitting in: Clients Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10206-x. [PMID: 38782860 DOI: 10.1007/s10926-024-10206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To explore clients' experiences of receiving job support from employment specialists (ESs) working with individual placement and support (IPS) in Norway. IPS is developed to help people with severe mental illness (SMI) into competitive employment as an integral component of mental health services. METHODS Using a hermeneutic phenomenological methodology, this study comprises individual semi-structured interviews with ten participants engaged in IPS at two districts psychiatric centers. Data analysis was conducted according to systematic text condensation. RESULTS Three themes emerged: (1) ES-a door opener? (2) Striving to sidestep a "spider web" of triggers at and away from work; and (3) Calling for a safer route. CONCLUSION This study highlights the importance of ESs offering IPS clients' opportunities to try out diverse jobs and focusing more on assessing the work environment in the jobs they place people into. Our findings imply that ESs should spend more time on building a good working alliance with both clients and employers, and pay more attention on understanding individuals' vocational capacities and support needs at the worksite. The ES training should focus not simply on the technical processes of job development and placement, but more directly on empowering clients to stay focused on their vocational ambitions and prospects. The salutogenic model of health can help ESs to analyze whether clients experience workplaces as meaningful, manageable, and comprehensible.
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Affiliation(s)
- Liv Grethe Kinn
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | | | | | - Eva Langeland
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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2
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Bjørkedal ST, Fisker J, Hellström LC, Hoff A, Poulsen RM, Hjorthøj C, Bojesen AB, Rosenberg NG, Eplov LF. Predictors of return to work for people on sick leave with depression, anxiety and stress: secondary analysis from a randomized controlled trial. Int Arch Occup Environ Health 2023; 96:715-734. [PMID: 36934162 DOI: 10.1007/s00420-023-01968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Knowledge about predictors of return to work (RTW) in people on sick leave with common mental disorders (CMDs) may inform the development of effective vocational rehabilitation interventions for this target group. In this study, we investigated predictors of RTW at 6 and 12 months in people on sick leave with depression, anxiety disorders or stress-related disorders. METHODS We have performed a secondary analysis, utilizing data from two RCTs that evaluated the efficacy of an integrated health care and vocational rehabilitation intervention. Data were obtained from mental health assessments, questionnaires and registers. Using Cox regression analysis, the relationship between baseline variables and RTW was analysed at 6 and 12 months after randomization within the group of CMD as a whole and within the subgroups of depression, anxiety and stress-related disorders. RESULTS Symptom burden and employment status at baseline predicted RTW in the CMD group (n = 1245) and in the three diagnostic subgroups at both time points. RTW self-efficacy predicted RTW in the depression group but not in the anxiety or stress subgroups. CONCLUSION Many predictors of RTW were similar over time and, to some extent, across the CMD subgroups. Findings highlight the need not only to take health-related and psychological factors into account when developing vocational rehabilitation interventions but also to consider workplace strategies and options for support.
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Affiliation(s)
- Siv-Therese Bjørkedal
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark.
| | - Jonas Fisker
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
| | - Lone Christina Hellström
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
| | - Andreas Hoff
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
| | - Rie Mandrup Poulsen
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark.,National Board of Social Services in Denmark, Edisonsvej 1, 5000, Odense, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
| | - Anders Bo Bojesen
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
| | - Nicole Gremaud Rosenberg
- Mental Health Centre Copenhagen, Mental Health Services Capital Region of Denmark, 2200, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Institute for Mental Health [CORE], Mental Health Services Capital Region of Denmark, University of Copenhagen, Gentofte Hospitalsvej 15.4, 2900, Hellerup, Denmark
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3
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Gjerdalen OS, Lystad JU, Bull H, Ringen PA, Røssberg JI, Martinsen EW, Ueland T, Falkum E, Evensen S. Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study. Nord J Psychiatry 2023; 77:23-30. [PMID: 35209785 DOI: 10.1080/08039488.2022.2042598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). METHODS One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n = 64) or CBT (n = 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. RESULTS At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. CONCLUSION To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.
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Affiliation(s)
| | - June Ullevoldsaeter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helen Bull
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of health science, Oslo Metropolitan University, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil W Martinsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
| | - Erik Falkum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
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4
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Johnsen TL, Fyhn T, Jordbru A, Torp S, Tveito TH, Øyeflaten I. Workplace Inclusion of People With Health Issues, Immigrants, and Unemployed Youths—A Qualitative Study of Norwegian Leaders’ Experiences. Front Psychol 2022; 13:687384. [PMID: 35783778 PMCID: PMC9245710 DOI: 10.3389/fpsyg.2022.687384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To explore leaders’ perceptions and experiences of facilitators and barriers for successful workplace inclusion of immigrants, unemployed youths, and people who are outside the labor market due to health issues. Methods Semi-structured individual interviews with 16 leaders who actively engaged in inclusion work, representing different occupations, were conducted. Systematic Text Condensation was used to structure the analysis. Results The participating leaders emphasized that job match, including their perception of workers’ motivation, respect for workplace policies, and the availability of appropriate accommodation at the workplace, facilitated work inclusion. An active public support system providing professional and financial support to workers and leaders was also an important facilitating factor. The leaders emphasized that their perception of workers’ lack of motivation for the job was the most important barrier in their own hiring and inclusion engagement. Successful inclusion depended on all workers acknowledging responsibility for and contributing to an inclusive work environment. Being open and willing to discuss challenges was an important part of making the inclusion work. In addition, leadership qualities, such as empathy, patience, and a non-judgmental attitude, appeared as a hallmark among these leaders who actively engaged in inclusion work. Conclusion Workplace inclusion of this population of marginalized people was facilitated by job match, mutual respect, commitment, and trust, as well as financial and practical support from the public support system. Leaders’ inclusion practices were furthermore affected by personal attitudes and perceptions of social responsibility. Even so, successful workplace inclusion was presented as a two-way street. Leaders have the main responsibility in initiating a respectful and trusting relationship, but both the worker and the leader needs to contribute to make the relationship thrive.
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Affiliation(s)
- Tone Langjordet Johnsen
- Department of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
- NORCE Norwegian Research Centre, Bergen, Norway
- *Correspondence: Tone Langjordet Johnsen,
| | - Tonje Fyhn
- NORCE Norwegian Research Centre, Bergen, Norway
| | - Anika Jordbru
- Department of Sport, Physical Education and Outdoor Life Studies, University of South-Eastern Norway, Borre, Norway
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Borre, Norway
| | - Torill Helene Tveito
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Borre, Norway
| | - Irene Øyeflaten
- NORCE Norwegian Research Centre, Bergen, Norway
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
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5
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Meulenbroek P, O'Neil-Pirozzi TM, Sohlberg MM, Lemoncello R, Byom L, Ness B, MacDonald S, Phillips B. Tutorial: The Speech-Language Pathologist's Role in Return to Work for Adults With Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:188-202. [PMID: 34929113 DOI: 10.1044/2021_ajslp-21-00129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Return to work (RTW) is a major life participation metric used for persons with a traumatic brain injury (TBI). Speech-language pathologists (SLPs) have clinical expertise in the cognitive-communication aspects of TBI. This clinical focus article aims to support the clinical practice of SLPs by summarizing key interprofessional vocational rehabilitation (VR) models and illustrating the role of the SLP throughout the RTW process with a case study. METHOD This clinical focus article was written by the Academy of Neurologic Communication Disorders and Sciences TBI Research Group along with a VR expert. Authors engaged in deliberative, agenda-based discussions beginning with a literature review based on previous systematic studies. Discussions explored relevant VR and SLP practices. RESULTS This clinical focus article presents key VR models in parallel with SLP assessment and treatment to illustrate best practice patterns in an RTW field with a dearth of SLP-specific literature. We summarize general VR approaches and four evidence-supported VR models for adults with TBI. We highlight how a model of interprofessional assessment can assist with planning and communication of important work-related concerns. We illustrate how the chronological model of work return can assist with developing goals and planning treatment. CONCLUSIONS SLPs play an important role in identifying, managing, and collaborating with an RTW team following TBI. A working knowledge of VR models can assist with improving the dialogue between SLPs and VR professionals and can inform practice when working with persons with TBI who have work return as a goal.
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Affiliation(s)
- Peter Meulenbroek
- Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Therese M O'Neil-Pirozzi
- Communication Sciences and Disorders, Northeastern University, Boston, MA
- Spaulding/Harvard Traumatic Brain Injury Model System, Boston, MA
| | | | - Rik Lemoncello
- School of Communication Sciences and Disorders, Pacific University, Forest Grove, OR
| | - Lindsey Byom
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of Chapel Hill, NC
| | - Bryan Ness
- Communication Sciences and Disorders, California Baptist University, Riverside
| | - Sheila MacDonald
- Sheila MacDonald & Associates, University of Toronto, Ontario, Canada
| | - Brian Phillips
- Special Education & Rehabilitation Counseling, Utah State University, Logan
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Holmås TH, Monstad K, Reme SE. Regular employment for people with mental illness - An evaluation of the individual placement and support programme. Soc Sci Med 2021; 270:113691. [PMID: 33465601 DOI: 10.1016/j.socscimed.2021.113691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tor Helge Holmås
- NORCE Norwegian Research Centre, Nygårdsgaten 112, 5008 Bergen, Norway
| | - Karin Monstad
- NORCE Norwegian Research Centre, Nygårdsgaten 112, 5008 Bergen, Norway.
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7
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Abidin MZRZ, Yunus FW, Rasdi HFM, Kadar M. Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review. Br J Occup Ther 2021. [DOI: 10.1177/0308022620980683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Muhammad Zairul Rezal Zainol Abidin
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Farahiyah Wan Yunus
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanif Farhan Mohd Rasdi
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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8
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Johanson S, Markström U, Larsson ME, Bejerholm U. Implementation of a novel return-to-work approach for persons with affective disorders in a traditional vocational rehabilitation context: a case study. Int J Ment Health Syst 2020; 14:22. [PMID: 32206085 PMCID: PMC7079353 DOI: 10.1186/s13033-020-00355-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months. Results Anticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity. Conclusions The IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.
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Affiliation(s)
- Suzanne Johanson
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
| | | | - Maria E Larsson
- 3Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Ulrika Bejerholm
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
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Porter S, Bejerholm U. The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders: outcome of a randomized control trial. Nord J Psychiatry 2018; 72:259-267. [PMID: 29382250 DOI: 10.1080/08039488.2018.1432685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effect of Individual Enabling and Support (IES) on empowerment and depression severity as compared to Traditional Vocational Rehabilitation (TVR) in people with affective disorders at 12 months follow-up. Additionally, longitudinal changes within the intervention groups and the correlation over time between empowerment and depression severity were evaluated. METHOD A single-blind randomized controlled trial of two intervention groups, IES (n = 33) and TVR (n = 28), was performed with measurement points at baseline, 6, and 12 months. Individuals with affective disorders, including depression and bipolar disorder diagnoses were included. The Empowerment Scale and Montgomery-Åsberg Depression Self-Rating Scale were administered, and Intention-To-Treat analysis was applied. The study was registered with the trial number ISRCTN93470551. RESULT There was a statistically significant difference between the intervention groups on empowerment and depression severity at 12 months. Within-group analysis showed that IES-participants increased their perceived empowerment and decreased their depression severity between measurement points, this was not seen among TVR-participants. A moderate, inverse relationship was detected between empowerment and depression. CONCLUSION IES is more effective in increasing empowerment and decreasing depression severity after a 12-month intervention than is TVR. This study was limited by a small sample size and larger trials in different contexts are needed.
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Affiliation(s)
- Susann Porter
- a Department of Health Sciences, Mental Health Activity and Participation Medical Faculty , Lund University , Lund , Sweden
| | - Ulrika Bejerholm
- a Department of Health Sciences, Mental Health Activity and Participation Medical Faculty , Lund University , Lund , Sweden
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10
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Linnemørken LTB, Sveinsdottir V, Knutzen T, Rødevand L, Hernæs KH, Reme SE. Protocol for the Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial investigating the effectiveness of IPS for patients with chronic pain. BMC Musculoskelet Disord 2018; 19:47. [PMID: 29433493 PMCID: PMC5809966 DOI: 10.1186/s12891-018-1962-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Work disability involves large costs to the society as well as to the individual. Work disability is common among people with chronic pain conditions, yet few effective interventions exist. Individual Placement and Support (IPS) is an evidence-based work rehabilitation model originally developed to help people with severe mental illness obtain and maintain employment. The effectiveness of IPS for patients with severe mental illness is well documented, but the model has never before been tested for patients with chronic pain. Methods/design The aim of the IPS in Pain trial is to investigate the effectiveness of IPS as an integrated part of the interdisciplinary treatment for patients with chronic pain in a hospital outpatient clinic. The study is a randomized controlled trial comparing pain treatment with integrated IPS to treatment as usual in unemployed patients suffering from various chronic pain conditions. The primary outcome of the study is labor market participation during 12 months after enrollment, and secondary outcomes include physical and mental health and well-being, collected at baseline, 6, and 12 months. Finally, there will be an additional long-term follow-up for the primary outcome, which will be collected through a brief phone interview at 24 months. Discussion The IPS in Pain trial will be the first report of the effectiveness of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. It will thus provide important information about the effectiveness of repurposing IPS to a new patient group in great need of job support. Trial registration Clinicaltrials.gov: NCT02697656. Registered January 15th, 2016.
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Affiliation(s)
| | | | - Thomas Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
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11
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Rødevand L, Ljosaa TM, Granan LP, Knutzen T, Jacobsen HB, Reme SE. A pilot study of the individual placement and support model for patients with chronic pain. BMC Musculoskelet Disord 2017; 18:550. [PMID: 29282028 PMCID: PMC5746000 DOI: 10.1186/s12891-017-1908-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model. Methods We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study. Results The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment. Conclusions This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.
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Affiliation(s)
- L Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T M Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - L P Granan
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - H B Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - S E Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Postboks 1094 Blindern, 0317, Oslo, Norway.
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12
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Davidson L. Habits and other Anchors of Everyday Life That People with Psychiatric Disabilities May Not Take for Granted. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/15394492070270s108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article argues for the adoption of action theory as the foundation for rethinking psychiatric research and practice as it relates to individuals with serious mental illnesses. Action theory involves viewing human beings as agents who are active in creating their experiences and environments at the same time as they are shaped by them. Rather than following from insight, actions are viewed as preceding and generating insight. When viewed in this manner, the chronicity formerly associated with psychosis is reinterpreted as habits stemming from institutionalization, while recovery is understood as developing new habits based on the person's need to establish caring relationships and focus on being grounded in the present. What results is a strengths-based approach to practice that shares many basic principles with occupational science and therapy, leading us to call for a renewed interest in mental illness among investigators and practitioners within this discipline and profession.
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Sveinsdottir V, Løvvik C, Fyhn T, Monstad K, Ludvigsen K, Øverland S, Reme SE. Protocol for the effect evaluation of Individual Placement and Support (IPS): a randomized controlled multicenter trial of IPS versus treatment as usual for patients with moderate to severe mental illness in Norway. BMC Psychiatry 2014; 14:307. [PMID: 25403470 PMCID: PMC4244061 DOI: 10.1186/s12888-014-0307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Roughly one third of disability pensions in Norway are issued for mental and behavioral disorders, and vocational rehabilitation offered to this group has traditionally been dominated by train-and-place approaches with assisted or sheltered employment. Based on a more innovative place-and-train approach, Individual Placement and Support (IPS) involves supported employment in real-life competitive work settings, and has shown great promise for patients with severe mental illness. METHODS/DESIGN The study is a multicenter Randomized Controlled Trial (RCT) of IPS in a Norwegian context, involving an effect evaluation, a process evaluation, and a cost/benefit analysis. IPS will be compared to high quality treatment as usual (TAU), with labor market participation and educational activity at 12 months post inclusion as the primary outcome. The primary outcome will be measured using register data, and the project will also include complete follow-up up to 4 years after inclusion for long-term outcome data. Secondary outcomes include mental health status, disability and quality of life, collected through survey questionnaires at baseline, and after 6 and 12 months. Participants will include patients undergoing treatment for moderate to severe mental illness who are either unemployed or on sickness or social benefits. The estimated total sample size of 400-500 will be randomly assigned to the interventions. To be eligible, participants must have an expressed desire to work, and sufficient Norwegian reading and writing skills to fill out the questionnaires. DISCUSSION The Effect Evaluation of Individual Placement and Support (IPS) will be one of the largest randomized controlled trials to date investigating the effectiveness of IPS on competitive employment, and the first study to evaluate the effectiveness of IPS for patients with moderate to severe mental illness within a Norwegian context. TRIAL REGISTRATION Clinicaltrials.gov: NCT01964092 . Registered October 16th, 2013.
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Affiliation(s)
| | - Camilla Løvvik
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
| | - Tonje Fyhn
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
| | - Karin Monstad
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Kari Ludvigsen
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Simon Øverland
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Nydalen, POB 4404, Oslo, NO-0403, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
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Aas RW, Tuntland H, Holte KA, Røe C, Lund T, Marklund S, Moller A. Workplace interventions for neck pain in workers. Cochrane Database Syst Rev 2011; 2011:CD008160. [PMID: 21491405 PMCID: PMC6485986 DOI: 10.1002/14651858.cd008160.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Musculoskeletal disorders are the most common cause of disability in many industrial countries. Recurrent and chronic pain accounts for a substantial portion of workers' absenteeism. Neck pain seems to be more prominent in the general population than previously known. OBJECTIVES To determine the effectiveness of workplace interventions (WIs) in adult workers with neck pain. SEARCH STRATEGY We searched: CENTRAL (The Cochrane Library 2009, issue 3), and MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, OTseeker, PEDro to July 2009, with no language limitations;screened reference lists; and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials (RCT), in which at least 50% of the participants had neck pain at baseline and received interventions conducted at the workplace. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. Authors were contacted for missing information. Since the interventions varied to a large extend, International Classification of Functioning, Disability and Health (ICF) terminology was used to classify the intervention components. This heterogeneity restricted pooling of data to only one meta-analysis of two studies. MAIN RESULTS We identified 1995 references and included10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (N = 8) examined office workers. Few workers were sick-listed. Thus, WIs were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short- (OR 0.83, 95% CI 0.52 to 1.34) or long-term (OR 1.28, 95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed. AUTHORS' CONCLUSIONS Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs.
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Affiliation(s)
- Randi Wågø Aas
- International Research Institute of Stavanger (IRIS)Box 8046StavangerNorway4068
| | - Hanne Tuntland
- Bergen University CollegeFaculty of Health and Social SciencesHaugeveien 28BergenNorway5005
| | - Kari Anne Holte
- International Research Institute of Stavanger (IRIS)Box 8046StavangerNorway4068
| | - Cecilie Røe
- Oslo University Hospital UllevålPhysical Medicine and RehabilitationKirkevn 166OsloNorway0407
| | - Thomas Lund
- International Research Institute of Stavanger (IRIS)Box 8046StavangerNorway4068
| | - Staffan Marklund
- Karolinska InstitutetDepartment of Clinical Neuroscience and Division of Insurance MedicineBerzelius väg 3StockholmSweden171 77
| | - Anders Moller
- Nordic School of Public HealthGothenburgSwedenSE‐40242
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Abstract
OBJECTIVE Social Enterprises (SEn) are innovative companies that help disadvantaged people (e.g., individuals with mental disorders) with the work integration process. This study explores the working plan patterns of people with mental disorders employed in SEn. METHODS A cross-sectional design was adopted. One hundred and forty individuals with mental disorders employed in 19 Italian SEn filled out a battery of questionnaires. RESULTS We identified three patterns of working plans: Cluster 1 (n = 39, 30%) showed a stronger intention to work in a competitive labor market; Cluster 2 (n = 16, 12.3%) showed a stronger intention to stop working; Cluster 3 (n = 75, 57.7%) showed a stronger intention to continue working at a SEn. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Most of the sample had a pattern of intentions to keep working, thereby demonstrating the effectiveness of the SEn approach to work integration. Future studies should explore the approach further. Indeed, these results seem important for implications for practice, suggesting that people with mental disorders inside SEn can improve their level of interpersonal skills and reinforce their vocational identity, and ultimately increase their chances of employment in the regular labor market.
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Roder V, Müller DR, Zorn P. Therapieverfahren zu sozialen Fertigkeiten bei schizophren Erkrankten in der Arbeitsrehabilitation. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2006. [DOI: 10.1026/1616-3443.35.4.256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Arbeitsrehabilitation zählt heute zu den zentralen Ansätzen in der Behandlung und Rehabilitation schizophren Erkrankter. Fragestellung: Evaluation eines neu entwickelten manualisierten kognitiven Therapieverfahrens zu sozialen Fertigkeiten für den Arbeitsbereich (Experimentalgruppe, EG). Methode: Ziel der Studie war die EG mit einem herkömmlichen, unspezifischen Sozialen Fertigkeitstraining (Kontrollgruppe, KG) in einem bedingt randomisierten Studiendesign zu vergleichen. Insgesamt nahmen 41 ambulante oder teilstationäre schizophren Erkrankte an der Studie teil. Ergebnisse: Die EG-Patienten erzielten signifikant größere Effekte in Variablen zu Psychopathologie und Therapiemotivation verglichen mit den KG-Patienten. EG und KG unterschieden sich in der kognitiven und sozialen Funktionsfähigkeit nicht signifikant. Eine höhere Therapiemotivation erwies sich als Prädiktor für eine Reduktion negativer Symptome und ein verbessertes soziales Funktionsniveau in der Katamneseerhebung. Zusätzlich nahmen EG-Patienten vermehrt eine kompetitive Arbeit auf als KG-Patienten. Schlussfolgerungen: Der neu entwickelte Therapieansatz (EG) könnte eine effektive zusätzliche Behandlungsmöglichkeit innerhalb einer multimodalen Arbeitsrehabilitation darstellen.
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Affiliation(s)
| | | | - Peter Zorn
- Universitäre Psychiatrische Dienste Bern, Externe Psychiatrische Dienste Liestal
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Corrigan PW, Kerr A, Knudsen L. The stigma of mental illness: Explanatory models and methods for change. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.appsy.2005.07.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Twamley EW, Jeste DV, Lehman AF. Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. J Nerv Ment Dis 2003; 191:515-23. [PMID: 12972854 DOI: 10.1097/01.nmd.0000082213.42509.69] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although most individuals with schizophrenia are unemployed, plentiful evidence suggests that work rehabilitation is effective for this population. Yet, there have been only 11 published randomized controlled trials of work rehabilitation interventions for people with severe mental illness. We review these 11 studies, 9 of which were trials examining Individual Placement and Support (IPS) or supported employment (SE) interventions. Outcomes strongly favored the experimental groups in terms of the percentage of participants who worked at any point during the studies (weighted mean effect size = 0.66). In the 5 investigations comparing IPS/SE to conventional vocational rehabilitation services, 51% of the participants receiving IPS/SE worked competitively, versus 18% of those in the comparison groups (weighted mean effect size = 0.79). This effect size may be a useful benchmark for future trials. Further investigations should examine individual differences as predictors of response, to identify modifiable versus nonmodifiable factors that yield better outcomes.
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Affiliation(s)
- Elizabeth W Twamley
- University of California, San Diego, Department of Psychiatry, San Diego, CA 92161, USA
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