1
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Witte I, Strandberg T, Granberg S, Gustafsson J. Intersectional perspectives on the employment rate in Supported Employment for people with psychiatric, neuropsychiatric, or intellectual disabilities: A scoping review. Work 2023; 74:435-454. [PMID: 36278382 PMCID: PMC9986703 DOI: 10.3233/wor-211155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention. OBJECTIVE To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history. METHODS A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included. RESULTS The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power. CONCLUSIONS Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.
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Affiliation(s)
- Ingrid Witte
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Thomas Strandberg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sarah Granberg
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Gustafsson
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway
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2
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Ottomanelli L, Goetz LL, O'Neill J, Lauer E, Dyson-Hudson T. 30 Years After the Americans with Disabilities Act: Perspectives on Employment for Persons with Spinal Cord Injury. Phys Med Rehabil Clin N Am 2020; 31:499-513. [PMID: 32624107 DOI: 10.1016/j.pmr.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Americans with Disabilities Act, passed in 1990, represented landmark legislation and led to significant improvements in accessibility, such as prohibiting discrimination based on disability in public life, including employment. Now 30 years later, however, employment rates for persons with disabilities, including spinal cord injury, remain low. This article discusses why employment is so important for persons with spinal cord injury and challenges that remain. Presented are previously unpublished employment data from a nationally representative US sample. Finally, the state of the art of vocational rehabilitation, including models proven to facilitate this critical rehabilitation outcome, is discussed.
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Affiliation(s)
- Lisa Ottomanelli
- Research Service (151R), James A. Haley Veterans' Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33637, USA; Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, 4202 E. Fowler Ave, Tampa, FL 33620, USA.
| | - Lance L Goetz
- Spinal Cord Injury and Disorders (128), Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - John O'Neill
- Center for Employment and Disability Research, Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ 07936, USA
| | - Eric Lauer
- Institute on Disability/University Centers for Excellence in Disabilities Education, Research, and Service, College of Health and Human Services, University of New Hampshire, 10 West Edge Drive, Suite 101, Durham, NH 03824, USA
| | - Trevor Dyson-Hudson
- Center for Spinal Cord Injury Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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3
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How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic model. Clin Psychol Rev 2020; 76:101815. [DOI: 10.1016/j.cpr.2020.101815] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 01/16/2023]
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4
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Richter D, Hoffmann H. Effectiveness of supported employment in non-trial routine implementation: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:525-531. [PMID: 30078035 DOI: 10.1007/s00127-018-1577-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/30/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE While supported employment (SE) programs for people with mental illness have demonstrated their superiority in randomized controlled trials (RCTs) and meta-analyses, little is known about the effectiveness of non-trial routine programs. The primary objective of this study was to estimate a pooled competitive employment rate of non-trial SE programs by means of a meta-analysis. A secondary objective was to compare this result to competitive employment rates of SE programs in RCTs, prevocational training programs in RCTs and in routine implementation. METHODS A systematic review and a random-effects meta-analysis of proportions were conducted. Quality assessment was provided. Moderator analyses by subgroup comparisons were conducted. RESULTS Results from 28 samples were included in the meta-analysis. The pooled competitive employment rate for SE routine programs was 0.43 (95% CI 0.37-0.50). The pooled competitive employment rates for comparison conditions were: SE programs in RCTs: 0.50 (95% CI 0.43-0.56); prevocational programs in RCTs: 0.22 (95% CI 0.16-0.28); prevocational programs in routine programs: 0.17 (95% CI 0.11-0.23). SE routine studies conducted prior to 2008 showed a significantly higher competitive employment rate. CONCLUSION SE routine programs lose only little effectiveness compared to SE programs from RCTs but are much more successful in reintegrating participants into the competitive labor market than prevocational programs. Labor market conditions have to be taken into account when evaluating SE programs.
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Affiliation(s)
- Dirk Richter
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland. .,Health Division, Bern University of Applied Sciences, Bern, Switzerland.
| | - Holger Hoffmann
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland.,Soteria, Bern, Switzerland
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5
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Rodríguez Pulido F, Caballero Estebaranz N, Tallo Aldana E, Méndez Abad ME, Hernández Álvarez-Sotomayor MC, López Reig S, Vílchez de León PI, González-Dávila E. Efectividad de una estrategia de apoyo individualizado al empleo para personas con trastornos mentales graves. GACETA SANITARIA 2018; 32:513-518. [DOI: 10.1016/j.gaceta.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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6
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Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J. Individual placement and support: from research to
practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vocational rehabilitation for people with severe mental health problems is
poorly developed in the UK. Although there is a clear evidence base
indicating the effectiveness of approaches to helping people with severe
mental health problems gain and retain employment there is generally a lack
of awareness of this evidence. As a result there has been a lack of
implementation within routine clinical practice of the most effective
approaches to improving employment outcomes for such individuals.
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7
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Wan Kasim SH, Midin M, Abu Bakar AK, Sidi H, Nik Jaafar NR, Das S. Employment program for patients with severe mental illness in Malaysia: a 3-month outcome. Compr Psychiatry 2014; 55 Suppl 1:S38-45. [PMID: 23602390 DOI: 10.1016/j.comppsych.2013.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 02/17/2013] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to examine the rate and predictive factors of successful employment at 3 months upon enrolment into an employment program among patients with severe mental illness (SMI). METHODS A cross-sectional study using universal sampling technique was conducted on patients with SMI who completed a 3-month period of being employed at Hospital Permai, Malaysia. A total of 147 patients were approached and 126 were finally included in the statistical analyses. Successful employment was defined as the ability to work 40 or more hours per month. Factors significantly associated with successful employment from bivariate analyses were entered into a multiple logistic regression analysis to identify predictors of successful employment. RESULTS The rate of successful employment at 3 months was 68.3% (n=81). Significant factors associated with successful employment from bivariate analyses were having past history of working, good family support, less number of psychiatric admissions, good compliance to medicine, good interest in work, living in hostel, being motivated to work, satisfied with the job or salary, getting a preferred job, being in competitive or supported employment and having higher than median scores of PANNS on the positive, negative and general psychopathology. Significant predictors of employment, from a logistic regression model were having good past history of working (p<0.021; OR 6.12; [95% CI 2.1-11.9]) and getting a preferred job (p<0.032; [OR 4.021; 95% CI 1.83-12.1]). CONCLUSION Results showed a high employment rate among patients with SMI. Good past history of working and getting a preferred job were significant predictors of successful employment.
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Knapp M, Patel A, Curran C, Latimer E, Catty J, Becker T, Drake RE, Fioritti A, Kilian R, Lauber C, Rössler W, Tomov T, van Busschbach J, Comas-Herrera A, White S, Wiersma D, Burns T. Supported employment: cost-effectiveness across six European sites. World Psychiatry 2013; 12:60-8. [PMID: 23471803 PMCID: PMC3619176 DOI: 10.1002/wps.20017] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment.
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Affiliation(s)
- Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political ScienceHoughton Street, London, WC2A 2AE, UK,Centre for the Economics of Mental and Physical Health, King's College London, Institute of PsychiatryDe Crespigny Park, London, SE5 8AF, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, King's College London, Institute of PsychiatryDe Crespigny Park, London, SE5 8AF, UK
| | - Claire Curran
- Personal Social Services Research Unit, London School of Economics and Political ScienceHoughton Street, London, WC2A 2AE, UK
| | - Eric Latimer
- Division of Social and Transcultural PsychiatryMontreal, Quebec, H3A 1A1 Canada
| | - Jocelyn Catty
- Division of Mental Health, St. George's, University of LondonLondon, UK
| | - Thomas Becker
- Department of Psychiatry II, University of UlmBKH Günzburg, Germany
| | - Robert E Drake
- New Hampshire-Dartmouth Psychiatric Research CentreLebanon, NH, USA
| | | | - Reinhold Kilian
- Department of Psychiatry II, University of UlmBKH Günzburg, Germany
| | - Christoph Lauber
- Institute of Psychology, Health and Society, University of LiverpoolLiverpool, L69 3GL, UK
| | - Wulf Rössler
- Psychiatric University HospitalZürich, Switzerland
| | - Toma Tomov
- Institute of Human RelationsSofia, Bulgaria
| | | | - Adelina Comas-Herrera
- Personal Social Services Research Unit, London School of Economics and Political ScienceHoughton Street, London, WC2A 2AE, UK
| | - Sarah White
- Division of Mental Health, St. George's, University of LondonLondon, UK
| | - Durk Wiersma
- Psychiatry Department, University HospitalGroningen, Netherlands
| | - Tom Burns
- University Department of PsychiatryWarneford Hospital, Oxford, UK
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9
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A prospective examination of the impact of a supported employment program and employment on health-related quality of life, handicap, and disability among Veterans with SCI. Qual Life Res 2013; 22:2133-41. [PMID: 23345022 DOI: 10.1007/s11136-013-0353-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
PURPOSES To investigate impact of participation in a supported employment program and impact of employment itself on health-related quality of life (HRQOL), disability, and handicap among Veterans with spinal cord injury (SCI). METHODS We used a prospective, randomized, controlled, multi-site trial of supported employment (SE) versus treatment as usual (TAU) for vocational issues. Subjects were 157 Veterans with SCI who received either SE or TAU for vocational issues. Outcomes were examined in terms of type of vocational treatment received and whether competitive employment was obtained. Outcomes investigated were HRQOL as measured by the Veterans RAND 36-item health survey (VR-36), handicap as measured by the Craig Handicap Assessment and Reporting Technique (CHART), and disability as measured by the functional independence measure (FIM). Subjects were assessed at baseline and at 3, 6, 9, and 12 months. RESULTS There were no significant differences between Veterans who participated in SE compared to those who received TAU in study measures. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. There were no observed differences in VR-36 scores or FIM scores for those obtaining competitive employment. CONCLUSION(S) This study suggests that employment has a positive effect on an individual's ability to participate in social relationships, move about their home and community, and spend time in productive and usual roles. Inability to detect differences across other domains of handicap or any changes in HRQOL may have been due to several factors including level and intensity of employment, insufficient follow-up period, or measurement limitations.
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10
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Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths. Community Ment Health J 2012; 48:490-502. [PMID: 21964720 DOI: 10.1007/s10597-011-9440-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 09/24/2011] [Indexed: 10/17/2022]
Abstract
Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.
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11
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Sun AP. Helping homeless individuals with co-occurring disorders: the four components. SOCIAL WORK 2012; 57:23-37. [PMID: 22768626 DOI: 10.1093/sw/swr008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless individuals with co-occurring disorders (CODs) of severe mental illness and substance use disorder are one of the most vulnerable populations. This article provides practitioners with a framework and strategies for helping this client population. Four components emerged from a literature review: (1) ensuring an effective transition for individuals with CODs from an institution (such as a hospital, foster care, prison, or residential program) into the community, a particularly important component for clients who were previously homeless, impoverished, or at risk of homelessness; (2) increasing the resources of homeless individuals with CODs by helping them apply for government entitlements or supported employment (3) linking homeless individuals to supportive housing, including housing first options as opposed to only treatment first options, and being flexible in meeting their housing needs; and (4) engaging homeless individuals in COD treatment, incorporating modified assertive community treatment, motivational interviewing, cognitive-behavioral therapy, contingency management, and COD specialized self-help groups.
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Affiliation(s)
- An-Pyng Sun
- School of Social Work, University of Neveda, Las Vegas, Nevada 89154-5032, USA.
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12
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Ferguson KM, Xie B, Glynn S. Adapting the Individual Placement and Support Model with Homeless Young Adults. CHILD & YOUTH CARE FORUM 2011. [DOI: 10.1007/s10566-011-9163-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Bejerholm U. Relationships between occupational engagement and status of and satisfaction with sociodemographic factors in a group of people with schizophrenia. Scand J Occup Ther 2011; 17:244-54. [PMID: 19929266 DOI: 10.3109/11038120903254323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study is part of a larger project investigating occupational engagement and health in a group of people with schizophrenia. This study was aimed at extending this knowledge base with regard to occupational engagement and sociodemographic factors. Seventy-four outpatients participated in the study. The Profile of Occupational Engagement in People with Schizophrenia, the Lancashire Quality of Life Profile scale and a standardized questionnaire were used to gather data. Contrary to what was expected, occupational engagement was not associated with a certain type of schizophrenia, being younger or older, or gender. The results showed that a high level of occupational engagement was related to greater satisfaction with the participants' social and living situation, having a reliable alliance and a close friend, school-leaving age, living in a flat, and working or studying. Satisfaction with living independently, having had a recent experience of accomplishment, and working together explained 55% of the variance in occupational engagement. Occupational therapists should thus focus on and promote social engagement appropriate to the client's level of engagement, the client's opportunity and ability to work, his/her experience of accomplishment, and, most importantly, satisfaction with the home and living situation.
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Affiliation(s)
- Ulrika Bejerholm
- The Vårdal Institute, Swedish Institute for Health Sciences, Lund University, Sweden.
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14
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Statewide initiative of intensive psychiatric rehabilitation: outcomes and relationship to other mental health service use. Psychiatr Rehabil J 2011; 35:9-19. [PMID: 21768073 DOI: 10.2975/35.1.2011.9.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs. METHODS This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores. RESULTS The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.
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15
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Predictors of referral to Supported Employment among consumers with co-occurring mental and substance use disorders. Community Ment Health J 2009; 45:427-38. [PMID: 19768541 DOI: 10.1007/s10597-009-9242-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
Abstract
Clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining competitive employment. However, little is known about the factors related to consumers' decisions to pursue employment, especially for consumers with co-occurring substance and mental disorders. This study examines the demographic, socioeconomic and illness characteristics of consumers referred for Supported Employment services. Consumers were drawn from Integrated Dual Diagnosis Treatment programs in four community mental health agencies. Study participants included 113 consumers referred for Supported Employment services and 78 randomly selected non-referred consumers as the comparison group. Results suggest that consumers who have past work experience are more likely to be referred to Supported Employment, while consumers who perceive themselves as disabled or who are diagnosed as substance dependent are less likely to be referred to Supported Employment. Implications for agency practice and future research are discussed.
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16
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Ottomanelli L, Lind L. Review of critical factors related to employment after spinal cord injury: implications for research and vocational services. J Spinal Cord Med 2009; 32:503-31. [PMID: 20025147 PMCID: PMC2792457 DOI: 10.1080/10790268.2009.11754553] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Employment rates after spinal cord injury (SCI) vary widely because of discrepancies in studies' definition of employment and time of measurement. The objective of this study was to provide a comprehensive summary of the literature on employment rates, predictors of employment, and the benefits and barriers involved. METHODS A search using the terms spinal cord injury and employment in the databases PubMed, PsycINFO, and MEDLINE. The search included a review of published manuscripts from 1978 through 2008. RESULTS A total of 579 articles were found and reviewed to determine the presence of reported employment rates. Of these, 60 articles were found to include a report of employment rates for individuals with SCI. Results indicated that, in studies that examined paid employment, the average rate of any employment after SCI was approximately 35%. CONCLUSIONS Characteristics associated with employment after SCI include demographic variables, injury-related factors, employment history, psychosocial issues, and disability benefit status. It is recommended that researchers studying employment after SCI use common outcome measures such as competitive employment rates, duration of employment, and job tenure. Empirical evidence is lacking in regard to the most effective methods of vocational rehabilitation among this population. Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment. Controlled studies are needed to test this assumption.
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Affiliation(s)
- Lisa Ottomanelli
- Department of Psychology, VA North Texas Health Care System, 4500 S. Lancaster Road (128), Dallas, TX 75216, USA.
| | - Lisa Lind
- University of Texas Southwestern Medical School, Dallas, Texas
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17
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Waghorn G, Lloyd C, Clune A. Reviewing the Theory and Practice of Occupational Therapy in Mental Health Rehabilitation. Br J Occup Ther 2009. [DOI: 10.1177/030802260907200708] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes. These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success. This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.
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Affiliation(s)
- Geoff Waghorn
- Queensland Centre for Mental Health Research, Sumner Park BC, Queensland, Australia
| | - Chris Lloyd
- Queensland Centre for Mental Health Research, Sumner Park BC, Queensland, Australia
| | - Alexis Clune
- University of Queensland, St Lucia, Queensland, Australia
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18
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Yanos PT, Vreeland B, Minsky S, Fuller RB, Roe D. Partial Hospitalization. J Psychosoc Nurs Ment Health Serv 2009; 47:41-7. [DOI: 10.3928/02793695-20090201-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Zito W, Greig TC, Wexler BE, Bell MD. Predictors of on-site vocational support for people with schizophrenia in supported employment. Schizophr Res 2007; 94:81-8. [PMID: 17512172 PMCID: PMC1986779 DOI: 10.1016/j.schres.2007.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 03/22/2007] [Accepted: 03/26/2007] [Indexed: 11/16/2022]
Abstract
This study examined predictors of intensity of vocational specialist support for clients with schizophrenia or schizoaffective disorder in supported employment. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were recruited from a community mental health center for 12 months of vocational and cognitive rehabilitation. Neuropsychological test scores, symptom ratings, illness severity, and employment history were used to predict vocational support intensity, expressed as hours coached in ratio to total hours worked over 12 months for each client. Weekly work hours were inversely correlated with intensity of vocational support. Half of the sample averaged 10 to 40 h of work per week and received significantly lower proportions of on-site job coaching than the lowest quartile, which averaged 2 to 5 h of work per week. Regressions predicting support intensity from neuropsychological composite scores, educational/vocational, and hospitalization history were not significant. Significant regressions included PANSS, SANS, and SAPS subscales, after which individual symptoms responsible for explained variance were isolated. SANS social inattention and PANSS active avoidance together predicted 23% of the variance in support intensity. A one-way ANOVA comparing work participation quartiles on these symptoms revealed significantly higher levels of active avoidance and social inattention for participants working less than 10 h per week. A profile emerged of the high intensity client as a socially inattentive or avoidant individual requiring a limited work schedule. Results suggest that these clients require more specialist contact because of failure to adequately engage natural supports at work.
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Affiliation(s)
- Wayne Zito
- Yale University School of Medicine, Department of Psychiatry, 34 Park St., New Haven, CT 06519, United States.
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Schizophrénie et réadaptation. Interventions spécifiques selon les phases de la maladie. ANNALES MEDICO-PSYCHOLOGIQUES 2006. [DOI: 10.1016/j.amp.2006.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rapp CA, Bond GR, Becker DR, Carpinello SE, Nikkel RE, Gintoli G. The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Ment Health J 2005; 41:347-63. [PMID: 16131012 DOI: 10.1007/s10597-005-5008-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The role of state mental health authorities (SMHA) is critical to implementing and sustaining evidence-based practices. This paper describes the seven major tasks of SMHA's that comprise that role and provides examples from states which have been actively pursuing evidence-based practices.
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Affiliation(s)
- Charles A Rapp
- University of Kansas School of Social Welfare, 1545 Lilac Lane, Lawrence, KS, USA.
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MARRONE JOE. Creating Hope Through Employment for People Who are Homeless or in Transitional Housing. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2005. [DOI: 10.1080/15487760590953939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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MARRONE JOE, FOLEY SUSAN, SELLECK VIRGINIA. How Mental Health and Welfare to Work Interact: The Role of Hope, Sanctions, Engagement, and Support. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2005. [DOI: 10.1080/15487760590953911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mueser KT, Clark RE, Haines M, Drake RE, McHugo GJ, Bond GR, Essock SM, Becker DR, Wolfe R, Swain K. The Hartford Study of Supported Employment for Persons With Severe Mental Illness. J Consult Clin Psychol 2004; 72:479-90. [PMID: 15279531 DOI: 10.1037/0022-006x.72.3.479] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, PSR, or standard services and followed for 2 years. Clients in IPS had significantly better employment outcomes than clients in PSR and standard services, including more competitive work (73.9% vs. 18.2% vs. 27.5%, respectively) and any paid work (73.9% vs. 34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI.
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Affiliation(s)
- Kim T Mueser
- New Hampshire-Dartmouth Psychiatric Research Center, Dartmouth Medical School, Concord 03301, USA.
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Abstract
Supported employment for people with severe mental illnesses is an evidence-based practice, based on converging findings from 4 studies of the conversion of day treatment to supported employment and 9 randomized controlled trials comparing supported employment to a variety of alternative approaches. These two lines of research suggest that between 40% and 60% of consumers enrolled in supported employment obtain competitive employment while less than 20% of similar consumers do so when not enrolled in supported employment. Consumers who hold competitive jobs for a sustained period of time show benefits such as improved self-esteem and better symptom control, although by itself, enrollment in supported employment has no systematic impact on nonvocational outcomes, either on undesirable outcomes, such as rehospitalization, or on valued outcomes, such as improved quality of life. The psychiatric rehabilitation field has achieved consensus on a core set of principles of supported employment, although efforts continue to develop enhancements. A review of the evidence suggests strong support for 4 of 7 principles of supported employment, while the evidence for the remaining 3 is relatively weak. Continued innovation and research on principles is recommended.
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Affiliation(s)
- Gary R Bond
- Department of Psychology, Indiana University Purdue University, Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202-3275, USA.
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The program of assertive community treatment: Implementation and dissemination of an evidence-based model of community-based care for persons with severe and persistent mental illness. COGNITIVE AND BEHAVIORAL PRACTICE 2003. [DOI: 10.1016/s1077-7229(03)80047-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE This study sought to describe the New Hampshire incentive financing policy and report on its results over the first seven years. METHODS The description of the policy was based on reviewing state documents and interviews with state officials. The data were obtained from state records. RESULTS On the targeted outcomes of employment and psychiatric hospitalization the statewide improvement was dramatic. The service system concurrently became more efficient. CONCLUSION The results suggest the incentive financing based on client outcomes may be a potent state strategy for improving service system performance.
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Affiliation(s)
- Charles A Rapp
- School of Social Welfare, University of Kansas, Lawrence 66044-3184, USA.
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Latimer EA. Economic impacts of supported employment for persons with severe mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:496-505. [PMID: 11526805 DOI: 10.1177/070674370104600603] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most persons with severe mental illness prefer competitive to sheltered vocational settings. Supported employment (SE) has become a clearly defined model for helping people with severe mental illness to find and maintain competitive jobs. It involves individualized and rapid placement, ongoing support and assessment, and integration of vocational and mental health staff within a single clinical team. Previous studies show that SE secures competitive employment much more effectively than do other approaches. This review focuses on its economic impacts. METHODS Studies reporting some service use or monetary outcomes of adding SE programs were identified. These outcomes were tabulated and are discussed in narrative form. RESULTS Five nonrandomized and 3 randomized studies compare SE programs with day treatment or transitional employment programs. The introduction of SE services can result in anything from an increase to a decrease in vocational service costs, depending on the extent to which they substitute for previous vocational or day treatment services. Overall service costs tend to be lower, but differences are not significant. Earnings increase only slightly on average. CONCLUSIONS Converting day treatment or other less effective vocational programs into SE programs can be cost-saving or cost-neutral from the hospital, community centre, and government points of view. Investments of new money into SE programs are unlikely to be materially offset by reductions in other health care costs, by reductions in government benefit payments, or by increased tax revenues. Such investments must be motivated by the value of increasing the community integration of persons with severe mental illness.
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Affiliation(s)
- E A Latimer
- Douglas Hospital Research Centre, Verdun, Quebec. Department of Psychiatry, McGill University, Montreal, Quebec.
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Macias C, DeCarlo LT, Wang Q, Frey J, Barreira P. Work interest as a predictor of competitive employment: policy implications for psychiatric rehabilitation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2001; 28:279-97. [PMID: 11577655 PMCID: PMC4636005 DOI: 10.1023/a:1011185513720] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Consumers with serious mental illness (N = 166) enrolling in two community-based mental health programs, a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development (ICCD), were asked about their interest in work. About one third of the new enrollees expressed no interest in working. Equivalent supported employment services were then offered to all participants in each program. Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job. Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service. Once employed, these two groups held comparable jobs for the same length of time. These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness, and the viability of integrating these services into routine mental health care.
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Affiliation(s)
- C Macias
- Fountain House, Inc., 425 West 47th Street, New York, NY 10036, USA.
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