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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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Cafaro R, Rosti CAM, Cerolini L, Varinelli A, Charitos S, Magnotti R, Benatti B, Dell’Osso B, Viganò CA. Gender impact on the outcome of rehabilitation programs in psychiatry: Brief report from a metropolitan residential rehabilitative service. Front Psychiatry 2023; 14:1145940. [PMID: 37113552 PMCID: PMC10126770 DOI: 10.3389/fpsyt.2023.1145940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023] Open
Abstract
Background Differences based on gender in the presentation and outcome of many psychiatric conditions have been highlighted in the past years. Moreover, women are often underrepresented in research samples, thus leading to a poorer understanding and addressing of their needs. As regards psychiatric rehabilitation, few studies have focused on the influence of gender on the outcomes of rehabilitation programs. Objectives This study aimed to analyze the impact of gender on socio-demographic and clinical characteristics, as well as on main rehabilitation outcomes, in a sample of subjects undergoing rehabilitation programs in a metropolitan residential service. Methods We collected socio-demographic, clinical variables and rehabilitation outcomes of all subjects discharged from the metropolitan residential rehabilitative service of the Luigi Sacco Hospital in Milan, Italy, from January 2015 to December 2021. Gender differences were analyzed through t-test and chi-square for continuous and categorical variables, respectively. Results In a total sample of 129 subjects equally distributed for gender (50.4% women), all subjects improved after their rehabilitation program, as measured through specific psychometric scales. However, women had a higher proportion of discharges to their own household (52.3% vs. 25% of men). They also showed higher educational status (53.8% completed high school vs. 31.3% of men). Clinically, they showed longer duration of untreated illness (3.6 ± 7.31 vs. 1.06 ± 2.35 years) and lower frequency of substance use disorders compared to men (6.4% vs. 35.9%). Conclusion The main result of this study shows, in light of an equal improvement in psychopathological and psychosocial functioning after the rehabilitation program, better outcomes in women compared to men, with a higher frequency of return to their own household after the completion of a rehabilitation program compared to men.
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Affiliation(s)
- Rita Cafaro
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Chiara Ada Maria Rosti
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | - Lucia Cerolini
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Varinelli
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Socrates Charitos
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Magnotti
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Department of Health Sciences, "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Caterina A. Viganò
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
- *Correspondence: Caterina A. Viganò,
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Carrà G, Bartoli F, Capogrosso CA, Cioni RM, Moretti F, Piacenti S, Riboldi I, Crocamo C, Bebbington PE. Innovations in community-based mental health care: an overview of meta-analyses. Int Rev Psychiatry 2022; 34:770-782. [PMID: 36786120 DOI: 10.1080/09540261.2022.2113043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In the last four decades, mental health services for people with Severe Mental Illness (SMI) have seen asylums replaced by a balanced model of Community Mental Healthcare (CMH). Innovative approaches and strategies in the field of CMH have been extensively researched. However, this research has been hampered by issues limiting their capacity to inform clinicians and policymakers. We conducted an overview of meta-analyses of the effectiveness of innovative CMH models focussing on clinical and psychosocial outcomes in comparisons with standard care in adults with SMI. Based on the 12 eligible studies, we appraised, synthesised and graded the resulting evidence. There was moderate quality evidence that case management, Early Intervention Services (EIS) and caregiver-directed interventions were superior to standard care in reducing hospital admission. In relation to psychosocial outcomes, EIS showed high quality evidence of a small effect on global functioning. There was moderate quality evidence for a similar effect of Intensive Case Management, and for a large effect of family intervention. For quality of life, both EIS and self-management education had a small effect, with moderate quality. The level of research about effective CMH models is therefore substantial. However, several gaps related to innovative CMH not yet covered in meta-analytic synthesis, need to be filled.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara A Capogrosso
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Riccardo M Cioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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İNCEDERE A, YILDIZ M. Şizofreni Hastalarında Destekli İşe Yerleştirim: Üç Yıllık İzlem Sonucunun Değerlendirmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.901262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Stengler K, Bechdolf A, Becker T, Döring A, Höhl W, Jäckel D, Kilian H, Theißing A, Torhorst A, Wirtz G, Zeidler R, Riedel-Heller S. [Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]. DER NERVENARZT 2021; 92:955-962. [PMID: 33570685 DOI: 10.1007/s00115-020-01038-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.
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Affiliation(s)
- K Stengler
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - A Bechdolf
- Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Akademische Lehrkrankenhäuser, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Becker
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - A Döring
- Fachausschuss Psychiatrie, Deutscher Verband der Ergotherapeuten e. V., Karlsbad, Deutschland.,Referat "Gesundheitsfachberufe", DGPPN, Berlin, Deutschland
| | - W Höhl
- arbeit & integration e. V., Düsseldorf, Deutschland
| | - D Jäckel
- Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Akademische Lehrkrankenhäuser, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H Kilian
- Bundesarbeitsgemeinschaft Beruflicher Trainingszentren e. V. (BAG BTZ), Berlin, Deutschland
| | - A Theißing
- beta89, Verein für betreuendes Wohnen und Tagesstrukturierung psychisch Gesundender e. V., Hannover, Deutschland
| | - A Torhorst
- RPK Bad Tölz und München, ReAL Holding AG, Bad Tölz, Deutschland
| | - G Wirtz
- SRH Rehabilitationseinrichtung für psychisch Kranke Karlsbad GmbH, Karlsbad, Deutschland
| | - R Zeidler
- DGPPN-Geschäftsstelle, Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V. (DGPPN), Reinhardtstraße 27 B I, 10117, Berlin, Deutschland.
| | - S Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
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Subramaniam M, Zhang Y, Shahwan S, Vaingankar JA, Satghare P, Teh WL, Roystonn K, Goh CMJ, Maniam Y, Tan ZL, Tay B, Verma S, Chong SA. Employment of young people with mental health conditions: making it work. Disabil Rehabil 2020; 44:2033-2043. [DOI: 10.1080/09638288.2020.1822932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore
| | | | | | | | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Yogeswary Maniam
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Zhuan Liang Tan
- Sector Strategy Group, National Council of Social Service, Singapore
| | - Benjamin Tay
- Sector Strategy Group, National Council of Social Service, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Abstract
PURPOSE OF REVIEW To provide an overview of the update of the evidence-based and consensus-based German S3 guideline on psychosocial therapies for severe mental illnesses (SMI), with particular attention to current developments and future research tasks. RECENT FINDINGS There has been a significant increase in studies on the effectiveness of psychosocial interventions in treatment of people with SMI. In the guideline a distinction is made between system-level interventions (e.g. multidisciplinary team-based psychiatric community care) and single-handed (nonteam-based) interventions (e.g. psychoeducation). Furthermore, principles of treatment (e.g. recovery-orientation) and self-help interventions (e.g. peer support) are addressed. The update of the guideline includes 33 recommendations and 12 statements. Compared with the first edition, there were upgrades in the recommendation of Supported Employment (A) and Supported Housing (A). Interventions such as peer support (B) and lifestyle interventions (A) were included for the first time. Developments are discussed in the context of most recent literature. Areas for further research are highlighted and fields for next updates such as antistigma interventions and supported parenting were identified. SUMMARY The present guideline offers an important opportunity to further improve health services for people with SMI. However, guideline implementation is challenging.
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Keefe K, Styron T, O'Connell M, Mattias K, Davidson L, Costa M. Understanding family perspectives on supported employment. Int J Soc Psychiatry 2020; 66:76-83. [PMID: 31623499 DOI: 10.1177/0020764019882970] [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: 11/15/2022]
Abstract
BACKGROUND One integral way by which individuals in recovery pursue meaning and productivity in their lives is via employment. Unfortunately, the vast majority of individuals with serious mental illness (SMI) who express the desire to work remain unemployed. Families have the potential to play an important role in the domain of supported employment (SE), though may not have the knowledge or skills to do so. AIMS This quantitative study aimed to better understand the perspectives of family members on the role of employment in recovery and the barriers faced by their loved ones in pursuing work. METHOD Participants included 86 family members of individuals with SMI who were affiliated with their state NAMI Chapter and agreed to take part in an online survey. Wilcoxon signed-rank tests were used to determine meaningful differences between the highest and lowest ranked statements for each main research question. RESULTS Family members recognize that employment is important to recovery and offers individuals with SMI a valued social role. Relative to other factors, financial independence and being employed in a competitive job were viewed as less important to recovery. The most salient barriers to employment included stable housing, need for transportation, concerns about losing benefits, low self-esteem, and medication side effects. CONCLUSIONS While family members can appreciate the importance of SE and their loved ones' desire to work, they still tend to rank other factors as more integral to recovery. This underscores the need for additional education about the potential for employment to facilitate these other factors in recovery.
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Affiliation(s)
- Kristen Keefe
- Connecticut Mental Health Center, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Thomas Styron
- Connecticut Mental Health Center, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maria O'Connell
- Yale Program for Recovery and Community Health (PRCH), Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kate Mattias
- National Alliance on Mental Illness (NAMI) Connecticut, Hartford, CT, USA
| | - Larry Davidson
- Yale Program for Recovery and Community Health (PRCH), Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Institution for Social and Policy Studies, Yale University, New Haven, CT, USA.,Connecticut Department of Mental Health and Addiction Services, Hartford, CT, USA
| | - Mark Costa
- Yale Program for Recovery and Community Health (PRCH), Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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White C, Frimpong E, Huz S, Ronsani A, Radigan M. Effects of the Personalized Recovery Oriented Services (PROS) Program on Hospitalizations. Psychiatr Q 2018; 89:261-271. [PMID: 28971347 DOI: 10.1007/s11126-017-9531-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Though the recovery model has been implemented widely in outpatient mental health settings, there are no large sample evaluations of recovery oriented psychiatric rehabilitation programs that address both serious mental illness (SMI) and co-occurring disorders (COD) using a more comprehensive Medicaid reimbursable approach. This study examined preliminary hospitalization outcomes, for adults with SMI and COD enrolled in the NYS Personalized Recovery Oriented Services (PROS) program. McNemar's chi-square test was used to examine changes in hospitalization rates from pre-PROS admission to post-PROS discharge in a sample of 12,006 adults discharged from PROS. Negative binomial regression models were used to calculate adjusted rates of hospitalizations and hospital days. Demographic, psychosocial, and diagnosis predictor variables were extracted from the OMH web-based Child and Adult Integrated Reporting System. Hospitalization data were extracted from the Mental Health Automated Recordkeeping System, and Medicaid. From pre-admission to post-discharge, psychiatric hospitalization rate decreased significantly, from 24% to 14%. Substance related hospitalizations also decreased significantly, from 5% to 3%. Average number of hospitalizations and number of days hospitalized decreased even after adjusting for sociodemographic factors. PROS serves a high number of COD patients, and the number of psychiatric and substance related hospitalizations decreased after an episode of PROS, as did the number of days hospitalized. Findings support the maintenance of psychiatric rehabilitation models that include recovery oriented components. Further analyses with control samples are proposed.
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Affiliation(s)
- Candace White
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA.
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
| | - Steve Huz
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
| | - Adrienne Ronsani
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
| | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, USA
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Sharing the Voice and Experience of our Community Members with Significant Disabilities in the Development of Rehabilitation Games. SYSTEMIC PRACTICE AND ACTION RESEARCH 2018. [DOI: 10.1007/s11213-018-9449-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bertram M, Howard L. Employment status and occupational care planning for people using mental health services. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.2.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThe aim of the study was to identify the employment rates of people using local mental health services and examine any evidence in care plans for vocational or occupational interventions. We investigated case notes retrospectively.ResultsA total of 297 case notes were examined: 88% of the patients were unemployed, but there was evidence of documentation relating to vocational needs in only 18% of out-patients; 8% in patients of community mental health teams; and 39% in acute wards; 8% of patients were engaged in work schemes; 10% of patients were in education; and 9% were engaged in vocational interventions with their care coordinator; the latter was less likely if the patient was from a Black or minority ethnic group (OR=2.44, 95% CI 0.18–1.05).Clinical ImplicationsDespite high rates of unemployment, patients with psychiatric disorders are not referred for vocational interventions. Growing professional awareness of vocational possibilities for patients with severe mental illness should mean that many patients could return to competitive employment and return to mainstream society.
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Sayce L, Measey L. Strategies to reduce social exclusion for people with mental health problems. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.23.2.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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13
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Perkins R, Rinaldi M. Unemployment rates among patients with long-term mental health problems. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.26.8.295] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo examine the vocational status of people with longer-term mental health problems in the inner London Borough of Wandsworth. Data collected over 10 years on 1 April each year as part of an annual census of adults with longer-term mental health problems using community mental health and rehabilitation teams were analysed to examine the vocational status of these groups.ResultsWithin the borough unemployment rates among people with longer-term mental health problems increased steadily during the 1990s, despite a decreasing rate of general unemployment for the majority of that period. Unemployment among people with long-term mental health problems increased from 80% in 1990 to 92% in 1999, and the unemployment rates among those with a diagnosis of schizophrenia increased from 88% in 1990 to 96% in 1999.Clinical ImplicationsWork and employment is important in health as well as social functioning. Greater attention to vocational issues in clinical teams is required: the challenge for mental health services is to make employment interventions of demonstrated effectiveness available to all who need them.
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Abstract
Unemployment is high among those with mental disorders, particularly severe mental disorders, and there are a range of social and economic barriers impeding their employment. In general, there is a lack of vocational rehabilitation services in the UK for people with both physical and mental illnesses, despite good evidence for the effectiveness of some work schemes. Here, the need is discussed for a national strategy for vocational rehabilitation that involves employment and health services, and covers both physical and mental disorders.
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McKay C, Nugent KL, Johnsen M, Eaton WW, Lidz CW. A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:28-47. [PMID: 27580614 PMCID: PMC5756274 DOI: 10.1007/s10488-016-0760-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT's), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.
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Affiliation(s)
- Colleen McKay
- Department of Psychiatry, Program for Clubhouse Research, Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Katie L Nugent
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Matthew Johnsen
- Department of Sociology, Worcester State University, 486 Chandler Street, Worcester, MA, 01602, USA
| | - William W Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Room 880B, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Charles W Lidz
- Department of Psychiatry, Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Provision of Health Services: Mental Health Care. Health Serv Res 2018. [DOI: 10.1007/978-1-4614-6419-8_25-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Howe EI, Langlo KPS, Terjesen HCA, Røe C, Schanke AK, Søberg HL, Sveen U, Aas E, Enehaug H, Alves DE, Klethagen P, Sagstad K, Moen CM, Torsteinsbrend K, Linnestad AM, Nordenmark TH, Rismyhr BS, Wangen G, Lu J, Ponsford J, Twamley EW, Ugelstad H, Spjelkavik Ø, Løvstad M, Andelic N. Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial. Trials 2017; 18:483. [PMID: 29041954 PMCID: PMC5645893 DOI: 10.1186/s13063-017-2218-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces. Methods/design This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed. Discussion The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided. Trial registration ClinicalTrials.gov, NCT03092713. Registered on 10 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2218-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Knut-Petter S Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Eline Aas
- Department of Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heidi Enehaug
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Daniele E Alves
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Pål Klethagen
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Kjersti Sagstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Christine M Moen
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Karin Torsteinsbrend
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | | | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Birte Sand Rismyhr
- The Norwegian User Organization (Personskadeforbundet LTN), Oslo, Norway
| | - Grete Wangen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennie Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Faculty of Medicine, Nursing and Health Sciences , Clayton, Victoria, Australia
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Øystein Spjelkavik
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Atal Z, Wang SW, Biella-Battista R. The effects of brief indirect contact on mental illness stigma: Preliminary evidence from an Italian vocational rehabilitation center. JOURNAL OF VOCATIONAL REHABILITATION 2017. [DOI: 10.3233/jvr-170876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zara Atal
- Department of Psychology, Haverford College, Haverford, PA, USA
| | - Shu-wen Wang
- Department of Psychology, Haverford College, Haverford, PA, USA
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Rouse J, Mutschler C, McShane K, Habal-Brosek C. Qualitative participatory evaluation of a psychosocial rehabilitation program for individuals with severe mental illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2017.1278964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jennifer Rouse
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Kelly McShane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Fortin G, Lecomte T, Corbière M. Does personality influence job acquisition and tenure in people with severe mental illness enrolled in supported employment programs? J Ment Health 2017; 26:248-256. [PMID: 28084116 DOI: 10.1080/09638237.2016.1276534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND When employment difficulties in people with severe mental illness (SMI) occur, it could be partly linked to issues not specific to SMI, such as personality traits or problems. Despite the fact that personality has a marked influence on almost every aspect of work behavior, it has scarcely been investigated in the context of employment for people with SMI. AIMS We aimed to evaluate if personality was more predictive than clinical variables of different competitive work outcomes, namely acquisition of competitive employment, delay to acquisition and job tenure. METHOD A sample of 82 people with a SMI enrolled in supported employment programs (SEP) was recruited and asked to complete various questionnaires and interviews. Statistical analyses included logistic regressions and survival analyses (Cox regressions). RESULTS Prior employment, personality problems and negative symptoms are significantly related to acquisition of a competitive employment and to delay to acquisition whereas the conscientiousness personality trait was predictive of job tenure. CONCLUSION Our results point out the relevance of personality traits and problems as predictors of work outcomes in people with SMI registered in SEP. Future studies should recruit larger samples and also investigate these links with other factors related to work outcomes.
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Affiliation(s)
- Guillaume Fortin
- a Department of Psychology , Université de Montréal , Montréal, Quebec , Canada and
| | - Tania Lecomte
- a Department of Psychology , Université de Montréal , Montréal, Quebec , Canada and
| | - Marc Corbière
- b Department of Education , Université du Québec à Montréal , Montréal, Quebec , Canada
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21
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Chen RK, Blankenship CJ, Austin BS, Cantu VC, Kotbungkair W. Hiring of people with disabilities: Perceptions of Hispanic small business owners. JOURNAL OF VOCATIONAL REHABILITATION 2016. [DOI: 10.3233/jvr-160822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roy K. Chen
- University of Texas Rio Grande Valley, Edinburg, TX, USA
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22
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Rogers ES, Anthony WA, Lyass A, Penk WE. A Randomized Clinical Trial of Vocational Rehabilitation for People With Psychiatric Disabilities. REHABILITATION COUNSELING BULLETIN 2016. [DOI: 10.1177/00343552060490030201] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, the researchers examined the effectiveness of two vocational rehabilitation interventions in improving employment, educational, clinical, and quality-of-life outcomes for people with psychiatric disabilities. The authors recruited participants in waves over a 2-year period and randomly assigned them to receive either psychiatric vocational rehabilitation (PVR) or enhanced state vocational rehabilitation (ESVR) services. Although both groups improved significantly over time in their vocational and educational outcomes, no differences were found between the two interventions on any outcomes. In this article, the authors explore why ESVR achieved better outcomes than previous research would have suggested.
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Affiliation(s)
- E. Sally Rogers
- Center for Psychiatric Rehabilitation, Boston University,
erogers@bu .edu
| | | | - Asya Lyass
- Center for Psychiatric Rehabilitation, Boston University
| | - Walter E. Penk
- Center for Psychiatric Rehabilitation, Boston University
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23
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Bond GR, Drake RE, Becker DR, Mueser KT. Effectiveness of Psychiatric Rehabilitation Approaches for Employment of People with Severe Mental Illness. JOURNAL OF DISABILITY POLICY STUDIES 2016. [DOI: 10.1177/104420739901000104] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors review studies of (a) traditional psychiatric rehabilitation (including clubhouse programs and approaches offering an array of employment options) and (b) supported employment approaches for helping people with severe mental illness gain and maintain competitive employment. Based on the results of this review, the authors conclude that the effectiveness of traditional psychiatric rehabilitation in helping people gain competitive employment cannot be conclusively determined at this point. On the other hand, research on the effectiveness of supported employment was consistently positive. The authors recommend that further research be conducted on model definition, intermediate vocational options, interaction between client characteristics and program models, and long-term outcomes.
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Affiliation(s)
- Gary R. Bond
- Indiana University-Purdue University Indianapolis
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Abstract
Over the years, the state vocational rehabilitation agency has failed to create work-producing programs for individuals with serious mental illness. The author uses his 21 years of experience as a state commissioner of mental health in three states as a basis for describing this failure. Current trends, including proposed national legislation, that will drastically change the state vocational rehabilitation agency as we have known it are described and, consequently, a case for closure of the agency is proposed.
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25
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Employment Benefit Receipt Among Ontario Public Disability Benefit Recipients with a Disability Related to a Mental Disorder. Community Ment Health J 2016; 52:203-11. [PMID: 26408430 DOI: 10.1007/s10597-015-9942-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
Abstract
Using administrative data from the public long-term disability support program in Ontario, Canada, this paper examines the factors related to receipt of a paid employment benefit. These analyses include only ODSP beneficiaries who were primary beneficiaries, who had active files in March 2011 and who were <65 years of age and had a disability-related primary diagnosis (n = 253,492). About 9 % of primary beneficiaries received the employment benefit. Logistic regression results suggest that compared to those who have a disability related to a physical disorder, those who have a psychotic disorder (OR 1.125), a mood disorder (OR 1.139) or a developmental disability (OR 1.618) are significantly more likely to receive the benefit while those who have a substance use disorder were significantly less likely (OR 0.540). These results indicate that a proportion of people who receives public disability benefits are employed. In addition, all things being equal, people with mental disorders are more likely to use this type of program than people with physical disorders.
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26
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Viering S, Jäger M, Bärtsch B, Nordt C, Rössler W, Warnke I, Kawohl W. Supported Employment for the Reintegration of Disability Pensioners with Mental Illnesses: A Randomized Controlled Trial. Front Public Health 2015; 3:237. [PMID: 26539425 PMCID: PMC4611964 DOI: 10.3389/fpubh.2015.00237] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
Work is beneficial for the recovery from mental illness. Although the approach of individual placement and support (IPS) has been shown to be effective in Europe, it has not yet been widely implemented in European health care systems. The aim of this randomized controlled trial was to assess the effectiveness of IPS for disability pensioners with mental illnesses new on disability benefits in Switzerland. In the study at hand, 250 participants were randomly assigned to either the control or the intervention group. The participants in the intervention group received job coaching according to IPS during 2 years. The control group received no structured support. Both groups were interviewed at baseline and followed up every 6 months (baseline, 6, 12, 16, 18, 24 months) for 2 years. Primary outcome was to obtain a job in the competitive employment. IPS was more effective for the reintegration into the competitive employment market for disability pensioners than the control condition. Thirty-two percent of the participants of the intervention group and 12% of the control group obtained new jobs in the competitive employment. IPS is also effective for the reintegration into competitive employment of people with mental illness receiving disability pensions.
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Affiliation(s)
- Sandra Viering
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Bettina Bärtsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland ; University of Zurich , Zurich , Switzerland ; Laboratory of Neuroscience, LIM 27, Institute of Psychiatry, University of São Paulo , São Paulo , Brazil
| | - Ingeborg Warnke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland ; University of Zurich , Zurich , Switzerland
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27
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28
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Baron RC. The Impact of Behavioral Managed Care on Employment Programming for Persons with Serious Mental Illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.1998.11449441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Reissner V, Scherbaum N, Wiltfang J, Kis B, Meiler B, Lieb B, Mikoteit T, Ehren G, Hebebrand J. Psychiatrische Interventionen für Arbeitslose. DER NERVENARZT 2015; 87:74-81. [DOI: 10.1007/s00115-015-4299-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shankar J, Collyer F. Vocational rehabilitation of people with mental illness: The need for a broader approach. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/jamh.2.2.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Janki Shankar
- School of Humanities and Social Sciences, Charles Sturt University, NSW, Australia
| | - Fran Collyer
- Department of Sociology and Social Policy, University of Sydney, NSW, Australia
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31
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Shankar J. Improving job tenure for people with psychiatric disabilities through ongoing employment support. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/jamh.4.1.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Janki Shankar
- School of Humanities and Social Sciences, Charles Sturt University, New South Wales, Australia
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32
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Chang YJ, Kang YS, Liu FL. A computer-based interactive game to train persons with cognitive impairments to perform recycling tasks independently. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3672-3677. [PMID: 25262012 DOI: 10.1016/j.ridd.2014.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 06/03/2023]
Abstract
This study assessed the possibility of training three people with cognitive impairments using a computer-based interactive game. A game was designed to provide task prompts in recycling scenarios, identify incorrect task steps on the fly, and help users learn to make corrections. Based on a multiple baseline design, the data showed that the three participants considerably increased their target response, which improved their vocational job skills during the intervention phases and enabled them to maintain the acquired job skills after intervention. The practical and developmental implications of the results are discussed.
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Affiliation(s)
- Yao-Jen Chang
- Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li 320, Taiwan; Holistic Medical Device Development Center, Chung Yuan Christian University, Chung-Li 320, Taiwan.
| | - Ya-Shu Kang
- Department of Special Education, Chung Yuan Christian University, Chung-Li 320, Taiwan.
| | - Fang-Lin Liu
- Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li 320, Taiwan.
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33
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Lim Y, Millington M, Mpofu E. The Evidentiary Basis for Supported Employment Practice for Workers with Schizophrenia: A Thematic Analysis. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2014. [DOI: 10.1080/15487768.2013.877409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Corrigan PW. Recovery from schizophrenia and the role of evidence-based psychosocial interventions. Expert Rev Neurother 2014; 6:993-1004. [PMID: 16831114 DOI: 10.1586/14737175.6.7.993] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recovery is the new vision for mental health services, in which two definitions of recovery dominate. Firstly, recovery is an outcome; research suggests that many people with serious mental illness learn to cope with their disabilities so they can achieve major life goals related to independent living. Secondly, recovery is a process; it reintroduces such important values as hope, empowerment and goal orientation into the service system. Both definitions have data that support its assertions, suggesting that an integration of the two offers the most complete and effective picture of recovery. Psychosocial interventions integrated with psychopharmacological strategies have been shown to most effectively help individuals recover. Effective interventions are those that are evidence based and include, illness management, supported employment, assertive community treatment, services to families and dually diagnosed services.
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Affiliation(s)
- Patrick W Corrigan
- Illinois Institute of Technology, Joint Research Programs in Psychiatric Rehabilitation, 3424 S. State Street, Chicago, IL 60616, USA.
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35
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Lepage M, Bodnar M, Bowie CR. Neurocognition: clinical and functional outcomes in schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:5-12. [PMID: 24444318 PMCID: PMC4079224 DOI: 10.1177/070674371405900103] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-to-date description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one's competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes.
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Affiliation(s)
- Martin Lepage
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Michael Bodnar
- Research Associate, Douglas Mental Health University Institute, Montreal, Quebec
| | - Christopher R Bowie
- Associate Professor, Department of Psychology, Queen's University, Kingston, Ontario
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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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Perspectives on Employment Integration, Mental Illness and Disability, and Workplace Health. ADVANCES IN PUBLIC HEALTH 2014. [DOI: 10.1155/2014/258614] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This paper reviews the literature on the interplay between employment integration and retention of individuals diagnosed with mental health and related disability (MHRD). Specifically, the paper addresses the importance of an integrative approach, utilizing a social epidemiological approach to assess various factors that are related to the employment integration of individuals diagnosed with severe mental illness. Our approach to the review incorporates a research methodology that is multilayered, mixed, and contextual. The review examines the literature that aims to unpack employers’ understanding of mental illness and their attitudes, beliefs, and practices about employing workers with mental illness. Additionally we offer a conceptual framework entrenched within the social determinants of the mental health (SDOMH) literature as a way to contextualize the review conclusions. This approach contributes to a holistic understanding of workplace mental health conceptually and methodologically particularly as practitioners and policy makers alike are grappling with better ways to integrate employees who are diagnosed with mental health and disabilities into to the workplace.
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Jäger M, Paras S, Nordt C, Warnke I, Bärtsch B, Rössler W, Kawohl W. [How sustainable is supported employment? A follow-up investigation]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2013; 27:196-201. [PMID: 24155052 DOI: 10.1007/s40211-013-0085-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
SUBJECT The largest European multicenter randomized controlled trial to date on the effectiveness of supported employment (EQOLISE) was conducted in six European centres until 2005. It revealed that the intervention "individual placement and support" was more effective than conventional prevocational training services. The aim of this investigation was to assess the Zurich sample (individuals with schizophrenic, schizoaffective or bipolar disorders) 24 months after termination of the EQOLISE trial in terms of working situation, income, and hospital admissions. More favorable outcomes concerning these parameters were assumed for the intervention group. METHODS Assessment of the working situation and psychiatric hospitalizations since the end as well as the development of salaries since the start of EQOLISE. Comparisons between groups and illustration of incomes using a random coefficient model were conducted. RESULTS 50% of the original sample could be assessed. All subjects who worked in competitive workplaces at the end of EQOLISE were met in a different situation. No differences were found concerning hospital admissions. The mean monthly income considerably increased during EQOLISE and decreased during the third year. At the time of follow-up it was approximately at the same level as the slightly increased control group. CONCLUSIONS This investigation points at limited sustainability of supported employment among individuals with severe mental disorders in terms of maintenance of employment and income if the job coaching is not continued.
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Affiliation(s)
- Matthias Jäger
- Universität Zürich, Militärstrasse 8, Postfach 1930, 8021, Zürich, Schweiz
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Mavranezouli I, Megnin-Viggars O, Cheema N, Howlin P, Baron-Cohen S, Pilling S. The cost-effectiveness of supported employment for adults with autism in the United Kingdom. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:975-84. [PMID: 24126866 PMCID: PMC4230968 DOI: 10.1177/1362361313505720] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings.
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Affiliation(s)
| | | | | | | | - Simon Baron-Cohen
- Cambridge University, UK; NIHR CLAHRC for Cambridgeshire and Peterborough NHS Foundation Trust, UK
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Chang YJ, Kang YS, Huang PC. An augmented reality (AR)-based vocational task prompting system for people with cognitive impairments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3049-3056. [PMID: 23880030 DOI: 10.1016/j.ridd.2013.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 06/02/2023]
Abstract
This study assessed the possibility of training three people with cognitive impairments using an augmented reality (AR)-based task prompting system. Using AR technology, the system provided picture cues, identified incorrect task steps on the fly, and helped users make corrections. Based on a multiple baseline design, the data showed that the three participants considerably increased their target response, which improved their vocational job skills during the intervention phases and enabled them to maintain the acquired job skills after intervention. The practical and developmental implications of the results are discussed.
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Affiliation(s)
- Yao-Jen Chang
- Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li 320, Taiwan; Holistic Medical Device Development Center, Chung Yuan Christian University, Chung-Li 320, Taiwan.
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Kinoshita Y, Furukawa TA, Kinoshita K, Honyashiki M, Omori IM, Marshall M, Bond GR, Huxley P, Amano N, Kingdon D. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 2013; 2013:CD008297. [PMID: 24030739 PMCID: PMC7433300 DOI: 10.1002/14651858.cd008297.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People who suffer from severe mental disorder experience high rates of unemployment. Supported employment is an approach to vocational rehabilitation that involves trying to place clients in competitive jobs without any extended preparation. The Individual placement and support (IPS) model is a carefully specified form of supported employment. OBJECTIVES 1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual.2. Secondary objectives were to establish how far:(a) fidelity to the IPS model affects the effectiveness of supported employment,(b) the effectiveness of supported employment can be augmented by the addition of other interventions. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (February 2010), which is compiled by systematic searches of major databases, handsearches and conference proceedings. SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, of working age (normally 16 to 70 years), where supported employment was compared with other vocational approaches or treatment as usual. Outcomes such as days in employment, job stability, global state, social functioning, mental state, quality of life, satisfaction and costs were sought. DATA COLLECTION AND ANALYSIS Two review authors (YK and KK) independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% (CI). We employed a fixed-effect model for analyses. A random-effects model was also employed where heterogeneity was present. MAIN RESULTS A total of 14 randomised controlled trials were included in this review (total 2265 people). In terms of our primary outcome (employment: days in competitive employment, over one year follow-up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n = 951, RR 3.24 CI 2.17 to 4.82, very low quality of evidence). Supported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n = 204, MD 70.63 CI 43.22 to 94.04, very low quality evidence). Supported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n = 510, MD 84.94 CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n = 204, MD 9.86 CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n = 735, MD 3.86 CI -2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n = 204, MD -161.60 CI -225.73 to -97.47, very low quality evidence). A large amount of data were considerably skewed, and therefore not included in meta-analysis, which makes any meaningful interpretation of the vast amount of data very difficult. AUTHORS' CONCLUSIONS The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.
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Affiliation(s)
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public HealthDepartments of Health Promotion and Behavior Change and of Clinical EpidemiologyYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan601‐8501
| | | | - Mina Honyashiki
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Ichiro M Omori
- Toyokawa City HospitalDepartment of PsychiatryKoumei 1‐19ToyokawaAichiJapan442‐8561
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Gary R Bond
- Dartmouth Medical SchoolDepartment of PsychiatryRivermill Commercial Centre85 Mechanic StreetLebanonNew HampshireUSA03766
| | - Peter Huxley
- University of SwanseaApplied Social StudiesVivian BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Naoji Amano
- Shinshu University, School of MedicineDepartment of PsychiatryMatsumotoJapan
| | - David Kingdon
- University of SouthamptonMental Health GroupCollege Keep4‐12 Terminus TerraceSouthamptonUKSO14 3DT
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Work reintegration for veterans with mental disorders: a systematic literature review to inform research. Phys Ther 2013; 93:1163-74. [PMID: 23043148 PMCID: PMC3771875 DOI: 10.2522/ptj.20120156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Some veterans, and especially those with mental disorders, have difficulty reintegrating into the civilian workforce. PURPOSE The objectives of this study were to describe the scope of the existing literature on mental disorders and unemployment and to identify factors potentially associated with reintegration of workers with mental disorders into the workforce. DATA SOURCES The following databases were searched from their respective inception dates: MEDLINE, EMBASE, Cumulative Index Nursing Allied Health (CINAHL), and PsycINFO. STUDY SELECTION In-scope studies had quantitative measures of employment and study populations with well-described mental disorders (eg, anxiety, depression, posttraumatic stress disorder, substance-use disorders). DATA EXTRACTION A systematic and comprehensive search of the relevant published literature up to July 2009 was conducted that identified a total of 5,195 articles. From that list, 81 in-scope studies were identified. An update to July 2012 identified 1,267 new articles, resulting in an additional 16 in-scope articles. DATA SYNTHESIS Three major categories emerged from the in-scope articles: return to work, supported employment, and reintegration. The literature on return to work and supported employment is well summarized by existing reviews. The reintegration literature included 32 in-scope articles; only 10 of these were conducted in populations of veterans. LIMITATIONS Studies of reintegration to work were not similar enough to synthesize, and it was inappropriate to pool results for this category of literature. CONCLUSIONS Comprehensive literature review found limited knowledge about how to integrate people with mental disorders into a new workplace after a prolonged absence (>1 year). Even more limited knowledge was found for veterans. The results informed the next steps for our research team to enhance successful reintegration of veterans with mental disorders into the civilian workplace.
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Viering S, Bärtsch B, Obermann C, Rüsch N, Rössler W, Kawohl W. The effectiveness of individual placement and support for people with mental illness new on social benefits: a study protocol. BMC Psychiatry 2013; 13:195. [PMID: 23883137 PMCID: PMC3750223 DOI: 10.1186/1471-244x-13-195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Switzerland, people with a severe mental illness and unable to work receive disability benefits ('IV-pension'). Once they are granted these benefits, the chances to regain competitive employment are usually small. However, previous studies have shown that individual placement and support (IPS) supports a successful reintegration into competitive employment. This study focuses on the integration of newly appointed IV-pensioners, who have received an IV-pension for less than a year. METHOD/DESIGN The present pilot project ZHEPP (Zürcher Eingliederungs-Pilot Projekt; engl.: Zurich integration pilot project) is a randomized controlled trial (RCT). The 250 participants will be randomized to either the intervention or the control group. The intervention group receives support of a job coach according to the approach of IPS. Participants in the control group do not receive IPS support. Participation takes a total of two years for each participant. Each group is interviewed every six months (T0-T4). A two-factor analysis of variance will be conducted with the two factors group (intervention versus control group) and outcome (employment yes/no). The main criterion of the two-factor analysis will be the number of competitive employment contracts in each group. DISCUSSION This study will focus on the impact of IPS on new IV-pensioners and aims to identify predictors for a successful integration. Furthermore, we will examine the effect of IPS on stigma variables and recovery orientation. TRIAL REGISTRATION ISRCTN54951166.
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Affiliation(s)
- Sandra Viering
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Bettina Bärtsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Wulf Rössler
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
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Buizza C, Pioli R, Lecchi S, Bonetto C, Bartoli A, Taglietti R, Ghilardi A, Riva E. Mental disorders and work integration: a retrospective study in a northern italian town. Clin Pract Epidemiol Ment Health 2013; 10:9-17. [PMID: 24600480 PMCID: PMC3942865 DOI: 10.2174/1745017901410010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 01/20/2013] [Accepted: 12/20/2013] [Indexed: 11/22/2022]
Abstract
Objectives: The present study was conducted in a vocational integration service of a northern Italian town with two major aims: to assess vocational integration programs undertaken from 1st January 2004 to 1st January 2007; and to identify job tenure-associated predictors. Methods: This is a retrospective study; we collected data such as gender, age, duration, type and outcome of the vocational integration program, and number of interventions performed by the vocational integration service. Self-report questionnaires were also used to assess the satisfaction of users, caregivers, practitioners, and of the company contacts involved in the study. Results: The service has enrolled 84 users during the observation period. Out of these users, 64.3% of them still had their jobs after three years. Users, caregivers and company contacts expressed high levels of satisfaction for the support received by the vocational integration service. The company expressed less satisfaction for the collaboration received by the Departments of Mental Health (DMHs) that coached the users. The only variable associated to the outcome was the number of interventions that the users received before their placement on the job. Conclusions: Despite all the limits of this study, its results show that the chance of taking advantage of a supported job placement service has likely proven itself effective in helping people with mental disorders to obtain and maintain a competitive employment. Our results, however, also point to the necessity of implementing newer strategies meant to develop a greater integration among all services dealing with mentally ill people.
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Affiliation(s)
- Chiara Buizza
- Unit of Dynamic and Clinic Psychology, Department of Clinical and Experimental Sciences, University of Brescia, It-aly
| | - Rosaria Pioli
- IRCCS "St. John of God" Fatebenefratelli, Brescia, Italy
| | - Sara Lecchi
- IRCCS "St. John of God" Fatebenefratelli, Brescia, Italy
| | - Chiara Bonetto
- Department of Medicine and Public Health, University of Verona, Italy
| | | | | | - Alberto Ghilardi
- Unit of Dynamic and Clinic Psychology, Department of Clinical and Experimental Sciences, University of Brescia, It-aly
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Becker T, Arnold K, Gühne U, Riedel-Heller SG. Psychosoziale Therapien bei schweren psychischen Erkrankungen. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s15005-012-0542-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Harvey C, Killaspy H, Martino S, Johnson S. Implementation of assertive community treatment in Australia: model fidelity, patient characteristics and staff experiences. Community Ment Health J 2012; 48:652-61. [PMID: 22089145 DOI: 10.1007/s10597-011-9466-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Abstract
The impact of variable implementation of the Assertive Community Treatment (ACT) model on patient outcomes is increasingly recognised. We conducted the first study of four established Australian ACT teams, examining team composition, processes and model fidelity, using previously validated questionnaires. Demographic and clinical details of patients and their own experiences of ACT were gathered from staff. Associations between burnout and work experiences were examined. All teams were ACT-like (mean DACTS score = 3.7, SD = 0.3) with few significant patient differences between teams, except diagnosis (schizophrenia 61-93%, co-morbid substance abuse 16-33%) and proportion living alone (23-72%). Clinicians were fairly satisfied, but inter-team differences in staffing profile and experience emerged and one team scored highly on emotional exhaustion. Increased burnout was associated with greater stress due to taking a team approach. Inter-team differences suggested that attention to effective team working and leadership, as well as model fidelity, may be warranted.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, The University of Melbourne & North Western Mental Health, Psychosocial Research Centre, 130 Bell Street, Coburg, VIC, 3058, Australia.
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Enhancing work-focused supports for people with severe mental illnesses in australia. Rehabil Res Pract 2012; 2012:863203. [PMID: 22966462 PMCID: PMC3395169 DOI: 10.1155/2012/863203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/26/2012] [Indexed: 11/17/2022] Open
Abstract
Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI.
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Additional interventions to enhance the effectiveness of individual placement and support: a rapid evidence assessment. Rehabil Res Pract 2012; 2012:382420. [PMID: 22685665 PMCID: PMC3364687 DOI: 10.1155/2012/382420] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/08/2012] [Accepted: 03/22/2012] [Indexed: 11/17/2022] Open
Abstract
Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS). Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion. Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.
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Chang YJ, Chen SF, Chou LD. A feasibility study of enhancing independent task performance for people with cognitive impairments through use of a handheld location-based prompting system. ACTA ACUST UNITED AC 2012; 16:1157-63. [PMID: 22581142 DOI: 10.1109/titb.2012.2198484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An autonomous task-prompting system is presented to increase workplace and life independence for people with cognitive impairments such as traumatic brain injury, intellectual disability, schizophrenia, and Down syndrome. This paper describes an approach to providing distributed cognition support of work engagement for persons with cognitive disabilities. In the pilot study, a prototype was built and tested in a community-based rehabilitation program involving pre-service food preparation training of 8 participants with cognitive impairments. The results show improvement in helping with task engagement is statistically significant compared to the oral-instruction method. A follow-up comparative study with 2 participants evaluated the shadow-team approach against the proposed system. Although the number of participants was few, the participants were studied in depth and the findings were very promising. The results in the autonomous task prompting without staff intervention indicate that the performance is statistically as good as the shadow-team approach. Our findings suggest that acquisition of job skills may be facilitated by the proposed system in conjunction with operant conditioning strategies.
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Bond GR, Drake RE, Becker DR. Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry 2012; 11:32-9. [PMID: 22295007 PMCID: PMC3266767 DOI: 10.1016/j.wpsyc.2012.01.005] [Citation(s) in RCA: 209] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.
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Affiliation(s)
- Gary R Bond
- Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH 03766, USA
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