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Wang X, Guo J, Li H. Multidimensional poverty of persons with disabilities in China: An analysis of poverty reduction effect of employment services. Front Public Health 2023; 11:1093978. [PMID: 36844854 PMCID: PMC9950746 DOI: 10.3389/fpubh.2023.1093978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Disability is a global public health problem, and poverty due to illness and disability has always been a major problem and challenge for global poverty governance. In order to eradicate poverty, China has carried out a series of welfare reforms and employment interventions for people with disabilities. The purpose of this study is to examine the levels of multidimensional poverty of persons with disabilities aged 16-59 in China and the poverty reduction effect of employment services. Methods The Alkire-Foster (AF) method is applied to measure and decompose the multidimensional poverty index (MPI) of people with disabilities in this study. In order to make the results more robust, ordinary least squares (OLS) regression and the combination of propensity score matching and difference-in-differences (PSM-DID) are used to study the effect of employment services on multidimensional poverty of the disabled. Results The results show that among persons with disabilities aged 16-59, about 90% are deprived in at least one dimension, and about 30% are in a state of severe multidimensional poverty until 2019. The contributions of deprivation in the dimensions of education and social participation are remarkably higher than dimensions of economy, health and insurance. In addition, employment services have a significant improvement effect on multidimensional poverty, which is reflected not only in the economic dimension, but also in the dimensions of education, insurance and social participation. Conclusion People with disabilities are generally in multidimensional poverty in China, and their abilities in learning and social integration are seriously inadequate. Employment services have played a great role in improving poverty, but the improvement has been different in different dimensions and different disability categories. These findings provide important evidence for recognizing multidimensional poverty of persons with disabilities and the poverty reduction effect of employment services, which will help to formulate more reasonable public policies to eradicate poverty.
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Affiliation(s)
- Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Jiamin Guo
- Northeast Asian Research Center, Jilin University, Changchun, China
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Drake RE, Bond GR, Mascayano F. Modification of the Individual Placement and Support Model of Supported Employment. Psychiatr Serv 2023:appips20220484. [PMID: 36718603 DOI: 10.1176/appi.ps.20220484] [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: 02/01/2023]
Abstract
Individual placement and support (IPS) is a robust evidence-based model of supported employment for people with mental health conditions that has been implemented in high-income countries. The model is now being extended to new populations and settings, often with modifications. Current evidence indicates that minor modifications may increase fit, major alterations of core principles generally reduce effectiveness, and augmentations have mixed success. The authors recommend that those who implement IPS adhere to its core principles whenever possible, use standardized methods to document and assess modifications, and follow basic scientific procedures to develop, measure, and evaluate modifications before recommending policy changes.
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Affiliation(s)
- Robert E Drake
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
| | - Gary R Bond
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
| | - Franco Mascayano
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
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Barnett P, Steare T, Dedat Z, Pilling S, McCrone P, Knapp M, Cooke E, Lamirel D, Dawson S, Goldblatt P, Hatch S, Henderson C, Jenkins R, K T, Machin K, Simpson A, Shah P, Stevens M, Webber M, Johnson S, Lloyd-Evans B. Interventions to improve social circumstances of people with mental health conditions: a rapid evidence synthesis. BMC Psychiatry 2022; 22:302. [PMID: 35484521 PMCID: PMC9047264 DOI: 10.1186/s12888-022-03864-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Poor social circumstances can induce, exacerbate and prolong symptoms of mental health conditions, while having a mental health condition can also lead to worse social outcomes. Many people with mental health conditions prioritise improvement in social and functional outcomes over reduction in clinical symptoms. Interventions that improve social circumstances in this population should thus be considered a priority for research and policy. METHODS This rapid evidence synthesis reports on randomised controlled trials of interventions to improve social circumstances across eight social domains (Housing and homelessness; money and basic needs; work and education; social isolation and connectedness; family, intimate and caring relationships; victimisation and exploitation; offending; and rights, inclusion and citizenship) in people with mental health conditions. Economic evaluations were also identified. A comprehensive, stepped search approach of the Cochrane library, MEDLINE, Embase, PsycINFO, Web of Science and Scopus was conducted. RESULTS One systematic review and 102 randomised controlled trials were included. We did not find RCT evidence for interventions to improve family, intimate and caring relationships and only one or two trials for each of improving money and basic needs, victimisation and exploitation, and rights, inclusion and citizenship. Evidence from successful interventions in improving homelessness (Housing First) and employment (Individual Placement and Support) suggests that high-intensity interventions which focus on the desired social outcome and provide comprehensive multidisciplinary support could influence positive change in social circumstances of people with mental health conditions. Objective social isolation could be improved using a range of approaches such as supported socialisation and social skills training but interventions to reduce offending showed few benefits. Studies with cost and cost-effectiveness components were generally supportive of interventions to improve housing and vocational outcomes. More research is needed to ensure that social circumstances accompanied by high risks of further exacerbation of mental health conditions are adequately addressed. CONCLUSIONS Although there is a large body of literature examining how to support some aspects of life for people with mental health conditions, more high-quality evidence is required in other social domains. Integration into mental health services of interventions targeting social circumstances could significantly improve a number of social outcomes.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. .,Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK.
| | - Thomas Steare
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Zainab Dedat
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Stephen Pilling
- grid.83440.3b0000000121901201Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK ,grid.452735.20000 0004 0496 9767National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Paul McCrone
- grid.36316.310000 0001 0806 5472Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Martin Knapp
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eleanor Cooke
- grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust and MH Policy Research Unit, London, UK
| | - Daphne Lamirel
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Dawson
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Peter Goldblatt
- grid.83440.3b0000000121901201Department of Epidemiology & Public Health, Institute of Health Equity, University College London, London, UK
| | - Stephani Hatch
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764ESRC Centre for Society and Mental Health, Kings College London, London, UK
| | - Claire Henderson
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Jenkins
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neurology, Kings College London, London, UK
| | - T K
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Karen Machin
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Alan Simpson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Kings College London, London, UK ,grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Kings College London, Midwifery & Palliative care, London, UK
| | - Prisha Shah
- grid.83440.3b0000000121901201Mental Health Policy Research Unit Lived Experience Working Group, Department of Psychiatry, University College London, London, UK
| | - Martin Stevens
- grid.13097.3c0000 0001 2322 6764NIHR Policy Research Unit On Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Martin Webber
- grid.5685.e0000 0004 1936 9668International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, England
| | - Sonia Johnson
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- grid.83440.3b0000000121901201Department of Psychiatry, Mental Health Policy Research Unit, University College London, London, UK
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Albers WMM, Nijssen YAM, Roeg DPK, van Weeghel J, Bongers IMB. Addressing victimization to enable societal participation in flexible assertive community treatment: A process evaluation of the implementation of a new intervention. Front Psychiatry 2022; 13:956133. [PMID: 36203830 PMCID: PMC9530599 DOI: 10.3389/fpsyt.2022.956133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness experience more victimization and discrimination than other persons in the community. Effective rehabilitation and recovery-oriented care interventions aimed at addressing this issue are lacking. We therefore developed a victimization-informed intervention (accompanied by a training module for professionals) called the Victoria intervention. The purpose of the present study was to understand the trial effects by examining the implementation process and the factors that influenced it. MATERIALS AND METHODS A process evaluation was conducted using a mixed-methods design. During the professionals' intervision sessions, we used observations to understand the learning processes (n = 25). Subsequently, we studied the use of the intervention in practice through structured questionnaires (n = 215) and semi-structured interviews (n = 34) with clients and professionals. We used descriptive and inferential statistics for the quantitative data and the framework method for the analyses of the qualitative data. RESULTS The observations showed that the trainings were well received. The professionals shared the urgency of paying attention to victimization and discrimination and its harmful effects on participation. They also found the intervention steps to be logical and the intervention protocol easy to use. Nevertheless, they mentioned in the interviews that they had experienced difficulties initiating a conversation about victimization, and if they started one, they did not always follow the steps of the intervention as intended. Few clients said that victimization was placed on the agenda, though those who had discussed victimization with their caregivers expressed their appreciation in the interviews; they felt acknowledged and supported. DISCUSSION The findings indicate that the intervention was considered helpful in raising awareness and the acknowledgment of victimization. However, professionals remain reluctant to talk about the subject, and the results show they need more practical training in this regard. This process evaluation has an important added value in that it helps us to understand the results of the effect evaluation of the intervention. The findings will facilitate the development and implementation of interventions that address clients' victimization experiences in community mental healthcare settings and subsequently enable their participation in society.
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Affiliation(s)
- Wendy M M Albers
- Tranzo, Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Kwintes Supported Housing, Zeist, Netherlands
| | - Yolanda A M Nijssen
- Tranzo, Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Parnassia Group Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Diana P K Roeg
- Tranzo, Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Kwintes Supported Housing, Zeist, Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
| | - Inge M B Bongers
- Tranzo, Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Research Group Evidence Based Management of Innovation, GGzE, Mental Health Care Institute Eindhoven, Eindhoven, Netherlands
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Development of an Intervention Aimed at Increasing Awareness and Acknowledgement of Victimisation and Its Consequences Among People with Severe Mental Illness. Community Ment Health J 2021; 57:1375-1386. [PMID: 33515177 PMCID: PMC8416871 DOI: 10.1007/s10597-021-00776-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Abstract
Individuals with severe mental illness have a significant risk of (anticipated) discrimination and (criminal) victimisation, which is not structurally and systematically addressed by mental health practitioners. The aim of this study was to develop and pilot an intervention which supports professionals to address victimisation and its consequences, in order to reinforce safe social participation and improve recovery. Following the rehabilitation and positive risk management literature, in addition to current practice, intervention components were developed in two focus groups and four subsequent expert meetings. The intervention was piloted in two outpatient teams before being finalised. The Victoria intervention includes positive risk management, focusing on clients' narratives and strengths, and awareness of unsafe (home) environments: it comprises four steps: exploring issues with social participation, analysing victimisation experiences, clarifying the context of these experiences, and determining future steps, including victimisation-sensitive rehabilitation planning and optional trauma treatment. Future research should further test this intervention.
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Abidin MZRZ, Yunus FW, Rasdi HFM, Kadar M. Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review. Br J Occup Ther 2021. [DOI: 10.1177/0308022620980683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Employment programmes for people with mental illness vary widely in range, but nonetheless all share the same objectives of restoring or initiating vocational roles to promote recovery in psychosocial rehabilitation. The current interventions available usually focus on the specific vocational outcomes of the intervention rather than focusing holistically on the client’s needs. Method This review aimed to examine the effectiveness of intervention programmes and determine the best intervention for schizophrenia and other severe mental illness, considering both vocational and non-vocational outcomes. Searching five databases – CINAHL, Medline via Ovid, Scopus, OT Seeker and Web of Science – a total of 3108 studies was identified; 24 met the selection criteria and were reviewed. Interventions were categorised into five major programmes of supported employment, integrated supported employment, vocational rehabilitation, cognitive intervention and virtual reality-based vocational training. Results Integrated supported employment was found to be the most effective approach for a vocational outcome. However, evidence concerning non-vocational outcomes of employment programmes and the use of cognitive training remains unclear. Conclusion Clinicians are advised to consider the needs and preferences of the client before selecting the best intervention programme. More research is needed to determine the applicability and the efficacy of intervention programmes.
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Affiliation(s)
- Muhammad Zairul Rezal Zainol Abidin
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Farahiyah Wan Yunus
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanif Farhan Mohd Rasdi
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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Sanches SA, Swildens WE, Schaefer B, Moerbeek M, Feenstra TL, van Asselt ADI, Danner UN, van Weeghel J, van Busschbach JT. Effectiveness of the Boston University Approach to Psychiatric Rehabilitation in Improving Social Participation in People With Severe Mental Illnesses: A Randomized Controlled Trial. Front Psychiatry 2020; 11:571640. [PMID: 33173519 PMCID: PMC7538503 DOI: 10.3389/fpsyt.2020.571640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities. AIMS To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands. METHOD In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients' views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning. RESULTS During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms. CONCLUSIONS While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.
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Affiliation(s)
- Sarita A Sanches
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.,Altrecht Institute for Mental Health Care, Department Research and Monitoring, Utrecht, Netherlands
| | - Wilma E Swildens
- Altrecht Institute for Mental Health Care, Department Research and Monitoring, Utrecht, Netherlands.,Inholland University of Applied Sciences, Interprofessional Mental Health Care, Department of Nursing, Amsterdam, Netherlands
| | | | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, Netherlands
| | - Talitha L Feenstra
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,Centre for Nutrition, Prevention, and Health Services Research, Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Antoinette D I van Asselt
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Groningen, Netherlands.,School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, Netherlands
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Strategies to Support the Education Goals of Youth and Young Adults with Serious Mental Health Conditions: A Case Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:661-671. [PMID: 29423557 DOI: 10.1007/s10488-018-0852-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This manuscript describes efforts to support youth and young adults living with serious mental health conditions (SMHC) as they pursue their education goals. Case studies were conducted with three supported education initiatives across the US. Data were collected through individual interviews and focus groups. Key ingredients exist across various settings (e.g., mental health, post-secondary education) to support the pursuit of education goals for students living with SMHC, while individual settings have unique circumstances to address. Findings can inform stakeholders of relevant core components and implementation strategies across settings that support education goals for students with SMHCs.
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10
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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Langi FLFG, Oberoi A, Balcazar FE, Awsumb J. Vocational Rehabilitation of Transition-Age Youth with Disabilities: A Propensity-Score Matched Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:15-23. [PMID: 26815454 DOI: 10.1007/s10926-016-9627-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Objective To investigate the employment outcomes of vocational rehabilitation (VR) services for youth with disabilities in a targeted, enhanced, and contract-based secondary transition program as compared to the traditional VR transition services. Methods A population-based study was conducted on 4422 youth with physical, intellectual, learning, mental and hearing disabilities aged 14-21 at application and whose case was closed after receiving VR transition services in a Midwestern state. Selected youth were classified into either targeted secondary transition program (START) or non-START treatment group. The employment outcomes of the groups were compared using propensity-score matching procedures. Results 2211 youth with disabilities in each treatment group were successfully matched based on demographic characteristics, types of disabilities, existence of severe functional limitations, and year of referral. The overall rehabilitation rate was 57 % [95 % confidence interval (CI) 56-59 %], where the START group rate was 61 % (95 % CI 59-63 %) and the non-START group 53 % (95 % CI 51-55 %). The propensity-score matched odds ratio (OR) was 1.40 (95 % CI 1.24-1.58; p < 0.001). Subgroup analyses showed that the odds of rehabilitation in youth with disabilities were consistently higher when they were in START as compared to non-START (OR ranged from 1.27 to 1.92 with p < 0.05 except for the Hispanic subgroup). Conclusion The results suggest that VR services in a targeted, enhanced, and contract-based secondary transition program are more effective in transitioning youth with disabilities to employment than the regular VR transition services.
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Affiliation(s)
- F L Fredrik G Langi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ashmeet Oberoi
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Coral Gables, FL, USA
| | - Fabricio E Balcazar
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Awsumb
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Smith DL, Atmatzidis K, Capogreco M, Lloyd-Randolfi D, Seman V. Evidence-Based Interventions for Increasing Work Participation for Persons With Various Disabilities. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:3S-13S. [DOI: 10.1177/1539449216681276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Title I of the Americans With Disabilities Act prohibits discrimination in employment; however, 26 years later, employment rates for persons with disabilities hover at 34%. This systematic review investigates the effectiveness of evidence-based interventions to increase employment for people with various disabilities. Forty-six articles met the inclusion criteria for evidence-based interventions. The majority of studies assessed interventions for persons with mental health disabilities. Strong evidence was found for ongoing support and work-related social skills training prior to and during competitive employment for persons with mental health disabilities. Moderate evidence supported simulation and use of assistive technology, especially apps for cueing and peer support to increase work participation for persons with intellectual disabilities, neurological/cognitive disabilities, and autism spectrum disorder. Many of the strategies to increase work participation were appropriate for occupational therapy intervention. Suggestions were made for research, specifically looking at more rigorous evaluation of strategies in the long term.
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Bond GR, Drake RE, Campbell K. Effectiveness of individual placement and support supported employment for young adults. Early Interv Psychiatry 2016; 10:300-7. [PMID: 25138195 PMCID: PMC4417652 DOI: 10.1111/eip.12175] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
AIM The individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap. METHODS To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures. RESULTS On all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ(2) = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001. CONCLUSIONS The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing.
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Affiliation(s)
- Gary R. Bond
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
| | - Robert E. Drake
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
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Sanches SA, Swildens WE, van Busschbach JT, Stant AD, Feenstra TL, van Weeghel J. Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol. BMC Psychiatry 2015; 15:217. [PMID: 26373711 PMCID: PMC4571072 DOI: 10.1186/s12888-015-0593-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT's) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial. METHODS In a multisite RCT, 225 adults (18-64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios. DISCUSSION The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make decisions about further implementation of the method. Also, assessing budgetary impact will facilitate policymaking. The large sample size, geographic coverage and heterogeneity of the study group will ensure reliable generalisation of the study results. TRIAL REGISTRATION Current Controlled Trials: ISRCTN88987322. Registered 13 May 2014.
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Affiliation(s)
- Sarita A Sanches
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512, PG, Utrecht, The Netherlands.
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Wilma E Swildens
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512, PG, Utrecht, The Netherlands.
| | - Jooske T van Busschbach
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands.
- Department of Movement and Education, Windesheim University of Applied Sciences, Postbus 10090, 8000, GB, Zwolle, The Netherlands.
| | - A Dennis Stant
- Zovon, Walhofstraat 28, 7522, BL, Enschede, The Netherlands.
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands.
| | - Talitha L Feenstra
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands.
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
- Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.
- Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900, AH, Castricum, The Netherlands.
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Little DM, Cook AJ, Morissette SB, Klocek JW. Considerations for return to work following traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:465-479. [PMID: 26563804 DOI: 10.1016/b978-0-444-62627-1.00027-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Population-based studies have demonstrated that a history positive for traumatic brain injury (TBI) can result in cognitive impairment, behavioral alterations, and pain. These outcomes can and do influence occupational function, can affect others in the workplace, and raise concerns about workplace safety upon re-entry to the workplace. Risk for long-term impairment and disability can in some cases be mitigated by assessment of capabilities relative to job duties, conservative return-to-work schedules, and, in some cases, interventions to support that return. For those in occupations at high risk for brain injury, including first responders, soldiers, and construction workers, the long-term risk of brain injury as a risk factor for neurodegenerative disease must and should inform increased concern for those with repeated injuries to the brain over the course of their lifetime and career. This chapter reviews the risks of TBI, considers factors that optimize functional recovery, and discusses potential interventions and factors that aid in return to the workplace.
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Affiliation(s)
- Deborah M Little
- Baylor Scott and White Healthcare, Temple, TX, USA; Neuroscience Institute, Texas A&M Health Science Center College of Medicine, Temple, TX, USA.
| | - Andrew J Cook
- Neuroscience Institute, Texas A&M Health Science Center College of Medicine, Temple, TX, USA; Central Texas Veterans Healthcare System, Temple, TX, USA
| | - Sandra B Morissette
- Neuroscience Institute, Texas A&M Health Science Center College of Medicine, Temple, TX, USA; Central Texas Veterans Healthcare System, Temple, TX, USA
| | - John W Klocek
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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Svedberg P, Svensson B, Hansson L, Jormfeldt H. A 2-year follow-up study of people with severe mental illness involved in psychosocial rehabilitation. Nord J Psychiatry 2014; 68:401-8. [PMID: 24228778 DOI: 10.3109/08039488.2013.851737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED BACKGROUNDS. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on health and wellbeing, there is a lack of research regarding the model called the Psychiatric Rehabilitation Approach from Boston University (BPR). AIM The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of healthcare services, quality of life, health, psychosocial functioning and empowerment. METHODS The study has a prospective longitudinal design and the setting was seven mental health services who worked with the BPR in the county of Halland in Sweden. In total, 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments. RESULTS The most significant finding was an improved psychosocial functioning at the follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up. There were significant differences with regard to health, empowerment, quality of life and psychosocial functioning for those who reported that they had mainly/completely had achieved their self-formulated rehabilitation goals compared to those who reported that they only had to a small extent or not at all reached their goals. CONCLUSIONS Our results indicate that the BPR approach has impact on clients' health, empowerment, quality of life and in particular concerning psychosocial functioning.
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Affiliation(s)
- Petra Svedberg
- Petra Svedberg, Associate Professor, School of Social and Health Sciences, Halmstad University , Sweden
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Jormfeldt H, Svensson B, Hansson L, Svedberg P. Clients' experiences of the Boston Psychiatric Rehabilitation Approach: a qualitative study. Int J Qual Stud Health Well-being 2014; 9:22916. [PMID: 24717265 PMCID: PMC3982115 DOI: 10.3402/qhw.v9.22916] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2013] [Indexed: 11/14/2022] Open
Abstract
The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients' experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients' experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in "A sense of being in communion with self and others" theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients' ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.
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Affiliation(s)
- Henrika Jormfeldt
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;
| | - Bengt Svensson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Petra Svedberg
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
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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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VAN Wel TF, Landsheer JA. Societal participation: examining the impact of a rehabilitation approach for young people with schizophrenia. J Psychiatr Ment Health Nurs 2012; 19:792-8. [PMID: 22212238 DOI: 10.1111/j.1365-2850.2011.01854.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper is based on research that focuses on the impact of a rehabilitation approach with respect to 99 young people diagnosed with schizophrenia in a Dutch mental health facility. The approach focused on societal participation goals. Nurses and social workers play a key role in such treatment. The research focused on developmental trajectories and showed significant improvement with respect to societal participation levels. Impairment scores remained stable. The results indicate that rehabilitation counselling by nurses and social workers, in addition to medication and psychosocial treatment and integrated in a multidisciplinary team, can make a difference in a patient's societal participation.
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Affiliation(s)
- T F VAN Wel
- Department of ABC, Altrecht Mental Health Care Institute, Utrecht, The Netherlands.
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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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Swildens W, van Busschbach JT, Michon H, Kroon H, Koeter MWJ, Wiersma D, van Os J. Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:751-60. [PMID: 22152644 DOI: 10.1177/070674371105601207] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands. METHOD A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR (n = 80) or CAU (n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved. RESULTS The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures. CONCLUSIONS The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life.
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Affiliation(s)
- Wilma Swildens
- Senior Researcher, Altrecht Mental Health Care, Utrecht, the Netherlands
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Abstract
AIMS This meta-analysis sought to identify which subgroups of clients with severe mental illness (SMI) benefited from evidence-based supported employment. METHODS We used meta-analysis to pool the samples from 4 randomized controlled trials comparing the Individual Placement and Support (IPS) model of supported employment to well-regarded vocational approaches using stepwise models and brokered services. Meta-analysis was used to determine the magnitude of effects for IPS/control group differences within specific client subgroups (defined by 2 work history, 7 sociodemographic, and 8 clinical variables) on 3 competitive employment outcomes (obtaining a job, total weeks worked, and job tenure). RESULTS The findings strongly favored IPS, with large effect sizes across all outcomes: 0.96 for job acquisition, 0.79 for total weeks worked, and 0.74 for job tenure. Overall, 90 (77%) of the 117 effect sizes calculated for the 39 subgroups exceeded 0.70, and all 117 favored IPS. CONCLUSIONS IPS produces better competitive employment outcomes for persons with SMI than alternative vocational programs regardless of background demographic, clinical, and employment characteristics.
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Affiliation(s)
- Kikuko Campbell
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
| | - Gary R. Bond
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH,Dartmouth Psychiatric Research Center, Lebanon, NH
| | - Robert E. Drake
- Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Hanover, NH, and,Dartmouth Psychiatric Research Center, Lebanon, NH
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Olavides-Soriano ME, Ampo E, Escorpizo R. Occupational rehabilitation policy and practice in the Philippines: initiatives and challenges. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21 Suppl 1:S62-S68. [PMID: 21279426 DOI: 10.1007/s10926-010-9284-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Challenges to occupational rehabilitation or work integration or reintegration which include the socio-political system, poor labour infrastructure, legislation implementation and monitoring limit work participation of an estimated eight million Filipinos with disabilities. This paper aims to present government-level initiatives and ongoing challenges of occupational rehabilitation as a field of practice and research in the Philippines. METHODS We performed a review of occupational rehabilitation literature relevant to the Philippines looking at legislation, policies, and practice. RESULTS While several socio-political mechanisms exists, we found no concrete information on the surveillance or distinction of services and their effectiveness provided under occupational rehabilitation and there was also no systemic reporting of the characteristics of the population (persons with disabilities vs. injured workers) requiring those services--despite the effort of the Philippines in adopting a state policy for the total development of persons with disabilities towards gainful employment. CONCLUSIONS The dearth of information and literature in occupational rehabilitation is likely related to the scarcity of research in the broader area of occupational safety and health and work disability management in the Philippines. The findings of this study could guide work disability management and address further development of infrastructure in occupational rehabilitation in the Philippines.
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Escorpizo R, Ekholm J, Gmünder HP, Cieza A, Kostanjsek N, Stucki G. Developing a Core Set to describe functioning in vocational rehabilitation using the international classification of functioning, disability, and health (ICF). JOURNAL OF OCCUPATIONAL REHABILITATION 2010; 20:502-511. [PMID: 20514511 DOI: 10.1007/s10926-010-9241-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The consequences of accidents, injuries, and health conditions that prevent workers from engaging in employment are prevailing issues in the area of work disability. Vocational rehabilitation (VR) programs aim to facilitate return-to-work process but there is no universal description of functioning for patients who participate in VR. Our objective is to develop a Core Set for VR based on the international classification of functioning, disability, and health (ICF). An ICF Core Set is a short list of ICF categories with alphanumeric codes relevant to a health condition or a health-related event. METHODS Development process consists of three phases. First is the preparatory phase which consists of four parallel studies: (1) systematic review of the literature, (2) worldwide survey of experts, (3) cross-sectional study, and (4) focus group interview. Patients with various health conditions are to be recruited from five VR centers located in Switzerland and Germany. The second phase is a consensus conference where findings from the preparatory phase will be presented followed by a multi-stage consensus process to determine the ICF categories that will comprise the Core Set for VR. The final phase consists of validation studies in several health conditions and settings. CONCLUSIONS We expect the first version of the ICF Core Set for VR to be completed in 2010. The Core Set can serve as a guide in the evaluation of patients and in planning appropriate intervention within VR programs. This Core Set could also provide a standard and common language among clinicians, researchers, insurers, and policymakers in the implementation of successful VR.
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Affiliation(s)
- Reuben Escorpizo
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
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Flannery KB, Benz MR, Yovanoff P, Kato MM, Lindstrom L. Predicting Employment Outcomes for Consumers in Community College Short-Term Training Programs. REHABILITATION COUNSELING BULLETIN 2010. [DOI: 10.1177/0034355210368432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postsecondary education has been linked to improved access to employment opportunities for individuals with and without disabilities. The purpose of this study was to determine factors associated with increased employment outcomes for Vocational Rehabilitation consumers enrolled in community college short term occupational skill training programs. Findings indicate that certain student and program factors were associated with more positive program and employment outcomes. Females, older participants, and those who received financial support were more likely to complete a certificate, be employed at exit, and maintain employment for 90 days. Individuals with psychiatric disabilities and other skill barriers were less likely to obtain positive program outcomes. Being female or a member of an ethnic minority group was associated with lower annual wages, while completion of all program outcomes predicted higher total annual wages. Implications for rehabilitation practice are discussed.
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Dunn EC, Wewiorski NJ, Rogers ES. A qualitative investigation of individual and contextual factors associated with vocational recovery among people with serious mental illness. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2010; 80:185-194. [PMID: 20553512 DOI: 10.1111/j.1939-0025.2010.01022.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Most people with serious mental illness (SMI) experience difficulty in fulfilling a vocational role, with many being unemployed or underemployed. Given the profound social and economic costs of this level of work impairment, researchers have investigated ways to enhance "vocational recovery," or the processes through which people with SMI regain their role as workers and reintegrate into the workforce. Using data collected from a larger qualitative study of 23 individuals who had progressed to an advanced stage of recovery from SMI, this study explored respondents' perspectives on employment and its relationship to their vocational recovery. Text passages describing employment were analyzed inductively by a diverse team of researchers. Seven themes were identified as being important in helping participants return to work or remain employed following the onset of a serious psychiatric disability: having the confidence to work, having the motivation to work, possessing work-related skills, assessing person-job fit, creating work opportunities, receiving social support, and having access to consumer-oriented programs and services. Implications of these findings on the development of interventions and policies to improve the vocational outcomes of people with SMI are discussed.
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Affiliation(s)
- Erin C Dunn
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, USA.
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Abstract
This study explores the capacity of individuals with severe mental illness to be employed in managerial or professional jobs and the correlates of their vocational success. Using purposive sampling techniques, we identified a national sample of 347 individuals for a mail survey who had succeeded in obtaining and retaining mid to upper level managerial or professional positions. The majority worked full-time and held their job for more than 2 years. Their vocational success was operationalized based on 4 employment outcomes: employment status (full-time vs. part-time), job tenure, occupational rank, and annual income. Key factors that contributed to respondents' vocational success were lesser severity of the illness as indicated by lack of lifetime receipt of disability benefits, capacity to manage one's own psychiatric condition, and higher education. Study findings point to the role of supported education and self-efficacy in promoting the employment outcomes among individuals with severe mental illnesses.
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