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Marsden J, Anders P, Shaw C, Amasiatu C, Collate W, Eastwood B, Horgan P, Khetani M, Knight J, Knight S, Melaugh A, Clark H, Stannard J. Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial. EClinicalMedicine 2024; 68:102400. [PMID: 38299044 PMCID: PMC10828604 DOI: 10.1016/j.eclinm.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness. Methods IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed. Findings Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions. Interpretation In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold). Funding UK government Work and Health Unit.
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Affiliation(s)
- John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Paul Anders
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Claire Shaw
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Chioma Amasiatu
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Winnie Collate
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Brian Eastwood
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Patrick Horgan
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Meetal Khetani
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jonathan Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Sandy Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Alexandra Melaugh
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Helen Clark
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jez Stannard
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
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Strømstad K, Skarpaas LS, Haslerud SI, Alve YA, Sandqvist J, Aas RW. Exploring return to work barriers through the lens of model of human occupation. The NOW WHAT project. Scand J Occup Ther 2024; 31:2297732. [PMID: 38242153 DOI: 10.1080/11038128.2023.2297732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The challenges of returning to work after sickness absence demands a wide conceptual understanding of what hinders the employee's work participation. Thus, there is a need to know more about self-perceived barriers for Return to Work (RTW). AIM This study aimed to investigate RTW barriers experienced by employees on long-term sick leave, through the lens of the Model of Human Occupation (MOHO). MATERIAL AND METHODS The study was a large-scale qualitative interview study (n = 85) using semi-structured telephone interviews. Eligible participants had received sick leave benefits for between 6 months and 1.5 years. The data were analysed with quantitative and qualitative content analysis. A deductive approach using the MOHO concepts guided the analysis process. RESULTS The study generated 941 coded meaning units describing barriers for RTW, of which we were able to code 895 within the framework of MOHO. In the person-specific concepts, performance capacity barriers were most often described (n = 303), followed by volitional barriers (n = 165) and barriers related to habituation (n = 66). Barriers related to the environmental components amounted to 361. Barriers in the occupational environment was dominant (n = 214). CONCLUSION Experienced barriers related to both environmental components and person-specific concepts. SIGNIFICANCE The habituational and volitional perspective on barriers can contribute to the identification and communication of performance capacity-related barriers not previously identified.
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Affiliation(s)
- Kine Strømstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Lisebet S Skarpaas
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Sturla I Haslerud
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Yeasir A Alve
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA
| | - Jan Sandqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Randi W Aas
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
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Kwan A, Berinstein S, Morris J, Barbic S. Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada. BMC Psychiatry 2023; 23:919. [PMID: 38062406 PMCID: PMC10704795 DOI: 10.1186/s12888-023-05395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Individual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers. METHODS A case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation. RESULTS Integration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge. CONCLUSIONS Implementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.
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Affiliation(s)
- Amanda Kwan
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Jonathan Morris
- Canadian Mental Health Association BC Division, Vancouver, BC, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Providence Research, Vancouver, BC, Canada
- Centre for Health Evaluation Outcome Sciences, Vancouver, BC, Canada
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Mavindidze E, Nhunzvi C, Van Niekerk L. Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review. PLoS One 2023; 18:e0291869. [PMID: 37733732 PMCID: PMC10513264 DOI: 10.1371/journal.pone.0291869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace. DESIGN The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework. DATA SOURCES AND ELIGIBILITY Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included. STUDY APPRAISAL AND SYNTHESIS Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work. RESULTS The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace. CONCLUSIONS There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.
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Affiliation(s)
- Edwin Mavindidze
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Occupational Therapy Programme, Rehabilitation Sciences Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Clement Nhunzvi
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Occupational Therapy Programme, Rehabilitation Sciences Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Lana Van Niekerk
- Faculty of Medicine and Health Sciences, Division of Occupational Therapy, Stellenbosch University, Cape Town, Western Cape, South Africa
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Rennhack F, Lindahl-Jacobsen LE, Schori D. Pre-vocational therapy in mental health. Clients' desired and achieved productivity status. Scand J Occup Ther 2023; 30:195-210. [PMID: 34602019 DOI: 10.1080/11038128.2021.1968950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knowledge about work-related occupational therapy in psychiatric inpatient and day hospital clients is limited. AIMS The aim of the study was to explore the desired and achieved productivity status in mental health service users participating in a pre-vocational therapy (PVT) intervention. Outcome variables were productivity status and achievement of desired productivity status at discharge, and change or persistence of productivity status between admission and discharge. METHODS This is a short-term prospective study based on observational data from health records (N = 98). RESULTS At admission, 53.2% of participants named a clear desired productivity status; 46.8% did not. Of the former, 76.9% expressed a desire for employment or education on the regular job market; 28.0% achieved their desired outcome at discharge, whereas 72.0% did not. Overall, 58.5% retained, established or increased productive activities, while 41.5% were not engaged in or had reduced productive activities at discharge. These two groups differed in socio-economic and social-security-related characteristics, treatment-related characteristics and psychiatric diagnosis. CONCLUSIONS AND SIGNIFICANCE Some, but not all kinds of clients in acute psychiatric inpatient and day hospital settings manage to take a first step towards productive activities during the first phase of treatment.
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Affiliation(s)
- Frauke Rennhack
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | | | - Dominik Schori
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Franzsen D, de Witt P, Saohatse L, van Niekerk M. A conceptual framework for return to work for clients with major depressive disorder. Work 2023; 74:97-109. [PMID: 36214009 DOI: 10.3233/wor-210520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Return to work (RTW) may be a lengthy and complex process for individuals with major depressive disorder (MDD) especially when not well managed. This increases the risk of isolation and loss of routine which negatively influences their mental health. However, for clients with MDD, a comprehensive overview of all the factors that influence RTW based on a model of occupation is lacking. OBJECTIVE To develop a conceptual framework to guide an occupation-based process of RTW for clients with MDD, treated in the private sector in South Africa. METHODS This paper describes the development of a conceptual framework using literature and thematic synthesis of a qualitative descriptive study based on interviews with eight participants diagnosed with MDD which were linked to constructs of Kielhofner's Model of Human Occupation (MOHO). RESULTS Qualitative data from key informant interviews were deductively analysed according to the subsystems of MOHO for waiting to RTW and experience of RTW. The conceptual framework developed included the constructs of Person and Occupational Setting from MOHO as well as the components of Occupational Identity and Competence central to intervention to achieve successful RTW. CONCLUSION A successful RTW process for clients with MDD is dependent on the person and the occupational setting. The role of the occupational therapist in the RTW can be facilitated by the occupation-based conceptual framework developed on MOHO.
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Affiliation(s)
- Denise Franzsen
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Patricia de Witt
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Lebohang Saohatse
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Matty van Niekerk
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Gjerdalen OS, Lystad JU, Bull H, Ringen PA, Røssberg JI, Martinsen EW, Ueland T, Falkum E, Evensen S. Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study. Nord J Psychiatry 2023; 77:23-30. [PMID: 35209785 DOI: 10.1080/08039488.2022.2042598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). METHODS One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n = 64) or CBT (n = 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. RESULTS At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. CONCLUSION To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.
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Affiliation(s)
| | - June Ullevoldsaeter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helen Bull
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of health science, Oslo Metropolitan University, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil W Martinsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
| | - Erik Falkum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
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Fernández-Solano AJ, Rodríguez-Bailón M, Del Baño-Aledo ME. Increasing occupational participation: A qualitative analysis within the “Occupational Self-Analysis” program. Br J Occup Ther 2022. [DOI: 10.1177/03080226221145389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Occupational participation is a key element to increase the quality of life in the population. One of the effective interventions to increase occupational participation is the “Occupational Self-Analysis” program. The aim of this study was to analyze participant’s reported benefits about the “Occupational Self-Analysis” program. Method: This is a qualitative study with 26 participants (12 people with intellectual disability, 7 affected by acquired brain injury, and 7 students) who participated in weekly group sessions and one individual session. The outcomes were measured based on participant diaries and focus group transcriptions. Results: Two main themes emerged: (1) supports for occupational participation and (2) barriers for occupational participation. The thematic analysis of the categories was based on the Model of Human Occupation to increase applicability of the program in occupational therapy practice. Conclusions: The “Occupational Self-Analysis” program allowed participants to increase their knowledge of supports provided for and the barriers against occupational participation.
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Affiliation(s)
- Ana Judit Fernández-Solano
- Occupational Therapy Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Murcia, Spain
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Fukuura Y, Shigematsu Y, Mizuochi Y, Kakuma T. Assessing Continued Employability among People with Mental Illnesses: Development of a Scale in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14786. [PMID: 36429523 PMCID: PMC9690244 DOI: 10.3390/ijerph192214786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Continued employment enables people with mental illnesses to maintain and improve their mental health, and its mutual understanding between them and their workplaces can help provide specific support and improve the work environment. Hence, this study developed a Continued Employability Scale to provide people with mental illnesses solutions for achieving continued employment and examined the scale's reliability and validity. It is based on a conceptual analysis of the skills necessary for continued employment and comprises items related to continued employability and the consequences of continued employment. We performed conceptual analyses to prepare the item list, conducted the study using a questionnaire survey, and examined its content validity and reliability using factor analyses. The results showed that the developed scale, which can determine self-management, dedication to work, environmental adjustments, and expression of sincerity necessary for continued employment, was reliable and valid. This can be a potentially helpful tool for assessing the ability to continue working and help people with mental illnesses visualise their continued employability, clarify what is being assessed, and improve the self-management ability necessary for continued employment. Further, it can help people who support them at work and enable existing support and programs to function effectively.
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Affiliation(s)
- Yoshitomo Fukuura
- Department of Nursing, Kurume University Graduate School of Medicine, 777-1 Higashikushiharamachi, Kurume-shi 830-0003, Fukuoka, Japan
| | - Yukako Shigematsu
- School of Nursing, Kurume University, 777-1 Higashikushiharamachi, Kurume-shi 830-0003, Fukuoka, Japan
| | - Yumi Mizuochi
- Department of Nursing, Kurume University Graduate School of Medicine, 777-1 Higashikushiharamachi, Kurume-shi 830-0003, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- The Biostatistics Center, Kurume University, 777-1 Higashikushiharamachi, Kurume-shi 830-0003, Fukuoka, Japan
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Moe C, Brinchmann B, Rasmussen L, Brandseth OL, McDaid D, Killackey E, Rinaldi M, Borg M, Mykletun A. Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study. BMC Psychiatry 2021; 21:632. [PMID: 34930203 PMCID: PMC8690340 DOI: 10.1186/s12888-021-03644-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. METHODS Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. RESULTS While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. CONCLUSION The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues.
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Affiliation(s)
- Cathrine Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Line Rasmussen
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Oda Lekve Brandseth
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eóin Killackey
- grid.488501.0Orygen, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Marit Borg
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Drammen, Norway
| | - Arnstein Mykletun
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division for Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
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11
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Rocamora-Montenegro M, Compañ-Gabucio LM, Garcia de la Hera M. Occupational therapy interventions for adults with severe mental illness: a scoping review. BMJ Open 2021; 11:e047467. [PMID: 34716157 PMCID: PMC8559113 DOI: 10.1136/bmjopen-2020-047467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the occupational therapy (OT) interventions in adults with severe mental illness (SMI) most investigated in intervention studies and to describe their characteristics. DESIGN Scoping review. DATA SOURCES On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the first quartile of OT according to the SCImago Journal Rank. We updated our search on 10 March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major depression, obsessive-compulsive, severe mental, OT and intervention. STUDY SELECTION The study screening was peer-reviewed. Inclusion criteria were: (1) OT intervention studies in SMI: experimental, randomised, non-randomised and pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive-compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a discipline involved in the intervention; (4) English or Spanish language and (5) studies with full text available. RESULTS Thirty-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention. CONCLUSION Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2-3 weekly 60 min sessions and a duration of 3-6 months.
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Affiliation(s)
- María Rocamora-Montenegro
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
| | - Manuela Garcia de la Hera
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Vukadin M, Schaafsma FG, Michon HWC, de Maaker-Berkhof M, Anema JR. Experiences with Individual Placement and Support and employment - a qualitative study among clients and employment specialists. BMC Psychiatry 2021; 21:181. [PMID: 33827498 PMCID: PMC8025385 DOI: 10.1186/s12888-021-03178-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/22/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness (SMI) achieve competitive employment. The aim of the present study is to explore experiences with Individual Placement and Support using a multifaceted implementation strategy (IPS + MIS), and competitive employment. The goal of this strategy was to improve IPS implementation by enhancing collaboration between mental health care and vocational rehabilitation stakeholders, and realizing a secured IPS funding with a 'pay for performance' element. METHODS A qualitative, exploratory study was performed using semi-structured interviews with IPS clients (n = 10) and two focus groups with IPS employment specialists (n = 7 and n = 8) to collect rich information about their experiences with IPS + MIS and competitive employment. Thematic content analysis was used to analyse the data. RESULTS Themes related to experiences with IPS and the multifaceted implementation strategy were identified, including the importance of discussing the client's motivation and motives to work, facilitators and barriers to obtaining and maintaining employment, facilitators to collaboration between stakeholders, barriers to benefits counselling, organizational barriers to IPS execution and collaboration between stakeholders, financial barriers to IPS execution and experiences with the pay for performance element. CONCLUSIONS Although the multifaceted implementation strategy seems to contribute to an improved IPS implementation, the barriers identified in this study suggest that further steps are necessary to promote IPS execution and to help people with SMI obtain and maintain competitive employment.
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Affiliation(s)
- Miljana Vukadin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands. .,Research Center for Insurance Medicine: Collaboration Between AMC- UMCG - UWV - VUmc, Amsterdam, The Netherlands.
| | - Frederieke G. Schaafsma
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands ,grid.5650.60000000404654431Research Center for Insurance Medicine: Collaboration Between AMC– UMCG – UWV – VUmc, Amsterdam, The Netherlands
| | - Harry W. C. Michon
- grid.416017.50000 0001 0835 8259Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands ,grid.491356.c0000 0004 0622 0186Movisie, Churchilllaan 11, 3527 BG Utrecht, The Netherlands
| | - Marianne de Maaker-Berkhof
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands ,grid.5650.60000000404654431Research Center for Insurance Medicine: Collaboration Between AMC– UMCG – UWV – VUmc, Amsterdam, The Netherlands
| | - Johannes R. Anema
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands ,grid.5650.60000000404654431Research Center for Insurance Medicine: Collaboration Between AMC– UMCG – UWV – VUmc, Amsterdam, The Netherlands
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Pichler EM, Stulz N, Wyder L, Heim S, Watzke B, Kawohl W. Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:709732. [PMID: 34712153 PMCID: PMC8546221 DOI: 10.3389/fpsyt.2021.709732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, Windisch, Switzerland.,Integrated Psychiatric Services Winterthur-Zurcher Unterland (IPW), Winterthur, Switzerland
| | - Lea Wyder
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Simone Heim
- Psychiatric Services Aargau, Windisch, Switzerland.,Praxis Dr. Pramstaller, Uetikon am See, Switzerland
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
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