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Bond GR, Mascayano F, Metcalfe JD, Riley J, Drake RE. Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences? JOURNAL OF VOCATIONAL REHABILITATION 2023. [DOI: 10.3233/jvr-230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.
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Witte I, Strandberg T, Granberg S, Gustafsson J. Intersectional perspectives on the employment rate in Supported Employment for people with psychiatric, neuropsychiatric, or intellectual disabilities: A scoping review. Work 2023; 74:435-454. [PMID: 36278382 PMCID: PMC9986703 DOI: 10.3233/wor-211155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention. OBJECTIVE To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history. METHODS A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included. RESULTS The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power. CONCLUSIONS Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.
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Affiliation(s)
- Ingrid Witte
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Thomas Strandberg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sarah Granberg
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Gustafsson
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway
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Richter D, Hoffmann H. Effectiveness of supported employment in non-trial routine implementation: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:525-531. [PMID: 30078035 DOI: 10.1007/s00127-018-1577-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/30/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE While supported employment (SE) programs for people with mental illness have demonstrated their superiority in randomized controlled trials (RCTs) and meta-analyses, little is known about the effectiveness of non-trial routine programs. The primary objective of this study was to estimate a pooled competitive employment rate of non-trial SE programs by means of a meta-analysis. A secondary objective was to compare this result to competitive employment rates of SE programs in RCTs, prevocational training programs in RCTs and in routine implementation. METHODS A systematic review and a random-effects meta-analysis of proportions were conducted. Quality assessment was provided. Moderator analyses by subgroup comparisons were conducted. RESULTS Results from 28 samples were included in the meta-analysis. The pooled competitive employment rate for SE routine programs was 0.43 (95% CI 0.37-0.50). The pooled competitive employment rates for comparison conditions were: SE programs in RCTs: 0.50 (95% CI 0.43-0.56); prevocational programs in RCTs: 0.22 (95% CI 0.16-0.28); prevocational programs in routine programs: 0.17 (95% CI 0.11-0.23). SE routine studies conducted prior to 2008 showed a significantly higher competitive employment rate. CONCLUSION SE routine programs lose only little effectiveness compared to SE programs from RCTs but are much more successful in reintegrating participants into the competitive labor market than prevocational programs. Labor market conditions have to be taken into account when evaluating SE programs.
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Affiliation(s)
- Dirk Richter
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland. .,Health Division, Bern University of Applied Sciences, Bern, Switzerland.
| | - Holger Hoffmann
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland.,Soteria, Bern, Switzerland
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DeTore NR, Hintz K, Khare C, Mueser KT. Disclosure of mental illness to prospective employers: Clinical, psychosocial, and work correlates in persons receiving supported employment. Psychiatry Res 2019; 273:312-317. [PMID: 30677720 DOI: 10.1016/j.psychres.2019.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
Deciding whether to disclose one's psychiatric disorder to a prospective employer is a complex decision for people with severe mental illness seeking to return to work, with potential advantages and disadvantages. The present study examined the rates, patterns, and correlates of disclosure in 51 participants (74.5% schizophrenia or schizoaffective disorder) receiving high fidelity Individual Placement Support (IPS) who obtained competitive work over a two-year study period. Most participants (64.7%) disclosed their psychiatric disorder in their first job, and there was a tendency for those with multiple jobs who did not disclose initially to shift to disclosure in subsequent jobs. Participants who disclosed for their first job had worse baseline cognitive scores on the Positive and Negative Syndrome Scale (PANSS), lower self-esteem, and poorer psychosocial functioning than those who did not disclose. However, participants who disclosed to their first employer were more likely to obtain jobs that matched their interests, and worked significantly longer than those who did not disclose (32.55 vs. 12.50 weeks, respectively). The findings suggest that individuals receiving supported employment who disclose their mental illness to prospective employers may have better work outcomes.
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Affiliation(s)
- Nicole R DeTore
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kathryn Hintz
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Chitra Khare
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
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Pinto AD, Hassen N, Craig-Neil A. Employment Interventions in Health Settings: A Systematic Review and Synthesis. Ann Fam Med 2018; 16:447-460. [PMID: 30201643 PMCID: PMC6130994 DOI: 10.1370/afm.2286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Employment is a key social determinant of health. People who are unemployed typically have worse health than those employed. Illness and disability can result in unemployment and be a barrier to regaining employment. We combined a systematic review and knowledge synthesis to identify both studies of employment interventions in health care settings and common characteristics of successful interventions. METHODS We searched the peer-reviewed literature (1995-2017), and titles and abstracts were screened for inclusion and exclusion criteria by 2 independent reviewers. We extracted data on the study setting, participants, intervention, methods, and findings. We also conducted a narrative synthesis and iteratively developed a conceptual model to inform future primary care interventions. RESULTS Of 6,729 unique citations, 88 articles met our criteria. Most articles (89%) focused on people with mental illness. The majority of articles (74%) tested interventions that succeeded in helping participants gain employment. We identified 5 key features of successful interventions: (1) a multidisciplinary team that communicates regularly and collaborates, (2) a comprehensive package of services, (3) one-on-one and tailored components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers. CONCLUSIONS Our findings can inform new interventions that focus on employment as a social determinant of health. Although hiring a dedicated employment specialist may not be feasible for most primary care organizations, pathways using existing resources with links to external agencies can be created. As precarious work becomes more common, helping patients engage in safe and productive employment could improve health, access to health care, and well-being.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada .,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nadha Hassen
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amy Craig-Neil
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J. Individual placement and support: from research to
practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vocational rehabilitation for people with severe mental health problems is
poorly developed in the UK. Although there is a clear evidence base
indicating the effectiveness of approaches to helping people with severe
mental health problems gain and retain employment there is generally a lack
of awareness of this evidence. As a result there has been a lack of
implementation within routine clinical practice of the most effective
approaches to improving employment outcomes for such individuals.
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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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Porteous N, Waghorn G. Implementing Evidence-Based Employment Services in New Zealand for Young Adults with Psychosis: Progress during the First Five Years. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This practice evaluation demonstrates how occupational therapists can play a key role in providing vocational services for young people experiencing a first episode of psychosis. By implementing the evidence-based Individual Placement and Support model, occupational therapists can expand their traditional roles to provide services that integrate functional recovery with clinical recovery. This New Zealand programme achieved vocational outcomes of between 49% and 59% over a 4-year period. The lessons learned from these experiences add to the body of international knowledge on how best to implement evidence-based employment services for young people with mental health problems.
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Affiliation(s)
- Nikki Porteous
- Early Intervention Service, Capital and Coast District Health Board, New Zealand
| | - Geoffrey Waghorn
- The Queensland Centre for Mental Health Research and The University of Queensland
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9
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Kirsh B. Client, Contextual and Program Elements Influencing Supported Employment: A Literature Review. Community Ment Health J 2016; 52:809-20. [PMID: 27055809 DOI: 10.1007/s10597-015-9936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
Supported employment is an evidence-based practice with a well-established research base. Most studies track such outcomes as employment rates, time to employment and wages earned. Few studies address client and contextual factors that impact outcomes or consider program elements beyond those that comprise the individual placement and support model. This paper reviews existing literature to shed light on the following questions: (1) What impact do labour market trends have on the effectiveness of SE? (2) How lasting are the effects of SE and what factors influence longevity of SE effects? (3) What levels and types of employment are targeted by SE? (4) What are the characteristics of people who benefit from SE? (5) What is the role of peer support in SE? and (6) What are the barriers to effective SE implementation? Research findings are synthesized and suggestions for service enhancements are offered so that the model can continue to evolve.
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Affiliation(s)
- Bonnie Kirsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Canada.
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Affiliation(s)
- Geoff Waghorn
- Policy and Economics Group, Queensland Centre for Mental Health Research (QCMHR), School of Population Health, University of Queensland, Australia
| | - Chris Lloyd
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
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11
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Corbière M, Villotti P, Toth K, Waghorn G. [Disclosure of a mental disorder in the workplace and work accommodations: two factors associated with job tenure of people with severe mental disorders]. L'ENCEPHALE 2014; 40 Suppl 2:S91-S102. [PMID: 24948480 DOI: 10.1016/j.encep.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
Job tenure for people with severe mental disorders (e.g., schizophrenia) remains a stumbling-block to their work integration. However, the length of job tenure can vary according to the workplace (e.g., provided resources) and the work context (e.g., regular market, social firms). This gap can be explained in part by diverse organisational components, particularly the implementation of work accommodations, which is related to the disclosure of the mental disorder in the workplace. Indeed, in the scientific literature, the principal reason associated with disclosure is in regards to requesting work accommodations. The main objective of this paper is to increase our understanding of the relationships between these three concepts - disclosure of a mental disorder, work accommodations and natural supports, and job tenure - by reviewing the specialized literature and presenting the work of the authors of this paper. To do so, the authors will address the following questions: How do we define 'disclosure' of a mental disorder in the workplace and what are the strategies to consider before disclosing? What is the decision-making process related to disclosure in the workplace? How are the three concepts - disclosure of the mental disorder in the workplace, work accommodations and job tenure - intertwined? Finally, how can employment specialists facilitate the work integration of people with severe mental disorders by considering the three concepts mentioned above? Results from a review of the literature show that disclosure of a mental disorder is a dialectical process that goes beyond the question: to tell or not to tell? In fact, it is not a single binary decision. Several components are associated with the disclosure concept, and can be summarized by the questions: What, how, when and to whom to disclose his/her mental condition? Reasons for disclosing his/her mental disorder in the workplace are numerous, characterized by personal, interpersonal and work environmental factors, on one hand. On the other hand, disclosure has potential consequences, both positive (e.g., to obtain work accommodations) and negative (e.g., stigma). A decision-making process takes place when people with a severe mental disorder think about the possibility of disclosing their mental condition in the workplace - a complex decisional process involving the need to evaluate different aspects (i.e. individual, interpersonal and work environmental factors). Also, the literature supports the fact that requiring work accommodations is often related to the disclosure of the mental disorder, when natural supports in the workplace are not available. The literature is scarce regarding the correlations between the concepts of disclosure, implementation of work accommodations and job tenure; however, a more recent study demonstrated this significant relationship, in which the supervisor and co-worker supports are crucial. Employment specialists or counselors recognise the importance of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma. The employment specialist working in supported employment programs for instance, could adopt with his/her clients a plan for managing the pros and cons of disclosure of the mental disorder in the workplace; this plan is entitled: Managing personal information. It consists of several steps - for example, to collect details of any sensitive information such as diagnosis, to identify work restrictions with the client, to have a common agreement (employment specialists and clients together) on terms to describe work restrictions - to help clients feel empowered and more confident as productive and valued workers. This plan allows employment specialists to work through the disclosure concept, often negatively connoted, and to adopt a more normalising strategy. Furthermore, additional tools for supporting the management of personal information plan could be used such as the Decision-Making About Disclosure Scale, the Barriers to Employment and Coping Efficacy Scale, and the Work Accommodation and Natural Support Scale, to name a few. To conclude, job tenure for people with severe mental disorders is not a pious vow, several pragmatic ingredients for intervening on this issue are now available.
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Affiliation(s)
- M Corbière
- École de réadaptation, université de Sherbrooke, campus de Longueuil, 150, place Charles LeMoyne, J4K 0A8 Longueuil, Québec, Canada.
| | - P Villotti
- Département de psychologie et sciences cognitives, université de Trente, via Matteo del Ben 5, 38068 Rovereto, Italie
| | - K Toth
- Lawrence Kinlin School of Business, Fanshawe College, 1001 Fanshawe College Blvd., N5Y 5R6 London, Ontario, Canada
| | - G Waghorn
- Queensland centre for mental health research, level 3 Dawson House, The Park, 4076 Wacol, QLD, Australie
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12
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Allott KA, Turner LR, Chinnery GL, Killackey EJ, Nuechterlein KH. Managing disclosure following recent-onset psychosis: utilizing the individual placement and support model. Early Interv Psychiatry 2013; 7:338-44. [PMID: 23343040 DOI: 10.1111/eip.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/16/2012] [Indexed: 11/28/2022]
Abstract
AIMS Individual Placement and Support is the most defined and evidence-based approach to supported employment for severe mental illness, including recent-onset psychosis. However, there is limited evidence or detailed guidelines informing the management of mental illness disclosure to educators or employers when delivering individual placement and support. In this paper, we describe the initial disclosure preferences of young people with recent-onset psychosis enrolled in individual placement and support and provide guidance for managing disclosure when delivering Individual Placement and Support with this population. METHODS Drawing from sites in Melbourne, Australia and Los Angeles, USA, clients' initial disclosure preferences were examined. We describe approaches to providing individual placement and support when no disclosure is permitted compared with when disclosure is permitted, including two illustrative case vignettes. RESULTS No disclosure of mental illness or disability was requested by 54-59% of clients; 41-46% of clients permitted partial or complete disclosure. The 'no disclosure' scenario required the individual placement and support worker to provide support 'behind the scenes', whereas when disclosure was permitted, the individual placement and support worker could have contact with instructors/employers and work 'on the front lines'. The case vignettes illustrate how both approaches can lead to successful vocational outcomes. CONCLUSIONS We found that Individual Placement and Support can be provided in an educative, flexible, creative and collaborative manner according to client disclosure preferences. We suggest that disclosure preferences do not prevent successful vocational outcomes, although this supposition requires empirical investigation.
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Affiliation(s)
- Kelly A Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
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13
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Enhancing work-focused supports for people with severe mental illnesses in australia. Rehabil Res Pract 2012; 2012:863203. [PMID: 22966462 PMCID: PMC3395169 DOI: 10.1155/2012/863203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/26/2012] [Indexed: 11/17/2022] Open
Abstract
Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI.
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Jones AM. Disclosure of Mental Illness in the Workplace: A Literature Review. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2011. [DOI: 10.1080/15487768.2011.598101] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Williams A, Fossey E, Harvey C. Sustaining Employment in a Social Firm: Use of the Work Environment Impact Scale V2.0 to Explore Views of Employees with Psychiatric Disabilities. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12892992239279] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evidence suggests that people with psychiatric disabilities find it difficult to get and keep jobs, with workplace characteristics contributing to difficulties staying in employment. This qualitative study aimed to understand the views of employees with a psychiatric disability about working in an Australian social firm designed to provide an inclusive and supportive work environment. Method: Seven participants who had sustained jobs for 6 months or longer in the social firm, a contract cleaning business, were interviewed using the Work Environment Impact Scale (Version 2.0). Interviews were audiotaped, transcribed and analysed inductively using thematic and narrative analysis. Findings: Participants' views of the work environment included that the regular structure and achievable tasks, the supportive and cooperative team and the benefits of the job made working in the social firm enjoyable and the right job for now. The findings suggest that participants' decisions to stay in their jobs were influenced by the social firm environment, which supported their wellbeing, and by their individual illness and occupational narratives. Conclusion: The WEISv2.0 was effective in gaining participants' views on wide-ranging features of their workplaces. Further research is recommended to expand the evidence base concerning workplace features that support employees with psychiatric disabilities to sustain their jobs.
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Affiliation(s)
- Anne Williams
- Lecturer, School of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
| | - Ellie Fossey
- Senior Lecturer, School of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
| | - Carol Harvey
- Associate Professor, Department of Psychiatry, The University of Melbourne, Carlton, Victoria, Australia
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Sherring J, Robson E, Morris A, Frost B, Tirupati S. A working reality: Evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities. Aust Occup Ther J 2010; 57:261-7. [DOI: 10.1111/j.1440-1630.2009.00844.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roberts MM, Pratt CW. A Construct Validity Study of Employment Readiness in Persons with Severe Mental Illness. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2010. [DOI: 10.1080/15487760903489259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Edward KL, Munro I. Depression and other mental illnesses in the context of workplace efficacy. J Psychiatr Ment Health Nurs 2008; 15:605-11. [PMID: 18768014 DOI: 10.1111/j.1365-2850.2008.01253.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K-L Edward
- School of Nursing, Deakin University, Melbourne Campus, Melbourne, Vic, Australia
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Abstract
Readiness in the work domain has been a controversial issue for the psychiatric rehabilitation community. Judgments of a lack of readiness have relegated many persons to lives of continued unemployment and service dependency. Conversely, proponents of the rapid placement strategy of supported employment have down-played the importance of readiness. Yet, a careful review of the supported employment research suggests that readiness may indeed be an important factor in vocational outcomes. This paper presents evidence that the screening criteria employed in SE studies are often related to readiness factors and that these criteria are highly predictive of vocational outcomes. Acceptance of the importance of readiness for success in the vocational arena implies new service strategies and may serve to improve vocational outcomes in general.
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Affiliation(s)
- Melissa M Roberts
- Department of Psychiatric Rehabilitation, University of Medicine and Dentistry of New Jersey, Scotch Plains 07076, USA.
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King R, Waghorn G, Lloyd C, McLeod P, McMah T, Leong C. Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment. Aust N Z J Psychiatry 2006; 40:471-7. [PMID: 16683974 DOI: 10.1080/j.1440-1614.2006.01824.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. METHOD Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. RESULTS Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. CONCLUSIONS Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.
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Affiliation(s)
- Robert King
- School of Medicine, University of Queensland, Brisbane, Australia.
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Abstract
Supported employment for people with severe mental illnesses is an evidence-based practice, based on converging findings from 4 studies of the conversion of day treatment to supported employment and 9 randomized controlled trials comparing supported employment to a variety of alternative approaches. These two lines of research suggest that between 40% and 60% of consumers enrolled in supported employment obtain competitive employment while less than 20% of similar consumers do so when not enrolled in supported employment. Consumers who hold competitive jobs for a sustained period of time show benefits such as improved self-esteem and better symptom control, although by itself, enrollment in supported employment has no systematic impact on nonvocational outcomes, either on undesirable outcomes, such as rehospitalization, or on valued outcomes, such as improved quality of life. The psychiatric rehabilitation field has achieved consensus on a core set of principles of supported employment, although efforts continue to develop enhancements. A review of the evidence suggests strong support for 4 of 7 principles of supported employment, while the evidence for the remaining 3 is relatively weak. Continued innovation and research on principles is recommended.
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Affiliation(s)
- Gary R Bond
- Department of Psychology, Indiana University Purdue University, Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202-3275, USA.
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