Matching services to needs. Vocational services for substance abusers

Problems with employment are common among individuals with substance use disorders, yet comprehensive vocational services are not generally available to them, and vocational interventions are often not matched to their specific needs. This article describes the wide range of vocational problems found among individuals with substance use disorders and the elements of a recently funded vocational program for patients in outpatient and residential drug and alcohol treatment programs. Data are presented describing program activity and documenting program effectiveness for the first 2 years of operation of the program. Three case histories are presented to illustrate the types of services delivered and the matching of services delivered to specific, identified client needs (see Case Histories).

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.

A Qualitative Analysis of Career Advice Given to Women Leaders in an Academic Medical Center

IMPORTANCE

Women in academic medicine continue to face systemic obstacles on their paths to leadership. In addition to improving recruitment and advancement opportunities, academic medical centers must facilitate a cultural shift that ensures sustained leadership pathways for women.

OBJECTIVE

To better understand, from the perspective of women leaders, the workplace and cultural changes that need to take place in academic medicine to increase inclusivity and gender equity.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study of 40 women physicians and administrators with senior leadership roles at Mayo Clinic, a nonprofit academic medical center and research institution with campuses in Arizona, Florida, and Minnesota, examined participants' responses to a question regarding their paths to leadership. Replies were submitted between November and December 2018.

MAIN OUTCOMES AND MEASURES

Women were asked to describe career advice (positive or negative) they had received that was the hardest to accept but, in retrospect, turned out to be valuable.

RESULTS

Of 40 participants, 25 (63%) were physicians and 15 (37%) were administrators at Mayo Clinic; 27 (68%) had achieved the role of chair or the administrative equivalent. Career experience ranged from 6 to 40 years. Of the 40 women leaders queried, 38 (95%) provided written responses, which were separated into the 4 following categories: leadership styles are perceived as having gendered qualities, attaining leadership skills involves a strategic learning process, collisions between personal life and the workplace should not deter individuals from pursuing leadership roles, and leadership pathways for women involved hurdles. These categories represented a roadmap illuminating perceptions about the academic medical workplace.

CONCLUSIONS AND RELEVANCE

These findings link generalizable principles to help to drive new strategies for gender parity. Shifting the culture of academic medicine begins with fully understanding impediments to women's advancement. The advice women leaders recounted offered a roadmap as well as a glimpse of the extra effort required for women to succeed amid some of the system's limitations and obstacles. A more complete understanding of gender biases may help to shape future programs to expand inclusivity and establish sustained leadership paths for women.

Recruiting future neuroscientists: what asking the recruits can teach us

Many different strategies are used to recruit students into scientific research careers, including neuroscience research. These strategies are rarely based on knowledge about students; instead, activities are selected based on their ease of implementation. The goal of the LEARN Project is to encourage high school students into mental health science research using the theme of learning and memory. One intervention the authors developed is five Web-based biographies introducing students to contemporary neuroscientist role models studying learning and memory. To guide the design of this intervention, the authors created a survey to determine where students obtain career information and who and what influences their career selection. In a convenience sample of 124 students, the authors found that almost all students use the Internet for information about careers, in addition to consulting family members and teachers. Students' career selections are influenced most by family members, teachers, and people already in the field. The most important factors students look for in their future career are money, fun, and a good match between current interests and future careers. The data affirm the value of outreach efforts that go beyond students to include a broader audience of parents and teachers who play a critical role in career selection.

International perspective of vocational options for people with mental retardation: the promise and the reality

Developments in research into the vocational needs and preparation of people with mental retardation were briefly traced over recent decades. The premise was made that the study of vocational programs for this population should be examined in the context of the labor market developments of individual countries. Areas for future research were identified, with specific reference to community-based vocational programs.

[30 years rehabilitation preparatory courses and their role in the future exemplified by the Hamburg vocational promotion center]

Over the last 30 years, some 12,000 disabled people have participated in the pre-rehabilitation courses ("Rehabilitationsvorbereitungslehrgänge", RVL) offered by the Hamburg Vocational Training Centre (on average, some 75% of all rehabilitees have attended RVLs prior to their specific vocational retraining); 90% of them successfully, hence able to start their retraining as scheduled. In some 1000 rehabilitees, the original occupational objective was reconsidered at the end of the course, attributable in particular to the fact that less than 40% of participants had gone through vocational assessment/work trial measures beforehand. Over these years, some 1400 rehabilitees obtained their lower secondary school leaving certificate (Hauptschulabschluss). Data collected over the last six years revealed that legasthenic disorders have been present in an average 7% of all RVL participants (a total of 50 persons a year), problems which were dealt with through special remedial measures to the extent that the prerequistites for successful retraining were achieved. Over the decades of their existence, the effectiveness of RVLs in preparing for successful vocational rehabilitation has been unchallenged. It is in particular the action competencies acquired in this preparatory phase already, such as team functioning, communication and project work skills as well as coping with the disablement present, that are found to complement and enhance the technical, occupation-specific competencies acquired during the retraining, so that subsequent job application and placement in gainful employment will have far greater prospects of lasting success than had the RVL training been omitted.

Trends in seniors' financial aid counseling and career counseling

The responses to questions regarding financial aid counseling show a small but significant increase in the quality of counseling when compared to 1983 responses. The percent of students who received "enough" information increased, while the percent who received "no" information on financial aid decreased. In addition, seniors have a greater awareness of the broad range of topics that concern securing and managing loans. Improvement can also be seen in the schools' effectiveness in providing assistance in career and placement counseling. The percentage of seniors who said the school was "very helpful" in career choice counseling increased from 11.2 percent to 18.6 percent. In placement counseling, the percent who responded in the "very helpful" category almost doubled. Despite the improvement in counseling during the past five years, most seniors say they have not received enough information concerning financial aid, and over 80 percent of the seniors rated their career choice counseling and placement counseling as "limited" or non-existent. Clearly, from the students' perspective, the schools could be doing a better job of providing counseling services to students.

[Predictors of success in supported employment programmes--results of a prospective study]

BACKGROUND

Vocational integration of mentally ill patients is confronted not only with illness-related restrictions but also with the current situation on the labour market and prejudices on the part of potential employers. The Consultancy Centres for Vocational Integration work with a supported employment approach which was adapted to the German situation. It includes prevocational training, assistance in finding appropriate jobs, cooperation with employing companies and long-term job site support.

METHODS AND PATIENTS

Within the scope of a major study on vocational rehabilitation in the German region of Westphalia-Lippe, we carried out a prospective study of the further vocational course of 61 patients who had already been placed in competitive employment within the framework of the Consultancy Centres. These patients (30 men, 31 women) had a mean age of 31 years (+/- 6.9); 54% of them were suffering from schizophrenic disorders; mean duration of illness was 8.2 years (+/- 6.8).

RESULTS

After two years (and for a subsample of 33 patients also after 3 years) two-thirds of patients were still in competitive employment. Predictors of success proved to be 1) a higher ability to cope with vocational stress on introduction of the measure, 2) an earlier start to rehabilitation, and 3) financial assistance for the company. A close correlation was recorded between course of illness (rehospitalizations) and success of rehabilitation.

CONCLUSIONS

Even in the current situation of high unemployment rates vocational integration of mentally ill patients is possible and stable in medium term. Especially highly-motivated patients with favourable preconditions (early start of rehabilitation measures, higher ability to cope with work stress) are successful if intensive long-term support--including efforts involving employers--is provided.

Opportunity for progress

The Cavendish review into HCAs and support workers highlighted the contribution such staff make to patient care, and called for them to be supported with improved training, career opportunities and status. This article shows how some enlightened employers are leading the way in developing their HCA workforce.

[Vocational integration of disabled patients--perspectives and recommendations in changing labor market conditions]

Current labour market developments, i.e. decreasing manpower demands, aggravation of selection, will in the years ahead confront vocational rehabilitation policy, too, with important decisions in terms of expanded service provision or intensified selectiveness. Short-term economic, labour market-oriented cost-benefit considerations will in this process be opposed by longer-term, education and social policy ones. The risk of lasting ruptures occurring between the employment-possessing population and the long-term unemployed, or those in highly jeopardized jobs, with the new social inequities thus generated, will in particular have to be given attention in future decision-making.

[Socioeconomic reality: the context in which vocational and professional guidance have to deal with]

In this work we describe and analyze today's Latin American occupational reality, according to the world economical context we live in. We mention up-to-date data about employment and unemployment rates, from different countries of Latin America, Europe, and also from Japan. Besides that we have taken into account the technological development and the demographic growth, as essential variables in order to understand the labor phenomenon and its possible prospect, as well as the psychosociological consequences or unemployment. We also analyze the future of some professions. We think that all this information gathered from different sources, is essential to the professional who has to guide teen-agers at the time of the Ocupational-Vocational election. This is also necessary to all those who deal with Professional Guidance and with the Planning of Careers that have already been chosen.

Working with Hispanic women who are deaf: recommendations from the literature

The authors used the hermeneutics approach within social cognitive career theory to explore employment trends and issues over the past 20 years relevant to Hispanic women who are deaf. Barriers to employment were discovered including discrepancies due to gender, race/ethnicity, and severity of hearing loss. Recommendations for policymakers and professionals suggest a need for research that addresses the unique experiences of Hispanic women who are deaf within vocational rehabilitation, the use of social cognitive career theory as it relates to career development and choices, and an increase in education and training to better prepare vocational rehabilitation counselors to work with individuals from multiple minority backgrounds. While information about Hispanic women who are deaf is limited, this review provides a better understanding of Hispanic deaf women and encourages expansion of knowledge in practice and research for professionals working with this unique population.