Psychiatric Vocational Rehabilitation Research Articles

Incidence rates and employment trends in schizophrenia spectrum disorders, bipolar affective disorders and recurrent depression in the years 2000–2013: a Danish nationwide register-based study

Aims The study aimed to investigate time trends in incidence rates in schizophrenic spectrum disorders (ICD-10: F20–F29), bipolar affective disorder (ICD-10: F30, F31), and recurrent depression (ICD-10: F33) and to investigate the rates of employment for all incident cases. Method We used nationwide longitudinal data from 2000 to 2013 on all psychiatric inpatients and outpatients contacts in Denmark. Age-adjusted incidence rate ratios were calculated for the three diagnostic groups, and rates of employment, education, and disability pension were measured 1 year before and 2 years after the diagnosis for all the incident cases. Results The incidence rates increased significantly in all diagnostic groups and both sexes. Comparing the incidence rates in 2013 with 2000 yielded an incidence rate ratio of 1.67 (95% CI 1.51–1.84) for schizophrenic spectrum disorders, 3.82 (95% CI 3.23–4.52) for bipolar affective disorder, and 2.80 (95% CI 2.58–3.04) for recurrent depression. During the same observation period, the employment rates decreased, both 1 year before and 2 years after diagnosis in all three subgroups. In the year 2002, employment rates, 2 years after diagnosis, were 24.6% for schizophrenia spectrum disorder, 35.0% for bipolar affective disorder and 47.1% for recurrent depression. These rates had declined to 15.8%, 26.8%, and 34.7%, respectively, in 2013. Conclusion This study of three severe mental illness subgroups shows significant increasing incidence rates and decreasing employment rates both before and after the diagnosis between 2000 and 2013, highlighting the importance of timely and correct volume of the psychiatric treatment and vocational rehabilitation programs.

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

An Analysis of Research Trends on Psychiatric Vocational Rehabilitation in Korea

본 연구의 목적은 정신장애인 직업재활에 대한 국내 연구동향을 분석하여 앞으로의 연구방향과 과제를 제시하는 것이다. 이를 위해서 실제와 연구의 조응, 사회복지학과 다른 학문분야와의 관계에 방점을 두고 내용분석을 이용하여 체계적으로 살펴보았다. 분석대상은 1997년부터 2016년 학술지에 게재된 정신장애인 직업재활 관련 논문 96편이었으며 학문분야, 연구대상, 연구관점, 연구방법에 따라 분석되었다. 분석의 결과로 첫째, 정신장애인 직업재활의 실제와 연구에서는 조응하는 지점들과 간극들이 혼재하고 있었다. 정신장애인 직업재활의 전개과정과 학문분야 분포에서는 실제와 연구가 조응하고 있었다. 반면 정신장애인의 경제활동 실태, 직업재활 실천현황과 연구동향 사이에는 커다란 간극이 있는 것으로 나타났다. 둘째, 정신장애인 직업재활 연구에서 사회복지학과 다른 학문분야들은 연구대상, 연구관점, 연구방법에서 차이가 있는 것으로 드러났다. 향후 연구방향은 정신장애인 직업재활 실제와 연구의 조응이며, 이에 따른 구체적인 연구과제가 제안되었다.

Special Issue: Vocational rehabilitation (I)

The range of articles included in the first part of this special issue reflects current trends and practices in vocational rehabilitation across four disciplines, with five relating to mental illness and disabilities. Vocational rehabilitation is important because it can counter the social and economic exclusion so often associated with mental illness and other psychiatric conditions. While occupational therapists are aware of the generally beneficial effects of occupation and meaningful activity, they may not be so aware of the leveraging effect on the individual that vocational rehabilitation can produce. Establishing a place in the open labour market seems to enhance recovery in ways that cannot be achieved by medical interventions, talk therapies, or by any other rehabilitation intervention. Each article in this special issue highlights different opportunities for occupational therapists to become involved in vocational rehabilitation. This collection also illustrates a diverse mix of research methods including a randomised controlled trial, a systematic review, a population survey and several qualitative investigations. In the research paper by Schneider et al. (2016), an exploratory feasibility study for a randomised controlled trial reveals the potential for a new intervention to enhance outcomes from an evidence-based supported employment programme for people with first episode psychosis. Although this study was not conclusive, the intervention was promising because 41% of those who received the enhancement obtained employment compared to 29% of those who received the standard employment service without the enhancement. The new intervention consists of work-focused counselling using principles of cognitive behaviour therapy. Occupational therapists have the background training to assist with the further development and delivery of this intervention. A practice analysis from Singapore by Tan et al. (2016) describes another way that occupational therapists can become involved in psychiatric vocational rehabilitation. The authors converted an existing vocational intervention into one that was more integrated with existing psychiatric rehabilitation services, and more in line with evidencebased practices in supported employment. This conversion resulted in good employment outcomes being achieved that were more in line with international expectations for this type of programme. Two qualitative studies examined established workers diagnosed with mental illness or a psychiatric disorder. Cameron et al. (2016) explored the experiences of being on sick leave among people with severe mental illnesses. The results showed how much people treasured their work identity, and how potentially damaging sick leave can be to those that benefit from the structured routines and social interaction that employment provides. This is a new area, with opportunities for occupational therapists to help existing workers retain employment by minimising the unintended negative consequences of sick leave. With a similar focus on job retention, Williams and Lloyd (2016) examined the risk to continuing employment among those who experience a first episode of psychosis. The authors found that only three out of 11 were still employed 6 months later; of those, only two were in the same jobs. The research paper by Waghorn et al. (2016) uses a large population survey to reveal issues in vocational rehabilitation for people diagnosed with a psychotic disorder and co-morbid substance abuse. A key finding was that those with previous lifetime abuse or dependence did not seem to have additional disabilities, but they were less likely to utilise the most appropriate and intensive forms of vocational rehabilitation. In a systematic review of vocational rehabilitation after stroke, Wei et al. (2016) found limited evidence that rehabilitation increases returns to work among those of working age. This suggests that vocational rehabilitation for people post stroke is in its infancy compared to the more advanced form developed for people with mental health or psychiatric conditions. In their research paper, Sergiou-Kita et al. (2016) highlight the low proportions of

Comparing Traditional and Distance Formats of a Psychiatric Rehabilitation Course

Purpose:The purpose of this study was to discover if an online course in psychiatric rehabilitation is as successful as a traditional on-campus course in terms of content delivery and learning outcomes.Method:A traditional on-campus (n= 25) and an online (n= 17) course were compared at pretest and posttest on a measure entitled “Psychiatric Vocational Rehabilitation Knowledge and Skills Inventory.” A 4 (Skill) × 3 (Time) within-subjects analysis of variance with repeated measures was used to assess changes in the skills of process, potential, partnership, and career advancement over time.Results:The results were that scores for both formats significantly increased from Time 1 to Time 2, but one format did not perform significantly better than another. The Psychiatric Vocational Rehabilitation Knowledge and Skills Inventory was found to be a reliable measure.Conclusion:The study underscores the value of a dedicated psychiatric rehabilitation course in rehabilitation graduate education.

Inter-organizational collaboration at the local level—models and experiences

Integration and collaboration has been an important strategy for development of the health and welfare system in Sweden since the 1960s. This development has been intensified during the 1990s and the first decade of the 2000s. This key note speech will focus on the development of interorganizational collaboration between health care, social service and other welfare services on the local level of the Swedish society. There will be examples from care of the elderly, social psychiatric care and vocational rehabilitation. Different organizational models will be presented and experiences of barriers as well as facilitating factors will be discussed.

Illness self-management assessment in psychiatric vocational rehabilitation.

People with severe mental illnesses experience difficulty finding and maintaining employment, even if they are offered psychiatric vocational rehabilitation services. When service recipients are able to apply more effective illness self-management strategies, vocational rehabilitation outcomes improve. To assess the use of these strategies, the Illness Self-Management assessment instrument for Psychiatric Vocational Rehabilitation (ISM-PVR) was developed. Experts were consulted to design the ISM-PVR instrument which was then tested by 8 vocational rehabilitation workers and 26 of their service recipients. This study indicated sufficient internal consistency of the ISM-PVR self-report questionnaire, especially for the subscales assessing goal related self-efficacy, perceived illness-related barriers, and four of the eight coping scales. The number of self-reported illness barriers was associated with a higher number of reported work-related coping strategies. The ISM-PVR aided the identification of specific mental illness-related barriers perceived by the service recipients. The instrument also facilitated obtaining information on individual self-management strategies that clients employed to overcome such barriers or make them manageable. The application of the ISM-PVR in vocational rehabilitation practice warrants further research. The study suggests that this instrument is a useful add-on to existing vocational assessment and provides insight in self-management strategies that people use, and that may help those people and their job coaches make more effective vocational plans.

Arbeitsrehabilitation psychisch kranker Menschen – ein Überblick über Erfolgsprädiktoren

Unemployment has a strong negative impact on quality of life and on the further course of the disease of mentally disordered individuals. Therefore, vocational rehabilitation programmes are necessary to help people with mental disorders to obtain work. There is increasing scientific evidence concerning positive predictors for vocational integration. This paper intends to give an overview about established predictors for successful integration. "Pubmed" was searched for studies on psychiatric vocational rehabilitation programmes published between 1997 and 2007, which had the focus on predictors of successful outcome. Some of the most important predictors are a better history of work integration and better work performance measured during psychiatric vocational rehabilitation. Successful vocational integration is harder if negative symptoms or cognitive deficits are present. The impact of sociodemographic factors, diagnosis, motivation to work and social skills is discussed controversially. Future research should be directed to design vocational rehabilitation programmes, which address the specific needs of psychiatric patients.

Comorbid physical health conditions hinder employment among people with psychiatric disabilities.

To investigate whether comorbid physical health conditions hinder employment for people with psychiatric disabilities. A secondary analysis of a 12-month longitudinal natural observation study. Community residents (n = 104) with schizophrenia or schizoaffective disorder were interviewed at baseline, 6 and 12 months. Comorbid physical health conditions were negatively associated with employment status. More attention to physical health conditions may improve outcomes in psychiatric vocational rehabilitation.

A Randomized Clinical Trial of Vocational Rehabilitation for People With Psychiatric Disabilities

In this study, the researchers examined the effectiveness of two vocational rehabilitation interventions in improving employment, educational, clinical, and quality-of-life outcomes for people with psychiatric disabilities. The authors recruited participants in waves over a 2-year period and randomly assigned them to receive either psychiatric vocational rehabilitation (PVR) or enhanced state vocational rehabilitation (ESVR) services. Although both groups improved significantly over time in their vocational and educational outcomes, no differences were found between the two interventions on any outcomes. In this article, the authors explore why ESVR achieved better outcomes than previous research would have suggested.

Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes

There is increasing recognition of the importance of psychiatric vocational rehabilitation (PVR) programmes in helping individuals with severe mental illnesses to find and secure jobs. However, little is known concerning the factors related to PVR outcomes. This review identifies those person-related factors which most strongly influence employment outcomes after participation in PVR programmes. Medline, Psychinfo, Pubmed and CINAHL were searched for studies using multivariate analysis of longitudinal data, which analysed employment outcomes after at least 6 months of programme participation, and which analysed at least three predictor domains. Eight studies presented in 16 publications met all the criteria. Better employment outcomes were most strongly related to better work performance measured during PVR participation and to higher work-related self-efficacy. Better social functioning during PVR participation was also significantly related to positive employment outcomes, but this relationship was generally weaker than those of the two aforementioned factors. In most studies, employment outcomes after PVR were not related to past functioning, including work history and diagnosis. Findings on the severity of psychiatric symptoms measured during PVR were mixed. In terms of contribution to outcome, severity of symptoms usually ranked below work performance, when measured concurrently. Contrary to previous reviews, this study suggests that the influence of past functioning, including work history, diagnosis and psychiatric history, is outweighed by work performance in PVR. Further prospective and controlled studies are needed to reach more definite conclusions about the individual contributions of person-related factors.

Work-Related Self-Efficacy Among Community Residents with Psychiatric Disabilities.

A new measure of work-related self-efficacy for people with psychiatric disabilities is reported. The 37-item scale measures self-efficacy in four relevant activity domains: (1) vocational service access and career planning, (2) job acquisition, (3) work-related social skills, and (4) general work skills. The scale was developed in a 12-month longitudinal survey of urban residents diagnosed with schizophrenia or schizoaffective disorder (n=104). Results indicate validity of both a four-factor structure differentiating four core skill domains, and a single factor representing total work-related self-efficacy. The favorable psychometric properties support further research and trial applications in supported employment and psychiatric vocational rehabilitation.

The Generic Work Behavior Questionnaire (GWBQ): assessment of core dimensions of generic work behavior of people with severe mental illnesses in vocational rehabilitation.

The purpose of this study was the development of a short self-reporting and supervisor-reporting questionnaire to assess generic work behavior of people with severe mental illnesses participating in psychiatric vocational rehabilitation. An 18-item generic work behavior questionnaire (GWBQ) was developed, which contains core dimensions derived from both supervisor scores and self-report scores. The factor structure of the GWBQ was replicated for both versions (supervisor and self reports). The GWBQ was very reliable for supervisor reports and moderately so for self-reports. Although self-report scores and supervisor scores correlated significantly, participants rated their own work behavior consistently higher than supervisors did.

Psychiatric vocational rehabilitation: Where are the customers' views?

Psychiatric vocational rehabilitation: Where are the customers' views?

Longitudinal outcome of young adults who participated in a psychiatric vocational rehabilitation program.

Longitudinal outcome of young adults who participated in a psychiatric vocational rehabilitation program.

Psychiatric vocational rehabilitation services in Hong Kong: A critical review.

Psychiatric vocational rehabilitation services in Hong Kong: A critical review.

Evaluating psychiatric vocational rehabilitation services: A community rehabilitation information system.

Evaluating psychiatric vocational rehabilitation services: A community rehabilitation information system.

An Investigation of Vocational Programmes and Services in North America

This article offers an overview of the psychiatric vocational rehabilitation system studied by the author under the auspices of the Winston Churchill Memorial Trust Travelling Fellowships. Brief accounts of Canadian and American programme models are used to describe employment preparation services and vocational programmes. The visits clearly demonstrate that people with psychiatric disabilities are potentially employable if they are provided with appropriate services, employment programmes and support. Although vocational programmes are evolving throughout the United Kingdom, there are strong indications that more programming and funding are urgently needed.

Motivation and employee^supervisor discrepancies in a psychiatric vocational rehabilitation setting.

Motivation and employee^supervisor discrepancies in a psychiatric vocational rehabilitation setting.

Motivation and employee-supervisor discrepancies in a psychiatric vocational rehabilitation setting.

Supervisor ratings of employees' motivation and adjustment in psychiatric rehabilitation settings are among the best predictors of future work potential (Anthony & Jansen, 1984). Additionally, some research reports low correlations between supervisor ratings and employee self-reports with regard to adjustment and motivation. Consequently, we examine (a) how current program participation and estimates of readiness for competitive employment relate to employee and supervisor ratings of motivation; and (b) the correlates of rating discrepancies between employees and supervisors. Program participation and work-readiness were associated with both employee and supervisor ratings of motivation after controlling for employee benefit plan, residential status, and social adjustment. Additionally, the degree of supervisor-employee discrepancy in these ratings was negatively correlated with program participation, work- readiness, and estimates of premorbid social competence. The role of motivational factors in vocational rehabilitation and the dynamics of supervisor and employee perceptions of work motivation and adjustment are discussed.