Vocational Rehabilitation Success Research Articles

Work Motivation and Employment Outcomes in People with Severe Mental Illness

Purpose To study associations between the level of self-reported work motivation and employment outcomes in people with severe mental illness (SMI) enrolled in a vocational rehabilitation program. Methods Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Multiple logistic regression, linear regression and cox regression analyses were performed to analyse the association between the level of work motivation at baseline and job obtainment, duration of job, and time until job obtainment during the 30-month follow-up period. Results No statistically significant associations were found between the level of work motivation and job obtainment (OR 1.83, 95% CI 0.55–6.06, p = 0.32), job duration (B = − 0.74, 95% CI − 2.37 to 0.89, p = 0.37, R-squared = 0.03), or time until job obtainment (HR = 1.53, 95% CI 0.64–3.68, p = 0.34). Conclusions The results of this study show no statistically significant associations between the level of work motivation and employment outcomes in people with SMI enrolled in a vocational rehabilitation program. These associations may be underestimated due to range restriction of the work motivation’s level. Further research is recommended to increase knowledge on the associations between work motivation and employment outcomes, as it could be relevant for further understanding success in vocational rehabilitation.

Transitions and vocational rehabilitation success: Tracking outcomes for different types of youth

Transitions and vocational rehabilitation success: Tracking outcomes for different types of youth

From admiration of the problem to action: Addressing the limited success in vocational rehabilitation of persons from diverse racial and cultural backgrounds

From admiration of the problem to action: Addressing the limited success in vocational rehabilitation of persons from diverse racial and cultural backgrounds

The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

Introduction It is unclear from prior research whether or not substance abuse co-morbid with psychosis is an added barrier to success in vocational rehabilitation. The aim of this study was to examine the relationships among three types of co-morbid substance abuse or dependence, by type of employment assistance received (disability employment services, mainstream unemployment services, other government programmes, and own resources), and by type of employment attained (competitive and non-competitive). Method Data were drawn from the Australian National Survey of High Impact Psychosis ( N = 1825). The survey was conducted in seven Australian catchment areas March to December 2010. Descriptive statistics and logistic regression methods were used. Results There were no added effects of lifetime substance abuse or dependence on any employment. However, there were some minor substance-specific effects. Past year cannabis use was negatively associated, while alcohol use was positively associated with being employed. All categories of lifetime substance abuse or dependence were associated with reduced utilisation of intensive forms of employment assistance. Conclusion At a population level, lifetime substance abuse or dependence had no added impact on current employment status. Those with psychosis co-morbid with lifetime substance abuse or dependence could benefit from greater utilisation of evidence-based supported employment.

Evaluation of competencies in the field of vocational rehabilitation and the employment of persons with disabilities

For decades, employment of a person with disabilities has been considered a key indicator of the success of vocational rehabilitation. There is a link between the quality of vocational rehabilitation and a better quality of life for service users; these services have a significant impact on efficiency in the field of work. Very few authors have researched the qualification and skills of rehabilitation experts essential for successfully carrying out their professional activities. The objective of the present study was to investigate the perceived importance attached to the competencies of vocational rehabilitation professionals and the frequency of their application at work in three different countries, which was conducted using a questionnaire that was prepared on the basis of a questionnaire designed by Australian researchers. Basic competencies comprise four sets: vocational counselling, professional practice, personal counselling and rehabilitation case management. Special competencies are composed of two sets: workplace disability case management and workplace intervention and programme management. The questionnaire was completed by 131 respondents, of whom 61 were from Slovenia, 34 were from Austria and 36 were from the UK. t-Tests for two independent samples (sex), analysis of variance (type of education, country) and Pearson's correlation coefficient were used to compare the perception of basic and special competencies. The respondents perceived personal counselling, vocational counselling and management of rehabilitation cases as being the most important, whereas the least importance was assigned to interventions. In practice, the respondents used personal counselling most frequently and very few interventions.

Profesionalna rehabilitacija i prediktori zaposlenosti osoba sa invaliditetom

Medical rehabilitation of people with disabilities, regardless of whether it is a congenital or acquired disability, must be followed by vocational rehabilitation and synchronization of all rehabilitative consequences is necessary. The objective of this paper is that, by examining the available literature, conduct review of research that are aimed to detect effectiveness of vocational rehabilitation and to define predictors of employment of people with disabilities. The results suggest that the success of vocational rehabilitation is directly determined by a complex interaction between factors of injury, damage, injury, personal factors and environmental factors, which affect the results of returning to work. Also, one could conclude that it could be difficult to isolate the predictors of employment of people with disabilities and to define the difficulties with which this population is facing with during the employment or returning to work and that they could be generalized and completely related to each subgroup within the population of people with disabilities. .

Linking Crohn's disease health status measurements with International Classification of Functioning, Disability and Health and vocational rehabilitation outcomes

The International Classification of Functioning, Disability and Health (ICF) serves as a unifying model for rehabilitation medicine. Variables of the health status measurements, the Crohn's Disease Activity Index and the Harvey-Bradshaw Index, have not been linked with the ICF categories and compared with other predictors of rehabilitation outcomes. Crohn's Disease Activity Index variables were linked with ICF categories using linking rules. A chart review included the patients of our in-patient rehabilitation centre during one year (n=355) with International Classification of Disease Codes for Crohn's disease (ICD K50). We identified variables linked with clinical improvement (decrease in the Harvey-Bradshaw Index of > or = 2 U) and rehabilitation success (conversion from unfit-to-work to fit-to-work) by multivariate logistic regression. The ICF component, activities and participation, was not represented in the Crohn's Disease Activity Index and the Harvey-Bradshaw Index. A Harvey-Bradshaw Index > or = 5 U was associated with clinical improvement during rehabilitation (odds ratio 5.65 (95% CI 3.41-9.35)). Normal C-reactive protein (odds ratio 2.8 (95% CI 1.1-7.0)) and higher body mass index (odds ratio (per 1 kg/m2 increase) 1.1 (95% CI 1.0-1.2)), but not Harvey-Bradshaw Index, were associated with vocational rehabilitation success in 124 patients who were initially unfit-to-work. Variables representing activities and participation as well as immune functions may improve Crohn's disease health status measurements on the basis of better prediction of vocational rehabilitation success.

Reviewing the Theory and Practice of Occupational Therapy in Mental Health Rehabilitation

The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes. These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success. This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.

Change in Work Performance in Vocational Rehabilitation for People with Severe Mental Illness: Distinct Responder Groups

Vocational rehabilitation aims to improve work performance. Few studies have examined the course of work performance during vocational rehabilitation. It remains unclear whether all subjects profit equally from rehabilitation programs regarding improvement of work performance. The purpose of this study is to examine the course of work performance in order to differentiate between responder groups and to distinguish between those groups regarding sociodemographic status, psychiatric diagnosis, level of individual satisfaction and vocational rehabilitation success. Work performance of N = 125 subjects with severe mental disorders was rated on intake to the rehabilitation program and six months later with the German version of the Work Personality Profile (WPP). A cluster analysis was conducted to identify different responder groups. Groups with poor, moderate, improving and superior work performance were identified. These groups differed in educational level, psychiatric diagnosis, individual satisfaction and rehabilitation outcome. Not all subjects profit equally from vocational rehabilitation in terms of improvement of work performance. Unfavorable courses of work skills were shown for participants with schizophrenia and low education. Low individual satisfaction with performance is related to consistently low or moderate performance. Group differences predicted reintegration success. Future research should focus on different responder groups and their identification in early stages of the rehabilitation process to ensure appropriate assistance, particularly for subjects with poorer performance.

Motivation zur psychosomatisch-psychotherapeutischen Bearbeitung von beruflichen Belastungen - Entwicklung und Validierung eines Fragebogens

There is a lack of questionnaires assessing the motivation of inpatients to scrutinize occupational stresses and deal with them as part of their psychotherapeutic treatment. Work-related stress contributes significantly to the development of mental disorders. Vocational reintegration is an outcome criterion for the success of vocational rehabilitation. Patients are often not motivated for dealing with occupational stresses during inpatient medical rehabilitation. Therefore it is necessary to assess patient motivation at the beginning of treatment, in order to assign them to specific interventions, e. g. promoting motivation. A questionnaire (Fragebogen zur berufsbezogenen Therapiemotivation -- FBTM) consisting of 84 items was developed, based on published questionnaires for psychotherapy motivation. 283 psychosomatic rehabilitation inpatients were administered the FBTM, subsequently analyzed by item and factor analyses. Based on a second sample (n = 282) confirmatory factor analyses and validation of the questionnaire were executed. Item and factor analyses revealed a four factor structure. 24 items constituted the subscales that could be described as "intention to change", "wish for pension", "negative treatment expectations" and "active coping". Reliability (Cronbach's Alpha) was satisfactory with coefficients between 0.69 and 0.87, and only low correlations could be found between the four subscales. Correlations with other measures were most pronounced for the subscale "intention to change". Some significant but low correlations could be reported between the FBTM and a standardized questionnaire of psychotherapy motivation (FMP). Confirmatory factor analyses of a second sample (n = 282) confirmed the original four factors. First evidence of sensitivity could be observed in a sample of patients who took part in an intervention promoting work-related therapy motivation during psychosomatic inpatient rehabilitation. The FBTM is a reliable and valid instrument assessing work-related therapy motivation of inpatients, as a relevant therapeutic measure in psychosomatic rehabilitation. Further validation, especially the analysis of predictive validity is desirable.

Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia

Cognitive impairments in schizophrenia appear to be associated with social problem solving, social and vocational functioning, and psychosocial skill acquisition. The present study examined the relationship of cognitive functioning, as well as clinical symptoms, to vocational outcomes among individuals with schizophrenia. One hundred and twelve participants with DSM-IV schizophrenia spectrum diagnoses underwent a comprehensive neuropsychiatric evaluation after enrolling in one of several employment programs. The neuropsychological evaluation examined verbal learning and memory, attention, speed of information processing, and executive functioning. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). Vocational outcomes were assessed 4 months after baseline assessment and included both measures of employment outcome (e.g., earnings) and of work performance as assessed by the Work Behavior Inventory (WBI). Negative symptoms, learning and memory performance, processing speed, and executive functioning were related to hours, weeks, and wages earned on the job. Stepwise multiple regression analyses found that among baseline clinical and cognitive predictors, only verbal learning and memory and cognitive disorganization symptoms were significant predictors of work behaviors 4 months later. Learning and memory were the only significant predictors of integrated employment at 4 months. These results suggest specific aspects of cognition may be modestly predictive of vocational outcomes.

Hmong Perceptions of Disability: Implications for Vocational Rehabilitation Counselors

The purpose of this study was to identify Hmong perceptions and attitudes toward people with disabilities that may affect vocational rehabilitation success. Nineteen Hmong participants were interviewed for this ethnographic research. Discussion derived from these interviews produced two naturally occurring categories of biological (genetics, illnAss, and injury) and traditional (sin and punishment) perspectives regarding attitudes toward causation of disability. The traditional perspective was found to influence all participants, regardless of acknowledgment in biological factors. Factors found to impact perceptions and attitudes included social status, family involvement, perceived causation, and ideations that negative treatment may be reciprocated down generational lines in the from of disability. Implications for vocational rehabilitation counselors are addressed.

Neurovisual rehabilitation: recent developments and future directions

Central visual1 and oculomotor2 disorders are present in some 20%-40% of patients in neurological rehabilitation centres.3 Gianutsos reported that 50% of the patients in a head trauma rehabilitation centre show visual system disorders not assessed before although most of the patients were chronic and had been treated in other hospitals previously.4 In a large sample of 314 patients with postchiasmatic visual field disorders from a rehabilitation department 70% had a parafoveal visual field sparing of 5° or less. Of these patients, 50%-70% subjectively reported and objectively showed chronic reading and visual exploration deficits.5 Furthermore, visual field disorders are associated with an adverse prognosis in outcome studies according to life table analysis6 and impair the success of vocational rehabilitation.4 7 Spatial-perceptual deficits may delay the rehabilitation progress in physiotherapy,8 9 lead to complications due to repeated accidents,10 and correlate highly with deficits in activities of daily living (dressing, transfers, or manoeuvring a wheelchair.11-16 In the presence of limited financial resources in health policy it might be argued that central visual disorders do not require treatment as they do not affect outcome adversely. Although nothing supports this opinion there is some evidence to the contrary. Cutting inpatient stroke rehabilitation to a maximum of 60 days (in Italy) led to a deterioration in neuropsychological and activities of daily living in patients with stroke, especially those with right hemispheric lesions.17 Hence, withdrawing neuropsychological treatment deteriorates functional performance and creates new costs. Whereas the systematic treatment of language, speech, and motor disorders is traditionally viewed as unequivocally necessary the possible influence of visual-sensory and oculomotor disorders on the patient's outcome is still neglected in neurorehabilitation. This review summarises therapeutic approaches for acquired central visual disorders. It is split into five parts. After an introduction …

A Norwegian approach to supported employment: Arbeid med bistand

This article sums up and discusses central aspects of a three year Norwegian pilot project on supported employment, initiated by the Ministry of Local Government and Labour, and called ``Arbeid med bistand'' (AB). The Work Research Institute was hired by the Ministry to carry out the evaluation of the pilot project. Project activity started in the Autumn of 1992 and was completed by the end of 1995. The main objective of AB was to develop new approaches for integrating people with vocational disabilities in ordinary jobs. The new element in AB has been integrated support and a total person orientation. In addition to giving support in finding a job and in working on that job, job coaches also gave the participants support in issues to do with living conditions and leisure activities. Experiences from the project showed that flexibility in approach is an important criterion for success in vocational rehabilitation. On this basis, the project evaluation asserts that the quality of vocational rehabilitation can be better assured when there is room for reflection and exchange of experiences, than by setting standards and creating routines. It is also asserted that the main principles of AB should be fundamental in all vocational rehabilitation. From January 1996, AB became established as one of the ordinary vocational rehabilitation services offered by the state. Preliminary findings from recent and ongoing research on these services indicate that AB has undergone some modifications concerning some of the original principles. The article ends up with a brief discussion of that issue.

Vocational rehabilitation of young adults with a disability of one arm or hand.

The paper presents a summary of a study of the vocational rehabilitation of young adults with a disability of one hand or arm. It demonstrates the importance of labor research in vocational rehabilitation. The success of vocational rehabilitation depends in large measure on the suitability of the job chosen and the adaptability of the workplace. The study was carried out by Netherlands organization for applied scientific research (TNO), one of the largest research institutes in the Netherlands. Part of this institute's program is devoted to research on the quality of the work. Within this section there is a research program on work for disabled people. The aim of the study was to determine which jobs on a lower education level are suitable for young adults with a disability of one hand or arm.

Rheumatoid arthritis: vocational rehabilitation.

The consequences of inflation and accelerating introduction of automation and microprocessors into industry are a shift from unskilled to skilled work, the lessening of opportunities for the unskilled worker, and growing unemployment. If disabled people are competing for employment they must take every opportunity to extend education and acquire skills. Juvenile chronic arthritis presents one set of problems in vocational rehabilitation at the beginning of a working career and adult rheumatoid arthritis another, commonly in those over 45 years old and previously established in work. The prevalence of severe disability in juvenile chronic arthritis is about 1 in 20 000 of the population, females are affected twice as often as males and 1 in 10 has defective vision or blindness due to chronic iridocyclitis. At school, besides education, there must be emphasis on encouraging independence, self-confidence, mobility and determination. A School Leavers' Conference early in the last year at school gives the adolescent the best chance of choosing a career. Rheumatoid arthritis is three times more common in women and increasingly, over the last 40 years, women are working besides home-making. Morning stiffness, fatigue, immobility and pain are the common symptoms of widespread involvement of joints and systemic disturbance. The principal determinant in the success of vocational rehabilitation is personality, and the social and environmental factors are more significant than the degree of disability. The Disablement Resettlement Officer can assure continuity of rehabilitation between the health and employment services: a favourable outcome is work, self-derived income independence and freedom of movement using whatever technical aids are required to achieve this.

Functional Factors Related to Vocational Rehabilitation Outcome: Implications for Service Providers and Researchers

This study investigated the relationship of functional and demographic factors to vocational rehabilitation outcome among a sample of legislatively mandated “severaly physically disabled” clients served by a public vocational rehabilitation agency. Critical functional and demographic factors were identified which were used to construct client typologies and their associated probabilities of vocational rehabilitation success. Implications of a prediction model based on functional factor are discussed in regard to rehabilitation plan development, Independent Living Rehabilitation, defining severity of disability, measuring counselor performance, and with respect to improving rehabilitation research and program evaluation techniques.

Emotional, intellectual and physiological predictors of vocational outcome of pulmonary rehabilitation patients.

Previous researchers have independently shown that pulmonary function measures, intelligence test scores, and a recently developed MMPI-derived scale can predict post-hospital employment among rehabilitation patients with chronic obstructive pulmonary disease. This study compared the effectiveness of the three variables in predicting employment among a group of vocational rehabilitation candidates with chronic obstructive pulmonary disease. Only the MMPI-derived scale (COPD-VR) identified the non-working patients significantly above base rate. While this finding does not necessarily mean that personality, or attitudinal, factors are more important than physiological or intellectual variables in vocational rehabilitation success among such patients, it gives further support to the validity of the COPD-VR scale.

Personality traits affecting vocational rehabilitation success in patients with chronic obstructive pulmonary disease.

Item analysis of the Minnesota Multiphasic Personality Inventory responses of 147 patients with chronic obstructive pulmonary disease produced 48 items associated with three levels of post-hospital vocational adjustment, and with death. A subgroup of vocational rehabilitation candidates provided insights to the psychological processes underlying successful outcome. Those who worked more than six months following hospitalization were more gregarious and used more denial than other patients. Those who did not work at all were more anxious and had lower self-confidence. Patients who died within a year had shown a charitable philosophical orientation'.

Predicting vocational rehabilitation success for psychiatric patients with psychological tests.

In studying the possibility of predicting to a success-fail vocational outcome criterion, information on 10 biographical variables and 6 psychological tests was gained from a group of psychiatric patients at the time of acceptance to a Vocational Rehabilitation Ward. Successful prediction from the biographical information was not possible, nor was prediction above the base rate of success possible from psychological tests for the total psychiatric population. Predictions well above the success base rate were possible for 3 of 4 groups when the information from psychological tests was evaluated separately for four major diagnostic populations. Information concerning patients' behavioral symptoms seems to be necessary in order to know which variables to use in a predictive model.