Vocational Disability Research Articles

Issues on Extended Employment Services to Persons with Disabilities in Legal Borderline

이 연구의 목적은 확대 장애 유형에 대한 장애인 고용서비스 현안을 고찰하기 위하여 수행되었다. 이 연구를 위하여 관련 논문과 보고서를 토대로 직업적 장애의 정의, 관련 연구 결과와 소송 결과를토대로 장애범주 확대 현안, 정책 및 고용서비스 확대 현안과 직업평가의 역할이 포괄적으로 검토되었다. 직업적 장애는 직업과 사회생활 영역을 포함해 개인의 다양한 평가영역을 포괄하는 것으로기술되었다. 확대 장애 유형은 법규와 소송 사례를 토대로 조사되었고, 이전 연구 결과를 토대로장애의 직업적 측면에서 다음 장애범주가 제시되었다: ADHD, 소뇌위축증, 외상후스트레스장애(PTSD), 복합부위통증증후군(CRPS), 강박충동장애(OCD), 경계선급 지적장애(BIF), 기면증 및 뚜렛증후군이 장애범주 확대로 기술되었다. 고용서비스 대상자에 대한 적적성 결정 과정에서 직업능력 평가사의 역할이 논의되었고, 국내외 고용서비스 현황 및 정책 현안들이 비교되었다. 국가별로 잠재적 고용서비스 대상자에 대한 차별적인 평가도구와 절차가 활용되고 있는 것으로 나타났다. 확대 장애 유형과 관련된 고용서비스를 경계선에 있는 장애범주로 확대할 필요성이 제기되었고, 전문가 훈련 및 정체성 확립을 통해 잠재적 고용서비스 대상자의 삶의 질과 사회통합을 향상할 수 있는 방안이 논의되었다.The purpose of this study was to review the issues on extended employment services toward persons with disabilities(PWD) in legal borderline in South Korea. To fulfill the purpose of the study, articles and reports were reviewed focusing on definition of vocational disability, extended types of disabilities based on research and litigation cases, employment service and policy issues, and role of vocational evaluators. Vocational disability is regarded as various evaluation areas of encompassing one’s vocational and social life dimensions. Extended types of disabilities were reported by the national legal systems and litigation cases and based on the preliminary studies about vocational aspects of disability, current status of extended types of disabilities were illustrated as follows: ADHD, Cerebellum Atrophy, PTSD, CRPS, OCD, BIF, Narcolepsy, and Tourette Syndrome. The roles of vocational evaluators in the process of eligibility determinations for employment services were reviewed and comparisons were made based on differential employment service and policy in terms of countries, including USA, Japan and Australia. The countries illustrated were found to have run their own evaluation services for potential recipients of employment services. It is suggested that legal nomination of extended types of disabilities and its associated employment services needed to be dispatched to PWD in legal borderline in the future. Professional training and identity issues were discussed in a way of improving the quality of life and social integration of potential recipients for employment services.

Understanding the vocational functioning of autistic employees: the role of disability and mental health

Purpose Employment rates for autistic people are low, despite increasing employment-focused programmes. Given the reported complexities for autistic people in finding and keeping work and flourishing there, further exploration is needed to understand how best to help employers accommodate autistic employees. Material and methods We assessed 88 employed autistic adults, without comorbid intellectual disability and examined whether self-reported disability and mental health symptoms were associated with two measures of vocational functioning: disability days off work and vocational disability. Results Nearly half (47%) reported at least one disability day absence in the previous month. Autism severity and IQ were not associated with either measure of vocational functioning. Greater disability and higher mental health symptoms were associated with both types of vocational functioning. However, the associations of anxiety and stress with both vocational outcomes were attenuated to null in a multivariable model. Disability (B = 6.74, p = 0.009; B = 1.18, p < 0.001) and depression (B = 4.46, p = 0.035; B = 1.01, p = 0.049) remained independently associated with both outcomes. Conclusions Clinicians and vocational support programmes addressing modifiable factors may need to focus on addressing mental health comorbidities, specifically depression rather than anxiety, or core features of autism to improve vocational outcomes for autistic people. Implications for Rehabilitation Individual-level interventions that reduce disablement, particularly in social areas, and depressive symptoms as a way of reducing days off work and improving workplace activities in autistic employees are recommended. Organisations can accommodate autistic employees by encouraging use of mental health programmes or looking at how the workplace environment can be adapted to limit social disability.

Concept of the Munich/Augsburg Consortium Precision in Mental Health for the German Center of Mental Health.

The Federal Ministry of Education and Research (BMBF) issued a call for a new nationwide research network on mental disorders, the German Center of Mental Health (DZPG). The Munich/Augsburg consortium was selected to participate as one of six partner sites with its concept “Precision in Mental Health (PriMe): Understanding, predicting, and preventing chronicity.” PriMe bundles interdisciplinary research from the Ludwig-Maximilians-University (LMU), Technical University of Munich (TUM), University of Augsburg (UniA), Helmholtz Center Munich (HMGU), and Max Planck Institute of Psychiatry (MPIP) and has a focus on schizophrenia (SZ), bipolar disorder (BPD), and major depressive disorder (MDD). PriMe takes a longitudinal perspective on these three disorders from the at-risk stage to the first-episode, relapsing, and chronic stages. These disorders pose a major health burden because in up to 50% of patients they cause untreatable residual symptoms, which lead to early social and vocational disability, comorbidities, and excess mortality. PriMe aims at reducing mortality on different levels, e.g., reducing death by psychiatric and somatic comorbidities, and will approach this goal by addressing interdisciplinary and cross-sector approaches across the lifespan. PriMe aims to add a precision medicine framework to the DZPG that will propel deeper understanding, more accurate prediction, and personalized prevention to prevent disease chronicity and mortality across mental illnesses. This framework is structured along the translational chain and will be used by PriMe to innovate the preventive and therapeutic management of SZ, BPD, and MDD from rural to urban areas and from patients in early disease stages to patients with long-term disease courses. Research will build on platforms that include one on model systems, one on the identification and validation of predictive markers, one on the development of novel multimodal treatments, one on the regulation and strengthening of the uptake and dissemination of personalized treatments, and finally one on testing of the clinical effectiveness, utility, and scalability of such personalized treatments. In accordance with the translational chain, PriMe’s expertise includes the ability to integrate understanding of bio-behavioral processes based on innovative models, to translate this knowledge into clinical practice and to promote user participation in mental health research and care.

Vocational disability in teachers – influencing factors among a highly burdened sample

Vocational disability in teachers – influencing factors among a highly burdened sample

The Significance of Work Motivation for Rehabilitation Success

Apart from the reduction of symptoms and the restoration of working ability, return to work is a long-term goal of medical rehabilitation. The aim of this study is to analyze the influence of work motivation on the outcome of rehabilitation. The data basis consists of N=998 patients at the psychosomatic department of the Oberharz Rehabilitation Center as well as data from insurance accounts. Using multiple linear regression analysis the predictive power of work motivation on rehabilitation outcome as well as different facets of work motivation in their function as predictors are analyzed. Only minor statistical relations could be found between work motivation and rehabilitation success when also taking employment status of the previous year and subjective vocational disability into account. A small predictive power can be attributed to work motivation as a factor in rehabilitation success in the sense of a reduction of symptoms. Particular facets of work motivation are suitable to predict rehabilitation success. Patients with a work motivation risk profile differ from patients with a normal work motivation profile as regards their capacity to work in the year following rehabilitation treatment. Work motivation represents a relevant construct in rehabilitation success but is strongly influenced by individual factors. During rehabilitation, individual problems which influence work motivation should be taken into account more strongly.

Benchmarks of meaningful impairment on the MSFC and BICAMS

Background: Cognitive and motor abilities in multiple sclerosis (MS) are typically quantified using reliable, consensus standard tests validated in the MS population. While these performance measures are associated with vocational disability in parametric analyses, translation of raw scores into anchors reflecting clinically relevant, functional impairment requires further research. Objective: To examine performance-based motor and cognitive outcomes among definitive anchors that designate varying degrees of functional impairment, thereby establishing benchmarks for score interpretation. Methods: We evaluated MS patients and healthy controls, all undergoing a brief test battery. Outcomes were derived from the MS Functional Composite (MSFC) and the Brief International Cognitive Assessment for MS (BICAMS). Functional impairment anchors were (1) disability benefits, (2) employed with negative work events, and (3) employed without problems. Results: All measures yielded statistically significant differences across all levels of work status, after accounting for the effects of age and education. Benchmark values distinguished the functional impairment groups. When evaluated in combination, the Timed 25-Foot Walk and the Symbol Digit Modalities Test were the most robust predictors of functional decline. Conclusion: We have established benchmark scores for popular motor and cognitive tests that are associated with specific degrees of impairment in work status.

Biopsychosocial Approach to Assessing and Managing Patients with Chronic Pain.

Chronic pain affects nearly one-third of the American population. Chronic pain can lead to a variety of problems for a pain sufferer, including developing secondary medical problems, depression, functional and vocational disability, opioid abuse and suicide. Current pain care models are deficient in providing a necessary comprehensive approach. Most patients with chronic pain are managed by primary care clinicians who are typically ill prepared to effectively and efficiently manage these cases. A biopsychosocial approach to evaluate and treat chronic pain is clinically and economically efficacious, but unique delivery systems are required to meet the challenge of access to specialty care.

Disability Adjustment and Vocational Guidance Counseling for Individuals with Traumatic Brain Injury

Traumatic Brain Injury (TBI) is a multi-faceted and complex injury with unique incidence, prevalence, and consequence that affects health, independent function, and participation in society. Currently, limited long-term funding sources are available to support the vocational rehabilitation needs of individuals with TBI. To improve our understanding of the diverse needs of this population, eight vocational organizations throughout Florida received community capacity-building grants awards. Through these grants, 81 individuals with TBI received vocational guidance counseling and disability adjustment services for a period of one year. Participants completed a project survey upon entry into and exit from the program, with a completion response rate of 48%. Results indicate that the participants’ internal thoughts and beliefs about ability to work showed significant improvement after receipt of customized services. Survey findings suggest that the individuals who received tailored vocational guidance and disability adjustment services showed better adjustment to return to work.

Is psychiatry intervention in Indian setting complete?

Byline: B. Chavan, Subhash. Das Mental illness (MI) not only afflicts the individual, but it has widespread ramification that affects the families and even the community. Chronic MI like schizophrenia and bipolar disorders can incapacitate an individual to such an extent that even the routine activities of daily living becomes difficult, and in fact, these two disorders together are among the top 10 causes of disability-adjusted life years for the 15–44 years old population (WHO report 2001).[sup][1] Such chronic illnesses also result in an enormous burden on the caregivers as reported by several studies.[sup][2],[3],[4] In fact, a large part of caregivers' burden is due to the deficits that persist even after recovery from acute symptoms of MI.[sup][3] Although, antipsychotic medication is effective during the acute phase of MI, these medicines do not have much beneficial effect on cognition and social skill deficits and a large number of such patients, even after recovery from positive symptoms of illness, continue to have cognitive dysfunctions as well as significant social and vocational disability leading to poor functional recovery and poor quality-of-life.[sup][5],[6] Thus, all these factors cumulatively make the rehabilitation of these patients a very challenging task. Where medicines have negligible role, nonpharmacological interventions like cognitive remediation (CR) and social skill training (SST) have shown moderate amount of success in improving the condition of the patients having significant amount of cognitive and socio-occupational dysfunctions. In 25 independent, randomized controlled trials of CR, the majority of the studies have demonstrated positive changes in attention, speed of processing, working memory, and executive functioning in the persons with schizophrenia.[5] A review has even reported about the benefits of CR in improving the social and vocational functioning in individuals with schizophrenia.[sup][7] However, one study also reports that there is no benefit of CR on cognition.[sup][5] Taken together, the findings of these studies show a modest level of improvement in the basic neurocognitive functioning following CR in individuals having schizophrenia.[sup][5] SST has been found to be quite promising in rectifying the social skill deficits due to chronic MI.[sup][8] Even in studies on enhancing the vocational skills of people with chronic MI, some amount of success has been reported. Intervention model like “supported employment” have been shown to be effective for people with chronic MI and those who have found long.term placement through supported employment had shown improvement in cognition, quality.of.life, and symptom management.[sup][8] Although, the initiatives to rehabilitate people with MI have been undertaken in different parts of the world, however, the outcome is not the same. The limitations like lack of trained manpower, inadequate rehabilitation.focused training in psychiatry, poor interest in this sub.specialty, limited resources for research on nonpharmacological interventions, longer duration of interventions before results become apparent, like for example in SST[sup][8],[9] and strong advertisement by the pharmaceutical companies to promote a pill for every deficit could be major factors for such a varied outcome. Thus, pharmacological intervention alone may not be adequate treatment, and even the caregivers feel that the majority of mental health facilities lack rehabilitation services and support that could help their patients regain skills for independent living.[sup][10] In developing countries, psychiatric rehabilitation is still in its infancy, and there are negligible rehabilitation facilities.[sup][9] Like in India, whatever rehabilitation facilities are available, these are being run primarily by nongovernment organizations (NGOs) and these facilities are not readily accessible to the trainees in metal health and most of them charge fees for their services. …

The relationship between timely delivery of vocational rehabilitation services and subsequent federal disability benefit application and receipt

Abstract Federal/state vocational rehabilitation (VR) agencies offer services to individuals with disabilities that may help them remain in the labor force and avoid entering Social Security Administration (SSA) disability programs. We assess how the availability of VR services within an agency at the time an individual applies to receive VR services is related to subsequent application and receipt of SSA disability benefits. We find that individuals have a higher likelihood of subsequently applying for and receiving disability benefits when they apply in months that the VR agency serves a lower percentage of applicants or has a longer average wait for services. JEL codes H55, H75, J29

State vocational rehabilitation programs and federal disability insurance: an analysis of Virginia’s vocational rehabilitation program

Abstract We examine the association between the receipt of vocational rehabilitation (VR) services and Federal Disability Insurance using a unique panel data source on persons who applied for assistance from Virginia’s VR program in 2000. Three central findings emerge: first, VR services are associated with lower rates of participation in disability insurance programs-a nearly 2 point drop in SSDI receipt and 1 point drop in SSI receipt. Second, VR service receipt is associated with lower take-up rates of SSDI/SSI. Finally, among VR applicants on SSDI/SSI, those who receive substantive VR services are more likely to be employed. JEL codes H51, I13, J24

Screening of Vocational disability and Exploring of Employment and Vocational Rehabilitation Service Protocol

Screening of Vocational disability and Exploring of Employment and Vocational Rehabilitation Service Protocol

Allen Ginsberg’s Kind of Psychiatrist

Allen Ginsberg’s Kind of Psychiatrist

Evaluating cognitive outcome measures for MS clinical trials: what is a clinically meaningful change?

Brief cognitive assessments are increasingly emphasized in MS treatment studies and clinical care. While much is known about the reliability of several widely-used neuropsychological tests, interpretation of the changes in individual patients is inadequate. The FDA offers guidance on the issue, as related to patient-reported outcomes. Unfortunately, cognitive ability is only weakly correlated with the frequency and severity of self-reported cognitive problems. In this review, we critically examined the psychometrics of neuropsychological testing in MS, emphasizing statistical and anchor-based approaches to interpreting clinically meaningful change. We suggest that there are two paths forward that should be currently pursued. First, to employ co-primary outcomes, including a brief cognitive test and a clinician or observer’s impression on a scale of change, where successful treatment would require showing significant improvement in both measures. Secondly, to work toward showing that when reliable brief cognitive tests are employed, increments of statistically-relevant change would correlate with changes in clinically-relevant anchors (such as vocational disability or clinical relapses with cognitive impairment). The latter goal will allow a more parsimonious and scientifically efficient approach of utilizing only the brief cognitive test as a primary outcome. While some progress has been made in this direction, more research is needed. We are of the opinion that data from both the statistical and clinically meaningful approaches will be necessary to develop valid definitions of meaningful change on cognitive outcome measures, and that it would be best to pursue research using tests that already have well-established reliability and validity.

Comparison of Neuropsychological Impairment and Vocational Outcomes in Systemic Lupus Erythematosus and Multiple Sclerosis Patients

Systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are chronic immunologic diseases that can cause cognitive dysfunction. MS is a central nervous system (CNS) disease characterized by demyelination and progressive brain atrophy. SLE is an autoimmune disease capable of damaging multiple organ systems, including the CNS. Cognitive disturbances are seen in both SLE and MS. The present study is concerned with understanding the similarities and differences between the cognitive profiles of SLE and MS as well as the relationship between cognitive impairment and vocational disability in these patients. We examined 47 SLE patients, 47 MS patients, and 44 healthy controls. The groups were well matched on demographics and the patient groups were also matched on disease duration and severity. Group comparisons revealed that generative verbal fluency and visual-spatial memory are more profoundly affected in MS than SLE; whereas depression, fatigue, and working memory deficits are similarly involved in both diseases. Logistic regression analysis revealed that executive function, in particular, was predictive of vocational outcomes in SLE and MS patients.

Reliability and equivalence of alternate forms for the Symbol Digit Modalities Test: implications for multiple sclerosis clinical trials

Background: Cognitive impairment is common in multiple sclerosis (MS), but is seldom assessed in clinical trials investigating the effects of disease-modifying therapies. The Symbol Digit Modalities Test (SDMT) is a particularly promising tool due to its sensitivity and robust correlation with brain magnetic resonance imaging (MRI) and vocational disability. Unfortunately, there are no validated alternate SDMT forms, which are needed to mitigate practice effects. Objective: The aim of the study was to assess the reliability and equivalence of SDMT alternate forms. Methods: Twenty-five healthy participants completed each of five alternate versions of the SDMT – the standard form, two versions from the Rao Brief Repeatable Battery, and two forms specifically designed for this study. Order effects were controlled using a Latin-square research design. Results: All five versions of the SDMT produced mean values within 3 raw score points of one another. Three forms were very consistent, and not different by conservative statistical tests. The SDMT test–retest reliability using these forms was good to excellent, with all r values exceeding 0.80. Conclusions: For the first time, we find good evidence that at least three alternate versions of the SDMT are of equivalent difficulty in healthy adults. The forms are reliable, and can be implemented in clinical trials emphasizing cognitive outcomes.

Cognitive Impairment in Mental Illness: An SSA Blind Spot?

Back to table of contents Previous article Next article LettersFull AccessCognitive Impairment in Mental Illness: An SSA Blind Spot?Mark A. Amdur, M.D.Mark A. AmdurSearch for more papers by this author, M.D.Published Online:1 Jun 2011AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: The field now recognizes that our patients, particularly those with a diagnosis of schizophrenia, have significant co-occurring cognitive impairment (1). Unfortunately, in our experience at Thresholds, the disability determination process used by the Social Security Administration (SSA) often does not recognize cognitive impairment of individuals with schizophrenia and similar conditions otherwise considered stable (the exception is for the category of patients with dementia, delirium, or amnestic disorders, for whom cognitive impairment is taken into account). SSA does not recognize the importance of cognitive impairment in most mental disorders as a vocational impairment in determining disability.The current SSA guidelines for determining disability focus heavily on the overt signs and symptoms of mental impairments but do not focus on cognitive impairment. Proposed new rules would deemphasize the signs and symptoms, but there is no evidence of concern about cognitive impairment in schizophrenia and other psychiatric disorders in the proposed rules. The actual vocational disability that results from these disorders is often unrelated to delusions, hallucinations, sadness, or anxiety. Our patients, even when their symptoms have remitted, are left with cognitive impairments that interfere with concentration, attention, visuospatial function, language, memory, and executive function. These are the enduring and disabling features of serious mental illness. There is no good way to demonstrate these impairments unless you test for them.The Montreal Cognitive Assessment (MoCA) was designed as a rapid test for “mild cognitive impairment” among elderly persons (2). Like the Folstein Mini-Mental State Exam, scores on the MoCA range from 0 to 30. The MoCA takes about 12 minutes to administer. For persons with no cognitive impairment, MoCA scores averaged 27.4±2.2. Persons with known dementia of the Alzheimer type had MoCA scores that averaged 16.2±4.8. Persons with “mild cognitive impairment” had MoCA scores that averaged 22.1±3.1.In a 2010 study at Thresholds, we administered the MoCA and the Folstein Mini-Mental State Exam to 112 stable individuals with schizophrenia (Wilkniss S, Teachout A, Robin L, et al., unpublished manuscript, 2010). The mean±SD MoCA score of persons with schizophrenia was 22.7±4.3. This score falls squarely into the “mild cognitive impairment” range observed with an elderly sample. On the Folstein Mini-Mental State Exam, the same individuals had a score of 27.1±2.5, which is in the normal range.As part of preparing a report for SSA, we also administered the MoCA to 224 individuals seen for consecutive psychiatric evaluations. The group had a wide range of diagnoses. We cannot validate the representativeness of the sample with respect to all individuals who apply to SSA for disability benefits; however, we did nothing to specially select the sample. We were surprised by the high rates of cognitive impairment across all diagnostic categories. [A table with mean MoCA scores for patients in the main diagnostic categories is available in an online supplement to this letter at ps.psychiatryonline.org.]On the basis of our experience, we propose that SSA recognize cognitive impairment as a common work-related impairment in a wide range of mental disorders not confined to dementia, delirium, or amnestic disorders. Failure to do so risks inappropriate denials of disability benefits. Physicians reporting to SSA need to perform more sophisticated cognitive testing. The SSA guidelines should accommodate the concept of co-occurring cognitive impairment in all diagnostic categories. Adjudicators and administrative law judges need to be educated about this phenomenon. At the same time, strategies to facilitate recovery and exit from the disability roll must target cognitive impairment and remediation of cognitive deficits.Dr. Amdur is senior psychiatric consultant at Thresholds, Chicago.Acknowledgments and disclosuresThe author reports no competing interests.References1 Keefe RSE , Fenton WS : How should DSM-V criteria for schizophrenia include cognitive impairment? Schizophrenia Bulletin 33:912–920, 2007 Crossref, Medline, Google Scholar2 Nasreddine ZS , Phillips NA , Bédirian V , et al.: The Montreal Cognitive Assessment (MoCA): a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society 53:695–699, 2005 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 6 June 2011Pages 682-682 Metrics Acknowledgments and disclosuresThe author reports no competing interests.PDF download History Published online 1 June 2011 Published in print 1 June 2011

Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates

The skin is the second most frequently affected organ system in lupus erythematosus. Although only very rarely life threatening--an example is lupus erythematosus-associated toxic epidermal necrolysis--skin disease contributes disproportionally to disease burden in terms of personal and psychosocial wellbeing, vocational disability, and hence in medical and social costs. Since several manifestations are closely associated with the presence and activity of systemic lupus erythematosus, prompt and accurate diagnosis of cutaneous lupus erythematosus is essential. This review aims to cover common, rare, and atypical manifestations of lupus erythematosus-associated skin disease with a detailed discussion of histopathological correlates. Cutaneous lupus erythematosus covers a wide morphological spectrum well beyond acute, subacute and chronic cutaneous lupus erythematosus, which are commonly classified as lupus-specific skin disease. Other uncommon or less well-known manifestations include lupus erythematosus tumidus, lupus profundus, chilblain lupus, mucosal lupus erythematosus, and bullous lupus erythematosus. Vascular manifestations include leukocytoclastic and urticarial vasculitis, livedoid vasculopathy and livedo reticularis/ racemosa. Finally, we discuss rare presentations such as lupus erythematosus-related erythema exsudativum multiforme (Rowell syndrome), Kikuchi-Fujimoto disease, extravascular necrotizing palisaded granulomatous dermatitis (Winkelmann granuloma), and neutrophilic urticarial dermatosis.

The International Classification of Functioning, Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users' perspective

Objective. This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.Method. A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.Results. The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.Conclusion. ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.

Performance-Based Measurement of Functional Disability in Schizophrenia: A Cross-National Study in the United States and Sweden

Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden. The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were. While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.