Vocational Rehabilitation For People Research Articles

Testing the efficacy of WORK-ON: vocational rehabilitation for people with chronic inflammatory arthritis in Denmark—protocol for a randomised controlled trial

IntroductionAmong people with chronic inflammatory arthritis (IA), up to 40% lose their job in the first few years after diagnosis of this condition and are hence at high risk of...

A qualitative study exploring how vocational rehabilitation for people with multiple sclerosis can be integrated within existing healthcare services in the United Kingdom

BackgroundTo explore how a vocational rehabilitation (VR) intervention can be integrated within existing healthcare services for people with multiple sclerosis (MS) in the United Kingdom (UK) National Health Service (NHS).MethodsData from 37 semi-structured interviews with 22 people with MS, eight employers, and seven healthcare professionals were analysed using a framework method informed by the Consolidated Framework for Implementation Research and an intervention logic model.ResultsFour themes were identified relating to the structure of current NHS services, how to improve access to and awareness of VR services, the collaboration between internal and external networks, and the benefits of integrating VR within the NHS services. Participants identified several implementation barriers such as poor links with external organisations, staffing issues, and lack of funding. To overcome these barriers, participants suggested enablers such as technology (e.g., apps or online assessments) and collaboration with third-sector organisations to reduce the pressure on the NHS.ConclusionSignificant organisational changes are required to ensure a successful implementation of a VR intervention within current NHS services. Despite this, the NHS was seen as a trustworthy organisation to offer support that can optimise the health and professional lives of people with MS.

‘A new sense of my former self’ – transforming the self through vocational rehabilitation for people with acquired brain injury

Background Acquired Brain injury (ABI) causes ripples throughout the occupational and social fabric. It enters people’s lives at a significant personal cost, encroaching on people’s sense of self. Vocational rehabilitation is a viable venue to regain control of their life and support them in forming a new sense of self. From an occupational perspective, little is known about how vocational rehabilitation can support people through transforming their sense of self. Aim This study aims to explore how vocational rehabilitation may influence the relationship between sense of self and occupational engagement for persons with ABI. Material and Methods: Six persons with ABI were purposely sampled. Data were collected using semi-structured individual interviews and analysed using a hermeneutic approach. Results The analysis resulted in three themes: a new sense of my former self, engaging in occupations as transformation, and the significance of support. Conclusions Participating in vocational rehabilitation can enable persons with ABI to form a new sense of self. Engaging in occupations and professional support is significant in the transformation process. Significance From an occupational perspective, the knowledge gained in this study stresses the essential role occupational engagement and proper targeted support have for people struggling to return to work after ABI.

Integrated mental healthcare and vocational rehabilitation for people on sick leave with stress-related disorders: 24-month follow-up of the randomized IBBIS trial

Integrating vocational rehabilitation and mental healthcare has shown effects on vocational outcomes during sick leave with common mental disorders. In a previous paper, we showed that a Danish integrated healthcare and vocational rehabilitation intervention (INT) had a surprisingly negative impact on vocational outcomes compared to service as usual (SAU) at 6- and 12-month follow-up. That was also the case with a mental healthcare intervention (MHC) tested in the same study. This article reports the 24-month follow-up results of that same study. A randomized, parallel-group, three-arm, multi-centre superiority trial was conducted to test the effectiveness of INT and MHC compared to SAU. In total, 631 persons were randomized. Contrary to our hypothesis, SAU showed faster return to work than both INT [hazard rate (HR) 1.39, P=0.0027] and MHC (HR 1.30, P=0.013) at 24-month follow-up. Overall, no differences were observed regarding mental health and functional level. Compared to SAU, we observed some health benefits of MHC, but not INT, at 6-month follow-up but not thereafter, and lower rates of employment at all follow-ups. Since implementation problems might explain the results of INT, we cannot conclude that INT is no better that SAU. The MHC intervention was implemented with good fidelity and did not improve return to work. This trial does not support the hypothesis that INT lead to faster return to work. However, implementation failure may explain the negative results.

Integrated Mental Healthcare and Vocational Rehabilitation for People on Sick Leave with Anxiety or Depression: 24-Month Follow-up of the Randomized IBBIS Trial

Integration of vocational rehabilitation and mental healthcare has shown some effect on work participation at 1-year follow-up after sick leave with depression and anxiety. We aimed to study the effect on work and health outcomes at 2-year follow-up, why we performed a randomized trial was conducted to study the effectiveness of integrated intervention (INT) compared to service as usual (SAU) and best practice mental healthcare (MHC). We included 631 participants, and at 24-month follow-up, we detected no differences in effect between INT and SAU. Compared to MHC, INT showed faster return-to-work (RTW) rates (p = 0.044) and a higher number of weeks in work (p = 0.024). No symptom differences were observed between the groups at 24 months. In conclusion, compared to SAU, INT was associated with a slightly higher work rate reaching borderline statistical significance at 12-month follow-up and lower stress levels at 6-month follow-up. The disappearance of relative effect between 12 and 24 months may be explained by the fact that the intervention lasted less than 12 months or by delayed spontaneous remission in the SAU group after 12 months. Despite the lack of effect at long-term follow-up, INT still performed slightly better than SAU overall. Moderate implementation difficulties, may partly explain the absence of the hypothesized effect. Integrated intervention, as implemented in this trial, showed some positive effects on mid-term vocational status and short-term stress symptom levels. However, these effects were not sustained beyond the duration of the intervention.

A mixed-methods feasibility case series of a job retention vocational rehabilitation intervention for people with multiple sclerosis

Purpose To ascertain the feasibility and acceptability of delivering a job retention vocational rehabilitation intervention [MSVR] for people with multiple sclerosis (pwMS) in a community setting. Secondary objectives included determining whether MSVR was associated with changes in quality of life, fatigue, mood, cognition, workplace accommodations, work instability, work self-efficacy, and goal attainment. Methods Single-centre mixed-methods feasibility case series. Results 15 pwMS and three employers received 8.36 (SD = 4.48) and 1.94 (SD = 0.38) hours of MSVR respectively over three months. The intervention predominantly addressed managing cognition, fatigue, and negotiating reasonable accommodations. Four healthcare professionals were recruited to clarify clinical information. The intervention was feasible to deliver, and there was a significant positive impact on goal attainment immediately following MSVR (t(14) = 7.44, p = .0001, d = 1.9), and at months 3 (t(13) = 4.81, p = .0001, d = 1.28), 6 (t(11) = 4.45, p = .001, d = 1.28), and 12 (t(9) = 5.15, p = .001, d = −2.56). There was no impact on quality of life, fatigue, mood, cognition, workplace accommodations, work instability, and work self-efficacy. In post-intervention interviews, participants reported that MSVR was acceptable. Four themes were derived regarding the context, employer engagement, empowerment through knowledge, and intervention components and attributes. Conclusion It was feasible and acceptable to deliver MSVR. Participants better understood their MS, became more confident managing problems at work and attained their work-related goals. IMPLICATIONS FOR REHABILITATION People with multiple sclerosis (MS) experience problems at work because of the interaction between symptoms and environmental factors (e.g., co-workers’ attitudes). Vocational rehabilitation for people with MS and their employers should be tailored in terms of content and intensity. People with MS can be empowered at work by learning about MS and how their symptoms fluctuate over time. Understanding legal responsibilities and examples of accommodations at work can be beneficial for employers.

Vocational rehabilitation via social firms: a qualitative investigation of the views and experiences of employees with mental health problems, social firm managers and clinicians

BackgroundEmployment within social firms in the UK is under-developed and under-researched, but a potentially beneficial route to vocational rehabilitation for people with mental health problems. This study explores the views and experiences of employees with mental ill-health, managers of social firms and mental health clinicians, in order to understand the potential value of social firms for the vocational rehabilitation, employment and well-being of people with mental health problems.MethodsSemi-structured interviews were conducted with 23 employees with mental health problems in 11 social firms in England. A focus group and individual interviews were conducted with 12 managers of social firms. Two focus groups were held with 16 mental health clinicians. Data were analysed using thematic analysis.ResultsMost employees expressed very positive views about working in a social firm. In responses from both employees and social firm managers, an overarching theme regarding the supportive ethos of social firms encompassed several related features: openness about mental health issues; peer, team and management support; flexibility; and support to progress and develop skills over time. Managers identified benefits of employing people with mental health problems who were sufficiently recovered. Knowledge of social firms within clinician focus groups was very limited, although clinicians thought they could be a welcome additional vocational resource.ConclusionsHigh levels of job satisfaction among social firm employees may be explained by the supportive ethos of these working environments. Social firms have potential to be a helpful addition to the range of vocational pathways available for people with mental ill-health. Further mixed methods investigations of experiences and outcomes in order to understand who engages with and benefits from this form of vocational rehabilitation would be valuable in informing decisions about scaling up the model.

Vocational rehabilitation resources from the perspective of people with spinal cord injury and service providers

BACKGROUND: Vocational rehabilitation for people with spinal cord injury (SCI) in Iran as one of the countries in the Middle East and North Africa region is under-studied. OBJECTIVES: The purpose of this study was to explore the perspective of people with SCI and service providers about vocational rehabilitation challenges. METHODS: We used an ethnographic methodology to collect data. Observation (2018 –2020) and semi-structured interviews with 21 persons with SCI and 11 service providers were the data collection methods, and a thematic analysis approach was used to analyze the data. RESULTS: Results demonstrate that career self-knowledge (knowledge about capabilities, aspirations, and interests) and career knowledge (the importance of career exploration, vocational support and job characteristics) were the main two vocational rehabilitation resources. CONCLUSIONS: Knowledge (about the self and careers) is the main resource mentioned by the participants regarding the vocational rehabilitation. Implications for professionals and policy makers are presented.

Healthcare professionals' roles within UK welfare-to-work provision: a multiple case study exploration

Background/aims Healthcare professionals play an important role in vocational rehabilitation for people receiving welfare support. The research questions for this study were: how do qualified healthcare professionals operate in UK welfare-to-work settings? What factors influence healthcare professionals' practice within a UK welfare-to-work setting? Methods A qualitative methodology was adopted. Four semi-structured interviews were conducted and additional documents (the awarded Work and Health Programme bids and job descriptions) about the healthcare professionals' roles were reviewed. Inductive thematic analysis was undertaken. Results Five themes were generated from the interview data: supporting frontline staff to understand clients' health needs; moving clients with complex needs closer to work; getting it right for the client by individualising support; gaining consent and maintaining confidentiality; and seeking and organising clinical supervision. These themes were corroborated with the document data. Conclusions Healthcare professionals have a key role within welfare-to-work provision. Further research is needed to determine if the proposed healthcare professional roles have come to fruition, to identify their prevalence, and to explore their effectiveness.

Rehabilitacja społeczna i zawodowa osób z niepełnosprawnością

Rehabilitacja społeczna i zawodowa osób z niepełnosprawnością

Comparing outcome measures of persons with severe mental illness in vocational rehabilitation programs: a dual perspective of consumers and providers.

Vocational rehabilitation for people with severe mental illness (SMI) has many benefits. Among the existing models, supported employment has consistently shown to have better impact on vocational outcomes while the findings on non-vocational outcomes are inconsistent. One source of variation with regard to non-vocational outcomes could be related to differences between consumers' self-reports and the providers' point of view. A cross-sectional study of people with SMI consuming three different vocational services and their service providers. Data were collected as part of the Israeli Psychiatric Rehabilitation Patient Reported Outcome Measurement project. The current data is based on 3666 pairs of people with SMI consuming vocational services and their service providers. Vocational services included supported employment, sheltered workshops and vocational support centers. The consumers-filled self-report questionnaires, which consisted of the following patient-reported outcome measurements (PROMs): quality of life, functioning and illness management. Primary professional providers were given instruments that mirrored the ones designed for self-report. According to providers' ratings, supported employment was associated with higher functioning (F=78.6, P<0.001) and illness management (F=33.0, P<0.001) compared to other vocational services. PROMs revealed that supported employment was associated with higher functioning only (F=31.5, P<0.001). Consumers rated themselves higher compared to providers on all measures. This study provides a deeper insight into non-vocational outcomes of people with SMI participating in vocational services and suggests differences in perspectives between consumers and providers with regard to outcome measures.

A Study on the Employment and Vocational Rehabilitation of People with Severe Disabilities in the COVID-19 Situation: Focused on the Role of Disabled Product Sales Facilities

A Study on the Employment and Vocational Rehabilitation of People with Severe Disabilities in the COVID-19 Situation: Focused on the Role of Disabled Product Sales Facilities

Aktywizacja zawodowa i społeczna osób niepełnosprawnych na współczesnym rynku pracy – zakłady aktywności zawodowej

The article is for an overview. It presents the issues of vocational rehabilitation of people with disabilities on the example of vocational development centers. Th work is based on publications about vocational development centers from the last ten years. Th purpose of the article is to present the current state of functioning of vocational development centers as one of the contemporary forms of professional activation of disabled people in Poland. Th social, legal and organizational aspects of the activity of vocational development centers were analyzed, with particular reference to the local labor market of the Lublin Voivodeship.

The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review

Background Employment is one of the strongest predictors of positive outcomes for persons with substance use disorder. Purpose: To conduct a systematic review of interventions intended to improve employment outcomes for persons with substance use disorder (SUD) at any stage of recovery. This is an update of a prior review published in 2004. Methods: Two bibliographic databases, PUBMED and PSYCHINFO, were searched for articles published in the period 2005–2018 that referenced employment, education, or vocational rehabilitation for people with SUD. Results: One hundred thirty-two articles were identified of which 14 met the criteria for inclusion, primarily a minimum of a quasi-experimental evaluation design. Each study was reviewed with the following format: setting (modality); subject characteristics; research procedures; results; limitations/comments. Results: Nine programs or models were represented among the 14 studies, with Individual Placement and Pupport (IPS) and its variant Customized Employment Supports (CES) having the most studies with positive results. But generally, the magnitude of any intervention effects on employment was small for all interventions; one outcome may have shown statistical significance while one or more other outcomes did not, and there was little consistency in how outcomes were measured among the studies. Conclusions/Importance: IPS/CES currently shows the most evidentiary support. But all the studies of interventions with positive outcome data should be replicated with larger samples in diverse settings.

Rethinking Vocational Rehabilitation through Institutional Ethnography

In Norway, vocational rehabilitation for people with support needs involves complex inter-professional and inter-organizational processes that do not have clear institutional boundaries. Every process involves a new constellation of actors, representing divergent practices, ideas and objectives. This article argues that much of the current research on the implementation of activation policy inadequately captures the mechanisms and processes that influence vocational rehabilitation practices. The article proposes the use of institutional ethnography (IE) to empirically examine vocational rehabilitation, and argues that IE provides methodological concepts and tools that enable researchers to link and make visible the everyday practices, the social relations and the institutional contexts that make up vocational rehabilitation processes.

System kwotowy jako źródło problemów finansowych Państwowego Funduszu Rehabilitacji Osób Niepełnosprawnych

People with disabilities without adequate support from the state are unable to compete effectively with non-disabled people in the labor market. Therefore, there is commonly used legal compulsion to employ a specific quota of such people called quota system. This system is also used in Poland, and also in order to increase its effectiveness it applies subsidies for salaries of employees with disabilities. In case of not reaching the required employment rate for disabled workers, employers are required to deposit financial penalties on account of the State Fund for Rehabilitation of Disabled Persons, which finances subsidies for wages of workers with disabilities and other activities in the field of social and vocational rehabilitation of people with disabilities. Dependence of the Fund's expenditure for these tasks from the received contributions of employers is a threat to the financial situation of the Fund.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries.

The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

Perceived and actual barriers to work for people with mental illness

BACKGROUND: Unemployment is high among people with severe mental illness and often hinders community integration. OBJECTIVES: To inform the effectiveness of vocational rehabilitation programs, our study examined whether self-perceived barriers to work differ among clinical and demographic subgroups of people with mental illness, and whether self-perceived barriers to work, clinical and demographic factors are related to employment outcomes. METHODS: Multivariate regression analyses were conducted on self-perceived barriers to work, clinical and demographic factors of N=279 people with mental illness who presented to Career Management Service. RESULTS: Older as opposed to younger participants were less likely to obtain competitive employment. Being of an ethnic minority group increased the likelihood of entering education/training but made it less likely to enter non-competitive employment, while no difference was found for obtaining competitive employment. A trend was found for people with schizophrenia versus those with a different diagnosis to be more likely to enter education/training and non-competitive employment. Except for health problems and social/structural disadvantages, self-perceived barriers to work were not related to actual employment outcomes. CONCLUSIONS: The results indicate that vocational rehabilitation for people with mental illness does not occur in isolation but is influenced by factors beyond clinical impairment which generally affect the labor market.

“Watch your steps” – Community mental health professionals’ perspectives on the vocational rehabilitation of people with severe mental illness

Community mental health services are expected to focus on vocational recovery. Thus, the aim of this qualitative study was to explore Norwegian mental health professionals’ views of their clients’ potential for working and understanding of local vocational resources. Three focus group discussions with 21 participants, covering supported housing, activity centers, and case management, revealed: (1) viewing clients as vulnerable and not ready for employment and discovering their own lack of belief in their clients’ vocational potential as a latent barrier, (2) laying stepping stones to everyday life activities, from which clients could be launched into the community and meet new role responsibilities, and (3) feeling skepticism toward the competence of vocational rehabilitation staff. This study indicates that mental health professionals interviewed in these focus groups were ambivalent toward supporting clients’ work potential. They primarily viewed their clients as having no chance in the labor market.

Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness

Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses (SMI). The CBT-based Indianapolis Vocational Intervention Program (IVIP) was specifically designed to reduce defeatist beliefs related to work functioning. In the current study, we examined the impact of IVIP on defeatist beliefs and motivation for work, hypothesizing that IVIP would be associated with a reduction in defeatist beliefs and greater motivation for work. We also examined the effects of IVIP on these variables as well as work outcomes during a 12-month follow-up. Participants with SMI (n=64) enrolled in a four-month work therapy program were randomized to IVIP or a support therapy group (SG). Assessments were conducted at baseline, post-treatment (4months), and follow-up (1year). Compared to those in SG condition, individuals randomized to IVIP condition reported greater reductions in defeatist beliefs and greater motivation for work at follow-up, along with greater supported employment retention rates. Specifically treating and targeting negative expectations for work therapy improves outcomes, even once active supports of the IVIP program and work therapy are withdrawn.