Vocational Rehabilitation Project Research Articles

Vocational Rehabilitation Professionals’ Perceptions of Facilitators and Barriers to Return to Work: A Qualitative Descriptive Study

This is a qualitative descriptive study of professionals’ perceptions of facilitators and barriers for returning to work for women on long-term sick leave due to musculoskeletal pain and/or common mental disorder who participated in a vocational rehabilitation project. Data were collected through semi-structured interviews with 13 purposefully selected professionals from the Swedish Social Insurance Agency, the Swedish Public Employment Service, the health care services, and the municipal services. The interviews were analyzed with a manifest content analysis. The main facilitators were the close cooperation between the professionals and the individual support that was offered to the project participants. The main barriers were differences among the stakeholders’ missions and goals, limitations in project duration and within the labor market, and the project participants’ personal factors. These results emphasize the importance of cooperation between the various stakeholder professionals and a focus on the individual’s resources and needs. The study highlights the value of including health care professionals in vocational rehabilitation to benefit from their specific knowledge of the target group and that group’s strengths and needs. Moreover, the study highlights the need to incorporate collaboration with employers and align with the local labor market in the development of vocational rehabilitation interventions.

Positive experiences of a vocational rehabilitation intervention for individuals on long-term sick leave, the Dirigo project: a\xa0qualitative study

BackgroundThe process of returning to work after long-term sick leave can sometimes be complex. Many factors, (e.g. cooperation between different authorities and the individual as well as individual factors such as health, emotional well-being and self-efficacy) may have an impact on an individual’s ability to work. The aim of this study was to investigate clients’ experiences with an individually tailored vocational rehabilitation, the Dirigo project, and encounters with professionals working on it. The Dirigo project was based on collaboration between rehabilitation authorities, individually tailored interventions and a motivational interviewing approach.MethodsA descriptive qualitative design was used with data collected through interviews. Fourteen individuals on long-term sick leave took part in individual semi-structured interviews. The interviews were analysed using content analysis.ResultsThe analysis showed overall positive experience of methods and encounters with professionals in a vocational rehabilitation project. The positive experiences were based on four key factors: 1. Opportunities for receiving various dimensions of support. 2. Good overall treatment by the professionals. 3. Satisfaction with the working methods of the project, and 4. Opportunities for personal development.ConclusionsThe main result showed that the clients had an overall positive experience of a vocational rehabilitation project and encounters with professionals who used motivational interviewing as a communication method. The overall positive experience indicated that their interactions with the different professionals may have affected their self-efficacy in general and in relation to transition to work. The knowledge is essential for the professionals working in the area of vocational rehabilitation. However, vocational rehabilitation interventions also need a societal approach to be able to offer clients opportunities for job training and real jobs.

The relationship between self-efficacy and transition to work or studies in young adults with disabilities.

To investigate perceived self-efficacy in unemployed young adults with disabilities, and the association between self-efficacy and transition to work or studies. This prospective cohort study collected data through self-report questionnaires and registry data from a vocational rehabilitation project with young adults, aged 19-29 years. The Swedish Social Insurance Agency, the Swedish Public Employment Service and the participating municipalities identified potential participants for the study. A total of 531 participants were included in the study, of which 249 (47%) were available for analysis. Multinomial logistic regression models were carried out to estimate the associations between self-efficacy, demographic (age, country of birth, education level), health and employment status. The latter was coded as: 'no transition to work or studies', 'transition to studies', and 'transition to work'. A higher level of self-efficacy was associated with increased odds for 'transition to work' (OR = 2.37, p < 0.05). This finding remained consistent when adjusting for possible confounders. The mean value of self-efficacy was low, and participants with lower self-efficacy reported worse self-rated health ( p < 0.001) compared to participants with higher self-efficacy. The results from this study suggest that self-efficacy should be addressed in the vocational rehabilitation of young adults with disabilities in order to support their transition and integration into the labour market.

Process evaluation of an interorganizational cooperation initiative in vocational rehabilitation: the Dirigo project

BackgroundThis study analyzes the process of establishing and developing a cooperative vocational rehabilitation project with special focus on organizational and professional aspects. In the project, officials from the Swedish Social Insurance Agency and the Swedish Public Employment Service worked cooperatively with participants on long-term sick leave, youths with disability benefits, and people receiving social allowances. The officials used Motivational Interviewing (MI) as a method when meeting participants, and were able to offer flexible and tailored case management. The goal was to improve work ability and promote self-sufficiency.MethodsThe process evaluation was carried out through continuous data collection throughout the project (2012–2014), resulting in a total of 28 individual interviews and 17 focus groups with officials and managers. The material was categorized through an inductive content analysis, and analyzed using social capital as a theoretical frame.ResultsThe evaluation points to how issues related to design, organization and management contributed to the project not reaching its goals, e.g. problems with recruitment of participants, the funding structure, and staffing problems on the managerial level. Still, officials reported positive effects of close cooperation, which was perceived as facilitating the case management by fostering a mutual understanding and access to resources and rehabilitation measures from more than one authority.ConclusionsCooperative work combined with the use of MI and flexible case management seem to promote an increased trust between officials from different authorities and participants, which in the study is conceptualized as bonding and bridging social capital (between officials) and linking social capital (between officials and participants). The organizational problems combined with the relatively large differences in approaches between the project and regular practice obstructed implementation, where the authorities involved did not appear to be ready for implementing methodologies that require organizational restructuring.

An examination of concepts in vocational rehabilitation that could not be linked to the ICF based on an analysis of secondary data.

In the last few years the International Classification of Functioning, Disability and Health (ICF) has become a widely known and useful reference classification in vocational rehabilitation. It would be equally important to know which aspects of work-related health information cannot be assigned to distinct ICF categories. The objective of this study is to examine the concepts derived from three studies conducted within the ICF Core Set for vocational rehabilitation project, which could not be linked to distinct ICF codes in order to complement the current understanding of functioning in vocational rehabilitation. Secondary data analysis of the concepts from the systematic literature review, expert survey and patient focus group study of the ICF Core Set for vocational rehabilitation project that were marked as nd = not definable, nc = not covered or pf = personal factor. Nd-concepts were assigned to the biopsychosocial model of the ICF; additional ICF categories were formulated where needed. Nc-concepts were grouped into common themes not covered by the ICF. Pf-categories were linked to a proposed personal factors classification. 1093 nd-concepts were matched to overarching terms in the ICF, and "other specified"-categories were detailed. 1924 pf-concepts were linked to 31 second level categories of a proposed personal factors classification. 441 nc-concepts were grouped into six themes including the concept of well-being and attributes related to processes and time. With concepts that emerged from the secondary analysis of data gathered during the vocational rehabilitation ICF Core Set project, we have enriched the ICF model with constructs specific to vocational rehabilitation. However, additional research is needed to further explore personal factors specific to vocational rehabilitation. The influence of themes complementary to the ICF such as well-being and quality of life on return-to-work should be further investigated.

"Coffee Stands": A vocational rehabilitation project in the community for people coping with mental disorders

The "Coffee Stands" project was developed to provide a work place where individuals with long term mental illness can receive job training within the community. It is similar to a supported employment program, except that it does not provide individual job placement services. The objective of the study was to describe the participants who worked at the "coffee stands", with respect to their participation in occupations, functional cognition, executive functions and awareness, perception of their quality of life (QoL), satisfaction and self esteem. Moreover, the study aimed at examining whether changes occurred in these variables during the 6-month period in which participants worked at the coffee stands. Participants included 44 people with chronic mental illness; 27 men and 17 women, mean age 43.43 (SD = 9.02); mean years of education 11.81 (SD = 1.83); mean age of illness onset 27.72 (SD = 11.12) and mean number of hospitalizations 3.27 (SD = 2.64). All signed an informed consent to participate in the study. A battery of eight instruments measuring the various variables was administered at two points in time; at the beginning of the work at the coffee stands and 6 months later. Indicated that the training was successful and that participants were able to maintain an average 3 hours of work daily, demonstrating an improvement in their perception of their ability to work. In the area of planning, they needed structure, suggesting some difficulties in executive functions, but they seemed to be aware of their difficulties. After 6 months, participants showed improvements in health related measures of QoL and satisfaction, but not in self esteem. The findings strengthen the premise that people coping with an emotional disorder place great importance on working, are able to work and derive satisfaction from their work.

Organizing vocational rehabilitation through interorganizational integration—a case study in Sweden

This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

Development of interorganisational integration—a vocational rehabilitation project

The project was one of several structural efforts that were launched in Sweden in the 1990s to increase integration between different organisations regarding vocational rehabilitation. The goal was to obtain advantages for both clients and society through coordination of joint resources. To understand the development of interorganisational integration four studies were performed based on data collection from four years. The specific objectives were to analyse: (i) variation in views on long-term goals, (ii) different views on clients, (iii) the perceived barriers to the progress of the project and (iv) to describe and analyse the organising of the project over time. Each of the four objectives was undertaken as a separate study during the research.

Stakeholder conflict: a case study

Evaluation studies may take many forms and have many different functions, but commonly assume consensus on evaluation criteria. Reasoning from a theory of value pluralism, it is more likely that stakeholders will have different, and sometimes conflicting, views on an evaluated program. In order to acknowledge this plurality, Guba and Lincoln (1989) proposed taking different stakeholder constructions as a departure point for a negotiation process towards consensus or a heightened personal and mutual understanding. Impasses and conflicts are, however, considered to be an inevitable part of social relationships. This article suggests that an evaluator can create or restore the social negotiation process through the introduction of ‘other point multiplicity’. The features, (dis)advantages and required conditions for this evaluation and method of conflict management are illustrated by a case study which deals with an evaluation of a vocational rehabilitation project for psychiatric patients. During this project a conflict developed between management and the therapists who were involved in the evaluated program.

Storytelling as inquiry in a mental hospital.

People give meaning to chaotic experiences and try to persuade others of their perspectives by telling stories. In the process of meaning making, some stories gain and maintain the status of a standard story. When people no longer recognize themselves in the standard story, it loses credibility and a different story is needed to endow their lives and practices with meaning. A narrative inquiry of a vocational rehabilitation project in a mental hospital shows that inherited stories sustained the therapists' professional practice but prevented a successful rehabilitation of patients. Several therapists were willing to place this standard story between brackets and to listen to other unheard stories told by patients who participated in the project. These marginalized stories did not replace the standard story but enriched it. New plot lines were woven into the existing story and constituted changes in professional practice.

Identifying Unique Challenges to the Provision of Rehabilitation Services on the Navajo Reservation

The purpose of this study was to Investigate client factors related to the success or failure of American Indians in the Navajo Vocational Rehabilitation Project (NVRP). Previous information from rehabilitation service providers, including both state and Indian vocational rehabilitation project staff, indicated that there were barriers to service delivery unique to reservation-based Indians. However, little formal documentation of those barriers existed in the professional literature. It was the intent of this study to systematically review individual case files and provide documentation of client, family, communication, and service system variables that influence the success or failure of NVRP clients. Several variables were identified through discriminate function analysis as predictive of successful case closure in the Navajo Vocational Rehabilitation System.

REMOTIVATION OF LONG‐TERM MALE SCHIZOPHRENIC PATIENTS*

AbstractA vocational rehabilitation project for chronically ill schizophrenic male patients at Hawaii State Hospital involved the comparison of two groups of patients: (a) 32 who underwent a program of work conditioning plus vocational rehabilitation services, and (b) 19 who received only the regular hospital vocational therapy. By means of work‐tolerance and adequate‐vocational‐personality tests, it was possible to assess the patient's ability to adjust to community placement. Placement in a job in the community involved follow‐up assessments at twelve and eighteen months.The results of this study support the concept that vocational rehabilitation programs for patients with chronic schizophrenia can increase their chances for discharge from the hospital and can enable them to maintain themselves in the community if provided with vocational rehabilitation services and follow‐up. Work‐conditioning did not seem to be the prime factor in this success. The study also illustrates the cooperation of both private and governmental agencies in the use of manpower, facilities and funds to reduce the schizophrenic patient's difficult transition from the hospital to the community.

Manifest Anxiety and the Postinstitutional Adjustment of Young Offenders

Staff members of the Vocational Rehabilitation Project at Oklahoma State Reformatory noted an apparent relationship between the anxiety shown by inmates at the time of release and their subsequent adjustment to the rehabilitation program. This observation was investigated by a systematic study involving the Taylor Manifest Anxiety Scale and ratings of postinstitutional adjustment by a sociologist, who closely observed the young of fenders on their return to society. It was found that those who scored in the mid-range on the Manifest Anxiety Scale were rated as satisfactory in adjustment, without exception. All those scor ing below 5 were rated as unsatisfactory, while approximately half those scoring above 10 were rated as satisfactory and half as unsatisfactory.