The double whammy of a work handicap (differential) effects of health on working conditions and outcomes.

OBJECTIVE: To determine the effect of health on working conditions and outcomes. METHODS: Data were collected in the longitudinal Study on Health at Work (n = 1597 employees), using multiple regression analyses and focusing on three groups of employees: 1) healthy, 2) chronic health complaints without a work handicap, and 3) chronic health complaints with a work handicap. RESULTS: 1) Employees with a work handicap experienced less favorable working conditions and outcomes than other employees. 2) Employees with a work handicap experienced less favorable working conditions and outcomes over time. 3) Employees with chronic health complaints were more vulnerable to the influence of working conditions on outcomes, whereas employees with a work handicap, unexpectedly, benefited from high work pressure and low autonomy. CONCLUSION: 1) Employees with a work handicap differ considerably from employees with chronic health complaints. 2) Employees with a work handicap drift into less favorable working conditions and outcomes. 3) Healthy employees, employees with chronic health complaints, and employees with a work handicap, all are vulnerable to different working conditions.

A multisite study of implementing supported employment in the Netherlands.

OBJECTIVE: This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions. METHODS: The authors used structured site visits, employment data, and semistructured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation. RESULTS: At 24 months, the four sites reached a mean+/-SD fidelity score of 4.1+/-.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff. CONCLUSIONS: To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.