Considerations in developing a specialized epilepsy employment program: A sponsor's playbook.

Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.

Factors associated with unsuccessful return-to-work following work-related upper extremity injury.

BACKGROUND: Returning to work following occupational injury is a key outcome for both workers' compensation boards and injured workers. Predictive factors for returning remain unclear. AIMS: To describe factors associated with unsuccessful return-to-work (RTW) in a hand injury population to identify target areas through which occupational rehabilitation programmes can help injured workers achieve successful RTW outcomes. METHODS: Demographic data, functional, pain and psychosocial scores were recorded for injured workers discharged between April 2011 and September 2015 from a multidisciplinary upper extremity treatment programme. The primary outcome of RTW status was assessed at programme discharge. Bivariate analyses and multivariable logistic regression were used to identify factors associated with being unable to RTW. RESULTS: Of 872 participants who met the inclusion criteria, 65% were male and the mean age was 46 (standard deviation [SD] 11) years. In unadjusted bivariate analyses, the group with an unsuccessful RTW outcome had higher mean baseline pain, catastrophizing and QuickDASH scores; a higher baseline prevalence of depression, and reported a high level of pain more frequently than those who were working at discharge. In the adjusted logistic regression model, not working at baseline, higher QuickDASH score and presence of depression at baseline were independently associated with unsuccessful work status outcome. CONCLUSIONS: Negative baseline work status, greater self-reported functional disability and presence of depression were associated with greater odds of unsuccessful RTW following a workplace upper extremity injury. Integrating mental healthcare provision with occupational rehabilitation is a potential programmatic approach to improve RTW.

The Workplace Discrimination Experiences of Individuals with Cancer in the Americans with Disabilities Act Amendments Act Era.

Background The purpose of this study was to investigate the patterns in allegations of workplace discrimination filed by individuals with cancer. Objective The goal of the research was to describe discrimination, both actual and perceived, that has occurred against individuals with cancer in comparison to a group of individuals with other general disabilities (GENDIS) through analyses of the United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database. Methods An ex post facto, causal comparative quantitative design was used to examine Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints received by the EEOC from people with cancer from 2009 through 2016 (n = 10,848) in comparison to the GENDIS group over the same time period (n = 13,338). Results Results revealed statistically significant differences in the patterns of issues alleged by the two groups. When compared to the GENDIS group, the cancer group was significantly older and had proportionally more individuals who identified as Asian than the GENDIS group. People with cancer were more likely to allege discrimination in the areas of unlawful discharge, demotion, wages, layoff, benefits, and referrals. They were less likely to allege discrimination in areas of reasonable accommodation, hiring, and suspension. Also, the cancer group was more likely than the GENDIS group to file allegations against smaller employers and employers in the Southeast region of the United States, while employers in the Mid-Atlantic and Rocky Mountain regions were less likely to be named in allegations by people with cancer. The cancer group was also significantly more likely than the GENDIS group to find that EEOC investigations of their allegations resulted in merit-based case resolution, that is, discrimination had indeed occurred. Owing to the large sample size, some of these between-group differences were small in magnitude. Conclusion The workplace discrimination experiences of people with cancer are substantially different from those of people with other disabilities.

Employment Rates in Flexible Assertive Community Treatment Teams in The Netherlands: An Observational Study.

We determined the proportions of clients treated in Flexible Assertive Community Treatment teams who were unemployed and gained employment and who were employed and lost employment. Secondly, we explored the demographical and clinical factors associated with employment. Data were collected during routine outcome monitoring. We calculated differences in employment rates over a year and explored differences in demographic characteristics at baseline between patient groups. Logistic regression analysis was used to estimate the role of clinical predictor variables on employment status. Over time, 10% remained employed, 5% lost their employment, 3% gained employment and 82% remained unemployed. Clients who found employment were younger, more often male, and had significantly fewer psychosocial problems and a higher subjective quality of life during follow-up than those who remained unemployed. Problems with motivation for treatment at baseline were related to losing employment or remaining unemployed. Better implementation of vocational services is very important for increasing the number of clients gaining employment.

A Qualitative Examination of the Physical Activity Needs of People with Severe Mental Illness.

It is recognised that physical activity has a positive impact on quality of life, social well-being and overall health of people with severe mental illness. However, there is a lack of theory informed programmes that support people with mental illness to adopt regular physical activity behaviour. The aim of this case study was to identify determinants of long-term physical activity among people with severe mental illness that may then inform the development of more suitable physical activity programmes. Semi-structured interviews were conducted with 15 people (13 men and 2 women) with a mean age of 36.7 [standard deviation (SD)=11.8] who had a diagnosed mental illness and were attending a physical activity programme run by a mental health non-governmental organisation. Interview data was analysed using the documentary method to emphasise the perspective of people with severe mental illness. Three participation types were generated in the context of individuals' physical activity orientation and social background-first 'rehabilitative orientated' (physical activity as a supportive measure to re-enter the labour market and develop a daily routine); second 'social-orientated' (social well-being within the group as the primary motive); finally, 'trust-orientated' (a sense of trust that encourages participation). Based on these type-specific categories, it is suggested that different settings (mental health care centres and sport clubs) might be needed to attract and maintain the physical activity engagement of people with severe mental illness. In the context of sport clubs, it is recommended that coaches undergo training in mental health literacy.

Supported Employment for Veterans With Traumatic Brain Injury: Provider Perspectives.

OBJECTIVE: To identify any pilot and nonpilot site differences regarding current (1) provision of supported employment (SE) to veterans with traumatic brain injury (TBI); (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE. DESIGN: Mixed methods cross-sectional survey study. SETTING: Veterans Health Administration SE programs. PARTICIPANTS: Respondents (N=144) included 54 SE supervisors and 90 vocational rehabilitation specialists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Web-based surveys of forced-choice and open-ended items included questions on SE team characteristics, communication with polytrauma/TBI teams, and experiences with providing SE to veterans with TBI history. RESULTS: SE was provided to veterans with TBI at 100% of pilot and 59.2% of nonpilot sites (P=.09). However, vocational rehabilitation specialists at pilot sites reported that communication with the polytrauma/TBI team about SE referrals was more frequent than at nonpilot sites (P=.003). In open-ended items, suggestions for improving SE were similar across pilot and nonpilot sites, and included increasing staffing for vocational rehabilitation specialists and case management, enhancing communication and education between SE and polytrauma/TBI teams, and expanding the scope of the SE program so that eligibility is based on employment support need, rather than diagnosis. CONCLUSIONS: These findings may contribute to an evidence base that informs SE research and clinical directions on service provision, resource allocation, team integration efforts, and outreach to veterans with TBI who have employment support needs.

Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial.

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group's self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10-0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI - 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54-0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Psychodynamic Online Treatment Following Supportive Expressive Therapy (SET):Therapeutic Rationale, Interventions and Treatment Process.

OBJECTIVES: The feasibility of psychodynamic online treatments has remained an issue of debate. The paper presents rationale and technique of a psychodynamic online intervention discussing therapeutic process and alliance based on two case examples from an RCT. METHODS: A weekly writing task is followed by individual feedback from the online therapist. Treatment focuses on a 'Core Conflict Relationship Theme' based on relationship episodes according to the wish of the patient, reactions of the others and reactions of the self. Maladaptive interpersonal interactions are worked through by supportive and expressive therapeutic interventions. RESULTS: Case reports from our study illustrate a productive therapeutic process without immediate personal contact or nonverbal communication. CONCLUSIONS: Emotional reactions and felt concern of the online therapist promote engagement in patients. Online therapists need to detect alliance ruptures based on text messages and remedy them. We discuss psychodynamic online treatments as adjuncts to face to face psychotherapy.

[Work-Anxieties and their Treatment in Medical Rehabilitation - Hand Tools for Capacity Training and Psychotherapy]. / Arbeitsängste und ihre Behandlung in der medizinischen Rehabilitation ­ Handwerkszeug für Fähigkeitentrainings und Psychotherapie.

Work-anxieties are often going along with workplace problems and long-term sick leave. Psychopathologically, different qualities of work anxiety can be distinguished: worrying, phobic anxiety, health-related anxiety, anxiety of insufficiency. An evaluation of a work-anxiety treatment showed that confronting patients with the topic work during medical rehabilitation leads to a better course. In work-oriented capacity trainings or behavior therapy groups, coping with everyday phenomena at work may be trained (self-presentation, social rules, work organization and problem solving, coping with chronic illness and impairment conditions). Active coping and communication (explaining impairment to the supervisor and occupational physician for making problem solving possible) are helpful. In some cases, correction of expectations must be done, and normalizing everyday work problems (conflicts and achievement requirements are normal at work, work does not make happy all the time).

Gender Influences on Return to Work After Mild Traumatic Brain Injury.

OBJECTIVE: To examine the influence of gender on the return to work experience of workers who sustained a work-related mild traumatic brain injury (TBI). DESIGN: Qualitative study using in-depth telephone interviews. SETTING: Community. PARTICIPANTS: Purposive sampling was used to recruit participants. Participants were adults (N=12; males, n=6, females, n=6) with a diagnosis of mild TBI sustained through a workplace injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women after work-related mild TBI. Women in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (eg, feminine) workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally masculine work environments. For all participants, employer and coworker relations were critical elements in RTW outcomes. CONCLUSIONS: The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the RTW process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for RTW after work-related MTBI.

Affect, work-goal schemas, and work-goal striving among adults with chronic pain: a multilevel structural equation analysis.

For individuals with chronic pain, the within-person influence of affect and goal cognition on daily work-related goal striving is not yet well understood. The present study tested the hypothesis that anticipatory goal cognition in the form of a morning work goal schema mediates the relations between morning affect and later (afternoon and evening) work goal striving. Working adults with chronic pain (N = 131) completed a 21-day diary with morning, afternoon, and evening assessments analyzed via multi-level structural equation modeling. At the within-person level, morning positive and negative affect were positively associated with morning work goal schemas; and morning work goal schemas, in turn, positively predicted both afternoon and evening work goal striving. Our findings underscore the complex dynamics over time of the relationship between affect and self-regulatory processes and have implications for future studies and for interventions to assist working adults with chronic pain.

[Relevance of Personality Factors for Successful Vocational Rehabilitation]. / Die Bedeutsamkeit von Persönlichkeitsfaktoren für den beruflichen Rehabilitationserfolg.

BACKGROUND: The Main purpose of vocational rehabilitation is occupational reintegration of clients into the job market who have lost their job or whose job is threatened because of a handicap or chronicl illness. With regard to existing evidence for the relevance of personality factors for work performance and job achievement, the present study investigated the influence of participants' personality factors on a successful reintegration after a retraining program in a vocational training center over 2 years. A central research objective was to identify prognostic personality factors for successful vocational integration. METHOD: In this longitudinal study 15 vocational training centers participated at 3 time points of measurement (T1, T2 and T3). Data gathering was based on rehabilitants' self-reports (standardized questionnaires: SVF, BSW, SPR, CSES) about personality aspects. First data collection started at the beginning (T1) and a second survey was conducted at the end of the training 2 years later (T2). Based on the data at measurement points T1 and T2, 4 prognostic models were computed (binary logistic regression analysis) and evaluated, examining the differenzial influence of several scales and items on direct reintegration after completing the vocational retraining and reintegration status 6 months later (T3). RESULTS: As expected, different variables turned out to be relevant for occupational integration at the end of the training program and 6 months later. Correspondingly other variables appeared to be relevant for occupational reintegration at T1 and at T2. At the end of the vocational training program, approximately 24% of the participants had a job. With respect to direct reintegration, regression analysis revealed that vocational self-efficacy (R(2)=0,175) and self-evaluation were relevant (R(2)=0,383). Approximately 70% of the participants had gotten a job 6 months later. Several stress coping strategies (R(2)=0,170), estimation of the own reintegration prognosis and aspects like vocational center contextual factors (R(2)=0,280) appeared to be relevant for reintegration 6 months later.

[Adaptive Performance in Vocational Rehabilitation - A Standardized Self-assessment Questionnaire (ReHadapt) for Application in RehaAssessment® and RehaConsulting]. / Anpassungsleistungen in der beruflichen Rehabilitation - Ein Selbsteinschätzungsfragebogen (ReHadapt) zur Anwendung im RehaAssessment® und in der Reha-Beratung.

OBJECTIVES AND METHODS: A rehabilitation training requires the ability to adapt to a changed living and working environment. Qualitative content analysis and quantitative studies were conducted to (1(st)) provide a definition of adaptive performance (AP) in vocational rehabilitation. (2(nd)) A self-assessment questionnaire (ReHadapt) to measure AP was developed and (3(rd)) its validity was proved by the use of exploratory (N1=344) and confirmatory factor analysis (N2=301; N3=254) for categorical variables. RESULTS: AP is a multidimensional construct which can be assessed by the ReHadapt questionnaire. The ReHadapt questionnaire consists of 30 items which are categorized to the 6 dimensions training-related AP, subject-related AP, health-related AP, social AP towards other participants, social AP towards trainers and identification with future occupation. As expected, reliability (0,81≤Cronbach's Alpha≤0,95) and validity are confirmed. Adaptive Performance predicts return to work mediated by the health-related quality of life. IMPLICATIONS: Because of its economy and applicability in everyday work-life the ReHadapt can be used for diagnostic and training in RehaAssessment(®) and RehaConsulting.

[Prediction and Prevention of Dropouts in Vocational Retraining]. / Prognose und Verhinderung von Abbrüchen bei Qualifizierungen in der beruflichen Rehabilitation.

UNLABELLED: Principal objective: To verify if a psychological intervention targeting individuals with high resignation tendency prevents dropouts in vocational retraining. For individuals with high resignation tendency a high risk of dropping out was assumed under regular conditions. METHOD: Data was collected at 2 adult education institutes. At the beginning of vocational training the occupational inventory Work-related Behaviour and Experience Patterns (AVEM) was used. The questionnaire allows to classify 4 types of coping behaviour. G: healthy-ambitious, S: unambitious, A: excessively ambitious, B: resigned. Using a quasi-experimental design, the effect of resilience building was verified by comparing a treatment group with a control group. Control group was offered the usual treatment of the education institute. The treatment group was additionally offered two individual meetings and a work-related group treatment focussing on coping behaviour. RESULTS: Given a very high resignation tendency in both groups, dropping out of rehabilitation was less frequent in the treatment group. Other individuals tended to drop out more frequently, but this is not statistically significant. CONCLUSION: The study shows that work-related resilience building helps to minimize risk of dropping out of vocational rehabilitation in the case of extremely resigned coping behaviour.

Work participation for people with severe mental illnesses: An integrative review of factors impacting job tenure.

BACKGROUND: Enabling people with severe mental illness to sustain employment remains a challenge. This is despite most wishing to be employed, and the development of effective vocational interventions and employment supports for this population. To better understand how to enable their sustained involvement in the workforce, this review sought to identify, analyse and summarise studies investigating the factors that impact the job tenure of workers with severe mental illness, irrespective of the type of employment support they received. METHODS: An integrative literature review approach was employed to locate, appraise and synthesise quantitative and qualitative research focused on job tenure published in the 20 years up to 2013. Findings from nineteen studies were extracted and integrated using thematic analytic strategies. RESULTS: Job tenure was mostly conceptualised across the reviewed studies as time spent in individual jobs rather than as ongoing participation in the workforce. Three themes describe the factors contributing to job tenure: (1) the worker's experience of doing the current job; (2) natural supports in the workplace; and (3) strategies for integrating work, recovery and wellness, each of which could either support or impede ongoing employment. CONCLUSION: Occupational therapists, other vocational specialists and mental health staff can use these factors as a guide to supporting people with severe mental illness in employment. More detailed examination of job tenure is required in future research not only on job duration but also on the quality of jobs held, their value for career development and the role of services in supporting tenure.

[Cognitive remediation and nursing care]. / Remédiation cognitive et prise en charge infirmière.

Therapies based on cognitive remediation integrate psychiatric care. Cognitive remediation helps to ease cognitive disorders and enable patients to improve their day-to-day lives. It is essential to complete nurses' training in this field. This article presents the example of a patient with schizophrenia who followed the Cognitive Remediation Therapy programme, enabling him to access mainstream employment.

Re/creating entrepreneurs of the self: discourses of worker and employee 'value' and current vocational rehabilitation practices.

Vocational rehabilitation for people experiencing work disability is a social practice often situated within health services, but the social and political drivers and effects of this practice are rarely critically analysed in health research or policy. In this study we used a Foucauldian theoretical perspective to analyse the ways in which current vocational rehabilitation practices in New Zealand re/produce notions of worker and employee 'value', and how different approaches to vocational rehabilitation deploy current discourses about value. We also consider the subject positions produced through these different approaches and the identities and actions they make possible for people experiencing work disability. The analysis showed that notions about the importance of worker and employee value in a job market are pervasive in vocational rehabilitation, and reflect wider societal discourses. However, the deployment of those discourses in different approaches to vocational rehabilitation practice are diverse, producing different opportunities and constraints for people experiencing disability. We argue that an examination of these various opportunities and constraints at the level of practice approaches is important, as considerable time and resources are allocated to developing solutions to help those who do not thrive in the current systems, yet we rarely critique the premises on which the systems are based.

A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice.

OBJECTIVE: A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment. DESIGN: In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit. STUDY SAMPLE: Sixty-six employees with hearing impairment participated in the VEP. The multidisciplinary team providing the VEP comprised six professionals. RESULTS: The professionals performed the VEP according to the protocol. Of the recommendations delivered by the professionals, 31% were perceived as implemented by the employees. Compliance rate was highest for hearing-aid uptake (51%). Both employees and professionals were highly satisfied with the VEP. Participants rated good perceived benefit from it. CONCLUSIONS: Our results indicate that the VEP could be a useful treatment for employees with hearing difficulties from a process evaluation perspective. Implementation research in the audiological setting should be encouraged in order to further provide insight into parameters facilitating or hindering successful implementation of an intervention and to improve its quality and efficacy.

The Experience of KAI MAHI, an Employment Initiative for People with an Experience of Mental Illness, as Told by Zarna, Zeus, Lulu, Mary, Paul, and Hemi.

There is a growing body of evidence endorsing the use of supported employment models for people with an experience of mental illness. However current literature and research regarding the perspective of people with experience of mental illness, as well as alternate models of employment support, is sparse. This study has captured the stories of employment of people with experience of mental illness who participated in KAI MAHI, a group based employment program. Findings identified key components of KAI MAHI, consistent with their overall experiences of employment, which were influential in assisting them to find and sustain employment. These included the opportunity for self-determination, a sense of self-efficacy, and respectful relationships.

[Individual and Contextual Reasons for Drop-outs in Vocational Retraining]. / Individuelle und kontextbezogene Ursachen von Abbrüchen beruflicher Qualifizierungsmaßnahmen.

BACKGROUND AND AIMS: The study focusses on the explanation of the individual, process-driven, and institutional factors and their interplay, and on the subjective accounts for the high drop-out rates in vocational retraining which are reported by the German statutory pension insurance scheme. METHODS: 454 participants of 2-year lasting vocational retraining schemes in 3 vocational promotion centers and 3 education providers took part in the questionnaire survey. Furthermore, experts, dropouts and participants were interviewed and group discussions with experts and participants were conducted. RESULTS: Drop-out is not a definite term. Instead, it consists of different dimensions. 3 personal factors for predicting a drop-out could be identified: suffering from depression, negative health assessment and lack of social support. Generally speaking, drop-out of vocational retraining is a complex and mainly situational process which can hardly be predicted by personal factors, job-biographies or foregoing unemployment.