Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver's downtown and DTES.

BACKGROUND: Employment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver's downtown and Downtown Eastside (DTES). METHODS AND DESIGN: This prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences. DISCUSSION: The results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.

Employment Trends in Rhode Island From 2011 to 2017 for Adults With Intellectual Disability and Developmental Disabilities.

This study reports on state-level data in Rhode Island on employment and non-work activities of adults with intellectual and developmental disabilities receiving services between 2011 and 2017. The goal was to examine the complex patterns of change over time in individual-level employment outcomes and the potential short-term impacts of a consent decree entered into by the state of Rhode Island to address integrated employment outcomes. Findings suggest that policy initiatives such as the consent decree can lead to reductions in reliance on facility-based work, but also highlight the importance of planning for the transition to competitive, integrated employment and not simply a shift toward non-work activities. Further, the data support the notion that the best predictor of integrated employment over time is previous experiences in integrated employment (not facility-based or other work or non-work activities), suggesting the role of ongoing supported employment and transition services that create and support the maintenance of integrated employment.

Individual placement and support in the Netherlands: Past, present, and future directions.

OBJECTIVE: This article addresses the rise of individual placement and support (IPS) within vocational services for people with severe mental illness (SMI), the current state of affairs, and future directions of IPS in the Netherlands. METHOD: Review of the literature on IPS in the Netherlands, analysis of registration data, and exploration of future avenues for IPS in Dutch mental health care. FINDINGS: In the first decade of this century, an implementation study showed that IPS was feasible in the Netherlands, and a multisite randomized controlled trial (RCT) indicated that IPS was also effective in the Dutch context. Nationwide, from the start of 2016 to the end of 2017, the number of enrolled IPS participants doubled from 1,038 to 2,100, which was largely due to the introduction of preliminary national funding of IPS. Future directions include expanding the IPS practice in terms of target groups, types of providers, goals, and added interventions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Involvement of clinicians and the employment opportunities for people with SMI have increased, which is mainly due to the successes of IPS. However, considerable efforts are still needed to make IPS more widely available. Important facilitators are regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved, and secured IPS funding. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Predictors of work outcomes following supported employment in veterans with a history of traumatic brain injury.

BACKGROUND: The effects of traumatic brain injury (TBI) on return to work have been the focus of many clinical studies in recent years. Veterans with a history of TBI may be at increased risk of unemployment. OBJECTIVE: We sought to understand predictors of work outcomes for Veterans with a history of TBI who received evidence-based supported employment. METHODS: Fifty unemployed Veterans with a history of mild-to-moderate TBI and current neuropsychological impairment participated in a 12-month supported employment intervention. Demographic data and baseline assessments of neuropsychological impairment, functional capacity, and psychiatric and post-concussive symptom severity were investigated as predictors of work outcomes (job attainment, weeks worked, and wages earned). RESULTS: Bivariate analyses showed that lower disability ratings, more recent work history, more months worked in the past 5 years, lower PTSD symptom severity, worse verbal memory, and better cognitive flexibility were all associated with better work outcomes. In multivariate regression analyses, better cognitive flexibility and worse verbal memory performance predicted better work outcomes. CONCLUSIONS: Further research is needed to determine how treatment of cognitive impairments and psychiatric symptoms is related to return to work in Veterans with a history of TBI.

Purely Patrick: A case study report.

This case study will focus on the "evolution" of finding meaningful occupation for a young man, Patrick, 27, in spite of his multiple disabilities within his rural home environment in Stowe, Vermont. The purpose of this case study is to show others (family members, therapists, support service individuals and adult agencies) that it is possible to be self-employed despite life's challenges, and that with some creativity (and funding), there is a niche of meaningful occupation available for all!

Accommodating individuals with traumatic brain injury: An analysis of employer-initiated cases handled by the Job Accommodation Network.

BACKGROUND: The Job Accommodation Network (JAN) has provided customized accommodation information to employers, individuals with disabilities, and their representatives (e.g., family, rehabilitation counselors, union representatives) since 1983. For each inquiry where such information is sought, detailed records are maintained regarding the type of inquiries made and the information provided. OBJECTIVE: The objective of the current study is to present a descriptive analysis of the employer-initiated cases related to Traumatic Brain Injury (TBI) handled by the accommodation specialists at JAN during the five years from 2012 through 2016. METHODS: Records related to instances of TBI as recorded by the JAN accommodation specialists were reviewed. Information pertaining to the type of business, occupational category, limitations being experienced by the individual, and issues discussed with the accommodation specialist are presented. RESULTS: The type of businesses and the occupational categories indicated by the employer were broad ranging, although there was a preponderance of cases in the area of Public Administration. Limitations related to cognition were the most frequent for which employers sought accommodation information. The largest category for the type of issues discussed was related to the Americans with Disabilities Act and other disability-pertinent legislation. CONCLUSIONS: The incidence of employers seeking accommodation information for individuals who have incurred a TBI is very low (0.5%). Findings support those of other authors such as Ponsford and Spitz (2015), in that accommodation information was most frequently requested for individuals in professional (i.e., office-type jobs), rather than for laborer positions.

Work outcome in persons with musculoskeletal diseases: comparison with other chronic diseases & the role of musculoskeletal diseases in multimorbidity.

BACKGROUND: Chronic diseases and multimorbidity are increasingly common among persons in working age. This study explores the impact of type, number and combinations of chronic diseases with focus on the role of MSKD on (1) adverse work status (i.e. work disability (WD), economic unemployment (UE) or receiving a living allowance (LA)) and on (2) the occurrence of sick leave. METHODS: Subjects participating in a Dutch household survey, who were ≤65 years and could have paid work, provided data on socio-demographics and nine physician diagnosed chronic diseases. To explore the independent association of each chronic disease, of multimorbidity and of MSKD in context of multimorbidity with 1) work status (employed, WD, LA, UE) and 2) sick leave (SL) in those employed, multinomial logistic regressions and logistic regressions were used, respectively. RESULTS: Among 5396 subjects, MSKD was the most common morbidity (17%), multimorbidity occurred in 755/5396 (14%), 436/755 (61%) of subjects with multimorbidity had an MSKD. For MSKD the odds of WD, LA and UE were 2.06 [95% CI 1.56;2.71], 2.15[1.18;3.91] and 1.35[0.94;1.96], respectively, compared to being employed and the odds of SL in MSKD were 2.29[1.92;2.73]. Mental diseases had a stronger impact on all these outcomes. The odds for adverse work outcomes increased strongly with an increasing number of diseases. When an MSKD was part of multimorbidity, an additional impact on the association with WD and SL was observed. CONCLUSIONS: Multimorbidity has a stronger impact on all work outcomes compared to single chronic diseases. The presence of the MSKD in the context of multimorbidity amplifies the chance of WD or SL.

Time utilisation trends of supported employment services by persons with mental disability in South Africa.

BACKGROUND: This paper reports on the second phase of a two-phased study that was undertaken to determine the feasibility of supported employment (SE) as a strategy with which to facilitate the employment of persons with disability in competitive work contexts. The study population comprised people with mental disabilities receiving SE in the Western Cape Province, South Africa. OBJECTIVE: To describe the components of SE utilised by persons with mental disability (i.e. psychiatric or intellectual disability) in terms of type and time utilisation patterns over 12 months. METHODS: Criterion sampling, a form of purposive sampling, was used to identify 29 study participants - 19 with intellectual disability and 10 with psychiatric disability. Data collection commenced for each participant when a work placement had been identified and preparation for such ensued. Data was collected prospectively for a period of 12 months. SE service components utilised by participants were captured using a data capture sheet that was developed for this purpose. RESULTS: Time utilisation indicated a steep downwards trend for both cohorts. The decrease in utilisation of SE service components over a period of one year was more pronounced in the psychiatric disability (PD) cohort, who utilized almost half the total SE services in the first month. CONCLUSIONS: SE services can be considered as a viable option for return to work in resource-constrained environments. Providers of SE services will need to modify approaches in order to meet contextual realities.

Employment Interventions for Individuals with ASD: The Relative Efficacy of Supported Employment With or Without Prior Project SEARCH Training.

This paper presents findings from a retrospective observational records review study that compares the outcomes associated with implementation of supported employment (SE) with and without prior Project SEARCH with ASD Supports (PS-ASD) on wages earned, time spent in intervention, and job retention. Results suggest that SE resulted in competitive employment for 45 adults with ASD. Twenty-five individuals received prior intervention through PS-ASD while the other 20 individuals received SE only. Individuals in this sample who received PS-ASD required fewer hours of intervention. Additionally, individuals in the PS-ASD group achieved a mean higher wage and had higher retention rates than their peers who received SE only. Further research with a larger sample is needed to confirm these findings.

Supported employment for persons with serious mental illness: current status and future directions.

The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.

The role of community rehabilitation providers in employment for persons with intellectual and developmental disabilities: results of the 2010-2011 National Survey.

Based on the 2010-2011 National Survey of Community Rehabilitation Providers, findings are presented on people with all disabilities and people with intellectual and developmental disabilities (IDD) who are served in employment and nonwork settings by community rehabilitation providers. Findings suggest little change over the past eight years in participation in integrated employment. Overall, 28% of all individuals and 19% of individuals with IDD were reported to receive individual integrated employment services. The results suggest that 15% of individuals with IDD work in individual integrated jobs for pay. Group supported employment continues to play a smaller but significant role in employment supports, with almost 10% of individuals with IDD participating in enclaves or mobile work crews. Data do reflect a decline in participation in facility-based work for individuals with IDD, from 41% to 27.5% and a concurrent growth in participation in nonwork services to 43% of all purchased services.

Work support for persons with mental disabilities in Japan.

OBJECTIVES: The purpose of this paper is to review the methods and the activities of occupational therapists (OTs) in the field of work support for persons with mental disabilities in Japan. METHODS: Necessary information is gathered through review of literatures. RESULTS: Japanese OTs are working in myriad locations across a number of areas in the field of mental disabilities, including medical institutions, self-support facilities, public employment security offices, employment and life support centers for persons with disabilities, public health centers, and vocational rehabilitation centers. Work support has been implemented in each setting, and there is a diverse range of implementations. In discussing work support in Japan, it is important to note that it is still often implemented in a conventional way - that is to say, through a gradual-support methodology, based on the working-readiness model. However, some of the work support initiatives have begun to embrace cutting-edge approaches, such as network-oriented implementation. CONCLUSION: It is necessary for OTs in Japan to implement work support using the most effective means available. Repeating such efforts will drive a paradigm shift facilitating a transition from the outdated working-readiness model, andhelp persons with disabilities to have decent jobs.

Barriers in implementation of evidence-based practice: Supported employment in Swedish context.

PURPOSE: The aim of this paper is to identify initial barriers influencing implementation of supported employment (SE). SE, according to the individual placement and support (IPS) approach, has been recognised as an evidence-based method to help people with severe mental illness to find regular employment. DESIGN/METHODOLOGY/APPROACH: A systematic implementation evaluation of the first randomised controlled SE (IPS) trial in Sweden was conducted in August 2008 and August 2009. Data were collected on a regular basis from SE employment specialists, process heads, clients and representatives from mental health care units and vocational services (social insurance and public employment offices) using interviews, non-participant observations and document analysis. FINDINGS: SE employment specialists reported that existing regulations for social insurance and employment regulations presented major obstacles to implementation. Difficulties were reported in cooperation with handling officers at the vocational services. Scepticism towards persons with mental illness was common and employers expected to receive subsidies if they hired a person with mental illness. SE participants expressed fear of losing their social benefits. ORIGINALITY/VALUE: The results illuminate a collision between an innovative evidence-based practice and the existing systems for social benefits and work rehabilitation.

Supported employment for persons with mental illness: systematic review of the effectiveness of individual placement and support in the UK.

BACKGROUND: High levels of unemployment among persons with mental illness are a significant social disability. The individual placement and support (IPS) model of vocational support has been shown to be effective in establishing persons with mental health problems back into competitive employment in North America. Evidence outside North America is more limited. AIM: To examine the evidence for the effectiveness of the IPS model of supported employment within the United Kingdom. METHODS: Systematic review of studies of the effectiveness of IPS conducted principally in the United Kingdom. RESULTS: The evidence base was small. Overall quality of evidence was fair. There is evidence that interventions with high fidelity to the IPS model increase the proportion of patients engaged in work or education/training over the short- to medium-term (6-18 months follow-up). CONCLUSIONS: More research is needed to improve the evidence base in relation to IPS within a UK context. Evaluation should focus on both the nature and quality of the employment gained, patient and service factors.

Cognitive remediation and vocational rehabilitation.

Persons with severe mental illness (SMI) who are striving to improve their work prospects are often hindered in work endeavors because of difficulties with cognitive skills, such as paying attention or concentrating, learning and remembering information, responding in a reasonable amount of time to environmental demands, and planning ahead and solving problems. In addition to limiting work functioning, cognitive impairments are obstacles to receiving the full benefits of vocational rehabilitation, including supported employment. Efforts to improve cognition in people with SMI, or cognitive remediation, have produced modest but consistent gains in a variety of cognitive domains. More recent efforts have focused on combining cognitive remediation with vocational rehabilitation in order to improve work functioning. Initial results from four published studies of combined cognitive remediation and vocational programs are encouraging, indicating improvements in both cognitive and work functioning. The approaches to cognitive remediation used in these studies vary considerably, as do the characteristics of participants, the vocational rehabilitation models, and the methods of combining cognitive and vocational therapies. The differences in key components of programs combining cognitive remediation and vocational rehabilitation indicate the need to replicate findings, and raise important questions about what aspects of the programs are associated with improvements in work.

The future of supported employment for people with severe mental illness.

This paper reviews current research on innovative attempts to improve the dissemination and effectiveness of supported employment. The domains of active investigation include: (1) organization and financing of services, (2) disability policies, (3) program implementation and quality, (4) motivation, (5) job development, (6) illness-related barriers, (7) job supports, (8) career development, and (9) new populations. Work in each of these areas offers the promise of improving services and outcomes in the near future.

Long-term employment trajectories among participants with severe mental illness in supported employment.

OBJECTIVE: The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment. METHODS: We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods. RESULTS: All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions. CONCLUSIONS: The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective.

OBJECTIVES: A growing number of persons aged 16-65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful. METHOD: The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma. RESULTS: Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6x) or group programmes (3x). They used methods like education (9x), assessment (7x), counselling (5x), training or role playing (5x). The most important outcome measures were employment status (5x), actions to arrange work accommodations (3x), and psychosocial measures like self-efficacy and social competence (3x). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies. CONCLUSIONS: There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is needed.