From Blue to Green: The Development and Implementation of a Therapeutic Horticulture Program for Residents of a Battered Women's Shelter.

The delivery of therapeutic services to clients is influenced by service providers' understanding of the "fit" of a specific program with their service mandate as well as their perceptions of the potential benefits of the program. This article discusses the development and implementation of a therapeutic horticulture (TH) program at a battered women's shelter that serves 17 counties in Central Kentucky. Through semistructured interviews, we gauge the shelter staff's perceptions of the relationship of the TH program to the shelter's overall mission; their sense of the program's benefits for residents, for the shelter as a community organization, and for themselves; and their concerns about the TH program. We consider how these findings may impact future programming at the shelter, and we discuss plans for further evaluation of the TH program in terms of its impact on shelter residents' long-term outcomes.

[Two "hybrid" vocational services for people with a severe mental illness in France and Quebec]. / Deux structures d'insertion professionnelle de format hybride pour personnes avec un trouble mental : les ESAT de transition de Messidor (France) et Accès-Cible SMT (Québec).

Many different types of vocational programs (services) exist to help people with severe mental disorders (e.g., schizophrenia) integrate the regular labor market: sheltered workshops, social enterprises, and supported employment programs to name a few. Each type of vocational services has its specificities: on one hand, some of them are following the "train and place" approach. For example, sheltered workshops offer to people with a severe mental illness a training during a long period of, with a small proportion obtaining competitive employment. On the other hand, other programs adopt the "place and train" philosophy, such as supported employment programs, in which employment specialists help people obtain a competitive job as fast as possible with no requested training. This article presents two original vocational services, the Messidor's sheltered workshops in France and the Accès-Cible SMT supported employment program in Quebec, following an "hybrid" approach including both philosophies "place and train" and "train and place". More particularly, they are both aiming at competitive employment on the regular labor market for people with a severe mental illness, with a different length of training. Messidor consists of a sheltered workplace for people with a severe mental illness in France, using this time of transition in the workshops as a tool to obtain a competitive job. Thanks to three key factors, Messidor succeeds in placing many of their workers in the French regular labor market: (1) Workers with severe mental disorders work on tasks and workplaces similar to those in regular labor market; (2) Messidor's managers have small teams (5-7 persons) that offer a nearby and personalized management to workers; (3) Each worker is followed by a Messidor's employment counsellor, to build together a working plan and put in place work strategies to obtain a competitive job. This "double management" seems to be a key ingredient of this support as it promotes some success in getting a job as well as in developing some recovery effects. Accès-Cible SMT located in Montreal (Quebec, Canada) is also an interesting "hybrid" program since people with severe mental disorders can be supported by a counsellor, with a short period of training (a 28-week program with 6 steps) before integrating the regular labor market. The philosophy of Accès-Cible SMT is to consider their clients as normal persons more than as patients, and its objective is mainly to restore confidence and self-esteem of the person by putting emphasis on their professional skills. Meetings in groups, practicums in the workplace, and the utilization of job search strategies are essential ingredients of Accès-Cible SMT, which are also efficient tools to develop a better empowerment of the person. Indeed, the common ingredients/elements of these two vocational services, Messidor and Accès-Cible SMT, seem to be the development of empowerment for people with severe mental disorders. The scientific literature supports that empowerment is one of the key factors of recovery for people with a mental illness, a recovery process that can be illustrated by their work integration in the regular labor market as a final goal.

[Reform steps toward networking sheltered workshops and the general labour market]. / Reformschritte zur Vernetzung von Werkstätten für behinderte Menschen und allgemeinem Arbeitsmarkt.

Only 0.16% of disabled employees are enabled to change from sheltered workshops to the general labour market. At the same time the number of disabled employees in sheltered workshops is increasing more than anticipated. Investigations into the growing admissions to sheltered workshops resulted in recommendations to improve the practice of change over. More and more admissions of students having finished special schools could be reduced by improved cooperation between special schools and the local employment market. Special schools should offer suitable job trainings and support students to develop an understanding of the requirements of specific jobs and of their opportunities to develop their skills to do these jobs. In 2009, supported employment has been regulated in social security law, lasting up to three years and aimed at qualifying disabled youngsters for employment in the general labour market instead of entering sheltered workshops. The majority of admissions to sheltered workshops in the meantime concern people with psychological handicaps, with more than 30% however leaving the workshops later on. For this population, "virtual sheltered workshops" are offering more suitable means for reintegration in the general labour market, such as temporary employment in the general labour market or in occupations with small earnings. The personal budget for work is meant to be a model project within the German Länder, to transfer personal support from the sheltered workshop into the general labour market. The conference of German Länder Ministers of Social Affairs has been active since 2007 to develop a concept for reform of the social security law concerning integration assistance for disabled people, which in future is to concentrate on individual needs, removal of obstacles in the law to facilitate the transition from sheltered workshops into the general labour market. The "Deutsche Verein für öffentliche und private Fürsorge" (German association for public and private welfare) has contributed valuable suggestions to the reform debate, all of which should be realized by the German Government during the seventeenth legislative period.

The Flower Workshop in psychosocial rehabilitation: a pilot study.

We report a pilot study with the Flower Workshop, a new modality of psychosocial rehabilitation group activity. Cognitive performance in schizophrenia and other mental conditions can be impaired depending on the tasks to be executed and their respective social context. The vulnerability of these individuals can be reduced by means of cognitive and socio-affective facilitation. We conducted a pilot study to introduce the Flower Workshop in a public Mental Health Service in the city of Ribeirão Preto (São Paulo-Brasil) with 12 participants during 18 months (2002-2003). With cognitive and socio-affective facilitation, participants were able to construct vases and make flower arrangements successfully.

Differences in subjective quality of life of people with a schizophrenia diagnosis between participants in Occupational Therapy Workshops and those working in a Sheltered Employment Establishment. / Róznice w subiektywnej jakosci zycia osób z diagnoza schizofrenii pomiedzy uczestnikami Warsztatów Terapii Zajeciowej a osobami pracujacymi w Zakladzie Pracy Chronionej.

OBJECTIVES: The research objective was to compare the course of illness among patients with schizophrenia undergoing rehabilitation in Occupational Therapy Workshops (OTW) or employed in the Vocational Development Center "Pensjonat u Pana Cogito" (VDC), with particular focus on quality of life (QoL), and to analyse the relations between QoL and general, social, and cognitive functioning, psychopathological condition and insight in the two groups. METHODS: The sample comprised 52 subjects (VDC = 25 and OT = 27). The following tools were used: the LQoLP (for quality of life assessment) by Oliver, the PANSS, GAF, and SOFAS scales, the MoCA, RAVLT and RHLB cognitive tests, and the insight questionnaire "My thoughts and feelings". RESULTS: Differences were found between the groups, to the VDC group's advantage, in such areas of subjective QoL as: family relationships (p . 0.05), somatic health (p . 0.05) and selfesteem (p . 0.05). In the VDC group, QoL correlated negatively with symptoms of distress and positively with overall insight into symptoms, while in the OTW group it correlated negatively with cognitive function and positively with insight as a reaction to information from others. CONCLUSIONS: For people with schizophrenia obtaining and retaining employment in a VDC translates into better outcomes in important areas of quality of life such as family relationships, overall health, and self-esteem. Poorer QoL was associated with the severity of symptoms, in particular depressive symptoms. People employed in the VDC benefited to a greater extent from autonomous control of symptoms, while among the OTW group an important role was played by others.

Employment support agencies in the UK: current operation and future development needs.

Disabled people are amongst the most excluded in society, while people with learning disability have the lowest rates of employment. Supported employment promises to address the gaps, but it is a new approach, one whose development has been incremental. The present authors explore some of the features of agencies providing employment support to disabled people, together with their managers' views. This paper describes semistructured telephone interviews with the managers of 31 employment support agencies. The survey sought to understand the types of service provided, the staff and caseload numbers, the training offered, and the targets used. The authors also asked the managers what would help them in delivering employment opportunities to disabled people. The responses of the managers highlight gaps between current policy and practice. Particular attention is given to the use of targets, fragmented funding and what managers consider is required to improve employment opportunities for disabled people. Managers endorsed the vision expressed in current policy, and identified numerous obstacles to its implementation in employment support. Taken together, their views can be used to guide the development of supported employment.

Hospital-based industrial therapy units and the people who work within them - an Irish case analysis using a soft-systems approach.

Occupational training and employment is seen as a central concern in the delivery of community-orientated mental health services aimed at enhancing the quality of life of people with enduring mental illness. A range of schemes from sheltered to open employment now operates in a number of countries, with a concomitant growth of interest in their evaluation. At the same time, hospital-based workshops, often referred to as industrial therapy units (ITUs), have steadily declined because they are seen as outdated and less efficacious compared with community-located training and employment. However, whether the total disappearance of the traditional ITU is a positive development may be open to question. This paper reports on a study of five mental health hospital-based sheltered workshops located in one Health Board area in Ireland, which catered for the needs of people with enduring mental health problems. Utilizing a soft-systems methodological approach, it examined their role and significance to 'users' who spent occupational time in them, the staff who worked in them and the clinicians who referred users to them.

Work activity in the process of recovery - an interpretive phenomenological analysis of the experiences of people with a schizophrenia spectrum diagnosis. / Aktywnosc zawodowa w procesie zdrowienia ­ interpretacyjna analiza fenomenologiczna doswiadczen pacjentów ze spektrum schizofrenii.

OBJECTIVES: Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. METHODS: Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). RESULTS: Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. G oing to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget. CONCLUSIONS: This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.

A case report of the conversion of sheltered employment to evidence-based supported employment in Canada.

This case report describes the transformation of a sheltered workshop program to a program that provides evidence-based supported employment services in partnership with five community treatment teams. Over a 15-year period, a Canadian nonprofit agency that provides employment services for persons with severe mental illness made a series of programmatic changes to increase the effectiveness of the services. The agency initially modified its facility-based sheltered workshop to include a prevocationally oriented work preparation program, later added brokered supported employment services, and finally completely transformed its organization by relocating its vocational rehabilitation counselors to five community mental health teams, in order to implement an evidence-based supported employment program that is based on the individual placement and support model. During the initial period in which the sheltered employment program was utilized, less than 5 percent of clients who were unemployed when they entered the workshop achieved competitive employment annually. The annual competitive employment rate did not increase during the prevocational phase; it increased during the brokered supported employment phase but did not exceed 25 percent. By contrast, after shifting to evidence-based supported employment, 84 (50 percent) of 168 unemployed clients who received between six and 27 months of individual placement and support services achieved competitive employment. This article also documents the role of agency planning and commitment quality improvement in implementing change.

Supported employment and job outcomes. Typicalness and other related variables.

The purpose of this study is to improve supported employment programs analyzing the relationships between different variables involved in its development on job outcomes. One important variable is typicalness (understood as the degree to which the job of the person with a disability is similar in its different characteristics to that of co-workers without a disability). It also compares sheltered employment and supported employment in employment outcomes. The results showed more length of service in the job and salary for supported employment workers. As regards the developmental variables, time of external support, type of support, and adaptations are critical to get better outcomes. Finally, the need to finely balance the typicalness of the job and the characteristics of the worker involved is stressed.

The Learning of Difficult Visual Discriminations by the Moderately and Severely Retarded.

A procedure to effectively and efficiently train moderately and severely retarded individuals to make fine visual discriminations is described. Results suggest that expectancies for such individuals are in need of examination. Implications for sheltered workshops, work activity centers and classrooms are discussed.

Production-orientated education and training of the mentally disabled in sheltered employment (PIONIER).

PURPOSE: The development and realization of a production-orientated education and training system for mentally disabled people in sheltered employment in the course of the project PIONIER. It focuses on the metal and electronic branches of a workshop with a mentally disabled workforce in Alsdorf, Germany. METHODS: For the development of the modules an assessment tool called MELBA was used to determine the abilities of the disabled people and the requirements of the tasks. Methods for the collection of this information was: observation, questionnaires and documents. RESULTS: Three months after the introduction of educational measures the improvements of the capacity for learning and education of disabled persons was visible. In the same way the development of their self-reliance and social abilities was recorded. The metal working branch was capable of fulfilling every task with respect to quality issues and within set delivery times. The electro working branch was accomplished enough to create new workplaces and to get orders from the computer industry. CONCLUSIONS: By the use of a qualification system like PIONIER the tasks of the disabled employees have been enlarged and enriched. In order to cope with the increase competition sheltered workshops have to realize new ways of vocational training for mentally disabled employees.

Proving the effectiveness of community programs in jeopardy: the role of formative evaluation.

Today's health care programs are being scrutinized like never before and yet few clinicians and managers know how to show the value of programs without time-consuming outcomes research. This is especially true for new and innovative programs that are dependent on outside funding and may not have enough time to show an effect. However, even well established programs usually lack a clear operational model (clear aim, well defined target population, objectives, performance measures) and well-defined theory (plausible link between activities and desired outcomes). This article proposes a methodology to assure that programs have all the components needed to assure success.

Transforming sheltered workshops into affirmative businesses: an outcome evaluation.

This paper examines the outcomes associated with Voices, Opportunities and Choices Employment Club (VOCEC), which used the resources of a sheltered workshop to evolve affirmative businesses for people receiving mental health services. Quantitative and qualitative methodologies were used to understand the impact of VOCEC on employment and well-being outcomes compared to the former sheltered workshops and to competitive work. The results suggest that VOCEC has been successful in creating paid employment opportunities at levels approximating minimum wage and establishing a structure to incubate new businesses. The evaluation revealed the process by which Associates experience their participation as rewarding. It also indicated constraints on participation within the VOCEC model.

Vocational and social learning of people with severe disabilities in sheltered employment.

In addition to prevocational centres for young people with disabilities about to enter the labour market and vocational training centres for older persons, the Federal Republic of Germany provides a network of sheltered workshops for those who are unable or unlikely to work under competitive conditions. This paper describes the programme for persons in the latter category, based on applications of learning theory, provided at the sheltered workshop in Detmold, Westphalia. It also reports various steps which have been taken to evaluate and refine the two-fold approach to training developed at this centre, based on job analysis and detailed appraisal of workers' social and psychological characteristics, and to apply that approach to persons with a wider range of disabilities.

The organization of vocational rehabilitation: the structure of success.

Focusing on vocational rehabilitation goals provides an understanding of the underlying structural and behavioural factors affecting successful employment outcomes. Two types of vocational centres having contrasting rehabilitation employment orientations are examined. Both types have similar end goals but organizational structures shaping divergent means toward the gainful employment of disabled persons. Utilizing a split sample of 14 vocational rehabilitation programmes in Israel, 7 sheltered and 7 supported programmes, a structured questionnaire of key administrative personnel and employees was generated. Success was based on six consensus measures. Clear differences between administrative, organizational and programme goals emerge, which affect goal priority and source of success measurement. Employing regression models, three keys to success are detected which stress the interplay between internal and external organization reference criteria in affecting success attainment. The results suggest that the organization of vocational rehabilitation has a direct impact on rehabilitation success.

Voices, Opportunities & Choices Employment Club: transforming sheltered workshops using an affirmative business approach. The VOCEC Board of Directors.

Voices, Opportunities & Choices Employment Club (VOCEC) is a non-profit "umbrella" corporation that facilitates the development of affirmative businesses to create jobs for consumers of mental health services. To date, 5 independent businesses have been developed by transforming the resources of sheltered workshops within Kingston Psychiatric Hospital and 2 businesses have been established in collaboration with a local public library. This paper provides a description of VOCEC, including an overview of the affirmative business approach, the structure of the organization, and the process of business development. Personal reflections provide insights into the experiences of consumers, staff, and Board members associated with the corporation.

Mental health recovery on care farms and day centres: a qualitative comparative study of users' perspectives.

PURPOSE: Mental health services increasingly incorporate the vision of recovery. This qualitative study analysed and compared experiences of recovery on prevocational services, in order to assess if users make progress towards recovery, relative to a staged recovery model. METHOD: Data were collected through semi-structured interviews with participants on care farms (n = 14), work (n = 7) and creative projects (n = 5). RESULTS: The transition from past to current lives was described as a progressive, non-linear process, with different stages guided by different goals. Participants on creative projects lacked clear goals, presented less interest in peers and high need for emotional support. Participants on work projects aimed for occupational rehabilitation, but struggled with the patient culture of the peer community. Participants on care farms aimed for daytime occupations and closer contact with society. They experienced care farms as open, real-life work settings where they could exercise responsibility and connect with people. CONCLUSIONS: Participants progressed towards recovery, as care farms, work- and creative projects empowered them to leave behind inactive, isolated or disorganized living. In day centres, users focused on self-reflection and personal development (creative projects) or on occupational performance (work projects), whereas on care farms, users fulfilled worker roles in a real-life, open community environment. IMPLICATIONS FOR REHABILITATION: Organized as open communities in real-life settings, care farms facilitate the reflection on personal and social responsibility, and therefore have the potential to help users internalize worker identities and improve their motivation to progress towards recovery. Supervisors on care farms are regarded by users as close contacts within the social networks they develop on the service, a position that allows supervisors to actively engage and promote users' progress towards recovery. Elements of the farm environment (such as the "normal life", presence of family members and visitors, and nature) can serve as anchors for supporting the progress towards recovery.

Excusable deficiency: staff perceptions of mothering at shelters for abused women.

This study examined how staff members in shelters for abused women perceive the women's mothering and the challenges when working with these mothers. Data were collected through focus group interviews with 30 workers at Israeli shelters for abused women. Findings revealed that workers typically held a "deficit perspective" when describing the residents' mothering skills. Most seemed committed to the notion of empowerment as a guiding framework for intervention with the women and made an effort to facilitate the women's choices and autonomy in spite of the obstacles. The study examined workers' perceptions from personal, professional, and sociocultural perspectives.