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.

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.

An assessment of the trainability of beggars and the destitute in Abakaliki Nigeria: implication for policy on their health, vocational rehabilitation and social reintegration.

BACKGROUND: Begging and destitution constitute serious health and social problems in low and middle-income countries (LMICs). OBJECTIVES: The objective of this study was to assess the trainability of beggars and the destitute in Abakaliki Nigeria in order to provide scientific evidence required for the development of a policy on their health, vocational rehabilitation and social reintegration. METHODS: The study was a cross-sectional descriptive survey of 50 purposively selected beggars and destitute persons identified from motor parks, church cathedrals, market places etc. Data was collected using a structured interviewer-administered questionnaire. Analysis was based on mean rating (MNR), median rating (MDR), and range. Interview of each respondent lasted approximately 20 minutes. RESULTS: Of the 50 respondents who participated in this study, 17 (34%) were females. Most subjects were of age category 31-35 years (30%) and 36-40 years (34%). Fifteen (30%) admitted having sight impairment while 17 (34%) admitted that they were physically challenged. The outcome of the trainability assessment showed relatively high mean ratings (MNRs) ranging from 3.42-4.06 on a scale of 5 points. CONCLUSION: The findings of this study clearly suggest that there is a very high potential for the vocational rehabilitation and social reintegration of beggars and the destitute in the study area.

[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.

The role of emotional intelligence in vocational rehabilitation with special respect to physically and cognitively disabled persons.

In the past several years we have done a research about the processes and the actors of workforce rehabilitation in Hungary. We have discovered some strengths and flaws of that processes, and based on that research we would like to see a turning point in the near future. We think that one of the keys of the success in the processes of the rehabilitation of workforce is the attitude of the positive psychology. Based on our researches the emotional competences and psychological immunity have been found to have very important and special roles in the personal side of the rehabilitation process. The attitude of the employers and the society to the rehabilitation is also important based also on the emotional awareness.

Not quite a win-win: the corporate agenda of the stay at work/return to work project.

The idea that efforts are necessary to transform the dominant framework of workplace safety and health in the United States, from one of compensation and disability to one of stay at work/return to work (SAW/RTW) for workers injured or made ill on the job, has become increasingly widespread. SAW/RTW advocates argue that everyone "wins" when unnecessary disability is reduced. Toward this end, advocates have put forward a program and implemented a strategy with strong proponents among a coalition of corporate-connected professionals. The seemingly obvious conclusions of their arguments bear closer critical scrutiny, however. Addressing key questions-why injured workers do not SAW/RTW, who the coalition of SAW/RTW proponents includes, and what the coalition proposes-reveals that the SAW/RTW approach mainly benefits employers and the corporate-connected advocates. These assertions are detailed, and principles of an alternative approach that will serve the needs of injured workers are outlined.

[A supported employment experience in western Switzerland for persons with mental health disorders]. / Une expérience de soutien à l'emploi pour les personnes souffrant de troubles psychiques en Suisse romande.

Access and maintenance of competitive employment represent a challenge for people with mental health problems. Effective methods to support employment attain only a fraction of people who wish to re-enter the labour market. The objective of the article is to describe the development of a service to support competitive employment for mental disorders in collaboration between public psychiatry, disability insurance and social welfare. Three pathways were differentiated according to target populations and to ensure fidelity to effective intervention models: 1) individual placement and support (IPS) for severe psychiatric disorders; 2) progressive rehabilitation for instable situations and 3) critical time clinical case management for untreated mental disorders in employment integration programs.

Vocational rehabilitation program evaluation: comparison group challenges and the role of unmeasured return-to-work expectations.

PURPOSE: Despite the importance and cost of workers' compensation (WC)-based vocational rehabilitation (VR) programs, outcome evaluations are rare, in part due to the scarcity of suitable comparison groups. The aims of this study were to assess (1) the adequacy of a commonly recommended internal comparison group, i.e., workers who were eligible for but did not receive services, and (2) return-to-work (RTW) expectations as a potential source of bias. METHODS: In this prospective cohort study, we used WC claims data and worker-reported RTW expectations to compare workers who received vocational retraining services to eligible workers who did not receive such services. Workers were surveyed after retraining eligibility determination, prior to the initiation of retraining activities. VR progress and RTW wage outcomes were followed for 3 years. The magnitude of confounding contributed by RTW expectations and other covariates was quantified. RESULTS: Workers who were somewhat or very certain they would RTW had significantly better outcomes. RTW expectations played a strong confounding role, reducing the retraining plan effect estimate by about 23 %, while education and physical capacity each changed the effect estimate by <5 %. CONCLUSIONS: RTW expectations predicted long-term RTW outcomes and can play a strong confounding role if unmeasured. We found that the internal comparison group approach, commonly recommended for VR program evaluation, is inappropriate for WC-based VR evaluations. Ultimately, there is no simple solution to the challenge of identifying a comparison group; however, measurement of RTW expectations, an easily-measured multi-dimensional construct, may be a useful addition to the VR evaluation toolbox.

Opening minds in Canada: targeting change.

OBJECTIVE: To summarize the ongoing activities of the Opening Minds (OM) Anti-Stigma Initiative of the Mental Health Commission of Canada regarding the 4 groups targeted (youth, health care providers, media, and workplaces), highlight some of the key methodological challenges, and review lessons learned. METHOD: The approach used by OM is rooted in community development philosophy, with clearly defined target groups, contact-based education as the central organizing element across interventions, and a strong evaluative component so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope. RESULTS: Results have been generally positive. Contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across various target groups and sectors. Variations in program outcomes have contributed to our understanding of active ingredients. CONCLUSIONS: Contact-based education has become a cornerstone of the OM approach to stigma reduction. A story of hope and recovery told by someone who has experienced a mental illness is powerful and engaging, and a critical ingredient in the fight against stigma. Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming. The next challenge will be to scale these up so that they may have a national impact.

Stigma in Canada: results from a rapid response survey.

OBJECTIVE: Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables. METHOD: Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured. RESULTS: Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression. Over one-third of people who had received treatment in the year prior to the survey reported discrimination in 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health. CONCLUSIONS: The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time.

Opening minds in Canada: background and rationale.

OBJECTIVE: To summarize the background and rationale of the approach taken by the Mental Health Commission of Canada's Opening Minds (OM) Anti-Stigma Initiative. METHOD: The approach taken by OM incorporates a grassroots, community development philosophy, has clearly defined target groups, uses contact-based education as the central organizing element across interventions, and has a strong evaluative component, so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope. RESULTS: OM has acted as a catalyst to develop partnerships between community groups who are undertaking anti-stigma work and an interdisciplinary team of academic researchers in 5 universities who are evaluating the results of these programs. CONCLUSIONS: Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming.

Function, health and psychosocial needs in job-seekers with anxiety, mood, and psychotic disorders who access disability employment services.

BACKGROUND: Labour force participation of people with mental disorders varies according to the nature of their disorder. Research that compares function and psychosocial need in job-seekers with different mental disorders, however, is scant especially in the Australian setting. Identifying rehabilitation needs of job-seekers with mental disorders receiving employment services is of interest to providers of disability employment services in Australia. OBJECTIVE: This study sought to identify differences in health, social needs and function in people with anxiety, mood, or psychotic disorders accessing disability employment services to inform disability service providers of vocational rehabilitation interventions. PARTICIPANTS: 106 adult job-seekers with anxiety (29%), mood (51%), and psychotic (20%) disorders receiving job placement services from a disability employment service provider consented to participate in this study. METHODS: Self-report measures and the Executive Interview (EXIT) were used to document function. Differences between disorders were determined using one-way analysis of variance. RESULTS: Significantly better estimates of social functioning as measured by the Behaviour and Symptom Identification Scale (BASIS-32) were reported by job-seekers with psychotic disorders compared to those with anxiety or mood disorders. However, job-seekers with psychotic disorders reported longer periods of unemployment compared to those with mood disorders and longer estimates of the time it would take to obtain work compared to both the other groups. CONCLUSIONS: Perceived psychosocial problems, such as poor social function in job-seekers with anxiety and mood disorders and perceptions of poor employability in those with psychotic disorders, should be considered when developing vocational rehabilitation interventions, or where additional support may be required once employment is obtained.

[Sequelae of severe injuries : consequences for trauma rehabilitation]. / Unfallfolgen nach schweren Verletzungen : Konsequenzen für die Trauma-Rehabilitation.

Consequences of accidents are found not only in physical but also in psychological and social areas. The quality of life of severely injured patients is significantly reduced compared with the normal population even years after the trauma. Subjective experiences of severely injured patients during and after hospitalization have a major impact on the subsequent quality of life. Knowledge of these factors is essential for the planning, organization and implementation of rehabilitation after severe injury. The phase model of rehabilitation after trauma requires early initiation of therapy even during acute treatment as so-called early rehabilitation. After a specialized post-acute rehabilitation additional therapeutic options are often required. Besides pain management the focus lies especially in work-related rehabilitation and psychological support which is also decisive for the success of rehabilitation of accident victims. For severely injured patients it is important to provide sufficient support, e.g. through a case manager which does not end with discharge from the rehabilitation facility. The aim of all efforts is reintegration into the working and social environment and the best possible quality of life.

The association between self-reported mental health status and alcohol and drug abstinence 5 years post-assessment for an addiction disorder in U.S. and Swedish samples.

This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally.

[Vocational rehabilitation after total laryngectomy]. / Berufliche Rehabilitation nach Laryngektomie.

BACKGROUND: Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation. PATIENTS AND METHODS: Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6). RESULTS: Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues. CONCLUSION: Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.

Oficina integrada de geração de trabalho e renda: estratégia para formação de empreendimento econômico solidário / Integrated workshop of work and income generation: strategy for the formation of solidarity economicalenterprises

A oficina integrada de geração de trabalho e renda foi composta por usuários de serviços da saúde mental e outros moradores residentes no território-alvo de um projeto realizado pela Incubadora Regional de Cooperativas Populares da UFSCar(INCOOP/UFSCar) que visava o desenvolvimento territorial de bairros periféricos no âmbito da economia solidária (ES). O estudo teve como objetivo conhecer as percepções das participantes da oficina sobre esta como estratégia para a formação de um empreendimento econômico solidário e compreender o que foi determinante para elas aceitarem trabalhar de acordo com os princípios da ES. Trata-se de um estudo de abordagem qualitativa. Para a coleta de dados utilizou-se entrevistas semiestruturadas que foram aplicadas com todas as participantes da oficina que permaneceram durante todo o trabalho, totalizando cinco pessoas. Os resultados apontam que a oficina propiciou o encaminhamento e a orientação das participantes e mostrou-se como espaço de inclusão de usuários da saúde mental. Dentre os motivos que levaram as participantes a permanecerem na oficina destaca-se a autogestão. Acredita-se que estudos desenvolvidos nesta direção possam fornecer subsídios para a elaboração de políticas públicas que fomentem tecnologias sociais que visem a inclusão social das pessoas em situação de desvantagem social.

The Integrated workshop of work and income generation was composed of users of mental health services and other residents living in the territory target of a project conducted by the Regional Incubator of Popular Cooperatives UFSCar (INCOOP / UFSCar). The study aimed to understand the perceptions of the participants of this workshop as a strategy for formation of solidary economical enterprise and understand what was important for them to accept work according to the principles of solidarity economy. This is a qualitative approach. For the data collection we used semi-structured interviews that were applied to all the participants of the workshop that remained throughout the work, totaling five people. The results indicate that the workshop provided the directing and the guidance of participants and showed as a space to inclusion of users of mental health. Among the reasonsthat led the participants to remain in the workshop highlights the self-management. It is believed that studies carried out in this direction can aid in the development of public policies that foster social technologies aimed at social inclusion of people who aresocial disadvantaged.

The association between labour force participation and being in income poverty amongst those with mental health problems.

OBJECTIVES: Mental health conditions are associated with lower standards of living. This study quantifies the relationship between employment, depression and other mental health conditions and being in income poverty. METHODS: Cross-sectional analysis was undertaken using the 2003 Survey of Disability, Ageing and Carers data for Australians aged 45-64 years. RESULTS: Those not in the labour force due to depression and other mental health conditions are significantly more likely (odds ratio (OR) 12.53, 95% CI: 12.20-12.86, p < 0.0001; OR 20.10, 95% CI: 19.67-20.54, p < 0.0001) to be in income poverty than those not in the labour force with no chronic health condition. Amongst those with depression and other mental health conditions, those who were in employment were significantly less likely to be in income poverty than those who have had to retire because of the condition. CONCLUSION: Due to the association between leaving the workforce due to mental health problems and poverty status, efforts to increase the employment of individuals with mental health conditions, or prevent the onset of the conditions, will likely improve living standards.