RESUMO
OBJECTIVE: This study examined the relationship between individual placement and support (IPS) employment specialists' time spent in the community and employment outcomes in the current digital age, featuring increased technology use and online hiring practices. METHODS: The authors examined the relationship between employment outcomes and IPS employment specialists' time spent in the community at 78 sites in 2018 and 84 sites in 2019. RESULTS: The amount of time staff spent in the community was significantly and positively associated with better employment outcomes. CONCLUSIONS: These data support the continued importance of employment specialists' spending time in the community with employers and IPS recipients to achieve optimal outcomes for recipients.
Assuntos
Readaptação ao Emprego , Transtornos Mentais , Humanos , Reabilitação VocacionalRESUMO
The COVID-19 pandemic has had an enormous impact on the provision of behavioral health care services across the United States. This column examines this impact within the context of New York State's supported employment initiative, which involved 89 implementation sites before the start of the pandemic. The pandemic caused changes to the training and implementation supports provided, the number of sites providing these services, and the ways in which sites provided supported employment services. Although mean self-assessed implementation fidelity decreased modestly, employment outcomes that dipped early in the pandemic rebounded quickly to prepandemic levels.
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COVID-19 , Readaptação ao Emprego , COVID-19/prevenção & controle , Humanos , Casamento , Pandemias/prevenção & controle , Reabilitação Vocacional , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: A growing body of literature demonstrates that high-fidelity implementation of the individual placement and support (IPS) model of supported employment increases the chances of achieving desired outcomes. This study examined the relationship between IPS fidelity, as self-reported by program sites, and employment outcomes and determined whether this relationship was maintained over time. METHODS: A total of 78 outpatient programs in New York State provided data on self-reported IPS fidelity and employment outcomes. Pearson correlations were used to determine the relationship between fidelity scores and competitive employment rates. A mixed-effects model examined the relationship between repeated fidelity and employment measures over time. RESULTS: A significant positive relationship was found between better self-reported IPS fidelity and greater employment. The relationship between IPS fidelity and employment was sustained over time (up to one year). CONCLUSIONS: Higher-fidelity implementation of the IPS model, as self-assessed by program sites, was associated with higher employment rates, which were sustained over time.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Readaptação ao Emprego/estatística & dados numéricos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Adulto , Humanos , Ciência da Implementação , New YorkRESUMO
OBJECTIVE: Fidelity assessments help ensure that evidence-based practices are implemented properly. Although assessments are typically conducted by independent raters, some programs have implemented self-assessments because of resource constraints. Self-assessments were compared with independent assessments of programs implementing individual placement and support supported employment. METHODS: Eleven community-based outpatient programs in New York State completed both self- and independent assessments. Intraclass correlation coefficients and paired t tests were used to compare scores from self- and independent assessments. RESULTS: For both assessment methods, mean scores for all programs were within the range of fair fidelity. Self- and independent assessment total scores were not significantly different; however, significant differences were found on some scale items in this small sample. CONCLUSIONS: Self-assessment may be valid for examining a program's overall functioning and useful when resource constraints prevent independent assessment. Independent assessors may be able to identify nuances, particularly on individual assessment items, that can point to areas for program improvement.
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Assistência Ambulatorial/normas , Readaptação ao Emprego/normas , Prática Clínica Baseada em Evidências/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Avaliação de Programas e Projetos de Saúde/normas , Humanos , New YorkRESUMO
This column focuses on use of learning collaboratives by the Center for Practice Innovations to help programs implement the evidence-based individual placement and support model of supported employment in New York State. These learning collaboratives use fidelity and performance indicator data to drive the development of program-specific individualized quality improvement plans. As of 2014, 59 (69%) of 86 eligible programs have joined the initiative. Programs are achieving employment outcomes for consumers on par with national benchmarks, along with improved fidelity.
Assuntos
Readaptação ao Emprego/métodos , Prática Clínica Baseada em Evidências/métodos , Serviços de Saúde Mental/organização & administração , Desenvolvimento de Programas/métodos , Governo Estadual , Comportamento Cooperativo , Humanos , New YorkRESUMO
UNLABELLED: During inflammation, immune cells migrate into inflamed tissue and release opioid peptides that activate opioid receptors on peripheral sensory neurons to reduce pain. A characteristic of the inflamed environment in which these opioids act is acidic pH. Activation of opioid receptors leads to a decrease in the calcium component of neuronal action potentials. We investigated the hypothesis that inhibitory effects of opioids on intracellular calcium transients in dorsal root ganglion neuronal cultures are potentiated at acidic extracellular pH. Intracellular calcium responses to stimulation with capsaicin were measured in untreated neurons or after preincubation with beta-endorphin or morphine. beta-Endorphin significantly inhibited calcium responses to 300 nmol/L capsaicin at the lowest experimental extracellular pH (6.1, 6.5, and 7.2), whereas morphine inhibited capsaicin (300 nmol/L) responses significantly at pH 6.1 with a trend of inhibition at pH 6.5. The effect of pH on morphine inhibition of K+ -evoked calcium responses was also assessed. Morphine inhibition of calcium responses was significantly enhanced at pH 6.8 compared with pH 7.2 and pH 7.6. The inhibitory effects were reversed by naloxone, an opioid receptor antagonist. In conclusion, low extracellular pH potentiated beta-endorphin and morphine inhibition of calcium transients and might contribute to improved opioid efficacy during inflammation. PERSPECTIVE: The results of the current study suggest that acidic pH might contribute to increased opioid efficacy in inflamed tissue. This highlights the therapeutic potential of endogenous opioid analgesia, whereby opioid peptides are delivered locally in inflamed tissues, as well as the use of locally applied opioids in inflammatory conditions.