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1.
Work ; 69(4): 1305-1316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34366312

RESUMO

BACKGROUND: Evidence-based services in vocational rehabilitation call for valid and reliable assessments of work performance for intervention planning and safe return to work for individuals with illness or injuries. Assessments that are easy to use, culturally adapted, and in a language professionals and clients understand is important for their utility. Translation and adaption of assessments to new languages and cultures are of importance to maintain high standards of assessments and the quality of services in the vocational rehabilitation setting. OBJECTIVE: The aim of this study was to translate and adapt the Assessment of Work Performance (AWP), into the Icelandic language and culture. Furthermore, to investigate the content validity and utility of the evaluation instrument. METHODS: The study was conducted in two phases. The first phase, based on the Dual-Panel translation method, included two expert panels performing translation and cultural adaption of the original Swedish AWP. In the second phase field testing of the translated instrument was followed by an online survey among vocational rehabilitation professionals for content validation and utility. RESULTS: The results of the study showed satisfactory opinions from experienced professionals toward the content validity, translation, cultural adaption, and utility of the Icelandic version of the AWP. CONCLUSIONS: The study indicates that the Dual-Panel translation method is a valid method when translating instruments from one language and culture to another. Furthermore, the results of the study imply that the AWP can be regarded as content valid up to an acceptable degree for implementation in vocational rehabilitation services in Iceland.


Assuntos
Idioma , Desempenho Profissional , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Tradução , Traduções
2.
BMC Psychiatry ; 21(1): 384, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344327

RESUMO

BACKGROUND: There is an evident discrepancy between need and provision of evidence-based return-to-work (RTW) interventions in existing mental health services. Online dissemination of evidence-based interventions is presumed to reduce this gap. However, there is almost no knowledge available on perceived acceptability of digital RTW interventions among service users, which are factors that might influence the development and implementation of future interventions. The aim of this study was to develop knowledge of service user acceptability of mWorks, a proposed digital RTW solution. METHODS: Participants (n = 18) with experience of common mental disorder and sick leave were recruited with a purposive snowball sampling method. Semi-structured interviews (n = 12) and one focus group interview (n = 6) were conducted. A deductive thematic analysis was performed according to the Theoretical Framework of Acceptability. RESULTS: Digital RTW interventions were perceived as acceptable and aligned with participant value. Participants expressed positive attitudes toward having access to support, regardless of time and place. A certain ambiguity between a decline in social interactions and opportunities to RTW in a safe space was reported. Participants were confident in their ability to use digital RTW solutions, but reported the need to reduce stressful elements of using smartphones. Overly demanding digital solutions, i.e. ones requiring high cognitive effort, were described as burdensome. CONCLUSIONS: For digital RTW solutions to be acceptable, they need to complement traditional services by providing accessible and person-centred support throughout the RTW process. They should be designed to reduce the need for cognitive effort. Future research should explore how to balance user autonomy with other support components in digital interventions.


Assuntos
Transtornos Mentais , Retorno ao Trabalho , Grupos Focais , Humanos , Transtornos Mentais/terapia , Pesquisa Qualitativa , Licença Médica
3.
Work ; 69(3): 1053-1061, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34219698

RESUMO

BACKGROUND: Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. OBJECTIVE: To evaluate the impact of SEAM on rehabilitation professionals' knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. METHODS: In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. RESULTS: SEAM significantly increased rehabilitation professionals' knowledge of mental health (T1-T2: z = -2.037, p = 0.042; T2-T3: z = -5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50-60%) also estimated that they had increased their use of supporting strategies towards service users and employers. CONCLUSIONS: The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users' resources and work ability, as well as on employers' support needs.


Assuntos
Letramento em Saúde , Humanos , Estudos Longitudinais , Saúde Mental , Reabilitação Vocacional , Retorno ao Trabalho
4.
Psychiatr Serv ; 72(9): 1040-1047, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33940948

RESUMO

OBJECTIVE: The objective of this review was to assess associations between Individual Placement and Support (IPS), employment, and personal and clinical recovery among persons with severe mental illness at 18-month follow-up. METHODS: A systematic literature search identified randomized controlled trials (RCTs) comparing IPS with services as usual. Outcomes were self-esteem, empowerment, quality of life, symptoms of depression, negative or psychotic symptoms, anxiety, and level of functioning. A total of six RCTs reported data suitable for meta-analyses, and pooled original data from five studies were also analyzed. RESULTS: Meta-analyses and analyses of pooled original data indicated that receipt of the IPS intervention alone did not improve any of the recovery outcomes. Participants who worked during the study period, whether or not they were IPS participants, experienced improved negative symptoms, compared with those who did not work (standardized mean difference [SMD]=-0.41, 95% confidence interval [CI]=-0.56, -0.26). For participants who worked, whether or not they were IPS participants, improvements were also found in level of functioning and quality of life (SMD=0.59, 95% CI=0.42, 0.77 and SMD=0.34, 95% CI=0.14, 0.54, respectively). CONCLUSIONS: Employment was associated with improvements in negative symptoms, level of functioning, and quality of life.

5.
J Occup Rehabil ; 2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661452

RESUMO

PURPOSE: To investigate the effect of Individual Placement and Support (IPS) according to diagnoses of schizophrenia, bipolar disorder, major depression, substance use disorders, or forensic psychiatric conditions. METHODS: A systematic search of the literature was conducted in June 2017 and repeated in December 2020. The systematic review included 13 studies. Analyses of pooled original data were based on the six studies providing data (n = 1594). No studies on forensic psychiatric conditions were eligible. Hours and weeks worked were analyzed using linear regression. Employment, and time to employment was analyzed using logistic regression, and cox-regression, respectively. RESULTS: The effects on hours and weeks in employment after 18 months were comparable for participants with schizophrenia, and bipolar disorder but only statistically significant for participants with schizophrenia compared to services as usual (SAU) (EMD 109.1 h (95% CI 60.5-157.7), 6.1 weeks (95% CI 3.9-8.4)). The effect was also significant for participants with any drug use disorder (121.2 h (95% CI 23.6-218.7), 6.8 weeks (95% CI 1.8-11.8)). Participants with schizophrenia, bipolar disorder, and any drug use disorder had higher odds of being competitively employed (OR 2.1 (95% CI 1.6-2.7); 2.4 (95% CI 1.3-4.4); 3.0 (95% CI 1.5-5.8)) and returned to work faster than SAU (HR 2.1 (95% CI 1.6-2.6); 1.8 (95% CI 1.1-3.1); 3.0 (95% CI 1.6-5.7)). No statistically significant effects were found regarding depression. CONCLUSIONS: IPS was effective regarding schizophrenia, bipolar disorder, and substance use disorder; however, the effect on hours, and weeks worked was not statistically significant regarding bipolar disorder. For people with depression the impact of IPS remains inconclusive. Non-significant results may be due to lack of power. TRIAL REGISTRATION: PROSPERO protocol nr. CRD42017060524.

6.
BMC Psychiatry ; 20(1): 508, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059664

RESUMO

BACKGROUND: People with severe mental illness (SMI) living in supported housing (SH) struggle in everyday life and we currently lack a comprehensive body of knowledge concerning how the residents experience their day. This paper aimed to gain knowledge about how people with SMI describe a day in SH in Sweden, in particular the activities they most frequently engage in and how they experience what they do in or outside their home. Furthermore, it is important to gain knowledge of which activities motivate residents to leave the housing facility and to participate in the community. This new knowledge can help staff to encourage a recovery process among the residents. METHODS: One hundred thirty-three people living in SH completed a time-use diary and a mixed-methods approach was applied, including calculations of what activity that was most frequently performed and a manifest content analysis addressing experiences of activity. RESULTS: The residents had a low activity level and were often alone. Approximately one-half of the reported activities were performed in their own apartments, and generally unaccompanied. A quarter of the activities were performed in the common areas and a further quarter outside the SH. The most frequently performed activities were quiet and tranquil ones, e.g. listening to music and resting. Doing errands and group activities with staff and residents were the main activities that motivated leaving the facility. The participant experience of a day is presented in three categories: "Experiences of chosen and enforced togetherness and overcoming loneliness", "Environmental change and emotional balance can generate activity", and "Met and unmet needs for support, friendship and security". CONCLUSIONS: The residents were generally satisfied with their quiet and tranquil lifestyle and appeared to demand little of life, which may relate to previous experiences of institutional life and can constitute a challenge for staff. The findings highlight experiences that can help to improve SH. Services need to support individually adjusted contextual stimuli and individualize the support to help residents find a good balance and motivate them to be active in and outside SH, which can support a recovery process.


Assuntos
Habitação , Transtornos Mentais , Humanos , Solidão , Satisfação Pessoal , Suécia
7.
Nurs Open ; 7(6): 1755-1765, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33072359

RESUMO

Aim: This study aimed to investigate changes in mental health among young adults participating in an integrated mental health and vocational support intervention according to the Södertälje Supported Employment and Education model. Design: A prospective longitudinal pre-post intervention study of 12 months. Methods: Instruments on depressive symptoms, quality of life, empowerment, engagement in activities and sociodemographic characteristics were administered to 42 young adults aged 19-28 years with mood disorders. Wilcoxon signed rank tests were used to assess changes in mental health. Results: Statistically significant positive changes between baseline and 12 months were noted for quality of life and engagement in activities. Difference in empowerment scores neared significance and a statistical trend towards lower depression scores was seen, corresponding to moderate depression at baseline and less severe depression at 12 months. Conclusions: Integrated mental health and vocational services may support young adults' mental health and is suggested to be linked to their personal recovery and clinical recovery.


Assuntos
Saúde Mental , Reabilitação Vocacional , Humanos , Estudos Longitudinais , Estudos Prospectivos , Qualidade de Vida , Adulto Jovem
8.
JMIR Form Res ; 4(9): e15625, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32936089

RESUMO

BACKGROUND: Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. OBJECTIVE: The aim of this study was to examine stakeholder groups' perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. METHODS: A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. RESULTS: The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers' concern of legislation incompatibility with innovative technology, and RTW professionals' concern of the possibility that digital solutions may replace them to a certain extent. CONCLUSIONS: This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.

9.
Trials ; 21(1): 789, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928298

RESUMO

BACKGROUND: Engagement in activities meaningful to the individual may support the process of recovery in those with mental illness. Persons with psychiatric disabilities may reduce their engagement in meaningful activities to various degrees with possible fluctuations over time. We hypothesized that activity engagement can be altered when opportunities and support are offered at an individual and a group peer-based level. Evidence is lacking regarding mental health interventions that enable engagement in meaningful activities, and powered effect studies are warranted. METHODS: We propose an 8-month combined individual and group peer-based intervention, Meaningful Activities and Recovery (MA&R), and a study protocol for a multicentre two-armed parallel randomized controlled trial (RCT). The trial investigates the effects of MA&R in community mental health centres in Copenhagen and municipality services in Denmark. The trial will comprise 128 participants with psychiatric disabilities who will be randomized to one of two groups: (1) MA&R in addition to standard mental healthcare or (2) standard mental healthcare alone. The primary outcome is self-reported activity engagement, measured by Profiles of Engagement in People with Severe Mental Illness. Secondary outcomes are recovery, functioning and quality of life. Data will be collected at baseline and at follow-up at the end of the intervention. DISCUSSION: This study adds new knowledge to a field with limited evidence, i.e. the clinical effectiveness of rehabilitation interventions among people with psychiatric disabilities, directly targeting activity engagement. The pragmatic design, regarding in- and exclusion criteria and settings, may allow assessment of the intervention's effect under real-life conditions. The randomization, adequate power and fidelity monitoring allow testing of the intervention's efficacy. The multicentre study design increases the potential for implementation in various mental health settings if the findings are positive. As the nature of the intervention does not permit blinding of the participants or staff, it may increase the risk of expectancy and performance bias. This must be considered when interpreting the findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03963245 . Registered on 29 May 2019.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Saúde Mental , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação Vocacional , Resultado do Tratamento
10.
Issues Ment Health Nurs ; 41(11): 1038-1046, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32605419

RESUMO

The aim was to explore informal carers' perceptions of supporting the everyday life of a relative who has a psychiatric disability and resides in supported housing (SH). A qualitative study based on interviews with 12 informal carers was performed, and the data was analyzed with qualitative content analysis. The theme "Navigating in a misty landscape when striving to support a relative with a psychiatric disability" was identified, encompassing four categories pertaining to residents' needs, collaboration, environmental issues and the carer's situation. SH services can be enhanced by addressing informal carers' experiences and developing greater collaboration involving informal carers, residents and staff.

11.
Scand J Occup Ther ; : 1-11, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32544360

RESUMO

Background: There is growing evidence that people with serious mental illness have impaired capacity for processing sensory inputs which affects daily occupation. Although this is known, research regarding the target groups experiences of sensory inputs in daily occupations is lacking.Aim: To investigate the experience of sensory input and strategies used in daily occupations among people with serious mental illness.Material and methods: Fourteen people with serious mental illness were interviewed regarding their experiences of sensory processing and strategies for managing sensory inputs in daily occupations. Data were analysed using content analysis.Results: Sensory processing issues affected occupational engagement and strategies to control inputs were intuitively used to cope with sensory challenges. Informants either ignored, reduced or avoided sensory inputs. Informants also enabled daily life through strategies such as creating a home that provides rest, finding a safe place, using nature and animals for relaxing and using effects of calming and alerting occupations.Discussion: Specific sensory inputs were difficult to process, which was experienced as stressful and affected occupations negatively. The results imply a need for further research exploring the management of sensory input and the use of sensory modulation approaches to enable engagement in daily activities.

12.
Int J Ment Health Syst ; 14: 22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32206085

RESUMO

Background: The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods: A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months. Results: Anticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity. Conclusions: The IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.

13.
Scand J Occup Ther ; 27(6): 462-473, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30706746

RESUMO

Background: There exist few recovery and occupation-based interventions for mental health service users. Balancing Everyday Life (BEL) is a new occupation-based lifestyle intervention that was created to fill this need.Aim: To gain group leaders' and participants' perspectives of the BEL intervention content and format, including factors that helped, hindered, and could be improved.Methods: A constructivist grounded theory method guided data collection and analysis. Interviews took place with 12 BEL group leaders and 19 BEL participants from out-patient psychiatry settings and community-based day centers in Sweden.Results: BEL's structure and content were appreciated, yet flexibility was desired to adapt to participant needs. BEL could act as a bridge, helping participants connect with others, and to a more engaged and balanced everyday life. Facilitating factors included a person-focused (versus illness-focused) approach, physical and emotional environments, and connection. Barriers included room resources. More sessions were desired for the intervention.Conclusion: Group leaders and participants experienced BEL as a useful tool to instigate meaningful change and connection in the participants' lives. The combination of a positive person-focused approach and group support was appreciated. These results could inform future research, evaluation, and development of occupation-focused lifestyle interventions for mental health service users.


Assuntos
Estilo de Vida , Transtornos Mentais/terapia , Psicoterapia de Grupo/métodos , Adulto , Idoso , Atitude do Pessoal de Saúde , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Liderança , Serviços de Saúde Mental , Pessoa de Meia-Idade , Terapia Ocupacional , Percepção
14.
Scand J Occup Ther ; 27(6): 431-440, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31298964

RESUMO

Background: How we identify ourselves is strongly related to employment. Young adults are a vulnerable group with regard to entering the Labor market. If they also have mental health problems, entering becomes more difficult and increases risk of early marginalization. Nevertheless, working can be essential for personal recovery process.Aims: To explore experiences of young adults with mental health problems who are starting to work, with a focus on the process of developing work identity.Methods: Grounded theory design was used. The data collection consisted of 13 in-depth interviews with young adults with mental health problems aged 19-26 years, who had worked for at least three months.Results: The experience of starting to work contributed to a process of internal and external change, new feelings, challenges, and understanding of the surrounding world. Former negative thought patterns became more positive. New roles and occupational patterns were developed and altered views on abilities, and thus self-efficacy. This development contributed to a work identity, and new directions in life.Conclusions: There is therapeutic potential in supporting work identity development, and this support can empower the personal recovery process for young adults.


Assuntos
Emprego/psicologia , Transtornos Mentais/psicologia , Autoeficácia , Trabalho/psicologia , Adulto , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Otimismo , Adulto Jovem
15.
Work ; 64(3): 495-506, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658083

RESUMO

BACKGROUND: Research is needed on how to optimize the return-to-work process for persons with mental health problems. OBJECTIVE: To develop a model that explains how employer and rehabilitation professional mental health literacy may influence strategies used in the return-to-work of persons with mental health problems. METHODS: A grounded theory study design was used to collect and analyse interview data from 23 employers and 22 rehabilitation professionals. RESULTS: The analysis resulted in four categories, illustrated in a conceptual process model: 1) seeing mental health problems through past experiences; 2) separating understandable and incomprehensible mental health problems; 3) balancing safeguarding one's personal interest with providing adequate support; and 4) facing conflicts and uncertainty in employee/service user return-to-work. A positional map of employer/rehabilitation types was created based on level of negative attitudes and uncertainty in supporting employees/service users and the employer in relation to the level of comprehensive understanding of mental health problems. CONCLUSIONS: Professional mental health literacy needs to be increased. Interventions need to be developed that provide employers with targeted support and knowledge in mental health literacy. Education on how to prevent and detect common mental health problems in the workplace is needed.


Assuntos
Emprego/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Transtornos Mentais/reabilitação , Retorno ao Trabalho , Adulto , Emprego/organização & administração , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade , Política Organizacional , Medição de Risco , Suécia , Incerteza
16.
Aust Occup Ther J ; 66(5): 627-636, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31344759

RESUMO

INTRODUCTION: Balancing Everyday Life (BEL) is a new lifestyle intervention for mental health services users, developed to support meaningful engagement in daily activities and a balanced lifestyle. This study aimed at exploring the BEL participants' process of making lifestyle changes. METHODS: This constructivist grounded theory study took place in Sweden from 2013-2017 and explored the processes of 19 BEL participants when making lifestyle changes. Data were collected through 29 interviews. RESULTS: A process of breaking a cycle of perceived failure and making changes toward a more balanced lifestyle was constructed, consisting of five categories: Going at it gently: change is an on-going process; Support for progress, permission to fail; Prioritising and setting boundaries; Adjusting for a sustainable balance; and Caring for a valued self. Each category included a strategy for change as well as a related inner change. Strategies involved learning and trying techniques for making changes toward a more balanced lifestyle, whereas the personal changes often involved a more self-compassionate approach and allowing oneself to utilise these techniques. CONCLUSION: The results contribute to knowledge in the process of making lifestyle changes, specifically, how strategies for change and inner changes interact and can support personal recovery toward mental health. This knowledge could help to support clients in making personally meaningful changes toward a more balanced lifestyle as well as inform future research in the process of making change.


Assuntos
Promoção da Saúde/organização & administração , Estilo de Vida , Serviços de Saúde Mental/organização & administração , Terapia Ocupacional/organização & administração , Adulto , Idoso , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
17.
Scand J Occup Ther ; 26(3): 205-218, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29078724

RESUMO

BACKGROUND: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives. METHODS: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed. RESULTS: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working. CONCLUSION: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.


Assuntos
Adaptação Psicológica , Readaptação ao Emprego/psicologia , Transtornos do Humor/reabilitação , Retorno ao Trabalho/psicologia , Autoeficácia , Licença Médica/estatística & dados numéricos , Adulto , Readaptação ao Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retorno ao Trabalho/estatística & dados numéricos
18.
Scand J Occup Ther ; 26(1): 69-78, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29105535

RESUMO

BACKGROUND: Day centers are a common form of mental health service internationally. They are aimed at enhancing occupational engagement and social relations, but there is a need to clarify the outcomes of day center programs, including the impact on important aspects of recovery such as empowerment. AIMS: The aim of this study was to explore whether perceived empowerment changed over time among Swedish day center users and whether self-esteem, quality of life, socio-demographic data and self-reported diagnosis, type of program and level of engagement in day center occupations could predict future empowerment. METHOD: The study involved a re-analysis of longitudinal data from 14 day centers, where measures of perceived empowerment and other individual factors were collected over a 15-month period. Non-parametric statistics were used, including Wilcoxon's signed-rank test and logistic regression analysis. RESULTS: There were no significant changes in day center attendee empowerment scores. Self-esteem and level of engagement in day center occupations were found to be predictors of empowerment, together explaining 34% of the variation. CONCLUSIONS: Developing empowerment in the day center context involves a complex interaction of individual, social and material factors. Potential barriers to empowerment are discussed along with considerations related to measuring empowerment as an outcome of day center programs.


Assuntos
Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Terapia Ocupacional , Poder Psicológico , Adulto , Centros Comunitários de Saúde Mental , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autoimagem , Suécia
19.
Int J Integr Care ; 18(4): 11, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30532665

RESUMO

Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative. Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The "Sustainable Implementation Scale" helped to identify critical implementation components, and these were further explored using the qualitative interview data. The "Tool for Measuring Assertive Community Treatment" addressed programme fidelity, and the initiative's sustainability was assessed. Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members' characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model's characteristics and existing organisational traditions and regulations. Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.

20.
Nord J Psychiatry ; 72(6): 420-430, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30383472

RESUMO

BACKGROUND: One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being. AIM: The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures. METHODS: A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used. RESULTS: Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed. CONCLUSIONS: The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.


Assuntos
Atenção à Saúde/métodos , Transtornos Mentais/terapia , Serviços de Saúde Mental , Psiquiatria/métodos , Serviços Comunitários de Saúde Mental/organização & administração , Aconselhamento/organização & administração , Nível de Saúde , Humanos , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Qualidade de Vida
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