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.

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.

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.

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.

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.

[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.

Empleo con apoyo para personas con enfermedad mental / Supported empleoyment for persons with mental illness

El empleo con apoyo es una metodología de inserción laboral para personas con discapacidad con amplia evidencia basada en resultados. En el colectivo de personas con enfermedad mental su aplicación es reciente sobre todo en España. El artículo realiza una revisión en este campo extrayendo evidencias de la efectividad y varias implicaciones para la práctica del modelo en el campo de la enfermedad mental en varios niveles (AU)

Supported employment is a job integration methodology for persons with disabilities with wide outcome based in evidence. For persons with mental illness the application has been more recently developed, especially in Spain. The article provides a revision of this field extracting evidences of effectiveness and practice implications in the area of mentalillness at different levels (AU)

Indicadores de mejora cognitiva en el "Proyecto Urbanita", modelo específico de integración sociolaboral de personas con discapacidad intelectual / Indicators of cognitive improvement in the "Urbanita Project", a specific model of socio-labour integration of persons with intellectual disabilities

El modelo de integración socio-laboral Urbanita I y Urbanita de Accesibilidad consiste en la generación de nuevos puestos de trabajo para personas con discapacidad intelectual, con una función específica dentro de la estructura del organigrama municipal. Las fases del proyecto Urbanita son: valoración, formación, trabajo tutelado y trabajo autónomo. En el presente trabajo se describen los indicadores de mejora cognitiva tras la evaluación en dos momentos del programa, la primera evaluación (pre-test) se realizó en octubre de 2005 y la segunda (post-test) en diciembre de 2006, es decir 14 meses después. Los participantes fueron 17 personas con retraso mental que han formado parte del Proyecto Urbanita de Valdemoro (Madrid). Las pruebas utilizadas en la valoración han sido el Luria-DNA y el Test Breve de Inteligencia Kaufman (K-BIT). Los resultados obtenidos indican una mejora en las escalas del Luria-DNA: orientación espacial, dibujos temáticos, actividad conceptual y en el cociente intelectual (C.I.); y en la escala de matrices del K-BIT. Los datos obtenidos en las pruebas neuropsicológicas aplicadas, revelan una serie de cambios en la mayoría de las escalas. Se analizan estas mejoras en función de labor propia de los urbanitas y de la formación recibida durante el periodo pre-post evaluación (AU)

Urbanita I and Urbanita of Accessibility are models of labour integration. They consist in the generation of new jobs specifically defined for persons with intellectual disability who develop a specific function in the municipal organization chart. The phases of the project are: evaluation, training, work with a tutor and autonomous work. In this article we describe the indicators of cognitive improvement after the evaluation in two moments of the program. The first evaluation took place in October 2005 (pre-test) and the second one (post-test) in December 2006, i.e. 14 months later. The participants were 17 persons with mental retardation who take part of the Urbanita Project in Valdemoro (Madrid). The tests used in the evaluation were the neuropsychological battery Luria-DNA and the Kaufman Brief Intelligence Test (K-BIT). The results show an improvement in some scales of the Luria-DNA: spatial orientation, thematic draws, conceptual activity and IQ, and in the matrix scale of the K-BIT. The data reveal changes in most of the scales. We analysed these improvements in function of the training and the work developed by the urbanites in the pre-post period (AU)

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.

El trabajo de jóvenes con discapacidad intelectual en entornos normalizados / No disponible

En esta investigación se han estudiado las historias laborales y personales de diez jóvenes del Projecte Aura en sus procesos de inserción laboral. La información se ha obtenido mediante análisis documental, entrevistas y cuestionarios. Han participado los diez jóvenes con discapacidad intelectual, sus familias, su preparador laboral y el supervisor de la empresa. Los casos estudiados permiten valorar la modalidad de empleo con apoyo como una muy buena opción para la inserción laboral de personas con graves discapacidades intelectuales en el mundo laboral competitivo no sólo por los beneficios que comporta para el trabajador en cuanto a crecimiento personal, satisfacción y mejor calidad de vida, sino también por los beneficios que reporta al entorno comunitario. En este sentido, todos los implicados modifican sus actitudes hacia las personas con discapacidad intelectual y sus expectativas sobre ellos. Nuestro estudio identifica algunos factores que favorecen un resultado positivo de los procesos de inserción laboral para todos los implicados -trabajador con discapacidad, familia y empresa- y otros que han de ser mejorados y a los que es preciso prestar especial atención (AU)

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Formación para la inserción laboral: Un proyecto conjunto entre la Facultad de Formación de Profesorado y Educación de la Universidad Autónoma de Madrid y la Fundación Prodis / No disponible

El derecho al trabajo de las personas con discapacidad intelectual es un hecho indiscutible en la sociedad actual. Sin embargo, el derecho a formarse tras finalizar la escolaridad obligatoria, no se ha convertido todavía en un derecho tangible para los jóvenes discapacitados. La necesidad incuestionable de responder, con una formación especializada y de carácter inclusivo desde el ámbito de la universidad, a las demandas de formación para el empleo que los jóvenes con discapacidad intelectual requieren actualmente, ha sido el motor que ha impulsado a un grupo de profesores de la Facultad de Formación del Profesorado y Educación de la Universidad Autónoma de Madrid y a la Fundación Prodis a diseñar un Programa de Formación para la Integración Laboral. Por ello, la Fundación Prodis y la Universidad Autónoma de Madrid han firmado un convenio, por el cual un grupo de 16 jóvenes con discapacidad intelectual ha iniciado un curso de Formación para la Inserción Laboral, en la Facultad de Formación de Profesorado y Educación de la U.A.M. de dos años de duración. El curso se encuentra inmerso en una investigación que está siendo realizada por profesores de la Universidad Autónoma de Madrid, la UNED y la Universidad Pablo de Olavide de Sevilla, resultando una experiencia altamente satisfactoria y con unas perspectivas de futuro muy alentadoras (AU)

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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.

IV Encuentro de autoayuda para jóvenes con discapacidad / No disponible

Un grupo de 40 jóvenes con síndrome de Down que trabajan en programas de Empleo con Apoyo en diversas ciudades españolas se reúnen anualmente en verano para analizar sus proyectos de autogestión, compartir e intercambiar experiencias y discutir sobre algún tema monográfico. Este año fue sobre las relaciones: relaciones familiares, relaciones con los amigos, relaciones con los compañeros de trabajo, relaciones con la pareja, relaciones con la sociedad. El artículo muestra las principales conclusiones obtenidas en este Encuentro (AU)

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Proyecto Aura – Habitat / No disponible

Se expone la experiencia piloto en la que jóvenes trabajadores con síndrome de Down que participan en el Proyecto Aura de Empleo con Apoyo (Barcelona )conviven en un piso durante dos o tres meses con estudiantes universitarios que están cursando estudios de Educación Especial. La experiencia ha durado un curso en total e inician ahora el segundo. El objetivo es darles la oportunidad de que salgan de su ambiente familiar, experimenten otras formas de vida, y se valoren a sí mismos para que tengan conciencia de sus posibilidades de vida autónoma y, si las circunstancias lo permiten, puedan elegir su forma de vida. Los estudiantes han de tener muy claro cuáles son las reglas de juego y el papel que deben desempeñar en un ambiente, por lo demás, absolutamente normal. Las tareas de la casa son compartidas con arreglo a unas normas y programaciones. Unos y otros están bajo la supervisión de un experto del Proyecto Aura. El artículo describe la organización y muestra la evaluación y resultados obtenidos

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