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1.
Trials ; 22(1): 705, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654464

RESUMO

BACKGROUND: Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. METHODS/DESIGN: The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. DISCUSSION: The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04289415 . Registered on February 28, 2020.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Transtornos Psicóticos , Transtornos Relacionados ao Uso de Substâncias , Emprego , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação Vocacional , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Desemprego
2.
Schizophr Res ; 236: 115-122, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34482187

RESUMO

BACKGROUND: After a first episode of psychosis, cognitive impairments present an important barrier to successful (re-)entry into work and education. We assessed whether cognitive remediation (CR) as an add-on to Individual Placement and Support (IPS) can improve participation in regular employment and education. METHOD: Participants with early psychosis (N = 73) were randomly assigned to receive IPS supplemented with computerized CR, or IPS plus an active control intervention (computer games). The primary outcome was the number of hours spent in competitive employment or regular education, which was assessed every month during the 18-month study period. Secondary outcomes included employment rate, cognitive functioning, mental health (assessed at baseline, 6 and 18 months), and job duration (assessed after 18 months). Both patients and assessors were blind to treatment. RESULTS: Participants receiving IPS + CR showed greater improvement of competitive employment over time in terms of hours worked (during follow-up period: 38.5 vs. 19.6 h, B = 2.94; Wald χ2 = 5.39; P = .02) and employment rate (at T2: 62.1% vs. 25.9%, χ 2 = 7.39; df = 1; P = .008), compared with the IPS + control group, particularly in the longer term. The number of hours spent in regular education was lower in the IPS + CR group, with more participants having ended education for a positive reason. There was a significant beneficial effect of adjunctive CR for executive functioning, subjective cognitive functioning, and empowerment. CONCLUSIONS: Augmenting IPS with CR has a significant impact on competitive employment in people with early psychosis, with beneficial effects being more pronounced after 18 months.


Assuntos
Disfunção Cognitiva , Remediação Cognitiva , Readaptação ao Emprego , Transtornos Psicóticos , Cognição , Disfunção Cognitiva/terapia , Emprego , Humanos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Reabilitação Vocacional
3.
BMC Psychiatry ; 21(1): 410, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412626

RESUMO

BACKGROUND: Individuals receiving means-tested benefits are at a higher risk of being diagnosed with a psychiatric illness compared to those who are employed, and the rate of those working in the first labor market is low. The intervention (Individual Placement and Support, IPS) aims at maintaining or regaining working ability and at facilitating reintegration into the (first) labor market following a "first place, then train"-approach. The objective of the study is to conduct the first RCT in Germany that addresses a broad group of long-term unemployed individuals with severe mental illnesses that receive means-tested benefits, and to test the effectiveness of the IPS intervention. METHODS: In this randomized controlled trial, about 120 eligible participants aged between 18 years and local retirement age will be randomly allocated to an intervention group (IG) or to an active control group (CG) using a parallel arm design. The IG will receive IPS + high quality treatment as usual (TAU), the active CG will receive TAU + a booklet on integration measures. A block-randomization algorithm with a targeted assignment ratio of 1:1 for participants in IG and active CG will be used, stratified by sex and three age groups. Assessments will take place before the intervention at baseline (t0), and 6 (t1), 12 (t2), and 18 (t3) months later. Primary outcome will be the proportion of participants having worked at least 1 day in competitive employment since baseline, as assessed at t3. Secondary outcomes will be related to employment/ vocation and mental health. In addition, there will be a process evaluation. Treatment effects on outcomes will be tested using appropriate panel-data regression models, and acceptability, uptake and adherence will be evaluated using descriptive statistics and appropriate inference testing. DISCUSSION: The results of this trial are expected to generate a better understanding of the efficiency, feasibility, acceptance, and relevance of the IPS intervention in a German setting. They could be a first step towards the implementation of the method and towards improving the situation of long-term unemployed individuals with severe mental health problems. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00023245 ), registered on 22.02.2021.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Adolescente , Humanos , Transtornos Mentais/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação Vocacional , Projetos de Pesquisa , Desemprego
4.
Psychiatr Rehabil J ; 44(2): 142-147, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33939452

RESUMO

Objective : This study evaluates the effects of time incarcerated on employment outcomes between a manualized vocational program, the About Face Vocational Program (AFVP), and a hybrid program of the AFVP and Individualized Placement and Support, Supported Employment (AFVP + IPS-SE). Method : Eighty-four veterans with the histories of felony convictions and a mental illness or a substance use disorder were randomly assigned to the AFVP or AFVP + IPS-SE conditions and followed for 6 months. The associations between time to employment and months incarcerated were evaluated using nonparametric tests. Findings : The number of months incarcerated was positively associated with time to employment in the hybrid AFVP + IPS-SE condition but not the AFVP condition. In addition, significant differences were found between employment rates of the groups at lower number of months incarcerated, with higher rates of employment in the hybrid AFVP + IPS-SE condition, becoming similar as months incarcerated increased. Conclusion and Implications for Practice : Number of months incarcerated may have a deleterious effect on employment rates when using IPS-SE. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Prisioneiros , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Humanos , Reabilitação Vocacional
5.
Soc Psychiatry Psychiatr Epidemiol ; 56(9): 1669-1677, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34032866

RESUMO

PURPOSE: People with severe mental illness experience disproportionately high rates of unemployment. Nonetheless, a substantial amount of research has demonstrated vocational benefits of the Individual Placement and Support (IPS) model and IPS supplemented with cognitive remediation (IPSE). The present study sought to examine demographic and clinical predictors of employment or education among people with severe mental illness and to investigate if IPS or IPSE can compensate for risk factors for unemployment. METHODS: Seven hundred twenty participants were randomly assigned to IPS, IPSE or Service as Usual. During the 18-month follow-up period participants in the two experimental groups obtained significantly more work or education. A series of univariate and multiple logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors for the total population and for the three groups individually. RESULTS: The strongest predictor for vocational recovery, besides treatment allocation, was previous work history (OR = 1.78; 95% CI = 1.28-2.47). Men had a lower probability for vocational recovery compared to women (OR = 0.71; 95% CI = 0.50-0.99) and higher age was also negatively associated with work or education (OR = 0.79; 95% CI = 0.67-0.93). Moreover, vocational recovery was predicted by higher readiness for change, measured on the readiness for change scale (OR = 1.42; 95% CI = 1.19-1.70). Participation in IPS or IPSE could not compensate for negative risk factors such as low cognitive function or negative symptoms. CONCLUSIONS: In a multiple logistic regression analysis age, previous work history and motivation for change were statistically significant predictors of obtaining work or education among people with severe mental illness who participated in the Danish IPS trial.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Dinamarca , Escolaridade , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Reabilitação Vocacional
6.
Eur Psychiatry ; 64(1): e31, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33853701

RESUMO

BACKGROUND: People suffering from schizophrenia cannot easily access employment in European countries. Different types of vocational programs coexist in France: supported employment, sheltered employment (ShE), and hybrid vocational programs. It is now acknowledged that the frequent cognitive impairments constitute a major obstacle to employment for people with schizophrenia. However, cognitive remediation (CR) is an evidence-based nonpharmacological treatment for these neurocognitive deficits. METHODS: RemedRehab was a multicentric randomized comparative open trial in parallel groups conducted in eight centers in France between 2013 and 2018. Participants were recruited into ShE firms before their insertion in employment (preparation phase). They were randomly assigned to cognitive training Cognitive Remediation for Schizophrenia (RECOS) or Treatment As Usual (TAU). The aim of the study was to compare with the benefits of the RECOS program on access to employment and work attendance for people with schizophrenia, measured by the ratio: number of hours worked on number of hours stipulated in the contract. RESULTS: Seventy-nine patients were included in the study between October 2018 and September 2019. Fifty-three patients completed the study. Hours worked / planned hours equal to 1 or greater than 1 were significantly higher in the RECOS group than in the TAU group. CONCLUSIONS: Participants benefited from a RECOS individualized CR program allows a better rate of work attendance in ShE, compared to the ones benefited from TAU. Traditional vocational rehabilitation enhanced with individualized CR in a population of patients with schizophrenia is efficient on work attendance during the first months of work integration.


Assuntos
Remediação Cognitiva , Readaptação ao Emprego , Esquizofrenia , Feminino , Humanos , Reabilitação Vocacional , Esquizofrenia/terapia , Psicologia do Esquizofrênico
7.
BMC Psychiatry ; 21(1): 181, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827498

RESUMO

BACKGROUND: Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness (SMI) achieve competitive employment. The aim of the present study is to explore experiences with Individual Placement and Support using a multifaceted implementation strategy (IPS + MIS), and competitive employment. The goal of this strategy was to improve IPS implementation by enhancing collaboration between mental health care and vocational rehabilitation stakeholders, and realizing a secured IPS funding with a 'pay for performance' element. METHODS: A qualitative, exploratory study was performed using semi-structured interviews with IPS clients (n = 10) and two focus groups with IPS employment specialists (n = 7 and n = 8) to collect rich information about their experiences with IPS + MIS and competitive employment. Thematic content analysis was used to analyse the data. RESULTS: Themes related to experiences with IPS and the multifaceted implementation strategy were identified, including the importance of discussing the client's motivation and motives to work, facilitators and barriers to obtaining and maintaining employment, facilitators to collaboration between stakeholders, barriers to benefits counselling, organizational barriers to IPS execution and collaboration between stakeholders, financial barriers to IPS execution and experiences with the pay for performance element. CONCLUSIONS: Although the multifaceted implementation strategy seems to contribute to an improved IPS implementation, the barriers identified in this study suggest that further steps are necessary to promote IPS execution and to help people with SMI obtain and maintain competitive employment.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Humanos , Motivação , Reabilitação Vocacional , Reembolso de Incentivo , Especialização
8.
Adm Policy Ment Health ; 48(3): 388-392, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33791925

RESUMO

The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health (mental health and substance use) disorders for many people, and created new disorders for others. Although policy changes have increased health care and unemployment benefits, most people want jobs and self-sufficiency rather than handouts. A robust evidence base shows that supported employment can enable unemployed people with behavioral health conditions to find competitive, integrated employment and behavioral health supports. Millions of U.S. citizens may need these services as the pandemic recedes and jobs become available. Government attention to supported employment is necessary now more than ever.


Assuntos
COVID-19/epidemiologia , Readaptação ao Emprego/organização & administração , Saúde Mental , Desemprego/psicologia , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
9.
Soc Psychiatry Psychiatr Epidemiol ; 56(9): 1657-1667, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33860804

RESUMO

PURPOSE: People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors. METHODS: This is a cross-sectional observational study of patients with SMI aged 18-65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model. RESULTS: Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work. CONCLUSION: Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed. STUDY REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801 ) and under the WHO-Platform "International Clinical Trials Registry Platform" (ICTRP) ( https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801 ) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Pessoas Mentalmente Doentes , Adolescente , Adulto , Idoso , Estudos Transversais , Humanos , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade
10.
Psychiatr Serv ; 72(9): 1088-1090, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33882715

RESUMO

Individual placement and support (IPS) is known to improve short-term outcomes for competitive employment. Questions remain, however, about the relationship between IPS and more robust forms of socioeconomic mobility and empowerment. This Open Forum questions the motivation and logic underlying IPS and suggests that it may be time to consider alternative approaches to improving the socioeconomic conditions of people who have serious mental illness.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Motivação , Reabilitação Vocacional
11.
Med Care ; 59(Suppl 2): S195-S198, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33710095

RESUMO

BACKGROUND: Homelessness is a significant issue affecting the general US population. Two subsets of the population overrepresented in the US homeless population are justice involved individuals and Veterans. However, relatively little research has addressed alleviating homelessness in justice-involved Veterans (JIV). One direction for addressing homelessness in this population is facilitating employment. OBJECTIVE: This study examined differences in housing and employment outcomes between homeless JIV enrolled in 2 different vocational rehabilitation conditions. METHODS: This study evaluates vocational outcomes of Veterans experiencing homelessness enrolled in a larger US Department of Veterans Affairs-funded study. Participants were randomized into 2 groups: those who participated in a job search group, the About Face Vocational Program (AFVP) and those who received AFVP plus Individualized Placement and Support, Supported Employment (AFVP+IPS-SE). RESULTS: Participants who received supported employment plus group were significantly more likely to secure employment compared with group alone. This significant difference was also found in individuals who identified as chronically homeless. Furthermore, participants who secured employment were significantly more likely to exit homelessness and secure housing, suggesting group membership had an indirect effect on housing status though improved employment outcomes. CONCLUSIONS: Vocational rehabilitation groups combined with supported employment is appropriate and effective for homeless, JIV seeking employment and may also improve downstream housing outcomes.


Assuntos
Readaptação ao Emprego , Pessoas em Situação de Rua , Desemprego , Veteranos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , United States Department of Veterans Affairs
12.
J Psychiatr Res ; 137: 250-257, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33714077

RESUMO

BACKGROUND: Depression and anxiety are heterogenous disorders often combined into one entity in studies. Few studies have compared trajectories of depression and anxiety among clinically ill. We aimed to identify specific trajectories of depression, and anxiety and predictors of trajectory membership. METHODS: Latent growth mixture modelling was carried out on data from the IPS-MA trial (n = 261), a supported employment intervention for people with mood or anxiety, to identify trajectories of depression and anxiety. Logistic regression was used to estimate predictors for trajectory membership. Associations between trajectory class and remission of comorbid depression or anxiety and return to work were also tested. RESULTS: We identified three trajectories of depression and anxiety symptoms respectively; moderate-decreasing (60%), moderate-stable (26%), and low-stable (14%) depression and mild-decreasing (59%), moderate-decreasing (33%), and moderate-stable (8%) anxiety. The depression model showed low precision in class separation (entropy 0.66), hence, predictors of class membership were not estimated. For anxiety, lower age and higher levels of depressive symptoms were associated with a less desirable trajectory. Remission of comorbid depressive symptoms after two years differed significantly between classes (p < 0.000). Fewer had returned to work in the two moderate classes compared to the mild-decreasing anxiety class. LIMITATIONS: Depression model not reliable. Only 80% of participants from original study included. Not able to distinguish between anxiety disorders. CONCLUSION: Trajectories of anxiety confirm that, even after two years, a rather large proportion in the moderate-stable class had symptoms of moderate anxiety, moderate comorbid depressive symptoms, and less probability of having returned to work. TRIAL REGISTRATION: ClinicalTrials.govNCT01721824.


Assuntos
Readaptação ao Emprego , Licença Médica , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Humanos
13.
Psychiatr Serv ; 72(6): 712-715, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33730884

RESUMO

OBJECTIVE: The authors examined how individual placement and support (IPS), an evidence-based model of supported employment, has been successfully adapted in rural communities across the United States. METHODS: Interviews with 27 key informants in 15 states with successful IPS programs in rural communities identified challenges that IPS workers faced because of rurality and the work-around methods they used to overcome these challenges. The authors conducted a thematic analysis of interviews. RESULTS: Significant challenges to implementing IPS in rural areas included limited availability of public transportation, Internet connectivity, employment opportunities, and workforce. The work-around strategies used by IPS teams differed in relation to local circumstances and cultures, but effective services generally used natural supports for transportation, provided computer access for job applicants, developed relationships with local employers, and hired IPS workers with local knowledge. CONCLUSIONS: The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Humanos , Reabilitação Vocacional , População Rural , Estados Unidos
14.
J Occup Rehabil ; 31(4): 699-710, 2021 Dec.
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.


Assuntos
Transtorno Depressivo , Readaptação ao Emprego , Transtornos Mentais , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias , Humanos , Reabilitação Vocacional
15.
Rev. Asoc. Esp. Espec. Med. Trab ; 30(1): 99-103, mar. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-201420

RESUMO

Las enfermedades de Steinert e Hirayama son dos entidades etiológicamente distintas que afectan el sistema locomotor con implicaciones neurológicas, catalogadas como raras suelen manifestarse de manera temprana en adultos o jóvenes en actividad laboral. La enfermedad de Steinert es una miopatía autosómica dominante que combina distintos grados de debilidad muscular y cansancio crónico. A su vez la enfermedad de Hirayama es una mielopatía cervical que causa debilidad y atrofia distal de los miembros superiores, clínicas que afectan la funcionalidad de la persona. La Medicina del Trabajo se enfrenta a retos en procura de conciliar la actividad del trabajador en el ejercicio de sus tareas con las patologías de base en busca de una buena adecuación del puesto de trabajo


Steinert and Hirayama diseases are two etiologically different entities that affect the locomotor system with neurological implications, classified as rare, usually manifest early in adults or young people in work activity. Steinert's disease is an autosomal dominant myopathy that combines varying degrees of muscle weakness and chronic fatigue. In turn, Hirayama disease is a cervical myelopathy that causes weakness and distal atrophy of the upper limbs, clinics that affect the functionality of the person. Occupational Medicine faces challenges in trying to reconcile the activity of the worker in the exercise of their tasks with the underlying pathologies in search of a good adaptation of the job


Assuntos
Humanos , Feminino , Adulto , Atrofias Musculares Espinais da Infância/fisiopatologia , Distrofia Miotônica/fisiopatologia , Readaptação ao Emprego , Força Muscular , Avaliação da Capacidade de Trabalho
16.
Schizophr Res ; 228: 472-480, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33582309

RESUMO

PURPOSE: Little is known about the longitudinal trajectories of employment in people with severe mental illnesses (SMI) in developing countries, including India. We examined stability and change in work status, interest in work, problems and benefits related to work among employed participants, and barriers and desired job supports among unemployed participants. METHODS: We conducted a one-year follow-up with 550 participants with SMI receiving psychiatric outpatient treatment in two hospitals in two districts in India. A total of 459 (83.5%) participants completed follow-up interviews. RESULTS: Rates of employment were stable across the one-year period, with over 60% employed at baseline and follow-up assessment. More than 80% who worked at both assessments were working in the same job for an average duration of 10 years. Among participants who were unemployed at baseline, 16.9% started working at follow-up, an outcome associated with interest in work and efforts to find work at baseline. Interest in work of those unemployed at both assessments was lower at follow-up than baseline, but over 60% of participants wanted to work across both assessments, and endorsed desired supports for their job search. CONCLUSIONS: There is considerable stability of work in people with SMI in India. Working in the same job for the long term may have contributed to consistent work. Most unemployed participants who wanted to work at baseline were not working at follow-up, and expressed a desire for help with job search, suggesting the need for vocational services to help people with SMI in developing countries obtain employment.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Humanos , Índia , Transtornos Mentais/epidemiologia , Reabilitação Vocacional , Desemprego
17.
Nord J Psychiatry ; 75(5): 389-396, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33559510

RESUMO

OBJECTIVES: We aimed to investigate the cost-utility and cost-effectiveness of a modified Individual Placement and Support intervention for people with mood and anxiety disorders (IPS-MA). METHODS: Costs were assessed from a societal perspective. Health care costs were derived from registers and combined with data on use of IPS-MA services, municipal social care, and labour market services. EQ-5D was used to compute QALY. Missing data were imputed in a sensitivity analysis. We also computed the cost per gain in hours worked. Incremental cost-effectiveness ratios (ICER) were computed and bootstrapped to obtain confidence intervals for QALY and gain in hours worked. RESULTS: We found no difference in overall costs between groups. A significant saving was found in use of labour market services in the IPS-MA group. But the IPS-MA group had significantly lower wage earnings compared to the control group. The intervention group had a higher, though statistically in-significant, increase in QALYs than the control group. The ICER did not show statistically significant results, but there was a tendency, that IPS-MA could have a positive effect on health-related quality of life without any additional costs. However, participants in the IPS-MA group had a significantly lower gain in hours worked compared to the control group. CONCLUSIONS: Despite a significant saving in use of labour market services, IPS-MA was not cost-effective. Participants in the IPS-MA group worked significantly fewer hours and earned significantly less than participants in the control group at 1-year follow-up.


Assuntos
Readaptação ao Emprego , Transtornos de Ansiedade/terapia , Análise Custo-Benefício , Dinamarca , Humanos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
18.
Nervenarzt ; 92(9): 955-962, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-33570685

RESUMO

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Pessoas Mentalmente Doentes , Comitês Consultivos , Alemanha , Humanos , Reabilitação Vocacional
19.
Work ; 68(1): 255-266, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33459680

RESUMO

BACKGROUND: Work holds great meaning and benefits beyond just monetary gain for people with intellectual disabilities. It gives these individuals the opportunity to engage in meaningful occupation. OBJECTIVE: The purpose of the study was to explore challenges that people with intellectual disabilities (PWID) experience when adapting to their worker roles in the open labor market. METHODS: The study used grounded theory as the research design. Five male participants and two key informants participated in the study. Two semi structured interviews were conducted with each one of the seven participants (five PWID and two key informants). RESULTS: Three core concepts emerged: 1) Unforeseen challenges of change; 2) A well-planned work preparation program enables success and 3) Crossing the bridge into the workplace: "Do I belong here?" CONCLUSIONS: This indicated that with sufficient external support, PWID are able to gain a sense of social belonging and develop the necessary skills to cope with challenges that arise in the workplace when PWID transition from protective/sheltered workshops to the open labor market. The findings of the study also indicated that work preparation programs and supportive employment approaches helped PWID transition to the open labor market.


Assuntos
Pessoas com Deficiência , Readaptação ao Emprego , Deficiência Intelectual , Humanos , Masculino , Ocupações , África do Sul
20.
Aust Occup Ther J ; 68(3): 246-256, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33458820

RESUMO

OBJECTIVE: People with severe mental illness often have difficulty sustaining employment. Work Behaviour Inventory and Work Environment Impact Scale are vocational assessments used by occupational therapists to evaluate the facilitators and barriers of work performance and work environment respectively. These factors may have an impact on job tenure and can inform occupational therapy practice. METHODS: This study analysed retrospective data of 85 clients who attended a 3-month Employment Internship Program from August 2016 to August 2017. Scores from Work Behaviour Inventory and Work Environment Impact Scale were analysed for associations with job tenure. Repeated measures were used to determine significant changes in Work Behaviour Inventory composite scores across the 3 months. RESULTS: One-month Work Behaviour Inventory composite scores, three Work Behaviour Inventory domains (cooperativeness, work habits, work quality), and three Work Environment Impact Scale domains (time demands, supervisor interaction, architecture) were significantly associated with job tenure. Significant differences in mean job tenure were also found between participants of different internship status. However, these factors did not predict job tenure in regression analysis. There were significant improvements in Work behaviour Inventory composite scores from the first to third month. CONCLUSIONS: Work behaviours such as cooperativeness, work habits, and work quality as well as work characteristics such as time demands, supervisor interaction, and workplace architecture may play a role in influencing job tenure. Occupational therapists may consider such factors and provide more targeted interventions to effectively sustain employment.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Terapia Ocupacional , Humanos , Reabilitação Vocacional , Estudos Retrospectivos , Local de Trabalho
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