Helping people with severe mental illness to obtain work: systematic review.
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OBJECTIVE: To determine the most effective way of helping people with severe mental illness to obtain competitive employment-that is, a job paid at the market rate, and for which anyone can apply. DESIGN: Systematic review. PARTICIPANTS: Eligible studies were randomised controlled trials comparing prevocational training or supported employment (for people with severe mental illness) with each other or with standard community care. OUTCOME MEASURES: The primary outcome was number of subjects in competitive employment. Secondary outcomes were other employment outcomes, clinical outcomes, and costs. RESULTS: Eleven trials met the inclusion criteria. Five (1204 subjects) compared prevocational training with standard community care, one (256 subjects) compared supported employment with standard community care, and five (484 subjects) compared supported employment with prevocational training. Subjects in supported employment were more likely to be in competitive employment than those who received prevocational training at 4, 6, 9, 12, 15, and 18 months (for example, 34% v 12% at 12 months; number needed to treat 4.45, 95% confidence interval 3.37 to 6.59). This effect was still present, although at a reduced level, after a sensitivity analysis that retained only the highest quality trials (31% v 12%; 5.3, 3.6 to 10.4). People in supported employment earned more and worked more hours per month than those who had had prevocational training. CONCLUSION: Supported employment is more effective than prevocational training at helping people with severe mental illness obtain competitive employment. (+info)
Increasing one aspect of self-determination among adults with severe multiple disabilities in supported work.
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We attempted to increase one aspect of self-determination among 3 supported workers with multiple disabilities. Following Baer's (1998) self-determination conceptualization, the workers were exposed to two conditions that involved working more versus less independently based on availability of assistive devices. Next, their condition preferences were assessed and honored. All participants consistently chose the more independent condition. Results reflect how self-determination may be enhanced by giving workers increased control over work situations. (+info)
A prework assessment of task preferences among adults with autism beginning a supported job.
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A prework paired-task assessment was evaluated for identifying work preferences among 3 adults with autism beginning a supported job. When the workers began the job, choices were provided between more and less preferred tasks (determined by previous assessment). Results supported the assessment for identifying single task preferences, but did not reveal preferences of 2 workers for alternate tasks. Results are discussed in terms of evaluating other prework assessments that may reveal task-alternation preferences. (+info)
Return to work after occupational injury. Family physicians' perspectives on soft-tissue injuries.
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OBJECTIVE: To document physicians' views about facilitating factors for and barriers to their helping workers recover after occupational soft-tissue injuries and to ascertain physicians' knowledge and attitudinal barriers to their involvement in return to work. DESIGN: Faxed survey. SETTING: Manitoba family practices and emergency departments. PARTICIPANTS: General practitioners, family physicians, and emergency physicians regularly caring for injured workers. MAIN OUTCOME MEASURES: Physicians' ranking of facilitating factors and barriers, changes to help their involvement in return to work, and their attitudes and knowledge about return to work. RESULTS: Respondents and nonrespondents were demographically similar, 232 physicians (51.3%) responded. Respondents believed the main facilitating factors were physicians' ability to explain the nature and prognosis of injuries to workers (69%) and the willingness of workplaces to accommodate injured workers (26%). The main barriers were workers' misunderstandings and fears about their injuries (70.7%) and non-supportive supervisors and co-workers (20.8%). The most frequently requested change was better workplace job accommodation (48%). Most physicians agreed they had a role in planning return to work and were aware of the effect of job satisfaction, psychosocial elements, and work-related factors. Despite supporting evidence, only one third of physicians stated they would say "try to continue usual activities" to patients with occupational low back pain. CONCLUSION: Most physicians seemed aware of their role in return to work and the effect of occupational factors, but their advice on activity after injury differed from that in practice guidelines. (+info)
What employees with rheumatoid arthritis, diabetes mellitus and hearing loss need to cope at work.
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OBJECTIVES: This study attempted to determine factors that help currently employed people with rheumatoid arthritis, diabetes mellitus or hearing loss to continue working. METHODS: This was a qualitative study that used three concept-mapping sessions. Sixty-nine participants (rheumatoid arthritis 21, diabetes mellitus 23, and hearing loss 25) were recruited from the patient records of the rheumatology, diabetes, and audiology outpatients of the Academic Medical Center (AMC), Amsterdam, and referrals from occupational physicians and patient associations. An arthritis consultant, a diabetes consultant, and an audiologist screened the patients for the used illness inclusion criteria. A researcher screened the patients for the inclusion criteria of age and work. RESULTS: The main factors enabling employees to continue working were ability to cope with the illness, support from management and colleagues, adequate work conditions, support of patient organizations and society, support of medical professionals and facilities, and benefits. The three groups of employees rated the priority of these factors differently. For the employees with rheumatoid arthritis, the support of management was the most important, followed by self-acceptance, self-efficacy, and professional advice on how to cope at work. For those with diabetes mellitus, self-acceptance, self-care, and support from management, colleagues and health professionals were the most important. For employees with hearing loss, being well informed about hearing equipment, reimbursement, and self-acceptance were the most important. A topic list was developed that can be used by health professionals as a guideline for exploring the work-related problems of patients with a chronic disease. CONCLUSION: The results provide an understanding of the needs chronically ill employees have at work and the areas to which health professionals need to pay attention. (+info)
Effects of video-assisted training on employment-related social skills of adults with severe mental retardation.
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Two studies investigated effects of video-assisted training on employment-related social skills of adults with severe mental retardation. In video-assisted training, participants discriminated a model's behavior on videotape and received feedback from the trainer for responses to questions about video scenes. In the first study, 3 adults in an employment program participated in video-assisted training to request their supervisor's assistance when encountering work problems. Results indicated that participants discriminated the target behavior on video but effects did not generalize to the work setting for 2 participants until they rehearsed the behavior. In the second study, 2 participants were taught to fix and report four work problems using video-assisted procedures. Results indicated that after participants rehearsed how to fix and report one or two work problems, they began to fix and report the remaining problems with video-assisted training alone. (+info)
Problem solving to prevent work injuries in supported employment.
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A problem-solving strategy was used to teach three groups of 3 individuals in supported employment how to prevent work-related injuries. The problem-solving strategy was taught in two training phases. The first training phase involved the use of cue cards, and the second involved the withdrawal of the cue cards. Interviews and staged generalization assessments in the participants' natural work environments were conducted before, during, and up to 12 weeks after training. In these assessments, situations were presented that were either similar or dissimilar to situations presented in training. Results of both the interviews and staged assessments indicated that the participants' newly acquired problem-solving skills generalized to similar and dissimilar situations. (+info)
An outcome management program for extending advances in choice research into choice opportunities for supported workers with severe multiple disabilities.
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We evaluated an outcome management program for increasing choice opportunities provided by 2 job coaches for 5 supported workers with severe multiple disabilities in a community job. The program involved specifying and monitoring behavioral outcomes among workers and staff, training staff, and supportive and corrective feedback. Increased choice provision occurred for both job coaches across a 1-year period. Results indicate how outcome management can help translate advances in choice research into routine practice. (+info)