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PubMedDate not supplied

Patient dynamics in early stages of vocational rehabilitation: a pilot study.

Since little is known of the dynamics of the rehabilitation process, this pilot study aims to explore (1) the work performance and personal and social functioning of patients attending a vocational reintegration program; (2) any significant differences in course between successful and unsuccessful patients; and (3) whether these subgroups differed at entrance assessment. Using the 30-item Nurses' Observation Scale for inpatient Evaluation (NOSIE) and a global work performance scale, the sample (N = 31) showed a significant decrease in work performance and a negative trend in most NOSIE scores, instead of the expected steady progress. The turning point is reached after 9 to 12 weeks. In the entrance assessment, the failure subgroup (n = 11) displayed more negative and general symptoms and fewer social skills. It seemed to be not their initial work performance but their resources to cope with the stress of the program that were insufficient. However, not every downhill trend leads automatically to failure, and some patients still have a chance of later improvement.

Affective Disorders, Psychotic↗
PubMed2003

High rates of pregnancy among vocational school students: results of audio computer-assisted self-interview survey in Chiang Rai, Thailand.

Unplanned pregnancy among young people can lead to adverse social, psychological, and health outcomes, particularly when it results in abortion. In 1999, we examined the prevalence of and factors associated with pregnancy and abortion among 1725 consenting vocational school students in northern Thailand. Results from an audio computer-assisted self-interview showed that 48% of the male and 43% of the female students reported ever having had sexual intercourse. Among those who had had intercourse, 27% of the women and 17% of the men said they or their partner had ever been pregnant. Among the last reported pregnancies that resulted in delivery or abortion, 95% were aborted. Age, current contraceptive use, early initiation of sexual intercourse (</=16 years), alcohol and drug use, and sexual coercion were associated with self or partner pregnancy. The high rates of pregnancy and abortion in this population indicate the need for better sexual health education and access to effective contraceptive methods.

Abortion, Illegal↗
PubMed1983

Prevalence of disease in Southeast Asian teenagers. Results of screening medical examination at a residential vocational training facility.

Findings on health screening of immigrant Southeast Asian adolescents enrolled at a Federally funded vocational training facility were reviewed for the years 1979-1982. History of or positive skin test for tuberculosis was found in 55%. A heavy parasite burden was found in 46% of the recent Laotian immigrants, but was infrequent in Vietnamese who had been in the United States for several months before testing. Anemia was found in only 5.5%, though an additional 6.5% had findings suggestive of Thalasemia trait. Hepatitis B surface antigen positivity occurred in 16.8% but none had abnormal liver enzymes. One case of leprosy and three cases of idiopathic microscopic hematuria were detected.

Adolescent↗
PubMed1998

An evaluative study into the effectiveness of level 3 National Vocational Qualification support staff to nurses.

A trial development of experienced nursing auxiliaries using the level 3 National Vocational Qualification (NVQ) awards in care commenced in 1993 as part of an evaluative study to consider the implications and potential benefits of this initiative for an acute National Health Service Trust. Two small cohorts (n = 17) undertook development programmes. With the first candidates gaining the award in 1995, an evaluative study was undertaken to assess the quality of care delivered by these staff. Using a modification of the Qualpac assessment tool, trained observers compared the quality of care delivered by the NVQ workers with that delivered by different grades of nurses in three specialist areas: medicine, general surgery and elderly care. The findings reveal that the NVQ-prepared staff performed considerably better than conventional nursing auxiliaries, and in many cases, outperformed qualified nurses in terms of quality of care. The study compares results across a range of nursing skills and discusses the possible implications.

Education, Nursing, Continuing↗
PubMed1985

Psychotropic and anticonvulsant drug use by mentally retarded adults across community residential and vocational placements.

The prevalence of psychotropic and anticonvulsant drug use across a comprehensive continuum of community programs for mentally retarded adults was examined. Psychotropic and/or anticonvulsant drugs were administered to 48% of the sample. The hypnotic, antidepressant, antimanic, and anxiolytic medications were used by 6%-12%, the anticonvulsants by 48%, and the neuroleptics by 66% of those who were prescribed psychotropic drugs. Mildly mentally retarded persons used more neuroleptic, manic, and antidepressant medication. Severely and profoundly mentally retarded individuals used more anxiolytics and hypnotic drugs. Psychotropic and anticonvulsant drug intake varied little by sex. However, an institutional history was associated with higher levels of drug use. Seventy percent of those with an institutional history were prescribed drugs; in comparison, only 27% of those without such a history used medication. The percentage of individuals who used psychotropic and anticonvulsant drugs increased dramatically as both the vocational and residential placements became more restrictive. Possible toxic behavioral effects of psychotropic and anticonvulsant medication upon habilitative efforts were discussed. Future research issues were suggested.

Adolescent↗
PubMed2001

The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients.

A better knowledge of differential treatment outcomes for subgroups of chronic spinal pain patients may, for instance, help clinicians in treatment planning or pain researchers in treatment outcome research. The purpose of this prospective study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the (West Haven Yale) Multidimensional Pain Inventory, the MPI-S. Patients referred to a vocational rehabilitation program were classified into one of three groups, labeled 'adaptive copers', 'dysfunctional' patients, and 'interpersonally distressed' patients, and followed over an 18-month follow-up period. The outcome variables were absence from work (defined as sick listing plus early retirement), general health status, and utilization of health care resources. To our knowledge, the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation. As hypothesized, the results showed that the 'dysfunctional' patient group had significantly more registered absences from work and reported higher utilization of health care, over the follow-up period compared to the 'adaptive copers'. Furthermore, as hypothesized, the 'interpersonally distressed' and 'dysfunctional' patient groups report a poorer general health status than the 'adaptive copers' over the whole follow-up period. However, contrary to our hypothesis, the proportion of improved patients did not differ significantly between the subgroups. Altogether, the predictive validity of the MPI-S subgroup classification was mainly confirmed. The clinical implications of this study suggest that the matching of treatment to patient needs may enhance treatment outcome, reduce pain and suffering among chronic spinal pain patients and facilitate a better health economic allocation of treatment resources.

Absenteeism↗
PubMed2001

A community-based trial of vocational problem-solving to increase employment among methadone patients.

UNLABELLED: Unemployment remains a common problem among methadone patients. This study examined the effectiveness of the Vocational Problem-Solving Skills (VPSS) intervention to help unemployed methadone patients obtain employment. METHODS: 109 patients were randomly assigned to receive 10 sessions of either VPSS (n=62) or Interpersonal Problem-Solving (IPS) (n=47). Fourteen counselors from two methadone programs were trained to deliver both the VPSS and IPS counseling sessions. RESULTS: Overall, 93% (101/109) of the patients completed a 6-month follow-up assessment which revealed that 58.6% (34/58) of patients in the VPSS condition were employed, whereas 37.2% (16/43) in the comparison condition worked (chi-square=4.53, 1 df, p<0.05). However, a multinomial regression equation found that the VPSS intervention did not significantly contribute to the prediction of employment. Other factors such as longer length of previous work experience, 40 years of age or older, treatment site, and baseline patient motivation to work emerged as significant predictors. CONCLUSION: Although VPSS alone was not a strong independent predictor of improved employment functioning, improvements in employment functioning were detected at one of the two sites as a function of VPSS.

Adult↗
PubMedDate not supplied

The effects of mastery training and explicit feedback on task design preference in a vocational setting.

The purpose of this study was to examine the effects of mastery training and explicit feedback on the selection behavior of two individuals with severe mental retardation across two different vocational task designs. The two design options were (a) a site-based (traditional) approach, and (b) a more efficient motion-economy based approach. The site-based design was developed from workshop-standard task analyses. The motion-economy design was developed by re-configuring the site-based design using principles of motion economy and resulted in less distance movement required for task completion. The study was comprised of four assessment phases: (a) no experience (i.e., participant had no experience with either site-based or motion-economy based designs), (b) after training (i.e., participant was trained to criterion level on both design options), (c) training and timer, and (d) training, timer, and work incentives. Selection behavior was affected by task efficiency, only when efficiency was made more salient by pairing task cues with work incentives.

Adult↗
PubMed2000

The role of cognition in vocational functioning in schizophrenia.

Schizophrenia is associated with long-term unemployment. Cognitive dysfunction, rather than clinical symptoms, may be the most important factor in the ability to work for patients with this disorder. To evaluate the relationship of clinical symptoms and cognitive functioning to work status, thirty patients with schizophrenia, who were participants in a vocational rehabilitation program, were evaluated with a comprehensive neuropsychological battery and assessment of psychopathology. Subjects were classified as being in stable full-time, part-time or unemployed work status for at least a year. Univariate analysis indicated that patients who were working full-time were significantly better educated, more likely to be treatment-resistant, more likely to be treated with an atypical antipsychotic medication, had more positive symptoms, and were engaged in work tasks which were more cognitively complex than the part-time employed and unemployed work groups. An ANCOVA controlling for education demonstrated that the full-time employed group performed significantly better than the unemployed group on measures of executive functioning, working memory and vigilance; and significantly better than the part-time group on measures of vigilance and executive functioning. Although negative symptoms did not significantly relate to work status in the univariate analysis, a multiple regression indicated that negative symptoms, level of education, and executive functioning differentiated the work groups. These results suggest that poor premorbid function, negative symptoms and cognitive dysfunction are significantly associated with unemployment in schizophrenia.

Adult↗
PubMed2000

Integrating vocational services on case management teams: outcomes from a research demonstration project.

Recent innovations to improve employment rates among persons with psychiatric disabilities include "hybrid case management/employment services." Project WINS was a research/demonstration project which integrated specialized vocational services into case management teams. In this report, client outcomes of WINS involvement are evaluated, using a quasiexperimental, longitudinal design. On almost all the work-related variables, participants in the immediate and delayed treatment conditions displayed better outcomes than those in the control condition, as did individuals receiving moderate or substantial service versus no/ minimal services. To address possible selection bias due to the quasiexperimental nature of the design, further analyses used baseline differences across conditions and participation levels as covariates. Results of multivariate analyses showed some anomalous findings regarding significant positive effects for the delayed, but not the immediate treatment condition versus the no-treatment control group. However, in similar analyses involving participation level as the independent variable, a moderate or substantial amount of service increased the odds of working by almost five times and also positively affected three other work-related variables. While limitations of this quasiexperimental design are noted, the results appear promising enough to support replications of WINS.

Adult↗
PubMed1995

Stability of vocational interests among the intellectually gifted from adolescence to adulthood: a 15-year longitudinal study.

A sample of 162 intellectually gifted adolescents (top 1%) were administered the Strong-Campbell Interest Inventory at age 13. Fifteen years later, they were administered the Strong again. This study evaluated the intra- and interindividual temporal stability of the 6 RIASEC (Realistic, Investigative, Artistic, Social, Enterprising, Conventional) themes and the Strong's 23 Basic Interest Scales. Over the 15-year test-retest interval, RIASEC's median interindividual correlation for the 6 themes was .46; the median of all 162 intraindividual correlations was .57. Configural analyses of the most dominant theme at age 13 revealed that this theme was significantly more likely than chance to be either dominant or adjacent to the dominant theme at age 28--following RIASEC's hexagonal structure. For intellectually gifted individuals, it appears to be possible to forecast salient features of their adult RIASEC profile by assessing their vocational interests during early adolescence, but some RIASEC themes seem more stable than others.

Adolescent↗
PubMed2001

The Indiana Job Satisfaction Scale: job satisfaction in vocational rehabilitation for people with severe mental illness.

The Indiana Job Satisfaction Scale (IJSS) is a brief job satisfaction questionnaire designed for use with individuals with a severe mental illness. This study seeks to validate the IJSS, as well as to examine the relationship between job satisfaction and job tenure in a group of 71 workers in supported employment. Job satisfaction measured during the first 3 months of a job was significantly associated with job tenure; however, this relationship weakened over time. Overall, the findings support the utility of job satisfaction as a tool in vocational rehabilitation, as well as the validity of the IJSS with this group.

Adult↗
PubMed1982

Social and vocational reintegration of paraplegic and tetraplegic patients in Switzerland.

The purpose of this statistical review (based on 90 acute SCI admissions into the Swiss Paraplegic Centre, Basle in 1979), is to give, in the form of an evaluation, consideration to the social and vocational significance of the patients' disability. Seventy patients (77.8 per cent), are working or will work, (of 35 tetraplegics, 25, of 55 paraplegics, 45); and 67.8 per cent drive a car. So far as marital status is concerned there have been no significant changes as yet. The important question of resettlement was ideally solved in 80 per cent of patients. The improvement of education following injury was in general relatively limited. Twenty-five per cent reported that they have improved their education subsequent to their disability, these coming from the group having initially more than basic education. Socio-economic conditions of our patients are satisfactory. Cases of hardship have been substantially supported by the Swiss Paraplegic Foundation.

Adolescent↗
PubMed1991

Vocational training. The interview.

January: the beginning of another year and time for another batch of dental graduates to decide on their next move. For those considering entering a vocational training scheme, Len D'Cruz outlines what a prospective trainee might expect at the interview stage and, in subsequent articles, during that dreaded first day and on the day releases.

Education, Dental↗
PubMed1998

Portfolio learning in general practice vocational training--does it work?

Reflective learning has been widely addressed as an important learning mechanism in the educational literature. The creation of portfolios has been seen as a mechanism to promote this, though there has been little exploration of the place of a portfolio in general practice training. This study examined the introduction of a model of a portfolio learning strategy into one training region. The model had been developed by previous pilot work. The study explored the model in terms of its usefulness in general practice training and its relationship to reflective learning. An educational facilitator was used to support this introduction. Workshops and written material were developed to disseminate and refine ideas generated in the pilot study. This was followed by visits to trainer/general practice registrar (GPR) pairs over a 2-year period. These visits included semistructured interviews, which were tape-recorded and analysed using qualitative methods. Additional written resources, video and audio material as well as new workshops were designed with the researched participants in order to promote the development of the concepts of portfolio learning. Sixty interviews were carried out over a 2-year period with 44 pairs of trainers and GPRs. This included a total of 27 trainers and 44 registrars. Eighteen pairs were interviewed twice. Two focus groups were used at the end of the project. Portfolios have a place to play in general practice vocational training. They act as a bridge between hospital and general practice. They can be used to develop a learner-centred curriculum, explore difficult emotive concerns and facilitate feedback. They do not suit all learning styles. Their use is determined by a cost-benefit analysis described in this study.

Education, Medical, Graduate↗
PubMed2003

Financial and vocational outcomes 1 year after traumatic brain injury.

OBJECTIVE: To characterize financial and vocational outcomes among persons with traumatic brain injury (TBI) in terms of employment status, earned and private income, and public assistance received at the time of injury and at 1 year after injury. DESIGN: Nonexperimental, longitudinal study. SETTING: Inpatient TBI rehabilitation unit and participants' community of residence. PARTICIPANTS: Thirty-five persons with new TBI from 1 national Traumatic Brain Injury Model Systems center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status, earned and private monthly income, and public assistance received monthly at the time of injury and at 1-year follow-up. RESULTS: From the time of injury until 1-year follow-up, the percentage of persons employed decreased from 69% to 31%; the percentage unemployed increased from 11% to 49%; the average earned monthly income declined 51% (from US dollars 1,491 to US dollars 726); and the mean total public assistance received per month increased 275% (from US dollars 153 to US dollars 421). CONCLUSION: Assuming that this study sample is representative of national statistics for TBI, during the first year after injury, TBI is associated with an estimated $642 million in lost wages, US dollars 96 million in lost income taxes, and US dollars 353 million in increased public assistance.

Adult↗
PubMed2003

[Potentials of the Berufliche Trainingszentren, BTZ--participant centered vocational rehabilitation of persons with chronic mental illness].

Potentials, opportunities of performance--a spectrum of alternatives which can be activated when required as a single measure, varied or in total, low- or high-powered, specifically adjusted or compressed. There are dynamism and power to it! This sounds and feels different from what is demanded all over the world: "standards" or even "minimum standards", minimum quality standards and minimum performance levels, standard equipment, reducing things to the lowest possible common denominator, uniformity, not meeting clients' needs but serving all in the same way, not in the sense of optimum but of minimum. These short polemics are to elucidate the fundamental difference between client focus and client orientation. At certain times in the process of vocational rehabilitation, men and women with mental problems or illness need individually conceived, if necessary improvised, individually composed and well-coordinated services. What kind of men and women we cope with is stated in the chapter on "Target groups", neither completely nor exhaustively--there are no limits to the fantasy and the opportunities of development of clients. In a second major chapter, an attempt is made to show--regarding to some carefully, not arbitrarily selected but not all--the criteria for whom the Berufliche Trainingszentren (BTZ) have developed adequate, client-focused, individual potentials.

Activities of Daily Living↗
PubMed2005

[An enquiry into the WILDE-Intelligence-Test (WIT): comparability of application of the paper-pencil-version vs. the computer based application -- an analysis based on data of the Leipzig Vocational Retraining Center].

This report investigates the equivalence of the computerized version of the WILDE intelligence test (WIT) and its paper-and-pencil analog in a group of occupationally reorienting adults at the Leipzig Vocational Retraining Centre (Berufsförderungswerk Leipzig). In particular, the normative as well as the structural equivalence of the two test formats (paper-and-pencil vs. computer) were examined. The results indicate that both test formats are measuring the same construct, i. e., the two tests are structurally equivalent. Significant differences in mean for the total scores of most of the WIT subtests favour separate standardization of the computerized test format.

Adult↗