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PubMed2005

Vocational training integrated into inpatient psychosomatic rehabilitation--short and long-term results from a controlled study.

PURPOSE: The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation. METHOD: 1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups. RESULTS: More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers. CONCLUSION: An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.

Adult↗
PubMedDate not supplied

Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: employing cautious optimism.

OBJECTIVE: While there are now effective interventions for the symptoms of psychosis and schizophrenia, treatment for the functional domains of these illnesses has received less attention. A key area affected by psychotic illness is vocational functioning. This area is currently of interest to clinicians, policy-makers, politicians and patients. This paper reviews several forms of vocational intervention practised over the years and highlights the issues around adopting an early intervention approach towards vocational rehabilitation. The paper has four aims: first, to consider some of the consequences of unemployment for those with psychotic illnesses; second, to review methods that have been used to address unemployment among the mentally ill; third, to highlight the importance of vocational development at a developmentally appropriate life stage; and finally, to consider the application of evidence-based vocational rehabilitation to those with first-episode psychosis. METHOD: An initial broad literature search was conducted using PsychInfo and Medline databases. Further narrower searches were conducted electronically where indicated. Finally, some articles were sourced through manual searches of relevant journals. RESULTS: People with psychotic illness have a high rate of unemployment at the outset of their illness which tends to worsen over time. This is complicated by systemic factors such as the structure of the welfare system. Approaches for assisting people with mental illness return to work have evolved over the history of psychiatry. There now exists an evidence-based method of intervention. To date this has not been trialled in a systematic way with people in the early stages of psychotic illness. CONCLUSIONS: There is cause for cautious optimism in the vocational recovery of people with psychotic illnesses. Limited evidence exists that the individual placement and support approach developed with chronic populations is very effective in early episode patients. There are a number of challenges to implementing vocational intervention in first-episode psychosis. Overcoming these obstacles will require the cooperation of clinicians, those with illness, policy-makers and politicians. However, the potential economic, health and personal gains, as well as current and future research should provide sufficient motivation to overcome these barriers.

Career Choice↗
PubMed2004

Better definition of vocational services is critical within substance user treatment programs.

Vocational rehabilitation in substance user treatment programs is often poorly defined; programs rarely provide adequate descriptions of the vocational services they offer. There is no standardization in the content of vocational counseling, in the format of its delivery, or in the qualifications of staff that deliver it. Thus, the type, intensity, and quality of vocational services can vary widely among programs, as well as over time within a given program due to vocational staff turnover. However, current demands for greater accountability in social services pose a challenge to this state of affairs. There is no evidence that vocational services as currently delivered in treatment programs are either effective or even reasonably efficient. Note that "programs are increasingly called on to justify their existence, their expenditure of funds and their achievement of objectives. Behind the call for accountability is an awareness of the gap between almost unlimited social need and limited resources" (Weiss, 2004). It is difficult to achieve accountability for ill-defined and variable vocational services.

Counseling↗
PubMed2005

Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation.

Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.

Adult↗
PubMed1991

Vocational rehabilitation in northern Sweden. III. Aspects of life satisfaction.

Levels of global (1 item) and domain-specific (8 items) life satisfaction were explored at the commencement of vocational rehabilitation and two years later in a consecutive series of subjects who were partly or completely vocationally disabled with a diagnosis of bodily impairment. At the onset of vocational rehabilitation, global life satisfaction (satisfaction with life as a whole) and satisfaction derived from performance- and provider-related (instrumental) domains of life were significantly lower than satisfaction derived from socio-emotional (expressive) facets of life. The eight domain-specific items of life satisfaction described a characteristic three-factor pattern (76% of variance) which resembled quite closely that of non-impaired subjects, one factor being expressive. The other two factors were instrumental and separated recreative from vocational domains of satisfaction. Successful vocational rehabilitation resulted in increases in vocational satisfaction. For those subjects who were successfully rehabilitated, satisfaction with other instrumental aspects of life and with life as a whole also increased. The results indicate that successful vocational rehabilitation leads to increased social well-being.

Persons with Disabilities↗
PubMed1982

Vocational development of spinal cord injury patients: an 8-year follow-up.

This study determined the relationship between the vocational and educational plans, interests, work values, and rehabilitation outlook of patients with traumatic spinal cord injury (SCI) and their vocational and social adjustment 8 years after first hospital discharge. While hospitalized the patients were given 15 measures of vocational development on a scale ranging from 13 to 52. Reliabilities (r) of the 15 measures ranged from r = 0.77 to r = 0.96, with the average reliability of the scale measured at 0.88. Eight years after discharge each patient was sent a questionnaire covering his/her school and employment history since discharge. Occupational status was classified by 3 categories: competitive labor market, student or homemaker, and unemployed. All data were subjected to intercorrelations and factor analysis. Five persons were employed in the competitive labor market, 1 was a student, 1 had retired after working for 6 1/2 years, and 17 were unemployed. Compared to a study of the same group after 4 years, 2 more persons were employed, including 1 who subsequently retired. The best predictors after 8 years were vocational plans, work interests, work values, remotivation, rehabilitation outlook, and grade completed. Four years after discharge, the best predictors were educational and vocational plans and remotivation and rehabilitation outlook. The findings indicated that patients with traumatic SCI did not significantly enhance their employment after another 4 years in the community. Nevertheless, 6 measures of vocational development were predictive of vocational adjustment after discharge.

Adult↗
PubMed1992

[Combined vocational education and industrial management--presentation of a cooperative project for improved integration of adolescents with learning handicaps].

Major structural labour market changes, i.e. dramatic losses in job opportunities for unskilled labour and continually rising levels of job requirements facing skilled workers on the one hand and an increasing demand for skilled workers on the other, are entailing enhanced job opportunities for disadvantaged societal groups, at the same time however also increasing the occupational risk of these populations, among them the learning disabled. The vocational training centres having for more than a decade been gaining experience in the vocational and social rehabilitation of this latter group, the project outlined is intended to make even better use of their potential. The main objectives of the project are: 1. optimizing the vocational training centres' range of placement-focussed measures by: intensifying industrial training periods, coordinated "start up" support on occupational entry, post-placement services; 2. transfer of the vocational training centres' technical knowledge and experience into industry-based training by: follow-along support services ("ausbildungsbegleitende Hilfen"), workshops on the initial vocational training of learning disabled young adults, and other forms of cooperation. Apart from reaching the goals outlined, the project is expected to give new impulse to the day-to-day practice of the vocational training centres as well as to generate even greater networking of the centres with their industrial environments.

Adolescent↗
PubMed2005

Doctors in vocational training: rural background and rural practice intentions.

OBJECTIVE: To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time. DESIGN: A self-administered mailed survey. SETTING: Vocational training: general practice and other medical college training programs. SUBJECTS: Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002. MAIN OUTCOME MEASURES: Intention to practise in a rural area on completion of vocational training; full-time or part-time practice plans; views about rural practice. RESULTS: Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time. A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrollment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1). CONCLUSIONS: The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.

Adult↗
PubMed2002

Nursing as vocation.

In this article the author argues that nursing is best understood as a vocational occupation. Using Blum's model of vocations it is argued that such occupations are socially expressed within practices embodying traditions, norms and a range of meanings: industrial, social, personal and moral. Vocational workers are those who identify in certain ways with these traditions, norms and meanings. One problem with the vocational model, as it has historically applied to nursing, is that it has been articulated through concepts of motherhood. Nursing was a vocation precisely because the character of the nurse was identified as feminine. The author argues that the vocational model for nursing can be conceptually disentangled from its identification with ideals of motherhood and femininity. It is nursing work and the identification with the moral and social meaning of nursing that give nursing its vocational status, not the feminized character of the nurse.

Career Choice↗
PubMedDate not supplied

Utilizing neuropsychological measures to predict vocational outcome in a head trauma population.

The present study examined the ability of traditional neuropsychological measures to predict successful vocational training in a severely neurologically impaired population. Eighty head trauma patients were evaluated prior to pre-vocational training which involved cognitive remediation and psychosocially-based intervention. Subjects were approximately 2 years post-injury. Results showed that of the total population studies, 73.8% participated in vocational evaluations, 23.8% did not, and 2.4% of the sample returned to work or college. Neuropsychological assessments were over 77% accurate in predicting whether subjects would successfully complete this vocational evaluation. The most significant predictors were reading comprehension, immediate and delayed verbal memory, level of depression, and dysphasic symptomatology. Issues relating to generalizability of cognitive retraining to the vocational evaluation and/or vocational training setting are discussed. Future considerations for both clinical practice and research include the use of ecologically valid measures.

Adolescent↗
PubMedDate not supplied

Occupational therapy's link to vocational reeducation, 1910-1925.

The development of occupational therapy is rooted in early 20th century medical reform. During the early 1910s, several members of the medical profession, human service workers, and the larger American society were increasingly disturbed by medical practices that did not consider the individual's personal experience of disability. Occupational therapy was developed, in part, out of this desire to provide persons with treatment that helped them to function in their communities despite their disability. Early occupational therapy leaders envisioned the fledgling profession as a societal service capable of assisting persons with disabilities to return to both work and community life. Vocational reeducation was initially considered to be an integral component of occupational therapy in the years from 1910 to 1920. However, the profession's early link to vocational reduction was challenged by vocational technical trainers during World War I. To prevent occupational therapy from being subsumed by vocational technical training, the early occupational therapy leaders implemented several strategies: adoption of physician prescription for all occupational therapy services, delivery of occupational therapy services primarily within hospital settings, and dissociation from vocational reeducation services. Reasons accounting for why the early occupational therapy leaders abandoned their initial commitment to vocational reeducation are explored. Suggestions about how this decision has affected present-day practice are also offered.

Persons with Disabilities↗
PubMed1981

[On the vocational counselling of physically disabled young people--some remarks on the findings presented by E.-M. Weinwurm-Krause (author's transl)].

Hand in hand with the continuing development of vocational counselling for disabled young people went to updating and differentiation of vocational orientation material available to the disabled for preparing their choice of occupation. Increased attention had above all been paid to counselling of the thalidomide-affected. Their concerns, especially as regards assessment of aptitudes and inclinations, are particularly headed in vocational guidance, an instrument that had been defined more specifically in the late seventies. The vocational education centres must be considered an essential aid in the training of, particularly, the physically disabled as the required accompanying services (for medical, psychological and social educational care) can be made available here. By means of training regulations for the disabled, as provided for in the Vocational Education Act and the handicrafts ordinance, these training facilities for the disabled are also most readily in a position to make allowances in view of the nature and consequences of a disability, when this is held to be necessary by the vocational counselling service due to the professional opinions presented by psychologists and/or physicians. No rehabilitation measure can however be initiated unless the disabled young person and his or her parents consent.

Adolescent↗
PubMed1993

[Adolescents with autism syndrome and autistic manifestations in vocational education centers].

Young people with autistic syndrome or autistic traits have for some years also been included in vocational training centre programmes. The present study had been aimed at analyzing the experience gained during vocational rehabilitation service provision and at fathoming conditions for a successful training course and placement process. 10 centres reported their experience from vocational training of 29 autistic young people, with the following noted in conclusion: The vocational training centres primarily accept young people with qualified educational levels and moderate behavioural peculiarities. The training as a rule is completed successfully. During programme participation, however, considerable problems arise in acquiring social and communication skills as well as in cognitive respects. Notwithstanding successful training completion, only some 25% could be placed in appropriate employment in the general labour market. Communication problems, impact of vocational training centre infrastructure, supportive and follow-up services, preparation and follow-along of staff, as well as alternatives to current vocational education practices are discussed.

Adolescent↗
PubMed1994

Vocational rehabilitation in maintenance dialysis patients.

When Congress was considering extending Medicare coverage to those with chronic renal failure, it was predicted that 100% of these individuals would be vocationally active. Unfortunately, the actual vocational rehabilitation rate for this population is much below these earlier predictions. A comprehensive review of the literature establishes that there are variables that affect the employability of those on dialysis. These variables can be grouped into four main categories: demographic, psychological, medical, and occupational. In addition, there are barriers to enhanced vocational rehabilitation for individuals receiving dialysis therapy, and these can be grouped accordingly: workplace, financial, dialysis facility/personnel, vocational rehabilitation, and labor market. Enhanced research efforts, intervention with employers and vocational rehabilitation programs, changes within the Social Security system, and modification of renal team practices could all serve to enhance the vocational rehabilitation status of individuals with chronic renal failure.

Chronic Disease↗
PubMed2003

Improving the vocational status of patients with long-term mental illness: a randomised controlled trial of staff training.

OBJECTIVE: To investigate the impact of training CMHT members in the practice of Individual Placement and Support on the vocational status of long-term patients. METHOD: Six CMHTs received vocational training by a work co-ordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified. RESULTS: There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome. CONCLUSION: Training in IPS at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful IPS.

Adolescent↗
PubMed2003

[Predictive factors of successful vocational re-integration in patients with chronic schizophrenia].

OBJECTIVE: Vocational re-integration of patients with chronic schizophrenia remains even with the help of comprehensive integration programs a very ambitious aim. Therefore, a profound and up-to-date knowledge of vocational outcome predictors is imperative. The objective of the present study was, while minimizing the influence of the instruments used, to generate factors, which predict best the re-integration outcome. METHOD: In a sample of 76 chronic schizophrenia patients ten relevant factors were derived from a factor analysis including 32 variables. In a second step the predictive value of these ten factors centering on vocational outcome were tested by logistic regression analysis. RESULTS: Participants who had a successful outcome showed a good vocational capacity before and during the two-week assessment phase, had no social deficits and no depressive-resignative coping strategies. Schizophrenia symptoms and cognitive deficits, however, were of minor relevance. CONCLUSIONS: The results of our factor-analytic approach confirm earlier findings that vocational functioning observed in a sheltered setting and social competence are the best predictors for successful vocational rehabilitation. Moreover, they serve to substantiate the necessity of developing therapeutic programs that enhance patients' hopefulness and self-confidence.

Adult↗
PubMed2006

[Problems in the vocational rehabilitation of mentally ill subjects--a simple procedure to identify persons with an increased risk for premature termination of a training programme].

UNLABELLED: A small number of young mentally ill persons consumes a disproportionate amount of psychiatric service resources. These persons are characterised by emotional instability, aggressive or delinquent behaviour, substance misuse and personality disorders. They are sometimes referred to as young adult chronic patients (YACP). To date there has been no investigation as to what impact this pattern of problem behaviour has on vocational rehabilitation. AIM: The aim of this study was to find out whether belonging to the YACP group, as determined by an operational definition, reduces the outcome of vocational rehabilitation. METHOD: A chart review was done of the files of all 174 participants of a 15-month vocational training course held between 1.1.1993 and 2.5.1998 in the vocational training centre at Cologne. A 15-item score was used to assess YACP status. RESULTS: 30 % were classified as high scorers, i. e. YACP. 59 % of the high scorers vs. 22 % of the low scorers terminated training prematurely. Of the high scorers who completed training, only 47 (vs. 74 % of low scorers) were judged to be able to work at the end of training. CONCLUSION: At the very beginning of the vocational training persons in need of a highly individualised format can be discerned by a few, easy to assess items. Concepts of vocational training should be developed to better suit the needs of young mentally ill persons with personality disorders and substance abuse.

Adult↗
PubMed2001

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Adult↗