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PubMed2004

Vocational rehabilitation in psychiatry: a re-evaluation.

OBJECTIVE: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. CONCLUSIONS AND SERVICE IMPLICATIONS: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.

Australia↗
PubMed1995

Vocational rehabilitation in schizophrenia.

Schizophrenia exacts a heavy toll on a person's capacity to work, and a variety of vocational rehabilitation interventions have been developed over the past few decades to enhance the vocational capacities of persons with this disorder. The research literature on outcomes of vocational rehabilitation during the era of deinstitutionalization for persons with schizophrenia is reviewed. Most vocational rehabilitation programs have a positive influence on work-related activities, but most have failed to show substantial and enduring impacts on independent, competitive employment. Recent advances in supported employment suggest that vocational rehabilitation offers greater promise than do transitional and sheltered employment approaches. Vocational rehabilitation intervention may also exert positive influences on such clinical outcomes as medication compliance, symptom reduction, and relapse.

Deinstitutionalization↗
PubMed1989

Vocational education students: a difficult-to-reach population at risk for smoking-related cancer.

Vocational education high school students comprise a significant proportion of the school-based population. Recent studies indicate vocational education students are at greater risk for cigarette smoking behavior than their non-vocational education counterparts. Vocational students have higher prevalence rates of smoking than do non-vocational students and are more likely to report that they expect to be smoking in the future. Characteristics of adolescents who participate in vocational education and their cigarette smoking behavior are reviewed, as well as the need to develop, implement, and evaluate new educational approaches designed to prevent cigarette smoking and the use of other tobacco products in this difficult-to-reach population.

Adolescent↗
PubMed2004

Response to vocational rehabilitation during treatment with first- or second-generation antipsychotics.

OBJECTIVE: Second-generation antipsychotics may enhance the rehabilitation of individuals with schizophrenia. The authors hypothesized that clients receiving second-generation antipsychotics would use vocational rehabilitation services more effectively and would have better employment outcomes than those receiving first-generation antipsychotics. METHODS: Ninety unemployed clients with schizophrenia and related disorders who were beginning a vocational rehabilitation program were followed for nine months. Three groups were defined according to the medication in use at study entry: olanzapine (N=39), risperidone (N=27), or first-generation antipsychotics only (N=24). Participants were interviewed monthly. RESULTS: The olanzapine and risperidone groups did not differ on any employment outcomes. On most vocational indicators, clients receiving second-generation agents did not differ from those receiving first-generation agents. However, at nine months the second-generation group had a significantly higher rate of participation in vocational training; a trend was found toward a higher rate of paid employment. All groups showed substantial improvement in employment outcomes after entering a vocational program. CONCLUSIONS: The hypothesis that second-generation antipsychotics promote better employment outcomes than first-generation antipsychotics was not upheld. However, second-generation agents appear to be associated with increased participation in vocational rehabilitation.

Adult↗
PubMed2004

Contributions of thinking styles to vocational purpose beyond self-rated abilities.

The present study predicted vocational purpose from thinking styles, a construct at the interface of intelligence and personality. 233 students majoring in history and computer science from a large research-oriented university in the People's Republic of China completed the Thinking Styles Inventory and the Iowa Vocational Purpose Inventory. The participants also rated their own analytical, creative, and practical abilities. In general, results indicated that thinking styles contributed to vocational purpose beyond self-rated abilities. Specifically, the more creativity-generating and complex thinking styles tended to contribute positively to vocational purpose, whereas the more conforming and simplistic thinking styles tended to contribute negatively to vocational purpose. This article points to the need theoretically for integrating the construct of thinking style into the definition of differential psychology. Practical data argue for a collaborative working relationship between teachers and vocational counselors in institutions of higher education.

Adolescent↗
PubMed1976

[Considerations on the selection of training programmes in vocational training centres for disabled adolescents (author's transl)].

Professional workers in vocational research are often asked what kinds of vocational training will be made available in the future for certain groups of people. An answer can be provided neither by demand prognoses nor by analyses carried out to determine the tendency of chance on the labour market. All the more so as today's scientific methods make it almost impossible to obtain reliable data on future vocational structures. When disabled adolescents chose their careers it becomes especially evident that permanent vocational resettlement is only possible when professionals from the various disciplines are closely co-operating in the selection and structuring of the different training programmes. On the other hand, the above considerations reveal the research gaps which have to be bridged if vocational training centres are to provide the disabled adolescents with an equilibrated selection of vocational training programmes. These considerations are presented here to a larger group of professionals from whom the author would appreciate incentives and critical comments.

Persons with Disabilities↗
PubMed2005

Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong.

OBJECTIVES: This study aimed to analyze the ability of the Patient Retraining and Vocational Resettlement (PRAVR) program to enhance the vocational outcomes of individuals with chronic illness, and to study the socio-demographic factors associated with successful vocational outcome. STUDY DESIGN: A retrospective study of 548 individuals with various types of chronic illness who enrolled in the program between 1995 and 2003. Their socio-demographic data and their employment outcome after a six-month job skills retraining and job settlement service were collected for analysis. RESULTS: The program was found to enhance the vocational outcomes of patients who completed the program. Logistic regression identified significant factors predicting successful vocational outcomes. For the male patients, the chances of employment were higher if the onset of illness had occurred at least 10 years before (odd ratios = 0.326). For the female patients, the chances of employment were higher if they had been unemployed for less than 1 year (odd ratio = 3.8). CONCLUSIONS: The PRAVR program is able to enhance the vocational outcomes of people with chronic illness in Hong Kong. The factors which were found to relate to successful employment were unique to the local situation. Further studies should explore these factors in a more in-depth manner.

Adult↗
PubMed1991

Vocational rehabilitation in northern Sweden. I. A socio-demographic description.

Some socio-demographic variables were registered by structured interview in a consecutive series (n = 149) of subjects referred for vocational rehabilitation with a diagnosis of somatic disease. Two years later the subjects were re-interviewed about current occupational and financial status. Initially 43% received sickness allowance and 18% unemployment compensation, the remaining 39% were vocationally active. Almost 19% needed only technical aids to be able to return to/remain in work; an intervention which was used significantly more often for the--relatively older--self-employed than for the rest of the sample. Two years later 80% of those who were vocationally active at the time of referral were still at work, the remaining 20% were undergoing training (11%) or were vocationally inactive (9%). Among those who were receiving sickness benefit/unemployment compensation at referral, 44% were at work and 20% were receiving education. Return to work after vocational inactivity was financially beneficial. It is concluded that vocational rehabilitation in Umeå had a fair rate of success. This may be due to the low rate of handicaps.

Adult↗
PubMed1991

Vocational rehabilitation in northern Sweden. II. Some psycho-socio-demographic predictors.

In this prospective investigation a consecutively referred series of vocational rehabilitation clients was studied using eleven socio-demographic and psycho-social items. Subjected to a factor analyses these items were included in five factors which explained 74% of the variance. By discriminant analysis the items could correctly classify 57% of those subjects who faced major vocational changes or were vocationally inactive. The level of experienced health and belief in vocational return had the heaviest overall predictive impact. The findings may help specialists in medical and vocational rehabilitation to estimate the likelihood of vocational return for somatically impaired subjects.

Persons with Disabilities↗
PubMed1999

An evaluation of a community-based vocational rehabilitation program for adults with psychiatric disabilities.

The purpose of this research is to examine the effectiveness of a project aimed at the vocational rehabilitation of individuals suffering from chronic psychiatric disabilities. Gastown Vocational Services (GVS) is a specialized vocational rehabilitation program, under the auspices of Greater Vancouver Mental Health Service Society. The project consisted of three distinct phases and utilized a gradual, step-by-step rehabilitative approach to achieve vocational success. The first phase of the GVS project included comprehensive vocational assessment and work-readiness skill training. Participants in this phase met in small groups for three hours, three times a week for a 12-week period. The second phase involved supported work-experience placements in the community. These placements were two to five months in duration. The final phase included assistance in seeking employment, job re-training, or educational programs. Assessment measures were taken before participants began the program, immediately after the 12-week job preparation program, and at six-month follow-up. Seventy-three individuals participated in the training program over a two-year period. Their progress was compared to 18 individuals comprising a Waiting List Control group. The results showed significant improvement in the Intervention group on measures of assertiveness, work behaviour, depression, income, and employment status. No changes were evident in the Waiting List Control group.

Adult↗
PubMed1999

How do vocational and relationship stressors and identity formation affect adolescent mental health?

PURPOSE: This article examines the effects of stressors in both the vocational and relationship career of youngsters in the formation of their identity; the effects of identity formation on adolescent mental health; the influence of career stressors on mental health, directly or via identity, and differences in these effects on boys and girls. METHODS: Data were used from the Dutch national panel study, Utrecht Study of Adolescent Development, a study of developmental processes as they occur in the life course of young people during the 1990s. Using LISREL, we tested hypotheses on two waves of a sample of 1222 respondents between 15 and 24 years of age in Wave 1 (1991). RESULTS: The correlation between relationship stressors and relationship identity can be neglected, while vocational stressors lead to a less achieved vocational identity, particularly in boys. Occupational and relationship identity have similar effects on mental health (i.e., the more achieved the identity, the better the person's mental health). Vocational and especially relationship stressors lead to poorer mental health, but did not affect the mental health of boys and girls differently. The same goes for the influence of relationship and vocational identity formation on mental health. CONCLUSIONS: Career stressors, especially stressors in the relationship domain, appear to have significant long-term effects on adolescent mental health. Vocational and relationship identity formation are also significant predictors for adolescent mental health.

Adolescent↗
PubMed2000

What makes a good dentist and do recent trainees make the grade? The views of vocational trainers.

OBJECTIVE: The aim of this paper is to examine the factors that vocational trainers regard as important in a 'good' dentist and to assess whether they think recent graduates were achieving these factors. DESIGN: The study was based on a statistical analysis of returns from a postal questionnaire. SETTING: Postal questionnaires were sent to all vocational advisors in England who then sent them on to a number of their vocational trainers. MATERIALS AND METHODS: The questionnaire was analysed using various statistical techniques including factor analysis. Analysis was undertaken to determine whether student or trainer characteristics influenced the trainer's responses. RESULTS: The vocational trainers judged that the group of skills that contribute to technical ability are the most important component in making a 'good' dentist. However, the most important single skill is communication with patients, closely followed by diagnostic skills and communication with the dental team. The areas where trainees are most likely to fall short in terms of actual as compared to desired performance are in areas of technical ability. CONCLUSION: Overall, recent trainees scored rather well when compared with an idealised good dentist. However, it is clear that more evaluation of vocational training is needed. Recent studies, including this one have looked at several different aspects of vocational training. However, the time seems ripe for a full-scale prospective evaluation.

Attitude of Health Personnel↗
PubMed1998

Are vocationally trained general practitioners better GPs? A review of research designs and outcomes.

Implicit and explicit in reviews of and changes to vocational education for general practitioners in the 1990s is the challenge to defend the assumption that vocationally trained GPs are better GPs. This paper provides a review of the international literature which has reported on outcomes of general practice vocational training programmes. Through the review we identify both the types of research methodologies used (including a brief discussion of their strengths and limitations) and the outcomes reported of vocational training. Twenty-five studies on the outcomes of vocational training are reviewed. These studies used multiple data sources and one of four methodologies: pre- and post-training comparisons, analysis of learners' or teachers' accounts, audits of general practice or analysis of examination pass rates. When collated, the following range of outcomes from vocational training were identified: improved quality of patient care, increased knowledge, improved general practice skills, increased confidence and desirable GP attitudes and personality traits, increased adherence to practice guidelines and higher examination pass rates. The paper concludes with a summary of research and education issues which arise when we examine the question posed at the outset: are trained GPs better GPs?

Career Choice↗
PubMed2004

Activity limitations in personal, domestic and vocational tasks: a study of adults with inborn and early acquired mobility disorders.

PURPOSE: To compare activity limitations at the workplace with those in the home situation. SUBJECTS AND METHODS: Sixty-nine subjects, 22-49 years of age, with inborn or early acquired mobility disorders and with experience of vocational employment were studied. They were interviewed to assess their level of dependence according to the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) and in 22 vocation-related items. Rasch analysis was perfomed in order to assess the relative difficulty of the items. In the vocational items the subjects rated perceived difficulty on a 4-level scale. Satisfaction in one general and six domain-specific areas was rated on a 6-level scale. RESULTS: Forty-six per cent of the subjects were dependent in one or several FIM items, 90% in IAM items and 38% in the vocation-related items. In 15 of these items great difficulty was reported by few subjects. Collapsing the 7-category scale for dependence to four categories gave the best Rasch model. Most of the IAM items were the hardest to manage without assistance. FIM social-cognitive and cognitive vocation-related items were the easiest items. Most subjects were satisfied in the general and domain-specific areas. CONCLUSIONS: Activities related to household tasks and transportation demonstrated the highest level of dependence, whereas it was easier to acquire independence in most vocation-related tasks.

Activities of Daily Living↗
PubMed1977

A 4-year prospective study of the relationship of different habitual vocational physical activity to risk and incidence of ischemic heart disease in volunteer male federal employees.

A prospective study of coronary heart disease (CHD) was done in 2,635 volunteer male federal employees of postal, health, aerospace, and other agencies, aged 35--59 years at intake. The present analysis is concerned with 2,065 initially well whites, of whom 65 suffered clinical CHD during a 4 years of annual follow-up. The subjects differed markedly in their levels of habitual vocational physical activity, which is classified (1) by division into sedentary, moderate, and heavy activity groups, (2) by blue collar or white collar type of occupation, and (3) by calculated annual caloric expenditure for both vocational and non-vocational physical activities. Intake variables that were studied in relation to physical activity and the CHD incidence include age, serum cholesterol, systolic blood pressure, relative body weight, ECG abnormality, and cigarette smoking. Socioeconomic status (SES) is assessed by levels of education and income and by a combined SES categorization based upon both. Estimated composite CHD risk scores are based upon Framingham equations. The CHD risk factors, singly, as well as in a derived composite risk score, are higher for men with heavy compared to sedentary or moderate habitual physical activity. However, this is a spurious association found to be induced by differences of SES. Thus, when physical activity and SES are studied in a concurrent analysis, a higher CHD risk is significantly associated with lower SES status but not with differences of vocational physical activity. The CHD incidence in this population is studied in relationship both to the risk factors and physical activity by multivariate analysis, using the multiple logistic risk model. The incidence of CHD is significantly associated with age, serum cholesterol, systolic blood pressure, and cigarette smoking. It is not found to be associated with the type of occupation (i.e., blue or white collar), the level of reported habitual vocational physical activity, or the calculated total vocational plus nonvocational caloric expenditure in physical activity.

Adult↗
PubMed1980

Vocational status: prediction by the Barthel index and PULSES profile.

Functional assessment measures of patients in a rehabilitation hospital were used to predict vocational status 18 months after discharge. The Granger adapted version of the Barthel index and the PULSES profile were administered to 118 disabled persons at discharge. Their total scores were correlated with vocational status measured by a scale of 1 to 6, ranging from unemployment to full-time employment. Analysis of data reveals that the Barthel index and sex (female) predicted vocational status 18 months after discharge (p < 0.05). PULSES showed no significant correlation with vocational status. Further analysis indicates that in a stepwise regression of independent variables on vocational status, the best predictors were the Barthel index, sex (female), age (the younger are more likely to pursue a vocation), contacts with state rehabilitation counselor, and contacts with Tufts counselor. Further studies are needed to examine specific subgroups of the physically impaired population seen by medical centers and state rehabilitation agencies.

Adolescent↗
PubMed1990

[Vocational preparation and education of adolescent patients with epilepsy].

Often young epileptics cannot begin a regular apprenticeship immediately after leaving school. Many cases show some somatic and psychointellectual retardation and delayed social development and maturation. Impairment of learning and concentration due to drug-side effects aggravates gaps in basic knowledge which result from frequent school absences due to epileptic illness. Attendance of a vocational training scheme for one year ensures that educational and social deficiencies can be reduced and the practice of daily work can be obtained. The epileptologist should pay particular attention to good compliance. The large variety of psycho-social and behavioural problems can be improved by event-orientated group psychotherapy. A vocational testing period can follow. Time and type of seizures have to be respected in vocational counselling. The vocational training centre for handicapped adolescents offers a comprehensive education by vocational instructors, epileptologists and psychologists.

Adolescent↗
PubMed2003

Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation: a randomized controlled trial.

OBJECTIVE: Job loss is a major consequence of rheumatic diseases, and clinicians may refer patients to vocational rehabilitation for help. When provided after job loss, the impact of vocational rehabilitation is short term. This randomized controlled trial with 48 months of followup was undertaken to determine the efficacy of vocational rehabilitation provided to persons with rheumatic diseases while they are still employed, but at risk for job loss. METHODS: A total of 242 patients with rheumatic diseases residing in Massachusetts were recruited through their rheumatologists for study. Participants were randomly assigned to the experimental group (n = 122) or the control group (n = 120). Subjects in the experimental group received two 1.5-hour sessions of vocational rehabilitation; those in the control group received print materials about disability employment issues and resources by mail. The main outcome assessed was the time to first job loss. Job losses were defined as permanent disability, premature retirement, or a period of unemployment. All analyses were conducted on an intent-to-treat basis. RESULTS: Job loss was delayed in the experimental group compared with the control group (P = 0.03 by log rank test). After adjustment for confounders, participation in the experimental group was found to be protective against job loss (odds ratio 0.58 [95% confidence interval 0.34-0.99], P = 0.05 by pooled logistic regression). CONCLUSION: Vocational rehabilitation delivered to patients at risk for job loss, but while they were still employed, delayed job loss. Such an intervention has the potential to reduce the high indirect costs, as well as the personal impact, of rheumatic diseases.

Adolescent↗