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PubMed2002

[Opinions of clients on vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVES: Evaluation of opinions of those evaluated by a multidisciplinary team on the evaluation, vocational rehabilitation they participated in and on the effect of the process on their self-confidence and self-reliance. MATERIAL AND METHOD: The Institute of Social Sciences carried out a telephone survey in October 2001, where it was attempted to contact the 109 individuals evaluated for rehabilitation potential by a multidisciplinary team in the year 2000. The data was analysed using descriptive statistics. RESULTS: 83 (76.1%) replied. After the evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. Approximately 80% were content with the vocational rehabilitation offered. 54% of those evaluated by the multidisciplinary team said that it had been useful for them to meet the members of the team and 59% said that the team had informed them on resources they had not been aware of. Approximately half of the participants said that their self-confidence and self-reliance had increased. CONCLUSION: Approximately 80% of the participants were content with the vocational rehabilitation offered and approximately 50% had gained more self-confidence and self-reliance.

English Abstract↗
PubMed2002

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.

English Abstract↗
PubMed1994

Vocational integration services in community mental health: professionals' perceptions of training needs.

Vocational integration in mental health is part of a national initiative to make quality, community-based work a possibility for persons with psychiatric disabilities. While effective delivery of these services requires trained staff, preparing professionals to provide relevant vocationally oriented services is complex and challenging. This study examines perceived priority training needs in vocational integration services from the perspectives of professionals in mental health, rehabilitation, and education organizations in Mississippi. Findings suggest that vocational integration activities are perceived differently across organizations and across occupational specialties. Implications for staff development in community support and psychosocial rehabilitation programs are discussed.

Community Mental Health Services↗
PubMed1995

Relationships between psychiatric symptomatology, work skills, and future vocational performance.

OBJECTIVE: Experts do not agree on what, if any, relationships exist between diagnosis, symptomatology, work skills, and the future vocational performance of persons with severe mental illness. The objective of this study was to longitudinally examine such relationships, using a sample of clients who were attending psychosocial rehabilitation programs. METHODS: Subjects were 275 clients of three psychosocial rehabilitation programs who had expressed a vocational goal. They were assessed at intake into the study and then quarterly until they left the rehabilitation program. The variables examined included symptoms, measured by the Brief Psychiatric Rating Scale; diagnosis; work skills, measured by the Griffiths Work Behavior Scale; and vocational status at end-point. RESULTS: Among subjects remaining in the study for one year, both symptomatology and work skills improved significantly. Moderately significant negative correlations were found between symptoms and work skills; subjects who became employed had lower symptom scores and higher work skills than persons who never became employed. CONCLUSIONS: Although a moderate relationship was found between symptomatology and work skills, symptoms should not be considered a proxy measure for vocational functioning among persons with severe mental illness. Participation in psychosocial rehabilitation programs appeared to have a salutary effect on symptoms and work skills.

Activities of Daily Living↗
PubMed1978

A comparative study of five groups of handicapped children in vocational rehabilitation.

This study explored the vocational and educational plans, work values, realism, initiative commitment to choice, and awareness of occupational information of five groups of handicapped children compared with a group of normal children in grades 6--12. Handicapped children tested significantly lower on all measures of vocational development. Only the cystic fibrosis group approached the high scores of the normal group. Age, grade, and social class were the best predictors of vocational development in all six groups. The findings confirmed the hypothesis that handicapped children are less prepared for vocational training and placement and consequently require special rehabilitation programs to prepare them for work.

Adolescent↗
PubMed2004

Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia.

Cognitive impairments in schizophrenia appear to be associated with social problem solving, social and vocational functioning, and psychosocial skill acquisition. The present study examined the relationship of cognitive functioning, as well as clinical symptoms, to vocational outcomes among individuals with schizophrenia. One hundred and twelve participants with DSM-IV schizophrenia spectrum diagnoses underwent a comprehensive neuropsychiatric evaluation after enrolling in one of several employment programs. The neuropsychological evaluation examined verbal learning and memory, attention, speed of information processing, and executive functioning. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS). Vocational outcomes were assessed 4 months after baseline assessment and included both measures of employment outcome (e.g., earnings) and of work performance as assessed by the Work Behavior Inventory (WBI). Negative symptoms, learning and memory performance, processing speed, and executive functioning were related to hours, weeks, and wages earned on the job. Stepwise multiple regression analyses found that among baseline clinical and cognitive predictors, only verbal learning and memory and cognitive disorganization symptoms were significant predictors of work behaviors 4 months later. Learning and memory were the only significant predictors of integrated employment at 4 months. These results suggest specific aspects of cognition may be modestly predictive of vocational outcomes.

Achievement↗
PubMed1995

Employment after rehabilitation for musculoskeletal impairments: the impact of vocational rehabilitation and working on a trial basis.

OBJECTIVE: To investigate to what extent vocational rehabilitation and working on a trial basis have an impact on employment after rehabilitation. DESIGN: Follow-up survey, conducted in 1991, among all patients, aged 14 to 64, who were treated between 1984 and 1987. SETTING: An out-clinic department of a rehabilitation center in the west of The Netherlands. SUBJECTS: 395 patients (59% of the original sample) participated in the study. They suffer from musculoskeletal impairments due to back pain (41%), brain injury (20%), neurological disorder (12%), trauma to the upper and/or lower extremities (8%), rheumatoid arthritis (7%), or other disorders (12%). No differences were found between those who did and those who did not respond with regard to age, gender, marital status, disorder, work experience, and participation in vocational rehabilitation. MAIN OUTCOME MEASURE: Odds ratio of having a paid job after rehabilitation. RESULTS: Participation in vocational rehabilitation and working on a trial basis depends on age, gender, work experience, and disorder. When statistically controlled for these variables vocational rehabilitation (odds ratio 1.96; 95% confidence interval 1.12 to 3.42) and working on a trial basis (odds ratio 3.26; 95% confidence interval 1.74 to 6.11) proved to have a significant impact on employment after rehabilitation. CONCLUSIONS: The findings suggest that rehabilitation programs that aim specifically at promoting employment for people with disabilities are effective, in particular when they take place in both a laboratory and a natural setting. The validity of this suggestion must be further tested by means of an experimental design.

Adolescent↗
PubMed2004

Stability of vocational outcome in adulthood after moderate to severe preschool brain injury.

We studied how moderate to severe childhood traumatic brain injury (TBI) affects vocational outcome with time. This is the second follow-up of patients who were injured as preschoolers in traffic accidents. In the first follow-up the mean age was 23 years and in the present study the average age of the 27-patient cohort was 40 years. Twenty-two patients were assessed clinically by a neuropsychologist, neurologist and a social worker. Five patients, although not able or willing to participate in the clinical study, were contacted by telephone and interviewed on their vocational outcome. Compared to the first follow-up, 20/27 patients in total had no change in their vocational status. Nine out of the 27 patients were working full-time, two had subsidized jobs and 16 were not working. Twenty-four of 27 patients were independent in daily living. In the neuropsychological tests of executive functions, preserved flexibility associated with full-time work status. In conclusion, 1/3 of the patients were still employed full-time over 30 years after the TBI. This suggests that favorable vocational outcome, reached by young adulthood, is maintained at least until middle age.

Adult↗
PubMed2000

Long-term psychiatric patients in vocational rehabilitation programmes: a naturalistic follow-up study over 3 years.

OBJECTIVE: This paper aims at assessing the vocational integration attained after a 3-year period by psychiatric patients who participated in different vocational rehabilitation programmes. METHOD: In the north-western German region of Westphalia-Lippe a naturalistic follow-up study was carried out on 471 patients from three different types of vocational rehabilitation programmes. The sample comprised chronically ill patients with a history of repeated and long-term hospitalization. RESULTS: After 3 years 11% of the patients were in competitive employment, 67% (still) in sheltered employment, 7% in out-patient work therapy programmes and 15% were unemployed. It is important to notice that 74% achieved their subjective rehabilitation goals expressed at baseline. CONCLUSION: Vocational rehabilitation programmes are an essential part in the treatment of people with chronic mental illness. Integration into work varies markedly while patients' satisfaction is comparably good. Competitive employment represents a realistic objective only for patients with high motivation and favourable preconditions.

Adult↗
PubMed2000

[Vocational rehabilitation in chronic mental illness. The current position].

Vocational rehabilitation has long been of central importance in the comprehensive treatment of the psychiatrically disabled. This is reflected by the creation of a broad spectrum of vocational rehabilitation programs, ranging from inpatient and outpatient work therapy and sheltered employment to supported employment programs within the competitive labour market. Evaluation studies have shown that although sheltered vocational rehabilitation programs effect a significant rise in the work activity, rate of employment, job tenure and income of people with chronic mental illness in the alternative labour market, these programmes do not substantially increase job placement in the competitive labour market. By contrast, supported employment programs have proven more successful in achieving a higher integration rate in the competitive labour market for the chronically mentally ill. As opposed to the well-developed alternative labour market, supported employment programs are not broadly disseminated in German-speaking countries. Furthermore, vocational rehabilitation in general suffers from a lack of systematic evaluation and thus from inadequate scientific foundation.

Humans↗
PubMed2005

[Predicting improvement in work status of patients with chronic mental illness after vocational and integrative rehabilitation measurements].

PURPOSE: Chronically mentally ill patients often need special rehabilitation to be able to re-enter competitive employment. We know only very little about predicting favourable or unfavourable rehabilitation courses. The present study seeks to examine the relationship between successful rehabilitation -- as defined by a progress in professional ability -- and individual parameters obtained at initiation off-take. METHOD: Data of 101 subjects who had completed a rehabilitation programme serve as the basis. At the beginning of rehabilitation, sociodemographic, intellectual, psychopathological and quality of life measures were obtained. Each participant was assigned to one of two rehabilitation outcome groups: progress vs. stagnation, determined by the vocational status after programme termination. Both groups were then compared regarding the aforementioned parameters at programme onset to identify substantial predictors for rehabilitation success via regression analysis. RESULTS: High level of functioning, fewer periods of unemployment, a high level of work-related adaptation, and young age at programme onset were found to be predictive of progress in vocational status. CONCLUSIONS: Objective parameters have a higher predictive potential regarding vocational reintegration of psychologically ill people compared to subjective criteria. Psychiatric diagnoses as defined by DSM-IV do not reveal relevant connections with subsequent vocational successful reintegration, whereas the initial level of functioning has a definite predictive value.

Adult↗
PubMed2005

Effect of traumatic subarachnoid haemorrhage on neuropsychological profiles and vocational outcome following moderate or severe traumatic brain injury.

OBJECTIVE: Traumatic subarachnoid haemorrhage (tSAH) frequently occurs in moderate or severe traumatic brain injury (TBI) and is related to worse outcome at time of discharge from the acute hospitalization. The current study compared neuropsychological impairment and vocational outcome at 1-year post-injury in patients with and without tSAH. DESIGN: Acute injury, neuroradiological, neuropsychological and vocational data were collected for 100 patients admitted for neurorehabilitation following TBI. RESULTS: Patients with tSAH had significantly worse vocational outcome than patients without tSAH. On neuropsychological measures, patients with tSAH generally performed worse than patients without tSAH across most neurocognitive domains. However, differences in neuropsychological test performance between patients with and without tSAH reached statistical significance on measures of visuospatial processing, verbal reasoning and mood only. CONCLUSION: The presence of tSAH appears to be associated with worse vocational outcome in survivors of moderate or severe TBI. As such, the presence of tSAH appears to have predictive value with respect to outcome following TBI.

Adult↗
PubMed2006

Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability.

PRIMARY OBJECTIVE: Replicated evaluation of the Vocational Case Co-ordinator (VCC) Model for vocational rehabilitation after acquired brain injury (ABI). RESEARCH DESIGN: Referral cohort studied within the social model of disability. METHODS AND PROCEDURES: One hundred and thirty-eight participants with ABI were assisted by a VCC to develop self-directed vocational plans and networks of medical centre and community services. Early intervention, work trials, temporary or long-term supported employment and employer education are fundamental features of the VCC Model. MAIN OUTCOMES AND RESULTS: One year after initial placement 80% of participants remained in community-based employment, 56% of the total sample with no support. Better outcomes were associated with earlier intervention but not with initial injury severity. CONCLUSIONS: Results replicate original findings of the effectiveness of the VCC Model of vocational rehabilitation after ABI with a different VCC. Implications for social change within the social model of disability are discussed.

Adolescent↗
PubMed2006

Effectiveness of vocational rehabilitation following acquired brain injury: preliminary evaluation of a UK specialist rehabilitation programme.

PRIMARY OBJECTIVE: To report the outcome of 232 clients undertaking Rehab UKs Vocational Rehabilitation Programme, over three consecutive years, in three centres across the UK. METHODS AND PROCEDURES: Data regarding demographic characteristics of participants, type and severity of acquired brain injury were collected on admission to the programme. The duration of the vocational programme and occupational status on discharge is also reported. INTERVENTIONS: A description of the vocational programme is given including selection and admission criteria, main components of the programme, monitoring and evaluation frameworks. RESULTS: Forty-one per cent of participants were discharged into paid competitive employment, with a further 16% gaining voluntary work and 15% taking up mainstream training or education. The remaining 28% were referred to other services or withdrew from the programme. CONCLUSIONS: Vocational rehabilitation offering educational and experiential learning opportunities is effective in enabling participants with severe acquired brain injuries to return to paid employment.

Adolescent↗
PubMedDate not supplied

Gender differences in vocational needs and outcomes for methadone treatment clients.

Data from a pilot randomized field experiment conducted from 1990 to 1992 in three methadone treatment programs were analyzed to examine potential gender differences in vocational needs and outcomes. The study data were collected from 103 female and 147 male clients who were recommended by their counselors or were randomly sampled from all remaining clients enrolled in treatment. Half of each of these two groups of clients were randomly assigned to standard treatment and half to standard treatment plus an experimental Training and Employment Program (TEP). Analysis of the data indicates that (a) males and females differed significantly in terms of initial employment histories, employment status, and vocational readiness; (b) males received an equal amount or more TEP services than females from an on-site vocational specialist; and (c) within the TEP condition at three months, males received more referrals and placement services than did females. These results suggest that males and females have different vocational service needs and outcomes.

Adolescent↗
PubMed2003

On prediction of vocational rehabilitation outcome at a Swedish employability institute.

OBJECTIVE: The main objective of this investigation was to identify a set of variables usable in early outcome prediction of vocational rehabilitation. DESIGN: On commencement of rehabilitation at an employability institute, data were sampled using structured interviews and checklists. Two years later the subjects were followed up by telephone interviews. SUBJECTS: The study sample was all unemployed with a somatic disorder as the cause of vocational disability, admitted from October 1995 to December 1996 (n = 149). Of these 109 (73%) agreed to participate. METHODS: Initially, data on demography, symptoms, expectations/beliefs about future capacity for gainful employment and sense of coherence (as an indicator of coping resources) were sampled. At follow-up the subjects' vocational situations were recorded. RESULTS: At follow-up, 40% were working or employable. Among the about 30 variables included, logistic regression showed that having a relatively high belief in vocational return (odds ratio, OR: 4.6, CI: 1.4-15.4), having a relatively high sense of coherence (OR: 3.5, CI: 1.5-8.4) and having a relatively high educational level (OR: 2.6, CI: 1.1-6.3) were significant predictors of positive outcome. CONCLUSION: In this sample, socio-psychological and educational aspects were far more predictive of outcome than were medical circumstances.

Adult↗
PubMed2004

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives.

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.

Humans↗
PubMed2000

Vocational rehabilitation for persons with schizophrenia: recent research and implications for practice.

This article presents research-based principles of vocational rehabilitation that have emerged from the study of diagnostically heterogeneous populations of persons with severe mental illness. Employment and vocational functioning outcomes of people with schizophrenia from recently published followup studies are described. In addition, we present research conducted over the past decade concerning differential outcomes of vocational rehabilitation services for people with schizophrenia versus other psychotic and nonpsychotic disorders. We then explore studies of people with schizophrenia that may illuminate the links between specific features of this disorder--including symptomatology, social skills, and neuropsychological impairments--and poorer vocational outcome. We conclude with a set of recommendations for clinical practice that draw upon the most recent discoveries and insights in this field.

Employment↗