Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with ...depression in Germany, the aim of this study was to investigate client variables that predict return to work.
The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses.
A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS.
Limitations.
The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited.
People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.
•Studying supported employment outcomes of participants with depression•56 % of the participants returned to work within one year•Longer duration of sick leave significantly decreased odds of return to work•More perceived cognitive deficits significantly decreased odds of return to work
Background:People with musculoskeletal disorders (MSDs) and arthritis often experience challenges at work with associated temporary work absence and reliance on illness payments. Low rates of return ...to paid work persist, and permanent work disability is common, therefore, supporting people to remain in work is key. Limited knowledge exists regarding the impact of vocational rehabilitation on work ability and work retention for this cohort. One-to-one tailored vocational rehabilitation for those with inflammatory arthritis has indicated positive outcomes (Hammond et al 2017).Work-Able Solutions is an occupational therapy vocational rehabilitation service for people with MSDs and arthritis in Ireland. This multisite clinical project is funded by the Sláintecare Integration Innovation Fund (2022) for a 24-month pilot. Work-Able Solutions services provide early access to individualised and tailored evidence-based interventions to people with MSDs and arthritis who require help to remain in or return to work. The project was designed by the National Clinical Programme for Rheumatology informed by the rheumatology programme of work and priorities, existing research, and clinical practice. Inclusion criteria include working age adults, with an MSD or arthritis, currently in paid employment or in receipt of illness benefit ≤6 months, with a client-reported work concern.Referrals are accepted from primary care and rheumatology multidisciplinary team members. Each patient receives a two-hour initial assessment followed by four one-hour intervention sessions (with scope for further intervention sessions subject to need) delivered by a skilled occupational therapist. Intervention is flexible in timing and delivery and may be face-to face, virtual, and include a workplace visit. The programme is now operational for a seven-month period however, pilot sites have had staggered starts. Concurrent to the clinical project delivery, research is ongoing to compare before and after outcomes and to examine the effectiveness of the project.Objectives:To provide a preliminary report on the profile and needs of individuals attending this service.Methods:An audit of the Work-Able Solutions dataset was completed. Ethical approval was obtained from the Research Ethics Committees of St Vincent’s Healthcare Group, Naas General Hospital, HSE South East.Results:Data up to 9th January 2023 are presented.TableRheumatology services (n= 108)Primary Care services (n=72)Referrals per DisciplineMedic2751Nursing210MSK Triage152Physiotherapist012Occupational Therapist467Referrals Received180Ineligible Eligible36 144DemographicsIn work137Out of work43In receipt of illness benefit25GenderFemale n=119Age (yrs)18-69 (Mean 47.19)Working Full time68Sole income earner43Completed46 (44 96% in work)Ongoing89DNA 9Service Usage178 sessionsIntensityRange 2-8 Median 3 Mean 3.48TypeFace-to-face 131 Virtual 41 Worksite visits 6Conclusion:Preliminary findings indicate the scale and needs of this cohort. High work retention at discharge and low attrition rates indicates the relevance of this service and provide early insights into the potential impact of Work-Able Solutions in supporting work return and retention.REFERENCES:1 Hammond, A., O’Brien, R., Woodbridge, S., Bradshaw, L., Prior, Y., Radford, K., Culley, J., Whitham, D., and Ruth, P.-J. (2017) ‘Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial’, BMC musculoskeletal disorders, 18(1), 315, available: https://doi.org/10.1186/s12891-017-1671-5.Acknowledgements:NIL.Disclosure of Interests:None declared.
IntroductionResearch on the effectiveness of vocational rehabilitation has often focused on small and selected groups of rehabilitees, lacked proper controls, or not captured dynamic changes in work ...participation. Using rich nationwide data on vocational rehabilitees and their matched controls, we examined long-term changes in work participation before and after vocational rehabilitation to assess its effectiveness.MethodsWe used representative Finnish register data to examine 2692 recently employed individuals with histories of musculoskeletal- and mental-related work disability who started vocational rehabilitation in 2008–2010 at age 30–55 (intervention group), and 2692 propensity score matched non-rehabilitees who otherwise met the same criteria (control group). Matching was performed based on sociodemographic and work-related factors, work disability diagnosis, and three-year labour market history. We used generalised estimation equations to examine differences in the proportion of time spent at work between periods of three years before and three years after rehabilitation among the intervention and control group and the difference in these differences (DID).ResultsAmong those with 105+days of work disability in the preceding three-year period, vocational rehabilitation resulted in significant percentage point gains in work participation, with the total DID across the disease groups and genders being 9.2 (95% confidence interval 7.3–11.1). The gains tended to actualise immediately after rehabilitation. No gains were observed among those with shorter preceding work disability.ConclusionsVocational rehabilitation after musculoskeletal- and mental-related work disability showed only shorter-term effectiveness on work participation and only among those with longer work disability histories. The effectiveness of alternative and complementary interventions to vocational rehabilitation should be investigated.
Abstract Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice ...Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on education and skills training interventions that address psychosocial, behavioral, and emotional skills for people with traumatic brain injury (TBI).
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ...generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.
Purpose: Youth with disabilities have lower rates of enrollment and completion of post-secondary education compared with youth without disabilities. The objective of this systematic review is to ...understand the best practices and components of post-secondary transition programs for youth with disabilities.
Method: Systematic searches of six international databases identified 18 studies meeting our inclusion criteria (youth with a disability, aged 15-30; focusing on post-secondary education program or intervention, published from 1997 to 2017). These studies were analyzed with respect to the characteristics of the participants, methodology, results, and quality of the evidence.
Results: Among the 18 studies, 2385 participants (aged 13-28, mean 17.7 years) were represented across three countries (US, Canada, and Australia). Although the outcomes of the post-secondary transition programs varied across the studies, all of them reported an improvement in at least one of the following: college enrollment, self-determination, self-confidence, social and vocational self-efficacy, autonomy, social support, career exploration, and transition skills. The post-secondary transition programs varied in duration, length, number of sessions, and delivery format which included curriculum-based, online, immersive residential experience, mentoring, simulation, self-directed, technology-based, and multi-component.
Conclusions: Our findings highlight that post-secondary transition programs have the potential to improve self-determination, transition skills, and post-secondary outcomes among youth with disabilities.
Implications for rehabilitation
Post-secondary education interventions have a beneficial influence on post-secondary and related transition outcomes in youth with disabilities.
Clinicians and educators should consider having multiple components, involving several sessions that include a curriculum, immersive college residential experience, mentoring, and/or simulations in their interventions for optimum program outcomes.
More research is needed to explore the types of interventions that work best for whom and the optimal age (including exploring the socio-demographic characteristics), setting, and delivery format.
Vocational Rehabilitation (VR) services and outcomes for individuals with and without psychiatric disabilities served in the State VR service-delivery system have been researched for over 40 years ...with strong evidence that disparities between these groups have persisted over time. We conducted a comparison of services and outcomes based on cases available within the 2016 Rehabilitation Services Administration 911 data set that had a primary disability coded, N = 502,134; these cases included all cases with a primary psychiatric disability coded, n = 159,843, and cases with all other primary disabilities coded, n = 342,291. Individuals with primary psychiatric disabilities were (a) nearly a third of all cases captured in State VR agency data (b) more likely to have their case closed prior to receiving VR services under an Individualized Plan for Employment (IPE), and (c) less likely to be closed successfully employed than clients with other primary disability types after receiving vocational services under an IPE. Based on these findings, we provide recommendations to provide in-service and pre-service education and training to VR counselors that will improve the services offered to this population, and to more effectively collaborate with county and local agencies that are providing evidence-based practices such as the Individualized Placement and Support model of employment.
Both neurocognition and negative symptoms have demonstrated strong links to functional outcomes, such as work functioning, among those with severe mental illness (SMI). Prior models have suggested ...that reduced neurocognition 1) precedes or predicts greater negative symptoms and 2) indirectly influences functional outcomes via its impact on negative symptoms. The current study sought to also test a divergent model: whether greater negative symptoms predict reduced neurocognition and indirectly influence work functioning through their impact on neurocognition. Both models were tested using cross-sectional and prospective data spanning 20-years in a sample of 277 people with a SMI with psychotic features. Results showed that both models were supported in cross-sectional analyses. However, in prospective models predicting work functioning, only the models examining the indirect influence of negative symptoms on work functioning (7.5 to up to 20-years later) through neurocognition demonstrated significant mediation (i.e., a significant indirect effect); further, higher negative symptoms significantly predicted lower prospective neurocognition, while lower neurocognition did not significantly predict greater prospective negative symptoms. Although cross-sectional data were consistent with prior models, our prospective models offered greater support for a putative causal pathway running from negative symptoms to neurocognition—rather than the reverse—to work functioning. Findings have implications for mechanisms contributing to longitudinal work functioning and suggest that targeting negative symptoms prior to neurocognition could be more beneficial for long-term work outcomes.
The literature on racial differences in vocational rehabilitation (VR) services has not been updated for over a decade. Using the 2017 individual-level U.S. national RSA-911 data, supplemented with ...the 2017 American Community Survey and publicly available information from the Kaiser Family Foundation, we investigated racial differences at each step of the VR process—application, eligibility, service provision, and employment outcomes at closure. At the first step, application, White individuals with disabilities were less likely to apply than their African American, American Indian/Alaska Native, and Hispanic counterparts, and more likely to apply than their Asian counterparts. For the remaining three steps, the results were inverted: the White subgroup had higher eligibility rates, service rates, and employment rates than the African American, American Indian/Alaska Native, and Hispanic subgroups, and lower rates than the Asian subgroup. These findings suggest that racial and ethnic differences continue to exist in the VR process despite several legislative acts and policy efforts. Within each racial and ethnic minority group, we also found large variation in application rates and employment rates across states, which indicates a need for developing performance measures and standardized guidelines for state VR agencies to better serve individuals with disabilities from racial and ethnic minorities.
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