Explaining the Variance Within Supported Employment Programs: Comment on “What Predicts Supported Employment Outcomes?”

Dartmouth Medical School, Lebanon, New Hampshire, USA,
Community Mental Health Journal (Impact Factor: 1.03). 07/2006; 42(3):315-8. DOI: 10.1007/s10597-006-9038-7
Source: PubMed


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    • "Une méta-analyse portant sur le programme IPS (Individual Placement and Support) « d'intégration dans l'emploi avec accompagnement individualisé » — le plus représentatif de la pratique de « soutien à l'emploi » — établit un taux d'insertion moyen en milieu ordinaire d'environ 60 % sur une période de suivi de 18 mois en moyenne, alors qu'il n'est que de 23 % avec les autres méthodes d'accompagnement [16]. Ces programmes de soutien à l'emploi s'opposent par divers aspects aux pratiques traditionnelles de réinsertion emploi spécialisés, parmi lesquelles la croyance qu'une telle réinsertion est possible [21] [22]. D'où l'essor des recherches portant justement sur les compétences et les attitudes de ces professionnels. "
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    ABSTRACT: Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness.
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    • "A suitable ongoing support for the client can be created if the vocational service is integrated with the psychiatric services , thus providing an accessible and flexible psychiatric need-based support. IPS teams that more adhere to the IPS model, as measured by fidelity scales, have been shown to generate better vocational outcomes for their clients [11] [12]. The vocational outcomes are also influenced by a number of clinical and sociodemographic characteristics among clients [13]. "
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    ABSTRACT: Objective: People with disabilities find it harder to enter the labour market than people without disabilities and those with a mental illness are, in relation to people with other disabilities, employed at an essentially lower extent. Many are effectively helped by the vocational rehabilitation model Individual Placement and Support (IPS), but there are still many individuals left in undesired unemployment. This study investigates potential predictors of the vocational outcomes of a one-year follow up of IPS in the north of Sweden. Participants: The participants were 65 men and women, mostly younger than 30 years of age diagnosed with a mental illness (predominantly with a diagnosis of anxiety and/or depression). Methods: Baseline data related to sociodemographic and clinical characteristics of the client, the client' own perceptions of every day living and participation, self-esteem and quality of life, as well as the quantity of employment support, were investigated using analyses of logistic regression. Results: Of three identified potential predictors, only psychiatric symptoms remained significant in the multivariate logistic regression analyses. A lower level of symptoms increased the odds with 5.5 for gaining employment during one year.Conclusions: Careful investigation of how psychiatric symptoms influence clients' occupational performance is of importance. By understanding essential aspects of the relationships between the clients' individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client.
    Work 06/2012; 45(1). DOI:10.3233/WOR-2012-1453 · 0.52 Impact Factor
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    • "Fidelity scales are used for both research and quality improvement purposes. Studies suggest that attainment of high fidelity leads to better patient outcomes (Drake et al. 2006). Feedback to clinicians in the form of fidelity reviews has proven to be an effective tool for quality improvement (McHugo et al. 2007). "
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    ABSTRACT: This paper describes the psychometric properties of two fidelity scales created as part of the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored medication management toolkit and their metric properties when used in 26 public mental health clinics with 50 prescribers. A 23-item scale, based on chart reviews, was developed to assess whether prescribers are following good medication practices, in conjunction with a 17-item scale to assess organizational support for and evaluation of prescriber adherence to recommended medication-related practices. Fundamental gaps in routine practice, including poor documentation of medication history and infrequent monitoring of symptoms and side effects were found.
    Administration and Policy in Mental Health and Mental Health Services Research 03/2009; 36(4):247-54. DOI:10.1007/s10488-009-0209-z · 3.44 Impact Factor
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