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Choose‐get‐keep: A psychiatric rehabilitation approach to supported employment
Abstract
Increasing numbers of people with psychiatric disabilities are residing in communities rather than in inpatient settings. They are also becoming more aware of the benefits of working and of their legal right to employment with accommodations. Traditional work preparation programs have failed to result in employment for many people with psychiatric disabilities. However, supported employment, when modified to reflect the basic principles and practices of effective psychiatric rehabilitation, has been shown to result in employment benefits for participants at a reasonable cost to providers. With supported employment methodologies such as the choose-get-keep approach, providers can do much to help people with psychiatric disabilities reap the many social and financial benefits of employment and achieve their community living goals.
... ( Bond , et al . , 1997 ; Danley , Sciarappa , McDonald - Wilson , 1992 ; Farkas , 1996 ) . ...
... action was found to be leisure . Work was found to be a major contributor , however , as it allowed the participants to engage in activities that contribute more directly to overall life satisfaction . For people with psychiatric disabilities , social networks have been found to be important to the process of obtaining and maintaining employment ( Danley et al . , 1992 ; Torrey et al . , 1998 ; Wallace , 1993 ) . Some studies , however , have identified that work can sometimes increase a person ' s sense of isolation because of their reduced access to their former social networks , which they have not been able to replicate at work ( Becker et al . , 1997 ; Bedell et al . , 1998 ; Strong , 1998 ) . Th ...
... ines emphasise vocational exploration and job matching ; interconnections with social networks ; clinical and rehabilitation planning ; support and problem solving methods ; and self management techniques that focus on the areas of substance abuse , wellness and on - the - job interpersonal issues . The intent of these guidelines is also echoed in Danley et al . ' s ( 1992 ) overview of the ' Choose - Get - Keep ' model , which emphasises : person - centred goals ; a client environment match ; prescriptive assessment , planning and intervention , and the development of skills and supports required to promote satisfaction and success within the selected work setting . More recent studies have emphasised th ...
Thesis (MHSc--Health Science) -- AUT University, 2006. Includes bibliographical references. Text (PDF file)
... Age Results regarding the relationship of age and SE benefits vary. Some researchers found younger participants, particularly those under the age of 35, had better employment outcomes (Cook 2007;Cook and O'Day 2006;Danley et al. 1992;O'Brien et al. 2003;Pandiani et al. 2004). According to Pandiani et al. (2004), there was an inverse relationship between employment rates and age where 45 % of clients ages 18-34 years succeeded in obtaining employment, 32 % of clients ages 35-49 years succeeded in obtaining employment, and 15 % of clients ages 50-64 years succeeded in obtaining employment. ...
... Clients who worked in the past benefited more from SE than clients who had no employment histories (Blitz and Mechanic 2006;Burke-Miller et al. 2006;Xie et al. 1997). In particular, clients who had a prior work history of one or more years were more likely to benefit from SE (Cook 2007;Cook and O'Day 2006;Danley et al. 1992;McGurk and Mueser 2006a;McGurk et al. 2003). Clients who worked more recently were also more likely to attain competitive employment (Regenold et al. 1999;Twamley et al. 2008). ...
Supported employment is an evidence-based practice with a well-established research base. Most studies track such outcomes as employment rates, time to employment and wages earned. Few studies address client and contextual factors that impact outcomes or consider program elements beyond those that comprise the individual placement and support model. This paper reviews existing literature to shed light on the following questions: (1) What impact do labour market trends have on the effectiveness of SE? (2) How lasting are the effects of SE and what factors influence longevity of SE effects? (3) What levels and types of employment are targeted by SE? (4) What are the characteristics of people who benefit from SE? (5) What is the role of peer support in SE? and (6) What are the barriers to effective SE implementation? Research findings are synthesized and suggestions for service enhancements are offered so that the model can continue to evolve.
... Om een start te kunnen maken met het Begeleid Leren-traject, is het van belang om te bepalen in welke fase de jongere volgens zichzelf verkeert, om vervolgens de bijbehorende activiteit te kiezen met welke men de jongere verder helpt (schema 2) (zie ook Danley et al., 1992;Sullivan et al. 1993). De fase van het verkennen helpt de jongere te bepalen of hij/zij eraan toe is om een opleiding te gaan kiezen. ...
... De termen kiezen, verkrijgen en behouden zijn echter gekozen omdat hiermee wordt aangeduid, dat de nadruk meer ligt op het proces van de deelnemer dan op de activiteiten van de hulpverlener. Eerder werd dit model al succesvol toegepast als variant op Supported Employment (Danley et al, 1992). In Nederland is de IRB in 1992 geïntroduceerd door de Stichting Rehabilitatie '92 (Dröes, 1992) en in 1999 hebben Stichting Rehabilitatie '92 en ROC Zadkine te Rotterdam het eerste Begeleid Leren-programma in Nederland ontwikkeld. ...
De meeste psychische problemen komen voor het eerst tot uiting tussen het achttiende en
vijfentwintigste levensjaar. De leeftijd waarop de meeste jongeren een studie volgen. Het
gevolg is vaak dat de jongere zijn studie moet onderbreken of afbreken. Dit heeft meestal
weer tot gevolg dat een ontwikkeling van (betaald) werk hierdoor stagneert. Veel jongeren
lukt het zelf om weer terug te keren naar school en een diploma te halen. Voor anderen is
het te moeilijk om dit zonder (professionele) ondersteuning voor elkaar te krijgen. Voor deze
laatste groep jongeren en hun ondersteuners is het Handboek Begeleid Leren geschreven.
Het Handboek Begeleid Leren beschrijft hoe jongeren met psychische beperkingen op een
praktische wijze ondersteund kunnen worden bij het kiezen, verkrijgen en behouden van
een reguliere opleiding. De werkwijze is gebaseerd op de Individuele Rehabilitatiebenadering
(IRB), een evidence based practice, en daardoor opgenomen in de databanken effectieve
interventies van Movisie (welzijn) en het Trimbos-instituut (langdurige GGz).
... Several Supported Education and Supported Employment interventions (SEE intervention) (i.e. Individual Placement and Support) particularly target to improve educational and occupational engagement (Danley et al. 1992;Drake et al. 2012;Ellison et al. 2018;Kane et al. 2016;Killackey et al. 2019;Mowbray et al. 2005;Mueser et al. 2015;Sullivan et al. 1993;Unger 1998;Humensky et al. 2019). The SEE intervention of Boston Psychiatric Rehabilitation Approach (PRA) was introduced in the Dutch Mental Health Care system in 1992 and has been widely used since then (Swildens et al. 2011). ...
Deteriorated functioning is a part of the clinical-high risk (CHR) criteria for psychosis. Diminished social, educational and occupational functioning in the phase of late adolescence and early adulthood are associated with long-term social, economic and health consequences, which stresses the importance of early intervention to stimulate functioning. This pilot study examines the effectiveness and feasibility of the choose-get-keep model of Supported Education and Supported Employment (SEE) to improve educational and occupational functioning of individuals at CHR for a psychosis. A single blind randomized controlled pilot study combined SEE with treatment as usual (TAU) versus TAU among adolescents and early adults at CHR. School performance and job status as well as global functioning scales were assessed at twelve months. Of the 78 eligible participants, 20 individuals consented to participate in this study. At follow-up, participants in the intervention condition (n = 9) did not start an education more often than the participants in the control condition (n = 11) and the school results for both conditions were similar. However, in the intervention condition there were no school dropouts, more participants gained a job and worked longer hours. Two participants quit the intervention. This pilot study provides preliminary evidence that a SEE intervention is effective and feasible in sustaining and improving the level of both educational and occupational functioning of individuals at CHR for psychosis by supporting them in attaining, keeping and elaborating of their education or employment.
... Ein vermutlich wesentlicher Wirkfaktor werden dabei die gerade angesprochenen Präferenzen der betroffenen Personen sein, die zweifelsfrei die Motivation maßgeblich stützen. In der US-amerikanischen Rehabilitation wird dieser Umstand im Rahmen des sogenannten »Choose-Get-Keep«-Modells therapeutisch genutzt ( Danley et al. 1992;Rogers et al. 2006). ...
Recovery praktisch Die von der Selbsthilfe geprägten Ideen von Recovery und Empowerment haben inzwischen Eingang in die S3-Leitlinie »Psychosoziale Therapien bei schweren psychischen Erkrankungen« gefunden, was sich in vielen Projekten in Behandlung und Ausbildung niederschlägt. Das fängt mit der gemeinsamen Entscheidungsfindung von Fachleuten, Psychiatrieerfahrenen und Angehörigen an und hört mit dem Einsatz von Experten aus Erfahrung noch lange nicht auf, wird doch gerade der Bildungsbereich durch Recovery Colleges entdeckt. Voraussetzung ist ein neues, auf Kooperation und Koproduktion ausgerichtetes Selbstverständnis psychiatrisch Tätiger. Die hier versammelten Grundlagen und Praxisprojekte bieten jede Menge Ideen, die dazu beitragen können, Menschen in psychischen Krisen zu unterstützen und sich selbst fachlich neu aufzustellen.
... Ein vermutlich wesentlicher Wirkfaktor werden dabei die Präferenzen der betroffenen Personen sein, die zweifelsfrei die Motivation maßgeblich stützen. In der US-amerikanischen Rehabilitation wird dieser Umstand im Rahmen des sogenannten »Choose-Get-Keep-Models« therapeutisch genutzt(Danley et al. 1992, Rogers et al. 2006. Das heißt, die betroffene Person wählt ihren Lebensentwurf sowie die damit verbundenen sozialen Rollen und Funktionen mit professioneller Unterstützung aus. ...
Das Kapitel beschreibt die Konzepte Inklusion und Integration im Zusammenhang mit psychischen Erkrankungen.
... Fase 4: Behouden-Functionele Diagnostiek (zie Verkrijgen)-Hulpbronnen Diagnostiek: Inventariseren en realiseren van persoonlijke hulpbronnen (bijvoorbeeld een bondgenotengroep).-Vaardigheidsinterventies § ontwikkelen van vaardigheden (bijvoorbeeld openheid geven) § stappenplan vaardigheidstoepassing maken-Hulpbronnen interventies § coördineren van hulpbronnen § aanpassen van hulpbronnen § creëren van hulpbronnen Bij het intakegesprek wordt samen met de jongere bepaald in welke fase hij/zij verkeert, om vervolgens de bijbehorende activiteit te kiezen met welke men de jongere verder helpt (zie ook Danley, Sciarappa & MacDonald-Wilson, 1992;Sullivan, Nicolellis, Danley & MacDonald-Wilson, 1993). Ook wordt besproken of de jongere de voorkeur geeft aan individuele of groepsactiviteiten. ...
Korte samenvatting van de interventie
Met Begeleid Leren worden jongeren (17-25 jaar) die door hun psychische problemen belemmerd worden bij het (gaan) studeren, ondersteund. Deze ondersteuning is op maat gemaakt; gericht op de studentrol en niet op de patiëntrol; individueel of groepsgewijs. Voor iedere fase zijn verschillende bijbehorende activiteiten uitgewerkt die de jongere kan doorlopen. De jongere wordt geholpen bij het bepalen of hij/zij eraan toe is om een opleiding te gaan kiezen; bij het maken van een weloverwogen keuze voor een opleiding; bij het verkrijgen van de opleiding en bij het ontwikkelen en coördineren van vaardigheden en hulpbronnen om met succes en naar tevredenheid de opleiding vol te houden en af te ronden.
Doelgroep
De doelgroep bestaat uit jongeren met psychische problemen tussen de 17 en 25 jaar, die door hun problemen belemmerd worden bij het (gaan) vervullen van de studentenrol op een reguliere opleiding van eigen voorkeur.
Doel
De interventie heeft als doel jongeren met psychische problemen helpen beter te functioneren, zodat ze met succes (vanuit de opleiding gezien) en tevredenheid (vanuit de jongere gezien) een reguliere opleiding van eigen voorkeur kunnen volgen met zo min mogelijk professionele hulp.
Aanpak
Begeleid Leren is opgebouwd uit vijf fases/modules met bijbehorende activiteiten: verkennen, kiezen, verkrijgen, behouden en verlaten. De ondersteuning is zo lang als nodig en gewenst. De modules kunnen individueel of groepsgewijs doorlopen worden, afhankelijk van het aanbod en de behoefte van de jongere. De jongere kan in iedere fase instappen.
Materiaal ¬
Op de website www.begeleidleren.nl is het Begeleid Leren materiaal gratis te downloaden. Het gaat om:
-Het handboek Begeleid Leren (Korevaar, 2015) .
-Een toolkit Begeleid Leren waarin de diverse onderdelen van Begeleid Leren zijn uitgewerkt.
-Diverse brochures voor studenten over ‘Studeren met Steun’.
Onderbouwing
Begeleid Leren is gebaseerd op de Individuele Rehabilitatie Benadering (IRB). De IRB gaat er vanuit dat ook jongeren met psychische problemen wensen en doelen hebben met betrekking tot hun rolfunctioneren op het gebied van leren. Begeleid Leren gaat er vervolgens vanuit dat jongeren deze wensen en doelen kunnen verwezenlijken door gebruik te maken van hun sterke kanten, door gerichte vaardigheidsontwikkeling en door gerichte aanpassingen in de omgeving, ook wel hulpbronnen (Anthony, Cohen, Farkas & Gagne, 2002). Begeleid Leren helpt jongeren op maat bij het inventariseren, verkrijgen en gebruiken van vaardigheden en hulpbronnen, omdat het per jongere varieert welke vaardigheden en hulpbronnen er ontbreken.
Onderzoek
Onderzoek naar Begeleid Leren interventies (Korevaar, 2005; Unger, Anthony & Rogers, 1991) laten positieve effecten zien, zoals een significante toename na het volgen van een Begeleid Leren programma op het gebied van werk en onderwijs, op de Rosenberg zelfwaarderingsschaal (Rosenberg, 1965) en de kwaliteit van Leven-schaal en een significante afname in het aantal ziekenhuisopnames gedurende het eerste jaar.
... At the same time, the program also drew on the Choose-Get-Keep (CGK) model to empower students to choose their own goals and learning objectives, to secure and sustain enrollment, and to maintain an acceptable level of success until their goals are achieved ( Mowbray et al., 2005;Soydan, 2004). The CGK model of psychiatric rehabilitation and SEd was meant to emphasize person-centered goals and focus on participant process rather than on practitioner activity (Sullivan, Nicolellis, Danley, & MacDonald-Wilson, 1993). The use of the CGK model is a necessary component of a strong SEd program. ...
Interviews with adult mental health in- and out-patients attending a psychiatric hospital-based supported education program, and their program staff and volunteers, demonstrated that while an informal program structure had initial success in increasing student confidence and independence, the subsequent expansion of the program requires formalizing it using adult and transformative education protocols to increase literacy gains. We argue that professional development in adult education showing the value of transformative learning for staff can complement their occupational therapy and mental healthcare training, so that the empowerment and identity transformation can be increased for these vulnerable students.
... Hier geht es um die Vorbereitung der Person auf die zu erwartende Aufgabe, die Unterstützung bei der Auswahl eines passenden Arbeitgebers, die Information des Arbeitgebers und der zukünftigen Kolleginnen und Kollegen sowie schließlich um Krisenintervention oder auch Mediation bei allfälligen Konflikten am neuen Arbeitsplatz. In der US-amerikanischen Literatur zur psychiatrischen Rehabilitation ist diese Aufgabe schon vor vielen Jahren mit dem "Choose -Get -Keep"-Ansatz beschrieben worden [27,28], der erstaunlicherweise in der deutschsprachigen Literatur kaum rezipiert worden ist. Dieser Ansatz kann auf sämtliche Rehabilitationsbereiche bezogen werden, also etwa auf Arbeit und Beschäftigung, Ausbildung und Wohnen. ...
Hintergrund: Die psychiatrische Rehabilitation folgt seit längerer Zeit zu weiten Teilen einem
Stufenleiterprinzip. Methode: Aktuelle Entwicklungen aus dem Umfeld der Rehabilitation (UN-Behindertenrechtskonvention, Theorie der Rehabilitation, Rehabilitationsforschung) werden beschrieben.
Ergebnisse: Den aktuellen Entwicklungen gemeinsam sind die Prinzipien der Wahlfreiheit und Autonomie für die Klienten sowie die soziale Inklusion, welche dem Stufenleiterprinzip widersprechen. Schlussfolgerungen: Das Stufenleiterprinzip der Rehabilitation sollte durch die unterstützte Inklusion ersetzt werden.
Background: For many decades, psychiatric rehabilitation in the German-speaking countries is following a conventional linear continuum approach. Methods: Recent developments in important fields related to psychiatric rehabilitation (UN Convention on the Rights of People with Disabilities, theory of rehabilitation, empirical research) are reviewed. Results: Common to all developments in the reviewed fields are the principles of choice, autonomy and social inclusion. These principles contradict the conventional linear continuum approach. Conclusions: The linear continuum approach of psychiatric rehabilitation should be replaced by the "supported inclusion"-approach.
... Goodwill Pivotal was launched in July 2013, with some initial one-time funding from the SW LHIN. It was premised on the "choose, get and keep" model of psychiatric rehabilitation, established in the last few decades by researchers at Boston University (Danley et al. 1992). Goodwill Pivotal provides a social enterprise environment with a focus on productivity and assistance for individuals who face barriers to competitive employment. ...
Social determinants of health such as housing and income have a large impact on mental health. Community-based initiatives have worked to address access to housing, prevent homelessness and assist people who are homeless with mental health problems. There have been several large research projects to tease out multiple subgroups such as youth and veterans and other individuals experiencing long-term homelessness. The issue of poverty has been addressed by exploring issues related to employment. The use of social enterprises is a promising practice to address issues around poverty, social inclusion and employment. Similarly, the community has worked to move hospital-based employment programs to the community.
... Een jobcoach traint de deelnemer ter plekke in benodigde vaardigheden en onderzoekt welke ondersteuning de deelnemer verder nodig heeft. Danley et al. (1992) beschrijven de 'choose-get-keep' benadering, waarin het SE-model en de IRB-benadering zijn geı¨ntegreerd. De 'choose'-fase komt overeen met de matching-fase uit de SE, de fase waarin wordt uitgezocht in welke omgeving de deelnemer kan en wil werken. ...
Schizofrenie en verwante psychotische stoornissen behoren tot de ernstigste en meest chronische psychiatrische ziekten. Dit
katern behandelt de consequenties daarvan voor het functioneren in arbeidssituaties. Het gaat daarbij in het bijzonder over
schizofrenie. De beschreven zorgprogramma’s en interventies zijn echter ook geschikt voor patiënten met allerlei andere psychische
stoornissen (bijvoorbeeld bipolaire stoornissen; ernstige en recidiverende depressies; andere psychotische stoornissen).
... Models of rehabilitation for people with chronic psychiatric illness that emphasize community living have been long since established. Representative models include Assertive Community Treatment (Test and Stein, 1976), Choose-Get-Keep model (Danley et al., 1992) and Intensive Psychiatric Rehabilitation Treatment (Lamberti et al., 1998). These rehabilitation programs emphasize a multi-disciplinary approach, skills acquisition, independent living, consumer advocacy and behavioral intervention in combination with pharmaceutical treatment. ...
Cognitive deficits in schizophrenia are pervasive, severe, and largely independent of the positive and negative symptoms of the illness. These deficits are increasingly considered to be core features of schizophrenia with evidence that the extent of cognitive impairment is the most salient predictor of daily functioning. Unfortunately, current schizophrenia treatment has been limited in addressing the cognitive deficits of the illness. Alterations in neuroplasticity are hypothesized to underpin these cognitive deficits, though preserved neuroplasticity may offer an avenue towards cognitive remediation. Key neuroplastic principles to consider in designing remediation interventions include ensuring sufficient intensity and duration of remediation programs, "bottom-up" training that proceeds from simple to complex cognitive processes, and individual tailoring of remediation regimens. We discuss several cognitive remediation programs, including cognitive enhancement therapy, which embrace these principles to target neurocognitive and social cognitive improvements and which havebeen demonstrated to be effective in schizophrenia. Future directions in cognitive remediation research include potential synergy with pharmacologic treatment, non-invasive stimulation techniques, and psychosocial interventions, identification of patient characteristics that predict outcome with cognitive remediation, and increasing the access to these interventions in front-line settings.
... Yet another principle is tailoring job development and support to the client's individual preferences. To some extent this principle grew out of a reaction against onesize-fits-all approaches in some service delivery models of vocational rehabilitation in which clients have little say over the nature of the jobs they are offered and the level of intrusiveness of the job support they receive (Danley et al. 1992;Mowbray et al. 1994). Instead, research shows that clients have better outcomes when their services are designed to coincide with their preferences. ...
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.
... Psychiatric Rehabilitation Services provided multiple program options across three agency locations. All partici-pants in the current study were receiving services from the supported employment (SE) program, in which clients were assisted in acquiring and maintaining long-term employment for competitive wages based on the Choose-Get-Keep model of SE (Danley, Sciarappa, & MacDonald Wilson, 1992). As indicated by the model, clients in SE received services as needed at each stage of job attainment and maintenance, including job selection based on personal preferences and abilities, longterm follow-along, and assistance with job changes if necessary {Mellen & Cobb, 1995). ...
The Indiana Job Satisfaction Scale (IJSS) is a brief job satisfaction questionnaire designed for use with individuals with a severe mental illness. This study seeks to validate the IJSS, as well as to examine the relationship between job satisfaction and job tenure in a group of 71 workers in supported employment. Job satisfaction measured during the first 3 months of a job was significantly associated with job tenure; however, this relationship weakened over time. Overall, the findings support the utility of job satisfaction as a tool in vocational rehabilitation, as well as the validity of the IJSS with this group.
... Once again, the employment continuum began simply in the sheltered workshop, but led on to social firms and mobile work crews and TEP. The goal is one of independent living for people with psychiatric disabilities, of complex rehabilitation, and restoration to society (Danley, Sciarappa, & MacDonald-Wilson, 1992). Graded, meaningful work is an integrated part of this vision. ...
This paper sets out in detail how the Singapore Anglican Welfare Council (SAWC) has worked from its charter vision to a number of interlocking strategies and programs in the rehabilitation of those with psychiatric disabilities in Singapore. While the pathway toward a holistic and integrated model of rehabilitation may seem, in the body of this paper, to be almost rational-comprehensive in formulation, it has emerged from ongoing diagnosis and assessment of societal needs, and of the needs of those with psychiatric disabilities. It began simply from a compassionate vision but enlarged significantly as the writer continued in a doctor of business and administration program, to sharpen perceptions, purpose change within, and to collaborate with other agencies, both government and private. To facilitate the journey through this paper, the writer speaks of various continua of education and training, of growing the needed employment opportunities for the disabled, and of offering graduated housing and living skills opportunities. In reality, each initiative generated another and fed off one another. But the goal of all the activities described in this paper seems to have emerged as offering a graduated independence to those with psychiatric disabilities at their own choice and pace. They have taught the writer to listen, consult and to act in concert with them.
... The efficacy of one such programme, Individual Placement and Support (IPS), is supported by strong evidence [1][2][3][4][5][6][7]. Other highly regarded programmes, like Transitional Employment (TE) [8] and the Choose-Get-Keep approach [9], have not yet been evaluated as rigorously as IPS. Nevertheless, these programmes are still in circulation and some of their elements have even been incorporated into IPS [10]. ...
There is increasing recognition of the importance of psychiatric vocational rehabilitation (PVR) programmes in helping individuals with severe mental illnesses to find and secure jobs. However, little is known concerning the factors related to PVR outcomes.
This review identifies those person-related factors which most strongly influence employment outcomes after participation in PVR programmes.
Medline, Psychinfo, Pubmed and CINAHL were searched for studies using multivariate analysis of longitudinal data, which analysed employment outcomes after at least 6 months of programme participation, and which analysed at least three predictor domains.
Eight studies presented in 16 publications met all the criteria. Better employment outcomes were most strongly related to better work performance measured during PVR participation and to higher work-related self-efficacy. Better social functioning during PVR participation was also significantly related to positive employment outcomes, but this relationship was generally weaker than those of the two aforementioned factors. In most studies, employment outcomes after PVR were not related to past functioning, including work history and diagnosis. Findings on the severity of psychiatric symptoms measured during PVR were mixed. In terms of contribution to outcome, severity of symptoms usually ranked below work performance, when measured concurrently.
Contrary to previous reviews, this study suggests that the influence of past functioning, including work history, diagnosis and psychiatric history, is outweighed by work performance in PVR. Further prospective and controlled studies are needed to reach more definite conclusions about the individual contributions of person-related factors.
Decades of research show that psychosocial treatments are effective for psychosis, yet they remain unimplemented as the American healthcare system relies primarily on pharmacological solutions instead. This book reviews the history and current state of research to provide a more nuanced understanding of the evidence for and barriers to psychosocial care for psychosis. It addresses a wide range of mental health research and multi-professional practice domains from historical, personal, societal, professional, and systems perspectives. The varied perspectives presented illustrate factors that limit support for recovery in SMI and psychosis as well as real hope for recovering the US mental healthcare system. With contributions of experts by training and by experience, this book represents an essential resource for students, practitioners and researchers.
This chapter discusses the history of psychiatric rehabilitation which has been shaped by a dialectic between conceptual models, research, and sociopolitical factors. A definition of psychiatric rehabilitation captures unique and essential aspects, which also tend to be areas of agreement among various conceptions of it. These include rehabilitation’s target population, a focus on disabilities or disadvantages, the primacy of the client’s goals, the role of functional assessment, and a set of components in the rehabilitation plan. With this grounding, an overview ensues of the history of the rehabilitation model and its usefulness going forward.
Objectives:
The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?'
Design:
We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention.
Results:
Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory.
Conclusions:
Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.
The importance of treatment of cognitive impairments of people with schizophrenia has long been established. Among many pharmaceutical and non-pharmaceutical approaches, cognitive remediation offers one of the best promises for the rehabilitation of cognitive impairments of schizophrenia. The purpose of this paper is to introduce one such approach, the Neuropsychological Educational Approach to Remediation (NEAR). NEAR has been utilized as a leading treatment model for cognitive impairments of schizophrenia. Cognitive remediation including NEAR is administered within a framework of psychiatric rehabilitation program. Cognitive remediation is most effectively administered when the rehabilitation goals in the social and domain are clarified. Social functions associated with the cognitive impairments of schizophrenia are discussed in the specific categories of independent living skills, vocational skills and social problem-solving. Highlights of various models of cognitive remediation are presented to illustrate the unique features of NEAR. In the theoretical framework of NEAR, intrinsic motivation, personalization and contextualization are the central concepts, and the patients are regarded as learners aiming for independent living. In order to provide a clinical overview, specific treatment issues, staff training and patient characteristics are discussed. A summary of the NEAR outcome studies with a diverse psychiatric population is presented to demonstrate its effectiveness. Functional measures associated with cognitive impairments are presented to suggest directions for future studies.
Description of Psychiatric Rehabilitation Approach. Published in Databank Effective Social Interventions of Movisie, 2010
Description Psychiatric Rehabilitation Approach in Databank Effective Social Interventions of Movisie, 2010
Psychiatric rehabilitation is a service designed to improve functioning that is impaired by the symptoms of severe mental illness. A review of the literature identified several functional domains impaired by mental illness and established the need and effectiveness of the service. Adult Rehabilitative Mental Health Services (ARMHS) is a psychiatric rehabilitation model that seeks to improve functioning in each impaired domain. ARMHS requires a complex array of documentation to demonstrate the existence of such impairments, the need for the service, and progress made toward improving functioning. The complexities of this documentation dissuade recipient and practitioner satisfaction, initial expeditious provision of services, compliance with state regulations, and fluid programmatic functioning. A training manual demarcating and edifying all components of required ARMHS documents was developed to assuage such dissuasions.
• Summary: This paper uses research from American, Australasian and UK-based perspectives to examine supported employment as an enabling strategy to support disabled people with complex needs to access mainstream employment. Supported employment is analysed in the context of models of disability and employment policy. Factors underlying and hindering successful provision are identified from research.
• Findings: Supported employment is successfully supporting some people with complex needs into mainstream employment. However, aspects of employment policy, the benefits system, a lack of funding, and geographical variation in provision act as barriers to success.
• Applications: The implications of supported employment for people with complex needs are identified for social services and social work departments.
Two models of provision of employment services to a caseload of severely and persistently mentally ill are explored: the Individual Placement and Support (IPS) model and the Menu Approach.The priority of the IPS model is to return interested clients to community-based, competitive, integrated employment with time-unlimited follow-along support. However, the IPS model offers little to clients unwilling or unable to work competitively. The priority of the Menu Approach is to assertively offer supported employment services to the agency's entire caseload, interested or not, and to provide the many benefits of a work experience to as many clients as possible. However, evidence points to this model reducing the likelihood of rapid direct entry into the competitive workplace.A case history illustrates the occupational therapist's role as an employment specialist offering both agency-based and community-based support services in an assertive community treatment program.
This article provides a thorough overview of supported education, tracing its inception and evolution as an application of the psychiatric rehabilitation approach. A host of factors, including disability legislation, supported employment, recognition of stigma, expanded access to college campuses, and new research and dissemination initiatives have all helped to develop, define, and document the components of supported education (SEd). This article illustrates that the essence of SEd is the process of psychiatric rehabilitation, with its unique client-centered focus: a well-defined mission, principles and philosophy of strength and hope; individualized goal setting and readiness, skill, and support assessments; and personalized skill and resource development. An in-depth discussion of the process needed to choose, get, and keep an educational path illustrates the application of the psychiatric rehabilitation approach. SEd may also go beyond rehabilitation to assist in the process of recovery. New studies in recovery and its phases present hope that supported education can play a key role in providing new and powerful opportunities for people who are in the process of adjusting to psychiatric disability and trying to move beyond its pervasive impact.
This article describes a pilot project that provided a job preparedness program specifically designed for individuals who suffer from borderline personality disorder (BPD). The program called "The Connections Place" or "TCP" was based on a 16-week curriculum that focused on both helping individuals with BPD overcome emotional barriers to employment and preparing these individuals to enter/reenter the work world. Ninety clients were enrolled in the pilot project that was conducted over three and one-half years. Almost all participants (n = 54) who completed at least 1 month of the program made significant strides in the following areas: obtained employment or achieved a similar goal (48 %), notably improved their job preparedness (22 %), or made some/limited progress toward job preparedness (26 %). These preliminary findings support the potential effectiveness of job preparedness programs targeted to individuals with BPD.
In the 1990s, managed care initiatives have confronted psychiatric rehabilitation with very specific questions about the effectiveness of its services, precisely who benefits from them and at what cost, and what exactly constitutes a psychiatric rehabilitation intervention. In order to more adequately address these questions, more empirical data is needed, particularly with respect to the following key issues: (1) the effectiveness of psychiatric rehabilitation; (2) the predictors of success in vocational rehabilitation; (3) the "readiness for rehabilitation" concept; and (4) the cost-effectiveness of psychiatric rehabilitation. The authors offer a vision for the mental heath system that is suggested as a guide for future developments in behavioral managed care and psychiatric rehabilitation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A5–9 yr followup study was conducted with 36 young adults with severe psychiatric disabilities who had previously participated in a vocationally oriented rehabilitation program aimed at developing the skills necessary to choose and implement a career plan. Longitudinal outcomes for work and educational status, hospitalization rates and self-esteem were examined. Ss showed a maintenance of initial gains in vocational and educational status, self-esteem scores, and hospitalization rates. Additional data on work outcomes and quality of life are presented. Overall, the findings of the followup show considerable evidence for the enduring positive effects of the career education program for this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discharge to the community of people who have made extensive use of state hospitals has become an accepted way to reduce the number of people in institutions, to close wards and decrease costs. However, concern exists over the ongoing community program costs and the sustained community functioning of individuals discharged after the reduction efforts have ended. This study investigated the program cost and community functioning of Ss discharged to a transition project that was sponsored and funded jointly by the Divisions of Vocational Rehabilitation and Mental Health. In the original study (Berkeley Planning Assoc, 1993), 26 people were discharged to a supported living/supported employment program. This paper reports on a follow-up study conducted 1 yr after the original evaluation of the project was completed. The follow-up study assessed residential and vocational status; data on ongoing need for program support and program costs were collected. Ss were able to maintain most of the residential and vocational gains made during their initial year of their transition to the community. Hospital days remained low, and the ongoing costs of the program, while still substantial, were significantly less than the costs for the 1st yr of their transition into the community. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychiatric rehabilitation (PSR) addresses global needs for communitybased services for individuals with psychiatric disabilities. This article describes one of the newest PSR innovations – supported education. Implementation of the program in the US and the Netherlands is described. Program differences are contrasted and related to the context of service delivery and the circumstances surrounding implementation. Many similarities are identified, suggesting that this innovation has the potential for successful utilization in many different locations. The article also demonstrates the benefits of international collaborations in terms of model improvements.
Engaging in rehabilitation and work can present individuals with a formidable prospect. From the consumer’s perspective, past failures, the daunting challenge of overcoming symptoms, stigma, inertia, and lack of support can contribute to keeping many people from beginning the rehabilitation process. Perhaps even more devastatingly, these barriers keep people believing that real change, such as a move to work, is impossible (Kramer & Gagne, 1997).
Psychiatric vocational rehabilitation, delivered through a variety of program models from transitional employment programs to supported employment programs, does appear to help individuals to develop the skills, supports, and accommodations over time that they will need to succeed in either competitive employment or some form of supported employment. The modest outcomes achieved to date, however, suggest that more understanding is needed in order to boost rates of employment. While research has begun to suggest that personal factors, rather than demographics or initial capacity, are correlated with vocational outcomes, further research is needed to explore the contribution that assessing and developing readiness can make to the process of gaining or regaining meaningful work and the valued role in society that comes with it.
The onset of mental illness may drastically interrupt individual lives, often occurring during young adulthood when people
are pursuing academic or vocational goals. Many individuals with psychiatric disabilities would like to resume these pursuits
but need support to be successful. Responding to this need, the Michigan Supported Education Research Project (MSERP) was
developed as a three-year federally funded collaborative effort providing support, assistance, and information to individuals
with serious mental illness who wish to pursue college or vocational education. This article describes implementation of the
project in metropolitan Detroit, the issues encountered, and solutions developed along the way. Significant factors in implementation
include an urban-based location on a college campus, the collaboration between the public mental health system and academic
institutions, and the many challenges presented by the students and the educational and mental health systems in place to
serve them.
The study utilised a quasi-experimental design and quota criteria sample of 38 adults with an acquired physical or psychological disability plus a history of long-term unemployment. At the end of the six months' rehabilitation intervention half of the participants of both disability groups were employed, which challenges the notion that adults with a psychological disability are less likely to achieve re-employment. It is important to note that similar numbers of males and females were employed, for women with a disability have historically been overrepresented in the unemployed numbers and underrepresented in rehabilitation programs. The study demonstrated that individuals with an acquired disability who reported higher self-confidence scores for gaining employment were 75% more likely to be later employed. There was a 29% improvement in General Health Questionnaire-28 scores at the end of the intervention. The program is reported and service delivery and wellbeing issues are discussed.
Supported employment (SE) is an evidence-based practice that helps people with severe mental disorders obtain competitive employment. The implementation of SE programs in different social contexts has led to adaptations of the SE components, therefore impacting the fidelity/quality of these services. The objective of this study was to assess the implementation of SE services in three Canadian provinces by assessing the fidelity and describing components of SE services using the Quality of Supported Employment Implementation Scale. About 23 SE programs participated in this study. Cluster analyses revealed six profiles of SE programs that varied from high to low level of fidelity with a stronger focus on a particular component, and reflected the reality of service delivery settings. Future investigations are warranted to evaluate relationships between the levels of implementation of SE components and work outcomes while considering individual characteristics of people registered in SE programs.
Intensive Psychiatric Rehabilitation Treatment (IPRT) is a new program of out-patient psychiatric rehabilitation which is currently operating in New York State and Iowa. IPRT is based upon a process of psychiatric rehabilitation which was developed at the Boston University Center for Psychiatric Rehabilitation. The purpose of IPRT is to assist individuals with serious and persistent mental illness in identifying and achieving personally meaningful goals within the community. This article will provide an overview of IPRT by examining the program as it operates in New York State, the research foundations of the program, and the preliminary results of a state-wide evaluation of IPRT programs. IPRT is an important new program of outpatient psychiatric rehabilitation. Controlled studies are needed to establish the effectiveness of the program.
This study of clubhouse-based transitional employment (TE) examined the ability of demographic data, diagnosis, and data on TE participation to predict TE tenure and a one-year competitive employment outcome following TE among clubhouse members. Baseline data on 138 club members who participated in TE over a 6-year period were retrospectively retrieved from a computerized database and written records. Most of the jobs held by members were maintenance or production jobs; members' average tenure on TE was 131.26 days. Older members, those with a longer club membership before their last TE job, and those working more days per week had longer average tenure on TE. Average tenure was unrelated to the severity of disability. Forty-two (30.4%) members obtained competitive employment in the one year following their last TE job. Members who worked more total hours on TE were more likely to obtain competitive employment. While aspects of the TE experience predict the move to competitive employment, further studies are needed.
This study examined the perspectives of people with psychiatric disabilities and employment service providers regarding factors that most directly help or hinder consumer efforts to obtain and maintain employment. Forty-four adults with serious mental illness (SMI) (consumers) and 30 providers participated in 12 focus groups across Massachusetts. We began both consumer and provider groups by posing two broad questions: 1) what factors most help people with SMI get and keep jobs (facilitators), and 2) what factors most prevent people with SMI from getting and keeping jobs (barriers)? Data were analyzed qualitatively and both person and environmental factors were highlighted. Among facilitators, participants agreed that quality consumer-provider relationships and individualized employment services are most instrumental in helping consumers achieve employment goals. Participants identified a range of environmental barriers, including issues related to the service system, entitlement programs, non-human resources, and social stigma. Implications for services are discussed.
Supported employment (SE) is considered an "evidence-based" practice for people with serious mental illness. We examined inpatient hospitalizations and emergency service visits among clients in a SE program based on the Individual Placement and Support (IPS) model in comparison to a propensity score matched group of clients who did not participate in IPS. A significant interaction showed that only IPS/SE clients who were also high in regular mental health services had fewer hospitalizations and emergency service visits than matched controls. The interaction effect was moderate, even when we controlled for client functioning. These findings provide support for the integration of mental health and vocational rehabilitation services, a key feature of evidence-based SE services.
Research examines aspirations and plans for college, perceptions of social support and acceptance, and perceived intellectual and emotional capacity for college reported by 80 adults with coping with serious mental illness. The role of consumers' age, prior college experience, hospitalization history, and feelings of personal loss due to mental illness in accounting for their views about college is examined. In general, consumers expressed strong aspirations for college, provided a positive assessment of their intellectual abilities, and mixed feelings about their emotional capacity to attend college. Participants were generally very optimistic about the level of acceptance from faculty and students and support from family and friends if they were to attend college. Amount of personal loss expressed by consumers accounted for a significant amount of variance in their reported aspirations and perceived capacity for college beyond that of age, prior college experience, and number of recent psychiatric hospitalizations. Participants' perceptions of support and acceptance were not related to total number of reported hospitalizations, but were positively related to the number of hospitalizations reported in the past year.
Presents an overview of the conceptual and legislative development of supported employment (SE) with developmentally disabled persons. The model of SE for psychiatrically disabled persons that is currently emerging reflects this conceptual and legislative history. Based on a literature review and interviews with people in the field, the present article describes how the SE approach is currently being adapted for persons with psychiatric disability. Other conceptual issues are highlighted, including the psychological importance of work, transitional vs SE, and vocational outcomes. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Explains the legal basis for reasonable accommodation and provides examples of how it may be applied to benefit workers with psychiatric disabilities. When the provisions of the Americans with Disabilities Act of 1990 become effective and corresponding regulations are implemented, most employers will be required to make reasonable accommodations for workers with disabilities. A list of accommodations for persons with psychiatric disabilities is included, based on actual work situations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Hypothesized that the process of vocational rehabilitation could be accelerated by artificially limiting the length of time members were assigned to prevocational crews. 107 clients admitted to a psychosocial rehabilitation program classified according to prior work experience, were assigned to either the standard gradual vocational program or an accelerated program requiring their early involvement in transitional employment. After 15 mo, 20% of the accelerated Ss were in competitive employment, compared with 7% of gradual Ss. 15% of accelerated Ss were in prevocational crews, compared with 35% of gradual Ss. All 7 of the members working full-time at 15 mo were in the accelerated group. Work-experienced Ss benefited from the accelerated approach. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The rehabilitation alliance refers to the mutual respect, trust, and seriousness of purpose that are essential for relationships that plan and support coordinated treatment-rehabilitation programming. It is considered in depth in the relationship between client and practitioner and among members of the rehabilitation team. Special mention is made of the vocational dimension of the rehabilitation process and the vocational rehabilitation practitioner as a member of the team.
Recent studies concerned with training clients in job-seeking skills, together with investigations on the relative effectiveness of formal and informal job seeking methods point to a promising alternative to selective placement for clients who are capable of an independent job search. (Author)
The "place-train" model of supported employment, appropriate for developmental disability, must be replaced by a "choose-get-keep" model for supported employment of people with psychiatric disabilities. Key model concepts include client job choice, development of job seeking skills, and application of appropriate job behaviors. (Author/DB)
Describes a work-placement program that incorporated intensive job-seeking skills training, components of Job Club programs, as outlined by N. H. Azrin and V. A. Besalel (1980), and other behavioral procedures designed to encourage independent job finding by psychiatric patients. Of the 1st 97 clients in the program, 95% were males. 55% were White, and 35% were Black. Ss ranged from 21 to 62 yrs of age. 87% of the Ss had at least a high school diploma. 74% of the Ss had a prior history of psychiatric hospitalization. The program operated on a full-day basis; incorporated individualized, daily goal-setting and incentives; and placed special emphasis on teaching Ss how to cope with daily living problems. Of the initial 97 Ss, 56% secured employment, and an additional 10 Ss entered full-time job-training programs. Ss spent an average of 23.9 working days in the program. Of the 54 Ss who entered jobs or training from the program, 6-mo follow-up data were collected on 40 Ss. The percentages of Ss in this group employed at 30, 60, 90, and 180 days after leaving the program were 80, 75, 80, and 67.5%, respectively. Results for this program more closely paralleled previous Job Club placement findings than did previous reports of work placement among people with psychiatric disabilities. (15 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents the theory and research base for the 3-phase approach proposed by K. S. Danley and W. A. Anthony (1987) as a framework for offering effective supported employment services to people with psychiatric disability. Descriptions are provided for (1) the choose phase, which gives participants the chance to select a job that matches their interests, values, and career goals; (2) the get phase, where participants learn to write resumes, complete applications, and interview for jobs; and (3) the keep phase, in which participants learn to overcome barriers to improving job and interpersonal skills. A case study illustrates interventions options for an Employment Training Specialist. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examines some basic premises of supported employment initiatives, particularly the role of agency-sponsored job coaches in supporting employees with severe disabilities in integrated work environments. A broader concept of supported employment is proposed, based on studies of the supports and informal interactions characteristic of natural work environments. Alternative support options, entitled the mentor option, the training consultant option, the job sharing option, and the attendant option, which involve the active participation of supervisors and coworkers, are presented with suggestions for implementation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews the literature on the outcome of psychiatric rehabilitation. The material reviewed reflects the mission, client demographics, types of interventions, and outcomes that characterize the field of psychiatric rehabilitation. All studies were analyzed with respect to certain key dimensions (source, setting, focus, outcome type, intervention, research design, and findings). Studies were categorized as to the predominant environment on which the intervention is focused (i.e., the client functioning in living, learning, or working environments). Indications of prevailing philosophies within psychiatric rehabilitation are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A recent national survey of family satisfaction with services to young adult chronic patients is discussed in terms of possible alternative treatment formats.
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Directory of Technical Assistance Resources for Community Support Systems
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Handbook of Psychiatric Rehabilitation
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The Skills of Community Service Coordination
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Massachusetts Client Preference Assessment
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Advances in Treating the Young Adult Chronic Patient
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The Skills of Career Counseling
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The Choose‐Get‐Keep Model: Serving Severely Psychiatrically Disabled People
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