Vocational Rehabilitation Library Toolkit

Abstract: People with a chronic psychiatric disorder (CPD) have low employment rates worldwide. This multicenter retrospective cohort study examined the employment outcomes of an innovative in-house vocational training program for people with CPD in Taiwan and explored which program parameters significantly predicted outcomes. Data were retrieved from the records of 323 participants who completed the training program. Satisfactory employment rates were found at 1 (52.9%), 3 (60.4%), and 6 (65.6%) mo posttraining, and 38.7% of participants demonstrated high employment sustainability (employed throughout the first 6 mo posttraining). Three program parameters significantly predicted employment outcomes: (1) occupational therapists' pursuit of additional training or short-term apprenticeship pertinent to clients' job interests, (2) posttraining vocational counseling provided by community-based occupational therapists, and (3) the duration of 6 mo posttraining to allow clients to prepare for competitive employment. Occupational therapist-led in-house vocational training is a promising alternative to traditional vocational training for people with CPD.

Abstract: Objective: Supported employment has experienced immense growth as an evidence-based intervention targeting the disproportionately high rates of unemployment among individuals with psychiatric disabilities who actively want to work. However, employment services are often not available to individuals who are ambivalent about work or lack work self-efficacy. The purpose of this study was to pilot-test the efficacy of a new peer-run photography-based group intervention (Vocational Empowerment Photovoice [VEP]) designed to empower individuals with psychiatric disabilities to consider employment services and pursue work.
Method: A total of 51 individuals with serious mental illnesses enrolled at a university-based recovery center, who were not employed or enrolled in any vocational services, were randomly assigned to the VEP program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of the VEP program on both extrinsic (enrollment in employment services and employment rates) and intrinsic (work hope, motivation and self-efficacy, vocational identity, overall empowerment and internalized stigma) work-related outcomes.
Results: Participation in the VEP program was associated with a significantly higher rate of engagement in employment services over the course of the intervention and with significantly higher overall empowerment and decrease of internalized stigma sustained through the 3-month follow-up assessment. Stronger engagement in the VEP program was associated with increased work hope, self-efficacy and sense of vocational identity.
Conclusions and Implications for Practice: The study highlights the malleable nature of defeatist beliefs which prevent many individuals with mental illnesses from pursuing employment services despite their inherent interest in working.

Abstract: BACKGROUND: Employment often has a defining role that shapes a person's identity. The aim of this study was to generate a rich description of the meaning of employment for people with mental illness and identify the facilitators and barriers they experience in gaining and sustaining employment. Low workforce participation rates exist for people with mental illness despite their ability to both benefit from, and contribute through, employment. OBJECTIVE: Individual in-depth interviews were used to gather information about participants' lived experiences of mental illness, what employment meant to them, their vocational aspirations, and the facilitators and barriers encountered while engaging in employment activities. METHODS: Focus groups (N= 3) and individual in-depth interviews (N= 9) were used to gather information about participants' lived experiences of mental illness, what vocation meant to them, their vocational aspirations, and the facilitators and barriers encountered while engaging in or pursuing employment. An inclusive research approach was employed in conducting interpretive phenomenological analysis. RESULTS: Four themes and nine subthemes described the meaning of employment, aspirations, and personal choices. Personal barriers to vocation included loss of valued roles, challenges of the vocational environment, and restrictions in opportunities. Examples of facilitators of employment were mental health services providers, family, and friends. Participants pursued paid employment because they wanted outcomes that would lead to work satisfaction such as making money, having financial security, socialising, and having a sense of achievement. CONCLUSION: Engaging in meaningful vocation allowed people with mental illness to establish and re-establish their identities and valued life roles.

Abstract: The current study explores factors predicting return to work in a sample of patients with neurological and neuropsychiatric disorders who have attended a prevocational readiness and social skills training programme many years after trauma. Participants were community-dwelling adults with long-term disabilities (N = 67). Results of univariate analyses followed by multivariate logistic regression analysis revealed that both pre-injury (prior) and post-injury (current) factors influenced the likelihood of employment in our sample: prior employment, current employment readiness, current cognitive competence (particularly memory and executive functioning) and emotional adjustment. Our findings demonstrate that both pre-trauma and current factors interact in predicting return to work not only for individuals with traumatic brain injury (TBI), but also for a broader group of patients with long-term disabilities due to a variety of neurological and neuropsychiatric conditions. Thus, our findings provide preliminary support for ongoing long-term management of individuals with long-term disabilities and warrant close attention of future investigators to potential benefits of cognitive remediation, psychotherapy and vocational rehabilitation in terms of maintenance of initial gains and increased probability of return to work many years after trauma.

Abstract: BACKGROUND: Veterans with mental illness often have poor employment outcomes. OBJECTIVE: This mixed-methods study sought to understand and describe Veteran perspectives of factors that impact their work success. METHODS: A sample of 40 employed and unemployed Veterans with post-traumatic stress disorder (PTSD) or other severe mental illness (SMI) completed a survey of factors that impact vocational functioning and provided narrative accounts of their most successful and challenging work experiences. RESULTS: Personal motivation, self-efficacy, work skills, interpersonal issues, health, and cognitive problems were rated as most impactful on work. There were no significant differences on ratings of work factors based on employment status. Veterans with PTSD reported significantly more barriers to work success compared with Veterans with SMI, notably, cognitive problems, physical health, and psychological stress. Veterans with SMI were more likely to receive VA vocational services and rated this assistance as beneficial to work success. Narrative findings corroborated the survey results, and yielded additional factors, including economic factors, person/job fit, and Veteran-specific issues. CONCLUSIONS: Several factors substantially impact work success in Veterans with mental illness. Veterans with PTSD and SMI experience a distinct set of barriers and facilitators, suggesting the need for tailoring clinical and rehabilitative services.

Abstract: Background: Common mental disorders are important contributors to the global burden of disease and cause negative effects on both the individual and society. Stress-related disorders influence the individual's workability and cause early retirement pensions in Denmark. There is no clear evidence that mental health care alone will provide sufficient support for vocational recovery for this group. Integrated vocational and health care services have shown good effects on return to work in other similar welfare contexts. The purpose of the Danish IBBIS (Integreret Behandlings- og BeskæftigelsesIndsats til Sygemeldte) study is to examine the efficacy of (1) a stepped mental health care intervention with individual stress coaching and/or group-based MBSR and (2) an integrated stepped mental health care with individual stress coaching and/or group-based MBSR and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark.
Method/design: This three-armed, parallel-group, randomized superiority trial is set up to investigate the effectiveness of a stepped mental health care intervention and an integrated mental health care and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. The trial has an investigator-initiated multicenter design. Six hundred and three patients will be recruited from Danish vocational rehabilitation centers in four municipalities and randomly assigned into three groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (BDI), anxiety (BAI), distress symptoms (4DSQ), work- and social functioning (WSAS), and register-based recurrent sickness absence.
Discussion: This study will contribute with knowledge on the consequence of the current organizational separation of health care interventions and vocational rehabilitation regarding the individual's process of returning to work after sick leave because of exhaustion disorder, adjustment disorder or distress. If the effect on return to work, symptom level, and recurrent sick leave is different in the intervention groups, this study can contribute with new knowledge on shared care models and the potential for preventing deterioration in stress symptoms, prolonged sick leave, and recurrent sick leave.
Trial Registration: ClinicalTrials.gov, registration number: NCT02885519 . Retrospectively registered on 15 August 2016). Participants have been included in the IBBIS trial for distress, adjustment disorder and exhaustion disorder since April 2016.

Abstract: BACKGROUND: Individuals with mental health problems often need support from vocational rehabilitation professionals in their return-to-work (RTW) process. Research has shown that this support can be deficient, with vocational rehabilitation professionals lacking relevant knowledge and an underlying belief in the individual's ability to resume a working life. More understanding is therefore needed of professionals' mental health literacy and their perception of and influence on employer roles in the RTW process. OBJECTIVE: To explore the mental health literacy of Swedish vocational rehabilitation professionals and their perception of employers in the RTW process. METHOD: Qualitative grounded theory study which included 22 interviews of vocational rehabilitation professionals working with individuals with mental health problems in their RTW process. RESULTS: Three categories emerged: holding a position of power in the RTW process, viewing and believing in individuals' work ability plays a central role, and recognizing the employer's role as a key factor for realizing employment. CONCLUSION: Increasing the mental health literacy of vocational rehabilitation professionals is crucial since they have a decisive role with both clients and employers in the RTW process.

Abstract: Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain.
Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions.
Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39⁻7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13⁻9.15) compared to the control group in adjusted models.
Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

Abstract: BACKGROUND: Unemployment is high among people with severe mental illness and often hinders community integration. OBJECTIVES:To inform the effectiveness of vocational rehabilitation programs, our study examined whether self-perceived barriers to work differ among clinical and demographic subgroups of people with mental illness, and whether self-perceived barriers to work, clinical and demographic factors are related to employment outcomes. METHODS: Multivariate regression analyses were conducted on self-perceived barriers to work, clinical and demographic factors of N= 279 people with mental illness who presented to Career Management Service. RESULTS: Older as opposed to younger participants were less likely to obtain competitive employment. Being of an ethnic minority group increased the likelihood of entering education/training but made it less likely to enter non-competitive employment, while no difference was found for obtaining competitive employment. A trend was found for people with schizophrenia versus those with a different diagnosis to be more likely to enter education/training and non-competitive employment. Except for health problems and social/structural disadvantages, self-perceived barriers to work were not related to actual employment outcomes. CONCLUSIONS: The results indicate that vocational rehabilitation for people with mental illness does not occur in isolation but is influenced by factors beyond clinical impairment which generally affect the labor market.

Abstract: BACKGROUND: Self-motivation, subjective norms, and support of social network are central factors in supported employment. OBJECTIVE: To measure these factors a short questionnaire was developed and tested. METHODS: 116 people with mental illness were enrolled. RESULTS: In the present study we found that self-motivation was high; 98% of the consumers think competitive employment is important or very important. The perceived motivation of the social network was also high, but significantly lower than self-motivation. Furthermore, the consumers assume that their social network supports their desire to work. CONCLUSION: People with mental illness are motivated to work, they are not idle.

Abstract: BACKGROUND: Vocational recovery is a concept that has grown out of the mental health recovery model and has been operationalized as a threshold for work capacity for persons working with serious mental illness (SMI). In this article, is it conceptualized as a process towards gainful employment and overall mental health recovery. OBJECTIVE: This article describes the early phases of the vocational recovery process of individuals with serious mental illness participating in a supported employment program and the factors that make up this process. This study describes the vocational recovery process and the mental health related recovery gains attained through employment. METHODS:Aconstructivist grounded theory approachwas employed in this study. The primary author conducted participant observations and conducted semi-structured interviews with 10 individuals at a supported employment program to develop a theory about a vocational process that is grounded in data. RESULTS: A phase like process emerged from the data, which moved individuals from prevocational to early vocational recovery to active vocational recovery process. Participants experienced both mental health and vocational recovery challenges and benefits as they moved through the supported employment program and substantial support from providers, family members, program director and peers emerged as a driving force to move individuals through the recovery process. CONCLUSION: Participants in this study rapidly placed into a supported employment program were able to move through their psychosocial barriers to employment and move towards an active vocational recovery process. The phase like progression suggests that appropriate interventions can be formulated that best meets the individual's vocational and mental health needs depending on where individuals are in their overall vocational recovery process. Follow up research is necessary.

Abstract: There is a deep research base in the employment and mental health (MH) field that has supported the development of effective strategies for people with significant psychiatric disabilities. However, overall employment outcomes for people with serious mental illness have not increased significantly. This is true even with the recent emphases on recovery and system change or transformation. While employment continues to be stated as one of the cornerstones of recovery within mental health, vocational rehabilitation (VR) remains a crucial resource through interagency partnerships, funding, training, and policy development. The Institute for Community Inclusion's Rehabilitation Research and Training Center on Vocational Rehabilitation (ICI VR-RRTC) did case studies with state VR agencies examining innovations in these areas. This article describes three VR agencies in particular (Delaware, Maryland, Oregon) that served in many ways as excellent exemplars of using the multiple resources, skills, and services models that produced better employment results. It describes each state's specific partnership strategies, then concludes with findings from each as well as an overall analysis of key issues that should be applicable more generally vis-á-vis VR-MH collaboration on employment interventions.

Abstract: Background: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes. Aim/Objective: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia. Materials and Method: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context. Results/Findings: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment. Conclusions: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services. Significance: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.

Excerpt from article: There are few things more infuriating to mental health professionals than hearing "ADHD is not real." Yes, we are headed into the year 2022, and there are still critics, cynics, criticizers, and non-believers vying for the opportunity to disprove the diagnosis.

Abstract: Background: This is one of the first studies to examine the structural brain anatomy and connectivity associated with an ADHD diagnosis and child as well as adult ADHD symptoms in young adults. It was hypothesized that an adult ADHD diagnosis and in particular childhood symptoms, are associated with widespread changes in the brain macro- and microstructure, which can be used to develop a morphometric biomarker for ADHD. Methods: Voxel-wise linear regression models were used to examine structural and diffusion-weighted MRI data in 72 participants (31 young adults with ADHD and 41 controls without ADHD) in relation to diagnosis and the number of self-reported child and adult symptoms. Results: Findings revealed significant associations between ADHD diagnosis and widespread changes to the maturation of white matter fiber bundles and gray matter density in the brain, such as structural shape changes (incomplete maturation) of the middle and superior temporal gyrus, and fronto-basal portions of both frontal lobes. ADHD symptoms in childhood showed the strongest association with brain macro- and microstructural abnormalities. At the brain circuitry level, the superior longitudinal fasciculus (SLF) and cortico-limbic areas are dysfunctional in individuals with ADHD. The morphometric findings predicted an ADHD diagnosis correctly up to 83% of all cases. Conclusion: An adult ADHD diagnosis and in particular childhood symptoms are associated with widespread micro- and macrostructural changes. The SLF and cortico-limbic findings suggest complex audio-visual, motivational, and emotional dysfunctions associated with ADHD in young adults. The sensitivity of the morphometric findings in predicting an ADHD diagnosis was sufficient, which indicates that MRI-based assessments are a promising strategy for the development of a biomarker.

Excerpt from article: About 11 percent of school-age children in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD). While many of these children eventually “outgrow” the disorder, some carry their difficulties into adulthood: About 10 million American adults are currently diagnosed with ADHD. In the first study to compare patterns of brain activity in adults who recovered from childhood ADHD and those who did not, MIT neuroscientists have discovered key differences in a brain communication network that is active when the brain is at wakeful rest and not focused on a particular task. The findings offer evidence of a biological basis for adult ADHD and should help to validate the criteria used to diagnose the disorder, according to the researchers.

Excerpt from article: Brain scientists have found that deficiencies in specific neurotransmitters underlie many common disorders, including anxiety, mood disorders, anger-control problems, and obsessive-compulsive disorder. ADHD was the first disorder found to be the result of a deficiency of a specific neurotransmitter — in this case, norepinephrine.

Abstract: Background: Depression and anxiety are among the largest contributors to the global burden of disease and have negative effects on both the individual and society. Depression and anxiety are very likely to influence the individual's work ability, and up to 40% of the people on sick leave in Denmark have depression and/or anxiety. There is no clear evidence that treatment alone will provide sufficient support for vocational recovery in this group. Integrated vocational and health care services have shown good effects on return to work in other, similar welfare contexts. The purpose of the IBBIS (Integrated Mental Health Care and Vocational Rehabilitation to Individuals on Sick Leave Due to Anxiety and Depression) interventions is to improve and hasten the process of return to employment for people in Denmark on sick leave because of depression and anxiety.
Methods/design: This three-arm, parallel-group, randomized superiority trial has been set up to investigate the effectiveness of the IBBIS mental health care intervention and the integrated IBBIS mental health care and IBBIS vocational rehabilitation intervention for people on sick leave because of depression and/or anxiety in Denmark. The trial has an investigator-initiated multicenter design. A total of 603 patients will be recruited from Danish job centers in 4 municipalities and randomly assigned to one of 3 groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (Beck Depression Inventory II), anxiety (Beck Anxiety Inventory), stress symptoms (Four-Dimensional Symptom Questionnaire), work and social functioning (Work and Social Adjustment Scale), and register-based recurrent sickness absence.
Discussion: This study will provide new knowledge on vocational recovery, integrated vocational and health care interventions, and prevention of recurrent sickness absence among people with depression and anxiety. If the effect on return to work is different in the intervention groups, this study can contribute to current knowledge on shared care models for health care and vocational rehabilitation services.

Excerpt from article: When you suffer CPTSD or PTSD long enough, you become wired for trauma, making even the slightest upset a potential trigger. Sending you into a tailspin. A downward spiral. A fight-or-flight response. And when you experience intergenerational trauma, trauma from your ancestors that rides on the strands of your DNA, you live in a fight-or-flight response. Every day. Day after day. And it takes everything you have to get out

Abstract: Objective: Transitional work (TW) for veterans with psychiatric disabilities is the predominant model of vocational rehabilitation in the Veterans Health Administration (VA). Although, on average, TW employment outcomes have been demonstrated to be inferior to supported employment, little is known about the potential subgroup of veterans for which TW may be most effective. This study of veterans with posttraumatic stress disorder (PTSD) examines differences in competitive employment outcomes and identifies characteristics of veterans who chose to engage in TW compared with those who did not.
Method: A post hoc comparative subgroup analysis of veterans with PTSD randomly assigned to TW as part of a randomized controlled trial was conducted. Veterans were divided into 2 subgroups: those who engaged in TW (n = 141) and nonengagers (n = 129). Differences in baseline characteristics were examined and 18-month employment outcomes were compared.
Results: There were no differences in 18-month employment outcomes between TW engagers and nonengagers. Compared with TW engagers, those that did not engage in TW were 2.5 times more likely to get a competitive job within the first 6 months and were less likely to obtain lower skilled jobs. Younger age, adequate housing, personal means of transportation, and recent work history factor into the odds of gaining and maintaining competitive work.
Conclusions and Implications for Practice: Consistent with past research, engagement in TW did not result in improved long-term competitive employment outcomes for veterans with PTSD. Those who did not engage in TW were more likely to gain a competitive job within the first 6 months.

Abstract: The classic fight-or-flight response to perceived threat is a reflexive nervous phenomenon thai has obvious survival advantages in evolutionary terms. However, the systems that organize the constellation of reflexive survival behaviors following exposure to perceived threat can under some circumstances become dysregulated in the process. Chronic dysregulation of these systems can lead to functional impairment in certain individuals who become “psychologically traumatized” and suffer from post-traumatic stress disorder (PTSD), A body of data accumulated over several decades has demonstrated neurobiological abnormalities in PTSD patients. Some of these findings offer insight into the pathophysiology of PTSD as well as the biological vulnerability of certain populations to develop PTSD, Several pathological features found in PTSD patients overlap with features found in patients with traumatic brain injury paralleling the shared signs and symptoms of these clinical syndromes.

Excerpt from article: It’s common to see references to the basic human instincts of ‘fight or flight’ when faced with a traumatic situation. In fact, the brain is hardwired to deliver a wider range of reactions, which can be summed up as fight, flight, freeze, fawn and flop. The latter two being the least discussed and talked about. All of them are a natural outcome of fearful situations or extended periods of abuse. With Post Traumatic Stress Disorder (PTSD) or C-PTSD, they can leave a lasting legacy and become a recurrent behaviour.

Abstract: 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.

Abstract: BACKGROUND: Unemployment among people with schizophrenia remains high despite slight improvements in vocational rehabilitation services and attitudes towards people with mental health disorders over the years. Experts are in a good position to increase our understanding on why this group still experiences such significant barriers to employment. OBJECTIVE: Interviews explored experts' views on schizophrenia and employment; with a particular focus on individual, attitudinal and structural barriers, as well as available interventions and their outcomes. METHODS: The sample of 20 experts were recruited using theoretical sampling. The experts consisted of: employment specialists, healthcare professionals, activists from patient organisations, academics, caregivers and employers. A thematic approach was used for analysis. RESULTS: Low expectations of healthcare professionals which were often manifested as minimal recognition of employment as an outcome for people with schizophrenia as well as a 'benefits trap' were identified as the strongest barriers to employment. In addition, the IPS model was identified as the most effective to support people to work, but lack of funding to implement the model nationally and concerns of poor implementation were raised by the experts. CONCLUSIONS: More research is required to examine which adaptations are needed for vocational interventions in order to implement them successfully.

Abstract: OBJECTIVE. This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep.
METHOD. Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis.
RESULTS. Sixty-one articles were selected for inclusion. The review yielded strong evidence for psycho-education and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions.
CONCLUSION. Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.

Abstract: BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation intervention for people with severe mental illness. IPS emphasizes client choice, rapid job finding, competitive employment, team-oriented approaches, benefits counseling, and ongoing supports. OBJECTIVE: This paper summarizes 20 years of research on IPS, describes studies in the field now, and proposes priorities for future research. METHODS: To identify published and unpublished IPS research studies, we conducted an electronic search of qualitative and quantitative IPS studies, findings from recent reviews, and sought expert recommendation. RESULTS: Past research indicates that IPS supported employment is the most effective and cost-effective approach for helping people with psychiatric disabilities find and maintain competitive employment. Employment improves clinical, social, and economic outcomes. Current studies on IPS address several research gaps: IPS modification, generalizability, program settings, international dissemination, cultural awareness, and supportive technology. Looking forward, the field needs studies that report long-term outcomes, financing mechanisms, cost offsets, and standardized supported education models. CONCLUSIONS: While IPS is one of the most extensively studied of all vocational models, significant literature gaps remain.

Abstract: Background: Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element.
Methods: A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS.
Results: Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier.
Conclusions: The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.

Abstract: BACKGROUND: The Individual Placement and Support (IPS) model of Supported Employment (SE) is an evidence-based practice that leads to an increase in successful employment outcomes for people with serious mental illness (Bond, Drake, & Becker, 2008). The practical application and implementation of this practice, however, is limited in the Southeastern region of the United States. OBJECTIVE: This study examined the perceptions held by and practices used by mental health professionals regarding the employment of individuals with serious mental illness at two sites in Alabama. METHODS: The two sites yielded 79 participants, including clinicians and case managers, who responded to the Health Professional Perceptions of Employment Survey - Revised. Analysis of the quantitative data was completed using an independent samples t-test, Pearson product moment correlation coefficient, and Spearman rank correlation coefficient. The qualitative data was analyzed for common themes based on survey responses. RESULTS: A statistically significant relationship was identified that supports the connection between perceptions and practices of mental health professionals related to the employment of people with serious mental illness. CONCLUSIONS: Mental health professionals' attitudes toward employment affects their consideration of employment for their clients, which will help or hinder the clients' vocational progress and recovery.

Abstract: BACKGROUND: Although individual placement and support (IPS) is established as an evidence-based model of supported employment, opportunities for improvements abound. Front-line supported employment practitioners are uniquely positioned to provide feedback on implementation. OBJECTIVE: This study investigates IPS from a practitioner perspective to illuminate themes in practitioner endorsement, advantages, disadvantages, growth opportunities, ideal practitioner characteristics, sequence of services and methods for promoting self-determination. METHODS: Sixty-seven employment practitioners completed an open-ended survey about IPS implementation. Qualitative results were analyzed using Lofland and Lofland's (1984) systematic filing system and Berg's (2004) themes to combine similar items into categorical frameworks. RESULTS: Three conceptual frameworks are described: Program, Practitioner Characteristics and Practitioner Essential Tasks. Despite general endorsement of IPS, many complexities are discussed. Practitioners emphasized the importance of interpersonal skills in establishing rapport, promoting hope and encouraging self-determination. Highly organized, persistent practitioners who balance client and business needs are seen as most effective. CONCLUSIONS: We offer these frameworks for utilization by IPS practitioners, researchers and stakeholders for the purposes of program development and organizational decision-making.

Plain language summary: "A majority of severely mentally ill people would like to work and there are compelling ethical, social and clinical reasons for helping them to achieve this goal. Pre‐vocational Training and Supported Employment are two different approaches to helping severely mentally ill people obtain employment. The key principle of Pre‐vocational Training is that a period of preparation is necessary before entering competitive employment. In contrast, the key principle of Supported Employment is that placement in competitive employment should occur as quickly as possible, followed by support and training on the job. This systematic review found that people who received Supported Employment were significantly more likely to be in competitive employment than those who received Pre‐vocational Training (at 12 months 34% employed in Supported Employment compared with 12% in Pre‐vocational Training)."

Abstract: BACKGROUND: While considerable research has been conducted on employment of people with serious mental illness (SMI), there is a dearth of research in this area focused on the work experiences of women with SMI. OBJECTIVE: This article fills a gap in the research by presenting the results from a study exploring the work experiences of women with SMI. METHODS: Grounded theory methodology was used to analyze the qualitative data. Several qualitative validity strategies were employed to enhance data quality. RESULTS: Six themes relating to work emerged from analysis of the qualitative data: (1) work drain; (2) symptom visibility; (3) work disclosure; (4) inconsistent work; (5) nontraditional work; and (6) work assets. CONCLUSIONS: Vocational rehabilitation practitioners can tailor rehabilitation plans to support the unique needs of women with SMI and leverage their strengths to help them gain greater satisfaction and meaning from work.

From the introduction: "Individuals with mental illness are a diverse group of people, with a wide range of talents and abilities. They work in all sectors of the U.S. economy, from the boardroom to the factory floor, from academia to art. Employment not only provides a paycheck, but also a sense of purpose, opportunities to learn and a chance to work with others. Most importantly, work offers hope, which is vital to recovery from mental illness."