Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis / Revisión sistemática y metaanálisis de la efectividad de intervenciones aumentadas de IPS para la obtención de empleo competitivo en personas con esquizofrenia

Abstract: Background: It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population. Objective: To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia. Method: A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions. Results: Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode. Discussion and conclusion: It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.

Resumen: Antecedentes: Se ha estimado que más del 70% de las personas que viven con diagnóstico de esquizofrenia desean trabajar. El modelo Individual Placement and Support (IPS) ha mostrado efectividad para que las personas con esquizofrenia consigan un empleo competitivo. Sin embargo, en esta población no se ha evaluado la eficacia de las intervenciones aumentadas de IPS -es decir, aquellas que añaden al modelo una intervención psicosocial. Objetivo: Evaluar la eficacia de las intervenciones aumentadas de IPS dirigidas a la obtención de empleo competitivo en personas con esquizofrenia. Método: Se realizó una revisión sistemática de la literatura de ensayos clínicos aleatorizados sobre intervenciones aumentadas de IPS publicados en inglés entre 2007 y 2017, en las bases de datos electrónicas de PubMed, Science Direct y EBSCO. Se calcularon el riesgo de sesgo y las tasas de empleo competitivo. Se realizó un metaanálisis mediante el método de efectos aleatorios para estimar el efecto de las intervenciones aumentadas de IPS. Resultados: Se identificaron 12 artículos en los que se comparaban 10 intervenciones aumentadas de IPS con alguna otra intervención. En ocho estudios realizados en personas con esquizofrenia, la intervención se basó en IPS + habilidades sociales/habilidades laborales/remediación cognitiva vs. IPS o IPS modificadas, sin que se encontrara un efecto general en favor de las intervenciones aumentadas (RR = 1.37, 95% IC [.97, 1.95], I2 = 52%). Las intervenciones aumentadas de IPS tienden a ser más efectivas cuando se llevan a cabo en el primer episodio psicótico. Discusión y conclusión: No se puede concluir que las intervenciones aumentadas de IPS tengan un mayor efecto sobre las intervenciones estándar de IPS para la obtención de empleo competitivo en personas con esquizofrenia.

Ajuste ocupacional com uso de tecnologia de comunicação em paciente com esclerose lateral amiotrófica: um autorrelato / Occupational adjust by communication technologies in a patient with amyotrophic lateral sclerosis: a self-report

AIMS: This self-report presents the case of a physician and university professor affected by amyotrophic lateral sclerosis, and his experience in adjusting his occupational activities through communication technologies, as a distance education lecturer. It is a personal communication written by the reported patient/professor. CASE DESCRIPTION: The Neurophysiology Subject at the Federal University of the Juiz de Fora Medical School includes clinical case discussions at an online teaching platform. The reported patient has been collaborating as a lecturer of this discipline following the amyotrophic lateral sclerosis diagnosis. His professional experience as a physician and personal experience as a patient with a neuromuscular disease enriches the virtual clinical discussions. Through distance education, the lecturer overcome the physical limitations imposed by his underlying condition. He is able to deepen the discussion, highlighting psychosocial aspects, doctor-patient relationship, and humanization in neurodegenerative diseases. CONCLUSIONS: The interaction with the students, through distance learning, of this neurophysiology lecturer suffering with advanced amyotrophic lateral sclerosis, resulted in greater interest, better commitment to patients' care, and better student performance in the subject. It also improved the professor's self-reported quality of life and satisfaction, as he overcame his physical and social limitations, "feeling useful" again.

OBJETIVO: Este autorrelato apresenta o caso de um médico e professor universitário, portador de esclerose lateral amiotrófica avançada, e sua experiência em ajustar as atividades ocupacionais por meio de tecnologias de comunicação, como professor de ensino à distância. Trata-se de uma comunicação pessoal escrita pelo próprio paciente/professor. DESCRIÇÃO DO CASO: A disciplina de Neurofisiologia do Curso de Medicina da Universidade Federal de Juiz de Fora dinamiza as aulas presenciais com discussões de casos clínicos à distância, via plataforma de ensino virtual. Surgiu a possibilidade do professor atuar como colaborador dessa disciplina, na qual pode aproveitar sua experiência enquanto médico e sua vivência como paciente vítima de doença neuromuscular nas discussões de casos com os estudantes. Através da educação à distância, esse médico e professor supera as limitações físicas impostas pela doença. Ele tem condições de aprofundar a discussão, evidenciando os aspectos biopsicossociais, relação médico-paciente e humanização nas doenças neurodegenerativas. CONCLUSÕES: A interação com os alunos, por meio do ensino à distância, desse professor de neurofisiologia acometido por esclerose lateral amiotrófica avançada, resultou em maior interesse, maior comprometimento com o atendimento aos pacientes e melhor desempenho dos estudantes na disciplina. Também melhorou a qualidade de vida e a satisfação autorrrelatadas pelo professor, ao superar suas limitações físicas e sociais e "sentir-se útil" novamente.

Inhalant Dependence: Is There A Role Of Achieving Abstinent Through Supported Employment? A Case Report

Objective: This case report highlights the success of community services and supported employment program that may be of help to a woman with chronic inhalant use to achieve a complete abstinence. Methods: We report the case of a 45 year old lady who chronically abused glue, presented after 10 years with substance induced psychosis and comorbid mood disorder. Results: Abstinent from inhalant dependence was achieved after series of home treatment services and supported employment program. Conclusion: Provision of acute community service and incorporating this patient in supported employment program contribute to her successful journey in achieving abstinence from inhalant dependence.

Estrategias de inserción laboral en población con discapacidad mental: una revisión / Strategies of employability in population with mental disabilities: a review

The employability and access to the productive market are considered key elements for the full integration of the patient with mental disability. The aim of this review was to describe and analyze the scientific literature for the main employability strategies: traditional vocational rehabilitation (sheltered work and social firms) and supported employment (particularly in its mode of individualized supported employment). The results of the review suggest that individualized supported employment is the most effective approach in obtaining employment for people with mental disabilities.

La inserción laboral y el acceso al mercado productivo son considerados elementos claves para la plena integración del paciente con discapacidad mental. El objetivo de la presente revisión fue describir y analizar la literatura científica correspondiente a las principales estrategias de inserción laboral: rehabilitación vocacional tradicional (empleo protegido y empresas sociales) y empleo con apoyo (particularmente en su modalidad de empleo con apoyo individualizado). Los resultados de la revisión indican que el empleo con apoyo individualizado es el abordaje más efectivo en la obtención de empleo en personas con discapacidad mental.

Economia solidária e reabilitação vocacional no campo da drogadição: possibilidades e limites das práticas atuais / Cooperative work and vocational rehabilitation in the drug addiction treatment: opportunities and limitations of current practices

Este artigo visa a contribuir ao debate sobre as potencialidades do trabalho no processo de recuperação de dependentes químicos. Consideramos nesta análise os princípios subjacentes à reabilitação vocacional praticada no contexto internacional, seguido da descrição das diretrizes brasileiras para a inclusão social de dependentes químicos por meio do trabalho. Por fim, procedemos a uma análise comparativa das matrizes conceituais, dos conceitos de saúde subjacentes e do potencial emancipatório em ambas as perspectivas. O material consultado foi levantado por meio de revisão bibliográfica em bases de dados da área da saúde. Já as informações sobre as diretrizes brasileiras foram coletadas nas publicações oficiais disponibilizadas on-line pelo Ministério da Saúde e Ministério do Trabalho e do Emprego do Brasil. A análise do material permitiu-nos verificar que a reabilitação vocacional praticada em países da América do Norte e da Europa destina-se a usuários de serviços de saúde mental, procedendo à inclusão pelo viés da doença. Enfatiza a recolocação no mercado formal de trabalho, por meio de programas voltados ao treinamento de habilidades para obter e manter um posto de trabalho conquistado. Já as diretrizes do governo brasileiro estão pautadas nos princípios do cooperativismo e da economia solidária. Privilegia o ser humano como sujeito e finalidade maior da atividade econômica, focalizando as potencialidades e recursos do trabalho, em detrimento das limitações impostas pela doença ou pela condição socioeconômica que tenha gerado a situação de exclusão.

Effects of supported employment on vocational rehabilitation for schizophrenia patients:a randomized controlled study / 中华行为医学与脑科学杂志

Objective To investigate the effects of supported employment(SE) on the vocational rehabilitation for schizophrenic rehabilitants.Methods 108 schizophrenic rehabilitants with stable conditions were recruited and randomly allocated into the control group and experimental group.Fifty-four cases in the control group received the general outpatient service and follow-up service with drug maintenance therapy and 54 cases in the experimental group received SE with drug maintenance therapy.At the baseline and the end of the sixth month,all of the 108 cases were assessed by the Positive and Negative Syndrome Scale (PANSS) and Work-related Social Skills Scale (WSSS) respectively.The competitive employment rate and average working days of the two groups were evaluated at the end of the sixth month.Results There was no significant difference in the total score of WSSS,and the total score of PANSS and its sub-scores on the Positive Scale,Negative Scale and General Psychopathological Scale betweeu the two groups at the baseline(P＞ 0.05).At the cnd of the sixth months,significant differences (P＜0.01 ～ 0.05) were found in the total score of WSSS,the sub-score of the Negative Scale,the competitive employment rate and the average working days((35.11 ± 12.71) d vs(20.15 ± 8.04) d) between the experimental and control groups.Conclusion SE can increase the employment rate of schizophrenic rehabilitants,improve their abilities to acquire and maintain competitive employment,and meanwhile relieve their negative symptoms.

Brain Injury Vocational Rehabilitation of Persons with Disabilities

Brain Injury employment of persons with disabilities and vocational rehabilitation, vocational evaluation difficult, but through a professional in the field of positive results can be obtained. In addition to the brain for people with disabilities if they utilize a variety of schemes to obtain professional help. For example, sheltered workshop, enclaves employment, homebound employment, reserved employment, work activity centers; Sheltered employment, Supported employment, Transition is that employment. Brain Injury Rehabilitation for people with disabilities, first to build job skills assessment system, brain injury rehabilitation services for people with disabilities to strengthen vocational and medical rehabilitation, vocational rehabilitation, and the Indians and an occupation requiring.