Evidence-based supported employment for people with psychiatric disabilities in Australia: Progress in the past 15 years.

OBJECTIVE: This report summarizes the major developments in Australia since the first introduction of Individual Placement and Support (IPS) in 2005 in order to outline the current situation and discuss future challenges and opportunities. METHOD: Using an informal snowball sampling method, all those known to be involved in IPS implementations in Australia in the last 5 years were contacted. RESULTS: The program has expanded from 2 full-time employment specialists in 2005 to 87.6 in 2018. The expansion has been most promising in youth mental health where an initial national 14-site trial of IPS was recently expanded to 24 sites. If the trial is successful, IPS may become a core component of a national youth mental health initiative. Expansion in the adult community mental health sector has been constrained by several factors including the low priority for rehabilitation in the public mental health system. On the positive side, the availability of independent technical support from Western Australia means that all new IPS sites can receive expert technical support for program implementation, continuing high-fidelity delivery, external fidelity assessment, outcome evaluation, and cohort-based outcome reporting. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The expansion of IPS in the public funded adult mental health sector has not kept pace with progress in the youth mental health sector. There is an urgent need for adult mental health services to cease excluding vocational rehabilitation from treatment, care, and recovery plans. Disability Employment Service contract managers could increase disincentives for providers to adopt high caseloads and low intensity services, at the expense of more intensive evidence-based practices. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Policy barriers to evidence-based practices in vocational rehabilitation for people with psychiatric disabilities in New Zealand.

BACKGROUND: Most working-age adults with psychiatric disabilities are not employed yet are interested in being in employment. This goal is achievable for the majority who are interested, with the help of international evidence-based practices in vocational rehabilitation. However, these practices are not widely available in developed countries. OBJECTIVE: To identify whether, and how, the availability of evidence-based vocational rehabilitation is linked to government policy. METHODS: A systematic examination of New Zealand's economic and social policy context to understand how it facilitates or hinders evidence-based vocational rehabilitation for people with psychiatric disabilities. RESULTS: The New Zealand policy context is currently hindering the availability of evidence-based vocational rehabilitation for people with psychiatric disabilities. Whilst policy reform has commenced, it has not yet translated into a purchasing framework free of policy conflicts and barriers. Consequently, the proportion of people with psychiatric disabilities not employed and not participating in the labor market is increasing. CONCLUSIONS: Adopting the policy adjustments identified could expand the availability of evidence-based vocational rehabilitation, reducing the disparity between individual vocational goals and actual labor force activity. This in turn could have national social and economic benefits through reduced welfare dependence, reduced health service utilization, and increased labor force participation.

Cognitive and clinical indicators of employment assistance needs from a national survey of individuals living with psychosis.

OBJECTIVE: The aim of this secondary analysis was to explore global functioning, course of illness (the number of episodes since onset and the degree of recovery between episodes), duration of illness, and cognitive ability as potential indicators of the extent of employment assistance needs. METHOD: A secondary analysis of Australia's second national survey of psychosis was undertaken. Screening for psychosis took place during March, 2010 at 7 national locations, within public mental health services and nongovernment organizations. Next, 1,825 of the 7,955 who screened positive for psychosis were randomly selected and completed face-to-face interviews. Of those, 1,619 also completed the Digit Symbol Coding Test (DSCT), a measure of current general cognitive ability. RESULTS: In epidemiological surveys, employment status is an important proxy indicator of employment assistance needs. The strongest correlates of any versus no employment in the current survey were: global functioning as represented by Personal and Social Performance Scale (PSP) total score, age, general cognitive ability as represented by DSCT scores, course of illness, and educational attainment. These correlates persisted following adjustment in a multivariate model. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Subject to the limitations identified, global functioning, cognitive ability, and course of illness were the most promising clinical and cognitive indicators of more intensive employment assistance needs. The demographic variables age and educational attainment indicated additional labor market disadvantage, which could also help to identify those more likely to need intensive employment assistance. These results inform further investigations aimed at developing a practical measure of employment-related psychiatric disability. (PsycINFO Database Record

Formal plan for self-disclosure enhances supported employment outcomes among young people with severe mental illness.

AIM: Young people with mental illness experience high levels of unemployment, which can be related to stigma and discrimination. This may result from poor choices in disclosing personal information, such as their mental illness diagnosis, in the workplace. The aim of this study was to investigate the predictive validity of a formal plan to manage personal information (PMPI) during the early stages of supported employment. The focal question was: does the use of a brief structured PMPI lead to more employment outcomes for young people with a mental illness? METHODS: A sample of 40 young unemployed mental health service users (mean age 23.9 years), who were also attending employment services on the Gold Coast, was asked about their disclosure preferences. If they preferred not to disclose at all, they did not complete a plan for managing personal information. If they preferred to disclose some personal information, they were provided with assistance to complete a PMPI. Baseline information was gathered from two equal groups of 20 individuals. Employment status was ascertained at a 6-week follow-up interview. RESULTS: Those who completed a plan to manage their personal information had 4.9 times greater odds of employment at 6 weeks than those who preferred not to disclose any personal information. CONCLUSIONS: A formal PMPI has promising predictive validity with respect to job seekers not opposed to pragmatic forms of self-disclosure. Further research is needed to examine other properties of this decision-making tool.

Implementing evidence-based practices in supported employment on the Gold Coast for people with severe mental illness.

AIM: The aim of this project was to evaluate program outcomes following the implementation of an evidence-based approach to supported employment on the Gold Coast, Queensland, Australia. METHOD: A prospective observational design was used to evaluate employment outcomes and fidelity to the evidence-based principles and practices of a specialised form of supported employment. The cohort was defined as all those (n = 114) that entered the program at each of three sites within a 21-month period. Each participant was followed up for a minimum of six months. All three sites implemented the employment program by establishing a partnership between a non-government organisation and the Gold Coast community mental health service. RESULTS: The primary outcome variable was the proportion commencing competitive employment during the follow-up period from among those that commenced receiving assistance (the denominator). This ranged from 12% at Site C to 33.3% at Site A, and 37% at Site B. Fidelity to evidence-based principles was fair at Sites A and C and good at Site B. These results were below expectations based on international-controlled trials. The variation in site effectiveness appeared related to both fidelity to evidence-based principles and to other factors at each site, which could not be clearly identified. CONCLUSIONS: Delivering an effective supported employment program using an inter-agency partnership method is challenging. There are several roles in which occupational therapists can be involved that facilitate improving both the implementation and the effectiveness of supported employment for people with severe mental illness in Australia.

Managing disclosure of personal information: An opportunity to enhance supported employment.

OBJECTIVE: To first provide an overview of studies that explore mental health disclosure in the workplace; including factors that influence the decision to disclose, and differing approaches to disclosure (binary, multidimensional, and evolving and ongoing). Second, to provide a critical overview of existing tools designed to help clients manage their mental health disclosure decisions. METHOD: Electronic searches of PubMed, PsycINFO and ScienceDirect were undertaken, excluding all articles published prior to 1990. The following search terms were used: mental health disclosure, employment, severe and persistent mental illness, psychosis, schizophrenia, supported employment, individual placement and support (IPS). RESULTS: We found that mental health disclosure involves a complex decision-making process, and yet clients of IPS supported employment are currently provided with little structured guidance on how to manage their personal information in the workplace. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: More extensive investigations are required of existing mental health disclosure tools before they can be developed into a standardized intervention for practitioners. However, preliminary evidence suggests that facilitating better disclosure decisions and management of personal information is a promising area of future research. This line of investigation is likely to find ways to enhance competitive employment outcomes in supported employment for people with severe and persistent mental illness.

A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness.

BACKGROUND/AIM: The Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems. METHODS: A four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area. RESULTS: At 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study. CONCLUSION: The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials.

Implementation of evidence-based supported employment in regional Australia.

OBJECTIVE: To implement the Individual Placement and Support (IPS) approach at 4 locations in regional New South Wales, Australia. Outcomes attained were compared with a national non-IPS program and with international trials of IPS within and outside the United States. METHODS: Four IPS programs were established through formal partnerships between mental health services and disability employment services. Ninety-five mental health service clients commenced employment assistance and were tracked for a minimum of 12 months. RESULTS: Two sites achieved good fidelity to IPS principles, and 2 sites achieved fair fidelity. IPS clients had 3.5 times greater odds of attaining 13 weeks' employment than those receiving assistance in the national network of disability employment services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Implementing IPS is challenging in the Australian service delivery context. Factors other than program fidelity appear to contribute to excellent employment outcomes. Further research is needed to identify these factors.

Correlates of competitive versus noncompetitive employment among adults with psychotic disorders.

OBJECTIVE: Studies of the demographic and clinical correlates of employment activity have proven useful for identifying employment assistance needs among people with severe and persistent mental illness. However, the results of prior studies remain unclear, and most reviews of prior studies have not differentiated competitive from noncompetitive employment. This study attempted to clarify the relative strength and consistency of correlates of competitive versus noncompetitive employment. METHODS: Data were drawn from a population-based survey of Australian adults with psychotic disorders between March and December 2010. Demographic, clinical, and employment assistance correlates of competitive and noncompetitive employment were compared. The sample comprised 1,825 participants who agreed to face-to-face interviews. RESULTS: A total of 408 (22.3%) participants were employed in the previous four weeks, 330 (18.1%) in competitive employment and 78 (4.3%) in noncompetitive employment. Those in competitive employment were more likely to be female and aged 18-34, to have a partner, to have received formal vocational training or education after high school, and to have no literacy difficulties. Better global functioning, shorter illness duration, less severe course of illness, and affective versus nonaffective psychosis were associated with a greater likelihood of competitive employment. Those using Australian government employment services were less likely to be in competitive employment, suggesting a service provider preference for noncompetitive employment. CONCLUSIONS: Four times as many employees were in competitive employment than in noncompetitive employment. The negative relationship between employment assistance and competitive employment highlights the urgent need to improve the effectiveness of Australian employment services for people with severe mental illnesses.

'Earning and learning' in those with psychotic disorders: the second Australian national survey of psychosis.

OBJECTIVE: Participation in mainstream education and employment facilitates both the recovery and the social inclusion of people with psychotic disorders. As part of the second Australian survey of psychosis, we assessed labour force activity and participation in formal education among working age adults with psychotic disorders. METHOD: Data were drawn from a large national community prevalence survey of adults with psychotic disorders. Known as the Survey of High Impact Psychosis (SHIP), it was conducted in seven Australian catchment areas during March to December 2010. Current and past year labour force activity, current employment, past year participation in formal education and vocational training, and key clinical and demographic characteristics were examined in a sample of 1825 participants. RESULTS: Only 22.4% of people with psychotic disorders were found to be employed (either full-time or part-time) in the month prior to the survey. In the previous 12 months, 32.7% were employed at some time. Of those in competitive employment, the majority worked part-time (63.9%), while a quarter worked 38 or more hours per week (23.4%). In terms of educational attainment, 18.4% reported difficulties with reading or writing, while 31.9% completed high school, which represents 12 years of formal education. CONCLUSIONS: The proportion currently employed has remained stable at 22% since the last national survey in 1997. Policy makers and service providers could do more to ensure people with psychotic disorders obtain access to more effective forms of assistance with respect to both their continuing education and employment. More effective vocational and educational interventions for people with psychotic disorders appear to be urgently needed.

Overworking among people with psychiatric disorders: results from a large community survey.

INTRODUCTION: Few studies have examined the characteristics of people with psychiatric disorders who work excessive hours compared to those with other health conditions, or compared to others with no health conditions or disabilities. METHODS: We conducted a secondary analysis of data files provided by the Australian Bureau of Statistics from a 2003 population survey (N = 23,851 in scope). We investigated candidate correlates of working excessive hours as the main dependent variable. RESULTS: Although, people with psychiatric disorders were less likely overall than healthy adults to work excessive hours, partnered males with dependant children, and males with higher educational attainment; were at greatest risk of working 49 or more hours per week. CONCLUSIONS: People with psychiatric disorders have a substantial risk of over working, and this should be considered in their long term treatment and care.

Receiving treatment, labor force activity, and work performance among people with psychiatric disorders: results from a population survey.

INTRODUCTION: Standard treatments for psychiatric disorders such as schizophrenia, depression and anxiety disorders are generally expected to benefit individuals, employers, and the wider community through improvements in work-functioning and productivity. METHODS: We repeated a previous secondary investigation of receiving treatment, labor force activity and self-reported work performance among people with ICD-10 psychiatric disorders, in comparison to people with other types of health conditions. Data were collected by the Australian Bureau of Statistics in 2003 repeating a survey administered in 1998 using representative multistage sampling strategies. The 2003 household probability sample consisted of 36,241 working age individuals. RESULTS: Consistent with the previous secondary investigation based on the 1998 survey administration, receiving treatment was consistently associated with non-participation in the labor force, and was negatively associated with work performance. CONCLUSIONS: At a population level, receiving treatment was negatively associated with labor force activity and work performance. The stability of these results in two independent surveys highlights the need to investigate the longitudinal relationships between evidence-based treatments for psychiatric conditions as applied in real-world settings, and labor force participation and work performance outcomes.

Reliability and validity of a measure of role functioning among people with psychiatric disabilities.

AIM: The aim was to investigate the reliability and validity of the Socially Valued Role Classification Scale (SRCS), a domain-specific measure of role functioning designed for use with community residents with psychiatric disabilities. Test-retest reliability, concurrent validity, face validity, consumer and clinician acceptability and utility were examined. METHODS: Sixty community residents with schizophrenia or schizoaffective disorder participated in this study where the SRCS was administered by telephone. RESULTS: Test-retest reliability showed good or very good agreement for subscale scores (intraclass correlations (ICCs): 0.78-0.89) and for items capturing amount of participation in domain-specific activities (ICC: 0.67-1.00). Greater variation was observed for items capturing assistance required with activities (κ: 0.40-0.75), and standard of activities performed (κ: 0.43-1.00). Concurrent validity was supported by moderate to very good associations in the directions expected. Face validity, user acceptability and utility in telephone interviews were adequate. CONCLUSIONS: These findings add to previous psychometric evidence and support the continued development of the SRCS for use in community mental health settings. The SRCS has promising utility for occupational therapists involved in psychiatric rehabilitation outcome measurement.

The reliability of an education-related self-efficacy scale for people with psychiatric disabilities.

We investigated the reliability of the Education-related Self Efficacy Scale (ESS-40), a measure of self-efficacy at a core task level designed for people with psychiatric disabilities. Sixty community residents with schizophrenia or schizoaffective disorder participated. The ESS-40 was administered twice via telephone interview. Short cycle test-retest reliability was very good for the total score and most items. The measure demonstrated signs of a coherent internal structure, adequate face validity, good client acceptability, and promising utility. The reliability evidence supports its use in community mental health services and in psychiatric rehabilitation settings. Sensitivity and predictive validity require further investigation.

Employment services as an early intervention for young people with mental illness.

AIM: To examine the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand. METHODS: The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16­25 years over a 2-year period (2005­2007). These results were compared with recent national and international benchmarks. RESULTS: As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables. CONCLUSIONS: Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.

A brief measure of vocational activity and community participation: development and reliability of the Activity and Participation Questionnaire.

OBJECTIVES: Social and economic marginalization are significant problems for many people living with mental illness. Clinicians and policy-makers have increased their focus on these aspects of recovery. Current outcome measures, however, do not support this focus, and detailed functional measures are not suitable for routine clinical use. This report describes the development and test-retest reliability of the Activity and Participation Questionnaire (APQ6); a self-report measure of vocational activity and social participation for routine use in community mental health services. METHOD: The APQ6 was developed from concepts of the Australian Bureau of Statistics Labour Force Surveys and Census. Field testing and consumer consultation were undertaken in New South Wales (NSW) mental health rehabilitation services. Test-retest reliability trials were conducted simultaneously by research teams in NSW and Queensland. RESULTS: Pairs of short-cycle test-retest reliability interviews were obtained from 129 mental health service consumers. Consumer feedback and test-retest reliability results at question and item levels indicate good construct validity. The measure has utility as both a telephone and a personal interview in community mental health settings. CONCLUSIONS: The reported psychometric properties support the proposed use of the APQ6 as a recovery-orientated measure focusing on vocational activity and community participation. The APQ6 is being introduced for routine use by NSW mental health services.

Reliability of a scale of work-related self-efficacy for people with psychiatric disabilities.

Work-related self-efficacy at a core task level fits with the social cognitive career theory explaining the career development of people with severe mental illness. The aim of this study was to further investigate the psychometric properties of the 'Work-related Self-Efficacy Scale' for use with people with psychiatric disabilities. Sixty individuals with schizophrenia or schizoaffective disorder participated in repeated telephone interviews conducted 2-5 days apart. Short-cycle test-retest reliability and internal structure were assessed. Face validity, consumer and clinician acceptability and utility were examined qualitatively. Short-cycle test-retest reliability was found to be very good at item and total score levels. The internal structure was consistent with previous investigations. Although face validity, acceptability and utility were adequate, use of face-to-face interviews is preferred over telephone interviews. The construct validity evidence supports wider use for research purposes in community mental health service, supported employment and other psychiatric rehabilitation settings.