[Psychiatric Rehabilitation in the GDR against the Background of Soviet Influences]. / Die psychiatrische Rehabilitation in der DDR vor dem Hintergrund sowjetischer Einflüsse.

The study describes developments and local models of psychiatric rehabilitation in the GDR and the USSR. After the Second World War patient care was focused on hospitals. The Rodewisch Theses and the Brandenburg Theses as well as the "Conception to improve the patient care for mentally ill people after 1980" were important suggestions. The GDR primary literature review shows that soviet concepts were often received. The principles of stages, continuity and sectorization set the stage for success here and there. Transition units such as psychoneurological dispensaries, the occupational/protected workshops and assisted residences, therapeutic clubs, day and night hospitals were created. The occupational therapy was intended to facilitate the transition into the normal working. As a consequence, during the 1970s and 1980s in the GDR a high level of employment of mentally ill people in the economy could be achieved.

Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver's downtown and DTES.

BACKGROUND: Employment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver's downtown and Downtown Eastside (DTES). METHODS AND DESIGN: This prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences. DISCUSSION: The results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.

Vocational Rehabilitation Service Utilization and Employment Outcomes Among Secondary Students on the Autism Spectrum.

U.S. policy interventions encourage earlier provision of Vocational Rehabilitation (VR) services to support students and youth with disabilities such as autism spectrum disorder (ASD) during the transition from school to work. We analyzed Rehabilitation Services Administration (RSA-911) data using multivariable logistic regression to determine the association of VR services receipt with employment outcomes for students ages 16-21, same-age non-student youth and young adults with ASD. Students with autism received job-related services (job search, job placement, and on-the-job supports) at rates significantly below comparison groups, even though odds of successful employment at VR exit were significantly higher if they received these services. Findings suggest that rates of employment among students with autism might be improved with intentional delivery of job-related services.

Employment Trends in Rhode Island From 2011 to 2017 for Adults With Intellectual Disability and Developmental Disabilities.

This study reports on state-level data in Rhode Island on employment and non-work activities of adults with intellectual and developmental disabilities receiving services between 2011 and 2017. The goal was to examine the complex patterns of change over time in individual-level employment outcomes and the potential short-term impacts of a consent decree entered into by the state of Rhode Island to address integrated employment outcomes. Findings suggest that policy initiatives such as the consent decree can lead to reductions in reliance on facility-based work, but also highlight the importance of planning for the transition to competitive, integrated employment and not simply a shift toward non-work activities. Further, the data support the notion that the best predictor of integrated employment over time is previous experiences in integrated employment (not facility-based or other work or non-work activities), suggesting the role of ongoing supported employment and transition services that create and support the maintenance of integrated employment.

Return to work after spinal cord injury: a Singaporean pilot community-based rehabilitation program.

STUDY DESIGN: Retrospective analysis of data collected as part of a pilot program. OBJECTIVES: The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. SETTING: A community-based rehabilitation center in Singapore. METHODS: Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants' clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. RESULTS: Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5-8) and 11 (95% CI, 7-15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. CONCLUSIONS: Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.

Individual placement and support in the Netherlands: Past, present, and future directions.

OBJECTIVE: This article addresses the rise of individual placement and support (IPS) within vocational services for people with severe mental illness (SMI), the current state of affairs, and future directions of IPS in the Netherlands. METHOD: Review of the literature on IPS in the Netherlands, analysis of registration data, and exploration of future avenues for IPS in Dutch mental health care. FINDINGS: In the first decade of this century, an implementation study showed that IPS was feasible in the Netherlands, and a multisite randomized controlled trial (RCT) indicated that IPS was also effective in the Dutch context. Nationwide, from the start of 2016 to the end of 2017, the number of enrolled IPS participants doubled from 1,038 to 2,100, which was largely due to the introduction of preliminary national funding of IPS. Future directions include expanding the IPS practice in terms of target groups, types of providers, goals, and added interventions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Involvement of clinicians and the employment opportunities for people with SMI have increased, which is mainly due to the successes of IPS. However, considerable efforts are still needed to make IPS more widely available. Important facilitators are 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. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

State-Level Variation in Vocational Rehabilitation Service Use and Related Outcomes Among Transition-Age Youth on the Autism Spectrum.

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014-2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.

Purely Patrick: A case study report.

This case study will focus on the "evolution" of finding meaningful occupation for a young man, Patrick, 27, in spite of his multiple disabilities within his rural home environment in Stowe, Vermont. The purpose of this case study is to show others (family members, therapists, support service individuals and adult agencies) that it is possible to be self-employed despite life's challenges, and that with some creativity (and funding), there is a niche of meaningful occupation available for all!

VR Employment Outcomes of Individuals with Autism Spectrum Disorders: A Decade in the Making.

This study utilized hierarchical linear modeling analysis of a 10-year extant dataset from Rehabilitation Services Administration to investigate significant predictors of employment outcomes for vocational rehabilitation (VR) clients with autism. Predictor variables were gender, ethnicity, attained education level, IEP status in high school, secondary disability status, and total number of VR services. Competitive employment was the criterion variable. Only one predictor variable, Total Number of VR Services, was significant across all 10 years. IEP status in high school was not significant in any year. The remaining predictors were significant in one or more years. Further research and implications for researchers and practitioners are included.

An Evaluation of a Social Skills Intervention for Adults with Autism Spectrum Disorder and Intellectual Disabilities preparing for Employment in Ireland: A Pilot Study.

Individuals with autism spectrum disorder (ASD) are faced with significant barriers relating to employment opportunities and workplace participation. This study evaluated the effectiveness of the Walker social skills curriculum: the ACCESS program and video modeling to increase social communication skills necessary for workplace inclusion. Participants attended two sessions (i.e., 3 h) per week across a period of 20 weeks. A multiple-probe design was used to demonstrate social skills outcomes across three broad curricular areas (i.e., peer-related, adult-related, and self-related social skills). Pre-and post-intervention standardized assessments were also taken. Results showed significant increases in target social skills and a significant decrease in problem behaviors following intervention. Evidence of maintenance and generalization were also demonstrated. Implications for practice and research are discussed.

Health services and rehabilitation for active duty service members and veterans with mild TBI.

OBJECTIVE: We review health services and reintegration practices that contribute to the rehabilitation of US active duty service members (ADSMs) and Veterans who experienced traumatic brain injury (TBI), especially mild TBI (mTBI), as discussed at the 2015 Department of Veterans Affairs (VA) TBI State-of-the-Art (SOTA) Conference. METHODOLOGY: We reviewed the state-of-the-art at the time of the previous 2008 TBI SOTA Conference, advances in the field since then, and future directions to address gaps in knowledge. MAIN RESULTS: We reviewed: (1) mTBI and its comorbid conditions documented in ADSMs and Veterans, and recognized the need for additional healthcare utilization, health cost and quality of care studies; (2) VA vocational rehabilitation programmes and the effectiveness of supported employment for helping those with workplace difficulties; (3) the application of technology to assist in TBI rehabilitation, including mobile device applications for self-management, videoconferencing with providers, and virtual reality to help with behavioural and cognitive challenges, and (4) Department of Defense (DoD)-VA partnerships on identification, evaluation and dissemination of TBI best practices. CONCLUSIONS: There have been significant advances in TBI rehabilitation, but multiple areas across the DoD and VA care continuum need further exploration and development to meet the needs of ADSMs and Veterans.

Development of vocational training systems for patients with intellectual disability in Poland.

BACKGROUND: The problem of employment of people with intellectual disabilities is present in many countries. The literature on this topic draws attention to the fact that the improvement of the situation in this area is conditioned by changes in government policies, practices of employers and adequate preparation to undertake professional duties by persons with intellectual disabilities. OBJECTIVE: The objective of this review was to explore the changes in vocational rehabilitation forms in Poland. RESULTS: As one of the ways to solve this problem since 1991 in Poland the so called Workshops of Vocational Therapy have been created. According to the regulations the Workshops were designed for adults with intellectual disabilities, aged over 16 years with a total incapacity of gaining an employment, for which occupational therapy was a form of social rehabilitation. The further step in this process was the establishment of Vocational Activation Centers, with which high hopes were associated. They were expected to be an intermediate link in the creation of career paths from rehabilitation forms ultimately to open labor market. In practice it turned out that the creation of these Centers in Poland has been too slow. CONCLUSIONS: This raised the necessity to change the attitude from the concept of matching the participant to work and to the new environment, which frequently ends as a trauma, to the concept of matching jobs to people. New initiatives and new rehabilitation programs are developed based on this attitude.

Contemporary vocational rehabilitation in Australia.

PURPOSE: There is a strong connection between disability and decreased participation rates in the Australian labour market. Australian government policy recognises vocational rehabilitation as a key strategy to increase employment rates of people with disabilities. METHODS: This paper examines current Australian disability employment policies and practices. It also reviews vocational rehabilitation competency research to identify knowledge and skill domains central to quality service provision, and explores the delivery of tertiary level vocational rehabilitation education. RESULTS: Policy changes in Australia over the last decade have been aimed at addressing the unsustainable increase in disability benefits. In this context vocational rehabilitation services continue to be viewed as crucial in assisting people with disabilities to maintain employment and reduce disengagement. Competencies research has consistently identified vocational counselling, personal counselling, professional practice and case management as central to quality vocational rehabilitation service provision. Two competencies identified in recent research, workplace disability case management and workplace interventions and program management, reflect the centrality of vocational rehabilitation to disability management. CONCLUSIONS: Changes in the policy environment to reduce the number of disability pension recipients will inevitably lead to an increased demand for trained vocational rehabilitation personnel. Given the development of strong accreditation standards for vocational rehabilitation education and practice that underpin the provision of tertiary level rehabilitation counselling training programs, professionally qualified rehabilitation counsellors are ideally placed to address the complex employment needs of people with a disability. IMPLICATIONS FOR REHABILITATION: It is important to understand changes that may occur in policy environments in terms of their impact on vocational rehabilitation service delivery for people with disabilities. Variable levels of training in the vocational rehabilitation sector result in people with complex needs not consistently receiving the services they need to access and maintain employment. Practitioners need to focus increasingly on individualized service delivery where the client has significant control over decisions about their rehabilitation program.

An empowerment model of entrepreneurship for people with disabilities in the United States / Un modelo de "empowerment" para dar iniciativa emprendedora a personas con discapacidades en EE.UU

People with disabilities are greatly underrepresented in the workforce, often face discrimination by employers, and often are not effectively served by the U.S. Vocational Rehabilitation System whose primary purpose is to get individuals with disabilities employed. Additionally, many individuals with disabilities face discrimination and/or fear of becoming a liability by business owners. The Chicago Add Us In (AUI) Initiative sponsored by the U.S. Department of Labor, Office of Disability Employment Policy, created an entrepreneurship program for people with disabilities in order to counteract these barriers, promote empowerment and facilitate economic self-sufficiency for people with disabilities. The model includes a course on how to write a business plan, one-on-one business mentoring, technical assistance, start-up business grants, and assistance from a business incubator. In addition to the core program components, there was an emphasis on creating systems change in the Illinois Division of Rehabilitation Services (DRS) to ensure program sustainability. In-depth case studies are offered to illustrate the process of consumer empowerment and the impact of the entrepreneurship program on the lives of the entrepreneurs who have participated thus far

Las personas con discapacidades están muy poco representadas en la fuerza de trabajo, con frecuencia sufren discriminación por parte de los empleadores y raramente el Sistema de Rehabilitación Profesional de los EE.UU., que se ocupa sobre todo de conseguir trabajo a las personas con discapacidades, les atiende debidamente. Además, muchas de estas personas enfrentan discriminación o los empleadores piensan que son un riesgo para ellos. La "Iniciativa Añádenos" en Chicago, patrocinada por el Departamento de Trabajo de los EE.UU, Oficina de Política de Empleo para los Discapacitados, ha creado un programa de desarrollo de pequeñas empresas para personas con discapacidades que pueda contrarrestar estas barreras, fomentar el incremento de poder y facilitar la autosuficiencia de estas personas. El modelo incluye un curso sobre cómo desarrollar un plan de negocios, orientación [mentoring] comercial individual, asistencia técnica, ayudas financieras para abrir negocios y la asistencia de una "incubadora" de empresas. Además de los componen tes centrales del programa se trató de crear un cambio de sistema en la División de Servicios de Rehabilitación de Illinois para garantizar la sostenibilidad del programa. Se presentan estudios de casos que ilustran el proceso de incremento de poder de los consumidores y el impacto del programa de desarrollo empresarial en la vida de las personas que han participado hasta la fecha

Vocational rehabilitation service patterns and employment outcomes of people with epilepsy.

This study aimed to examine the association between vocational rehabilitation (VR) services and employment outcomes of people with epilepsy (PWE), after controlling for demographic covariates. Data was retrieved from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year (FY) 2011. Multivariate logistic regression was used to predict employment outcomes of PWE. Of the 2030 previously unemployed PWE who received services, 884 (43.5%) achieved successful competitive employment. Results indicate that higher education level and cost of VR services consumed were positively related to successful employment. In contrast, having co-occurring anxiety/depression, receiving cash benefits, or increasing time spent in the VR system was negatively associated with employment. Eight specific VR services (e.g., education, vocational training, and job search and placement assistance) were also found to be significant predictors of employment. Services provided by state VR agencies were proven to be beneficial in improving employment outcomes. PWE should be encouraged to pursue VR services to increase the chances of attaining employment. Health care providers should also become familiar with the array of VR services.

Mental health reform at a systems level: widening the lens on recovery-oriented care.

This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.

Supported employment for persons with serious mental illness: current status and future directions.

The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.

Índice de reinserción laboral tras un programa de rehabilitación cardiaca / Index reinsertion working after cardiac rehabilitation program

El Infarto Agudo de Miocardio (IAM) es la Entidad que produce mayor morbimortalidad en nuestra Sociedad. Afecta a la Calidad de vida del Paciente y a su Situación Laboral, siendo responsable de un alto porcentaje de Incapacidades Permanentes. Así como también se encuentran entre las principales Causas de Incapacidad Temporal. Los datos de Reincorporación laboral tras un IAM varían mucho de unos Países a otros. Así como de unas Comunidades Autónomas a otras en nuestro país. Se han experimentado grandes Avances Tecnológicos en el campo del Intervencionismo Coronario Percutáneo (ACTP) y la colocación de Endoprótesis Vasculares (STENT). Así como los Programas de Rehabilitación Cardiaca y Prevención Secundaria, con actuaciones en el campo del control de los factores de riesgo cardiovascular, Programas de Entrenamiento físico, intervención psicológica, programas educativos y de valoración sociolaboral han facilitado la Recuperación funcional de los pacientes que han sufrido un IAM con mejoras en la funcionalidad cardiaca y en la capacidad funcional de los pacientes con mejor percepción y calidad de vida, que les permite la reincorporación a sus actividades anteriores a sufrir el evento coronario agudo, entre ellas la laboral. En un Programa de Actuaciones y de Colaboración conjunta entre la Unidad Médica de la Dirección Provincial de Sevilla del INSS y la Unidad de Rehabilitación Cardiaca y Prevención Secundaria del Hospital Universitario Virgen Macarena de Sevilla, nos planteamos hacer un seguimiento de los pacientes que realizaron estos Programas de Rehabilitación Cardiaca en el año 2011 con vistas a la posibilidad de su Reincorporación laboral. En nuestro estudio hemos demostrado que los Pacientes que siguen un Programa Multidisciplinar de Rehabilitación Cardiaca, consiguen mejoría en los variables que hemos analizado, con mejoría de su Funcionalidad Cardiaca (84,3%) y sensación de Bienestar Físico y Calidad de vida percibida (74%). Siendo subsidiarios de indicación de Reincorporación Laboral el 63% de los pacientes incluidos en nuestro Estudio

The Acute Myocardial Infarctio (AMI) is the entity that produces the greatest morbidity in our society. It affects the quality of life of the patient and their Employment Status, responsible for a high percentage of Permanent Disabilities. And also among the major causes of temporary disability. Data Return to work after an AMI, vary widely from country to country. And from one Autonomous Community to another in our country. They have experienced great technological advances in the field of percutaneous coronary intervention (PTCA) and Stent placement vascular (STENT). And Cardiac control of cardiovascular risk factors, physical training programs, psychological intervention, educational and socio-assessment have facilitated the functional recovery of patients with improvements in cardiac and functional capacity of patients with better insight and quality of life, allowing them to return to their previous suffering acute coronary event, including labor activities functionality. In a program of performances and joint collaboration between the Medical Unit of the Provincial Directorate of Sevilla INSS and Unit Cardiac Rehabilitation and Secondary Prevention of Hospital Virgen Macarena in Seville, we propose to monitor the patients undergoing these programs Cardiac Rehabilitation in 2011 with a view to the possibility of their return to work. In our study we have shown that patients who follow a Multidisciplinary Cardiac Rehabilitation Program, get improvement in the variables listed above, with improvement in their functionality cardiac (84,3%) and feeling of Physical fitness and perceived quality of life (74%). Being labor subsidiary indication reinstatement 63% of patients included in our study