EEPIC - Enhancing Employability through Positive Interventions for improving Career potential: the impact of a high support career guidance intervention on the wellbeing, hopefulness, self-efficacy and employability of the long-term unemployed - a study protocol for a randomised controlled trial.

BACKGROUND: Labour market policy (LMP) and its implementation have undergone rapid change internationally in the last three decades with a continued trend towards active LMP. In Ireland however, this shift has been more recent with ongoing reforms since 2012 and a concomitant move toward active labour market 'work-first' policy design (i.e. whereby unemployed people are compulsorily required to work in return for their social welfare benefits). Labour market policies vary from those that require this compulsory approach to those which enable the unemployed to move towards sustainable quality work in the labour market through upskilling (human capital approach). Despite this, however, long-term unemployment-a major cause of poverty and social exclusion-remains high, while current employment support approaches aimed at sustainable re-employment are, arguably, unevaluated and under examined. This study examines the effectiveness of a new high support career guidance intervention in terms of its impact on aspects of wellbeing, perceived employability and enhancing career sustainability. METHOD: The study involves a single-centre randomised, controlled, partially blinded trial. A total of 140 long-term unemployed job-seekers from a disadvantaged urban area will be randomly assigned to two groups: (1) an intervention group; and (2) a 'service as usual' group. Each group will be followed up immediately post intervention and six months later. The primary outcome is wellbeing at post intervention and at six-month follow-up. The secondary outcome is perceived employability, which includes a number of different facets including self-esteem, hopefulness, resilience and career self-efficacy. DISCUSSION: The study aims to assess the changes in, for example, psychological wellbeing, career efficacy and hopefulness, that occur as a result of participation in a high support intervention vs routinely available support. The results will help to inform policy and practice by indicating whether a therapeutic approach to job-seeking support is more effective for long-term unemployed job-seekers than routinely available (and less therapeutic) support. The findings will also be important in understanding what works and for whom with regard to potentially undoing the negative psychological impacts of unemployment, building psychological capital and employability within the individual, and developing career trajectories leading to more sustainable employment. TRIAL REGISTRATION: ISRCTN registry, ISRCTN16801028 . Registered on 9 February 2016.

Modifiable and nonmodifiable risk factors for falls after traumatic brain injury: an exploratory investigation with implications for medication use.

PURPOSE: Falls are a challenge for rehabilitation nurses, facilities, families, and individuals. Studies related to the causes of falls and potential strategies for risk management have been conducted across disability groups and with the elderly. Still, a focus on individuals with traumatic brain injuries (TBI), specifically, has been limited. This paper presents a brief review of relevant research and the results of a preliminary investigation. METHODS: This study was a retrospective study of 125 individuals with TBI in residential treatment. Specific risk factors for falls in this population were identified. FINDINGS: Results indicate that age, injury severity, medical complications, specific medications and polypharmacy are significantly linked to falls in individuals with brain injuries. Specifically, the use of anticholinergic medications was associated with falls in this study. CONCLUSIONS: The results of this study are limited both by the use of a convenience sample and the fact that it is an initial exploratory step to future multicenter research. Still, the resulting fall risk profile that emerged is an important consideration for rehabilitation practitioners working in brain injury. CLINICAL RELEVANCE: Identifying those individuals with TBI most at risk for falling and taking appropriate measures to prevent falling, including consideration of both number and type of medication used, are important measures for rehabilitation teams working with this population to take.