A descriptive, qualitative study of the challenges that individuals with Autism Spectrum Disorder experience when transitioning from skills training programs into the open labor market in Cape Town, South Africa.

BACKGROUND: There is limited existence of qualitative research on adults with Autism Spectrum Disorder (ASD), who are transitioning between skills training programs and finding employment in the open labor market, in South Africa. OBJECTIVE: The aim of this current study was to explore the experiences and perceptions of individuals living with ASD, regarding transitioning from a skills training program to working in the open labor market. PARTICIPANTS: The data were collected through semi-structured interviews with ten participants, who were diagnosed with ASD, and working in the open labor market, as well as five key informants, who have worked with autistic individuals in a skills training program. METHODS: The data collected, using an explorative, descriptive, qualitative method, were analyzed using thematic analysis, and resulted in three emerging themes. RESULTS: Theme one: The 'disorder' in the workplace -The individual and collective barriers that individuals experience in the workplace are described, including social, emotional, and communication difficulties, as well as the stigmatization experienced by persons with a disability. Theme two: Making the workplace work -The facilitative support that individuals are exposed to, in the form of intervention from occupational therapists, sensory psychologists, and other forms of skills training programs, are described. In addition to supportive intervention, the relationships and networking within, and outside of the workplace, are discussed in theme two. Theme three: What works for me -The individual adaptations made by the participants, in the form of unique coping mechanisms in the workplace, as well as in the home environment, are discussed. CONCLUSION: It was observed that, while there are barriers to the transitioning of autistic individuals into the open labor market, there are enablers that facilitate a less challenging transitioning process, in the form of family and workplace support, as well as skills training, and self-identified coping mechanisms.

International Comparison of Vocational Rehabilitation for Persons With Spinal Cord Injury: Systems, Practices, and Barriers.

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

The role of cardiac rehabilitation in vocational reintegration Belgian working group of cardiovascular prevention and rehabilitation position paper.

Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.

Analysis of barriers and facilitators of existing programs in Belgium for the purpose of implementing individual placement and support (IPS).

OBJECTIVE: The goal was to build a strategy before implementing individual placement and support (IPS) in the country, leveraging existing facilitators and mitigating, as much as possible, identified barriers. METHODS: A qualitative study called "group analysis" was conducted: Over 2 days, two groups of stakeholders were invited for a whole-day workshop to collect information on facilitators and barriers faced by existing programs. RESULTS: Many perceived facilitators were related to some guidelines or key principles of the IPS model. Main barriers were lack of long-time job support, lack of funding, lack of communication between stakeholders, social or financial insecurity of the beneficiary, denial of their own disease, high hiring selectivity, and on-the-job requirements by employers looking to maintain a competitive workforce. The four points of divergence between participants in relation with IPS were (a) the (dis)advantages of internships and trainings compared to standard work contracts, (b) the risk associated with the communication of a medical diagnosis and the disclosure issue, (c) the best time to start a job search or to return to work, and (d) whether priority should be given to the search for an adapted job or the adaptation of existing jobs to the specific needs of the beneficiaries. CONCLUSION: The IPS model appears as a potential solution to many issues faced by stakeholders in Belgium in charge of helping people with moderate to severe mental illness to find a job. A stronger legal framework could help to achieve the integration of such model. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Supported employment in Switzerland-Are we on track?

OBJECTIVES: Supported employment (SE) was introduced to Switzerland in 2002. Since then, an increasing number of SE programs have been launched across Switzerland. This article reviews the state of SE in Switzerland. METHOD: Several Individual Placement and Support (IPS-SE) studies have been conducted in Switzerland. We reviewed the implementation, results, and possible future developments related to all Swiss IPS-SE studies. FINDINGS: Studies have demonstrated that IPS-SE programs can be successfully implemented with excellent results in Switzerland, but most vocational rehabilitation programs do not provide SE. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While SE is becoming the first choice for vocational rehabilitation in Switzerland, development and potential improvements are underway. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

An instrument to measure perceptions of people with disabilities regarding the application of international vocational rehabilitation standards.

This study aimed to create a valid and reliable instrument to measure people with disabilities' perceptions regarding the extent of application of international standards issued by the Council of Europe, International Labour Organization, and the International Classification of Functioning, Disability and Health in vocational rehabilitation centers in the Basque country, Spain. The instrument items were selected from international recommendations and conventions issued by the International Labour Organization, Council of Europe, International Classification of Functioning, Disability and Health, and a vocational rehabilitation literature review. The instrument was translated from English to Spanish, and the content validity index of an expert panel survey was used to assess content validity. For the Spanish version of the instrument, internal consistency reliability, confirmatory factor analysis and factor analysis were examined with 186 people with disabilities in 10 vocational rehabilitation centers in the Basque country. The coefficient alpha estimate was 0.945, indicating excellent internal consistency. Three factors were identified: job-related services, aims of vocational rehabilitation center, and vocational rehabilitation guidance. The instrument appears to have good validity and reliability but requires further validation. Support is provided for its use in both English and Spanish. Implications for vocational rehabilitation practice and suggestions for future research are provided.

Model of Human Occupation as a framework for implementation of Motivational Interviewing in occupational rehabilitation.

BACKGROUND: A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE: This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD: Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE: The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS: Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.

Act with respect: Views of supportive actions for older workers after completion of comprehensive vocational rehabilitation services.

BACKGROUND: The number of older workers will expand during the next decades. Older workers have more long-term health problems and related limitations. OBJECTIVE: This study examined supportive actions provided in occupational healthcare services to older workers after vocational rehabilitation. An additional purpose was to explore occupational healthcare professionals' views on how to realize and improve adequate support activities. METHODS: Qualitative and quantitative methods were used, including a postal questionnaire and focus group discussions. Sixty-seven occupational healthcare service units participated in the postal questionnaire. Eight occupational healthcare professionals participated in two focus group discussions. The qualitative data was analyzed using qualitative content analysis. RESULTS: The qualitative analysis resulted in one theme (Act with respect), and four categories (Need for cooperation, Collaborative resources of involved stakeholders, Individual needs for support, and Gender as homogenous and separate groups). Quantitative results revealed that the workers' initiative strongly influenced the support carried out. Recommendations from the rehabilitation clinic were almost always considered when deciding on supportive actions. Focus group discussions brought up gender differences especially highlighted in the category Gender as homogenous and separate groups. CONCLUSIONS: Appropriate support of older workers requires cooperation between involved stakeholders, including occupational healthcare services. Provided support should be based on individual needs, but a mutual practice of determining needed support is requested.

Content validity of the WorkHab functional capacity evaluation.

INTRODUCTION: Validity is a dynamic process and as part of a continual process of evaluation of tools, this study aimed to evaluate content validity of the WorkHab functional capacity evaluation, a tool used in occupational rehabilitation. METHODS: A cross sectional survey of health professionals who conduct FCEs investigated their ratings of item relevance and item difficulty across different categories of work and injuries. The survey also explored the relationship of the WorkHab FCE items with the physical demand items of the Dictionary of Occupational Titles (DOT). RESULTS: The majority of items of the WorkHab FCE were rated as relevant for manual work and vocational retraining with over 90% agreement between the 106 respondents. Therapists identified the WorkHab items of climbing, crawling and balance as less relevant for sedentary work. Lifting items were perceived as the most difficult for those with a lower back injury, or an upper limb injury. Sixteen of the 18 WorkHab FCE items had 100% agreement with the equivalent items on the DOT. The WorkHab FCE items that had poor agreement with the DOT were mainly sensory items such as see, feel, talk and hear. CONCLUSIONS: The findings of this study support the content validity for the WorkHab FCE specifically in relation to manual work and for vocational retraining purposes.

Returning to work after breast cancer: A systematic review of reviews.

BACKGROUND: Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues. OBJECTIVE: To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it. METHODS: A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer. RESULTS: Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW. CONCLUSIONS: The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

Variation, companionship and manageability important for recovery during working hours: A qualitative focus group study.

BACKGROUND: Lack of recovery from everyday strains and demands is connected to increased levels of stress-related problems and development of ill-health. There is much research on how to handle and prevent fatigue and stress in leisure time, but research on working time is more scarce. A recent study found that employees' experience of recovery during working hours was related to high self-rated health. OBJECTIVE: The aim of this study was to explore the concept of recovery during working hours among primary health care workers. METHODS: Eight focus groups with 50 staff members, men and women, from different professions were conducted in the primary health care sector in southern Sweden. The analysis was inspired by systematic text condensation, a strategy for qualitative analysis. RESULTS: Three main categories were identified as important factors for experiencing recovery during working hours: variation (including changes in location, tasks and tempo) companionship (including helpfulness, appreciation, social chat and laughter) and manageability (including completion, satisfaction, influence, control and reflection). CONCLUSIONS: Recovery during working hours is multifaceted. The categories identified in this study will be further elaborated and tested.

Evaluation of the effect of psychological recovery tools on back pain in an out-patient prevention program.

BACKGROUND: Stress and recovery have recently been linked to health issues and back pain (BP) occurrence. However, the evaluation of these aspects in prevention programs has not been approached so far. OBJECTIVES: The primary aim of this study was to exploratively scrutinize the effectiveness of recovery interventions to reduce BP within a multimodal, out-patient prevention program. The secondary aim consisted in the evaluation of these recovery interventions in terms of reducing stress and increasing recovery. METHODS: A prospective cohort study with 58 employees was conducted. Thirty-one individuals participated in a multimodal out-patient prevention program for 12-weeks, with recovery interventions being conveyed as add-ons. The control group did not receive treatment. At baseline (T0) and after the prevention program (T1), both groups completed psychometric instruments assessing BP, stress, and recovery. RESULTS: A MANOVA indicated that Pain Intensity (p = 0.039), Disability (p = 0.011), and Overall Stress (p = 0.001) were significantly reduced in the intervention group compared to the control group. Overall Recovery (p = 0.008) significantly improved in the intervention group while deteriorating in the control group. CONCLUSIONS: The outcomes emphasize the relevance of recovery tools for BP prevention and for reducing stress and enhancing recovery in an out-patient prevention program.

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.

Critical factors for the return-to-work process among people with affective disorders: Voices from two vocational approaches.

BACKGROUND: Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today's workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process. OBJECTIVE: To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users' experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR). METHOD: Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included.RESULTSThree themes emerged as critical factors; Experiencing hope and power, professionals' positive attitudes, beliefs and behaviours, and employing a holistic perspective and integrating health and vocational service.CONCLUSIONThis study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe "you can work", who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

Experiences and perceptions of facilitators of The WORKS.

BACKGROUND: Some people who have a mental illness may require vocational rehabilitation and support to assist their participation in activity and employment. The WORKS is a vocational rehabilitation group intervention program, co-facilitated by Peer-Support Workers and Occupational Therapists. These facilitators provide support and guidance to people with a mental illness through practical activities and goal development. OBJECTIVE: This study aimed to explore the lived experiences and perceptions of facilitators of The WORKS. METHODS: The Integrating Theory, Evidence and Action (ITEA) method was used in this study, employing a phenomenological approach. Facilitators of The WORKS at a metropolitan Australian mental health service were purposively sampled, and four participated in semi-structured interviews. Data was transcribed verbatim and member checked, before being coded and analysed with reference to the Model of Human Occupation. RESULTS: Five themes emerged from the data; Consumer Growth [Volition], Facilitator's Occupational Identity [Volition], Role of Facilitators [Habituation], Workload of Facilitators [Performance Capacity], and Adaptation of The WORKS Resources [Performance Capacity]. CONCLUSIONS: All participants perceived benefits related to The WORKS however discussed a co-facilitation power imbalance between facilitators. Therefore, more development is needed around the co-facilitation relationship between Occupational Therapists and Peer-Support Workers.

The efficacy and efficiency of Disability Management in job-retention and job-reintegration. A systematic review.

BACKGROUND: Disability management (DM) is a systematic method to ensure job-retention and job-reintegration in competitive employment for individuals with a disability. There is evidence that 'returning to work' has a positive impact on the individual, the company and on the society. However, a clear overview of the efficacy and efficiency of the DM programs is scarce. OBJECTIVE: To systematically review the efficacy and efficiency of the disability management programs. Cochrane, PubMed, Google Scholar, and Web of Science were searched from 1994 to 2015. METHODS: Two reviewers independently evaluated the articles on title, abstract, and full text. The data extraction and results are documented according to the study designs. RESULTS: Twenty-eight articles were included in the review. These 28 articles consisted of 7 systematic reviews, 3 randomized controlled trials, 9 clinical trials, 4 mixed-method studies and 5 qualitative studies. CONCLUSIONS: The DM program has shown to be effective and efficient. A consensus about the DM components is still not reached. Nevertheless, some components are emphasized more than others; job accommodation, facilitation of transitional duty, communication between all stakeholders, health care provider advice, early intervention, and acceptance, goodwill and trust in the stakeholders, in the organization, and in the disability management process.

The Use of Standardized Discharge in IPS Supported Employment Programs.

OBJECTIVE: Some researchers have argued for using standardized discharge rules in individual placement and support (IPS) based on time of unemployment. To evaluate potential adverse outcomes of these rules, the authors examined time to first job over 24 months in a large randomized controlled study. METHODS: This secondary analysis of 2,055 participants in the Mental Health Treatment Study, using bootstrapping and survival analysis, estimated and compared the likelihood of finding a first job in the IPS and control groups during each quarter over 24 months. RESULTS: Although the likelihood of obtaining a first job declined over time, IPS recipients were more likely than participants in a control group to find first jobs for at least 18 months. CONCLUSIONS: Use of standardized discharge rules in IPS, based on initial periods of unemployment, may be cost-effective but would penalize recipients who respond more slowly. Natural attrition may be a more sensitive and ethical way to create capacity.

Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland.

We use discrete-time survival regression to study two empirical issues relating to take-up of individual placement and support (IPS) supported employment (SE) services for persons with serious mental illness: (1) the influence of client characteristics on take-up probability, and (2) the possible impacts of a major recent initiative in one state (Maryland) to overcome barriers to IPS-SE expansion. Our longitudinal analysis of population-based Medicaid cohorts, during 2002-2010, provides tentative evidence of positive state initiative impacts on SE take-up rates, and evidence of effects on take-up for clients' diagnoses, prior work-history, health and demographic characteristics, and geographic accessibility to SE providers.

The sink or SWIM hypothesis; a roadmap from pathology to work instability.

PURPOSE: Selecting the most appropriate health-related work outcome to evaluate an intervention can be fraught with difficulty. To aid clinicians in navigating this problem we have developed a model, which illustrates how pathology can affect specific measureable quantities, such as work instability. METHODS: Using a modified-Delphi procedure, a panel of experts met initially to analyze the content of 95 health-related work outcome measures and organize the identified areas of measurement into a coherent model, complemented by a narrative review of the literature. This initial model underwent two rounds of stakeholder-based feedback, the results of which were incorporated in the final expert panel meeting to produce the States-traits Work Instability Model (SWIM). RESULTS: The States-traits Work Instability Model (SWIM) illustrates how changes to an individual's physical and psychological states and traits might affect their work-related performance, well-being and self-efficacy. Moreover, each concept utilized in the model was specifically selected as it represents a measurable quantity, for which there are tools available. CONCLUSION: The SWIM is arguably the first holistic model of work that is based on both the clinical realities of vocational rehabilitation, sociological research, and is born from analyzing the basis of practical measurements. Implications for Rehabilitation Work Instability • Work instability has multiple causes many of which are amenable to intervention • The model clarifies the measureable domains of vocational rehabilitation interventions, which is of particular benefit for services working with people with disability at work who are struggling to remain in work • The model conceptualizes how the potential areas for intervention may be related based on evidence available in the literature.