RehabWire - Volume 8, Number 4, May 2006.

For May, RehabWire looks at current research in employment and people with psychiatric disabilities.

NIDRR Grantees on the Cutting Edge.

Exploratory Study of the Relationship Between Stigma at the Workplace and the Vocational Recovery of People with Psychiatric Disabilities. Boston University (H133G030190), led by Zlatka Russinova, PhD. Delores Watkins, Project Officer.
Abstract: The purpose of this project is to study the relationship between stigma of mental illness at the workplace and the vocational recovery of persons with psychiatric disabilities. More specifically, the project focuses, on one hand, on operationalizing the traumatic negative impact of stigma on mental health consumers’ capacity to obtain and sustain competitive employment, and, on the other hand, on the objective and subjective factors (i.e., supportive work environment, effective coping strategies, etc.) that minimize the interference of stigma with the vocational recovery of persons with psychiatric disabilities. In addition, the study explores the pivotal role of disclosure at the workplace in understanding the complex, multi-faceted relationship between stigma and the vocational recovery among persons with serious mental illness whose disability is often invisible.
Find out more at: www.bu.edu/SARPSYCH

15-year Course of Competitive Employment for People with Severe Mental Illness. Dartmouth Medical School (H133G050181), led by Robert E. Drake MD, PhD. Shelley Reeves, Project Officer.
Abstract: Little is known about long-term employment among people with severe and persistent psychiatric illnesses, such as schizophrenia or bipolar disorder, and vocational disabilities. Two small pilot studies suggest that a large proportion of these individuals, when exposed to effective vocational rehabilitation (VR) and supported employment services, do attain long-term jobs that are associated with greater independence, economic self-sufficiency, and recovery, but a prospective, longitudinal study is critically needed to confirm and amplify these findings. To address this issue, this study: (1) examines the longitudinal course of competitive employment (any competitive job) and long-term jobs (competitive employment lasting greater than one year) among people with severe mental illnesses; (2) details the impact of VR services, supported employment, and other services on long-term employment; and (3) examines the correlates of long-term employment, including independence, economic self-sufficiency, quality of life, and other aspects of recovery. The key objectives are to build a timeline of work, earned and other income, benefits, independent living, social functioning, symptom control, and quality of life over 15 years for each individual on the basis of multiple data sources; to link VR and other service records with employment outcomes by statistical means and by self-report; and to link employment outcomes with other manifestations of recovery, again by statistical means and by self-report. The project uses timeline methods, longitudinal data methods, and narrative self-reports to conduct these analyses. The outcomes of the study are to show that individuals with the most severe psychiatric disabilities are able to attain high rates of competitive employment and long-term employment, that VR and other services are critical to successful long-term employment, and that long-term employment is associated with independence, economic improvements, quality of life, and recovery.

Cognitive Training and Supported Employment in Severe Mental Illness. Dartmouth College (H133G050230), led by Susan McGurk, PhD. Shelley Reeves, Project Officer.
Abstract: Impaired cognitive functioning is an important predictor of employment outcomes in persons with severe mental illness (SMI), and a common complaint in consumers participating in vocational rehabilitation, including those in supported employment. This project evaluates a new, pilot tested and standardized intervention, the “Thinking Skills for Work” program is designed to help people with SMI succeed in supported employment programs, including both getting and keeping jobs. The Thinking Skills for Work program is aimed at improving the cognitive functioning of persons with SMI involved in supported employment, and is based on a heuristic model of the interactions between cognition, symptoms, work performance, and vocational services. According to the model, enhanced cognitive functions improve both work outcomes and the efficiency of vocational services (i.e., fewer support services needed per hour of consumer work). The Thinking Skills for Work program is delivered by a specialist who educates consumers about cognitive functioning and work, involves them in a three-month program of computerized cognitive skills training, and works in collaboration with the consumer and supported employment specialist to identify appropriate jobs, practice newly acquired cognitive skills in work-related settings, and develop compensatory strategies for managing persistent cognitive impairments.

University of Illinois at Chicago National Research and Training Center on Psychiatric Disability. University of Illinois at Chicago (H133B050003), led by Judith A. Cook, PhD. David W. Keer, Project Officer.
Abstract: The University of Illinois at Chicago National Research and Training Center on Psychiatric Disability (UIC-NRTC) promotes access to effective consumer-centered and community-based practices for adults with serious mental illness. The Center is conducting five rigorous research projects to enhance the state of evidence-based practice n this field: A randomized controlled trial (RCT) study of Wellness Recovery Action Planning to gather evidence regarding its effectiveness; an RCT to evaluate the effectiveness of BRIDGES, a 10-week peer-led education course designed to provide mental health consumers with basic education about the etiology and treatment of mental illness, self-help skills, and recovery principles; an RCT of peer support services delivered by Georgia’s Certified Peer Specialists at consumer-run Peer Support Centers in order to determine the outcomes of service recipients; a self-directed care program in which adults with serious mental illnesses are given control of financial resources to self-direct their own recovery; and a project using data from 12 clinical trials studies of consumer-operated service programs to create a national data repository to promote research and develop scholarship in this area. The Center also conducts state of the art training, dissemination, and technical assistance projects designed to enhance the leadership skills of people with psychiatric disabilities, and evaluate a self-advocacy skills training program delivered to clients of a large psychosocial rehabilitation agency. See Additional Resources on page 4 for more information about this project.
Find out more at: www.psych.uic.edu/uicnrtc .

Please note: These abstracts have been modified. Full, unedited abstracts, as well as any available REHABDATA citations, are available at naric.com.

According to a survey by the American Psychiatric Association: "Almost half the public - 44 percent - report knowing only a little or almost nothing at all about mental illnesses. But asked whether they would benefit from knowing more about the warning signs of mental illness, 84 percent said yes." .

From the NARIC Collection

Brooke, V., Buehlmann, B. (2003) Fast facts on . . . Psychiatric disabilities, 3(3). NARIC Accession Number: O15258. Project Number: H133B980036. Abstract: Fact sheet explains how accommodations and workplace supports can help employees with psychiatric disabilities overcome functional limitations. Scenarios involving issues related to medication, schizophrenia, and mood disorder demonstrate simple and inexpensive ways to accommodate workers with mental illness. Includes a list of resources.

New Research: Selections from REHABDATA

MacDonald-Wilson, K. (2003) Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities. Journal of Vocational Rehabilitation, 18(1), 15-24. NARIC Accession Number: J45642. Project Number: H133B990023.
Abstract: Study examines the relationship between the types and frequency of functional limitations experienced by employees with psychiatric disabilities and the related accommodations provided in supported employment programs. Cognitive limitations were the most prevalent type reported, followed by social, physical, and emotional/other. The presence of a cognitive limitation was the most consistent predictor of the number of accommodations provided. There was a significant relationship between the type of functional limitation and the number and type of accommodations received. There were no significant relationships found between any other clinical or demographic factors, functional limitations, or reasonable accommodations.

Cook, J. (2003) One-year followup of Illinois state vocational rehabilitation clients with psychiatric disabilities following successful closure into community employment. Journal of Vocational Rehabilitation, 18(1), 25-32. NARIC Accession Number: J45643. Project Number: H133B00011; H133B000700.
Abstract: Study examined the employment retention rate and nature of jobs held by clients successfully closed from the Illinois state vocational rehabilitation (VR) system. One year after closure, 71percent of those who were employed when they exited the state VR system were still employed; 63 percent were employed at the same positions held at closure.

Killeen, M., O’Day, B. (2004) Challenging expectations: How individuals with psychiatric disabilities find and keep work. Psychiatric Rehabilitation Journal, 28(2), 157-163. NARIC Accession Number: J46974. Project Number: H133G020116.
Abstract: Article describes the systematic and programmatic barriers to employment experienced by 32 individuals with psychiatric disabilities. Authors discuss how negative beliefs and expectations concerning employment are imbedded within the policies and programs that impacted the study participants. They describe the experiences of three study participants who were successful at finding and maintaining employment and identify some of the common factors that may contribute to successful employment.

Jonikas, J., Laris, A. (2003) The passage to adulthood: Psychiatric rehabilitation service and transition-related needs of young adult women with emotional and psychiatric disorders. Psychiatric Rehabilitation Journal, 27(2), 114-121. NARIC Accession Number: J47046. Project Number: H133B000700.
Abstract: Literature review examines the needs and experiences of young adult women, aged 16 to 21, who have a diagnosis of serious emotional disturbance or mental illness, as they transition into adulthood. Review includes research on mental health needs of young adults with depressive disorder, bipolar disorders, adolescent schizophrenia and other psychotic disorder, and substance abuse disorders. Authors also examined research on transition-related needs and outcomes of female youth, including relationships with family and peers, abuse and trauma, academic performance, independent living, and employment.

Cook, J. (2004) Blazing new trails: Using evidence-based practice and stakeholder consensus to enhance psychosocial rehabilitation services in Texas. Psychiatric Rehabilitation Journal, 27(4), 305-306. NARIC Accession Number: J47590. Project Number: H133B000700.
Abstract: Introduces a series of articles that describe an initiative to use evidence-based practice along with stakeholder consensus to a design a package of psychosocial rehabilitation (PSR) services for people using public mental health services in Texas. PSR services included supported housing, supported employment, integrated mental health and substance abuse treatment, case management, life skills training, and peer support, self-help, and consumer operated services.

McGrew, J., Johannesen, J. (2005) Performance-based funding of supported employment: A multi-site controlled trial. Journal of Vocational Rehabilitation, 23(2), 81-99. NARIC Accession Number: J49779. Project Number: H133G030106.
Abstract: The outcomes of consumers served using results-based funding (RBF) for supported employment services were compared with outcomes under a traditional fee-for-service model for people with severe mental illness in Indiana. Under the RBF system, providers received payment only when clients successfully attained each of five employment milestones. Results indicated better vocational outcomes for clients funded using RBF. Clients served under RBF were more likely to achieve all five milestones, and were significantly more likely to have a person-centered plan and to retain employment for nine months.

Bowers, S., McKee, T. (2003) The jump start initiative. Recovery & Rehabilitation, 2(4). NARIC Accession Number: O14762. Project Number: H133B990023.
Abstract: Describes program that promotes recovery and career development for young people with psychiatric disabilities as they transition from high school to employment and/or secondary education. The program uses mentors to provide role models, increase social support, and teach valuable skills. Jump Start students, parents, and mentors briefly describe their experiences with the program. Mentoring and transition resources and a list of mentoring websites are included.

Cook, J., Petersen, C. (2003) Seeking supported employment: What you need to know. NARIC Accession Number: O15887. Project Number: H133B000700.
Abstract: Presents an overview of four different methods of obtaining employment for people with psychiatric disabilities: competitive, transitional, sheltered, and supported. It includes guidelines for how to find supported employment and checklists for self-evaluation in determining the kind of work that will match the individual’s needs and preferences.

Where Can I Find More? A quick keyword search is all you need to connect to a wealth of disability and rehabilitation research. NARIC’s databases hold more than 75,000 resources. Visit www.naric.com/research to search for literature, current and past research projects, and organizations and agencies in the US and abroad.

Additional Resources

May is Mental Health Month
According to the APA, "one in five Americans suffer from a diagnosable mental illness during any given year." Source: Let’s Talk Facts About Mental Illness
Visit the American Psychiatric Association for events, activities, promotional items, and, of course, information on mental health, and where to find help at www.healthyminds.org

closeup portrait of a young man. Photo credit: Oliver Ingrouille, UK