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Returning to work is an important sign of recovery and returning to normal life for patients. Most patients have a strong desire to return to work, however, their confidence is low. Return-to-work self-efficacy is not only a reflection of patients' confidence in returning to work but also an important predictor of his readiness to get back to work. Based on the concept and meaning of return-to-work self-efficacy, this study introduces its related theoretical models, summarizes the contents, scoring criteria, validity and reliability of related assessment tools, and conducts a comparative analysis of the tools, to provide Chinese rehabilitation care workers with evidence contributing to the selection of an appropriate return-to-work self-efficacy assessment tool.

Purpose: Research indicates that the implementation of work-related medical rehabilitation (WMR) is characterized by pronounced heterogeneity and that the requirements defined by the German Pension Insurance are not consistently met. The study aimed to investigate the implementation of the WMR guideline in patients with musculoskeletal disorders with regard to the identification of a need for WMR as well as the assessment of the individual demands of work., Methods: 317 rehabilitation facilities authorized for WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria., Results: Although most facilities reported that nearly all patients receive WMR if they have a need for it, the proportion of WMR measures provided was below ten percent in the majority of cases. With regard to work demands, respondents demanded greater involvement of employers in order to strengthen validity., Conclusion: The findings indicate that WMR is largely implemented in accordance with the WMR guideline. The main challenges include meeting the need for WMR and strengthening the involvement of employers in the assessment of work requirements., Competing Interests: Die Autoren sind für das Institut für Qualitätssicherung in Prävention und Rehabilitation GmbH an der Deutschen Sporthochschule Köln tätig., (Thieme. All rights reserved.)

Purpose: As the effect evaluation of our randomized controlled trial the "Comprehensive Approach of Reintegration for clients with Multiple problems" (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol., Methods: Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems., Results: Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes., Conclusion: The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol.

Background: Although people receiving means-tested benefits are regularly taken care of at the job center, little is known about their mental health situation and mental health care., Objective: The aim of the study was to describe the diagnostic spectrum and the functional status as well as the mental health care utilization of individuals with mental illnesses who are receiving means-tested benefits., Methods: Mentally ill people with means-tested benefits were recruited at the job center as part of the "Leipzig Individual Placement and Support for Mentally Ill People" (LIPSY) project, where they were initially diagnosed according to ICD-10 and included in the project if they had a mental disorder. Mental healthcare utilization was recorded. In the present study, data from n = 583 consecutively included persons were analyzed descriptively and by multivariate statistics., Results: Of the study participants 60.7% (n = 583; 51.5% female; average age 36 years; unemployed for an average of 4.8 years) suffered from affective disorders, followed by neurotic, stress and somatoform disorders (42.5%). With a mean global assessment of functioning (GAF) value of 49.4 (SD 7.7), there was on average a serious impairment. Nearly half of the subjects (48.5%) had never received psychotherapeutic, psychiatric or neurological treatment in the 6 months prior to inclusion in the project., Discussion: It could be shown that there is a broad spectrum of mental disorders with substantial functional impairment. The data suggest that this group is significantly undertreated and difficult to reach., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work., Method: A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale., Results: A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work., Conclusion: The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion., (© 2024. The Author(s).)

Background: Professional reintegration is an indicator of recovery and a common goal for many stroke survivors. However, data on the effect of professional reintegration on the quality of life (QoL) of stroke survivors is scarce., Aims: To assess and synthesize the available evidence, and identify the gaps on the effect of professional reintegration on the QoL of stroke survivors., Methods: A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the effect of professional reintegration on QoL of stroke survivors. The main quantitative findings were synthesized and qualitative data was explored by thematic content analysis., Results: The included studies, 7 quantitative, 1 qualitative, and 1 mixed-methods, were published between 2009 and 2021. The assessment of QoL was highly heterogenic but globally most studies reported a significant and positive association between return to work (RTW) and QoL, 3 to 36 months post-stroke. For some stroke survivors, being able to focus on their rehabilitation was more important for their QoL than RTW., Conclusions: The results highlight the importance of investing in professional reintegration after stroke to improve survivors' QoL. Further mixed-methods longitudinal research, performed in different countries and settings, with higher, homogeneous, and comparable samples, providing a broader approach to professional reintegration and the use of specific and standardized instruments to assess subjective domains of stroke survivors' QoL, is needed., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW., Materials and Methods: Ten men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework., Results: Multiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation., Conclusion: Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.

To identify, appraise, and summarize outcomes reported in trial-based economic evaluations of Individual Placement and Support programs for adults with severe mental illness. Six databases were searched, including Medline, PsycINFO, CINAHL, Cochrane, Scopus, and EconLit. Inclusion criteria were trial-based, full economic evaluations comparing Individual Placement and Support programs to traditional vocational rehabilitation programs for adults 18 years and older with severe mental illness. Study quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Of the 476 articles identified in the database search, seven were included in the review. Studies conducted across Europe (n = 4) and Japan (n = 1) suggested that Individual Placement and Support may be a cost-effective alternative to traditional vocational rehabilitation programs. Two studies conducted in the United States demonstrated that Individual Placement and Support led to better vocational outcomes, but at neutral or higher costs than traditional vocational rehabilitation, depending on the benefit measure used. Trial-based economic evaluations of supported employment for adults with severe mental illness are limited and heterogeneous. The interpretation of economic outcomes warrants consideration of factors that may impact cost-effectiveness, such as geographical location. Future studies should evaluate whether the benefits of IPS outweigh additional costs for patients and other stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare mobile technology devices (i.e., Tablets) with built-in decision prompts and branching to improve the independent vocational performance of four secondary students with autism spectrum disorder (ASD) and/or intellectual and developmental disability (IDD)., Materials and Methods: An adapted alternating treatments design was used to compare the effectiveness of the prompting system presented on Apple iPads and Microsoft Windows-based tablets. The prompting system contained audio, video, and picture prompts. Further, we investigated the effectiveness of improving problem-solving through decision-making prompts and branching. Participants used the devices to make decisions on how to properly prepare a teacher's lounge including filling salt and pepper shakers, cleaning tables, and filling silverware containers., Results: Results indicated that both devices produced immediate and significant increases in independent responding for all participants. All participants also self-faded prompt dependence throughout the duration of the intervention as vocational skill acquisition increased., Conclusion: Teachers and students have enhanced access to powerful devices capable of providing individual support for vocational skills. This study indicates that a multimedia prompting system with multiple prompt mediums can improve independent completion of targeted vocational skills while decreasing the reliance on technological support.

Purpose: Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE., Methods: The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups., Results: Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system., Conclusion: Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.IMPLICATIONS FOR REHABILITATIONGender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

Purpose: Supported employment is a promising vocational rehabilitation intervention for improving disability employment. Its implementation, however, is not without challenges. Lack of funding and the heavy caseload of job coaches significantly constrain its impacts. A mobile software, avail® by CentralReach, was created based on the individual placement and support model for assisting individuals with disabilities to perform their job tasks. The purpose of this pilot study was to explore the feasibility and preliminary efficacy of avail., Method: A total of 17 participants with disabilities were recruited in a Midwestern state from the United States to try avail for a period of time ranging from 40 to 348 days. Participants' experiences, including perceived usability, acceptance, and satisfaction, were collected to determine the feasibility of avail. In addition, a pre- and post-intervention analysis was conducted to identify its effects on users' job satisfaction, self-efficacy, and self-determination., Results: Participants of this study expressed positive user experience for avail. Specifically, they felt that avail was helpful for their job performance. The results also showed a statistically significant result for improving participants' self-determination., Conclusion: avail is a feasible and potentially promising application for assisting workers with disabilities in their job performance. Directly available on mobile devices, avail has several advantages, such as real-time support and good portability. Suggestions and future directions were discussed for further software development.

Purpose: To assess the reliability and validity of the work-ability support scale (WSS) in a severe traumatic/acquired brain injury (TBI/ABI) population seeking to return to work (RTW)., Materials and Methods: One hundred forty-four clients were enrolled in a vocational rehabilitation (VR) intervention trial through the Brain Injury Rehabilitation Program in New South Wales, Australia. Each client's primary brain injury clinician and VR provider completed the WSS pre- and post-intervention. Validating measures assessing dysexecutive behavior, disability, participation, and work instability were completed. Several aspects of reliability and validity were evaluated., Results: Internal consistency was excellent for Part A (Cronbach's α s > 0.9) but unacceptably low to questionable for Part B ( α s < 0.6). Inter-rater reliability between clinicians and VR providers was generally fair to moderate for Part A ( κ w < 0.6) and worse for Part B ( κ w < 0.5), with both slightly improving at post-intervention. Strong support was found for predictive and convergent validity, but not divergent validity. Confirmatory factor analysis indicated a poor fit for Part A, whereas most Part B fit indices met criteria., Conclusions: The WSS can play a useful role in assessing return to work (RTW) potential, planning and evaluation after severe TBI/ABI. Training could improve consistency of administration among staff working across health and VR service sectors.

Purpose: The study approach sought to understand which vocational rehabilitation (VR) strategies are available for individuals seeking return to work (RTW) following traumatic brain injury (TBI). Secondly, the review aimed to identify how these RTW interventions and outcomes are evaluated., Materials and Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the scoping review began by identifying relevant English language articles via PubMed, CINAHL, PsycINFO, and Embase databases for peer-reviewed journal articles published from January 2013 to September 2021. The review focused on identifying studies with a sample population of people with moderate to severe TBI., Results: A total of 23 studies met the search criteria. For each included study, the following data were extracted: (a) country of origin, (b) sample size, (c) civilian or military sample population, (d) age, (e) participant gender, (f) RTW definition, (g) intervention approach, and (h) RTW outcome. The results were synthesized by placement into one of four categories as a function of the study's underlying methodological approach., Conclusions: The development of effective RTW approaches has largely been neglected in the rehabilitation literature for persons with TBI in civilian and military populations. Effective strategies do exist to help guide efforts to return this population to productive activity, including work.Implications for RehabilitationLack of productive engagement in work and school among persons with traumatic brain injury (TBI) presents a chronic challenge in rehabilitation systems internationally.Rehabilitation professionals should utilize multidisciplinary and integrated return-to-work (RTW) interventions given the varied areas of function that can result from TBI.Rehabilitation professionals should apply RTW interventions that promote on-site training and workplace integration.Given the idiosyncratic nature of TBI, RTW interventions should be tailored to meet the specific needs of the person seeking support.

Purpose: Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation., Materials and Methods: The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five., Results: The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features., Conclusion: The framework has the potential to translate to other similar service contexts.

Purpose: Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke., Method: Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach., Results: Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills., Conclusions: Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs.

Purpose: To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors., Materials and Methods: A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors., Results: On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status., Conclusions: Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.

Purpose: Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services., Materials and Methods: This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration's Case Service Report from fiscal years 2017-2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data., Results: Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all p < .001)., Conclusion: The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided.

Introduction: Occupational therapy students need to be ready to work autonomously in a range of environments as soon as they complete their degree. Practice education experiences are considered key to students developing the competencies that autonomous work requires. To function autonomously in practice environments, it is argued that practitioners need to be able to judge the quality of their own work and the work of others. This is referred to as evaluative judgement. However, there is limited empirical literature relating to evaluative judgement and even less exploring the concept within occupational therapy., Methods: This study used qualitative methods, seeking to understand the evaluative judgements of clinical practice made by third- and fourth-year occupational therapy students during practice education., Results: Twenty-one interviews were conducted with third- (n = 10) and fourth-year occupational therapy students (n = 1), university support staff supporting practice education (n = 4), and practice education supervisors (n = 5) at one Australian university. Practice education grades and documentation were also used as data. Data were analysed thematically, and two themes, each with three sub-themes, were identified: students coming to understand expected standards, with the following sub-themes: students attuning to cues, cues that inform supervisors about students' meeting the standards, and barriers and frustrations to understanding standards; and practising and developing evaluative judgement, with the following sub-themes: making comparisons, acting on feedback, and reflective practice., Conclusions: Practice education experiences provide many context-specific opportunities for students to develop their evaluative judgement. Students may be supported to come to know what quality work looks like by offering scaffolded opportunities to develop evaluative judgement in university and practice education settings., (© 2024 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To establish the effectiveness of Individual Placement and Support (IPS) to integrate people with mental illness into the general labor market, controlled comparisons with usual rehabilitative practice in terms of employment rates and cost-effectiveness are needed., Methods: 20 IPS participants with psychoses (primarily schizophrenia spectrum disorders) were compared with 20 controls who were offered usual rehabilitative practices in adjacent counties (rehabilitation as usual, RAU) over 18 months., Results: IPS was significantly superior to RAU on all job-related criteria with moderate to high effect sizes, with no differences in absenteeism, hospital days, or dropout rates. IPS was significantly superior to RAU on cost-effectiveness., Conclusion: This study provides evidence that IPS is an effective and cost-efficient addition to existing vocational rehabilitation services for people with psychoses., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: This feasibility study focusses on the implementation and use of a decision aid, which supports vocational rehabilitation (VR) professionals in helping clients with a disability pension return to work in practice. The decision aid shows an overview of the clients' return to work barriers and suggests suitable VR interventions based on these barriers., Methods: The study population consisted of VR professionals working at the Dutch Social Security Institute and their clients receiving a (partial) work disability pension. The feasibility was measured with concepts of the Linnan and Steckler framework and the attitude, social norm and self-efficacy model. Data were collected using questionnaires, checklists and qualitative interviews., Results: Ten professionals participated in this study. Fifty-four clients were asked to fill in the questionnaire of the decision aid and 32 clients received VR care based on the decision aid. In general, VR professionals and clients were satisfied with the decision aid and perceived a few barriers for using the decision aid., Conclusions: This study showed that it is feasible to implement and use the decision aid. To improve the implementation of this decision aid, it should be implemented in digital systems used by professionals to improve efficiency of working with the decision aid., (© 2023. The Author(s).)

Objective: Many young adults who are unemployed and not in school need support achieving employment goals. Individual Placement and Support (IPS) is an evidence-based employment practice for adults with serious mental illness, but its applicability to young adults with mental health conditions has not been well-researched. The present study prospectively assessed IPS effectiveness in a national sample of young adults enrolled in routine practice settings in the U.S. public mental health system., Method: Nine community agencies in five states participated in a 1-year follow-up study of young adults (aged 16-24) enrolled in IPS services. The study examined three outcomes: retention in services, employment, and education. State fidelity reviewers examined IPS fidelity using a new fidelity scale, the IPS-Y., Results: In a sample of 111 participants, the mean age was 19.2, 72 (64.9%) had never worked, and 76 (68.5%) had a diagnosis of depressive and/or anxiety disorder. Participants averaged 8 months of enrollment before terminating from IPS services. During follow-up, 51 (45.9%) participants obtained a competitive job ( N = 50) or paid internship ( N = 1); 14 (12.6%) achieved a new education outcome., Conclusions and Implications for Practice: IPS has promising outcomes for helping young adults with mental health conditions achieve positive employment outcomes, but its effectiveness in helping young adults achieve education goals has not been demonstrated. IPS should be offered to young adults with employment goals. Targeted funding for supported education and training for IPS specialists in delivering educational supports may be necessary to ensure optimal education outcomes in IPS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Individual Placement and Support (IPS) has been shown to effectively help people with serious mental illness obtain competitive employment, and IPS programs have been established in over 40 U.S. states and at least 20 other countries. As this expansion continues, the field needs data describing IPS implementation, clients, fidelity, and outcomes in real-world, non-research settings, specifically regarding racial and ethnic disparities and young adults. The goal of this study was to observe the initial three years of IPS implementation, measuring fidelity, client characteristics, and employment outcomes in three mental health agencies in one California county. In 2018, officials in one California county contracted with the IPS Center to provide training and measure IPS program fidelity at three mental health agencies in a large urban area. The goal was to establish and maintain IPS programs with good fidelity and effectiveness. After an initial year of preparation, three mental health programs recruited unemployed clients with interest in employment and implemented IPS. An IPS trainer provided initial training, ongoing consultation, and measured program fidelity. The program clinicians documented client characteristics, IPS service use, and quarterly employment throughout 13 quarters. The project followed 351 mental health clients as they participated in three new supported employment programs over a three-year period. The average client age was 36 years, including 107 (31%) young adults (ages 18-25) and 244 older adults (ages 26+); 177 (50%) identified their gender as female, 173 as male, and 1 as other or declined to answer; 119 (36%) identified as Hispanic, 116 (35%) as non-Hispanic White, 42 (13%) as non-Hispanic Asian, 35 (11%) as non-Hispanic Black, and 20 (6%) as other non-Hispanic. Most clients (78%) had diagnoses of non-psychotic conditions such as anxiety or depression, and 22% had diagnoses of schizophrenia, schizoaffective, or other psychotic disorder. During the project, 312 (87%) engaged in supported employment services, 206 (58%) attained competitive employment, and 177 (50%) found their first job within nine months of enrolling. Hispanics (64%), Asians (57%), and non-Hispanic Blacks (77%) achieved higher employment rates than non-Hispanic Whites (49%). Young adults (73%) achieved higher employment rates than older adults (51%). Engaging in new IPS supported employment programs over several months led to high rates of competitive employment across all groups in real-world, non-research settings, typically within nine months. Hispanics, Asians, and non-Hispanic Blacks achieved higher rates of competitive employment than non-Hispanic Whites, and young adults achieved higher rates than older adults. Further research may explain these differences., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25–62 years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to investigate person-related, injury-related, activity-related and rehabilitation-related risk markers for not return to work among patients with acquired brain injury (ABI). Methods Retrospective data from the Quality register, WebRehab Sweden, on an ABI cohort of 2008 patients, was divided into two groups: those who had returned to work (n = 690) and those who had not returned to work (n = 1318) within a year of the injury. Results Risk ratio analyses showed that several factors were risk markers for not returning to work: personal factors, including being a woman, being born outside of Sweden, having a low education level, and not having children in the household; injury-related factors, including long hospital stay (over 2 months), aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; activity-related factors, including low function in self-care, inability to perform usual activities, and not having a driver's license; and rehabilitation-related factors, including being dissatisfied with the rehabilitation process and the attentiveness of the staff having limited influence over the rehabilitation plan, or not having a rehabilitation plan at all. Conclusion Several factors in different aspects of life were risk markers for not returning to work among patients with ABI. This suggests that rehabilitation and interventions need to address not only direct injury-related issues, but also person-related, activity-related, and rehabilitation-related factors in order to increase the patient's opportunities to return to work. [ABSTRACT FROM AUTHOR]

Purpose: Our process evaluation (trial registration: DRKS00022468) monitored the implementation of a multi-component strategy including case management aiming to improve rehabilitation coverage and work participation of people with a high risk of permanent work disability., Methods: A risk score using administrative data, particularly on employment and welfare benefits, was employed to identify individuals with higher probability of receiving disability pension and therefore potentially needing support. These individuals were contacted by post and encouraged to phone their regional case manager if they needed assistance. Content for the intervention components was developed collaboratively with the case managers. We examined the sample reached, dose delivered, fidelity, dose received and satisfaction with the intervention., Results: Out of 1074 individuals with high-risk scores were contacted, there were 57 case managements. The participants reached were in poor health, and 42.1% reported at least four diagnosed conditions, mostly musculoskeletal and mental disorders. About two-thirds (63.0%) reported poor work ability at baseline. On average, 72.5% of the content of the initial telephone contacts, 88.7% of the content of the face-to-face interviews and 45.2% of the content of the case management were delivered. The participants were highly satisfied with the various components and content of the intervention. Knowledge about rehabilitation improved significantly, with 43 of the 57 participants (75.4%) applying for rehabilitation, mainly medical rehabilitation. At the end of the case management intervention, most participants (91.7%) were still employed., Conclusion: The risk score offers an opportunity to screen for people with a high risk of permanent work disability. Case management participants found participation worthwhile and were significantly better informed about participation services after completing case management. More than every second participant received medical or vocational rehabilitation., Competing Interests: The authors declare no conflict of interest. Funding covered personnel, material and traveling expenses. The German Pension Insurance North additionally contributed by sending out study materials and patient questionnaires and by providing administrative data on the rehabilitation and work participation of study participants. The funding body had no impact on the design of the study, data collection, data analysis, data interpretation and on writing the manuscript., (Thieme. All rights reserved.)

Background: This study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences., Methods: We used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences., Results: Our sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services., Conclusions: Multiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education., Trial Registration: German Clinical Trials Register DRKS00009910, registration 25/01/2016., (© 2024. The Author(s).)

Background: Customized employment (CE) is recognized in the Workforce Innovation and Opportunity Act (2014) as a strategy for promoting competitive integrated employment. However, the existing body of evidence supporting CE is mainly descriptive rather than experimental research., Objective: This study examined the impact of CE on the employment outcomes, hours worked per week, and wages of transition-age youth with intellectual and developmental disabilities., Method: The outcomes of transition-age youth participating in a CE intervention were compared to those receiving treatment-as-usual using a randomized controlled trial design., Results: Participants receiving CE were significantly more likely to secure competitive integrated employment than controls who received treatment-as-usual. Participants in the intervention and control conditions earned similar wages. Participants in the control condition worked more hours per week than those in CE., Conclusion: The findings from this study demonstrate the effectiveness of CE to assist transition-age youth with intellectual and developmental disabilities in obtaining competitive integrated employment, but future research is needed to examine factors impacting weekly hours and wages of participants in CE.

Background: Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW., Objective: This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support., Methods: A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted., Results: Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed., Conclusion: RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.

Background: The heuristic potential of work activity-focused territory analyses has yet to be explored in depth. Instead of viewing territories as a product of their actors, the prevailing approaches rely on statistical indicators to view them "from above"., Objective: To understand how work activity acts upon a territory and transforms it, and to discuss what the main indicators used to characterize territories reveal and conceal., Methods: Case studies led on two territories, each in a different industry. One on transportation in a sparsely populated "low density" area; the other in an industrial district, focusing on its "high activity rate" cork industry. In the first case, work activity analyses were led with drivers and mobility designers, including systematic observations and interviews, in the context of an endeavour to redesign a local transport network. In the second case, work activity analyses led among cork stopper choosers were followed with an integrative literature review of indicators about the cork industry and its health impacts., Results: This territory analysis highlights: (i) traces of bus drivers' work activity on the mitigation of inequalities in access to public transportation; (ii) "absent indicators" regarding cork choosers' work activity and its health impacts, stressing the existence of a development agenda for this territory focused on cork processing rather than on those who perform it., Conclusion: Our analysis of territorialization processes through the lens of work activity signposts a path for research-action seeking to associate territorial development with improvements in the working conditions of citizen workers.

Purpose: The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process., Materials and Methods: This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively., Results: Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants' experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants., Conclusion: The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants' return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work.Implications for rehabilitationMulti- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients.VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work processVR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goalsVR service providers should address concurrent or future concerns that could impact on their clients' ability to return to or remain at work.

Background: Unemployment is a structural inequality which raises the risk of premature deaths among people with mental illness., Aims: This study examined whether UK National Health Service (NHS) patients with mental illness get support to find or keep a job because reducing unemployment rates can reduce the risk of premature mortality., Methods: This study analysed recently released data from 54 NHS trusts which randomly sampled patients for a Care Quality Commission survey. This study assessed 11 001 working-age patients with mental illness, of whom 50% are long-term service users (6+ years)., Results: Perceived access to occupational support was poor with 46% of patients who wanted the support saying that they did not get help finding or returning to work. Perceived occupational support for physical co-morbidities needed improvement because 40% of patients with physical co-morbidities did not receive support for physical health needs. Twenty-five per cent said that medication side effects were not discussed, and 24% lacked medication follow-up although 87% of patients found medication beneficial to their mental health. Occupational support significantly benefited overall patient satisfaction to an equivalent extent as the main treatment (i.e. receiving medication and talking therapies), and it was a more consistent predictor of patient satisfaction than talking therapies., Conclusions: Improved access to schemes which reduce unemployment among NHS patients with mental illness is needed (e.g. individual placement and support programmes), although limited availability might be due to funding constraints. As well as addressing unemployment, occupational support should address other risk factors for premature mortality, for example, poverty, stigma, discrimination and social exclusion., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Previous studies have shown that being employed is associated not only with patients' health but also with the outcome of their treatment for severe mental illness. This study examined what influence employment had on improvements in mental health and functioning among patients with common mental disorders who received brief treatment and how patients' diagnosis, environmental and individual factors moderated the association between being employed and treatment outcome., Methods: The study used naturalistic data from a cohort of patients in a large mental health franchise in the Netherlands. The data were obtained from electronic registration systems, intake questionnaires and Routine Outcome Monitoring (ROM). The International Classification of Functioning, Disability and Health (ICF) framework was used to identify potential subgroups of patients. Logistic regression models were used to analyze the relationship between employment status and treatment outcome and to determine how the relationship differed among ICF subgroups of patients., Results: A strong relationship was found between employment status and the outcome of brief therapy for patients with common mental disorders. After potential confounding variables had been controlled, patients who were employed were 54% more likely to recover compared to unemployed patients. Two significant interactions were identified. Among patients who were 60 years of age or younger, being employed was positively related to recovery, but this relationship disappeared in patients older than 60 years. Second, among patients in all living situations there was a positive effect of being employed on recovery, but this effect did not occur among children (18+) who were living with a single parent., Conclusions: Being employed was positively associated with treatment outcome among both people with a severe mental illness and those with a common mental disorder (CMD). The main strength of this study was its use of a large dataset from a nationwide franchised company. Attention to work is important not only for people with a severe mental illness, but also for people with a CMD. This means that in addition to re-integration methods that focus on people with a severe mental illness, more interventions are needed for people with a CMD., (© 2023. The Author(s).)

Participation in work during school is a known predictor of postsecondary employment for transition-age youth with intellectual and developmental disabilities (IDD). Recent research has demonstrated the benefits of work on skill development in major life domains. The purpose of this study was to examine the impact of customized employment on the support needs of youth with IDD with a significant disability compared to those receiving treatment as usual. Findings indicated significant increases in independence in three specific domains for the treatment group versus control on the Supports Intensity Scale-Adult Version, including Home Living, Employment, and Protection and Advocacy. Findings suggest a therapeutic effect of work activities on growth and development in important life domains. Implications for future research, policy, and practice are discussed., (©AAIDD.)

Background: Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD., Aim: To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps., Methods: A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians., Results: Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored., Conclusions: This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.

Background. Current state of knowledge regarding occupational therapy's contribution to chronic pain (CP) management has evolved over the past decade. Yet, has this been transferred to clinical practice? Purpose. Describe the current state of practice of CP management-specific occupational therapy. Method. An online survey was sent to occupational therapists working with CP patients. Findings. Of the 90 respondents (11.9%), 42.2% worked in primary care and 52.2% in secondary care. They reported that their primary role aimed at enabling occupation and providing vocational rehabilitation. The Canadian Model of Occupational Performance and Engagement (CMOP-E) (87.8%), semi-structured interview (86.7%), and education on energy conservation (65.6%) and postural hygiene (60.0%) were the most frequently reported conceptual model, assessment, and intervention methods. Implications. Results illustrate the diversity of current occupational therapy practice in CP management and suggest opportunities for improvement to ensure best practices are adopted, by emphasizing an occupation-based vision of health and well-being.

Purpose: Sociodemographic and structural conditions have consequences for the labor market participation of young persons with disabilities (YPWD) in vocational rehabilitation (VR). As the type of program determines the labor market chances, we analyze the processes of selecting active labor market programs (ALMP) in VR. Which factors determine the allocation to (1) programs in general and (2) moreover, the allocation to specific programs?, Materials and Methods: We conduct logistic (1) and multinomial regression (2) using register data of the German Federal Employment Agency. Besides variables on the micro level, we control for a wide range of structural and organizational influences. The sample comprises VR and employment biographies of 255,009 YPWD accepted to VR between 2010 and 2015. Program participation is restricted to start 180 days after VR acceptance., Results: Sociodemographic factors, like age and the status before entering VR as well as the local apprenticeship market as a structural condition, highly influence the general allocation to ALMP. For the allocation to specific ALMP, sociodemographics (age, education, type of disability, status before entering VR) are highly relevant. Furthermore, structural conditions (regional structure of subsidized vocational training and of the apprenticeship market as well as local work possibilities on a special labor market for PWD) and - to a lesser extent - re-organization processes at the FEA (NEO, VR cohort) are important determinants., Conclusion: (Automatic) paths into VR programs for especially persons with mental disabilities in sheltered workshop are clearly shown. Furthermore, it is somewhat questionable that YPWD participate more often in sheltered workshops in regions where sheltered work possibilities are more common, as well as where NEO was implemented locally; and participate more often in company-external vocational training where VR service providers are commissioned to a greater extent., (© 2023. The Author(s).)

Objective: The aims were to: revise the Work Experience Survey-Rheumatic Conditions (WES-RC- UK), a work assessment listing 142 workplace barriers; investigate content validity, reliability, and concurrent validity; update the accompanying WES-RC and WORKWELL Solutions Manuals; and investigate workplace barriers of people with inflammatory arthritis., Methods: Rheumatology therapists, following vocational rehabilitation (VR) training, assessed participants in the WORKWELL VR trial using the WES-RC. Data were extracted from the WES-RC to identify the frequency of workplace barriers, and from trial baseline questionnaires (e.g., Work Limitations Questionnaire-25 (WLQ-25). Barriers reported by ≤5 participants were considered for removal. WES-RC content validity was assessed by linking to the International Classification of Functioning, Health, and Disability Core Set for VR (ICF-VR). Reliability was assessed using Cronbach's α and concurrent validity by correlating the total number of workplace barriers reported with WLQ-25 scores., Results: WES-RCs were completed with 116 employed participants: 79% women, age 48.72 (SD 9.49) years, and 57% working full-time. The WES-RC was reduced to 121 barriers. Content validity was good, with 73/90 ICF-VR items linked. Cronbach's α = 0.92, that is, suitable for individual use. Concurrent validity was moderate: WLQ-25 (r s  = 0.40). The three most common barriers were Physical Job Demands (100%: e.g., mobility 99%; hand use 74%), Mental, Time, Energy, Emotional Job Demands (91%, e.g., concentration 47%, remembering 41%); Getting Ready for and Travel to Work (87%, e.g., driving 60%)., Conclusion: The WES-RC (UK) has good content validity, reliability, and concurrent validity. The wide range of barriers emphasises the need for biopsychosocial work rehabilitation., (© 2023 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.)