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      Improving vocational recovery among people with psychosis: a two-pronged approach

      research-article
      Niall Turner , Tara Nesbitt , Felicity Fanning , Mary Clarke
      Irish Journal of Occupational Therapy
      Emerald Publishing
      Occupational therapy, Psychosis, Schizophrenia, Job retention, Vocational recovery

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          Abstract

          Purpose

          This paper aims to investigate the feasibility of conducting research on a two-pronged vocational intervention for people with first episode psychosis. The paper also aims to empirically examine the impact of a two-pronged vocational intervention for people with first episode psychosis by determining what effect, if any, introducing a two-pronged vocational intervention to an early intervention for psychosis service (EIPS) has on vocational outcomes using a prospective follow-up design. The approach consisted of supported employment (individual placement and support, IPS) for participants without a productive role and a job retention programme for those employed or studying.

          Design/methodology/approach

          Between 2010 and 2013, a supported employment specialist joined an EIPS where occupational therapy was available to all attenders. The appropriate intervention was determined by the occupational therapist on the team. Participants were interviewed at baseline and one follow-up. Ethical approval was attained. The Individual Placement and Support Fidelity Scale was used to ensure the quality of IPS implementation.

          Findings

          In total, 39 (20 men, 19 women) consented; 21 (54 per cent) of these participants were unoccupied; 18 (46 per cent) had a productive role; 87 per cent ( n = 34) were followed up. The mean length of follow-up was 18 months. At follow-up, 50 per cent ( n = 10) of unoccupied participants had attained a productive role, and 17 of the 18 participants had retained their productive role. Overall, participants were found to have spent an average of 62 per cent of the follow-up period in a productive role.

          Research limitations/implications

          Rates of vocational recovery among people affected by psychosis may be enhanced by a two-pronged approach that allows for the persons individual work circumstances to be taken into account.

          Originality/value

          This study highlights the impact of a two-progroned vocational intervention for people with first episode psychosis in Ireland. It is the first study of its kind to be published in the Republic of Ireland and the first world-wide to include a job retention element in its design.

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          Most cited references38

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          The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial.

          The value of the individual placement and support (IPS) programme in helping people with severe mental illness gain open employment is unknown in Europe. Our aim was to assess the effectiveness of IPS, and to examine whether its effect is modified by local labour markets and welfare systems. 312 patients with severe mental illness were randomly assigned in six European centres to receive IPS (n=156) or vocational services (n=156). Patients were followed up for 18 months. The primary outcome was the difference between the proportions of people entering competitive employment in the two groups. The heterogeneity of IPS effectiveness was explored with prospective meta-analyses to establish the effect of local welfare systems and labour markets. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, with the number NCT00461318. IPS was more effective than vocational services for every vocational outcome, with 85 (55%) patients assigned to IPS working for at least 1 day compared with 43 (28%) patients assigned to vocational services (difference 26.9%, 95% CI 16.4-37.4). Patients assigned to vocational services were significantly more likely to drop out of the service and to be readmitted to hospital than were those assigned to IPS (drop-out 70 [45%] vs 20 [13%]; difference -32.1% [95% CI -41.5 to -22.7]; readmission 42 [31%] vs 28 [20%]; difference -11.2% [-21.5 to -0.90]). Local unemployment rates accounted for a substantial amount of the heterogeneity in IPS effectiveness. Our demonstration of the effectiveness of IPS in widely differing labour market and welfare contexts confirms this service to be an effective approach for vocational rehabilitation in mental health that deserves investment and further investigation.
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            Rates and correlates of employment in people with schizophrenia in the UK, France and Germany.

            Little is known about international variations in employment rates among people with schizophrenia or about the factors associated with employment in this disorder. To describe employment patterns and the variables associated with working in an international sample of people with schizophrenia. An analysis was made of baseline data from the European Schizophrenia Cohort study, a 2-year investigation of people with schizophrenia in contact with secondary services and living in France, Germany and the UK (n=1208). Participants were working in all sections of the job market. People who had a degree, were living with their families or had experienced only a single episode of illness were more likely to be working. A continuous illness course, more severe non-psychotic symptoms and drug misuse reduced the odds of employment. There were large variations between centres in employment rates, which were highest in the three German study sites. These differences persisted after adjustment for individual characteristics. Local social contexts may be as important as individual or illness-related factors in explaining employment status.
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              • Record: found
              • Abstract: found
              • Article: not found

              The mental health benefits of employment: Results of a systematic meta-review.

              The literature on mental health in the workplace largely focuses on the negative impacts of work and how work may contribute to the development of mental disorders. The potential mental health benefits of employment have received less attention.
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                Author and article information

                Contributors
                Journal
                IJOT
                10.1108/IJOT
                Irish Journal of Occupational Therapy
                IJOT
                Emerald Publishing
                2398-8819
                2398-8819
                04 June 2019
                28 November 2019
                : 47
                : 2
                : 114-123
                Affiliations
                [1]St John of Gods, Dublin, Ireland
                [2]Detect, St John of Gods, Dublin, Ireland
                Author notes
                Niall Turner can be contacted at: niall.turner@gmail.com
                Article
                627477 IJOT-12-2018-0023.pdf IJOT-12-2018-0023
                10.1108/IJOT-12-2018-0023
                9adeadb4-2f17-4d9b-84f5-6913d9eee914
                © Niall Turner, Tara Nesbitt, Felicity Fanning and Mary Clarke.

                Published in Irish Journal of Occupational Therapy. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

                History
                : 05 December 2018
                : 21 March 2019
                : 10 April 2019
                : 11 April 2019
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 37, Pages: 10, Words: 5252
                Categories
                research-article, Research paper
                cat-HSC, Health & social care
                cat-HEDU, Health education
                Custom metadata
                Web-ready article package
                Z
                Yes
                Yes
                JOURNAL
                excluded

                Health & Social care
                Psychosis,Job retention,Vocational recovery,Schizophrenia,Occupational therapy

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