British Journal of Occupational Therapy

The purpose of this article is to describe the outcomes of the enhanced intersectoral links (EIL) approach to supporting employment outcomes for individuals accessing a large mental health service.

Based on individual placement and support (IPS) principles, features of EIL included: strong service-level relationships between mental health and local disability employment services; monthly joint meetings to share information; resources to assist mental health clinicians in supporting consumers to access employment services; and provision of training. Programme fidelity was evaluated against IPS principles. Outcome measures included: time from referral to commencement; time to first employment placement; employment placement rate; and duration of employment.

Seventy-nine consumers were referred to the programme. At the close of data collection, 60 participants remained in the programme and 38 of these (63%) had gained at least one employment placement. Average duration of employment was 10.9 weeks. As expected, the EIL programme demonstrated ‘fair’ fidelity against IPS principles. The average time from referral to commencement was 47 days and from commencement to first placement was 81 days.

This project demonstrated how EIL can be implemented in a large mental health service. Further development is required to avoid delays in consumers’ commencement with employment services and support better job tenure.

Individual placement and support is recognized as current best practice vocational rehabilitation for people living with a severe mental illness. This study aimed to provide insight into the consumer perspective of factors that impact the success of an individual placement and support programme in Australia.

A qualitative study was conducted using semi-structured interviews with five participants. Participants were diagnosed with a severe mental illness and were engaged with an individual placement supported employment programme in one area health service in New South Wales, Australia. Data analysis was conducted using grounded theory methods.

Analysis revealed the core category of pushing through, a three-step process that involved experiencing discomfort, learning to adapt, and getting into a groove. Pushing through described the participants' direct experience of individual placement and support, as well as their management of their health and ability to cope with everyday practicalities and relationships while engaged in the programme.

The participants in this study described their experiences of being involved in an individual placement and support programme as being characterized by a process of pushing through. The participants' actions and experiences at each stage of this process provide cues for more tailored support within individual placement and support to meet changing needs.

Engagement in occupation, including employment, is central to mental health recovery. However, evidence demonstrates that people living with mental illness struggle to maintain their employment. The aim of this qualitative study was to gain a rich understanding of the experiences of people living with mental illness who have managed to maintain their employment, and specifically, the strategies they actively choose and use to stay in work.

Semi-structured interviews explored the perspectives of 10 people living with mental illness who were successfully maintaining their employment. Data were analysed using constant comparative analysis.

Participants described maintaining employment through a conscious and active process of using individualised combinations of specific strategies within the broader categories of: identifying and connecting with helpful people; looking after all of me; having a job that fits with who I am; staying motivated; positive reflection and re-framing; and choosing and using strategies in the workplace.

Occupational therapists might better support long-term employment outcomes for people living with mental illness by adopting a more recovery-oriented approach, facilitating people to actively identify, choose and use their own strategies to maintain employment.

People with mental illness, in particular those with psychosis, have more problems related to getting and keeping a job than people in the general population. Clubhouses for people with mental illness are becoming increasingly common, but little is known about clubhouse members and their participation in work and education. The aim of this study was to explore these issues.

A member survey was conducted at one clubhouse in Oslo during February 2015. The data were analyzed with descriptive statistics and logistic regression analysis.

Eighty-nine clubhouse members completed the survey (response rate 55.6%). More than half of the sample had a desire to work, but only 14% participated in ordinary work. Sixty-seven percent of the participants were more than 50 years old, and they were frequent users and long-time members of the clubhouse. Higher age among the participants decreased their chances for participating in work and/or education.

The study indicates that the clubhouse is of importance to its members, and that older members who have a desire to participate in work and/or education may be particularly challenged in their work towards such goals.

Evidence supports the benefits of providing early intervention following non-catastrophic musculoskeletal injury to facilitate successful and sustained resumption of work.

Not returning to work within a few months post-musculoskeletal injury can complicate the recovery and return to work process. A recently developed vocational rehabilitation model attempts to impact where others have failed.

This novel, evidence-based service delivery model aligns well with the theory of planned behaviour and current psychosocial models of work disability, and provides vital support to individuals who find themselves out of work for periods greater than 12 months.

The World Health Organization estimates that 10% of the 35.6 million people worldwide with dementia are aged under 65 years. In an ageing workforce this has implications for employers, employees, and statutory and third sector services. Limited research has been conducted into this emerging global issue.

This systematic review, employing the methodology of the Joanna Briggs Institute, aimed to identify and synthesise the best available qualitative evidence regarding the needs, experiences and perspectives of people with early onset dementia or mild cognitive impairment who were either in employment or wished to gain employment.

Of 69 studies identified, eight met the inclusion criteria. From these, four themes emerged: disease progression and recognition; the emotional impact of change; the employer’s management of the worker; and changes to the worker role.

There are health benefits to the individual with dementia or mild cognitive impairment of continuing to engage in meaningful occupation. Retirement policy changes have resulted in an ageing workforce with concurrent risk factors for dementia. A lack of understanding of reasonable adjustments and sheltered employment opportunities was evident from the literature. This review highlights the potential for occupational therapists to engage this client group in vocational rehabilitation.

In a feasibility randomised controlled trial, training was developed to equip occupational therapists to deliver early specialised traumatic brain injury vocational rehabilitation in the English National Health Service (NHS).

The package was developed by experts in vocational rehabilitation and traumatic brain injury, and included a manual, direct instruction by six trainers and opportunity for mentorship by four therapists. Following training, therapists were interviewed regarding the effectiveness and ease of use of the package. Interviews were analysed using the framework approach.

Five trained therapists were interviewed regarding the package. Results were organised into six categories: (1) motivation to participate in research; (2) impact of the learning environment; (3) changing confidence levels over time; (4) growing appreciation of complexities about the intervention; (5) acceptability of the training package; and (6) lessons for future implementation.

The therapists reported acquiring the knowledge necessary to implement the intervention. The data indicate that the training packages require detailed descriptions of the interventions being taught for local implementation in the NHS and for future research. The training materials are valued by therapists but require time for familiarisation, and reminders from mentors help put training into practice. The therapists have concerns about implementing the interventions within a research context, which researchers should address.

Vocational training and rehabilitation programs are effective in increasing employability and community participation of individuals with intellectual disabilities. Much of the research on effective programming has been conducted in high-income countries with resources targeted at individuals with intellectual disabilities. Although Trinidad and Tobago is a high-income country, there is a dearth of services and resources available to individuals with intellectual disabilities. This article explores stakeholder perspectives on the current status of vocational training and rehabilitation programs for individuals with intellectual disabilities in Trinidad and Tobago.

Participants from diverse groups were identified through snowball sampling. Data were collected in the form of semi-structured interviews conducted in person in Trinidad and Tobago and ranging from 45 to 75 minutes in duration. Interviews followed a loose structure of open-ended questions and the person–environment–occupation model helped inform the questions.

Thirty participants completed the interviews including clients, parents, teachers, principals, non-governmental organization representatives and occupational therapists. Several themes and subthemes emerged including balancing the need for inclusion and segregation, stigma, social policy, issues in current vocational services and independence and expectations.

Vocational services in Trinidad and Tobago face many challenges including resource shortages and meeting the varying needs of clients. They also provide important safe spaces for socialization and acceptance. Resources are needed to improve the level of current services and to help address the competing and at times contradictory goals of differing stakeholders.

Employees with disabilities in supported employment are ageing and, as their retirement from work approaches, it is critical to consider how they perceive their occupational roles might change. They need to consider what activities they choose to engage in, and what service or supports might be necessary to make a successful transition to retirement. The aim of this study was to understand how ageing employees with disabilities perceive retirement, and how their occupational roles might change.

A qualitative study was conducted with 10 participants working in a supported employment service, for whom transitioning from work to retirement was imminent.

Participants perceived retirement to be boring, full of meaningless activities and lonely. It also meant a reduced income that would result in hardship, and a loss of self-esteem at losing their employee role. They had limited knowledge about alternative activities in retirement.

Participants perceived significant barriers to making the transition from employee to retiree. Occupational therapy can provide support with pre-retirement planning and evidence-based strategies such as a client-centred approach, mapping new routines, and training staff and mentors. They could also advocate for changes in service delivery to improve practices that will encourage active ageing for people with disabilities in retirement.