Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial

Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial

Case management training needs to support vocational rehabilitation for case managers and general practitioners: a survey study

<b>Background</b><p></p> The use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR.<p></p> <b>Methods</b><p></p> 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed.<p></p> <b>Results</b><p></p> In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training.<p></p> <b>Conclusions</b><p></p> This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work

If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause?

[Excerpt] The importance of high expectations has been well established as a tool in successful goal achievement and life advancement. The challenge for helpers is ensuring that this pressure of high expectation is initially borne more by rehabilitation staff members who are charged with assisting people with a psychiatric disability to realize success and not merely transferred through as an added burden to the clients they serve

Strategic Assessment of the State of the Science in Research on Employment for Individuals with Disabilities

This report provides a systematic review of recent research (primarily since 2002) related to employment of people with disabilities. It also identifies limitations and gaps in this research. The report reviews research in a variety of areas including supply-side factors influencing employment, employer attitudes and practices, labor market organization, work accommodations, progression of disability benefits and disability management, impact of public policy on employment, and vocational services interventions

ILR Faculty Publications 2012-13

The production of scholarly research continues to be one of the primary missions of the ILR School. During a typical academic year, ILR faculty members published or had accepted for publication over 25 books, edited volumes, and monographs, 170 articles and chapters in edited volumes, numerous book reviews. In addition, a large number of manuscripts were submitted for publication, presented at professional association meetings, or circulated in working paper form. Our faculty's research continues to find its way into the very best industrial relations, social science and statistics journals.Faculty_Publications_2012_13.pdf: 77 downloads, before Oct. 1, 2020

Systematic Review of Supported Housing Literature 1993 – 2008

Supported housing for individuals with severe mental illness strives to provide the services necessary to place and keep individuals in independent housing that is integrated into the community and in which the consumer has choice and control over his or her services and supports. Supported housing can be contrasted to an earlier model called the “linear residential approach” in which individuals are moved from the most restrictive settings (e.g., inpatient settings) through a series of more independent settings (e.g., group homes, supervised apartments) and then finally to independent housing. This approach has been criticized as punishing the client due to frequent moves, and as being less likely to result in independent housing. In the supported housing model (Anthony & Blanch, 1988) consumers have choice and control over their living environment, their treatment, and supports (e.g., case management, mental health and substance abuse services). Supports are flexible and faded in and out depending on needs. Results of this systematic review of supported housing suggest that there are several well-controlled studies of supported housing and several studies conducted with less rigorous designs. Overall, our synthesis suggests that supported housing can improve the living situation of individuals who are psychiatrically disabled, homeless and with substance abuse problems. Results show that supported housing can help people stay in apartments or homes up to about 80% of the time over an extended period. These results are contrary to concerns expressed by proponents of the linear residential model and housing models that espoused more restrictive environments. Results also show that housing subsidies or vouchers are helpful in getting and keeping individuals housed. Housing services appear to be cost effective and to reduce the costs of other social and clinical services. In order to be most effective, intensive case management services (rather than traditional case management) are needed and will generally lead to better housing outcomes. Having access to affordable housing and having a service system that is well-integrated is also important. Providing a person with supported housing reduces the likelihood that they will be re-hospitalized, although supported housing does not always lead to reduced psychiatric symptoms. Supported housing can improve clients’ quality of life and satisfaction with their living situation. Providing supported housing options that are of decent quality is important in order to keep people housed and satisfied with their housing. In addition, rapid entry into housing, with the provision of choices is critical. Program and clinical supports may be able to mitigate the social isolation that has sometimes been associated with supported housing.National Institute on Disability and Rehabilitation Research, Grant # (H133A050006

The Impact of Cognitive Functioning on Daily Occupations for People with Multiple Sclerosis: A Qualitative Study

Background: Cognitive rehabilitation research in multiple sclerosis is ever-developing, but the impact of cognitive difficulties, seen in 40% to 80% of people, on daily occupations is not well known. The aim of this study is to explore the needs of people with MS who have self-reported cognitive deficits. Methods: An exploratory qualitative descriptive research design was used. Data was collected through semi-structured telephone interviews with the participants. Recordings were transcribed and analyzed thematically. Results: Seven participants were recruited (mean age 47). Three themes were developed through associations found in the data. “Neglected symptom” reported the participants’ frustrations around the importance afforded to cognition by health care providers. “Impact on participation in daily occupations” described the everyday impacts of cognitive difficulties. “Adaptations and adjustments to continued participation” reported how the participants manage, despite their difficulties. Conclusion: The findings describe how cognitive difficulties affect individuals with multiple sclerosis and their occupations, as well as the dissatisfaction felt with the progress in and access to cognitive treatment and research. The results indicate the need for occupation-focused interventions in cognition for people with multiple sclerosis that address daily challenges

New Zealand spinal cord impairment action plan 2014–2019

Outlines a vision, purpose, priorities and eight overarching objectives to help ensure the best possible health and wellbeing outcomes for people with spinal cord impairment, enhancing their quality of life and ability to participate in society. Introduction Spinal cord impairment (SCI) is rare but complex. Every year in New Zealand approximately 80 to 130 people are diagnosed with SCI through injury or medical/congenital causes. This affects their lives and those of many others, especially their families and whānau. SCI can occur at any age from birth, during childhood or as an adult. Due to medical advancements most people living with SCI now have a near normal life expectancy, but this brings with it progressive complexity for people and their lifelong self-management