Expectations, visions and sense of empowerment: in the face of a vocational rehabilitation process for people with psychiatric disabilities

The aim of this study is to reveal the meaning some people with psychiatric disabilities assigned to important experiences related to long periods of participation restrictions owing to unemployment and sick leave. The data comprise open-ended interviews with eight informants. A hermeneutic approach together with a comparative analysis was used to analyze the data. The results showed six types of mechanisms important for the outcome of the rehabilitation process: support, understanding, time, control, self-image and vision of the future. Our results indicate that environmental factors such as experience of support and understanding of professionals and time-efficacy seemed to have a great effect on the individuals' attitudes concerning the activities and measures they expected to carry out during their coming rehabilitation. These experiences seemed to affect their belief in their own abilities, their sense of control, and their belief in successful performance. Theories about empowerment closely related to social emotions like pride and shame are also discussed in an attempt to deepen the understanding of the studied phenomena

Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv : brukarens och de professionellas perspektiv

Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv - brukarens och de professionellas perspektiv. Örebro, Studies from the Swedish Institute of Disability Research No 34, 107 pp.The overall aim of this dissertation is to (1) describe and analyse perceived barriers and opportunities from the perspective of the individual receiving vocational rehabilitation services as a result of unemployment and psychiatric disability (2) describe and analyse perceived barriers and opportunities in services for unemployed people with psychiatric disabilities from the perspective of professionals working in the area of vocational rehabilitation and (3) utilize empowerment theory to explore and develop a deeper understanding of the experiences and perceptions described by these individuals and professionals. The data consists of open-ended interviews with service users and professionals’ working in the area of vocational rehabilitation. A content analysis together with an interpretive approach was used to analyse the data. The results revealed that support and the psychosocial work environment are important factors that influence the rehabilitation process for the individual. These factors can facilitate opportunities to develop skills in contacts with fellow employees, increase belief in one’s own abilities, and can contribute to the achievement of specified goals. These factors are also seen as supporting empowerment and active participation in the rehabilitation process. However, the results also revealed that the rehabilitation process is negatively effected by environmental factors to which the professionals and their organizations contributed. Barriers related to interagency collaboration contributed to barriers to a successful rehabilitation for the individual. The professionals were consistent in what they viewed as enabling factors in the rehabilitation process but the results also showed how difficult it was for the service system to create a rehabilitation context in line with their knowledge and experience.Keywords: Psychiatric disabilities, vocational rehabilitation, empowerment, interagency collaboration, support system

Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv : brukarens och de professionellas perspektiv

Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv - brukarens och de professionellas perspektiv. Örebro, Studies from the Swedish Institute of Disability Research No 34, 107 pp.The overall aim of this dissertation is to (1) describe and analyse perceived barriers and opportunities from the perspective of the individual receiving vocational rehabilitation services as a result of unemployment and psychiatric disability (2) describe and analyse perceived barriers and opportunities in services for unemployed people with psychiatric disabilities from the perspective of professionals working in the area of vocational rehabilitation and (3) utilize empowerment theory to explore and develop a deeper understanding of the experiences and perceptions described by these individuals and professionals. The data consists of open-ended interviews with service users and professionals’ working in the area of vocational rehabilitation. A content analysis together with an interpretive approach was used to analyse the data. The results revealed that support and the psychosocial work environment are important factors that influence the rehabilitation process for the individual. These factors can facilitate opportunities to develop skills in contacts with fellow employees, increase belief in one’s own abilities, and can contribute to the achievement of specified goals. These factors are also seen as supporting empowerment and active participation in the rehabilitation process. However, the results also revealed that the rehabilitation process is negatively effected by environmental factors to which the professionals and their organizations contributed. Barriers related to interagency collaboration contributed to barriers to a successful rehabilitation for the individual. The professionals were consistent in what they viewed as enabling factors in the rehabilitation process but the results also showed how difficult it was for the service system to create a rehabilitation context in line with their knowledge and experience.Keywords: Psychiatric disabilities, vocational rehabilitation, empowerment, interagency collaboration, support system

Implementation of individual placement and support in a first‐episode psychosis unit : A new way of working

The aim of this study is to explore the IPS implementation process in a first‐episode psychosis (FEP) mental health service team in Sweden. More specifically, the study explores how integration processes and critical situations are perceived over time by team members who originated from two diverse welfare organizations. A serial interview design was used (initially, at 6 and 12 months) to describe experiences of 16 team members. Material was analyzed using a constant comparison grounded theory approach. Team members dealt with the ambivalence of sharing mental health information, and whether the new way of working was a risk or benefit for users. They gradually learned new perspectives and knowledge, built trust and shared common views. After a year, the team workload perceived reduced and became person‐centred. Some members described remaining unclear roles and requested further support. Negotiated goals for integration and early knowledge transfer are critical. Organizational change and trusting team relationships have to be facilitated. Anticipated gains of integration should be clearly described and discussed early on, and continuous support for sustainability should be considered. This study confirmed the importance and potential of integrating IPS into FEP teams.Stöd av en donation av MISA.</p

Cultural Change of Applying User Involvement for Improving Healthcare Quality : A Review of the Impact on Attitudes, Values and Assumptions among Healthcare Professionals and Users

Purpose: The purpose of this study is to provide a review of the impact on culture (attitudes, values and assumptions) among both healthcare professionals, as well as users, when involving users for improving quality in healthcare. Methodology/Approach: The paper is based on an extensive, narrative literature review considering studies that included professional’s and users experiences of user involvement in quality improvement. The included articles were analyzed using an interpretive, along with a deductive, approach according to a theoretical framework. Findings: The results indicate that there is currently limited research focusing on the impact of user involvement in quality improvement processes regarding professionals’ and users’ attitudes, values and/or assumptions. The articles identified during the study provides situations and statements, during the process of development, which can be interpreted as change in the culture. Although few articles specifically draw conclusions on user involvement as a “tool” for cultural change, the authors interpret several findings which strengthens that theory. Research Limitation/implication: Research published in other databases could have been missed. The authors have tried to avoid this by using a snowball method reading references in identified articles. Originality/Value of paper: The review provides a platform for both future research and the development of current practice within the area. There have been literature reviews showing obstacles and enablers when using patients, users and relatives in quality improvement work, but few which investigates cultural change

Supported Education in a Swedish Context : Opportunities and Challenges for Developing Career-Oriented Support for Young Adults with Mental Health Problems

Young adults experiencing mental health problems often need both individual support and educational accommodations to successfully complete their studies. Recent research also points to the need for career-related, educational services in a labor market that increasingly demands formal education or training. The aim of this study was to investigate the development of supported education services in Sweden, in relation to pursuing educational and vocational goals. Interviews were conducted with a broad sample of stakeholders who are currently developing supported education services, as well as young adults utilizing educational support. The results suggest a number of key factors for accommodating the needs of these students which include, in addition to basic academic, mental health and individual supports, attention to economic challenges, social contexts and improved mental health literacy for educational actors. The results additionally substantiate the relevance of educational supports to long-term vocational goals when providing employment support services

Integrating Interventions That Can Support a Career-Oriented Recovery for Young Adults : Building on the Supported Education Knowledge Base

Young adults experiencing mental health problems are less educated than their peers, putting them in a more vulnerable position for employment and career possibilities. While Supported employment models have been widely implemented, educational supports may be necessary in order to contribute to longer term and sustainable employment. The aim of this study was to describe the state of current research regarding Supported education services for individuals with mental health problems, with a particular focus on studies that address both educational and vocational goals. A scoping review of articles published between 2000 and July 2020 was conducted. Eight databases were searched, titles/abstracts and full-text articles were reviewed for inclusion. The results, which built on 56 included articles, were analysed both descriptively and thematically. The results suggest that the focus in the literature has primarily been on adapting and implementing models for the needs of different populations and contexts. Many of these build on integrated models focusing on both vocational and educational needs. Despite addressing varied populations and working in varied contexts, it is possible to identify a number of essential components when delivering educational support. The review suggests a need to look at work and studies as equally important from a career development perspective. The knowledge base developed through studying supported education services and the educational components of newly emerging services, can contribute to the further development of integrated models for young adults

Navigating the gap between policy and practice : frontline and second-tier management perspectives and strategies in offering vocational and educational support to young adults with mental health problems

Mental health problems among young adults often lead to obstacles to completing higher education and becoming established in the labour market. It is important to offer support that can help these individuals realize educational and vocational goals in order to become self-sufficient and achieve social inclusion. Individual Placement and Support (IPS) and Supported Education (SEd) are two methods developed for supporting people with mental health problems in attaining competitive employment and reaching educational goals. These methods have not been widely implemented in Sweden, therefore making it interesting to study management perspectives in organizations offering IPS/SEd. The study aimed to explore the reasoning and strategies managers described in offering vocational and educational support to young adults with mental health problems. This study is based on 12 qualitative interviews with managers from six units in Sweden offering support through IPS/SEd. Results show a variety in interpretation of legislation and responsibility for young adults with mental health problems. The managers were positioned between policy and practice, having to navigate between the organizational restraints and their professional assessment in offering this support and pushing traditional boundaries in prioritizing long-term individual goals over short-term economic and political considerations. These managers demonstrate the possibilities for how IPS/SEd can be implemented and made to fit different organizational contexts, even within a highly sectorized welfare system as in Sweden. However, the methods might need to be adapted and adjusted to not only fit local organizational restraints, but also to fit into the Swedish welfare system.

Individual Placement and Support for persons with alcohol and drug addiction in a Swedish context (IPS-ADAS) : study protocol for a randomised controlled trial

Background: Employment is a vital source for experiencing well-being and lowering the risk of long-term social marginalisation and poverty. For persons with alcohol and drug addiction, it may also improve sobriety. However, the unemployment situation for this group reflects the knowledge gap in effective interventions to support employment. While Individual Placement and Support (IPS) is recognised as evidence-based supported employment for those with serious mental health problems, no scientific evidence for the target group of addiction exists to date. The aim of the present IPS for Alcohol and Drug Addiction in Sweden (IPS-ADAS) trial is to study whether IPS has an effect on gaining employment for this group. Methods: The IPS-ADAS trial is a multisite, pragmatic, parallel, and single-blinded, superiority randomised controlled trial (RCT). Participants (N = 330) will be randomly assigned (1:1) and participate in IPS plus treatment as usual within Addiction Services (IPS + TAU) or Traditional Vocational Rehabilitation (TVR) available plus TAU (TVR + TAU) for 12 months. The principle of intention-to-treat (ITT) will be applied. The hypothesis is that a significantly larger proportion of IPS + TAU participants will be employed for &gt; 1 day (primary outcome), reach employment sooner, work more hours and longer periods of time, and have a higher income as compared to TVR + TAU participants at 18-month follow-up. We further anticipate that those who benefit from IPS + TAU will use less alcohol and drugs, experience better health, and use less care and support, including support from the justice system, in comparison to TVR + TAU participants, at 6, 12, and 18 months. A supplementary process evaluation, using the IPS Fidelity Scale (25 items) and adhered interviews will address delivery and receipt of the IPS as well as contextual hinders and barriers for coproduction and implementation. Working age (18–65), willingness to work, unemployment, participation in an information meeting about the RCT, treatment for addiction diagnosis, and being financially supported by welfare, constitute eligible criteria. Discussion: A primary study on the effectiveness of IPS on employment for the new target group of addictions will add to the international IPS knowledge base and inform national policy to include the underrepresented group in working life. Trial registration: WHO International Clinical Trials Registry Platform ISRCTN10492363. Registered on 14 August 2023.