Le soutien à l’emploi de type « IPS » pour les personnes souffrant de troubles mentaux graves : une voie d’avenir pour le Québec?

Jusqu'à tout récemment, trois approches principales ont été utilisées aux États-Unis et au Canada pour favoriser l'intégration au travail des personnes souffrant de troubles mentaux graves : formations préparatoires à l'emploi compétitif, emplois non compétitifs proposés comme substituts à l'emploi compétitif et incitatifs et contraintes visant à atténuer les réticences des employeurs potentiels à embaucher des personnes atteintes de troubles mentaux. Le soutien à l'emploi représente une nouvelle approche qui se répand de plus en plus aux États-Unis et au Canada. Le soutien à l'emploi de type «»Individual Placement and Support », ou IPS (Placement et soutien individuels) dont les principes s'appuient sur les résultats de la recherche évaluative, vise le placement aussi rapide que possible dans un emploi régulier choisi en fonction des intérêts et habiletés du client. Il implique une intégration étroite entre les activités de soutien à l'emploi et les activités cliniques. Les études recensées démontrent qu'il est beaucoup plus efficace que les autres approches évaluées quant à l'obtention d'emplois réguliers. Des études québécoises sont nécessaires pour en évaluer l'efficacité ici. Son implantation au Québec soulèverait plusieurs enjeux notamment au niveau de l'organisation des services et des politiques d'emploi et de la sécurité du revenu. Les politiques actuelles facilitent peu l'intégration en milieu de travail régulier.Individual Placement Support (IPS) for people with severe mental disorders : An approach to favor in Québec? Until recently, three major approaches have been used in the USA and Canada to favor employment integration of people with severe mental disorders : training for competitive employment, non-competitive jobs as a substitute to competitive employment and incentives aiming at alleviating hesitation of potential employers to hire people with mental disorders. Supported employment represents a new approach that is increasingly spreading in the USA as well as in Canada. The principles of IPS, based on results of evaluative research, aim at placing individuals as rapidly as possible in regular jobs according to the interests and skills of the client. It implies close integration of both employment support and clinical activities. Studies reviewed show that this approach is more effective than others assessed regarding obtaining regular employment. Studies conducted in Québec are necessary to evaluate its effectiveness here. Its implementation in Québec raises several questions relative to organization of services and employment and income support policies. Current policies do not favor integration in the regular job market.El apoyo de tipo "IPS" para personas que padecen turbios mentales graves: ¿Una vía del futuro para el Québec? Hasta recientemente tres aproximaciones favorecendo la integración al trabajo de personas que padecen de turbios mentales graves han sido utilisadas en Estados Unidos y Canada: formaciones preparatorias al empleo competitivo, empleos non-competitivos como sustitutos al empleo competitivo y obligaciones para atenuar resistencias de empleadores potenciales a contratar personas que padecen turbios mentales. El apoyo al empleo representa una nueva aproximación propagada a través los Estados Unidos y Canada. Los principios del tipo "Individual Placement and Support", o IPS (empleo y apoyo individual) se basan sobre investigaciones cualitativas y con objeto de contratar un empleo regular el más pronto posible. Implica una integración estrecha entre las actividades del apoyo al empleo y las actividades clínicas. La recención de investigaciones demuestra una eficacia más grande de esta aproximación en la busqueda de empleos regulares. Investigaciones quebequenses estan necesarias para evaluar su eficacia aquí. Su establecimiento en Québec plantea varias cuestiones al nivel de la organisación de servicios y politicas de empleo y de seguridad de ingreso. Las politicas actuales facilitan poco la integración en un medio de trabajo regular.Apoio ao emprego de tipo "IPS" para pessoas que sofrem de problemas mentais graves: caminho promissor para o Quebec? Até recentemente, três principais abordagens foram utilizadas nos Estados Unidos e no Canadá para favorecer a integração ao trabalho das pessoas que sofrem de problemas mentais graves: treinamentos preparatórios para o emprego competitivo, empregos não competitivos propostos como substitutos aos empregos competitivos, e medidas incitativas e coercivas que visam atenuar a resistência dos empregadores potenciais em contratar pessoas que sofrem de problemas mentais. O apoio ao emprego representa uma nova abordagem que se difunde cada vez mais nos Estados Unidos e no Canadá. O apoio ao emprego de tipo "Individual Placement and Support", ou IPS (Orientação e Apoio Individual) cujos princípios apóiam-se nos resultados da pesquisa evolutiva, visa a orientação o mais rápido possível para um emprego normal escolhido em função dos interesses e habilidades do paciente. É necessário haver uma integração estreita entre as atividades de apoio ao emprego e as atividades clínicas. Os estudos examinados demonstram que esta abordagem é muito mais eficaz que as outras avaliadas quanto à obtenção de empregos normais. Para avaliar a eficácia desta abordagem aqui no Quebec, serão necessários outros estudos. Sua implantação no Quebec levantaria várias questões, principalmente com respeito à organização dos serviços, das políticas empregatícias e da segurança social. As políticas atuais facilitam pouco a integração ao meio de trabalho normal

Model of Community, Local, and Regional Food Systems Extension Programming

Community, local, and regional food systems (CLRFS) programming reflects important issues and priorities that intersect with Extension and the sustainability of our food system. CLRFS programming in Extension, however, is still developing slowly while food movements grow nationally. This article describes a CLRFS model and complementary process for conducting listening sessions with Extension professionals and community leaders to develop and enhance CLRFS programming to address critical food system needs. A recommendation for Cooperative Extension is that such a tool may aid CLRFS program potential as an integrated “food, farm, and health” approach for community-level application

Supported employment: Cost effectiveness across six European sites

A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support(IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n5312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment

The nature and correlates of paid and unpaid work among service users of London Community Mental Health Teams

Aims Little is known about how the rates and characteristics of mental health service users in unpaid work, training and study compare with those in paid employment. Methods: From staff report and patient records, 1353 mental health service users of seven Community Mental Health Teams in two London boroughs were categorised as in paid work, unpaid vocational activity or no vocational activity. Types of work were described using Standard Occupational Classifications. The characteristics of each group were reported and associations with vocational status were explored. Results: Of the sample, 5.5% were in paid work and 12.7% were in unpaid vocational activity, (including 5.3% in voluntary work and 8.1% in study or training). People in paid work were engaged in a broader range of occupations than those in voluntary work and most in paid work (58.5%) worked part-time. Younger age and high educational attainment characterised both groups. Having sustained previous employment was most strongly associated with being in paid work. Conclusions: Rates of vocational activity were very low. Results did not suggest a clear clinical distinction between those in paid and unpaid activity.The motivations for and functions of unpaid work need further research

Metabolic reconstructions identify plant 3‐methylglutaconyl‐CoA hydratase that is crucial for branched‐chain amino acid catabolism in mitochondria

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144600/1/tpj13955_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144600/2/tpj13955.pd

The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities

This article was published in BMJ Open following peer review and can also be viewed on the journal’s website at http://bmjopen.bmj.comIntroduction: Housing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions. Methods: A pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy. Ethics and dissemination: Research ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project.This work was supported by a contract from Health Canada administrated by the Mental Health Commission of Canada

Evaluation of a treatment-based classification algorithm for low back pain

Poster Presentation Theme: How can we better translate evidence into clinical practice? Background: Several studies have investigated criteria for classifying patients with low back pain into treatment-based subgroups. A comprehensive algorithm was recently created to translate these criteria into a clinical decision-making guide. This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting each treatment subgroup, more than one treatment subgroup, and none of the treatment subgroups. The reliability of the classification decision was also investigated

Exile Vol. XXXV No. 2

Peter Goes Groovy, by Carolyn Bern (cover) I Hate Poetry by Craig Bagno 1 Truancy by Richard Latimer 2 I ate a Star Last Night by Rory Herbster 3 Delivery by Amy Judge 4 Untitled by Sue McLain 5 Road Signs by Richard Latimer 7-8 Haiku for Me to Possess by Shannon J. Salser 9 Patches by Michael Payne 10 Untitled by Laura Johnson 11 He by Kent Lambert 13 At the Corner Grill by Lynn Pendleton 14-15 Black Licorice by Richard Latimer 16-17 Blue Shirt by Michael Payne 18 ...Loves a Clown by Margaret Dawson 21-24 The Surreal Sonnet by Shannon J. Salser 26 Untitled by Mat Benson 27 Swimming Lessons by Richard Latimer 29 Communion by Amy Judge 30 Beth\u27s Last Funny Joke by Ted Gould 31-35 Hope for a Peaceful Coming Around by Shannon J. Salser 36 Untitled by Laura Johnson 37 A Child\u27s Moment by Peter Witonsky 39 Observation by Rosemary Walsh 40 Untitled by Carolyn Burns 41 To My Sister by Amy B. Judge 43 Ideas In Bloom by Randy Casden 44 Untitled by Deb Tily 45 A Child of Mind by Charles Riedinger 47 Ars Poetica by Rory Herbster 48 Untitled by Mat Benson 49 REPRINTS Dancer by Bradford Cover 52 Skin Deep by Eric Whitney 53-55 Sunset by Chris Rynd 56 Editorial decision is shared equally among the Editorial Board Members -cover page The editors of Exile would like to formally apologize to those contributors whose works were misprinted in the Fall issue. We have reprinted a few of the pieces that contained the most errors. -51 NOTE: An uncredited and untitled piece of artwork appears on page 19. NOTE: Carolyn Bern (cover) Burns (41) and Berns (contributor notes) all appear to refer to the same artist

A dedicated flavin-dependent monooxygenase catalyzes the hydroxylation of demethoxyubiquinone into ubiquinone (coenzyme Q) in \u3ci\u3eArabidopsis\u3c/i\u3e

Ubiquinone (Coenzyme Q) is a vital respiratory cofactor and liposoluble antioxidant. In plants, it is not known how the C-6 hydroxylation of demethoxyubiquinone, the penultimate step in ubiquinone biosynthesis, is catalyzed. The combination of cross-species gene network modeling along with mining of embryo-defective mutant databases of Arabidopsis thaliana identified the embryo lethal locus EMB2421 (At1g24340) as a top candidate for the missing plant demethoxyubiquinone hydroxylase. In marked contrast with prototypical eukaryotic demethoxyubiquinone hydroxylases, the catalytic mechanism of which depends on a carboxylatebridged di-iron domain, At1g24340 is homologous to FADdependent oxidoreductases that instead use NAD(P)H as an electron donor. Complementation assays in Saccharomyces cerevisiae and Escherichia coli demonstrated that At1g24340 encodes a functional demethoxyubiquinone hydroxylase and that the enzyme displays strict specificity for the C-6 position of the benzoquinone ring. Laser-scanning confocal microscopy also showed that GFP-tagged At1g24340 is targeted to mitochondria. Silencing of At1g24340 resulted in 40 to 74% decrease in ubiquinone content and de novo ubiquinone biosynthesis. Consistent with the role of At1g24340 as a benzenoid ring modification enzyme, this metabolic blockage could not be bypassed by supplementation with 4-hydroxybenzoate, the immediate precursor of ubiquinone’s ring. Unlike in yeast, in Arabidopsis overexpression of demethoxyubiquinone hydroxylase did not boost ubiquinone content. Phylogenetic reconstructions indicated that plant demethoxyubiquinone hydroxylase is most closely related to prokaryotic monooxygenases that act on halogenated aromatics and likely descends from an event of ho