SESAMI study of employment support for people with severe mental health problems: 12-month outcomes

In the context of UK policy to promote employment for people with disability as a means to greater social inclusion, this study investigated how people with severe mental health problems fare in existing supported employment agencies. The aim of the study was to identify factors associated with successful placement in work and to test the impact of working on psychological well-being in this group. One hundred and fifty-five users of six English agencies were followed up for 1 year (2005-2006). Information was collected about their employment status, job-seeking behaviour, perceived obstacles to work, self-esteem and hope, and the employment support received. Eighty-two per cent of those working at baseline were still in work a year later. The support agencies helped 25% of unemployed clients into work, a statistically significant increase in the proportion of clients in employment. Gaining employment was associated with improvements in financial satisfaction and self-esteem. There was a trend towards working half time. People who had been out of work longer were less likely to secure employment. No significant associations were found between getting a job and personal characteristics, the quantity of employment support given, nor the recipient's rating of the support offered. The odds of moving into work were nearly four times higher for those people who visited a job centre prior to the start of the study. Clients of specialist agencies rated their provision more highly than clients of pan-disability agencies. These results demonstrate the benefits of working for this group and support the development of employment services with an individualised, rapid placement approach, linked to job centre advice and expert mental health service input. This is consistent with the Individual Placement and Support model, and highlights in addition the importance of job centres for its implementation in England.     

A Systematic Review of the Benefits of Hiring People with Disabilities

Purpose We reviewed literature on the benefits of hiring people with disabilities. Increasing attention is being paid to the role of people with disabilities in the workplace. Although most research focuses on employers’ concerns, many companies are now beginning to share their successes. However, there is no synthesis of the peer-reviewed literature on the benefits of hiring people with disabilities. Methods Our team conducted a systematic review, completing comprehensive searches of seven databases from 1997 to May 2017. We selected articles for inclusion that were peer-reviewed publications, had a sample involving people with disabilities, conducted an empirical study with at least one outcome focusing on the benefits of hiring people with disabilities, and focused on competitive employment. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Results Of the 6176 studies identified in our search, 39 articles met our inclusion criteria. Findings show that benefits of hiring people with disabilities included improvements in profitability (e.g., profits and cost-effectiveness, turnover and retention, reliability and punctuality, employee loyalty, company image), competitive advantage (e.g., diverse customers, customer loyalty and satisfaction, innovation, productivity, work ethic, safety), inclusive work culture, and ability awareness. Secondary benefits for people with disabilities included improved quality of life and income, enhanced self-confidence, expanded social network, and a sense of community. Conclusions There are several benefits to hiring people with disabilities. Further research is needed to explore how benefits may vary by type of disability, industry, and job type.     

Disability at Work: A Look Back and Forward

Purpose This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, linking the disparities to employee attitudes. Methods Analyses use the 2006 General Social Survey to connect disability to workplace disparities and attitudes in a structural equation model. Results Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Conclusion Prior research and the present findings show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.     

Nutrition knowledge and influence on diet in the carer–client relationship in residential care settings for people with intellectual disabilities

People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in ‘making everyday food choices’ (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.     

Influence of Health on Job-Search Behavior and Re-employment: The Role of Job-Search Cognitions and Coping Resources

Purpose To investigate the influence of poor health on job-search behavior and re-employment, and the mediating role of job-search cognitions and coping resources. Methods A prospective study was conducted among unemployed persons receiving social security benefits in the Netherlands (n = 510). Self-rated health, self-esteem, mastery, job-search cognitions, and the intention to search for a job were measured at baseline. Logistic regression analysis was used to investigate determinants of job-search behavior during a follow-up period of 6 months. Cox proportional hazards analysis was used to investigate the influence of health, job-search cognitions and coping resources on re-employment during a mean follow-up period of 23 months. Results Persons with poor health were less likely to search for paid employment (OR 0.58, 95 % CI 0.39–0.85) and were also less likely to find paid employment (HR 0.58, 95 % CI 0.39–0.89). Persons with a positive attitude toward job-search, high perceived social pressure to look for a job, high job-search self-efficacy and high job-search intention were more likely to search actively and also to actually find paid employment. Adjustment for job-search cognitions and coping reduced the influence of health on active search behavior by 50 % and on re-employment by 33 %. Conclusions Health-related differences in job-search behavior and re-employment can be partly explained by differences in coping, job-search attitude, self-efficacy, and subjective norms towards job-search behavior. Measures to reduce the negative impact of poor health on re-employment should address the interplay of health with job-search cognitions and coping resources.     

Preparing young adults with disability for employment

Young people with disabilities are often excluded from the labour market. The present paper describes an evaluation of an innovative 2‐year pilot initiative called Vocational Opportunities in Training for Employment (VOTE) implemented in Northern Ireland to provide employment training and support for vulnerable young adults with a wide range of disabilities. The principal aims of the study were to assess the impact of the new service in the extent to which: (1) it had created and developed training and employment opportunities for young people; and (2) promoted inclusive working partnerships. Documentary analysis was used as a basis for describing and assessing the project objectives in combination with face‐ to‐face interviews with a small number of key stakeholders. A total of 122 young people participated in the initiative in the pilot period, during which time 160 qualifications were obtained. Key stakeholders expressed positive views about the initiative, and in particular, its therapeutic benefits and the extent of interagency working and shared learning. The VOTE initiative achieved considerable success in enabling a significant proportion of young adults to engage in society by developing social and employment skills, and by improving their employment opportunities and prospects. Factors critical to the continued success of this and similar initiatives include: the close involvement of parents; addressing the concerns of local employers; the sympathetic treatment of workplace issues; and effective partnership working.     

Factors Affecting the Acceptance of People with Disabilities at Work: A Literature Review

Purpose A lack of social acceptance by non-disabled co-workers is often the reason why employees with disabilities fail to stay in regular organizations for sustained periods. The aim of the study is to present a coherent review of the extant literature on factors affecting the acceptance of people with disabilities in regular employment. Method We conducted a search of the electronic databases PsychINFO and Web of Science (period: 1996–2011) supplemented with a search for additional relevant articles by means of cross-referencing. In total 48 articles were selected, coded and analyzed by three coders into three overarching themes. Results The analysis of included articles shows that the acceptance of employees with disabilities is influenced by three main variable groups: characteristics of co-workers, of the persons with disabilities and of the employers/organizations. Most studies present factors that influence co-workers’ or employers’ attitudes toward employees with disabilities such as demographic variables. Conclusion Although, recent research has started to accumulate findings on factors that affect the acceptance of employees with disabilities, many gaps remain in the understanding of the concept of acceptance and its relation to the employment of people with disabilities.     

Evaluating the effects of a multicomponent support service for people recently diagnosed with dementia and their carers: A qualitative study

Introduction

Although prior research has provided an understanding of the needs of people living with dementia (PLWD) and their carers, less is known about how tailored multicomponent interventions impact their lives. This study explored the effect of providing ongoing support to people who had been recently diagnosed with dementia and to their carers.

Methods

We conducted interviews with a convenience sample of key stakeholders: 11 interviews with people who had dementia and their familial carers (n = 14) and six interviews with staff and other practitioners involved with the service (n = 13). Inductive thematic analysis was performed on the data.

Results

Four themes were developed: the service as a source of respite, peer support, activities as facilitators of emotional wellbeing, and social support. The service was well-respected, credible, and trusted and was highly valued by practitioners, clients, and carers. It had a clear role in supporting PLWD and their carers. Peer support provided through the service contributed to greatly reducing self-reported carer burden.

Conclusion

Recommendations arising from this study include offering holistic services to PLWD and their carers, developing activities for men, raising awareness of services among practitioners working with PLWD, and improving partnerships between services and agencies working with older people.

Patient or Public Contribution

Service users were consulted on the themes generated from the data and were asked to provide feedback to help guide the interpretation of the data and ensure this reflected their views and experiences.     

Work Environment-Related Factors in Obtaining and Maintaining Work in a Competitive Employment Setting for Employees with Intellectual Disabilities: A Systematic Review

Background People with an intellectual disability value work as a significant part of their lives, and many of them want to participate in regular paid employment. Current estimates show that the number of people with ID who have some form of paid employment are very low, ranging from 9 to 40 % across different countries, despite legislations. This review examines papers published in the past 20 years in an attempt to answer the following research question: ‘What work environment-related factors contribute to obtaining or maintaining work in competitive employment for people with an intellectual disability?’ Method The databases of PubMed, PsycINFO, CINAHL, Embase and Web of Science were searched for relevant papers published between 1993 and 2013. All papers were independently screened by two researchers. Methodological quality of the studies was evaluated, and data on work environment-related factors stimulating employment for people with intellectual disabilities were extracted and grouped into categories. Results A total of 1932 articles were retrieved. After extensive screening for relevance and quality, 26 articles were included in this review. Four themes/categories with work environment-related factors that could influence work participation were distinguished. Five studies were conducted on employers’ decisions and opinions. Eight focused on job content and performance, and eight on workplace interaction and culture. Five studies evaluated support by job coaches. Conclusion Despite ongoing legislation to promote participation of people with intellectual disabilities in the paid workforce, research in this area is still extremely scarce. In the past 20 years, very few studies have focused on work environment-related factors that can enhance competitive work for people with intellectual disabilities. This review shows that relevant work environment-related factors for obtaining and maintaining work in competitive employment include supporting the employers by paying specific attention to: employer’s decisions, job content, integration and work culture and job coaches.     

What Types of Jobs Do People with Disabilities Want?

Introduction Do non-employed people with disabilities want to work, and if so, what types of jobs do they want? Researchers seeking to explain the low employment rate among people with disabilities have focused primarily on skill gaps, employment disincentives from disability income, accommodation mandates, and (to a lesser extent) employer attitudes and unwelcoming corporate cultures. There has been little attention paid to the attitudes of non-employed people with disabilities. Methods This paper uses the 2006 General Social Survey, a representative national survey of US adults that has disability information and a special supplement on worker preferences, to examine the above question. Results We find that, relative to their non-disabled counterparts, non-employed people with disabilities are (a) as likely to want a job but less likely to be actively searching, (b) as likely to have prior job experience, and (c) similar in their views of the importance of income, job security, and other valued job characteristics. The results, which vary little by type of impairment, indicate that the low employment rate of people with disabilities is not due to their reluctance to work or different job preferences. Conclusion Combined with evidence that a large share of new jobs can be performed by people with disabilities, the findings point toward the value of dismantling barriers to employment facing many people with disabilities.     

Sources of well-being and commitment of staff in the Australian Disability Employment Services

This study examined the role of working conditions in predicting the psychological health, job satisfaction and organisational commitment of personnel responsible for helping people with disabilities gain employment in the mainstream Australian labour market. The working conditions were assessed using two theories: the Job Strain Model (job demand, social support and job control) and Psychological Contract Theory (unwritten reciprocal obligations between employers and employees). In the case of the Job Strain Model, the generic dimensions had been augmented by industry-specific sources of stress. A cross-sectional survey was undertaken in June and July 2005 with 514 staff returning completed questionnaires (representing a response rate of 30%). Comparisons between respondents and non-respondents revealed that on the basis of age, gender and tenure, the sample was broadly representative of employees working in the Australian disability employment sector at that time. The results of regression analyses indicate that social support was predictive of all of the outcome measures. Job control and the honouring of psychological contracts were both predictive of job satisfaction and commitment, while the more situation-specific stressors--treatment and workload stressors--were inversely related to psychological health (i.e. as concern regarding the treatment and workload stressors increased, psychological health decreased). Collectively, these findings suggest that strategies aimed at combating the negative effects of large-scale organisational change could be enhanced by addressing several variables represented in the models--particularly social support, job control, psychological contracts and sector-specific stressors.     

Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work

In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work. In this article we draw on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however, 'natural supports' of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. These themes might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.     

Psychiatric disabilities and the Americans with Disabilities Act: implications for policy and practice

People with psychiatric disabilities are often victims of job discrimination. The Americans with Disabilities Act (ADA) of 1990 makes it very clear that job discrimination based on a psychiatric impairment is illegal. The Equal Employment Opportunity Commission (EEOC) reports that psychiatric disability is one of the leading causes why persons file discrimination complaints. Given this situation, an analysis is offered of what constitutes a psychiatric disability under the ADA. An overview, an analysis, and examples of the kinds of accommodations employers can be expected to provide people with psychiatric disabilities are offered. The policy and practice implications of the employment provisions (Title I) in the area of psychiatric disabilities are presented.     

A Test of the Occupational Matching Hypothesis for Rehabilitation Clients with Severe Mental Illness

Purpose This study compared job matching rates for clients with severe mental illness enrolled in two types of employment programs. Also examined was the occupational matching hypothesis that job matching is associated with better employment outcomes. Methods The study involved a secondary analysis of a randomized controlled trial comparing evidence-based supported employment to a diversified placement approach. The study sample consisted of 187 participants, of whom 147 obtained a paid job during the 2-year follow-up. Jobs were coded using the Dictionary of Occupational Titles classification system. Match between initial job preferences and type of job obtained was the predictor variable. Outcomes included time to job start, job satisfaction, and job tenure on first job. Results Most occupational preferences were for clerical and service jobs, and most participants obtained employment in these two occupational domains. In most cases, the first job obtained matched a participant’s occupational preference. The occupational matching hypothesis was not supported for any employment outcome. The occupational matching rate was similar in this study to previous studies. Conclusions Most clients who obtain employment with the help of evidence-based supported employment or diversified placement services find jobs matching their occupational preference, and most often it is a rough match. Occupational matching is but one aspect of job matching; it may be time to discard actuarial classification systems such as the Dictionary of Occupational Titles as a basis for assessing job match.     

Employment advice in primary care: a realistic evaluation

Every organisation in the UK is affected by mental distress and ill‐health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.     

Young people supporting parents with mental health problems: experiences of assessment and support

The explosion of interest in young people as carers over the last decade and a half conceals the fact that there are still no reliable estimates of the number of young people with caregiving responsibilities. This is even more problematic in circumstances where the 'looked after' person has a mental health problem. In this study, we reflect on what can be done to identify, assess and support young people in these circumstances. We draw on selected findings from a study that has been examining the constituents of good assessment practice in work with family carers supporting relatives with mental health problems. The study embraces different carer groups but this paper concentrates on the experiences of young carers at one study site where Barnardo's and partner organisations had developed a joint initiative targeting young people who are looking after parents and relatives with mental health problems. Following a review of the literature about young people as carers, the paper describes how Barnardo's worked to support them through its young carers projects. Based on face-to-face interviews with the young people (N = 10) caring for a mother with mental health problems, the main part of the paper provides an account of how they talk about, make sense of and evaluate the support they have received through this combined initiative. The findings underscore the value of one particular young carers project, and provide clues about what lessons may be transferable to other similar projects.     

Getting Hired: Successfully Employed People with Disabilities Offer Advice on Disclosure, Interviewing, and Job Search

Introduction Many people with disabilities want to work, but face employment barriers that have resulted in dismal employment rates. Successfully employed people with disabilities have valuable experience that can help others seeking employment, yet research literature provides little information about their strategies for discussing disabilities with employers and negotiating the hiring process. Method In five focus groups, 41 people competitively employed for at least 5 years discussed employment experiences related to their varied disabilities. The sample excluded people in disability-related jobs or self-employed. Data were coded and analyzed using a grounded theory method. Results Disclosure and discussion decisions were influenced by the nature of disability (visible, hidden, stigmatized, multiple), whether and when people needed accommodations, and the perceived “disability-friendliness” of organizations. Qualitative data analysis suggested guidelines for whether, when, and how to discuss disability, while acknowledging the complexity of decision-making depending on workplace culture and personal choices. Interview strategies included ways to emphasize strengths, gather information about duties and work environment, handle inappropriate questions, and address unspoken employer concerns. Participants gave disability-specific advice to help job-seekers balance their abilities and interests, and use networking and other approaches to find favorable opportunities. Concluding that people with disabilities must work harder than others to get a job, they described approaches and tools to help others achieve success. Conclusions Findings suggest approaches to assist job-seekers to make decisions about disclosing or discussing their disability, present themselves in a straight-forward, disability-positive manner, and find satisfying work based on their skills and interests.     

Factors Affecting Employment Outcomes for People with Disabilities Who Received Disability Employment Services in Taiwan

Purpose. One of the most important rehabilitation goals is to return people with disabilities to paid employment. The purposes of this study were (1) to explore employment status and (2) to identify factors that may affect the employment outcomes of people with disabilities who received Disability Employment Services (DES). Methods. A retrospective study was conducted on clients who commenced and closed DES between January 2008 and December 2010 in a metropolitan city in Taiwan, using the files from the National Vocational Rehabilitation Services Documentary System. Results. Sixty-nine percent (1,684 out of 2,452) of the clients in this study were engaged in paid employment after receiving DES. Logistic regression analyses indicated that clients with no psychiatric disability or mild impairment and with useful vocational qualifications, typical work experience, more post-employment services, and less pre-employment services were associated with a higher rate of successful employment outcomes. Conclusion. This study provides empirical evidence of the association between person- and DES-related factors and the employment outcomes of people with disabilities. Future improvements in health, school-to-work transition services, and vocational rehabilitation for people with disabilities should place more emphasis on providing work-based work experience, professional vocational training, access to college/professional education, career exploration, effective supported employment services, and other post-employment services.