Supported work: An innovative approach to the vocational rehabilitation of persons who are psychiatrically disabled.

Presents a model for the vocational rehabilitation of persons with severe psychiatric disability (SPD) that helps clients find private-sector jobs and provides support to both client and employer. Preliminary data on a supported work program in which 152 Ss with SPD participated suggest that the model is effective in returning individuals with SPD to competitive employment. Close monitoring of a subset of 34 Ss during the 1st yr of the program revealed that Ss whose disabilities were identified in adolescence (age 19 yrs or younger) were almost twice as likely to be employed as those with an adult onset. Clinical stability and level of motivation also appeared to affect program outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Disclosure Conundrum: How People With Psychiatric Disabilities Navigate Employment.

The vocational rehabilitation and mental health literatures usually urge people with psychiatric disabilities to disclose their disability at work. Reasons for preferring disclosure include the opportunity to invoke rights conferred by the Americans with Disabilities Act of 1990, the risk of losing federal disability benefits when earning a higher income, and the belief--held by many professionals--that people with psychiatric disabilities will experience permanently debilitating symptoms. However, a newer model of recovery from psychiatric disability challenges these assumptions. A qualitative study of people with psychiatric disabilities explored these issues. The participants were current or former recipients of social security benefits provided to persons with significant disabilities. Participants described complex situations around employment and disclosure, which were more difficult to resolve than disclosure advocates have recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Induction of tolerance via the respiratory mucosa

The authors examined patterns and risk factors of illicit drug use among people with disabilities by use of a random sample of 1,876 persons actively involved in vocational rehabilitation services in three Midwestern states. Compared with regional drug use data from the general population, respondents with disabilities reported higher rates of illicit drug use for nearly every drug category. Factors significantly associated with illicit drug use included level of disability acceptance, best friends' drug use, attitude of disability entitlement, self-esteem, and risk-taking. These findings provide additional insight into illicit drug use among people with disabilities. The authors discuss implications from these findings for rehabilitation and disability policy.     

Supported employment for adults with psychiatric disability: Results of an innovative demonstration project.

Describes an innovative 3-yr research and demonstration project evaluating a supported employment program on a university campus designed specifically for persons with psychiatric disability. The vocational status, job satisfaction, work integration, symptomatology, and social supports of 20 Ss were assessed during the project, and a 2-yr follow-up of employment status was conducted. While a university setting was ideal for providing supported employment services for persons with psychiatric disabilities, the university itself was not a particularly receptive or compatible employer. The 2-yr follow-up showed that 10 Ss were employed an average of 17.5 hrs per week with mean earnings of $156 per week, representing a modest increase in percentage of Ss employed, and a substantial increase in average hours worked and average wages earned. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood parameter and heart rate response to training in Andalusian horses

The psychopathology and associated disabilities experienced by persons with schizophrenia have only partially responded to conventional pharmacological and psychosocial treatment approaches. Biobehavioral treatment and rehabilitation employs behavioral assessment, social learning principles, skills training, and a focus on the recovery process to amplify the effects of pharmacotherapy. Utilizing the Medline database, we review a selection of English-language studies published from 1970 to 1994 that support the effectiveness of each of the components of biobehavioral therapy, such as case management, psychopharmacology with behavioral assessment, psychoeducation, family involvement, and social skills training. An integrated biobehavioral therapy directed toward early detection and treatment of schizophrenic symptoms, collaboration between consumers and caregivers in managing treatment, family and social skills training, and teaching coping skills and self-help techniques has been documented to improve the course and outcome of schizophrenia, as measured by symptom recurrence, social functioning, and quality of life. A case vignette is presented to illustrate the successful integration of biobehavioral therapies into a treatment system that focuses on consumers' attempts to become increasingly responsible for recovering from illness.     

Personality factors associated with severe traumatic disability.

Investigated whether persons with traumatic injuries are more extraverted than nontraumatically disabled persons. 111 rehabilitation patients with either traumatic or nontraumatic disabilities associated with either chronic pain or motor loss completed the Eysenck Personality Inventory and the SCL-90. Results show that the traumatically disabled Ss with motor loss (paraplegia or quadriplegia) were more extraverted and less distressed than Ss with nontraumatic disabilities or with traumatically induced pain. It is contended that the external orientation characteristic of extraversion and the style of learning through actively and repeatedly challenging the environment may account for the prominence of extraversion within the traumatically disabled group with motor loss and for the relative absence of distress for this group in the highly structured medical/rehabilitation environment. It is suggested that the psychological adjustment of more extraverted personalities to disability involving motor loss may be better facilitated by interventions that encourage experiential learning and challenging environmental limits than by introspective psychotherapy or counseling. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute respiratory response to prolonged, moderate levels of sidestream tobacco smoke

Carefully controlled, clinical research has shown psychiatric rehabilitation to significantly help persons with severe mental illness address their disabilities and obtain a higher quality of life. For psychiatric rehabilitation to yield its greatest effect, discrete principles and skills that are part of the rehabilitation paradigm must be disseminated to staff working in real-world settings. Staff training strategies that help the rehabilitation team develop effective programs are especially important. This paper reviews Interactive Staff Training (IST), an approach to team building and program development that combines educational and organizational strategies. IST comprises four stages--introduction to the system, program development, program implementation, and program maintenance--with each stage defined by behavioral tasks that engage the team and corresponding products that serve as markers of progress. Testing treatment dissemination strategies poses interesting problems for the researcher, some which are reviewed here. Outcome studies completed on IST are summarized in light of these problems. The paper ends with a consideration of some future directions for research in this area.     

Introduction to special issue: Rehabilitation psychology and persons with psychiatric disabilities: Are they mutually exclusive?

This guest-edited issue of the journal illustrates the relevance of psychiatric rehabilitation to rehabilitation psychologists. It demonstrates that the focus of psychiatric rehabilitation includes some areas of functioning typically identified with rehabilitation psychologists, for example, vocational, residential, and family functioning. Further, it shows that traditional assessment methodologies and treatment settings are beginning to reflect a psychiatric rehabilitation orientation. Finally, it illustrates the philosophy and treatment models that form the basis of physical rehabilitation as also underlying psychiatric rehabilitation. It is hoped that this issue of Rehabilitation Psychology will assist in the resolution of the debate over contextual issues by considering why psychologists working with psychiatrically impaired persons may be identified as rehabilitation psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom subtypes in persons institutionalized with schizophrenia: Comparison of demographics, outcome and functional skills.

Using a formula based on the concept by N. C. Andreasen (see record 1982-29376-001) and N. C. Andreasen and S. Olsen (see record 1982-30452-001) of classifying subtypes into positive, negative, and mixed schizophrenia, 312 persons institutionalized with Diagnostic and Statistical Manual of Mental Disorders (DSM-III) schizophrenia were retrospectively examined. 59 Ss were classified into the positive symptom subtype, 33 into the negative symptom subtype, and 220 into the mixed symptom subtype. Symptom subtypes were compared on traditional demographic and outcome indicators, as well as on a dimension critical to rehabilitation (i.e., measures of degree of assistance necessary to perform functional skills). No significant differences were found among the subtypes on demographic items and traditional indicators of outcome such as level of vocational functioning or independent living. However, on measures of degree of assistance necessary to perform functional skills, significant differences were found among the symptom subtypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia

Many patients with schizophrenia are characterized by cognitive deficits that limit their ability to benefit from psychiatric rehabilitation interventions. While this suggests that cognitive rehabilitation is important, more needs to be known about which cognitive deficits interfere with which aspects of outcome and functioning before effective interventions are developed. We report data on cognitive predictors of three types of outcome: acquisition and performance of skills in a skills training group; aspects of daily ward functioning; and ability to be discharged from a state hospital. Our data indicate that poorer outcomes in each of these areas are associated with different, but somewhat overlapping, profiles of cognitive deficits. These data are relevant for designing both ward-based and individualized interventions. Integrating traditional psychiatric rehabilitation approaches with targeted cognitive interventions is necessary to maximize the impact of psychiatric rehabilitation services on individuals with chronic schizophrenia.     

The role of psychologists in the treatment, management, and prevention of chronic mental illness.

In addition to suffering from the severe psychiatric symptoms of chronic mental illness (CMI), people with this type of disorder suffer from a variety of secondary disabilities and face societal obstacles that interfere with their ability to maximize their personal, social, and vocational potentials. Following the deinstitutionalization of long-term psychiatric patients in recent decades, many different understandings of the etiology, treatment, and management of CMI have evolved, including those derived from the biological, vulnerability, cognitive, case management, rehabilitation, and psychoeducational models. Because psychologists are trained in a wide range of psychological theories and a broad repertoire of applications, they have unique contributions to make within each model, particularly, as discussed here, to prevent, treat, and manage CMI through research, assessment, and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric rehabilitation as the preferred response to the needs of individuals with severe psychiatric disability.

Defines severe psychiatric disability (SPD) and discusses the demographic characteristics of persons with SPD. Two groups with SPD have become sources of public policy debate: the homeless and young adults (aged 18–35 yrs). Attempts to impact client rehabilitation outcome are noted. It is suggested that interventions based on a rehabilitation model show promise as a way to reduce psychiatric disability. These interventions are based on strategies aimed at increasing a person's skills and supports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between osmotic stress and calcium elevation: in vitro and in vivo rat lens models

Recent evaluations by the U.S. General Accounting Office and the National Alliance for the Mentally Ill of reemployment efforts of the federal-state vocational rehabilitation program found that services offered by state vocational rehabilitation agencies do not produce long-term earnings for clients with emotional or physical disabilities. This paper examines reasons for these poor outcomes and the implications of recent policy reform recommendations. Congress must decide whether to take action at the federal level to upgrade programs affecting persons with severe mental illnesses or to continue to rely on state decision making. The federal-state program largely wastes an estimated $490 million annually on time-limited services to consumers with mental illnesses. Rechanneled into a variety of innovative and more appropriate integrated services models, the money could buy stable annual vocational rehabilitation funding for 62,000 to 90,000 consumers with severe mental illnesses. Larger macrosystem problems involve the dynamics of the labor market that limit job opportunities and the powerful work disincentives for consumers with severe disabilities now inherent in Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid.     

Team-building in vocational rehabilitation: the Horizon Telecentre project

This report concerns an ambitious project which created a functionally independent team of young people with physical disabilities who had no previous experience of employment. The aim of the project was to expand the training opportunities for people with disabilities through the provision of team-building. The team was brought together in order to run a self-financing office bureau business in Athens, providing services to the local community. This project intended to find an innovative alternative to sheltered workshops, which are not found in Greece. A systemic and developmental approach to team-building was explored. The approach consisted of work-hardening, education, experiential learning, and providing the physical structures necessary for self-employment. The paper describes the approach with examples, and includes an evaluation by the trainees. The paper also identifies the importance of including a team-building approach within vocational rehabilitation.     

Differential inhibition of cyclooxygenases-1 and -2 by meloxicam and its 4''-isomer

Our objective was to delineate the educational and behavioral differences between learning disabled children with and without attention-deficit hyperactivity disorder (ADHD). A restrospective (TROHOC) multimeasure comparative design was employed. Parents' and teachers' questionnaires (ANSER system) pertaining to attention-activity, associated behaviors, and scholastic achievements were compared. Parents' questionnaires failed to distinguish between the two groups. Teachers' questionnaires were significantly more sensitive. Significant correlations between educational achievements and attention-activity and associated behaviors scores among children with learning disabilities were evident, no such correlations were found in the group with learning disability with ADHD. The factor analysis identified different educational and behavioral aggregates with language related difficulties and externalizing behaviors more typically aggregated in the learning disabled group with ADHD and recall deficit and internalizing/neurotic behaviors in the group with learning disability only. ADHD appears to be an associated comorbidity and not necessarily a specific learning deficit. However, children with learning disability with ADHD possibly have a different underlying neurocognitive pattern than their peers with learning disabilities only.     

Rehabilitation psychology practice, ethics, and a changing health care environment.

Rapid changes in the health care environment have brought about ethical and professional challenges for rehabilitation and rehabilitation psychology. The response of rehabilitation psychologists to the threats and opportunities of these challenges will have an impact on the welfare of persons with disabilities and the future of the profession. Managed care organizations have focused their efforts on the management of acute illness. Ethical concerns are being raised about patient access to care, self-determination, confidentiality, provider accountability, and marketing in managed care systems. Rehabilitation psychologists' skills in program development and outcome evaluation place them in a key position to influence the changes in the health care environment. To be effectual, however, fundamental changes must be made in research psychology practice, education and training, research focus, and professional activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The choose-get-keep model of psychiatric rehabilitation: A synopsis of recent studies.

Objective: Comprehensive review of studies using the choose-get-keep (CGK) process model of psychiatric rehabilitation. Also, other studies are identified that have demonstrated methodologies useful in future research on the CGK model. Intervention Model: The CGK process is conceptualized as the phases through which people with psychiatric disabilities proceed as they engage in psychiatric rehabilitation. Conclusion: The CGK model is a potentially useful psychiatric rehabilitation intervention that can be implemented in a variety of service settings and that focuses on the activities of the practitioner and the service recipient. The CGK model warrants further empirical study to examine its effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Programming for occupational outcomes following traumatic brain injury".

Responds to an article Programming for occupational outcomes following traumatic brain injury by William J. Haffey and Frank D. Lewis (see record 1990-02644-001). The dramatic upsurge in attention paid in the past 10 years to the rehabilitation of persons with traumatic brain injury (TBI) has resulted in an accelerating proliferation of treatment programs purporting to apply specialized techniques that will "remediate" the cognitive and behavioral deficits of this population, with implicit or explicit promises of functional gain. Specifically, given the epidemiologic realities of the TBI population, returning to work is a major goal of the rehabilitation process. With the movement of TBI rehabilitation programs out of academic medical centers and into the private sector, increasing numbers of zealous professionals are ready to apply a variety of treatment approaches, thousands of families are eager to find the "best" program, and more and more nervous insurers are both mandated and requested to pay for expensive treatments that hold out the promise of return to work. Unfortunately, the field of TBI rehabilitation has been more eager to provide services than critically evaluate the effectiveness of those services. The first major contribution of the Haffey and Lewis article is to call attention both to the paucity of posttreatment vocational outcome studies, and to emphasize the need to evaluate the success of various models of vocational rehabilitation. The second major contribution of the Haffey and Lewis article is their offering of a concrete example of one approach to systematic programming for vocational outcomes. Our experience is that vocational potential—and therefore reasonable goals—only emerge as the product of a process that involves testing the client's capacities not just cognitively and behaviorally, but also his or her capacity to conform to a series of messages and procedures that will determine the viability of any given vocational plan. Readers should take from the concrete programming suggestions in this article the laudable objective of making vocational goals, obstacles, and critical events specific and public, but beware of mechanically applying the approach without appreciating the complex subtleties in enabling a brain-injured person to become a productive worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting vocational outcome of psychiatric patients with the Edwards Personal Preference Schedule.

Evaluated the validity of the EPPS in predicting vocational success of psychiatric patients and evaluated a special predictive model described by A. Goss to determine if its application could significantly increase the predictive accuracy of the EPPS. The EPPS was administered to 47 male and 64 female psychiatric patients upon admission to a vocational rehabilitation program in a state mental hospital. Follow-up of these Ss on subsequent success or failure outcome in the program revealed no significant relationship between any of the EPPS scales and vocational success. Evaluation of the Goss model with the total sample and with a subgroup of schizophrenic patients reveals no support for increased predictive efficiency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching secondary students with learning disabilities to self-manage classroom survival skills

This multiple baseline study investigated the effectiveness of a cognitive-behavioral self-management training package on the consistent use of specific classroom survival skills. Participants were three adolescent males with learning disabilities in Grades 7 and 8. The training package involved a multicomponent strategy focused on the improvement, maintenance, and cross-classroom generalization of targeted classroom preparedness skills. Following intervention, the training procedures were systematically faded. Results demonstrated more consistent use of targeted classroom survival skills by all three students in both learning support and mainstream generalization settings. Long-term maintenance of the intervention effects was observed for two students in both settings. Three social validity measures revealed positive results. Implications for self-management in secondary education settings are discussed.