Impact of a vocational counselor on employment-related outcomes among methadone patients

A vocational rehabilitation counselor (VRC) was placed in a methadone maintenance (MM) clinic (Clinic 1; N=333) to increase vocational–educational (v–e) services and improve v–e outcomes. Data on individual service delivery and monthly patient v–e status provided project implementation and outcome data, respectively, in Clinic 1; v–e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. V–e services increased significantly in Clinic 1; net v–e involvement increased from 53 to 56% in Clinic 1 and declined in Clinic 2, 45–43%. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v–e change and that VRC services contributed significantly to v–e change among patients not working at admission. It was concluded that placing a VRC in an MM clinic is a cost-effective v–e intervention.     

Internal locus of control and vocational rehabilitation

In previous studies, internal locus of control (ILC) has been pointed out as a key factor for return to work after vocational rehabilitation. The aim of the current study was to gain a deeper understanding of the concept of ILC in a Swedish vocational rehabilitation context. The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational rehabilitation. A first bi-variate analysis showed that ILC was positively associated with physical functioning and general health, and negatively associated with bodily pain. The analysis also showed that women, more than men, reported high internal locus of control. After a second multivariate analysis, only bodily pain remained associated. It is concluded that there exist a strong and negative association between bodily pain and internal locus of control. Clients with severe pain often also suffer from low internal locus of control. This should be kept in mind when providing vocational rehabilitation.     

The Model of Creative Ability in vocational rehabilitation

Occupational therapy literature has reported on the concept of motivation in great depth and it is evident that motivation has many constructs. Motivation is seen as a key indicator for success in rehabilitation. When assessing a client's vocational skills and performance, occupational therapists in South Africa have found the Model of Creative Ability to be a useful model to determine the quality and quantity of motivation. This article briefly describes the development of the Model of Creative Ability in South Africa and explains the fundamental concepts and terminology used in the model. Criticism of the model as well as the reasons for the popularity of this model are given. A case study is used as an example to illustrate the unique contribution of the levels of motivation and action to a medico-legal report.     

Users of assistive technology also require assistance with ergonomics

This case study describes an ergonomics workstation assessment conducted for an administrative worker with vision impairment due to keratoconus. The worker, PT, was provided with multiple assistive technology devices to help her with her work, but this resulted in an overcrowded workspace. The purpose of the workstation assessment was to assist the worker with her workstation arrangement to make it more comfortable and efficient. During the assessment, a range of physical, cognitive and organisational ergonomics issues were identified and addressed. Multidisciplinary teams are often used in the rehabilitation of workers with complex medical problems. An ergonomist can play a valuable role on this team.     

Occupational roles and life satisfaction in psychiatric outpatients with vocational disabilities

OBJECTIVES: To investigate: 1) internalization of occupational roles and 2) levels of satisfaction in psychiatric outpatients with vocational disability. STUDY DESIGN: Twenty subjects, 8 men and 12 women, aged 20-55, participated in the study. The past, present and expected values of 10 occupational roles were identified. Levels of satisfaction with life as whole and on eight different domains were reported on a six-step scale ranging from very dissatisfied to very satisfied. RESULTS: The student and worker roles were not part of current life, in contrast to the past (5 years ago) and the expected future. The roles of family member and home maintainer were the most appreciated both in the past and at present. All of the participants expected to add both number and level of role involvement in the future. No-one were satisfied with life as whole. All but one were dissatisfied with their vocational and financial situations. Most were also dissatisfied with their leisure situation, family life, partnership relations, sexual life, and contacts with friends. CONCLUSIONS: The low levels of satisfaction with life as whole and the different domains reflect the disadvantageous situation of the participants in the study. The low number of occupational roles and the low level of meaningful role involvement support the associations between occupational roles and life satisfaction. It is suggested that occupational role assessment would be an important focus in occupational therapy to help people to more adaptive daily routines and to improve their quality of life.     

Individual status at the start of rehabilitation: Implications for vocational rehabilitation programs

This research investigated the situation of 143 unemployed sick leavers at the start of vocational rehabilitation in Sweden. It is argued in this paper that in order to gain a meaningful picture of the vocational rehabilitation process it is necessary to know and understand something of individual differences and status at the onset. In doing so, assessment was carried out of the possible influence of one contextual factor and five individual factors on health, duration of sick leave and unemployment. Findings suggest that individual differences exist in health status, length of sick leave and unemployment, at the upstart of vocational rehabilitating. Locus of control was found to exert important influence on the differences between the individuals in the study sample, with persons of external locus of control having a less favourable point of departure at the start of vocational rehabilitation compared to other groups. It is therefore assumed that these persons will be in greater need of support during the vocational rehabilitation process. The level of unemployment within a geographical area was also found to influence the length of sick leave. CONCLUSIONS: Our suggestion is for rehabilitation programs to be developed and selected to match the special needs and differences whether they are of individual or of social nature.     

Disability and job stress: Implications for vocational rehabilitation planning

Because people with disabilities often experience an increased risk for physical and psychological complications of job stress, vocational rehabilitation professionals must be able to (a) identify individual and work-environmental risk factors for job stress and (b) design appropriate interventions to minimize those risk factors. The purpose of this article is to (a) present two models of occupational stress, (b) examine factors common to each of these models that are associated with employee health and well-being, and (c) suggest implications for rehabilitation planning.     

Canonical correlation analysis of residential and vocational outcomes following psychiatric rehabilitation

This analysis uses canonical correlation techniques to explore client outcomes following psychosocial rehabilitation services in two rehabilitation areas: vocational and residential. At issue are the ways in which these two outcomes are affected by a series of eight client characteristics and service delivery features. The overarching question is the effectiveness of the program in establishing independence vocationally and residentially, and whether the same set of factors influences these two outcomes for persons with mental illness. Subjects were 212 ex-clients of a psychosocial rehabilitation agency who were working six months after leaving the program. The analysis derived two canonical functions both of which were significant. Canonical loadings and cross loadings indicated that client level of functioning and program tenure loaded most strongly with residential status on the first canonical variate while education loaded most strongly with salary on the second. These results support the notions that different predictors account for the variance associated with different outcomes following psychosocial rehabilitation. Discussion of the relevance of strong predictor variables highlights ways they can impact program design. Finally, the usefulness of canonical correlation in longitudinal program evaluation research is explored.     

A new approach in vocational rehabilitation in Iceland: preliminary report

The lack of vocational rehabilitation in Iceland inspired the Janus Rehabilitation initiative in the year 2000. The team currently consists of two occupational therapists, a social worker, a physiotherapist, a psychologist, and a physician. Janus uses resources from local education establishments and is located at the Reykjavík Technical School. A client-centred approach is used, enabling a flexible rehabilitation timeframe. The aim is to help the client back to employment/education. Advantage is taken of the facilities of the school where integration between education and rehabilitation takes place. Forty individuals have been admitted, with a mean time from work of 2.9 years, (range: 0-11 years). Seventeen (43%) have returned to employment/education. Twenty-three of those entering the programme are still on invalidity pension. The Canadian Occupational Performance Measurement (COPM) shows improvement in occupational performance and satisfaction. The Icelandic Quality of Life measurement also shows improvement. The results have been promising. However, a larger group is needed in order to draw clear unequivocal conclusions.     

Counselor confounds in evaluations of vocational rehabilitation methods in substance dependency treatment

Evaluation research on vocational counseling in substance dependency treatment should distinguish between the effects of counselors and counseling methods on clients' employment outcomes. Three experimental designs permit investigation of possible confounds between these types of effects: (a) nested designs (each counselor delivers one counseling method so counselors are nested under methods), (b) crossed designs (each counselor delivers all counseling methods so counselors are crossed with methods), and (c) no-treatment control group designs (experimental group's counselors all deliver the same method). Each design is optimal for one stage of evaluation research. No-treatment control group designs are best for exploratory evaluations of new types of vocational counseling. Nested designs are best for outcome evaluations of different types of interventions. Crossed designs are best for (causal) process evaluations of counseling methods of demonstrated efficacy. Despite the importance of methodological issues and problems, vocational rehabilitation in substance dependency treatment has a greater need for stronger interventions than better evaluation designs.     

Hand therapy and ergonomics: integration of approaches in vocational rehabilitation and promotion of decent work in Brazil

Among the indicators of Decent Work in Brazil, the one referring to the "Safe Working Environment" was the only which had no improvement in the time series analyzed by the International Labor Organisation. There is an increased number of accidents with significant economic and social impacts. Given that many of these accidents involve the hands and cause functional sequels, this paper presents an integration between the approaches of Hand Therapy and Ergonomics in order to facilitate the process of rehabilitation and reintegration, as well as acting to prevent further accidents, thus contributing to the promotion of Decent Work in the country, particularly with regard to safety and health at work and equal opportunities.     

The role of neighborhood physical environment on mobility and social participation among people using mobility assistive technology

This paper presents a systematic literature review on the impact of the neighborhood physical environment on mobility and social participation among people using mobility assistive technology (MAT). Peer-reviewed articles from eight databases published in French or English from 1990 to 2016 were searched. Thirty studies were included in this review. Factors related to neighborhood environmental features, mobility in transit, and accessibility of homes and public buildings influenced mobility and social participation of MAT users. The majority of reviewed studies combined different types of MAT, which made the interpretation of the results challenging. Few studies included walker, cane, and crutch users. Definitions of mobility and social participation lacked consistency and were often simplistic. Future empirical research needs to examine the impact of neighborhood physical environment factors separately for different MAT users. Causality and links between mobility and social participation of different MAT users at the neighborhood level should be further explored.