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Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society.

ABSTRACT: This study examined the outcomes of a vocational rehabilitation program (The Job Management Program, JUMP) for persons with psychotic disorders based on close collaboration between health and welfare services.Participants (N?=?148) with broad schizophrenia spectrum disorders (age 18-65) were recruited from six counties in Norway. Three counties were randomized to vocational rehabilitation augmented with cognitive behaviour therapy (CBT), while the remaining three counties were randomized to vocational rehabilitation augmented with cognitive remediation (CR). This paper compares the vocational activity of the total group of JUMP participants with a treatment as usual group (N?=?341), and further examines differences between the two JUMP interventions. Employment status (working/not working) was registered at the time of inclusion and at the end of the intervention period.The total number of JUMP participants in any kind of vocational activity increased from 17 to 77% during the intervention. Of these, 8% had competitive employment, 36% had work placements in ordinary workplaces with social security benefits as their income, and 33% had sheltered work. The total number of working participants in the TAU group increased from 15.5 to 18.2%. The JUMP group showed significant improvements of positive (t?=?-2.33, p?=?0.02) and general (t?=?-2.75, p?=?0.007) symptoms of psychosis. Significant differences between the CBT and CR interventions were not demonstrated.The study supports existing evidence that the majority of persons with broad schizophrenia spectrum disorders can cope with some kind of work, given that internal and external barriers are reduced. Those who wish to work should be offered vocational rehabilitation.ClinicalTrials.gov Identifier: NCT01139502 . Registered on 6 February 2010.

SUBMITTER: Falkum E

PROVIDER: S-EPMC5240414 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society.

Falkum Erik E Klungsøyr Ole O Lystad June Ullevoldsæter JU Bull Helen Christine HC Evensen Stig S Martinsen Egil W EW Friis Svein S Ueland Torill T

BMC psychiatry 20170117 1

<h4>Background</h4>This study examined the outcomes of a vocational rehabilitation program (The Job Management Program, JUMP) for persons with psychotic disorders based on close collaboration between health and welfare services.<h4>Methods</h4>Participants (N = 148) with broad schizophrenia spectrum disorders (age 18-65) were recruited from six counties in Norway. Three counties were randomized to vocational rehabilitation augmented with cognitive behaviour therapy (CBT), while the remaining thr ...[more]

PMID: 28095813

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Project description:BackgroundVocational rehabilitation (VR) has increasingly become an important intervention targeting poor occupational functioning in schizophrenia. The Norwegian Job Management Program (JUMP), sought to enhance occupational outcomes by augmenting VR with either cognitive behavioral therapy (CBT) techniques aiming to improve psychotic symptoms or cognitive remediation (CR) aiming to improve cognition. CBT is standard treatment in schizophrenia, but recent meta-analyses question the effect of CBT on negative psychotic symptoms. It is of interest to study the causal role of psychotic symptoms and cognitive functioning on occupational functioning.MethodsData from the JUMP VR - program, was reanalyzed with a causal inference method to assess the causal effects of reduced symptoms / improved neurocognitive functioning on occupational functioning measured by number of working hours per week. Participants (N = 131) had been randomized to either VR + CBT (N = 68) or VR + CR (N = 63). Large improvements in number of working hours were demonstrated in both intervention groups (nonsignificant group difference). G-estimation was used to assess the strength and nature of the causal effects, adjusted for time-varying confounding and selection - bias from loss to follow-up.ResultsSignificant causal effects of reduction in each of four dimensions of symptoms and improved neurocognition respectively, on number of working hours were found (separate models). The effect of negative symptoms was the strongest and increased in magnitude during the whole observation period, while the effect of two other symptoms and neurocognition was constant. Adjusted for confounding (including potential feedback), the causal effect of a hypothetical change in negative symptoms equal to the average improvement in the CBT group corresponded to an increase in working hours of 3.2 h per week (95% CI: 1.11, 5.35).ConclusionHigh performance of g-estimation in a small psychiatric data set with few repeated measures and time-varying confounding and effects, was demonstrated. Augmented vocational rehabilitation showed causal effects of intervention targets with the strongest and increasing effect from negative symptoms on number of working hours. Combination of therapy and activation (indirect and direct approach) might explain improvement in both cognition and negative symptoms, and shed some light on effective ingredients for improved treatment of negative symptoms.

Project description:BackgroundPeople suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment's process.MethodThe roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data.ResultsRegions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process.ConclusionsOur study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients' perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients' perspectives.

Dataset Information

Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society.

Publications

Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society.

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