IntroClin - Integrated Supported Employment

7/30/2019 IntroClin - Integrated Supported Employment

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JOURNAL REPORT

Submitted by:

BOOC, JARED M.

SABA, MARY JEAN A.


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Integrated Supported Employment for a Person with Severe Mental Illness

Ashley S. M. Chan, Hector W. H. Tsang, Sally M. Y. Li

INTRODUCTION

Severe mental illness and employment are two of the subjects tackled in the journal presented here. Thetwo subjects are most controversial especially in the context of todays society where opportunities for the

mentally ill are deprived because of the sheer prejudice about their incompetence and mental capacity.

The program studied and implemented gives the people with severe mental illness the chance to make

up for lost time, the chance to make more meaning in their already difficult life and the chance to prove

their worth. The study would be able to give more mentally ill patients not only the work they have always

wanted but also to last in their chosen career.

It is associated with self esteem and self worth. Employment, apart from gaining a source of income,

gives a man value for everything that he is and for everything that he does. People with SMI are known to

have a diminished self-concept and a distorted sense of self-efficacy. The act of working is powerful in

creating and facilitating change in a persons self-concept and self efficacy. It gives them the power to

take control over the lives they have always wanted to live by experiencing and overcoming thechallenges that present in their every day career. The individual placement and support (IPS) approach, a

specific model of supported employment, is an evidence-based vocational rehabilitation approved for

people with SMI.

REVIEW OF RELATED LITERATURE

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive

disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality

disorder. The good news about mental illness is that recovery is possible. They cannot be overcome

through "will power" and are not related to a person's "character" or intelligence. Mental illness falls along

a continuum of severity. Even though mental illness is widespread in the population, the main burden of

illness is concentrated in a much smaller proportion-about 6 percent, or 1 in 17 Americans-who live with aserious mental illness. The National Institute of Mental Health reports that One in four adults-

approximately 57.7 million Americans-experience a mental health disorder in a given year.

The World Health Organization has reported that four of the 10 leading causes of disability in the US and

other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading

cause of disability in the world for women and children. Stigma erodes confidence that mental disorders

are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of

hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is

time to take these barriers down. Of all persons with disabilities, those with a serious mental illness face

the highest degree of stigmatization in the workplace, and the greatest barriers to employment. Many and

varied employment obstacles face adults with psychiatric disabilities, such as gaps in work history, limited

employment experience, lack of confidence, fear and anxiety, workplace discrimination and inflexibility,social stigma and the rigidity of existing income support/benefit programs.

The unemployment rate of persons with serious mental illness reflects these obstacles and has been

commonly reported to range from 70-90%, depending on the severity of the disability. These statistics are

particularly disturbing in light of the fact that productive work has been identified as a leading component

in promoting positive mental health and in paving the way for a rich and fulfilling life in the community.

Access to meaningful, paid work is a basic human right for every citizen, and those who experience

serious mental illness should have equal access to the fundamental elements of citizenship which

include: housing, education, income and work. This means that each individual has the right to be

employed in a mainstream job, rather than being labeled as a client in a training program or a sheltered

workshop.

There is growing evidence of the global impact of mental illness. Mental health

problems are among the most important contributors to the burden of disease and disability worldwide.

Five of the 10 leading causes of disability worldwide are mental health problems. They are as relevant in

low-income countries as they are in rich ones, cutting across age, gender and social strata. Furthermore,

all predictions indicate that the future will see a dramatic increase in mental health problem. The burden


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of mental health disorders on health and productivity has long been underestimated. The United Kingdom

Department of Health and the Confederation of British Industry have estimated that 15-30% of workers

will experience some form of mental health problem during their working lives. In fact, mental health

problems are a leading cause of illness and disability. The European Mental Health Agenda of the

European Union (EU) has recognized the prevalence and impact of mental health disorders in the

workplace in EUcountries. It has been estimated that 20% of the adult working population hassome type

of mental health problem at any given time. In the USA, it is estimated that more than 40 million people

have some type of mental health disorder and, of that number, 4-5 million adults are considered seriously

mentally ill. Depressive disorders, for example, represent one of the most common health problems of

adults in the United States workforce.

JOURNAL PROPER

People with schizophrenia and other forms of SMI have deficits in social functioning (Bond, Drake, &

Becker, 1998). The literature has documented that social competence is one of the most significant and

consistent predictors of employment outcome among people with mental illness (Tsang, Lam, Ng, &

Leung, 2000). Moreover, problems with job retention have been found to be related to social functioning.

Studies have shown that interpersonal difficulty is the most frequently reported job problem (58%; Becker

et al., 1998; Mak, Tsang, & Cheung, 2006). Tsang (2003) therefore developed the integrated supported

employment (ISE) approach to help people with SMI acquire the social skill necessary in the workplace

and also to support them in obtaining and maintaining competitive employment. The service protocol

consists of two basic intervention components: IPS and work-related social skills training (WSST; Tsang

& Pearson, 1996).

Individual Placement and Support (IPS) Approach

Specific model of supported employment, an evidence-based vocational rehabilitation approved

for people with SMI

assists people with psychiatric disabilities with rapidly and directly obtaining competitive

employment

With the introduction of IPS, the employment rate of people with SMI was reported to reach 56%

Integrated Supported Employment Approach

Literature has documented that social competence is one of the most significant and consistent

predictors of employment outcome among people with mental illness.

Problems with job retention have been found to be related to social functioning

Interpersonal difficulty is the most frequently reported job problem

Tsang (2003)

developed the integrated supported employment (ISE) approach to help people with SMI acquire

the social skills necessary in the workplace and also to support them in obtaining and maintaining

competitive employment.

consists of two basic intervention components: A. IPS B. Work-related Social Skills Training

(WSST)

found that significantly more ISE participants (78.8%) than IPS participants (53.6%) obtained

competitive employment.

ISE participants worked longer than IPS participants (25.12 weeks vs. 11.95 weeks,

respectively) after 15 months follow-up service.

This study bolstered a hypothesis that ISE participants would have better vocational out-

comes than IPS participants. Because ISE has been shown to be effective in developing social

skills and improving vocational outcomes, it likely exerts a positive impact on the recovery

process of people with mental illness.


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ISE Protocol

implementation of ISE follows the steps of a typical IPS program

WSST is provided to ISE participants before they obtain employment

skills generalization approach is used throughout the follow-up process

SGA >> places special emphasis on providing assistance to participants in developing and

maintaining good and cooperative working relationships with their supervisors, fellow workers,

and customers.

Although ISE has been empirically tested (Tsang, 2007), this testing does not mean its innovative

protocol translates automatically into clinical practice

This article illustrates with a case vignette how an employment specialist helped a participant go

through different stages of the ISE service and supported her in obtaining and maintaining

competitive employment

OUTCOME

The study demonstrated how ISE was associated with the success of a person with SMI in obtaining and

sustaining employment. Although Ms. L had been unemployed for more than 10 years, our innovative

ISE approach helped her achieve continuous employment as a part-time office assistant for 8 months.We

propose that the major factor contributing to her successful job search was improved job interview skills,

which were essential for getting a job. Participants learned interview skills during the WSST sessions,

and Ms. L practiced these skills before attending job interviews. Joining the WSST may also have

improved her motivation to gain competitive employment. This finding is consistent with Tsang and

Pearsons (2001) report regarding technical guidance during follow-up services after WSST and its role in

helping participants defuse the potential difficulties and obstacles that reduce job-seeking attempts. Ms. L

stayed in the job for 8 months before she was discharged from our study. Although we do not have further

follow-up data, it is possible that she may have remained in the job for a longer period of time. This

outcome represents a job tenure longer than that reported by other vocational programs (Drake, McHugo,

et al., 1999; Wong, Chiu, Tang, Chiu, & Tang, 2006). The ISE programs strength in this aspect was that

WSST and efforts targeted at skills generalization throughout the entire follow-up process enhanced

participants job-retaining social skills. Participants received social skills training, including training in

maintaining a good working relationship with ones supervisor and coworkers (Tsang, 2003). These skills

equipped participants to cope with interpersonal conflicts in the workplace that might have caused them

to leave their jobs. In the case of Ms. L, follow-up support focused on solving her relationship problems

with her supervisor and coworkers. Because ISE fills this postemployment support gap, she was able to

get through the problems and keep her job for 8 months.

RECOMMENDATION/INSIGHT

The program is effective and proven to work given the appropriate contexts that would enable the

therapist, employer and client to engage in work-related efforts that would comprise the working

environment of the client. It would be a help not only in terms of the generation of the clients income but

as well as the clients value about himself that would also promote treatment for the mental illness the

client has. Thought the study needs further research, it still is a viable candidate for success. It already

has the right scientific study, it just needs a little more of more testing. It does not deserve the poor regard

it is garnering now. But we cannot blame the professionals for not adapting it because it needs a wide

range of skills for it to be a success. For one professional, it may take them a lot more things to know and

a lot more skills to learn for this to be effectively administered and make the clientcompetent for the realworld.

Documents

IntroClin - Integrated Supported Employment