Augmenting vocational outcomes of supported employment with social skills training. (Vocational Outcomes of Supported Employment).Work has long been regarded as a potential contributor and a tool for the treatment of mental illness (Ekdawi, Conning, & Campling, 1994). It is an important part of a cultural role, filling much of an individual's time, supplying a source of income, providing a source of identity, and contributing to one's physiological and psychological well-being psychological well-being Research A nebulous legislative term intended to ensure that certain categories of lab animals, especially primates, don't 'go nuts' as a result of experimental design or conditions in societies (Dawis, 1987; Mowbray, Bybee, Harris & McCrohan, 1995; Osipow, 1968). Unemployment, on the other hand, has demonstrated adverse effects on health caused by poverty, poor housing, and rejection by society (Brenner, 1987; Smith, 1987). While work serves an important function in a person's life, not every person can manage this important aspect of life, particularly those suffering from schizophrenia schizophrenia (skĭt'səfrē`nēə), group of severe mental disorders characterized by reality distortions resulting in unusual thought patterns and behaviors. and other major mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. . Difficulties in choosing, getting, and keeping a job in the community are common among persons with mental disorders (Anthony, Howell, & Danley, 1984; Massel et al., 1990). Studies show that the employment rates of persons discharged from psychiatric hospitals psychiatric hospital
A hospital for the care and treatment of patients affected with acute or chronic mental illness. Also called mental hospital. ranged from 15 to 30% (Dion & Anthony, 1987; Unger & Anthony, 1984). With the introduction of supported employment, more promising findings were reported. The employment rate among those with serious mental illness could be as high as 50% following the Individual Placement and Support (IPS (1) (Inches Per Second) The measurement of the speed of tape passing by a read/write head or paper passing through a pen plotter.
(2) (IPS) (Intrusion Prevention S ) model of supported employment developed by Drake drake
1. male duck.
2. loliumtemulentum. and his team (Drake & Becker, 1996). Although supported employment has been shown to be effective in boosting the rate of job acquisition, a major limitation is that it showed no advantage over traditional vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment
rehabilitation - the restoration of someone to a useful place in society services in helping workers retain their jobs (Wallace, Tauber, & Wilde, 1999). As discussed by Drake, Becker, Clark, and Mueser (1999), available evidence only demonstrates that IPS can improve short-term rates of competitive employment. Nevertheless, the long-term course of jobs and vocational careers in relation to IPS remains an unknown. Many individuals move on to other jobs (Tsang, Ng & Chiu, 2002), but little is known about the underlying reasons and their subsequent vocational patterns.
In this article, the author attempts to trace the development and evidence related to the effectiveness of supported employment, reviews the role of social functioning social functioning,
n the ability of the individual to interact in the normal or usual way in society; can be used as a measure of quality of care. in employment outcome, and argues that the vocational outcomes in terms of job retention using supported employment can be improved with the addition of a social skills training program specially designed and developed for job tenure.
The Supported Employment Approach
Current interest in vocational rehabilitation among people with mental illness brings the development of several innovative vocational rehabilitation strategies with promising results. The most promising and evidenced-based one is the supported employment approach, particularly the Individual Placement and Support (IPS) model (Drake & Becker, 1996). This model can be regarded as a specific model of supported employment for consumers with long-term impairments due to severe mental illness. As defined by Bond et al. (2001), supported employment is a well-defined approach to helping people with disabilities participate as much as possible in the competitive labor market labor market A place where labor is exchanged for wages; an LM is defined by geography, education and technical expertise, occupation, licensure or certification requirements, and job experience , working in jobs they prefer with the level of professional help they need. Typically, the clients work for pay, are in regular contact with non-handicapped workers, and receive ongoing support (Bond, Drake, Mueser, & Becker, 1997).
The central theme of this model is integrating employment specialists into case management or mental health team to provide consumers with practical assistance in finding and maintaining competitive employment. There are six principles Six Principles can refer to:
* Rehabilitation rehabilitation: see physical therapy. as an integral component of mental health treatment
* Goal is competitive employment in work settings integrated into a community's economy
* Participants are expected to obtain jobs directly, rather than following lengthy pre-employment training
* Services are continuous and based in real work experiences in the community
* Follow along support should be time-unlimited
* Services are based on consumer's preferences and choices, rather than providers' judgment
As described by Drake et al. (1999), supported employment represents a fundamental paradigm shift A dramatic change in methodology or practice. It often refers to a major change in thinking and planning, which ultimately changes the way projects are implemented. For example, accessing applications and data from the Web instead of from local servers is a paradigm shift. See paradigm. from the traditional vocational services of "train-and-place" to a "place-and-train" approach. It has been demonstrated to be effective in numerous research projects. The first piece of evidence came from an experiment in New Hampshire New Hampshire, one of the New England states of the NE United States. It is bordered by Massachusetts (S), Vermont, with the Connecticut R. forming the boundary (W), the Canadian province of Quebec (NW), and Maine and a short strip of the Atlantic Ocean (E). in converting the rehabilitative re·ha·bil·i·tate
tr.v. re·ha·bil·i·tat·ed, re·ha·bil·i·tat·ing, re·ha·bil·i·tates
1. To restore to good health or useful life, as through therapy and education.
2. day program by an IPS supported employment program. The employment outcomes of day treatment patients following IPS model jumped significantly from 33% to 56% while the comparison day center showed no significant improvement (Drake et al., 1994). In a comprehensive review by Bond, Drake and Mueser, and Becker (1997), there were six randomized controlled trials A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. on the effectiveness of supported employment published from 1994 to 1996. The results have been consistent, with a mean of 58 percent of supported employment clients achieved competitive employment over a 12 to 18 month follow-up period, which were significantly better than 21% in the controlled group participants. The outcomes tended to favor time employed and employment earnings. No evidence was found that supported employment led to increased stress levels precipitating pre·cip·i·tate
v. pre·cip·i·tat·ed, pre·cip·i·tat·ing, pre·cip·i·tates
1. To throw from or as if from a great height; hurl downward: higher re-hospitalization rates. Two other features related to the outcomes are that the programs adhered to ongoing support and attention of client preferences. A more up-to-date study by Lehman et al. (2002) compared the effectiveness of IPS to traditional vocational or psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.
Involving aspects of both social and psychological behavior. approach and reported similar result that IPS group participants (42%) were more likely to obtain competitive employment than the participants in the comparison group (11%).
Job Tenure and Social Competence
Limitations of the Supported Employment Approach
Although the success rate of the IPS clients is shown to be impressive based on available research results, there were still nearly half of the participants who failed in the process of securing competitive employment. It has been reported that persons with severe mental illness had problems in maintaining jobs (Cook, 1992; MacDonald-Wilson, Revell, Nguyen, & Peterson, 1991; Xie, Dain, Becker, & Drake, 1997). In discussing the results of a randomized clinical trial randomized clinical trial,
n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies. comparing IPS and enhanced vocational rehabilitation (EVR EVR Enhanced Vapor Recovery
EVR Electronic Video Recording
EVR Equine Viral Rhinopneumonitis
EVR Extravehicular Robotics
EVR Expanded Virtual Register
EVR Exudative Vitreoretinopathy, Familial, Autosomal Dominant
EVR Eläinten Vapautus Rintama ) (Drake, et al., 1999), the researchers claimed only that IPS was more successful than EVR in helping persons with severe mental illness to obtain competitive employment. The IPS participants showed no advantage over EVR participants in terms of the wages they earned, job satisfaction, and non vocational outcomes.
In discussing the role of social functioning in vocational rehabilitation, Bond, Drake, and Becker (1998) commented that the job acquisition process includes locating available jobs, successfully interviewing for a job, and acclimating to an unfamiliar setting whereas job retention also requires skills in getting along with others for an extended period of time. Based on this basic understanding, failures of people with severe mental illness in getting and maintaining their jobs may be due to problems related to their social functioning. In a study to identify masons for job terminations among persons with severe mental illness participating in supported employment, it was found that interpersonal in·ter·per·son·al
1. Of or relating to the interactions between individuals: interpersonal skills.
2. difficulty was the most frequently reported job problem (58%) that may lead to job termination (Becker et al., 1998). This is in line with available evidence in the literature (Cook & Razzano, 2000; Tsang, Lam, Ng, & Leung, 2000) which has shown that social competence is one of the most significant predictors of employment outcome among individuals with mental illness.
Relationship between Social Competence and Job Tenure
Social competence plays a significant role in vocational functioning and employment outcomes among people with mental illness. In a review of previous cross-sectional and longitudinal studies longitudinal studies,
n.pl the epidemiologic studies that record data from a respresentative sample at repeated intervals over an extended span of time rather than at a single or limited number over a short period. , it is concluded that the relationship between social and vocational functioning is well established (Bond, Drake & Becker, 1998). It is however surprising to find that theoretical models in linking the relationship between social and vocational functioning of persons with severe mental illness are limited.
There are at least two reasons for this. First, there is the neglect of the fact that accommodation in the workplace is a social process (Gates, 2000). Most of the traditional vocational rehabilitation approach views accommodation as technical changes to job tasks, job routines, or the physical environment. The interpersonal aspect of the accommodation is largely neglected. Examples include how to deal with customers, how to deal with criticisms from supervisor, and how to deal with stigmatizing attitude from co-workers. Second, there is little attempt to conceptualize con·cep·tu·al·ize
v. con·cep·tu·al·ized, con·cep·tu·al·iz·ing, con·cep·tu·al·iz·es
To form a concept or concepts of, and especially to interpret in a conceptual way: social skills needed for job acquisition and retention among people with mental illness. A recent attempt is a three -tier framework proposed by Tsang and Pearson (1996) which conceptualized those specific social skills necessary for job search and job tenure in a three-tier hierarchical structure See hierarchical. . A person masters concepts and skills sequentially in each tier before proceeding to the next stage. The first tier is comprised of basic social skills and basic survival skills on the job. The second tier is comprised of two clusters of core skills needed to handle both general and specific work-related situations. The third tier of the program encompasses the goals for which the basic and core skills had prepared participants; that is, learning the benefits that a person can obtain by possessing these skills. These benefits are the consequences of getting a job, such as salary, social contacts, structure for one's time, and a sense of achievement and satisfaction from working.
Social skills play a crucial role in the process of job search and retention among people with severe mental illness. Although social skills training is a well established treatment modality treatment modality Medtalk The method used to treat a Pt for a particular condition for people with schizophrenia which helps to improve their social competence (Penn & Mueser, 1996), its potential benefit to augment the vocational outcome of supported employment has not been explored. A possible reason may be that prolonged pro·long
tr.v. pro·longed, pro·long·ing, pro·longs
1. To lengthen in duration; protract.
2. To lengthen in extent. training of consumers in the treatment setting leads to a delay of the job search process. This may easily be solved by using a training program that is short, effective for job search and retention, and evidence-based. In most of the studies that compared the effectiveness between supported employment (experimental) and skills training (comparison), the comparison group was not based on an effective and evidence-based training module geared towards job search and job maintenance of people with mental illness. This may be due to the fact there have been only a few programs of this kind available in the literature (Jacobs, Wissusik, Collier, Stackman, & Burkeman, 1992; Corrigan, Reedy reed·y
adj. reed·i·er, reed·i·est
1. Full of reeds.
2. Made of reeds.
3. Resembling a reed, especially in being thin or fragile: , Thadani, & Ganet, 1995; Kelly, Laughlin, Claiborne, et al., 1979). These attempts mainly studied the short-term effect of training on job seeking skills. Studies on skills for job maintenance are even more limited. One study based on the single case study approach was reported by Mueser, Foy, and Carter (1986). A recent and more systematic attempt to adopt the skills training approach to help persons with serious mental illness maintain their jobs is the "Workplace fundamentals" developed by Wallace, Tauber, and Wilde (1999). The reason for developing this module was that supported employment had demonstrated no advantage over traditional vocational rehabilitation services in helping workers retain their jobs. The skill areas covered in the module include identifying how work changes participants' life, using problem solving problem solving
Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. to manage symptoms and medications at the workplace, learning how to interact with supervisors and peers to improve job task performance, and using problem solving to recruit social support on and off the job.
A training module designed to improve the social skills necessary for getting and keeping a job based on a conceptual framework For the concept in aesthetics and art criticism, see .
A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to a system analysis project. put forward and validated by Tsang & Pearson (1996). The Tsang's module applied the basic principles of social skills training developed by Liberman, DeRisi, and Mueser (1989). The training program or module for finding and keeping a job has been outlined elsewhere (Tsang, 2001). It consists of 10 weekly sessions, of 1-1/2 to 2 hours each, thus fitting into the clinical workload of most psychiatric rehabilitation Psychiatric rehabilitation, also known as Psychosocial rehabilitation, is the process of restoration of community functioning and wellbeing of an individual who has a psychiatric disability (been diagnosed with a mental disorder). professionals. The curriculum can be delivered to individual clients or in a group format. Although it is preferable that participants in this program should first be equipped with training in basic social skills, this ideal scenario is not always possible.
Towards an Integrated Approach
Although social skills training (Penn & Mueser, 1996) and supported employment (Bond, Drake, Mueser, & Becker, 1997) have been widely accepted as effective treatment modalities to improve social and vocational outcomes of persons with severe mental illness, they are in general seen as two unrelated and sometimes even conflicting strategies. Limited effort has been made to combine these two techniques in producing a better vocational outcome. There is a recent trend to apply social skills training in the vocational context. Controlled trials controlled trial Clinical research A clinical study in which one group of participants receives an experimental drug while the other receives either a placebo or an approved–'gold standard' therapy. See Blinding, Double-blinded. of IPS on the average showed that about 50% participants were competitively employed at the follow-up periods. Results of the vocational social skills training reported a figure of about 40% (Tsang & Pearson, 2001). The preliminary results of Tsang's study suggest that social skills training and vocational rehabilitation are not two separate entities for the rehabilitation of people with schizophrenia and other persistent mental illness. Social skills training should become an integral part of vocational rehabilitation programs Noun 1. vocational rehabilitation program - a program of rehabilitation through job training with an eye to gainful employment
rehabilitation program - a program for restoring someone to good health for people with schizophrenia and other persistent mental disorders, whether in psychiatric hospitals, psychiatric psy·chi·at·ric
Of or relating to psychiatry.
psychiatric adjective Pertaining to psychiatry, mental disorders day facilities, and community facilities such as the Assertive Community Treatment Assertive community treatment, or ACT, is a form of total in-community care for people with serious, long-term mental illness. Definition
The defining characteristics of ACT include:
Providing a gain; profitable: gainful employment.
gainful·ly adv. employed in the community are enhanced. Social skills training in the vocational context is particularly compatible to the IPS model. The module may form an integral part of the IPS program from vocational assessment to on-going support provided by the employment specialist so as to help clients with severe mental illness to get and keep their jobs.
If any of the social skills training modules (either Wallace's workplace fundamentals module or Tsang's module) are used together with IPS to form an integrated model, it is expected that the vocational outcome would even be better. It is suggested that this combined strategy may become a new model for psychiatric facilities to improve employment opportunities for people with mental illness. The remaining parts of this article describe a preliminary service protocol and a hypothetical case to illustrate the run down of this integrated approach.
A Preliminary Service Protocol
The service protocol consists of two basic intervention components: individual placement and support (IPS) and social skills training (SST SST: see airplane. ). The actual implementation follows the steps of a typical IPS program (Becker & Drake, 1993):
* Building a relationship
* Vocational assessment
* Individual employment plan
* Obtaining employment
* Follow-along support
Skills training begins to be an integral part of the treatment during the step of vocational assessment. Individual and Placement Support model emphasizes tracking experiences in competitive jobs. The goal is to find out how well the client does in a competitive job out in the community. Assessment should cover work background, current adjustment, work skills, and other work-related factors. Assessment on social skills necessary for seeking and maintaining a job should be incorporated into the above. The Vocational Social Skills Assessment Scale (VSSAS; Tsang & Pearson, 2000) may be used for this purpose. The scale consists of a 10 item self-administered checklist and a role-play exercise. The self-administered checklist aims at tapping the participants' perception of their own social competence and the role-play exercise assesses the participants' skills under simulated social situations. Validation studies showed that the scale had (.80 for the self-administered checklist and .96 for the role-play exercise) very good to excellent internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. . Meanwhile, the self-administered checklist had acceptable to good test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument (.35 to .78) while the role-play exercise had good to very good inter-rater reliability Inter-rater reliability, Inter-rater agreement, or Concordance is the degree of agreement among raters. It gives a score of how much , or consensus, there is in the ratings given by judges. (.77 to .90). The concurrent validity concurrent validity,
n the degree to which results from one test agree with results from other, different tests. was also statistically acceptable using the method of contrasted groups. In addition, observation checklists using the situational assessment principle will provide useful information about the clients' problems and needs.
Individual Employment Plan
In the stage of formulating an employment plan, a course of action after taking into account everything that the treatment team knows about the client related to the client's ability to get and hold a job should be worked out. As suggested by Becker and Drake (1993), the plan should consist of five sections: client's vocational goals, his/her related strengths and weaknesses, objectives enabling the client to meet his/her goals, the type of support the client wants from the employment specialist, and people/services/supports that will help the client achieve the objectives. In the proposed integrated approach, an emphasis should be given to the role social skills play in the individual employment plan. We should be fully aware of social skills needed by jobs that fall into the client's vocational plan. For instance, we should bear in mind that the client has to know how to handle complaints from customers if he/she plans to be an sales assistant sales assistant n (BRIT) → dependiente/a m/f
sales assistant (US), sales clerk sale n → vendeur/euse
in a department store. The social competence required would then become one of the objectives. Services or programs that improve the client's capability in this aspect should also be considered.
Before the process of obtaining employment, services or programs mentioned above that help the client to upgrade his/her level of social competence in attending job interviews and the workplace should be given. A typical example will be the social skills training module described above by Tsang (2001). In fact, the content of the module is flexible especially the core skills which are specific to the particular kind of job. This part should be tailor-made to suit the needs of the client. As described above, the program should not be prolonged. The program can be completed within a month. The client will then be guided by the employment specialist to enter a rapid job search program. This can be done by following employment advertisement, contacting the employers directly, using the consumer's social network, and job shadowing as suggested by Becker & Drake (1993).
Perhaps the most important process is the step of follow-along support. As mentioned by Becker and Drake, clients would not be able to maintain a job successfully without ongoing help. The IPS program offers clients a complete set of supports, from 24-hour emergency services emergency services Emergency care '…services …necessary to prevent death or serious impairment of health and, because of the danger to life or health, require the use of the most accessible hospital available and equipped to furnish those services' to peer support groups, employment counseling, benefits planning, and reliable transportation. With this integrated approach, ongoing support includes special emphasis on providing assistance to the clients how to develop and maintain good and cooperative working relationship with their fellow-workers, supervisors, and customers. This process can be conducted individually and in group. It can be conducted in the workplace, at clients' home or the psychiatric facility. Contents covered in the module are revised with the clients. Emphasis should be given to the generalization gen·er·al·i·za·tion
1. The act or an instance of generalizing.
2. A principle, a statement, or an idea having general application. of the skills taught. A problem solving approach should be used to help clients to handle their interpersonal conflicts.
Case Vignette Vignette
A symbol or pictorial representation of the corporation on a stock certificate. Usually a complicated and artistic design, it is meant to make the counterfeiting of stock certificates as difficult as possible.
Mr Cheung is a 32 year old single man. He came to Hong Kong Hong Kong (hŏng kŏng), Mandarin Xianggang, special administrative region of China, formerly a British crown colony (2005 est. pop. 6,899,000), land area 422 sq mi (1,092 sq km), adjacent to Guangdong prov. from the Chinese Mainland at the age of 15 with his family. His father died five years ago. He used to live with his mother who was overprotective o·ver·pro·tect
tr.v. o·ver·pro·tect·ed, o·ver·pro·tect·ing, o·ver·pro·tects
To protect too much; coddle: overprotected their children. and treated him like a child. His mother was now 65 years old, suffering from high blood pressure and subsisted on public assistance. Mr. Cheung was very dependent on his mother. Mr. Cheung completed primary school in China. After he came to Hong Kong, he studied one year in a secondary school with very poor results and had frequent conflicts with his classmates Classmates can refer to either:
Mr. Cheung was described by his mother to be an introvert introvert /in·tro·vert/ (in´tro-vert)
1. a person whose interest is turned inward to the self.
2. to turn one's interest inward to the self.
3. a structure that can be turned or drawn inwards. . He liked to stay at home and read books while he was in China. Nothing abnormal was observed. After migrating to Hong Kong, he started to have some abnormal behaviors which included talking to Noun 1. talking to - a lengthy rebuke; "a good lecture was my father's idea of discipline"; "the teacher gave him a talking to"
rebuke, reprehension, reprimand, reproof, reproval - an act or expression of criticism and censure; "he had to himself and saying that triad society Triad Society, name given to a number of Chinese antidynastic secret societies by 19th-century Western observers. Most of these groups claimed descent from the Heaven and Earth Society (Taendi hui) or the Triad Society (Sanhe hui), two secret societies of the late members were following him. Also, he did not like going to school because his schoolmates were teasing teasing
the act of parading a male before a female to see if she displays estrus, and is therefore in a state where mating is likely to be fertile. him. He then left school and worked as a restaurant worker. Yet he was dismissed after only working for a few weeks because of poor performance and conflicts with colleagues. He had never been gainfully employed since. He also developed the obsessive ob·ses·sive
Of, characteristic of, or causing an obsession.
ob·sessive n. compulsive com·pul·sive
Caused or conditioned by compulsion or obsession.
A person with behavior patterns governed by a compulsion.
the state of being subject to compulsion. feature of checking over the past two years. His mother took him for medical consultation because his personal hygiene personal hygiene person n → Körperhygiene f deteriorated significantly for a year and his checking behaviors occurred more frequently. He was subsequently receiving treatment in a supported employment team affiliated to a community-based psychiatric facility. His mental state was now more stable. After meeting the employment specialist in the team a couple of times, he began to have trust in the employment specialist and talked about his unpleasant experiences associated with his previous work experiences. He revealed that he had frequent conflicts with his fellow workers because of discrimination. Despite failures in the past, Mr. Cheung was still keen to get a job but he expressed that he did not know how to make this happen. The employment specialist then arranged a comprehensive vocational assessment for Mr. Cheung. In addition to the work sample and situational approaches, the specialist used the Vocational Social Skills Assessment Scale (VSSAS) to assess Mr. Cheung's social competence in getting and holding job. In the self-administered part, he rated himself from 3 (sometimes difficult) to 1 (always difficult) in most of the 10 items. Items that he ranked himself "always difficult" included "participate appropriately in a job interview", "resolve a conflict with supervisor" and "resolve a conflict with a colleague". During the role play exercise, he appeared to be very nervous and uncomfortable. When being asked about his work experience, he had a lot of pauses and hesitations.
Based on the assessment results, the therapist discussed with Mr. Cheung his likes, dislikes, and job preferences and formulated the employment plan for Mr. Cheung. They decided that being a cleaning worker in a restaurant would be the first choice. As social competence was a major problem of Mr. Cheung, he was referred to a vocational social skills training group which lasted for about one month. At the same time, the specialist met with Mr. Cheung regularly to give psychological support and practical advice about how to look for a job. Two weeks after the completion of the training program, Mr. Cheung was successful in securing a job as a cleaner in a fast-food shop.
One week after Mr. Cheung had started his job, the employment specialist met him in the workplace and had lunch together. Mr. Cheung looked sad and complained that his fellow-workers did not talk to him. The specialist reassured re·as·sure
tr.v. re·as·sured, re·as·sur·ing, re·as·sures
1. To restore confidence to.
2. To assure again.
3. To reinsure. him that the situation would improve if he took more initiative in a socially skilled manner. They went through the skills Mr. Cheung learned in the social skills training program and did some role play exercises with him. Mr. Cheung then took initiative to greet and initiated conversation with his colleagues. After three months, Mr. Cheung said that the situation had eventually improved. He now had a good friend in his workplace. Although there were new interpersonal problems, he tried to discuss these with the employment specialist and find a solutions for each problem.
For the next 12 months, the employment specialist and Mr. Cheung met regularly. During the meeting, they talked about everything that Mr. Cheung felt important, including his jobs, leisure, and finances. Whenever Mr. Cheung had problems with his colleagues or supervisor, the specialist reminded him of the social and problem-solving skills learned in the vocational social skills training group. When Mr. Cheung did not know how to apply materials learned previously to his day-to-day interpersonal problems, the specialist provided additional assistance to him so that he could bridge the gap in generalizing the skills to his job context. This strategy worked successfully for this year. Mr. Cheung settled well in his job and had no plan for changing his job anymore.
The above case shows that IPS goes smoothly together with the skills training approach. As the duration of the skills training module lasts only for one month, it does not contradict con·tra·dict
v. con·tra·dict·ed, con·tra·dict·ing, con·tra·dicts
1. To assert or express the opposite of (a statement).
2. To deny the statement of. See Synonyms at deny. the "place-then-train" approach of supported employment (Wehman, 1986). On the other hand, it acts as a supplement to IPS especially for clients who have obvious deficits in social skills that hinder hin·der 1
v. hin·dered, hin·der·ing, hin·ders
1. To be or get in the way of.
2. To obstruct or delay the progress of.
v.intr. their process of getting and holding a job. The above protocol is formulated at a theoretical level and based on indirect evidence available in the literature. A randomized clinical trial funded by the Health Services Research Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, Committee is now underway in Hong Kong to see if evidence matches with the above analysis.
This study was supported by the Health Services Research Grant H-ZK12 in Hong Kong. I would like to give my sincere thanks to Dr. Gary Bond and Ms. Debbie Becker for their comments in revising the manuscript leading to publication of this article in the Journal of Rehabilitation. I am also grateful to Wai Ming for her support.
Anthony, W. A., Howell, J., & Danley, K. S. (1984). Vocational rehabilitation of the psychiatrically disabled. In M. Mirabi (ed.), The chronically mentally ill: Research and services (pp. 215-237). New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Spectrum Publications.
Becker, D. R., & Drake, R. E. (1993). A working life: The individual placement and support (IPS) program. New Hampshire: Dartmouth Psychiatric Research Center.
Becker, D. R., Drake, R. E., Bond, G. R., Xie, H., Dain, B. J., & Harrison, K. (1998). Job terminations among persons with severe mental illness participating in supported employment. Community Mental Health Journal, 34 (1), 71-81.
Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Miesler, N., Lehman, A. F., Bell, M. D., & Blyker, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52 (3), 313-322.
Bond, G. R., Drake, R. E., & Becker, D. R. (1998). The role of social functioning in vocational rehabilitation. In K. T. Mueser & N. Tarrier tar·ry 1
v. tar·ried, tar·ry·ing, tar·ries
1. To delay or be late in going, coming, or doing. See Synonyms at stay1.
2. To wait.
3. (Eds.), Handbook of social functioning in schizophrenia (pp. 372-390). Boston: Allyn & Bacon.
Bond, G. R., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services, 48 (3), 335-346.
Brenner, M. A. (1987). Relation of economic and social well-being, 1950-1980. Social Science Medicine, 25, 183-196.
Cook, J. A. (1992). Job ending among youth and adults with severe mental illness. The Journal of Mental Health Administration, 19, 158-169.
Cook, J. A., & Razzano, L. (2000). Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophrenia Bulletin, 26 (1), 87-103.
Corrigan, P. W., Reedy, P., Thadani, D., &Ganet, M. (1995). Correlates of participation and completion in a job club for clients with psychiatric disability. Rehabilitation Counseling rehabilitation counseling,
n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the Bulletin, 39 (1), 42-53.
Dawis, R. (1987). A theory of work adjustment. In B. Bolton (ed). Handbook on the measurement and evaluation in rehabilitation, 2 ed. (pp. 207-217). Baltimore, MD: Paul H. Brooks.
Dion, G. L., & Anthony, W. A. (1987). Research in psychiatric rehabilitation: A review of experimental and quasi-experimental studies. Rehabilitation Counseling Bulletin, March, 177-203.
Drake, R. E., & Becker, D. R. (1996). The individual placement and support model of supported employment. Psychiatric Services, 47 (5), 473-475.
Drake, R. E., Becker, D. R., Biesanz, J. C., Torrey, W. C., McHugo, G. J., & Wyzik, P. F. (1994). Rehabilitative day treatment vs. supported employment: I. Vocational outcomes. Community Mental Health Journal, 30 (5), 519-532.
Drake, R. E., Becker, D. R., Clark, R. E., & Mueser, K. T. (1999). Research on the individual placement and support model of supported employment. Psychiatric Quarterly, 70 (4), 289-301.
Drake, R.E., McHugo, G.J., Bebout, R.R., Becker, M.H., Harris, M., Bond, G.R., & Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorder mental disorder
Any illness with a psychological origin, manifested either in symptoms of emotional distress or in abnormal behaviour. Most mental disorders can be broadly classified as either psychoses or neuroses (see neurosis; psychosis). Psychoses (e.g. . Archives of General Psychiatry Archives of General Psychiatry is a monthly professional medical journal published by the American Medical Association. Archives of General Psychiatry publishes original, peer-reviewed articles about psychiatry, mental health, behavioral science and related fields. , 56, 627-633.
Ekdawi, M. Y., Conning, A. M., & Campling, J. (1994). Psychiatric Rehabilitation-A practical guide. London: Chapman & Hall.
Gates, L. B. (2000). Workplace accommodation as a social process. Journal of Occupational Rehabilitation, 10 (1), 8598.
Jacobs, H. E., Wissusik, D., Collier, R., Stackman, D., & Burkeman, D. (1992). Correlates between psychiatric disabilities and vocational outcome. Hospital and Community Psychiatry com·mu·ni·ty psychiatry
Psychiatry focusing on detection, prevention, early treatment, and rehabilitation of emotional and behavioral disorders as they develop in a community. , 43 (4), 365-369.
Kelly, J. A., Laughlin, C., & Claiborne, M., et al. (1979). A group procedure for teaching job interviewing skills to formerly hospitalized psychiatric patients. Behavior Therapy behavior therapy or behavior modification, in psychology, treatment of human behavioral disorders through the reinforcement of acceptable behavior and suppression of undesirable behavior. , 10, 299310.
Lehman, A.F., Goldberg, R., Dixon, L.A. et al. (2002). Improving employment outcomes for persons with severe mental illnesses. Archive of General Psychiatry psychiatry (səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. , 59, 165-172.
Liberman R.P., DeRisi, W.J., & Mueser H.K. (1989). Social skills training for psychiatric patients. New York: Pergamon Press.
MacDonald-Wilson, K. L., Revell, W. G., Nguyen, N., & Peterson, M. E. (1991). Supported employment outcomes for people with psychiatric disability: A comparative analysis. Journal of Vocational Rehabilitation, 1 (3), 30-44.
Massel, H. K., Liberman, R. P., Mintz, J., Jacobs, H. E., Rush, T. V., Giannini, C. A., Zarate, R. (1990). Evaluating the capacity to work of the mentally ill. Psychiatry, 53, 31-43.
Mowbray, C. T., Bybee, D., Harris, S. N., & McCrohan, N. (1995). Predictors of work status and future work orientation in people with a psychiatric disability. Psychiatric Rehabilitation Journal, 19(2), 17-28.
Mueser, K. T., Foy, D. W., & Carter, M. J. (1986). Social skills training for job maintenance in a psychiatric patient. Journal of Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. , 33, 360-362.
Osipow, S. H. (1968). Theories of career development. New York: Appleton-Century-Crofts.
Penn, D.L., & Mueser, K.T. (1996). Research update on the psychosocial treatment of schizophrenia The concept of a cure as such in the treatment of schizophrenia remains controversial, as there is no consensus on the definition of "treatment" in the case of schizophrenia, although some criteria for the remission of symptoms have recently been suggested. . American Journal of Psychiatry The American Journal of Psychiatry (AJP) is the most widely read psychiatric journal in the world. It covers topics on biological psychiatry, treatment innovations, forensic, ethical, economic, and social issues. , 153 (5), 607-616.
Smith, R. (1987). Unemployment and health. Oxford: Oxford University Press.
Tsang, H. W. H. (2001). Social skills training for finding and keeping a job with the mentally ill. Psychiatric Services, 52 (7), 891-894.
Tsang, H. W. H., Ng, B., & Chiu, F. (2002). Job profiles of people with schizophrenia: Implications for rehabilitation. International Journal of Rehabilitation Research, 25 (3), 189-196.
Tsang, W., Lam, P., Ng, B., & Leung, O. (2000). Predictors of employment outcome of people with psychiatric disabilities: A review of the literature since mid 80s. Journal of Rehabilitation, 66 (2), 19-31.
Tsang, W., & & Pearson, V. (1996). A conceptual framework on work-related social skills for psychiatric rehabilitation. Journal of Rehabilitation, 62(3), 61-67.
Tsang, W., & Pearson, V. (2000). Reliability and validity of a simple measure for assessing the social skills of people with schizophrenia necessary for seeking and securing a job. Canadian Journal of Occupational Therapy, 67 (4), 250-259.
Tsang, H. W. H., & Pearson, V. (2001). A work-related social skills training for people with schizophrenia in Hong Kong. Schizophrenia Bulletin, 27 (1), 139-148.
Unger, K. V., & Anthony, W. A. (1984). Are families satisfied with services to young adult chronic patients. A recent survey and a proposed alternative, In B. Pepper & H. Ryglewicz (Eds.), Advances in treating the young adult chronic patients (New Directions for Mental Health Services health services Managed care The benefits covered under a health contract , No. 21, pp. 9197). San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden : Jossey-Bass.
Wallace, C. J., Tauber, R., & Wilde, J. (1999). Teaching fundamental workplace skills to persons with serious mental illness. Psychiatric Services, 50 (9), 1147-1153.
Wehman, P. (1986). Supported competitive employment for persons with severe disabilities. Journal of Applied Rehabilitation Counseling, 17, 24-29.
Xie, H., Dain, B. J., Becker, D. R., & Drake, R. E. (1997). Job tenure among persons with severe mental illness. Rehabilitation Counseling Bulletin, 40 (4), 230-239.
Hector W. H. Tsang, Ph.D., Associate professor, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University The Hong Kong Polytechnic University (Abbreviated:PolyU or HKPU Traditional Chinese: 香港理工大學 , Hung Hom Hung Hom (Traditional Chinese: 紅磡) is an area of Kowloon, in Hong Kong, administratively part of the Kowloon City District, with a portion west of the railway in the Yau Tsim Mong District. , Hong Kong. E-mail: firstname.lastname@example.org