‘Placement budgets’ for supported employment – improving competitive employment for people with mental illness: study protocol of a multicentre randomized controlled trial

BMC Psychiatry

Wulf Rössler¹  Nicolas Rüsch¹  Helene Haker¹  Bettina Bärtsch¹  Wolfram Kawohl¹  Elisabeth Brantschen¹  Carlos Nordt¹ 

[1] Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Lenggstrasse 31, PO Box 1931, 8032, Zürich, Switzerland

关键词: Switzerland;    Stigmatization;    Social support;    Social network;    Randomized controlled trial;    Supported employment;    Mental illness;   

Others  :  1124266
DOI  :  10.1186/1471-244X-12-165

 received in 2012-04-25, accepted in 2012-09-27,  发布年份 2012

【 摘 要 】

Background

Vocational integration of people with mental illness is poor despite their willingness to work. The ‘Individual Placement and Support’ (IPS) model which emphasises rapid and direct job placement and continuing support to patient and employer has proven to be the most effective vocational intervention programme. Various studies have shown that every second patient with severe mental illness was able to find competitive employment within 18 months. However, the goal of taking up employment within two months was rarely achieved. Thus, we aim to test whether the new concept of limited placement budgets increases the effectiveness of IPS.

Methods/Design

Six job coaches in six out-patients psychiatric clinics in the Canton of Zurich support unemployed patients of their clinic who seek competitive employment. Between June 2010 and May 2011 patients (N=100) are randomly assigned to three different placement budgets of 25h, 40h, or 55h working hours of job coaches. Support lasts two years for those who find a job. The intervention ends for those who fail to find competitive employment when the respective placement budgets run out. The primary outcome measure is the time between study inclusion and first competitive employment that lasted three months or longer. Over a period of three years interviews are carried out every six months to measure changes in motivation, stigmatization, social network and social support, quality of life, job satisfaction, financial situation, and health conditions. Cognitive and social-cognitive tests are conducted at baseline to control for confounding variables.

Discussion

This study will show whether the effectiveness of IPS can be increased by the new concept of limited placement budgets. It will also be examined whether competitive employment leads in the long term to an improvement of mental illness, to a transfer of the psychiatric support system to private and vocational networks, to an increase in financial independence, to a reduction of perceived and internalized stigma, and to an increase in quality of life and job satisfaction of the patient. In addition, factors connected with fast competitive employment and holding that job down in the long term are being examined (motivation, stigmatization, social and financial situation).

Trial register

ISRCTN89670872

【 授权许可】

   
2012 Nordt et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Burns T, Catty J, White S, Becker T, Koletsi M, Fioritti A, Rössler W, Tomov T, van Busschbach J, Wiersma D, Lauber C for the EQOLISE Group: The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophr Bull 2009, 35:949-958.
• [2]Becker DR, Drake RE: A Working Life for People with Severe Mental Illness. New York: Oxford University Press; 2003.
• [3]Crowther RE, Marshall M, Bond GR, Huxley P: Helping people with severe mental illness to obtain work: systematic review. BMJ 2001, 322:204-208.
• [4]Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, van Busschbach J, White S, Wiersma D, for the EQOLISE Group: The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 2007, 370:1146-1152.
• [5]Tausig M: Work and mental health. In Handbook of the sociology of mental health. Edited by Aneshensel CS, Phelan JC. New York: Kluwer Academic/Plenum Publishers; 1999:255-274.
• [6]Müller B, Nordt C, Lauber C, Rössler W: Changes in social network diversity and perceived social support after psychiatric hospitalization: results from a longitudinal study. Int J Soc Psychiatry 2007, 53:564-575.
• [7]Nordt C, Müller B, Rössler W, Lauber C: Predictors and course of vocational status, income, and quality of life in people with severe mental illness: a naturalistic study. Soc Sci Med 2007, 65:1420-1429.
• [8]Wewiorski NJ, Fabian ES: Association between demographic and diagnostic factors and employment outcomes for people with psychiatric disabilities: a synthesis of recent research. Ment Health Serv Res 2004, 6:9-21.
• [9]Catty J, Lissouba P, White S, Becker T, Drake RE, Fioritti A, Knapp W, Lauber C, Rössler W, Tomov T, van Busschbach J, Wiersma D, Burns T, on behalf of the EQOLISE Group: Predictors of employment for people with severe mental illness: results of an international six-centre randomised trial. Br J Psychiatry 2008, 192:224-231.
• [10]Fishbein M, Ajzen I: Belief, attitude, intention, and behaviour. Reading, MA: Addison-Wesley; 1975.
• [11]Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP: A modified labeling theory approach to mental disorders: an empirical assessment. Am Sociol Rev 1989, 54:400-423.
• [12]Müller B, Nordt C, Lauber C, Rüesch P, Meyer PC, Rössler W: Social support modifies perceived stigmatization in the first years of mental illness: a longitudinal approach. Soc Sci Med 2006, 62:39-49.
• [13]Corrigan PW, Powell KJ, Rüsch N: How does stigma affect work in people with serious mental illnesses? Psychiatr Rehabil Jin press
• [14]Rüsch N, Corrigan PW, Wassel A, Michaels P, Olschewski M, Wilkniss S, Batia K: A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophr Res 2009, 110:59-64.
• [15]Ritsher JB, Otilingam PG, Grajales M: Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003, 121:31-49.
• [16]Drake RE, Bond GR, Rapp C: Explaining the variance within supported employment programs: comment on "What predicts supported employment outcomes?". Community Ment Health J 2006, 42:315-318.
• [17]Edwards J, Jackson HJ, Pattison PE: Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. Clin Psychol Rev 2002, 22:789-832.
• [18]Baron-Cohen S, Jolliffe T, Mortimore C, Robertson M: Another advanced test of theory of mind: evidence from very high functioning adults with autism or asperger syndrome. J Child Psychol Psychiatry 1997, 38:813-822.
• [19]Rössler W, Lackus B: Cognitive disorders in schizophrenics viewed from the attribution theory. Eur Arch Psychiatry Neurol Sci 1986, 235:382-387.
• [20]Haker H, Rössler W: Empathy in schizophrenia: impaired resonance. Eur Arch Psychiatry Clin Neurosci 2009, 259:352-361.
• [21]Davis MA: A multidimensional approach to individual differences in empathy. JSAS Cat Sel Doc Psychol 1980, 10:85.
• [22]Roick C, Kilian R, Matschinger H, Bernert S, Mory C, Angermeyer MC: Die deutsche Version des Client Sociodemographic and Service Receipt Inventory: Ein Instrument zur Erfassung psychiatrischer Versorgungskosten. Psychiatr Prax 2001, 28(Suppl 2):84-90.
• [23]Meyer PC: Rollenkonfigurationen, Rollenfunktionen und Gesundheit. Zusammenhänge zwischen sozialen Rollen, sozialem Stress, Unterstützung und Gesundheit. Opladen: Leske+Budrich; 2000.
• [24]Resnick SG, Bond GR: The Indiana Job Satisfaction Scale: Job satisfaction in vocational rehabilitation for people with severe mental illness. Psychiatr Rehabil J 2001, 25:12-19.
• [25]Angermeyer MC: WHO-QoL-Bref, Kurzversion des Fragebogens zur gesundheitsbezogenen Lebensqualität, deutsche Version. Leipzig: Universitätsklinikum, Klinik und Poliklinik für Psychiatrie; 1998.
• [26]Franke GH: BSI, Kurzversion des SCL-90 von Derogatis, deutsche Version. Göttingen: Beltz; 2000.
• [27]Rosenberg M: Conceiving the Self. New York: Basic Books; 1979.
• [28]Aster M, Neubauer A, Horn R (Eds): Wechsler Intelligenztest für Erwachsene. Deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler. Frankfurt/M: Harcourt Test Services; 2006.
• [29]Aschenbrenner S, Tucha O, Lange KW: RWT, Regensburger Wortflüssigkeits-Test. Göttingen: Hogrefe; 2000.
• [30]Bäumler G: Farbe-Wort-Interferenztest (FWIT) nach J.R. Stroop. Handanweisung. Göttingen: Hogrefe; 1985.
• [31]Helmstaedter C, Lendt M, Lux S: Verbaler Lern- und Merkfähigkeitstest, VLMT. Göttingen: Beltz Test GmbH; 2001.
• [32]Dilling H, Mombour W, Schmidt MH (Eds): Internationale Klassifikationen psychischer Störungen ICD-10. Bern: Huber; 1991.
• [33]Sass H, Wittchen H-U, Zaudig M: Diagnostisches und Statistisches Manual Psychischer Störungen DSM-IV. Göttingen: Hogrefe; 1996.
• [34]Internationale Skalen für Psychiatrie. Collegium Internationale Psychiatriae Scalarum. Weinheim: Beltz; 1986.
• [35]Linden M, Baron S: Das “Mini-ICF-Rating für psychische Störungen (Mini-ICF-P)”. Ein Kurzinstrument zur Beurteilung von Fähigkeitsstörungen bei psychischen Erkrankungen. Rehabilitation 2005, 44:144-151.
• [36]Collett D: Modelling survival data in medical research. 2nd edition. Boca Raton: Chapman & Hall/CRC; 2003.
• [37]Brown H, Prescott R: Applied mixed models in medicine. Chichester: Wiley; 1999.
• [38]Becker DR, Xie H, McHugo GJ, Halliday J, Martinez RA: What predicts supported employment program outcomes? Community Ment Health J 2006, 42:303-313.
• [39]Drake RE, Bond GR: The future of supported employment for people with severe mental illness. Psychiatr Rehabil J 2008, 31:367-376.