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BACKGROUND: Fidelity scales are an important way to control the quality of implementation of psychosocial interventions such as supported employment programs. However, little is known about the utility of item level scores for informing the implementation of supported employment programs. OBJECTIVE: To explore the utility of item level scores from the IPS-25 fidelity scale for developing evidence based practices in supported employment for people with severe mental illnesses in Sussex, United Kingdom (UK). METHODS: Fidelity was assessed in 18 sites representing 34 independent cohorts where IPS was implemented by one organisation. Item-level fidelity scores were examined descriptively. Nine item level correlations were selected a-priori and examined with respect to two employment milestones and program attrition. RESULTS: Mean total fidelity score was associated with commencing competitive employment (r = 0.36, p = 0.04). None of the three items selected as likely to be related to either commencing employment or to employment duration, were correlated as expected. Of the three items selected as likely to influence attrition, only one ‘Rapid commencement of job searching’ was correlated as expected (r = 0.38, p = 0.02). CONCLUSIONS: Individual fidelity score items appear useful for improving supported employment programs, in terms of item response characteristics and expected correlations with particular program outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the predictive validity of two measures of fidelity to the individual placement and support (IPS) approach to supported employment.Design/methodology/approach A systematic review and meta-analysis was conducted of IPS programs. In total, 30 studies provided information characterizing 69 cohorts and 8,392 participants. Predictive validity was assessed by a precision and negative prediction analysis and by multivariate analysis of deviance.Findings Fidelity scores on the IPS-15 scale of 60 or less accurately predicted poor outcomes, defined as 43 percent or less of participants commencing employment, in 100 percent of cohorts. Among cohorts with IPS-15 fidelity scores of 61-75, 63 percent attained good employment outcomes defined as 44 percent or more commencing employment. A similar pattern emerged from the precision analysis of the smaller sample of IPS-25 cohorts. Multivariate analysis of deviance for studies using the IPS-15 scale examined six cohort characteristics. Following adjustment for fidelity score, only fidelity score (χ2=15.31, df=1, p<0.001) and author group (χ2=35.01, df=17, p=0.01) representing an aspect of cohort heterogeneity, remained associated with commencing employment.Research limitations/implications This study provides evidence of moderate, yet important, predictive validity of the IPS-15 scale across diverse international and research contexts. The smaller sample of IPS-25 studies limited the analysis that could be conducted.Practical implications Program implementation leaders are encouraged to first focus on attaining good fidelity, then supplement fidelity monitoring with tracking the percentage of new clients who obtain a competitive job employment over a pre-defined period of time.Originality/value The evidence indicates that good fidelity may be necessary but not sufficient for good competitive employment outcomes. [ABSTRACT FROM AUTHOR]

Introduction Few studies have examined the characteristics of people with psychiatric disorders who work excessive hours compared to those with other health conditions, or compared to others with no health conditions or disabilities. Methods We conducted a secondary analysis of data files provided by the Australian Bureau of Statistics from a 2003 population survey ( N = 23,851 in scope). We investigated candidate correlates of working excessive hours as the main dependent variable. Results Although, people with psychiatric disorders were less likely overall than healthy adults to work excessive hours, partnered males with dependant children, and males with higher educational attainment; were at greatest risk of working 49 or more hours per week. Conclusions People with psychiatric disorders have a substantial risk of over working, and this should be considered in their long term treatment and care. [ABSTRACT FROM AUTHOR]

Introduction Standard treatments for psychiatric disorders such as schizophrenia, depression and anxiety disorders are generally expected to benefit individuals, employers, and the wider community through improvements in work-functioning and productivity. Methods We repeated a previous secondary investigation of receiving treatment, labor force activity and self-reported work performance among people with ICD-10 psychiatric disorders, in comparison to people with other types of health conditions. Data were collected by the Australian Bureau of Statistics in 2003 repeating a survey administered in 1998 using representative multistage sampling strategies. The 2003 household probability sample consisted of 36,241 working age individuals. Results Consistent with the previous secondary investigation based on the 1998 survey administration, receiving treatment was consistently associated with non-participation in the labor force, and was negatively associated with work performance. Conclusions At a population level, receiving treatment was negatively associated with labor force activity and work performance. The stability of these results in two independent surveys highlights the need to investigate the longitudinal relationships between evidence-based treatments for psychiatric conditions as applied in real-world settings, and labor force participation and work performance outcomes. [ABSTRACT FROM AUTHOR]

Abstract: At a population level the extent that psychiatric disorders and other health conditions disrupt participation in education and employment is rarely considered simultaneously and remains largely unknown. This is an important issue because policy makers are as concerned with educational attainment, school to work transitions, and workforce skills, as they are with overall labour force participation. We investigated earning or learning, and educational attainment, among Australian community residents by age group and by category of psychiatric disorder. Data files were provided by the Australian Bureau of Statistics (ABS) from a population survey conducted in 2003 using a multi-stage probability sample (N =23,787). Adults with schizophrenia, depression, and anxiety disorders were compared to (1) working age adults with other non-psychiatric health conditions and disabilities; and (2) healthy adults of working age. Participation in formal education and employment was extensively disrupted by all health conditions and by psychiatric disorders in particular. The extent of career-related disruption provides benchmarks for policy makers and service providers attempting to increase participation in formal education and in the labour force. [Copyright &y& Elsevier]

At a population level, the extent that labour market conditions influence labour force activity among people with psychiatric disorders, remains equivocal. Similarly equivocal is the hypothesised relationship between economic conditions and the reported prevalence of specific psychiatric disorders. We investigated these issues by examining the extent that labour market conditions were associated with change in labour force activity among people with anxiety disorders, affective disorders, and schizophrenia, in comparison to healthy working age adults. Data files were provided by the Australian Bureau of Statistics (ABS) from a population survey conducted in 1998 and replicated in 2003. Multi-stage probability samples were obtained in 1998 ( N1 = 37,580) and 2003 ( N2 = 36,088). Adults with schizophrenia, depression, and anxiety disorders were compared to healthy working age adults. Greater labour demand in 2003 was positively associated with increased labour force participation among healthy adults. The proportions actively looking for work declined among healthy adults and among those with anxiety disorders. Full-time employment significantly increased among healthy working age residents. The proportions employed part-time significantly increased in all groups except among people with schizophrenia. These results support policies which remove disincentives and increase access to the more intensive evidence-based employment programs even when labour market conditions are improving. [ABSTRACT FROM AUTHOR]

An increased emphasis on community-based care has not ensured that people recovering from psychiatric disorders return to active and valued roles in their local communities. Although clinical recovery remains a priority for mental health services there is increasing recognition of the need for functional recovery to be attained and demonstrated in roles valued by the wider community. With this need in mind, a method for classifying socially-valued role functioning among people with schizophrenia or schizoaffective disorder was developed and trialed. Participants (n = 104) were recruited via mental health, psychosocial rehabilitation, and other community support services. Socially-valued roles were investigated via participation in five categories: (1) self-care and home duties; (2) caring for others; (3) self-development, voluntary work or rehabilitation; (4) formal education or training; and (5) employment. Activities were classified by primary role type and role status level at baseline, six, and 12 months. Current role status was assessed along with highest and lowest status in the previous year. Preliminary psychometric results were favorable. Research applications are now recommended for monitoring socially-valued role functioning in community settings. [ABSTRACT FROM AUTHOR]

Objectives: To compare employment functioning and disability among people with bipolar affective disorder in comparison to adults with schizophrenia. Methods: A secondary analysis was conducted using data from the Australian National Survey of Mental Health and Wellbeing 1997–1998. Participants were aged 18–64 years with a DSM-III-R diagnosis of either bipolar affective disorder (BPD, n = 156) or schizophrenia (n = 385) and were community residents with either outpatient or short-stay inpatient status. The survey began by screening 5,710 people for psychosis, hence the sample consists mostly of bipolar disorder with psychotic features. Those with BPD were examined both in aggregation with and in contrast to people with schizophrenia on 24 independent variables covering demographic, clinical, and functioning characteristics with respect to two employment status variables and a global rating of social and occupational functioning. Results: The unadjusted and fully adjusted models revealed key functioning differences between BPD and schizophrenia. Adjusted correlates of employment functioning unique to people with BPD were: age, course of disorder, insight into positive symptoms, impairment attributed to medication, family history of schizophrenia, lifetime substance dependence, and lifetime repeated use of illicit or non-prescription drugs. Conclusions: The population-level correlates of employment functioning among people with BPD warrant special attention when providing both clinical and vocational assistance. Employment functioning in both BPD and schizophrenia is partly explained by demographic, clinical and functioning correlates, which can be independent of global assessments of social and occupational functioning. [ABSTRACT FROM AUTHOR]

Background: People remanded into custody by the courts have a substantially higher rate of severe mental disorder than other prisoners and the general population. Knowledge of their prevalence, needs and characteristics and an analysis of pathways to care may be necessary to provide mental health care effectively and efficiently. Previous prison studies focusing on psychotic offenders have suffered from the use of instruments not validated in a forensic setting and lack of a relevant comparison group. Method: The Diagnostic Interview for Psychosis (DP) is a composite semi-structured standardized interview schedule. It combines social and demographic descriptors with measures of functioning adapted from the World Health Organisation Disability Assessment Schedule (DAS). The remand centre surveyed had 466 cells and is the main remand and reception centre for males for the southern region of the state of Queensland, Australia. Of the 621 men screened, 65 answered yes to at least one question in the DP and were interviewed. Results: Six hundred and twenty-one remandees were screened and of these 61 were interviewed as screened positive for psychotic disorder. Thirty-five per cent had been homeless for an average of 32 weeks during the previous year. Most had had little contact with families or close friends. Eighty-one per cent were receiving no treatment at the time of offence. Seventy-eight per cent were unemployed and in receipt of a pension. Eighty per cent were dependent on alcohol, cannabis or amphetamines. Statistical issues of power are detailed in the text. Conclusions: The simplistic ‘prison, hospital or community treatment’ debate is misleading. Instead, the development of flexible preventative, management and accommodation services for people with severe mental disorder who have committed offences is a priority. [ABSTRACT FROM AUTHOR]

The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon.This study was based on secondary analysis of data collected in the national‘Disability, Ageing and Carers Survey, 1998’. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling.Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individual's capacity to participate in a clinical assessment is limited. [ABSTRACT FROM AUTHOR]

Background: While much attention has been given to the prediction of violent offending behaviour amongst people with psychotic disorders, less attention has been given to the fact that these same individuals are often the victims of violence. In this paper, we examine victimisation amongst participants in a prevalence study of psychosis, and describe demographic and clinical correlates of victimisation. METHOD The study was based on the Australian National Survey of Mental Health and Wellbeing--Low Prevalence (Psychotic) Disorders. The participants were asked if they had been a victim of violence in the previous year. The association between selected demographic and clinical variables and being a victim of violence was examined using logistic regression.Results: Of the 962 individuals with psychosis, 172 reported being a victim of violence in the past 12 months (17.9 %). The odds of being a victim were increased in those who: (a) were female, (b) were homeless, (c) had a lifetime history of substance abuse, (d) had been arrested in the previous 12 months, (e) had poorer social and occupational function, and (f) had higher scores on the disorganisation summary score.Conclusions: Clinicians should remain mindful that one out of every six individuals with a psychotic disorder reports being a victim of violence in the previous year. Models of care that address issues related to symptom relief, accommodation, and exposure to high-crime areas may reduce the rates of victimisation amongst those with psychotic disorders. [ABSTRACT FROM AUTHOR]

The article reports on the result of the study which assesses the factors that contribute to the development of psychological distress among employees in the workplace. The study has evaluated the data provided by 60,556 full-time employees in the Health and Performance at Work Questionnaire with the utilization of the Kessler 6 (K6) health risk assessment (HRA) survey. It reveals that 4.5 percent of full-time employees suffer from psychological distress where only 22 percent receive treatment. It was found that working for more than 6-hours a week is the major factor that contributes to the development of the mental illness. It states that the findings play essential role in the development of health care programs which aim to treat the disorder.