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Because of work's contribution to recovery, governments have moved to improve employment rates of people with severe mental disorders (SMDs). Social enterprises (SEs) have been identified as a means to achieve employment. In Ontario, Canada, the Ministry of Health and Long-Term Care (MOHLTC) have provided SEs government subsidies. Public funding arrangements create a potential trade-off for governments that must decide how to distribute constrained budgets to meet a variety of public needs. In Ontario, the government is potentially faced with choosing between supporting employment versus healthcare services. This study addresses the question, are there significant differences in service use and costs from the MOHLTC's perspective for people with SMDs working in SEs versus those who are not working and looking for work? Our results indicate there is a significant difference in healthcare use between the two groups suggesting there could be less healthcare use associated with SE employment. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory and descriptive study contributes to the growing knowledge about the return-to-work (RTW) experience of head and neck cancer (HNC) survivors. Viewing RTW as a process, participants were asked to consider the work-related experience with HNC at different phases: (1) at diagnosis/pre-treatment, (2) working during treatment (if the respondent did not take a work disability leave), and (3) post-treatment/RTW (if the respondent took a work disability leave).Methods: Data were gathered in nine individual semi-structured in-depth interviews with patients receiving treatment at a quaternary cancer center’s HNC clinic in Ontario, Canada. Using a constant comparative method of theme development, codes were identified in and derived from the data. Codes with similar characteristics were grouped, used to develop overarching themes, and were organized according to the RTW factors identified in the literature.Results: Each phase has different barriers that are in turn addressed by different facilitators. As reflected in the literature, we found that RTW or the process of work continuation is complex. Many players and interactions contribute to the worker’s experience.Conclusions: By recognizing that work-related experiences differ by phases, clinicians and employers can better support HNC survivors depending on the phase of the RTW process. Implications for Rehabilitation Our findings suggest that when rehabilitation specialists are working with survivors to develop interventions, the return-to-work phase and work context rather than diagnosis should be considered as a starting point.At every phase, supportive and empathetic managers are a key to successful work experiences for people who have been diagnosed and are being treated for head and neck cancer.Rehabilitation specialists should help survivors to seek supportive interactions with the environment that are essential to enable the ability to work. [ABSTRACT FROM AUTHOR]

Objective: Because health care resources are constrained, decision-making processes often require clarifying the potential costs and savings associated with different options. This involves calculating a program's costs. The chosen costing perspective defines the costs to be considered and can ultimately influence decisions. Yet reviews of the literature suggest little attention has been paid to the perspective in economic evaluations. This article's purpose is to explore how the costing perspective can affect cost estimates.Method: As a vehicle for our discussion, we use service use data for clients enrolled in 6 Ontario early psychosis intervention programs. Governmental and nongovernmental payer costing perspectives are considered. We examine annual costs associated with early psychosis intervention clients enrolled for ≤12 months versus those enrolled for >12 months. This also allows for an assessment of the impact that choice of time horizon can make on the results.Results: The difference in total between group cost for hospital, emergency room, and physicians is $2499; the >12-month group has relatively higher mean costs. When all governmental and nongovernmental costs are considered, there is a mean between-group cost difference of $1272, with lower mean costs for the >12-month group.Conclusions: Although the Ministry of Health bears a large proportion of costs, other governmental agencies and the private sector can incur a sizeable share. This example demonstrates the potential importance of including other cost perspectives with the hospital sector in analyses as well as the impact of time horizon on cost estimates. [ABSTRACT FROM AUTHOR]

Using administrative data from the public long-term disability support program in Ontario, Canada, this paper examines the factors related to receipt of a paid employment benefit. These analyses include only ODSP beneficiaries who were primary beneficiaries, who had active files in March 2011 and who were <65 years of age and had a disability-related primary diagnosis (n = 253,492). About 9 % of primary beneficiaries received the employment benefit. Logistic regression results suggest that compared to those who have a disability related to a physical disorder, those who have a psychotic disorder (OR 1.125), a mood disorder (OR 1.139) or a developmental disability (OR 1.618) are significantly more likely to receive the benefit while those who have a substance use disorder were significantly less likely (OR 0.540). These results indicate that a proportion of people who receives public disability benefits are employed. In addition, all things being equal, people with mental disorders are more likely to use this type of program than people with physical disorders. [ABSTRACT FROM AUTHOR]

Objectives: To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level.Method: Three major financial reimbursement models--fee-for-service, capitation, and blended payment mechanisms--are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism.Results: The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment.Conclusions: Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care. [ABSTRACT FROM AUTHOR]

Background Direct support providers (DSPs) in community residential services are often central figures in the lives of service recipients. There is little research to date focusing on what motivates these employees to remain in the field despite stressful work conditions. Methods An exploratory descriptive analysis of qualitative data obtained from semistructured interviews with 19 community residential DSPs in Ontario, Canada, was conducted. Data were analysed for modes of entry into the field and reasons for remaining. Results DSPs are motivated to remain in the sector because of the people supported, the nature of the work and the work environment, practical reasons like job security, and personal ambitions and reward. Most staff are motivated in multiple domains. Conclusion Future research can use these findings to further explore DSP work motivations and relationships to job performance and turnover. For researchers and human resource practitioners, adapting existing models and measures of organisational commitment may be a useful strategy for studying and utilising knowledge of DSP motivations. [ABSTRACT FROM AUTHOR]

Objective: This article estimates the decrease in workplace productivity losses associated with removal of three types of barriers to mental health service use among workers with depression. Methods: A model of productivity losses based on the results of a population-based survey of Canadian workers was used to estimate the impact of three types of barriers to mental health service use among workers with depression. Results: Removing the service need recognition barrier is associated with a 33% decrease in work productivity losses. There is a 49% decrease when all three barriers are removed. Conclusions: Our results suggest recognizing the need for treatment is only one barrier to service use; attitudinal and structural barriers should also be considered. The greatest decrease in productivity losses is observed with the removal of all three barriers. [ABSTRACT FROM AUTHOR]

Background: There is a significant proportion of workers with mental disorders who either are struggling at work or who are trying to return to work from a disability leave. Objective: Using a population-based survey of working adults in Ontario, Canada, this paper examines the perceptions of workers towards mental disorders in the workplace. Methods: Data are from a sample of 2219 working adults identified through random digit dialing who either completed a telephone questionnaire administered by professional interviewers or a web-based survey. Results: A third of workers would not tell their managers if they experienced mental health problems. Rather than a single factor, workers more often identified a combination of factors that would encourage disclosure to their managers. One of the most identified disincentives was the fear of damaging their careers. The most pervasive reasons for concerns about a colleague with a mental health problem included safety and the colleague's reliability. Conclusion: Although critical for workers who experience a mental disorder and who find work challenging, a significant proportion do not seek support. One barrier is fear of negative repercussions. Organizations' policies can create safe environments and the provision of resources and training to managers that enable them to implement them. By making disclosure safe, stigma and the burden of mental disorders in the workplace can be decreased. [ABSTRACT FROM AUTHOR]

Experiencing aggressive behaviour has been associated with increased stress and turnover among staff who support adults with intellectual disabilities. Incident perception is a strong predictor of psychological outcomes after trauma but has not been studied in this staff group. This study clustered exposure to aggression and endorsement of emotional difficulties among 386 community residential group home staff and evaluated the contribution of four behavioural topographies to staff-rated perceived severity. Staff exposure varied considerably. Perceived severity correlated with subjective emotional difficulties. High perceived severity was associated with daily exposure, aggression towards others causing injury, and property aggression causing injury or damage. Therefore, the role the staff plays, whether a witness or target, may impact their experience. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities ( ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. Background Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. Design This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. Methods Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. Results Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion ( EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. Conclusions Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. Relevance to clinical practice There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe. [ABSTRACT FROM AUTHOR]

Individuals experiencing their first psychotic episode report rates of substance and tobacco use that are higher than observed in the general population. In this sample of individuals diagnosed with first episode psychosis, rural/non-rural variations in substance use and smoking behaviour were evaluated. Analyses were performed utilizing data from a sample of individuals enrolled in early intervention programs located throughout the province of Ontario. Based upon population density, two geographical regions were developed: rural and non-rural. Illicit drug use, alcohol consumption, and smoking behaviour were assessed. The total sample consisted of 152 individuals experiencing their first episode of psychosis. Of these individuals, 82 and 70 resided in rural and non-rural areas, respectively. Rural vs non-rural residence was not significantly associated with substance or tobacco use. Regardless of geographical location, early intervention programs for individuals experiencing their first psychotic episode need to incorporate interventions that address substance use. [ABSTRACT FROM AUTHOR]

Background Studies have shown that staff who support adults with intellectual disabilities (ID) are exposed to challenging behaviour in their work including client aggression. Exposure to aggressive behaviour has been associated with staff stress and burnout. Study samples have been small however, and there has been very little data exploring this issue among North American staff. Methods A cross-sectional survey which included demographics, measures of frequency and severity (including perceived severity and a standardised severity score) of exposure to client aggression and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was completed by 926 community staff who support adults with ID in Ontario, Canada. Relationships between demographic variables and exposure to aggression were examined with descriptive statistics. Pearson correlations were used to analyse exposure variables and MBI-HSS scores. Results Nearly all staff reported being exposed to client aggression in the prior 6 months. Mean MBI-HSS scores were comparable to previously published data in similar populations with the exception of a higher score in the personal accomplishment domain. All measures of exposure to aggression were significantly positively correlated with MBI-HSS scores in the emotional exhaustion and depersonalisation dimensions of burnout. Conclusions The prevalence of burnout in this North American sample is comparable to what has been reported in similar populations in other locations, although these staff may have a higher sense of accomplishment with regard to their work. Findings from this large sample support the evidence that exposure to client aggression affects staff emotional well-being but is by no means the only important factor. Further study is needed to explore the differences and similarities reported here as well as other contributing factors which will guide the implementation of effective strategies to improve staff well-being. [ABSTRACT FROM AUTHOR]

Background Psychological trauma in the workplace is gaining recognition as an important cause of workplace disability but little is known about the workers who are affected. The Psychological Trauma Program (PTP) in Toronto (Canada) is a specialized provincial worker's compensation board assessment program for workers with psychological sequelae of workplace trauma.Aims To characterize workers presenting to the PTP in terms of demographic, occupational, traumatic exposure and diagnostic variables.Methods A retrospective secondary analysis of all workers referred to the PTP for assessment within 1 year of traumatic event between 1999 and 2006.Results Five hundred and thiry-one referred workers were included in the study. Most workers were working-age male (76%), married (65%) and labourers (43%). Nearly half were born outside Canada. Post-traumatic stress disorder was the primary diagnosis in 44%. Fifty-eight percent had one or more secondary diagnoses. For just over half of the workers, the traumatic event resulted in a permanent physical impairment.Conclusions Specialist referral may be indicated for workers experiencing prolonged recovery following workplace trauma. Male workers and those with co-morbidities or permanent injuries may be more likely to require referral. Individualized treatment approaches are likely important; however, more research is needed to guide future interventions. [ABSTRACT FROM AUTHOR]

Studies of continuity of care (CoC) have largely been quantitative and have originated outside of Canada. This qualitative study examined CoC using verbatim transcripts of interviews with 45 clients and 22 family members of early intervention or court support programs in Ontario. Data were analyzed drawing on Dewa et al.'s (this volume) conceptualization of CoC, which has orderliness, and temporal and cross-sectional aspects. Our analysis revealed a high degree of convergence in clients' and families' perspectives regarding key features of each of the five dimensions, indicating that indeed all dimensions are important to clients and families. [ABSTRACT FROM AUTHOR]

In this paper we examine the changes in continuity of care (CoC) likely to be affected by new system investments and the contributing factors. A mixed method approach was used. Decision-makers participated in two rounds of qualitative interviews. A 3-year cross-sectional quantitative data collection approach was used with clients and case managers. A main finding was that new system investments can improve CoC in terms of increased care access. However, it is not clear how other CoC dimensions will be affected. New funding can also have negative consequences related to the service models in which investments are made. [ABSTRACT FROM AUTHOR]

Abstract: Community mental health services benefit from measuring clinical outcomes relevant to a community-based context in contrast to medically modeled outcomes. The Multnomah Community Ability Scale (MCAS) addresses broad dimensions of community functioning and was developed for clinical and evaluation purposes. We assessed the structural consistency and fit of the scale as a measure of community functioning through confirmatory factor analysis using a longitudinal sample of individuals (n =408) with severe and persistent mental illness receiving services from community mental health programs. None of the previously hypothesised factor solutions achieved a good fit and a high degree of invariance over time was observed. Through exploratory factor analysis, the possibility of alternative solutions was explored. After exclusion of two of the 17 items, four models – including four-, three-, two- and one-factor solutions - were tested for fit and invariance with no improvement. We discuss our findings of poor fit under the assumption that the MCAS should psychometrically behave as a scale. Alternative interpretations for the tool and suggestions for the use of its items as an index that measures aspects of disability are proposed. [Copyright &y& Elsevier]