An In-House Vocational Training (IHVT) Program for Individuals With Chronic Mental Illnesses: The Employment Outcomes Reported by a Multicenter Study

PURPOSE: This study introduces an innovative in-house vocational training (IHVT) program for people with chronic psychiatric disorders (CPD). We explore the program outcomes including employment rates and employment sustainability and determine the program parameters significantly predictive of the outcomes.

RATIONALE: People with CPD worldwide continue to experience low employment rates. The IHVT program reflects the occupational therapy's Centennial Vision in disseminating evidence that supports the profession's role in mental health by helping the clients develop the skills necessary for productive living.

DESIGN: This was a multicenter cohort design examining the outcomes of the IHVT program. This program is implemented by occupational therapists in 4 regional psychiatric hospitals of Taiwan. It uses the existing spaces, facilities and manpower of the hospitals along with community sources to train participants in various job options. The program includes 3 areas: (a) the work-related behavior training, (b) the on-the-job skill training, and (c) the life balance counseling.

PARTICIPANTS: The study included 323 participants with CPD who were newly discharged patients of the hospitals, and who completed the IHVT program and the follow-up interviews.

DATA COLLECTION: The outcome (dependent) variables were employment rates and the sustainability of employment. Employment rates were the percentages of participants who were employed at the 1^st-, 3^rd-, and 6^th-month follow-up interviews. The sustainability of employment during the first 6 months post-training was graded into 5 levels, from very low sustainability (not employed throughout) to high sustainability (employed throughout the 6 months). Eight program parameters such as participant's pre-training evaluation, therapist's obtaining additional job training, and life balance counseling time were treated as predictive (independent) variables.

DATA ANALYSIS: Analyses used to preselect program parameters and identify control variables (e.g., participant demographics) included Chi-square test and simple logistic regression for categorical data, and ANOVA and Pearson's r for continuous data. Finally, the generalized estimating equation (GEE) was used to confirm the program parameters predictive of the employment outcomes.

RESULTS: Satisfactory employment rates were found at the1^st-, 3^rd-, and 6^th-month follow-ups (52.9%, 60.4%, and 65.6%, respectively) and 38.7% of participants demonstrated a high sustainability of employment (employed throughout the 6 months). Three program parameters predicted the employment outcomes: (a) occupational therapists’ pursuing additional training (b) post-training vocational counseling service, and (c) the duration of 6 months post-training.

CONCLUSION: A holistic and client-centered employment service program should include the areas of work-related behaviors, on-the-job skills, and life balance issues along with the ongoing vocational counseling. Practitioners should consider the followings when developing a vocational training program for people with CPD: (1) when applicable, therapists should pursue additional training or short-term apprenticeship pertinent to the clients’ job interests (2) post-training vocational counseling should be provided continuously by community-based occupational therapists, and (3) sufficient time post-training (>6 months) should be included to allow the clients to prepare for competitive employment.

IMPACT STATEMENT: The outcomes yielded by the IHVT program support the role of occupational therapy in helping people with CPD develop the skills and obtain the supports necessary for employment, which echoes the profession's philosophical core of emphasizing the sense of self-worth and productivity of the clients.

References

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