Archival data from 25,480 adults entering the Compensated Work Therapy (CWT) program of the Veterans Health Administration were analyzed to identify differences in work functioning and vocational r...

Patterns in Work Functioning and Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance Use Disorders

The relationship between substance use disorder and vocational functioning among people with severe mental illness.

According to 2007 statistics reported by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2008), there were an estimated 22.3 million individuals in the U.S. aged 12 or older (9% of the population) who met the DSM-IV diagnostic criteria for either substance abuse or dependence. Of those 22.3 million, 15.5 million were classified with alcohol abuse or dependence, 3.7 million were classified with drug abuse or dependence, and approximately 3.2 million had abuse or dependence on both alcohol and drugs. The present study examines employment outcomes and workplace accommodation issues for individuals with substance abuse disorders. Rehabilitation Services Administration (RSA) client service records show the types of employment successfully rehabilitated individuals have attained. Workplace accommodation information, however, is not included in the RSA case-closure record (RSA-911 form). Given the importance of workplace accommodations, data from the Job Accommodation Network (JAN) have been incorporated to provide a more complete picture of the services needed for individuals with substance abuse disorders to retain employment. Thus, the focus of the current article is on approaches to serving individuals with substance abuse disorders, drawn from two databases. Analyses are conducted to examine the rates of successful employment outcomes (case closures) of clients with either alcoholism or drug addictions who were served by the State/Federal Vocational Rehabilitation System across three years (1996, 2000, 2004). A primary reason for selecting 1996 as the first year for the RSA data was that the available JAN database spanned 1996 to 2005. Counselors in the Rehabilitation Services Administration (RSA) provide counseling and employment-related services to individuals with disabilities to obtain employment and live more independently (Rehabilitation Services Administration, 2006). Analyses are conducted to examine the prevalence of accommodation inquiries made to the Job Accommodation Network (JAN) for clients with substance abuse (alcoholism or drug addiction). JAN is a free resource for information regarding job accommodations and Title I of the ADA. The service is available free of charge to anyone, but the majority of inquiries (68%) are from employers and individuals with disabilities. JAN averages about 32,000 telephone inquiries (cases) per year and provides one-on-one consultation (and follow-up materials and communications, as necessary) to each person about all aspects of job accommodation, including the accommodation process, effective accommodation options, funding sources for accommodations, product information, disability awareness, and legal rights and responsibilities under the employment provisions of the ADA. The following research questions are investigated: 1. What are the demographic characteristics for individuals with substance abuse disorders (Alcoholism vs Drug Addiction) who received Vocational Rehabilitation services? 2. Are there differences between clients (consumers) with Alcoholism vs Drug Addiction, in terms of Vocational Rehabilitation services received and outcome (rehabilitated vs not rehabilitated)? 3. What occupations were involved for those Vocational Rehabilitation consumers whose outcomes were successful (rehabilitated)? 4. In the JAN case data for substance abuse calls from 1996 to 2005, what are the relative proportions of (a) Causative Factor, (b) Caller Industry, (c) Job Function, and (d) Issue Discussed? 5. What commonalities link the findings from the RSA cases to the findings from the JAN cases on substance abuse disorders? In the workplace, individuals with substance abuse disorders often exhibit difficulties with attendance, concentration, staying organized, meeting deadlines, handling stress, and maintaining stamina during the workday (Batiste, 2005a; 2005b). The obligation to provide accommodations for people with substance abuse under the ADA can be confusing to employers because the obligation differs somewhat from the obligation to accommodate employees with other types of disabilities. …

Vocational Rehabilitation and Job Accommodations for Individuals with Substance Abuse Disorders

This article reports findings of an exploratory study of 71 parents with substance abuse conditions involved in a child dependency court. Over half (59%) of the parents had a co-occurring mental health condition. Parents with co-occurring conditions (PWCC) differed in several important ways from those with only substance abuse conditions. PWCC were also more likely than their case managers were to report a need for mental health treatment. Implications for child welfare practice and research are offered.

Parents with co-occurring mental health and substance abuse conditions involved in Child Protection Services: clinical profile and treatment needs

Vocational rehabilitation (VR) services can be challenging for certain persons with disabilities, particularly persons with mental illness, traumatic brain injury (TBI), and substance use disorders (SUD). This study focused on successful (status 26) and unsuccessful (status 28) closures contained in the Longitudinal Study of the Vocational Rehabilitation Services Programs (LSVRSP). Individuals with ADHD, mental illness, physical disabilities, SUD, and learning disabilities had the lowest successful closure rates (43.2%, 45.5%, 50.6%, 51.3%, and 51.4%, respectively). Consumers reported a need for additional services, lack of job availability, family problems, discrimination, and transportation issues as leading reasons for unsuccessful closure. The results indicate a need for more comprehensive services directed towards persons with behavioral disabilities.

The Relationship between Substance Use Disorders and Unsuccessful Case Closures in Vocational Rehabilitation Agencies

Individuals who have a dual diagnosis of substance abuse and chronic mental illness pose unique challenges in the delivery of vocational rehabilitation services. Barriers to service provision include an underestimation of prevalence; agency classifications that require a separation of disability conditions into primary and secondary disability; a lack of counselors’ awareness of the unique needs of this population; and the impact of negative attitudes and stigma on vocational success. Although individuals with dual diagnosis can benefit from rehabilitation services and stable employment, changes in the traditional service delivery system are recommended. To address the unique needs of this population, rehabilitation practitioners are encouraged to seek specialized training and continuing education through regional training programs and interagency consultation.

Vocational Rehabilitation Needs of Individuals Dually Diagnosed with Substance Abuse and Chronic Mental Illness

BACKGROUND
The use of screening questionnaires (SQ) to evaluate affective or cognitive tendencies (CAT) in persons with low back pain (LBP) is recommended by clinical practice guidelines (CPG) yet few physical therapists (PTs) have adopted these recommendations.


OBJECTIVE
To develop and implement a tailored knowledge translation (KT) intervention in an outpatient rehabilitation practice to facilitate the uptake of SQ for CAT in persons with LBP.


METHODS
In a mixed-methods study, using the knowledge to action framework, PTs (n = 12) collaborated with research clinicians to improve the use of three SQ: 1) Primary Care Evaluation of Mental Disorders for Depressive Symptoms; 2) Fear-Avoidance Beliefs Questionnaire; and 3) Pain Catastrophizing Scale. Success of the intervention was measured through questionnaires, focus groups and chart audit.


RESULTS
A multimodal intervention to overcome specific identified barriers (i.e. time, forgetfulness, and lack of knowledge) was implemented. There was a 10% increase in the use of at least one SQ. PTs reported increased knowledge and use of the SQ but reported time and lack of confidence as barriers to implementation.


CONCLUSION
It was concluded that SQ for CAT can be successfully implemented; however, PTs felt unprepared to use the screening results to evaluate persons with CAT and more extensive training is recommended to change this practice pattern.

A. Lisa Brown

Papers

Vocational Rehabilitation Needs of Individuals Dually Diagnosed with Substance Abuse and Chronic Mental Illness

Standardized screening of cognitive and affective tendencies in persons with low back pain: A knowledge translation project.