BACKGROUND: Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse.
AIMS: To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients' occupational outcomes.
METHOD: Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786).
RESULTS: Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants' gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6).
CONCLUSIONS: Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work.
| Discipline Area | Score |
|---|---|
| Nurse |  |
| Rehab Clinician (OT/PT) | |
| Physician |  |
Nurse rater
The abstract is a little confusing. There is a line in the introduction that could be added to the abstract to provide clarity ... "the attitudes of key clinicians who discourage a return to work through a fear that the demands of employment might precipitate relapse". It's difficult to work out who the intervention was really targeted at in the abstract.
Nurse rater
Relevant especially with regard to a recovery focus in managing schizophrenia.
Nurse rater
There is definitely a need for more or a continuation of studies such as, Enhancing Delivery and Outcomes of Vocational Rehabilitation (ENDEAVOR). Individual placement and support (IPS) is significant to restoring the complete functional capacity of the mentally ill, particularly so, for first episode psychosis, which could certainly decrease the negative esteem for these consumers.
Physician rater
Helpful information that should encourage clinicians to support young patients with a first episode of psychosis to attempt to return to work (though this study focused only on a supported work environment). We should not be unnecessarily confined by our expectations in helping our patients return to better social functioning.
Physician rater
Doctors can unnecessarily deter patients with psychosis from working. This reluctance can be lessened by training.
Rehab Clinician (OT/PT) rater
Many practitioners would benefit from being reminded of the referent power they hold within the return to work process.
, McMaster University