Occupational Therapy Interventions for Employment and Education for Adults With Serious Mental Illness: A Systematic Review

Abstract

In this systematic review, we investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on participation and performance in occupations related to paid and unpaid employment and education for people with serious mental illness. The review included occupation-and activity-based interventions and interventions addressing performance skills, aspects of the environment, activity demands, and client factors. The results indicate that strong evidence exists for the effectiveness of supported employment using individual placement and support to result in competitive employment. These outcomes are stronger when combined with cognitive or social skills training. Supported education programs emphasizing goal setting, skill development, and cognitive training result in increased participation in educational pursuits. The evidence for instrumental activities of daily living interventions that targeted specific homemaking occupations and supported parenting was limited but positive. Environmental cognitive supports, such as signs, and other compensatory strategies are useful in managing maladaptive behavior. Focused Clinical QuestionWhat occupational therapy interventions are effective for improving and maintaining participation and performance in paid and unpaid employment (volunteer opportunities, home management, child care) and education for adults with severe mental illness?Objective of the Evidence-Based Literature ReviewThe objective was to systematically investigate research literature evaluating the effectiveness of interventions within occupational therapy's scope of practice that focus on participation and performance in occupations related to paid and unpaid employment and education for people with serious mental illness. The systematic review included occupation-and activity-based interventions and interventions addressing performance skills, aspects of the environment, activity demands, and client factors.

A Qualitative Research Synthesis Examining the Effectiveness of Interventions Used by Occupational Therapists in Mental Health

“…For example, falls prevention with people with Alzheimer's disease and related dementias (Jensen and Padilla 2011) and interventions focusing on participation and performance in occupations related to both paid and unpaid employment, as well as education for people with serious mental illness (Arbesman and Logsdon 2011). Such studies are valuable in reviewing the existing evidence about specific occupational interventions to inform future practice and research.…”

Psychosocial Functioning in Bipolar Disorder from a Social Justice Perspective

“…SE programs have been found to be highly effective in improving employment outcomes for people with severe MI, including BD (Arbesman & Logsdon, 2011;Tse & Yeats, 2002). Importantly, as Tse & Yeats (2002) note, the absence of time limits in SE programs is likely critical in helping people with BD achieve their long-term vocational goals.…”

“…Qualitative studies (Michalak et al, 2007;Tse & Yeats, 2002) indicate that augmenting employment in BD requires interventions in four key areas: illness management, social support, and employer-employee relations, as well as in combating broader societal barriers such as stigma and disincentives to working embedded in disability regulations (Elinson et al, 2007;Tse & Yeats, 2002). Evidence-based supported employment (SE) programs that include early intervention after diagnosis, integrated clinical care and vocational services (Cook et al, 2005;Cook et al, 2008), training in goal-setting, cognitive and social skills (Arbesman & Logsdon, 2011;Cook, 2006;Cook et al, 2008;Krupa, 2007;Krupa et al, 2009), a collaborative and individualized approach to rapid employment placement without lengthy pre-placement training, and especially, highintensity on-the-job support of unlimited duration (G. R. Bond & Kukla, 2011;Cook et al, 2005;Evans & Bond, 2008;McHugo, Drake, & Becker, 1998), address the first three of these areas.…”

Individual Placement and Support is the keyhole: Employer experiences of supporting persons with mental illness

“…One of the challenges faced by professionals in vocational rehabilitation is enabling persons with serious mental illness (SMI) to gain and keep preferred and chosen employment (Arbesman & Logsdon, 2011;Waghorn, Lloyd, & Clune, 2009). The evidence-based supported employment approach called Individual Placement and Support (IPS), which was developed to provide a means for people with a SMI to seek and obtain competitive employment, has shown to be two to three times as effective as traditional prevocational training services for gaining employment (Arbesman & Logsdon, 2011;Bond, Drake, & Becker, 2008, 2012Waghorn et al, 2009).…”

“…The evidence-based supported employment approach called Individual Placement and Support (IPS), which was developed to provide a means for people with a SMI to seek and obtain competitive employment, has shown to be two to three times as effective as traditional prevocational training services for gaining employment (Arbesman & Logsdon, 2011;Bond, Drake, & Becker, 2008, 2012Waghorn et al, 2009). IPS is guided by seven evidence-based principles that emphasize 1) the goal of gaining and keeping competitive employment, 2) service users willingness to work, 3) a rapid job search, 4) close collaboration with mental health care team, 5) service user preferences and choice, 6) an individualized time-unlimited support to minimize work disabilities, and 7) benefit counselling at an early stage (Bond, 2004).…”