Outcomes of a Vocational Program for Persons With AIDS

Abstract

Advances in medical treatment combined with changes in the demographics of persons who are becoming infected with autoimmune deficiency syndrome (AIDS) have transformed this illness from a rapidly progressing to a chronically disabling condition in a short period of time. This paper describes the development, implementation, and outcomes of a program of vocational services for persons with AIDS. This program was studied using a single group design, in which participatory action research strategies were used to investigate and improve the program as it unfolded. In addition to examining the overall outcomes of services, the study aimed to discover which components were most helpful to participants and which participants were most likely to benefit from the program. Of 129 participants of who initially enrolled, 39 dropped out before finishing the program. Sixty of the 90 participants who completed the program achieved employment, returned to school, or began a volunteer position or internship. Consequently, the overall success rate was 46.5% and the success rate for program completers was 66.7%. The occupational narrative, which participants told in their initial assessment interview, was closely associated with both program completion and successful outcomes. This association adds support to the importance of narrative for understanding participants and predicting future behavior, as well as for the therapy process.

Narrative slope as a predictor of work and other occupational participation

“…The only factor in this study that showed a relationship to return to work and engagement in other productive activity was the narrative slope. This finding replicates the finding of Kielhofner et al (27) that narrative slopes were significant predictors of employment and other productive outcomes.…”

“…In a study of 129 participants with AIDS, Kielhofner et al (27) found that the narrative slopes were significant predictors of whether clients would remain in or drop out of a program of vocational services and of whether those who successfully participated in the program would achieve employment or other productive outcomes. In another qualitative study of 12 men living with AIDS who were attempting to return to paid employment, Braveman et al (23) investigated the relationship between their return-to-work efforts and their narrative slopes.…”

“…This model has also been applied specifically to the understanding of work-related choices and behaviors (21,22). A number of studies based on MOHO have documented the value of narratives in revealing important dimensions of work-related experience and action (18,23,24), explaining reactions of clients to work rehabilitation (17,25,26) and in predicting future work-related behaviors (27,28).…”

Scoping the Field: Identifying Key Research Priorities in HIV and Rehabilitation

“…The majority of these articles were randomized controlled trials, many of which were included in two systematic reviews that documented the benefits of aerobic, resistive or combined aerobic and resistive exercise for some outcomes of cardiopulmonary fitness, strength, weight and body composition, and quality of life for medically stable adults living with HIV (O' Brien et al 2004Brien et al , 2006. Other studies documented the positive impact of vocational rehabilitation interventions (Braveman et al 2006;Kielhofner et al 2004), cognitive behavioral programs (Chan et al 2005), self care strategies (Eller et al 2005), and massage therapy (Birk et al 2000;Shor-Posner et al 2004, 2006 on health outcomes for adults with HIV. Despite their widespread use, the effectiveness of complementary and alternative therapies has not yet been established (Mills et al 2005).…”

Assessing Employment Needs of Bulgarian Youths with Intellectual Impairments

“…First, this model provides a comprehensive framework for understanding barriers to employment . Second, MOHO has been successfully utilized as a framework for understanding the problems of disabled workers and for developing work-related services (Kielhofner et al, , 2004Mentrup, Neihaus, & Kielhofner, 1999;Paul-Ward, Braveman, Kielhofner, & Levin, 2005). Third, MOHO addresses the multifactorial influences on work behavior Kielhofner, 2008;Mentrup, Neihaus, & Kielhofner, 1999).…”