Deborah Gioia

Career Development in Schizophrenia: A Heuristic Framework

Adults with schizophrenia continue to have poor rates of competitive employment. We have learned how to support individuals in the workplace with supported employment (SE); but have paid limited attention to early vocational identity development, work antecedents, illness characteristics, and career preferences. Vocational identity development is an important and natural condition of human growth for all persons and is well-researched in career counseling. For young adults with schizophrenia, the predictor of positive work outcome with the most evidence has been that working competitively prior to illness leads to better chances for work post-diagnosis. A heuristic framework is proposed to conceptualize how pre-illness vocational development (paid and unpaid) plus life cycle supports can provide direction to the individual in their work recovery.

Adoption of Evidence-Based Practices in Community Mental Health: A Mixed-Method Study of Practitioner Experience

This mixed method study examined practitioners as they adopted four evidence-based practices (EBPs) in a community mental health center. In-depth semi-structured interviews; a measure of EBPs attitudes; and a final focus-group were used over a 2-year study period to assess 14 mental health practitioners on one immersion team. The framework for data collection was adapted from organizational theories that view culture and climate as mediating factors. Analysis of practitioner themes demonstrated that there were facilitating and impeding factors in the adoption process. Practitioners reported positive changes in their individual competency but two years was inadequate for training on four EBPs. Involvement of agency administration and consistent supervision were regarded by practitioners as crucial to successful adoption of EBPs.

Knowledge and use of workplace accommodations and protections by young adults with schizophrenia: A mixed method study

Employment is an important outcome for individuals with schizophrenia and the Americans with Disabilities Act (ADA) is a key structural variable designed to favorably influence work. Little is known about how individuals understand and utilize ADA rights. The purpose of this mixed method study was to elicit understanding of the knowledge and use of ADA provisions from 20 persons with schizophrenia who returned to work. Three distinct groups emerged. Group differences suggest that use of ADA provisions may be dependent on individual need and comfort with ADA opportunity.

INCORPORATING INTEGRATIVE HEALTH SERVICES IN SOCIAL WORK EDUCATION

More than one third of Americans practice complementary and alternative medicine (CAM). Social workers continue to provide most first-line health, mental health, and psychological referral and direct practice services in the United States, despite a lack of systematic education and training opportunities in CAM. Schools of social work are appropriate venues for providing regular and continuing educational opportunities. The gap between education and practice can be addressed in social work curricula by (1) addressing integrative health from a general systems perspective, (2) reaffirming the role of social workers in health care, and (3) providing opportunities to develop competence with a simple yet conceptually integrated CAM-based skill set. Several content approaches and suggestions for curricula deployment are provided, including stand-alone courses, curricular infusion strategies across core areas of social work education, and location of curricular homes across college and university departments.

Examining Work Delay in Young Adults with Schizophrenia

Work delay as a dimension of work restoration in young adults with schizophrenia has not been explored with much frequency in the vocational rehabilitation literature; and it has never been explored and analyzed from the subjective experience of the person with the disorder. In this exploratory, mixed-method study of 20 first-episode young adults diagnosed with schizophrenia who returned to work, there were many dimensions to explore with in-depth interviews about the process of work re-engagement. However, it was a striking finding that the length of time to first job ranged from 1–65 months. There are several possible correlates in the literature to consider when looking at work delay. This study yielded qualitative themes that were mostly congruent with the literature and were split between illness-related factors (e.g., symptoms, medication side-effects) and non-illness-related factors (e.g., childcare, job training). In addition, messages from mental health professionals and families about returning to work and fears related to symptom return on the job were prominent themes in this study. Implications for psychosocial rehabilitation and career counseling interventions are discussed.

Neurocognition, Ecological Validity, and Daily Living in the Community for Individuals with Schizophrenia: A Mixed Methods Study

The ecological validity of neurocognitive measures concerns translating laboratory-based neuropsychological (NP) findings into relevant predictions about how people will perform in varied real world settings. There have been no studies of the ecological validity of psychosocial or neurocognitive measures in schizophrenia that incorporated direct observation of naturally occurring community behavior. The research questions for this mixed method study were: (1) Are there differences in the daily community functioning of persons with schizophrenia who have high or low cognitive functioning as determined by lab-based assessments? and (2) Can ethnographic methods be used to create descriptions of functioning that are useful for assessing ecological validity? Ten individuals from a larger longitudinal study were randomly selected from two strata that reflected low or high neurocognitive functioning. Individuals completed quantitative measures of psychosocial functioning and were also observed ethnographically for three days by an observer who was blind to their neurocognitive status. A new method developed in this study for characterizing the predominant behavioral living strategies of individuals with schizophrenia found notable differences between high and low NP groups in their community functioning. This study found evidence to support the ecological validity of NP measures and yielded an ethnographically based observational protocol to reliably characterize the predominant individual daily behavioral strategies.

A Contextual Study of Daily Living Strategies in Neurocognitively Impaired Adults With Schizophrenia

Schizophrenia is a severe mental illness often recognized as a degenerative neurocognitive condition. For some with the disorder, the impairment is fairly mild, but for others, neurocognitive abilities can be severely compromised. In this study, 5 individuals with schizophrenia had been assessed through a laboratory-based neurocognitive battery as having severe impairment. Their neurocognitive status was unknown to the author, and she was able to observe daily tasks and ask questions about strategies they employed while completing tasks, and analyze the data without preconceptions about their status. This study was guided by notions of ecological validity, which is the comparison between lab tests and real-world functioning. Despite their cognitive deficits, these individuals had remarkable strengths, which included drawing supportive people into their worlds to fulfill their daily tasks. These data contribute to the rehabilitation literature and propose remedies for struggles of daily living when one has schizophrenia.

Supported Education Enhancing Rehabilitation (SEER): A Community Mental Health and Community College Partnership for Access and Retention

Individuals who are recovering from psychiatric disabilities often need specialized programs in order to prepare for, gain access to, and sustain participation in college education and the vocational opportunities that will hopefully follow a degree. A unique supported education program located on a community college campus in Spokane, Washington, known as SEER (Supported Education Enhancing Rehabilitation) is a vocational and educational partnership that delivers its services in the form of one-to-one, on-site support, thereby ensuring that educational recovery is not a process consumers will have to endure on their own. This article outlines the unique program components of SEER while recognizing the need for more research attention on the factors that promote educational and vocational success, so that they might be replicated across the country.

“I Can Get Through This and I Will Get Through This”: The unfolding journey of teenage motherhood in and beyond foster care:

Using a series of 18 in-depth qualitative interviews from six participants, the present study employed Interpretative Phenomenological Analysis (IPA) to explore emerging conceptualizations of motherhood among young mothers who gave birth as teenagers while living in foster care. Analysis revealed three themes: Ambivalent Beginnings, Coming into Our Own, and Finding Our Way, which, together, offer an understanding of youths’ interpretation of their experiences of motherhood over time. Findings extend and complicate a risk-only view of teenage pregnancy within foster care settings. They call for a compassionate view of mothering and attuned intervention in these challenging circumstances in order to support both mother and infant mental health and well-being. Study findings further suggest a need for ongoing, relationship-based parenting support coupled with thoughtful pregnancy planning, foster parent training in coming alongside teens rather than either withdrawing or taking over, and nurturing postpartum support.

Understanding the Ecological Validity of Neuropsychological Testing Using an Ethnographic Approach

Neurocognitive impairment is a defining and disabling feature of schizophrenia and other physical disorders. Most of our understanding about neurocognitive deficits comes from laboratory-based testing in research protocols. There has been little research using direct behavioral community observation over a prolonged period to understand the association of daily functioning with cognitive performance.The purpose of this study was to develop an observational method that could be replicated by researchers interested in viewing cognitive deficits in vivo, and then comparing this data to laboratory measures to affirm the ecological validity of those measures.The eight-step method explained here was developed from the targeted ethnographic study of 10 persons with schizophrenia. Obtaining real world context with this method will help to increase the generalizability of effective cognitive treatments, create improved interventions for this population, and bring into greater relief the coping and compensatory strategies already used by individuals to complete daily tasks.