Errol Cocks

Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale

BACKGROUND The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS. METHODS The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted. RESULTS The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment. DISCUSSION Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations. CONCLUSIONS The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted.

Successful approaches to placing and supporting apprentices and trainees with disability in Australia

This paper presents an amalgamation of three sequential research projects conducted by EDGE Employment Solutions over the past decade. The first project, commenced in 1999, was a local initiative to increase the number of apprentices and trainees with disability being supported by EDGE. The completion rate for participants in this project was equivalent to that of people without disability undertaking apprenticeships and traineeships in Australia. However, it was found that Group Training Organisations, who hire apprentices and trainees to then place them with different employers, did not have the necessary skills or resources to place and support people with disability. To fill this gap, the second research project, undertaken in 2002, surveyed all 180 Group Training Organisations operating in Australia. This was followed by a site visit of six GTOs who were most successful in their disability efforts, to discern best practice in placing and supporting apprentices and trainees with disability. The third research project, which built on the findings of the previous two projects, was initiated in 2003 and enlisted 20 Group Training Organisations and 20 Disability Employment Services from around Australia to form partnerships to capitalise on their complementary expertise and resources. Apprenticeship and traineeship completion rates for participants in the third project surpassed those for people without disability in Australia. This paper presents and discusses the successful strategies researched and developed through these three projects.

Characteristics of those Persons with Mental Retardation Registered with the Mental Retardation Division

The paper describes a range of characteristics of the population of persons identified as having mental retardation in Victoria, Australia in January, 1983. The data are maintained on a computerized client data bank which functions in conjunction with a client information system maintained by the Mental Retardation Division of the Health Commission of Victoria. Some implications are drawn from an analysis of the data for the future provision of services for persons with mental retardation in Victoria. Comparisons are drawn between data on similar populations in two other Australian States.

Facilitators and barriers to employment for people with mental illness: A qualitative study

BACKGROUND: Employment often has a defining role that shapes a person’s identity. The aim of this study was to generate a rich description of the meaning of employment for people with mental illness and identify the facilitators and barriers they experience in gaining and sustaining employment. Low workforce participation rates exist for people with mental illness despite their ability to both benefit from, and contribute through, employment. OBJECTIVE: Individual in-depth interviews were used to gather information about participants’ lived experiences of mental illness, what employment meant to them, their vocational aspirations, and the facilitators and barriers encountered while engaging in employment activities. METHODS: Focus groups (N = 3) and individual in-depth interviews (N = 9) were used to gather information about participants’ lived experiences of mental illness, what vocation meant to them, their vocational aspirations, and the facilitators and barriers encountered while engaging in or pursuing employment. An inclusive research approach was employed in conducting interpretive phenomenological analysis. RESULTS: Four themes and nine subthemes described the meaning of employment, aspirations, and personal choices. Personal barriers to vocation included loss of valued roles, challenges of the vocational environment, and restrictions in opportunities. Examples of facilitators of employment were mental health services providers, family, and friends. Participants pursued paid employment because they wanted outcomes that would lead to work satisfaction such as making money, having financial security, socialising, and having a sense of achievement. CONCLUSION: Engaging in meaningful vocation allowed people with mental illness to establish and re-establish their identities and valued life roles.

Health status and use of medications by adults with intellectual disability in Western Australia

ABSTRACT Background Evidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia. Method We conducted a cross-sectional survey by interview of 328 adults with ID (M age = 37 years, range: 18–82) and their families/support persons (79% proxy or joint informants). Results Although 90% of participants reported long-term health conditions (M = 2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn = 3 medications, range: 0–21). Conclusions Many participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID.

Examples of individual supported living for adults with intellectual disability.

Background: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. Materials and Methods: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. Results: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. Conclusion: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs.

Development of a fidelity measure for community integration programmes for people with acquired brain injury

Abstract Objective: The paper describes development of the Assessment of Community Integration Programme Attributes (ACIPA) measure based on a descriptive community integration framework. The purpose of this measure is to allow evaluation of community integration programmes for adults with acquired brain injury (ABI). Methods: The Community Integration Framework (CIF) was used to design a fidelity evaluation measure through consultation with 37 participants from five stakeholder groups (practitioners, researchers, policy-makers, people with ABI and family members of people with ABI) using semi-structured interviews, focus groups, iterative surveys and a multi-attribute utility (MAU) method. Results: The resultant measure included seven themes and 21 attributes. Each attribute included indicators and probing questions. Weights were assigned to each theme and constituent attributes. Conclusion: Programme evaluation commonly focuses on outcomes, often overlooking analysis of programme processes. Although it requires further psychometric (reliability and validity) development, the Assessment of Community Integration Programme Attributes may be used to assess the relationship between programme processes and specific outcomes and also to inform the development of programmes aiming to enhance community integration for adults with ABI.

Launching: The experiences of two young adults with intellectual disability and their families in transition to individual supported living

Abstract Background A major milestone in the transition to adulthood is leaving the parental home, known as launching. This study explored the experiences of 2 young people with intellectual disability during launching into individual supported living, including the impact of a Western Australian (WA) funding approach. Method Two case studies employed interviews, documentation review, and observations. Three staff members of the WA Disability Services Commission participated. Results The transition period was stressful for parents. Gaining independence occurred gradually for the young adults and was influenced by parent involvement. All parents desired more formal support. Social isolation was a major issue for the young adults. Conclusions Families need long-term assistance to prepare for launching, and parents may need reassurance as they withdraw from their caring role. More consideration is needed into how young people with intellectual disability may be best supported to develop friendships.

Measures of Outcome in an Early Intervention Programme

As part of a broad exploratory research project (Cocks, 1979), both norm-referenced and criterion-referenced measures were utilized as child outcome measures for a group of 49 intellectually handicapped children aged from 12 to 48 months who participated in early intervention programmes. This paper discusses the issues involved in the use of these types of measure and also development indices, and describes the use of a gain-rate index which takes account of the amount of time in intervention. On the norm-referenced measure, 45 of the children gained an average of 0.829 months per month of intervention. On the criterion-referenced measure, the children gained an average of 2.58 skills per week. It is suggested that criterion-referenced measures are more sensitive to change than are currently developed norm-referenced procedures.

Process Evaluation of Service Provision for Pre-School Intellectually Handicapped Children

This paper describes the transition of service provision for 240 intellectually handicapped children and their families provided by Division for the Intellectually Handicapped in the Perth metropolitan area, from a relatively traditional service delivery system to one emphasising home and family involvement and placement of services closer to the consumer. Four areas of primary data collection are described which aim to evaluate services at a number of levels. Preliminary results are presented which enable evaluation of the extent to which service provision reflects initial objectives. The overall plan described emphasises collection of data which will provide objective evidence for more effective future service provision.