Kim L. MacDonald-Wilson

An Investigation of Reasonable Workplace Accommodations for People with Psychiatric Disabilities: Quantitative Findings from a Multi-Site Study

Despite the requirement of many employers to provide accommodations in the workplace for individuals with disabilities under Section 504 of the Rehabilitation Act of 1973, the preponderance of accommodations that have been described in the literature concern physical rather than psychiatric disabilities. This study was an exploratory, descriptive, longitudinal, multi-site investigation of reasonable workplace accommodations for individuals with psychiatric disabilities involved in supported employment programs. We discuss the functional limitations and reasonable accommodations provided to 191 participants and the characteristics of 204 employers and 22 service provider organizations participating in the study. Implications for service providers and administrators in supported employment programs are discussed.

Unique Issues in Assessing Work Function Among Individuals with Psychiatric Disabilities

With the admission of people who experience psychiatric disabilities in the state–federal vocational rehabilitation system and the Social Security disability rolls in the 1960s, assessment of their capacity to work has been a major concern. Given the rising rates of claims for psychiatric disability in both the public and the private sectors, and the disappointing employment outcomes of people with psychiatric disabilities compared to those with other disabilities, there have been numerous initiatives to accurately assess their employment potential. Historically, such assessment within the Social Security Administration has relied upon evaluation of a persons medical impairment, but numerous studies suggest a weak relationship between measures of psychiatric diagnosis or symptoms and work outcome. Efforts have been undertaken to identify valid and reliable methods of assessing the ability of people with psychiatric disabilities to work. The authors review (a) methods of assessing work function for this population, and (b) the literature on predictors of work functioning and the nature of psychiatric disability, and suggest implications for disability determination policies and for future research.

Disclosure of Mental Health Disabilities in the Workplace

There are a number of barriers that contribute to the low employment rates of people with mental health disabilities; these barriers exist at the individual level, the programs and services level, and the systems, policy, and societal level (Anthony et al. 2002). One issue that intersects with all three is disclosure of psychiatric disability in the workplace. Individuals with mental health disabilities must weigh the personal benefits and risks of disclosing their psychiatric disability and make a number of decisions about disclosure given their particular employment circumstances. In addition, employment programs and services, and especially supported employment practitioners, must determine how to represent their services to employers, decide how to inform employers that they work with people with mental health disabilities, and plan with the individual to handle disclosure. Employers must be aware of state and federal policies regarding disability-related employment issues in the face of societal stereotypes, personal experiences with, and misunderstandings about people with mental health disabilities. And while legislation such as the Americans with Disabilities Act (ADA 1990) is in place to protect rightful access to employment, people with mental health difficulties may have little knowledge or understanding of these policies or how disclosure of disability and reasonable accommodations may allow them to enjoy full access to employment opportunities.

Vocational Capacity among Individuals with Mental Health Disabilities

Decades have passed since individuals with mental health disabilities, particularly those with serious mental illness, were widely considered unable to sustain work. Many individuals were housed in institutional settings, but those in the community were often labeled unemployable. With the advent of deinstitutionalization in the 1960s and 1970s, individuals with more severe mental health problems were served using a “train and place” model of vocational rehabilitation services, delivered primarily in sheltered workshops. This approach dictated that individuals be placed in work-like settings in order to be “trained,” sometimes for years at a time, prior to being “placed” in employment. With the recent evolution of supported employment, the prevailing approach has become “place and train,” introducing the concept of rapid entry into employment with wraparound supports. The cornerstone of supported employment is the philosophy that the majority of individuals with mental health disabilities who want to work, can work. But what have these last few decades of community-based vocational rehabilitation services revealed in terms of the capacity of individuals with mental health disabilities to enter into the workplace and maintain employment? We explore in this chapter the empirical findings and knowledge regarding the assessment and prediction of vocational capacity among individuals with significant mental health problems.

Establishing a Consortium of Psychiatric Rehabilitation Educators

ABSTRACT In recent years there has been significant growth in academic programs that prepare students to become psychiatric rehabilitation practitioners. Educators from a number of these programs have come together to form a consortium. This group has the potential to enhance psychiatric rehabilitation education by developing curricula and fieldwork standards, sharing educational resources, providing professional development opportunities for faculty in a newly emerging academic field, and promoting increased dissemination of psychiatric rehabilitation education at both the undergraduate and graduate level. These activities can positively impact mental health systems by providing the recipients of psychiatric rehabilitation services increased access to well-trained professionals who have internalized recovery-oriented principles and values.

Value of psychiatric rehabilitation in a behavioral health medicaid managed care system.

Objective: The present study was designed to describe individuals receiving psychiatric rehabilitation (PR) service and investigate program outcomes and factors associated with progress in a multisite, descriptive evaluation across Pennsylvania. Method: Through an outcomes-monitoring process integrated into routine service delivery, survey responses from 408 individuals participating in PR were summarized. Linear mixed models were used to examine change over time in self-reported progress ratings in rehabilitation domains and factors associated with progress. Results: Significantly lower utilization of inpatient psychiatric service was observed in the 12 months after initiating PR versus the 12 months before service (15% vs. 24%; p = .002). Peer and case management service increased after initiation of PR. Specifying a domain as a goal in the service plan was associated with higher progress ratings in the learning (&bgr; = .75, p < 0001), working (&bgr; = 1.06, p < .0001), and physical wellness (&bgr; = 1.27, p < .0001) domains. Average hopefulness rating was positively and significantly associated with self-reported progress in all domains. Conclusions and Implications for Practice: The current investigation provides some evidence that individuals participating in PR decrease utilization of inpatient service. This finding and the goals and activities reported in domains over time support the added value of PR as a Medicaid-reimbursable service to managed care efforts to promote rehabilitation outcomes and recovery for individuals with psychiatric disabilities.