Employment Services, Outcomes, and Program Evaluation

 

Braveman, B ., Kielhofner, G., Albrecht, G. & Helfrich, C. (2006). Occupational identity, occupational competence and occupational behavior settings: Influences on return to work in men living with HIV/AIDS. Work: A Journal of Prevention, Assessment & Rehabilitation, 27 (3), 267-276.

This paper presents results of a prospective qualitative study that examined the experiences of twelve men during a one year period following completion of a vocational rehabilitation program for people with AIDS. Findings illustrate how constructs measured by the scales of the Occupational Performance History Interview (OPHI-II) may be helpful in understanding how persons frame past, present and anticipated experiences as they attempt to reestablish a life role lost after the onset of disability. The OPHI-II is an occupational therapy semi-structured interview used to obtain information about a person's life history and their participation and performance in daily life. The OPHI-II allows exploration of the roles, social contacts and environments in which one operates and has been shown to measure three underlying constructs; two of which are related to self (occupational identity and occupational competence) and one of which is related to the environment (occupational behavior settings).

 

Braveman, B., Levin, M., & Kielhofner, G. (2006). HIV/AIDS and return to work: A literature review one decade post-introduction of combination therapy. Work: A Journal of Prevention, Assessment & Rehabilitation, 27 (3), 295-204.

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000--950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the U.S. , issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns . The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.

 

Conyers, L. M. (2004). The impact of vocational services and employment on people with HIV/AIDS. Work, 23 (3).

The perceptions of vocational services and the impact of employment among 25 individuals with HIV/AIDS diagnoses were explored through a qualitative study. Participants who ranged in age from 22 to 58, represented diverse ethnic backgrounds and were at various stages of the employment process. The key themes that emerged from the data fell into three main areas: (a) personal impact of vocational services, (b) programmatic qualities of vocational services, and (c) impact of employment. Factors that influenced each of these themes and the implications for rehabilitation counselors are discussed.

 

Escovitz, K., & Donegan, K. (2005). Providing effective employment supports for persons living with HIV: The KEEP project. Journal of Vocational Rehabilitation, 22, 105-114.

This paper discusses project KEEP, a 3-year Special Demonstration Project, was charged with identifying effective employment service strategies for people living with HIV/AIDS in Philadelphia , PA. Strategic outreach was done to ensure that participants would reflect the demographics of HIV/AIDS in urban settings. Individualized employment services, based in principles of psychosocial rehabilitation, were provide to 148 individuals. Longitudinal data were collected to track services, employment experiences, disclosure, self-reported health measures, and quality of life. This paper discusses the results of the project, giving particular attention to the strong employment outcomes and the value of "rapid-attachment", intensive support once working, and the impact of work on self-reported quality of life. Implications for service delivery as well as directions for future services research are discussed.

 

Kielhofner, G., Braveman, B. , Finlayson, M., Paul-Ward, A., Goldbaum, L. & Goldstein, K. (2004). Outcomes of a vocational program for persons with AIDS. American Journal of Occupational Therapy , 58 (1): 64-72.

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.

 

Kielhofner, G., Braveman, B., Levin, M., & Fogg, L. (2008). A controlled study of services to enhance productive participation among persons with HIV/AIDS. American Journal of Occupational Therapy , 62 (1), 62-45.

This study assessed the effectiveness of a model program designed to increase productive participation among people living with HIV/AIDS within supportive-living facilities.

Using a nonrandomized, two-group design, 65 study participants were assigned to either the model program or standard care. Data on productive participation were collected at 3, 6, and 9 months after completion of the model or standard program. Outcomes were compared at each time point. Forty-six participants completed the study. Participants in the two programs did not differ significantly on baseline demographic variables. Model program participants showed significantly higher levels of productive participation at all three time points (p < .05). Odds ratios were all > 3, reflecting that participants attending the model program were at least twice as likely to be productively engaged at all three time points. Results support the effectiveness of the model program in achieving sustained productive participation in persons living with HIV/AIDS.

 

Martin, D. J., Chernoff, R. A., & Buitron, M. (2005). Tailoring a vocational rehabilitation program to the needs of people with HIV/AIDS: The Harbor-UCLA experience. Journal of Vocational Rehabilitation, 22, 95-103.

This article describes new treatments introduced in the early to mid 1990s led to greatly improved health and quality of life for many people with HIV/AIDS, prompting some to consider workforce reentry. In this paper, we relate three projects we have undertaken since 1996 in which we have worked to develop and understanding of the workforce reentry process for people with HIV/AIDS. In the first, a survey of HIV/AIDS case management clients throughout Los Angeles County , we noted a substantial need for workforce reentry assistance services, and noted six broad categories of workforce-reentry concern for people with HIV/AIDS. Our second project was designed as a demonstration project to assist people with HIV/AIDS in their efforts to return to work. We found, among other things, that significant obstacles unrelated to employment also thwarted workforce reentry efforts. Finally, in our current clinical-trials study, we continue to learn from participants in their efforts to rejoin the workforce. We discuss our cumulative results to date, and highlight certain future directions for research and service.

 

Paul-Ward, A., Braveman, B., Kielhofner, G., & Levin, M. (2005). Developing employment services for individuals with HIV/AIDS: Participatory action strategies at work. Journal of Vocational Rehabilitation, 22 , 85-93.

This paper details the development and implementation of employment and independent living services for people living with HIV/AIDS over year one of a three-year project. Specifically, we describe the ongoing collaborative process, based on participatory action strategies, that is being utilized in the development of this multi-faceted, intensive, personalized and coordinated program of services. Further, we provide preliminary results regarding the benefits of this model of service provision for addressing the employment needs of individuals living with HIV/AIDS. We conclude with a detailed discussion of the challenges and successes of these efforts.