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Purpose There are substantial costs associated with sickness absence and struggling at work however existing services in the UK are largely restricted to those absent from work for greater than 6 months. This paper details the development of an early Vocational Advice Intervention (VAI) for adult primary care consulters who were struggling at work or absent due to musculoskeletal pain, and the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver the VAI, as part of the Study of Work and Pain (SWAP) cluster randomised trial. Methods In order to develop the intervention, we conducted a best-evidence literature review, summarised evidence from developmental studies and consulted with stakeholders. Results A novel early access, brief VAI was developed consisting of case management and stepped care (three steps), using the Psychosocial Flags Framework to identify and overcome obstacles associated with the health-work interface. Four healthcare practitioners were recruited to deliver the VAI; three physiotherapists and one nurse (all vocational advice was actually delivered by the three physiotherapists). They received training in the VA role during a 4-day course, with a refresher day 3 months later, along with monthly group mentoring sessions. Conclusions The process of development was sufficient to develop the VAI and associated training package. The evidence underpinning the VAI was drawn from an international perspective and key components of the VAI have the potential to be applied to other settings or countries, although this has yet to be tested.

This study evaluated the effectiveness of an internet accessed training program that included Theory of Mind-based guidance, video models, visual supports, and virtual reality practice sessions in teaching appropriate job interview skills to individuals with high functioning Autism Spectrum Disorders. In a randomized study, twenty-two youth, ages 16–19, were evaluated during two employment interviews. Half received a training intervention following the initial interview and the half who served as a contrast group did not. Their performance pre and post intervention was assessed by four independent raters using a scale that included evaluation of both Content and Delivery. Results suggest that youth who completed the JobTIPS employment program demonstrated significantly more effective verbal content skills than those who did not.

This study aimed to identify the factors associated with participation in employment for high school leavers with autism. A secondary data analysis of the National Longitudinal Transition Study 2 (NLTS2) data was performed. Potential factors were assessed using a weighted multivariate logistic regression. This study found that annual household income, parental education, gender, social skills, whether the child had intellectual disability, whether the child graduated from high school, whether the child received career counseling during high school, and whether the child’s school contacted postsecondary vocational training programs or potential employers were the significant factors associated with participation in employment. These findings may have implications for professionals who provide transition services and post-secondary programs for individuals with autism.

The history of mental health service delivery has been marked by an emphasis on clients’ vulnerabilities and deficits. As treatment programs have moved out of hospitals and into communities, however, the need to work with clients in developing real-world, practical skills, such as job training, has never been more important. Versions of this approach traditionally include skills training classes, job clubs, and sheltered employment, but have not been successful in helping people with severe mental illness gain competitive employment. This book describes the theory, empirical support, and practice of the Individual Placement and Support (IPS) approach to supported employment. IPS is the most widely studied and validated approach to supported employment for people with severe mental illness. The overall goals of IPS are to assist clients in finding jobs that are consistent with their preferences and skills, and to support their efforts in working. The book is divided into three sections: 1) Conceptual and Empirical Support for Individual Placement and Support; 2) Practice Guidelines for Implementing Supported Employment; and 3) Special Issues. Many vignettes and sample documents that provide practical information are included.

Physician burnout begins in medical school. Professional coaching can improve physician well-being, but generalizable evidence in medical students is lacking. We aim to evaluate a coaching program in a national sample of students. A randomized clinical trial assessing a four-month, web-based, group coaching program was conducted between September 1, 2023, and December 31, 2023, among medical students from seven institutions. The primary outcome was burnout measured using the Maslach Burnout Inventory. Secondary outcomes included impostor syndrome, moral injury, self-compassion, and flourishing. A linear mixed effect model analysis was performed on an intent-to-treat basis. Among the 390 participating students (mean [SD] age, 25.3 [2.38]), 197 were randomized to the intervention group. There were no significant post-coaching differences in burnout, moral injury or impostor syndrome between groups. After the coaching intervention, the intervention group had significantly greater self-compassion with an absolute difference of 3.00 points (SE = 1.29; 95% CI, 0.48 to 5.53 points; P = 0.021)), and significantly higher flourishing scores, with an absolute difference of 0.45 points (SE = 0.23; 95% CI, 0.01 to 0.90 points; P = 0.048) compared to the control. Web-based group coaching did not have an impact on measures of distress in medical students, though did improve well-being outcomes including self-compassion and flourishing. Trial Registration: ClinicalTrials.gov Identifier: NCT05822375.

Background A constraint in South Africa’s mental health system is the human resources required to provide services. Given the shortage of specialist mental health professionals, the use of non-specialists such as clinical associates in mental health task-sharing is essential. The study aimed to explore the views of health managers, doctors, and nurses in four districts of South Africa on the scale of mental illness seen in their health services, their human resources challenges, and their attitudes towards mental health task-sharing involving clinical associates. Methods Focus group discussions were conducted in one district in each of the four provinces where clinical associates were known to be employed. Focus group participants were purposively sampled to ensure that each focus group consisted of a combination of managers and healthcare professionals from hospital and primary health care levels. Audio recordings were transcribed, and thematic analysis was conducted. Results A total of 29 individuals participated. Four themes emerged from the focus group discussions. The first theme to emerge was ‘mental illness is not going away’ with substance use, increasing numbers of younger patients, and high rates of relapse and readmission accounting for this. The second theme identified was ‘the health system cannot cope with mental illness’ as mental health had not been prioritised and this had resulted in a lack of mental health units and beds, deficiencies at primary health care level, and human resources for mental health challenges. The third theme was ‘clinical associates could be part of the remedy’ based on past experience in other disciplines but constraints such as their scope of practice would need to be addressed. The final theme identified was ‘specialised clinical associates could help mend the mental health system’ but this would require a review of employment policies and a clarification of their roles. Conclusions Mental health is a significant and expanding concern. Clinical associates could help alleviate human resource constraints in mental health with enhanced undergraduate and advanced training. However, overcoming structural barriers such as scope of practice, regulatory issues, and creation of posts will be crucial to realise their potential contribution.

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees’ levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000–March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors.

This study examined the clinical effects of career counseling on psychological distress and the role of counselor adherence, working alliance, and client neuroticism in predicting these effects. The 239 participants received an average of 7.81 sessions at a university career counseling center. Among clients with a clinical level of psychological distress (n = 179) at the study's inception, 55.87% recovered, 22.35% improved, 19.55% experienced no change, and 2.23% saw an aggravation of their psychological distress. Results showed that a higher level of counselor adherence to the intervention manual significantly increased the probability that clients recovered or improved as compared to not experiencing significant change. Working alliance did not predict clinical change, nor did it moderate the effect of counselor adherence. Clients who improved had higher levels of neuroticism than clients who recovered.