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Unique Issues in Assessing Work Function Among Individuals with Psychiatric Disabilities

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Abstract

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 person's 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.

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REFERENCES

  1. Harris Interactive. 2000 N.O.D./Harris survey of Americans with disabilities (Study No. 12384). New York: Harris Interactive, 2000.

    Google Scholar 

  2. Stoddard S, Jans L, Ripple J, Kraus L: Chartbook on work and disability in the United States: An infouse report. Washington, DC: U.S. National Institute in Disability and Rehabilitation Research, 1998.

    Google Scholar 

  3. Salkever D, Goldman HH, Purushothaman M, Shinogle J: Disability management, employee health and fringe benefits, and long-term disability claims for mental disorders: An empirical exploration. Milbank Q 2000; 78: 79-113.

    PubMed  Google Scholar 

  4. Anthony WA, Cohen MR, Cohen BF. Psychiatric rehabilitation. In: Talbot JA, ed. The chronic mental patient: Five years later. New York: Grune & Stratton, 1984.

    Google Scholar 

  5. Anthony WA, Buell GJ, Sharrat S, Althoff ME: Efficacy of psychiatric rehabilitation. Psychol Bull 1972; 78: 447-456.

    PubMed  Google Scholar 

  6. Anthony WA, Cohen MR, Vitalo RL. The measurement of rehabilitation outcome. Schizophr Bull 1978; 4: 365-383.

    Google Scholar 

  7. Dion GL, Anthony WA. Research in psychiatric rehabilitation: A review of experimental and quasiexperimental studies. Rehab Counsel Bull 1987; 30: 177-203.

    Google Scholar 

  8. Mulkern VM, Manderscheid RW. Characteristics of community support program clients in 1980 and 1984. Hosp Community Psychiatry 1989; 40: 165-172.

    PubMed  Google Scholar 

  9. Anthony WA, Cohen MR, Farkas MD, Psychiatric rehabilitation. Boston, MA: Boston University Center for Psychiatric Rehabilitation, 1990.

    Google Scholar 

  10. Bond GR, McDonel EC. Vocational rehabilitation outcomes for persons with psychiatric disabilities: An update. J Voc Rehab 1991; 1: 9-20.

    Google Scholar 

  11. Anthony WA, Cohen MR, Farkas MD, Gagne C: Psychiatric rehabilitation. Boston, MA: Boston University Center for Psychiatric Rehabilitation, in press.

  12. New York State Office of Mental Health. Jobs: People should not face "40 years of unemployment." OMH Q 4, 1998.

  13. Rehabilitation Services Administration. The provision of vocational rehabilitation services to individuals who have severe mental illnesses: Program administrative review (Final report).Washington, DC: Office of Special Education and Rehabilitative Services, U.S. Department of Education, 1995.

    Google Scholar 

  14. National Institute on Disability and Rehabilitation Research. Consensus statement: Strategies to secure and maintain employment for people with long-term mental illness. Washington, DC: National Institute on Disability and Rehabilitation Research, 1992.

    Google Scholar 

  15. National Institute on Disability and Rehabilitation Research. Trends in labor force participation among persons with disabilities, 1983-94. Report 10, U.S. Department of Education, Office of Special Education and Rehabilitative Services, 1997.

  16. Andrews H, Barker J, Pittman J, Mars L, Struening E, LaRocca N: National trends in vocational rehabilitation: A comparison of individuals with physical disabilities and individuals with psychiatric disabilities. J Rehab 1992; 58: 7-18.

    Google Scholar 

  17. Marshak L, Bostick D, Turton L. Closure outcomes for clients with psychiatric disabilities served by the vocational rehabilitation system. Rehab Counsel Bull 1990; 33: 247-250.

    Google Scholar 

  18. Bond GR, Drake RE, Mueser KT, Becker DR: An update of supported employment for people with severe mental illness. Psychiatr Serv 1997; 48: 335-346.

    PubMed  Google Scholar 

  19. Bond GR, Drake RE, Becker DR, Mueser KT: Effectiveness of psychiatric rehabilitation approaches for employment of people with severe mental illness. J Disab Pol Stud 1999; 10: 18-25.

    Google Scholar 

  20. Social Security Administration. Quarterly report on SSI disabled workers and work incentive provisions. Baltimore, MD: Social Security Administration, Office of Research, Evaluation and Statistics, 2000.

    Google Scholar 

  21. Social Security Administration. Social security bulletin: Annual statistical supplement. Washington, DC: Social Security Administration, Office of Research, Evaluation and Statistics. 2001.

    Google Scholar 

  22. Rupp K, Scott CG. Trends in the characteristics of DI and SSI disability awardees and duration of program participation. Soc Secur Bull 1996; 59: 3-21.

    Google Scholar 

  23. National Academy of Social Insurance. Rethinking disability policy: The role of income, health care, rehabilitation and related services in fostering independence, preliminary status report of the Disability Policy Panel. Washington, DC: National Academy of Social Insurance, 1994.

    Google Scholar 

  24. Muller LS. Disability beneficiaries who work and their experience under program work incentives. Soc Secur Bull 1992; 55: 2-19.

    PubMed  Google Scholar 

  25. Jansen M. Introduction to the series of articles on Social Security Disability Reform. Psychosoc Rehab J 1985; 9: 3-7.

    Google Scholar 

  26. Rubenstein LS. Science, law, and psychiatric disability. Psychosoc Rehab J 1985; 9: 7-19.

    Google Scholar 

  27. Anthony WA, Jansen M. Predicting the vocational capacity of the chronically mentally ill: Research and policy implications. Am Psychol 1984; 39: 537-544.

    PubMed  Google Scholar 

  28. Social Security Administration. Titles II and XVI: Residual functional capacity for mental impairments. 20 CFR 402.1545(c); SSR 85-16; 20 CFR, Appendix 1, Part A, Section 12.00, et seq., May 30, 2001, 2001.

  29. Koyanagi C. Social security disability benefits reform act of 1984: Implications for those disabled by mental illness. Psychosoc Rehab J 1985; 9: 21-31.

    Google Scholar 

  30. Piagesi DC, Anthony WA. Social Security and psychiatric disability: What a practitioner must know and do. Psychosoc Rehab J 1985; 9: 31-44.

    Google Scholar 

  31. Kennedy C, Simmens SJ, Pincus HA, Goldman HH, Sharfstein SS: The social security disability evaluation study. New dir Ment Health Serv 1990; 45: 29-36.

    PubMed  Google Scholar 

  32. Pincus HA, Kennedy C, Simmens SJ, Goldman HH, Sirovatka P, Sharfstein SS: Determining disability due to mental impairment: APA's evaluation of Social Security Administration guidelines. Am J Psychiatry 1991; 148: 1037-1043.

    PubMed  Google Scholar 

  33. Liberman R. Psychiatric symptoms and the functional capacity forwork: Final report. Social Security Administration Grant No. 10-P-98193-9004. Los Angeles CA: UCLA Clinical Research Center for Schizophrenia and Psychiatric Rehabilitation, UCLA School of Medicine and VA Medical Center. 1990.

    Google Scholar 

  34. Massel HK, Liberman R, Mintz J, Jacobs HE, Rush TV, Giannini CA, Zarate R: Evaluating the capacity to work of the mentally ill. Psychiatry 1990; 53: 31-43.

    PubMed  Google Scholar 

  35. Rucker KS, Wehman P, Kregel J. Analysis of functional assessment instruments for disability/rehabilitation programs. Report on Findings and Recommendations for Future Directions. Baltimore, MD: Social Security Administration, 1996.

    Google Scholar 

  36. Matheson LI, et al. Functional assessment measures database. J Occup Rehab 2001; 11(3): 177-199.

    Google Scholar 

  37. Center for Psychiatric Rehabilitation. Interim report: Selecting targeted assessment measures for persons with psychiatric disabilities: Procedures and issues. Boston, MA: Center for Psychiatric Rehabilitation, Boston University, 1999a.

    Google Scholar 

  38. Center for Psychiatric Rehabilitation. Summary of targeted assessment measures level 2 review: Emotional/Interpersonal domain. Boston, MA: Center for Psychiatric Rehabilitation, Boston University, 1999b.

    Google Scholar 

  39. Ciardiello JA, Klein ME, Sobkowski S. Ego functioning and vocational rehabilitation. In: Ciardiello JA, Bell MD, eds. Vocational rehabilitation of persons with prolonged psychiatric disorders. Baltimore, MD: The John Hopkins University Press, 1988.

    Google Scholar 

  40. Moller HJ, von Zerssen D, Werner-Eilert K, Wuschner-Stockheim M: Outcome in schizophrenic and similar paranoid psychoses. Schizophr Bull 1982; 8: 99-108.

    PubMed  Google Scholar 

  41. Schwartz C, Myers J, Astrachan B. Concordance of multiple assessments of the outcome of schizophrenia. Arch Gen Psychiatry 1975; 32: 1221-1227.

    PubMed  Google Scholar 

  42. Strauss JS, Carpenter WT. The prediction of outcome of schizophrenia: I. Characteristics of outcome. Arch Gen Psychiatry 1972; 27: 739-746.

    PubMed  Google Scholar 

  43. Strauss JS, Carpenter WT. The prediction of outcome of schizophrenia: II. Relationships between predictor and outcome variables. Arch Gen Psychiatry 1974; 31: 37-42.

    PubMed  Google Scholar 

  44. Rogers ES, Anthony WA, Toole J, Brown MA: Vocational outcomes following psychosocial rehabilitation: A longitudinal study of three programs. J Voc Rehab 1991; 1: 21-29.

    Google Scholar 

  45. Anthony WA: Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment. Psychosoc Rehab J 1994; 17: 3-13.

    Google Scholar 

  46. Coryell W, Tsuang M. DSM-III schizophreniform disorder: comparisons with schizophrenia and affective disorder. Arch Gen Psychiatry 1982; 39: 66-69.

    PubMed  Google Scholar 

  47. Coryell W, Lavori P, Endicott J, Keller M, Van Eerdewegh M: Outcome in schizoaffective, psychotic, and nonpsychotic depression. Arch Gen Psychiatry 1984; 41: 787-799.

    PubMed  Google Scholar 

  48. Coryell W, Grove W, Van Eerdewegh M, Keller M, Endicott J: Outcome in RDC schizo-affective depression: the importance of diagnostic subtyping. J Affect Disord 1987; 12: 47-56.

    PubMed  Google Scholar 

  49. Coryell W, Keller M, Lavori P, Endicott J: Affective syndromes, psychotic features, and prognosis. Arch Gen Psychiatry 1990; 47: 651-657.

    PubMed  Google Scholar 

  50. Tsuang M, Coryell W. An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia. Am J Psychiatry 1993; 150: 1182-1188.

    PubMed  Google Scholar 

  51. Rogers ES, Anthony WA, Cohen M, Davies RR: Prediction of vocational outcome based on clinical and demographic indicators among vocationally ready clients. Community Ment Health J 1997; 33: 99-112.

    PubMed  Google Scholar 

  52. Anthony WA, Rogers ES, Cohen M, Davies RR: Relationships between psychiatric symptomatology, work skills, and future vocational performance. Psychiat Serv 1995; 46: 353-358.

    Google Scholar 

  53. Tsang H, Lam P, Ng B, Leung O: Predictors of employment outcomes for people with psychiatric disabilities: A review of literature since the mid'80s. J Rehab 2000; 66: 19-31.

    Google Scholar 

  54. Fabian E. Longitudinal outcomes in supported employment: A survival analysis. Rehab Psychol 1992; 37: 23-25.

    Google Scholar 

  55. Jacobs H, Wissusik D, Collier R, Stackman D, Burkeman D: Correlations between psychiatric disabilities and vocational outcome. Hospi Community Psychiatry 1992; 43: 365-369.

    Google Scholar 

  56. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd edn. Washington, DC: American Psychiatric Association, 1987.

    Google Scholar 

  57. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: American Psychiatric Association, 1994.

    Google Scholar 

  58. Arns PG, Linney JA: Relating functional skills of severely mentally ill clients to subjective and societal benefits. Psychiatr Serv 1995; 46: 260-265.

    PubMed  Google Scholar 

  59. Mowbray CT, Bybee D, Harris SN, McCrohan N: Predictors of work status and future work orientation in people with a psychiatric disability. Psychiatr Rehab J 1995; 19: 17-28.

    Google Scholar 

  60. Lysaker P, Bell MD, Milstein R, Bryson G, Shestopal A, Goulet J: Work capacity in schizophrenia. Hospi and Community Psychiatry 1993; 44: 278-280.

    Google Scholar 

  61. Bryson G, Bell MD, Lysaker P, Zito W: The Work Behavior Inventory: A scale for the assessment of work behavior for people with severe mental illness. Psychiatr Rehab J 1997; 20: 47-55.

    Google Scholar 

  62. Harding CM, Brooks GW, Ashikaga T, Strouss JS, Breier A: The Vermont longitudinal study of persons with severe mental illness: 11. Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. Am J Psychiatry 1987; 144: 727-735.

    PubMed  Google Scholar 

  63. Spitzer RL, Williams JB, Gibbon M, First M: Structured clinical interview for DSM-III-R. New York: Biometrics Research Press, New York State Psychiatric Institute, 1990.

    Google Scholar 

  64. First MB, Spitzer RL, Gibbon M, Williams JB: Structured clinical interview for DSM-IV axis I disorders, research version, patient edition (SCID I/P). New York: Biometrics Research Press, New York State Psychiatric Institute, 1997.

    Google Scholar 

  65. Danley KS. Improving vocational rehabilitation for persons with psychiatric disabilities. Unpublished manuscript. Boston, MA: Center for Psychiatric Rehabilitation, Boston University, 1985.

    Google Scholar 

  66. Ikebuchi E, Iwasaki S, Sugimoto T, Miyauchi M, Liberman R: The factor structure of disability in schizophrenia. Psychiatr Rehab Skills 1999; 3: 220-230.

    Google Scholar 

  67. Liberman RP. Social and Independent Living Skills: The community re-entry program. Los Angeles, CA: UCLA Department of Psychiatry, 1995.

    Google Scholar 

  68. Rutman ID. How psychiatric disability expresses itself as a barrier to employment. Psychosoc Rehab J 1994; 17: 15-35.

    Google Scholar 

  69. Wallace CJ. Functional assessment in rehabilitation. Schizophr Bull 1986; 12: 604-630.

    PubMed  Google Scholar 

  70. MacDonald-Wilson KL, Rogers ES, Massaro JM, Lyass A, Crean T: An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study. Community Ment Health J in press.

  71. Becker DR, Drake RE, Bond GR, Xie H, Dain BJ, Harrison K: Terminations among persons with severe mental illness participating in supported employment. Community Ment Health J 1998; 34: 71-82.

    PubMed  Google Scholar 

  72. Tsang H, Pearson V. A conceptual framework for work-related social skills in psychiatric rehabilitation. J Rehab 1996; 62: 61-67.

    Google Scholar 

  73. Wallace CJ, Tauber R, Wilde J. Teaching fundamentalworkplace skills to persons with serious mental illness. Psychiatr Serv 1999; 50: 1147-1149, 1153.

    PubMed  Google Scholar 

  74. Anthony WA, Cohen MR, Nemec PB. Assessment in psychiatric rehabilitation. In: Bolton B, ed. Handbook of measurement and evaluation in rehabilitation. Baltimore, MD: Paul Brookes, 1987.

    Google Scholar 

  75. Dickerson FB. Assessing clinical outcomes: The community functioning of persons with serious mental illness. Psychiatr Serv 1997; 48: 897-902.

    PubMed  Google Scholar 

  76. Scott JE, Lehman AF. Social functioning in the community. In: Mueser KJ, Tarrier N, eds. Handbook of social functioning in schizophrenia. Needham Heights, MA: Allyn & Bacon, 1998, pp. 1-19.

    Google Scholar 

  77. Wykes T. Social functioning in residential and institutional settings. In: Mueser KT, Tarrier N, eds. Handbook of social functioning in schizophrenia. Needham Heights, MA: Allyn & Bacon, 1998, pp. 20-38.

    Google Scholar 

  78. MacDonald-Wilson KL, Anthony WA, Nemec PB, Cohen MR: Assessment in psychiatric rehabilitation. In: Bolton B, eds. Handbook of measurement and evaluation, 3rd edn. Baltimore, MD: Paul H. Brookes, 2001, pp. 423-448.

    Google Scholar 

  79. Lysaker PH, Bell MD, Zito WS, Bioty SM: Social skills at work: Deficits and predictors of improvement in schizophrenia. J Nerv Ment Dis 1995; 183: 688-692.

    PubMed  Google Scholar 

  80. Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996; 153: 321-330.

    PubMed  Google Scholar 

  81. Green MF, Kern RS, Braff DL, Mintz J: Neurocognitive deficitis and functional outcome in schizophrenia: Are we measuring the "right stuff"? Schizophr Bull 2000; 26: 119-136.

    PubMed  Google Scholar 

  82. Brekke JS, Raine A, Ansel M, Lencz T, Bird L: Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia. Schizophr Bull 1997; 23: 19-28.

    PubMed  Google Scholar 

  83. Taylor SF, Liberzon I. Paying attention to emotions in schizophrenia. Br J Psychiatry 1999; 174: 6-8.

    PubMed  Google Scholar 

  84. Hodel B, Brenner HD, Merlo MCG, Teuber JF: Emotional management therapy in early psychosis. Br J Psychiatry 1998; 172(Suppl. 33): 128-133.

    Google Scholar 

  85. Bryson G, Bell MD, Kaplan E, Greig T: The functional consequences of memory impairments on initial work performance in people with schizophrenia. J Ner Ment Dis 1998; 186: 610-615.

    Google Scholar 

  86. Lysaker PH, Bell MD, Goulet JL. The wisconsin card sorting test and work performance in schizophrenia. Schizophr Bull 1995; 11: 45-51.

    Google Scholar 

  87. Gold JM, Queern C, Iannone VN, Buchanan RW: Repeatable battery for the assessment of neuropsychological staus as a screening test in schizophrenia, I: Sensitivity, reliability, and validity. Am J Psychiatry 1999; 156: 1944-1950.

    PubMed  Google Scholar 

  88. Hursh NC, Rogers ES, Anthony WA. Vocational evaluation with people who are psychiatrically disabled: Results of a national survey. Voc Eval Work Adjustm Bull 1988; 21: 149-155.

    Google Scholar 

  89. Tashjian MD, Hayward BJ, Stoddard S, Kraus L: Best practice study of vocational rehabilitation services to severely mentally ill persons, Vol.1: Study findings. Washington, DC: Policy Study Associates, 1989.

    Google Scholar 

  90. Bond GR, Friedmeyer MH. Predictive validity of situational assessment at a psychiatric rehabilitation center. Rehab Psychol 1987; 32: 99-112.

    Google Scholar 

  91. Griffiths RDP. A standardized assessment of the work behavior of psychiatric patients. Br J Psychiatry 1973; 123: 403-408.

    PubMed  Google Scholar 

  92. Griffiths RDP. The prediction of psychiatric patients' work adjustment in the community. Br J Soc Clin Psychol 1977; 16: 165-173.

    PubMed  Google Scholar 

  93. Watts FN. A study of work behavior in a psychiatric rehabilitation unit. Br J Soc Clin Psychol 1978; 17: 85-92.

    PubMed  Google Scholar 

  94. Griffiths RDP. The accuracy and correlates of psychiatric patients' self-assessment of their work behavior. Br J Soc Clin Psychol 1975; 14: 181-189.

    PubMed  Google Scholar 

  95. Rogers ES, Sciarappa K, Anthony WA. Development and evaluation of situational assessment instruments and procedures for persons with psychiatric disability. Voc Eval Work Adjustm Bull 1991; 24: 61-67.

    Google Scholar 

  96. Rogers ES, Hursh N, Kielhofner GR, Spaniol L: Situational assessment: Scales to assess work adjustment and interpersonal skills. Boston, MA: Center for Psychiatric Rehabilitation, Boston University, 1990.

    Google Scholar 

  97. Schulteis AMM, Bond GR. Situational assessment ratings of work behaviors: Changes across time and between settings. Psychosoc Rehab J 1993; 17: 107-119.

    Google Scholar 

  98. Lysaker P, Bell MD, Bryson G, Zito W: Raters guide for the work behavior inventory: Rehabilitation, research and development service. West Haven, CT: Department of Veteran Affairs, 1993.

    Google Scholar 

  99. Bryson G, Bell MD, Greig T, Kaplan E: The Work Behavior Inventory: Prediction of future work success of people with schizophrenia. Psychiatr Rehab J 1999; 23: 113-117.

    Google Scholar 

  100. Social Security Administration. Plan for a new disability claim process. Baltimore, MD: Social Security Administration, 1994.

    Google Scholar 

  101. Zarate R, Liberman RP, Mintz J, Massel HK: Validation of a work capacity evaluation for individuals with psychiatric disorders. J Rehab 1998; 64: 28-34.

    Google Scholar 

  102. Kennedy C, Tully R, Craft L, Ullery B, Champney TF, Goldman HH: Expedited social security determinations: The Ohio experience. New Dir Ment Health Serv 1990; 45: 19-27.

    PubMed  Google Scholar 

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MacDonald-Wilson, K., Rogers, E.S. & Anthony, W.A. Unique Issues in Assessing Work Function Among Individuals with Psychiatric Disabilities. J Occup Rehabil 11, 217–232 (2001). https://doi.org/10.1023/A:1013078628514

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