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Impact of Mental Health
or erTexas Community Rehabilitation
Program Conferences
May 13, June 17, June 24, July 8, 2010
Gary L. Fischler, Ph.D., L.P.
1Copyright 2010 All rights reserved
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8:00 10am - Overview: Relationships between mental health disorders and
vocational functionin
-Video presentations and discussion: Symptoms & functionalimpairment of Axis I mental health disorders
10:00 10:15 - Break / Networking
10:15 - noon - Personality disorders: Functional impairments &rehabilitation strategies
-Problem-solving approaches; Partnering with mental
health service providers, employers, & consumers
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Some Facts and Fi uresAbout 20% of adults have a diagnosable
Surgeon Genera s Report,
1999)
48% lifetime revalence Kessler et al. 1994
Mental disorders are the second leadingcause of disabilit after cardiovasculardisease (Surgeon Generals Report, 1999)
Mental disorders account for 20% rimarto 65% (secondary) of all disability claims(Wagner et al., 2000)
3
Genera emp oyment rate o SPMI s on y
10-30% (Anthony, 1994)
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Clients Seeking Rehab ServicesBy Diagnosis*
Mental illness 32%
Ortho edic 20%
Learning disability 12%
Mental retardation 10%
Chemical dependency 7%
Deafness 5%
Brain injury 4%
Other 9%
4
*Minnesota Dept. of Rehab Services (1999)
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Relationship Between Psychiatricsor ers an o u es
Ps chiatric EssentialDisorders
Dutiessyc o og ca
Factors
5
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ESSENTIAL PSYCHOLOGICAL FACTORS
IN JOB PERFORMANCE (Fischler & Booth, 1999)PSYCHOLOGICAL
FACTORS
EFFECTS ON JOB
PERFORMANCE
DIAGNOSTIC
EXAMPLES
Cognition
Intelligence, memory,
academic skills, and theability to use these skills
Depression, anxiety, bipolar,
schizophrenia, dementia, chronicchemical abuse
Pace
e a y o per orm as s a
a reasonable speed.
epress on, o sess ve-compu s ve
disorder, passive-aggressive personality
disorder
Persistence
until it is complete.
,
deficit hyperactivity disorder, histrionic
personality disorder, somatization
disorder, schizophrenia.
Reliability
Coming to work every day inspite of personal or emotional
problems.
Agoraphobia, somatization disorder,mood disorders, avoidant personality
disorder, chemical abuse
onsc en ousness
and Motivation
an ng an ry ng o o a
good job; persisting until it is
accomplished.
a or epress on, persona y sor ers,
chemical abuse
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PSYCHOLOGICAL EFFECTS ON JOB DIAGNOSTIC
FACTORS PERFORMANCE EXAMPLES
Interpersonal
Functioning
The ability to accept
supervision, to get along with
Bipolar disorder manic phase,
post-traumatic stress disorder,
cowor ers or e pu c. many persona y sor ers,
chemical abuse.
Honesty, The ability to be truthful, Anti-social personality disorder,
trustworthiness direct, and straightforward, to
refrain from such things as
lying and theft at work.
borderline personality disorder,
chemical dependency.
Stress tolerance
The ability to withstand job
pressures such as deadlines or
working with difficult people.
Schizophrenia, post-traumatic
stress disorder, somatization
disorder, agoraphobia, major
de ression chemical abuse
Job-specific
requirements
e.g., Typing speed, conflict
resolutions skills, people
Any
skills.
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Overview of PsychiatricDiagnosis (DSM-IV)
Depression, anxiety, schizophrenia
Somatoform disorders
Learning disorders
Axis II: Personality traits & disorders; mentalretardation
Axis III: Physical problems
Axis IV: Psychosocial stressors
Axis V: Global assessment of functioning (0-100)
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Most commonly has progressive onset
-
Affects about 1% of population
Often intermittent symptoms
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Characteristics of Schizophrenia Compromised reality operations
Hallucinations and delusions; illogical thinking; mayshow denial or oor insi ht ma show oor ud ment
Communication problems Unusual or illogical language; disorganized thought and
speec
Negative symptoms
Flat affect low ener slee disturbance amotivationaland anhedonic
Cognitive problems
decision-making skills
Interpersonal problems
10
Suspicious; frightened or argumentative; social
withdrawal, indifference; unusual appearance or behavior
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Schizophrenias Effecton Work
,
Distrusts coworkers and supervisors; may be fearful orargumentative; criticism is viewed as attack; difficult towork in a team
Coworkers may become rejecting or hostile in return,
Interested in achievement or promotions may bediminished by negative symptoms; passive or avoidant in
response to performance demands Easily distracted; cognitively inefficient; increased error
11
Symptoms increase under stress; reliability problems
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Schizo hrenias Effect onEssential Psychological Factors
Level of Impairment:
1. No impairment.
2. Mild -- minimal impairment with little or no effect on
.
3. Moderate -- some impairment which limits ability to
function fully.
4. Serious -- major impairment which may at timespreclude ability to function.
12
. .
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Understanding and Memory 1 2 3 4 5
Remembers locations and basic workprocedures
x
Understands and remembers short, simple
instructions
x
instructions.
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Concentration and Persistence 1 2 3 4 5
Carries out short, simple instructions. x
.
Maintains attention and concentration for xexten e per o s o t me.
,
attendance, and be punctual.
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Concentration and Persistence (Cont) 1 2 3 4 5
Sustains ordinary routine without special
su ervision.
x
Can work with or close to others withoutbeing distracted by them
x
Makes simple work-related decisions x
or s qu c y an e c ent y, meets
deadlines, even under stressful conditions.
x
Comp etes norma wor ay an wor weewithout interruptions due to symptoms
x
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Works at consistent pace without an
unreasonable number or length of breaks.
x
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Social Interaction 1 2 3 4 5
Interacts appropriately with the general x
.
Asks simple questions or requestsassistance when necessary.
x
Accepts instructions and responds
appropriately to criticism from supervisors.
x
Gets along with coworkers without
distracting them
x
Maintains socially appropriate behavior x
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a n a ns as c s an ar s o c ean ness
and grooming
x
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Adaptive Behavior 1 2 3 4 5
Responds appropriately to changes at work. x
Is aware of normal work hazards and takes
necessar recautions.
x
Can get around in unfamiliar places, can xuse public transportation.
e s rea s c goa s, ma es p ansindependently.
x
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Management Strategies with Schizophrenia
Refer for treatment; encourage compliance
Flexible scheduling
ee s g egree o s ruc ure an rou ne; avo
occupations with less structure where misinterpretationsare more likely (e.g. human services)
Avoid high-speed or cognitively complex assignments
Allow solitary work; avoidance of team participation;-
Tangible and frequent incentives (e.g., piecework, break-times, cigarettes)
Dress and behavior codes may need to be clarified Open and direct communication; discuss upcoming
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Consider debriefing coworkers regarding oversensitivityand need for benign environment
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psychotic symptoms
ea y-or en e psyc o erapy s use u or
education, identify symptom precipitants,
,
hallucinations and delusions
eu t erapy e p u or soc adysfunction and negative symptoms
19
Family psycho-educational therapy may
also be useful
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Affects up to 25% of females; 12% of malesnd =
Chance of 3rdepisode = 70%
Chance of 4th e isode = 80-90%
Usually begins in mid twenties
D sth mia is milder more chronic and
predisposes individual to major depression
U to 15% die of suicide
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Characteristics of Majorepression
, ,
Lack of interest in life; low motivation
oor s eep; poor appe e; a gue
Pessimism; low self-confidence; feelings ofwor essness; gu
Poor concentration, memory, & decision-
ma ng pseu o emen aHopelessness; preoccupation with dying;
21
su c a ea on
Sometimes irritable
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Ma or De ressions Effecton Work
Low motivation, energyLow initiative for independent activity
Poor persistence, endurance
Hypersensitive to criticism or rejection
Poor ability to deal with stress, pressure,deadlines
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Irritable with, or withdrawn from, coworkers
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Mana ement Strate ies forMajor Depression u e wor se ng
Avoidspeed-dependent tasks
Max m zepre cta ty n wor ass gnments;
improve self-confidence for new tasks
ons er wr en gu e nes, pro oco s
Flexible scheduling, including breaks
Max m ze soc a support; wor on team; max m zepositive feedback
23
vo o s w su c e r s s
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Anti-depressant medication is usually very
effective, especially for physical symptoms (e.g.,fatigue, sleep disturbance, concentration)
ogn ve- e av ora psyc o erapy can a so every effective, especially for mood disturbance,
relationshi issues etc. Combination often produces long-term relief from
symptoms
Shock therapy (ECT) may be effective for severecases that are resistant to other treatments but
24
often interferes with ability to work
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,
Occurs in .4% to 1.6% of population
75% will return to full functioning
u c e may occur n - o cases
Onset is later than schizophrenia twenties to
Equally common among men and women
25
n erm en ep so es an symp oms
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Characteristics ofMania/Hypomania
, ,
Grandiosity
Re uce nee or s eep
Increased sociability, flamboyancePressured speech, hyperactivity, racing
thou hts fli ht of ideas
Mood-congruent hallucinations and
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-
Excessive energy, but inefficient &
Reduced social judgment; irritable or
Distractibility; distracts coworkers
Work quality decreases under stress and
27Can be very creative and productive
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Management Strategieswith Mania
Encourage a structured, predictable lifestyle
Clear deadlines
A ro riate outlets for creativit socializinFlexible scheduling
,necessary
28
ons er e r e ng cowor ers; u y can
help with organizational tasks
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stabilize mood
n -psyc o c me ca on may a so e
helpful if psychotic symptoms are present
Rea ty-or ente psyc ot erapy can e
useful to improve judgment and identify
esty e prec p tants
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30
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Accommodations forPsychiatric Disorders
EEOC recommendations for non-obvious disabilities
(Also see American Bar Association, 1997):
9 Determine essential functions of job
9 Assess functional limitations re: essentialpsychological factors)
9 Employee and employer mutually identify
accommo at ons9 Accommodations implemented by employer, taking
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Mutual accommodations require
disclosure of psychiatric problems to
employer:
9 Likely to result in better fit betweenfunctional limitations and accommodations.
9 Employees can be coached to make adjustments
for themselves.
9 Employee may be coached in asking for
work lace ad ustments without disclosure.
9 Indirect suggestions by employee may result in
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accommodate.
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T es o Accommodationse. . Mancuso 1993
:9 Most frequent schedule flexibility or changes
(e.g., part-time, flex time, more frequent breaks,
9 Formal or informal job coaches during difficulttimes
9 Change of supervisory methods (e.g., written,
verbal, frequency)9 Rearranging job duties with other employees
9 Reassignment to less stressful work
9 Private or solitary work space
9 Telecommuting
33
9 Additional supervisory support
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Em lo er can re uire treatment as accommodation:
[a] qualified individual with a disability is not requiredto accept an accommodation, aid, service, opportunity or
accept. However, if such individual rejects a reasonableaccommodation, aid, service, opportunity or benefit that
essential functions of the position held or desired, andcannot, as a result of that rejection, perform the essential
,considered a qualified individual with a disability. (U.S.Dept. of Labor, 41 CFR 60-741.21).
34
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plaintiffs depression should not affect hiswork erformance. Several of his su ervisorsurged him to seek treatment, which he
refused to do for more than fourteen months.P a nt s re usa to see t e recommen eand available treatment precludes him from
disability under the ADA (Roberts v. County
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considered to have a voluntary disability.Employers duty to accommodate ends if
employee is non-compliant with treatment:
An employee with bipolar disorder had problemswith attendance and performance was not
otherwise qualified because of med
. . ,
Inc.,No. 96-4072, 1997, U.S. App., LEXIS
12232, 10th Cir.)
36
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Debrief Coworkers
or uperv sors
has a mental health problem (disability ifaccommodation is sou ht
Educational in nature
factors that are external rather than volitional:
Cognitively slow vs. unmotivated (lazy)
Concentration difficulties vs. not capable (stupid)
Interpersonally sensitive vs. rude (snobbish)
37
Consider within the context of team building
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Disclosure of Mental Health
ro ems - vantages
Receive support from colleagues
Therapeutic affirmation
Becomin a consumer advocateMost have no regrets (Ellison et al., 2003)
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Disclosure of Mental Health
ro ems - sa vantages
Shame & embarrassment
Stigma
Discrimination
39
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Encoura e Treatment Com lianceReasons for noncompliance:
Side effects Need to remember and or anize
Expense & inconvenience
Denial
Involve family & social supports
40
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General Vocational Facts About(SPMI)
employment, especially when they are integratedwith mental health treatment programs (Drake et al.,1996)
Longer involvementbetter outcomes (Bond, 1998)
OTJ training produces outcomes equal to or better
than extended unpaid pretraining (Bond, 1998)
or s ncent ves e.g., can e s gn cantnegative predictors (e.g., Edelson, 1993; Ford, 1995)
41
P iti P h i l P di t
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Positive Psychosocial Predictors
o o ace e o(Alforson et al., 1998)
Close relationships with family and friends
Values competitive employment as
Strong desire for financial independence
Ready transportation to and from workShows stron ob-seekin initiative
42
independent of VR system
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Axis II: Personality Traits andDisorders
enduring patterns of perceiving, relating to, andthinking about the environment and oneself,and are exhibited in a wide range of social and
personal contexts
ersona ty sor ers are ex reme var an sof these traits, which lead to either:
mpa rmen n soc a or occupa onafunctioning;
43
Clinically significant distress
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cognitive confusion are strongest negative,
Agreeable andConscientiouspersonality
outcomes (Costa & Widiger, 1994)
nterpersona pro ems are t e mostfrequent cause of unsatisfactory
44
term nat ons (Becker, et al. 1998)
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-
47-90% incidence in those diagnosed withx s sor ers
PDs tend to improve with age
Compulsive and histrionic traits (not
disorders) improve functioning; all others
worsen functioningPDs more likel in those with abuse histories
45
Onset by early adulthood
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-
Insight tends to be poor Self-ratin s and eer ratin s are onl
modestly related:
r= .36 (Klonsky, Oltmanns, & Turkheimer, 2002)Diagnosis is more difficult than Axis I,
requiring:
Extensive history-taking, Review of records
46
Personality testing
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Treatment outcomes are uneven: Lon -term s chothera or rou thera is
treatment of choice
Dialectic Behavior Therapy (DBT) is especially
Medication often ineffective
Impossible to change without motivation
Subjective distress improves prognosisPositive RTW outcomes are also difficult
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PDs b Cluster
Cluster A Odd
Idiosyncratic thinking, suspiciousness, social withdrawal
Paranoid, Schizoid, & Schizotypal
Cluster B Dramatic
Intense emotional expression, mood instability, poor
Antisocial, Borderline, Histrionic, Narcissistic
Anxious, worried, emotionally constricted, poor decision-
making, risk-adverse, cowardly
48
Avoidant, Dependent, Compulsive, Passive-Aggressive
Dramatic Cluster Characteristics
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Dramatic Cluster Characteristics
Grandiose Sense of entitlement; Self-centered
Reacts to criticism or rejection with rage, shame Disregard for rules and ethics
Irresponsible and unreliable
Impulsive; seeks immediate gratification; self-centered;
Often argumentative, hostile, and aggressive
Oppositional relationships with authority
High co-occurrence of substance abuse Unstable mood; often have co-occurring mood disorder
49
-
Impulsive, irresponsible, unreliable
Self-destructive behavior, often manipulative motive
Dramatic Cluster Effects on Work
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Dramatic Cluster Effects on Work
Overestimates skills, accomplishments; underestimatesweaknesses
, ,
Resents coworkers and supervisors who make demandsand dont recognize specialness
Takes direction or criticism poorly
Can be talented, charming, entertaining
uper c a , con c ua re a ons ps w cowor ers
Chafes under supervisory direction
Shows poor judgment
Violates workplace rules, including safety procedures
50
Potentially violent
Can be superficially charming and persuasive
Management Strategies with
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Management Strategies with
ra a c u er
Set clear expectations, boundaries, & consequences Maximize ob ectivit of erformance review standards
Allow opportunity to feel important and valued, but
monitor for exploitation of others
Maximize strengths such as superficial charm and a desire
to be noticed, such as in some customer service work
must be firm, street smart, but not thin-skinned
Standards for performance and attendance must be set and
51
maintained; manipulation resisted
Random drug testing may be valuable
Management Strategies with
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Management Strategies with
Dramatic Cluster (cont) ons er occupa on w g ac v y eve an c ange o
scenery Avoid jobs that are detail-oriented
Closely monitor adherence to safety procedures; avoiddangerous work
-behavior
Flexible scheduling to accommodate mood swings
Can develop close relationships with coworkers, butboundaries should be clarified and monitored
Consider debriefin coworkers re ardin boundar issues
52
and employees need to avoid hostile situations
Ps h l i l E l ti :
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Psychological Evaluation:
Recommended Practices
Training and experience in forensic and/or
Is preferably not the treating clinician:
(Greenberg & Shuman, 1997):
Who is the client/patient?
Competency ssues
Interference with therapeutic relationship
Evaluation procedures
53
Psychological Evaluation:
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Psychological Evaluation:
Recommended Practices
avoid agreeing toperform an evaluation ofhis patient for legal purposes because his
forensic evaluation usually requires that
other people be interviewed and testimony
may a verse y a ect t e t erapeut c
relationship. (American Academy of
,
for the Practice of Forensic Psychiatry,1995
54
Psychological Evaluation:
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Psychological Evaluation:
Recommended Practices
Procedures Confidentialit
Distribution of information
Conse uences of coo eratin or declininReview relevant collateral information,
includin :
Medical records VR records
55
School or employment records
Psychological Evaluation:
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Psychological Evaluation:
Recommended Practices
Personality (e.g. MMPI-2) Co nitive intelli ence and memor
Academic
Structured interview: Mental health, chemical dependency, employment,
education, legal, medical, social, family histories
serve e av or
Reported symptoms
56
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Psychological Evaluation:
Recommended Practices
Summary of personal history, symptoms, andtest results
DSM-IV diagnoses
Functional strengths and limitations Treatment recommendations
Individual, group, or family therapy
e cat on eva uat on
Environmental recommendations for successful
57
Ethical Issues: Interpretation
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Ethical Issues: Interpretation
of Results F.1.a. RCs:
Will take reasonable steps to ensure that appropriateexplanations are given to the client.
. .a. sc osure to c ents. s
Take steps to ensure that clients understand the
im lications o dia nosis, the intended use o tests andreports
B.3.1. Records. RCs:
rovi e access to recor s an copies o recor s w enrequested by clientsIn instances where the recordscontain information that may be sensitive or detrimental
58
to t e c ient, t e RC as a responsi i ity to a equate yinterpret such information to the client.
Guidelines for Interpreting
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Guidelines for Interpreting
Exam Results to Clients
Abilities, strengths, & weaknesses Personalit & emotional fit with VR lan
Briefly describe the tests and test results:
Describe intellectual and academic strengths Explain how identified weaknesses can be dealt with
What implications do the diagnoses have for functional
mpa rmen s an p an
Helps insure that VR plan is consistent with the
abilities and circumstances o the client. see A.1.b.
59
Client Welfare)
Guidelines for Interpreting
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Guidelines for Interpreting
Exam Results to Clients
Allow client to vent feelings, but keepclients focus on understandin self with
regards to developing a:
realistic lan that isconsistent with the abilities and
circumstances o the client. see A.1.b.
Client Welfare)
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S SS
61
REFERENCES
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competitive employment among people with severe mental illness. PsychiatricRehabilitation Journal, 22, 34-45.
mer can ar ssoc a on . enta sa t es an t e mer cans w t sa ty ct (2ndEd.). Washington, DC: Author.
American Ps chiatric Association 1995 . Dia nostic and statistical manual o mentaldisorders (4thEd.). Washington, DC: Author.
Anthony, W.A. (1994). The vocational rehabilitation of people with severe mental illness.ssues an my s. nnova ons an esearc , , - .
Becker, D.R., Drake, R.E., Bond, G.E., Xie, H. Daine, B.J., & Harrision, K. (1998). Jobterminations amon eo le with severe mental illness artici atin in su ortedemployment. Community Mental Health Journal, 34, 71-82.
Bond, G.R. (1998). Principles of the individual placement and support model: Empiricalsuppor . syc a r c e a a on ourna , , -
Costa, P.T., & Widiger, T.A. (1994). Personality disorders and the five-factor model ofpersonality. Washington, DC: American Psychological Association
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ra e, . ., c ugo, . ., ec er, . ., n ony, . ., ar , . . . e ew amps restudy of supported employment for people with severe mental illness. Journal of Consulting andClinical Psychology, 62. 391-399.
Edelson D.S. 1993 . Prediction o vocational rehabilitation outcome: A com arison o the redictivevalidity of demographic variables, MMPI-2, WRK, TRT. Unpublished doctoral thesis. Minneapolis,MN: Minnesota School of Professional Psychology
Ellison, M. L., Russinova, Z., MacDonald-Wilson, K.L., & Lyass, A. (2003). Patterns and correlates ofwor p ace sc osure among pro ess ona s an managers w psyc a r c con ons. ourna oVocational Rehabilitation, 18, 3-14.
Fischler, G.L. & Booth, N.E. (1999). Vocational impact of psychiatric disorders: A guide for
rehabilitation ro essionals. Gaithersbur MD: As en Publishers
Ford, L.H. (1995). Providing employment support for people with long-term mental illness. Baltimore,MD: Paul Brookes Publishing Co.
Greenberg, S.A. & Shuman, D.W. (1997). Irreconcilable conflict between therapeutic and forensic
roles. Professional Psychology: Research and Practice, 28, 50-57.
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S, Wittchen, H-U, &K dl K S (1994) Lif ti d 12 th l f DSM III R hi t i di d i th
-
8/22/2019 Understanding the vocational impact of mental health disorders.
64/65
Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in then e a es: esu s rom e a ona omor y urvey. rc ves o enera syc a ry, ,
819.
Kessler, R.C. & Frank, R.G. (1997). The impact of psychiatric disorders on work loss days.syc o og ca e c ne, , - .
Klonsky, E.D., Oltmanns, T.F., & Turkheimer, E. (2002). Informant reports of personality disorder:Relation to self-report, and future research directions. Clinical Psychology: Science and Practice, 9,
- .
Mancuso, l. (1993). Case studies on reasonable accommodation for workers with psychologicaldisorders. Washington, DC: Washington Business Group on Health.
U.S. Department of Health and Human Services (1999). Mental health: A report of the SurgeonGeneral. Rockville, MD: National Institute of Mental Health.
Wagner, C.C., Danczyk Hawley, C.E., & Reid, C.A. The progression of employees with mental
disorders through disability benefits systems. Journal of Vocational Rehabilitation, 15, 17-29.
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8/22/2019 Understanding the vocational impact of mental health disorders.
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Gary L. Fischler, Ph.D.icense syc o ogist
Diplomate, American Board Psychological Specialties, Forensic Clinical
PsychologyDiplomate, American Board of Disability Analysts
p oma e, mer can oar o aw n orcemen xper s
Dr. Fischler earned his doctorate in Clinical Psychology from theUniversity of Minnesota in 1984. He is an adjunct assistant professoro psyc o ogy a e n vers y o nneso a an an a unc acu y aArgosy University, the Minnesota School of ProfessionalPsychology. He is also a court appointed psychologist and aconsultant to vocational rehabilitation, disability determination, and
pu c sa e y agenc es. r. sc er s spec a n eres s re a e o e
interface between mental health, legal issues, and workplace concerns,and he offers independent medical exams (IMEs), pre-employment,promotional, and fitness-for-duty exams to private and public
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organ za ons. e as wr en severa pu ca ons on ese op cs, ancoauthored a book, Vocational Impact of Psychiatric Disorders: AGuide For Rehabilitation Professionals. He can be reached [email protected].