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Abstract
Aim: The aim of this study was to provide new
insight into the factors that affect work participation by those with
cognitive deficits following an acquired brain injury.
Method: The study had a qualitative
exploratory design, with three focus-group interviews used to collect data.
The first group comprised workers with experience of cognitive deficits
after a traumatic brain injury (TBI), anoxic brain damage and stroke, the
second group professionals from specialist levels of social security service
and the third professionals from specialised health care services.
Transcribed interviews were analysed using a conventional approach to
content analysis. Major findings: A broad range
of factors affected work participation. Personal factors, the psychosocial
adaptation process, injury-related consequences as well as factors in the
working environment were found to inhibit work participation. Acceptance of
a different level of functioning and a new role in working life was an
important but time-consuming process. Significant working-environment
barriers were workplace demands, the attitudes of employers and colleagues,
complicated information, excessive bureaucracy, too little practice before
going back to work and physical barriers. Optimism and being determined were
found to be particularly important facilitating personal factors. Important
resources provided by the working environment were social support,
time-related flexibility, relevant tasks and accommodations.

Background: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. Methods: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). Results: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ 2 (7) = 41.38 p < .001. Conclusion: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. ; This study was funded by the Scottish Government. ; publishedVersion