BACKGROUND:Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. OBJECTIVE:Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. METHODS:Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher’s Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. RESULTS:Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. CONCLUSION:About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable.
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In many Western welfare states, social work services that have traditionally been provided by paid employees are being replaced by family support, community support, informal networks and volunteering. For the field of social work, it is relevant to know what it matters to beneficiaries whether services are provided by volunteers or by paid employees. The central question of this article is therefore as follows: What are the differences between unpaid and paid social services for beneficiaries? The article is based on literature review and focus groups.Our results suggest that beneficiaries do experience some differences regarding the advantages of volunteer services for beneficiaries that can be summarized in three propositions: (1) Services provided by volunteers are more relational than are services provided by paid employees, and they are therefore perceived as more equal, flexible and sincere. (2) The effects of volunteer services for beneficiaries are not exclusively positive. (3) Although particular tasks may appear to be interchangeable to some extent, the relative advantages of a given task depend upon whether it is performed by a paid worker or by a volunteer. Additional research is needed in order to provide further validation.
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PURPOSE: To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). METHODS: A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. RESULTS: Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. CONCLUSIONS: Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning.
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