BACKGROUND: This study used the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to examine the individual and interactional impact of personal characteristics, state vocational rehabilitation (VR) services, and state environmental factors on employment quality for people with disabilities served by the state-federal VR system. DESIGN: Quantitative descriptive research design using multilevel analysis. PARTICIPANTS: Data extracted from the Rehabilitation Services Administration (RSA) case service report (RSA-911) database and other related databases from FY 2007 to 2009 were analyzed using multilevel (hierarchical) linear modeling to investigate patterns explaining variations among state VR agencies in achieving quality employment outcomes for consumers whose cases were closed successfully. RESULTS: Consumer characteristics predominantly predicted employment quality among the personal, service, and environmental factors studied. Personal factors also explained a considerable amount of between-state differences in quality employment outcomes. Improvement in educational attainment was related to higher employment quality, whereas receiving supported employment and job placement-related services were associated with lower employment quality. Additionally, the proportion of consumers receiving social security benefits in a particular state and state per capita income factors were strong environmental predictors of employment quality. CONCLUSION: Personal and environmental factors used in the present study were useful in predicting the quality of employment outcomes of VR consumers. However, developing a better measurement model for assessing quality employment and including additional factors in future research is warranted.

The VOES is a brief, reliable and valid instrument for assessing vocational outcome expectancy in individuals with SMI that can be integrated into SDT/SET as a vocational rehabilitation engagement and recovery model in psychiatric rehabilitation.

B ackground: Self-determination theory (SDT) has increasingly been used as a theoretical framework for evaluating key elements of the recovery paradigm in rehabilitation and mental health services research and policy-making for people living with severe mental illnesses. Purpose: The purpose of this study was to validate the Behavioral Regulation in Work Questionnaire (BRWQ), an adaptation of the Behavioral Regulation in Exercise Questionnaire-2, as a measure of self-determined work motivation for use in psychiatric rehabilitation settings. Methods: One hundred and twenty-four individuals with severe mental illness were recruited from eight Clubhouse programmes in Hawaii. Factorial validity of the BRWQ was evaluated using exploratory factor analysis. Findings: Principal components analysis of the BRWQ yielded four factors (amotivation, external regulation, introjection and autonomous motivation). The autonomous motivation factor was found to be significantly related to other SDT constructs, including competency, relatedness, outcome expectancy and vocational rehabilitation engagement. Conclusions: The BRWQ is a psychometrically sound SDT measure for assessing self-determined work motivation and could contribute to the use of self-determination as a paradigm for improving recovery and employment outcomes of people with severe mental illness in rehabilitation settings.

The main objective of this study was to determine whether motivational and volitional variables identified in the health action process approach (HAPA) model can be used to successfully differentiate people with multiple sclerosis (MS) in different stages of change for exercise and physical activity. Ex-post-facto design using multiple discriminant analysis was used. Participants were 215 individuals with MS. The outcome variable was measured by the Physical Activity Stages of Change Instrument, along with motivational and volitional measures (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). Participants in the precontemplation, contemplation, and action groups can be maximally separated by two significant canonical discriminant functions, volition and motivation. The action group can be differentiated from other groups based on high group mean (centroid) score on the volition function, and the precontemplation group can be differentiated based on low group means on both the motivation and volition functions. The contemplation group can be differentiated based on high centroid score on the motivation function. Research findings of this study support the concept of stage-matching exercise and physical activity intervention. The HAPA framework can be used to design health promotion behavioral interventions for people with MS in vocational rehabilitation.

Objective: Social support is essential to the health and well-being of persons with serious mental illness (SMI), and family members are a primary source of this support. Despite the primary role of family in the lives of persons with SMI, family is an understudied source of support. This study investigated the types of social support beneficial for persons with SMI from the perspective of family members. Method: Participants were 14 adult family members recruited from a Bay Area National Alliance on Mental Illness who provided regular support for a family member with SMI. Focus group data was analyzed using NVivo10 and consensual qualitative research. Results: Results revealed five support categories: (a) person-centered support, (b) autonomy support, (c) community participation support, (d) health management support, and (e) day-to-day living support. Discussion: Participants described family supports that are conceptually distinct from traditional models of social support and uniquely tied to SMI-related stressors. Findings are also aligned with the mental health recovery model and self-determination theory. Conclusion: Results advance our understanding of SMI-specific types of social support by describing five support categories grounded in the voices of family members supporting a loved one with SMI.