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Providing vocational support to clients with mental health issues has become a pressing need. Clients with mental health challenges experience disproportionately higher unemployment and underemployment rates despite evidence that suggests they express a desire and preference to work and engage in productive occupations (Ali, Schur, & Blanck, 2011; Lohss, Forsyth, & Kottorp, 2012). Studies have also found a strong association between unemployment and depression, anxiety, and/or previous psychiatric hospitalizations (Egan & Hoagland, 2006; Lohss et al., 2012). Egan and Hoagland (2006) reported that vocational challenges are exacerbated by issues related to comorbidities, substance use disorder, homelessness, and previous incarcerations.
Work is the primary way that most adults establish the financial means to address their personal, health, and leisure needs (American Occupational Therapy Association [AOTA], 2011; Cacciacarro & Kirsh, 2006). Moreover, work provides individuals with a sense of achievement, self-esteem, self-control, and an opportunity to experience productivity. Not surprisingly, there is usually a strong relationship between being employed and positive mental health (Cacciacarro & Kirsh, 2006).
A focus on supporting clients to engage or resume meaningful work roles and work-related occupations aligns with occupational therapy's focus on using occupation(s) to promote health, wellness, and full participation in life (AOTA, 2011, 2014). The inclusion of work and work-related occupations within the domain of occupational therapy is consistent with the profession's deep roots and belief that personal health and well-being are supported by work performance (AOTA, 2011). It is critical that occupational therapy practitioners strongly consider a variety of factors when evaluating a client's ability to assume or resume the worker role because unsuccessful work attempts can have negative and long lasting consequences on one's self-concept and sense of self-efficacy, particularly for individuals with mental health challenges (AOTA, 2010; Braveman et al., 2005; Lohss et al., 2012).
The Worker Role Interview (WRI; Braveman et al., 2005) is an occupational therapy assessment tool that was specifically developed to determine psychosocial variables that influence work performance and to document changes in work capacity. The following case study was developed to document the usefulness of the WRI as a strategy for gathering information on one client's transition to work, occupational therapy services that were provided, and factors that either support or interfere with her ability to maintain her worker role.
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