Restart : reflections on the British scheme of the 80s for the long term unemployed

The chapter reflects on the first two years of the Restart Scheme introduced by the Manpower Services Commission for Long term unemployed people in the UK from a facilitator's perspective ten years later. It examines the actual weekly program for participants with some case examples from one of the pilot centres, Crawley College, West Sussex, an area of low unemployment. The observations suggested that even in a place where there are many job vacancies, there will be a 3-4% of the population who are unable to compete for jobs and participate in the work force unless sheltered workshops and specialized training initiatives are established.

Special study of the long-term unemployed married secondary wage earners.

Mode of access: Internet.

Voucher-based training for the long-term unemployed /

"April 1983."

Unemployment compensation : a history of extended benefits for the long-term unemployed /

"September 23, 1992; updated May 18, 1993."

Long-term clinical outcome after liver transplantation

With transplant rejection rendered a minor concern and survival rates after liver transplantation (LT) steadily improving, long-term complications are attracting more attention. Current immunosuppressive therapies, together with other factors, are accompanied by considerable long-term toxicity, which clinically manifests as renal dysfunction, high risk for cardiovascular disease, and cancer. This thesis investigates the incidence, causes, and risk factors for such renal dysfunction, cardiovascular risk, and cancer after LT. Long-term effects of LT are further addressed by surveying the quality of life and employment status of LT recipients. The consecutive patients included had undergone LT at Helsinki University Hospital from 1982 onwards. Data regarding renal function – creatinine and estimated glomerular filtration rate (GFR) – were recorded before and repeatedly after LT in 396 patients. The presence of hypertension, dyslipidemia, diabetes, impaired fasting glucose, and overweight/obesity before and 5 years after LT was determined among 77 patients transplanted for acute liver failure. The entire cohort of LT patients (540 patients), including both children and adults, was linked with the Finnish Cancer Registry, and numbers of cancers observed were compared to site-specific expected numbers based on national cancer incidence rates stratified by age, gender, and calendar time. Health-related quality of life (HRQoL), measured by the 15D instrument, and employment status were surveyed among all adult patients alive in 2007 (401 patients). The response rate was 89%. Posttransplant cardiovascular risk factor prevalence and HRQoL were compared with that in the age- and gender-matched Finnish general population. The cumulative risk for chronic kidney disease increased from 10% at 5 years to 16% at 10 years following LT. GFR up to 10 years after LT could be predicted by the GFR at 1 year. In patients transplanted for chronic liver disease, a moderate correlation of pretransplant GFR with later GFR was also evident, whereas in acute liver failure patients after LT, even severe pretransplant renal dysfunction often recovered. By 5 years after LT, 71% of acute liver failure patients were receiving antihypertensive medications, 61% were exhibiting dyslipidemia, 10% were diabetic, 32% were overweight, and 13% obese. Compared with the general population, only hypertension displayed a significantly elevated prevalence among patients – 2.7-fold – whereas patients exhibited 30% less dyslipidemia and 71% less impaired fasting glucose. The cumulative incidence of cancer was 5% at 5 years and 13% at 10. Compared with the general population, patients were subject to a 2.6-fold cancer risk, with non-melanoma skin cancer (standardized incidence ratio, SIR, 38.5) and non-Hodgkin lymphoma (SIR 13.9) being the predominant malignancies. Non-Hodgkin lymphoma was associated with male gender, young age, and the immediate posttransplant period, whereas old age and antibody induction therapy raised skin-cancer risk. HRQoL deviated clinically unimportantly from the values in the general population, but significant deficits among patients were evident in some physical domains. HRQoL did not seem to decrease with longer follow-up. Although 87% of patients reported improved working capacity, data on return to working life showed marked age-dependency: Among patients aged less than 40 at LT, 70 to 80% returned to work, among those aged 40 to 50, 55%, and among those above 50, 15% to 28%. The most common cause for unemployment was early retirement before LT. Those patients employed exhibited better HRQoL than those unemployed. In conclusion, although renal impairment, hypertension, and cancer are evidently common after LT and increase with time, patients’ quality of life remains comparable with that of the general population.

Place-based initiatives to tackle mature-age workers’ long-term unemployment in Australia, drawing on successful Nordic precedents

In order to tackle unemployment for the at-risk group of mature-age workers displaced by industry sector restructuring, exemplary place-based initiatives are needed focusing on a selected area of high disadvantage identified by Professor Tony Vinson’s 2015 Jesuit Social Services report Dropping off the Edge, with an Australian state government committed to supporting the initiative, as that report recommends. In order to make such a place-based initiative exemplary in its outcomes, so that it leads to uptake in other areas of high disadvantage, it needs to be thoroughly informed by successful Nordic precedents. In particular, the new Australian place-based initiative needs to be informed by Danish regionally-focused large-scale job skills programs involving transition into a proximate sector of employment growth; and by Norwegian measures for more even population distribution outside capital cities or in particular hard-hit regions within capital cities. An advantage of the proposed initiative is that it will also produce measurable results for children in families in which neither parent works, whose needs are normally tackled (if at all) by separate policy actions in separate tiers or departments of government. Australian children are disproportionately disadvantaged by the internationally extreme concentration of joblessness. Denmark’s Løntilskud and Virksomhedspraktik job training programs subsidised by municipalities and the national government, and supported by Danish trade unions, will be discussed in this paper for the positive effects they have for participants, including establishing or re-establishing unemployed people’s structured work habits and routines, improving their networks along with their social skills, and boosting their confidence. This paper will outline in detail the types of features the proposed new Australian place-based initiative will require, drawing on and drilling down further into data and analysis presented in the author’s recent book: Northern Lights: The Positive Policy Example of Sweden, Finland, Denmark and Norway.

Long-term effectiveness of supported employment: 5-year follow-up of a randomized controlled trial

Objective The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1-2 years in persons with severe mental illness. The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years. Method A randomized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness. Competitive work and hospital admissions were tracked for 5 years, and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life. A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment. Results The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period. Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% compared with 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from 2 years to 5 years for participants in supported employment. Participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital. The social return on investment was higher for supported employment participants, whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs. Conclusions The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment.