Blajeski Shannon M, Klodnick Vanessa V, Caruso Nybelle, Sale Tamara G
School of Social Work.
Youth & Young Adult Services Research & Innovation.
Psychiatr Rehabil J. 2022 Jun;45(2):144-152. doi: 10.1037/prj0000502. Epub 2021 Oct 7.
This study explored the pathways to employment, education, and/or disability among young adults with First-Episode Psychosis (FEP) with the intent to reduce poverty and disability among this population.
Using a critical case design, 10 young adults (ages 21-28) completed two qualitative interviews exploring the key moments that influenced their pathway toward employment and education or disability after experiencing a first-episode of psychosis. Participants had lived experience of an FEP, had completed a Coordinated Specialty Care (CSC) program, and were members of the Early Assessment and Support Alliance's Young Adult Leadership Council (YALC). Qualitative analysis was completed using a four-step template approach and focus group.
Early stigmatizing behavior by hospital staff and the diagnostic label of psychosis challenged participants' self-identity and self-confidence which led to a pause in vocational activities. Meeting peers (i.e., other individuals who had experienced a first-episode of psychosis) through their CSC program normalized their psychosis diagnosis and alleviated feelings of self-stigma; this was integral in returning to and initiating new employment and education goals. YALC involvement provided opportunities for practicing work skills, such as public speaking, and additional peer support that further eradicated self-stigma and improved connection to employment.
Implications for CSC models include broad consideration of the ways that early psychiatric labeling can construct self-stigma, and how this phenomenon stunts the self-confidence needed to pursue employment and education goals. Specific recommendations include utilizing peer connections, peer spaces, and peer-delivered anti-stigma interventions to enhance employment and education pathways. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
本研究探索了首发精神病（FEP）青年成人的就业、教育和/或残疾途径，旨在减少该人群中的贫困和残疾现象。
采用关键案例设计，10名年龄在21至28岁之间的青年成人完成了两次定性访谈，探讨了在经历首次精神病发作后影响其就业、教育或残疾途径的关键时刻。参与者有首发精神病的生活经历，完成了协调专科护理（CSC）项目，并且是早期评估与支持联盟青年成人领导委员会（YALC）的成员。使用四步模板法和焦点小组完成定性分析。
医院工作人员早期的污名化行为以及精神病的诊断标签挑战了参与者的自我认同和自信心，导致职业活动暂停。通过他们的CSC项目结识同龄人（即其他经历过首次精神病发作的人）使他们的精神病诊断正常化，并减轻了自我污名感；这对于回归并启动新的就业和教育目标至关重要。参与YALC提供了练习工作技能（如公开演讲）的机会，以及额外的同伴支持，进一步消除了自我污名感，并改善了与就业的联系。
对CSC模式的启示包括广泛考虑早期精神病标签构建自我污名的方式，以及这种现象如何阻碍追求就业和教育目标所需的自信心。具体建议包括利用同伴联系、同伴空间和同伴提供的反污名干预措施来加强就业和教育途径。（PsycInfo数据库记录（c）2022美国心理学会，保留所有权利）
