Abstracts

Rationale: Employment issues are known to significantly impact the overall quality of life for adults with epilepsy. However, effective vocational rehabilitation services are scarce especially for those with epilepsy and comorbid conditions (e.g., psychiatric, developmental, cognitive issues) in Japan. One employment model demonstrated as evidence-based for people with severe psychiatric disabilities is the Individual Placement and Support (IPS) model of supported employment. In this study, the IPS model was integrated as part of a new hospital-based comprehensive care management system, called the Multidisciplinary and Individualized Recovery Assisting Intervention (MIRAI) to better fit the multi-dimensional needs of the individuals. This is the first case-based study to assess the preliminary effect of the MIRAI model on employment outcome of individuals with epilepsy and comorbid conditions. Methods: Three individuals with epilepsy and comorbid conditions were provided services based on the MIRAI model. The MIRAI model is a hospital-based comprehensive care management system with a strength-based and client-centered philosophy. It is comprised of a team of multidisciplinary staffs providing (1) a long-term medical treatment, (2) the IPS services, and (3) other on-going supports. Services consist of continuous medical follow-ups, multidisciplinary team meeting for individualized treatment planning, individual and group psychoeducation about symptom monitoring and medication management, and vocational services. An occupational therapist (OT) particularly played a significant role in delivering vocational services throughout the process of job search, job development, a job interview, consultation with employers, and periodic site-visit for job maintenance. Results: The implementation of the MIRAI model led to the placement and retention of the competitive employment for more than a year for all three individuals. In one case, the seizure frequency was also reduced from three times a week to once a week after the intervention. Medication adherence was also improved as a result of psychoeducation and goal-oriented approach towards employment. Conclusions: This preliminary implementation of the MIRAI framework was successful in the participants' job placement and retention with high subjective job satisfaction. Similarly, the employers reported reduced anxiety about hiring individuals with epilepsy and other comorbid conditions. Adequate communication between medical staffs and employers, epilepsy education, and on-going support might have enhanced the employers' satisfaction. Furthermore, a team of multidisciplinary staffs continuously followed up with appropriate medical and vocational services for each individual as needed. With further research, the MIRAI model has a potential to become an effective comprehensive care framework for people with epilepsy and comorbid conditions in Japan.