La réinsertion professionnelle et le retour aux études chez les personnes en début d’évolution d’un trouble psychotique

Pothier, William; Lecomte, Tania; Cellard, Caroline; Delfosse, Cynthia; Fortier, Stéphane; Corbière, Marc

doi:https://doi.org/10.7202/1088182ar

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Résumé

Introduction La réinsertion socioprofessionnelle est un objectif régulièrement mis de l’avant par les personnes en début d’évolution d’un trouble psychotique. Malgré tout, les taux d’emploi sont faibles chez cette population et des taux de décrochages scolaires élevés subsistent.

Objectifs et méthode. Cette synthèse des écrits scientifiques basée sur les méta-analyses et études récentes vise à faire le point sur les éléments déterminants de la réinsertion professionnelle et du retour aux études pour des personnes en début d’évolution d’un trouble psychotique. Les obstacles et les facilitateurs à la réinsertion socioprofessionnelle, les programmes étudiés, notamment les programmes de soutien à l’emploi et aux études, et les interventions complémentaires aux programmes de soutien sont présentés. De plus, les concepts clés sont illustrés par l’utilisation de vignettes cliniques chez cette clientèle.

Résultats Plusieurs obstacles et déterminants à la réinsertion socioprofessionnelle et scolaire chez cette population, entre autres des facteurs individuels (p. ex. histoire d’emploi, durée d’absence du marché du travail, symptômes négatifs et cognitifs, motivation) et environnementaux (p. ex. disponibilité des programmes de soutien à l’emploi, compétences du conseiller spécialisé, prestation d’aide sociale, attitude de l’employeur), sont présentés. Le programme de soutien à l’emploi accumulant le plus de données probantes est l’Individual Placement and Support (IPS) ; ce programme est fréquemment utilisé au Québec. L’IPS met notamment l’accent sur la recherche d’un emploi compétitif, le placement rapide sur le marché du travail et la collaboration entre le conseiller spécialisé, le client et l’employeur. Le programme de soutien aux études de Mowbray, ainsi que l’IPS adapté aux études, permettent de répondre plus spécifiquement aux besoins des personnes en début d’évolution d’un trouble psychotique qui visent le retour aux études. Deux exemples cliniques de programmes offerts au Québec sont décrits dans le présent article. Malgré des résultats intéressants de ce type de programme de soutien, la réinsertion socioprofessionnelle et le maintien de l’activité (travail ou études) demeurent difficiles chez les personnes en début d’évolution d’un trouble psychotique. Pour pallier ces difficultés, il est proposé dans la littérature scientifique de personnaliser les interventions offertes chez les personnes aux prises avec un trouble psychotique, étant donné la grande hétérogénéité liée à cette condition. La combinaison d’interventions spécifiques visant des enjeux individuels préexistants chez chacune des personnes (p. ex. remédiation cognitive, thérapie cognitive-comportementale, entraînement des habiletés sociales) apparaît être une solution efficace pour optimiser la réponse thérapeutique dans les programmes de soutien à l’emploi ou aux études.

Conclusion. Cet article met en lumière les enjeux reliés à la réinsertion socioprofessionnelle chez les personnes en début d’évolution d’un trouble psychotique, afin de guider les intervenants dans le domaine et d’offrir des pistes de solutions.

Mots-clés :

troubles psychotiques,
premier épisode psychotique,
réinsertion professionnelle,
retour aux études,
soutien à l’emploi,
soutien aux études

Abstract

Introduction Socio-professional reintegration is an objective that is regularly sought-after by people in the early stages of a psychotic disorder. Despite this, employment rates are low for this population and high school dropout rates remind at a high level.

Objectives and method This literature synthesis based on recent meta-analyses and studies aims at presenting the determinants of vocational and school integration for people in the early stages of a psychotic disorder. This will be followed by the presentation of the most studied supported employment and education programs, as well as by complementary interventions to support existing programs. In addition, key concepts are illustrated through clinical vignettes for this clientele.

Results. Several barriers to socio-professional reintegration in this population could help explain the lower success rates when compared to the general population, including individual factors (e.g., past employment history, length of absence from the labour market, negative and cognitive symptoms, motivation) and environmental factors (e.g., availability of supported employment or education programs, competence of the employment specialist, social assistance benefits, employer attitude). The program that shows the most accumulated evidence is called Individual Placement and Support (IPS) and is frequently used in Quebec. IPS focuses on competitive job search, rapid placement in the labour market and collaboration between an employment specialist, the client, and the employer. Mowbray’s supported education programs, as well as IPS adapted for education, help respond more specifically to the needs of people in the early stages of a psychotic disorder, who often wish to return to school. This article describes two clinical examples of programs offered in Quebec. Despite the interesting results provided by supported programs, socio-professional reintegration and maintaining employment remain difficult for people who are in the early stages of a psychotic disorder. Considering this, several researchers suggest that interventions for people with psychotic disorders should be more individualized, given the great heterogeneity associated with this condition. Combining interventions that are specific to each candidate’s pre-existing individual deficits (e.g., cognitive remediation, cognitive-behavioural therapy, social skills training) appears to be an effective solution for optimizing the therapeutic response in supported employment or education programs.

Conclusion This article highlights the issues related to the professional or academic reintegration of people in the early stages of a psychotic disorder, in order to guide practitioners in the field and to offer possible solutions to the current limitations of these programs in Quebec, including access to certain interventions.

Keywords:

psychotic disorders,
first episode psychosis,
work reintegration,
school reintegration,
supported employment,
supported education

Parties annexes

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