Detecting the Unidentified Victims: Recognized Versus Unrecognized Child Sexual Abuse Sarah DeGue1, John Clemmons1, David DiLillo1, and Issac Martinez2 University of Nebraska-Lincoln1 Family Violence and Injury Lab Our Lady of the Lake University2

1

Vocational Rehabilitation Specialists
Perspectives of Schizophrenia and
Employment Kristen Laib, M.S.1,2 Yuliana E.
Gallegos, M.A.1 Dennis R. Combs, Ph.D.2
William D. Spaulding, Ph.D.1 1Department of
Psychology, University of Nebraska-Lincoln 2Depart
ment of Psychology, University of Texas at Tyler

RESULTS
METHOD
INTRODUCTION OBJECTIVES

• The 20 questions in Part 2 of the questionnaire
  was divided into three symptom categories based
  on the DSM-IV criteria for schizophrenia
  positive symptoms, negative symptoms, and
  neurocognitive symptoms. Each of the subscales
  was converted to item based mean score positive
  symptoms (mean 2.97 SD .94), negative
  symptoms (mean 2.88, SD .82),
  social/neurocognitive symptoms (mean 3.12, SD
  .85). A repeated measures ANOVA was conducted
  comparing the three subscales. The results of
  Wilks Lambda .862, F (2, 113) 9.05, p lt
  .001, was significant. Pairwise comparisons
  between the mean subscale scores showed higher
  ratings for social/cognitive factors than
  negative symptom factors as barriers in job
  attainment there was no difference with positive
  symptom scores.
• Principal components analysis (PCA) with
  varimax rotation was conducted to assess the
  underlying structure for the twenty items in Part
  2 of the questionnaire. The results of the first
  PCA, based on the eigenvalue greater than 1 rule,
  revealed a 4-factor solution as the best fit for
  the data . The total variance accounted for by
  this analysis was 71.21. The first factor,
  appears to reflect disorganized and catatonic
  behavior, had strong factor loadings on variables
  4-10. The second factor, appears to reflect
  decreased thought processes, had high loadings on
  variables13-20. The third factor, appears to
  reflect paranoia, loaded highly on variables 1-3.
  The fourth factor, appears to reflect flat
  affect, had high loadings of variables 11-12.
• A second PCA was run with a forced 3 factor
  solution. The total variance accounted for by
  this analysis was 65.18, which is approximately
  6.03 less variance than the initial PCA. The
  first factor, appears to reflect catatonic and
  disorganized behavior, includes the same
  variables as in the first analysis, variables
  4-10. The second factor, appears to reflect
  negative processing, includes variables 11-18
  20. The third factor, appears to reflect
  paranoia, includes variables 1-3 19 (Table 3).
• The 3-facotr solution was considered a better
  reflection of underlying constructs (see
  discussion). As such, based on the 3-factor
  solution, a repeated measures ANOVA was conducted
  comparing the three subscales identified in the
  PCA catatonic and disorganized behavior,
  negative thought processing, and paranoia. The
  results of Wilks Lambda .721, F (2, 113)
  21.89, Plt.001, was significant. Pairwise
  comparisons between the mean subscale scores
  shows a significant difference between all three
  subscales with paranoia rated the highest,
  followed by disorganized and cationic behavior,
  and negative thought processing rated as the
  lowest barrier to employment.

• Schizophrenia is often a debilitating condition
  that negatively impacts ones level of
  functioning, including employment.
• U.S. unemployment rates for individuals diagnosed
  with schizophrenia averages 90 (Geertsen, Davis,
  Ellis, 2002). In the UK, unemployment rate
  averages 80-90 (Marwaha Johnson, 2004).
• In the research literature, negative symptoms of
  schizophrenia are more associated with
  unemployment than positive symptoms (Rosenheck,
  et al., 2006).
• Negative symptoms may lead to microbehaviors and
  interview skills that are not rated favorably for
  employment (i.e., poverty of speech, flat affect,
  restriction in goal directed behavior, or
  avolition) (Solinski, et al., 1992).
• However, the association between negative
  symptoms and unemployment is not entirely clear.
  Part of the difficulty lies in the inability to
  separate certain negative symptoms from social or
  cognitive deficits associated with schizophrenia.
  
• While social/cognitive deficits are not formally
  included in the diagnosis of schizophrenia, the
  DSM-IV includes 7 references to cognitive
  dysfunction in the disorder (Keefe Easley,
  2006).
• Additionally, in neuropsychological testing, 27
  of the population diagnosed with schizophrenia
  are classified as neuropsychologically normal,
  compared to 85 of the general population
  (Palmer, et al., 1997).
• Research also indicates deficits in social
  cognition, including theory of mind (Roncone, et
  al., 2002), and the identification and
  discrimination of facial affect (Pinkham, Penn,
  Perkins, Bieberman, 2003).
• To date, research on schizophrenia and employment
  has considered the characteristics of the
  consumer to understand the various symptoms of
  schizophrenia that negatively affect employment.
  The current study focuses on the perspective of
  the vocational rehabilitation specialist to
  identify the barriers they face when working with
  individuals diagnosed with schizophrenia in
  finding employment.

This study was approved by the University of
Texas at Tyler Institutional Review Board and
supported by the Texas Department of Assistive
and Rehabilitative Services (DARS).
Participants The Vocational Rehabilitation
program of DARS serves individuals with mental
and physical disabilities in obtaining
employment. Participants included Vocational
Rehabilitation Specialists (VRS) ,as their job
duties are solely in the area of employment. A
total of 171 individuals started the
questionnaire. Of those individuals, 127 (75.6)
were currently employed as a VRS at the time of
the questionnaire and 41 individuals (24.4) were
not employed as a VRS. Only individuals
currently employed as a VRS were included in the
analysis of the hypotheses. Measures A lengthy
search was conducted to identify an existing
questionnaire to identify the barriers to
employment for those with schizophrenia from the
perspective of the vocational specialist. No
measures were identified that addresses the
perspective of the vocational provider. Since an
appropriate questionnaire was not identified, a
questionnaire was created by the examiner. The
questionnaire consists of three parts. Part One
includes questions about the personal and
professional characteristics of the participant.
Part Two of the questionnaire consists of 20
questions regarding the symptoms and/or features
of schizophrenia. These questions were based on
positive, negative, and social/neurocognitive
features of schizophrenia. Part Three of the
questionnaire asks demographic questions about
the participant including race/ethnicity, gender,
marital status, age, etc. Procedure The
questionnaire was converted to an online survey.
Participants were requested to complete the
survey by email, via the survey website.
Table 1 Table 1
VRSs Demographics VRSs Demographics
n ()
Gender
Male 38 (29.9)
Female 81 (63.8)
Age Range
23-30 yrs 13 (10.2)
31-40 yrs 23 (18.1)
41-50 yrs 29 (22.8)
51-60 yrs 40 (31.5)
61 yrs 14 (11.0)
Ethnicity
European American 69 (54.3)
African American 21 (16.5)
Hispanic/Latino 22 (17.3)
Native American 3 (2.4)
Educational Level
Some College 3 (2.4)
Bachelors Degree 15 (11.8)
Masters Degree 98 (77.2)
Doctoral Degree 3 (2.4)
Marital Status
Single 16 (12.6)
Married 66 (52.0)
Separated 2 (1.6)
Divorced 22 (17.3)
Widowed 6 (4.7)
Table 3 Table 3 Table 3 Table 3
Factor Analysis Three Factor Solution Disorganized Catatonic Behavior Negative Thought Processes Paranoia
1. Barrier - hear voices, noises, sounds .391 .041 .660
2. Barrier - see images or objects .543 -.023 .668
3. Barrier - have delusions .223 .275 .666
4. Barrier - incoherent speech .813 -.078 .343
5. Barrier - speech is derailed .554 .422 .347
6. Barrier - dresses in unusual manner .758 .227 .150
7. Barrier - dresses inappropriately for work .875 .212 .075
8. Barrier - grooming habits inappropriate .774 .382 -.016
9. Barrier - client is non-responsive to environment .829 .186 .331
10. Barrier - has unusual/rigid body positions .713 .242 .323
11. Barrier - has flat/restricted affect .119 .682 -.111
12. Barrier - responds in brief replies .204 .733 -.119
13. Barrier - does not engage in goal directed activity .308 .653 .071
14. Barrier - unable to maintain attention .341 .597 .359
15. Barrier - unable to learn or retain information .299 .599 .392
16. Barrier - cannot adapt to new environment .258 .682 .302
17. Barrier - slow processing speed .172 .640 .327
18. Barrier - cannot discriminate affect of others .111 .690 .447
19. Barrier - cannot identify others intentions .012 .565 .621
20. Barrier - does not find pleasure/interest -.057 .783 .208
Table 2
Positive Symptoms
1. Barrier - hear voices, noises, sounds
2. Barrier - see images or objects
3. Barrier - have delusions
4. Barrier - incoherent speech
5. Barrier - speech is derailed
6. Barrier - dresses in unusual manner
7. Barrier - dresses inappropriately for work
Negative Symptoms
8. Barrier - grooming habits inappropriate
9. Barrier - client is non-responsive to environment
10. Barrier - has unusual/rigid body positions
11. Barrier - has flat/restricted affect
12. Barrier - responds in brief replies
13. Barrier - does not engage in goal directed activity
20. Barrier - does not find pleasure/interest
Social/Cognitive Deficits
14. Barrier - unable to maintain attention
15. Barrier - unable to learn or retain information
16. Barrier - cannot adapt to new environment
17. Barrier - slow processing speed
18. Barrier - cannot discriminate affect of others
19. Barrier - cannot identify others intentions
DISCUSSION

• A questionnaire was created to identify the
  symptoms of schizophrenia that are the greatest
  barriers to employment based on the perspectives
  of VRS. The DSM-IV diagnostic criteria of
  schizophrenia is comprised of positive and
  negative symptoms. In addition to the DSM-IV
  criteria, research has identified
  social/cognitive deficits associated with
  schizophrenia. The questionnaire included 20
  items which related to the three underlying
  constructs positive symptoms, negative symptoms,
  and social/cognitive deficits (Table 2).
• Research shows that negative symptoms are more
  associated with unemployment, as compared to
  positive symptoms. The presented results did not
  support this research finding, as the
  participants rated social/cognitive deficits as
  the greatest barrier in assisting consumers to
  obtain employment, when compared with positive or
  negative symptoms. However, it should be noted
  that social/cognitive features of schizophrenia
  are a more recent interest of research and have
  probably not been studied specifically as a
  predictor of (un)employment. It is anticipated
  that VRS would benefit from additional training
  in the area of schizophrenia and the symptom
  areas associated with the disorder. More
  specifically, VRS should receive training about
  the negative symptoms of schizophrenia and the
  effect of these symptoms on ones ability to
  obtain and/or maintain employment.
• PCA of the 20-item questionnaire was conducted
  twice. First, allowing SPSS to determine the
  number of factors based on eigenvalue greater
  than 1. Second, a three factor solution was
  specified based on the fact that the items were
  designed to index three primary constructs
  positive symptoms, negative symptoms, and
  social/cognitive symptoms. The results of the
  first analysis revealed four factors, while the
  results of the second analysis revealed three
  factors. While the first factor accounted for
  slightly more variance (71.28) than the second
  factor (65.89), the second factor analysis is a
  better representation of the underlying
  constructs as it is more precisely aligned with
  the DSM-IV diagnostic category of schizophrenia.
  The three factors identified are paranoia,
  disorganized and catatonic behavior, and negative
  thought processes (Table 3).
• Based on the second PCA (Table 3), an analysis
  was conducted to determine which of these
  subscales are rated as the greatest barrier to
  obtaining employment, as rated by VRS. While
  the first analysis was based on the DSM-IV
  criteria of positive symptoms, negative symptoms,
  and social/cognitive deficits (Table 2) the
  second analysis is based on the subscales of
  paranoia, disorganized and catatonic behavior,
  and negative thought processes identified by the
  PCA (Table 3). The results were not consistent
  with the first analysis, as the symptoms of
  paranoia , were rated as the greatest barrier to
  assisting consumers in obtaining employment.
  This was followed by disorganized and catatonic
  behavior. Negative thought processes were rated
  as the lowest barrier to assisting consumers in
  obtaining employment. Notably, the positive
  symptom subscale includes items of paranoia, as
  well as disorganized speech and behavior. When
  separating paranoia from disorganized behavior,
  these symptoms are seen as a greater barrier to
  employment. Thus, a subset of positive symptoms,
  paranoia, are rated as the greatest barrier to
  employment in this analysis. This is not
  consistent with the first analysis which
  identified social/neurocognitive deficits as the
  greatest barrier. The factor analysis revealed
  that the symptoms of schizophrenia are not
  consistent with the current DSM-IV-TR diagnostic
  category of schizophrenia. While the diagnostic
  criteria of positive symptoms includes symptoms
  or paranoia and disorganized symptoms, the factor
  analysis separated these symptoms into two
  clusters. As such, when just analyzing paranoid
  symptoms alone, they are reported as the greatest
  barrier to obtaining employment. Further
  research is needed to corroborate these results.
  If corroborated, the underlying structure of
  schizophrenia symptoms should be examined.