Factors affecting the likelihood that people with intellectual disabilities will gain employment

Authors: 
Rosenheck, R. A. & Mare, A. S.
Year Published: 
2005
Publication: 
Journal of Intellectual Disabilities
Volume: 
9
Number: 
1
Pages: 
9-23
Publisher: 
Sage
Background: 

People with intellectual disabilities have the lowest employment rates in society. (p. 9) There are many barriers both social and psychological that impact access to employment.

Purpose: 

The study's purpose was to identify factors that may affect "the likelihood that people with intellectual disabilities will find employment through a supported employment agency". (p 9)

Setting: 

The setting was a Supported Employment Agency in a large British city.

Sample: 

The study sample was the files of 200 clients who had received services and most recently exited the agency.

Data Collection: 

Routinely collected data was collected from the review of client records. Written descriptions of motivation when a client entered and left the agency were assessed and entered into a five-point motivation scale.

Intervention: 

The intervention was Supported Employment services for individuals with intellectual disabilities.

Control: 

There was no comparison or control group.

Findings: 

When clients entered services, motivations levels averaged 3.8 based on the scale developed by the researchers. The average motivation when leaving the agency was 2.88. Clients who found employment had motivation levels of 3 or above when leaving the agency. There was a "significant association between motivation and outcome, referrer and outcome, and punctuality and outcome". (p. 19)

Conclusions: 

The higher the initial motivation, the more likely the client was to gain employment.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/1744629505049725
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

Authors: 
Rose J., Saunders K., Hensel, E., & Kroese, B. S.
Year Published: 
2004
Publication: 
Psychiatric Bulletin
Volume: 
28
Number: 
8
Pages: 
281-284
Publisher: 
Royal College of Psychiatrists
Background: 

Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.

Purpose: 

The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Setting: 

The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George‚ Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.

Sample: 

The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.

Data Collection: 

Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included:
• demographic variables: age, gender, ethnicity;
• clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator.
Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.

Intervention: 

A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.

Control: 

There was no control or comparison condition.

Findings: 

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying good implementation

Conclusions: 

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

URL: 
http://pb.rcpsych.org/content/28/8/281
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness

Authors: 
Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P.
Year Published: 
2003
Publication: 
The Journal of Nervous and Mental Disease
Volume: 
191
Number: 
3
Pages: 
139-144
Publisher: 
Lippincott, Williams and Wilkens
Background: 

Supported employment is an evidenced based practice that assists individuals with mental illness with gaining and maintaining employment. One of the major barriers to work are disability payments offered by the Social Security Administration and the Veterans Administration. A few studies have shown that the amount of public income is negatively associated with employment, involvement with vocational rehabilitation services and income received from employment. There are no studies related to to the impact of disability benefits on employment of those individuals who receive intensive case management services.

Purpose: 

The purpose of this study was to explore the relationship between income from public support, participation in Intensive Psychiatric Community Care and employment among veterans with severe mental illness.

Sample: 

The sample included 520 veterans with severe mental illness who were randomly assigned to either IPCC or standard care. Prior to entering the study the majority or 87.5% were receiving at least one form of public payment. The average amount was nine hundred and fifty five dollars.
At the 12 month follow up interview, most of the sample 91.2%) were classified as non workers. There were few differences on baseline and demographic and mental health status. There was a significant difference between workers and non-workers on the amount of public income received in the month prior to baseline assessment, with non workers receiving more money.

Data Collection: 

Demographic and mental health status were obtained through participant interviews at baseline and one year out. Symptom severity was measured using the Brief Psychiatric Rating Scale. Alcohol and drug use were examined using scores from the Addiction Severity Index. Functional status was assessed using the Global Assessment Scale. Fidelity to the IPCC Model was measured using the Dartmouth Assertive Community Treatment scale. A liberal measure was used to determine employment. In the data analysis, only composite scores were examined. Bivariate analyses were used to examine differences between demographic and mental health status variables. Multivariate logistic regression was used to look at the contribution of the independent variable.

Intervention: 

The intervention was Intensive Psychiatric Community Care (IPCC).

Control: 

The control condition was standard care.

Findings: 

Public support levels were inversely related to employment. Symptom severity did not appear to be an independent barrier to work.

Conclusions: 

Previous analyses of this study did not look at infrequent outcomes like employment. However, there is value in doing so as the results revealed the impact of assertive case management on employment outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12637839
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The impact of employment counseling on substance user treatment participation and outcomes

Authors: 
Resnick, S. G., Neale, M. S., & Rosenheck, R. A.
Year Published: 
2004
Publication: 
Substance Use & Misuse
Volume: 
39
Number: 
13
Pages: 
2391-2424
Publisher: 
Marcel Dekker
Background: 

Employment Counseling (EC) is one of the more frequently received ancillary services in substance user treatment. Examining the impact of EC on treatment participation, post discharge abstinence and employment helps determine need for services and future study.

Purpose: 

This article provides an analysis of the impact employment counseling has on individual‚ participation in treatment, post discharge abstinence and employment.

Setting: 

The setting included various community mental health centers providing substance abuse counseling.

Sample: 

A sub-sample of 988 adult clients discharged from 143 outpatient non- methadone substance abuse treatment facilities from the Alcohol and Drug Services Study was used.

Data Collection: 

Data obtained from the treatment record abstracts and from interviews with the same clients were used in multivariate regressions that controlled for client demographic and background characteristics, facility characteristics, and characteristics of the sampled treatment episode. (pg. 2397)
Five dependent variables were examined: treatment participation, treatment duration, treatment completion, abstinence since discharge, and employment since discharge.

Intervention: 

The intervention was substance abuse treatment with employment counseling as an ancillary service.

Control: 

Clients were in two groups for comparison. One group had met-need for employment counseling. The second group had unmet need and did not participate in employment counseling.

Findings: 

Clients with met need for employment counseling had longer treatment duration than those with unmet need (did not participate in employment counseling). There was no significant difference for treatment completion between the met-need and the unmet-need groups. Receipt of employment counseling has no impact on post discharge abstinence. Clients with met need for employment counseling were more than three times more likely to be employed at any time after discharge than clients with unmet needs. (p 2407)

Conclusions: 

This study showed that clients who needed and received employment counseling have both better treatment participation and greater likelihood of employment after discharge than clients with unmet need. (p 2413)

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603009
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of post-high school employment among young adults with disabilities

Authors: 
Reif, S., Horgan, C., Ritter, G., & Tompkins, C.
Year Published: 
2002
Publication: 
Career Development for Exceptional Individuals
Volume: 
25
Number: 
1
Pages: 
25-40
Publisher: 
Sage
Background: 

Employment status is one of the most frequently researched outcomes following school exit for young adults with disabilities. Reported employment rates have been low, particularly for full-time employment. Factors related to transition success have also been investigated.

Purpose: 

The purpose of this study was to examine data from the Alabama Transition Initiative related to student outcomes. The aim was to identify school, student, and program related variables that contributed to successful employment after school.

Setting: 

The study settings were 37 of Alabama‚ 128 public school systems. These school systems served as the state‚ demonstration sites for its transition systems change project. They were selected through ATI‚ annual competition for transition mini-grants to enhance their transition programs through implementation of a set of best practices and participation in the Alabama Student Tracking System.

Sample: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Data Collection: 

Data for this study were obtained through the Alabama Student Tracking System and a follow-along survey one year post school exit related to participation in employment, postsecondary education, and other adult activities. Data analysis was a hierarchical logistic regression analysis.

Intervention: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Control: 

There were no control or comparison groups.

Findings: 

The follow-up survey found that 73% of former students were employed one year following school exit. Employment outcomes were better for those who were male, with learning disabilities, from urban school systems. Related to the interventions, having a job at school exit was a significant predictor of post-school employment, but assistance from VR or MH/MI services were not.

Conclusions: 

These findings suggest that students with disabilities can benefit from paid work experiences while in high school. In addition, females in rural settings need better transition planning and programs.

URL: 
http://cde.sagepub.com/content/25/1/25.refs?patientinform-links=yes&legid=spcde;25/1/25
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare

Authors: 
Michalak, E., Yatham, L., Maxwell, V., Hale, S., & Lam, R.
Year Published: 
2003
Publication: 
Evaluation Review
Volume: 
27
Number: 
6
Pages: 
656-680
Publisher: 
Sage
Background: 

Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.

Purpose: 

The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.

Setting: 

Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.

Sample: 

The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.

Data Collection: 

Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.

Intervention: 

The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.

Control: 

There was no control or comparison condition. The study used a pre/during/post intervention design.

Findings: 

Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.

Conclusions: 

Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.

URL: 
http://erx.sagepub.com/content/27/6/656.full.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Cognitive training and supported employment for persons with severe mental illness: One-year results from a randomized controlled trial

Authors: 
McGurk, S. R., Mueser, K. T., Harvey, P. D., LaPuglia, R., & Marder, J.
Year Published: 
2005
Publication: 
Schizophrenia Bulletin
Volume: 
31
Number: 
4
Pages: 
898-909
Publisher: 
Oxford University Press
Background: 

Individuals with severe mental illness have poor unemployment rates. Past research indicates supported employment can help improve employment rates among this group. However, not all person with severe mental illness have benefited from that model. For example, poor job tenure rates have been reported. Therefore, it is important to try to improve the effectiveness of these programs. One possible way to enhance outcomes may relate to improving cognitive functioning through an intervention such as cognitive training.

Purpose: 

The purpose of this study was to measure the impact of cognitive rehabilitation on employment outcomes among individuals with severe mental illness who had not been successfully employed and were receiving supported employment services.

Setting: 

The study took place at two mental health centers that provided a wide range of services including supported employment.

Sample: 

Participants included 44 individuals with severe mental illness who were receiving services from 2 mental health centers in New York. The majority were males (62%), from a minority like African American (59%), followed by Hispanic (24%) and had a diagnosis of Schizophrenia. The mean age of participants was 31 years and most had relatively low levels of education. Participants were assigned to either the cognitive training and supported employment program or supported employment.

Data Collection: 

Comprehensive employment data were collected the first year. Cognitive and psychological assessments were administered at baseline and three months later.
Diagnostic and background information were retrieved from the participants charts, interviews, and staff reports. Employment outcomes were measured through contact with the participants and staff. Seven different tests were used to measure cognitive functions (i.e.. attention and concentration, psychomotor speed, information processing speed, verbal learning and memory, executive functioning and overall cognitive functioning) at baseline and 3 month follow up.
Psychiatric symptoms were measured with interviews using the Positive and Negative Syndrome Scale. Efforts were made to get follow up employment data for the one year following randomization. Intent to treat analyses of the employment outcomes were conducted on the entire randomized sample that had some follow up data (n=44). The statistical analysis included: x2, t test and analyses of covariance. Due to skewed data Mann Whitney U tests were also used.

Intervention: 

The intervention was cognitive training titled Thinking Skills for Work and supported employment services.

Control: 

The control was supported employment services without cognitive training.

Findings: 

The rate of retention of the cognitive training program was high. The program was successfully implemented at two sites that predominantly served inner city minorities. Participant who received cognitive training showed improvements in several areas over the first 3 months of the study as well as a better overall cognitive functioning score as compared to those who received only supported employment services. They also had higher rates of employment. Notably, this group showed improvements on the PANSS depression scale.

Conclusions: 

The Thinking Skills for Work program may help individuals with severe mental illness with employment. This program was successfully implemented in a challenging inner city setting. More research is needed.

URL: 
https://academic.oup.com/schizophreniabulletin/article/31/4/898/1877695
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Cognitive and emotional consequences of TBI: Intervention strategies for vocational rehabilitation

Authors: 
McDonnall, M. C., & Cmar, J.
Year Published: 
2006
Publication: 
NeuroRehabilitation
Volume: 
21
Number: 
4
Pages: 
315-326
Publisher: 
IOS Press
Background: 

Traumatic Brain Injury (TBI) negatively impacts successful return to work for many individuals. Training individuals to use effective interventions to compensate for common deficits like attention, memory and executive functioning post injury should improve return to work outcomes.

Purpose: 

The purpose of this study was to describe examples of effective cognitive rehabilitation strategies through the use of 3 case studies and a review of literature. Professionals in the field need this type of information to better serve individuals with TBI who are returning to work.

Sample: 

The study sample included three people with TBI.

Data Collection: 

Various scales were used to measure improvements specifically related to the cognitive ability that was being treated (i.e.. attention deficits, memory problems, executive deficits) in each of the 3 case studies.

Intervention: 

The intervention was individualized cognitive rehabilitation interventions for four individuals with traumatic brain injury.

Findings: 

There are numerous strategies that can be taught to individuals after TBI to help them compensate for common cognitive deficits (ie. attention, memory, executive functioning). Therapists must understand the possibilities and be able to implement specific interventions for each person and be able to use effective teaching strategies to train the individual. It is also important to be aware of ways to support a person who is particularly "challenging" by becoming aware of ways to improve social behaviors and self awareness.

Conclusions: 

Intervention strategies must be individualized. Other considerations include considering the nature and degree of the disability and environmental context. Therapist must be able to think outside the box and use creative problem solving to assist individuals with TBI with using strategies to improve employment outcomes.

URL: 
http://content.iospress.com/articles/neurorehabilitation/nre00329
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A ten-year follow-up of a supported employment program

Authors: 
Schene, A., Koeter, M., Kikkert, M., Swinkels, J., & Crone, P.
Year Published: 
2004
Publication: 
Psychiatric Services
Volume: 
55
Number: 
3
Pages: 
302-308
Publisher: 
American Psychiatric Association
Background: 

Supported employment is considered to be an evidence-based practice for people with psychiatric disabilities. The rate of competitive employment within supported employment programs is three times higher than those in other programs.

Purpose: 

The purpose of the study was to review the outcomes of supported employment 10 years after an initial demonstration project.

Setting: 

The setting included two rural rehabilitative day centers in New Hampshire that became Individual Placement and Support model centers.

Sample: 

The sample included 20 participants in the 1990 Lebanon group and 24 participants in the 1992 Claremont group; a total of 36 were in the follow-up study 10 years later.

Data Collection: 

A semi-structured interview was developed, which included open-ended questions. Open-ended questions were transferred into structured ratings

Intervention: 

The intervention was the Individual Placement and Support (IPS) model of supported employment.

Control: 

There was no control or comparison condition.

Findings: 

Seventy percent of the participants had had some type of competitive employment. Eighty eight percent (N=17) were employed at the time of the study.

Conclusions: 

The study concluded that supported employment is a viable option for people with psychiatric disorders. Further study is needed to determine is self-sufficiency is a realistic goal given that many people don't consider self-sufficiency as a goal to reach when obtaining competitive employment.

URL: 
http://www.worksupport.com/kter/documents/pdf/A10yearfollowupofSupportedEmployment.pdf
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Quality of life and supported employment: A case study of three women with developmental disabilities

Authors: 
Staines, G., L., Blankertz, L., Magura, S., Bali, P., Madison, E. M., Spinelli, M.,Horoqitz, E., Guarino, H.,Grandy, A., Fong, C., Gomez, A., Dimun, A., & Friedman, E.
Year Published: 
2004
Publication: 
The American Journal of Occupational Therapy
Volume: 
58
Number: 
4
Pages: 
455-465
Publisher: 
The American Occupational Therapy Association Inc.
Background: 

Programs aimed at enhancing the quality of life for individuals with disabilities are on the rise. This includes work. To understand the impact of new models of vocational training, it may be instructive to look at sheltered work, the long standing model. The job coach model of supported employment helps individuals with disabilities work in the community. The case for a positive relationship between supported employment and quality of life is not well understood. Research aimed at understanding a person's experiences with supported employment and other factors that impact quality of life may identify whether or not the consumers' needs are really being met.

Purpose: 

The purpose of this study was to better understand the experience of supported employment and a wide range of other factors that affect quality of life for people with developmental disabilities.

Setting: 

The setting for the study included various employment settings where each participant worked as a member of an enclave.

Sample: 

The study included nine participants. Three women with developmental disabilities, three job coaches and either a family member or group home manager for each. All women were white, and able to make their own decisions including informed consent. The women had previously worked at a sheltered workshop and were currently working in a enclave of 8 to 10 adults that was supervised by a job coach. The most frequent type of work performed by the enclave included cleaning at various places and entry level food services.

Data Collection: 

Open-ended interviews and on site observations were used to collect data. The interviews were guided by a script and recorded. Afterwards they were transcribed. The women were also observed while working as a member of an enclave. On site field observations lasted about 2 hours. The job coaches and family members were also interviewed. The data was analyzed using a constant comparative method. All interview and observational data were reviewed and coded. Some quotes were also selected to serve as exemplars of each woman's quality of life experience.

Intervention: 

The intervention was supported employment services.

Control: 

There was no control or comparison condition.

Findings: 

The three women preferred enclave work over the workshop setting. The participants indicating satisfaction with work assignments and relationships with others in the enclave. Policies and regulations like social security, impacted quality of life.

Conclusions: 

People with developmental disabilities can and do form their own opinions when give the opportunity. Professionals must be in tune with this fact and find ways to help make sure consumer voices are heard.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15315252
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes