Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes

Authors: 
O'Brien, A., Price, C., Burns, T., & Perkins, R.
Year Published: 
2011
Publication: 
Scandinavian Journal of Caring Sciences, 25(3), 591-598.
Volume: 
25
Number: 
3
Pages: 
591-598
Publisher: 
Nordic College of Caring Science
Background: 

Lack of participation in the open labor market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe.

Purpose: 

Vocational rehabilitation through individual placement and support (IPS) model has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden.

Setting: 

The study was designed as a follow-up of clients included in two SE services for people with a mental illness. Assessments were made at baseline, and at 1-year and 2-year follow-ups. In addition, service use and vocational situation were registered at 2-monthly intervals during the follow-up period. One of these services is situated in a town of 115,000 inhabitants, and the other team is situated in a town where 70,000 people live. Both teams are organized in the municipalities social service organization as time-limited projects. They are financed by a coordinating organization, where representatives of the employment office, social insurance bureau, psychiatric service and the local social service are members.

Sample: 

The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. Assessments included vocational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning. The present paper includes results from the 1-year follow-up.

Data Collection: 

The clients were contacted by the first author as soon as possible after inclusion in the programme. The clients were given the opportunity to choose where the data collection would take place and this was usually at the SE office. However, but some interviews were held in the client‚ residence or in the first author‚ office at the university. In most cases, the data collection lasted for 60‚Äì90 minutes to complete the questionnaires.

Intervention: 

Individual Placement and Support (IPS) model is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice.

Control: 

There was no control or comparison condition.

Findings: 

The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified.

Conclusions: 

This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/21323690
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Individual placement and support for individuals with recent-onset schizophrenia: Integrating supported education and supported employment

Authors: 
Nygren, U., Markström, U., Svensson, B., Hansson, L., & Sandlund, M.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
38
Number: 
4
Pages: 
340-349
Publisher: 
American Psychological Association
Background: 

In recent years, functional outcome has become a very salient target for intervention for individuals with severe mental illnesses. In particular, supported employment has generated substantial research as a means of facilitating return to competitive jobs for individuals with schizophrenia and other severe mental illnesses. This article summarizes the design of an 18-month longitudinal study of IPS in the early course of schizophrenia. Improving and Predicting Work Outcome in Recent-Onset Schizophrenia and discusses the adaptations of the IPS model that were found important for this phase of the illness.

Purpose: 

The purpose of this study was to describe the adaptation of the Individual Placement and Support model of supported employment to individuals with a recent first episode of schizophrenia or a related psychotic disorder.

Setting: 

All study participants were receiving outpatient psychiatric treatment at the UCLA Aftercare Research Program and were participants in the third phase of the Developmental Processes in Schizophrenic Disorders Project.

Sample: 

The study sample consisted of 69 individuals that were recruited from a variety of local Los Angeles area psychiatric hospitals and psychiatric clinics and through referrals from the UCLA outpatient service at the Resnick Neuropsychiatric Hospital at UCLA.

Data Collection: 

A comparison of individuals who were randomized (n=69) to IPS or the Brokered treatment with those who were not randomized (n=18) reveals no statistically significant demographic differences between the two samples. Similarly the randomized individuals did not differ significantly from those who were not randomized in prior illness indicators or symptom severity at screening.

Intervention: 

Given that the vocational goals of persons with a recent onset of schizophrenia often involve completion of schooling rather than only competitive employment, the principles of Individual Placement and Support were extended to include supported education. This extension involved initial evaluation of the most appropriate goal for individual participants, having the IPS specialist working on placement either with the participant or directly with educational and employment settings (depending on permitted disclosure and individual need), and follow-along support that included work with teachers and aid in study skills and course planning as well as typical supported employment activities. Work with family members also characterized this application of IPS.

Control: 

The condition was Vocational rehabilitation through referral to traditional separate agencies(Brokered Vocational Rehabilitation.

Findings: 

A randomized controlled trial is comparing the combination of Individual Placement and Support and skills training with the Workplace
Fundamentals Module with the combination of brokered vocational rehabilitation and broad-based social skills training. Participants in the IPS condition have returned to school, competitive work, and combined school and work with approximately equal frequency.

Conclusions: 

Individual Placement and Support principles can be successfully extended to integrate supported education and supported employment within one treatment program. The distribution of return to school, work, or their combination in this group of individuals with recent-onset schizophrenia supports the view that an integrated program of supported education and supported employment fits this initial period of illness.

URL: 
http://psycnet.apa.org/journals/prj/31/4/340/
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: A pilot study

Authors: 
Noel, V. A., Oulvey, E., Frake, R. E., & Bond, G. R.
Year Published: 
2006
Publication: 
Journal of Occupational Rehabilitation
Volume: 
16
Number: 
4
Pages: 
647-657
Publisher: 
Springer Science+Business Media, LLC
Background: 

Return to work continues to be a challenge among providers and cancer survivors. Cancer patients are a risk for unemployment, due to the long term side effects of cancer and related treatments. Some forms of cancer are chronic diseases and can negatively impact a person's quality of life and lead to long term problems such as fatigue, pain, depression and other functional limitations. The loss of work can further impact quality of life due to loss of income and negative impact on self esteem. Employers and society are also impacted. Cancer survivors tend to get little advice on return to work from the medical community. Work related interventions are limited and the quality of existing studies is only moderate. Interventions are needed to improve return to work outcomes for cancer survivors.

Purpose: 

The purpose of this study is to determine if enhancing communication between the attending and the occupational physicians about a patient's status or providing educational materials with advice on return to work to a patient will enhance the individual's employment outcome.

Setting: 

Patients were recruited from the radiotherapy department at the a large medical center in the Netherlands.

Sample: 

Thirty five patients, who had a prognosis of at least 80% chance of two year survival and who were employed at the time of diagnosis, were enrolled in the study. Twenty six were able to be interviewed.

Data Collection: 

A self administered baseline questionnaire was completed by patients. The overall score on 8 items that were predictive of return to work, according to a previous cohort study, was treated as a predictor of return to work. Variables included:age, gender, diagnosis, type of cancer treatment, depressed mood, physical complaints, physical workload and fatigue. Additionally, satisfaction on the advice from the educational materials was gained during a semi-structured interview. At this time the participants rated the materials on a scale of one (very poor) to 10(very good). Satisfaction with each of the 10 steps, (ie.adherence to the advice), was also rated as useful, somewhat useful, not useful or redundant. Occupational physicians were also interviewed about their satisfaction and perceived influence of the letters and educational material.

Intervention: 

There were 2 interventions. First the radiation oncologist sent two letters to the general practitioner. The first letter was sent at the onset of treatment. The second letter was sent at the conclusion of the treatment and included information on the patient's outcome. Copies of the two letters were also sent to the occupational physician. In the second intervention the radiation oncologist gave the patient educational material that offered ten steps to enhance a patient's return to work. A copy of the leaflet was also sent to the occupational physician along with the second letter sent by the radiation oncologist.

Control: 

In this study the subjects served as their own comparison group in pretest/post-test.

Findings: 

Among the 24 occupational physicians interviewed, 22 considered the information provided in the letters as "helpful". Fifty percent indicated the information influenced their rehabilitation efforts. In particular, this group noted the information on diagnosis and treatment as particularly useful. The educational leaflet was rated on a scale of 1 to 10 as 7.3 with SD of 1.0. Patients were also interviewed after treatment. They gave the educational leaflet a mean score of 7.9 with SD of 0.6. Scores ranges for this group from 6.5 to 10. Not all who rated the advice as useful, acted upon it. Time from ending treatment to return to work ranged from 0 to 133 days. After 6 months 65% of the patients had returned to work. And by month 18,92% of the sample had returned to work.

Conclusions: 

The pilot shows encouraging results on the use of the interventions to assist individuals with cancer with returning to work. Large randomized controlled trials are needed.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17063404
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Vocational support approaches in autism spectrum disorder: A synthesis review of the literature

Authors: 
Nieuwenhuijsen, K., Bos-Ransdrop, B., Uitterhoeve, L. L. J., Sprangers, M. A. G., & Verbeek, J. H. A. M.
Year Published: 
2014
Publication: 
Autism
Volume: 
1
Number: 
1
Pages: 
1-11
Publisher: 
Sage
Background: 

Individuals with autism spectrum disorder have poor employment outcomes. Those who are employed typically work part time and in low skilled occupations.
The literature cites a number of challenges for individuals with ASD. It also suggest dissatisfaction with existing ASD vocational supports. The few studies that do exist suggest using models that support a person with ASD in the workplace. However little is known about the application of these supports.

Purpose: 

This review of the literature takes a look at the overall state of the vocational support intervention literature related to autism spectrum disorder.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The sample included 10 studies about employment support for adults and youth with autism spectrum disorder.

Data Collection: 

A total of 22,878 studies were retrieved using databases comprised of Cochrane, Scholar's Portal, CINAHL,EMBASE, ERIC, Medline, PsycINFO, Google Scholar, Google, review of key ASD Association websites. All articles identified were reviewed using a 3 state retrieval and synthesis process including: initial screening, strict screening for inclusion or exclusion and data extraction and article review. A conceptual scheme was developed for cross comparison of studies whereby interventions and outcomes were reviewed, analyzed and categorized to a common theme.

Intervention: 

There was no intervention. This is a synthesis based analysis of the literature. It is based on a larger systematic review of intervention studies.

Control: 

There were no comparison or control conditions.

Findings: 

The search led to 22,878 autism related intervention studies. After reviewed using a broad inclusion criteria, the number was reduced to 3974. Of the 3974, 501 targeted individuals 18 and over. These were reviewed for specific elements related to vocational intervention and outcome. In total 10 articles were identified. The following categories were found: supported employment comprising of community placement and jobcoaching (8 studies); technology-related applications including media and online use (2 studies).Of the 10 studies identified four focused on individuals with Asperger's Syndrome, and most include a substantial portion of more cognitively able adults with ASD. The literature focuses on using a supported employment approach with an emerging focus on technology related tools.

Conclusions: 

The vocational literature is not substantial in this area. The existing literature must be reviewed with caution due to its low volume and research design issues. It does offer provisional guidance however, more research is needed.

URL: 
http://www.autismalberta.ca/files/Vocational_Support_Approaches.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes

Successful return to work for cancer survivors

Authors: 
Nicholas, D. B., Attridge, M Zwaigenbaum, L., & Clarke, M.
Year Published: 
2007
Publication: 
American Association of Occupational Health Nurses Journal
Volume: 
55
Number: 
7
Pages: 
290-295
Publisher: 
Europe Pubmed Central
Background: 

Advances in diagnosis and treatment has increased the 5 year survival rate among individuals with cancer. With this improvement, comes and increase in individuals who will return to work. Return to work is important in order to improve quality of life, a sense of normalcy and in terms of economic well being. The Americans with Disabilities Act (ADA) may offer legal protections to survivors both before and after treatment. Few studies have looked at return to work experiences among cancer survivors and how the ADA provisions may related to that experience.

Purpose: 

The purpose of this study is to determine factors (related to the ADA) that influence a successful return to work for cancer survivors.

Setting: 

Patients were recruited from an oncology department in a metropolitan hospital in Minnesota and a focus group was held.

Sample: 

Seven individuals attended a 2 hour focus group help at the hospital. All were female and four were breast cancer survivors. The majority were white, married and had a Bachelor's degree or higher level of education. Participants had been employed 8 to 20 months prior to diagnosis.

Data Collection: 

A focus group was help to identify common themes about health, health care, economic security, and return to work. Analysis were descriptive and qualitative. Transcripts of the group meeting were read along with moderator notes. General themes were pulled from this material.

Intervention: 

The intervention in the study included job accommodations and supports.

Control: 

There was no control or comparison condition.

Findings: 

For the majority of participant (N=5) the reason for returning to work was an essential part of their healing. All members of the group were aware of the ADA however, none had engaged in formal conversations with their employers about its provisions. Factors aiding in return to work included: job flexibility, coworker support,and health care provider support. Factors hindering return to work were: ignorance about cancer in the workplace, lack of emotional support, physical effects of cancer, and the impact of cancer on the person's priorities.

Conclusions: 

Occupational nurses have an important role to play in the return to work of individuals who survive cancer. They need to be aware of the positive and negative factors that influence return to work and understand the legal requirements such as the ADA.

URL: 
http://whs.sagepub.com/content/55/7/290.full.pdf
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Effectiveness of vocational rehabilitation following acquired brain injury: Preliminary evaluation of a UK specialist rehabilitation programme

Authors: 
Nachreiner, N. M., Dagher, R. K., McGovern, P. M., Baker, B. A., Alexander, B. H., & Gerberich, S. G.
Year Published: 
2006
Publication: 
Brain Injury
Volume: 
20
Number: 
11
Pages: 
1119-1129
Publisher: 
Informa Healthcare
Background: 

Individuals with Acquired Brain Injury have difficulties with returning to work. Studies show only around 30% returning to work.

Purpose: 

The purpose of the study is to determine the effectiveness of a vocational rehabilitation programme in assisting individuals with Acquired Brain Injury with returning to work or other meaningful activity.

Setting: 

Three Brain Injury Centres based across the United Kingdom.

Sample: 

Participants included 232 individuals with ABI who were discharged from the program between January 2000 and December 2002. The majority were males (82%) and 12% were females. The mean age was 33 years with a range from 17 to 62 years. The majority of injuries were TBI (62%). The date of a person's' injury and enrollment in the programme. ranged from 7 months to 35.5 years. And at the time of injury the majority of individuals has been employed (70%). At the time of entry into the program 92% of the participants were receiving an Incapacity Benefit and regarded as unemployable.

Data Collection: 

Data was gathered using administrative databases and other records located at the three centres. Job roles were classified using the UK standard occupational classification system. Data on outcomes was classified into one of the following: paid competitive work, education and training, voluntary work, discharge to other services, client withdrew and discharged for other reasons.

Intervention: 

Participants engaged in a vocational programme that included a per-vocational rehabilitation phase that provided intensive basic cognitive rehabilitation and in-site vocational trails phase. Afterwards, a supported job search and job coaching was offered to assist individuals with gaining work along with follow up support for up to 5 years.

Control: 

There was no control or comparison condition.

Findings: 

Upon exiting the programme, 41% of the participants had secured paid competitive employment; 16% were volunteering and 15% had entered a training or education. Among the remaining 28%, 15 % were discharged due to medical or rehabilitation programmes to deal with other issues and 13% withdrew. There was no formal cost analysis of the effectiveness of the intervention.

Conclusions: 

A total of 72% of those enrolled in the programme left to start a meaningful activity with 41% securing work. Vocational rehabilitation seems effective in assisting individuals with ABI with returning to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17123928
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The effectiveness of supported employment in people with dual disorders

Authors: 
Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J. Bond, G. R, Essock, S. M., Becker, D. M., Wolfe, R., & Swain, K.
Year Published: 
2011
Publication: 
Journal of Dual Diagnosis
Volume: 
7
Number: 
2
Pages: 
90-102
Publisher: 
PubMed
Background: 

Competitive work is a common goal for people with a severe mental illness (e.g., schizophrenia, bipolar disorder, treatment refractory major depression) and substance use disorder (or dual disorder). Despite this fact, relatively little has been firmly established as to whether substance use problems interfere with the ability of clients with severe mental illness to work or to benefit from vocational rehabilitation programs.

Purpose: 

This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder.

Setting: 

Despite similar methods, the RCTs differed on geographic location, control group interventions, and length of follow-up. The four studies were as follows: The NH study was conducted in two mental health centers in Concord and Manchester, New Hampshire. The DC study recruited clients in an intensive case management program in Washington, DC. In the Hartford study, participants receiving services at a mental health center in Hartford, Connecticut, were randomly assigned. In the Chicago study, clients attending two day programs at a comprehensive psychiatric rehabilitation agency in Chicago, Illinois, were randomly assigned.

Sample: 

The study group consisted of study participants with co-occurring substance use disorders from four RCTs of IPS supported employment versus usual vocational services. All four studies compared a newly established IPS program to one or more well-established vocational programs. In all four studies, participants were recruited from mental health centers (or a psychiatric rehabilitation agency in the Chicago study). Participants were adults who met each state‚ criteria for severe mental illness, typically a DSM-IV Axis I or II diagnosis plus severe and persistent impairment in psychosocial functioning. All participants were unemployed at the time of study admission.

Data Collection: 

This study used archival data from four independent RCTs to determine the effect of IPS supported employment on clients with co-occurring substance use disorders. Institutional Review Boards at local sites and participating universities approved the four studies. In addition, the Institutional Review Board of Indiana University-Purdue University Indianapolis approved the data re-analyses reported here. To evaluate differences at baseline between the clients randomized to IPS compared to the comparison programs on demographic, diagnostic, clinical, and background characteristics, study computed t-tests for continuous variables and chi-square tests for categorical variables.

Intervention: 

Individual Placement and Support (IPS) model is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice.

Control: 

All of the comparison vocational services were highly regarded, active programs, considered at the time to be state-of-the-art. Common principles shared among these comparison groups were the emphasis on stepwise entry into competitive employment (with the exception of one subprogram in the Hartford study) and brokered services in which the vocational program was provided by a separate agency from the mental health program (with the exception of the Chicago program).

Findings: 

In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up.

Conclusions: 

The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23275763
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The Hartford study of supported employment for persons with severe mental illness

Authors: 
Murphy, L., Chamberlain, E., Weir, J., Berry, A., James, D. N., & Agnew, R.
Year Published: 
2004
Publication: 
Journal of Consulting and Clinical Psychology
Volume: 
72
Number: 
3
Pages: 
479-490
Publisher: 
American Psychological Association
Background: 

High rates of unemployment persist with people with psychiatric disorders despite their desire to work. Moderate evidence suggests that people with psychiatric disorders who do work experience "modest benefits in terms of symptoms and life satisfaction" (p. 479).

Purpose: 

Three approaches to vocational rehabilitation were compared for people with psychiatric disorders. This included the Individualized Placement and Support Model(IPS), a psychosocial rehabilitation program (PSR), and standard services.

Setting: 

The setting included community mental health center in Hartford, Connecticut. The psychosocial rehabilitation program was located off-site. Standard services were offered off-site.

Sample: 

One hundred ninety-eight clients consented to participate (out of 258 who were asked): 86% were Latino(n = 64 consents/74 total), 81% were African-American (n = 91 consented/119 total), and 66% were White (n=43 consented/65 total).

Data Collection: 

Several assessments were used: diagnosis,
background information, employment outcomes, and nonvocational outcomes. Interviews were completed by one of three research staff and reliability checks were conducted on 15% of the interviews by having a 2nd person review the interviews.

Job satisfaction was rated by the Indiana Job Satisfaction Scale. PANSS was used for nonvocational outcomes and modified to be entirely client self-report.

Overall functioning was rated by the Global Assessment Scale, while social and leisure functioning was rated using one subscale from the Social Adjustment Scale-II: Social-Leisure subscale, as well as a global rating.

Social network information was rated with a variant of the Social Support and Social Network Interview and was requested at baseline, 12 months and 24 months. Quality of Life was assessed through the Brief Version of Quality of Life Interview. Substance abuse was also tracked using the Alcohol Use Scale and Drug Use Scale.

Statistical analyses were conducted as follows:
- "Intent-to-treat analyses of employment outcomes were conducted on the entire randomized sample" (p. 483).
- A second set of analyses were conducted to determine if clients differed in their vocational outcomes.
- Employment outcomes were collected over the entire 2-year period. The 3 groups on time to job were restricted to clients who obtained any work.
-Changes in non-vocational outcomes used mixed-effects regression models, using the vocational program as the independent variable.

Intervention: 

Two interventions were studied: IPS and PSR. The IPS model used "was based on the principles in the IPS manual (D.R. Becker & Drake, 1993)" (p. 481). The PSR program "incorporated transitional employment into its into its vocational rehabilitation approach" (p. 481). Clients focused on clerical and janitorial skills training with transitional jobs and later obtaining competitive employment.

Control: 

Standard services that are considered typical of most supported employment services, which included access to all other vocational services available to everyone with severe mental illness, vocational program with substandard wages, or competitive wages under contracts negotiated by the program. Two programs were evaluated: standard-supported and standard-enclave.

Findings: 

Fidelity to the IPS model (for each of the programs) was evaluated using the IPS Fidelity Scale. The programs were rated in order from highest to lowest: IPS, standard-supported, PSR, and standard-enclave.

Conclusions: 

The Individual Placement and Support model was the most effective at retaining clients and improving employment outcomes.

URL: 
http://www.worksupport.com/kter/documents/pdf/TheHartfordStudyofSupportedEmployment.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment, job preferences, job tenure and satisfaction

Authors: 
Mueser, K. T., Campbell, K., & Drake, R. E.
Year Published: 
2001
Publication: 
Journal of Mental Health
Volume: 
10
Number: 
4
Pages: 
411-417
Publisher: 
Informa Health Care
Background: 

Brief job tenure is problematic because it often reflects client dissatisfaction with work, and it prevents advancement and the potential to earn higher wages. Relatively few client or situational factors have been consistently correlated with job tenure, with the exception of work experience. However, the role of client job preferences has been examined in only a few studies.

Purpose: 

The relationships between job preferences, job satisfaction and job tenure were examined in a sample of 204 unemployed clients with severe mental illness randomly assigned to one of three vocational rehabilitation programs and followed for 2 years.

Setting: 

The study was conducted at the Capitol Region Mental Health Center (CRMHC) in Hartford, Connecticut. All clients were receiving standard care for severe mental illness, including medication, case management, housing assistance, and access to psychiatric rehabilitation programs.

Sample: 

The study participants were 204 clients with severe mental illness. Criteria for participation included: (1) not currently employed in competitive work ( by US Department of Labor); (2) interest in competitive employment; (3) attendance at two research introduction groups designed to inform clients about the study.

Data Collection: 

Throughout the 2 years of the study information on work, including the type of job, wages, and hours worked, was obtained weekly through brief interviews with clients and vocational staff. In addition, job satisfaction was rated using the Indiana Job Satisfaction Scale 2 weeks after beginning a new job and bi-monthly thereafter as long as clients remain on the job.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

The condition was a psychiatric rehabilitation program (PSR) and standard services (Standard).

Findings: 

For clients in the IPS program, those who obtained jobs that matched their pre-employment preferences for type of work desired reported higher levels of job satisfaction and had longer job tenures than clients who obtained jobs that did not match their preferences. For clients in the PSR or Standard programs, job preferences were not related to job tenure or satisfaction.

Conclusions: 

The findings replicate previous research in this area, and suggest that helping clients obtain work that matches their job preferences is an important ingredient of success in supported employment program.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/09638230123337
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

The effectiveness of skills training for improving outcomes in supported employment

Authors: 
Mueser, K. T., Becker, D. R., & Wolfe, R.
Year Published: 
2005
Publication: 
Psychiatric Services
Volume: 
56
Number: 
10
Pages: 
1254-1260
Publisher: 
Psychiatryonline.org
Background: 

Supported employment for individuals with mental illness is recognized as an evidenced based practice. Although this approach is more successful at assisting individuals with mental illness with gaining and maintaining work, than other traditional means, better outcomes related to job retention is needed.

Purpose: 

The purpose of this study was to evaluate the impact of a supplementary skills training program on employment outcomes for individuals who were receiving supported employment services.

Setting: 

The study took place at an employment support organization that is funded by State vocational rehabilitation.

Sample: 

Thirty five individuals who were enrolled in a supported employment program and had a diagnosis of severe or persistent mental illness participated in the study. Among these individuals, the majority or 80% were men and 97% were non-Hispanic white. About a third or 30% had graduated from secondary education. The mean age was 38 years.

Data Collection: 

Those who consented to participate, completed a Workplace Fundamentals Knowledge Test. Afterwards they were randomly assigned to receive supported employment services alone or to receive supported employment services and the supplementary skills training about workplace fundamentals. Individuals were assigned to the group on an average of 56 days after obtaining a job. Among the 35 participants, 18 received treatment as usual (supported employment services alone) the rest were assigned to the receive the work fundamentals training too. Chi square test and t test indicated no significant difference in the two groups. Workplace knowledge was measured with the Workplace Fundamental Knowledge Test scores at baseline and at nine month intervals. Rates of employment for each month of the study period for individuals who recently went to work was documented by control group and workplace fundamentals group. These rates were compared using a generalized estimating equations analysis. The researchers also compared cumulative time worked, wages earned and job tenure for the first and subsequent jobs held. Mann-Whitney tests were used because that data was skewed. Vocational services used were also analyzed with Mann-Whitney tests.

Intervention: 

The intervention was the supplementary workplace skills training program in SE

Control: 

The control group was the participants who only received supported employment services and did not attend the workplace skills training.

Findings: 

During the study period, participants held a total of 49 different jobs. Forty three percent of the sample worked in the same job during the study period (18 months), others were laid off, fired or quit their jobs. The majority had disclosed their psychiatric disability to their employers. Individuals who attended the workplace fundamentals program received higher scores on the Workplace Fundamentals Knowledge Test than those who did not. Although more individuals who attended the supplementary training were working during the study period this trend was not significant. Earnings and hours worked was not significant either. Both groups used comparable amounts and intensity of employment services. Job tenures for the first job for participants was 331.6 days for workplace fundamentals group and 288.5 for the control group.

Conclusions: 

The workplace fundamentals program may not be an effective addition to supported employment services, but more research is needed.

URL: 
https://www.ncbi.nlm.nih.gov/pubmed/16215191
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes