Psychological Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review and Meta-Analysis

Authors: 
Frank, E., Soreca, I., Swartz, H., Fagiolini, A., Mallinger, A., Thase, M., Grochocinski, V., Houck, P., & Kupfer, D.
Year Published: 
2015
Publication: 
Research on Social Work Practice
Volume: 
28
Number: 
1
Pages: 
84-98
Publisher: 
SAGE
Background: 

The number of cancer survivors continues to increase in the United States and around the world. Cancer survivors typically have a higher rate of unemployment as compared to their healthy counterparts. Additionally, survivors were 4 times more likely to be employed when they received employment related supports. While other reviews of this subject have been conducted, this review includes more recent research, focuses more squarely on psychosocial interventions more broadly, and expands the definition of employment outcomes to include additional interventions.

Purpose: 

This systematic review focuses on examining interventions that facilitate cancer survivors' employment outcomes, including (a) employment status, (b) return to work, (c) absenteeism, and (d) time spent on work disability or sick leave. This review expands the scope of previous reviews to include additional employment outcome measures, across additional databases.

Setting: 

Interventions included in this review typically took place in medical settings.

Sample: 

Twelve studies met the criteria for inclusion in this review and included over 2000 participants who had been diagnosed with cancer. Participants were typically over the age of 50. Only four studies reported ethnicity of participants.

Data Collection: 

Data collection in all included studies was done through a hospital or clinic. Recruitment was typically through referrals or after a medical procedure.

Intervention: 

The interventions, for included studies described in this review, included behavioral, psychological, educational, or vocational content that facilitated cancer survivors' employment outcomes.

Control: 

There was no control group.

Findings: 

There were 20,249 records found after the initial search. After screening, 70 records remained to be evaluated in full-text. Of those 70, 58 records were excluded with reasons. This left 12 studies to be evaluated in the quantitative synthesis. Of the 10 studies that included measures of employment status, those that were randomized controlled trials (RCTs) showed no significant difference when examined alone. When combined with Quasi Experimental Designs (QEDs) the weighted mean effect size for employment status was OR= 2.18, p=.002. Two studies measured number of hours worked, and showed no significant results, OR = 0.89, p =.67. Four RCTs measured sick leave and results were nonsignificant OR = 1.18, p =.39.

Conclusions: 

The multicomponent nature of the interventions in this review make it difficult to pinpoint exactly "what works". Further exploration of employment outcomes in relevant research would allow for a more in-depth analysis of intervention effects. Additional RCTs would also strengthen the field.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/1049731515604741
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Current Opinion in Psychiatry

Authors: 
Bond, G. R. & Kukla, M.
Year Published: 
2008
Publication: 
Current Opinion in Psychiatry
Volume: 
21
Number: 
4
Pages: 
362-369
Publisher: 
Wolters Kluwer Health/Lippincott Williams and Wilkins
Background: 

Researches continue to examples predictors of employment among three types of variables: patient characteristics, environmental characteristics, and interventions. Provision of supported employment is the strongest predictor of competitive employment among patients with schizophrenia. Patent characteristics show modest association with employment outcomes; environmental factors are presumed to have major influences, but have been little studied.

Purpose: 

Researchers continue to study factors that are relatively easy to study rather than those that are powerful and meaningful from a public health perspective. Truly critical factors are first, disability, insurance, and employment regulations that discourage most people from trying to work, and second, failure to align finances and organization of services with evidenced based practices." Article reviews current literature on the various factors being researched that impact employment outcomes for patients with schizophrenia.

Setting: 

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

Sample: 

The study sample was recently published studies examining predictors of competitive employment for patients with schizophrenia.

Data Collection: 

Literature search included a combination of strategies,, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.

Control: 

There were no comparison or control conditions.

Findings: 

Implementing supported employment services with high fidelity to the IPS model clearly improves competitive employment outcomes.

Conclusions: 

According to the published literature, the single best predictor of competitive employment for patients with schizophrenia is supported employment. Despite numerous studies seeking to identify patients characteristics predicting employment, the reported findings have been generally unimpressive. Many factors influencing employment outcomes continue to be understudied, including societal and cultural factors, access to supported employment, regulatory factors, and criminal justice involvement.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18520741
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model

Authors: 
O'Brien, L.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
13
Pages: 
765-783
Publisher: 
Taylor & Francis Ltd
Background: 

Employment outcomes post traumatic brain injury (TBI) result in a financial and social burden. In addition, unemployment may impact the individual's quality of life and emotional well being. The ability to predict vocational outcome using evidenced based guidelines can assist with rehabilitation planning, development of vocational support services and the role adjustment of the individual with a TBI and his or her family members.

Purpose: 

A review of the literature to identify key variables associated with positive employment outcomes post TBI can pave the way for future research and the development of rehabilitation practices.

Data Collection: 

Eighty five studies were identified between 1980 and 2003 that reported on factors associated with employment outcomes post TBI. Among those fifty studies met the inclusion criteria for the second stage review. The criteria used to evaluate and rate the quality of methodology for each study was adapted on guidelines by Sherer 2002 and Pengel et. al. 2003.

Intervention: 

The review highlights demographic, injury and neuropsychological factors associated with return to work. It also examines interventions that focus on modifying the social environment in addition to emotional and metacognitive factors. A conceptual model is presented that outlines the factors associated with employment outcomes.

Control: 

No control or comparison

Findings: 

The most consistent predictors and indicators of employment outcomes included premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. The authors note that although the presence of specific characteristics may be a predictor for failure to return to work the absence of a factor does not guarantee return to work.
There is little evidence to support cognitive rehabilitation. The most successful programs target problems with motivation and emotional disturbance. Interventions to modify the social environment need to occur on multiple levels. A person's preferences for employment impact job retention. Supported employment has been described however, further evaluation of outcomes is needed. At a policy level a major barrier exists in the current service delivery system in which individuals do not have access to long term rehabilitation or specialized vocational support. Changes in public policy and funding could improve service delivery. Developing disability management programs may also assist those at risk for chronic unemployment post TBI.

Conclusions: 

The review of literature reported that the level of empirical support for employment outcome was greatest for: premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. Future research is needed to determine the role of metacognitive, emotional and social environment factors that can be modified with various interventions. Interventions need to be evaluated to determine evidenced based practices.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15371049
NIDILRR Funded: 
Peer Reviewed: 
Yes

Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services

Authors: 
Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., Barnett, S. D., Cipher, D. J., Lind, L. M., Dixon, T. M., Holmes, S. A., Kerrigan, A. J., & Thomas, F. P.
Year Published: 
2009
Publication: 
The Journal of Spinal Cord Medicine
Volume: 
32
Number: 
5
Pages: 
503-531
Publisher: 
American Paraplegia Society
Background: 

Unemployment is a serious problem for individuals with spinal cord injury (SCI). According to the authors, unemployment for the population of SCI individuals is ten times greater than the general population. In addition, return to preinjury jobs has been reported as very low for this group of individuals.

Purpose: 

The purpose of this study was to provide a comprehensive summary of the literature regarding predictors of employment, the benefits, and barriers.

Setting: 

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

Sample: 

The sample consisted of 60 articles that reported on employment rate of individuals with spinal cord injury.

Data Collection: 

Authors identified 579 articles and reviewed to determine presence of reported employment rates. Of these, 60 articles were found to include employment rates for individuals with SCI. These articles were reviewed to identify critical factors related to employment after spinal cord injury.

Intervention: 

The intervention was evidence-based supported employment and traditional vocational rehabilitation.

Control: 

There were no comparison or control conditions.

Findings: 

Results indicated that the average rate of any employment after SCI was approximately 35%. The review of literature indicates that there are 11 factors associated with employability of individuals with SCI. This includes education, type of employment, severity of disability, age, time post injury, sex, marital status, social support, vocational counseling, medical problems associated with SCI, employer role, environment, and professional interests. Individuals with college backgrounds are more likely to return to work. Being younger at the time of injury is associated with the best employment outcomes. The probability of employment after SCI improves with increasing time since injury. Race is also associated with obtaining employment after SCI. Individuals who are white are more likely to be employment than those from minorities. Evidence-based supported employment seems to be the most applicable model for assisting individuals with SCI in restoring meaningful employment.

Conclusions: 

Characteristics associated with employment include demographic variables, injury-related factors, employment history, psychosocial issues and disability benefit status. Evidence-based supported employment practices seem to be the most applicable model for assisting individuals with SCI in restoring meaningful employment. Control studies are needed to test this conclusion.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792457/
Populations: 
NIDILRR Funded: 
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

A systematic review of vocational interventions for young adults with autism spectrum

Authors: 
Test, D.W., Mazzotti, V.L., Mustian, A.L., Fowler, C.H., Kortering, L., & Kohler, P.
Year Published: 
2012
Publication: 
Pediatrics
Volume: 
130
Number: 
3
Pages: 
531-538
Publisher: 
American Academy of Pediatrics
Background: 

Not much is known about effective vocational interventions to assist individuals with ASD. Yet, that population is rapidly growing. Programs and interventions to serve youth are not well understood. The lack of information impacts successful transition to work.

Purpose: 

The purpose of this systematic review of the literature was to assess the effectiveness of vocational interventions for individuals with ASD who are 13 to 30 years old.

Setting: 

The studies that were reviewed were undertaken in various locations and settings in the US, UK, Spain and Germany.

Sample: 

Multiple databases and reference lists were searched to find relevant studies that were published between 1980 and 2011. Afterwards, each study was examined against an inclusion criteria developed by an expert panel. Data about sample, intervention characteristics, assessment techniques, and outcomes, were evaluated and an overall quality and strength of evidence rating was assigned to the included studies according to a specific criteria. The final sample consisted of 5 studies involving young adults with autism.

Data Collection: 

Characteristics of study participants and interventions were summarized. Descriptive statistics were used to report study outcomes. No meta analysis was conducted.

Intervention: 

The studies reviewed looked at a variety of vocational interventions which involved identifying and implementing work supports for young adults with ASD.

Control: 

There were no comparison or control conditions.

Findings: 

Only five studies, related to on the job supports and employment and vocational interventions were found. All of these received a poor quality rating by the reviewers which may be due to the fact that this is a new area of research. The studies included one non randomized trial that looked at the impact of supported employment versus sheltered work settings for 55 young adults with autism. A related study from the same researchers looked at the effect of supported employment versus sheltered work on the cognitive development of 44 young adults with autism. Two cohort studies and one cross sectional study reported on the influence of vocational interventions on independent living outcomes.

Conclusions: 

There is very little evidence about vocational interventions for individuals with ASD. High quality research is needed. Supported employment may be a promising intervention however much more research is needed.

URL: 
http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-0682
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Evidence-based secondary transition predictors for improving post-school outcomes for students with disabilities

Authors: 
Texler, L. E., Texler, L. C., Malec, J. F., Klyce, D., & Parrott, D.
Year Published: 
2009
Publication: 
Career Development for Exceptional Individuals
Volume: 
32
Number: 
3
Pages: 
1-22
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Post secondary school outcomes for youth with disabilities are poor. For example, the National Longitudinal Transition Study 2 Wave 3 data indicated students continue to live with their parents, did not attend post secondary education and had high rates of unemployment as compared to their non disabled peers, after exiting school. The National Secondary Transition Technical Assistance Center had been identifying evidenced based practices to help improve these and other outcomes. The Council for Exceptional Children was also looking for evidenced based practices in Special Education.

Purpose: 

The purpose of this study was to conduct a systematic review of the secondary transition correlational literature using recommended quality indicators to identify in-school predictors of improved post school outcomes for students with disabilities.

Setting: 

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

Sample: 

One hundred and sixty two articles were identified for review. Sixty three passed an analyses and were passed on for further review. Among these, 35 were excluded which left 28 articles for comparison against a quality of evidence checklist for correlational research. This resulted in 22 articles for final review. Three were exploratory studies and the others were a priori studies related to students with disabilities.

Data Collection: 

The remaining studies were examined for the following: population, sample size, predictor variables, postschool outcome variables, type of statistical analysis used, relationships among variables, significance levels, and data that allowed for calculation of effect sizes. It was not possible to extract conclusions across studies, so the researchers chose to convert significant relationships to standardize effect size measures to allow comparisons. Various conversions were calculated.

Intervention: 

The interventions were various transition practices.

Control: 

There were no comparison or control conditions.

Findings: 

A review of the literature identified 16 evidence-based in school predictors of post-school outcomes. These include: career awareness, community experiences, exit exam requirements/high school diploma status, inclusion in general education, interagency collaboration, occupational courses, paid employment/work experience, parental involvement, program of study, self advocacy/self determination, self-care/independent living skills, social skills, student support, transition program, vocational education and work study. Some negative findings were also found. Two studies reported negative relationships between secondary transition predictors and one or more post school outcomes. Among the 16 predictor categories: inclusion in general education, paid employment and work experience, self care/independent living, and student support improved outcomes in all 3 post school outcome areas.

Conclusions: 

The results from this review provide information to help practitioners improve post school outcomes for students with disabilities. Combining knowledge gained from this review with evidenced based instructional practices should provide state and local education agencies with a foundation to improve programs and thereby increase post school outcomes.

URL: 
http://sites.bu.edu/miccr/files/2015/03/Evidence-based-secondary-transition-predictors-for-improving-post-school-outcomes-for-students-with-disabilities.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effects of job development and job support on competitive employment of persons with severe mental illness

Authors: 
Lehman, A.F., Goldberg, R., Dixon, L.B., McNary, S., Postrado, L., Hackman, A., & McDonnell, K.
Year Published: 
2005
Publication: 
Psychiatric Services
Volume: 
56
Number: 
10
Pages: 
1237-1244
Publisher: 
American Psychiatric Association
Background: 

Few studies have tried to determine which specific supported employment services improve employment outcomes for people with psychiatric disabilities. This study examined the effects of job development and job support among other services on acquisitions and retention of competitive employment for individuals with a psychiatric disability. It found that job development is a very effective service when the goal is job acquisition. Job support is associated with retention in first competitive job, but it's casual role is questionable.

Purpose: 

The study hypothesized that participants who received job development would be more likely to acquire competitive employment than those who did not receive it, and would likely be more prepared for work and more likely to acquire competitive jobs than those who received it later. It was further hypothesized that those who received job support would work more months and hours that those who did not.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings. Data used in the analysis came from the two year EIDP (Employment Demonstration Intervention Project)that collected data from sites in seven different states.

Sample: 

A total of 1,340 persons from the seven state employment demonstration sites were included in the analysis. Persons doing paid work at baseline (N=28) and those with no follow-up employment data (N=98) were excluded. Individuals included in the study if they were 18 years old or older at enrollment, were willing and able to provide informed consent, had a DSM diagnosis of mental illness, and were unemployed.

Data Collection: 

Interview assessments with EIDP participants elicited information about demographic characteristics, previous employment, current income, clinical indicators, and other relevant information at six month intervals for 24 months. Sites also collected data on the types of vocational and clinical services received by EIDP participants. Recruitment of study participants took place between February 1996 and May 2000. Random effects meta analysis were fist to the data over multiple sites. All analyses showed consistency between sites. Effect sizes for the job acquisition and job retention variables were calculated using Comprehensive Meta-Analysis statistical software. A;; hypothesis were two-tailed, and the standard p value of p<.05 was used for rejection of the null hypothesis.

Intervention: 

Job development was as direct of indirect contact with potential employers or networking with individuals or organizations that had job information. Job support was as on-site counseling, support, and problem solving.

Control: 

Comparison services included for example a variety of employment services such as vocational assessment and evaluation and off site job skills training, vocational treatment planning or career development, and vocational support groups.

Findings: 

Job development helped participants obtain competitive employment. Individuals who received job development sere almost five times more likely to obtain competitive employment than individuals who not received job development. Individuals with no previous work experience had virtually no chance of acquiring competitive employment without job development.
A significant association between months in the first competitive job and receipt of job support was found.

Conclusions: 

Data from this study support the importance of job development and job supports to successful job acquisition and job retention. On average, receipt of job support was positively correlated with the number of months and hours worked in the first competitive job.

URL: 
http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.56.10.1237
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

An analysis of evidence-based best practices in the public vocational rehabilitation program: Gaps, future directions, and recommended steps to move forward

Authors: 
Leff, S., Cook, J., Gold, P. l., Toprac, M., Blyler, D., Goldberg, R., McFarlane, W., Shafer, M., Allen, E., Allen, E., Camacho-Gonsalves, T., & Rabb, B.
Year Published: 
2014
Publication: 
Journal of Vocational Rehabilitation
Volume: 
41
Number: 
1
Pages: 
147-163
Publisher: 
Journal of Vocational Rehabilitation
Background: 

People with disabilities face high rates of unemployment and underemployment. The rate is about double (12.9%) for individuals with disabilities versus (6.1%) rate for people without disabilities. This is true, despite the fact that billions of dollars have been spent by the state-federal vocational rehabilitation program to combat the problem. The vocational rehabilitation program needs to find ways to improve employment outcomes for people with disabilities. The evidence based practice movement has started to influence rehabilitation counseling practices. Using research to inform best practices should help those charged with improving the effectiveness of vocational rehabilitation services and outcomes. Identifying promising practices and gaps in the evidence based practice research will lead to recommendations for future research and knowledge translation efforts to improve vocational rehabilitation service delivery practices.

Purpose: 

The purpose of the review was to identify emerging and promising vocational rehabilitation service delivery practices that can improve work outcomes for people with disabilities.

Setting: 

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

Sample: 

As a systematic review, this study included studies with various populations of vocational rehabilitation clients.

Data Collection: 

As a systematic review, this study included studies with a variety of data collection methods.

Intervention: 

As a systematic review, this study included multiple vocational interventions, including supported employment, benefits counseling, and specialized training programs.

Control: 

This is a systematic review. The review had no control or comparison conditions.

Findings: 

Rehabilitation counselors in state vocational rehabilitation agencies use some services that are supported by strong scientific evidence. These include: counseling, skills training, and supported employment. Several researchers have also investigated the overall effect of state vocational rehabilitation services.
In addition, promising practices have been identified by four state case studies that resulted from research by the Rehabilitation Research and Training Center on Evidenced Based Practices in Vocational Rehabilitation. From this work, a number of promising practices, that are currently used by state vocational rehabilitation emerged. Related to organizational and management, best practices included: advocacy, culture leads to innovation, outcome focused business models, advanced information technology, collaborative partnerships that enhance results, staff training and development. Transition from school to adulthood, individual placement and supported employment model, workplace specialized skills training, benefits counseling and workplace supports were identified as clinical service delivery promising practices.

The research team reviewed, analyzed and discussed the findings from this and other studies to identify gaps in research and make recommendations about future directions.
These included investigating the Human Service Value Curve framework to identify where human service agencies fall and move beyond the use of the basic regulatory collaborative business model towards a integrative/generative business model. In terms of the gaps in research there is a need to convene a panel of scholars, policymakers and administrators representing business, management, human service administration, vocational rehabilitation, and information technology fields. This panel would identify essential features of an integrative/generative business model for leadership and management in state vocational rehabilitation. Research is also needed to develop and validate an effective diffusion of innovation measure in vocational rehabilitation agencies. Instead of relying on old business systems vocational rehabilitation needs to investigate advanced health technologies aimed at becoming more consumer rather than professional centric. Research is needed about how to recruit, retain and engage vocational rehabilitation professionals to provide customized and effective services based on innovations and communication technologies. Some of the evidenced based practices identified have not been comprehensively evaluated. Using the International Classification of Functioning, Disability and Health (ICF) model to develop a systematic vocational rehabilitation agenda may allow researchers to quickly identify and validate best practices that can be integrated into state vocational rehabilitation practices. Knowledge translation is gaining recognition in the field. The Knowledge to Action framework may prove useful. Knowledge Translation should be bidirectional and participatory in nature. Embedding such methods into future research and program evaluation should promote continued collaboration between researchers and practitioners and transfer research findings to practice. It should also help improve outcomes, including relationships with employers. And again, providing evidenced based tools and practices to vocational rehabilitation counselors and administrators to improve employment outcomes for individuals with disabilities will result from Knowledge Translation.

Conclusions: 

Most of the work in vocational rehabilitation for the past 50 years has been descriptive in nature. Future research should be aimed at identifying evidenced based practices. More intervention studies are needed about employment and other related outcomes of rehabilitation. More replication and extensions of prior research are needed to build on what is known and inform policies and practices.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr707
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Approaches to improving employment outcomes for people with serious mental illness. Work accommodation and retention in mental health

Authors: 
Kukla, M., & Bond, G. R.
Year Published: 
2011
Publication: 
Journal of Mental Health
Volume: 
20
Number: 
4
Pages: 
368-380
Publisher: 
ISSN
Background: 

Certain models of vocational service have been shown to be effective in establishing persons with mental health problems back into employment. The individual placement and support (IPS) model has the widest evidence base in studies conducted in North America. Evidence from North America has led to an increasing interest in the use of IPS in the UK. Employment is dependent on economic and social factors which are often country specific.

Purpose: 

This review examines the evidence of the effectiveness of the IPS model of supported employment within the United Kingdom. The study conducted a systematic review of the literature to answer the principal research question: What is the evidence of effectiveness of the IPS model of supported employment within the United Kingdom?

Setting: 

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

Sample: 

The majority of the population was patients recruited from community mental health teams, including an early intervention in psychosis service. Psychotic illness was the largest diagnostic group in the four studies that reported diagnostic categories.

Data Collection: 

Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV):
1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter.
2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter.
3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.

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: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

The evidence base for the effectiveness of IPS within a UK context is small. There is promising evidence, including from a high quality RCT, that IPS is more effective than conventional training and place vocational rehabilitation in placing people into competitive employment. However, the quality of the evidence was generally weak. Several studies lacked adequate controls, meaning potential confounding factors were not controlled for.

Conclusions: 

This study has highlighted the need for better quality evidence on the effectiveness and application of IPS in the UK, preferably using an RCT approach. Where controlled trials are not feasible, good quality naturalistic evaluations could improve the evidence base. Evaluation should focus on the nature, quality and occupational level of the employment gained and the length of time employment is sustained. Examining both service (e.g. time from entry into service to employment) and patient factors (e.g. previous vocational history, motivational factors) would add to evidence. Integration of the IPS intervention with mental health teams, positive attitudes to competitive employment among staff and motivational assessment of clients may improve placement rates.

URL: 
http://link.springer.com/chapter/10.1007/978-1-4419-0428-7_11#page-1
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes