Implementing supported employment as an evidence-based practice

Authors: 
Bond, G. R., Campbell, K., & Drake, R.
Year Published: 
2001
Publication: 
Psychiatric Services
Volume: 
52
Number: 
3
Pages: 
313-322
Publisher: 
American Psychiatric Association
Background: 

The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.

Purpose: 

The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).

Setting: 

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

Sample: 

The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.

Data Collection: 

A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.

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 following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).

Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.

Conclusions: 

Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

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

The viability of self employment for individuals with disabilities in the United States: A synthesis of empirical-research literature

Authors: 
Yao-Jen Chang, Hung-Huan Liu, Shu-Min Peng, Tsen-Yung Wang
Year Published: 
2011
Publication: 
Journal of Vocational Rehabilitation
Volume: 
35
Number: 
2
Pages: 
117-127
Publisher: 
IOS Press
Background: 

The lack of employment opportunities and stable employment for individuals with disabilities continues to pose personal and social difficulties and challenges. Individuals with disabilities experience persistently higher poverty rates. Very little is known about individuals with disability in self employment as compared to the more extensive research literature on individuals with a disability who work for someone else.

Purpose: 

Paper reports on a review, analysis, and synthesis the findings of empirical-research studies on self-employment of individuals with disabilities in the United States. Paper addresses the question: "How viable is self employment for individuals with disabilities in the U.S."

Setting: 

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

Sample: 

The data search used five large data bases: Academic Search Premier, ERIC, PsycINFO, Sociological Abstracts, and Business Source Premier/Econ-Lit. The database search used the terms self employment, entrepreneurship and micro enterprise as synonymous terms in the search. Results were sorted to identify U.S. empirical literature. Twelve studies met the selection criteria.

Data Collection: 

Coding of selected studies comprised the following steps: First author completed multiple readings noting, for example, research questions, research design, data collection and measurement, and research findings, and limitations. Second and third author evaluated first and second authors evaluated first authors coding for accuracy. Full interobserver accuracy (100%) was established before proceeding to the synthesis of selected studies.

Intervention: 

The study adopted a two part definition of self employed worker:
a) Self employed in own not incorporated business workers. This includes people who worked for profit or fees in their own unincorporated business, professional practice, or trade or who operated a farm.
b) Self employed in own incorporated business workers.

Control: 

There were no comparison or control conditions.

Findings: 

In recent years, approximately 12% of working individuals with disabilities have earned an income from self-employment. The national Vocational Rehabilitation closure rates in self employment have remained around 2-3% since the late 1980s (although the rate varies considerably from state to state). The reasons individuals with disabilities pursue self employment are diverse and vary in complexity. Individuals can derive a range of benefits and challenges in self employment. Primary benefit is financial. Other potential benefits involve having a more of a decision making role in their own lives, and personal control and autonomy. Primary challenge in self employment is the access to adequate capital and financing for funding a business, extending beyond individual and family resources. Support in self employment has typically meant relying on a patchwork of resources.

Conclusions: 

In the 21st century, self employment can be a catalyst for expanding work opportunities and improving outcomes for individuals with disabilities. Tentative indications that Individuals with disabilities can succeed in self employment under certain conditions involve a number of stakeholders. State and federal agencies could expand their support of self employment for individuals with disabilities through the establishment of micro finance development funds outside the VR system.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr559
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

An update on randomized controlled trials of evidence-based supported employment

Authors: 
Bond, G. R., McHuggo, G. J., Becker, D.R., Rapp, C. A., & Whitley, R.
Year Published: 
2008
Background: 

Supported employment is the best described and most widely used practice for supporting people with mental illness. Randomized Controlled Trials (RCTs) evidence accumulates quickly; as such, reviews of RCTs become obsolete as new data become available.

Purpose: 

The current review was conducted to provide a "comprehensive summary of competitive employment outcomes for RCTs evaluating evidence-based supported employment for this population" (p. 281).

Setting: 

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

Sample: 

To be included in this review, a study had to be an RCT design, which examined longitudinal competitive employment outcomes for people with severe mental illness. Participants must have been "randomly assigned to two or more conditions, one of which used a high-fidelity IPS supported employment model" (p. 281). Another requirement for inclusion in this review was that the control group(s) must have received services as usual, other than IPS.

Eleven studies were included in the current literature review that included individuals with mental illness.

Data Collection: 

"Three main sources were used to identify studies" (p. 281). The first source was published literature reviews, the second was to review studies in the Employment Intervention Demonstration Project, and the third was to contact "principal investigators and continuous review of the published literature" (p. 281).

Data were recorded directly from published reports or calculated by hand from the information presented.

Intervention: 

Individual Placement and Support model of supported employment

Control: 

There were no comparison or control conditions.

Findings: 

Comprehensive employment rates were significantly higher for IPS (61%) than for the control groups (23%). In addition, people in IPS worked 20 hours per week or more (43.6%), compared to the control groups (14.2%). The average time to obtain a job for people with IPS was 50% faster than those in the control groups, ranging between 4 and 5 months for those with IPS. The average weeks worked for those with IPS was over two times that of the control groups.

Conclusions: 

The majority of IPS participants obtain competitive employment at a significantly higher rate than those in other vocational programs. Most IPS participants work part-time, possibly due to health or financial considerations. In addition, the IPS model supports a rapid job placement; most clients are placed are placed in a competitive job within the first six months.

URL: 
http://www.worksupport.com/kter/documents/pdf/UpdateofRandomizedControlledTrials1.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Measurement of fidelity of implementation of evidence-based practices: Case example of the IPS fidelity scale

Authors: 
Bond, G. R., Becker, D., Baker, S., Carlson, L., Flint, L., Howell, R., Lindsay, S., Moore, M., Reeder, S., & Drake, R.
Year Published: 
2011
Publication: 
Clinical Psychology: Science and Practice
Volume: 
18
Number: 
2
Pages: 
126-141
Publisher: 
Wiley Periodicals, Inc.
Background: 

Increasing the use of evidence-based interventions is the central theme of current mental health reforms.Fidelity, as adherence to evidence-based program models (Bond, Evans, Salyers, Williams, & Kim, 2000), has also emerged as a central concept in these efforts. A fidelity scale is an assessment procedure to measure the extent to which an intervention or practice is implemented as intended. Fidelity can be measured at the system, organization, program, practitioner or client level.

Purpose: 

The purpose of the study was to examine the literature on the Individual Placement and Support Fidelity Scale to illustrate the strengths and limitations of this methodology.

Setting: 

The setting included a mixed group of Supported employment programs.

Sample: 

Review of 20 articles that examined the psychometric adequacy and practical utility of the IPS Fidelity Scale.

Data Collection: 

This article reviews the emerging literature examining the psychometric adequacy and practical utility of the IPS Fidelity Scale, addressing the following questions: (1) Does the IPS Fidelity Scale display appropriate psychometric properties (adequate reliability, content and discriminative validity, and sensitivity to change)? (2) Do programs that score higher in IPS fidelity have better employment outcomes? (3) Is the IPS Fidelity Scale a useful tool for guiding implementation in multisite projects? (4) Is the IPS Fidelity Scale useful for accrediting programs for funding decisions? (5) Is the IPS Fidelity Scale useful for monitoring purposes in formal research studies? For the first two questions, we provide quantitative evidence from published and unpublished studies. Our evidence for the remaining three questions is primarily descriptive and anecdotal.

Intervention: 

The intervention was fidelity of implementation of individual support.

Control: 

There was no control or comparison condition.

Findings: 

Findings illustrate that this scale has excellent psychometric properties. Nine of 10 studies assessing its predictive validity found positive associations with employment outcomes. Its use in quality improvement was supported by positive reports from seven multisite projects. Although not yet evaluated as an accreditation tool, three states have adopted the scale for reimbursement purposes.

Conclusions: 

Mental health reform rests on the wide-scale adoption of EBPs that are faithfully implemented. Fidelity scales are the lynchpin of both scientific advances and quality improvement. For fidelity scales to be useful, however, they must demonstrate discriminative and predictive validity. This review has documented the considerable evidence supporting the use of a fidelity scale for one EBP. Research is also needed to increase the efficiency of fidelity assessment so that it can be integrated into routine practice in the public mental health system.

URL: 
http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2850.2011.01244.x/abstract
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Workplace impacts of anti-TNF therapies in rheumatoid arthritis: review of the literature

Authors: 
Blake, J., Brooks, J., Greenbaum, H., Chan, F.
Year Published: 
2009
Publication: 
Expert Opinion on Pharmacotherapy
Volume: 
10
Number: 
2
Pages: 
255-269
Publisher: 
Informa Healthcare
Background: 

Rheumatoid arthritis causes pain and serious functional impacts and substantially affects patients' daily lives, including their ability to work.

Purpose: 

The purpose of the paper is to examine recent studies of patients with Rheumatoid Arthritis treated with TNF antagonists and the impacts these therapies have on the workplace.

Setting: 

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

Sample: 

The sample included 133 articles and 14 poster abstracts that studied the impact of Rheumatoid Arthritis.

Data Collection: 

The studies were categorized into three distinct groups: general RA, DMARD, and TNF-antagonist literature. The general RA literature was used as a backdrop when examining literature regarding the impacts of DMARDs and the emergence of anti-TNF therapies on the workplace.

Intervention: 

The intervention was medical treatment of Rheumatoid Arthritis including TNF antagonists and DMARDs.

Control: 

There were no comparison or control conditions.

Findings: 

The results of early studies of the TNF antagonists varied regarding their effects on patients with RA in the workplace. Recent studies of adalimumab showed positive impacts across a range of workplace burdens.

Conclusions: 

Treatments such as adalimumab may help employees with RA to remain in the workforce and lead to reduced workplace costs to the employers and employees.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19236197
Populations: 
Peer Reviewed: 
Yes

The effect of vocational rehabilitation on return-to-work rates post stroke: A systematic review

Authors: 
Baldwin, C. & Bursco, N. K.
Year Published: 
2011
Publication: 
Topics in Stroke Rehabilitation
Volume: 
18
Number: 
5
Pages: 
562-572
Publisher: 
Thomas Land Publishers Inc.
Background: 

Return to work rates for individuals with stroke vary from as low as 4% to 75%. Those who do return to work report higher levels of satisfaction with life. It is important to evaluate the effect of vocational rehabilitation programs on return to work rates of people who have had stroke and are of working age.

Purpose: 

The purpose of this review was to investigate the effects on return to work rates of individuals who had strokes and had participated in a vocational rehabilitation program.

Setting: 

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

Sample: 

The sample included 6 studies involving individuals who had strokes.

Data Collection: 

Electronic databases and web based sites were searched. The search led to 3,120 articles of which 3,106 were excluded. This left 6 article for inclusion that were published between 1990 and 2008. All were retrospective, single cohort studies. The number of participants within the studies ranged from 23 to 200.

Intervention: 

The intervention was various vocational rehabilitation services.

Control: 

There was no control or comparison condition.

Findings: 

All studies reported work rates after the completion of the vocational rehabilitation program. This ranged from 12% to 49% employment post intervention. How soon the employment rates were collected after the intervention was not reported in five of the six studies reviewed. None of the studies provided follow up data related to employment rates at a later point in time.

Conclusions: 

Evidence about whether or not vocational rehabilitation programs improve return to work rates for individuals with stroke is inconclusive. Quality randomized controlled trials are needed. Within the literature there is much variation in the definitions of employment, return to work and vocational rehabilitation.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22082705
NIDILRR Funded: 
Peer Reviewed: 
Yes