An effective community-based mentoring program for return to work and school after brain and spinal cord injury

Authors: 
Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E.
Year Published: 
2012
Publication: 
NeuroRehabilitation
Volume: 
31
Number: 
1
Pages: 
63-73
Publisher: 
IOS Press
Background: 

Individuals with traumatic brain injury (TBI), spinal cord injury (SCI), and other neurological disorders often have severe disabilities impacting their ability to return to previous activities and return to work is limited. There is an ongoing need for education and vocational rehabilitation systems to work together to improve outcomes for youth and young adults with disabilities.

Purpose: 

The purpose of this article was to present information on a community-based mentoring program for young adults, ages 16 - 26 years with a recently acquired TBI, SCI, and other neurological disorders. The two objectives of this study were to 1) to demonstrate continuing increased in standardized measures of community integration from the time of enrollment in the program to the time of exit, and 2) improve the percentage of youth and adults who successfully access post-secondary education or employment opportunities.

Setting: 

The setting was various community sites in California.

Sample: 

The study sample included 131 individuals with TBI, SCI, or other neurologic disabilities recruited between 2005 and 2010. The majority were individuals with TBI or SCI with one individuals dually diagnosed with TBI and SCI (0.8%) and 8.4% with other disabilities to include other neurological disabilities. The majority were male (67.9%). The mean age was 20.3 years. Participants were primarily Hispanic (42%) or Caucasian (36.3%) with the remaining Asians (10.7%) or African American (4.6%). In addition, there were 121 trained "mentors" who were a minimum of two years post injury and had "a high level of acceptance and successful integration into the community". This included working or post-secondary education. Most were working (57%) while 30% were attending school, and 13% were retired.

Data Collection: 

Assessment was conducted a minimum number of four times: at enrollment, three months after entry, and every three months thereafter until attempted entry to post-secondary education or employment. In addition, each mentor and mentee completed a questionnaire which documented satisfaction with the relationship. Finally, the program used standardized assessments to include the Disability Rating Scale to include Employability and Level of Functioning, the Participation Index of the Mayo-Portland Adaptability Inventory, version 4, the Supervision Rating Scale, the Craig Handicap Assessment and Reporting Technique Short Form, and the Diener Satisfaction with Life Scale. A successful transition was as the individual remained in the post-secondary education or employment environment.

Data were collected by mentors and project staff. Formal assessments were collected by trained research assistants. Mentors submitted meeting logs documenting when, where, and topics discussed. Data were stored in an Access database and descriptive and inferential analyses were conducted using SPSS. Pre and post test program scores on standardized outcome measures were compared by paired T-tests.

Intervention: 

A mentoring program was developed called the "Back on Track to Success Mentoring Program." The goal of the program was to improve the ability of youth/young adults with disabilities to navigate through the services and programs available to individuals with disabilities. In addition, the goal was to increase the rate of return to work and post-secondary education. Each of the program participants were matched with a "mentor" who had training on a specific curriculum and refresher sessions throughout the entire program. Mentor/mentee relationships were required to have a minimum of three contacts per month in-person, telephone, or electronic mail methods.

Control: 

No comparison condition.

Findings: 

A total of 89 mentees were successfully matched with community-based mentors and participated in the program through to completion. Of this number 77 completed the entire program. Of this number 42 (54.5%) were considered program successes and 35 (45.5%) were considered program failures. Of the 42, 69% returned to school and 13 became employed (31%). For program successes, significant CHART subscale increases were seen for Cognitive Independence and Mobility. For program "failures" no statistically significant changes were seen in CHART subscale scores. For program successes, there were also significant improvements seen in the M2PI, the DRS, and SRS. For failures there were improvements seen in DRS but these were not statistically significant.

Conclusions: 

Overall, findings suggest that mentoring can be beneficial toward achieving the goals of post-secondary education, employment and community independence for individuals with disabilities; specifically those with traumatic brain injury, spinal cord injury and other neurological disorders.

URL: 
http://content.iospress.com/articles/neurorehabilitation/nre00775
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Three year follow-up study of an integrated supported employment for individuals with severe mental illness.

Authors: 
Tsang, H. W., Chan, A., Wong, A., & Liberman, R. P.
Year Published: 
2010
Publication: 
Australian and New Zealand Journal of Psychiatry
Volume: 
44
Number: 
1
Pages: 
49-58
Publisher: 
PubMed
Background: 

Persons experiencing severe mental have traditionally experienced high rates of unemployment. The Individual Placement and Support model is an evidenced based practice effective in assisting persons with severe mental illness achieve employment outcomes at a rate higher than traditional approaches.

Purpose: 

The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) program, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS program on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years.

Setting: 

Non government organizations and day hospitals in Hong Kong in association with the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Sample: 

One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong.

Data Collection: 

Study participants were randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up.

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 comparison condition was traditional vocational rehabilitation.

Findings: 

After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive.

Conclusions: 

The long-term effectiveness of the ISE program in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20073567
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness.

Authors: 
Twamley, E. W., Narvaez, J. M., Becker, D.R. Bartels, S. J., & Jeste, D. V.
Year Published: 
2009
Publication: 
Journal of behavior therapy and experimental psychiatry
Volume: 
40
Number: 
2
Pages: 
292-305
Publisher: 
Elsevier B.V.
Background: 

The traditional vocational rehabilitation (TVR) services adopt a step-wise approach which offers pre-vocational training at the beginning of the service. In Hong Kong and mainland China, participants usually undergo a prolonged period of preparation before seeking competitive employment. Rates for competitive employment are usually less than 20%. As TVR is the most common form of vocational rehabilitation in Hong Kong, it was important to local service development to benchmark innovative interventions against standard interventions. IPS is an evidence-based rehabilitation service that includes job development and placement, on-going employment supports, coordination of vocational services with multidisciplinary treatment teams, indefinite services and the opportunity for choice of jobs by participants. PS is less than optimal in clients' maintaining their jobs, with 50% of those employed experiencing job terminations by the six-month follow-up. Over a longer follow-up period, considerably fewer than half of the participants in IPS are working during any single month. In the current study, IPS was amplified by the addition of work-related, social skills training (WSST) together with ongoing supports in the community for aiding generalization of social skills in the workplace following the integrated supported employment (ISE) protocol.

Purpose: 

The purpose of this study was to examine the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment.

Setting: 

The setting included community mental health programs which offered a range of rehabilitation services.

Sample: 

The study sample was 163 participants from community mental health programs which offered a range of rehabilitation services. The recruitment was based on the following selection criteria: (1) suffering from SMI (operationally as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent major depression, or borderline personality disorder); (2) being unemployed; (3) willing and cognitively competent to give informed consent; (4) lacking obvious cognitive, learning and neurological impairments as determined by mental status exam; (5) completed primary education; and (6) expressing a desire to work.

Data Collection: 

Data collection involved the following: Employment Outcome Checklist (EOC) assessed their employment outcomes such as the number of job interviews attended, the number of jobs obtained, number of hours per week worked, and salary received from each of the jobs that were obtained . The 21-item Chinese Job Stress Coping Scale (CJSC) assessed the coping strategies of participants when faced with job stress, using a five-point response scale ranging from 1 (hardly ever do this) to 5 (almost always do this). The coping dimensions included help seeking, positive self-appraisal, work adjustment, and avoidance. The Chinese Job Termination Checklist (CJTC) is the Chinese version of the Job termination Scale.

Intervention: 

A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). The ISE participants joined the ISE program which integrated IPS and WSST. The eight principles of IPS also applied to this intervention. The 10-session WSST consisted of a structured program to teach participants job interview skills, basic conversation and social survival skills for effective communication with supervisors, co-workers and customers.

Control: 

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.Traditional Vocational rehabilitation services that clients received included sheltered workshop and supported employment.

Findings: 

After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

Conclusions: 

The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

URL: 
http://www.sciencedirect.com/science/article/pii/S0005791608000852
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment for middle-aged and older people with schizophrenia.

Authors: 
Twamley, E. W., Padin, D. S., Bayne, K. S., Narvaez, J. M., Williams, R. E., & Jeste, D. V.
Year Published: 
2008
Publication: 
American Journal of Psychiatric Rehabilitation
Volume: 
11
Number: 
1
Pages: 
76-89
Publisher: 
Routledge
Background: 

Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work. However, very few vocational rehabilitation programs target older clients with psychiatric illness.

Purpose: 

This study examined employment outcomes among adults with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation.

Setting: 

The setting was an outpatient clinic in San Diego, California and various places of employment.

Sample: 

The study sample included 50 participants,30 men and 20 women who were 45 years or older, had a DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder, and were receiving their psychiatric care at an outpatient clinic. Twenty subjects were diagnosed with schizophrenia, and 30 were diagnosed with schizoaffective disorder. They were referred by state vocational rehabilitation.

Data Collection: 

The following techniques were used t-tests, chi-square, logistic regression, and repeated measures ANOVA to analyze the data. Alpha for significance was set at p < .05, and all tests were two-tailed. Cohen's d effect sizes to provide estimates of the magnitude of effects was also calculated.

Intervention: 

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

Conventional vocational rehabilitation programs use a train-then-place approach, emphasizing prevocational training classes and volunteer, transitional, or trial employment before seeking competitive work (i.e., employment in the community at prevailing wages).

Findings: 

Compared with Conventional Vocational Rehabilitation, Individual Placement and Support resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not.

Conclusions: 

These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19212460
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trial.

Authors: 
Wehman, P., Targett, P., Yasuda, S., & Brown, T.
Year Published: 
2014
Publication: 
Journal of Autism and Developmental Disabilities.
Volume: 
44
Number: 
3
Pages: 
487-500
Publisher: 
Springer US
Background: 

Unemployment rates for individuals with autism after existing secondary education are high. Rates for individuals with ASD are between 4 to 12 percent. They also have low rates of participation in vocational or technical education, and post secondary education as compared to individuals with speech and language impairments, learning and intellectual disabilities. Furthermore, state vocational rehabilitation programs are experiencing difficulties responding to the employment service needs of transition aged youth with ASD. The employment outcome rate reported by VR for individuals with ASD has declined much in recent years. Research is limited on intervention to assist adults with ASD with gaining and maintaining employment. Project Search is an intensive internship program that has been replicated with modifications and has shown some degree of success with assisting transition aged youth with gaining and maintaining real work for real pay in their communities.

Purpose: 

This study had two hypotheses. First, higher number of individuals who participate in an employer based employment training and placement program will be employed than those in the control condition at a)completion of intervention and b) 3 months post completion of the intervention.Second, those who participate in the program will require less work support as measured by the Support Intensity Scale Employment Activities Subscale than those in the control condition at a) completion of the intervention and b) 3 months post completion of the intervention. The study was continuing at this writing and this analysis presents results from the first 3 years of cohorts who have completed one school year in Project SEARCH plus ASD Supports.

Setting: 

The students worked in a variety of internships in two suburban hospitals.

Sample: 

A total of 40 students participated in the study. 16 were assigned to the control group and 24 were in the treatment group. The two groups were equivalent on a number of demographic variables including gender, race, medical diagnosis, and Individualized Education Plan category. There was a significant difference between the ages of the treatment and control groups. The age range for both was between 18 and 21.5 years old.

Data Collection: 

Information was collected from the application process and a brief interviews at scheduled times to gain insight into the person's employment status, wage earned, hours worked, and employer paid benefits. The Supports Intensity Scale was also used to assess adaptive behavior and intensity of support needs. The six subscales used were: home living, community living, lifelong learning, employment, health and safety, and social. The SIS allowed the examiners to identify the types of work supports individuals required and provided a measure of the overall adaptive behavioral support needs of participants at baseline. Data collectors were trained in the administration of the instrument and inter-rater reliability was high 92.5%.Preliminary analysis included frequencies, means, standard deviations and distribution of scores.

Intervention: 

The intervention was Project SEARCH.

Control: 

The control condition was traditional transition service.

Findings: 

The treatment group attained employment at a rate of 87.5% after completing Project SEARCH internship and the ASD program compared to the control group at 6.25%. The treatment group also experienced an increase in weekly hours worked and wages.Three months later there was a significant difference between the treatment and control group mean standard scores on the Employment Activities Subscale of the SIS.

Conclusions: 

This study provided preliminary results.Twenty one out of 24 or 87.5 percent of the treatment group acquired employment. While only one in 16 or 6.25 percent of the control group went to work.Employment after graduating from high school is an attainable goal for youth with ASD who display challenging behavior and who have a comorbid medical diagnoses.

URL: 
http://researchautism.net/publications/5492/competitive-employment-for-youth-with-autism-spectrum-disorders:-early-results-from-a-randomized-clinical-trial.
NIDILRR Funded: 
Peer Reviewed: 
Yes

Influence of least restrictive environment and community based training on integrated employment outcomes for transitioning students with severe disabilities.

Authors: 
Wickizer, T. M., Campbell, K., Krupski, A., & Stark, K.
Year Published: 
2004
Publication: 
Journal of Vocational Rehabilitation
Volume: 
21
Number: 
3
Pages: 
149-156
Publisher: 
IOS Press
Background: 

In light of the data supporting the education of individuals with severe disabilities in natural contexts, it stands to reason that programs would no longer provide training in contexts other than those that result insurable employment opportunities. However, this continue to occur. Even with mandated transition planning integrated employment outcomes are not improving for students with severe disabilities. Many of these students will then enter the public welfare system and/or segregated adult programs.

Purpose: 

The purpose of this study was to identify variables that are correlated with successful integrated employment outcomes for transitioning students with severe disabilities.

Setting: 

The setting included 20 different schools sites within 12 school districts in a county in California.

Sample: 

The sample included 104 students with severe disabilities, ages 18-22, who had exited school without diploma. Close to half (48%) of the participants had an IQ that placed them in the profound (25%) or severe (23%) category. The majority of the participants were white (53%), followed by Hispanic (28%), Asian (13%),African American (4%) and Pacific (2%). Around 53% of the students were males. Around 80% of the participants lived at home; the others lived in group homes.

Data Collection: 

The specific variables measured in this study included: the influence of duration of community-based training (CBT) that included on-the-job training, on the-job training as a subset of CBT, the least restrictive environment (LRE), or the degree of integration with non-disabled peers during the school day, demographics(gender, ethnicity, home setting, behavior problems, physical disability and mental ability) as measured by
intelligence quotient (I.Q.).Data was collected by structured interview with teachers and administrators, record review and on site observations. Correlations were used to examine predictive relationships between the independent variables and the dependent variable of post-school integrated employment. Cross tabulations and chi-square analysis of correlated variables were then used to identify significance of specific variables on employment outcome.

Intervention: 

The intervention was community based training. This included on the job training and physical integration with non disabled peers.

Control: 

There was no comparison or control group

Findings: 

These data indicate significant interactions between community based training (r = 0.387, p < 0.001), degree of integration with typical peers (r = 0.360, p < 0.001), andon-the-job training (r = 0.305, p = 0.001) and employment outcome. There were also strong intercorrelations among the three variables of CBT, degree of integration or LRE and on-the-job training.Transitioning students who received CBT and on the job training had a 69% integrated employment rate after leaving school.

Conclusions: 

The combinations of least restrictive environments,CBT/on-the-job training, and innovative teacher advocacy are potent predictors of post school employment for students with severe disabilities, regardless of intellectual functioning.

URL: 
http://www.kcdsg.org/files/content/Cheryl%20Jorgensen_Influence%20of%20LRE%20on%20Outcomes.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The relation between VR services and employment outcomes of individuals with traumatic brain injury

Authors: 
Garcia-Villamisar D., & Hughes C.
Year Published: 
2003
Publication: 
Journal of Rehabilitation
Volume: 
69
Number: 
3
Pages: 
31-38
Publisher: 
National Rehabilitation Association
Background: 

Individuals with severe traumatic brain injury (TBI) have poor vocational outcomes. Post injury employment rates have ranged between 22% to 55%. Many studies have looked at predictors for employment outcomes for this group. Other studies have looked at neuropsychological functioning, severity of injury, demographic characteristics, length of time from injury and return to work, assistive technology and rehabilitation outcomes. However, there are no studies about vocational rehabilitation services impact on employment outcomes for individuals with TBI.

Purpose: 

The purpose of this study was to examine the relationships between the provision of six rehabilitation services and vocational outcomes for individuals with TBI. The research questions included: How many participants received assessment, college, counseling and guidance, job placement, restoration and work adjustment services? Are assessment, college, counseling and guidance, job placement, restoration and work adjustment services significantly related to closure status? Are there significant differences in weekly earnings based on the provision of assessment, college, counseling and guidance, job placement, restoration and work adjustment services?

Setting: 

This study included individuals with TBI served by multiple vocational rehabilitation agencies in various settings.

Sample: 

The study sample included 1,073 individuals with TBI who received state vocational rehabilitation services from a southeastern state and whose cases were closed in either competitive employment or non-rehabilitated from 1992 to 2000. Forty nine percent of the participants were competitively employed when there case was closed by state vocational rehabilitation (VR) and 51% were not. The majority (89%) reportedly had a severe disability. Most were single (79%), Caucasian (78%), and male (70%). The ages ranged from 16 to 71 years. The majority had 11 years of education or better. At the times of services 91% reported no prior work experience.

Data Collection: 

A number of variables were examined in the study. This included: successful employment outcome, hours worked and wages and the cost of services. Data was pulled for all of the United States. Washington DC and US territories were excluded. Data from each state and year was reported for each study question. In order to identify trends data from 2002 to 2006 was compared to 2007 to 2011 and regression analysis was used to evaluate the data. Mean data for the total transition population served by VR was compared to the ASD group and t test statistics were used to compare outcomes between the two groups.

Intervention: 

The interventions included six vocational rehabilitation services. This included: assessment, college, counseling and guidance, job placement, restoration, and work adjustment services.

Control: 

There was not control or comparison condition.

Findings: 

Counseling/guidance was the most frequently provided services (89%). VR services identified as positive predictors of closure status were: college, counseling/guidance, and job placement services. The odds of obtaining competitive employment after receiving college services was 5.21 times the odd for those not receiving services. The odds of obtaining competitive employment for those receiving counseling/guidance services was 3.03 times greater than those who did not receive the services and the odds of competitive employment among those who received job placement services was 20.77 times greater than those who did not. Notably, work adjustment was a significant negative predictor of closure status. Individuals who did not receive assessment or college services had higher earnings than those who receive college services alone. When job placement services were not provided the effect of college training on mean weekly earnings was different at each level of assessment.

Conclusions: 

College, counseling/guidance and job placement services were significantly and positively related to closure status.
Work adjustment services were inversely related to weekly earnings for competitively employed individuals and assessment, college, and job placements services interacted significantly on weekly earnings of those competitively employed. Job placement is the most important positive predictor of closure. Rehabilitation counselor education and training should focus on job placement services. College training benefited an small number of individuals in the sample. Additional research is needed to investigate the relationship between VR services and employment outcomes for individuals with TBI.

URL: 
https://www.questia.com/library/journal/1G1-106646165/the-relation-between-vr-services-and-employment-outcomes
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A hybrid supported employment program for persons with schizophrenia in Japan

Authors: 
Gamble, D., & Moore, C. L.,
Year Published: 
2000
Publication: 
Psychiatric Services
Volume: 
51
Number: 
7
Pages: 
864-866
Publisher: 
Psychiatric Services
Background: 

Individuals with Schizophrenia remain hospitalized for extended periods of time in Japan even after their symptoms have lessened. There are few community rehabilitation programs for this group. Most return to live with families, who may not be prepared, to provide the support the individuals requires to remain in the community. Getting involved in work activities can help facilitate successful community reentry.

Purpose: 

This paper described an innovative hybrid program; that combined practices associated with transitional employment and supported employment models, to assist individuals with schizophrenia with employment.

Setting: 

The setting was a psychiatric hospital and various employment sites in Japan.

Sample: 

Charts were reviewed to determine social and vocational adjustment and rehospitalization rates of 52 individuals who had participated in the program and went to work. The average age of the participants at the time of the survey was 51 years. Thirty six were men and 16 were women who had been consecutively discharged between 1977 and 1990. The onset of mental illness was 23 years. All had a diagnosis of schizophrenia and on average had been hospitalized for 8.9 years prior to going to work.

Data Collection: 

Clinical records since the onset of illness were reviewed for each participant.

Intervention: 

The intervention was a hybrid model of vocational rehabilitation that included occupational therapy with an employer council.

Control: 

There was no control or comparison conditions.

Findings: 

Fifty two individuals worked from three months to seventeen years. The follow up survey indicated 20 individuals were employed and living in the community, 15 lived with families and were not working and 17 were hospitalized. On average participants were hospitalized an average of 1.5 times after supported employment as compared to 3.2 beforehand. Events associated with this included: more symptoms due to not taking medication and quitting a job. The time spent out of the hospital increased from 54% before supported employment to 68% afterwards.

Conclusions: 

The hybrid model of vocational rehabilitation helped many patients successfully integrate in to the community. Success rates at work were excellent for a population that typically experiences poor outcomes. There appears to be cross cultural validity in this approach.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10875948
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
No

A randomized clinical trial of supported employment for inner-city patients with severe mental disorders

Authors: 
Dutta, A., Gervey R., Chan, E. F., Chou, C., & Ditchman, N.
Year Published: 
1999
Publication: 
Archives of General Psychiatry
Volume: 
56
Number: 
7
Pages: 
627-633
Publisher: 
American Medical Association
Background: 

One primary goal for people with psychiatric disabilities is competitive employment. However, the actual rate of employment is less than 15%. The authors hypothesize two reasons: individuals with psychiatric disorders are discouraged from seeking competitive employment because health professionals believe that "the stress of competitive work produces adverse effects" (p. 627), and once in the standard vocational system, people tend to stay in sheltered workshops instead of transitioning to competitive work.

Purpose: 

The purpose of this study was to replicate the New Hampshire study in Washington, D.C., with a more diverse and disadvantaged group of patients and a variety of vocational agencies.

Setting: 

"Community Connections, an agency in southeast Washington, DC that serves people with severe mental disorders who need intensive case management" (p. 628)

Sample: 

152 unemployed, inner-city patients with severe mental disorders

Data Collection: 

Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven states in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.

Intervention: 

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

Control: 

The control group received Enhanced Vocational Rehabilitation (EVR)

Findings: 

During the 18-month study period, participants receiving IPS were more likely than those in EVR to obtain competitive employment. IPS participants "also had superior outcomes in other dimensions of competitive employment" (p. 629). In addition, IPS participants were more satisfied than their EVR counterparts.

Conclusions: 

IPS appears to be superior to EVR; however, a lack of evidence exists for the IPS model producing negative results in non-vocational areas, such as self-esteem and quality of life. In fact, the study validated an increase in those two areas, in both IPS and EVR. IPS increased the rate of competitive employment as compared to EVR.

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

Predictors of successful return to work from HIV-related disability

Authors: 
Drake, R. E. & Bond, G. R.
Year Published: 
2004
Publication: 
Journal of HIV/AIDS and Social Services
Volume: 
3
Number: 
3
Pages: 
89-96
Publisher: 
Journal of HIV/AIDS and Social Services
Background: 

Many individuals with HIV/AIDS experience periods of unemployment as their physical symptoms increase. However, some in treatment do continue or return to employment.

Purpose: 

The purpose of this study was to compare a sample of individuals with HIV/AIDS who successfully return to employment and those that do not. The factors included disease-related factors and service-related factors.

Setting: 

The setting was an HIV/AIDS primary care clinic of a large, university-affiliated hospital.

Sample: 

The study sample consisted of 135 patients whose records indicated that they had successfully regained employment following disease-related job loss. A matched cohort of individuals with HIV/AIDS who had not regained employment was selected as a comparison group.

Data Collection: 

The data consisted of patient clinical records related to HIV/AIDS treatment and symptoms and services delivered. Statistical analyses consisted of descriptive statistics and analysis of variance (ANOVA).

Intervention: 

The majority of predictor variables were related to HIV/AIDS, such as CD4 cell count and length of time in treatment. However, the effects of one intervention were also included, the provision of mental health services.

Control: 

A matched comparison group was selected consisting of individuals with HIV/AIDS who had not returned to work following disease-related job loss.

Findings: 

Substance use disorders were more prevalent in those who had not achieved return to work. Those who had returned to work were more likely to have received mental health assessment and treatment.

Conclusions: 

Mental health services may serve as a gateway to return to work for many individuals with HIV/AIDS. In addition, identifying patients who are already being treated by the mental health team in order to assess their desire and ability to return to work is an important first step in increasing the effectiveness of a return to work program.

URL: 
http://www.tandfonline.com/doi/abs/10.1300/J187v03n03_07?journalCode=whiv20
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes