Asian

Populations:

Outcomes:

Increase in tenure

Wages

Other

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong

Authors:

Wong, K. K., Chiu, S. N., Chiu, L. P., & Tang, S. W.

Year Published:

2008

Publication:

Psychiatric Services

Volume:

Number:

Pages:

84-90

Publisher:

American Psychiatric Association

Background:

Supported employment is an evidence-based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment. Most research on the effectiveness of supported employment comes from the United States.

Purpose:

This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting.

Setting:

The setting was community rehabilitation programs in Hong Kong.

Sample:

Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were randomly assigned to either a supported employment program or a conventional vocational rehabilitation program.

Data Collection:

Both vocational and non-vocational outcomes were measured in this study. Vocational outcomes include competitive employment rates, time to first job, total days employed, and total earnings. Non-vocational outcomes include self-perceived quality of life. Major assessments were conducted at baseline and at six and 18 month follow up points by the employment specialist.

Intervention:

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

Control:

Traditional Vocational Rehabilitation Services

Findings:

Over an 18 month study period, compared with participants in the conventional vocational rehabilitation program, those in the supported employment group were more likely to work competitively, held a greater number of competitive jobs, earned more income, worked more days and sustained longer job tenures.

Conclusions:

Consistent with previous research findings, the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting.

URL:

http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2008.59.1.84

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Critical strategies for implementing supported employment

Authors:

Bond, G. R., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R.

Year Published:

2007

Publication:

Journal of Vocational Rehabilitation

Volume:

Number:

Pages:

13-20

Publisher:

IOS Press

Background:

Supported employment is considered to be "the most effective approach to increase work opportunities for people with severe mental illness [3‚Äì5]" (p. 13). However, access to Supported Employment services is difficult to obtain.

Purpose:

The paper offers "a review of experiences by six states and the District of Columbia in disseminating an evidence-based practice, supported employment (SE). Each jurisdiction had unique strengths and barriers to overcome to effectively implement supported employment services for people with severe mental illness" (p. 13).

Setting:

"Project leaders from the original six states and the District of Columbia" provided information as to how they were able to increase "access to high-quality SE services in their areas" (p. 13).

Sample:

Maryland, South Carolina, District of Columbia, Oregon, Vermont, Kansas, Connecticut

Data Collection:

Seven states (including the District of Columbia) reported unique aspects of implementing supported employment. The approach used was similar to that of a case study.

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:

"Diverse strategies were used to augment implementation of supported employment services: a) Instituting state-level administrative procedures and reconfiguration of local staffing to enhance collaboration between mental health and vocational rehabilitation; b) Promoting SE services through the media, online training, and training by early adopters; c) Hiring benefits specialists; d) Teaching outcome-based supervision; and e) Building capacity for supported employment fidelity reviews" (p. 13).

Conclusions:

"Dissemination of evidenced-based supported employment was enhanced when six states and the District of Columbia addressed special aspects. Supported employment implementation included different pathways to good employment outcomes" (p. 13).

URL:

http://www.worksupport.com/kter/documents/pdf/CriticalStrategies.pdf

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Case reports

Peer Reviewed:

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:

Populations:

Outcomes:

Systematic reviews and meta-analysis

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Is job tenure brief in individual placement and support (IPS) employment programs?

Authors:

Bond, G. R., Becker, D. R., & Drake, R. E.

Year Published:

2011

Publication:

Psychiatric Services

Volume:

Number:

Pages:

950-953

Publisher:

American Psychiatric Association

Background:

Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.

Purpose:

The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.

Setting:

Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.

Sample:

Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.

Data Collection:

Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.

Intervention:

Control:

The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.

Findings:

The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7‚Äì12, 13 (9%) during months 13‚Äì18, and ten (7%) during months 19‚Äì24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6¬±10.2 hours per week and 10.7¬±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5¬±8.3 hours per week and 16.4¬±4.2 days per month. Mean wage rate for working clients was $7.90¬±$3.00 per hour

Conclusions:

Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/21807836

Disabilities:

Populations:

American Indian or Alaska Native

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Neurocognitive enhancement therapy with vocational services: Work outcomes at two-year follow-up

Authors:

Berthoud, R.

Year Published:

2008

Publication:

Schizophrenia Research

Volume:

105

Number:

Pages:

18-29

Publisher:

Elsevier

Background:

Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory.

Purpose:

The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.

Setting:

The study setting was a Community Mental Health Center serving individuals with psychiatric disabilities.

Sample:

Seventy-seven stable outpatients with diagnoses of schizophrenia or schizoaffective disorder were recruited at a large urban community mental health center. Participants met diagnostic criteria based on the Structured Clinical Interview for DSM-IV (First et al., 1996) from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association & Task Force on DSM-IV, 1994), conducted by research psychologists, and were eligible if they were clinically stable (i.e., GAF > 30, no housing changes, psychiatric medication alterations, or psychiatric hospitalizations in the 30 days prior to intake). Exclusion criteria included history of traumatic brain injury, known neurological diseases, developmental disability, and active substance abuse within the past 30 days

Data Collection:

The statistical consultant compared hours worked by condition across quarters over the course of the two-year study using mixed models, repeated measures ANOVAs. Analyses were performed separately for total hours of community-based work activity (transitional and competitive payment combined), and hours of community-based work activity paid exclusively by the employer (competitive payment). Because of significant skew introduced by non-working participants in each quarter, analyses were repeated using ranked data as a nonparametric check of the results. Except where corrected for multiple comparisons, alpha was set at .05 and all tests were two-tailed.

Intervention:

Patients (N = 72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET + VOC or VOC only. NET + VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.

Control:

The control condition was VOC only.

Findings:

NET + VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.

Conclusions:

NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/18715755

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

Increase in hours worked

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Converting day treatment centers to supported employment programs in Rhode Island

Authors:

Becker, D. R., Bond, G. R., McCarthy, D., Thompson, D., Xie, H., McHugo, G. J., & Drake, R. E.

Year Published:

2001

Publication:

Psychiatric Services

Volume:

Number:

Pages:

351-357

Publisher:

American Psychiatric Association

Background:

Day treatment centers were originally designed to provide "partial hospitalization" for patients with serious mental disorders who required intensive, comprehensive, and multidisciplinary treatment that was unavailable in an outpatient setting. These programs began to develop rehabilitative services, rather than "hospital diversion". However, research indicates that these centers do not assist clients in obtaining jobs in the community. Because of the expense involved in maintaining these centers, they are coming under closer scrutiny. As such, several day treatment centers were successfully converted to supported employment programs.

Purpose:

The intent of the study was to determine if phasing out day treatment centers in support of supported employment and other activities can be implemented statewide.

Setting:

Three community day care treatment centers in Rhode Island participated in the study. Two were converted to supported employment programs, while the third remained a day treatment center until after the study was complete, for comparison purposes.

Sample:

The study sample include 28 day treatment clients with severe mental illness in three community mental health centers.

Data Collection:

"Participants were assessed at baseline and again at follow-up 30 to 36 months later; follow-up for clients in the converted programs took place 18 months after the conversion was completed. An independent research team conducted the interviews and evaluation." (p. 352)

Intervention:

The intervention related to conversion of two day treatment centers to ones offering supported employment services.

Control:

One of the centers remained as a rehabilitative day center.

Findings:

"Former day treatment clients in the converted centers attained higher rates of competitive employment than those in the comparison group (44.2 percent and 56.7 percent versus 19.5 percent). Other employment outcomes also improved, and hospitalization rates and overall social functioning were unchanged." (p. 351)

Conclusions:

"This study supports findings of previous studies suggesting that replacing rehabilitative day treatment programs with supported employment programs yields improvements in employment outcomes without adverse effects." (p. 351)

URL:

http://www.worksupport.com/kter/documents/pdf/ConvertingDayCenters.pdf

Disabilities:

Populations:

Outcomes: