Variations in social capital among vocational rehabilitation applicants

Authors: 
da Silva, C. E., Romero, M. G., Chan, F., Dutta, A., & Rahimi, M.
Year Published: 
2017
Publication: 
Journal of Vocational Rehabilitation
Volume: 
46
Pages: 
187-194
Publisher: 
IOS Press
Background: 

The authors examine the intricacies of individual and community level social capital. Specifically, the relationship between social capital and state vocational rehabilitation (VR) agencies interaction with individuals with disabilities. Previous research reveals that people with disabilities will typically have lower levels of social capital than their non-disabled counterparts. However, this relationship has not been shown to be causational.

Purpose: 

The goal of this work is to examine how social capital varies by employment status for VR applicants. It is also hypothesized that levels of social capital would vary by employment status for VR applicants when controlling for disability and individual characteristics.

Setting: 

In 2014 and 2015 Mathematica Policy Research collected survey data from applicants to the New Jersey Division of Vocational Rehabilitation Services, the Mississippi Department of Rehabilitation Services, and Opportunities for Ohioans with Disabilities.

Sample: 

2,804 surveys were completed. After cleaning data with missing social capital information, 2639 cases remained. The sample was relatively split between male (49.9%) and female (50.1%) participants. Half (50.5%) identified as non-Hispanic white, with 37.5% identifying as non-Hispanic black, with age ranging from 25-34 (22.6%) to as high as 55-65 (18.7%) years old. Less than 57% of applicants reported having access to someone who could help with financial concerns.

Data Collection: 

Data collection was done across three state VR agencies. Social capital was measured by looking at four questions including if applicants had anyone that they could rely on for help: 1. finding a job 2. borrowing money to pay an urgent bill, 3. with transportation to get to work urgently, and 4. help with a serious personal crisis.

Intervention: 

No intervention was presented.

Control: 

There was no control or comparison condition.

Findings: 

Both hypothesis were confirmed. Additionally, disability type, employment status, and perceived health had an effect on social capital. Overall, younger, healthier, employed, and less severely disabled individuals were shown to have higher rates of social capital than their counterparts. This remained true across all four social capital questions.

Conclusions: 

This work confirms that there is a strong link between employment status and social capital. As social capital has shown to be lower for individuals with severe disabilities, it would be beneficial for state VR agencies to pay close attention to supporting this community. Similarly, those individuals with a disability onset age of 25 or older could benefit greatly from additional support.

URL: 
https://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr854
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: Two-Year outcomes

Authors: 
Rosenthal, D. A., Dalton, J. A. & Gervey, R.
Year Published: 
2007
Publication: 
Psychiatric Services
Volume: 
58
Number: 
3
Pages: 
325-333
Publisher: 
American Psychiatric Association
Background: 

Experimental studies have robustly demonstrated the effectiveness of the Individualized Placement and Support (IPS) model of supported employment services for people with severe mental illness, and several studies of real-world implementation have shown significant cross-sectional correlations between employment success and fidelity to the IPS model. Experiences with IPS programs have stimulated broad efforts to disseminate evidence-based practices. Although multiple dissemination efforts are underway, analyses on the benefits of efforts to disseminate IPS have been on cross-sectional and site-level data, rather than on longitudinal information on individual clients. To implement IPS in health care systems with limited previous experience, sustained and individualized training programs may be needed to realize potential client benefits. Few studies have demonstrated that IPS, or other evidence-based practices for that matter, can both be implemented in a system that lacks prior experience with the model and yield outcomes for comparable cohorts that are superior, over several years, to those of a comparison group for which this intervention was not available.

Purpose: 

This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).

Setting: 

The setting included 9 Veterans Administration Programs for Homeless Veterans.

Sample: 

A total of 308 veterans were recruited during phase 1, starting in January 2001, when IPS was still unavailable anywhere in the VA. An additional 321 veterans were recruited in phase 2, starting in July 2001, after the IPS employment specialist had been hired and trained, and were invited to participate in IPS for at least two years. Follow-up data collection continued through March 2005.

Data Collection: 

Participants in phase 1 were compared with participants in phase 2 on baseline characteristics by using chi square tests and t tests. All available participants were included in all analyses whether or not they were currently participating in IPS. Mixed models were then used to compare outcomes between the phases over the two-year follow-up period, controlling for baseline differences, using the MIXED procedure of SAS, with the alpha set at <.05.

Intervention: 

Training began with a one-day, on-site, face-to-face orientation for both employment specialists and other VA mental health staff that was led by a social worker with experience training IPS specialists and conducting IPS fidelity ratings. For the duration of the project regular teleconferences continued providing weekly individual case reviews for the first three months, monthly individual case review conferences, and monthly conference calls with all nine employment specialists jointly. A review of ratings of model fidelity at six, 12, and 18 months after program implementation was also performed with a modified version of the IPS fidelity scale. Training was provided by a social worker with extensive experience disseminating the IPS model in other research projects. He was assisted by a VA occupational therapist with experience in supported employment. Monthly conference calls were also held with administrators responsible for program implementation at each site.

Control: 

Phase 1 control group did not receive IPS services. Comparison was made with Phase 2 group who did receive IPS services.

Findings: 

Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. (Psychiatric Services 58:325—333, 2007)

Conclusions: 

A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

URL: 
http://www.nchv.org/images/uploads/Implementation_of_Supported_Employment_for_Homeless_Veterans_With_Psychiatric_or_Addiction_Disorders-Two-Year_Outcomes.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

Authors: 
Rose J., Saunders K., Hensel, E., & Kroese, B. S.
Year Published: 
2004
Publication: 
Psychiatric Bulletin
Volume: 
28
Number: 
8
Pages: 
281-284
Publisher: 
Royal College of Psychiatrists
Background: 

Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.

Purpose: 

The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Setting: 

The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George‚ Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.

Sample: 

The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.

Data Collection: 

Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included:
• demographic variables: age, gender, ethnicity;
• clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator.
Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.

Intervention: 

A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.

Control: 

There was no control or comparison condition.

Findings: 

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying good implementation

Conclusions: 

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

URL: 
http://pb.rcpsych.org/content/28/8/281
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness

Authors: 
Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P.
Year Published: 
2003
Publication: 
The Journal of Nervous and Mental Disease
Volume: 
191
Number: 
3
Pages: 
139-144
Publisher: 
Lippincott, Williams and Wilkens
Background: 

Supported employment is an evidenced based practice that assists individuals with mental illness with gaining and maintaining employment. One of the major barriers to work are disability payments offered by the Social Security Administration and the Veterans Administration. A few studies have shown that the amount of public income is negatively associated with employment, involvement with vocational rehabilitation services and income received from employment. There are no studies related to to the impact of disability benefits on employment of those individuals who receive intensive case management services.

Purpose: 

The purpose of this study was to explore the relationship between income from public support, participation in Intensive Psychiatric Community Care and employment among veterans with severe mental illness.

Sample: 

The sample included 520 veterans with severe mental illness who were randomly assigned to either IPCC or standard care. Prior to entering the study the majority or 87.5% were receiving at least one form of public payment. The average amount was nine hundred and fifty five dollars.
At the 12 month follow up interview, most of the sample 91.2%) were classified as non workers. There were few differences on baseline and demographic and mental health status. There was a significant difference between workers and non-workers on the amount of public income received in the month prior to baseline assessment, with non workers receiving more money.

Data Collection: 

Demographic and mental health status were obtained through participant interviews at baseline and one year out. Symptom severity was measured using the Brief Psychiatric Rating Scale. Alcohol and drug use were examined using scores from the Addiction Severity Index. Functional status was assessed using the Global Assessment Scale. Fidelity to the IPCC Model was measured using the Dartmouth Assertive Community Treatment scale. A liberal measure was used to determine employment. In the data analysis, only composite scores were examined. Bivariate analyses were used to examine differences between demographic and mental health status variables. Multivariate logistic regression was used to look at the contribution of the independent variable.

Intervention: 

The intervention was Intensive Psychiatric Community Care (IPCC).

Control: 

The control condition was standard care.

Findings: 

Public support levels were inversely related to employment. Symptom severity did not appear to be an independent barrier to work.

Conclusions: 

Previous analyses of this study did not look at infrequent outcomes like employment. However, there is value in doing so as the results revealed the impact of assertive case management on employment outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12637839
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of post-high school employment among young adults with disabilities

Authors: 
Reif, S., Horgan, C., Ritter, G., & Tompkins, C.
Year Published: 
2002
Publication: 
Career Development for Exceptional Individuals
Volume: 
25
Number: 
1
Pages: 
25-40
Publisher: 
Sage
Background: 

Employment status is one of the most frequently researched outcomes following school exit for young adults with disabilities. Reported employment rates have been low, particularly for full-time employment. Factors related to transition success have also been investigated.

Purpose: 

The purpose of this study was to examine data from the Alabama Transition Initiative related to student outcomes. The aim was to identify school, student, and program related variables that contributed to successful employment after school.

Setting: 

The study settings were 37 of Alabama‚ 128 public school systems. These school systems served as the state‚ demonstration sites for its transition systems change project. They were selected through ATI‚ annual competition for transition mini-grants to enhance their transition programs through implementation of a set of best practices and participation in the Alabama Student Tracking System.

Sample: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Data Collection: 

Data for this study were obtained through the Alabama Student Tracking System and a follow-along survey one year post school exit related to participation in employment, postsecondary education, and other adult activities. Data analysis was a hierarchical logistic regression analysis.

Intervention: 

The sample consisted of 1,393 former special education students from the participating school systems and who responded to a follow-up survey. The majority the sample members were male (67%) and Caucasian (52%), with 38% African-American. The largest disability group was those with learning disabilities (42%) followed by those with intellectual disabilities (20%).

Control: 

There were no control or comparison groups.

Findings: 

The follow-up survey found that 73% of former students were employed one year following school exit. Employment outcomes were better for those who were male, with learning disabilities, from urban school systems. Related to the interventions, having a job at school exit was a significant predictor of post-school employment, but assistance from VR or MH/MI services were not.

Conclusions: 

These findings suggest that students with disabilities can benefit from paid work experiences while in high school. In addition, females in rural settings need better transition planning and programs.

URL: 
http://cde.sagepub.com/content/25/1/25.refs?patientinform-links=yes&legid=spcde;25/1/25
NIDILRR Funded: 
Research Design: 
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

Methods of a multisite randomized clinical trial of supported employment amount veterans with spinal cord injury

Authors: 
Ownsworth, T., & McKenna, K.
Year Published: 
2009
Publication: 
Journal of Rehabilitation Research & Development
Volume: 
46
Number: 
7
Pages: 
919-930
Publisher: 
Department of Veterans Affairs
Background: 

Baseline data revealed that 65% of the study sample of veterans with spinal cord injury (SCI) who were seeking employment had never been employed postinjury. Nearly half (41%) of this group had received some type of prior vocational rehabilitation. This rate is consistent with veterans with SCI reported for samples in the community of individuals with SCI.

Purpose: 

This article compares evidence-based supported employment (SE) with conventional vocational rehabilitation for veterans with SCI. The researchers hypothesis was that evidence-based supported employment when compared with conventional vocational rehabilitation will significantly improve competitive employment outcomes. The secondary hypothesis was that evidence-based supported employment for veterans with SCI would be more cost-effective than standard care.

Setting: 

The study took place at multiple competitive employment sites versus standard vocational rehabilitation care at various Department of Veterans Affairs medical SCI centers.

Sample: 

Veterans with spinal cord injury consisting of 95% males with an average age of 48.3 years. More than half of the subjects were white, 35.3% African American, 5% Hispanic.

Data Collection: 

All subjects were followed for 12 months with face-to-face interviews every three months to collect data on primary employment variables and secondary outcomes measured. After this initial 12 months, the follow-up period was extended to 24 months at all sites including telephone interviews every three months. MANCOVAs were used to determine treatment group differences over time on the outcome variables (employment index, perceived barriers to employment, level of disability, quality of life, depression, and sustaining care needs), controlling for specified covariates. This included study site, sex, and age.

Competitive employment was as a primary outcome measure and measured every three months. Competitive employment is "community jobs that pay at least minimum wage (directly by the employer to the employee) that any person can apply for, including full-time and part-time jobs." General rehabilitation outcomes were measured at baseline and 3-month follow-up interviews. Standardized measures used included 1) Alcohol Use Disorders Identification test, 2)The Craig Handicap Assessment and Reporting Technique (CHART), 3) VR-36 that measures health-related quality of life in veterans, and 4) The Quick Inventory of Depressive Symptomatology Self-Report.

Demographic variables were also collected such as age, sec, race/ethnicity, employment history, previous levels of income, educational background, legal history, lifetime employment history, vocational services history, duration of SCI, level of SCE, and type of family structure.

Intervention: 

The Spinal Cord Injury Vocational Integration Program uses the principles of evidence-based supported employment. The program integrates vocational services into the SCI continuum of healthcare. The SE principles include 1) integrated treatment, 2) rapid engagement, 3)competitive employment, 4) belief that success is possible regardless of severity or type of disability, 5) ongoing support, 6) veteran preferences, 7) community-based services, and 8)personalized benefits counseling. The investigators spent 4 to 6 months recruiting and hiring staff to provide the evidence-based SE services. All vocational rehabilitation counselors (VRCs) have master's degrees and are certified rehabilitation counselors. Training consisted of 3-day workshop taught by VA faculty. VRCs received ongoing instruction and coaching by a co-investigator who has more than 30 years experience in vocational rehabilitation (VR).

Control: 

The study design was a randomized clinical trial that consisted of an experimental group and a comparison group. Interventional-site subjects were randomized to either the experimental group or the comparison group. Observational sites were selected based on similarity to the intervention site facilities with regards to subjects, communities, and VAMC culture. The observational sites were included because the researchers were considered that veterans and staff at the four intervention sites might be vicariously influenced by veterans and staff involved with the implementation study.

Findings: 

The findings of this study were preliminary. The final enrollment count for the study was 301 subjects. At the time of this publication, 93 participants had reached study completion. Some of the challenges faced included exhausting the study pool earlier than expected, staff turnover, and slow process of culture change within the centers.

Conclusions: 

This article discussed the methods of an ongoing randomized clinical trial of VR approaches among veterans with SCI. Strengths of the study design include repeated measures to evaluate employment across time, inclusion of benefits-counseling, and ongoing fidelity monitoring of the treatment conditions. Before the study, the researchers concluded that there was a lack of attention to identifying or addressing vocational issues in the treatment setting. A culture change occurred such that providers began to introduce and explore the topic. In this study, the recruitment relied on clinical providers' willingness to broaden their definition of rehabilitation to include vocational issues. The preliminary baseline data from this sample showed that the majority (72%) had never been employed postinjury.

URL: 
http://www.rehab.research.va.gov/jour/09/46/7/Ottomanelli.html
NIDILRR Funded: 
Peer Reviewed: 
Yes

The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury

Authors: 
Ottomanelli, L., & Lind, L.
Year Published: 
2004
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
85
Number: 
2
Pages: 
68-72
Publisher: 
Elsevier
Background: 

Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.

Purpose: 

The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.

Setting: 

The setting included communities and two district vocational rehabilitation offices in the state of New York.

Sample: 

The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (i.e.. black and Asian). Related to education, close to half (48%) had not completed high school.

Data Collection: 

The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000–September 30, 2001) and 2002 (October 1, 2001–September 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (i.e., case status 26) were compared with unsuccessful closures (i.e., case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.

Intervention: 

All participants went through the initial VR procedures for eligibility determination and development of an individualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.

Control: 

Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.

Findings: 

Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.

Conclusions: 

The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15083424
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

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

Findings: 

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

Conclusions: 

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

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

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

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

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

Purpose: 

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

Setting: 

Three Brain Injury Centres based across the United Kingdom.

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

There was no control or comparison condition.

Findings: 

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

Conclusions: 

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

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