Black / African American

Populations:

Randomized Controlled Trials (RCTs)

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Service intensity as a predictor of competitive employment in an individual placement and support model

Authors:

McGurk, S. R., Mueser, K. T, Feldman, K., Wolfe, R., & Pascaris, A.

Year Published:

2011

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1066-1072

Publisher:

Psychiatric Services

Background:

Research has been done on supported employment for people with psychiatric disorders; however, little of it has been focused "on variables that moderate the relationship between service intensity and vocational outcomes" (p. 1067)

Purpose:

The study reviewed "four aspects of service intensity in a supported employment program" (p. 1067):
1. Average level of service intensity
2. Association between service intensity and weeks worked
3. Individual demographics and clinical variables associated with service intensity
4. Individual characteristics that moderate the relationship between service intensity and weeks worked

Setting:

The setting included 2 Psychiatric Rehabilitation Centers located in Chicago, Illinois.

Sample:

The sample was made up of 96 participants in the IPS group and 98 in the diversified placement approach group. Participants were randomly assigned to the two groups, and 5 discontinued IPS services within the first 3 months, which reduced the sample size for IPS to 91.

Data Collection:

The intervention group was enrolled between 1999 and 2002, while data collection continued until 2004. Data were obtained from Threshold PsychServe system and were measured in terms of hours of support. Clients were also completed a survey, which included demographics, as well as a self-report of number of weeks worked and number of years since last employment.

The Positive and Negative Syndrome Scale was administered, as well as the number of lifetime hospitalizations and diagnosis (using DSM-IV). These were collected at baseline.

Data were analyzed using SPSS 11.0 for Windows and Hierarchical Linear Modeling. Zeroes were recorded for participants' IPS contacts for quarters when they dropped IPS.

Hypotheses were tested by totaling variables across the entire study and conducting hierarchical linear modeling regressions, as well as examining the data longitudinally by using the hierarchical linear model.

Intervention:

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

Control:

The comparison condition was the Diversified Placement Approach.

Findings:

Forty-eight participants continued IPS services for the entire two years. People who dropped out did not differ from those who continued on either demographics or clinical variables.

IPS services and mental health services declined over time; therefore, the intensity of IPS services was positively correlated with mental health services. The number of IPS contacts in one quarter was positively associated with the number of weeks worked in the following quarter.

Conclusions:

Increasing ISP services intensity may improve employment outcomes.

URL:

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

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

The effects of primary care depression treatment on patients' clinical status and employment

Authors:

Schonebaum, A., Boyd, J., & Dudek, K.

Year Published:

2002

Publication:

Health Services Research

Volume:

Number:

Pages:

1145-1158

Publisher:

John Wiley & Sons, Inc.

Background:

Effective treatment of depression could thus have major public health benefits. Yet despite availability of efficacious treatments, that is, antidepressant medications and psychotherapies, and of national practice guidelines, rates of appropriate treatment for depression remain low nationally, particularly in primary care where only about a quarter of depressed patients receive appropriate care.

Purpose:

The goal of this study was to evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.

Setting:

The study was conducted in six diverse, non academic managed primary care organizations. Forty-six of 48 primary care practices and 181 of 183 clinicians participated. Practices were matched into blocks of three clusters, based on factors that might affect baseline quality of care or intervention response: clinician specialty mix, distribution of patient socioeconomic and demographic characteristics, and presence of onsite mental health clinicians.

Sample:

Study staff screened 27,332 consecutive patients in participating practices over five to seven months. Patients were eligible if they intended to use the clinic during the next twelve months and screened positive for depression, using items from the World Health Organization's twelve-month Composite International Diagnostic Interview. Patients were positive if they reported at least one week of depression in the last 30 days, plus two weeks or more of depressed mood or loss of interest in pleasurable activities or persistent depression over the year.

Data Collection:

Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.

Intervention:

Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. One intervention supported the same nurses to provide six or twelve months of medication follow-up (randomized at the patient level) through telephone contacts or visits, and the other intervention trained local therapists in group and individual Cognitive Behavioral Therapy. These therapists were available to intervention patients at reduced copay. All patients could have other types of psychotherapy for usual copays.

Control:

Usual care practices only received written depression treatment guidelines by mail. In all intervention conditions, patients and providers made their own treatment decisions and use of intervention resources was optional.

Findings:

At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.

Conclusions:

Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.

URL:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464020/

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Workforce re-entry for people with HIV/AIDS: Intervention effects and predictors of success

Authors:

Martin, D., Chernoff, R., & Buitron, M.

Year Published:

2006

Publication:

Work

Volume:

Number:

Pages:

221-233

Publisher:

IOS Press

Background:

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent. Little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work.

Purpose:

The purposes of this study were to (1) identify factors predicting workforce re-entry among a group of participants in a workforce-reentry demonstration project for people with HIV/AIDS; and (2) determine whether an intervention designed to help people with HIV/AIDS return to work was successful.

Setting:

Participants were recruited from community-based service agencies in the southern region of Los Angeles County, CA. The intervention was coordinated by the Career Transition Center (CTC) in Long Beach, CA but was delivered at various local centers. The CTC offers an array of services, including resume writing, guided and self-directed job search, vocational counseling, job training and job placement.

Sample:

A total of 235 participants were recruited into the workforce reentry demonstration project from local community agencies. Entry criteria included the following: (1) an HIV/AIDS
diagnosis, (2) disabled/unemployed (exceptions to this were individuals working part time under the table or volunteering), (3) receiving medical care for their HIV/AIDS conditions, (4) enrolled in an HIV/AIDS case management program, and (5) contemplating workforce re-entry. The mean age was 40, and was predominantly males who were sexually active with other males.

Data Collection:

Program participants and comparison respondents completed questionnaires that included demographic questions, measures of income and income source, health indices, an interview and a questionnaire related to current and prior employment status. Descriptive statistics were calculated for all variables. Chi-square tests were used to compare the intervention group with the comparison group for categorical variables and a combination of t-tests and Wilcoxon rank-sum tests were used for continuous variables.

Intervention:

The intervention tested was a work re-entry program that included vocational assessments, counseling, case management, job search assistance, and job placement. In addition, tuition assistance was provided for training through independent training institutions and local community colleges.

Control:

Fifty-one comparison respondents were recruited from the same community agencies as the intervention participants. These individuals met the same requirements as intervention participants with the exception that they were not seeking to re-enter the workforce. They were not provided with an alternative treatment.

Findings:

Of the 235 enrolled participants, 172 completed at least one follow-up. Of this group, 90 were in some form of work at baseline, but 46 stopped working at some time later in the study and their time to return to work was reset to start at the time that they stopped working. Participants in the intervention condition were more likely to return to work than those in the comparison group. In addition, men, those in relatively poor health, those receiving either Social Security or state disability income and those with higher incomes at baseline were less likely to return to work.

Conclusions:

The study provides evidence for the efficacy of return to work services for individuals with HIV/AIDS. Those who completed the intervention were more likely to return to work and to return to work more quickly. Although lengthier interventions may be needed for some individuals with HIV/AIDS seeking workforce re-entry, the ?findings suggest that even limited assistance may be useful to individuals seeking to return to work following a period of disability.

URL:

http://content.iospress.com/articles/work/wor00565

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Vocational rehabilitation service patterns related to successful competitive employment outcomes of persons with spinal cord injury

Authors:

Martin, D. J., Arns, P. G., Batterham, P. J., Afifi, A. A., & Steckart, M. J.

Year Published:

2008

Publication:

Journal of Vocational Rehabilitation

Volume:

Number:

Pages:

1-13

Publisher:

IOS Press

Background:

It is well documented in the literature that the employment rate of people with spinal cord injuries (SCI) decreases drastically after their injuries. Because of the importance of work to the physiological and psychological health and well being of persons with a disability, considerable research efforts have been devoted to studying the employment problems of persons with a spinal cord injury. Over a half of a million individuals are served by state vocational rehabilitation agencies each year, making it possible to study a large number of persons with SCI who are living in the community.

Purpose:

To examine the effect of demographic, work disincentives, and service variables on employment outcomes of persons with spinal cord injury in state vocational rehabilitation agencies.

Setting:

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

Sample:

10,901 persons with spinal cord injury whose cases were closed either as employed (54%) or not employed (46%) by state vocational rehabilitation agencies in the fiscal year 2001.

Data Collection:

An ex post facto design, using data mining as a statistical analysis strategy. Data was taken from the RSA-911 report for all the persons with SCI closed by State Vocational Rehabilitation agencies in 2001. A chi-squared automatic interaction detector (CHAID) based data mining analysis was used to identify the strongest associations between predictors (VR services) and the outcome variable (employment outcomes).

Intervention:

The interventions were the range of Vocational Rehabilitation Services received by the study sample of persons with a Spinal Cord Injury. These services included, but were not limited to, rehabilitation engineering, personal assistance services, assistive technology services, job placement, counseling and guidance, and assessment services.

Findings:

The CHAID data mining analysis revealed that job placement services, work disincentives, and case expenditures as the most important predictors of employment outcomes. In addition, physical restoration, substantial counseling, and assistive technology services all led to positive employment outcomes. Importantly, the CHAID analysis segmented the sample into 45 mutually exclusive homogeneous end groups, with a wide range of employment outcomes. The CHAID analysis indicated that demographic variables interacted with rehabilitation services to affect employment outcomes.

Conclusions:

The results confirmed substantial counseling, assistive technology, and job placement and support services are important to the return-to-work success of persons with SCI.

URL:

http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00399

Populations:

American Indian or Alaska Native

Asian

Native Hawaiian / other Pacific Islander

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Yes

Research Design:

Observational

Peer Reviewed:

Yes

A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Authors:

Man, D. W. K., Poon, W. S., & Lam, C.

Year Published:

2000

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

1007-1015

Publisher:

Elsevier

Background:

The present study tested a Medical/Vocational Case Coordination System (MVCCS) designed for persons with brain injury. The MVCSS, which was based on knowledge gained from the research literature and from clinical experience in medical and vocational rehabilitation for persons with BI, emphasize early intervention and coordinated service delivery through integrated medical center based and community-based services. Early intervention was emphasized to reduce the time between injury and community reintegration and to reduce the associated psychosocial complications that may result from lack of early intervention. The MVCCS was expected to maximize participants vocational and independent living outcomes and to minimize the use of medical and community resources.

The researchers review of previous research supported the belief that an intervention system for improving vocational outcomes of persons with BI must include these features: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) temporary or long-term supported employment in appropriate cases. To be viable, the system must significantly improve on the benchmark of 60% unemployment with results at least equivalent to those of earlier intervention studies; that is, approximately 75% of participants in community-based employment: approximately 50% working without long-term supports and approximately 25% in long-term, community-based, supported employment or in educational or training programs. They studied vocational outcomes of the MVCCS over a 4-year period.

Purpose:

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. The study design evaluated 2 hypotheses. The first hypothesis was that vocational outcomes will meet or exceed those reported previously, that is, (1) 75% of participants in community-based independent or supported community-based employment or education/training programs (Vocational Independence Scale [VIS] levels 3 to 5); and (2) 50% of participants in independent community-based employment (VIS level 5). The second hypothesis was that vocational outcomes will be related to (1) severity of injury, (2) severity of impairment/disability, (3) ISA, (4) time since injury, (5) presence of additional non-brain injuries, and (6) preinjury educational/vocational status.

Setting:

The setting was a large urban medical center.

Sample:

One hundred fourteen Minnesota residents with traumatic or other acquired brain injury between the ages of 18 and 65 years. The majority (or 64%) had TBI followed by CVA (26%) and other (10%). The largest portion (36%) of the sample was referred for vocational services through outpatient rehabilitation evaluations. Severity of injury was classified only in TBI cases, based on results of available initial Glasgow Coma Scale (GCS) score and duration of loss of consciousness (LOC) at the time of injury; 56% were classified as severe TBI. Among all participants N=114, the majority (61%) were male. Mean age was 37.4. Preinjury education was less than 12 (22 %); 12 to 15 years (61%) and greater than 16 years (17%). Sixty nine percent were working prior to injury and 77% had an independent living status. The mean time since injury for the group was 65.5 months with a median of 12.7 months.

Data Collection:

Vocational outcome at time of initial placement and at 1-year follow-up was measured using the Vocational Integration Scale. The Mayo-Portland Adaptability Inventory (MPAI), a scale based on the Portland Adaptability Inventory was used for rating the range of physical, cognitive, emotional, and social impairments and disabilities resulting from BI. It was completed by rehabilitation staff, the patient and a significant other. Rating scale (Rasch) analyses of the Staff MPAI based on 305 assessments led to a reduction in the number of items from 30 to 22 by eliminating non-contributing items. An indicator of Impaired self-awareness ISA was item 24 from the Staff MPAI, which rates level of indifference or lack of awareness of deficits. The second indicator of ISA used was the difference between the Rasch-converted score for 22-item Staff MPAI and the Rasch-converted score for the 22-item Survivor MPAI. Preinjury vocational status, the presence of other non-brain injuries, time since injury, and the Rasch-transformed Staff MPAI appeared to have some value in predicting the level of initial vocational placement. At 1-year follow-up, vocational status was predicted by time since injury and Rasch Staff MPAI. The VIS at initial placement also significantly predicted VIS at follow-up (Spearman coefficient 5 .75, n 5 101, p, .0001). The efficiency of services (i.e., months to placement) was significantly predicted by preinjury education, injury severity, time since injury, Rasch Staff MPAI, Rasch Survivor MPAI, and the difference between the Rasch Staff MPAI and Rasch Survivor MPAI. To control for experiment-wise error, potential predictor variables were further scrutinized using regression analyses.

Intervention:

The MVCCS interfaced a medical center based BI Nurse Case Coordinator (NCC) with a medical-center based BI Vocational Case Coordinator (VCC) who served as a liaison to community-based services. This interface provided: (1) early identification by the NCC of individuals needing medical
services, medical rehabilitation, vocational rehabilitation, and social services; (2) late identification of other persons with chronic impairments after BI and their service needs by either the NCC or the VCC; (3) personal vocational counseling, consumer advocacy, and on-site consultation to other vocational services provided by the VCC; (4) access to community-based vocational services through the VCC that included: vocational evaluations, supported work trials, long-term community- based supported employment, job coaching, job development, and job placement; (5) access to other community based services that support employment, such as independent living services, community-based social services and mental health services, and traumatic brain injury (TBI) waivered services, including behavioral aide services; and (6) access to medical center services that enhance vocational re-entry for persons with BI, such as a CI day rehabilitation program; a 3-hour weekly community reintegration group; individual cognitive rehabilitation; medical rehabilitation services such as standard rehabilitation therapies, work hardening, and physical work assessments; neuropsychological and psychiatric services, including psychotherapy, family therapy, behavioral medicine, and substance abuse treatment; and other medical diagnostic and therapeutic services, including psychiatric and behavioral neurology services.

In the day-to-day operation of the MVCCS, the NCC, working with emergency room staff, identified all brain-injured
persons admitted to the hospital each working day and served as case coordinator for these cases. She reviewed the medical record, met with the patient, recommended additional services to the primary medical service, obtained consent, and entered participants into the clinical database. The NCC followed the patient after dismissal from acute care. If the patient left from acute care to home, she followed up by telephone within 1 month to identify potential BI sequelae and service needs and to assist in scheduling required services. If the patient left acute service to the rehabilitation unit, the NCC turned medical case coordination over to the rehabilitation social worker. In all cases referred, the VCC met with study participants and obtained consent for study participation, provided all appropriate vocational evaluations and counseling, completed the Staff MPAI with input from other involved rehabilitation staff, obtained the Survivor MPAI, and referred appropriate participants to community-based vocational services. The VCC followed up on each participant 1 year after the person was placed or left the project.

Control:

There was no comparison condition. Participants served as their own controls.

Findings:

he MVCCS evaluated in this study appeared to substantially improve employment outcome for persons with BI without interventions. Results were better than projections based on the previous literature 80% of those served were placed in community-based work with 46% in independent community-based employment. Employment outcomes for persons who received vocational services through this project approached or exceeded outcomes reported previously for intensive rehabilitation interventions. Just as importantly, initial vocational placements were maintained at 1-year follow-up. At the follow-up interview, 81% were working in the community and 53% were employed independently without job supports. Although the results were equivalent to those of other rehabilitation programs that are based on best practices the authors could not make direct comparisons with those programs because we did not investigate specific interventions. Primary predictors of initial placement in the present study were time since injury and overall impairment/disability as measured by the Staff MPAI. Return to previous work should be considered especially for the more recently injured who have retained ties to their previous employer. Results indicate that more severe impairments and disabilities, as measured by the MPAI, are significant barriers to employment in the general population of persons with BI. However, for persons with TBI, the presence of additional non-brain injuries appears to be a more important factor.

The best predictor of employment level at 1-year follow-up was the level of initial placement. ISA (as measured by the difference between Rasch Staff MPAI and Rasch Survivor MPAI) did not contribute to the prediction of either initial placement or job maintenance. This finding is inconsistent with some other studies reporting an association between ISA and long-term employment after BI. The results suggest that ISA may be a barrier to employment that can be overcome through rehabilitation, through education and support for employers, and by discriminating placement of those persons with ISA in work environments that are more tolerant of limitations in self-awareness. Overall level of impairment and disability also appears to be a factor in time required for placement. In some cases, more intensive rehabilitation efforts, such as a CI day rehabilitation program, were required for more severely disabled persons so they could develop cognitive compensation, communication, behavioral self-management, social, and other pre-vocational skills required for eventual placement. Because of the time required for participation in such an intensive rehabilitation program, most individuals who participated in CI day rehabilitation required 6 to 12 months from the time they were admitted to services to their eventual placement. Our data suggest that most placements (92%) can be made within 1 year of admission to services. Preinjury years of education also contributed slightly to prediction of time to placement, with more highly educated individuals being placed more quickly.

Conclusions:

Introducing a VCC into an MVCCS program appears to optimize participants vocational outcome after BI, resulting in community-based employment for 81% of persons served with 53% working independently in the community 1 year after placement. Time since injury and overall level of impairment/ disability were the most significant factors in predicting vocational outcomes. Beyond its association with overall level of disability and chronicity, ISA did not contribute to the prediction of initial placement or job maintenance. The best predictor of employment status at 1 year follow-up was the level of initial placement. Persons with greater overall disability required more extended time and more extensive rehabilitation services before job placement.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/10943747

Disabilities:

Populations:

Outcomes:

Full-time employment

Increase in hours worked

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

Authors:

Malec, J. F.

Year Published:

2010

Publication:

Social psychiatry and psychiatric epidemiology

Volume:

Number:

Pages:

1-8

Publisher:

Springer

Background:

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.

Purpose:

The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.

Setting:

The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.

Sample:

The study sample consisted of consecutive new referrals (age 17‚Äì35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was as the presence of psychotic symptoms (clinically delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken antipsychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly ).

Data Collection:

Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice

Intervention:

The intervention represents a locally derived modification of the supported employment model. It is consistent with the model in that the service is embedded within the mental health team. Choices are based on individual preference, competitive employment is a major aim, and follow on support indefinite. Where it differs is in the greater emphasis on education (necessary in view of the typical developmental age of onset of first episode psychoses) and use of a broader approach, beyond just rapid job placement, to address specific areas of vocational functioning in the early stages of recovery (for example rebuilding confidence and structuring time).

Control:

There was no control or comparison condition.

Findings:

The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not.

Conclusions:

This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

URL:

http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models

Authors:

Magura, S., Blankertz, L., Madison, E., Friedman, E., & Gomez, A.

Year Published:

2006

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1406-1415

Publisher:

American Psychiatric Association

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. One of the highlights of this approach is rapid job placement which does not necessitate a need for job readiness training or sheltered work. Some individuals have used this approach to gain work but do not maintain employment. Some individuals do not need the intensity of services offered in a SE approach, but may benefit from a clubhouse approach.

Purpose:

This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).

Setting:

The setting included a number of different job sites across 5 states and DC where individuals with mental illness received supported employment services. Services were provided by 5 different experimental programs that adopted the individual placement and support model of supported employment.

Sample:

The participants included 310 individuals with mental illness who were unemployed, 18 years of age or older and who did not have a diagnosis of severe mental retardation. Each person was randomly assigned to the ACT or the Clubhouse programs. Most participants were white males with a schizophrenia diagnosis.

Data Collection:

The research measures included participant characteristics and employment. Control variables included: age, severity of psychiatric symptoms, severity of physical health problems and active substance use. Gender was also added.
Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale. Physical health problems were measured through PANSS probes, Medicaid claims, and interviews. Substance abuse was identified through records, reports and interviews. Two motivational control variable were collected related to interest in working at baseline and match of random assignment to participant preference. The programs kept the same service logs and other records.
The data analysis plan included benchmark comparisons of program performance by using published outcome data from exemplary SE programs. A comparison of ACT and clubhouse outcomes was completed using a services of hierarchical regression analyses.

Intervention:

The intervention was the Individual Placement and Support(IPS)model of supported employment delivered through Assertive Community Treatment programs.

Control:

There was no control condition as supported employment has already been identified as an evidenced based practice. Comparison services were delivered through Clubhouse programs.

Findings:

The results included a comparison with benchmark employment outcomes. Club house participants had higher earnings and hours worked as compared to participants in exemplary supported employment programs. Earnings and work hours for ACT participants was greater than two of those programs. A comparison of ACT and clubhouse outcomes found ACT program had better service engagement. There was no difference in time to obtain a first job. Club house participants were employed longer and for more hours and earned more than than ACT participants. Background variables were predictive of receipt of job search services, which predicted higher employment rates. Wage was an incentive for employment success. A few participants in transitional employment, had about the same job tenure as other participants.
ACT participants received services faster than clubhouse participants. The strong integration of vocational and clinical services, provided by ACT, appeared to be especially helpful to participants with co-occurring disorders.

Conclusions:

The authors concluded that adding supported employment into multiservice programs like ACT and clubhouses, is a way to provide more services to individuals with mental illness, without compromising quality of those services. Although, a cost analysis was not presented, it is suspected that this may also be a cost effective approach to providing supported employment services.

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759891/

Disabilities:

Populations:

Asian

Randomized Controlled Trials (RCTs)

Outcomes:

Increase in hours worked

Other

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Patterns of employment and independent living of adult graduates with learning disabilities and mental retardation of an inclusionary high school vocational program

Authors:

Lynas, L.

Year Published:

2005

Publication:

Research in Developmental Disabilities

Volume:

Number:

Pages:

317-325

Publisher:

Elsevier

Background:

Although employment rates for individuals with disabilities may be improving, improvement is needed. The picture for independent living is not much better. Studies have indicated that most adults with disabilities remain both single and living with their parents. They are isolated socially with few friends or meaningful relationships. Schools and school programs that facilitate the transition to adult life are needed.

Purpose:

The purpose of this study was to examine the employment careers of graduates in an inclusionary vocational and technology high school.

Setting:

The setting for the study was an inclusionary vocational/technical high school in Ohio.

Sample:

Thirty six students participated in the study. Nineteen individuals (11 males and 8 females) had been diagnosed with mild mental retardation and 17 (10 males and 7 females) with a specific learning disability by a school psychologist. All had been enrolled in full time programs for students with special needs and had an Individual education plan on file. During the last two years of high school they attended high school for two or three periods then spent the remainder of the day at a Vocational/Technology Center. Students were aged between 20 to 25 years. The majority or 26 of the students were caucasians. The subjects had been enrolled in a variety of vocational programs while attending the vocational tech center. On average, participants had exited or graduated from high school and the vocational center within the last five years at the time of the study.

Data Collection:

A sixteen item questionnaire was used to learn more about participants' employment and living situation. Participants were contacted by telephone. After answering each question, the participant was given the opportunity to make comments. Chi-square analysis was used to determine statistical differences between the two groups.

Intervention:

The intervention was Vocational Technical Education.

Control:

The study included a comparison group.

Findings:

Overall, the majority or 81% of the participants were employed. However, only 68% of individuals with mild mental retardation were employed as compared to 94% of those with learning disabilities. This was a significant statistical difference. There was no differences related to gender or the program the student attended at the vocational technical center. More participants with learning disabilities were employed in skilled jobs than those with mild mental retardation. Those individuals were working in service industry and factory jobs.
The mean rate of pay for those working was $9.00. there was no significant difference on rate of pay or benefits held by disability type. The majority or 94% of the sample were single. Most or 95% of those with mild mental retardation lived with their parents as compared to 53% of those with learning disability. The majority or 94% of those with learning disabilities owned a car while only 26%of those with mild mental retardation had one. Among those who were working and not driving 40% relied on public transportation. Related to recreation, a third of the respondents indicated watching movies was their main activity. All of the individuals with learning disabilities were registered to vote and had voted. Only 63% of those with mild mental retardation reported having voted.

Conclusions:

Overall over 81% of the graduates were employed. However, this is primarily accounted for by employment of students with specific learning disabilities (94%) as opposed to respondents with mild mental retardation (68%). However, even when this variance between the two disability types is accounted for, even the students with mild mental retardation are employed at a higher rate than other figures reported in earlier studies.
Another positive finding in the study was the rate of pay for the respondents. For those students working, the median hourly rate was $8.90 which is significantly above the national minimum wage with no statistical significant difference found between the two disability types. Additionally, 68% of those working reported to be receiving benefits.
The majority of participants with mental retardation (95%) were still living with their parents; whereas, 53% of those with learning disabilities were living at home. Members of both groups could benefit from training in this area including how to secure housing.
Individuals with learning disabilities were much more mobile in the community than their peer respondents with mental retardation. The students with learning disabilities were much more likely to own a car (94%) and thus get around the community in a more independent fashion. In areas without public transportation local agencies should provide transportation services for those adults with disabilities who do not or cannot maintain an automobile. The individuals who graduated from an inclusionary high school vocational and technology environment have done fairly well compared to respondents in other reported studies on the areas of employment, pay, and independent living. This may have been partially due to the fact that the learning environment moved students quickly through the exploratory phases of vocational education into the focused phase where students received specific vocational and job training as well as training in independent living skills. This was accomplished in a setting with other non-disabled peers who were also receiving strong vocational training.

URL:

http://www.sciencedirect.com/science/article/pii/S0891422204000253

Disabilities:

Intellectual disabilities

Specific learning disabilities

Populations:

Outcomes:

Intellectual disabilities

NIDILRR Funded:

Not Reported

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Paid internships and employment success for youth in transition

Authors:

Luftig, R. L., & Muthert, D.

Year Published:

2000

Publication:

Career Development for Exceptional Individuals

Volume:

Number:

Pages:

205-221

Publisher:

Sage

Background:

Most recent extensive national longitudinal studies of school leavers with disabilities show employment rates lagging significantly behind their non-disabled peers. There is a considerable body of research literature that supports the value of work experience as a critical educational intervention for improving post-school employment. To maximize effective educational interventions, including the use of work-based learning and paid employment experiences, it is necessary to examine specific individual characteristics, strategies, and circumstances that promote or deter successful employment outcomes.

Purpose:

The purpose of this study was to assess the efficacy of a standardized, multi-site, community-based employment internship program developed by the Marriott Foundation for People with disabilities, called Bridges...From School to Work. The study also examines the relationship of various participant and programmatic variables to transition outcomes for participating youth.

Setting:

The settings for the study consisted of multiple workplaces engaged in the Bridges program with the Marriott Foundation. During the study, Bridges operated in Montgomery County, MD; Fairfax County, VA; Washington, DC; Los Angeles, CA; San Francisco, CA; Atlanta, GA; and Chicago, IL.

Sample:

The sample for this study includes 3,024 special education high school students who participated in one of the 10 Bridges projects. There was relatively equal distribution for males and females. Participants were largely minority group members (81%). Students had an array of disabilities but were predominantly learning disabled (57.1%), intellectually disabled (17.8%), and emotionally disabled (14.8%). Disability severity ratings were 41.0% mild, 38% moderate, and 21.0% severe.

Data Collection:

Referral data for Bridges includes demographic, disability, and previous educational/employment histories. Additional data come from a placement data form, an internship log, an internship completion form, and a follow-up questionnaire. Follow-up data collection occurs at 6, 12, and 18 months after internship completion. The data instruments were standardized across all 10 sites. Data analysis consisted of descriptive results for internship performance, and the exploration of the relationship between predictor and outcome variables at each of the three periods using logistic regression procedures.

Intervention:

The Bridges program consists of three phases: (a) pre-vocational orientation program (two to three weeks); (b) pre-vocational preparation skills training (two to four weeks); and (c) internship placement and support. The internship is a paid work experience whereby a student intern spends a minimum of 12 consecutive weeks performing work tasks in a community employment setting. The employer pays the wages and benefits for the student, but the employer and the student are under no obligation to continue the employment relationship beyond the internship period.

Control:

There was no comparison condition.

Findings:

Employment status at six months post-internship was not different across gender, race, or primary disability. Work behaviors during the internship were highly predictive of post-school employment at 6 and 12 month follow-up intervals. 68% of those contacted were employed at six months. Enrollment in postsecondary education was the most frequently cited reason for not working (43%), followed by not being able to find work (21%). A small percentage (13%) cited not wanting to work as the reason for unemployment.

Conclusions:

Findings of this study demonstrate the efficacy of structured work experiences for youth with disabilities in secondary school. Students in the paid internship showed better short-term outcomes regardless of demographic factors and educational placement factors. However, at long-term follow-up the employment rate had declined, indicating a need for sustained employment support services.

URL:

http://cde.sagepub.com/content/23/2/205.full.pdf+html

Disabilities:

Specific learning disabilities

Populations: