Individuals with severe mental illness have high rates of unemployment. The Individual Placement and Support(IPS) model of supported employment has demonstrated superior employment outcomes as compared to other conditions (ie. day treatment, sheltered work and counseling)through a number of randomized control trials. It is important to find out if this approach can be effectively implemented with fidelity in the field and yield similar results.
The purpose of this study was to conduct a retrospective evaluation of the employment outcomes of individuals who were involved in a Services for Employment and Education (SEE) program, based on the IPS model, in Massachusetts over a 4 and half year period of time.
The setting included a number of employment sites in Massachusetts where individuals with mental illness who received supported employment services worked.
Participants were 90 individuals who enrolled in the program from 1995 to 1999. The majority were Caucasian (90%) and male (65.7%). The mean age was 42 years with a range from 21 to 65. The majority (66%) had schizophrenia or another psychotic disorder and were receiving disability benefits. Over three quarters or (77.8%) had never been married.
The mean total score on work readiness was 1.33 and annual clinical contact hours was 23.62; the mean Clinical Evaluation of Risk and Functioning score was 39.62.
An independent retrospective evaluation of the SEE employment outcomes was conducted. In addition, the SEE program fidelity was assessed using the IPS Fidelity scale.
Data was selected from three major sources. Demographics, days in program, number of jobs held previously and self rating of "work readiness were collected from the SEE program records. The SEEIS database provided data related to each job obtained (i.e.. start and end date, hours worked, wages etc...) and services received (i.e.. benefits counseling, assistance with job related problems and workplace supports, disclosure of disability etc.... Behavioral health program records provided treatment plan information, clinical contact hours and diagnosis. The case management services client tracking system had information about the person's level of functioning at program exit.
The intervention was, the Services for Employment and Education program, a modification of the Individual Placement and Support Supported Employment Model.
There was no control or comparison group.
SEE participants held 196 jobs. The majority or 35.4% were service jobs. This was followed by 28.6% in marketing or sales, 20.9% were operator, fabricator, or technical jobs and 10.2% were professional, administrative or managerial in nature. The average number of hours worked per week was 16 with a range of 1 to 40 hours. One third of the jobs required 20 or more hours per week.
Wages ranged from $4.75 to $12.00.
Participants frequently received job related supports like benefits counseling, problem solving and on the job support on issues like negotiating changes in schedule, conflicts with coworkers and changes in management.
Support was also offered to assist individuals with disclosing their disability in order to receive reasonable accommodation.
Individuals in non professional jobs quit or were fired from their jobs more often than those who were not.
Eighty two percent of participants held at least one job. The mean was 2.69 positions with a range from 1 to 10. There were no significant differences between those who did and did not obtain work.
On average it took around 3.5 months for participants to secure employment. The average amount of time worked per job was a little more than 11 months.
Employment outcomes were related to education level which was correlated with more highly educated individuals working more total hours across all types of jobs. Participants who had higher self rated work readiness scores remained employed longer than those with lower rates. Also those with more active days in SEE and more employer accommodations remained employed longer. However, those who receive more on the job supports tended to work less hour and earn lower wages. Overall the SEE program had good fidelity to the IPS model.
The majority of participants gained and maintained employment. The model had high IPS fidelity and had outcomes similar to and in some areas superior to the Supported employment and IPS model programs. Programs that follow a evidenced based employment model are more likely to have positive outcomes.