Black / African American

Populations:

Randomized Controlled Trials (RCTs)

Outcomes:

Other

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Do sheltered workshops enhance employment outcomes for adults with autism spectrum disorder?

Authors:

Cimera, R., Burgess, S., & Wiley, A.

Year Published:

2012

Publication:

Autism

Volume:

Number:

Pages:

87-94

Publisher:

Sage

Background:

Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.

Purpose:

This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.

Setting:

The study took place in sheltered workshop settings and a variety of businesses.

Sample:

The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.

Data Collection:

Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.

Intervention:

The intervention was sheltered work.

Control:

Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.

Findings:

Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.

Conclusions:

Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.

URL:

http://aut.sagepub.com/content/16/1/87

Disabilities:

Autism Spectrum Disorder

Populations:

Specific learning disabilities

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Utilizing co-workers as "Natural Supports" evidence on cost efficiency, job retention, and other employment outcomes

Authors:

Cimera, R. E., Wehman, P., West, M., & Burgess, S.

Year Published:

2001

Publication:

Journal of Disability Policy Studies

Volume:

Number:

Pages:

194-201

Publisher:

Hammill Institute on Disabilities and Sage

Background:

Much discussion has taken place about the use of natural supports in supported employment. However, a review of the literature indicates empirical evidence supporting or refuting the concept is lacking.

Purpose:

The purpose of this study was to provide empirical research on the use of natural supports, coworkers without disabilities, as a training strategy for supported employees.

Setting:

A variety of job sites in Illinois where individuals who received supported employment services worked.

Sample:

The initial sample included 166 individuals with a primary diagnosis of mental retardation, who were 21 to 69 years old. The majority or 66% were European American and 34% were African American. Of these 166 individuals 31 were replaced because they were lost to contact or the support agency refused to participate or the person did not want to participate. Of 197 (166 plus 31 replacement) surveys mailed, 111 were returned, resulting in a 56% return rate.

Data Collection:

A survey was sent to the adult service providers of 166 people who were included in the Illinois Supported Employment Projects database. The survey include questions related to: worker characteristics, Job coach/Co-worker involvement, Benefit-cost analysis, and Job separation. Dependent variables included: cost efficiency, length of employment, job retention, hours worked per month, gross pay, IQ,level of mental retardation, gender, ethnicity, age and number of disabilities. The independent variable was collected by the coworker Involvement Instrument that assesses the Involvement of coworkers in training supported employees. There was no control. Four analysis took place. The first compared employment outcomes to the degree of coworker Involvement. The second compared the supported employee demographics to the degree of coworker Involvement. Both of these analysis were repeated using data from 1990 and 1994. In addition, an analysis of variance were performed for the nominal-scale variables and Pearsonian correlation coefficients were generated for continuous scale variables.

Intervention:

The intervention was coworker supports.

Control:

There was no control or comparison condition.

Findings:

The study found that coworker involvement did not increase cost efficiency. However, it did seem to increase the length of time the supported employees maintained their jobs. No other employment outcomes were related to coworker involvement. Coworker involvement was not associated with any of the demographic variables.

Conclusions:

Utilizing coworkers to train supported employees does not increase cost efficiency. Coworker involvement appears to increase the supported employees job tenure. Coworker involvement was not impacted by the demographics of the supported employees, meaning that coworkers are willing to aid in the training of individuals with diverse disabilities and functioning levels.

URL:

http://dps.sagepub.com/content/11/4/194.full.pdf

Disabilities:

Populations:

Outcomes:

Increase in hours worked

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

State rehabilitation services tailored to employment status among cancer survivors

Authors:

Cimera, R. E.

Year Published:

2014

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

89-99

Publisher:

Springer Science + Business Media New York

Background:

Studies have shown that certain vocational rehabilitation services are associated with return to work for unemployed patients with cancer. These include: counseling and guidance, job search assistance, and job placement. Patients who have a job return to post disability may require different interventions to assist them with return to work.

Purpose:

The purpose of this study was to determine whether differences in the types of services were based on the employment status of those with a history of cancer at the time of application.

Setting:

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

Sample:

Data on 1,460 people who had cancer were extracted from the Rehabilitation Services Administration Case Service Report.

Data Collection:

Data on demographics and vocational services were analyzed. Multiple discriminant analysis was used to identify different services used by cancer survivors who were unemployed and those who were employed.

Intervention:

There were multiple vocational rehabilitation services interventions. This included: assessment, diagnosis and treatment of impairments, vocational rehabilitation counseling and guidance, college or university training, occupational vocational training, on the job training, basic academic remedial or literacy training, job readiness training, disability related, augmentative skills training, miscellaneous training, job search assistance, job placement assistance, on the job supports, transportation services, maintenance services, rehabilitation technology, technical assistance services, information and referral services and other services.

Control:

There was no control or comparison condition.

Findings:

Vocational rehabilitation service plans can be individualized to meet the employment status and needs of cancer survivors.

Conclusions:

Cancer survivors have the potential to return to work. Services received by cancer survivors who were unemployed and those who were at risk of losing their job received different services from state vocational rehabilitation services. This suggests that services were tailored to meet individual client needs. Vocational rehabilitation services are a resource to assist cancer survivors with employment.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/23504487

Populations:

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Not Reported

Research Design:

Observational

Peer Reviewed:

Yes

Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation

Authors:

Catty, J., Lissouba, P., White, S., Becker, T., Drake, R., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschback, J., Wiersma, D., & Burns, T.

Year Published:

2006

Publication:

NeuroRehabilitation

Volume:

Number:

Pages:

279-293

Publisher:

IOS Press

Background:

A number of cognitive, physical, and psychosocial impairments can occur following a TBI. These deficits can have a profound effect on daily functioning including an individual's ability to work. This may raise significant challenges for vocational rehabilitation professionals when helping individuals with TBI to prepare, obtain, and maintain competitive employment. Given the prevalence of TBI and the young age of many survivors, vocational rehabilitation will be needed. Professionals serving these individuals need to be prepared to develop appropriate rehabilitation plans. To be effective, they need to be familiar with TBI and the current research that looks at what impacts successful vocational outcomes. This may help facilitate the best use of limited funds for the vocational rehabilitation of persons with TBI. There are limitations in the research to date and more research is needed.

Purpose:

The purpose of this study was to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns through an analysis of the Rehabilitation Services Administration (RSA) case service report (RSA-911) data on employment outcomes of persons with traumatic brain injuries (TBI) for fiscal year 2004.

Setting:

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

Sample:

The sample included 7,366 individuals with TBI whose cases were closed by state vocational rehabilitation agencies as employed or not employed in the fiscal year (FY) 2004.

This included 4,862 men (66%) and 2,504 women (34%). The majority or 78% were European Americans. The average age of participants was 37 years. Thirteen percent had co-commitment disabilities (psychiatric or substance abuse). Seventy six percent had a high school degree or more education. The average time between applying to eligible for VR services was a month and a half. The average time between eligibility and case closure was 30 months. Case expenditures averaged $4,238.

Data Collection:

A data mining technique, exhaustive chi-squared automatic interaction detector (CHAID), was used to analyze. In the current study, exhaustive CHAID was used to build classification trees. This technique uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (e.g., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the employment outcome variable. The degree of differentiation is depicted sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation clients could be identified based on their demographic characteristics, work disincentives, and service patterns in terms of their observed levels on the outcome variable. The statistical software SPSS Answer Tree 2.0 was used to conduct the exhaustive CHAID analysis. The alpha level for all statistical tests was 0.01. This study corrected for the number of statistical tests within each predictor using a Bonferroni feature in the Answer Tree software.

Intervention:

The interventions included various vocational rehabilitation services. This included job search assistance, job placement assistance, and on-the-job support services for individuals with TBI.

Control:

There was no control or comparison condition.

Findings:

The employment success rate for the entire sample was 50%. The employment success rate for persons with TBI is somewhat lower than the 55% rate for
the overall sample of vocational rehabilitation clients closed in FY 2004. European Americans had higher competitive employment rates than other groups. Clients with co-occurring psychiatric disabilities had a lower employment rate than those without psychiatric disabilities . Clients who had work disincentives also showed significantly poorer employment outcomes than those without disincentives. In terms of education, clients with a bachelor or higher educational degree had the highest competitive employment rate as compared to those with less education.

Case expenditure was related to outcomes, with more money spent on clients who were closed as successfully rehabilitated. Clients who were successfully rehabilitated also required less time in the rehabilitation process than unsuccessfully rehabilitated clients. Clients who received the following vocational rehabilitation services on-the-job training, job readiness training, miscellaneous training (e.g., GED or high school training needing to diploma), job search assistance, job placement assistance, on-the-job supports, maintenance, rehabilitation technology, and/or other services (e.g., occupational licenses, tools and equipment, and initial stocks and supplies) had significantly higher competitive employment rates than those who did not receive such services. Overall, the results indicated that the TBI clients could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.

Conclusions:

Several vocational rehabilitation clinical practice guidelines came from the results of this study. First, the study underscore the importance of considering job placement and workplace support services in the vocational rehabilitation of persons with TBI. Unfortunately, job placement assistance and on-the job supports were found to be significantly underutilized by rehabilitation counselors in serving their TBI clients. Second, this study highlights the influence of disincentives on employment outcomes. Increased emphasis appears needed in the education of rehabilitation counseling students and practitioners on the importance of benefits counseling services and to encourage rehabilitation counselors to discuss this important service with consumers early in the rehabilitation planning process. Third, co-occurring psychiatric disabilities were found to significantly affect employment outcomes. This finding underscores the importance for rehabilitation counselors to (a) appropriately assess the emotional and psychological functioning of those served and to provide mental health counseling (b) increase knowledge about evidence-based mental health practices, and (c) to utilize the various interventions that have been found successful in diminishing psychiatric symptoms in the rehabilitation process. Finally, the very low incidence of co-occurring substance abuse disorders identified in this study (3%) is unusual, given research has indicated that about 50% to 66% of TBI clients had a history of alcohol and other drug abuse. This may be under reported. Rehabilitation counselors, need better education and training in substance abuse assessment and treatment within the context co-occurring disabilities.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/17361045

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Observational

Peer Reviewed:

Yes

Working it out: Development and testing of a multimedia, vocational education program

Authors:

Campbell, K., Bond, G., & Drake, R.

Year Published:

2004

Publication:

Substance Use and Misuse

Volume:

Number:

Pages:

2525-2558

Publisher:

Marcel Dekker Inc.

Background:

Employment is a ongoing problem for individuals with substance dependency. Their vocational needs are unmet. Earlier studies have shown a positive correlation between employment and retention in treatment. Despite evidence about the value of addressing employment issues in treatment, the service delivery system does not address these needs. Welfare reform has increased expectations for substance abuse beneficiaries to gain employment. Due to shorter stays and funding cuts more programs primarily focus on substance use. Employment and work problems are not given priority. A multimedia interactive computer program may offer a cost effective way to address employment problems.

Purpose:

The study hypothesis was that an interactive and tailored multimedia presentation of vocational rehabilitation information would be more effective than a general printed package of information and work book in reducing the severity of employment problems.

Setting:

The study took place in residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico.

Sample:

One-hundred and ninety-four (194) individuals who received residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico participated in the study. The average age of participants was 37 years and the majority or 64% were men. About 43% were from a minority group.

Data Collection:

The measures included the Addiction severity index-multimedia version (ASI-MV), Social adjustment scale-self report (SAS-SR), Employment questionnaire, Treatment services review and Satisfaction questionnaire. Around 75% of the sample completed 3 or more CD-ROM sessions. These participants completed a satisfaction questionnaire after each session and at the end entire course. Follow up assessment was scheduled 6 month from baseline. Subjects completed SAS-SR and Employment Questionnaire. They were also contacted by telephone to complete a follow up to the ASI.

Intervention:

The intervention included: Working It Out CD-ROM, a multi-session, computer based, self-administered, vocational education and intervention program for clients in substance dependency treatment programs.

Control:

There was a comparison between the group that received the intervention and the control group members. The control group members used the Looking for Work Printed Package booklet along with a workbook with information on: facing fears, why work?, coping with job-related stress, job-finding skills (writing a resume, networking, interviewing, etc.), caring for oneself and the job, and what to say about ones recovery.

Findings:

The study demonstrated that a multimedia vocational rehabilitation program that is self-administered, interactive, and tailored to clients employment status and motivation can be used in a substance dependency treatment program. The study did not find significant differences over the use of printed versus multimedia material. However, clients reported enjoying using the computer program and found the experience more relevant to their particular concerns.

Conclusions:

The multimedia Working It Out program can be effectively used by clients who are in substance dependency treatment.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15603013

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Supported employment outcomes for transition age youth and young adults

Authors:

Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D., & Lauber, C.

Year Published:

2012

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

171-179

Publisher:

PubMed

Background:

Over the last few decades, major developments have occurred in evidenced based practice supported employment (SE) services for people living with diagnoses of severe mental illness. However, the differential effectiveness of SE for different age groups of people in recovery is not well-studied. A group with particular need for employment services are youth age 18-24 and young adults ages 25-30 living with mental illness.

Purpose:

The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes.

Setting:

Data are from the Employment Intervention Demonstration Program (EIDP), a multisite randomized controlled trial of SE among 1,272 individuals with psychiatric disabilities in 7 states. The study uses 24 months of data from EIDP participants in seven states (AZ, CT, ME, SC, MA, TX, and MD)

Sample:

EIDP participants were recruited from existing clinical populations via case manager referral, self referral, word of mouth, and at one site, newspaper advertisements. Participants were as those meeting the following inclusions criteria: being 18 years or older at time of study enrollment, being willing and able to provide informed consent, having an Axis I DSM-IV diagnosis of mental illness, and being unemployed at time of entry into the study.

Data Collection:

Literature search included a combination of strategies, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.

Intervention:

At each site, the experimental condition was a form of enhanced best-practice supported employment compared to either services as usual or an unenhanced version of the experimental model. For example, The Maryland, Connecticut, and South Carolina sites tested the individual placement and support model in which multidisciplinary provider teams engage in minimal pre-vocational assessment, rapid job search, and placement into competitive jobs, with the provision of training and ongoing follow-along support for as long as the patient requests it.

Control:

As with many multisite studies, the nature of the comparison conditions varied. Arizona, Connecticut, Maryland, and South Carolina used a services-as-usual comparison condition in which the subjects received whatever services were available in the local community. Massachusetts used the Clubhouse model, in which facility-based services were provided according to a work-ordered day, with patients and staff working together on jobs within the program as well as at job placements in the community. Both Texas and Maine used an "unenhanced" version of their experimental condition (i.e., no social network services in Texas and no employer consortium in Maine).

Findings:

Among all study participants, youth and young adults had significantly better outcomes in terms of any employment and competitive employment than older (>30 years) adults. However, in multivariable models of participants randomly assigned to SE, young adults had significantly better outcomes than youth or older adults. Other significant predictors of employment and competitive employment were future work expectations, not receiving Supplemental Security Income, and receipt of more hours of SE services. Characteristics of youth, young adults and SE programs that enhance employment are discussed in terms of policy and practice.

Conclusions:

The finding that younger people had better employment outcomes in SE relative to older people provides empirical support for policies that encourage the provision of SE services to youth and young adults. However, it does not obscure the fact that work and return to work are ongoing challenges in the lives and people in recovery.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/22246115

Disabilities:

Transition-age youth (14 - 24)

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Employment outcomes of transition-aged adults with autism spectrum disorder: A state of the states report

Authors:

Escovitz, K., & Donegan, K.

Year Published:

2014

Publication:

American Journal on Intellectual and Developmental Disabilities

Volume:

119

Number:

Pages:

64-83

Publisher:

AAIDD

Background:

Youth with Autism Spectrum Disorder (ASD) face a number of obstacles when transitioning from school to work. The cost to society to support individuals with ASD who do not work is very high. The incidence of ASD is on the rise. It is important to make sure vocational services provided by the states are leading to successful employment outcomes for these individuals.

Purpose:

The goal of this study was to examine the employment outcomes of transition aged youth with ASD served by the states vocational rehabilitation system.

Setting:

This study included individuals with autism spectrum disorder served by multiple vocational rehabilitation agencies in various settings.

Sample:

Data was taken from the Rehabilitation Services Administration's (RSA); RSA-911 Case Service Report database. This database hold records of adults who apply for a states' vocational rehabilitation services. Demographics, vocational services received, and outcomes for closed cases (i.e. employed or not, hours worked etc...) are located there. The study examined the records of 34, 314 youth with ASD who were age 21 and under. Data was pulled for individuals whose cases were closed from 2002 to 2011.

Data Collection:

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

Intervention:

The intervention was various vocational rehabilitation services provided to assist youth with ASD with achieving successful employment.

Control:

There was no control or comparison condition.

Findings:

Over a ten year time span, the number of transition aged individuals with ASD served by VR has increased over time. While employment outcomes, hours and wages have not improved for the group. Transition aged youth with ASD were more likely to receive a positive employment outcome if they received VR services as compared to all youth with disabilities served by VR. However, youth with ASD worked less hours and had lower wages. This means they were underemployed. The cost of VR services for this group remained stable. There is much variability between states.

Conclusions:

Transition aged individuals with ASD are accessing VR services. However, their employment outcomes have not improved. More research is needed to determine what influences the variability between states and improve work outcomes for this group.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/24450322

Disabilities:

Autism Spectrum Disorder

Populations:

Outcomes:

Increase in hours worked

Wages

NIDILRR Funded:

Not Reported

Research Design:

Observational

Peer Reviewed:

Yes

Implementing supported employment as an evidence-based practice

Authors:

Bond, G. R., Campbell, K., & Drake, R.

Year Published:

2001

Publication:

Psychiatric Services

Volume:

Number:

Pages:

313-322

Publisher:

American Psychiatric Association

Background:

The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.

Purpose:

The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).

Setting:

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample:

The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.

Data Collection:

A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.

Intervention:

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control:

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings:

The following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).

Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.

Conclusions:

Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

URL:

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

Disabilities:

Populations:

Outcomes:

Increase in tenure

Systematic reviews and meta-analysis

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Validation of the revised individual placement and support fidelity scale

Authors:

Bond, G. R., Peterson, A., Becker, D., & Drake, R.

Year Published:

2012

Publication:

Psychiatric Services

Volume:

Number:

Pages:

758-763

Publisher:

American Psychiatric Association

Background:

Systematic reviews have concluded that the Individualized Placement and Support (IPS) model of supported employment is an evidence-based practice. The IPS model is a systematic approach to helping clients with severe mental illness obtain competitive employment The 15-item IPS Fidelity Scale (IPS-15) was developed and has been widely adopted in routine practice as a quality improvement tool and in formal research studies to monitor treatment integrity and drift. Nine of ten evaluations have found a positive association between the IPS-15 and competitive employment outcomes. Since the publication of the IPS-15 in 1997, researchers and fidelity assessors have noted deficiencies in the IPS-15, some owing to under-specification of the IPS model in early publications. Specifically, early conceptualizations of the IPS model gave little attention to benefits counseling about Social Security, Medicaid, and other government programs in relation to gaining employment.

Purpose:

The individual placement and support (IPS) model of supported employment for people with severe mental illness is an evidence-based practice. The 15-item IPS Fidelity Scale (IPS-15) was developed to measure program fidelity and has been shown to have good psychometric properties, including predictive validity. On the basis of field experience and research updates, the authors developed an expanded and revised version of this scale, the IPS-25, also known as the Supported Employment Fidelity Scale. This study evaluated the psychometric properties of the IPS-25. The primary hypothesis was that the IPS-25 would be positively associated with the competitive employment rate. Our two secondary hypotheses were that the unemployment rate would be negatively correlated with the competitive employment rate and that program longevity would be positively correlated with both the IPS-25 and competitive employment rate.

Setting:

The study drew on secondary data analysis from an ongoing quality improvement strategy employed in an IPS learning collaborative in 13 states devoted to implementing high-fidelity IPS services. Eight of the 13 states in the IPS learning collaborative participated. We excluded the one state not using the IPS-25 and three states that were still in the start-up phase of IPS implementation. One state opted not to participate in the project.

Sample:

The sample consisted of 79 sites; the number of sites per state varied (range two to 21), consistent with the stage of IPS dissemination within each state. On average, programs had an active caseload of 59 clients (range ten to 334). Most sites had reported outcomes for at least one year before the most recent fidelity assessment. However, 17 sites had been reporting outcomes for fewer than three quarters before the date of the fidelity assessment used in the analysis.

Data Collection:

As part of the agreement for participating in the IPS learning collaborative, individual sites agree to collect annual fidelity assessments and quarterly competitive employment outcomes. Fidelity reviews were conducted according to each state's procedures. The fidelity assessors for each state included trainers from technical assistance centers and state mental health and vocational rehabilitation agencies.
Following exploratory data analysis to plan statistical methods, the study used multiple regression to examine the fidelity-outcome relationship, controlling for unemployment rate and program longevity. Finally, the study conducted the analysis of variance linear trend analysis on the classification based on benchmark fidelity levels.

Intervention:

Interventions with the IPS model of supported employment are based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports.

Findings:

Internal consistency reliability for the IPS-25 was .88. Predictive validity, measured as the correlation between the IPS-25 and site-level employment rate, was .34. Eight of the IPS-25 items were significantly positively correlated with employment rate. Items related to the vocational generalist role, disclosure, follow-along support, and vocational unit were the most strongly correlated with employment. Program longevity was positively associated with employment, whereas the unemployment rate was not.

Conclusions:

The IPS-25 has promising psychometric properties, with greater precision and content coverage than the IPS-15. However, it has not demonstrated an advantage over the IPS-15 in predictive validity. Research directly comparing the two scales is needed.

URL:

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

Disabilities:

Populations:

Outcomes: