Emotional disturbance

Populations:

Outcomes:

Systematic reviews and meta-analysis

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Working with schools: What employment providers need to know for successful collaboration

Authors:

Grunert, B. K., Smucker, M. R., Weis, J. M., & Rusch, M. D.

Year Published:

2016

Publication:

Journal of Vocational Rehabilitation

Volume:

Pages:

355-359

Publisher:

IOS Press

Background:

In 2004, the Individuals with Disabilities Education Act (IDEA) mandated that transition services focus on improving academic and functional achievement of students with disabilities. In 2008 report from the National Council on Disability (NCD) highlighted that outcomes were not being accessed in regards to the benefits being provided to youth with disabilities. Additionally, in 2014 the Workforce Innovation and Opportunity Act, addressed the role of Vocational Rehabilitation Services, that were being provided through the states, in relation to supporting youth with disabilities and transition services.

Purpose:

This paper examines a collaborative transition model and preliminary results of a 5-year study. The study evaluated the effects of embedded employment resources in schools, the impact on agency connections, employment outcomes, and lessons learned. These results were then used as the basis for the National Association of People Supporting Employment First (APSE) Conference and associated workshop. There were three questions that guided the workshop discussions.

Setting:

One example that was provided looked at the Indiana School-to-Work Collaborative. IN*SOURCE is a parent training and information center in Indiana that provides information to families.

Sample:

Students with a disability who had difficulties meeting diploma requirements and were hoping to enter the workforce where the primary target of the Collaborative. There were 208 Experimental Sites and 66 Control Sites. Examples of Agencies involved included Vocational Rehabilitation, Employment Providers, Case Management Providers and several others.

Data Collection:

Implementation and data collection occurred over three years. Metrics measured included number of internships obtained, employment rate for students, and pay.

Intervention:

There were 7 aspects of the Collaborative that focused on integrating services for students. Some examples include having a single-point-of-contact, participating in internships through the school, and having Benefits Information Network (BIN) liaisons available for students and families.

Control:

The control sites included districts that did not have employment resources embedded into schools.

Findings:

Students were more likely to be connected to vocational services when they are embedded within schools.

Conclusions:

Schools and employment supports should be integrated to offer students with disabilities the most opportunities for success.

URL:

https://content.iospress.com/download/journal-of-vocational-rehabilitation/jvr872?id=journal-of-vocational-rehabilitation%2Fjvr872

Disabilities:

Autism Spectrum Disorder

Intellectual disabilities

Specific learning disabilities

Populations:

Transition-age youth (14 - 24)

Outcomes:

Increase in hours worked

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:

Number:

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‚Äî333, 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:

Populations:

Asian

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

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:

Number:

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:
‚Ä¢ demographic variables: age, gender, ethnicity;
‚Ä¢ 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:

Populations:

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Mixed methods

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:

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:

Populations:

Veterans

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Developing evidence-based supported employment services for young adults receiving public mental health services

Authors:

Pryce, J., Munir, F., & Haslam, C.

Year Published:

2009

Publication:

New Zealand Journal of Occupational Therapy

Volume:

Number:

Pages:

34-39

Publisher:

Zealand Association of Occupational Therapists Inc.

Background:

Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts.

Purpose:

This report describes the application of an evidence-based practice fidelity measure to monitor the effectiveness of an expanding supported employment program for youth adults with first episode psychosis.

Setting:

The setting was 4 demonstration sites where employment staff co-located within an early intervention psychosis team.

Sample:

The study sample was made up of 134 individuals. Sixty four percent were diagnosed with first episode psychosis, and received services from a community based early intervention psychosis team.

Data Collection:

The IPS Fidelity scale was applied to each site. Data was collected and scored consistent with the Fidelity Scale directions.

Intervention:

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

Both low and high scoring fidelity items helped identify practical ways to further develop evidence-based practices at each site.

Conclusions:

Fidelity strengths and weaknesses can be identified that have implications for other sites in terms of what employment consultants can most constructively do in context of the restraints of their immediate environment.

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/

Disabilities:

Native Hawaiian / other Pacific Islander

Populations:

Male

Outcomes:

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training

Authors:

O'Neill, J. H. , Zuger, R. R., Fields, A.,Fraser, R., & Pruce, T.

Year Published:

2003

Publication:

Community Mental Health Journal, 39(4), 333-347.

Volume:

Number:

Pages:

333-347

Publisher:

Springer Science+Business Media

Background:

High unemployment rates are found in people with long-term mental health problems although they want to work. Various approaches to increasing access to work have been described. Currently evidence favors the individual placement and support (IPS) model. Here the aim is to help patients obtain open employment with a minimal period of pre-vocational training; a place-train approach rather than vice versa. Once a job or training place has been obtained as much support as possible is given with the aim of retaining the position. This model is gaining increasing recognition in the United States and a Cochrane review concluded that it was more effective than pre-vocational training in helping people with severe mental illness return to work. However mental health services in Europe have been slower to prioritize this issue.

Purpose:

To investigate the impact of training Community Mental Health Team members in the practice of Individual Placement and Support on the vocational status of long-term patients.

Setting:

Subjects were recruited from ten Community Mental Health Teams of a large London Mental Health Trust. Subjects were eligible for inclusion if they had been in continuous contact with their Community Mental Health Team for at least one year and were unemployed. All subjects were
over the age of 16. Males over 65 and females over 60 (normal retirement age) were excluded from the study.

Sample:

Six Community Mental Health Teams received vocational training by a work co-coordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified.

Data Collection:

Data were entered into SPSS for windows version 10 and cleaned using logical searches. The data were analyzed without adjustment for the cluster design. This was because the inter-cluster correlation coefficient (ICC) was 0.00148, which leads to a design effect of 1.01. The small ICC means that individual behavior is only affected to a minor degree by cluster membership, meaning that the cluster design has little overall effect. To test any effect of the intervention the categorical variables were analyzed using tests and continuous variables were analyzed using independent t-tests. A stratified chi-square analysis was conducted to allow for differences between the groups at baseline. When examining factors associated with return to work differences within categories were compared using the z-test. For all statistical tests a significant p-value was set at 0.05.

Intervention:

This was a randomised controlled trial of the effect of training of Community Mental Health Team members on the vocational needs of long-term patients. The training and provision of information was by a Consultant Clinical Psychologist specialising in vocational rehabilitation (RP)and a work coordinator with experience in supported employment. The unit of randomization was the team rather than the patient. Local Research Ethics Committee approval was obtained for the study, which did not require written consent from individual patients.

Control:

The control condition was high quality standard Community Mental Health Team care.

Findings:

There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome.

Conclusions:

Training in Individual Placement and support at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful Individual Placement and Support.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/12908647

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes

Authors:

O'Brien, A., Price, C., Burns, T., & Perkins, R.

Year Published:

2011

Publication:

Scandinavian Journal of Caring Sciences, 25(3), 591-598.

Volume:

Number:

Pages:

591-598

Publisher:

Nordic College of Caring Science

Background:

Lack of participation in the open labor market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe.

Purpose:

Vocational rehabilitation through individual placement and support (IPS) model has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden.

Setting:

The study was designed as a follow-up of clients included in two SE services for people with a mental illness. Assessments were made at baseline, and at 1-year and 2-year follow-ups. In addition, service use and vocational situation were registered at 2-monthly intervals during the follow-up period. One of these services is situated in a town of 115,000 inhabitants, and the other team is situated in a town where 70,000 people live. Both teams are organized in the municipalities social service organization as time-limited projects. They are financed by a coordinating organization, where representatives of the employment office, social insurance bureau, psychiatric service and the local social service are members.

Sample:

The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. Assessments included vocational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning. The present paper includes results from the 1-year follow-up.

Data Collection:

The clients were contacted by the first author as soon as possible after inclusion in the programme. The clients were given the opportunity to choose where the data collection would take place and this was usually at the SE office. However, but some interviews were held in the client‚ residence or in the first author‚ office at the university. In most cases, the data collection lasted for 60‚Äì90 minutes to complete the questionnaires.

Intervention:

Individual Placement and Support (IPS) model 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:

There was no control or comparison condition.

Findings:

The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified.

Conclusions:

This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/21323690

Disabilities:

Populations:

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., Markstr√∂m, U., Svensson, B., Hansson, L., & Sandlund, M.

Year Published:

2008

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

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:

Populations:

Hispanic or Latino

Outcomes:

Randomized Controlled Trials (RCTs)

Increase in hours worked

Increase in tenure

Return to work

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

The effectiveness of supported employment in people with dual disorders

Authors:

Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J. Bond, G. R, Essock, S. M., Becker, D. M., Wolfe, R., & Swain, K.

Year Published:

2011

Publication:

Journal of Dual Diagnosis

Volume:

Number:

Pages:

90-102

Publisher:

PubMed

Background:

Competitive work is a common goal for people with a severe mental illness (e.g., schizophrenia, bipolar disorder, treatment refractory major depression) and substance use disorder (or dual disorder). Despite this fact, relatively little has been firmly established as to whether substance use problems interfere with the ability of clients with severe mental illness to work or to benefit from vocational rehabilitation programs.

Purpose:

This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder.

Setting:

Despite similar methods, the RCTs differed on geographic location, control group interventions, and length of follow-up. The four studies were as follows: The NH study was conducted in two mental health centers in Concord and Manchester, New Hampshire. The DC study recruited clients in an intensive case management program in Washington, DC. In the Hartford study, participants receiving services at a mental health center in Hartford, Connecticut, were randomly assigned. In the Chicago study, clients attending two day programs at a comprehensive psychiatric rehabilitation agency in Chicago, Illinois, were randomly assigned.

Sample:

The study group consisted of study participants with co-occurring substance use disorders from four RCTs of IPS supported employment versus usual vocational services. All four studies compared a newly established IPS program to one or more well-established vocational programs. In all four studies, participants were recruited from mental health centers (or a psychiatric rehabilitation agency in the Chicago study). Participants were adults who met each state‚ criteria for severe mental illness, typically a DSM-IV Axis I or II diagnosis plus severe and persistent impairment in psychosocial functioning. All participants were unemployed at the time of study admission.

Data Collection:

This study used archival data from four independent RCTs to determine the effect of IPS supported employment on clients with co-occurring substance use disorders. Institutional Review Boards at local sites and participating universities approved the four studies. In addition, the Institutional Review Board of Indiana University-Purdue University Indianapolis approved the data re-analyses reported here. To evaluate differences at baseline between the clients randomized to IPS compared to the comparison programs on demographic, diagnostic, clinical, and background characteristics, study computed t-tests for continuous variables and chi-square tests for categorical variables.

Intervention:

Control:

All of the comparison vocational services were highly regarded, active programs, considered at the time to be state-of-the-art. Common principles shared among these comparison groups were the emphasis on stepwise entry into competitive employment (with the exception of one subprogram in the Hartford study) and brokered services in which the vocational program was provided by a separate agency from the mental health program (with the exception of the Chicago program).

Findings:

In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up.

Conclusions:

The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/23275763

Disabilities:

Populations:

Hispanic or Latino

Urban

Outcomes: