High rates of unemployment persist with people with psychiatric disorders despite their desire to work. Moderate evidence suggests that people with psychiatric disorders who do work experience "modest benefits in terms of symptoms and life satisfaction" (p. 479).
Three approaches to vocational rehabilitation were compared for people with psychiatric disorders. This included the Individualized Placement and Support Model(IPS), a psychosocial rehabilitation program (PSR), and standard services.
The setting included community mental health center in Hartford, Connecticut. The psychosocial rehabilitation program was located off-site. Standard services were offered off-site.
One hundred ninety-eight clients consented to participate (out of 258 who were asked): 86% were Latino(n = 64 consents/74 total), 81% were African-American (n = 91 consented/119 total), and 66% were White (n=43 consented/65 total).
Several assessments were used: diagnosis,
background information, employment outcomes, and nonvocational outcomes. Interviews were completed by one of three research staff and reliability checks were conducted on 15% of the interviews by having a 2nd person review the interviews.
Job satisfaction was rated by the Indiana Job Satisfaction Scale. PANSS was used for nonvocational outcomes and modified to be entirely client self-report.
Overall functioning was rated by the Global Assessment Scale, while social and leisure functioning was rated using one subscale from the Social Adjustment Scale-II: Social-Leisure subscale, as well as a global rating.
Social network information was rated with a variant of the Social Support and Social Network Interview and was requested at baseline, 12 months and 24 months. Quality of Life was assessed through the Brief Version of Quality of Life Interview. Substance abuse was also tracked using the Alcohol Use Scale and Drug Use Scale.
Statistical analyses were conducted as follows:
- "Intent-to-treat analyses of employment outcomes were conducted on the entire randomized sample" (p. 483).
- A second set of analyses were conducted to determine if clients differed in their vocational outcomes.
- Employment outcomes were collected over the entire 2-year period. The 3 groups on time to job were restricted to clients who obtained any work.
-Changes in non-vocational outcomes used mixed-effects regression models, using the vocational program as the independent variable.
Two interventions were studied: IPS and PSR. The IPS model used "was based on the principles in the IPS manual (D.R. Becker & Drake, 1993)" (p. 481). The PSR program "incorporated transitional employment into its into its vocational rehabilitation approach" (p. 481). Clients focused on clerical and janitorial skills training with transitional jobs and later obtaining competitive employment.
Standard services that are considered typical of most supported employment services, which included access to all other vocational services available to everyone with severe mental illness, vocational program with substandard wages, or competitive wages under contracts negotiated by the program. Two programs were evaluated: standard-supported and standard-enclave.
Fidelity to the IPS model (for each of the programs) was evaluated using the IPS Fidelity Scale. The programs were rated in order from highest to lowest: IPS, standard-supported, PSR, and standard-enclave.
The Individual Placement and Support model was the most effective at retaining clients and improving employment outcomes.