Emotional disturbance

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.

Hours worked were measured weekly, and work performance was assessed biweekly with the use of the Work Behavior Inventory. Hope and self-esteem were assessed at baseline and at 5 months with the Beck Hopelessness Scale and the Rosenberg Self-Esteem Schedule.

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 cumulative measures of employment, total hours worked, and wages earned during the study period were analyzed with fixed-effect procedures. Logistic regression was used to test whether the participant worked during the study, and an analysis of variance was used to test log hours worked and log wages earned. The probability of working over time by treatment group was analyzed as a repeated binary measure using generalized estimating equations to adjust SEs. This secured an estimate of the "population-averaged" effect of working over time for the 2 treatment groups.

Interview assessments with EIDP participants elicited information about demographic characteristics, previous employment, current income, clinical indicators, and other relevant information at six month intervals for 24 months. Sites also collected data on the types of vocational and clinical services received by EIDP participants. Recruitment of study participants took place between February 1996 and May 2000. Random effects meta analysis were fist to the data over multiple sites. All analyses showed consistency between sites. Effect sizes for the job acquisition and job retention variables were calculated using Comprehensive Meta-Analysis statistical software. A;; hypothesis were two-tailed, and the standard p value of p<.05 was used for rejection of the null hypothesis.

Baseline comparisons

In order to assess baseline equivalence of the groups, proportions of categorical variables at baseline were compared according to initial group assignment using 2-tests. Values of continuous measures were compared using either the t-test or, for non-normally distributed variables, the (non-parametric) Mann-Whitney U-test.

Vocational outcomes

Intention-to-treat analyses were conducted first, including all individuals and time periods for which we had data. Groups were compared on measures pertaining to any paid work (competitive or not) and competitive work only.

Individuals were randomly assigned to DPA or IPS. Afterwards they were followed for two years. Objective data related to paid employment outcomes was collected through quarterly participant interviews. Data pertaining to the predictor variable, working alliance were collected by participant interviews every 6 months for individuals who were working at the time.
Demographic variables were measured by the Uniform Client Data Inventory and work history by the Employment and Income Review at baseline. Psychiatric symptoms were assessed at baseline and semiannual periods using the Positive and Negative Symptom Scale. Employment outcomes included total duration of paid work and mean paid job tenure. A scale was developed to measure working alliance. It included items related to emotional support, instrumental/informational support, frequency of performance feedback, stressfulness of the relationship, how critical the vocational worker was to the client and the person's overall satisfaction with the relationship.
Fidelity to the IPS or DPA model tenants were assessed every 6 months for both sites where individuals received services.
Stepwise hierarchical multiple regression analysis were run to determine relationships between the working alliance and employment outcomes. Baseline variables were controlled for and were entered into the regression model. Related to the number of days of paid work and job tenure applicable covariates were entered.
The working alliance variable was added in the second step of the regression analysis. Zero order correlates were also run. Independent t test was used to determine differences between IPS and DPA on working alliance.

Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV):
1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter.
2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter.
3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.

The study looks at three case studies

Study participants were randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up.