Emotional disturbance

Populations:

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Observational

Peer Reviewed:

Yes

Access to supported employment for consumers with criminal justice involvement

Authors:

Frounfelker, R. L., Wilkniss, S. M., Bond, G. R., Devitt, T. S., & Drake, R. E.

Year Published:

2010

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

49-56

Publisher:

American Psychological Association

Background:

Compared to the general ex-offender population, individuals with SMI have higher rates of homelessness, unemployment, and greater reliance on public assistance. Given the additional challenges and needs of this subpopulation, it is critical that consumers have access to services found to be effective.

Purpose:

This research aims to provide further understanding of the influence of severe mental illness (SMI) and criminal justice involvement (CJI) on access to Supported Employment (SE) services. The authors investigate differences between consumers with and without CJI regarding access to SE and explore reasons for group differences. This study employs a mixed-methods design. The quantitative portion compares employment service utilization of consumers with CJI to consumers without CJI to examine hypothesized differences in frequency of access and time to receipt of SE services. The qualitative portion includes in-depth, individual interviews with consumers with CJI and service providers to gain various perspectives on consumers' with CJI entry to SE.

Setting:

This study examined access to SE among individuals with SMI and CJI receiving services at a community mental health agency.

Sample:

A total of 1,191 individuals with SMI admitted to Thresholds between December 2007 and December 2008 were included in the quantitative portion of the study. A criterion for entry into Thresholds is an individual having a primary psychiatric diagnosis of a SMI such as schizophrenia, bipolar disorder, or schizoaffective disorder. A total of 12 individuals were recruited for the qualitative portion of the study, four employment specialists, four mental health treatment team leaders, and four consumers with past or current CJI.

Data Collection:

Descriptive statistics and chi-square analyses were used to compare group (CJI vs. without CJI) frequencies on demographics and SE service utilization variables.

Intervention:

Thresholds provides a comprehensive array of treatment and rehabilitation services, including medication management, residential services, case management, and day programming. Currently, Thresholds has 22 employment specialists that assist consumers in obtaining and keeping jobs.

Control:

There was not control or comparison condition.

Findings:

Consumers with CJI take longer to access SE services. Consumers with CJI and service providers identify the following as barriers or facilitators to access to SE: competing challenges for consumers with CJI such as mental health probation, the adverse impact of CJI on consumers' psychosocial functioning, social networks, consumers' relationships with practitioners, and practitioners' relationship with SE.

Conclusions:

Consumers with CJI do receive SE services at the same rate as those without CJI, but it takes them substantially longer to engage in SE services. Both programmatic and policy level interventions and modifications may ameliorate this problem.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/20615845

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder

Authors:

Frounfelker, R. L., Glover, C. M., Teachout, A., Wilkniss, S., & Whitley R.

Year Published:

2008

Publication:

American Journal of Psychiatry

Volume:

165

Number:

Pages:

1559-1565

Publisher:

American Psychiatric Association

Background:

Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder.

Purpose:

The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years.

Setting:

Participants were enrolled in the Maintenance Therapies in Bipolar Disorder study, which was conducted from 1991 to 2002 through the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA.

Sample:

Participants were eligible for study entry if they were acutely ill, ages 18‚Äì60, had a lifetime diagnosis of bipolar I disorder and schizoaffective disorder, manic type, and were experiencing their third or more lifetime affective episode. A score of ?15 on the 17-item HAM-D or ?15 on the Bech-Rafaelsen Mania Scale was required for study entry. Patients were excluded if they met criteria for rapid cycling (?4 episodes/year), borderline or antisocial personality disorder, an active eating disorder, or chronic drug or alcohol abuse or if they had an uncontrolled medical illness that would preclude protocol pharmacotherapy or were pregnant.

Data Collection:

Study used mixed-effects repeated measures analysis to examine the data, with the subject as a random variable and the assessment points (baseline, end of acute treatment, end of 1 year of maintenance treatment, and end of 2 years of maintenance treatment) as fixed variables. Acute treatment assignment and acute treatment by assessment time point interaction were also included in the model. The covariance matrix was unstructured. Vocational functioning scores were also examined by gender.

Intervention:

Each study participant was randomly assigned to one of four treatment groups: one of four psychosocial treatment strategies: 1) acute and maintenance interpersonal and social rhythm therapy, 2) acute and maintenance intensive clinical management, 3) acute interpersonal and social rhythm therapy followed by maintenance intensive clinical management, or 4) acute intensive clinical management followed by maintenance interpersonal and social rhythm therapy. All participants received pharmacotherapy according to a standardized algorithm, which is described in detail elsewhere.

Control:

Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment.

Findings:

The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes.

Conclusions:

In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/18829872

Disabilities:

Populations:

Outcomes:

Other

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Providing effective employment supports for persons living with HIV: The KEEP project

Authors:

Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong

Year Published:

2005

Publication:

Journal of Vocational Rehabilitation

Volume:

Number:

Pages:

105-114

Publisher:

IOS Press

Background:

The Kirk Employment Empowerment Project (KEEP) was a three-year demonstration project funded by the Rehabilitation Services Administration (RSA) to test strategies for improving employment outcomes of individuals with HIV/AIDS. KEEP sought to identify and test service strategies that would be effective for individuals who have multiple barriers to employment, and individuals from populations that are typically underrepresented in HIV/AIDS research.

Purpose:

The purposes of this article are to (1) describe the KEEP model and (2) provide data regarding program outcomes.

Setting:

The study setting was the Horizon House, a treatment center for individuals with HIV/AIDS in Philadelphia, PA.

Sample:

The study sample was 148 individuals who were referred to and accepted for KEEP services. The sample was predominantly African-American (72.3%) and male (60%). A substantial proportion had co-occurring disorders, with over a third report a psychiatric disorder.

Data Collection:

Employment tracking data were collected for each participant upon job start, significant job changes, and job end. Initial baseline interviews were conducted by research staff with each participant to obtain demographic data and income, motivation to work and satisfaction with life issues in general as reflected by participants responses to quality of life items. Follow-up interviews were conducted at 6-month intervals for the duration of the project. Descriptive statistics were used to report outcomes for participants.

Intervention:

The KEEP model emphasizes rapid attachment in the workforce and expecting participants to do as much for themselves as possible with support. Among the specific individualized services offered by ESC‚ were assessment and evaluation, job search assistance, benefits and legal counseling, disability management education, on-site job support (such as help negotiating with an employer), job-related problem-solving, specific skills training (such as learning to use public transportation), referral to auxiliary services, coordination and collaboration with other service providers, and other miscellaneous wrap-around services.

Control:

The study used a pre/post intervention design without a control or comparison condition.

Findings:

Of 148 participants in the project, 114 (77%) were employed at some point during the project. They held a total of 278 jobs during the project, averaging 2.4 jobs per participant. Sixty-three percent of participants were employed for 90 days or longer during the project, Earnings ranged from $2.50 per hour to $44.23 per hour, with an average hourly wage of $8.49 (median $7.50/hour). Of the 278 jobs, only 4 paid less than minimum wage. The vast majority of all jobs obtained (87.4%) did not include any benefits at any time.

Conclusions:

The fact that they achieved such high employment rates in the KEEP project supports the evidence that for people with a variety of disabilities, a history of competitive employment, no matter how limited, can be considered an indicator for future employment success. Employment also contributed to improved health and physical functioning.

URL:

http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00278

Disabilities:

Populations:

Urban

Outcomes:

NIDILRR Funded:

Research Design:

Single group

Peer Reviewed:

Yes

Vocational rehabilitation services and employment outcomes for people with disabilities: A United States study

Authors:

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

Year Published:

2008

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

326-334

Publisher:

Springer Science+Business Media, LLC

Background:

Work is fundamental to the physical and psychological well-being of all people. The United States state-federal vocational rehabilitation programs spend more than $2.5 billion annually. Understanding the factors and service patterns that contribute to successful employment outcomes will help enhance services.

Purpose:

The purpose of the study is to identify key factors associated with successful employment outcomes for people with sensory/communicative, physical, and mental impairments in the United States.

Setting:

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

Sample:

Data for this study were extracted from the fiscal year 2005 RSA-911 Case Service Report. The sample includes 5,000 clients from each disability group (sensory/communicative, physical, and mental impairments) whose cases were closed as either rehabilitated or not rehabilitated.

Data Collection:

Data extracted from the RSA-911 data were analyzed using Statistical Package for the Social Sciences (SPSS). Logistic regression analysis was used to examine the association among demographic characteristics, provision of cash or medical benefits, VR service patterns, and employment outcomes. (p. 328)

Intervention:

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, job search assistance, job placement assistance, on-the-job supports, transportation, maintenance, rehabilitation technology, reader services, interpreter services, personal attendant services, information and referral, and other services.

Control:

Comparison of cases that were closed rehabilitated to those that were closed not rehabilitated.

Findings:

Individuals with sensory/communicative impairments had the highest employment rate (75%) compared to 56% for the physical impairments group and 55% for those with mental impairments. Job placement, on-the-job support, maintenance, and other services were identified as significant predictors of employment success.

Conclusions:

This study provides some empirical support documenting the association between vocational rehabilitation services and employment outcomes of people with disabilities. (p. 326)

URL:

https://www.researchgate.net/publication/23449787_Vocational_Rehabilitation_Services_and_Employment_Outcomes_for_People_with_Disabilities_A_United_States_Study

Disabilities:

Intellectual disabilities

Orthopedic impairments

Speech or language impairments

Populations:

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Observational

Peer Reviewed:

Yes

A randomized clinical trial of supported employment for inner-city patients with severe mental disorders

Authors:

Dutta, A., Gervey R., Chan, E. F., Chou, C., & Ditchman, N.

Year Published:

1999

Publication:

Archives of General Psychiatry

Volume:

Number:

Pages:

627-633

Publisher:

American Medical Association

Background:

One primary goal for people with psychiatric disabilities is competitive employment. However, the actual rate of employment is less than 15%. The authors hypothesize two reasons: individuals with psychiatric disorders are discouraged from seeking competitive employment because health professionals believe that "the stress of competitive work produces adverse effects" (p. 627), and once in the standard vocational system, people tend to stay in sheltered workshops instead of transitioning to competitive work.

Purpose:

The purpose of this study was to replicate the New Hampshire study in Washington, D.C., with a more diverse and disadvantaged group of patients and a variety of vocational agencies.

Setting:

"Community Connections, an agency in southeast Washington, DC that serves people with severe mental disorders who need intensive case management" (p. 628)

Sample:

152 unemployed, inner-city patients with severe mental disorders

Data Collection:

Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven states in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.

Intervention:

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

Control:

The control group received Enhanced Vocational Rehabilitation (EVR)

Findings:

During the 18-month study period, participants receiving IPS were more likely than those in EVR to obtain competitive employment. IPS participants "also had superior outcomes in other dimensions of competitive employment" (p. 629). In addition, IPS participants were more satisfied than their EVR counterparts.

Conclusions:

IPS appears to be superior to EVR; however, a lack of evidence exists for the IPS model producing negative results in non-vocational areas, such as self-esteem and quality of life. In fact, the study validated an increase in those two areas, in both IPS and EVR. IPS increased the rate of competitive employment as compared to EVR.

URL:

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

Disabilities:

Populations:

Asian

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

The future of supported employment for people with severe mental illness

Authors:

Drake, R. E., McHugo, G. J., Bebout, R. R. Becker, D. R., Harris, M., Bond, G. R., & Quimby, E.

Year Published:

2008

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

367-376

Publisher:

American Psychological Association

Background:

People with psychiatric disabilities have been able to be competitively employed using supported employment. However, limits to supported employment include: not everyone with psychiatric disabilities wants to work; people are afraid of losing benefits; they lack confidence; they receive little reinforcement from their counselors; or they may not receive the help they need. In addition, finding competitive employment may be difficult due to employee illness, inadequate services, and fear of losing benefits.

Purpose:

The article "reviews current research on innovative attempts to improve the dissemination and effectiveness of supported employment" (p. 367). The intent is to expand the success of supported employment.

Setting:

This is a review of literature. The included studies were undertaken in various locations and settings.

Sample:

he sample included published literature in MEDLINE, PubMed, PsychlNFO, and Scopus; currently funded grant titles, such as NIMH, NIDILRR, and the Social Security Administration. The researchers also discussed the current research with individual investigators.

Data Collection:

Research was reviewed in each of the 9 areas identified in the Intervention section.

Intervention:

The review suggests enhancing 9 areas to improve the success of supported employment: "(1) organization and financing of services, (2) disability policies, (3) program implementation and quality, (4) motivation, (5) job development, (6) illness-related barriers, (7) job supports, (8) career development, and (9) new populations" (p. 368).

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:

With regard to organization and financing of services, clinical and vocational services should be integrated at the client level, which would offer the client "single team of providers who provide a consistent message" (p. 368). Disability policies actually "socialize people into disability" rather than supporting them. Increasing the quality of vocational services will address several of the areas identified in the Intervention section, in addition to learning to implement, maintain, and update supported employment programs as research becomes available. Motivating people with psychiatric disabilities to work can be difficult, especially with the overwhelming issues they face, such as treatment itself, applying for benefits, obtaining insurance, or societal stigma. Job development is critical to supported employment; none of the approaches mentioned have been studied empirically. Individuals with greater symptoms are less likely to be employed unless vocational and psychiatric services are integrated.

Improving job supports would enhance the employability of the individual, such as increasing the use of natural supports and skills training. Career development implies a pattern of growth and increasing satisfaction in employment over time. And lastly, supported employment was proven as a successful technique in the field of developmental disabilities; it is being evaluated as a technique for use with populations other than those with psychiatric disabilities.

Conclusions:

Supported employment is an evidence-based practice that needs improvement.

URL:

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

Disabilities:

Populations:

Outcomes:

Systematic reviews and meta-analysis

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

A randomized controlled trial of supported employment among veterans with post-traumatic stress disorder

Authors:

Diclementi, J. D., Ross, M. K., Mallo, C., & Johnson, S.

Year Published:

2012

Publication:

Psychiatric Services in Advance

Volume:

Number:

Pages:

464-470

Publisher:

American Psychiatric Association

Background:

Post traumatic stress disorder (PTSD) is a potentially disabling mental illness that can cause occupational dysfunction. Although vocational rehabilitation is often prescribed for patients with PTSD, standard vocational services are far from adequate in helping them obtain and maintain competitive employment.

Purpose:

This study is the first to examine the outcome of evidence-based supported employment for veterans with PTSD. Study addressed this gap in the field of rehabilitation research.

Setting:

The setting for the study was the Tuscaloosa Veterans Administration Medical Center.

Sample:

Veterans were eligible for the study if they had a diagnosis of PTSD, wee aged 19-60, were eligible for the VAMC Vocational Rehabilitation Program, were currently unemployed, were interested in competitive employment, and were planning to remain in a 100 mile radius of the Tuscaloosa VAMC for the 12-month duration.

Data Collection:

Using intent to treat analyses and two tailed tests with significance set at p less than or equal to .05, researchers compared rates of competitive employment, as well as number of weeks , day and hours worked; gross wages earned from all sources; and gross wages earned from competitive jobs.

Intervention:

Unemployed veterans with PTSD were randomly assigned to either individual placement and support (IPS) supported employment (N = 42) or a Veterans Health Administration Vocational Rehabilitation Program (VRP) treatment as usual (N = 43). Employment rates and occupational outcomes were followed for 12 months. IPS intervention involved several important features. For example, the IPS specialist was integrated into the clinical mental health or PTSD treatment team, carried out all phases of the vocational services, provided predominantly community based employment, had a caseload of no more than 25 clients, and provided continuous time unlimited follow along supports for vocational services.

Control:

The VRP followed the standard care in place at the VMC, which included one or more of these components: routine prevocational testing and evaluation for all patients on referral to VRP, vocational rehabilitation therapy and provided a work regimen with monetary incentives, and a transitional work program that included a temporary work experience.

Findings:

During the 12-month study, 76% of the IPS participants gained competitive employment, compared with 28% of the VRP participants (number needed to treat = 2.07; ?(2) = 19.84, df = 1, p<.001). Veterans assigned to IPS also worked substantially more weeks than those assigned to VRP (42% versus 16% of the eligible weeks, respectively; Mann-Whitney z test p<.001) and earned higher 12-month income (mean ¬± SD income of $9,264 ¬± $13,294 for IPS versus $2,601 ¬± $6,009 for VRP; Mann-Whitney z test p<.001) during the 12-month period.

Conclusions:

Veterans with PTSD who received IPS were 2.7 times more likely to gain competitive employment than those who received VRP. Because work is central to recovery, these results should assist stakeholders in planning improved services for veterans with PTSD.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/22307881

Disabilities:

American Indian or Alaska Native

Populations:

Veterans

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

Authors:

Cooper, R. A., Boninger, M. L., Cooper, R., Fitzgerald, S. G., & Kellerher, A.

Year Published:

2007

Publication:

Journal of Rehabilitation Research and Development

Volume:

Number:

Pages:

837-850

Publisher:

United States Department of Veterans Affairs

Background:

A growing body of literature indicates the high prevalence of medical disorders among people with severe mental illness, including cardiovascular disease, tuberculosis, and diseases of the lungs, kidneys, and digestive tract. In addition, substance use is perhaps the most frequently identified co-occurring disorder among psychiatric outpatients. Other common co-occurring disorders include ADHD and cognitive disabilities. Each of these may influence employment outcomes.

Purpose:

The purposes of this study are to (1) examine the effects of co-occurring disorders on employment and earnings; (2) assess the efficacy of a supported employment approach for individuals with severe mental illnesses and co-occurring disorders, and (3) assess the impact of co-occurring disorders on decisions to disclose disability to employers and prospective employers.

Setting:

This study was conducted in eight study sites of the Employment Intervention Demonstration Program (EIDP). The sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.

Sample:

The study sample consisted of 1,273 individuals who were clients of one of the EIDP demonstration sites. Participants were at age 18 and over, with a confirmed diagnosis of severe and persistent mental illness. Individuals were excluded who were working at randomization, were involved in a trial of another intervention, or had no vocational outcome data.

Data Collection:

Data collection consisted of chart review protocol for collecting comorbidity data used in this analysis. Interview assessments with EIDP participants elicited information regarding demographic characteristics, employment history, and other relevant information at the time of study enrollment (baseline) and at 6-month follow-up intervals for 24 months. Vocational data were collected weekly and included job tenure, hours worked, earnings, job characteristics, and workplace disclosure of psychiatric disability. Data analysis included ordinary least-squares regression for the multivariate analysis of interval-level dependent variables and logistic regression for dichotomous outcomes.

Intervention:

The interventions were enhanced best-practices models of supported employment for individuals with severe mental illness. At some sites, the Individual Placement and Support (IPS) was the intervention and at others the Program of Assertive Community Treatment (PACT). Services associated with the IPS include minimal prevocational assessment, rapid job search, placement into competitive jobs, and provision of training and ongoing follow-up supports. PACT interventions are provided exclusively in the community through a mobile team comprising psychiatrists, nurses, case managers, and vocational specialists who collaboratively
place clients in competitive employment and provide job training and continuous employment support.

Control:

Sites elected to use one of two types of control conditions: (1) services-as-usual or (2) a comparison condition that was lacking the active ingredient being-tested in the site experimental condition. The services-as-usual control condition was by whatever services were typically available in the local community.

Findings:

More than half (59.9%) the study participants were reported to have one or more comorbidities. Individuals in experimental conditions had significantly higher employment rates, earnings, and work hours per week. Rates of disclosure were not different between experimental and control conditions. Those with any comorbidity had lower earnings. Those with comorbidities affecting physical functioning had significantly lower employment rates and less work hours than those other or no comorbidities. Individuals with comorbidities affecting both physical and cognitive functioning were more than twice as likely to disclose; individuals with learning disabilities were more than three times as likely to disclose.

Conclusions:

The study findings point to the influence of co-occurring disorders in employment outcomes for individuals with severe mental illness in supported employment. Those in the experimental conditions had better employment outcomes regardless of comorbidities, evidencing the value of supported employment models for this population.

URL:

http://www.worksupport.com/kter/documents/pdf/CookErrectsofCooccuringDisordersonEmployOutcomes1.pdf

Disabilities:

Populations:

Rural

Urban

Outcomes:

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness

Authors:

Cook, J. A., Lehman, A. F., Drake, R., McFarlane, W. R., Gold, P. B., Leff, H. S., ... & Grey, D. D.

Year Published:

2005

Publication:

Archives of General Psychiatry

Volume:

Number:

Pages:

505-512

Publisher:

American Medical Association

Background:

The majority of people with chronic mental illness are unemployed. Research shows that a supported employment (SE) model approach to vocational rehabilitation for people with chronic mental illness establishes SE as an evidence-based practice and more effective than "services as usual or unenhanced services" (p. 505).

Purpose:

This study tested three hypotheses:
1. The experimental group receiving SE services would be better able to to achieve competitive employment than those in the comparison group (work 40 or more hours per month and higher monthly earnings).
2. Differences between experimental and control groups would increase over time
3. experimental group would achieve greater outcomes regardless of demographics and receipt of disability income

Setting:

Eight study sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.

Sample:

People "with severe and persistent mental illness receiving outpatient psychiatric services" (p. 506). Additional requirements included:
- 18 years old
- willing and able to provide informed consent
- unemployed at time of entry into the study

The criteria for "severe and persistent mental illness based on diagnosis, duration, and level of disability as established by the federal Center for Mental Health Services" were met (p. 506). The total number of participants was 1648, and 1273 were included in the study analysis.

Data Collection:

Data were collected at intake and every 6 months for the entire 24-month period using the Positive and Negative Syndrome Scale. In addition, two sites used the DSM-IV at study enrollment, while other sites extracted information from clinical records.

Public disability income beneficiary status was monitored bi-annually, as well as "self-rated level of functioning, marital status, and educational attainment" (p. 507). Sites also collected labor force data, such as weekly earnings and hours worked, job duties, eligibility for health and sick leave benefits, and level of integration in the workplace. Sites reported on amount of vocational and psychiatric services received each month.

Intervention:

Supported employment interventions were offered, which consisted of:
1. integrated services by "a multidisciplinary team that met 3 or more times per week to plan and coordinate employment interventions with case management and psychiatric
treatment" (p. 506)
2. Clients were placed in competitive jobs, which paid at least minimum wage, and were socially integrated (not set aside for people with disabilities)
3. Jobs were developed based on client preferences
4. Job search began as soon as client entered program and moved as rapidly as the client wanted
5. Ongoing vocational supports were readily available throughout the study period (supports did not fade once employment was obtained)

Several sites developed additional interventions, including the Individual Placement and Support model, the Program of Assertive Community Treatment vocational model, as well as services designed to "enrich clients' natural supports" (p. 507).

Control:

Four sites maintained services as usual; 2 sites used a "weaker version" of the experimental condition; and one site compared two pre-existing vocational models.

Findings:

The experimental groups achieved competitive employment (55%), worked 40 hours or more per month (51%), and had significantly higher earnings ($122/month) than the control groups (34%, 39%, and $99/month, respectively). These outcomes increased significantly over time.

Conclusions:

The experimental programs yielded higher and more positive effects than "services as usual" (p. 510). This advantage increased over time.

URL:

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

Disabilities:

Populations: