Emotional disturbance

This article summarizes findings of published articles about EIDP. "For pre-existing models, fidelity was assessed via established measures; the EIDP also developed and administered a cross-site measure of adherence to supported employment principles and practices" (p. 292).

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 counties 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.

Dependent variables were two vocational outcome measures: competitive employment and work for 40 or more hours in a single month. All experimental programs integrated psychiatric treatment and vocational services. An Employment Intervention Demonstration Program measure was developed to operationalize the level of integration. In addition, the effects of the number of hours of psychiatric and vocational services were examined separately. A running cumulative total of service hours for each service was calculated monthly for each of the 24 months of study. Dichotomous variables were used for gender, minority status, and education. Age was measured in 10 year intervals. The structured Clinical Interview for DSM IV was administered at two sites while case records by treating psychiatrist were used at the other sites. Level of functioning was self rated. Receipt of public assistance was reported by the subjects. An evaluation of the Employment Intervention Demonstration Program's protocol found good to excellent validity and reliability on these measures. Of the 1,273 participants, 65% completed five interviews. Those participants were compared to others regarding model covariates. The only significant differences were gender and age. After calculation and inspection of frequency distributions and zero order relationships, outcome were visually inspected. Then random-effects logistic regression modeling, was used to address hypotheses at the multivariate level. All models included: demographics, clinical factors, time and study site.

Researchers performed descriptive univariate analyses for all variables. Researchers were concerned that depression knowledge and attitudes might vary among the work sites, especially among the healthcare industries compared with the non-health care industries. Therefore, researchers examined response differences among company sites. Nevertheless, companies generally were similar in structure, urban location, employee socio-demographics (per general employer-published reports), health care availability, and health care insurance programs. Additionally, most companies were lacking in prior depression awareness-raising programs.

Researchers were also concerned that respondents with a history of depression might have different knowledge, attitudes, and help-seeking behavior than those without a history of depression. Therefore, we examined response differences between those with and without a self-reported depression history.

Field observations revealed none of the participants got lost. A number of scenarios were set up to test the advance functions of the system. An evaluation also took place. The information gained was used to convince job coaches to participate in upcoming trials and give feedback about how to improve the design.

Three analyses were conducted. First, patient characteristics collected at baseline, including illness characteristics and the patient‚ reported relationship with their clinical key worker, were tested as potential predictors of the employment outcomes. Second, early process factors, collected at patient level at the first follow-up interview (T1), when the patient had been in the service for up to 6 months, were tested as potential predictors. Service allocation (IPS v. vocational service) was included as a possible explanatory variable in the early process models, despite the fact that the greater effectiveness of the IPS service had already been demonstrated.7 This was to ensure that it was not confounding any significant associations between other potential predictor variables and employment outcomes. It was not included in the patient characteristics models, as these variables were measured before randomisation. The impact of service as such is not the focus of the current paper. Finally, key characteristics of the services themselves were tested. As the latter were service-level factors, they were tested against the effectiveness of the IPS service at each international centre.

This meta-analytic study used archival data from 4 independent RCTs to determine the magnitude of effects for IPS within specific client subgroups ( by 2 work history, 7 sociodemographic, and 8 clinical variables) on 3 competitive employment outcomes (obtaining a job, total weeks worked, and job tenure).

To determine whether there were any differences between the IPS and vocational service patient groups, a between-group analysis was conducted to compare the 2 on each clinical and social functioning variable at T3, along with whether they had been hospitalized during or were in remission for the last 6 months of the study. Analysis of covariance was used to compare the 2 groups in terms of the clinical and social functioning variables at T3 while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively. These analyses were then repeated for those patients who had worked only. To determine the impact of having worked at any point during the 18-month follow-up period, patients who worked for at least one day (the study‚ primary outcome) were compared with those who did not in terms of each clinical and social functioning variable, along with whether they had been hospitalized during the final 6 months of the study and were in remission for the final 6 months. Analysis of covariance was used to compare the 2 groups (worked/not worked) in terms of the clinical and social functioning variables at T3, while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively.

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.

The service had a comprehensive business information system that tracked all clients throughout the contract. Records of clients(n=49) aged 16–25 years were retrospectively examined. Data analysis was conducted by the team leader using Microsoft Excel 2003, guided by the outcome variables identified from published reports of comparable services. The comprehensive data management system enabled most variables of interest to be reported. Data quality was governed by the contract that required 100% accuracy and supporting evidence for all employment outcomes. All client records were reviewed monthly by an employment specialist, an administrator and by the team leader for the term of the contract. The records were also subject to regular internal review and intensive external auditing as a condition of the contract.