Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services

Authors: 
Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., Barnett, S. D., Cipher, D. J., Lind, L. M., Dixon, T. M., Holmes, S. A., Kerrigan, A. J., & Thomas, F. P.
Year Published: 
2009
Publication: 
The Journal of Spinal Cord Medicine
Volume: 
32
Number: 
5
Pages: 
503-531
Publisher: 
American Paraplegia Society
Background: 

Unemployment is a serious problem for individuals with spinal cord injury (SCI). According to the authors, unemployment for the population of SCI individuals is ten times greater than the general population. In addition, return to preinjury jobs has been reported as very low for this group of individuals.

Purpose: 

The purpose of this study was to provide a comprehensive summary of the literature regarding predictors of employment, the benefits, and barriers.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The sample consisted of 60 articles that reported on employment rate of individuals with spinal cord injury.

Data Collection: 

Authors identified 579 articles and reviewed to determine presence of reported employment rates. Of these, 60 articles were found to include employment rates for individuals with SCI. These articles were reviewed to identify critical factors related to employment after spinal cord injury.

Intervention: 

The intervention was evidence-based supported employment and traditional vocational rehabilitation.

Control: 

There were no comparison or control conditions.

Findings: 

Results indicated that the average rate of any employment after SCI was approximately 35%. The review of literature indicates that there are 11 factors associated with employability of individuals with SCI. This includes education, type of employment, severity of disability, age, time post injury, sex, marital status, social support, vocational counseling, medical problems associated with SCI, employer role, environment, and professional interests. Individuals with college backgrounds are more likely to return to work. Being younger at the time of injury is associated with the best employment outcomes. The probability of employment after SCI improves with increasing time since injury. Race is also associated with obtaining employment after SCI. Individuals who are white are more likely to be employment than those from minorities. Evidence-based supported employment seems to be the most applicable model for assisting individuals with SCI in restoring meaningful employment.

Conclusions: 

Characteristics associated with employment include demographic variables, injury-related factors, employment history, psychosocial issues and disability benefit status. Evidence-based supported employment practices seem to be the most applicable model for assisting individuals with SCI in restoring meaningful employment. Control studies are needed to test this conclusion.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792457/
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Achieving a successful and sustainable return to the workforce after ABI: A client-centered approach

Authors: 
Phillips, V. L., Temkin, A., Vesmarovich, S., Burns, R., & Idleman, L.
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
5
Pages: 
465-478
Publisher: 
Informa Healthcare
Background: 

Acquired brain injury (ABI) can be caused by cerebrovascular accident, trauma (such as assault or motor vehicle accident), tumors, hypoxia, infection or degenerative conditions and is a common occurrence [1]. It may result in significant disability and, in people of working age, limit their ability to join or return to the workforce.

Purpose: 

The aim of this study was to describe the services provided (including assessments, interventions and post-job placement support) and outcomes achieved by CRS Australia‚ Victorian ABI team and compare and contrast this with other models.

Setting: 

The study setting was a rehabilitation service organization in Australia.

Sample: 

The study sample consisted of 27 individuals with ABI who had received rehabilitation services at CRS Australia. The sample was randomly selected from cases that had been closed in the previous year with an employment outcome. Additional characteristics of the sample are not provided.

Data Collection: 

A data extraction method was used to audit patient information relevant to the study. Team members were also asked to indicate which of 17 vocational rehabilitation strategies they used with their clients and to rate each in terms of effectiveness in achieving a successful job placement. which of five post job-placement strategies (email to client, weekly or fortnightly phone calls to client, weekly or fortnightly phone calls to employer, support/counseling outside client‚ work hours and regular scheduled workplace visits) they used and to evaluate their perceived effectiveness.

Intervention: 

The intervention is described as client-centered practice. Each client is allocated to a Rehabilitation Consultant (RC) with whom they work one-to-one, wherever possible, throughout the duration of services. Active client involvement in the negotiation of individual rehabilitation plans is standard practice in all cases and clients are informed of their rights, responsibilities and the complaints handling mechanism at the earliest opportunity. Specific interventions are tailored to the individual and can include vocational counseling, skills training, cognitive retraining, job seeking, interview preparation, work behavior coaching, and post-employment services.

Control: 

There was no control or comparison condition. Outcomes for the study group were compared to those of other models.

Findings: 

Of the patient files audited, 42% were placed in professional, managerial, office or administrative work, two were placed in a trade-qualified job, eight were placed in semi-skilled positions, and four were placed in unskilled labor. Of the clients who had jobs to return to (n=10) all returned to their previous role or a similar job following a graded return with professional/clerical jobs figuring highly (50%; n=5). Those clients who did not have a job to return to (n=17) were placed in similar roles to their pre-injury employment, with seven placed in a professional role, six placed in semi-skilled work and four placed in unskilled labor positions. Half were employed more than 13 weeks.

Conclusions: 

The CRS Australia model resulted in higher than average employment outcome rates for this population (50% working at award wage for more than 13 weeks, compared to Australian ABI population estimates of 28–46.5%). This study shows that the CRS Australia model has been successful with people with mild, moderate and severe impairment following an ABI and significantly less time-intensive and therefore less costly than other models.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17522986
Populations: 
NIDILRR Funded: 
Research Design: 
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: 
39
Number: 
4
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: 
NIDILRR Funded: 
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: 
25
Number: 
3
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: 
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., Markström, U., Svensson, B., Hansson, L., & Sandlund, M.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
38
Number: 
4
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: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational support approaches in autism spectrum disorder: A synthesis review of the literature

Authors: 
Nieuwenhuijsen, K., Bos-Ransdrop, B., Uitterhoeve, L. L. J., Sprangers, M. A. G., & Verbeek, J. H. A. M.
Year Published: 
2014
Publication: 
Autism
Volume: 
1
Number: 
1
Pages: 
1-11
Publisher: 
Sage
Background: 

Individuals with autism spectrum disorder have poor employment outcomes. Those who are employed typically work part time and in low skilled occupations.
The literature cites a number of challenges for individuals with ASD. It also suggest dissatisfaction with existing ASD vocational supports. The few studies that do exist suggest using models that support a person with ASD in the workplace. However little is known about the application of these supports.

Purpose: 

This review of the literature takes a look at the overall state of the vocational support intervention literature related to autism spectrum disorder.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The sample included 10 studies about employment support for adults and youth with autism spectrum disorder.

Data Collection: 

A total of 22,878 studies were retrieved using databases comprised of Cochrane, Scholar's Portal, CINAHL,EMBASE, ERIC, Medline, PsycINFO, Google Scholar, Google, review of key ASD Association websites. All articles identified were reviewed using a 3 state retrieval and synthesis process including: initial screening, strict screening for inclusion or exclusion and data extraction and article review. A conceptual scheme was developed for cross comparison of studies whereby interventions and outcomes were reviewed, analyzed and categorized to a common theme.

Intervention: 

There was no intervention. This is a synthesis based analysis of the literature. It is based on a larger systematic review of intervention studies.

Control: 

There were no comparison or control conditions.

Findings: 

The search led to 22,878 autism related intervention studies. After reviewed using a broad inclusion criteria, the number was reduced to 3974. Of the 3974, 501 targeted individuals 18 and over. These were reviewed for specific elements related to vocational intervention and outcome. In total 10 articles were identified. The following categories were found: supported employment comprising of community placement and jobcoaching (8 studies); technology-related applications including media and online use (2 studies).Of the 10 studies identified four focused on individuals with Asperger's Syndrome, and most include a substantial portion of more cognitively able adults with ASD. The literature focuses on using a supported employment approach with an emerging focus on technology related tools.

Conclusions: 

The vocational literature is not substantial in this area. The existing literature must be reviewed with caution due to its low volume and research design issues. It does offer provisional guidance however, more research is needed.

URL: 
http://www.autismalberta.ca/files/Vocational_Support_Approaches.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effectiveness of vocational rehabilitation following acquired brain injury: Preliminary evaluation of a UK specialist rehabilitation programme

Authors: 
Nachreiner, N. M., Dagher, R. K., McGovern, P. M., Baker, B. A., Alexander, B. H., & Gerberich, S. G.
Year Published: 
2006
Publication: 
Brain Injury
Volume: 
20
Number: 
11
Pages: 
1119-1129
Publisher: 
Informa Healthcare
Background: 

Individuals with Acquired Brain Injury have difficulties with returning to work. Studies show only around 30% returning to work.

Purpose: 

The purpose of the study is to determine the effectiveness of a vocational rehabilitation programme in assisting individuals with Acquired Brain Injury with returning to work or other meaningful activity.

Setting: 

Three Brain Injury Centres based across the United Kingdom.

Sample: 

Participants included 232 individuals with ABI who were discharged from the program between January 2000 and December 2002. The majority were males (82%) and 12% were females. The mean age was 33 years with a range from 17 to 62 years. The majority of injuries were TBI (62%). The date of a person's' injury and enrollment in the programme. ranged from 7 months to 35.5 years. And at the time of injury the majority of individuals has been employed (70%). At the time of entry into the program 92% of the participants were receiving an Incapacity Benefit and regarded as unemployable.

Data Collection: 

Data was gathered using administrative databases and other records located at the three centres. Job roles were classified using the UK standard occupational classification system. Data on outcomes was classified into one of the following: paid competitive work, education and training, voluntary work, discharge to other services, client withdrew and discharged for other reasons.

Intervention: 

Participants engaged in a vocational programme that included a per-vocational rehabilitation phase that provided intensive basic cognitive rehabilitation and in-site vocational trails phase. Afterwards, a supported job search and job coaching was offered to assist individuals with gaining work along with follow up support for up to 5 years.

Control: 

There was no control or comparison condition.

Findings: 

Upon exiting the programme, 41% of the participants had secured paid competitive employment; 16% were volunteering and 15% had entered a training or education. Among the remaining 28%, 15 % were discharged due to medical or rehabilitation programmes to deal with other issues and 13% withdrew. There was no formal cost analysis of the effectiveness of the intervention.

Conclusions: 

A total of 72% of those enrolled in the programme left to start a meaningful activity with 41% securing work. Vocational rehabilitation seems effective in assisting individuals with ABI with returning to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17123928
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: 
7
Number: 
2
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: 

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: 

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: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The Hartford study of supported employment for persons with severe mental illness

Authors: 
Murphy, L., Chamberlain, E., Weir, J., Berry, A., James, D. N., & Agnew, R.
Year Published: 
2004
Publication: 
Journal of Consulting and Clinical Psychology
Volume: 
72
Number: 
3
Pages: 
479-490
Publisher: 
American Psychological Association
Background: 

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).

Purpose: 

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.

Setting: 

The setting included community mental health center in Hartford, Connecticut. The psychosocial rehabilitation program was located off-site. Standard services were offered off-site.

Sample: 

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).

Data Collection: 

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.

Intervention: 

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.

Control: 

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.

Findings: 

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.

Conclusions: 

The Individual Placement and Support model was the most effective at retaining clients and improving employment outcomes.

URL: 
http://www.worksupport.com/kter/documents/pdf/TheHartfordStudyofSupportedEmployment.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Ex-post-facto analysis of competitive employment outcomes for individuals with mental retardation: National perspective

Authors: 
Morgan, L., Leatzow, A., Clark, S., & Siller, M.
Year Published: 
2004
Publication: 
Mental Retardation
Volume: 
42
Number: 
4
Pages: 
253-262
Publisher: 
American Association on Mental Retardation
Background: 

Employment outcomes have often been used as a benchmark of vocational rehabilitation success. Not until the Rehabilitation Act of 1973, were states required to target individuals with significant disabilities for services using an order of selection process. Because of the functional differences that exist between individuals with mild, moderate and significant cognitive disabilities, rehabilitation counselors must be aware of the types of services most needed and those services that more often result in high quality employment outcomes for each target group.

Purpose: 

The purpose of this study was to provide a snapshot to generate new knowledge that rehabilitation counselors can apply to enhance competitive employment outcome placements for individuals of varying abilities. In addition, the purpose of the study was to identify disparities in the proportions of competitive job placements between individuals with mild, moderate, and significant cognitive disabilities.

Setting: 

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

Sample: 

The study sample included all consumers with cognitive disabilities closed into Status 26 during fiscal year 1998 in the RSA-911 national database maintained by the Rehabilitation Services Administration. This included a total of 28,565 consumers: mild (n = 17,033, 60%), moderate (n = 9,784, 34%), severe/profound (n = 1,748, 6.1%).

Data Collection: 

The data was obtained from the individual client closure reports and RSA-911 national data tape, provided by the Rehabilitation Services Administration (RSA). The authors used two tests of statistical significance: chi-square and logistic regression analysis. Chi-square analysis was conducted for type of mental retardation and work status at closure. In addition the authors conducted a post hoc pairwise comparisons (2 x 2 chi-square) for mild by moderate, mild by severe/profound and moderate by severe/profound. To guard against Type I errors, the authors used the Bonferroni technique, which resulted in an adjusted alpha of .003. Then, the authors used logistic regression analysis to evaluate the linear relationship between vocational rehabilitation services and work status at closure. Then, chi-square tests were used to evaluate the proportions of significant vocational rehabilitation services received by consumers with mild, moderate, or severe/profound cognitive disabilities. Then, the relationship between type of cognitive disability and work status at closure were evaluated for consumers who received vocational rehabilitation services. Those consumers who had not received VR services were then eliminated from the sample. The desktop version of SPSS for Windows, version 11.5 was used in this analysis.

Intervention: 

The intervention was vocational rehabilitation services.

Control: 

There was no control or comparison condition.

Findings: 

The majority of the individuals in the population were Caucasian (73%). Assessment, adjustment, counseling, job-finding services, and job-placement services were received by 81%, 34%, 78%, 60% and 58%, respectively. Analysis of the data found that 8%5 of the participants were closed into competitive jobs following vocational rehabilitation intervention. Consumers with mild mental retardation were significantly more likely to achieve competitive jobs when compared to those with moderate or severe/profound cognitive disabilities. In addition, individuals with moderate cognitive disabilities were significantly more likely to be placed into competitive jobs compared to those with severe/profound disabilities. The odds of obtaining competitive employment for consumers who received job placement services was 2.05 times the odds for those not receiving those services. The odds of obtaining competitive employment for consumers who received counseling were 1.52 times the odds of those who did not receive counseling. The odds of obtaining competitive employment for consumers who received business and vocational training were 2.14 times the odds of those who did not. However, consumers with mild mental retardation were provided with business and vocational training at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. Consumers with moderate mental retardation were no more likely to receive counseling services than those with mild cognitive disabilities. However, consumers with severe/profound cognitive disabilities were less likely to receive counseling services than those with mild/moderate disabilities. Consumers who received job placement services with mild cognitive disabilities achieved competitive jobs at a significantly higher proportion than those with moderate or severe/profound mental retardation. In addition, consumers with moderate cognitive disabilities were significantly more likely to achieve competitive jobs than individuals with severe/profound disabilities. Consumers with mild cognitive disabilities who received business and vocational services achieved competitive jobs at a significantly higher proportion than those with moderate and severe/profound cognitive disabilities. Consumers with mild disabilities who received counseling achieved competitive jobs at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. In addition, consumers with moderate cognitive disabilities were more likely to achieve competitive employment when compared to consumers with severe/profound disabilities.

Conclusions: 

Consumers with Moderate or severe/profound cognitive disabilities were closed into competitive employment at a significantly lower rate than those with mild cognitive disabilities. Consumers who were provided with business and vocational training, counseling, and job-placement services were significantly more likely to achieve competitive jobs. A significantly lower proportion of these services were provided to consumers with severe/profound cognitive disabilities.

The authors concluded that the significantly higher proportion of consumers with mild cognitive disabilities achieving competitive employment could be related to the specific services they more often receive. Perhaps consumers with mild disabilities are more likely to be provided job-placement services as opposed to those with severe/profound cognitive disabilities. The authors ask the questions: Why do consumers with mild or moderate cognitive disabilities more likely to receive job placement and counseling services compared to those with severe/profound disabilities? They propose that too much attention may be given to assessment/testing results and other nonrelevant dimensions that could prohibit the provision of effective services. They also propose that there may be a subjective belief that places a lesser value on the overall potential of individuals with significant cognitive disabilities. Counselors may believe that consumers with severe/profound cognitive disabilities are more difficult to place. Their expectation of successful employment outcomes may result in less significant placement efforts for this population.

The authors state that their findings raise questions that could not be answered through the RSA-911 database. The database does not provide information on reasons for the provision of certain services to consumers with mild, moderate, or severe/profound cognitive disabilities. The database does not contain information on Counselors' perceptions of service effectiveness or how they provide the specific services. Finally, the small proportion of individuals with severe/profound cognitive disabilities raises an important question about the decision-making process counselors use to determine if a consumer can benefit from vocational rehabilitation services.

URL: 
https://www.ncbi.nlm.nih.gov/pubmed/15230653
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes