Disparities in job placement outcomes among deaf, late-deafened, and hard-of-hearing consumers

Authors: 
Moore, C. L., Harley, D. A., & Gamble, D.
Year Published: 
2001
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
44
Number: 
3
Pages: 
144-150
Publisher: 
Hammill Institute on Disabilities
Background: 

There is an emphasis placed on vocational rehabilitation programs to deliver high-quality employment outcomes. Competitive jobs allow VR consumers to acquire transferable skills as well as to earn higher wages.

Purpose: 

The purpose of this study is to provide state VR agencies a national benchmark to compare rates at which consumers who are deaf, late-deafened, and hard-of-hearing achieve competitive jobs and to compare rates at which these target groups are provided with specific types of VR services.

Setting: 

This study included individuals who are deaf, late deafened and hard of hearing served by multiple vocational rehabilitation agencies in various settings.

Sample: 

RSA-911 data on all VR consumers who were identified as deaf, late-deafened, and hard-of-hearing during fiscal year 1997 and closed successfully in status 26. (15,248 individuals)

Data Collection: 

RSA-911 national data tape. Chi-square and logistic regression analyses.

Intervention: 

VR services including assessment, restoration, college or university training, adjustment, on-the-job training, counseling, job-finding services, job placement, transportation, and maintenance.

Control: 

There was no control or comparison condition.

Findings: 

A significantly greater proportion of VR consumers who are deaf achieve competitive jobs than of consumers who are late-deafened and hard-of-hearing. Consumers who were deaf were provided with significantly more college/university training, business and vocational training, on-the-job training and job placement than consumers were were late-deafened and hard-of-hearing.

Conclusions: 

Consumers who were late-deafened and hard-of-hearing were not provided with effective training and with job placement services at the same rate as consumers who were deaf. Some VR counselors may have assumed that consumers who are late-deafened and hard-of-hearing were less likely to benefit from such services. VR counselors may want to inform consumers of the availability of such services.

URL: 
http://rcb.sagepub.com/content/44/3/144.short
Disabilities: 
Hearing impairments
Populations: 
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
Yes
Research Design: 
Observational
Peer Reviewed: 
Yes

Predictors of employment and postsecondary education of youth with autism

Authors: 
Moore, C. L.
Year Published: 
2012
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
55
Number: 
3
Pages: 
176-184
Publisher: 
Sage
Background: 

The increasing numbers of students diagnosed with autism spectrum disorders (ASD), exiting school an seeking Vocational Rehabilitation (VR) services has sparked interest in research of predictors of employment success.

Purpose: 

The purpose of this study was to identify predictors or employment success for students with ASD who use VR services in transition from school to adulthood. Predictors included both demographic and specific VR service categories.

Setting: 

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

Sample: 

The study sample consisted of 2,913 youth and young adults who received VR services during the transition period from school to adulthood. Ages at application for services ranged from 16 to 26, and none were employed at application.

Data Collection: 

Data collection for the RSA 911 data system is initiated at the time of application and ends at case closure. The system includes client demographic variables, service delivery variables, and outcome variables. Stepwise backward binary logistic regression was used to test the relationships between the predictors and the outcomes that were measured as categorical variables integrated employment and postsecondary education improvement.

Intervention: 

Interventions were the following service categories used in the VR RSA 911 data set: Assessment, counseling and guidance, job readiness training, job search, job placement, on-the-job supports, college, miscellaneous training, and other services.

Control: 

There was no control or comparison condition.

Findings: 

The odds of achieving competitive employment were greater for youth who received job placement services. However, only 48% of youth with ASD received this service. In addition, postsecondary education was among the strongest predictors of better earnings, yet only 10% of youth received college services.

Conclusions: 

The study's findings provide evidence that job placement services and college services can improve employment outcomes for youth with autism. They recommend that VR agencies offer those services to more youth with autism.

URL: 
http://www.worksupport.com/kter/documents/pdf/Migliore2012.pdf
Disabilities: 
Autism Spectrum Disorder
Populations: 
Transition-age youth (14 - 24)
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes

One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare

Authors: 
Michalak, E., Yatham, L., Maxwell, V., Hale, S., & Lam, R.
Year Published: 
2003
Publication: 
Evaluation Review
Volume: 
27
Number: 
6
Pages: 
656-680
Publisher: 
Sage
Background: 

Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.

Purpose: 

The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.

Setting: 

Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.

Sample: 

The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.

Data Collection: 

Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.

Intervention: 

The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.

Control: 

There was no control or comparison condition. The study used a pre/during/post intervention design.

Findings: 

Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.

Conclusions: 

Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.

URL: 
http://erx.sagepub.com/content/27/6/656.full.pdf
Populations: 
Female
Hispanic or Latino
Black / African American
White / Caucasian
Rural
Outcomes: 
Employment acquisition
Increase in hours worked
NIDILRR Funded: 
Not Reported
Research Design: 
Single group
Peer Reviewed: 
Yes

Work, recovery and comorbidity in schizophrenia: A randomized controlled trial of cognitive remediation

Authors: 
McHugo, G., Drake, R., & Becker, Dl.
Year Published: 
2009
Publication: 
Schizophrenia Bulletin
Volume: 
35
Number: 
2
Pages: 
319-335
Publisher: 
Oxford University Press
Background: 

A common theme that cuts across all definitions of recovery is work. Work is valued by most and it enables on to make a contribution to society and offers the promise of liberating consumers from financial dependence on others. In recent years, a recovery paradigm has emerged that offers a guiding vision for self-empowerment, treatment, and rehabilitation for individuals with schizophrenia and comorbid problems such as: cognitive impairment,9 substance abuse,10 and medical disorders. This study addressed the impact of comorbidity on recovery of work functioning and response to vocational rehabilitation, described strategies for minimizing its effects, and provided data from a new study targeting the problem of cognitive impairment in order to improve employment outcomes.

Purpose: 

The purpose of the study is to evaluate the impact of adding cognitive remediation to vocational rehabilitation to determine the impact on comorbid substance abuse and medical disorders on work outcomes and response to the treatment program.

Setting: 

The study took place in a vocational rehabilitation program associated with an urban medical center.

Sample: 

The study included 34 participants who were 18 years or older, had severe mental illness, expressed an interest in work, had a history of being fired or quitting employment prior to locating new work. Participants received either vocational rehabilitation plus cognitive retraining or Vocational rehabilitation only.
In both groups, the majority of subjects were male (61% and 56%) black (61% and 63%) and had never been married (78% and 75%). The primary diagnosis was Schizophrenia (75% and 60%) and most had a comorbid disorder (67% and 81%). The mean age of the group members was (46 and 42 years).

Data Collection: 

Referrals were made by therapists and work services personnel. Those interested had a baseline assessment scheduled. Consumers were not paid for assessments. Following completion of the assessments, consumers were randomized to either vocational rehabilitation alone (VR) or vocational rehabilitation and cognitive remediation (VR and CR)using a computer program. The examiners compared the groups at baseline on the demographic, clinical, and cognitive measures using t-tests (continuous variables) and v2 analyses (categorical variables). Next they computed the percentage of consumers who were exposed to the cognitive remediation program, as completing 6 or more cognitive remediation sessions, the average number of sessions completed, and the number of weeks to complete them.

Then to evaluate changes over the treatment period in cognitive functioning and clinical variables, they performed a series of analyses of covariance (ANCOVAs), with the cognitive/symptom measures at posttreatment as the dependent variables, the cognitive/ symptom measures at baseline as the covariate, and treatment group as the independent variable. Finally they looked at work outcomes. Because continuous work outcomes were highly positively skewed, main treatment effects were evaluated by performing Mann-Whitney U tests comparing the 2 treatment groups on wages earned and hours and weeks worked. To evaluate whether substance abuse directly influenced vocational outcomes or interacted with treatment group, separate analyses were performed for current drug-use disorder and alcohol-use disorder. For these analyses, the work variables were log transformed to minimize skew. For each series of analyses, analysis of variance were performed with current drug-use disorder (or current alcohol-use disorder), treatment group, and their interactions as the independent variables and the work outcomes as the dependent variables. The main effect for drug-use disorder (or alcohol-use disorder) in these analyses was a test of whether the disorder had an overall impact on vocational outcomes, whereas the drug-use disorder (or alcohol-use disorder) by treatment group interaction effect was a test of whether the outcomes of the treatment groups differed significantly as a function of the disorders.

Intervention: 

The intervention was adding cognitive remediation to a hybrid vocational rehabilitation program that combined paid internship jobs with supported employment.

Control: 

Participants were randomly assigned to either vocational rehabilitation alone or vocational rehabilitation and cognitive remediation using a computer-generated randomization program.

Findings: 

Statistical tests comparing consumers assigned to VR only or VR and CR indicated no significant differences in any demographic, diagnostic, or baseline clinical or cognitive performance measures.

The results of the ANCOVAs comparing changes over time in cognitive functioning and symptoms between consumers who received cognitive remediation and those who did not were summarized. Significant improvements favoring cognitive remediation were found for several cognitive measures. Results of the Mann-Whitney U tests comparing work outcomes for the 2 groups indicated that the VR and CR group worked significantly more internship weeks and hours and earned more wages than the VR-only group.

The VR and CR group also worked significantly more weeks than VR only, and there was a trend for them to earn more wages, although hours
worked did not differ between the groups. Number of weeks or hours of competitive work did not differ between the 2 groups nor did wages earned. Overall rates of competitive rates were 39% for the VR and CR group vs 31% for the VR-only group, which did not differ significantly. Analyses of relationship of substance-abuse disorder and medical comorbidity focused on total (log transformed) hours worked for each vocational outcome. Alcohol-use disorder was marginally significantly related to total hours worked with the absence of current alcohol-use disorder associated with more hours worked compared with the presence of an alcohol-use disorder. Drug-use disorder was also related to total hours worked, with absence of current drug-use disorder associated with more hours worked compared with the presence of a drug-use disorder.

There were no interactions between either alcohol or drug-use disorder and treatment group, suggesting that the addition of cognitive remediation to vocational services was just as helpful in the consumers with a substance-use disorder as those without. A similar analysis of total hours worked comparing consumers with high levels of medical comorbidity to those with low levels indicated that both the main effect for medical comorbidity and the interaction with treatment group were not significant. Thus, consumers with higher medical comorbidity burden appeared to have comparable vocational outcomes compared with those with less such burden. For the VR-only group, Spearman correlations between overall cognitive performance at baseline and total work over the study period were significant for total hours worked and wages earned and marginally significant for number of weeks worked, whereas for the VR and CR group, none of these correlations were significant Thus, cognitive performance at baseline was more predictive of work in the study for those in the control group than those in the cognitive remediation group.

Conclusions: 

Providing cognitive remediation in addition to vocational rehabilitation can improve cognitive functioning and employment outcomes for individuals with severe mental illness. Comorbid substance abuse impacts work outcomes while medical comorbidity does not. More research is needed to evaluate the impact of comorbidity and their interaction on treatment. More research is needed to evaluate the impact of comorbidity on work functioning in VR and its interaction with cognitive remediation.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19269925
Disabilities: 
Emotional disturbance
Populations: 
Hispanic or Latino
American Indian or Alaska Native
Asian
Black / African American
Male & Female
Outcomes: 
Employment acquisition
Return to work
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
Peer Reviewed: 
Yes

Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment

Authors: 
McGurk,S., R., Mueser, K. T., DeRosa, T., J., & Wolfe, R.
Year Published: 
2003
Publication: 
Psychiatric Services
Volume: 
54
Number: 
8
Pages: 
1129-1135
Publisher: 
American Psychiatric Association
Background: 

Although previous research has indicated that symptoms and cognitive functioning are related to employment outcomes for clients with severe mental illness, few studies have examined the relationship between these client factors and outcomes in supported employment programs.

Purpose: 

This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program.

Setting: 

Study sample received outpatient services at a state hospital. Research team was based at Mount Sinai School of Medicine, New York, New York.

Sample: 

The study participants were 30 clients with schizophrenia or schizoaffective disorder who are receiving outpatients services at a state hospital. The clients diagnoses were made by a member of the research team on the basis of clinical interviews with the Comprehensive Assessment of Symptoms and History and information form the clients charts.

Data Collection: 

Data for the study included work outcomes, an analysis of demographic and other background predictors of work outcomes, the degree of change in clients' symptom severity and cognitive functioning over the year follow up period, and an analysis of symptom and cognitive predictors of work outcomes. Final analysis was on the relationship of symptoms and cognitive functioning with utilization of supported employment services by the clients who obtained competitive employment.

Intervention: 

The program provided at the hospital's outpatients clinics was based on the individual placement and support employment model. At entry into the program, each client was assigned an employment specialist who provided all components of supported employment, including assessment, assistance with job search, and job support. Each employment specialist functioned as a member of the client's interdisciplinary team. The supported employment program provided follow along as needed for an unlimited time, including both on- and off-site support, depending on the client's needs or preferences.

Control: 

There was no control or comparison condition.

Findings: 

Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms.

Conclusions: 

Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.

URL: 
http://schizophreniabulletin.oxfordjournals.org/content/31/4/898.short
Disabilities: 
Emotional disturbance
Populations: 
Hispanic or Latino
Black / African American
White / Caucasian
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Quasi-experimental
Peer Reviewed: 
Yes

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial

Authors: 
McGurk, S. R., Mueser, K. T., & Pascaris, A.
Year Published: 
2007
Publication: 
American Journal of Psychiatry
Volume: 
164
Number: 
3
Pages: 
437-441
Publisher: 
American Psychiatric Publishing
Background: 

Supported employment has been repeatedly demonstrated to improve competitive work outcomes in people with severe mental illnesses such as schizophrenia and bipolar disorder (1). Although strong research supports the effectiveness of supported employment, and efforts are underway to increase access to these programs (2, 3), not all participants benefit from supported employment. Specifically, across most studies between 20% and 40% of patients do not find jobs (4–8), and of those who do, many have brief job tenures that end unsuccessfully, such as being fired for poor work performance. These findings have stimulated efforts to address illness-related impairments that may limit the effectiveness of supported employment for some individuals with severe mental illness.

Purpose: 

To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.

Setting: 

The setting was supported employment programs and various places of employment.

Sample: 

The sample included patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City. The eligibility criteria was severe mental illness as by the State of New York Office of Mental Health, current unemployment, desire for employment, enrollment in supported employment, history of at least one unsatisfactory job ending (getting fired from a job held less than 3 months or walking off a job without another job in place), and willingness and capacity to provide informed consent.

Data Collection: 

Employment outcomes were aggregated by computing the total number of jobs, hours worked, and wages earned over the entire follow-up period. Potential interactions between site, treatment group, and work were evaluated by performing an analysis of variance (ANOVA), with site and treatment group (supported employment with cognitive training or supported employment alone) as the independent variables and the total number of jobs worked as the dependent variable. A chi-square analysis was conducted to compare the two treatment groups on percentage of patients who obtained work over the course of the follow-up period. Additional analysis was also done to address a variety of data factors.

Intervention: 

Patients with severe mental illness N=44 and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2–3 years.

Control: 

The comparison condition was supported employment only.

Findings: 

Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2–3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone.

Conclusions: 

The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.

URL: 
http://www.coalitionny.org/the_center/resources/cognitive_remediation/documents/CogTrainingAmJPsychiatry0307.pdf
Disabilities: 
Emotional disturbance
Populations: 
Hispanic or Latino
Asian
Black / African American
White / Caucasian
Male & Female
Outcomes: 
Employment acquisition
Increase in hours worked
Increase in tenure
Return to work
Wages
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
Peer Reviewed: 
Yes

Service intensity as a predictor of competitive employment in an individual placement and support model

Authors: 
McGurk, S. R., Mueser, K. T, Feldman, K., Wolfe, R., & Pascaris, A.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
9
Pages: 
1066-1072
Publisher: 
Psychiatric Services
Background: 

Research has been done on supported employment for people with psychiatric disorders; however, little of it has been focused "on variables that moderate the relationship between service intensity and vocational outcomes" (p. 1067)

Purpose: 

The study reviewed "four aspects of service intensity in a supported employment program" (p. 1067):
1. Average level of service intensity
2. Association between service intensity and weeks worked
3. Individual demographics and clinical variables associated with service intensity
4. Individual characteristics that moderate the relationship between service intensity and weeks worked

Setting: 

The setting included 2 Psychiatric Rehabilitation Centers located in Chicago, Illinois.

Sample: 

The sample was made up of 96 participants in the IPS group and 98 in the diversified placement approach group. Participants were randomly assigned to the two groups, and 5 discontinued IPS services within the first 3 months, which reduced the sample size for IPS to 91.

Data Collection: 

The intervention group was enrolled between 1999 and 2002, while data collection continued until 2004. Data were obtained from Threshold PsychServe system and were measured in terms of hours of support. Clients were also completed a survey, which included demographics, as well as a self-report of number of weeks worked and number of years since last employment.

The Positive and Negative Syndrome Scale was administered, as well as the number of lifetime hospitalizations and diagnosis (using DSM-IV). These were collected at baseline.

Data were analyzed using SPSS 11.0 for Windows and Hierarchical Linear Modeling. Zeroes were recorded for participants' IPS contacts for quarters when they dropped IPS.

Hypotheses were tested by totaling variables across the entire study and conducting hierarchical linear modeling regressions, as well as examining the data longitudinally by using the hierarchical linear model.

Intervention: 

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

Control: 

The comparison condition was the Diversified Placement Approach.

Findings: 

Forty-eight participants continued IPS services for the entire two years. People who dropped out did not differ from those who continued on either demographics or clinical variables.

IPS services and mental health services declined over time; therefore, the intensity of IPS services was positively correlated with mental health services. The number of IPS contacts in one quarter was positively associated with the number of weeks worked in the following quarter.

Conclusions: 

Increasing ISP services intensity may improve employment outcomes.

URL: 
http://www.worksupport.com/kter/documents/pdf/ServiceIntensityasaPredictor.pdf
Disabilities: 
Emotional disturbance
Populations: 
Hispanic or Latino
Black / African American
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Mixed methods
Peer Reviewed: 
Yes

Work, rehabilitation and mental health

Authors: 
McGuire, A. B., Bond, G. R., Clendenning, D. R., & Kukla, M.
Year Published: 
2000
Publication: 
Journal of Mental Health
Volume: 
9
Number: 
2
Pages: 
199-210
Background: 

Unemployment rates are high for individuals with psychiatric problems. Not working also has a negative impact on mental health. New services have evolved to assist people with mental health problems with employment particularly in the United States. The United Kingdom is moving in this direction. A key player is Northern Ireland which provides Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services for people with mental health issues.

Purpose: 

This study evaluated the ACCEPT services for individuals with mental health problems during their first 12 to 18 months of operation.

Setting: 

The setting included four ACCEPT centers.

Sample: 

Sixty three people participated in the study. Demographic data was presented on 74 who started the study but later 11 dropped out. Those data indicate about half or 53% were female. Mean age for men was 38 and women 36 years. Forty three percent of the men were single, and 41% of the women. A little over half of the men or 51% had a primary diagnosis of neurotic depression. The majority or 44% of the women had the same diagnosis.

Data Collection: 

An ACCEPT intake form provided a profile of the trainees. The Lancashire Quality of Life Profile was used to obtain information on perceived quality of life. A Goal Attainment Form documented the trainees top five goals or objectives. Participant views about ACCEPT quality of services was gained using an Client Evaluation Form. A Stakeholder Questionnaire was also used. T-Tests were used to examine pre and post training differences in the mean LSS scores.

Intervention: 

The intervention was Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services. It includes a combination of psychosocial rehabilitation and job training.

Control: 

There was no control or comparison conditions. The study used a pretest/posttest design.

Findings: 

Pre and post training assessment revealed improvements in the participants satisfaction with employment status, religion and purpose of life, social relationships and overall well being. Minor psychiatric problems also decreased after training. Participants reported positive views about ACCEPT services. At the close of the study around 50% of the participants were employed or either engaged in volunteer work or a work experience.

Conclusions: 

Mental health professionals play and important role in work oriented programs. Interagency collaboration is critical. These types of programs can contribute to therapeutic outcomes for individuals with mental health problems.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/09638230050009195
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Single group
Peer Reviewed: 
Yes

Analyzing vocational outcomes of individuals with psychiatric disabilities who received state vocational rehabilitation services: A data mining approach

Authors: 
Roush, S.
Year Published: 
2007
Publication: 
International Journal of Social Psychiatry
Volume: 
53
Number: 
4
Pages: 
357-368
Publisher: 
Sage
Background: 

Poor vocational rehabilitation outcomes are seen for those with psychiatric disabilities; 80% to 85% are unemployed nationally. The authors claim that a lack of research into vocational rehabilitation services and outcomes is the cause for the high unemployment rates.

Purpose: 

The purpose of the study is to examine factors that affect vocational outcomes in the vocational rehabilitation process for people with psychiatric disabilities who received state Vocational Rehabilitation (VR) services.

Setting: 

The Rehabilitation Services Administration FY 2001 Case Service Report (RSA-911)was analyzed using data mining. This study included individuals with psychiatric disabilities served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Participants in the study included only individuals who had a status code of 26 (working) or status code of 28 (not working).

Data Collection: 

The Exhaustive Chi-Square Automatic Interaction Detector (CHAID) data mining technique was used. The technique requires the use of categorical values; therefore, age and education (continuous variables) were recoded into categories. Decision trees "were used to generate rules for the classification of this dataset" (p. 360). SPSS AnswerTree 2.0 statistical software was used for the data analysis.

Intervention: 

The independent variables were: gender, age, race, severity of disability, education, benefits, rehabilitation services provided.

Control: 

The dependent variable included were the status codes 26 or 28.

Findings: 

Those who were receiving job placement and counseling services, did not receive any government benefits, attended special education in high school, graduated from high school or had college experience, and received comprehensive assessment and vocational training were the most likely to be employed. Those who did not receive job placement services but did receive counseling, restorative and transportation services, and government benefits were the most likely to remain unemployed.

Conclusions: 

An increase in the number of persons diagnosed with a psychiatric disability is expected as services are provided by public rehabilitation services rather than community-based services. Rehabilitation professionals should be made aware of the unique challenges and trained in the use of the Individual Placement and Support model.

URL: 
http://www.worksupport.com/kter/documents/pdf/AnalyzingVocationalOutcomes.pdf
Disabilities: 
Emotional disturbance
Populations: 
Male & Female
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Observational
Peer Reviewed: 
Yes

The effects of primary care depression treatment on patients' clinical status and employment

Authors: 
Schonebaum, A., Boyd, J., & Dudek, K.
Year Published: 
2002
Publication: 
Health Services Research
Volume: 
37
Number: 
5
Pages: 
1145-1158
Publisher: 
John Wiley & Sons, Inc.
Background: 

Effective treatment of depression could thus have major public health benefits. Yet despite availability of efficacious treatments, that is, antidepressant medications and psychotherapies, and of national practice guidelines, rates of appropriate treatment for depression remain low nationally, particularly in primary care where only about a quarter of depressed patients receive appropriate care.

Purpose: 

The goal of this study was to evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.

Setting: 

The study was conducted in six diverse, non academic managed primary care organizations. Forty-six of 48 primary care practices and 181 of 183 clinicians participated. Practices were matched into blocks of three clusters, based on factors that might affect baseline quality of care or intervention response: clinician specialty mix, distribution of patient socioeconomic and demographic characteristics, and presence of onsite mental health clinicians.

Sample: 

Study staff screened 27,332 consecutive patients in participating practices over five to seven months. Patients were eligible if they intended to use the clinic during the next twelve months and screened positive for depression, using items from the World Health Organization's twelve-month Composite International Diagnostic Interview. Patients were positive if they reported at least one week of depression in the last 30 days, plus two weeks or more of depressed mood or loss of interest in pleasurable activities or persistent depression over the year.

Data Collection: 

Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.

Intervention: 

Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. One intervention supported the same nurses to provide six or twelve months of medication follow-up (randomized at the patient level) through telephone contacts or visits, and the other intervention trained local therapists in group and individual Cognitive Behavioral Therapy. These therapists were available to intervention patients at reduced copay. All patients could have other types of psychotherapy for usual copays.

Control: 

Usual care practices only received written depression treatment guidelines by mail. In all intervention conditions, patients and providers made their own treatment decisions and use of intervention resources was optional.

Findings: 

At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.

Conclusions: 

Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464020/
Disabilities: 
Emotional disturbance
Populations: 
Hispanic or Latino
Black / African American
White / Caucasian
Outcomes: 
Employment acquisition
NIDILRR Funded: 
No
Research Design: 
Randomized Controlled Trials (RCTs)
Peer Reviewed: 
Yes