An innovative job placement model for unemployed methadone patients: A randomized clinical trial

Authors: 
Major, B. S., Hinton, M. F., Flint, A., Chalmers-Brown, A., McLoughlin, K., & Johnson, S
Year Published: 
2007
Publication: 
Substance Use and Misuse
Volume: 
42
Number: 
5
Pages: 
811-828
Publisher: 
Informa Healthcare
Background: 

Methadone treatment patients, have had poorer employment outcomes than other substance users. Employment may enhance clinical outcomes for this group by reducing rates of relapse, criminality, and parole violation. Work is also associated with lower rates of drug use during treatment, as well as longer retention in treatment. Substance users have been eliminated and federal welfare reform legislation. Substance users in treatment must achieve work readiness in specific time frames. Traditional vocational services for substance users, including methadone treatment patients, have had limited positive results. Innovative vocational interventions or programs are needed to assist this group with employment.

Purpose: 

The hypothesis of this study was that patients assigned to the experimental Customized Employment Support model condition would have better employment outcomes
than those assigned to a control condition who received standard vocational counseling.

Setting: 

The study was implemented at two sites in Manhattan. One is a free-standing methadone clinic operated by Greenwich House, a nonprofit social services agency. The other methadone clinic is operated by Harlem Hospital but is located separately from the hospital.

Sample: 

The data was collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. *(Note this is a follow up to the study by Staines, Blankertz, Magura et al 2004) The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years.

Data Collection: 

The study collected data on patient employment and behaviors from the following sources: personal interviews, vocational activities log and employment documentation. Employment measures drew on and integrated information from these sources. The major employment outcome was the attainment of a paid job.
To provide a single overall index of vocational outcomes, they were combined into a four-level, ordinal measure of highest level of vocational attainment:
1. Attained a competitive job (highest).
2. Attained an informal job.
3. Performed constructive activity other than paid employment.
4. None of the above (lowest).
CES counselors left during the study period. Patients who received no counseling (N=24) were excluded from this sample. The interview follow up rate for follow up at 12 months was 91%. The main analytical technique was multiple logistic regression with statistical significance set at p < .05 (2-tailed). Vocational intervention condition was introduced into the analysis as an indicator variable (CES=1, standard=0). The statistical control for period of intervention, as described above, is also an indicator variable (earlier cases = 1, later cases = 0). All analyses of employment outcomes included the baseline measure of the outcome variable as a covariate. Since the study had no dollar measure of earnings prior to baseline, work in the prior 6-month period was used as the covariate in the analysis of earnings as an outcome. Patient baseline variables were examined to determine whether any were significantly associated with both an employment outcome and vocational intervention assignment (CES vs. standard counseling); none were. Thus, none of these variables was a potential confounder in the regression analysis. Work in the pre-study period was included as a covariate in the multivariate analysis, however, to enable the potential independent effect of the CES intervention on employment outcomes to be determined.

Intervention: 

The intervention, the Customized Employment Supports (CES) model, is designed to help patients overcome these employment barriers and attain paid work as soon as possible. The model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients and enhance their self-efficacy. Methods used to help patients increase their self-efficacy include role modeling, persuasion, and minimizing emotional arousal.

Control: 

Participants were randomized into intervention and control groups.

Findings: 

The results supported the hypothesis for two measures of employment; i.e., the Customized Employment Support group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings.

Conclusions: 

Vocational rehabilitation services for unemployed methadone patients can be improved by implementing a Customized Employment Support model.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17613946
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Enhanced cognitive behavioral therapy for vocational rehabilitation in schizophrenia: Effects on hope and work

Authors: 
Macias, C., Rodican, C. F., Hargreaves, W. A., Jones, D. R., Barreira, P. J., & Wang, Q.
Year Published: 
2005
Publication: 
Journal of Rehabilitation Research & Development
Volume: 
42
Number: 
5
Pages: 
673-682
Publisher: 
Department of Veteran Affairs
Background: 

Many unemployed or disabled adults with schizophrenia spectrum disorders wish to work again yet doubt their ability to succeed. As the result of factors including stigma, practitioners' negative expectations, and the deficits associated with severe mental illness, many with schizophrenia spectrum disorders view themselves as being minimally competent, of low social value, and possibly beyond help. They may believe that they have little ability to influence their lives and construct a personal narrative in which they expect social and vocational failure.

Purpose: 

To address the effects of dysfunctional cognitions on vocational outcome of people with schizophrenia spectrum disorders, the Indianapolis Vocational Intervention Program, a cognitive-behavioral program of group and individual interventions was developed.

Setting: 

The setting was various community employment sites.

Sample: 

The study sample included 50 individuals with schizophrenia or schizoaffective disorders.

Data Collection: 

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

Intervention: 

The intervention was the Indianapolis Vocational Intervention Program.

Control: 

The condition was standard support services.

Findings: 

Analysis of variance (ANOVA) revealed that the IVIP group worked significantly more weeks and had better average work performance than the standard support group. Repeated measures ANOVA of baseline and follow-up scores indicated that the Indianapolis Vocational Intervention Program. group sustained baseline levels of hope and self-esteem through follow-up, while the standard support group experienced declines.

Conclusions: 

Results provide initial evidence of the effectiveness of the Indianapolis Vocational Intervention Program.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16586193
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Project ABLE (Autism: Building Links to Employment): A specialist employment service for young people and adults with an autism spectrum condition

Authors: 
Lysaker P. H., Bond G., Davis L. W., Bryson G.J., & Bell, M.D.
Year Published: 
2014
Publication: 
Journal of Vocational Rehabilitation
Volume: 
41
Number: 
1
Pages: 
13-21
Publisher: 
IOS Press
Background: 

Individuals with Autism face high rates of unemployment due to a myriad of challenges. There have been some reports that participating in an employability program early on can improve work outcome for this group.

Purpose: 

This study examined using a customized approach to either develop or improve employability skills of individuals with Autism.

Setting: 

The settings included work experience sites across a wide range of community businesses.

Sample: 

Participants included 27 students in special education, 15 young adults who were preparing to leave or who had recently left school and 30 who were 18 or older who were not in secondary education in Ireland. All but 4 of the participants were males. The cognitive profile varied among participants and included 27 individuals who had severe learning disability opposed to 14 who were high functioning. All were unemployed.

Data Collection: 

An action research approach was used. Results were presented for each 3 groups of participants. The individualized approach was successful for 17 of the adult participants. By the end of year four 56% had secured full time and part time work. Among the special education group 27 people had the chance to participate in one to three work experiences. Eighteen required one to one ongoing support throughout the duration of the work placement. Some parents of the young adults in this group reported feeling less anxious about what would happen when the child left school. The mainstream group required work experience for short periods of time. A program spanning the entire school year was not possible due to difficulties associated with being released from school. During the engagement phase individuals completed a individual induction, an assessment, a vocational profile, and an action plan. The plan was reviewed and updated every six months.

Intervention: 

The intervention was a Supported Employment Model in Northern Ireland. This model ensure correct level of support are in place for a person with disability, coworkers, management and families. The model include the following phases: engage; place, train, maintain and progress.
To develop employability and related skills participants chose from a range of interventions.

Control: 

There was no control or comparison condition.

Findings: 

The majority or 95% of the participants experience at least one work experience and 66% had two or more placements. Most individuals 47% worked in retail this was followed by job in administration (24%). Experiences lasted between six weeks to six months or more. The experiences took place across all types of businesses and included retail, business, catering and more. Some individuals also went on to secure employment. Feedback was solicited from participants through interviews and focus groups. They indicated a number of key areas improvement; the top two were better use of time and vocational skills.

Conclusions: 

Work preparation and employability training at an early stage appears to help young people with autism spectrum condition in Ireland successfully transition from school to work. A Supported Employment Model assisted young people with autism spectrum condition prepare for and enter work.

URL: 
https://www.qub.ac.uk/research-centres/CentreforBehaviourAnalysis/filestore/Filetoupload,503346,en.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Patterns of employment and independent living of adult graduates with learning disabilities and mental retardation of an inclusionary high school vocational program

Authors: 
Lynas, L.
Year Published: 
2005
Publication: 
Research in Developmental Disabilities
Volume: 
26
Number: 
4
Pages: 
317-325
Publisher: 
Elsevier
Background: 

Although employment rates for individuals with disabilities may be improving, improvement is needed. The picture for independent living is not much better. Studies have indicated that most adults with disabilities remain both single and living with their parents. They are isolated socially with few friends or meaningful relationships. Schools and school programs that facilitate the transition to adult life are needed.

Purpose: 

The purpose of this study was to examine the employment careers of graduates in an inclusionary vocational and technology high school.

Setting: 

The setting for the study was an inclusionary vocational/technical high school in Ohio.

Sample: 

Thirty six students participated in the study. Nineteen individuals (11 males and 8 females) had been diagnosed with mild mental retardation and 17 (10 males and 7 females) with a specific learning disability by a school psychologist. All had been enrolled in full time programs for students with special needs and had an Individual education plan on file. During the last two years of high school they attended high school for two or three periods then spent the remainder of the day at a Vocational/Technology Center. Students were aged between 20 to 25 years. The majority or 26 of the students were caucasians. The subjects had been enrolled in a variety of vocational programs while attending the vocational tech center. On average, participants had exited or graduated from high school and the vocational center within the last five years at the time of the study.

Data Collection: 

A sixteen item questionnaire was used to learn more about participants' employment and living situation. Participants were contacted by telephone. After answering each question, the participant was given the opportunity to make comments. Chi-square analysis was used to determine statistical differences between the two groups.

Intervention: 

The intervention was Vocational Technical Education.

Control: 

The study included a comparison group.

Findings: 

Overall, the majority or 81% of the participants were employed. However, only 68% of individuals with mild mental retardation were employed as compared to 94% of those with learning disabilities. This was a significant statistical difference. There was no differences related to gender or the program the student attended at the vocational technical center. More participants with learning disabilities were employed in skilled jobs than those with mild mental retardation. Those individuals were working in service industry and factory jobs.
The mean rate of pay for those working was $9.00. there was no significant difference on rate of pay or benefits held by disability type. The majority or 94% of the sample were single. Most or 95% of those with mild mental retardation lived with their parents as compared to 53% of those with learning disability. The majority or 94% of those with learning disabilities owned a car while only 26%of those with mild mental retardation had one. Among those who were working and not driving 40% relied on public transportation. Related to recreation, a third of the respondents indicated watching movies was their main activity. All of the individuals with learning disabilities were registered to vote and had voted. Only 63% of those with mild mental retardation reported having voted.

Conclusions: 

Overall over 81% of the graduates were employed. However, this is primarily accounted for by employment of students with specific learning disabilities (94%) as opposed to respondents with mild mental retardation (68%). However, even when this variance between the two disability types is accounted for, even the students with mild mental retardation are employed at a higher rate than other figures reported in earlier studies.
Another positive finding in the study was the rate of pay for the respondents. For those students working, the median hourly rate was $8.90 which is significantly above the national minimum wage with no statistical significant difference found between the two disability types. Additionally, 68% of those working reported to be receiving benefits.
The majority of participants with mental retardation (95%) were still living with their parents; whereas, 53% of those with learning disabilities were living at home. Members of both groups could benefit from training in this area including how to secure housing.
Individuals with learning disabilities were much more mobile in the community than their peer respondents with mental retardation. The students with learning disabilities were much more likely to own a car (94%) and thus get around the community in a more independent fashion. In areas without public transportation local agencies should provide transportation services for those adults with disabilities who do not or cannot maintain an automobile. The individuals who graduated from an inclusionary high school vocational and technology environment have done fairly well compared to respondents in other reported studies on the areas of employment, pay, and independent living. This may have been partially due to the fact that the learning environment moved students quickly through the exploratory phases of vocational education into the focused phase where students received specific vocational and job training as well as training in independent living skills. This was accomplished in a setting with other non-disabled peers who were also receiving strong vocational training.

URL: 
http://www.sciencedirect.com/science/article/pii/S0891422204000253
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Paid internships and employment success for youth in transition

Authors: 
Luftig, R. L., & Muthert, D.
Year Published: 
2000
Publication: 
Career Development for Exceptional Individuals
Volume: 
23
Number: 
2
Pages: 
205-221
Publisher: 
Sage
Background: 

Most recent extensive national longitudinal studies of school leavers with disabilities show employment rates lagging significantly behind their non-disabled peers. There is a considerable body of research literature that supports the value of work experience as a critical educational intervention for improving post-school employment. To maximize effective educational interventions, including the use of work-based learning and paid employment experiences, it is necessary to examine specific individual characteristics, strategies, and circumstances that promote or deter successful employment outcomes.

Purpose: 

The purpose of this study was to assess the efficacy of a standardized, multi-site, community-based employment internship program developed by the Marriott Foundation for People with disabilities, called Bridges...From School to Work. The study also examines the relationship of various participant and programmatic variables to transition outcomes for participating youth.

Setting: 

The settings for the study consisted of multiple workplaces engaged in the Bridges program with the Marriott Foundation. During the study, Bridges operated in Montgomery County, MD; Fairfax County, VA; Washington, DC; Los Angeles, CA; San Francisco, CA; Atlanta, GA; and Chicago, IL.

Sample: 

The sample for this study includes 3,024 special education high school students who participated in one of the 10 Bridges projects. There was relatively equal distribution for males and females. Participants were largely minority group members (81%). Students had an array of disabilities but were predominantly learning disabled (57.1%), intellectually disabled (17.8%), and emotionally disabled (14.8%). Disability severity ratings were 41.0% mild, 38% moderate, and 21.0% severe.

Data Collection: 

Referral data for Bridges includes demographic, disability, and previous educational/employment histories. Additional data come from a placement data form, an internship log, an internship completion form, and a follow-up questionnaire. Follow-up data collection occurs at 6, 12, and 18 months after internship completion. The data instruments were standardized across all 10 sites. Data analysis consisted of descriptive results for internship performance, and the exploration of the relationship between predictor and outcome variables at each of the three periods using logistic regression procedures.

Intervention: 

The Bridges program consists of three phases: (a) pre-vocational orientation program (two to three weeks); (b) pre-vocational preparation skills training (two to four weeks); and (c) internship placement and support. The internship is a paid work experience whereby a student intern spends a minimum of 12 consecutive weeks performing work tasks in a community employment setting. The employer pays the wages and benefits for the student, but the employer and the student are under no obligation to continue the employment relationship beyond the internship period.

Control: 

There was no comparison condition.

Findings: 

Employment status at six months post-internship was not different across gender, race, or primary disability. Work behaviors during the internship were highly predictive of post-school employment at 6 and 12 month follow-up intervals. 68% of those contacted were employed at six months. Enrollment in postsecondary education was the most frequently cited reason for not working (43%), followed by not being able to find work (21%). A small percentage (13%) cited not wanting to work as the reason for unemployment.

Conclusions: 

Findings of this study demonstrate the efficacy of structured work experiences for youth with disabilities in secondary school. Students in the paid internship showed better short-term outcomes regardless of demographic factors and educational placement factors. However, at long-term follow-up the employment rate had declined, indicating a need for sustained employment support services.

URL: 
http://cde.sagepub.com/content/23/2/205.full.pdf+html
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Chemical dependency treatment and employment outcomes: results from the 'ADATSA' program in Washington State

Authors: 
Luecking, D. M., & Luecking, R. G.
Year Published: 
2000
Publication: 
Drug and Alcohol Dependence
Volume: 
60
Number: 
2
Pages: 
151-159
Publisher: 
Elsevier
Background: 

In 1987, the Washington State legislature passed the Alcohol and Drug Abuse Treatment and Support Act (ADATSA), creating a program for indigent adults deemed unemployable and incapacitated as a result of their addiction. This legislation was designed to provide treatment instead of the traditional public assistance/cash grants available.

Purpose: 

The purpose of the study was to examine the relationship between chemical dependency treatment and subsequent earnings.

Setting: 

The setting included multiple methadone treatment centers in Washington State.

Sample: 

2195 clients were referred to an ADATSA assessment center and determined to be financially eligible for assistance. Of those assessed, 1537 individuals were found to be clinically eligible for treatment and 1228 entered treatment.

Data Collection: 

All data came from secondary sources, as there was no direct contact between researchers and clients. Data on earnings came from the wage and hour file collected by Washington State's Department of employment Security.

Intervention: 

There were three phases of treatment: primary, reintegration, and aftercare. In primary care, addiction was addressed and information and tools needed to recover were provided to patients. In the reintegration phase, patients were aided in moving from a structured treatment setting to independent living. In aftercare, they were provided continued support to maintain sobriety in an unstructured setting.

Control: 

There was no comparison or control condition.

Findings: 

Clients who completed their plan of treatment earned more than those who did not. Those clients who received vocational services, in addition to completing treatment, earned more than those who completed treatment only.

Conclusions: 

This study shows that clients once deemed "unemployable" can become productive.

URL: 
https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-4-45.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Waging a living: Career development and long-term employment outcomes for young adults with disabilities

Authors: 
Linsay, S., & DePape, A. M.
Year Published: 
2011
Publication: 
Council for Exceptional Children
Volume: 
77
Number: 
4
Pages: 
423-434
Publisher: 
Exceptional Children
Background: 

Employment rates for individuals with disabilities are poor and contribute to the ongoing high poverty rates for this group. Although overall employment rates have risen over the years, work outcomes for young adults with disabilities still lag behind those without disabilities. Career development takes place overtime and is influenced by multiple variables such as individual, family, school, and community factors. However, for individuals with disabilities, career development is often complex, nonlinear, and chaotic. High school and post-school services can have a positive impact on employment for youth with disabilities. Students with disabilities who participate in vocational courses and community based work experiences are more likely to obtain and maintain employment after high school. Additionally, participation in adult services like vocational rehabilitation or post secondary education or training can lead to better job opportunities. Research studying patterns of career development for successfully employed adults with disabilities may be able inform clinical practices through the identification of common themes that influence employment in living wage occupations.

Purpose: 

This study examined the process of career development for young adults with disabilities.

Setting: 

The study took place in multiple interview settings.

Sample: 

Young adults with disabilities (5 with learning disability, 2 with orthopedic impairment, and 1 with emotional disability) were recruited from a statewide network of special education and transition specialist. Criteria for selection included: had a documented disability and received special education, participated in school to work transition program at least one year, and exited school between the years 1996 and 2001. The chosen group included 4 women and four men with disabilities who were between 25 to 29 years old. All participants were caucasian and half resided in rural areas. Seven had graduated with a standard high school diploma and one had dropped out during the last year of school. All were employed full time at the time of their postschool interview and reported earning more than $20,000 per year. This was above the federal poverty line of $9,800 per year and exceeded the living wage of $17,035 per year. Key informants were also selected to provide information on family, high school, post school experiences and opportunities. This included: one or both parents, a high school teacher or transition specialist, a rehabilitation counselor, and current employer.

Data Collection: 

Researchers identified a set of topics to address through a review of the relevant literature. This included:

(a) individual characteristics and personal attributes,

(b) family support and expectations,

(c) high school and postschool school services and supports,

(d) workplace experiences, and

(e) other postschool training or education.

Data was collected over four years. Initial post-school interviews took place when participants were between 3 and 6 years out of high school. The second phase of data collection occurred up to 4 years following the initial interview when participants were between 7 and 10 years out of school. In total there were 66 interviews. this included interviews with 24 young adults, 18 with family 11 with employers, 8 with school personnel and 5 with rehabilitation counselors. In addition a family background questionnaire, job history form were completed for each participant along with a file review of special education and vocational rehabilitation records.

Field notes were kept on all contacts with participants and key informants. Onsite observations, field notes and file reviews were recorded on structured forms. Case study data for each participant was completed following standard qualitative analysis procedures. Cross case data summaries and explanatory tables were used to determine which characteristics influenced outcomes similarly or uniquely across cases.

Intervention: 

The study included multiple school-based and transition-focused interventions.

Control: 

The study did not include a control or comparison condition.

Findings: 

A common set of themes seemed to impact employment in living wage occupations. These included: the importance of ongoing education and/or training, steady work experiences, and personal attributes. More specifically the study found that the interrelated elements of family expectations, work experience during high school, and transition services and supports led these individuals to an initial postschool placement in either employment or postsecondary training. During the ensuing span of years, participants advanced in their careers based on a combination of factors that included: (a) enrollment in higher education or job training programs, (b) patterns of workforce participation, and (c) a set of personal attributes such as self-efficacy, persistence, and coping skills. These factors were present across all participants, yet varied by sex.

Conclusions: 

The findings confirm and extend previous research documenting the critical contribution of work experience for youth with disabilities. Young adults with disabilities need transition services to secure financial stability. Initial transition services and ongoing opportunities for further education and training are needed to work in jobs that pay a living wage. Transition education needs to focus on individual knowledge and skills like self determination, self advocacy and communication. Additional studies are needed to understand and highlight the variables that influence gaining occupations with livable wages that promote financial self sufficiency. More research is needed on the role of transition supports, post secondary education or training, family factors and personal attributes.

URL: 
http://eric.ed.gov/?id=EJ931146
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Learning from disappointing outcomes: An evaluation of prevocational interventions for methadone maintenance patients

Authors: 
Lindstrom, L. E., Benz M. R., & Doren, B.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2287-2308
Publisher: 
Informa Healthcare
Background: 

Employment rates in the drug-dependent population are typically low. Obtaining employed work is viewed as basic to successful treatment and recovery. (p. 2288)

Purpose: 

The goal of the study was to evaluate three pre-vocational training programs designed to be delivered as adjunct services for patients at methadone maintenance clinics.

Setting: 

The setting was various community mental health centers.

Sample: 

A total of 417 subjects were enrolled at five methadone clinics between March 1995 and April 1998. They were enrolled in the study after completing 30 days of treatment at the clinics to ensure they were stable and familiar with clinic routines to effectively participate.

Data Collection: 

Employment data was collected at 6-month and 12-month follow up interviews.

Intervention: 

Subjects were assigned to either the Vocational Problem-Solving (VPS) program, the Job Seekers Workshop (JSW) , or a combination of VPS and JSW.

Control: 

The employment outcomes of the 3 program groups were compared.

Findings: 

None of the three models produced significantly greater employment or better overall rehabilitation.

Conclusions: 

This study suggests that closer integration of pre-vocational training with treatment, individualizing efforts to meet training needs, and providing support during job-finding and early job-holding might improve program effectiveness. (p. 2288)

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15200244
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Improving employment outcomes for persons with severe mental illnessesImproving employment outcomes for persons with severe mental illnesses

Authors: 
Levack, W., McPherson, K., & McNaughton, H.
Year Published: 
2002
Publication: 
Archives of General Psychiatry
Volume: 
59
Number: 
2
Pages: 
165-172
Publisher: 
American Medical Association
Background: 

Unemployment remains a major consequence of schizophrenia and other severe mental illnesses. This study assesses the effectiveness of the Individual Placement and Support model of supportive employment relative to usual psychosocial rehabilitation services for improving employment among inner-city patients with these disorders.

Purpose: 

This study evaluates the Individual Placement and Support model among a population of high-risk inner-city patients with severe mental illnesses, extending previously published work that compared the IPS model with an enhanced vocational rehabilitation program among a similar population. In our study, men and women with severe mental illnesses were randomly assigned to either an IPS program or a comparison psychosocial rehabilitation program, the predominant mode of rehabilitation services offered in Maryland and many other states. This comparison program includes, but does not emphasize, enhanced vocational services.

Setting: 

The setting was a university-run community mental health agency in Baltimore, Maryland and various employment sites.

Sample: 

Two hundred nineteen outpatients with severe mental illnesses, 75% with chronic psychoses, from an inner-city catchment area were randomly assigned to either the Individual Placement and Support program or a comparison psychosocial rehabilitation program. Participants completed a battery of assessments at study enrollment and every 6 months for 2 years. Employment data, including details about each job, were collected weekly.

Data Collection: 

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

Intervention: 

Individual Placement and Support (IPS) 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: 

The comparison psychosocial rehabilitation program provided an array of services, including evaluation and skills training, socialization, access to entitlements, transportation, housing supports, counseling, and education. Vocational services included in-house evaluation and training for individuals who staff believed were not yet fully prepared for competitive employment. Training focused on improving specific work readiness skills, such as work endurance, appropriate social interaction in the workplace, and acceptance of supervision. In-house sheltered work and factory enclave projects were also available. For those ready for competitive employment, the psychosocial program either provided in-house assistance in securing employment or referred participants to city-based rehabilitation or vocational service programs.

Findings: 

Individual Placement and Support program participants were more likely than the comparison patients to work (42% vs 11%; P<.001; odds ratio, 5.58) and to be employed competitively (27% vs 7%; P<.001; odds ratio, 5.58). Employment effects were associated with significant differences in cumulative hours worked (t(211) = -5.0, P =.00000003) and wages earned (t = -5.5, P =.00000003). Among those who achieved employment, however, there were no group differences in time to first job or in number or length of jobs held. Also, both groups experienced difficulties with job retention.

Conclusions: 

As hypothesized, the Individual Placement and Support program was more effective than the psychosocial rehabilitation program in helping patients achieve employment goals. Achieving job retention remains a challenge with both interventions.

URL: 
http://archpsyc.jamanetwork.com/article.aspx?articleid=206027
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effects of job development and job support on competitive employment of persons with severe mental illness

Authors: 
Lehman, A.F., Goldberg, R., Dixon, L.B., McNary, S., Postrado, L., Hackman, A., & McDonnell, K.
Year Published: 
2005
Publication: 
Psychiatric Services
Volume: 
56
Number: 
10
Pages: 
1237-1244
Publisher: 
American Psychiatric Association
Background: 

Few studies have tried to determine which specific supported employment services improve employment outcomes for people with psychiatric disabilities. This study examined the effects of job development and job support among other services on acquisitions and retention of competitive employment for individuals with a psychiatric disability. It found that job development is a very effective service when the goal is job acquisition. Job support is associated with retention in first competitive job, but it's casual role is questionable.

Purpose: 

The study hypothesized that participants who received job development would be more likely to acquire competitive employment than those who did not receive it, and would likely be more prepared for work and more likely to acquire competitive jobs than those who received it later. It was further hypothesized that those who received job support would work more months and hours that those who did not.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings. Data used in the analysis came from the two year EIDP (Employment Demonstration Intervention Project)that collected data from sites in seven different states.

Sample: 

A total of 1,340 persons from the seven state employment demonstration sites were included in the analysis. Persons doing paid work at baseline (N=28) and those with no follow-up employment data (N=98) were excluded. Individuals included in the study if they were 18 years old or older at enrollment, were willing and able to provide informed consent, had a DSM diagnosis of mental illness, and were unemployed.

Data Collection: 

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

Intervention: 

Job development was as direct of indirect contact with potential employers or networking with individuals or organizations that had job information. Job support was as on-site counseling, support, and problem solving.

Control: 

Comparison services included for example a variety of employment services such as vocational assessment and evaluation and off site job skills training, vocational treatment planning or career development, and vocational support groups.

Findings: 

Job development helped participants obtain competitive employment. Individuals who received job development sere almost five times more likely to obtain competitive employment than individuals who not received job development. Individuals with no previous work experience had virtually no chance of acquiring competitive employment without job development.
A significant association between months in the first competitive job and receipt of job support was found.

Conclusions: 

Data from this study support the importance of job development and job supports to successful job acquisition and job retention. On average, receipt of job support was positively correlated with the number of months and hours worked in the first competitive job.

URL: 
http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.56.10.1237
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NIDILRR Funded: 
Peer Reviewed: 
Yes