Employment acquisition

Populations:

American Indian or Alaska Native

Asian

Outcomes:

Randomized Controlled Trials (RCTs)

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Work rehabilitation for middle-aged and older people with schizophrenia: a comparison of three approaches

Authors:

van den Hout, J. H. C., Vlaeyen, J. W. S., Heuts, P. H. T. G., Zijlema, J. H. L., & Wijnen, J. A. G.

Year Published:

2005

Publication:

The Journal of Nervous and Mental Disease

Volume:

193

Number:

Pages:

596-601

Publisher:

Lippencott, Williams, and Wilkins

Background:

There are increasing numbers of middle-aged and older people with schizophrenia-spectrum disorders, most of whom are unemployed. Across all age groups, rates of paid employment among people with these disorders are less than 15%. Yet the potential benefits of employment (e.g., increased income, activity, structure, socialization, and self-esteem) could improve symptoms, everyday functioning, and overall health. Many older people with severe mental illness (SMI) want to work. However, work rehabilitation programs usually do not target older patients, and no published studies have addressed work rehabilitation specifically in middle-aged and older people with SMI.

Purpose:

To examine employment outcomes among middle-aged and older clients with schizophrenia in three work rehabilitation programs that varied in their emphasis on conventional vocational rehabilitation (train-then-place) versus supported employment principles (place-then-train). We analyzed retrospective data from 36 veterans receiving VA Wellness and Vocational Enrichment Clinic (WAVE) services and prospective data from a randomized controlled trial of 30 subjects receiving Department of Rehabilitation/Employment Services (DOR) or Individual Placement and Support (IPS).

Setting:

Study settings were three separate programs: (a) the VA San Diego Healthcare System's Wellness and Vocational Enrichment Clinic (WAVE), (b) the Department of Rehabilitation/Employment Services (DOR), and (c) IPS. The WAVE Clinic provides conventional vocational rehabilitation (CVR) with some elements of SE. The DOR provides CVR services, as do most of the federally funded state agencies across the United States.

Sample:

Participants were 40 years of age or older and had DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder made by their treating psychiatrists and confirmed by a diagnostic chart review by trained research staff. Exclusion criteria were alcohol or substance dependence within the past month and presence of dementia or other major neurological disorders.

Data Collection:

All participants were classified as working (including volunteering) at any point in the study or nonworking for the analyses. Three IPS subjects and three DOR subjects decided not to pursue work and dropped out of the prospective study, but these subjects were included in the analyses. We used analysis of variance, [chi]2, and logistic regression techniques to analyze the data. All variables were distributed normally. The [alpha] for significance was set at p < 0.05, and all tests were two-tailed.

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:

Two Comparison Conditions:
(1) WAVE: The WAVE Clinic assists veterans in achieving work readiness by providing prevocational classes and job contracts with various community employers. WAVE services are consistent with CVR, but unlike most CVR programs, the vocational services are integrated with psychiatric services.
(2)Department of Rehabilitation: In San Diego, vocational rehabilitation services for clients with mental illness are contracted to an organization called Employment Services. Individuals first become DOR clients and are then referred to Employment Services. To become a DOR client, the individual must first attend an orientation session and then attend an intake appointment with a DOR counselor. Following the intake appointment, the DOR has 60 days to determine eligibility for services.
Once eligibility has been approved, clients are referred to Employment Services and assigned a vocational counselor (a bachelor's-level or master's-level provider with a typical caseload of 35 clients). Job development and job coaching are provided by additional staff members. The DOR uses a train-then-place approach; individuals receive job readiness coaching and attend pre-vocational classes before their job search begins.

Findings:

Across interventions, half the subjects obtained volunteer or paid work. IPS participants, those with schizophrenia (versus schizoaffective disorder), and those with more education were more likely to work or volunteer. Rates of volunteer or paid work were 81% in IPS, 44% in WAVE, and 29% in DOR. Rates of competitive/paid work only were highest in IPS (69%), followed by DOR (29%) and WAVE (17%).

Conclusions:

Although they are typically written off as having little potential to return to work, especially paid work, middle-aged and older people with severe mental illnesses can obtain employment. Furthermore, they are more likely to do so in the context of a supported employment intervention than with traditional vocational services.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/16131942

Disabilities:

Populations:

Hispanic or Latino

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

A multisite study of implementing supported employment in the Netherlands.

Authors:

Varekamp, I., Verbeek, J. H., de Boer, A., & van Dijk, F. J. H.

Year Published:

2007

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1421-1426

Publisher:

American Psychiatric Association

Background:

In the Netherlands, a small western European country with 16 million inhabitants,persons with severe mental illnesses consistently have the worst employment outcomes of all disability groups; only 12% are enrolled in competitive jobs. The Dutch approach to vocational rehabilitation for this group has been a cautious one, mainly encompassing prevocational training,sheltered employment, volunteer work, or trainee placements in regular businesses (8). Many clinicians in the Netherlands believe that competitive employment is too ambitious or too stressful for clients with severe mental illnesses. Clients are offered work tasks in segregated settings to prepare them for competitive employment,but the progression from sheltered to competitive jobs is not substantial (9).Another feature of Dutch practice is the parallel organization of mental health services and vocational services,based on the belief that this segregation enables employment specialists to focus solely on vocational issues without causing any stigma.

Purpose:

This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions.The main objective of the Dutch Study was to determine whether the individual placement and support model of supported employment could be implemented in the Netherlands.Study sought to answer the following questions: what is the level of fidelity of the implementation, what are the employment outcomes in the four sites (client outcomes and job characteristics), what are the barriers to implementation, and what strategies to overcome these barriers are successful.

Setting:

In 2003 four Dutch mental health agencies began to implement individual placement and support programs of supported employment. Employment Specialists from vocational services(such as generic vocational agencies, sheltered workshops, and rehabilitation centers) were assigned to mental health teams delivering comprehensive treatment and care for persons with severe mental illnesses. Sites were selected on criteria including a case manager client ratio of at most 1:30, a client population of at least 240, regular contacts with vocational services, and willingness to provide funding.

Sample:

The study group was predominantly male, the mean age was 35±10, and most clients were living independently. At intake 107 participants (46%) did not perform any vocational activities. The most common diagnoses were schizophrenia and related psychotic disorders. On average, participants had received 8±7 years of mental health services.

Data Collection:

The authors used structured site visits, employment data, and semi-structured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation.

Intervention:

Control:

There was no control or comparison condition.

Findings:

At 24 months, the four sites reached a mean¬±SD fidelity score of 4.1¬±.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff.

Conclusions:

To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.

URL:

http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2007.58.11.1421

Disabilities:

Populations:

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention.

Authors:

Vlasveld, M. C., Anema, J. R , Beekman, A. T. F., van Mechelen, W., Hoedeman, R., van Marwijk, H. W. J., Rutten, F. F., Hakkaart-van Roijen, L., & van der Feltz-Cornelis, C. M.

Year Published:

2014

Publication:

Journal of Occupational Rehabilitation

Volume:

Number:

Pages:

42-51

Publisher:

Springer Science+Business Media New York

Background:

Employment leads to more independence as an adult. Many youth with physical disabilities have difficulty gaining and maintaining employment. This may result in a reduced quality of life.

Purpose:

The purpose of the study was to examine how occupational performance of participants of a vocational rehabilitation intervention changed over time. More specifically, it looked at work, self care and leisure. The researchers also looked at the differences between individuals who were employed and those who remained unemployed after the vocational rehabilitation intervention.

Setting:

The setting was an outpatient rehabilitation clinic for young adults located in Rotterdam, the Netherlands.

Sample:

Participants include eleven young adults with physical disabilities; six male and five females. Their mean age was 22 years prior to the intervention. Three individuals had cerebral palsy, 2 had muscular disease, 2 had traumatic brain injury and the remainder had other types of physical disabilities. The amount time participants had spent looking for work ranged from Five of the participants had not yet looked for work while 2 had been looking for more than 2 years.

Data Collection:

Demographic data was collected. Severity of physical limitations was categorized using scores on the Physical Functioning scale of the MOS Short-Form General Health Survey. Occupational performance was explored at baseline and one year later using semi structured interviews. The Canadian Occupational Performance Measure (COPM), an interview, was used to assess self perception of work performance in the areas of self care, productivity and leisure over time. The Occupational Performance History Interview II (OPHI-II) was used to assess aspects of occupational adaptation: occupational identity, competence and setting. Results were summarized using descriptive statistics. Sores on the COPM subscales and the OPHI-II scales were calculated. Qualitative data from the COPM and audio taped OPHI-II were summarized and categorized into the 3 occupational performance categories: self care, leisure and work productivity. Narrative were classified as regressive, stable or progressive. Differences between pre and post intervention scores on COPM and OPHI-II were tested using Wilcoxon signed rank test. Demographics between the employed and unemployed groups were compared using the Mann-Whitney U test. Non-parametric test were used. Data was analyzed using SPSS 16.0.

Intervention:

The intervention was "At Work?! This is a multidisciplinary vocational rehabilitation intervention that was designed for young adults with physical disabilities, who are entering the labor market, and is geared towards improving abilities to achieve employment. The year long intervention brought rehabilitation and vocational services into a group program that included individuals assessments and coaching.

Control:

There was no control group. The participants served as their own controls.

Findings:

The participants expressed fewer problems after the intervention. Additionally, they showed improved in work performance, self care and leisure. An increase in satisfaction with these improvements was also reported. Occupational identify, competence and overall scores on the OPHI II also increased. The demographic characteristics of the individuals who did not gain employment were not difference from the group that was employed. The unemployed experienced difficulties in all three areas of occupational performance prior to the intervention and more difficulty in the work setting. Post-intervention, their levels of occupational identity, competence and settings were like those of employed persons. Participants showed improved occupational performance post intervention. The unemployed participants appeared to catch up during the intervention but had not achieved employment within one year.

Conclusions:

Young adults with physical disabilities, showed improved occupational performance in work, self care and leisure and were more satisfied with their performance after participating in a one year multidisciplinary vocational rehabilitation intervention. Those who did not go to work faced problems in all three areas at pre-intervention. The goal of employment and the intervention appeared to motivate participants to solve problems related to work, self care and leisure. There is a need for interventions aimed at improving work participation by address problem across the three areas. Young adults who go to work may benefit from ongoing coaching to help address new problems.

URL:

http://link.springer.com/article/10.1007%2Fs10926-013-9446-9

Disabilities:

Populations:

Transition-age youth (14 - 24)

Outcomes:

Other

NIDILRR Funded:

Research Design:

Single group

Quasi-experimental

Peer Reviewed:

Yes

A controlled study of services to enhance productive participation among people with HIV/AIDS

Authors:

Killackey, E., Jackson, H. J., & McGorry, P. D.

Year Published:

2008

Publication:

American Journal of Occupational Therapy

Volume:

Number:

Pages:

36-45

Publisher:

American Occupational Therapy Association

Background:

With improved treatment options, more individuals with HIV/AIDS are surviving longer and returning to productivity. Few studies have examined interventions that improve employment outcomes for HIV/AIDS survivors.

Purpose:

This study assessed the effectiveness of a model program designed to increase productive participation among people living with HIV/AIDS within supportive-living facilities. The model program is entitled Enabling Self-Determination (ESD).

Setting:

This study was implemented in four supportive living units in metropolitan Chicago, IL. These units exclusively serve individuals with HIV/AIDS.

Sample:

The study sample consisted of 65 individuals with HIV/AIDS who were randomly assigned to the intervention group or a standard care group. The study group was predominantly male (82%) and African-American (71%).

Data Collection:

Demographic and impairment data were collected at baseline. Information on engagement in productive activities (either employment, education, or volunteering) was collected at three, six, and nine months following completion of the ESD or standard treatment.

Data analysis consisted of first comparing the two groups to determine if they differed on baseline variables. Then, chi-square analyses were used to compare employment status at the three, six, and nine-month checkpoints.

Intervention:

The ESD model consists of eight weekly one-hour sessions led by an Occupational Therapist. Sessions were designed with both educational and peer support components. Examples of sessions include: Managing one‚ own physical and mental health; Developing skills and habits for independent living; Developing occupational roles, habits, and skills; Building vocational confidence (job search, interviewing, etc.); and Learning self-advocacy and self-management skills.

Control:

A non-randomized two-group design was used. This design was used because having both intervention and control conditions in the same residence would have contaminated the study. Two residences served as the intervention settings, and the other two as standard treatment settings.

Findings:

No significant differences were found between the two groups. Of the original 65 participants, employment outcome data could be obtained for 46. Attrition rates were not significantly different for the two groups. Participants in the ESD group were significantly more likely to be employed at each of the three checkpoints. Employment rates for the ESD group were more than double those of the standard treatment group.

Conclusions:

The findings of this study support the efficacy of the ESD model for individuals with HIV/AIDS, and that the benefits can be sustained over time. Replication of the ESD model with larger study groups and other populations would more fully evaluate the efficacy of the model.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/18254429

Populations:

Hispanic or Latino

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Effect of a vocationally-focused brief cognitive behavioural intervention on employment-related outcomes for individuals with mood and anxiety disorders

Authors:

Kielhofner, G., Braveman, B., Fogg, L., & Levin, M.

Year Published:

2008

Publication:

Cognitive Behaviour Therapy

Volume:

Number:

Pages:

247-251

Publisher:

Taylor & Francis

Background:

The topic of employment among persons with mental illness has become increasingly salient in the research literature, as practitioners identify both the benefits of employment to quality of life and the difficulties faced by persons with mental illness in obtaining and maintaining competitive positions (Bond, Drake, & Becker, 2008). These difficulties include the impact of symptoms on work task completion, difficulty coping with work stress, and the impact of interpersonal stressors (Becker et al., 1998).

Purpose:

The purpose of this pilot study was to examine the effectiveness of a brief cognitive behavioral therapy group intervention that targets vocational stressors for individuals whose vocational functioning had been significantly impacted by mental illness.

Setting:

The setting was a community counseling center.

Sample:

The study sample included 16 individuals with mood and anxiety disorder diagnoses.

Data Collection:

Wilcoxon's signed rank test was used to test change as a result of the intervention.

Intervention:

The intervention was brief cognitive behavioral therapy.

Control:

There was no control or comparison condition.

Findings:

It was found that employed persons reported an improved sense of mastery in the completion of work tasks, improved satisfaction with work supervision, and decreased satisfaction with advancement and job security. Unemployed participants reported improved expectancy for employment success.

Conclusions:

Promising areas for future investigation include (a) examination of the outcomes of separate CBT interventions specifically tailored for employed and unemployed individuals; (b) examination of the impact of CBT interventions when paired with an evidence based vocational intervention (e.g., supported employment), as has been suggested by others (e.g., Bond, 2004); and (c) examination of longer versions of this form of intervention (e.g., 8‚Äì10 sessions) to help to determine whether this would improve assimilation of materials/techniques and provide more opportunities to practice skills.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19023766

Disabilities:

Populations:

Outcomes:

Full-time employment

Part-time employment

NIDILRR Funded:

Research Design:

Case reports

Peer Reviewed:

Yes

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

Authors:

Kidd, S. A., Boyd, G. M., Bieling, P., Pike, S. & Kazarian-Keith, D.

Year Published:

2009

Publication:

Cochrane Database of Systematic Reviews

Volume:

Number:

Pages:

1-22

Publisher:

John Wiley & Sons, LTD

Background:

Multiple sclerosis is described as a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.

Purpose:

The purpose of the study is to evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in patients with M.S.; and to evaluate the cost effectiveness of these programs.

Setting:

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

Sample:

Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (subtypes of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity.

Data Collection:

Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.

Intervention:

Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls.

Control:

There are no comparison on control conditions.

Findings:

Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a competitive employment in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labor force; (b) for altering work ability' by improving participants confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.

Conclusions:

There was inconclusive evidence to support VR for patients with MS However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigor of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

URL:

http://onlinelibrary.wiley.com/store/10.1002/14651858.CD007256.pub2/asset/CD007256.pdf;jsessionid=DB8AF3AB7E7D7D9A9280998D0E812DCD.f03t01?v=1&t=imnmwg11&s=378f4ad624105aa799bc84c37a0ca5d3c51082c5

Populations:

Outcomes:

Systematic reviews and meta-analysis

Other

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Rehab rounds: Supplementing supported employment with workplace skills training.

Authors:

Wang, P., Simon, G., Avorn, J., Azocar, F., Ludman, E., McCulloch, J., Petukhova, M., & Kessler, R.

Year Published:

2004

Publication:

Psychiatric Services

Volume:

Number:

Pages:

513-515

Publisher:

American Psychiatric Publishing

Background:

Supported Employment for persons with serious and persistent mental illness has been termed Individual Placement and Support. In two randomized controlled trials clients who received Individual Placement and Support services were more likely to obtain at least one job in the competitive sector and to work more hours, and to have a higher total income than their counterparts who received more traditional types of vocational rehabilitation. However, individual placement and support did not improve the length of time the employed participants kept their jobs.

Purpose:

The purpose of this report is to present the preliminary results of a randomized comparison of the workplace fundamental skills module's effects on job retention, symptoms, and community functioning when coupled with individual placement and support.

Setting:

The setting was a community mental health center and various places of employment.

Sample:

The study sample included 42 individuals with a diagnosed mental health disorders.

Data Collection:

Data was collected about job acquisition, hours worked, wage and job retention.

Intervention:

The intervention was Work skills training and Individual Placement and Support.

Control:

The control condition was Individual Placement and Support only.

Findings:

Thirty-four individuals, 17 in each group were employed during the project. There was no significant difference in the hours worked or the earnings for the two groups. The control group held significantly more jobs than the group receiving both modalities indicating there was significantly more job turnover in the group that received individual placement and support only.

Conclusions:

The most relevant finding from the study was the greater job retention among the participants who received the combination of individual placement and support and the workplace fundamental skills module.

URL:

https://www.researchgate.net/publication/8576628_Rehab_Rounds_Supplementing_Supported_Employment_With_Workplace_Skills_Training

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Vocational rehabilitation of participants with severe substance use disorders in a VA Veterans Industries Program

Authors:

Walker, W. C., Marwitz, J. H, Kreutzer, J. S., Hart, T., & Novack, T. A.

Year Published:

2004

Publication:

Substance Use and Misuse

Volume:

Number:

Pages:

2513-2523

Publisher:

Marcel Dekker

Background:

The VA Veterans Industries programs have been established across the country to provide a therapeutic gateway to gainful employment for veterans who have physical and mental disabilities or addictive disorders. Eighty percent of patients referred to vocational rehabilitation programs have a history of severe substance use disorders. Despite the interest in the vocational rehabilitation of substance users (Hawkins and Catalano, 1985), little empirical evidence exists about which specific vocational rehabilitation services promote successful employment outcomes.

Purpose:

The purpose of this study was to evaluate the effectiveness of the Veterans Industries program, a component of the Addictions Partial Hospitalization Program (APHP) at the Houston Veterans Affairs Medical Center (VAMC). Outcome rates are reported including employment, abstinence, and housing support.

Setting:

The study was conducted at the Houston, TX VAMC within the APHP, an addiction treatment program.

Sample:

The study sample consisted of 80 veterans who were out-patients of the APHP and who were referred for vocational rehabilitation. The mean age of patients was 45 (range 29‚Äì59). Participants were predominantly male (98%) and African-American (62%). Most (68%) were Vietnam era veterans. At enrollment, 100% were unemployed, 73% were homeless, and 15% were receiving a disability pension.

Data Collection:

Data were collected at intake for age, education, military history, training, employment history, earnings, disability, disability compensation, substance use, and living situation. Employment data were collected following program exit and at three-month follow-up.

Intervention:

Veterans Industries is a therapeutic work-for-pay program in which the VA contracts with private industry and federal agencies for work to be performed by veterans. These Compensated Work Therapy (CWT) programs have been established since the 1950s. The majority of veterans are involved in outpatient substance user programs and live in VA domiciliaries or supportive housing in the community. In addition to therapeutic work, veterans receive job readiness training group, assistance with job placement, and referral to the state vocational rehabilitation service for assistance with supportive housing in a drug-free environment.

Control:

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

Findings:

Of 80 patients, 72 (90%) successfully completed APHP and received a regular discharge. This means that they completed 4 weeks of partial hospital treatment and graduated to outpatient treatment consisting of group therapy twice a week. Fifty-nine percent of the homeless veterans received supportive housing. All veterans who remained abstinent and continued to participate in work therapy received supportive housing. The average length of service was 3 months. Forty-three of the 80 veterans (54%) obtained competitive employment. The majority of jobs were in entry-level service positions including housekeeping, building maintenance, security, shipping, and receiving. A follow-up conducted 3 months after discharge from Veterans Industries indicated that 60% maintained competitive employment.

Conclusions:

The study findings support the conclusion that vocational services improve the employment rates of clients leaving treatment. The existence of job counseling, job placement, and job development services in clinics is positively correlated with the difference between admission and discharge employment rates.

URL:

http://www.tandfonline.com/doi/abs/10.1081/JA-200034695?journalCode=isum20

Populations:

Hispanic or Latino

Homeless

Veterans

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Not Reported

Research Design:

Single group

Quasi-experimental

Peer Reviewed:

Yes

Supported employment for persons with traumatic brain injury: A preliminary investigation of long-term follow-up costs and program efficiency.

Authors:

Wehman, P., Lau, S., Molinelli, A., Brooke, V., Thompson, K., Moore, C., & West, M.

Year Published:

2003

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

192-196

Publisher:

Elsevier

Background:

Research shows that individuals with traumatic brain injury (TBI) often experience great difficulty returning to competitive employment postinjury. Challenges arise from cognitive, physical, sensory and/or psychosocial problems. Supported employment is one approach in vocational rehabilitation that has been used to assist individuals with significant disabilities, including TBI, with returning to preinjury work or securing and maintaining new employment.In the individual placement approach typically a vocational professional known as an employment specialist or job coach, works one to one with the individual. The specialist assist the person with locating employment by developing job opportunities. Then, once the individual is hired the specialist provides and facilitates on-the-job supports such as: skills training and/or identifying various types of supports (ie. compensatory memory strategies, assistive technology) to help the new hire learn how to perform the job and meet the employer‚ performance standards. Furthermore, long-term follow-up services are offered throughout the duration of a person‚ employment. During this time, additional on-the-job assistance is available, and, as indicated, select case management services related to resolving off-the-job-site issues that if left unattended would impact job retention, are provided. Information on cost and benefits is needed to determine the efficacy of this approach for individuals with TBI.

Purpose:

The purpose of this study was to investigate the long-term follow-up costs associated with supported employment. It also examined wage and employment characteristics for individuals with moderate to severe traumatic brain injury (TBI) received supported employment services over a 14-year time span.Specifically, this research sought to answer the following questions:(1) What is the average cost of supported employment services for individuals with TBI? (2) What is the average length of employment for individuals with TBI who have received supported employment services? and (3) How do benefits (ie, participant income) compare with costs of supported employment during a 14-year time period (from 1985 to 1999)?

Setting:

The setting was multiple employment sites where individuals worked.

Sample:

The sample size included 59 individuals with moderate to severe TBI who were consecutively referred for supported employment services. The sample was restricted those who were employed in at least one job during the study period. The eligibility criteria for receiving supported employment services included the following: the person was between the ages of 18 and 64 years, and had sustained a moderate to severe TBI, as indicated by length of coma greater than 24 hours or a Glasgow Coma Scale score of less than 13 on admission to the hospital. In addition, individuals had to present clear indications of the need for ongoing vocational intervention to return to preinjury employment or to obtain and maintain new employment. These indications came from the individual‚ post injury employment history or from reports from his/her family, physician, or vocational rehabilitation counselor. The demographics of the group were as follows. The majority (81%) were males; (75%) were white. The average age was 33 years. The majority (64%) had a high school diploma or less education. The majority (71%) were working prior to injury.

Data Collection:

Data were collected on individuals who used supported employment services to assist them with gaining and maintaining work anytime between 1985 to 1999.Data about each participant's length of employment, wages, and costs associated with service delivery were collected by the employment specialist assigned to serve the person. For those individuals who had been employed in more than one job over the years, data on length of employment and cost of service delivery were combined. Analyses were performed to examine the costs of supported employment, employment characteristics (e.g., wages, length of employment), and benefit-cost ratios of supported employment for individuals with TBI. Descriptive statistics were calculated for length of employment, costs associated with supported employment services, and wages earned. Subgroup comparisons were also performed to examine the influence of length of employment on wages and supported employment costs. Calculations were based on individual clients, not job placements. Therefore, employment and billing data were combined and averaged for individuals who worked in more than 1 job over the study period.

Intervention:

The intervention was individualized supported employment services.

Control:

Subgroup comparisons were performed to take a look at the influence of length of employment on wages (less than and greater than 2 years) and cost of services.

Findings:

Participants worked an average of 30 hours per week. and earned between $3.35 (minimum wage at the time) and 11.99 an hour. The average length of employment was 43 months. Average earnings were cited as $633.63 per month. Average gross earnings was $26,129.74. The majority of the sample worked over 2 years and approximately 25% had worked 7 years or more.The average hourly billing cost associated with the provision of supported employment services was $10,349.37; with a mean cost of $8614.00. This resulted in a mean monthly cost of $202.00 per participant.The subgroup cost-earning comparison revealed that cost were substantially less for those who maintained employment for 2 or more years. Individuals earned an average of $17,515.00 more than the cost associated with service implementation.

Conclusions:

Supported employment is a cost effective way to assist individuals with TBI with gaining and maintaining employment. Over time the cost associated with long term services (ie. follow along) decreases.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/12601649

Disabilities:

Populations:

Outcomes: