Employment services as an early intervention for young people with mental illness
|Authors:||Brucker, D. L.|
|Publication||Early Intervention in Psychiatry|
|Publisher||Blackwell Publishing Asia Pty Ltd|
The individual placement and support (IPS) approach to supported employment for people with severe mental illness is becoming widely accepted as an essential component of evidence-based psychosocial rehabilitation. A key feature of IPS is that employment services are closely integrated with public mental health services. This can be challenging to implement in developed countries where mental health and employment systems are typically segregated. The demonstrated success of integrated mental health and employment programs implies that this approach can enhance early intervention mental health services and recovery-oriented mental health services.
This study examined the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand.
Workwise Employment Ltd in Christchurch, New Zealand is a supported employment service provider for people with mental illness, including substance misuse. Eligible participants were in receipt of either SB or IB due to a diagnosed mental health condition, often with concurrent family and social problems that exacerbated their situation. Four full-time employment specialists were supported by one administration position and one team leader. Employment specialists were not externally trained in IPS principles. However, in 2002 Workwise adopted these principles for internal training throughout its national network of disability employment services.
Employment outcomes were investigated for 49 young clients aged 16-25 years who entered the program between 1 July 2005 and 30 June 2007. These young clients represented 18% of the 270 clients assisted during this period. Data collection ceased on 4 April 2008. Eligible candidates were identified and referred by Work and Income staff from regular Work and Income seminars, and from individual income support reviews. Self-referrals were also permitted. Referrals were accepted if: (i) the person was in receipt of SB or IB for mental health or psychiatric reasons (including substance misuse); (ii)Work and Income approved the self-referral and (iii) it was clear people were volunteering for employment assistance. Clients were recommended to a particular employment service by the Work and Income staff. Clients could accept the initial referral or insist on choosing another of three alternative service providers.
The service had a comprehensive business information system that tracked all clients throughout the contract. Records of clients(n=49) aged 16‚Äì25 years were retrospectively examined. Data analysis was conducted by the team leader using Microsoft Excel 2003, guided by the outcome variables identified from published reports of comparable services. The comprehensive data management system enabled most variables of interest to be reported. Data quality was governed by the contract that required 100% accuracy and supporting evidence for all employment outcomes. All client records were reviewed monthly by an employment specialist, an administrator and by the team leader for the term of the contract. The records were also subject to regular internal review and intensive external auditing as a condition of the contract.
The condition was published outcomes from recent national and international benchmarks that were based on studies using Random Controlled Trials.
As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables.
Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.
|Disabilities||Autism Spectrum Disorder | Emotional disturbance|
|Populations||Transition-age youth (14 - 24) | Native Hawaiian / other Pacific Islander | White / Caucasian | Male & Female|
|Outcomes||Employment acquisition | Increase in tenure | Wages|
|Research Design||Case reports|