Psychological Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review and Meta-Analysis

Authors: 
Frank, E., Soreca, I., Swartz, H., Fagiolini, A., Mallinger, A., Thase, M., Grochocinski, V., Houck, P., & Kupfer, D.
Year Published: 
2015
Publication: 
Research on Social Work Practice
Volume: 
28
Number: 
1
Pages: 
84-98
Publisher: 
SAGE
Background: 

The number of cancer survivors continues to increase in the United States and around the world. Cancer survivors typically have a higher rate of unemployment as compared to their healthy counterparts. Additionally, survivors were 4 times more likely to be employed when they received employment related supports. While other reviews of this subject have been conducted, this review includes more recent research, focuses more squarely on psychosocial interventions more broadly, and expands the definition of employment outcomes to include additional interventions.

Purpose: 

This systematic review focuses on examining interventions that facilitate cancer survivors' employment outcomes, including (a) employment status, (b) return to work, (c) absenteeism, and (d) time spent on work disability or sick leave. This review expands the scope of previous reviews to include additional employment outcome measures, across additional databases.

Setting: 

Interventions included in this review typically took place in medical settings.

Sample: 

Twelve studies met the criteria for inclusion in this review and included over 2000 participants who had been diagnosed with cancer. Participants were typically over the age of 50. Only four studies reported ethnicity of participants.

Data Collection: 

Data collection in all included studies was done through a hospital or clinic. Recruitment was typically through referrals or after a medical procedure.

Intervention: 

The interventions, for included studies described in this review, included behavioral, psychological, educational, or vocational content that facilitated cancer survivors' employment outcomes.

Control: 

There was no control group.

Findings: 

There were 20,249 records found after the initial search. After screening, 70 records remained to be evaluated in full-text. Of those 70, 58 records were excluded with reasons. This left 12 studies to be evaluated in the quantitative synthesis. Of the 10 studies that included measures of employment status, those that were randomized controlled trials (RCTs) showed no significant difference when examined alone. When combined with Quasi Experimental Designs (QEDs) the weighted mean effect size for employment status was OR= 2.18, p=.002. Two studies measured number of hours worked, and showed no significant results, OR = 0.89, p =.67. Four RCTs measured sick leave and results were nonsignificant OR = 1.18, p =.39.

Conclusions: 

The multicomponent nature of the interventions in this review make it difficult to pinpoint exactly "what works". Further exploration of employment outcomes in relevant research would allow for a more in-depth analysis of intervention effects. Additional RCTs would also strengthen the field.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/1049731515604741
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Attachment and Employment Outcomes for People With Spinal Cord Injury: The Intermediary Role of Hope

Authors: 
Blonk, R. W., Brenninkmeijer, V., Lagerveld, S. E., & Houtman, I. L.
Year Published: 
2017
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
60
Number: 
2
Pages: 
77-87
Publisher: 
SAGE
Background: 

Compared to people without disabilities, people with spinal cord injury (SCI) have significantly lower employment rates. There are approximately 270,000 people in the United States living with a SCI. Recently, industrial/organizational (I/O) psychology has focused on adopting positive psychological approaches to work related behaviors. Positive organizational behavior (POB) and I/O psychology findings indicate that attachment and hope are related to important vocational variables.

Purpose: 

This study explores the relevance of attachment and hope for vocational rehabilitation (VR), in relation to full time employment, for individuals with SCI. More specifically, this study aims to a) examine the relationship between attachment, hope, and full-time employment for individuals with SCI, and b) to examine the mediation effect of hope on the relationships between attachment and full-time employment for individuals with SCI.

Setting: 

Participants were recruited from SCI advocacy organizations, specifically through newsletters. Data were collected via an anonymous online survey.

Sample: 

Participants (N =84) ranged from 21 to 64 years of age (M= 47.05,SD= 10.72). There were 57 males, and 26 females in the sample, with one participant not responding to the gender question. Participants were predominantly Caucasian (88.1%), with 48 participants reporting being unemployed (57.2%) and 23 participants reporting full-time employment (27.4%). A large majority of participants (85.5%) reported completing some post-secondary education.

Data Collection: 

Employment was coded as binary, employed full time or not employed full-time. The Attachment Style Questionnaire (ASQ, Feeney, Noller, & Hanrahan, 1994) was used to measure attachment. The Trait Hope Scale (THS; Snyder et al., 1991) was developed as a 12-item instrument to score total hope, pathways thoughts, and agency thoughts.

Intervention: 

There was no intervention.

Control: 

There was no control group.

Findings: 

Results indicate that attachment and hope were significantly related and predictive of full-time employment. Hope was also a significant mediator between attachment and full-time employment.

Conclusions: 

Vocational rehabilitation counselors should strive to maintain and enhance positive time perspective for individuals with secure attachment. Individuals with low agency/low pathways experience increased barriers to the goal pursuit process and would benefit from increased direction.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/0034355215621036
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Methods of a multisite randomized clinical trial of supported employment amount veterans with spinal cord injury

Authors: 
Ownsworth, T., & McKenna, K.
Year Published: 
2009
Publication: 
Journal of Rehabilitation Research & Development
Volume: 
46
Number: 
7
Pages: 
919-930
Publisher: 
Department of Veterans Affairs
Background: 

Baseline data revealed that 65% of the study sample of veterans with spinal cord injury (SCI) who were seeking employment had never been employed postinjury. Nearly half (41%) of this group had received some type of prior vocational rehabilitation. This rate is consistent with veterans with SCI reported for samples in the community of individuals with SCI.

Purpose: 

This article compares evidence-based supported employment (SE) with conventional vocational rehabilitation for veterans with SCI. The researchers hypothesis was that evidence-based supported employment when compared with conventional vocational rehabilitation will significantly improve competitive employment outcomes. The secondary hypothesis was that evidence-based supported employment for veterans with SCI would be more cost-effective than standard care.

Setting: 

The study took place at multiple competitive employment sites versus standard vocational rehabilitation care at various Department of Veterans Affairs medical SCI centers.

Sample: 

Veterans with spinal cord injury consisting of 95% males with an average age of 48.3 years. More than half of the subjects were white, 35.3% African American, 5% Hispanic.

Data Collection: 

All subjects were followed for 12 months with face-to-face interviews every three months to collect data on primary employment variables and secondary outcomes measured. After this initial 12 months, the follow-up period was extended to 24 months at all sites including telephone interviews every three months. MANCOVAs were used to determine treatment group differences over time on the outcome variables (employment index, perceived barriers to employment, level of disability, quality of life, depression, and sustaining care needs), controlling for specified covariates. This included study site, sex, and age.

Competitive employment was as a primary outcome measure and measured every three months. Competitive employment is "community jobs that pay at least minimum wage (directly by the employer to the employee) that any person can apply for, including full-time and part-time jobs." General rehabilitation outcomes were measured at baseline and 3-month follow-up interviews. Standardized measures used included 1) Alcohol Use Disorders Identification test, 2)The Craig Handicap Assessment and Reporting Technique (CHART), 3) VR-36 that measures health-related quality of life in veterans, and 4) The Quick Inventory of Depressive Symptomatology Self-Report.

Demographic variables were also collected such as age, sec, race/ethnicity, employment history, previous levels of income, educational background, legal history, lifetime employment history, vocational services history, duration of SCI, level of SCE, and type of family structure.

Intervention: 

The Spinal Cord Injury Vocational Integration Program uses the principles of evidence-based supported employment. The program integrates vocational services into the SCI continuum of healthcare. The SE principles include 1) integrated treatment, 2) rapid engagement, 3)competitive employment, 4) belief that success is possible regardless of severity or type of disability, 5) ongoing support, 6) veteran preferences, 7) community-based services, and 8)personalized benefits counseling. The investigators spent 4 to 6 months recruiting and hiring staff to provide the evidence-based SE services. All vocational rehabilitation counselors (VRCs) have master's degrees and are certified rehabilitation counselors. Training consisted of 3-day workshop taught by VA faculty. VRCs received ongoing instruction and coaching by a co-investigator who has more than 30 years experience in vocational rehabilitation (VR).

Control: 

The study design was a randomized clinical trial that consisted of an experimental group and a comparison group. Interventional-site subjects were randomized to either the experimental group or the comparison group. Observational sites were selected based on similarity to the intervention site facilities with regards to subjects, communities, and VAMC culture. The observational sites were included because the researchers were considered that veterans and staff at the four intervention sites might be vicariously influenced by veterans and staff involved with the implementation study.

Findings: 

The findings of this study were preliminary. The final enrollment count for the study was 301 subjects. At the time of this publication, 93 participants had reached study completion. Some of the challenges faced included exhausting the study pool earlier than expected, staff turnover, and slow process of culture change within the centers.

Conclusions: 

This article discussed the methods of an ongoing randomized clinical trial of VR approaches among veterans with SCI. Strengths of the study design include repeated measures to evaluate employment across time, inclusion of benefits-counseling, and ongoing fidelity monitoring of the treatment conditions. Before the study, the researchers concluded that there was a lack of attention to identifying or addressing vocational issues in the treatment setting. A culture change occurred such that providers began to introduce and explore the topic. In this study, the recruitment relied on clinical providers' willingness to broaden their definition of rehabilitation to include vocational issues. The preliminary baseline data from this sample showed that the majority (72%) had never been employed postinjury.

URL: 
http://www.rehab.research.va.gov/jour/09/46/7/Ottomanelli.html
NIDILRR Funded: 
Peer Reviewed: 
Yes

A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Authors: 
Man, D. W. K., Poon, W. S., & Lam, C.
Year Published: 
2000
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
81
Number: 
8
Pages: 
1007-1015
Publisher: 
Elsevier
Background: 

The present study tested a Medical/Vocational Case Coordination System (MVCCS) designed for persons with brain injury. The MVCSS, which was based on knowledge gained from the research literature and from clinical experience in medical and vocational rehabilitation for persons with BI, emphasize early intervention and coordinated service delivery through integrated medical center based and community-based services. Early intervention was emphasized to reduce the time between injury and community reintegration and to reduce the associated psychosocial complications that may result from lack of early intervention. The MVCCS was expected to maximize participants vocational and independent living outcomes and to minimize the use of medical and community resources.

The researchers review of previous research supported the belief that an intervention system for improving vocational outcomes of persons with BI must include these features: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) temporary or long-term supported employment in appropriate cases. To be viable, the system must significantly improve on the benchmark of 60% unemployment with results at least equivalent to those of earlier intervention studies; that is, approximately 75% of participants in community-based employment: approximately 50% working without long-term supports and approximately 25% in long-term, community-based, supported employment or in educational or training programs. They studied vocational outcomes of the MVCCS over a 4-year period.

Purpose: 

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. The study design evaluated 2 hypotheses. The first hypothesis was that vocational outcomes will meet or exceed those reported previously, that is, (1) 75% of participants in community-based independent or supported community-based employment or education/training programs (Vocational Independence Scale [VIS] levels 3 to 5); and (2) 50% of participants in independent community-based employment (VIS level 5). The second hypothesis was that vocational outcomes will be related to (1) severity of injury, (2) severity of impairment/disability, (3) ISA, (4) time since injury, (5) presence of additional non-brain injuries, and (6) preinjury educational/vocational status.

Setting: 

The setting was a large urban medical center.

Sample: 

One hundred fourteen Minnesota residents with traumatic or other acquired brain injury between the ages of 18 and 65 years. The majority (or 64%) had TBI followed by CVA (26%) and other (10%). The largest portion (36%) of the sample was referred for vocational services through outpatient rehabilitation evaluations. Severity of injury was classified only in TBI cases, based on results of available initial Glasgow Coma Scale (GCS) score and duration of loss of consciousness (LOC) at the time of injury; 56% were classified as severe TBI. Among all participants N=114, the majority (61%) were male. Mean age was 37.4. Preinjury education was less than 12 (22 %); 12 to 15 years (61%) and greater than 16 years (17%). Sixty nine percent were working prior to injury and 77% had an independent living status. The mean time since injury for the group was 65.5 months with a median of 12.7 months.

Data Collection: 

Vocational outcome at time of initial placement and at 1-year follow-up was measured using the Vocational Integration Scale. The Mayo-Portland Adaptability Inventory (MPAI), a scale based on the Portland Adaptability Inventory was used for rating the range of physical, cognitive, emotional, and social impairments and disabilities resulting from BI. It was completed by rehabilitation staff, the patient and a significant other. Rating scale (Rasch) analyses of the Staff MPAI based on 305 assessments led to a reduction in the number of items from 30 to 22 by eliminating non-contributing items. An indicator of Impaired self-awareness ISA was item 24 from the Staff MPAI, which rates level of indifference or lack of awareness of deficits. The second indicator of ISA used was the difference between the Rasch-converted score for 22-item Staff MPAI and the Rasch-converted score for the 22-item Survivor MPAI. Preinjury vocational status, the presence of other non-brain injuries, time since injury, and the Rasch-transformed Staff MPAI appeared to have some value in predicting the level of initial vocational placement. At 1-year follow-up, vocational status was predicted by time since injury and Rasch Staff MPAI. The VIS at initial placement also significantly predicted VIS at follow-up (Spearman coefficient 5 .75, n 5 101, p, .0001). The efficiency of services (i.e., months to placement) was significantly predicted by preinjury education, injury severity, time since injury, Rasch Staff MPAI, Rasch Survivor MPAI, and the difference between the Rasch Staff MPAI and Rasch Survivor MPAI. To control for experiment-wise error, potential predictor variables were further scrutinized using regression analyses.

Intervention: 

The MVCCS interfaced a medical center based BI Nurse Case Coordinator (NCC) with a medical-center based BI Vocational Case Coordinator (VCC) who served as a liaison to community-based services. This interface provided: (1) early identification by the NCC of individuals needing medical
services, medical rehabilitation, vocational rehabilitation, and social services; (2) late identification of other persons with chronic impairments after BI and their service needs by either the NCC or the VCC; (3) personal vocational counseling, consumer advocacy, and on-site consultation to other vocational services provided by the VCC; (4) access to community-based vocational services through the VCC that included: vocational evaluations, supported work trials, long-term community- based supported employment, job coaching, job development, and job placement; (5) access to other community based services that support employment, such as independent living services, community-based social services and mental health services, and traumatic brain injury (TBI) waivered services, including behavioral aide services; and (6) access to medical center services that enhance vocational re-entry for persons with BI, such as a CI day rehabilitation program; a 3-hour weekly community reintegration group; individual cognitive rehabilitation; medical rehabilitation services such as standard rehabilitation therapies, work hardening, and physical work assessments; neuropsychological and psychiatric services, including psychotherapy, family therapy, behavioral medicine, and substance abuse treatment; and other medical diagnostic and therapeutic services, including psychiatric and behavioral neurology services.

In the day-to-day operation of the MVCCS, the NCC, working with emergency room staff, identified all brain-injured
persons admitted to the hospital each working day and served as case coordinator for these cases. She reviewed the medical record, met with the patient, recommended additional services to the primary medical service, obtained consent, and entered participants into the clinical database. The NCC followed the patient after dismissal from acute care. If the patient left from acute care to home, she followed up by telephone within 1 month to identify potential BI sequelae and service needs and to assist in scheduling required services. If the patient left acute service to the rehabilitation unit, the NCC turned medical case coordination over to the rehabilitation social worker. In all cases referred, the VCC met with study participants and obtained consent for study participation, provided all appropriate vocational evaluations and counseling, completed the Staff MPAI with input from other involved rehabilitation staff, obtained the Survivor MPAI, and referred appropriate participants to community-based vocational services. The VCC followed up on each participant 1 year after the person was placed or left the project.

Control: 

There was no comparison condition. Participants served as their own controls.

Findings: 

he MVCCS evaluated in this study appeared to substantially improve employment outcome for persons with BI without interventions. Results were better than projections based on the previous literature 80% of those served were placed in community-based work with 46% in independent community-based employment. Employment outcomes for persons who received vocational services through this project approached or exceeded outcomes reported previously for intensive rehabilitation interventions. Just as importantly, initial vocational placements were maintained at 1-year follow-up. At the follow-up interview, 81% were working in the community and 53% were employed independently without job supports. Although the results were equivalent to those of other rehabilitation programs that are based on best practices the authors could not make direct comparisons with those programs because we did not investigate specific interventions. Primary predictors of initial placement in the present study were time since injury and overall impairment/disability as measured by the Staff MPAI. Return to previous work should be considered especially for the more recently injured who have retained ties to their previous employer. Results indicate that more severe impairments and disabilities, as measured by the MPAI, are significant barriers to employment in the general population of persons with BI. However, for persons with TBI, the presence of additional non-brain injuries appears to be a more important factor.

The best predictor of employment level at 1-year follow-up was the level of initial placement. ISA (as measured by the difference between Rasch Staff MPAI and Rasch Survivor MPAI) did not contribute to the prediction of either initial placement or job maintenance. This finding is inconsistent with some other studies reporting an association between ISA and long-term employment after BI. The results suggest that ISA may be a barrier to employment that can be overcome through rehabilitation, through education and support for employers, and by discriminating placement of those persons with ISA in work environments that are more tolerant of limitations in self-awareness. Overall level of impairment and disability also appears to be a factor in time required for placement. In some cases, more intensive rehabilitation efforts, such as a CI day rehabilitation program, were required for more severely disabled persons so they could develop cognitive compensation, communication, behavioral self-management, social, and other pre-vocational skills required for eventual placement. Because of the time required for participation in such an intensive rehabilitation program, most individuals who participated in CI day rehabilitation required 6 to 12 months from the time they were admitted to services to their eventual placement. Our data suggest that most placements (92%) can be made within 1 year of admission to services. Preinjury years of education also contributed slightly to prediction of time to placement, with more highly educated individuals being placed more quickly.

Conclusions: 

Introducing a VCC into an MVCCS program appears to optimize participants vocational outcome after BI, resulting in community-based employment for 81% of persons served with 53% working independently in the community 1 year after placement. Time since injury and overall level of impairment/ disability were the most significant factors in predicting vocational outcomes. Beyond its association with overall level of disability and chronicity, ISA did not contribute to the prediction of initial placement or job maintenance. The best predictor of employment status at 1 year follow-up was the level of initial placement. Persons with greater overall disability required more extended time and more extensive rehabilitation services before job placement.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10943747
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

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

Success in the workplace following traumatic brain injury: Are we evaluating what is most important?

Authors: 
Lidz, V., Sorrentino, D. M., Robison, L., & Bunz, S.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
5
Pages: 
290-298
Publisher: 
Informa Healthcare
Background: 

Vocational outcome is one of the most important indicators of rehabilitation following a traumatic brain injury. Specifically, types of paid vocations, especially full-time work, are often viewed most favorably as a sign of success. The factors related to this perception of success are vast.

Purpose: 

This study aims at evaluating whether or not the common perceptions of success are in line with those factors that those individuals undergoing rehabilitation for traumatic brain injury (TBI) view as most indicative of progress following an injury.

Sample: 

The study sample included 4 males and 3 females between the ages of 26-51. Six were Europeans and one was of Maori descent. Participants had memory loss of one day to months. All were one year post injury.

Data Collection: 

Open-ended interviews with minimal prompting were taped and transcribed. They were then read and coded with comparisons to other interviews taking place at the same time. The transcripts were then sent to the participants for verification of accuracy.

Intervention: 

The effects of returning to full-time paid employment on the feeling of success, impact on non-working lives, feelings of productivity and ability to sustain employment.

Control: 

There was no control or comparison condition.

Findings: 

The results indicated that while participants view return to work as an important goal of rehabilitation following TBI, they also valued other means of feeling successful , not having a stressful work life affect their personal life, and feeling successful without full time pay (previously considered the goal) to be of near equal importance.

Conclusions: 

While paid employment is important, the work must also provide feelings of productivity and success. The researchers also feel evaluation of these individuals should take more subjective factors into consideration of their "success" of rehabilitation.

URL: 
http://www.worksupport.com/kter/documents/pdf/LevackRTWafterTBI.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
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: 
37
Number: 
4
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., 8–10 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: 
NIDILRR Funded: 
Research Design: 
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: 
84
Number: 
2
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
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment for young adults with autism spectrum disorder: Preliminary data

Authors: 
Wehman, P., Schall, C., McDonough, J., Molinelli, A. Riehle, E., Ham, W., & Thiss, W.
Year Published: 
2012
Publication: 
Research & Practice for Persons with Severe Disabilities
Volume: 
37
Number: 
3
Pages: 
160-169
Publisher: 
Tash Publishing
Background: 

There is extremely limited information about using a supported employment approach to assist individuals with autism with gaining and maintaining employment in the community. Among the few studies that do exist, most are descriptive in nature. More research is needed.

Purpose: 

This study took a close look at the work histories of individuals with ASD over a 23 month period of time. The purpose was to examine the effects of supported employment in assisting them with employment.

Setting: 

The setting included a variety of different workplaces. This included: health care field, retail, recreational and educational field, food service and janitorial industry.

Sample: 

Thirty three individuals with ASD were included in the study. Each was referred for supported employment services by a vocational rehabilitation counselor. The majority were white (76%) and males (76%). The average age of participants was 22 years old. Seventy percent of the individuals reported a secondary disability. All participants had received a high school diploma or equivalency diploma. Around 40% had some college. Over 90% had either no or short intermittent work histories. More than three fourths had high social interaction support needs. Notably close to a third or 13 individuals had participated in a extended work internship at a hospital that was modeled after the Project SEARCH approach.

Data Collection: 

Employment specialist traced actual time spent either directly or indirectly working for the person with ASD across various types of supported employment interventions. This included developing a vocational profile about the person served, developing a job, job site training, and long term supports to enhance job retention. All data were stored in password protected database. The employment specialist's intervention time and participant outcomes were aggregated across the group of participants and over time.

Intervention: 

The intervention was individualized supported employment services. This is an approach that supports one person at a time with gaining and maintaining work in a real job for real pay in the community.

Control: 

There was no control. Due to the exploratory nature of the study no comparison group was used.

Findings: 

Twenty seven or 82% of those served went to work in an entry level occupation. They earned between $7.25 and $10.50 per hour.Mean hours worked was 23 per week.The average intervention time for various interventions was as follows:completing a job seeker profile was about 9 hours; job development around 30 hours (notably some of the individuals went to work where they interned which reduced the hours needed to develop a job); job site training and support 107 hours; and long term support 27 hours.

Conclusions: 

An individualized supported employment approach can assist individuals with ASD with gaining and maintaining employment. More research is needed.

URL: 
http://rps.sagepub.com/content/37/3/160.full.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes