Generalisability of the individual placement and support model of supported employment: results of a Canadian randomized controlled trial | Knowledge Translation for Employment Research Center

Authors:	Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.
Year Published	2006
Publication	British Journal of Psychiatry
Volume	189
Number	1
Pages	65-73
Publisher	The Royal College of Psychiatrists
Background	Studies conducted in the United States have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.
Purpose	The purpose of this study was to determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.
Setting	The study was carried out at a teaching psychiatric hospital in Montreal, Canada. The hospital provides psychiatric treatment and rehabilitation services to people who live within a geographical sector in the south-west of Montreal. In addition to one central facility, which provides in-patient as well as various outpatient services, the hospital operates seven satellite out-patient clinics and a vocational rehabilitation center located about 1 mile from the main facility.
Sample	A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75). To be included in the study, individuals had to: 1. Be between 18 and 64 years of age; 2. Have a diagnosis of schizophrenia-spectrum disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychosis not otherwise specified), bipolar disorder, or major depression; 3. If their principal diagnosis was one of major depression, be classified as disabled due to mental illness by the provincial welfare system; 4. Express interest in competitive employment; and 5. Be unemployed at the time of signing the consent form.
Data Collection	Baseline comparisons In order to assess baseline equivalence of the groups, proportions of categorical variables at baseline were compared according to initial group assignment using 2-tests. Values of continuous measures were compared using either the t-test or, for non-normally distributed variables, the (non-parametric) Mann-Whitney U-test. Vocational outcomes Intention-to-treat analyses were conducted first, including all individuals and time periods for which we had data. Groups were compared on measures pertaining to any paid work (competitive or not) and competitive work only.
Control	Clients assigned to the control group were invited to an interview at the hospital's vocational rehabilitation centre. There they were given an opportunity to sign up for one of the many vocational services normally available. These included sheltered workshops, creative workshops, a client-run boutique and horticultural programmes. Job-finding-skills training, as well as psychosocial interventions administered through two day-treatment centres, were also available. None of these programmes had competitive employment as their immediate goal. In addition, clients could be offered a social integration measure, that is a Quebec government programme that offers clients part-time work in competitive settings, in exchange for a Can $120 top-up to their monthly welfare cheque and a free public transport pass. Finally, clients could also be referred to a non-profit community agency that sought to place clients either in competitive jobs or in government-subsidized adapted businesses, in which wages equal or exceed the legal minimum wage but where the majority of jobs are reserved for people who have disabilities. This agency was not integrated with clinical services, nor did it provide ongoing support to clients, two hallmarks of supported employment.
Findings	Over the 12 months of follow up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P < 0.001). They averaged 126 h of competitive work, v. 72 in the control group (P < 0.001). Conclusions Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.
Conclusions	Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalized to settings in other countries.
URL	http://www.pandora.com/station/play/650824915812121606
Disabilities	Emotional disturbance
Populations	Male & Female \| White / Caucasian
Outcomes	Employment acquisition \| Increase in tenure
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2006

Publication

British Journal of Psychiatry

Volume

189

Number

1

Pages

65-73

Publisher

The Royal College of Psychiatrists

Background

Studies conducted in the United States have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

Purpose

The purpose of this study was to determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

Setting

The study was carried out at a teaching psychiatric hospital in Montreal, Canada. The hospital provides psychiatric treatment and rehabilitation services to people who live within a geographical sector in the south-west of Montreal. In addition to one central facility, which provides in-patient as well as various outpatient services, the hospital operates seven satellite out-patient clinics and a vocational rehabilitation center located about 1 mile from the main facility.

Sample

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).
To be included in the study, individuals had to:
1. Be between 18 and 64 years of age;
2. Have a diagnosis of schizophrenia-spectrum disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychosis not otherwise specified), bipolar disorder, or major depression;
3. If their principal diagnosis was one of major depression, be classified as disabled due to mental illness by the provincial welfare system;
4. Express interest in competitive employment; and
5. Be unemployed at the time of signing the consent form.

Data Collection

Baseline comparisons

In order to assess baseline equivalence of the groups, proportions of categorical variables at baseline were compared according to initial group assignment using 2-tests. Values of continuous measures were compared using either the t-test or, for non-normally distributed variables, the (non-parametric) Mann-Whitney U-test.

Vocational outcomes

Intention-to-treat analyses were conducted first, including all individuals and time periods for which we had data. Groups were compared on measures pertaining to any paid work (competitive or not) and competitive work only.

Control

Clients assigned to the control group were invited to an interview at the hospital's vocational rehabilitation centre. There they were given an opportunity to sign up for one of the many vocational services normally available. These included sheltered workshops, creative workshops, a client-run boutique and horticultural programmes. Job-finding-skills training, as well as psychosocial interventions administered through two day-treatment centres, were also available. None of these programmes had competitive employment as their immediate goal.

In addition, clients could be offered a social integration measure, that is a Quebec government programme that offers clients part-time work in competitive settings, in exchange for a Can $120 top-up to their monthly welfare cheque and a free public transport pass. Finally, clients could also be referred to a non-profit community agency that sought to place clients either in competitive jobs or in government-subsidized adapted businesses, in which wages equal or exceed the legal minimum wage but where the majority of jobs are reserved for people who have disabilities. This agency was not integrated with clinical services, nor did it provide ongoing support to clients, two hallmarks of supported employment.

Findings

Over the 12 months of follow up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P < 0.001). They averaged 126 h of competitive work, v. 72 in the control group (P < 0.001).

Conclusions Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Conclusions

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalized to settings in other countries.

URL

http://www.pandora.com/station/play/650824915812121606

Disabilities

Emotional disturbance

Populations

Male & Female | White / Caucasian

Outcomes

Employment acquisition | Increase in tenure

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes