Generalisability of the individual placement and support model of supported employment: results of a Canadian randomized controlled trial
|Authors:||Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.|
|Publication||British Journal of Psychiatry|
|Publisher||The Royal College of Psychiatrists|
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.
The purpose of this study was to determine the effectiveness of the individual placement and support (supported employment) model in a Canadian 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.
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).
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.
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.
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.
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.
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.
|Populations||Male & Female | White / Caucasian|
|Outcomes||Employment acquisition | Increase in tenure|
|Research Design||Randomized Controlled Trials (RCTs)|