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: 
39
Number: 
13
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 29–59). 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
NIDILRR Funded: 
Peer Reviewed: 
Yes

Influence of least restrictive environment and community based training on integrated employment outcomes for transitioning students with severe disabilities.

Authors: 
Wickizer, T. M., Campbell, K., Krupski, A., & Stark, K.
Year Published: 
2004
Publication: 
Journal of Vocational Rehabilitation
Volume: 
21
Number: 
3
Pages: 
149-156
Publisher: 
IOS Press
Background: 

In light of the data supporting the education of individuals with severe disabilities in natural contexts, it stands to reason that programs would no longer provide training in contexts other than those that result insurable employment opportunities. However, this continue to occur. Even with mandated transition planning integrated employment outcomes are not improving for students with severe disabilities. Many of these students will then enter the public welfare system and/or segregated adult programs.

Purpose: 

The purpose of this study was to identify variables that are correlated with successful integrated employment outcomes for transitioning students with severe disabilities.

Setting: 

The setting included 20 different schools sites within 12 school districts in a county in California.

Sample: 

The sample included 104 students with severe disabilities, ages 18-22, who had exited school without diploma. Close to half (48%) of the participants had an IQ that placed them in the profound (25%) or severe (23%) category. The majority of the participants were white (53%), followed by Hispanic (28%), Asian (13%),African American (4%) and Pacific (2%). Around 53% of the students were males. Around 80% of the participants lived at home; the others lived in group homes.

Data Collection: 

The specific variables measured in this study included: the influence of duration of community-based training (CBT) that included on-the-job training, on the-job training as a subset of CBT, the least restrictive environment (LRE), or the degree of integration with non-disabled peers during the school day, demographics(gender, ethnicity, home setting, behavior problems, physical disability and mental ability) as measured by
intelligence quotient (I.Q.).Data was collected by structured interview with teachers and administrators, record review and on site observations. Correlations were used to examine predictive relationships between the independent variables and the dependent variable of post-school integrated employment. Cross tabulations and chi-square analysis of correlated variables were then used to identify significance of specific variables on employment outcome.

Intervention: 

The intervention was community based training. This included on the job training and physical integration with non disabled peers.

Control: 

There was no comparison or control group

Findings: 

These data indicate significant interactions between community based training (r = 0.387, p < 0.001), degree of integration with typical peers (r = 0.360, p < 0.001), andon-the-job training (r = 0.305, p = 0.001) and employment outcome. There were also strong intercorrelations among the three variables of CBT, degree of integration or LRE and on-the-job training.Transitioning students who received CBT and on the job training had a 69% integrated employment rate after leaving school.

Conclusions: 

The combinations of least restrictive environments,CBT/on-the-job training, and innovative teacher advocacy are potent predictors of post school employment for students with severe disabilities, regardless of intellectual functioning.

URL: 
http://www.kcdsg.org/files/content/Cheryl%20Jorgensen_Influence%20of%20LRE%20on%20Outcomes.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of engagement in vocational counseling for methadone treatment patients

Authors: 
Kemp, K., Savitz, B., Thompson, W., & Zanis, D. A.
Year Published: 
2000
Publication: 
Substance Use and Misuse
Volume: 
41
Number: 
8
Pages: 
1125-1138
Publisher: 
Informa Healthcare
Background: 

Employment enhances the outcomes of substance dependency treatment. Although unemployed methadone treatment patients frequently state they are interested in a job, many fail to participate in vocational services when available. Unless patients become engaged, vocational services do not have an opportunity to be effective.

Purpose: 

The purpose of this study is to examine a broad array of variables that may be associated with differential engagement in vocational services among methadone patients, including the availability of a special vocational program that emphasized outreach to ambivalent patients. The ?ndings are intended to inform recommendations to improve engagement of methadone patients in vocational services.

Setting: 

The setting was two methadone maintenance clinics in Manhattan in New York City.

Sample: 

The study sample consisted of 211 patients of the two clinics. The criteria for inclusion were unemployed or underemployed at study entry, stabilized on methadone dose, negative urine toxicology for both opiates and cocaine for the patient‚ last four weekly urine tests, and no physical or mental condition or caretaker responsibilities that would absolutely preclude employment Nearly three of the study participants were male, and a majority (75%) was non-white, with an average age of 45 years.

Data Collection: 

Participants were interviewed at study entry using a computer-assisted personal interview constructed with the Questionnaire Development System. In addition to the interview data, a vocational activities log that included information on vocational services provided and patients vocational outcomes during the period of service was recorded by the vocational counselors. Chi-square tests, t-tests, and logistic regression analyses were used for bivariate analyses. Multiple logistic regression was used for multivariate analysis.

Intervention: 

The experimental vocational program, Customized Employment Supports (CES), offered more individualized counseling than traditional services. Patients were expected to participate in up to three sessions per week at the start, which was made possible by limiting CES counselors caseloads to 15 active cases. The emphasis was on establishing a therapeutic alliance, overcoming both vocational and non-vocational barriers to employment, and enhancing patients' self-efficacy and motivation to work.

Control: 

The control group received the clinics standard vocational programs. In both clinics this consisted of individual and group vocational counseling depending on the needs and desires of the patients. These activities included initial assessment, helping with resume preparation, and workshops on topics such as job readiness and interviewing skills.

Findings: 

Thirty percent of the sample was de?ned as engaged, that is, had 5 or more in-person sessions with their counselors during the ?rst 6 months after study induction. Those who became engaged with vocational services were more likely to be non-Hispanic, with high school education or beyond, had ever injected drugs, had ever used crack, experienced a drug overdose, had reported emotional chronic problems and scored relatively high on depression and psychological distress, had ever attended Anonymous groups, had previously enrolled in
methadone two or more times, had been exposed to hepatitis B or C, and had positive attitudes toward employment. Relative to the intervention more engagement was found among CES than standard vocational program participants. The CES intervention was also the strongest predictor of engagement in the multivariate analysis.

Conclusions: 

Methadone treatment is a challenging environment for vocational counseling. The CES model suggests a new approach to increasing active participation of unemployed patients in vocational services, without which no service can be effective. In addition, the acceptance rate of the model was high among patients.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16798680
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of employment outcomes for state-federal vocational rehabilitation consumers with HIV/AIDS

Authors: 
Kang, S., Magura, S., Blankertz, L., Madison, E., & Spinelli, M.
Year Published: 
2010
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
53
Number: 
3
Pages: 
175-185
Publisher: 
Sage
Background: 

As the widespread use of potent combination antiretroviral therapy has improved their health and longevity, people with HIV/AIDS have increasingly focused on entering or reentering the workforce. Despite their growing interest in and need for employment, however, many persons living with HIV/AIDS have faced barriers to employment, remained unemployed, in need for vocational rehabilitation (VR) services. Little research is available regarding individuals with HIV/AIDS service by the VR system.

Purpose: 

The purpose of this study was to investigate the effect of demographic, medical, and service variables on employment outcomes for persons with HIV/AIDS who received State-Federal VR services.

Setting: 

This study included individuals with HIV/AIDS served by multiple vocational rehabilitation agencies in various settings.

Sample: 

The study sample consisted of 1,178 individuals with a primary diagnosis of HIV/AIDS who were clients of the State-Federal VR services in 2006, and who were closed either successfully or unsuccessfully.

Data Collection: 

The RSA-911 database includes client demographic and historical information, case service information, case expenditures, and service outcomes. Data are submitted to the RSA-911 database at case closure. A logistic regression model was employed to estimate the contribution of each predictor variable while simultaneously taking other predictor variables into account and was tested across the two random groups of participants to assess the generalizability of the model.

Intervention: 

The study included client demographic variables, disability variables, and intervention variables. The intervention variables consisted of the 10 VR service codes contained in the RSA-911 database. In addition, a variable was created for training service, which would include participation in any training activity, including higher education, vocational/technical training, etc.

Control: 

This study did not include a control or comparison group. Comparisons were made between those who were successfully rehabilitated and those who were unsuccessful.

Findings: 

Four service-related variables were found to be predictive of successful rehabilitation: Job placement assistance, on-the-job supports, months in VR program (12–23 months, 24–35 months, and 36–162 months), and service expenditures ($2,001–$4,500 and $4,501–$65,000). Of the four predictive variables, on-the-job supports was one of the most important variables that contributed to the prediction of a successful employment outcome. Provision of job placement assistance and on-the-job supports increased the probability of achieving employment by 2 to 4 times.

Conclusions: 

This study underscores the importance of job placement assistance and on-the-job supports (e.g., job coaching, follow-along, job retention services) in employment success of VR clients with HIV/AIDS. The authors note that these individuals may have been unemployed for a long period since they left their job after an HIV/AIDS diagnosis. Thus, they might be unsure of their readiness for a job, what types of jobs match with their skills and preferences, and how to find job information and job leads. Rehabilitation counselors can assist individuals with HIV/AIDS who need to discuss work-related issues and make more informed decisions about accommodation needs and requests that can enhance job retention.

URL: 
http://rcb.sagepub.com/content/53/3/175.short
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness

Authors: 
Graham, C., Inge, K., Wehman, P., Murphy, K., Revell, W. G., & West, M.
Year Published: 
2006
Publication: 
Schizophrenia Bulletin
Volume: 
32
Number: 
2
Pages: 
378-395
Publisher: 
Oxford University Press
Background: 

Urban Based randomized clinical trials of integrated supported employment and mental health services in the United States on average have doubled the employment rates for adults with severe mental illness compared to traditional vocational rehabilitation. However, studies have not explored if the service integrative functions of supported employment will be effective in coordinating rural based services.

Purpose: 

Study designed and implemented a program blending Assertive Community Treatment (ACT) with a supported employment model using Individual Placement and Support (IPS) in a rural setting. In a 24 month randomized controlled trial, the ACT_IPS approach was compared to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults for serious mental illness.

Setting: 

Sumter County South Carolina catchment area of the South Carolina Department of Mental Health served by the Santee-Wateree Community Mental Health Center. Population = 102,000; African American (47%), White (49%)

Sample: 

Study sample met the federal Center for Mental Health Services criteria for severe and persistent mental illness. All were age 18 or older and unemployed at time of study entry. All had been a client of the Santee-Wateree Community Mental Health Center (SWCMHC) for at least 6 months.

Data Collection: 

Data collection and analysis addressed five key questions: (1) What obstacles would a rural South Carolina setting posed to implementing and sustaining ACT-IVR and IPS model? (2) How do the competitive work outcomes of the ACT-IVR and IPS programs compare to a traditional program providing parallel services in a rural economy? (3) How are overall work outcomes affected by differing strategies for obtaining employment? (4) How do rates of income earned from competitive employment change over time by program? (5) How do the programs' work outcomes compare after controlling for the number of participants' service contacts?

Intervention: 

Intervention was a fully integrated combination of Assertive Community Treatment with Integrated Vocational Rehabilitation (ACT-IVR)and Individual Placement and Support (IPS). ACT-IVR tightly integrated vocational with mental health services within a self contained provider team. IPS integrated its vocational services with its host agency or another agency's mental health services.

Control: 

Comparison program was a formal partnership between a local vocational rehabilitation agency and the SWCMHC. Program provided parallel traditional vocational rehabilitation and mental health services, respectively. The rehabilitation agency's employment specialists prepare participants for competitive jobs by taking a gradual, stepwise approach that focused on developing skills to manage workplace demands in staff supervised jobs set aside for adults with work disabilities.

Findings: 

More ACT-IPWS participants held competitive jobs and earned more income than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs.

Conclusions: 

The ACT-IPS program aided persons with serious mental illness-related work impairments, limited job experience, and tremendous educational and economic disadvantage to attain competitive work outcomes on a par with the urban supported employment programs cited in the literature. the ACT-IPS service-coordinating functions and immediate attention to competitive work may have been key processes that overcame rural-area obstacles to receipt of appropriate services and to labor market participation. However, the earnings generated fall far short of economic independence. It is recommended that barriers to accessing higher education for adults with SMI in rural areas must be reduced, with more of a focus placed on career-oriented job opportunities providing a means to develop highly marketable technical skills.

URL: 
http://schizophreniabulletin.oxfordjournals.org/content/32/2/378.full.pdf+html
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

The relation between VR services and employment outcomes of individuals with traumatic brain injury

Authors: 
Garcia-Villamisar D., & Hughes C.
Year Published: 
2003
Publication: 
Journal of Rehabilitation
Volume: 
69
Number: 
3
Pages: 
31-38
Publisher: 
National Rehabilitation Association
Background: 

Individuals with severe traumatic brain injury (TBI) have poor vocational outcomes. Post injury employment rates have ranged between 22% to 55%. Many studies have looked at predictors for employment outcomes for this group. Other studies have looked at neuropsychological functioning, severity of injury, demographic characteristics, length of time from injury and return to work, assistive technology and rehabilitation outcomes. However, there are no studies about vocational rehabilitation services impact on employment outcomes for individuals with TBI.

Purpose: 

The purpose of this study was to examine the relationships between the provision of six rehabilitation services and vocational outcomes for individuals with TBI. The research questions included: How many participants received assessment, college, counseling and guidance, job placement, restoration and work adjustment services? Are assessment, college, counseling and guidance, job placement, restoration and work adjustment services significantly related to closure status? Are there significant differences in weekly earnings based on the provision of assessment, college, counseling and guidance, job placement, restoration and work adjustment services?

Setting: 

This study included individuals with TBI served by multiple vocational rehabilitation agencies in various settings.

Sample: 

The study sample included 1,073 individuals with TBI who received state vocational rehabilitation services from a southeastern state and whose cases were closed in either competitive employment or non-rehabilitated from 1992 to 2000. Forty nine percent of the participants were competitively employed when there case was closed by state vocational rehabilitation (VR) and 51% were not. The majority (89%) reportedly had a severe disability. Most were single (79%), Caucasian (78%), and male (70%). The ages ranged from 16 to 71 years. The majority had 11 years of education or better. At the times of services 91% reported no prior work experience.

Data Collection: 

A number of variables were examined in the study. This included: successful employment outcome, hours worked and wages and the cost of services. Data was pulled for all of the United States. Washington DC and US territories were excluded. Data from each state and year was reported for each study question. In order to identify trends data from 2002 to 2006 was compared to 2007 to 2011 and regression analysis was used to evaluate the data. Mean data for the total transition population served by VR was compared to the ASD group and t test statistics were used to compare outcomes between the two groups.

Intervention: 

The interventions included six vocational rehabilitation services. This included: assessment, college, counseling and guidance, job placement, restoration, and work adjustment services.

Control: 

There was not control or comparison condition.

Findings: 

Counseling/guidance was the most frequently provided services (89%). VR services identified as positive predictors of closure status were: college, counseling/guidance, and job placement services. The odds of obtaining competitive employment after receiving college services was 5.21 times the odd for those not receiving services. The odds of obtaining competitive employment for those receiving counseling/guidance services was 3.03 times greater than those who did not receive the services and the odds of competitive employment among those who received job placement services was 20.77 times greater than those who did not. Notably, work adjustment was a significant negative predictor of closure status. Individuals who did not receive assessment or college services had higher earnings than those who receive college services alone. When job placement services were not provided the effect of college training on mean weekly earnings was different at each level of assessment.

Conclusions: 

College, counseling/guidance and job placement services were significantly and positively related to closure status.
Work adjustment services were inversely related to weekly earnings for competitively employed individuals and assessment, college, and job placements services interacted significantly on weekly earnings of those competitively employed. Job placement is the most important positive predictor of closure. Rehabilitation counselor education and training should focus on job placement services. College training benefited an small number of individuals in the sample. Additional research is needed to investigate the relationship between VR services and employment outcomes for individuals with TBI.

URL: 
https://www.questia.com/library/journal/1G1-106646165/the-relation-between-vr-services-and-employment-outcomes
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Enrollment in supported employment services for clients with a co-occurring disorder

Authors: 
Fuller, T. R., Oka, M., Otsuka, K., Yokoyama, N., Liberman, R. P., & Niwa, S.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
5
Pages: 
545-547
Publisher: 
American Psychiatric Association
Background: 

People with serious psychiatric disorders often experience "co-occurring substance use disorders" (p. 545). Therefore, they require integrated services and employment offers "a meaningful activity that supports recovery" (p. 545).

Purpose: 

The study examined "the relationship between co-occurring disorders and enrollment in supported employment services among clients with serious mental illness" (p. 545).

Setting: 

The setting was Thresholds Psychiatric Rehabilitation Centers in Chicago Illinois.

Sample: 

The study sample included 1,748 clients who were admitted to Thresholds services between January 2008 and December 2009 (p. 545).

Data Collection: 

Data was retrieved from electronic medical records at Thresholds Psychiatric Rehabilitation Center in Chicago and analyzed for clients admitted during a 2-year period.

Intervention: 

The intervention was supported employment for people with chronic mental illness with co-occurring substance use disorders.

Control: 

The comparison condition was supported employment for people with chronic mental illness without substance use disorders.

Findings: 

Clients with a co-occurring substance use disorder were 52% less likely to enroll in a supported employment program. However, of those that did enter the program, the competitive employment outcomes for both groups was similar.

Conclusions: 

People with chronic mental illness and co-occurring substance use disorders are interested in competitive employment; however, they have difficulty accessing supported employment programs and are successful once they do.

URL: 
http://www.worksupport.com/kter/documents/pdf/EnrollmentinSupportedEmployment.pdf
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Effect of job skills training on employment and job seeking behaviors in an American Indian substance abuse treatment sample

Authors: 
Fong, C. J., Murphy, K. M., Westbrook, J. D., & Markle, M. M.
Year Published: 
2010
Publication: 
Journal of Vocational Rehabilitation
Volume: 
33
Number: 
3
Pages: 
181-192
Publisher: 
IOS Press
Background: 

Employment problems are often significant in American Indian communities. Barriers such as historically high unemployment rates or a lack of job finding skills may contribute to lower than expected job skills and career development. Likewise, unemployment is high for those with substance abuse disorders. There is little empirical research addressing interventions for American Indians with substance abuse disorders for improving employment status.

Purpose: 

The purpose of this study was to implement the Job Seekers Workshop (JSW), a 12-hour job search-training program, in an American Indian addiction treatment program, and to evaluate its outcomes in comparison to the Job Interview Videos (JIV), a 40-minute two-part video.

Setting: 

The study setting was the Na Nizhoozhi Center (NCI) in Gallup, NM. The NCI is a 150-bed facility that provides culturally specific treatment programs to meet the needs of American Indian.

Sample: 

The study sample consisted of 102 individuals with American Indian heritage who were drug and/or alcohol dependent, 18 years of age or older, enrolled at NCI for at least 10 days, categorized as either unemployed (i.e., not having worked at all for the month prior to study recruitment) or underemployed (i.e., having worked no more than 20 hours/week in any
given week during the past month), and interested in obtaining a job. The majority were Navajo males.

Data Collection: 

The measures included several standardized instruments measuring addiction severity, current use of substances, reading ability, and life experiences. Employment information was captured using the Timeline Follow Back for Employment (TLFB-E). Two variables served as primary outcomes: 1) time (number of days) to employment, either a new taxed job or enrollment in a job-training program within the follow-up period, and 2) total hours either working or enrolled in a job-training program within the time period. Time to employment and time to enrollment in a job-training program were tested using the Cox Regression procedure. Analyses addressing the number of participants reporting employment or enrollment in a training program were conducted using Chi-square tests. Analyses focused on hours spent working or in training were conducted using an analysis of variance (ANOVA). Comparisons based on repeated measures over time were tested using multivariate repeated measures analyses of variance (MANOVA).

Intervention: 

Two interventions were tested. First, the Job Seeker‚ Workshop (JSW) is a standardized 12-hour job search-training program designed to increase job-seeking skills, particularly interviewing. The program consists primarily of focused, individual instruction with videotaped feedback for group discussion. The Job Interviewing Video (JIV) is a 40-minute instructional video related to answering job interview questions, including difficult questions.

Control: 

The study used a two-group comparison design.

Findings: 

There were no significant differences between the JSW and JIV groups at baseline, nor were there differences in completion time of the program or time to employment at either three or six months following completion or in job-seeking behaviors. A significant difference was found on enrollment in a training program, with more participants who were involved in the JIV intervention enrolled in a training program than in the JSW intervention. Satisfaction was rated relatively high for both programs. There were also no differences in substance use post-completion, with both groups reporting reduced use.

Conclusions: 

Although both groups showed some gains in employment from baseline to follow-up, overall rates of employment remained low at follow-up, averaging less than 50 total hours worked within the first three months following randomization. However, positive changes were observed related to substance use. Significant differences in the primary outcomes were not detected between the JSW and JIV interventions

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr526
NIDILRR Funded: 
Peer Reviewed: 
Yes

Providing effective employment supports for persons living with HIV: The KEEP project

Authors: 
Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong
Year Published: 
2005
Publication: 
Journal of Vocational Rehabilitation
Volume: 
22
Number: 
2
Pages: 
105-114
Publisher: 
IOS Press
Background: 

The Kirk Employment Empowerment Project (KEEP) was a three-year demonstration project funded by the Rehabilitation Services Administration (RSA) to test strategies for improving employment outcomes of individuals with HIV/AIDS. KEEP sought to identify and test service strategies that would be effective for individuals who have multiple barriers to employment, and individuals from populations that are typically underrepresented in HIV/AIDS research.

Purpose: 

The purposes of this article are to (1) describe the KEEP model and (2) provide data regarding program outcomes.

Setting: 

The study setting was the Horizon House, a treatment center for individuals with HIV/AIDS in Philadelphia, PA.

Sample: 

The study sample was 148 individuals who were referred to and accepted for KEEP services. The sample was predominantly African-American (72.3%) and male (60%). A substantial proportion had co-occurring disorders, with over a third report a psychiatric disorder.

Data Collection: 

Employment tracking data were collected for each participant upon job start, significant job changes, and job end. Initial baseline interviews were conducted by research staff with each participant to obtain demographic data and income, motivation to work and satisfaction with life issues in general as reflected by participants responses to quality of life items. Follow-up interviews were conducted at 6-month intervals for the duration of the project. Descriptive statistics were used to report outcomes for participants.

Intervention: 

The KEEP model emphasizes rapid attachment in the workforce and expecting participants to do as much for themselves as possible with support. Among the specific individualized services offered by ESC‚ were assessment and evaluation, job search assistance, benefits and legal counseling, disability management education, on-site job support (such as help negotiating with an employer), job-related problem-solving, specific skills training (such as learning to use public transportation), referral to auxiliary services, coordination and collaboration with other service providers, and other miscellaneous wrap-around services.

Control: 

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

Findings: 

Of 148 participants in the project, 114 (77%) were employed at some point during the project. They held a total of 278 jobs during the project, averaging 2.4 jobs per participant. Sixty-three percent of participants were employed for 90 days or longer during the project, Earnings ranged from $2.50 per hour to $44.23 per hour, with an average hourly wage of $8.49 (median $7.50/hour). Of the 278 jobs, only 4 paid less than minimum wage. The vast majority of all jobs obtained (87.4%) did not include any benefits at any time.

Conclusions: 

The fact that they achieved such high employment rates in the KEEP project supports the evidence that for people with a variety of disabilities, a history of competitive employment, no matter how limited, can be considered an indicator for future employment success. Employment also contributed to improved health and physical functioning.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00278
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The future of supported employment for people with severe mental illness

Authors: 
Drake, R. E., McHugo, G. J., Bebout, R. R. Becker, D. R., Harris, M., Bond, G. R., & Quimby, E.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
31
Number: 
4
Pages: 
367-376
Publisher: 
American Psychological Association
Background: 

People with psychiatric disabilities have been able to be competitively employed using supported employment. However, limits to supported employment include: not everyone with psychiatric disabilities wants to work; people are afraid of losing benefits; they lack confidence; they receive little reinforcement from their counselors; or they may not receive the help they need. In addition, finding competitive employment may be difficult due to employee illness, inadequate services, and fear of losing benefits.

Purpose: 

The article "reviews current research on innovative attempts to improve the dissemination and effectiveness of supported employment" (p. 367). The intent is to expand the success of supported employment.

Setting: 

This is a review of literature. The included studies were undertaken in various locations and settings.

Sample: 

he sample included published literature in MEDLINE, PubMed, PsychlNFO, and Scopus; currently funded grant titles, such as NIMH, NIDILRR, and the Social Security Administration. The researchers also discussed the current research with individual investigators.

Data Collection: 

Research was reviewed in each of the 9 areas identified in the Intervention section.

Intervention: 

The review suggests enhancing 9 areas to improve the success of supported employment: "(1) organization and financing of services, (2) disability policies, (3) program implementation and quality, (4) motivation, (5) job development, (6) illness-related barriers, (7) job supports, (8) career development, and (9) new populations" (p. 368).

Control: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

With regard to organization and financing of services, clinical and vocational services should be integrated at the client level, which would offer the client "single team of providers who provide a consistent message" (p. 368). Disability policies actually "socialize people into disability" rather than supporting them. Increasing the quality of vocational services will address several of the areas identified in the Intervention section, in addition to learning to implement, maintain, and update supported employment programs as research becomes available. Motivating people with psychiatric disabilities to work can be difficult, especially with the overwhelming issues they face, such as treatment itself, applying for benefits, obtaining insurance, or societal stigma. Job development is critical to supported employment; none of the approaches mentioned have been studied empirically. Individuals with greater symptoms are less likely to be employed unless vocational and psychiatric services are integrated.

Improving job supports would enhance the employability of the individual, such as increasing the use of natural supports and skills training. Career development implies a pattern of growth and increasing satisfaction in employment over time. And lastly, supported employment was proven as a successful technique in the field of developmental disabilities; it is being evaluated as a technique for use with populations other than those with psychiatric disabilities.

Conclusions: 

Supported employment is an evidence-based practice that needs improvement.

URL: 
http://www.worksupport.com/kter/documents/pdf/FutureofSupportedEmployment.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes