Over the last few decades, major developments have occurred in evidenced based practice supported employment (SE) services for people living with diagnoses of severe mental illness. However, the differential effectiveness of SE for different age groups of people in recovery is not well-studied. A group with particular need for employment services are youth age 18-24 and young adults ages 25-30 living with mental illness.
The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes.
Data are from the Employment Intervention Demonstration Program (EIDP), a multisite randomized controlled trial of SE among 1,272 individuals with psychiatric disabilities in 7 states. The study uses 24 months of data from EIDP participants in seven states (AZ, CT, ME, SC, MA, TX, and MD)
EIDP participants were recruited from existing clinical populations via case manager referral, self referral, word of mouth, and at one site, newspaper advertisements. Participants were as those meeting the following inclusions criteria: being 18 years or older at time of study enrollment, being willing and able to provide informed consent, having an Axis I DSM-IV diagnosis of mental illness, and being unemployed at time of entry into the study.
Literature search included a combination of strategies, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.
At each site, the experimental condition was a form of enhanced best-practice supported employment compared to either services as usual or an unenhanced version of the experimental model. For example, The Maryland, Connecticut, and South Carolina sites tested the individual placement and support model in which multidisciplinary provider teams engage in minimal pre-vocational assessment, rapid job search, and placement into competitive jobs, with the provision of training and ongoing follow-along support for as long as the patient requests it.
As with many multisite studies, the nature of the comparison conditions varied. Arizona, Connecticut, Maryland, and South Carolina used a services-as-usual comparison condition in which the subjects received whatever services were available in the local community. Massachusetts used the Clubhouse model, in which facility-based services were provided according to a work-ordered day, with patients and staff working together on jobs within the program as well as at job placements in the community. Both Texas and Maine used an "unenhanced" version of their experimental condition (i.e., no social network services in Texas and no employer consortium in Maine).
Among all study participants, youth and young adults had significantly better outcomes in terms of any employment and competitive employment than older (>30 years) adults. However, in multivariable models of participants randomly assigned to SE, young adults had significantly better outcomes than youth or older adults. Other significant predictors of employment and competitive employment were future work expectations, not receiving Supplemental Security Income, and receipt of more hours of SE services. Characteristics of youth, young adults and SE programs that enhance employment are discussed in terms of policy and practice.
The finding that younger people had better employment outcomes in SE relative to older people provides empirical support for policies that encourage the provision of SE services to youth and young adults. However, it does not obscure the fact that work and return to work are ongoing challenges in the lives and people in recovery.