Supported employment outcomes for transition age youth and young adults

Authors: 
Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D., & Lauber, C.
Year Published: 
2012
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
35
Number: 
3
Pages: 
171-179
Publisher: 
PubMed
Background: 

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.

Purpose: 

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.

Setting: 

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)

Sample: 

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.

Data Collection: 

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.

Intervention: 

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.

Control: 

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).

Findings: 

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.

Conclusions: 

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.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22246115
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Employment outcomes of transition-aged adults with autism spectrum disorder: A state of the states report

Authors: 
Escovitz, K., & Donegan, K.
Year Published: 
2014
Publication: 
American Journal on Intellectual and Developmental Disabilities
Volume: 
119
Number: 
1
Pages: 
64-83
Publisher: 
AAIDD
Background: 

Youth with Autism Spectrum Disorder (ASD) face a number of obstacles when transitioning from school to work. The cost to society to support individuals with ASD who do not work is very high. The incidence of ASD is on the rise. It is important to make sure vocational services provided by the states are leading to successful employment outcomes for these individuals.

Purpose: 

The goal of this study was to examine the employment outcomes of transition aged youth with ASD served by the states vocational rehabilitation system.

Setting: 

This study included individuals with autism spectrum disorder served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Data was taken from the Rehabilitation Services Administration's (RSA); RSA-911 Case Service Report database. This database hold records of adults who apply for a states' vocational rehabilitation services. Demographics, vocational services received, and outcomes for closed cases (i.e. employed or not, hours worked etc...) are located there. The study examined the records of 34, 314 youth with ASD who were age 21 and under. Data was pulled for individuals whose cases were closed from 2002 to 2011.

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 intervention was various vocational rehabilitation services provided to assist youth with ASD with achieving successful employment.

Control: 

There was no control or comparison condition.

Findings: 

Over a ten year time span, the number of transition aged individuals with ASD served by VR has increased over time. While employment outcomes, hours and wages have not improved for the group. Transition aged youth with ASD were more likely to receive a positive employment outcome if they received VR services as compared to all youth with disabilities served by VR. However, youth with ASD worked less hours and had lower wages. This means they were underemployed. The cost of VR services for this group remained stable. There is much variability between states.

Conclusions: 

Transition aged individuals with ASD are accessing VR services. However, their employment outcomes have not improved. More research is needed to determine what influences the variability between states and improve work outcomes for this group.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/24450322
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Implementing supported employment as an evidence-based practice

Authors: 
Bond, G. R., Campbell, K., & Drake, R.
Year Published: 
2001
Publication: 
Psychiatric Services
Volume: 
52
Number: 
3
Pages: 
313-322
Publisher: 
American Psychiatric Association
Background: 

The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.

Purpose: 

The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.

Data Collection: 

A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

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: 

The following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).

Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.

Conclusions: 

Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

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

Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US

Authors: 
Bond, G. R., Drake, R.E., & Becker, D. R.
Year Published: 
2012
Publication: 
World Psychiatry
Volume: 
11
Number: 
1
Pages: 
32-39
Publisher: 
World Psychiatric Association
Background: 

While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ability to generalize to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies.

Purpose: 

The current review has two goals. First, given the growing international attention to IPS, it examines the effectiveness of IPS in studies conducted outside the US compared to US studies. Second, it expands the scope of prior IPS reviews by adding recent randomized controlled trials (RCTs) and enlarging the range of outcome measures in order to examine the hypothesis that IPS yields better competitive employment outcomes across a range of measures than alternative vocational programs.

Setting: 

In most studies, participants were recruited from clients receiving services from community mental health centers. Altogether, the 15 studies analyzed Control enrolled 1063 IPS participants (mean = 70.9 per study) and 1117 control participants (mean = 74.5 per study).

Sample: 

The study identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. It examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered non-competitive employment, program retention, and nonvocational outcomes.

Data Collection: 

Data were recorded directly from published reports or calculated from information presented in the published studies. For the measure of job duration, the study converted total weeks worked to an annualized rate, reporting the findings for both the full intent-to-treat sample and the worker subsample (those who obtained at least one competitive job during follow-up).

Intervention: 

The intervention was the Individual Placement and Support (IPS) model which is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

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: 

Rigorous evaluations of IPS suggest that 60% or more of IPS clients obtain competitive jobs, compared to about 25% of those who receive other types of vocational assistance. One way of interpreting this finding is that approximately 25% of clients who express an interest in competitive employment will succeed in obtaining a job in diverse and ineffective vocational programs or even without any vocational services, but IPS helps an additional 35% of the target group who otherwise would remain unemployed. The finding of a large and statistically significant beneficial impact of IPS is robust, upheld in all 15 studies. The effectiveness of IPS is also suggested by other measures of competitive employment outcome, including time to first job, job duration and total hours employed during the follow-up period. Most IPS clients work part-time, typically half-time; about two-thirds of those who obtain competitive employment work 20 hours or more per week. Few IPS clients work full-time, likely due to preferences, limited stamina, and/or fear of losing health insurance or other benefits. Consistent with the principle of rapid job search, the time to first competitive job for IPS participants is nearly 10 weeks sooner than for controls. The mean length of time to first job for IPS participants (19 weeks) is, however, still lengthy for a model that prescribes rapid job search.

Conclusions: 

To summarize, the question of IPS transportability outside the US remains unanswered. While the published studies suggest that the labor and disability laws in some European countries may make a direct replication of IPS difficult, there are also indications that IPS transports well to other countries, such as Australia and the Hong Kong region of China. Finally, before concluding that the IPS must undergo radical adaptations in another nation, IPS programs should receive sufficient training and guidance to implement the model with high fidelity.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22295007
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A community-based trial of vocational problem-solving to increase employment among methadone patients.

Authors: 
Zanis D, Coviello D, Alterman A. Appling S
Year Published: 
2001
Publication: 
Journal of Substance Abuse Treatment
Volume: 
21
Number: 
1
Pages: 
19-26
Publisher: 
Elsevier
Background: 

Following drug use stabilization, employment has long been considered an important secondary goal for patients enrolled in methadone maintenance treatment programs. Several studies have found moderate positive correlations between increased employment, decreased substance use, and positive social functioning. Given the low rates of employment, patients desire for
employment services, and the association of employment with improved outcomes, employment interventions appear to be important to explore.

Purpose: 

The main purposes of the study were to (a) train methadone counselors to deliver the Vocational Problem-Solving Skills (VPSS) intervention and (2) evaluate whether unemployed patients randomized to VPSS counseling would improve their employment functioning compared to patients randomized to an alternate activity.

Setting: 

The study was conducted at two comparable methadone treatment centers, each of which had both employed and unemployed clients.

Sample: 

The study sample consisted of 109 individuals receiving methadone treatment. Entrance criteria included the following: (1) Unemployed or underemployed, as working ‚under the table‚ less than 10 hours per week; (2) stabilized on methadone and enrolled in the treatment program for a minimum of 3 months; (3) expressed interest and capacity to work at least 20 hours per week; and (4) actively seeking employment as by the Bureau of Labor Statistics. Males constituted 61% of the sample, and African-Americans 61%

Data Collection: 

Participants were assessed by interviews at baseline, biweekly for 12 weeks, and at 6 months post-baseline. Measures included standardized measures of addiction and independent urine sampling, a vocational assessment, a treatment service review, chart review, and independent employment verification. Data analysis included descriptive statistics, a series of bivariate analyses to examine the correlation between potential predictor variables and the criterion variable (employed/not employed at least one day in the past 30 days at the 6-month follow-up point), and multinomial regression analysis.

Intervention: 

Vocational Problem-Solving Skills (VPSS) is a cognitive-based intervention designed to assist chronically unemployed individuals transition to work. The five objectives of the VPSS intervention are to help participants (1) understand why they want to work; (2) understand how to overcome barriers to work; (3) set realistic vocational goals; (4) identify realistic resources to help locate job opportunities; and (5) take appropriate actions to obtain work. All VPSS sessions were designed to be approximately 30 to 60 minutes in length and delivered within a maximum of a 12-week period. Both patients and counselors were provided with a manual and workbook, outlining each of the sessions.

Control: 

The comparison group participated in an Interpersonal Problem Solving (IPS) intervention of similar duration and intensity as the VPSS. The goal of IPS counseling was to help patients develop improved problem-solving skills to either reduce drug use or continue abstinence from drug use. The five objectives of the IPS counseling were to: (1) reduce/eliminate illicit drug
use or maintain an abstinence plan; (2) understand the utility of social supports in recovery; (3) examine successful and unsuccessful efforts at recovery; (4) formulate realistic recovery plans; and (5) engage in planned activities.

Findings: 

Of the 109 participants, 101 could be located for six-month follow-up. At the point, 53 (54.6%) were considered, 19 (19.6%) were termed part-time employees (paid for working between 1 and 14 days), and 25 (25.8%) were considered full-time employees (paid for working 15 or more days in the past 30). VPSS participants were significantly more likely to be employed than the comparison group. However, enrollment in the VPSS condition did not predict employment when entered into the regression analysis with the other variables.

Conclusions: 

Although a greater percentage of patients who received the VPSS counseling program actually worked, VPSS was not predictive of employment after controlling for other factors, such as work history and motivation. Structured employment interventions may assist unemployed methadone patients in obtaining employment; however, the type of employment services provided must reflect a variety of employment needs.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/11516923
NIDILRR Funded: 
Peer Reviewed: 
Yes

Standardizing measures in four domains of employment outcomes for individual placement and support

Authors: 
Bond, G. R., Drake, R., & Becker, D.
Year Published: 
2012
Publication: 
Psychiatric Services
Volume: 
63
Number: 
8
Pages: 
751-757
Publisher: 
American Psychiatric Association
Background: 

Virtually all studies of the individual placement and support (IPS) model of supported employment measure outcomes for job acquisition, but studies are less consistent in measuring job tenure, hours worked, and employment earnings. Lack of a common set of employment measures limits comparisons across studies and cumulative knowledge about IPS.

Purpose: 

This study examined measures in four employment domains and their interrelationships. It examined two hypotheses. First, IPS improves both the rate of obtaining employment (job acquisition) and the amount of work (job duration, hours worked per week, and total hours and wages). Second, employment outcomes within domains are strongly correlated, whereas outcomes across domains are relatively weakly related.

Setting: 

All study participants were clients enrolled in public mental health programs. The four study groups were located in Manchester and Concord NH; Washington DC; Hartford CT, and Chicago

Sample: 

All study participants were clients enrolled in public mental health programs. They were unemployed adults who met each state's criteria for severe mental illness. Other common eligibility criteria included desire for competitive work, ability and willingness to give informed consent, and absence of significant general medical conditions precluding employment. The studies used similar protocols to track employment outcomes. Despite similar research methods, the four studies differed in geographic location and control group interventions.

Data Collection: 

Using a combined data set from four randomized controlled trials of IPS, this study examined mean differences between IPS participants (N=307) and participants in other vocational services (control sample) (N=374) in four domains (job acquisition, job duration, hours worked per week, and total hours and wages). Eight competitive employment measures were examined (employed at any time, total weeks worked, tenure in the longest-held job, total hours worked, average hours per week worked, total wages, days to first job, and working =20 hours per week during follow-up). Correlations between measures within both the IPS and control samples were determined.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

The conditions include: 1) group skills training; initial training in choosing, getting, keeping a job; followed by job placement services from a stand alone rehabilitation program (2) enhanced rehabilitation services provided by a vocational rehabilitation counselor assigned to the project: club house and brokered supported employment (4) diversified placement services.

Findings: 

IPS participants had significantly better outcomes across all employment measures and domains. Correlations between measures were strong within each domain, but they were variable between domains

Conclusions: 

In addition to improving job acquisition, IPS improved job duration, hours worked per week, and total hours and wages. The correlational findings suggest proxy measures to assist meta-analysts in the synthesis of studies for which direct measures are unavailable. Initial steps toward a cross-disciplinary theoretical framework for employment outcomes are described.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22660524
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Critical strategies for implementing supported employment

Authors: 
Bond, G. R., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R.
Year Published: 
2007
Publication: 
Journal of Vocational Rehabilitation
Volume: 
27
Number: 
1
Pages: 
13-20
Publisher: 
IOS Press
Background: 

Supported employment is considered to be "the most effective approach to increase work opportunities for people with severe mental illness [3–5]" (p. 13). However, access to Supported Employment services is difficult to obtain.

Purpose: 

The paper offers "a review of experiences by six states and the District of Columbia in disseminating an evidence-based practice, supported employment (SE). Each jurisdiction had unique strengths and barriers to overcome to effectively implement supported employment services for people with severe mental illness" (p. 13).

Setting: 

"Project leaders from the original six states and the District of Columbia" provided information as to how they were able to increase "access to high-quality SE services in their areas" (p. 13).

Sample: 

Maryland, South Carolina, District of Columbia, Oregon, Vermont, Kansas, Connecticut

Data Collection: 

Seven states (including the District of Columbia) reported unique aspects of implementing supported employment. The approach used was similar to that of a case study.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

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: 

"Diverse strategies were used to augment implementation of supported employment services: a) Instituting state-level administrative procedures and reconfiguration of local staffing to enhance collaboration between mental health and vocational rehabilitation; b) Promoting SE services through the media, online training, and training by early adopters; c) Hiring benefits specialists; d) Teaching outcome-based supervision; and e) Building capacity for supported employment fidelity reviews" (p. 13).

Conclusions: 

"Dissemination of evidenced-based supported employment was enhanced when six states and the District of Columbia addressed special aspects. Supported employment implementation included different pathways to good employment outcomes" (p. 13).

URL: 
http://www.worksupport.com/kter/documents/pdf/CriticalStrategies.pdf
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
No

Fidelity of supported employment: Lessons learned from the National Evidence-Based Practice Project

Authors: 
Bond, G. R., Peterson, A., Becker, D., & Drake, R.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
31
Number: 
4
Pages: 
300-305
Publisher: 
American Psychological Association
Background: 

As the movement to disseminate evidence-based practices (EBPs) for people with severe mental illness gatherers momentum, providers need guidance about implementing and sustaining high-quality services. The National Evidence Based Practices Project evaluated the implementation of five EBPs across 53 sites in eight states over a two-year period.

Purpose: 

The purpose of the study was to describe the implementation of supported employment in the National Evidence-Based Practices Project, examining and interpreting fidelity changes over two years of program implementation.

Setting: 

Nine sites that initially provided vocational services for persons with severe mental illness. Services departed from high fidelity supported employment. All nine sites took prompt action to transform existing vocational services that were contrary to evidence-based supported employment.

Sample: 

Nine sites, three from each state, implemented supported employment. Eight sites provided mental health treatment, while one was a psychiatric rehabilitation agency that did not offer clinical services. Five sites with in urban areas; four in rural.

Data Collection: 

Nine new supported employment programs were evaluated by examining supported employment fidelity ratings at baseline and every 6 months thereafter. Site reports based on the nine case studies were used to interpret the fidelity findings.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice.

Control: 

Comparison 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: 

At two years, eight of nine sites achieved high fidelity. Most changes occurred within the first year. Twelve of the 15 supported employment fidelity items showed rapid improvement.

Conclusions: 

A review of the site reports suggested four factors that facilitated movement toward high fidelity: (1) Discontinuing non-evidence-based vocational services, (2) Making rapid structural changes through administrative action, (3) Measuring key process indicators to move toward desired changes, and (4) Gradually improving integration of the employment specialists with clinical services, primarily through supervisor leadership.

URL: 
http://www.worksupport.com/kter/details.cfm
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

An update on randomized controlled trials of evidence-based supported employment

Authors: 
Bond, G. R., McHuggo, G. J., Becker, D.R., Rapp, C. A., & Whitley, R.
Year Published: 
2008
Background: 

Supported employment is the best described and most widely used practice for supporting people with mental illness. Randomized Controlled Trials (RCTs) evidence accumulates quickly; as such, reviews of RCTs become obsolete as new data become available.

Purpose: 

The current review was conducted to provide a "comprehensive summary of competitive employment outcomes for RCTs evaluating evidence-based supported employment for this population" (p. 281).

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings

Sample: 

To be included in this review, a study had to be an RCT design, which examined longitudinal competitive employment outcomes for people with severe mental illness. Participants must have been "randomly assigned to two or more conditions, one of which used a high-fidelity IPS supported employment model" (p. 281). Another requirement for inclusion in this review was that the control group(s) must have received services as usual, other than IPS.

Eleven studies were included in the current literature review that included individuals with mental illness.

Data Collection: 

"Three main sources were used to identify studies" (p. 281). The first source was published literature reviews, the second was to review studies in the Employment Intervention Demonstration Project, and the third was to contact "principal investigators and continuous review of the published literature" (p. 281).

Data were recorded directly from published reports or calculated by hand from the information presented.

Intervention: 

Individual Placement and Support model of supported employment

Control: 

There were no comparison or control conditions.

Findings: 

Comprehensive employment rates were significantly higher for IPS (61%) than for the control groups (23%). In addition, people in IPS worked 20 hours per week or more (43.6%), compared to the control groups (14.2%). The average time to obtain a job for people with IPS was 50% faster than those in the control groups, ranging between 4 and 5 months for those with IPS. The average weeks worked for those with IPS was over two times that of the control groups.

Conclusions: 

The majority of IPS participants obtain competitive employment at a significantly higher rate than those in other vocational programs. Most IPS participants work part-time, possibly due to health or financial considerations. In addition, the IPS model supports a rapid job placement; most clients are placed are placed in a competitive job within the first six months.

URL: 
http://www.worksupport.com/kter/documents/pdf/UpdateofRandomizedControlledTrials1.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Is job tenure brief in individual placement and support (IPS) employment programs?

Authors: 
Bond, G. R., Becker, D. R., & Drake, R. E.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
8
Pages: 
950-953
Publisher: 
American Psychiatric Association
Background: 

Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.

Purpose: 

The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.

Setting: 

Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.

Sample: 

Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.

Data Collection: 

Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice. The intervention was IPS services with high fidelity to the program model and practices.

Control: 

The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.

Findings: 

The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7–12, 13 (9%) during months 13–18, and ten (7%) during months 19–24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6±10.2 hours per week and 10.7±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5±8.3 hours per week and 16.4±4.2 days per month. Mean wage rate for working clients was $7.90±$3.00 per hour

Conclusions: 

Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/21807836
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes