Impact of a vocational counselor on employment-related outcomes among methadone patients

Authors: Appel, P. W., Smith, R., Schmeidler, J. B., & Randell, J.
Year Published 2000
Publication Evaluation and Program Planning
Volume 23
Number 4
Pages 437-448
Publisher Elsevier Science Ltd.

There had been ongoing concerns from New York state government about the steady decline in the rate of employment among methadone maintenance treatment (MMT) patients. One effort to try and change that trend was the VENUS project. The project was designed to identify obstacles to the provision and use of vocational–educational (v–e) services in MMT programs, and then, to evaluate selected remedial interventions. The VENUS project implemented the role of “vocational integrator” to enhance the use of v–e resources in routine MMT clinic operations and removed welfare disincentives for patients. The vocational integrator increased v–e participation by patients while the removal of the welfare disincentive to employment was associated with a small decline in patient v–e involvement. Another initiative was to improve patient v–e participation and employment by placing a full-time vocational rehabilitation counselor (VRC) in an MMT clinic. The objective was to provide on-site v–e services and improve v–e outcomes.

Purpose The purpose of this paper was to summarize results of the intervention. The overall objective was to show how patient involvement in v-e can be enhanced by having a full time on site VRC integrated into daily operations.
Setting The settings were two adjacent methadone treatment clinics affiliated with a hospital in Jamaica, Queens, New York
Sample The sample size in the MM intervention clinic was 364 patients. Earlier admissions comprised 68% of Clinic 1 patients. Two-thirds of this group were male; 57% were Black; and median age was 33 years.  Median time in treatment for the early admissions was 33 months. The sample size in the comparison clinic was 358 patients.
Data Collection

Aggregate data regarding v-e services offered to patients were obtained from reports submitted monthly state substance abuse office. This provided information on the volume and type of service activities provided throughout the study period. In addition the VRC provided individual service information on each person served. Data on individual service delivery and monthly patient v–e status provided project implementation and outcome data.

In Clinic 1; v–e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. Vocational-educational services increased significantly in Clinic 1 and declined in Clinic 2. Logistic regression of factors involved in staying or becoming vocationally involved (vocationally involved refers to working full- or part-time, or being enrolled in education/training) vs. staying or becoming vocationally uninvolved among patients in Clinics 1 and 2 were conducted. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v-e change and that VRC services contributed significantly  to v-e change among patients not working at admission.

For the first and second hypotheses, a repeated measures of motivation to find employment and of eight job-seeking activities for the two intervention groups were compared using linear, mixed-effects models. The third and fourth hypotheses were analyzed using multinomial logistic regression analysis. For the third hypotheses a total motivation score was calculated by summing the motivation scores across the six time points of the 12-week intervention. For the fourth hypotheses, a total job seeking score was calculated by summing the number of job search activities over the 12-week intervention period.

Control Intervention and comparison groups were not matched or assigned.
Findings Having a VRC in a MM clinic increased v-e activity and outcomes. Results show increases in average number of counseling sessions, assessments conducted, v-e plans developed, and in the number of patients involved in counseling and pre-employment groups/workshops each month. Referrals for education, training and employment increased.
Conclusions The examiners concluded that having a VRC in a MM clinic has a positive impact by increasing patient v-e activity and employment outcomes. It is also cost effective. Greater emphasis should be placed on employment and training of MM patients to improve employment outcomes.
Populations Hispanic or Latino | Female | Male | Black / African American | White / Caucasian
Outcomes Employment acquisition | Return to work
Research Design Quassi-experimental
Peer Reviewed Yes