Improving employment outcomes for persons with severe mental illnessesImproving employment outcomes for persons with severe mental illnesses
|Authors:||Levack, W., McPherson, K., & McNaughton, H.|
|Publication||Archives of General Psychiatry|
|Publisher||American Medical Association|
Unemployment remains a major consequence of schizophrenia and other severe mental illnesses. This study assesses the effectiveness of the Individual Placement and Support model of supportive employment relative to usual psychosocial rehabilitation services for improving employment among inner-city patients with these disorders.
This study evaluates the Individual Placement and Support model among a population of high-risk inner-city patients with severe mental illnesses, extending previously published work that compared the IPS model with an enhanced vocational rehabilitation program among a similar population. In our study, men and women with severe mental illnesses were randomly assigned to either an IPS program or a comparison psychosocial rehabilitation program, the predominant mode of rehabilitation services offered in Maryland and many other states. This comparison program includes, but does not emphasize, enhanced vocational services.
The setting was a university-run community mental health agency in Baltimore, Maryland and various employment sites.
Two hundred nineteen outpatients with severe mental illnesses, 75% with chronic psychoses, from an inner-city catchment area were randomly assigned to either the Individual Placement and Support program or a comparison psychosocial rehabilitation program. Participants completed a battery of assessments at study enrollment and every 6 months for 2 years. Employment data, including details about each job, were collected weekly.
The cumulative measures of employment, total hours worked, and wages earned during the study period were analyzed with fixed-effect procedures. Logistic regression was used to test whether the participant worked during the study, and an analysis of variance was used to test log hours worked and log wages earned. The probability of working over time by treatment group was analyzed as a repeated binary measure using generalized estimating equations to adjust SEs. This secured an estimate of the "population-averaged" effect of working over time for the 2 treatment groups.
The comparison psychosocial rehabilitation program provided an array of services, including evaluation and skills training, socialization, access to entitlements, transportation, housing supports, counseling, and education. Vocational services included in-house evaluation and training for individuals who staff believed were not yet fully prepared for competitive employment. Training focused on improving specific work readiness skills, such as work endurance, appropriate social interaction in the workplace, and acceptance of supervision. In-house sheltered work and factory enclave projects were also available. For those ready for competitive employment, the psychosocial program either provided in-house assistance in securing employment or referred participants to city-based rehabilitation or vocational service programs.
Individual Placement and Support program participants were more likely than the comparison patients to work (42% vs 11%; P<.001; odds ratio, 5.58) and to be employed competitively (27% vs 7%; P<.001; odds ratio, 5.58). Employment effects were associated with significant differences in cumulative hours worked (t(211) = -5.0, P =.00000003) and wages earned (t = -5.5, P =.00000003). Among those who achieved employment, however, there were no group differences in time to first job or in number or length of jobs held. Also, both groups experienced difficulties with job retention.
As hypothesized, the Individual Placement and Support program was more effective than the psychosocial rehabilitation program in helping patients achieve employment goals. Achieving job retention remains a challenge with both interventions.
|Populations||Male & Female|
|NIDILRR Funded||Not Reported|
|Research Design||Randomized Controlled Trials (RCTs)|