Increase in hours worked

Intellectual disabilities

Specific learning disabilities

Populations:

Transition-age youth (14 - 24)

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Individual placement and support for individuals with recent-onset schizophrenia: Integrating supported education and supported employment

Authors:

Nygren, U., Markstr√∂m, U., Svensson, B., Hansson, L., & Sandlund, M.

Year Published:

2008

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

340-349

Publisher:

American Psychological Association

Background:

In recent years, functional outcome has become a very salient target for intervention for individuals with severe mental illnesses. In particular, supported employment has generated substantial research as a means of facilitating return to competitive jobs for individuals with schizophrenia and other severe mental illnesses. This article summarizes the design of an 18-month longitudinal study of IPS in the early course of schizophrenia. Improving and Predicting Work Outcome in Recent-Onset Schizophrenia and discusses the adaptations of the IPS model that were found important for this phase of the illness.

Purpose:

The purpose of this study was to describe the adaptation of the Individual Placement and Support model of supported employment to individuals with a recent first episode of schizophrenia or a related psychotic disorder.

Setting:

All study participants were receiving outpatient psychiatric treatment at the UCLA Aftercare Research Program and were participants in the third phase of the Developmental Processes in Schizophrenic Disorders Project.

Sample:

The study sample consisted of 69 individuals that were recruited from a variety of local Los Angeles area psychiatric hospitals and psychiatric clinics and through referrals from the UCLA outpatient service at the Resnick Neuropsychiatric Hospital at UCLA.

Data Collection:

A comparison of individuals who were randomized (n=69) to IPS or the Brokered treatment with those who were not randomized (n=18) reveals no statistically significant demographic differences between the two samples. Similarly the randomized individuals did not differ significantly from those who were not randomized in prior illness indicators or symptom severity at screening.

Intervention:

Given that the vocational goals of persons with a recent onset of schizophrenia often involve completion of schooling rather than only competitive employment, the principles of Individual Placement and Support were extended to include supported education. This extension involved initial evaluation of the most appropriate goal for individual participants, having the IPS specialist working on placement either with the participant or directly with educational and employment settings (depending on permitted disclosure and individual need), and follow-along support that included work with teachers and aid in study skills and course planning as well as typical supported employment activities. Work with family members also characterized this application of IPS.

Control:

The condition was Vocational rehabilitation through referral to traditional separate agencies(Brokered Vocational Rehabilitation.

Findings:

A randomized controlled trial is comparing the combination of Individual Placement and Support and skills training with the Workplace
Fundamentals Module with the combination of brokered vocational rehabilitation and broad-based social skills training. Participants in the IPS condition have returned to school, competitive work, and combined school and work with approximately equal frequency.

Conclusions:

Individual Placement and Support principles can be successfully extended to integrate supported education and supported employment within one treatment program. The distribution of return to school, work, or their combination in this group of individuals with recent-onset schizophrenia supports the view that an integrated program of supported education and supported employment fits this initial period of illness.

URL:

http://psycnet.apa.org/journals/prj/31/4/340/

Disabilities:

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

The effectiveness of skills training for improving outcomes in supported employment

Authors:

Mueser, K. T., Becker, D. R., & Wolfe, R.

Year Published:

2005

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1254-1260

Publisher:

Psychiatryonline.org

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. Although this approach is more successful at assisting individuals with mental illness with gaining and maintaining work, than other traditional means, better outcomes related to job retention is needed.

Purpose:

The purpose of this study was to evaluate the impact of a supplementary skills training program on employment outcomes for individuals who were receiving supported employment services.

Setting:

The study took place at an employment support organization that is funded by State vocational rehabilitation.

Sample:

Thirty five individuals who were enrolled in a supported employment program and had a diagnosis of severe or persistent mental illness participated in the study. Among these individuals, the majority or 80% were men and 97% were non-Hispanic white. About a third or 30% had graduated from secondary education. The mean age was 38 years.

Data Collection:

Those who consented to participate, completed a Workplace Fundamentals Knowledge Test. Afterwards they were randomly assigned to receive supported employment services alone or to receive supported employment services and the supplementary skills training about workplace fundamentals. Individuals were assigned to the group on an average of 56 days after obtaining a job. Among the 35 participants, 18 received treatment as usual (supported employment services alone) the rest were assigned to the receive the work fundamentals training too. Chi square test and t test indicated no significant difference in the two groups. Workplace knowledge was measured with the Workplace Fundamental Knowledge Test scores at baseline and at nine month intervals. Rates of employment for each month of the study period for individuals who recently went to work was documented by control group and workplace fundamentals group. These rates were compared using a generalized estimating equations analysis. The researchers also compared cumulative time worked, wages earned and job tenure for the first and subsequent jobs held. Mann-Whitney tests were used because that data was skewed. Vocational services used were also analyzed with Mann-Whitney tests.

Intervention:

The intervention was the supplementary workplace skills training program in SE

Control:

The control group was the participants who only received supported employment services and did not attend the workplace skills training.

Findings:

During the study period, participants held a total of 49 different jobs. Forty three percent of the sample worked in the same job during the study period (18 months), others were laid off, fired or quit their jobs. The majority had disclosed their psychiatric disability to their employers. Individuals who attended the workplace fundamentals program received higher scores on the Workplace Fundamentals Knowledge Test than those who did not. Although more individuals who attended the supplementary training were working during the study period this trend was not significant. Earnings and hours worked was not significant either. Both groups used comparable amounts and intensity of employment services. Job tenures for the first job for participants was 331.6 days for workplace fundamentals group and 288.5 for the control group.

Conclusions:

The workplace fundamentals program may not be an effective addition to supported employment services, but more research is needed.

URL:

https://www.ncbi.nlm.nih.gov/pubmed/16215191

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare

Authors:

Michalak, E., Yatham, L., Maxwell, V., Hale, S., & Lam, R.

Year Published:

2003

Publication:

Evaluation Review

Volume:

Number:

Pages:

656-680

Publisher:

Sage

Background:

Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.

Purpose:

The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.

Setting:

Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.

Sample:

The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.

Data Collection:

Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.

Intervention:

The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.

Control:

There was no control or comparison condition. The study used a pre/during/post intervention design.

Findings:

Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.

Conclusions:

Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.

URL:

http://erx.sagepub.com/content/27/6/656.full.pdf

Populations:

Female

Rural

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Single group

Peer Reviewed:

Yes

The durability of supported employment effects

Authors:

Mclellan, A.T., Gutman, M., Lynch, K., Mckay, J.R., Ketterlinus, R., Morgenstern, J., & Woolis, D.

Year Published:

1998

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

55-61

Publisher:

American Psychological Association

Background:

The original New Hampshire Supported Employment Study was a two-site, controlled, clinical trial with random assignment to Group Skills Training (GST) or Individual Placement and Support (IPS) (within site) and 18-month follow-up. Both the GST and IPS programs were implemented in two New Hampshire cities and surrounding regions with populations of 166,000 and 119,000. Implementation data supported the fidelity of both interventions, and clients received approximately the same number of direct contact hours and amount of service costs in the two interventions. Following 18 months in the experimental phase, clients were allowed to leave their assigned vocational condition and were asked to participate in a 2-year extension phase. Guided by advice from providers, they pursued additional vocational services at their own discretion. Those who gave written informed consent were reassessed after 1 and 2 years (30 months and 42 months from original baseline) with a composite interview that was administered by a research interviewer who was independent of the clinical or vocational programs.

Purpose:

The purpose of this study was to examine the persistence of supported employment outcomes and the influence of continuing vocational services following the experimental phase of the New Hampshire Supported Employment Study. In the original study, one form of supported employment, Individual Placement and Support (IPS), was found to be more effective than another form, Group Skills Training (GST), in improving clients' competitive employment. IPS clients worked approximately twice as much and earned twice as many wages

Setting:

The original New Hampshire Supported Employment Study was a two-site, controlled, clinical trial with random assignment to GST or IPS (within site) and 18-month follow-up. Both the GST and IPS programs were implemented in two New Hampshire cities and surrounding regions with populations of 166,000 and 119,000.

Sample:

The original study included 143 unemployed adults with severe mental illness from two community mental health centers in New Hampshire. Of the 140 participants who completed 18 months in the original study (experimental phase), 126 (90.0%) consented to participate in the 2-year extension phase. At the start of the original study, the 126 extension phase participants had an average age of 36.8 years (SD = 9.5); 50% were female; 52.4% were never married, and 8.7% were currently married; 27.8% had not completed high school or received a GED; and 96% were Caucasian. Their primary psychiatric diagnoses were heterogeneous: schizophrenia and related psychotic disorders, 46.8%; bipolar and other severe mood disorders, 44.4%; and other disorders (primarily severe personality disorders), 8.7%. During the 18-month experimental phase, 61.1% of the extension phase clients (77/126) worked in at least one competitive job, and they worked an average of 430.8 (SD = 716.5) hours.

Data Collection:

Competitive employment was as work in the competitive job market at prevailing wages that was supervised by personnel employed by the business. Employment was assessed regularly by employment specialists in GST and IPS during the 18 months of the experimental phase and by direct interviews with clients at the 1-year and 2-year points of the extension phase (30-month and 42-month interviews) using the Employment and Income Review. To assess vocational services during the extension phase, clients reported on the vocational services received in the previous 2 months, including type of service, the provider, number of days, and the average amount of time each day. Consequently, estimates of vocational service utilization during the extension phase are based on 4 of the 24 months.
Other variables reported in this paper derived from the structured interview that was conducted with clients at regular intervals throughout the study period. This interview, which is described more fully elsewhere contained measures from the following domains: demographics, psychiatric symptoms, income and benefits, quality of life, drug and alcohol use, self-esteem, recent work and school history, and residential history. This hour-long interview was conducted by research staff members, who had been trained in standardized research interviewing and who were supervised throughout the study.

Intervention:

GST was a vocational rehabilitation program located in a private agency outside the mental health centers that offered individualized intake, 8 weeks of pre-employment skills training in a group format, individualized job placement, liaison with mental health providers, and follow-along supports. During the pre-employment training, clients were encouraged to explore values, preferences, strengths, and weaknesses, as well as to discuss and practice skills in choosing, getting, and keeping a job.

IPS offered an integrated and direct approach in which employment specialists joined the case management teams in the mental health centers and immediately helped clients to begin searching for a job on an individualized basis. The IPS employment
specialists assumed that clients would learn about the job world, and about their skills and preferences, on the job rather than through pre-employment training.

Control:

The comparison conditions were Individual Placement and Support; and the Group Skills Training and other Vocational Rehabilitation Services model; and No Services.

Findings:

This 2-year extension of an experimental study of supported employment showed persistence of the experimental effects on competitive employment. Overall, clients experienced no significant deterioration in amount of competitive employment, despite the fact that only 60% continued to receive vocational services. This finding is in contrast to that found in earlier studies of supported employment although it is consistent with the persistence found by Bond and colleagues.
Moreover, differences between the original experimental groups that emerged during the 18-month experimental phase persisted throughout the 2-year extension phase with only moderate attenuation. The evidence indicates a continuation of the momentum gained during the experimental phase of the study despite minimal continued vocational supports overall. This finding was also contrary to expectations, as earlier studies have often found a decrease in group differences following the termination of a formal intervention. The results also showed that receiving services during the extension phase was related to amount of employment for clients in the original IPS group. More than half of the IPS clients received IPS-like services during the extension phase, and together with those few who received other services, they were more than twice as likely to work than clients who received no services.

Conclusions:

It appears that continued vocational services, even if minimal, are critical to the durability of the elevated vocational outcomes from an IPS program. As IPS becomes implemented more widely, it will be important to design and to build in mechanisms that provide continued services in order to maintain the higher rates of competitive employment that IPS provides.

URL:

http://psycnet.apa.org/journals/prj/22/1/55/

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial

Authors:

McGurk, S. R., Mueser, K. T., & Pascaris, A.

Year Published:

2007

Publication:

American Journal of Psychiatry

Volume:

164

Number:

Pages:

437-441

Publisher:

American Psychiatric Publishing

Background:

Supported employment has been repeatedly demonstrated to improve competitive work outcomes in people with severe mental illnesses such as schizophrenia and bipolar disorder (1). Although strong research supports the effectiveness of supported employment, and efforts are underway to increase access to these programs (2, 3), not all participants benefit from supported employment. Specifically, across most studies between 20% and 40% of patients do not find jobs (4‚Äì8), and of those who do, many have brief job tenures that end unsuccessfully, such as being fired for poor work performance. These findings have stimulated efforts to address illness-related impairments that may limit the effectiveness of supported employment for some individuals with severe mental illness.

Purpose:

To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.

Setting:

The setting was supported employment programs and various places of employment.

Sample:

The sample included patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City. The eligibility criteria was severe mental illness as by the State of New York Office of Mental Health, current unemployment, desire for employment, enrollment in supported employment, history of at least one unsatisfactory job ending (getting fired from a job held less than 3 months or walking off a job without another job in place), and willingness and capacity to provide informed consent.

Data Collection:

Employment outcomes were aggregated by computing the total number of jobs, hours worked, and wages earned over the entire follow-up period. Potential interactions between site, treatment group, and work were evaluated by performing an analysis of variance (ANOVA), with site and treatment group (supported employment with cognitive training or supported employment alone) as the independent variables and the total number of jobs worked as the dependent variable. A chi-square analysis was conducted to compare the two treatment groups on percentage of patients who obtained work over the course of the follow-up period. Additional analysis was also done to address a variety of data factors.

Intervention:

Patients with severe mental illness N=44 and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2‚Äì3 years.

Control:

The comparison condition was supported employment only.

Findings:

Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2‚Äì3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone.

Conclusions:

The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.

URL:

http://www.coalitionny.org/the_center/resources/cognitive_remediation/documents/CogTrainingAmJPsychiatry0307.pdf

Disabilities:

Populations:

Asian

Outcomes:

Return to work

NIDILRR Funded:

Research Design:

Traumatic brain injury (TBI)

Peer Reviewed:

Yes

A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Authors:

Man, D. W. K., Poon, W. S., & Lam, C.

Year Published:

2000

Publication:

Archives of Physical Medicine and Rehabilitation

Volume:

Number:

Pages:

1007-1015

Publisher:

Elsevier

Background:

The present study tested a Medical/Vocational Case Coordination System (MVCCS) designed for persons with brain injury. The MVCSS, which was based on knowledge gained from the research literature and from clinical experience in medical and vocational rehabilitation for persons with BI, emphasize early intervention and coordinated service delivery through integrated medical center based and community-based services. Early intervention was emphasized to reduce the time between injury and community reintegration and to reduce the associated psychosocial complications that may result from lack of early intervention. The MVCCS was expected to maximize participants vocational and independent living outcomes and to minimize the use of medical and community resources.

The researchers review of previous research supported the belief that an intervention system for improving vocational outcomes of persons with BI must include these features: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) temporary or long-term supported employment in appropriate cases. To be viable, the system must significantly improve on the benchmark of 60% unemployment with results at least equivalent to those of earlier intervention studies; that is, approximately 75% of participants in community-based employment: approximately 50% working without long-term supports and approximately 25% in long-term, community-based, supported employment or in educational or training programs. They studied vocational outcomes of the MVCCS over a 4-year period.

Purpose:

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. The study design evaluated 2 hypotheses. The first hypothesis was that vocational outcomes will meet or exceed those reported previously, that is, (1) 75% of participants in community-based independent or supported community-based employment or education/training programs (Vocational Independence Scale [VIS] levels 3 to 5); and (2) 50% of participants in independent community-based employment (VIS level 5). The second hypothesis was that vocational outcomes will be related to (1) severity of injury, (2) severity of impairment/disability, (3) ISA, (4) time since injury, (5) presence of additional non-brain injuries, and (6) preinjury educational/vocational status.

Setting:

The setting was a large urban medical center.

Sample:

One hundred fourteen Minnesota residents with traumatic or other acquired brain injury between the ages of 18 and 65 years. The majority (or 64%) had TBI followed by CVA (26%) and other (10%). The largest portion (36%) of the sample was referred for vocational services through outpatient rehabilitation evaluations. Severity of injury was classified only in TBI cases, based on results of available initial Glasgow Coma Scale (GCS) score and duration of loss of consciousness (LOC) at the time of injury; 56% were classified as severe TBI. Among all participants N=114, the majority (61%) were male. Mean age was 37.4. Preinjury education was less than 12 (22 %); 12 to 15 years (61%) and greater than 16 years (17%). Sixty nine percent were working prior to injury and 77% had an independent living status. The mean time since injury for the group was 65.5 months with a median of 12.7 months.

Data Collection:

Vocational outcome at time of initial placement and at 1-year follow-up was measured using the Vocational Integration Scale. The Mayo-Portland Adaptability Inventory (MPAI), a scale based on the Portland Adaptability Inventory was used for rating the range of physical, cognitive, emotional, and social impairments and disabilities resulting from BI. It was completed by rehabilitation staff, the patient and a significant other. Rating scale (Rasch) analyses of the Staff MPAI based on 305 assessments led to a reduction in the number of items from 30 to 22 by eliminating non-contributing items. An indicator of Impaired self-awareness ISA was item 24 from the Staff MPAI, which rates level of indifference or lack of awareness of deficits. The second indicator of ISA used was the difference between the Rasch-converted score for 22-item Staff MPAI and the Rasch-converted score for the 22-item Survivor MPAI. Preinjury vocational status, the presence of other non-brain injuries, time since injury, and the Rasch-transformed Staff MPAI appeared to have some value in predicting the level of initial vocational placement. At 1-year follow-up, vocational status was predicted by time since injury and Rasch Staff MPAI. The VIS at initial placement also significantly predicted VIS at follow-up (Spearman coefficient 5 .75, n 5 101, p, .0001). The efficiency of services (i.e., months to placement) was significantly predicted by preinjury education, injury severity, time since injury, Rasch Staff MPAI, Rasch Survivor MPAI, and the difference between the Rasch Staff MPAI and Rasch Survivor MPAI. To control for experiment-wise error, potential predictor variables were further scrutinized using regression analyses.

Intervention:

The MVCCS interfaced a medical center based BI Nurse Case Coordinator (NCC) with a medical-center based BI Vocational Case Coordinator (VCC) who served as a liaison to community-based services. This interface provided: (1) early identification by the NCC of individuals needing medical
services, medical rehabilitation, vocational rehabilitation, and social services; (2) late identification of other persons with chronic impairments after BI and their service needs by either the NCC or the VCC; (3) personal vocational counseling, consumer advocacy, and on-site consultation to other vocational services provided by the VCC; (4) access to community-based vocational services through the VCC that included: vocational evaluations, supported work trials, long-term community- based supported employment, job coaching, job development, and job placement; (5) access to other community based services that support employment, such as independent living services, community-based social services and mental health services, and traumatic brain injury (TBI) waivered services, including behavioral aide services; and (6) access to medical center services that enhance vocational re-entry for persons with BI, such as a CI day rehabilitation program; a 3-hour weekly community reintegration group; individual cognitive rehabilitation; medical rehabilitation services such as standard rehabilitation therapies, work hardening, and physical work assessments; neuropsychological and psychiatric services, including psychotherapy, family therapy, behavioral medicine, and substance abuse treatment; and other medical diagnostic and therapeutic services, including psychiatric and behavioral neurology services.

In the day-to-day operation of the MVCCS, the NCC, working with emergency room staff, identified all brain-injured
persons admitted to the hospital each working day and served as case coordinator for these cases. She reviewed the medical record, met with the patient, recommended additional services to the primary medical service, obtained consent, and entered participants into the clinical database. The NCC followed the patient after dismissal from acute care. If the patient left from acute care to home, she followed up by telephone within 1 month to identify potential BI sequelae and service needs and to assist in scheduling required services. If the patient left acute service to the rehabilitation unit, the NCC turned medical case coordination over to the rehabilitation social worker. In all cases referred, the VCC met with study participants and obtained consent for study participation, provided all appropriate vocational evaluations and counseling, completed the Staff MPAI with input from other involved rehabilitation staff, obtained the Survivor MPAI, and referred appropriate participants to community-based vocational services. The VCC followed up on each participant 1 year after the person was placed or left the project.

Control:

There was no comparison condition. Participants served as their own controls.

Findings:

he MVCCS evaluated in this study appeared to substantially improve employment outcome for persons with BI without interventions. Results were better than projections based on the previous literature 80% of those served were placed in community-based work with 46% in independent community-based employment. Employment outcomes for persons who received vocational services through this project approached or exceeded outcomes reported previously for intensive rehabilitation interventions. Just as importantly, initial vocational placements were maintained at 1-year follow-up. At the follow-up interview, 81% were working in the community and 53% were employed independently without job supports. Although the results were equivalent to those of other rehabilitation programs that are based on best practices the authors could not make direct comparisons with those programs because we did not investigate specific interventions. Primary predictors of initial placement in the present study were time since injury and overall impairment/disability as measured by the Staff MPAI. Return to previous work should be considered especially for the more recently injured who have retained ties to their previous employer. Results indicate that more severe impairments and disabilities, as measured by the MPAI, are significant barriers to employment in the general population of persons with BI. However, for persons with TBI, the presence of additional non-brain injuries appears to be a more important factor.

The best predictor of employment level at 1-year follow-up was the level of initial placement. ISA (as measured by the difference between Rasch Staff MPAI and Rasch Survivor MPAI) did not contribute to the prediction of either initial placement or job maintenance. This finding is inconsistent with some other studies reporting an association between ISA and long-term employment after BI. The results suggest that ISA may be a barrier to employment that can be overcome through rehabilitation, through education and support for employers, and by discriminating placement of those persons with ISA in work environments that are more tolerant of limitations in self-awareness. Overall level of impairment and disability also appears to be a factor in time required for placement. In some cases, more intensive rehabilitation efforts, such as a CI day rehabilitation program, were required for more severely disabled persons so they could develop cognitive compensation, communication, behavioral self-management, social, and other pre-vocational skills required for eventual placement. Because of the time required for participation in such an intensive rehabilitation program, most individuals who participated in CI day rehabilitation required 6 to 12 months from the time they were admitted to services to their eventual placement. Our data suggest that most placements (92%) can be made within 1 year of admission to services. Preinjury years of education also contributed slightly to prediction of time to placement, with more highly educated individuals being placed more quickly.

Conclusions:

Introducing a VCC into an MVCCS program appears to optimize participants vocational outcome after BI, resulting in community-based employment for 81% of persons served with 53% working independently in the community 1 year after placement. Time since injury and overall level of impairment/ disability were the most significant factors in predicting vocational outcomes. Beyond its association with overall level of disability and chronicity, ISA did not contribute to the prediction of initial placement or job maintenance. The best predictor of employment status at 1 year follow-up was the level of initial placement. Persons with greater overall disability required more extended time and more extensive rehabilitation services before job placement.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/10943747

Disabilities:

Populations:

Outcomes:

Full-time employment

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models

Authors:

Magura, S., Blankertz, L., Madison, E., Friedman, E., & Gomez, A.

Year Published:

2006

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1406-1415

Publisher:

American Psychiatric Association

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. One of the highlights of this approach is rapid job placement which does not necessitate a need for job readiness training or sheltered work. Some individuals have used this approach to gain work but do not maintain employment. Some individuals do not need the intensity of services offered in a SE approach, but may benefit from a clubhouse approach.

Purpose:

This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).

Setting:

The setting included a number of different job sites across 5 states and DC where individuals with mental illness received supported employment services. Services were provided by 5 different experimental programs that adopted the individual placement and support model of supported employment.

Sample:

The participants included 310 individuals with mental illness who were unemployed, 18 years of age or older and who did not have a diagnosis of severe mental retardation. Each person was randomly assigned to the ACT or the Clubhouse programs. Most participants were white males with a schizophrenia diagnosis.

Data Collection:

The research measures included participant characteristics and employment. Control variables included: age, severity of psychiatric symptoms, severity of physical health problems and active substance use. Gender was also added.
Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale. Physical health problems were measured through PANSS probes, Medicaid claims, and interviews. Substance abuse was identified through records, reports and interviews. Two motivational control variable were collected related to interest in working at baseline and match of random assignment to participant preference. The programs kept the same service logs and other records.
The data analysis plan included benchmark comparisons of program performance by using published outcome data from exemplary SE programs. A comparison of ACT and clubhouse outcomes was completed using a services of hierarchical regression analyses.

Intervention:

The intervention was the Individual Placement and Support(IPS)model of supported employment delivered through Assertive Community Treatment programs.

Control:

There was no control condition as supported employment has already been identified as an evidenced based practice. Comparison services were delivered through Clubhouse programs.

Findings:

The results included a comparison with benchmark employment outcomes. Club house participants had higher earnings and hours worked as compared to participants in exemplary supported employment programs. Earnings and work hours for ACT participants was greater than two of those programs. A comparison of ACT and clubhouse outcomes found ACT program had better service engagement. There was no difference in time to obtain a first job. Club house participants were employed longer and for more hours and earned more than than ACT participants. Background variables were predictive of receipt of job search services, which predicted higher employment rates. Wage was an incentive for employment success. A few participants in transitional employment, had about the same job tenure as other participants.
ACT participants received services faster than clubhouse participants. The strong integration of vocational and clinical services, provided by ACT, appeared to be especially helpful to participants with co-occurring disorders.

Conclusions:

The authors concluded that adding supported employment into multiservice programs like ACT and clubhouses, is a way to provide more services to individuals with mental illness, without compromising quality of those services. Although, a cost analysis was not presented, it is suspected that this may also be a cost effective approach to providing supported employment services.

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759891/

Disabilities:

Populations:

Asian

Outcomes:

Other

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial

Authors:

Wehman, P., Kregel, J., Keyser-Marcus, L., Sherron-Targett, P., Campell, L., West, M., & Cifu, D. X.

Year Published:

2007

Publication:

The Journal of the American Medical Association

Volume:

298

Number:

Pages:

1401-1411

Publisher:

American Medical Association

Background:

Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.

Purpose:

The purpose of this study was to evaluate the effects of a depression outreach-treatment program on workplace outcomes.

Setting:

The study was conducted over the telephone with individuals all over the U.S. with behavioral health plan coverage.

Sample:

A randomized controlled trial involving 604 employees covered by a managed behavioral health plan were identified in a 2-stage screening process as having significant depression. Patient treatment allocation was concealed and assessment of depression severity and work performance at months 6 and 12 was blinded. Employees with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality were excluded.

Data Collection:

Intervention effects on depression severity were estimated using multiple imputation multiple linear regression with simulated standard errors. QIDS-SR scores at 6 and 12 months were regressed on a dichotomous predictor for randomization status. Dichotomous measures of symptom improvement (?50% reduction in QIDS-SR scores) and complete remission (QIDS-SR scores of ?5) were also examined using multiple imputation multiple logistic regression. Comparable multiple imputation regression analyses were used to estimate intervention effects on work outcomes. The primary outcome was a composite measure of the number of effective hours worked in the prior 7 days, for which participants no longer working contributed no hours and numbers of hours worked by employed respondents were weighted by job performance.

Intervention:

The intervention was a telephonic outreach and care management program. This program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy.

Control:

Those assigned to usual care were informed that their responses indicated possible depression and advised to consult with a clinician; they could receive any normally available insurance benefit or service (eg, psychotherapy or pharmacotherapy), just not the additional telephone care management components provided to those in the intervention group.

Findings:

The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes. Combining data across 6- and 12-month assessments, the intervention group had significantly lower QIDS self-report scores (relative odds of recovery, 1.4; 95% confidence interval, 1.1-2.0; P = .009), significantly higher job retention (relative odds, 1.7; 95% confidence interval, 1.1-3.3; P = .02), and significantly more hours worked among the intervention (?=2.0; P=.02; equivalent to an annualized effect of 2 weeks of work) than the usual care groups that were employed.

Conclusions:

A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/17895456

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Project SEARCH for youth with autism spectrum disorders: Increasing competitive employment on transition from high school

Authors:

Wehman, P., Schall, C.M., McDonough, J., Kregel, J., Brooke, V., Molinelli., A., Ham, W., Graham, C. W., Riehle, J. E. Collins, H. T., & Thiss, W.

Year Published:

2013

Publication:

Journal of Positive Behavior Interventions.

Volume:

Number:

Pages:

144-155

Publisher:

Hammill Institute on Disabilities and Sage

Background:

Transition from school to work for youth with ASD is an ongoing problem for the public education system. Teachers also struggle with their attempts to match the strengths of a particular student to a job. Project SEARCH is a transition program for youth with disabilities. In this model students rotate through full day internships in businesses to gain work and related skills that may lead to an employment offer for some.Others have a positive work experience to highlight as they apply for jobs in their communities.Project SEARCH helps facilitate the transition from school to work.

Purpose:

The purpose of this study was to determine how a Project SEARCH approach would work for youth with ASD.

Setting:

The student internships took place in a large hospital.

Sample:

Two case studies were presented for two young men with ASD. A 19 year with autism and a 20 year old with Asperger Syndrome as well as severe scoliosis.

Data Collection:

The following data demographics, internship characteristics, job coach interventions was collected for each young man.

Intervention:

The intervention was Project SEARCH model along with some specific ASD supports.

Control:

There was no control or comparison condition.

Findings:

One young man participated in internships in the hospitals' radiation, engineering and infection control departments. His performance improved over time and he was offered a job in the infection control department working 20 hours and week and earning $9.14 an hour.The other young man participated in internships in the Coronary Care Unit, Biomedical Durable Equipment, and Intensive Care Unit (ICU). His abilities also improved during the internships. After completing the internships he was offered a job working 20 hours a week in the ICU earning $9.14 per hour.

Conclusions:

A Project SEARCH approach appears to be an effective way to assist youth with ASD with transition from school to work. This study was part of a larger study researching the use of Project SEARCH model to serve youth with ASD. The results from this larger study should help shed light on this topic.

URL:

http://pbi.sagepub.com/content/early/2012/10/11/1098300712459760

Disabilities:

Autism Spectrum Disorder

Populations:

Male

Transition-age youth (14 - 24)

Outcomes: