Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trial.

Authors: 
Wehman, P., Targett, P., Yasuda, S., & Brown, T.
Year Published: 
2014
Publication: 
Journal of Autism and Developmental Disabilities.
Volume: 
44
Number: 
3
Pages: 
487-500
Publisher: 
Springer US
Background: 

Unemployment rates for individuals with autism after existing secondary education are high. Rates for individuals with ASD are between 4 to 12 percent. They also have low rates of participation in vocational or technical education, and post secondary education as compared to individuals with speech and language impairments, learning and intellectual disabilities. Furthermore, state vocational rehabilitation programs are experiencing difficulties responding to the employment service needs of transition aged youth with ASD. The employment outcome rate reported by VR for individuals with ASD has declined much in recent years. Research is limited on intervention to assist adults with ASD with gaining and maintaining employment. Project Search is an intensive internship program that has been replicated with modifications and has shown some degree of success with assisting transition aged youth with gaining and maintaining real work for real pay in their communities.

Purpose: 

This study had two hypotheses. First, higher number of individuals who participate in an employer based employment training and placement program will be employed than those in the control condition at a)completion of intervention and b) 3 months post completion of the intervention.Second, those who participate in the program will require less work support as measured by the Support Intensity Scale Employment Activities Subscale than those in the control condition at a) completion of the intervention and b) 3 months post completion of the intervention. The study was continuing at this writing and this analysis presents results from the first 3 years of cohorts who have completed one school year in Project SEARCH plus ASD Supports.

Setting: 

The students worked in a variety of internships in two suburban hospitals.

Sample: 

A total of 40 students participated in the study. 16 were assigned to the control group and 24 were in the treatment group. The two groups were equivalent on a number of demographic variables including gender, race, medical diagnosis, and Individualized Education Plan category. There was a significant difference between the ages of the treatment and control groups. The age range for both was between 18 and 21.5 years old.

Data Collection: 

Information was collected from the application process and a brief interviews at scheduled times to gain insight into the person's employment status, wage earned, hours worked, and employer paid benefits. The Supports Intensity Scale was also used to assess adaptive behavior and intensity of support needs. The six subscales used were: home living, community living, lifelong learning, employment, health and safety, and social. The SIS allowed the examiners to identify the types of work supports individuals required and provided a measure of the overall adaptive behavioral support needs of participants at baseline. Data collectors were trained in the administration of the instrument and inter-rater reliability was high 92.5%.Preliminary analysis included frequencies, means, standard deviations and distribution of scores.

Intervention: 

The intervention was Project SEARCH.

Control: 

The control condition was traditional transition service.

Findings: 

The treatment group attained employment at a rate of 87.5% after completing Project SEARCH internship and the ASD program compared to the control group at 6.25%. The treatment group also experienced an increase in weekly hours worked and wages.Three months later there was a significant difference between the treatment and control group mean standard scores on the Employment Activities Subscale of the SIS.

Conclusions: 

This study provided preliminary results.Twenty one out of 24 or 87.5 percent of the treatment group acquired employment. While only one in 16 or 6.25 percent of the control group went to work.Employment after graduating from high school is an attainable goal for youth with ASD who display challenging behavior and who have a comorbid medical diagnoses.

URL: 
http://researchautism.net/publications/5492/competitive-employment-for-youth-with-autism-spectrum-disorders:-early-results-from-a-randomized-clinical-trial.
NIDILRR Funded: 
Peer Reviewed: 
Yes

Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness

Authors: 
Graham, C., Inge, K., Wehman, P., Murphy, K., Revell, W. G., & West, M.
Year Published: 
2006
Publication: 
Schizophrenia Bulletin
Volume: 
32
Number: 
2
Pages: 
378-395
Publisher: 
Oxford University Press
Background: 

Urban Based randomized clinical trials of integrated supported employment and mental health services in the United States on average have doubled the employment rates for adults with severe mental illness compared to traditional vocational rehabilitation. However, studies have not explored if the service integrative functions of supported employment will be effective in coordinating rural based services.

Purpose: 

Study designed and implemented a program blending Assertive Community Treatment (ACT) with a supported employment model using Individual Placement and Support (IPS) in a rural setting. In a 24 month randomized controlled trial, the ACT_IPS approach was compared to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults for serious mental illness.

Setting: 

Sumter County South Carolina catchment area of the South Carolina Department of Mental Health served by the Santee-Wateree Community Mental Health Center. Population = 102,000; African American (47%), White (49%)

Sample: 

Study sample met the federal Center for Mental Health Services criteria for severe and persistent mental illness. All were age 18 or older and unemployed at time of study entry. All had been a client of the Santee-Wateree Community Mental Health Center (SWCMHC) for at least 6 months.

Data Collection: 

Data collection and analysis addressed five key questions: (1) What obstacles would a rural South Carolina setting posed to implementing and sustaining ACT-IVR and IPS model? (2) How do the competitive work outcomes of the ACT-IVR and IPS programs compare to a traditional program providing parallel services in a rural economy? (3) How are overall work outcomes affected by differing strategies for obtaining employment? (4) How do rates of income earned from competitive employment change over time by program? (5) How do the programs' work outcomes compare after controlling for the number of participants' service contacts?

Intervention: 

Intervention was a fully integrated combination of Assertive Community Treatment with Integrated Vocational Rehabilitation (ACT-IVR)and Individual Placement and Support (IPS). ACT-IVR tightly integrated vocational with mental health services within a self contained provider team. IPS integrated its vocational services with its host agency or another agency's mental health services.

Control: 

Comparison program was a formal partnership between a local vocational rehabilitation agency and the SWCMHC. Program provided parallel traditional vocational rehabilitation and mental health services, respectively. The rehabilitation agency's employment specialists prepare participants for competitive jobs by taking a gradual, stepwise approach that focused on developing skills to manage workplace demands in staff supervised jobs set aside for adults with work disabilities.

Findings: 

More ACT-IPWS participants held competitive jobs and earned more income than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs.

Conclusions: 

The ACT-IPS program aided persons with serious mental illness-related work impairments, limited job experience, and tremendous educational and economic disadvantage to attain competitive work outcomes on a par with the urban supported employment programs cited in the literature. the ACT-IPS service-coordinating functions and immediate attention to competitive work may have been key processes that overcame rural-area obstacles to receipt of appropriate services and to labor market participation. However, the earnings generated fall far short of economic independence. It is recommended that barriers to accessing higher education for adults with SMI in rural areas must be reduced, with more of a focus placed on career-oriented job opportunities providing a means to develop highly marketable technical skills.

URL: 
http://schizophreniabulletin.oxfordjournals.org/content/32/2/378.full.pdf+html
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies

Authors: 
Gersons,B. P. R., Carlier,I. V. E., Lamberts, R. D., & van der Kolk, B. A.
Year Published: 
2012
Publication: 
Journal of Vocational Rehabilitation
Volume: 
37
Number: 
2
Pages: 
75-85
Publisher: 
Journal of Vocational Rehabilitation
Background: 

Personal digital assistants (PDAs) offer task management and organizational features that may be utilized to help people with autism spectrum disorder (ASD) function more successfully in the workplace. However, most of the focus in autism research is on the identification, assessment and treatment of children; few studies examine interventions and outcomes in adulthood. As a result, evidence-based programs of workplace support are limited.

Purpose: 

The purpose of the study was to determine if supported employment could improve the cognitive performance of individuals with autism. More specific, the researchers wanted to know what types of employment might have such benefits? Does supported employment also improve non-vocational outcomes?

Setting: 

The setting included three employment sites in 3 different businesses.

Sample: 

The three people profiled were adults with autism spectrum disorder who were participants in a 4 year randomized trial examining the use of these devices as job coaching aids in the workplace. The participants were: a 21-year-old man working as a daytime custodian in a fast food restaurant, a woman aged 60 years responsible for processing incoming mail at an office, and a 20-year-old female non-reading hospital worker,

Data Collection: 

Data was maintained for each study participant on average hours worked per week, average job coach direct verbal/gestural supervision hours per week, and average job coach indirect monitoring hours per week. Date was also maintained on software applications used.

Intervention: 

Onboard iPod Touch task organization applications were used to set up work schedules with audible task prompts and reminder alarms. The Notes application was used to provide additional task guidance, and the PDAs video camera was used to record short videos guiding the mail clerk around various stations in her work environment. Other apps utilized included Simply Being, providing relaxation and meditation coaching; VoCal, a verbal reminder application; iCal, for creating a color coded alternating-day calendar; StoryKit for creating picture-prompting task lists; and iReward for positive performance feedback, the latter three added for the non-reader hospital worker.

Control: 

There was no control or comparison condition.

Findings: 

Participants wore the portable PDAs, clipped to a belt or with a lanyard around their neck, as vocational supports throughout their workday for a period of six months, resulting in improved functional performance and reduced behavioral challenges

Conclusions: 

PDAs should be considered as an assistive technology for use with people with cognitive-behavioral conditions. The partnership of an Occupational therapist familiar with task analysis, PDAs and applications and an employment specialist onsite at the job site can facilitate successful individualized strategies for vocational support using PDAs.

URL: 
http://worksupport.com/documents/apple_ipod_touch.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Effect of job skills training on employment and job seeking behaviors in an American Indian substance abuse treatment sample

Authors: 
Fong, C. J., Murphy, K. M., Westbrook, J. D., & Markle, M. M.
Year Published: 
2010
Publication: 
Journal of Vocational Rehabilitation
Volume: 
33
Number: 
3
Pages: 
181-192
Publisher: 
IOS Press
Background: 

Employment problems are often significant in American Indian communities. Barriers such as historically high unemployment rates or a lack of job finding skills may contribute to lower than expected job skills and career development. Likewise, unemployment is high for those with substance abuse disorders. There is little empirical research addressing interventions for American Indians with substance abuse disorders for improving employment status.

Purpose: 

The purpose of this study was to implement the Job Seekers Workshop (JSW), a 12-hour job search-training program, in an American Indian addiction treatment program, and to evaluate its outcomes in comparison to the Job Interview Videos (JIV), a 40-minute two-part video.

Setting: 

The study setting was the Na Nizhoozhi Center (NCI) in Gallup, NM. The NCI is a 150-bed facility that provides culturally specific treatment programs to meet the needs of American Indian.

Sample: 

The study sample consisted of 102 individuals with American Indian heritage who were drug and/or alcohol dependent, 18 years of age or older, enrolled at NCI for at least 10 days, categorized as either unemployed (i.e., not having worked at all for the month prior to study recruitment) or underemployed (i.e., having worked no more than 20 hours/week in any
given week during the past month), and interested in obtaining a job. The majority were Navajo males.

Data Collection: 

The measures included several standardized instruments measuring addiction severity, current use of substances, reading ability, and life experiences. Employment information was captured using the Timeline Follow Back for Employment (TLFB-E). Two variables served as primary outcomes: 1) time (number of days) to employment, either a new taxed job or enrollment in a job-training program within the follow-up period, and 2) total hours either working or enrolled in a job-training program within the time period. Time to employment and time to enrollment in a job-training program were tested using the Cox Regression procedure. Analyses addressing the number of participants reporting employment or enrollment in a training program were conducted using Chi-square tests. Analyses focused on hours spent working or in training were conducted using an analysis of variance (ANOVA). Comparisons based on repeated measures over time were tested using multivariate repeated measures analyses of variance (MANOVA).

Intervention: 

Two interventions were tested. First, the Job Seeker‚ Workshop (JSW) is a standardized 12-hour job search-training program designed to increase job-seeking skills, particularly interviewing. The program consists primarily of focused, individual instruction with videotaped feedback for group discussion. The Job Interviewing Video (JIV) is a 40-minute instructional video related to answering job interview questions, including difficult questions.

Control: 

The study used a two-group comparison design.

Findings: 

There were no significant differences between the JSW and JIV groups at baseline, nor were there differences in completion time of the program or time to employment at either three or six months following completion or in job-seeking behaviors. A significant difference was found on enrollment in a training program, with more participants who were involved in the JIV intervention enrolled in a training program than in the JSW intervention. Satisfaction was rated relatively high for both programs. There were also no differences in substance use post-completion, with both groups reporting reduced use.

Conclusions: 

Although both groups showed some gains in employment from baseline to follow-up, overall rates of employment remained low at follow-up, averaging less than 50 total hours worked within the first three months following randomization. However, positive changes were observed related to substance use. Significant differences in the primary outcomes were not detected between the JSW and JIV interventions

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr526
NIDILRR Funded: 
Peer Reviewed: 
Yes

Utilizing co-workers as "Natural Supports" evidence on cost efficiency, job retention, and other employment outcomes

Authors: 
Cimera, R. E., Wehman, P., West, M., & Burgess, S.
Year Published: 
2001
Publication: 
Journal of Disability Policy Studies
Volume: 
11
Number: 
4
Pages: 
194-201
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Much discussion has taken place about the use of natural supports in supported employment. However, a review of the literature indicates empirical evidence supporting or refuting the concept is lacking.

Purpose: 

The purpose of this study was to provide empirical research on the use of natural supports, coworkers without disabilities, as a training strategy for supported employees.

Setting: 

A variety of job sites in Illinois where individuals who received supported employment services worked.

Sample: 

The initial sample included 166 individuals with a primary diagnosis of mental retardation, who were 21 to 69 years old. The majority or 66% were European American and 34% were African American. Of these 166 individuals 31 were replaced because they were lost to contact or the support agency refused to participate or the person did not want to participate. Of 197 (166 plus 31 replacement) surveys mailed, 111 were returned, resulting in a 56% return rate.

Data Collection: 

A survey was sent to the adult service providers of 166 people who were included in the Illinois Supported Employment Projects database. The survey include questions related to: worker characteristics, Job coach/Co-worker involvement, Benefit-cost analysis, and Job separation. Dependent variables included: cost efficiency, length of employment, job retention, hours worked per month, gross pay, IQ,level of mental retardation, gender, ethnicity, age and number of disabilities. The independent variable was collected by the coworker Involvement Instrument that assesses the Involvement of coworkers in training supported employees. There was no control. Four analysis took place. The first compared employment outcomes to the degree of coworker Involvement. The second compared the supported employee demographics to the degree of coworker Involvement. Both of these analysis were repeated using data from 1990 and 1994. In addition, an analysis of variance were performed for the nominal-scale variables and Pearsonian correlation coefficients were generated for continuous scale variables.

Intervention: 

The intervention was coworker supports.

Control: 

There was no control or comparison condition.

Findings: 

The study found that coworker involvement did not increase cost efficiency. However, it did seem to increase the length of time the supported employees maintained their jobs. No other employment outcomes were related to coworker involvement. Coworker involvement was not associated with any of the demographic variables.

Conclusions: 

Utilizing coworkers to train supported employees does not increase cost efficiency. Coworker involvement appears to increase the supported employees job tenure. Coworker involvement was not impacted by the demographics of the supported employees, meaning that coworkers are willing to aid in the training of individuals with diverse disabilities and functioning levels.

URL: 
http://dps.sagepub.com/content/11/4/194.full.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of employment for people with severe mental illness: Results of an international six-centre randomised controlled trial

Authors: 
Chan, F., Cheing, G., Chan, J.Y.C., Rosenthal, D.A., & Chronister, J.A.
Year Published: 
2008
Publication: 
The British Journal of Psychiatry
Volume: 
192
Number: 
1
Pages: 
224-231
Publisher: 
The Royal College of Psychiatry
Background: 

An international six-centre randomised controlled trial comparing Individual Placement and Support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.

Purpose: 

The purpose of the study was to determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes. Patient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS. Aim was to explore who among a group of patients with severe mental illness would do well in vocational services in terms of both obtaining and maintaining open, competitive employment, and which process and service factors would be associated with better outcomes. Therefore, study aimed to determine predictors of employment outcomes from among demographic and illness characteristics, early process factors and service features

Setting: 

A randomized controlled trial was conducted in six European centres , London, Ulmnzburg, Rimini, Zurich, Groningen and Sofia comparing IPS with usual high-quality vocational rehabilitation based on the train and place model.

Sample: 

Patients (n=312) were recruited if they had psychotic illness, were aged between 18 and the local retirement age, had been ill and had major role dysfunction for at least 2 years, were in the community, had not been in competitive employment in the preceding year and wanted to enter competitive employment. Randomisation was carried out centrally and stratified by centre, gender and work history (1 month or less of continuous open employment v. more than 1 month in the previous 5 years), replicating the original IPS study.

Data Collection: 

Three analyses were conducted. First, patient characteristics collected at baseline, including illness characteristics and the patient‚ reported relationship with their clinical key worker, were tested as potential predictors of the employment outcomes. Second, early process factors, collected at patient level at the first follow-up interview (T1), when the patient had been in the service for up to 6 months, were tested as potential predictors. Service allocation (IPS v. vocational service) was included as a possible explanatory variable in the early process models, despite the fact that the greater effectiveness of the IPS service had already been demonstrated.7 This was to ensure that it was not confounding any significant associations between other potential predictor variables and employment outcomes. It was not included in the patient characteristics models, as these variables were measured before randomisation. The impact of service as such is not the focus of the current paper. Finally, key characteristics of the services themselves were tested. As the latter were service-level factors, they were tested against the effectiveness of the IPS service at each international centre.

Intervention: 

The IPS service in each center was implemented in accordance with the IPS place and train supported employment model, which has 6 key features: its goal is competitive employment in work settings integrated into a community‚ economy; clients are expected to obtain jobs directly, rather than following lengthy pre-employment training (rapid job search); rehabilitation is treated as an integral component of mental health treatment rather than a separate service; services are based on clients preferences and choices; assessment is continuous and based on real work experiences; and follow-on support is continued indefinitely.

Control: 

The vocational service (control service) at each center was the best alternative vocational rehabilitation service available locally, with a structured program conducted mostly in day facilities (although mostly residential in Ulm). Each was based on the more traditional principles of train and place providing vocational training and job preparation before the client proceeded to seek competitive employment. Each vocational service had to guarantee taking patients into the service within 2 months of randomization.

Findings: 

Patients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.

Conclusions: 

The IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

URL: 
http://www.rug.nl/research/portal/files/6715928/Catty_2008_Br_J_Psychiatry.pdf
Disabilities: 
Populations: 
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

Additional interventions to enhance the effectiveness of individual placement and support: A rapid evidence assessment

Authors: 
Brooks, B. M., Rose, F. D., Atree, E. A., & Elliot-Square, A.
Year Published: 
2012
Publication: 
Rehabilitation Research and Practice
Volume: 
2012
Number: 
1
Pages: 
101-108
Publisher: 
Hindawi Publishing Corporation
Background: 

Individual placement and support (IPS) has been developed as a standardized approach to supported employment aimed at helping people with severe mental health problems find competitive work. IPS has proven very effective in improving vocational outcomes amongst people with severe mental illness when compared to other vocational services, with a recent review reporting that 61% of participants enrolled in IPS programs gained employment, compared to 23% of those on other vocational programs. IPS does have limitations, however. As the results above would suggest, around 40% of people on IPS programs do not gain employment despite the support. A second criticism of IPS relates to job tenure of the people employed through these schemes, which tends to be short

Purpose: 

To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. The aim of this rapid evidence assessment was to identify studies which have sought to improve on the effectiveness of standard IPS by adding a supplementary intervention. The aims are to answer the following questions: (1) what supplementary interventions have been used with IPS? (2) What are the results and what is the quality of those studies? (3) Do supplementary interventions improve employment rates and job tenure compared to IPS alone? (4) Are any supplementary interventions superior to others?

Setting: 

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

Sample: 

The search was for empirical studies conducted from 1980 to July 2011. Studies were considered for inclusion if they: involved people with a severe mental illness; indicated the use of IPS or IPS core principles; involved supplementary interventions categorised as skills training, education, cognitive training, or psycho-therapeutic techniques. Studies meeting these criteria were only included if the design compared IPS alone with enhanced IPS. The sample included 11 studies involving individuals with mental illness.

Data Collection: 

A Rapid evidence assessment provides an overview of existing research on a specific research topic, as well as a simple extraction and synthesis of the relevant data. The methods used to search for and appraise the research are systematic and rigorous, but the depth of the search is limited by the development of search terms and breadth of resources searched. This type of assessment is particularly useful to quickly gather existing evidence in a research area and determine what future research needs to be done.
Data regarding employment rates and job tenure were extracted directly from the papers. Odds ratios were calculated where possible using data on participants employed/not employed per experimental group in each study. Where necessary, authors were contacted for further clarification or information.

Intervention: 

A rapid evidence assessment of the literature was conducted for studies where behavioral or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion.

Control: 

There were no comparison or control conditions.

Findings: 

In total 627 papers were identified and 246 remained after duplicates were removed, of which 241 were excluded at this stage (reasons are given below). References of the 5 included papers and relevant (excluded) systematic reviews were screened for potentially relevant titles, which identified a further 15 records for screening once duplicates had been removed. Of these, 6 further papers met the inclusion criteria. In total, 11 papers were included in the review and 250 papers were excluded. Averaging across the employment rates reported by four studies, enhanced IPS does appear to produce higher rates of competitive employment compared to IPS or control groups alone. The average enhanced rate of 76% would also appear to be higher than the average IPS employment rates reported in previous reviews [3], and this difference is accentuated when focusing on studies using skills training, where on average the employment rate is 25% higher. In addition, rates were moderately higher than previous reviews for studies involving cognitive training.

Conclusions: 

Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

URL: 
http://www.hindawi.com/journals/rerp/2012/382420/
Disabilities: 
Populations: 
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 supported competitive employment programme for individuals with chronic mental illness

Authors: 
Wong, K., Chiu, L. P., Tang, S. W., Kan, H. K., Kong, C. L., Chu, H. W.,& Chiu, S. N.
Year Published: 
2001
Publication: 
Hong Kong Journal of Psychiatry
Volume: 
11
Number: 
2
Pages: 
13-18
Publisher: 
Hong Kong Academy of Medicine Press
Background: 

Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. Numerous reports demonstrate enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness. Not much is known about the program outcomes and applicability in Hong Kong.

Purpose: 

The objective of this study was to ascertain the vocational outcomes of individuals with chronic mental illness participating in a supported employment program.

Setting: 

The setting included supported Employment Services in a hospital in Hong Kong.

Sample: 

The sample was 388 individuals with chronic mental illness.

Data Collection: 

Referral forms were used to collect demographic data. A job placement and follow up record was used to assess job retention rate, job tenure, nature of job placement and earnings. A job termination form was used to evaluate the reasons for the termination of employment.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

The comparison condition was traditional vocational rehabilitation services.

Findings: 

Of the 388 patients, 267 (68.8%) obtained competitive employment. The mean job tenure was 133 days. The mean salary was HK$4,737 for full-time jobs and HK$2,329 for part-time jobs. The majority of the patients (59.6%) sustained their job placement for more than 30 days, 69 patients (25.8%) worked for more than 6 months, and 35 (13.1%)maintained the job for more than 1 year.

Conclusions: 

This study concluded that a supported competitive employment program could be an effective approach to enhancing vocational outcomes for individuals with chronic mental illness. Recommendations for future research for evaluation of the effectiveness of the supported competitive employment program are suggested.

URL: 
https://www.questia.com/library/journal/1G1-169678962/a-supported-competitive-employment-programme-for-individuals
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes