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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

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

Findings: 

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

Conclusions: 

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

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

Neurocognitive enhancement therapy with vocational services: Work outcomes at two-year follow-up

Authors: 
Berthoud, R.
Year Published: 
2008
Publication: 
Schizophrenia Research
Volume: 
105
Number: 
1
Pages: 
18-29
Publisher: 
Elsevier
Background: 

Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory.

Purpose: 

The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.

Setting: 

The study setting was a Community Mental Health Center serving individuals with psychiatric disabilities.

Sample: 

Seventy-seven stable outpatients with diagnoses of schizophrenia or schizoaffective disorder were recruited at a large urban community mental health center. Participants met diagnostic criteria based on the Structured Clinical Interview for DSM-IV (First et al., 1996) from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association & Task Force on DSM-IV, 1994), conducted by research psychologists, and were eligible if they were clinically stable (i.e., GAF > 30, no housing changes, psychiatric medication alterations, or psychiatric hospitalizations in the 30 days prior to intake). Exclusion criteria included history of traumatic brain injury, known neurological diseases, developmental disability, and active substance abuse within the past 30 days

Data Collection: 

The statistical consultant compared hours worked by condition across quarters over the course of the two-year study using mixed models, repeated measures ANOVAs. Analyses were performed separately for total hours of community-based work activity (transitional and competitive payment combined), and hours of community-based work activity paid exclusively by the employer (competitive payment). Because of significant skew introduced by non-working participants in each quarter, analyses were repeated using ranked data as a nonparametric check of the results. Except where corrected for multiple comparisons, alpha was set at .05 and all tests were two-tailed.

Intervention: 

Patients (N = 72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET + VOC or VOC only. NET + VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.

Control: 

The control condition was VOC only.

Findings: 

NET + VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.

Conclusions: 

NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18715755
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes