Is job tenure brief in individual placement and support (IPS) employment programs? | Knowledge Translation for Employment Research Center

Authors:	Bond, G. R., Becker, D. R., & Drake, R. E.
Year Published	2011
Publication	Psychiatric Services
Volume	62
Number	8
Pages	950-953
Publisher	American Psychiatric Association
Background	Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.
Purpose	The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.
Setting	Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.
Sample	Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.
Data Collection	Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.
Control	The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.
Findings	The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7‚Äì12, 13 (9%) during months 13‚Äì18, and ten (7%) during months 19‚Äì24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6¬±10.2 hours per week and 10.7¬±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5¬±8.3 hours per week and 16.4¬±4.2 days per month. Mean wage rate for working clients was $7.90¬±$3.00 per hour
Conclusions	Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.
URL	http://www.ncbi.nlm.nih.gov/pubmed/21807836
Disabilities	Emotional disturbance
Populations	Male & Female \| Hispanic or Latino \| American Indian or Alaska Native \| Asian \| Black / African American \| White / Caucasian
Outcomes	Increase in tenure
NIDILRR Funded	Yes
Research Design	Quasi-experimental
Peer Reviewed	Yes

Year Published

2011

Publication

Psychiatric Services

Volume

62

Number

8

Pages

950-953

Publisher

American Psychiatric Association

Background

Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.

Purpose

The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.

Setting

Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.

Sample

Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.

Data Collection

Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.

Control

The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.

Findings

The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7‚Äì12, 13 (9%) during months 13‚Äì18, and ten (7%) during months 19‚Äì24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6¬±10.2 hours per week and 10.7¬±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5¬±8.3 hours per week and 16.4¬±4.2 days per month. Mean wage rate for working clients was $7.90¬±$3.00 per hour

Conclusions

Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.

URL

http://www.ncbi.nlm.nih.gov/pubmed/21807836

Disabilities

Emotional disturbance

Populations

Outcomes

Increase in tenure

NIDILRR Funded

Yes

Research Design

Quasi-experimental

Peer Reviewed

Yes