Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: Two-Year outcomes

Authors: 
Rosenthal, D. A., Dalton, J. A. & Gervey, R.
Year Published: 
2007
Publication: 
Psychiatric Services
Volume: 
58
Number: 
3
Pages: 
325-333
Publisher: 
American Psychiatric Association
Background: 

Experimental studies have robustly demonstrated the effectiveness of the Individualized Placement and Support (IPS) model of supported employment services for people with severe mental illness, and several studies of real-world implementation have shown significant cross-sectional correlations between employment success and fidelity to the IPS model. Experiences with IPS programs have stimulated broad efforts to disseminate evidence-based practices. Although multiple dissemination efforts are underway, analyses on the benefits of efforts to disseminate IPS have been on cross-sectional and site-level data, rather than on longitudinal information on individual clients. To implement IPS in health care systems with limited previous experience, sustained and individualized training programs may be needed to realize potential client benefits. Few studies have demonstrated that IPS, or other evidence-based practices for that matter, can both be implemented in a system that lacks prior experience with the model and yield outcomes for comparable cohorts that are superior, over several years, to those of a comparison group for which this intervention was not available.

Purpose: 

This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).

Setting: 

The setting included 9 Veterans Administration Programs for Homeless Veterans.

Sample: 

A total of 308 veterans were recruited during phase 1, starting in January 2001, when IPS was still unavailable anywhere in the VA. An additional 321 veterans were recruited in phase 2, starting in July 2001, after the IPS employment specialist had been hired and trained, and were invited to participate in IPS for at least two years. Follow-up data collection continued through March 2005.

Data Collection: 

Participants in phase 1 were compared with participants in phase 2 on baseline characteristics by using chi square tests and t tests. All available participants were included in all analyses whether or not they were currently participating in IPS. Mixed models were then used to compare outcomes between the phases over the two-year follow-up period, controlling for baseline differences, using the MIXED procedure of SAS, with the alpha set at <.05.

Intervention: 

Training began with a one-day, on-site, face-to-face orientation for both employment specialists and other VA mental health staff that was led by a social worker with experience training IPS specialists and conducting IPS fidelity ratings. For the duration of the project regular teleconferences continued providing weekly individual case reviews for the first three months, monthly individual case review conferences, and monthly conference calls with all nine employment specialists jointly. A review of ratings of model fidelity at six, 12, and 18 months after program implementation was also performed with a modified version of the IPS fidelity scale. Training was provided by a social worker with extensive experience disseminating the IPS model in other research projects. He was assisted by a VA occupational therapist with experience in supported employment. Monthly conference calls were also held with administrators responsible for program implementation at each site.

Control: 

Phase 1 control group did not receive IPS services. Comparison was made with Phase 2 group who did receive IPS services.

Findings: 

Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. (Psychiatric Services 58:325—333, 2007)

Conclusions: 

A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

URL: 
http://www.nchv.org/images/uploads/Implementation_of_Supported_Employment_for_Homeless_Veterans_With_Psychiatric_or_Addiction_Disorders-Two-Year_Outcomes.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

What are the benefits of evidence-based supported employment for patients with first-episode psychosis?

Authors: 
Rose J., Saunders K., Hensel, E., & Kroese, B. S.
Year Published: 
2004
Publication: 
Psychiatric Bulletin
Volume: 
28
Number: 
8
Pages: 
281-284
Publisher: 
Royal College of Psychiatrists
Background: 

Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.

Purpose: 

The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Setting: 

The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George‚ Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.

Sample: 

The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.

Data Collection: 

Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included:
• demographic variables: age, gender, ethnicity;
• clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator.
Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.

Intervention: 

A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.

Control: 

There was no control or comparison condition.

Findings: 

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying good implementation

Conclusions: 

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

URL: 
http://pb.rcpsych.org/content/28/8/281
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Achieving a successful and sustainable return to the workforce after ABI: A client-centered approach

Authors: 
Phillips, V. L., Temkin, A., Vesmarovich, S., Burns, R., & Idleman, L.
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
5
Pages: 
465-478
Publisher: 
Informa Healthcare
Background: 

Acquired brain injury (ABI) can be caused by cerebrovascular accident, trauma (such as assault or motor vehicle accident), tumors, hypoxia, infection or degenerative conditions and is a common occurrence [1]. It may result in significant disability and, in people of working age, limit their ability to join or return to the workforce.

Purpose: 

The aim of this study was to describe the services provided (including assessments, interventions and post-job placement support) and outcomes achieved by CRS Australia‚ Victorian ABI team and compare and contrast this with other models.

Setting: 

The study setting was a rehabilitation service organization in Australia.

Sample: 

The study sample consisted of 27 individuals with ABI who had received rehabilitation services at CRS Australia. The sample was randomly selected from cases that had been closed in the previous year with an employment outcome. Additional characteristics of the sample are not provided.

Data Collection: 

A data extraction method was used to audit patient information relevant to the study. Team members were also asked to indicate which of 17 vocational rehabilitation strategies they used with their clients and to rate each in terms of effectiveness in achieving a successful job placement. which of five post job-placement strategies (email to client, weekly or fortnightly phone calls to client, weekly or fortnightly phone calls to employer, support/counseling outside client‚ work hours and regular scheduled workplace visits) they used and to evaluate their perceived effectiveness.

Intervention: 

The intervention is described as client-centered practice. Each client is allocated to a Rehabilitation Consultant (RC) with whom they work one-to-one, wherever possible, throughout the duration of services. Active client involvement in the negotiation of individual rehabilitation plans is standard practice in all cases and clients are informed of their rights, responsibilities and the complaints handling mechanism at the earliest opportunity. Specific interventions are tailored to the individual and can include vocational counseling, skills training, cognitive retraining, job seeking, interview preparation, work behavior coaching, and post-employment services.

Control: 

There was no control or comparison condition. Outcomes for the study group were compared to those of other models.

Findings: 

Of the patient files audited, 42% were placed in professional, managerial, office or administrative work, two were placed in a trade-qualified job, eight were placed in semi-skilled positions, and four were placed in unskilled labor. Of the clients who had jobs to return to (n=10) all returned to their previous role or a similar job following a graded return with professional/clerical jobs figuring highly (50%; n=5). Those clients who did not have a job to return to (n=17) were placed in similar roles to their pre-injury employment, with seven placed in a professional role, six placed in semi-skilled work and four placed in unskilled labor positions. Half were employed more than 13 weeks.

Conclusions: 

The CRS Australia model resulted in higher than average employment outcome rates for this population (50% working at award wage for more than 13 weeks, compared to Australian ABI population estimates of 28–46.5%). This study shows that the CRS Australia model has been successful with people with mild, moderate and severe impairment following an ABI and significantly less time-intensive and therefore less costly than other models.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17522986
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The effectiveness of supported employment in people with dual disorders

Authors: 
Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J. Bond, G. R, Essock, S. M., Becker, D. M., Wolfe, R., & Swain, K.
Year Published: 
2011
Publication: 
Journal of Dual Diagnosis
Volume: 
7
Number: 
2
Pages: 
90-102
Publisher: 
PubMed
Background: 

Competitive work is a common goal for people with a severe mental illness (e.g., schizophrenia, bipolar disorder, treatment refractory major depression) and substance use disorder (or dual disorder). Despite this fact, relatively little has been firmly established as to whether substance use problems interfere with the ability of clients with severe mental illness to work or to benefit from vocational rehabilitation programs.

Purpose: 

This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder.

Setting: 

Despite similar methods, the RCTs differed on geographic location, control group interventions, and length of follow-up. The four studies were as follows: The NH study was conducted in two mental health centers in Concord and Manchester, New Hampshire. The DC study recruited clients in an intensive case management program in Washington, DC. In the Hartford study, participants receiving services at a mental health center in Hartford, Connecticut, were randomly assigned. In the Chicago study, clients attending two day programs at a comprehensive psychiatric rehabilitation agency in Chicago, Illinois, were randomly assigned.

Sample: 

The study group consisted of study participants with co-occurring substance use disorders from four RCTs of IPS supported employment versus usual vocational services. All four studies compared a newly established IPS program to one or more well-established vocational programs. In all four studies, participants were recruited from mental health centers (or a psychiatric rehabilitation agency in the Chicago study). Participants were adults who met each state‚ criteria for severe mental illness, typically a DSM-IV Axis I or II diagnosis plus severe and persistent impairment in psychosocial functioning. All participants were unemployed at the time of study admission.

Data Collection: 

This study used archival data from four independent RCTs to determine the effect of IPS supported employment on clients with co-occurring substance use disorders. Institutional Review Boards at local sites and participating universities approved the four studies. In addition, the Institutional Review Board of Indiana University-Purdue University Indianapolis approved the data re-analyses reported here. To evaluate differences at baseline between the clients randomized to IPS compared to the comparison programs on demographic, diagnostic, clinical, and background characteristics, study computed t-tests for continuous variables and chi-square tests for categorical variables.

Intervention: 

Individual Placement and Support (IPS) model 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: 

All of the comparison vocational services were highly regarded, active programs, considered at the time to be state-of-the-art. Common principles shared among these comparison groups were the emphasis on stepwise entry into competitive employment (with the exception of one subprogram in the Hartford study) and brokered services in which the vocational program was provided by a separate agency from the mental health program (with the exception of the Chicago program).

Findings: 

In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up.

Conclusions: 

The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23275763
Disabilities: 
NIDILRR Funded: 
Research Design: 
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: 
22
Number: 
1
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: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Service intensity as a predictor of competitive employment in an individual placement and support model

Authors: 
McGurk, S. R., Mueser, K. T, Feldman, K., Wolfe, R., & Pascaris, A.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
9
Pages: 
1066-1072
Publisher: 
Psychiatric Services
Background: 

Research has been done on supported employment for people with psychiatric disorders; however, little of it has been focused "on variables that moderate the relationship between service intensity and vocational outcomes" (p. 1067)

Purpose: 

The study reviewed "four aspects of service intensity in a supported employment program" (p. 1067):
1. Average level of service intensity
2. Association between service intensity and weeks worked
3. Individual demographics and clinical variables associated with service intensity
4. Individual characteristics that moderate the relationship between service intensity and weeks worked

Setting: 

The setting included 2 Psychiatric Rehabilitation Centers located in Chicago, Illinois.

Sample: 

The sample was made up of 96 participants in the IPS group and 98 in the diversified placement approach group. Participants were randomly assigned to the two groups, and 5 discontinued IPS services within the first 3 months, which reduced the sample size for IPS to 91.

Data Collection: 

The intervention group was enrolled between 1999 and 2002, while data collection continued until 2004. Data were obtained from Threshold PsychServe system and were measured in terms of hours of support. Clients were also completed a survey, which included demographics, as well as a self-report of number of weeks worked and number of years since last employment.

The Positive and Negative Syndrome Scale was administered, as well as the number of lifetime hospitalizations and diagnosis (using DSM-IV). These were collected at baseline.

Data were analyzed using SPSS 11.0 for Windows and Hierarchical Linear Modeling. Zeroes were recorded for participants' IPS contacts for quarters when they dropped IPS.

Hypotheses were tested by totaling variables across the entire study and conducting hierarchical linear modeling regressions, as well as examining the data longitudinally by using the hierarchical linear model.

Intervention: 

The intervention was the Individual Placement and Support (IPS) model of supported employment

Control: 

The comparison condition was the Diversified Placement Approach.

Findings: 

Forty-eight participants continued IPS services for the entire two years. People who dropped out did not differ from those who continued on either demographics or clinical variables.

IPS services and mental health services declined over time; therefore, the intensity of IPS services was positively correlated with mental health services. The number of IPS contacts in one quarter was positively associated with the number of weeks worked in the following quarter.

Conclusions: 

Increasing ISP services intensity may improve employment outcomes.

URL: 
http://www.worksupport.com/kter/documents/pdf/ServiceIntensityasaPredictor.pdf
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Impact of comprehensive day treatment on societal participation for persons with acquired brain injury

Authors: 
Malec, J. F., Buffington, A. L. H., Moessner, A. M., & Degiorgio, L.
Year Published: 
2001
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
82
Number: 
7
Pages: 
885-895
Publisher: 
Elsevier
Background: 

Employment rates for individuals with disabilities are poor and contribute to the ongoing high poverty rates for this group. Although overall employment rates have risen over the years, work outcomes for young adults with disabilities still lag behind those without disabilities. Career development takes place overtime and is influenced by multiple variables such as individual, family, school, and community factors. However, for individuals with disabilities, career development is often complex, nonlinear, and chaotic. High school and post-school services can have a positive impact on employment for youth with disabilities. Students with disabilities who participate in vocational courses and community based work experiences are more likely to obtain and maintain employment after high school. Additionally, participation in adult services like vocational rehabilitation or post secondary education or training can lead to better job opportunities. Research studying patterns of career development for successfully employed adults with disabilities may be able inform clinical practices through the identification of common themes that influence employment in living wage occupations.

Purpose: 

There were 2 hypotheses. The first was that vocational outcomes will meet or exceed those cited in prior research. Specifically, 75% of participants in community-based independent or supported community-based employment or education/training programs; and (b) 50% of individuals in independent community-based employment. The other hypothesis was 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 injuries not related to the brain injury, and (6) preinjury educational/vocational status.

Setting: 

The setting was a Rehabilitation Center.

Sample: 

One hundred and thirteen individuals with brain injury, who were consecutively admitted to the CDT program from 1988 to 1998. This included 96 individuals who completed the program and 17 who did not. Traumatic brain injury accounted for the majority or 72% of the participants who completed the program and 71% of the drop outs. The severity of the TBI sample was 82% and 92% respectively. The mean time since injury (TBI, CVA or other) among those who completed the program was 4.6 years.
The subjects had myriad of problems in the following areas post injury: self awareness, cognitive, communication, social skills and emotional/behavioral.
They were also either unemployed or facing failure at work. Participants had mobility, functional communication skills and exhibited some capacity for applying new knowledge. The average length of stay among participants in the CDT program was 189.5.

Data Collection: 

Evaluation and outcome data were analyzed for each participant. For those who completed the program, work outcomes was measured using the Vocational Independence Scale at program end and 1-year follow-up and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. Data was collected from the Independent Living Scale, VIS, GAS and MPAI-22 when participants entered and exited the program to measure this factor. Logistic regression analysis was conducted for the ILS and VIS were for those who completed the program one year post completion with potential outcome predictors that included: age, education, severity of injury, type of injury, time post injury, degree of impairment prior to program participation.

Intervention: 

Participants attended a CDT that followed guidelines developed by prior research for post acute brain injury rehabilitation programs, along with the following changes: combination of physical therapy and recreation therapy into a Life Skills Group, family education and use of a vocational counselor to provide employer education and support.

Control: 

There was no control or comparison condition.

Findings: 

Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated post acutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury.

Conclusions: 

Community Day Treatment program improves participation in society for individuals with brain injury. Next steps needed are randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for individuals with severe brain injury.

URL: 
https://www.archives-pmr.org/article/S0003-9993(01)74722-3/fulltext
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Project ABLE (Autism: Building Links to Employment): A specialist employment service for young people and adults with an autism spectrum condition

Authors: 
Lysaker P. H., Bond G., Davis L. W., Bryson G.J., & Bell, M.D.
Year Published: 
2014
Publication: 
Journal of Vocational Rehabilitation
Volume: 
41
Number: 
1
Pages: 
13-21
Publisher: 
IOS Press
Background: 

Individuals with Autism face high rates of unemployment due to a myriad of challenges. There have been some reports that participating in an employability program early on can improve work outcome for this group.

Purpose: 

This study examined using a customized approach to either develop or improve employability skills of individuals with Autism.

Setting: 

The settings included work experience sites across a wide range of community businesses.

Sample: 

Participants included 27 students in special education, 15 young adults who were preparing to leave or who had recently left school and 30 who were 18 or older who were not in secondary education in Ireland. All but 4 of the participants were males. The cognitive profile varied among participants and included 27 individuals who had severe learning disability opposed to 14 who were high functioning. All were unemployed.

Data Collection: 

An action research approach was used. Results were presented for each 3 groups of participants. The individualized approach was successful for 17 of the adult participants. By the end of year four 56% had secured full time and part time work. Among the special education group 27 people had the chance to participate in one to three work experiences. Eighteen required one to one ongoing support throughout the duration of the work placement. Some parents of the young adults in this group reported feeling less anxious about what would happen when the child left school. The mainstream group required work experience for short periods of time. A program spanning the entire school year was not possible due to difficulties associated with being released from school. During the engagement phase individuals completed a individual induction, an assessment, a vocational profile, and an action plan. The plan was reviewed and updated every six months.

Intervention: 

The intervention was a Supported Employment Model in Northern Ireland. This model ensure correct level of support are in place for a person with disability, coworkers, management and families. The model include the following phases: engage; place, train, maintain and progress.
To develop employability and related skills participants chose from a range of interventions.

Control: 

There was no control or comparison condition.

Findings: 

The majority or 95% of the participants experience at least one work experience and 66% had two or more placements. Most individuals 47% worked in retail this was followed by job in administration (24%). Experiences lasted between six weeks to six months or more. The experiences took place across all types of businesses and included retail, business, catering and more. Some individuals also went on to secure employment. Feedback was solicited from participants through interviews and focus groups. They indicated a number of key areas improvement; the top two were better use of time and vocational skills.

Conclusions: 

Work preparation and employability training at an early stage appears to help young people with autism spectrum condition in Ireland successfully transition from school to work. A Supported Employment Model assisted young people with autism spectrum condition prepare for and enter work.

URL: 
https://www.qub.ac.uk/research-centres/CentreforBehaviourAnalysis/filestore/Filetoupload,503346,en.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Learning from disappointing outcomes: An evaluation of prevocational interventions for methadone maintenance patients

Authors: 
Lindstrom, L. E., Benz M. R., & Doren, B.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2287-2308
Publisher: 
Informa Healthcare
Background: 

Employment rates in the drug-dependent population are typically low. Obtaining employed work is viewed as basic to successful treatment and recovery. (p. 2288)

Purpose: 

The goal of the study was to evaluate three pre-vocational training programs designed to be delivered as adjunct services for patients at methadone maintenance clinics.

Setting: 

The setting was various community mental health centers.

Sample: 

A total of 417 subjects were enrolled at five methadone clinics between March 1995 and April 1998. They were enrolled in the study after completing 30 days of treatment at the clinics to ensure they were stable and familiar with clinic routines to effectively participate.

Data Collection: 

Employment data was collected at 6-month and 12-month follow up interviews.

Intervention: 

Subjects were assigned to either the Vocational Problem-Solving (VPS) program, the Job Seekers Workshop (JSW) , or a combination of VPS and JSW.

Control: 

The employment outcomes of the 3 program groups were compared.

Findings: 

None of the three models produced significantly greater employment or better overall rehabilitation.

Conclusions: 

This study suggests that closer integration of pre-vocational training with treatment, individualizing efforts to meet training needs, and providing support during job-finding and early job-holding might improve program effectiveness. (p. 2288)

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15200244
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Success in the workplace following traumatic brain injury: Are we evaluating what is most important?

Authors: 
Lidz, V., Sorrentino, D. M., Robison, L., & Bunz, S.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
5
Pages: 
290-298
Publisher: 
Informa Healthcare
Background: 

Vocational outcome is one of the most important indicators of rehabilitation following a traumatic brain injury. Specifically, types of paid vocations, especially full-time work, are often viewed most favorably as a sign of success. The factors related to this perception of success are vast.

Purpose: 

This study aims at evaluating whether or not the common perceptions of success are in line with those factors that those individuals undergoing rehabilitation for traumatic brain injury (TBI) view as most indicative of progress following an injury.

Sample: 

The study sample included 4 males and 3 females between the ages of 26-51. Six were Europeans and one was of Maori descent. Participants had memory loss of one day to months. All were one year post injury.

Data Collection: 

Open-ended interviews with minimal prompting were taped and transcribed. They were then read and coded with comparisons to other interviews taking place at the same time. The transcripts were then sent to the participants for verification of accuracy.

Intervention: 

The effects of returning to full-time paid employment on the feeling of success, impact on non-working lives, feelings of productivity and ability to sustain employment.

Control: 

There was no control or comparison condition.

Findings: 

The results indicated that while participants view return to work as an important goal of rehabilitation following TBI, they also valued other means of feeling successful , not having a stressful work life affect their personal life, and feeling successful without full time pay (previously considered the goal) to be of near equal importance.

Conclusions: 

While paid employment is important, the work must also provide feelings of productivity and success. The researchers also feel evaluation of these individuals should take more subjective factors into consideration of their "success" of rehabilitation.

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