Developing evidence-based supported employment services for young adults receiving public mental health services

Authors: 
Pryce, J., Munir, F., & Haslam, C.
Year Published: 
2009
Publication: 
New Zealand Journal of Occupational Therapy
Volume: 
56
Number: 
1
Pages: 
34-39
Publisher: 
Zealand Association of Occupational Therapists Inc.
Background: 

Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts.

Purpose: 

This report describes the application of an evidence-based practice fidelity measure to monitor the effectiveness of an expanding supported employment program for youth adults with first episode psychosis.

Setting: 

The setting was 4 demonstration sites where employment staff co-located within an early intervention psychosis team.

Sample: 

The study sample was made up of 134 individuals. Sixty four percent were diagnosed with first episode psychosis, and received services from a community based early intervention psychosis team.

Data Collection: 

The IPS Fidelity scale was applied to each site. Data was collected and scored consistent with the Fidelity Scale directions.

Intervention: 

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

Both low and high scoring fidelity items helped identify practical ways to further develop evidence-based practices at each site.

Conclusions: 

Fidelity strengths and weaknesses can be identified that have implications for other sites in terms of what employment consultants can most constructively do in context of the restraints of their immediate environment.

URL: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417652/
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Vocational rehabilitation service patterns related to successful competitive employment outcomes of persons with spinal cord injury

Authors: 
Martin, D. J., Arns, P. G., Batterham, P. J., Afifi, A. A., & Steckart, M. J.
Year Published: 
2008
Publication: 
Journal of Vocational Rehabilitation
Volume: 
28
Number: 
1
Pages: 
1-13
Publisher: 
IOS Press
Background: 

It is well documented in the literature that the employment rate of people with spinal cord injuries (SCI) decreases drastically after their injuries. Because of the importance of work to the physiological and psychological health and well being of persons with a disability, considerable research efforts have been devoted to studying the employment problems of persons with a spinal cord injury. Over a half of a million individuals are served by state vocational rehabilitation agencies each year, making it possible to study a large number of persons with SCI who are living in the community.

Purpose: 

To examine the effect of demographic, work disincentives, and service variables on employment outcomes of persons with spinal cord injury in state vocational rehabilitation agencies.

Setting: 

This study included individuals with SCI served by multiple vocational rehabilitation agencies in various settings.

Sample: 

10,901 persons with spinal cord injury whose cases were closed either as employed (54%) or not employed (46%) by state vocational rehabilitation agencies in the fiscal year 2001.

Data Collection: 

An ex post facto design, using data mining as a statistical analysis strategy. Data was taken from the RSA-911 report for all the persons with SCI closed by State Vocational Rehabilitation agencies in 2001. A chi-squared automatic interaction detector (CHAID) based data mining analysis was used to identify the strongest associations between predictors (VR services) and the outcome variable (employment outcomes).

Intervention: 

The interventions were the range of Vocational Rehabilitation Services received by the study sample of persons with a Spinal Cord Injury. These services included, but were not limited to, rehabilitation engineering, personal assistance services, assistive technology services, job placement, counseling and guidance, and assessment services.

Findings: 

The CHAID data mining analysis revealed that job placement services, work disincentives, and case expenditures as the most important predictors of employment outcomes. In addition, physical restoration, substantial counseling, and assistive technology services all led to positive employment outcomes. Importantly, the CHAID analysis segmented the sample into 45 mutually exclusive homogeneous end groups, with a wide range of employment outcomes. The CHAID analysis indicated that demographic variables interacted with rehabilitation services to affect employment outcomes.

Conclusions: 

The results confirmed substantial counseling, assistive technology, and job placement and support services are important to the return-to-work success of persons with SCI.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00399
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Influence of least restrictive environment and community based training on integrated employment outcomes for transitioning students with severe disabilities.

Authors: 
Wickizer, T. M., Campbell, K., Krupski, A., & Stark, K.
Year Published: 
2004
Publication: 
Journal of Vocational Rehabilitation
Volume: 
21
Number: 
3
Pages: 
149-156
Publisher: 
IOS Press
Background: 

In light of the data supporting the education of individuals with severe disabilities in natural contexts, it stands to reason that programs would no longer provide training in contexts other than those that result insurable employment opportunities. However, this continue to occur. Even with mandated transition planning integrated employment outcomes are not improving for students with severe disabilities. Many of these students will then enter the public welfare system and/or segregated adult programs.

Purpose: 

The purpose of this study was to identify variables that are correlated with successful integrated employment outcomes for transitioning students with severe disabilities.

Setting: 

The setting included 20 different schools sites within 12 school districts in a county in California.

Sample: 

The sample included 104 students with severe disabilities, ages 18-22, who had exited school without diploma. Close to half (48%) of the participants had an IQ that placed them in the profound (25%) or severe (23%) category. The majority of the participants were white (53%), followed by Hispanic (28%), Asian (13%),African American (4%) and Pacific (2%). Around 53% of the students were males. Around 80% of the participants lived at home; the others lived in group homes.

Data Collection: 

The specific variables measured in this study included: the influence of duration of community-based training (CBT) that included on-the-job training, on the-job training as a subset of CBT, the least restrictive environment (LRE), or the degree of integration with non-disabled peers during the school day, demographics(gender, ethnicity, home setting, behavior problems, physical disability and mental ability) as measured by
intelligence quotient (I.Q.).Data was collected by structured interview with teachers and administrators, record review and on site observations. Correlations were used to examine predictive relationships between the independent variables and the dependent variable of post-school integrated employment. Cross tabulations and chi-square analysis of correlated variables were then used to identify significance of specific variables on employment outcome.

Intervention: 

The intervention was community based training. This included on the job training and physical integration with non disabled peers.

Control: 

There was no comparison or control group

Findings: 

These data indicate significant interactions between community based training (r = 0.387, p < 0.001), degree of integration with typical peers (r = 0.360, p < 0.001), andon-the-job training (r = 0.305, p = 0.001) and employment outcome. There were also strong intercorrelations among the three variables of CBT, degree of integration or LRE and on-the-job training.Transitioning students who received CBT and on the job training had a 69% integrated employment rate after leaving school.

Conclusions: 

The combinations of least restrictive environments,CBT/on-the-job training, and innovative teacher advocacy are potent predictors of post school employment for students with severe disabilities, regardless of intellectual functioning.

URL: 
http://www.kcdsg.org/files/content/Cheryl%20Jorgensen_Influence%20of%20LRE%20on%20Outcomes.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of successful return to work from HIV-related disability

Authors: 
Drake, R. E. & Bond, G. R.
Year Published: 
2004
Publication: 
Journal of HIV/AIDS and Social Services
Volume: 
3
Number: 
3
Pages: 
89-96
Publisher: 
Journal of HIV/AIDS and Social Services
Background: 

Many individuals with HIV/AIDS experience periods of unemployment as their physical symptoms increase. However, some in treatment do continue or return to employment.

Purpose: 

The purpose of this study was to compare a sample of individuals with HIV/AIDS who successfully return to employment and those that do not. The factors included disease-related factors and service-related factors.

Setting: 

The setting was an HIV/AIDS primary care clinic of a large, university-affiliated hospital.

Sample: 

The study sample consisted of 135 patients whose records indicated that they had successfully regained employment following disease-related job loss. A matched cohort of individuals with HIV/AIDS who had not regained employment was selected as a comparison group.

Data Collection: 

The data consisted of patient clinical records related to HIV/AIDS treatment and symptoms and services delivered. Statistical analyses consisted of descriptive statistics and analysis of variance (ANOVA).

Intervention: 

The majority of predictor variables were related to HIV/AIDS, such as CD4 cell count and length of time in treatment. However, the effects of one intervention were also included, the provision of mental health services.

Control: 

A matched comparison group was selected consisting of individuals with HIV/AIDS who had not returned to work following disease-related job loss.

Findings: 

Substance use disorders were more prevalent in those who had not achieved return to work. Those who had returned to work were more likely to have received mental health assessment and treatment.

Conclusions: 

Mental health services may serve as a gateway to return to work for many individuals with HIV/AIDS. In addition, identifying patients who are already being treated by the mental health team in order to assess their desire and ability to return to work is an important first step in increasing the effectiveness of a return to work program.

URL: 
http://www.tandfonline.com/doi/abs/10.1300/J187v03n03_07?journalCode=whiv20
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Do sheltered workshops enhance employment outcomes for adults with autism spectrum disorder?

Authors: 
Cimera, R., Burgess, S., & Wiley, A.
Year Published: 
2012
Publication: 
Autism
Volume: 
16
Number: 
1
Pages: 
87-94
Publisher: 
Sage
Background: 

Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.

Purpose: 

This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.

Setting: 

The study took place in sheltered workshop settings and a variety of businesses.

Sample: 

The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.

Data Collection: 

Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.

Intervention: 

The intervention was sheltered work.

Control: 

Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.

Findings: 

Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.

Conclusions: 

Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.

URL: 
http://aut.sagepub.com/content/16/1/87
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

State rehabilitation services tailored to employment status among cancer survivors

Authors: 
Cimera, R. E.
Year Published: 
2014
Publication: 
Journal of Occupational Rehabilitation
Volume: 
24
Number: 
1
Pages: 
89-99
Publisher: 
Springer Science + Business Media New York
Background: 

Studies have shown that certain vocational rehabilitation services are associated with return to work for unemployed patients with cancer. These include: counseling and guidance, job search assistance, and job placement. Patients who have a job return to post disability may require different interventions to assist them with return to work.

Purpose: 

The purpose of this study was to determine whether differences in the types of services were based on the employment status of those with a history of cancer at the time of application.

Setting: 

This study included individuals with cancer served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Data on 1,460 people who had cancer were extracted from the Rehabilitation Services Administration Case Service Report.

Data Collection: 

Data on demographics and vocational services were analyzed. Multiple discriminant analysis was used to identify different services used by cancer survivors who were unemployed and those who were employed.

Intervention: 

There were multiple vocational rehabilitation services interventions. This included: assessment, diagnosis and treatment of impairments, vocational rehabilitation counseling and guidance, college or university training, occupational vocational training, on the job training, basic academic remedial or literacy training, job readiness training, disability related, augmentative skills training, miscellaneous training, job search assistance, job placement assistance, on the job supports, transportation services, maintenance services, rehabilitation technology, technical assistance services, information and referral services and other services.

Control: 

There was no control or comparison condition.

Findings: 

Vocational rehabilitation service plans can be individualized to meet the employment status and needs of cancer survivors.

Conclusions: 

Cancer survivors have the potential to return to work. Services received by cancer survivors who were unemployed and those who were at risk of losing their job received different services from state vocational rehabilitation services. This suggests that services were tailored to meet individual client needs. Vocational rehabilitation services are a resource to assist cancer survivors with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23504487
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation

Authors: 
Catty, J., Lissouba, P., White, S., Becker, T., Drake, R., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschback, J., Wiersma, D., & Burns, T.
Year Published: 
2006
Publication: 
NeuroRehabilitation
Volume: 
21
Number: 
4
Pages: 
279-293
Publisher: 
IOS Press
Background: 

A number of cognitive, physical, and psychosocial impairments can occur following a TBI. These deficits can have a profound effect on daily functioning including an individual's ability to work. This may raise significant challenges for vocational rehabilitation professionals when helping individuals with TBI to prepare, obtain, and maintain competitive employment. Given the prevalence of TBI and the young age of many survivors, vocational rehabilitation will be needed. Professionals serving these individuals need to be prepared to develop appropriate rehabilitation plans. To be effective, they need to be familiar with TBI and the current research that looks at what impacts successful vocational outcomes. This may help facilitate the best use of limited funds for the vocational rehabilitation of persons with TBI. There are limitations in the research to date and more research is needed.

Purpose: 

The purpose of this study was to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns through an analysis of the Rehabilitation Services Administration (RSA) case service report (RSA-911) data on employment outcomes of persons with traumatic brain injuries (TBI) for fiscal year 2004.

Setting: 

This study included individuals with TBI served by multiple vocational rehabilitation agencies in various settings.

Sample: 

The sample included 7,366 individuals with TBI whose cases were closed by state vocational rehabilitation agencies as employed or not employed in the fiscal year (FY) 2004.

This included 4,862 men (66%) and 2,504 women (34%). The majority or 78% were European Americans. The average age of participants was 37 years. Thirteen percent had co-commitment disabilities (psychiatric or substance abuse). Seventy six percent had a high school degree or more education. The average time between applying to eligible for VR services was a month and a half. The average time between eligibility and case closure was 30 months. Case expenditures averaged $4,238.

Data Collection: 

A data mining technique, exhaustive chi-squared automatic interaction detector (CHAID), was used to analyze. In the current study, exhaustive CHAID was used to build classification trees. This technique uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (e.g., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the employment outcome variable. The degree of differentiation is depicted sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation clients could be identified based on their demographic characteristics, work disincentives, and service patterns in terms of their observed levels on the outcome variable. The statistical software SPSS Answer Tree 2.0 was used to conduct the exhaustive CHAID analysis. The alpha level for all statistical tests was 0.01. This study corrected for the number of statistical tests within each predictor using a Bonferroni feature in the Answer Tree software.

Intervention: 

The interventions included various vocational rehabilitation services. This included job search assistance, job placement assistance, and on-the-job support services for individuals with TBI.

Control: 

There was no control or comparison condition.

Findings: 

The employment success rate for the entire sample was 50%. The employment success rate for persons with TBI is somewhat lower than the 55% rate for
the overall sample of vocational rehabilitation clients closed in FY 2004. European Americans had higher competitive employment rates than other groups. Clients with co-occurring psychiatric disabilities had a lower employment rate than those without psychiatric disabilities . Clients who had work disincentives also showed significantly poorer employment outcomes than those without disincentives. In terms of education, clients with a bachelor or higher educational degree had the highest competitive employment rate as compared to those with less education.

Case expenditure was related to outcomes, with more money spent on clients who were closed as successfully rehabilitated. Clients who were successfully rehabilitated also required less time in the rehabilitation process than unsuccessfully rehabilitated clients. Clients who received the following vocational rehabilitation services on-the-job training, job readiness training, miscellaneous training (e.g., GED or high school training needing to diploma), job search assistance, job placement assistance, on-the-job supports, maintenance, rehabilitation technology, and/or other services (e.g., occupational licenses, tools and equipment, and initial stocks and supplies) had significantly higher competitive employment rates than those who did not receive such services. Overall, the results indicated that the TBI clients could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.

Conclusions: 

Several vocational rehabilitation clinical practice guidelines came from the results of this study. First, the study underscore the importance of considering job placement and workplace support services in the vocational rehabilitation of persons with TBI. Unfortunately, job placement assistance and on-the job supports were found to be significantly underutilized by rehabilitation counselors in serving their TBI clients. Second, this study highlights the influence of disincentives on employment outcomes. Increased emphasis appears needed in the education of rehabilitation counseling students and practitioners on the importance of benefits counseling services and to encourage rehabilitation counselors to discuss this important service with consumers early in the rehabilitation planning process. Third, co-occurring psychiatric disabilities were found to significantly affect employment outcomes. This finding underscores the importance for rehabilitation counselors to (a) appropriately assess the emotional and psychological functioning of those served and to provide mental health counseling (b) increase knowledge about evidence-based mental health practices, and (c) to utilize the various interventions that have been found successful in diminishing psychiatric symptoms in the rehabilitation process. Finally, the very low incidence of co-occurring substance abuse disorders identified in this study (3%) is unusual, given research has indicated that about 50% to 66% of TBI clients had a history of alcohol and other drug abuse. This may be under reported. Rehabilitation counselors, need better education and training in substance abuse assessment and treatment within the context co-occurring disabilities.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17361045
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Working it out: Development and testing of a multimedia, vocational education program

Authors: 
Campbell, K., Bond, G., & Drake, R.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2525-2558
Publisher: 
Marcel Dekker Inc.
Background: 

Employment is a ongoing problem for individuals with substance dependency. Their vocational needs are unmet. Earlier studies have shown a positive correlation between employment and retention in treatment. Despite evidence about the value of addressing employment issues in treatment, the service delivery system does not address these needs. Welfare reform has increased expectations for substance abuse beneficiaries to gain employment. Due to shorter stays and funding cuts more programs primarily focus on substance use. Employment and work problems are not given priority. A multimedia interactive computer program may offer a cost effective way to address employment problems.

Purpose: 

The study hypothesis was that an interactive and tailored multimedia presentation of vocational rehabilitation information would be more effective than a general printed package of information and work book in reducing the severity of employment problems.

Setting: 

The study took place in residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico.

Sample: 

One-hundred and ninety-four (194) individuals who received residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico participated in the study. The average age of participants was 37 years and the majority or 64% were men. About 43% were from a minority group.

Data Collection: 

The measures included the Addiction severity index-multimedia version (ASI-MV), Social adjustment scale-self report (SAS-SR), Employment questionnaire, Treatment services review and Satisfaction questionnaire. Around 75% of the sample completed 3 or more CD-ROM sessions. These participants completed a satisfaction questionnaire after each session and at the end entire course. Follow up assessment was scheduled 6 month from baseline. Subjects completed SAS-SR and Employment Questionnaire. They were also contacted by telephone to complete a follow up to the ASI.

Intervention: 

The intervention included: Working It Out CD-ROM, a multi-session, computer based, self-administered, vocational education and intervention program for clients in substance dependency treatment programs.

Control: 

There was a comparison between the group that received the intervention and the control group members. The control group members used the Looking for Work Printed Package booklet along with a workbook with information on: facing fears, why work?, coping with job-related stress, job-finding skills (writing a resume, networking, interviewing, etc.), caring for oneself and the job, and what to say about ones recovery.

Findings: 

The study demonstrated that a multimedia vocational rehabilitation program that is self-administered, interactive, and tailored to clients employment status and motivation can be used in a substance dependency treatment program. The study did not find significant differences over the use of printed versus multimedia material. However, clients reported enjoying using the computer program and found the experience more relevant to their particular concerns.

Conclusions: 

The multimedia Working It Out program can be effectively used by clients who are in substance dependency treatment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603013
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

Employment services as an early intervention for young people with mental illness

Authors: 
Brucker, D. L.
Year Published: 
2010
Publication: 
Early Intervention in Psychiatry
Volume: 
4
Number: 
4
Pages: 
237-335
Publisher: 
Blackwell Publishing Asia Pty Ltd
Background: 

The individual placement and support (IPS) approach to supported employment for people with severe mental illness is becoming widely accepted as an essential component of evidence-based psychosocial rehabilitation. A key feature of IPS is that employment services are closely integrated with public mental health services. This can be challenging to implement in developed countries where mental health and employment systems are typically segregated. The demonstrated success of integrated mental health and employment programs implies that this approach can enhance early intervention mental health services and recovery-oriented mental health services.

Purpose: 

This study examined the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand.

Setting: 

Workwise Employment Ltd in Christchurch, New Zealand is a supported employment service provider for people with mental illness, including substance misuse. Eligible participants were in receipt of either SB or IB due to a diagnosed mental health condition, often with concurrent family and social problems that exacerbated their situation. Four full-time employment specialists were supported by one administration position and one team leader. Employment specialists were not externally trained in IPS principles. However, in 2002 Workwise adopted these principles for internal training throughout its national network of disability employment services.

Sample: 

Employment outcomes were investigated for 49 young clients aged 16-25 years who entered the program between 1 July 2005 and 30 June 2007. These young clients represented 18% of the 270 clients assisted during this period. Data collection ceased on 4 April 2008. Eligible candidates were identified and referred by Work and Income staff from regular Work and Income seminars, and from individual income support reviews. Self-referrals were also permitted. Referrals were accepted if: (i) the person was in receipt of SB or IB for mental health or psychiatric reasons (including substance misuse); (ii)Work and Income approved the self-referral and (iii) it was clear people were volunteering for employment assistance. Clients were recommended to a particular employment service by the Work and Income staff. Clients could accept the initial referral or insist on choosing another of three alternative service providers.

Data Collection: 

The service had a comprehensive business information system that tracked all clients throughout the contract. Records of clients(n=49) aged 16–25 years were retrospectively examined. Data analysis was conducted by the team leader using Microsoft Excel 2003, guided by the outcome variables identified from published reports of comparable services. The comprehensive data management system enabled most variables of interest to be reported. Data quality was governed by the contract that required 100% accuracy and supporting evidence for all employment outcomes. All client records were reviewed monthly by an employment specialist, an administrator and by the team leader for the term of the contract. The records were also subject to regular internal review and intensive external auditing as a condition of the contract.

Intervention: 

The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16–25 years over a 2-year period (2005–2007). These results were compared with recent national and international benchmarks.

Control: 

The condition was published outcomes from recent national and international benchmarks that were based on studies using Random Controlled Trials.

Findings: 

As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables.

Conclusions: 

Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/21043209
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes