SESAMI* study of employment support for people with severe mental health problems: 12-month outcomes

Authors: 
Schoenbaum, M., Unützer, J., McCaffrey, D., Duan N., Sherbourne, C., & Wells, K.
Year Published: 
2009
Publication: 
Health & Social Care in the Community
Volume: 
17
Number: 
2
Pages: 
151-158
Publisher: 
Blackwell Publishing Ltd.
Background: 

Individuals with severe mental illness are underrepresented in the workforce in the United Kingdom. A welfare to work policy was implemented. Guidelines recommend using evidenced based practices, the Individual Placement and Support model, to help people with mental health issues with gaining and maintaining work. It is important to understand what is currently going on to improve existing practices.

Purpose: 

This study was undertaken to learn about factors associated with successful employment and the impact of work on individuals with mental illness.

Setting: 

Six British agencies that specialized in providing services to individuals with mental illness.

Sample: 

One hundred and eighty two individuals with mental health problems participated in the study. Follow up interviews were conducted with 85% of this sample. The majority or 84% were White British or European. Ages ranged from 22 to 67 years with an mean of 42 years. About a third, or 32% reported depression, 25% anxiety, 25% schizophrenia, hallucinations or hearing voices, 14% bipolar and 4% other in response to being asked to describe his or her condition. Fifty five percent of the participants were unemployed, 29% were unemployed, 9% were in work placement and 5% in sheltered work.

Data Collection: 

The study questionnaire included the following measures. The Empowerment Among Users of Mental Health Services Scale; the Herth Hope Index, Perceived obstacles to work; and behaviours indicating nearness to the labour market. This questionnaire was usually completed during an approximately one hour face to face interview. The first was completed at baseline and another at follow up (12 months later).Statistically significant differences were tested. Analysis of variance was also used. SPSS 15.0 was used to analyze all data.

Intervention: 

The intervention was supported employment in the United Kingdom.

Control: 

There was no comparison or control group.

Findings: 

Eighty two percent of those working at baseline were employed one year later. Twenty five percent of those individuals who were unemployed were assisted with gaining work during this time. Financial satisfaction and self esteem increased among those who went to work. In addition, there was a tendency to work part-time.

Conclusions: 

Those who worked reported multiple benefits. The evidence from this study should inform service planning and the Individual Placement and Support model should be implemented in England.

URL: 
https://www.researchonline.org.uk/sds/search/taxonomy.do%3Bjsessionid=948B7FBF03C6A71157E4FD25729AE479?action=document&ref=A20206&pager.offset=140&taxonomy=GIN
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A comparison of competitive employment outcomes for the clubhouse and PACT models

Authors: 
Secker, J., & Membrey, H.
Year Published: 
2006
Publication: 
Psychiatric services
Volume: 
57
Number: 
10
Pages: 
1416-1420
Publisher: 
Psychiatric Services
Background: 

The unemployment rate among individuals with severe mental illness is high, ranging from 67 to 85 percent. Many studies focus on job placement rates without considering job retention. Supported employment programs vary a lot and no single definition exists. Furthermore, the rapid placement guideline may mean that a lack of job readiness may be impacting an individual's success at work. The clubhouse model to employment may be able to help individuals gain and maintain work at higher rates than other approaches.

Purpose: 

The goal of this study was to determine if a clubhouse model could achieve and maintain employment rates comparable to the Program of Assertive Community Treatment model of supported employment.

Setting: 

The study was conducted in Western Massachusetts Genesis Club.

Sample: 

The study sample included 177 individuals who data was collected over a four year time period. All had a diagnosis of bipolar disorder, depression or schizophrenia and were 18 years of age or older. They were not screened for work readiness and interest in work was not required.

Data Collection: 

After acceptance into the study the Positive and Negative Syndrome Scale was conducted. Interviews were also conducted at baseline and then every 6 months over two and half years. Questions related to symptoms, jobs, hospitalizations and more. Program staff tracked job information. Employment data was also provided by staff or through interviews with participants. Each participant was followed for the study period or until he or she exited services. Time based analyses compared weekly employment and job placement rates for participants in each group. Binary employment outcomes were analyzed with generalized estimating equations of the Genmod procedure in SAS with a logit link function. Another group of job based analyses was also conducted to examine average job duration, hours and wages to compare outcomes from participants in the two groups. Spearman rank-order correlations between job duration, hours and wages were estimated to identify potential covariates in the hours and wages test model.

Intervention: 

The intervention was Supported Employment services delivered through Club Houses.

Control: 

The control was Supported Employment services delivered via Program of Assertive Community Treatment (PACT).

Findings: 

The PACT model had a 14% higher job placement rate than the clubhouse model. Participants in either approach maintained weekly employment levels at or exceeding other published reports. On average participants in more than 2 jobs during the study period and worked 20 hours a week. Clubhouse participants remained employed 2 months longer than individuals in PACT, which resulted in a 66% difference in duration.

Conclusions: 

No difference was found in job placement rates between clubhouse and PACT participants over two and half years. Clubhouse participants remained employed for more weeks and earned slightly higher wages than participants in PACT.

URL: 
http://www.fountainhouse.org/sites/default/files/C.%20Schonebaum%20article.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Efficacy of the customized employment supports(CES) model of vocational rehabilitation for unemployed methadone patients: Preliminary results

Authors: 
Strickland, D., Coles, C., & Southern, L.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2261-2285
Publisher: 
Informa Healthcare
Background: 

Methadone-maintained patients experience great difficulty with gaining and maintaining competitive employment due to personal barriers and limited vocational services. Federal and state policy reforms require substance users to obtain work or risk losing public benefits. Innovative vocational rehabilitation models need to be tested in order to improve employment outcomes for patients enrolled in addiction treatment programs.

Purpose: 

The purpose of the study was to evaluate a Customized Employment Supports (CES) model designed to improve employment outcomes for unemployed methadone-maintained patients.

Setting: 

The study was implemented at two sites in Manhattan. One is a free-standing methadone clinic operated by Greenwich House, a nonprofit social services agency. The other methadone clinic is operated by Harlem Hospital but is located separately from the hospital.

Sample: 

The study eligibility criteria for methadone patients included the following: unemployed or remarkably underemployed; stabilized on an appropriate methadone dose; negative urine toxicologies for both opiates and cocaine for last 4 tests; absence of any condition that would preclude working (e.g., serious mental illness, developmental disability, severe physical health problem, or time-intensive dependent care responsibilities) and willingness to participate and be randomly assigned to either the innovative vocational program or the clinic‚ existing vocational counseling program. The participants included at total of 135 patients: 79 at Greenwich House's methadone clinic and 56 at the Harlem Hospital's methadone clinic. Participants were randomly assigned to either the customized employment supports vocational model or the clinic's standard vocational program. The final sample included 55 in the experimental group and 66 in the control or a total of 121 patients. Some of the key characteristics of the overall sample at baseline included the following: male (58%); minority group (68%); mean age 44 years (s.d.¬º8.8 years); high school graduate/GED (65%); no paid job within last 6 months (60%); unemployed at study entry (100%); ever arrested (81%); rates own overall health as excellent, very good, or good (62%), but reports having trouble standing for long periods (67%), climbing stairs (73%) and lifting a medium weight (90%); received prior treatment for substance misuse (67%) and mental health problems (53%); has attended some form of 12-step program (79%); and has received public assistance benefits in the past year (82%).

Data Collection: 

The study collected data on patient employment and behaviors from the following sources: baseline interviews of patients prior to before random assignment; patient follow-up interviews at 6, 12, and 18 months later using the same procedure as the baseline but adding measures about the intervention; review of vocational activities log kept by both CES and standard counselors as well as employment documentation. The employment measures drew on and integrated information from these sources since no single source was completed using the combined ordinal outcome measure, the initial analysis was a cross-tabulation of the highest level of vocational activity attained by study condition using the combined ordinal outcome measure. Next, cross-tabulations were conducted between experimental condition and four separate indices of vocational outcomes. Pearson chi square provided the tests of statistical significance across the board. Since the hypotheses involving vocational outcomes were directional predictions (i.e., better outcomes were predicted for the experimental group), single-tailed significance tests were reported. Four dichotomous measures of vocational activities, which constitute the outcome measures for this analysis, were obtained at baseline and at 6-month follow-up: 1. Whether the patient attained any paid job in the previous 6 months. 2. Whether the patient attained a competitive job in the previous 6 months. 3. Whether the patient attained an informal job in the previous 6 months. 4. Whether the patient participated in any other socially constructive, vocationally relevant activity in the previous 6 months. The three basic vocational measures (i.e., competitive, informal, constructive activity) were not significantly associated with each other (p>0.05). To provide a single overall index of vocational outcomes, they were combined into a four-level, ordinal measure of highest level of vocational attainment: 1. Attained a competitive job (highest). 2. Attained an informal job. 3. Performed constructive activity other than paid employment. 4. None of the above (lowest).

Intervention: 

The intervention, the Customized Employment Supports (CES) model, is designed to help patients overcome these employment barriers and attain paid work as soon as possible. The model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients and enhance their self-efficacy. Methods used to help patients increase their self-efficacy included: role modeling, persuasion, and minimizing emotional arousal.

Control: 

The participants were randomized into intervention and control groups.

Findings: 

Consistent with the study‚ main hypothesis, the experimental group achieved significantly higher levels of vocational activities than the comparison group during the 6-month follow-up. Each of the four measures of vocational outcomes was also evaluated individually. Compared with the standard vocational services group, patients in the CES program were significantly more likely to have obtained any form of paid employment, competitive employment, and informal employment. However, the two groups did not differ significantly on engaging in constructive vocational activities other than paid work.

Conclusions: 

The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. More research is needed.

URL: 
http://www.tandfonline.com/doi/abs/10.1081/JA-200034618?journalCode=isum20
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A systematic review of vocational interventions for young adults with autism spectrum

Authors: 
Test, D.W., Mazzotti, V.L., Mustian, A.L., Fowler, C.H., Kortering, L., & Kohler, P.
Year Published: 
2012
Publication: 
Pediatrics
Volume: 
130
Number: 
3
Pages: 
531-538
Publisher: 
American Academy of Pediatrics
Background: 

Not much is known about effective vocational interventions to assist individuals with ASD. Yet, that population is rapidly growing. Programs and interventions to serve youth are not well understood. The lack of information impacts successful transition to work.

Purpose: 

The purpose of this systematic review of the literature was to assess the effectiveness of vocational interventions for individuals with ASD who are 13 to 30 years old.

Setting: 

The studies that were reviewed were undertaken in various locations and settings in the US, UK, Spain and Germany.

Sample: 

Multiple databases and reference lists were searched to find relevant studies that were published between 1980 and 2011. Afterwards, each study was examined against an inclusion criteria developed by an expert panel. Data about sample, intervention characteristics, assessment techniques, and outcomes, were evaluated and an overall quality and strength of evidence rating was assigned to the included studies according to a specific criteria. The final sample consisted of 5 studies involving young adults with autism.

Data Collection: 

Characteristics of study participants and interventions were summarized. Descriptive statistics were used to report study outcomes. No meta analysis was conducted.

Intervention: 

The studies reviewed looked at a variety of vocational interventions which involved identifying and implementing work supports for young adults with ASD.

Control: 

There were no comparison or control conditions.

Findings: 

Only five studies, related to on the job supports and employment and vocational interventions were found. All of these received a poor quality rating by the reviewers which may be due to the fact that this is a new area of research. The studies included one non randomized trial that looked at the impact of supported employment versus sheltered work settings for 55 young adults with autism. A related study from the same researchers looked at the effect of supported employment versus sheltered work on the cognitive development of 44 young adults with autism. Two cohort studies and one cross sectional study reported on the influence of vocational interventions on independent living outcomes.

Conclusions: 

There is very little evidence about vocational interventions for individuals with ASD. High quality research is needed. Supported employment may be a promising intervention however much more research is needed.

URL: 
http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-0682
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Factors associated with participation in employment for high school leavers with autism

Authors: 
Chiu, C., Chan, F., Strauser, D., Feuerstein, M., Ditchman, N.,Cardoso, E., O'Neill, J., & Muller, V.
Year Published: 
2013
Publication: 
Journal of Autism and Developmental Disorders
Volume: 
43
Number: 
8
Pages: 
1832-1842
Publisher: 
Springer US
Background: 

Research about what happens after students with autism leave high school is limited. Some research has focused on factors related to transitioning from school to work. In addition a few studies have investigated predictors of participation in employment for individuals with autism. Individuals with autism would like to be gainfully employed but many barriers exist. To help ensure a successful transition from secondary school to work more information about the factors associated with this process is needed.

Purpose: 

This study used a national representative data set to identify factors associated with employment.

Setting: 

The setting for this study is not described.

Sample: 

A secondary data analysis of NLTS2 longitudinal data set was performed. The sample included 830 secondary school students (ages 13 through 16) who had autism as a primary disability. The study sample was taken from currently available NLTS2 raw data from Institute of Educational Sciences.

Data Collection: 

This included data from the NLTS2 Waves 1 to Wave 4 parent/youth phone interview and/or mail survey data (Wave 1 was collected in the 2000–2001; Wave 2 was collected in the 2002–2003; Wave 3 was collected in the 2004–2005; and Wave 4 was collected in the 2006–2007 school years) and Wave 1 to Wave 2 school program survey data (Wave 1 was collected in the 2001–2002 and Wave 2 was collected in the 2003–2004 school years). The information was gathered for the first time in the 2000–2001 school year and last time in the 2006–2007 school year. SAS 9.2 was used for statistical analyses. All the data used had no missing values. The cases containing missing values were removed. Variables were described using descriptive statistics. Continuous variables, values were reported as means ± standard deviations (SDs). Categorical variables, values were reported as percents. A three-step process was used to determine the factors significantly associated with participation in employment for students with autism.

Intervention: 

There were several interventions. These included school based counseling and vocational services as well as contacting post secondary service providers.

Control: 

There was no control or comparison condition.

Findings: 

Among those students who left high school (weighted n = 4,167), 56 % (weighted n = 2,333)had participated in employment after exiting high school and 44 % (weighted n = 1,834) had not. The average age of those who went to work was 21 years. They worked in 29 different types of occupations. The top five job types included: material recording, scheduling, dispatching, and distribution (36.3 %), information and record clerks (12.9 %), building cleaning and pest control workers (8.5 %), retail sales workers (5.2 %), and other production occupations (5.1 %). The mean hourly wage was $7.90 with a range from $2.00 to $30.00, (SD = $22.00).

Conclusions: 

Family social status, student characteristics, and high school transition planning services were the significant factors that impacted whether or not individuals participated in employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23224594
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
No