Predictors of referral to supported employment among consumers with co-occurring mental and substance us disorders | Knowledge Translation for Employment Research Center

Authors:	Birnbaum, H., Shi, L., Pike, C., Kaufman, R., Sun, P., & Cifaldi, M.
Year Published	2009
Publication	Community Mental Health Journal
Volume	45
Number	5
Pages	427-438
Publisher	American Association of Community Psychiatrists
Background	Clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining competitive employment. However, little is known about the factors related to consumers decisions to pursue employment, especially for consumers with co-occurring substance and mental disorders.
Purpose	This study examines the demographic, socioeconomic and illness characteristics of consumers referred for Supported Employment services. Study examines the following research question: What are the effects of consumers demographic and socioeconomic characteristics, mental health and substance use status, functioning and life status, work history and work interest, and agency organizational characteristics on referral of consumers for Supported Employment services?
Setting	Consumers were drawn from Integrated Dual Diagnosis Treatment programs in four community mental health agencies.
Sample	Study participants included 113 consumers referred for Supported Employment services and 78 randomly selected non-referred consumers as the comparison group. The criteria for consumers in the intervention group were that: (1) they had been diagnosed with co-occurring substance use and mental illness disorders and were receiving IDDT services; (2) they expressed a desire to engage in competitive employment; (3) they were being referred for Supported Employment services; and (4) they had not previously received Supported Employment services. The sampling criteria for the consumers in the comparison group were that: (1) they had been diagnosed with co-occurring substance use and mental illness disorders; (2) they had not received Supported Employment services in the past; and (3) they did not express an interest in competitive employment.
Data Collection	Data for the study was generated through four sources: consumer and provider questionnaires already in use by the study agencies, data collection forms designed specifically for this research project which were completed by case managers and Supported Employment staff at the study agencies, data from agency administrative records, and IDDT and supported employment (SE) fidelity scores from a state-funded training and consultation center. Prior to the beginning of data collection, approval of data collection procedures and consent forms was received from the Case Western Reserve University IRB.
Control	The comparison was Integrated Dual Diagnosis Treatment programs in four community mental health agencies.
Findings	Results suggest that consumers who have past work experience are more likely to be referred to Supported Employment, while consumers who perceive themselves as disabled or who are diagnosed as substance dependent are less likely to be referred to Supported Employment.
Conclusions	Future research is needed to obtain a fuller understanding of consumer and agency level barriers to referral to Supported Employment suggested by the current study. First, future studies should use larger sample sizes and include a larger number of agency sites. In order to more fully examine the role of fidelity in impacting referrals to supported employment, future studies should include a larger number of agencies representing a fuller range of fidelity scores, including agencies that have reached and maintained high SE fidelity, than was realized in the present study.
URL	http://www.ncbi.nlm.nih.gov/pubmed/19768541
Disabilities	Emotional disturbance
Populations	Black / African American \| White / Caucasian \| Male & Female
Outcomes	Employment acquisition
NIDILRR Funded	No
Research Design	Quasi-experimental
Peer Reviewed	Yes

Year Published

2009

Publication

Community Mental Health Journal

Volume

45

Number

5

Pages

427-438

Publisher

American Association of Community Psychiatrists

Background

Clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining competitive employment. However, little is known about the factors related to consumers decisions to pursue employment, especially for consumers with co-occurring substance and mental disorders.

Purpose

This study examines the demographic, socioeconomic and illness characteristics of consumers referred for Supported Employment services. Study examines the following research question: What are the effects of consumers demographic and socioeconomic characteristics, mental health and substance use status, functioning and life status, work history and work interest, and agency organizational characteristics on referral of consumers for Supported Employment services?

Setting

Consumers were drawn from Integrated Dual Diagnosis Treatment programs in four community mental health agencies.

Sample

Study participants included 113 consumers referred for Supported Employment services and 78 randomly selected non-referred consumers as the comparison group. The criteria for consumers in the intervention group were that: (1) they had been diagnosed with co-occurring substance use and mental illness disorders and were receiving IDDT services; (2) they expressed a desire to engage in competitive employment; (3) they were being referred for Supported Employment services; and (4) they had not previously received Supported Employment services. The sampling criteria for the consumers in the comparison group were that: (1) they had been diagnosed with co-occurring substance use and mental illness disorders; (2) they had not received Supported Employment services in the past; and (3) they did not express an interest in competitive employment.

Data Collection

Data for the study was generated through four sources: consumer and provider questionnaires already in use by the study agencies, data collection forms designed specifically for this research project which were completed by case managers and Supported Employment staff at the study agencies, data from agency administrative records, and IDDT and supported employment (SE) fidelity scores from a state-funded training and consultation center. Prior to the beginning of data collection, approval of data collection procedures and consent forms was received from the Case Western Reserve University IRB.

Control

The comparison was Integrated Dual Diagnosis Treatment programs in four community mental health agencies.

Findings

Results suggest that consumers who have past work experience are more likely to be referred to Supported Employment, while consumers who perceive themselves as disabled or who are diagnosed as substance dependent are less likely to be referred to Supported Employment.

Conclusions

Future research is needed to obtain a fuller understanding of consumer and agency level barriers to referral to Supported Employment suggested by the current study. First, future studies should use larger sample sizes and include a larger number of agency sites. In order to more fully examine the role of fidelity in impacting referrals to supported employment, future studies should include a larger number of agencies representing a fuller range of fidelity scores, including agencies that have reached and maintained high SE fidelity, than was realized in the present study.

URL

http://www.ncbi.nlm.nih.gov/pubmed/19768541

Disabilities

Emotional disturbance

Populations

Black / African American | White / Caucasian | Male & Female

Outcomes

Employment acquisition

NIDILRR Funded

No

Research Design

Quasi-experimental

Peer Reviewed

Yes