Predictors of referral to supported employment among consumers with co-occurring mental and substance us disorders

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

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.


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?


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


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.


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


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.


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.

Disabilities Emotional disturbance
Populations Black / African American | White / Caucasian | Male & Female
Outcomes Employment acquisition
Research Design Quasi-experimental
Peer Reviewed Yes