The effectiveness of skills training for improving outcomes in supported employment

Authors: 
Mueser, K. T., Becker, D. R., & Wolfe, R.
Year Published: 
2005
Publication: 
Psychiatric Services
Volume: 
56
Number: 
10
Pages: 
1254-1260
Publisher: 
Psychiatryonline.org
Background: 

Supported employment for individuals with mental illness is recognized as an evidenced based practice. Although this approach is more successful at assisting individuals with mental illness with gaining and maintaining work, than other traditional means, better outcomes related to job retention is needed.

Purpose: 

The purpose of this study was to evaluate the impact of a supplementary skills training program on employment outcomes for individuals who were receiving supported employment services.

Setting: 

The study took place at an employment support organization that is funded by State vocational rehabilitation.

Sample: 

Thirty five individuals who were enrolled in a supported employment program and had a diagnosis of severe or persistent mental illness participated in the study. Among these individuals, the majority or 80% were men and 97% were non-Hispanic white. About a third or 30% had graduated from secondary education. The mean age was 38 years.

Data Collection: 

Those who consented to participate, completed a Workplace Fundamentals Knowledge Test. Afterwards they were randomly assigned to receive supported employment services alone or to receive supported employment services and the supplementary skills training about workplace fundamentals. Individuals were assigned to the group on an average of 56 days after obtaining a job. Among the 35 participants, 18 received treatment as usual (supported employment services alone) the rest were assigned to the receive the work fundamentals training too. Chi square test and t test indicated no significant difference in the two groups. Workplace knowledge was measured with the Workplace Fundamental Knowledge Test scores at baseline and at nine month intervals. Rates of employment for each month of the study period for individuals who recently went to work was documented by control group and workplace fundamentals group. These rates were compared using a generalized estimating equations analysis. The researchers also compared cumulative time worked, wages earned and job tenure for the first and subsequent jobs held. Mann-Whitney tests were used because that data was skewed. Vocational services used were also analyzed with Mann-Whitney tests.

Intervention: 

The intervention was the supplementary workplace skills training program in SE

Control: 

The control group was the participants who only received supported employment services and did not attend the workplace skills training.

Findings: 

During the study period, participants held a total of 49 different jobs. Forty three percent of the sample worked in the same job during the study period (18 months), others were laid off, fired or quit their jobs. The majority had disclosed their psychiatric disability to their employers. Individuals who attended the workplace fundamentals program received higher scores on the Workplace Fundamentals Knowledge Test than those who did not. Although more individuals who attended the supplementary training were working during the study period this trend was not significant. Earnings and hours worked was not significant either. Both groups used comparable amounts and intensity of employment services. Job tenures for the first job for participants was 331.6 days for workplace fundamentals group and 288.5 for the control group.

Conclusions: 

The workplace fundamentals program may not be an effective addition to supported employment services, but more research is needed.

URL: 
https://www.ncbi.nlm.nih.gov/pubmed/16215191
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment

Authors: 
McGurk,S., R., Mueser, K. T., DeRosa, T., J., & Wolfe, R.
Year Published: 
2003
Publication: 
Psychiatric Services
Volume: 
54
Number: 
8
Pages: 
1129-1135
Publisher: 
American Psychiatric Association
Background: 

Although previous research has indicated that symptoms and cognitive functioning are related to employment outcomes for clients with severe mental illness, few studies have examined the relationship between these client factors and outcomes in supported employment programs.

Purpose: 

This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program.

Setting: 

Study sample received outpatient services at a state hospital. Research team was based at Mount Sinai School of Medicine, New York, New York.

Sample: 

The study participants were 30 clients with schizophrenia or schizoaffective disorder who are receiving outpatients services at a state hospital. The clients diagnoses were made by a member of the research team on the basis of clinical interviews with the Comprehensive Assessment of Symptoms and History and information form the clients charts.

Data Collection: 

Data for the study included work outcomes, an analysis of demographic and other background predictors of work outcomes, the degree of change in clients' symptom severity and cognitive functioning over the year follow up period, and an analysis of symptom and cognitive predictors of work outcomes. Final analysis was on the relationship of symptoms and cognitive functioning with utilization of supported employment services by the clients who obtained competitive employment.

Intervention: 

The program provided at the hospital's outpatients clinics was based on the individual placement and support employment model. At entry into the program, each client was assigned an employment specialist who provided all components of supported employment, including assessment, assistance with job search, and job support. Each employment specialist functioned as a member of the client's interdisciplinary team. The supported employment program provided follow along as needed for an unlimited time, including both on- and off-site support, depending on the client's needs or preferences.

Control: 

There was no control or comparison condition.

Findings: 

Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms.

Conclusions: 

Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.

URL: 
http://schizophreniabulletin.oxfordjournals.org/content/31/4/898.short
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Job tips: A transition to employment program for individuals with autism spectrum disorders

Authors: 
Taylor, J. l., McPheeters, M., Sathe, N.A., Dove, D., Veenstra-VanderWeele, J. & Warren, Z.
Year Published: 
2013
Publication: 
The Journal of Autism and Developmental Disorders
Volume: 
43
Number: 
10
Pages: 
2472-2483
Publisher: 
Springer
Background: 

Shattuck et al. (2012) reported that youth with an ASD are uniquely at risk for negative post-school outcomes, as indicated by the fact that while only 55 % of those with an ASD are employed in the 6 years beyond high school, 86 % of those with a speech or language impairment, 94 % of those with a learning disability, and 69 % of those with an intellectual disability have found employment.

Purpose: 

The current study evaluated the effectiveness of a treatment package comprised of a web-based interviewing skills program (JobTIPS) and virtual reality practice on responses to employment interview questions by adolescents with high functioning autism and Asperger‚ Disorder.

Setting: 

The setting was a University Research Center.

Sample: 

The study sample included 22 youth who were between the ages of 16–19 years old.

Data Collection: 

An Interview Skills Rating Instrument was developed by researchers. The first scale was Response Content: A 10 item scale that measures the content of the participant's response to 10 interview questions. The second scale: Response Delivery: 20 items that measure behaviors related to greetings and farewells (handshakes, eye contact, verbal greeting, verbal expression of appreciation at end of interview), as well as the non-verbal behaviors (body positioning, facial expressions) that accompany verbal responses during the actual interview questioning period.

Intervention: 

Internet based transition program

Control: 

Services as usual

Findings: 

The results of the study suggest that youth with ASD who completed the Job TIPS training program showed significant improvement in their job interviewing skills when compared to the control group. The program was more effective in teaching content rather than delivery skills. Participants were able to produce more appropriate verbal responses to interview questions following intervention, but the features that accompany those responses did not improve to the same degree.

Conclusions: 

The findings demonstrate that a web-based training program can be effective as an intervention method to improve employment related interviewing skills for individuals with ASD.

URL: 
http://link.springer.com/article/10.1007%2Fs10803-013-1800-4
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Workforce re-entry for people with HIV/AIDS: Intervention effects and predictors of success

Authors: 
Martin, D., Chernoff, R., & Buitron, M.
Year Published: 
2006
Publication: 
Work
Volume: 
27
Number: 
3
Pages: 
221-233
Publisher: 
IOS Press
Background: 

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent. Little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work.

Purpose: 

The purposes of this study were to (1) identify factors predicting workforce re-entry among a group of participants in a workforce-reentry demonstration project for people with HIV/AIDS; and (2) determine whether an intervention designed to help people with HIV/AIDS return to work was successful.

Setting: 

Participants were recruited from community-based service agencies in the southern region of Los Angeles County, CA. The intervention was coordinated by the Career Transition Center (CTC) in Long Beach, CA but was delivered at various local centers. The CTC offers an array of services, including resume writing, guided and self-directed job search, vocational counseling, job training and job placement.

Sample: 

A total of 235 participants were recruited into the workforce reentry demonstration project from local community agencies. Entry criteria included the following: (1) an HIV/AIDS
diagnosis, (2) disabled/unemployed (exceptions to this were individuals working part time under the table or volunteering), (3) receiving medical care for their HIV/AIDS conditions, (4) enrolled in an HIV/AIDS case management program, and (5) contemplating workforce re-entry. The mean age was 40, and was predominantly males who were sexually active with other males.

Data Collection: 

Program participants and comparison respondents completed questionnaires that included demographic questions, measures of income and income source, health indices, an interview and a questionnaire related to current and prior employment status. Descriptive statistics were calculated for all variables. Chi-square tests were used to compare the intervention group with the comparison group for categorical variables and a combination of t-tests and Wilcoxon rank-sum tests were used for continuous variables.

Intervention: 

The intervention tested was a work re-entry program that included vocational assessments, counseling, case management, job search assistance, and job placement. In addition, tuition assistance was provided for training through independent training institutions and local community colleges.

Control: 

Fifty-one comparison respondents were recruited from the same community agencies as the intervention participants. These individuals met the same requirements as intervention participants with the exception that they were not seeking to re-enter the workforce. They were not provided with an alternative treatment.

Findings: 

Of the 235 enrolled participants, 172 completed at least one follow-up. Of this group, 90 were in some form of work at baseline, but 46 stopped working at some time later in the study and their time to return to work was reset to start at the time that they stopped working. Participants in the intervention condition were more likely to return to work than those in the comparison group. In addition, men, those in relatively poor health, those receiving either Social Security or state disability income and those with higher incomes at baseline were less likely to return to work.

Conclusions: 

The study provides evidence for the efficacy of return to work services for individuals with HIV/AIDS. Those who completed the intervention were more likely to return to work and to return to work more quickly. Although lengthier interventions may be needed for some individuals with HIV/AIDS seeking workforce re-entry, the ?findings suggest that even limited assistance may be useful to individuals seeking to return to work following a period of disability.

URL: 
http://content.iospress.com/articles/work/wor00565
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Authors: 
Man, D. W. K., Poon, W. S., & Lam, C.
Year Published: 
2000
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
81
Number: 
8
Pages: 
1007-1015
Publisher: 
Elsevier
Background: 

The present study tested a Medical/Vocational Case Coordination System (MVCCS) designed for persons with brain injury. The MVCSS, which was based on knowledge gained from the research literature and from clinical experience in medical and vocational rehabilitation for persons with BI, emphasize early intervention and coordinated service delivery through integrated medical center based and community-based services. Early intervention was emphasized to reduce the time between injury and community reintegration and to reduce the associated psychosocial complications that may result from lack of early intervention. The MVCCS was expected to maximize participants vocational and independent living outcomes and to minimize the use of medical and community resources.

The researchers review of previous research supported the belief that an intervention system for improving vocational outcomes of persons with BI must include these features: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) temporary or long-term supported employment in appropriate cases. To be viable, the system must significantly improve on the benchmark of 60% unemployment with results at least equivalent to those of earlier intervention studies; that is, approximately 75% of participants in community-based employment: approximately 50% working without long-term supports and approximately 25% in long-term, community-based, supported employment or in educational or training programs. They studied vocational outcomes of the MVCCS over a 4-year period.

Purpose: 

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. The study design evaluated 2 hypotheses. The first hypothesis was that vocational outcomes will meet or exceed those reported previously, that is, (1) 75% of participants in community-based independent or supported community-based employment or education/training programs (Vocational Independence Scale [VIS] levels 3 to 5); and (2) 50% of participants in independent community-based employment (VIS level 5). The second hypothesis was that 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 non-brain injuries, and (6) preinjury educational/vocational status.

Setting: 

The setting was a large urban medical center.

Sample: 

One hundred fourteen Minnesota residents with traumatic or other acquired brain injury between the ages of 18 and 65 years. The majority (or 64%) had TBI followed by CVA (26%) and other (10%). The largest portion (36%) of the sample was referred for vocational services through outpatient rehabilitation evaluations. Severity of injury was classified only in TBI cases, based on results of available initial Glasgow Coma Scale (GCS) score and duration of loss of consciousness (LOC) at the time of injury; 56% were classified as severe TBI. Among all participants N=114, the majority (61%) were male. Mean age was 37.4. Preinjury education was less than 12 (22 %); 12 to 15 years (61%) and greater than 16 years (17%). Sixty nine percent were working prior to injury and 77% had an independent living status. The mean time since injury for the group was 65.5 months with a median of 12.7 months.

Data Collection: 

Vocational outcome at time of initial placement and at 1-year follow-up was measured using the Vocational Integration Scale. The Mayo-Portland Adaptability Inventory (MPAI), a scale based on the Portland Adaptability Inventory was used for rating the range of physical, cognitive, emotional, and social impairments and disabilities resulting from BI. It was completed by rehabilitation staff, the patient and a significant other. Rating scale (Rasch) analyses of the Staff MPAI based on 305 assessments led to a reduction in the number of items from 30 to 22 by eliminating non-contributing items. An indicator of Impaired self-awareness ISA was item 24 from the Staff MPAI, which rates level of indifference or lack of awareness of deficits. The second indicator of ISA used was the difference between the Rasch-converted score for 22-item Staff MPAI and the Rasch-converted score for the 22-item Survivor MPAI. Preinjury vocational status, the presence of other non-brain injuries, time since injury, and the Rasch-transformed Staff MPAI appeared to have some value in predicting the level of initial vocational placement. At 1-year follow-up, vocational status was predicted by time since injury and Rasch Staff MPAI. The VIS at initial placement also significantly predicted VIS at follow-up (Spearman coefficient 5 .75, n 5 101, p, .0001). The efficiency of services (i.e., months to placement) was significantly predicted by preinjury education, injury severity, time since injury, Rasch Staff MPAI, Rasch Survivor MPAI, and the difference between the Rasch Staff MPAI and Rasch Survivor MPAI. To control for experiment-wise error, potential predictor variables were further scrutinized using regression analyses.

Intervention: 

The MVCCS interfaced a medical center based BI Nurse Case Coordinator (NCC) with a medical-center based BI Vocational Case Coordinator (VCC) who served as a liaison to community-based services. This interface provided: (1) early identification by the NCC of individuals needing medical
services, medical rehabilitation, vocational rehabilitation, and social services; (2) late identification of other persons with chronic impairments after BI and their service needs by either the NCC or the VCC; (3) personal vocational counseling, consumer advocacy, and on-site consultation to other vocational services provided by the VCC; (4) access to community-based vocational services through the VCC that included: vocational evaluations, supported work trials, long-term community- based supported employment, job coaching, job development, and job placement; (5) access to other community based services that support employment, such as independent living services, community-based social services and mental health services, and traumatic brain injury (TBI) waivered services, including behavioral aide services; and (6) access to medical center services that enhance vocational re-entry for persons with BI, such as a CI day rehabilitation program; a 3-hour weekly community reintegration group; individual cognitive rehabilitation; medical rehabilitation services such as standard rehabilitation therapies, work hardening, and physical work assessments; neuropsychological and psychiatric services, including psychotherapy, family therapy, behavioral medicine, and substance abuse treatment; and other medical diagnostic and therapeutic services, including psychiatric and behavioral neurology services.

In the day-to-day operation of the MVCCS, the NCC, working with emergency room staff, identified all brain-injured
persons admitted to the hospital each working day and served as case coordinator for these cases. She reviewed the medical record, met with the patient, recommended additional services to the primary medical service, obtained consent, and entered participants into the clinical database. The NCC followed the patient after dismissal from acute care. If the patient left from acute care to home, she followed up by telephone within 1 month to identify potential BI sequelae and service needs and to assist in scheduling required services. If the patient left acute service to the rehabilitation unit, the NCC turned medical case coordination over to the rehabilitation social worker. In all cases referred, the VCC met with study participants and obtained consent for study participation, provided all appropriate vocational evaluations and counseling, completed the Staff MPAI with input from other involved rehabilitation staff, obtained the Survivor MPAI, and referred appropriate participants to community-based vocational services. The VCC followed up on each participant 1 year after the person was placed or left the project.

Control: 

There was no comparison condition. Participants served as their own controls.

Findings: 

he MVCCS evaluated in this study appeared to substantially improve employment outcome for persons with BI without interventions. Results were better than projections based on the previous literature 80% of those served were placed in community-based work with 46% in independent community-based employment. Employment outcomes for persons who received vocational services through this project approached or exceeded outcomes reported previously for intensive rehabilitation interventions. Just as importantly, initial vocational placements were maintained at 1-year follow-up. At the follow-up interview, 81% were working in the community and 53% were employed independently without job supports. Although the results were equivalent to those of other rehabilitation programs that are based on best practices the authors could not make direct comparisons with those programs because we did not investigate specific interventions. Primary predictors of initial placement in the present study were time since injury and overall impairment/disability as measured by the Staff MPAI. Return to previous work should be considered especially for the more recently injured who have retained ties to their previous employer. Results indicate that more severe impairments and disabilities, as measured by the MPAI, are significant barriers to employment in the general population of persons with BI. However, for persons with TBI, the presence of additional non-brain injuries appears to be a more important factor.

The best predictor of employment level at 1-year follow-up was the level of initial placement. ISA (as measured by the difference between Rasch Staff MPAI and Rasch Survivor MPAI) did not contribute to the prediction of either initial placement or job maintenance. This finding is inconsistent with some other studies reporting an association between ISA and long-term employment after BI. The results suggest that ISA may be a barrier to employment that can be overcome through rehabilitation, through education and support for employers, and by discriminating placement of those persons with ISA in work environments that are more tolerant of limitations in self-awareness. Overall level of impairment and disability also appears to be a factor in time required for placement. In some cases, more intensive rehabilitation efforts, such as a CI day rehabilitation program, were required for more severely disabled persons so they could develop cognitive compensation, communication, behavioral self-management, social, and other pre-vocational skills required for eventual placement. Because of the time required for participation in such an intensive rehabilitation program, most individuals who participated in CI day rehabilitation required 6 to 12 months from the time they were admitted to services to their eventual placement. Our data suggest that most placements (92%) can be made within 1 year of admission to services. Preinjury years of education also contributed slightly to prediction of time to placement, with more highly educated individuals being placed more quickly.

Conclusions: 

Introducing a VCC into an MVCCS program appears to optimize participants vocational outcome after BI, resulting in community-based employment for 81% of persons served with 53% working independently in the community 1 year after placement. Time since injury and overall level of impairment/ disability were the most significant factors in predicting vocational outcomes. Beyond its association with overall level of disability and chronicity, ISA did not contribute to the prediction of initial placement or job maintenance. The best predictor of employment status at 1 year follow-up was the level of initial placement. Persons with greater overall disability required more extended time and more extensive rehabilitation services before job placement.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/10943747
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Patterns of employment and independent living of adult graduates with learning disabilities and mental retardation of an inclusionary high school vocational program

Authors: 
Lynas, L.
Year Published: 
2005
Publication: 
Research in Developmental Disabilities
Volume: 
26
Number: 
4
Pages: 
317-325
Publisher: 
Elsevier
Background: 

Although employment rates for individuals with disabilities may be improving, improvement is needed. The picture for independent living is not much better. Studies have indicated that most adults with disabilities remain both single and living with their parents. They are isolated socially with few friends or meaningful relationships. Schools and school programs that facilitate the transition to adult life are needed.

Purpose: 

The purpose of this study was to examine the employment careers of graduates in an inclusionary vocational and technology high school.

Setting: 

The setting for the study was an inclusionary vocational/technical high school in Ohio.

Sample: 

Thirty six students participated in the study. Nineteen individuals (11 males and 8 females) had been diagnosed with mild mental retardation and 17 (10 males and 7 females) with a specific learning disability by a school psychologist. All had been enrolled in full time programs for students with special needs and had an Individual education plan on file. During the last two years of high school they attended high school for two or three periods then spent the remainder of the day at a Vocational/Technology Center. Students were aged between 20 to 25 years. The majority or 26 of the students were caucasians. The subjects had been enrolled in a variety of vocational programs while attending the vocational tech center. On average, participants had exited or graduated from high school and the vocational center within the last five years at the time of the study.

Data Collection: 

A sixteen item questionnaire was used to learn more about participants' employment and living situation. Participants were contacted by telephone. After answering each question, the participant was given the opportunity to make comments. Chi-square analysis was used to determine statistical differences between the two groups.

Intervention: 

The intervention was Vocational Technical Education.

Control: 

The study included a comparison group.

Findings: 

Overall, the majority or 81% of the participants were employed. However, only 68% of individuals with mild mental retardation were employed as compared to 94% of those with learning disabilities. This was a significant statistical difference. There was no differences related to gender or the program the student attended at the vocational technical center. More participants with learning disabilities were employed in skilled jobs than those with mild mental retardation. Those individuals were working in service industry and factory jobs.
The mean rate of pay for those working was $9.00. there was no significant difference on rate of pay or benefits held by disability type. The majority or 94% of the sample were single. Most or 95% of those with mild mental retardation lived with their parents as compared to 53% of those with learning disability. The majority or 94% of those with learning disabilities owned a car while only 26%of those with mild mental retardation had one. Among those who were working and not driving 40% relied on public transportation. Related to recreation, a third of the respondents indicated watching movies was their main activity. All of the individuals with learning disabilities were registered to vote and had voted. Only 63% of those with mild mental retardation reported having voted.

Conclusions: 

Overall over 81% of the graduates were employed. However, this is primarily accounted for by employment of students with specific learning disabilities (94%) as opposed to respondents with mild mental retardation (68%). However, even when this variance between the two disability types is accounted for, even the students with mild mental retardation are employed at a higher rate than other figures reported in earlier studies.
Another positive finding in the study was the rate of pay for the respondents. For those students working, the median hourly rate was $8.90 which is significantly above the national minimum wage with no statistical significant difference found between the two disability types. Additionally, 68% of those working reported to be receiving benefits.
The majority of participants with mental retardation (95%) were still living with their parents; whereas, 53% of those with learning disabilities were living at home. Members of both groups could benefit from training in this area including how to secure housing.
Individuals with learning disabilities were much more mobile in the community than their peer respondents with mental retardation. The students with learning disabilities were much more likely to own a car (94%) and thus get around the community in a more independent fashion. In areas without public transportation local agencies should provide transportation services for those adults with disabilities who do not or cannot maintain an automobile. The individuals who graduated from an inclusionary high school vocational and technology environment have done fairly well compared to respondents in other reported studies on the areas of employment, pay, and independent living. This may have been partially due to the fact that the learning environment moved students quickly through the exploratory phases of vocational education into the focused phase where students received specific vocational and job training as well as training in independent living skills. This was accomplished in a setting with other non-disabled peers who were also receiving strong vocational training.

URL: 
http://www.sciencedirect.com/science/article/pii/S0891422204000253
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Three year follow-up study of an integrated supported employment for individuals with severe mental illness.

Authors: 
Tsang, H. W., Chan, A., Wong, A., & Liberman, R. P.
Year Published: 
2010
Publication: 
Australian and New Zealand Journal of Psychiatry
Volume: 
44
Number: 
1
Pages: 
49-58
Publisher: 
PubMed
Background: 

Persons experiencing severe mental have traditionally experienced high rates of unemployment. The Individual Placement and Support model is an evidenced based practice effective in assisting persons with severe mental illness achieve employment outcomes at a rate higher than traditional approaches.

Purpose: 

The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) program, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS program on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years.

Setting: 

Non government organizations and day hospitals in Hong Kong in association with the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Sample: 

One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong.

Data Collection: 

Study participants were randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up.

Intervention: 

Individual Placement and Support (IPS) 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: 

The comparison condition was traditional vocational rehabilitation.

Findings: 

After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive.

Conclusions: 

The long-term effectiveness of the ISE program in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20073567
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness.

Authors: 
Twamley, E. W., Narvaez, J. M., Becker, D.R. Bartels, S. J., & Jeste, D. V.
Year Published: 
2009
Publication: 
Journal of behavior therapy and experimental psychiatry
Volume: 
40
Number: 
2
Pages: 
292-305
Publisher: 
Elsevier B.V.
Background: 

The traditional vocational rehabilitation (TVR) services adopt a step-wise approach which offers pre-vocational training at the beginning of the service. In Hong Kong and mainland China, participants usually undergo a prolonged period of preparation before seeking competitive employment. Rates for competitive employment are usually less than 20%. As TVR is the most common form of vocational rehabilitation in Hong Kong, it was important to local service development to benchmark innovative interventions against standard interventions. IPS is an evidence-based rehabilitation service that includes job development and placement, on-going employment supports, coordination of vocational services with multidisciplinary treatment teams, indefinite services and the opportunity for choice of jobs by participants. PS is less than optimal in clients' maintaining their jobs, with 50% of those employed experiencing job terminations by the six-month follow-up. Over a longer follow-up period, considerably fewer than half of the participants in IPS are working during any single month. In the current study, IPS was amplified by the addition of work-related, social skills training (WSST) together with ongoing supports in the community for aiding generalization of social skills in the workplace following the integrated supported employment (ISE) protocol.

Purpose: 

The purpose of this study was to examine the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment.

Setting: 

The setting included community mental health programs which offered a range of rehabilitation services.

Sample: 

The study sample was 163 participants from community mental health programs which offered a range of rehabilitation services. The recruitment was based on the following selection criteria: (1) suffering from SMI (operationally as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent major depression, or borderline personality disorder); (2) being unemployed; (3) willing and cognitively competent to give informed consent; (4) lacking obvious cognitive, learning and neurological impairments as determined by mental status exam; (5) completed primary education; and (6) expressing a desire to work.

Data Collection: 

Data collection involved the following: Employment Outcome Checklist (EOC) assessed their employment outcomes such as the number of job interviews attended, the number of jobs obtained, number of hours per week worked, and salary received from each of the jobs that were obtained . The 21-item Chinese Job Stress Coping Scale (CJSC) assessed the coping strategies of participants when faced with job stress, using a five-point response scale ranging from 1 (hardly ever do this) to 5 (almost always do this). The coping dimensions included help seeking, positive self-appraisal, work adjustment, and avoidance. The Chinese Job Termination Checklist (CJTC) is the Chinese version of the Job termination Scale.

Intervention: 

A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). The ISE participants joined the ISE program which integrated IPS and WSST. The eight principles of IPS also applied to this intervention. The 10-session WSST consisted of a structured program to teach participants job interview skills, basic conversation and social survival skills for effective communication with supervisors, co-workers and customers.

Control: 

Individual Placement and Support (IPS) 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.Traditional Vocational rehabilitation services that clients received included sheltered workshop and supported employment.

Findings: 

After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

Conclusions: 

The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

URL: 
http://www.sciencedirect.com/science/article/pii/S0005791608000852
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention.

Authors: 
Vlasveld, M. C., Anema, J. R , Beekman, A. T. F., van Mechelen, W., Hoedeman, R., van Marwijk, H. W. J., Rutten, F. F., Hakkaart-van Roijen, L., & van der Feltz-Cornelis, C. M.
Year Published: 
2014
Publication: 
Journal of Occupational Rehabilitation
Volume: 
24
Number: 
1
Pages: 
42-51
Publisher: 
Springer Science+Business Media New York
Background: 

Employment leads to more independence as an adult. Many youth with physical disabilities have difficulty gaining and maintaining employment. This may result in a reduced quality of life.

Purpose: 

The purpose of the study was to examine how occupational performance of participants of a vocational rehabilitation intervention changed over time. More specifically, it looked at work, self care and leisure. The researchers also looked at the differences between individuals who were employed and those who remained unemployed after the vocational rehabilitation intervention.

Setting: 

The setting was an outpatient rehabilitation clinic for young adults located in Rotterdam, the Netherlands.

Sample: 

Participants include eleven young adults with physical disabilities; six male and five females. Their mean age was 22 years prior to the intervention. Three individuals had cerebral palsy, 2 had muscular disease, 2 had traumatic brain injury and the remainder had other types of physical disabilities. The amount time participants had spent looking for work ranged from Five of the participants had not yet looked for work while 2 had been looking for more than 2 years.

Data Collection: 

Demographic data was collected. Severity of physical limitations was categorized using scores on the Physical Functioning scale of the MOS Short-Form General Health Survey. Occupational performance was explored at baseline and one year later using semi structured interviews. The Canadian Occupational Performance Measure (COPM), an interview, was used to assess self perception of work performance in the areas of self care, productivity and leisure over time. The Occupational Performance History Interview II (OPHI-II) was used to assess aspects of occupational adaptation: occupational identity, competence and setting. Results were summarized using descriptive statistics. Sores on the COPM subscales and the OPHI-II scales were calculated. Qualitative data from the COPM and audio taped OPHI-II were summarized and categorized into the 3 occupational performance categories: self care, leisure and work productivity. Narrative were classified as regressive, stable or progressive. Differences between pre and post intervention scores on COPM and OPHI-II were tested using Wilcoxon signed rank test. Demographics between the employed and unemployed groups were compared using the Mann-Whitney U test. Non-parametric test were used. Data was analyzed using SPSS 16.0.

Intervention: 

The intervention was "At Work?! This is a multidisciplinary vocational rehabilitation intervention that was designed for young adults with physical disabilities, who are entering the labor market, and is geared towards improving abilities to achieve employment. The year long intervention brought rehabilitation and vocational services into a group program that included individuals assessments and coaching.

Control: 

There was no control group. The participants served as their own controls.

Findings: 

The participants expressed fewer problems after the intervention. Additionally, they showed improved in work performance, self care and leisure. An increase in satisfaction with these improvements was also reported. Occupational identify, competence and overall scores on the OPHI II also increased. The demographic characteristics of the individuals who did not gain employment were not difference from the group that was employed. The unemployed experienced difficulties in all three areas of occupational performance prior to the intervention and more difficulty in the work setting. Post-intervention, their levels of occupational identity, competence and settings were like those of employed persons. Participants showed improved occupational performance post intervention. The unemployed participants appeared to catch up during the intervention but had not achieved employment within one year.

Conclusions: 

Young adults with physical disabilities, showed improved occupational performance in work, self care and leisure and were more satisfied with their performance after participating in a one year multidisciplinary vocational rehabilitation intervention. Those who did not go to work faced problems in all three areas at pre-intervention. The goal of employment and the intervention appeared to motivate participants to solve problems related to work, self care and leisure. There is a need for interventions aimed at improving work participation by address problem across the three areas. Young adults who go to work may benefit from ongoing coaching to help address new problems.

URL: 
http://link.springer.com/article/10.1007%2Fs10926-013-9446-9
NIDILRR Funded: 
Peer Reviewed: 
Yes

Occupational categories and return to work after traumatic brain injury: A multicenter study

Authors: 
Wallace, C. J., & Tauber, R.
Year Published: 
2006
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
87
Number: 
12
Pages: 
1576-1582
Publisher: 
Elsevier
Background: 

A number of researchers have indicated that postinjury return to work rates are a function of pre-injury job classifications. However, these and other job category studies have conflicting findings, differing methodology and small sample sizes. This makes it difficult to determine if this is a significant and unique predictor that impacts return to work rates. Due to poor post injury employment rates for individuals with TBI knowing the relation between pre-injury occupational category and return to work could improve employment outcomes.

Purpose: 

The purpose of the study was to find out if pre-employment occupation was a significant and unique predictor of return to work for individuals with TBI.

Setting: 

The setting was 17 NIDILRR funded TBI Model Systems Projects (TBIMS) located across the United States.

Sample: 

The sample size was 1,341 individuals with TBI who had data in the TBIMS national database including one year follow up data. The majority of the sample were males (77%) and white (69%). Most had sustained an injury that would be considered moderate to severe.

Data Collection: 

Data was collected at TBIMS rehabilitation centers that include a wide array of services. Hospital records and admission and discharge FIM instrument used to evaluate level of independence were used to collect medical information. Annual telephone interviews were attempted to collect follow up information at month 10 and 14 post-injury. If this was not successful, a questionnaire via mail and/or an interview with significant other was completed.

Intervention: 

The intervention included an array of return-to-work services.

Control: 

There was no control or comparison condition.

Findings: 

Individuals who held professional and managerial jobs were more likely to be working during the one year follow up. Approximately, 33% of those who had worked in manual labor jobs were working at follow up with a slightly improved rate among those in skilled labor positions.Severity of injury was not predictive. However, the following variables: preinjury job category, education level, hospital LOS and discharge FIM total score were predictors. Additional analysis, clearly supported that job category predicts return to work outcomes beyond using educational level obtained prior to injury alone.

Conclusions: 

Preinjury occupational factors influence return to work post injury for individuals with TBI. Given that individuals, who were worked as manual laborers prior to injury had the poorest return to work rate, this group may have a greater need for vocational services. More research is needed to better understand return to work rates and evaluate possible strategies to improve employment outcomes.

URL: 
http://www.msktc.org/publications/detail/1732
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes