A Supported Employment program for people with Mental Illness in Hong Kong

Authors: 
Wong, K. K., Chiu, R., Tang, B., Mak, D., Liu, J., & Chiu, S. N.
Year Published: 
2004
Publication: 
American Journal of Psychiatric Rehabilitation
Volume: 
7
Number: 
1
Pages: 
83-96
Publisher: 
Routledge, Taylor and Francis
Background: 

People with mental illness have high rates of unemployment and underemployment. Hong Kong is interested in investigating new ways to assist this population with employment. Research is needed.

Purpose: 

The purpose of this article is to report on the vocational outcomes of people with mental illness participating in a supported employment (SE) program in Hong Kong.

Setting: 

The setting was community vocational rehabilitation providers and various places of business in Hong Kong.

Sample: 

The study sample included 748 individuals with mental illness who enrolled in supported employment programs in Hong Kong.

Data Collection: 

Employment data was collected on participants, including wages and job tenure was collected.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

There was no control or comparison group.

Findings: 

Of the 748 participants, 458 (61.2%) obtained competitive employment. The mean job tenure was 151 days. The mean salary was HK$4,561 (US$585.00) for full-time jobs and $2,368 (US$304.00) for part-time jobs. The majority of participants (62.4%) could sustain their job placement for more than 30 days, 110 (24.0%) participants could work for more than six months, and 59 (12.9%) could maintain their jobs for more than one year.

Conclusions: 

This study concluded that IPS programs could improve vocational outcomes for people with mental illness in Hong Kong. Recommendations for future research on evaluation of the effectiveness of SE program and for further development of SE in Hong Kong were suggested.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/15487760490465004
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A supported competitive employment programme for individuals with chronic mental illness

Authors: 
Wong, K., Chiu, L. P., Tang, S. W., Kan, H. K., Kong, C. L., Chu, H. W.,& Chiu, S. N.
Year Published: 
2001
Publication: 
Hong Kong Journal of Psychiatry
Volume: 
11
Number: 
2
Pages: 
13-18
Publisher: 
Hong Kong Academy of Medicine Press
Background: 

Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. Numerous reports demonstrate enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness. Not much is known about the program outcomes and applicability in Hong Kong.

Purpose: 

The objective of this study was to ascertain the vocational outcomes of individuals with chronic mental illness participating in a supported employment program.

Setting: 

The setting included supported Employment Services in a hospital in Hong Kong.

Sample: 

The sample was 388 individuals with chronic mental illness.

Data Collection: 

Referral forms were used to collect demographic data. A job placement and follow up record was used to assess job retention rate, job tenure, nature of job placement and earnings. A job termination form was used to evaluate the reasons for the termination of employment.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

The comparison condition was traditional vocational rehabilitation services.

Findings: 

Of the 388 patients, 267 (68.8%) obtained competitive employment. The mean job tenure was 133 days. The mean salary was HK$4,737 for full-time jobs and HK$2,329 for part-time jobs. The majority of the patients (59.6%) sustained their job placement for more than 30 days, 69 patients (25.8%) worked for more than 6 months, and 35 (13.1%)maintained the job for more than 1 year.

Conclusions: 

This study concluded that a supported competitive employment program could be an effective approach to enhancing vocational outcomes for individuals with chronic mental illness. Recommendations for future research for evaluation of the effectiveness of the supported competitive employment program are suggested.

URL: 
https://www.questia.com/library/journal/1G1-169678962/a-supported-competitive-employment-programme-for-individuals
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment program

Authors: 
Xu, Y.W., Chan, C. C., Lam, C. S., Li-Tsang, C. W., Lo-Hui, K. Y., & Gatchel, R. J.
Year Published: 
2000
Publication: 
Work: A Journal of Prevention, Assessment and Rehabilitation
Volume: 
14
Number: 
3
Pages: 
247-256
Publisher: 
IOS Press
Background: 

Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. Numerous reports demonstrate enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness.

Purpose: 

This study provides information about vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment (SCE) program.

Setting: 

The setting was a community based supported competitive employment program.

Sample: 

The sample was 458 individuals with chronic mental illness.

Data Collection: 

Demographic and employment data was collected by the employment specialists during the study.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

The comparison condition was traditional Vocational Rehabilitation.

Findings: 

Of the 458 subjects, 308 (67.3%) obtained competitive employment. The mean job tenure was 134 days. The mean salary was $4,740 for full-time jobs and was $2,321 for part-time jobs. The majority of subjects (59.4%) could sustain their job placement for more than 30 days, 74 (24.0%) subjects could work for more than six months, and 38 (12.3%) could maintain the job for more than one year.

Conclusions: 

Subjects who became employed were compared to those who did not gain employment on a variety of demographic variables. Significant differences were found between two groups in terms of sex and source of referral. The rate of employment in the current study was slightly higher, but the job retention rate was lower than in earlier studies. Recommendations for future research on evaluation of the effectiveness of SCE program are suggested.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12441521
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Is job tenure brief in individual placement and support (IPS) employment programs?

Authors: 
Bond, G. R., Becker, D. R., & Drake, R. E.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
8
Pages: 
950-953
Publisher: 
American Psychiatric Association
Background: 

Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.

Purpose: 

The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.

Setting: 

Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.

Sample: 

Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.

Data Collection: 

Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.

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. The intervention was IPS services with high fidelity to the program model and practices.

Control: 

The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.

Findings: 

The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7–12, 13 (9%) during months 13–18, and ten (7%) during months 19–24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6±10.2 hours per week and 10.7±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5±8.3 hours per week and 16.4±4.2 days per month. Mean wage rate for working clients was $7.90±$3.00 per hour

Conclusions: 

Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/21807836
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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
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.

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 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: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Fidelity of supported employment programs and employment outcomes

Authors: 
Becker, D. R., Xie, H., McHugo, G. J., Halliday, J., & Martinez, R. A.
Year Published: 
2001
Publication: 
Psychiatric Services
Volume: 
52
Number: 
6
Pages: 
834-836
Publisher: 
American Psychiatric Association
Background: 

Employment is a primary goal for the majority of people with severe mental illness. Recent research shows that supported employment is a more effective approach to vocational rehabilitation for this population than traditional methods. However, supported employment is currently implemented in a variety of ways. Bond, Cook and Razzano, among others, have identified several aspects of vocational services that are associated with good employment outcomes. These factors have been incorporated into a fidelity scale for supported employment.

Purpose: 

The purpose of this study was to identify critical components of a supported employment program that were strongly correlated with competitive employment outcomes in a state mental health system.

Setting: 

The setting was 10 community mental health centers in Vermont.

Sample: 

The study sample included 2,639 individuals aged 18 to 64 years who were diagnosed as having severe and persistent mental illness and who were enrolled in community rehabilitation and treatment programs.

Data Collection: 

The case manager or another staff member completed an employment survey for each eligible client that included questions about competitive employment, average number of hours worked, and number of weeks worked in the last quarter of 1999. This data collection method has been validated by the Mental Health Statistics Improvement Project of the Center for Mental Health Services.
Researchers also visited the ten mental health centers to learn how employment services were provided. For each center, the researchers completed the Individual Placement and Support Fidelity Scale.

Intervention: 

The intervention was supported employment.

Control: 

There was no control or comparison condition.

Findings: 

Higher competitive employment rates were strongly correlated with overall program fidelity and with two program components, namely, providing services in the community as opposed to providing them in the clinic and using full-time employment specialists as opposed to staff with mixed roles.

Conclusions: 

This study provides preliminary validation of an overall supported employment fidelity scale. This pilot study suggests that the supported employment components it measured account for about 50 percent of the variance in competitive employment outcomes. Most of the programs scored in the midrange of the supported employment scale, indicating that there is clearly room for improvement. Studies to determine whether improvements result in better employment outcomes are planned.

URL: 
http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.52.6.834
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Converting day treatment centers to supported employment programs in Rhode Island

Authors: 
Becker, D. R., Bond, G. R., McCarthy, D., Thompson, D., Xie, H., McHugo, G. J., & Drake, R. E.
Year Published: 
2001
Publication: 
Psychiatric Services
Volume: 
52
Number: 
3
Pages: 
351-357
Publisher: 
American Psychiatric Association
Background: 

Day treatment centers were originally designed to provide "partial hospitalization" for patients with serious mental disorders who required intensive, comprehensive, and multidisciplinary treatment that was unavailable in an outpatient setting. These programs began to develop rehabilitative services, rather than "hospital diversion". However, research indicates that these centers do not assist clients in obtaining jobs in the community. Because of the expense involved in maintaining these centers, they are coming under closer scrutiny. As such, several day treatment centers were successfully converted to supported employment programs.

Purpose: 

The intent of the study was to determine if phasing out day treatment centers in support of supported employment and other activities can be implemented statewide.

Setting: 

Three community day care treatment centers in Rhode Island participated in the study. Two were converted to supported employment programs, while the third remained a day treatment center until after the study was complete, for comparison purposes.

Sample: 

The study sample include 28 day treatment clients with severe mental illness in three community mental health centers.

Data Collection: 

"Participants were assessed at baseline and again at follow-up 30 to 36 months later; follow-up for clients in the converted programs took place 18 months after the conversion was completed. An independent research team conducted the interviews and evaluation." (p. 352)

Intervention: 

The intervention related to conversion of two day treatment centers to ones offering supported employment services.

Control: 

One of the centers remained as a rehabilitative day center.

Findings: 

"Former day treatment clients in the converted centers attained higher rates of competitive employment than those in the comparison group (44.2 percent and 56.7 percent versus 19.5 percent). Other employment outcomes also improved, and hospitalization rates and overall social functioning were unchanged." (p. 351)

Conclusions: 

"This study supports findings of previous studies suggesting that replacing rehabilitative day treatment programs with supported employment programs yields improvements in employment outcomes without adverse effects." (p. 351)

URL: 
http://www.worksupport.com/kter/documents/pdf/ConvertingDayCenters.pdf
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Impact of a vocational counselor on employment-related outcomes among methadone patients

Authors: 
Appel, P. W., Smith, R., Schmeidler, J. B., & Randell, J.
Year Published: 
2000
Publication: 
Evaluation and Program Planning
Volume: 
23
Number: 
4
Pages: 
437-448
Publisher: 
Elsevier Science Ltd.
Background: 

There were ongoing concerns from New York state government about the steady decline in the rate of employment among methadone maintenance treatment (MMT) patients. One effort to try and change that trend was the VENUS project. The project was designed to identify obstacles to the provision and use of vocational–educational (v–e) services in MMT programs, and then, to evaluate selected remedial interventions. The VENUS project implemented the role of a vocational integrator‚ to enhance the use of v-e resources in routine MMT clinic operations and removed welfare disincentives for patients. The vocational integrator increased v-e participation by patients while the removal of the welfare disincentive to employment was associated with a small decline in patient v-e involvement. Another initiative was to improve patient v-e participation and employment by placing a full-time vocational rehabilitation counselor (VRC) in an MMT clinic. The objective was to provide on-site v-e services and improve v-e outcomes.

Purpose: 

The purpose of this paper was to summarize results of the intervention. The overall objective was to show how patient involvement in v-e can be enhanced by having a full time on site VRC integrated into daily operations.

Setting: 

The settings were two adjacent methadone treatment clinics affiliated with a hospital in Jamaica, Queens, New York

Sample: 

The sample size in the MM intervention clinic was 364 patients. Earlier admissions comprised 68% of Clinic 1 patients. Two-thirds of this group were male; 57% were Black; and median age was 33 years. Median time in treatment for the early admissions was 33 months. The sample size in the comparison clinic was 358 patients.

Data Collection: 

Aggregate data regarding v-e services offered to patients were obtained from reports submitted monthly state substance abuse office. This provided information on the volume and type of service activities provided throughout the study period. In addition the VRC provided individual service information on each person served. Data on individual service delivery and monthly patient v-e status provided project implementation and outcome data.

In Clinic 1; v-e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. Vocational-educational services increased significantly in Clinic 1 and declined in Clinic 2. Logistic regression of factors involved in staying or becoming vocationally involved (vocationally involved refers to working full- or part-time, or being enrolled in education/training) vs. staying or becoming vocationally uninvolved among patients in Clinics 1 and 2 were conducted. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v-e change and that VRC services contributed significantly to v-e change among patients not working at admission.

For the first and second hypotheses, a repeated measures of motivation to find employment and of eight job-seeking activities for the two intervention groups were compared using linear, mixed-effects models. The third and fourth hypotheses were analyzed using multinomial logistic regression analysis. For the third hypotheses a total motivation score was calculated by summing the motivation scores across the six time points of the 12-week intervention. For the fourth hypotheses, a total job seeking score was calculated by summing the number of job search activities over the 12-week intervention period.

Intervention: 

The intervention was in-house vocational rehabilitation counseling. Intervention and comparison groups were not matched or assigned. One setting delivered the intervention and the other provided standard treatment.

Control: 

Intervention and comparison groups were not matched or assigned.

Findings: 

Having a VRC in a MM clinic increased v-e activity and outcomes. Results show increases in average number of counseling sessions, assessments conducted, v-e plans developed, and in the number of patients involved in counseling and pre-employment groups/workshops each month. Referrals for education, training and employment increased.

Conclusions: 

The examiners concluded that having a VRC in a MM clinic has a positive impact by increasing patient v-e activity and employment outcomes. It is also cost effective. Greater emphasis should be placed on employment and training of MM patients to improve employment outcomes.

URL: 
https://www.researchgate.net/publication/4763062_Impact_of_a_vocational_counselor_on_employment-related_outcomes_among_methadone_patients
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Providing effective early intervention vocational rehabilitation at the community level

Authors: 
Allaire, S. J., Niu, J., Zhu, Y., & Brett, B.
Year Published: 
2011
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
54
Number: 
3
Pages: 
154-163
Publisher: 
Hammill Institute on Disabilities
Background: 

The National Council on Disability noted that the number of persons with disabilities in the United States is increasing and that this is because our population is aging, and rates of disability increase with age.

Purpose: 

The purpose of this study was to evaluate the translation of positive research findings about a job retention intervention for persons with chronic illnesses to rehabilitation practice.

Setting: 

The setting was various rehabilitation counseling agencies.

Sample: 

The study sample included 57 individuals with chronic illness.

Data Collection: 

Data was collected by telephone within two weeks of the last meeting with the counselor and again at 6 months.

Intervention: 

Job retention intervention that included: vocational counseling and guidance, job accommodation, and educational and self-advocacy.

Control: 

There was no control or comparison condition.

Findings: 

Follow-up data indicated that the interventions should be more individualized. Short term outcomes evaluated in this study showed that consumer participants experienced significant improvement in awareness and confidence in ability to manage health related work problems and took actions recommended by the counselors.

Conclusions: 

The results indicate that job retention interventions can be effective when carried out in practice at the community level.

URL: 
http://rcb.sagepub.com/content/54/3/154.full.pdf+html
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes