A randomized clinical trial of supported employment for inner-city patients with severe mental disorders

Authors: Dutta, A., Gervey R., Chan, E. F., Chou, C., & Ditchman, N.
Year Published 1999
Publication Archives of General Psychiatry
Volume 56
Number 7
Pages 627-633
Publisher American Medical Association

One primary goal for people with psychiatric disabilities is competitive employment. However, the actual rate of employment is less than 15%. The authors hypothesize two reasons: individuals with psychiatric disorders are discouraged from seeking competitive employment because health professionals believe that "the stress of competitive work produces adverse effects" (p. 627), and once in the standard vocational system, people tend to stay in sheltered workshops instead of transitioning to competitive work.


The purpose of this study was to replicate the New Hampshire study in Washington, D.C., with a more diverse and disadvantaged group of patients and a variety of vocational agencies.


"Community Connections, an agency in southeast Washington, DC that serves people with severe mental disorders who need intensive case management" (p. 628)


152 unemployed, inner-city patients with severe mental disorders

Data Collection

Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven states in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.


The control group received Enhanced Vocational Rehabilitation (EVR)


During the 18-month study period, participants receiving IPS were more likely than those in EVR to obtain competitive employment. IPS participants "also had superior outcomes in other dimensions of competitive employment" (p. 629). In addition, IPS participants were more satisfied than their EVR counterparts.


IPS appears to be superior to EVR; however, a lack of evidence exists for the IPS model producing negative results in non-vocational areas, such as self-esteem and quality of life. In fact, the study validated an increase in those two areas, in both IPS and EVR. IPS increased the rate of competitive employment as compared to EVR.

URL http://www.worksupport.com/kter/documents/pdf/RandomizedClinicalTrialofSupportedEmployment.pdf
Disabilities Emotional disturbance
Populations Male & Female | Asian | Black / African American | White / Caucasian
Outcomes Employment acquisition
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes