Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial

Authors: 
Wehman, P., Kregel, J., Keyser-Marcus, L., Sherron-Targett, P., Campell, L., West, M., & Cifu, D. X.
Year Published: 
2007
Publication: 
The Journal of the American Medical Association
Volume: 
298
Number: 
12
Pages: 
1401-1411
Publisher: 
American Medical Association
Background: 

Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.

Purpose: 

The purpose of this study was to evaluate the effects of a depression outreach-treatment program on workplace outcomes.

Setting: 

The study was conducted over the telephone with individuals all over the U.S. with behavioral health plan coverage.

Sample: 

A randomized controlled trial involving 604 employees covered by a managed behavioral health plan were identified in a 2-stage screening process as having significant depression. Patient treatment allocation was concealed and assessment of depression severity and work performance at months 6 and 12 was blinded. Employees with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality were excluded.

Data Collection: 

Intervention effects on depression severity were estimated using multiple imputation multiple linear regression with simulated standard errors. QIDS-SR scores at 6 and 12 months were regressed on a dichotomous predictor for randomization status. Dichotomous measures of symptom improvement (?50% reduction in QIDS-SR scores) and complete remission (QIDS-SR scores of ?5) were also examined using multiple imputation multiple logistic regression. Comparable multiple imputation regression analyses were used to estimate intervention effects on work outcomes. The primary outcome was a composite measure of the number of effective hours worked in the prior 7 days, for which participants no longer working contributed no hours and numbers of hours worked by employed respondents were weighted by job performance.

Intervention: 

The intervention was a telephonic outreach and care management program. This program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy.

Control: 

Those assigned to usual care were informed that their responses indicated possible depression and advised to consult with a clinician; they could receive any normally available insurance benefit or service (eg, psychotherapy or pharmacotherapy), just not the additional telephone care management components provided to those in the intervention group.

Findings: 

The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes. Combining data across 6- and 12-month assessments, the intervention group had significantly lower QIDS self-report scores (relative odds of recovery, 1.4; 95% confidence interval, 1.1-2.0; P = .009), significantly higher job retention (relative odds, 1.7; 95% confidence interval, 1.1-3.3; P = .02), and significantly more hours worked among the intervention (?=2.0; P=.02; equivalent to an annualized effect of 2 weeks of work) than the usual care groups that were employed.

Conclusions: 

A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17895456
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trial.

Authors: 
Wehman, P., Targett, P., Yasuda, S., & Brown, T.
Year Published: 
2014
Publication: 
Journal of Autism and Developmental Disabilities.
Volume: 
44
Number: 
3
Pages: 
487-500
Publisher: 
Springer US
Background: 

Unemployment rates for individuals with autism after existing secondary education are high. Rates for individuals with ASD are between 4 to 12 percent. They also have low rates of participation in vocational or technical education, and post secondary education as compared to individuals with speech and language impairments, learning and intellectual disabilities. Furthermore, state vocational rehabilitation programs are experiencing difficulties responding to the employment service needs of transition aged youth with ASD. The employment outcome rate reported by VR for individuals with ASD has declined much in recent years. Research is limited on intervention to assist adults with ASD with gaining and maintaining employment. Project Search is an intensive internship program that has been replicated with modifications and has shown some degree of success with assisting transition aged youth with gaining and maintaining real work for real pay in their communities.

Purpose: 

This study had two hypotheses. First, higher number of individuals who participate in an employer based employment training and placement program will be employed than those in the control condition at a)completion of intervention and b) 3 months post completion of the intervention.Second, those who participate in the program will require less work support as measured by the Support Intensity Scale Employment Activities Subscale than those in the control condition at a) completion of the intervention and b) 3 months post completion of the intervention. The study was continuing at this writing and this analysis presents results from the first 3 years of cohorts who have completed one school year in Project SEARCH plus ASD Supports.

Setting: 

The students worked in a variety of internships in two suburban hospitals.

Sample: 

A total of 40 students participated in the study. 16 were assigned to the control group and 24 were in the treatment group. The two groups were equivalent on a number of demographic variables including gender, race, medical diagnosis, and Individualized Education Plan category. There was a significant difference between the ages of the treatment and control groups. The age range for both was between 18 and 21.5 years old.

Data Collection: 

Information was collected from the application process and a brief interviews at scheduled times to gain insight into the person's employment status, wage earned, hours worked, and employer paid benefits. The Supports Intensity Scale was also used to assess adaptive behavior and intensity of support needs. The six subscales used were: home living, community living, lifelong learning, employment, health and safety, and social. The SIS allowed the examiners to identify the types of work supports individuals required and provided a measure of the overall adaptive behavioral support needs of participants at baseline. Data collectors were trained in the administration of the instrument and inter-rater reliability was high 92.5%.Preliminary analysis included frequencies, means, standard deviations and distribution of scores.

Intervention: 

The intervention was Project SEARCH.

Control: 

The control condition was traditional transition service.

Findings: 

The treatment group attained employment at a rate of 87.5% after completing Project SEARCH internship and the ASD program compared to the control group at 6.25%. The treatment group also experienced an increase in weekly hours worked and wages.Three months later there was a significant difference between the treatment and control group mean standard scores on the Employment Activities Subscale of the SIS.

Conclusions: 

This study provided preliminary results.Twenty one out of 24 or 87.5 percent of the treatment group acquired employment. While only one in 16 or 6.25 percent of the control group went to work.Employment after graduating from high school is an attainable goal for youth with ASD who display challenging behavior and who have a comorbid medical diagnoses.

URL: 
http://researchautism.net/publications/5492/competitive-employment-for-youth-with-autism-spectrum-disorders:-early-results-from-a-randomized-clinical-trial.
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment: Randomized controlled trial

Authors: 
Ipsen, C., Seekins, T., & Arnold, N.
Year Published: 
2010
Publication: 
British Journal of Psychiatry
Volume: 
196
Number: 
5
Pages: 
401-410
Publisher: 
Royal College of Psychiatrists.
Background: 

There is evidence from North American trials that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.

Purpose: 

The purpose of the study was to investigate the effectiveness and cost-effectiveness of Individual Placement and Support in the United Kingdom.

Setting: 

Individuals with severe mental illness in South London were randomized to IPS or local traditional vocational services.

Sample: 

Participants were recruited from community mental health teams in two boroughs of South London. Inclusion criteria were that participants should be receiving outpatient or community psychiatric care from local mental health services, have severe mental illness (duration of illness over 2 years, global assessment of functioning (GAF)8 score of 60 or less, and a diagnosis of a psychotic or chronic affective disorder), aged 18–65, able to read and speak English to a high enough standard to give informed written consent, to have been unemployed for at least 3 months.

Data Collection: 

All data were analyzed using SPSS for Windows (version 15.0). The primary and secondary hypotheses were tested on the whole group. For comparing groups, t-tests and ?2-tests were used to compare means and proportions respectively, unless the data were highly skewed, in which case non-parametric tests were used. Logistic and linear regression models were also fitted including potential confounding variables: (grouped) age, gender, ethnic group, educational level, symptomatology and diagnosis. All data were analyzed in groups as randomized, whether or not receiving an intervention (i.e. intention-to-treat). Data were compared for those followed up with those not followed up, overall and by each treatment arm.

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 control condition (treatment as usual) involved existing psychosocial rehabilitation and day care programmes available in the local area. Each service employed, on average, 7 vocational staff, had a median of 58 places available to clients (range 6–3000) and 79% of services received referrals from clinical teams. A range of courses were offered, most commonly pre-employment preparation (e.g. interview skills, curriculum vitae coaching and application form practice), computers/information technology and confidence building/motivation.

Findings: 

Two hundred and nineteen participants were randomized, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95–1.93, P = 0.15), nor in secondary outcomes.

Conclusions: 

There was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20435968
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A randomized controlled trial of the efficacy of supported employment

Authors: 
Hogberg, G., Pagani, M., Sundin, O., Soares, J., Aberg-Wistedt, A., Tarnell, B., & Hallstrom, T.
Year Published: 
2012
Publication: 
Acta Psychiatrica Scandinavica
Volume: 
125
Number: 
2
Pages: 
157-167
Publisher: 
Wiley-Blackwell
Background: 

Western Europe does not have enough evidence that supported employment is a more effective service than traditional vocational rehabilitation services. More research is needed to determine the efficacy of this approach in Switzerland, a country with highly evolved systems and rehabilitation programs.

Purpose: 

This study looked at the effectiveness of using supported employment (place and train) to assist individuals with mental illness with employment versus a traditional (train and place) approach.

Setting: 

The setting included various places of employment.

Sample: 

The study sample include 100 unemployed individuals with severe mental illness. All were stabilized at the time of acceptance into the study. Forty six were assigned to the supported employment group and 54 to traditional vocational rehabilitation. Data analysis was conducted on 42 individuals in the supported employment group, where 4 were lost to follow up and 51 of the traditional vocational rehabilitation group, where 3 were lost to follow up. The two groups did not show any differences in clinical measures or demographics at intake.

Data Collection: 

Participants went through a two week intake assessment prior to being randomly assigned to one of the two groups. Afterwards participants were followed for a 24 month study period. Random effects logistic regression was used to assess overall differences between the two groups in month by month employment rates during this time.

Intervention: 

The intervention in this study was supported employment.

Control: 

The most viable locally available traditional vocational program was the control condition.

Findings: 

Approximately, 59% of the supported employment group went to work. At the conclusion of the study 46% remained employed. This is compared to only 26% of the group that received traditional vocational rehabilitation services. At the end of the study only 17% were still employed. The supported employment group was also employed for a longer length of time than the traditional VR group at 24.5 weeks versus ten weeks.

Conclusions: 

In Switzerland, supported employment is more effective than traditional vocational rehabilitation programs in assisting individuals with mental illness with competitive employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22077907
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Outcomes of a family-centered transition process for students with autism spectrum disorders

Authors: 
Ham, W., McDonough, J., Molinelli, A., Schall, C., & Wehman, P.
Year Published: 
2012
Publication: 
Focus on Autism and other Developmental Disabilities
Volume: 
27
Number: 
1
Pages: 
42-50
Publisher: 
Sage
Background: 

The federal Individuals With Disabilities Education Act (IDEA) requires transition planning for students with disabilities in the United States who are 16 years or older. Even with required transition planning, few young adults with ASD transition from school into employment or higher education, and many attend sheltered workshops or day activity programs.

Purpose: 

The purpose of this study was to assess the effectiveness of a transition planning approach that empowers students with ASD and their families, educates them about the transition process, and helps them connect with community resources on the transition readiness of youth with ASD.

Setting: 

The setting was public high schools located in New Hampshire and Maine.

Sample: 

The study sample included 47 youth transitioning from high school to adult life with ASD.

Data Collection: 

Standardized surveys were used to measure the impact of the project on student and parent expectations for the future, self-determination and vocational decision making ability. Data was collected at enrollment and 12 months later.

Intervention: 

Family centered transition planning consisting of group training sessions for families in the transition process, person-centered planning meetings facilitated by project staff, and follow-up assistance with career exploration and plan implementation.

Control: 

The control condition was transition planning as usual.

Findings: 

The group receiving family transitions services reported significantly higher student expectations for the future, parent expectations for the future, self-determination, and vocational decision-making ability. None of these variables improved significantly for the control group.

Conclusions: 

For students with ASD, the family-centered transition planning model shows promise as an effective, evidence-based transition practice.

URL: 
http://foa.sagepub.com/content/27/1/42.refs?patientinform-links=yes&legid=spfoa;27/1/42
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Moving employment research into practice: Knowledge and application of evidence-based practices by state vocational rehabilitation agency staff

Authors: 
Grossi, T., & Thomas, F.
Year Published: 
2013
Publication: 
Journal of Vocational Rehabilitation
Volume: 
39
Number: 
1
Pages: 
75-81
Publisher: 
IOS Press
Background: 

The need for evidence-based research is greater than ever in order to promote quality placements, as vocational rehabilitation (VR) counselors are facing extremely large caseloads. Vocational rehabilitation counselors are facing three main difficulties in order to successfully close cases. The first difficulty is the reluctance of business to hire during a bad economy, and there is a limited need for workers. The second difficulty is the number and complexity of people that are on caseloads. There are a large number of individuals and the number is growing. The third difficulty faced by vocational rehabilitation counselors is that there is no easy solution to these challenges. The solutions could be found in evidence-based research, but the vocational rehabilitation counselors may not have easy access to them. There is much more knowledge on how to assist with employment and provide appropriate supports, however, it takes time to translate the knowledge in a way that can be used by counselors. Knowledge translation (KT) aims to ensure that information and understanding gained through research ultimately betters the lives of the individuals with disabilities. Integrated KT includes intended users of the research findings in the actual research to help with the questions, message format, and use of strategies. Collaboration is a key component of integrated KT.

Purpose: 

The purpose of this study was to determine barriers and facilitators to the use of evidence. This study looks at the use of evidence by professional staff at state vocational rehabilitation agencies.

Setting: 

The study takes place at three state vocational rehabilitation departments. The three states are in different regions of the country, with participants from the East, South, and Southwest.

Sample: 

The sample was comprised of 265 females, 85 males, and 14 participants who chose not to identify gender. 29% of participants were from the East, 11.3% were from the South, and 59.7% were from the Southwest. The sample consisted of 87.3% participants with a Master‚ degree. 91.1% of graduates had a minimum of one graduate degree, while 7.9% held a Bachelor‚ degree. There were 2.3% of participants with high school diploma or post-secondary education. 11.57 years was the mean number of years in vocational rehabilitation. Vocational counselors made up the majority of participants with 83.5% of the sample. Vocational rehabilitation technicians, unit supervisors, area supervisors, area directors, program administration staff vocational rehabilitation consultants, vocational rehabilitation evaluators, vocational rehabilitation specialists, support staff, and consumer case coordinators comprised the rest of the study sample.

Data Collection: 

Making Research Work for VR Agencies, a questionnaire created for this survey study, was developed based on existing literature on knowledge translation. The questionnaire is comprised of three open-ended questions, in addition to 72 Likert type response items, and demographics. The open ended questions focused on the term evidence-based practice whose opinion the participant valued in terms of decision making when helping individuals with disabilities, and when evidence-based practice is helpful in their job. The Likert type items focused on: organizational supports for using evidence-based practices, how skilled the individual felt with using research when working, the value of evidence-based practices, organizational interactions that helped on the job, training activities, text information sources that assisted on the job, and information from human sources. Participants at the three state vocational rehabilitation agencies were encouraged to participate in the study via email. Confidentiality was ensured. $10 gift cards were offered to the first 20 participants to respond after the first email invitation in the Southwest state. The first 15 people to respond to the two follow-up emails in the Southwestern state also received $10 gift cards. Due to state ethics regulations or agency preferences this incentive was not used in the other two states.

Findings: 

The responses from the open-ended questions were coded by staff at Virginia Commonwealth University. The first question had participants define evidence-based practices. The response of 45.6% of participants was categorized as research-based. The rest of the responses were categorized as documented evidence with 18.3%, proven effective with 15.2%, and practice or experience with 8.5%. The sample responded that research for practice was valued with 84.2% of participants reporting this. Most of the participants reported that they did understand how to read and apply research literature to their job, with 76.3% participants responding this. Over half of the sample reported the ability to evaluate the quality of research, the ability to understand research findings, and that when it comes to using research for their job they consider themselves skilled. Participants indicated that the current research was applicable to their consumers, with 52.9% of respondents indicating this. Independently searching for research literature was reported by 68.2% of participants and 53.8% of participants reported practicing the latest research. 40.5% of participants reported that academic research articles do not clearly explain how evidence-based practices should be implemented. The third question focused on how the state agency valued and encouraged the use of evidence-based practices to serve clients. Only 48.2% of participants reported that evidence-based practices were valued by their agency. 38% of participants reported that their supervisor expected evidence-based practices for delivering services and 36.1% reported evidence-based practices were expected evidence-based practices in decision making. Participants reported professional collaboration and the internet (not social media) as the two most used information sources.

Conclusions: 

The data found that while vocational rehabilitation staff were open to using new strategies based on research, the staff face challenges in translating the research practices into products and strategies. Further research is needed to develop knowledge translation strategies to be used by vocational rehabilitation strategies.

URL: 
http://www.worksupport.com/documents/jvr_moving_employment.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes

Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness

Authors: 
Graham, C., Inge, K., Wehman, P., Murphy, K., Revell, W. G., & West, M.
Year Published: 
2006
Publication: 
Schizophrenia Bulletin
Volume: 
32
Number: 
2
Pages: 
378-395
Publisher: 
Oxford University Press
Background: 

Urban Based randomized clinical trials of integrated supported employment and mental health services in the United States on average have doubled the employment rates for adults with severe mental illness compared to traditional vocational rehabilitation. However, studies have not explored if the service integrative functions of supported employment will be effective in coordinating rural based services.

Purpose: 

Study designed and implemented a program blending Assertive Community Treatment (ACT) with a supported employment model using Individual Placement and Support (IPS) in a rural setting. In a 24 month randomized controlled trial, the ACT_IPS approach was compared to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults for serious mental illness.

Setting: 

Sumter County South Carolina catchment area of the South Carolina Department of Mental Health served by the Santee-Wateree Community Mental Health Center. Population = 102,000; African American (47%), White (49%)

Sample: 

Study sample met the federal Center for Mental Health Services criteria for severe and persistent mental illness. All were age 18 or older and unemployed at time of study entry. All had been a client of the Santee-Wateree Community Mental Health Center (SWCMHC) for at least 6 months.

Data Collection: 

Data collection and analysis addressed five key questions: (1) What obstacles would a rural South Carolina setting posed to implementing and sustaining ACT-IVR and IPS model? (2) How do the competitive work outcomes of the ACT-IVR and IPS programs compare to a traditional program providing parallel services in a rural economy? (3) How are overall work outcomes affected by differing strategies for obtaining employment? (4) How do rates of income earned from competitive employment change over time by program? (5) How do the programs' work outcomes compare after controlling for the number of participants' service contacts?

Intervention: 

Intervention was a fully integrated combination of Assertive Community Treatment with Integrated Vocational Rehabilitation (ACT-IVR)and Individual Placement and Support (IPS). ACT-IVR tightly integrated vocational with mental health services within a self contained provider team. IPS integrated its vocational services with its host agency or another agency's mental health services.

Control: 

Comparison program was a formal partnership between a local vocational rehabilitation agency and the SWCMHC. Program provided parallel traditional vocational rehabilitation and mental health services, respectively. The rehabilitation agency's employment specialists prepare participants for competitive jobs by taking a gradual, stepwise approach that focused on developing skills to manage workplace demands in staff supervised jobs set aside for adults with work disabilities.

Findings: 

More ACT-IPWS participants held competitive jobs and earned more income than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs.

Conclusions: 

The ACT-IPS program aided persons with serious mental illness-related work impairments, limited job experience, and tremendous educational and economic disadvantage to attain competitive work outcomes on a par with the urban supported employment programs cited in the literature. the ACT-IPS service-coordinating functions and immediate attention to competitive work may have been key processes that overcame rural-area obstacles to receipt of appropriate services and to labor market participation. However, the earnings generated fall far short of economic independence. It is recommended that barriers to accessing higher education for adults with SMI in rural areas must be reduced, with more of a focus placed on career-oriented job opportunities providing a means to develop highly marketable technical skills.

URL: 
http://schizophreniabulletin.oxfordjournals.org/content/32/2/378.full.pdf+html
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Randomized clinical trail of brief eclectic psychotherapy for police officers with post traumatic stress disorder

Authors: 
Gewurtz, R. E., Cott, C., Rush, B., & Kirsh, B.
Year Published: 
2000
Publication: 
Journal of Traumatic Stress
Volume: 
13
Number: 
2
Pages: 
333-347
Publisher: 
Wiley
Background: 

Post-traumatic stress disorder (PTSD) is quite common and often disabling. PTSD has serious long-term morbidity, and effective treatments are urgently needed.

Purpose: 

The purpose of this study was to assess the effectiveness of Brief Eclectic Psychotherapy (BEP) in a sample of police officers with PTSD.

Setting: 

The setting for the study was the Department of Psychiatry at the Academic Medical Center of the University of Amsterdam.

Sample: 

The study sample included 42 patients with PTSD. 22 were randomly assigned to the treatment group and 20 to the wait-list control group.

Data Collection: 

Psychometric assessments were conducted by trained research psychologists at four points in time: one week before the start of treatment, one month after the start, four months after the start and three months after termination.

Intervention: 

Individual psychotherapy, 60 minute sessions over 16 weeks. BEP course which included psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual.

Control: 

The control group was waitlisted and told they would receive treatment in 7 months. They were monitored by a non-assessor psychologist in the interim.

Findings: 

At post test and at follow-up BEP had produced significant improvement in PTSD, in work resumption and in comorbid other conditions.

Conclusions: 

Further research is needed to see if BEP will be effective for other traumatized populations and if the effects of treatment will be long term.

URL: 
http://link.springer.com/article/10.1023%2FA%3A1007793803627#page-1
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Reducing the need for personal supports among workers with autism using and iPod Touch as an assistive technology: Delayed randomized control trial

Authors: 
Gentry, T., Lau, S., Molinelli, A., Fallen, A., & Kriner, R.
Year Published: 
2014
Publication: 
Journal of Autism and Developmental Disorders
Volume: 
45
Number: 
3
Pages: 
668-684
Publisher: 
Springer Science+Business Media
Background: 

Adults with autism have typically not been considered suitable candidates for employment in the workforce. This is despite a multitude of information on employment of people with severe disabilities and published examples of how individuals with autism have successfully gained and maintained work in their communities using supported employment. People with autism remains underrepresented in supported employment programs. There is little research that focuses on analysis of differential efficacy between various employment modalities (ie. supported employment versus sheltered work).

Purpose: 

The purpose of the study was to determine if the use of an Apple iPod Touch, as trained by an occupational therapist, would significantly reduce the need for personal supports in performing job duties and building competence on the job. The examiners hypothesized that the group that received the device and training prior to employment would require fewer job coaching support hours than the other group who received it and training 12 weeks later.

Setting: 

The study took place in various types of work settings where each individual with ASD was employed.

Sample: 

The study sample included 50 individuals with ASD who were clients of the state's vocational rehabilitation program. Most were males (84%) and ranged in age from 18 to 60 years. Most lived at home (86%) and the majority or (68%) had conversant skills.
Half were assigned to the "now" group. These are the people who received the AT and training prior to going to work. The remainder were assigned to the "delayed" group and received the same 12 weeks after their job placement.

Data Collection: 

An initial assessment was conducted using a demographic survey and CHART (Craig Handicap Assessment and Rating Technique) review.
The job coach completed the Supports Intensity Scale Employment Subscale and the Employee Performance Evaluation Report (EPER) at pre-scheduled intervals. The EPER was used as a dependent measure of job performance. Data was collected on hours worked, job coach hours worked (only face to face or telephonic support), support needs and work performance across 24 weeks. The OT collected intervention data that included notes and hours. of AT training, follow along and more. Participants were also interviewed at the close of the study.

Intervention: 

The intervention included four components. A detailed workplace AT assessment by an OT along with the individual with ASD, job coach and employer; identification of an individualize suite of iPod Touch-based applications and strategies to support the participant at work; training the participant to use the AT and apps on the job and follow along and fading of supports as the worker learned to use the device at work.

Control: 

The control was business as usual. The delayed group received job coach services.

Findings: 

Training in the use of a PDA reduced job coaching among all participants. However, starting sooner was more effective. The reduction in the job coach hours was great enough to set off the cost of the AT intervention which means a potential cost saving for state vocational rehabilitation.

Conclusions: 

The study support previous research into the use of mobile devices as vocational support aides. The HAAT model appears to be a sound one to provide this type of intervention. More research is needed as this type of AT continues to evolves. This study show that a mobile device can offer cost effective support and may improve employment outcomes for individuals with ASD. Research should also explore how devices may impact career development too. Research is also needed to develop applications and support users with varied abilities.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/25212414
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment improves cognitive performance in adults with autism

Authors: 
García-Villamisar, D., Ross, D., & Wehman, P.
Year Published: 
2007
Publication: 
Journal of Intellectual Disability Research
Volume: 
51
Number: 
2
Pages: 
142-150
Publisher: 
Blackwell Publishing Ltd
Background: 

Over the years there has been an increased interest in the vocational rehabilitation of adults with autism. Traditionally, individuals with severe or profound autism attend prevocational centers, sheltered workshops, or day activity enters. Supported employment provides an alternative. In this approach individuals with the most severe disabilities are assisted with gaining and maintaining employment in their communities. Characteristics of supported employment are: paid employment, integrated work setting, and ongoing supports. Services are provided by a job coach and are highly individualized and adaptable to the needs of the person with the disability needs and the employer who hires him.

Purpose: 

The purpose of the study was to determine if supported employment could improve the cognitive performance of individuals with autism.
More specific, the researchers wanted to know what types of employment might have such benefits? Does supported employment also improve non-vocational outcomes?

Setting: 

Participants in the supported employment group worked in a variety of community workplaces. This included food services, retail, cattle raising, gardening, industrial laundry and more.

Sample: 

The sample included 44 adults with autism who were in an employment program in Spain. The mean educational attainment for the group was 5 years. The following selection criteria was used: participated in sheltered workshop, no prior supported work services, participation, no severe behavioural problems, acceptable professional and vocational abilities.

Data Collection: 

Participants memory and executive functions were evaluated at the beginning and at the end of the programme, using a series of neuropsychological tests from the Cambridge Neuropsychological Tests: Automated Battery (CANTAB). These tests were presented on a high-resolution touch-screen monitor under computer control. The battery included two control tasks: Big Circle/Little Circle (BLC), which assesses psychomotor speed, and Spatial Recognition Memory (SRM) and Span Tasks (SST). In addition, executive tasks were measured using: Intradimensional/Extradimensional (ID/ED) attentional set-shifting task; Spatial Working Memory Task; and Tower of
London Planning Task. Other tests included the Trail Making Test, Matching Familiar Figures Test and the Word Fluency Test.
Statistical analyses consisted of a t- test and a series of univariate analyses, comparing supported employment and non-supported employment groups on all demographic, clinical and neuropsychological measures. Between-group and intra-group differences on
neuropsychological variables were examined with repeated measures analysis of variance. All analyses were conducted using the SPSS statistical package 12.0.

Intervention: 

The intervention was supported employment. A vocational rehabilitation specialist, known as a job coach, was assigned to work with each participant. The supported employment program placed an emphasis on individual strengths and interests to identify possible jobs, once the person was hired structured teaching techniques were used on the job, and as long as the person remained employed long term support services were provided.

Control: 

The control group was individuals involved in employment or vocational activities in non-working settings.

Findings: 

The study found that adults with autism who work in competitive employment for an extended period of time show a greater rate of improvement in several cognitive variables. It also provided preliminary support for the view that competitive employment causes positive cognitive changes outside the work domain.

Conclusions: 

Supported employment(competitive work in the community)seems to have a positive impact on the cognitive performance of individuals with autism.

URL: 
http://sid.usal.es/idocs/f8/art9945/supported_employment_autism.pdf
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes