Predictors of employment for people with severe mental illness: Results of an international six-centre randomised controlled trial

Authors: 
Chan, F., Cheing, G., Chan, J.Y.C., Rosenthal, D.A., & Chronister, J.A.
Year Published: 
2008
Publication: 
The British Journal of Psychiatry
Volume: 
192
Number: 
1
Pages: 
224-231
Publisher: 
The Royal College of Psychiatry
Background: 

An international six-centre randomised controlled trial comparing Individual Placement and Support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.

Purpose: 

The purpose of the study was to determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes. Patient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS. Aim was to explore who among a group of patients with severe mental illness would do well in vocational services in terms of both obtaining and maintaining open, competitive employment, and which process and service factors would be associated with better outcomes. Therefore, study aimed to determine predictors of employment outcomes from among demographic and illness characteristics, early process factors and service features

Setting: 

A randomized controlled trial was conducted in six European centres , London, Ulmnzburg, Rimini, Zurich, Groningen and Sofia comparing IPS with usual high-quality vocational rehabilitation based on the train and place model.

Sample: 

Patients (n=312) were recruited if they had psychotic illness, were aged between 18 and the local retirement age, had been ill and had major role dysfunction for at least 2 years, were in the community, had not been in competitive employment in the preceding year and wanted to enter competitive employment. Randomisation was carried out centrally and stratified by centre, gender and work history (1 month or less of continuous open employment v. more than 1 month in the previous 5 years), replicating the original IPS study.

Data Collection: 

Three analyses were conducted. First, patient characteristics collected at baseline, including illness characteristics and the patient‚ reported relationship with their clinical key worker, were tested as potential predictors of the employment outcomes. Second, early process factors, collected at patient level at the first follow-up interview (T1), when the patient had been in the service for up to 6 months, were tested as potential predictors. Service allocation (IPS v. vocational service) was included as a possible explanatory variable in the early process models, despite the fact that the greater effectiveness of the IPS service had already been demonstrated.7 This was to ensure that it was not confounding any significant associations between other potential predictor variables and employment outcomes. It was not included in the patient characteristics models, as these variables were measured before randomisation. The impact of service as such is not the focus of the current paper. Finally, key characteristics of the services themselves were tested. As the latter were service-level factors, they were tested against the effectiveness of the IPS service at each international centre.

Intervention: 

The IPS service in each center was implemented in accordance with the IPS place and train supported employment model, which has 6 key features: its goal is competitive employment in work settings integrated into a community‚ economy; clients are expected to obtain jobs directly, rather than following lengthy pre-employment training (rapid job search); rehabilitation is treated as an integral component of mental health treatment rather than a separate service; services are based on clients preferences and choices; assessment is continuous and based on real work experiences; and follow-on support is continued indefinitely.

Control: 

The vocational service (control service) at each center was the best alternative vocational rehabilitation service available locally, with a structured program conducted mostly in day facilities (although mostly residential in Ulm). Each was based on the more traditional principles of train and place providing vocational training and job preparation before the client proceeded to seek competitive employment. Each vocational service had to guarantee taking patients into the service within 2 months of randomization.

Findings: 

Patients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.

Conclusions: 

The IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

URL: 
http://www.rug.nl/research/portal/files/6715928/Catty_2008_Br_J_Psychiatry.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Working it out: Development and testing of a multimedia, vocational education program

Authors: 
Campbell, K., Bond, G., & Drake, R.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2525-2558
Publisher: 
Marcel Dekker Inc.
Background: 

Employment is a ongoing problem for individuals with substance dependency. Their vocational needs are unmet. Earlier studies have shown a positive correlation between employment and retention in treatment. Despite evidence about the value of addressing employment issues in treatment, the service delivery system does not address these needs. Welfare reform has increased expectations for substance abuse beneficiaries to gain employment. Due to shorter stays and funding cuts more programs primarily focus on substance use. Employment and work problems are not given priority. A multimedia interactive computer program may offer a cost effective way to address employment problems.

Purpose: 

The study hypothesis was that an interactive and tailored multimedia presentation of vocational rehabilitation information would be more effective than a general printed package of information and work book in reducing the severity of employment problems.

Setting: 

The study took place in residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico.

Sample: 

One-hundred and ninety-four (194) individuals who received residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico participated in the study. The average age of participants was 37 years and the majority or 64% were men. About 43% were from a minority group.

Data Collection: 

The measures included the Addiction severity index-multimedia version (ASI-MV), Social adjustment scale-self report (SAS-SR), Employment questionnaire, Treatment services review and Satisfaction questionnaire. Around 75% of the sample completed 3 or more CD-ROM sessions. These participants completed a satisfaction questionnaire after each session and at the end entire course. Follow up assessment was scheduled 6 month from baseline. Subjects completed SAS-SR and Employment Questionnaire. They were also contacted by telephone to complete a follow up to the ASI.

Intervention: 

The intervention included: Working It Out CD-ROM, a multi-session, computer based, self-administered, vocational education and intervention program for clients in substance dependency treatment programs.

Control: 

There was a comparison between the group that received the intervention and the control group members. The control group members used the Looking for Work Printed Package booklet along with a workbook with information on: facing fears, why work?, coping with job-related stress, job-finding skills (writing a resume, networking, interviewing, etc.), caring for oneself and the job, and what to say about ones recovery.

Findings: 

The study demonstrated that a multimedia vocational rehabilitation program that is self-administered, interactive, and tailored to clients employment status and motivation can be used in a substance dependency treatment program. The study did not find significant differences over the use of printed versus multimedia material. However, clients reported enjoying using the computer program and found the experience more relevant to their particular concerns.

Conclusions: 

The multimedia Working It Out program can be effectively used by clients who are in substance dependency treatment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603013
NIDILRR Funded: 
Peer Reviewed: 
Yes

The impact of supported employment and working on clinical and social functioning: Results of an international study of individual placement and support

Authors: 
Butler, S., F.,Chiauzzi, E., & Thum, C. C.
Year Published: 
2009
Publication: 
Schizophrenia Bulletin
Volume: 
35
Number: 
5
Pages: 
949-958
Publisher: 
Schizophrenia Bulletin
Background: 

Concerns are frequently expressed that working might worsen the mental health of people with severe mental illness(SMI). Several studies of Individual Placement and Support (IPS), however, have found associations between working and better nonvocational outcomes. IPS has been found to double the return to work of people with SMI in 6 European countries.

Purpose: 

To explore separately associations between IPS, returning to work, and clinical and social outcomes. The study tested 4 specific questions. (1) Are there any differences in clinical and social functioning outcomes at 18-month follow-up between the IPS and control service groups? (2) Is there any association between (a) having worked, (b) total duration of work, and (c) job tenure and clinical and social functioning outcomes at 18-month follow-up? (3) Is being in work at any given time point associated with (a) particular concurrent clinical and social functioning variables or (b) change in clinical and social functioning over the subsequent 6 months?

Setting: 

A randomized controlled trial comparing IPS to usual high-quality vocational rehabilitation was conducted in 6 European centers.

Sample: 

Patients (n=312)in a randomized controlled trial of IPS in 6 European centers were followed up for 18 months. Patients were recruited if they had a psychotic illness, were aged 18 to local retirement age, had been ill and had major role dysfunction for at least 2 years, were living in the community, had not been in competitive employment in the preceding year and wanted to enter competitive employment.

Data Collection: 

To determine whether there were any differences between the IPS and vocational service patient groups, a between-group analysis was conducted to compare the 2 on each clinical and social functioning variable at T3, along with whether they had been hospitalized during or were in remission for the last 6 months of the study. Analysis of covariance was used to compare the 2 groups in terms of the clinical and social functioning variables at T3 while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively. These analyses were then repeated for those patients who had worked only. To determine the impact of having worked at any point during the 18-month follow-up period, patients who worked for at least one day (the study‚ primary outcome) were compared with those who did not in terms of each clinical and social functioning variable, along with whether they had been hospitalized during the final 6 months of the study and were in remission for the final 6 months. Analysis of covariance was used to compare the 2 groups (worked/not worked) in terms of the clinical and social functioning variables at T3, while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively.

Intervention: 

The IPS service in each center was implemented in accordance with the IPS place and train or supported employment‚ model, which has 6 key features: its goal is competitive employment in work settings integrated into a community economy; clients are expected to obtain jobs directly, rather than following lengthy pre-employment training (rapid job search); rehabilitation is treated as an integral component of mental health treatment rather than a separate service; services are based on clients preferences and choices; assessment is continuous and based on real work experiences; and follow-on support is continued indefinitely.

Control: 

The vocational service (control service) at each center was the best alternative vocational rehabilitation service available locally, with a structured program conducted mostly in day facilities (although mostly residential in Ulm). Each was based on the more traditional principles of train and place providing vocational training and job preparation before the client proceeded to seek competitive employment. Each vocational service had to guarantee taking patients into the service within 2 months of randomization.

Findings: 

There were no differences in clinical and social functioning between IPS and control patients at 18 months. Those who worked had better global functioning, fewer symptoms, and less social disability at final follow-up; greater job tenure was associated with better functioning. Working was associated with concurrently better clinical and social functioning, but this contrast was stronger in the control up, suggesting that IPS was better than the control service at helping more unwell patients into work. Working was associated with having been in remission and out of hospital for the previous 6 months. It was also associated with a slight decrease in depression and with being in remission over the subsequent 6 months.

Conclusions: 

Concerns among clinicians about possible detrimental effects of working and supported employment have been misplaced. Although some of the associations found may have been selection effects, there is sufficient evidence of work having beneficial effects on clinical and social functioning to merit further exploration.

URL: 
http://www.medicine.gu.se/digitalAssets/1453/1453428_burns.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment outcomes for transition age youth and young adults

Authors: 
Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D., & Lauber, C.
Year Published: 
2012
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
35
Number: 
3
Pages: 
171-179
Publisher: 
PubMed
Background: 

Over the last few decades, major developments have occurred in evidenced based practice supported employment (SE) services for people living with diagnoses of severe mental illness. However, the differential effectiveness of SE for different age groups of people in recovery is not well-studied. A group with particular need for employment services are youth age 18-24 and young adults ages 25-30 living with mental illness.

Purpose: 

The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes.

Setting: 

Data are from the Employment Intervention Demonstration Program (EIDP), a multisite randomized controlled trial of SE among 1,272 individuals with psychiatric disabilities in 7 states. The study uses 24 months of data from EIDP participants in seven states (AZ, CT, ME, SC, MA, TX, and MD)

Sample: 

EIDP participants were recruited from existing clinical populations via case manager referral, self referral, word of mouth, and at one site, newspaper advertisements. Participants were as those meeting the following inclusions criteria: being 18 years or older at time of study enrollment, being willing and able to provide informed consent, having an Axis I DSM-IV diagnosis of mental illness, and being unemployed at time of entry into the study.

Data Collection: 

Literature search included a combination of strategies, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.

Intervention: 

At each site, the experimental condition was a form of enhanced best-practice supported employment compared to either services as usual or an unenhanced version of the experimental model. For example, The Maryland, Connecticut, and South Carolina sites tested the individual placement and support model in which multidisciplinary provider teams engage in minimal pre-vocational assessment, rapid job search, and placement into competitive jobs, with the provision of training and ongoing follow-along support for as long as the patient requests it.

Control: 

As with many multisite studies, the nature of the comparison conditions varied. Arizona, Connecticut, Maryland, and South Carolina used a services-as-usual comparison condition in which the subjects received whatever services were available in the local community. Massachusetts used the Clubhouse model, in which facility-based services were provided according to a work-ordered day, with patients and staff working together on jobs within the program as well as at job placements in the community. Both Texas and Maine used an "unenhanced" version of their experimental condition (i.e., no social network services in Texas and no employer consortium in Maine).

Findings: 

Among all study participants, youth and young adults had significantly better outcomes in terms of any employment and competitive employment than older (>30 years) adults. However, in multivariable models of participants randomly assigned to SE, young adults had significantly better outcomes than youth or older adults. Other significant predictors of employment and competitive employment were future work expectations, not receiving Supplemental Security Income, and receipt of more hours of SE services. Characteristics of youth, young adults and SE programs that enhance employment are discussed in terms of policy and practice.

Conclusions: 

The finding that younger people had better employment outcomes in SE relative to older people provides empirical support for policies that encourage the provision of SE services to youth and young adults. However, it does not obscure the fact that work and return to work are ongoing challenges in the lives and people in recovery.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22246115
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effectiveness of an intervention to reduce sickness absence in patients with emotional distress or minor mental disorders: a randomized controlled effectiveness trial

Authors: 
Brown, L., Shiraga, B., & Kessler, K.
Year Published: 
2006
Publication: 
General Hospital Psychiatry
Volume: 
28
Number: 
3
Pages: 
223-229
Publisher: 
Elsevier
Background: 

Mental health problems have an impact on well-being and quality of life and often affect functioning to such an extent that they are associated with absenteeism. In the Netherlands, about one third of the people receiving disability benefits do so because of mental health problems, the majority of which are minor mental health problems including emotional distress.

Purpose: 

The purpose of this study was to evaluate the effectiveness of an activating intervention designed to reduce sick leave duration in patients with emotional distress or minor mental disorders.

Setting: 

The settings were various places where participants worked.

Sample: 

The sample included 194 patients with minor mental disorders.

Data Collection: 

Outcome measures were sick leave duration, mental health and physical health (questionnaires included the Hospital Anxiety and Depression Scale, the Four-Dimensional Symptom Questionnaire and SF-36), all measured at baseline at and 3, 6 and 18 months later. Multilevel analyses were used to evaluate differences between groups.

Intervention: 

Participants received either an experimental intervention by social workers or general practitioners' usual care. The intervention focused on understanding causes, developing and implementing problem-solving strategies and promoting early work resumption.

Control: 

The control condition was the general practitioner's usual care.

Findings: 

The groups did not differ significantly on any of the outcome measures, except that the experimental group reported higher satisfaction with treatment.

Conclusions: 

Although the intervention has benefits, it was not successful at its primary goal (i.e., to reduce sick leave duration in patients with emotional distress or minor mental disorders). Programs aimed at the reduction of sick leave duration may yield better results if targeted at patients with more severe emotional problems than at those with exclusively emotional distress or minor mental disorders, or if delivered by caregivers who are closer to the work environment than are social workers, such as occupational physicians.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16675365
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US

Authors: 
Bond, G. R., Drake, R.E., & Becker, D. R.
Year Published: 
2012
Publication: 
World Psychiatry
Volume: 
11
Number: 
1
Pages: 
32-39
Publisher: 
World Psychiatric Association
Background: 

While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ability to generalize to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies.

Purpose: 

The current review has two goals. First, given the growing international attention to IPS, it examines the effectiveness of IPS in studies conducted outside the US compared to US studies. Second, it expands the scope of prior IPS reviews by adding recent randomized controlled trials (RCTs) and enlarging the range of outcome measures in order to examine the hypothesis that IPS yields better competitive employment outcomes across a range of measures than alternative vocational programs.

Setting: 

In most studies, participants were recruited from clients receiving services from community mental health centers. Altogether, the 15 studies analyzed Control enrolled 1063 IPS participants (mean = 70.9 per study) and 1117 control participants (mean = 74.5 per study).

Sample: 

The study identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. It examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered non-competitive employment, program retention, and nonvocational outcomes.

Data Collection: 

Data were recorded directly from published reports or calculated from information presented in the published studies. For the measure of job duration, the study converted total weeks worked to an annualized rate, reporting the findings for both the full intent-to-treat sample and the worker subsample (those who obtained at least one competitive job during follow-up).

Intervention: 

The intervention was the Individual Placement and Support (IPS) model which 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: 

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings: 

Rigorous evaluations of IPS suggest that 60% or more of IPS clients obtain competitive jobs, compared to about 25% of those who receive other types of vocational assistance. One way of interpreting this finding is that approximately 25% of clients who express an interest in competitive employment will succeed in obtaining a job in diverse and ineffective vocational programs or even without any vocational services, but IPS helps an additional 35% of the target group who otherwise would remain unemployed. The finding of a large and statistically significant beneficial impact of IPS is robust, upheld in all 15 studies. The effectiveness of IPS is also suggested by other measures of competitive employment outcome, including time to first job, job duration and total hours employed during the follow-up period. Most IPS clients work part-time, typically half-time; about two-thirds of those who obtain competitive employment work 20 hours or more per week. Few IPS clients work full-time, likely due to preferences, limited stamina, and/or fear of losing health insurance or other benefits. Consistent with the principle of rapid job search, the time to first competitive job for IPS participants is nearly 10 weeks sooner than for controls. The mean length of time to first job for IPS participants (19 weeks) is, however, still lengthy for a model that prescribes rapid job search.

Conclusions: 

To summarize, the question of IPS transportability outside the US remains unanswered. While the published studies suggest that the labor and disability laws in some European countries may make a direct replication of IPS difficult, there are also indications that IPS transports well to other countries, such as Australia and the Hong Kong region of China. Finally, before concluding that the IPS must undergo radical adaptations in another nation, IPS programs should receive sufficient training and guidance to implement the model with high fidelity.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22295007
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong

Authors: 
Wong, K. K., Chiu, S. N., Chiu, L. P., & Tang, S. W.
Year Published: 
2008
Publication: 
Psychiatric Services
Volume: 
59
Number: 
1
Pages: 
84-90
Publisher: 
American Psychiatric Association
Background: 

Supported employment is an evidence-based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment. Most research on the effectiveness of supported employment comes from the United States.

Purpose: 

This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting.

Setting: 

The setting was community rehabilitation programs in Hong Kong.

Sample: 

Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were randomly assigned to either a supported employment program or a conventional vocational rehabilitation program.

Data Collection: 

Both vocational and non-vocational outcomes were measured in this study. Vocational outcomes include competitive employment rates, time to first job, total days employed, and total earnings. Non-vocational outcomes include self-perceived quality of life. Major assessments were conducted at baseline and at six and 18 month follow up points by the employment specialist.

Intervention: 

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

Control: 

Traditional Vocational Rehabilitation Services

Findings: 

Over an 18 month study period, compared with participants in the conventional vocational rehabilitation program, those in the supported employment group were more likely to work competitively, held a greater number of competitive jobs, earned more income, worked more days and sustained longer job tenures.

Conclusions: 

Consistent with previous research findings, the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting.

URL: 
http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2008.59.1.84
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A community-based trial of vocational problem-solving to increase employment among methadone patients.

Authors: 
Zanis D, Coviello D, Alterman A. Appling S
Year Published: 
2001
Publication: 
Journal of Substance Abuse Treatment
Volume: 
21
Number: 
1
Pages: 
19-26
Publisher: 
Elsevier
Background: 

Following drug use stabilization, employment has long been considered an important secondary goal for patients enrolled in methadone maintenance treatment programs. Several studies have found moderate positive correlations between increased employment, decreased substance use, and positive social functioning. Given the low rates of employment, patients desire for
employment services, and the association of employment with improved outcomes, employment interventions appear to be important to explore.

Purpose: 

The main purposes of the study were to (a) train methadone counselors to deliver the Vocational Problem-Solving Skills (VPSS) intervention and (2) evaluate whether unemployed patients randomized to VPSS counseling would improve their employment functioning compared to patients randomized to an alternate activity.

Setting: 

The study was conducted at two comparable methadone treatment centers, each of which had both employed and unemployed clients.

Sample: 

The study sample consisted of 109 individuals receiving methadone treatment. Entrance criteria included the following: (1) Unemployed or underemployed, as working ‚under the table‚ less than 10 hours per week; (2) stabilized on methadone and enrolled in the treatment program for a minimum of 3 months; (3) expressed interest and capacity to work at least 20 hours per week; and (4) actively seeking employment as by the Bureau of Labor Statistics. Males constituted 61% of the sample, and African-Americans 61%

Data Collection: 

Participants were assessed by interviews at baseline, biweekly for 12 weeks, and at 6 months post-baseline. Measures included standardized measures of addiction and independent urine sampling, a vocational assessment, a treatment service review, chart review, and independent employment verification. Data analysis included descriptive statistics, a series of bivariate analyses to examine the correlation between potential predictor variables and the criterion variable (employed/not employed at least one day in the past 30 days at the 6-month follow-up point), and multinomial regression analysis.

Intervention: 

Vocational Problem-Solving Skills (VPSS) is a cognitive-based intervention designed to assist chronically unemployed individuals transition to work. The five objectives of the VPSS intervention are to help participants (1) understand why they want to work; (2) understand how to overcome barriers to work; (3) set realistic vocational goals; (4) identify realistic resources to help locate job opportunities; and (5) take appropriate actions to obtain work. All VPSS sessions were designed to be approximately 30 to 60 minutes in length and delivered within a maximum of a 12-week period. Both patients and counselors were provided with a manual and workbook, outlining each of the sessions.

Control: 

The comparison group participated in an Interpersonal Problem Solving (IPS) intervention of similar duration and intensity as the VPSS. The goal of IPS counseling was to help patients develop improved problem-solving skills to either reduce drug use or continue abstinence from drug use. The five objectives of the IPS counseling were to: (1) reduce/eliminate illicit drug
use or maintain an abstinence plan; (2) understand the utility of social supports in recovery; (3) examine successful and unsuccessful efforts at recovery; (4) formulate realistic recovery plans; and (5) engage in planned activities.

Findings: 

Of the 109 participants, 101 could be located for six-month follow-up. At the point, 53 (54.6%) were considered, 19 (19.6%) were termed part-time employees (paid for working between 1 and 14 days), and 25 (25.8%) were considered full-time employees (paid for working 15 or more days in the past 30). VPSS participants were significantly more likely to be employed than the comparison group. However, enrollment in the VPSS condition did not predict employment when entered into the regression analysis with the other variables.

Conclusions: 

Although a greater percentage of patients who received the VPSS counseling program actually worked, VPSS was not predictive of employment after controlling for other factors, such as work history and motivation. Structured employment interventions may assist unemployed methadone patients in obtaining employment; however, the type of employment services provided must reflect a variety of employment needs.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/11516923
NIDILRR Funded: 
Peer Reviewed: 
Yes

Standardizing measures in four domains of employment outcomes for individual placement and support

Authors: 
Bond, G. R., Drake, R., & Becker, D.
Year Published: 
2012
Publication: 
Psychiatric Services
Volume: 
63
Number: 
8
Pages: 
751-757
Publisher: 
American Psychiatric Association
Background: 

Virtually all studies of the individual placement and support (IPS) model of supported employment measure outcomes for job acquisition, but studies are less consistent in measuring job tenure, hours worked, and employment earnings. Lack of a common set of employment measures limits comparisons across studies and cumulative knowledge about IPS.

Purpose: 

This study examined measures in four employment domains and their interrelationships. It examined two hypotheses. First, IPS improves both the rate of obtaining employment (job acquisition) and the amount of work (job duration, hours worked per week, and total hours and wages). Second, employment outcomes within domains are strongly correlated, whereas outcomes across domains are relatively weakly related.

Setting: 

All study participants were clients enrolled in public mental health programs. The four study groups were located in Manchester and Concord NH; Washington DC; Hartford CT, and Chicago

Sample: 

All study participants were clients enrolled in public mental health programs. They were unemployed adults who met each state's criteria for severe mental illness. Other common eligibility criteria included desire for competitive work, ability and willingness to give informed consent, and absence of significant general medical conditions precluding employment. The studies used similar protocols to track employment outcomes. Despite similar research methods, the four studies differed in geographic location and control group interventions.

Data Collection: 

Using a combined data set from four randomized controlled trials of IPS, this study examined mean differences between IPS participants (N=307) and participants in other vocational services (control sample) (N=374) in four domains (job acquisition, job duration, hours worked per week, and total hours and wages). Eight competitive employment measures were examined (employed at any time, total weeks worked, tenure in the longest-held job, total hours worked, average hours per week worked, total wages, days to first job, and working =20 hours per week during follow-up). Correlations between measures within both the IPS and control samples were determined.

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 conditions include: 1) group skills training; initial training in choosing, getting, keeping a job; followed by job placement services from a stand alone rehabilitation program (2) enhanced rehabilitation services provided by a vocational rehabilitation counselor assigned to the project: club house and brokered supported employment (4) diversified placement services.

Findings: 

IPS participants had significantly better outcomes across all employment measures and domains. Correlations between measures were strong within each domain, but they were variable between domains

Conclusions: 

In addition to improving job acquisition, IPS improved job duration, hours worked per week, and total hours and wages. The correlational findings suggest proxy measures to assist meta-analysts in the synthesis of studies for which direct measures are unavailable. Initial steps toward a cross-disciplinary theoretical framework for employment outcomes are described.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22660524
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A randomized controlled trial comparing two vocational models for persons with severe mental illness

Authors: 
Bootes, K. & Chapparo, C.
Year Published: 
2007
Publication: 
Journal of Consulting and Clinical Psychology
Volume: 
75
Number: 
6
Pages: 
968-982
Publisher: 
The American Psychological Association
Background: 

Most individuals with severe mental illness (SMI) express a desire to work in competitive jobs, defined as regular community jobs, with nondisabled coworkers, paying minimum wage or higher (McQuilken et al., 2003). Yet surveys typically have found competitive employment rates of 15% or less in this population (Rosenheck et al., 2006; Salkever et al., 2007) pg. 968

Purpose: 

The purpose of this study was to compare two vocational rehabilitation models for individuals with severe mental illness. The Individual Placement and Support (IPS)model of supported employment and the Diversified Placement Approach (DPA)were reviewed and compared.

Setting: 

This report examined vocational outcomes for clients enrolled in Thresholds, a large psychiatric rehabilitation agency in Chicago, IL.

Sample: 

The sample was 187 clients with severe mental illness.

Data Collection: 

Data were obtained through participant interviews, chart review, information from staff and agency records, direct queries to Thresholds staff (to corroborate other data sources), Medicaid claims, and hospital discharge forms.

Intervention: 

Employment services were provided. Clients were assigned to either the IPS or DPA group.

Control: 

Clients were assigned to one of two groups (IPS or DPA) for employment services.

Findings: 

IPS had significantly better competitive employment outcomes than DPA. Competitive employment rates over the 2-year follow up were 75.0% for IPS and 33.7% for DPA. However, IPS and DPA did not differ on paid employment outcomes.

Conclusions: 

The authors conclude that IPS is more effective than DPA in achieving competitive employment, but not paid employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18085913
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes