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

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.


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.


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%)


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?


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.


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.


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 Emotional disturbance
Populations Hispanic or Latino | Black / African American | White / Caucasian | Male & Female | Rural
Outcomes Employment acquisition | Increase in hours worked | Part-time employment
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes