Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness
|Authors:||Cook, J. A., Lehman, A. F., Drake, R., McFarlane, W. R., Gold, P. B., Leff, H. S., ... & Grey, D. D.|
|Publication||Archives of General Psychiatry|
|Publisher||American Medical Association|
The majority of people with chronic mental illness are unemployed. Research shows that a supported employment (SE) model approach to vocational rehabilitation for people with chronic mental illness establishes SE as an evidence-based practice and more effective than "services as usual or unenhanced services" (p. 505).
This study tested three hypotheses:
Eight study sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.
People "with severe and persistent mental illness receiving outpatient psychiatric services" (p. 506). Additional requirements included:
The criteria for "severe and persistent mental illness based on diagnosis, duration, and level of disability as established by the federal Center for Mental Health Services" were met (p. 506). The total number of participants was 1648, and 1273 were included in the study analysis.
Data were collected at intake and every 6 months for the entire 24-month period using the Positive and Negative Syndrome Scale. In addition, two sites used the DSM-IV at study enrollment, while other sites extracted information from clinical records.
Public disability income beneficiary status was monitored bi-annually, as well as "self-rated level of functioning, marital status, and educational attainment" (p. 507). Sites also collected labor force data, such as weekly earnings and hours worked, job duties, eligibility for health and sick leave benefits, and level of integration in the workplace. Sites reported on amount of vocational and psychiatric services received each month.
Four sites maintained services as usual; 2 sites used a "weaker version" of the experimental condition; and one site compared two pre-existing vocational models.
The experimental groups achieved competitive employment (55%), worked 40 hours or more per month (51%), and had significantly higher earnings ($122/month) than the control groups (34%, 39%, and $99/month, respectively). These outcomes increased significantly over time.
The experimental programs yielded higher and more positive effects than "services as usual" (p. 510). This advantage increased over time.
|Populations||Hispanic or Latino | Black / African American | White / Caucasian | Male & Female|
|Research Design||Randomized Controlled Trials (RCTs)|