The shift to rapid job placement for people living with mental illness: An analysis of consequences | Knowledge Translation for Employment Research Center

Authors:	Gignac, M. A. M., Jetha, A., Bowring, J., Beaton, D., & Badley, E.
Year Published	2012
Publication	Psychiatric Rehabilitation Journal
Volume	35
Number	6
Pages	428-434
Publisher	Psychiatric Rehabilitation Administration
Background	The Individual Placement and Support (IPS) model, a standardized and evidence-based approach to supported employment (SE) for individuals living with mental illness, focuses on minimizing pre-employment training and supporting individuals to enter integrated competitive work settings. In an effort to address poor employment outcomes associated with many traditional approaches to vocational rehabilitation, policy structures and funding mechanisms have been developed that link pay incentives directly to job placement and maintenance rates. . The question of whether policy revisions encourage fidelity to models of best practice is a salient one in light of this observation. Indeed, heterogeneity within the IPS model persists despite the association between fidelity to the model and positive employment outcomes.
Purpose	This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from pre-employment to job placement services, with a particular focus on rapid placement into available jobs. This article reports on the findings from a case study of policy revision affecting employment supports for individuals living with mental illness in Ontario, Canada. The purpose is to examine the impact of this policy change, comprised largely of a new outcome-based funding model, with an eye to the principle and practice of rapid job placement.
Setting	Recruitment focused on three main stakeholder groups: (1) program informants who were involved in developing and/or delivering employment services for people living with mental illness under the policy; (2) policy informants who were involved in constructing and/or implementing the policy; and (3) consumer informants who self-identified as a person living with a mental illness and were involved in informing the policy, planning services under the policy, or advocacy/activism related to the policy.
Sample	Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness.
Data Collection	Interviews were audio-recorded and transcribed verbatim. The computer software program NVivo was used to organize the data for efficient analysis. Data from the key informant interviews and the documents were analyzed simultaneously. Emerging ideas were used to direct and focus later data collection and analysis according to the constant comparative approach. Guided by the principles of constructivist grounded theory, during initial coding we explored the data and considered different possible theoretical and analytical permutations. Later, coding became more focused and selective as we categorized data by grouping codes together and prioritizing some codes over others.
Control	There was no control or comparison condition.
Findings	The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than pre-employment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits.
Conclusions	These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.
URL	http://www.ncbi.nlm.nih.gov/pubmed/23276235
Disabilities	Emotional disturbance
Populations	Male & Female
Outcomes	Employment acquisition \| Full-time employment \| Part-time employment \| Wages
NIDILRR Funded	No
Research Design	Qualitative
Peer Reviewed	Yes

Year Published

2012

Publication

Psychiatric Rehabilitation Journal

Volume

35

Number

6

Pages

428-434

Publisher

Psychiatric Rehabilitation Administration

Background

The Individual Placement and Support (IPS) model, a standardized and evidence-based approach to supported employment (SE) for individuals living with mental illness, focuses on minimizing pre-employment training and supporting individuals to enter integrated competitive work settings. In an effort to address poor employment outcomes associated with many traditional approaches to vocational rehabilitation, policy structures and funding mechanisms have been developed that link pay incentives directly to job placement and maintenance rates. . The question of whether policy revisions encourage fidelity to models of best practice is a salient one in light of this observation. Indeed, heterogeneity within the IPS model persists despite the association between fidelity to the model and positive employment outcomes.

Purpose

This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from pre-employment to job placement services, with a particular focus on rapid placement into available jobs. This article reports on the findings from a case study of policy revision affecting employment supports for individuals living with mental illness in Ontario, Canada. The purpose is to examine the impact of this policy change, comprised largely of a new outcome-based funding model, with an eye to the principle and practice of rapid job placement.

Setting

Recruitment focused on three main stakeholder groups: (1) program informants who were involved in developing and/or delivering employment services for people living with mental illness under the policy; (2) policy informants who were involved in constructing and/or implementing the policy; and (3) consumer informants who self-identified as a person living with a mental illness and were involved in informing the policy, planning services under the policy, or advocacy/activism related to the policy.

Sample

Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness.

Data Collection

Interviews were audio-recorded and transcribed verbatim.
The computer software program NVivo was used to organize the data for efficient analysis. Data from the key informant interviews and the documents were analyzed simultaneously. Emerging ideas were used to direct and focus later data collection and analysis according to the constant comparative approach. Guided by the principles of constructivist grounded theory, during initial coding we explored the data and considered different possible theoretical and analytical permutations. Later, coding became more focused and selective as we categorized data by grouping codes together and prioritizing some codes over others.

Control

There was no control or comparison condition.

Findings

The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than pre-employment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits.

Conclusions

These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.

URL

http://www.ncbi.nlm.nih.gov/pubmed/23276235

Disabilities

Emotional disturbance

Populations

Male & Female

Outcomes

Employment acquisition | Full-time employment | Part-time employment | Wages

NIDILRR Funded

No

Research Design

Qualitative

Peer Reviewed

Yes