One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare

Authors: 
Michalak, E., Yatham, L., Maxwell, V., Hale, S., & Lam, R.
Year Published: 
2003
Publication: 
Evaluation Review
Volume: 
27
Number: 
6
Pages: 
656-680
Publisher: 
Sage
Background: 

Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.

Purpose: 

The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.

Setting: 

Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.

Sample: 

The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.

Data Collection: 

Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.

Intervention: 

The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.

Control: 

There was no control or comparison condition. The study used a pre/during/post intervention design.

Findings: 

Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.

Conclusions: 

Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.

URL: 
http://erx.sagepub.com/content/27/6/656.full.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Work, rehabilitation and mental health

Authors: 
McGuire, A. B., Bond, G. R., Clendenning, D. R., & Kukla, M.
Year Published: 
2000
Publication: 
Journal of Mental Health
Volume: 
9
Number: 
2
Pages: 
199-210
Background: 

Unemployment rates are high for individuals with psychiatric problems. Not working also has a negative impact on mental health. New services have evolved to assist people with mental health problems with employment particularly in the United States. The United Kingdom is moving in this direction. A key player is Northern Ireland which provides Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services for people with mental health issues.

Purpose: 

This study evaluated the ACCEPT services for individuals with mental health problems during their first 12 to 18 months of operation.

Setting: 

The setting included four ACCEPT centers.

Sample: 

Sixty three people participated in the study. Demographic data was presented on 74 who started the study but later 11 dropped out. Those data indicate about half or 53% were female. Mean age for men was 38 and women 36 years. Forty three percent of the men were single, and 41% of the women. A little over half of the men or 51% had a primary diagnosis of neurotic depression. The majority or 44% of the women had the same diagnosis.

Data Collection: 

An ACCEPT intake form provided a profile of the trainees. The Lancashire Quality of Life Profile was used to obtain information on perceived quality of life. A Goal Attainment Form documented the trainees top five goals or objectives. Participant views about ACCEPT quality of services was gained using an Client Evaluation Form. A Stakeholder Questionnaire was also used. T-Tests were used to examine pre and post training differences in the mean LSS scores.

Intervention: 

The intervention was Assessment, Counseling and Coaching in Employment Placement and Training (ACCEPT) services. It includes a combination of psychosocial rehabilitation and job training.

Control: 

There was no control or comparison conditions. The study used a pretest/posttest design.

Findings: 

Pre and post training assessment revealed improvements in the participants satisfaction with employment status, religion and purpose of life, social relationships and overall well being. Minor psychiatric problems also decreased after training. Participants reported positive views about ACCEPT services. At the close of the study around 50% of the participants were employed or either engaged in volunteer work or a work experience.

Conclusions: 

Mental health professionals play and important role in work oriented programs. Interagency collaboration is critical. These types of programs can contribute to therapeutic outcomes for individuals with mental health problems.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/09638230050009195
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work

Authors: 
Siporin, S. and Lysack, C.
Year Published: 
2003
Publication: 
Health Education Research
Volume: 
18
Number: 
2
Pages: 
207-215
Publisher: 
Oxford University Press
Background: 

In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work.

Purpose: 

This study draws on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific objectives were:
(1) To identify a sample of employment support service users who had retained open, competitive employment for 12 months or longer.
(2) To identify a sample where employment had broken down after a period of less than 12 months employment.
(3) To explore the experiences of both groups from their own perspective.
(4) To explore the perspectives of the other key individuals involved, including employment project workers and workplace managers.
(5) To identify factors associated with the success or breakdown of supported employment on the basis of the accounts obtained.

Setting: 

The study was conducted at five project sites in England. Of the five projects, two were based in geographically and demographically diverse areas of outer London (Projects A and B), one operated in a semi-rural area of southeast England (Project C), and one in an urban area of the southeast (Project D). The fifth project (Project E) was based in a Midlands city.

Sample: 

Clients of the five projects who had current or recent experience of open employment were invited to a meeting at their project where the research and what would be involved was explained. As a result of the meetings some clients decided not to take part because they had not disclosed their mental health problems at work, while others who were currently employed had not yet been in their job for a year. These clients therefore withdrew from the study. In total, 10 male clients and seven female clients did take part. Eleven clients had been able to retain open employment for 12 months or longer, while the other six clients jobs had ended within 12 months for reasons they themselves saw as problematic.

Data Collection: 

With participants permission, the interviews were tape recorded and transcribed verbatim. A staged analysis was then carried out. Initially, each job was treated as a case and the 17 cases were divided into jobs that had been retained and jobs that had broken down. Data relating to each case (i.e. the client‚, project worker‚ and manager‚ accounts of a job) were then grouped under broad categories according to whether they related to employment support, workplaces or service users personal circumstances. Data within each category were analysed to generate subcategories within each main category, e.g. workplace factors relating to managers, colleagues and conditions of employment. These were then compared across cases in order to identify those factors that were associated with job retention and job breakdown. As noted earlier, in this article we focus on clients accounts of those factors relating to the workplace.

Intervention: 

Since the aim was to explore clients perceptions of their employment experiences, a semi-structured interview schedule was developed to enable each participant to tell the story of the job concerned from its beginning in the assessment and preparation stage leading up to the job, through its development to its end or to the present time in the case of ongoing jobs. The schedule explored key events during each stage of the job, including client first meetings with their manager and colleagues, their induction, and subsequent significant developments identified by participants themselves. Throughout the interview, participants feelings and attitudes, their accounts of factors which had either positive or negative effects, and their views about what else might have been helpful were explored. Questions were also included to obtain background data, including clients employment and mental health history. The interviews varied in length from 40 min to just over 3 hour.

Control: 

There was no control or comparison condition.

Findings: 

Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however natural supports of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. Themes from the findings might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.

Conclusions: 

On the basis of this study, four organizational initiatives in particular might help to ensure that workplaces are mentally healthy, both for mental health service users starting or returning to work, and for other employees:
Ensuring that a formal period of induction, of sufficient length, is routine practice for all new employees. For many jobs, induction will need to include formal training geared to the employee‚ pace of learning, opportunities to observe colleagues work and the explicit identification of sources of support for tackling problems that arise.
Embedding attention to employees ongoing development in routine workplace practice through formal supervision and appraisal procedures.
Team building aimed at creating a welcoming workplace where difference is accepted and employees strengths are valued.
Training and other learning opportunities, e.g. action learning sets, for managers, covering mental health and safety at work, team building, and individual staff management. Opportunities to explore the boundaries between a friendly, supportive approach and ensuring that work is completed would be particularly valuable, as would training in techniques for providing constructive criticism for employees.

URL: 
http://her.oxfordjournals.org/content/18/2/207.full
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Three year follow-up study of an integrated supported employment for individuals with severe mental illness.

Authors: 
Tsang, H. W., Chan, A., Wong, A., & Liberman, R. P.
Year Published: 
2010
Publication: 
Australian and New Zealand Journal of Psychiatry
Volume: 
44
Number: 
1
Pages: 
49-58
Publisher: 
PubMed
Background: 

Persons experiencing severe mental have traditionally experienced high rates of unemployment. The Individual Placement and Support model is an evidenced based practice effective in assisting persons with severe mental illness achieve employment outcomes at a rate higher than traditional approaches.

Purpose: 

The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) program, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS program on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years.

Setting: 

Non government organizations and day hospitals in Hong Kong in association with the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Sample: 

One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong.

Data Collection: 

Study participants were randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up.

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 comparison condition was traditional vocational rehabilitation.

Findings: 

After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive.

Conclusions: 

The long-term effectiveness of the ISE program in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20073567
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness.

Authors: 
Twamley, E. W., Narvaez, J. M., Becker, D.R. Bartels, S. J., & Jeste, D. V.
Year Published: 
2009
Publication: 
Journal of behavior therapy and experimental psychiatry
Volume: 
40
Number: 
2
Pages: 
292-305
Publisher: 
Elsevier B.V.
Background: 

The traditional vocational rehabilitation (TVR) services adopt a step-wise approach which offers pre-vocational training at the beginning of the service. In Hong Kong and mainland China, participants usually undergo a prolonged period of preparation before seeking competitive employment. Rates for competitive employment are usually less than 20%. As TVR is the most common form of vocational rehabilitation in Hong Kong, it was important to local service development to benchmark innovative interventions against standard interventions. IPS is an evidence-based rehabilitation service that includes job development and placement, on-going employment supports, coordination of vocational services with multidisciplinary treatment teams, indefinite services and the opportunity for choice of jobs by participants. PS is less than optimal in clients' maintaining their jobs, with 50% of those employed experiencing job terminations by the six-month follow-up. Over a longer follow-up period, considerably fewer than half of the participants in IPS are working during any single month. In the current study, IPS was amplified by the addition of work-related, social skills training (WSST) together with ongoing supports in the community for aiding generalization of social skills in the workplace following the integrated supported employment (ISE) protocol.

Purpose: 

The purpose of this study was to examine the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment.

Setting: 

The setting included community mental health programs which offered a range of rehabilitation services.

Sample: 

The study sample was 163 participants from community mental health programs which offered a range of rehabilitation services. The recruitment was based on the following selection criteria: (1) suffering from SMI (operationally as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent major depression, or borderline personality disorder); (2) being unemployed; (3) willing and cognitively competent to give informed consent; (4) lacking obvious cognitive, learning and neurological impairments as determined by mental status exam; (5) completed primary education; and (6) expressing a desire to work.

Data Collection: 

Data collection involved the following: Employment Outcome Checklist (EOC) assessed their employment outcomes such as the number of job interviews attended, the number of jobs obtained, number of hours per week worked, and salary received from each of the jobs that were obtained . The 21-item Chinese Job Stress Coping Scale (CJSC) assessed the coping strategies of participants when faced with job stress, using a five-point response scale ranging from 1 (hardly ever do this) to 5 (almost always do this). The coping dimensions included help seeking, positive self-appraisal, work adjustment, and avoidance. The Chinese Job Termination Checklist (CJTC) is the Chinese version of the Job termination Scale.

Intervention: 

A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). The ISE participants joined the ISE program which integrated IPS and WSST. The eight principles of IPS also applied to this intervention. The 10-session WSST consisted of a structured program to teach participants job interview skills, basic conversation and social survival skills for effective communication with supervisors, co-workers and customers.

Control: 

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.Traditional Vocational rehabilitation services that clients received included sheltered workshop and supported employment.

Findings: 

After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

Conclusions: 

The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

URL: 
http://www.sciencedirect.com/science/article/pii/S0005791608000852
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention.

Authors: 
Vlasveld, M. C., Anema, J. R , Beekman, A. T. F., van Mechelen, W., Hoedeman, R., van Marwijk, H. W. J., Rutten, F. F., Hakkaart-van Roijen, L., & van der Feltz-Cornelis, C. M.
Year Published: 
2014
Publication: 
Journal of Occupational Rehabilitation
Volume: 
24
Number: 
1
Pages: 
42-51
Publisher: 
Springer Science+Business Media New York
Background: 

Employment leads to more independence as an adult. Many youth with physical disabilities have difficulty gaining and maintaining employment. This may result in a reduced quality of life.

Purpose: 

The purpose of the study was to examine how occupational performance of participants of a vocational rehabilitation intervention changed over time. More specifically, it looked at work, self care and leisure. The researchers also looked at the differences between individuals who were employed and those who remained unemployed after the vocational rehabilitation intervention.

Setting: 

The setting was an outpatient rehabilitation clinic for young adults located in Rotterdam, the Netherlands.

Sample: 

Participants include eleven young adults with physical disabilities; six male and five females. Their mean age was 22 years prior to the intervention. Three individuals had cerebral palsy, 2 had muscular disease, 2 had traumatic brain injury and the remainder had other types of physical disabilities. The amount time participants had spent looking for work ranged from Five of the participants had not yet looked for work while 2 had been looking for more than 2 years.

Data Collection: 

Demographic data was collected. Severity of physical limitations was categorized using scores on the Physical Functioning scale of the MOS Short-Form General Health Survey. Occupational performance was explored at baseline and one year later using semi structured interviews. The Canadian Occupational Performance Measure (COPM), an interview, was used to assess self perception of work performance in the areas of self care, productivity and leisure over time. The Occupational Performance History Interview II (OPHI-II) was used to assess aspects of occupational adaptation: occupational identity, competence and setting. Results were summarized using descriptive statistics. Sores on the COPM subscales and the OPHI-II scales were calculated. Qualitative data from the COPM and audio taped OPHI-II were summarized and categorized into the 3 occupational performance categories: self care, leisure and work productivity. Narrative were classified as regressive, stable or progressive. Differences between pre and post intervention scores on COPM and OPHI-II were tested using Wilcoxon signed rank test. Demographics between the employed and unemployed groups were compared using the Mann-Whitney U test. Non-parametric test were used. Data was analyzed using SPSS 16.0.

Intervention: 

The intervention was "At Work?! This is a multidisciplinary vocational rehabilitation intervention that was designed for young adults with physical disabilities, who are entering the labor market, and is geared towards improving abilities to achieve employment. The year long intervention brought rehabilitation and vocational services into a group program that included individuals assessments and coaching.

Control: 

There was no control group. The participants served as their own controls.

Findings: 

The participants expressed fewer problems after the intervention. Additionally, they showed improved in work performance, self care and leisure. An increase in satisfaction with these improvements was also reported. Occupational identify, competence and overall scores on the OPHI II also increased. The demographic characteristics of the individuals who did not gain employment were not difference from the group that was employed. The unemployed experienced difficulties in all three areas of occupational performance prior to the intervention and more difficulty in the work setting. Post-intervention, their levels of occupational identity, competence and settings were like those of employed persons. Participants showed improved occupational performance post intervention. The unemployed participants appeared to catch up during the intervention but had not achieved employment within one year.

Conclusions: 

Young adults with physical disabilities, showed improved occupational performance in work, self care and leisure and were more satisfied with their performance after participating in a one year multidisciplinary vocational rehabilitation intervention. Those who did not go to work faced problems in all three areas at pre-intervention. The goal of employment and the intervention appeared to motivate participants to solve problems related to work, self care and leisure. There is a need for interventions aimed at improving work participation by address problem across the three areas. Young adults who go to work may benefit from ongoing coaching to help address new problems.

URL: 
http://link.springer.com/article/10.1007%2Fs10926-013-9446-9
NIDILRR Funded: 
Peer Reviewed: 
Yes

Occupational categories and return to work after traumatic brain injury: A multicenter study

Authors: 
Wallace, C. J., & Tauber, R.
Year Published: 
2006
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
87
Number: 
12
Pages: 
1576-1582
Publisher: 
Elsevier
Background: 

A number of researchers have indicated that postinjury return to work rates are a function of pre-injury job classifications. However, these and other job category studies have conflicting findings, differing methodology and small sample sizes. This makes it difficult to determine if this is a significant and unique predictor that impacts return to work rates. Due to poor post injury employment rates for individuals with TBI knowing the relation between pre-injury occupational category and return to work could improve employment outcomes.

Purpose: 

The purpose of the study was to find out if pre-employment occupation was a significant and unique predictor of return to work for individuals with TBI.

Setting: 

The setting was 17 NIDILRR funded TBI Model Systems Projects (TBIMS) located across the United States.

Sample: 

The sample size was 1,341 individuals with TBI who had data in the TBIMS national database including one year follow up data. The majority of the sample were males (77%) and white (69%). Most had sustained an injury that would be considered moderate to severe.

Data Collection: 

Data was collected at TBIMS rehabilitation centers that include a wide array of services. Hospital records and admission and discharge FIM instrument used to evaluate level of independence were used to collect medical information. Annual telephone interviews were attempted to collect follow up information at month 10 and 14 post-injury. If this was not successful, a questionnaire via mail and/or an interview with significant other was completed.

Intervention: 

The intervention included an array of return-to-work services.

Control: 

There was no control or comparison condition.

Findings: 

Individuals who held professional and managerial jobs were more likely to be working during the one year follow up. Approximately, 33% of those who had worked in manual labor jobs were working at follow up with a slightly improved rate among those in skilled labor positions.Severity of injury was not predictive. However, the following variables: preinjury job category, education level, hospital LOS and discharge FIM total score were predictors. Additional analysis, clearly supported that job category predicts return to work outcomes beyond using educational level obtained prior to injury alone.

Conclusions: 

Preinjury occupational factors influence return to work post injury for individuals with TBI. Given that individuals, who were worked as manual laborers prior to injury had the poorest return to work rate, this group may have a greater need for vocational services. More research is needed to better understand return to work rates and evaluate possible strategies to improve employment outcomes.

URL: 
http://www.msktc.org/publications/detail/1732
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Vocational rehabilitation of participants with severe substance use disorders in a VA Veterans Industries Program

Authors: 
Walker, W. C., Marwitz, J. H, Kreutzer, J. S., Hart, T., & Novack, T. A.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2513-2523
Publisher: 
Marcel Dekker
Background: 

The VA Veterans Industries programs have been established across the country to provide a therapeutic gateway to gainful employment for veterans who have physical and mental disabilities or addictive disorders. Eighty percent of patients referred to vocational rehabilitation programs have a history of severe substance use disorders. Despite the interest in the vocational rehabilitation of substance users (Hawkins and Catalano, 1985), little empirical evidence exists about which specific vocational rehabilitation services promote successful employment outcomes.

Purpose: 

The purpose of this study was to evaluate the effectiveness of the Veterans Industries program, a component of the Addictions Partial Hospitalization Program (APHP) at the Houston Veterans Affairs Medical Center (VAMC). Outcome rates are reported including employment, abstinence, and housing support.

Setting: 

The study was conducted at the Houston, TX VAMC within the APHP, an addiction treatment program.

Sample: 

The study sample consisted of 80 veterans who were out-patients of the APHP and who were referred for vocational rehabilitation. The mean age of patients was 45 (range 29–59). Participants were predominantly male (98%) and African-American (62%). Most (68%) were Vietnam era veterans. At enrollment, 100% were unemployed, 73% were homeless, and 15% were receiving a disability pension.

Data Collection: 

Data were collected at intake for age, education, military history, training, employment history, earnings, disability, disability compensation, substance use, and living situation. Employment data were collected following program exit and at three-month follow-up.

Intervention: 

Veterans Industries is a therapeutic work-for-pay program in which the VA contracts with private industry and federal agencies for work to be performed by veterans. These Compensated Work Therapy (CWT) programs have been established since the 1950s. The majority of veterans are involved in outpatient substance user programs and live in VA domiciliaries or supportive housing in the community. In addition to therapeutic work, veterans receive job readiness training group, assistance with job placement, and referral to the state vocational rehabilitation service for assistance with supportive housing in a drug-free environment.

Control: 

The study used a pre/post intervention design, without a control or comparison group.

Findings: 

Of 80 patients, 72 (90%) successfully completed APHP and received a regular discharge. This means that they completed 4 weeks of partial hospital treatment and graduated to outpatient treatment consisting of group therapy twice a week. Fifty-nine percent of the homeless veterans received supportive housing. All veterans who remained abstinent and continued to participate in work therapy received supportive housing. The average length of service was 3 months. Forty-three of the 80 veterans (54%) obtained competitive employment. The majority of jobs were in entry-level service positions including housekeeping, building maintenance, security, shipping, and receiving. A follow-up conducted 3 months after discharge from Veterans Industries indicated that 60% maintained competitive employment.

Conclusions: 

The study findings support the conclusion that vocational services improve the employment rates of clients leaving treatment. The existence of job counseling, job placement, and job development services in clinics is positively correlated with the difference between admission and discharge employment rates.

URL: 
http://www.tandfonline.com/doi/abs/10.1081/JA-200034695?journalCode=isum20
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment for persons with traumatic brain injury: A preliminary investigation of long-term follow-up costs and program efficiency.

Authors: 
Wehman, P., Lau, S., Molinelli, A., Brooke, V., Thompson, K., Moore, C., & West, M.
Year Published: 
2003
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
84
Number: 
2
Pages: 
192-196
Publisher: 
Elsevier
Background: 

Research shows that individuals with traumatic brain injury (TBI) often experience great difficulty returning to competitive employment postinjury. Challenges arise from cognitive, physical, sensory and/or psychosocial problems. Supported employment is one approach in vocational rehabilitation that has been used to assist individuals with significant disabilities, including TBI, with returning to preinjury work or securing and maintaining new employment.In the individual placement approach typically a vocational professional known as an employment specialist or job coach, works one to one with the individual. The specialist assist the person with locating employment by developing job opportunities. Then, once the individual is hired the specialist provides and facilitates on-the-job supports such as: skills training and/or identifying various types of supports (ie. compensatory memory strategies, assistive technology) to help the new hire learn how to perform the job and meet the employer‚ performance standards. Furthermore, long-term follow-up services are offered throughout the duration of a person‚ employment. During this time, additional on-the-job assistance is available, and, as indicated, select case management services related to resolving off-the-job-site issues that if left unattended would impact job retention, are provided. Information on cost and benefits is needed to determine the efficacy of this approach for individuals with TBI.

Purpose: 

The purpose of this study was to investigate the long-term follow-up costs associated with supported employment. It also examined wage and employment characteristics for individuals with moderate to severe traumatic brain injury (TBI) received supported employment services over a 14-year time span.Specifically, this research sought to answer the following questions:(1) What is the average cost of supported employment services for individuals with TBI? (2) What is the average length of employment for individuals with TBI who have received supported employment services? and (3) How do benefits (ie, participant income) compare with costs of supported employment during a 14-year time period (from 1985 to 1999)?

Setting: 

The setting was multiple employment sites where individuals worked.

Sample: 

The sample size included 59 individuals with moderate to severe TBI who were consecutively referred for supported employment services. The sample was restricted those who were employed in at least one job during the study period. The eligibility criteria for receiving supported employment services included the following: the person was between the ages of 18 and 64 years, and had sustained a moderate to severe TBI, as indicated by length of coma greater than 24 hours or a Glasgow Coma Scale score of less than 13 on admission to the hospital. In addition, individuals had to present clear indications of the need for ongoing vocational intervention to return to preinjury employment or to obtain and maintain new employment. These indications came from the individual‚ post injury employment history or from reports from his/her family, physician, or vocational rehabilitation counselor. The demographics of the group were as follows. The majority (81%) were males; (75%) were white. The average age was 33 years. The majority (64%) had a high school diploma or less education. The majority (71%) were working prior to injury.

Data Collection: 

Data were collected on individuals who used supported employment services to assist them with gaining and maintaining work anytime between 1985 to 1999.Data about each participant's length of employment, wages, and costs associated with service delivery were collected by the employment specialist assigned to serve the person. For those individuals who had been employed in more than one job over the years, data on length of employment and cost of service delivery were combined. Analyses were performed to examine the costs of supported employment, employment characteristics (e.g., wages, length of employment), and benefit-cost ratios of supported employment for individuals with TBI. Descriptive statistics were calculated for length of employment, costs associated with supported employment services, and wages earned. Subgroup comparisons were also performed to examine the influence of length of employment on wages and supported employment costs. Calculations were based on individual clients, not job placements. Therefore, employment and billing data were combined and averaged for individuals who worked in more than 1 job over the study period.

Intervention: 

The intervention was individualized supported employment services.

Control: 

Subgroup comparisons were performed to take a look at the influence of length of employment on wages (less than and greater than 2 years) and cost of services.

Findings: 

Participants worked an average of 30 hours per week. and earned between $3.35 (minimum wage at the time) and 11.99 an hour. The average length of employment was 43 months. Average earnings were cited as $633.63 per month. Average gross earnings was $26,129.74. The majority of the sample worked over 2 years and approximately 25% had worked 7 years or more.The average hourly billing cost associated with the provision of supported employment services was $10,349.37; with a mean cost of $8614.00. This resulted in a mean monthly cost of $202.00 per participant.The subgroup cost-earning comparison revealed that cost were substantially less for those who maintained employment for 2 or more years. Individuals earned an average of $17,515.00 more than the cost associated with service implementation.

Conclusions: 

Supported employment is a cost effective way to assist individuals with TBI with gaining and maintaining employment. Over time the cost associated with long term services (ie. follow along) decreases.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12601649
NIDILRR Funded: 
Peer Reviewed: 
Yes

Supported employment for young adults with autism spectrum disorder: Preliminary data

Authors: 
Wehman, P., Schall, C., McDonough, J., Molinelli, A. Riehle, E., Ham, W., & Thiss, W.
Year Published: 
2012
Publication: 
Research & Practice for Persons with Severe Disabilities
Volume: 
37
Number: 
3
Pages: 
160-169
Publisher: 
Tash Publishing
Background: 

There is extremely limited information about using a supported employment approach to assist individuals with autism with gaining and maintaining employment in the community. Among the few studies that do exist, most are descriptive in nature. More research is needed.

Purpose: 

This study took a close look at the work histories of individuals with ASD over a 23 month period of time. The purpose was to examine the effects of supported employment in assisting them with employment.

Setting: 

The setting included a variety of different workplaces. This included: health care field, retail, recreational and educational field, food service and janitorial industry.

Sample: 

Thirty three individuals with ASD were included in the study. Each was referred for supported employment services by a vocational rehabilitation counselor. The majority were white (76%) and males (76%). The average age of participants was 22 years old. Seventy percent of the individuals reported a secondary disability. All participants had received a high school diploma or equivalency diploma. Around 40% had some college. Over 90% had either no or short intermittent work histories. More than three fourths had high social interaction support needs. Notably close to a third or 13 individuals had participated in a extended work internship at a hospital that was modeled after the Project SEARCH approach.

Data Collection: 

Employment specialist traced actual time spent either directly or indirectly working for the person with ASD across various types of supported employment interventions. This included developing a vocational profile about the person served, developing a job, job site training, and long term supports to enhance job retention. All data were stored in password protected database. The employment specialist's intervention time and participant outcomes were aggregated across the group of participants and over time.

Intervention: 

The intervention was individualized supported employment services. This is an approach that supports one person at a time with gaining and maintaining work in a real job for real pay in the community.

Control: 

There was no control. Due to the exploratory nature of the study no comparison group was used.

Findings: 

Twenty seven or 82% of those served went to work in an entry level occupation. They earned between $7.25 and $10.50 per hour.Mean hours worked was 23 per week.The average intervention time for various interventions was as follows:completing a job seeker profile was about 9 hours; job development around 30 hours (notably some of the individuals went to work where they interned which reduced the hours needed to develop a job); job site training and support 107 hours; and long term support 27 hours.

Conclusions: 

An individualized supported employment approach can assist individuals with ASD with gaining and maintaining employment. More research is needed.

URL: 
http://rps.sagepub.com/content/37/3/160.full.pdf
NIDILRR Funded: 
Peer Reviewed: 
Yes