Supported employment for middle-aged and older people with schizophrenia. | Knowledge Translation for Employment Research Center

Authors:	Twamley, E. W., Padin, D. S., Bayne, K. S., Narvaez, J. M., Williams, R. E., & Jeste, D. V.
Year Published	2008
Publication	American Journal of Psychiatric Rehabilitation
Volume	11
Number	1
Pages	76-89
Publisher	Routledge
Background	Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work. However, very few vocational rehabilitation programs target older clients with psychiatric illness.
Purpose	This study examined employment outcomes among adults with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation.
Setting	The setting was an outpatient clinic in San Diego, California and various places of employment.
Sample	The study sample included 50 participants,30 men and 20 women who were 45 years or older, had a DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder, and were receiving their psychiatric care at an outpatient clinic. Twenty subjects were diagnosed with schizophrenia, and 30 were diagnosed with schizoaffective disorder. They were referred by state vocational rehabilitation.
Data Collection	The following techniques were used t-tests, chi-square, logistic regression, and repeated measures ANOVA to analyze the data. Alpha for significance was set at p < .05, and all tests were two-tailed. Cohen's d effect sizes to provide estimates of the magnitude of effects was also calculated.
Control	Conventional vocational rehabilitation programs use a train-then-place approach, emphasizing prevocational training classes and volunteer, transitional, or trial employment before seeking competitive work (i.e., employment in the community at prevailing wages).
Findings	Compared with Conventional Vocational Rehabilitation, Individual Placement and Support resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not.
Conclusions	These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.
URL	http://www.ncbi.nlm.nih.gov/pubmed/19212460
Disabilities	Emotional disturbance
Populations	Male & Female \| American Indian or Alaska Native \| Asian \| Black / African American \| White / Caucasian
Outcomes	Employment acquisition \| Wages
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2008

Publication

American Journal of Psychiatric Rehabilitation

Volume

11

Number

1

Pages

76-89

Publisher

Routledge

Background

Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work. However, very few vocational rehabilitation programs target older clients with psychiatric illness.

Purpose

This study examined employment outcomes among adults with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation.

Setting

The setting was an outpatient clinic in San Diego, California and various places of employment.

Sample

The study sample included 50 participants,30 men and 20 women who were 45 years or older, had a DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder, and were receiving their psychiatric care at an outpatient clinic. Twenty subjects were diagnosed with schizophrenia, and 30 were diagnosed with schizoaffective disorder. They were referred by state vocational rehabilitation.

Data Collection

The following techniques were used t-tests, chi-square, logistic regression, and repeated measures ANOVA to analyze the data. Alpha for significance was set at p < .05, and all tests were two-tailed. Cohen's d effect sizes to provide estimates of the magnitude of effects was also calculated.

Control

Conventional vocational rehabilitation programs use a train-then-place approach, emphasizing prevocational training classes and volunteer, transitional, or trial employment before seeking competitive work (i.e., employment in the community at prevailing wages).

Findings

Compared with Conventional Vocational Rehabilitation, Individual Placement and Support resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not.

Conclusions

These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.

URL

http://www.ncbi.nlm.nih.gov/pubmed/19212460

Disabilities

Emotional disturbance

Populations

Male & Female | American Indian or Alaska Native | Asian | Black / African American | White / Caucasian

Outcomes

Employment acquisition | Wages

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes