The effectiveness of supported employment in people with dual disorders

Authors: 
Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J. Bond, G. R, Essock, S. M., Becker, D. M., Wolfe, R., & Swain, K.
Year Published: 
2011
Publication: 
Journal of Dual Diagnosis
Volume: 
7
Number: 
2
Pages: 
90-102
Publisher: 
PubMed
Background: 

Competitive work is a common goal for people with a severe mental illness (e.g., schizophrenia, bipolar disorder, treatment refractory major depression) and substance use disorder (or dual disorder). Despite this fact, relatively little has been firmly established as to whether substance use problems interfere with the ability of clients with severe mental illness to work or to benefit from vocational rehabilitation programs.

Purpose: 

This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder.

Setting: 

Despite similar methods, the RCTs differed on geographic location, control group interventions, and length of follow-up. The four studies were as follows: The NH study was conducted in two mental health centers in Concord and Manchester, New Hampshire. The DC study recruited clients in an intensive case management program in Washington, DC. In the Hartford study, participants receiving services at a mental health center in Hartford, Connecticut, were randomly assigned. In the Chicago study, clients attending two day programs at a comprehensive psychiatric rehabilitation agency in Chicago, Illinois, were randomly assigned.

Sample: 

The study group consisted of study participants with co-occurring substance use disorders from four RCTs of IPS supported employment versus usual vocational services. All four studies compared a newly established IPS program to one or more well-established vocational programs. In all four studies, participants were recruited from mental health centers (or a psychiatric rehabilitation agency in the Chicago study). Participants were adults who met each state‚ criteria for severe mental illness, typically a DSM-IV Axis I or II diagnosis plus severe and persistent impairment in psychosocial functioning. All participants were unemployed at the time of study admission.

Data Collection: 

This study used archival data from four independent RCTs to determine the effect of IPS supported employment on clients with co-occurring substance use disorders. Institutional Review Boards at local sites and participating universities approved the four studies. In addition, the Institutional Review Board of Indiana University-Purdue University Indianapolis approved the data re-analyses reported here. To evaluate differences at baseline between the clients randomized to IPS compared to the comparison programs on demographic, diagnostic, clinical, and background characteristics, study computed t-tests for continuous variables and chi-square tests for categorical variables.

Intervention: 

Individual Placement and Support (IPS) model 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: 

All of the comparison vocational services were highly regarded, active programs, considered at the time to be state-of-the-art. Common principles shared among these comparison groups were the emphasis on stepwise entry into competitive employment (with the exception of one subprogram in the Hartford study) and brokered services in which the vocational program was provided by a separate agency from the mental health program (with the exception of the Chicago program).

Findings: 

In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up.

Conclusions: 

The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23275763
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Cognitive training and supported employment for persons with severe mental illness: One-year results from a randomized controlled trial

Authors: 
McGurk, S. R., Mueser, K. T., Harvey, P. D., LaPuglia, R., & Marder, J.
Year Published: 
2005
Publication: 
Schizophrenia Bulletin
Volume: 
31
Number: 
4
Pages: 
898-909
Publisher: 
Oxford University Press
Background: 

Individuals with severe mental illness have poor unemployment rates. Past research indicates supported employment can help improve employment rates among this group. However, not all person with severe mental illness have benefited from that model. For example, poor job tenure rates have been reported. Therefore, it is important to try to improve the effectiveness of these programs. One possible way to enhance outcomes may relate to improving cognitive functioning through an intervention such as cognitive training.

Purpose: 

The purpose of this study was to measure the impact of cognitive rehabilitation on employment outcomes among individuals with severe mental illness who had not been successfully employed and were receiving supported employment services.

Setting: 

The study took place at two mental health centers that provided a wide range of services including supported employment.

Sample: 

Participants included 44 individuals with severe mental illness who were receiving services from 2 mental health centers in New York. The majority were males (62%), from a minority like African American (59%), followed by Hispanic (24%) and had a diagnosis of Schizophrenia. The mean age of participants was 31 years and most had relatively low levels of education. Participants were assigned to either the cognitive training and supported employment program or supported employment.

Data Collection: 

Comprehensive employment data were collected the first year. Cognitive and psychological assessments were administered at baseline and three months later.
Diagnostic and background information were retrieved from the participants charts, interviews, and staff reports. Employment outcomes were measured through contact with the participants and staff. Seven different tests were used to measure cognitive functions (i.e.. attention and concentration, psychomotor speed, information processing speed, verbal learning and memory, executive functioning and overall cognitive functioning) at baseline and 3 month follow up.
Psychiatric symptoms were measured with interviews using the Positive and Negative Syndrome Scale. Efforts were made to get follow up employment data for the one year following randomization. Intent to treat analyses of the employment outcomes were conducted on the entire randomized sample that had some follow up data (n=44). The statistical analysis included: x2, t test and analyses of covariance. Due to skewed data Mann Whitney U tests were also used.

Intervention: 

The intervention was cognitive training titled Thinking Skills for Work and supported employment services.

Control: 

The control was supported employment services without cognitive training.

Findings: 

The rate of retention of the cognitive training program was high. The program was successfully implemented at two sites that predominantly served inner city minorities. Participant who received cognitive training showed improvements in several areas over the first 3 months of the study as well as a better overall cognitive functioning score as compared to those who received only supported employment services. They also had higher rates of employment. Notably, this group showed improvements on the PANSS depression scale.

Conclusions: 

The Thinking Skills for Work program may help individuals with severe mental illness with employment. This program was successfully implemented in a challenging inner city setting. More research is needed.

URL: 
https://academic.oup.com/schizophreniabulletin/article/31/4/898/1877695
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Paid internships and employment success for youth in transition

Authors: 
Luftig, R. L., & Muthert, D.
Year Published: 
2000
Publication: 
Career Development for Exceptional Individuals
Volume: 
23
Number: 
2
Pages: 
205-221
Publisher: 
Sage
Background: 

Most recent extensive national longitudinal studies of school leavers with disabilities show employment rates lagging significantly behind their non-disabled peers. There is a considerable body of research literature that supports the value of work experience as a critical educational intervention for improving post-school employment. To maximize effective educational interventions, including the use of work-based learning and paid employment experiences, it is necessary to examine specific individual characteristics, strategies, and circumstances that promote or deter successful employment outcomes.

Purpose: 

The purpose of this study was to assess the efficacy of a standardized, multi-site, community-based employment internship program developed by the Marriott Foundation for People with disabilities, called Bridges...From School to Work. The study also examines the relationship of various participant and programmatic variables to transition outcomes for participating youth.

Setting: 

The settings for the study consisted of multiple workplaces engaged in the Bridges program with the Marriott Foundation. During the study, Bridges operated in Montgomery County, MD; Fairfax County, VA; Washington, DC; Los Angeles, CA; San Francisco, CA; Atlanta, GA; and Chicago, IL.

Sample: 

The sample for this study includes 3,024 special education high school students who participated in one of the 10 Bridges projects. There was relatively equal distribution for males and females. Participants were largely minority group members (81%). Students had an array of disabilities but were predominantly learning disabled (57.1%), intellectually disabled (17.8%), and emotionally disabled (14.8%). Disability severity ratings were 41.0% mild, 38% moderate, and 21.0% severe.

Data Collection: 

Referral data for Bridges includes demographic, disability, and previous educational/employment histories. Additional data come from a placement data form, an internship log, an internship completion form, and a follow-up questionnaire. Follow-up data collection occurs at 6, 12, and 18 months after internship completion. The data instruments were standardized across all 10 sites. Data analysis consisted of descriptive results for internship performance, and the exploration of the relationship between predictor and outcome variables at each of the three periods using logistic regression procedures.

Intervention: 

The Bridges program consists of three phases: (a) pre-vocational orientation program (two to three weeks); (b) pre-vocational preparation skills training (two to four weeks); and (c) internship placement and support. The internship is a paid work experience whereby a student intern spends a minimum of 12 consecutive weeks performing work tasks in a community employment setting. The employer pays the wages and benefits for the student, but the employer and the student are under no obligation to continue the employment relationship beyond the internship period.

Control: 

There was no comparison condition.

Findings: 

Employment status at six months post-internship was not different across gender, race, or primary disability. Work behaviors during the internship were highly predictive of post-school employment at 6 and 12 month follow-up intervals. 68% of those contacted were employed at six months. Enrollment in postsecondary education was the most frequently cited reason for not working (43%), followed by not being able to find work (21%). A small percentage (13%) cited not wanting to work as the reason for unemployment.

Conclusions: 

Findings of this study demonstrate the efficacy of structured work experiences for youth with disabilities in secondary school. Students in the paid internship showed better short-term outcomes regardless of demographic factors and educational placement factors. However, at long-term follow-up the employment rate had declined, indicating a need for sustained employment support services.

URL: 
http://cde.sagepub.com/content/23/2/205.full.pdf+html
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Waging a living: Career development and long-term employment outcomes for young adults with disabilities

Authors: 
Linsay, S., & DePape, A. M.
Year Published: 
2011
Publication: 
Council for Exceptional Children
Volume: 
77
Number: 
4
Pages: 
423-434
Publisher: 
Exceptional Children
Background: 

Employment rates for individuals with disabilities are poor and contribute to the ongoing high poverty rates for this group. Although overall employment rates have risen over the years, work outcomes for young adults with disabilities still lag behind those without disabilities. Career development takes place overtime and is influenced by multiple variables such as individual, family, school, and community factors. However, for individuals with disabilities, career development is often complex, nonlinear, and chaotic. High school and post-school services can have a positive impact on employment for youth with disabilities. Students with disabilities who participate in vocational courses and community based work experiences are more likely to obtain and maintain employment after high school. Additionally, participation in adult services like vocational rehabilitation or post secondary education or training can lead to better job opportunities. Research studying patterns of career development for successfully employed adults with disabilities may be able inform clinical practices through the identification of common themes that influence employment in living wage occupations.

Purpose: 

This study examined the process of career development for young adults with disabilities.

Setting: 

The study took place in multiple interview settings.

Sample: 

Young adults with disabilities (5 with learning disability, 2 with orthopedic impairment, and 1 with emotional disability) were recruited from a statewide network of special education and transition specialist. Criteria for selection included: had a documented disability and received special education, participated in school to work transition program at least one year, and exited school between the years 1996 and 2001. The chosen group included 4 women and four men with disabilities who were between 25 to 29 years old. All participants were caucasian and half resided in rural areas. Seven had graduated with a standard high school diploma and one had dropped out during the last year of school. All were employed full time at the time of their postschool interview and reported earning more than $20,000 per year. This was above the federal poverty line of $9,800 per year and exceeded the living wage of $17,035 per year. Key informants were also selected to provide information on family, high school, post school experiences and opportunities. This included: one or both parents, a high school teacher or transition specialist, a rehabilitation counselor, and current employer.

Data Collection: 

Researchers identified a set of topics to address through a review of the relevant literature. This included:

(a) individual characteristics and personal attributes,

(b) family support and expectations,

(c) high school and postschool school services and supports,

(d) workplace experiences, and

(e) other postschool training or education.

Data was collected over four years. Initial post-school interviews took place when participants were between 3 and 6 years out of high school. The second phase of data collection occurred up to 4 years following the initial interview when participants were between 7 and 10 years out of school. In total there were 66 interviews. this included interviews with 24 young adults, 18 with family 11 with employers, 8 with school personnel and 5 with rehabilitation counselors. In addition a family background questionnaire, job history form were completed for each participant along with a file review of special education and vocational rehabilitation records.

Field notes were kept on all contacts with participants and key informants. Onsite observations, field notes and file reviews were recorded on structured forms. Case study data for each participant was completed following standard qualitative analysis procedures. Cross case data summaries and explanatory tables were used to determine which characteristics influenced outcomes similarly or uniquely across cases.

Intervention: 

The study included multiple school-based and transition-focused interventions.

Control: 

The study did not include a control or comparison condition.

Findings: 

A common set of themes seemed to impact employment in living wage occupations. These included: the importance of ongoing education and/or training, steady work experiences, and personal attributes. More specifically the study found that the interrelated elements of family expectations, work experience during high school, and transition services and supports led these individuals to an initial postschool placement in either employment or postsecondary training. During the ensuing span of years, participants advanced in their careers based on a combination of factors that included: (a) enrollment in higher education or job training programs, (b) patterns of workforce participation, and (c) a set of personal attributes such as self-efficacy, persistence, and coping skills. These factors were present across all participants, yet varied by sex.

Conclusions: 

The findings confirm and extend previous research documenting the critical contribution of work experience for youth with disabilities. Young adults with disabilities need transition services to secure financial stability. Initial transition services and ongoing opportunities for further education and training are needed to work in jobs that pay a living wage. Transition education needs to focus on individual knowledge and skills like self determination, self advocacy and communication. Additional studies are needed to understand and highlight the variables that influence gaining occupations with livable wages that promote financial self sufficiency. More research is needed on the role of transition supports, post secondary education or training, family factors and personal attributes.

URL: 
http://eric.ed.gov/?id=EJ931146
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

"Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI"

Authors: 
Johnstone, B., Vessell, R. Bounds, T., Hoskins, S., & Sherman, A.
Year Published: 
2003
Publication: 
NeuroRehabilitation
Volume: 
18
Number: 
3
Pages: 
197-203
Publisher: 
IOS Press
Background: 

After TBI many individuals experience difficulties with returning to work and if financially eligible turn to federally funded state vocational rehabilitation (VR) programs for services. Although billions of taxpayer dollars are spent on VR services each year, little is known about their effectiveness. Few studies have been published on the vocational outcomes of persons with TBI who utilize
state VR programs. More research is needed about individuals with TBI who receive state VR services in order to identify problems, develop appropriate services, and improve vocational outcomes. There are few published studies regarding persons with TBI in rural areas. Furthermore, the published research specifically on the vocational outcomes of persons with TBI in rural areas is essentially non existent with only one study identified on this topic.

Purpose: 

The purpose of the study was to evaluate differences in demographics, injury severity, and vocational outcomes for individuals with TBI based on whether that resided in a rural vs. urban environment. It was hypothesized that individuals from rural and urban areas would not differ in demographics, that rural individuals would have greater injury severity based on previous studies, and that rural individuals would receive fewer VR services and have a lower rate of successful employment.

Setting: 

The setting for the study was vocational rehabilitation agencies in Missouri.

Sample: 

The study included 78 individuals with TBI who had completed services from the Missouri Division of Vocational
Rehabilitation (VR). The majority or 71% were male. Eighty percent were Caucasian.
Demographic and injury severity data was reported by rural (N=28) and urban status (N=50). For the rural group, the mean age was 37; mean years of education was 12, and mean years post injury was 8 for the rural group. Mean number of hours in coma was 241 hours, mean days of post traumatic amnesia was 53 and mean days of hospitalization was 53 days. For the urban group, the mean age was 36; mean years of education was 12, and mean years post injury was 11 for the rural group. Mean number of hours in coma was 96 hours, mean days of post traumatic amnesia was 25 and mean days of hospitalization was 33 days.

Data Collection: 

Each participant was administered a standard neuropsychological evaluation used as part of a statewide VR protocol. Information about demographic and psychosocial variables was obtained by the evaluating psychologist. Self-report information regarding duration of loss of consciousness (LOC), posttraumatic amnesia (PTA), and hospitalization was obtained from most clients because medical records were not routinely available for review.

Information from Missouri DVR was obtained on each participant, including the specific services provided, the vocational status of the participant at case closure, and the financial cost of the case to DVR. Vocational outcome was determined using standard DVR categories, including: 1) successfully closed, 2) closed, no services provided, 3) closed, services interrupted, and 4) unsuccessfully closed. Rural and urban status was determined by definitions used by the US Office of Management and Budget (OMB). Data analysis included Chi-squares, Fisher‚ Exact tests, Wilcoxon Rank Sums test, and MANOVAs.

Intervention: 

The intervention was vocational rehabilitation services.

Control: 

A comparison was made between two groups of individuals with TBI; those living in rural versus urban settings.

Findings: 

There were no remarkable differences between the groups in terms of demographics. People residing in urban areas received significantly more maintenance funds, transportation services, and on-the-job training, than those living in rural settings. Additionally these individuals had more case service dollars expended on them. Finally, although statistically non-significant, individuals from urban areas were successfully employed at VR case closure, compared to those from rural areas.

Conclusions: 

The results suggest that rehabilitation professionals and vocational counselors should focus on possible environmental factors that limit the successful vocational outcomes of individuals with TBI in rural areas. VR counselors need to focus on environment factors that limit vocational outcomes for those living in rural areas. They need to find creative ways to address difficulties associated with limited resources in rural environments like transportation , locating vocational training settings, and developing job opportunities. VR counselors also need to better determine why many of their rural clients with TBI discontinue services after they are deemed eligible to receive them. This information can help them develop strategies to increase their client retention.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/14530584
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Providing effective employment supports for persons living with HIV: The KEEP project

Authors: 
Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong
Year Published: 
2005
Publication: 
Journal of Vocational Rehabilitation
Volume: 
22
Number: 
2
Pages: 
105-114
Publisher: 
IOS Press
Background: 

The Kirk Employment Empowerment Project (KEEP) was a three-year demonstration project funded by the Rehabilitation Services Administration (RSA) to test strategies for improving employment outcomes of individuals with HIV/AIDS. KEEP sought to identify and test service strategies that would be effective for individuals who have multiple barriers to employment, and individuals from populations that are typically underrepresented in HIV/AIDS research.

Purpose: 

The purposes of this article are to (1) describe the KEEP model and (2) provide data regarding program outcomes.

Setting: 

The study setting was the Horizon House, a treatment center for individuals with HIV/AIDS in Philadelphia, PA.

Sample: 

The study sample was 148 individuals who were referred to and accepted for KEEP services. The sample was predominantly African-American (72.3%) and male (60%). A substantial proportion had co-occurring disorders, with over a third report a psychiatric disorder.

Data Collection: 

Employment tracking data were collected for each participant upon job start, significant job changes, and job end. Initial baseline interviews were conducted by research staff with each participant to obtain demographic data and income, motivation to work and satisfaction with life issues in general as reflected by participants responses to quality of life items. Follow-up interviews were conducted at 6-month intervals for the duration of the project. Descriptive statistics were used to report outcomes for participants.

Intervention: 

The KEEP model emphasizes rapid attachment in the workforce and expecting participants to do as much for themselves as possible with support. Among the specific individualized services offered by ESC‚ were assessment and evaluation, job search assistance, benefits and legal counseling, disability management education, on-site job support (such as help negotiating with an employer), job-related problem-solving, specific skills training (such as learning to use public transportation), referral to auxiliary services, coordination and collaboration with other service providers, and other miscellaneous wrap-around services.

Control: 

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

Findings: 

Of 148 participants in the project, 114 (77%) were employed at some point during the project. They held a total of 278 jobs during the project, averaging 2.4 jobs per participant. Sixty-three percent of participants were employed for 90 days or longer during the project, Earnings ranged from $2.50 per hour to $44.23 per hour, with an average hourly wage of $8.49 (median $7.50/hour). Of the 278 jobs, only 4 paid less than minimum wage. The vast majority of all jobs obtained (87.4%) did not include any benefits at any time.

Conclusions: 

The fact that they achieved such high employment rates in the KEEP project supports the evidence that for people with a variety of disabilities, a history of competitive employment, no matter how limited, can be considered an indicator for future employment success. Employment also contributed to improved health and physical functioning.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00278
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predictors of successful return to work from HIV-related disability

Authors: 
Drake, R. E. & Bond, G. R.
Year Published: 
2004
Publication: 
Journal of HIV/AIDS and Social Services
Volume: 
3
Number: 
3
Pages: 
89-96
Publisher: 
Journal of HIV/AIDS and Social Services
Background: 

Many individuals with HIV/AIDS experience periods of unemployment as their physical symptoms increase. However, some in treatment do continue or return to employment.

Purpose: 

The purpose of this study was to compare a sample of individuals with HIV/AIDS who successfully return to employment and those that do not. The factors included disease-related factors and service-related factors.

Setting: 

The setting was an HIV/AIDS primary care clinic of a large, university-affiliated hospital.

Sample: 

The study sample consisted of 135 patients whose records indicated that they had successfully regained employment following disease-related job loss. A matched cohort of individuals with HIV/AIDS who had not regained employment was selected as a comparison group.

Data Collection: 

The data consisted of patient clinical records related to HIV/AIDS treatment and symptoms and services delivered. Statistical analyses consisted of descriptive statistics and analysis of variance (ANOVA).

Intervention: 

The majority of predictor variables were related to HIV/AIDS, such as CD4 cell count and length of time in treatment. However, the effects of one intervention were also included, the provision of mental health services.

Control: 

A matched comparison group was selected consisting of individuals with HIV/AIDS who had not returned to work following disease-related job loss.

Findings: 

Substance use disorders were more prevalent in those who had not achieved return to work. Those who had returned to work were more likely to have received mental health assessment and treatment.

Conclusions: 

Mental health services may serve as a gateway to return to work for many individuals with HIV/AIDS. In addition, identifying patients who are already being treated by the mental health team in order to assess their desire and ability to return to work is an important first step in increasing the effectiveness of a return to work program.

URL: 
http://www.tandfonline.com/doi/abs/10.1300/J187v03n03_07?journalCode=whiv20
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

Authors: 
Cooper, R. A., Boninger, M. L., Cooper, R., Fitzgerald, S. G., & Kellerher, A.
Year Published: 
2007
Publication: 
Journal of Rehabilitation Research and Development
Volume: 
44
Number: 
6
Pages: 
837-850
Publisher: 
United States Department of Veterans Affairs
Background: 

A growing body of literature indicates the high prevalence of medical disorders among people with severe mental illness, including cardiovascular disease, tuberculosis, and diseases of the lungs, kidneys, and digestive tract. In addition, substance use is perhaps the most frequently identified co-occurring disorder among psychiatric outpatients. Other common co-occurring disorders include ADHD and cognitive disabilities. Each of these may influence employment outcomes.

Purpose: 

The purposes of this study are to (1) examine the effects of co-occurring disorders on employment and earnings; (2) assess the efficacy of a supported employment approach for individuals with severe mental illnesses and co-occurring disorders, and (3) assess the impact of co-occurring disorders on decisions to disclose disability to employers and prospective employers.

Setting: 

This study was conducted in eight study sites of the Employment Intervention Demonstration Program (EIDP). The sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.

Sample: 

The study sample consisted of 1,273 individuals who were clients of one of the EIDP demonstration sites. Participants were at age 18 and over, with a confirmed diagnosis of severe and persistent mental illness. Individuals were excluded who were working at randomization, were involved in a trial of another intervention, or had no vocational outcome data.

Data Collection: 

Data collection consisted of chart review protocol for collecting comorbidity data used in this analysis. Interview assessments with EIDP participants elicited information regarding demographic characteristics, employment history, and other relevant information at the time of study enrollment (baseline) and at 6-month follow-up intervals for 24 months. Vocational data were collected weekly and included job tenure, hours worked, earnings, job characteristics, and workplace disclosure of psychiatric disability. Data analysis included ordinary least-squares regression for the multivariate analysis of interval-level dependent variables and logistic regression for dichotomous outcomes.

Intervention: 

The interventions were enhanced best-practices models of supported employment for individuals with severe mental illness. At some sites, the Individual Placement and Support (IPS) was the intervention and at others the Program of Assertive Community Treatment (PACT). Services associated with the IPS include minimal prevocational assessment, rapid job search, placement into competitive jobs, and provision of training and ongoing follow-up supports. PACT interventions are provided exclusively in the community through a mobile team comprising psychiatrists, nurses, case managers, and vocational specialists who collaboratively
place clients in competitive employment and provide job training and continuous employment support.

Control: 

Sites elected to use one of two types of control conditions: (1) services-as-usual or (2) a comparison condition that was lacking the active ingredient being-tested in the site experimental condition. The services-as-usual control condition was by whatever services were typically available in the local community.

Findings: 

More than half (59.9%) the study participants were reported to have one or more comorbidities. Individuals in experimental conditions had significantly higher employment rates, earnings, and work hours per week. Rates of disclosure were not different between experimental and control conditions. Those with any comorbidity had lower earnings. Those with comorbidities affecting physical functioning had significantly lower employment rates and less work hours than those other or no comorbidities. Individuals with comorbidities affecting both physical and cognitive functioning were more than twice as likely to disclose; individuals with learning disabilities were more than three times as likely to disclose.

Conclusions: 

The study findings point to the influence of co-occurring disorders in employment outcomes for individuals with severe mental illness in supported employment. Those in the experimental conditions had better employment outcomes regardless of comorbidities, evidencing the value of supported employment models for this population.

URL: 
http://www.worksupport.com/kter/documents/pdf/CookErrectsofCooccuringDisordersonEmployOutcomes1.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

The quest for ordinary lives: The integrated post-school vocational functioning of fifty workers with significant disabilities

Authors: 
Browne, D. J. & Waghorn, G.
Year Published: 
2006
Publication: 
Research and Practice for Persons with Severe Disabilities
Volume: 
31
Number: 
2
Pages: 
93-121
Publisher: 
TASH Publishing
Background: 

More individuals with significant disabilities are entering and exiting schools and outliving their parents than ever before. As these individuals age, many are presenting more longitudinal, complicated, and expensive difficulties than their chronological age peers (Bittles and Glasson, 2004).

Purpose: 

The purposes of this study are to: (1) share information about the integrated vocational functioning of 50 adults with significant disabilities, (2( celebrate their vocational achievements, and (3) affirm the feasibility of integrated vocational functioning.

Setting: 

All participants were clients of Community Work Services, an employment services program in Madison Wisconsin.

Sample: 

The 50 participants were assisted into integrated jobs prior to 2005. The sample included individuals with a variety of disabilities, including autism, intellectual disabilities, and cerebral palsy. All were at least 15 years out of high school.

Data Collection: 

The data consisted of service records maintained by Community Work Services during the course of services. Additional information was collected from interviews with participants, family members, employers, and others.

Intervention: 

The intervention was community-integrated employment utilizing a job coach and long-term support.

Control: 

There was no comparison condition.

Findings: 

Job retention ranged from 2 months to 27 years and 6 months. Job changes occurred for a variety of reasons, but primarily to enhance opportunities and create better job matches. Work hours ranged from 6 to 30.5 hr/week, with an average of 20.15 hr/week. Hourly wages averaged $5.76, six cents above the prevailing minimum wage at the time of placement.

Conclusions: 

The study findings provide evidence for the feasibility of integrated employment for individuals with severe disabilities in need of long-term employment supports.

URL: 
https://pdfs.semanticscholar.org/3172/5be67b88b211fb2d73faa67d50824d704104.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The viability of self employment for individuals with disabilities in the United States: A synthesis of empirical-research literature

Authors: 
Yao-Jen Chang, Hung-Huan Liu, Shu-Min Peng, Tsen-Yung Wang
Year Published: 
2011
Publication: 
Journal of Vocational Rehabilitation
Volume: 
35
Number: 
2
Pages: 
117-127
Publisher: 
IOS Press
Background: 

The lack of employment opportunities and stable employment for individuals with disabilities continues to pose personal and social difficulties and challenges. Individuals with disabilities experience persistently higher poverty rates. Very little is known about individuals with disability in self employment as compared to the more extensive research literature on individuals with a disability who work for someone else.

Purpose: 

Paper reports on a review, analysis, and synthesis the findings of empirical-research studies on self-employment of individuals with disabilities in the United States. Paper addresses the question: "How viable is self employment for individuals with disabilities in the U.S."

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The data search used five large data bases: Academic Search Premier, ERIC, PsycINFO, Sociological Abstracts, and Business Source Premier/Econ-Lit. The database search used the terms self employment, entrepreneurship and micro enterprise as synonymous terms in the search. Results were sorted to identify U.S. empirical literature. Twelve studies met the selection criteria.

Data Collection: 

Coding of selected studies comprised the following steps: First author completed multiple readings noting, for example, research questions, research design, data collection and measurement, and research findings, and limitations. Second and third author evaluated first and second authors evaluated first authors coding for accuracy. Full interobserver accuracy (100%) was established before proceeding to the synthesis of selected studies.

Intervention: 

The study adopted a two part definition of self employed worker:
a) Self employed in own not incorporated business workers. This includes people who worked for profit or fees in their own unincorporated business, professional practice, or trade or who operated a farm.
b) Self employed in own incorporated business workers.

Control: 

There were no comparison or control conditions.

Findings: 

In recent years, approximately 12% of working individuals with disabilities have earned an income from self-employment. The national Vocational Rehabilitation closure rates in self employment have remained around 2-3% since the late 1980s (although the rate varies considerably from state to state). The reasons individuals with disabilities pursue self employment are diverse and vary in complexity. Individuals can derive a range of benefits and challenges in self employment. Primary benefit is financial. Other potential benefits involve having a more of a decision making role in their own lives, and personal control and autonomy. Primary challenge in self employment is the access to adequate capital and financing for funding a business, extending beyond individual and family resources. Support in self employment has typically meant relying on a patchwork of resources.

Conclusions: 

In the 21st century, self employment can be a catalyst for expanding work opportunities and improving outcomes for individuals with disabilities. Tentative indications that Individuals with disabilities can succeed in self employment under certain conditions involve a number of stakeholders. State and federal agencies could expand their support of self employment for individuals with disabilities through the establishment of micro finance development funds outside the VR system.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr559
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes