Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.
This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.
The study took place in sheltered workshop settings and a variety of businesses.
The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.
Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.
The intervention was sheltered work.
Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.
Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.
Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.
Much discussion has taken place about the use of natural supports in supported employment. However, a review of the literature indicates empirical evidence supporting or refuting the concept is lacking.
The purpose of this study was to provide empirical research on the use of natural supports, coworkers without disabilities, as a training strategy for supported employees.
A variety of job sites in Illinois where individuals who received supported employment services worked.
The initial sample included 166 individuals with a primary diagnosis of mental retardation, who were 21 to 69 years old. The majority or 66% were European American and 34% were African American. Of these 166 individuals 31 were replaced because they were lost to contact or the support agency refused to participate or the person did not want to participate. Of 197 (166 plus 31 replacement) surveys mailed, 111 were returned, resulting in a 56% return rate.
A survey was sent to the adult service providers of 166 people who were included in the Illinois Supported Employment Projects database. The survey include questions related to: worker characteristics, Job coach/Co-worker involvement, Benefit-cost analysis, and Job separation. Dependent variables included: cost efficiency, length of employment, job retention, hours worked per month, gross pay, IQ,level of mental retardation, gender, ethnicity, age and number of disabilities. The independent variable was collected by the coworker Involvement Instrument that assesses the Involvement of coworkers in training supported employees. There was no control. Four analysis took place. The first compared employment outcomes to the degree of coworker Involvement. The second compared the supported employee demographics to the degree of coworker Involvement. Both of these analysis were repeated using data from 1990 and 1994. In addition, an analysis of variance were performed for the nominal-scale variables and Pearsonian correlation coefficients were generated for continuous scale variables.
The intervention was coworker supports.
There was no control or comparison condition.
The study found that coworker involvement did not increase cost efficiency. However, it did seem to increase the length of time the supported employees maintained their jobs. No other employment outcomes were related to coworker involvement. Coworker involvement was not associated with any of the demographic variables.
Utilizing coworkers to train supported employees does not increase cost efficiency. Coworker involvement appears to increase the supported employees job tenure. Coworker involvement was not impacted by the demographics of the supported employees, meaning that coworkers are willing to aid in the training of individuals with diverse disabilities and functioning levels.
Concerns are frequently expressed that working might worsen the mental health of people with severe mental illness(SMI). Several studies of Individual Placement and Support (IPS), however, have found associations between working and better nonvocational outcomes. IPS has been found to double the return to work of people with SMI in 6 European countries.
To explore separately associations between IPS, returning to work, and clinical and social outcomes. The study tested 4 specific questions. (1) Are there any differences in clinical and social functioning outcomes at 18-month follow-up between the IPS and control service groups? (2) Is there any association between (a) having worked, (b) total duration of work, and (c) job tenure and clinical and social functioning outcomes at 18-month follow-up? (3) Is being in work at any given time point associated with (a) particular concurrent clinical and social functioning variables or (b) change in clinical and social functioning over the subsequent 6 months?
A randomized controlled trial comparing IPS to usual high-quality vocational rehabilitation was conducted in 6 European centers.
Patients (n=312)in a randomized controlled trial of IPS in 6 European centers were followed up for 18 months. Patients were recruited if they had a psychotic illness, were aged 18 to local retirement age, had been ill and had major role dysfunction for at least 2 years, were living in the community, had not been in competitive employment in the preceding year and wanted to enter competitive employment.
To determine whether there were any differences between the IPS and vocational service patient groups, a between-group analysis was conducted to compare the 2 on each clinical and social functioning variable at T3, along with whether they had been hospitalized during or were in remission for the last 6 months of the study. Analysis of covariance was used to compare the 2 groups in terms of the clinical and social functioning variables at T3 while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively. These analyses were then repeated for those patients who had worked only. To determine the impact of having worked at any point during the 18-month follow-up period, patients who worked for at least one day (the study‚ primary outcome) were compared with those who did not in terms of each clinical and social functioning variable, along with whether they had been hospitalized during the final 6 months of the study and were in remission for the final 6 months. Analysis of covariance was used to compare the 2 groups (worked/not worked) in terms of the clinical and social functioning variables at T3, while controlling for the baseline level of the respective measure. Logistic regression was used to analyze the hospitalization and remission variables, controlling for the number of previous lifetime admissions and being in remission for the first 6 months of the study, respectively.
The IPS service in each center was implemented in accordance with the IPS place and train or supported employment‚ model, which has 6 key features: its goal is competitive employment in work settings integrated into a community economy; clients are expected to obtain jobs directly, rather than following lengthy pre-employment training (rapid job search); rehabilitation is treated as an integral component of mental health treatment rather than a separate service; services are based on clients preferences and choices; assessment is continuous and based on real work experiences; and follow-on support is continued indefinitely.
The vocational service (control service) at each center was the best alternative vocational rehabilitation service available locally, with a structured program conducted mostly in day facilities (although mostly residential in Ulm). Each was based on the more traditional principles of train and place providing vocational training and job preparation before the client proceeded to seek competitive employment. Each vocational service had to guarantee taking patients into the service within 2 months of randomization.
There were no differences in clinical and social functioning between IPS and control patients at 18 months. Those who worked had better global functioning, fewer symptoms, and less social disability at final follow-up; greater job tenure was associated with better functioning. Working was associated with concurrently better clinical and social functioning, but this contrast was stronger in the control up, suggesting that IPS was better than the control service at helping more unwell patients into work. Working was associated with having been in remission and out of hospital for the previous 6 months. It was also associated with a slight decrease in depression and with being in remission over the subsequent 6 months.
Concerns among clinicians about possible detrimental effects of working and supported employment have been misplaced. Although some of the associations found may have been selection effects, there is sufficient evidence of work having beneficial effects on clinical and social functioning to merit further exploration.
Youth with Autism Spectrum Disorder (ASD) face a number of obstacles when transitioning from school to work. The cost to society to support individuals with ASD who do not work is very high. The incidence of ASD is on the rise. It is important to make sure vocational services provided by the states are leading to successful employment outcomes for these individuals.
The goal of this study was to examine the employment outcomes of transition aged youth with ASD served by the states vocational rehabilitation system.
This study included individuals with autism spectrum disorder served by multiple vocational rehabilitation agencies in various settings.
Data was taken from the Rehabilitation Services Administration's (RSA); RSA-911 Case Service Report database. This database hold records of adults who apply for a states' vocational rehabilitation services. Demographics, vocational services received, and outcomes for closed cases (i.e. employed or not, hours worked etc...) are located there. The study examined the records of 34, 314 youth with ASD who were age 21 and under. Data was pulled for individuals whose cases were closed from 2002 to 2011.
A number of variables were examined in the study. This included: successful employment outcome, hours worked and wages and the cost of services. Data was pulled for all of the United States. Washington DC and US territories were excluded. Data from each state and year was reported for each study question. In order to identify trends data from 2002 to 2006 was compared to 2007 to 2011 and regression analysis was used to evaluate the data. Mean data for the total transition population served by VR was compared to the ASD group and t test statistics were used to compare outcomes between the two groups.
The intervention was various vocational rehabilitation services provided to assist youth with ASD with achieving successful employment.
There was no control or comparison condition.
Over a ten year time span, the number of transition aged individuals with ASD served by VR has increased over time. While employment outcomes, hours and wages have not improved for the group. Transition aged youth with ASD were more likely to receive a positive employment outcome if they received VR services as compared to all youth with disabilities served by VR. However, youth with ASD worked less hours and had lower wages. This means they were underemployed. The cost of VR services for this group remained stable. There is much variability between states.
Transition aged individuals with ASD are accessing VR services. However, their employment outcomes have not improved. More research is needed to determine what influences the variability between states and improve work outcomes for this group.
The individual placement and support (IPS) approach to supported employment for people with severe mental illness is becoming widely accepted as an essential component of evidence-based psychosocial rehabilitation. A key feature of IPS is that employment services are closely integrated with public mental health services. This can be challenging to implement in developed countries where mental health and employment systems are typically segregated. The demonstrated success of integrated mental health and employment programs implies that this approach can enhance early intervention mental health services and recovery-oriented mental health services.
This study examined the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand.
Workwise Employment Ltd in Christchurch, New Zealand is a supported employment service provider for people with mental illness, including substance misuse. Eligible participants were in receipt of either SB or IB due to a diagnosed mental health condition, often with concurrent family and social problems that exacerbated their situation. Four full-time employment specialists were supported by one administration position and one team leader. Employment specialists were not externally trained in IPS principles. However, in 2002 Workwise adopted these principles for internal training throughout its national network of disability employment services.
Employment outcomes were investigated for 49 young clients aged 16-25 years who entered the program between 1 July 2005 and 30 June 2007. These young clients represented 18% of the 270 clients assisted during this period. Data collection ceased on 4 April 2008. Eligible candidates were identified and referred by Work and Income staff from regular Work and Income seminars, and from individual income support reviews. Self-referrals were also permitted. Referrals were accepted if: (i) the person was in receipt of SB or IB for mental health or psychiatric reasons (including substance misuse); (ii)Work and Income approved the self-referral and (iii) it was clear people were volunteering for employment assistance. Clients were recommended to a particular employment service by the Work and Income staff. Clients could accept the initial referral or insist on choosing another of three alternative service providers.
The service had a comprehensive business information system that tracked all clients throughout the contract. Records of clients(n=49) aged 16‚Äì25 years were retrospectively examined. Data analysis was conducted by the team leader using Microsoft Excel 2003, guided by the outcome variables identified from published reports of comparable services. The comprehensive data management system enabled most variables of interest to be reported. Data quality was governed by the contract that required 100% accuracy and supporting evidence for all employment outcomes. All client records were reviewed monthly by an employment specialist, an administrator and by the team leader for the term of the contract. The records were also subject to regular internal review and intensive external auditing as a condition of the contract.
The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16‚Äì25 years over a 2-year period (2005‚Äì2007). These results were compared with recent national and international benchmarks.
The condition was published outcomes from recent national and international benchmarks that were based on studies using Random Controlled Trials.
As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables.
Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.
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).
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.
All participants were clients of Community Work Services, an employment services program in Madison Wisconsin.
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.
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.
The intervention was community-integrated employment utilizing a job coach and long-term support.
There was no comparison condition.
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.
The study findings provide evidence for the feasibility of integrated employment for individuals with severe disabilities in need of long-term employment supports.
Individual placement and support (IPS) has been developed as a standardized approach to supported employment aimed at helping people with severe mental health problems find competitive work. IPS has proven very effective in improving vocational outcomes amongst people with severe mental illness when compared to other vocational services, with a recent review reporting that 61% of participants enrolled in IPS programs gained employment, compared to 23% of those on other vocational programs. IPS does have limitations, however. As the results above would suggest, around 40% of people on IPS programs do not gain employment despite the support. A second criticism of IPS relates to job tenure of the people employed through these schemes, which tends to be short
To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. The aim of this rapid evidence assessment was to identify studies which have sought to improve on the effectiveness of standard IPS by adding a supplementary intervention. The aims are to answer the following questions: (1) what supplementary interventions have been used with IPS? (2) What are the results and what is the quality of those studies? (3) Do supplementary interventions improve employment rates and job tenure compared to IPS alone? (4) Are any supplementary interventions superior to others?
This study is a systematic review. The included studies were undertaken in various locations and settings.
The search was for empirical studies conducted from 1980 to July 2011. Studies were considered for inclusion if they: involved people with a severe mental illness; indicated the use of IPS or IPS core principles; involved supplementary interventions categorised as skills training, education, cognitive training, or psycho-therapeutic techniques. Studies meeting these criteria were only included if the design compared IPS alone with enhanced IPS. The sample included 11 studies involving individuals with mental illness.
A Rapid evidence assessment provides an overview of existing research on a specific research topic, as well as a simple extraction and synthesis of the relevant data. The methods used to search for and appraise the research are systematic and rigorous, but the depth of the search is limited by the development of search terms and breadth of resources searched. This type of assessment is particularly useful to quickly gather existing evidence in a research area and determine what future research needs to be done.
Data regarding employment rates and job tenure were extracted directly from the papers. Odds ratios were calculated where possible using data on participants employed/not employed per experimental group in each study. Where necessary, authors were contacted for further clarification or information.
A rapid evidence assessment of the literature was conducted for studies where behavioral or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion.
There were no comparison or control conditions.
In total 627 papers were identified and 246 remained after duplicates were removed, of which 241 were excluded at this stage (reasons are given below). References of the 5 included papers and relevant (excluded) systematic reviews were screened for potentially relevant titles, which identified a further 15 records for screening once duplicates had been removed. Of these, 6 further papers met the inclusion criteria. In total, 11 papers were included in the review and 250 papers were excluded. Averaging across the employment rates reported by four studies, enhanced IPS does appear to produce higher rates of competitive employment compared to IPS or control groups alone. The average enhanced rate of 76% would also appear to be higher than the average IPS employment rates reported in previous reviews , and this difference is accentuated when focusing on studies using skills training, where on average the employment rate is 25% higher. In addition, rates were moderately higher than previous reviews for studies involving cognitive training.
Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.
People with mental illness have high rates of unemployment and underemployment. Hong Kong is interested in investigating new ways to assist this population with employment. Research is needed.
The purpose of this article is to report on the vocational outcomes of people with mental illness participating in a supported employment (SE) program in Hong Kong.
The setting was community vocational rehabilitation providers and various places of business in Hong Kong.
The study sample included 748 individuals with mental illness who enrolled in supported employment programs in Hong Kong.
Employment data was collected on participants, including wages and job tenure was collected.
The intervention was the Individual Placement and Support model of supported employment.
There was no control or comparison group.
Of the 748 participants, 458 (61.2%) obtained competitive employment. The mean job tenure was 151 days. The mean salary was HK$4,561 (US$585.00) for full-time jobs and $2,368 (US$304.00) for part-time jobs. The majority of participants (62.4%) could sustain their job placement for more than 30 days, 110 (24.0%) participants could work for more than six months, and 59 (12.9%) could maintain their jobs for more than one year.
This study concluded that IPS programs could improve vocational outcomes for people with mental illness in Hong Kong. Recommendations for future research on evaluation of the effectiveness of SE program and for further development of SE in Hong Kong were suggested.
Supported employment is an evidence-based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment. Most research on the effectiveness of supported employment comes from the United States.
This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting.
The setting was community rehabilitation programs in Hong Kong.
Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were randomly assigned to either a supported employment program or a conventional vocational rehabilitation program.
Both vocational and non-vocational outcomes were measured in this study. Vocational outcomes include competitive employment rates, time to first job, total days employed, and total earnings. Non-vocational outcomes include self-perceived quality of life. Major assessments were conducted at baseline and at six and 18 month follow up points by the employment specialist.
The intervention was the Individual Placement and Support model of supported employment.
Traditional Vocational Rehabilitation Services
Over an 18 month study period, compared with participants in the conventional vocational rehabilitation program, those in the supported employment group were more likely to work competitively, held a greater number of competitive jobs, earned more income, worked more days and sustained longer job tenures.
Consistent with previous research findings, the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting.