White / Caucasian

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

Authors:

Malec, J. F.

Year Published:

2010

Publication:

Social psychiatry and psychiatric epidemiology

Volume:

Number:

Pages:

1-8

Publisher:

Springer

Background:

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.

Purpose:

The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.

Setting:

The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.

Sample:

The study sample consisted of consecutive new referrals (age 17‚Äì35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was as the presence of psychotic symptoms (clinically delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken antipsychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly ).

Data Collection:

Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice

Intervention:

The intervention represents a locally derived modification of the supported employment model. It is consistent with the model in that the service is embedded within the mental health team. Choices are based on individual preference, competitive employment is a major aim, and follow on support indefinite. Where it differs is in the greater emphasis on education (necessary in view of the typical developmental age of onset of first episode psychoses) and use of a broader approach, beyond just rapid job placement, to address specific areas of vocational functioning in the early stages of recovery (for example rebuilding confidence and structuring time).

Control:

There was no control or comparison condition.

Findings:

The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not.

Conclusions:

This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

URL:

http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models

Authors:

Magura, S., Blankertz, L., Madison, E., Friedman, E., & Gomez, A.

Year Published:

2006

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1406-1415

Publisher:

American Psychiatric Association

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. One of the highlights of this approach is rapid job placement which does not necessitate a need for job readiness training or sheltered work. Some individuals have used this approach to gain work but do not maintain employment. Some individuals do not need the intensity of services offered in a SE approach, but may benefit from a clubhouse approach.

Purpose:

This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).

Setting:

The setting included a number of different job sites across 5 states and DC where individuals with mental illness received supported employment services. Services were provided by 5 different experimental programs that adopted the individual placement and support model of supported employment.

Sample:

The participants included 310 individuals with mental illness who were unemployed, 18 years of age or older and who did not have a diagnosis of severe mental retardation. Each person was randomly assigned to the ACT or the Clubhouse programs. Most participants were white males with a schizophrenia diagnosis.

Data Collection:

The research measures included participant characteristics and employment. Control variables included: age, severity of psychiatric symptoms, severity of physical health problems and active substance use. Gender was also added.
Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale. Physical health problems were measured through PANSS probes, Medicaid claims, and interviews. Substance abuse was identified through records, reports and interviews. Two motivational control variable were collected related to interest in working at baseline and match of random assignment to participant preference. The programs kept the same service logs and other records.
The data analysis plan included benchmark comparisons of program performance by using published outcome data from exemplary SE programs. A comparison of ACT and clubhouse outcomes was completed using a services of hierarchical regression analyses.

Intervention:

The intervention was the Individual Placement and Support(IPS)model of supported employment delivered through Assertive Community Treatment programs.

Control:

There was no control condition as supported employment has already been identified as an evidenced based practice. Comparison services were delivered through Clubhouse programs.

Findings:

The results included a comparison with benchmark employment outcomes. Club house participants had higher earnings and hours worked as compared to participants in exemplary supported employment programs. Earnings and work hours for ACT participants was greater than two of those programs. A comparison of ACT and clubhouse outcomes found ACT program had better service engagement. There was no difference in time to obtain a first job. Club house participants were employed longer and for more hours and earned more than than ACT participants. Background variables were predictive of receipt of job search services, which predicted higher employment rates. Wage was an incentive for employment success. A few participants in transitional employment, had about the same job tenure as other participants.
ACT participants received services faster than clubhouse participants. The strong integration of vocational and clinical services, provided by ACT, appeared to be especially helpful to participants with co-occurring disorders.

Conclusions:

The authors concluded that adding supported employment into multiservice programs like ACT and clubhouses, is a way to provide more services to individuals with mental illness, without compromising quality of those services. Although, a cost analysis was not presented, it is suspected that this may also be a cost effective approach to providing supported employment services.

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759891/

Disabilities:

Populations:

Hispanic or Latino

Asian

Randomized Controlled Trials (RCTs)

Outcomes:

Increase in hours worked

Other

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Patterns of employment and independent living of adult graduates with learning disabilities and mental retardation of an inclusionary high school vocational program

Authors:

Lynas, L.

Year Published:

2005

Publication:

Research in Developmental Disabilities

Volume:

Number:

Pages:

317-325

Publisher:

Elsevier

Background:

Although employment rates for individuals with disabilities may be improving, improvement is needed. The picture for independent living is not much better. Studies have indicated that most adults with disabilities remain both single and living with their parents. They are isolated socially with few friends or meaningful relationships. Schools and school programs that facilitate the transition to adult life are needed.

Purpose:

The purpose of this study was to examine the employment careers of graduates in an inclusionary vocational and technology high school.

Setting:

The setting for the study was an inclusionary vocational/technical high school in Ohio.

Sample:

Thirty six students participated in the study. Nineteen individuals (11 males and 8 females) had been diagnosed with mild mental retardation and 17 (10 males and 7 females) with a specific learning disability by a school psychologist. All had been enrolled in full time programs for students with special needs and had an Individual education plan on file. During the last two years of high school they attended high school for two or three periods then spent the remainder of the day at a Vocational/Technology Center. Students were aged between 20 to 25 years. The majority or 26 of the students were caucasians. The subjects had been enrolled in a variety of vocational programs while attending the vocational tech center. On average, participants had exited or graduated from high school and the vocational center within the last five years at the time of the study.

Data Collection:

A sixteen item questionnaire was used to learn more about participants' employment and living situation. Participants were contacted by telephone. After answering each question, the participant was given the opportunity to make comments. Chi-square analysis was used to determine statistical differences between the two groups.

Intervention:

The intervention was Vocational Technical Education.

Control:

The study included a comparison group.

Findings:

Overall, the majority or 81% of the participants were employed. However, only 68% of individuals with mild mental retardation were employed as compared to 94% of those with learning disabilities. This was a significant statistical difference. There was no differences related to gender or the program the student attended at the vocational technical center. More participants with learning disabilities were employed in skilled jobs than those with mild mental retardation. Those individuals were working in service industry and factory jobs.
The mean rate of pay for those working was $9.00. there was no significant difference on rate of pay or benefits held by disability type. The majority or 94% of the sample were single. Most or 95% of those with mild mental retardation lived with their parents as compared to 53% of those with learning disability. The majority or 94% of those with learning disabilities owned a car while only 26%of those with mild mental retardation had one. Among those who were working and not driving 40% relied on public transportation. Related to recreation, a third of the respondents indicated watching movies was their main activity. All of the individuals with learning disabilities were registered to vote and had voted. Only 63% of those with mild mental retardation reported having voted.

Conclusions:

Overall over 81% of the graduates were employed. However, this is primarily accounted for by employment of students with specific learning disabilities (94%) as opposed to respondents with mild mental retardation (68%). However, even when this variance between the two disability types is accounted for, even the students with mild mental retardation are employed at a higher rate than other figures reported in earlier studies.
Another positive finding in the study was the rate of pay for the respondents. For those students working, the median hourly rate was $8.90 which is significantly above the national minimum wage with no statistical significant difference found between the two disability types. Additionally, 68% of those working reported to be receiving benefits.
The majority of participants with mental retardation (95%) were still living with their parents; whereas, 53% of those with learning disabilities were living at home. Members of both groups could benefit from training in this area including how to secure housing.
Individuals with learning disabilities were much more mobile in the community than their peer respondents with mental retardation. The students with learning disabilities were much more likely to own a car (94%) and thus get around the community in a more independent fashion. In areas without public transportation local agencies should provide transportation services for those adults with disabilities who do not or cannot maintain an automobile. The individuals who graduated from an inclusionary high school vocational and technology environment have done fairly well compared to respondents in other reported studies on the areas of employment, pay, and independent living. This may have been partially due to the fact that the learning environment moved students quickly through the exploratory phases of vocational education into the focused phase where students received specific vocational and job training as well as training in independent living skills. This was accomplished in a setting with other non-disabled peers who were also receiving strong vocational training.

URL:

http://www.sciencedirect.com/science/article/pii/S0891422204000253

Disabilities:

Intellectual disabilities

Specific learning disabilities

Populations:

Outcomes:

Intellectual disabilities

NIDILRR Funded:

Not Reported

Research Design:

Quasi-experimental

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:

Number:

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

Disabilities:

Specific learning disabilities

Populations:

Hispanic or Latino

Transition-age youth (14 - 24)

Urban

Outcomes:

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

Evaluation of an individual placement and support model system

Authors:

Luchansky, B., Brown, M., Longhi, D., Stark, K., & Krupski, A.

Year Published:

2004

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

251-257

Publisher:

Hogrefe Publishing

Background:

Individuals with severe mental illness have high rates of unemployment. The Individual Placement and Support(IPS) model of supported employment has demonstrated superior employment outcomes as compared to other conditions (ie. day treatment, sheltered work and counseling)through a number of randomized control trials. It is important to find out if this approach can be effectively implemented with fidelity in the field and yield similar results.

Purpose:

The purpose of this study was to conduct a retrospective evaluation of the employment outcomes of individuals who were involved in a Services for Employment and Education (SEE) program, based on the IPS model, in Massachusetts over a 4 and half year period of time.

Setting:

The setting included a number of employment sites in Massachusetts where individuals with mental illness who received supported employment services worked.

Sample:

Participants were 90 individuals who enrolled in the program from 1995 to 1999. The majority were Caucasian (90%) and male (65.7%). The mean age was 42 years with a range from 21 to 65. The majority (66%) had schizophrenia or another psychotic disorder and were receiving disability benefits. Over three quarters or (77.8%) had never been married.
The mean total score on work readiness was 1.33 and annual clinical contact hours was 23.62; the mean Clinical Evaluation of Risk and Functioning score was 39.62.

Data Collection:

An independent retrospective evaluation of the SEE employment outcomes was conducted. In addition, the SEE program fidelity was assessed using the IPS Fidelity scale.
Data was selected from three major sources. Demographics, days in program, number of jobs held previously and self rating of "work readiness were collected from the SEE program records. The SEEIS database provided data related to each job obtained (i.e.. start and end date, hours worked, wages etc...) and services received (i.e.. benefits counseling, assistance with job related problems and workplace supports, disclosure of disability etc.... Behavioral health program records provided treatment plan information, clinical contact hours and diagnosis. The case management services client tracking system had information about the person's level of functioning at program exit.

Intervention:

The intervention was, the Services for Employment and Education program, a modification of the Individual Placement and Support Supported Employment Model.

Control:

There was no control or comparison group.

Findings:

SEE participants held 196 jobs. The majority or 35.4% were service jobs. This was followed by 28.6% in marketing or sales, 20.9% were operator, fabricator, or technical jobs and 10.2% were professional, administrative or managerial in nature. The average number of hours worked per week was 16 with a range of 1 to 40 hours. One third of the jobs required 20 or more hours per week.
Wages ranged from $4.75 to $12.00.
Participants frequently received job related supports like benefits counseling, problem solving and on the job support on issues like negotiating changes in schedule, conflicts with coworkers and changes in management.
Support was also offered to assist individuals with disclosing their disability in order to receive reasonable accommodation.
Individuals in non professional jobs quit or were fired from their jobs more often than those who were not.
Eighty two percent of participants held at least one job. The mean was 2.69 positions with a range from 1 to 10. There were no significant differences between those who did and did not obtain work.
On average it took around 3.5 months for participants to secure employment. The average amount of time worked per job was a little more than 11 months.
Employment outcomes were related to education level which was correlated with more highly educated individuals working more total hours across all types of jobs. Participants who had higher self rated work readiness scores remained employed longer than those with lower rates. Also those with more active days in SEE and more employer accommodations remained employed longer. However, those who receive more on the job supports tended to work less hour and earn lower wages. Overall the SEE program had good fidelity to the IPS model.

Conclusions:

The majority of participants gained and maintained employment. The model had high IPS fidelity and had outcomes similar to and in some areas superior to the Supported employment and IPS model programs. Programs that follow a evidenced based employment model are more likely to have positive outcomes.

URL:

http://psycnet.apa.org/journals/prj/27/3/251/

Disabilities:

Populations:

Specific learning disabilities

Outcomes:

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:

Number:

Pages:

423-434

Publisher:

Exceptional Children

Background:

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,

(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

Disabilities:

Orthopedic impairments

Populations:

Outcomes:

NIDILRR Funded:

Not Reported

Research Design:

Qualitative

Peer Reviewed:

Yes

Use of vocational rehabilitative services among adults with autism

Authors:

Leahy, M. J., Chan, F., Lui, J., Rosenthal, D., Tansey, T., Wehman, P., Kundu, M., Dutta, A., Anderson, C. A., Valle, R.D., Sherman, S., & Menz, F. E.

Year Published:

2009

Publication:

Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.

Volume:

Number:

Pages:

487-494

Publisher:

Springer

Background:

Individuals with autism can have complex and significant impairments that hinder their ability to gain and maintain employment. The United States Vocational Rehabilitation (VR) System is set up to maximize the employment outcomes of individuals with disabilities by providing a variety of services. There is limited research on how existing services may assist individuals with autism with employment. Among those studies most do not report favorable results. More information is needed on how to improve access to services and enhance employment outcomes for individuals with autism.

Purpose:

The purpose of the study was to examine VR services for individuals with autism. More specific, the researchers examined if adults with ASD were more likely to be denied services as compared to adults with other impairments; costs of VR services for adults with autism as compared to adults with other impairments and whether individuals with autism achieved the goal of competitive employment at the time of case closure.

Setting:

This study included individuals with autism served by multiple vocational rehabilitation agencies in various settings.

Sample:

The dataset included 382,221 adults who were served by state vocational rehabilitation and had their cases closed in 2005 for reasons other than death or because they were determined not to need vocational rehabilitation services. There were 37 causes of disability in the dataset. The authors sorted them into the following categories: autism spectrum disorder (n=1,707); mental retardation (n=30,728); specific learning disabilities (n=33,155)and all others were combined into other impairments (n=316,471).

Data Collection:

Data on individuals receiving vocational rehabilitation services were obtained from the US Department of Education‚ Office of Special Education and Rehabilitative Services. This included demographic variables, impairment cause, types and cost of services paid for by the Rehabilitation Services Administration, reasons for closure, and competitive employment status. There were three dependent variables. The first indicating whether the case was closed because the rehabilitation service provider believed that the individual‚ disability was too significant to benefit from services. The second was the total dollar amount the state VR agency spent on services. The third was whether individuals
achieved competitive employment by the time of case closure. Bivariate associations between impairment cause and all other variables were estimated using means, medians and ANOVA for expenditure data, and frequencies and chi square tests for all other variables.

Intervention:

The intervention was various types of services provided by states' vocational rehabilitation agencies that led to competitive employment. This included services like: assessment and diagnosis, counseling, job search assistance, assistive technology,
and on-the-job training.

Control:

There was no control or comparison condition.

Findings:

The results revealed the following. First, relative to other individuals served by the vocational rehabilitation system, individuals with ASD were more likely to be denied services because it was believed that their disability was too severe for them to benefit from services. Second, among those who received services, people with ASD received a more expensive set of services than those with other impairments, although their service costs did not differ from individuals with mental retardation. And lastly, competitive employment rates among people with ASD did not differ from those with Specific Learning Disabilities or Mental Retardation, and were much higher than those of people with other impairments. Post hoc analyses seems to reveal that their employment is associated with on the job supports.

Conclusions:

Many individuals with autism can work. Individuals with autism and their families should seek out supports. Vocational rehabilitation should emphasize employment. Policy makers should examine ways to ensure individuals with autism have access to supports needed to make work a reality.

URL:

http://link.springer.com/article/10.1007%2Fs10803-008-0649-4#/page-1

Disabilities:

Autism Spectrum Disorder

Populations:

Outcomes:

Return to work

NIDILRR Funded:

Not Reported

Research Design:

Observational

Peer Reviewed:

Yes

Generalisability of the individual placement and support model of supported employment: results of a Canadian randomized controlled trial

Authors:

Lawer L., Brusilovskiy E., Salzer M.S., & Mandell, D. S.

Year Published:

2006

Publication:

British Journal of Psychiatry

Volume:

189

Number:

Pages:

65-73

Publisher:

The Royal College of Psychiatrists

Background:

Studies conducted in the United States have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

Purpose:

The purpose of this study was to determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

Setting:

The study was carried out at a teaching psychiatric hospital in Montreal, Canada. The hospital provides psychiatric treatment and rehabilitation services to people who live within a geographical sector in the south-west of Montreal. In addition to one central facility, which provides in-patient as well as various outpatient services, the hospital operates seven satellite out-patient clinics and a vocational rehabilitation center located about 1 mile from the main facility.

Sample:

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).
To be included in the study, individuals had to:
1. Be between 18 and 64 years of age;
2. Have a diagnosis of schizophrenia-spectrum disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychosis not otherwise specified), bipolar disorder, or major depression;
3. If their principal diagnosis was one of major depression, be classified as disabled due to mental illness by the provincial welfare system;
4. Express interest in competitive employment; and
5. Be unemployed at the time of signing the consent form.

Data Collection:

Baseline comparisons

In order to assess baseline equivalence of the groups, proportions of categorical variables at baseline were compared according to initial group assignment using 2-tests. Values of continuous measures were compared using either the t-test or, for non-normally distributed variables, the (non-parametric) Mann-Whitney U-test.

Vocational outcomes

Intention-to-treat analyses were conducted first, including all individuals and time periods for which we had data. Groups were compared on measures pertaining to any paid work (competitive or not) and competitive work only.

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:

Clients assigned to the control group were invited to an interview at the hospital's vocational rehabilitation centre. There they were given an opportunity to sign up for one of the many vocational services normally available. These included sheltered workshops, creative workshops, a client-run boutique and horticultural programmes. Job-finding-skills training, as well as psychosocial interventions administered through two day-treatment centres, were also available. None of these programmes had competitive employment as their immediate goal.

In addition, clients could be offered a social integration measure, that is a Quebec government programme that offers clients part-time work in competitive settings, in exchange for a Can $120 top-up to their monthly welfare cheque and a free public transport pass. Finally, clients could also be referred to a non-profit community agency that sought to place clients either in competitive jobs or in government-subsidized adapted businesses, in which wages equal or exceed the legal minimum wage but where the majority of jobs are reserved for people who have disabilities. This agency was not integrated with clinical services, nor did it provide ongoing support to clients, two hallmarks of supported employment.

Findings:

Over the 12 months of follow up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P < 0.001). They averaged 126 h of competitive work, v. 72 in the control group (P < 0.001).

Conclusions Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Conclusions:

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalized to settings in other countries.

URL:

http://www.pandora.com/station/play/650824915812121606

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

Increase in tenure

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs

Authors:

Lacaille, D., Sheps, S., Spinelli, J. J., Chalmers, A., & Esdaile, J. M.

Year Published:

2009

Publication:

Rehabilitation Psychology

Volume:

Number:

Pages:

175-163

Publisher:

American Psychological Association

Background:

Individuals with severe mental illness have a desire to work. however, they often face many barriers. The Working Alliance which is a collaborative working relationship within a counseling relationship has been a key element in therapeutic outcomes and has become linked to positive outcomes in psychiatric rehabilitation programs. Research has shown that a good working relationship between a person with mental illness and his service provider can improve symptoms, enhance medication compliance, improve quality of life and global functioning. More research on the working alliance in vocational rehabilitation services is needed. This study is a secondary analysis of data that was collected in a randomized control trial comparing to vocational models the Individual Placement and Support (IPS) model and the Diversified Placement Approach (DPA).

Purpose:

Setting:

The setting was two vocational programs that provided employment services to individuals with severe mental illness.

Sample:

Two hundred individuals were randomly assigned to the IPS or DPA model of supported employment in the parent study. The sample in this study included 91 (45 in the DPA and 46 in IPS). Most were men (61). The mean age was 38.9 years. About half (49.4%) had a schizophrenia-spectrum disorder. The majority or (63.7%) had more than a 12 year education. Most (81.3%) had prior work histories.

Data Collection:

Individuals were randomly assigned to DPA or IPS. Afterwards they were followed for two years. Objective data related to paid employment outcomes was collected through quarterly participant interviews. Data pertaining to the predictor variable, working alliance were collected by participant interviews every 6 months for individuals who were working at the time.
Demographic variables were measured by the Uniform Client Data Inventory and work history by the Employment and Income Review at baseline. Psychiatric symptoms were assessed at baseline and semiannual periods using the Positive and Negative Symptom Scale. Employment outcomes included total duration of paid work and mean paid job tenure. A scale was developed to measure working alliance. It included items related to emotional support, instrumental/informational support, frequency of performance feedback, stressfulness of the relationship, how critical the vocational worker was to the client and the person's overall satisfaction with the relationship.
Fidelity to the IPS or DPA model tenants were assessed every 6 months for both sites where individuals received services.
Stepwise hierarchical multiple regression analysis were run to determine relationships between the working alliance and employment outcomes. Baseline variables were controlled for and were entered into the regression model. Related to the number of days of paid work and job tenure applicable covariates were entered.
The working alliance variable was added in the second step of the regression analysis. Zero order correlates were also run. Independent t test was used to determine differences between IPS and DPA on working alliance.

Intervention:

The intervention was the Working Alliance where a person with a disability received emotional support, assistance, and more.

Control:

The comparison condition was low or no working alliance.

Findings:

The first hypothesis stating that the working alliance would be positively associated with employment was not confirmed. The second hypothesis that individuals would have a stronger working alliance with their vocational workers in IPS was confirmed.

Conclusions:

The finding that there is a lack of associations between working alliance and employment outcomes is not in alignment with previous literature. Evidenced based supported employment appears to lead to better relationships than the DPS approach. Additional research is needed.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19469605

Disabilities:

Populations:

Hispanic or Latino