An effective community-based mentoring program for return to work and school after brain and spinal cord injury

Authors: 
Kowalske, K., Plenger, P. M., Lusby, B., & Hayden, M., E.
Year Published: 
2012
Publication: 
NeuroRehabilitation
Volume: 
31
Number: 
1
Pages: 
63-73
Publisher: 
IOS Press
Background: 

Individuals with traumatic brain injury (TBI), spinal cord injury (SCI), and other neurological disorders often have severe disabilities impacting their ability to return to previous activities and return to work is limited. There is an ongoing need for education and vocational rehabilitation systems to work together to improve outcomes for youth and young adults with disabilities.

Purpose: 

The purpose of this article was to present information on a community-based mentoring program for young adults, ages 16 - 26 years with a recently acquired TBI, SCI, and other neurological disorders. The two objectives of this study were to 1) to demonstrate continuing increased in standardized measures of community integration from the time of enrollment in the program to the time of exit, and 2) improve the percentage of youth and adults who successfully access post-secondary education or employment opportunities.

Setting: 

The setting was various community sites in California.

Sample: 

The study sample included 131 individuals with TBI, SCI, or other neurologic disabilities recruited between 2005 and 2010. The majority were individuals with TBI or SCI with one individuals dually diagnosed with TBI and SCI (0.8%) and 8.4% with other disabilities to include other neurological disabilities. The majority were male (67.9%). The mean age was 20.3 years. Participants were primarily Hispanic (42%) or Caucasian (36.3%) with the remaining Asians (10.7%) or African American (4.6%). In addition, there were 121 trained "mentors" who were a minimum of two years post injury and had "a high level of acceptance and successful integration into the community". This included working or post-secondary education. Most were working (57%) while 30% were attending school, and 13% were retired.

Data Collection: 

Assessment was conducted a minimum number of four times: at enrollment, three months after entry, and every three months thereafter until attempted entry to post-secondary education or employment. In addition, each mentor and mentee completed a questionnaire which documented satisfaction with the relationship. Finally, the program used standardized assessments to include the Disability Rating Scale to include Employability and Level of Functioning, the Participation Index of the Mayo-Portland Adaptability Inventory, version 4, the Supervision Rating Scale, the Craig Handicap Assessment and Reporting Technique Short Form, and the Diener Satisfaction with Life Scale. A successful transition was as the individual remained in the post-secondary education or employment environment.

Data were collected by mentors and project staff. Formal assessments were collected by trained research assistants. Mentors submitted meeting logs documenting when, where, and topics discussed. Data were stored in an Access database and descriptive and inferential analyses were conducted using SPSS. Pre and post test program scores on standardized outcome measures were compared by paired T-tests.

Intervention: 

A mentoring program was developed called the "Back on Track to Success Mentoring Program." The goal of the program was to improve the ability of youth/young adults with disabilities to navigate through the services and programs available to individuals with disabilities. In addition, the goal was to increase the rate of return to work and post-secondary education. Each of the program participants were matched with a "mentor" who had training on a specific curriculum and refresher sessions throughout the entire program. Mentor/mentee relationships were required to have a minimum of three contacts per month in-person, telephone, or electronic mail methods.

Control: 

No comparison condition.

Findings: 

A total of 89 mentees were successfully matched with community-based mentors and participated in the program through to completion. Of this number 77 completed the entire program. Of this number 42 (54.5%) were considered program successes and 35 (45.5%) were considered program failures. Of the 42, 69% returned to school and 13 became employed (31%). For program successes, significant CHART subscale increases were seen for Cognitive Independence and Mobility. For program "failures" no statistically significant changes were seen in CHART subscale scores. For program successes, there were also significant improvements seen in the M2PI, the DRS, and SRS. For failures there were improvements seen in DRS but these were not statistically significant.

Conclusions: 

Overall, findings suggest that mentoring can be beneficial toward achieving the goals of post-secondary education, employment and community independence for individuals with disabilities; specifically those with traumatic brain injury, spinal cord injury and other neurological disorders.

URL: 
http://content.iospress.com/articles/neurorehabilitation/nre00775
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Supported employment for middle-aged and older people with schizophrenia.

Authors: 
Twamley, E. W., Padin, D. S., Bayne, K. S., Narvaez, J. M., Williams, R. E., & Jeste, D. V.
Year Published: 
2008
Publication: 
American Journal of Psychiatric Rehabilitation
Volume: 
11
Number: 
1
Pages: 
76-89
Publisher: 
Routledge
Background: 

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

The intervention was the Individual Placement and Support (IPS) model of supported employment. This 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: 

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

Findings: 

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

Conclusions: 

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

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19212460
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Work rehabilitation for middle-aged and older people with schizophrenia: a comparison of three approaches

Authors: 
van den Hout, J. H. C., Vlaeyen, J. W. S., Heuts, P. H. T. G., Zijlema, J. H. L., & Wijnen, J. A. G.
Year Published: 
2005
Publication: 
The Journal of Nervous and Mental Disease
Volume: 
193
Number: 
9
Pages: 
596-601
Publisher: 
Lippencott, Williams, and Wilkins
Background: 

There are increasing numbers of middle-aged and older people with schizophrenia-spectrum disorders, most of whom are unemployed. Across all age groups, rates of paid employment among people with these disorders are less than 15%. Yet the potential benefits of employment (e.g., increased income, activity, structure, socialization, and self-esteem) could improve symptoms, everyday functioning, and overall health. Many older people with severe mental illness (SMI) want to work. However, work rehabilitation programs usually do not target older patients, and no published studies have addressed work rehabilitation specifically in middle-aged and older people with SMI.

Purpose: 

To examine employment outcomes among middle-aged and older clients with schizophrenia in three work rehabilitation programs that varied in their emphasis on conventional vocational rehabilitation (train-then-place) versus supported employment principles (place-then-train). We analyzed retrospective data from 36 veterans receiving VA Wellness and Vocational Enrichment Clinic (WAVE) services and prospective data from a randomized controlled trial of 30 subjects receiving Department of Rehabilitation/Employment Services (DOR) or Individual Placement and Support (IPS).

Setting: 

Study settings were three separate programs: (a) the VA San Diego Healthcare System's Wellness and Vocational Enrichment Clinic (WAVE), (b) the Department of Rehabilitation/Employment Services (DOR), and (c) IPS. The WAVE Clinic provides conventional vocational rehabilitation (CVR) with some elements of SE. The DOR provides CVR services, as do most of the federally funded state agencies across the United States.

Sample: 

Participants were 40 years of age or older and had DSM-IV (American Psychiatric Association, 1994) diagnosis of schizophrenia or schizoaffective disorder made by their treating psychiatrists and confirmed by a diagnostic chart review by trained research staff. Exclusion criteria were alcohol or substance dependence within the past month and presence of dementia or other major neurological disorders.

Data Collection: 

All participants were classified as working (including volunteering) at any point in the study or nonworking for the analyses. Three IPS subjects and three DOR subjects decided not to pursue work and dropped out of the prospective study, but these subjects were included in the analyses. We used analysis of variance, [chi]2, and logistic regression techniques to analyze the data. All variables were distributed normally. The [alpha] for significance was set at p < 0.05, and all tests were two-tailed.

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: 

Two Comparison Conditions:
(1) WAVE: The WAVE Clinic assists veterans in achieving work readiness by providing prevocational classes and job contracts with various community employers. WAVE services are consistent with CVR, but unlike most CVR programs, the vocational services are integrated with psychiatric services.
(2)Department of Rehabilitation: In San Diego, vocational rehabilitation services for clients with mental illness are contracted to an organization called Employment Services. Individuals first become DOR clients and are then referred to Employment Services. To become a DOR client, the individual must first attend an orientation session and then attend an intake appointment with a DOR counselor. Following the intake appointment, the DOR has 60 days to determine eligibility for services.
Once eligibility has been approved, clients are referred to Employment Services and assigned a vocational counselor (a bachelor's-level or master's-level provider with a typical caseload of 35 clients). Job development and job coaching are provided by additional staff members. The DOR uses a train-then-place approach; individuals receive job readiness coaching and attend pre-vocational classes before their job search begins.

Findings: 

Across interventions, half the subjects obtained volunteer or paid work. IPS participants, those with schizophrenia (versus schizoaffective disorder), and those with more education were more likely to work or volunteer. Rates of volunteer or paid work were 81% in IPS, 44% in WAVE, and 29% in DOR. Rates of competitive/paid work only were highest in IPS (69%), followed by DOR (29%) and WAVE (17%).

Conclusions: 

Although they are typically written off as having little potential to return to work, especially paid work, middle-aged and older people with severe mental illnesses can obtain employment. Furthermore, they are more likely to do so in the context of a supported employment intervention than with traditional vocational services.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16131942
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A controlled study of services to enhance productive participation among people with HIV/AIDS

Authors: 
Killackey, E., Jackson, H. J., & McGorry, P. D.
Year Published: 
2008
Publication: 
American Journal of Occupational Therapy
Volume: 
62
Number: 
1
Pages: 
36-45
Publisher: 
American Occupational Therapy Association
Background: 

With improved treatment options, more individuals with HIV/AIDS are surviving longer and returning to productivity. Few studies have examined interventions that improve employment outcomes for HIV/AIDS survivors.

Purpose: 

This study assessed the effectiveness of a model program designed to increase productive participation among people living with HIV/AIDS within supportive-living facilities. The model program is entitled Enabling Self-Determination (ESD).

Setting: 

This study was implemented in four supportive living units in metropolitan Chicago, IL. These units exclusively serve individuals with HIV/AIDS.

Sample: 

The study sample consisted of 65 individuals with HIV/AIDS who were randomly assigned to the intervention group or a standard care group. The study group was predominantly male (82%) and African-American (71%).

Data Collection: 

Demographic and impairment data were collected at baseline. Information on engagement in productive activities (either employment, education, or volunteering) was collected at three, six, and nine months following completion of the ESD or standard treatment.

Data analysis consisted of first comparing the two groups to determine if they differed on baseline variables. Then, chi-square analyses were used to compare employment status at the three, six, and nine-month checkpoints.

Intervention: 

The ESD model consists of eight weekly one-hour sessions led by an Occupational Therapist. Sessions were designed with both educational and peer support components. Examples of sessions include: Managing one‚ own physical and mental health; Developing skills and habits for independent living; Developing occupational roles, habits, and skills; Building vocational confidence (job search, interviewing, etc.); and Learning self-advocacy and self-management skills.

Control: 

A non-randomized two-group design was used. This design was used because having both intervention and control conditions in the same residence would have contaminated the study. Two residences served as the intervention settings, and the other two as standard treatment settings.

Findings: 

No significant differences were found between the two groups. Of the original 65 participants, employment outcome data could be obtained for 46. Attrition rates were not significantly different for the two groups. Participants in the ESD group were significantly more likely to be employed at each of the three checkpoints. Employment rates for the ESD group were more than double those of the standard treatment group.

Conclusions: 

The findings of this study support the efficacy of the ESD model for individuals with HIV/AIDS, and that the benefits can be sustained over time. Replication of the ESD model with larger study groups and other populations would more fully evaluate the efficacy of the model.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18254429
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

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

Findings: 

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

Conclusions: 

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

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

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

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

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

Purpose: 

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

Setting: 

The setting was multiple employment sites where individuals worked.

Sample: 

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

Data Collection: 

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

Intervention: 

The intervention was individualized supported employment services.

Control: 

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

Findings: 

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

Conclusions: 

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

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

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

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

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

Purpose: 

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

Setting: 

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

Sample: 

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

Data Collection: 

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

Intervention: 

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

Control: 

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

Findings: 

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

Conclusions: 

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

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

Project SEARCH for youth with autism spectrum disorders: Increasing competitive employment on transition from high school

Authors: 
Wehman, P., Schall, C.M., McDonough, J., Kregel, J., Brooke, V., Molinelli., A., Ham, W., Graham, C. W., Riehle, J. E. Collins, H. T., & Thiss, W.
Year Published: 
2013
Publication: 
Journal of Positive Behavior Interventions.
Volume: 
15
Number: 
3
Pages: 
144-155
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Transition from school to work for youth with ASD is an ongoing problem for the public education system. Teachers also struggle with their attempts to match the strengths of a particular student to a job. Project SEARCH is a transition program for youth with disabilities. In this model students rotate through full day internships in businesses to gain work and related skills that may lead to an employment offer for some.Others have a positive work experience to highlight as they apply for jobs in their communities.Project SEARCH helps facilitate the transition from school to work.

Purpose: 

The purpose of this study was to determine how a Project SEARCH approach would work for youth with ASD.

Setting: 

The student internships took place in a large hospital.

Sample: 

Two case studies were presented for two young men with ASD. A 19 year with autism and a 20 year old with Asperger Syndrome as well as severe scoliosis.

Data Collection: 

The following data demographics, internship characteristics, job coach interventions was collected for each young man.

Intervention: 

The intervention was Project SEARCH model along with some specific ASD supports.

Control: 

There was no control or comparison condition.

Findings: 

One young man participated in internships in the hospitals' radiation, engineering and infection control departments. His performance improved over time and he was offered a job in the infection control department working 20 hours and week and earning $9.14 an hour.The other young man participated in internships in the Coronary Care Unit, Biomedical Durable Equipment, and Intensive Care Unit (ICU). His abilities also improved during the internships. After completing the internships he was offered a job working 20 hours a week in the ICU earning $9.14 per hour.

Conclusions: 

A Project SEARCH approach appears to be an effective way to assist youth with ASD with transition from school to work. This study was part of a larger study researching the use of Project SEARCH model to serve youth with ASD. The results from this larger study should help shed light on this topic.

URL: 
http://pbi.sagepub.com/content/early/2012/10/11/1098300712459760
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trial.

Authors: 
Wehman, P., Targett, P., Yasuda, S., & Brown, T.
Year Published: 
2014
Publication: 
Journal of Autism and Developmental Disabilities.
Volume: 
44
Number: 
3
Pages: 
487-500
Publisher: 
Springer US
Background: 

Unemployment rates for individuals with autism after existing secondary education are high. Rates for individuals with ASD are between 4 to 12 percent. They also have low rates of participation in vocational or technical education, and post secondary education as compared to individuals with speech and language impairments, learning and intellectual disabilities. Furthermore, state vocational rehabilitation programs are experiencing difficulties responding to the employment service needs of transition aged youth with ASD. The employment outcome rate reported by VR for individuals with ASD has declined much in recent years. Research is limited on intervention to assist adults with ASD with gaining and maintaining employment. Project Search is an intensive internship program that has been replicated with modifications and has shown some degree of success with assisting transition aged youth with gaining and maintaining real work for real pay in their communities.

Purpose: 

This study had two hypotheses. First, higher number of individuals who participate in an employer based employment training and placement program will be employed than those in the control condition at a)completion of intervention and b) 3 months post completion of the intervention.Second, those who participate in the program will require less work support as measured by the Support Intensity Scale Employment Activities Subscale than those in the control condition at a) completion of the intervention and b) 3 months post completion of the intervention. The study was continuing at this writing and this analysis presents results from the first 3 years of cohorts who have completed one school year in Project SEARCH plus ASD Supports.

Setting: 

The students worked in a variety of internships in two suburban hospitals.

Sample: 

A total of 40 students participated in the study. 16 were assigned to the control group and 24 were in the treatment group. The two groups were equivalent on a number of demographic variables including gender, race, medical diagnosis, and Individualized Education Plan category. There was a significant difference between the ages of the treatment and control groups. The age range for both was between 18 and 21.5 years old.

Data Collection: 

Information was collected from the application process and a brief interviews at scheduled times to gain insight into the person's employment status, wage earned, hours worked, and employer paid benefits. The Supports Intensity Scale was also used to assess adaptive behavior and intensity of support needs. The six subscales used were: home living, community living, lifelong learning, employment, health and safety, and social. The SIS allowed the examiners to identify the types of work supports individuals required and provided a measure of the overall adaptive behavioral support needs of participants at baseline. Data collectors were trained in the administration of the instrument and inter-rater reliability was high 92.5%.Preliminary analysis included frequencies, means, standard deviations and distribution of scores.

Intervention: 

The intervention was Project SEARCH.

Control: 

The control condition was traditional transition service.

Findings: 

The treatment group attained employment at a rate of 87.5% after completing Project SEARCH internship and the ASD program compared to the control group at 6.25%. The treatment group also experienced an increase in weekly hours worked and wages.Three months later there was a significant difference between the treatment and control group mean standard scores on the Employment Activities Subscale of the SIS.

Conclusions: 

This study provided preliminary results.Twenty one out of 24 or 87.5 percent of the treatment group acquired employment. While only one in 16 or 6.25 percent of the control group went to work.Employment after graduating from high school is an attainable goal for youth with ASD who display challenging behavior and who have a comorbid medical diagnoses.

URL: 
http://researchautism.net/publications/5492/competitive-employment-for-youth-with-autism-spectrum-disorders:-early-results-from-a-randomized-clinical-trial.
NIDILRR Funded: 
Peer Reviewed: 
Yes

Influence of least restrictive environment and community based training on integrated employment outcomes for transitioning students with severe disabilities.

Authors: 
Wickizer, T. M., Campbell, K., Krupski, A., & Stark, K.
Year Published: 
2004
Publication: 
Journal of Vocational Rehabilitation
Volume: 
21
Number: 
3
Pages: 
149-156
Publisher: 
IOS Press
Background: 

In light of the data supporting the education of individuals with severe disabilities in natural contexts, it stands to reason that programs would no longer provide training in contexts other than those that result insurable employment opportunities. However, this continue to occur. Even with mandated transition planning integrated employment outcomes are not improving for students with severe disabilities. Many of these students will then enter the public welfare system and/or segregated adult programs.

Purpose: 

The purpose of this study was to identify variables that are correlated with successful integrated employment outcomes for transitioning students with severe disabilities.

Setting: 

The setting included 20 different schools sites within 12 school districts in a county in California.

Sample: 

The sample included 104 students with severe disabilities, ages 18-22, who had exited school without diploma. Close to half (48%) of the participants had an IQ that placed them in the profound (25%) or severe (23%) category. The majority of the participants were white (53%), followed by Hispanic (28%), Asian (13%),African American (4%) and Pacific (2%). Around 53% of the students were males. Around 80% of the participants lived at home; the others lived in group homes.

Data Collection: 

The specific variables measured in this study included: the influence of duration of community-based training (CBT) that included on-the-job training, on the-job training as a subset of CBT, the least restrictive environment (LRE), or the degree of integration with non-disabled peers during the school day, demographics(gender, ethnicity, home setting, behavior problems, physical disability and mental ability) as measured by
intelligence quotient (I.Q.).Data was collected by structured interview with teachers and administrators, record review and on site observations. Correlations were used to examine predictive relationships between the independent variables and the dependent variable of post-school integrated employment. Cross tabulations and chi-square analysis of correlated variables were then used to identify significance of specific variables on employment outcome.

Intervention: 

The intervention was community based training. This included on the job training and physical integration with non disabled peers.

Control: 

There was no comparison or control group

Findings: 

These data indicate significant interactions between community based training (r = 0.387, p < 0.001), degree of integration with typical peers (r = 0.360, p < 0.001), andon-the-job training (r = 0.305, p = 0.001) and employment outcome. There were also strong intercorrelations among the three variables of CBT, degree of integration or LRE and on-the-job training.Transitioning students who received CBT and on the job training had a 69% integrated employment rate after leaving school.

Conclusions: 

The combinations of least restrictive environments,CBT/on-the-job training, and innovative teacher advocacy are potent predictors of post school employment for students with severe disabilities, regardless of intellectual functioning.

URL: 
http://www.kcdsg.org/files/content/Cheryl%20Jorgensen_Influence%20of%20LRE%20on%20Outcomes.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes