White / Caucasian

Consumers with CJI take longer to access SE services. Consumers with CJI and service providers identify the following as barriers or facilitators to access to SE: competing challenges for consumers with CJI such as mental health probation, the adverse impact of CJI on consumers' psychosocial functioning, social networks, consumers' relationships with practitioners, and practitioners' relationship with SE.

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

During the 18-month study period, participants receiving IPS were more likely than those in EVR to obtain competitive employment. IPS participants "also had superior outcomes in other dimensions of competitive employment" (p. 629). In addition, IPS participants were more satisfied than their EVR counterparts.

With regard to organization and financing of services, clinical and vocational services should be integrated at the client level, which would offer the client "single team of providers who provide a consistent message" (p. 368). Disability policies actually "socialize people into disability" rather than supporting them. Increasing the quality of vocational services will address several of the areas identified in the Intervention section, in addition to learning to implement, maintain, and update supported employment programs as research becomes available. Motivating people with psychiatric disabilities to work can be difficult, especially with the overwhelming issues they face, such as treatment itself, applying for benefits, obtaining insurance, or societal stigma. Job development is critical to supported employment; none of the approaches mentioned have been studied empirically. Individuals with greater symptoms are less likely to be employed unless vocational and psychiatric services are integrated.

Improving job supports would enhance the employability of the individual, such as increasing the use of natural supports and skills training. Career development implies a pattern of growth and increasing satisfaction in employment over time. And lastly, supported employment was proven as a successful technique in the field of developmental disabilities; it is being evaluated as a technique for use with populations other than those with psychiatric disabilities.

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

During the 12-month study, 76% of the IPS participants gained competitive employment, compared with 28% of the VRP participants (number needed to treat = 2.07; ?(2) = 19.84, df = 1, p<.001). Veterans assigned to IPS also worked substantially more weeks than those assigned to VRP (42% versus 16% of the eligible weeks, respectively; Mann-Whitney z test p<.001) and earned higher 12-month income (mean ± SD income of $9,264 ± $13,294 for IPS versus $2,601 ± $6,009 for VRP; Mann-Whitney z test p<.001) during the 12-month period.

The study looked at the employment outcomes between European American and Hispanic clients. In FY 2005, 2961 European Americans with TBI (55%) were closed in status 26 (competitive employment) and 2443 (45%) were closed in status 28 (unemployment). In comparison, 214 Hispanics with TBI (49%) were closed in status 26 and 223 (51%) were closed in status 28. The study also examined the effect of demographic and case service variables on employment outcomes. Significant predictors included: sex, age, education, receiving work disincentives and co-occurring alcohol or other drug abuse. The following VR services were found to be statistically significant as they improved the odds of obtaining competitive employment: substantial counseling, university training vocational training, job search assistance, job placement assistance, on-the-job support, maintenance, and assistive technology.

Most notably, clients who received job placement assistance and on-the-job supports were twice as likely to be successfully employed. In addition, transportation was found to be a significant risk indicator. Those who needed transportation services during the rehabilitation process had a reduction in odds of obtaining competitive employment. Hispanic clients who had work disincentives, who needed a comprehensive assessment to determine service needs, and who received physical or mental rehabilitation services had significantly lower odds of obtaining employment than did European American clients who received the same services And those in either group who did not need these services. Conversely, Hispanic clients who received technical assistance services were five times more likely to become competitively employed. There was no significant difference between European American and Hispanic clients in their odds of receiving substantial counseling, university training, job search assistance, job placement assistance, and assistive technology services. Hispanic clients were 1.5 times more likely to receive vocational training than were European American clients; 1.6 times more likely to receive transportation services than were European American clients ; and were times more likely to receive maintenance services than were European American clients. However, Hispanic clients had a reduction in odds of receiving on-the-job support services than did European American clients, the most significant predictor of successful employment outcomes.

The study revealed that there were no differences by condition in the level of motivation to secure employment and the number of job seeking activities. Whereas, the motivation to work and number of action steps did predict gaining employment for the entire sample.

The experimental groups achieved competitive employment (55%), worked 40 hours or more per month (51%), and had significantly higher earnings ($122/month) than the control groups (34%, 39%, and $99/month, respectively). These outcomes increased significantly over time.

Supported employment models were more effective than services as usual. In addition, Experimental condition subjects were
more likely to be competitively employed (55% of experimental versus 34% of control participants), work 40 or more hours per month (51% versus 39%), and have higher earnings ($i22/month vs. $99/month) despite controlling for demographic, clinical, and work history confounds. And, the advantage that the experimental group clients had over the comparison group increased over time.