Effects of local unemployment rate on vocational outcomes in a randomized trial of supported employment for individuals with psychiatric disabilities

Authors: 
Cook, J. A., Razzano, L. A., Burke-Miller, J. K., Blyler, C. R., Leff, H. S., Mueser, K. T., Gold, P. B., Goldberg, R. W., Shafer, M. S., Onken, S. J., McFarlane, W. R., Donegan, K., Carey, Kaufmann, C., & Grey, D. D.
Year Published: 
2006
Publication: 
Journal of Vocational Rehabilitation
Volume: 
25
Number: 
2
Pages: 
71-84
Publisher: 
IOS Press
Background: 

Research confirms that workers with disabilities have high unemployment rates. Among this group, less is known about barrier to employment for individuals with psychiatric disabilities, especially those who receive vocational rehabilitation services. Information about this could help improve service delivery.

Purpose: 

This study examined the impact of unemployment rates on the outcomes of individuals with psychiatric disabilities who were participating in supported employment services.

Setting: 

The setting was multiple community job sites across 7 states where individuals with psychiatric disabilities went to work.

Sample: 

Participants include 1,273 individuals with psychiatric disabilities from seven states, who were randomly assigned to experimental supported employment (51%) or services as usual(49%) for 24 months. There were approximately equal numbers of males and females. About 50% of the group were non minority. The median age of the participants was 38 years and around one third (35%) had a less than a high school education. The most prevalent diagnosis was schizophrenia (31%) followed by schizoaffective disorder, major depression and bipolar disorder. Almost all participants were prescribed medications at baseline.

Data Collection: 

Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven counties in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.

Intervention: 

The intervention was the Individual Placement and Support Model of supported employment for individuals with mental illness.

Control: 

The control was typical vocational rehabilitation services.

Findings: 

Participants residing in areas with low unemployment rates who received evidenced based Supported employment services had consistently better outcomes than all others. This included those who received evidence based supported employment services in areas with high unemployment. The study condition and employment rate were significant predictors of both competitive employment and working 40 or more hours a month.

Conclusions: 

Evidenced based supported employment can help improve the effects of high unemployment on work outcomes for individuals with psychiatric disabilities. The labor market influences employment outcomes for individuals with psychiatric disabilities who are participating in vocational rehabilitation programs. Individuals who reside in areas with high unemployment rates are likely to have poor outcomes if they do not receive high quality supported employment services.

URL: 
http://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr00344
Disabilities: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Do sheltered workshops enhance employment outcomes for adults with autism spectrum disorder?

Authors: 
Cimera, R., Burgess, S., & Wiley, A.
Year Published: 
2012
Publication: 
Autism
Volume: 
16
Number: 
1
Pages: 
87-94
Publisher: 
Sage
Background: 

Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.

Purpose: 

This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.

Setting: 

The study took place in sheltered workshop settings and a variety of businesses.

Sample: 

The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.

Data Collection: 

Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.

Intervention: 

The intervention was sheltered work.

Control: 

Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.

Findings: 

Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.

Conclusions: 

Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.

URL: 
http://aut.sagepub.com/content/16/1/87
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Utilizing co-workers as "Natural Supports" evidence on cost efficiency, job retention, and other employment outcomes

Authors: 
Cimera, R. E., Wehman, P., West, M., & Burgess, S.
Year Published: 
2001
Publication: 
Journal of Disability Policy Studies
Volume: 
11
Number: 
4
Pages: 
194-201
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Much discussion has taken place about the use of natural supports in supported employment. However, a review of the literature indicates empirical evidence supporting or refuting the concept is lacking.

Purpose: 

The purpose of this study was to provide empirical research on the use of natural supports, coworkers without disabilities, as a training strategy for supported employees.

Setting: 

A variety of job sites in Illinois where individuals who received supported employment services worked.

Sample: 

The initial sample included 166 individuals with a primary diagnosis of mental retardation, who were 21 to 69 years old. The majority or 66% were European American and 34% were African American. Of these 166 individuals 31 were replaced because they were lost to contact or the support agency refused to participate or the person did not want to participate. Of 197 (166 plus 31 replacement) surveys mailed, 111 were returned, resulting in a 56% return rate.

Data Collection: 

A survey was sent to the adult service providers of 166 people who were included in the Illinois Supported Employment Projects database. The survey include questions related to: worker characteristics, Job coach/Co-worker involvement, Benefit-cost analysis, and Job separation. Dependent variables included: cost efficiency, length of employment, job retention, hours worked per month, gross pay, IQ,level of mental retardation, gender, ethnicity, age and number of disabilities. The independent variable was collected by the coworker Involvement Instrument that assesses the Involvement of coworkers in training supported employees. There was no control. Four analysis took place. The first compared employment outcomes to the degree of coworker Involvement. The second compared the supported employee demographics to the degree of coworker Involvement. Both of these analysis were repeated using data from 1990 and 1994. In addition, an analysis of variance were performed for the nominal-scale variables and Pearsonian correlation coefficients were generated for continuous scale variables.

Intervention: 

The intervention was coworker supports.

Control: 

There was no control or comparison condition.

Findings: 

The study found that coworker involvement did not increase cost efficiency. However, it did seem to increase the length of time the supported employees maintained their jobs. No other employment outcomes were related to coworker involvement. Coworker involvement was not associated with any of the demographic variables.

Conclusions: 

Utilizing coworkers to train supported employees does not increase cost efficiency. Coworker involvement appears to increase the supported employees job tenure. Coworker involvement was not impacted by the demographics of the supported employees, meaning that coworkers are willing to aid in the training of individuals with diverse disabilities and functioning levels.

URL: 
http://dps.sagepub.com/content/11/4/194.full.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Factors associated with participation in employment for high school leavers with autism

Authors: 
Chiu, C., Chan, F., Strauser, D., Feuerstein, M., Ditchman, N.,Cardoso, E., O'Neill, J., & Muller, V.
Year Published: 
2013
Publication: 
Journal of Autism and Developmental Disorders
Volume: 
43
Number: 
8
Pages: 
1832-1842
Publisher: 
Springer US
Background: 

Research about what happens after students with autism leave high school is limited. Some research has focused on factors related to transitioning from school to work. In addition a few studies have investigated predictors of participation in employment for individuals with autism. Individuals with autism would like to be gainfully employed but many barriers exist. To help ensure a successful transition from secondary school to work more information about the factors associated with this process is needed.

Purpose: 

This study used a national representative data set to identify factors associated with employment.

Setting: 

The setting for this study is not described.

Sample: 

A secondary data analysis of NLTS2 longitudinal data set was performed. The sample included 830 secondary school students (ages 13 through 16) who had autism as a primary disability. The study sample was taken from currently available NLTS2 raw data from Institute of Educational Sciences.

Data Collection: 

This included data from the NLTS2 Waves 1 to Wave 4 parent/youth phone interview and/or mail survey data (Wave 1 was collected in the 2000–2001; Wave 2 was collected in the 2002–2003; Wave 3 was collected in the 2004–2005; and Wave 4 was collected in the 2006–2007 school years) and Wave 1 to Wave 2 school program survey data (Wave 1 was collected in the 2001–2002 and Wave 2 was collected in the 2003–2004 school years). The information was gathered for the first time in the 2000–2001 school year and last time in the 2006–2007 school year. SAS 9.2 was used for statistical analyses. All the data used had no missing values. The cases containing missing values were removed. Variables were described using descriptive statistics. Continuous variables, values were reported as means ± standard deviations (SDs). Categorical variables, values were reported as percents. A three-step process was used to determine the factors significantly associated with participation in employment for students with autism.

Intervention: 

There were several interventions. These included school based counseling and vocational services as well as contacting post secondary service providers.

Control: 

There was no control or comparison condition.

Findings: 

Among those students who left high school (weighted n = 4,167), 56 % (weighted n = 2,333)had participated in employment after exiting high school and 44 % (weighted n = 1,834) had not. The average age of those who went to work was 21 years. They worked in 29 different types of occupations. The top five job types included: material recording, scheduling, dispatching, and distribution (36.3 %), information and record clerks (12.9 %), building cleaning and pest control workers (8.5 %), retail sales workers (5.2 %), and other production occupations (5.1 %). The mean hourly wage was $7.90 with a range from $2.00 to $30.00, (SD = $22.00).

Conclusions: 

Family social status, student characteristics, and high school transition planning services were the significant factors that impacted whether or not individuals participated in employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23224594
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
No

Factors affecting employment following spinal cord injury: A qualitative study

Authors: 
Charbonneau, A., Bruning, W., Titus-Howard, T., Ellerbeck, E., Whittle, J., Hall, S., Campbell, J., Lewis, S., & Munro, S.
Year Published: 
2001
Publication: 
Rehabilitation Psychology
Volume: 
46
Number: 
4
Pages: 
400-416
Publisher: 
Educational Publishing Foundation
Background: 

Results from the University of Michigan Model Spinal Cord Injury Care Systems database indicate that, even though 59% of persons with spinal cord injury (SCI) are employed before injury, the majority (75%) are not employed at follow-up after injury.

Purpose: 

The purpose of the study was to examine factors influencing successful return to work following spinal cord injury (SCI).

Setting: 

The setting included a variety of rehabilitation programs.

Sample: 

Six employed and 6 unemployed persons with SCI were matched based on education, race, age, gender, time since injury, and level of function.

Data Collection: 

This was a qualitative research design. Interviews were used to collect data.

Intervention: 

Interviews were conducted regarding work history, family life, impact of disability, role models, barriers to employment, and satisfaction with vocational rehabilitation services received.

Control: 

A comparison was made between employed persons to unemployed persons.

Findings: 

Psychological and environmental factors were found to be the strongest moderating variables affecting employment. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation.

Conclusions: 

Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI. A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI.

URL: 
http://psycnet.apa.org/psycinfo/2001-05160-003
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities

Authors: 
Chapin, M. H. & Kewman, D. G.
Year Published: 
2006
Publication: 
Disability and Rehabilitation
Volume: 
28
Number: 
5
Pages: 
257-270
Publisher: 
Taylor & Francis
Background: 

Work is fundamental to persons with disabilities having some sort of independence and quality of life. Vocational rehabilitation services measure their effectiveness largely on employment outcomes of their clients. Employment outcomes of clients and thus what services should be offered to them can be predicted to some degree using data mining techniques such as the chi-squared automatic interaction detector (CHAID). Using CHAID to study data sets can yield a wealth of information about that data set.

Purpose: 

The purpose of this study was to use CHAID to mine the Rehabilitation Service Administration (RSA)-911 data set to determine what influences employment rates of rehabilitation clients with orthopedic disabilities.

Setting: 

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

Sample: 

The study participants (N=74,861) had their data mined from the RSA-911 database. All of the cases were closed by public rehabilitation agencies in fiscal year 2001. The sample was 55% male. European Americans numbered 73.2% of the sample. The mean age of the participants was 41.4 years. Forty-three percent of the sample completed high school and 28% had some college education. Eighty-eight percent had a severe disability.

Data Collection: 

Variables that predicted employment outcomes were grouped into personal variables: gender, race, disability severity, age, education, and government benefits and rehabilitation variables. Rehabilitation variables consisted of: receiving an initial assessment, medical restoration, post-secondary education, business and vocational training, adjustment training, on the job training, miscellaneous training, substantial counseling and guidance, job finding services, job placement, transportation, maintenance, personal assistive services, rehab engineering, assistive technology, and other. Data was analyzed using CHAID.

Control: 

The employment outcome was the comparison condition.

Findings: 

Job placement services significantly enhanced employment outcomes but were very much underutilized (only 25% of the study sample used them). Clients that had work disincentives such as social security disability insurance had lower employment rates than clients without such disincentives.

Conclusions: 

The CHAID analysis proved to be an effective approach for examining the data set and interpreting relationships between variables. Vocational rehabilitation counselors should be aware of the predictors to employment that this study suggests.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/16492620
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation

Authors: 
Catty, J., Lissouba, P., White, S., Becker, T., Drake, R., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., van Busschback, J., Wiersma, D., & Burns, T.
Year Published: 
2006
Publication: 
NeuroRehabilitation
Volume: 
21
Number: 
4
Pages: 
279-293
Publisher: 
IOS Press
Background: 

A number of cognitive, physical, and psychosocial impairments can occur following a TBI. These deficits can have a profound effect on daily functioning including an individual's ability to work. This may raise significant challenges for vocational rehabilitation professionals when helping individuals with TBI to prepare, obtain, and maintain competitive employment. Given the prevalence of TBI and the young age of many survivors, vocational rehabilitation will be needed. Professionals serving these individuals need to be prepared to develop appropriate rehabilitation plans. To be effective, they need to be familiar with TBI and the current research that looks at what impacts successful vocational outcomes. This may help facilitate the best use of limited funds for the vocational rehabilitation of persons with TBI. There are limitations in the research to date and more research is needed.

Purpose: 

The purpose of this study was to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns through an analysis of the Rehabilitation Services Administration (RSA) case service report (RSA-911) data on employment outcomes of persons with traumatic brain injuries (TBI) for fiscal year 2004.

Setting: 

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

Sample: 

The sample included 7,366 individuals with TBI whose cases were closed by state vocational rehabilitation agencies as employed or not employed in the fiscal year (FY) 2004.

This included 4,862 men (66%) and 2,504 women (34%). The majority or 78% were European Americans. The average age of participants was 37 years. Thirteen percent had co-commitment disabilities (psychiatric or substance abuse). Seventy six percent had a high school degree or more education. The average time between applying to eligible for VR services was a month and a half. The average time between eligibility and case closure was 30 months. Case expenditures averaged $4,238.

Data Collection: 

A data mining technique, exhaustive chi-squared automatic interaction detector (CHAID), was used to analyze. In the current study, exhaustive CHAID was used to build classification trees. This technique uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (e.g., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the employment outcome variable. The degree of differentiation is depicted sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation clients could be identified based on their demographic characteristics, work disincentives, and service patterns in terms of their observed levels on the outcome variable. The statistical software SPSS Answer Tree 2.0 was used to conduct the exhaustive CHAID analysis. The alpha level for all statistical tests was 0.01. This study corrected for the number of statistical tests within each predictor using a Bonferroni feature in the Answer Tree software.

Intervention: 

The interventions included various vocational rehabilitation services. This included job search assistance, job placement assistance, and on-the-job support services for individuals with TBI.

Control: 

There was no control or comparison condition.

Findings: 

The employment success rate for the entire sample was 50%. The employment success rate for persons with TBI is somewhat lower than the 55% rate for
the overall sample of vocational rehabilitation clients closed in FY 2004. European Americans had higher competitive employment rates than other groups. Clients with co-occurring psychiatric disabilities had a lower employment rate than those without psychiatric disabilities . Clients who had work disincentives also showed significantly poorer employment outcomes than those without disincentives. In terms of education, clients with a bachelor or higher educational degree had the highest competitive employment rate as compared to those with less education.

Case expenditure was related to outcomes, with more money spent on clients who were closed as successfully rehabilitated. Clients who were successfully rehabilitated also required less time in the rehabilitation process than unsuccessfully rehabilitated clients. Clients who received the following vocational rehabilitation services on-the-job training, job readiness training, miscellaneous training (e.g., GED or high school training needing to diploma), job search assistance, job placement assistance, on-the-job supports, maintenance, rehabilitation technology, and/or other services (e.g., occupational licenses, tools and equipment, and initial stocks and supplies) had significantly higher competitive employment rates than those who did not receive such services. Overall, the results indicated that the TBI clients could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.

Conclusions: 

Several vocational rehabilitation clinical practice guidelines came from the results of this study. First, the study underscore the importance of considering job placement and workplace support services in the vocational rehabilitation of persons with TBI. Unfortunately, job placement assistance and on-the job supports were found to be significantly underutilized by rehabilitation counselors in serving their TBI clients. Second, this study highlights the influence of disincentives on employment outcomes. Increased emphasis appears needed in the education of rehabilitation counseling students and practitioners on the importance of benefits counseling services and to encourage rehabilitation counselors to discuss this important service with consumers early in the rehabilitation planning process. Third, co-occurring psychiatric disabilities were found to significantly affect employment outcomes. This finding underscores the importance for rehabilitation counselors to (a) appropriately assess the emotional and psychological functioning of those served and to provide mental health counseling (b) increase knowledge about evidence-based mental health practices, and (c) to utilize the various interventions that have been found successful in diminishing psychiatric symptoms in the rehabilitation process. Finally, the very low incidence of co-occurring substance abuse disorders identified in this study (3%) is unusual, given research has indicated that about 50% to 66% of TBI clients had a history of alcohol and other drug abuse. This may be under reported. Rehabilitation counselors, need better education and training in substance abuse assessment and treatment within the context co-occurring disabilities.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17361045
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Working it out: Development and testing of a multimedia, vocational education program

Authors: 
Campbell, K., Bond, G., & Drake, R.
Year Published: 
2004
Publication: 
Substance Use and Misuse
Volume: 
39
Number: 
13
Pages: 
2525-2558
Publisher: 
Marcel Dekker Inc.
Background: 

Employment is a ongoing problem for individuals with substance dependency. Their vocational needs are unmet. Earlier studies have shown a positive correlation between employment and retention in treatment. Despite evidence about the value of addressing employment issues in treatment, the service delivery system does not address these needs. Welfare reform has increased expectations for substance abuse beneficiaries to gain employment. Due to shorter stays and funding cuts more programs primarily focus on substance use. Employment and work problems are not given priority. A multimedia interactive computer program may offer a cost effective way to address employment problems.

Purpose: 

The study hypothesis was that an interactive and tailored multimedia presentation of vocational rehabilitation information would be more effective than a general printed package of information and work book in reducing the severity of employment problems.

Setting: 

The study took place in residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico.

Sample: 

One-hundred and ninety-four (194) individuals who received residential and outpatient services for substance misuse from six treatment facilities in Massachusetts, New Hampshire, Vermont, Rhode Island, and New Mexico participated in the study. The average age of participants was 37 years and the majority or 64% were men. About 43% were from a minority group.

Data Collection: 

The measures included the Addiction severity index-multimedia version (ASI-MV), Social adjustment scale-self report (SAS-SR), Employment questionnaire, Treatment services review and Satisfaction questionnaire. Around 75% of the sample completed 3 or more CD-ROM sessions. These participants completed a satisfaction questionnaire after each session and at the end entire course. Follow up assessment was scheduled 6 month from baseline. Subjects completed SAS-SR and Employment Questionnaire. They were also contacted by telephone to complete a follow up to the ASI.

Intervention: 

The intervention included: Working It Out CD-ROM, a multi-session, computer based, self-administered, vocational education and intervention program for clients in substance dependency treatment programs.

Control: 

There was a comparison between the group that received the intervention and the control group members. The control group members used the Looking for Work Printed Package booklet along with a workbook with information on: facing fears, why work?, coping with job-related stress, job-finding skills (writing a resume, networking, interviewing, etc.), caring for oneself and the job, and what to say about ones recovery.

Findings: 

The study demonstrated that a multimedia vocational rehabilitation program that is self-administered, interactive, and tailored to clients employment status and motivation can be used in a substance dependency treatment program. The study did not find significant differences over the use of printed versus multimedia material. However, clients reported enjoying using the computer program and found the experience more relevant to their particular concerns.

Conclusions: 

The multimedia Working It Out program can be effectively used by clients who are in substance dependency treatment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15603013
NIDILRR Funded: 
Peer Reviewed: 
Yes

Tablet-based video modeling and prompting in the workplace for individuals with autism

Authors: 
Burke-Miller, J., Razzano, L. A., Grey, D. D., Blyler, C. R., & Cook, J. A.
Year Published: 
2013
Publication: 
Journal of Vocational Rehabilitation
Volume: 
38
Number: 
1
Pages: 
1-14
Publisher: 
IOS Press
Background: 

The number of adults with autism closed by Vocational Rehabilitation remains low. Employment rates for this group is the lowest for individuals with intellectual disabilities. For instance, the National Longitudinal Transition Study-2 reported that at two years post high school, only 28% of individuals with autism were employed (including competitive, supported, or sheltered employment).

Purpose: 

This article presents the findings from a preliminary study testing computer software across a range of employment settings for young adults with autism.

Setting: 

The study took place in a manufacturing and shipping warehouse in a Midwestern city.

Sample: 

The study sample included four young men ages 19 to 28, with autism spectrum disorder. One young man was Asian American and the other three were European American. All were unemployed; three lived with their parents; one lived in a community-based group home.

Data Collection: 

Participants were asked to complete a shipping task that involved an average of 73 steps. The percentage of task steps completed correctly was calculated by dividing the number of relevant completed steps by the sum of relevant completed and relevant not completed steps and multiplying by 100.

Intervention: 

A task analysis of the job was completed within the shipping department of the large manufacturing and shipping warehouse. The actual task was rental box shipping, which was reported as the most challenging of the shipping tasks due to the number of complex steps. A 13 minute, 10 second video was produced that depicted job responsibilities for the shipping tasks. This video had recorded voice overs to guide the user. The shipping task was then edited into 36 segments so that users could view portions of the task at a time. This video was loaded onto a software program called, VideoTote that was designed for an Android platform and made available to the study subjects on a Samsung Galaxy Tablet. The software was designed with universal design features.

Control: 

This study was a single subject design, the subjects were their own controls.

Findings: 

Results from this study suggest that the combination of video modeling during pre-employment training and on-the-job video prompting was helpful for individuals with autism when completing a complex shipping task.

Conclusions: 

The current study provides preliminary evidence that use of the tablet-based VideoTote software was an effective video modeling and prompting intervention for individuals with ASD in competitive employment. The results suggest that for some individuals with autism, job coaches likely will remain necessary.

URL: 
http://www.scholars.northwestern.edu/pubDetail.asp?t=pm&id=84873177849&
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Supported employment outcomes for transition age youth and young adults

Authors: 
Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rossler, W., Tomov, T., van Busschbach, J., Wiersma, D., & Lauber, C.
Year Published: 
2012
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
35
Number: 
3
Pages: 
171-179
Publisher: 
PubMed
Background: 

Over the last few decades, major developments have occurred in evidenced based practice supported employment (SE) services for people living with diagnoses of severe mental illness. However, the differential effectiveness of SE for different age groups of people in recovery is not well-studied. A group with particular need for employment services are youth age 18-24 and young adults ages 25-30 living with mental illness.

Purpose: 

The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes.

Setting: 

Data are from the Employment Intervention Demonstration Program (EIDP), a multisite randomized controlled trial of SE among 1,272 individuals with psychiatric disabilities in 7 states. The study uses 24 months of data from EIDP participants in seven states (AZ, CT, ME, SC, MA, TX, and MD)

Sample: 

EIDP participants were recruited from existing clinical populations via case manager referral, self referral, word of mouth, and at one site, newspaper advertisements. Participants were as those meeting the following inclusions criteria: being 18 years or older at time of study enrollment, being willing and able to provide informed consent, having an Axis I DSM-IV diagnosis of mental illness, and being unemployed at time of entry into the study.

Data Collection: 

Literature search included a combination of strategies, including PubMed search with keywords, examination of table of contents from major journals in related fields, and consultation with leading researchers.

Intervention: 

At each site, the experimental condition was a form of enhanced best-practice supported employment compared to either services as usual or an unenhanced version of the experimental model. For example, The Maryland, Connecticut, and South Carolina sites tested the individual placement and support model in which multidisciplinary provider teams engage in minimal pre-vocational assessment, rapid job search, and placement into competitive jobs, with the provision of training and ongoing follow-along support for as long as the patient requests it.

Control: 

As with many multisite studies, the nature of the comparison conditions varied. Arizona, Connecticut, Maryland, and South Carolina used a services-as-usual comparison condition in which the subjects received whatever services were available in the local community. Massachusetts used the Clubhouse model, in which facility-based services were provided according to a work-ordered day, with patients and staff working together on jobs within the program as well as at job placements in the community. Both Texas and Maine used an "unenhanced" version of their experimental condition (i.e., no social network services in Texas and no employer consortium in Maine).

Findings: 

Among all study participants, youth and young adults had significantly better outcomes in terms of any employment and competitive employment than older (>30 years) adults. However, in multivariable models of participants randomly assigned to SE, young adults had significantly better outcomes than youth or older adults. Other significant predictors of employment and competitive employment were future work expectations, not receiving Supplemental Security Income, and receipt of more hours of SE services. Characteristics of youth, young adults and SE programs that enhance employment are discussed in terms of policy and practice.

Conclusions: 

The finding that younger people had better employment outcomes in SE relative to older people provides empirical support for policies that encourage the provision of SE services to youth and young adults. However, it does not obscure the fact that work and return to work are ongoing challenges in the lives and people in recovery.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22246115
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes