White / Caucasian

American Indian or Alaska Native

Native Hawaiian / other Pacific Islander

Outcomes:

Increase in hours worked

Wages

NIDILRR Funded:

Not Reported

Research Design:

Observational

Peer Reviewed:

Yes

Employment services as an early intervention for young people with mental illness

Authors:

Brucker, D. L.

Year Published:

2010

Publication:

Early Intervention in Psychiatry

Volume:

4

Number:

4

Pages:

237-335

Publisher:

Blackwell Publishing Asia Pty Ltd

Background:

The individual placement and support (IPS) approach to supported employment for people with severe mental illness is becoming widely accepted as an essential component of evidence-based psychosocial rehabilitation. A key feature of IPS is that employment services are closely integrated with public mental health services. This can be challenging to implement in developed countries where mental health and employment systems are typically segregated. The demonstrated success of integrated mental health and employment programs implies that this approach can enhance early intervention mental health services and recovery-oriented mental health services.

Purpose:

This study examined the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand.

Setting:

Workwise Employment Ltd in Christchurch, New Zealand is a supported employment service provider for people with mental illness, including substance misuse. Eligible participants were in receipt of either SB or IB due to a diagnosed mental health condition, often with concurrent family and social problems that exacerbated their situation. Four full-time employment specialists were supported by one administration position and one team leader. Employment specialists were not externally trained in IPS principles. However, in 2002 Workwise adopted these principles for internal training throughout its national network of disability employment services.

Sample:

Employment outcomes were investigated for 49 young clients aged 16-25 years who entered the program between 1 July 2005 and 30 June 2007. These young clients represented 18% of the 270 clients assisted during this period. Data collection ceased on 4 April 2008. Eligible candidates were identified and referred by Work and Income staff from regular Work and Income seminars, and from individual income support reviews. Self-referrals were also permitted. Referrals were accepted if: (i) the person was in receipt of SB or IB for mental health or psychiatric reasons (including substance misuse); (ii)Work and Income approved the self-referral and (iii) it was clear people were volunteering for employment assistance. Clients were recommended to a particular employment service by the Work and Income staff. Clients could accept the initial referral or insist on choosing another of three alternative service providers.

Data Collection:

The service had a comprehensive business information system that tracked all clients throughout the contract. Records of clients(n=49) aged 16‚Äì25 years were retrospectively examined. Data analysis was conducted by the team leader using Microsoft Excel 2003, guided by the outcome variables identified from published reports of comparable services. The comprehensive data management system enabled most variables of interest to be reported. Data quality was governed by the contract that required 100% accuracy and supporting evidence for all employment outcomes. All client records were reviewed monthly by an employment specialist, an administrator and by the team leader for the term of the contract. The records were also subject to regular internal review and intensive external auditing as a condition of the contract.

Intervention:

The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16‚Äì25 years over a 2-year period (2005‚Äì2007). These results were compared with recent national and international benchmarks.

Control:

The condition was published outcomes from recent national and international benchmarks that were based on studies using Random Controlled Trials.

Findings:

As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables.

Conclusions:

Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/21043209

Disabilities:

Autism Spectrum Disorder

Transition-age youth (14 - 24)

Populations:

Native Hawaiian / other Pacific Islander

Outcomes:

Traumatic brain injury (TBI)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Difficulties with multitasking on return to work after TBI: A critical case study

Authors:

Boycott, N., Schneider, J., & McMurran, M.

Year Published:

2010

Publication:

Work

Volume:

36

Number:

2

Pages:

207-216

Publisher:

IOS Press

Background:

Cognitive functioning is a strong predictor of success at work. Every job requires a specific set of cognitive skills. Multitasking requires a person to switch between several concurrent tasks, requiring the application of a variety of cognitive strategies to succeed without errors. After a traumatic brain injury (TBI) a person may have problems processing cognitive information. This is one of the leading reasons for loss of work among individuals with mild TBI. People who return to work after injury have reported increased cognitive demand with associated stress. Occupational rehabilitation providers have noted organizational and planning of complex or multiple work tasks difficult for high functioning individuals post TBI. The difficulty seemed to not only stem from cognitive problems but also the ability to apply cognitive strategies on the spot or situations with increased cognitive load. While neuropsychological evaluations may prove useful in helping determine potential cognitive capacity to return to work, there are some limitations to its usefulness. Some believe that sampling work behaviors through observation or client and employer interview may be a much better way to obtain accurate evaluation of cognitive work demands for individuals who are attempting to return to work after TBI.

Purpose:

The study examines the use of the Perceive, Recall, Plan, Perform@WORK:Questionnaire/interview with category rating response format, by an employer to determine information processing strategy application difficulties.

Setting:

The study took place at a telemarketing company.

Sample:

A thirty year old man who sustained a TBI nine months earlier. His Glascow coma score was 9/15 and he experienced post traumatic amnesia for 21 days post injury.

Data Collection:

The participant's employer was interviewed by an occupational therapist using the PRPP@work questionnaire/interview format. The participant's case manager was also present to provide background information, and to corroborate interview data from other assessment sources like client observation and interview.

Intervention:

A case study method using the PRPP at work questionnaire/interview format.

Control:

There was no control or comparison condition.

Findings:

The employer did not perceive that the employee with TBI, was adequately applying cognitive information strategies in any of the four areas (perceive, recall, perform, plan) to meet job requirements. The findings indicated specific areas of information processing strategy strengths and weaknesses during work performance as categorized by PRPP@WORK Employer Questionnaire/Interview.

Conclusions:

More research is needed. A measure of mental effort should be included in future studies assessing a person's ability to apply cognitive information processing strategies in multitasking work environments. While it is not possible to generalize the findings to the broader population of individuals with TBI the findings contribute to targeting future research in the area of improving multitasking work behaviors. The PRPP@WORK may have potential to offer useful information about the capacity of a person to engage in complex information processing for multitasking work performance post TBI.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/20634614

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Implementing supported employment as an evidence-based practice

Authors:

Bond, G. R., Campbell, K., & Drake, R.

Year Published:

2001

Publication:

Psychiatric Services

Volume:

52

Number:

3

Pages:

313-322

Publisher:

American Psychiatric Association

Background:

The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.

Purpose:

The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).

Setting:

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample:

The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.

Data Collection:

A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.

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:

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings:

The following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).

Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.

Conclusions:

Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

URL:

http://www.worksupport.com/kter/documents/pdf/ImplementingSupportedEmployment.pdf

Disabilities:

Populations:

Outcomes:

Systematic reviews and meta-analysis

Increase in tenure

Return to work

NIDILRR Funded:

Not Reported

Research Design:

Peer Reviewed:

Yes

Validation of the revised individual placement and support fidelity scale

Authors:

Bond, G. R., Peterson, A., Becker, D., & Drake, R.

Year Published:

2012

Publication:

Psychiatric Services

Volume:

63

Number:

8

Pages:

758-763

Publisher:

American Psychiatric Association

Background:

Systematic reviews have concluded that the Individualized Placement and Support (IPS) model of supported employment is an evidence-based practice. The IPS model is a systematic approach to helping clients with severe mental illness obtain competitive employment The 15-item IPS Fidelity Scale (IPS-15) was developed and has been widely adopted in routine practice as a quality improvement tool and in formal research studies to monitor treatment integrity and drift. Nine of ten evaluations have found a positive association between the IPS-15 and competitive employment outcomes. Since the publication of the IPS-15 in 1997, researchers and fidelity assessors have noted deficiencies in the IPS-15, some owing to under-specification of the IPS model in early publications. Specifically, early conceptualizations of the IPS model gave little attention to benefits counseling about Social Security, Medicaid, and other government programs in relation to gaining employment.

Purpose:

The individual placement and support (IPS) model of supported employment for people with severe mental illness is an evidence-based practice. The 15-item IPS Fidelity Scale (IPS-15) was developed to measure program fidelity and has been shown to have good psychometric properties, including predictive validity. On the basis of field experience and research updates, the authors developed an expanded and revised version of this scale, the IPS-25, also known as the Supported Employment Fidelity Scale. This study evaluated the psychometric properties of the IPS-25. The primary hypothesis was that the IPS-25 would be positively associated with the competitive employment rate. Our two secondary hypotheses were that the unemployment rate would be negatively correlated with the competitive employment rate and that program longevity would be positively correlated with both the IPS-25 and competitive employment rate.

Setting:

The study drew on secondary data analysis from an ongoing quality improvement strategy employed in an IPS learning collaborative in 13 states devoted to implementing high-fidelity IPS services. Eight of the 13 states in the IPS learning collaborative participated. We excluded the one state not using the IPS-25 and three states that were still in the start-up phase of IPS implementation. One state opted not to participate in the project.

Sample:

The sample consisted of 79 sites; the number of sites per state varied (range two to 21), consistent with the stage of IPS dissemination within each state. On average, programs had an active caseload of 59 clients (range ten to 334). Most sites had reported outcomes for at least one year before the most recent fidelity assessment. However, 17 sites had been reporting outcomes for fewer than three quarters before the date of the fidelity assessment used in the analysis.

Data Collection:

As part of the agreement for participating in the IPS learning collaborative, individual sites agree to collect annual fidelity assessments and quarterly competitive employment outcomes. Fidelity reviews were conducted according to each state's procedures. The fidelity assessors for each state included trainers from technical assistance centers and state mental health and vocational rehabilitation agencies.
Following exploratory data analysis to plan statistical methods, the study used multiple regression to examine the fidelity-outcome relationship, controlling for unemployment rate and program longevity. Finally, the study conducted the analysis of variance linear trend analysis on the classification based on benchmark fidelity levels.

Intervention:

Interventions with the IPS model of supported employment are 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.

Findings:

Internal consistency reliability for the IPS-25 was .88. Predictive validity, measured as the correlation between the IPS-25 and site-level employment rate, was .34. Eight of the IPS-25 items were significantly positively correlated with employment rate. Items related to the vocational generalist role, disclosure, follow-along support, and vocational unit were the most strongly correlated with employment. Program longevity was positively associated with employment, whereas the unemployment rate was not.

Conclusions:

The IPS-25 has promising psychometric properties, with greater precision and content coverage than the IPS-15. However, it has not demonstrated an advantage over the IPS-15 in predictive validity. Research directly comparing the two scales is needed.

URL:

http://www.worksupport.com/kter/documents/pdf/Bond_ValidationoftheRevisedIndividualPlacementandSupportFidelityScale.pdf

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

Validation of the revised individual placement and support fidelity scale

Authors:

Bond, G. R., Picone, J., Mauer, B., Fishbein,S., & Stout, R.

Year Published:

2012

Publication:

Psychiatric Services

Volume:

63

Number:

8

Pages:

758-763

Publisher:

Psychiatric Services

Background:

Systematic reviews have concluded that the Individualized Placement and Support (IPS) model of supported employment is an evidence-based practice. The IPS model is a systematic approach to helping clients with severe mental illness obtain competitive employment The 15-item IPS Fidelity Scale (IPS-15) was developed and has been widely adopted in routine practice as a quality improvement tool and in formal research studies to monitor treatment integrity and drift. Nine of ten evaluations have found a positive association between the IPS-15 and competitive employment outcomes. Since the publication of the IPS-15 in 1997, researchers and fidelity assessors have noted deficiencies in the IPS-15, some owing to under-specification of the IPS model in early publications. Specifically, early conceptualizations of the IPS model gave little attention to benefits counseling about Social Security, Medicaid, and other government programs in relation to gaining employment.

Purpose:

The individual placement and support (IPS) model of supported employment for people with severe mental illness is an evidence-based practice. The 15-item IPS Fidelity Scale (IPS-15) was developed to measure program fidelity and has been shown to have good psychometric properties, including predictive validity. On the basis of field experience and research updates, the authors developed an expanded and revised version of this scale, the IPS-25, also known as the Supported Employment Fidelity Scale. This study evaluated the psychometric properties of the IPS-25. The primary hypothesis was that the IPS-25 would be positively associated with the competitive employment rate. Our two secondary hypotheses were that the unemployment rate would be negatively correlated with the competitive employment rate and that program longevity would be positively correlated with both the IPS-25 and competitive employment rate.

Setting:

The study drew on secondary data analysis from an ongoing quality improvement strategy employed in an IPS learning collaborative in 13 states devoted to implementing high-fidelity IPS services. Eight of the 13 states in the IPS learning collaborative participated. We excluded the one state not using the IPS-25 and three states that were still in the start-up phase of IPS implementation. One state opted not to participate in the project.

Sample:

The sample consisted of 79 sites; the number of sites per state varied (range two to 21), consistent with the stage of IPS dissemination within each state. On average, programs had an active caseload of 59 clients (range ten to 334). Most sites had reported outcomes for at least one year before the most recent fidelity assessment. However, 17 sites had been reporting outcomes for fewer than three quarters before the date of the fidelity assessment used in the analysis.

Data Collection:

As part of the agreement for participating in the IPS learning collaborative, individual sites agree to collect annual fidelity assessments and quarterly competitive employment outcomes. Fidelity reviews were conducted according to each state's procedures. The fidelity assessors for each state included trainers from technical assistance centers and state mental health and vocational rehabilitation agencies.
Following exploratory data analysis to plan statistical methods, the study used multiple regression to examine the fidelity-outcome relationship, controlling for unemployment rate and program longevity. Finally, the study conducted the analysis of variance linear trend analysis on the classification based on benchmark fidelity levels.

Intervention:

Interventions with the IPS model of supported employment are 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.

Findings:

Internal consistency reliability for the IPS-25 was .88. Predictive validity, measured as the correlation between the IPS-25 and site-level employment rate, was .34. Eight of the IPS-25 items were significantly positively correlated with employment rate. Items related to the vocational generalist role, disclosure, follow-along support, and vocational unit were the most strongly correlated with employment. Program longevity was positively associated with employment, whereas the unemployment rate was not.

Conclusions:

The IPS-25 has promising psychometric properties, with greater precision and content coverage than the IPS-15. However, it has not demonstrated an advantage over the IPS-15 in predictive validity. Research directly comparing the two scales is needed.

URL:

http://www.worksupport.com/kter/documents/pdf/Bond_ValidationoftheRevisedIndividualPlacementandSupportFidelityScale.pdf

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US

Authors:

Bond, G. R., Drake, R.E., & Becker, D. R.

Year Published:

2012

Publication:

World Psychiatry

Volume:

11

Number:

1

Pages:

32-39

Publisher:

World Psychiatric Association

Background:

While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ability to generalize to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies.

Purpose:

The current review has two goals. First, given the growing international attention to IPS, it examines the effectiveness of IPS in studies conducted outside the US compared to US studies. Second, it expands the scope of prior IPS reviews by adding recent randomized controlled trials (RCTs) and enlarging the range of outcome measures in order to examine the hypothesis that IPS yields better competitive employment outcomes across a range of measures than alternative vocational programs.

Setting:

In most studies, participants were recruited from clients receiving services from community mental health centers. Altogether, the 15 studies analyzed Control enrolled 1063 IPS participants (mean = 70.9 per study) and 1117 control participants (mean = 74.5 per study).

Sample:

The study identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. It examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered non-competitive employment, program retention, and nonvocational outcomes.

Data Collection:

Data were recorded directly from published reports or calculated from information presented in the published studies. For the measure of job duration, the study converted total weeks worked to an annualized rate, reporting the findings for both the full intent-to-treat sample and the worker subsample (those who obtained at least one competitive job during follow-up).

Intervention:

The intervention was the Individual Placement and Support (IPS) model which 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:

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings:

Rigorous evaluations of IPS suggest that 60% or more of IPS clients obtain competitive jobs, compared to about 25% of those who receive other types of vocational assistance. One way of interpreting this finding is that approximately 25% of clients who express an interest in competitive employment will succeed in obtaining a job in diverse and ineffective vocational programs or even without any vocational services, but IPS helps an additional 35% of the target group who otherwise would remain unemployed. The finding of a large and statistically significant beneficial impact of IPS is robust, upheld in all 15 studies. The effectiveness of IPS is also suggested by other measures of competitive employment outcome, including time to first job, job duration and total hours employed during the follow-up period. Most IPS clients work part-time, typically half-time; about two-thirds of those who obtain competitive employment work 20 hours or more per week. Few IPS clients work full-time, likely due to preferences, limited stamina, and/or fear of losing health insurance or other benefits. Consistent with the principle of rapid job search, the time to first competitive job for IPS participants is nearly 10 weeks sooner than for controls. The mean length of time to first job for IPS participants (19 weeks) is, however, still lengthy for a model that prescribes rapid job search.

Conclusions:

To summarize, the question of IPS transportability outside the US remains unanswered. While the published studies suggest that the labor and disability laws in some European countries may make a direct replication of IPS difficult, there are also indications that IPS transports well to other countries, such as Australia and the Hong Kong region of China. Finally, before concluding that the IPS must undergo radical adaptations in another nation, IPS programs should receive sufficient training and guidance to implement the model with high fidelity.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/22295007

Disabilities:

Populations:

Outcomes:

Increase in hours worked

Increase in tenure

NIDILRR Funded:

Randomized Controlled Trials (RCTs)

Research Design:

Peer Reviewed:

Yes

A community-based trial of vocational problem-solving to increase employment among methadone patients.

Authors:

Zanis D, Coviello D, Alterman A. Appling S

Year Published:

2001

Publication:

Journal of Substance Abuse Treatment

Volume:

21

Number:

1

Pages:

19-26

Publisher:

Elsevier

Background:

Following drug use stabilization, employment has long been considered an important secondary goal for patients enrolled in methadone maintenance treatment programs. Several studies have found moderate positive correlations between increased employment, decreased substance use, and positive social functioning. Given the low rates of employment, patients desire for
employment services, and the association of employment with improved outcomes, employment interventions appear to be important to explore.

Purpose:

The main purposes of the study were to (a) train methadone counselors to deliver the Vocational Problem-Solving Skills (VPSS) intervention and (2) evaluate whether unemployed patients randomized to VPSS counseling would improve their employment functioning compared to patients randomized to an alternate activity.

Setting:

The study was conducted at two comparable methadone treatment centers, each of which had both employed and unemployed clients.

Sample:

The study sample consisted of 109 individuals receiving methadone treatment. Entrance criteria included the following: (1) Unemployed or underemployed, as working ‚under the table‚ less than 10 hours per week; (2) stabilized on methadone and enrolled in the treatment program for a minimum of 3 months; (3) expressed interest and capacity to work at least 20 hours per week; and (4) actively seeking employment as by the Bureau of Labor Statistics. Males constituted 61% of the sample, and African-Americans 61%

Data Collection:

Participants were assessed by interviews at baseline, biweekly for 12 weeks, and at 6 months post-baseline. Measures included standardized measures of addiction and independent urine sampling, a vocational assessment, a treatment service review, chart review, and independent employment verification. Data analysis included descriptive statistics, a series of bivariate analyses to examine the correlation between potential predictor variables and the criterion variable (employed/not employed at least one day in the past 30 days at the 6-month follow-up point), and multinomial regression analysis.

Intervention:

Vocational Problem-Solving Skills (VPSS) is a cognitive-based intervention designed to assist chronically unemployed individuals transition to work. The five objectives of the VPSS intervention are to help participants (1) understand why they want to work; (2) understand how to overcome barriers to work; (3) set realistic vocational goals; (4) identify realistic resources to help locate job opportunities; and (5) take appropriate actions to obtain work. All VPSS sessions were designed to be approximately 30 to 60 minutes in length and delivered within a maximum of a 12-week period. Both patients and counselors were provided with a manual and workbook, outlining each of the sessions.

Control:

The comparison group participated in an Interpersonal Problem Solving (IPS) intervention of similar duration and intensity as the VPSS. The goal of IPS counseling was to help patients develop improved problem-solving skills to either reduce drug use or continue abstinence from drug use. The five objectives of the IPS counseling were to: (1) reduce/eliminate illicit drug
use or maintain an abstinence plan; (2) understand the utility of social supports in recovery; (3) examine successful and unsuccessful efforts at recovery; (4) formulate realistic recovery plans; and (5) engage in planned activities.

Findings:

Of the 109 participants, 101 could be located for six-month follow-up. At the point, 53 (54.6%) were considered, 19 (19.6%) were termed part-time employees (paid for working between 1 and 14 days), and 25 (25.8%) were considered full-time employees (paid for working 15 or more days in the past 30). VPSS participants were significantly more likely to be employed than the comparison group. However, enrollment in the VPSS condition did not predict employment when entered into the regression analysis with the other variables.

Conclusions:

Although a greater percentage of patients who received the VPSS counseling program actually worked, VPSS was not predictive of employment after controlling for other factors, such as work history and motivation. Structured employment interventions may assist unemployed methadone patients in obtaining employment; however, the type of employment services provided must reflect a variety of employment needs.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/11516923

Populations:

Outcomes:

Full-time employment

Part-time employment

NIDILRR Funded:

Randomized Controlled Trials (RCTs)

Research Design:

Peer Reviewed:

Yes

Standardizing measures in four domains of employment outcomes for individual placement and support

Authors:

Bond, G. R., Drake, R., & Becker, D.

Year Published:

2012

Publication:

Psychiatric Services

Volume:

63

Number:

8

Pages:

751-757

Publisher:

American Psychiatric Association

Background:

Virtually all studies of the individual placement and support (IPS) model of supported employment measure outcomes for job acquisition, but studies are less consistent in measuring job tenure, hours worked, and employment earnings. Lack of a common set of employment measures limits comparisons across studies and cumulative knowledge about IPS.

Purpose:

This study examined measures in four employment domains and their interrelationships. It examined two hypotheses. First, IPS improves both the rate of obtaining employment (job acquisition) and the amount of work (job duration, hours worked per week, and total hours and wages). Second, employment outcomes within domains are strongly correlated, whereas outcomes across domains are relatively weakly related.

Setting:

All study participants were clients enrolled in public mental health programs. The four study groups were located in Manchester and Concord NH; Washington DC; Hartford CT, and Chicago

Sample:

All study participants were clients enrolled in public mental health programs. They were unemployed adults who met each state's criteria for severe mental illness. Other common eligibility criteria included desire for competitive work, ability and willingness to give informed consent, and absence of significant general medical conditions precluding employment. The studies used similar protocols to track employment outcomes. Despite similar research methods, the four studies differed in geographic location and control group interventions.

Data Collection:

Using a combined data set from four randomized controlled trials of IPS, this study examined mean differences between IPS participants (N=307) and participants in other vocational services (control sample) (N=374) in four domains (job acquisition, job duration, hours worked per week, and total hours and wages). Eight competitive employment measures were examined (employed at any time, total weeks worked, tenure in the longest-held job, total hours worked, average hours per week worked, total wages, days to first job, and working =20 hours per week during follow-up). Correlations between measures within both the IPS and control samples were determined.

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:

The conditions include: 1) group skills training; initial training in choosing, getting, keeping a job; followed by job placement services from a stand alone rehabilitation program (2) enhanced rehabilitation services provided by a vocational rehabilitation counselor assigned to the project: club house and brokered supported employment (4) diversified placement services.

Findings:

IPS participants had significantly better outcomes across all employment measures and domains. Correlations between measures were strong within each domain, but they were variable between domains

Conclusions:

In addition to improving job acquisition, IPS improved job duration, hours worked per week, and total hours and wages. The correlational findings suggest proxy measures to assist meta-analysts in the synthesis of studies for which direct measures are unavailable. Initial steps toward a cross-disciplinary theoretical framework for employment outcomes are described.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/22660524

Disabilities:

Populations:

Randomized Controlled Trials (RCTs)

Outcomes:

Full-time employment

Increase in hours worked

Increase in tenure

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

Critical strategies for implementing supported employment

Authors:

Bond, G. R., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R.

Year Published:

2007

Publication:

Journal of Vocational Rehabilitation

Volume:

27

Number:

1

Pages:

13-20

Publisher:

IOS Press

Background:

Supported employment is considered to be "the most effective approach to increase work opportunities for people with severe mental illness [3‚Äì5]" (p. 13). However, access to Supported Employment services is difficult to obtain.

Purpose:

The paper offers "a review of experiences by six states and the District of Columbia in disseminating an evidence-based practice, supported employment (SE). Each jurisdiction had unique strengths and barriers to overcome to effectively implement supported employment services for people with severe mental illness" (p. 13).

Setting:

"Project leaders from the original six states and the District of Columbia" provided information as to how they were able to increase "access to high-quality SE services in their areas" (p. 13).

Sample:

Maryland, South Carolina, District of Columbia, Oregon, Vermont, Kansas, Connecticut

Data Collection:

Seven states (including the District of Columbia) reported unique aspects of implementing supported employment. The approach used was similar to that of a case study.

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:

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings:

"Diverse strategies were used to augment implementation of supported employment services: a) Instituting state-level administrative procedures and reconfiguration of local staffing to enhance collaboration between mental health and vocational rehabilitation; b) Promoting SE services through the media, online training, and training by early adopters; c) Hiring benefits specialists; d) Teaching outcome-based supervision; and e) Building capacity for supported employment fidelity reviews" (p. 13).

Conclusions:

"Dissemination of evidenced-based supported employment was enhanced when six states and the District of Columbia addressed special aspects. Supported employment implementation included different pathways to good employment outcomes" (p. 13).

URL:

http://www.worksupport.com/kter/documents/pdf/CriticalStrategies.pdf

Disabilities:

Populations:

Outcomes: