Who benefits from supported employment: A meta-analytic study

Authors: Carolina, H., Ellice, S., Strobel Gower, W.
Year Published 2011
Publication Schizophrenia Bulletin
Volume 37
Number 2
Pages 370-380
Publisher Oxford University Press

Individual Randomized Controlled Trials (RCTs) of supported employment often have not had sufficient power to examine individual client subgroups. Research is needed that examines the question: Among various subgroups of clients with SMI ( by work history, demographic, and clinical variables), which subgroups benefit from evidence-based supported employment? Alternatively, which subgroups benefit more from brokered stepwise vocational models?


Meta-analysis sought to identify which subgroups of clients with severe mental illness (SMI) benefited from evidence-based supported employment.


This study is a systematic review. The included studies were undertaken in various locations and settings. This included mental health programs in Washington DC, Hartford CT, Concord and Manchester N.H,, and Chicago IL.


The sample consisted of study participants from 4 RCTs of IPS vs usual services.31–34 All 4 studies compared a newly established IPS program with one or more well-established vocational programs. In all 4 studies, participants were recruited from mental health centers (or a psychiatric rehabilitation agency in the Chicago Study). Participants were adults who met each state's criteria for SMI, typically a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) Axis I or II diagnosis plus severe and persistent impairment in psychosocial functioning. All participants were unemployed at the time of study admission.

Data Collection

This meta-analytic study used archival data from 4 independent RCTs to determine the magnitude of effects for IPS within specific client subgroups ( by 2 work history, 7 sociodemographic, and 8 clinical variables) on 3 competitive employment outcomes (obtaining a job, total weeks worked, and job tenure).


Standardized vocational rehabilitation services such as transitional employment, brokered supported employment (which lacked the integrated services offered by IPS), and paid work adjustment services.


The findings strongly favored IPS, with large effect sizes across all outcomes: 0.96 for job acquisition, 0.79 for total weeks worked, and 0.74 for job tenure. Overall, 90 (77%) of the 117 effect sizes calculated for the 39 subgroups exceeded 0.70, and all 117 favored IPS.


IPS produces better competitive employment outcomes for persons with SMI than alternative vocational programs regardless of background demographic, clinical, and employment characteristics.

URL http://www.ncbi.nlm.nih.gov/pubmed/19661196
Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition | Full-time employment | Part-time employment
NIDILRR Funded Yes
Research Design Systematic reviews and meta-analysis
Peer Reviewed Yes