The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs
|Authors:||Lacaille, D., Sheps, S., Spinelli, J. J., Chalmers, A., & Esdaile, J. M.|
|Publisher||American Psychological Association|
Individuals with severe mental illness have a desire to work. however, they often face many barriers. The Working Alliance which is a collaborative working relationship within a counseling relationship has been a key element in therapeutic outcomes and has become linked to positive outcomes in psychiatric rehabilitation programs. Research has shown that a good working relationship between a person with mental illness and his service provider can improve symptoms, enhance medication compliance, improve quality of life and global functioning. More research on the working alliance in vocational rehabilitation services is needed. This study is a secondary analysis of data that was collected in a randomized control trial comparing to vocational models the Individual Placement and Support (IPS) model and the Diversified Placement Approach (DPA).
This study had two purposes. These included to examine the relationship between the working alliance and the employment outcomes of individuals with severe mental illness who were receiving vocational services. The study also looked at whether working alliance differences existed between client receiving evidenced based supported employment service and those receiving traditional vocational rehabilitation services (DPA). This is a highly regarded team model organized within a day program where individuals get ready to work, then work with a group and overtime progress through a series of placements and eventually move into competitive work. The hypotheses was individuals receiving supported employment services would have a stronger working alliance with their IPS vocational provider than those receiving traditional vocational services (DPA).
The setting was two vocational programs that provided employment services to individuals with severe mental illness.
Two hundred individuals were randomly assigned to the IPS or DPA model of supported employment in the parent study. The sample in this study included 91 (45 in the DPA and 46 in IPS). Most were men (61). The mean age was 38.9 years. About half (49.4%) had a schizophrenia-spectrum disorder. The majority or (63.7%) had more than a 12 year education. Most (81.3%) had prior work histories.
Individuals were randomly assigned to DPA or IPS. Afterwards they were followed for two years. Objective data related to paid employment outcomes was collected through quarterly participant interviews. Data pertaining to the predictor variable, working alliance were collected by participant interviews every 6 months for individuals who were working at the time.
The comparison condition was low or no working alliance.
The first hypothesis stating that the working alliance would be positively associated with employment was not confirmed. The second hypothesis that individuals would have a stronger working alliance with their vocational workers in IPS was confirmed.
The finding that there is a lack of associations between working alliance and employment outcomes is not in alignment with previous literature. Evidenced based supported employment appears to lead to better relationships than the DPS approach. Additional research is needed.
|Populations||Hispanic or Latino | Black / African American | White / Caucasian | Male & Female|
|Research Design||Randomized Controlled Trials (RCTs)|