Supported Employment Programs Research Articles

Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia

The present study was conducted to explore correlates of vocational outcome for individuals with schizophrenia. Seventy-eight individuals with schizophrenia were recruited to take part in a supported employment program in which they were provided with approximately 6 months of part-time work through a VA hospital. Positive symptoms, negative symptoms, and level of insight into mental illness were assessed once every 4 weeks, in addition to a work performance evaluation with participants' supervisors. Hierarchical longitudinal regression analysis revealed that negative symptom severity and impaired insight were significantly associated with poor work performance, and this relationship persisted over time. By contrast, positive symptom severity was not significantly associated with work performance. These results indicate that insight and negative symptoms, which can fluctuate over time, may be driving fluctuations in work performance and may therefore be a valuable target for future interventions.

A location-based prompting system to transition autonomously through vocational tasks for individuals with cognitive impairments

This study assessed the possibility of training two individuals with cognitive impairments using location-based task prompting system in a supported employment program. This study was carried out according to an ABAB sequence in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their target response, thus improving vocational job performance during the intervention phases. Practical and developmental implications of the findings are discussed.

Individual Placement and Support: Does Rurality Matter?

Little is known about the relationship between population density and employment rates in individual placement and support (IPS), the evidence-based approach to supported employment. Using longitudinal employment data from 87 agencies that provide IPS to clients with severe mental illness in diverse regions of the United States, we categorized and compared agencies according to population density data as metropolitan, micropolitan, or small town. We tested for an association between population density category and employment rate. Mean program-level competitive employment rates were 43% for 66 metropolitan, 49% for 14 micropolitan, and 40% for 7 small-town IPS programs. Population density of the community in which a supported employment program is located was not associated with program-level competitive employment rates. Despite differences in the number and diversity of employers, cultural norms, and other factors associated with population density, rurality does not adversely influence the effectivenes...

Job Acquisition for People with Severe Mental Illness Enrolled in Supported Employment Programs: A Theoretically Grounded Empirical Study

The main purpose of this study was to test a conceptual model based on the theory of planned behaviour (TPB) to explain competitive job acquisition of people with severe mental disorders enrolled in supported employment programs. Using a sample of 281 people with severe mental disorders participating in a prospective study design, the authors examined the contribution of the TPB in a model including clinical (e.g., severity of symptoms), psychosocial (e.g., self-esteem) and work related variables (e.g., length of time absent from the workplace) as predictors of job acquisition. Path analyses were used to test two conceptual models: (1) the model of job acquisition for people with mental illness adapted from the TPB, and (2) the extended TPB including clinical, psychosocial, and work related variables recognized in the literature as significant determinants of competitive employment. Findings revealed that both models presented good fit indices. In total, individual factors predicted 26% of the variance in job search behaviours (behavioural actions). However, client characteristics explained only 8% of variance in work outcomes, suggesting that environmental variables (e.g., stigma towards mental disorders) play an important role in predicting job acquisition. About 56% (N = 157) of our sample obtained competitive employment. Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.

Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a US sample

Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. Participants (n=181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

Enrollment in Supported Employment Services for Clients With a Co-occurring Disorder

People with serious mental illnesses and co-occurring substance use disorders are often excluded from vocational services, despite the lack of evidence that having a substance use disorder prevents them from being able to work. This study explored enrollment in supported employment services among clients with and without co-occurring substance use disorders. With data from electronic medical records from a psychiatric rehabilitation agency, relationships between co-occurring substance use disorders and supported employment were examined among 1,748 clients with serious mental illnesses who were consecutively admitted to the agency over a two-year period. Despite a similar interest in employment, clients with a co-occurring substance use disorder were 52% less likely than those without to enroll in a supported employment program. Those who were enrolled had similar competitive employment rates (25% for those with co-occurring disorders and 28% for those without). People with co-occurring substance disorders have reduced rates of enrollment in supported employment services.

Enrollment in Supported Employment Services for Clients With a Co-occurring Disorder

Objective: People with serious mental illnesses and co-occurring substance use disorders are often excluded from vocational services, despite the lack of evidence that having a substance use disorder prevents them from being able to work. This study explored enrollment in supported employment services among clients with and without co-occurring substance use disorders. Methods: With data from electronic medical records from a psychiatric rehabilitation agency, relationships between co-occurring substance use disorders and supported employment were examined among 1,748 clients with serious mental illnesses who were consecutively admitted to the agency over a two-year period. Results: Despite a similar interest in employment, clients with a co-occurring substance use disorder were 52% less likely than those without to enroll in a supported employment program. Those who were enrolled had similar competitive employment rates (25% for those with co-occurring disorders and 28% for those without). Conclusions: People with co-occurring substance disorders have reduced rates of enrollment in supported employment services. (Psychiatric Services 62:545–547, 2011)

Organizational analysis of Canadian supported employment programs for people with psychiatric disabilities

Supported employment (SE) is widely considered to be the most effective intervention for helping people with psychiatric disabilities integrate into the competitive workforce. While fidelity to principles and standards of evidence-based SE, i.e. the Individual Placement and Support model, is positively associated with vocational outcomes, studies have revealed significant heterogeneity in SE programs implemented in Canada. This qualitative study thus aimed to shed light on organizational and contextual factors influencing SE implementation in three Canadian provinces (British Columbia, Ontario and Quebec). The study adopted several key concepts from the field of organizational studies (e.g. coalitions, archetypes, isomorphism) to guide data collection and analysis. Overall, 20 SE programs provided by 15 different agencies were examined. Findings revealed that agencies’ exposure to different institutional pressures, their interactions and relationships with other groups and organizations, as well as their values, beliefs and ideologies played determining roles in shaping the evolution of SE services in each province.

Salient components in supported employment programs: Perspectives from employment specialists and clients

Objective: This study aimed to identify the key components of supported employment (SE) programs needed to help people with serious mental illness obtain and maintain competitive employment. Participants and methods: Viaconvenience sampling, semi-structured interviews were conducted with69 employment specialists and ninety-nine (99) clients who successfully obtained employment through SE programs in three Canadian provinces. Results: The findings describe five themes important to getting a job and to keeping a job: 1) philosophy of the program, 2) programmatic SE components, 3) employment specialists' competencies (skills, attitudes, and behaviours), 4) clients' skills and characteristics, and 5) elements related to employers. Employment specialists perceived a positive attitude and a client-centered program philosophy to be important for obtaining employment, while they perceived the support offered, the frequency and length of the follow-up as essential elements for maintaining a job. Clients perceived the employment specialists' competencies (e.g., positive attitude, marketing skills) to be important components. Conclusion: These results suggest a need to update the essential components in SE programs, or to include additional SE components.

Preliminary Outcomes from an Individualised Supported Education Programme Delivered by a Community Mental Health Service

This paper describes the implementation and preliminary results of a supported education programme designed to complement a youth-oriented supported employment programme. Method: The programme was delivered by occupational therapists employed by a community mental health service in the Hunter New England region, New South Wales, Australia. Twenty mental health service users were assisted with their course of study over an 18-month period. Results: Education outcomes were promising, with 70% of service users either continuing or completing their chosen course of formal study. The education support provided was modelled on the Individual Placement and Support approach to supported employment. Conclusion: Occupational therapists working in public mental health can use this promising approach to supplement supported employment programmes, which should also be closely coordinated with the mental health service.

A Need to Study Day Programs and Minority Populations

Back to table of contents Next article Taking IssueFull AccessA Need to Study Day Programs and Minority PopulationsDianna Dragatsi M.D.,Dianna Dragatsi M.D.Search for more papers by this author,Published Online:1 Jun 2010https://doi.org/10.1176/ps.2010.61.6.543AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Trends in outpatient psychiatric care are in constant flux. Many of the outpatient mental health centers that were created by the Community Mental Health Act of 1963 housed day treatment programs. More recently, day programs have developed a bad reputation for segregating people with severe mental illness and hindering recovery. In New York State there is an initiative to reduce the number of day programs in favor of services that are perceived as more recovery oriented.Of note, no evidence exists that day programs and recovery-oriented services are mutually exclusive. The literature on recovery emphasizes that it is a personal process—it could mean employment for one person and improved grooming for someone else. In our New York City day program, staff members are well versed in recovery principles. We work in an underserved area with high levels of need and with clients who are mostly from minority groups. In a day program we can reach out to more clients via group therapy, and we can also provide a culturally sensitive environment where clients are encouraged to pursue their personal recovery. Our program employs evidence-based practices, such as family psychoeducation, social skills training, and integrated treatment for co-occurring disorders. In addition, we offer relief for families because we provide not only mental health care but also increased access to medical care and community resources through case management and peer support.Unfortunately, few case-control studies have evaluated day programs, and certainly none have compared their outcomes with those of clubhouses, to which they are often equated. Clubhouses, perhaps a more cost-effective alternative to day programs, have been touted as an evidence-based, recovery-oriented service, no empirical evidence shows that either type of program is more likely to lead to stagnation and segregation of clients.Several studies have found positive outcomes when day programs were converted to recovery-oriented supported employment programs. However, as indicated in those reports, special funding was received to implement the conversion, and, most important, the studies did not include persons from culturally diverse minority populations whose ability to speak English is limited.Although I see merit in "graduating" people with chronic mental illness from day programs, I have concerns about closing one type of program in favor of another, especially when there is no evidence supporting the benefit of doing so. Rather than continuing to regard day programs as relics of the past, it may be fruitful to pursue research on whether contemporary day programs that provide evidence-based and culturally sensitive care can lead to positive outcomes for some clients from minority groups. Closing my New York City day program is not a trend I am eager to follow—yet.director, Inwood Clinic, Washington Heights Community Service, New York City FiguresReferencesCited byDetailsCited byNone Volume 61Issue 6 June, 2010Pages 543-543PSYCHIATRIC SERVICES June 2010 Volume 61 Number 6 Metrics PDF download History Published online 1 June 2010 Published in print 1 June 2010

Advancing Research at the Intersection of Two Systems

Back to table of contents Next article Taking IssueFull AccessAdvancing Research at the Intersection of Two SystemsMarvin S. Swartz M.D.,Marvin S. Swartz M.D.Search for more papers by this author,Published Online:1 May 2010https://doi.org/10.1176/ps.2010.61.5.431AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail By 2010 even the most casual observer of mental health care recognizes that the criminal justice system is inundated with persons who have mental illnesses and is ill equipped to address their needs. Many would lay the blame on deinstitutionalization, but a hydraulic model of transfer from hospital to jail is probably far too simplistic. In the late 1930s Lionel Penrose sought empirical evidence of transinstitutionalization from the mental health to the criminal justice system. After studying 14 European countries, he posited that the proportion of individuals who required institutional care remained relatively constant over time, assuming that if people with a mental disorder could not access hospital beds they would land in prison. Penrose wrote, "As a general rule if the prison services are extensive, the asylum population is relatively small and the reverse also tends to be true."Since then the belief that the criminal justice and mental health systems are functionally interdependent has gained widespread acceptance—despite the lack of consistent empirical support for Penrose's hypotheses. Psychiatric hospital beds are disappearing and jails are growing, but many other causal factors have been implicated: the paucity of affordable housing, shortfalls in social insurance programs, inadequate community rehabilitative programs, and the limited number of supported employment programs—to name just a few. Whatever the causes of the rising prevalence of individuals with mental illness in the criminal justice system, there is a clear need to develop and refine interventions at multiple entry points in the system. Several articles in this issue of Psychiatric Services describe and evaluate a range of diversion and treatment options that point the way to more appropriate and improved services at the interface. As a group they reinforce several take-home messages: Many persons with mental illness can and should be diverted from the criminal justice system, and there is likely no single point of diversion or program configuration to serve all people and local systems. However, it is clear that the deeper the person with mental illness penetrates the criminal justice system, or the longer the tenure there, the greater the peril. Those who cannot be diverted need better treatment than they are often afforded, although coordinating treatment across mental health and criminal justice interfaces can be daunting. Finally, although the Penrose hypothesis may have led many to believe that persons with severe mental illness in either system have identical treatment needs, often they do not. Far too many mental health interventions have been haphazardly implemented for persons with a history of criminal justice involvement without consideration of the effects of the criminogenic environments that they come from or the developmental pathways that have spawned antisocial behavior. The reports in this issue illustrate the progress and the long road ahead in addressing the needs of persons with mental illness in jails and prisons.Duke University Medical Center FiguresReferencesCited byDetailsCited ByBritish Journal of Psychiatry, Vol. 208, No. 5 Volume 61Issue 5 May, 2010Pages 431-431PSYCHIATRIC SERVICES May 2010 Volume 61 Number 5 Metrics PDF download History Published online 1 May 2010 Published in print 1 May 2010

Understanding and Creating Caring and Compassionate Organizations

Academy of Management ReviewVol. 35, No. 2 Call for PapersUnderstanding and Creating Caring and Compassionate OrganizationsPublished Online:30 Nov 2017https://doi.org/10.5465/amr.35.2.zok334AboutSectionsView articleView Full TextPDF/EPUB ToolsDownload CitationsAdd to favoritesTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail View articleREFERENCES Anderson R. C. , White R. 2009. Confessions of a radical industrialist: Profits, people, purpose—Doing business by respecting the earth. New York: St. Martin's Press. Google Scholar Cameron K. S. , Dutton J. E. , Quinn R. E. 2003. Positive organizational scholarship: Foundations of a new discipline. San Francisco: Berrett-Koehler. Google Scholar Cappelli P. 2008. Employment relationships: New models of white-collar work. New York: Cambridge University Press. Google Scholar Chouinard Y. 2005. Let my people go surfing: The education of a reluctant businessman. New York: Penguin Press. Google Scholar Dees J. G. 1998. The meaning of social entrepreneurship. Stanford, CA: Stanford University Graduate School of Business. Google Scholar Fineman S. 2006. On being positive: Concerns and counterpoints. Academy of Management Review, 31: 270– 291.Abstract , Google Scholar Frost P. J. 1999. Why compassion counts! Journal of Management Inquiry 8: 127– 133. Google Scholar George B. 2004. Authentic leadership: Rediscovering the secrets to creating lasting value. San Francisco: Jossey-Bass. Google Scholar Grant A. M. , Dutton J. E. , Rosso B. 2008. Giving commitment: Employee support programs and the prosocial sensemaking process. Academy of Management Journal, 51: 898– 918.Abstract , Google Scholar Harter J. K. , Schmidt F. L. , Hayes T. L. 2002. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: A meta-analysis. Journal of Applied Psychology, 87: 268– 279. Google Scholar Hawken P. 2008. Blessed unrest: How the largest social movement in history is restoring grace, justice, and beauty to the world. New York: Penguin Press. Google Scholar Kaul G. 2009. Gautam Kaul on his sustainable finance course. Available at http://www.youtube.com/sustfin. Google Scholar Keltner D. 2009. Born to be good: The science of a meaningful life. New York: Norton. Google Scholar Prahalad C. K. , Hammond A. 2002. Servicing the world's poor, profitably. Harvard Business Review, 80 (9): 4– 11. Google Scholar Yunus M. 2003. Banker to the poor: Micro-lending and the battle against world poverty. New York: PublicAffairs. Google Scholar Zuboff S. 2009. The old solutions have become the new problems. Business Week, July 2: 1. Google ScholarFiguresReferencesRelatedDetails Vol. 35, No. 2 Permissions Metrics in the past 12 months History Published online 30 November 2017 Published in print 1 April 2010 Information© Academy of Management ReviewDownload PDF

A working reality: Evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities

Supported employment (SE) programmes have been found to improve the rates of competitive employment for people with severe mental illness. Evidence has suggested that the most effective SE model is one in which the employment specialist is co-located with mental health services. However, this may not always be achievable. The aim of this study was to investigate the effectiveness of the enhanced intersectoral links approach to SE. A total of 43 people with a mental illness participated in the programme in which formal links were created between a community mental health team and three employment services. The outcomes of the programme were evaluated over 24 months. Of all participants, 77% achieved a competitive employment outcome, with 60.6% remaining in employment at the end of the evaluation period. The average duration of employment was 44.8 weeks. For those who were unable to maintain a job, the average period of employment was 14.2 weeks. The study found that participants with less severe symptoms at baseline were more likely to obtain employment and those who had worked in the year preceding entry into the programme were employed for a higher proportion of time. The factors related to job loss were the short-term nature of the position, cognitive difficulties and social skills. The study found that the enhanced intersectoral links approach was effective in achieving outcomes consistent with international studies of SE programmes and may offer a viable alternative to the co-location of employment specialists with community mental health teams.

A Construct Validity Study of Employment Readiness in Persons with Severe Mental Illness

This archival study examined the construct validity of rehabilitation readiness in the employment domain. Rehabilitation readiness in the employment domain is a measure of one's intent to seek employment rather than one's ability to work. A multitrait-multimethod matrix design for construct validation was used to support an inference of construct validity augmented by predictive validity assessments. Participants were 111 unemployed adults with serious psychiatric illnesses newly enrolled in supported employment programs in New Jersey who agreed to participate in the study. Data were collected on demographics, readiness, and symptoms at baseline, as well as on employment activities on a monthly basis for up to 6 months. Participants were enrolled on an ongoing basis, and not all participants reached the 6-month point before the study ended. Two methods of data collection were used: interviewer ratings and client self-report. The resultant pattern of coefficients within the multitrait-multimethod matrix su...

Adapting Evidence-Based Interventions to Fit Usual Practice: Staff Roles and Consumer Choice in Psychiatric Rehabilitation

This proof-of-concept study tested the viability of adapting a specialized practice to fit multi-service programs by switching from specialist to generalist staff roles. The intervention under study was supported employment, an evidence-based practice for adults with severe mental illness. Program data on participant characteristics, attendance, staff contact, and employment were retrieved for the 2007 calendar year (N = 99). Two hierarchical regression analyses compared (1) participants with any versus no mainstream employment, and (2) participants who started a new job in 2007 versus all other participants. In both analyses, individual participant counts of days on which employment services were provided and count of different employment service providers independently predicted mainstream employment over and above program attendance and background factors. The study program's employment rate approximated rates published for specialized supported employment programs, suggesting that it is feasible to adapt specialized evidence-based practices to fit multi-service settings without compromising service quality.

Implementation of the thinking skills for work program in a psychosocial clubhouse.

Cognitive remediation programs aimed at improving role functioning have been implemented in a variety of different mental health treatment settings, but not in psychosocial clubhouses. This study sought to determine the feasibility and preliminary outcomes of providing a cognitive remediation program (the Thinking Skills for Work program), developed and previously implemented in supported employment programs at mental health agencies, in a psychosocial club-house. Twenty-three members with a history of difficulties getting or keeping jobs, who were participating in a supported employment program at a psychosocial clubhouse, were enrolled in the Thinking Skills for Work program. A neurocognitive battery was administered at baseline and 3 months later after completion of the computer cognitive training component of the program. Hours of competitive work were tracked for the 2 years before enrollment and 2 years following enrollment. Other work-related activities (school, volunteer) were also tracked for 2 years following enrollment. Twenty-one members (91%) completed 6 or more computer cognitive training sessions. Participants demonstrated significant improvements on neurocognitive measures of processing speed, verbal learning and memory, and executive functions. Sixty percent of the members obtained a competitive job during the 2-year follow-up, and 74% were involved in some type of work-related activity. Participants worked significantly more competitive hours over the 2 years after joining the Thinking Skills for Work program than before. The findings support the feasibility and promise of implementing the Thinking Skills for Work program in the context of supported employment provided at psychosocial clubhouses.

A-Visions: A Scripps supported employment program

This expository paper describes an innovative Scripps designed supported employment program, using an evidence- based practice model based on recovery by Scripps Behavioral Health Services staff to fill a gap in the continuum of care for Behavioral Health Services. The A-Visions Program was also developed to increase offerings to mental health consumers (typically those with serious and persistent mental illness) struggling to find help in an under funded, fragmented mental health system of care. The program has grown since its inception and has received commendations from external stakeholders. This paper reviews the prevalence of mental illness in the United States, a review of the classic and recent evidence-based literature, a comprehensive description of the program (including analyses of outcome measures), a plan to spread this innovation across the Scripps enterprise, and conclusions. Due to the success of the program in providing essential services to individuals with serious mental illness, the authors recommend replication in other Scripps facilities. The author makes a strong case for the spread of this innovation, as these services typically are not a part of the mental health care continuum. These program development strategies are replicable in other mental health programs.

Psicoterapia de la Psicosis: De la Persona en Riesgo al Paciente Crónico

The authors review the psychotherapy interventions used most in psychotic patients, stressing, firstly, those conducted in the early phases of the disease, the most classical interventions during periods of stability, and, finally interventions related with psychosocial rehabilitation of the psychotic patient. Within the early phases of the disease, a distinction is made between high-risk subjects and those who have already had a first psychotic episode. The efficacy and the current intervention model in each of the most conventional psychotherapies: dynamic, cognitive-behavioral, family, and group therapies, are described. Special emphasis is placed on adaptation to the patient’s needs in each intervention model. Finally, the psychosocial interventions that have demonstrated their efficacy are indicated, that is to say, assertive community therapy, social skills training and supported employment programs.

A study of the impact of social support development on job acquisition and retention among people with psychiatric disabilities

The current study examined the relationship between specific techniques for developing social support (i.e., Person Centered Planning) and job related outcomes among 110 individuals with psychiatric disabilities receiving Supported Employment (SE) services in a northeastern state. Seven SE programs participated. All individuals receiving SE services from any of the seven SE programs were eligible to enroll in the study. Participant data were collected on demographics, psychiatric history, work history, and social support over a period of two years. Data on the use of Person Center Planning practices were collected from SE staff every three months for the first 12 months of the study. This information was recorded in the Quality Indicators Survey, an instrument developed for this study. A positive relationship was found between total days employed and the number of non- paid supporters an individual reported having; a negative relationship existed between total days employed and number of paid supporters; and there was a positive correlation between total days employed and Person Centered Planning techniques used at nine and 12 months.