Supported Employment Programs Research Articles

The applicability of supported employment to adults with participation obligations as a condition for receiving welfare benefits

ABSTRACTIndividual Placement and Support (IPS) is an evidence-based approach to supported employment designed specifically for people with severe mental illness or psychiatric disabilities. It is unclear whether this approach generalizes to adults with less severe mental illnesses. In addition, because IPS is intended for motivated volunteers, it remains unclear whether it is also applicable to individuals with mental illness who have government-imposed obligations to participate in supported employment programs. This study evaluated an IPS enhancement intervention on the Central Coast of New South Wales, Australia, involving 68 adults with a range of different mental illnesses. Thirty-seven of 68 participants had participation obligations as a condition of receiving welfare benefits, and 31 of 68 participants had no such obligations. All participants were tracked for 18 months following program commencement to assess job commencements and 13- and 26-week employment milestones. Usual services enhanced by ...

Predictors of Acquisition of Competitive Employment for People Enrolled in Supported Employment Programs.

This study aims at assessing the relative contribution of employment specialist competencies working in supported employment (SE) programs and client variables in determining the likelihood of obtaining competitive employment. A total of 489 persons with a severe mental illness and 97 employment specialists working in 24 SE programs across three Canadian provinces were included in the study. Overall, 43% of the sample obtained competitive work. Both client variables and employment specialist competencies, while controlling for the quality of SE programs implementation, predicted job acquisition. Multilevel analyses further indicated that younger client age, shorter duration of unemployment, and client use of job search strategies, as well as the working alliance perceived by the employment specialist, were the strongest predictors of competitive employment for people with severe mental illness, with 51% of variance explained. For people with severe mental illness seeking employment, active job search behaviors, relational abilities, and employment specialist competencies are central contributors to acquisition of competitive employment.

Autism Spectrum Disorders: Challenges and Opportunities for Transition to Adulthood.

Improved outcomes for individuals with autism spectrum disorder (ASD) have opened a range of potential pathways during the transition to adulthood. These include attending college, entering the labor force, and achieving a degree of independent living. Less cognitively able individuals may be eligible for state benefits and may enter supported employment programs. Those attending college require careful support and planning. Practitioners need to be familiar with the unique needs of young adults with ASD. Further research should attempt to define the priorities of individuals and families with ASD making this transition and clarify the value of existing supports and interventions.

Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury

Purpose: In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified.Methods: Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes.Results: Some barriers to implementation occurred throughout the study, such as Veterans’ lack of motivation and providers’ difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team.Conclusions: Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities.Implications for RehabilitationKey facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support.Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns.Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

Age as a moderator of change following compensatory cognitive training in individuals with severe mental illnesses.

This study explored whether age moderated cognitive, symptom, and functional changes over a 12-week compensatory cognitive training (CCT) intervention for participants with severe mental illnesses. CCT focused on the cognitive domains of attention, learning, prospective memory, and executive functioning, often impaired in this population. Seventy-seven unemployed individuals (46 participants with severe mood disorders and 31 participants with schizophrenia/schizoaffective disorder; mean age = 44 years) received CCT for 12 weeks in the context of a supported employment program. Participants were administered cognitive, symptom severity, and functional measures at baseline and 3-, 6-, and 12-month follow-ups, as well as at 18 and 24 months for symptom/functional measures. Mixed effects models, controlling for diagnosis, examined whether age impacted the trajectories of change following CCT. Analyses showed several significant time by age interactions; younger participants improved more over time on category fluency, β = -.280, t(42.10) = -2.76, p = .008, and financial capacity (UCSD Performance-Based Skills Assessment), β = -.194, t(54.02) = -2.21, p = .031, whereas older participants showed greater reduction in positive symptom severity (Positive and Negative Syndrome Scale), β = -.109, t(78.35) = -2.34, p = .022, and less functional decline on the Independent Living Skills Survey, β = .118, t(109.77) = 2.05, p = .043. Age moderated the effects of CCT over time on measures of cognition, symptom severity, and functioning. Younger participants improved on objective measures of verbal processing speed and financial capacity, whereas older participants showed reduced positive symptom severity and less decline in self-reported daily functioning. These findings suggest that CCT may differentially benefit persons with severe mental illnesses depending on age. (PsycINFO Database Record

Does personality influence job acquisition and tenure in people with severe mental illness enrolled in supported employment programs?

Background: When employment difficulties in people with severe mental illness (SMI) occur, it could be partly linked to issues not specific to SMI, such as personality traits or problems. Despite the fact that personality has a marked influence on almost every aspect of work behavior, it has scarcely been investigated in the context of employment for people with SMI.Aims: We aimed to evaluate if personality was more predictive than clinical variables of different competitive work outcomes, namely acquisition of competitive employment, delay to acquisition and job tenure.Method: A sample of 82 people with a SMI enrolled in supported employment programs (SEP) was recruited and asked to complete various questionnaires and interviews. Statistical analyses included logistic regressions and survival analyses (Cox regressions).Results: Prior employment, personality problems and negative symptoms are significantly related to acquisition of a competitive employment and to delay to acquisition whereas the conscientiousness personality trait was predictive of job tenure.Conclusion: Our results point out the relevance of personality traits and problems as predictors of work outcomes in people with SMI registered in SEP. Future studies should recruit larger samples and also investigate these links with other factors related to work outcomes.

Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of a randomized controlled trial.

The aim of this study was to clarify whether improvement of cognitive functioning by cognitive remediation therapy can improve work outcome in schizophrenia and other severe mental illnesses when combined with supported employment. The subjects of this study were persons with severe mental illness diagnosed with schizophrenia, major depression, or bipolar disorder (ICD-10) and cognitive dysfunction who participated in both cognitive remediation using the Thinking Skills for Work program and a supported employment program in a multisite, randomized controlled study. Logistic and multiple linear regression analyses were performed to clarify the influence of cognitive functioning on vocational outcomes, adjusting for demographic and clinical variables. Improvement of cognitive functioning with cognitive remediation significantly contributed to the total days employed and total earnings of competitive employment in supported employment service during the study period. Any baseline demographic and clinical variables did not significantly contribute to the work-related outcomes. A cognitive remediation program transferring learning skills into the real world is useful to increase the quality of working life in supported employment services for persons with severe mental illness and cognitive dysfunction who want to work competitively.

Study of Improvement Plan for the Employment Support Program to Promote Self-Reliance of the Disadvantaged Youth: Compared to Canada Case

Study of Improvement Plan for the Employment Support Program to Promote Self-Reliance of the Disadvantaged Youth: Compared to Canada Case

Barriers and Facilitators to Sustainment of an Evidence-Based Supported Employment Program.

Large-scale initiatives to expand evidence-based practices are often poorly implemented and rarely endure. The purpose of this study was to identify the perceived barriers and facilitators to sustainment of an evidence-based supported employment program, Individual Placement and Support (IPS). Within a 2-year prospective study of sustainment among 129 IPS programs in 13 states participating in a national learning community, we interviewed IPS team leaders and coded their responses to semi-structured interviews using a conceptual framework adapted from another large-scale implementation study. Leaders in 122 agencies (95%) that sustained their IPS programs identified funding, prioritization, and workforce characteristics as both key facilitators and barriers. Additional key factors were lack of local community supports as a barrier and leadership and structured workflow as facilitators. Within the IPS learning community, team leaders attributed the sustainment of their program to funding, prioritization, workforce, agency leadership, and structured workflow. The actions of the learning community's leadership, state governments, and local programs together may have contributed to the high sustainment rate.

Predictors of employment in schizophrenia: The importance of intrinsic and extrinsic motivation

Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. A contributing factor that may be relevant but has received little attention in the work rehabilitation literature is motivation. People with schizophrenia show marked deficits in both intrinsic and extrinsic motivation but these deficits have not been directly examined in relation to work outcomes. The present study sought to examine the relationship between intrinsic and extrinsic motivation and work outcome among a sample of 65 adults with schizophrenia enrolled in a supported employment program. One-third of the participants in the study obtained work. Intrinsic motivation related to valuing and feeling useful in a work role significantly predicted who would obtain employment. Extrinsic motivation related to gaining rewards and avoiding obstacles showed a non-significant trend-level relationship such that workers had higher extrinsic motivation than nonworkers. These findings highlight the importance of considering both intrinsic and extrinsic motivation in work-related interventions and supported employment for individuals with schizophrenia. The results are discussed in terms of clinical implications for improving rehabilitation and occupational outcomes in schizophrenia.

Pushing through: Mental health consumers' experiences of an individual placement and support employment programme

Introduction Individual placement and support is recognized as current best practice vocational rehabilitation for people living with a severe mental illness. This study aimed to provide insight into the consumer perspective of factors that impact the success of an individual placement and support programme in Australia. Method A qualitative study was conducted using semi-structured interviews with five participants. Participants were diagnosed with a severe mental illness and were engaged with an individual placement supported employment programme in one area health service in New South Wales, Australia. Data analysis was conducted using grounded theory methods. Results Analysis revealed the core category of pushing through, a three-step process that involved experiencing discomfort, learning to adapt, and getting into a groove. Pushing through described the participants' direct experience of individual placement and support, as well as their management of their health and ability to cope with everyday practicalities and relationships while engaged in the programme. Conclusions The participants in this study described their experiences of being involved in an individual placement and support programme as being characterized by a process of pushing through. The participants' actions and experiences at each stage of this process provide cues for more tailored support within individual placement and support to meet changing needs.

Association of Supported Employment With Cognitive Functioning and Employment Outcomes.

Cognitive functioning affects employment outcomes in supported employment. This study examined which cognitive parameters are associated with employment outcomes for persons with mental illnesses and discusses possible mechanisms involved. Data stem from a randomized controlled trial conducted as part of the Zürich Impulse Program for the Sustainable Development of Mental Health Services (ZInEP). A sample of 116 patients in supported employment was recruited, coached, and followed up. Factor analysis and logistic regression were used to determine cognitive parameters associated with employment outcomes. Results showed that verbal learning was positively associated with better employment outcomes (any job and employment for at least three months). Results of this study imply that training in verbal learning should be included in supported employment programs. More generally, elaborated models are needed to explain interactions between cognitive functioning, supported employment, and employment outcomes and to enhance understanding of the interrelationships between cognitive functioning, employment outcomes, and any mediating and moderating variables.

Neo-liberalism: Employability, and the Labor Market Mobility among Racialized Migrants- Canada's Study

The paper discusses the effect of political paradigm on the path of career development and the predicament of employment outcomes among racialized migrants in Canada. The study highlights challenge of retraining, skills development and access to Canadian work experience that meets neo-labor market demands. The study also examines how neoliberals’ interventions in market place, elimination of social services, and employment support programs have deterred labor force integration of the racialized migrants’ job seekers. In this Grounded Theory study (GT), participants have shared their experiences and challenges they have encountered form own perspectives. They shared stories about difficulties of finding suitable training and employment support programs within the current neo-liberalized labor market in Canada. The outcomes suggested that the rise of neoliberalism as noted in policies of social and employment services cuts, coupled with employment standard Acts reforms (ESA), have given employers more powers over hiring process which in many cases has nothing to do with candidate’s skills or qualifications. In this neo-political paradigm, the racialized migrants felt they have wasted most of their productive years searching for (1) training, mentorship or employment support programs that can facilitate effective transition to the labor force, and (2) dealing with challenges of improving unrecognized skills and qualification attained from countries of origin.

In-vivo job development training among peer providers of homeless veterans supported employment programs.

This column describes a goal-oriented, time-limited in vivo coaching/training approach for skills building among peer veterans vocational rehabilitation specialists of the Homeless Veteran Supported Employment Program (HVSEP). Planning, implementing, and evaluating the training approach for peer providers was intended, ultimately, to support veterans in their goal of returning to community competitive employment. The description draws from the training experience that aimed to improve the ability of peer providers to increase both rates of employment and wages of the homeless veterans using their services. Training peers using an in vivo training approach provided a unique opportunity for the veterans to improve their job development skills with a focus to support employment outcomes for the service users. Peers who received training also expressed that learning skills through an in vivo training approach was more engaging than typical classroom trainings. (PsycINFO Database Record

Special Issue: Vocational rehabilitation (I)

The range of articles included in the first part of this special issue reflects current trends and practices in vocational rehabilitation across four disciplines, with five relating to mental illness and disabilities. Vocational rehabilitation is important because it can counter the social and economic exclusion so often associated with mental illness and other psychiatric conditions. While occupational therapists are aware of the generally beneficial effects of occupation and meaningful activity, they may not be so aware of the leveraging effect on the individual that vocational rehabilitation can produce. Establishing a place in the open labour market seems to enhance recovery in ways that cannot be achieved by medical interventions, talk therapies, or by any other rehabilitation intervention. Each article in this special issue highlights different opportunities for occupational therapists to become involved in vocational rehabilitation. This collection also illustrates a diverse mix of research methods including a randomised controlled trial, a systematic review, a population survey and several qualitative investigations. In the research paper by Schneider et al. (2016), an exploratory feasibility study for a randomised controlled trial reveals the potential for a new intervention to enhance outcomes from an evidence-based supported employment programme for people with first episode psychosis. Although this study was not conclusive, the intervention was promising because 41% of those who received the enhancement obtained employment compared to 29% of those who received the standard employment service without the enhancement. The new intervention consists of work-focused counselling using principles of cognitive behaviour therapy. Occupational therapists have the background training to assist with the further development and delivery of this intervention. A practice analysis from Singapore by Tan et al. (2016) describes another way that occupational therapists can become involved in psychiatric vocational rehabilitation. The authors converted an existing vocational intervention into one that was more integrated with existing psychiatric rehabilitation services, and more in line with evidencebased practices in supported employment. This conversion resulted in good employment outcomes being achieved that were more in line with international expectations for this type of programme. Two qualitative studies examined established workers diagnosed with mental illness or a psychiatric disorder. Cameron et al. (2016) explored the experiences of being on sick leave among people with severe mental illnesses. The results showed how much people treasured their work identity, and how potentially damaging sick leave can be to those that benefit from the structured routines and social interaction that employment provides. This is a new area, with opportunities for occupational therapists to help existing workers retain employment by minimising the unintended negative consequences of sick leave. With a similar focus on job retention, Williams and Lloyd (2016) examined the risk to continuing employment among those who experience a first episode of psychosis. The authors found that only three out of 11 were still employed 6 months later; of those, only two were in the same jobs. The research paper by Waghorn et al. (2016) uses a large population survey to reveal issues in vocational rehabilitation for people diagnosed with a psychotic disorder and co-morbid substance abuse. A key finding was that those with previous lifetime abuse or dependence did not seem to have additional disabilities, but they were less likely to utilise the most appropriate and intensive forms of vocational rehabilitation. In a systematic review of vocational rehabilitation after stroke, Wei et al. (2016) found limited evidence that rehabilitation increases returns to work among those of working age. This suggests that vocational rehabilitation for people post stroke is in its infancy compared to the more advanced form developed for people with mental health or psychiatric conditions. In their research paper, Sergiou-Kita et al. (2016) highlight the low proportions of

The role of work related self-efficacy in supported employment for people living with serious mental illnesses.

This study tested whether higher work-related self-efficacy would predict the achievement of competitive employment in supported employment (SE) programs. N = 105 individuals were recruited from 5 state-funded SE programs in a Northeastern state. Participants were required to be unemployed and seeking employment to be eligible to enter the study. Research staff met with the individuals at baseline and collected demographic information and data on self-efficacy and psychiatric symptoms. For the follow-up assessment at 6 months, data were collected on participants, self-efficacy, psychiatric symptoms, and employment activity. Thirty-eight percent of the participants achieved competitive employment at the 6-month follow-up. However, self-efficacy was not a positive predictor of competitive employment. Surprisingly, 1 of the subscales, work-related social skills self-efficacy, was negatively associated with employment. These findings suggest that self-efficacy is not a predictor of competitive employment for individuals living with serious mental illness and receiving supported employment services. It appears that SE can be helpful for participants with a range of self-efficacy.

Evaluation of a national supported employment programme for people with psychiatric conditions

Statement of context Job Club is a National Mental Health Blueprint programme funded by the Ministry of Health in Singapore, to provide supported employment for people recovering from psychiatric conditions. Critical reflection on practice Professional staff such as occupational therapists were re-designated as vocational specialists in this programme. Between financial years 2009 and 2014, a total of 1449 job placements were carried out. Fifty-six per cent of all job placements lasted more than two months and 47% of them lasted more than three months. From 2012, the service was integrated with an existing occupational therapy psychiatric rehabilitation service, resulting in an improved job placement rate from 19% to 63%. Linear regression analyses found that only prior vocational training predicted job tenure. Implications for practice Overall, occupational therapists found that our training in activity analyses enabled us to conduct job task analyses, employer education as well as worksite support and modifications competently.

Recovery Assessment Scale: Testing validity with Portuguese community-based mental health organization users.

The aim of the present study was to develop the Portuguese version of the Recovery Assessment Scale (RAS-P), and to assess the validity of the findings using the revised test, with 213 users from 5 nonprofit community-based mental health organizations. Participants in the assessment completed a self-reported survey investigating their sense of personal recovery, personal empowerment, capabilities achievement, psychiatric symptoms' frequency, and demographic data. Evidence from exploratory and confirmatory factor analyses using the 24-item version of the test, validated a 4-factor structure for the RAS-P model based on the dimensions of Personal Goals and Hope, Managing Help Needs, Supportive Interpersonal Relationships, and Life Beyond Symptoms, consistent with components of the recovery process. Convergent and discriminant validity was also achieved using bivariate correlation coefficients among the 4 subscales' scores, between the overall scale and the subscales, and in relation to external variables. Findings allowed for the interpretation that the RAS-P is measuring a particular psychological construct, which is different from symptoms of the mental illness. A hypothesized significant association with personal empowerment and with capabilities achievement was demonstrated. Positive association was also found between participants' use of recovery-oriented services such as independent housing or supported employment programs. The RAS-P scores also revealed excellent internal consistency for the overall scale (α = .90), and good consistency for the subscales (>.75), which attest to its precision in measurement. In conclusion, the study proved the RAS-P a reliable and useful tool in the context of the community mental health practice.

Who are shelter housing users and what do they expect?

Abstract Objectives Answers were sought to the following questions: who are sheltered housing users?; how do they evaluate the accommodation offer?; and what is the position of sheltered housing in the support systems for the mentally ill? Method Participants in the study were 302 people diagnosed with schizophrenia (F-20), who had been users of support systems in Warsaw, Cracow and Lublin for at least 3 months. In this sample, 34 participants lived in sheltered accommodation. The Sociodemographic Questionnaire, the Community Support System Use Questionnaire and the Global Assessment Scale (GAS) were administered to each sample participant. Results Sheltered housing users turned out to be relatively young and well educated. They presented with low levels of psychopathological symptoms and difficulties in social functioning. Many of them were users of other rehabilitation programs, such as Community Self-Help Centers, patient clubs and supported employment programs. Accessibility of contacts with other people, learning new skills and a sense of security were considered to be the most important benefits of sheltered housing. Conclusions Sheltered housing should be a part of broader support systems, since only under such circumstances, living in sheltered accommodation can have a truly positive impact on the recovery process. When people with mental illness are offered sheltered housing, they should participate in the planning of a comprehensive psychosocial intervention, including also more active forms of support and rehabilitation.

Employment Interventions for Return to Work in Working Aged Adults Following Traumatic Brain Injury (TBI): A Systematic Review

Employment Interventions for Return to Work in Working Aged Adults Following Traumatic Brain Injury (TBI): A Systematic Review