Competitive Employment Rates Research Articles

Measuring Fidelity to Individual Placement and Support for Transition Age Youth: Psychometric Findings.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment)item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

Evaluation of Individual Placement and Support at Three Community Mental Health Centers in California.

Individual Placement and Support (IPS) has been shown to effectively help people with serious mental illness obtain competitive employment, and IPS programs have been established in over 40 U.S. states and at least 20 other countries. As this expansion continues, the field needs data describing IPS implementation, clients, fidelity, and outcomes in real-world, non-research settings, specifically regarding racial and ethnic disparities and young adults. The goal of this study was to observe the initial three years of IPS implementation, measuring fidelity, client characteristics, and employment outcomes in three mental health agencies in one California county.In 2018, officials in one California county contracted with the IPS Center to provide training and measure IPS program fidelity at three mental health agencies in a large urban area. The goal was to establish and maintain IPS programs with good fidelity and effectiveness. After an initial year of preparation, three mental health programs recruited unemployed clients with interest in employment and implemented IPS. An IPS trainer provided initial training, ongoing consultation, and measured program fidelity. The program clinicians documented client characteristics, IPS service use, and quarterly employment throughout 13 quarters.The project followed 351 mental health clients as they participated in three new supported employment programs over a three-year period. The average client age was 36 years, including 107 (31%) young adults (ages 18-25) and 244 older adults (ages 26+); 177 (50%) identified their gender as female, 173 as male, and 1 as other or declined to answer; 119 (36%) identified as Hispanic, 116 (35%) as non-Hispanic White, 42 (13%) as non-Hispanic Asian, 35 (11%) as non-Hispanic Black, and 20 (6%) as other non-Hispanic. Most clients (78%) had diagnoses of non-psychotic conditions such as anxiety or depression, and 22% had diagnoses of schizophrenia, schizoaffective, or other psychotic disorder. During the project, 312 (87%) engaged in supported employment services, 206 (58%) attained competitive employment, and 177 (50%) found their first job within nine months of enrolling. Hispanics (64%), Asians (57%), and non-Hispanic Blacks (77%) achieved higher employment rates than non-Hispanic Whites (49%). Young adults (73%) achieved higher employment rates than older adults (51%).Engaging in new IPS supported employment programs over several months led to high rates of competitive employment across all groups in real-world, non-research settings, typically within nine months. Hispanics, Asians, and non-Hispanic Blacks achieved higher rates of competitive employment than non-Hispanic Whites, and young adults achieved higher rates than older adults. Further research may explain these differences.

Virtual Interview Training Among BIPOC Autistic Transition-Age Youth: A Secondary Analysis of an Initial Effectiveness RCT.

Black, Indigenous, and Persons of Color (BIPOC) autistic transition-aged youth (TAY) report lower rates of competitive employment compared to White autistic TAY and even greater deficits with social skills associated with positive job interviewing. A virtual job interviewing program was adapted to support and improve the job interviewing skills of autistic TAY. The current study evaluates the effectiveness of an efficacious virtual interview training program on the job interview skills, interview anxiety, and likeliness to be hired, for a subsample of 32 BIPOC autistic TAY, ages 17-26years old from a previous randomized control trial of the program. Bivariate analyses were used to evaluate between-group differences at pre-test related to background characteristics, and whether Virtual Interview Training for Transition-Age Youth (VIT-TAY) was associated with changes between pre-test and post-test measures of job interview skills. Additionally, a Firth logistic regression was conducted to examine the relationship between VIT-TAY and competitive integrative employment at 6months, covarying for fluid cognition, having ever had a job interview, and baseline employment status. Participants receiving pre-employment services (Pre-ETS) and virtual interview training had better job interview skills (F=12.7, <.01; =.32), lower job interview anxiety (F = .3.96, < .05; = .12), and a higher likeliness of receiving employment (F = 4.34, <.05; =.13 at the 6-month follow up compared to participants that only had Pre-ETS. Findings from this study suggest that virtual interview training for TAY is effective for BIPOC autistic TAY in improving their interview skills to gain competitive employment and lower their job interview anxiety.

Racial Disparities in Employment Status After Moderate/Severe Traumatic Brain Injuries in Southeast Michigan

ObjectiveTo examine the progress made in recent decades by assessing the employment rates of Black and non-Hispanic White (NHW) patients after traumatic brain injury (TBI), controlling for pre-TBI employment status and education status. DesignRetrospective analysis in a cohort of patients treated in Southeast Michigan at major trauma centers in more recent years (February 2010 to December 2019). SettingSoutheastern Michigan Traumatic Brain Injury Model System (TBIMS): 1 of 16 TBIMSs across the United States. ParticipantsNHW (n=81) and Black (n=188) patients with moderate/severe TBI (N=269). InterventionNot applicable. Main Outcome MeasuresEmployment status, which is separated into 2 categories: student plus competitive employment and noncompetitive employment. ResultsIn 269 patients, NHW patients had more severe initial TBI, measured by percentage brain computed tomography with compression causing >5-mm midline shift (P<.001). Controlling for pre-TBI employment status, we found NHW participants who were students or had competitive employment prior to TBI had higher rates of competitive employment at 2-year (P=.03) follow-up. Controlling for pre-TBI education status, we found no difference in competitive and noncompetitive employment rates between NHW and Black participants at all follow-up years. ConclusionsBlack patients who were students or had competitive employment before TBI experience worse employment outcomes than their NHW counterparts after TBI at 2 years post TBI. Further research is needed to understand better the factors driving these disparities and how social determinants of health affect these racial differences after TBI.

The Impact of the Workforce Innovation and Opportunity Act on Agency-Level Vocational Rehabilitation Outcomes for Adults and Youth With Blindness and Low Vision

The purpose of this study was to evaluate the impact of the U.S. Workforce Innovation and Opportunity Act (WIOA) on outcomes (competitive employment rates and median earnings) for adult and youth vocational rehabilitation consumers with blindness or low vision (B/LV) and to determine whether impacts differed by agency type. We utilized RSA-911 data to create two agency-level longitudinal datasets, one for youth and one for adults, with 6-year pre-WIOA and 3-year post-WIOA periods. Data were analyzed using discontinuous growth modeling to assess longitudinal changes in agency-level outcomes through the inclusion of variables representing WIOA and subsequent change in response to WIOA. After WIOA, both youth and adult agency-level competitive employment rates decreased significantly for consumers with B/LV, with a larger impact on youth, and median earnings increased. Results document that the impact of WIOA on agencies varied widely. Separate agencies had a significant decrease in adult competitive employment rates for consumers with B/LV and a significant increase in median earnings compared with combined agencies. Overall, the influence of WIOA on B/LV consumer outcomes appears to be mixed at best, and the effect is surprisingly similar for youth and adults.

The creation and implementation of an employment participation pathway model for youth with disabilities

Purpose Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. IMPLICATIONS FOR REHABILITATION Employment for individuals with disabilities is lower than the national average, with rates being even lower for young people (ages 15–25) with disabilities. Low workplace participation for individuals with disabilities is particularly troubling due to the myriad social and health benefits of engagement in employment. Programs that start early (during high school) and provide ongoing, community-integrated support are reported to be most beneficial to the eventual job attainment and retention for young job seekers with disabilities. The presented employment participation pathway model that was developed using the Knowledge to Action Framework integrates evidence and best practices to support service providers in facilitating progressive workplace participation for clients and families.

Individual placement and support in young people with severe mental illness: an Italian experience

IntroductionIndividual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to obtain and maintain competitive jobs in the labour market. IPS closely follows 8 main principles (such as it aims to get people into competitive employment, it is open to all those who want to work, it tries to find jobs consistent with people’s preferences, it works quickly, it brings employment specialists into clinical teams, it provides time unlimited, individualised support, benefits counselling is included). However, little data in young adults are currently available, especially in Europe.ObjectivesAim of this study was to evaluate the beneficial effect of IPS in Italian young adults with severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period.Methods54 participants were recruited from patients receiving psychiatric treatment in adult Community Mental Health Centers of an Italian Department of Mental Health. Together with drop out rates, we examined job acquisition, job duration (total number of days worked), total hours per week worked and job tenure (weeks worked on the longest-held competitive job).ResultsA crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period.ConclusionsThis research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.DisclosureNo significant relationships.

Effects of work experiences on the post-school employment outcomes of youth with disabilities: A study of one state vocational rehabilitation agency’s transition program

BACKGROUND: The Oklahoma Department of Rehabilitation Services provided eight years’ worth of de-identified data on transition-aged clients to be examined in this study. OBJECTIVE: This study presents information on the predictive impact of work experiences, age at time of application for vocational rehabilitation (VR) services, and priority group category of eligibility on successful VR case closure (i.e., achievement of competitive integrated employment). METHODS: Using logistic regression, the extant data were analyzed (consisting of 8,966 participants). RESULTS: Results indicated age, priority group category, gender and racial identification were each statistically significant predictors of achieving a successful VR case closure. Work experience as a predictor was not found to predict outcomes. Among work experiences, Project SEARCH was the only work experience to significantly predict successful employment outcomes. Individuals achieving higher rates of competitive integrated employment tended to be in the less severe priority category of eligibility, older, and those who identified as male and who identified as White. CONCLUSIONS: Findings inform special education and VR in considering the possible factors behind the results, examining data further, and potentially changing existing programs, policies, and practices or creating new ones to increase the employment outcomes of transition age clients.

Implementation of Pre–Employment Transition Services: A Content Analysis of Workforce Innovation and Opportunity Act State Plans

Many youth with disabilities experience persistently low rates of competitive integrated employment (CIE) and participation in higher education. In 2014, the Workforce Innovation and Opportunity Act (WIOA) established a policy focus on CIE as the goal of vocational services for youth and individuals with disabilities. In addition, WIOA created provision for Pre–Employment Transition Services (Pre-ETS) to ensure that state vocational rehabilitation (VR) agencies focused sufficient resources toward transition-age youth. This study examined a sample of WIOA state implementation plans in depth using content analysis to identify how state VR agencies prioritized the provision of Pre-ETS services to youth with disabilities. Analysis of state plans resulted in three emergent themes: (a) instructional priorities, (b) instructional contexts, and (c) networks of stakeholders. We discuss the implications of these themes for future research, policy, and practice related to the employment of individuals with disabilities.

The effects of supported employment interventions in populations of people with conditions other than severe mental health: a systematic review.

To assess the effectiveness of supported employment interventions for improving competitive employment in populations of people with conditions other than only severe mental illness. Supported employment interventions have been extensively tested in severe mental illness populations. These approaches may be beneficial outside of these populations. We searched PubMed, Embase, CINAHL, PsycInfo, Web of Science, Scopus, JSTOR, PEDro, OTSeeker, and NIOSHTIC for trials including unemployed people with any condition and including severe mental illness if combined with other co-morbidities or other specific circumstances (e.g., homelessness). We excluded trials where inclusion was based on severe mental illness alone. Two reviewers independently assessed risk of bias (RoB v2.0) and four reviewers extracted data. We assessed rates of competitive employment as compared to traditional vocational rehabilitation or waiting list/services as usual. Ten randomised controlled trials (913 participants) were included. Supported employment was more effective than control interventions for improving competitive employment in seven trials: in people with affective disorders [risk ratio (RR) 10.61 (1.49, 75.38)]; mental disorders and justice involvement [RR 4.44 (1.36,14.46)]; veterans with posttraumatic stress disorder (PTSD) [RR 2.73 (1.64, 4.54)]; formerly incarcerated veterans [RR 2.17 (1.09, 4.33)]; people receiving methadone treatment [RR 11.5 (1.62, 81.8)]; veterans with spinal cord injury at 12 months [RR 2.46 (1.16, 5.22)] and at 24 months [RR 2.81 (1.98, 7.37)]; and young people not in employment, education, or training [RR 5.90 (1.91-18.19)]. Three trials did not show significant benefits from supported employment: populations of workers with musculoskeletal injuries [RR 1.38 (1.00, 1.89)]; substance abuse [RR 1.85 (0.65, 5.41)]; and formerly homeless people with mental illness [RR 1.55 (0.76, 3.15)]. Supported employment interventions may be beneficial to people from more diverse populations than those with severe mental illness alone. Defining competitive employment and increasing (and standardising) measurement of non-vocational outcomes may help to improve research in this area.

Implementation of Individual Placement and Support in Italy: The Reggio Emilia Experience.

Individual placement and support (IPS) is an evidence-based intervention helping people with mental illness to obtain competitive jobs. In the last decade, European mental health leaders were interested on its implementation. Aim of the study was to assess the IPS feasibility in Italian patients with moderate-to-severe mental illness. To date, no evaluation of IPS has been conducted exclusively in Italy. Participants (n = 95) were clients of community mental health centers of the Reggio Emilia Department of Mental Health. In addition to drop-out rates, we calculated job acquisition, job duration, and total hours per week worked. A crude competitive employment rate of 41.1% and a crude drop-out rate of 30.5% were found over 42-month follow-up period. Using a Kaplan-Meyer survival analysis, the cumulative employment rate increased up to 44% at 12months and 61% both at 24 and 42months. This study documents the feasibility of an implementation strategy for introducing the IPS model in the public mental health care system in Italy.

Implementation of the individual placement and support pilot program in Spain.

This article describes the adoption of Individual Placement and Support (IPS) supported employment between 2013 and 2017 in Catalonia (Spain) in the context of high unemployment and a predominance of traditional preemployment training approaches. It reports the experience of implementing IPS to promote competitive job placement of people with mental disorders. The Avedis Donabedian Research Institute (FAD) designed, trained, implemented, and evaluated the project. We used a longitudinal, mixed-methods approach. The demonstration project comprised 7 employment services and 12 ambulatory mental health centers. It followed up programs and participants from October 2013 to December 2017. The project added 1,188 new competitive jobs, increased the rate of competitive employment from 16% to 43%, and improved the fidelity of IPS by 44% on the organizational dimension and by 34% on services dimension. The quality of employment was similar to the overall employment market, with 94% of temporary jobs. The qualitative analysis confirmed several areas of improvement, including the vision of recovery, collaborations between vocational and mental health services, work patterns of practitioners, and views of work as an important treatment. A strong leadership team, consistent training, and commitment to model fidelity have established IPS in the pilot region as an important intervention to obtain and maintain competitive employment and recovery for people with a mental health condition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Comorbid Traumatic Brain Injury and Visual Impairment: Vocational Rehabilitation Service Provision and Agency-Level Outcomes

Introduction: The purpose of this study was to investigate how services are provided to state–federal vocational rehabilitation consumers with comorbid traumatic brain injury (TBI) and visual impairment and the prevalence of and competitive employment rates for this population. Methods: We utilized a mixed-methods approach by incorporating interview data from 51 vocational rehabilitation agency administrators (to identify strategies used to serve these consumers) and case service data (to identify prevalence and competitive employment rates at the agency level). We combined the data to examine the relationship between strategies used and the prevalence of and employment outcomes for this population. A modified grounded theory approach was used for qualitative data analysis and descriptive statistics, and analyses of variance were used for quantitative data analyses. Results: Strategies used to serve these consumers included collaboration between counselors, involvement of external organizations, specialized TBI units or caseloads, staff training in TBI, and personnel with dual expertise in TBI and visual impairment. Over a third of agency administrators reported that they did not do anything special or different to serve this population. The average percentage of consumers with visual impairments who also had TBIs being served by agencies was 2.1%. Their average competitive employment rate by agency was 43.2%. Employing staff with dual expertise in TBI and visual impairment was associated with serving a greater percentage of consumers and having a higher competitive employment rate. Discussion: No agencies had a unique service delivery program or method to serve this population, perhaps due to its low prevalence. Agencies had substantial variability in the proportion of consumers with TBI and visual impairment served and their competitive employment rates. Implications for practitioners: Training vocational rehabilitation professionals to develop expertise in both TBIs and visual impairments may help agencies better serve these consumers.

Individual placement and support in Italian young adults with mental disorder: Findings from the Reggio Emilia experience.

Individual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to achieve and maintain competitive jobs. However, little data in young adult populations are currently available, especially in Europe. Aim of this study was to assess the effect of IPS in Italian young adults with moderate-to-severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period. Participants (n = 54) were recruited from patients receiving psychiatric treatment in one of the seven adult Community Mental Health Centers of the Reggio Emilia Department of Mental Health. Together with drop out rates, we investigated job duration (total number of days worked), job acquisition (employment in the labour market for at least 1 day during the follow-up), total hours per week worked, and job tenure (weeks worked on the longest-held competitive job). A crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period. This research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.

Expanding Individual Placement and Support to Populations With Conditions and Disorders Other Than Serious Mental Illness.

A systematic review of studies of individual placement and support (IPS) for populations other than those with serious mental illness was conducted. The authors searched three electronic databases (PubMed, Web of Science, and Scopus) for studies of IPS and modified IPS. Eligibility criteria for the systematic review included randomized controlled trials with prospective data collection on competitive employment rate and at least 10 study participants from a well-defined population other than people with serious mental illness. Results were compiled for competitive employment rates, IPS fidelity, and other outcomes. Three clinical groups other than people with serious mental illness have been studied: people with psychiatric disorders other than serious mental illness, people with substance use disorders, and people with musculoskeletal or neurological disorders. Nine controlled trials with a total of 2,902 participants included six trials with people who had psychiatric disorders other than serious mental illness, two with people who had substance use disorders, and one with people who had spinal cord injuries. In eight studies, results for competitive employment rates significantly favored IPS. Meta-analysis yielded an overall weighted odds ratio of 2.23 (95% confidence interval=1.53-3.24, p<.001). Findings for other employment outcomes also favored IPS, but findings on symptom reduction and quality of life were inconsistent. The strongest (and only replicated) findings were for veterans with posttraumatic stress disorder (PTSD). Methodological limitations included small samples, major modifications to IPS fidelity, and short follow-up periods. IPS, often with modifications, is a promising employment intervention for several populations in addition to people with serious mental illnesses. The strongest evidence pertains to veterans with PTSD. IPS should be offered to these veterans. Research on other populations, including people with anxiety, depression, substance use disorder, musculoskeletal or neurological conditions, or pain syndromes, needs development, amplification, and replication.

Services for Consumers Who Are Deafblind: Vocational Rehabilitation Agency Service Models Utilized and Their Effectiveness

Introduction: Little is known about how state-federal vocational rehabilitation agencies provide services to consumers who are deafblind. The purpose of this study was to investigate these service models and their effectiveness. Methods: A mixed-methods approach was utilized with data from interviews with 51 vocational rehabilitation agency administrators and the Rehabilitation Services Administration Case Service Report. Information about how these agencies serve deafblind consumers was combined with data from 2,119 consumers served by those agencies to determine competitive employment rates based on service model type. Descriptive statistics, chi-square tests of independence, and logistic regression analysis were utilized. Results: Four vocational rehabilitation agency service models were identified: specialist, professional collaboration, specialist plus professional collaboration, and miscellaneous. Significant differences in competitive employment closure rates were found based on service model type, in both univariate and multivariate analyses. The specialist and professional collaboration models were superior to miscellaneous models. Discussion: This study is the first empirical evaluation of the effectiveness of vocational rehabilitation services for consumers who are deafblind. The results support two previous recommendations about providing services to consumers who are deafblind: establish a deafblind coordinator or specialist position and use a dual-case approach (collaboration between general-service agencies and those for people who are visually impaired). Implications for agencies: To improve competitive employment outcomes for individuals who are deafblind, vocational rehabilitation agency administrators should explore options for specialized deafblind positions and promote collaboration within and beyond their agency.

Hispanic Caregiver Experiences Supporting Positive Postschool Outcomes for Young Adults With Disabilities

The rate of competitive employment, or employment in community settings for minimum wage or higher, of working-age individuals with disabilities trails behind individuals without disabilities in the United States. These statistics are even more alarming among Hispanic individuals who have disabilities. The purpose of this study was to explore the negative and positive experiences of Hispanic caregivers from a Midwestern state as they support their family members with disabilities to achieve positive postschool outcomes, including competitive employment. We conducted semistructured interviews with 13 caregivers of family members with disabilities aged 14-25 years. Three key themes emerged from our analysis: (a) negative experiences with school educators, (b) negative experiences with community-based service providers, and (c) positive experiences and strategies for overcoming barriers. Implications for practice and future research are discussed.

Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis

Background. It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population. Objective. To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia. Method. A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions. Results. Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode. Discussion and conclusion. It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.

Effectiveness of supported employment in non-trial routine implementation: systematic review and meta-analysis.

While supported employment (SE) programs for people with mental illness have demonstrated their superiority in randomized controlled trials (RCTs) and meta-analyses, little is known about the effectiveness of non-trial routine programs. The primary objective of this study was to estimate a pooled competitive employment rate of non-trial SE programs by means of a meta-analysis. A secondary objective was to compare this result to competitive employment rates of SE programs in RCTs, prevocational training programs in RCTs and in routine implementation. A systematic review and a random-effects meta-analysis of proportions were conducted. Quality assessment was provided. Moderator analyses by subgroup comparisons were conducted. Results from 28 samples were included in the meta-analysis. The pooled competitive employment rate for SE routine programs was 0.43 (95% CI 0.37-0.50). The pooled competitive employment rates for comparison conditions were: SE programs in RCTs: 0.50 (95% CI 0.43-0.56); prevocational programs in RCTs: 0.22 (95% CI 0.16-0.28); prevocational programs in routine programs: 0.17 (95% CI 0.11-0.23). SE routine studies conducted prior to 2008 showed a significantly higher competitive employment rate. SE routine programs lose only little effectiveness compared to SE programs from RCTs but are much more successful in reintegrating participants into the competitive labor market than prevocational programs. Labor market conditions have to be taken into account when evaluating SE programs.

Relationship Between Self-Assessed Fidelity and Self-Reported Employment in the Individual Placement and Support Model of Supported Employment.

A growing body of literature demonstrates that high-fidelity implementation of the individual placement and support (IPS) model of supported employment increases the chances of achieving desired outcomes. This study examined the relationship between IPS fidelity, as self-reported by program sites, and employment outcomes and determined whether this relationship was maintained over time. A total of 78 outpatient programs in New York State provided data on self-reported IPS fidelity and employment outcomes. Pearson correlations were used to determine the relationship between fidelity scores and competitive employment rates. A mixed-effects model examined the relationship between repeated fidelity and employment measures over time. A significant positive relationship was found between better self-reported IPS fidelity and greater employment. The relationship between IPS fidelity and employment was sustained over time (up to one year). Higher-fidelity implementation of the IPS model, as self-assessed by program sites, was associated with higher employment rates, which were sustained over time.