Supported Employment Participants Research Articles

Economic evaluation of a supported employment program for veterans with spinal cord injury

Objective: To estimate the net monetary benefit of an individual placement and support-based supported employment program for Veterans with spinal cord injuries.Design: Economic evaluation comparing a supported employment program to treatment as usual, using cost and quality-of-life data from a longitudinal study of Veterans with spinal cord injuries.Setting: Spinal cord injury centers in the Veterans Health Administration.Participants: Subjects (N = 213) who participated in a 24-month supported employment program at seven spinal cord injury centers. Supported employment participants were compared with a group of spinal cord injury Veterans who received treatment as usual in a prior study.Main outcome measures: Costs and quality-adjusted life years using the Veterans Rand-6 Dimension, estimated from the Veterans Rand 36-Item Health Survey.Results: The supported employment program was more effective at both 1- and 2-year periods compared with treatment as usual. Outpatient costs were significantly higher for supported employment, but inpatient costs were not significantly different from treatment as usual. When cost and effectiveness were compared jointly using net monetary benefit, a supported employment program following the core principles of Individual Placement and Supported employment was more effective but not cost-effective at standard willingness to pay thresholds. When we considered a sub-group of the supported employment participants who more closely resemble the treatment as usual group from a randomized trial, there was no significant difference in the cost-effectiveness of supported employment when compared to treatment as usual.Conclusions: With higher effectiveness and similar costs, supported employment for spinal cord injury Veterans has the potential to be cost-effective. Future studies need to randomize participants or carefully match participants based on observable patient characteristics to improve cost-effectiveness evaluations of this population.Implications for RehabilitationSupported employment as part of ongoing rehabilitation care helps individuals with spinal cord injury return to work and improve their quality of life.Many studies show that supported employment programs are cost effective for persons with mental disabilities, but there is only limited economic evaluation data on use of supported employment with persons with spinal cord injury.This study shows that supported employment integrated with ongoing rehabilitation care is more effective in restoring employment and health-related quality of life.

Work-related discrimination and change in self-stigma among people with mental illness during supported employment.

The relationship of work-related discrimination to the change in self-stigma and stigma stress was assessed among supported employment participants in Switzerland. Self-stigma and the cognitive appraisal of mental illness stigma as a stressor were measured at baseline among supported employment participants (N=116). These variables and work-related discrimination in the past year were assessed one year later (N=96). Compared with participants who did not find employment (N=30), those who worked without experiencing discrimination (N=25) had lower levels of self-stigma and stigma stress at one year. Among those who worked and reported work-related discrimination (N=38), these measures did not decrease significantly. Experiencing discrimination at work may determine whether employment has positive effects in terms of self-stigma and stigma stress among individuals with mental illness. Interventions to reduce discrimination in work settings and to improve coping resources of these individuals could augment the positive effects of supported employment.

Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review.

Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio=3.66 [1.93-6.93], p<0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.

The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs.

The purpose of this study was to determine the relationship between the working alliance and employment outcomes in persons with severe mental illness receiving vocational services. Another purpose of this study was to determine whether working alliance differences exist between clients receiving evidence-based supported employment services and those receiving traditional stepwise vocational services. This study was a secondary analysis of a 2-year randomized controlled trial comparing two employment programs providing services to people with severe mental illness. Contrary to expectations, no overall relationship was found between the working alliance and employment outcomes. As predicted, supported employment participants each assigned to a single vocational worker had more positive working alliances than participants served by a team of vocational workers in the traditional vocational program. The lack of an association between the working alliance and employment outcomes is inconsistent with previous literature. Further research is needed using standardized working alliance measures and larger samples that include both working and nonworking clients. Evidence-based supported employment, which employs individual caseloads, seems to foster better relationships than a team-based vocational approach, although future research is needed to replicate this finding.

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment. We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods. All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions. The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

The Job Developer's Presence in the Job Interview: Is It Helpful or Harmful to Persons with Psychiatric Disabilities Seeking Employment?

This study examines the effect of having an employment specialist join supported employment participants at job interviews. The sample consists of 45 individuals with psychiatric disabilities who sought job placement services during a 28-month period between December 1991 and March 1994. Seventy-nine percent of the job offers occurred when the job developer was present in the interview as compared to only 21% when the job applicants went alone. The finding challenges "current" conventional wisdom about having rehabilitation staff at the worksite. Rehabilitation professionals need to take a fresh look at program policies and practices regarding on-site services to SE participants.

A self-rating scale for supported employment participants and practitioners.

Supported Employment services have significantly enhanced the opportunities for competitive employment among persons with mental illnesses. However, the research shows that there remain problems with under-utilization and attrition in these programs. In addition, the rates of termination among those in supported employment placements are high. This article describes a self-rating scale that can be used by both employed and unemployed persons that has the potential to address these problems. The article also reports a study that shows this self-rating scale to be a valid, summary index for the employment relevant variables of job satisfaction, motivation, and job-related experiences. The self-rating scale appears to be a worthy candidate for a trial in supported employment operations.

Employer Attitudes and Satisfaction with Supported Employment

The attitudes of employers toward workers with severe mental and physical disabilities and supported employment programs were examined through structured interviews with 47 employers who had hired or supervised workers participating in supported employment programs in Tennessee. Results indicated that employers generally hold favorable attitudes regarding the employment potential of workers with disabilities and the quality of services provided through supported employment programs. The physical presence of employment specialists at the job site was viewed by employers as a strength of the supported employment program. However, some employers indicated that few opportunities exist for career advancement within their businesses for the supported employment participants. Finally, employers identified a number of strategies that could be used to market supported employment services to other businesses in their local communities.

Customer initiated supported employment

One of the recurring problems reported by supported employment participants has been an overall lack of involvement in the process. People with disabilities have reported feeling powerless within programs which offer no opportunity for choice and control. This creates a need to provide opportunities within supported employment to maximize consumer participation. The Consumer Initiated Approach to Supported Employment demonstrates how to promote full consumer inclusion. The authors provide an overview of this approach. Key model components include: customer lead assessment, customer driven job selection, individualized vocational supports and customized job retention services. The outcome data from this federally funded demonstration project are also provided.

Personal and functional characteristics of supported employment participants with severe mental retardation

Personal and functional characteristics of supported employment participants with severe mental retardation

The Impact of Behavioral Deficits on Employment Retention: An Illustration from Supported Employment1

Supported employment has emerged as a viable alternative to conventional rehabilitation approaches for tens of thousands of individuals previously excluded from employment opportunities. However, the ability to retain a job in business or industry for an extended period of time remains a challenge for many supported employment participants. An exploratory investigation of the reasons for job separation of 1,484 individuals participating in supported employment programs in eight states was completed to investigate behavioral characteristics that facilitate or hinder employment retention. Results illustrate that employment retention is affected by a wide variety of vocational, behavioral, economic, and external factors. A number of different approaches currently used to address behavioral difficulties in employment settings are discussed, including compensatory strategies, self-management, and co-worker supports.

Achievements and Challenges I: A Five-Year Report on Consumer and System Outcomes from the Supported Employment Initiative

This article presents results from the 1990 fiscal year survey of state supported employment implementation conducted by the Rehabilitation Research and Training Center on Supported Employment at Virginia Commonwealth University, and a longitudinal analysis of findings from the 5-year course of this investigation. State vocational rehabilitation agencies reported a total of 74,657 supported employment participants and 2,647 provider agencies for 1990. Persons with mental retardation continue to be the primary service group, but there has been a dramatic increase in the proportion of supported employment participants with mental illness. Among participants with mental retardation, those with mild retardation continue to be the primary recipients of services. Use of the individual placement model has also increased substantially, with a corresponding decrease in the use of most group options. The availability of extended services funding was found to be limited across a number of disability groups. Findings are discussed in relation to the achievements of the states in implementing supported employment, and challenges to the states for improving service access and delivery for individuals with severe disabilities.