Supported Employment Services Research Articles

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.

JOB AVAILABILITY FOR OLDER WORKERS IN A COMMUNITY: ANALYSIS ON JOB POSTINGS

Abstract Objectives This study examined the current job availability in a local job market for older workers and investigated the required skills the older workers to be competitive. Background Most studies approached older workers’ employment transition from the supply side of the labor market, examining individual-level factors for a successful employment transition. However, there is a lack of knowledge on the demand side, such as job opportunities, regarding older workers’ employment transition. Methods The study uses combined data with job postings collected in the 4th quarter of 2021 from three engines and the O*NET database with occupational information to identify job opportunities and required skills. Additionally, the 2020 and 2021 American Community Survey were used to explore the characteristics of the older workforce in the community. Results A total of 5,160 job postings divided into 468 occupations were found in the community. The most frequently available jobs were healthcare (14%), transportation and material moving (13 %), and sales (13%) occupations, which required some work experience needed. The older labor force mostly had a college or associate degree (45.8%) and was in educational (16%), office (11%), and sales (11%) occupations. All occupations require technological skills. Conclusion The study found a mismatch between the available jobs and the actual older labor force, and those who are in employment transition, even downward movement, would be required some related experience. These suggest that a pre-employment transition program providing job training and age-friendly employment support services would be helpful for older workers in all occupational classes.

Identifying user profiles of healthcare, social and employment services in a working-age population: A cluster analysis with linked individual-level register data from Finland.

A thorough understanding of the use of services in the population is important in order to comprehend the varying service needs of different groups. This explorative study aimed to find distinct user profiles in a working-age population based on individuals' annual use of healthcare, social and employment services and to explore socio-demographic and morbidity-related predictors of the user groups. Administrative register data on the use of various services and individual-level covariates from year 2018 were linked for all residents aged 18-64 of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their frequency of using 22 distinct healthcare, social and employment services during 2018. Multinomial logistic regression models were utilized to assess the associations of cluster assignment with socio-demographic and health-related covariates (sex, age, marital status, education, occupational class, income, days in employment, chronic disease and receipt of different social benefits). Five distinct clusters were identified in terms of service use, labelled low to moderate users of healthcare (82.0%), regular employment services users with moderate use of healthcare (9.6%), supported employment services users with moderate use of healthcare with an emphasis on preventive care (2.9%), frequent users of healthcare, social and employment services (2.9%), and rehabilitation, disability services and specialized healthcare users (2.6%). Each cluster not only showed different patterns of service use but were also differently associated with demographic, socio-economic and morbidity-related covariates, creating distinct service user types. Knowledge on the different user profiles and their determinants may help predict future need and use of services in a population, plan timely, coordinated and integrated services, and design early interventions and prevention measures. This is important in order to save costs and improve the effectiveness of services for groups with different care needs.

Research on The Integrated Education Adaptability of Visually Impaired Students—A Study on Binzhou Medical University from China

The education of visually impaired students in China has also gone through a developmental stage from "segregated education" to "special education" and then to "integrated education". In this paper, we take the visually impaired students at Binzhou Medical College, the first university in China to provide higher education for the disabled, as the research object. The study was carried out to investigate the adaptability of visually impaired students, using various research methods such as literature review method, questionnaire method and case study method, we investigated and researched the adaptation of visually impaired students to integrated education from several aspects such as quality of life, social support, mental health level, self-esteem and self-efficacy study. Finally, the study proposed several countermeasures and suggestions, such as attaching importance to the physical and psychological rehabilitation of visually impaired students, emphasising the integration of education and rehabilitation, strengthening the training of professional teachers for visually impaired students, emphasising the complementarity between schools and professions, and improving the employment support service system for visually impaired students, which are of great significance in promoting the development of the cause of integrated education for visually impaired students and improving the adaptability of integrated education for visually impaired students.

Clustering users of healthcare, social and employment services: a register study from Finland

Abstract Background Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment services during one year and to investigate sociodemographic and health-related predictors of user groups. Methods Administrative register data on the use of 22 distinct healthcare, social and employment services and on socio-demographic and health-related covariates from year 2018 were linked for all working-age residents of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their yearly frequency of using each service. Multinomial logistic regression was used to assess the associations of sociodemographic and health-related covariates with cluster assignment. Results Five distinct clusters were identified, labelled ‘low to moderate users of healthcare’ (82%), ‘regular employment services users with moderate use of healthcare’ (10%), ‘supported employment services users’ (3%), ‘frequent users of healthcare, social and employment services’ (3%) and ‘disability and specialized services users’ (3%). Each cluster showed different patterns of service use and was also uniquely associated with sociodemographic and health-related covariates, reflecting distinct service user types. Conclusions The study identified five distinct groups of healthcare, social and employment services users in a working-age population. Knowledge of different user profiles and their determinants can help predict future need and use of services, coordinate and integrate services, and plan early interventions and prevention measures. This is important in order to save costs and improve the overall quality and effectiveness of services for groups with different care needs. Key messages • In terms of their use of healthcare, social and employment services, the working-age population can be classified into distinct groups, uniquely associated with various determinants. • Understanding the population’s use of different services can help predict future needs and improve coordination, integration and effectiveness of services in groups with different needs.

A Qualitative Study on the Experience of Using Employment Support Services for Self-reliance-prepared youth

A Qualitative Study on the Experience of Using Employment Support Services for Self-reliance-prepared youth

국내 대학생의 진로개발역량에 관한 연구동향 분석

The purpose of this study was to analyze research trends on the career development competencies of college students in South Korea. A total of 25 papers were analyzed, selected from the Academic Information Service (RISS) using keywords 'undergraduate' or ‘college’ and 'career development competencies'. Key findings are as follows. First, studies on career development competencies of college students have been consistently published since 2002, peaking in 2015, primarily in education-related journals. Second, the majority of research subjects were 4-year college students. Third, most studies focused on enhancing career education by exploring the relationship between career development competencies and related variables. Fourth, in terms of research method, it was found that quantitative research conducted as cross-sectional studies were the most. Fifth, the measures of Heejin Sung and Seung-il Na(2012) were the mostly used to measure the career development competencies. In addition, the sub-factors were self-understanding, major and occupational knowledge, career decision certainty, decision-making efficacy, relationship utilization efficacy, and job search skills. Sixth, career development competencies of college students were most often used as a dependent variable and had a positive relationship with employment support service experience, career exploration behavior, employment possibility, major satisfaction, and career decision-making. Based on the research findings, several future research directions in the area of the career development competencies are provided.

Predictors of employment for transition-aged youth with co-occurring substance use disorder and psychiatric disorder in the state vocational rehabilitation service-delivery system.

To identify state vocational rehabilitation (VR) services that were associated with employment for transition-aged youth with co-occurring disabilities (TAYWCD). Hierarchical logistic regression analyses were utilized. Participants were 830 youth aged 24 and younger who had a co-occurring substance use disorder and another mental illness. After controlling for the effect of demographic covariates, assessment services (OR = .53, 95% CI [.35, .80], p < .01), job placement services (OR = 2.56, 95% CI [1.73, 3.78], p < .001), and supported employment services (OR = 3.7, 95% CI [2.33, 5.89], p < .001) were found to significantly impact employment outcomes. State VR services that aligned with the individual placement and support model of supported employment principles were correlated with successful employment outcomes for TAYWCD who received these services. Recommendations include the following: (a) prepare VR counselors to effectively work with individuals with psychiatric disabilities; (b) provide TAYWCD with high-quality assessment and the individual placement and support model of supported employment services; (c) require VR counselors who serve TAYWCD to collaborate with community partner agencies that provide coordinated specialty care model services; (d) require VR counselors to collaborate with community partner agencies that provide recovery-oriented and evidence-based services; (e) encourage clients to formulate a Wellness Recovery Action Plan (WRAP) as a state VR assessment and Individualized Plan for Employment planning service; (f) include the state VR on-the-job training service in the Individualized Plan for Employment; (g) make use of benefits counseling services; and (h) institute in-service learning opportunities in state VR agencies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supporting employment consultants leveraging data to deliver quality services and outcomes

BACKGROUND: Ensuring that job seekers with disabilities receive high-quality supported and customized employment services is key for increasing their chances of achieving their career aspirations. OBJECTIVE: To draw attention to the need for better support of employment consultants in the delivery of quality services. METHODS: Nine employment programs piloted ES-Coach, a tool designed to help employment consultants and managers visualize the implementation of supported and customized employment, reflect, set goals, and take action for continuous quality improvement. RESULTS: The nine employment programs invested an estimated 1:19 to 4:10 hours per day on getting to know job seekers, finding jobs, and any other support leading to hire combined. A large amount of their time was invested in administrative activities, ranging from 2:11 to 4:12 hour per day. ES-Coach helped the participants reflect on the quality of their employment support services and set goals for quality improvement. CONCLUSION: Supporting employment consultants with data-enabled feedback is key for improving the quality of supported and customized employment services, a key step toward improving job seekers’ employment outcomes.

중복발달장애인의 맞춤형 고용지원서비스 적용에 대한 심층면담 연구

중복발달장애인의 맞춤형 고용지원서비스 적용에 대한 심층면담 연구

Predictive factors associated with trajectory of job satisfaction of workers with physical disabilities: A latent growth curve analysis.

Job satisfaction is a highly useful factor in maintaining a successful work life for the disabled. This study aimed to evaluate how job satisfaction among workers with physical disabilities evolves over time, and to identify predictive factors that influence the trajectory of job satisfaction. A longitudinal data analysis using the three-year databases of the 2016-2018 Employment Panel Survey for the Disabled (n = 693). A latent growth curve model analysis was conducted to determine the trajectory of the job satisfaction among workers with physical disabilities, as well as the predictive factors affecting it. Job satisfaction among workers with physical disabilities increased over time, and there were substantial individual differences in the trajectory of the job satisfaction. The significant predictors for the job satisfaction over the three years were degree of disability, computer usage ability, employment support services, and experience of discrimination. Gender, educational background, interpersonal relationship/organizational adaptability, convenience facilities for the disabled, job suitability, disability acceptability, and self-esteem had a considerable impact on the intercept of the job satisfaction, but not on the slope. The findings would inform healthcare providers to establish mid-to-long-term vocational rehabilitation intervention plans that could increase the job satisfaction among workers with physical disabilities.

Barriers to Client Engagement and Strategies to Improve Participation in Mental Health and Supported Employment Services.

A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.

The effect of military sexual trauma on competitive employment status following veterans health administration supported employment services.

Military sexual trauma (MST) is prevalent, and some initial evidence suggests it is associated with impaired employment outcomes. The Veterans Health Administration (VHA) offers supported employment (SE) and Community-Based Employment Services (CBES), which consist of individualized employment support integrated with mental health treatment. The objective of this study was to examine the prevalence and effect of MST on competitive employment outcomes following participation in SE or CBES. Participants were a national set of Veterans who participated in VHA SE or CBES services between 2015 and 2019 and whose medical record contained a completed MST screen (N = 12,689). Data were obtained from clinician-administered SE and CBES admission and discharge forms merged with electronic health records. One thousand five hundred fifteen (11.9%) Veterans reported experiencing MST: 6.2% (n = 676) of men and 47.8% (n = 839) of women. Veterans who experienced MST were significantly less likely to hold competitive employment at discharge, 568 (41.0%) versus 4,702 (47.4%) of those without MST history; χ² = 19.79, p < .001. In adjusted analyses, MST was associated with lower likelihood of competitive employment over and above psychiatric comorbidities and other variables associated with employment status, such as receipt of disability, previous unemployment, homelessness, incarceration, and medical comorbidity. Findings suggest that Veterans seeking employment services may represent a high-risk group for having experienced MST and reinforce the importance of trauma-informed care. Providers should assess for and incorporate MST into treatment planning and job development when indicated. More work is needed to inform employment support for Veterans who have experienced MST. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supported Employment for Veterans with Traumatic Brain Injury History: Is it Working?

<h3>Research Objectives</h3> To examine characteristics and employment outcomes among Veterans with traumatic brain injury (TBI) history enrolled in Supported Employment. This program provides intense, individualized supported for individuals whose disabilities interfere with finding and maintaining employment. Supported Employment providers work closely with the Veteran's clinical treatment team, Veterans, and employers to ensure clinical and vocational supports are provided to facilitate workplace success. <h3>Design</h3> Review of Department of Veterans Affairs (VA) administrative and electronic medical record data collected between 2020-2022. <h3>Setting</h3> 12 VA medical centers. <h3>Participants</h3> Veterans with TBI history. <h3>Interventions</h3> Supported Employment. <h3>Main Outcome Measures</h3> Employment status. <h3>Results</h3> 92 Veterans with TBI history were referred to a VA Supported Employment program. They were primarily male (96%), White (74%), non-Hispanic (85%), Post-9/11 Veterans (59%) with an average age of 41 ± 10.4 years. The majority (83%) received VA service-connected disability compensation for up to 29 health conditions, and 30% were 100% service-connected. The majority were referred by the Polytrauma/TBI clinic (53%). At enrollment, they had been unemployed for 5 months (median). To date, half (51%) obtained at least 1 job within approximately 3 months (median = 97 days) of Supported Employment program entry. Incarceration history, current homelessness, and level of service-connected disability rating did not differ among Veterans who did or did not obtain employment (all ps > .05). <h3>Conclusions</h3> The majority of Veterans with TBI history and co-occurring military-related health conditions have demonstrated success in obtaining employment within a relatively short amount of time following enrollment in a Supported Employment program. Health and psychosocial factors that may be barriers to employment were not associated with obtaining a job, underscoring the effectiveness of Supported Employment services for Veterans with TBI history who may otherwise have employment challenges. <h3>Author(s) Disclosures</h3> The authors have no conflicts to declare.

Outcomes of Peer-Provided Individual Placement and Support Services in a Mental Health Peer-Run Vocational Program.

The authors sought to determine whether staff at a peer-run agency could deliver supported employment services with high fidelity to the individual placement and support (IPS) model and whether employment outcomes of peer-delivered IPS plus work-specific health promotion were superior to usual supported employment services. Two teams from a vocational program of a large peer-run agency were studied from July 2015 to July 2017. One team received training and supervision in delivering IPS plus employment-focused physical wellness support and mentoring. The other team continued providing usual supported employment services. Study data included vocational outcomes from 348 clients served by the two teams (IPS, N=184; comparison condition, N=164) and the results of IPS fidelity reviews of the IPS team at study baseline, midpoint, and end. The authors modeled the primary outcome of competitive employment with random-effects logistic regression and adjusted propensity scores for age, gender, race, ethnicity, education, and months of service receipt. Following training, the IPS team demonstrated acceptable and increasing fidelity to the IPS model, achieving "good fidelity" by the end of the 25-month observation period. Among IPS recipients, 43% achieved competitive employment versus 21% of comparison recipients (p<0.001). Multivariable analysis indicated that IPS recipients were significantly more likely to achieve competitive employment than individuals in the comparison group (OR=4.06, p<0.001). Providing training in IPS along with health promotion to the behavioral health peer workforce may help address the severe shortage of IPS services and enhance the competitive employment outcomes of people served by peer-run programs.

Update on funding IPS supported employment services in the IPS learning community.

Individual placement and support (IPS) is the evidence-based supported employment approach for people with serious mental illness. Because funding is the major barrier for states to implement IPS and increase access, the IPS Learning Community collected information about sources of IPS funding from 24 member states. In early 2020, IPS employment leaders from the public mental health authority and the state vocational rehabilitation (VR) authority completed a questionnaire identifying sources of funding for IPS in their states. The main sources of funding were Medicaid, Substance Abuse and Mental Health Services Administration (SAMHSA) block grants, state and county government, the Ticket to Work program, and the federal-state VR programs. Funding IPS services requires braided funding from multiple sources. This complicated method limits scaling up services statewide. Solving this funding problem would require coordinated action from federal and state agencies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating the performance diagnostic checklist-human services to address performance issues of adults with intellectual disabilities

ABSTRACT The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool used to assess performance issues in human service settings by identifying performance barriers and suggest matched interventions. There are few applications of the PDC-HS assessing performance in populations with intellectual disabilities. We used the PDC-HS to assess inaccurate book-shelf cleaning by three participants with intellectual disabilities in supported employment services at a library. We identified insufficient training and prompting as barriers to accurate and timely performance. We evaluated behavioral skills training, video modeling with voice-over instruction, and prompting on accuracy for all participants and timeliness for one participant. All participants exhibited increased accuracy on the shelf-cleaning task. One participant showed an increase in timeliness of completion, and one participant maintained and generalized performance after the training phase. Participants indicated positive experiences with the intervention. We discuss limitations and future directions of using the performance diagnostic checklists with individuals with intellectual disabilities.

Effects of Unemployment on Opioid Use Treatment Trajectories: Impact of the COVID-19 Pandemic.

Living with an opioid use disorder (OUD) can make finding and sustaining employment a significant challenge and is only expected to get worse in the COVID-19 environment. For most individuals in OUD treatment, being employed is an important part of their recovery journey. Employment has several benefits, including reductions in preoccupation with symptoms, social isolation, risk of suicide, hopelessness, and economic instability, which if not addressed often result in homelessness. Therefore, employment is an important social determinant of health, especially among those with OUD. Employment success and OUD, however, may vary based on race, age, gender, and socioeconomic status. Return to work support as states begin to reopen will be critically important to improve treatment outcomes for individuals with OUD in a post-COVID-19 environment, requiring utilizations of evidence-based interventions. Nurses, particularly psychiatric mental health and addiction nurses, should routinely screen for employment needs of their patients with OUD and connect them to the necessary support services. Finally, nurses should advocate for regulatory reform that allows for employment support services to be billable and integrated in psychiatric and behavioral health services just like other mental health services.

Total Metacognitive Capacity Predicts Competitive Employment Acquisition Across 6 Months in Adults With Serious Mental Illness Receiving Psychiatric Rehabilitation Services.

Deficits in metacognitive capacity are common among people with serious mental illness (SMI), although there is a gap in knowledge regarding how these impairments predict later functioning, especially employment. This study aimed to prospectively examine the relationship between metacognitive capacity and 6-month competitive employment attainment in adults with SMI who were participating in a study testing a cognitive behavioral therapy intervention added to supported employment services. Sixty-seven participants with complete data at baseline and the 6-month follow-up comprised the sample. Data were analyzed using stepwise logistic regression covarying for work history and study assignment. Results indicate that total metacognitive capacity at baseline significantly predicted employment acquisition at 6 months; the final model correctly classified 83.3% of participants who obtained work. In conclusion, these findings suggest that better overall metacognitive capacity may be key for future work functioning. Thus, interventions that target metacognitive capacity may lead to enhancements in community outcomes.

I feel frozen: Client perceptions of how posttraumatic stress disorder impacts employment.

Objective: There is evidence that posttraumatic stress disorder (PTSD) is a hidden barrier to employment among individuals with serious mental illnesses (SMI) among whom PTSD is highly prevalent. This study aimed to explore how PTSD interferes with achieving employment outcomes among persons with SMI. Methods: Participants included 119 individuals with SMI and co-occurring PTSD receiving Supported Employment services. Responses to the question, "In what ways are PTSD symptoms interfering with your work during the past month?" were analyzed. Results: Six themes emerged: (a) I don't like being around people, (b) I feel frozen and unable to get started, (c) troubling negative affect, (d) mind is scattered and all over the place, (e) feeling fatigued all the time, and (f) flashbacks and triggers can happen whenever. Conclusions and Implications for Practice: Findings provide insight into how PTSD symptoms impact work outcomes and suggest that there is a need for Supported Employment providers to screen clients for trauma exposure to identify those in need of additional support in order to improve work outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).