Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Implementation Resource Kit User's Guide

Special Populations Appendix

A review of the literature addressing the range of populations for which supported employment has demonstrated efficacy or effectiveness, including factors such as age, race, ethnicity, gender, institutional setting, sexual orientation, and geographic location.

The most consistent finding from the supported employment literature has been the absence of specific client factors predicting better employment outcomes. Specifically, diagnosis, symptomatology, age, gender, disability status, prior hospitalization, and education have been examined and none have proven to be strong or consistent predictors (Bond, Dietzen, McGrew, & Miller, 1995; Drake et al., 1999; Drake, McHugo, Becker, Anthony, & Clark, 1996). Notably, a co-occurring condition of substance use has not been found to predict work outcomes (Bell, Greig, Gill, Whelahan, & Bryson, 2002; Goldberg et al., 2001; Meisler, Blankertz, Santos, & McKay, 1997; Sengupta, Drake, & McHugo, 1998). Although work history predicts better employment outcomes in supported employment programs, supported employment remains more effective than traditional vocational services for clients with both good and poor work histories (Becker, Bond et al., 2001; Drake et al., 1999; Drake, McHugo et al., 1996). We speculate that the professional assistance provided by supported employment programs at every stage of the employment process compensates for client deficits in a way that less assertive vocational rehabilitation approaches do not. Consequently, the extensive literature on client predictors of work outcomes in people with SMI who either have had little vocational assistance or have been enrolled in traditional vocational programs (Cook & Razzano, 2000) may be largely irrelevant for supported employment programs.

Some client factors have not been systematically examined in the literature. For example, we know of no studies that have examined sexual orientation and how that might affect outcomes in supported employment programs.

Randomized controlled trials of supported employment have been conducted in settings in which there were significant numbers of Caucasian (Bond et al., 1995; Chandler, Meisel, Hu, McGowen, & Madison, 1997; Drake, McHugo et al., 1996; Test, Allness, & Knoedler 1995), African American (Drake et al., 1999; Lehman et al., 2002; Meisler, Williams, Kelleher, & Gold, 2000), and Latino clients (Mueser et al., submitted). Although more replications are needed, all the evidence to date suggests that the effectiveness of supported employment compared to traditional vocational services generalizes to both the African American and Latino populations. Within-study comparisons in employment rates for different ethnic groups have been hampered by a lack of statistical power, so that we cannot currently adequately answer whether supported employment is equally effective across all ethnic groups within a specific setting. We may make our best progress in understanding the role of ethnicity in supported employment programs by combining results across studies using meta-analytic techniques and through qualitative studies (Alverson & Vicente, 1998; Harris, Bebout, Freeman, & Hobbs, 1997; Quimby, Drake, & Becker, in press). Anecdotally, we know that culture and language pose significant barriers to providing supported employment in some populations.

Community characteristics do not appear to impose a major barrier to implementing supported employment. Supported employment has been successfully implemented in both very urban (Becker, Bond et al., 2001; Bond et al., 1995; Drake et al., 1999; Gervey & Bedell, 1994; Lehman et al., 2002; Mueser et al., submitted) and very rural settings (Becker, Smith, Tanzman, Drake, & Tremblay, 2001; Drake et al., 1994; Drake, Becker, Biesanz, Wyzik, & Torrey, 1996; Gowdy, 2000; Meisler et al., 2000), as well as in midsized cities (Bond et al., 1995; Drake, McHugo et al., 1996; Test et al., 1995). Many different states have implemented supported employment (Bond et al., 2001).

Nearly all of the controlled research on the effectiveness of supported employment has been conducted in community mental health centers. The extent to which supported employment can be successfully adapted to other types of provider agencies is the subject of current research, but no strong conclusions can be drawn at this time.

References

Alverson, H., & Vicente, E. (1998). An ethnographic study of vocational rehabilitation for Puerto Rican Americans with severe mental illness. Psychiatric Rehabilitation Journal, 22(1), 69-72.

Becker, D. R., Bond, G. R., McCarthy, D., Thompson, D., Xie, H., McHugo, G. J., & Drake, R. E. (2001). Converting day treatment centers to supported employment programs in Rhode Island. Psychiatric Services, 52, 351-357.

Becker, D. R., Smith, J., Tanzman, B., Drake, R. E., & Tremblay, T. (2001). Fidelity of supported employment programs and employment outcomes. Psychiatric Services, 52, 834-836.

Bell, M., Greig, T., Gill, P., Whelahan, H., & Bryson, G. (2002). Work rehabilitation and patterns of substance use among persons with schizophrenia. Psychiatric Services, 53, 63-69.

Bond, G. R., Dietzen, L. L., McGrew, J. H., & Miller, L. D. (1995). Accelerating entry into supported employment for persons with severe psychiatric disabilities. Rehabilitation Psychology, 40, 91-111.

Bond, G. R., Vogler, K. M., Resnick, S. G., Evans, L. J., Drake, R. E., & Becker, D. R. (2001). Dimensions of supported employment: Factor structure of the IPS Fidelity Scale. Journal of Mental Health, 10, 383-393.

Catalano, R., Drake, R. E., Becker, D. R., & Clark, R. E. (1999). Labor market conditions and employment of the mentally ill. The Journal of Mental Health Policy and Economics, 2, 51-54.

Chandler, D., Meisel, J., Hu, T., McGowen, M., & Madison, K. (1997). A capitated model for a cross-section of severely mentally ill clients: Employment outcomes. Community Mental Health Journal, 33, 501-516.

Cook, J., & Razzano, L. (2000). Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophrenia Bulletin, 26, 87-103.

Drake, R. E., Becker, D. R., Biesanz, J. C., Torrey, W. C., McHugo, G. J., & Wyzik, P. F. (1994). Rehabilitation day treatment vs. supported employment: I. Vocational outcomes. Community Mental Health Journal, 30, 519-532.

Drake, R. E., Becker, D. R., Biesanz, J. C., Wyzik, P. F., & Torrey, W. C. (1996). Day treatment versus supported employment for persons with severe mental illness: A replication study. Psychiatric Services, 47, 1125-1127.

Drake, R. E., Fox, T. S., Leather, P. K., Becker, D. R., Musumeci, J. S., Ingram, W. F., & McHugo, G. J. (1998). Regional variation in competitive employment for persons with severe mental illness. Administration and Policy in Mental Health, 25, 493-504.

Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., & Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental illness. Archives of General Psychiatry, 56, 627-633.

Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness: Vocational outcomes. Journal of Consulting and Clinical Psychology, 64, 391-399.

Gervey, R., & Bedell, J. R. (1994). Supported employment in vocational rehabilitation. In J. R. Bedell (Ed.), Psychological assessment and treatment of persons with severe mental disorders (pp. 151-175). Washington, DC: Taylor & Francis.

Goldberg, R. W., Lucksted, A., McNary, S., Gold, J. M., Dixon, L., & Lehman, A. (2001). Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness. Psychiatric Services, 52, 101-103.

Gowdy, E. A. (2000). Work is the best medicine I can have: Identifying best practices in supported employment for people with psychiatric disabilities. Unpublished dissertation, University of Kansas, School of Social Welfare, Lawrence, KS.

Gowdy, E. A., Rapp, C. A., Coffman, M., & Carlson, L. S. (2000). The relationship between economic conditions and employment of people with severe and persistent mental illness. Lawrence, KS: University of Kansas, School of Social Welfare.

Harris, M., Bebout, R. R., Freeman, D. W., & Hobbs, M. D. (1997). Work stories: Psychological responses to work in a population of dually diagnosed adults. Psychiatric Quarterly, 68, 131-153.

Lehman, A. F., Goldberg, R. W., Dixon, L. B., McNary, S., Postrado, L., Hackman, A., & McDonnell, K. (2002). Improving employment outcomes for persons with severe mental illness. Archives of General Psychiatry, 59, 165-172.

Meisler, N., Blankertz, L., Santos, A. B., & McKay, C. (1997). Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders. Community Mental Health Journal, 33, 113-122.

Meisler, N., Williams, O., Kelleher, J., & Gold, P. (2000, October 11-13). Rural-based supported employment approaches: Results from South Carolina site of the Employment Intervention Demonstration Project. Paper presented at the Paper presented at the 4th Biennial Research Seminar on Work (Matrix Research Institute), Philadelphia, PA.

Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J., Bond, G. R., Essock, S. M., Becker, D. R., Wolfe, R., & Swain, K. (submitted). The Hartford study of supported employment for severe mental illness: I. Employment and nonvocational outcomes.

Purlee, G. D. (1993). Predictors of employment outcome for persons with serious mental illness. Unpublished dissertation, Indiana University, Bloomington.

Quimby, E., Drake, R. E., & Becker, D. R. (in press). Ethnographic findings from the Washington, DC, Vocational Services Study. Psychiatric Rehabilitation Journal.

Sengupta, A., Drake, R. E., & McHugo, G. J. (1998). The relationship between substance use disorder and vocational functioning among persons with severe mental illness. Psychiatric Rehabilitation Journal, 22(1), 41-45.

Test, M. A., Allness, D. J., & Knoedler , W. H. (1995, October). Impact of seven years of assertive community treatment. Paper presented at the American Psychiatric Association Institute on Psychiatric Services, Boston, MA.

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