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Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Supported Employment
Workbook
Chapter 2: Evidence On Supported Employment
Chapter overview
This chapter reviews the research showing that supported employment works.
References
Please see the Psychiatric Services article (Bond, et. al., 2001 1) in this resource kit for specific research references.
1 G.R. Bond, D.R. Becker, R.E. Drake, C.A. Rapp, Meisler, N., Lehman, A.F., and M.D. Bell, “Implementing Supported Employment as an Evidence-based Practice,” Psychiatric Services, 52, (2001), 313-322.
Supported Employment gets results
Supported employment has been the most extensively studied model of vocational rehabilitation for persons with psychiatric disabilities, and ample evidence supports its effectiveness. At last count, 9 different research studies involving random assignment of consumers to either supported employment or a comparison program, have been conducted to evaluate the effects of supported employment programs. In each study, the supported employment program has been found to produce better vocational outcomes than the comparison program or programs. In these studies, consumers in supported employment programs are more successful in obtaining competitive work, they work more hours, and they earn more wages from competitive employment than consumers receiving other vocational services.
No evidence of negative effects
Practitioners, consumers, and family members are sometimes concerned that competitive work will be a stressful experience that may increase the chances of relapses and rehospitalizations. However, the research on supported employment has consistently found that there are no negative effects related to participating in a supported employment program. Specifically, consumers who participate in supported employment programs do not experience more severe symptoms, or higher levels of distress, nor do they require more intensive psychiatric treatment, such as emergency room visits or psychiatric hospitalizations.
Nonvocational outcomes
Research on supported employment programs indicates that participation usually does not result in significant improvements in non-vocational outcomes, such as symptoms or quality of life, compared to other vocational rehabilitation programs. However, some research shows that when consumers succeed in finding competitive work, improvements may occur in symptoms, self-esteem, and satisfaction with finances (Bond et. al., 20012). Most consumers who obtain work in supported employment programs work part-time and are able to keep their benefits. This work often becomes a meaningful part of their lives.
Cost issues
Only a limited amount of research has examined the cost of providing supported employment services. This research indicates that when a supported employment program is added to an existing psychiatric rehabilitation program, overall costs of services (that is, the combined treatment and employment program costs) increase. However, when a supported employment program replaces another rehabilitation program, such as a day treatment program, the overall treatment costs remain the same. Some programs have found the cost ranges from two to four thousand dollars per client per year (Clark, 19983).
Chapter summary
In summary, extensive research on supported employment shows that it improves vocational outcomes more than other programs while not causing any negative effects. Modest benefits in areas of non-vocational functioning may occur when people obtain competitive work, such as in the areas of symptom severity and self-esteem. Supported employment programs may either increase overall treatment costs or not affect treatment costs, depending on whether the services added or substitutes another service in a rehabilitation program.
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