PowerPoint Presentation

							Research & Evaluation of
Supported Employment:
    Where Are We?
      Lisa A. Razzano, Ph.D.
   Associate Professor of Psychiatry
  National Research & Training Center
    University of Illinois at Chicago

         Annual Meeting of the
   National Alliance on Mental Illness
             June 22, 2007
             San Diego, CA
 Do we still need to talk about
        employment?
• Definitely.
• Research indicates that the unemployment
  rate among people with mental illness
  ranges 3-5 time higher than among those
  with no mental illnesses…
      … And an even higher proportion of
  people with severe mental illnesses are
  out of the labor force, i.e., not working and
  not looking for work.
    Research on Employment
• There continues to be strong evidence
    regarding the importance of
    employment to people living with
    severe mental illnesses in terms of:
•   alleviation of poverty;
•   therapeutic gains;
•   skill acquisition; and
•   quality of life.
  Research on Employment
• There are social and community benefits from
  reductions in overall cost of care and use of
  disability entitlements.
• Advancements in policy (ADA, TWWIIA,
  Olmstead) and treatment options
  (community-based care and pharmacological
  agents) support return-to-work
• Over the last decade, mounting evidence
  from small scale trials that Supported
  Employment is an effective, evidence-based
  practice in mental health treatment.
An Evidence-Based Practice?




Guide to Research Methods-The Evidence Pyramid; http://servers.medlib.hscbklyn..edu/2100.htm
      Characterizing the Levels
Level                        Type of Evidence
 1a     Evidence obtained from meta-analysis of randomized controlled
        trials (RCTs)  (underway – Dr. Gary Bond)

 1b     Evidence obtained from at least 1 RCT 

 2a     Evidence obtained from at least 1 well-designed controlled study
        without randomization

 2b     Evidence obtained from at least 1 other type of well-designed
        quasi-experimental study
        Evidence obtained from well-designed non-experimental
        descriptive studies, such as comparative studies, correlation
 3      studies and case control studies

 4      Evidence obtained from expert committee reports or opinions
        and/or clinical experience of respected authorities
 The Employment Intervention
 Demonstration Program (EIDP)
A multi-site, longitudinal (1996-2001) evaluation of
clinical & rehabilitative employment interventions,
into which newly-enrolled participants were
randomly assigned and followed for two years,
with bi-annual in-person interviews, & ongoing
employment and services data collection.
                   Sites
    Arizona                  Massachusetts
    Connecticut              Pennsylvania
    Maine                    South Carolina
    Maryland                 Texas
        All EIDP Experimental
      Interventions Provided…
• fully integrated clinical, case management, &
    vocational services
•   multidisciplinary provider teams representing
    mental health, vocational rehabilitation,
    concurrent mental health & substance use
    treatment, peer support, & benefits counseling
•   rapid job search & placement activities
•   a desired outcome of competitive employment
•   jobs that were customized to meet the needs &
    preferences of consumers
•   ongoing supports available with no time limits
Core EIDP Study Outcomes
•   Employment Status (ever worked)
•   Earnings
•   Amount of Work (hours)
•   Competitive Employment*
*Competitive Employment:
   • pays minimum wage or higher;
   • located in mainstream, integrated settings;
   • not set-aside for mental health consumers;
     and
   • job is consumer-owned.
EIDP Findings: SE vs. Comparison
   • those in the experimental (SE)
     groups had better outcomes
     than those in the comparison
     groups
   • the advantage of the
     experimental group
     participants increased over
     time relative to the comparison
     groups
            Effects of Participant
               Characteristics
• Outcomes were better for…
  • people with fewer symptoms (positive or negative)
  • people with lower levels of functional impairment
  • people with no health problems or co-occurring
       disabilities
   •   people not receiving disability income
   •   people with diagnoses other than schizophrenia
   •   people with better work histories
   •   people with a high school education or equivalent
   •   younger people
• Even though participants with some
 characteristics did better, the
 experimental models were effective…..

   ….. REGARDLESS OF CONSUMERS’
      PERSONAL CHARACTERISTICS
             Bottom Line:
• Some people may need extra assistance or
  tailoring of programs to meet special needs
  (e.g. help with medical problems, support for
  dealing with troublesome symptoms, extra
  training for those with little prior work
  experience)
• Integrated, supported employment services
  result in positive employment outcomes
  regardless of consumers’ personal
  characteristics, health problems, diagnoses,
  symptom levels, work histories, and
  functioning levels.
    Research-Based Principles of Successful
  Vocational Rehabilitation Strategies: Are These
             Available in Your Area?

1. People with serious mental illness can be
   successfully engaged in competitive employment.
2. Vocational rehabilitation services should involve
   employment in integrated settings for minimum wage
   or above.
3. Consumers should be placed in paid jobs as quickly
   as possible and according to their preferred pace.
4. Ongoing vocational support should be available as
   needed and desired.
5. Consumers should be helped to find jobs that match
   their career preferences.
        Research-Based Principles
6. Vocational rehabilitation services should explicitly address
   financial planning and provider education/support around
   disability benefits and entitlements.
7. Vocational and mental health services should be integrated
   and coordinated.
8. Vocational service providers should work collaboratively with
   consumers to address issues of stigma and discrimination,
   and to help negotiate reasonable accommodations with
   employers.
9. Vocational rehabilitation services should be made available
   to all mental health consumers.
10. Vocational services should involve family and friends in
   supporting consumers’ efforts to work.
              Employment Intervention Demonstration Program
                        www.psych.uic.edu/eidp
                         Center for Mental Health Services
             Substance Abuse and Mental Health Services Administration