Article Details

Research Database: Article Details

Citation:  Gewurtz, R. E., Cott, C., Rush, B., & Kirsh, B. (2012). The shift to rapid job placement for people living with mental illness: An analysis of consequences. Psychiatric Rehabilitation Journal, 35 (6), 428-434.
Title:  The shift to rapid job placement for people living with mental illness: An analysis of consequences
Authors:  Gewurtz, R. E., Cott, C., Rush, B., & Kirsh, B.
Year:  2012
Journal/Publication:  Psychiatric Rehabilitation Journal
Publisher:  Psychiatric Rehabilitation Administration
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Case history review

Structured abstract:

Background:  The Individual Placement and Support (IPS) model, a standardized and evidence-based approach to supported employment (SE) for individuals living with mental illness, focuses on minimizing preemployment training and supporting individuals to enter integrated competitive work settings. In an effort to address poor employment outcomes associated with many traditional approaches to vocational rehabilitation, policy structures and funding mechanisms have been developed that link pay incentives directly to job placement and maintenance rates. . The question of whether policy revisions encourage fidelity to models of best practice is a salient one in light of this observation. Indeed, heterogeneity within the IPS model persists despite the association between fidelity to the model and positive employment outcomes
Purpose:  This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from preemployment to job placement services, with a particular focus on rapid placement into available jobs. This article reports on the findings from a case study of policy revision affecting employment supports for individuals living with mental illness in Ontario, Canada. The purpose is to examine the impact of this policy change, comprised largely of a new outcome-based funding model, with an eye to the principle and practice of rapid job placement.
Setting:  Recruitment focused on three main stakeholder groups: (1) program informants who were involved in developing and/or delivering employment services for people living with mental illness under the policy; (2) policy informants who were involved in constructing and/or implementing the policy; and (3) consumer informants who self-identified as a person living with a mental illness and were involved in informing the policy, planning services under the policy, or advocacy/activism related to the policy.
Study sample:  Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness.
Intervention:  This study utilizes an interpretive approach to qualitative research. It draws on a case study of ODSP-ES, an employment support policy in Ontario, Canada to explore the consequences of this policy revision, with particular attention to the practice of rapid placement into jobs that was encouraged by the revised policy. The case study design is an effective approach to explore real-live events and broad social processes. While it can be difficult to generalize findings from case studies to other contexts, those conducted in contexts that are representative of other cases and that are focused on developing theoretical understandings of circumstances can offer broad insights and innovations.
Control or comparison condition:  There was no control or comparison condition.
Data collection and analysis:  Interviews were audio-recorded and transcribed verbatim. The computer software program NVivo was used to organize the data for efficient analysis. Data from the key informant interviews and the documents were analyzed simultaneously. Emerging ideas were used to direct and focus later data collection and analysis according to the constant comparative approach. Guided by the principles of constructivist grounded theory, during initial coding we explored the data and considered different possible theoretical and analytical permutations. Later, coding became more focused and selective as we categorized data by grouping codes together and prioritizing some codes over others.
Findings:  The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than preemployment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits.
Conclusions:  These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.

Disabilities served:  Chronic mental illness
Populations served:  Gender: Female and Male
Interventions:  Other
Outcomes:  Employment acquisition
Full-time employment
Part-time employment