Article Details

Research Database: Article Details

Citation:  Cook, J.A., Leff, H.S., Blyler, C.R., Gold, P.B., Goldberg, R.W., Mueser, K.T., Toprac, M.G., McFarlane, W.R., Shafer, M.S., Blankertz, L.E., Dudek, K., Razzano, L.A., Grey, D.D., & Burke-Miller, J. (2005). Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Archives of General Psychiatry, 62 (5), 505-512.
Title:  Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness
Authors:  Cook, J.A., Leff, H.S., Blyler, C.R., Gold, P.B., Goldberg, R.W., Mueser, K.T., Toprac, M.G., McFarlane, W.R., Shafer, M.S., Blankertz, L.E., Dudek, K., Razzano, L.A., Grey, D.D., & Burke-Miller, J.
Year:  2005
Journal/Publication:  Archives of General Psychiatry
Publisher:  American Medical Association
DOI:  https://doi.org/10.1001/archpsyc.62.5.505
Full text:  http://proxy.library.vcu.edu/login?url=http://archpsyc.jamanetwork....    |   PDF   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Randomized controlled trial

Structured abstract:

Background:  The majority of people with chronic mental illness are unemployed. Research shows that a supported employment (SE) model approach to vocational rehabilitation for people with chronic mental illness establishes SE as an evidence-based practice and more effective than "services as usual or unenhanced services" (p. 505).
Purpose:  This study tested three hypotheses: 1. The experimental group receiving SE services would be better able to to achieve competitive employment than those in the comparison group (work 40 or more hours per month and higher monthly earnings). 2. Differences between experimental and control groups would increase over time 3. experimental group would achieve greater outcomes regardless of demographics and receipt of disability income
Setting:  Eight study sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.
Study sample:  People "with severe and persistent mental illness receiving outpatient psychiatric services" (p. 506). Additional requirements included: - 18 years old - willing and able to provide informed consent - unemployed at time of entry into the study The criteria for "severe and persistent mental illness based on diagnosis, duration, and level of disability as established by the federal Center for Mental Health Services" were met (p. 506). The total number of participants was 1648, and 1273 were included in the study analysis.
Intervention:  Supported employment interventions were offered, which consisted of: 1. integrated services by "a multidisciplinary team that met 3 or more times per week to plan and coordinate employment interventions with case management and psychiatric treatment" (p. 506) 2. Clients were placed in competitive jobs, which paid at least minimum wage, and were socially integrated (not set aside for people with disabilities) 3. Jobs were developed based on client preferences 4. Job search began as soon as client entered program and moved as rapidly as the client wanted 5. Ongoing vocational supports were readily available throughout the study period (supports did not fade once employment was obtained) Several sites developed additional interventions, including the Individual Placement and Support model, the Program of Assertive Community Treatment vocational model, as well as services designed to "enrich clients' natural supports" (p. 507).
Control or comparison condition:  Four sites maintained services as usual; 2 sites used a "weaker version" of the experimental condition; and one site compared two pre-existing vocational models.
Data collection and analysis:  Data were collected at intake and every 6 months for the entire 24-month period using the Positive and Negative Syndrome Scale. In addition, two sites used the DSM-IV at study enrollment, while other sites extracted information from clinical records. Public disability income beneficiary status was monitored bi-annually, as well as "self-rated level of functioning, marital status, and educational attainment" (p. 507). Sites also collected labor force data, such as weekly earnings and hours worked, job duties, eligibility for health and sick leave benefits, and level of integration in the work place. Sites reported on amount of vocational and psychiatric services received each month.
Findings:  The experimental groups achieved competitive employment (55%), worked 40 hours or more per month (51%), and had significantly higher earnings ($122/month) than the control groups (34%, 39%, and $99/month, respectively). These outcomes increased significantly over time.
Conclusions:  The experimental programs yielded higher and more positive effects than "services as usual" (p. 510). This advantage increased over time.

Disabilities served:  Chronic mental illness
Populations served:  Gender: Female and Male
Race: Black / African American
Race: White / Caucasian
Ethnicity: Hispanic or Latino
Interventions:  Individual Placement and Support (IPS) model of supported employment
Job search and placement assistance
Psychological counseling
Rehabilitation counseling
Supported employment
Outcomes:  Employment acquisition