Article Details

Research Database: Article Details

Citation:  O'Brien, A., Price, C., Burns, T., & Perkins, R. (2003). Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training. Community Mental Health Journal, 39(4), 333-347., 39 (4), 333-347.
Title:  Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training
Authors:  O'Brien, A., Price, C., Burns, T., & Perkins, R.
Year:  2003
Journal/Publication:  Community Mental Health Journal, 39(4), 333-347.
Publisher:  Springer Science+Business Media
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Yes
Research design:  Randomized controlled trial

Structured abstract:

Background:  High unemployment rates are found in people with long-term mental health problems although they want to work. Various approaches to increasing access to work have been described. Currently evidence favors the “individual placement and support” (IPS) model. Here the aim is to help patients obtain open employment with a minimal period of pre-vocational training; a “place-train” approach rather than vice versa. Once a job or training place has been obtained as much support as possible is given with the aim of retaining the position. This model is gaining increasing recognition in the United States and a Cochrane review concluded that it was more effective than pre-vocational training in helping people with severe mental illness return to work. However mental health services in Europe have been slower to prioritize this issue.
Purpose:  To investigate the impact of training Community Mental Health Team members in the practice of Individual Placement and Support on the vocational status of long-term patients.
Setting:  Subjects were recruited from ten Community Mental Health Teams of a large London Mental Health Trust. Subjects were eligible for inclusion if they had been in continuous contact with their Community Mental Health Team for at least one year and were unemployed. All subjects were over the age of 16. Males over 65 and females over 60 (normal retirement age) were excluded from the study.
Study sample:  Six Community Mental Health Teams received vocational training by a work co-coordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified.
Intervention:  This was a randomised controlled trial of the effect of training of Community Mental Health Team members on the vocational needs of long-term patients. The training and provision of information was by a Consultant Clinical Psychologist specialising in vocational rehabilitation (RP)and a work co-ordinator with experience in supported employment. The unit of randomization was the team rather than the patient. Local Research Ethics Committee approval was obtained for the study, which did not require written consent from individual patients. The training intervention involved three structured one- hour seminars given by a Consultant Clinical Psychologist (RP) specialism in employment issues and a Work Placement Co-ordinator. The seminars, supplemented by a written handbook, addressed vocational assessment, access to work and education and vocational planning/intervention for longer term, unemployed CMHT patients. The first seminar focused on the local work and structured activities available locally. The second covered the best ways to match individual patients’ needs and wishes with the opportunities available. The third was about incorporating work and education targets as a routine in the care plans. Team members were also supplied with a directory of work and educational opportunities and services in the local area
Control or comparison condition:  The control condition was high quality standard Community Mental Health Team care.
Data collection and analysis:  Data were entered into SPSS for windows version 10 and cleaned using logical searches. The data were analyzed without adjustment for the cluster design. This was because the inter-cluster correlation coefficient (ICC) was 0.00148, which leads to a design effect of 1.01. The small ICC means that individual behavior is only affected to a minor degree by cluster membership, meaning that the cluster design has little overall effect. To test any effect of the intervention the categorical variables were analyzed using tests and continuous variables were analyzed using independent t-tests. A stratified chi-square analysis was conducted to allow for differences between the groups at baseline. When examining factors associated with return to work differences within categories were compared using the z-test. For all statistical tests a significant p-value was set at 0.05.
Findings:  There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome.
Conclusions:  Training in Individual Placement and support at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful Individual Placement and Support.

Disabilities served:  Bi-polar
Populations served:  Gender: Male
Gender: Female
Interventions:  Individual Placement and Support (IPS) model of supported employment
Rehabilitation counseling