Article Details

Research Database: Article Details

Citation:  Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P (2004). What are the benefits of evidence-based supported employment for patients with first-episode psychosis?. Psychiatric Bulletin, 28 (8), 281-284.
Title:  What are the benefits of evidence-based supported employment for patients with first-episode psychosis?
Authors:  Rinaldi, M., Mcneil, K., Firn, M., Koletsi, M., Perkins, R., & Singh, S. P
Year:  2004
Journal/Publication:  Psychiatric Bulletin
Publisher:  Royal College of Psychiatrists
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported
Research design:  Cross-sectional

Structured abstract:

Background:  Early intervention services provide community-based treatment and support to young people with psychosis and their families, with an emphasis on maintaining normal social roles. The experience of psychosis can exclude a young person from a sense of autonomy, employment and youth culture. Young people aspire to social roles and goals: employment and education provide social identity and status, social contacts and support, a means of structuring and occupying time, activity and involvement, and a sense of personal. Quite apart from the money that can be earned, work tells us who we are and enables us to tell others who we are.
Purpose:  The purpose of the study was to examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.
Setting:  The Early Treatment and Home-based Outreach Service (ETHOS) is an early intervention service that has been in operation within South West London and St George’s Mental Health National Health Service (NHS) Trust since June 2001. It provides a comprehensive package of community-based care for a maximum of 2 years to young people (aged 17-30 years) with a first episode of psychosis.
Study sample:  The vocational specialist worked with all 40 patients within the service; 35 had a diagnosis of schizophrenia and 5 had diagnoses of other psychoses. The median age was 21 years with a range of 18-32 years.
Intervention:  A half-time vocational specialist was integrated into the ETHOS team to address the vocational needs of patients within the service. This specialist (K.M.) was an integral member of the multidisciplinary team but did not carry out care coordinator tasks. She coordinated all the vocational plans with the team, and worked directly with patients and their care coordinators to ensure that vocational goals were given a high priority. Direct client interventions included engagement, assessing vocational need, proactively helping patients to find (and keep) jobs and attend education courses, providing welfare benefits advice, addressing support needs and ensuring adjustments to enable patients to keep their jobs or remain in education. All patients within the service (n=40) received an intervention for 6 months, and 22 clients received it for 12 months.
Control or comparison condition:  There was no control or comparison condition.
Data collection and analysis:  Data were collected from November 2001 to November 2002 for all patients who received vocational input. This information included: • demographic variables: age, gender, ethnicity; • clinical variables: primary diagnosis, duration of contact with the team, discipline of care coordinator. Information on vocational status was collected on first contact with each patient and thereafter on a monthly basis.
Findings:  Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’
Conclusions:  The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service. These results lend support for an evidence-based supported employment approach where vocational rehabilitation is integrated into the clinical team, to help people with severe mental health problems gain and retain employment and education. There is a national commitment to the development of early intervention services, and consideration needs to be given to the successful engagement and outcomes of young people with first-episode psychosis within services. If these young people aspire to social roles and goals, then helping them to gain and retain employment and education should not only improve longer-term outcomes but also provide a potential key to engagement.

Disabilities served:  Bi-polar
Populations served:  Gender: Male
Gender: Female
Race: Black / African American
Race: White / Caucasian
Interventions:  Individual Placement and Support (IPS) model of supported employment
Outcomes:  Employment acquisition