By Rebecca A. Clay
Other Answers
The EIDP study also answered more specific questions:
Demographic factors. A Community
Mental Health Journal article co-authored by UIC's
Jane K. Burke-Miller, M.S., for instance, reports that
certain demographic characteristics were associated with
employment success.
Having any work history in the previous 5 years roughly
tripled study participants' chances of getting a job,
for instance. Other demographic characteristics lessened
participants' chances of success. With every 10-year
increment in participants' age, their chances of getting
a job dropped by almost 20 percent. And those with less
than a high school education were nearly 40 percent less
likely to find jobs. The same characteristics also predicted
who did—and didn't—work 40 hours or more
a month.
Those findings have important implications for supported
employment programs, the authors say. The positive effect
of recent work history, for instance, supports the idea
that individuals should start looking for jobs as quickly
as possible. The other findings suggest the need for
interventions tailored to older people and to younger
people who need help completing secondary and post-secondary
education.
Clinical factors. Clinical factors
are another important variable, according to an article
in the Journal of Nervous and Mental Disease
co-authored by Lisa A. Razzano, Ph.D., of UIC.
Recent psychiatric hospitalizations, self-rated poor
functioning, and negative psychiatric symptoms like low
motivation and the monotonous voice, unvaried facial
expression, and apathetic demeanor known as "flat
affect" are all associated with failure to get jobs
and to work at least 40 hours a month. Co-occurring medical
conditions and substance abuse were also barriers to
getting jobs.
These findings suggest the need to tailor supported
employment programs to better fit the needs of various
clinical subpopulations, say the study's authors.
Programs should also focus on helping people re-enter
the workforce as soon as possible after hospitalizations.
In addition, assistance with choosing appropriate jobs
and designing workplace accommodations could help people
get and keep jobs despite negative symptoms.
Specific services. Other articles focus
not on the participants but on the services offered.
A Psychiatric Services article co-authored by
H. Stephen Leff, Ph.D., of the Human Services Research
Institute in Cambridge, MA, examines the effect of two
specific supported employment services: job development
and job support. The researchers defined job development
as contact with potential employers or networking with
people who might have job information; they defined job
support as counseling, support, and problem-solving.
The study's results were mixed. Study participants who
received job development services were nearly five times
more likely to get jobs than those who didn't, the researchers
found. But while job support was associated with participants
keeping their first jobs, the researchers questioned
whether such services actually caused the improved retention
rate.
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Site Studies
Some EIDP sites have published articles drawing on data
from their own geographic locations.
In an article published in Schizophrenia Bulletin,
for instance, Paul B. Gold, Ph.D., of the Medical University
of South Carolina, and other researchers there and at
the South Carolina Department of Mental Health, examined
the question of whether supported employment works in
rural areas where job opportunities are scarce and services
are limited, fragmented, and geographically dispersed.
The answer was "yes." The researchers randomly
assigned participants in a rural county to receive either
integrated mental health and vocational services or traditional
vocational and mental health services provided by two
different agencies.
They found that outcomes in this rural area were comparable
to outcomes in the large urban areas where supported
employment has been studied the most. Sixty-four percent
of participants receiving integrated services got competitive
jobs, compared to just 26 percent of those receiving
parallel services. They also earned more.
Although the participants made significant progress,
however, they still didn't earn enough to achieve economic
independence. The authors call for public policies to
reduce barriers to higher education, promote career-oriented
jobs for those with serious mental illnesses, and restore
benefits eligibility to those who leave Federal insurance
programs to work but later suffer setbacks in their recovery.
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Ongoing Data Analysis
Researchers will continue to analyze the EIDP data,
said Dr. Cook. They want to study the effect employment
has on people's quality of life, for instance. They also
want to find ways to help people get higher-paying jobs
with health insurance benefits, so it won't matter if
they lose their disability benefits and access to Medicaid.
"There are many important questions we still want
to address," said Dr. Cook. "After all, we
devoted close to 10 years of our lives to the study."
For more information about the EIDP, visit the study's
home page at www.psych.uic.edu.
For information on mental illnesses, visit the SAMHSA
Web site at www.samhsa.gov.
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References
Burke-Miller, J.K., et al. "Demographic Characteristics
and Employment Among People with Severe Mental Illness
in a Multisite Study." Community Mental Health
Journal, 2006. Published online.
Cook, J.A., et al. "Integration of Psychiatric
and Vocational Services: A Multisite Randomized, Controlled
Trial of Supported Employment." American Journal
of Psychiatry, 2005. 162(10):1948-1956.
Cook, J.A., et al. "Results of a Multisite Randomized
Trial of Supported Employment Interventions for Individuals
with Severe Mental Illness." Archives of General
Psychiatry, 2005. 62:505-512.
Gold, P.B., et al. "Randomized Trial of Supported
Employment Integrated with Assertive Community Treatment
for Rural Adults with Severe Mental Illness." Schizophrenia
Bulletin, 2005. Published online.
Leff, H.S., et al. "Effects of Job Development
and Job Support on Competitive Employment of Persons
with Severe Mental Illness." Psychiatric Services,
2005. 56(10):1237-1244.
Razzano, L.A., et al. "Clinical Factors Associated
with Employment among People with Severe Mental Illness:
Findings from the Employment Intervention Demonstration
Program." Journal of Nervous and Mental Disease,
2005. 193(11):705-713.
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Employment Resources
SAMHSA's Center for Mental Health Services (CMHS)
offers a supported employment toolkit designed
to help state mental health agencies and others
provide help for employment.
Part of the Evidence-Based Practice Implementation
Resource Kit series, the toolkit offers downloads
of articles about supported employment plus information
for consumers, families and friends, practitioners,
mental health program leaders, and public mental
health authorities. The site also provides information
about creating supported employment programs and
monitoring their effectiveness, including a workbook
for practitioners.
The toolkit is available at www.mentalhealth.samhsa.gov/
cmhs/communitysupport/toolkits/employment.
With funding from CMHS and the National Institute
on Disability and Rehabilitation Research, a publication
called Seeking Supported Employment: What You
Need to Know takes the message directly to
consumers themselves.
Co-authored by Judith A. Cook, Ph.D., Principal
Investigator of the Employment Intervention Demonstration
Program's Coordinating Center, the booklet describes
the different ways of finding jobs and then offers
suggestions for getting started with supported
employment. A checklist allows consumers to rate
how well a given program adheres to the evidence
base on supported employment.
"People sometimes feel that only scientists
or state administrators can understand the evidence
base," said Dr. Cook, noting that consumers
helped develop the resource. "What we've found
is that with a little translation and the creation
of an easy-to-use tool, we can really empower people
and create more savvy consumers."
The publication is available online at www.psych.uic.edu/
eidp/seekingemployment.pdf. For more
information on other CMHS programs, visit the SAMHSA
Web site at www.samhsa.gov.
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