Research in Supported Employment for People with Psychiatric Disabilities

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Research in Supported Employment for People with
Psychiatric Disabilities
Sandra G. Resnick, Ph.D. June 23rd, 2008

• Department of Psychiatry, Yale University School
  of Medicine and
• VA Northeast Program Evaluation Center (NEPEC)

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DisclaimerThe conclusions presented in this
presentation are my own opinion, and nothing but
my opinion.
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Disability and employment Are psychiatric
disabilities different?

• Veterans who are they?
• Researchers lumpers or splitters?
• Universal design
• Accommodations
• Stigma
• Where are services provided?
• State vocational rehabilitation
• Community Mental Health
• Part of treatment

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Research Agenda Two Levels

• Individuals How to improve work success?
• Programs Implementation dissemination

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Models of Vocational Services

• Sheltered Workshops
• Piece rate
• Not integrated
• Transitional Employment
• Goal may not be competitive employment
• General job development
• Some sheltered, some integrated
• Diversified Placement approaches
• Gradualism
• Goal is PAID employment
• Array of options
• Supported Employment
• Goal is competitive employment in community
• Individualized approach

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Supported Employment Principles

• Goal is competitive employment
• Zero-exclusion
• Rapid job search
• Individualized job search
• Long-term follow along support
• Benefits Counseling
• Integration with Mental Health Team
• Job Carving (small businesses)

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Competitive Employment Rates in 15 RCTs of
Supported Employment
Bond (2007)
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Mean days to first competitive job7 IPS RCTs
Bond, 2008
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Weeks worked (annualized)7 IPS RCTs
control 18.9 wks
IPS/SE 19.2 wks
IPS/SE 12.1 wks
control 4.8 wks
total sample
workers only
Bond, 2008
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Improving Employment Rates in SE Research Areas

• Adjunctive interventions
• Illness Management and Recovery
• Cognitive remediation
• Work-specific skills training
• Peer-provided services
• Disclosure and accommodations
• Critical ingredients
• Employer interventions

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What is Fidelity?

• Degree to which program follows a model
• Fidelity Scales operationalize a model
• IPS (SE) Scale gold standard
• Empirical norms
• Discriminates between vocational models
• Implementation tool
• Initial training
• Program drift
• Sustainability
• VHA example

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Fidelity in VHA as of June 2008Total Score
Consistent with SE
Fair SE Implementation
Not SE
52.2
64.4
63.5
60.8
64.7
64.3
n 21
n 20
n 21
n 21
n 19
n 3
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Who trains and rates?

• In VHA one person
• Limited number of experts
• Mentor-trainers different skill sets
• Doing is not teaching
• Teaching is not evaluating
• How much can be taught?

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What influences dissemination?
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Gowdy (2004)
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Gowdy (2004)
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Summary

• Unique aspects of psychiatric disabilities
• SE is effective, but still has shortcomings
• Adjunctive interventions
• Disclosure and accommodations
• Critical ingredients
• Employer interventions
• Access and interest
• Benefits
• Programmatic research
• How to train
• How to rate
• What influences successful dissemination