Recent Research on Vocational Rehabilitation for Persons With Severe Mental Illness

Robert E Drake, Deborah R Becker, Gary R Bond

Disclosures

Curr Opin Psychiatry. 2003;16(4) 

In This Article

Studies of Supported Employment

Two separate studies using experimental designs provided further evidence in favor of supported employment over traditional vocational services. Lehman et al.[9] showed that the individual placement and support model of supported employment was more effective than a traditional vocational rehabilitation program in helping inner-city clients in Baltimore with severe mental illness to achieve competitive employment (odds ratio=5.58). In a separate experimental study of the same individual placement and support model of supported employment in Washington, DC, Dixon et al.[10] also found that inner-city clients in supported employment attained significantly better outcomes in competitive employment. While supported employment was more cost-effective, service costs relative to wages earned were higher for supported employment because clients in traditional stepwise programs earned similar amounts of income by working extensively in sheltered, noncompetitive settings.

The evidence-based components of supported employment were also a common topic. In a survey of 144 vocational programs, Bond et al.[11] documented large differences in the organization and provision of services between supported employment and other vocational approaches. Focusing on the issue of integrating clinical and rehabilitative services, Jacobs et al.[12] provided suggestions for successful integration, such as educating the medical staff about rehabilitation and building multidisciplinary treatment teams. Lal and Mercier[13] addressed the issue of integration and collaboration among stakeholders from a more theoretical standpoint related to building consensus and coalitions for change. Paulson et al.[14] emphasized the importance of attention to client preferences and choices throughout the vocational process.

Several articles addressed innovative attempts to modify or expand the basic model of evidence-based supported employment. Furlong et al.[15] modified the individual placement and support model slightly by including rapid placement in agency-run businesses as an alternative to competitive employment for clients on assertive community treatment teams and found good outcomes in a quasi-experimental study. Similarly, Gaal et al.[16] involved parents in finding and supervising jobs as part of the individual placement and support model for young clients with schizophrenia and found success in a pilot project.

Research also continues to focus on skills training, often as a supplement to supported employment. Kern et al.[17] showed experimentally that clients who have cognitive deficits can be taught entry-level job tasks with a technique called errorless learning, which relies on implicit rather than explicit memory and therefore compensates for cognitive deficits.

Many programs add supported education to supported employment: the same workers provide both services. In a study of three supported education programs, Unger and Pardee[18] found that almost half of the participating clients worked competitively during their tenure in the programs. Furthermore, there was some evidence that education improved the quality and appropriateness of the jobs they secured.

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