Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, IOP 4 South, Charleston, SC 29425, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 04/2006; 32(2):378-95. DOI: 10.1093/schbul/sbi056
Source: PubMed

ABSTRACT Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = 549 US dollars, interquartile range [IQR] = 0-5,145 US dollars, versus Mdn = 0 US dollars, IQR = 0-40 US dollars; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills.

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Available from: Alberto B Santos, Sep 27, 2015
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    • "During the search for relevant articles, five further studies of enhanced IPS were identified, although these were not included as they were not comparative in design and so the contribution of the enhancement could not accurately be judged. Of these studies, one was a further case study of ISE [32], one was an RCT of IPS and WFT versus standard vocational rehabilitation [33], and another study examined assertive community treatment (ACT) and IPS [34]. The latter study consisted of two staff teams: ACT and IPS, who tailored and coordinated care to address individuals' mental health and vocational needs. "
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    ABSTRACT: Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS). Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion. Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.
    05/2012; 2012:382420. DOI:10.1155/2012/382420
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    • "Only 1 of these 11 trials was performed in a rural setting. That study's employment outcomes were at the median, with a competitive employment rate of 64% (Gold et al., 2006). Although this result is encouraging, Bond's review nonetheless reveals that few randomized controlled trials of IPS have been conducted in rural settings. "
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    ABSTRACT: Little is known about the relationship between population density and employment rates in individual placement and support (IPS), the evidence-based approach to supported employment. Using longitudinal employment data from 87 agencies that provide IPS to clients with severe mental illness in diverse regions of the United States, we categorized and compared agencies according to population density data as metropolitan, micropolitan, or small town. We tested for an association between population density category and employment rate. Mean program-level competitive employment rates were 43% for 66 metropolitan, 49% for 14 micropolitan, and 40% for 7 small-town IPS programs. Population density of the community in which a supported employment program is located was not associated with program-level competitive employment rates. Despite differences in the number and diversity of employers, cultural norms, and other factors associated with population density, rurality does not adversely influence the effectiveness of IPS supported employment programs.
    American Journal of Psychiatric Rehabilitation 07/2011; 14(3):237-244. DOI:10.1080/15487768.2011.598106
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    • "The South Carolina (Gold et al. 2006) and Massachusetts (Macias et al. 2006) sites of the eight-site employment intervention demonstration program (EIDP, Cook et al. 2005) provided data for the employment rate computations. The South Carolina site evaluated an individual placement and support program (IPS, Becker and Drake 2003) integrated with an assertive community treatment team. "
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    ABSTRACT: Cumulative employment rates published by randomized trials are based on each enrollee's pre-planned 18-24-months of study participation. By contrast, community programs typically report employment rates for clients active in services during a calendar quarter. Using data from three supported employment programs in randomized trials, we show that trial cumulative employment rates are about twice as large as quarterly employment rates for the same program. Therefore, we recommend that administrators, service networks, and mental health authorities begin to publish quarterly employment rates, and quarterly median earnings, to allow policymakers to set realistic performance expectations for supported employment programs.
    Administration and Policy in Mental Health and Mental Health Services Research 12/2009; 37(5):427-32. DOI:10.1007/s10488-009-0258-3 · 3.44 Impact Factor
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