Robert E Drake

Dartmouth College, Hanover, New Hampshire, United States

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Publications (342)955.54 Total impact

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    ABSTRACT: People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders.
    Psychiatric services (Washington, D.C.) 07/2014; · 2.81 Impact Factor
  • G R Bond, R E Drake, A Luciano
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    ABSTRACT: Aims. Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. Methods. We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. Results. Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. Conclusions. In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.
    Epidemiology and Psychiatric Sciences 07/2014; · 2.94 Impact Factor
  • Robert E Drake, Gary R Bond
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    ABSTRACT: This issue of the Psychiatric Rehabilitation Journal presents an update on individual placement and support (IPS), the evidence-based practice of supported employment for people with psychiatric disabilities. The papers in this special issue testify to the enormous potential of the IPS model. Clients, families, researchers, policy experts, practitioners, and administrators continue to identify creative ways to expand services to reach more people. The state of the art of IPS is expanding, changing, and ramifying broadly. IPS is appearing in middle-income countries in Latin America and in new populations, such as young adults with autism-spectrum disorders in Europe. Continued growth should follow the fundamental principles of values and science. First, we must honor basic values by listening to and learning from clients (Strickler, 2014), as well from IPS trainers, mental health and vocational rehabilitation leaders, and practitioners who face the daily realities of developing and sustaining recovery-oriented services (Swanson et al., 2014). Second, we must insist on rigorous research to ground our employment services in hard evidence. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric rehabilitation journal. 06/2014; 37(2):76-78.
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    ABSTRACT: Medicaid is now the main payment source and financing mechanism for services for adults with serious mental illness. Services formerly paid with state mental health funds have been converted to Medicaid, lightening the burden on state budgets affected by recession and other factors. The change has allowed states to maintain community care and inpatient services (in general hospitals). Medicaid service benefits include clinic and inpatient care, case management, and some rehabilitation services. But using Medicaid to finance some high-priority services such as supported employment has proven difficult. Now critical changes in Medicaid under the Affordable Care Act allow states to amend their Medicaid State Plans to provide more flexible services to people with serious mental illness. Advocacy and support may be needed to encourage this step. A national campaign to finance supported employment would join various stakeholders in the field, including professional organizations, family and service user groups, and organizations representing service providers. The authors of this editorial pledge their energies to support this campaign. They present suggestions for a campaign, including building a coalition, goals and targets, and online resources. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric rehabilitation journal. 06/2014; 37(2):73-75.
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    ABSTRACT: Topic: The potential of technology to enhance delivery and outcomes of Individual Placement and Support (IPS) supported employment. Purpose: IPS supported employment has demonstrated robust success for improving rates of competitive employment among individuals with psychiatric disabilities. Still, a majority of those with serious mental illnesses are not employed (Bond, Drake, & Becker, 2012). The need to promote awareness of IPS and expand services is urgent. In this study, we describe ways that technologies may enhance delivery of IPS supported employment across the care continuum and stakeholder groups. Directions for research are highlighted. Sources Used: published literature, clinical observations, IPS learning collaborative. Conclusions and Implications for Practice: Technology has the potential to enhance direct service as well as workflow in the IPS supported employment process, which may lead to improved fidelity and client outcomes. Mobile and cloud technologies open opportunities for collaboration, self-directed care, and ongoing support to help clients obtain and maintain meaningful employment. Research is needed to evaluate efficacy of technology-based approaches for promoting client employment outcomes, to identify provider and organization barriers to using technology for IPS delivery, and to determine effective strategies for implementing technology with IPS in different settings and with diverse client audiences. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric rehabilitation journal. 06/2014; 37(2):99-106.
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    ABSTRACT: Objective: Despite the large number of Latinos living in the United States, little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population. This article presents a secondary analysis of a randomized, controlled trial comparing supported employment with 2 other vocational rehabilitation programs in 3 ethnic/racial groups of participants with severe mental illness: Latinos, non-Latino African Americans, and non-Latino Whites. Method: The data were drawn from a previously published randomized, controlled trial comparing supported employment with standard vocational rehabilitation services and a psychosocial clubhouse program in persons with severe mental illness (Mueser et al., 2004), including 64 Latinos, 91 non-Latino African Americans, and 43 non-Latino Whites. Comparisons were made between the 3 groups at baseline on demographic characteristics, clinical and psychosocial functioning, and quality of life. Within each ethnic/racial group, competitive employment and all paid employment outcomes were compared between the 3 vocational rehabilitation programs over the 2-year study period. Results: At baseline, the Latino participants had lower levels of education and disability income, were less likely to have worked competitively over the previous 5 years, had more severe symptoms, and worse psychosocial functioning than the non-Latino African American or non-Latino White participants. Latinos randomized to supported employment had better competitive and all-paid work outcomes than those assigned to either standard services or the psychosocial clubhouse program, similar to the non-Latino consumers. Rates of competitive work for consumers in supported employment were comparable across all 3 racial/ethnic groups. Discussion: Supported employment is effective at improving competitive work in Latinos with severe mental illness. Efforts should be made to increase access to supported employment in the growing population of Latinos with severe mental illness. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric rehabilitation journal. 06/2014; 37(2):113-122.
  • Robert E Drake, Rob Whitley
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    ABSTRACT: The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 05/2014; 59(5):236-242. · 2.48 Impact Factor
  • Robert E. Drake, Ilirjana Bajraktari
    Acta Psychiatrica Scandinavica 03/2014; · 4.86 Impact Factor
  • Deborah R Becker, Robert E Drake, Gary R Bond
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    ABSTRACT: Objective: Learning collaboratives aim to improve the quality and outcomes of health care. This paper updates the Johnson & Johnson-Dartmouth Community Mental Health Program, a 12-year learning collaborative on supported employment for people with mental illness. Methods: We gathered data from quarterly employment reports, monthly Individual Placement and Support (IPS) meetings, and presentations at the 2013 annual meeting of the learning collaborative. Results: The number of participant states or regions (and sites within these jurisdictions) was expanded to 16 jurisdictions in the United States and 3 in European countries. The quarterly rate of competitive employment has averaged 43% over 11 years in the U.S. sites. The collaborative has spawned numerous interactions, trainings, innovations, and research projects. Conclusions and Implications for Practice: Long-term learning collaboratives can produce high quality services, good outcomes, sustainability, and innovation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 02/2014; · 0.75 Impact Factor
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    ABSTRACT: Individual Placement and Support (IPS) is an evidence-based model to help people with serious mental illness achieve employment. This study examined variation in model adherence in small and large communities. We compared program-level ratings on a standardized 25-item IPS fidelity scale (range = 25-125) for 79 sites in eight states categorized by local community size. Programs in large and small communities achieved comparable fidelity scores (mean = 100 and 104, respectively). Fidelity-outcome correlations within the two groups were both of moderate size. As a practical guide, the IPS fidelity scale is suitable for use in both small and large communities.
    Community Mental Health Journal 12/2013; · 1.03 Impact Factor
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    ABSTRACT: State administrative supports of evidence-based practices (EBPs) may critically affect sustainability. As part of a larger follow-up to the multistate National Implementing Evidence-Based Practices Project, 13 leaders from eight States reported on recent statewide policies and resources that influenced the maintenance of 49 EBP programs 6 years after implementation. Nearly three-quarters (71 %) of the programs were currently operational and adhering to State fidelity standards. Most of the programs had level or increased funding over the last few years, and most received other State support and resources, such as training and technical assistance. Steady State funding as well as State-sponsored training and expertise appear critical to long-term EBP program maintenance.
    The Journal of Behavioral Health Services & Research 09/2013; · 0.78 Impact Factor
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    ABSTRACT: Topic: A growing research literature indicates that cognitive enhancement (CE) interventions for people with schizophrenia can improve cognitive functioning and may benefit psychosocial functioning (e.g., competitive employment, quality of social relationships). Debate continues regarding the strength of evidence for CE and related policy implications, such as the appropriateness of funding CE services. Purpose: This paper summarizes and updates a meeting of experts and stakeholders convened in 2008 by the New York Office of Mental Health to review evidence on the impact of CE for people with schizophrenia and other serious mental illnesses, and addresses whether the evidence base for CE interventions is sufficient to warrant funding. Sources Used: Specific recommendations based on the extant literature are provided regarding the structure and components of CE programs that should be present in order to improve cognitive and psychosocial outcomes and therefore merit consideration of funding. Conclusions and Implications for Practice: These recommendations may serve as a starting point in developing standards for CE programs. Establishing evidence-based practice standards for implementing CE interventions for people with serious mental illnesses may facilitate dissemination of programs that have the greatest potential for improving individuals' functional outcomes while minimizing incremental costs associated with providing CE services. Important open questions include how the performance of CE programs should be monitored and which individuals might be expected to benefit from CE as evidenced by improved functioning in their everyday lives. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 09/2013; 36(3):133-45. · 0.75 Impact Factor
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    ABSTRACT: OBJECTIVE People with psychiatric impairments (primarily schizophrenia or a mood disorder) are the largest and fastest-growing group of Social Security Disability Insurance (SSDI) beneficiaries. The authors investigated whether evidence-based supported employment and mental health treatments can improve vocational and mental health recovery for this population. METHOD Using a randomized controlled trial design, the authors tested a multifaceted intervention: team-based supported employment, systematic medication management, and other behavioral health services, along with elimination of barriers by providing complete health insurance coverage (with no out-of-pocket expenses) and suspending disability reviews. The control group received usual services. Paid employment was the primary outcome measure, and overall mental health and quality of life were secondary outcome measures. RESULTS Overall, 2,059 SSDI beneficiaries with schizophrenia, bipolar disorder, or depression in 23 cities participated in the 2-year intervention. The teams implemented the intervention package with acceptable fidelity. The intervention group experienced more paid employment (60.3% compared with 40.2%) and reported better mental health and quality of life than the control group. CONCLUSIONS Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.
    American Journal of Psychiatry 08/2013; · 14.72 Impact Factor
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    ABSTRACT: Objective: The present demonstration project involved development of a training program designed to teach recovering consumers employed as peer advocates how to provide evidence-based supported employment services to consumers with severe mental illness. Methods: A training curriculum was developed to teach the core competencies of the Individual Placement and Support (IPS) model of supported employment. Three peers participated in training and provided work outcome data from their caseloads. Assessments were conducted of peers' competence in implementing IPS and effectiveness in promoting job placements. Peer competency was assessed by the following: (a) a formal IPS fidelity review performed by two external reviewers to evaluate service implementation, and (b) the Kansas Employment Specialist Job Performance Evaluation, an objective measure of employment specialist attitudes and skills. Program efficacy was assessed by examining the number of job placements and corresponding tenure. Results: The fidelity review revealed that peers met IPS standards of implementation on 7 of 14 items assessing service delivery. The Kansas scale results revealed attitudes to be a relative strength and job performance competency ratings fell in the average to above average range across skill areas assessed (e.g., vocational assessment, job development). Thirty-three percent of consumers from the peers' caseloads got competitive jobs; mean tenure was 26.1 weeks. Conclusions and Implications for Practice: This demonstration project provides a starting point for future efforts aimed at expanding the role of peers as providers of evidence-based mental health services and provides a measured degree of optimism that this is a realistic, attainable goal. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 06/2013; 36(2):99-107. · 0.75 Impact Factor
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    ABSTRACT: Few studies have examined predictors of long-term sustainability of evidence-based practices in mental health. This study used assessments of five evidence-based practices implemented in 49 sites in eight states at baseline and years 2, 4, and 8. Program characteristics, implementation characteristics, reinforcement activities, and sustainability factors were used to predict program survival status. The majority of predictors were not significant. Supervisor turnover in year 4 predicted survival status in year 8, but site characteristics, fidelity at implementation, quality improvement activities, and post-implementation activities had little impact on long-term program survival. This study extends previous sustainability research by examining the long-term impact of internal program factors over a substantial period of time using longitudinal prediction. Future research should also consider the influence of external factors such as financial policies.
    The Journal of Behavioral Health Services & Research 05/2013; · 0.78 Impact Factor
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    ABSTRACT: Health concerns are common reasons for wanting to quit smoking among smokers with mental illnesses. Motivational interventions have used feedback from a carbon monoxide monitor to increase awareness of health concerns, but this device is not commonly available. Whether brief motivational interventions can be effective without this feedback is unknown. Using a randomized controlled trial, this study tested the effect of carbon monoxide feedback within a brief, multi-component, computerized motivational intervention among 124 smokers with schizophrenia or mood disorders. The main outcome was initiating cessation treatment over two months. Although participants in the carbon monoxide group increased their knowledge about the carbon monoxide, (χ(2)=6.97, df=1, p=.008), the main and secondary outcomes did not differ significantly between groups. Overall, 32% of participants initiated treatment. This study suggests that a computerized motivational decision support system can lead users to initiate cessation treatment, and that carbon monoxide feedback is not a necessary component.
    Journal of substance abuse treatment 05/2013; · 2.90 Impact Factor
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    Robert E Drake
    Culture Medicine and Psychiatry 04/2013; · 1.29 Impact Factor
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    ABSTRACT: BACKGROUND: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. METHODS: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. RESULTS: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. CONCLUSIONS: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.
    Schizophrenia Research 03/2013; · 4.59 Impact Factor

Publication Stats

11k Citations
955.54 Total Impact Points


  • 1997–2014
    • Dartmouth College
      • • Department of Psychiatry
      • • Department of Anthropology
      • • Department of Community and Family Medicine
      Hanover, New Hampshire, United States
    • University of Maryland, College Park
      • Department of Psychology
      College Park, MD, United States
  • 1988–2014
    • Geisel School of Medicine at Dartmouth
      • • Department of Psychiatry
      • • Institute for Health Policy and Clinical Practice
      • • Psychiatric Research Center
      • • Department of Community and Family Medicine
      Hanover, New Hampshire, United States
  • 2012
    • RAND Corporation
      Santa Monica, California, United States
  • 2011–2012
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2004–2011
    • McGill University
      • • Division of Social and Transcultural Psychiatry
      • • Department of Psychiatry
      Montréal, Quebec, Canada
  • 1997–2010
    • Indiana University-Purdue University Indianapolis
      • Department of Psychology
      Indianapolis, IN, United States
  • 2009
    • University of Connecticut
      • School of Social Work
      Storrs, CT, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 2008
    • University of Birmingham
      Birmingham, England, United Kingdom
    • Westat
      Maryland, United States
    • University of California, Los Angeles
      • Department of Psychiatry and Biobehavioural Sciences
      Los Angeles, CA, United States
  • 2007
    • Trimbos-instituut
      Utrecht, Utrecht, Netherlands
    • University of Massachusetts Medical School
      Worcester, Massachusetts, United States
  • 2004–2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2003
    • St. George's School
      • Department of Psychiatry
      Middletown, Rhode Island, United States
  • 2001
    • Howard University
      • Department of Sociology and Anthropology
      Washington, WV, United States
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 1998
    • University of South Florida
      • Department of Mental Health Law & Policy
      Tampa, Florida, United States
  • 1989
    • Duke University
      Durham, North Carolina, United States
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States
  • 1984
    • Tufts University
      • Department of Psychiatry
      Georgia, United States