An Innovative Job Placement Model for Unemployed Methadone Patients: A Randomized Clinical Trial

ArticleinSubstance Use & Misuse 42(5):811-28 · February 2007with12 Reads
DOI: 10.1080/10826080701202403 · Source: PubMed
Abstract
This article presents the outcomes of an innovative vocational rehabilitation model designed for methadone-maintained patients -- the Customized Employment Supports (CES) model. CES counselors work intensively with a small caseload of patients to overcome the vocational as well as non-vocational barriers that hinder employment, with the goal of attaining rapid job placement. A randomized clinical trial was implemented at two methadone treatment programs in New York City and was funded by the National Institute on Drug Abuse The study tested the hypothesis that patients assigned to the experimental (CES) condition would have better employment outcomes than those assigned to a control condition who received standard vocational counseling at the programs. The data were collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years. The results supported the hypothesis for two measures of employment; i.e., the CES group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings. The study's limitations are noted. Implications of the findings for the improvement of vocational rehabilitation for addiction patients are discussed.
    • "Additional file 1: Search strategy. Additional file 2: Results #1 – Intervention contexts that elicit and/ or support engagement (Abbott et al. 1999, Abbott et al. 1998, Appel et al. 2000, Aszalos et al. 1999, Bigelow et al. 1980, Carpenter et al. 2006, Cohen et al. 1982, Connett 1980, Coviello et al. 2004, Coviello et al. 2009, Dansereau et al. 1996, Farabee et al. 2002, Glickman et al. 2006, Joe et al. 1997, Joe et al. 1994, Kidorf et al. 1998, Lidz et al. 2004, Magura et al. 2007, McLellan et al. 1993, Najavits et al. 2007, Nurco et al. 1995, Platt et al. 1993, Ronel et al. 2011, Rounsaville et al. 1983, Sees et al. 2000, Staines et al. 2004, Woody et al. 1983, Woody et al. 1987, Woody et al. 1995). "
    [Show abstract] [Hide abstract] ABSTRACT: For over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why. The realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data. For individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients' psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients' socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement. It is important to consider how the contexts of interventions might elicit and/or support clients' engagement. Further research is needed to explore how an individual's background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use.
    Full-text · Article · Sep 2014
    • "Small caseloads reflect the effort to spend more time understanding emerging participant interests and goals as well as a key focus on employment facilitated by additional funding and support resources. The data from initial empirical evaluations are quite limited at this point7374. "
    [Show abstract] [Hide abstract] ABSTRACT: As the field of vocational services (VS) research matures, it is necessary to review its progress and identify any important gaps in measurement and methodology that may hamper future efforts. To encourage progress, we have identified (1) ways to increase consistency in measuring employment outcomes, (2) emerging patterns and lingering gaps in the range of variables and measures commonly used in VS research, (3) broader methodological patterns and needs in the area of study design and sampling, (4) interventions that warrant additional study, and (5) broad strategies to increase the overall amount and quality of VS research. The goal of this article is to assist the field in achieving clearer coherence in shared expectations and standards for research so that the field can consolidate its gains as it helps people successfully return to rewarding jobs in the community.
    Full-text · Article · Feb 2012
    • "Of these 8 individuals, three began longer-term peer education training at the conclusion of the intervention; three others gained full-time employment as a direct result of participating in the intervention; one person began training to become a certified substance abuse counselor; and another began taking computer classes in a community center adjacent to the project's field site office. Although these numbers are small, when considered in the context of both the extremely low rates of formal employment for clients of MMTPs (Magura et al., 1999) and the limited success of traditional vocational rehabilitation programs for methadone-maintained patients (Blankertz et al., 2004; Magura et al., 2007) they appear promising. Of those peers who were able to transition to longer-term vocational activities postintervention , not all were able to sustain these gains. "
    [Show abstract] [Hide abstract] ABSTRACT: From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n = 49; 67% male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.
    Full-text · Article · Feb 2010
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