Study Details | Pathways to Work

25092-Study of Community C

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a randomized controlled trial with low attrition, suggesting the findings can be attributed to the program.

Program: Community Connections Individual Placement and Support (IPS) (as compared to Enhanced Vocational Rehabilitation [EVR])

Characteristics of study participants:

Mental health condition, Unemployed

Services provided:

Case management, Job placement, Job search assistance, Mental health services, Post-employment participant follow-up, Transportation assistance

Setting: Urban only

Methods and Standards Protocol version used for review: Version 1.0

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Study design

Design:

Randomized controlled trial

Study group formation:

Clients at Community Connections, a large mental health agency in Washington, DC, were recruited to participate in the study. One hundred and fifty-two unemployed individuals with severe mental disorders who expressed interest in competitive employment were stratified according to work history and randomly assigned to IPS or EVR using computer-generated random numbers. The study team collected data on individuals at baseline and 6, 12, and 18 months after random assignment.

Time period of study:

Individuals were enrolled in the study from January 1994 to July 1995 and were followed for 18 months.

Primary outcome domains examined:

Increase short-term earnings

Other outcome domains examined:

Life skills; quality of life; self-esteem; mental health

Study funded by:

Study funding was provided by the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health, both within the U.S. Department of Health and Human Services.

Results

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Outcome domain	Measure	Timing	Study quality by finding	Impact	Units	Findings	Sample size
Increase short-term earnings	Total earnings over follow-up period	Quarters 1–6	High	-5.46	1995 dollars		150

Short-term outcomes are those measured 18 months or fewer after participants are first offered services. Long-term outcomes are those measured between 18 months and 5 years after participants are first offered services. Very long-term outcomes are those measured 5 years or more after participants are first offered services.

Means are not displayed when not reported or not aligned with the impact estimates. For example, if the impact estimate is regression-adjusted but only unadjusted means are reported in the study, the unadjusted means are not displayed as they are not aligned with the adjusted impact estimate.

Impact estimates are not shown when the estimate units cannot be converted to natural units.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the program. We do not display findings that rate low.

Findings key:

A moderate-to-large favorable finding that is unlikely to be due to chance
A moderate-to-large favorable finding that might to be due to chance
A small favorable finding that is unlikely to be due to chance
A small favorable finding that might be due to chance
A favorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
A favorable finding that might be due to chance, but we cannot determine the standardized effect size
A moderate-to-large unfavorable finding that is unlikely to be due to chance
A moderate-to-large unfavorable finding that might to be due to chance
A small unfavorable finding that is unlikely to be due to chance
A small unfavorable finding that might be due to chance
An unfavorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
An unfavorable finding that might be due to chance, but we cannot determine the standardized effect size
A finding that is unlikely to be due to chance, but we cannot determine the standardized effect size or direction
A finding of no effect that might be due to chance

Favorable findings are impacts in a direction that is socially desirable. Statistical significance indicates the likelihood that a study finding is due to the program, rather than due to chance. Findings are described as moderate-to-large if the program produced a sufficiently large change in the outcome. An impact receives this designation if the standardized effect size is equal to or greater than 0.25 or equal to or less than -0.25.

Sample characteristics

A majority of participants (83 percent) were African American, and 61 percent of participants were female. The mean age was about 39 years old. All clients had a severe mental disorder diagnosis, with the most commonly reported disorders being schizophrenia spectrum (67 percent) and bipolar (14 percent) disorders. Some individuals also reported alcohol use (9 percent) or drug use (14 percent) disorder diagnoses. The average individual had worked about eight months in the past five years.

Age

Mean age

39 years

Sex

Female	61%
Male	39%

Race and ethnicity

Black or African American

83%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Employment and public benefit status

Were unemployed

100%

Education

Had a high school diploma or GED	65%
Did not have a high school diploma or GED	35%

Specific employment barriers

Had a mental illness	100%
Had a substance abuse disorder	24%

Program implementation

Implementing organization:

Community Connections implemented IPS. The District of Columbia Rehabilitation Services Administration recommended several rehabilitation agencies to implement EVR.

Program history:

IPS is a well-established program for helping people with severe mental illness attain employment. Community Connections did not appear to implement IPS before the study. The agencies that implemented EVR were described as well-established providers of similar vocational rehabilitation services. The study does not specify whether those services were enhanced with the addition of a vocational counselor for the purpose of the study.

Program services:

Employment specialists within a mental health center helped individuals with severe mental illness obtain competitive jobs and provided ongoing support. The IPS model provided individualized and rapid job-search assistance based on participant preferences, a vocational assessment, job development, and optional interview accompaniment. There was no time limit on IPS services; employment support was given as needed.

Mandatory services:

None

Comparison services:

Individuals received stepped vocational services through several rehabilitation agencies. All rehabilitation agencies involved with EVR had the goal of gradually preparing individuals for competitive employment through a stepped approach of prevocational experiences that primarily consisted of paid work adjustment training in a sheltered workshop. The services were called "enhanced" because an additional vocational counselor was responsible for monthly monitoring and ensuring participants were linked to rehabilitation agencies.

Service receipt duration:

Services were available indefinitely.

Program funding:

Not available

Study publications

Drake, Robert E., Gregory J. McHugo, Richard R. Bebout, Deborah R. Becker, Maxine Harris, Gary R. Bond, and Ernest Quimby (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorders, Archives of General Psychiatry 56(7): 627-33.

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Pathways to Work refers to programs by the names used in study reports or manuscripts. Some program names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Community Connections Individual Placement and Support (IPS) (as compared with Enhanced Vocational Rehabilitation [EVR])