Study Details | Pathways to Work

25092R - Enhanced Vocational

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a low-attrition randomized controlled trial with no known issues that suggest the findings cannot be attributed to the intervention.

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

Population and employment barriers:

Employment status and income level (Unemployed), Specific employment barriers (Mental illness)

Services provided:

Case management, Employment retention services, Health services, Training, Work readiness activities (Job development/job placement)

Setting: Urban only

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.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the intervention. 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 intervention, rather than due to chance. Findings are described as moderate-to-large if the intervention 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%

Participant 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.

Participant employment and public benefit status

Were unemployed

100%

Participant 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%

Intervention 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.

Intervention 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.

Mandatory services:

None

Comparison 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.

Service receipt duration:

Services were available indefinitely.

Intervention 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.

View the glossary for more information about these and other terms used on this page.

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

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