Absence of conflict of interest.
The study's objective was to examine the impact of supported education and employment services (SEE) on employment.
The study is an interrupted time series analyses: participants were assessed quarterly for one year. The authors use a statistical model to examine the association between using SEE services for employment only in one quarter and employment in the subsequent quarter.
The study found that receiving supportive employment services from a specialist in the first quarter of program participation is associated with being employed three months later.
This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to supported education and employment services (SEE); other factors are likely to have contributed.
Supported education and employment (SEE) services
Features of the Intervention
The supported education and employment (SEE) services provided in this study are based on the Individual Placement and Support (IPS) model. This model focuses on helping individuals obtain competitive employment and/or school enrollment in jobs or educational programs aligned with participants' interests, regardless of participants’ level of symptoms. The model also provides continued support after employment or educational enrollment.
In this study, the SEE services were integrated into the broader OnTrackNY program, which serves individuals ages 16 to 30 who have experienced non-affective psychosis for at least one week but less than two years. Participants had access to SEE services once they enrolled and were encouraged but not required to utilize the services as soon as they enrolled. The OnTrackNY program is operated by a multidisciplinary team that includes an education and employment specialist, along with a clinician, nurse, and other staff. OnTrackNY took place at licensed outpatient clinics in urban and suburban areas of New York. Since this is a new program, the analyses focus on one-year outcomes.
Features of the Study
The study is an interrupted time series analysis: participants were observed quarterly for one year. Participant data was collected at admission (baseline) and then after 3, 6, 9, and 12 months. The number of data points for individuals varies because some participants dropped out or were discharged from the program, and others did not have data for a full year because they entered the study toward the end of the study period.
The initial sample is 779 individuals ages 16-30 in urban and suburban areas of New York who had experienced psychosis for at least one week but less than two years. Six months into the study (i.e., at the time of Q2 outcomes), 458 individuals were remaining in the sample. At the 9- and 12-month measurement periods (Q3 and Q4), the sample sizes were 355 and 283 participants, respectively.
All demographic information is reported for the initial sample. Participants' average age was 21. Among the baseline sample, 74% of the participants were male, 27% were White, non-Hispanic, 36% were black, non-Hispanic, and 27% were Hispanic. Among all the participants, 28% had not completed high school; 19% had a high school diploma or GED; 41% had some college; and 12% had finished college. Almost all of the participants had been prescribed antipsychotic medication.
During treatment period, the participants were deemed as receiving the treatment by meeting with the supported SEE specialist (not counting team meetings or brief introductions), in a given quarter. For each meeting, the purpose was categorized as focused on employment, education, or both. For analyses of the eligible outcome, employment, the focus of the meeting must have been employment only. The comparison condition is not meeting with the SEE specialist to discuss employment only during a particular quarter.
The authors use a statistical model to examine the association between using SEE services for employment only in one quarter and employment in the subsequent quarter, i.e., using SEE services for employment only in quarter 1 and being employed in quarter 2, using SEE services for employment only in quarter 2 and being employed in quarter 3, and using SEE services for employment only in quarter 3 and being employed in quarter 4. Since the number of individuals included in the sample decreased each quarter, the sample size for each model varies. The statistical models control for employment status at baseline and for many other participant characteristics like race/ethnicity, age, educational attainment, and more.
- The study found a positive statistically significant relationship between using supported employment services in the first quarter and being employed in the second quarter. The study found no statistically significant relationship between using supported employment services in the second quarter or third quarter and being employed in the third or fourth quarter, respectively.
Considerations for Interpreting the Findings
The authors compared the outcomes of one group of participants measured at different time points. For this type of design, the authors must observe outcomes for multiple periods before the intervention to show that trends of the outcomes were stable before enrollment in the program. This study only measured whether or not individuals were employed at one time point prior to receiving services, i.e., at the time they were enrolled in the program. Without knowing the trends before program enrollment, we cannot figure out whether the changes in outcomes are related to the program or the pre-existing trend. Therefore, the study receives a low causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this study is low because the authors did not examine and account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to the supported education and employment services (SEE); other factors are likely to have contributed.