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The efficacy of supported employment for middle-aged and older people with schizophrenia. (Twamley et al. 2012)

Absence of conflict of interest.

Citation

Twamley, E. W., Vella, L., Burton, C. Z., Becker, D. R., Bell, M. D., & Jeste, D. V. (2012). The efficacy of supported employment for middle-aged and older people with schizophrenia. Schizophrenia Research, 135(1-3), 100-104.

Highlights

  • The study examined the impact of Individual Placement and Support (IPS) on competitive employment for older people with schizophrenia
  • The study was a randomized controlled trial (RCT) conducted at a community mental health clinic and used weekly work logs cross-referenced with pay stubs to measure employment outcomes over a 12-month period.
  • The study found that IPS was positively associated with employment and earnings.
  • The quality of causal evidence presented in this report is low because the RCT has a confounding factor. This means we are not confident that the estimated effects are attributable to the IPS program; other factors are likely to have contributed.

Intervention Examined

Individual Placement and Support and Vocational Rehabilitation Program

Features of the Intervention

IPS was a supported employment intervention that provided services from an employment specialist. The model is more interactive and flexible than typical services. Services were aimed at obtaining competitive, integrated work and included follow-up support with no time limit. The employment specialist had a maximum caseload of 25 clients.

CVR services provide job coaching before the job search. Services were provided by a program for people with mental illness after the Department of Rehabilitation made an initial eligibility assessment. Vocational counselors typically maintained a caseload of 35 clients. Participants also received additional support through this study, such as phone reminders and transportation assistance to their first three appointments, which were meant to retain participants.

Features of the Study

This study used an RCT to examine the impact of IPS on competitive employment for older people with schizophrenia. IPS and CVR were offered to 58 patients who were referred or self-referred to receive care at a mental health clinic; were ages 45 to 60; were diagnosed with schizophrenia or schizoaffective disorder; were unemployed but had worked in the past and desired work; did not have alcohol or substance dependence at the time of study entry; and did not have history of head injury, mental retardation, or neurological disorders. In all, 30 patients were randomly assigned to the treatment group, which received IPS services, and 28 were assigned to the control group, which received CVR services. 30 were assigned to IPS and 28 to CVR. The authors used t-tests to measure demographic characteristics, chi-square tests to measure program impacts on work obtainment, and Mann-Whitney nonparametric tests for job durations and earnings.

Findings

Employment

  • The study found that the treatment group was significantly more likely to achieve competitive employment compared with the control group

Earnings

  • The study found that IPS was associated with significantly higher earnings from both competitive work and any paid work.

Considerations for Interpreting the Findings

Only one vocational specialist provides all services for ISP. It is impossible to separate the effect of the program from the effect of the provider. Further, several participants dropped out of the program but were included in the analysis and assumed to have not found competitive work or to have any earnings. Including these people might have biased the results toward lower employment and earnings.

Causal Evidence Rating

The quality of causal evidence presented in this report is low because that the RCT has a confounding factor in which one provider providing all services to ISP group. This means we are not confident that the estimated effects are attributable to the IPS program; other factors are likely to have contributed.

Reviewed by CLEAR

September 2019

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