Absence of conflict of interest.
Citation
Twamley, E., Narvaez, J., Becker, D., Bartels, S., & Jeste, D. (2008). Supported employment for middle-aged and older people with schizophrenia. American Journal of Psychiatric Rehabilitation, 11(1), 76-89.
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) and used weekly work logs cross-referenced with pay stubs to measure employment outcomes over a 12-month period.
- The study found that IPS increased competitive employment and earnings compared with conventional services.
- 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 a vocational specialist. The model is more interactive and flexible than typical services. Services included initial assessment, a collaborative job search process, and follow-up support with no time limit. The vocational specialist typically had a bachelor’s degree and maintained a caseload of 20 to 25 clients.
Conventional vocational rehabilitation (CVR) services provide job coaching before the job search. Services were provided by vocational counselors through Employment Services after the Department of Rehabilitation made an initial eligibility assessment. Vocational counselors typically had a bachelor’s or master’s degree and maintained a caseload of 35 clients. Services included evaluation, employment preparation, job development, and job retention (with up to 90 days of support). Participants also received additional support through this study, such as phone reminders and transportation assistance, 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 50 patients who were referred or self-referred to receive care at a clinic in San Diego, were age 45 or older, 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 dementia or other major neurological disorders. In all, 28 patients were randomly assigned to the treatment group for IPS services, and 22 were assigned to the control group to receive CVR services. The authors used t-tests to measure program impacts on employment and earnings after 12 months and a logistic regression model to predict the impact of IPS on work status after accounting for age, education, duration of illness, medication dose, and work recency.
Findings
Employment
- The study found that the IPS significantly increased probability of achieving competitive employment. The IPS group also worked significantly more weeks during the year than the CVR group.
Earnings
- The study found that the IPS significantly increased wages from competitive work, with the treatment group earning more than the control group.
Considerations for Interpreting the Findings
There is only one vocational specialist providing all services for IPS. 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 not have found competitive work or to have had 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 the RCT has a confounding factor in which one provider provided all services to the IPS group. This means we are not confident that the estimated effects are attributable to the IPS program; other factors are likely to have contributed.