Re. Drake et al., A randomized clinical trial of supported employment for inner-city patients with severe mental disorders, ARCH G PSYC, 56(7), 1999, pp. 627-633
Background: This experiment evaluated the effectiveness of 2 approaches to
vocational services for persons with severe mental disorders: (1) individua
l placement and support (IPS), in which employment specialists within the m
ental health center help patients to obtain competitive jobs and provide on
going support, and (2) enhanced vocational rehabilitation (EVR), in which s
tepwise vocational services are delivered by rehabilitation agencies.
Methods: One hundred fifty-two unemployed, inner-city patients with severe
mental disorders who expressed interest in competitive employment were rand
omly assigned to IFS or EVR and followed up for 18 months. Following diagno
stic assessment, participants were assessed with standardized measures of w
ork, income, self-esteem, quality of life, symptoms, and hospitalization at
baseline and at 6-, 12-, and 18-month follow-up evaluations. Employment wa
s tracked monthly and job satisfaction every 2 months.
Results: During the 18-month study, participants in the IFS program were mo
re likely to become competitively employed (60.8% vs 9.2%) and to work at l
east 20 hours per week in a competitive job (45.9% vs 5.3%), whereas EVR pa
rticipants had a higher rate of participation in sheltered employment (71.1
% vs 10.8%). Total earnings,job satisfaction, and nonvocational outcomes we
re similarly improved for both groups.
Conclusion: The IFS model of supported employment is more effective than st
andard, stepwise EVR approaches for achieving competitive employment, even
for inner-city patients with poor work histories and multiple problems.