A randomized clinical trial of supported employment for inner-city patients with severe mental disorders

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.