Laura Blankertz

Clinical factors associated with employment among people with severe mental illness: Findings from the employment intervention demonstration program

Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of patient clinical factors to employment outcomes. Multivariate random regression analysis indicated that, even when controlling for an extensive series of demographic, study condition (experimental versus control), and work history covariates, clinical factors were associated with individuals’ ability to achieve competitive jobs and to work 40 or more hours per month. Poor self-rated functioning, negative psychiatric symptoms, and recent hospitalizations were most consistently associated with failure to achieve these employment outcomes. These findings suggest ways that providers can tailor supported employment programs to achieve success with a diverse array of clinical subpopulations.

Demographic Characteristics and Employment Among People with Severe Mental Illness in a Multisite Study

People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site. Longitudinal analyses found that people with more recent work history, younger age, and higher education were more likely to achieve competitive employment and to work more hours per month, while race and gender effects varied by employment outcome. Results provide strong evidence of demographic subgroup variation and need.

Turnover Intentions of Community Mental Health Workers in Psychosocial Rehabilitation Services

Staff turnover is an important topic for community mental health administrators. This paper reports on turnover intentions of PSR workers, a rapidly growing sector of the community mental health labor force as reported in a nationwide survey. A predictive model of intended turnover, suggested by literature in the field as well as study finding, included worker characteristics, job characteristics and worker attitudes. It was found that seven variables predicted intended turnover: younger age, higher emotional exhaustion, a feeling of lower job fulfillment, the lack of a perception of a career path, having a masters degree, having held a previous job in PSR and working with clients who have both a mental illness and AIDS. To assist agencies in reducing turnover, organizational policies and recommendations for staff development are discussed.

Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders

This study evaluated the impact of an integrated (mental health/substance abuse) assertive community treatment program on homeless persons with serious mental and substance use disorders. High rates of retention in treatment, housing stability, and community tenure were attained, and all but the most severe substance users appeared to gain these benefits. While the intervention appears to be an effective means of retaining in services and monitoring such difficult-to-treat and costly populations, it did not yield high rates of abstinence and social benefits in severe users.

Work as a rehabilitative tool for individuals with dual diagnoses

There has been little emphasis on vocational rehabilitation for individuals with dual diagnoses of mental illness and substance abuse among the health, substance abuse, and vocational rehabilitation systems of care. This article promotes work as an important rehabilitative tool which can result in both a stabilization of symptoms of mental illness and sobriety. A framework for client assessment and successfully integrating employment at different stages of the rehabilitation process as well as a case example is provided.

Assessing consumer program needs: advantages of a brief unstructured format.

To be empowered, consumers must provide feedback on services so that modifications can be made. The most frequently used method to attain such information is consumer satisfaction measures. However, often the measures are not useful because they have a strong positive response bias or because they do not contain items that reflect consumer needs. An alternative brief unstructured assessment was piloted with individuals served by four Community Treatment Teams in Delaware. The high number of needs expressed suggests that further work should be done in this area.