Michael S. Shafer

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.

A Comparison of Prebooking and Postbooking Diversion Programs for Mentally Ill Substance-Using Individuals With Justice Involvement

Eight programs are described representing a variety of approaches to diversion in terms of point of criminal justice intervention (prebooking or postbooking), degree of criminal justice coercion, type of linkages provided to community-based treatment, and approaches to treatment retention. The authors also describe the characteristics of almost 1000 study participants who were diverted into these programs over an 18-month period and examine the extent to which systematic differences are observed between prebooking and postbooking subjects, as well as among sites in each of the diversion types. Results suggest that prebooking and postbooking diversion subjects were similar on most mental health indicators, but differed substantially on measures of social functioning and substance use and criminality, with postbooking subjects scoring worse on social functioning and reporting more serious substance use and criminal histories. Variability among sites was also observed, indicating differences in local preferences for the types of individuals deemed appropriate for diversion.

The employment intervention demonstration program: major findings and policy implications.

This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The studys results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.

Traumatic Histories and Stressful Life Events of Incarcerated Parents: Childhood and Adult Trauma Histories

Abuse and trauma are common in the histories of prison inmates. This article presents the results of research on the trauma histories and stressful life events experienced by 2,279 male and female inmate parents in Arizona, with a particular focus on gender and ethnic differences across inmates. A sample of 838 incarcerated fathers and 1,441 mothers completed anonymous questionnaires regarding traumatic and stressful events experienced as children and/or adults. High rates of exposure to childhood and adult traumatic events, especially child abuse, were found for both males and females and across ethnic groups.

Using distance education to promote the transfer of motivational interviewing skills among behavioral health professionals

This study evaluated the effectiveness of distance education for training behavioral health professionals. Five live video workshops that covered key elements of Motivational Interviewing (MI) were delivered. The programs occurred a month apart, each 3 hours long. The programs used compressed video, transmitting the video signal through telephone lines. The audience was staff at substance abuse treatment organizations throughout the state of Arizona. Participants completed assessments regarding their training experiences, knowledge and self-efficacy in MI, and their satisfaction with the training, prior to, during, and subsequent to the workshops. Participation in the five workshops varied; the first workshop had the largest attendance of 351, the fourth the lowest of 92; 145 participants attended all five workshops. Participants expressed moderate levels of satisfaction with most aspects of the training, although some expressed frustration with interrupted audio or video signals during the programs. The handouts and videotaped examples of MI were identified as the more helpful aspects of the training. Participants reported statistically significant improvements in their self-perceived knowledge and skills. They demonstrated a statistically significant but clinically insignificant increase in knowledge. A small group of participants provided audiotapes of actual counseling sessions. These participants demonstrated minimal improvement in skills across the study that were not statistically significant. These results are discussed in terms of their implications for future research in the use of distance education as a technology transfer tool in the addiction treatment profession.

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness.

Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immuno-deficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success.

Traumatic histories and stressful life events of incarcerated parents II: Gender and ethnic differences in substance abuse and service needs

Substance abuse is increasingly common in prison inmates. This article presents findings on substance abuse and service needs of male and female inmate parents in Arizona, with a particular focus on gender and ethnic differences across inmates. A sample of 838 incarcerated fathers and 1,441 mothers completed anonymous questionnaires regarding traumatic and stressful events experienced as children and/or adults, including addiction. Exposure to childhood and adult traumatic events, especially child abuse, was related to self-reported alcohol and drug problems for both males and females. Mothers reported significantly more postrelease service needs than fathers. Implications for practice and policy are discussed.

Effectiveness of supported employment for individuals with schizophrenia: Results of a multi-site, randomized trial

Background: Prior studies of supported employment efficacy for individuals with schizophrenia have yielded mixed results, with some finding poorer outcomes for those with this diagnosis and others finding no differences.Aims: This multi-site effectiveness trial examined the relative impact of diagnosis with schizophrenia and evidence-based practice supported employment on the likelihood of competitive employment.Method: At seven U.S. sites, 1,273 outpatients with severe mental illness were randomly assigned to either an experimental supported employment program or to a comparison/services as usual condition and followed for two years. Data collection involved semi-annual, in-person interviews, and weekly recording of all paid employment by vocational and research staff. Mixed-effects random regression analysis was used to examine the effects of study condition, schizophrenia diagnosis, and their interaction, on the likelihood of competitive employment.Results: Subjects in experimental group programs and t...

Receptive acquisition and generalization of prepositional responding in autistic children: A comparison of two procedures

Abstract This investigation compared the effectiveness of two strategies with respect to the receptive acquisition and generalization of prepositional concepts in four autistic children. During “position self” training, the student was instructed to place himself in a specific relation to an object; “position object” training involved the student placing an object in a specific prepositional relation to another object. Data on the acquisition of the prepositional concepts showed that both strategies were effective, with prepositions trained in the “position object” condition acquired in slightly fewer sessions. For three of the students, specific programming was required before responding generalized to novel stimuli and/or across response topographies. Implications of these findings with respect to the training of generalized receptive comprehension of prepositions are discussed.

A cluster randomized trial of an organizational process improvement intervention for improving the assessment and case planning of offenders: a Study Protocol

BackgroundThe Organizational Process Improvement Intervention (OPII), conducted by the NIDA-funded Criminal Justice Drug Abuse Treatment Studies consortium of nine research centers, examined an organizational intervention to improve the processes used in correctional settings to assess substance abusing offenders, develop case plans, transfer this information to community-based treatment agencies, and monitor the services provided by these community based treatment agencies.Methods/DesignA multi-site cluster randomized design was used to evaluate an inter-agency organizational process improvement intervention among dyads of correctional agencies and community based treatment agencies. Linked correctional and community based agencies were clustered among nine (9) research centers and randomly assigned to an early or delayed intervention condition. Participants included administrators, managers, and line staff from the participating agencies; some participants served on interagency change teams while other participants performed agency tasks related to offender services. A manualized organizational intervention that includes the use of external organizational coaches was applied to create and support interagency change teams that proceeded through a four-step process over a planned intervention period of 12 months. The primary outcome of the process improvement intervention was to improve processes associated with the assessment, case planning, service referral and service provision processes within the linked organizations.DiscussionProviding substance abuse offenders with coordinated treatment and access to community-based services is critical to reducing offender recidivism. Results from this study protocol will provide new and critical information on strategies and processes that improve the assessment and case planning for such offenders as they transition between correctional and community based systems and settings. Further, this study extends current knowledge of and methods for, the study of evidence-based practice adoption and implementation.