Abstract
For people with psychiatric disabilities, demographic characteristics and measures of clinical status are often used to allocate scarce employment services. This study examined a battery of potential client predictors of competitive employment, testing the hypothesis that evidence-based supported employment would mitigate the negative effects of poor work history, uncontrolled symptoms, substance abuse, and other client factors. In a secondary analysis of 2055 unemployed Social Security Disability Insurance beneficiaries with schizophrenia or affective disorders, we examined 20 baseline client factors as predictors of competitive employment. The analysis used logistic regression to identify significant client predictors and then examined interactions between significant predictors and receipt of evidence-based supported employment. Work history was a strong predictor of employment, and other client measures (fewer years on disability rolls, Hispanic ethnicity, and fewer physical health problems) were modestly predictive. Evidence-based supported employment mitigated negative client factors, including poor work history. Participants with a poor work history benefitted from supported employment even more than those with a recent work experience. Evidence-based supported employment helps people with serious mental illness, especially those with poor job histories, to obtain competitive employment. Factors commonly considered barriers to employment, such as diagnosis, substance use, hospitalization history, and misconceptions about disability benefits, often have little or no impact on competitive employment outcomes.
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Acknowledgements
The authors thank Susan Kalasunas and Tom Hale from the U.S. Social Security Administration (SSA) for their assistance. This study extends work that was conducted under Contract SS00-05-60072 between the SSA and Westat and Grant #H133B140028 from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The contents of this manuscript were developed under a grant with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research and from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA) within the United States Department of Health and Human Services (NIDILRR Grant 90RT5029). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services. The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government. The opinions expressed in this article are those of the authors and not necessarily those of the SSA.
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The data were collected under contract SS00-05-60072 and are under the auspice of the Social Security Administration.
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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
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Metcalfe, J.D., Drake, R.E. & Bond, G.R. Predicting Employment in the Mental Health Treatment Study: Do Client Factors Matter?. Adm Policy Ment Health 44, 345–353 (2017). https://doi.org/10.1007/s10488-016-0774-x
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DOI: https://doi.org/10.1007/s10488-016-0774-x