Recent Projects: Rehabilitation Interventions
An Investigation of the Effectiveness of an Intensive Psychiatric Rehabilitation Process on Functional Recovery
Marsha Langer Ellison, Ph.D.
The purpose of this project was to examine the effect of an intensive psychiatric rehabilitation process, administered under a managed care structure in one state, on the recovery of persons with long-term mental illness. Several hundred recipients of Intensive Psychiatric Rehabilitation (IPR) services were followed over an 18-month period to ascertain their functional recovery in vocational, residential, and educational domains, and their goal achievement. This cohort was compared to a group of individuals not receiving IPR to determine the effect of these services on rehabilitation and recovery outcomes, as well as on service utilization.
This study examined the outcomes of intensive psychiatric rehabilitation (IPR) services in Iowa. Results indicate there are significant increases in residential status and earnings for those completing IPR services. Analyses of mental health service use and expenditures based on Medicaid data suggest that IPR results in reduced use of costly mental health services, especially in-patient and day treatment services.
Ellison, M.L., Anthony, W.A., Sheets, J., Dodds, W., Barker, W.J., Massaro, J., Wewiorski, N. (2002).
The integration of psychiatric rehabilitation services in behavioral health care structures: A state example.
Journal of Behavioral Health Services and Research, 29(4), 381-393.
A Longitudinal Study of the Relationship Between Sustained Employment and Recovery
Zlatka Russinova, Ph.D.
The purpose of this project was to generate longitudinal data about the patterns of sustained competitive employment among people with psychiatric disabilities and about the relationship between sustained employment and the overall process of recovery from long-term mental illness. A prospective longitudinal cohort design was used with three assessments at 12-month intervals. A battery of standardized instruments along with a survey developed for this project was administered to several hundred study participants. This project was planned as a continuation of an exploratory, two-year longitudinal NIDRR funded study (Field Initiated Research Grant #H133G980124-99) examining the relationship between sustained employment and the psychosocial adjustment of people with psychiatric disabilities.
This longitudinal study examined the correlates of sustained employment in individuals with severe psychiatric disabilities. Respondents to the survey had the capacity to sustain employment but experienced ascending and descending trends in the hours and continuity of employment. Individuals in the study demonstrated the capacity to sustain employment at all occupational levels, from menial to professional and top executive levels. Individuals with a diagnosis of schizophrenia tended to work fewer hours, have lower occupational status, and earn lower wages. A large proportion (82%) of those who sustained employment have disclosed their psychiatric disability. Most individuals who sustain employment (90%) still experience psychiatric symptoms and receive ongoing mental health services, including psychopharmacological management. Findings suggest that meaningful employment is possible despite ongoing mental health symptoms and treatment.
Russinova, Z., Wewiorski, N., Lyass, A., Rogers, E. S., & Massaro, J. (2002). Correlates of vocational recovery for persons with schizophrenia. International Review of Psychiatry, 14(4), 303-311.
Sherer, R.A. (2003). Employment programs help patients with mental illness succeed. Psychiatric Times, 20, 1-5.
A Process and Outcome Evaluation of a Recovery Center That Integrates Employment and Education Services with Wellness and Recovery
Kathy Furlong Norman, M.S.W.
The purpose of this project was to conduct a program evaluation of the Recovery Center, an innovative model of service delivery developed at the Boston University Center for Psychiatric Rehabilitation. The Recovery Center provides vocational, educational, wellness, and spirituality services in a supported education environment through awareness building, skill development, and provision of supports. The impact of these recovery services on vocational, psychosocial, and wellness outcomes was evaluated. The project refined and tested a management information system (ROMIS) that addressed the need for programs to capture evidence based processes and outcomes. Integrating rehabilitation and alternative approaches in the same project permitted a much-needed evaluation of recovery-oriented services. Administrators and instructors have disseminated aspects of the Recovery Center and replication of this approach to services was initiated in Texas, Arizona, and South Carolina.
This study developed, demonstrated, and evaluated an innovative model for supported education/supported employment. The Recovery Center model of services can be replicated by traditional mental health service providers. The varying course of psychiatric disability makes continuous involvement in an intervention difficult; programs must be flexible to accommodate individuals’ changes in functioning. An Access-based Recovery Oriented Management Information System is a useful tool to track both processes and outcomes of service delivery. Six-month outcomes comparing experimental to control participants suggested no differences in role functioning, however, experimental participants appeared to improve in some subjective domains. Data analysis is ongoing.