Boston University College of Health & Rehabilitation Sciences: Sargent College:
Center for Psychiatric Rehabilitation

Boston University College of Health & Rehabilitation Sciences: Sargent College:
Center for Psychiatric Rehabilitation

Improving Employment Outcomes for Individuals with Psychiatric Disabilities

Rehabilitation Research and Training Center 2009-2014

Funding:

NIDILRR, SAMHSA/CMHS

Dates:

2009 - 2014

Contact:

E. Sally Rogers, Sc.D., Co-Principal Investigator
Marianne Farkas, Sc.D., Co-Principal Investigator

 

Description

This project developed and tested innovative interventions, identified barriers to and facilitators of effective partnerships among providers of employment services, and developed and tested adaptations of evidence-based employment interventions for individuals with psychiatric disabilities from traditionally underserved groups. This project also incorporated research findings into practice and policy by developing, evaluating, and implementing strategies to increase utilization of research findings; and conducts training, technical assistance, and dissemination activities (TDTA) with the same purpose. TDTA projects were organized into programmatic areas which together focus on the development and implementation of practices and services to improve employment outcomes. Using the knowledge transfer framework, TDTA projects produce usable, new technologies for improving employment outcomes.

 

Projects

Research Projects

Project Directors

R-1

A randomized clinical trial evaluating the incremental efficacy of Vocational Illness Management and Recovery (V-IMR) when compared to Individual Placement and Support (IPS) alone

The purpose of this study was to evaluate the effectiveness of an innovative modification of the evidence-based Illness Management and Recovery (IMR). Vocational Illness Management and Recovery (V-IMR) is designed to increase the capacity of individuals to manage their own psychiatric condition and to improve vocational outcomes. The study was a multi-site randomized trial that took place in Colorado, Connecticut and Texas. All participants received the evidence-based supported employment (Individual Placement and Support, IPS) and experimental participants received up to 24 weeks of the manualized V-IMR intervention. Employment outcomes were assessed as well as overall psychosocial functioning, vocational hope, work-related self-efficacy, proactive coping, and self-stigma.

Link to this manual.

A randomized clinical trial evaluating the incremental efficacy of Vocational Illness Management and Recovery (V-IMR) when compared to Individual Placement and Support (IPS) alone

The purpose of this study was to evaluate the effectiveness of an innovative modification of the evidence-based Illness Management and Recovery (IMR). Vocational Illness Management and Recovery (V-IMR) is designed to increase the capacity of individuals to manage their own psychiatric condition and to improve vocational outcomes. The study was a multi-site randomized trial that took place in Colorado, Connecticut and Texas. All participants received the evidence-based supported employment (Individual Placement and Support, IPS) and experimental participants received up to 24 weeks of the manualized V-IMR intervention. Employment outcomes were assessed as well as overall psychosocial functioning, vocational hope, work-related self-efficacy, proactive coping, and self-stigma.

Link to this manual.

Project Directors

R-2

Analysis of the effectiveness of the Northeast Partnership of Medicaid Infrastructure Grants (MIGs) in improving interagency collaboration to promote employment among persons with disabilities

The purpose of this project was to study the barriers to, and facilitators of, effective collaboration and partnerships among a state recipients of Medicaid Infrastructure and Comprehensive Employment Opportunity Grants (MICEO grants) authorized under the Ticket to Work and Work Incentives Improvement Act. The mission of those grant awards was to improve work opportunities and services to individuals with disabilities by improving the system infrastructure for employment services. The entities involved included state vocational rehabilitation (VR) agencies, the Social Security Administration, state and local mental health programs, Department of Labor One-Stops, universities and other consumer-directed programs. We conducted key informant interviews and other data collection to examine the activities of a subset of MICEO awardees consisting of all New England states. We examined their interagency collaboration and partnerships as they implemented their grant activities.

Analysis of the effectiveness of the Northeast Partnership of Medicaid Infrastructure Grants (MIGs) in improving interagency collaboration to promote employment among persons with disabilities

The purpose of this project was to study the barriers to, and facilitators of, effective collaboration and partnerships among a state recipients of Medicaid Infrastructure and Comprehensive Employment Opportunity Grants (MICEO grants) authorized under the Ticket to Work and Work Incentives Improvement Act. The mission of those grant awards was to improve work opportunities and services to individuals with disabilities by improving the system infrastructure for employment services. The entities involved included state vocational rehabilitation (VR) agencies, the Social Security Administration, state and local mental health programs, Department of Labor One-Stops, universities and other consumer-directed programs. We conducted key informant interviews and other data collection to examine the activities of a subset of MICEO awardees consisting of all New England states. We examined their interagency collaboration and partnerships as they implemented their grant activities.

Project Directors

R-3

A randomized clinical trial evaluating the efficacy of a peer-run Photovoice-based intervention to empower individuals with psychiatric disabilities to pursue employment.

The purpose of this project was to develop and evaluate an innovative peer-run psycho-educational group intervention titled “Vocational Empowerment Photovoice (VEP)” that aims to empower individuals with psychiatric disabilities to pursue vocational goals through the enhancement of their vocational hope, sense of vocational identity, work motivation, work-related self-efficacy, and capacity to deal with psychiatric stigma and discrimination. This intervention is specifically designed for individuals who are not engaged in employment services with the expectation that they will move closer to establishing a vocational goal and engaging in employment services as a result of participating in VEP. We conducted a randomized controlled trial (RCT) with individuals receiving VEP or services as usual.

Link to VIMR manual.
Link to this article.

A randomized clinical trial evaluating the efficacy of a peer-run Photovoice-based intervention to empower individuals with psychiatric disabilities to pursue employment.

The purpose of this project was to develop and evaluate an innovative peer-run psycho-educational group intervention titled “Vocational Empowerment Photovoice (VEP)” that aims to empower individuals with psychiatric disabilities to pursue vocational goals through the enhancement of their vocational hope, sense of vocational identity, work motivation, work-related self-efficacy, and capacity to deal with psychiatric stigma and discrimination. This intervention is specifically designed for individuals who are not engaged in employment services with the expectation that they will move closer to establishing a vocational goal and engaging in employment services as a result of participating in VEP. We conducted a randomized controlled trial (RCT) with individuals receiving VEP or services as usual.

Link to VIMR manual.
Link to this article.

R-4

A randomized clinical trial of vocational peer support services.

The purpose of this project was to develop and test a vocational peer support (VPS) intervention and to examine its effects on readiness for employment, work hope, and vocational activity. We conducted a randomized clinical trial in two locations (Massachusetts and Arizona) by training experienced peer support specialists to deliver VPS. We recruit N=166 individuals to receive Vocational Peer Support, or peer support services-as-usual. Modest differences were found between recipients of the intervention and the control group on domains of readiness for work and work activity. The VPS intervention also mediated some aspects of better quality of life and greater work hope.

Link to this article.
Link to Center Manual.

A randomized clinical trial of vocational peer support services.

The purpose of this project was to develop and test a vocational peer support (VPS) intervention and to examine its effects on readiness for employment, work hope, and vocational activity. We conducted a randomized clinical trial in two locations (Massachusetts and Arizona) by training experienced peer support specialists to deliver VPS. We recruit N=166 individuals to receive Vocational Peer Support, or peer support services-as-usual. Modest differences were found between recipients of the intervention and the control group on domains of readiness for work and work activity. The VPS intervention also mediated some aspects of better quality of life and greater work hope.

Link to this article.
Link to Center Manual.

Project Directors

R-5

Enhancing employment through a combined supported employment/supported education model: An exploratory study.

The purpose of this project was to conduct an exploratory study designed to address the needs of young adults with psychiatric conditions who wished to pursue employment or educational goals. The study was conducted at the Center for Psychiatric Rehabilitation, Recovery Services Center. We examined the effects of this integrated supported employment (SE) and supported education (SEd) program that aimed to overcome structural and programmatic barriers to create seamless supported education and supported employment services for young adults. We examined educational and employment outcomes as well as psychological functioning over a one year period in an open trial with n=57 individuals. Results were promising in terms of work and school outcomes as well as the effect on psychological distress.

Link to following article.

Enhancing employment through a combined supported employment/supported education model: An exploratory study.

The purpose of this project was to conduct an exploratory study designed to address the needs of young adults with psychiatric conditions who wished to pursue employment or educational goals. The study was conducted at the Center for Psychiatric Rehabilitation, Recovery Services Center. We examined the effects of this integrated supported employment (SE) and supported education (SEd) program that aimed to overcome structural and programmatic barriers to create seamless supported education and supported employment services for young adults. We examined educational and employment outcomes as well as psychological functioning over a one year period in an open trial with n=57 individuals. Results were promising in terms of work and school outcomes as well as the effect on psychological distress.

Link to following article.

Project Directors

Mihoko Maru, MSW

National Resource Center: Training, Dissemination, and Technical Assistance

Project Directors

TDTA-1

Developing a Vocational Illness Management Recovery Curriculum to Train Providers.

Work continues to serve as an anchor of and a beacon for a meaningful life in the community for people with serious psychiatric conditions. While an evidence based supported employment model (Individual Placement and Support, IPS) has been developed and tested in numerous randomized trials, research also suggests that in order to maintain employment, individuals often need assistance with understanding the impact of their psychiatric challenges and symptoms in the workplace and to provide skills for coping at work.

This project served as a companion to the research project R-1. We modified Illness Management and Recovery, an evidence based psychoeducational intervention, to be vocationally focused. This intervention combines clinical and rehabilitation strategies and requires training providers to deliver these services in the community. The project developed a vocationally oriented IMR (V-IMR) Training program, Curriculum, Leaders Guide and Implementation Guide to help agencies use VIMR with IPS or other employment services to maximize employment outcomes.

See the manual.
See our available training programs.

Developing a Vocational Illness Management Recovery Curriculum to Train Providers.

Work continues to serve as an anchor of and a beacon for a meaningful life in the community for people with serious psychiatric conditions. While an evidence based supported employment model (Individual Placement and Support, IPS) has been developed and tested in numerous randomized trials, research also suggests that in order to maintain employment, individuals often need assistance with understanding the impact of their psychiatric challenges and symptoms in the workplace and to provide skills for coping at work.

This project served as a companion to the research project R-1. We modified Illness Management and Recovery, an evidence based psychoeducational intervention, to be vocationally focused. This intervention combines clinical and rehabilitation strategies and requires training providers to deliver these services in the community. The project developed a vocationally oriented IMR (V-IMR) Training program, Curriculum, Leaders Guide and Implementation Guide to help agencies use VIMR with IPS or other employment services to maximize employment outcomes.

See the manual.
See our available training programs.

Project Directors

TDTA-2

Vocational Peer Support: The Development of a Curriculum to Train Peer Specialists to Support the Vocational Aspirations of People with Psychiatric Disabilities.

Many individuals with psychiatric conditions who obtain work through vocational rehabilitation or supported employment programs experience limited success because of short tenured jobs or negative job endings. This project developed an intervention that addresses the need for vocational support delivered by peer specialists. It enables peers to gain the skills and knowledge necessary to address issues of readiness for work, awareness of the world of work, vocational decision-making, and job-keeping strategies. It was a companion project to R-4, which tested the intervention in a randomized clinical trial. The intervention is called Vocational Peer Support (or VPS). A Leader’s Guide and Participant Handbook supports peers who want to teach or provide Vocational Peer Support.

See the manual.
See our page on training programs.

Vocational Peer Support: The Development of a Curriculum to Train Peer Specialists to Support the Vocational Aspirations of People with Psychiatric Disabilities.

Many individuals with psychiatric conditions who obtain work through vocational rehabilitation or supported employment programs experience limited success because of short tenured jobs or negative job endings. This project developed an intervention that addresses the need for vocational support delivered by peer specialists. It enables peers to gain the skills and knowledge necessary to address issues of readiness for work, awareness of the world of work, vocational decision-making, and job-keeping strategies. It was a companion project to R-4, which tested the intervention in a randomized clinical trial. The intervention is called Vocational Peer Support (or VPS). A Leader’s Guide and Participant Handbook supports peers who want to teach or provide Vocational Peer Support.

See the manual.
See our page on training programs.

Project Directors

Debbie Nicollelis

TDTA-3

Vocational Empowerment: The Development of a Culturally Competent Peer-Run Photovoice Training Program.

Despite recent advances in supported employment and vocational rehabilitation services, the vast majority of people with psychiatric conditions of are unemployed or underemployed. In this project, we used a technique originally used in Public Health research (i.e. “Photovoice”) to develop an intervention, Vocational Empowerment Photovoice (VEP), that is designed to empower individuals with psychiatric conditions, to consider engaging in employment services or work. This project was a companion to the R-3 research study. R-3 tested this intervention, in a randomized trial to examine the effect on hope, internalized stigma, empowerment and objective employment outcomes.

VEP focuses on increasing vocational empowerment using both Photovoice and other psychoeducational approaches. A Training Manual, Curriculum, and Leader’s Guide was created to support practitioners to deliver VEP.

See the manual.
See our page on training programs.

Vocational Empowerment: The Development of a Culturally Competent Peer-Run Photovoice Training Program.

Despite recent advances in supported employment and vocational rehabilitation services, the vast majority of people with psychiatric conditions of are unemployed or underemployed. In this project, we used a technique originally used in Public Health research (i.e. “Photovoice”) to develop an intervention, Vocational Empowerment Photovoice (VEP), that is designed to empower individuals with psychiatric conditions, to consider engaging in employment services or work. This project was a companion to the R-3 research study. R-3 tested this intervention, in a randomized trial to examine the effect on hope, internalized stigma, empowerment and objective employment outcomes.

VEP focuses on increasing vocational empowerment using both Photovoice and other psychoeducational approaches. A Training Manual, Curriculum, and Leader’s Guide was created to support practitioners to deliver VEP.

See the manual.
See our page on training programs.

Project Directors

Maria Restrepo-Toro

TDTA-4

Distance Learning Course: Job Development and Job Retention for Individuals with Psychiatric Disabilities.

Job development and job retention support have long been identified as two areas in need of innovation to amplify employment outcomes. While programs that provide substantial job development greatly increase positive outcomes, the skill of job development, or getting the job that matches individual preferences with job support, is most critical in producing employment outcomes.

This project developed a blended learning training program for employment specialists and other providers tasked with helping individuals get and keep work. The course is a 5-module, 15-hour course, delivered through both asynchronous recorded webinars, live webinar discussions and Discussion Boards. A total of 80% of those surveyed found the materials useful or very useful relevant to their work. Interviews of graduates of the training program found that the majority of those interviewed (n=25), used materials from at least 3 modules in the past 6 months. Over 260 practitioners have participated in the program as of 2019.

See our available course.

Distance Learning Course: Job Development and Job Retention for Individuals with Psychiatric Disabilities.

Job development and job retention support have long been identified as two areas in need of innovation to amplify employment outcomes. While programs that provide substantial job development greatly increase positive outcomes, the skill of job development, or getting the job that matches individual preferences with job support, is most critical in producing employment outcomes.

This project developed a blended learning training program for employment specialists and other providers tasked with helping individuals get and keep work. The course is a 5-module, 15-hour course, delivered through both asynchronous recorded webinars, live webinar discussions and Discussion Boards. A total of 80% of those surveyed found the materials useful or very useful relevant to their work. Interviews of graduates of the training program found that the majority of those interviewed (n=25), used materials from at least 3 modules in the past 6 months. Over 260 practitioners have participated in the program as of 2019.

See our available course.

Project Directors

Joan Rapp

TDTA-5

Improving the Use of Research on Job Accommodations Using a Knowledge Translation Process.

This project used the Center for Psychiatric Rehabilitation’s knowledge translation process (Farkas & Rogers, 2005) to conduct a comprehensive review of the literature on job accommodations for individuals with psychiatric disabilities. It then worked with three specific target associations to develop informational tools based on the review, and provide web-based technical assistance through enhancements to an existing Job Accommodation website so that the organizations could disseminate new research findings to their constituencies and broader national audiences. The strategy of developing tailored materials for individual associations proved successful in terms of its perceived utility in the eyes of the organizations targeted. The materials were added to the existing website. In the final 3 months of the project, there were approximately 101,000 page views of this section alone. Of those visitors, 17% of the visitors were people interested in resources for employers and 23% of visitors sought resources for individuals with psychiatric disabilities. All other visitors were spread equally between the remaining sections of the links to job accommodation resources.

The comprehensive literature review that was developed, can be accessed here

The current Center website has revised its structure and the materials can be accessed through links such as:
- What accommodations work on the job
- What accommodations support school performance
- Recovery and Rehabilitation Newsletters
-Employment Repository

Improving the Use of Research on Job Accommodations Using a Knowledge Translation Process.

This project used the Center for Psychiatric Rehabilitation’s knowledge translation process (Farkas & Rogers, 2005) to conduct a comprehensive review of the literature on job accommodations for individuals with psychiatric disabilities. It then worked with three specific target associations to develop informational tools based on the review, and provide web-based technical assistance through enhancements to an existing Job Accommodation website so that the organizations could disseminate new research findings to their constituencies and broader national audiences. The strategy of developing tailored materials for individual associations proved successful in terms of its perceived utility in the eyes of the organizations targeted. The materials were added to the existing website. In the final 3 months of the project, there were approximately 101,000 page views of this section alone. Of those visitors, 17% of the visitors were people interested in resources for employers and 23% of visitors sought resources for individuals with psychiatric disabilities. All other visitors were spread equally between the remaining sections of the links to job accommodation resources.

The comprehensive literature review that was developed, can be accessed here

The current Center website has revised its structure and the materials can be accessed through links such as:
- What accommodations work on the job
- What accommodations support school performance
- Recovery and Rehabilitation Newsletters
-Employment Repository

Project Directors

Joan Rapp

TDTA-6

A Modern Day Learning Community Focused on the Vision of Full Employment for People with Psychiatric Disabilities.

Stakeholders representing both a diversity of backgrounds and groups were brought together both face-to-face and online with the vision of transforming the dialogue on employment and create strategies designed to promote “parity in employment” for individuals with psychiatric disabilities, meaning equal rates of employment and levels of employment as individuals without disabilities. The community met in an online format for 3 years and culminated their work in an Employment Summit, held in Washington DC in September of 2013.

Executive Summary: State of the Science Meeting on Policy And Employment for Individuals With Psychiatric Disabilities

Henry, A. D., Barkoff, A., Mathis, J., Lilly, B., & Fishman, J. (2016). Policy opportunities for promoting employment for people with psychiatric disabilities. University of Massachusetts Medical School and the Bazelon Center for Mental Health Law. Monograph. 1-14.

Marrone, J., Farkas, M., Abramson, L. (2019) All Change is Difficult-No Matter How Long You Put it off. Making Mental health Systems “High Performers” in Employment Outcomes. American Journal of Psychiatric Rehabilitation, 21:3-4, 261-279.

A Modern Day Learning Community Focused on the Vision of Full Employment for People with Psychiatric Disabilities.

Stakeholders representing both a diversity of backgrounds and groups were brought together both face-to-face and online with the vision of transforming the dialogue on employment and create strategies designed to promote “parity in employment” for individuals with psychiatric disabilities, meaning equal rates of employment and levels of employment as individuals without disabilities. The community met in an online format for 3 years and culminated their work in an Employment Summit, held in Washington DC in September of 2013.

Executive Summary: State of the Science Meeting on Policy And Employment for Individuals With Psychiatric Disabilities

Henry, A. D., Barkoff, A., Mathis, J., Lilly, B., & Fishman, J. (2016). Policy opportunities for promoting employment for people with psychiatric disabilities. University of Massachusetts Medical School and the Bazelon Center for Mental Health Law. Monograph. 1-14.

Marrone, J., Farkas, M., Abramson, L. (2019) All Change is Difficult-No Matter How Long You Put it off. Making Mental health Systems “High Performers” in Employment Outcomes. American Journal of Psychiatric Rehabilitation, 21:3-4, 261-279.

Project Directors

Rick Forbess, MSW

TDTA-7

General Training

General Training

Project Directors

Joan Rapp

Findings

For R-3 findings: Russinova, Z., Gidugu, V., Bloch, P., Restrepo-Toro, M., Rogers, E. S. (2018). Empowering individuals with psychiatric disabilities to work: Results of a randomized trial. Psychiatric Rehabilitation Journal, 41(3), 196-207. doi:10.1037/prj0000303. https://www.ncbi.nlm.nih.gov/pubmed/29985014 and https://psycnet.apa.org/record/2018-32572-001

For R-4 findings: Balogun-Mwangi O, Rogers ES, Maru M, Magee C. Vocational Peer Support: Results of a Qualitative Study. (2019) Journal of Behavioral Health Services Research. 46(3):450-463. doi: 10.1007/s11414-017-9583-6.  https://www.ncbi.nlm.nih.gov/pubmed/29285720

For R-5 findings: Maru, M., Rogers, E.S., Hutchinson, D., & Shappell, H. (2018). An integrated supported employment and education model: Exploratory study of an innovative approach designed to better meet the needs of young adults with psychiatric conditions.  Journal of Behavioral Health Services & Research, 45(3), 489-498. https://link.springer.com/article/10.1007%2Fs11414-018-9595-x

For Vocational Illness Management and Recovery Curricula and Vocational Empowerment Photovoice (R-1, Vocational Illness Management and Recovery see Vocational Illness Management and Recovery  and for R-3 see Vocational Empowerment Photovoice. For curricula related to R-4, see Vocational Peer Support Vocational Peer Support.


			
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