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, 2014 - 2020

Rehabilitation Research and Training Center (RRTC)

Funding:

NIDILRR, CMHS, SAMHSA

Dates:

2014 - 2020

Contact:

E. Sally Rogers, Sc.D. (Research)
Marianne Farkas, Sc.D. (Training)

Description

This grant focuses on promising practices needed to improve employment outcomes through development of technology, examination of individual and work environment factors associated with improved employment outcomes, and by investigating the effects of government practices, policies and programs on employment outcomes for individuals with psychiatric disabilities, including those from traditionally underserved groups. The projects also increase the incorporation of research findings into practice and policy by developing a National Resource Center (NRC) on Employment and Vocational Recovery, which conducts training, technical assistance, and dissemination activities to increase the utilization of research findings. We target this increased utilization of research findings to states seeking to implement evidence-based supported employment, to organizations delivering or planning to deliver employment services, and to individuals with psychiatric disabilities, families, employers, providers, administrators and other key stakeholders.

Projects are organized into programmatic areas which together focus on the development, implementation and validation of interventions, technology and policies to improve employment outcomes. Research studies are designed at appropriate stages given the state of the knowledge in each area, and to have an impact on the field at the personnel, program and system levels. Both research and NRC projects rely on participatory processes with significant input from consumers and other key stakeholders. Furthermore, all projects use knowledge translation as their framework to produce usable, new technologies for improving employment outcomes.

Please contact the Principal Investigators for additional information.

Investigators

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

Projects

Research projects

Project Directors

Project R-1

Enhancing the Impact of the Thinking Skills for Work Program on Cognitive Functioning and Work Through Tablet-based Home Practice.

The Thinking Skills for Work (TSW) is an evidence-based cognitive remediation program combined with supported employment services for individuals with psychiatric conditions. TSW has been shown to improve cognitive functioning and work in multiple studies. The goal of this project is to further improve the cognitive and work outcomes by capitalizing on recent advances in the cognitive software technology used in TSW that make it usable on a tablet. Having TSW operating on a tablet will make home practice of cognitive exercises a workable option in addition to practice in a mental health agency. This project was divided into three phases. Phase I focused on developing guidelines for tablet-based home practice and modifying the TSW manual. Phase II was a small pilot test of the TSW program using tablets. Phase III is a randomized trial testing the effectiveness of the tablet TSW compared to supported employment services alone to determine if the tablet version leads to greater improvements in cognitive functioning and work compared to traditional TSW.

Enhancing the Impact of the Thinking Skills for Work Program on Cognitive Functioning and Work Through Tablet-based Home Practice.

The Thinking Skills for Work (TSW) is an evidence-based cognitive remediation program combined with supported employment services for individuals with psychiatric conditions. TSW has been shown to improve cognitive functioning and work in multiple studies. The goal of this project is to further improve the cognitive and work outcomes by capitalizing on recent advances in the cognitive software technology used in TSW that make it usable on a tablet. Having TSW operating on a tablet will make home practice of cognitive exercises a workable option in addition to practice in a mental health agency. This project was divided into three phases. Phase I focused on developing guidelines for tablet-based home practice and modifying the TSW manual. Phase II was a small pilot test of the TSW program using tablets. Phase III is a randomized trial testing the effectiveness of the tablet TSW compared to supported employment services alone to determine if the tablet version leads to greater improvements in cognitive functioning and work compared to traditional TSW.

Project R-2

Predicting Employment Outcomes with Client and Program Characteristics, Work Environment Features, and Community Characteristics

The aim of this project was to conduct secondary analyses of two large datasets to identify predictors of employment outcomes for individuals with psychiatric conditions. The first dataset is the Mental Health Treatment Study, which was a randomized controlled trial comparing usual services to a comprehensive evidence-based mental health and supported employment approach to helping Social Security Disability Insurance beneficiaries gain employment. The second dataset consisted of aggregated data from 5 studies that examined the effects of combining cognitive remediation and vocational rehabilitation to vocational rehabilitation alone. We employed multivariate statistical approaches with predictors from the following domains: client characteristics, program characteristics, work environment, and community characteristics. The second dataset of cognitive remediation studies allowed us to determine if cognitive functioning is more predictive of employment outcomes in vocational rehabilitation when cognitive remediation is also provided than when it is not. Two employment domains were examined: job acquisition and job duration.

Predicting Employment Outcomes with Client and Program Characteristics, Work Environment Features, and Community Characteristics

The aim of this project was to conduct secondary analyses of two large datasets to identify predictors of employment outcomes for individuals with psychiatric conditions. The first dataset is the Mental Health Treatment Study, which was a randomized controlled trial comparing usual services to a comprehensive evidence-based mental health and supported employment approach to helping Social Security Disability Insurance beneficiaries gain employment. The second dataset consisted of aggregated data from 5 studies that examined the effects of combining cognitive remediation and vocational rehabilitation to vocational rehabilitation alone. We employed multivariate statistical approaches with predictors from the following domains: client characteristics, program characteristics, work environment, and community characteristics. The second dataset of cognitive remediation studies allowed us to determine if cognitive functioning is more predictive of employment outcomes in vocational rehabilitation when cognitive remediation is also provided than when it is not. Two employment domains were examined: job acquisition and job duration.

Project Directors

Gary Bond, Ph.D.

garybond@westat.com

Project R-3

Randomized Clinical Trial Evaluating the Efficacy of the Peer-Run Vocational Empowerment Photovoice (VEP) to Increase the Capacity of Individuals with Psychiatric Disabilities to Pursue Employment

The purpose of this project was to evaluate a promising peer-run, psycho-educational group intervention titled “Vocational Empowerment Photovoice (VEP)” that aims to empower individuals with the most disabling psychiatric conditions to engage in vocational services and pursue employment through the enhancement of vocational hope, vocational identity, work motivation, work-related self-efficacy, and the ability to deal with stigma and discrimination. VEP is a 10-week, peer-run program with the addition of weekly individual support provided by the VEP peer leaders and focuses on each participant’s work-related goals. We conducted a randomized trial in multiple locations with a total of n=144 individuals who were not engaged in vocational services or working, but who expressed such interests. The study was carried out in different mental health agencies (Thresholds in Chicago, IL and Pilgrim Psychiatric Center in Long Island, NY and Transitions of Boston), all of who provided supported employment services. Individuals were followed for 12 months to examine engagement in employment services, job-seeking activities, vocational hope, vocational identity, work motivation, and work-related self-efficacy.

Link to the VEP manual.
View the article: Empowering individuals with psychiatric disabilities to work: Results of a randomized trial Zlatka Russinova, Vasudha Gidugu, Philippe Bloch, Maria Restrepo-Toro, E. Sally Rogers

Randomized Clinical Trial Evaluating the Efficacy of the Peer-Run Vocational Empowerment Photovoice (VEP) to Increase the Capacity of Individuals with Psychiatric Disabilities to Pursue Employment

The purpose of this project was to evaluate a promising peer-run, psycho-educational group intervention titled “Vocational Empowerment Photovoice (VEP)” that aims to empower individuals with the most disabling psychiatric conditions to engage in vocational services and pursue employment through the enhancement of vocational hope, vocational identity, work motivation, work-related self-efficacy, and the ability to deal with stigma and discrimination. VEP is a 10-week, peer-run program with the addition of weekly individual support provided by the VEP peer leaders and focuses on each participant’s work-related goals. We conducted a randomized trial in multiple locations with a total of n=144 individuals who were not engaged in vocational services or working, but who expressed such interests. The study was carried out in different mental health agencies (Thresholds in Chicago, IL and Pilgrim Psychiatric Center in Long Island, NY and Transitions of Boston), all of who provided supported employment services. Individuals were followed for 12 months to examine engagement in employment services, job-seeking activities, vocational hope, vocational identity, work motivation, and work-related self-efficacy.

Link to the VEP manual.
View the article: Empowering individuals with psychiatric disabilities to work: Results of a randomized trial Zlatka Russinova, Vasudha Gidugu, Philippe Bloch, Maria Restrepo-Toro, E. Sally Rogers

Project R-4

Opening Doors: Development and Testing of a Career Education and Development Project

Despite the existence of an evidence-based practice that promotes employment for individuals with psychiatric disabilities (i.e., Individual Placement and Support (IPS), many individuals continue to experience low workforce participation, poor job retention, participation in menial jobs, and a general lack of career advancement. Being “stuck in dead end jobs” is often a cited reason individuals with disabilities remain on the Social Security rolls. The purpose of this project was to develop and test a career guidance intervention called “Opening Doors”, an approach based on based on vocational interventions developed by the Center and which combined group and individuals career guidance services and mainstream Internet-based resources. We conducted a randomized trial of Opening Doors with n=116 individuals delivered in 9 waves of the intervention to determine its effects on vocational recovery as well as clarity about a career path

Opening Doors: Development and Testing of a Career Education and Development Project

Despite the existence of an evidence-based practice that promotes employment for individuals with psychiatric disabilities (i.e., Individual Placement and Support (IPS), many individuals continue to experience low workforce participation, poor job retention, participation in menial jobs, and a general lack of career advancement. Being “stuck in dead end jobs” is often a cited reason individuals with disabilities remain on the Social Security rolls. The purpose of this project was to develop and test a career guidance intervention called “Opening Doors”, an approach based on based on vocational interventions developed by the Center and which combined group and individuals career guidance services and mainstream Internet-based resources. We conducted a randomized trial of Opening Doors with n=116 individuals delivered in 9 waves of the intervention to determine its effects on vocational recovery as well as clarity about a career path

Project Directors

Project R-5

Examining the Impact of Federal and State Government Policies and Practices on Employment Outcomes for People with Psychiatric Disabilities

The goal of this project was to examine what government policies and practices promote positive employment outcomes and facilitate access to evidence-based and promising employment services for individuals with psychiatric conditions. This project included three phases. Phase 1: A Study of Disability Policies, Labor Laws, and National Economies on Employment Outcomes to examine the effects of government policies and practices (such as disability policies, labor laws, and national economies) on employment rates for individuals with psychiatric conditions. Phase 2: National Survey of Access to Evidence-Based and Promising Employment Services which consisted of a national telephone survey of state leaders to determine what employment services are available in each state in the U.S. and comprehensive documentation of access to employment services for people with psychiatric disabilities. Phase 3: Qualitative Study of High-Performing and Low-Performing States with respect to employment services and access to evidence-based and promising employment practices.

Articles
1. Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis Justin D Metcalfe , Robert E Drake , Gary R Bond.
2. Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis Justin D Metcalfe, Jarnee Riley, Susan McGurk, Thomas Hale, Robert E Drake, Gary R Bond.
3. A Tale of Four States: Factors Influencing the Statewide Adoption of IPS Gary R. Bond, Ph.D., Annalee Johnson-Kwochka, M.S., Jacqueline A. Pogue, M.A., Sandra Langfitt-Reese, B.S., Deborah R. Becker, M.Ed., CRC, and Robert E. Drake, M.D., Ph.D. In Press: Administration and Policy in Mental Health and Mental Health Services Research. Available from first author.

Examining the Impact of Federal and State Government Policies and Practices on Employment Outcomes for People with Psychiatric Disabilities

The goal of this project was to examine what government policies and practices promote positive employment outcomes and facilitate access to evidence-based and promising employment services for individuals with psychiatric conditions. This project included three phases. Phase 1: A Study of Disability Policies, Labor Laws, and National Economies on Employment Outcomes to examine the effects of government policies and practices (such as disability policies, labor laws, and national economies) on employment rates for individuals with psychiatric conditions. Phase 2: National Survey of Access to Evidence-Based and Promising Employment Services which consisted of a national telephone survey of state leaders to determine what employment services are available in each state in the U.S. and comprehensive documentation of access to employment services for people with psychiatric disabilities. Phase 3: Qualitative Study of High-Performing and Low-Performing States with respect to employment services and access to evidence-based and promising employment practices.

Articles
1. Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis Justin D Metcalfe , Robert E Drake , Gary R Bond.
2. Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis Justin D Metcalfe, Jarnee Riley, Susan McGurk, Thomas Hale, Robert E Drake, Gary R Bond.
3. A Tale of Four States: Factors Influencing the Statewide Adoption of IPS Gary R. Bond, Ph.D., Annalee Johnson-Kwochka, M.S., Jacqueline A. Pogue, M.A., Sandra Langfitt-Reese, B.S., Deborah R. Becker, M.Ed., CRC, and Robert E. Drake, M.D., Ph.D. In Press: Administration and Policy in Mental Health and Mental Health Services Research. Available from first author.

Project Directors

Gary Bond, Ph.D.

garybond@westat.com

National Resource Center: Training, Dissemination, and Technical Assistance

Project Directors

Project D-1

The National Resource Center on Employment and Vocational Recovery Online: A Tailored Dissemination Strategy

Central to the development of an online component of the National Resource Center on Employment and Vocational Recovery (NRC), is an understanding that knowledge of resources and access to evidence increases understanding of a topic and improves the ability to make decisions. Designing information strategies that are both generic and tailored are more likely to both reach the broad population and meet the needs of specific subgroups. Both approaches increase exposure and aid in any decision- making process. The goal of this project was to design the online component of the NRC to make it accessible using generic and tailored strategies, through both computer and mobile devices. In addition, the project aimed to engage the participation of individuals with psychiatric disabilities, families, providers, administrators, employers and researchers, across diverse communities and to assist them in utilizing information about vocational recovery and employment.

The National Resource Center on Employment and Vocational Recovery Online: A Tailored Dissemination Strategy

Central to the development of an online component of the National Resource Center on Employment and Vocational Recovery (NRC), is an understanding that knowledge of resources and access to evidence increases understanding of a topic and improves the ability to make decisions. Designing information strategies that are both generic and tailored are more likely to both reach the broad population and meet the needs of specific subgroups. Both approaches increase exposure and aid in any decision- making process. The goal of this project was to design the online component of the NRC to make it accessible using generic and tailored strategies, through both computer and mobile devices. In addition, the project aimed to engage the participation of individuals with psychiatric disabilities, families, providers, administrators, employers and researchers, across diverse communities and to assist them in utilizing information about vocational recovery and employment.

Project Directors

Project D-2

“Let’s Talk Employment” Family Toolkit: Educating Families about Employment and Vocational Recovery

Family members play an important role in supporting people with psychiatric disabilities. The positive effect of educating families to facilitate the recovery of individuals with psychiatric disabilities has been well established. Families help “keep hope alive”, supporting and reinforcing the self-efficacy of their relatives and their progress toward achieving personally meaningful goals such as employment. Many families also worry that work may be too stressful for their loved one, or may have other negative attitudes towards work. When families feel positive about the possibilities of employment and know about effective practices, they can play an important role in advocating for access to evidence-based employment. This project developed a toolkit for families that increased their awareness and knowledge about employment and vocational recovery, enabling them to be supportive of their relative’s vocational recovery journey.

See more information on our website here.

“Let’s Talk Employment” Family Toolkit: Educating Families about Employment and Vocational Recovery

Family members play an important role in supporting people with psychiatric disabilities. The positive effect of educating families to facilitate the recovery of individuals with psychiatric disabilities has been well established. Families help “keep hope alive”, supporting and reinforcing the self-efficacy of their relatives and their progress toward achieving personally meaningful goals such as employment. Many families also worry that work may be too stressful for their loved one, or may have other negative attitudes towards work. When families feel positive about the possibilities of employment and know about effective practices, they can play an important role in advocating for access to evidence-based employment. This project developed a toolkit for families that increased their awareness and knowledge about employment and vocational recovery, enabling them to be supportive of their relative’s vocational recovery journey.

See more information on our website here.

Project Directors

Project TR-1

Advanced Practitioner and Peer Specialist Skills (APPS): Building Partnerships for Employment and Vocational Recovery through Distance Learning

The low employment rates for people with psychiatric disabilities are exacerbated for people with disabilities from minority backgrounds who have been traditionally underserved by state VR. A good working alliance, choice, participation in decision-making, are all predictive of successful rehabilitation outcomes. The availability of online learning opportunities is on the rise, and over 75% of academic leaders at public institutions argue that online education is as good as, if not better than, in-person learning. Blended learning, an integration of online and in-person may be more effective than either format alone. Online rehabilitation counseling education is of special benefit to those with difficulties attending traditional classrooms. This project (named Advanced Practitioner and Provider Skills, or APPS) developed a blended learning program to teach vocational rehabilitation staff and peer workers critical skills for promoting vocational recovery, including engagement, partnership, and choice.

Advanced Practitioner and Peer Specialist Skills (APPS): Building Partnerships for Employment and Vocational Recovery through Distance Learning

The low employment rates for people with psychiatric disabilities are exacerbated for people with disabilities from minority backgrounds who have been traditionally underserved by state VR. A good working alliance, choice, participation in decision-making, are all predictive of successful rehabilitation outcomes. The availability of online learning opportunities is on the rise, and over 75% of academic leaders at public institutions argue that online education is as good as, if not better than, in-person learning. Blended learning, an integration of online and in-person may be more effective than either format alone. Online rehabilitation counseling education is of special benefit to those with difficulties attending traditional classrooms. This project (named Advanced Practitioner and Provider Skills, or APPS) developed a blended learning program to teach vocational rehabilitation staff and peer workers critical skills for promoting vocational recovery, including engagement, partnership, and choice.

Project Directors

Project TR-2

Moving Along to Employment: Exposure Training to Inspire Networks of Support

Often mental health professionals discourage the individuals they support from pursuing employment believing that work is too stressful or because of low expectations for persons in recovery from mental health conditions. Attitudes about work among family members (related to concerns about stress or the loss of benefits), can have similar discouraging effects. Employer beliefs about persons with psychiatric disabilities also suggest that stigma and discrimination remain common. There is a need to increase awareness among providers, family members and employers, to dispel the ideas of the “unemployable” and rather to create a “Conspiracy of Hope” (Deegan, 1996). This project, “Moving Along to Employment” was a training project intended to help move audiences to the next level of participation in an ongoing discussion to inspire greater support for employment and vocational recovery.

Moving Along to Employment: Exposure Training to Inspire Networks of Support

Often mental health professionals discourage the individuals they support from pursuing employment believing that work is too stressful or because of low expectations for persons in recovery from mental health conditions. Attitudes about work among family members (related to concerns about stress or the loss of benefits), can have similar discouraging effects. Employer beliefs about persons with psychiatric disabilities also suggest that stigma and discrimination remain common. There is a need to increase awareness among providers, family members and employers, to dispel the ideas of the “unemployable” and rather to create a “Conspiracy of Hope” (Deegan, 1996). This project, “Moving Along to Employment” was a training project intended to help move audiences to the next level of participation in an ongoing discussion to inspire greater support for employment and vocational recovery.

Project Directors

Project TA-1

An Online Technical Assistance Response for Organizations Providing Employment Services

At a time when budget constraints limit access to Technical Assistance (TA) to organizations providing employment services, online TA has the potential to be effective at reduced costs. Although the evaluation of TA needs more rigorous attention due to its increasing use and the ever-changing technology used for its delivery, a review of evaluations found that online TA, using Internet-based approaches, along with telephone consultation and other emerging communication technologies, shows promise. This approach, with a blend of direct and indirect TA appears to be feasible, less costly, and effective. This project aims to deliver blended, direct and indirect online organizational TA that is easily accessible, collaborative, and interactive, to address the myriad individual and environmental factors and service gaps that impact vocational recovery and employment.

An Online Technical Assistance Response for Organizations Providing Employment Services

At a time when budget constraints limit access to Technical Assistance (TA) to organizations providing employment services, online TA has the potential to be effective at reduced costs. Although the evaluation of TA needs more rigorous attention due to its increasing use and the ever-changing technology used for its delivery, a review of evaluations found that online TA, using Internet-based approaches, along with telephone consultation and other emerging communication technologies, shows promise. This approach, with a blend of direct and indirect TA appears to be feasible, less costly, and effective. This project aims to deliver blended, direct and indirect online organizational TA that is easily accessible, collaborative, and interactive, to address the myriad individual and environmental factors and service gaps that impact vocational recovery and employment.

Project Directors

Project TA-2

Supporting Evidence-Based Supported Employment: State-Level Technical Assistance to SAMHSA Grantees

Individual Placement and Support (IPS) is an individualized, person-centered, evidence-based practice that helps people with psychiatric disabilities get and keep competitive employment. The Substance Abuse and Mental Health Services Administration (SAMHSA) joined other national efforts to overcome these identified barriers by awarding grants to seven states to implement supported employment. This project was designed to help these states to focus on changing the capacity of systems and agencies to support the implementation and maintenance of evidence-based supported employment. This Technical Assistance (TA) project used four major strategies: 1) monthly calls with the state IPS teams; 2) on-site TA and consultation visits to the states several times a year; 3) providing information and coaching to stakeholders; 4) providing TA to help states develop learning communities in order to sustain and improve their capacity for IPS delivery. TA also expanded existing state learning communities, develop robust financing arrangements, and added technology tools to amplify workforce capacity.

Supporting Evidence-Based Supported Employment: State-Level Technical Assistance to SAMHSA Grantees

Individual Placement and Support (IPS) is an individualized, person-centered, evidence-based practice that helps people with psychiatric disabilities get and keep competitive employment. The Substance Abuse and Mental Health Services Administration (SAMHSA) joined other national efforts to overcome these identified barriers by awarding grants to seven states to implement supported employment. This project was designed to help these states to focus on changing the capacity of systems and agencies to support the implementation and maintenance of evidence-based supported employment. This Technical Assistance (TA) project used four major strategies: 1) monthly calls with the state IPS teams; 2) on-site TA and consultation visits to the states several times a year; 3) providing information and coaching to stakeholders; 4) providing TA to help states develop learning communities in order to sustain and improve their capacity for IPS delivery. TA also expanded existing state learning communities, develop robust financing arrangements, and added technology tools to amplify workforce capacity.

Project Directors

Deborah R. Becker

deborahbeck@westat.com

Contact

Inquiries related to the project should be addressed to:

E. Sally Rogers (for Research projects) erogers@bu.edu
Marianne Farkas (For projects involving Training, Dissemination or Technical Assistance) mfarkas@bu.edu
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215

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