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

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

Improving Employment Outcomes for Individuals with Psychiatric Disabilities, 2019 - 2024

Rehabilitation Research and Training Center (RRTC)

Funding:

NIDILRR

Dates:

2019 - 2024

Contact:

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

This grant focuses on promising practices needed to improve employment outcomes for individuals with psychiatric conditions.

 

Description

The Center for Psychiatric Rehabilitation, with its network of collaborators, will conduct a coordinated program of research and knowledge translation projects and activities that build on the existing evidence-based supported employment and improve employment outcomes for individuals with psychiatric disabilities.

Research objectives are: 1) conduct a qualitative study of the barriers and facilitators to accessing IPS; 2) create a typology of provider-generated adaptations to IPS; 3) examine performance-based incentives and their effects on clients and IPS specialists; 4) test an intervention of self-management strategies for workplace success; 5) develop and test of an innovative metacognitive intervention to improve work outcomes; 6) test an integrated career guidance and supported education intervention to improve employment outcomes and income.

The National Resource Center (NRC) will conduct training, technical assistance, and dissemination activities and increase utilization of research findings; objectives are to: 1) to provide academic and in-service training to help providers and stakeholders improve employment services; 2) test an innovative approach to benefits counseling; 3) conduct online technical assistance to improve employment services; 4) conduct online dissemination activities; 5) develop and test a mobile application to change providers’ low expectations about work, particularly in treatment settings. Anticipated outcomes include: increased awareness and adoption of promising enhancements to IPS; increase knowledge and skill about benefits counseling; increased facts and resources about employment, and increased positive attitudes about work. Products include: training and technical assistance programs, research syntheses, briefs, manualized interventions and curricula, mobile phone apps, publications and presentations.

 

Projects

Research projects

Project Directors

R-1

A qualitative study of barriers and facilitators to accessing high fidelity IPS from the perspectives of multiple stakeholders.

This project will investigate barriers and facilitators related to accessing evidence-based supported employment (Individual Placement and Support, or IPS) from the perspectives of clients, family members, case managers and clinicians, employment services team, and senior management in 4 states (CT, IL, NC, and WA); states with varying amounts of experience with and availability of IPS services. We will conduct an in-depth inquiry using qualitative interviews exploring barriers and facilitators based on the perspectives of these stakeholders within IPS programs.

A qualitative study of barriers and facilitators to accessing high fidelity IPS from the perspectives of multiple stakeholders.

This project will investigate barriers and facilitators related to accessing evidence-based supported employment (Individual Placement and Support, or IPS) from the perspectives of clients, family members, case managers and clinicians, employment services team, and senior management in 4 states (CT, IL, NC, and WA); states with varying amounts of experience with and availability of IPS services. We will conduct an in-depth inquiry using qualitative interviews exploring barriers and facilitators based on the perspectives of these stakeholders within IPS programs.

R-2

Development of a typology of provider-generated adaptations of IPS.

This project will develop a catalogue of adaptations and enhancements that have been undertaken by states and programs to their evidence-based supported employment programs (Individual Placement and Support, or IPS) using qualitative interviews. Starting with all IPS Learning Collaborative (LC) members we will identify key informants who can assist us to understand adaptations in their states and conduct interviews to describe the drivers of the adaptations and their characteristics.

Development of a typology of provider-generated adaptations of IPS.

This project will develop a catalogue of adaptations and enhancements that have been undertaken by states and programs to their evidence-based supported employment programs (Individual Placement and Support, or IPS) using qualitative interviews. Starting with all IPS Learning Collaborative (LC) members we will identify key informants who can assist us to understand adaptations in their states and conduct interviews to describe the drivers of the adaptations and their characteristics.

R-3

A study of provider-generated adaptations of IPS using performance-based incentives to reduce staff turnover and improve client outcomes.

In this study we will carry out an in-depth inquiry into the use of performance-based incentives (PBIs) for staff of evidence based supported employment programs (Individual Placement and Support or IPS) as a way to reduce staff turnover and improve client employment outcomes. The project has multiple parts, including: 1) developing a categorization of the types of PBI’s used in IPS programs; 2) examining the impact of PBIs on staff turnover, burnout and job satisfaction; and 3) examining the impact of PBIs on the employment outcomes of clients receiving IPS services. The study will be carried out in the state of Illinois which has been in the forefront of using PBI’s.

A study of provider-generated adaptations of IPS using performance-based incentives to reduce staff turnover and improve client outcomes.

In this study we will carry out an in-depth inquiry into the use of performance-based incentives (PBIs) for staff of evidence based supported employment programs (Individual Placement and Support or IPS) as a way to reduce staff turnover and improve client employment outcomes. The project has multiple parts, including: 1) developing a categorization of the types of PBI’s used in IPS programs; 2) examining the impact of PBIs on staff turnover, burnout and job satisfaction; and 3) examining the impact of PBIs on the employment outcomes of clients receiving IPS services. The study will be carried out in the state of Illinois which has been in the forefront of using PBI’s.

R-4

A pilot randomized trial of evidence-based Self-Management Strategies for employment success delivered by IPS Specialists

Cognitive deficits have been repeatedly shown to limit employment outcomes for individuals with psychiatric conditions. Thinking Skills for Work (TSW) is an evidence based intervention designed to be delivered in combination with supported employment (SE). TSW has two components: cognitive training (practice of computer cognitive exercises with coaching in strategies to improve performance), and self-management strategies to improve cognitive functioning in work situations. Multiple controlled studies of TSW have demonstrated its effectiveness. The goal of this project is to conduct a preliminary study focused on the cognitive self-management skills component of TSW, delivered directly by IPS Specialists and embedded into routine SE services. We will conduct a cluster randomized trial and follow individuals over 18 months to track cognitive and work outcomes.

A pilot randomized trial of evidence-based Self-Management Strategies for employment success delivered by IPS Specialists

Cognitive deficits have been repeatedly shown to limit employment outcomes for individuals with psychiatric conditions. Thinking Skills for Work (TSW) is an evidence based intervention designed to be delivered in combination with supported employment (SE). TSW has two components: cognitive training (practice of computer cognitive exercises with coaching in strategies to improve performance), and self-management strategies to improve cognitive functioning in work situations. Multiple controlled studies of TSW have demonstrated its effectiveness. The goal of this project is to conduct a preliminary study focused on the cognitive self-management skills component of TSW, delivered directly by IPS Specialists and embedded into routine SE services. We will conduct a cluster randomized trial and follow individuals over 18 months to track cognitive and work outcomes.

R-5

Mastering the World of Work: Development and testing of a work-focused metacognitive intervention to improve employment outcomes.

The purpose of this study is to develop and test an innovative intervention entitled “Mastering the World of Work” (MWW) that aims to improve the employment outcomes of individuals with psychiatric conditions who experience “metacognitive” deficits. Metacognitive deficits represent diminished capacity to form an integrated sense of self and others and to respond to challenges in life. We will establish the ability of the MWW intervention to increase the metacognitive capacity of individuals interested in pursuing employment with a small pilot study at the Recovery Center and then will conduct a randomized trial at the Mental Health Center of Greater Manchester in New Hampshire (NH). We will examine the effects of the intervention on employment outcomes.

Mastering the World of Work: Development and testing of a work-focused metacognitive intervention to improve employment outcomes.

The purpose of this study is to develop and test an innovative intervention entitled “Mastering the World of Work” (MWW) that aims to improve the employment outcomes of individuals with psychiatric conditions who experience “metacognitive” deficits. Metacognitive deficits represent diminished capacity to form an integrated sense of self and others and to respond to challenges in life. We will establish the ability of the MWW intervention to increase the metacognitive capacity of individuals interested in pursuing employment with a small pilot study at the Recovery Center and then will conduct a randomized trial at the Mental Health Center of Greater Manchester in New Hampshire (NH). We will examine the effects of the intervention on employment outcomes.

R-6

FastTrack: Enhancing IPS services with a career guidance + supported education intervention to improve work outcomes and earnings.

There is a critical need to enhance evidence-based supported employment (Individual Placement and Support, or IPS) to address the low educational and vocational attainment of individuals with psychiatric conditions, thereby improving their employment outcomes and earnings. IPS emphasizes rapid entry into employment and by default, deemphasizes career guidance, vocational training and supported education. We will test an intervention using a randomized trial called FastTrack, which is designed to increase the ability of individuals with psychiatric conditions to pursue career-focused employment and earn higher wages. We will conduct this trial in collaboration with the 2SUCCEED Supported Employment and Education program of the Mental Health Center of Denver.

FastTrack: Enhancing IPS services with a career guidance + supported education intervention to improve work outcomes and earnings.

There is a critical need to enhance evidence-based supported employment (Individual Placement and Support, or IPS) to address the low educational and vocational attainment of individuals with psychiatric conditions, thereby improving their employment outcomes and earnings. IPS emphasizes rapid entry into employment and by default, deemphasizes career guidance, vocational training and supported education. We will test an intervention using a randomized trial called FastTrack, which is designed to increase the ability of individuals with psychiatric conditions to pursue career-focused employment and earn higher wages. We will conduct this trial in collaboration with the 2SUCCEED Supported Employment and Education program of the Mental Health Center of Denver.

National Resource Center: Training, Dissemination, and Technical Assistance

Project Directors

D-1

The National Resource Center on Improving Employment Outcomes: An online push pull dissemination strategy

A one-stop online National Resource Center (NRC) portal will engage stakeholders across a variety of media using Push-Pull strategies. Push strategies include Personal Stories of Vocational Recovery & Economic Self Sufficiency, Town Hall Conversations, research-based Issue Briefs, and a bi-monthly email newsletter. NRC Pull strategies encompass formats and topics that respond to stakeholder inquiries or requests, including through input from other KT and MHTT Centers. These platforms include, for example, an interactive “Ask Me Anything” About Employment webinars and a series of talks on Making Sense of Employment Research. Dissemination activities are designed to encourage people to seek further assistance, if needed, as they consider putting this new knowledge into practice.

The National Resource Center on Improving Employment Outcomes: An online push pull dissemination strategy

A one-stop online National Resource Center (NRC) portal will engage stakeholders across a variety of media using Push-Pull strategies. Push strategies include Personal Stories of Vocational Recovery & Economic Self Sufficiency, Town Hall Conversations, research-based Issue Briefs, and a bi-monthly email newsletter. NRC Pull strategies encompass formats and topics that respond to stakeholder inquiries or requests, including through input from other KT and MHTT Centers. These platforms include, for example, an interactive “Ask Me Anything” About Employment webinars and a series of talks on Making Sense of Employment Research. Dissemination activities are designed to encourage people to seek further assistance, if needed, as they consider putting this new knowledge into practice.

Project Directors

D-2

Ripple: A Mobile Application to Change Provider Work Expectations

In this project we will develop Ripple, a mobile application that will be available for iOS and Android phones and that will deliver a series of 90 myth-busting facts about the employment of people with psychiatric conditions. These myth-busting facts will be delivered like text messages to mental health providers. The “app” will be designed for use in mental health settings, and other settings, and will be paired with interactive agency-based discussions and staff development.

Ripple: A Mobile Application to Change Provider Work Expectations

In this project we will develop Ripple, a mobile application that will be available for iOS and Android phones and that will deliver a series of 90 myth-busting facts about the employment of people with psychiatric conditions. These myth-busting facts will be delivered like text messages to mental health providers. The “app” will be designed for use in mental health settings, and other settings, and will be paired with interactive agency-based discussions and staff development.

Project Directors

TR-1

Rise Up Above Benefits: Changing the Culture, Peer and Practitioner Capacity to Enhance Access to Quality Benefits Counseling.

Rise UP Above Benefits is a two-tiered training program. General peer support workers will receive experience-level training as “Peer Benefits Coaches” (PBC) consisting of basic knowledge to overcome myths about Social Security work incentives, sharing personal vocational recovery stories, including the role of benefits and facilitating vocational plans. Peer and non-peer staff, working specifically to support those pursuing employment goals, will receive expertise-level “Benefit Navigator” (BN) training. This includes skills such as evaluating current benefit situations; determining the need for referral to Certified Work Incentive Counselors (CWIC); communicating work options and benefits, and providing strategic planning to manage incentive programs.

Rise Up Above Benefits: Changing the Culture, Peer and Practitioner Capacity to Enhance Access to Quality Benefits Counseling.

Rise UP Above Benefits is a two-tiered training program. General peer support workers will receive experience-level training as “Peer Benefits Coaches” (PBC) consisting of basic knowledge to overcome myths about Social Security work incentives, sharing personal vocational recovery stories, including the role of benefits and facilitating vocational plans. Peer and non-peer staff, working specifically to support those pursuing employment goals, will receive expertise-level “Benefit Navigator” (BN) training. This includes skills such as evaluating current benefit situations; determining the need for referral to Certified Work Incentive Counselors (CWIC); communicating work options and benefits, and providing strategic planning to manage incentive programs.

Project Directors

TR-2

Changing Hearts, Minds and Practice: National Resource Center General Training.

This project will provide different levels of training (called exposure, experience and expertise-level training) about employment for individuals with psychiatric conditions. Pre-Service Training will be accomplished via the inclusion of new content and materials in academic settings such as undergraduate, masters and doctoral program courses at Boston University in the Departments of Occupational Therapy and Social Work; supervision of doctoral students and internships at the Center for Psychiatric Rehabilitation and through “Discipline Champions” (psychology, psychiatry, rehabilitation) at other academic programs, committed to promoting the use of the RRTC employment content and teaching materials. In-service Training which will focus on three strategies: 1) creating a ‘Training Library’ composed of existing or modified online expertise and exposure level courses; 2) developing brief events tailored for specific provider associations; and 3) delivering these broadly, through collaboration with professional networks and organizations. Online training, On-demand Technical Assistance, and webinars designed for professional associations, such as PRA and the National Council will be created. In addition, we will hold a National Employment Summit to examine issues at the intersection of research and practice. We intend to reach the broadest possible audiences using a variety of modalities.

Changing Hearts, Minds and Practice: National Resource Center General Training.

This project will provide different levels of training (called exposure, experience and expertise-level training) about employment for individuals with psychiatric conditions. Pre-Service Training will be accomplished via the inclusion of new content and materials in academic settings such as undergraduate, masters and doctoral program courses at Boston University in the Departments of Occupational Therapy and Social Work; supervision of doctoral students and internships at the Center for Psychiatric Rehabilitation and through “Discipline Champions” (psychology, psychiatry, rehabilitation) at other academic programs, committed to promoting the use of the RRTC employment content and teaching materials. In-service Training which will focus on three strategies: 1) creating a ‘Training Library’ composed of existing or modified online expertise and exposure level courses; 2) developing brief events tailored for specific provider associations; and 3) delivering these broadly, through collaboration with professional networks and organizations. Online training, On-demand Technical Assistance, and webinars designed for professional associations, such as PRA and the National Council will be created. In addition, we will hold a National Employment Summit to examine issues at the intersection of research and practice. We intend to reach the broadest possible audiences using a variety of modalities.

Project Directors

TA-1

Enhanced Online Technical Assistance Response (E-OTAR) Model: Helping organizations utilize new knowledge to improve employment outcomes.

This Technical Assistance project will target change among mental health agencies in the following areas: 1) increasing expectations of employment for those being served; 2) increasing access to high quality benefits counseling; 3) promoting increased earnings potential for service participants; and 4) implementing a range of complementary supports to enhance access to and effectiveness of Individual Placement and Support (the evidence-based supported employment program). The process will be designed to use related approaches such as training curricula, policies, procedures, performance expectations, into the organization’s operations and culture. These materials will be summarized across organizations, into a Compendium to further assist others contemplating similar changes. The project will employ established elements for providing successful technical assistance such as assessing organizational readiness for change and goal setting.

Enhanced Online Technical Assistance Response (E-OTAR) Model: Helping organizations utilize new knowledge to improve employment outcomes.

This Technical Assistance project will target change among mental health agencies in the following areas: 1) increasing expectations of employment for those being served; 2) increasing access to high quality benefits counseling; 3) promoting increased earnings potential for service participants; and 4) implementing a range of complementary supports to enhance access to and effectiveness of Individual Placement and Support (the evidence-based supported employment program). The process will be designed to use related approaches such as training curricula, policies, procedures, performance expectations, into the organization’s operations and culture. These materials will be summarized across organizations, into a Compendium to further assist others contemplating similar changes. The project will employ established elements for providing successful technical assistance such as assessing organizational readiness for change and goal setting.

Project Directors

General Technical Assistance Activities

Project Directors

Contact

Inquiries related to the project should be addressed to:

Marianne Farkas, Sc.D.  mfarkas@bu.edu

E. Sally Rogers, Sc.D.  erogers@bu.edu

Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215