This study was designed to identify correlates of success in Supported Employment (SE) programs for persons with psychiatric disabilities. Indiana policy-makers are seriously considering a managed care, or "capitated," system of payment to make SE provider programs more efficient economically. However, many agencies are concerned about providing services to more severely impaired individuals because of the potentially higher costs of serving these individuals. Two studies are included in this project. The goals of the first study were to identify SE consumer (clinical) characteristics that predict (1) successful outcomes, defined as whether the consumer achieves gainful work, and (2) program costs, defined as the amounts of SE service hours utilized by consumers who obtain work. In two large samples of SE consumers with serious mental illness, no clinical characteristics (e.g., diagnosis, rated functioning, hospitalization history) were associated with vocational outcome or service costs. The goal of the second study was to describe the types and amounts of services utilized by SE consumers who obtain work. Specific service categories associated with obtaining work were travel, training, and advocacy that was unrelated to the consumer's job. The implications of these findings are discussed in the framework of the debate over clinical versus empirical prediction. The need for a theoretical model of SE services that allows the use of predictive clinical and consumer driven services is also discussed. / Department of Psychological Science

Individuals with a psychiatric disability have had the poorest vocational outcomes of all the disabled populations when comparing rehabilitation success rates. The purpose of this study was to explore the relationships between selected background, social, and service variables and vocational rehabilitation outcome in order to identify potential indicators of success or failure. Data was gathered from records in the Tucson, Arizona offices of the state-federal vocational rehabilitation program. The sample included 210 White and Hispanic subjects with a psychiatric disability. Their records had been closed in the years 1983 through 1987. The independent variables were the background variables of Age, Age of Onset, Ethnicity, and Educational Level, the social variables of Living Situation, Ability To Get Along With Others, and Employment History, and the service variables of Training and Support. The dependent variable was Employment Status as determined by the vocational rehabilitation program: Successful subjects, coded a Status 26, were closed having been employed at least 60 days; unsuccessful subjects, coded a Status 08, 28, or 30, left the program unemployed. The study followed a correlational design using a regression approach. Logistic Regression Analysis with forward selection was the strategy employed to identify the best predictive model. A chi-square test of independence was used to further study variables that showed some predictive potential. An effort was made to control for the presence of one or more additional disabilities. The results indicated that the variables most highly related to Employment Outcome, in the order of their importance, were Training, Employment History, and Ability To Get Along With Others. Ability To Get Along With Others disappeared as a key indicator when the sample was divided into single and multiple disability groups. However, the findings suggest that Ability To Get Along With Others and Support Services may contribute to the effect of the two more powerful variables. It is also cautiously suggested that Training that is job-related and skill-building in nature may be more useful than formal education for this population.

AIM The purpose of the research study was to explore and to describe stereotypes associated with serious mental illness and the effects of familiarity on the serious mental illness stigma process in potential employer informants in the greater Durban area, eThekwini district, KwaZulu-Natal. Methods A quantitative non-experimental cross sectional survey relational research design was used to describe firstly, the stereotyping and individual discriminatory behavior (desire for social distance) of potential employers to a person with a SMI, and secondly, the effect of familiarity and other person variables (culture, age and gender) on the stigma components of stereotyping, emotional reaction and individual discriminatory behavior (desire for social distance). The population included potential employers of the SMI person in the greater Durban area, eThekwini District, KwaZulu-Natal. The target population was all students enrolled for a part-time management course at two academic institutions in the Durban central area. Non-randomized, non-probability purposive sampling was used. Demographic data and four self report tools were compiled into one self report questionnaire to collect data. Results The sample was evenly distributed amongst male and female within the various age groups. All cultural groups were represented but this representation was not a perfect fit with national or provincial population statistics. Just less than half of the participants (48% n=55), both genders and across all cultural groups, had intimate and or personal contact with persons with a serious mental illness. Demographic associations suggest that male participants had greater perceptions of dangerousness, unpredictability and incompetence and a greater desire for social distance. The statistical results indicated limited correlations between emotional reactions and desire for social distance, stigmatizing attitudes and desire for social distance, and evidence of no significant relationship between familiarity and other components within the stigmatizing path. Fear was associated with a desire for social distance and with perceptions of limited potential for recovery. Stigmatizing attitudes were most negative towards persons who had a previous admission to a psychiatric hospital and the least negative towards 'bipolar mood disorder'. Stigmatising attitudes were recorded for all serious mental illness labels (including that of bipolar) with 75% of participants scoring closer to the negative polar adjective of stigmatizing attitude. Conclusion and Recommendations In conclusion, the supposed lack of desire for social distance, the dependent variable in this study, may reflect political policy and current ideology but the strength of the negative stereotypes suggests that changing policy is easier than changing attitudes. It is suggested that the stigmatizing stereotype of limited potential for recovery may have more salience in developing countries such as South African than the developed western world. Limited potential for recovery has financial and emotional implication within a developing country and to this extent, desire for social distance and fear are correlated to perceptions of limited potential for recovery. Recommendations include additional research include measures of social desirability bias to clarify the relationship between familiarity, emotional reaction and social distance. Secondly, intervention studies, specifically with potential employers, are required to obtain empirical data related to the combine effectiveness of disconfirming information and contact with people with a serious mental illness. Further, that health departments actively engage in evidence based anti-stigma initiatives. Lastly it is recommended nursing curricula recognise the importance of student psychiatric nurses developing a balanced view of mental health care users assigned the serious mental illness labels through a balanced clinical exposure to recovered, as well as acutely ill mental health care users. That the new undergraduate nursing degree curricula strengthen content related to recovery and psychosocial rehabilitation, specifically nursing interventions / strategies to facilitate rehabilitation in all the areas of study, socialization, community living, and specifically in the area of work. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.

The purpose of this study was to identify individual characteristics and school experiences of youth with serious emotional disturbance (SED) that may influence their postsecondary employment status.

Care for individuals with a severe mental illness has changed dramatically over the past 50 years. Deinstitutionalization gave patients the opportunity for independence and community reintegration, including employment. Employment specialists play an important role in assisting clients with obtaining employment but there has been limited research investigating employers’ perceptions of employment specialists in the hiring process. 76 undergraduate and graduate students participated in a study in which referral source (employment specialist vs. friend) and criminal history (misdemeanor vs. felony) of an applicant recovering from schizophrenia were manipulated. Participants assumed the role of an employer, reviewed an application for a job (which included a brief video of the applicant and his employment specialist/friend), and made a hiring recommendation. Results showed no significant differences in hiring recommendations when the applicant was referred by his employment specialist than when he was referred by his friend, and criminal history of the applicant also did not play a significant role in hiring recommendations. There appeared to be a ceiling effect in that most participants were affirmative in hiring the applicant, although their prior attitudes toward people with mental illness also correlated with their hiring recommendation. Limitations of the study are discussed and directions for future research include: increasing the sample size, sampling professionals in the community and finding ways that are perhaps more ecologically valid and less susceptible to ceiling effects instead of using hypothetical case vignettes. / Department of Psychological Science

Indiana University-Purdue University Indianapolis (IUPUI) / This study was a subset of a large two-year randomized controlled trial of two employment programs providing services to people with severe mental illness (SMI). Because prior research has found that the strength of the relationship, or working alliance, between service providers and people with SMI is related to a variety of beneficial outcomes, the purpose of the current study was to address the working alliance between participants and their vocational workers and its association with employment outcomes, including the total duration of paid employment over two years and mean paid job tenure after two years. Another primary purpose of the current study was to determine whether working alliance differences exist between a team vocational approach (Diversified Placement Approach) and an individual vocational approach (Individual Placement and Support Model). The final aim of the current study was to investigate the psychometric properties of the ad hoc scale utilized to measure the working alliance. Contrary to expectations, no relationship was found between the working alliance and employment outcomes after two years. As expected, it was found that participants in the individual vocational approach (IPS) had higher working alliance scores across the study than participants in the team vocational program (DPA). Finally, the working alliance measure used in this study was found to have promising psychometric properties, including adequate criterion-related validity and test-retest reliability, although the internal consistency was a bit low. The scale items are a loose fit with existing theory, however, necessitating the addition of items and revision of the current scale and underlying theory to enhance its utility in clinical and research settings.

Indiana University-Purdue University Indianapolis (IUPUI) / The primary purpose of the current study was to determine the relationship between employment and the nonvocational functioning of people with severe mental illness in a prospective 24 month study, as a partial replication of another study. An employment typology was utilized that was comprised of participants at four employment levels: no work (those who did not work the entire study period), minimal work (those who worked 24 weeks or less in competitive and/or noncompetitive, paid employment), paid work (those who worked 24 or more weeks, the majority of which was spent in noncompetitive, paid employment), and competitive work (those who worked 24 or more weeks, the majority of which was spent in competitive employment). Both objective and subjective outcomes were addressed, including quality of life, symptoms, psychiatric hospitalizations, social networks, and residential status. Participants consisted of persons with severe mental illness (most with a schizophrenia-spectrum disorder) who were receiving employment services at a large, urban psychiatric rehabilitation center. Mixed effects regression modeling and logistic regression were used to analyze the date. Results indicate that the competitive work group experienced an accelerated improvement in negative symptoms across time and was less likely to have psychiatric hospitalization days as compared with the no work group. The paid work group showed an accelerated improvement in social network scores across time as compared with the no work, minimal work, and competitive work groups. The full sample demonstrated improvements across the study period regardless of employment typology status in the areas of overall quality of life, financial quality of life, cognitive symptoms, and social networks. In conclusion, this study adds to the growing body of evidence indicating that work, particularly periods of extended competitive work may lead to important benefits in clinical and social domains, although threats to internal validity that could not be ruled out preclude a causal link from being established. Future research is needed to further investigate this relationship, particularly in regards to those outcomes that are not well understood, such as residential status.

Indiana University-Purdue University Indianapolis (IUPUI) / Employment specialist competencies were examined as predictors of employment outcomes for consumers with severe mental illness participating in supported employment. Using a cross-sectional correlational design a variety of self-report and supervisor-rated performance measures were examined for their association with three consumer employment outcomes (e.g., the percentage of consumers on an employment specialist's caseload that were competitively employed, the percentage of consumers on an employment specialist's caseload that were employed 90 consecutive days, and the rate in which consumers dropped out of employment services). Six mental health agencies with a total of 57 employment specialists and 14 supervisors from across the nation participated in the study. Competitive employment rates ranged among employment specialists from 0% to 80%. Higher supervisor-rated job performance, supervisor-rated employment specialist efficacy, percentage of work time spent in the community during the past month, and number of contacts with consumers during the past month were related to improved consumer employment outcomes. However, employment specialist attitudes, knowledge of supported employment, conscientiousness, and self-efficacy were unrelated to employment outcomes. This study is one of the first of its kind to examine employment specialist competencies as they relate to supported employment for consumers with severe mental illness. While supported employment is a great improvement over traditional vocational programs, further examination of employment specialist competencies could hold the key to unlocking employment success for many more consumers.