Overview of supported employment

Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review

OBJECTIVE

To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace.

DESIGN

The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework.

DATA SOURCES AND ELIGIBILITY

Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included.

STUDY APPRAISAL AND SYNTHESIS

Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work.

RESULTS

The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace.

CONCLUSIONS

There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.

Intersectional perspectives on the employment rate in Supported Employment for people with psychiatric, neuropsychiatric, or intellectual disabilities: A scoping review

BACKGROUND

Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention.

OBJECTIVE

To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history.

METHODS

A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included.

RESULTS

The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power.

CONCLUSIONS

Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.

Supported Employment and Social Validity

Whereas considerable data exist demonstrating positive outcomes for people working as a result of supported employment, little attention has been paid to more qualitative measures of consumer satisfaction. Given the vast array of potential consumers of supported employment services, it seems imperative to determine consumer acceptability, or the social validity, of supported employment goals, procedures, and outcomes. The purpose of the present paper was to review a portion of the supported employment/social validity literature in relation to a proposed Social Validity Matrix and to suggest areas for future research. A review of 30 studies based on the matrix indicated future research is needed to (a) broaden the scope of supported employment social validity assessment, (b) investigate alternative strategies for assessing social validity, (c) develop systematic procedures for collecting and using social validity data, and (d) establish functional variables within supported employment.

Reduction of Severe Problem Behavior in Community Employment Using an Hypothesis-Driven Multicomponent Intervention Approach

Individuals with severe problem behavior typically are excluded from integration efforts involving community employment. This study examined one strategy for reducing severe problem behavior in an employment situation. The strategy involved three factors: (a) interventions were chosen based on hypotheses about the maintaining variables for the problem behavior (hypothesis-driven model); (b) a multicomponent intervention package was used that included some combination of functional communication training, building rapport, making choices, embedding demands, and building tolerance for delay of reinforcement; and (c) measures of latency to problem behavior and percentage of work steps completed were used instead of the more traditional measure of frequency. The results demonstrated both an increase in the time spent in the employment situation without problem behavior and increases in completion of work steps to maximum. Social validation of these results was provided by employment site management. The value of this strategy for addressing the obstacles to assessment, measurement, and intervention for severe problem behavior in community employment situations was discussed.

A Systems Analysis of the Case Coordinator Model and an Outcomes Analysis in Supported Employment

This study examined a state-operated mental retardation service delivery system and conducted a systems analysis of the case coordinator referral system to determine the characteristics of individuals who were likely to be referred to supported employment. It also performed an outcomes analysis of the system's supported employment program to determine who was likely to be successful in the program. This examination was conducted by building prediction models using existing case file information. This study provided some evidence that empirically derived prediction models (i.e., logistic and multiple regression) can be a functional evaluation tool for supported employment managers, administrators, and rehabilitation counselors.

Quantitative Research: Common Myths and Cautions for Utilization in Supported Employment

Quantitative research is often used to provide justification for programs and policies; however, such research has great potential for misuse. A partnership of researchers and service providers is recommended to limit such misuse and increase the relevance of supported employment research to policy and practice. In order to assist service providers in the application of quantitative research to supported employment, the following myths of research are discussed: (a) findings from a single supported employment research study can be directly applied to policy, planning, and program improvement; (b) no differences were found between supported employment and another service option, therefore no differences exist; and (c) the research was published, therefore it is accurate. The following cautions regarding the application of research in supported employment are then presented: (a) ask questions of researchers, (b) make quality program evaluation an integral part of supported employment, and (c) adopt a healthy skepticism. And finally, a planned program of supported employment research is recommended.

Effect of supported employment on vocational rehabilitation outcomes of transition-age youth with intellectual and developmental disabilities: a case control study

The purpose of this study was to examine the effect of supported employment intervention on the employment outcomes of transition-age youth with intellectual and developmental disabilities served by the public vocational rehabilitation system using a case-control study design. Data for this study were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year 2009. The sample included 23,298 youth with intellectual and developmental disabilities aged between 16 and 25 years old at the time of application. The classification and regression tree (CART) method was used to estimate propensity scores and to adjust for selection bias on the basis of all prominent covariates relevant to the dependent variable (i.e., competitive employment). Results yielded six homogeneous subgroups, and receipt of supported employment was found to increase the employment rates across all of the groups. The effect of supported employment was especially strong for youth who were Social Security beneficiaries, special education students, and individuals with intellectual disabilities or autism who were high school graduates. These findings suggest that supported employment is an effective service for enhancing the vocational rehabilitation outcomes of young adults and provides valuable information for policy makers, health care providers, rehabilitation counselors, and educators.

Vocational support approaches in autism spectrum disorder: A synthesis review of the literature

This synthesis-based analysis identifies and reviews studies evaluating vocational resources for adults with autism spectrum disorder. It is based on a larger systematic review of intervention studies in autism spectrum disorder, from which a critical interpretive synthesis was conducted on studies related to vocation and autism spectrum disorder. In total, 10 studies were found that examine employment support for youth and adults with autism spectrum disorder. Two domains of vocational intervention in the literature were found: supported employment including community placement and job coaching and media and technology–based augmentative tools. The literature is limited in volume and quality of methodology, yet emerging constructs are promising in introducing the utility of vocational resources, in particular, supported employment in community settings. These vocational approaches are examined, along with representative studies. Recommendations for advancing practice, community capacity, and research are offered.

Enhancing job-site training of supported workers with autism: a reemphasis on simulation

Currently recommended practice in supported work emphasizes training job skills to workers with severe disabilities while on the job. Early behavioral research indicated that skills needed in natural environments could also be trained in simulated settings. We compared job-site plus simulation training for teaching job skills to supported workers with autism to provision of training exclusively on the job. Job-site training occurred in a small publishing company during the regular work routine, and simulation training occurred in an adult education site for people with severe disabilities. Two pairs of workers received training on two job skills; one skill was trained at the job site and the other was trained using job-site plus simulation training. Results indicated that for 3 of the 4 comparisons, job-site plus simulation training resulted in a higher level of skill or more rapid skill acquisition than did job-site-only training. Results suggested that job-site training, the assumed best practice for teaching vocational skills, is likely to be more effective if supplemented with simulation training. Directions for future research include expanding applications of behavioral technologies to other aspects of the current support paradigm.

A preliminary analysis of adaptive responding under open and closed economies

In the current investigation, we evaluated the effects of open and closed economies on the adaptive behavior of 2 individuals with developmental disabilities. Across both types of economy, progressive-ratio (PR) schedules were used in which the number of responses required to obtain reinforcement increased as the session progressed. In closed-economy sessions, participants were able to obtain reinforcement only through interaction with the PR schedule requirements (i.e., more work resulted in more reinforcer access). In open-economy sessions, participants obtained reinforcers by responding on the PR schedule and were given supplemental (free) access to the reinforcers after completion of the session. In general, more responding was associated with the closed economy.

Improving day-treatment services for adults with severe disabilities: a norm-referenced application of outcome management

We evaluated an outcome management program for working with staff to improve the performance of adults with severe disabilities in a congregate day-treatment setting. Initially, observations were conducted of student task involvement and staff distribution of teaching interactions across students in four program sites. Using recent normative data to establish objective goals for student performance, management intervention was warranted in two of the sites. A six-step outcome management program was then implemented in the two sites. The program involved defining desired student and staff outcomes, systematic monitoring of the outcomes, staff training, and supportive and corrective feedback. The outcome management program was accompanied by increases in student on-task behavior and staff distribution of teaching interactions in both sites. The increases brought the levels of on-task behavior above the normative average; on-task behavior was maintained above the baseline average for over 1 year in both sites. These results are discussed in terms of the benefits of relying on normative data for objectively evaluating and improving service delivery systems. Discussion of future research needs focuses on applying the outcome management program to other settings and services for people with disabilities.

Evaluation of a shared-work program for reducing assistance provided to supported workers with severe multiple disabilities

Concern has been expressed recently regarding the need to enhance the performance of individuals with highly significant disabilities in community-based, supported jobs. We evaluated a shared-work program for reducing job coach assistance provided to three workers with severe multiple disabilities in a publishing company. Following systematic observations of the assistance provided as each worker worked on entire job tasks, steps comprising the tasks were then re-assigned across workers. The re-assignment involved assigning each worker only those task steps for which the respective worker received the least amount of assistance (e.g., re-assigning steps that a worker could not complete due to physical disabilities), and ensuring the entire tasks were still completed by combining steps performed by all three workers. The shared-work program was accompanied by reductions in job coach assistance provided to each worker. Work productivity of the supported workers initially decreased but then increased to a level equivalent to the higher ranges of baseline productivity. These results suggested that the shared-work program appears to represent a viable means of enhancing supported work performance of people with severe multiple disabilities in some types of community jobs. Future research needs discussed focus on evaluating shared-work approaches with other jobs, and developing additional community work models specifically for people with highly significant disabilities.

Problem social behavior in the workplace: an analysis of social behavior problems in a supported employment setting

The social skills problems that may influence the work-related success of supported employees has been only infrequently documented in the research literature. Though a multitude of research describes the performance-related challenges faced by supported employees, few papers address the interpersonal difficulties encountered by supported employees in the workplace. The present paper uses job trainer or "coaches" logs and two promising rating scales (the Psychopathology Instrument for Mentally Retarded Adults [PIMRA and PIMRA-S]) to describe the social problems encountered by some supported employees. Job coach's logs indicated that approximately 58% of supported employees had experienced one or more incidents of interpersonal difficulty during their employment tenure and that 40% of the problems experienced by these individuals could be described as sexuality-related. Overall, about 25% of all supported employees had reported incidents of conflict with employees or customers that seemed sexuality-related. In addition, social and developmental factors that might contribute to the interpersonal problems found in the present research are discussed.

Training quality job interviews with adults with developmental disabilities

Supported work models of vocational integration have increased the employability of individuals with developmental disabilities. Interview questions most frequently used and corresponding responses considered most beneficial to job applicants were derived from an empirical analysis of the "hiring community" and served as a basis for the development of the verbal job interview skills training package evaluated in this research. Dependent measures were objective, behavioral indices of the quality of job interview responses. One-to-one training by a direct training staff, job coach, and a trained behavior analyst resulted in improved responding by all subjects as indicated in a multiple baseline design across interview questions. Improved quality in responding to questions generalized to variations in interview questions, to a novel interviewer, and in an in vivo interview situation. Finally, global measures of social validity support the value of the quality-of-response training.

Adaptive computer education--more than "high-tech"

Advances in technology have greatly broadened the range of occupational opportunities available to persons with disabilities. While technical devices help in making participation in computer-based work functions possible, a variety of strategies are required to help individuals with special needs prepare for, acquire, and maintain employment. The experience of the Centre for Adaptive Computer Education, a vocational training programme for adults with disabilities, highlights several strategies that have proven effective in helping persons with disabilities to access work training and employment. Techniques used to embrace a number of structural and behavioural approaches to training, including extended training time, individualized curricula, individual tutoring, stress management training, behaviour management, supportive counselling, and promotion in the workplace.