Nonvocational Outcomes from a Randomized Controlled Trial of Two Employment Interventions for Homeless Youth

Background and Purpose:

The assumption that "work is therapeutic" in the general housed population has received considerable attention from policymakers and researchers, yet less is known about the nonvocational benefits of employment among homeless youth. This study thus uses a randomized controlled trial (RCT) to compare the efficacy and short-term, nonvocational outcomes of two employment interventions for homeless youth with mental illness. The Social Enterprise Intervention (SEI) engages individuals with mental illness in paid employment and clinical and case-management services through a social enterprise. The Individual Placement and Support (IPS) provides customized, long-term, and integrated vocational, case-management, and clinical services to help individuals with mental illness gain and maintain competitive employment. This study answered two research questions: 1) Do homeless youth with mental illness in the SEI and IPS experience improvements in their a) mental health status (self-esteem, life satisfaction, depression, and attention-deficit problems [ADHD]); b) housing stability, and c) social support; and 2) What are the differences between the SEI and IPS groups on mental health, housing stability, and social support outcomes?

Methods:

A randomized comparative efficacy trial of the short-term, nonvocational outcomes of the SEI and IPS was conducted over 20 months with 72 homeless youth with mental illness at one drop-in center. Researchers used non-probability quota sampling to select 72 eligible homeless youth (ages 16-24), who were randomly assigned to either the SEI group (n=36) or the IPS group (n=36). Data were collected from both groups at two time points over 20 months using face-to-face interviews that assessed demographics, housing stability, mental health (Adult Self Report), self-esteem (Rosenberg Self-Esteem Scale), satisfaction with life (Satisfaction with Life Scale), and social support (Adult Self Report). Mixed ANOVA analyses were used to identify differences over time between SEI and IPS participants on the study’s outcome variables.

Results:

Within-subjects tests indicate that there was a statistically significant time effect (between baseline and follow-up) for five outcome variables. Both the SEI and IPS groups experienced significant changes in self-esteem (F[1, 28] = 5.90, p < .05), ADHD Problems (F[1, 28] = 8.86, p < .01), Inattention Problems (F[1, 28] = 11.13, p < .01), living in a shelter (F[1, 28] = 8.43, p < .01), and living in a private residence (F[1, 28] = 6.43, p < .05). Between-groups tests indicate that there was no statistically significant effect for condition (SEI vs. IPS).

Conclusions and Implications:

Despite conceptual differences in the type of intervention, neither intervention fared better than the other on mental health and housing outcomes. The SEI group experienced higher effect sizes for mental health outcomes whereas the IPS group experienced higher effect sizes for housing outcomes. Findings suggest that the intervention type might not be as important as the particular components (i.e., integrated clinical and case-management services, frequent contact, and ongoing mentoring), which were offered in both interventions. Future research is needed to test the comparative effectiveness of the SEI and IPS with a broader population of homeless youth, in multiple agencies, and over a longer period of time.