Research That Matters (January 17 - 20, 2008)

Purpose: Employment serves as an important aid in the recovery process for persons with mental illness, providing hope and helping people to envision a different sort of life. Employment helps mental health consumers focus on positive aspects of their lives and reduce negative behaviors, such as substance use (Mueser, Noordsy, Drake, & Fox, 2003). Results of clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining and maintaining competitive employment (Bond, 2004). However, little is known about the impact of supported employment for consumers with co-occurring substance and mental disorders, in particular what factors are related to such consumers' decision to enroll in Supported Employment services. The poster examines the demographic, socioeconomic and illness characteristics at baseline of consumers referred for Supported Employment services compared to consumers who were not referred for services. Methods: Adult consumers in the study with co-occurring substance and mental disorders were drawn from Integrated Dual Diagnosis Treatment (IDDT) programs in four community mental health agencies. Study participants included 129 consumers referred for Supported Employment services and 79 randomly selected non-referred consumers as the comparison group. Cross-sectional data was collected at baseline through consumer questionnaires, case manager assessments, and administrative records. Results: The mean age of the entire sample was 39.5 years. Almost two-thirds (62%) were male and a similar percentage (63.9%) was Caucasian. One-third had less than a high school education. Employed consumers in the comparison group (n=13) were removed from further analysis, as they would not benefit from referral to Supported Employment. Bivariate analyses identified significant differences between the Supported Employment group and the comparison group on the following indicators: age (comparison group was 3.4 years older); housing status (comparison more likely to live independently); previous employment in past five years (comparison group had less previous employment – 40% to 61%); perception of being unable to work due to a disability (comparison group twice as likely to endorse being disabled). A logistic regression using the significant variables was conducted to predict the likelihood that a consumer would be referred to Supported Employment services. A test of the full model versus the model with intercept only was statistically significant ÷2 (8, N = 152) = 47.2, p < .001. Employing a .05 criterion of statistical significance, having worked in the past five years and lack of perceived disability had significant partial effects in the direction of predicting referral to Supported Employment. Implications: Lack of previous work history may be a barrier to referral to Supported Employment services. Consumers who haven't worked in the past might be reluctant or fearful of expressing interest in work. Mental health and substance abuse agencies should be encouraged to provide educational sessions in which consumers can hear from other similar consumers who have successfully entered employment. Such exposure to education in a non-coercive manner may also encourage consumers who self-identify as disabled to consider Supported Employment as an option.