Employment Entry Through Supported Employment: Influential Factors for Clients with Co-Occurring Mental and Substance Disorders

Purpose: A key element of Supported Employment (SE) that differentiates it from other non-evidence based employment interventions is rapid employment entry.  This study uses Event History analysis to identify factors that predict time to employment among clients with co-occurring disorders that have been referred to SE. Data from a state-funded study examined the effects of the client's demographic and socioeconomic characteristics, mental health and substance use status, functioning and life status, work history and work interest, use of Supported Employment Services, and agency organizational characteristics on time to employment entry for their first competitive job following referral to Supported Employment.

Method: Clients were drawn from Integrated Dual Diagnosis Treatment programs in four mental health agencies. Study size for this analysis was 113 clients (75 male and 38 female) who were referred for SE services and were not employed at the time of referral. Data was collected through client questionnaires, case manager assessments, and administrative records.  Each client was tracked for one year following referral.

Results: Study participants averaged 39 years of age. Over two-thirds had a high school education. Two-thirds of the sample identified as White. Half of the clients received monthly entitlement income and 82% had some previous work experience.  Variables selected for multivariate analysis of time to employment entry were race, drug use, community functioning, client empowerment, perceived disability, mental illness diagnosis, financial status, agency site, and county unemployment rate. The multivariate model was a survival analysis based on a discrete-time Cox regression model and backward selection procedure.  Clients who did not enter employment within twelve months were censored cases. Fifty-two cases experienced an event, fifty-seven cases were censored, and four cases were lost due to missing data. A test of the full model was statistically significant X² (5, N = 109) = 32.63, p < .001. The model identified four key factors of employment: community functioning, empowerment, financial adequacy, and race.  Clients with a greater sense of empowerment (ratio = 3.647) and clients with higher community functioning (ratio = 1.054) had greater odds of entering into employment within one year of being referred to SE services.  Among clients who perceived that their financial status was adequate, their odds of entering employment decreased (ratio = 0.624).  Finally, Whites were more likely to enter employment than African-Americans (ratio = 0.241). 

Implications:  Agencies providing SE should recognize low community functioning and weak empowerment as potential barriers to employment entry. Strategies, such as enhancing social ties and improving Activities of Daily Living functions of clients, like hygiene, as well as increasing clients' self-efficacy should be utilized to mitigate these barriers.  The finding related to financial status supports research that indicates motivation for employment entry decreases as financial satisfaction increases.  Agencies need to be aware of this relationship and emphasize the non-monetary benefits of employment, as well as provide information that addresses misconceptions about the effects of employment on entitlement income. The racial difference may reflect our data findings that African-Americans had lower comparative educational attainment and lacked previous work experience.