Recovery and Work: The Association of Case Managers' Perception of Consumer Work Readiness with Employment

Background/purpose: Many individuals with a serious mental illness (SMI) view meaningful employment as an essential part of recovery and desire to work. Yet, persons with SMI have high rates of unemployment.  While there are many factors associated with unemployment for individuals with mental illnesses, no studies have explored the impact of direct service workers’ perceptions as a factor.  Case managers are often the direct service workers most likely to help an individual work toward employment-related goals. Attitudes case managers hold about what it takes for a consumer to be “ready” for work may serve as a catalyst or a barrier to  employment.   The purpose of this study was to explore the extent to which case managers perceptions of work readiness are associated with consumer employment

Methods: All case managers (n=113) from eight community mental health centers in a Midwestern state provided data for this study. Case managers provided information on 1,556 consumers, including diagnosis, time in treatment, and employment status. Case managers also completed the Case Managers Work Perception Scale (CMWPS).  Case managers rated on a five-point Likert scale how important it was to address hygiene, social skills, substance use, compliance with medications, and management of symptoms before assisting with employment goals (1 = not at all and 5 = extremely).     The data for this study were nested. Consumers (level 1) were nested in case manages (levels 2). We used multilevel modeling to account for nested structure; specifically, we used hierarchical generalized linear modeling with a logit link function, which allows for a dichotomous dependent variable (employed vs unemployed). 

Results:  The first model tested explored the effects of case managers on consumer employment.  Case managers accounted for 9.8% of the variability in the odds of consumer employment. The next model explored the impact of consumer level variables, including diagnosis, interest in work, education, gender, race, hospitalizations in the past 90 days, and education. The second model accounted for 25.9% of the variance in the odds of consumer employment.  Interest in work was positively associated with the odds of being employed.  Hospitalization in the past 90 days was negatively associated with the odds of employment. Lastly, the level 2 variable CMWPS was added to the model. The CMWPS variable was significantly and negatively associated with odds of employment and accounted for an additional 5% of variance.  Higher scores on the CMWPS were associated with reduced odds or consumer employment.  

Conclusions/Implications: The study shows that case managers’ perceptions about readiness for employment has an effect on consumer employment. The recovery paradigm in mental health is focused on helping people with serious mental illness reach their full potential through the achievement of meaningful and important goals. Case management services should serve as a conduit for people to achieve these goals rather being an additional barrier. Further research is needed on the impact of case manager perceptions and attitudes around employment and other recovery-oriented outcomes.