Effects of local unemployment rate on vocational outcomes in a randomized trial of supported employment for individuals with psychiatric disabilities

Article type: Research Article

Authors: Cook, Judith A. | Mulkern, Virginia | Grey, Dennis D. | Burke-Miller, Jane | Blyler, Crystal R. | Razzano, Lisa A. | Onken, Steven J. | Balser, Richard M. | Gold, Paul B. | Shafer, Michael S. | Kaufmann, Caroline L. | Donegan, Kate | Chow, Clifton M. | Steigman, Pamela A.

Affiliations: University of Illinois at Chicago Department of Psychiatry, Chicago, IL, USA | Human Services Research Institute, Cambridge, MA, USA | Center for Mental Health Services, Rockville, MD, USA | Columbia University School of Social Work, New York, NY, USA | Maine Medical Center, Portland, ME, USA | Medical University of South Carolina, Charleston, SC, USA | University of Arizona, Tucson, AZ, USA | Consumer Research and Advocacy, Pittsburgh, PA, USA | The Matrix Center at Horizon House, Philadelphia, PA, USA

Note: [] Corresponding author: Dr. Judith A. Cook, University of Illinois at Chicago, Department of Psychiatry, 1601 West Taylor Street, 4th Floor, M/C 912, Chicago, IL 60612 USA. Tel.: +1 312 355 3323; Fax: +1 312 355 4189; E-mail: cook@ripco.com

Abstract: The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n=1,273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixed-effects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes.

Keywords: Mental illness, supported employment, unemployment rate, psychiatric disability

Journal: Journal of Vocational Rehabilitation, vol. 25, no. 2, pp. 71-84, 2006