Supported Employment Outcomes of a Randomized Controlled Trial of ACT and Clubhouse Models

Charles F. Rodican · William A. Hargreaves · Paul J. Barreira · Qi Wang

94 citations0/0 files storedPsychiatric Services

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Disability Education and Employment Schizophrenia research and treatment Psychiatric care and mental health services

Abstract

OBJECTIVE: In a randomized controlled trial, a vocationally integrated program of assertive community treatment (ACT) was compared with a certified clubhouse in the delivery of supported employment services. METHODS: Employment rates, total work hours, and earnings for 121 adults with serious mental illness interested in work were compared with published benchmark figures for exemplary supported employment programs. The two programs were then compared on service engagement, retention, and employment outcomes in regression analyses that controlled for background characteristics, program preference, and vocational service receipt. RESULTS: Outcomes for 63 ACT and 58 clubhouse participants met or exceeded most published outcomes for specialized supported employment teams. Compared with the clubhouse program, the ACT program had significantly (p<.05) better service engagement (ACT, 98 percent; clubhouse, 74 percent) and retention (ACT, 79 percent; clubhouse, 58 percent) over 24 months, but there was no significant difference in employment rates (ACT, 64 percent; clubhouse, 47 percent). Compared with ACT participants, clubhouse participants worked significantly longer (median of 199 days versus 98 days) for more total hours (median of 494 hours versus 234 hours) and earned more (median of $3,456 versus $1,252 total earnings). Better work performance by clubhouse participants was partially attributable to higher pay. CONCLUSIONS: Vocationally integrated ACT and certified clubhouses can achieve employment outcomes similar to those of exemplary supported employment teams. Certified clubhouses can effectively provide supported employment along with other rehabilitative services, and the ACT program can ensure continuous integration of supported employment with clinical care.

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References

1980Alternative to Mental Hospital Treatment 2001Implementing Supported Employmentas an Evidence-Based Practice 2004Supported Employment: Evidence for an Evidence-Based Practice.2001Helping people with severe mental illness to obtain work: systematic review 1996The New Hampshire study of supported employment for people with severe mental illness.2002Medical Morbidity, Mental Illness, and Substance Use Disorders 1999A Randomized Clinical Trial of Supported Employment for Inner-city Patients With Severe Mental Disorders 2002Improving Employment Outcomes for Persons With Severe Mental Illnesses

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2007Extending Assertive Community Treatment to Criminal Justice Settings: Origins, Current Evidence, and Future Directions 2016A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation 2014Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment 2015A Bibliography of Randomized Controlled Experiments in Social Work (1949–2013)2008

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