Becker Deborah, Whitley Rob, Bailey Edward L, Drake Robert E
Department of Community and Family Medicine, Dartmouth Medical School, 2 Whipple Pl., Suite 202, Lebanon, NH 03766, USA.
Psychiatr Serv. 2007 Jul;58(7):922-8. doi: 10.1176/ps.2007.58.7.922.
The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment.
We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods.
All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions.
The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.
支持性就业参与者的长期就业轨迹尚不清楚。本探索性研究呈现了参与支持性就业的成年精神疾病患者8至12年的就业轨迹。
我们在新英格兰一个小型城市心理健康中心对78名参与支持性就业研究的重度精神疾病患者中的38名（49%）进行了随访，时间为他们入组研究后的8至12年。采用定量和定性方法对数据进行分析。
所有38名参与者在随访期间都有工作，绝大多数（82%）从事竞争性工作，71%在超过一半的随访年份中工作。参与者报告了与就业相关的诸多益处，包括自尊、人际关系和疾病管理方面的改善。精神疾病是工作的主要障碍；兼职工作和长期支持是主要促进因素。定性分析得出三个重叠主题，被认为对参与者的工作相关行为有重大影响。首先，成功管理症状和运用适当的应对技能似乎在找到并维持工作方面发挥了重要作用。其次，由于这类工作要求较低且被认为能维持社会保障和医疗福利，参与者普遍更倾向于兼职工作。第三，参与者认识到持续的个人安置和支持服务的重要性。参与者表示，这对于在不同工作之间或从失业到就业的成功过渡以及帮助协商加薪或工作条件变化至关重要。
支持性就业项目参与者的长期就业轨迹，无论是职业方面还是非职业方面，似乎都是积极的。
