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支持性就业:评估证据。

Supported employment: assessing the evidence.

出版信息

Psychiatr Serv. 2014 Jan 1;65(1):16-23. doi: 10.1176/appi.ps.201300262.

Abstract

OBJECTIVE

Supported employment is a direct service with multiple components designed to help adults with mental disorders or co-occurring mental and substance use disorders choose, acquire, and maintain competitive employment. This article describes supported employment and assesses the evidence base for this service.

METHODS

Authors reviewed meta-analyses, research reviews, and individual studies from 1995 through 2012. Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. Authors chose from three levels of evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence for service effectiveness.

RESULTS

The level of research evidence for supported employment was graded as high, based on 12 systematic reviews and 17 randomized controlled trials of the individual placement and support model. Supported employment consistently demonstrated positive outcomes for individuals with mental disorders, including higher rates of competitive employment, fewer days to the first competitive job, more hours and weeks worked, and higher wages. There was also strong evidence supporting the effectiveness of individual elements of the model.

CONCLUSIONS

Substantial evidence demonstrates the effectiveness of supported employment. Policy makers should consider including it as a covered service. Future research is needed for subgroups such as young adults, older adults, people with primary substance use disorders, and those from various cultural, racial, and ethnic backgrounds.

摘要

目的

支持性就业是一种具有多种组成部分的直接服务,旨在帮助患有精神障碍或同时患有精神和物质使用障碍的成年人选择、获得和维持竞争性就业。本文描述了支持性就业,并评估了这项服务的证据基础。

方法

作者回顾了 1995 年至 2012 年期间的荟萃分析、研究综述和单独研究。调查的数据库包括 PubMed、PsycINFO、应用社会科学索引和摘要、社会学摘要、社会服务摘要、创伤后应激发表国际文献、教育资源信息中心和护理与联合健康文献累积索引。作者根据研究数量和方法质量的基准,从三个证据级别(高、中、低)中进行选择。他们还描述了服务效果的证据。

结果

支持性就业的研究证据水平被评为高,这是基于 12 项系统评价和 17 项个体安置和支持模型的随机对照试验。支持性就业对精神障碍患者的结果始终显示出积极的影响,包括竞争性就业的比例更高、获得第一份竞争性工作的天数更少、工作时间和周数更多、工资更高。该模型的各个要素的有效性也有强有力的证据支持。

结论

大量证据表明支持性就业的有效性。政策制定者应考虑将其作为一项涵盖服务。对于年轻人、老年人、主要物质使用障碍者以及来自不同文化、种族和族裔背景的人等亚组,需要进行未来的研究。

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