Leddy Meaghan, Stefanovics Elina, Rosenheck Robert
Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, Bldg 15, Rm 127, West Haven, CT 06516.
J Rehabil Res Dev. 2014;51(1):161-75. doi: 10.1682/JRRD.2013.01.0011.
Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.
支持性就业，特别是个别安置与支持（IPS），可提高重症精神疾病患者的竞争性就业率，但在非职业成果方面，与其他康复方法相比，并未显示出更大的改善。美国退伍军人事务部提供两种职业服务，即IPS和过渡性工作体验（TWE），但尚无研究对这些方法的有效性进行比较。这项对无家可归退伍军人研究数据的二次分析，比较了五种就业模式在不同成果方面6个月的改善情况：从未工作、仅在TWE中工作、先在TWE中工作然后进入竞争性就业、在没有IPS转介的情况下进入竞争性就业，以及在有IPS转介的情况下进入竞争性就业。被转介至IPS的退伍军人更有可能实现竞争性就业。与仅在TWE中工作或根本未工作的退伍军人相比，那些进入竞争性就业的退伍军人（无论之前是否有TWE经历，以及是否有IPS转介）在工作天数、就业收入和总收入方面增幅最大，公共支持收入降幅最大。参与TWE的退伍军人在住院治疗天数方面增幅最大，但各群体在非职业成果方面没有其他差异。实现竞争性就业有多种途径，但不同就业经历在非职业成果方面差异不大。
