Can Supported Employment Help People with Various Health Conditions Return to Work?

What you need to know

• Supported employment interventions may help people with various health conditions, not just severe mental illness, return to competitive work
• These interventions were effective for populations like veterans with PTSD, people with affective disorders, and young people not in employment or training
• More research is needed on long-term employment outcomes and impacts on quality of life

What is supported employment?

Supported employment is an approach to helping people with health conditions find and keep competitive jobs. Unlike traditional vocational rehabilitation, which follows a “train-then-place” model, supported employment uses a “place-then-train” approach. This means quickly placing people in real work settings and then providing ongoing support.

A well-known type of supported employment is Individual Placement and Support (IPS). IPS was originally developed for people with severe mental illness. It follows eight key principles:

1. Focus on competitive employment
2. Eligibility based on client choice
3. Integration of employment services with mental health treatment
4. Attention to client preferences
5. Personalized benefits counseling
6. Rapid job search
7. Systematic job development
8. Individualized job supports

Supported employment, including IPS, has been extensively studied in populations with severe mental illness. However, less is known about its effectiveness for people with other health conditions or circumstances. This review aimed to examine the evidence on supported employment for more diverse groups.

How was the study conducted?

The researchers conducted a systematic review, searching multiple databases to find randomized controlled trials of supported employment interventions. They included studies of any population except those focused solely on severe mental illness. To be included, studies had to:

• Compare a supported employment intervention to traditional vocational rehabilitation or usual care
• Include participants who were unemployed at the start
• Measure competitive employment as an outcome

The review ultimately included 10 randomized trials with a total of 913 participants. The studies covered diverse populations such as:

• People with affective disorders
• Veterans with PTSD or spinal cord injuries
• Formerly incarcerated veterans
• People with substance use disorders
• Young people not in employment, education or training

The researchers assessed the quality of each study and extracted data on employment outcomes as well as other measures like income and quality of life.

What were the main findings?

Overall, supported employment interventions were more effective than control interventions for improving competitive employment in 7 out of 10 studies. Specifically:

• For people with affective disorders, 42% in the supported employment group obtained competitive work compared to 4% in the control group
• For veterans with PTSD, 76% vs 28%
• For formerly incarcerated veterans, 46% vs 21%
• For people receiving methadone treatment, 50% vs 4%
• For veterans with spinal cord injury, 26% vs 11% at 1 year, and 19% vs 7% at 2 years
• For young people not in employment/education/training, 48% vs 8%

The interventions were also more effective for people with severe mental illness plus justice involvement (31% vs 7%).

However, three studies did not find significant benefits from supported employment:

• For workers with musculoskeletal injuries (84% vs 61%)
• For people with substance use disorders (10% vs 6%)
• For formerly homeless people with mental illness who were recently housed (34% vs 22%)

In addition to higher employment rates, participants in supported employment groups tended to work more hours and earn higher wages compared to control groups.

What else did the review examine?

The researchers looked at how studies defined “competitive employment,” finding that definitions varied. Some counted as little as one day of paid work, while others required at least 4 weeks of part-time work.

They also examined what other outcomes studies measured beyond employment. Few studies looked at impacts on quality of life or other non-vocational outcomes. The researchers suggest future studies should measure these broader impacts.

What are the limitations of the evidence?

There are some important limitations to keep in mind:

• Most studies had relatively short follow-up periods of about 12 months. The long-term impacts remain unclear.

• Sample sizes were generally small, leading to imprecise estimates of effects.

• The studies covered very different populations, making it difficult to draw overall conclusions.

• As randomized trials, the interventions may differ from how supported employment is implemented in real-world settings.

• Some studies were judged to have a high risk of bias in their methods.

Conclusions

Supported employment interventions show promise for helping diverse groups of people with health conditions return to work, not just those with severe mental illness. However, more research is needed to determine long-term impacts and effects on quality of life. Future studies should use consistent definitions of competitive employment and measure a broader range of outcomes. Policymakers and practitioners should consider supported employment approaches for various populations who face barriers to work due to health conditions or circumstances.

• Supported employment may benefit people beyond those with only severe mental illness
• Effects vary across populations - more research needed on who benefits most
• Future studies should examine long-term job retention and quality of life impacts