title: Integration of psychiatric and vocational services: a multisite randomized, controlled trial of supported employment.
abstract: OBJECTIVE
  Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood of successful work outcomes.
  
  
  METHODS
  At seven sites nationwide, 1,273 outpatients with severe mental illness were randomly assigned either to an experimental supported employment program or to a comparison/services-as-usual condition and followed for 24 months. Data collection involved monthly services tracking, semiannual in-person interviews, recording of all paid employment, and program ratings made by using a services-integration measure. The likelihood of competitive employment and working 40 or more hours per month was examined by using mixed-effects random regression analysis.
  
  
  RESULTS
  Subjects served by models that integrated psychiatric and vocational service delivery were more than twice as likely to be competitively employed and almost 1(1/2) times as likely to work at least 40 hours per month when the authors controlled for time, demographic, clinical, and work history confounds. In addition, higher cumulative amounts of vocational services were associated with better employment outcomes, whereas higher cumulative amounts of psychiatric services were associated with poorer outcomes.
  
  
  CONCLUSIONS
  Supported employment models with high levels of integration of psychiatric and vocational services were more effective than models with low levels of service integration.
authors.affiliation: UIC Department of Psychiatry, University of Illinois at Chicago, 104 South Michigan Ave., Suite 900, Chicago, IL 60603, USA. cook@ripco.com
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cook
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Lehman
authors.forename: Robert
authors.initials: R
authors.lastname: Drake
authors.forename: William R
authors.initials: WR
authors.lastname: McFarlane
authors.forename: Paul B
authors.initials: PB
authors.lastname: Gold
authors.forename: H Stephen
authors.initials: HS
authors.lastname: Leff
authors.forename: Crystal
authors.initials: C
authors.lastname: Blyler
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Toprac
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Razzano
authors.forename: Jane K
authors.initials: JK
authors.lastname: Burke-Miller
authors.forename: Laura
authors.initials: L
authors.lastname: Blankertz
authors.forename: Michael
authors.initials: M
authors.lastname: Shafer
authors.forename: Susan A
authors.initials: SA
authors.lastname: Pickett-Schenk
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Grey
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods* / Q000458:organization & administration; D003156:Community Mental Health Services; D004522:Educational Status; D004651:Employment; D016832:Employment, Supported / Q000379:methods* / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts; D010358:Patient Participation; D011569:Psychiatric Status Rating Scales; D012050:Rehabilitation, Vocational / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome