Community-based vocational rehabilitation: effectiveness and cost impact of a proposed program model.
OBJECTIVE
To study the vocational, service use and relative cost impact for schizophrenia or schizoaffective disorder of an innovative community-based vocational rehabilitation program.


METHODS
Participants were consecutive enrollees in a community-based vocational rehabilitation program who had remained in the program for at least 1 year. Lifetime vocational history and mental health service utilization for 2 years prior and up to 4 years subsequent to program enrollment were studied. Retrospective data were collected using a questionnaire completed by the patient and available family and case workers, patient interview and chart review.


RESULTS
Months in paid work increased after enrollment, while earned income did not (most work was low wage and/or part-time). Annual inpatient days decreased precipitously, a change which could not be explained by hospitalization trends during the same period. Average relative cost units, based on charges for mental health services used, dropped over 70% following enrollment.


CONCLUSIONS
Community-based vocational rehabilitation may be cost-effective in this population, largely as a result of its impact on hospitalizations and utilization of the most costly services. Such programs represent an important alternative to supported employment that may be particularly suited to cognitively or functionally impaired patients unwilling or unable to work in a competitive environment.
Jaeger
Judith
J
Albert Einstein College of Medicine, Center for Neuropsychiatric Outcome and Rehabilitation Research, Zucker Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, New York 11004, USA. jaeger.ju@gmail.com [corrected]
Berns
Stefanie
S
Douglas
Estelle
E
Creech
Bonnie
B
Glick
Bruce
B
Kane
John
J