Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models.
OBJECTIVE
In a randomized controlled trial, a vocationally integrated program of assertive community treatment (ACT) was compared with a certified clubhouse in the delivery of supported employment services.


METHODS
Employment rates, total work hours, and earnings for 121 adults with serious mental illness interested in work were compared with published benchmark figures for exemplary supported employment programs. The two programs were then compared on service engagement, retention, and employment outcomes in regression analyses that controlled for background characteristics, program preference, and vocational service receipt.


RESULTS
Outcomes for 63 ACT and 58 clubhouse participants met or exceeded most published outcomes for specialized supported employment teams. Compared with the clubhouse program, the ACT program had significantly (p<.05) better service engagement (ACT, 98 percent; clubhouse, 74 percent) and retention (ACT, 79 percent; clubhouse, 58 percent) over 24 months, but there was no significant difference in employment rates (ACT, 64 percent; clubhouse, 47 percent). Compared with ACT participants, clubhouse participants worked significantly longer (median of 199 days versus 98 days) for more total hours (median of 494 hours versus 234 hours) and earned more (median of $3,456 versus $1,252 total earnings). Better work performance by clubhouse participants was partially attributable to higher pay.


CONCLUSIONS
Vocationally integrated ACT and certified clubhouses can achieve employment outcomes similar to those of exemplary supported employment teams. Certified clubhouses can effectively provide supported employment along with other rehabilitative services, and the ACT program can ensure continuous integration of supported employment with clinical care.
Macias
Cathaleene
C
Community Intervention Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, and Department of Psychiatry, University of California, San Francisco, USA. cmacias@mclean.harvard.edu
Rodican
Charles F
CF
Hargreaves
William A
WA
Jones
Danson R
DR
Barreira
Paul J
PJ
Wang
Qi
Q
D000328:Adult; D002568:Certification / Q000331:legislation & jurisprudence; D002755:Choice Behavior; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D016832:Employment, Supported / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D012153:Retention, Psychology; D012657:Self-Help Groups / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013997:Time Factors