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Biomedical subjects

D R Becker

Publications and source records attributed to D R Becker.

At least 19 recordsLinked to original sources
PubMed2001

Ethnographic findings from the Washington, D.C., Vocational Services Study.

Based on a 20-month period of participant observations and interviews of persons receiving services, employment specialists and clinicians, this ethnographic substudy identified and documented dilemmas encountered during implementation of an assertive, manualized supported employment program, Individual Placement and Support (IPS), situated in a Washington, D.C., community mental health organization that previously focused on clinical interventions but lacked vocational services. Those receiving services, primarily African Americans, had extensive histories of homelessness and dual diagnosis, and minimal work experiences. Real-world issues centered on conflicting expectations and priorities, diverse perceptions of the role of work, and difficulties in integrating vocational rehabilitation with clinical treatment.

Employment, Supported↗
PubMed2001

Implementing supported employment as an evidence-based practice.

Supported employment for people with severe mental illness is an evidence-based practice, based on converging findings from eight randomized controlled trials and three quasi-experimental studies. The critical ingredients of supported employment have been well described, and a fidelity scale differentiates supported employment programs from other types of vocational services. The effectiveness of supported employment appears to be generalizable across a broad range of client characteristics and community settings. More research is needed on long-term outcomes and on cost-effectiveness. Access to supported employment programs remains a problem, despite their increasing use throughout the United States. The authors discuss barriers to implementation and strategies for overcoming them based on successful experiences in several states.

Community Mental Health Centers↗
PubMed2001

Converting day treatment centers to supported employment programs in Rhode Island.

OBJECTIVE: The purpose of the study was to compare vocational and nonvocational outcomes of clients of two community mental health centers that underwent conversion from day treatment programs to supported employment programs with outcomes of clients of a center that delayed conversion until after the study was completed. METHODS: As part of a statewide effort in Rhode Island to convert day treatment programs to supported employment programs, the authors assessed 127 day treatment clients with severe mental illness in three community mental health centers. Two of the centers converted to supported employment, and one continued its rehabilitative day program. Participants were assessed prospectively for 30 to 36 months, with special attention to vocational and social outcomes. RESULTS: Former day treatment clients in the converted centers attained higher rates of competitive employment than those in the comparison group (44.2 percent and 56.7 percent versus 19.5 percent). Other employment outcomes also improved, and hospitalization rates and overall social functioning were unchanged. CONCLUSIONS: This study supports findings of previous studies suggesting that replacing rehabilitative day treatment programs with supported employment programs yields improvements in employment outcomes without adverse effects.

Adolescent↗
PubMed2001

Fidelity of supported employment programs and employment outcomes.

This study attempted to identify critical components of a supported employment program that were strongly correlated with competitive employment outcomes in a state mental health system. Researchers used a supported employment fidelity scale to rate programs at ten community mental health centers in Vermont. The staff at the centers concurrently assessed competitive employment outcomes for 2,639 clients who had been diagnosed as having severe and persistent mental illness. Higher competitive employment rates were strongly correlated with overall program fidelity and with two program components, namely, providing services in the community as opposed to providing them in the clinic and using full-time employment specialists as opposed to staff with mixed roles.

Adolescent↗
PubMed1999

A randomized clinical trial of supported employment for inner-city patients with severe mental disorders.

BACKGROUND: This experiment evaluated the effectiveness of 2 approaches to vocational services for persons with severe mental disorders: (1) individual placement and support (IPS), in which employment specialists within the mental health center help patients to obtain competitive jobs and provide ongoing support, and (2) enhanced vocational rehabilitation (EVR), in which stepwise vocational services are delivered by rehabilitation agencies. METHODS: One hundred fifty-two unemployed, inner-city patients with severe mental disorders who expressed interest in competitive employment were randomly assigned to IPS or EVR and followed up for 18 months. Following diagnostic assessment, participants were assessed with standardized measures of work, income, self-esteem, quality of life, symptoms, and hospitalization at baseline and at 6-, 12-, and 18-month follow-up evaluations. Employment was tracked monthly and job satisfaction every 2 months. RESULTS: During the 18-month study, participants in the IPS program were more likely to become competitively employed (60.8% vs 9.2%) and to work at least 20 hours per week in a competitive job (45.9% vs 5.3%), whereas EVR participants had a higher rate of participation in sheltered employment (71.1% vs 10.8%). Total earnings, job satisfaction, and nonvocational outcomes were similarly improved for both groups. CONCLUSION: The IPS model of supported employment is more effective than standard, stepwise EVR approaches for achieving competitive employment, even for inner-city patients with poor work histories and multiple problems.

Adult↗
PubMed1999

Research on the individual placement and support model of supported employment.

This paper reviews research on the Individual Placement and Support (IPS) model of supported employment for people with severe mental illness. Current evidence indicates that IPS supported employment is a more effective approach for helping people with psychiatric disabilities to find and maintain competitive employment than rehabilitative day programs or than traditional, stepwise approaches to vocational rehabilitation. There is no evidence that the rapid-job-search, high-expectations approach of IPS produces untoward side effects. IPS positively affects satisfaction with finances and vocational services, but probably has minimal impact on clinical adjustment. The cost of IPS is similar to the costs of other vocational services, and cost reductions may occur when IPS displaces traditional day treatment programs. Future research should be directed at efforts to enhance job tenure and long-term vocational careers.

Cost-Benefit Analysis↗
PubMed1998

Benefits and costs of supported employment from three perspectives.

Administrators, consumers, and policy makers are increasingly interested in supported employment as a way of helping persons with severe mental illness get and keep competitive jobs. However, in an atmosphere of increased expectations for performance and declining public financing, administrators want to know the costs and benefits of different approaches before they reallocate scarce treatment or rehabilitative dollars. This article discusses the net benefits of two approaches to supported employment that were compared in a randomized trial: Individual Placement and Support (IPS) and Group Skills Training (GST). The authors analyze costs and benefits from societal, government, and consumer perspectives. Although a previous analysis showed that IPS participants were significantly more likely to find work, worked more hours, and had higher earnings, net benefits of the two programs were not significantly different. The authors also discuss some of the strengths and weaknesses of cost-benefit analysis in mental health care and suggest future directions for policy and research.

Adult↗
PubMed1998

Job terminations among persons with severe mental illness participating in supported employment.

For persons with psychiatric disabilities, maintaining a job is often more difficult than acquiring a job. A large proportion of jobs end unsatisfactorily. This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs. More than half of the job terminations were unsatisfactory, defined as the client quitting without having other job plans or being fired. Baseline ratings of demographic and clinical characteristics, preemployment skills training, and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations. Clients with better work histories were less likely to experience unsatisfactory terminations. In addition, unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning, mental illness, dissatisfaction with jobs, quality of work, medical illnesses, dependability, and substance abuse. These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job.

Adult↗
PubMed1998

A research induction group for clients entering a mental health research project: a replication study.

Through education and discussion, the research induction group introduces mental health clients to participation in a research study. The purpose is to help clients to understand fully the clinical and research procedures involved in the study so that they can make a truly informed decision about whether or not to participate. This study replicated a previous study in showing that the research induction group resulted in informed decision-making, high rates of participation in the clinical services and in the research, and high rates of satisfaction with both vocational services and research procedures.

Adolescent↗
PubMed1997

Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis.

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.

Activities of Daily Living↗
PubMed1997

An update on supported employment for people with severe mental illness.

OBJECTIVE: This review examines the effectiveness of supported employment for people with severe mental illness. METHODS: A comprehensive search was made for quantitative studies, primarily in the published literature. RESULTS: Seven descriptive studies, three surveys, one quasi-experimental study, and six experimental studies were found. All studies suggested significant gains in obtaining employment for persons enrolled in supported employment programs. In experimental studies, a mean of 58 percent of clients in supported employment programs achieved competitive employment, compared with 21 percent for control subjects, who typically received traditional vocational services. Employment outcomes relating to time employed and employment earnings also favored clients in supported employment over control subjects. No evidence was found that supported employment led to stress levels precipitating higher rehospitalization rates. Two features of many supported employment programs have the most empirical support: integration of mental health and vocational services within a single service team and the avoidance of preplacement training. Two other widely held principles-ongoing support and attention to client preferences-have not been systematically evaluated. CONCLUSIONS: Supported employment appears to be a promising approach for people with severe mental illness, but more studies are needed, with close attention to program implementation and long-term follow-up.

Employment↗
PubMed1996

The New Hampshire study of supported employment for people with severe mental illness.

This study compared supported employment services in 2 contrasting programs: (a) Group Skills Training, a professional rehabilitation agency outside of the mental health center that provided pre-employment skills training and support in obtaining and maintaining jobs, or (b) the Individual Placement and Support (IPS) model, which integrated clinical and vocational services within the mental health center. People with severe mental disorders who expressed interest in competitive employment (N = 143) were randomly assigned to 1 of these 2 programs. Results showed that clients in the IPS program were more likely to be competitively employed throughout most of the 18-month follow-up. Among those who obtained jobs, there were few group differences, although workers in the IPS program did work more total hours and earn more total wages during the 18-month follow-up. There were no group differences on nonvocational outcomes.

Adult↗
PubMed1996

Day treatment versus supported employment for persons with severe mental illness: a replication study.

Outcomes for 112 clients with severe mental disorders in a community mental health center that converted its rehabilitative day treatment program to a supported employment program were assessed during the year after the program conversion. The study replicated a previous study in showing that the rate of competitive employment improved, especially among clients who had formerly attended the day treatment program, without evidence of adverse effects.

Adult↗
PubMed1996

Job preferences of clients with severe psychiatric disorders participating in supported employment programs.

OBJECTIVE: The job preferences of adults with severe mental illness who were participating in supported employment programs were examined. METHODS: Data were collected on job preferences, attainment of competitive employment, job satisfaction, and job tenure of 135 adults who participated in two supported employment programs in New Hampshire. Data obtained at baseline and at six-month follow-up were analyzed. RESULTS: When the clients entered the supported employment programs, 81 percent expressed job preferences, and their preferences tended to be realistic and stable. People who obtained employment in preferred areas were more satisfied with their jobs and remained in their jobs twice as long as those who worked in nonpreferred areas. Clients were more likely to develop a new job preference or to change their preference if they participated in a program that emphasized rapid job search than if they participated in a prevocational skills training program. They were also more likely to develop a preference or change their preference if they obtained a competitive job. CONCLUSIONS: Helping people with severe mental illness obtain competitive jobs that correspond with their explicit job preferences increases job satisfaction and tenure. Job preferences are more likely to develop or change through searching for a job or working at a job than through prevocational training.

Adult↗
PubMed1995

Analgesia after thoracotomy: effects of epidural fentanyl concentration/infusion rate.

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 micrograms/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-micrograms/mL concentration infused at a rate half that used in the 5-micrograms/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-microgram/kg initial dose and an initial infusion rate of 1 microgram.kg-1.h-1 in both the 5-micrograms/mL and 10-micrograms/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Individual Placement and Support: a community mental health center approach to vocational rehabilitation.

Individual Placement and Support (IPS) is a vocational rehabilitation intervention for people with severe mental disabilities. IPS draws from components and philosophies of several other models. Employment specialists, who are part of the community mental health center team, provide services in the community. IPS emphasizes client preferences, rapid job finding, continuous assessment, competitive employment, integrated work settings, and follow-along supports. Initial research on IPS shows favorable results.

Community Mental Health Centers↗
PubMed1994

Rehabilitative day treatment vs. supported employment: I. Vocational outcomes.

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

Adolescent↗