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Long-Term Effectiveness of Supported Employment: 5-Year Follow-Up of a Randomized Controlled Trial
Holger Hoffmann, M.D.; Dorothea Jäckel, M.A.; Sybille Glauser, M.A.; Kim T. Mueser, Ph.D.; Zeno Kupper, Ph.D.
Am J Psychiatry 2014;:. doi:10.1176/appi.ajp.2014.13070857
View Author and Article Information

The authors report no financial relationships with commercial interests.

Supported by grant 3200-064032 from the Swiss National Science Foundation; unconditional grants from the Federal Social Insurance Office; the Stanley Thomas Johnson Foundation; the Gottfried and Julia Bangerter-Rhyner Foundation; the Bank Vontobel Foundation; the Dosenbach-Waser Foundation; and the Karl Mayer Foundation.

Current Controlled Trials identifier: ISRCTN26099032 (http://www.controlled-trials.com).

From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.

Address correspondence to Dr. Hoffmann (hoffmann@spk.unibe.ch).

Copyright © 2014 by the American Psychiatric Association

Received June 02, 2013; Revised May 01, 2014; Accepted May 09, 2014.

Abstract

Objective  The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1–2 years in persons with severe mental illness. The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years.

Method  A randomized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness. Competitive work and hospital admissions were tracked for 5 years, and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life. A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment.

Results  The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period. Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% compared with 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from 2 years to 5 years for participants in supported employment. Participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital. The social return on investment was higher for supported employment participants, whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs.

Conclusions  The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment.

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FIGURE 1. CONSORT Diagram for a Long-Term Study Comparing Supported Employment to Traditional Vocational Rehabilitation

FIGURE 2. Year-by-Year Rates of Competitive Employment Among Participants in Supported Employment and Traditional Vocational Rehabilitation Programs

**p<0.01. ***p<0.001.

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TABLE 1.Baseline Clinical and Demographic Characteristics of Participants in a Long-Term Study Comparing Supported Employment to Traditional Vocational Rehabilitationa
Table Footer Note

a No significant differences between groups on any variable.

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TABLE 2.Differences in Vocational Outcomes Among Participants in Supported Employment and Traditional Vocational Rehabilitation Programs Over the 5-Year Follow-Up
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TABLE 3.Differences in Patterns of Competitive Employment Among Participants in Supported Employment and Traditional Vocational Rehabilitation Programs Over the 5-Year Follow-Upa
Table Footer Note

a Significant difference between groups (χ2=13.88, df=3, p=0.003).

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TABLE 4.Benefits, Investments, and Social Return on Investment in Supported Employment and Traditional Vocational Rehabilitation Programs Over the 5-Year Follow-Up (N=83)
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