Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. A. Introduction


In Chapter II, we reviewed evidence on the effectiveness of employment supports for individuals with SMI in the three target populations: individuals who are now or who are expected to be long-term clients of mental health agencies, employees at risk of job loss due to mental illness, and individuals experiencing a FE of psychosis and needing EI. ASPE is particularly interested in providing services and supports to enable people with SMI to find or keep employment, thereby reducing applications for Social Security disability benefits. In this chapter and the next one, we focus on individuals with other types of disabilities, and include information about the effectiveness of services to promote employment and the trajectory of service use prior to application for SSDI benefits. We summarize in this chapter an environmental scan we conducted to identify evidence of effectiveness of RTW or employment-support interventions for people with physical, developmental, or intellectual disabilities (Martin et al. 2013). The scan informed our discussion about effective services and supports for people with SMI (Appendix A, Table A.8).

RTW and employment-support interventions are intended to help people with disabilities and injured workers join or reintegrate into the workforce after a period of unemployment or sickness absence improve their health status and/or quality of life, and provide a cost-effective mechanism that will result in employment. RTW interventions are also intended to reduce the costs associated with loss of worker productivity and increased disability insurance benefits.

RTW interventions often extend beyond merely providing health care or medical services. For instance, they may include case management, workplace accommodations, integrated medical care and occupational training, or other strategies which vary in intensity or duration (van Oostrom et al. 2009). For those with early onset disabilities and limited or no work experience, employment supports often include habilitation services, which are intended to provide the necessary knowledge, skills, and abilities to obtain employment and reduce reliance on government-sponsored safety-net programs. For example, the state VR and the Ticket to Work (TTW) programs offer both rehabilitation and habilitation services.

In Section B, we describe disability management (DM) programs conducted by employers and the systematic reviews of these interventions. We included in our review interventions offered by health care providers if the intervention was initiated by the workplace or was integrated into the workplace. We included interventions with a primary goal of RTW; we did not include clinical studies that focused solely on health care or medical interventions. In Section C, we review demonstrations conducted by the Federal Government. In Section D and Section E, we review evidence of the effectiveness of VR and SE services, and in Section F, we review evidence of RTW programs conducted outside the United States.

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