CLINICAL HANDBOOK OF SCHIZOPHRENIA

26. Vocational Rehabilitation 263VR counselors can purchase services, work-related equipment and supplies, provide guidanceand counseling, and specialized knowledge about medical problems and local employers.Practitioners from other agencies are invited to be part of the team and, togetherwith the client, help with the planning.The employment specialist and other members of the treatment team provide individualizedsupport as long as the person wants and needs assistance. It is through expectations,hope, and support that people move forward in their lives.RESEARCH EVIDENCEExtensive research demonstrates the effectiveness of supported employment. In quasiexperimentalstudies, 5-day treatment programs and one sheltered workshop were convertedto supported employment. Day treatment services were discontinued and the staffwas reassigned to employment specialist positions. The results were similar in all sites:large increases in the employment rates at the converted sites, and virtually no change inemployment rates at the control sites. There were no negative outcomes, such as increasedhospitalization or program dropout. Overall, clients, families, and staff haveliked the change. Some clients, however, have reported that they miss the socializationopportunities of the day treatment program. With peer support centers, started in part asa response to this concern, the results were even more dramatic when employment servicesof a sheltered workshop were transformed to IPS-supported employment. Competitiveemployment outcomes increased from a rate of 5–50%.The strongest scientific evidence that a practice is effective is a randomized controlledtrial. To date, there are 16 randomized controlled trials of supported employment (Figure26.1) (Bond, 2007). In 15 out of 16 studies, supported employment resulted in increasedemployment outcomes. Supported employment was compared to sheltered work, stepwiseFIGURE 26.1. Employment rates in 16 randomized controlled trials of supported employment.