Predictors of Referral to Supported Employment Among Consumers with Co-Occurring Mental and Substance Use Disorders

Abstract

Clinical trials demonstrate that Supported Employment is effective in assisting persons with severe mental illness in obtaining competitive employment. However, little is known about the factors related to consumers' decisions to pursue employment, especially for consumers with co-occurring substance and mental disorders. This study examines the demographic, socioeconomic and illness characteristics of consumers referred for Supported Employment services. Consumers were drawn from Integrated Dual Diagnosis Treatment programs in four community mental health agencies. Study participants included 113 consumers referred for Supported Employment services and 78 randomly selected non-referred consumers as the comparison group. Results suggest that consumers who have past work experience are more likely to be referred to Supported Employment, while consumers who perceive themselves as disabled or who are diagnosed as substance dependent are less likely to be referred to Supported Employment. Implications for agency practice and future research are discussed.

Predictors of Competitive Employment Among Consumers With Co-Occurring Mental and Substance Use Disorders

“…First, consumers were referred to SE based on their expressed interest in entering employment, which means they may be more motivated to find employment. Second, it is hypothesized that some predictors of employment entry may also be predictors of referral to SE (Biegel, Beimers, Stevenson, Ronis, & Boyle, 2008) and therefore referral to SE may mediate a relationship between predictor variables and entry into competitive employment. Entering the referral to SE variable in the second step helps clarify the relationship between these predictor variables and competitive employment.…”

“…Means, percentages, and standard deviations of significant variables are presented in Table 1 as well significance levels from bivariate tests. Substance diagnosis was not significant but is shown on Table 1 because of the importance of this variable to the study as a significant predictor of referral to SE (Biegel et al, 2008).…”

“…The final sample for this analysis was 191 consumers (113 who had expressed interest in being referred for SE services and 78 that did not). Differences between these two groups on consumer and organizational and community level characteristics utilizing logistic regression showed that consumers with previous work experience were more likely to be in the referred group, while consumers who perceived themselves as disabled or who were diagnosed as substance dependent were less likely to be in the referred group (Biegel et al, 2008).…”

The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

“…This is not desirable given the many studies that demonstrate the benefits of more intensive and evidence-based employment services for this population (Drebing et al, 2002;McGurk et al, 2009;Mueser et al, 2011). This finding has international relevance because other studies have reported a negative bias in referral to employment services for dually diagnosed clients (Biegel et al, 2009;Frounfelker et al, 2011). Although these data cannot clarify the extent that underutilisation involves service exclusion via a referral or acceptance bias, they support zero exclusion principles and support increasing the availability of evidence-based supported employment programmes for those with psychotic disorders and co-morbid substance abuse or dependence (Drake et al, 2012;Mueser et al, 2011).…”

Characterizing Factors of Employment Status in Persons With Major Depressive Disorder

“…Studies show that most consumers express the desire to work but receive less employment guidance from providers compared to guidance in other life domains (McQuilken et al, 2003). Clinical decisions on referrals to supported employment programs also tend to be influenced by consumers’ co-occurring substance abuse (Biegel, Beimers, Stevenson, Ronis, & Boyle, 2009; Frounfelker, Wilkniss, Bond, Devitt, & Drake, 2011), despite the explicit eligibility criteria set forth by Substance Abuse and Mental Health Services Administration for supported employment programs which include substance abusers (Substance Abuse and Mental Health Services Administration, 2009). However, the relationship between substance abuse and employment of persons with mental illness is inconclusive.…”