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Service Intensity and Job Tenure in Supported Employment: A Final Report

by Gary R. Bond & Marina Kukla

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Background:  The effectiveness of the Individual Placement and Support (IPS) model of supported employment in helping clients with severe mental illness to work in competitive jobs is well established.  However, one key component of the model, ongoing support for clients who obtain employment, has not been adequately specified or empirically validated.  This study examined three questions: (1) What are the two-year employment outcomes for competitively employed clients enrolled in supported employment?  (2) What are the patterns of employment specialist contacts over time?  (3) What is the relationship between frequency of employment specialist contact and duration of employment over two years?  We hypothesized that intensity of support would be positively correlated with duration of employment.

Methods:  Employment specialists from four IPS programs provided monthly data on their contacts with 142 clients with severe mental illness and employment outcomes for a two-year period after each client obtained a competitive job.  Using either web-based or hard copy surveys, employment specialist provided information on employment outcomes (i.e., hours worked per week, days worked, wage rate), employment changes (i.e., job starts, job losses, and changes within jobs) and follow-along support provided by employment specialists  (i.e., frequency, mode, location, and duration of support).

Results:  With regard to employment outcomes, the sample of 142 clients included 21 (15%) who held a single job the entire two years, while 73 (51%) held multiple jobs over follow-up.  The sample averaged 9.6 months of job tenure in their initial job and 12.9 months employment during the two-year follow-up period.  Clients held an average of 1.92 jobs across two years; for those with multiple jobs, the period of unemployment between the first and second job averaged 2.9 months.  With regard to intensity of services, 99 (69%) clients received services over the entire 2-year follow-up period.  Employment specialists averaged 1.72 contacts per month; over 75% of all contacts were face-to-face and were made at a variety of locations, including the job site, other community locations, and agency offices.  The overall pattern of contact was approximately weekly contact immediately after the job start, with a sharp decline in intensity within a few months, followed by a steady level of approximately one contact per month for the remainder of the two-year follow-up.  Analyses examining correlations between employment specialist contact and duration of employment were focused on clients receiving IPS services for the entire 2-year period.  Intensity of support was positively correlated with months worked over the two years (r = .27, p < .01), supporting the study hypothesis.  Intensity of face-to-face contact was similarly positively correlated (r = .26, p < .01).  However, intensity of support was not associated with job tenure in the initial job.

Conclusion:  For clients with severe mental illness who have started a job, ongoing support by an employment specialist is modestly associated with subsequent duration of employment.  Face-to-face contact may be the most effective mode of contact, but there is no evidence that location or length of contacts influence job tenure.  IPS supported employment programs often provide two years of contact after a job start, although typically this contact is once monthly after the client has been successfully employed for several months.  Future research should seek to identify the specific characteristics of effective employment specialist interventions, optimal timing of interventions around job transitions and crises, and the complementary roles for mental health treatment and nonprofessional support in promoting job tenure.

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