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Frontline Report   |    
Combining Supported Education With Supported Employment
Abraham Rudnick, M.D., Ph.D.; Maya Gover, M.A., R.S.W.
Psychiatric Services 2009; doi: 10.1176/appi.ps.60.12.1690
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Dr. Rudnick is associate professor, Departments of Psychiatry and Philosophy, University of Western Ontario, London, and psychiatrist and physician-leader at Regional Mental Health Care, 850 Highbury Ave., London, Ontario, Canada N6A 4H1 (e-mail: arudnic2@uwo.ca). Ms. Gover is a social worker who was affiliated with the vocational rehabilitation and training center in Ra'anana, Israel, where she was the coordinator of this project at the time of data collection; she is now in private practice.

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Supported employment has had remarkable success in finding and keeping gainful employment for individuals with serious mental illness such as schizophrenia. This success has been largely in unskilled vocational occupations. Supported education can train people in skilled vocational occupations, yet it has rarely been combined with supported employment and never for a wide variety of such skilled occupations. We describe here a pilot of such a combination project.

A pilot project that combines supported employment and supported education was (and continues to be) conducted at the vocational rehabilitation and training center in Ra'anana, Israel, which provides certified courses in skilled occupations for individuals with various disabilities. Interested applicants residing in the center's region were referred to an intake meeting conducted by the project's social worker and were then selected in a multidisciplinary team meeting at the center. The participants were provided with mental health care, as needed, by their preproject mental health care services.

The project consisted of three stages (or fewer) for each participant. Stage 1 was preparatory supported education, which lasted up to three months and consisted of graded and customized training in generic skills, such as cognitive remediation, basic computer skills, and social skills training. This training was provided individually and in groups of no more than eight participants for five days a week, six hours each day, by a multidisciplinary team. In addition, vocational assessment and experiential exposure to the various courses offered at the center were conducted for each participant in order to confirm or revise course selection. Supportive group and individual counseling and liaison were offered weekly, and each participant met the supported employment worker.

Stage 2 was supported education in a skilled occupation. This education took up to one year and consisted of group training for five days each week with persons who have psychiatric and other disabilities. Training was provided by trained instructors at the center. In addition, generic skills training, counseling, and liaison (including with the course instructors) were offered, and the supported employment worker explored supported employment or other vocational options (including unpaid practicums) for each participant.

Stage 3 was posttraining in supported employment. After some coursework or participants' successful course completion, the supported employment worker helped participants secure employment and supported them on the job as needed. In addition the social worker continued to provide supportive counseling and liaison. Participants could continue to attend counseling and generic skills training, even after starting employment.

The results reported here pertain to the first two years of the project. Ninety-six persons voluntarily participated in the project during this period; 65 were men, 66 were aged 30 or younger, 38 had education beyond high school before the project, 70 had a primary psychiatric diagnosis of schizophrenia, 18 had a primary psychiatric diagnosis of a mood or anxiety disorder, and eight had a primary psychiatric diagnosis of a personality disorder.

A total of 53 participants proceeded to stage 2, and the distribution was as follows: six persons each trained in graphics design, accounting, or computer technician work; seven in quality auditing or secretarial work; five in computer programming; four in video editing; three in high school credits completion or warehouse clerkship; two in optics or electrician training; and one each in supported employment work and computerized chip manufacturing.

Stage of training and employment status achieved at the end of data collection were as follows: 53 completed stage 1 and proceeded to stage 2; of these, 15 completed their course, 31 were still in their course, four dropped out of their course (one was already in supported employment), and three took a break from their course. Of the 15 who completed their course, six were competitively employed in their vocation of choice, five were in individual training for gainful employment, two were searching for work, and two were working in sheltered (industrial) employment as a planned transition to supported employment.

The results of this project are promising. Most participants completed the preparatory stage and proceeded to the vocational stage, and nearly half of those who completed their course training were competitively employed in their vocation of choice by the end of data collection. A similar project with qualitative evaluation is in progress, led by the first author in London, Ontario, Canada.

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