Article Figures & Data
Figures
- Figure 1
PRISMA flow diagram.
- Figure 2
Successful interventions include patient-centered relationships among the health care worker, employment specialist, and employer.
Note: All relationships are focused on the goal of achieving employment for the patient. Bold text denotes features derived from evidence in the systematic review. Nonbold text denotes features not found in the evidence; however, we include them in the model because they were considered important and are supported in other literature.
Tables
Type of Intervention Features Supported Employment Nine values for programs for people with developmental disabilities: (1) employment in integrated settings, (2) decent pay, (3) vocational choices, (4) competitive employment, (5) vocational training to reflect local labor needs, (6) parent involvement in planning, (7) parent education relative to Social Security laws, (8) community-based vocational training, and (9) systematically planned transition.17 Individual Placement and Support A Supported Employment approach developed by Becker and Drake in 1994.18,19 Key principles include (1) approach focuses on competitive employment (ie, positions available to those without severe mental illness), (2) any individual who wishes to work in a competitive job is eligible, (3) a rapid job search approach is used so that individuals can start working as quickly as possible, (4) employment specialists or team is closely integrated with the mental health team, (5) individual preferences are respected and considered, and (6) ongoing and individualized support is provided as long as necessary.12 Integrated Medical and Vocational Program A program that reportedly integrates vocational programs with medical services; however, it does not follow a specific program such as Individual Placement and Support. Clubhouse Model Clubhouses use work-ordered days, which involves participation in activities to develop participants’ motivation to get involved in transitional employment.19,20 A primary component of the clubhouse model is transitional employment, which consists of the following19(p:42) • Realistic job experience (entry-level employment) • A staff worker first performs tasks with new placements • Part-time employment (15 to 20 hours/week) • Temporary (6 to 9 months) • Staff members guarantee a replacement if participant is absent • Tolerates job failures • Job coaching at work site • Employees encouraged to work at clubhouse when not at work Other In a number of studies, the intervention could not be classified as any of the interventions above. This group was heterogeneous. For example, one article considered having only an employment specialist to be an intervention.20 Authors, Year Random Sequence Generation (selection Bias) Allocation Concealment (Selection Bias) Blinding of Participants and Personnel (Performance) Blinding of Outcome Assessors (Detection Bias) Incomplete Outcome Data, Description of Exclusions and Attrition (Attrition Bias) Selective Outcome Reporting (Reporting Bias) Other Bias Au et al,42 2015 + ? − + + ? + Becker et al,43 1996 − − − + + + ? Bejerholm et al,44 2017 + + − + − ? ? Bejerholm et al,45 2015 + + − + + ? + Bell et al,46 2014 + ? − ? + ? ? Bell et al,47 2008 + + − + + + ? Blankertz and Robin-son,20 1996 − − − + + ? ? Bond et al,48 2015 + + − ? + ? ? Bond et al,49 2013 ? ? − ? ? ? ? Bond et al,50 2016 ? ? − ? ? ? ? Bond et al,51 2007 + + − + ? + ? Bond et al,52 1995 ? ? − ? − ? ? Burns et al,53 2015 + ? − + − ? ? Burns et al,54 2007 + + − ? + ? + Burns and Catty,24 2008 − + − + ? + ? Cook et al,55 2008 ? − − + + + ? Cook et al,25 2005 + + − + ? + ? Cook et al,56 2005 ? − − + + + ? Craig et al,57 2014 ? ? − ? + ? ? Fraser et al,58 2008 ? − − + + ? ? Gold et al,26 2006 + + − + + + + Heslin et al,59 2011 + + − + + + + Hoffmann et al,60 2012 + + − + + + + Hoffmann et al,61 2014 + + − + + + ? Howard et al,62 2010 + + − + + + ? Lehman et al,63 2002 − + − + + + ? LePage et al,64 2016 + + − ? + ? + Macias et al,65 2006 + + − + + + ? McGurk et al,66 2016 + + − ? + ? ? McGurk et al,67 2015 + + − + + ? ? McGurk et al,68 2009 + + − ? − + ? McGurk et al,69 2005 + + − + + + + Michon et al,70 2014 + + − + ? + ? Mueser et al,71 2011 + + − + + + + Mueser et al,72 2004a + + − + ? ? ? Mueser et al,73 2004b − + − + + − ? Oshima et al,74 2014 + + − + + + ? Ottomanelli et al,75 2014 − ? − + + + ? Ottomanelli et al,76 2012 + + − + + + ? Poremski et al,77 2017 + + − + + + + Poremski et al,78 2016 + + − + + + + Tsang et al,79 2016 + + − + + + + Tsang et al,80 2010 ? ? − + + ? + Tsang et al,81 2009 + ? − + + ? + Twamley et al,82 2014 + + − + + + ? Twamley et al,83 2015 + + − + + + ? Waghorn et al,84 2014 + + − ? + ? + Wong et al,85 2008 + ? − ? + + + Note: + indicates process followed; – indicates process not followed, ? indicates unknown whether process was followed.
Author(s), Year Study Design Study Design Includes Pre- and Post-Intervention Data Study Design Includes Control or Comparison Group Study Design Includes Cohort Comparison Groups Equivalent at Baseline on Sociodemographics Comparison Groups Equivalent at Baseline on Outcome Measures Random Assignment (Group or Individual) to the Intervention Participants Randomly Selected for Assessment Control for Potential Confounders Follow-up Ratea Total Rigor Scoreb Alverson et al,86 1995 Prospective cohort Yes No Yes n/a n/a n/a No Not reported Yes 3 Becker et al,87 2007 Retrospective cohort Yes No Yes n/a n/a n/a No Not reported n/a 2 Becker et al,88 2001 Prospective cohort No Yes No Not reported Not reported Not reported Not reported Not reported Not reported 1 Becker et al,11 1999 Retrospective cohort (secondary analysis) No No Yes n/a n/a n/a n/a No n/a 1 Bowie et al,89 2017 Prospective cohort Yes Yes Yes Yes Yes No No Yes Yes 7 Burt,23 2012 Prospective cohort Yes Yes Yes Yes Yes No No Yes Not reported 6 Chang et al,90 2016 Prospective cohort Yes No Yes n/a n/a n/a n/a Not reported Yes 3 Chiu and Wong,91 2001 Retrospective cohort Yes No Yes n/a n/a n/a No Not reported Not reported 2 Chuang et al,92 2015 Retrospective cohort No No Yes n/a n/a n/a n/a No n/a 1 Dresser et al,93 2015 Prospective cohort Yes No Yes n/a n/a n/a n/a Not reported Yes 3 Ellison et al,94 2015 Prospective cohort Yes No Yes Not reported Not reported n/a No No Yes 3 Fuller et al,95 2000 Retrospective cohort Yes No Yes n/a No n/a n/a No n/a 2 Kielhofner et al,96 2004 Prospective cohort Yes No Yes n/a n/a n/a No Yes No 3 Landolt et al,97 2016 Prospective cohort Yes No Yes n/a n/a n/a n/a Not reported Not reported 2 Leff et al,98 2005 Prospective cohort Yes No Yes n/a n/a n/a n/a Yes Not reported 3 LePage et al,99 2011 Prospective cohort Not reported Yes Yes Not reported Yes Yes No Yes Not reported 5 LePage et al,100 2013 Prospective cohort Not reported Yes Yes Yes Yes Yes No No Not reported 5 Lucca et al,101 2004 Retrospective cohort Not reported No Yes Not reported No No No Yes Not reported 2 Marwaha et al,102 2014 Prospective cohort Yes Yes Yes No No No No No Not reported 3 McCarthy et al,103 1998 Prospective cohort No No Yes n/a n/a n/a No No Unknown 1 Morris et al,104 2014 Prospective cohort Yes No Yes n/a n/a n/a n/a No No 2 Ottomanelli et al,105 2017 Prospective cohort Yes No Yes n/a n/a n/a No n/a Yes 3 Ottomanelli et al,106 2015 Prospective cohort Yes No Yes n/a n/a n/a n/a Not reported Not reported 2 Pandiani et al,107 2004 Retrospective cohort (secondary analysis) Not reported Yes Yes Yes n/a n/a No Yes n/a 4 Porteous and Waghorn,108 2007 Prospective cohort No No Yes n/a n/a n/a Not reported Not reported Not reported 1 Puig et al,109 2016 Prospective cohort Yes No Yes n/a n/a n/a No Yes n/a 3 Reddy et al,110 2016 Prospective cohort No No Yes n/a n/a n/a No Yes No 2 Roush,111 2009 Retrospective cohort (secondary analysis) Yes No Yes n/a n/a n/a n/a Yes n/a 3 Rüsch et al,112 2014 Retrospective cohort No No Yes n/a n/a No No Yes Yes 3 Sato et al,113 2014 Prospective controlled Yes Yes Yes Yes Yes No No Yes No 6 Tan et al,114 2016 Prospective cohort Yes No Yes n/a n/a n/a n/a n/a No 2 Van Veggel et al,115 2015 Prospective cohort/parallel design Yes Yes Yes Yes Yes No No No No 5 Waghorn et al,116 2015 Prospective cohort/parallel design Yes No Yes No No No No Yes No 3 Watzke et al,117 2009 Prospective cohort Yes Yes Yes Yes Yes No Not reported Yes Yes 7 Waynor and Gill,118 2015 Prospective cohort Yes n/a Yes n/a n/a n/a n/a No No 2 Williams et al,119 2015 Prospective cohort No Yes Yes Yes Yes n/a n/a n/a No 4 Wittich et al,120 2013 Prospective cohort Yes No Yes n/a n/a n/a n/a No Yes 3 Wong et al,121 2000 Prospective cohort Yes Yes Yes No Yes n/a n/a Yes Not reported 5 Wong et al,122 2001 Prospective cohort Yes Yes Yes Yes Yes n/a Not reported Not reported Not reported 5 Zanis and Coviello,123 2001 Prospective cohort Yes No Yes n/a n/a n/a No Not reported Yes 3
Supplemental Appendixes 1-3
Supplemental appendixes 1-3
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The Article in Brief
Employment Interventions in Health Settings: A Systematic Review and Synthesis
Andrew D. Pinto , and colleagues
Background Employment status is a key social determinant of health. This analysis sets out to identify existing studies of employment interventions in health settings and common characteristics of successful interventions.
What This Study Found When health care organizations try to help patients find employment, they do so through innovative, complex interventions. Researchers in Toronto conducted a systematic review of 88 existing studies of interventions in a variety of health settings (e.g., primary care practices, hospitals, emergency departments, community health centers, and health centers in prisons) to help unemployed patients gain employment. Most articles (89 percent) focused on people with mental illness. The majority of studies (74 percent) succeeded in helping patients gain employment. Characteristics of successful interventions included, (1) a collaborative multidisciplinary team with regular communication, (2) a comprehensive package of services, (3) individualized components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers.
Implications
- The authors suggest that primary care practices can begin addressing employment issues by raising awareness of employment as an important social determinant of health, training staff (e.g., social workers, community health workers and system navigators) to provide employment support, and building relationships with employment services.
- Research to evaluate the long-term impact of employment interventions across different health care settings and with diverse patients is also needed, the authors state.
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