Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients.
The empirical literature on the impact of psychiatric disability on employment outcomes has consistently shown that individuals with psychiatric disabilities are more likely than those without to experience adverse labor market outcomes. One strategy invoked to address barriers to employment has been reasonable job accommodations, developed originally through the Americans With Disabilities Act legislation. However, little is known about the factors associated with the request for reasonable job accommodations among those with serious psychiatric disabilities. Data for this study come from a longitudinal multisite demonstration project funded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. Accommodations were reported by individuals with serious mental health disabilities who became employed. Results from logistic regression analysis found that those who disclosed their disability to their employers, who were more severely disabled, and who had positive social relationships were more likely to request accommodations. This study advances our knowledge of the factors that influence the decision of individuals with serious mental health disabilities to seek accommodation in the work environment and offers a framework for guiding rehabilitation counselors in ways that might help to enhance employment outcomes for this population.
Self-direction has emerged worldwide as a promising practice for persons with serious mental health conditions and as a means toward creating more person-centered service systems. In self-direction, service users control an individualized budget, purchasing goods or services that can help them achieve personal recovery goals. This Open Forum describes an international learning exchange meeting, held in September 2015, in which experts in self-direction and mental health from seven nations convened for sharing best practices, discussing challenges, and laying the groundwork for a learning community to support the continued development of self-direction. Meeting participants identified three themes that represent next steps toward ensuring that the promise of self-direction is realized. First, self-direction involves creating a culture shift for value-based systems change. Second, people with lived experience must be involved and supported at every level, including direct support, leadership, and oversight. Third, stakeholder communication about self-direction's impact is critical.
Federal investments should take into account evidence that infrastructure changes alone do not necessarily contribute to better consumer outcomes, support operationally defined infrastructure improvements, require that service improvements accompany infrastructure changes, and provide sufficient resources to oversee grantee behaviors. In addition, future evaluation should support evaluation best practices.
BACKGROUND: Two decades since the passage of the Americans with Disabilities Act in 1990, individuals with psychiatric disabilities continue to face barriers to employment that includes sensitivity to the benefit structure of the Supplemental Security Income (SSI). OBJECTIVE: This study examines cost-savings to the SSI program due to enhanced employment outcomes for persons with psychiatric disabilities associated with the receipt of job accommodations. METHODS: Data come from a federally funded, multi-site, implementation effectiveness study of supported employment models for 987 working age adults. Cost-savings were estimated using ordinary least squares regression to examine averted SSI payment. RESULTS: Accommodations were associated with a marginal monthly SSI savings of $11.73, and these savings were 68 percent higher compared to the non-accommodations group. Being married, having independent housing, and recent employment history predicted savings increases. Physical and emotional problems affecting work, a schizophrenia diagnosis, and symptoms of social withdrawal and blunted affect predicted lower savings. CONCLUSIONS: This study adds to a small body of literature examining the impact of accommodations for persons with psychiatric disabilities. Future work in this area might examine savings to the Social Security Disability Insurance program and should include factors unavailable in this analysis.
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