Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness

Lisa Dixon, Jeffrey S Hoch, Robin Clark, Richard Bebout, Robert Drake, Greg McHugo, Deborah Becker

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help patients obtain competitive jobs and provide them with ongoing support, and enhanced vocational rehabilitation (EVR), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. Methods: A total of 150 unemployed inner-city patients with severe mental disorders who expressed an interest in competitive employment were randomly assigned to IPS or EVR programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. Results: No statistically significant differences were found in the overall costs of IPS and EVR. Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The ICER estimates indicated that participants in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of $283 ($13 an hour). Conclusions: The analyses suggest that IPS participants engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.

Original languageEnglish (US)
Pages (from-to)1118-1124
Number of pages7
JournalPsychiatric Services
Volume53
Issue number9
DOIs
StatePublished - Sep 2002
Externally publishedYes

Fingerprint

vocational rehabilitation
Vocational Rehabilitation
mental illness
Cost-Benefit Analysis
human being
costs
Costs and Cost Analysis
Salaries and Fringe Benefits
wage
Mental Health
mental health
Statistical Data Interpretation
Program Evaluation
mental disorder
Mental Disorders
Health Care Costs
rehabilitation
Rehabilitation

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness. / Dixon, Lisa; Hoch, Jeffrey S; Clark, Robin; Bebout, Richard; Drake, Robert; McHugo, Greg; Becker, Deborah.

In: Psychiatric Services, Vol. 53, No. 9, 09.2002, p. 1118-1124.

Research output: Contribution to journalArticle

Dixon, Lisa ; Hoch, Jeffrey S ; Clark, Robin ; Bebout, Richard ; Drake, Robert ; McHugo, Greg ; Becker, Deborah. / Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness. In: Psychiatric Services. 2002 ; Vol. 53, No. 9. pp. 1118-1124.
@article{a081ebc49df64e44be194946c2567989,
title = "Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness",
abstract = "Objective: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help patients obtain competitive jobs and provide them with ongoing support, and enhanced vocational rehabilitation (EVR), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. Methods: A total of 150 unemployed inner-city patients with severe mental disorders who expressed an interest in competitive employment were randomly assigned to IPS or EVR programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. Results: No statistically significant differences were found in the overall costs of IPS and EVR. Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The ICER estimates indicated that participants in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of $283 ($13 an hour). Conclusions: The analyses suggest that IPS participants engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.",
author = "Lisa Dixon and Hoch, {Jeffrey S} and Robin Clark and Richard Bebout and Robert Drake and Greg McHugo and Deborah Becker",
year = "2002",
month = "9",
doi = "10.1176/appi.ps.53.9.1118",
language = "English (US)",
volume = "53",
pages = "1118--1124",
journal = "Psychiatric Services",
issn = "1075-2730",
publisher = "American Psychiatric Association",
number = "9",

}

TY - JOUR

T1 - Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness

AU - Dixon, Lisa

AU - Hoch, Jeffrey S

AU - Clark, Robin

AU - Bebout, Richard

AU - Drake, Robert

AU - McHugo, Greg

AU - Becker, Deborah

PY - 2002/9

Y1 - 2002/9

N2 - Objective: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help patients obtain competitive jobs and provide them with ongoing support, and enhanced vocational rehabilitation (EVR), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. Methods: A total of 150 unemployed inner-city patients with severe mental disorders who expressed an interest in competitive employment were randomly assigned to IPS or EVR programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. Results: No statistically significant differences were found in the overall costs of IPS and EVR. Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The ICER estimates indicated that participants in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of $283 ($13 an hour). Conclusions: The analyses suggest that IPS participants engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.

AB - Objective: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help patients obtain competitive jobs and provide them with ongoing support, and enhanced vocational rehabilitation (EVR), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. Methods: A total of 150 unemployed inner-city patients with severe mental disorders who expressed an interest in competitive employment were randomly assigned to IPS or EVR programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. Results: No statistically significant differences were found in the overall costs of IPS and EVR. Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The ICER estimates indicated that participants in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of $283 ($13 an hour). Conclusions: The analyses suggest that IPS participants engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.

UR - http://www.scopus.com/inward/record.url?scp=0036707647&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036707647&partnerID=8YFLogxK

U2 - 10.1176/appi.ps.53.9.1118

DO - 10.1176/appi.ps.53.9.1118

M3 - Article

C2 - 12221310

AN - SCOPUS:0036707647

VL - 53

SP - 1118

EP - 1124

JO - Psychiatric Services

JF - Psychiatric Services

SN - 1075-2730

IS - 9

ER -