Improving Employment Outcomes for Probationers With Mental Illnesses

Employment is a key protective factor against recidivism; however, the lack of job opportunities keeps justice-involved mentally ill individuals, especially young adults of color, unemployed and at risk for future justice involvement. To address these issues and grow the evidence for evidence-based practices for justice-involved adults with mental illnesses, the investigators will study the implementation and outcomes of individual placement support-supported employment (IPS-SE) combined with specialty mental health probation (SMHP) for probationers with mental illnesses.

Study Overview

• Status: Completed
• Conditions: Mental Disorders, Severe
• Intervention / Treatment: Behavioral: Individual Placement Support - Supported Employment

Detailed Description

The large and growing number of individuals with mental illnesses who are on probation have a difficult time accessing housing, employment, and health and mental health care, which is especially concerning for young adults aged 19-25 who make up just 10% of the population but 26% of those on probation. Employment is a key protective factor against recidivism; however, the lack of job opportunities keeps justice-involved mentally ill individuals, especially young adults of color, unemployed and at risk for future justice involvement. Without access to evidence-based supported employment interventions, economic inequality and poverty among justice-involved young adults with mental illnesses will remain unchanged.

To this end, an experienced multidisciplinary team will study the implementation and outcomes of individual placement support-supported employment (IPS-SE) combined with specialty mental health probation (SMHP) for probationers with mental illnesses. The investigators' long-term goal is to develop the evidence for interventions designed to improve employment outcomes among justice-involved individuals who have mental illnesses and conduct translational research with broad application to justice-involved individuals living with mental illnesses. The investigators will pursue the following specific aims:

Aim 1: Examine the barriers and facilitators to implementing IPS-SE in a probation setting. The investigators will use qualitative methods and semi-structured interviews with key stakeholders involved in the implementation of SMHP+IPS-SE to understand how IPS-SE can be embedded successfully in a probation setting.

Aim 2: Conduct a randomized trial to examine the impact of the SMHP+IPS-SE on employment and annual income for probationers with mental illnesses. The investigators will randomly assign 120 individuals to receive SMHP + treatment as usual (TAU) or SMHP+IPS-SE. The research team will test the following hypothesis - H1: SMHP+IPS-SE recipients will be more likely to obtain and sustain employment compared to SMHP+TAU recipients.

The expected outcomes include: (1) an understanding of the implementation barriers and facilitators associated with providing IPS-SE in a probation setting; (2) an understanding of how IPS-SE needs to be adapted for probationers with mental illnesses; and (3) evidence that SMHP+IPS-SE can improve employment outcomes among justice-involved probationers with mental illnesses. This research has the potential to promote the adoption and dissemination of best practices at the interface of the mental health and criminal justice systems and promises to grow the evidence for interventions that improve employment and reduce economic inequalities among a vulnerable population.

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Gary S Cuddeback, Ph.D.; Phone Number: 919-260-9913; Email: gcuddeba@email.unc.edu
• Study Contact Backup: Name: Tonya VanDeinse, PhD; Phone Number: 919-962-6428; Email: tbv@email.unc.edu

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
      • University of North Carolina at Chapel Hill

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion criteria include:

• on probation and supervised by a SMHP officer;
• aged 18-99;
• interested in obtaining employment; and
• competent to provide informed consent.

Exclusion criteria:

• Does not meet inclusion criteria; and
• Unable/unwilling to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Treatment as usual; Treatment as usual, with respect to employment, for individuals on probation typically entails the probation officer informing the probationer that probationer is responsible for obtaining employment or could entail a referral from a probation officer to an employment or job assistance service, such as vocational rehabilitation. The probationer is responsible for follow up with that service.
Experimental: Intervention - Individual Placement Support-Supported Employment; Subjects in this condition will receive services from a 1.5 FTE IPS-SE team that will work to provide one-on-one person-centered services to help obtain employment, including but not limited to career profiling, resume assistance, job placement, training and other activities.	Behavioral: Individual Placement Support - Supported Employment; Individual, person-centered intervention designed to help individuals living with mental illnesses obtain and sustain meaningful employment. This is an evidence-based practice for individuals with severe mental illnesses.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Employment, Time 0	Absence or presence of employment - categorical variable (full-time, part-time, none)	Baseline (Time 0)
Employment, Time 1	Absence or presence of employment - categorical variable (full-time, part-time, none)	3-months (Time 1)
Employment, Time 2	Absence or presence of employment - categorical variable (full-time, part-time, none)	6-months (Time 2)
Days worked in past 30 days, Time 0	Number of days worked in last 30 days	Baseline (Time 0)
Days worked in past 30 days, Time 1	Number of days worked in last 30 days	3-months (Time 1)
Days worked in past 30 days, Time 2	Number of days worked in last 30 days	6-months (Time 2)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duke-UNC Functional Social Support Questionnaire (FSSQ)	This is an 8-item self-report measure of perceived social support. Scores on the FSSQ range from 8 - 40 with higher scores indicating higher levels of perceived social support.	Baseline (Time 0)
Duke-UNC Functional Social Support Questionnaire (FSSQ)	This is an 8-item self-report measure of perceived social support. Scores on the FSSQ range from 8 - 40 with higher scores indicating higher levels of perceived social support.	3-months (Time 1)
Duke-UNC Functional Social Support Questionnaire (FSSQ)	This is an 8-item self-report measure of perceived social support. Scores on the FSSQ range from 8 - 40 with higher scores indicating higher levels of perceived social support.	6-months (Time 2)
Symptom Checklist (SCL-10-R)	This is a 10-item self-report measure of mental health symptom distress. Scores on the SCL-10-R range from 0 - 40 with higher scores indicating higher levels of symptom distress.	Baseline (Time 0)
Symptom Checklist (SCL-10-R)	This is a 10-item self-report measure of mental health symptom distress. Scores on the SCL-10-R range from 0 - 40 with higher scores indicating higher levels of symptom distress.	3-months (Time 1)
Symptom Checklist (SCL-10-R)	This is a 10-item self-report measure of mental health symptom distress. Scores on the SCL-10-R range from 0 - 40 with higher scores indicating higher levels of symptom distress.	6-months (Time 2)
Rosenberg Self-Esteem Scale (RSE)	This is a 10-item self-report measure of self-esteem. Scores on the RSE range from 10 - 40 with higher scores indicating greater self-esteem.	Baseline (Time 0)
Rosenberg Self-Esteem Scale (RSE)	This is a 10-item self-report measure of self-esteem. Scores on the RSE range from 10 - 40 with higher scores indicating greater self-esteem.	3-months (Time 1)
Rosenberg Self-Esteem Scale (RSE)	This is a 10-item self-report measure of self-esteem. Scores on the RSE range from 10 - 40 with higher scores indicating greater self-esteem.	6-months (Time 2)
Quality of Life (QOL)	This is a 17-item self-report measure of quality of life. Scores on the QOL range from 17 - 68 with higher scores indicating greater quality of life.	Baseline (Time 0)
Quality of Life (QOL)	This is a 17-item self-report measure of quality of life. Scores on the QOL range from 17 - 68 with higher scores indicating greater quality of life.	3-months (Time 1)
Quality of Life (QOL)	This is a 17-item self-report measure of quality of life. Scores on the QOL range from 17 - 68 with higher scores indicating greater quality of life.	6-months (Time 2)
Employment Motivation/Readiness (EMR)	This is a 7-item self-report measure of motivation to become employed and readiness to engage with an employment service. Scores on the EMR range from 0 - 70 with higher scores indicating greater motivation and readiness to work.	Baseline (Time 0)
Employment Motivation/Readiness (EMR)	This is a 7-item self-report measure of motivation to become employed and readiness to engage with an employment service. Scores on the EMR range from 0 - 70 with higher scores indicating greater motivation and readiness to work.	3-months (Time 1)
Employment Motivation/Readiness (EMR)	This is a 7-item self-report measure of motivation to become employed and readiness to engage with an employment service. Scores on the EMR range from 0 - 70 with higher scores indicating greater motivation and readiness to work.	6-months (Time 2)
Internalized Stigma of Mental Illness (ISMI)	This is a 29-item self-report measure of internalized and socialized stigma of mental illness. Scores on the ISMI range from 29 - 116 with higher scores indicating greater perceived stigma.	Baseline (Time 0)
Internalized Stigma of Mental Illness (ISMI)	This is a 29-item self-report measure of internalized and socialized stigma of mental illness. Scores on the ISMI range from 29 - 116 with higher scores indicating greater perceived stigma.	3-months (Time 1)
Internalized Stigma of Mental Illness (ISMI)	This is a 29-item self-report measure of internalized and socialized stigma of mental illness. Scores on the ISMI range from 29 - 116 with higher scores indicating greater perceived stigma.	6-months (Time 2)

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: U.S. Department of Justice
• Investigators: Principal Investigator: Gary S Cuddeback, Ph.D., Virginia Commonwealth University; Principal Investigator: Tonya VanDeinse, PhD, University of North Carolina, Chapel Hill

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2021
• Primary Completion (Actual): July 31, 2023
• Study Completion (Actual): July 31, 2023

Study Registration Dates

• First Submitted: June 23, 2021
• First Submitted That Met QC Criteria: June 30, 2021
• First Posted (Actual): July 2, 2021

Study Record Updates

• Last Update Posted (Actual): December 1, 2023
• Last Update Submitted That Met QC Criteria: November 30, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: employment; probation
• Additional Relevant MeSH Terms: Mental Disorders
• Other Study ID Numbers: 21-0972; 2019-MO-BX-0022 (Other Grant/Funding Number: Department of Justice)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: In the interest of reinforcing open scientific inquiry, data from this study will be made available by the Principal Investigator (PI) as freely as possible while safeguarding the confidentiality and privacy of participants. A final research data set will be prepared containing de-identified data on the ~130 expected participants. A data-sharing agreement will be required and those seeking data access will be required to obtain ethics approval. Researchers with a convincing scientific interest in the data will be eligible to receive the data. The data-sharing agreement will provide for the use of the data only for research and no other purpose, require a plan for the security of the data, forbid the further dissemination of the data without entering into an agreement, and provide a deadline for the completion of analyses and destruction of the data. Data will be made available under the auspices of the PIs by secure file transfer protocols or other secure, industry-approved means.
• IPD Sharing Time Frame: The data will become available 24 calendar months after completion of the study. The data will be available for up to 5 years.
• IPD Sharing Access Criteria: Upon request for the data to be shared and evidence of ethics approval, a data-sharing agreement will be required. Researchers with a convincing scientific interest in the data will be eligible to receive the data, without regard for the type of research question.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No