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Rehabilitative day treatment vs. supported employment: I. Vocational outcomes

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Abstract

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

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Authors and Affiliations

  1. Dartmouth Medical School, USA

    Robert E. Drake M.D., Ph.D., Deborah R. Becker M.Ed., Jeremy C. Biesanz B.A., William C. Torrey M.D., Gregory J. McHugo Ph.D. & Philip F. Wyzik M.A.

  2. New Hampshire Division of Mental Health, and West Central Services, USA

    Robert E. Drake M.D., Ph.D., Deborah R. Becker M.Ed., Jeremy C. Biesanz B.A., William C. Torrey M.D., Gregory J. McHugo Ph.D. & Philip F. Wyzik M.A.

  3. New Hampshire-Dartmouth Psychiatric Research Center, 105 Pleasant Street, 03301, Concord, NH

    Robert E. Drake M.D., Ph.D., Deborah R. Becker M.Ed., Jeremy C. Biesanz B.A., William C. Torrey M.D., Gregory J. McHugo Ph.D. & Philip F. Wyzik M.A.

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  1. Robert E. Drake M.D., Ph.D.
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  2. Deborah R. Becker M.Ed.
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  3. Jeremy C. Biesanz B.A.
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  4. William C. Torrey M.D.
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  5. Gregory J. McHugo Ph.D.
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  6. Philip F. Wyzik M.A.
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Additional information

This work was supported by U.S. Public Health Service grants #K02-MH-00839 from the National Institute of Mental Health and #R18-MH-47650 from the Substance Abuse and Mental Health Services Administration. The authors thank Don Shumway and Tom fox of the New Hampshire division of Mental Health and Jess Turner and Steve Bartels of West Central Services for facilitating this project.

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Drake, R.E., Becker, D.R., Biesanz, J.C. et al. Rehabilitative day treatment vs. supported employment: I. Vocational outcomes. Community Ment Health J 30, 519–532 (1994). https://doi.org/10.1007/BF02189068

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