ISRCTN - ISRCTN26099032: The Job Coach Project: Implementing supported employment in Switzerland

Plain English Summary

Background and study aims
Before 2002 supported employment (SE) program had not been introduced in Switzerland. Only vocational rehabilitation training program was offered. The aim of this study is to assess the long-term effects of SE in Switzerland over 2 and 5 years.

Who can participate?
Unemployed persons with stabilised severe mental illness aged between 18 and 64 years.

What does the study involve?
Following a two-week intake assessment, 100 unemployed persons with stabilised severe mental illness were randomly allocated to either the SE-programme (n=46) or to the most viable locally available traditional vocational rehabilitation programmes (TVR, n=54). Competitive work and hospital admissions were tracked for 5-years, and interviews were conducted at 2- and 5-years to assess recovery attitudes and quality of life.

What are the possible benefits and risks of participating?
Findings of the study suggest that participants in SE programme were more likely to obtain competitive work than TVR, worked more hours and weeks, earned more wages, and had longer job tenures. SE participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital than those in TVR. The SE-programme in Switzerland also proved more effective than TVR and seems to be applicable to the socio-economic context of Western European countries. The findings also suggest that the long-term provision of the SE program may contribute to reduced hospitalizations in people with severe mental illness.

Where is the study run from?
The study was conducted at the University Hospital of Psychiatry, University of Bern.

When is the study starting and how long is it expected to run for?
The study started in September 2002. Follow-up data were collected up to the end of 2009.

Who is funding the study?
The study was funded by Swiss National Science Foundation

Who is the main contact?
PD Dr. med. H. Hoffmann
hoffmann@spk.unibe.ch

Trial website

http://www.upd.gef.be.ch/upd_gef/de/index/arbeit_wohnen/arbeit-wohnen/job_coach_placement.html

Contact information

Type

Scientific

Primary contact

Dr Holger Hoffmann

ORCID ID

Contact details

University Hospital of Psychiatry
Murtenstr. 46
P.O. Box 52
Bern
Ch-3010
Switzerland
+41 31 632 47 04
hoffmann@spk.unibe.ch

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

SNF 3200-064032.00/ 1

Study information

Scientific title

The Job Coach Project: a randomised controlled study on implementing supported employment in Switzerland

Acronym

JCP

Study hypothesis

Though numerous randomised controlled trials indicated the superiority of supported employment (SE), we still have too little evidence that SE is more effective than traditional vocational rehabilitation programmes (TVR) at improving competitive work over 1-2 years in persons with severe mental illness in Western European countries with highly developed social security and welfare systems, sophisticated rehabilitation programmes and high thresholds to the open labour market. The aim of this study is to prove the longer term effects of SE in Switzerland over 2 and 5 years.

Ethics approval

The study protocol and the consent forms (application No 112/02) were approved by the Canton of Bern Ethics Committee (KEK) (president Prof. Dr. M. Hess, secretary general Dr. D. Pfiffner) on 01/11/2002

Study design

Randomised controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Hospitals

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Persons with stabilised severe mental illness (schizophrenia, affective disorders, personality disorders)

Intervention

100 unemployed persons with stabilised severe mental illness randomly allocated to either SE (n=46) or TVR (n=54).
1. Supported Employment (Job Coach Project)
As opposed to the traditional 'train-place' model of vocational rehabilitation in which a person is trained to 'get ready' for competitive employment, SE emphasises a 'place-train' approach which rapidly places individuals with SMI in real-world competitive employment settings, so that they can experience the benefits and challenges of the job environment first hand. SE then provides the necessary training and support to successfully sustain these placements. The Job Coach Project (JCP) of the Bern University Hospital of Psychiatry was derived from the Individual Placement and Support (IPS) (16) model. Some modifications were however made in order not only to meet the standards of the Swiss social insurance system and the needs of the Swiss labour market, but also to enhance the sustainability. The JCP is staffed by employment specialists (job coaches) that are experienced in the long-term treatment and rehabilitation of individuals with SMI. The employment specialist assists each participant in the programme in seeking competitive employment on the basis of his or her educational background, work preference and previous work experience. Great attention is paid to aiding these persons to obtain and sustain competitive jobs. Once employed, on-the-job training and follow-along support is provided to ensure that the individual retains the job for as long as possible. If employment is terminated for any reason, the employment specialist assists the individual in dealing with job loss, and helps him or her to secure another place. In order to provide sufficient support for each participant, the maximum caseload of each employment specialist is limited to 12 participants. The employment specialists were requested to have contact (face to face, by phone or e-mail) at least once a fortnight with each participant and once a month with supervisors, social counsellors or other relevant persons. In parallel, particular emphasis is also placed on employer support and on ongoing collaboration with other significant persons within the participant's work and home environment. Several incentives were given to employers, i.e. the JCP acts as a temporary placement agency by paying all social insurance and pension fund contributions and by offering as many incentives as possible. Salaries are defined as a performance-linked wage, thereby facilitating a win-win situation for both parties. Since the JCP is part of the community mental health division of the Bern University Hospital of Psychiatry, the employment specialists are in close contact with the attending therapists from the outset. Moreover, supervision sessions with a psychiatrist are scheduled on a bi-weekly basis.
2. Control intervention: Traditional vocational rehabilitation programmes (TVR)
All control interventions must be verified as high-quality, train-place vocational rehabilitation programmes within the Canton of Bern, and be deemed by the Federal Social Insurance Office to be the best locally available alternative for each prospective participant. A precept of the TVR is that persons with SMI exhibit functional deficits that prevent them from fitting into a competitive work environment. As a result, participants in a TVR require a period of preparation before entering into regular employment. To facilitate a smooth transition into the real-world work environment, persons participating in a TVR are typically placed in sheltered workshops for 6 to 12 months, after which a 3 to 6-month training stint in a companion open market may be feasible. The accompanying support by employment specialists terminates at the end of the TVR. The wage paid by the Federal Social Insurance Office to participants during their programme attendance is equivalent to 80% of their last obtained wage in competitive employment.

Follow-up duration: 2- and 5-year follow-up

Intervention type

Behavioural

Phase

Drug names

Primary outcome measures

The primary outcome variable was whether the participant successfully obtained competitive employment, which had been operationally defined as a job on the open labour market which anyone could hold, not only individuals with disabilities.

Secondary outcome measures

Vocational outcomes included:
1. Rates of competitive employment
2. Time to first job (i.e. time from study entry to first job start)
3. Total weeks competitively employed
4. Hours worked per week during the second year
5. Percentage of participants employed 20 hours a week or more
6. Job tenure in the longest competitive job held during the follow-up period
7. Employment status at the 2- and 5-year follow-up
8. Total earnings in the second year
9. Employment status at 2- and 5-year follow-up
10. Hours worked per week at 2- and 5-year follow-up
11. Hourly wage at 2- and 5-year follow-up
12. Monthly income at 2- and 5-year follow-up
Non-vocational outcomes included:
1. Psychiatric symptoms
2. Global functioning
3. Relapses (number of hospitalisations and time spent in hospital)
4. Coping with stress
5. The self-perceived and objective quality of life

Overall trial start date

01/10/2002

Overall trial end date

31/12/2009

Reason abandoned

Eligibility

Participant inclusion criteria

To be included in the study, persons had to:
1. Be between 18 and 64 years of age
2. Have a stabilised mental disorder in accordance with International Classification of Diseases (ICD-10) criteria
3. Be mandated by the Swiss Invalidity Insurance State Office
4. Express an interest in competitive employment
5. Be out of competitive work at the time of signing the consent form

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

100

Participant exclusion criteria

Persons exhibiting the following were excluded:
1. Learning disability (IQ < 70)
2. Primary substance abuse disorder
3. Physical or organic handicap that seriously impeded work
4. Unwillingness to attend regular outpatient therapy
5. Performance less than 50% of normal work performance as evidenced during the assessment phase
6. Attendance in the programme of less than 15 hours per week.

Recruitment start date

01/10/2002

Recruitment end date

31/12/2009

Locations

Countries of recruitment

Switzerland

Trial participating centre

University Hospital of Psychiatry
Bern
Ch-3010
Switzerland

Sponsor information

Organisation

Swiss National Science Foundation (Switzerland)

Sponsor details

Wildhainweg 3
P.O. Box 8232
Bern
CH-3001
Switzerland
+41 31 308 22 22
com@snf.ch

Sponsor type

Research organisation

Website

http://www.snf.ch

Funders

Funder type