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
Dr Holger Hoffmann
University Hospital of Psychiatry
P.O. Box 52
+41 31 632 47 04
SNF 3200-064032.00/ 1
The Job Coach Project: a randomised controlled study on implementing supported employment in Switzerland
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.
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
Randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Persons with stabilised severe mental illness (schizophrenia, affective disorders, personality disorders)
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
Primary outcome measure
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
Overall trial end date
Reason abandoned (if study stopped)
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
Target number of participants
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
Recruitment end date
Countries of recruitment
Trial participating centre
University Hospital of Psychiatry
Biology and Medicine Division, Swiss National Science Foundation (Switzerland) (Ref: 3200-064032.00/ 1)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Hoffmann H, Jäckel D, Glauser S, Kupper Z, A randomised controlled trial of the efficacy of supported employment., Acta Psychiatr Scand, 2012, 125, 2, 157-167, doi: 10.1111/j.1600-0447.2011.01780.x.
Hoffmann H, Jäckel D, Glauser S, Mueser KT, Kupper Z, Long-term effectiveness of supported employment: 5-year follow-up of a randomized controlled trial, Am J Psychiatry, 2014 , 171, 11, 1183-1190, doi: 10.1176/appi.ajp.2014.13070857.