Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of Breaking Barriers, a program implementing the Individual Placement and Support (IPS) model in a workforce setting, on employment, earnings, use of public benefits, and health.
- The study is a randomized controlled trial. The primary data source was a follow-up survey conducted an average of 15 months after random assignment. The authors used a statistical model to compare the outcomes of treatment and control group members.
- The study did not find any statistically significant effects on individuals’ employment, earnings, use of public benefits, or health.
- This study receives a high evidence rating. This means we would be confident that any estimated effects would be attributable to the Breaking Barriers program and not to other factors. However, the study did not find any statistically significant effects.
Intervention Examined
Individual Placement and Support (IPS)
Features of the Intervention
Individual Placement and Support (IPS) is designed to help individuals with disabilities rapidly conduct a job search and find competitive employment while continuing to receive job support services. IPS started in the 1990s and has been tested in many settings, with most IPS implementations focused on individuals with serious mental illness. The San Diego Workforce Partnership adapted this model to provide IPS services in a workforce setting, rather than in a clinical setting as in prior implementations. The program, Breaking Barriers, was provided at four job centers in San Diego County. IPS services included career counseling, job search assistance, job development (outreach to employers), benefits counseling, and follow-along services. Three of the four job centers were operated by private sector health and human services providers, while the fourth was operated by a local school district. The program served low-income San Diego County adults who self-identified as having a disability, were unemployed or underemployed, and were a client of CalWORKS, the California Department of Rehabilitation, or the San Diego County Behavioral Health Services.
Features of the Study
The study is a randomized controlled trial. 1,061 individuals were randomly assigned, 528 to the intervention group and 533 to the control group. Because random assignment was rolling, based on when individuals were referred to the program, and the survey administration also took place in waves, the exact timing of the follow-up survey ranged from 10 to 19 months after assignment; the average length of time was 15 months. The analytic sample, comprised of those who responded to the survey, varied slightly across outcomes, ranging from 644 to 657 participants. The authors used a statistical model to compare the outcomes of treatment and control group members.
The Breaking Barriers program was largely implemented as intended. Almost all treatment group participants completed a career profile with their employment specialist and received job search assistance. Other employment services were received by lower percentages of the treatment group but were based on individual participants’ needs. Although members of the control group did not have access to the specific type of supported employment program provided by Breaking Barriers, they did have access to the job centers’ standard services, employment-related support services from the Department of Rehabilitation, and other services in the county.
Findings
Employment
- The study found no significant difference in employment outcomes between the treatment and comparison groups.
Earnings and wages
- The study found no significant difference in earnings or wages between the treatment and comparison groups.
Health and safety
- The study found no significant difference in health outcomes between the treatment and comparison groups.
Public benefits receipt
- The study also found no significant differences between the treatment and comparison groups in the use of government assistance after random assignment. Unlike the analyses above, these have a lower strength of evidence rating because outcome data was available for fewer study participants. Thus, due to high attrition, these analyses received a moderate evidence rating.
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Findings were the same for subgroups of participants based on employment status prior to the intervention (employed vs. unemployed) and educational attainment (any postsecondary education vs. none).
Considerations for Interpreting the Findings
The authors reported that the average contrast between the job placement services received by the treatment and control group members was not as large as the authors had expected. The authors hypothesize that the individuals targeted by the Breaking Barriers program may have been more able to find employment with minimal support compared to participants in past studies of Individual Placement and Support.
Causal Evidence Rating
This study receives high evidence rating because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to the Breaking Barriers program and not to other factors. However, the study did not find statistically significant effects.