Participation in individual placement support: Ethnoracial differences in the supported employment demonstration.

Abstract

Objective: The Supported Employment Demonstration (SED), a large, multisite randomized controlled trial, provided evidence-based supported employment to help individuals recently denied Social Security disability benefits for reason of mental illness to gain competitive employment and avoid disability. Monthly, client-level measurement of participation in individual placement and support permitted the first detailed exploration of potential ethnoracial disparities in the IPS participation process, from enrollment to end of follow-along job supports, in a vulnerable population with ready access to the intervention.

Method: Monthly participation data in a subsample of enrollees randomized to receive supported employment enabled decomposition of IPS service participation into take-up, effectiveness, and follow-along support phases, yielding times to participation duration milestones, job start, and end of follow-along supports for 614 non-Hispanic White, non-Hispanic Black, and Hispanic SED enrollees. Cox proportional hazards models provided differences in the monthly hazard of each event by race and ethnicity.

Results: Black non-Hispanics (hazard ratio [HR] = 1.50) and Hispanics (HR = 1.52) were both more likely than White non-Hispanics to complete consecutive 3-month periods of supported employment participation. However, ethnoracial group was not significantly associated with either increased effectiveness, measured as the monthly likelihood of finding a job during IPS participation, or likelihood of ending follow-along job supports.

Conclusions and implications for practice: Potential clients' race and ethnicity are associated with a differential willingness to engage IPS services. For this reason, ethnoracial differences in IPS penetration may persist even when structural barriers to IPS access are removed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).