Canadian Council on Learning | Conseil Canadien sur l'Apprentissage

Augmented Education: Effectiveness of a new employment training and support model for people with mental illness

By Joan Nandlal (Centre for Addiction and Mental Health)
Monica Bettazzoni (Centre for Addiction and Mental Health)
Tony Priolo (George Brown College)
Susan McGurk (Dartmouth Medical School)
Nina Flora (Centre for Addiction and Mental Health)
Colin Perrier (Centre for Addiction and Mental Health)

Background

Many people living with mental illness or addiction are unemployed or underemployed. Supported employment is an evidence-based best practice for supporting people to return to work and procure ‘competitive employment’, that is, a paid position that anyone can apply for and which has not been specifically earmarked for persons with a mental illness or an addiction.

Studies have found that whether or not a person has worked prior to participation in a supported employment program is a predictor of whether or not they will return to work after completing the supported-employment program.

Research has also shown that while a fair number of supported-employment program graduates have competitive employment a year after completing such programs, job retention beyond the one year mark wanes. There are two implications of this finding. First, additional strategies would appear to be needed to strengthen labour-force participation by persons with a mental illness or an addiction. Second, research on innovative supported-employment strategies need to explore employment outcomes beyond the first year post-graduation.

Description

Given the importance of having a post-secondary education for accessing the majority of paid positions, George Brown College and the Centre for Addiction and Mental Health in Toronto worked collaboratively to create the Augmented Education program, which is delivered through the College.

Augmented Education (AE) is an innovative model that combines elements of supported employment (e.g., job coaching) with supported education (e.g., make-up tests, additional teaching labs). This report describes the findings of a prospective longitudinal study aimed at evaluating the effectiveness of the AE model in helping individuals graduate from college, and acquire and sustain competitive employment over a two-year period. More specifically, the study aimed to answer the following four questions:

1. Do Augmented Education program graduates acquire and sustain competitive employment?
2. To what extent does participation in Augmented Education programs affect clinical functioning as assessed by hospitalizations and change in mental health status?
3. What clinical and non-clinical factors are related to graduation from Augmented Education and employment success?
4. What benefits aside from acquiring and sustaining competitive employment are accrued through participation in Augmented Education programs?

Method

There are currently two streams of the Augmented Education program offered at George Brown College: the Assistant Cook Extended Training program and the Construction Craft Worker Extended Training program.

Data were gathered from 123 students of both streams who began the program between April 2004 and April 2008 and agreed to participate in the study. Data collected from students at program entry, program completion, 12-month follow up, and 24-month follow up included: demographic characteristics, prior work history, psychiatric diagnosis, psychiatric symptoms, recovery and employment outcomes. These quantitative data were used to address the first three-study questions and semi-structured interviews were held with 13 key informants (program instructors, student employers and Augmented Education program staff) to address the last study question.

Key Findings

1. Over 60% of graduates are employed a year after and 58% of graduates are employed two years after completing an Augmented Education. Of those employed a year after graduation, 72% were working in the industry that they were trained in (i.e., cooking or construction) and this figure decreased to 55% two years after graduation.
2. Augmented Education program participation appears to have had little or no effect on clinical functioning; however, hospitalization prior to participating in Augmented Education was found to be related to whether or not a person graduated from the program. These findings highlight the need for adequate clinical supports both within and linked to Augmented Education programs.
3. It is unclear what clinical and non-clinical factors are related to graduation and employment success due to the high rate of study attrition. Future research on this program might benefit from increasing study honoraria and/or making research/evaluation participation a mandatory component of Augmented Education program acceptance. It might also benefit from a combined methodology that includes information from student files, and clinician or program staff ratings.
4. Participation in Augmented Education appears to contribute to empowerment, moving beyond the illness, and being connected to society. Moreover, the Augmented Education program completion rate of 57.2% is comparable to the completion rate across all programs offered at George Brown College, which points to the immense value of Augmented Education in supporting students.

That many students are also entering competitive employment following program completion further highlights the supported employment facets of Augmented Education. Together, these findings demonstrate that individuals with mental illness have the capacity to complete post-secondary education and acquire gainful employment. These findings are also rather positive given the infancy of the Augmented Education programs.