Efficacy of the Customized Employment Supports (CES) Model of Vocational Rehabilitation for Unemployed Methadone Patients: Preliminary Results

Abstract

This article presents initial efficacy data for an innovative vocational rehabilitation model designed for methadone-maintained patients—the Customized Employment Supports (CES) model. In this model, a CES counselor works intensively with a small caseload of patients in order to overcome the vocational as well as nonvocational barriers that hinder their employment, with the goal of attaining rapid placement in competitive employment. The CES model was implemented at two Manhattan methadone treatment programs as part of a randomized clinical trial comparing the model's employment outcomes with those of standard vocational counseling. The study tested the hypothesis that patients in the experimental group will have better employment outcomes than those in the comparison group. The data were collected from May 2001 through September 2003. The sample consisted of the first 121 patients who had completed their 6-month follow-up interviews. The preliminary results supported the hypothesis for two indices of paid employment, i.e., the CES group was more likely to obtain both competitive employment and informal paid employment. The clinical trial is continuing.

• Customized Employment Supports model
• Vocational counseling
• Substance use
• Methadone treatment
• Randomized clinical trial
• Competitive employment
• Therapeutic alliance
• Fieldwork

Additional information

Notes on contributors

Graham L. Staines

Graham Staines, Ph.D., is a Senior Project Director at NDRI where he has directed projects on modified therapeutic communities for both methadone patients and mentally ill chemical abusers (MICAs), treatment matching on levels of care among alcoholics, and new models of vocational rehabilitation for methadone clients. Prior to coming to NDRI, he was a Study Director at the Institute for Social Research at the University of Michigan. Funded by the Department of Labor, his research, which focused on the quality of work life, included three national Quality of Employment Surveys of representative samples of workers. In addition to journal articles, his publications on the relationship between work and family life include The Impact of Work Schedules on the Family (co-authored with Joseph H. Pleck in 1983).

Laura Blankertz

Laura Blankertz, Ph.D., is a research associate at Bryn Mawr College and a consultant. She has been a principal investigator on studies sponsored by the Center for Mental Health Services, the National Institute on Alcohol Abuse and Alcoholism, and the Department of Education. These studies have included mental health services research, treatment outcomes for individuals with comorbidities of serious mental illness and substance abuse, and vocational rehabilitation programs for individuals with serious mental illness and for youth with serious emotional disorders. Dr. Blankertz is the past president of the Eastern Evaluation and Research Society, has served on national research steering committees, is on the editorial boards of two professional journals, and is a recipient of the International Association of Psychosocial Rehabilitation Services research award.

Stephen Magura

Stephen Magura, Ph.D., C.S.W., is Acting Executive Director of NDRI and has been the Principal Investigator of many studies sponsored by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Child Health and Development. These studies have included drug abuse clinical trials, treatment outcome evaluations, health services research, social epidemiology studies, HIV prevention research, and policy analysis. Dr. Magura has authored or edited several books and special journal issues, including Outcome Measures for Child Welfare Services (1986), Experimental Therapeutics in Addiction Medicine (1994), a special issue of Health and Social Work on “Chemical Dependency” (1994), and a special issue of Substance Use & Misuse on “Program Quality in Substance Dependency Treatment” (2000). He serves on the Editorial Boards of five professional journals, is an elected member of the College on Problems of Drug Dependence (CPDD) and the Research Society on Alcoholism (RSA), serves on federal advisory committees, and is a faculty member of the Middle Eastern-Mediterranean Summer Institute on Drug Use.

Priti Bali

Priti Bali, B.A. is an Assistant Project Director at the National Development and Research Institutes, Inc. in New York City. She conducts data management and data analysis, along with other day-to-day project operations, for the NIDA-funded Innovative Job Placement study, and has been working at NDRI for over five years. She received her undergraduate degree in Forensic Psychology from John Jay College of Criminal Justice. Ms. Bali was recently accepted to a Ph.D. program in Holistic Counseling Psychology in Bangalore, India, which she plans on attending in August 2004. Her main research interests are concentrated around substance abuse and gender issues.

Elizabeth M. Madison

Elizabeth M. Madison holds an M.A. in Vocational Rehabilitation from New York University, a B.S. in Forensic Psychology, and is a Certified Rehabilitation Counselor (CRC), and Certified Workforce Development Professional (CWDP). She is a professional in the field of career and workforce development, specializing in vocational rehabilitation for chemically dependent individuals and the welfare-to-work population. She has developed innovative and creative programs to help these populations achieve self-sufficiency and economic independence. She is the Director for NADAP/Project ACE and the owner and president of Potential Unlimited, which develops career and workforce development programs and training for nonprofit organizations, school systems, and individuals. Ms. Madison facilitates training on vocational rehabilitation and substance abuse at various academic institutions and nonprofit organizations such as Lehman College at the City University of New York and Local 1199. She is a Fellow with the Join Together Program at Boston University and a member of the National Association of Workforce Development Professionals (NAWDP) and the Advocates for Vocational Rehabilitation and Substance Abuse (AVRASA).

Michael Spinelli

Michael Spinelli, M.S.Ed., CRC, ADS, CASAC-T, is an employment specialist with the NIDA-funded vocational research project, Innovative Job Placement in methadone treatment. After graduating with a Masters of Science in Education (rehabilitation counseling), Mr. Spinelli acquired national certification as a Certified Rehabilitation Counselor (CRC), Acupuncture Detoxification Specialist (ADS) and is in the final stage of becoming a New York State Credentialed Alcohol/Substance Abuse Counselor (CASAC). Mr. Spinelli has worked in the social service field for approximately 14 years, with specialties in vocational rehabilitation and MMTP. The Psychopharmacology/neurobiology of heroin addicts/methadone patients and their effects on job acquisition/retention are two of Mr. Spinelli's prime professional interests, on which he also provides trainings.

Emily Horowitz

Emily J. Horowitz, B.A., has been a Senior Research Assistant on the NIDA-funded Innovative Job Place-ment for methadone-treatment patients since 2002. She received her B.A. from Tufts University and is currently pursuing her Psy.D. in clinical psychology from the Ferkauf Graduate School of Psychology at Yeshiva University. Her interests include post-traumatic stress disorder and substance misuse.

Honoria Guarino

Honoria Guarino, Ph.D., is a Senior Research Assistant for the Innovative Job Placement study at NDRI, and has worked on the project since its inception in 2000. Dr. Guarino received her Ph.D. in Linguistic Anthropology from the University of Arizona in 2003. Her dissertation focused on the effects of institutional involvement on the personal narratives and self-concepts of HIV-positive clients of a New York City AIDS service organization. She is interested in pursuing research on the social aspects of HIV/AIDS and drug use and language use in institutional settings.

Audrey Grandy

Audrey Grandy, B.A., attended Trinity and New Paltz State University and has worked on projects for the Columbia School of Public Health, New York State Psychiatric Institute, New York Urban League, Harlem Center for Health Promotion, and Disease Prevention; she is currently Sr. Research Assistant with National Development and Research Institutes. She has been a major contributor on an array of social- and health-related projects. Her responsibilities have spanned all phases of research, including creating and maintaining data sets, assisting in construction and editing of code books, and coordinating schedules at study sites, with particular emphasis on the day-to-day operations of a research project. Ms. Grandy has extensive experience with interviewing, recruitment, screening, and locating individuals who are considered inaccessible or unreachable. Her future goal is to collaborate on a project that would focus on alternatives to incarceration for nonviolent felons and have an active role in implementing such changes.

Chunki Fong

Chunki Fong, M.S. serves as Director of Data Management and Analysis for the Institute of Treatment and Services Research at NDRI. With his background in statistics and computer science, he conducts research and data analysis and provides data and technical support for various substance use research studies in the Institute.

Amy Dimun

Amy Dimun, MA, CRC, CASAC, is the Coordinator of Vocational Services at Greenwich House since 1998. She received her Masters in Rehabilitation Counseling from New York University. Ms. Dimun is also the Co-Chair of AVRASA, Association of Vocational Rehabilitation in Alcoholism and Substance Abuse, an organization which educates and advocates for professionals in the field and promotes self-sufficiency for consumers, including obtaining and maintaining employment.

Ellen Friedman

Ellen Friedman received her doctorate in Clinical Social Work at New York University and holds a Certificate in Psychoanalytic Psychotherapy from the Metropolitan Institute. She is Director of Chemical Dependency and AIDS Mental Health at Greenwich House, New York City and has practiced in the addiction field for thirty years. She has collaborated on several clinical trials of innovative treatment and services for substance users. Dr. Friedman has spoken at national conference and written on such topics as intimacy problems in addiction, the impact of AIDS on women's lives and methadone maintenance treatment. She is active in community work and committed to improving services for the most vulnerable citizens.