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Educational and vocational training interventions

This page refers to the current evidence on the effectiveness of the available educational interventions for improving the employability of drug users. Information on the methodology used and the definition of terms can be found on the methodology page.

Date of last update: 12.2016     Next update: 04.2017

Available evidence for educational interventions

Summary: Motivated Stepped care interventions (motivational behavioural reinforcement) for methadone maintenance clients is effective in helping people to find employment. Employment-based interventions and vocational training may support the employment rate, while employment counselling is ineffective.

Beneficial

Motivated stepped care to promote motivation on employment rate

Motivated stepped care intervention based on motivational behavioural reinforcement and specifically targeting methadone maintenance clients was found to be effective in one cross-sectional study (n = 228; Kidorf et al., 2004, cited in EMCDDA, 2012 - Online appendix):

  • 70 % and 19 % of participants had full- and part-time employment, respectively, and 4 % were school volunteers. A total of 92 % were paying tax (i.e. 8 % were receiving salaries as ‘cash in hand’); and
  • of the 110 clients who were unemployed at the time of treatment entry, 84 % were employed at follow-up.

Likely to be beneficial

Customised employment supports to promote motivation on employment rate

Customised employment supports for methadone maintenance clients focusing on individualised interventions to promote vocational skills and reduction of non-vocational barriers (e.g. low self-efficacy) was found to be effective in one RCT (n = 168; Magura et al., 2007, cited in EMCDDA, 2012 - Online appendix):

  • 41 % of intervention vs. 25.5 % of standard vocational counselling participants had paid employment (full or part time) during both follow-up periods;
  • regression analysis showed that having prior paid employment, full intervention and receiving the intervention rather than the control were significant predictors of having any paid employment at follow-up;
  • there was, however, no difference in mean income during the study period.

Employment-based training to develop skills on employment rate

Employment-based training, including vocational counselling, job-seeking skills and job development, was found to be effective in one cross-sectional study (n = 223; Schottenfeld et al., 1992, cited in EMCDDA, 2012 - Online appendix):

  • 120 of the 172 initially unemployed clients were successfully placed in either full- or part-time employment; and
  • 25 were employed at the time of completion of the programme and continued with vocational follow-up.

Employment counselling on employment rate and treatment outcomes

Employment counselling was found to be effective in one secondary analysis of national survey (n = 297; SAMHSA - Substance Abuse and Mental Health Services Administration; Reif et al., 2004, cited in EMCDDA, 2012 - Online appendix):

  • at follow-up, 72 % of clients were employed at some point since discharge. Individuals belonging to the employment counselling group were three times more likely to be employed at any time after discharge than clients in the control group;
  • individuals who received employment counselling had better treatment participation and outcomes than clients in the control group. Characteristics likely to impact upon employment were the following: being married or common law at admission, homelessness at admission and Hispanic origin.

Helping Offenders to Work to develop employment skills on employment rate

The Helping Offenders to Work programme, consisting of four different targeted strategies to help recipients gain skills and employment, was found to be effective in one UCBA (n = 245; Kemp et al., 2004, cited in EMCDDA, 2012 - Online appendix):

  • skills development and supported work — 54.2 % employed;
  • life skills development — 58.1 % employed;
  • job training — 59.0 % employed.

Vocational training to develop employment skills for drug court attendees on employment rate

A skills training programme for drug court attendees, divided among a low-upgrading intervention group (LUG), a high-upgrading intervention group (HUG) and a no intervention group, was found to be effective in one RCT (n = 500; Leukefeld et al., 2007, cited in EMCDDA, 2012 - Online appendix):

  • improving employment rates. There was a significant association between intervention level and pattern of employment in the past year, with participants in the HUG reporting more full-time employment than the LUG and no intervention group;
  • fewer participants were unemployed in the HUG;
  • participants in HUG reported working more days in the past and in the previous 30 days than either the LUG or the no intervention group;
  • participants in the no intervention group worked more days than those in the LUG; and
  • participants in the HUG reported more income in the past year than those in the LUG.

Vocational training as a component of a comprehensive package to promote stable employment

A multiservice intervention designed targeting women substance users and promoting the move to sobriety and self-sufficiency, with vocational training sessions as a component of the programme, was found to be effective in one UCBA (n = 529; McLennan et al., 2003, cited in EMCDDA, 2012 - Online appendix):

  • improvements on the employment composite score and on all seven of the additional measures in this area;
  • on the four employment measures, there was significant change from baseline to 6 months and then again from 6 months to 12 months. For example, the percentage of participants employed at least half time rose from 6 % at baseline to 20.4 % at 6 months and to 29.9 % at 12 months;
  • measures of welfare utilisation did not change significantly between baseline and 6 months, but they did improve from 6 to 12 months. For example, the percentage of participants receiving TANF actually increased from 72.7 % to 74.6 % between baseline and 6 months but then decreased to 58.4 % at 12 months.

Trade-off between benefits and harms

No interventions met the criteria for this category.

Unknown effectiveness

Job Seekers’ Workshop vs. job interviewing video on employment outcomes

The Job Seekers’ Workshop (JSW) programme focused on job skills training, in particular interview preparation, versus a job interviewing video (JIV) revealed in one RCT (n = 102; Foley et al., 2010, cited in EMCDDA, 2012 - Online appendix):

  • no significant effects of JSW;
  • regression analysis did not reveal any statistically significant effect of group membership (JSW and JIV) on time to employment, defined as either a new taxed job or enrolment in a job-training programme, during the three months after randomisation;
  • at 6-month follow-up, the Cox regression procedure did not detect any significant between-group difference in time to employment;
  • no significant differences between groups in work hours or total work and training hours were found; and
  • no significant differences between the two interventions (JSW vs. JIV) at 3- or 6-month follow-up.

Effectiveness of Vocational Problem Solving Skills to promote employment motivation

The Effectiveness of Vocational Problem Solving Skills (VPSS) intervention focused on job-seeking motivation and action steps for stabilised in clients receiving methadone treatment revealed in one RCT (n = 109; Coviello et al., 2004, cited in EMCDDA, 2012 - Online appendix):

  • no effect of the VPSS intervention on clients’ motivation to work;
  • clients who were highly motivated at baseline continued to be highly motivated throughout the intervention, regardless of group assignment;

One RCT (n = 109; Zanis et al., 2001, cited in EMCDDA, 2012 - Online appendix):

  • based on the Yates adjusted chi-square statistic, the employment rate difference between conditions was statistically significant;
  • however, there was no difference in employment functioning between the two intervention groups at the 6-month follow-up when controlling for baseline differences.

Experimental Training Programme to develop employment skills on employment outcomes

The Experimental Training Programme (TEP), focused on job employment training and skills development, showed no difference in one RCT (n = 250; Karuntzos et al., 1994, cited in EMCDDA, 2012 - Online appendix):

  • in specific employment outcomes;
  • in both TEP and standard groups more females than males were referred to classes, educational services or job training. More males than females within each condition received help with job search.

Training and Employment Programme to develop skills on employment rate

The Training and Employment Programme, including skills development and a budget for any identified training needs, showed no evidence of effectiveness in one RCT (n = 249; Dennis et al., 1993, cited in EMCDDA, 2012 - Online appendix):

  • site-specific changes were recorded (e.g. intervention subjects received significantly more classes/education; referrals to job skills sessions; vocational assessments, job skills services and job support services), but overall the intervention had no significant effect on employment rates.

Vocational Problem-Solving programme vs. Job Seekers’ Workshop to develop employment skills

A combination of the Vocational Problem-Solving programme and the Job Seekers’ Workshop programme based on cognitive behavioural intervention and interpersonal problem-solving theories revealed in one RCT (n = 417; Lidz et al., 2004, cited in EMCDDA, 2012 - Online appendix):

  • all three groups show substantial increases in mean days worked from baseline to 6-month follow-up; moreover, the VPS and JSW groups showed further increases in mean days worked at the 12 month follow-up, while the VPS and JSW group showed a decrease from the 6-month level;
  • however, differences in mean days of employment among groups by analysis of variance did not approach significance;
  • those who attended 50 % or more of their assigned training sessions did not have significantly more days employed at 6- or 12-month follow-up than subjects who attended less than 50 % of sessions or subjects who attended no sessions.

Vocational rehabilitation counselling to promote employment motivation

Vocational rehabilitation counselling showed no evidence of effectiveness in one CBA (n = 691; Appel et al., 2000, cited in EMCDDA, 2012 - Online appendix):

  • involvement in vocational and employment activities increased from 53 % to 56 % in the intervention site, but decreased from 45 % to 43 % in the control site. However, this change was not significant;
  • regression analysis indicated that in those clients who were unemployed at study entry, being involved in the programme for a greater length of time, being younger or being enrolled at the intervention site were significant predictors of finding employment.

Vocational training to develop skills on employment outcomes and criminal recidivism

A Drug Treatment Alternative-to-Prison (DTAP) programme, focusing on vocational training and job skills development, showed no evidence of effectiveness in one secondary analysis of client records (n = 406; Sung, 2001, cited in EMCDDA, 2012 - Online appendix):

  • of DTAP graduates, 52 % met with the job developer for employment counselling and 40 % were placed on jobs with the assistance of the DTAP job developer;
  • 4 % (4) of the 93 graduates with available data accepted employment offers from participating members of the business advisory council; and
  • results from data analysis show that improved employment rates prevented post-treatment criminal recidivism among DTAP graduates.

Evidence of ineffectiveness

Employment counselling on employment rate

Employment counselling was found to be not effective in one secondary analysis of national survey, the Alcohol and Drug Services Study (n = 1 802; Shepard and Reif, 2004, cited in EMCDDA, 2012 - Online appendix):

  • out of all clients discharged from outpatient non-methadone treatment, just under 10 % received VR (vocational rehabilitation) or employment counselling. These clients were significantly less likely to have had a full-time job in the year prior to admission to substance use treatment. Alternatively, they were more likely to be unemployed throughout the year prior to admission than those who did not receive VR.

References and definitions

List of references

Explanation of terms used

Below you can find definitions and further explanation for some of the terms used in this section of the Best practice portal. A more general glossary for the best practice portal is also available.

Affective-focused prevention intervention

A type of prevention intervention which aims to they aim to modify inner qualities (personality traits such as self-esteem and self-efficacy, and motivational aspects such as the intention to use drugs).

BA

Before-after (BA) study design

BAL

Blood alcohol level (BAL)

Beneficial

Interventions for which precise measures of the effects in favour of the type of intervention were found in systematic reviews of relevant studies. An intervention ranked as ‘beneficial’ is suitable for most patients/contexts. See the relevant module methodology page for further information.

CBA

Controlled before-after (CBA) study design. UCBA stands for Uncontrolled before-after study design.

CBT

Cognitive behavioral therapy is an individual based intervention occurring in three stages. Phase 1 is aimed at determining and prioritizing the patient’s problems and constructing the treatment contract. Phase 2 is aimed at increasing coping competence and reducing risky behaviors. Phase 3 focuses on relapse prevention. Each session is administered once per week over a period of 4-6 months with 60- to 90-minute sessions (Beck AT, Wright FW, Newman CF, Liese B. Cognitive Therapy of substance abuse. New York: Guilford Press, 1993).

CCT

Controlled clinical trials (CCT)

Cohort study

A cohort study is a type of observational study that follows a group of people (i.e. a cohort) over time. In a prospective cohort study, the cohort is formed and then followed over time. In a retrospective cohort study, data is gathered for a cohort that was formed sometime in the past.

Confidence Interval (CI)

The Confidence Interval (CI) is a measure of the precision (or uncertainty) of study results. It is the interval that most likely includes the true value of the parameter we are calculating, where 'most likely' is taken by common usage to be a 95% probability. Thus the current expression of '95 % CI'. A wide CI indicates less precise estimates of effect and vice versa.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
CPS

Current population survey (CPS)

Cross-sectional study

A cross-sectional study is a study employing a single point of data collection for each participant or system being studied.They are usually conducted to estimate the prevalence of the outcome of interest for a given population at a given point in time.

Evidence of ineffectiveness

Interventions that gave negative results if compared with a standard intervention or no intervention, for example. See the relevant module methodology page for further information.

Additional information for prevention
For ethical reasons this category in prevention should be considered as interventions with negative and undesired (iatrogenic) effect.

IP

Individual psychotherapy is a standard individual treatment based on counseling and motivational interviewing and focused on substance use triggers and strategies for relapse prevention. It includes elements of cognitive-behavioral therapy (CBT).

IQR

Interquartile range (IQR) - also called the midspread or middle fifty - is a measure of statistical dispersion. It is a trimmed estimator, defined as the 25% trimmed mid-range, and is the most significant basic robust measure of scale.

ITS

Intermittent time series design (ITS)

Knowledge-focused prevention intervention

A type of prevention intervention which aims to to enhance knowledge of drugs, and drug effects, and consequences.

Likely to be beneficial

Interventions that were shown to have limited measures of effect, that are likely to be effective but for which evidence is limited. An intervention ranked as ‘likely to be beneficial’ is suitable for most contexts/patients, with some discretion. See the relevant module methodology page for further information.

Number Needed to Treat (NNT)

The Number Needed to Treat (NNT)indicates the number of patients that needs to be treated to obtain one respondent patient. Numerically the NNT is the reciprocal of the difference between the proportion of events in the experimental and the comparison group (absolute risk reduction). Taking into consideration that the ideal NNT would be 1 (the unreal situation in which every single patient succeeded) it is easily understood that a NNT value close to 3 or 4 would be very good.

Adjusted Odds Ratio (AOR)

The Adjusted Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups, yet they are calculated adjusting for or controlling for other possible contributions from other variables (tipically demographic variables) in the model. An AOR equal to 1 implies that the the event is equally probable in both groups. An AOR greater than 1 implies that the event is more likely in the first group. An AOR less than 1 implies that the event is less likely in the first group.

Odds Ratio (OR)

The Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups. Like the Relative Risk, an OR equal to 1 implies that the the event is equally probable in both groups. A OR greater than 1 implies that the event is more likely in the first group. A OR less than 1 implies that the event is less likely in the first group. In medical research, the odds ratio is commonly used for case-control studies, as odds, but not probabilities, are usually estimated. Relative risk is used in randomized controlled trials and cohort studies.

p value

A p-value is a measure of how much evidence we have against the null hypothesis. The null hypothesis represents the hypothesis of no change or no effect. The smaller the p-value, the more evidence we have against the null hypothesis thus it is more likely that our sample result is true. Traditionally, researchers will reject a null hypothesis if the p-value is less than 0.05.

RBS

Responsible beverage service (RBS)

RCT

Randomised controlled trial (RCT)

Relative Risk (RR)

The Relative Risk (RR) is used to compare the risk in the two different groups of people, i.e. treated and control groups to see if belonging to one group or another increases or decreases the risk of developing certain outcomes. This measure of effect will tell us the number of times an outcome is more likely (RR > 1) or less likely (RR < 1) to happen in the treatment group compared with the control group.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
Trade-off between benefits and harms

Interventions that obtained measures of effects in favour of the intervention, but that showed some limitations or unintended effects that need to be assessed before providing them. See the relevant module methodology page for further information.

 
Unknown effectiveness

Interventions for which there are not enough studies or where available studies are of low quality (with few patients or with uncertain methodological rigour), making it difficult to assess if they are effective or not. Interventions for which more research should be undertaken are also grouped in this category.

Additional information for prevention
For prevention interventions,  this  is also known as 'zero effect'.

Skill-focused prevention intervention

A type of prevention intervention which aims to enhance students’ abilities in generic skills, refusal skills and safety skills.

Standardised Mean Difference (SMD)

The Standardised Mean Difference (SMD) is the difference in means divided by a standard deviation. Note that it is not the standard error of the difference in means (a common confusion). The standardized mean difference has the important property that its value does not depend on the measurement scale. It may be useful if there are several trials assessing the same outcome, but using different scales.

z score (Standard Score)

The z-score (aka, a standard score) indicates how many standard deviations an element is from the mean of the population.

Definition

In this portal, ‘education’ is defined as a specific learning opportunity for former or current drug users. This implies that education is defined as the learning or upgrading of literacy or numeracy skills but does not include specific training for a given kind of job. Vocational training is designed to help participants acquire employment readiness and/or the practical skills and understanding necessary for employment in a particular occupation or trade or class of occupations or trades.

Barriers to social inclusion

Personal level:
limited or no qualifications, including low levels of literacy and numeracy; poor employment histories; criminal records precluding certain careers (e.g. police, teaching, working with children, financial institutions); chronic mental and physical ill health; insecure housing circumstances; limited interpersonal skills; complex personal needs; lack of confidence; chaotic lifestyles (e.g. poor timekeeping); family problems; low expectations of themselves and of life in general.

Structural level:
requirement to attend treatment on a daily basis; inadequate opening hours of treatment services that are incompatible with working hours; lack of interagency coordination; stigmatising and discriminative views, actions and procedures; inability to open a bank account to receive wages; increased likelihood of temporary or insecure work; shortage of suitable employment opportunities; perceived ‘benefit trap’ whereby an (incorrect) belief is held that the loss of welfare benefits as a consequence of employment will result in a reduction in income that is not compensated by the salary; criminal record checks required by employers.

Interventions

Vocational training

Vocational training incorporates programmes that aim to support employment-finding strategies and self-efficacy; improve commitment to work and interview skills; and develop transferable (e.g. time management, presentation skills, self-evaluation) and role-specific (e.g. computer literacy) skills. Training courses are often offered by both drug treatment services and specialist private or state providers (e.g. national employment services).

Qualifications

These interventions refer to formalised education during which the client undertakes examinations and other forms of assessment to gain nationally recognised qualifications.

Retraining as drug workers

Not a formalised intervention per se, but many problematic drug users who have recovered or are in recovery contribute to drug treatment services after retraining as drugs workers themselves. Clients enter the workplace in the drug treatment field as either a volunteer or a specialist worker.

Volunteering and temporary work experience placements

Volunteering and temporary work experience placements are often important components of vocational rehabilitation. The objective of volunteering (with respect to the long-term goal of gaining employment) is to allow the individual to gain workplace confidence and self-esteem, acquire new skills and demonstrate to potential employers that he or she is able to adapt to the workplace environment.
Temporary work experience aims to enhance existing skills and prepares the individual to conduct a specific role, particularly those of a more specialist nature. Selection processes often mirror those of paid employment, and work experience may attract a salary.

Outcomes

The main outcomes considered as proxy of social reintegration were employment-related outcomes.

Primary outcomes

  • Employment rate
  • Employment attendance
  • Average income

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Page last updated: Friday, 16 December 2016