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Mental Health Directors
Many mental health agencies are confronted with the challenge of meeting the needs of consumers in an environment of limited resources. Evidence-based practices are practices that lead to positive outcomes for consumers, based on a growing body of research.

While many mental health agencies are committed to assisting adults with severe mental illness improve their lives, relatively few offer up-to-date services with demonstrated effectiveness in their practice settings.

Making a decision to modify service delivery typically involves training and some programmatic changes. To assist agencies and administrators in this process, specific "resource kits" have been developed. These resource kits include introductory materials for consumers, families, and staff. Training information is delivered in a multi-modal format. One of these resource kits pertains to supported employment. Supported employment provides a practice model that has demonstrated good outcomes in assisting adults with severe mental illness to obtain and sustain competitive employment.

People with mental illness have many strengths, talents, and abilities that are often overlooked, including the ability and motivation to work. Work has become an important part of the recovery process for many consumers. Research has shown that:

  • 70% of adults with a severe mental illness desire work.
  • 60% or more of adults with mental illness can be successful at working when using supported employment.

How do we know supported employment works?

A recent review of 17 studies involving employment programs consistently demonstrated that supported employment programs showed significant advantages over traditional approaches.2 Across these studies 58% of those in supported employment obtained competitive employment compared to 21% in traditional programs.

How do we know this model is right for this agency?

Findings support superior outcomes for supported employment following evidence-based principles compared to a variety of traditional approaches, including programs that emphasize considerable pre-vocational training before helping consumers to find competitive jobs, traditional psychiatric rehabilitation programs, and rehabilitative day treatment.

Why should our agency give priority to supported employment over other vocational services?

Surveys have consistently found that adults with severe mental illness and their families identify finding and keeping jobs as a top priority.

How will our agency be reimbursed for these services?

Financing mechanisms vary from agency to agency and state to state. The leaders of numerous agencies and systems have successfully established ways to fund supported employment programs using Medicaid, vocational rehabilitation funding, and other sources. In some states, agencies have worked out a mechanism to pool monies that can be used to reimburse the services of supported employment programs. Also, Medicaid rules have been rewritten to allow reimbursement for selected supported work activities. Consultation with agencies and system administrators who have been successful in this area can provide useful ideas and strategies.

How will our agency know what changes are necessary?

The supported employment resource kit includes information regarding effective program structures, tools for measuring fidelity to the model, and simple outcome measures. The extent of changes in any agency depends on the extent of services already provided in this area and other services that are being provided to adults with severe mental illness.

What are the core principles of the supported employment model?

  • Eligibility is based on consumer choice. No one is excluded who wants to participate.
  • Supported employment is integrated with treatment: Employment specialists coordinate plans with the treatment team: the case manager, therapist, psychiatrist, etc.
  • Competitive employment is the goal. The focus is community jobs anyone can apply for that pay at least minimum wage, including part-time and full-time jobs.
  • Job search starts soon after a consumer expresses interest in working. There are no requirements for completing extensive pre-employment assessment and training, or intermediate work experiences (like prevocational work units, transitional employment, or sheltered workshops).
  • Follow-along supports are continuous. Individualized supports to maintain employment continue as long as consumers want the assistance.
  • Consumer preferences are important. Choices and decisions about work and support are individualized based on the person's preferences, strengths, and experiences.

How will our agency know if we are following the core principles?

A program fidelity scale has been piloted that measures adherence to supported employment practice. Programs that score higher on this fidelity scale were found to have higher employment rates in one study.

What training is available regarding the supported employment model?

Consultation and training from mental health services training institutes are available along with implementation resource kit materials that include: brochures, introductory and training videos, workbooks, and Web site support.

What does the training for supported employment include?

Some training institutes offer multi-model training that includes the implementation resource kit materials plus:

  • introductory training to supported employment
  • practice skills training
  • job shadowing at agencies that have implemented supported employment
  • post-training consultations
  • post-training supervision
  • post-training fidelity measures
  • post-training outcome measures

Refer to the Supported Employment Implementation Resource Kit's Implementation Tips for Mental Health Program Leaders Adobe Acrobat Reader Symbol for more information.

Have other agencies successfully implemented supported employment?

Yes, the supported employment model has been successfully implemented by agencies in a variety of states, counties, and regions.

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