Article Details

Research Database: Article Details

Citation:  Bond, G.R., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52 (3), 313-322.
Title:  Implementing supported employment as an evidence-based practice
Authors:  Bond, G.R., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R.
Year:  2001
Journal/Publication:  Psychiatric Services
Publisher:  American Psychiatric Association
Full text:    |   PDF   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported
Research design:  Systematic review / meta-analysis

Structured abstract:

Background:  The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.
Purpose:  The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).
Setting:  This study is a systematic review. The included studies were undertaken in various locations and settings.
Study sample:  The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.
Intervention:  Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice
Control or comparison condition:  Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psycho-social rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.
Data collection and analysis:  A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.
Findings:  The following components "are almost always present in successful vocational programs" (p. 315): 1. The agency providing supported employment services is committed to competitive employment as an attainable goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment or sheltered work. . . 2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy preemployment assessment, training, and counseling. . . 3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . . 4. Follow-along supports are maintained indefinitely. . . 5. The supported employment program is closely integrated with the mental health treatment team" (p. 315). Limitations of supported employment are: 1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce drop-out rates. 2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316). 3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits. 4. Specific details about the best way to implement supported employment has not been researched. 5. The relationship between employment and medication have not been addressed. 6. Long-term outcomes have not been studied. 7. Most clients lack access to supported employment. 8. Funding support is devoted primarily to administrative and preemployment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement. 9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.
Conclusions:  Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

Disabilities served:  Chronic mental illness
Populations served:  Gender: Female and Male
Race: Black / African American
Race: White / Caucasian
Ethnicity: Hispanic or Latino
Interventions:  Individual Placement and Support (IPS) model of supported employment
Supported employment
Outcomes:  Employment acquisition
Return to work
Increase in tenure