Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Supported Employment

Information for Public Mental Health Authorities

Public mental health authorities need current and accurate information about the goals and challenges of people with severe mental illness in order to help shape public mental health policy. There is a growing body of research, known as evidence-based practices, that provides information around the principles and practices of the most effective services for people with severe mental illness. Supported employment is one of the evidence-based practices. 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

What is supported employment?

Supported employment programs assist people in finding competitive employment—community jobs paying at least minimum wage, which any person can apply for according to their choices and capabilities.
Supported employment is a successful approach that has been used in various settings by culturally diverse consumers, employment specialists, and practitioners.
Supported employment programs do not screen people for work readiness, unlike other vocational approaches, but help all who say they want to work.
Supported employment programs are staffed by employment specialists who help consumers look for jobs soon after entering the program. Extensive pre-employment assessment and training, or intermediate work experiences, such as prevocational work units, transitional employment, or sheltered workshops are not required.
Employment specialists facilitate job acquisition. For example, they may assist with application forms or accompany consumers on interviews.
Employment specialists support consumers as long as they want the assistance, usually outside of the work place. Support can include help from other practitioners, family members, coworkers, and supervisors

What are the core principles of the supported employment approach?

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, e.g., 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.

What are the advantages of supported employment?
Supported employment programs:

are effective for helping people to obtain competitive employment
address one of the top priorities of people with severe mental illness and their families
help people to move beyond the patient role and develop new employment-related roles as part of their recovery process
help to decrease stigma around mental illness by helping people become integrated into community life through competitive employment

What does supported employment cost?

There is variability in the costs reported by different programs and states for providing supported employment. Some programs have found the cost ranges from $2,000 to $4,000 per client, per year.¹ The cost figures vary according to many factors, including the severity of disability of the consumers served, the local wage scales for employment specialists, and the degree to which indirect costs and costs of clinical services are included in the estimates.

How is supported employment funded?

Funding mechanisms have varied from agency to agency and state to state. For the most part, funds are used from state divisions of Vocational Rehabilitation, Division of Mental Health, and Medicaid. State leaders from the agencies work out a mechanism to pool monies that can be used to reimburse the services of supported employment programs. Medicaid rules have been rewritten to allow reimbursement for selected supported work activities. Consultation with agency or system administrators who have successfully worked out a plan provides useful ideas and strategies.

What training materials are available regarding supported employment?

Supported employment information and training materials include brochures, introductory and training videos, workbooks, and website support. The materials have been developed for the major stakeholders including consumers, families and supporters, practitioners and supervisors, mental health program leaders, and public mental health authorities. Consultation and training regarding supported employment are available from mental health services training institutes.

What does the training for supported employment include?

Some training institutes offer multimodal 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

¹ Clark RE: Supported employment and managed care: Can they coexist? Psychiatric Rehabilitation Journal 22:62-68, 1998.

Refer to the Supported Employment Implementation Resource Kit’s Implementation Tips for Mental Health Program Leaders for more information.

How will mental health authorities know if they have a successful program?

How successful a supported employment program is in improving outcomes depends, in part, on how closely the program follows the supported employment practice. Programs that only partially adopt the practice or that are allowed to “drift” back into old ways of providing services may not produce the beneficial outcomes associated with supported employment. The Supported Employment Fidelity Scale is a 15-item scale that measures adherence to supported employment. Evidence indicates that programs that score high on this fidelity scale have better employment outcomes. Refer to the Supported Employment Fidelity Scale in the supported employment resource kit for more information.

For more information:

Refer to the Supported Employment Implementation Resource Kit’s Implementation Tips for Public Mental Health Authorities for more information. The resource kit also contains copies of research articles and an annotated bibliography in the User’s Guide.

More information about supported employment, as well as other evidence-based practices for the treatment of mental illness in the community, can be found at www.mentalhealthpractices.org.

Back to Supported Employment