Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Supported Employment

Implementation Tips for Public Mental Health Authorities

The development of the Evidenced-Based Practice Implementation Package—training, consultation, and resource materials presents the public mental health authority with a unique opportunity to bring the latest research foundation about services for adults with mental illness to the many constituency groups. The work of mental health services system research has reached a point in its evolution where it has been able to identify a cluster of practices that have demonstrated their consistent positive impact on the lives of consumers and their families. These interventions are:

• integrated dual disorders treatment
• supported employment
• family education
• illness management and recovery
• assertive community treatment
• medication

The implementation package developed by the Implementing Evidence-Based Practice Project have been designed to involve consumers, family members, clinicians, program leaders, and the public mental health authority in a consolidated effort to implement these practices in routine mental health settings to support the recovery process for consumers. The success of this initiative depends on the public mental health authority’s leadership and ongoing oversight of these projects as they develop in local communities across your state and region.

In the implementation of these interventions, the public mental health authority will first need to assemble all of the stakeholders that need to be involved in each of the tool kit implementations. This certainly will involve consumers, family members, related state and public organizations, and provider groups. It may also involve organizations not usually associated with the mental health service system. For example, in planning for the development of the supported employment intervention, involving the Chamber of Commerce or other business associations, Department of Labor One-Stop Centers and Workforce Investment Boards, Division of Vocational Rehabilitation, and offices of Medicaid and social security can be very helpful. From the beginning, the public mental health authority needs to lead this group in understanding and articulating the specific evidence-based practice and how it is going to be developed in the service system. Articulating the vision and building momentum for that vision is essential for the success of the project.

With a vision (e.g., that persons with mental illness can work and experience competitive employment through supported employment) firmly in place, the intervention in the service system can begin. Careful planning of this process will go a long way to ensure a successful outcome. A pilot or demonstration site can be useful both in managing the inevitable problems that will arise, as well as giving all the constituents an opportunity to see that this intervention works. The public mental health authority should ensure that there are incentives in place so new practices can be implemented. Attention to the alignment of these incentives in a positive way (e.g., financial incentives for competitive employment outcomes) is vital to the success of the implementation of each of these clinical interventions.

Sustaining the project is a challenge that should be addressed in the initial planning process. Unfortunately, there are countless examples of excellent initiatives that began well and had the enthusiastic support of participants, which then floundered at the end of a year because no one thought to address the critical issue of ongoing project maintenance. The public mental health authority needs strategies to address this issue and assure that the project will continue to grow and develop.

How can public mental health authorities increase the access to supported employment programs and improve consumer employment outcomes?

• Establish competitive employment as an outcome for the mental health system.
• Provide information on supported employment to major stakeholders to enlist their support.
• Set employment performance outcomes with financial incentives.
• Consider shifting resources from services that have not been scientifically demonstrated to be effective or that are less desired by consumers. Reallocate reimbursement rates to provide incentive to implement supported employment.
• Identify and solve the financial and organizational barriers to implementation.
• Meet regularly (at least quarterly) with the director of Vocational Rehabilitation to work out collaborative efforts between mental health agencies and Vocational Rehabilitation offices.
• Designate at least one person or task force charged with overseeing the employment initiative in the state.
• Arrange for ongoing systematic training and consultation and supervision for all levels within the provider agencies (e.g., management, supervisors, case managers, supported employment staff).
• Establish an annual statewide conference on supported employment.
• Systematically measure fidelity of program implementation and provide feedback on performance both to the state mental health authority and to the local provider.
• Consider establishing a pilot or demonstration site that will allow for managing the inevitable problems that will arise, as well as giving all constituents the opportunity to see that the intervention works.
• Provide public recognition for programs achieving the highest levels of competitive employment.
• Write Medicaid rules to allow reimbursement for selected supported work activities.
• Explicitly reference evidence-based practices in licensing standards and other program review documents (e.g., grant applications, contracts, requests for proposals, etc.)
• Conduct a review of public mental health authority practices that foster competitive employment.

NOTE: Each state is different, in many cases a supported employment initiative can be mounted with little or no additional appropriations.

For more information:

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.

The Supported Employment Implementation Resource Kit contains copies of research articles and an annotated bibliography in the User’s Guide.

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