Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Supported Employment

Workbook
Chapter 3: Principles Of Supported Employment

Chapter overview

Supported employment programs are based on a core set of principles. These principles form the foundation of the program, and they are critical to ensuring that services are available to all consumers, that program staff are respectful of consumer choices, and the program is effective in achieving and sustaining the goal of competitive work in the community. These principles are listed below, and are subsequently elaborated upon.

List of six core principles
Core Principles of Supported Employment

1. Eligibility is based on consumer choice
2. Supported employment is integrated with treatment
3. Competitive employment is the goal
4. Job search starts soon after a consumer expresses interest in working
5. Follow-along supports are continuous
6. Consumer preferences are important

Supervisor’s note

These principles are so important that it is helpful to ask employment specialists to memorize them. You can begin supervision sessions by having each employment specialist write down the principles from memory until they can all do it easily and understand the ideas.

Principle One: zero exclusion
No one is excluded

Consumers who are interested in work are not prevented from participating in supported employment, regardless of their psychiatric diagnosis, symptoms, work history, or other problems, including substance abuse and cognitive impairment. The core philosophy of supported employment is that all persons with a disability can work at competitive jobs in the community without prior training, and that no one should be excluded from this opportunity. Supported employment does not attempt to bring consumers to some preconceived standard of “work readiness” before seeking employment. Consumers are “work ready” when they say they want to work. Research on which consumers are most likely to succeed in supported employment programs indicates that symptoms, substance abuse, and other consumer factors are not strong and consistent predictors of work. Therefore, there is no justification for excluding consumers who are interested in work from supported employment programs.

Principle Two: integration of vocational rehabilitation and mental health
Vocational and mental health services are integrated

Vocational rehabilitation and mental health treatment are integrated at the team level by the different providers of these services. It is best when employment specialists function as members of consumers’ treatment teams and participate regularly in team meetings. Close coordination of supported employment with other rehabilitation and treatment services ensures that consumers’ vocational goals are given a high priority by everyone involved in providing services, and not just the employment specialist. Participation of employment specialists in team meetings provides a vehicle for discussing clinical and rehabilitation issues relevant to work, such as medication side effects, persistent symptoms (e.g., hallucinations), cognitive difficulties, or other rehabilitation needs (e.g., skills training to improve ability to socialize with co-workers or self-assertion skills). Regular meetings between employment specialists and other team members also give other practitioners the opportunity to help and have input into assisting the consumer achieve his or her vocational goals.

Principle Three: competitive employment
Competitive employment is the goal

Supported employment emphasizes helping consumers obtain competitive jobs, paying competitive wages. “Competitive jobs” are jobs that exist in the open labor market, that anyone could have regardless of their disability status, rather than jobs that are set aside for persons with a disabilities, and pay at least minimum wage. The wage should not be less than the normal wage (and level of benefits) paid for the same work performed by individuals who do not have a mental illness.

Competitive work is valued for several reasons. First, consumers express a strong preference for competitive work over sheltered work, and a desire to work in community settings. Second, competitive work promotes the integration of persons with psychiatric disabilities into the community through their involvement in normal activities, which will reduce the stigma of mental illness experienced by these individuals. Third, consumers’ self-esteem often improves as they see they are able to work competitively, that their work is valued, and that they can contribute to society. Last, historically, many vocational rehabilitation programs have placed consumers with disabilities into non-competitive jobs, often paying sub-minimum wages, with only rare progression onto competitive employment. Experience shows that consumers can successfully work at competitive jobs without prior participation in training programs or non-competitive jobs.

Principle Four: rapid job search
The job search starts soon after expressing interest in working

The process of looking for work begins soon after a consumer begins working with an employment specialist, and is not postponed by requirements for completing extensive pre-employment assessment and training, or intermediate work experiences (like prevocational work units, transitional employment, or sheltered workshop experiences). Rapid job search is crucial for several reasons. As consumers begin the process of identifying and exploring specific job possibilities, they (and their employment specialists) learn more about the type of work and work setting they desire. Beginning the search process early demonstrates to consumers that their desire to work is taken seriously, and conveys optimism that there are multiple opportunities available in the community for the consumer to achieve their vocational goals. Looking for jobs soon after a consumer has been referred to a supported employment program may also be important for consumers who are ambivalent about work, and whose motivation may be tenuous. Fears and misconceptions about work can often be best confronted by helping consumers actually explore possible jobs. Seeking work immediately takes advantage of the consumer’s current motivation. Studies show that fewer people obtain employment when the job search is delayed by prevocational preparations and requirements. Finally, rapid job search is critical because many jobs may need to be explored before the right one is selected, and beginning this process early increases the chances of eventual success. Similar to how most people become steady workers, consumers commonly try several jobs before finding one that they keep.

To help direct the job search the employment specialist draws up a vocational profile that includes a review of the consumers’ work, preferences for type of work, and other background information. Information is collected from the consumer, service providers, and with permission from the consumer from family members and previous employers. This profile can be completed within a few days of the consumer joining the vocational program. However, rather than assessment being static and occurring only before obtaining a job, assessment is ongoing, without a defined beginning and end. Employment specialists, in collaboration with consumers, are constantly in the process of updating and revising their evaluation of consumers’ strengths, challenges, and areas of support, and critical environmental factors that influence work and adjustment at the workplace based on their competitive, community-based job experiences.

Principle Five: time-unlimited support
Support is provided over time, as long as consumers want it

The assistance provided to consumers receiving supported employment services needs to be given on a time unlimited basis. Some consumers struggle with psychiatric disabilities that persist over time so their optimal treatment and rehabilitation requires a long-term commitment. Thus, consumers receiving supported employment services are never terminated from these services, despite the extent of their vocational success, unless they directly request it. While support is provided on a time unlimited basis, for many consumers the extent of support gradually decreases over time as employment specialists teach and facilitate the ability of consumers to meet their own needs for success at the workplace (e.g., arranging own transportation to work, ability to perform the job without coaching, socialization skills at work, skills for responding to criticism from a supervisor). Thus, the goal of the employment specialist is to help the consumer become as independent as possible in his or her vocational role, while always remaining available to provide support and assistance.

Principle Six: attention to consumer preferences
Job choice follows consumer preference

Consumer preferences play a key role in determining the type of job that is sought, the nature of support provided by the employment specialist, and the decision about whether to disclose the person’s psychiatric disability to the employer. Consumers who obtain work in their area of interest tend to have higher levels of satisfaction with their jobs, and have longer job tenures. Thus, attending to consumer job preferences can often make the work of the employment specialist easier because consumers are more likely to remain on the job. Consumers differ in how they want to be supported by their employment specialists, and these preferences are given close attention. Some consumers are willing to disclose their disability to prospective employers, and want their employment specialist involved in all aspects of work, including help in identifying and obtaining jobs, maintaining ongoing contact with the employer, and providing on-site and off-site job support. Other consumers prefer to keep their psychiatric disability confidential, and look to their employment specialist to provide “behind the scenes” support, but not to have direct contact with employers. These preferences are honored as it is crucial to listen to how consumers want to be supported in their pursuit of vocational goals.

Chapter summary

In summary, supported employment is guided by six clear core principles. These principles, corroborated by research, describe supported employment and differentiate it from other practices.

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