SUPPORTED
EMPLOYMENT
EVIDENCE-BASED
PRACTICE
Evidence-Based Practices
Copyright West Institute
Why Focus on
Employment?
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Viewed by many as an essential part
of recovery
Most consumers want to work
A typical role for adults in our
society
Cost-effective alternative to
day treatment
Evidence-Based Practices
Copyright West Institute
Positive Outcomes from
Competitive Work
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Higher self-esteem
Better control of psychiatric symptoms
More satisfaction with finances and with
leisure
(Bond et al., 2001)
Evidence-Based Practices
Copyright West Institute
Is Work Too Stressful?
As compared to what?
 Joe Marrone, an employment
trainer:
“If you think work is stressful, try
unemployment.”
 Stresses of work do not translate
into higher rates of hospitalization
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Evidence-Based Practices
Copyright West Institute
Negative Effects of
Unemployment in General
Population
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Increased substance abuse
Increased physical problems
Increased psychiatric disorders
Reduced self-esteem
Loss of social contacts
Alienation and apathy
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Evidence-Based Practices
(Warr, 1987)
Copyright West Institute
Competitive Employment
for People with Severe
Mental Illness
Say they want to work: 70%
 Are currently working: <15%
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Evidence-Based Practices
Copyright West Institute
Quotes from Consumers
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“I feel so much better about myself now
that I have a job.”
“Holding down my job is not always easy
but it has helped my self esteem.”
“When I go to work I don’t hear the
voices.”
“Now that I am working again I can buy
my daughter presents.”
Evidence-Based Practices
Copyright West Institute
Quotes from Family
Members
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“I worried that if my son got a job he would
get stressed. But just the opposite happened.
He is doing so much better than before.”
“I feel better that she tries working when she
has the support of mental health.”
“I was really glad that my son’s employment
counselor asked me about work ideas. He
landed a job that I suggested.”
Evidence-Based Practices
Copyright West Institute
Quotes from Employers
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“Andre is as good as any worker that I have.”
Automotive parts store manager.
“I count on Juanita. If she is feeling stressed,
she sits in the back room for awhile. That’s
OK; she gets the job done.” Bakery
supervisor.
“The employment counselor helped me
understand why Tony paces. It’s okay in the
security business.” Security business owner.
Evidence-Based Practices
Copyright West Institute
Evidence for Effectiveness
% Gaining Competitive Employment:
• 58% -- Supported Employment
• 21% -- Traditional Voc Services,
such as:
Prevocational programs
 Sheltered workshops
 Transitional employment

(Bond et al., 1997)
Evidence-Based Practices
Copyright West Institute
Figure 2. Competitive Employment Rates in 6 RCTs of Supported
Employment
90%
80%
70%
60%
50%
Supported
Employ ment
40%
30%
20%
10%
0%
Bond 95
Chandler
97
Evidence-Based Practices
Drake 96
Drake 99
Gervey 94
McFarlane
00
Copyright West Institute
Cont rol
Definition of
Supported Employment
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Mainstream job in community
Pays at least minimum wage
Work setting includes people who are not
disabled
Service agency provides ongoing support
Intended for people with most severe
disabilities
Evidence-Based Practices
Copyright West Institute
Evidence-Based
Principles
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Eligibility is based on consumer choice
Supported employment is integrated with
treatment
Competitive employment is the goal
Job search starts soon after a consumer
expresses interest in working
Follow-along supports are continuous
Consumer preferences are important
Evidence-Based Practices
Copyright West Institute
Eligibility Is Based on
Consumer Choice
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Consumers are not excluded
because they are not “ready” or
because of prior work history,
hospitalization history, substance
use, symptoms, or other
characteristics.
No one is excluded who wants to
participate.
Evidence-Based Practices
Copyright West Institute
Supported Employment Is
Integrated with Mental
Health Treatment

Employment specialists
coordinate plans with the
treatment team, e.g., case
manager, therapist,
psychiatrist, etc.
Evidence-Based Practices
Copyright West Institute
Competitive Employment
Is the Goal
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The agency needs to devote sufficient
resources to supported employment to
permit full access to all consumers who
seek competitive employment
Consumers interested in employment
are not steered into day treatment or
sheltered work.
Evidence-Based Practices
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Job Search Starts
Soon After A
Consumer Expresses
Interest In Working
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Pre-employment assessment,
training, and counseling are
kept to a minimum.
Evidence-Based Practices
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Follow-Along
Supports Are
Continuous

Supported employment staff
continue to stay in regular
contact with consumer and
(when appropriate) the
employer without arbitrary
time limits.
Evidence-Based Practices
Copyright West Institute
Consumer Preferences
Are Important
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Job finding is based on consumers’
preferences, strengths, and work
experiences, not on a pool of jobs
that are available.
Evidence-Based Practices
Copyright West Institute
Key Factors in
Implementation
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Build Consensus
Maximize Financing
Examine Agency Philosophy
Identify Leadership
Key on Organizational Structure
Provide Ongoing Training
Make Time Commitment
Track Process and Outcomes
Evidence-Based Practices
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Build Consensus
Commitment of state mental
health authority is not enough
 Better to involve all stakeholders
- consumers, family members,
providers, and local and state
administrators
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Evidence-Based Practices
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Maximize Financing
Determine how supported
employment services can be funded
 Explore funding through mental
health, vocational rehabilitation,
and Medicaid
 Reallocate resources to supported
employment when feasible

Evidence-Based Practices
Copyright West Institute
What Does Supported
Employment Cost?
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Some programs, $2,000-$4,000 per
client per year (Clark, 1998).
Figures vary according to severity of
disability, local wages of employment
specialists, and how much indirect
costs and costs of clinical services are
included
Evidence-Based Practices
Copyright West Institute
Examine Agency
Philosophy
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Determine if service agency’s
philosophy, mission statement, and
service paradigm are consistent
with recovery-oriented, evidencebased approach to supported
employment.
Evidence-Based Practices
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Identify Leadership
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You need a champion!
• Identify committed leader with sufficient
authority to oversee and ensure
implementation
Leaders at all levels visibly show support for
supported employment
Center director buy-in is critical
Evidence-Based Practices
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Leadership Roles
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Provide necessary resources
Seek buy-in from consumers, families,
and practitioners
Give recognition to staff and
consumer for successes
Rapp’s finding – Critical role of
supervisor in program success
Evidence-Based Practices
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Organizational
Structure
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Employment specialists
• Each join one or two treatment teams.
• Share office space with treatment team.
• Communicate frequently with treatment
team members.
Team integrates supported employment,
benefits counseling, case management,
psychiatric services, and dual diagnosis
treatment.
Evidence-Based Practices
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Provide Ongoing
Training
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Initial training for all team
members, including medical staff
Continuing access to expert
consultation
Ongoing supervision that is
outcomes-oriented
Evidence-Based Practices
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Make Time
Commitment
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Typically, 6 - 12 months needed to
develop skills, interest, and
confidence for implementing
evidence-based supported
employment
Evidence-Based Practices
Copyright West Institute
Track Implementation
Process and Outcomes
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Track employment outcomes monthly
Set goals: 40% rate of competitive
employment is achievable
Service agencies should use 15-item
Supported Employment Fidelity Scale to
measure implementation of evidencebased practice (Bond et al., 1997)
Evidence-Based Practices
Copyright West Institute
Summary
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People with severe mental illness can work
in competitive employment
Programs following evidence-based
principles of supported employment have
better outcomes
Programs must address financial and
organizational barriers to be successful
Evidence-Based Practices
Copyright West Institute