Professional Documents
Culture Documents
Supported Employment:
Evidence for an
Evidence-Based Practice
▼
Gary R. Bond
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Introduction
W ithin the psychiatric rehabilitation (Shumway et al., 2003) and society in
field, most consumers consider em- general also view employment as a
ployment as a key element in recovery high priority and valued outcome.
(Rogers, 1995; Steele & Berman, Most consumers with severe mental
2001). Family members (Noble, illnesses (SMI) want to work
Honberg, Hall & Flynn, 1997; Stein- (McQuilken et al., 2003; Mueser,
wachs, Kasper & Skinner, 1992), men- Salyers & Mueser, 2001; Rogers,
tal health professionals (NASMHPD, Walsh, Masotta & Danley, 1991). In
2002; New Freedom Commission on identifying work as a goal, consumers
Mental Health, 2003), policy makers usually mean competitive employ-
articles
345
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
ment, defined as community jobs that disability” (Rehabilitation Act Consumers are not excluded on the
any person can apply for, in regular Amendments, 1998). As a practice, basis of “work readiness,” diag-
places of business, paying at least min- supported employment refers to pro- noses, symptoms, substance use
imum wage, with mostly nondisabled grams to help people with disabilities history, psychiatric hospitaliza-
coworkers. The large majority of con- find and keep these kinds of jobs. tions, or level of disability.
sumers prefer competitive employment
This paper examines the practice of 3. Rapid Job Search: Supported
to sheltered work (Bedell, Draving,
supported employment for individuals employment programs use a rapid
Parrish, Gervey & Guastadisegni, 1998;
with severe mental illnesses. It is job search approach to help
Bond, Dietzen, McGrew & Miller, 1995;
divided into three sections: (1) a brief consumers obtain jobs directly,
Rogers et al., 1991). Unfortunately, con-
description of the supported employ- rather than providing lengthy pre-
sumer surveys often find that assis-
ment model; (2) summary of evidence employment assessment, training,
tance with employment is a major
regarding the effectiveness of support- and counseling.
unmet need, sometimes unrecognized
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
articles
346
Spring 2004—Volume 27 Numb er 4
(Becker & Drake, 2003). The unique model differs in this respect from the et al., 2001; Bond, Drake, Mueser &
contribution of IPS was not so much formulation by the Madison Program Becker, 1997; Crowther et al., 2001;
the invention of new techniques as it for Assertive Community Treatment Ridgway & Rapp, 1998; Schneider et
was the distillation of the best knowl- (PACT), which conceives of vocational al., 2002; Twamley, Jeste & Lehman,
edge in the field at that time and the specialists as practitioners who devote 2003). The impact of supported em-
rejection of unfounded ideas. Two as- part of their time to employment and ployment is specific to employment
sumptions once in vogue that have part of their time to mental health outcomes. Studies suggest that enroll-
been discarded because research has treatment (Russert & Frey, 1991). ment in supported employment has no
proven them to be unhelpful are: (1) Anecdotally, PACT’s formulation of the systematic impact on nonvocational
people with SMI need an extended pe- vocational specialist role appears to re- outcomes, either on undesirable out-
riod of time in vocational preparation sult sometimes in a less dependable comes, such as rehospitalization, or on
before entering a competitive job in focus on employment, because it dif- valued outcomes, such as improved
order to become work ready and to fuses the vocational focus within the quality of life. However, consumers
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
identify career goals (Anthony & team and creates role conflict for the who hold competitive jobs for a sus-
Blanch, 1987) and (2) rehabilitation practitioner expected to balance voca- tained period of time show benefits
services should be provided separately tional and clinical responsibilities. such as improved self-esteem and bet-
from mental health treatment services ter symptom control (Bond, Resnick, et
The position taken in this paper is that
(Noble et al., 1997). A third idea, in- al., 2001). Converging lines of evidence
IPS is not a distinct supported employ-
cluded in the definition of supported come from two primary sources: day
ment model. Instead, Becker and Drake
employment in the federal legislation treatment conversion studies and ran-
view IPS as a standardization of sup-
(Rehabilitation Act Amendments, 1998) domized controlled trials.
ported employment principles in pro-
but not incorporated into the IPS
grams for people with SMI, so that Day treatment conversion studies. Four
model, was the use of transitional em-
supported employment can be clearly studies have been conducted examin-
ployment (Beard, Propst & Malamud,
described, scientifically studied, and ing the effectiveness of converting day
1982). Transitional employment con-
implemented in new communities. treatment services to supported em-
sists of time-limited job placements
Over the last decade no new models of ployment (Bailey, Ricketts, Becker, Xie
developed by a rehabilitation agency
supported employment for people with & Drake, 1998; Becker, Bond, et al.,
that consumers work in preparation for
SMI articulating a distinctly different 2001; Drake et al., 1994; Drake, Becker,
competitive jobs. The debate over the
set of principles than those of IPS have Biesanz, Wyzik & Torrey, 1996; Gold &
merits of transitional employment (and
appeared in the literature. Therefore, it Marrone, 1998). These studies involved
other forms of “protected work,” i.e.,
makes sense to consider the IPS princi- 6 different sites converting from day
jobs reserved for people with disabili-
ples as a starting point for the princi- treatment to supported employment, 5
ties) continues. Transitional employ-
ples of supported employment, of which closed down their day treat-
ment is a defining feature of the
recognizing that additions, refine- ment services altogether (Becker,
clubhouse model (Macias, Barreira,
ments, and deletions are all ongoing Bond, et al., 2001; Drake et al., 1994;
Alden & Boyd, 2001), although its use
processes in an empirical approach to Drake, Becker, et al., 1996; Gold &
appears to be diminishing (Cook &
defining an evidence-based practice. In Marrone, 1998) and one which cur-
Razzano, 1995; Starks, Zahniser, Maas
this paper, the term IPS is used inter- tailed its day treatment services (Bailey
& McGuirk, 2000).
changeably with evidence-based sup- et al., 1998). The first study compared a
One element in IPS that does appear to ported employment. day treatment program conversion to a
be an original and critically important center that did not initially convert its
contribution is the model’s organiza- services (Drake et al., 1994), but later
Evidence for the Effectiveness of
tional structure, which stipulates that did (Drake, Becker, et al., 1996); the
Supported Employment
employment programs operate in close second compared a portion of their
collaboration with mental health treat- Using the most stringent requirements program that converted to a group of
ment teams (an idea extrapolated from for level of evidence, all the recent re- day treatment clients not involved in
the assertive community treatment views of supported employment for the conversion (Bailey et al., 1998); the
model), but in a fashion in which the consumers with SMI point to the con- third compared two centers undergoing
employment program retains its sepa- clusion that it should be considered an conversions to one that did not
rate identity and mission. The IPS evidence-based practice (Bond, Becker, (Becker, Bond, et al., 2001); and the
articles
347
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
Figure 1—Competitive Employment Rates Before and After Converting from Day Treatment to
Supported Employment
70%
60%
50%
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
40%
This document is copyrighted by the American Psychological Association or one of its allied publishers.
30%
20%
10%
0%
Notes: Drake (1994) and (1996) based on 1-year baseline and 1-year follow-up; Bailey (1998) baseline based on 3-month period
before conversion and post data based on final 3-month period of follow-up year; Gold (1998) based on indeterminant baseline peri-
od before conversion and 1-year follow-up; Becker (2001) based on 6-month baseline and 24-month follow-up. Gold (1998) and
Becker’s (2001) Conversion Site A had 0% employment at baseline.
fourth was a 1-year follow-up study of ployment and 184 consumers in the the percentage of consumers obtaining
consumers enrolled in a day treatment comparison sites. The pre-post time competitive jobs nearly tripled after
program after its closing (Gold & periods varied across studies, ranging conversion of day treatment to sup-
Marrone, 1998). The sample in this last from 3 to 12 months for baseline and ported employment, while competitive
study consisted of consumers who from 3 to 24 months for follow-up. employment rates in nonconverting
originally were referred because they During the baseline period, while con- sites remained virtually static.
“had no rehabilitation potential.” sumers were still attending day treat-
One rival hypotheses sometimes of-
They had averaged over 8 years of at- ment, the employment rate was 13% in
fered to explain these findings is that
tendance and none had any recent the conversion sites and 12% in the
because consumers have often been
employment. comparison sites. During follow-up,
enrolled for years in day treatment
after the converting sites had switched
Pre-post employment rates in these 6 prior to a conversion, they are better
to supported employment, 38% of the
conversion sites and 3 comparison prepared to enter the work force.
consumers in the supported employ-
sites are shown in Figure 1. Altogether, However, this hypothesis does not ap-
ment sites worked competitively, com-
these studies included 317 consumers pear credible, given the unpublished
pared to 15% of the consumers in the
in sites converting to supported em- findings from the Rhode Island study
comparison sites. On average, then,
articles
348
Spring 2004—Volume 27 Numb er 4
articles
349
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
(Becker, Bond, et al., 2001). After the These 9 studies have been conducted to supported employment (Bond,
closure of one program, new admis- by 7 different research teams (although Dietzen, McGrew, et al., 1995). The final
sions directly to the supported employ- Becker and Drake were consultants on 2 studies compared supported employ-
ment program (i.e., consumers who the Gold and Lehman studies) in vari- ment to referral to the state-federal vo-
previously would have gone into day ous geographic regions (Indiana, cational rehabilitation (VR) program
treatment) increased their rate of com- California, New Hampshire, District of (Chandler et al., 1997; McFarlane et al.,
petitive employment to over 50% even Columbia, New York, South Carolina, 2000).
more rapidly than former day treatment Connecticut, and Maryland), represent-
The studies used a variety of measures
clients (Becker & Drake, 2003). There is ing both rural and urban communities.
to assess effectiveness of employment
no evidence that attendance in day Five of the studies have compared IPS
services, including the percentage ob-
treatment is a useful strategy for to some form of standard practice
taining competitive employment, total
preparing consumers for competitive (Drake et al., 1999; Drake, McHugo, et
wages earned, and number of weeks
employment. al., 1996; Gold et al., submitted;
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
articles
350
Spring 2004—Volume 27 Numb er 4
The implications are that supported involving organized participation of the centage of PACT clients achieved em-
employment yields superior employ- family and the formation of an employ- ployment than clubhouse members,
ment outcomes compared to standard er’s council (McFarlane, 2002); and in apparently largely a result of a signifi-
services, even factoring in the com- Texas, Toprac and colleagues studied a cantly higher dropout rate for club-
monly encountered difficulties of the social network enhancement to sup- house members. (During the last
start-up phase of implementation. Of ported employment (Toprac, unpub- 6-month period of the 2-year follow-up,
the comparison groups, referral to VR lished). Using a quasi-experimental 40% of clubhouse participants had
would be considered the weakest, design, an Oregon project evaluated dropped out, compared to 19% of PACT
given the dismal record overall for this “IPS Plus,” an approach seeking to in- clients.) However, among those who
agency, especially for consumers with tensify consumer choice (Paulson, achieved employment, the clubhouse
SMI (Noble et al., 1997). Nonetheless, Post, Herinckx & Risser, 2002). To date, sample averaged more days of employ-
one RCT evaluating a well-regarded vo- none of these innovations have demon- ment than the PACT sample. A fascinat-
cational approach—the Choose-Get- strated incremental utility over the evi- ing finding from the study was the low
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Keep skill building approach—failed to dence-based supported employment proportion (28%) of transitional em-
show differences in competitive em- approach previously outlined. ployment placements among the club-
ployment outcomes compared with a Nevertheless, efforts to refine evi- house jobs held during the
control group who were referred to VR dence-based practices are critical in study—lower than one might expect
(Rogers, 2000). In summary, the RCTs order to avoid the rigidity of beliefs to based on the clubhouse literature.
of supported employment have in- which proponents of a practice are so
Two factors may have diminished the
volved reasonably stringent tests of its very susceptible.
vocational effectiveness of the PACT
effectiveness.
Finally, one recent study compared a program in this study. First, the start-
Several additional studies, some of well-established clubhouse program to up phase is generally longer and more
which are still in progress, offer further a newly-developed PACT program difficult for a PACT program than for a
stringent tests of the effectiveness of (Macias, 2001). Of particular note is the supported employment program only.
supported employment by comparing it comparison to the clubhouse model, Simultaneously developing both a new
to strong alternatives, while others which has been widely disseminated PACT program and its vocational com-
offer enhancements of the basic but infrequently studied. The club- ponent may have compounded the
model. RCTs in progress include a house program was accredited by the challenges of start-up. Second, the
multinational European study (Burns, International Center for Clubhouse PACT model approach to defining the
Oxford University, UK) and a Canadian Development, using standards defining vocational specialist role may be less
study (Latimer, Douglas Hospital, high fidelity to the clubhouse model effective than programs in which em-
Montreal) comparing IPS to usual serv- (Macias et al., 2001). Conversely, the ployment specialists have exclusively
ices, a study comparing IPS to a diver- PACT program attained high fidelity to vocational responsibilities, although
sified placement approach (Bond, the ACT model (Teague, Bond & Drake, this hypothesis has not been experi-
IUPUI), two studies comparing stan- 1998). In addition, its vocational servic- mentally studied.
dard IPS to IPS + skills training (Tsang, es attained high fidelity to most items
Hong Kong Polytechnic University; on the IPS Fidelity Scale, although the
Evidence for the Principles of
Marder, UCLA) and another comparing PACT approach requires the vocational
Supported Employment
IPS + skills training to referral to VR specialist to provide clinical services in
services (Nuechterlein, UCLA), and a addition to vocational services, which This section examines the evidence
study evaluating a motivational inter- the IPS model does not. The employ- supporting the criticality of 7 principles
viewing enhancement of IPS intended ment outcomes measured in this study of supported employment, including
to increase consumer interest in em- did not differentiate between competi- the 6 IPS principles defined above,
ployment (Corrigan, University of tive employment and protected jobs plus one additional principle, benefits
Chicago). Two recent experimental developed by the clubhouse program, counseling, which refers to ongoing
studies compared enhancements of so direct comparisons to the supported planning and guidance to help con-
supported employment to supported employment programs reviewed above sumers make well-informed decisions
employment without these enhance- are difficult. Neither program showed regarding Social Security, Medicaid,
ments. In Maine, McFarlane and col- clearly superior employment out- and other government entitlements.
leagues studied an enhancement comes. A nonsignificantly higher per- Evidence is examined from three
articles
351
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
sources: expert opinion, studies of more specific practice guidelines. employment, explaining their low suc-
supported employment “as a pack- Overall, the 10 top-ranked items were cess rate.
age,” and studies shedding light on in- as follows: (1) Benefits counseling;
In a qualitative study, Gowdy, Carlson,
dividual principles. (2) Non-exclusionary policy (i.e., not
and Rapp (2003) examined employ-
excluding consumers from services);
Evidence from Expert Opinion ment rates for 27 community mental
(3) Adequate funding available;
The published sources describing the health centers in Kansas, identifying
(4) Individualized job supports;
principles (or “critical ingredients”) of program features differentiating the 5
(5) Attention to consumer preferences;
supported employment for people with centers with the highest employment
(6) Job match; (7) Focus on competitive
SMI generally show large areas of rates from the 4 with the lowest rates.
employment; (8) Recovery philosophy;
agreement (Bond, 1994, 1998; Cook & Three of the 7 supported employment
(9) Employment specialist contact
Razzano, 2000; Gowdy, Carlson & principles identified above emerged
with mental health treatment team;
Rapp, 2003; Ridgway & Rapp, 1998). from their analysis. The high perform-
(10) Rapid job search. Thus, within the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Cook and Razzano (2000) identified 6 ing centers (1) strongly focused on
This document is copyrighted by the American Psychological Association or one of its allied publishers.
articles
352
Spring 2004—Volume 27 Numb er 4
(A) Specific targeted efforts toward proponents. Family psychoeducation ployment outcomes (Bond & Meyer,
competitive employment are more ef- has also been proposed as helpful to 1999).
fective than indirect strategies; improving employment outcomes
B. Day treatment, sheltered employ-
(B) Day treatment, sheltered employ- (McFarlane, Dushay & Stastny, 1995);
ment, and other approaches lacking a
ment, and other approaches lacking a its impact on employment outcome is
competitive employment focus, do not
competitive employment focus, do not modest in the absence of a targeted vo-
contribute to and may interfere with
contribute to, and may interfere with, cational program (Mueser, Salyers, et
the goal of competitive employment.
the goal of competitive employment; al., 2001). Similarly, few experts as-
The strongest evidence for the ineffec-
(C) Competitive employment outcomes sume that excellent case management
tiveness of day treatment is given by
are more desired and more recovery- services, in and of themselves, lead to
the day treatment conversion studies
oriented than other forms of paid em- better employment outcomes. The liter-
reviewed above. The dismal employ-
ployment. ature suggests case management in
ment rates in most such programs,
the absence of specific vocational ef-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
articles
353
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
ing whether employment specialists 2000), especially in economies that from vocational services are based on
spent most of their direct contact time feature high unemployment (Krupa, misconceptions. For example, sub-
outside the office was the single best 1998). stance use is widely used to exclude
predictor of employment outcomes. consumers with SMI from receiving vo-
It should be acknowledged that if paid
cational services, yet the preponder-
A final line of evidence regarding the employment is the goal, then programs
ance of evidence suggests that
ineffectiveness of day treatment and offering sheltered/protected job place-
co-occurring substance use disorder
sheltered approaches consists of a se- ments sometimes achieve significantly
does not predict how well a consumer
ries of statewide surveys suggesting better paid employment outcomes than
will do in employment (Bell, Greig, Gill,
that mental health centers de-empha- do supported employment programs
Whelahan & Bryson, 2002; Drebing et
sizing prevocational preparation for (e.g., Drake et al., 1999), although this
al., 2002; Pickett-Schenk et al., 2002;
employment have higher competitive is not always the case (Gervey &
Sengupta, Drake & McHugo, 1998), al-
employment rates (Becker, Smith, et Bedell, 1994; Gold et al., submitted;
though one study did find such a rela-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
al., 2001; Drake et al., 1998; Gowdy et Macias, 2001; Mueser et al., 2004).
This document is copyrighted by the American Psychological Association or one of its allied publishers.
articles
354
Spring 2004—Volume 27 Numb er 4
approaches subscribe to rapid place- direct, leading to cautious conclusions; each individual, because we know from
ment, and of those that do, many do new evidence (Gold et al., submitted; many consumers’ stories of their recov-
not practice rapid job placement. For Gowdy et al., 2003; Lehman et al., ery process that the journey is very per-
example, a retrospective study of one 2002; Mueser et al., 2004) makes this sonal and often not linear (Strauss,
well-regarded clubhouse program case stronger, with the Mueser et al. Hafez, Lieberman & Harding, 1985).
found that the average time spent in (2004) study coming the closest to ex- Surprisingly, we have little direct evi-
the clubhouse (e.g., on work units) be- amining this factor in isolation. Based dence of this principle, with the best
fore a member’s first transitional em- on these studies and on clinical experi- evidence coming from one correlation-
ployment placement was 356 days ence, Drake et al. (2003) identified 4 al study of a group of consumers inter-
(Henry, Barreira, Banks, Brown & tangible benefits from integrated ap- viewed 42 months after enrollment in
McKay, 2001)! proaches compared to non-integrated supported employment (McHugo,
services: (1) more effective engage- Drake & Becker, 1998).
In various forms, skills training as a
ment and retention of consumers,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
articles
355
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
Lyass, 2003). Both practitioners as well Bell, M., Greig, T., Gill, P., Whelahan, H., &
as experts recognize the importance of
References Bryson, G. (2002). Work rehabilitation and
patterns of substance use among persons
the provision of benefits counseling as Anthony, W. A., & Blanch, A. (1987). Supported with schizophrenia. Psychiatric Services,
part of a supported employment pro- employment for persons who are psychi- 53, 63–69.
atrically disabled: An historical and con-
gram (Evans, 2002). Benefits counsel- ceptual perspective. Psychosocial Bell, M., Lysaker, P., & Bryson, G. (2003). A be-
ing was the most frequently mentioned Rehabilitation Journal, 11(2), 5–23. havioral intervention to improve work per-
formance in schizophrenia: Work Behavior
job-related support in one study (Lucca Bailey, E., Ricketts, S., Becker, D. R., Xie, H., & Inventory feedback. Journal of Vocational
et al., 2004). A Vermont study found Drake, R. E. (1998). Conversion of day Rehabilitation, 18, 43–50.
treatment to supported employment: One-
that a well-designed program of sys- year outcomes. Psychiatric Rehabilitation Bilby, R. (1992). A response to the criticisms of
tematic benefits counseling led to sig- Journal, 22(1), 24–29. transitional employment. Psychosocial
Rehabilitation Journal, 18(2), 69–82.
nificantly higher earnings from Beard, J. H., Propst, R. N., & Malamud, T. J.
(1982). The Fountain House model of psy- Bissonnette, D. (1994). Beyond traditional job
employment for vocational rehabilita-
chiatric rehabilitation. Psychosocial development: The art of creating opportu-
tion clients, compared to historical
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Rehabilitation Journal, 5(1), 47–53. nity. Chatsworth, CA: Milt Wright &
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ployment and its principles. Over the Mental Health Services, Substance Abuse Bond, G. R. (1994). Applying psychiatric reha-
and Mental Health Services bilitation principles to employment:
last decade, the evidence has in- Administration. Recent findings. In R. J. Ancill & S. Holliday
creased. The evidence gleaned from a Becker, D. R., Bond, G. R., McCarthy, D., & J. Higenbottam (Eds.), Schizophrenia:
dozen studies drawn from two types of Thompson, D., Xie, H., McHugo, G. J., & Exploring the spectrum of psychosis (pp.
Drake, R. E. (2001). Converting day treat- 49–65). Chichester, England: John Wiley.
rigorous research designs shows con-
ment centers to supported employment Bond, G. R. (1998). Principles of the Individual
sistent support for the effectiveness of
programs in Rhode Island. Psychiatric Placement and Support model: Empirical
supported employment, particularly Services, 52, 351–357. support. Psychiatric Rehabilitation
when delivered in a high-fidelity man- Becker, D. R., & Drake, R. E. (1993). A working Journal, 22(1), 11–23.
ner. This set of findings is in striking life: The Individual Placement and Support Bond, G. R., Becker, D. R., Drake, R. E., Rapp,
(IPS) Program. Concord, NH: New C. A., Meisler, N., Lehman, A. F., Bell, M.
contrast to the literature on other types
Hampshire-Dartmouth Psychiatric D., & Blyler, C. R. (2001). Implementing
of vocational programs for consumers Research Center. supported employment as an evidence-
with SMI. No other vocational model is Becker, D. R., & Drake, R. E. (2003). A working based practice. Psychiatric Services, 52,
as clearly defined, has been as widely life for people with severe mental illness. 313–322.
studied, nor achieved a consistent pat- New York: Oxford Press. Bond, G. R., Becker, D. R., Drake, R. E., &
Becker, D. R., Drake, R. E., Farabaugh, A., & Vogler, K. M. (1997). A fidelity scale for the
tern of positive outcomes regarding Individual Placement and Support model
Bond, G. R. (1996). Job preferences of
competitive employment. clients with severe psychiatric disorders of supported employment. Rehabilitation
participating in supported employment Counseling Bulletin, 40, 265–284.
If this practice is to continue to expand
programs. Psychiatric Services, 47, Bond, G. R., Dietzen, L. L., McGrew, J. H., &
its utility, continued experimentation 1223–1226. Miller, L. D. (1995). Accelerating entry into
on enhancing the evidence-based prac- Becker, D. R., Smith, J., Tanzman, B., Drake, R. supported employment for persons with
severe psychiatric disabilities.
tice and additional focused research E., & Tremblay, T. (2001). Fidelity of sup-
ported employment programs and em- Rehabilitation Psychology, 40, 91–111.
evaluating specific program compo-
ployment outcomes. Psychiatric Services, Bond, G. R., Dietzen, L. L., Vogler, K. M.,
nents are needed. Enhancements are 52, 834–836. Katuin, C. H., McGrew, J. H., & Miller, L. D.
particularly needed to improve the job Bedell, J. R., Draving, D., Parrish, A., Gervey, (1995). Toward a framework for evaluating
tenure and career advancement of con- R., & Guastadisegni, P. (1998). A descrip- costs and benefits of psychiatric rehabili-
tion and comparison of experiences of tation: Three case examples. Journal of
sumers who want to work. Vocational Rehabilitation, 5, 75–88.
people with mental disorders in supported
employment and paid prevocational train- Bond, G. R., Drake, R. E., Becker, D. R., &
ing. Psychiatric Rehabilitation Journal, Mueser, K. T. (1999). Effectiveness of psy-
21(3), 279–283. chiatric rehabilitation approaches for em-
ployment of people with severe mental
illness. Journal of Disability Policy Studies,
10(1), 18–52.
articles
356
Spring 2004—Volume 27 Numb er 4
Bond, G. R., Drake, R. E., Mueser, K. T., & Cook, J. A., & Razzano, L. (1995). Discriminant Drebing, C. E., Fleitas, R., Moore, A., Krebs, C.,
Becker, D. R. (1997). An update on sup- function analysis of competitive employ- Van Ormer, A., Penk, W., Seibyl, C., &
ported employment for people with severe ment outcomes in a transitional employ- Rosenheck, R. (2002). Patterns in work
mental illness. Psychiatric Services, 48, ment program for persons with severe functioning and vocational rehabilitation
335–346. mental illness. Journal of Vocational associated with coexisting psychiatric and
Bond, G. R., Drake, R. E., Mueser, K. T., & Rehabilitation, 5, 127–140. substance use disorders. Rehabilitation
Latimer, E. (2001). Assertive community Crane-Ross, D., Roth, D., & Lauber, B. G. Counseling Bulletin, 46, 5–13.
treatment for people with severe mental (2000). Consumers’ and case managers’ Evans, L. J. (2002). Obtaining expert consensus
illness: Critical ingredients and impact on perceptions of mental health and commu- on the critical ingredients of supported
patients. Disease Management & Health nity support service needs. Community employment programs for people with se-
Outcomes, 9, 141–159. Mental Health Journal, 36, 161–178. vere mental illness. Unpublished disserta-
Bond, G. R., Kim, H. W., Meyer, P. S., Gibson, P. Crowther, R. E., Marshall, M., Bond, G. R., & tion, Indiana University Purdue University
J., Tunis, S. L., Evans, J. D., Lysaker, P., Huxley, P. (2001). Helping people with se- Indianapolis, Indianapolis.
McCoy, M. L., Weitzel, D., Dincin, J., & Xie, vere mental illness to obtain work: Gervey, R., & Bedell, J. R. (1994). Supported
H. (2004). Response to vocational rehabili- Systematic review. British Medical Journal, employment in vocational rehabilitation.
tation during treatment with olanzapine, 322, 204–208. In J. R. Bedell (Ed.), Psychological assess-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
risperidone, or first-generation antipsy- Dick, N., & Shepherd, G. (1994). Work and ment and treatment of persons with severe
chotics. Psychiatric Services, 55, 59–66. mental health: A preliminary test of Warr’s mental disorders (pp. 151–175).
Bond, G. R., & Meyer, P. S. (1999). The role of model in sheltered workshops for the Washington, DC: Taylor & Francis.
medications in the employment of people mentally ill. Journal of Mental Health, 3, Gervey, R., & Kowal, H. (1994, May). A descrip-
with schizophrenia. Journal of 387–400. tion of a model for placing youth and
Rehabilitation, 65(4), 9–16. Dincin, J. (1995). A pragmatic approach to psy- young adults with psychiatric disabilities
Bond, G. R., Resnick, S. R., Drake, R. E., Xie, H., chiatric rehabilitation: Lessons from in competitive employment. Paper pre-
McHugo, G. J., & Bebout, R. R. (2001). Chicago’s Thresholds program. New sented at the International Association of
Does competitive employment improve Directions for Mental Health Services, 68. Psychosocial Rehabilitation Services
nonvocational outcomes for people with Conference, Albuquerque, NM.
Drake, R. E., Becker, D. R., Biesanz, J. C.,
severe mental illness? Journal of Torrey, W. C., McHugo, G. J., & Wyzik, P. F. Gold, M., & Marrone, J. (1998). Mass Bay
Consulting and Clinical Psychology, 69, (1994). Rehabilitation day treatment vs. Employment Services (a service of Bay
489–501. supported employment: I. Vocational out- Cove Human Services, Inc.): A story of
Brekke, J. S., Long, J. D., Nesbitt, N., & Sobel, comes. Community Mental Health Journal, leadership, vision, and action resulting in
E. (1997). The impact of service character- 30, 519–532. employment for people with mental ill-
istics on functional outcomes from com- ness, Roses and Thorns from the
Drake, R. E., Becker, D. R., Biesanz, J. C.,
munity support programs for persons with Grassroots (Vol. Spring). Boston, MA:
Wyzik, P. F., & Torrey, W. C. (1996). Day
schizophrenia: A growth curve analysis. Institute for Community Inclusion.
treatment versus supported employment
Journal of Consulting and Clinical for persons with severe mental illness: A Gold, P. B., Meisler, N., Santos, A. B., Williams,
Psychology, 65, 464–475. replication study. Psychiatric Services, 47, O. H., Kelleher, J., & Carnemolla, M. A.
Carpenter, V., & Perkins, D. V. (1997, November 1125–1127. (submitted). A randomized, clinical trial of
8). Supported employment as a transition integrated supported employment and as-
Drake, R. E., Becker, D. R., Bond, G. R., &
from state hospital to community. Paper sertive community treatment for rural
Mueser, K. T. (2003). A process analysis of
presented at the American Public Health Southern patients with severe mental ill-
integrated and non-integrated approaches
Association, Indianapolis, IN. ness.
to supported employment. Journal of
Chandler, D., Levin, S., & Barry, P. (1999). The Vocational Rehabilitation, 18, 51–58. Gowdy, E. A., Carlson, L. S., & Rapp, C. A.
menu approach to employment services: (2003). Practices differentiating high-per-
Drake, R. E., Fox, T. S., Leather, P. K., Becker, D.
Philosophy and five-year outcomes. forming from low-performing supported
R., Musumeci, J. S., Ingram, W. F., &
Psychiatric Rehabilitation Journal, 23(1), employment programs. Psychiatric
McHugo, G. J. (1998). Regional variation in
24–33. Rehabilitation Journal, 26, 232–239.
competitive employment for persons with
Chandler, D., Meisel, J., Hu, T., McGowen, M., severe mental illness. Administration and Gunderson, J. G., Frank, A. F., Katz, H. M.,
& Madison, K. (1997). A capitated model Policy in Mental Health, 25, 493–504. Vannicelli, M. L., Frosch, J. P., & Knapp, P.
for a cross-section of severely mentally ill H. (1984). Effects of psychotherapy in
Drake, R. E., McHugo, G. J., Bebout, R. R.,
clients: Employment outcomes. schizophrenia: II. Comparative outcome of
Becker, D. R., Harris, M., Bond, G. R., &
Community Mental Health Journal, 33, two forms of treatment. Schizophrenia
Quimby, E. (1999). A randomized clinical
501–516. Bulletin, 10, 564–596.
trial of supported employment for inner-
Connors, K. A., Graham, R. S., & Pulso, R. city patients with severe mental illness. Hamilton, S. H., Edgell, E. T., Revicki, L. A., &
(1987). Playing the store: Where is the vo- Archives of General Psychiatry, 56, Breier, A. (2000). Functional outcomes in
cational in psychiatric rehabilitation? 627–633. schizophrenia: A comparison of olanzap-
Psychosocial Rehabilitation Journal, 10(3), ine and haloperidol in a European sample.
Drake, R. E., McHugo, G. J., Becker, D. R.,
21–33. International Clinical Psychopharmacology,
Anthony, W. A., & Clark, R. E. (1996). The 15, 245–255.
Cook, J., & Razzano, L. (2000). Vocational reha- New Hampshire study of supported em-
bilitation for persons with schizophrenia: ployment for people with severe mental Henry, A. D., Barreira, P., Banks, S., Brown, J.,
Recent research and implications for prac- illness: Vocational outcomes. Journal of & McKay, C. (2001). A retrospective study
tice. Schizophrenia Bulletin, 26, 87–103. Consulting and Clinical Psychology, 64, of clubhouse-based transitional employ-
391–399. ment. Psychiatric Rehabilitation Journal,
24, 344–354.
articles
357
P s y c h i at r i c R e h a b i l i tat i o n J o u r n a l Supported Employment: Evidence for an Evidence-Based Practice
Hogan, M. F. (1999). Supported employment: Macias, C., Barreira, P., Alden, M., & Boyd, J. NASMHPD. (2002). Performance measures for
How can mental health leaders make a dif- (2001). The ICCD benchmarks for club- mental health systems
ference? Columbus, OH: Ohio Department houses: A practical approach to quality (www.rdmc.org/nri/document.htm).
of Mental Health. improvement in psychiatric rehabilitation. Alexandria, VA: National Association of
Hogarty, G. E. (2002). Personal therapy for Psychiatric Services, 52, 207–213. State Mental Health Program Directors
schizophrenia and related disorders: A McFarlane, W. R. (2002, May 20). Employment Research Institute.
guide to individualized treatment. New Intervention Demonstration Project (EIDP): New Freedom Commission on Mental Health.
York: Guilford. Outcome of best practice. Paper presented (2003). Achieving the promise:
Honey, A. (2000). Psychiatric vocational reha- at the American Psychiatric Association, Transforming mental health care in
bilitation: Where are the customers’ Philadelphia. America. Final Report. DHHS Pub. No.
views? Psychiatric Rehabilitation Journal, McFarlane, W. R., Dushay, R., & Stastny, P. SMA-03-3832. Rockville, MD: Substance
23, 270–279. (1995). Vocational outcomes on family- Abuse and Mental Health Services
aided assertive community treatment. New Administration.
Koop, J., Rollins, A. L., Bond, G. R., Salyers, M.
P., Dincin, J., Kinley, T., Shimon, S., & York: New York State Research Foundation Noble, J. H., Honberg, R. S., Hall, L. L., & Flynn,
Marcelle, K. (in press). Development of the for Mental Health Final Report. L. M. (1997). A legacy of failure: The inabil-
ity of the federal-state vocational rehabili-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
DPA Fidelity Scale: Using fidelity to define McFarlane, W. R., Dushay, R. A., Deakins, S.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
an existing vocational model. Psychiatric M., Stastny, P., Lukens, E. P., Toran, J., & tation system to serve people with severe
Rehabilitation Journal. Link, B. (2000). Employment outcomes in mental illness. Arlington, VA: National
family-aided assertive community treat- Alliance for the Mentally Ill.
Krupa, T. (1998). The consumer-run business:
People with psychiatric disabilities as en- ment. American Journal of Paulson, R. I., Post, R. L., Herinckx, H. A., &
trepreneurs. Work, 11, 3–10. Orthopsychiatry, 70, 203–214. Risser, P. (2002). Beyond components:
McGrew, J. H. (in preparation). Supported em- Using fidelity scales to measure and as-
Lehman, A. F. (1995). Vocational rehabilitation
ployment fidelity assessment as a predic- sure choice in program implementation
in schizophrenia. Schizophrenia Bulletin,
tor of successful VR closures. and quality assurance. Community Mental
21(4), 645–656.
Health Journal, 38, 119–128.
Lehman, A. F., Goldberg, R. W., Dixon, L. B., McGurk, S. R., & Mueser, K. T. (2003).
Cognitive functioning and employment in Pickett-Schenk, S. A., Cook, J. A., Grey, D.,
McNary, S., Postrado, L., Hackman, A., &
severe mental illness. Journal of Nervous Banghart, M., Rosenheck, R. A., &
McDonnell, K. (2002). Improving employ-
and Mental Disease, 191, 789–798. Randolph, F. (2002). Employment histories
ment outcomes for persons with severe of homeless persons with mental illness.
mental illness. Archives of General McGurk, S. R., Mueser, K. T., Harvey, P. D., La Community Mental Health Journal, 38,
Psychiatry, 59, 165–172. Puglia, R., & Marder, J. (2003). Cognitive 199–211.
Lucca, A. M., & Allen, G. J. (2001). A statewide and symptom predictors of work outcomes
for clients with schizophrenia in support- Rapp, C. A., Huff, S., & Hansen, K. (2003). The
assessment of psychosocial rehabilitation
ed employment. Psychiatric Services, 54, New Hampshire financing policy.
programs: General characteristics and
1129–1135. Psychiatric Rehabilitation Journal, 26,
services. Psychosocial Rehabilitation 385–391.
Journal, 24, 205–213. McHugo, G. J., Drake, R. E., & Becker, D. R.
(1998). The durability of supported em- Rehabilitation Act Amendments. (1998). Title
Lucca, A. M., Henry, A. D., Banks, S., Simon,
ployment effects. Psychiatric IV of the Workforce Investment Act of
L., & Page, S. (2004). Evaluation of an
Rehabilitation Journal, 22(1), 55–61. 1998, Pub. L. No. 105-220, 112 Stat. 936.
Individual Placement and Support (IPS)
model program. Psychiatric Rehabilitation McQuilken, M., Zahniser, J. H., Novak, J., Resnick, S. G., Neale, M. S., & Rosenheck, R. A.
Journal, 27, 251–257. Starks, R. D., Olmos, A., & Bond, G. R. (2003). Impact of public support pay-
(2003). The Work Project Survey: ments, intensive psychiatric community
MacDonald-Wilson, K. L., Rogers, E. S., Ellison,
Consumer perspectives on work. Journal care, and program fidelity on employment
M. L., & Lyass, A. (2003). A study of the
of Vocational Rehabilitation, 18, 59–68. outcomes for people with severe mental
Social Security Work Incentives and their illness. Journal of Nervous and Mental
relation to perceived barriers to work Mueser, K. T., Becker, D. R., & Wolfe, R. S. Disease, 191, 139–144.
among persons with psychiatric disability. (2001). Supported employment, job pref-
Rehabilitation Psychology, 48, 301–309. erences, job tenure and satisfaction. Ridgway, P., & Rapp, C. (1998). The active in-
Journal of Mental Health, 10, 411–417. gredients in achieving competitive em-
MacDonald-Wilson, K. L., Rogers, E. S., & ployment for people with psychiatric
Massaro, J. (2003). Identifying relation- Mueser, K. T., Clark, R. E., Haines, M., Drake, R.
disabilities: A research synthesis.
ships between functional limitations, job E., McHugo, G. J., Bond, G. R., Essock, S.
Lawrence, KS: University of Kansas School
accommodations, and demographic char- M., Becker, D. R., Wolfe, R., & Swain, K.
of Social Welfare.
acteristics of persons with psychiatric dis- (2004). The Hartford study of supported
abilities. Journal of Vocational employment for persons with severe men- Rogers, E. S. (2000, October 13). A randomized
Rehabilitation, 18, 15–24. tal illness. Journal of Consulting and controlled study of psychiatric vocational
Clinical Psychology, 72. rehabilitation services. Paper presented at
Macias, C. (2001). Massachusetts Employment the 4th Biennial Research Seminar on
Intervention Demonstration Project: An ex- Mueser, K. T., Salyers, M. P., & Mueser, P. R. Work (Matrix Research Institute),
perimental comparison of PACT and club- (2001). A prospective analysis of work in Philadelphia, PA.
house (Final report to SAMHSA schizophrenia. Schizophrenia Bulletin, 27,
Cooperative Agreement SM51831). New 281–296. Rogers, E. S., Walsh, D., Masotta, L., & Danley,
York: International Center for Clubhouse K. (1991). Massachusetts survey of client
Development (http://www.fountain- preferences for community support servic-
house.org/pdfs/samhsa_final.pdf ). es: Final report. Boston: Center for
Psychiatric Rehabilitation.
articles
358
Spring 2004—Volume 27 Numb er 4
Rogers, J. A. (1995). Work is key to recovery. Tremblay, T., Smith, J., Xie, H., & Drake, R. E.
Psychosocial Rehabilitation Journal, 18(4), (in press). The impact of specialized bene-
5–10. fits counseling services on Social Security
Russert, M. G., & Frey, J. L. (1991). The PACT vo- Administration disability beneficiaries in
cational model: A step into the future. Vermont. Journal of Rehabilitation.
Psychosocial Rehabilitation Journal, 14(4), Tsang, H. W. H., & Pearson, V. (2001). A work-
7–18. related social skills training for people
Salyers, M. P., Becker, D. R., Drake, R. E., with schizophrenia in Hong Kong.
Torrey, W. C., & Wyzik, P. F. (2004). Ten- Schizophrenia Bulletin, 27, 139–148.
year follow-up of clients in a supported Twamley, E. W., Jeste, D. V., & Lehman, A. F.
employment program. Psychiatric (2003). Vocational rehabilitation in schizo-
Services, 55, 302–308. phrenia and other psychotic disorders: A
Schneider, J., Heyman, A., & Turton, N. (2002). literature review and meta-analysis of
Occupational outcomes: from evidence to RCTs. Journal of Nervous and Mental
implementation (www.dur.ac.uk/CASSS/ Disease, 191, 515–523.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Durham, UK: Centre for Applied Social Teaching fundamental workplace skills to
Studies, University of Durham. persons with serious mental illness.
Sengupta, A., Drake, R. E., & McHugo, G. J. Psychiatric Services, 50, 1147–1149, 1153.
(1998). The relationship between sub-
stance use disorder and vocational func-
tioning among persons with severe mental
illness. Psychiatric Rehabilitation Journal,
22(1), 41–45.
Shimon, S. M., & Forman, J. D. (1991). A busi-
ness solution to a rehabilitation problem.
Psychosocial Rehabilitation Journal, 14(4),
19–22.
Shumway, M., Saunders, T., Shern, D., Pines,
E., Downs, A., Burbine, T., & Beller, J.
(2003). Preferences for schizophrenia
treatment outcomes among public policy
makers, consumers, families, and
providers. Psychiatric Services, 54,
1124–1128.
Starks, R. D., Zahniser, J. H., Maas, D., &
McGuirk, F. (2000). The Denver approach
to rehabilitation services. Psychiatric
Rehabilitation Journal, 24, 59–64.
Steele, K., & Berman, C. (2001). The day the
voices stopped. New York: Basic Books.
Steinwachs, D. M., Kasper, J. D., & Skinner, E.
A. (1992). Family perspectives on meeting
the needs for care of severely mentally ill
relatives: A national survey. Baltimore,
MD: Center on the Organization and
Financing of Care for the Severely Mentally
Ill, Johns Hopkins University.
Strauss, J. S., Hafez, H., Lieberman, P., &
Harding, C. M. (1985). The course of psy-
chiatric disorder, III: Longitudinal princi-
ples. American Journal of Psychiatry, 142,
289–296.
Teague, G. B., Bond, G. R., & Drake, R. E.
(1998). Program fidelity in assertive com-
munity treatment: Development and use
of a measure. American Journal of
Orthopsychiatry, 68, 216–232.
Toprac, M. (unpublished). EIDP study.
articles
359