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Supported Employment

Supported employment is based on the following six principles: 1) eligibility of the consumer is based on the consumer’s choice, and therefore no one is prevented from participating; 2) supported employment is incorporated with other treatments, and the employment specialists arrange plans and goals with the treatment team; 3) competitive employment is the goal, focusing on local full-time or part-time employment that pays at least minimum wage and is open to anyone; 4) a job search begins almost immediately after the consumer conveys an interest in employment, and there are no prerequisites required prior to this process; 5) follow-up support systems work on a steady basis, and individualized provisions continue until the consumer no longer wants assistance; and 6) the preferences of the consumer are essential, and the options and choices regarding work are founded on the consumer’s requirements and skills.

Supported employment programs afford those with severe mental illness and other disabilities the opportunity for employment in viable and valid work scenarios with supportive assistance on-site and as needed. These services are tailored to the individual strengths and deficits of each person to facilitate learning and carrying out a chosen job. While the concept of supported employment has been in use for some years, recently it has received increased attention as an integral component of programming to afford better access for those with disabilities to significant and comprehensive work venues.

Any individual with a disability who has an aspiration and a need to work is entitled to supported employment services if he or she needs support in order to find and sustain a job. Consumers should always understand that they have the right to work, and contacting supported employment agencies within their communities is the first step. The next step is for the agency to assign the consumer an employment specialist/job coach, whose responsibility is to connect with the consumer and, if possible, the family to look for suitable employment for the individual. The specialist should always take into account the consumer's work preference, as well as his or her interests, skills, and preferred work environment. Once a worksite is found, the job coach is responsible for providing individualized job counseling and assistance. Types of help might entail thorough job training on the job, direction, transportation, or other support enabling that individual to retain his or her employment. There is no time limit attached to the supported employment process. If the consumer requires continuous support, then the specialist is responsible for assisting the consumer for the extent of the consumer’s employment. The specialist might need to provide full time assistance on a one-to-one basis or might need to assist only on an occasional basis if the consumer needs minimal support or training. Since the requirements are based entirely on the needs of the consumer, the specialist must invest the time to truly understand the needs of the consumer and establish an effective rapport.

Supported employment programs are different from more conventional approaches to job placement. Traditional programs utilized pre-employment vocational training aimed at learning and practicing general job skills before looking for employment. Supported employment employs a rapid job search and trains consumers on-site in real-life jobs in their communities. As such, it allows for new employment opportunities for people with disabilities who might not be ready to move directly into independent competitive employment. Often people with disabilities begin the process of workforce re-entry in a graduated fashion. Volunteer work, training, and supported employment can serve as a springboard to independent competitive employment.
Evidence-Based Practice
Most supported employment programs are founded on evidence-based practices that have displayed positive results. Researchers have collected far-reaching statistics for the past 15 years to delineate which psychosocial and pharmacological management approaches to mental illness have the most influence on recovery, and supported employment has a demonstrated effect in improving outcomes for people with mental illness.

In 1998, the Robert Wood Johnson Foundation formed a panel of researchers, clinicians, administrators, consumers, and family advocates to confer about the existing research and establish which modes of assistance presently display a compelling evidence base. Supported employment was one practice identified as objectively beneficial, along with standardized pharmacological treatment, teaching illness management and recovery skills, psycho-education, assertive community treatment, and integrated treatment for substance abuse and mental disorders.

In July of 2002, six states and the Netherlands initiated a project to study how these evidence-based practices fare when they are implemented in public agency settings. The University of Kansas School of Social Welfare was chosen to impart the training, consultation, and research components for this project, and the Kansas Department of Social and Rehabilitation Services was selected to execute evidence-based practice in supported employment and dual-diagnosis (combined mental illness and substance abuse) services.  This is called the Individual Placement and Support model (Bond, 2004).

The eventual goal of this research is the translation of the evidence-based principles into practice. The research looks at the effective approaches, ineffective approaches, and existing barriers. It also investigates economic value, evaluates the dependability of the project sites, and tracks how closely outcomes match performance expectations. Conquering barriers that threaten the availability of supported employment services has been a major endeavor. The best evidence, compiled from an exhaustive review of available research, reflects that supported employment far surpasses all other vocational rehabilitation approaches for people with severe mental illness. It is imperative that there is continuous research conducted to improve the process.
Studies have shown that 7 out of 10 consumers are interested in finding paid and useful employment, and that 6 out of 10 consumers are able to work in the community if the right type of supports and services are easily accessible. Because research demonstrates that supported employment is responsible for greater numbers of consumers getting and maintaining jobs than any other approach, it has been praised as a worthy approach toward a successful and therapeutic employment outcome.

Although researchers recognize the importance of expanding outcomes and improving the revitalization practices for persons with severe mental illness, the carrying out of evidence-based practices lags significantly behind the level of knowledge. For instance, “case-management” activities like linkage to agencies providing supported employment are not considered by insurance providers to be reimbursable care. Consequently, rarely do consumers with mental health problems such as schizophrenia have access to more holistic evidence-based treatments within a general mental health setting. The practice of using evidence-based approaches must often overcome ideological, economic, and practical obstacles. All the same, the field of mental health services is gradually striving to afford a broader spectrum of research-based services as the basis of care. Supported employment affords consumers the prospect of self-sufficiency through productive employment, and it is vital that it be available in this spectrum of care.
Text taken from Gale Alexander Kamen:
Further reading:
Miles Rinaldi, Rachel Perkins, Edmund Glynn, Tatiana Montibeller, Mark Clenaghan and  Joan Rutherford (2008). Individual placement and support: from research to practice. Advances in Psychiatric Treatment (2008)  14:  50-60.
last edited by Jean Pierre Wilken March 2013