The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.
The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).
This study is a systematic review. The included studies were undertaken in various locations and settings.
The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.
A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.
Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice
Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.
The following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).
Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.
Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.