Fidelity of supported employment programs and employment outcomes

Authors: Becker, D. R., Xie, H., McHugo, G. J., Halliday, J., & Martinez, R. A.
Year Published 2001
Publication Psychiatric Services
Volume 52
Number 6
Pages 834-836
Publisher American Psychiatric Association

Employment is a primary goal for the majority of people with severe mental illness. Recent research shows that supported employment is a more effective approach to vocational rehabilitation for this population than traditional methods. However, supported employment is currently implemented in a variety of ways. Bond, Cook and Razzano, among others, have identified several aspects of vocational services that are associated with good employment outcomes. These factors have been incorporated into a fidelity scale for supported employment.


The purpose of this study was to identify critical components of a supported employment program that were strongly correlated with competitive employment outcomes in a state mental health system.


The setting was 10 community mental health centers in Vermont.


The study sample included 2,639 individuals aged 18 to 64 years who were diagnosed as having severe and persistent mental illness and who were enrolled in community rehabilitation and treatment programs.

Data Collection

The case manager or another staff member completed an employment survey for each eligible client that included questions about competitive employment, average number of hours worked, and number of weeks worked in the last quarter of 1999. This data collection method has been validated by the Mental Health Statistics Improvement Project of the Center for Mental Health Services.
Researchers also visited the ten mental health centers to learn how employment services were provided. For each center, the researchers completed the Individual Placement and Support Fidelity Scale.


There was no control or comparison condition.


Higher competitive employment rates were strongly correlated with overall program fidelity and with two program components, namely, providing services in the community as opposed to providing them in the clinic and using full-time employment specialists as opposed to staff with mixed roles.


This study provides preliminary validation of an overall supported employment fidelity scale. This pilot study suggests that the supported employment components it measured account for about 50 percent of the variance in competitive employment outcomes. Most of the programs scored in the midrange of the supported employment scale, indicating that there is clearly room for improvement. Studies to determine whether improvements result in better employment outcomes are planned.

Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition
Research Design Quasi-experimental
Peer Reviewed Yes