Outcomes-based funding for vocational services and employment of people with mental conditions

Authors: Gentry, T., Kriner, R., Sima, A., McDonough, J., & Wehman, P.
Year Published 2005
Publication Psychiatric Services
Volume 56
Number 11
Pages 1429-1435
Publisher American Psychiatric Publishing

Individuals with mental health condition have low employment rates. In order to promote better employment outcomes policy makers have investigated funding strategies. This includes outcomes funding paying the provider for milestones. However, there is limited evidence about this approach.


The purpose of this study was to describe the employment experiences of individuals with psychiatric disabilities, who received services through an outcomes based funding program in New York. The study questions were What was the likelihood that participants in the performance based contracting demonstration secured a placement and retained work? And what factors were associated with securing a placement,time to secure a placement and job retention?


The settings for this study were seven non-profit social services agencies in New York state who submitted proposals for and were funded for an outcome-based service funding demonstration project.


Seven non profit social service agencies in New York State participated in the study. They represented various regions from city to rural. They also ranged in size from 40 to 2000 employees. Each offered vocational rehabilitation services. Some offered other types of services too like housing, mental health etc...

Data Collection

Data was reviewed for individuals who were still active at the end of the study period. The likelihood that placements retained their jobs was assessment using life tables. Logistic regression was used too. SPSS 12.0 was used to perform all analyses.


The study used a pre/post design with agencies serving as their own controls.


At the end of the demonstration, 171 of 310 consumers with mental illness remained active. The mean age of these individuals was 42 years, and most or 57% were male. Over a third or 35% lived in supported housing. Most receive federal income assistance. About half (47%) completed some or received a post secondary degree. Thirty three percent had a diagnosis of schizophrenia. This was followed by 23% other mood disorders, 22% bipolar and 14% schizoaffective disorder and 9% other. Among the 171 participants,70 were placed in a job and 38 were placed more than once. The most frequent type of job was administrative and sales at 24% each. At the end of the demonstration, 73% of the participants were employed and 54% had retained employment for 6 months. Factors related to outcomes included: number of hours provider expended assisting the consumer on a weekly basis, length of time to job acquisition, consumer enrollment with state vocational rehabilitation services, and quality of jobs developed.


Outcomes based funding leads to successful employment outcomes for individuals with mental illness. Rates of placement and retention are comparable to those of other vocational programs. More research is needed.

URL http://www.ncbi.nlm.nih.gov/pubmed/16282263
Disabilities Emotional disturbance
Populations Male & Female
Outcomes Other
Research Design Quasi-experimental
Peer Reviewed No