As the movement to disseminate evidence-based practices (EBPs) for people with severe mental illness gatherers momentum, providers need guidance about implementing and sustaining high-quality services. The National Evidence Based Practices Project evaluated the implementation of five EBPs across 53 sites in eight states over a two-year period.
The purpose of the study was to describe the implementation of supported employment in the National Evidence-Based Practices Project, examining and interpreting fidelity changes over two years of program implementation.
Nine sites that initially provided vocational services for persons with severe mental illness. Services departed from high fidelity supported employment. All nine sites took prompt action to transform existing vocational services that were contrary to evidence-based supported employment.
Nine sites, three from each state, implemented supported employment. Eight sites provided mental health treatment, while one was a psychiatric rehabilitation agency that did not offer clinical services. Five sites with in urban areas; four in rural.
Nine new supported employment programs were evaluated by examining supported employment fidelity ratings at baseline and every 6 months thereafter. Site reports based on the nine case studies were used to interpret the fidelity findings.
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.
Comparison 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.
At two years, eight of nine sites achieved high fidelity. Most changes occurred within the first year. Twelve of the 15 supported employment fidelity items showed rapid improvement.
A review of the site reports suggested four factors that facilitated movement toward high fidelity: (1) Discontinuing non-evidence-based vocational services, (2) Making rapid structural changes through administrative action, (3) Measuring key process indicators to move toward desired changes, and (4) Gradually improving integration of the employment specialists with clinical services, primarily through supervisor leadership.