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August 01, 2009
LUCKY NUMBER
7 Core principles of supported employment, the evidence-based practice
—by Paul M. Kubek, Sarah Swanson, and Patrick E. Boyle
(Editor's note: The original version of this story appeared in the Summer 2004 issue of "SAMI Matters," a newsletter of the Center for Evidence-Based Practices at Case Western Reserve University [get free PDF].)
Supported Employment (SE), the evidence-based practice, helps people diagnosed with severe mental illness or co-occurring severe mental illness and substance use disorders find  competitive jobs of their choice in local communities with rapid job-search and placement services.
There are seven core principles that make the SE model different from traditional vocational programs. The principles are briefly described below. Research has demonstrated that these principles produce positive consumer outcomes and improved program and service-system outcomes (see "Sources" below).
1. Zero Exclusion Policy
All consumers who want to work are eligible for help, even if they
• Have experienced job loss in the past;
• Lose a job(s) while enrolled in SE;
• Are still experiencing symptoms of mental illness;
• Are still using alcohol or other drugs*;
• Have problems with transportation;
• Do not know how to fill out an application;
• Do not know how to talk to an employer;
• Do not have previous training;
• Are afraid they might not learn the job fast enough; or
• Are afraid they might not fit in with others.
*The use of alcohol and other drugs may limit consumer job choices because many employers test for drug use. If consumers can pass a drug test, their choices of jobs typically increase.
2. Consumer Preferences are Important
The mental health case manager and supported-employment specialist help each consumer identify his or her personal strengths, skills, and interests. These are excellent motivators. Consumers who find jobs that they want experience a higher level of satisfaction and tend to keep their jobs longer. The case manager and employment specialist are trained to give as much or as little help as the consumer wants.
3. Rapid Job Search
Once a consumer expresses the desire to work, his or her case manager will contact the employment specialist. In two to three weeks, the specialist may be helping the consumer research jobs, fill out applications, and interview with potential employers. The case manager will also contact a benefits counselor. Research shows that fewer people obtain employment when their job search is delayed. The SE service model does not require consumers to complete lengthy pre-employment assessment, training, and workshops.
4. A Competitive Job is the Goal
The employment specialist is committed to helping each consumer find a regular part-time or full-time job in the community that pays minimum wage or more. A regular job is a competitive job that anyone in the community can apply for. The SE model only endorses competitive jobs for several reasons:
- Consumers like competitive jobs more than they like sheltered work.
- Competitive jobs reduce stigma by enabling consumers to work side-by-side with people who may not be experiencing mental disabilities.
- Competitive jobs inspire self-esteem.
- Consumers want to live in the mainstream of life.
5. Employment is Integrated with Mental
Health Services
Employment specialists are included in service-team meetings, and they work closely with case managers, psychiatrists, and other professionals to help consumers achieve their employment goals. Team members openly discuss and find solutions for clinical issues that affect work performance, such as the following:
• Medication side effects (e.g., drowsiness)
• Persistent symptoms (e.g., hallucinations)
• Cognitive difficulties (e.g., problem-solving skills)
• Other rehabilitation needs (e.g., social skills)
6. Time-Unlimited Support
Some consumers need support over long periods of time. Therefore, consumers are never terminated from SE services, unless they request it.
 7. Personalized Benefits Planning
Benefits counselors help consumers calculate exactly how much money they can make at their jobs without disrupting benefits, such as Medicaid insurance, supplemental security income (SSI), and social security disability insurance (SSDI). Benefits counselors advise consumers and caregivers about the following:
• Benefits requirements
• Income ceilings
• Work incentives
• Other issues and regulations related to employment benefits
(Visit the Center for EBP's "Benefits Planning" web site [click here].)
 THE NATIONAL SCENE
Supported Employment, the evidence-based practice, was created by researchers Deborah R. Becker, MEd, CRC, and Robert E. Drake, MD, PhD, and their colleagues at the New Hampshire-Dartmouth Psychiatric Research Center at Dartmouth Medical School.
They have provided leadership for national implementation of SE via the Johnson & Johnson-Dartmouth Community Mental Health Program. The State of Ohio—and the Center for EBPs at Case—is participating in this national initiative.
| learn more |
SOURCES & RESOURCES
Deborah R. Becker and Robert E. Drake (2003). A Working Life for People with Severe Mental Illness. New York: Oxford University Press.
| get resource |
Gary R. Bond (2004). Supported Employment: Evidence for an Evidence-Based Practice. Psychiatric Rehabilitation Journal. Spring, v27, n4, p345-359.
| get resource |
SAMHSA Supported Employment Toolkit
| web site |
(See sidebar in right column for education and training resources from the Center for Evidence-Based Practices at Case Western Reserve University.)
RELATED STORIES, THIS SITE
 SCIENCE TO SERVICE
New fidelity scale finds its way to Ohio’s supported-employment services
| get full story |
DRAKE TIME
IDDT pioneer Bob Drake reflects upon the ongoing evolution of integrated treatment and the importance of supported employment
| get full story |
A sample of consumer success stories . . .
 EVERY JOURNEY HAS A STORY
Nicole Clevenger's back-to-work recovery story (order the CD and listen to or download free MP3 tracks)
| get full story & audio |
MAGICAL METROPARKS
Employer, employee team-up with onsite job coaching
| get full story |
A POINT OF PRIDE
John Moneypenny draws upon a strong work ethic to advance his recovery, purpose
| get full story & audio |
THE CHEESE WALL
Zero-exclusion is the ultimate optimism, everyone who wants to work receives supported-employment services
| get full story & audio |
Paul M. Kubek, MA, is director of communications and Patrick E. Boyle, MSSA, LISW-S, LICDC, is director of implementation services at the Center for Evidence-Based Practices (EBPs) at Case Western Reserve University. Sarah Swanson, MRC, LSW, CRC, currently works at the New Hampshire-Dartmouth Psychiatric Research Center.
The Center for EBPs at Case is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case School of Medicine. The Ohio SAMI Coordinating Center of Excellence (CCOE) and the Ohio Supported Employment CCOE are initiatives of the Center for EBPs at Case.
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