Supported Employment is an evidence-based practice that helps people with severe mental illness identify, acquire, and maintain competitive employment ("real jobs") in their local communities. These are jobs that pay at least minimum wage for which anyone in the community may apply. Competitive jobs may be part time or full time and are not provided or owned by health and human service organizations. SE is also known as Individual Placement & Support (IPS).
SE is different from traditional vocational rehabilitation (voc rehab). SE emphasizes consumer choice and utilizes rapid job-search and placement services as well as time-unlimited and individualized follow-along services, among other components that are described below. SE does not delay competitive employment by requiring consumers to utilize sheltered workshops, pre-employment training, and volunteer experiences. Service providers who utilize the SE approach are assertive about helping people find the jobs they want as soon as they express the desire to work. Part-time employment is a popular work option.
The SE model only endorses competitive jobs for several reasons:
Research shows that 60 to 70 percent of people with severe mental illness want to work. Research also shows that Supported Employment responds effectively to consumer needs.
| Supported Employment, the evidence-based practice | VS. | Traditional Vocational Rehabilitation |
• 58 percent of the people receiving these services are employed in competitive jobs in their local communities. | • Only 21 percent of the people receiving these services find competitive jobs in the community. |
(For more information, see Bond (2004), Becker & Drake (2003), and Drake (1999) in Resources below.)
Consumers who work are more likely to achieve their personal recovery goals and, thus, a higher quality of life. Employment also helps consumers begin the process of economic independence, which reduces their vulnerability to poverty and their dependence upon social-service systems. With a steady income, consumers have more spending power to buy what they want and need.
SE is different from traditional vocational rehabilitation (voc rehab). SE emphasizes consumer choice and utilizes rapid job-search and placement services as well as time-unlimited and individualized follow-along services. |
The process of identifying, finding, acquiring, and maintaining competitive employment is therapeutic and a source of active, lifelong learning. Many consumers who work express an interest in establishing a savings account, building wealth, and achieving other long-term financial goals.
SE Increases
SE Decreases
Competitive Employment Improves
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 ...
*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:
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:
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:
(For more information, visit the CEBP's "Benefits Planning" web page [click here].)
There are treatment characteristics (components) and organizational characteristics of the SE model that are called fidelity domains. These domains encourage service systems and organizations to develop holistic integrated program structures and treatments. These domains also provide a structure for a continuous quality-improvement process that addresses multiple outcomes.
SE facilitates systems change, organizational change, and clinical change when it is implemented with fidelity. Research shows that organizations which maintain fidelity to the original design of SE achieve and sustain the best outcomes. SE has a fidelity scale that helps organizations implement and sustain the model (see "Related Resources" below).
RESEARCH & DEVELOPMENTSupported Employment (SE), the evidence-based practice, was created and is studied by researchers Deborah R. Becker, MEd, CRC, Robert E. Drake, MD, PhD, Gary Bond, PhD, and their colleagues at the Dartmouth Psychiatric Research Center of Dartmouth Medical School. SE is also known as Individual Placement & Support (IPS).
The Dartmouth PRC has provided leadership for national implementation of SE via the Johnson & Johnson-Dartmouth Community Mental Health Program. The State of Ohio and the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University—through its Ohio SE Coordinating Center of Excellence (CCOE)—are participating in this national initiative, making contributions to the advancement and enhancement of the model.
• Gary R. Bond (2004). Supported Employment: Evidence for an Evidence-Based Practice. Psychiatric Rehabilitation Journal, v27, n4, p345-359.
• Deborah R. Becker and Robert E. Drake, MD (2003). A Working Life for People with Severe Mental Illness. New York: Oxford University Press, Inc.
• Robert E. Drake, Guest Editor. (1998). Supported Employment: A Special Issue of Psychiatric Rehabilitation Journal. Psychiatric Rehabilitation Journal. Summer, v22, n1.
RELATED RESOURCES• Some Reasons to Try Supported Employment (Poster)
• Every Journey Has a Story (Audio)
• Work Is Recovery: True stories about real people who benefit from Supported Employment (Booklet)
• More Resources & Tools• SE pioneer Gary Bond provides an update on research, evidence for supported employment
