SHIFTING FROM TRADITIONAL TO EVIDENCE-BASED PRACTICES FOR PEOPLE WITH SEVERE MENTAL ILLNESS
Carol Blessing, Faculty
Employment and Disability Institute
School of Industrial and Labor Relations
The TRANSITIONS Series is produced by Cornell University’s Program on Employment and Disability. This information series focuses on supporting the continued development and evolution of the educational paradigm in the United States. Specifically the ways in which we prepare youth with disabilities for successful adult living, learning and earning. The author wishes to thank………
Moving from………………………………………………..Moving toward
Sheltered work………………………………………………Community work
Most people with long-term mental illness are not employed at any level. This is primarily because many people with a history of severe mental illness are not able to obtain and sustain jobs in the competitive market with no support and they are not interested in the generally low paying, repetitive jobs typically found in sheltered workshop settings (Ford, 1995). Current research indicates, among other things, that most people with psychiatric disabilities want to be employed and that gainful employment in jobs that improve a person’s status results in higher levels of self-esteem and overall life satisfaction (SPI, Virginia Commonwealth University, 2001).
A relative newcomer to the field known as Evidence-Based Vocational Practices is challenging the traditional service approaches available to people with severe mental illness. Evidence-based practices are interventions for which there is consistent scientific evidence showing that they improve customer outcomes. One of the six areas of evidence-based practices is supported employment. Supported employment was originally developed for individuals with developmental disabilities who were considered to be “unemployable” or who needed a great deal of “readiness” training if employment would ever be realized. The supported employment framework was based on the following principles:
*This is a New York State standard. This standard can be waived for good reason if negotiated in the development of the Individualized Plan for Employment (IPE).
Recent research shows that employment outcomes are higher for people who participate in programs that incorporate evidence-based principles that for people in programs that follow different principles, (Becker 2001). Evidence-based supported employment practices follow six basic principles:
This is a drastically different approach to supporting individuals who are living with severe mental illness. Traditional treatment modalities incorporate a continuum approach to providing services and supports, requiring people to achieve some standard of performance at one stage prior to being granted opportunity to move to the next. This was based on the theory that wellness and social independence should precede efforts to obtain employment (Ford, 1995). Evidence-based practices eliminate the need for people who are interested in work to “jump through the hoops” in order to the support necessary to get a job.
The implementation of evidence-based practices or its equivalent will require a shift in the current system for the provision of supports and services to individuals who have severe mental illness. Some critical elements for systemic change will include the need for:
Agencies wishing to put forth the effort for system change will have to grapple with the obvious questions:
WHERE TO START, WHO TO START WITH?
HOW TO BUILD MOMENTUM?
HOW TO SUSTAIN AND REPLICATE ACTION?
WHAT’S IT GOING TO TAKE?
The New York State Office of Mental Health is on the brink of implementing its Career Development Initiative in collaboration with the Cornell University School of Industrial and Labor Relations’ Program on Employment and Disability. The intent of the Career Development Initiative is to help facility-based vocational rehabilitation programs increase the amount and quality of successful employment outcomes for individuals receiving services by moving from an employer based system (where the jobs obtained are those offered within the facility) to service delivery system that facilitates community-based employment options.
1. Begin with those consumers who express a desire to work
2. Build interest and demand for employment services
Becker, D. (2001). Implementing Supported Employment as an Evidence-Based Practice.
SPI Connections, Spring/Summer, 2-3.
Ford, L.H. (1995). Providing Employment Support for People with Long-Term Mental
Illness Choices, Resources and Practical Strategies. Baltimore: Paul H. Brookes Publishing Co.